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Zheng XQ, Wu DM, Chen X, Lin JX, Wang XC, Ren KH, Liu HQ, Xu RL, Yan JY. Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis. J Matern Fetal Neonatal Med 2024; 37:2250045. [PMID: 38403928 DOI: 10.1080/14767058.2023.2250045] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/15/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. METHODS The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. RESULTS The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. CONCLUSION Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.
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Affiliation(s)
- Xiu-Qiong Zheng
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Dao-Ming Wu
- Department of Ultrasonography, Clinical Medical School of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xian Chen
- Department of Obstetrics, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Jin-Xiao Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Xue-Chun Wang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Kun-Hai Ren
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Hong-Qing Liu
- Department of Obstetrics, Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Rong-Li Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
| | - Jian-Ying Yan
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Maternal-Fetal Medicine, Fuzhou, China
- Department of Obstetrics, National Key Obstetric Clinical Specialty Construction Institution of China, Fuzhou, China
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Lu Y, Mo L, Chen J, Peng W. Perforation of barium sulfate enterography in an infant: A case report. Medicine (Baltimore) 2024; 103:e37926. [PMID: 38669395 PMCID: PMC11049704 DOI: 10.1097/md.0000000000037926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 01/09/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
RATIONALE Barium peritonitis is an inflammatory response that occurs when barium accidentally enters the abdominal cavity during a barium test. In extreme circumstances, it has the potential to harm various organs and even result in death. PATIENT CONCERNS A 3-month-old infant was diagnosed with multiple organ failure after severe barium peritonitis. DIAGNOSIS Multiple organ dysfunction is associated with barium peritonitis. INTERVENTIONS The infant underwent surgical intervention and received ventilator support, anti-infection therapy, myocardial nutrition, liver and kidney protection, rehydration, circulation stabilization, and other symptomatic supportive care. OUTCOMES The patient experienced clinical death after treatment and resuscitation was unsuccessful. LESSONS Barium enema perforation complications are uncommon, but can lead to fatal injuries with a high mortality rate. This case highlights the importance of raising awareness among clinicians about the risks of gastroenterography in infants and children and actively preventing and avoiding similar serious complications. The mortality rate can be reduced by timely multidisciplinary consultation and joint management once a perforation occurs.
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Affiliation(s)
- Yixing Lu
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lixian Mo
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Junhong Chen
- Department of Pathology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wei Peng
- Department of Anesthesiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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De Raeymaeker X, Van Cauwenbergh S, Houben B, Karimi A, Sergeant G, Appeltans B. Magnets and children: a dangerous combination. Acta Chir Belg 2024; 124:156-159. [PMID: 37259806 DOI: 10.1080/00015458.2023.2219086] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Accidental ingestion of foreign bodies is a common problem in children. Fortunately, the gastrointestinal tract is quite resilient to foreign bodies. On the other hand, the ingestion of magnets can result in enormous morbidity. Because of their natural tendency to firmly adhere they can cause intestinal obstruction, pressure necrosis, fistula formation or perforation. With this case report, we aim to raise awareness of the risks that these magnets pose to children. METHODS We describe a case of intestinal perforation caused by the separate ingestion of multiple magnets from a children's toy (buckyballs, Neodymium spheres) by a two-year-old boy. A search in the Pubmed database showed some publications and varied management guidelines. RESULTS The boy was treated with an exploratory laparoscopy converted to a mini-laparotomy. We removed the four magnets through separate enterotomies. Postoperative recovery was uneventful. The boy was discharged on a postoperative day five and had no complications at three months follow-ups. CONCLUSION Accidental ingestion of multiple magnets is rare but can create a life-threatening situation in children. If the magnets are still in the stomach, endoscopic retrieval is needed. If they are beyond the stomach, in asymptomatic cases close clinical and radiographic vigilance is mandatory. When symptomatic we advise urgent removal. If treated on time, the surgical outcome is good and fast recovery is expected.
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Affiliation(s)
- X De Raeymaeker
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | | | - B Houben
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - A Karimi
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - G Sergeant
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - B Appeltans
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
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Zhou W, Ding L, Dong T, Liu X. Unusual case of acute appendicitis with perforation caused by an Ingested fish bone. Asian J Surg 2024; 47:1421-1422. [PMID: 38030492 DOI: 10.1016/j.asjsur.2023.11.111] [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: 10/19/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Wenqing Zhou
- Department of General Surgery MD, The Fifth People's Hospital of Wujiang Area, Suzhou, Jiangsu, PR China.
| | - Lei Ding
- Department of Pediatrics MD, The Fifth People's Hospital of Wujiang Area, Suzhou, Jiangsu, PR China.
| | - Tiangeng Dong
- Department of General Surgery MD, Zhongshan Hospital, Fudan University, PR China
| | - Xing Liu
- Department of Pain Treatment MD The Fifth People's Hospital of Wujiang Area, Suzhou, Jiangsu, PR China.
