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Sample records for cecum perforation due

  1. A Case Report of Stercoraceous Perforation of the Cecum due to Scybalum

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    HR Khorshidi

    2006-10-01

    Introduction & Objective: Non-traumatic colon perforations are usually caused by malignancy, diverticulum and colitis. Stercoraceous perforation of the colon has rarely been reported in the literature. This lesion is assumed to be produced by the pressure from a hard scybalum resulting in a perforated ulcer with necrotic edges. We report a case of stercoraceous perforation of the cecum due to scybalum. Case: We report a 50-year-old man who had a severe abdominal pain from 3 days ago and had peritonitis in physical exam. He was admitted in Mars, 2005 at Mobasher Kashani Hospital in Hamadan and he was parapelegic from 8 months ago due to trauma in his medical history and then he had severe and chronic constipation that necessitated the use of cathartic drugs. We operated him with diagnosis of peritonitis, and perforation of cecum due to scybalum was seen and right hemicolectomy and colostomy and ileostomy was done. Conclusion: The most common site of colon perforation due to scybalum is rectosigmoid area and cecal perforation is a rare area in the literature. It is presented with peritonitis in old patients that have chronic constipation. It is difficult to diagnose this lesion preoperatively. This lesion was only 11% correctly diagnosed before operation and should be always suspected when a patient with chronic constipation suffers from sudden abdominal pain. Resection and colostomy is the treatment of choice in most situations.

  2. [Delayed perforation of the cecum and sigmoid colon after blunt abdominal trauma in a patient with multiple injuries].

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    Miranda, E; Arroyo, A; Ronda, J M; Muñoz, J L; Alonso, C; Martínez-Peñuelas, F; Martí-Viaño, J L

    2007-01-01

    Blunt abdominal trauma can damage the intestinal vasculature and may occasionally lead to delayed intestinal perforation, associated with a combined rate of morbidity and mortality of 25%. The diagnosis of such complications is hindered by sedation in critical patients, however, and morbimortality in this population is therefore higher. We report the case of a man with multiple injuries admitted to the intensive care unit, where delayed perforations of the sigmoid colon and cecum were diagnosed. The management of blunt abdominal trauma is reviewed and the possible causes, diagnostic approaches, and treatment options for colon injuries are discussed.

  3. [Intestinal perforation due to multiple magnet ingestion: a case report].

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    Cevizci, Mehmet Nuri; Karadağ, Cetin Ali; Demir, Mesut; Dokucu, Ali Ihsan

    2012-03-01

    Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.

  4. A Rare Case: Appendectomy After Connected Stump Appendicitis Perforation of the Cecum

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    Berke Manoglu

    2016-01-01

    Full Text Available Stump appendicitis is a rare complication after appendectomy . Stump appendicitis made of incomplete appendectomy after a rest appendix tissue develops as a result of the inflammation. Admitted to the emergency department with acute abdomen and a history of appendectomy in patients with a history of current pain in the right lower quadrant , especially that of the patient must be evaluated in terms of stump appendicitis. The fact that the earlier story appendectomy patients , causing a delay in diagnosis and increasing the morbidity Cecal perforation was offered an advanced case of delayed depending on the stump appendicitis in this article.

  5. Traumatic oesophageal perforation due to haematoma

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    Grønhøj Larsen, Christian; Brandt, Bodil

    2014-01-01

    . Three explanations postulated to be the cause for late perforation which might be due to esophageal wall ischemia from pressure built up between the hematoma, azygos vein and the lower part of thoracic trachea; or could be an immediate rupture walled-off until the patient became symptomatic......; or the intramural hematoma gradually lysed and causing late perforation. CONCLUSION: Although extremely rare, an oesophageal haematoma and late complications must be considered in patients on anti-coagulant therapy following blunt thoracic trauma and complaining only of chest pain....

