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PubMedDate not supplied

Perforation of the jejunum secondary to AIDS-related gastrointestinal Kaposi's sarcoma.

Intestinal perforation in human immunodeficiency virus-positive patients due solely to Kaposi's sarcoma (KS) has rarely been described. A homosexual man with acquired immunodeficiency syndrome-related KS who presented with an acute abdomen is presented. He was found to have a jejunal perforation through a small KS lesion. There were no infectious organisms identified at the site of perforation.

Abdomen, Acute↗
PubMed2004

Endoscopic perforation rates at a Canadian university teaching hospital.

BACKGROUND: Despite advances in training, operative techniques and endoscopic technology, upper and lower endoscopic procedures continue to have potential for intestinal perforation. Perforation rates provided to patients at the time of consent have frequently been derived from historical cohorts and survey datasets. OBJECTIVE: This study examined the perforation rates of upper and lower endoscopic procedures at a major Canadian tertiary care centre. METHODS: Inpatient and outpatient gastroscopies and colonoscopies performed during a three year period were evaluated. Endoscopies with perforations occurring within 14 days of procedure were retrospectively isolated using the International Classification of Diseases - 9th Revision code descriptions, then retrieved and hand searched to confirm a procedure-related perforation. Data were extracted to identify risk factors and patient outcomes. RESULTS: A total of 21,217 endoscopies (13,792 gastroscopies and 7425 colonoscopies) were reviewed. Of these, 359 were identified, isolated and hand searched for confirmation of a perforation event. Eighteen were found to have an endoscopy-associated perforation. Ten perforations occurred with colonoscopy (0.13%) (incidence, 1.3/1000 procedures), resulting in one death (0.013%) (incidence, 0.13/1000 procedures). Eight perforations occurred with gastroscopy (0.06%) (incidence, 0.6/1000 procedures), resulting in zero mortality. Of colonoscopy procedures the rate of perforation with diagnostic colonoscopy was 0.13% (incidence, 1.3/1000 procedures) and with therapeutic colonoscopy was 0.14% (incidence, 1.4/1000 procedures). Of gastroscopy procedures the rate with therapeutic gastroscopy was 0.15% (incidence, 1.5/1000 procedures). No perforations occurred with diagnostic gastroscopy. CONCLUSION: Gastroscopy and colonoscopy procedures, especially those with therapeutic maneuvers, continue to carry morbidity and mortality risks associated with perforation.

Adult↗
PubMed1999

[Vascular complications during laparoscopy. An analysis of a personal case].

Vascular complications of laparoscopy most often occur during Veress needle or primary trocar placement. Veress needle punctures are insignificant and require no further treatment, whereas trocar induced vascular injuries can be catastrophic. The frequency of vascular or viscus injuries is difficult to calculate since several complications are not published. A vascular complication occurred in a young girl with neurologic problems and a kyphoscoliosis operated on in laparoscopy for a gastroesophageal reflux is discussed. After the establishment of pneumoperitoneum, an important hemoperitoneum was rapidly evident at insertion of the laparoscope. An open laparotomy was performed showing right common iliac vessel injuries and several intestinal perforations. After a complex vascular reconstruction and a multiple intestinal suture, the Nissen fundoplication with pyloroplasty was performed traditionally and the patient leave the hospital free of symptoms after 20 days. In laparoscopy, as in all areas of surgery, experience knowledge and meticulous attention to details are the most important factors in order to avoid complications. The authors believe that the open approach with Hasson cannula is the most important factor in avoiding complications.

Child, Preschool↗
PubMed1994

Isolated small bowel perforation following intrauterine treatment with indomethacin.

Indomethacin, a prostaglandin synthetase inhibitor, is an effective tocolytic agent that may have adverse fetal side effects such as constriction of the ductus arteriosus, pulmonary hypertension, and reduced urine production. We describe an unusual neonatal complication following 6 days of tocolysis with indomethacin. A 22-year-old gravida 5, para 3104 was admitted at 25 weeks of gestation in labor. Attempts to stop labor using magnesium sulfate and terbutaline failed. The contractions stopped following the administration of indomethacin, which was continued for 6 days. On day 7, due to contractions and vaginal bleeding, she underwent a classic cesarean section. The female newborn, weighting 1044 g, did well for 2 days, when she developed pneumoperitoneum. On laparotomy, an isolated midileal perforation was found, with otherwise normal-appearing bowel. Isolated intestinal perforation has been described in premature neonates who were treated with indomethacin for patent ductus arteriosus. This complication is caused by splanchnic ischemia secondary to the loss of the vasodilatory effect of prostaglandins. This case indicates that this rare but serious complication may also follow intrauterine exposure to indomethacin.

