Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Perforations”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMedDate not supplied

[Esophageal perforation: which factors affect the prognosis? Results of a 10-year experience].

Oesophageal perforations are a catastrophic event with a 10-40% mortality rate. The decisive prognostic factor is the time from the event to the diagnosis, while there is no agreement as to the therapeutic options. The aim of this study was to present our ten-year experience in the treatment of oesophageal perforations together with an evaluation of the prognostic factors. From January 1995 to January 2005, 18 patients (11 M, 7 F), mean age 49.3 years (range: 22-79), with oesophageal perforations were treated in our department. They were classified according to the cause and localization of the perforation and the time elapsing since the event. The perforation was localised in the cervical oesophagus in 4 patients (22.2%), in the abdominal oesophagus in 4 patients (22.2%) and in the thoracic oesophagus in 10 patients (55.5%). It was spontaneous in 4 patients (22.2%), traumatic in 4 (22.2%) and iatrogenic in the remaining 10 (55.5%). In 7 patients (38.9%), the treatment was started during the first 24 hours from the event, while the remaining 11 (61.1 %) were referred to us more than 24 hours after the perforation occurred. The overall mortality was 27.8% (5 patients). The only decisive prognostic factor was the time of observation: only 1 patient (14.3%) died in the group observed in the first 24 hours, while the remaining 4 who died (36.4%) were in the group treated more than 24 hours after the event (p < 0.05). Our series confirms that the time elapsing from the event to the diagnosis is the only decisive prognostic factor in the treatment of oesophageal perforations. There is no therapeutic option of choice since there is no significant influence of either cause or localisation of the perforation on outcome.

Adult↗
PubMed1991

[Studies of selective non-surgical therapy in perforated duodenal ulcer indicated by gastrografin test].

One hundred ml of Gastrografin was administered through the gastric tube to each of ten subjects with duodenal ulcer perforation and to each of twenty subjects which had no gastrointestinal perforation. Urine was collected from the subjects every 10 minutes up to 180 minutes following the administration of gastrogratin. The iodine level of every urine sample was assayed using inductively coupled plasma atomic emission spectrometry. The iodine level of seven subjects with open duodenal ulcer perforation was higher than the mean +2 = SD of urine from the subjects without gastrointestinal perforations. Two of the subjects had no leakage of Gastrografin demonstrated intra-abdominally during an upper gastrointestinal series. The urine iodine level of subjects with closed duodenal perforation was lower than the mean +2 X SD of urine from the subjects without gastrointestinal perforations. One of the subjects was selected non-surgical therapy, and two other subjects which underwent emergent surgery may also have been candidates for non-surgical therapy, as suggested by its indications. The above results suggest that patients with duodenal ulcer perforation but without intra-abdominal leakage of Gastrografin and urine iodine level lower than the mean +2 X SD of urine from subjects without gastrointestinal perforation following Gastrografin administration may be selectable for non-surgical therapy.

Adolescent↗
PubMed1991

[Treatment of perforated peptic ulcer using the round ligament under celioscopy].

We propose an original technique of treatment of perforated peptic ulcer with celioscopic monitoring which has principles and indications similar to those of simple surgical suture via laparotomy. The procedure consists in obliterating the ulcerous perforation with the round ligament (RL) that has previously been predicled from its insertion on the liver, under celioscopy. The umbilical end of the RL is then caught with a Dormia probe inserted through the perforation with a fibrogastroscope. By pulling the probe, the RL is then inserted into the perforation and obturates it. Peritoneal washing and transcutaneous infrahepatic drainage complete the procedure. This was proposed to 9 patients (8 M, 1 F) with a mean age of 41 years (24-59) having ulcers perforated for less than 6 hours. The obliteration of the perforation using the RL was performed easily in 7 cases. In 3 cases, the procedure could not be carried out, either because the diameter of the perforation exceeded 1.5 cm (n = 2) or because of purulent peritonitis (n = 1). No postoperative complications occurred. The endoscopic control showed healed ulcers in all cases after 5 weeks of treatment with anti-H2 drugs. These still preliminary results suggest that the celioendoscopic treatment of perforated peptic ulcers might be proposed whenever vagotomy does not seem to be absolutely necessary, especially in cases of acute ulcer occurring in younger subjects. In comparison with laparotomy, this procedure prevents parietal sequellae and improves the postoperative comfort. This procedure might also be proposed as an alternative to Taylor's procedure, thus avoiding the diagnostic errors and delays in surgery that are inherent in this therapeutic method.

Adult↗
PubMedDate not supplied

[Laparoscopy in the treatment of uterine perforation in induced abortions].

