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Terui K, Tachimori H, Oita S, Fujiogi M, Fujishiro J, Hirahara N, Miyata H, Hishiki T. Influence of surgical volume on the mortality and morbidity of gastro intestinal perforation in children. Surg Today 2024; 54:419-427. [PMID: 37615756 DOI: 10.1007/s00595-023-02742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To clarify the influence of surgical volume on the mortality and morbidity of gastrointestinal perforation in children in Japan. METHODS We collected data on pediatric patients with gastrointestinal perforation between 2017 and 2019, from the National Clinical Database. The surgical volumes of various institutions were classified into three groups: low (average number of surgeries for gastrointestinal perforation/year < 1), medium (≥ 1, < 6), and high (≥ 6). The observed-to-expected (o/e) ratios of 30-day mortality and morbidity were calculated for each group using an existing risk model. RESULTS Among 1641 patients (median age, 0.0 years), the 30-day mortality and morbidity rates were 5.2% and 37.7%, respectively. The 30-day mortality rates in the low-, medium-, and high-volume institutions were 4.9%, 5.3%, and 5.1% (p = 0.94), and the 30-day morbidity rates in the three groups were 26.8%, 39.7%, and 37.7% (p < 0.01), respectively. The o/e ratios of 30-day mortality were 1.05 (95% confidence interval [CI] 0.83-1.26), 1.08 (95% CI 1.01-1.15), and 1.02 (95% CI 0.91-1.13), and those of 30-day morbidity were 1.72 (95% CI 0.93-2.51), 1.03 (95% CI 0.79-1.28), and 0.95 (95% CI 0.56-1.33), respectively. CONCLUSION Surgical volume does not have significant impact on the outcomes of pediatric gastrointestinal perforation in Japan.
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Affiliation(s)
- Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Oita
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Michimasa Fujiogi
- Department of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norimichi Hirahara
- Digital Health and Innovation Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hiroaki Miyata
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
- Department of Health Policy and Management, Keio University, Tokyo, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Chen SY, Grisotti G, Mack SJ, Walther AE, Chapman RL, Falcone RA, Kim ES. A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation. J Surg Res 2024; 297:56-62. [PMID: 38432084 DOI: 10.1016/j.jss.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/04/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Neonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications. METHODS A multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis. RESULTS Overall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5). CONCLUSIONS Stoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.
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Affiliation(s)
- Stephanie Y Chen
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabriella Grisotti
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shale J Mack
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley E Walther
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachel L Chapman
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, California; Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Richard A Falcone
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
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Bellia MA, Sofia C, Marino MA, Mazzeo C, Biondo SA, Cucinotta E, Fleres F. Intestinal Perforation in a patient with peritoneal carcinomatosis from colon cancer treated with Regorafenib. Description of a case and review of the literature. Radiol Case Rep 2024; 19:2013-2019. [PMID: 38449482 PMCID: PMC10917637 DOI: 10.1016/j.radcr.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Regorafenib is a multikinase inhibitor approved for treatment of patients with metastatic Colo-Rectal Cancer (mCRC) and Gastro-Intestinal Stromal Tumor (GIST) progression after the administration of other tyrosine-kinase inhibitors such as imatinib and sunitinib. Only a handful of severe side effects such as intestinal perforations and fistulas have been described in the literature in patients undergoing multikinase inhibitor treatment. We report a case of a patient with peritoneal mCRC who experienced an intestinal perforation during the administration of Regorafenib and review the literature. A 48-year-old man with previously resected sigmoid colon cancer and peritoneal metastatic disease under Regorafenib treatment presented to our Emergency Department with severe abdominal pain and asthenia. Abdominal X-ray and contrast-enhanced computed tomography examination revealed an intestinal perforation. The patient underwent emergency surgery which demonstrated acute diffuse peritonitis, necrosis, and perforation of a distal ileal loop affected by peritoneal metastatic disease. The necrosis of peritoneal implants on bowel walls could be regarded as a potential factor leading to intestinal perforation in metastatic colorectal cancer patients undergoing Regorafenib treatment complaining of severe abdominal pain and asthenia. Surgeons, radiologists and oncologists should always keep in mind this rare adverse event during Regorafenib administration. Appropriate diagnostic tests and treatments should be carried out.
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Affiliation(s)
- Maria Alessandra Bellia
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98125, Messina, Italy
| | - Carmelo Sofia
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98125, Messina, Italy
| | - Maria Adele Marino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino” Via Consolare Valeria 1, 98125, Messina, Italy
| | - Carmelo Mazzeo
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Santino Antonio Biondo
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Eugenio Cucinotta
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Francesco Fleres
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Section of General Surgery, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
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Hou TY, Tzeng WJ, Lee PH. Small intestine angioleiomyoma as a rare cause of perforation: A case report. World J Clin Cases 2024; 12:2116-2121. [DOI: 10.12998/wjcc.v12.i12.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Angioleiomyoma is a rare and benign stromal tumor typically found in subcutaneous tissue. It rarely occurs in the gastrointestinal tract. Among the reported cases, the most common complication was gastrointestinal bleeding. Perforation has only been reported as a complication in the last few decades.
CASE SUMMARY This case report detailed the discovery of intestinal angioleiomyoma in a 47-year-old male presenting with abdominal pain that had persisted for 3 d. After suspecting hollow organ perforation, surgical intervention involving intestinal resection and anastomosis was performed.
CONCLUSION The report underscores the significance of early surgical intervention in effectively treating angioleiomyoma while emphasizing the pivotal role of timely and appropriate measures for favorable outcomes.
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Affiliation(s)
- Teng-Yuan Hou
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Wei-Juo Tzeng
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Pei-Hang Lee
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
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Sample JW, Yonkus JA, Mirande MD, Graham RP, Kelley SR. Gastrointestinal histoplasmosis with small intestinal perforation: 20-year experience. Updates Surg 2024:10.1007/s13304-024-01797-4. [PMID: 38507175 DOI: 10.1007/s13304-024-01797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Postmortem studies show gastrointestinal tract involvement in as many as 70% of patients affected by disseminated histoplasmosis. Although gastrointestinal involvement is common in disseminated disease, the presentation of small intestinal perforation is exceedingly rare with few reported cases in the literature. Herein we present our institutional case series. The aim of the study is to describe small intestinal perforation in gastrointestinal histoplasmosis with attention to management and outcomes. This is a retrospective single-institution review of patients ≥ 18 years of age treated for small intestinal perforation due to gastrointestinal histoplasmosis. A prospectively maintained institutional database was searched from 2002 to 2022. Data obtained included demographics, comorbidities, treatment course, and outcomes. Five patients with a mean age of 54 years (range 25-72) were identified. Pertinent underlying comorbid conditions included Crohn's disease, psoriatic arthritis, rheumatoid arthritis, and solid organ transplantation. All patients were on chronic immunosuppressive medication(s) with the most common being tumor necrosis factors alpha inhibitors and corticosteroids. Four had a clinical diagnosis of perforation based on physical examination and imaging. All patients underwent segmental resection(s) of the small intestine and received medical treatment with intravenous amphotericin B and eventual transition to an oral antifungal. No patients experienced complications related to surgery. The limitations of the study include nonrandomized retrospective review, single-institution experience, and small patient sample size. Although rare, histoplasmosis should be considered in the differential of patients on chronic immunosuppressive therapy who present with gastrointestinal symptoms concerning perforation, especially from endemic areas. Small intestinal perforation due to gastrointestinal histoplasmosis can be successfully treated with resection and antifungal therapy.
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Affiliation(s)
- Jack W Sample
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jennifer A Yonkus
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Maxwell D Mirande
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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Yoshizaki M, Matsuo Y, Yasuda S, Doi S, Sakata T, Nagai M, Nakamura K, Kohara Y, Toyoda S, Tanaka T, Sho M. Successful management of splenic artery dissection after sigmoid colon perforation in vascular Ehlers-Danlos syndrome. Surg Case Rep 2024; 10:60. [PMID: 38485809 PMCID: PMC10940564 DOI: 10.1186/s40792-024-01845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/13/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome (EDS) is a genetic disorder that causes fragility of the systemic connective tissues. Of the 13 subtypes, vascular EDS (vEDS) is associated with abnormalities in collagen production, resulting in arterial rupture and intestinal perforation. Herein, we report the case of a man with confirmed vEDS who survived a ruptured dissected splenic artery aneurysm triggered by perforation of the sigmoid colon. CASE PRESENTATION A 48-year-old man presented to our hospital with sudden severe lower abdominal pain. The patient was genetically diagnosed with vEDS at the age of 43 years. Abdominal computed tomography (CT) showed fluid and free air surrounding the sigmoid colon. These findings suggested sigmoid colon perforation, and emergency surgery was needed. Hartmann's procedure was performed. The resected specimen showed a 2-cm-sized depression around the perforation. Histopathological findings showed an abscess and exudate in the serosa of the perforation and thinning of the intrinsic muscular layer in the depressed area. The patient was doing well postoperatively; however, on the ninth postoperative day, sudden upper abdominal pain developed. CT revealed an intra-abdominal hemorrhage due to rupture of a dissecting splenic artery aneurysm. The aneurysm was not observed on preoperative CT and was distant from the surgical site. Urgent transcatheter arterial embolization was performed. Although embolization of the splenic artery was attempted during the procedure, the arterial dissection spread to the common hepatic artery. Moreover, the proper hepatic and gastroduodenal arteries were poorly visualized, probably due to vasospasm. Although complications associated with extensive embolization were a concern, embolization of the splenic and common hepatic arteries was necessary to save the patient's life. After embolization, angiography showed that the left hepatic blood flow was maintained from the inferior phrenic artery, and the right hepatic inflow was maintained from the superior mesenteric artery via the peribiliary vascular plexus in the hilar area. The patient recovered well and was discharged on the 19th postoperative day. CONCLUSIONS vEDS can cause arterial rupture after intestinal surgery. Therefore, careful post-operative management is necessary. Moreover, cooperation with interventional radiologists is important for prompt treatment of vascular complications.
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Affiliation(s)
- Moegi Yoshizaki
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuko Matsuo
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Satoshi Yasuda
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shunsuke Doi
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takeshi Sakata
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kota Nakamura
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yuichiro Kohara
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shohei Toyoda
- Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Bekeny JC, Huffman SS, Thomas C, Tumminello M, Kata A, Parikh R, Tom LK, Kleiber GM. Small Intestinal Perforation after 360-Degree Liposuction: A Case Report. Aesthetic Plast Surg 2024; 48:946-952. [PMID: 37653177 DOI: 10.1007/s00266-023-03567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE As one of the most commonly performed cosmetic procedures, liposuction is relatively safe. Bowel injury following liposuction is a rare but devastating complication, which necessitates hospital admission and surgical intervention. The authors highlight a case report describing the presentation, diagnosis, and management of a patient with bowel injury following liposuction. CASE A 58-year-old woman presented with abdominal pain, erythema, and discharge three days after 360-degree abdominal liposuction with concomitant fat grafting to bilateral buttocks at an outpatient surgery center. Bowel perforation was suspected after CT-scan revealed extraluminal gas in the abdomen and communication that traversed the peritoneum. Exploratory laparotomy was performed which demonstrated at least one site of distinct perforation of the small bowel and an area omentum noted to be inflamed, thickened and with a purulent rind. The patient underwent 20-cm small bowel resection and partial omentectomy temporarily closed with negative pressure wound therapy. After subsequent abdominal wall debridements the patient received ventral hernia repair with bridging mesh and abdominal closure. CONCLUSIONS While safe, elective cosmetic procedures are not without risk of serious and even fatal complications. Providers must be familiar with the presentation of bowel injury following abdominal liposuction to prevent delays in appropriate surgical and medical care. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Jenna C Bekeny
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Samuel S Huffman
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Chris Thomas
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mariana Tumminello
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anna Kata
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Rajiv Parikh
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Laura K Tom
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA
| | - Grant M Kleiber
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, NW, 20007, USA.
