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Lu Y, Mo L, Chen J, Peng W. Perforation of barium sulfate enterography in an infant: A case report. Medicine (Baltimore) 2024; 103:e37926. [PMID: 38669395 PMCID: PMC11049704 DOI: 10.1097/md.0000000000037926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Barium peritonitis is an inflammatory response that occurs when barium accidentally enters the abdominal cavity during a barium test. In extreme circumstances, it has the potential to harm various organs and even result in death. PATIENT CONCERNS A 3-month-old infant was diagnosed with multiple organ failure after severe barium peritonitis. DIAGNOSIS Multiple organ dysfunction is associated with barium peritonitis. INTERVENTIONS The infant underwent surgical intervention and received ventilator support, anti-infection therapy, myocardial nutrition, liver and kidney protection, rehydration, circulation stabilization, and other symptomatic supportive care. OUTCOMES The patient experienced clinical death after treatment and resuscitation was unsuccessful. LESSONS Barium enema perforation complications are uncommon, but can lead to fatal injuries with a high mortality rate. This case highlights the importance of raising awareness among clinicians about the risks of gastroenterography in infants and children and actively preventing and avoiding similar serious complications. The mortality rate can be reduced by timely multidisciplinary consultation and joint management once a perforation occurs.
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Affiliation(s)
- Yixing Lu
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lixian Mo
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Junhong Chen
- Department of Pathology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wei Peng
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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2
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Barajas Pérez J, Moralejo Lozano Ó, Arietti López NM, López Torres LM, Lomas Pérez RO, Muñoz Rosas C, Gómez Rodríguez RÁ. Iatrogenic rectal perforation due to application of topical treatment in a patient with ulcerative colitis: a rare complication. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:49-51. [PMID: 37073710 DOI: 10.17235/reed.2023.9599/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Rectal perforations due to topical treatments (enemas or foams) are unusual complications and they have been mostly reported in the use of barium enemas or in elderly patients with constipation. Very little has been reported about perforations secondary to topical treatment in patients with ulcerative colitis. We present the case of a patient with ulcerative colitis who suffered a rectal perforation complicated with a superinfected collection after the application of topical mesalazine foam.
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Affiliation(s)
- Jorge Barajas Pérez
- Gastroenterology and Hepatology, Complejo Hospitalario Universitario de Toledo, España
| | - Óscar Moralejo Lozano
- Gastroenterology and Hepatology, Complejo Hospitalario Universitario de Toledo, España
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3
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Ramírez-Olivencia G, Arsuaga M, Torrús D, Belhassen-Garcia M, Rodríguez-Guardado A, Herrero-Mendoza MD, Mateo-Maestre M, Campos-Rivas RP, Membrillo-de Novales FJ. Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study. Rev Clin Esp 2023; 223:193-201. [PMID: 36842660 DOI: 10.1016/j.rceng.2023.02.008] [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: 09/12/2022] [Accepted: 01/09/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10-20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. METHODS An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. RESULTS After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25-62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25-45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. CONCLUSIONS The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered.
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Affiliation(s)
- G Ramírez-Olivencia
- Sección de Infecciosas, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Servicio de Medicina Interna, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain.
| | - M Arsuaga
- Sección de Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - D Torrús
- Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis de Alicante-Instituto de Investigación Sanitaria y Biomédica de ALICANTE (ISABIAL), Alicante, Spain
| | - M Belhassen-Garcia
- Servicio de Medicina Interna, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Rodríguez-Guardado
- Área de Gestión Clínica Medicina Interna, Hospital Universitario Central de Asturias, Grupo de Microbiología Traslacional, Instituto de Investigación del Principado de Asturias, Asturias, Spain
| | - M D Herrero-Mendoza
- Servicio de Medicina Interna, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - M Mateo-Maestre
- Servicio de Microbiología, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - R P Campos-Rivas
- Servicio de Radiología, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
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4
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Ramírez-Olivencia G, Arsuaga M, Torrús D, Belhassen-Garcia M, Rodríguez-Guardado A, Herrero-Mendoza M, Mateo-Maestre M, Campos-Rivas R, Membrillo-de Novales F. Prevalencia de alteraciones digestivas asociadas a Chagas importado (estudio PADChI): un estudio observacional. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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5
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Barium Meal Peritonitis, Fatal Outcome in Unsuspected Small Bowel Perforation. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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6
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Zula D, Narasimhan V, Arachchi A, Nguyen TC, Chouhan H, Teoh W, Tay YK. Extra-peritoneal rectal perforation from self-administered enema. ANZ J Surg 2021; 92:293-294. [PMID: 34151509 DOI: 10.1111/ans.17036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- David Zula
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Asiri Arachchi
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Thang C Nguyen
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Hanumant Chouhan
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - William Teoh
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Yeng Kwang Tay
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
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7
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Klimko A, Tieranu CG, Preda CM, Olteanu AO, Ionescu EM. Massive Hematochezia Secondary to Rectal Enema Injury: The Role of Sengstaken-Blakemore Tube for Hemostasis When Endoscopy Fails. Cureus 2021; 13:e13946. [PMID: 33880283 PMCID: PMC8051529 DOI: 10.7759/cureus.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In rare instances, rectal cleansing enemas may cause rectal injury, precipitating lower gastrointestinal hemorrhage (LGIH). In a subset of LGIH cases, the bleeding diathesis may fail to respond to traditional treatment modalities and can be life-threatening. We present a case of an 84-year-old female with cleansing enema induced rectal bleeding - she was a poor surgical candidate and due to lack of access to in-house interventional radiology teams, hemostasis was attempted with sui generis use of the Sengstaken-Blakemore tube. Our transanal application of the Sengstaken-Blakemore tube for the management of LGIH contributes further evidence supporting the use of balloon tamponade in achieving hemostasis in select patients when traditional therapeutic modalities are unavailable.
