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PubMed1998

[Intestinal perforation caused by a toothpick].

Intestinal injuries are pathologies frequently caused by toothpicks. In literature are reported serious damage to the cardiovascular system, lung and systemic fatal sepsis. In literature are also reported some deaths caused by delayed diagnosis. The authors report two cases of intestinal perforation by toothpick. Both patients had accidentally swallowed the toothpick. The clinical state was compatible with acute abdomen in a 59 year old psychopathic patient and acute appendicitis in a 27 year old patient. The aim of this paper is to emphasize the importance of a careful anamnesis for detecting the swallowing of a toothpick.

Abdomen, Acute↗
PubMed1999

The role of peritoneal drainage for intestinal perforation in infants with and without necrotizing enterocolitis.

BACKGROUND/PURPOSE: This report reviews our experience using peritoneal drainage (PD) as initial therapy for intestinal perforation in premature infants with and without necrotizing enterocolitis (NEC). METHODS: A chart review was conducted of 18 consecutive premature infants who underwent PD for intestinal perforation from 1995 to 1998. Infants were divided into two groups. Group 1 consisted of eight infants who had intestinal perforation without evidence of NEC. Group 2 consisted of 10 infants who had perforation associated with evidence of NEC. A cohort of 10 infants with intestinal perforation treated with primary laparotomy between 1990 and 1995 was identified by chart review for historical control. RESULTS: All infants improved immediately after PD. In group 1, all survived. Seven (88%) recovered systemically after PD. Of these, five (63%) never required laparotomy. Two (25%) required delayed laparotomy. One infant (12%) failed to continue to improve 48 hours after PD and underwent urgent laparotomy and recovered. In group 2, eight (80%) infants survived. Six (60%) recovered from NEC after PD, but five required delayed laparotomy for obstruction or persistent drainage. Four infants (40%) failed to progress from their initial improvement after PD. Three underwent laparotomy; two recovered and one had total intestinal necrosis and died. The fourth infant died without exploration and total intestinal necrosis was discovered during autopsy. Thus, seven of eight survivors (88%) in group 2 required laparotomy at some point in their course. CONCLUSIONS: In premature infants with intestinal perforation, PD allows acute improvement and usually systemic recovery. In infants without evidence of NEC, PD may afford definitive treatment. In contrast, infants with evidence of NEC will likely require laparotomy, but initial PD may allow systemic stabilization and recovery of much of the involved intestine before laparotomy.

Drainage↗
PubMed1989

Intestinal perforation in children.

There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S. Hospital, Varanasi during a 3 year period. Enteric (typhoid) perforation (29%), intussusception (15%) Ascaris lumbricoides infestation (9%) and appendicitis (9%), which are rarities in the reported literature, were the major causes of intestinal perforation. Radiological evidence of pneumoperitoneum was seen in 88% of patients. The majority of cases in this study were older than 5 years of age (48%). Peritoneal fluid culture revealed Escherichia coli and Klebsiella to be the most common aerobic micro-organisms, while Bacteroides fragilis, Clostridia and Peptostreptococcus were the most frequent anaerobes. The overall mortality rate was high (19%).

Child↗
PubMed2003

Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth-weight infants.

BACKGROUND/PURPOSE: The optimal management of extremely low-birth-weight (ELBW) infants with intestinal perforation remains unclear. The authors evaluated ELBW neonates with intestinal perforation in whom peritoneal drainage (PD) was intended as definitive therapy. METHODS: The records of 29 consecutive ELBW infants with intestinal perforation were reviewed. All underwent PD. Survival, the need for other abdominal procedures, the transition to enteral feeding, and the incidence of cholestasis and infectious complications were noted. Variables associated with nonsurvival were assessed. RESULTS: Overall survival rate was 66%. In 24% of cases, a second abdominal procedure was required. Full feedings were achieved at a mean of 69 days. Extraabdominal infectious complications occurred in 63% of survivors, and direct bilirubin was greater than 2.0 mg/dL in 57% at 2 months. Thrombocytopenia and vasopressor requirements at the time of perforation were associated with nonsurvival. CONCLUSIONS: In this consecutive series of ELBW infants in whom PD was intended as definitive treatment for intestinal perforation survival was comparable with that found in series in which immediate laparotomy and resection were used. Few secondary abdominal procedures were required. The interval between PD and full enteral nutrition, however, was long, and the incidence of nonabdominal infectious complications and cholestasis was substantial.