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Tahouri T, Hedayati Omami S, Hosseini M, Rahimi-Movaghar E. Concurrent rectal perforation and obstruction following neoadjuvant chemoradiation for locally advanced rectal cancer: A case report. Int J Surg Case Rep 2024; 116:109337. [PMID: 38310787 PMCID: PMC10847799 DOI: 10.1016/j.ijscr.2024.109337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Locally advanced rectal cancer (LARC) is commonly managed with neoadjuvant chemoradiation (neoCRT) followed by surgery, though not without complications. The anatomical exposure of the colon and rectum and pelvic radiotherapy poses risk, with rectal perforation and bowel obstruction, though rare, carrying life-threatening potential. PRESENTATION OF CASE This case highlights an exceptionally rare occurrence of concurrent rectal perforation and rectal obstruction in a 77-year-old male with LARC, just two months post neoCRT. Initial symptoms included rectal bleeding, and diagnostic procedures confirmed rectal T1N3adenocarcinoma with no metastasis. Emergency admission, prompted by complete bowel obstruction symptoms, led to discovery of rectal perforation during laparotomy, sealed by the bladder. Pathological analysis attributed the cause to radiation proctitis, reporting complete response to neoCRT with no residual tumor. DISCUSSION The rarity of both bowel obstruction and perforation as neoCRT complications, particularly in the acute phase of radiation proctitis, is noteworthy in this case. The absence of tumoral cells at the affected sites emphasizes the exceptional nature of this case. CONCLUSION This case underscores the importance of recognizing acute post neoCRT injuries as potentially life-threatening complications, emphasizing the need for heightened awareness and consideration in clinical management.
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Affiliation(s)
- Tahmineh Tahouri
- Pediatric Cardiology, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Maryam Hosseini
- Anatomical & Clinical Pathologist, Shahid Chamran Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsanollah Rahimi-Movaghar
- Department of Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
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Huang P, Luo N, Shi X, Yan J, Huang J, Chen Y, Du Z. Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation. BMC Pediatr 2024; 24:143. [PMID: 38413889 PMCID: PMC10898055 DOI: 10.1186/s12887-024-04640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE To investigate the clinical characteristics of neonatal necrotizing enterocolitis (NEC) complicated by intestinal perforation and predict the incidence of intestinal perforation in NEC. METHODS Neonates diagnosed with NEC at the Affiliated Hospital of Zunyi Medical University from January 2012 to May 2022 were enrolled, and the clinical data were collected and analyzed retrospectively. The patients were divided into two groups based on intestinal perforation occurrence or not. Mann-Whitney U tests, t-tests, chi-square tests, and fisher's exact tests were performed between-group comparisons. Logistic and lasso regressions were applied to screen independent risk factors for concomitant bowel perforation, and R software (RMS package) was used to formulate the nomogram prediction model. In addition, the receiver operating curve (ROC) and the calibration curve were drawn to verify the predictive power, while decision curve analysis (DCA) was constructed to evaluate the clinical applicability of the nomogram model. RESULTS One hundred eighty neonates with NEC were included, of which 48 had intestinal perforations, and 132 did not; the overall incidence of intestinal perforation was 26.67% (48/180). Bloody stool (OR = 5.60), APTT ≥ 50 s (OR = 3.22), thrombocytopenia (OR = 4.74), and hypoalbuminemia (OR = 5.56) were identified as independent risk variables for NEC intestinal perforation (P < 0.05) through multivariate logistic regression analysis. These factors were then applied to develop a nomogram prediction model (C-index = 0.838) by using the R software. The area under the curve (AUC) for the nomogram in the training and validation cohorts were 0.838 (95% Cl: 0.768, 0.908) and 0.802 (95% CI: 0.659, 0.944), respectively. The calibration curve shown that the nomogram has a good predictive ability for predicting the risk of intestinal perforation occurrence. And the decision curve and clinical impact curve analyses demonstrated good clinical utility of the nomogram model. CONCLUSION We found that Bloody stool, APTT ≥ 50 s, Thrombocytopenia, and hypoalbuminemia could be used as independent risk factors for predicting intestinal perforation in neonates with NEC. The nomogram model based on these variables had high predictive values to identify NEC patients with intestinal perforation.
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Affiliation(s)
- Pei Huang
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China
| | - Nandu Luo
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China
| | - Xiaoqi Shi
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China
| | - Jiahong Yan
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China
| | - Jiaojiao Huang
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China
| | - Yan Chen
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China.
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China.
| | - Zuochen Du
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China.
- Collaborative Innovation Center for Tissue Injury Repair and Regenerative Medicine of Zunyi Medical University, Zunyi, China.
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Narciso-Schiavon JL, Fonseca KK, Silva JS, Rodrigues SST, I-Ching L, Gentili AC, De Meireles CZ, Fonseca JS, Lacombe LA, Schiavon LDL. Acute abdominal perforation as a clinical presentation of coeliac disease. Arab J Gastroenterol 2024; 25:64-66. [PMID: 37989674 DOI: 10.1016/j.ajg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023]
Abstract
Intestinal perforation is described in coeliac disease in the setting of refractoriness or Enteropathy-Associated T-cell Lymphoma (EATL). We report the case of a man with untreated coeliac disease who presented intestinal perforation and was diagnosed with EATL over one year later.
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Affiliation(s)
- Janaína Luz Narciso-Schiavon
- Gastroenterology, Internal Medicine Department - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
| | - Karoline Kuhnen Fonseca
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Jandir Santos Silva
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Sarah Sayuri Tiemi Rodrigues
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Lee I-Ching
- Pathological Anatomy Division - University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Arthur Conelian Gentili
- Pathological Anatomy Division - University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Cintia Zimmermann De Meireles
- Digestive Endoscopy, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Janaina Sant'Ana Fonseca
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Luiz Augusto Lacombe
- Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Leonardo De Lucca Schiavon
- Gastroenterology, Internal Medicine Department - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Gastroenterology Division, Digestive System Unit, University Hospital - Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Muhammed MM, Bwala KJ, Okoruwa JO. Typhoid Fever Presenting with Ileal Perforation and Gastric Perforation. West Afr J Med 2024; 41:92-96. [PMID: 38412528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Typhoid fever is caused by Salmonella typhi and Salmonella paratyphi. It is a disease of developing countries and is seen among people of low socio-economic status. Patients can develop complications like typhoid intestinal perforation which is associated with higher mortality. A 15-year-old female presented to the emergency pediatric unit with fever, abdominal pain and abdominal distension. She was septic, in respiratory distress, and had marked generalized abdominal tenderness with guarding. An assessment of generalized peritonitis secondary to typhoid intestinal perforation was made. She had exploratory laparotomy with intra-operative findings of ileal perforation and gastric perforation. She had repair of the intestinal and gastric perforations. Our patient presented late with concurrent use of NSAIDs and overwhelming sepsis which likely contributed to the gastric perforation as this is not a usual finding in patients with typhoid intestinal perforation. Gastric perforation is an unusual finding in patients with typhoid intestinal perforation. Typhoid fever and its complications can be easily prevented by the provision of safe water, proper facilities for sanitation, and practicing good hygiene.
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Affiliation(s)
- M M Muhammed
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. +2348061666943
| | - K J Bwala
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. +2348061666943
| | - J O Okoruwa
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. +2348061666943
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12
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Kim TS, Min BH, Min YW, Lee H, Rhee PL, Kim JJ, Lee JH. Delayed Perforation Occurring after Gastric Endoscopic Submucosal Dissection: Clinical Features and Management Strategy. Gut Liver 2024; 18:40-49. [PMID: 37161697 PMCID: PMC10791500 DOI: 10.5009/gnl220508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 05/11/2023] Open
Abstract
Background/Aims Delayed perforation is a rare but serious adverse event of gastric endoscopic submucosal dissection (ESD). The aim of this study was to clarify the clinical features and appropriate management strategy of patients with delayed perforation. Methods Among 11,531 patients who underwent gastric ESD, the clinical features and outcomes of patients who experienced delayed perforation were retrospectively reviewed and compared with those of the control group. Results Delayed perforation occurred in 15 of 11,531 patients (0.13%). The patients with delayed perforation were significantly older than those without delayed perforation (p=0.027). The median time to diagnosis of delayed perforation was 28.8 hours (range, 14 to 71 hours). All 15 patients with delayed perforation complained of severe abdominal pain after gastric ESD and underwent subsequent chest X-rays (CXRs) for evaluation. In subsequent CXR, free air was found in 12 patients (80%). For three (20%) patients without free air in CXR, delayed perforation was finally diagnosed by computed tomography. Leukocytosis was significantly less frequent in the patients without free air in CXR (p=0.022). A perforation hole smaller than 1 cm in size was more frequently observed in the six patients who underwent successful non-surgical treatments than in the nine patients who underwent surgery (p<0.001). There was no mortality related to delayed perforation. Conclusions One-fifth of the patients with delayed perforation did not show free air in CXR and exhibited less leukocytosis than those with free air. Non-surgical treatments including endoscopic closure might be considered as an initial treatment modality for delayed perforation smaller than 1 cm.
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Affiliation(s)
- Tae-Se Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J. Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Gachabayov M, Kajmolli A, Quintero L, Felsenreich DM, Popa DE, Ignjatovic D, Bergamaschi R. Inadvertent laparoscopic lavage of perforated colon cancer: a systematic review. Langenbecks Arch Surg 2024; 409:35. [PMID: 38197963 DOI: 10.1007/s00423-023-03224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Although laparoscopic lavage for perforated diverticulitis with peritonitis has been grabbing the headlines, it is known that the clinical presentation of peritonitis can also be caused by an underlying perforated carcinoma. The aim of this study was to determine the incidence of patients undergoing inadvertent laparoscopic lavage of perforated colon cancer as well as the delay in cancer diagnosis. METHODS The PubMed database was systematically searched to include all studies meeting inclusion criteria. Studies were screened through titles and abstracts with potentially eligible studies undergoing full-text screening. The primary endpoints of this meta-analysis were the rates of perforated colon cancer patients having undergone inadvertent laparoscopic lavage as well as the delay in cancer diagnosis. This was expressed in pooled rate % and 95% confidence intervals. RESULTS Eleven studies (three randomized, two prospective, six retrospective) totaling 642 patients met inclusion criteria. Eight studies reported how patients were screened for cancer and the number of patients who completed follow-up. The pooled cancer rate was 3.4% (0.9%, 5.8%) with low heterogeneity (Isquare2 = 34.02%) in eight studies. Cancer rates were 8.2% (0%, 3%) (Isquare2 = 58.2%) and 1.7% (0%, 4.5%) (Isquare2 = 0%) in prospective and retrospective studies, respectively. Randomized trials reported a cancer rate of 7.2% (3.1%, 11.2%) with low among-study heterogeneity (Isquare2 = 0%) and a median delay to diagnosis of 2 (1.5-5) months. CONCLUSIONS This systematic review found that 7% of patients undergoing laparoscopic lavage for peritonitis had perforated colon cancer with a delay to diagnosis of up to 5 months.