  6. Jejunal Diverticular Perforation due to Enterolith

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    Ronaldo Nonose

    2011-08-01

    Full Text Available Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman was admitted with signs of diffuse peritonitis. After initial fluid recovery the patient underwent emergency laparotomy. The surgery showed that she had small bowel diverticular disease, mainly localized in the proximal jejunum. The peritonitis was due to intestinal perforation caused by an enterolith 12 cm in length, localized inside one of these diverticula. The intestinal segment containing the perforated diverticulum with the enterolith was removed and an end-to-end anastomosis was done to reconstruct the intestinal transit. The patient recovered well and was discharged from hospital on the 5th postoperative day. There were no signs of abdominal pain 1 year after the surgical procedure. Although jejunal diverticular disease with its complications, such as formation of enteroliths, is difficult to suspect in patients with peritonitis, it should be considered as a possible source of abdominal infection in the elderly patient when more common diagnoses have been excluded.

  7. Common Bile Duct Perforation Due to Tuberculosis: A Case Report

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    Razman Jarmin

    2004-10-01

    Full Text Available A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

  8. Common Bile Duct Perforation Due to Tuberculosis: A Case Report

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    Razman Jarmin; Shaharin Shaharuddin

    2004-01-01

    A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

  9. Nasal Septum Perforation due to Methamphetamine abuse

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    Mehdi Bakhshaee

    2012-07-01

    Full Text Available Introduction: Spontaneous Perforation of the nasal septum is an uncommon condition. Nasal inhalation of substances such as cocaine has long been linked to this Perforation. Case Report: This report describes the case of a 46-year-old woman who was addicted to methamphetamine and who presented with perforation of the nasal septum.This is the first reported case of nasal septal necrosis linked to nasal inhalation of methamphetamine. Conclusions: Patient history and assurance regardingillegal drug consumption and abuse is a key point for fast and accurate diagnosis. The pathophysiology of drug-induced sinunasal disease and a review of the literature are also presented.

  10. Sigmoid Colonic Perforation with Faecal Peritonitis due to Faecaloma

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    Ibrahim Khalil

    2014-09-01

    Full Text Available Colon perforation is an uncommon event usually caused by malignancy, diverticular disease, amoebic colitis, steroid therapy, trauma and ulcerative colitis, but stercoral perforation is very rare. Severe chronic constipation is considered to be the main causative factor in development of stercoral perforation of colon. Sometimes it can also produce catastrophic complications like colonic obstruction, faecal peritonitis and septicaemia. We report a rare case of sigmoid colonic perforation with faecal peritonitis and pneumoperitonium due to faecaloma which was diagnosed after exploratory laparotomy.

  11. Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

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    John Robotis

    2014-07-01

    Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

  12. Fournier′s gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient

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    Georgios Papadimitriou

    2015-01-01

    Full Text Available Fournier′s gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier′s gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified. Subsequently, the patient underwent scheduled cecostomy closure (right hemicolectomy, while the scrotum trauma healed with tertiary intention. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier′s gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development.

  13. Tension pneumothorax due to perforated colon.

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    Abdullah, Muhammad; Stonelake, Paul

    2016-05-31

    A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation. 2016 BMJ Publishing Group Ltd.

  14. Small bowel perforation due to fish bone: A case report

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    Huseyin Pulat

    2015-09-01

    Full Text Available Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen. Keywords: Foreign body, Small intestine, Perforation

  15. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

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    Tahsin Colak

    2013-01-01

    Full Text Available Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT. The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass.

  16. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

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    Loabat Geranpayeh

    2006-01-01

    Full Text Available Spontaneous perforation of the uterus is rare, its incidence being about 0.01%–0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

  17. Biliary peritonitis due to gall bladder perforation after percutaneous nephrolithotomy

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    Nikhil Ranjan

    2015-01-01

    Full Text Available A 19-year-old male patient underwent right percutaneous nephrolithotomy (PNL for right renal 1.5 × 1.5 cm lower pole stone. The procedure was completed uneventfully with complete stone clearance. The patient developed peritonitis and shock 48 h after the procedure. Exploratory laparotomy revealed a large amount of bile in the abdomen along with three small perforations in the gall bladder (GB and one perforation in the caudate lobe of the liver. Retrograde cholecystectomy was performed but the patient did not recover and expired post-operatively. This case exemplifies the high mortality of GB perforation after PNL and the lack of early clinical signs.

  18. PERITONITIS DUE TO TRANSVERSE COLON PERFORATION: A RARE PRESENTATION

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    Vandana B.

