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PubMed1991

[Digestive complications of non-steroidal anti-inflammatory drugs].

Gastrointestinal complications associated with non-steroidal antiinflammatory drugs (NSAID) represent a frequent and expensive drug side effect. Recent publications have shown that the deleterious effect of NSAID is not limited to the gastroduodenal tract but can involve all segments of the gut. Epidemiological and clinical studies have demonstrated that 20-30% of patients under NSAID develop digestive symptoms. The relative risk of gastric ulceration is 5 times higher and this risk increases in older patients and in those with peptic ulcer history. Bleeding and perforated gastroduodenal ulcer occur more frequently in patients who received NSAID and mortality in these complications seems to be higher than in control groups. Curative and preventive treatments are effective in gastropathy associated with NSAID use, but the indications for prophylactic therapy need to be more precise in the future. The risk of oesophageal stenosis is increased in patients with gastroesophageal reflux taking NSAID. Diarrhea occurs in 5-30% of patients under NSAID. Intestinal perforation and hemorrhage are more frequent in anti-inflammatory drug takers than in control groups. Mild intestinal inflammation had been recently reported under NSAID, marked by ileal dysfunction, blood and protein loss and occasionally diaphragm-like small intestinal stricture. The pathogenesis of the inflammation is uncertain but seems to be related to an increase in mucosal permeability.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Management of uterine perforations in connection with legal abortions.

The incidence of uterine perforation while performing legal abortions was evaluated in the Stockholm area. Among 84,850 legal abortions performed during 1982-1992 there were 145 cases of uterine perforation, 0.17%. In about half of these cases an immediate exploration of the abdomen was decided upon and in 18 patients there were significant bleeding and/or lacerations to organs situated in the pelvis. No case of intestinal perforation was encountered. It is likely that many of these injuries would have healed just as well unattended. Based on this study, the authors advocate a conservative approach in dealing with uterine perforation in connection with vacuum aspiration for legal abortion.

Abortion, Legal↗
PubMed2006

Intestinal tuberculosis in a regional hospital in Hong Kong: a 10-year experience.

OBJECTIVE: To study the clinical and pathological characteristics of patients with intestinal tuberculosis. DESIGN: Retrospective study. SETTING: United Christian Hospital, Hong Kong. PATIENTS: Patients with intestinal tuberculosis diagnosed between January 1995 and December 2004 inclusive. RESULTS: The median age of the 13 male and 9 female patients was 53 years (range, 12-81 years). Nineteen (86%) had a definitive diagnosis of intestinal tuberculosis confirmed by the presence of caseating granulomas and/or acid-fast bacilli in histological specimens. In three (14%) the diagnosis was based on histology revealing non-caseating granulomas and a positive response to anti-tuberculous treatment. Common symptoms included abdominal pain (82%), diarrhoea (55%), weight loss (55%), and fever (45%). Three (14%) of the patients were complicated by intestinal obstruction, and another two (9%) had intestinal perforation. Four (18%) had concomitant active pulmonary tuberculosis. The most frequently involved site was the ileocaecal region, which was affected in 19 (86%) patients. Other sites included the jejunum, ascending and sigmoid colon. The diagnosis of intestinal tuberculosis was facilitated by examination of colonoscopic biopsy specimens (11 patients), and by examination of resected surgical specimens in the remainder. Two patients died from terminal malignancy. The remainder completed anti-tuberculous therapy and responded satisfactorily. CONCLUSIONS: The diagnosis of intestinal tuberculosis is difficult due to the lack of specific signs or symptoms. Colonoscopy with ileoscopy are useful tools in the search for colonic and terminal ileal tuberculosis. Surgical exploration is reserved for equivocal cases and for those who present as emergencies.

Adolescent↗
PubMed1987

Right hemicolectomy and ileal resection with primary reanastomosis for irradiation injury of the terminal ileum.

Injury to the small intestine from pelvic irradiation increases in frequency when extended treatment fields are utilized and when radiation therapy follows a major abdominal operation. Recommended surgical correction of such injury has been intestinal bypass to avoid the excessive morbidity and mortality from anastamotic leaks associated with primary resection and anastomosis. Since 1980, eight patients with extensive ileal injury secondary to irradiation have been seen at the Naval Hospital Bethesda, Maryland. All patients had previously undergone an abdominal operation and three patients had irradiation utilizing extended fields. In all cases, right hemicolectomy and extended ileal resection were performed with primary anastamosis of the ileum to the ascending colon or the transverse colon. Operating time averaged 4 1/2 hr utilizing hand closure anastomoses and 2 1/2 hr with stapled anastomoses. All patients received postoperative hyperalimentation and six of eight patients received preoperative hyperalimentation. One operative death occurred in a patient with intestinal perforation who required multiple resections. The remaining seven patients experienced no serious complications and had rapid return of bowel function. Our experience indicates that wide ileal resection with right hemicolectomy and primary reanastomosis is an acceptable alternative to intestinal bypass for the treatment of severe irradiation injury, especially when performed with gastrointestinal stapling devices.

