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PubMedDate not supplied

Jejunal perforation in a patient with adult T-cell leukemia.

We present a case of adult T-cell leukemia (ATL) with jejunal perforation at the site of intestinal involvement by ATL. A 39-year-old woman presented with sudden-onset abdominal pain. Physical examination showed generalized severe abdominal tenderness and intraabdominal free air was seen on radiographic examination. Under a diagnosis of peritonitis due to intestinal perforation, an emergency operation was performed. A pinhole-like perforation was found in the jejunum 80 cm distal to Treitz's ligament, and the patient underwent partial resection of the affected jejunum. Microscopic examination revealed diffuse infiltration of abnormal lymphocytes into the entire wall of the jejunum and mesenteric lymph nodes. A diagnosis of ATL was confirmed by the presence of antibody to human T-lymphotropic virus type 1 (HTLV-1) in the serum, a positive result for T-cell markers and the HTLV-1 proviral genome in the mononuclear cells in the specimens. The final diagnosis was thus lymphoma subtype of ATL. Combination chemotherapy was repeated until the patient died 14 months postoperatively. Emergent surgery followed by intense chemotherapy might improve survival in patients with ATL and perforated intestine.

Adult↗
PubMed1988

Recurrent perforation complicating intestinal neurofibromatosis.

A patient with diffuse intestinal neurofibromatosis who presented with recurrent small bowel perforation is described. Such recurrent perforation has not been reported previously. Management at first perforation consisted of laparotomy, and excision of the perforated nodular lesion, with removal of the gall-bladder and appendix. The diagnosis of von Recklinghausen's disease was confirmed by skin biopsy. Management of the second perforation was conservative, with administration of intravenous antibiotics, fluid replacement therapy, and nasogastric suction. The third perforation was treated surgically, with resection of the small bowel, leaving approximately 50 cm of small bowel. Such an approach represented a compromise between cure of the neurofibromatosis and leaving sufficient small bowel to allow satisfactory alimentation.

Adult↗
PubMedDate not supplied

[Spontaneous perforations of the large intestine].

Spontaneous perforation of colon is a rare disease and physiopathologic basis are actually unknown. Surgical treatment is standardized and post-operative survival is over 60%, morbidity and mortality rate depends on peritoneal contamination. In 1984 J.A. Berry classified spontaneous perforations into "stercoral" and "idiopathic" perforations on the basis of etiopathogenetical causes of lesions. Anatomopathologically stercoral and idiopathic perforations present different characteristics. Macroscopically stercoral perforation origines from an ulcerative lesion often situated on the sigmoid colon or rectum. Microscopical characteristic is represented by a superficial ischemic necrosis of mucosa (caused by fecalomas) followed by an extension to sub-mucosa and muscular tissues of the colonic wall. On the contrary, "idiopathic perforation", frequently situated on the sigma, is a linear laceration of anti-mesenteric side of the colon without pathologic modifications of the colon. Physiopathologic basis of spontaneous perforations of the colon were also discussed. Stercoral perforation is often a consequence of chronic constipation. Instead, two hypoteses are advanced as regards idiopathic perforations. S.V. Kessing e coll. (1962) hypotized a parietal suffering caused by ischemia of anti-mesenteric side of the colon, depending on ipoperfusion of colonic tissues; they also hypotized a constitutional weakness of colonic wall as a cause of idiopathic perforation. Others hypotized an intraluminal hypertension caused by intestinal hernias (J.W. Eadie, 1955; K. Cronin, 1959), rectal prolapse or abnormal depth of Douglas cavity (D.C. Lyon, 1969). In these cases, lesion is caused by contraction of abdominal muscles during defecation, which presses colonic wall during distension.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2003

Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma.

