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Journal of Neonatal Surgery 2015The term Spontaneous Intestinal Perforation (SIP) suggests a perforation in the gastrointestinal tract of a newborn with no demonstrable cause.
BACKGROUND
The term Spontaneous Intestinal Perforation (SIP) suggests a perforation in the gastrointestinal tract of a newborn with no demonstrable cause.
METHODS
Four neonates presenting with spontaneous bowel perforation were analyzed with respect to clinical presentation, management and outcome.
RESULTS
The mean age at presentation was 11.4 days. There were three males and one female. One of the neonates was preterm, very low birth weight and the other three were full term. Two neonates underwent emergency exploratory laparotomy and two were initially managed by peritoneal drainage in view of poor general condition; one of them improved and did not require further operative intervention. The preterm very low birth weight neonate was stabilized and explored after 48 hours. Intra-operatively, two of them had two ileal perforations each which required ileostomy; one had single perforation in the transverse colon which was primarily repaired. All four had an uneventful recovery.
CONCLUSION
SIP is a distinct clinical entity and has better outcome than neonates with intestinal perforation secondary to Necrotizing Enterocolitis (NEC).
PubMed: 26034708
DOI: No ID Found -
Acta Gastro-enterologica Belgica 2021Pneumatosis Intestinalis (PI) is a rare radiological finding defined as the presence of extra-luminal gas within the intestinal wall. Several anti-tumor drugs can induce...
Pneumatosis Intestinalis (PI) is a rare radiological finding defined as the presence of extra-luminal gas within the intestinal wall. Several anti-tumor drugs can induce a damage of the gastrointestinal walls as an adverse effect, causing loss of mucosal integrity and endoluminal gas diffusion, responsible for PI development. We retrospectively analyzed 8 cases of PI detected through radiological imaging in oncologic patients undergoing various therapeutic regimens: five patients were receiving chemotherapy, two molecular targeted therapy (MTT) and one immunotherapy. Three patients were asymptomatic and pneumatosis was incidentally detected at routinary follow-up CT and then treated conservatively. Five patients presented acute abdomen symptoms and in these cases bowel perforation was the cause of death. Our experience confirms PI and perforation as rare complications of drug toxicity, especially in oncologic patients treated with combinations of different anticancer drugs and documented the second reported case of PI associated with atezolizumab and alectinib single administration.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Intestinal Perforation; Pneumatosis Cystoides Intestinalis; Retrospective Studies; Spontaneous Perforation
PubMed: 34599575
DOI: 10.51821/84.3.015 -
World Journal of Clinical Cases Aug 2014As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in...
As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.
PubMed: 25133156
DOI: 10.12998/wjcc.v2.i8.398 -
Journal of Minimal Access Surgery 2022The present study aims to report the outcomes of a multidisciplinary, minimally invasive approach to treating patients with delayed presentation of oesophageal...
BACKGROUND
The present study aims to report the outcomes of a multidisciplinary, minimally invasive approach to treating patients with delayed presentation of oesophageal perforation.
PATIENTS AND METHODS
The present study is a retrospective analysis of prospectively maintained data at a tertiary care centre. All patients with oesophageal perforation presenting over 48 h after the onset of symptoms and without oesophageal obstruction were included in the study. Self-expanding Metallic Stent (SEMS) or endoscopic clip placement was performed in all the patients, followed by video-assisted thoracoscopic surgery (VATS) debridement and decortication of pleural cavity collection. 'Success' was defined as, discharge without the need of oesophageal diversion and complete healing of leak site at 8 weeks with successful removal of the stent.
RESULTS
Between March 2012 and December 2019, 12 patients (10 males, median age of 55 years- range of 39-71 years) with oesophageal perforation and delayed presentation underwent treatment with this approach. Ten patients had spontaneous perforation (83.3%) and one patient each had upper gastrointestinal endoscopy-induced and post-traumatic perforation. The median duration of symptoms was 8 days (range 3-31 days). SEMS was placed in ten patients and, in two patients, an over-the-scope clip was used. VATS decortication was done in ten patients (83.3%) and the remaining two (16.7%) underwent VATS debridement. One patient required oesophageal diversion and another patient expired due to sepsis. The overall success with this approach was 83.3%.
CONCLUSION
This multidisciplinary, minimally invasive approach is feasible in patients with thoracic oesophageal perforation and delayed presentation, with a high success rate.
PubMed: 35708379
DOI: 10.4103/jmas.JMAS_28_21 -
Journal of Ayub Medical College,... 2016Spontaneous perforation of bile duct (SPBD) is a rare and often misdiagnosed entity. Though rare, it is the second most common surgical cause of jaundice in infants,...
