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PubMed1979

Intestinal lesions caused by incorrectly placed seat belts.

Employment of seat belts reduces the number of fatal accidents and alters the pattern of lesions. However, seat belts themselves can produce serious lesions, particularly if incorrectly placed. Three cases of traumatic intestinal perforation are mentioned. Intestinal perforation often produces few initial symptoms. The diagnosis is difficult and is frequently established late. If marks are present on the abdomen from the seat belt, the patient should be admitted for observation. The possible pathogenesis of the intestinal lesions are mentioned. The seat belt should be correctly placed in order to obtain optimal effect. Reasons for incorrect placing are mentioned. It is important that the seat belt is adjusted to the passenger employing it.

Accidents, Traffic↗
PubMed2001

Perforation peritonitis in primary intestinal tuberculosis.

Primary intestinal tuberculosis is unusual in European and North American countries today. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. The authors present a rare case of severe stercoral peritonitis caused by multiple intestinal perforations in a patient with primary ileocecal tuberculosis. Initial clinical and laboratory investigations led to the suspicion of inflammatory bowel disease. The subsequent diagnostic workup included colonoscopic examination of the cecal and terminal region of the ileum with multiple biopsies. After the pathologist had assessed the specimen as indicating Crohn's disease, appropriate therapy was initiated. Several days later, however, the patient was readmitted to a surgical intensive care unit with clinical signs of peritonitis and immediately operated on. The final diagnosis from a resection specimen confirmed the diagnosis of primary intestinal tuberculosis. The follow-up was complicated by a subhepatic abscess formation with the necessity for surgical drainage. The patient's recovery was uneventful, she underwent intensive antituberculotic therapy and is asymptomatic at present. Surgeons caring for patients with acute abdomen should be aware of tuberculous perforation peritonitis even in non-risk groups of patients.

Abdomen, Acute↗
PubMed2003

Gastro-intestinal tract perforation in neonates.

BACKGROUND: Gastro-intestinal tract (GIT) perforation in neonates is a serious problem associated with high mortality due to resulting sepsis. Co-morbid factors, eg. prematurity, respiratory problems, low birth weight, and nutritional factors, negatively affect the outcome. OBJECTIVES: To review the management outcome of gastro-intestinal tract perforation in neonates in KwaZulu-Natal and identify factors that require attention for better survival of neonates with GIT perforation. DESIGN: Retrospective study of consecutive complete data sets of patients presenting with a diagnosis of GIT perforation. SETTING: Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa. SUBJECTS: Fifty four neonates treated for gastro-intestinal tract perforation between January 1998 and January 2003. MAIN OUTCOME MEASURES: Morbidity as determined by complications and mortality. RESULTS: More males (69%) were affected than females (31%). The median birth weight was 2.3 kg and median age at presentation was four days. Eighty nine percent were referred from peripheral hospitals. Abdominal distension was the leading symptom and sign (74%). Co-morbid factors were present in 89%, with prematurity as the leading factor (52%). Necrotising enterocolitis (NEC) was the main cause of perforation (33%) and the terminal ileum was the most common site. Most (56%) were treated by excision and primary repair of perforations. Sepsis was the leading complication (44%) and major cause of death (72%). Mortality was highest (56%) in perforations due to other primary pathology followed by NEC (53%). Overall mortality was 46%. CONCLUSION: It is essential to prevent secondary perforations by early recognition and management of primary pathology. Management of pneumoperitoneum in neonates with respiratory difficulties should be included in resuscitation before transfer. Rectal temperature monitoring and herbal enemas should be strongly discouraged.

Anti-Infective Agents↗
PubMed1976

[Complications resulting from ventriculo-peritoneal shunt: an anticipatory comment-case report (author's transl)].

