1
|
Ma L, Liu Z, Wang Y, Wang T, Sun G, Wang L, Fan K, Liu J, Ma L, Qin W, Hu J, Cai M, Zhang G, Li Q, Zhou P. Endoscopic management of duodenal perforation caused by foreign bodies in adults: A retrospective study. United European Gastroenterol J 2024; 12:390-398. [PMID: 38159037 PMCID: PMC11017768 DOI: 10.1002/ueg2.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND AIMS Duodenal perforation caused by foreign bodies (FBs) is very rare but is an urgent emergency that traditionally requires surgical intervention. Several case reports have reported the successful endoscopic removal of duodenal perforating FBs. Here we aimed to evaluate the safety and efficacy of endoscopic management of duodenal perforating FBs in adults. METHODS Between October 2004 and October 2022, 12,851 patients with endoscopically diagnosed gastrointestinal FBs from four tertiary hospitals in China were retrospectively reviewed. Patients were enrolled if they were endoscopically and/or radiographically diagnosed with duodenal perforating FBs. RESULTS The incidence of duodenal total FBs and perforating FBs was 1.9% and 0.3%, respectively. Thirty-four patients were enrolled. Endoscopic removal was achieved in 25 patients (73.5%), and nine patients (26.5%) received surgery. For the endoscopic group, most perforating FBs were located in the duodenal bulb (36.0%) and descending part (28.0%). The adverse events included 3 mucosal injuries and 1 localized peritonitis. All patients were cured after conventional treatment. In the surgical group, most FBs were lodged in the descending part (55.6%). One patient developed localized peritonitis and one patient died of multiple organ failure. The significant features of FBs requiring surgery included FB over 10 cm, both sides perforation, multiple perforating FBs and massive pus overflow. CONCLUSION Endoscopic removal of duodenal perforating FBs is safe and effective, and can be the first choice of treatment for experienced endoscopists. Surgical intervention may be required for patients with FBs over 10 cm, both sides perforation, multiple perforating FBs, or severe infections.
Collapse
Affiliation(s)
- Li‐Yun Ma
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Zu‐Qiang Liu
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Ye Wang
- Department of GastroenterologyTianjin First Central HospitalTianjinChina
| | - Tao Wang
- Department of GastroenterologyTianjin Medical University General HospitalTianjinChina
| | - Guang‐bin Sun
- Department of GastroenterologyTianjin Fifth Central HospitalTianjinChina
| | - Li Wang
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Ke‐Yang Fan
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Jing‐Zheng Liu
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Li‐Li Ma
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Wen‐Zheng Qin
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Jian‐Wei Hu
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Ming‐Yan Cai
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
| | - Guo‐Liang Zhang
- Department of GastroenterologyTianjin First Central HospitalTianjinChina
| | - Quan‐Lin Li
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Collaborative Innovation Center of EndoscopyShanghaiChina
| | - Ping‐Hong Zhou
- Endoscopy Center and Endoscopy Research InstituteZhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Collaborative Innovation Center of EndoscopyShanghaiChina
| |
Collapse
|
2
|
Bekeny JC, Huffman SS, Thomas C, Tumminello M, Kata A, Parikh R, Tom LK, Kleiber GM. Small Intestinal Perforation after 360-Degree Liposuction: A Case Report. Aesthetic Plast Surg 2024; 48:946-952. [PMID: 37653177 DOI: 10.1007/s00266-023-03567-w] [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: 04/10/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE As one of the most commonly performed cosmetic procedures, liposuction is relatively safe. Bowel injury following liposuction is a rare but devastating complication, which necessitates hospital admission and surgical intervention. The authors highlight a case report describing the presentation, diagnosis, and management of a patient with bowel injury following liposuction. CASE A 58-year-old woman presented with abdominal pain, erythema, and discharge three days after 360-degree abdominal liposuction with concomitant fat grafting to bilateral buttocks at an outpatient surgery center. Bowel perforation was suspected after CT-scan revealed extraluminal gas in the abdomen and communication that traversed the peritoneum. Exploratory laparotomy was performed which demonstrated at least one site of distinct perforation of the small bowel and an area omentum noted to be inflamed, thickened and with a purulent rind. The patient underwent 20-cm small bowel resection and partial omentectomy temporarily closed with negative pressure wound therapy. After subsequent abdominal wall debridements the patient received ventral hernia repair with bridging mesh and abdominal closure. CONCLUSIONS While safe, elective cosmetic procedures are not without risk of serious and even fatal complications. Providers must be familiar with the presentation of bowel injury following abdominal liposuction to prevent delays in appropriate surgical and medical care. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
Affiliation(s)
- Jenna C Bekeny
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Samuel S Huffman
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Chris Thomas
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mariana Tumminello
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anna Kata
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Rajiv Parikh
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Laura K Tom
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Grant M Kleiber
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA.
| |
Collapse
|
3
|
Onken F, Senne M, Königsrainer A, Wichmann D. Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis. J Clin Med 2022; 11:jcm11195748. [PMID: 36233616 PMCID: PMC9572575 DOI: 10.3390/jcm11195748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.
Collapse
Affiliation(s)
- Flurina Onken
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany
| | - Moritz Senne
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-2968165
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| |
Collapse
|
4
|
A fatal perforation of the distal ileum from an ingested fish bone: A case report. Int J Surg Case Rep 2022; 96:107331. [PMID: 35751968 PMCID: PMC9240790 DOI: 10.1016/j.ijscr.2022.107331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Foreign body-induced perforations of the ileum are rare consequences among adults. PRESENTATION OF CASE This is a case report of a delayed presentation of an ileal perforation and concurrent faecal peritonitis presented as an acute abdomen, resultant from an ingested fishbone, which led to fatality despite urgent laparotomy. CLINICAL DISCUSSION Perforations following ingested foreign bodies are frequently unanticipated clinically, and diagnosed during advanced imaging studies or surgical interventions. Endoscopy, laparoscopy, and laparotomy have been used during surgical management in reported cases; however, prior early identification is pivotal for good outcomes as delayed presentations and delayed diagnosis carry a poorer prognosis. CONCLUSION Despite fish bones being frequent foreign bodies in the gastrointestinal tract and the majority causing no life-threatening adverse effects, they are the leading foreign bodies instigating gastrointestinal perforations. A high degree of suspicion is required when attending to patients with suspected gastrointestinal perforations and absent typical findings in routine imaging, where fish bones could be the aetiology.
