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Morgan AA, Mahmood A, Russell GK, Kon OM. Intestinal perforation due to miliary tuberculosis in a patient with myasthenia gravis. BMJ Case Rep 2022; 15:e249547. [PMID: 35868806 PMCID: PMC9315895 DOI: 10.1136/bcr-2022-249547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A man in his early 70s presented to the emergency department with a fall, following a history of fatigue and malodorous urine. On presentation, he was feverish, tachycardic and confused and was treated for presumed urinary sepsis. A chest radiograph showed increased opacification in the left upper lobe with calcification. CT imaging and bronchoalveolar lavage demonstrated miliary tuberculosis infection. His background included myasthenia gravis, which led to challenges in selecting appropriate antituberculosis treatment. During his stay, he developed sudden-onset abdominal pain due to intestinal perforation. He subsequently deteriorated and underwent multiple interventions, including a Hartmann's procedure and ileocaecal resection. Histological examination of his sigmoid colon revealed abundant acid-fast bacilli. Unfortunately, the patient died due to multiorgan failure in the context of several complications. This case highlights intestinal perforation as a rare complication of miliary tuberculosis and emphasises the importance of being vigilant for this potential complication.
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Bhadbhade M, Connolly E, Badiani S, Yeo D, Bhadri V. Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis. BMJ Case Rep 2022; 15:e247774. [PMID: 35473702 PMCID: PMC9045112 DOI: 10.1136/bcr-2021-247774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/13/2022] Open
Abstract
Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.
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Shinar S, Agrawal S, Ryu M, Van Mieghem T, Daneman A, Ryan G, Zani A, Chiu P, Chitayat D. Fetal Meconium Peritonitis - Prenatal Findings and Postnatal Outcome: A Case Series, Systematic Review, and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:194-203. [PMID: 32575129 DOI: 10.1055/a-1194-4363] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery. METHODS We retrospectively reviewed all fetuses with ultrasound findings suspicious for meconium peritonitis at a single center over a 10-year period. A systematic review and meta-analysis were then performed pooling our results with previous studies assessing prenatally diagnosed meconium peritonitis and postnatal outcome. Prenatal sonographic findings were analyzed to identify predictors for postnatal surgery. RESULTS 34 cases suggestive of meconium peritonitis were diagnosed at our center. These were pooled with cases from 14 other studies yielding a total of 244 cases. Postnatal abdominal surgery was required in two thirds of case (66.5 %). The strongest predictor of neonatal surgery was meconium pseudocyst (OR [95 % CI] 6.75 [2.53-18.01]), followed by bowel dilation (OR [95 % CI] 4.17 [1.93-9.05]) and ascites (OR [95 % CI] 2.57 [1.07-5.24]). The most common cause of intestinal perforation and meconium peritonitis, found in 52.2 % of the cases, was small bowel atresia. Cystic fibrosis was diagnosed in 9.8 % of cases. Short-term neonatal outcomes were favorable, with a post-operative mortality rate of 8.1 % and a survival rate of 100 % in neonates not requiring surgery. CONCLUSION Meconium pseudocysts, bowel dilation, and ascites are prenatal predictors of neonatal surgery in cases of meconium peritonitis. Fetuses with these findings should be delivered in centers with pediatric surgery services. Though the prognosis is favorable, cystic fibrosis complicates postnatal outcomes.
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Wiesler B, Linke KS, Delko T. Rare case of an 83-year-old woman with transrectal small bowel evisceration caused by spontaneous rectal perforation. BMJ Case Rep 2022; 15:e246965. [PMID: 35140088 PMCID: PMC8830219 DOI: 10.1136/bcr-2021-246965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/03/2022] Open
Abstract
Spontaneous rectal perforation with transanal small intestinal evisceration is a rare condition. We report the case of an 83-year-old woman with a rectal perforation and transanal prolapse of small intestine through the rectal opening who was treated with transanal reposition under general anaesthesia and open Hartmann's procedure. As part of the Hartmann's procedure, segmental resection of the perforated colon was performed. This case illustrates that spontaneous rectal perforation is a severe surgical emergency, which needs immediate reposition and resection of the perforated rectum.