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Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Jacobi Medical Center, New York City Health Hospitals, Building 1, Suite 610, 1400 Pelham Parkway S, New York, NY, USA
- Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Agon Kajmolli
- Department of Surgery, Jacobi Medical Center, New York City Health Hospitals, Building 1, Suite 610, 1400 Pelham Parkway S, New York, NY, USA
- Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Luis Quintero
- Department of Surgery, Jacobi Medical Center, New York City Health Hospitals, Building 1, Suite 610, 1400 Pelham Parkway S, New York, NY, USA
- Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Daniel M Felsenreich
- Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Dorin E Popa
- Department of General Surgery, Linköping University Hospital, Linköping, Sweden
| | - Dejan Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway
| | - Roberto Bergamaschi
- Department of Surgery, Jacobi Medical Center, New York City Health Hospitals, Building 1, Suite 610, 1400 Pelham Parkway S, New York, NY, USA.
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Quitadamo P, Gragnaniello P, Isoldi S, Bucci C, Esposito F, Russo S, Grella MG, Caldore M. Magnetic foreign body ingestion in pediatric age. Dig Liver Dis 2023:S1590-8658(23)01027-7. [PMID: 37985250 DOI: 10.1016/j.dld.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To assess the clinical complications reported after the ingestion of magnetic foreign bodies (FBs) in pediatric age, along with their incidence among all FB ingestions and clinical presentation. STUDY DESIGN We've consecutively recruited all children aged 0-14 years who were admitted for single or multiple magnet ingestion from May 2015 to December 2022. Patient demographics, admission sources and discharge status were accurately recorded, along with their clinical management and outcomes. RESULTS Sixty-one children were enrolled, of whom 49/61 (80.3%) had ingested a single magnet and 12/61 (19.7%) multiple magnets. Only 1/49 children with single magnet required endoscopic removal due to esophageal retention. Among children having ingested multiple magnets, 5/12 (41.7%) undergo endoscopic removal since magnets were amenable to endoscopic retrieval whereas in 7/12 (58.3%) magnets could not be promptly removed. Among these, 4/12 (33.3%) later developed intestinal ischemia/necrosis or perforation and required FB surgical intervention whereas 3/12 (25%) uneventfully evacuated magnets. CONCLUSIONS Our data confirm that multiple magnet ingestion, unlike single magnet ingestion, pose a serious health hazard. Parents and caregivers should remove them from the reach of children. Medical providers should maintain a high index of suspicion of their ingestion since prompt evaluation and likely removal may be lifesaving and intestine saving.
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Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Piergiorgio Gragnaniello
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Cristina Bucci
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Francesco Esposito
- Department of Emergency Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Silvana Russo
- Pediatric Surgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | | | - Mariano Caldore
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Hsu IL, Chen PJ, Chiang PH, Hsu YC, Chai CY, Tsai EM. Coincidental spontaneous perforation of the small intestine following operative hysteroscopy: A case report. Taiwan J Obstet Gynecol 2023; 62:915-917. [PMID: 38008515 DOI: 10.1016/j.tjog.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Operative hysteroscopy is a common gynecologic procedure, but it carries the risk of complications. Spontaneous small intestine perforation is rare and fatal, especially in young adults. We present a spontaneous small intestine perforation after operative hysteroscopy with mimicking sign of uterine perforation after operation hysteroscopy. CASE REPORT A 30-year-old nulligravida woman underwent Truclear® hysteroscopic polypectomy in the morning in LMD. She suffered from upper abdominal pain in the afternoon. Subsequently, progressive abdominal distention and imminent shock occurred the next morning. Initially, it was supposed to be a case of uterine rupture with internal bleeding. She was transferred to the emergency department of our hospital. Complete biochemistry data and abdominal CT were performed. The CT revealed pneumoperitoneum and ascites. Emergent laparoscopy was arranged. The abdominal cavity was full of intestinal fluid and the myomatous uterus was intact. The surgeon performed a laparotomy, two sites of spontaneous perforation of the small intestine were detected. The patient underwent laparotomic segmental resection and anastomosis and was discharged 14 days after surgery without incident. CONCLUSIONS The risk of uterine perforation during hysteroscopy is up to 1.6%. The use of non-thermal intrauterine morcellator device (Truclear®) has been shown to significantly reduce the risk of perforation and thermal injury. As this case highlights, we suspected the possibility of uterine perforation immediately after hysteroscopic surgery. However, it happened to be rare spontaneous perforation of small bowel. The patient recovered well after timely transfer and management. Hysteroscopy is a very common procedure in gynecologic clinics, but even relatively safe intrauterine morcellator devices carry risk of complications. As a healthcare provider, we should beware of any comorbidity, for sometimes it would be catastrophic.
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Affiliation(s)
- I-Le Hsu
- Department of Gynecology and Obstetrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Po-Jung Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Yu-Chung Hsu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Eing-Mei Tsai
- Department of Gynecology and Obstetrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Jadhav P, Choi PM, Gollin G. Percutaneous Pigtail Catheter Drainage of Spontaneous Intestinal Perforation in Premature Infants. J Surg Res 2023; 291:265-269. [PMID: 37480754 DOI: 10.1016/j.jss.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Peritoneal drainage is an established management strategy for spontaneous intestinal perforation (SIP) in premature infants. We sought to evaluate the safety and efficacy of percutaneous pigtail catheter placement as an alternative to drain insertion via a lower quadrant incision. METHODS Patients less than 32 weeks gestational age who underwent peritoneal drain placement for SIP at two neonatal intensive care units between 2011 and 2022 were identified. Incisional drainage (ID) or percutaneous pigtail catheter drainage (PD) was used based upon the usual practices of the surgeons. ID (n = 19) was performed via a 5-mm right lower quadrant incision into which a one-fourth-inch Penrose or red rubber catheter was placed. PD (n = 18) was accomplished using a Seldinger technique by which a 6.0 or 8.5 F pigtail catheter was passed through the left lower quadrant. Demographics and physiological parameters at the time of drainage were recorded and short-term and long-term outcomes were evaluated. RESULTS Thirty seven infants were identified. There were no differences in demographics or physiological derangement between the groups. Patients who underwent ID had more frequent stool drainage, a greater transfusion requirement, and a longer time to full feedings (60.6 v 37.7 d, P = 0.04). Incisional hernias (n = 3, 16%) only developed after ID. The duration of drain placement, length of stay, and time to resolution of pneumoperitoneum were similar with ID and PD as was the incidence of premature drain dislodgement and subsequent laparotomy. CONCLUSIONS Percutaneous drain placement provided effective drainage in infants with SIP and was associated with more rapid feeding advancement and no incidence of incisional hernia.
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Affiliation(s)
- Priyanka Jadhav
- University of California San Diego, School of Medicine, San Diego, California
| | | | - Gerald Gollin
- University of California San Diego, School of Medicine, San Diego, California; Rady Children's Hospital, San Diego, California.
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Vaucel JA, Recher M, Paradis C, Labadie M, Courtois A, Michaud L, Petyt C, Guimber D, Tournoud C, Enaud R, Nisse P. Severe post-pyloric injury after button battery ingestion: Systematic literature review and case report. Arch Pediatr 2023; 30:501-504. [PMID: 37394366 DOI: 10.1016/j.arcped.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/04/2023] [Accepted: 05/21/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The health and safety hazards related to button batteries (BB) have been extensively studied, highlighting that the presence of a button battery in the esophagus is a life-threatening emergency. However, complications related to bowel BB are poorly evaluated and not well known. The objective of this review of the literature was to describe severe cases of BB that have passed the pylorus. CASE REPORT This case, from the PilBouTox cohort, is the first report of small-bowel occlusion following ingestion of an LR44 BB (diameter: 11.4 mm) by a 7-month-old infant with a history of intestinal resections. In this case, the BB was ingested without a witness. The initial presentation mimicked acute gastroenteritis evolving into hypovolemic shock. An X-ray revealed a foreign body stuck in the small bowel causing an intestinal occlusion and local necrosis without perforation. The patient's history of intestinal stenosis and intestinal surgery were the contributing factor of impaction. SYSTEMATIC LITERATURE REVIEW The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was conducted on September 12, 2022 through five database and the U.S. Poison Control Center website. An additional 12 severe cases of intestinal or colonic injury after ingestion of a single BB were identified. Of these, 11 were related to small BBs (< 15 mm) that impacted Meckel's diverticulum and one was related to postoperative stenosis. CONCLUSION In view of the findings, the indications for digestive endoscopy for extraction of a BB in the stomach should include a history of intestinal stenosis or intestinal surgery so as to avoid delayed intestinal perforation or occlusion and prolonged hospitalization.
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Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France.
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Camille Paradis
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Magali Labadie
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Arnaud Courtois
- Centre Antipoison de Bordeaux (Bordeaux Poison Control Center), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Laurent Michaud
- Services des urgences pédiatriques (Pediatric Emergency care], Lille University Hospital, Lille 59000, France
| | - Caroline Petyt
- Service de chirurgie digestive (Department of Digestive Surgery), Lille University Hospital, Lille 59000, France
| | - Dominique Guimber
- Service de gastro-enterologie, hépatologie et nutrition pédiatrique (Department of Pediatric Gastroenterology, Hepatology and Nutrition), Lille University Hospital, Lille 59000, France
| | - Christine Tournoud
- Centre Antipoison de Nancy (Nancy Poison Control Center), Nancy University Hospital, Nancy 54000, France
| | - Raphael Enaud
- Service de gastro-enterologie, hépatologie et nutrition pédiatrique (Department of Pediatric Gastroenterology, Hepatology and Nutrition), Bordeaux University Hospital, Bordeaux Cedex 33076, France
| | - Patrick Nisse
- Centre Antipoison de Lille (Lille Poison Control Center), Lille University Hospital, Lille 59000, France
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Liu G, Chen T, Song X, Chen B, Kang Q. Case report: a case report and literature analysis on intestinal tuberculosis intestinal perforation complicated by umbilical intestinal fistula and bladder ileal fistula. BMC Infect Dis 2023; 23:559. [PMID: 37641023 PMCID: PMC10464473 DOI: 10.1186/s12879-023-08550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Intestinal tuberculosis is a chronic and specific infection caused by Mycobacterium tuberculosis invading the intestine. Due to the nonspecific clinical presentation, it is stressed that intestinal perforation complicates umbilical intestinal fistula and bladder ileal fistula is very rare and extremely difficult to be diagnosed. It is significant to identify the disease and take urgent intervene in the early stage. CASE PRESENTATION An 18-month-old boy patient presented with abdominal pain. Abdominal CT suggested abscess formation in the right lower abdomen and pelvis. The patient underwent resection of necrotic and stenotic intestinal segments with the creation of an ileostomy, cystostomy and vesicoureteral fistula repair for the presence of intestinal perforation complicated by vesicoureteral fistula and umbilical enterocutaneous fistula. Histopathology confirmed the intestinal tuberculosis. The patient was discharged successfully after 11 days post anti-tuberculosis treatment. CONCLUSION Our case report here is a rare case of umbilical intestinal fistula with bladder ileal fistula secondary to intestinal perforation from intestinal tuberculosis. The purpose of this report is to make the surgical community aware of atypical presentations of intestinal tuberculosis. If our peers encounter the similar situation, they can be prepared for corresponding diagnosis and treatment.
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Affiliation(s)
- Guobin Liu
- Department of General Surgery and Trauma Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Tianyan Chen
- Department of General Surgery and Trauma Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Xiaofeng Song
- Department of General Surgery and Trauma Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Bolin Chen
- Department of General Surgery and Trauma Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China
| | - Quan Kang
- Department of General Surgery and Trauma Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 400014, Chongqing, China.