Collapse
|
5
|
MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation. Tomography 2022; 8:667-687. [PMID: 35314633 PMCID: PMC8938822 DOI: 10.3390/tomography8020056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Gastrointestinal perforations are a frequent cause of acute abdominal symptomatology for patients in the emergency department. The aim of this study was to investigate the findings of multidetector-row computed tomography of gastrointestinal perforations and analyze the impact of any imaging signs on the presurgical identification of the perforation site. Methods: We retrospectively reviewed emergency MDCT findings of 93 patients submitted to surgery for gastrointestinal perforation at two different institutions. Two radiologists separately reviewed the emergency MDCT examinations performed on each patient, before and after knowing the surgical diagnosis of the perforation site. A list of findings was considered. Positive predictive values were estimated for each finding with respect to each perforation site, and correspondence analysis (CA) was used to investigate the relationship between the findings and each of the perforation types. Results: We did not find inframesocolic free air in sigmoid colorectal perforations, and in rare cases, only supramesocolic free fluid in gastroduodenal perforations was found. A high PPV of perivisceral fat stranding due to colonic perforation and general distension of upstream loops and collapse of downstream loops were evident in most patients. Conclusions: Our data could offer additional information on the perforation site in the case of doubtful findings to support surgeons, especially in planning a laparoscopic approach.
Collapse
|
6
|
Prasad N. Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia. Radiol Case Rep 2022; 17:928-930. [PMID: 35079314 PMCID: PMC8777093 DOI: 10.1016/j.radcr.2021.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
|
7
|
Xia F, Zhu P, Chen XP, Zhang BX, Zhang MY. Liver abscess in the caudate lobe caused by a fishbone and treated by laparoscopy: a case report. BMC Surg 2022; 22:6. [PMID: 34996410 PMCID: PMC8741587 DOI: 10.1186/s12893-021-01457-z] [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: 04/28/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare. Case presentation A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications. Conclusions Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01457-z.
Collapse
Affiliation(s)
- Feng Xia
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China
| | - Peng Zhu
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China.
| | - Xiao-Ping Chen
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China
| | - Bi-Xiang Zhang
- Department of Hepatic Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China
| | - Ming-Yu Zhang
- Department of Digestive Medical, Tongji Hospital of Tongji Medical College in Huazhong University of Science and Techology, Wuhan, Hubei, China
| |
Collapse
|
8
|
Mathew RP, Sarasamma S, Jose M, Toms A, Jayaram V, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1. SA J Radiol 2021; 25:2022. [PMID: 33936794 PMCID: PMC8063768 DOI: 10.4102/sajr.v25i1.2022] [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: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.
Collapse
Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Sreekutty Sarasamma
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Merin Jose
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Ajith Toms
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vinayak Jayaram
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| |
Collapse
|
9
|
Intestinal Perforation by Ingested Foreign Bodies. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00303.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of our article is to study the incidence, diagnosis, and treatment of bowel perforation by foreign body ingestion. Bowel perforation by foreign body ingestion has been believed to be relatively rare, and most commonly caused by fish bones, chicken bones, and toothpicks. Our clinical experience, however, suggests such perforations may be more common than previously thought, and caused by various other objects as well. Medical records of all patients diagnosed with foreign body–induced intestinal perforation, from the Department of General Surgery at Tonji Hospital, from January 2000 to June 2015, were retrospectively analyzed. A total of 17 men and 8 women suffered intestinal perforations by ingestion of dietary foreign bodies. Among the 25 total patients, 4 ingested foreign bodies intentionally, whereas the other 21 cases were accidental. The foreign bodies were identified by plain X-ray film in 2 patients (2 cases of needles) and by multidetector computed tomography (MDCT) in 11 patients (6 cases of date stones, 3 cases of metallic objects, and 2 cases of bone fragments), thus supporting the correct preoperative diagnosis (13 cases; 52%). The most common location of the perforation was the terminal ileum (n = 17). The offending objects were date stones (n = 13), bones (n = 7), and metallic objects (n = 5). The most common treatment was removal of the foreign body and closure of the perforation with simple suture (n = 22). Ten patients were treated laparoscopically. The present study shows that the most common foreign bodies causing intestinal perforation are date stones and bones. Although about 50% of the foreign bodies could be identified by MDCT, definite diagnosis remained preoperatively difficult. Consequently, because of high misdiagnosis rates, laparoscopy may be the optimal choice for diagnosis and treatment of bowel perforation by foreign bodies.
Collapse
|
10
|
Villanueva Campos A, Martínez Rodríguez C, Tardáguila de la Fuente G, Utrera Pérez E, Jurado Basildo C. Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Blunt small bowel perforation (SBP): An Eastern Association for the Surgery of Trauma multicenter update 15 years later. J Trauma Acute Care Surg 2020; 86:642-650. [PMID: 30633100 DOI: 10.1097/ta.0000000000002176] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous work demonstrated diagnostic delays in blunt small bowel perforation (SBP) with increased mortality and inability of scans to reliably exclude the diagnosis. We conducted a follow-up multicenter study to determine if these challenges persist 15 years later. METHODS We selected adult cases with blunt injury, International Classification of Diseases, Ninth Revision or current procedural terminology (CPT) indicating small bowel surgery, no other major injury and at least one abdominal computed tomography (CT) within initial 6 hours. Controls had blunt trauma with abdominal CT but not SBP. After institutional review board approval, data from each center were collected and analyzed. RESULTS Data from 39 centers (from October 2013 to September 2015) showed 127,919 trauma admissions and 94,743 activations. Twenty-five centers were Level 1. Centers submitted 77 patients (mean age, 39; male, 68%; mean length of stay, 11.3 days) and 131 controls (mean age, 44; male, 64.9%; length of stay, 3.6 days). Small bowel perforation cases were 0.06% of admissions and 0.08% of activations. Mean time to surgery was 8.7 hours (median, 3.7 hours). Initial CT showed free air in 31 cases (43%) and none in controls. Initial CT was within normal in three cases (4.2%) and 84 controls (64%). Five cases had a second scan; two showed free air (one had an initial normal scan). One death occurred among the patients (mortality, 1.4%; and time to surgery, 16.9 hours). Regression analysis showed sex, abdominal tenderness, distention, peritonitis, bowel wall thickening, free fluid, and contrast extravasation were significantly associated with SBP. CONCLUSIONS Blunt SBP remains relatively uncommon and continues to present a diagnostic challenge. Trauma centers have shortened time to surgery with decreased case mortality. Initial CT scans continue to miss a small number of cases with potentially serious consequences. We recommend (1) intraperitoneal abnormalities on CT scan should always evoke high suspicion and (2) strong consideration of additional diagnostic/therapeutic intervention by 8 hours after arrival in patients who continue to pose a clinical challenge. LEVEL OF EVIDENCE Observational study, level III.
