1
|
Liu C, Deng S, Chen Z, Tang H. Successful intervention of an impacted basket and duodenal perforation secondary to endoscopic retrograde cholangiopancreatography. Asian J Surg 2023; 46:4513-4515. [PMID: 37179189 DOI: 10.1016/j.asjsur.2023.04.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Chenming Liu
- Shaoxing People's Hospital, Shaoxing, 312000, China; Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Shiqing Deng
- Shaoxing People's Hospital, Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | | | - Haijun Tang
- Shaoxing People's Hospital, Shaoxing, 312000, China.
| |
Collapse
|
2
|
Watanabe G, Satou S, Tsuru M, Momiyama M, Nakajima K, Nagao A, Satodate H, Muramoto T, Ohata K, Noie T. Pancreas-sparing partial duodenectomy as an alternative to emergency pancreaticoduodenectomy for a major duodenal perforation: a case report. Clin J Gastroenterol 2023; 16:761-766. [PMID: 37389799 DOI: 10.1007/s12328-023-01823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to delayed duodenal perforation. Emergency laparotomy was performed. A huge perforation formed at the descending duodenum without ampulla involvement. Pancreas-sparing partial duodenectomy (PPD) with gastrojejunostomy was performed (250 min operative time) with 50 mL of intraoperative blood loss. She required intensive care for 3 days and was discharged on postoperative day 21 with no severe complications. Emergency treatment for a major duodenal injury or perforation remains challenging because of high morbidity and mortality. An appropriate treatment should be considered according to the nature of the defect. Although PPD is an acceptable procedure for patients with a duodenal neoplasm, its use in emergency surgery is rarely reported. PPD is more reliable than primary repair or anastomosis using a jejunal wall, and less invasive than pancreaticoduodenectomy, for emergency treatment. We performed PPD in this patient because the duodenal perforation was too large to reconstruct and did not involve the ampulla. PPD can be a safe and feasible alternative surgical procedure to pancreaticoduodenectomy for a major duodenal perforation, especially in patients with a duodenal perforation that does not involve the ampulla.
Collapse
Affiliation(s)
- Genki Watanabe
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shouichi Satou
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan.
| | - Mao Tsuru
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | | | - Atsuki Nagao
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Takashi Muramoto
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tamaki Noie
- Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
Luna-Álvarez RD, Navarro-Pimiento DC, Alarcón-Carvajal YF, Naranjo-Soler AJ. Case report emphasize pearls of duodenal perforation. Int J Surg Case Rep 2023; 110:108615. [PMID: 37647753 PMCID: PMC10509796 DOI: 10.1016/j.ijscr.2023.108615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Isolated duodenal perforation secondary to trauma is a rare abdominal surgical condition, with a questionable surgical approach depending on the case. PRESENTATION OF CASE This is a case report of a 27-year-old male patient who presented with a free perforation in the posterior wall of the third portion of the duodenal frame and secondary retropneumoperitoneum without injuring any contiguous organ, after a medium-impact blunt abdominal trauma during a soccer game. DISCUSSION A laparotomy was performed, followed by duodenorraphy with Connell-Mayo suture and Lambert suture using vascular prolene in two planes. A nasogastric tube was placed up to the jejunum, and a Jackson-Pratt drain was placed in close to the duodenum next to the sutures. During hospitalization was found a positive bacterial culture of the peritoneal fluid hence received antibiotics, without complication. CONCLUSION It is essential to make a timely diagnosis with its respective individualized surgical approach and it must be managed as an emergency surgical procedure.
Collapse
|
4
|
Shen Q, Liu T, Wang S, Wang L, Wang D. Experience in diagnosis and treatment of duodenal ulcer perforation in children. BMC Pediatr 2023; 23:144. [PMID: 36997985 PMCID: PMC10061964 DOI: 10.1186/s12887-023-03957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children's Health. METHODS Fifty-two children with duodenal perforation hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from January 2007 to December 2021 were retrospectively collected. According to the inclusion and exclusion criteria, patients with duodenal ulcer perforation were included in the group. They were divided into the surgery group and the conservative group according to whether they received surgery. RESULTS A total of 45 cases (35 males and 10 females) were included, with a median age of 13.0 (0.3-15.4) years. Forty cases (40/45, 88.9%) were over 6 years old, and 31 (31/45, 68.9%) were over 12 years old. Among the 45 cases, 32 cases (32/45, 71.1%) were examined for Helicobacter pylori (HP), and 25 (25/32, 78.1%) were positive. There were 13 cases in the surgery group and 32 cases in the conservative group, without a significant difference in age between the two groups (P = 0.625). All cases in the surgery group and the conservative group started with abdominal pain. The proportion of history time within 24 h in the two groups was 6/13 and 12/32 (P = 0.739), and the proportion of fever was 11/13 and 21/32 (P = 0.362). The proportion of pneumoperitoneum in the surgery group was higher than that in the conservative group (12/13 vs. 15/32, P = 0.013). The fasting days in the surgery group were shorter than those in the conservative group (7.7 ± 2.92 vs. 10.3 ± 2.78 days, P = 0.014). There was no significant difference in the total hospital stay (13.6 ± 5.60 vs14.8 ± 4.60 days, P = 0.531). The operation methods used in the surgery group were all simple sutures through laparotomy (9 cases) or laparoscopy (4 cases). All patients recovered smoothly after surgery. CONCLUSION Duodenal ulcer perforation in children is more common in adolescents, and HP infection is the main cause. Conservative treatment is safe and feasible, but the fasting time is longer than the surgery group. A simple suture is the main management for the surgery group.
Collapse
Affiliation(s)
- Qiulong Shen
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Tingting Liu
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Siwei Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Dayong Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.
| |
Collapse
|
5
|
Chevallay M, Lorenz F, Bichard P, Frossard JL, Schmidt T, Goeser T, Bruns CJ, Mönig SP, Chon SH. Outcome of endoscopic vacuum therapy for duodenal perforation. Surg Endosc 2023; 37:1846-53. [PMID: 36241747 DOI: 10.1007/s00464-022-09686-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/25/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks. METHODS We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate. RESULTS Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT was used as a first-line treatment in seven patients and as a second-line treatment in three patients. EVT was successfully applied in all interventions (n = 10, 100%). Overall, EVT lead to definitive closure of the defects in eight out of ten patients (80%). No severe EVT-related adverse events occurred. CONCLUSION EVT is safe and technically feasible, so it emerges as a promising endoscopic treatment option for duodenal leaks. However, multidisciplinary collaboration and management are important to reduce the occurrence of postoperative complications, and to improve recovery rates.
Collapse
|
6
|
Zhang Y, Qiu X, Chen B. Foreign body penetrating duodenum into kidney: A case report. Urol Case Rep 2023; 46:102315. [PMID: 36713059 PMCID: PMC9876819 DOI: 10.1016/j.eucr.2022.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/31/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023] Open
Abstract
The case of penetrating injury of the kidney caused by a foreign body mistakenly swallowing through the duodenum is rare. A 22-year-old male patient found that a strip of the foreign body penetrated the descending duodenum - the lower pole of the right kidney through an abdominal CT examination. After Multi-Disciplinary treatment, the patient underwent extracorporeal ultrasound-assisted endoscopic foreign body removal and hemostatic clamp suture. Extracorporeal ultrasound monitoring and intravenous pyelography showed that there was no leakage of contrast medium around the right kidney. No hematuria and urinary tract infection were found during the follow-up.
Collapse
|
7
|
Pachhai P, Khadka R, Maharjan N, Sharma D, Pradhan S, Bhandari RS. Duodenal perforation due to migrated biliary stent: Case report. Int J Surg Case Rep 2022; 97:107354. [PMID: 35870218 DOI: 10.1016/j.ijscr.2022.107354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Biliary stents are frequently associated with various complications; however biliary stent migration causing duodenal perforation is rare and has only been reported in few cases. PRESENTATION OF CASE We present a case of 33 years old male with pain abdomen and fever for 2 days came to Emergency department. He had undergone open common bile duct exploration (CBD), clearance of stone and placement of CBD stent. In X-ray abdomen, biliary stent migration was suspected. CECT abdomen was done for the confirmation of diagnosis which showed migrated stent with duodenal perforation. Patient underwent exploratory laparotomy and Thal patch repair, pyloric exclusion, retrograde duodenostomy and feeding jejunostomy. Post-operative period was uneventful. DISCUSSION Biliary stents are used to relieve biliary obstruction. There is increasing use of endoscopic retrograde drainage via plastic endoprosthesis and so the related morbidities. One of the rare but serious complications is intestinal perforation and duodenal perforation is seen in most of the cases, explanation being the relative fixed position of the duodenum. CONCLUSION Although intestinal perforation is an uncommon complication following CBD stenting, we should suspect it in patients presenting with pain and fever.
