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PubMed1999

[Perforation of the small intestine].

BACKGROUND: Small bowel perforation is a major problem in abdominal typhi disease, but is seldom observed in Italy, as Salmonella typhi infections are rare in this Nation. The cause of perforation varies greatly. The reported mortality is high and varies from 23 up to 42%. A retrospective study has been performed in order to find how to improve the outcome. METHODS: A series spanning 10 years is reviewed, from January 1, 1987 to December 31, 1997, comprising 60 patients with small bowel perforation, operated in a urgency setting in the Operating Room of the Emergency Department of the Molinette Hospital in Torino. Resection and primary anastomosis were utilized in 33 patients, 27 underwent oversewing. In 3 patients a colostomy was felt necessary because of a concomitant damage of the colon. RESULTS: No leakages occurred. Hospital stay varies from 1 day to 76 days (24 days mean). Mortality is consistent with literature: 20 patients (33%) but the cause is related to the primary diseases of the patients. Delay in diagnosis did not affect the patient's outcome. CONCLUSIONS: In conclusion, it is confirmed the one-time surgery as the choice treatment in small bowel perforations from causes other then S. typhi infection. Mortality is not directly related to the consequences of surgical repair.

Abdominal Injuries↗
PubMed1993

Intestinal stenosis and perforating complications in Crohn's disease.

The charts of 384 patients with Crohn's disease were reviewed to assess the prognostic value of a bowel stenosis documented at the time of initial diagnosis for the occurrence of perforating (abscess, fistula, free perforation) or obstructing complications requiring surgical intervention. Mean follow-up was 5.6 years. At time of diagnosis a bowel stenosis (S) was documented in 143 patients (37.2%). 130 patients underwent surgery, 62 (48%) for obstruction, 18 (14%) for a perforating complication, 12 (9%) for both obstructing and perforating complication and 38 (29%) for intractable disease. The cumulative rates of surgery were calculated using lifetable analysis. The presence of a stenosis at the time of initial diagnosis was a risk factor for the likelihood of surgery overall [65% (S) vs. 40% (no S) after 10 years; P < 0.001] and of surgery for obstruction [70% (S) vs. 34% (no S); P < 0.001] but did not increase the likelihood of a perforating complication [24% (S) vs. 29% (no S); n.s.]. A perforating complication requiring surgery may therefore not be predicted by the mere diagnosis of a stenosis. Prophylactic surgery of stenotic lesions in patients with Crohn's disease to prevent the development of a perforating complication therefore is not recommended.

Adult↗
PubMed1992

Treatment of bowel injuries in war surgery.

Provided that the surgeon is familiar with small and large bowel surgery, primary resection and anastomosis of the bowel, as well as primary suture of the perforations, are safe and advantageous procedures in treating war related intestinal perforations, whereas the use of colostomosis should be restricted to selected cases.

Adolescent↗
PubMed2004

[Collagen diseases with gastrointestinal manifestations].

Collagen vascular diseases are known to present with a diverse array of gastrointestinal manifestations. These can be classified as: 1) gastrointestinal damage due to the collagen vascular disease itself; 2) adverse events caused by pharmacotherapies; or 3) gastrointestinal infections following immunosuppression due to corticosteroid (CS) administration. The first group includes lupus enteritis and protein-losing gastroenteropathy in systemic lupus erythematosus (SLE), reflux esophagitis, chronic intestinal pseudo-obstruction, and pneumatosis cystoids intestinalis in systemic sclerosis, amyloidosis in rheumatoid arthritis, bowel ulcer and bleeding in rheumatoid vasculitis and microscopic polyangiitis, and ileocecal ulcer in Behcet disease. In particular, colonic ulcers associated with SLE represent refractory lesions resistant to CS. Analysis of reported cases showing colonic lesions with SLE (22 cases in Japan) revealed that mean duration of SLE was 9.9 years and 77% of colonic lesions were observed in the rectum and sigmoid colon. Half of the patients developed intestinal perforation or penetration, and 6 of the 11 patients with perforation died. The second group includes lesions in the small and large intestine due to nonsteroidal anti-inflammatory drugs (NSAIDs) and CSs, in addition to peptic ulcers. As perforation in CS-treated patients displays relatively high incidence with poor prognosis, careful attention to such complications is needed. The third group includes candidal esophagitis and cytomegalovirus (CMV) enteritis. Prompt diagnosis is required to prevent colonic bleeding and perforation due to CMV.

Adrenal Cortex Hormones↗
PubMed1988

[Perforations of the small intestine and intestinal parasitic diseases. Apropos of a case of peritonitis caused by the perforation of the small intestine combined with Taenia saginata infection].

A case is reported of peritonitis from perforation of the small intestine found on operation to be due to Taenia saginata. A review of the relevant literature of the last 20 years failed to find many similar cases, parasites, particularly Taenia being an exceptional direct cause of perforation. In the case reported, however, a direct cause/effect relation is highly probable.

Adult↗
PubMed2002

Gastric perforation due to the ingestion of a hollow toothpick: report of a case.

A perforation due to the ingestion of a toothpick is a condition seldom seen in the stomach. We herein describe an 80-year-old woman with a perforation of the stomach due to an ingested hollow toothpick. The toothpick was easily removed during a mini-laparotomy. The site of perforation was closed with absorbable sutures and omentum was used to function as an overlying patch. The postoperative course was uncomplicated. The hollow toothpick functioned as a fistula between the contents of the stomach and the peritoneal cavity. This resulted in a very different clinical picture from that observed in "classical wooden" toothpick injury, where the toothpick is not able to function as a fistula. To the best of our knowledge, this is the first description of a hollow toothpick perforating the stomach. A hollow toothpick perforation must be considered in any patient with symptoms of intestinal perforation, even when there is no history of swallowing toothpicks. Removal of a toothpick and subsequent suturing of the puncture site is a simple and relatively minor surgical procedure, which may have a lower morbidity and mortality as compared to other causes of gastric perforation. A precaution to observe, is the potential danger that one of the members of the operating team might perforate a finger.