Collapse
|
12
|
Song J, Yang W, Zhu Y, Fang Y, Qiu J, Qiu J, Lin L, Wu W, Lin C, Wang Y. Ingested a fish bone-induced ileal perforation: A case report. Medicine (Baltimore) 2020; 99:e19508. [PMID: 32282701 PMCID: PMC7440113 DOI: 10.1097/md.0000000000019508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone. CASE PRESENTATION A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago. DIAGNOSIS Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body. INTERVENTIONS Partial intestinal resection and manual ileum end anastomosis were performed. OUTCOMES The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain. CONCLUSION An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.
Collapse
Affiliation(s)
- Junchuan Song
- Department of General Surgery, Dongfang Hospital, Xiamen University
| | - Weijin Yang
- Department of General Surgery, 900 Hospital of the Joint Logistics Team
| | - Yuewen Zhu
- Department of General Surgery, Dongfang Hospital, Xiamen University
| | - Yongchao Fang
- Department of General Surgery, Dongfang Hospital, Xiamen University
| | - Jiandong Qiu
- Clinical Institute of Fuzhou General Hospital, Fujian Medical University
| | - Jianshen Qiu
- Interventional ward of medical imaging center, 900 Hospital of the Joint Logistics Team, China
| | - Lan Lin
- Department of General Surgery, 900 Hospital of the Joint Logistics Team
| | - Weihang Wu
- Department of General Surgery, 900 Hospital of the Joint Logistics Team
| | - Chen Lin
- Department of General Surgery, 900 Hospital of the Joint Logistics Team
| | - Yu Wang
- Department of General Surgery, Dongfang Hospital, Xiamen University
| |
Collapse
|
13
|
Villanueva Campos AM, Martínez Rodríguez C, Tardáguila de la Fuente G, Utrera Pérez E, Jurado Basildo C. Gastrointestinal perforation caused by ingested fish bone. Computed tomography findings in 58 patients. RADIOLOGIA 2020; 62:384-391. [PMID: 32122648 DOI: 10.1016/j.rx.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 08/14/2019] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT AND OBJETIVE Fish bones (FB) are the most commonly ingested objects and the most common cause of foreign body perforation of the GI tract. Patients present with varied and nonspecific clinical presentations. The inability to obtain a history of FB ingestion and its wide spectrum of nonspecific clinical presentations makes dietary FB perforation extremely difficult to diagnose, being a laparoscopic or surgical diagnosis. The aim of our study is to describe radiological features in CT that will alert you to look for the FB and then make an accurate presurgical diagnosis. MATERIALS AND METHODS All patients (n=58) with radiological diagnosis of gastrointestinal perforation caused by fish bone detected by CT between 2007 to 2017 were retrospectively reviewed. Inclusion criteria were: fish bone located beyond the esophagus, radiological diagnosis by CT and confirmation by surgery, endoscopy or radiological control. Descriptive analysis was made. Radiological features were studied including radioopaque foreign body, mural thickness, fatty infiltration or extraluminal air bubbles. Also potential complications were assessed. RESULTS There were 58 patients, 39 men and 19 women, with an average age of 70. Ileon was the most frequent site of perforation (20 patients). 100% showed regional fatty infiltration, 98% included foreign body, 45% had mural thickening and 20% localized extraluminal air bubbles. 15 abscess were found (3 in the liver) and just 5 showed pneumoperitoneum. CONCLUSION Fatty infiltration is the feature more common. Therefore, if fatty infiltration is seen in isolation radiologist should look for foreign body.
Collapse
|
14
|
Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging 2020; 11:31. [PMID: 32086627 PMCID: PMC7035412 DOI: 10.1186/s13244-019-0823-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022] Open
Abstract
Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis. Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations. The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.
Collapse
Affiliation(s)
- Styliani Pouli
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Androniki Kozana
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Ioanna Papakitsou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Daskalogiannaki
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece.
| |
Collapse
|
15
|
Ichikawa S, Onishi H, Motosugi U. Computed Tomography Findings of Emergency Cases Resulting From Fish Bone Ingestion. Can Assoc Radiol J 2020; 72:432-437. [DOI: 10.1177/0846537119899198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Fish bones are some of the most commonly ingested foreign bodies. In most cases, fish bone ingestion is asymptomatic, and the bones are expelled from the body spontaneously. Otherwise, patients with fish bone ingestion can present to the emergency department with nonspecific symptoms. Fish bones can become impacted in various part of the body. Even in cases that are initially asymptomatic after ingestion, serious complications may develop at a later stage. Computed tomography (CT) plays an important role in the diagnosis of fish bone ingestion because it is the most sensitive modality for detecting these foreign bodies. It is important to be familiar with CT findings to detect ingested fish bones and the related complications and to direct further management of the condition.
