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PubMed1989

Unrecognized viscus perforation in the elderly.

Thirty-four consecutive patients with unrecognized intra-abdominal perforation were identified from post-mortem records and retrospective analysis was undertaken. The common factors that appeared to contribute to the missed diagnoses included obesity (50%), communication difficulty (33%) and previous abdominal surgery (38%). In addition, symptoms and signs may have been obscured in those patients receiving analgesics (26%), steroids (21%) or non-steroidal anti-inflammatory drug therapy (44%). Cardiopulmonary presentation (79%) and the absence of free intraperitoneal gas on conventional radiology also may have diverted clinical attention. Elderly obese women appeared to be at particular risk and the diagnosis should be considered especially in the presence of associated, unexplained tachycardia (38%), hypotension (59%) or pyrexia (29%) as gastro-intestinal perforation remains a potentially curable condition.

Aged↗

PubMed2000

Invasive Candida enteritis of the newborn.

Three premature infants (<800 g) showed invasive Candida at the site of their intestinal perforations. This entity is distinct from Candida peritonitis complicating necrotizing enterocolitis and was uniformly fatal. Recognition and aggressive antifungal therapy may improve outcomes.

Amphotericin B↗

PubMedDate not supplied

[Necrotizing enteritis and geophagia].

Two cases of intestinal perforation due to necrotising enteritis in patients with pica are presented. The aetiopathogenesis of pica is discussed as well as its role in the development of necrotising enteritis.

Achlorhydria↗

PubMed1975

Intestinal necrosis and perforation after renal transplantation.

An acute intestinal disorder occurred in seven patients soon after renal transplantation. The disorder was characterized initially by massive abdominal distention with progression to multiple bowel perforations in three patients and extensive bowel necrosis in two. Surgical manipulation did not appear to be the cause since the transplants were performed retroperitoneally in the iliac fossa. Ischemia also was not a factor since the mesenteric vessels were patent with no evidence of thrombus formation or vasculitis. The cause appeared to be related to immunosuppressive agents, in particular, high doses of corticosteroids. The disease process appeared to be reversible if immunosuppression was discontinued early, as occurred in two patients.

Adult↗

PubMed1993

[Percutaneous nephrolithotomy (PCNL): evaluation of 250 PCNL by the same operator].

The author reports his 8-year experience of PCNL in 250 patients between the ages of 8 and 86 years, including 31 staghorn calculi and 52 ureteric stones treated via a descending approach. The other stones were pelvic or caliceal and 4 occurred in a solitary kidney. The technique used and the complications are described in detail. The most serious complication was infection, which was almost fatal in 1 case. Haemorrhage (7 cases) and intestinal perforation (2 right colonic perforations) never required surgical intervention. There were no deaths or nephrectomies. The results were immediately perfect (stone-free) in 77.6% of cases and in 82.8% of cases after spontaneous elimination of stone debris or repeat PCNL.

Adolescent↗

PubMed1989

[Peritonitis, septic shock and endotoxin--an animal experiment study].

Fecal peritonitis was produced by a sphincter-system leading to intestinal perforation. In 10 beagle dogs endotoxin was measured with the Limulus test. There was a correlation between endotoxin appearance and microbiological findings in the peritoneal cavity and in the blood. Endotoxinaemia correlated with the clinical severity of peritonitis.

Animals↗

PubMed1979

Alimentary tract complications after renal transplantation.

A computer analysis of post renal transplantation gastrointestinal problems was performed to identify important associated clinical factors. Thirty-seven per cent of all transplant recipients developed one or more significant problems. Hemorrhage, nondiverticular intestinal perforation, and esophagitis occurred most frequently in hospitalized patients. Pancreatitis, diverticulitis, and gastroduodenal perforation occurred characteristically in long-term survivors with well functioning allografts. Eleven of 32 HLA identical recipients treated with maintenance corticosteroids during stable kidney function developed gastrointestinal disease while only one of 13 HLA identical recipients not given maintenance steroids developed a problem, which strongly suggests a causal role for steroids in the development of late complications. The association of preexisting peptic ulcer and diverticular disease with hemorrhage and perforation supports previous recommendations that documented peptic ulcer disease or diverticulitis should be corrected surgically prior to transplantation.

Adolescent↗

PubMed1994

Ultrasonography in the management of blunt abdominal and thoracic trauma.