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Malik R, Leviter J, Gross I, Saluja S, Cowles RA, Riera A. Point-of-Care Ultrasound to Evaluate the Acute Abdomen: A Case of Bowel Perforation After Unknown Single Magnet Ingestion. Pediatr Emerg Care 2022; 38:e1022-e1024. [PMID: 34116554 DOI: 10.1097/pec.0000000000002460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We report the case of a 3-year-old boy who presented to the pediatric emergency department in undifferentiated shock with an acute abdomen. Point-of-care ultrasound revealed viscous perforation with a large amount of free fluid. Intraoperatively, a single magnet was discovered as the likely cause of bowel perforation and the resulting state of shock.
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Obana T, Yamasaki S. [A case of duodenal perforation due to ingested fishbone with retroperitoneal abscess formation where surgical drainage was necessary after endoscopic removal]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 2022; 119:744-749. [PMID: 35944992 DOI: 10.11405/nisshoshi.119.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A female in her 60s was referred to our institution with epigastric pain and abdominal fullness persisting for one week. She was afebrile and mild abdominal tenderness was found on physical examination. Computed tomography (CT) revealed free air, and the dirty fat sign outside the duodenal wall. Her previous CT had not shown causative findings such as duodenal diverticula. A slightly high-attenuated linear structure penetrating the duodenal wall at the second portion was suspected after review of present CT images. Based on the history of her current illness, the possibility of mackerel bone ingestion was considered. Esophagogastroduodenoscopy (EGD) revealed a fishbone sticking out of the duodenal wall, which was extracted with biopsy forceps. Although antibiotic treatment under fasting was continued, the formation of retroperitoneal abscess was detected by CT on the 6th postprocedural day. Given that she also developed a high fever, surgical drainage was performed. The patient was discharged on the 15th postoperative day. Thus, in cases of duodenal perforations, a fishbone should be taken into account as a possible cause. Even if endoscopic removal was initially selected, careful observation is mandatory and an additional treatment should be considered depending on the clinical course.
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Yu L, Liu C, Cui Y, Xue L, Ma L. Imaging manifestations of neonatal necrotizing enterocolitis to predict timing of surgery. Turk J Pediatr 2022; 64:632-639. [PMID: 36082637 DOI: 10.24953/turkjped.2021.5048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND To find the predictor of optimal surgical timing for neonatal necrotizing enterocolitis (NEC) patients by analyzing the risk factors of conservative treatment and surgical therapy. METHODS Data were collected from 184 NEC patients (Surgery, n=41; conservative treatment, n=143) between the years 2015 and 2019. Data were analyzed by univariate analysis, and multivariate binary logistic regression analysis. RESULTS Univariate analysis showed that statistically significant differences between the surgery and conservative treatment groups. The results of multivariate Logistic regression analysis indicated intestinal wall thickening by B-ultrasound and gestational age were independent factors to predict early surgical indications of NEC (p < 0.05). The true positive rate, false positive rate, true negative rate and false negative rate in the diagnosis of necrotic bowel perforation guided by DAAS (Duke abdominal X-ray score) ≥7 and MD7 (seven clinical metrics of metabolic derangement) ≥3 were 12.8%, 0.0%, 100.0% and 87.2%, respectively. CONCLUSIONS In summary, the ultrasound examination in NEC children showing thickening intestinal wall and poor intestinal peristalsis indicated for early operation.
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Kawano S, Tsuchiya Y, Motegi S, Sugimoto K, Inami Y, Asaoka D, Ishibiki Y, Iwanuma Y, Sakamoto K, Fukunaga M. [Management of a perforated duodenal diverticulum using an endoscopic nasobiliary drainage tube:a case report]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 2022; 119:47-52. [PMID: 35022370 DOI: 10.11405/nisshoshi.119.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A man in his 70s visited our hospital for abdominal pain. Upon admission, abdominal computed tomography findings suggested a duodenal diverticular perforation. Upper gastrointestinal endoscopy revealed an incarcerated enterolith in the periampullary diverticulum. We achieved conservative management by inserting an endoscopic nasobiliary drainage tube into the duodenal diverticulum to aid drainage. The patient was discharged without serious complications 35 days after admission. We report a case of duodenal diverticular perforation with an incarcerated enterolith managed conservatively using endoscopic therapy.