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Affiliation(s)
- Artsiom Klimko
- Division of Physiology and Neuroscience, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Cristian G Tieranu
- Department of Gastroenterology, "Elias" Emergency University Hospital, Bucharest, ROU.,Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Carmen M Preda
- Department of Gastroenterology, Fundeni Clinical Institute, Bucharest, ROU.,Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Andrei O Olteanu
- Department of Gastroenterology, "Elias" Emergency University Hospital, Bucharest, ROU
| | - Elena M Ionescu
- Department of Gastroenterology, "Elias" Emergency University Hospital, Bucharest, ROU.,Department of Gastroenterology, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
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8
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Venditti D, Gravante G, Sena G, Orsaria P, Petrella G. Iatrogenic Rectal Perforations from Phosphate Enemas: A Retrospective Series over 1 Year of Activity in a University Hospital. Am Surg 2020. [DOI: 10.1177/000313481307900504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dario Venditti
- Department of Surgery Tor Vergata University Hospital Rome, Italy
| | | | - Giuseppina Sena
- Department of Surgery Tor Vergata University Hospital Rome, Italy
| | - Paolo Orsaria
- Department of Surgery Tor Vergata University Hospital Rome, Italy
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9
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Abstract
Teaching point: Barium granuloma is a rare but potentially risky complication of barium studies that should be prevented, especially in susceptible patients.
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10
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Liang Y, Di Re A, Ctercteko G. Iatrogenic rectal injury associated with fleet enema administration masquerading as Fournier's Gangrene. J Surg Case Rep 2020; 2020:rjz414. [PMID: 32123559 PMCID: PMC7038653 DOI: 10.1093/jscr/rjz414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022] Open
Abstract
Rectal injuries secondary to fleet enemas are the result of a chemical irritation as well as mechanical trauma causing localized perforation and mucosal necrosis. These injuries can be managed expectantly. Fournier’s Gangrene is a life-threatening, fulminant soft tissue infection of the genito-perineal region commonly secondary to a perianal infection, requiring extensive debridement of all affected tissue and judicious antibiotic therapy. This distinction is critical in the management of the current case, allowing for limited debridement and judicious observation without a resection of the injured rectum. A diverting colostomy allows for effective faecal management and minimizes contamination of the perineal wound.
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Affiliation(s)
- Yi Liang
- Department of General Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead NSW 2145, Australia
| | - Angelina Di Re
- Department of General Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead NSW 2145, Australia
| | - Grahame Ctercteko
- Department of General Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead NSW 2145, Australia
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11
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Duarte JDOM, Pereira PMLP, Sobral ASG, de Oliveira JPR, Rita HJB, de Sousa e Costa JA. Rectal perforation after barium enema: A case report. Clin Case Rep 2019; 7:2565-2567. [PMID: 31893100 PMCID: PMC6935644 DOI: 10.1002/ccr3.2563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022] Open
Abstract
Colorectal perforation after barium enema it is a rare complication, but has a high mortality rate. With the emergence of endoscopic examinations, barium enemas have fallen into disuse and doctors are less aware of its complications. This case is of the utmost importance as failure to recognize it could be fatal.
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12
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Leevan E, Carmichael JC. Iatrogenic bowel injury (early vs delayed). SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Fujii T, Toda S, Inoshita N, Tomizawa K, Hanaoka Y, Matoba S, Kuroyanagi H. Appendiceal mucinous neoplasm with myxoglobulosis occurring 3 years after perforated barium appendicitis: a case report. Surg Case Rep 2019; 5:107. [PMID: 31267369 PMCID: PMC6606682 DOI: 10.1186/s40792-019-0665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myxoglobulosis is considered a subtype of appendiceal mucinous neoplasm (AMN). Factors affecting the occurrence of myxoglobulosis include proximal appendiceal obstruction and mucosal secretion at the residual appendiceal mucosa. In addition, myxoglobulosis has also been reportedly associated with persistent chronic inflammation. We report a case of AMN with myxoglobulosis occurring 3 years after perforated barium appendicitis and the importance of caution during surgery for barium peritonitis and elucidate the pathology of myxoglobulosis. CASE PRESENTATION A 45-year-old man with an AMN underwent laparoscopic ileocecal resection 3 years after peritonitis caused by perforated barium appendicitis. The patient had a medical history of perforated barium appendicitis after barium swallow imaging, which was treated conservatively 3 years ago. Computed tomography (CT) revealed cystic enlargement of the appendix and remnant barium around the appendix. He was then pathologically diagnosed with a low-grade AMN based on the resected specimen, and the appendix filled with white globules was diagnosed as myxoglobulosis. When barium is not absorbed, it causes chronic inflammation. As barium was observed around the appendix, prolonged inflammation, and appendicitis may have contributed to the myxoglobulosis. The circumference of the appendix firmly adhered to the surrounding tissue with barium; hence, it was difficult to perform appendectomy. Barium that enters the anastomotic site causes stenosis of this part; therefore, excision of the ileocecal region in the intestinal part where barium is not present was selected instead of appendectomy. Colonoscopy performed 1 year after surgery and showed no evidence of anastomotic stricture. CONCLUSION This case suggested that barium peritonitis caused strong adhesions with the surrounding tissue; thus, careful manipulation was necessary to avoid perforating the appendix. Appendectomy and partial cecal resection were predicted to be difficult because of adhesion by barium. In addition, the ileocecal resection was selected because we had to choose an anastomotic site without barium. The perforated appendicitis caused stenosis of the appendix orifice, and barium surrounding the appendix caused persistent chronic inflammation. This was suggested to contribute to the myxoglobulosis.