From 1981 to 1988, 32 uterine perforations per 44,052 artificial abortions (0.07%) were recorded. Also three more perforations having occurred outside the Department were treated. In two patients the perforation was done by a probe and the evacuation of the uterus was completed vaginally. Six perforations were in the parametrium, producing no injury of the serosa; three of them required laparotomy because of abundant bleeding (laparotomy had to be applied previously in the two) and in the remaining 27 patients the uterine corpus was perforated either by a dilatator, forceps, curette or aspiration cannula. If the injuries of the abdominal organs were evident, laparotomy was applied in the first place (in two patients) and the same was done in perforations by the aspiration canulla with the inclusion of the negative pressure (three patients). In 28 patients laparoscopy was applied, three of them having been selected for laparotomy. Out of the remaining 25 patients, the perforation opening in 22 was treated endothermically by the low voltage current or electrocoagulation by a probe of high frequency current to stop bleeding. In three patients the uterus was adequately contracted, there was no bleeding from the edges of the perforation opening and therefore no coagulation was necessary.

Abortion, Induced↗
PubMed1989

Factors responsible for the high perforation rate seen in early childhood appendicitis.

The incidence of perforated appendicitis has remained high in the infant and young child resulting in substantial morbidity. The purpose of the present study was to investigate the factors contributing to the high perforation rate seen in this age group. A retrospective analysis was done on 77 patients under the age of seven who underwent appendectomy for appendicitis. The perforation rate was 72.7 per cent. Duration of pain correlated with patient age and perforation rate. Under the age of five, only 17 per cent had symptoms for less than 36 hours. Children with symptoms that lasted longer than 48 hours had a perforation rate of 98 per cent. Associated illnesses including respiratory infections, otitis media, and gastroenteritis were common in both simple and perforated appendicitis, often leading to a delay in diagnosis. Of patients with perforation, 36 per cent were seen at least once by the primary physician and discharged. The keys to the diagnosis of appendicitis in this young age group were history and physical exam. Right lower quadrant findings were present in 95 per cent of patients with simple appendicitis and 71 per cent of patients with perforation. The primary-care physician and consulting surgeon have crucial roles in diagnosing the disease early in its course.

Appendicitis↗
PubMed1988

[Perforated gastroduodenal ulcers. Treatment by peritoneal dialysis. 72 cases].

Seventy-two perforated gastroduodenal ulcers were treated by an original method aimed at avoiding emergency surgery, which consists of peritoneal dialysis associated, during 3 days, with gastric aspiration. Over a 3-year period this method was applied to all patients admitted with a perforated ulcer. The ulcer was revealed by the perforation in 25 p. 100 of the cases, and 90 p. 100 of the patients had pneumoperitoneum. Contrast radiography with Gastrografine (sodium and meglumine amidotrizoate) located the perforation. Fifteen patients had another disease which made the prognosis worse. The time elapsed between perforation and treatment was 15 hours on average. Peritoneal fluid infection was present in 30 p. 100 of the cases. The outcome was favourable in 69 patients (96 p. 100). One patient died of pulmonary embolism, another was operated upon on the 4 th post-perforation day for a bleeding ulcer and a third patient with giant gastric ulcer developed subphrenic abscess. This method seems to be indicated in patients at high surgical risk (elderly people or people with severe underlying disease), and in young patients with perforated acute ulcer. In chronic ulcers, peritoneal dialysis ties the patient over the first hours, thus enabling radical surgery to be electively performed. In perforations seen after 24 hours, it helps in supporting the patient prior to surgery. The method in contra-indicated in gastric ulcers.

Adolescent↗
PubMed1971

Treatment and mortality of perforated peptic ulcer: a survey of 852 cases.

All proved cases of perforated peptic ulcer occurring in the Greater Vancouver area during the decade 1959-1968 have been studied. The incidence of perforation was approximately 10 per 100,000 population. The mean age was 55 years and the peak age incidence was in the fifth decade. The site of perforation was pyloroduodenal in 88% of cases and simple closure was the treatment employed in 81%. The overall mortality rate was 18.3% and one-third of these fatalities were due to misdiagnosis. The operative mortality rate was 9%.The overall mortality rate was significantly greater among women and the elderly, in gastric perforations, and in perforations occurring between 11 p.m. and 8 a.m.A close correlation was found between operative mortality rate and the time interval between perforation and operation. This elapsed time was found to be significantly greater among women and the elderly, in gastric perforations and in perforations occurring during the night.