Colectomy↗
PubMed1987

Intra-abdominal sepsis: controversies and choices in management.

Contamination of the peritoneal cavity may lead to generalized peritonitis or abscess formation. Both aerobic and anaerobic bacteria participate in the infectious process. The concentration and the particular mix of aerobes and anaerobes depends on the site of perforation, with the highest concentrations and greatest predominance of anaerobes in the colon. A number of factors contribute to the risk of infection, and a formula has been devised for calculating a given patient's risk for infection following intestinal perforation secondary to penetrating abdominal trauma. The goal of therapy is to reduce morbidity, mortality, and duration of hospital stay. Specific techniques used to achieve this goal are controversial. In essence, the keys to successful management of intra-abdominal sepsis are early diagnosis and surgical intervention, supplemented by systemic antibiotics that are effective against the aerobic and anaerobic components. Considerations in choosing antibiotics are efficacy, safety, and cost-effectiveness. Some second-generation and third-generation cephalosporins often offer an effective, safer, and more economical alternative to antibiotic combinations.

Animals↗
PubMed1976

Emergency abdominal surgery in the aged.

The results of 375 emergency abdominal operations in elderly patients over the age of 75 years are presented and discussed in detail. There has been a fourfold increase in the population over the age of 75 years in England and Wales during the 60-year period from 1911 to 1971. The overall mortality of these patients of 31-7 per cent is unrelated to the age of the patient, but appears to be directly related to the severity of the surgical condition and to cardiorespiratory complications. Our approach to these problems is presented and discussed.

Abdomen, Acute↗
PubMed1995

An intestinal fistula in a 3-year-old child caused by the ingestion of magnets: report of a case.

We describe herein the case of a 3-year-old child in whom a jejunoileal fistula was caused by the ingestion of magnets. This case report demonstrates that if more than one magnet is found as a foreign body in the intestine, they should not be left untreated even if there are no sharp edges and, it seems they could be evacuated spontaneously. This recommendation is made because the magnets will attract each other and hold the intestinal walls between them, causing necrosis and resulting in intestinal perforation or a fistula.

Child, Preschool↗
PubMed1987

[Colonic necrosis, an unusual extrarenal involvement in hemolytic and uremic syndrome].

A seventeen years old girl presented a HUS. The usual gastrointestinal symptoms of the prodromal phase involved secondary complications leading to emergency surgical treatment. Laparotomy exploration revealed segmental necrosis of the colon which was treated by colectomy: histological studies revealed its ischemic nature with specific lesions of thrombotic microangiopathy. Later course was uneventful with the exception of renal failure requiring maintenance hemodialysis. Review of literature confirms the rare and severe nature of gastrointestinal lesions requiring surgery. Great care should be taken on one hand, not to undertake a useless operation and on the other hand to operate in time colonic necrosis involving or not intestinal perforation or intussusception.

Adolescent↗
PubMed1983

Hexosaminidase: a marker for intestinal gangrene in necrotizing enterocolitis.

Detection of intestinal ischemia, prior to necrosis, is a major clinical problem. The lysosomal acid hydrolase, hexosaminidase (HEX), is known to be elevated in intestinal infarction. To determine if this enzyme could differentiate between partial intestinal ischemia and full-thickness intestinal gangrene, the following rat study was designed. Partial segmental intestinal ischemia was created by ligating alternate vascular bundles over a short (6 vessel) segment of the small-bowel mesentery, and complete segmental intestinal vascular occlusion was achieved by ligating the blood supply to the ileocecal segment. Preoperative serum HEX values were obtained from 15 animals. The rats were separated into one sham-operated and two intestinal ischemia groups. At four hours after surgery HEX values were determined. Total HEX activity was significantly elevated four hours after insult in both partial and complete intestinal ischemia, (P less than 0.005 and P less than 0.001 respectively). Total HEX activity was greater in complete intestinal ischemia than in partial ischemia, (P less than 0.05). Three neonates with intestinal perforation, secondary to necrotizing enterocolitis, were evaluated. The mean preoperative HEX activity was 1421 nmol/hr/mL serum and the mean post-resection HEX activity was 808 nmol/hr/mL serum. These data suggest that serum HEX activity may be a good marker for intestinal gangrene in neonates with necrotizing enterocolitis.

Animals↗
PubMed1978

[Adhesive prophylaxis: Noble's intestine plication (author's transl)].

By chronic recidivating ileus with massive extensive adhesions, small intestine plications according to Noble or Childs and Philipps, respectively, have stood the test of time. In view of the total lethality rate of 5%, no plication should be attempted for acute ileus syndrome or for local or diffuse peritonitis. Serious complications include fistulization, intestinal perforation, recurring ileus, and peritonitis. Prophylactic plication is not recommended. The cases treated by the surgical department of the university clinic in Mainz, which include a total of 233 laparotomies for chronic adhesions of the ileus, reflect strict adherence to indications for small intestine plication. Among our own cases, we had no postoperative lethality.