OBJECTIVE: To assess the sensitivity, specificity, and predictive value of ultrasonography in patients with blunt abdominal or thoracic trauma in regard to the indication for immediate operation, delayed abdominal exploration, or conservative treatment. DESIGN: A retrospective study was conducted after consecutive sampling of 1151 patients in a nonrandomized control trial. SETTING: The study was conducted at the University Hospital of Innsbruck (Austria), which serves as a general community hospital and a major primary care and referral center. PATIENTS: All patients with blunt abdominal or thoracic trauma with or without polytraumatization were eligible for the study; a total of 1151 patients were observed from 1980 to 1990. According to the ultrasonographic findings, patients were divided into three groups: immediate operation, primary conservative treatment, and conservative treatment (normal ultrasonographic findings). Ultrasonography was repeated when the clinical findings or laboratory test results showed the development of intra-abdominal hemorrhage or signs of organ laceration. INTERVENTION: Ultrasonography in the emergency department or intensive care unit. MAIN OUTCOME MEASURES: Conservative or operative treatment based on ultrasonographic and clinical findings. RESULTS: Ultrasonography showed a sensitivity of 99%, a specificity of 98%, a positive predictive value of 0.97, and a negative predictive value of 0.99 in regard to the indication for surgery in cases of blunt abdominal or thoracic trauma. Ultrasonography is not reliable in patients with intestinal perforation and large retroperitoneal hematomas. CONCLUSION: Ultrasonography saves time and money, can be performed in the emergency department, shows high sensitivity and specificity, and is the method of first choice in the evaluation of blunt trauma.

Abdominal Injuries↗

PubMed1991

A case of intestinal hemorrhage due to small intestinal metastases from primary lung cancer.

Although intestinal metastases from lung cancer are not rare at postmortem studies, the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. We report a case of small intestinal hemorrhage leading to intestinal perforation secondary to metastases from a large cell carcinoma of the lung in a 31-year-old man along with a review of the literature.

Adult↗

PubMed2002

[Necrotic eosinophilic angiitis with ileal perforation and peritonitis secondary to abdominal angiostrongyliasis].

INTRODUCTION: Abdominal angiostrongyliasis caused by the filiform nematode Angiostrongylus costaricensis, is an endemic disease in Central and South America. A case of necrotic eosinophilic angeitis with ileum perforation and peritonitis due to abdominal angiostrongyliasis is reported. OBSERVATION: A 32 year-old man, living in a Paris suburb, underwent segmentary resection of the ileum with end to end anastomosis for perforation with generalized peritonitis. The anatomopathological examination revealed eosinophilic necrotic lesions with thrombosis on the borders of the ileum perforation. The discovery of a section of A. costaricensis in the lumen of a nearby muscular artery initiated an epidemiological survey, revealing that the patient had visited French Guyana 2 months earlier. DISCUSSION: Angiostrongylus costaricensis is a nematode parisiting certain forest rodents that become its permanent host. The intermediate hosts are earth molluscs or slugs of the same family. Humans are accidentally infected following ingestion of vegetables infested with L3 larvae or slugs carrying the disease. The clinical symptomatology is unspecific: prolonged fever, anorexia, and right iliac fossa pain with eosinophilia of the blood. Often benign, the progression of abdominal angiostrongylosis is punctuated by complications: occlusive syndrome, generalised peritonitis due to intestinal perforation and mass syndrome. Hemorrhage, infarct, pseudo-tumoural fibrosis and ulcers represent the surgical or macroscopic rearrangements. In the tissue, 4 lesions characterize abdominal angiostrongylosis: eosinophilic necrotic angeitis, foreign body granulomas, eosinophilia in the digestive wall, and the presence of A. costaricensis in the lumen of the vessels. There is presently no medical treatment and surgery is the only therapeutic option.

Abdomen↗

PubMed1990

Small bowel injuries following blunt abdominal trauma. Early recognition and management.

We reviewed the cases of 15 patients with intestinal perforation following blunt abdominal trauma, which occurred between 1971 and 1988. Twelve patients were treated at The Mary Imogene Bassett Hospital (Cooperstown, NY); three other patients were treated at surrounding area hospitals. These injuries included 11 motor vehicle accidents, three low-velocity impact injuries, and one blast injury. There were four duodenal, ten jejunal, and two ileal injuries. Five patients who were operated on within 12 hours had classic signs of peritonitis or gross blood on diagnostic peritoneal lavage. Four patients were operated on after 12 hours, and six after 24 hours; physical signs were subtle in this group. Pain was a universal finding but was usually moderate; nausea and vomiting were frequent early findings in the ten patients with late recognition. An altered sensorium due to intoxication or head injury was present in three of ten patients operated on after 12 hours. Laboratory determinations, including a white blood cell count and amylase analysis, as well as abdominal radiographs, were often not helpful. Diagnostic peritoneal lavage is an important test, but when it is performed within four hours post-injury, it may yield false negative findings in up to 50% of patients and may need to be repeated. Computer tomographic scanning should employ oral and intravenous contrast to increase accuracy; perforation of a hollow viscus may not be immediately recognized. Four of the five patients operated on within 12 hours had an uncomplicated course. Complications occurred in all six patients operated on beyond 24 hours and included intraabdominal abscesses in five, and death for one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

Reconstructive intestinal surgery after open management of severe intraabdominal infection.