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Ng Hung Shin PB, Cattanach DE, Purcell S, Drysdale HRE, Gourlas P. Necrotising fasciitis secondary to an occult traumatic small bowel perforation into an inguinal hernia. ANZ J Surg 2024; 94:487-488. [PMID: 38135887 DOI: 10.1111/ans.18824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Affiliation(s)
| | | | - Shaun Purcell
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Peter Gourlas
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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6
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Matsuyama S, Fukuda A, Ohana M. Gastrointestinal: Lupus enteritis with duodenojejunal fistula causing intestinal obstruction and gastrointestinal perforation. J Gastroenterol Hepatol 2024; 39:220-221. [PMID: 37921551 DOI: 10.1111/jgh.16373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Affiliation(s)
- S Matsuyama
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
| | - A Fukuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Ohana
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
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Fuentes-Martín Á, Gregorio Crespo B, Cilleruelo-Ramos Á, Matilla JM. Bowel perforation as a late complication of pleuroperitoneal shunt. Asian Cardiovasc Thorac Ann 2024; 32:43-44. [PMID: 37993981 DOI: 10.1177/02184923231215535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Affiliation(s)
- Álvaro Fuentes-Martín
- Department of Thoracic Surgery, Clinic University Hospital of Valladolid, Valladolid, Spain
| | - Begoña Gregorio Crespo
- Department of Thoracic Surgery, Clinic University Hospital of Valladolid, Valladolid, Spain
| | - Ángel Cilleruelo-Ramos
- Department of Thoracic Surgery, Clinic University Hospital of Valladolid, Valladolid, Spain
| | - José María Matilla
- Department of Thoracic Surgery, Clinic University Hospital of Valladolid, Valladolid, Spain
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Wang CJ, Chao YJ, Liu YS, Liao FT, Chang SS, Liao TK, Lu WH, Su PJ, Shan YS. Prediction of surgical outcomes in severe encapsulating peritoneal sclerosis using a computed tomography scoring system. J Formos Med Assoc 2024; 123:98-105. [PMID: 37365098 DOI: 10.1016/j.jfma.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/18/2022] [Revised: 04/27/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND/PURPOSE Encapsulating peritoneal sclerosis (EPS) is a rare and potential lethal complication of peritoneal dialysis characterized by bowel obstruction. Surgical enterolysis is the only curative therapy. Currently, there are no tools for predicting postsurgical prognosis. This study aimed to identify a computed tomography (CT) scoring system that could predict mortality after surgery in patients with severe EPS. METHODS This retrospective study enrolled patients with severe EPS who underwent surgical enterolysis in a tertiary referral medical center. The association of CT score with surgical outcomes including mortality, blood loss, and bowel perforation was analyzed. RESULTS Thirty-four patients who underwent 37 procedures were recruited and divided into a survivor and non-survivor group. The survivor group had higher body mass indices (BMIs, 18.1 vs. 16.7 kg/m2, p = 0.035) and lower CT scores (11 vs. 17, p < 0.001) than the non-survivor group. The receiver operating characteristic curve revealed that a CT score of ≥15 could be considered a cutoff point to predict surgical mortality, with an area under the curve of 0.93, sensitivity of 88.9%, and specificity of 82.1%. Compared with the group with CT scores of <15, the group with CT scores of ≥15 had a lower BMI (19.7 vs. 16.2 kg/m2, p = 0.004), higher mortality (4.2% vs. 61.5%, p < 0.001), greater blood loss (50 vs. 400 mL, p = 0.007), and higher incidence of bowel perforation (12.5% vs. 61.5%, p = 0.006). CONCLUSION The CT scoring system could be useful in predicting surgical risk in patients with severe EPS receiving enterolysis.
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Affiliation(s)
- Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying Jui Chao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fan-Ting Liao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shen-Shin Chang
- Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ting-Kai Liao
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Hsun Lu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Jui Su
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yan-Shen Shan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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Meshay IM, Robbins JB, Wainwright J, Sonstein J, Person J, Hagedorn JC. Delayed Presentation of Bowel Injury Associated with Pelvic Fragility Fracture in Patient with Bladder Sling: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00015. [PMID: 38241445 DOI: 10.2106/jbjs.cc.23.00599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
CASE An 85-year-old woman with a history of bladder mesh sling placement sustained a pelvic fracture and extraperitoneal bladder rupture after a ground-level fall. The patient underwent cystorrhaphy and percutaneous anterior column screw placement. Free air was identified on abdominal computed tomography scan on postoperative day 5. Exploratory laparotomy revealed a sigmoid colon perforation and extensive bowel adhesions to the anterior pelvis. CONCLUSION This is the first report describing bowel injury and associated bladder rupture in a pelvic fragility fracture related to a prior bladder mesh sling. This case highlights the importance of obtaining a thorough surgical history when treating pelvic injuries.
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Affiliation(s)
- Ian M Meshay
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Jordan B Robbins
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Jared Wainwright
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Joseph Sonstein
- Division of Urology, The University of Texas Medical Branch, Galveston, Texas
| | - Joshua Person
- Division of Trauma and Acute Care Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - John C Hagedorn
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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Huang WF, Ding Y, Sun J, Zhang JY. More than meets the eye: a strange cause of bowel obstruction and perforation. Gut 2023; 72:2259-2320. [PMID: 36788017 DOI: 10.1136/gutjnl-2023-329568] [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] [Received: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Wei-Feng Huang
- Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Yi Ding
- Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jie Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Yan Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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Sasaki Y, Nakahodo J, Onishi T, Tachibana A, Minami R, Noma E, Moriguchi Y, Tabata H, Shimizuguchi R, Takao A, Shibata S, Chiba K, Arakawa T, Iizuka T, Kamisawa T. Duodenal Diverticular Perforation Treated Conservatively: Reassessing Indications for Treatment. Intern Med 2023; 62:3327-3331. [PMID: 36948615 DOI: 10.2169/internalmedicine.1211-22] [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] [Indexed: 03/24/2023] Open
Abstract
A 59-year-old woman presented with a chief complaint of melena. She had no abdominal findings, such as tenderness or tapping pain. Laboratory tests revealed a white blood cell count of 5,300 cells/μL and C-reactive protein level of 0.07 mg/dL. Inflammation and anemia (hemoglobin 12.4 g/dL) were denied. Contrast-enhanced computed tomography (CT) revealed multiple duodenal diverticula and air surrounding a descending duodenal diverticulum. Based on these findings, duodenal diverticular perforation (DDP) was suspected. Oral food intake was stopped, and nasogastric tube feeding and conservative treatment with cefmetazole, lansoprazole, and ulinastatin were begun. On day 8 of hospitalization, follow-up CT revealed the disappearance of the air surrounding the duodenum, and the patient was discharged on day 19 after the resumption of oral feeding.
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Affiliation(s)
- Yuri Sasaki
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Jun Nakahodo
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Tomoko Onishi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Ayu Tachibana
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Ryogo Minami
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Eriko Noma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Yoshiaki Moriguchi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Hiroki Tabata
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Ryoko Shimizuguchi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Satomi Shibata
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Takeo Arakawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
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Lim AM, Yap TL, Kong JY. Incarcerated hernia with ileal perforation in an extreme preterm infant. BMJ Case Rep 2023; 16:e257640. [PMID: 37914168 PMCID: PMC10626876 DOI: 10.1136/bcr-2023-257640] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
We describe a case of a premature 24 weeks gestation infant who presented with clinical lability and abdominal distention with initial concerns of necrotising enterocolitis. On further examination, a right inguinal hernia was noted and serial abdominal X-rays showed bowel loop dilatation with intramural air and no perforation. However, the hernia was recurrent and later found to be not reducible. He underwent right groin exploration. Intraoperatively, distal ileal perforation was noted and he was found to have an additional five sites of perforation. He had a stoma sited at the left iliac fossa as well as primary anastomosis at the site of the second to fifth perforations. He had a stormy postoperative period but is currently doing well. Although obstructed hernias are rare in the initial course of an extreme preterm infant, it should not be missed as a cause of intestinal obstruction and early surgical opinion should be sought.