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Affiliation(s)
- Takatsugu Fujii
- Department of gastrointestinal surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Shigeo Toda
- Department of gastrointestinal surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Naoko Inoshita
- Department of pathology, Tokyo Metropolitan Geriatric Medical Center, 35-2 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Kenji Tomizawa
- Department of gastrointestinal surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yutaka Hanaoka
- Department of gastrointestinal surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Shuichiro Matoba
- Department of gastrointestinal surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Hiroya Kuroyanagi
- Department of gastrointestinal surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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14
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Towers GD, Ng L, Maxwell RA, Madison S, Yaklic JL. Vaginal laceration during barium enema with extraperitoneal extravasation: Case report and literature review. Radiol Case Rep 2019; 14:851-857. [PMID: 31193046 PMCID: PMC6514427 DOI: 10.1016/j.radcr.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Unrecognized vaginal intubation during the barium enema procedure with subsequent balloon inflation and contrast instillation is a potentially fatal complication of an otherwise common and routine procedure. We describe a patient who, while undergoing a routine barium enema, had misplacement of the enema catheter into the vagina, subsequent rupture of the superior/lateral vagina upon inflation of the catheter retention balloon, and injection of barium contrast into the retroperitoneum. The patient was admitted for surgical repair of the vaginal laceration and monitoring for chemical peritonitis; and was managed without exploratory laparotomy. We review the existing literature, summarize 18 reported cases from worldwide literature, detail potential complications and propose management and prevention strategies based on the mechanism of injury.
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Puia I, Pommaret E, Spindler L, Fathallah N, de Parades V. [Massive rectal bleeding after enemas for constipation]. Presse Med 2019; 48:578-580. [PMID: 30926205 DOI: 10.1016/j.lpm.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Iulia Puia
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Elise Pommaret
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Lucas Spindler
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Nadia Fathallah
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Vincent de Parades
- Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France.
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16
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A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep 2017; 19:28. [PMID: 28439845 DOI: 10.1007/s11894-017-0566-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This study aimed to systematically review small bowel obstruction (SBO), focusing on recent changes in diagnosis/therapy. RECENT FINDINGS SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.
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Pandit N, Singh H, Jaiswal LS. Barium peritonitis: a disastrous complication of an unnecessary diagnostic study. Trop Doct 2017; 48:171-173. [DOI: 10.1177/0049475517739796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Narendra Pandit
- Associate Professor, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Nepal
| | - Harjeet Singh
- Assistant Professor, Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lokesh Shekher Jaiswal
- Associate Professor, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Nepal
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18
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de Miranda CLVM, de Sousa CSM, Cordão NGNP, Bastos BB, Mont'Alverne Filho FE. Intestinal perforation: an unusual complication of barium enema. Radiol Bras 2017; 50:339-340. [PMID: 29085170 PMCID: PMC5656077 DOI: 10.1590/0100-3984.2015.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lee KH, Kim JY, Sul YH. Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome. Ann Coloproctol 2017; 33:146-149. [PMID: 28932724 PMCID: PMC5603344 DOI: 10.3393/ac.2017.33.4.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/07/2017] [Indexed: 12/25/2022] Open
Abstract
We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.
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Affiliation(s)
- Kyung Ha Lee
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Ji Yeon Kim
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Young Hoon Sul
- Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju, Korea
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Kojima H, Hojo S, Manabe T, Demura S, Sekine S, Shibuya K, Hashimoto I, Yoshioka I, Okumura T, Nagata T, Fujii T. The efficacy of steroids for postoperative persistent inflammatory reaction in a patient with barium peritonitis: A case report. Int J Surg Case Rep 2017; 36:38-41. [PMID: 28531867 PMCID: PMC5440279 DOI: 10.1016/j.ijscr.2017.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022] Open
Abstract
Residual barium in intraperitoneal cavity causes persistent inflammatory reaction. Steroids are effective for persistent inflammation caused by residual barium. If infectious or other inflammation origins exist, steroids should be avoided.
Introduction Barium peritonitis is a serious and life-threatening disease requiring intensive care. Residual barium in the intraperitoneal cavity can cause persistent inflammation, postoperatively. Presentation of case An 80-year-old woman was admitted to our hospital because of abdominal pain and vomiting after barium meal examination. Physical and radiographic examination showed sigmoid colon perforation. Barium sulfate extravasation was noted in the intraperitoneal cavity. We diagnosed the patient with barium peritonitis, and performed Hartmann’s procedure and thorough lavage of the intraperitoneal cavity with 20-L saline. Postoperative blood examination results were not readily improved because of the residual barium in the intraperitoneal and retroperitoneal cavities. We excluded the presence of any other inflammation origin, except that from residual barium. Methylprednisolone 500 mg/body/day was administered for 3 days and the dose was gradually decreased thereafter. The white blood cell count and serum C-reactive protein levels immediately improved to normal levels. Discussion Barium peritonitis is associated with high mortality. Residual barium in the intraperitoneal cavity can cause chemical peritonitis, leading to granuloma formation and ileus, postoperatively. Therefore, complete removal of barium in the abdominal cavity with aggressive drainage and large quantity of saline is necessary to prevent postoperative inflammatory reaction. The use of steroids improves the persistent inflammation caused by residual barium, unless any infectious origins are present, which can worsen with steroid-use. Conclusion Residual barium in the intraperitoneal cavity causes persistent inflammatory reaction in patients with barium peritonitis. The use of steroids is effective for postoperative persistent inflammation due to the residual barium.
