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PubMed2004

Management of intussusception.

Intussusception represents the most common abdominal emergency in infancy. The classical clinical triad, consisting of abdominal colics, red jelly stools and a palpable mass, is only present in approximately 50% of cases, 20% of patients are symptom free at clinical presentation. Primary imaging modality of choice is ultrasound scanning, which enables the diagnosis or exclusion of an intussusception at a sensitivity of 98-100%, specificity of 88% and a negative predictive value of 100%. In emergency cases, additional plain films are necessary to detect potential intestinal perforation, to identify intestinal obstruction or other diseases mimicking the clinical presentation. Once the diagnosis of an intussusception is established, non-surgical reduction (NSR) is used. A surgical approach is chosen in patients with signs of perforation, shock or peritonitis. Depending on the choice of guiding imaging technique, different contrast media are used for NSR. Barium suspension or air with fluoroscopic guidance, or saline only or mixed with water-soluble contrast under sonographic guidance, has to be used. Regardless of the used contrast medium, NSR is an effective technique, being successfully employed in more than 90% of cases.

Abdomen, Acute↗
PubMed1984

Risk of infection after penetrating abdominal trauma.

To identify the risk factors for the development of postoperative septic complications in patients with intestinal perforation after abdominal trauma, and to compare the efficacies of single-drug and dual-drug prophylactic antibiotic therapy, we studied 145 patients who presented with abdominal trauma and intestinal perforation at two hospitals between July 1979 and June 1982. Logistic-regression analysis showed that a higher risk of infection (P less than 0.05) was associated with increased age, injury to the left colon necessitating colostomy, a larger number of units of blood or blood products administered at surgery, and a larger number of injured organs. The presence of shock on arrival, which was found to increase the risk of infection when this factor was analyzed individually, did not add predictive power. Patients with postoperative sepsis were hospitalized significantly longer than were patients without infection (13.8 vs. 7.7 days, P less than 0.0001). Both treatment regimens--cefoxitin given alone and clindamycin and gentamicin given together--resulted in similar infection rates, drug toxicity, duration of hospitalization, and costs.

Abdominal Injuries↗
PubMed2000

Small-bowel perforation in very low birth weight neonates treated with high-dose dexamethasone.

INTRODUCTION: Early postnatal treatment with high doses of corticosteroids may be effective in reducing the duration of mechanical ventilation in very low birth weight infants at risk for bronchopulmonary dysplasia. However, serious side effects may occur. MATERIAL AND METHODS: A retrospective study on 5 very low birth weight neonates, mean (+/- SEM): gestational age range 27.5 +/- 2 weeks, mean birth weight (+/- SEM): 836 g +/- 169 referred between April 1997 and October 1998 from a single academic neonatal intensive care unit to our tertiary pediatric surgical center with the diagnosis of intestinal perforation. During the same period, 60 very low birth weight infants have been treated in that unit following a standardized protocol including surfactant for respiratory distress syndrome and high-dose dexamethasone to prevent bronchopulmonary dysplasia. RESULTS: Pneumoperitoneum was diagnosed between 6 to 9 days after birth. Clinically, all babies remained surprisingly stable. An isolated ileal perforation, without sign of necrotizing enterocolitis, was found at laparotomy in each patient. A limited intestinal resection was performed, with primary end-toend anastomosis (3 cases) or with transient ileostomies (2 cases). Surgical outcome was favorable in all patients. CONCLUSION: isolated intestinal perforation may be a complication of the preventive treatment of chronic lung disease with high-dose corticosteroids in very low birth weight infants. Conversely, corticosteroids may reduce the clinical signs and the multiple organ dysfunction associated with an abdominal drama, explaining the very good surgical prognosis of these newborns. Attention must be paid to an insidious pneumoperitoneum.

Bronchopulmonary Dysplasia↗
PubMed2000

Recurrent idiopathic perforations of the small intestine.

BACKGROUND/AIMS: Idiopathic perforation of the small intestine is extremely rare. The definition depends on the absence of any detectable pathology that could be responsible for the perforation. This study was undertaken to outline the criteria for determination of the condition. METHODS: Case report and review of the literature. RESULTS: A 50-year-old male patient underwent surgery including laparostomy and planned reexplorations for multiple recurrent small intestinal perforations of unknown origin; the patient made an uneventful recovery. Extensive investigations were carried out to search for any pathology that could explain the occurrence of perforations, but yielded no results. CONCLUSIONS: Further studies will possibly give more information concerning idiopathic perforation of the small intestine, provided that judicious criteria for its determination are applied.

Humans↗
PubMed2004

[Intraabdominal complications in the lumbar disc surgery].

INTRODUCTION: : Removal of a lumbar disc herniation is, at present, the most frequent surgical procedure, related to the spine in Neurosurgical Departments. It carries a very low rates of complications and a short postoperative hospital stay. However, in spite of their rarity, serious adverse intraoperative complications may occur, so we must be aware of its existence in order to make an early diagnosis and treatment to prevent a fatal outcome. It is important to ensure that the patient understand the possible complications and obtaining written consent to avoid later medico-legal problems. CLINICAL CASES: We report two cases with typical lumbociatic pain secondary to lumbar disc herniation operated at our Department, that resulted in intraoperative complications, due to perforation of intraabdominal structures. Initially, the patients underwent planned flavectomy, followed by simple disc removal. However, symptoms of abdominal pain and systemic hypotension in each case, began some hours later. Early diagnosis was achieved using abdominal-pelvic CT scan, showing an intestinal perforation in one patient and a tear of both iliac artery and vein in the other. In both, an urgent laparotomy was performed by colleagues from the Department of General and Vascular Surgery, with surgical repair. The final outcome was good and both are asymptomatic. CONCLUSION: Surgical removal of the lumbar disc herniation is a very effective procedure, but is not free from certain severe though rare complications. Intestinal perforation and vascular tears are two possible complications to suspect if abdominal pain or systemic arterial to suspect if abdominal pain or systemic arterial urgent surgical repair of such complications. It is of vital importance that the patient knows the existence of such complications and so obtain a written consent.

Abdomen↗
PubMed2006

Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal.

A retrospective study was performed to determine the predisposing factors associated with the complications of ingested gastrointestinal (GI) tract foreign bodies (FBs) in children who had surgical or endoscopic removal. The study was performed in 161 children who had endoscopic or surgical removal. The clinical data were evaluated in two groups. In groups I and II, respectively, 135 patients with no complications and 26 patients with complications were analyzed. The relative risk analysis was performed for the risk factors. The number of the patients with an accurate history and the radiopaque FBs was significantly higher in group I. Metal, especially sharp objects, and food plugs obstructing a diseased esophagus were the most common FBs found in group II. The majority of the FBs of both groups were entrapped in esophagus, the number of the FBs distal to esophagus was significantly higher and duration of lodgment was significantly longer in group II. Esophageal abrasion, laceration and bleeding, complete esophageal obstruction, caustic injury, severe esophageal stricture, laryngeal edema, recurrent aspiration pneumonia, loss of weight, intestinal perforation, constipation and intestinal obstruction were determined as complications. The relative risk was >1 for duration of lodgment more than 24 h, for sharp or pointed objects, button batteries, nonopaque objects, diseased esophagus and for the objects located below the upper third of esophagus. Type, radiopacity, location and duration of the ingested GI tract FB determine the outcome. A delayed diagnosis is the most significant factor increasing the risk of complications. Physician must maintain a high index of suspicion and a more extensive history; physical examination and radiodiagnostic investigation should be obtained in suspected cases.

Adolescent↗