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At least 595 records · Page 33Linked to original sources
PubMed2006

[Repairing large perforation of nasal septum with titanium membrane and local pedicled mucoperiosteum flap].

OBJECTIVE: To study a new treatment to repair large perforation of nasal septum with medical titanium membrane and local padicled mucoperiosteum flap. METHOD: The bottom mucoperiosteum of nasal cavity around the perforation of nasal septum were separated from the bone surface except with the margin part of perforation. Then the distal part of mucoperiosteum flap was incised and turn over to cover the perforation, free edge of the flap was sutured to secure immobilization. Finally, the Titanium membrane was cut to the right size to tuck into subperiosteal pocket around the perforation, and was sutured to the mucoperiosteal for added immobilization. RESULT: The perforations of nasal septum in 11 patients were closed satisfactorily. Perforation of nasal septum did not recur and the follow-up time ranged from half a year to 1 year. CONCLUSION: Titanium membrane is easy of application, and has good tissue tolerance. In our study, it is a good material to repair large perforation of nasal septum.

Adult↗
PubMed1995

Spontaneous perforation of choledochal cyst.

BACKGROUND: Spontaneous perforation of the common bile duct in children is very rare and its etiology is unknown. We describe herein five patients treated for the spontaneous perforation of choledochal cyst and suggest the important factors leading to perforation. STUDY DESIGN: All patients were initially treated with T-tube drainage through the perforated site. Cholangiography through the T tube was performed intraoperatively and the important factors leading to perforation were examined. Furthermore, histological examination of the perforated wall of the common bile duct was performed. RESULTS: Cholangiography through a T tube revealed the presence of a pancreaticobiliary junction malformation and filling defects (protein plugs) in the common channel in all patients. Postoperatively, the T tube was gently irrigated with a physiological salt solution until the free flow of bile into the duodenum was established. Histological examination showed that the wall near the perforation was covered with a granulation tissue that was present only at the limited area. CONCLUSIONS: Perforation of the common bile duct was related to the abrupt increase in intraluminal pressure due to obstruction by protein plugs at the common channel.

Anastomosis, Roux-en-Y↗
PubMed1994

[Diagnosis of incompetent perforators in primary varicose veins by high resolution ultrasonography].

The purpose of this study is to investigate morphological changes of incompetent perforators in primary varicose vein, and to elucidate diagnostic accuracy of high resolution ultrasonography regarding the incompetent perforators. The subjects were 42 lower limbs in 28 patients. Sixteen lower limbs had stasis symptoms and 26 had stasis dermal findings. Perforators were diagnosed when they penetrated the strong echo from the fascia. Their diameter was measured and their subfascial draining veins were identified. By operation, their penetrating portions on the fascia were confirmed and bleed back test was performed. They were divided into 8 types according to their draining veins. Eighty-nine perforators were detected and of them were major 3 types. The incompetent perforators arose at 3mm in diameter, and the all perforators more than 7mm became incompetent. The diagnostic accuracy of ultrasonography regarding their positions was 92%. However, the diagnostic accuracy of ultrasonography regarding their incompetency was 65% in total accuracy, when 4mm in diameter was used as a cut-off line. The positions of perforators were accurately detected using ultrasonography, but their competency was not precisely evaluated by diameter measurement. Therefore, this method was available for marking the precise position of incompetent perforators preoperatively.

Female↗
PubMed1997

[Transesophageal echocardiographic findings of cortical and perforating infarctions in patients with atrial fibrillation].

The predictive value of transesophageal echocardiography was investigated for the risk stratification of atherothrombotic or embolic cerebral infarction in patients with atrial fibrillation. Left atrial spontaneous echo contrast, peak flow velocity in the left atrial appendage and generalized atherosclerosis as estimated by the intima-media wall thickness of the thoracic aorta were assessed by transesophageal echocardiography in consecutive patients with paroxysmal (n = 25) or chronic (n = 60) atrial fibrillation (mean [+/-SD] age; 63 +/- 11 years). All patients underwent brain computed tomography or magnetic resonance imaging to evaluate the presence or absence of cerebral infarction. The location of cerebral infarction was divided into two territories, the cortical branch (cortical infarction) and deep perforators (perforating infarction), to evaluate embolic and atherothrombotic cerebral infarction, respectively. Cortical and perforating infarctions were found in 42% and 16% of all patients, respectively. The grade of spontaneous echo contrast was higher in patients with cortical infarction than in those without cortical infarction. Patients with perforating infarction showed thicker aortic wall compared with patients without perforating infarction. Other parameters had no predictive value to differentiate perforating from cortical infarctions. Multiple regression analysis revealed that spontaneous echo contrast and age were independent predictors of embolic cortical infarction, whereas intima-media wall thickness of the aorta and hypertension were useful in predicting the risk of atherothrombotic perforating infarction. Transesophageal echocardiography is useful for predicting embolic cortical infarction and atherothrombotic perforating infarction.

