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Ullah R, Saeed S, Rafael HA, Nishat N, Rosario-Curcio J, Gul A. Co-occurrence of Tuberculous Meningitis and Intestinal Perforation in Abdominal Tuberculosis (TB): A Report of a Rare Case From Pakistan. Cureus 2024; 16:e55132. [PMID: 38558686 PMCID: PMC10979716 DOI: 10.7759/cureus.55132] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Tuberculosis (TB) remains a significant global health concern, with millions affected worldwide each year. Extrapulmonary TB, particularly involving the digestive tract and central nervous system, poses distinctive difficulties in both diagnosis and treatment. We report a case involving a 15-year-old girl with a history of intestinal TB on anti-tuberculous therapy who presented with symptoms suggestive of meningitis, along with abdominal pain and distension. Our initial suspicion was tuberculous meningitis, considering the underlining abdominal TB, which was later supported by cerebrospinal fluid analysis showing lymphocytic-predominant pleocytosis and positive acid-fast bacilli staining. Concurrently, the patient developed hemodynamic instability and severe abdominal pain, which on repeat X-rays of the abdomen showed air under the diaphragms, prompting surgical exploration and revealing multiple ileal perforations. Histopathological examination confirmed TB as the cause of perforation. This case highlights the diagnostic and therapeutic complexities of concurrent tuberculous meningitis and intestinal TB perforation. Early recognition and interdisciplinary management are crucial for optimal patient outcomes.
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Affiliation(s)
- Rizwan Ullah
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Saad Saeed
- Internal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | | | - Nadia Nishat
- Family Medicine, Adichunchanagiri Institute of Medical Sciences, Mandya, IND
| | | | - Aiysha Gul
- Obstetrics and Gynaecology, Mardan Medical Complex, Mardan, PAK
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2
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Shao H, Liu D, Zheng X, Zhang J, Li W, Chen P, Qian Z, Yang J, Liu D. Ileal perforation involvement in Wegener granulomatosis comorbid with COVID-19 infection: A case report and review of the literature. Medicine (Baltimore) 2024; 103:e36973. [PMID: 38277571 PMCID: PMC10817022 DOI: 10.1097/md.0000000000036973] [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: 10/10/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
RATIONALE Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disease. The typical clinical involvement of GPA entails the upper and lower respiratory tracts, and the kidneys. Gastrointestinal (GI) involvement is uncommon and unless detected and treated promptly, may lead to life-threatening complications such as perforation. We aim to review all available publications since the first description in 1982 dealing with GI perforation in patients with Wegener granulomatosis and draw attention to this serious situation. PATIENT CONCERNS We present a 54-year-old man diagnosed with GPA who presented initially with nasal symptoms and suffered ileal perforation following Corona Virus Disease 2019 infection. We also review previously reported patients with Wegener granulomatosis who had GI perforation to investigate the perforation site and period, pathology, diagnosis, and treatment methods. DIAGNOSES AND INTERVENTIONS The case of a GPA-diagnosed patient who presented initially with nasal symptoms and suffered ileal perforation following Corona Virus Disease 2019 infection. We recommended a renal puncture biopsy, steroids, and immunosuppressants to improve the patient condition. The patient and his family refused these treatment recommendations. OUTCOMES Our patient exhibited continued progressive vascular inflammatory changes and eventual irreversible systemic damage. These sequelae were attributed to the patient declining prednisolone and immunosuppressant therapy. LESSONS GI perforation is rare in GPA but severe complication. Consequently, we recommend that early diagnosis and treatment with steroid hormones and immunosuppressants for GPA patients with GI perforation.
