-
ISRN Surgery 2014Background. Perforation peritonitis is the one of the commonest emergency encountered by surgeons. The aim of this paper is to provide an overview of the spectrum of...
Background. Perforation peritonitis is the one of the commonest emergency encountered by surgeons. The aim of this paper is to provide an overview of the spectrum of perforation peritonitis managed in a single unit of a tertiary care hospital in Delhi. Methods. A retrospective study was carried out between May 2010 and June 2013 in a single unit of the department of Surgery, Lok Nayak Hospital, Delhi. It included 400 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included. Results. The commonest cause of perforation peritonitis included 179 cases of peptic ulcer disease (150 duodenal ulcers and 29 gastric ulcers) followed by appendicitis (74 cases), typhoid fever (48 cases), tuberculosis (40 cases), and trauma (31). The overall mortality was 7%. Conclusions. Perforation peritonitis in India has a different spectrum as compared to the western countries. Peptic ulcer perforation, perforating appendicitis, typhoid, and tubercular perforations are the major causes of gastrointestinal perforations. Early surgical intervention under the cover of broad spectrum antibiotics preceded by adequate aggressive resuscitation and correction of electrolyte imbalances is imperative for good outcomes minimizing morbidity and mortality.
PubMed: 25006512
DOI: 10.1155/2014/105492 -
Journal of Surgical Case Reports Aug 2023Gastric perforations typically occur in the distal stomach, along the greater curvature or the antrum. The vast majority of upper gastrointestinal (GI) perforations are...
Gastric perforations typically occur in the distal stomach, along the greater curvature or the antrum. The vast majority of upper gastrointestinal (GI) perforations are caused by peptic ulcer disease. We present a case of an atypical location of gastric perforation. A 31-year-old patient was experiencing nausea and severe abdominal pain. Explorative laparoscopy revealed a large fundal perforation. The patient underwent an abdominoplasty 5 days before with revisional surgery for hemorrhage. He had recently lost 42 kg after endoscopic sleeve gastroplasty (ESG) 8 months before. ESG is a minimally invasive alternative for bariatric surgery. Since its implementation, several studies have been published indicating the procedure as safe. However, some major adverse events, such as upper GI-bleeding, peri-gastric leak, and pneumoperitoneum, have been described. The atypical location of the perforation might be explained by a combination of events such as surgical stress, revisional surgery, major weight loss, and the history of ESG.
PubMed: 37645699
DOI: 10.1093/jscr/rjad480 -
Przeglad Gastroenterologiczny 2021Although colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment.
INTRODUCTION
Although colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment.
AIM
In this study, the clinical results of patients who were operated in emergency conditions due to colorectal cancer perforation were evaluated.
MATERIAL AND METHODS
The data of 18 patients treated for colorectal cancer perforation in our clinic between February 2014 and February 2017 were retrospectively reviewed. The following data were evaluated: demographic features of the patients, location of the tumour, metastasis, stage of the tumour, number of lymph nodes dissected, survival, type, and prognosis of the surgery.
RESULTS
Eight (44%) of 18 patients with perforated colon cancers were female and 10 (56%) were male. The mean age was 65.2 (31-104) years. Four of the patients had liver metastasis only, and 5 had multiple metastases. All cases had sudden abdominal pain and acute abdominal clinical findings. Fourteen of the patients underwent full resection, and 4 of them underwent partial resection and trephine stoma (colostomy). Perioperative mortality was not observed. The long-term mortality rate in our study was 77.7% ( = 14), and the operative mortality rate was 44% ( = 8). Additional organ injuries occurred during resection in 2 patients.
CONCLUSIONS
Colorectal cancer perforation seen in advanced ages is one of the causes of acute abdominal syndrome, which can be fatal. The general condition of the patient and the size and localization of the perforation should be taken into consideration in the choice of treatment. Curative surgery can also be performed in perforated colorectal cancers. However, partial resection and trephine colostomy should be performed in patients with multiple metastases and poor general condition.
PubMed: 34276844
DOI: 10.5114/pg.2021.106667 -
Nigerian Journal of Surgery : Official... 2017Perforated gastric ulcer is one of the most life-threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for... (Review)
Review
Perforated gastric ulcer is one of the most life-threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59-year-old male patient who presented with perforated giant gastric ulcer complicated by generalized peritonitis and severe sepsis. The debate is based on a systematized table dividing all factors into three groups and putting them on surgical scales. Pathology-related factors influencing the decision-making are size and site of perforation, local tissue inflammation, signs of malignancy, simultaneous complications of peptic ulcer, peritonitis, and sepsis. Besides these factors, patient- and healthcare-related factors should also be considered.