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Affiliation(s)
- Alicia May Lim
- Neonatology, KK Women's and Children's Hospital, Singapore
| | - Te-Lu Yap
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Juin Yee Kong
- Neonatology, KK Women's and Children's Hospital, Singapore
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13
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Loberman B, Kuhnreich E, Matter I, Sroka G. Laparoscopic management of iatrogenic colon perforation. Int J Colorectal Dis 2023; 38:259. [PMID: 37889340 DOI: 10.1007/s00384-023-04550-2] [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] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Iatrogenic colon perforation (ICP) due to colonoscopy is a severe complication and is associated with significant morbidity and mortality. The global estimated incidence of ICP is 0.03% and up to 3% for diagnostic and therapeutic colonoscopies, respectively. Treatment options include endoscopic repair, conservative therapy, and surgery. Treatment decision is based on the time and the setting of the diagnosis, the type, and location of the perforation, the presence of related pathologies, the clinical status and characteristic of the patient, and surgeon's skills. We present our experience in the treatment of ICPs. METHODS A retrospective review was undertaken of all patients suffering from ICP at Bnai-Zion Medical Center between 1/1/2010 and 1/3/2021. Clinical presentation, therapeutic approach, and short-term outcomes were analyzed. RESULTS There were 51 cases of ICPs. Fourteen (27%) were diagnosed by the gastroenterologist during the procedure, 2 of whom were treated with endoscopic clips. The rest of the patients (72.5%) were diagnosed in the ER after a CT scan. Forty-three patients (84%) went on to operative management: 5 (11%) operations started with laparotomy-all were conducted in the early study period (until 2013). All other operations (88%) started with a diagnostic laparoscopy, 4 of whom (10%) were converted to laparotomy. Out of the 38 laparoscopic cases 29 (80%) were treated with primary suturing. Seven patients went on to colon resection (5 of whom with primary anastomosis). Six patients required ICU admission-with 1/38 (2%) from the laparoscopic cases, and 5/9 (55%) from the laparotomy cases. A total of 49/51 (96%) patients recovered and were discharged after 5 ± 2 for conservative and laparoscopic cases, and 12 ± 9 for open cases. CONCLUSION Laparoscopic treatment of ICP is safe and feasible in most cases. Our data supports a laparoscopic attempt at any such scenario.
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Affiliation(s)
- Boaz Loberman
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel.
| | - Eviatar Kuhnreich
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Ibrahim Matter
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
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14
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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.
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15
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Carballo-Folgoso L, Cuevas-Pérez J, Blanco-García L, Celada-Sendino M, Castaño-Fernández O. Intestinal perforation secondary to systemic mastocytosis: Report of an exceptional case. Rev Gastroenterol Mex (Engl Ed) 2023; 88:450-452. [PMID: 38129248 DOI: 10.1016/j.rgmxen.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 12/23/2023]
Affiliation(s)
- L Carballo-Folgoso
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - J Cuevas-Pérez
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - L Blanco-García
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - M Celada-Sendino
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - O Castaño-Fernández
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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16
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Shimizu T, Yoshioka M, Matsushita A, Kaneko K, Ueda J, Kawashima M, Irie T, Ono T, Furuki H, Kanda T, Mizuguchi Y, Kawano Y, Nakamura Y, Yoshida H. Causes and Management of Endoscopic Retrograde Cholangiopancreatography-Related Perforation: A Retrospective Study. J NIPPON MED SCH 2023; 90:316-325. [PMID: 37271549 DOI: 10.1272/jnms.jnms.2023_90-305] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is essential for diagnosing and treating biliopancreatic disease. Because ERCP-related perforation can result in death, therapeutic decisions are important. The aim of this study was to determine the cause of ERCP-related perforation and suggest appropriate management. METHODS Between January 1999 and August 2022, 7,896 ERCPs were performed in our hospital. We experienced 15 cases (0.18%) of ERCP-related perforation and conducted a retrospective review. RESULTS Of the 15 patients, 6 were female and 9 were male, and the mean age was 77.1 years. According to Stapfer's classification, the 15 cases of ERCP-related perforation comprised 3 type I (duodenum), 3 type II (periampullary), 9 type III (distal bile duct or pancreatic duct), and no type IV cases. Fourteen of 15 (92.6%) were diagnosed during ERCP. The main cause of perforation was scope-induced damage, endoscopic sphincterotomy, and instrumentation penetration in type I, II, and III cases, respectively. Four patients with severe abdominal pain and extraluminal fluid collection underwent emergency surgery for repair and drainage. One type III patient with distal bile duct cancer underwent pancreaticoduodenectomy on day 6. Three type III patients with only retroperitoneal gas on computed tomography (CT) performed immediately after ERCP had no symptoms and needed no additional treatment. Seven of the 15 patents were treated by endoscopic nasobiliary drainage (n=5) or CT-guided drainage (n=2). There were no deaths, and all patients were discharged after treatment. CONCLUSIONS Early diagnosis and appropriate treatment are important in managing ERCP-related perforation.