Atrial Fibrillation↗
PubMed1998

Intranasal steroids and septum perforation--an overlooked complication? A description of the course of events and a discussion of the causes.

The use of intranasal steroids for the treatment of allergic and vasomotor rhinitis has doubled during the past 5 years. The number of reported cases of nasal septum perforation has increased correspondingly. The mechanism behind this is unknown, and steroid-induced septum perforation is rarely described in the literature. In order to describe the course of events and to form an idea of the extent of the problem, we have reviewed the cases reported at our clinic and compiled reports on side-effects from the Swedish Medical Products Agency. In our department we found 32 patients with septum perforation (21 women and 11 men). The most common risk factor for septum perforation was steroid treatment, 11 cases (10 women, 1 man, average age 33 years, range 19-49 years). The information obtained from the Swedish Medical Products Agency showed that 38 cases of steroid induced septum perforation had been reported during the past 10 years. The number of side-effects per million Defined Daily Dose (DDD) was averaged to 0.21. The risk of perforation is greatest during the first 12 months of treatment and the majority of cases involves young women. We conclude that septum perforation due to nasal sprays are underreported in Sweden and that perforations are most likely to appear in young females during their first months of medication.

Administration, Intranasal↗
PubMedDate not supplied

Perforation of the alimentary tract: evaluation with computed tomography.

BACKGROUND: To assess the value of computed tomography (CT) in the diagnosis of perforation of the alimentary tract (AT). METHODS: During a 4-year period 76 patients with proven AT perforation underwent CT within 1 week before surgery or endoscopy. We retrospectively reviewed these CT scans to determine the signs of AT perforation. There were 41 men and 35 women (28-90 years old). Our goal was to establish the diagnosis of AT perforation and, if this was possible, to identify the site and cause of the AT wall rupture. The CT diagnosis of perforation was based on (a) direct findings of extraluminar air or gastrografin and (b) indirect findings of an abscess or an inflammatory mass surrounding an enterolith in the region of appendix or a bowel wall-related phlegmon or abscess with fluid in the mesentery or surrounding radiopaque foreign body. RESULTS: There were 65 true-positive and 11 false-negative cases. Levels of perforation were the esophagus (two), stomach (five), duodenum (12), small bowel (15), appendix (six), and colon (36). Causes were peptic ulcer (11), foreign body (five), trauma (seven), iatrogenic (nine), appendicitis (six), diverticulitis (21), Crohn disease (five), AT carcinoma (eight), and ischemia (four). Level and cause were correctly predicted in 55 and 51 instances, respectively. The sensitivity was estimated to 85.5%. CONCLUSION: CT is a valuable method in the diagnosis of AT perforation. The diagnosis can be established rapidly, without patient preparation and with a high sensitivity.

Adult↗
PubMed2005

Laparoscopic treatment of gastroduodenal perforations: comparison with conventional surgery.

BACKGROUND: Laparoscopic techniques have been proposed as an alternative to open surgery for the treatment of peptic ulcer perforation. This study compared the outcome of laparoscopic and open approaches for the repair of gastroduodenal perforations. METHODS: A retrospective review was conducted with 134 consecutive patients treated for gastroduodenal perforations. These patients included 122 with perforated duodenal ulcers, 10 with perforated gastric ulcers, and 2 with iatrogenic duodenal perforations. Whereas 68 patients were treated laparoscopically, 66 patients underwent conventional (open) surgery. RESULTS: Laparoscopic repair was successful in 65 cases (96 %). The mean operating time was shorter with the laparoscopic technique (68 vs 59 min), but the difference was not significant. The duration of postoperative nasogastric aspiration and time to resumed oral intake were shorter in the laparoscopic group (2.6 vs 4.1 days and 4.4 vs. 5.2 days, respectively; p = 0.043). The postoperative analgetic requirements, and overall complications rate were significantly lower after laparoscopic surgery (p = 0.03 and p = 0.004, respectively). There was no statistically significant difference in hospital stay (5.1 vs 6.1 days) or mortality rate between the two procedures. CONCLUSION: Laparoscopic repair of gastroduodenal perforations is a safe alternative treatment offering certain significant short-term advantages.