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Affiliation(s)
- Hirofumi Kojima
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Shozo Hojo
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Takahiro Manabe
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Shiori Demura
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Shinichi Sekine
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Kazuto Shibuya
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Isaya Hashimoto
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Isaku Yoshioka
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Tomoyuki Okumura
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Takuya Nagata
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
| | - Tsutomu Fujii
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical, Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, Toyama 930-0194, Japan, Japan.
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Gastrografin ® (diatrizoate meglumine and diatrizoate sodium solution) induced acute renal failure following lower GI examination and subsequent colonoscopic biopsy. Radiography (Lond) 2017; 23:e20-e22. [PMID: 28290355 DOI: 10.1016/j.radi.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/18/2016] [Accepted: 09/15/2016] [Indexed: 11/21/2022]
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Federle MP, Jaffe TA, Davis PL, Al-Hawary MM, Levine MS. Contrast media for fluoroscopic examinations of the GI and GU tracts: current challenges and recommendations. Abdom Radiol (NY) 2017; 42:90-100. [PMID: 27503380 DOI: 10.1007/s00261-016-0861-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One of the significant challenges facing radiologists who perform and interpret studies of the gastrointestinal and genitourinary systems have been periodic interruptions in the availability of barium and iodinated contrast media specially formulated for gastrointestinal (GI) and genitourinary (GU) studies. These interruptions are due to the US Food and Drug Administration's recent requirement for more stringent documentation of the safety and efficacy of contrast media and the consolidation among contrast manufacturers. Therefore, radiologists may be required to recommend an alternative means of evaluation, such as computed tomography, magnetic resonance, or endoscopy, or they may need to substitute a different formulation of a contrast agent not specifically developed for GI or GU use, for example the utilization of an agent designed and marketed for vascular use. This article reviews the current status of fluoroscopic contrast media, and provides suggestions and recommendations for the optimal and alternative use of contrast media formulations.
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Affiliation(s)
- Michael P Federle
- Stanford University Medical Center, 300 Pasteur Drive, Rm H1330, Stanford, CA, 94305, USA.
| | - Tracy A Jaffe
- Duke University Medical Center, Box 3808 DUMC, Durham, NC, 27710, USA
| | - Peter L Davis
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Mahmoud M Al-Hawary
- University of Michigan, 1500 E. Medical center Dr, Ann Arbor, MI, 48109, USA
- University Hospital, Room B1 D502, San Antonio, USA
| | - Marc S Levine
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Lara LF, Avalos D, Huynh H, Jimenez-Cantisano B, Padron M, Pimentel R, Erim T, Schneider A, Ukleja A, Parlade A, Castro F. The safety of same-day CT colonography following incomplete colonoscopy with polypectomy. United European Gastroenterol J 2015; 3:358-63. [PMID: 26279844 DOI: 10.1177/2050640615577881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/24/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC. OBJECTIVE The objective of this article is to describe the complications including colon perforations associated with same-day CTC in a cohort who had polypectomies but an incomplete colonoscopy. DESIGN We conducted a retrospective study. SETTING Our study took place in a single, tertiary referral center. PATIENTS We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy. INTERVENTIONS Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC. MAIN OUTCOME MEASUREMENTS Our main outcome measurements included perforation rate with long-term follow-up. RESULTS A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were ≤ 5 mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up. LIMITATIONS Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD. CONCLUSIONS Radiologists' apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of same-day CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.
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Bruketa T, Majerovic M, Augustin G. Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options. World J Gastroenterol 2015; 21:9002-9020. [PMID: 26290629 PMCID: PMC4533034 DOI: 10.3748/wjg.v21.i30.9002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/08/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.