Case is 23 year-old man, Who was admitted to the University Hospital with a diagnosis of acoustic neurinoma as a manifestation of von Recklinghausen's disease. V-P shunt was performed because of the increased intracranial pressure and post-operative course was complicated by repeated bout of meningitis. Otherwise, postoperative course was uneventful till about 7 month after placement of V-P shunt when the proximal end of the shunt tube perforated into the lumen of the intestine and about 30 cm length of shunt tube emerged from anus. Subsequently the patient developed meningitis. Nowadays, the tendency was noted that ventriculo-peritoneal shunt is more frequently performed than ventriculoauricular shunt and so increased incidences of complications attributable to the position of the tip of the shunt tube in theperitoneal cavity is naturally anticipated. In this report, we discussed the mechanism of development of intestinal perforation, its prophylactic measures and the earty diagnosis. Number one factor which is attributed to the cause of intestinal perforation is a fact that any intra-peritoneal foreign body is potentially able to cause intestinal perforation. The second factor is the sharp tip of the peritoneal shunt tlbe which more easily cause intestinal perforation than otherwise. The third factor is the constant pressure at the same location of the intestinal wall over a long period of time which is applied by a peritoneal tip, which is considered to cause necrosis of the intestinal wall. The fourth factor is relatively poor general condition of the patient and secondary decrease in resistance of the intestinal wall against the foreign body. We therefore postulate for the prophylaxis and early diagnosis that we should often check the position of the tip of the shunt tube end should performed the radiological evaluation at the first sight of peritoneal irritation sign. The architecture and the location of the tip of the tube, the length and material of the tube seem to have intimate relation to the prophylaxis against intestinal perforation and these factors have to be evaluated in the future.

Adult↗
PubMed2006

Laparoscopy as an adjunct to peritoneal drainage in perforated necrotizing enterocolitis.

Intestinal perforation in very low birth weight infants with necrotizing enterocolitis has a high morbidity and mortality. We report the use of laparoscopy on day 30 of life in the treatment of a very low birth weight infant (900 g) with perforated necrotizing enterocolitis. The question of laparotomy versus peritoneal drain is ongoing. Laparoscopy may have a major role to play in the answer to this debate. The versatility of laparoscopy enables good visualization of the bowel and organs: a drain can be placed in a port site if there is no fecal contamination and a more conservative approach is warranted, or a conversion to a laparotomy can be undertaken if there are obvious feces or necrotic bowel. We feel that laparoscopy in the initial evaluation of necrotizing enterocolitis is invaluable, and can avoid potentially unnecessary surgery in an already extremely unwell infant.

Combined Modality Therapy↗
PubMed1989

[Perforation of the small intestine as a sequela of blunt injuries of the abdomen during a 12-year period].

The paper presents 44 cases of small intestine perforation caused by blunt abdominal trauma in a period of 12 years. 34 patients were men and 10 were women. The patients were aged from 10 to 82 years which gives an average age of 39 years. The average incidence of cases was 4 per year. In 23 patients associated injuries were diagnosed, namely: 5 spleen ruptures, 3 liver ruptures, 5 colon perforations, 1 pancreas injury and 1 kidney injury. Associated injuries in which the dominant syndrome was intraabdominal hemorrhage presented no diagnostical difficulties seeing that the results of punction or abdomen lavage indicated immediate laparotomy. In patients with isolated injury of the small intestine and clinical signs of peritonitis laparotomy was treated with a two layer suture in 32 patients; in 12 patients resection with T-T or L-L anastomosis was made. Associated injuries were treated in the same act. Of 44 patients treated in our Clinic 37 were treated successfully, while 7 died.

Abdominal Injuries↗
PubMed1997

Mesenteric vasculopathy in intestinal tuberculosis.

BACKGROUND: Involvement of mesenteric vessels in intestinal tuberculosis and its role in the pathogenesis of the intestinal changes have not been studied histologically. AIM: To study mesenteric vessels in patients undergoing surgery for complications of intestinal tuberculosis. METHODS: Resected intestinal specimens from 68 patients presenting with intestinal perforation and intestinal obstruction were examined; involvement of the major mesenteric vessels was evaluated. RESULTS: Granulomas were seen in the vessel wall in one case and near the vessel wall in 11 cases, intraluminal thrombi were seen in 23 cases, and subintimal fibrosis in nine cases. Perivascular cuffing was seen in intramural and subserosal vessels in ten cases. CONCLUSIONS: Changes in the vessel wall may lead to gut ischemia, which may contribute to the development of strictures and stercoral perforation in intestinal tuberculosis.

Adolescent↗
PubMedDate not supplied

[Features of clinical course of enteric fever associated with polyresistant strains of Sp.typhi 61-0 ].

Particular features have been studied of the clinical course of present-day abdominal typhoid caused by Sp. typhi 61-0 polyresistant strains. The clinical analysis performed has shown that Sp. typhi 61-0 polyresistant strain-associated enteric fever runs a moderately severe and severe course. There is an increased frequency of complications such as intestinal hemorrhage, perforated intestine, pneumonia, in the above patients. In the time-related course of the disease, Widal's reaction is not considered to be expedient for use in the diagnosis of Sp. typhi 61-0 strain-associated abdominal fever.