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19
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Reynard ME, Strati TM, Egger B. Small intestinal perforation secondary to metastasis from skin squamous cell carcinoma: A case report and literature review. Int J Surg Case Rep 2023; 109:108599. [PMID: 37544098 PMCID: PMC10423921 DOI: 10.1016/j.ijscr.2023.108599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary and metastatic carcinoma of the small intestine are rare. While most of these malignancies are adenocarcinomas, squamous cell carcinoma (SCC) of the gastrointestinal tract is uncommon. We present a case report of a rare occurrence of skin SCC metastasizing to the ileum, highlighting diagnostic challenges and clinical implications. CASE PRESENTATION An 83-year-old female had a history of cutaneous SCC excision in the right temporal region two years prior to the current emergency department visit, followed by metastatic recurrence in a right intra-parotid lymph node treated with radiotherapy. The patient exhibited septic shock and an acute abdomen, and an abdominal computed tomography scan revealed signs of intestinal perforation. Emergency exploratory laparotomy confirmed purulent peritonitis and perforation of the terminal ileum. Subsequently, a 20 cm intestinal resection was performed. Histopathological examination of the resected specimen revealed a 4 cm perforated SCC of the small intestine (pT4 pN0 L0 V1 Pn0 R0). CLINICAL DISCUSSION Metastases of the small intestine are rare. The primary sites for these metastases are typically the uterus, cervix, colon, lung, breast, or melanoma. SCC of the small intestine is particularly rare and poses challenges in diagnosis owing to non-specific symptoms. The prognosis for SCC of the small intestine is generally poor, and the potentially aggressive behavior of some skin SCC emphasizes the need for increased awareness and vigilance in managing such cases. CONCLUSION This case report underscores the importance of considering metastatic disease in the small bowel of patients with a history of skin SCC who present with new-onset abdominal symptoms.
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Affiliation(s)
- Maxence Emmanuel Reynard
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Switzerland
| | - Titika-Marina Strati
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Switzerland.
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Gweon TG, Yang DH. Management of complications related to colorectal endoscopic submucosal dissection. Clin Endosc 2023; 56:423-432. [PMID: 37501624 PMCID: PMC10393575 DOI: 10.5946/ce.2023.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.
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Affiliation(s)
- Tae-Geun Gweon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Vargova P, Abecia Martinez EI, Escartín Villacampa R, Ruiz de Temiño Bravo M, Del Valle Sanchez E, Bragagnini Rodriguez P. Segmental absence of intestinal musculature in newborn: Case report. Int J Surg Case Rep 2023; 108:108424. [PMID: 37390581 PMCID: PMC10382769 DOI: 10.1016/j.ijscr.2023.108424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Segmental absence of the muscularis propria intestinalis (SAIM) is a rare pathology characterized by a partial or complete absence of the intestinal musculature. Diagnosis requires histological confirmation, and treatment includes urgent laparotomy, resection of affected areas, and end-to-end anastomosis or creation of stomas. The work has been reported in line with the SCARE guideline criteria. CASE REPORT We present the case of a 31-week preterm newborn with prenatal diagnosis of polyhydramnios and non-immune fetal ascites. Radiological tests confirmed meconium peritonitis, and laparotomy was indicated. The patient had a torpid postoperative course requiring multiple surgeries due to intestinal occlusion and leakage of the anastomosis. Finally, he was discharged with good oral tolerance and bowel function. The anatomopathological examination reported the congenital absence of intestinal muscle with segmental and multifocal distribution. CLINICAL DISCUSSION Most neonatal cases share similar clinical features, and if SAIM is suspected during surgery, the suspicious areas should be resected to prevent future complications. The prognosis depends on the extent of the lesion, possibility of resecting affected segments, and concomitant pathologies. CONCLUSION In conclusion, this study aims to describe SAIM based on a clinical case and review of the literature. SAIM is a rare pathology that requires prompt diagnosis and treatment to prevent complications. Surgeons should consider resecting suspicious areas during surgery to prevent future complications.
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Affiliation(s)
- Paulina Vargova
- Department of Pediatric Surgery, Hospital Miguel Servet, Spain.
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22
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Ogawa K, Shiraishi Y, Karashima R, Nitta H, Masuda T, Matsumoto K, Sawayama H, Miyamoto Y, Baba H, Takamori H. Prolonged door-to-antibiotics time is associated with high hospital mortality in patients with perforated colorectal peritonitis. Langenbecks Arch Surg 2023; 408:220. [PMID: 37261545 DOI: 10.1007/s00423-023-02966-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Colorectal perforation is a fatal disease that presents with generalized peritonitis, leading to sepsis and septic shock. Recently, the association between prolonged door-to-antibiotics time and increased mortality in sepsis has been widely reported. In this study, we investigated the prognostic impact of a prolonged door-to-antibiotics time in patients with perforated colorectal peritonitis undergoing emergency surgery. METHODS This retrospective study included 93 patients with perforated colorectal peritonitis who underwent emergency surgery at our institution between April 2015 and August 2019. Patients were divided into two groups depending on the door-to-antibiotics time (< 162 min or ≥ 162 min). The primary outcome was in-hospital mortality. The secondary outcomes were the length of hospital stay and severe complication rate. The logistic regression analysis was used to estimate the odds ratio for in-hospital mortality. RESULTS We identified 38 patients who presented with an extended door-to-antibiotics time (≥ 162 min) and 55 patients who presented with a shortened door-to-antibiotics time (< 162 min). We found a strong association between the door-to-antibiotics time ≥ 162 min and in-hospital mortality. There were no significant differences between the two groups regarding the length of hospital stay and postoperative complication rate. However, in multivariate analysis, extended door-to-antibiotics time was an independent prognostic factor for in-hospital mortality (odds ratio = 244; 95% confidence interval, 11 -23,885). CONCLUSION A prolonged door-to-antibiotics time (≥ 162 min) worsened hospital mortality rates in patients with perforated colorectal peritonitis.
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Affiliation(s)
- Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Yuta Shiraishi
- Department of Gastroenterological Surgery, Graduate School of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | | | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Toshiro Masuda
- Division of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | | | - Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
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Horino T, Miyamoto Y, Ohuchi M, Ogawa K, Yoshida N, Ishiko T, Kukinaka C, Sasaki R, Ohba T, Baba H. Repeated intestinal perforations in vascular Ehlers-Danlos syndrome: a case report of a novel mutation in the COL3A1 gene. Surg Case Rep 2023; 9:78. [PMID: 37171638 PMCID: PMC10182206 DOI: 10.1186/s40792-023-01643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Ehlers-Danlos syndrome is an inherited connective-tissue disorder characterized by skin hyperextensibility, joint hypermobility, and tissue fragility. Intestinal perforation is one of the fatal manifestations of this syndrome, and its management is complicated. CASE PRESENTATION A 58-year-old woman with a familial history of Ehlers-Danlos syndrome visited the emergency department due to a sudden onset of lower abdominal pain. Plain abdominal computed tomography showed abdominal free air. We found a perforated descending colon and subsequently resected this lesion and performed ileostomy. Fifty-one days after this first operation, the patient had transverse colon perforation and thus underwent the Hartmann procedure as the second operation. In addition, she was diagnosed with small bowel perforation 53 days after the first operation and consequently underwent a third operation-partial resection of the jejunum with functional end-to-end anastomosis. Fifty-eight days after the first operation, she complained of acute abdominal pain. Plain abdominal computed tomography showed fluid collection near the jejunojejunal anastomosis. We detected dehiscence at the entry hole of the linear stapler during the operation and thus performed partial resection of the affected jejunum, followed by jejunostomy. The postoperative course of the fourth operation was uneventful. Genetic testing revealed a novel missense mutation (c.2095G>T, p.Gly699Cys) in the COL3A1 gene, which is presumed to be a pathogenic variant of vascular Ehlers-Danlos syndrome. CONCLUSION Vascular Ehlers-Danlos syndrome should be considered in the case of repeated intestinal perforation. The identified missense mutation in the COL3A1 gene (c.2095G>T, p.Gly699Cys) might be a novel pathogenic variation causing vascular Ehlers-Danlos syndrome. Careful postoperative screening and multidisciplinary management are required.
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Affiliation(s)
- Taichi Horino
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Mayuko Ohuchi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Takatoshi Ishiko
- Department of Gastroenterological Surgery, Kumamoto Kenhoku Hospital, Tamana, Kumamoto, Japan
| | - Chieko Kukinaka
- Department of "Development of Nursing Practice", Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Rumi Sasaki
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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24
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Barila P, Molino JA, Hidalgo E, Quintero J, Juampérez J, Mercadal-Hally M, Ortega J, Bilbao I, Charco R. Intestinal perforation after pediatric liver transplantation: risk factors and management. Cir Pediatr 2023; 36:73-77. [PMID: 37093116 DOI: 10.54847/cp.2023.02.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Intestinal perforation (IP) after pediatric liver transplant (PLT) is an uncommon complication with high mortality reported. The aim of this study is to identify the risk factors and management of this complication. MATERIALS AND METHODS Retrospective study of IP after PLT from January 2014 to October 2020. RESULTS Four intestinal perforations were indentificated in 102 PLT (3,9%). Three patients with BA and one neonate with hemochromatosis (HC) presented this complication. The mean weight of patients with IP was 6.3± 2.5kg (3.1-9) and 19.9 ± 15.4kg for the rest (p< 0.05). All IP with BA had a previous laparotomy. Two living donors and two left lateral reduced liver were implanted. The diagnosis of intestinal perforation was done on day 11 ± 3.3 (8-15 days). Diagnosis was suspected with clinical and biological signs of perforation, CT scan confirmed the diagnosis in patiens with BA and by direct visualization through the mesh for temporary closure in the patient with hemocromatosis. Urgent laparotomy was performed. We identified three colonic perforations, all of them in BA patients and all repaired with direct suture. The patient with HC presented multiple perforations secondary to necrotizing enterocolitis requiring an ileostomy and finally died due to multiorgan failure. CONCLUSION Intestinal perforation after PLT is an infrequent complication. Age, weight, previous laparotomy and BA could be risk factors for IP in PLT. Urgent laparotomy after diagnosis should be performed in order to reduce mortality. Isolated IP with adequate treatment might not affect long term outcomes after pediatric liver transplantation.