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Neri E, Mantarro A, Faggioni L, Scalise P, Bemi P, Pancrazi F, D'Ippolito G, Bartolozzi C. CT colonography with rectal iodine tagging: Feasibility and comparison with oral tagging in a colorectal cancer screening population. Eur J Radiol 2015; 84:1701-7. [PMID: 26032131 DOI: 10.1016/j.ejrad.2015.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate feasibility, diagnostic performance, patient acceptance, and overall examination time of CT colonography (CTC) performed through rectal administration of iodinated contrast material. MATERIALS AND METHODS Six-hundred asymptomatic subjects (male:female=270:330; mean 63 years) undergoing CTC for colorectal cancer screening on an individual basis were consecutively enrolled in the study. Out of them, 503 patients (group 1) underwent CTC with rectal tagging, of which 55 had a total of 77 colonic lesions. The remaining 97 patients (group 2) were randomly selected to receive CTC with oral tagging of which 15 had a total of 20 colonic lesions. CTC findings were compared with optical colonoscopy, and per-segment image quality was visually assessed using a semi-quantitative score (1=poor, 2=adequate, 3=excellent). In 70/600 patients (11.7%), CTC was performed twice with both types of tagging over a 5-year follow-up cancer screening program. In this subgroup, patient acceptance was rated via phone interview two weeks after CTC using a semi-quantitative scale (1=poor, 2=fair, 3=average, 4=good, 5=excellent). RESULTS Mean per-polyp sensitivity, specificity, positive and negative predictive values of CTC with rectal vs oral tagging were 96.1% (CI95% 85.4÷99.3%) vs 89.4% (CI95% 65.4÷98.1%), 95.3% (CI95% 90.7÷97.8%) vs 95.8% (CI95% 87.6÷98.9%), 86.0% (CI95% 73.6÷93.3) vs 85.0% (CI95% 61.1÷96.0%), and 98.8% (CI95% 95.3÷99.8%) vs 97.2% (CI95% 89.4÷99.5%), respectively (p>0.05). Polyp detection rates were not statistically different between groups 1 and 2 (p>0.05). Overall examination time was significantly shorter with rectal than with oral tagging (18.3±3.5 vs 215.6±10.3 minutes, respectively; p<0.0001). CONCLUSIONS Rectal iodine tagging can be an effective alternative to oral tagging for CTC with the advantages of greater patient acceptance and lower overall examination time.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
| | - Annalisa Mantarro
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Paola Scalise
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Pietro Bemi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Francesca Pancrazi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giuseppe D'Ippolito
- Federal University of São Paulo - Sena Madureira 1500 - Vila Mariana, UNIFESP, São Paulo, SP, Brazil
| | - Carlo Bartolozzi
- Diagnostic and Interventional Radiology - Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
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Vahedian-Ardakani J, Nazerani S, Saraee A, Sarmast A, Saraee E, Keramati MR. Proper management for morbid iatrogenic retroperitoneal barium insufflation. Ann Coloproctol 2015; 30:285-9. [PMID: 25580416 PMCID: PMC4286776 DOI: 10.3393/ac.2014.30.6.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/25/2014] [Indexed: 02/03/2023] Open
Abstract
A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.
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Affiliation(s)
| | - Shahram Nazerani
- Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Saraee
- Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarmast
- Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Saraee
- Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
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ElGendy K. Rectal perforation after neoadjuvant chemoradiotherapy for low-lying rectal cancer. BMJ Case Rep 2015; 2015:bcr-2014-207105. [PMID: 25564637 DOI: 10.1136/bcr-2014-207105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Khalil ElGendy
- Department of Colorectal Surgery, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
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28
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Yang X, Xia L, Huang J, Wang J, Pan K. Phased surgical treatment of barium enema-induced rectal injury and retention of barium in the pelvic floor space. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:101. [PMID: 25405155 DOI: 10.3978/j.issn.2305-5839.2014.06.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/30/2014] [Indexed: 11/14/2022]
Abstract
Iatrogenic injuries caused by barium enema are rarely reported. Following a phased surgical protocol for up to one year, we have successfully treated a patient with rectal injury and severe infection of the pelvic floor space complicated with retention of large amounts of barium and vaginal fistula. In this article, the phased surgery planning for the treatment of rectal injury complicated with vaginal fistula is discussed in terms of the pros and cons, and the observed effect and evolution of barium retained in the pelvic floor space are described.
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Affiliation(s)
- Xuefei Yang
- 1 Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China ; 2 Department of Gastrointestinal Surgery, Shenzhen People's Hospital & Second Clinical Medical College of Jinan University, Shenzhen 518020, China ; 3 Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Ligang Xia
- 1 Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China ; 2 Department of Gastrointestinal Surgery, Shenzhen People's Hospital & Second Clinical Medical College of Jinan University, Shenzhen 518020, China ; 3 Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Jun Huang
- 1 Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China ; 2 Department of Gastrointestinal Surgery, Shenzhen People's Hospital & Second Clinical Medical College of Jinan University, Shenzhen 518020, China ; 3 Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Jianping Wang
- 1 Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China ; 2 Department of Gastrointestinal Surgery, Shenzhen People's Hospital & Second Clinical Medical College of Jinan University, Shenzhen 518020, China ; 3 Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Kai Pan
- 1 Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China ; 2 Department of Gastrointestinal Surgery, Shenzhen People's Hospital & Second Clinical Medical College of Jinan University, Shenzhen 518020, China ; 3 Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
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Li C, Wen TF, Yan LN, Li B. Risk factors for abdominal bleeding after living-donor liver transplant. EXP CLIN TRANSPLANT 2014; 12:424-8. [PMID: 24568675 DOI: 10.6002/ect.2013.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to identify the incidence, outcomes, and risk factors of postoperative abdominal bleeding after living-donor liver transplant. MATERIALS AND METHODS Adult patients who had living-donor liver transplant between 2001 and 2013 were evaluated. Preoperative and intraoperative variables of transplant recipients were analyzed retrospectively with univariate analysis. Cox proportional hazards regression model was used to identify independent factors for postoperative bleeding. RESULTS There were 241 living-donor liver transplant recipients included in the study. Postoperative abdominal bleeding was observed in 12 recipients (5%). The 3-month cumulative survival was significantly lower in recipients who had postoperative bleeding (survival, 8 patients [67%]) than recipients who did not have postoperative bleeding (survival, 204 patients [89%]; P = .009). Univariate analysis showed that preoperative albumin level, Child-Pugh class, and intraoperative blood loss were risk factors for postoperative bleeding. In multivariate analysis, intraoperative blood loss and Child-Pugh status were significant risk factors for postoperative bleeding. CONCLUSIONS Living-donor liver transplant recipients who had postoperative bleeding had a poor outcome. Postoperative bleeding was associated with higher intraoperative blood loss and Child-Pugh class.
