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At least 991 records · Page 55Linked to original sources
PubMed1996

Cytomegalovirus infection and colonic perforation in renal transplant patients.

Cytomegalovirus (CMV) infection in immunocompromised patients is a major cause of morbidity and mortality. A well-documented manifestation of gastrointestinal CMV infection is gastrointestinal haemorrhage. In contrast, CMV-associated intestinal perforation has rarely been reported after transplantation, although it is well documented in AIDS patients. Three patients are reported who received their first cadaveric renal transplant in 1994 and subsequently developed CMV disease. During the course of their CMV illness, which was treated with ganciclovir, each presented with clinical suspicion of peritonitis and proceeded to laparotomy. All three were found to have sigmoid colon perforations with histological evidence of CMV infection. Following bowel resection and defunctioning, two patients made an uneventful recovery and have had the continuity of their bowel restored, but one died of overwhelming sepsis within hours of surgery. The explanation for the apparent clustering of this rare condition in transplant patients is uncertain.

Aged↗
PubMedDate not supplied

Chronic perforation of the sigmoid colon by foreign body.

Colorectal foreign bodies (FBs) may be ingested or introduced transanally and then migrate proximally. Without a reliable history, it may be impossible to determine which way a certain colorectal FB gained access. We present a case of a nonverbal mentally retarded boy with a flat piece of plastic impacted in the sigmoid colon, the colonoscopic extraction of which failed. He underwent laparotomy more than a year later to remove the FB, where chronic perforation of the sigmoid colon was discovered. The perforation was sealed with extensive adhesions to the pelvic wall, and histologically, the colon showed a chronic granulomatous reaction. We discuss the types, presentations, and diagnosis of intestinal perforation with FBs. Chronic perforation may present with radiologic and pathologic features that suggest inflammatory bowel disease.

Adolescent↗
PubMed2000

Possibilities and limits of treatment in patients with thrombotic thrombocytopenic purpura.

Results of treatment of 18 patients fulfilling the criteria for TTP are presented. Thrombocytopenia was present in all patients (100%). Sixteen of the 18 patients (88.8%) had mental status changes, and seven of the 18 patients (38.8%) had renal impairment. One patient had a secondary type of TTP, caused by non-Hodgkin's lymphoma of the large intestine (that was diagnosed later) and was excluded from the study. Immunosuppresive therapy with steroids, plasma exchange and replacement of removed volume with fresh frozen plasma in a dosage of 25 ml/kg body weight resulted in a statistically significant increase of platelet count (P = 0.00222), and a significant improvement in consciousness defined by increased GCS after 2 weeks (P = 0.00222). In two patients renal function recovered, and in one of them hemodialysis was no longer needed. This improvement in a small group of patients had no statistical significance. TTP recurred in seven patients. High doses of steroids caused serious side effects in two patients: in one patient, steroid diabetes, and in the other one, intestinal perforation.

Adolescent↗
PubMed2002

Hydroblast intra-abdominal organ trauma.

Hydroblast injuries of the extremities are not uncommon. Hydroblast injuries involving intra-abdominal organs are more unusual. Usually there are subtle findings on the abdominal wall with severe intra-abdominal trauma and undue delay in appropriate treatment may occur, resulting in increased morbidity. In addition to a review of the literature, this article presents a case of intestinal perforation due to hydroblast trauma.

Abdominal Injuries↗
PubMed1993

Perforation of the ileum secondary to Enterobius vermicularis report of a rare case.

An isolated ileal perforation is presented in a 12-yr-old patient. Microscopic examination revealed granulomatous inflammation due to Enterobius vermicularis (pinworm). This is only the third documented report of intestinal perforation involving pinworms. Although infestation with this parasite is generally considered to be relatively harmless, on rare occasions, it can be a significant cause of morbidity due to its potential ability to invade the tissues.

Child↗
PubMed2005

Instrumental misdiagnosis and colon perforation: an autopsy case.

The authors report the case of a 75 year old man with bilateral inguinal hernia who suddenly died a few hours after hospitalization. Autopsy revealed death was related to a stercoral peritonitis ensuing from a perforation of the colon. The clinical picture during hospitalisation showed no typical signs of this. Court proceedings identified failure by the radiologist to identify the radiological signs of an intestinal perforation. The case report reviews the matter of the cause-effect relationship between death and radiological misdiagnosis and on the possible judicial consequences in Italy for the doctor, responsible for the failure to diagnose.

Aged↗
PubMed1975

Neonatal small left colon syndrome: intramural not intraluminal obstruction.

We have described a characteristic syndrome of intestinal dysfunction in infants of diabetic mothers. This finding appears to result from a transient intramural dysfunction. Many respond to rectal irrigations alone. However, a significant number will require close observation and possible diversion for persistent partial intestinal obstruction. Failure to recognize persistent obstruction may result in intestinal perforation.

Cecal Diseases↗
PubMed1998

[Perforated jejunal tuberculosis in a patient with HIV-infection].

Patients with AIDS are particularly susceptible to tuberculosis infection with a high incidence of extrapulmonary disease and surgical complications. Authors describe a 38-year-old male infected with the human immunodeficiency virus who presented intestinal perforation due to mycobacterium tuberculosis. A resection of jejunum was performed with primary anastomosis. The postoperative course was further compromised by hepatic failure and the patient died 16 days after the initial surgery.

Adult↗
PubMed1991

[Meconium peritonitis: diagnosis, etiology and treatment].