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Aydin I, Sengul I. Case series: isolated small bowel perforations, secondary to blunt abdominal traumas. Ann Ital Chir 2022; 93:174-177. [PMID: 35476668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Isolated small bowel trauma after blunt abdominal trauma is rare and diagnosis may be difficult. The method used in the diagnostic is computed tomography so there is no consensus on this issue. Difficulty in diagnosis and delay in treatment can cause increased morbidity and mortality. We present the diagnosis and treatment modalities of interesting three cases, admitted to the Emergency Service with the complaint of blunt abdominal trauma and were found to have isolated small bowel perforations. Isolated small bowel perforation is secondly seen in cases with blunt abdominal trauma. To this end, a careful examination and the way of the trauma that occurs are crucial for diagnosis. Of note, we postulate that a physician should remain vigilant whether taking the decision of immediate operation to be able to attenuate the morbidity and mortality for a blunt trauma phenomenon. KEY WORDS: Trauma, Blunt trauma; Small bowel perforation; Emergency.
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Yaryura Montero JG, Zanatta Scattolini J, García Fascio H, García JS, Romero Reyna GH, Ferrero CI. Jejunal perforation secondary to kick during kick-boxing practice: laparoscopic management. Medicina (B Aires) 2022; 82:448-451. [PMID: 35639069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.
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Wu KH, Young YR, Guo DY, Chang KC, Hsiao CT, Chang CP. A Woman with Acute Right Upper Abdominal Pain. Ann Emerg Med 2021; 78:e77-e78. [PMID: 34688447 DOI: 10.1016/j.annemergmed.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Indexed: 11/19/2022]
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Thees-Laurenz R. Covered Perforation of the Ileum Caused by an Ingested Blister Pill Pack - A Rare Sonographic Diagnosis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:553-554. [PMID: 32207124 DOI: 10.1055/a-1123-1594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Abstract
A 72-year-old women was referred to our hospital because of lower left abdominal pain. Computed tomography showed prominent sigmoid colon dilation and double tumors on both the oral and anal sides. Surgical resection revealed an expanded sigmoid colon involved in double cancer that showed strong adhesion to the surrounding tissues. The pathological findings revealed obstructive colitis and minor perforation in the dilated colon. The minor perforation was considered to have been caused by fecal impaction in the closed cavity between the two tumors, resulting in an increase in colon pressure.
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Lastunen K, Leppäniemi A, Mentula P. Perforation rate after a diagnosis of uncomplicated appendicitis on CT. BJS Open 2021; 5:6106188. [PMID: 33609386 PMCID: PMC7893470 DOI: 10.1093/bjsopen/zraa034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/01/2020] [Indexed: 12/29/2022] Open
Abstract
Background Appendicectomy is a common emergency operation. The aim of this analysis was to study the effect of preoperative delay on disease progression, and whether a novel scoring system (Atema score) could be useful in predicting complicated appendicitis. Methods Patients with uncomplicated acute appendicitis on CT and who underwent appendicectomy in 2014–2015 were analysed for patient characteristics, preoperative delay and outcomes. Results Of 837 patients with uncomplicated appendicitis on CT, 187 (22.3 per cent) were found to have complicated appendicitis at surgery. The median time estimate for perforation was 25.4 h after CT, with an hourly rate of perforation of 2 per cent. Patients with an Atema score of 6 or less and those with no appendicolith on CT and a C-reactive protein level below 51 mg/l were the slowest to develop perforation, reaching a perforation rate of 5 per cent in 7.1 and 7.6 h respectively. Conclusion A substantial proportion of patients with uncomplicated acute appendicitis on CT have complicated appendicitis at surgery. However, in patients with no risk factors, surgery can be postponed safely for up to 7 h.
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Urru A, Romano N, Melani EF, Rollandi GA. An unusual cause of large bowel perforation: ingestion of a clam valve. Intern Emerg Med 2021; 16:225-226. [PMID: 32562205 DOI: 10.1007/s11739-020-02409-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022]
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Kriegler T, Majernik J, Ninger V. Perforation of descending colon diverticulum by swallowed rabbit bone - a case report. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2021; 100:94-96. [PMID: 33910343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Authors present a case of a 58-year old pacient that underwent acute surgery for perforation of descending colon diverticulum by swallowed rabbit bone. The thesis focuses only on foreign bodies swallowed by adult patients. Comprehensive spectrum of foreign bodies that have entered the digestive tract in another way is omitted.
