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PubMed2005

Outcome of primary peritoneal drainage for perforated necrotizing enterocolitis: comparison between laparotomy and drainage.

Perforation of the gastrointestinal tract in neonates is still associated with high mortality rates. Laparotomy is usually required to treat gastrointestinal perforation, however peritoneal drainage under local anesthesia has been also described as an alternative mode of treatment. In our institute, laparotomy was the first choice for the management of gastrointestinal perforation in neonates until 1999. Because of the high mortality rates in this group of patients, our policy has since changed to the use of primary peritoneal drainage instead. The aim of this study is to compare the effectiveness of primary peritoneal drainage (PPD) and primary laparotomy (PL) procedures in the management of gastrointestinal perforation due to necrotizing enterocolitis in neonates. Between 1994 - 1998, ten babies with intestinal perforation underwent PL, whereas fifteen newborns with similar findings were treated with PPD between 1999 and 2003. Eight (80 %) of the patients died in the PL group prior to 1999. In the PPD group 8 (53.3 %) of babies required no further treatment and were discharged without any complications. Four (26.7 %) patients in this group needed laparotomy later, and three (75 %) of them survived. In conclusion, we believe that PPD is more effective than PL for the management of perforated necrotizing enterocolitis in neonates. Laparotomy can be used in particularly unresponsive cases after primary peritoneal drainage.

Drainage↗

PubMed2004

Iatrogenic perforation during an endoscopic examination of the gastrointestinal tract.

OBJECTIVE: The study was aimed to highlighting the situations leading to increased risk of iatrogenic perforation during an endoscopic examination of the GIT. The optimization of surgical care procedure following intestinal perforation was suggested as well. METHODS: We analysed 3897 colonoscopic examinations performed during the past 5 years. We have found 6 cases (0.15 %) of iatrogenic colon perforation. RESULTS: All six cases of iatrogenic GIT perforations were followed by surgical revision. A suture was done twice, stomy three times, resection once, and restomisation also once. CONCLUSIONS: Polypectomy of thick polyps with a wider base and more rigid consistency is dangerous. The longer is the time and stronger the coagulation, the higher is the chance of iatrogenic perforation. Therefore we recommend laparoscopically assisted procedure. (Ref. 10.)

Colon↗

PubMed2000

Silent bowel perforation and transanal prolapse of a ventriculoperitoneal shunt.

A 2-year-old hydrocephalic child presenting with ventriculitis following intestinal perforation by a ventriculoperitoneal (VP) shunt is reported. The peritoneal end of the shunt had extruded through the anus without causing any abdominal signs. Removal of the shunt, external ventriculostomy, and antibiotics were effective treatment.

Cerebral Ventricles↗

PubMed1989

[Conservative treatment of perforation of the transverse colon caused by a catheter for continuous peritoneal dialysis. A case report].

In rare cases of intestinal perforation in patients dialysed peritoneally may be the dialyzing catheter introduced into the peritoneal cavity for repeated use. The therapeutic procedure (conservative or operative) is the matter of dispute. The authors present a female patient, aged 62, undergoing intermittent peritoneal dialysis for terminal renal failure. The perforation of the transverse colon due to the dialyzing catheter was successfully treated conservatively: the catheter was removed, antibacterial drugs, parenteral nutrition and bedrest were administered. Uraemia was controlled by haemodialysis.

Colon↗

PubMed1987

Serious air gun injuries in children: update of injury statistics and presentation of five cases.

There were over 70,000 injuries to children caused by air guns reported from 1981 to 1984. The majority of these injuries were minor; however, serious injury resulted in eight deaths. Reported injuries include corneal perforation, liver laceration, stomach and intestinal perforation, intracranial bleeding, cardiac perforation, and hemopneumothorax. Primary care physicians must be aware of the potentially serious or lethal nature of air gun injury and educate their patients accordingly. Legislation is also needed to restrict the sale of these guns, or increase the safety of air gun use. We report five cases of potentially life-threatening injury caused by air guns, three of which required emergency laparotomy.

Child↗

PubMedDate not supplied

[Changes in upper gastrointestinal motility during scleroderma].

Scleroderma (progressive systemic sclerosis) is a systemic collagen disease in which the upper gut is frequently involved. In particular, most patient show altered esophageal motility, which frequently result in severe esophagitis, often resistant to therapeutic measures. The small bowel is also frequently involved by the disease, especially in the late stage of scleroderma. Small bowel alterations are sometimes clinically silent, but can also be the origin of malabsorption syndrome, small intestine perforation, pneumatosis cystoides or chronic intestinal pseudo-obstruction. The occurrence of an altered gastrointestinal motility in scleroderma can be detected by means of manometric techniques; their use in the wide area of collagenopathies may help understanding the pathophysiology of the altered gastrointestinal function frequently existing in these diseases.