Collapse
|
8
|
Shah H, Sabbah BN, Elwy BA, Arabi TZ, Sabbah AN, Shah SY. Duodenal transection following a seat belt injury: A case report. Int J Surg Case Rep 2022; 96:107272. [PMID: 35704986 PMCID: PMC9198315 DOI: 10.1016/j.ijscr.2022.107272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The rare presentation of duodenal injuries has led to a lack of guidelines for managing and diagnosing such cases. In most duodenal injuries, intramural hematoma and perforation are seen; however, complete resection of the duodenum is rare, which is seen in our case. CASE PRESENTATION We report a rare case of a 6-year-old boy who suffered from a complete isolated duodenal transection at the pylorus and a 90% transection at D3 and D4 following a seat-belt injury. The surgeon performed a primary anastomosis for the first part of the duodenum with pyloric exclusion. Then, primary repair with controlled fistula for the second transection at D3 and D4 and a gastrojejunostomy were performed. After further management, the patient was discharged with no further complaints. CLINICAL DISCUSSION Due to the retroperitoneal location of the duodenum, it is challenging to diagnose a duodenal injury. CT scan with contrast is considered the best diagnostic tool in the case of a duodenal injury. Treatment of duodenal injuries depends on the type of injury and the present level of damage. It is imperative to differentiate between a duodenal hematoma, a duodenal perforation, or a duodenal transection as the management for each complication differs. CONCLUSION No official guidelines have been set in the case of management or diagnosis of duodenal transection. Based on our experience with this patient and similar literature, guidelines for managing and diagnosing duodenal transection should be set, and further studies on the matter are warranted.
Collapse
Affiliation(s)
- Hassan Shah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Belal Nedal Sabbah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Corresponding author at: 7357 Al-Hayaniyah Street, Riyadh 19705, Saudi Arabia.
| | - Badr Ahmed Elwy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Syed Yousaf Shah
- Department of Pediatric Surgery, King Salman Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Tsukihara S, Onda S, Son K, Ito D, Kanno H, Morikawa T, Hanyu N, Eto K. Laparoscopic surgery for duodenal perforation due to a diverticulum with heterotopic pancreas: a case report. Surg Case Rep 2022; 8:106. [PMID: 35648320 PMCID: PMC9160170 DOI: 10.1186/s40792-022-01460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) refers to the presence of abnormally located pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. HP can occur in the gastrointestinal tract and be complicated by gastrointestinal bleeding, pancreatitis, obstruction, or malignant generation. Specifically, perforation of the gastrointestinal tract because of HP is extremely rare. CASE PRESENTATION A 91-year-old woman was diagnosed with duodenal perforation, and an emergency laparoscopic operation was performed. The operative findings indicated a tumor and duodenal wall perforation. The tumor and the perforated site were resected with a linear stapler. Histopathological examination revealed the presence of HP tissue in the submucosal layer around the diverticulum without any signs of inflammation. The perforated site was not covered by HP tissues, and the duodenal wall might have been weaker than the other areas, which could have caused the internal pressure to increase and led to the perforation. CONCLUSIONS Preoperative HP diagnosis is difficult, and it is crucial to consider HP as the differential diagnosis in gastrointestinal perforations. The duodenal diverticula can be perforated due to increased internal pressure of the duodenum caused by the imbalanced localization of HP.
Collapse
Affiliation(s)
- Shu Tsukihara
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan.
| | - Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kyonsu Son
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Daisuke Ito
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Hironori Kanno
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Nobuyoshi Hanyu
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| |
Collapse
|
10
|
Lu YL, Hu J, Zhang LY, Cen XY, Yang DH, Yu AY. Duodenal perforation after organophosphorus poisoning: A case report. World J Clin Cases 2021; 9:8186-8191. [PMID: 34621879 PMCID: PMC8462211 DOI: 10.12998/wjcc.v9.i27.8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Organophosphorus poisoning (OP) is one of the common critical conditions in emergency departments in China, which is usually caused by suicide by taking oral drugs. Patients with severe OP have disturbance of consciousness, respiratory failure, toxic shock, gastrointestinal dysfunction, and so on. As far as we know, the perforation of the duodenum caused by OP has not been reported yet.
CASE SUMMARY A 33-year-old male patient suffered from acute severe OP, associated with abdominal pain. Multiple computed tomography scans of the upper abdomen showed no evidence of intestinal perforation. However, retrograde digital subtraction angiography, performed via an abdominal drainage tube, revealed duodenal perforation. After conservative treatment, the symptoms eased and the patient was discharged from hospital.
CONCLUSION Clinicians should pay close attention to gastrointestinal dysfunction and abdominal signs in patients with severe OP. If clinical manifestation and vital signs cannot be explained by common complications, stress duodenal ulcer or perforation should be highly suspected.
Collapse
Affiliation(s)
- Yuan-Lan Lu
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Jie Hu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Lu-Ying Zhang
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Xiang-Yin Cen
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Deng-Hui Yang
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - An-Yong Yu
- Department of Emergency Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| |
Collapse
|
11
|
Templeton E, Eliachevsky C, Nanda AK. Granular cell tumor presenting with perforation of fourth part of the duodenum: A case report. Int J Surg Case Rep 2021; 86:106336. [PMID: 34454210 PMCID: PMC8397910 DOI: 10.1016/j.ijscr.2021.106336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/13/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Granular cell tumors (GCT) are relatively rare neoplasms most commonly occurring in skin or soft tissues. GCT are thought to be of Schwann cell origin and strongly positive for s100 protein. GCT of the intestinal tract are usually asymptomatic and found incidentally in the esophagus on endoscopy. CASE PRESENTATION Here, we present a case of GCT jejunum and the fourth part of the duodenum. The patient is a 41-year-old female who presented with abdominal pain and was subsequently found to have pneumoperitoneum with a perforation of the fourth part of the duodenum. Intraoperatively, there were multiple enlarged and hard mesenteric lymph nodes, which were found to be due to GCT involving the fourth duodenum and proximal jejunum. CLINICAL DISCUSSION The occurrence of GCT in the gastrointestinal (GI) tract are even less common accounting for 5-9% of all GCT with very few cases reported in the duodenum. GCT of the GI tract are often asymptomatic, consequently leading to misdiagnosed delays in treatment. CONCLUSION In the setting of GCT in the fourth part of the duodenum with evidence of locally advanced disease, local resection is the preferred treatment.
Collapse
Affiliation(s)
- Erin Templeton
- St. George's University School of Medicine, Humboldt Park Health, 1044 N Francisco Avenue, Chicago, IL 60622, USA.
| | - Christina Eliachevsky
- St. George's University School of Medicine, Humboldt Park Health, 1044 N Francisco Avenue, Chicago, IL 60622, USA.
| | - Atul K Nanda
- Humboldt Park Health, 1044 N Francisco Avenue, Chicago, IL 60622, USA.
| |
Collapse
|
12
|
Platten M, Aladellie L. Neisseria meningitidis serogroup W(P1.5-2) sepsis presenting with myopericarditis in an elderly previously healthy male. IDCases 2021; 25:e01238. [PMID: 34377672 PMCID: PMC8329507 DOI: 10.1016/j.idcr.2021.e01238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
A rare complication of Neisseria meningitidis is pericarditis. Here a 74-year-old male with Neisseria meningitidis serogroup W(P1.5−2) presented with myopericarditis. The patient developed cardiac tamponade and a pericardiocentesis was subsequently performed. The patient also developed a duodenal perforation, possibly secondary to the stress from being critically ill. The patient fully recovered.