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Affiliation(s)
- Huijuan Shao
- Department of Gastroenterology, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Dong Liu
- Department of Intensive Care Unit, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Xiaofeng Zheng
- Department of Gastroenterology, Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jiucong Zhang
- Department of Gastroenterology, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Wenbo Li
- Department of Intensive Care Unit, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Peng Chen
- Department of General Surgery, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Zhen Qian
- Department of Pathology, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Jie Yang
- Department of Pathology, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
| | - Dongmei Liu
- Department of Intensive Care Unit, The 940 Hospital of Joint Logistic Support Force of PLA, Lanzhou, China
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3
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Das S, Prakash S, Sunil J, Shaikh O, Balasubramanian G. A Rare Phenomenon of Stercoral Ileal Perforation in a Pregnant Woman. Cureus 2023; 15:e41529. [PMID: 37551234 PMCID: PMC10404455 DOI: 10.7759/cureus.41529] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Perforation peritonitis is one of the most common emergency presentations in Indian hospitals. Stercoral perforations are rare due to increased intraluminal pressure on the gut wall from impacted feces. This is associated with transmural necrosis. We present a 31-year-old pregnant woman who reported abdominal pain and vomiting at 34 weeks of gestation. The diagnosis was unclear from examination and imaging studies, and a provisional diagnosis of acute appendicitis was made. The patient underwent laparotomy and was found to have fecal contamination and multiple stercoral ileal perforations. The bowel segment was resected and exteriorized as a stoma.
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Affiliation(s)
- Snehasis Das
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Julia Sunil
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Gopal Balasubramanian
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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4
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Rumney S, Rajesh A, Brigmon E. Primary Gastrointestinal Diffuse Large B-cell Lymphoma Presenting as Ileal Perforation. Cureus 2023; 15:e37341. [PMID: 37182022 PMCID: PMC10169252 DOI: 10.7759/cureus.37341] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma and can rarely present as a primary gastrointestinal malignancy. Primary gastrointestinal lymphoma (PGIL) is associated with a significant risk of perforation and peritonitis, with high rates of mortality. Here we describe a case of a newly diagnosed PGIL in a previously healthy 22-year-old male presenting for new-onset abdominal pain with diarrhea. Early hospital course was characterized by peritonitis and severe septic shock. Despite multiple surgical interventions and resuscitative efforts, the patient's condition continued to deteriorate until cardiac arrest and death on hospital day five. A diagnosis of DLBCL of the terminal ileum and cecum was made by pathology post-mortem. The prognosis for these patients can be improved through early intervention with chemotherapy regimens and surgical resection of the malignant tissue. This report highlights DLBCL as a rare cause of gastrointestinal perforation that can culminate in precipitous multiorgan failure and death.
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Affiliation(s)
- Sean Rumney
- General Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Aashish Rajesh
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Erika Brigmon
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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Fatima M, Kumar S, Hussain M, Memon NM, Vighio A, Syed MA, Chaudhry A, Hussain Z, Baig ZI, Baig MA, Asghar RJ, Ikram A, Khader Y. Morbidity and Mortality Associated with Typhoid Fever Among Hospitalized Patients in Hyderabad District, Pakistan, 2017-2018: Retrospective Record Review. JMIR Public Health Surveill 2021; 7:e27268. [PMID: 33999000 PMCID: PMC8167610 DOI: 10.2196/27268] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/19/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited. OBJECTIVE To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan. METHODS We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths. RESULTS A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06). CONCLUSIONS As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.
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Affiliation(s)
- Munaza Fatima
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | - Santosh Kumar
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | - Mudassar Hussain
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | | | - Anum Vighio
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | | | | | - Zakir Hussain
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | | | - Mirza Amir Baig
- Field Epidemiology and Laboratory Training Program, Islamabad, Pakistan
| | | | - Aamer Ikram
- National Institute of Health Pakistan, Islamabad, Pakistan
| | - Yousef Khader
- Department of Public Health, Community Medicine and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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6
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Qazi SH, Yousafzai MT, Saddal NS, Dehraj IF, Thobani RS, Akhtar A, Syed JR, Kazi AM, Hotwani A, Rahman N, Mehmood J, Andrews JR, Luby SP, Garrett DO, Qamar FN. Burden of Ileal Perforations Among Surgical Patients Admitted in Tertiary Care Hospitals of Three Asian countries: Surveillance of Enteric Fever in Asia Project (SEAP), September 2016-September 2019. Clin Infect Dis 2021; 71:S232-S238. [PMID: 33258928 PMCID: PMC7705870 DOI: 10.1093/cid/ciaa1309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/21/2022] Open
Abstract
Background Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan. Methods Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue samples were collected for histopathology and blood cultures where available. Results Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0–15 (117/242; 48%) and 16–30 (89/242; 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases; 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients; 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 samples tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived. Conclusions Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi.