Esophagus↗

PubMed1978

Surgical problems in necrotizing enterocolitis in childhood.

The problem of necrotizing enterocolitis is discussed based on the experience with 24 patients. It has been found that the time factor plays an important role in the decision whether to operate. The indications for operation are intestinal perforation, threatening perforation, and penetration of a covered perforation. Operation is carried out in order to treat the peritonitis caused by perforation. The various operative methods are described and evaluated. Intestinal resection, exclusion enterostomies, and suture of the perforation may all be justified, depending on the findings at operation. The difficulties in the differential diagnosis are discussed. The importance of late complications are stressed, and it is pointed out that every case will require routine controls long after discharge from the hospital. The high mortality is directly related not to the surgical complications, but rather to the septicemia which so often develops.

Diagnosis, Differential↗

PubMed2002

Congenital bowel perforation in twin-to-twin transfusion syndrome.

Two unrelated survivors of twin-to-twin transfusion syndrome (TTTS) presented with intestinal perforation at birth. Both were localised perforations without any suggestion of widespread ischaemic disease to the splanchnic bed. Histopathology from the perforation site showed evidence of focal ischaemic necrosis, presumably from a vascular accident. One infant later died of multiple organ failure with major brain damage, but the other survived without long-term sequelae. These two cases appear to represent an unreported variation of the ischaemic intestinal complications of TTTS.

Female↗

PubMed2004

Duodenal perforation associated with breath stacking and annular pancreas.

Gastrointestinal perforations have been reported occasionally in neonates. The authors describe a 9-month-old girl with mosaic trisomy 8 on home breath-stacking therapy who presented with an acute abdomen. A large perforation in the first portion of the duodenum was found as well as an incidental annular pancreas. Despite occupying approximately half of the circumference of the lumen, the perforation was able to be closed primarily without complications. Several etiologies have been suggested for intestinal perforations. This report hypothesizes the possible involvement of breath stacking in conjunction with partial obstruction by an annular pancreas.

Chromosomes, Human, Pair 8↗

PubMed2003

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

Intestinal obstruction belongs to highly severe conditions in gastroenterology, namely from the viewpoint of quick and correct diagnosis as well as at determining rational and effective therapy. Etiological multifactorial characteristics leading to processes resulting in mechanical or dynamic obstruction of the intestine, often referred to as paralytic ileus, are undoubtedly serious factors influencing the accuracy of diagnosis and therapeutic approach. Digestive endoscopy is a mandatory method in the diagnosis of intestinal obstructions. Diagnostic endoscopy, colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine are the methods indicated in the majority of obstructive intestinal lesions. Besides their diagnostic importance, they also enable an effective therapeutic approach which may immediately follow the diagnostic intervention. Besides endoscopy that--due to the nature of performance--belongs to invasive methods, the diagnosis of obstructive intestinal processes is unthinkable without the use of non-invasive imaging methods. Abdominal ultrasound examination, a widely applied method, provides--under optimal examination conditions--information, e.g., about the width of the intestinal lumen or about the intestinal wall thickness; however, the specificity of investigation is not always sufficient. Both specificity and sensitivity of exploration are increased by a plain X-ray of the abdomen supplementing the ultrasound examination. Better results are achieved when the abdominal cavity is inspected by means of spiral CT examination that is nowadays not fashionable but highly effectively applied in the modification of the so-called CT enteroclysis or CT colonography. The usage of magnetic resonance (e.g. virtual colonography) is similar, but its efficacy is lower than that of CT examination. From a gastroenterologist's perspective, endoscopic examination is the fundamental diagnostic and therapeutic method. However, endoscopic examination is initially limited by the cardiopulmonary state of the patient--in a number of cases, first the cardiopulmonary condition must be stabilized, dysbalance of water and mineral state must be restored, and only then can endoscopic investigation be carried out. The application of enteroscopy in small intestine disorders is only suitable in cases where air must be aspirated from the region of the stomach and mainly small intestine as it happens, for example, in acute intestinal pseudo-obstruction. The success of complex conservative therapy in these states is reached in 80% of the cases. In acute and complete intestinal obstruction, a surgical treatment performed in time is the only method. In these cases, the importance of identification of obstruction and timing of the intervention performance from the viewpoint of the patient's survival is explicitly the principal and life-saving concern. In acute intestinal obstructions developing in patients with malignant affection of the intestine, it is necessary to choose--according to the obstruction location and general state of the patient--either urgently performed surgery or palliative endoscopic intervention which is the reduction of the intestinal lumen of the growing tumor mass and following insertion of a drain. This method also concerns lesions localized in the left half of the abdominal cavity, i.e. in the region of the rectosigmoid and descending part of the colon. Most patients in whom acute intestinal obstruction developed on the basis of malignant disease are risk and polymorbid subjects, and acute surgical intervention may be either impracticable or highly stressing. In such cases it is therefore helpful to insert a drain and to bridge the obstructed area after restoring the cardiopulmonary state including adjustment of the aqueous and mineral environment. Later, the performance of an elective surgical intervention is safer. Another alternative before inserting a drain is the dilatation of the stenotic site by means of a balloon, followed by stenting. Up until today, various types of intestinal drains have been introduced--they have always been self-expanding metallic stents. Just the application of self-expanding stents in patients with malignant intestinal obstruction and the endoscopic possibility of dilatations of benign intestinal obstructions with dilatation balloons are the most significant therapeutic contributions of digestive endoscopy in these states.