    2015-08-01

    Full Text Available Abdominal tuberculosis is defined as infection of the peritoneum, hollow or solid abdominal organs with Mycobacterium tuberculi . TB can affect any part of the gastrointestinal (GI tract including anus, peritoneum and hepatobiliary system. The peritoneum and the ileocaecal region are the most likely sites of infection. The clinical manifestations of abdominal tuberculosis are nonspecific and mimic various GI disorders and cause delay in diagnosis and management. This pa thology has several complications, including free intestinal perforation.

  19. A CLINICAL STUDY TO ANALYSE THE SPECTRUM OF PERITONITIS DUE TO HOLLOW VISCUS PERFORATION

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    Sai Datta

    2015-07-01

    Full Text Available Perforation peritonitis is the one of the common abdominal surgical emergency . The spectrum of etiology of perforation in Tropical countries continues to be different from its Western counterpart. The objective of the study was to highlight the spectrum of perforation peritonitis as encountered at K aturi M edical C ollege and H ospital , G untur. A.P. Hundred consec utive cases of perforation peritonitis over a period of 26 months . (June 2010 - July 2012 were reviewed in terms of clinical presentation, operative findings and postoperative course retrospectively. The most common type of perforation in our series was per forated duodenal ulcer (56 cases followed by Appendicular (16 cases, Ileal (12 cases, Colonic ( 6 cases, Gastric ( 4 cases, Jejunal (2 cases, Gall bladder (2 cases, Anastomotic ulcer ( 2 cases were reported . Despite delay in seeking medical treatment (32%, the overall mortality (11% , favorably comparable with other published series though the overall morbidity (29% was favorable. In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tr act perforations constitute the majority of cases in India. Mostly males and elderly people are affected due to injudicious usage of NSAIDS, alcohol, smoking. ( 11 Withdrawal from these habits and using of proton pump inhibitors and H - Pylori eradication which warrant early recognition and prompt treatment to avoid serious complications and death.

  20. Improving results of surgery for fecal peritonitis due to perforated colorectal disease: A single center experience.

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    Mineccia, Michela; Zimmitti, Giuseppe; Ribero, Dario; Giraldi, Francesco; Bertolino, Franco; Brambilla, Romeo; Ferrero, Alessandro

    2016-01-01

    fecal peritonitis due to colorectal perforation is a dramatic event characterized by high mortality. Our study aims at determining how results of sigmoid resection (eventually extended to upper rectum) for colorectal perforation with fecal peritonitis changed in recent years and which factors affected eventual changes. Seventy-four patients were operated on at our institution (2005-2014) for colorectal perforation with fecal peritonitis and were divided into two numerically equal groups (operated on before (ERA1-group) and after (ERA2-group) May 2010). Mannheim Peritonitis Index (MPI) was calculated for each patient. Characteristics of two groups were compared. Predictors of postoperative outcomes were identified. Postoperative overall complications, major complications, and mortality occurred in 59%, 28%, and 18% of cases, respectively, and were less frequent in ERA2-group (51%, 16%, and 8%, respectively), compared to ERA1-group (68%, 41%, and 27%, respectively; p = .155, .02, and .032, respectively). Such results paralleled lower MPI values in ERA2-group, compared to ERA1-group (23(16-39) vs. 28(21-43), p = .006). Using receiver operating characteristic analysis, the best cut-off value for MPI for predicting postoperative complications and mortality was 28.5. MPI>28 was the only independent predictor of postoperative overall (p = .009, OR = 4.491) and major complications (p peritonitis longer than 24 h (p = .045, OR = 17.099). results of surgery for colorectal perforation with fecal peritonitis have improved over time, matching a concurrent decrease of MPI values and a better preoperative patient management. MPI value may help in selecting patients benefitting from surgical treatment. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  1. ACTH-Secreting tumor of cecum. Case report

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    N S Kuznetsov

    2013-06-01

    Full Text Available Ectopic hormonesecreting of cecum are rare. We report the case of a 52yearold woman with a typical clin ical picture of Cushing disease. Diagnostic tests confirmed ACTH dependent Cushing’s syndrome, which is caused by neuroendocrine tumor of the cecum. Due to the rarity of the disease, we believe it appropriate to share our experience of this group of patients.