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Affiliation(s)
- Saqib H Qazi
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rozina S Thobani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Afshan Akhtar
- Aga Khan University Medical College, Karachi, Pakistan
| | - Jamal R Syed
- National Institute of Child Health, Karachi, Pakistan
| | - Abdul M Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Rajput D, Gupta A, Roshan R, Kumar A. Stillbirth as the primary manifestation of disseminated tuberculosis in a young immunocompetent mother with multiple perforations of the ileum. BMJ Case Rep 2021; 14:e239386. [PMID: 33563666 PMCID: PMC7875273 DOI: 10.1136/bcr-2020-239386] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis (TB), a significant cause of morbidity and mortality worldwide, is particularly relevant in low/middle-income countries like India, where the disease is endemic. The female reproductive system is very vulnerable to this infection with, the clinical presentation being utterly silent in most patients. Symptoms of TB in pregnancy may initially be attributed to the gravidity itself besides temporary concealment of associated weight loss by the normally occurring weight gain during the pregnancy. Untreated TB may cause pregnancy loss by either placental damage or direct harm to both the mother and child. We report a case of latent disseminated TB in a young immunocompetent female that was revealed in the postpartum state (after full-term stillbirth delivery at home) as 20 ileal perforations secondary to intestinal TB. Due to ongoing sepsis and delayed presentation to the hospital, the patient could not be salvaged despite the best possible efforts.
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Affiliation(s)
- Deepak Rajput
- General Surgery, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Amit Gupta
- General Surgery, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Ravi Roshan
- General Surgery, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Arvind Kumar
- Pathology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
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8
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Otaka Y, Yukawa N, Yoshida Y, Tamura J, Tsutsui T. A folded-blister pill pack causes ileal perforation. Clin Case Rep 2019; 7:2254-2255. [PMID: 31788293 PMCID: PMC6878064 DOI: 10.1002/ccr3.2440] [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: 07/23/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 11/13/2022] Open
Abstract
Ileal perforation by an accidental ingestion of a blister pill pack is rare. A detailed history of the present illness is the initial key to proceed appropriate investigations. Computed tomography is the gold standard for diagnosis of the disease.
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Affiliation(s)
- Yukihiro Otaka
- Kidney Disease and Dialysis CenterHidaka HospitalTakasakiJapan
- Department of General MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Naoko Yukawa
- Kidney Disease and Dialysis CenterHidaka HospitalTakasakiJapan
| | - Yuichi Yoshida
- Kidney Disease and Dialysis CenterHidaka HospitalTakasakiJapan
| | - Jun'ichi Tamura
- Department of General MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Takaaki Tsutsui
- Kidney Disease and Dialysis CenterHidaka HospitalTakasakiJapan
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Sundaramurthi S, H S, Raj Kumar N, Dasarathan S, D K. Delayed Presentation of Complete Ileal Transection Following Blunt Trauma Abdomen: A Condition to Cognize. Cureus 2019; 11:e5973. [PMID: 31803555 PMCID: PMC6874287 DOI: 10.7759/cureus.5973] [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] [Indexed: 11/26/2022] Open
Abstract
Isolated small bowel perforation is a rare presentation of blunt abdominal trauma, and most cases present immediately following the trauma. Delayed presentation of such cases beyond one week of trauma is extremely rare, and various pathophysiological mechanisms were described for the same. We present a 20-year-old male patient who sustained blunt abdominal and pelvic trauma, underwent open reduction and internal fixation for right acetabular fracture, and later developed features of acute peritonitis after one month. On laparotomy, complete terminal ileal transection was found and an ileostomy was done. Delayed perforation of the intestine following trauma occurs due to ischemic necrosis, either through direct trauma to the intestinal wall or indirectly by injury to the mesenteric vessels. Direct trauma to the bowel can result in large hematomas on the bowel wall, which can later perforate due to ischemia. Surgeons should be aware of this rare presentation as the management is challenging and it poses significant medico-legal sequel. Close monitoring of the patient’s vitals and examination for the development of abdominal signs along with repeat imaging at the onset of abdominal signs are cornerstones for successful management of these patients.