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Affiliation(s)
- Tetsuya Shimizu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Masato Yoshioka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Akira Matsushita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Keiko Kaneko
- Department of Gastroenterology, Nippon Medical School
| | - Junji Ueda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Mampei Kawashima
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Toshiyuki Irie
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Takashi Ono
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hiroyasu Furuki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Tomohiro Kanda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yoshiaki Mizuguchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yoichi Kawano
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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17
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Li K, Nambiar M, Karsz N, Anderson D. Stercoral perforation: a rare complication of faecal impaction. ANZ J Surg 2023; 93:2028-2029. [PMID: 36876953 DOI: 10.1111/ans.18332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Kenny Li
- Radiology Department, Monash Health, Monash Medical Centre, Victoria, Melbourne, Australia
| | - Mithun Nambiar
- Radiology Department, Monash Health, Monash Medical Centre, Victoria, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Melbourne, Australia
| | - Nicholas Karsz
- Radiology Department, Monash Health, Monash Medical Centre, Victoria, Melbourne, Australia
| | - Douglas Anderson
- Radiology Department, Monash Health, Monash Medical Centre, Victoria, Melbourne, Australia
- Imaging Associates Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia
- Radiology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
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18
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Lefter M, Heffernan E, Nolan N, Hanly A. Crohn's disease presenting as acute bowel perforation and superior mesenteric vein thrombosis. Ir Med J 2023; 116:750. [PMID: 37555688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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19
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Abstract
A 77-year-old man presented with abdominal pain for 1 week. He was taking enteric-coated low-dose aspirin (LDA) to prevent secondary cardiovascular events and a proton pump inhibitor (PPI). Computed tomography indicated a small intestinal perforation; thus, small intestine resection was performed. Two months after surgery, he experienced a recurrence of the perforation. Since his repeated perforation was suspected to be due to LDA, LDA was discontinued. He has experienced no further recurrence since then. This is the first case of small intestinal perforation caused by enteric-coated LDA. Enteric-coated LDA may cause small intestinal perforation in patients with severe atherosclerosis under PPI administration.
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Affiliation(s)
| | - Ken-Ei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Japan
| | - Haruo Sawada
- Department of Internal Medicine, Oida Hospital, Japan
| | - Jiro Oida
- Department of Surgery, Oida Hospital, Japan
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20
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Foula MS, Boumarah DN, Alabbad A, AlQahtani M, Alsaffar AH, Nabri M, Alshomimi S. Dilemma of Blunt Abdominal Trauma in Patients with Crohn's Disease, Can Intestinal Perforation be Missed? Med Arch 2023; 77:231-236. [PMID: 37700915 PMCID: PMC10495144 DOI: 10.5455/medarh.2023.77.231-236] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Isolated intestinal injury after blunt abdominal trauma is a rare challenging clinical entity. Patients with Crohn's disease (CD) are considered more prone to spontaneous intestinal perforation rather than normal population However, spontaneous intestinal perforation remains rare. In the literature, there are few cases reports discussing intestinal perforation after blunt abdominal trauma in CD patients. Objective Herein, we report a young male patient with CD who had missed traumatic intestinal perforation along with literature review of similar cases. Case Presentation A young male patient, known to have CD, was brought to the emergency department after a road traffic accident. He had mild tenderness over his right iliac fossa with no signs of peritonitis. His chest X-rays revealed right-sided pneumothorax. His pan-computed tomography revealed thickened terminal ileum and minimal collection between the intestinal loops that were interpreted as interval regression of his Crohn's disease. On the second day, he remained hemodynamically-stable with no signs of peritonitis but his chest X-rays showed air under diaphragm. A repeated CT showed pneumoperitoneum, air foci around the terminal ileum and mild free fluid. An ileal perforation was found around 25 cm from the ileo-cecal valve. The involved ileal segment was completely resected with double-barrel ileostomy. Conclusion Traumatic intestinal injury in patients with Crohn's disease represent both diagnostic and management dilemma. Inaccurate interpretation of radiological signs may lead to a delayed or missed diagnosis and surgical intervention. Abdominal CT scan should be routinely repeated, within 24 hours, for such patients, regardless absence of symptoms or signs suggestive of intestinal perforation.
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Affiliation(s)
- Mohammed S. Foula
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Dhuha N. Boumarah
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Aqilah Alabbad
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Motaz AlQahtani
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Ali H. Alsaffar
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mamoun Nabri
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Saeed Alshomimi
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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21
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Yilmaz S, Aydin H, Bolukbasi H. Insidious Onset of Localised Small Intestinal Perforation by Ingested Plastic Fork. J Coll Physicians Surg Pak 2022; 32:1070-1072. [PMID: 35932137 DOI: 10.29271/jcpsp.2022.08.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/19/2020] [Indexed: 06/15/2023]
Abstract
Ingestion of a foreign body is generally observed in the psychiatric patients and children. Healthy adult individuals may also swallow a foreign body unintentionally. Here, we report a case of a patient who swallowed a plastic fork and treated with laparoscopic repair. A 46-year man was admitted to the emergency room with the abdominal pain. His physical evaluation and diagnostic imaging revealed free air in the abdomen. Further imaging with CT scan showed a foreign body in the proximal ileum. On taking details of his swallowing history, he remembered swallowing a broken part of a plastic fork unwittingly during dinner. Following the removal of the foreign body, the perforation area was primarily repaired in double layers. The postoperative course was uneventful. An accurate diagnosis of the small intestinal perforation caused by the ingested foreign bodies, particularly in cases where the patient is unaware of the ingestion, can be difficult. CT scan is a useful tool when available to establish the diagnosis before the surgical intervention. Key Words: Small intestine, Perforation, Foreign body, Laparoscopic surgery.
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Affiliation(s)
- Serhan Yilmaz
- Department of General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training & Research Hospital, Istanbul, Turkey
| | - Husnu Aydin
- Department of General Surgery, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Bolukbasi
- Department of General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training & Research Hospital, Istanbul, Turkey
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22
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Bhadbhade M, Connolly E, Badiani S, Yeo D, Bhadri V. Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis. BMJ Case Rep 2022; 15:e247774. [PMID: 35473702 PMCID: PMC9045112 DOI: 10.1136/bcr-2021-247774] [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] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/13/2022] Open
Abstract
Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.