  2. A case of perforative peritonitis due to radiation enteritis 33 years after radiotherapy

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    Takaya, Yoshihiro; Yasaka, Takahiro; Fujiwara, Shinsuke [Kamigotou Hospital, Nagasaki (Japan)

    2001-11-01

    We report a case of perforative peritonitis due to radiation enteritis. An 88-year-old woman who had undergone pelvic irradiation for a gynecological malignancy was referred to our hospital due to hematomesis and epigastralgia with fever. We determined that she had perforative peritonitis, based on intraabdominal extrabowel gases in abdominal computed tomography. We conducted emergency operation to resect the damaged bowel, such as necrotic intestine combound with a damaged bladder in ''frozen pelvis'' and reconstruct jejuno-ascending colostomy. Pathological findings for resected specimens were compatible with radiation enteritis, such as excessive collagen deposition within the bowel wall, vasculitis, and intramural edema. The woman had a jejuno-subcutaneous fistula and suffered recurrent urinary infection or jaundice due to chronic hepatitis C after the surgical procedure. But eight months later, recovery enabled a successful second laparotomy to reconstruct the residual intestine. Even long after irradiation for malignant disease, radioactive damage to the body as a whole should always be considered. (author)

  3. Malignant lymphoma incidentally diagnosed due to the perforation of the small intestine caused by a fish bone: A case report

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    Masatsugu Hiraki

    Full Text Available Introduction: The ingestion of a foreign body is relatively common. However, it rarely results in the perforation of gastrointestinal tract. We herein report an unusual case of malignant lymphoma incidentally diagnosed after the perforation of the small intestine by a fish bone. Presentation of case: A 90-year-old woman was admitted to our hospital because of abdominal pain and vomiting. Abdominal computed tomography demonstrated free air and ascites in the abdominal cavity. In the pelvic cavity, a radiopaque linear shadow about 35 mm in diameter was shown in the small intestine, and the stricture was exposed to the abdominal cavity. Therefore, a diagnosis of perforation of the small intestine due to ingestion of a foreign body and panperitonitis was made. Emergent laparotomy was performed. The intraoperative findings revealed perforation of the small intestine with a fish bone in the jejunum. Local inflammation at the perforation site was seen, and circulated wall thickness was observed at the distal side of the jejunum. Partial resection of the jejunum and anastomosis of jejuno-jejunostomy was performed. A pathological examination and immunohistochemical study of the resected specimen resulted in a diagnosis of malignant lymphoma of follicular lymphoma Grade 1. Discussion: It is very difficult to identify the existence malignancy accompanied with gastrointestinal perforation with ingestion of a foreign body. Conclusion: In cases suspected of involving malignancy, careful observation during surgery is needed in order to avoid missing the accompanying malignancy. Keywords: Fish bone, Perforation, Small intestine, Malignant lymphoma, Foreign body, Ingestion

  4. An unusual cause of duodenal perforation due to a lollipop stick

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    Mi Jin Kim

    2013-04-01

    Full Text Available Children have a natural tendency to explore objects with their mouths; this can result in the swallowing of foreign objects. Most ingested foreign bodies pass uneventfully through the gastrointestinal tract.However, some foreign bodies cause obstruction or perforation of the gastrointestinal tract, requiring surgical intervention. Perforation of the gastrointestinal tract may be associated with considerable morbidity and mortality. The most common sites of intestinal foreign body perforation are the ileocecal and rectosigmoid regions. Foreign body perforation of the duodenum is relatively uncommon. We report the first Korean case of duodenal perforation by an ingested 8-cm lollipop stick. Lollipops are popular with the children and fairly accessible to them, as most parents are not aware of their potential harm. Pediatric clinicians should be aware of the risks associated with lollipop stick ingestion. Our report also describes the feasibility and safety of laparoscopic diagnosis and management of pediatric patients with peritonitis induced by the ingestion of foreign bodies.

  5. Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?

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    Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo

    2011-03-01

    Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience. From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP. A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P clinical anastomotic leakage and needed re-operation. RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.

  6. Ileum perforation due to accidental chicken bone ingestion a rare cause of the acute abdomen

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    Doklestić Krstina S.