Adolescent↗
PubMed1993

Use of ultrasound in the detection of occult bowel perforation in neonates.

Intestinal perforation is a common and serious complication of NEC in neonates. Plain film evidence often is absent in patients with surgically proved perforation. Some patients with NEC develop a distended, gasless abdomen suitable for sonographic evaluation. Five neonates with gasless abdominal distention and clinical decline were studied with ultrasonography. Four patients demonstrated intraperitoneal fluid-debris levels and ascites; all had surgical proof of perforation. The fifth patient did not demonstrate these findings and subsequently recovered. The sonographic findings of ascites and intraperitoneal fluid-debris levels in patients with NEC are suggestive of perforation.

Ascitic Fluid↗
PubMed1999

Tetanus after a resection for a gangrenous perforated small intestine: report of a case.

We report herein the case of a 75-year-old man who developed severe tetanus 24 h after the resection of a gangrenous perforated small intestine. It seemed that the tetanus was caused by a spillage of the intestinal contents harboring Clostridium tetani; however, this was not identified by a culture. The diagnosis of tetanus was made only when opisthotonus in this patient became evident and normal tetanus treatment proved to be successful.

Aged↗
PubMed1989

[Meconium peritonitis complicated with Enterobacter aerogenes infection--a case report].

Meconium peritonitis is an aseptic peritonitis that follows a perforation of the intestines in fetal life. It is a serious complication of intestinal perforation. This article reports a female newborn who was born with gestational age of 40 weeks and birth body weight of 3400 gm. She was admitted at age of 6 days, owing to persistent vomiting, abdominal distention, tachypnea and acrocyanosis since birth. The plain abdomen showed intra-abdominal calcification and intestinal distention. Under the impression of meconium peritonitis, she was treated aggressively with exploratory laparotomy, TPN and antibiotics. During operation, dense fibrous adhesions and agglutination of the intestine were found. But no intestinal perforation was noted. Culture of ascites isolated Enterobacter aerogenes. The patient's condition was gradually recovered and she was discharged at age of 32 days. According to the previous literature, meconium peritonitis is a relative rare disease with poor prognosis. So we would like to report this case.

Enterobacter↗
PubMed2003

Helminth parasites of the southern sea otter Enhydra lutris nereis in central California: abundance, distribution and pathology.

From October 1997 to May 2001, the gastrointestinal tracts from 162 beach-cast southern sea otters Enhydra lutris nereis were examined for helminth parasites and associated lesions. Carcasses were collected opportunistically in central California between Pt. San Pedro and Pt. Arguello. The primary goals of this study were to examine spatial and temporal variability in mortality due to parasite infection, identify factors associated with increased risk of infection, and illustrate the process of intestinal perforation by Profilicollis spp. Two genera and 4 species of acanthocephalans (Profilicollis altmani, P. kenti, P. major, Corynosoma enhydri) were found in 46.3% (Profilicollis spp.) and 94.4% (C. enhydri) of the carcasses examined. Three species of Digenea (Microphallus pirum, M. nicolli, Plenosoma minimum) were found in 47% of carcasses, at times in massive numbers (> 3000 per cm2). This is the first report of the latter 2 species from the sea otter. Mortality resulting from infection by Profilicollis spp. occurred in 13.0% (n = 21) of sampled carcasses, either directly, due to perforation of the intestinal wall and peritonitis (9.9%, n = 16), or indirectly, due to inhibition of host nutrient uptake or depletion of host energy reserves to fight chronic infections (3.1%, n = 5). The most massive infections (< 8760 parasites), and all cases of intestinal perforation occurred in carcasses infected by P. altmani and/or P. kenti. Mortality due to infection by Profilicollis spp. occurred more frequently among juvenile and old-adult females (chi2 = 17.479, df = 9, p = 0.045) from sand and mixed habitats in Monterey and Santa Cruz in the north of the sea otter range (chi2 = 9.84, df = 4, p = 0.045). Spatial differences in sea otter mortality coincided with the relative distributions of Profilicollis altmani, P. kenti, and P. major, and may reflect differences in sea otter diet, or differences in intensity of infection in intermediate hosts. Mortality rate due to infection by Profilicollis spp. decreased between 1998 and 2001, though differences were not significant (chi2 = 3.983, df = 3, p = 0.40), and may vary on multi-year cycles due to environmental factors such as density of definitive hosts (e.g. the surf scoter Melanitta perspicillata), or El Niño. Corynosoma enhydri did not cause significant damage to the intestine of the host, even when present in great numbers.

Acanthocephala↗