BACKGROUND
Spontaneous perforation of bile duct (SPBD) is a rare and often misdiagnosed entity. Though rare, it is the second most common surgical cause of jaundice in infants, after biliary atresia. This study was planned to determine the clinical presentation, study different diagnostic modalities, treatment and outcome of patients with spontaneous perforation of bile duct.
METHODS
This descriptive case series, comprising 22 patients with spontaneous perforation of bile duct over a period of 24 months. Clinical presentation, biochemical abnormalities, imaging details, treatment options and outcome were studied.
RESULTS
Total 22 patients (12 Males and 10 Females) between ages of 1.5-36 months were studied. Associated anatomical defects included choledochal cyst in 7 (31.8%) while acquired biliary atresia in 1 (4.5%). Elevated liver enzymes (ALT and AST) were present in 16 patients (72.7%) and 5 (22.7%) had bilirubin above 3 mg/dl. Coagulopathy was seen in 8 (36.6%) patients. Abdominal USG showed presence of ascites in all 22 (100%), hydrocele in 2 (9.0%), inguinal hernia in 1 (4.5%), choledochal cyst in 7 (31.8%) and atretic gall bladder suggestive of acquired biliary atresia in one (4.5%) patient. HIDA scan was diagnostic in all 17 (77.27%) in which it was performed. MRCP was done in 3 (13.6%) patients. Mortality frequency was 3/22 (13.6%); one died of post-surgical sepsis second one was cirrhotic at time of presentation and didn't make It. Two were lost to follow up one which died at home while we lost contact with fourth patient.
CONCLUSIONS
Spontaneous perforation of bile duct can present and should be suspected as an important cause of neonatal biliary ascites or peritonitis. Most patients can be managed with intravenous antibiotics, percutaneous drainage and ttube insertion while patients with choledochal cysts required cholecystectomy with roux en y choledochjejunostomy. Timely recognition and intervention is associated with favourable outcome.
Topics: Alanine Transaminase; Ascites; Aspartate Aminotransferases; Bile Ducts; Biliary Atresia; Bilirubin; Child, Preschool; Choledochal Cyst; Female; Humans; Infant; Infant, Newborn; Male; Peritonitis; Spontaneous Perforation
PubMed: 28712226
DOI: No ID Found -
Journal of Thoracic Disease Jun 2023
PubMed: 37426155
DOI: 10.21037/jtd-23-436 -
Turkish Journal of Surgery Dec 2018Pyometra, the accumulation of purulent material in the uterine cavity, is a rare gynecological condition whose etiology is impaired drainage of the uterine cavity. It is...
Pyometra, the accumulation of purulent material in the uterine cavity, is a rare gynecological condition whose etiology is impaired drainage of the uterine cavity. It is uncommon in premenopausal age and occurs mainly in older and postmenopausal women. Clinical signs of pyometra are vaginal discharge, postmenopausal bleeding, and lower abdominal pain. An 87-year-old woman was admitted to our emergency department with abdominal pain, fever, and vomiting. The results of physical examination revealed rebound tenderness and muscular rigidity in the lower abdomen. Ultrasonography demonstrated free fluid in the abdomen, and percutaneous aspiration revealed that this fluid was purulent. A computed tomography scan showed a large amount of free fluid in the abdominal cavity and a uterine myoma. The patient underwent emergency laparotomy due to acute abdomen. During the laparotomy, a 2×1 cm perforation was seen at the fundus of the uterus. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. A culture of the pus grew Escherichia coli. Histopathological examination revealed degenerative uterine myoma with no evidence of malignancy. Pathological results indicated myometrial suppurative inflammation along with neutrophilia and necrosis. Pyometra is a rare event; however, it must be considered when investigating acute abdomen etiology. Because pyometra involves abscess formation, drainage and evacuation of the uterine cavity while leaving a drain in the cavity and dilating the cervical canal is the main treatment protocol. In cases of perforation, hysterectomy is the treatment choice; however, with concomitant diseases in older patients, immediate surgery is related to important morbidity and mortality risks.
PubMed: 30664439
DOI: 10.5152/turkjsurg.2017.3203 -
International Journal of Surgery Case... Jul 2022Spontaneous gallbladder (GB) perforation is a rare and severe condition. Herein, we present a case of spontaneous acalculous gallbladder perforation mimicking duodenal...
INTRODUCTION AND IMPORTANCE
Spontaneous gallbladder (GB) perforation is a rare and severe condition. Herein, we present a case of spontaneous acalculous gallbladder perforation mimicking duodenal stump leak after a subtotal gastrectomy for gastric cancer.