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Affiliation(s)
- Chuan Li
- From the Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China
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Affiliation(s)
- Harma K Turbendian
- 1 Department of Surgery, Joan and Sanford I. Weill Medical College of Cornell University , New York, New York
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Abstract
Rectal trauma is associated with high rates of morbidity and mortality and generally affects young males due to its aetiology of violent crime and vehicular collision. Historically, management has followed principles derived from military practice, with faecal diversion, pre-sacral drainage and distal washout being mandatory. Civilian trauma studies examining management of colon and rectum injuries from the early 1950s identified major differences in the level of energy transfer between civilian and military wounds, given that the vast majority are penetrating in nature. This led to a re-evaluation of the necessity for these interventions for all rectal injuries. Current management depends on whether the injury is intra- or extraperitoneal, with those above the peritoneal reflection being readily accessible and amenable to treatment as for colon injury. Extraperitoneal injuries remain difficult to access and direct repair is usually impossible; the mainstay of treatment in most instances remains faecal diversion. The role of pre-sacral drainage and distal washout remains contentious in the realms of civilian rectal injury but retains a place in battlefield or other high-energy transfer rectal injuries where aggressive early management reduces septic complications. This article reviews the historical and current evidence for the management of both civilian and military extraperitoneal rectal injuries.
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Affiliation(s)
- Sarah Barkley
- Department of Colorectal Surgery, Northern General Hospital, Sheffield, UK
| | - Mansoor Khan
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Jeff Garner
- Rotherham NHS Foundation Trust and Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease. Pediatr Radiol 2012; 42:1099-106. [PMID: 22526281 DOI: 10.1007/s00247-012-2394-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 02/20/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation. OBJECTIVE We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis. MATERIALS AND METHODS Children were identified from our colorectal surgery database. At the time of abstract submission, 35 children had contrast enemas prior to reoperation. Additional children continue to present for evaluation. The majority of children included in the study had their primary repair performed elsewhere. The initial procedures included: Duhamel (n = 11), Soave (n = 20) or Swenson (n = 3). One child had undergone a primary Soave repair and subsequently had a Swenson-type reoperation but continued to have a poor outcome. One child's initial surgical repair could not be determined. Images were reviewed by a staff pediatric radiologist and a pediatric radiology fellow. RESULTS Findings encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment (8), dilated/hypomotile distal segment (7), thickened presacral space due to compressing Soave cuff (11), dilated Duhamel pouch (8), active enterocolitis (3) and partially obstructing twist of the pull-through segment (1). CONCLUSION Multiple anatomical and pathological complications exist that can lead to bowel dysfunction in children after repair of Hirschsprung disease. Little recent literature exists regarding the radiographic findings in children. We had the opportunity to review a substantial series of these children, describe the contrast enema findings in these difficult cases and correlate them with operative findings. Radiologic evaluation is key to assessing such patients; it defines the potential anatomical problem with the pull-through and facilitates surgical planning.
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Mori H, Kobara H, Fujihara S, Nishiyama N, Kobayashi M, Masaki T, Izuishi K, Suzuki Y. Rectal perforations and fistulae secondary to a glycerin enema: Closure by over-the-scope-clip. World J Gastroenterol 2012; 18:3177-80. [PMID: 22791955 PMCID: PMC3386333 DOI: 10.3748/wjg.v18.i24.3177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/17/2012] [Accepted: 04/20/2012] [Indexed: 02/06/2023] Open
Abstract
Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position. Once the perforation occurs and peritonitis results, death is usually inevitable. We describe two cases of rectal perforation and fistula caused by a GE. An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE. Her case was further complicated by an abscess in the right rectal wall. The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE. In both cases, we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure. These procedures resulted in dramatic improvement in both patients. Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure, respectively, in elderly patients who are in poor general condition. Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.
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Abstract
The authors present the case of an elderly, nonverbal nursing home resident with dementia who developed fecal impaction, despite interventions such as enema. Subsequent stercoral perforation of the sigmoid colon resulted in peritonitis, sepsis, and death. The authors discuss colon perforation as a result of fecal impaction, as well as the difficulties of pain assessment and communication in patients with dementia.
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Hwang SS, Cannom RR, Abbas MA, Etzioni D. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum 2010; 53:1699-707. [PMID: 21178867 DOI: 10.1007/dcr.0b013e3181f5643c] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The clinical course of diverticular disease in immunosuppressed patients is widely believed to be more severe than in the general population. In this study we systematically reviewed the literature regarding the epidemiology and clinical course of diverticulitis in immunosuppressed patients. Our goal was to develop recommendations regarding the care of this group of patients. METHODS Using PubMed and Web of Knowledge we systematically reviewed all studies published between 1970 and 2009 that analyzed the epidemiology, clinical manifestation, or outcomes of treatment of diverticulitis in immunosuppressed patients. Keywords of "transplantation," "corticosteroid," "HIV," "AIDS," and "chemotherapy" were used. RESULTS Twenty-five studies met our inclusion criteria. All of these studies focused on the impact of diverticulitis in patients with transplants or on chronic corticosteroid therapy. The reported incidence of acute diverticulitis in these patients was approximately 1% (variable follow-up periods). Among patients with known diverticular disease the incidence was 8%. Mortality from acute diverticulitis in these patients was 23% when treated surgically and 56% when treated medically. Overall mortality was 25%. CONCLUSIONS Our study summarizes evidence that patients with transplants or patients on chronic corticosteroid therapy 1) have a rate of acute diverticulitis that is higher than the baseline population and 2) a mortality rate with acute diverticulitis that is high. Further research is needed to define whether these risks constitute a mandate for screening and prophylactic sigmoid colectomy.