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Sert OZ. Multiple small bowel perforation in a young adult female due to Rapunzel Syndrome. Ann Ital Chir 2020; 9:S2239253X20034258. [PMID: 33170155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Rapunzel's syndrome is the state of the gastric trichobezoar (hair ball) extending to the small intestine. Although it is seen very rarely, it is a psychiatric and mental illness especially in young women. We present here, a young female with recurrent trichotillomania. CASE PRESENTATION In a 24-year-old patient who underwent laparotomy due to recurrent trichobezoar, which completely filled the stomach and extended to the small intestine, caused perforation in two places in the small intestine, was removed by gastrotomy and enterotomy. One of the perforated areas was very close to ligament of Treitz, and perforation occurred due to the ulcer caused by trichobezoar. Post-operative central total parenteral nutrition was given and oral intake was started at the end of the first week. The patient was referred to psychiatry and antipsychotic medication was started. She was discharged on the 9th postoperative day without any problem. CONCLUSION Although there are no signs of peritonitis in such Rapunzel syndrome cases, a detailed exploration should be made by keeping in mind that trichobezoar will cause ulceration and perforation. In addition, as the primary cause is the underlying psychiatric disorder, patients should be referred to the psychiatry clinic to prevent recurrence. KEY WORDS Adult, Rapunzel syndrome, Surgery, Trichobezoar, Trichotillomania.
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Schumacher C, Decker G, Ries F. Esophageal stent migration leading to distal small bowel perforation. Acta Gastroenterol Belg 2020; 83:663-665. [PMID: 33321027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Covered oesophageal stents are often used to treat dysphagia in patients with inoperable oesophageal cancer. Stent migration is a well-known but usually benign complication. We report the case of a patient whose esophageal stent migrated into the distal ileum with perforation hereof. A laparoscopic stent extraction and intestinal repair was necessary to treat the perforation.
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Anker JP, Córdova H, Guerrero JA, Fernández-Esparrach G, Cuatrecasas M. Colonic perforation after piecemeal mucosectomy diagnosed by confocal microscopy. Gastrointest Endosc 2020; 92:971-973. [PMID: 32376329 DOI: 10.1016/j.gie.2020.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
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Manco G, Caramaschi S, Malagoli M, Bonetti LR, Rossi A. Laparoscopic treatment of Meckel's diverticulum perforation caused by a chicken bone. A case report. Ann Ital Chir 2020; 9:S2239253X20032740. [PMID: 33337432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We describe an uncommon case of a Meckel's diverticulum perforation by a chicken bone in a patient with symptoms of acute appendicitis. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. The incidence is approximately 2% of the population. Most patients are asymptomatic, only 4-16% presenting complications, including bleeding, obstruction, and diverticulitis. The perforation due to a foreign body is a very infrequent complication and may have a bad prognosis in case of a delayed diagnosis. Only in a few cases, a careful evaluation of the CT scan leads to correct preoperative diagnosis. Definitive treatment is surgical intervention and should not be delayed in patients with peritonitis. Laparoscopy is a safe diagnostic and therapeutic tool to treat complicated Meckel's diverticulum. In our case, a stapled laparoscopic diverticulectomy has been performed with an excellent outcome. KEY WORDS: Laparoscopy, Meckel's diverticulum, Perforation.
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Bartolo AD, Sircar S, Mitchell R. Post-partum duodenal perforation. THE NEW ZEALAND MEDICAL JOURNAL 2020; 133:97-99. [PMID: 32525866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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E Silva GS, Gomes NBN, Pacheco EO, Bezerra FMR, Nunes RB, Mcphee HL, Torres US, D'Ippolito G. Emergency CT of abdominal complications of ingested fish bones: what not to miss. Emerg Radiol 2020; 28:165-170. [PMID: 32504281 DOI: 10.1007/s10140-020-01800-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Since this condition is usually not suspected by referring physicians of the emergency department (ED), radiologists play a key role in this diagnosis; the spectrum of these imaging features must be known in order to be accurately reported in the ED.
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Portelli Tremont JN, Barnes E, Woodham C, Udekwu PO. A Perforated Small Bowel GI Stromal Tumor: An Unsuspecting Diagnosis in a Patient with Focal Peritonitis. Am Surg 2020; 86:e208-e209. [PMID: 32391782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Arnold MJ, Jonas CE, Carter RE. Point-of-Care Ultrasonography. Am Fam Physician 2020; 101:275-285. [PMID: 32109031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.
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Wang VY, Wang VL, Kao L, Elwood DR. A Complex Game of Go Fish: A Hybrid Endoscopic and Surgical Approach to a Fish Bone Perforation of the Portal Vein. Am Surg 2020; 86:e153-e155. [PMID: 32223827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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