PubMed: 28584503
DOI: 10.4103/1117-6806.199959 -
Otology & Neurotology : Official... Feb 2020Microneedles can create microperforations in the round window membrane (RWM) without causing anatomic or physiologic damage.
HYPOTHESIS
Microneedles can create microperforations in the round window membrane (RWM) without causing anatomic or physiologic damage.
BACKGROUND
Reliable delivery of agents into the inner ear for therapeutic and diagnostic purposes remains a challenge. Our novel approach employs microneedles to facilitate intracochlear access via the RWM. This study investigates the anatomical and functional consequences of microneedle perforations in guinea pig RWMs in vivo.
METHODS
Single three-dimensional-printed, 100 μm diameter microneedles were used to perforate the guinea pig RWM via the postauricular sulcus. Hearing was assessed both before and after microneedle perforation using compound action potential and distortion product otoacoustic emissions. Confocal microscopy was used ex vivo to examine harvested RWMs, measuring the size, shape, and location of perforations and documenting healing at 0 hours (n = 7), 24 hours (n = 6), 48 hours (n = 6), and 1 week (n = 6).
RESULTS
Microneedles create precise and accurate perforations measuring 93.1 ± 29.0 μm by 34.5 ± 16.8 μm and produce a high-frequency threshold shift that disappears after 24 hours. Examination of perforations over time demonstrates healing progression over 24 to 48 hours and complete perforation closure by 1 week.
CONCLUSION
Microneedles can create a temporary microperforation in the RWM without causing significant anatomic or physiologic dysfunction. Microneedles have the potential to mediate safe and effective intracochlear access for diagnosis and treatment of inner ear disease.
Topics: Animals; Ear, Inner; Guinea Pigs; Hearing; Needles; Round Window, Ear
PubMed: 31789795
DOI: 10.1097/MAO.0000000000002491 -
Journal of Surgical Case Reports Jan 2024Appendicitis is a common condition in daily clinical practice. Appendicitis due to foreign bodies is uncommon and may result from obstruction or perforation mechanism....
Appendicitis is a common condition in daily clinical practice. Appendicitis due to foreign bodies is uncommon and may result from obstruction or perforation mechanism. We present a rare case of a 43-year-old male patient who was diagnosed with perforated appendicitis due to a fish bone by imaging studies and confirmed postoperatively. Confirming the fish bone causing the perforation on images is sometimes difficult, requiring the radiologist to actively search and determine the source. In addition to appendectomy, the surgeon also needs to pay attention to removing all foreign objects and treating perforations of surrounding organs.
PubMed: 38186759
DOI: 10.1093/jscr/rjad694 -
International Journal of Surgery Case... Aug 2022The perforation of the bowel as the first presentation of inflammatory bowel disease is a rare occurrence reported in about 0.15-3 % of the literature and is especially...
INTRODUCTION
The perforation of the bowel as the first presentation of inflammatory bowel disease is a rare occurrence reported in about 0.15-3 % of the literature and is especially unusual in young patients <30 years of age. It is a serious event with most of the perforations occurring on the ileum. This article describes a unique case of a 20-year-old female patient who presented with perforated ileum due to Crohn's disease as an initial presentation operated at a private surgical center.
CASE PRESENTATION
We present a case of a previously asymptomatic 21-year-old female presenting with intestinal perforation secondary to Crohn's disease for the first time. The patient presented with crampy abdominal pain and frequent bilious vomiting of 3 days duration. She also had a high-grade fever and abdominal distension. WBC was 24,000 and an abdominal CT scan showed perforation of the bowel consistent with Crohn's Disease. Ruling out other etiologies perforated viscous secondary to query Crohn's Disease was entertained and laparotomy revealed 2 × 2 cm perforation on the anti-mesenteric border of the terminal ileum. The perforated segment was resected primary anastomosis was performed. Following surgery, the patient was discharged symptom-free and linked to the Gastroenterology unit after a biopsy confirmed Crohn's disease. She was started on Prednisolone and Azathioprine exactly a month after her surgery. Her 6-month follow-up is smooth.
CONCLUSION
Presentation of bowel perforation as an initial feature of Crohn's Disease is a rare phenomenon. Adequate resuscitation followed by emergency laparotomy with primary resection and anastomosis could be life-saving for a hemodynamically stable patient.
PubMed: 35907295
DOI: 10.1016/j.ijscr.2022.107305 -
Graefe's Archive For Clinical and... Jul 2023The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK).
PURPOSE
The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK).
METHODS
This monocentric retrospective study was performed at the Department of Ophthalmology, University Hospital Ulm, Germany. A total of 78 eyes of 78 patients were included. Thirty-nine eyes received an AMT, and 39 patients were treated with a PK. Primary outcome was recurrence of perforation. Secondary outcomes were patient mortality and visual acuity.