Adolescent↗
PubMed1987

Peptic ulcer perforation associated with steroid use.

A ten-year (1974 to 1984) retrospective chart review was conducted to find all patients with peptic ulcer perforation associated with steroid treatment. During this period, 151 peptic ulcer perforations occurred, 25 (17%) associated with steroid use. Twenty patients had the diagnosis confirmed at operation, five at autopsy. The most common operative procedure was oversewing of the perforation with an omental patch (ten cases). Postoperative complications occurred in 16 patients and were multiple in 11. Underlying malignant neoplasms were the most common concurrent disease (11 patients), five patients having brain metastasis. Of 25 patients, 15 died--five preoperatively and ten postoperatively. Patients older than age 50 years had an overall mortality of 85%; those younger than age 50 years, 17%. A recurring pattern in 21 patients was perforation occurring after a major increase in steroid dose (pulse). Ulcer perforations associated with steroid use constitute a significant portion of all ulcer perforations, are lethal in most patients older than age 50 years, and are often associated with a steroid pulse before perforation.

Female↗
PubMed1993

Spontaneous gastroduodenal perforation in patients with cancer receiving chemotherapy and steroids. Report of four cases combining 5-fluorouracil infusion and cisplatin with antiemetics dexamethasone.

BACKGROUND: Spontaneous gastroduodenal perforation is an uncommon but life-threatening complication of systemic chemotherapy and/or steroids. Here, the authors reported four cases of gastroduodenal perforation following combined chemotherapy with steroids. METHODS: The chemotherapeutic regimens all included 5-fluorouracil (5-FU) by continuous infusion and cisplatin. The authors used dexamethasone as an antiemetic. All patients took analgesics for pain relief. No patient had a history of peptic ulcer disease. RESULTS: Severe epigastralgia occurred 3-5 days after the start of chemotherapy. The peptic ulcer perforations were diagnosed within 3 days of onset of symptoms. All patients had an emergency laparotomy. Three of the perforations were located in the duodenum and one was located in the stomach. Pathologic examination of one patient revealed a chronic peptic ulcer. Two patients with preoperative shock died in the postoperative period. CONCLUSIONS: The cause of spontaneous gastroduodenal perforation is not known, but the etiology can be complex. Either 5-FU or steroids can induce the perforation. An asymptomatic peptic ulcer may be aggravated by 5-FU, cisplatin, or dexamethasone. The authors suggest that patients receiving 5-FU infusion and cisplatin with dexamethasone for antiemesis who complain of epigastric pain should be mentioned for a gastroduodenal ulcer or even a perforation.

Adult↗
PubMed2004

Routine use of laparoscopic repair for perforated peptic ulcer.

BACKGROUND: Laparoscopic repair of perforated peptic ulcer was reported in 1990 but has not gained wide acceptance. The aim of this study was to evaluate the safety and efficacy of laparoscopic repair for perforated peptic ulcer in routine clinical practice. METHODS: This was a prospective analysis of 172 patients who underwent laparoscopic repair of a perforated peptic ulcer between July 1997 and June 2003. RESULTS: One hundred and seventy-two patients of mean age 54 (range 14-93) years had perforated peptic ulcer diagnosed by laparoscopy. There were 172 duodenal ulcers, 22 prepyloric and 13 non-juxtapyloric gastric ulcers. One hundred and sixty-five patients underwent omental patch closure of perforations; there were six Pólya gastrectomies and one ulcerectomy. Thirty-seven patients (21.5 per cent) required conversion to laparotomy. The mean operating time was 64.8 (range 14-180) min. The median postoperative requirement for intramuscular pethidine was one dose. The median postoperative hospital stay was 6 days. Complications occurred in 28 patients (16.3 per cent) resulting in three reoperations. Six patients with intra-abdominal collections were managed by percutaneous drainage. Two patients who underwent conversion developed a wound infection. Fourteen patients (8.1 per cent) died, 11 of whom were American Society of Anesthesiologists grade III and IV. CONCLUSION: Laparoscopic repair of perforated peptic ulcer is a safe emergency procedure in routine clinical practice for patients with perforated pyloroduodenal ulcer.

