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PubMed1987

Nontraumatic perforation of the small bowel.

Small intestinal perforation is an infrequent but often fatal complication of a variety of disorders. Treatment of 76 adults with nontraumatic perforation occurring during a 21 year period was reviewed. The majority of perforations were due to mechanical causes, malignancy, and Crohn's disease. An abdominal mass (53 percent, p less than 0.05) and fever (81 percent, p less than 0.01) were most frequently documented in patients with Crohn's disease, whereas a positive result on fecal occult blood testing (77 percent, p less than 0.025) was common in those with malignant perforations. Otherwise, clinical and laboratory manifestations, including radiographic evidence of free air, were inconstant. The overall mortality rate was 29 percent, with 65 (86 percent) of the patients undergoing operation. Survival was independent of diagnostic delay (p greater than 0.10). In general, despite various causes and delays in diagnosis, resection and primary anastomosis remains an effective treatment for perforation of the small bowel.

Adolescent↗
PubMedDate not supplied

[Comparison of the efficacy of ibuprofen and indomethacin in the treatment of patent ductus arteriosus in prematurely born infants].

AIM: To assess the efficacy and safety of early treatment with ibuprofen (IBU) and indomethacin (INDO) of patent ductus arteriosus in preterm infants. Prospective study with blind trial. MATERIAL AND METHODS: We studied 35 preterm infants (19 treated with INDO, 16 IBU) (gestation age <33 and birth weight < 1500 g), who had an echocardiographicaly confirmed patent ductus arteriosus (PDA). The infants were randomly assigned in two groups to receive INDO (0.2-0.2-0.2 mg/kg) or IBU (10-5-5 mg/kg) in first 72 hours of life (average 2 days of life). The rate of ductal closure, the need for surgical ligation, side effects, complications, and the infants clinical course were recorded. RESULTS: The rate of ductal closure was similar in two groups (15/19, 80% INDO; 11/16, 69% IBU). 27 infants (15 INDO, 12 IBU) were treated per protocol (3 doses). For remaining 8 infants we stopped treatment due to side effects. In the IBU group the main reason to stop treatment was pulmonary hemorrhage (3/16, 19%) and pulmonary hypertension (1/16, 6%), but in the INDO group it was increased serum creatinine and urea nitrogen concentrations (3/19, 16%) and intraventricular hemorrhage (IVH IV) grade (1/19 5%). In IBU group vs. INDO, urine output decreased (p=0.02), but never before below the level of oliguria (defined as urine output below 1 ml/kg/h). Risk of necrotizing enterocolitis (NEC) grade II was similar in two groups, but only patients treated with INDO showed intestinal perforations (p=ns). They received also postnatal hydrocortisone and we showed near significant tendency (p=0.06) for intestinal perforation in patients treated with INDO and hydrocortisone. There were no significant differences with respect to IVH or PVL between the groups. CONCLUSIONS: The efficacy of ibuprofen and indomethacin in PDA treatment is similar. Treatment of ibuprofen and indomethacin may cause transient renal dysfunction: diminished urine output and increase of serum creatinine and urea nitrogen concentrations. Indomethacin, especially with concomitant treatment with hydrocortisone, may increase the risk of intestinal perforation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

[Gastrointestinal perforations in neonatal surgery].

From 1970 until 1987 we treated 69 newborns with gastro-intestinal perforations. Immediate measures in form of laparotomy were undoubtedly necessary. Regarding our casuistic the authors present the clinical findings, necessary preoperative diagnostic measures and intra-operative and postoperative treatment. The localisation and the origin of the perforation are pointed out. The most frequent localisation was the small bowel (58%), followed by the colon (35%). Etiologically we found extensive NEC, atresias, meconium ileus and Hirschsprung's disease. In 4 cases iatrogenic rectum perforations, in 3 cases spontaneous gastric and duodenal perforations and twice an appendicular perforation were seen. Our operative procedure depends on the localisation, the degree of peritonitis, on intestinal necrosis and trophic alterations of the gut following ileus. In spite of intensive care, the mortality rate is still very high indicated with 33%. Furthermore more than half premature newborns died (18 out of 33). Based on these facts we propose quick diagnostic measures, interdisciplinary cooperation, an emergency operation followed by intensive care to ameliorate the results. Nevertheless we must keep in mind that newborns, who some years ago were condemned to die, nowadays can be operated, thus changing the mortality of gastro-intestinal perforations.