Collapse
Affiliation(s)
- Shintaro Ichikawa
- Department of Radiology, University of Yamanashi, Shimokato, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Shimokato, Yamanashi, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Shimokato, Yamanashi, Japan
| |
Collapse
|
16
|
Rao N, Kumar S, Taylor S, Plumb A. Diagnostic pathways in Crohn's disease. Clin Radiol 2019; 74:578-591. [PMID: 31005268 DOI: 10.1016/j.crad.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
The management of Crohn's disease (CD) is shifting from a stepwise, incremental approach based on symptom control to more aggressive early combined immunosuppression in an attempt to induce remission more rapidly and avoid long-term bowel damage. Accurately defining disease activity is a major challenge, as there is often a disconnect between symptomatology and underlying disease status. The role of imaging in CD has evolved such that it now plays a central role establishing the initial diagnosis, characterising disease phenotype, activity assessment, disease surveillance, and assessing response to therapy. Furthermore, the "treat-to-target" approach is being investigated in CD, with resolution of transmural inflammation on cross-sectional imaging being the treatment goal. In this review, we summarise the principal imaging techniques available to the radiologist, the key findings, and provide some guidance on the preferred imaging option in the diagnostic pathway. We consider the relative merits and drawbacks of each imaging technique before offering a brief discussion of some current developments and research avenues in CD imaging. We discuss how imaging may be useful in a "treat-to-target" approach. Finally, we highlight some practical considerations around service configuration and delivery to optimise imaging in CD in an accurate, cost-effective manner.
Collapse
Affiliation(s)
- N Rao
- Department of Radiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - S Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - S Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - A Plumb
- Centre for Medical Imaging, University College London, London, UK.
| |
Collapse
|
17
|
Multidetector CT findings in gastrointestinal tract perforation that can help prediction of perforation site accurately. Clin Radiol 2019; 74:736.e1-736.e7. [PMID: 31303326 DOI: 10.1016/j.crad.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022]
Abstract
AIM To assess the accuracy, sensitivity, and specificity of multidetector computed tomography (MDCT) findings by comparing the locations of free air in the abdomen and imaging findings with the site of gastrointestinal perforation. MATERIALS AND METHODS Ninety-three patients with acute abdominal pain who visited the emergency department between January 2015 and October 2018 were included in the study. There were 59 male and 34 female patients with a mean age of 50.5 years. The site of perforation was based on surgical findings in all cases. RESULTS Among specific air distributions, periportal free air and subphrenic free air were statistically significant in differentiating upper gastrointestinal tract perforation. Whereas free air in the minor pelvis, right lower quadrant free air, left lower quadrant free air, and air in the mesentery were statistically significant in differentiation of lower gastrointestinal tract perforation. CONCLUSION Multidetector findings may help to predict the site of gastrointestinal perforation, which would change the treatment plan.
Collapse
|
18
|
Elbanna KY, Mohammed MF, Huang SC, Mak D, Dawe JP, Joos E, Wong H, Khosa F, Nicolaou S. Delayed manifestations of abdominal trauma: follow-up abdominopelvic CT in posttraumatic patients. Abdom Radiol (NY) 2018; 43:1642-1655. [PMID: 29051983 DOI: 10.1007/s00261-017-1364-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Our study aims to investigate the frequency and patterns of delayed manifestations of abdominal and pelvic injuries which may not be identified or which fail to manifest on the initial abdominopelvic CT in posttraumatic patients. METHODS For our institutional review board (IRB)-approved retrospective study, our hospital trauma registry was queried for patients with blunt multitrauma and Injury Severity Score (ISS) ≥ 16 between January 2010 and August 2016, yielding 3735 patients. A total of 203 patients received a follow-up abdominopelvic CT within six months from the initial scan and those with new findings on follow-up CT were identified. A retrospective blinded review of the initial CT examinations was performed by two experienced radiologists. The retrospective readings and original reports were compared to categorize the new abnormalities detected on follow-up CT scans. The categories included missed injuries, late presentations and sequelae of trauma, and complications of surgery, hospital admission, and invasive procedures. The patients' notes were reviewed for the clinical indications, time interval for repeat CT examination, and subsequent clinical management. The software used for statistical analysis of the extracted data was Microsoft Excel for Mac (version 15.33). RESULTS Out of 3735 patients, 203 patients received 232 follow-up abdominopelvic CTs. The average elapsed time between the initial CT and the follow-up CT was 15 ± 27 days. Evaluation for an abdominal fluid collection was the most common clinical indication, accounting for 40% of the total number (n = 243) of indications. Delayed manifestations and complications of trauma were present in 41 patients due to 47 abnormalities, most commonly related to solid organ injury, followed by abdominal collections and hematoma. Twenty-nine CT findings (62%) were only detectable on follow-up CT, while nine injuries (19%) were missed on initial CT. The findings on repeated CT warranted eight surgical and 15 interventional procedures. CONCLUSION A small percentage of traumatic injuries may be unidentified or fail to manifest on the initial CT, resulting in delayed manifestations of abdominopelvic trauma, which may lead to subsequent readmission, delayed management, and more severe medical complications.
Collapse
Affiliation(s)
- Khaled Y Elbanna
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
- , Toronto, ON, Canada.
| | - Mohammed F Mohammed
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Shih-Chieh Huang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Mak
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - J Philip Dawe
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Emilie Joos
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Heather Wong
- Trauma Services, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Faisal Khosa
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Savvas Nicolaou
- Emergency & Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| |
Collapse
|
19
|
Li PH, Tee YS, Fu CY, Liao CH, Wang SY, Hsu YP, Yeh CN, Wu EH. The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients. Am Surg 2018. [DOI: 10.1177/000313481808400658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute surgical abdomen is commonly encountered in the ED and CT is widely used as an informative diagnostic tool to evaluate potential surgical indications. However, the adverse effects of contrast material used in CTscanning have been documented. We sought to delineate the role of noncontrast CT in the evaluation of patients with acute surgical abdomen. Between August 2015 and December 2015, patients with nontraumatic surgical abdomen who underwent preoperative CT were enrolled in the current study. The patients for whom the CT results permitted surgical decision-making were the focus of this study. The disease entities included acute appendicitis, acute cholecystitis, hollow organ perforation, mechanical bowel obstruction, intra-abdominal abscess that could not be drained percutaneously, and ischemic bowel disease. The results of contrast-enhanced and noncontrast CT were compared and analyzed. The surgical conditions identifiable by noncontrast CT were recorded. In total, 227 patients were enrolled in the study. In 90.7 per cent of patients overall, the findings indicating the need for surgical treatment were visualized on both the noncontrast and contrast-enhanced images (acute appendicitis: 89.3%, acute cholecystitis: 89.7%, hollow organ perforation: 97.4%, bowel obstruction: 100%, intra-abdominal abscess: 100%, and ischemic bowel disease: 55.6%). Noncontrast CT provides benefit for critical decision-making. Body mass index may affect the accuracy of noncontrast imaging in the evaluation of patients with surgical abdomen. In some specific situations, contrast enhancement remains necessary.