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Affiliation(s)
- Megha Bhadbhade
- Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- Department of Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - Elizabeth Connolly
- Sarcoma Unit, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarit Badiani
- Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- Department of Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - David Yeo
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Vivek Bhadri
- Sarcoma Unit, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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23
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Shinar S, Agrawal S, Ryu M, Van Mieghem T, Daneman A, Ryan G, Zani A, Chiu P, Chitayat D. Fetal Meconium Peritonitis - Prenatal Findings and Postnatal Outcome: A Case Series, Systematic Review, and Meta-Analysis. Ultraschall Med 2022; 43:194-203. [PMID: 32575129 DOI: 10.1055/a-1194-4363] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery. METHODS We retrospectively reviewed all fetuses with ultrasound findings suspicious for meconium peritonitis at a single center over a 10-year period. A systematic review and meta-analysis were then performed pooling our results with previous studies assessing prenatally diagnosed meconium peritonitis and postnatal outcome. Prenatal sonographic findings were analyzed to identify predictors for postnatal surgery. RESULTS 34 cases suggestive of meconium peritonitis were diagnosed at our center. These were pooled with cases from 14 other studies yielding a total of 244 cases. Postnatal abdominal surgery was required in two thirds of case (66.5 %). The strongest predictor of neonatal surgery was meconium pseudocyst (OR [95 % CI] 6.75 [2.53-18.01]), followed by bowel dilation (OR [95 % CI] 4.17 [1.93-9.05]) and ascites (OR [95 % CI] 2.57 [1.07-5.24]). The most common cause of intestinal perforation and meconium peritonitis, found in 52.2 % of the cases, was small bowel atresia. Cystic fibrosis was diagnosed in 9.8 % of cases. Short-term neonatal outcomes were favorable, with a post-operative mortality rate of 8.1 % and a survival rate of 100 % in neonates not requiring surgery. CONCLUSION Meconium pseudocysts, bowel dilation, and ascites are prenatal predictors of neonatal surgery in cases of meconium peritonitis. Fetuses with these findings should be delivered in centers with pediatric surgery services. Though the prognosis is favorable, cystic fibrosis complicates postnatal outcomes.
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Affiliation(s)
- Shiri Shinar
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Swati Agrawal
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Michelle Ryu
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital Sidney Liswood Health Sciences Library, Toronto, Canada
| | - Tim Van Mieghem
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Alan Daneman
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Greg Ryan
- Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
| | - Augusto Zani
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Priscilla Chiu
- Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - David Chitayat
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital Sidney Liswood Health Sciences Library, Toronto, Canada
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24
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Wiesler B, Linke KS, Delko T. Rare case of an 83-year-old woman with transrectal small bowel evisceration caused by spontaneous rectal perforation. BMJ Case Rep 2022; 15:e246965. [PMID: 35140088 PMCID: PMC8830219 DOI: 10.1136/bcr-2021-246965] [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] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/03/2022] Open
Abstract
Spontaneous rectal perforation with transanal small intestinal evisceration is a rare condition. We report the case of an 83-year-old woman with a rectal perforation and transanal prolapse of small intestine through the rectal opening who was treated with transanal reposition under general anaesthesia and open Hartmann's procedure. As part of the Hartmann's procedure, segmental resection of the perforated colon was performed. This case illustrates that spontaneous rectal perforation is a severe surgical emergency, which needs immediate reposition and resection of the perforated rectum.
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Affiliation(s)
- Benjamin Wiesler
- Center for Gastrointestinal and Liver Diseases, Clarunis, University Hospital of Basel, Basel, Switzerland
| | - Katja Simone Linke
- Center for Gastrointestinal and Liver Diseases, Clarunis, University Hospital of Basel, Basel, Switzerland
| | - Tarik Delko
- Center for Gastrointestinal and Liver Diseases, Clarunis, University Hospital of Basel, Basel, Switzerland
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25
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Malik R, Leviter J, Gross I, Saluja S, Cowles RA, Riera A. Point-of-Care Ultrasound to Evaluate the Acute Abdomen: A Case of Bowel Perforation After Unknown Single Magnet Ingestion. Pediatr Emerg Care 2022; 38:e1022-e1024. [PMID: 34116554 DOI: 10.1097/pec.0000000000002460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We report the case of a 3-year-old boy who presented to the pediatric emergency department in undifferentiated shock with an acute abdomen. Point-of-care ultrasound revealed viscous perforation with a large amount of free fluid. Intraoperatively, a single magnet was discovered as the likely cause of bowel perforation and the resulting state of shock.
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Affiliation(s)
- Rabia Malik
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics
| | - Julie Leviter
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics
| | - Isabel Gross
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics
| | - Saurabh Saluja
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Robert A Cowles
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Antonio Riera
- From the Section of Pediatric Emergency Medicine, Department of Pediatrics
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26
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Obana T, Yamasaki S. [A case of duodenal perforation due to ingested fishbone with retroperitoneal abscess formation where surgical drainage was necessary after endoscopic removal]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:744-749. [PMID: 35944992 DOI: 10.11405/nisshoshi.119.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A female in her 60s was referred to our institution with epigastric pain and abdominal fullness persisting for one week. She was afebrile and mild abdominal tenderness was found on physical examination. Computed tomography (CT) revealed free air, and the dirty fat sign outside the duodenal wall. Her previous CT had not shown causative findings such as duodenal diverticula. A slightly high-attenuated linear structure penetrating the duodenal wall at the second portion was suspected after review of present CT images. Based on the history of her current illness, the possibility of mackerel bone ingestion was considered. Esophagogastroduodenoscopy (EGD) revealed a fishbone sticking out of the duodenal wall, which was extracted with biopsy forceps. Although antibiotic treatment under fasting was continued, the formation of retroperitoneal abscess was detected by CT on the 6th postprocedural day. Given that she also developed a high fever, surgical drainage was performed. The patient was discharged on the 15th postoperative day. Thus, in cases of duodenal perforations, a fishbone should be taken into account as a possible cause. Even if endoscopic removal was initially selected, careful observation is mandatory and an additional treatment should be considered depending on the clinical course.
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Affiliation(s)
- Takashi Obana
- Department of Gastroenterology, Kyojinkai Komatsu Hospital
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27
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Abstract
BACKGROUND To find the predictor of optimal surgical timing for neonatal necrotizing enterocolitis (NEC) patients by analyzing the risk factors of conservative treatment and surgical therapy. METHODS Data were collected from 184 NEC patients (Surgery, n=41; conservative treatment, n=143) between the years 2015 and 2019. Data were analyzed by univariate analysis, and multivariate binary logistic regression analysis. RESULTS Univariate analysis showed that statistically significant differences between the surgery and conservative treatment groups. The results of multivariate Logistic regression analysis indicated intestinal wall thickening by B-ultrasound and gestational age were independent factors to predict early surgical indications of NEC (p < 0.05). The true positive rate, false positive rate, true negative rate and false negative rate in the diagnosis of necrotic bowel perforation guided by DAAS (Duke abdominal X-ray score) ≥7 and MD7 (seven clinical metrics of metabolic derangement) ≥3 were 12.8%, 0.0%, 100.0% and 87.2%, respectively. CONCLUSIONS In summary, the ultrasound examination in NEC children showing thickening intestinal wall and poor intestinal peristalsis indicated for early operation.