RESULTS
No statistically significant difference was observed with regard to a recurrence of perforation between the two groups (26% in AMT vs 23% in PK, p > 0.99). The time of recurrences was within the first two years and did not differ statistically (p = 0.97). In addition, a proportional hazards model with cox regression regarding recurrent perforation showed no significant differences (p = 0.5). After AMT, 41% and after KP, 28% of the patients died during follow-up (p = 0.2), respectively. The Charlson Comorbidity Index (p < 0.0001) and the age at the time of surgery (p = 0.0002) were statistically significantly higher in those who were deceased. A mean follow-up of 485 ± 517 days was recorded.
CONCLUSION
Both surgical methods show good results and no statistically significant difference regarding recurrent perforation rate. About a third of the patients died during the follow-up period. The decision regarding the appropriate method should therefore be based on a combination of all factors.
Topics: Humans; Keratoplasty, Penetrating; Corneal Perforation; Amnion; Retrospective Studies; Treatment Outcome; Corneal Transplantation; Corneal Diseases
PubMed: 36680612
DOI: 10.1007/s00417-022-05914-0 -
Optics Express Oct 2020This paper presents a detailed analysis examining the absorption performance of a metal-dielectric slab with subwavelength size periodic perforations exploiting...
This paper presents a detailed analysis examining the absorption performance of a metal-dielectric slab with subwavelength size periodic perforations exploiting quarter-wave impedance matching (QWIM) technique within long wave infrared (LWIR) regime (8-12µm). Integration of perforations to a simple stack with various period sizes and perforated area ratios are examined through theory, simulation, and measurements that are in great agreement. Advantages of perforated absorbers for thermal detectors are discussed in maximizing optical absorption and reducing thermal-mass point of view. Introducing perforation in umbrella type absorbers is mainly employed for reducing the thermal-mass while maintaining the high absorption performance. Within the scope, it is experimentally shown that a perforation ratio (width/period) of 50% with square holes for the umbrella layer is possible without degrading the maximum LWIR absorption performance of 96% when the sheet resistance of R=400Ω/□ is employed for the absorbing metal layer, which is close to free space impedance of 377Ω/□. Nevertheless, this ratio can be increased up to 77% by depositing a thicker absorber metal with smaller sheet resistance, such as R=100Ω/□ while still maintaining an average absorption performance of 93%, which are all predicted numerically by simulations and physically explained through effective medium approach (EMA).
PubMed: 33115029
DOI: 10.1364/OE.405100 -
Acta Orthopaedica Et Traumatologica... 2012The aim of the present study was to investigate glove perforation rate and time and evaluate the factors affecting glove perforation in total hip arthroplasty (THA).
OBJECTIVE
The aim of the present study was to investigate glove perforation rate and time and evaluate the factors affecting glove perforation in total hip arthroplasty (THA).
METHODS
Nine hundred seventy-nine gloves used in 57 THA procedures were assessed according to the perforation. Forty-four (77.2%) procedures were primary THA and 13 (22.8%) were revision THA. Gloves were changed when perforated, become dirty with blood or blood products, and before bone cementing. All gloves were filled with water at the end of the operation and controlled for perforation. Two hundred and one surgical gloves used during scrubbing and removed after draping the patient were examined as the control group. The location (which finger), number and time of the perforation, surgery type and duration, and distribution of the perforation location according to the surgical team were assessed.
RESULTS
Patients' mean age was 62.9 ± 14.6 (range: 33 to 97) years and the mean surgery duration was 162.9 ± 32.0 minutes. Thirty-two glove perforations were noted in 19 of the operations. Of these perforations, 28 belonged to the surgeons and first assistants. There was no significant difference between the dominant or non-dominant hand according to the location of perforations. Perforations in the first and second fingers of the gloves accounted for 81.3% of all perforations. There was no significant difference in terms of number of gloves used, perforation numbers and operation duration between the primary and revision THA procedures. Two perforated gloves (0.99%) were found in the control group and the difference between the number of perforations in the control and study groups was significant (p=0.048).
CONCLUSION
We recommend the use of two pairs of gloves to avoid the risk of contamination and protect the surgical team from infectious disease in major surgeries like THA. Surgical gloves should be changed when they are excessively contaminated with surgical fluids and the surgeon and first assistant should also change their outer gloves at an average of every 90 minutes.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Equipment Failure; Equipment Safety; Gloves, Surgical; Humans; Infectious Disease Transmission, Patient-to-Professional; Middle Aged; Physicians; Risk Assessment; Time Factors; Turkey
PubMed: 22441453
DOI: 10.3944/aott.2012.2660