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Science Progress 2020Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current...
Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann's operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features (≤ 0.001, = 0.005). Age of patients was associated with both postoperative complication ( = 0.012, = 0.044) and mortality ( = 0.013, = 0.034). Univariate analysis showed that HSP was associated with postoperative complication ( = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.
Topics: Aged; Colon, Sigmoid; Colonic Diseases; Humans; Intestinal Perforation; Middle Aged; Retrospective Studies
PubMed: 32993458
DOI: 10.1177/0036850420945462 -
The American Journal of Case Reports Sep 2016BACKGROUND Spontaneous gastric perforation is a rare clinical disorder. The majority of the available data have been reported in the neonatal age group. There are a few...
BACKGROUND Spontaneous gastric perforation is a rare clinical disorder. The majority of the available data have been reported in the neonatal age group. There are a few cases of spontaneous gastric perforation in preschool children. To our knowledge, there is no published information on spontaneous gastric perforation in older children and adolescents. CASE REPORT We describe the presentation and clinical course of two adolescent children who presented with spontaneous gastric perforation. Both children presented with acute onset abdominal pain, which progressively worsened. In both cases, the patient were taken urgently to the operating room after imaging studies had shown pneumoperitoneum. In both cases, surgery revealed gastric perforation with no obvious etiology, specifically no -ulcer, inflammation, or other pathology. CONCLUSIONS These two cases highlight the importance of including spontaneous gastric perforation, not just the typical duodenal/gastric ulcer, in the differential of a patient with severe abdominal pain and distension, who has imaging showing pneumoperitoneum.
PubMed: 27686129
DOI: 10.12659/ajcr.898939 -
Cureus Apr 2022Boerhaave's syndrome is a rare spontaneous perforation of the esophagus with high mortality. The diagnosis is difficult because it has no specific symptom. It requires...
Boerhaave's syndrome is a rare spontaneous perforation of the esophagus with high mortality. The diagnosis is difficult because it has no specific symptom. It requires urgent intervention. We report the case of a 63-year-old male admitted to the emergency department with respiratory distress. Chest computed tomography (CT) revealed large, bilateral, and tension hydropneumothorax, stomach distention, and aerobilia. Thoracic drainage was performed immediately. Control CT revealed esophagus perforation in the middle third of the esophagus with extravasation of the contrast product from the esophagus to the pleura. Urgent surgery was performed, and the patient was admitted to the intensive care unit (ICU) with septic shock. Early diagnosis and management with a damage control approach including thoracic drainage and surgery are essential to improve prognosis and reduce mortality.
PubMed: 35530901
DOI: 10.7759/cureus.23836 -
Postgraduate Medical Journal Jun 2002Bacille Calmette-Guérin (BCG) lymphadenitis is the most common complication of BCG vaccination. Two forms of BCG lymphadenitis can be recognised in its natural... (Review)
Review
Bacille Calmette-Guérin (BCG) lymphadenitis is the most common complication of BCG vaccination. Two forms of BCG lymphadenitis can be recognised in its natural course-simple or non-suppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative BCG lymphadenitis distinguished by the development of fluctuations in the swelling, with erythema and oedema of overlying skin. Healing in suppurative glands occurs through spontaneous perforation and sinus formation, followed by closure of the sinus by cicatrisation. Non-suppurative BCG lymphadenitis is best managed with expectant follow ups only, because medical treatment with erythromycin or antituberculous drugs do not hasten the regression or prevent development of suppuration. Suppurative BCG lymphadenitis may be treated by needle aspiration to hasten resolution and prevent spontaneous perforation and sinus formation. Surgical excision is rarely needed and is meant for cases of failed needle aspiration or for draining BCG nodes.
Topics: Adolescent; BCG Vaccine; Biopsy, Needle; Humans; Infant, Newborn; Lymphadenitis
PubMed: 12151684
DOI: 10.1136/pmj.78.920.327 -
Journal of Surgical Case Reports Aug 2022Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of...
Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of the cervical tract are the most common cause of pyometra, several benign conditions can contribute to this diagnosis. Traditionally hysterectomy has been the surgical approach of choice for this clinical entity; however, in the setting of septic shock, temporizing techniques may offer the opportunity to stabilize patients and complete a thorough work up before committing to definitive resection. This report explores a case of septic shock secondary to spontaneous perforation of pyometra that was definitively managed with peritoneal lavage and wide drainage. Intraoperative hysteroscopy and uterine biopsy were performed, and no malignancy was identified on final pathology. Intraoperative hysteroscopy along with peritoneal lavage and wide drainage may reduce the morbidity and mortality associated with sepsis from spontaneous perforation of pyometra and potentially avoid unnecessary hysterectomy.