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Affiliation(s)
- Stephanie S Hwang
- Department of Surgery, Kaiser Permanente, Los Angeles, California, USA
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36
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Hsieh MC, Lai JY, Chan WP. Medical Misadventure: Barium Extravasation in Colorectal Cancer. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n10p809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ming Chih Hsieh
- Taipei Medical University-Wan Fang Hospital, Taiwan, Republic of China
| | - Ji-Yun Lai
- School of Medicine, Taipei Medical University, Taiwan, Republic of China
| | - Wing P Chan
- Taipei Medical University-Wan Fang Hospital, Taiwan, Republic of China
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Fatal anorectal trauma in the setting of sexual assault: case report and literature survey. Am J Forensic Med Pathol 2010; 31:273-7. [PMID: 20512029 DOI: 10.1097/paf.0b013e3181e13269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Homicides exclusively due to genital trauma have not been widely reported, and anorectal trauma in sexual assaults is uncommon. We describe a case of a 45-year-old white woman who sustained devastating homicidal colorectal trauma that served as a primary cause of death in the setting of rape. Our patient sustained a 15-cm laceration of the anterior rectal wall and ultimately died of peritonitis and sepsis. Death from rectal perforation and sepsis in the setting of sexual assault is rare and has only been documented in 3 other cases, 2 pediatric patients and 1 elderly debilitated patient. Other representative and unique methods of perforation are reviewed along with a brief discussion of the development of peritonitis after perforating colorectal trauma.
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Soghoian S, Hoffman RS, Nelson L. Unintentional i.v. injection of barium sulfate in a child. Am J Health Syst Pharm 2010; 67:734-6. [DOI: 10.2146/ajhp080612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Samara Soghoian
- New York University (NYU), New York; at the time of writing she was Senior Medical Toxicology Fellow, New York City Poison Control Center (NYCPCC), NYU
| | - Robert S. Hoffman
- NYCPCC, and Associate Professor of Emergency Medicine and Medicine, NYU
| | - Lewis Nelson
- NYCPCC, and Associate Professor of Emergency Medicine, NYU
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Khan TR, Rawat JD, Ahmed I, Rashid KA, Maletha M, Wakhlu A, Kureel SN. Neonatal pneumoperitoneum: a critical appraisal of its causes and subsequent management from a developing country. Pediatr Surg Int 2009; 25:1093-7. [PMID: 19844726 DOI: 10.1007/s00383-009-2488-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diagnosis and management of neonatal pneumoperitoneum revolves around necrotizing enterocolitis (NEC) in most of the published literature. Although NEC remains the major cause of pneumoperitoneum in a neonate, there are several other causes leading to free air in the peritoneal cavity. A number of case reports have appeared describing pneumoperitoneum in a newborn due to rupture of one particular organ, but there have been only few collective reviews on the subject. The present study shares the experience with neonates admitted with a diagnosis of pneumoperitoneum in a pediatric surgical center of a developing country. The various causes of pneumoperitoneum in a newborn, their management and subsequent outcome are described. MATERIALS AND METHODS The study was conducted in the Department of Pediatric Surgery, CSMMU (upgraded King Georges Medical College), Lucknow, India. All the neonates admitted with a diagnosis of pneumoperitoneum during the period of last 3 years (2005-2008) were retrospectively analyzed. Other neonatal admissions were also retrieved for the same period. Free air was confirmed by erect abdominal X-ray or lateral decubitus films in certain cases. The data sheets were analyzed regarding age of presentation, cause of bowel perforation, management offered and subsequent outcome achieved. All patients of NEC without evidence of perforation were not included in the study (n = 21). RESULTS Out of total 537 neonatal admissions, 89 (16.5%) neonates were admitted with a diagnosis of pneumoperitoneum. There were 79 (88.7%) males and only 10 (11.6%) female neonates admitted during the study period. All of them had evidence of pneumoperitoneum at the time of admission. The age at presentation ranged from 4 to 32 days. NEC remained the single major cause of pneumoperitoneum in the newborn; however, in 44 (49.4%) patients the cause was not related to NEC. Perforated pouch colon, isolated colonic perforations, caecal perforations, gastric and duodenal perforations were the main causes of pneumoperitoneum not related to NEC. There were seven patients in whom no cause of pneumoperitoneum could be ascertained. The treatment was individualized according to the presentation. Most of the NEC-related perforations were managed by peritoneal drains. Laparotomy was done in rest of the patients. Three patients were managed conservatively. Overall, 19 (21.6%) patients expired. Most of those expired were of low birth weight with NEC and congenital pouch colon with perforation. CONCLUSION Neonatal pneumoperitoneum remains a surgical emergency and outcome can be lethal if the problem is not addressed early. NEC remains the major cause; however, there are several other important causes of isolated gastrointestinal perforations leading to neonatal pneumoperitoneum. The management should be individualized in these patients and the outcome largely depends on the early recognition of the condition.
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Affiliation(s)
- Tanvir Roshan Khan
- Department of Pediatric Surgery, CSM Medical University (Upgraded KGMC), Lucknow, India.
