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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↗
PubMed2003

Are localized intestinal perforations distinct from necrotizing enterocolitis?

BACKGROUND/PURPOSE: Localized intestinal perforation (LP) is thought to be a distinct entity when compared with perforation associated with necrotizing enterocolitis (NEC). Studies have indicated that LP is more amenable to percutaneous drainage and associated with a better outcome. We sought to determine whether LP and NEC could be distinguished based on clinical parameters alone. METHODS: A retrospective review of 40 neonates with gastrointestinal perforations between January 1990 and May 1998 was performed. All had undergone laparotomy and had histologic specimens available for evaluation. RESULTS: Twenty-one neonates had necrotizing enterocolitis (NEC), and 19 had localized perforation (LP) based on histologic criteria. More neonates with LP were exposed to prenatal indomethacin (37% v 5%; P <.05), received intravenous dexamethasone (42% v 10%; P <.05), had umbilical artery catheters (63% v 14%; P <.05), and had a higher white blood cell (WBC) count (27.1 +/- 23.1 v 14.3 +/- 11.5; P <.05). More neonates with NEC had pneumatosis intestinalis (47% v 11%; P <.05). No significant differences existed in enteral feeding (16% LP v 38% NEC) or overall mortality rate (37% LP v 38% NEC). No statistical differences in the timing of perforation or clinical presentation were found. CONCLUSIONS: NEC and LP are difficult to distinguish based on clinical parameters alone. The authors did find associations between LP and prenatal indomethacin, intravenous dexamethasone, umbilical artery catheters, and a higher WBC count. Mortality rate and clinical outcome were nearly identical in both groups. Pneumatosis intestinalis, thought to be pathognomonic for NEC, was seen on abdominal radiograph in 2 babies with histologically proven LP.

Adult↗
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↗
PubMed2003

Enteropathy-associated T-cell lymphoma of the jejunum complicated with intestinal perforation.

Enteropathy-associated T-cell lymphoma (EATL) is a rare, well-documented complication of celiac disease, accounting for less than 1% of the non-Hodgkin's lymphomas. Perforation as the presentation of intestinal lymphoma is rare, and as the presentation of EATL is even rarer. Herein, we report a 56-year-old female with EATL of the jejunum complicated with intestinal perforation. She was admitted because of sudden onset of severe abdominal pain. Emergent exploratory laparatomy was done under the impression of perforative peptic ulcer, however, an ulcerative tumor with perforation was noted unexpectedly at the proximal jejunum. After tumor resection and end-to-end anastomosis of the jejunum, the patient received eight courses of CHOP (cyclophosphamide, adriamycin, oncovin and prednisolone) chemotherapy. Now she has been disease-free for one and half years after the diagnosis. From our experience and that of others, we consider that combination chemotherapy should be helpful for patients with EATL.

Celiac Disease↗
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↗
PubMedDate not supplied

Neonatal intestinal perforation caused by congenital defect of the small intestinal musculature: report of one case.

Congenital defect of the small intestinal musculature is a rare cause of neonatal spontaneous intestinal obstruction or perforation. Its etiology and pathogenesis are still controversial. A male infant presented with intestinal obstruction at two days of age and rapidly progressed to perforation and septic shock. He died at seven days of age. Autopsy finding revealed a perforation hole at twenty-five cm proximal to ileocecal valve. Histology examination demonstrates multifocal deficiency of the inner circular muscle layer three cm around the perforation site. The clinical and histological characteristics are reviewed and discussed. We propose that the muscle defect of small intestine, especially ileum, is secondary to ischemic injury rather than an embryological malformation.

Diseases in Twins↗
PubMed1998

Peritoneal drainage as definitive treatment for intestinal perforation in infants with extremely low birth weight (<750 g).

BACKGROUND: Advances in neonatal intensive care have improved the survival of the extremely premature infant. However, survival at less than 25 weeks' gestational age remains tenuous, with intestinal perforation presenting a significant mortality. METHODS: During an 18-month period from 1995 to 1996, nine patients weighing less than 750 g (range, 485 to 740 g; mean, 615 g) presented with intestinal perforation. All patients were treated with peritoneal drainage. Drains were removed after clinical improvement and the cessation of peritoneal drainage. RESULTS: Seven patients survived the initial drainage procedure (78%). At a mean follow-up of 12 months, the six long-term survivors are all tolerating full enteral feeds, and none developed intestinal strictures or intraabdominal abscess. No patient required subsequent celiotomy. Peritoneal drainage has previously been considered in some centers as temporary therapy in extremely ill neonates deemed unlikely to survive operation. The authors have adopted drainage as the sole treatment in selected patients. CONCLUSION: Peritoneal drainage alone may be considered definitive therapy for intestinal perforation in the majority of micropremature infants.

Drainage↗
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↗