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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↗
PubMed1991

Spontaneous, isolated intestinal perforations in neonates with birth weight less than 1,000 g not associated with necrotizing enterocolitis.

From January 1986 through December 1988, we have seen 7 cases of isolated intestinal perforation in 250 infants with birth weights less than 1,000 g (3% incidence) without histological or clinical evidence of necrotizing enterocolitis (NEC). Patients had a mean birth weight of 670 g, gestational age of 25.1 weeks, and sustained a perforation at a chronological age of 10.4 days. No infants had been fed. A definite, blue-discolored abdomen was the only consistent clinical sign (n = 7). Free intraperitoneal air on radiograms was rarely observed (n = 1). Abdominal ultrasounds (n = 3) and metrizamide contrast studies (n = 3) were not diagnostic. The presence of an umbilical artery catheter (7/7), falling hematocrit (6/7), thrombocytopenia (5/7), and a positive diagnostic paracentesis were most commonly found. In 6 of 7 patients, this perforation was associated with coagulase-negative staphylococcal sepsis. Surgical or histological diagnosis showed focal perforation in either the terminal ileum (n = 4) or the transverse and descending colon (n = 3). Survival was 3 of 7; 2 patients died of intracranial hemorrhage and 2 died of Candida sepsis. We conclude that (1) intestinal perforation can occur in the absence of NEC; (2) bluish discoloration of the abdomen is the most reliable clinical finding; and (3) perforation may be associated with coagulase-negative staphylococcal infection.

Colonic Diseases↗
PubMed1995

Intestinal perforations in infants with a very low birth weight: a disease of increasing survival?

Seventeen infants with a very low birth weight (VLBW) and spontaneous, non-necrotizing enterocolitis (NEC), intestinal perforations are presented; 14 of them were seen in the past 3 years. A comparison with 16 surgically treated NEC infants (< 1,000 g) is provided. At our institution, the yearly survival of VLBW infants increased from 54% to 90% over the past 6 years. All 17 non-NEC patients were operated on, and 15 (88.2%) survived. Ileal perforations were observed frequently. Initial enterostomies were followed by reanastomosis at an average age of 3 months. A 22.6-month follow-up was attained for all survivors. Non-NEC intestinal perforations in tiny neonates are increasing and constitute a challenging but treatable group. The improving survival rate of VLBW infants will probably be accompanied by a variety of complications.

Enterocolitis↗
PubMedDate not supplied

[A case of multiple intestinal perforations due to TBC in a female patient with HIV-1 infection].

The authors report a case of HIV-1 infection, primary miliary tuberculosis of the lung and secondary intestinal tuberculosis complicated with multiple intestinal perforations. The surgical emergency therapy, supported by specific antitubercular drugs, antibiotics, and total parenteral nutrition, consisted in suturing seven perforative sites of the small and large intestine. The Authors stress the possibility that in the future tubercular complications up till now considered atypical may become more and more frequent because of the HIV-1 infection association.

AIDS-Related Opportunistic Infections↗
PubMed1988

[Intestinal perforation in abdominal contusions in children. 16 cases].

16 cases of intestinal perforation following blunt abdominal trauma in children (14 boys and 2 girls from 3, 5 to 15 years old) are recorded in a 18 years period. We found 12 injuries of the small bowel, 2 of the colon and 2 of the duodenum. Except in the cases with hypovolemia or traumatic coma, the diagnosis is often made on abdominal physical findings and clinical evolution. Laboratory and radiological data were often useless. Then, surgical management was often delayed, principally in the most recent period with the non operative management of most pediatric blunt trauma. Simple closure (7 cases), resection and anastomosis (7 cases) or resection and double ostomy (2 cases) were performed. The result summarize 2 death and one complication (fistula). Complications do not increase with delay.

Abdominal Injuries↗
PubMed1986

Intestinal perforation due to blunt trauma in children in an era of increased nonoperative treatment.