Fetal intestinal perforation causes a sterile inflammatory reaction of the peritoneum called meconium peritonitis. Twelve patients studied in the perinatal period serve to describe the classical fetal and neonatal signs and symptoms, the iconographical findings, treatment and prognosis. All but one infant, with a meconium pseudocyst, presented with the fibro-adhesive variety. Two were caused by cystic fibrosis, two by organic obstruction, one by fetal appendicitis and another two by ischemic necrosis of part of the ileum. In one of the latter two, the probable mechanism was feto-fetal embolisation following the in utero death of a co-twin. One idiopathic perforation, diagnosed in a preterm infant, healed spontaneously. The neonatal mortality rate was 18%. Primary enteric anastomosis was feasible in 3, Bishop-Koop anastomosis in 2 and an intestinal stoma in two others. Apart from the two survivors with cystic fibrosis, seven have no late gastro-intestinal sequelae.

Female↗
PubMed1979

[Colonic perforation with special reference to spontaneous ileo-colic perforation].

Aetiology of colonic perforation is reviewed and discussed. 8 cases of "spontaneous" ileo-colic perforations observed between 1975 and 1977 are presented. Two of these patients had recently undergone appendectomy, and 4 others showed a simultaneous distal carcinoma of the large bowel. Histo-pathological evaluation did not reveal the cause of intestinal perforation. Operative treatment and results are given.

Adolescent↗
PubMed2001

[An extremely low birth weight infant with pulmonary atresia complicated with necrotizing enterocolitis].

We experienced an extremely low birth weight (ELBW) infant complicated with pulmonary atresia and necrotizing enterocolitis. She was born at 25 weeks of gestation with a birth weight of 752 g. Five hours after birth, she manifested cyanosis and was diagnosed as having pulmonary atresia with intact ventricular septum (PAIVS). Infusion of lipo-prostaglandin E1 (PGE1) was started to keep the ductus open along with infusion of dopamine and dobutamine. At 8 days of life she developed hypotension and metabolic acidosis, and the diagnosis of intestinal perforation was made by free air in the abdomen. The excessive shunt flow to the pulmonary vasculature via the ductus was suspected to have caused an inadequate systemic flow leading to the intestinal ischemia and necrotizing enterocolitis. Lipo-PGE1 was discontinued to decrease the shunt flow through the ductus. Brock's operation (closed transventricular pulmonary valvotomy) was performed at the age of 8 and 11 days and the ligation of the ductus arteriosus was performed at the age of 13 days. Propranolol was administered to inhibit the pulmonary outflow tract constriction along with catecholamines to stabilize hemodynamics. She recovered slowly and her trachea was extubated at 58 days of life.

Anesthesia↗
PubMed1985

Delay in diagnosing gastrointestinal injury after blunt abdominal trauma in children.

Intestinal perforation after blunt abdominal trauma in children is rare and thus the diagnosis may be delayed. For this reason the authors reviewed their experience with 12 children to recommend a protocol for investigation that would reduce the delay in diagnosis. Of the 12 perforations, 2 were gastric, 2 duodenal, 7 jejunal and 1 colonic. The diagnosis of jejunal perforation, in particular, was usually delayed because free air was not seen radiologically in the first few hours after injury. This may be because of delayed rupture or spasm of the injured intestine. Serial films were valuable in aiding the diagnosis and are recommended, together with assessment of solid organ injury by radionuclide scanning. In this series peritoneal lavage was not used. No child died.

Abdominal Injuries↗
PubMed1982

Diverticulitis of the terminal ileum: report of a case and review of the literature.

In the past two decades, several reports have documented inflammatory changes in acquired diverticula of the terminal ileum and their associated complications, namely, perforation, intestinal obstruction, gastrointestinal hemorrhage, and fistulization. A comprehensive review revealed 28 cases of diverticulitis of the terminal ileum documented in the world medical literature. Only one case of internal fistula (ileovesical) has been reported previously. This report describes another patient with diverticulitis of the terminal ileum with associated perforation and jejunoileal fistula and reviews the world literature.

Diverticulitis↗
PubMed1985

[Corticotherapy and surgery. Apropos of 73 cases].

The authors reviewed the outcome of 73 operations performed on 60 patients on long-term steroid therapy: Eighteen operations were carried out for gastro-intestinal perforation but the causal role of steroid therapy was only established in 6 cases (4 gastric and 2 colonic perforations). In the other 12 cases there was intercurrent pathology or a recrudescence of the underlying disease process. More selective indications for steroid therapy and the protective action of new drugs on the gastro-intestinal mucosa are probably responsible for the low incidence of iatrogenic complications compared with previously published series. However, steroid therapy did affect the postoperative course: the risk of infection was 20 to 30 p. 100 higher than normal, very common after emergency surgery (75 p. 100) and a major cause of mortality (60 p. 100); the risk seems to be high when the steroid dose exceeds 0.5 mg/kg/day, the disunion of an anastomosis was observed in 6 cases, including 5 "dirty" operations with a mortality of 60 p. 100, healing was slow: 2 cases of evisceration and 2 of abdominal hernia were observed. It was not possible to assess the threshold dose of steroids with regards to this complication, metabolic complications, especially adrenal failure were much less common. Of the diseases requiring steroid therapy the problem of angiitis seemed particularly prominent. Although the prognosis of the intercurrent surgical condition was not aggravated; mortality from a relapse of the angiitis was nearly 100 p. 100. Therefore, medical control of the relapse would seem to be the first priority and should be taken into account when assessing the surgical indications.

Adult↗