SMALL-BOWEL ULCERATION APPARENTLY ASSOCIATED WITH THIAZIDE AND POTASSIUM THERAPY

Peritonitis - the Eastern experience

Peritonitis is a common emergency encountered by surgeons the world over. This paper aims to provide an overview of the spectrum of peritonitis seen in the East. Studies dealing with the overall spectrum of secondary peritonitis in various countries of this region were identified using Pubmed and Google. These were analyzed for the site and cause of perforation and the mortality. It was observed that perforation of duodenal ulcers was the most the commonly encountered perforations. These are followed by small bowel and appendicular perforations. Colonic perforations were uncommon. The overall mortality ranges between 6–27%.

Ascites

This article reviews the progress made during the last century in understanding and managing ascites. The list of known causes of ascites has lengthened considerably. There is improved understanding of the mechanism of ascites formation and the pathophysiology of the renal sodium retention that accompanies portal hypertensive ascites. Management of ascites has become substantially easier with the advent of new diuretics, and new procedures such as peritoneovenous shunting, transjugular intrahepatic portosystemic stent placement, and liver transplantation.

Small intestinal ulceration secondary to carcinoid tumour arising in a Meckel's diverticulum

A solitary small intestinal ulcer associated with a carcinoid tumour in a nearby Meckel's diverticulum was found in a 77 year old man presenting with massive rectal bleeding. Angiography and a radioisotope study localised the bleeding to the ileum. At operation, the Meckel's diverticulum was identified, with bleeding from an ulcer just distal to it. Pathological examination revealed a small carcinoid tumour confined to the Meckel's diverticulum. Close to the opening of the diverticulum, within the ileum, a well demarcated ulcer was present. Histology showed a non-specific ulcer which eroded a large blood vessel. This is the first documented occurrence of solitary small intestinal ulceration in association with a carcinoid tumour. Carcinoid tumour should be added to the list of possible causes of small intestinal ulceration. The ulceration may be secondary to release of cytokines by the tumour.

Drug-related pathological lesions of the intestinal tract

Pathologists need to be more aware of the capacity of drugs, in particular non-steroidal anti-inflammatory agents, to produce a wide spectrum of lesions in the intestinal tract. Whilst the histological changes brought about by drugs are generally non-specific in character, certain features such as tissue eosinophilia, the presence of apoptotic bodies in the crypts of Leiberkhun or an increase in intra-epithelial lymphocytes in the colon should always raise the suspicion of drug effects.

Osmosin and ileal ulceration: a case report

A 78-year-old woman presented with an acute abdomen and was found to have a perforation of her terminal ileum. She did not survive the post-operative period and at necropsy was found to have numerous ulcers of the ileum. In the ulcerated areas there was a transmural chronic inflammatory infiltrate, but no evidence of granulomata. We believe that this ulceration was caused by ingestion of Osmosin tablets containing indomethacin and suggest a possible pathogenesis.

Clinicopathologic study of nonspecific ulcers of the small intestine

Fifty-nine cases (31 men and 28 women) of nonspecific small bowel ulceration, representing the Mayo Clinic experience from 1956 to 1979, are reviewed. The average age was 51 years. Presenting symptoms or signs were those of intermittent small bowel obstruction (63%), blood loss (25%), and acute abdomen (12%). Whereas 78% of the ulcers were located in the ileum, 15% in the jejunum, and 7% in the jejunoileum, perforation was by far more common in the jejunum (78%) as compared with the ileum (11%). Diagnosis was rarely made preoperatively, although abnormalities were noted roentgenographically in 66%. Treatment was surgical and was usually curative. Operative mortality was 8.5%. No single cause was implicated.

Drug-induced gastrointestinal disease

The gastrointestinal tract is a common target for adverse drug reactions. The resultant changes are often nonspecific (e.g., mucosal ulceration, intestinal infarction, motility disturbance) and in many cases no radiographically detectable lesion may occur. A comprehensive review of the reported drug-induced disorders of the digestive organs is herein presented and their radiographic manifestations are described.

Multiple small bowel strictures in a child and accidental potassium chloride ingestion

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Perforated jejunal ulcer and heterotopic gastric mucosa

A case of perforated jejunal ulcer in a 16-year-old woman is detailed. The ulcer was associated with nearby polypoid heterotopic gastric mucosa. This is the first report of such an association.

Slow release potassium chloride treatment

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Letter: Mouth ulceration and slow-release potassium tablets

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Idiopathic and drug-induced ulceration of the small intestine

Ulceration of the small intestine is an uncommon lesion of multifactorial origin. The most important factor responsible for the reported increased incidence is the ingestion of enteric-coated potassium chloride. It is desirable that potassium supplements be given in another form, for example as a slow-release preparation. Other drugs which may play a part in the aetiology include corticosteroids and phenylbutazone.

Diagnosis is difficult and ulceration is usually only demonstrated after one of the complications (obstruction, perforation, or haemorrhage) has occurred. It is imperative that a full drug-taking history is obtained.

Laboratory tests are not helpful in diagnosis, but where radiological studies are carried out they often contribute useful information.

If the symptoms of such an ulcer are severe enough to warrant laparotomy, then the treatment of choice is excision of the affected segment followed by end-to-end anastomosis.

Recurrent benign ileal ulcer occurring with the coeliac syndrome

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Circumferential small bowel ulcers: a report of nine cases

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Surgical complications of adrenal steroid therapy

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Unusual case of multiple spontaneous perforation of small bowel

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