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Affiliation(s)
- Lei Yu
- Departments of Hospital Infection Administration, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Chao Liu
- Departments of Neonatal General Surgery, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yanhua Cui
- Departments of Hospital Infection Administration, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Linlin Xue
- Departments of Hospital Infection Administration, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Lishuang Ma
- Departments of Neonatal General Surgery, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
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28
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Kawano S, Tsuchiya Y, Motegi S, Sugimoto K, Inami Y, Asaoka D, Ishibiki Y, Iwanuma Y, Sakamoto K, Fukunaga M. [Management of a perforated duodenal diverticulum using an endoscopic nasobiliary drainage tube:a case report]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:47-52. [PMID: 35022370 DOI: 10.11405/nisshoshi.119.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A man in his 70s visited our hospital for abdominal pain. Upon admission, abdominal computed tomography findings suggested a duodenal diverticular perforation. Upper gastrointestinal endoscopy revealed an incarcerated enterolith in the periampullary diverticulum. We achieved conservative management by inserting an endoscopic nasobiliary drainage tube into the duodenal diverticulum to aid drainage. The patient was discharged without serious complications 35 days after admission. We report a case of duodenal diverticular perforation with an incarcerated enterolith managed conservatively using endoscopic therapy.
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Affiliation(s)
- Shingo Kawano
- Department of Surgery, Gastrointestinal Surgery, Juntendo Tokyo Koto Geriatric Medical Center
- Department of Coloproctological Surgery, Juntendo University
| | - Yuki Tsuchiya
- Department of Surgery, Gastrointestinal Surgery, Juntendo Tokyo Koto Geriatric Medical Center
| | - Shunsuke Motegi
- Department of Surgery, Gastrointestinal Surgery, Juntendo Tokyo Koto Geriatric Medical Center
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Juntendo University
| | - Yoshihiro Inami
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center
| | - Yoshiro Ishibiki
- Department of Surgery, Gastrointestinal Surgery, Juntendo Tokyo Koto Geriatric Medical Center
| | - Yoshimi Iwanuma
- Department of Surgery, Gastrointestinal Surgery, Juntendo Tokyo Koto Geriatric Medical Center
| | | | - Masaki Fukunaga
- Department of Surgery, Gastrointestinal Surgery, Juntendo Tokyo Koto Geriatric Medical Center
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29
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Aydin I, Sengul I. Case series: isolated small bowel perforations, secondary to blunt abdominal traumas. Ann Ital Chir 2022; 93:174-177. [PMID: 35476668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Isolated small bowel trauma after blunt abdominal trauma is rare and diagnosis may be difficult. The method used in the diagnostic is computed tomography so there is no consensus on this issue. Difficulty in diagnosis and delay in treatment can cause increased morbidity and mortality. We present the diagnosis and treatment modalities of interesting three cases, admitted to the Emergency Service with the complaint of blunt abdominal trauma and were found to have isolated small bowel perforations. Isolated small bowel perforation is secondly seen in cases with blunt abdominal trauma. To this end, a careful examination and the way of the trauma that occurs are crucial for diagnosis. Of note, we postulate that a physician should remain vigilant whether taking the decision of immediate operation to be able to attenuate the morbidity and mortality for a blunt trauma phenomenon. KEY WORDS: Trauma, Blunt trauma; Small bowel perforation; Emergency.
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Yaryura Montero JG, Zanatta Scattolini J, García Fascio H, García JS, Romero Reyna GH, Ferrero CI. Jejunal perforation secondary to kick during kick-boxing practice: laparoscopic management. Medicina (B Aires) 2022; 82:448-451. [PMID: 35639069] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.
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Affiliation(s)
| | | | | | - José S García
- Departamento de Cirugía General, Sanatorio Allende, Córdoba, Argentina
| | | | - Carlos I Ferrero
- Departamento de Cirugía General, Sanatorio Allende, Córdoba, Argentina
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Wu KH, Young YR, Guo DY, Chang KC, Hsiao CT, Chang CP. A Woman with Acute Right Upper Abdominal Pain. Ann Emerg Med 2021; 78:e77-e78. [PMID: 34688447 DOI: 10.1016/j.annemergmed.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Kai-Hsiang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Yui-Rwei Young
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Di-You Guo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Kao-Chi Chang
- Department of Gastroenterology, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | - Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
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Thees-Laurenz R. Covered Perforation of the Ileum Caused by an Ingested Blister Pill Pack - A Rare Sonographic Diagnosis. Ultraschall Med 2021; 42:553-554. [PMID: 32207124 DOI: 10.1055/a-1123-1594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ruth Thees-Laurenz
- Central interdisciplinary Sonography KH Barmherzige Brüder, Trier, Germany
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Abstract
A 72-year-old women was referred to our hospital because of lower left abdominal pain. Computed tomography showed prominent sigmoid colon dilation and double tumors on both the oral and anal sides. Surgical resection revealed an expanded sigmoid colon involved in double cancer that showed strong adhesion to the surrounding tissues. The pathological findings revealed obstructive colitis and minor perforation in the dilated colon. The minor perforation was considered to have been caused by fecal impaction in the closed cavity between the two tumors, resulting in an increase in colon pressure.
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Affiliation(s)
- Toshihiro Morita
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Japan
- Department of Surgery, Hamamatsu Rosai Hospital, Japan
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
| | | | | | - Yuji Ota
- Department of Surgery, Hamamatsu Rosai Hospital, Japan
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Abstract
Background Appendicectomy is a common emergency operation. The aim of this analysis was to study the effect of preoperative delay on disease progression, and whether a novel scoring system (Atema score) could be useful in predicting complicated appendicitis. Methods Patients with uncomplicated acute appendicitis on CT and who underwent appendicectomy in 2014–2015 were analysed for patient characteristics, preoperative delay and outcomes. Results Of 837 patients with uncomplicated appendicitis on CT, 187 (22.3 per cent) were found to have complicated appendicitis at surgery. The median time estimate for perforation was 25.4 h after CT, with an hourly rate of perforation of 2 per cent. Patients with an Atema score of 6 or less and those with no appendicolith on CT and a C-reactive protein level below 51 mg/l were the slowest to develop perforation, reaching a perforation rate of 5 per cent in 7.1 and 7.6 h respectively. Conclusion A substantial proportion of patients with uncomplicated acute appendicitis on CT have complicated appendicitis at surgery. However, in patients with no risk factors, surgery can be postponed safely for up to 7 h.