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Affiliation(s)
- P Barila
- Pediatric Surgery and Urology Department. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - J A Molino
- Pediatric Surgery and Urology Department. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - E Hidalgo
- HBP Surgery and Transplants Department. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - J Quintero
- Pediatric Hepatology and Liver Transplant Unit. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - J Juampérez
- Pediatric Hepatology and Liver Transplant Unit. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - M Mercadal-Hally
- Pediatric Hepatology and Liver Transplant Unit. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - J Ortega
- Pediatric Intensive Care Unit. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - I Bilbao
- HBP Surgery and Transplants Department. Vall d'Hebron Hospital Campus. Barcelona (Spain)
| | - R Charco
- HBP Surgery and Transplants Department. Vall d'Hebron Hospital Campus. Barcelona (Spain)
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Khan A, Eldos Y, Alansari K. Clinical Presentation and Outcome of Multiple Rare Earth Magnet Ingestions in Children of Qatar. A Single-Center Experience. Qatar Med J 2023; 2023:9. [PMID: 36846273 PMCID: PMC9943907 DOI: 10.5339/qmj.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/08/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Rare earth magnets are powerful magnets that can have several negative effects if ingested. The goal of our study is to describe the result of multiple rare earth magnets ingested by children in Qatar. MATERIALS AND METHODS This is observational research. We conducted a retrospective chart review and descriptive analysis of all cases of multiple rare earth magnetic ingestion that werepresented to the Emergency Department of Sidra Medicine between January 2018 and July 2022. We obtained an exemption for this study from our institutional review board (IRB). RESULTS In our research, we identified 21 children having multiple rare earth magnetic ingestions. The predominant symptoms were abdominal pain and vomiting which were observed in 57% (n = 12) and 48% (n = 10) of the patients respectively. The most common sign was abdominal tenderness,observed in 14% (n = 3) of the patients. In our sample, 38% (n = 8) of the patients were managed conservatively whereas 62% (n = 13) needed intervention. In our study, 48% (n = 10) of the patients sustained complications. The frequent complications were intestinal perforation appreciated in 24% (n = 5) and intestinal perforation with fistula formation in 19% (n = 4) of the patients. The median age of these patients was two years while the median number of magnets ingested was six. The ingestions were unwitnessed, and the duration of ingestions was unknowninthemajorityofpatientswhoexperiencedcomplications (n = 8/10). CONCLUSION If numerous rare earth magnetis ingested, children are in high danger of harm. It can be difficult to pinpoint the cases in younger children due to poor communication skills, especially if the intake is unreported. Although Qatar has established restrictions banning the import of rare earth magnets, there are reported cases of children with rare earth magnets ingestions.
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Affiliation(s)
- Abdullah Khan
- Sidra Medical and Research Center. E-mail: ORCID ID is 0000-0003-4314-5202
| | - Yazeed Eldos
- Sidra Medical and Research Center. E-mail: ORCID ID is 0000-0003-4314-5202
| | - Khalid Alansari
- Sidra Medical and Research Center. E-mail: ORCID ID is 0000-0003-4314-5202
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von Kroge PH, Duprée A, Mann O, Izbicki JR, Wagner J, Ahmadi P, Weidemann S, Adjallé R, Kröger N, Bokemeyer C, Fiedler W, Modemann F, Ghandili S. Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis. World J Emerg Surg 2023; 18:12. [PMID: 36747231 PMCID: PMC9900956 DOI: 10.1186/s13017-023-00481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear. METHODS We here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame. RESULTS A total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%. CONCLUSION In patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.
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Affiliation(s)
- Philipp H. von Kroge
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anna Duprée
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Oliver Mann
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jakob R. Izbicki
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jonas Wagner
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Paymon Ahmadi
- grid.13648.380000 0001 2180 3484Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sören Weidemann
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Raissa Adjallé
- grid.13648.380000 0001 2180 3484Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Nicolaus Kröger
- grid.13648.380000 0001 2180 3484Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Carsten Bokemeyer
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Walter Fiedler
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Franziska Modemann
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany ,grid.13648.380000 0001 2180 3484Mildred Scheel Cancer Career Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Susanne Ghandili
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Nakayama Y, Sawa N, Suwabe T, Sekine A, Yamanouchi M, Ikuma D, Mizuno H, Oba Y, Hasegawa E, Hoshino J, Matoba S, Ubara Y. Development of an enterocutaneous fistula from an intestinal perforation in a patient with autosomal dominant polycystic kidney disease. CEN Case Rep 2023; 12:45-49. [PMID: 35789990 PMCID: PMC9892373 DOI: 10.1007/s13730-022-00716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
We herein report a case of enterocutaneous fistula in a patient with autosomal dominant polycystic kidney disease (ADPKD). A 37-year-old Japanese man was admitted to our hospital. Three months prior to transfer to our hospital, he developed intense flank pain with gross hematuria. His serum creatinine had decreased to 7.8 mg/dL and hemodialysis was started, but gross hematuria persisted and he developed hypotension. Upon admission, plain chest radiography did not reveal any free air, but computed tomography (CT) showed generalized ventral subcutaneous air from the head to the lower extremities and enlarged kidneys. Enterography showed leakage of contrast medium from the descending colon into the subcutaneous area. C-reactive protein was 23.1 mg/dL. A colostomy was placed in the transverse colon proximal to the perforation, and systemic subcutaneous drainage was performed. The fever subsequently resolved, and the C-reactive protein test became negative. Three months later, renal artery embolization was performed, and 12 months thereafter, CT showed a marked decrease in kidney size. We assume that a markedly enlarged kidney leaded to intestinal perforation, which developed into an enterocutaneous fistula. Consequently, intestinal fluid leaked into the subcutaneous cavity of the abdominal wall and spread systemically, resulting in extensive subcutaneous abscesses.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Daisuke Ikuma
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Yuki Oba
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Shuichiro Matoba
- Department of Gastrointestinal Surgery, Toranomon Hosipital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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28
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Nematihonar B, Kouchak Hosseini SP, Haghbin Toutounchi A. Taenia saginata, the incidental find in case of intestinal perforation after blunt trauma and literature review. Int J Surg Case Rep 2023; 103:107909. [PMID: 36709698 PMCID: PMC9900391 DOI: 10.1016/j.ijscr.2023.107909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/10/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Taenia saginata (T. saginata) is one of the most common cestodes in humans. Isolated perforation of the small bowel after blunt abdominal trauma is infrequent and the diagnosis should be based on exclusion. CASE PRESENTATION We report a case of a 34-year-old man who presented following a car-pedestrian accident. Clinical examinations and symptoms suggested an acute abdomen. Investigations led to the diagnosis of hollow viscus perforation, so emergency laparotomy was performed. At the exploration of peritoneal cavity, unexpectedly, a live tapeworm was found in the peritoneal cavity. The perforation was repaired and medication were continued by anthelmintic. He was discharged with good condition. CLINICAL DISCUSSION We discuss this rare incidental finding in a patient with bowel perforation and suggest the taeniasis as a possible cause of intestinal perforation. The medical literature and reviews have been searched to find more information about taeniasis and its cause-effect in GI tract complications. CONCLUSION Increasing the public knowledge about food hygiene and encouraging eat well-cooked meat can control the cycle of transmission of cestodes. Taeniasis should be considered a possible cause of intestinal obstruction or perforation, especially in endemic areas.
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Affiliation(s)
- Behzad Nematihonar
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of medical sciences, Tehran, Iran.
| | - Seyed Pedram Kouchak Hosseini
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of medical sciences, Tehran, Iran.
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of medical sciences, Tehran, Iran.
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Jung K, Woo SY, Kim AR, Kim H. Upper gastrointestinal tract perforation assessed by contrast-enhanced ultrasonography after oral Sonazoid administration in a stomach leakage mouse model. Ultrasonography 2023; 42:297-306. [PMID: 36935594 PMCID: PMC10071069 DOI: 10.14366/usg.22192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/03/2023] [Indexed: 03/21/2023] Open
Abstract
PURPOSE The purpose of this study was to elucidate whether contrast-enhanced ultrasonography (CEUS) can visualize orally administered Sonazoid leaking into the peritoneal cavity in a postoperative stomach leakage mouse model. METHODS Adult female mice (n=33, 9-10 weeks old) were used. Preoperative CEUS was performed after delivering Sonazoid via intraperitoneal injection and the per oral route. A gastric leakage model was then generated by making a surgical incision of about 0.5 cm at the stomach wall, and CEUS with per oral Sonazoid administration was performed. A region of interest was drawn on the CEUS images and the signal intensity was quantitatively measured. Statistical analysis was performed using a mixed model to compare the signal intensity sampled from the pre-contrast images with those of the post-contrast images obtained at different time points. RESULTS CEUS after Sonazoid intraperitoneal injection in normal mice and after oral administration in mice with gastric perforation visualized the contrast medium spreading within the liver interlobar fissures continuous to the peritoneal cavity. A quantitative analysis showed that in the mice with gastric perforation, the orally delivered Sonazoid leaking into the peritoneal cavity induced a statistically significant (P<0.05) increase in signal intensity in all CEUS images obtained 10 seconds or longer after contrast delivery. However, enhancement was not observed before gastric perforation surgery (P=0.167). CONCLUSION CEUS with oral Sonazoid administration efficiently visualized the contrast medium spreading within the peritoneal cavity in a postoperative stomach leakage mouse model.
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Affiliation(s)
- Kyuhwan Jung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sook-Young Woo
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - A Ran Kim
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Honsoul Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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Asano H, Fukano H, Takagi M, Takayama T. Risk factors for the recurrence of stage II perforated colorectal cancer: A retrospective observational study. Asian J Surg 2023; 46:201-206. [PMID: 35331590 DOI: 10.1016/j.asjsur.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with perforated colorectal cancer (PCRC) experience higher recurrence rates than those with non-perforated tissue. We identified the promoting factors of stage II PCRC recurrence after R0 surgery. METHOD This retrospective observational study included patients treated for colorectal cancer at a single facility between 2007 and 2016, and compared the clinicopathological features of patients with perforating versus non-perforating stage II tumors who underwent R0 resection, while focusing on recurrences. RESULTS Thirty-two and 112 patients (predominantly men) with perforating and non-perforating tumors, respectively, were included. The perforated group had significantly higher proportions of T4 tumors than the non-perforated group (44% vs. 15%). The perforated group had significantly lower numbers of resected lymph nodes than the non-perforated group (6 vs. 17). Seven of 17 patients with follow-up data in the perforated group experienced recurrence (41%), versus 19 of 104 in the non-perforated group (18%). In the non-perforated group, male sex (89% vs. 60%, p = 0.030), T4 stage (32% vs. 9%, p = 0.029), and fewer resected lymph nodes (12.5 vs. 18.6, p = 0.003) were significantly associated with recurrence; however, no such influences on recurrence were observed in the perforated group. The recurrence sites in the perforated group were mostly local (6 patients, 86%). Conversely, recurrences in the non-perforated group were mostly distant; 8 of 19 patients (42%) had liver metastasis and 1 (5%) had lung metastasis. CONCLUSION Patients with stage II PCRC experienced higher recurrence rates regardless of clinicopathological features and had high local recurrence rates indicating possible local tumor cell dispersal owing to perforation.
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Affiliation(s)
- Hiroshi Asano
- Saitama Medical University, Department of General Surgery, Japan.
| | - Hiroyuki Fukano
- Saitama Medical University, Department of General Surgery, Japan
| | - Makoto Takagi
- Saitama Medical University, Department of General Surgery, Japan
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Wang RC, Chen BJ, Yuan CT, Ho CH, Chuang WY, Chen SW, Chang JH, Yu WH, Chuang SS. The spectrum of intestinal mature T- and NK-cell neoplasms in a tertiary center in Taiwan with a high frequency of perforation. Pathol Res Pract 2022; 240:154184. [PMID: 36327820 DOI: 10.1016/j.prp.2022.154184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Primary intestinal T-cell lymphomas (PITLs) comprise enteropathy-associated T-cell lymphoma (EATL), monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), extranodal NK/T-cell lymphoma (ENKTL), anaplastic large cell lymphoma (ALCL), and intestinal T cell lymphoma, NOS (ITCL-NOS). MEITL is composed of monomorphic medium cells expressing CD8 and CD56, with a cytotoxic phenotype. We retrospectively analyzed 77 cases of intestinal T-cell lymphomas, 71 primary and six secondary, at a tertiary center in Taiwan from 2001 to 2021. Perforation occurred in 57 (74%) patients, including 56 (73%) at presentation and one after chemotherapy. The primary cases included MEITL (68%), ENKTL (14%), ITCL-NOS (13%), ALCL (4%), and EATL (1%). The perforation rate was 90%, 70%, and 22% in MEITL, ENKTL, and ITCL-NOS cases, respectively (p < 0.0001, Fisher's exact test). Most (75%; n = 36) MEITL cases were typical; while seven (15%) had atypical morphology and five (10%) exhibited atypical immunophenotype. The tumor cells of ITCL-NOS were pleomorphic, with various expression of CD8 or CD56. All METIL, ITCL-NOS and ALCL cases were negative for EBER; while all ENKTL cases, either primary or secondary, were positive for cytotoxic granules and EBER. The prognosis of PITL was poor, with a medium survival of 7.0, 3.3, and 3.7 months among patients with MEITL, ENKTL, and ITCL-NOS, respectively. Of the six secondary cases, the primary tumors orginated from nasal ENKTL (n = 5) and cutaneous PTCL-NOS (n = 1). We showed a wide spectrum of intestinal T-cell lymphomas in Taiwan, with MEITL as the most common PITL, a high rate of perforation, and a wider morphological and immunophenotypic spectrum.