    2012-03-01

    Full Text Available Ingestion of foreign bodies is not an uncommon occurrence, but most of them will pass through the gastrointestinal tract without consequences. Complication such as perforation is rare. We present a case of small bowel perforation secondary to the accidental ingestion of a chicken bone. The patient presented with abdominal pain, constipation and vomiting. Clinical examination confirmed generalized abdominal tenderness and rebound tenderness. Abdominal radiography showed multiple dilated loops of small bowel, and abdominal ultrasound (US showed inflammatory changes on small bowel loops, with free fluid and fluid collection around intestinal loops. The patient underwent an emergency laparotomy. Intra operative findings revealed diffuse fibro purulent peritonitis with abscess between central small bowels loops. At about 60 cm from Bauchini valve we found a perforation of ileum at the anti-mesenteric site caused by a sharp chicken wishbone. The patient was treated with resection of the ileum segment (10 cm and primary end-to-end anastomosis. Even that intestinal perforation by a foreign body is rare, physicians should consider possibility of intestinal perforation by a foreign body in the differential diagnosis of acute abdomen in patients presenting with abdominal pain.

  7. [Volvulus of the cecum: a rare cause of intestinal occlusion: about two cases].

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    Mazine, Khalid; Elbouhaddouti, Hicham; Toughrai, Imane; Mouaqit, Ouadie; Benjelloun, Elbachir; Ousadden, Abdelmalek; Taleb, Khalid Ait

    2017-01-01

    The cecum is the second part of the colon that is most commonly affected by the volvulus after sigmoid colon and before left corner and the transverse colon. This condition occurs in patients with abnormally mobile cecum. Volvulus is characterized by torsion or tilt. Clinically, it appears as bowel obstruction due to acute strangulation. Abdominal x-ray without treatment and abdominal CT scan are the radiological procedures of choice in the diagnosis of volvulus of the cecum. Treatment is based on emergency surgical excision of the cecum and of the terminal ileum. We report two cases of patients with volvulus of the cecum admitted to the emergency department with acute intestinal obstruction. In both patients, the diagnosis was confirmed by abdomino-pelvic CT scan and the treatment was based on ileocolic resection with immediate restoration of the intestinal continuity. The postoperative course was uneventful.

  8. Intestinal Perforation Due to Foreign Body Ingestion in a Schizophrenic Patient

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    Zarei, Mina; Shariati, Behnam; Bidaki, Reza

    2016-01-01

    Introduction Ingestion of foreign bodies has been previously reported in some patients with schizophrenia. This behavior may be a manifestation of delusional beliefs or a response to command hallucinations and can lead to severe complications. Case Presentation This paper reports a patient with schizophrenia who, as a manifestation of his illness, ingested a metallic skewer to kill ademon inside his abdomen that he believed was controlling him. As a result, he developed an acute intestinal perforation and underwent surgery. Conclusions It is of a great importance to closely monitor the therapy compliance of patients suffering from mental illnesses. This will benefit them by preventing some of the serious complications of their disease, which may include life-threatening conditions such as intestinal perforation that needs surgical intervention. PMID:27803892

  9. Formed Due to Traumatic Diaphragmatic Injury, A Case of Gastric Perforation

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    Ceren Sen Tanrikulu

    2014-03-01

    Full Text Available Diaphragmatic hernia may be congenital or traumatic in origin. Diaphragmatic hernias are more common in adult and occur as a result of penetrating injuries are more common than from blunt injuries. Traumatic diaphragmatic hernia may manifest immediately or without any findings that several months/years after the incident. Early diagnosis is difficult, and it is usually made intraoperatively. Frequently during the early phase of traumatic diaphragmatic hernias, abdominal organ injury can be seen, such as stomach, colon and liver. In this study, we presented a case with acute gastric strangulation and perforation in the diaphragmatic injury occurred as a result of penetrating thoracic trauma.

  10. Point-of-Care Ultrasound in Necrotizing Acute Pancreatitis Complicated by Perforated Ileum Due to Nonocclusive Mesenteric Ischemia

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    Sonia López-Cuenca

    2016-09-01

    Full Text Available Necrotizing acute pancreatitis is the most severe form of pancreatitis, and it is a potentially life-threatening condition. Its diagnosis and severity are based on radiological signs. Although computed tomography is the most used imaging tool, ultrasound can be a quick and useful technique in emergency and intensive care scenarios. The use of abdominal ultrasound is generally limited to ruling out cholecystitis. Bowel gas can limit the accuracy of pancreatic imaging. When the pancreas is visualized, ultrasound can reveal pancreatic enlargement, echotextural changes, and peripancreatic fluid. We present a patient with necrotizing pancreatitis who developed peritonitis due to ileal perforation, where the use of ultrasound as a bedside imaging technique was very useful.