Collapse
Affiliation(s)
- Pei-Hua Li
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-San Tee
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Pao Hsu
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - En-Haw Wu
- From the Departments of Trauma & Emergency Surgery and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
20
|
Acute Jejunoileal Diverticulitis: Multicenter Descriptive Study of 33 Patients. AJR Am J Roentgenol 2018; 210:1245-1251. [DOI: 10.2214/ajr.17.18777] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
21
|
Kolar M, Pilkington M, Winthrop A, MacDonald H, Justinich C, Soboleski D, Sly L, Hurlbut D. Free intestinal perforation in children with Crohn's disease. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
22
|
Samita Bhat K, Ahuja VK, Somashekhar SP, Rakshit SH. Unusual Bowel Perforation Following Dilatation and Curettage in a Case of Endometrial Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0194-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
23
|
Gou ZH, Peng Y, Yang K. Sonographic and CT imaging features of intestinal perforation from a pill and packing: A case report. Medicine (Baltimore) 2018; 97:e0427. [PMID: 29668604 PMCID: PMC5916655 DOI: 10.1097/md.0000000000010427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Sharp foreign bodies such as toothpicks or chicken bones can lead to intestinal perforation. Small intestinal perforation secondary to foreign body ingestion is usually manifested as an acute abdomen without a history of trauma. Here we describe the diagnosis and treatment of a case of small bowel perforation caused by an ingested pill and its outer packing. PATIENT CONCERNS An 84 years old male patient complained of right lower abdominal pain for 4 days and the pain was becoming progressively worse. DIAGNOSES The patient, who has Alzheimer's disease, mistakenly took the pill (oxiracetam) without removing the outer packaging. This resulted in perforation of the small intestine. INTERVENTIONS During the ultrasound examination, the scanning physician discovered that the abnormal sonographic findings present could not be explained by the leading diagnosis of perforation of the small intestine at the time. This led the physician to suspect small bowel perforation secondary to a foreign body. The subsequent computerized tomography (CT) examination further confirmed the ultrasound findings. OUTCOMES Emergency laparotomy was performed and the foreign body was removed. After the surgical procedure, the patient resumed anti-inflammatory treatment (Cefoxitin sodium 2000mg tid) and rehydration therapy (Sodium Chloride Solution 100mL tid). LESSONS Because ingestion of foreign bodies of this type is relatively rare, when patients cannot provide an accurate history, diagnosis can be quite difficult. In this paper, the imaging features associated with intestinal perforation secondary to foreign body ingestion on ultrasound and CT are described. This series of events demonstrate how imaging findings can guide and alter a clinician's decision-making.
Collapse
Affiliation(s)
| | | | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Milito P, Siboni S, Asti E, Bonavina L. The seatbelt sign: early recognition may be life-saving. BMJ Case Rep 2017; 2017:bcr-2017-219814. [PMID: 28433971 DOI: 10.1136/bcr-2017-219814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pamela Milito
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Stefano Siboni
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Emanuele Asti
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
25
|
Venkatesh SH, Venkatanarasimha Karaddi NK. CT findings of accidental fish bone ingestion and its complications. Diagn Interv Radiol 2017; 22:156-60. [PMID: 26714057 DOI: 10.5152/dir.2015.15187] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Fish bone is one of the most common accidentally ingested foreign bodies, and patients commonly present to the emergency department with nonspecific symptoms. Fortunately, most of them are asymptomatic and exit the gastrointestinal tract spontaneously. However, fish bones can get impacted in any part of the aerodigestive tract and cause symptoms. Occasionally, they are asymptomatic initially after ingestion and may present remotely at a later date with serious complications such as gastrointestinal tract perforation, obstruction, and abscess formation. Radiographs are most often negative. High degree of clinical suspicion and familiarity with CT appearance can help to detect fish bone along with any associated complications, and direct further management. We describe and illustrate various CT presentations of ingested fish bone and its complications.
Collapse
|
26
|
Foreign Body Penetration through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct. ACG Case Rep J 2017; 4:e12. [PMID: 28144617 PMCID: PMC5247630 DOI: 10.14309/crj.2017.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/14/2016] [Indexed: 01/22/2023] Open
Abstract
Foreign body ingestion is common, although perforation after ingestion is rare. We report a case of an ingested sharp wooden stick that perforated the proximal jejunum toward the renal vasculature, causing segmental renal artery thrombosis and renal infarct. The patient presented with severe abdominal pain and vomiting. A computed tomography scan revealed a linear opacity corresponding to the foreign body. The wooden stick was removed endoscopically through deep-push enteroscopy with a rat-tooth forceps. We report this unique case of perforation by a foreign body through the proximal jejunum to the left kidney, which was managed endoscopically.
Collapse
|
27
|
Yang TH, Lu CY. Unexpected and unintentional fish bone ingestion causing acute abdomen and uncommon small intestinal perforation. ADVANCES IN DIGESTIVE MEDICINE 2016. [DOI: 10.1016/j.aidm.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
28
|
Totally laparoscopic repair of an ileal and uterine iatrogenic perforation secondary to endometrial curettage. Int Surg 2016; 100:244-8. [PMID: 25692425 DOI: 10.9738/intsurg-d-13-00267.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Small bowel perforation is a unique, serious complication during endometrial biopsy. The authors report a case of a double uterine-ileal perforation totally managed by primary laparoscopic repair. A 63-year-old female was admitted with acute abdomen 2 days after an endometrial curettage. Abdominal X-ray shows signs of pneumoperitoneum. Emergency diagnostic laparoscopy was performed and a uterine-ileal perforation was identified. Repair was accomplished by a totally laparoscopic intracorporeally suturing of the 2 breaches. Postoperative course showed only a delayed ileus and the patient was discharged after 5 days with no complications. When acute abdomen arises following uterine biopsy, a potential iatrogenic intestinal laceration always has to be ruled out. Laparoscopic approach is a quick and safe technique in these cases. Totally laparoscopic primary closure of the iatrogenic ileal laceration may be accomplished with low morbidity.