Over the past decade, nonoperative management of most pediatric blunt abdominal trauma has emerged as accepted practice. It is possible that treatment of associated hollow visceral disruption might be missed or delayed because of this nonoperative approach. In a review of all cases of intestinal perforation from blunt trauma seen over the past 6 years, we found 12 cases of intestinal disruption in more than 600 cases of significant blunt trauma. Child abuse caused eight cases and four were motor vehicle related (MVR). Seven of eight battered children had a delay of more than 48 hours from injury to hospital presentation. Three of four MVR patients had an 18-hour delay from injury to operation. Ten of 12 patients survived. The two children who succumbed were both battered and were moribund and unstable when first seen and failed to respond to aggressive stabilization and surgery. Serial physical examinations, contrast radiographic studies, and peritoneal lavage were the most helpful diagnostic modalities. There were no significant complications and no patient required more than one operation (except for ostomy closure). All surviving patients are well at followup and seven of ten have been followed for more than 3 years; two are not yet 1 year from surgery and one is lost to followup. Several principles have emerged from this review: 1) motor vehicle trauma and child abuse are the major etiologic factors in childhood blunt trauma; 2) accurate and rapid diagnosis of intestinal perforation in children is difficult; 3) recovery in the presence of stable vital signs can be expected, even with the long delays; and 4) abused children must be carefully evaluated for abdominal trauma.

Accidents, Traffic↗
PubMed1991

Intestinal perforation in a two-year-old child with eosinophilic gastroenteritis.

A two-year-old boy underwent a laparatomy for an intestinal perforation due to eosinophilic gastroenteritis. He had marked peripheral blood eosinophilia and a small duodenal biopsy showed heavy eosinophilic infiltration in the mucosa. After 1 1/2 year on a restricted diet, a control duodenal biopsy showed only slight eosinophilia. Perforation of the small intestine is a rare but serious complication in eosinophilic gastroenteritis.

Child, Preschool↗
PubMed1992

Multiple cytomegalovirus-related intestinal perforations in patients with acquired immunodeficiency syndrome. Report of two cases and review of the literature.

We present two cases of patients with acquired immunodeficiency syndrome who, in the course of their disease, suffered multiple intestinal perforations that were directly related to cytomegalovirus infection. Biopsy and surgical specimens and autopsy findings in both cases revealed extensive lesions of gastroenteritis; the gastroenteritis was characterized by randomly distributed deep ulcers, resulting in multiple perforations. The main characteristic histopathologic finding was the association of intestinal lesions with a severe form of cytomegalovirus-related occlusive vasculitis. This report provides evidence that supports the contention that cytomegalovirus is the primary causal agent of gastrointestinal lesions affecting immunocompromised patients.

Acquired Immunodeficiency Syndrome↗
PubMed1983

[Intestinal perforation in juvenile abdominal typhoid].

Eight of 19 children with typhus abdominalis who were between 4 and 12 years of age, showed perforation of the intestine. The terminal ileum was always the site of the perforation. Besides the clearly visualized air, meteorism of the small intestine was always seen. In individual cases, segments of the small intestine were seen in close proximity to each other, or an ileus developed. The x-ray film in typhus abdominalis in childhood shows the same signs as an adult x-ray. A characteristic feature of the perforation is its localization in the terminal ileum and the time at which it occurs, namely, between the end of the 2nd and the end of the 4th week of the diseased condition.

Child↗
PubMed1985

Intestinal perforation associated with indomethacin treatment in premature infants.

Within 9 months we observed intestinal perforations in three very low birth weight (VLBW) infants undergoing indomethacin treatment for symptomatic patent ductus arteriosus (sPDA). The three patients exhibited striking similarities in their clinical courses and predisposing factors. Although clinical and histological criteria did not differentiate the perforations from necrotising enterocolitis (NEC), a well-known entity in premature infants, these events were remarkable to us since we had observed no other cases of NEC in recent years. From animal experiments and pathophysiological data, a role for indomethacin in gastrointestinal ischaemic damage must be considered. This communication is not meant to discredit indomethacin treatment. However, awareness of potential complications and careful monitoring during treatment is warranted.

Ductus Arteriosus, Patent↗
PubMedDate not supplied

Intestinal perforation due to phytobezoar obstruction.

Phytobezoars are rare causes of acute abdomen cases. Here we are reporting two cases which were presented with acute abdomen symptoms and later were found to be small intestinal perforation due to bezoar.

Adult↗
PubMed1975

[Intestinal perforations caused by food foreign bodies].

Accidental ingestion of foreign bodies is common enough, especially in children, but is of relatively small importance as such objects readily pas through the body and no particular treatment is required. A more interesting and less frequent occurrence is the ingestion of objects such as bone fragments, fish bones, etc. that form part of ordinary food. Cases of intestinal perforation caused in this way are described, together with their clinical and surgical management.

Adult↗
PubMed1995

Congenital miliary tuberculosis with intestinal perforations.

The case of a male preterm baby who had congenital miliary tuberculosis with multiple intestinal perforations is reported. The patient was successfully treated with antituberculosis chemotherapy and surgical repair along with other supportive therapy. This is one of the rarest cases of the type described here.

Humans↗