Colonic Pseudo-Obstruction↗

PubMed2003

[Bowel perforation due to metastatic lung cancer: a case report].

We report a case of small bowel perforation secondary to metastasis from a lung squamous cell carcinoma that occurred in a 72-year-old man. He was admitted to the hospital because of remittant hemoptysis after undergoing a right upper lobectomy. Fiberoptic bronchoscopy revealed bleeding from the right upper lobe bronchial stump that was due to recurrence of the tumor. He developed abdominal pain, nausea and vomiting four months after resection of the primary tumor. An abdominal radiograph demonstrated free air in the abdominal cavity. He was diagnosed as having intestinal perforation and was operated on. The operative findings indicated adherence and perforation of the jejunum and ileum. The pathological diagnosis of the removed tumor was poorly differentiated squamous cell carcinoma. The patient died 32 days after the second operation. Although abdominal metastasis from lung cancer is not an unusual postmortem finding, it is rare in clinical situations. If a patient with lung cancer complains of abdominal pain, it is important to consider the possibility of abdominal metastasis.

Abdominal Pain↗

PubMed1988

Gastrointestinal perforation in infants.

We found that the mortality rate was no greater in patients with necrotizing enterocolitis complicated by perforation compared with the rate in those with other causes of perforation in similar weight classes. Iatrogenic injuries had a 50 percent mortality rate in all gestational age and birth weight categories and, therefore, great caution and surveillance are of utmost importance when using invasive monitoring and therapeutic modalities to prevent this cause of perforation. Term infants had a preponderance of mechanical causes of perforation which mainly occurred in the foregut and proximal midgut, whereas premature infants have a preponderance of asphyxial or ischemic events underlying perforations which mainly occurred in the ileocolic region and were often associated with necrotizing enterocolitis. Although neonatal intestinal perforation is a catastrophic event, the very premature infant weighing less than 1,000 g at birth is at significantly greatest risk. The discouraging 20 percent survival rate in the less than 1,000 g premature infants presents a challenge to the surgeon, since the overall survival rate was 59 percent and the term infants had a 78 percent survival rate. A substantial share of the mortality in the infants weighing less than 1,000 g at birth relates to the occurrence of intracerebral hemorrhage and bronchopulmonary dysplasia. Vigorous medical and surgical approaches can be used to salvage premature infants in all weight classes with gastrointestinal perforation.

Enterocolitis, Pseudomembranous↗

PubMed1989

Weber-Christian disease associated with multiple perforations of the ileum and colon.

Panperitonitis developed in a 57-yr-old Japanese man during the course of Weber-Christian disease (WCD). Emergent operation disclosed three perforations of the ascending colon and two of the distal ileum. Histological study of the surgical specimen showed that all perforations were located at the centers of acute subserosal panniculitic foci. No vasculitis was discerned. In the previously reported three cases of WCD with intestinal perforation, perforation was solitary and seen in the small intestine. The cause of perforation was considered to be vasculitis in two cases. In the remaining one, panniculitis around the perforation was in chronic granulomatous stage. This was the first case of WCD in which acute subserosal panniculitis caused multiple ileocolonic perforations.

Acute Disease↗

PubMed1979

Mortality of preoperative peritonitis in newborn infants without intestinal obstruction.

Within a period of 15 years 649 neonates were subjected to laparotomy; 60 (9%) of these patients died. Eighty-seven of the patients had a peritonitis already preoperatively without intestinal obstruction. Many of these were cases of ruptured omphaloceles or gastroschisis. In 17 infants a spontaneous intestinal perforation was the cause of the peritonitis. In 13 there was a preexisting meconium peritonitis. Seven children suffered from gangrenous intestine. Further causes for preoperative peritonitis were a complicated enteritis in 7 and a perforated appendix in 2 cases. Twenty-five or 29% of the children died. The highest mortality was found in children with ruptured omphalocele. It was 50% followed by gastroschisis with 36%. The mortality in patients with spontaneous intestinal perforation was rather similar, and the same high fatality rate was observed in infants with gangrenous intestine. In 28% of the children no cause for the peritonitis could be discovered. The high mortality rate is primarily due to the infants' bad general condition, i.e., low birth weight, prematurity and additional severe malformations.