Drainage↗
PubMed1997

Lead poisoning and intestinal perforations in a snapping turtle (Chelydra serpentina) due to fishing gear ingestion.

An adult male snapping turtle (Chelydra serpentina) was presented to the Tufts Wildlife Clinic with generalized weakness and limited ability to walk. A fishing hook was lodged in the corner of its mouth, monofilament line trailed from its cloaca, and radiography revealed that the turtle had ingested two additional hooks and a large sinker. The hemogram showed leukocytosis. At exploratory celiotomy, the fishing line was seen to have acted as a linear foreign body and had perforated the intestines. Multiple enterotomies were performed to remove the sinker and line, and perforations were repaired. Two of the hooks could not be surgically or endoscopically retrieved. Blood lead concentration was 3.6 ppm prior to start of chelation therapy with calcium disodium ethylenediaminetetraacetic acid and declined to undetectable levels within 6 wk. The turtle recovered and was released.

Animals↗
PubMed2000

Intestinal perforation by foreign bodies.

OBJECTIVE: To present our experience of patients who presented with intestinal perforation by foreign bodies to our hospital between 1980 and 1998. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 21 patients who presented with intestinal perforation by foreign bodies. MAIN OUTCOME MEASURES: Size of perforations, nature of foreign bodies, clinical symptoms, radiological findings, treatment and outcome. RESULTS: The most common location was the terminal ileum (n = 11), followed by the rectosigmoid junction (n = 5). The objects were mainly bone fragments and toothpicks. The diagnosis was generally made at operation, and only 4 of the 21 patients had signs of pneumoperitoneum on the preoperative abdominal film. The most common treatment was simple suture of the defect. CONCLUSIONS: Intestinal perforation by a foreign body is uncommon, and normally affects the ileocaecal and rectosigmoid regions, in which it is unusual to find pneumoperitoneum preoperatively. It must be considered in the differential diagnosis of such conditions as acute appendicitis and diverticulitis.

Adolescent↗
PubMed2000

Can falls on stairs result in small intestine perforations?

OBJECTIVE: Abusive parents often report that a fall on stairs resulted in their children's injuries. This review explores whether there is any evidence in the medical literature that a fall on stairs could be a plausible explanation for a small intestine perforation. METHODOLOGY: The English-language medical literature was searched by Medline, for a 29-year period (1970-1998), for reports of the types of injuries sustained in falls on stairs and for reports of the types of blunt abdominal trauma that result in small intestine perforations. Articles that exclusively focused on infant walker injuries or the elderly were excluded. Duodenal, jejunal, and ileal perforations were included, whereas intestinal hematomas and undescribed intestinal injuries were excluded. All types of injuries to the stomach, colon, and rectum were excluded. RESULTS: Falls on stairs were not reported to be a cause for any of the 312 cases of small intestine perforations reviewed. There were no reports of any intraabdominal injuries, including small intestine perforations, in any of the 677 cases of falls on stairs reviewed. Falls on stairs rarely resulted in any type of truncal injury. CONCLUSIONS: Although falls on stairs have been reported to be the most common cause of injury in childhood, no evidence was found to support the contention that an unobstructed fall on stairs could be consistent with perforation of the small intestine.

Abdominal Injuries↗
PubMed1995

In-utero cocaine exposure and neonatal intestinal perforation: a case report.