Open management (OM) of severe intraabdominal infection often is complicated by fistula formation and the need for complex reconstructive procedures. From 1988 to 1998 a series of 145 patients were treated by OM. Of these patients, 24 developed intestinal fistulas and 42 had to be treated by discontinuity resections prior to OM for intestinal perforations or anastomotic insufficiency. Of the patients with fistulas or enterostomies, 61% survived. Reconstructive surgery was performed after infections had completely subsided. Patients were examined on follow-up, and the quality of life was assessed by 36-item short-form health survey questionnaires. Restorative surgery was performed in 32 of 40 patients 102 days (median) after beginning OM. All patients survived. Anastomotic leakage developed in six patients (18%). Thirty patients (94%) were followed up; 70% indicated their quality of life to be good. Despite a higher rate of anastomotic problems than with elective visceral operations, reconstructive intestinal surgery after OM may be performed without mortality and satisfying long-term outcome.

Abdominal Abscess↗

PubMed1997

Malignant B-cell lymphoma in an infant with severe combined immunodeficiency with short-limbed skeletal dysplasia.

In an infant with skeletal anomalies and haemolytic disease, intestinal perforation was caused by necrosis of an as yet undetected B-cell lymphoma. Severe combined immunodeficiency with short-limbed skeletal dysplasia was diagnosed. This is the first published report of a patient with this syndrome in combination with haemolytic disease and B-cell-lymphoma.

Diagnosis, Differential↗

PubMedDate not supplied

Free perforation of small intestine in adults.

In a 14-year period 15 cases of free perforation of the small bowel in adults were treated in our department. In two patients perforation was caused by a foreign body and in six by each of the following: duplication of the small bowel, Hodgkin's lymphoma, vasculitis and steroid treatment, intussusception, adhesions, diverticulum. All patients presented with the signs of diffuse peritonitis. One patient died before surgery. Of the 14 patients operated upon, 10 underwent resection and primary anastomosis and four suturing of the perforation. In six cases the etiology remains unknown even after surgical intervention and pathological examination. The mortality rate of the 14 operated patients was 7.1%. 78.5% of the patients were operated on within 24 hours of onset of symptoms, and early surgery is considered to be the most important factor in the low mortality rate achieved in this series.

Abdomen↗

PubMed1981

[Abdominal traumas due to the safety belt (author's transl)].

The use of motorcar safety belts has reduced mortality in road accidents but has given rise to the so-called "safety belt syndrome", a new pattern of lesions the most common and most severe of which are lesions of the abdominal wall and viscera. A case of transsection of the whole abdominal wall with mesenteric tear is reported here and numerous cases of intestinal perforation have been published. Diagnosis is often difficult and delayed. Analysis of the pathophysiology of these lesions shows that most of them are caused by incorrectly placed or adjusted belts. Prevention can only result from improved education of car drivers and passengers and from the development of more efficient safety devices.

Abdominal Injuries↗

PubMed1988

Unusual complications of Salmonella enteriditis group D infection.

A 25-year-old Syrian presented complaining mainly of fever, night sweats and nausea. He had 3 days earlier mild abdominal cramps and short-lived diarrhoea. On admission, he developed signs of deep vein thrombosis and blood and stool cultures showed Salmonella enteriditis infection. The patient was started on chloramphenicol and later showed acute abdominal signs. Laparotomy revealed intestinal perforation on the lower ileum. The case together with the experience in this hospital and elsewhere of Salmonella enteriditis infections are discussed, showing that two complications shown in this case are common for Salmonella typhi and paratyphi infections but are unusual for other Salmonella infections.

Adult↗

PubMed1999

Delayed onset of intestinal injury after laparoscopic assisted vaginal hysterectomy: a case report.

Because of the increasing popularity of laparoscopic surgery for gynecological diseases, it is inevitable that complications from such procedures will become more common. The majority of complications occur during operation where they are immediately identified and managed; recovery and outcome are relatively good after immediate repair. However, there are still a few cases that are not diagnosed until severe complications become evident. Herein, we report a relatively rare complication--a delayed onset of small intestinal perforation detected one week after initial laparoscopic assisted vaginal hysterectomy. Although we performed an emergent exploratory laparotomy to repair this complication, the patient died of uncontrolled sepsis and possible sudden onset of arrhythmia. Through a review of the literature, possible mechanisms of this complication are discussed. In addition, we hope that this case review will help avoid such complications in the future.

Female↗

PubMed1983

Acute perforation of small intestine due to tuberculosis.

Twenty-two patients with acute perforations of the small intestine due to tuberculosis were operated upon at Irwin Hospital, New Delhi between 1971 and 1976. Most of them (85.36%) presented with features of peritonitis. Radiologically, evidence of pneumoperitoneum was found in six patients. Fourteen patients had a solitary perforation while multiple perforations were found in eight cases. Sixteen patients had an associated stricture immediately distal to the perforation. Management of these patients included resection anastomosis (12), closure of perforation with bypass (seven), and simple repair of perforation in three cases. The overall mortality was 45.45%. Mortality was significantly higher (P less than 0.05) in patients with multiple perforations and in those who had multiple strictures. The high mortality and difficulty of correct pre-operative diagnosis have been stressed.

Constriction, Pathologic↗