CASE PRESENTATION
An 83-year-old woman underwent a radical subtotal gastrectomy for advanced gastric cancer. On postoperative day 5, mild leukocytosis was observed. A computed tomography (CT) scan revealed a slightly distended non-thickened GB with minimal air and fluid collection near the duodenal stump, and fluid collection in the abdominal and pelvic cavities. We considered a duodenal stump leak. The effluent of the Barovac located in the abdominal cavity was serosanguinous and the patient was stable, thus we observed and continued using antibiotics. On day 13, the Barovac stopped functioning properly, so we replaced it with a percutaneous catheter drain (PCD) under ultrasonography guidance, aided by the Barovac tract. The PCD drained over 1000 cc of bile daily. On day 16, a follow-up CT showed an increased fluid collection in the abdominopelvic cavity. After comparing this with the previous CT, we rediagnosed as spontaneous GB perforation. An emergency cholecystectomy was performed. Postoperatively, the patient's condition returned to normal and antibiotic therapy continued until day 14. The patient recovered without other complications and was discharged on day 28.
CLINICAL DISCUSSION
Spontaneous GB perforation is a rare but serious complication immediately after gastrectomy which should be looked out for.
CONCLUSION
We report a rare case of spontaneous GB perforation mimicking duodenal stump leak after radical subtotal gastrectomy in gastric cancer.
PubMed: 35738140
DOI: 10.1016/j.ijscr.2022.107304 -
Acta Ophthalmologica Jun 2015To describe spontaneous corneal perforations in patients with atopic keratoconjunctivitis. (Review)
Review
PURPOSE
To describe spontaneous corneal perforations in patients with atopic keratoconjunctivitis.
METHODS
Records of patients with atopic keratoconjunctivitis and spontaneous corneal perforation seen by the authors were reviewed. A literature search of corneal complications in atopic keratoconjunctivitis and predisposing factors for spontaneous corneal perforations in corneal ectasias was undertaken.
RESULTS
Three patients with seven incidents of corneal perforation were identified and presented. Corneal thinning and keratoconus are observed at a higher rate in patients with atopic keratoconjunctivitis, and severe ocular allergy has been reported as a risk factor for corneal hydrops.
CONCLUSIONS
Atopic keratoconjunctivitis appears to be a risk factor for spontaneous sterile corneal perforation. Corneal thinning and keratoconus in addition to inflammatory changes of the cornea in these patients probably predispose to the corneal melt in these perforations. A close observation of the fellow eye of affected patients is important and systemic immunosuppressive therapy should be considered.
Topics: Aged; Conjunctivitis, Allergic; Cornea; Corneal Perforation; Female; Humans; Keratoconus; Male; Middle Aged; Risk Factors; Rupture, Spontaneous
PubMed: 25682856
DOI: 10.1111/aos.12617 -
International Journal of Surgery Case... Sep 2022Spontaneous esophageal perforation, also commonly referred to as Boerhaave's syndrome, is one of the most lethal diseases causing an acute abdomen. Though rare, emergent...
INTRODUCTION
Spontaneous esophageal perforation, also commonly referred to as Boerhaave's syndrome, is one of the most lethal diseases causing an acute abdomen. Though rare, emergent surgical intervention is often required and management can be various based upon the site of the perforation. This literature has been written in line with the SCARE criteria (Agha et al., 2020) [1].
PRESENTATION OF CASE
A 76-year-old man presented with acute abdominal pain. Computed tomography (CT) revealed and an emergent esophagogastroduodenoscopy (EGD) was performed carefully, which revealed a 7 cm all-layer esophageal laceration in the left lower esophageal wall. In our case, a hiatal hernia was protruding into the mediastinum, and the perforation site was inside of it, but there was no invasion into the thoracic cavity, thus a transabdominal approach was performed without thoracotomy.
DISCUSSION
This type of esophageal perforation within a hiatal hernia is quite rare and provides a unique clinical challenge. In addition, A review reported the average length of spontaneous esophageal perforation to be around 2 cm while our case had a perforation with a length of 7 cm. We chose the combination of the simple suture with omental buttress and wide drainage, but a complete fundoplication was impossible due to its large size of perforation.
CONCLUSION
We chose the open abdominal approach because the case had high inflammation, a hiatal hernia and possibility of retro-gastric perforation. However, MIS should have been considered first if a situation or human resources allow it.
PubMed: 36030761
DOI: 10.1016/j.ijscr.2022.107484