Collapse
Affiliation(s)
- Michael Platten
- Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
- Corresponding author at: Kungshamra 56A, Solna, 17070, Sweden.
| | | |
Collapse
|
13
|
Matsuoka M, Kobayashi K, Okura Y, Mochida T, Nozaka T, Sato A, Yauchi M, Matsumoto T, Furumoto Y, Horiuchi T, Asano T. Endoscopic Closure of an Acute Duodenal Perforation Occurring during Endoscopic Ultrasound Using Endoclips and Polyglycolic Acid Sheets with Fibrin Glue. Case Rep Gastroenterol 2021; 15:253-261. [PMID: 33790712 PMCID: PMC7989665 DOI: 10.1159/000512474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
Acute duodenal perforation during endoscopic ultrasound (EUS) is a serious complication. The conventional endoscopic treatment for duodenal perforations such as endoscopic clipping is unsatisfactory; recently, the effectiveness of over-the-scope clipping (OTSC) has been reported. A 91-year-old woman was referred to our hospital with the chief complaint of jaundice. Contrast-enhanced computed tomography showed a 2-cm mass in the pancreatic head; we planned EUS-guided fine-needle aspiration. During exploration for a puncture route from the duodenal bulb using a linear echoendoscope under carbon dioxide insufflation, the duodenal lumen was suddenly filled with blood. A perforation <15 mm was identified in the superior duodenal horn. We attempted an endoscopic closure with multiple endoclips but could not completely close the perforation site. Strips of bioabsorbable polyglycolic acid (PGA) sheets were placed over the gaps between the endoclips with biopsy forceps and fixed in place with fibrin glue, completely covering the perforation site. Two days after the procedure, the perforation site had closed. Nine days later, endoscopic biliary stenting was performed. The patient was diagnosed with pancreatic cancer through bile cytology, and the optimal supportive care for her age was selected. Endoscopic tissue shielding with PGA sheets and fibrin glue is increasingly being reported for use during gastrointestinal endoscopic procedures. In this case, surgery was avoided due to successful endoscopic treatment using endoclips and PGA sheets with fibrin glue without OTSC. This method may be useful for repairing acute duodenal perforations during EUS and should therefore be known to pancreatobiliary endoscopists.
Collapse
Affiliation(s)
- Mana Matsuoka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yukito Okura
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Tomohiro Mochida
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takahito Nozaka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ayako Sato
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masato Yauchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Taichi Matsumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takao Horiuchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toru Asano
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| |
Collapse
|
14
|
Wang R, He J, Chen Z, Wen K. Migration of fish bones into abdominal para-aortic tissue from the duodenum after leading to duodenal perforation: a case report. BMC Gastroenterol 2021; 21:82. [PMID: 33622248 PMCID: PMC7903620 DOI: 10.1186/s12876-021-01662-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background Migration of fish bones into abdominal para-aortic tissue after penetrating the junction of 3rd and 4th part of duodenum is incredibly rare. Case presentation A 68-year-old man was admitted to our hospital with persistent colic in the lower abdomen after eating fish two weeks ago. Abdominal computed tomography (CT) scan showed High density streaks along the anterior and lower edges of the 3rd part of duodenum with peripheral exudation and localized peritonitis. Esophagogastroduodenoscopy didn’t find foreign bodies and perforations in the digestive tract. Laparoscopic surgery and intraoperative endoscopy were made to detect foreign bodies and perforation site was found. After transition to open surgery, the fish bone was found in abdominal para-aortic tissue and removed without complications. Postoperative recovery is smooth, and the patient resumed normal diet and was discharged. Conclusions It is difficult to choose a treatment plan for foreign bodies at the 3rd part of the duodenum, because it is difficult to judge the damage caused by the foreign body to the intestine and the positional relationship with the surrounding important organs. Conservative treatment or surgical treatment both have huge risks. The handling of this situation will extremely test the psychology, physical strength and professional experience of the surgeon.
Collapse
Affiliation(s)
- Rong Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou, P.R. China
| | - Jinyan He
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou, P.R. China
| | - Zhengquan Chen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou, P.R. China
| | - Kunming Wen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou, P.R. China.
| |
Collapse
|
15
|
Sengupta TK, Prakash G, Ray S, Kar M. Surgical Management of Peptic Perforation in a Tertiary Care Center: A Retrospective Study. Niger Med J 2020; 61:328-333. [PMID: 33888930 PMCID: PMC8040944 DOI: 10.4103/nmj.nmj_191_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background The purpose of this study is to estimate disease burden, clinical features, and outcome in the emergency surgical management of peptic perforation in a rural government tertiary care center where patients are socioeconomically very poor and also impacted by lack of good quality health-care facility. Materials and Methods The study had retrospectively analyzed 121 patients with peptic perforation who had undergone emergency laparotomy at Midnapore medical college, West Bengal, India, from June 2018 to December 2019. All patients >12 years were included in this study. Exclusion criteria were other traumatic and nontraumatic gastrointestinal perforations. Results The study population had 112 males and 9 females with a mean age of 44.80 ± 15.29 years and maximum incidence in the 6th decade (P = 0.001). Smoking and alcohol were associated with 54.5% and 49.6%, respectively. The symptoms were pain abdomen (100%) with vomiting (38.8%) and fever (33.9%). The signs of hypotension, peritonitis, distension, and pneumoperitoneum were observed in 34.7%, 64.5%, 39.7%, and 83.5%, respectively. Only 20.7% of patients were admitted within the first 24 h. The mean duration of symptoms was 2.3 days. Most perforations were located on the duodenum (74.4%) with duodenal to gastric perforation ratio 2.9:1. The mean size was 1.02 cm. Chest infection (19%) was the most common complication. The mortality rate was 9.1%. The mean length of hospital stay was 11.1 days. Conclusion Peptic perforation remains a major disease burden in our environment predominantly due to late presentation, leading to high morbidity and mortality.
Collapse
Affiliation(s)
- Tamal Kanti Sengupta
- Department of General Surgery, Midnapore Medical College, West Midnapore, West Bengal, India
| | - Gautam Prakash
- Department of General Surgery, Midnapore Medical College, West Midnapore, West Bengal, India
| | - Saugata Ray
- Department of General Surgery, Midnapore Medical College, West Midnapore, West Bengal, India
| | - Manoranjan Kar
- Department of General Surgery, Midnapore Medical College, West Midnapore, West Bengal, India
| |
Collapse
|
16
|
Parikh A, Zhang J, Glaser J, Kalapatapu V. Symptomatic duodenal perforation by a Bird's Nest vena cava filter. J Vasc Surg Cases Innov Tech 2020; 7:104-107. [PMID: 33718677 PMCID: PMC7921187 DOI: 10.1016/j.jvscit.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/15/2020] [Indexed: 12/02/2022]
Abstract
This case describes a patient with a permanent Bird's Nest inferior vena cava filter in the setting of spinal cord injury and paraplegia who presented with epigastric pain resulting from duodenal perforation of his filter. After confirming that the patient was stable hemodynamically with normal laboratory values, he underwent open exploration with trimming of the extraluminal struts and wires, leaving the intact filter in place, with resolution of his pain. Although percutaneous removal of inferior vena cava filters is preferred for retrievable filters, this case demonstrates the safety and efficacy of open surgical management for permanent filters, not designed for retrieval.
Collapse
Affiliation(s)
- Anand Parikh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jason Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Julia Glaser
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Venkat Kalapatapu
- Division of Vascular and Endovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| |
Collapse
|
17
|
Briganti V, Tursini S, Ianniello S, Cortese A, Faggiani R. Double isolated asynchronous duodenal perforation due to abdominal blunt trauma in a child: A case report. Int J Surg Case Rep 2020; 77:67-70. [PMID: 33157336 PMCID: PMC7644788 DOI: 10.1016/j.ijscr.2020.09.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
This is the first case described in literature of a double asynchronous isolated perforation of the duodenum. Timing of diagnosis and treatment are described. Radiologic findings are provided.