Humans↗
PubMed1977

Neonatal necrotizing enterocolitis: 1. Clinical aspects.

Forty-infants were diagnosed as having necrotizing enterocolitis (NEC) during a 33 months' period; these represented 4% of all neonatal admissions. Pathological confirmation was obtained at surgery in 12 cases and at autopsy in 11, In the case of 21 infants who recovered without operation, the diagnosis was based on clinical and radiological criteria inculding the presence of intramural gas. NEC occurred primarily, though not exclusively , in low-birth-weight infants. Two-thirds of the infants developed NEC in the first week of life. Clinical features attributable to gastrointestinal malfunction as well as a systemic illness could be defined. Complications included pneumoperitoneum (34%), localized peritonitis as suggested by the development of an abdominal mass (11%) and intestinal obstruction (25%). Fourteen of the 15 cases of pneumoperitoneum were diagnosed within 24 hours after the onset of NEC. The 5 infants were localized peritonitis, who were managed conservatively initially, developed intestinal obstruction during recovery. Intestinal obstruction presented between 2 and 7 weeks after the onset of NEC. The overally mortality was 25%, infants with intestinal perforation or obstruction having and increased mortality of 38%.

Age Factors↗
PubMed1992

[Study of large intestinal microflora in newborns with Hirschsprung disease].

In 35 newborns and children at the age under 4 mos with Hirschsprung's disease, colonic microflora was studied. Disbacteriosis at phase 1 was revealed in 1 (2.9%) child, at phase 2--in 7 (20%), at phase 3--in 27 (77.1%). In acute form of Hirschsprung's disease, in 68.5% of cases, disbacteriosis at phase 3 with the signs of enterocolitis causing acute ileus was revealed. Intestinal perforation against background of enterocolitis developed in 8 cases.

Acute Disease↗
PubMed2003

[A case of primary malignant lymphoma of the duodenum successfully treated with dose escalating chemotherapy].

A 65-year-old woman with diabetes mellitus was hospitalized for heart failure and anemia in August 2001, and recovered with conservative treatment. An endoscopic examination revealed an ulcerative mass located in the duodenal bulb to the 2nd portion. Abdominal CT scan demonstrated tumor involvement in the pancreas head. The diagnosis of a diffuse large B-cell lymphoma, clinical stage IIE, was made by endoscopic biopsy. Although surgical resection of the localized intestinal tumor would have been a common choice for initial treatment, polychemotherapy was selected; the patient had diabetes mellitus and preferred polychemotherapy to surgical operation. Because of bulky intestinal mass, transmural disease and sensitive histological type, standard-dose chemotherapy was considered to include a high risk of intestinal perforation. We performed dose-escalating chemotherapy: A half dose of THP-COP (pirarubicin, cyclophosphamide, vincristine) was given at the start in October 2001, 60% THP-COP as the next cycle, 80% THP-COP as the 3rd cycle and thereafter. Without serious complications of the intestine, she received a total of 6 cycles of chemotherapy and subsequent involved field radiation. There has been no evidence of recurrence of disease 14 months from the start of chemotherapy. When conditions make surgical treatment difficult, dose-escalating chemotherapy in a treatment cycle may be considered as an alternative.

Aged↗
PubMed1986

Meconium periorchitis: a clinicopathologic study of four cases with a review of the literature.

Perforation of the bowel wall in utero, with meconium gaining access to the tunica vaginalis, results in meconium periorchitis. The clinical and pathologic features in four infants were studied; the findings were compared with those in the 20 cases reported in the literature. In the majority of cases, the intestinal perforation had apparently healed before birth, and the scrotal mass became increasingly obvious following birth. Cystic fibrosis was documented in only one case. A yellowish green paratesticular mass with multifocal dystrophic calcification was the principal gross finding. Lobules of fibromyxoid tissue containing the calcifications were separated by bands of connective tissue. A granulomatous reaction per se was not prominent in the four cases of the present study, although some authors have characterized the process as meconium granuloma. Before orchiectomy is performed in an infant with a scrotal mass, the possibility of meconium periorchitis should be considered.

Calcinosis↗
PubMed1991

Diaphragmatic injury.

From Feb. 1976 to Oct. 1990, 43 patients with diaphragmatic injuries were admitted to Kaohsiung Medical College Hospital. Blunt injuries occurred in 27 cases and penetrating injuries in 16 cases. The diagnosis is usually made by chest roentgenogram, chest CT, or during operations for other associated injuries. Delayed diagnoses were noted in 7 cases in blunt injury group and 2 cases in penetrating injury group. Isolated diaphragm injury was found in only 2 patients. The perforated diaphragm were almost repaired by two layers of continuous suture. None of them needed prosthetic mesh for reconstruction and no recurrence of hernia was found. In the blunt injury group, these patients usually combined with rib or long bone fractures, major intracranial injury, liver or spleen lacerations and intestinal perforations; while in the penetrating injury group, liver lacerations and stomach perforations were the most common associated injuries. Two deaths were noted in each group and the associated injury were accounted for these deaths.

Adolescent↗