Colonic Diseases↗
PubMed2005

Colonic perforation in the first few hours of life associated with rhizomelic chondrodysplasia punctata.

Rhizomelic chondrodysplasia punctata (RCP), a rare autosomal recessive disease characterized by a disorder of peroxisome metabolism, has been shown to affect multiple organ systems. A neonate presenting with a colonic perforation in the first few hours of life was subsequently diagnosed with RCP. A literature search revealed no previous reports of intestinal perforation associated with RCP. Intestinal perforation should be added to the list of medical complications associated with RCP.

Chondrodysplasia Punctata, Rhizomelic↗
PubMed2003

Small bowel perforation due to blunt trauma directly to the inguinal region: a case report.

We report on a patient with intestinal perforation caused by direct blunt trauma to the inguinal region. The patient had been previously diagnosed with an inguinal hernia. The perforation was managed surgically, and he subsequently underwent hernia repair. In our opinion, intestinal perforation caused by inguinal region trauma in patients with inguinal hernias is a rare and unfortunate situation but one that reveals the importance of inguinal hernia repair.

Adult↗
PubMed1982

Toxic dilatation and perforation in inflammatory bowel disease.

The diagnosis and management of dilatation of the colon and free intestinal perforation in inflammatory or infective bowel disease are reviewed with reference to 32 cases seen during an 8-year period. Toxic dilatation of the colon occurred in 20 patients, including 6 with infective colitis. Ileostomy with subtotal colectomy and mucous fistula is a satisfactory operation for toxic dilatation due to inflammatory bowel disease. Patients with infective colitis can generally be treated without operation. Free intestinal perforation was seen in 12 patients. Colonic perforation may occur in association with toxic dilatation, but more usually it occurs without dilatation as a complication of Crohn's disease. Free perforation of the ileum was seen after a short illness in patients with Crohn's disease.

Adult↗
PubMed2001

[Diagnostic, therapeutic and prognostic aspects of intestinal typhoid perforations in children of Abidjan, Côte d'Ivoire].

We conducted a retrospective study on 48 children (with a sex ratio of 22 males to 26 females) who had been operated over the preceding 10 years for typhoid perforation on the viscera ward within the paediatric surgery department of Yopougon teaching hospital in Abidjan, Côte d'Ivoire. The mean age was 9 years 3 months ranging from 3 to 16 years. Typhoid peritonitis was diagnosed on the basis of symptoms, intestinal injuries and only rarely by way of biological examinations. Medical treatment associated three antibiotics: aminosid, metronidazol and the third generation of cephalosporin. Hydroelectrolytical and haematological resuscitation was performed 3 to 6 hours before laparotomy. Excision-suture was made in 81% of cases. Exclusive parenteral nutrition began 48 hours after the laparotomy. Mortality occurred in 6% of patients and morbidity in 46%. Complications were parietal suppurations, digestive fistula, parietal hernia, early occlusive syndromes and necrosed cholecystisis. Rectorragy and leucocytosis were considered as pejorative signs when associated to the classic typhoid peritonitis.

Adolescent↗
PubMed2004

Needle perforation of the bowel in childhood.

Accidental ingestion of foreign bodies occurs frequently in childhood. The majority of them are passed spontaneously, and conservative management generally is recommended for foreign bodies in the stomach and duodenum. However, in some cases, operative intervention should be considered to prevent undesirable complications, such as intestinal perforation. Two cases of intestinal perforation owing to accidental ingestion of a needle are reported.

Abdomen, Acute↗
PubMed2003

Duodenal atresia associated with proximal jejunal perforations: a case report and review of the literature.

Duodenal atresia is associated with Down's syndrome, malrotation, and congenital cardiac defects. Idiopathic intestinal perforations in a newborn, which are not associated with necrotizing enterocolitis (NEC), have been described. The authors report on a full-term neonate who had multiple perforations of the proximal jejunum distal to duodenal atresia. To the best of the authors knowledge, the combination of idiopathic intestinal perforation and duodenal atresia has not been reported previously.

Duodenal Obstruction↗