Adolescent↗
PubMed1993

Intestinal stenosis and perforating complications in Crohn's disease.

The charts of 384 patients with Crohn's disease were reviewed to assess the prognostic value of a bowel stenosis documented at the time of initial diagnosis for the occurrence of perforating (abscess, fistula, free perforation) or obstructing complications requiring surgical intervention. Mean follow-up was 5.6 years. At time of diagnosis a bowel stenosis (S) was documented in 143 patients (37.2%). 130 patients underwent surgery, 62 (48%) for obstruction, 18 (14%) for a perforating complication, 12 (9%) for both obstructing and perforating complication and 38 (29%) for intractable disease. The cumulative rates of surgery were calculated using lifetable analysis. The presence of a stenosis at the time of initial diagnosis was a risk factor for the likelihood of surgery overall [65% (S) vs. 40% (no S) after 10 years; P < 0.001] and of surgery for obstruction [70% (S) vs. 34% (no S); P < 0.001] but did not increase the likelihood of a perforating complication [24% (S) vs. 29% (no S); n.s.]. A perforating complication requiring surgery may therefore not be predicted by the mere diagnosis of a stenosis. Prophylactic surgery of stenotic lesions in patients with Crohn's disease to prevent the development of a perforating complication therefore is not recommended.

Adult↗
PubMed1983

Spontaneous free perforation of the small intestine.

In western cultures, spontaneous free perforation of the small intestine in adults is rare. The vast majority of published reports are of isolated cases. A review of 19 patients treated at the Lahey Clinic over the past 23 years is presented. All patients presented with an acute onset of peritoneal signs, and free perforation subsequently was documented at operation or at autopsy. Causes of the perforations were malignancy, six; inflammatory small bowel disease, four; combinations of radiotherapy, chemotherapy, or steroids, four; mechanical, three; and iatrogenic, two. Of the 19 patients, 15 had a history of previous abdominal surgery or recent steroid use, chemotherapy, or radiation therapy. Although the underlying disease may be of prime importance in causing perforation, these treatment modalities may be important factors in enhancing predisposition to perforation. Of the 16 patients operated on, ten had intestinal resection with primary anastomosis, and six had primary closure of the perforation. Four major complications included two deaths, and five minor complications occurred. In general, earlier operative intervention decreased mortality. A population of patients who may be at risk for small bowel perforations is identified. A review of the pertinent literature is presented.

Abdomen↗
PubMed2007

[Management of iatrogenic esophageal perforations].

BACKGROUND: Iatrogenic esophageal perforations are still a life-threatening clinical entity. PATIENTS AND RESULTS: We present the case reports of six patients to demonstrate different treatment options and we focus on new therapeutic strategies which have evolved in the interdisciplinary management of iatrogenic esophageal perforations. Two patients with perforations in the cervical esophagus were operated and in another patient the perforation was closed with fibrin glue. Three patients with perforations in the thoracic esophagus were treated with self-expandable plastic stents. CONCLUSION: The surgical therapy of esophageal perforations still is regarded to be the gold standard and nonadherence should only be considered based on interdisciplinary decisions in individual cases. However, positive results are increasingly being reported for conservative endoscopic treatment, particularly for thoracic perforations.

Adult↗
PubMedDate not supplied

Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis.

This prospective study was performed to investigate epidemiological characteristics in terms of the age- and sex-specific incidence in patients with perforated and nonperforated appendicitis. The study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993. Two patient cohorts [n = 544 (37%)] were analyzed with regard to prehospitalization duration of symptoms and in-hospital observation time. The crude incidence of acute appendicitis was 86 per 100,000 per year. Although the incidence of nonperforated appendicitis was highest among adolescents and young adults (13-40 years of age), perforated appendicitis occurred at almost the same incidence in all sex and age groups. The diagnostic accuracy was 76%. Perforated appendicitis occurred in 19%, with higher rates in small children and the elderly, irrespective of gender. A high diagnostic accuracy was not associated with an increased rate of perforation. In small children and the elderly, the diagnostic accuracy was low and the perforation rate high. Patients with perforation had a significantly longer duration of symptoms as well as in-hospital observation time than did patients with nonperforated appendicitis. Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in-hospital observation time, probably due to patient-related factors. We suggest this observation deserves attention regarding clinical diagnosis and treatment decision-making for patients with suspected acute appendicitis.