Adolescent↗
PubMedDate not supplied

[Causes, diagnosis and treatment of uterine perforations by intrauterine devices].

Perforations of the uterus by intra-uterine devices (I.U.D.) are still at present serious complications. Their incidence is very varied and diverse because they are often asymptomatic. Pregnancy of a frequent circumstance under which they are discovered, as well as the more general way, which is the disappearance of the strings, which should always give rise to the suspicion that perforation has happened. There are two types to be distinguished from one another: Immediate perforation due to a faulty technique in insertion, secondary perforation due to gradual wearing down of the uterine wall. The factors predisposing to the occurrence of these accidents are numerous but notable among them are the date in the cycle when the insertion was done and above all the time in relationship to the last pregnancy, parity, the position of the uterus and the experience of the operator. Diagnosis of perforation is not always easy and may require not only radiological investigation without preliminary preparation but also hysterography, ultrasound examination and hysteroscopy. Withdrawal of a device that has perforated the uterus is advisable even if its migration has not given rise to any clinical symptoms. The technique for removing it varies often from case to cause between laparoscopy, laparotomy and culdotomy. Prevention of perforations should not only take into account the contra-indications to insertion but also knowledge of favourable factors, of a rigorous technique for insertion as well as clinical supervision in order to screen for secondary perforations.

Endoscopy↗
PubMed1980

Appendicitis: factors that influence the frequency of perforation.

The mortality from perforating appendicitis has decreased, but the incidence of perforation has not changed in 30 years. We found that among 335 consecutive patients treated for acute appendicitis, 108 (32%) had evidence of perforation. No significant differences between the groups were noted with respect to race, sex, educational level, family income, health insurance coverage, availability of transportation, and possession of a telephone. Perforation was more likely in patients who lived more than 20 miles from the hospital and in patients under age 10 years or over age 60. Patients with perforation were ill for a mean of 2.5 days before seeking medical attention, compared to a mean of 1.5 days for those without perforation (P < .001). Yet, approximately 75% of patients in each group stated that they had a "family doctor." Patients with perforation had significantly more physician visits before hospital admission (mean 1.61 vs 1.33, P < .005); 54.3% of patients with perforation had previous contact with a physician who failed to make the correct diagnosis.

Adolescent↗
PubMed1994

Clinical observation of neonatal gastrointestinal perforation.

BACKGROUND: Gastrointestinal perforation is an infrequent occurrence in neonates. Experience in its management is presented, while also attempting to analyze the factors affecting outcome. METHODS: From 1983 to 1992, 31 neonates with gastrointestinal perforation were treated at Taichung Veterans General Hospital. The medical records of these patients were reviewed thoroughly. In the meantime, Mann-Whitney U and Yates' correction chi square tests were used to analyze the factors predicting the outcomes. RESULTS: There were 21 males and 10 females, among whom 16 were premature births. The median age at diagnosis was 5 day; half (16/31) had occurred during the first 5 days of life. Abdominal distension was the most common manifestation (87%). Hemograms at admission showed leukopenia in 32% (10/31) and thrombocytopenia in 40% (8/20) of the patients. Metabolic acidosis was present in 46% (13/28) of the patients. Peritoneal fluid and preoperative blood cultures were positive in 71% (17/24) and 50% (13/26) of the patients, and both of them had Gram-negative enterobacteriacea as the most common pathogen. The overall mortality rate was 58%. The highest mortality rate was associated with gastric perforation (100%), followed by small bowel (50%) and colon (50%) perforations. The predominant cause of perforation was necrotizing enterocolitis (14/31), with the most common site the terminal ileum (16/29). Four patients with necrotizing enterocolitis had multiple perforations. Others who underwent surgery showed single perforation. The major cause of death in those patients who received operation was sepsis (8/13). An initial arterial pH value higher than 7.25, and surgical procedure performed within two days after disease onset may predict a favorable outcome (p < 0.01). CONCLUSIONS: Gastrointestinal perforation is a life-threatening complication in neonates. A better survival rate can be obtained by cooperation among neonatologists, pediatric surgeons and the nursing staff taking care of these high risk babies.

Chi-Square Distribution↗
PubMed1994

Selective management of colonoscopic perforations.