Collapse
|
29
|
de Araújo ROMB, de Matos MP, Penachim TJ, Pereira BMT, Mantovani MEDF, Rizoli S, Fraga GP. Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography? Rev Col Bras Cir 2016; 41:278-84. [PMID: 25295990 DOI: 10.1590/0100-699120140040010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/15/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. METHODS patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. RESULTS of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. CONCLUSION the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far.
Collapse
Affiliation(s)
| | | | - Thiago José Penachim
- Department of Radiology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | | | - Sandro Rizoli
- Department of Surgery and Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Gustavo Pereira Fraga
- Departmentof Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| |
Collapse
|
30
|
Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR. From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography. ACTA ACUST UNITED AC 2016; 39:802-23. [PMID: 24584681 DOI: 10.1007/s00261-014-0110-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While confirming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specific findings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.
Collapse
Affiliation(s)
- Andrew J Del Gaizo
- Department of Radiology, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC, 27157, USA,
| | | | | | | |
Collapse
|
31
|
Picone D, Rusignuolo R, Midiri F, Lo Casto A, Vernuccio F, Pinto F, Lo Re G. Imaging Assessment of Gastroduodenal Perforations. Semin Ultrasound CT MR 2015; 37:16-22. [PMID: 26827734 DOI: 10.1053/j.sult.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastroduodenal perforation is an emergency situation that usually requires early recognition and well-timed surgical treatment. It can arise from different natural, iatrogenic, or traumatic causes, and it can present with various symptoms especially in the early phase. This article reviews the role of the different imaging techniques in the diagnosis of gastroduodenal perforation, focusing on the direct and indirect signs that are encountered in conventional radiography and computed tomography; our personal experience is also provided.
Collapse
Affiliation(s)
- Dario Picone
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Roberta Rusignuolo
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Federico Midiri
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Antonio Lo Casto
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Federica Vernuccio
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Giuseppe Lo Re
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy.
| |
Collapse
|
32
|
Faggian A, Berritto D, Iacobellis F, Reginelli A, Cappabianca S, Grassi R. Imaging Patients With Alimentary Tract Perforation: Literature Review. Semin Ultrasound CT MR 2015; 37:66-9. [PMID: 26827740 DOI: 10.1053/j.sult.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alimentary tract perforation is a frequent emergency condition. Imaging plays an important role to make an accurate diagnosis, defining the presence, the level, and the cause of the perforation, essential information to enable the most correct therapeutic choice. Plain radiography is generally performed as the first choice. In case of a clinically suspected bowel perforation, not detected on x-ray imaging, the contribution of computed tomography is essential. Magnetic resonance is not yet widely used in diagnostic workup of patients with acute abdominal pain, but it can be useful in the differential diagnosis of acute abdomen in specific patients (pregnancy and pediatric patients).
Collapse
Affiliation(s)
- Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Daniela Berritto
- Institute of Radiology, Second University of Naples, Naples, Italy
| | | | | | | | - Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
| |
Collapse
|
33
|
Usurelu S, Bettencourt V, Melo G. Abdominal trauma by ostrich. Ann Med Surg (Lond) 2015; 4:41-3. [PMID: 25685344 PMCID: PMC4323753 DOI: 10.1016/j.amsu.2014.12.004] [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] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. PRESENTATION OF CASE A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. DISCUSSION The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. CONCLUSION In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen.
Collapse
Affiliation(s)
- Sergiu Usurelu
- ULS Castelo Branco, Cirurgia, Av. Pedro Alvares Cabral, 6000-084 Castelo Branco, Portugal
| | - Vanessa Bettencourt
- ULS Castelo Branco, Cirurgia, Av. Pedro Alvares Cabral, 6000-084 Castelo Branco, Portugal
| | - Gina Melo
- ULS Castelo Branco, Cirurgia, Av. Pedro Alvares Cabral, 6000-084 Castelo Branco, Portugal
| |
Collapse
|
34
|
Spinelli A, Allocca M, Jovani M, Danese S. Review article: optimal preparation for surgery in Crohn's disease. Aliment Pharmacol Ther 2014; 40:1009-22. [PMID: 25209947 DOI: 10.1111/apt.12947] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/16/2014] [Accepted: 08/13/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND One-third of Crohn's disease (CD) patients will undergo abdominal surgery within the first 5 years of diagnosis. AIM To review the available evidence on pre-operative optimisation of CD patients. METHODS The literature regarding psychological support, radiological imaging, abdominal abscess management, nutritional support, thromboembolic prophylaxis and immunosuppression in the perioperative setting was reviewed. RESULTS For diagnosis of fistulas, abscesses and stenosis, ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) have a high diagnostic accuracy. Under either CT or US guidance, it is possible to perform abscess percutaneous drainage (PD), which, with systemic antibiotic therapy, should be the first-line approach to intra-abdominal abscesses. CD patients with weight loss <10% within the last 3-6 months, body mass index < 18.5 kg/m(2) and/or albumin levels <30 g/L, are at an increased risk of post-operative complications. Pre-operative nutritional support should be used in these patients. IBD patients undergoing surgery have a higher risk of venous thromboembolic disease than patients with colorectal cancer, and current guidelines recommend that they should receive prophylaxis with heparin. Whether the use of anti-TNF agents before surgery increases the likelihood of post-operative complications, is the subject of much debate. To date, cumulative evidence from most studies (all retrospective) suggests that there is no such risk increment. Prospective studies are necessary to firmly establish this conclusion. CONCLUSIONS Preparation for surgery requires close interaction between surgeons, gastroenterologist, radiologists, psychologists and the patient. Correct pre-operative planning of surgical treatment has a major impact on the outcome of such treatment.