Adult↗
PubMed1984

Apparent traumatic perforation of the bowel in tetanus. A case report.

A case of severe tetanus complicated by intestinal perforation is described. Because of the nature of the treatment in tetanus, the diagnosis was missed for several weeks and the patient's life consequently put at great risk. The possibility that the perforation may have resulted from extreme intra-abdominal pressure changes during spasms is discussed as well as the difficulties of managing such complications in an intensive care unit.

Adult↗
PubMed1980

Indications for operation in acute necrotizing enterocolitis of the neonate.

A study to evaluate criteria for operation was carried out in 61 infants with acute necrotizing enterocolitis (NEC). A total of 10 clinical, roentgenographic, and laboratory criteria were considered. Each proposed operative criterion was correlated with the documented presence or absence of intestinal gangrene in these infants. Indications for operation verified by this study were (1) pneumoperitoneum, (2) paracentesis findings positive for gangrenous intestine, (3) erythema of the abdominal wall, (4) a fixed abdominal mass, and (5) a persistently dilated loop of intestine on serial abdominal radiographs. The first two signs occurred frequently; the latter three were rare. Operative indications which proved to be invalid in this study were (1) clinical deterioration, (2) persistent abdominal tenderness, (3) profuse lower gastrointestinal hemorrhage, (4) the roentgenographic finding of gasless abdomen with ascites, and (5) severe thrombocytopenia. Twenty-four of the infants were operated on. The mortality rate among the infants operated on after free intestinal perforation had occurred (64%) was double that of infants operated on for intestinal gangrene without perforation (30%). Paracentesis may identify infants with intestinal gangrene prior to the development of perforation and may permit advantagenous timing of operation. This analysis of the frequency and reliability of proposed operative criteria may aid the surgical decision.

Ascites↗
PubMed2007

Intestinal volvulus and perforation caused by multiple magnet ingestion: report of a case.

Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.

Child, Preschool↗
PubMed2003

Intestinal obstruction and perforation--the role of the surgeon.

Intestinal obstruction and perforation are always a challenge for the surgeon, not only in respect to the surgical option offered to the patient, but also to the ability to accurately diagnose and stage the disease. The understanding of the underlying pathophysiological mechanism is also very important in order to classify each patient in order to receive the more appropriate treatment. Mechanisms of obstruction and perforation, methods of diagnosis as well as prevention and treatment of the disease were reviewed.

Colonic Pseudo-Obstruction↗
PubMed1987

Slow-release potassium and perforation of Meckel's diverticulum.

A case of peritonitis following perforation of gastric-type mucosa in a Meckel's diverticulum is described. At laparotomy a wax core of a combined diuretic-slow-release potassium preparation was found extruding through the perforation and a further pellet was found free in the peritoneal cavity. Intestinal perforation due to potassium-containing drugs is recognized and led to the development of enteric-coated and slow-release delivery systems. The association of perforation of Meckel's diverticulum with a slow-release potassium perforation has not previously been described.

Aged↗
PubMed1994

Early onset of cecal perforation in neonatal, recto-sigmoid type Hirschsprung's disease.

Hirschsprung's disease has been considered to cause intestinal perforation in rare cases. Even if a perforation occurs, the majority of cases are associated with the long-segment or total colonic type. Our case developed the perforation in the neonatal period in spite of being of the recto-sigmoidal type, and it affected the cecum. We do not have a good explanation for this condition. However, the pathological examination of the specimens of the perforated cecum revealed some necrosis (ulceration, subcutaneous hemorrhage, congestion and severe edema) which was considered to be caused by ischemia, secondary to a localized vascular accident in the wall of the distended intestine.

Age of Onset↗
PubMed1991

Yersinia enterocolitica infection with ileal perforation associated with iron overload and deferoxamine therapy.

Despite the frequency of gastrointestinal disease caused by Yersinia enterocolitica, intestinal perforation is a rare complication of this infection and to date only eight cases have been reported in the English literature. We describe a case of this unusual condition in a 17-year-old male patient with thalassemia intermedia requiring transfusion, who was also taking deferoxamine. The severity of the clinical picture is probably due to the increased virulence of Yersinia enterocolitica in the presence of deferoxamine and iron.

Adolescent↗
PubMed2002

Perforation of toxic megacolon in non-typhoid Salmonella enterocolitis spares young infants and is immune-mediated.

Intestinal perforation, a life-threatening complication of toxic megacolon (TM) following non-typhoid Salmonella infection, is relatively uncommon in infants less than 1 year of age. The situation, also found in typhoid fever, appears to be cytokine-mediated. This finding may justify immunotherapy for older children with TM associated with non-typhoid Salmonella infection in order to prevent this complication.

Age Factors↗