BACKGROUND: Colonoscopy is a safe procedure if performed properly. Perforations from such procedures are rare, but not entirely avoidable. Usually perforations from diagnostic colonoscopy result in large defects requiring surgical management. Perforations from therapeutic colonoscopy occur by a different mechanism and frequently result in a smaller perforation. STUDY DESIGN: This is a retrospective review of 26,708 consecutive colonoscopic procedures performed from January 1986 to June 1992. RESULTS: There were 12 perforations, five from diagnostic colonoscopy and seven from therapeutic colonoscopy. All patients with perforation from diagnostic colonoscopy were treated operatively, while six of the seven perforations from therapeutic colonoscopy were managed nonoperatively. The type of operation depended upon the intraoperative findings. CONCLUSIONS: Perforations from therapeutic colonoscopy occur by a different mechanism than from diagnostic colonoscopy and may be selectively managed without an operation and with a low mortality and morbidity rate, provided proper guidelines are adhered to.

Aged↗
PubMed1993

Management of delayed esophageal perforation with mediastinal sepsis. Esophagectomy or primary repair?

Ninety patients with esophageal perforations were operated on at our institutions between 1970 and 1992. Thirty-four of them were seen after delayed diagnosis (> 24 hours) with mediastinal sepsis caused by perforation of the thoracic esophagus. There were 18 patients with spontaneous ruptures, 11 with instrumental perforations (including one caused during laparotomy), and 3 perforations caused by foreign bodies. One patient had perforation of an esophageal ulcer into the pericardium and another had perforation of an esophageal diverticulum into the mediastinum. Nineteen patients underwent primary repair of the perforation with cleansing and drainage of the mediastinum and the pleural cavity. The remaining 15 had primary extirpation of the thoracic esophagus, irrigation of the mediastinum with antibiotics, cervical esophagostomy, gastrostomy, and drainage of the mediastinum and pleural cavity. Nineteen of the 34 patients survived (hospital mortality 44%). Of patients with primary repair, only six survived (in-hospital mortality 68%), whereas only two patients treated with esophagectomy died (in-hospital mortality 13%). The difference was highly significant (p = 0.001). The most common cause of death was multiorgan failure resulting from sepsis. Postoperative complications developed in four patients treated with primary repair (two sepsis, one empyema, and one anuria) and in seven patients treated with esophagectomy (two empyema, two sepsis, one pneumonia, one mediastinal abscess, and one brain abscess). After healing of the mediastinitis, the esophagogastric continuity was reconstructed with colon in 11 patients and stomach in two patients. In the management of delayed esophageal perforation with mediastinal sepsis, esophagectomy is superior to primary repair alone, which often leads to mediastinal leakage, continued sepsis, and death.

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↗
PubMed1996

Endoscopic cecal perforation: mechanisms of injury.

OBJECTIVE: Most endoscopic perforations of the colon occur in the rectosigmoid area and are thought to be secondary to direct injury from the endoscopic instrument. The aim of this study was to describe the mechanisms of injury and clinical outcome of endoscopic perforation involving the cecum. METHODS: Retrospective review of 6684 consecutive colonoscopic procedures performed at a university hospital over a 7-yr period. RESULTS: Colonoscopy was complicated by perforation in 0.22%. Five of the 15 perforations occurred in the cecum. The mean age of these five patients was 79.6 +/- 17.7 yr (mean +/- SD). Indications for the procedure were bleeding (n = 4) and suspected obstructing cecal mass (n = 1). Abnormal endoscopic findings included diverticulosis, vascular malformations, cecal ulcer/inflammation, mass, and polyps. Perforation was directly attributable to an ancillary procedure (three routine biopsies, one electrocautery) in the cecal area in four patients, and cecal pathology (inflammation, ulceration) was a contributing risk factor in three patients. Mortality was 80%. In contrast, a noncecal perforation usually occurred at the sigmoid region and was associated with technical difficulties, e.g., inability to traverse a stricture or reach the cecum. CONCLUSIONS: Routine forceps biopsy (without electrocautery) is an under-recognized cause of cecal perforation. Ancillary endoscopic interventions in the cecal region should be minimized in elderly patients with evidence of cecal inflammation. Pneumatic injury may be an additional risk factor for cecal perforation in patients with a colonic stricture or a tortuous colon.

Aged↗
PubMed1997

Colonic perforations after renal transplantation.