Background Isolated duodenal perforation following blunt abdominal trauma is a rare injury in children. Bicycle accidents (falling on to the handlebar) are a frequent cause of blunt abdominal trauma in children and may occasionally be associated with isolated duodenal perforation (IDP). Prompt diagnosis and surgical treatment are vital to prevent increased morbidity and mortality. Case presentation We report the rare case of an 11-year-old boy admitted for blunt abdominal trauma and treated for an asynchronous double IDP. The first perforation, located on the 2nd/3rd portion of the duodenum, was promptly diagnosed by contrast-enhanced abdominal CT scan after a negative US scan, five hours after injury, and the lesion repaired with a single stitch suture. The second duodenal perforation appeared in the duodenal bulb as a worsening biliary leakage, 48 h after the primary suture of the initial lesion. The perforation was initially seen by digestive endoscopy and sutured in the same way as the first lesion. A third laparotomy was needed 4 days later due to an intestinal obstruction, after which the patient was recovered completely and was discharged home. Discussion and conclusion IDP is a rare consequence of blunt abdominal trauma, and is normally associated with a lesion of other organs, such as the pancreas or bile duct. A delayed diagnosis strongly increases the incidence of morbidity and mortality, and different kinds of surgical management have been proposed, depending on the type of lesion. To our knowledge, this is the first case described in literature of a double isolated asynchronous duodenal perforation following blunt abdominal trauma in children.
Collapse
Affiliation(s)
- V Briganti
- Pediatric Surgery Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| | - S Tursini
- Pediatric Surgery Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy.
| | - S Ianniello
- Emergency Radiology Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| | - A Cortese
- Radiology Operative Unit Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| | - R Faggiani
- Gastroenterology and Diagnostic and Operative Digestive Endoscopy Operative Unit, San Camillo, Forlanini Hospital, Rome, Italy
| |
Collapse
|
18
|
Rajaguru K, Sheong SC. Case report on a rare cause of silent duodenal perforation. Int J Surg Case Rep 2020; 76:320-323. [PMID: 33065491 PMCID: PMC7567171 DOI: 10.1016/j.ijscr.2020.09.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/27/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022] Open
Abstract
We describe a rare case of duodenal perforation related to foreign body ingestion which has rarely been reported in the literature. Foreign body perforations were uncommon and often missed in view of its atypical and latent presentation. Early multiplanar reformatting CT images help in identifying the cause and also to locate the foreign body in most of the patients, thus making it an important tool for preoperative diagnosis which assists in surgical planning. Though the majority of patients will require an exploratory laparotomy, minimally invasive procedures can be attempted in stable patients similar to this case.
Introduction Foreign body ingestion is a common clinical scenario encountered in clinical practice. Perforations related to foreign bodies are rare (<1%) but can present as a serious element in Emergency surgery. The most common site of perforations are angulated areas like ileocecal valve, sigmoid colon and duodeno-jejunal flexure and small bowel. We describe a rare case of duodenal perforation related to foreign body ingestion which has rarely been reported in the literature. Case presentation and management This case report describes the presentation and management of a 65 year old male who presented with septic shock without symptoms and signs of an acute abdomen. Imaging revealed a sealed foreign body perforation in the first part of duodenum with a localized abscess. The abscess cavity was drained and the foreign body (fish bone) was removed laparoscopically. Conclusion Foreign body perforations were often missed in view of its atypical and latent presentation with the history of foreign body ingestion is rare. Early multiplanar reformatting CT images help in identifying the cause and also to locate the foreign body in most of the patients, thus making it an important tool for preoperative diagnosis which assists in surgical planning. Though the majority of patients will require an exploratory laparotomy, minimally invasive procedures can be attempted in stable patients similar to this case.
Collapse
Affiliation(s)
- Kishore Rajaguru
- Ng Teng Fong General Hospital, Department of General Surgery, National University Health System, Singapore.
| | - Seow Choon Sheong
- Ng Teng Fong General Hospital, Department of General Surgery, National University Health System, Singapore
| |
Collapse
|
19
|
Rodrigues Gaspar JR, Vieira E Monteiro E, Costa Simões VJ, Durão Salgueiro PS. Renal Colic by Gastrointestinal Perforation: Endoscopic Approach. GE Port J Gastroenterol 2020; 28:222-224. [PMID: 34056049 DOI: 10.1159/000510033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Joana Raquel Rodrigues Gaspar
- Department of Surgery, General Surgery, Centro Hospitalar e Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Eunice Vieira E Monteiro
- Department of Surgery, General Surgery, Centro Hospitalar e Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Vítor José Costa Simões
- Department of Surgery, General Surgery, Centro Hospitalar e Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | | |
Collapse
|
20
|
Mao X, Yu N, Jia X, Fan W. Imaging findings and clinical features of atypical retroperitoneal abscess caused by duodenal perforation: a case report and review of the literature. J Med Case Rep 2020; 14:105. [PMID: 32678002 PMCID: PMC7367392 DOI: 10.1186/s13256-020-02393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas. Case presentation A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 109/L and a neutrophil absolute value of 18.81 109/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient’s body temperature gradually returned to normal, and his abdominal pain decreased. Conclusions A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.
Collapse
Affiliation(s)
- Xijin Mao
- Department of Radiology, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
| | - Ning Yu
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
| | - Xingfang Jia
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China
| | - Wanfeng Fan
- Department of Radiology, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, China.
| |
Collapse
|
21
|
Wang X, Qu J, Li K. Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature. BMC Gastroenterol 2020; 20:149. [PMID: 32398025 PMCID: PMC7216602 DOI: 10.1186/s12876-020-01294-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endoscopic retrograde biliary drainage (ERBD) is the most frequently performed procedure for treating benign or malignant biliary obstruction. Although duodenal perforations secondary to the biliary plastic stent are quite rare, they can be life-threatening. The treatment strategies for such perforations are diverse and continue to be debated. CASE PRESENTATION We report three cases of duodenal perforation due to the migration of biliary plastic stents that were successfully managed using an endoscope. The three patients were admitted on complaints of abdominal pain after they underwent ERBD. Abdominal computerized tomography (CT) revealed migration of the biliary plastic stents and perforation of the duodenum. Endoscopy was immediately performed, and perforation was confirmed. All migrated stents were successfully extracted endoscopically by using snares. In two of the three cases, the duodenal defects were successfully closed with haemostatic clips after stent retrieval, and subsequently, endoscopic nasobiliary drainage tubes were inserted. After the endoscopy and medical treatment, all three patients recovered completely. CONCLUSIONS Duodenal perforations due to the migration of biliary stents are rare, and the treatment strategies remain controversial. Our cases and cases in the literature demonstrate that abdominal CT is the preferred method of examination for such perforations, and endoscopic management is appropriate as a first-line treatment approach.
Collapse
Affiliation(s)
- Xiaopeng Wang
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China
| | - Junwen Qu
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China
| | - Kewei Li
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China.
| |
Collapse
|
22
|
Yang HH, Ke CJ, Shih TH. Duodenal perforation after gastrostomy tube replacement: Case report and literature review. Tzu Chi Med J 2019; 31:280-282. [PMID: 31867259 PMCID: PMC6905241 DOI: 10.4103/tcmj.tcmj_122_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/07/2018] [Accepted: 09/26/2018] [Indexed: 11/04/2022] Open
Abstract
Gastrostomy is commonly used to provide long-term enteral access for patients with feeding impairment. Routine replacement is a safe procedure, but it has various complications. We present a case of nasopharyngeal cancer, who visited the emergency department for gastrostomy tube dislodgement. Diffuse abdominal pain developed 3 days after replacement of the gastrostomy tube with a temporary silicone Foley tube. Emergency diagnostic laparoscopy was performed and found tip migration and causing duodenal perforation. Tip migration and compression necrosis of mucosa were the possible mechanisms. The condition was successfully treated by emergency laparoscopic duodenorrhaphy.