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Affiliation(s)
| | - Shankar H
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Nagarajan Raj Kumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Shanmugam Dasarathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, IND
| | - Kadambari D
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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10
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Iskandarani F, Hammoud C, Srour S, Pelizzo G, Nakib G, Calcaterra V, Khanafer A. Isolated Ileal Perforation in Infancy: A Lethal Initial Presentation of Hirschsprung's Disease. Pediatr Rep 2017; 9:7084. [PMID: 28706618 PMCID: PMC5494443 DOI: 10.4081/pr.2017.7084] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022] Open
Abstract
Arare case of ileal perforation, as a fatal initial presentation of total colonic aganglionosis (TCA) in infancy is reported. A 10-week-old boy, was brought to the emergency department with symptoms of complicated intestinal obstruction. He looked ill, was lethargic, markedly dehydrated and had a severely distended abdomen. An abdominal X-ray revealed multiple air fluid levels seen in a distended small intestine. During exploratory laparotomy the ileum was massively dilated with distal segment perforation. Ileal perforation repair was performed. A totally collapsed microcolon was identified. Biopsies were taken from the high rectum, sigmoid and hepatic flexure. Appendectomy and ileostomy were performed. All biopsies, as well as the appendix, showed absence of ganglion cells. Despite this procedure the patient progressively deteriorated and later died due to sepsis. Ileal perforation in infants is a rare, but potentially fatal initial presentation of TCA. Early detection is essential to prevent life-threatening complications.
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Affiliation(s)
- Fadi Iskandarani
- Faculty of Medicine, Lebanese University, Hadath, Beirut, Lebanon
- Sahel General Hospital, Ghobeiri, Beirut, Lebanon
| | - Chawki Hammoud
- Faculty of Medicine, Lebanese University, Hadath, Beirut, Lebanon
- Sahel General Hospital, Ghobeiri, Beirut, Lebanon
| | - Sarah Srour
- Faculty of Medicine, Lebanese University, Hadath, Beirut, Lebanon
- Sahel General Hospital, Ghobeiri, Beirut, Lebanon
| | - Gloria Pelizzo
- Pediatric Surgery Unit, Children's Hospital, Istituto Mediterraneo di Eccellenza Pediatrica, Palermo, Italy
| | - Ghassan Nakib
- Department of Pediatric Surgery, Medclinic Middle East, Mediclinic City Hospital Dubai, United Arab Emirates
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia
- Department of Internal Medicine, University of Pavia, Italy
| | - Amir Khanafer
- Faculty of Medicine, Lebanese University, Hadath, Beirut, Lebanon
- Sahel General Hospital, Ghobeiri, Beirut, Lebanon
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Abstract
The surgical management of the complications of Crohn disease is often challenging. These difficulties are compounded in pregnancy by competing interests of the mother and the baby. In this report, we describe the presentation and surgical management of a patient in her second trimester with active Crohn disease who required emergent surgical intervention. She had presented with the uncommon complication of a free perforation in the presence of active untreated disease.
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12
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Abstract
Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.
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Affiliation(s)
- TiJesuni Olatunji
- Department of Surgery, Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
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13
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Abstract
Forgotten foreign bodies, such as cotton sponges, gauze, or instruments, after any surgical procedure is considered a misadventure but avoidable complication. “Gossypiboma” denotes a mass of cotton that is accidentally retained in the body postoperatively. This study’s goal was to systematically review the literature on retained sponges to identify incidence, site of occurrence, time of discovery, methods for detection, pathogenesis for intraluminal migration and risk factors. Author is reporting this case in which a 45-year old woman presented with features of chronic pain abdomen following abdominal hysterectomy (first surgery) which lead to open cholecystectomy (second surgery) after two and half year of first surgery. As patients continued to have persistent abdominal pain in spite of second surgery patient went to medical gastroenterologist who advised her series of tests including colonoscopy examination. The whole colon was normal on examination but on examination of terminal portion of small bowel some intraluminal mass was visualized. Attempt to retrieve this mass lead to iatrogenic ileal perforation.
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Affiliation(s)
- Mohinder Kumar Malhotra
- Department of General Surgery, SGT Medical College, Hospital and Research Institute, Gurgaon, India
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14
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Yazaki N, Shiiba K, Ishii S, Mizoi T, Miura K, Oyama A, Tanaka N, Murata Y, Sasaki I. An unusual case of abdominal pain. Gut 2004; 53:1150, 1158. [PMID: 15247184 PMCID: PMC1774139 DOI: 10.1136/gut.2003.023929] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- N Yazaki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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