Pneumomediastinum and subcutaneous emphysema after perforation of the duodenum during gastroscopy

The first case of duodenal perforation during gastroscopy is reported. The patient's symptoms were mild in contrast to the dramatic picture of perforated peptic ulcer. He developed a pneumoperitoneum, pneumomediastinum, and, in addition, subcutaneous emphysema of the neck—signs more commonly associated with oesophageal rupture than perforation of the duodenum.

The aetiology of these signs and the prevention of this complication are discussed.

Stercoral perforation of the sigmoid colon

Stercoral perforation of the sigmoid colon is probably more common than is generally appreciated. The condition should be considered in patients who present with peritonitis, localizing signs in the left iliac fossa, and a history of chronic constipation. Operation after a period of resuscitation offers the only hope of survival and resection of the affected of sigmoid colon with exteriorization appears to be indicated.

Two additional examples of this condition are described and the salient features are reviewed.

Radiological evaluation of post-tracheostomy lesions

Post-tracheostomy lesions are becoming more commonplace and surgical techniques for definitive repair of these abnormalities are being developed. These lesions, in general, occur at two sites, the proximal lesions at the tracheostomy incision and the distal lesions 1·5 to 2·5 cm inferior in the area of the tracheostomy balloon cuff. Granuloma formation, stenosis, tracheomalacia, and perforation of the tracheal wall have been encountered in our experience. Clinical symptoms depend upon the type and location of the lesion as well as on the patient's awareness and physical activity. Radiological evaluation offers an accurate method to depict the anatomical and physiological alterations. This radiological assessment should begin with routine postero-anterior and lateral chest radiographs followed by fluoroscopy. Laminograms and special oblique views are often helpful. Contrast tracheograms using powdered tantalum allow good mucosal detail as well as excellent delineation of structural and physiological abnormalities.

Small bowel injuries in children after blunt abdominal trauma

Images