Collapse
Affiliation(s)
- Hsiao-Hui Yang
- Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chia-Jung Ke
- Division of General Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ting-Han Shih
- Division of Colorectal Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| |
Collapse
|
23
|
Nilay Güneş, Kutlu T, Tekant GT, Eroğlu AG, Üstündağ NÇ, Öztürk B, Onay H, Tüysüz B. Congenital generalized lipodystrophy: The evaluation of clinical follow-up findings in a series of five patients with type 1 and two patients with type 4. Eur J Med Genet 2020; 63:103819. [PMID: 31778856 DOI: 10.1016/j.ejmg.2019.103819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 10/02/2019] [Accepted: 11/24/2019] [Indexed: 11/23/2022]
Abstract
Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by lipoatrophy affecting the face, limbs and trunk, acromegaloid features, hepatomegaly, hypertriglyceridemia, and insulin resistance. The aim of this study is to evaluate the long-term follow-up findings including gastrointestinal and cardiac manifestations of the patients with CGL1 and CGL4, caused by mutations in the AGPAT2 and CAVIN1 genes, respectively. Two patients aged 2 and 9 years with the same biallelic CAVIN1 mutation and five patients aged between 6 months and 11 years 4 months with AGPAT2 mutations have been followed up for 3-9 years. The patients were between 7 and 20 years of age at their last examination. One of the two patients with CGL4 had congenital pyloric stenosis. The other patient with CGL4 have developed recurrent duodenal perforations which have not been reported in CGL patients previously. The pathological examination of duodenal specimens revealed increased subserosal fibrous tissue and absent submucosal adipose tissue. None of the five CGL1 patients had gastrointestinal problems. Two patients with CGL4 developed hypertrophic cardiomyopathy (HCMP) and severe cardiac arrhythmia, only one patient with CGL1 had HCMP. Hyperinsulinemia was detected in one patient with CGL4 and three patients with CGL1, these three CGL1 patients also had acanthosis nigricans. Hepatic steatosis was detected in one patient with CGL4 and two patients with CGL1 by ultrasonography. In conclusion, these findings suggest that CGL4 patients should also be carefully followed up for gastrointestinal and cardiac manifestations.
Collapse
|
24
|
Abstract
Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies.
Collapse
Affiliation(s)
- Daniel Ansari
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - William Torén
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Sarah Lindberg
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Helmi-Sisko Pyrhönen
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Roland Andersson
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| |
Collapse
|
25
|
Jamal MH, Karam A, Alsharqawi N, Buhamra A, AlBader I, Al-Abbad J, Dashti M, Abulhasan YB, Almahmeed H, AlSabah S. Laparoscopy in Acute Care Surgery: Repair of Perforated Duodenal Ulcer. Med Princ Pract 2019; 28:442-448. [PMID: 30995637 PMCID: PMC6771047 DOI: 10.1159/000500107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/03/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The use of laparoscopic management as a first choice for the treatment of duodenal perforation is gaining ground but is not routine in many centers. In this report, we aim to report our experience with laparoscopy as the first approach for the repair of duodenal perforation. MATERIALS AND METHODS This is a retrospective review of patients during our initial experience with the use of laparoscopy for the treatment of duodenal perforation between 2009 and 2013. RESULTS A total of 100 patients underwent management of duodenal perforation. Laparoscopy was attempted initially in 76 patients (76%) and completed in 64 patients (64%). The length of hospital stay was shorter in the laparoscopic group (mean 2.6) than in the open group (mean 3.1) (p = 0.008). Complications developed in 14 patients (20%). There was a tendency towards fewer admissions to intensive care, less acute kidney injuries, and less acute respiratory distress syndrome in the laparoscopic group. In patients who underwent laparoscopic surgery, the chances of uneventful recovery were 4.3 times higher than in those patients who underwent open surgery (95% CI 1.3-13.5, p = 0.014). CONCLUSIONS Laparoscopy in the treatment of perforated duodenal ulcer is safe and can be utilized as a routine approach for the treatment of this pathology.
Collapse
Affiliation(s)
| | - Abdulazeez Karam
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Nourah Alsharqawi
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Abdulla Buhamra
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Ibtesam AlBader
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Jasem Al-Abbad
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | - Mohammad Dashti
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| | | | - Husain Almahmeed
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Salman AlSabah
- Department of Surgery, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
26
|
Zhu S, Lin J, Xu F, Guo S, Huang S, Wang M. Purse-string sutures using novel endoloops and repositionable clips for the closure of large iatrogenic duodenal perforations with single-channel endoscope: a multicenter study. Surg Endosc 2018; 33:1319-1325. [PMID: 30460503 DOI: 10.1007/s00464-018-6586-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Serious complications due to perforation restrict the development of duodenal endoscopic treatment. The key stage for remediation is the successful endoscopic closure to prevent peritonitis and the need for surgical intervention. This report aimed to present a new simple method for the closure of large iatrogenic duodenal perforations with purse-string sutures using the novel endoloops and repositionable clips through a single-channel endoscope. METHODS A total of 23 patients with iatrogenic duodenal perforations ≥ 1 cm were retrospectively studied who were presently treated by purse-string sutures using the novel endoloops and the repositionable hemostasis clips with the single-channel endoscope at four institutes. During and after the procedure, a 20-gauge needle was used to relieve the pneumoperitoneum or subcutaneous emphysema. Finally, a gastroduodenal decompression tube was placed. RESULTS The median maximum diameter of iatrogenic duodenal perforations was 1.65 cm (range 1.0-3.0 cm). Complete endoscopic closure of all 23 perforations was achieved. No patient had severe complications such as peritonitis. The wounds were healed and no obvious duodenal stricture was observed in all cases after 3 months. CONCLUSION Purse-string sutures using the novel endoloops and repositionable endoclips through single-channel endoscope were feasible, effective and easy methods for the closure of large duodenal iatrogenic perforations.
Collapse
Affiliation(s)
- Sumin Zhu
- Medical Center for Digestive Diseases, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China.,Department of Gastroenterology, General Hospital of XuZhou Mining Group, Xuzhou, China
| | - Jie Lin
- Medical Center for Digestive Diseases, The Second Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Fazhen Xu
- Department of Gastroenterology, The People's Hospital of Lianshui, 6 Hongri Road, Huaian, 223400, China
| | - Simin Guo
- Department of Gastroenterology, General Hospital of XuZhou Mining Group, Xuzhou, China
| | - Shu Huang
- Department of Gastroenterology, The People's Hospital of Lianshui, 6 Hongri Road, Huaian, 223400, China.
| | - Min Wang
- Digestive Endoscopy Department, The First Affiliated Hospital, Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| |
Collapse
|
27
|
Ekmektzoglou K, Nikou E, Apostolopoulos P, Grigoraki D, Manesis K, Alexandrakis G. Size does matter: when a large plastic biliary stent ends up in the root of the mesentery. Clin J Gastroenterol 2018; 12:102-105. [PMID: 30284196 DOI: 10.1007/s12328-018-0914-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022]
Abstract
Duodenal perforations due to biliary stenting migration, although rare, can occur. We report a unique case of duodenal perforation due to a large in length plastic stent with no (or marginal) migration, which ended up in the root of the mesentery, explaining the normal laboratory values and minimal imaging findings observed. Any clinical symptom during the postprocedural period should raise the suspicion of a major complication and prompt quick management decisions.
Collapse
Affiliation(s)
- Konstantinos Ekmektzoglou
- Department of Gastroenterology, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12 Street, 11521, Athens, Greece. .,, Attica, Greece.
| | - Efstathios Nikou
- Second Department of Surgery, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12 Street, 11521, Athens, Greece
| | - Periklis Apostolopoulos
- Department of Gastroenterology, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12 Street, 11521, Athens, Greece
| | - Despina Grigoraki
- Department of Radiology, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12 Street, 11521, Athens, Greece
| | - Konstantinos Manesis
- Second Department of Surgery, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12 Street, 11521, Athens, Greece
| | - Georgios Alexandrakis
- Department of Gastroenterology, Army Share Fund Hospital (NIMTS), Monis Petraki 10-12 Street, 11521, Athens, Greece
| |
Collapse
|
28
|
Abstract
Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously and the rest can be removed endoscopically; only few ingested foreign bodies lead to complications and need surgical intervention. We are reporting a case of accidental nail ingestion in a 10-year-old child which led to a sealed perforation of duodenum. Operative management included primary duodenal repair after removal of nail. Post operative recovery was smooth and oral was started on day 5. We recommend that all ingested sharp and large foreign bodies should be removed endoscopically, if not passed spontaneously.
Collapse
Affiliation(s)
- Fatima Naumeri
- Dr. Fatima Naumeri, MCPS. FCPS. Department of Pediatric Surgery, King Edward Medical University, Lahore, Pakistan
| | - Bilal Qayyum
- Dr. Bilal Qayyum, Department of Pediatric Surgery, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Sohaib Yousaf
- Dr. Muhammad Sohaib Yousaf, Department of Pediatric Surgery, King Edward Medical University, Lahore, Pakistan
| |
Collapse
|
29
|
Abstract
Duodenal perforation is a rare but life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). Duodenal perforation can cause air leak into the extraperitoneal space. In rare instances, the air in the extraperitoneal space could dissect along the fascial planes of the abdomen to reach scrotum, leading to pneumoscrotum. We present the case of a 35-year-old male patient who developed scrotal pain and swelling following ERCP. He was found to have extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed with retroperitoneal duodenal perforation. He was managed conservatively with close monitoring and supportive care.