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Affiliation(s)
- Ren Ching Wang
- Department of Pathology, China Medical University Hospital and Department of Nursing, College of Nursing, HungKuang University, Taichung, Taiwan
| | - Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City and Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chang-Tsu Yuan
- Department of Pathology, National Taiwan University Cancer Center, Taipei, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, and Departments of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, and Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Wen-Yu Chuang
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University; School of Medicine and Chang Gung Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Wen Chen
- Division of Hemato-Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Lioying, Tainan, Taiwan
| | | | | | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.
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Yoshida BY, Araujo RLC, Farah JFM, Goldenberg A. Is it possible to adopt the same oncological approach in urgent surgery for colon cancer? World J Clin Oncol 2022; 13:896-906. [PMID: 36483972 PMCID: PMC9724181 DOI: 10.5306/wjco.v13.i11.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/16/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Locoregional complications may occur in up to 30% of patients with colon cancer. As they are frequent events in the natural history of this disease, there should be a concern in offering an oncologically adequate surgical treatment to these patients.
AIM To compare the oncological radicality of surgery for colon cancer between urgent and elective cases.
METHODS One-hundred and eighty-nine consecutive patients with non-metastatic colon adenocarcinoma were studied over two years in a single institution, who underwent surgical resection as the first therapeutic approach, with 123 elective and 66 urgent cases. The assessment of oncological radicality was performed by analyzing the extension of the longitudinal margins of resection, the number of resected lymph nodes, and the percentage of surgeries with 12 or more resected lymph nodes. Other clinicopathological variables were compared between the two groups in terms of sex, age, tumor location, type of urgency, surgical access, staging, compromised lymph nodes rate, differentiation grade, angiolymphatic and perineural invasion, and early mortality.
RESULTS There was no difference between the elective and urgency group concerning the longitudinal margin of resection (average of 6.1 in elective vs 7.3 cm in urgency, P = 0.144), number of resected lymph nodes (average of 17.7 in elective vs 16.6 in urgency, P = 0.355) and percentage of surgeries with 12 or more resected lymph nodes (75.6% in elective vs 77.3% in urgency, P = 0.798). It was observed that the percentage of patients aged 80 and over was higher in the urgency group (13.0% in elective vs 25.8% in urgency, P = 0.028), and the early mortality was 4.9% in elective vs 15.2% in urgency (P = 0.016, OR: 3.48, 95%CI: 1.21–10.06). Tumor location (P = 0.004), surgery performed (P = 0.016) and surgical access (P < 0.001) were also different between the two groups. There was no difference in other clinicopathological variables studied.
CONCLUSION Oncological radicality of colon cancer surgery may be achieved in both emergency and elective procedures.
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Affiliation(s)
- Bruno Yuki Yoshida
- Department of Surgery, Federal University of Sao Paulo, Sao Paulo 04024-002, Sao Paulo, Brazil
- Department of General and Oncological Surgery, Sao Paulo State Employee Hospital, Sao Paulo 04029-000, Sao Paulo, Brazil
| | - Raphael L C Araujo
- Department of Surgery, Federal University of Sao Paulo, Sao Paulo 04024-002, Sao Paulo, Brazil
| | - José Francisco M Farah
- Department of Surgery, Federal University of Sao Paulo, Sao Paulo 04024-002, Sao Paulo, Brazil
- Department of General and Oncological Surgery, Sao Paulo State Employee Hospital, Sao Paulo 04029-000, Sao Paulo, Brazil
| | - Alberto Goldenberg
- Department of Surgery, Federal University of Sao Paulo, Sao Paulo 04024-002, Sao Paulo, Brazil
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Nakamura H. [A case of bacterial meningitis due to colon perforation of V-P shunt tube in an elderly patient with prolonged high fever after hospitalization for urinary tract infection]. Nihon Ronen Igakkai Zasshi 2022; 59:551-558. [PMID: 36476704 DOI: 10.3143/geriatrics.59.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An 86-year-old woman who had received a V-P shunt for subarachnoid hemorrhage 23 years previously presented to the emergency room with a chief complaint of fever. The diagnosis on admission was urinary tract infection, and treatment with CMZ was started. Abdominal CT scan on admission revealed that the V-P shunt had penetrated the ascending colon; however, because there were no clinical symptoms or imaging findings suggestive of peritonitis or meningitis, the V-P shunt was not initially considered to be related to the fever. However, since the fever in the 39°C range persisted for a week despite a urine culture showing susceptible Escherichia coli, a spinal fluid examination was performed on the assumption of meningitis caused by the V-P shunt. We found elevated cell counts in the CSF and diagnosed the patient with bacterial meningitis. After shunt removal surgery was performed, the patient quickly recovered from fever. Later, Pseudomonas aeruginosa was detected at the shunt tube and in the CSF, and CFPM was administered continuously. The patient was discharged with good progress.A review of the relevant literature revealed that half of the patients with a V-P shunt penetrating the intestinal tract will pass asymptomatically and are unlikely to develop peritonitis, while half of the patients may develop meningitis. In addition, if there is an artifact in the body, it is always necessary to consider the possibility that it may be the source of infection.
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Betalli P, Cheli M, Colusso MM, Casotti V, Alberti D, Ferrari A, Starita G, Lucianetti A, Pinelli D, Colledan M, D'Antiga L. Association between Kasai portoenterostomy at low caseload centres and transplant complications in children with biliary atresia. J Pediatr Surg 2022; 57:223-228. [PMID: 35063251 DOI: 10.1016/j.jpedsurg.2021.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/09/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Kasai portoenterostomy (KPE) is the preferred treatment for biliary atresia (BA) patients. It has been shown that the center caseload of KPE impacts on native liver survival. We aimed to define the impact of KPE caseload on complications at the time of liver transplantation (LT). METHODS Retrospective data collection of LT for BA performed in our tertiary center between 2010 and 2018. The patients were grouped according to the caseload of the center that performed KPE: Group A (≥5 KPE/year) and Group B (<5 KPE/year). We analyzed total transplant time (TTT), hepatectomy time, amount of plasma and red blood cell (RBC) transfusions, occurrence of bowel perforations at LT. RESULTS Among 115 patients, Group A (n 44) and Group B (n 71) were comparable for age, sex, PELD score, TTT. The groups differed for: median hepatectomy time (57 min, IQR = 50-67; vs 65, IQR 55-89, p = 0.045); RBC transfusions (95 ml, IQR 0-250; vs 200 ml, IQR 70-500, p = 0.017); bowel perforations (0/44 vs 15/71, p = 0.001). One-year graft loss in Group A vs Group B was 1/44 vs 7/71 (p = 0.239), whereas deaths were 0/44 vs 5/71 respectively (p = 0.183); 5/15 patients who had a perforation eventually lost the graft. CONCLUSIONS This study found an association between KPE performed in low caseload center and the incidence of complications at LT. These patients tend to have a worse outcome. The centralization of KPE to referral center represents an advantage at the time of LT. MINI ABSTRACT We studied the impact of Kasai portoenterostomy (KPE) caseload on complications at the time of liver transplantation (LT), in 115 patients. We found an association between KPE performed in low caseload center and increased bowel perforations and blood transfusions. We suggest to centralize to experienced center all children requiring KPE.
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Affiliation(s)
- Pietro Betalli
- Department of Paediatric Surgery, "Papa Giovanni XXIII" ASST, Piazza OMS1, Bergamo 24127, Italy.
| | - Maurizio Cheli
- Department of Paediatric Surgery, "Papa Giovanni XXIII" ASST, Piazza OMS1, Bergamo 24127, Italy
| | - Mara Marcella Colusso
- Department of Paediatric Surgery, "Papa Giovanni XXIII" ASST, Piazza OMS1, Bergamo 24127, Italy
| | - Valeria Casotti
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, "Papa Giovanni XXIII" ASST, Bergamo, Italy
| | - Daniele Alberti
- Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Alberto Ferrari
- From Research Foundation, "Papa Giovanni XXIII" ASST, Bergamo, Italy
| | - Giusy Starita
- Department of Anaesthesia, "Papa Giovanni XXIII" ASST, Bergamo, Italy
| | | | - Domenico Pinelli
- Department of Surgery III, "Papa Giovanni XXIII" ASST, Bergamo, Italy
| | - Michele Colledan
- Department of Surgery III, "Papa Giovanni XXIII" ASST, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, "Papa Giovanni XXIII" ASST, Bergamo, Italy
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Mittelstadt S, Stäbler A, Kolb M, Krämer B, Horvat H, Reisenauer C, Bachmann C. Acute endometriosis-related sigmoid perforation in pregnancy- case report. BMC Pregnancy Childbirth 2022; 22:647. [PMID: 35978302 PMCID: PMC9386915 DOI: 10.1186/s12884-022-04973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background An acute abdomen is an emergency that requires accurate diagnosis and prompt treatment. In pregnancy, the process is even more challenging and sometimes the radiological findings are unclear. Moreover, endometriosis- related complications are rare, especially in previously unknown endometriosis. Case presentation We report on a case of acute endometriosis-related sigmoid perforation during pregnancy (34 weeks of gestation) due to a previously unknown deep intestinal infiltrating endometriosis with focal ulceration of the affected colonic mucosa. Conclusions Despite the low relative risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).
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Affiliation(s)
- S Mittelstadt
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - A Stäbler
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, 72076, Tübingen, Germany
| | - M Kolb
- Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - B Krämer
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - H Horvat
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Reisenauer
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Bachmann
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
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Talwar A, Ahuja A, Phulware RH. Medullary carcinoma of jejunum presenting as perforation peritonitis: A case report. INDIAN J PATHOL MICR 2022; 65:679-682. [PMID: 35900501 DOI: 10.4103/ijpm.ijpm_576_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Small intestinal medullary carcinoma (MC) is a newly recognized subclass of small intestinal carcinomas and is an exceptional entity for this site. A search of the literature for similar cases arising in the small intestine revealed only six previously reported cases. Here we present a case of MC arising in the jejunum of a 65-year-old male. The patient presented to the emergency with features of perforation peritonitis with liver metastasis and no known predisposing factors like inflammatory bowel disease and celiac disease. Studies conducted on this tumor's colonic counterpart have shown microsatellite instability (MSI) and B-type Raf kinase (BRAF) mutations; however, few exceptions are known. Also, this subtype of carcinoma is known to have a better prognosis than its other histological subtypes.
