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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↗
PubMed1996

Intestinal perforation in temporal arteritis, associated with paroxysmal nocturnal hemoglobinuria.

Temporal arteritis (TA) is an adult-onset, focal granulomatous inflammatory disorder of the small and medium sized arteries. Intestinal perforation is a rare complication of TA. Regarding its etiology, steroid-induced or arteritis-induced ulceration have been proposed. We describe a patient who developed TA in addition to preceding paroxysmal nocturnal hemoglobinuria. During steroid therapy for TA, intestinal perforation manifested, and it was proven to be arteritis induced perforation on histological examinations. The patient may be the 5th reported case of TA complicated with arteritis-induced intestinal perforation. The possibility of polyangitis overlap syndrome of TA and polyarteritis nodosa is discussed.

Anti-Inflammatory Agents↗
PubMed1992

Neonatal intestinal perforation due to congenital defects in the intestinal muscularis.

Congenital defect of the muscular layer of the small intestine is a rare cause of spontaneous bowel perforation in premature infants. During the last 12 years we have observed four similar cases. We describe the most recent one, a premature infant who developed two abdominal events. On her 2nd day of life, spontaneous perforation of the distal ileum due to focal absence of the muscular layer occurred. Several weeks later she developed the typical clinical and histological picture of necrotizing enterocolitis. The clinical and histological characteristics of the two different conditions are compared, and the 24 cases reported in the literature are discussed. We conclude that focal absence of intestinal musculature may be not such a rare entity as is commonly believed.

Female↗
PubMed1979

Intestinal perforation in ascariasis--case reports.

Two cases of intestinal perforation in association with ascariasis are described. In both cases adult ascarids were found either in the gut or lying free in the peritoneal cavity. Neither patient had typhoid fever, one had Hodgkin's lymphoma. The authors believe that the perforation were directly caused by the ascarids. Both patients died.

Adult↗
PubMed1994

Multiple spontaneous intestinal perforations from atheroembolism after thrombolytic therapy: a case report.

Atheroembolism after thrombolytic therapy, although rare, is unpredictable and carries a poor prognosis. Early diagnosis is difficult because of the many forms of presentation. A 76-year-old man with no history of atheromatous disease, who had received streptokinase as treatment for myocardial infarction, had lower gastrointestinal bleeding, progressive renal failure and peripheral ischemia. At laparotomy performed when the peritoneal dialysate was found to contain enteric contents, numerous ischemic small-bowel infarcts were seen, many of which had perforated. The entire intestine was involved, and despite efforts to repair the perforations, the patient had a downhill course and died 44 days after admission to hospital. In patients with disseminated atheroembolism after thrombolytic therapy, supportive care is the only treatment currently available. As thrombolytic therapy becomes more common in the treatment of myocardial infarction, greater effort will be needed to provide better treatment for patients with disseminated atheroembolism as a result of thrombolytic therapy.

Aged↗
PubMed1994

Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates.

OBJECTIVE: To better define the prognosis of neonates with gastrointestinal perforation and improve their management. METHODS: We reviewed the results of physical examinations, laboratory results, and radiographic tests of 42 patients in whom gastrointestinal perforation was diagnosed in our neonatal intensive care unit. RESULTS: Twenty-one patients had necrotizing enterocolitis and 21 had localized intestinal perforation. Perinatal history, gender, race, birth weight, and estimated gestational age were similar for both groups. Patients with localized perforation were more likely to have had an umbilical artery catheter in place within 48 hours of perforation, to have received higher doses of indomethacin, to have undergone primary surgical repair, and to have survived until discharge from the hospital. Patients with necrotizing enterocolitis were more likely to have received enteral feedings and to have had a metabolic acidosis and leukopenia at the time the perforation was diagnosed. CONCLUSIONS: We conclude that localized intestinal perforation and necrotizing enterocolitis, although similar in the organ system they affect, are distinctly different in clinical correlates and outcome. The increased awareness of localized perforations may help those taking care of neonates to diagnose this condition more accurately and to discuss its implications with family members.

Enterocolitis, Pseudomembranous↗
PubMed1994

[Malignant lymphoma of the small intestine as a cause of small intestine perforation].