Collapse
Affiliation(s)
- Mohammad Saud Khan
- aDepartment of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Faisal Jamal
- bDepartment of Radiology, Apollo Hospitals, New Delhi, India
| | - Zubair Khan
- aDepartment of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Abhinav Tiwari
- aDepartment of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Hermann Simo
- aDepartment of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Himani Sharma
- aDepartment of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| |
Collapse
|
30
|
Akbulut S, Isik B, Karipkiz Y, Yilmaz S. Massive Subcutaneous Emphysema, Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum following Endoscopic Retrograde Cholangiopancreatography in a Living Liver Donor. Int J Organ Transplant Med 2018; 9:132-135. [PMID: 30487961 PMCID: PMC6252177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Despite having many advantages, living donor liver transplantation has not been adopted by western countries due to risk of nearly life-threatening complications after living donor hepatectomy (LDH). Herein, we aimed at presenting the management of a 19-year-old patient who suffered life-threatening complications after right lobe LDH. A multiple detector computed tomography (MDCT) revealed a bilioma at the cut surface of the remnant liver, for which a transhepatic drainage catheter was placed. Endoscopic retrograde cholangiopancreatography (ERCP) performed to decompress biliary tract, but the biliary tract could not be cannulized due to post-precut bleeding. On the next day, extensive crepitation was detected and MDCT showed subcutaneous emphysema, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum (ERCP-related duodenal perforation?). However, the patient showed significant deterioration of physical examination findings, fever, and infectious parameters, and therefore was taken to the operating room. Kocher maneuver revealed no apparent duodenal perforation. Then, a 2-mm bile duct was found open at the caudate lobe, through which bile leaked. Then, common bile duct exploration and T-tube placement were performed, followed by suture closure of the bile orifice at the caudate lobe. Massive air previously identified completely disappeared one week after the operation.
Collapse
Affiliation(s)
- S. Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey,Correspondence: Sami Akbulut, Assos Prof, FICS, FACS,Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km Malatya 44280, Turkey
| | - B. Isik
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
| | - Y. Karipkiz
- Department of Nursing Service, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
| | - S. Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 244280, Malatya, Turkey
| |
Collapse
|
31
|
Coronado JA, Chávez MÁ, Manrique MA, Cerna J, Trejo AL. Retroperitoneal epithelioid sarcoma: A case report. World J Gastrointest Endosc 2017; 9:579-582. [PMID: 29290913 PMCID: PMC5740103 DOI: 10.4253/wjge.v9.i12.579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
Epithelioid sarcoma (ES), a mesenchymatous malign neoformation, is often diagnosed in later stages and associated with high recurrence index, metastasis and mortality. We report a case of a 65 years old male, with history of abdominal pain and upper gastrointestinal bleeding. Endoscopy demonstrated a posterior duodenal wall perforation communicating with a solid retroperitoneal neoformation. Endoscopic biopsy was performed, with a final report of ES. The patient was submitted for surgical palliation due to the tumor’s unresectability. Retroperitoneal ES is an extremely rare condition with limited reports in the literature where guidelines for its optimal treatment are not well established.
Collapse
Affiliation(s)
- José A Coronado
- Division of Gastrointestinal Endoscopy, Hospital Juarez de Mexico, Mexico City, CDMX 07760, Mexico
| | - Miguel Á Chávez
- Division of Gastrointestinal Endoscopy, Hospital Juarez de Mexico, Mexico City, CDMX 07760, Mexico
| | - Martín A Manrique
- Division of Gastrointestinal Endoscopy, Hospital Juarez de Mexico, Mexico City, CDMX 07760, Mexico
| | - Jony Cerna
- Division of Gastrointestinal Endoscopy, Hospital Juarez de Mexico, Mexico City, CDMX 07760, Mexico
| | - Ana L Trejo
- Division of Anatomic Pahology, Hospital Juarez de Mexico, Mexico City, CDMX 07760, Mexico
| |
Collapse
|
32
|
Kelm M, Seyfried F, Reimer S, Krajinovic K, Miras AD, Jurowich C, Germer CT, Brand M. Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC ® treatment: A case report. Int J Surg Case Rep 2017; 41:401-403. [PMID: 29546001 PMCID: PMC5699878 DOI: 10.1016/j.ijscr.2017.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION During damage control surgery for blunt abdominal traumata simultaneous duodenal perforations can be missed making secondary sufficient surgical treatment challenging. Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits. PRESENTATION OF THE CASE A 59-year old man with hemorrhagic shock due to rupture of the mesenteric root after blunt abdominal trauma received damage control treatment. Within a scheduled second-look, perforation of the posterior duodenal wall was identified. Due to local and systemic conditions, further surgical treatment was limited. Decision for endoscopic treatment was made but proved to be difficult due to the distal location. Finally, double-barreled jejunal stoma was created for transstomal EndoVAC™ treatment. Complete leakage healing was achieved and jejunostomy reversal followed subsequently. DISCUSSION During damage control surgery simultaneous bowel injuries can be missed leading to life-threatening complications with limited surgical options. EndoVAC™ treatment is an option for gastrointestinal perforations but has anatomical limitations that can be sufficiently shifted by a transstomal approach for intestinal leakage. CONCLUSION In trauma related laparotomy complete mobilization of the duodenum is crucial. As ultima ratio, transstomal EndoVAC™ is a safe and feasible option and can be considered for similar cases.
Collapse
Affiliation(s)
- M Kelm
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Germany
| | - F Seyfried
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Germany.
| | - S Reimer
- Department of Internal Medicine, Division of Gastroenterology, University of Würzburg, Germany
| | - K Krajinovic
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Germany
| | - A D Miras
- Department of Investigative Medicine, Imperial College London, UK
| | - C Jurowich
- Department of General, Visceral and Thoracic Surgery, Kreiskliniken Altoetting-Burghausen, Germany
| | - C T Germer
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Germany
| | - M Brand
- Department of Internal Medicine, Division of Gastroenterology, University of Würzburg, Germany
| |
Collapse
|
33
|
Poris S, Fontaine A, Glener J, Kubovec S, Veldhuis P, Du Y, Pepe J, Eubanks S. Routine versus selective upper gastrointestinal contrast series after omental patch repair for gastric or duodenal perforation. Surg Endosc 2017; 32:400-404. [PMID: 28664428 DOI: 10.1007/s00464-017-5695-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are no guidelines on the routine or selective use of contrast upper gastrointestinal series (UGI) after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective versus routine contrast study will lead to worse clinical outcomes. METHODS A retrospective analysis of 115 (n = 115) patients with OPR of GP or DP was performed. Data were obtained from seven Florida Hospital campuses. Patients aged 18 and older from 2006 to 2016 were identified by ICD9 billing information. Patients were divided into two groups: UGI and no UGI. The UGI group was subdivided into selective versus routine. A selective UGI was defined as one or more of the following after post-operative day 3: WBC >12,000, peritonitis, fever >100.4 F, tachycardia >110 bpm on three or more assessments, and any UGI performed after POD 7. Perioperative symptoms, perforation location, size, abdominal contamination, laparoscopic or open, leak detection, length of stay, mortality, and reoperation within 2 weeks were also examined. RESULTS No differences between the UGI group and non-UGI group relating to preoperative symptoms, leak detection, death, and reoperation rate were revealed. Differences in length of stay were found to be statistically significant with the UGI group and non-UGI at a median of 15.5 and 8 days, respectively. In the UGI subgroup, 20 of the 29 patients received selective studies. There were no statistical differences identified in leak detection, death, and reoperation. CONCLUSIONS Rates of leak detection, reoperation, and death in patients with GP or DP repaired with omental patch utilizing an UGI study were not statistically significant. An increased length of stay was observed within the UGI group. There was no advantage demonstrated between a selective versus routine UGI; therefore, the use of selective UGI should be based upon clinical indications.