Abdomen, Acute↗
PubMed1992

The prenatal diagnosis of imperforate anus with rectourinary fistula: dilated fetal colon with enterolithiasis.

The finding of extraluminal calcifications is commonly reported and usually indicates intrauterine intestinal perforation with intraperitoneal extravasation of meconium, most often associated with intestinal obstruction and/or atresias. Intraluminal calcification of meconium is more rare and appears to result from the mixing of stagnant urine and meconium in utero. The presence of the intraluminal calcifications in a dilated loop of intestine, particularly with an associated urinary tract abnormality, should suggest a rectourinary fistula. Two cases of prenatally diagnosed imperforate anus with rectourinary fistulae are reported.

Adult↗
PubMedDate not supplied

[Traumatic perforation of the small intestine in childhood].

INTRODUCTION: Traumatic perforation of the small bowel occurs in approximately 1 percent of children with either blunt or penetrating trauma to the abdomen. Difficulty in recognition of initial subtle signs of hollow viscus injury can lead to delay in both diagnosis and operative intervention. MATERIAL AND METHOD: Medical records for patients discharged with traumatic small bowel perforation from the General Surgery Department between 1991 and 1999 were reviewed. RESULTS: Bowel injuries were noted in 41 children. Blunt trauma (battered child syndrome, bike injuries, etc.), was responsible for 37 cases and penetrating wounds in three (firearm wounds and bike pedal accidents). There were 32 boys and a mean age of 6.8 years. The site of perforation was duodenal in four cases, jejunum in 21, and ileum in sixteen. Associated injuries occurred in 11 patients, including stomach, pancreas, liver, spleen, bladder, and ureter. Twenty-nine had simple closure, while seven were resected. Four children died. CONCLUSIONS: These injuries require prompt surgical intervention and are in general curable with excellent prognosis if one is alert to the possibility of their occurrence, if one is familiar with the approaches to prompt and accurate diagnosis, and if associated injuries are not serious.

Accidents↗
PubMed1999

Multiple intestinal ulcerations and perforations secondary to methicillin-resistant Staphylococcus aureus enteritis in infants.

PURPOSE: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. METHODS: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean Association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. RESULTS: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of Gram-positive cocci. (4) Methicillin-resistant Staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. CONCLUSIONS: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.

Anti-Bacterial Agents↗
PubMed2003

Free perforation due to intestinal lymphoma in biopsy-defined or suspected celiac disease.

Malignant complications occur in celiac disease and dermatitis herpetiformis, particularly small bowel lymphoma. Although intestinal ulceration, especially in jejunum or ileum is rare, spontaneous free perforation of the intestine developed in 6 patients with established or suspected celiac disease and dermatitis herpetiformis due to a malignant lymphoma. In 3 cases, perforation developed after celiac disease was diagnosed and compliance with a gluten-free diet was strictly maintained and repeatedly evaluated. In 1 of these cases, refractory celiac disease was defined. In another, free perforation was the presenting manifestation of the lymphoma and this led to a later diagnosis of subsequent biopsy-defined latent celiac disease. In 2 others, celiac disease was suspected but the rapidly deteriorating clinical course prohibited institution of a gluten-free diet. In all patients, the lymphoma involved the jejunum, but in 1 of these, perforation was defined in the colon indicating that any intestinal site may suffer free perforation from lymphoma in celiac disease. This report documents a high mortality for this serious complication in celiac disease, its lack of predictability and the potential for development even with strict compliance to a gluten-free diet.

Adult↗
PubMed2003

Primary ascaridial perforation of the small intestine: sonographic diagnosis.

Ascaris lumbricoides is the most common helminth affecting humans. Ascariasis can result in serious complications, including intestinal obstruction and perforation. Early diagnosis and treatment of such complications reduces the risk of mortality. We present a case of sonographically diagnosed ascaridial perforation in a 5-year-old girl. On sonography, each ascarid appeared as 2 pairs of parallel lines, representing the worm's outer margins, flanking a central sonolucent line, representing its digestive tract. Sonography revealed ascarides in the peritoneal cavity and in some loops of the small bowel. Emergent laparotomy was performed to remove ascarides from the peritoneal cavity and terminal ileum, and the patient recovered well and was asymptomatic at a 3-month follow-up. Knowledge of the sonographic features described herein may aid in the evaluation of patients, especially children, in tropical countries who have clinical symptoms of ascariasis.

Animals↗
PubMed1988

Perforation of the intestine in inflammatory bowel disease. An OMGE survey.

This presentation assesses the incidence of perforation of the intestine in patients with inflammatory bowel disease by reviewing the incidence of this complication in a total of 3175 patients from the OMGE inflammatory bowel disease multi-national survey. Amongst 1928 patients with ulcerative colitis, perforation was noted in only 5 (0.3%), which is much lower than in previous series (from 1% to 2%). By contrast, 19 of 1247 patients with Crohn's disease had perforated (1.5%). The survey thus suggests that the incidence of perforation in ulcerative colitis has fallen in the last 2 decades, probably as a result of the widespread implementation of early surgery. The risk of perforation of Crohn's disease remains quite high.

Colitis, Ulcerative↗