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Affiliation(s)
- Amrita Talwar
- Department of Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), Ram Manohar Lohia Hospital (RML), New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS), Ram Manohar Lohia Hospital (RML), New Delhi, India
| | - Ravi H Phulware
- Deparment of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Jamali Z, Sinaei R, Estabragh ER, Ahangaran A. Sigmoid colon perforation in a SARS-CoV-2 positive neonate: a uniqueness report and a brief review. BMC Pediatr 2022; 22:327. [PMID: 35659271 PMCID: PMC9164322 DOI: 10.1186/s12887-022-03392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Despite the relative prevalence of small bowel and proximal colon perforation in the neonatal period, recto-sigmoid perforation is extremely rare. Full-term neonates experience intestinal perforation less frequently than premature infants. Here we report a neonate with sigmoid perforation and simultaneous Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. Case presentation A 2550 g female neonate born at 38-weeks’ gestation from a coronavirus disease-2019 (COVID-19) infected mother by cesarean section. Despite a good Apgar score in the first and fifth minutes, she was admitted to the neonatal intensive care unit with grunting and mild respiratory distress. She underwent antibiotics and oxygen by head box resulting in an Oxygen Saturation rate of 94%. The patients’ respiratory distress decreased during the second day, resulting once breastfeeding without tolerance. While she passed meconium in the first 2 days, she developed abdominal distention on day 3. The nasopharyngeal SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) was performed with positive results. Surgical consultation was requested and a thoraco-abdominal X-Ray was performed at this stage, which suspected to be a gastrointestinal perforation. Due to clinical deterioration and persistent abdominal distention, a contrast study was performed with water-soluble contrast, which confirmed intestinal perforation. However, the surgical exploration revealed perforation of the sigmoid colon at the posterior segment. The patient underwent antibiotic therapy, abdominal lavage, and colostomy, immediately. She was discharged in good condition approximately 14-days later. Conclusion To our knowledge, this is the first report of sigmoid colon perforation in a term neonate following COVID-19.
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Affiliation(s)
- Zahra Jamali
- Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Sinaei
- Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. .,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Elahe Raeisi Estabragh
- Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Ahangaran
- Department of Surgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Mu T, Feng H. Bilateral pneumothorax and pneumomediastinum during colonoscopy in a patient with intestinal Behcet’s disease: A case report. World J Clin Cases 2022; 10:2030-2035. [PMID: 35317145 PMCID: PMC8891770 DOI: 10.12998/wjcc.v10.i6.2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy is essential for the diagnosis of intestinal Behcet’s disease (BD), which is characterized by a typical oval-shaped ulcer in the ileocecal region. However, potential risks of colonoscopy have rarely been reported.
CASE SUMMARY Herein, we describe a patient with intestinal BD who presented with decreased oxygen saturation and shortness of breath during a diagnostic colonoscopy. Bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema of the neck, chest, abdomen, back and scrotum were confirmed by computed tomography scan. The sudden change in condition was considered to be associated with iatrogenic bowel perforation. After receiving closed thoracic drainage and conservative therapy, the patient was discharged in stable condition.
CONCLUSION Endoscopists should be aware of the risks of colonoscopy in patients with intestinal BD and the possibility of pneumothorax associated with intestinal perforation and make adequate preparations before colonoscopy.
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Affiliation(s)
- Tong Mu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Hua Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Voldby AW, Aaen AA, Loprete R, Eskandarani HA, Boolsen AW, Jønck S, Ekeloef S, Burcharth J, Thygesen LC, Møller AM, Brandstrup B. Perioperative fluid administration and complications in emergency gastrointestinal surgery-an observational study. Perioper Med (Lond) 2022; 11:9. [PMID: 35189974 PMCID: PMC8862386 DOI: 10.1186/s13741-021-00235-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/11/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The fluid balance associated with a better outcome following emergency surgery is unknown. The aim of this study was to explore the association of the perioperative fluid balance and postoperative complications during emergency gastrointestinal surgery. METHODS We retrospectively included patients undergoing emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 2.5 L divided the cohort in a conservative and liberal group. Outcome was Clavien-Dindo graded complications registered 90 days postoperatively. We used logistic regression adjusted for age, sex, American Society of Anesthesiologists' classification, use of epidural analgesia, use of vasopressor, type of surgery, intraabdominal pathology, and hospital. Predicted risk of complications was demonstrated on a continuous scale of the fluid balance. RESULTS We included 342 patients operated between July 2014 and July 2015 from three centers. The perioperative fluid balance was 1.6 L IQR [1.0 to 2.0] in the conservative vs. 3.6 L IQR [3.0 to 5.3] in the liberal group. Odds ratio of overall 2.6 (95% CI 1.5 to 4.4), p < 0.001, and cardiopulmonary complications 3.2 (95% CI 1.9 to 5.7), p < 0.001, were increased in the liberal group. A perioperative fluid balance of 0-2 L was associated with minimal risk of cardiopulmonary complications compared to 1.5-3.5 L for renal complications. CONCLUSION We found a perioperative fluid balance above 2.5 L to be associated with an increased risk of overall and cardiopulmonary complications following emergency surgery for gastrointestinal obstruction or perforation. A perioperative fluid balance of 0-2 L was associated with the lowest risk of cardiopulmonary complications and 1.5-3.5 L for renal complications.
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Affiliation(s)
- Anders W Voldby
- Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Smedelundsgade 60, 4300, Holbaek, Denmark
| | - Anne A Aaen
- Department of Anesthesiology and Intensive Care Medicine, Holbæk Hospital, Holbæk, Denmark
| | | | - Hassan A Eskandarani
- Department of Anesthesiology and Intensive Care Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Anders W Boolsen
- Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Smedelundsgade 60, 4300, Holbaek, Denmark
| | - Simon Jønck
- Department of Emergency Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Sarah Ekeloef
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Jakob Burcharth
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - Lau C Thygesen
- Department of Population Health and Morbidity, University of Southern Denmark, Odense, Denmark
| | - Ann M Møller
- Department of Anesthesiology and Intensive Care Medicine, Herlev Hospital, Herlev, Denmark.,Institute for Clinical Medicins, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Brandstrup
- Department of Surgery, Holbæk Hospital, part of Copenhagen University Hospitals, Smedelundsgade 60, 4300, Holbaek, Denmark. .,Institute for Clinical Medicins, University of Copenhagen, Copenhagen, Denmark.
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Maeda H, Endo H, Ichihara N, Miyata H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Seto Y, Yamaue H, Yamamoto M, Kitagawa Y, Uemura S, Hanazaki K. Correlation between surgical mortality for perforated peritonitis and days of the week for operations: A retrospective study using the Japanese National Clinical Database. Am J Surg 2022:S0002-9610(22)00098-8. [PMID: 35210064 DOI: 10.1016/j.amjsurg.2022.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The association between weekend interventions and poor outcomes is termed the "weekend effect." This retrospective study investigated whether the weekend effect exists in the surgical treatment of acute diffuse peritonitis due to gastrointestinal perforation. METHODS Patients (n = 16,209) who underwent operation for acute diffuse peritonitis during 2016-2017 were included and grouped depending on the perforation site. Using 23 variables, we performed hierarchical logistic regression analysis and calculated odds ratios for surgical mortality. RESULTS Surgical mortality rates were 8.8%, 15.0%, and 14.1% for patients with gastroduodenal, small bowel, and large bowel perforations, respectively. Unadjusted odds ratios for surgical mortality differed significantly on Wednesdays only for patients with large bowel perforation (odds ratio: 0.772, 95% confidence interval: 0.613-0.972, P = 0.03). However, there was no significant difference in adjusted odds ratios. CONCLUSION The quality of emergency surgical treatment is uniform in Japan throughout the week in terms of mortality.
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Chung D. Ischaemic gastritis and perforation. Ann Med Surg (Lond) 2022; 73:103212. [PMID: 35070284 PMCID: PMC8767231 DOI: 10.1016/j.amsu.2021.103212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Gastric perforation is a common general surgical emergency. Ischaemia of the stomach is uncommon due to its rich vascular supply, and is an uncommon cause of perforation. Minimal literature is available on the topic of ischaemic gastritis, with the few cases available linked to gastric dilation. Presentation of case A 52 year old lady presents with a syncopal episode, nausea, vomiting, malaise, and abdominal discomfort. A chest X-ray identified free subdiaphragmatic gas, and her examination revealed a peritonitic abdomen, prompting urgent surgical intervention. She was found to have ischaemic gastritis with multiple perforations along the greater curvature, necessitating a sleeve gastrectomy. Her post-operative course was stormy, requiring significant haemodynamic and respiratory support in the intensive care unit with progressive multi-organ dysfunction. She eventually developed extensive bowel ischaemia, and further management was considered futile. She passed away 13 days post-operatively. Clinical discussion The vascular supply of the stomach is rich with collaterals, making ischaemia unlikely. Its occurrence requires either a proximal insult, global ischaemia from pressure, or a systemic coagulopathy. Aside from perforation, it may also present with GI bleeding. Depending on its aetiology, the disease has been managed successfully either conservatively, interventionally, or operatively. Conclusion Ischaemic gastritis is uncommon and likely underdiagnosed. Timely recognition of its aetiology early in its course is important, for choosing the appropriate management and to improve patient outcomes. Its management is dependent on the aetiology of the perforation. Ischaemic gastritis is uncommon owing to the rich vasculature of the stomach. It may present as upper GI bleeding resulting in underdiagnosis. Ischaemia requires either a proximal insult, pressure related ischaemia, or coagulopathy. Depending on its aetiology, it may be managed conservatively, angriographically, or operatively. Delayed presentation significantly worsens outcomes.
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Affiliation(s)
- Douglas Chung
- Campbelltown Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
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42
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Hashim Z, Khan A, Areekkara P, Neyaz Z, Nath A, Jaiswal S, Mohindra S. Thrombosis leading to acute abdomen in corona virus disease- 19:A case series. Indian J Gastroenterol 2022; 41:313-8. [PMID: 35907170 DOI: 10.1007/s12664-022-01260-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the gastrointestinal (GI) system in corona virus disease-19 (COVID-19) in form of diarrhea, loss of taste, nausea, and anorexia is common and associated with poor prognosis. COVID-19 is also associated with a hypercoagulable state that mainly involves the pulmonary vasculature. However, GI complications involving thrombosis are observed infrequently. We report two COVID-19 patients who had two different causes of acute abdomen. The first patient was a 49-year-old male diagnosed with an aortic thrombus along with a splenic infarct. He was diagnosed early and successfully managed with anticoagulants. The second patient was a 30-year-old male who developed pain in the abdomen and was found to have features suggestive of peritonitis. A contrast-enhanced computerized tomography (CECT) scan of the abdomen revealed dilated bowel loops. Immediate exploratory laparotomy was performed; he was found to have jejunal perforation with gangrene. Histopathological examination of the resected specimen showed inflammatory cells with edema and thrombotic vessels. However, he succumbed to sepsis and multiorgan failure. Therefore, it is important to investigate cases of acute abdomen in COVID-19 thoroughly and whenever indicated CT angiogram should be obtained.