PURPOSE: Intestinal perforation due to blunt abdominal trauma is rarely seen in children and delayed diagnosis is a major concern. Because the potential risk factors affecting morbidity are not well known, we evaluated whether diagnostic delay increases morbidity in gastrointestinal perforation from blunt abdominal trauma in children. METHODS: Twenty-nine children with gastrointestinal perforation caused by blunt abdominal trauma, admitted to our clinic between 1983 and 2001, were retrospectively evaluated by analyzing the relationship between overall morbidity and potential risk factors. RESULTS: There were 23 boys and 6 girls. Most of the injuries were caused by falls and motor vehicle accidents. The jejunum was the most frequent site of perforation followed by the ileum. Simple closure was the most common surgical procedure. Postoperative complications developed in five patients (17%) and included wound infections in two, wound dehiscence in one, and adhesive small bowel obstruction in two. Potential risk factors such as trauma mechanism, the presence of shock on admission, and associated organ injury were not significantly correlated with postoperative complications, whereas a period of delay exceeding 8 h and an Injury Severity Score (ISS) exceeding 15 were significantly related to septic complications (P < 0.05). The relative risk of a septic complication developing was higher than 2 for the following risk factors: a fall from a flat-roofed house and a time delay before operative intervention. There were three deaths (10%) in this series, caused by sepsis in two patients and head injury in one. CONCLUSION: These findings suggest that rapid diagnosis and treatment is important for preventing complications in patients with intestinal perforation caused by blunt abdominal trauma. A delay exceeding 8 h and an ISS score exceeding 15 were related to significant septic complications, and falls from flat-roofed houses are an important public safety risk in Turkey.

Abdominal Injuries↗
PubMed2006

Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction.

BACKGROUND: Carcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare. CASE PRESENTATION: A 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy. CONCLUSION: Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel.

Journal Article↗
PubMed1984

[Ultrasonic diagnosis of fetal ascites with polyhydramnios resulting from partial small intestine atresia and secondary intestinal wall perforation].

A primigravida was admitted to hospital in the 31st week of pregnancy after normal pregnancy course, with premature rupture of the amnion. Ultrasonography revealed a marked fetal ascites as well as polyhydramnion. Pregnancy was terminated via Caesarean section because of threatening intrauterine asphyxia. The asphyctic, hypotonic infant, which did not show any visible malformation, was intubated and the ascites was punctured. After a brief recovery, the infant died 24 hours post partum. Autopsy revealed partial atresia of the small intestine with secondary perforation of the intestinal wall, as well as a fibrinous-purulent peritonitis. Pathogenesis of the foetal ascites, as well as the possibilities of diagnosis via sonography in case of fetal malformations, are discussed on the basis of the present case and previous literature.

Adult↗
PubMed1993

[Complications and the proximate causes of death in typhoid].

The article analyses the 65 lethal cases by typhoid in the period 1980-1986 during an outbreak of infection among the servicemen of the 40-th Army. All the deceased had the age of 18-37, 79.8% of them were 18-20 years old. The most frequent complications were: myocarditis (84.6%), pneumonia (75.4%), hemorrhagic syndrome (50.8%), intestinal perforation (49.2%), intestinal ulcer hemorrhage (21.5%), pleuritis (20.0%), purulent complications (11.7%), endotoxic shock (12.3%). The structure of proximate causes of death was as following: perforative peritonitis (30.8%), pneumonia (20.0%), acute heart failure (13.8%), intestinal ulcer hemorrhage (12.3%), suprarenal hemorrhage (7.7%). The results obtained during this study prove the fact that this outbreak of epidemic infection had the features of classical typhoid.

Adolescent↗
PubMed1990

Peritoneal lavage white count: a reassessment.

Of 29 blunt trauma victims with a diagnostic peritoneal lavage white blood cell count (DPL:WBC) greater than or equal to 500/mm3 as the sole positive lavage criterion, only four underwent laparotomy at admission, and only one of these had sustained intestinal perforation. Two of the remaining 25 succumbed to extra-abdominal injuries within 24 hours, leaving 23 patients, who were followed clinically for an average of 34.7 days. None was ever discovered to have sustained intestinal perforation. Throughout the study period, 27 patients were seen who had sustained intestinal perforation from blunt abdominal trauma. Nine were explored based upon an initial physical examination suggestive of peritonitis. The remaining 18 underwent DPL: 17 demonstrated gross blood, and only one patient was diagnosed solely by an elevated DPL:WBC. We conclude that DPL:WBC is a nonspecific indicator of intestinal perforation from blunt abdominal trauma, and prospective studies are needed to properly define its role. Sequential determinations of DPL:WBC may be useful in the diagnosis of intestinal perforation.