This article describes a case of spontaneous neonatal intestinal perforation in a preterm infant with evidence of intrauterine exposure to cocaine. Clinical, laboratory, radiological, surgical, and pathological finds were inconsistent with necrotizing enterocolitis. Three previous case reports had made the association between spontaneous focal neonatal intestinal perforation and prior intrauterine cocaine exposure; however, in each case, there were extenuating circumstances that may weaken the etiological link. The case described here appears to strengthen the association/etiological link. After all other causes of focal neonatal intestinal perforation have been excluded, the possibility of intrauterine exposure to cocaine should be considered.

Adult↗
PubMed1982

An experimental study of the effect of an intestinal perforation at various developmental stages.

The effect of an experimentally induced intestinal perforation was studied in chick embryos. In 5 different groups of embryos a perforation was induced at 5 different developmental stages, while an equal number of sham operations was carried out for each stage. The results demonstrate that the effect of an intestinal perforation is determined by the developmental stage at which this perforation occurs. There was an inverse relationship between the developmental stage at which the perforation was induced and the remaining traces of the perforation site at the end of incubation. A perforation induced at an earlier developmental stage was more likely to lead to intestinal atresia coupled with only microscopic signs of meconium peritonitis. The severity of the adhesions increased concurrently with the developmental stage.

Animals↗
PubMed1966

Radiographic diagnosis of intestinal perforation in early infancy.

Records of 25 patients with intestinal perforation in early infancy who were treated at the Los Angeles County General Hospital in a period of 15 years were reviewed. Sixteen had roentgen evidence of pneumoperitoneum, and nine did not. The mortality rate was 94 per cent in the group with pneumoperitoneum, 78 per cent in the other, and 88 per cent overall. Multiple sites in the gastrointestinal tract were involved, and the causes of the lesions were diverse and frequently obscure. Prematurity, obstetrical and iatrogenic complications, and congenital anomalies were factors often associated with intestinal perforation. Roentgen features appeared to offer the best hope for diagnosis and appropriate treatment.

Female↗
PubMed1977

Scleroderma and intestinal perforation.

We report four cases of scleroderma and intestinal perforation. There were three instances of colonic perforations, two associated with fecal impaction and stercoral ulceration and one with evidence of vasculitis. The fourth patient was an unusual instance of spontaneous perforation of the small intestine in scleroderma.

Adolescent↗
PubMedDate not supplied

Typhoid fever complicated by intestinal perforation: a persisting fatal disease requiring surgical management.

In Bangladesh, clinical records of 323 patients with typhoid fever were reviewed to study the incidence, fatality, and optimal therapy of the complication of intestinal perforation. Fifteen patients (4.6%) developed intestinal perforation. Case-fatality rates were six of nine patients treated medically and one of four patients treated surgically for whom the postoperative courses were known. A literature review of 57,864 cases of typhoid fever in developing countries in the antibiotic era revealed that perforation developed in 2.5% of patients, a percentage that was similar to the incidence of 2.8% reported in the preantibiotic era. The median of case-fatality rates in these reports was 43% and the proportion of all reported typhoid deaths attributable to perforation was 25%. The case-fatality rates for patients with perforation were 70% for 410 patients managed medically and 26% for 1,835 patients managed surgically. Although some reports were biased toward placing patients at lower risk into surgical treatment, the large number of patients treated successfully by surgery suggests real improvement in surgical techniques in countries with endemic typhoid fever. These results indicate that intestinal perforation persists as a major cause of death in cases of typhoid fever in developing countries in the antibiotic era and that surgical treatment with use of antibiotic therapy is optimal for this complication.

Adolescent↗
PubMed2002

A comparison of the clinical presentation and outcome of focal intestinal perforation and necrotizing enterocolitis in very-low-birth-weight neonates.