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Alonso-Coello P, Marzo-Castillejo M, Mascort JJ, Hervás AJ, Viña LM, Ferrús JA, Ferrándiz J, López-Rivas L, Rigau D, Solà I, Bonfill X, Piqué JM. [Clinical practice guideline on the management of rectal bleeding (update 2007)]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 31:652-67. [PMID: 19174083 DOI: 10.1016/s0210-5705(08)75814-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Pablo Alonso-Coello
- Centro Cochrane Iberoamericano, Servicio de Epidemiología Clínica y Salud Pública (Universidad Autónoma de Barcelona), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Abstract
Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons.
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Dearing DD, Recabaren J, Alexander M. Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast? Am Surg 2008. [DOI: 10.1177/000313480807401007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.
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Affiliation(s)
| | - Jamesa Recabaren
- Department of Surgery, Huntington Hospital, Pasadena, California
| | - Magdi Alexander
- Department of Surgery, Huntington Hospital, Pasadena, California
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Abstract
OBJECTIVE Imaging the colon in suspected acute large bowel obstruction (LBO) is traditionally carried out with a supine abdominal X-ray (AXR) and erect chest X-ray. If there is no clinical or radiological evidence to suggest a perforation, then an unprepared barium or water-soluble contrast enema (CE) can be performed to confirm the presence of and demonstrate the site of obstruction. The advent of modern, fast multidetector CT (MDCT) scanners has changed management strategies for acute abdominal conditions including suspected LBO in all groups of patients especially the elderly, infirm and those on ITU/HDU. METHOD A retrospective case note analysis was carried over a 7-year period in a single centre. The study criteria involved investigation of suspected LBO with CE, CT and MDCT. RESULTS It showed a reduction in the number of contrast enemas performed. CONCLUSION MDCT was shown to be more accurate in the diagnosis of LBO, is usually available on a 24-h basis, and in many institutions has replaced the urgent CE in this group of patients. This also has the advantage of excluding incidental findings and in staging malignant disease.
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Affiliation(s)
- S E Jacob
- Department of Surgery, Manchester Royal Infirmary, Manchester, UK.
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Arnold SJ, Nash GF. Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic right lower-quadrant pain (Br J Surg 2008; 95 169-174). Br J Surg 2008; 95:800; author reply 800-1. [PMID: 18446756 DOI: 10.1002/bjs.6283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
The acute abdomen accounts for up to 40% of all emergency-surgical hospital admissions and is considered in the differential in the more than 7 million visits to the emergency department annually for abdominal pain in the United States. A large percentage of these cases are secondary to perforation or impending gastrointestinal perforation. Gastrointestinal perforation causes considerable mortality and usually requires emergency surgery.Rapid diagnosis and treatment of these conditions is essential to reduce the high morbidity and mortality of late-stage presentation. Successful treatment requires a thorough understanding of the anatomy, microbiology, and pathophysiology of this disease process and in-depth knowledge of the therapy, including resuscitation,antibiotics, source control, and physiologic support.
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Affiliation(s)
- John T Langell
- Department of Surgery, University of Utah, 30 North 1900 East, SOM 3B115, Salt Lake City, UT 84132, USA.
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Renschler J, Tarigo J, Neel J, Grindem C. What is your diagnosis? Particulate material in peritoneal fluid from a dog. Vet Clin Pathol 2008; 37:129-32. [PMID: 18366556 DOI: 10.1111/j.1939-165x.2008.00006.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
9-year-old castrated male Greyhound dog was presented for evaluation of vomiting and lethargy of 1-week duration. On physical examination, the dog was febrile and dehydrated with a tense abdomen and petechial hemorrhages. Clinicopathologic abnormalities included relative polycythemia, mild lymphopenia with reactive lymphocytes, hypoalbuminemia, hypocholesterolemia, hyperbilirubinemia, increased ALP, mild hypokalemia, hyperamylasemia, hyperlipasemia, increased D-dimer concentration, and hyperfibrinogenemia. Cytologic evaluation of peritoneal fluid revealed marked suppurative inflammation with intracellular barium sulfate particles. The day before presentation, the referring veterinarian had administered oral barium sulfate in an upper gastrointestinal contrast study. Radiographs revealed free contrast material in the peritoneal cavity, consistent with gastrointestinal perforation, and leakage of contrast material. Abdominal exploratory surgery revealed a mid-jejunal perforation and a hepatic nodule. Histopathologic diagnosis of the jejunal and liver lesions was T-cell lymphoma. The patient recovered well postoperatively and received chemotherapy for treatment of lymphoma. Most commercial barium sulfate preparations contain relatively uniform, weakly birefringent, pale yellow particles <1 microm in diameter. Because barium sulfate is found occasionally in clinical specimens, cytopathologists should be familiar with its cytologic appearance.
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Affiliation(s)
- Janelle Renschler
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC 27606, USA.
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Hollingshead MC, Warshauer DM. Diverticular perforation masquerading as maxillary sinusitis. Emerg Radiol 2006; 13:83-5. [PMID: 16941111 DOI: 10.1007/s10140-006-0510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Accepted: 04/21/2006] [Indexed: 11/30/2022]
Abstract
Although diverticular perforation and diverticulitis is usually a straightforward diagnosis, an occasional case can be difficult. In this report, we describe a patient who initially presented with symptoms suggestive of maxillary sinusitis and hip fracture. Findings of subcutaneous craniofacial emphysema eventually led to the diagnosis of a perforated sigmoid diverticulum with abscess.
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Affiliation(s)
- Michael C Hollingshead
- Department of Radiology, CB 7510, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510, USA.
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