Collapse
Affiliation(s)
- A Spinelli
- IBD Surgery Unit, Department of Surgery, Istituto Clinico Humanitas IRCCS, Milan, Italy; Department of Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | | | | | | |
Collapse
|
35
|
Li Y, Song J, Lin N, Zhao C. Computed tomography scan is superior to x-ray plain film in the diagnosis of gastrointestinal tract perforation. Am J Emerg Med 2014; 33:480.e3-5. [PMID: 25239695 DOI: 10.1016/j.ajem.2014.08.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022] Open
Abstract
Gastrointestinal (GI) tract perforation is one of the most severe acute abdomens. In clinical practice, abdominal x-ray plain film remains the first-line diagnostic modality for this entity. A proportion of the perforated patients, however, do not exhibit a classic x ray sign: free air at the subphrenic area. This insufficiency can bring difficulties to the diagnosis, delay appropriate treatments, and even cause lethal consequences. We describe herein a case of GI tract perforation, which was not detected by the abdominal x-ray plain film initially. Strikingly, the abdominal computed tomographic (CT)scan established the diagnosis and predicted the site and cause of the perforation, which were consistent with the intraoperative findings and pathological examination. In addition, CT scan was useful in monitoring the progression of the disease. Given the high performance of CT scan in the present case, we recommend it as a preferred diagnostic modality for patients who are suspected of GI perforation,especially when the abdominal x-ray plain film is inconclusive.
Collapse
Affiliation(s)
- Yang Li
- Department of Intensive Care Unit, Shengjing Hospital of China Medical University
| | - Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University.
| | - Nan Lin
- Department of Radiology, Shengjing Hospital of China Medical University
| | - Chuang Zhao
- Department of General Surgery, Shengjing Hospital of China Medical University
| |
Collapse
|
36
|
Imaging of complications associated with port access of abdominal laparoscopic surgery. ACTA ACUST UNITED AC 2014; 39:398-410. [PMID: 24362952 DOI: 10.1007/s00261-013-0060-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Advanced techniques and equipment in laparoscopic surgery offer advantages over open surgery, expanding the application of this minimally invasive procedure to a wide range of abdominal operations that used to be performed as an open procedure. Laparoscopic surgery is performed in the closed abdominal cavity in which the space is limited. To create a working space in the abdominal cavity, an artificial pneumoperitoneum is established and multiple ports are placed for the introduction of various laparoscopic instruments. Unlike open surgery in which the incision is made just above the target organ, laparoscopic access is made away from the area of dissection, with the instruments triangulated around the target organ within the abdomen. This fundamental difference in approach between the open and laparoscopic procedures may lead to peculiar postoperative complications after laparoscopic surgery, which may be present away from the target organ or in the abdominal wall, and be easily missed on postoperative imaging studies. These complications include port-related direct organ injuries, such as abdominal organ or vascular injury; abdominal wall complications related to laparoscopic port insertion such as vascular injury, infection, and hernia; abdominal wall complications related to specimen removal, such as port site tumor seeding and endometriosis; and complications related to gas insufflation. The radiologist plays an important role in the diagnosis of complications after laparoscopic surgery, and therefore should be familiar with the features of such complications on imaging scans in the era of laparoscopic surgeries.
Collapse
|
37
|
Affiliation(s)
- W-Y Chiu
- Department of Family medicine, Zouying Branch of Kaohsiung Armed Forces General Hospital; Department of Internal medicine, Kaohsiung Armed Forces General Hospital
| | - Y-J Chen
- Departments of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - P-C Cheng
- Department of Family medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - E-L Shiau
- Departments of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung
| |
Collapse
|
38
|
Kim HC, Yang DM, Kim SW, Park SJ. Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time. Eur Radiol 2014; 24:1386-93. [PMID: 24623365 DOI: 10.1007/s00330-014-3115-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/26/2014] [Accepted: 02/04/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate multidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. METHODS One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. RESULTS The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. CONCLUSIONS MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. KEY POINTS Perforation of the stomach and duodenum can be accurately predicted with MDCT. Knowledge of CT findings predicting perforation site can improve diagnostic accuracy. Elapsed time does not significantly affect accuracy in predicting perforation sites.
Collapse
Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, Republic of Korea,
| | | | | | | |
Collapse
|
39
|
Role of CT in the diagnosis of jejunal–ileal perforations. Radiol Med 2014; 119:651-7. [DOI: 10.1007/s11547-013-0375-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/30/2013] [Indexed: 12/15/2022]
|
40
|
Teixeira ACV, Torres UDS, Westin CEG, Oliveira EPD, Gual F, Cardoso LV, Bauab Jr. T. Multidetector-row computed tomography in the preoperative diagnosis of intestinal complications caused by clinically unsuspected ingested dietary foreign bodies: a case series emphasizing the use of volume rendering techniques. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000600006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The present study was aimed at describing a case series where a preoperative diagnosis of intestinal complications secondary to accidentally ingested dietary foreign bodies was made by multidetector-row computed tomography (MDCT), with emphasis on complementary findings yielded by volume rendering techniques (VRT) and curved multiplanar reconstructions (MPR). Materials and Methods The authors retrospectively assessed five patients with surgically confirmed intestinal complications (perforation and /or obstruction) secondary to unsuspected ingested dietary foreign bodies, consecutively assisted in their institution between 2010 and 2012. Demographic, clinical, laboratory and radiological data were analyzed. VRT and curved MPR were subsequently performed. Results Preoperative diagnosis of intestinal complications was originally performed in all cases. In one case the presence of a foreign body was not initially identified as the causal factor, and the use of complementary techniques facilitated its retrospective identification. In all cases these tools allowed a better depiction of the entire foreign bodies on a single image section, contributing to the assessment of their morphology. Conclusion Although the use of complementary techniques has not had a direct impact on diagnostic performance in most cases of this series, they may provide a better depiction of foreign bodies' morphology on a single image section.
Collapse
Affiliation(s)
| | | | | | | | - Fabiana Gual
- Faculdade de Medicina de São José do Rio Preto, Brazil
| | | | | |
Collapse
|
41
|
|
42
|
Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, Danese S, Halligan S, Marincek B, Matos C, Peyrin-Biroulet L, Rimola J, Rogler G, van Assche G, Ardizzone S, Ba-Ssalamah A, Bali MA, Bellini D, Biancone L, Castiglione F, Ehehalt R, Grassi R, Kucharzik T, Maccioni F, Maconi G, Magro F, Martín-Comín J, Morana G, Pendsé D, Sebastian S, Signore A, Tolan D, Tielbeek JA, Weishaupt D, Wiarda B, Laghi A. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013; 7:556-85. [PMID: 23583097 DOI: 10.1016/j.crohns.2013.02.020] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Abstract
The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.