Abdominal Injuries↗
PubMed2001

[Bowel perforation after extracorporeal shock wave lithotripsy: a case report].

A case of intestinal perforation caused by ESWL for left ureteral calculus is reported. A 69-year-old male underwent the graft replacement for bilateral iliac aneurysm in March, 1996. In February, 1999, there appeared left flank pain, and a diagnosis of left ureterolithiasis was made by radiological examination. On March 29 he was admitted to our department for ESWL. On March 30, ESWL for calculus in the pelvic region was performed with the patient in the prone position. The patient complained of the left lower abdominal pain immediately after ESWL, but no muscular defense was observed. Since the pain was not relieved, CT was performed on March 31, but no evident abnormal finding was found. Thereafter the pain continued and on April 2 muscular defense was also noted. On CT performed a second time, free air and evidence of ileus were found, so emergency operation was performed. Two perforations about 2 mm in size were found in the jejunum 130 cm from the Treitz' ligament, which led to diagnosis of intestinal perforation due to ESWL. The patient followed a satisfactory postoperative course and was discharged on April 23. There has been only one reported case of intestinal perforation due to ESWL. It is a very rare complication. However, this complication should be taken into consideration where the patient has the history of abdominal surgery and where ESWL was performed with the patient in the prone position.

Aged↗
PubMed1984

Nontraumatic perforation of the small intestine.

Nontraumatic perforation of the small intestine is very rare in western countries, while typhoid fever is the most common cause of such perforation in other parts of the world. A series spanning 24 years is reviewed, comprising 112 adults with perforation of the small intestine resulting in peritonitis. Perforations due to Crohn's disease, strangulation, postoperative complications and malignancy are not included. Causes of perforation were ingested foreign body (24 cases), radiotherapy (18), potassium chloride medication (13), diverticula of the small bowel (10), Zollinger-Ellison syndrome (2), and tuberculosis, actinomycosis and intrauterine contraceptive device (each in 1 case). The etiology could only be suspected in 13 cases and in 31 it was unknown. Difficulties in making the preoperative diagnosis contributed to lateness of surgical intervention. Mortality (23%) was related to patient age and cause of the perforation. The series permitted no conclusions concerning relationship between surgical method and mortality rate, but it is recommended that the method be adapted from case to case, depending on the etiology of the perforation.

Adult↗
PubMed2001

[Treatment strategy in iatrogenic perforation of the large intestine].

Iatrogenic perforation of the colon is a rare but feared complication of coloscopy with an incidence of up to 0.3%. During a period of 12 years we saw 14 perforations of this kind. The therapeutic approach varies with the state of peritonitis and type of perforation. Conservative primary therapy should only be chosen in rare cases. Classic operative therapy ranges from simple suturing to partial resection of the colon, in cases including even formation of a colostomy. In case of diffuse peritonitis discontinuity resection following Hartmann is still recognized as a secure procedure. Lethality of 7.1% in our own patients confirms the effectivity of conventional operating methods.

Aged↗
PubMed1987

Surgery for necrotizing enterocolitis.

Thirty-seven patients who had necrotizing enterocolitis and required emergency surgical intervention are reviewed. The indications for surgery were intestinal perforation (28), intestinal obstruction (7), clinical deterioration (1) and persistent rectal bleeding (1). The initial procedure was percutaneous peritoneal catheter drainage (13), intestinal diversion alone (8), intestinal resection (14), laparotomy and biopsy (1) and laparotomy alone (1). Twelve patients developed late intestinal strictures. The overall mortality rate was 35 per cent.

Age Factors↗