The malignant non-Hodgkin-lymphoma is the main cause of spontaneous extraduodenal small intestine perforation. This rare incidence occurs as a consequence of an enteropathic associated affection manifested extranodally, mostly in the higher part of the jejunum. The diagnosis is made after a spontaneous perforation. The risk of a recurrent perforation is high. In a female patient we made the diagnosis not before resecting the small intestine.

Aged↗
PubMed1980

Spontaneous intestinal perforation in Schönlein-Henoch purpura.

Schönlein-Henoch purpura (SHP) continues to present diagnostic and therapeutic challenges to internists and to surgeons. Indications for operation in this entity are solely for intussusception, ischemic bowel necrosis, and frank bowel perforation. We present two recent cases of spontaneous small bowel perforation in SHP and analyze the previously reported cases. Spontaneous intestinal perforation is often heralded by increase in rectal blood loss, even frank melena, and a worsening or unresponsive abdominal picutre such as progressive distention and loss of bowel sounds. Perforations, usually ileal, may be accompanied by intussusception.

Humans↗
PubMed1990

[Intestinal perforation occurring at the beginning of treatment: a severe complication of bacillary tuberculosis].

We report 2 cases of intestinal perforation caused by tuberculosis and affecting the small intestine in one case and the colon in the other case. The patients were men aged 49 and 51 years respectively. Both were cachectic and presented with advanced open pulmonary tuberculosis. Perforation in free peritoneal cavity occurred 2 and 8 days respectively after an antituberculous treatment was initiated. The outcome was rapidly fatal in both cases. Tuberculous enteritis has become rare, but it can still be observed in patients with severe open pulmonary tuberculosis, where the gastro-intestinal tract is contaminated by the large number of virulent mycobacteria swallowed. In such patients clinicians must be alert to abdominal premonitory signs. Intestinal perforations in free peritoneal cavity are uncommon. Most perforation are small, single or multiple, and located on the antimesenteric side of the terminal ileum. They may occur at any time, and particularly just after an antituberculous therapy has been instituted. Clinical presentation is one of acute peritonitis requiring emergency laparotomy. Mortality has been reduced by technical improvements, notably temporary enterostomy, but perforation remains a serious and often fatal complication of tuberculosis in patients with severe malnutrition.

Antitubercular Agents↗
PubMed1997

Intestinal perforation after suction lipoplasty: a case report and review of the literature.

Intrabdominal penetration with intestinal perforation is a relatively uncommon complication after liposuction. Seven cases have been reported in the literature, with a mortality rate > 50%. Here we present a case of a perforated viscus after suction lipoplasty of the abdomen using the tumescent technique. Multiple small-bowel enterotomies were made with the suction cannula. It is our hope that a heightened awareness of this potentially life-threatening complication will promote early and aggressive diagnosis and treatment of liposuction patients who present with gastrointestinal complaints in the early postoperative period.

Abdominal Abscess↗
PubMedDate not supplied

Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion.

A case of a patient who developed an intestinal perforation secondary to a charcoal stercolith is reviewed. The case involves a young female on methadone maintenance who received multiple-dose charcoal therapy for an amitriptyline ingestion. Peritoneal signs developed several days after admission, and an exploratory laparotomy was done. A perforation measuring 4 cm in diameter was found in the posterior wall of the sigmoid colon. A 120-gm obstructing charcoal mass was found at the site of the perforation. Previous reports of intestinal obstruction secondary to charcoal inspissation are noted, and case similarities are discussed. All reported cases of charcoal obstruction involve the administration of multiple-dose-activated charcoal in the treatment of ingestions of medications known to have antiperistaltic activity. With a rare potential of mechanical obstruction, the decision to use repetitive-dose charcoal therapy should be made judiciously when the ingested toxin or coincident therapeutic medications have antiperistaltic activity.

Adult↗
PubMed1988

[Cytomegalovirus infection as a cause of intestinal perforation].

Three male patients with the acquired immunodeficiency syndrome revealed perforations of the intestine (jejunum-ileum; colon ascendens; coecum). The cause was necrosis due to cytomegalovirus infection. The characteristic findings were cytomegalic inclusion bodies in endothelial cells of the capillaries. These lesions caused alterations of the microcirculation. Therefore it seems reasonable to conclude that in these cases necrosis and perforation were due to ischemia. Cytomegalovirus infection must be taken into consideration in any patient with the acquired immunodeficiency syndrome and gastrointestinal ulcerations.

Acquired Immunodeficiency Syndrome↗