[Apropos of a case of intestinal perforation associated with cranial trauma].
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A 17 year old male with symptoms of acute abdomen was operated upon. The preoperative diagnosis was peptic ulcus perforation but at the operation there were multiple perforations throughout the small bowels, multiple lymphadenopathies in the mesentery of the jejunum. 60 cm small bowel resection-end to end anastomosis, raphe omentoplasty, primary repair with suture were performed. The patient got well after the operation and was discharged postoperative 14th day. The pathological diagnosis was diffuse grand cell lymphoma. We conclude that, this rare condition which we could be able to find only one case in the literature must be thought among the reasons of acute abdomen.
RATIONALE AND OBJECTIVES: The authors evaluated the complication rate of transgressing small or large bowel during intraperitoneal percutaneous catheter placement in an animal model. METHODS: Twenty-four 8-F catheters were percutaneously placed through the small and large bowel of 12 pigs. In six animals, the catheters were left in place until autopsy, whereas in the remaining six animals, the catheters were withdrawn 5 days after insertion. Computed tomographic (CT) scans were performed on days 1 and 8 after catheter placement in pigs in which catheters were in place at time of autopsy, and on days 1, 5, and 8 in pigs in which catheters were removed. RESULTS: CT results showed no abscess or peritoneal effusion, but a pneumoperitoneum was present in four animals whose signs resolved on subsequent studies. Autopsy was performed in all animals 9 days after catheter placement. No clinical complication occurred, and no significant biochemical changes were observed. At autopsy, no bowel leakage, peritonitis, or abscess was visible. Bowel and peritoneal adhesions were found around the catheter tract. There was no difference between the animals with catheters in place at the time of autopsy and the animals without catheters. There also was no difference between the group of animals with small or large bowel transgression. CONCLUSION: This study suggests that traversing the intestine during percutaneous placement of an intra-abdominal catheter should not be considered an absolute contraindication when no other approach is available.
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Intestinal perforation as a presentation of Hirschsprung disease is rare, occurring mostly in infants less than 3 months of age, usually those with long-segment disease. Hirschsprung disease may also be associated with other anomalies, that complicate the management and prognosis. Identifying Hirschsprung disease as a cause of perforation will thus help in deciding the site of colostomy and looking for associated anomalies. We report a case of Hirschsprung disease with multiple intestinal perforations and bilateral multicystic kidney disease.
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We performed cadaveric renal transplantation on a 46-year-old man on long-term hemodialysis. Methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis occurred on the fifth postoperative day and severe intestinal ulceration and perforation followed. Subtotal abdominal colectomy and the simultaneous removal of the transplant were performed. Postoperatively, disseminated intravascular coagulopathy with pancytopenia and cerebral hemorrhagic infarction developed and the patient died 40 days later.
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