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Affiliation(s)
- K Lastunen
- Correspondence to: Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00029 Helsinki, Finland (e-mail: )
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Urru A, Romano N, Melani EF, Rollandi GA. An unusual cause of large bowel perforation: ingestion of a clam valve. Intern Emerg Med 2021; 16:225-226. [PMID: 32562205 DOI: 10.1007/s11739-020-02409-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Alessia Urru
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, 16132, Genoa, Italy.
| | - Nicola Romano
- Department of Area Radiologica, E.O. Ospedali Galliera, 16128, Genoa, Italy
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Kriegler T, Majernik J, Ninger V. Perforation of descending colon diverticulum by swallowed rabbit bone - a case report. Rozhl Chir 2021; 100:94-96. [PMID: 33910343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Authors present a case of a 58-year old pacient that underwent acute surgery for perforation of descending colon diverticulum by swallowed rabbit bone. The thesis focuses only on foreign bodies swallowed by adult patients. Comprehensive spectrum of foreign bodies that have entered the digestive tract in another way is omitted.
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Sert OZ. Multiple small bowel perforation in a young adult female due to Rapunzel Syndrome. Ann Ital Chir 2020; 9:S2239253X20034258. [PMID: 33170155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Rapunzel's syndrome is the state of the gastric trichobezoar (hair ball) extending to the small intestine. Although it is seen very rarely, it is a psychiatric and mental illness especially in young women. We present here, a young female with recurrent trichotillomania. CASE PRESENTATION In a 24-year-old patient who underwent laparotomy due to recurrent trichobezoar, which completely filled the stomach and extended to the small intestine, caused perforation in two places in the small intestine, was removed by gastrotomy and enterotomy. One of the perforated areas was very close to ligament of Treitz, and perforation occurred due to the ulcer caused by trichobezoar. Post-operative central total parenteral nutrition was given and oral intake was started at the end of the first week. The patient was referred to psychiatry and antipsychotic medication was started. She was discharged on the 9th postoperative day without any problem. CONCLUSION Although there are no signs of peritonitis in such Rapunzel syndrome cases, a detailed exploration should be made by keeping in mind that trichobezoar will cause ulceration and perforation. In addition, as the primary cause is the underlying psychiatric disorder, patients should be referred to the psychiatry clinic to prevent recurrence. KEY WORDS Adult, Rapunzel syndrome, Surgery, Trichobezoar, Trichotillomania.
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Schumacher C, Decker G, Ries F. Esophageal stent migration leading to distal small bowel perforation. Acta Gastroenterol Belg 2020; 83:663-665. [PMID: 33321027] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Covered oesophageal stents are often used to treat dysphagia in patients with inoperable oesophageal cancer. Stent migration is a well-known but usually benign complication. We report the case of a patient whose esophageal stent migrated into the distal ileum with perforation hereof. A laparoscopic stent extraction and intestinal repair was necessary to treat the perforation.
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Affiliation(s)
- C Schumacher
- Medical Oncology Intern, CHU de Liège, Liège, Belgium
| | - G Decker
- Department of Thoracic and General Surgery, Hôpitaux Robert Schuman, Luxembourg
| | - F Ries
- Department of Medical Oncology, Centre Hospitalier Luxembourg
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Anker JP, Córdova H, Guerrero JA, Fernández-Esparrach G, Cuatrecasas M. Colonic perforation after piecemeal mucosectomy diagnosed by confocal microscopy. Gastrointest Endosc 2020; 92:971-973. [PMID: 32376329 DOI: 10.1016/j.gie.2020.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Javiera P Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Henry Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José A Guerrero
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Pathology Department, CDB, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Banc de Tumors Biobanc Clinic-IDIBAPS, Barcelona, Spain
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Manco G, Caramaschi S, Malagoli M, Bonetti LR, Rossi A. Laparoscopic treatment of Meckel's diverticulum perforation caused by a chicken bone. A case report. Ann Ital Chir 2020; 9:S2239253X20032740. [PMID: 33337432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We describe an uncommon case of a Meckel's diverticulum perforation by a chicken bone in a patient with symptoms of acute appendicitis. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. The incidence is approximately 2% of the population. Most patients are asymptomatic, only 4-16% presenting complications, including bleeding, obstruction, and diverticulitis. The perforation due to a foreign body is a very infrequent complication and may have a bad prognosis in case of a delayed diagnosis. Only in a few cases, a careful evaluation of the CT scan leads to correct preoperative diagnosis. Definitive treatment is surgical intervention and should not be delayed in patients with peritonitis. Laparoscopy is a safe diagnostic and therapeutic tool to treat complicated Meckel's diverticulum. In our case, a stapled laparoscopic diverticulectomy has been performed with an excellent outcome. KEY WORDS: Laparoscopy, Meckel's diverticulum, Perforation.
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41
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Bartolo AD, Sircar S, Mitchell R. Post-partum duodenal perforation. N Z Med J 2020; 133:97-99. [PMID: 32525866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Sikhar Sircar
- Senior Medical Officer, Mid Central District Health Board, Palmerston North
| | - Rose Mitchell
- Trainee Intern, Mid Central District Health Board, Palmerston North
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E Silva GS, Gomes NBN, Pacheco EO, Bezerra FMR, Nunes RB, Mcphee HL, Torres US, D'Ippolito G. Emergency CT of abdominal complications of ingested fish bones: what not to miss. Emerg Radiol 2020; 28:165-170. [PMID: 32504281 DOI: 10.1007/s10140-020-01800-6] [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] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Fish bones are the most commonly ingested structures and the most common cause of foreign body perforation of the gastrointestinal tract (GIT). Clinical presentation of foreign body GIT perforation is nonspecific, in many cases with clinical signs of acute abdomen, which can mimic appendicitis, diverticulitis, ulcer peptic disease, and other common inflammatory conditions. Besides, patients commonly do not refer that a fish bone was swallowed. Since this condition is usually not suspected by referring physicians of the emergency department (ED), radiologists play a key role in this diagnosis; the spectrum of these imaging features must be known in order to be accurately reported in the ED.