Germany, West↗

PubMed2003

Small bowel perforation in the premature neonate: congenital or acquired?

To determine the potential aetiological factors of small bowel perforation in the premature neonate, we performed a retrospective chart review of those neonates with spontaneous intestinal perforation (SIP) of the small bowel seen in our tertiary paediatric hospital between January 1980 and December 2000. Data were collected on gestational feto-maternal health, medical interventions prior to perforation and the subsequent operative and laboratory findings. There were 23 patients with SIP of the small bowel over the 21-year review; 65% were male. There were 7 twin pregnancies but no cases linked to maternal drug abuse. The median gestational age was 27 weeks, the median birth weight 973 g, 19 neonates required ventilation, 15 steroids and 13 indomethacin. The median age at diagnosis was 7 days, heralded by rapid development of abdominal distension in 22 patients. Surgical intervention in addition to insertion of a peritoneal drain was required in 19 patients. Positive microbiological cultures of blood or peritoneal fluid at operation were documented in 8 patients; 5 grew Staphylococcus epidermidis and 4 Candida species. Perforations were located in the ileum in 20 and the jejunum in 1. Deficiency of the muscularis propria was found in 6 patients. Of the 6 deaths, 2 neonates had significant co-morbidity in addition to extreme prematurity. Small bowel SIP occurs in the premature neonate after the first week of life and usually presents with abdominal distension. Putative risk factors identified included twin gestation, neonatal ventilation, use of steroids and indomethacin, infection with Staphylococcus epidermidis and Candida species and deficiency of enteric smooth muscle.

Comorbidity↗

PubMedDate not supplied

Perforation of the sigmoid colon by swallowed chicken bone: case reports and review of literature.

Two hundred and ninety-eight cases of intestinal perforation due to foreign bodies have been reported so far. The majority of perforations occur at narrowings and angulations. In the cases reported by McPherson, 83% of the perforation occurred in the ileum. It is more common in the elderly who wear dentures, in the mentally infirm and in chronic alcoholics. We present three cases of chicken bone perforation of the sigmoid colon with three different clinical manifestations: 1) Sigmoidovesical fistula: 2) Acute surgical abdomen; 3) Inflammatory mass. All the patients were elderly and wore dentures, which cover the important sensory area of the palate, allowing foreign bodies to pass down the gullet without being noticed. The first patient, who had a sigmoidovesical fistula, was treated with proximal colostomy and repair of the fistula. The second patient had generalized peritonitis and was treated with exteriorization of the sigmoid colon. The sigmoid colon of the third patient, who had an inflammatory mass, was resected. One patient (Case 1) died as a result of portal pyemia; Case 2 developed jaundice due to portal pyemia, but recovered; and Case 3 had an uneventful recovery.

Aged↗

PubMed1989

Intraperitoneal chemotherapy complicated by erosion of a Tenckhoff catheter into the colon.

Insertion and maintenance of intraperitoneal catheters must be done with meticulous attention to detail. We recommend insertion under direct vision to minimize the incidence of intestinal perforation during catheter placement. Intraperitoneal catheters should not be placed in close proximity to a fresh intestinal anastomosis because this position may promote anastomotic dehiscence. Communication between the catheter and the intestinal lumen necessitates catheter removal.

Catheters, Indwelling↗

PubMed1998

Familial ileal perforation: prenatal diagnosis and postnatal follow-up.

We report sibs (a brother and a sister) who presented prenatally with ultrasound findings of meconium peritonitis and postnatally were found to have perforation of the terminal ileum. The sister presented with fetal ultrasound findings of severe ascites and peritoneal calcifications. She had no prenatal intervention and was born at 38 weeks' gestation. Laparatomy revealed perforation of the terminal ileum with meconium peritonitis. Her post-surgical course was uncomplicated and at 30 months of age her growth and development are normal. Her brother presented prenatally with signs of meconium peritonitis including severe ascites and peritoneal calcifications. Prenatal aspiration of the ascitic fluid was performed and unlike his sister he was born prematurely, was operated on at 8 days, and developed bronchopulmonary dysplasia. He is currently 1 year old and has normal growth and development. The aetiology of the ileal perforation is not known. There were no findings suggesting connective tissue disorder and the aetiology of the intestinal perforation is not known. The occurrence of the same rare abnormality in sibs of different sexes points towards an autosomal recessive disorder.

Adult↗