Collapse
Affiliation(s)
- J Panes
- Gastroenterology Department, Hospital Clinic Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Orry X, Balaj C, Lecocq S, Blum A, Delvaux M, Régent D, Claudon M, Laurent V. CT diagnosis of small bowel perforation by ingestion of a blister pack: two case reports. Diagn Interv Imaging 2013; 95:101-3. [PMID: 23726172 DOI: 10.1016/j.diii.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- X Orry
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - C Balaj
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - S Lecocq
- Imagerie Guilloz, Hôpital central, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - A Blum
- Imagerie Guilloz, Hôpital central, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - M Delvaux
- Department of Hepato-Gastroenterology, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Régent
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - M Claudon
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - V Laurent
- Department of radiology, Adult imaging, University hospital of Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| |
Collapse
|
44
|
Free peritoneal perforation in a patient with Crohn's disease - Report of a case. Int J Surg Case Rep 2013; 4:322-4. [PMID: 23416499 DOI: 10.1016/j.ijscr.2012.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/06/2012] [Accepted: 12/15/2012] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Bowel perforation with free peritoneal air is a rare complication of Crohn's disease (CD). PRESENTATION OF CASE We report a case of a 36 year-old male patient, with history significant for CD and he presented to the emergency room with a free peritoneal perforation, which was diagnosed by abdominal X-ray and confirmed by CT scan. The patient underwent a laparotomy surgery; however, no site of perforation was identified. The surgical approach was to clean the cavity, close the abdominal wall and administer antibiotic therapy. He demonstrated good early and late postoperative outcomes. DISCUSSION We report a rare case of free perforation to the peritoneum in a patient with CD. The most likely hypothesis is that it was a micro-colonic perforation. Antibiotic therapy and a conservative surgical approach without colon resection can be performed and it is reported in the literature. CONCLUSION Emergency conditions in CD may result in significant morbidity, but are normally associated with low mortality, if identified and treated properly.
Collapse
|
45
|
Liew CJY, Poh ACC, Tan TY. Finding nemo: imaging findings, pitfalls, and complications of ingested fish bones in the alimentary canal. Emerg Radiol 2012; 20:311-22. [PMID: 23269535 DOI: 10.1007/s10140-012-1101-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/17/2012] [Indexed: 12/24/2022]
Abstract
In Asian cuisine, fish is often prepared whole with the bones. Accidental fish bone (FB) ingestion is not an infrequently encountered condition in the emergency department. An impacted FB in the alimentary canal can lead to potentially life-threatening complications. For impacted FBs that cannot be visualized clinically, radiographs and multidetector computed tomography are helpful in localizing the FB, evaluating for complications, and planning treatment. In this pictorial essay, we illustrate the spectrum of radiological findings of impacted FBs, common imaging pitfalls, and complications. Finally, we highlight the imaging findings that are important to the clinician in planning treatment.
Collapse
Affiliation(s)
- Charlene Jin Yee Liew
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, 529889 Singapore, Singapore.
| | | | | |
Collapse
|
46
|
Perforation of the mesenteric small bowel: etiologies and CT findings. Emerg Radiol 2012; 20:155-61. [DOI: 10.1007/s10140-012-1095-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022]
|
47
|
Cho HJ, Kim SJ, Lee SW, Moon SW, Park JH. Pseudotumor of the omentum associated with migration of the ingested crab-leg. J Korean Med Sci 2012; 27:569-71. [PMID: 22563227 PMCID: PMC3342553 DOI: 10.3346/jkms.2012.27.5.569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 02/13/2012] [Indexed: 12/31/2022] Open
Abstract
Foreign body ingestion is not uncommon in clinical practice, and it may occasionally lead to penetration injuries. Emergency physicians and radiologists sometimes fail to obtain complete histories including ingestion and may overlook the possibility of foreign body-induced complications. Herein, we report a case of stomach antrum perforation due to foreign body migration. We were unaware of the patient's history of eating the Korean delicacy "Kanjang-gaejang," which is raw crab seasoned with soy sauce. Several imaging diagnostic modalities had suggested the possibility of a malignant mass in the gastrocolic ligament area. During the operation, a crab leg was discovered as the cause of an intra-abdominal abscess. The patient underwent an antrectomy, a vagotomay, and a transverse colon wedge resection. We present this unusual case of a pseudotumorous lesion caused by ingestion of Kanjang-gaejang.
Collapse
Affiliation(s)
- Han-Jin Cho
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Woo Moon
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong Hak Park
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Klein K, Pegoli W, Lee YH. Transluminal migration of ingested foreign body without peritonitis. J Pediatr Surg 2012; 47:788-91. [PMID: 22498397 DOI: 10.1016/j.jpedsurg.2011.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 10/28/2022]
Abstract
The authors present 2 cases of transluminal migration of an ingested foreign body into the peritoneal cavity without causing peritonitis. Clinical and radiologic features and surgical approach are described, focusing on the absence of an acute abdomen in transluminal migration and the use of laparoscopy in achieving extraction of the foreign object.
Collapse
Affiliation(s)
- Kendra Klein
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | | |
Collapse
|
49
|
["Atypical" anemia in a geriatric patient]. Z Gerontol Geriatr 2012; 45:186-8. [PMID: 22451306 DOI: 10.1007/s00391-012-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A gastroenterologic examination was performed on an 83-year-old woman due to unexplained anemia; however, no bleeding site could be identified. Because of the advanced age of the patient, no further diagnostic efforts were made and iron-deficiency anemia was suspected. After 3 weeks, an emergency laparotomy was performed for acute diffuse peritonitis, which was diagnosed as perforation of the jejunum by a wooden foreign body. After extraction of the foreign body and closure of the perforation in the small intestine, healing proceeded without complications.
Collapse
|
50
|
Lunsford KE, Sudan R. Small bowel perforation by a clinically unsuspected fish bone: laparoscopic treatment and review of literature. J Gastrointest Surg 2012; 16:218-22. [PMID: 21796463 DOI: 10.1007/s11605-011-1610-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
|