BACKGROUND: Perforation of the colon is a rare but serious complication in renal transplantation; allograft recipients constitute a patient population uniquely at risk with end-stage renal failure, maintenance therapy with dialysis before transplantation, and then chronic immunosuppression thereafter. STUDY DESIGN: In 1,401 consecutive transplants performed between 1951 and 1995 at the Brigham and Women's Hospital, 30 recipients (2.1 percent) experienced 34 episodes of colonic perforations, 13 of which (38 percent) were fatal. The medical records and clinic charts of each person were analyzed for variables between those who survived and those who died of the colon perforation. RESULTS: Significant differences in patient demography and clinical and laboratory findings including age, mean corticosteroid dose, and nutritional status were noted between the two groups. Early diagnosis and intervention improved the prognosis; 22 percent of those operated on within 24 hours died; 47 percent died after delayed intervention. Excision of the lesion with end-to-end anastomosis was effective in most right colon perforations, and removal of the lesion and formation of an end-colostomy and Hartmann pouch was preferred in rectosigmoid perforations. The incidence and outcome of posttransplant colonic perforations were associated with the intensity of immunosuppression, with 28 percent of perforations occurring within the first month after engraftment and 47 percent within the first 3 months; the mean daily dose of corticosteroids was three times higher in those who died compared with those who survived. The levels of serum albumin were significantly lower among nonsurvivors. CONCLUSIONS: Colon perforation is a catastrophic event in immunosuppressed renal transplant recipients. Prompt diagnosis and treatment are critical; because of the masking effects of corticosteroids on symptoms and signs, a high index of suspicion and urgent investigation are indicated. Prompt surgical intervention and attention to the nutritional status are essential for survival.

Adult↗
PubMed1997

Mechanisms of cardiac perforation leading to tamponade in balloon mitral valvuloplasty.

Mechanisms of cardiac perforation in 10 cases of cardiac tamponade encountered in a single-center series of 903 balloon mitral valvuloplasty procedures were elucidated by precise localization of the site of perforation at subsequent surgery. These mechanisms were perforation of the aortic root and adjacent right atrium by sliding up of the transseptal set (2), apical tears by straight-tip balloon catheters driven distally during mitral valve dilatation (3), apical perforations by guidewires introduced through catheters wedged in the apex (2), tear of the posterior right atrial wall by dilatation of the track produced by very low septal punctures (2), and right ventricular perforation by a pacing catheter (1). Multivariate analysis showed cardiac perforation to be significantly related to the total experience at the center (inversely) and to patient age (directly). Left ventricular perforation occurred exclusively in patients > 40 yr of age. Understanding these mechanisms has enabled formulation of effective strategies to prevent cardiac perforation.

Adolescent↗
PubMed1989

Number and anatomical distribution of incompetent thigh perforating veins.

Although incompetent thigh perforating veins are considered to be a common cause of recurrence of varicose veins after high saphenous ligation, the number and distribution of such incompetent veins have not been reported. The aim of the study was to determine the number and anatomical distribution of incompetent thigh perforating veins. Sixty-five limbs in 48 patients with varicose veins who were found to have incompetent thigh perforating veins on ascending deep to superficial venography were studied. In 80 per cent of patients one incompetent thigh perforating vein was found and in 20 per cent more than one was found. Concomitant incompetent calf perforating veins were found in 92 per cent of the limbs studied. The incompetent thigh perforating veins were found to occur anywhere in the thigh, from the upper edge of the patella to a few centimetres below the saphenofemoral junction. The majority (71 per cent) were found in the middle third of the thigh. All incompetent thigh perforating veins were communicating with the long saphenous vein, including those in five patients with incomplete stripping. The surgeon should be aware of incompetent thigh perforating veins which may be multiple and occur at any site on the medial aspect of the thigh.

Adult↗
PubMed2006

Breast reconstruction using perforator flaps.

BACKGROUND: Perforator flaps allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The deep inferior epigastric artery (DIEP) and superficial inferior epigastric artery (SIEA) flaps transfer the same tissue from the abdomen to the chest for breast reconstruction as the TRAM flap without sacrificing the rectus muscle or fascia. Gluteal artery perforator (GAP) flaps allow transfer of tissue from the buttock, also with minimal donor-site morbidity. INDICATIONS: Most women requiring tissue transfer to the chest for breast reconstruction or other reasons are candidates for perforator flaps. Absolute contraindications to perforator flap breast reconstruction include history of previous liposuction of the donor site or active smoking (within 1 month prior to surgery). ANATOMY AND TECHNIQUE: The DIEP flap is supplied by intramuscular perforators from the deep inferior epigastric artery and vein. The SIEA flap is based on the SIEA and vein, which arise from the common femoral artery and saphenous bulb. GAP flaps are based on perforators from either the superior or inferior gluteal artery. During flap harvest, these perforators are meticulously dissected free from the surrounding muscle which is spread in the direction of the muscle fibers and preserved intact. The pedicle is anastomosed to recipient vessels in the chest and the donor site is closed without the use of mesh or other materials. CONCLUSIONS: Perforator flaps allow the safe and reliable transfer of abdominal tissue for breast reconstruction.

Breast Neoplasms↗