There is controversy about the identity of focal intestinal perforation (FIP) and necrotizing enterocolitis (NEC). To elucidate the difference between them, we reviewed their clinical presentations. Over the last 20 years, 39 very-low-birth-weight (VLBW) neonates, including 21 extremely-low-birth-weight neonates, underwent a laparotomy for intestinal perforation without mechanical causes. Nineteen patients had typical findings of NEC, and 8 had FIP. FIP is defined as isolated intestinal perforation without gross necrosis. In FIP, the gestational age was significantly lower than in NEC (23.8 +/- 1.8 vs 27.0 +/- 2.5 weeks, P < 0.01). The birth weight (BW) of FIP patients was lower than that of NEC infants (635 +/- 134 vs 883 +/- 256 g, P < 0.05). The incidence of coexistent respiratory distress syndrome (RDS) was higher in FIP compared to NEC (88% vs 37%, P < 0.05). The age at onset was younger in FIP than NEC (7.3 +/- 2.7 vs 14.4 +/- 7.9 days, P < 0.05). All patients except 1 had the sites of perforation exteriorized. There was a trend toward higher survival in FIP compared to NEC (88% vs 58%, P = 0.136). Our data clearly show differences in BW, gestational age, and association of RDS between FIP and NEC. Based on our data, prematurity and RDS appear to be the major etiologic factors of FIP. The present series supports the fact that FIP is a definite clinical entity.

Chi-Square Distribution↗
PubMedDate not supplied

Percutaneous peritoneal drainage in the management of acute intestinal perforation.

This case series describes the use of percutaneous peritoneal drainage when it is performed as the definitive treatment for acute intestinal perforation. Seven extremely low birth weight neonates who were admitted to a neonatal intensive care unit of a regional center between March 1987 and October 1992 had acute intestinal perforation. Six neonates were initially treated with percutaneous peritoneal drainage while they were under local anesthesia. Despite reports that percutaneous peritoneal drainage alone can be curative in intestinal perforation, this approach without adjunctive surgery can delay the recovery of bowel integrity.

Disease-Free Survival↗
PubMed1995

Small intestinal perforation due to cytomegalovirus infection in patients with non-Hodgkin's lymphoma.

We describe two patients with non-Hodgkin's lymphoma (NHL) who suffered cytomegalovirus (CMV)-related small intestinal perforations during the course of chemotherapy. Surgical specimens from both patients revealed histologic evidence of occlusive vasculitis and tissue destruction caused by CMV-affected cells in the submucosa and muscular walls, that may have played an important role in the pathogenesis of these perforations. Although such intestinal perforations are rare complications in NHL patients, CMV infection should be recognized as a primary etiological factor in acute abdominal crises when treating NHL patients with pharmaceutical agents including steroids. Emergency surgery and the anti-CMV agent, ganciclovir, would improve the prognoses of such patients.

Combined Modality Therapy↗
PubMed1979

Multiple intestinal perforation due to Celestin tube.

Two cases of multiple intestinal perforation caused by the nylon from the core of disintegrating oesophageal Celestin tubes migrating down the alimentary tract are described. It is suggested that Celestin tubes should not be used in patients likely to survive for more than a few months.

Aged↗
PubMed2000

[Ileus and intestinal perforation in premature infants--current trends in diagnosis and treatment].

OBJECTIVE OF STUDY: a) assessment of the relationship between ileus of premature infants and the development of intestinal perforation in premature infants, b) suggestions of an optimal therapeutic procedure. In the study children (n = 50) are included a) with intestinal perforation in conjunction with impaired excretion of meconium (n = 22), b) with an ileus state based on obstruction of the ileum by a viscous meconium treated either surgically or conservatively (n = 28). Surgical treatment involved: a) establishment of a double ileostomy (n = 28), b) insertion of a T drain into the terminal ileum (n = 8), c) removal of meconium from the gut and its primary closure (n = 2). Conservative treatment in 11 children involved irrigography with an liquid contrast substance under X-ray control. The group of children with perforation was compared with the group of children without perforation, risk factors were evaluated by statistical methods. The necessity of ventilation (P = 0.051) and gestation age (P = 0.006) proved to be statistically significant risk factors for the development of perforation. Survival was not influenced by perforation. All 11 children treated conservatively survived, of 39 operated children 26 survived (66.7%). An early start of conservative treatment of ileus of premature infants reduces markedly the risk of intestinal perforation and can thus influence the survival of low birth weight neonates.

Female↗