Collapse
Affiliation(s)
- Stephenie Poris
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA.
| | - Andrew Fontaine
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Julie Glener
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Stacey Kubovec
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Paula Veldhuis
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Yuan Du
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Julie Pepe
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| | - Steve Eubanks
- Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA
| |
Collapse
|
34
|
Cirocchi R, Kelly MD, Griffiths EA, Tabola R, Sartelli M, Carlini L, Ghersi S, Di Saverio S. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. Surgeon 2017; 15:379-387. [PMID: 28619547 DOI: 10.1016/j.surge.2017.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The incidence of duodenal perforation after ERCP ranges from 0.09% to 1.67% and mortality up to 8%. METHODS This systematic review was registered in Prospective Register of Systematic Reviews, PROSPERO. Stapfer classification of ERCP-related duodenal perforations was used. RESULTS The systematic search yielded 259 articles. Most frequent post-ERCP perforation was Stapfer type II (58.4%), type I second most frequent perforation (17.8%) followed by Stapfer type III in 13.2% and type IV in 10.6%. Rate of NOM was lowest in Stapfer type I perforations (13%), moderate in type III lesions (58.1%) and high in other types of perforations (84.2% in type II and 84.6% in IV). In patients underwent early surgical treatment (<24 h from ERCP) the most frequent operation was simple duodenal suture with or without omentopexy (93.7%). In patients undergoing late surgical treatment (>24 h from ERCP) interventions performed were more complex. In type I lesions post-operative mortality rate was higher in patients underwent late operation (>24 h). In type I lesions, failure of NOM occurred in 42.8% of patients. In type II failure of NOM occurred in 28.9% of patients and in type III there was failure of NOM in only 11.1%, none in type IV. Postoperative mortality after NOM failure was 75% in type I, 22.5% in type II and none died after surgical treatment for failure of NOM in type III perforations. CONCLUSIONS This systematic review showed that in patients with Stapfer type I lesions, early surgical treatment gives better results, however the opposite seems true in Stapfer III and IV lesions.
Collapse
Affiliation(s)
- Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Terni, Italy.
| | | | - Ewen A Griffiths
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland.
| | - Renata Tabola
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2WB, United Kingdom.
| | | | - Luigi Carlini
- Section of Legal Medicine, University of Perugia, Terni, Italy.
| | - Stefania Ghersi
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy.
| | - Salomone Di Saverio
- Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy.
| |
Collapse
|
35
|
Wang L, Wen W, Huang J, Hu W, Zhou R, Li X, Wang X. Endoscopic Removal of a Duodenal-Perforating Leg of Glasses with Dormia Basket. Case Rep Gastroenterol 2016; 10:679-684. [PMID: 27920661 PMCID: PMC5126602 DOI: 10.1159/000452205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/03/2016] [Indexed: 01/08/2023] Open
Abstract
Ingestion of foreign bodies is common in clinical practice. Most ingested foreign bodies will pass through the gastrointestinal (GI) tract without any problems. While GI tract injury due to the ingested foreign body such as a toothpick, a fishbone, a date pit, or a chicken bone, is common, duodenal perforation is rare. In this report, our experience with this rare entity is shared. We present a 38-year-old male patient with GI tract perforation in the bulbus of the duodenum due to a leg of glasses. The patient was admitted to our hospital with severe abdominal pain. Right upper quadrant tenderness was detected at physical examination, and leukocytosis on the laboratory test results. Plain X-ray and computerized tomography showed an ingested foreign body in the bulbus of the duodenum. A leg of glasses perforating the duodenum was removed with endoscopy. The patient was managed nonoperatively, and discharged without any complications on the eighth day after endoscopy. Endoscopic removal and nonoperative management may be feasible in carefully selected patients with duodenal-perforating foreign bodies.
Collapse
Affiliation(s)
- Li Wang
- Department of Gastroenterology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Wen
- Department of Gastroenterology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiamiao Huang
- Department of Gastroenterology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Weijie Hu
- Department of Gastroenterology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Renrong Zhou
- Department of Gastroenterology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin Li
- Department of Gastroenterology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaojiang Wang
- Department of Anesthesiology, the Affiliated 81st Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
36
|
Kim K, Kim EB, Choi YH, Oh Y, Han JH, Park SM. Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping. Clin Endosc 2016; 50:202-205. [PMID: 27641150 PMCID: PMC5398357 DOI: 10.5946/ce.2016.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/30/2016] [Indexed: 12/29/2022] Open
Abstract
Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm oval-shaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.
Collapse
Affiliation(s)
- Keunmo Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Bee Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yong Hyeok Choi
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Youngmin Oh
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seon Mee Park
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| |
Collapse
|
37
|
Yao SY, Matsui Y, Shiotsu S. An unusual case of duodenal perforation caused by a blister pack: A case report and literature review. Int J Surg Case Rep. 2015;14:129-132. [PMID: 26263453 PMCID: PMC4573598 DOI: 10.1016/j.ijscr.2015.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 12/13/2022] Open
Abstract
Unnoticed ingestion of blister packs cause gastrointestinal perforation. Preoperative diagnosis of foreign body ingestion is often difficult. Duodenal perforation caused by blister packs is extremely rare. Perforation in the third portion of duodenum can lead to retroperitoneal abscess. Despite prompt management, duodenal perforation may be potentially fatal.
Introduction Ingestion of foreign bodies is a relatively common clinical problem. Blister packs have been known to be a causative agent of gastrointestinal perforation. We report a rare case of duodenal perforation caused by a blister pack, which was complicated by retroperitoneal abscess and having a poor outcome. Presentation of case A 72 year-old man with a history of dementia presented to the emergency department with a 2-day history of backache. Upon radiological findings, perforated peptic ulcer was suspected. However, emergency laparotomy revealed a blister pack protruding from the posterior wall of the third portion of the duodenum. It was complicated by a widespread retroperitoneal abscess. After removal of the foreign body, the perforation was treated with primary suture repair and an omental patch. However, the patient died two days after operation due to sepsis. Discussion According to a literature review, the ileum is the most common site of perforation caused by blister packs. To our knowledge, duodenal perforations have not been documented to date. Curative treatment often involves emergent surgery. However, duodenal perforation in the third portion may lead to retroperitoneal abscess, which can result in severe sepsis and have a poor outcome. As there is no consensus about an ideal surgical approach, retroperitoneal abscess is one of the clinical challenges for surgeons. Even with prompt management, duodenal perforation may become fatal. Conclusion Unnoticed ingestion of blister packs can cause duodenal perforation. Although prompt management is necessary, duodenal perforation, especially in the third portion, may be potentially fatal.
Collapse
|
38
|
Al Omran Y, Omer Anwar M, Al-Hindi S. Duodenal perforation in a neonate: an unusual presentation and analysis of the cause. J Neonatal Surg 2015; 4:19. [PMID: 26034713 PMCID: PMC4447472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/25/2015] [Indexed: 11/16/2022] Open
Abstract
Duodenal perforation in neonates is a rare surgical emergency. In the cases reported, most perforations are localised to the anterior duodenum and a few at posterior aspect. We present a case of duodenal perforation in the second part of the duodenum in a 26-day-old healthy male neonate.
Collapse
Affiliation(s)
- Yasser Al Omran
- Barts and the London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, United Kingdom.
| | - Mohammed Omer Anwar
- Barts and the London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, United Kingdom.
,
Correspondence: Mohammed Omer Anwar, Barts and the London School of Medicine and Dentistry
Garrod Building, Turner Street, Whitechapel, London. E1 2AD United Kingdom. E-mail:
| | | |
Collapse
|
39
|
Chertoff J, Khullar V, Burke L. Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU). Int J Surg Case Rep 2015; 10:121-5. [PMID: 25837967 PMCID: PMC4429852 DOI: 10.1016/j.ijscr.2015.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. PRESENTATION OF CASE We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. DISCUSSION Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. CONCLUSION This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD.
Collapse
Affiliation(s)
- Jason Chertoff
- University of Florida, College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608, USA.
| | - Vikas Khullar
- University of Florida, College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608, USA
| | - Lucas Burke
- University of Florida, College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608, USA
| |
Collapse
|
40
|
Goel B, Rani J, Huria A, Gupta P, Dalal U. Perforated duodenal ulcer -a rare cause of acute abdomen in pregnancy. J Clin Diagn Res 2014; 8:OD03-4. [PMID: 25386494 DOI: 10.7860/jcdr/2014/9130.4846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/11/2014] [Indexed: 11/24/2022]
Abstract
Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind while dealing with cases of acute abdomen in pregnancy and to proceed with multidisciplinary approach for better feto-maternal outcome.