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Affiliation(s)
- Gabriella Souza E Silva
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Natália Borges Nunes Gomes
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eduardo Oliveira Pacheco
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Ulysses S Torres
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil.
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Giuseppe D'Ippolito
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
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Portelli Tremont JN, Barnes E, Woodham C, Udekwu PO. A Perforated Small Bowel GI Stromal Tumor: An Unsuspecting Diagnosis in a Patient with Focal Peritonitis. Am Surg 2020; 86:e208-e209. [PMID: 32391782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Arnold MJ, Jonas CE, Carter RE. Point-of-Care Ultrasonography. Am Fam Physician 2020; 101:275-285. [PMID: 32109031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.
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Affiliation(s)
- Michael J Arnold
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Wang VY, Wang VL, Kao L, Elwood DR. A Complex Game of Go Fish: A Hybrid Endoscopic and Surgical Approach to a Fish Bone Perforation of the Portal Vein. Am Surg 2020; 86:e153-e155. [PMID: 32223827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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46
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Riedesel EL, Weber BC, Shore MW, Cartmill RS, Ostlie DJ, Leys CM, Gill KG, Kohler JE. Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis. Pediatr Radiol 2019; 49:1726-1734. [PMID: 31342129 DOI: 10.1007/s00247-019-04475-5] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/22/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recent clinical trials in adults and children have shown that uncomplicated acute appendicitis can be successfully treated with antibiotics alone. As treatment strategies for acute appendicitis diverge, accurate preoperative diagnosis of complicated appendicitis and appendiceal perforation has become increasingly important for clinical decision-making. OBJECTIVE To examine diagnostic performance of ultrasound for detecting perforated appendicitis in a single institution using a standardized technique. MATERIALS AND METHODS In this retrospective single-center study we evaluated 113 ultrasounds from pediatric patients who underwent appendectomy between November 2014 and December 2015. All ultrasounds were performed using a standardized US protocol including still and cine images of all four abdominal quadrants, with more targeted evaluation of the right lower quadrant (RLQ) using graded compression technique. We compared US findings to intraoperative diagnosis of non-perforated or perforated acute appendicitis. RESULTS The standardized image protocol generated a reproducible set of ultrasound images in all cases. The most common primary appendiceal finding on US in perforated appendicitis was appendix wall thickening >3 mm (54%, 171/314) and most common secondary finding was echogenic mesenteric fat (75%, 237/314). Thinning of the appendix wall and loculated fluid collection in the right lower quadrant were both highly specific (>90%) for perforation. CONCLUSION The diagnostic performance of ultrasound using a standardized US technique was similar to that reported in prior studies for detecting perforated appendicitis. Despite low sensitivity, individual ultrasound findings and overall diagnostic impression of "evidence of appendix perforation" remain highly specific.
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Affiliation(s)
- Erica L Riedesel
- Division of Pediatric Radiology, Children's Healthcare of Atlanta and Emory University, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Blake C Weber
- Department of Pediatric Surgery, University of Wisconsin, Madison, WI, USA
| | - Matthew W Shore
- Division of Pediatric Radiology, University of Wisconsin, Madison, WI, USA
| | - Randi S Cartmill
- Department of Pediatric Surgery, University of Wisconsin, Madison, WI, USA
| | - Daniel J Ostlie
- Department of Pediatric Surgery, Phoenix Children's Hospital and University of Arizona, Phoenix, AZ, USA
| | - Charles M Leys
- Department of Pediatric Surgery, University of Wisconsin, Madison, WI, USA
| | - Kara G Gill
- Division of Pediatric Radiology, University of Wisconsin, Madison, WI, USA
| | - Jonathan E Kohler
- Department of Pediatric Surgery, University of Wisconsin, Madison, WI, USA
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48
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Reddy CA, Bishu S, DiMagno MJ. Perforated Meckel's Diverticulitis Mimicking Penetrating Crohn's Disease. Clin Gastroenterol Hepatol 2019; 17:e105. [PMID: 30031176 DOI: 10.1016/j.cgh.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Affiliation(s)
| | - Shrinivas Bishu
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J DiMagno
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
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49
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González Ávila B, Muñoz Gost N, Anton Nieto E. [Chilaiditi sign and differential diagnosis with intestinal perforation]. Rev Esp Geriatr Gerontol 2019; 54:242-243. [PMID: 30755331 DOI: 10.1016/j.regg.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Bárbara González Ávila
- Unidad de Convalecencia, Centro Sociosanitario Albada, Corporación Sanitaria ParcTaulí, Sabadell, Barcelona, España.
| | - Neus Muñoz Gost
- Unidad de Convalecencia, Centro Sociosanitario Albada, Corporación Sanitaria ParcTaulí, Sabadell, Barcelona, España
| | - Esperanza Anton Nieto
- Unidad de Convalecencia, Centro Sociosanitario Albada, Corporación Sanitaria ParcTaulí, Sabadell, Barcelona, España
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50
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Mehmetoğlu F. Analysis of the use of upright abdominal radiography for evaluating intestinal perforations in handlebar traumas: Three case reports. Medicine (Baltimore) 2019; 98:e15889. [PMID: 31169697 PMCID: PMC6571247 DOI: 10.1097/md.0000000000015889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Intestinal perforations due to blunt abdominal handlebar trauma are difficult to diagnose. This report presents a retrospective analysis of 3 patients with intestinal perforations due to abdominal bicycle handlebar trauma who were diagnosed via upright abdominal radiography. PATIENTS CONCERNS All the patients lost their balance while riding a bicycle for leisure and had fallen on the handlebar tip. The patients were initially misdiagnosed at different-level health centers despite various radiologic investigations performed. DIAGNOSIS The patients' intestinal perforations were diagnosed via plain upright abdominal X-ray radiography (UAXR) in our institution. INTERVENTIONS AND OUTCOMES The children underwent exploratory laparotomy due to intestinal perforations. All the perforations were repaired either with primary closure or bowel resection and anastomosis with successful outcomes. LESSONS Pneumoperitoneum due to intestinal perforation can be diagnosed via UAXR with appropriate patient positioning and timing. This case series shows that to accurately diagnose intestinal perforations, upright plain X-ray should be routinely performed, carefully evaluated, and repeated in patients with enduring abdominal complaints.
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