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Ali Asgari A, Sazgarnejad S, Haghdoost B, Ghasemi Tirtashi M, Sadeghi A, Malekzadeh R. Colonoscopy Complications in an Iranian Teaching Hospital. Middle East J Dig Dis 2022; 14:51-56. [PMID: 36619721 PMCID: PMC9489328 DOI: 10.34172/mejdd.2022.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/09/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: Colonoscopy is generally a safe procedure with a limited number of adverse events. Few studies have addressed the rate of adverse events in teaching hospitals. This study aimed to investigate the rate of complications after colonoscopy performed by gastroenterology fellows in a teaching hospital in Tehran. METHODS: A historical cohort study was carried out to link the colonoscopy reports and the hospital information system to identify serious adverse events leading to unplanned hospitalization, unplanned procedures or interventions (e.g. surgery), prolongation of existing hospitalization, or death within 30 days after colonoscopy. RESULTS: We included 9928 colonoscopies (mean age of the patients 53.0±15.9 years, 52.3% men) in this study. In-hospital patients comprised (34.8%) of the procedures. The indications of colonoscopy included 7137 diagnostic (71.9%), and 2519 screening (25.4%) reasons. Colorectal polyps were found in 2005 (20.2%) patients. Major complications were seen in 17 patients (0.2%), including serious bleeding in seven patients, cardiopulmonary complications in five patients, perforation in four patients, and sepsis in one patient. CONCLUSION: Serious adverse events after colonoscopy are relatively rare. The rate of complications does not appear to be higher in an academic teaching hospital when performed by fellows under supervision.
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Affiliation(s)
- Ali Ali Asgari
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bahar Haghdoost
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Anahita Sadeghi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Anahita Sadeghi, MD Associate Professor of Medicine, Digestive Disease Research Institute (DDRI), Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Postal Code: 14117-13135 Telefax:+98 21 8241 5400
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Lee S, Hong SY, Son JA, Hyun S, Haam S. A Complication of Diaphragm Repair Using a Gore-Tex (Expanded Polytetrafluorethylene) Membrane: A Case Report. J Chest Surg 2021; 55:171-173. [PMID: 34907097 PMCID: PMC9005942 DOI: 10.5090/jcs.21.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
A 65-year-old man underwent right trisectionectomy of the liver and reconstruction of the chest wall and diaphragm with a 2-mm Gore-Tex membrane due to recurrent hepatocellular carcinoma. After 3 years, the Gore-Tex membrane in the diaphragm migrated to the abdominal cavity and perforated the colon. We report a rare complication of a Gore-Tex membrane after diaphragm repair.
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Affiliation(s)
- Seungwook Lee
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sung Yeon Hong
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jung A Son
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seungji Hyun
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seokjin Haam
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
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Kim SR, Chun SH, Jin JY, Gweon TG, Lee H, Jin MS, Lee GJ. Experience of serious intestinal hemorrhage and perforation in small bowel lymphoma: a case report. Korean J Clin Oncol 2021; 17:126-130. [PMID: 36945674 PMCID: PMC9942752 DOI: 10.14216/kjco.21020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/19/2021] [Indexed: 11/07/2022]
Abstract
There have been several reports of complications of small bowel lymphoma, such as bleeding, obstruction, and perforation, often require emergency surgery. It is hardly showed complications of bleeding and wound dehiscence for diffuse large B cell lymphoma with distal ileum involvement, which needed urgent surgery and medical management. A 65-year-old man with diffuse large B-cell lymphoma with distal ileum involvement experienced both intestinal bleeding and perforation during the course of treatment. As the patient was diagnosed with stage III disease, resection before chemotherapy was not considered due to the resulting delay in chemotherapy, which necessitated sufficient tissue healing. Chemotherapy is important when treating small bowel lymphoma, complications such as bleeding and perforation should always be considered for the treatment of small bowel lymphoma, and surgery is necessary in this situation. After surgery of the small bowel, subsequent chemotherapy could cause wound dehiscence and perforation; therefore, adequate recovery time should be given before chemotherapy.
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Affiliation(s)
- Seo Ree Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hoon Chun
- Division of Hematology-Oncology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Youl Jin
- Division of Hematology-Oncology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Geun Gweon
- Division of Gastroenterology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hayemin Lee
- Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Sun Jin
- Department of Pathology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Guk Jin Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee DB, Shin S, Yang CS. Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study. Yeungnam Univ J Med 2021; 39:133-140. [PMID: 34710320 PMCID: PMC8913914 DOI: 10.12701/yujm.2021.01445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. Methods A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes. Results The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery. Conclusion Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.
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Affiliation(s)
- Do-Bin Lee
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seonhui Shin
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chun-Seok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Cabrera-Vargas LF, Villarreal-Viana R, Pulido-Segura JA, Pedraza-Ciro M, Santafe-Guerrero M, Cabrera-Silva L, Acevedo-Fontalvo D. Surgical management of duodenal perforation after endoscopic retrograde cholangiopancreatography: case series. CIR CIR 2021; 89:611-617. [PMID: 34665174 DOI: 10.24875/ciru.20000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complications after endoscopic retrograde cholangiopancreatography (ERCP) are rare, approximately 0.09% to 1.8% are duodenal perforation. This type of injury requires early diagnosis and proper management since the outcomes can be catastrophic, leading to death in 20% of cases. OBJECTIVE To show our experience in the management of these injuries in order to establish if there is benefit from minimally invasive management versus conventional management. METHOD Observational, retrospective and descriptive study comparing patients who required surgical management after post-ERCP duodenal perforation in three centers in Bogotá, Colombia, between January 2013 and December 2018. RESULTS 13 patients were taken to surgical management after duodenal perforation post ERCP, 7 laparoscopically (53.8%), with an average hospital stay of 10.7 days and mortality of 0% and 6 by open route (46.1%), with an average hospital stay of 33 days and mortality of 50%, with a minimum follow-up of 6 months. CONCLUSIONS Post ERCP duodenal perforation, despite its low incidence, should be suspected due to its high mortality. Laparoscopic surgery is a good tool to address duodenal perforations after ERCP, because it presents a lower rate of complications and mortality.
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Affiliation(s)
- Luis F Cabrera-Vargas
- Departamento de Cirugía General, Los Cobos Medical Center, Universidad El Bosque.,Departamento de Cirugía General, Fundación Santa Fe de Bogotá, Universidad El Bosque.,Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque
| | - Ricardo Villarreal-Viana
- Departamento de Cirugía General, Los Cobos Medical Center, Universidad El Bosque.,Departamento de Cirugía General, Fundación Santa Fe de Bogotá, Universidad El Bosque.,Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque.,Departamento de Gastroenterología, Los Cobos Medical Center, Universidad El Bosque
| | - Jean A Pulido-Segura
- Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque.,Ilustrador médico. Bogotá, Colombia
| | - Mauricio Pedraza-Ciro
- Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque
| | - Marcia Santafe-Guerrero
- Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque
| | - Laura Cabrera-Silva
- Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque
| | - David Acevedo-Fontalvo
- Departamento de Cirugía General, Universidad El Bosque.,Departamento de Medicina, Universidad El Bosque
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Shrestha BM, Shrestha S, Kharel S, K C A, Shrestha S, Pradhan S, Bhandari RS. Ileal perforation as an initial manifestation of systemic lupus erythematosus: A case report. Int J Surg Case Rep 2021; 87:106409. [PMID: 34555679 DOI: 10.1016/j.ijscr.2021.106409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Lupus enteritis is uncommon in patients with SLE and usually presents with anorexia, vomiting, and abdominal pain. Intestinal perforation as an initial manifestation of SLE is rare and can have a grave prognosis if not timely diagnosed. Case history We report an unusual case of a 22-year-old regularly menstruating female who presented with features of perforation peritonitis as an initial manifestation of lupus enteritis. Intraoperatively, a gangrenous ileal segment with multiple perforations was present. Thus, with an intraoperative diagnosis of perforation peritonitis, a gangrenous segment of the small bowel was resected and a double-barrel jejuno-ileostomy was created. Discussion Lupus enteritis manifesting initially as bowel perforation can be an uncommon cause of acute abdomen. A plain chest X-ray can show gas under the diaphragm suggesting bowel perforation. A contrast-enhanced CT scan of the abdomen is the gold standard in diagnosing lupus enteritis with a good prognosis on steroids. Conclusion Primary closure, resection, and anastomosis of small gut or diverting stoma are required for management of perforation. A high degree of clinical suspicion is required for early diagnosis thus preventing the grave prognosis of such an entity. Bowel perforation in patients with SLE is rare. Diagnosis of this lupus enteritis is challenging owing to its rarity and non-specific presenting features. High degree of suspicion and timely diagnosis can prevent fatal complications.
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Kim CH, Kim DJ, Kim W. The role of laparoscopic management in perforated gastric cancer. Ann Surg Treat Res 2021; 101:151-159. [PMID: 34549038 PMCID: PMC8424433 DOI: 10.4174/astr.2021.101.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perforated gastric cancer is an extremely rare condition and usually presents in advanced stage with poor prognosis. Surgical strategies are still controversial regarding the extent to which complete resection or primary repair is performed and the application of laparoscopic techniques. We aim to determine the role of laparoscopic 2-stage approach in perforated gastric cancer. Methods Among 2,318 gastric cancers in Yeouido St. Mary's Hospital from January 1990 to December 2017, 20 patients with perforated gastric cancer were enrolled, and 5 patients underwent 2-stage gastrectomy consisting of primary closure on perforation followed by curative gastrectomy. Clinicopathological features, surgical outcomes, and survival analysis were evaluated. Results Two-stage approach for perforated gastric cancer was all performed by laparoscopic approach except 1 patient who needed paraaortic lymph node dissection (LND). Those were first treated on peritonitis with laparoscopic primary closure with or without Foley gastrostomy. Compared to 1-stage gastrectomy, more D2 LND was performed (60.0% vs. 100.0%, P = 0.260) and retrieved lymph nodes were significantly higher (median [range]: 17.0 [12.0–27.0] vs. 33.0 [26.5–43.5], P = 0.019]. Two patients of stage II and 3 patients of stage III were included in the 2-stage gastrectomy group. During the 38 months of median follow-up period, there were 8 and 1 recurrence among 1-stage and 2-stage gastrectomies, respectively. Except for 1 patient, 4 other 2-stage patients survived around 5 years without recurrence (5-year disease-free survival, 80%). Conclusion Laparoscopic 2-stage surgery for perforated gastric cancer is safe and might increase the curability of gastrectomy with extended LND.
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Affiliation(s)
- Chang Hwan Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Chung D. Jejunal diverticulitis secondary to a gastrointestinal stromal tumor: A case report. Int J Surg Case Rep 2021; 85:106291. [PMID: 34388891 PMCID: PMC8361120 DOI: 10.1016/j.ijscr.2021.106291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The common manifestations of gastrointestinal stromal tumors (GIST) are well established. However, jejunal diverticulosis is an uncommon phenomenon to be associated with this lesion, with its rarity compounded by the relative difficulty associated with its diagnosis. Limited literature is available on this topic. This article examines one such case of jejunal diverticulitis as a result of a GIST, and the intervention of said disease. CASE PRESENTATION A 69 year old lady presented with abdominal pain, vomiting, and low grade fevers, on a background of ulcerative colitis. She was peritonitic, raising concerns of an acute abdomen. Her imaging identified an intra-abdominal contained perforation, prompting a transfer to theatres overnight for a laparotomy, which identified a jejunal diverticulum, which resembled a contained perforation. This was resected, and sent for histopathological analysis, identifying the lesion as a GIST. DISCUSSION Unlike other forms of jejunal diverticular disease, those arising from GISTs tend to present perforated, necessitating resection. This disease displays a tendency towards formation on the anti-mesenteric border of the small bowel. Additionally, this particular form of GIST shows macroscopic and histopathological uniformity across reported cases to date despite significant geographical disparity. CONCLUSION A scant number of case reports worldwide have identified jejunal diverticulitis from GISTs. We suggest diverticula be excised if perforation is suspected, while incidental findings of such be left untouched. However, overall management should be undertaken at the discretion of the operating surgeon.
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