Acute Disease↗
PubMed2006

Non-traumatic colon perforation in children: a 10-year review.

Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.

Abdomen, Acute↗
PubMed2006

Typhoid intestinal perforation in children: a continuing scourge in a developing country.

Typhoid intestinal perforation is a principal cause of morbidity and mortality affecting both adults and children. This study aims to evaluate the pattern of typhoid intestinal perforation and outcome of its management in Nigerian children. The records of consecutive children managed for typhoid intestinal perforation at Juth, between 1996 and 2005 have been reviewed. There were 184 children (M:F = 1.04:1), with a mean of 5.8 years (range 4 to 15 years). More than a half (62.5%) of the patients were in the 5-6 year age group. The incidence peaked in April-May, and November-December. Increased incidence of typhoid perforation was observed between 2002 and 2005. All patients presented with the classic features of typhoid enteric perforation. Hypokalaemia and anaemia were common at presentation. Only 75 (40.6%) patients had operation within 24 h of perforation. The types of surgery included simple excision of the edges of the peroration and closure (74.5%), wedge resection and closure in (14.5%), segmental resection with primary end-to-end anastomosis (3.6%) and right hemi-colectomy with ileo-colic or ileo-transverse anastomosis. Wound infection and dehiscence, anastomotic breakdown with faecal fistula, intra peritoneal abscesses and chest infections were the main post operative complications. The overall mortality rate was 22.8 (42). Excision and simple closure was associated with the least incidence of anastomotic breakdown and operation time. The incidence of typhoid intestinal perforation is on the increase at our institution. Early limited surgery provides optimal results.

Adolescent↗
PubMed2002

Morbidity and mortality of perforated peptic gastroduodenal ulcer following emergency surgery.

BACKGROUND: This study assessed the surgical concept and prognosis of perforated gastroduodenal ulcers. PATIENTS AND METHODS: Data from 102 patients who underwent emergency surgery for peptic ulcer perforation were recorded prospectively. To evaluate morbidity and mortality ulcer perforation was classified into three types: type A, solitary peripyloric ulcer located anteriorly in which laparoscopic closure by suture with omentoplasty was treatment of choice and postoperative endoscopic biopsy was mandatory; type B, perforated ulcer with large defect in which excision and suture was necessary; type C, complicated perforated ulcer with destruction of proximal duodenum and penetration into adjacent organs in which resectional surgery was indicated. RESULTS: Morbidity and mortality were significantly lower in type A (9%, 4%, respectively) than types B (22%, 20%) and C (34%, 17%). Closure of type A perforation was managed laparoscopically in all cases. Billroth II resection was performed in 75% of type C cases. Age, ASA status, and time of surgery were independent prognostic factors by multivariate analysis, with increased mortality in patients older than 65 years, ASA III and IV, and surgery after 24 h following onset of symptoms. CONCLUSIONS: Prognosis of perforated ulcer disease is highly correlated with age, comorbid conditions (ASA status), and time of surgery. The proposed classification system helps to determine patients at risk of mortality.

Adult↗
PubMed2001

Abdominal ultrasonography reveals the perforation site of duodenal ulcers.

Regardless of whether or not the laparoscopic approach is used, the simple closure using an omental patch is considered to be preferable to other surgical therapies for a duodenal ulcer perforation. We used abdominal ultrasonography (US) to identify the perforation site of the duodenal ulcer. To our knowledge, this is the first report describing how the perforation site of duodenal ulcers can be identified using US. Three patients diagnosed with perforated duodenal ulcers based on abdominal computed tomography and abdominal radiographic findings were scheduled for surgery. Under general anesthesia, US demonstrated free air on the liver and a "fish-eye sign" when the anterior or lateral wall was perforated. We performed a simple closure using an omental patch through a skin incision measuring only 3 cm in diameter above the area showing the fish-eye sign. The postoperative recovery was no different from that seen when a laparoscopic approach is used at our hospital. Even though the laparoscopic procedure is still the surgical modality of choice, the US technique allows for a successful diagnosis without invasive examinations. We believe that most surgeons and/or radiologists should try to detect the fish-eye sign using US as the diagnostic modality of first choice if they suspect a duodenal ulcer perforation. This technique allows us to mark the perforation site accurately before surgery.

Duodenal Ulcer↗