PubMed: 36051005
DOI: 10.1093/jscr/rjac388 -
Journal of Menopausal Medicine Apr 2016Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5%...
Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.
PubMed: 27152313
DOI: 10.6118/jmm.2016.22.1.47 -
International Journal of Surgery... 2012Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This... (Review)
Review
BACKGROUND
Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This review summarises the evidence surrounding the natural progression of this condition and potential problems with Niemeier's classification, and proposes a management algorithm for the more complex type II perforation.
METHODS
Data from a retrospective case series and a systematic review were combined. The case series included all patients with gallbladder perforations from 2004 to 2008 at a British teaching hospital. The systematic review searched for gallbladder perforation using the MEDLINE, Embase, Web of Science and Cochrane Library (2011 Issue 4) databases, as well as recent conference abstracts. The outcome data were analysed using SPSS version 15. No adjustments were made for multiple testing.
RESULTS
198 patients (including 19 patients from the present series) with a mean age of 62.1+/-9.7 years and male gender proportion of 55.4% (range 33.3-76.7%) were included. The most common gallbladder perforations were type II (median 46.2%, range 7.4-83.3%), followed by type I (median 40.6%, range 16.7-70.0%) and type III (median 10.1%, range 0-48.1%). Perforation was associated with cholelithiasis in 86.6% (range 78.9-90.6%) of patients, and the overall median mortality rate was 10.8% (range 0-12.5%). Male gender was weakly associated with mortality (p = 0.089) but age (p = 0.877) and cholelithiasis (p = 0.425) were not. Mortality did not vary significantly with perforation type.
CONCLUSIONS
Gallbladder perforation should be reported according to the original Neimeier's classification to avoid heterogeneity in data (e.g. varying rates of perforation types). The algorithm proposed in this study aims to guide the management of complex type II gallbladder perforations to minimise subsequent morbidity and mortality.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystitis, Acute; Decision Support Techniques; Female; Gallbladder Diseases; Humans; Male; Middle Aged; Retrospective Studies; Rupture, Spontaneous
PubMed: 22210542
DOI: 10.1016/j.ijsu.2011.12.004 -
International Journal of Surgery Case... Apr 2021Spontaneous urinary bladder rupture is a rare complication of urosepsis. Its co-occurrence with pneumoperitoneum is even more unusual.
INTRODUCTION AND IMPORTANCE
Spontaneous urinary bladder rupture is a rare complication of urosepsis. Its co-occurrence with pneumoperitoneum is even more unusual.
CASE PRESENTATION
A 73-year-old patient presented with acute retention with mild lower abdominal pain and difficulty with urinary voiding and cystitis. He was treated with bladder catheter and antibiotics. After one month, he suddenly developed peritonitis and shock. Pneumoperitoneum was observed on a chest x-ray. An emergent laparotomy was performed and a perforation of the bladder secondary to necrosis of part of the wall was found and resected. The patient recovered satisfactorily after the surgical intervention.
CLINICAL DISCUSSION
Spontaneous bladder rupture is a life-threatening condition that could be missed. Surgical intervention is mandatory to rule out other more probable causes of peritonitis and to manage the bladder perforation itself.
CONCLUSION
Pneumoperitoneum is rarely secondary to a bladder perforation. Immediate surgical intervention is required in order to avoid delays in treating any intra-abdominal condition including a bladder wall perforation.
PubMed: 33744799
DOI: 10.1016/j.ijscr.2021.105783 -
Infectious Diseases in Obstetrics and... 2006Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01-0.5% in gynecologic patients; however, as far as elderly patients... (Review)
Review
Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01-0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.
Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Rupture, Spontaneous; Suppuration; Uterine Diseases; Uterine Rupture
PubMed: 17093350
DOI: 10.1155/IDOG/2006/26786 -
Indian Journal of Otolaryngology and... Dec 2021Spontaneous perforation of the esophagus is an emergency that requires early diagnosis and management. It may be fatal and delay in treatment can cause an increase in...
Spontaneous perforation of the esophagus is an emergency that requires early diagnosis and management. It may be fatal and delay in treatment can cause an increase in morbidity and mortality. Despite of being very rare in infants, we have to be watchful whenever we encounter signs and symptoms related to it. Only 7 cases of spontaneous esophageal perforation in infants have been report in the literature to the best of our knowledge. Here we are reporting a rare case of spontaneous esophageal rupture in an infant.
PubMed: 34692464
DOI: 10.1007/s12070-020-01993-9