Collapse
Affiliation(s)
- Bharti Goel
- Assistant Professor, Department of Obstetrics & Gynaecology, Government Medical College , Sector-32, Chandigarh, India
| | - Jyotsna Rani
- Senior Resident, Department of Obstetrics & Gynaecology, Government Medical College , Sector-32, Chandigarh, India
| | - Anju Huria
- Professor and HOD, Departmentof Obstetrics & Gynaecology, Government Medical College , Sector-32, Chandigarh, India
| | - Pratiksha Gupta
- Consultant, Department of Obstetrics & Gynaecology, ESI , Delhi, India
| | - Usha Dalal
- Associate Professor, Departmentof Surgery, Government Medical College , Sector-32, Chandigarh, India
| |
Collapse
|
41
|
Kim SH, Min SH, Kim HY, Jung SE. Duodenal perforation: unusual complication of gastrostomy tube replacement. Pediatr Gastroenterol Hepatol Nutr 2014; 17:112-5. [PMID: 25061587 PMCID: PMC4107218 DOI: 10.5223/pghn.2014.17.2.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 11/15/2022] Open
Abstract
Feeding gastrostomy is widely used for children with feeding impairment. The replacement of gastrostomy tube is known as an easy and safe procedure. However, various complications associated with replacement of gastrostomy tube were reported, including fistula disruption and colo-cutaneous fistula. For replacement of gastrostomy tube in small children with small stomach, special cautions are needed. Here, we report a rare case of duodenal perforation as an acute complication after the replacement of gastrostomy tube for a 33-month-old girl.
Collapse
Affiliation(s)
- Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea
| | - Sa-Hong Min
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| |
Collapse
|
42
|
Issa H, Nahawi M, Bseiso B, Al-Salem A. Migration of a biliary stent causing duodenal perforation and biliary peritonitis. World J Gastrointest Endosc 2013; 5:523-526. [PMID: 24147198 PMCID: PMC3797907 DOI: 10.4253/wjge.v5.i10.523] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/08/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.
Collapse
|
43
|
Kim MJ, Seo JM, Lee Y, Lee YM, Choe YH. An unusual cause of duodenal perforation due to a lollipop stick. Korean J Pediatr 2013; 56:182-5. [PMID: 23646057 PMCID: PMC3641315 DOI: 10.3345/kjp.2013.56.4.182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/11/2012] [Accepted: 07/12/2012] [Indexed: 12/26/2022]
Abstract
Children have a natural tendency to explore objects with their mouths; this can result in the swallowing of foreign objects. Most ingested foreign bodies pass uneventfully through the gastrointestinal tract. However, some foreign bodies cause obstruction or perforation of the gastrointestinal tract, requiring surgical intervention. Perforation of the gastrointestinal tract may be associated with considerable morbidity and mortality. The most common sites of intestinal foreign body perforation are the ileocecal and rectosigmoid regions. Foreign body perforation of the duodenum is relatively uncommon. We report the first Korean case of duodenal perforation by an ingested 8-cm lollipop stick. Lollipops are popular with the children and fairly accessible to them, as most parents are not aware of their potential harm. Pediatric clinicians should be aware of the risks associated with lollipop stick ingestion. Our report also describes the feasibility and safety of laparoscopic diagnosis and management of pediatric patients with peritonitis induced by the ingestion of foreign bodies.
Collapse
Affiliation(s)
- Mi Jin Kim
- Department of Pediatrics, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | | | | | | | | |
Collapse
|
44
|
Rossetti A, Buchs NC, Bucher P, Dominguez S, Morel P. Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series. World J Gastrointest Surg 2013; 5:47-50. [PMID: 23556061 PMCID: PMC3615304 DOI: 10.4240/wjgs.v5.i3.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/12/2012] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists’ score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.
Collapse
|
45
|
Abstract
Despite advances in the treatment of pancreatic diseases, they remain clinical challenges. In this review article, the author summarized the key abstracts presented at 9(th) Congress of the European Hepato-Pancreato-Biliary Association, held in Cape Town, South Africa, from April 12(th) to 16(th), 2011. These studies include the endoscopy, surgery, complications, and other clinical points of the pancreatic treatment.
Collapse
|
46
|
Fujikuni N, Tanabe K, Yamamoto H, Suzuki T, Tokumoto N, Ohdan H. Triple-tube-ostomy: a novel technique for the surgical treatment of iatrogenic duodenal perforation. Case Rep Gastroenterol 2011; 5:672-9. [PMID: 22235196 PMCID: PMC3254034 DOI: 10.1159/000335742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.
Collapse
Affiliation(s)
- Nobuaki Fujikuni
- Department of Surgery, Division of Frontier Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | |
Collapse
|
47
|
Vezakis A, Fragulidis G, Nastos C, Yiallourou A, Polydorou A, Voros D. Closure of a persistent sphincterotomy-related duodenal perforation by placement of a covered self-expandable metallic biliary stent. World J Gastroenterol 2011; 17:4539-41. [PMID: 22110286 PMCID: PMC3218146 DOI: 10.3748/wjg.v17.i40.4539] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/23/2011] [Accepted: 03/30/2011] [Indexed: 02/06/2023] Open
Abstract
Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic techniques have been described to close a variety of perforations. In this case report, we describe the closure of a persistent sphincterotomy-related duodenal perforation by using a covered self-expandable metallic biliary (CEMB) stent. A 61-year-old Greek woman underwent an endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for suspected choledocholithiasis, and a retroperitoneal duodenal perforation (sphincterotomy-related) occurred. Despite initial conservative management, the patient underwent a laparotomy and drainage of the retroperitoneal space. After that, a high volume duodenal fistula developed. Six weeks after the initial ERCP, the patient underwent a repeat endoscopy and placement of a CEMB stent with an indwelling nasobiliary drain. The fistula healed completely and the stent was removed two weeks later. We suggest the transient use of CEMB stents for the closure of sphincterotomy-related duodenal perforations. They can be placed either during the initial ERCP or even later if there is radiographic or clinical evidence that the leakage persists.
Collapse
|
48
|
Lee TH, Bang BW, Jeong JI, Kim HG, Jeong S, Park SM, Lee DH, Park SH, Kim SJ. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol 2010; 16:2305-10. [PMID: 20458771 PMCID: PMC2868227 DOI: 10.3748/wjg.v16.i18.2305] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment.
Collapse
|
49
|
Qureshi AU, Khan HM, Gondal KM. Duodenal perforation in a 14-year-old boy with abdominal tuberculosis despite being on antituberculous treatment. Indian J Surg 2010; 72:69-70. [PMID: 23133210 DOI: 10.1007/s12262-010-0015-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 11/29/2008] [Indexed: 11/26/2022] Open
Abstract
We are presenting a case of a 14-year-old male patient with known history of abdominal tuberculosis on medication for 4 months with frank peritonitis and air under the diaphragm found to have primary perforation of the duodenum due to tuberculosis. Tuberculosis is common in the third world but affects iliocaecal junction commonly. Cases with tuberculous duodenal are rarely reported in the literature.
Collapse
|
50
|
Katsinelos P, Paroutoglou G, Papaziogas B, Beltsis A, Dimiropoulos S, Atmatzidis K. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips. World J Gastroenterol 2005; 11:6232-4. [PMID: 16273659 PMCID: PMC4436649 DOI: 10.3748/wjg.v11.i39.6232] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Perforation is one of the most serious complications of endoscopic sphincterotomy (ES) necessitating immediate surgical intervention. We present a case of successful management of such a complication with endoclipping. A 85-year-old woman developed duodenal perforation after ES. The perforation was identified early and its closure was achieved using three metallic clips in a single session. There was no procedure-related morbidity or complications and our patient was discharged from hospital 10 d later. Endoclipping of duodenal perforation induced by ES is a safe, effective and alternative to surgery treatment.
Collapse
Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, "G.Gennimatas" Hospital, Ethnikis Aminis 41, 54635 Thessaloniki, Greece.
| | | | | | | | | | | |
Collapse
|