  11. Successful Treatment of Septic Shock due to Spontaneous Esophageal Perforation 96 Hours after Onset by Drainage and Enteral Nutrition

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    Risako Yamashita

    2014-12-01

    Full Text Available Spontaneous esophageal perforation is relatively uncommon, but carries a high mortality rate if diagnosis or treatment is delayed. We report the case of a 68-year-old man with spontaneous esophageal perforation who was successfully treated over 96 h after onset by thoracic drainage and jejunostomy for enteral nutrition. He vomited after drinking alcohol, soon followed by epigastralgia. Heart failure was suspected on admission to another hospital. Spontaneous esophageal perforation was diagnosed 48 h after admission. Chest tube drainage was performed, but his general condition deteriorated and he was transferred to our hospital. Emergent surgery was performed and esophageal perforation combined with pyothorax and mediastinitis was identified on the left side of the lower esophagus. The left thoracic cavity was rinsed and thoracic drainage was performed. Feeding jejunostomy was performed for postoperative enteral nutrition. Effective drainage and sufficient nutrition management appear extremely valuable in treating spontaneous esophageal perforation.

  12. Trans-anal barotrauma by compressed air leading to sigmoid perforation due to a dangerous practical joke.

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    Pahwa, Harvinder Singh; Kumar, Awanish; Srivastava, Rohit; Rai, Anurag

    2012-08-01

    To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

  13. Cecal perforation with an ascending colon cancer caused by upper gastrointestinal endoscopy

    Directory of Open Access Journals (Sweden)

    Hiroyuki Miyatani

    2009-04-01

    Full Text Available Hiroyuki Miyatani1, Yukio Yoshida1, Hirokazu Kiyozaki21Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, Japan; 2Department of Surgery, Jichi Medical University, Saitama Medical Center, Saitama, JapanAbstract: Colonic perforation caused by upper gastrointestinal (GI endoscopy is extremely rare. A 69-year-old woman was referred to our hospital because of abdominal fullness. Colonoscopy could be performed only up to the hepatic flexure due to an elongated colon and residual stools. Because her symptoms improved, upper GI endoscopy was performed 11 days later. The patient developed severe abdominal pain two hours after the examination. Abdominal X-ray and computed tomography showed massive free air. Immediate laparotomy was performed for the intestinal perforation. After removal of stool, a perforation site was detected in the cecum with an invasive ascending colon cancer. Therefore, a right hemicolectomy, ileostomy, and transverse colostomy were performed. Although she developed postoperative septicemia, the patient was discharged 38 days after admission. Seven months postoperatively, the patient died of lung, liver, and brain metastases. Even in cases with a lesion that is not completely obstructed, it is important to note that air insufflations during upper GI endoscopy can perforate the intestinal wall in patients with advanced colon cancer.Keywords: colonic perforation, colon cancer, upper gastrointestinal endoscopy, fecal peritonitis

  14. Delayed graft duodenal perforation due to impacted food five years after simultaneous pancreas-kidney transplantation: A case report

    Directory of Open Access Journals (Sweden)

    Taizo Sakata

    2017-01-01

    Conclusion: When a patient is stable, even in the presence of delayed duodenal graft perforation, graft excision may not be necessary. Intraoperative exploration should include Doppler ultrasound examination of the vasculature to rule out thrombosis as a contributor to ischemia. Tissue biopsy should be performed to diagnose rejection.

  15. Computed-tomography attenuation values of the peritoneum reflect the severity of peritonitis due to upper gastrointestinal perforations

    International Nuclear Information System (INIS)

    Tsujimoto, Hironori; Yaguchi, Yoshihisa; Hiraki, Shuichi; Kinoshita, Manabu; Yamamoto, Junji; Hase, Kazuo; Ono, Satoshi

    2011-01-01

    The aim of this study was to evaluate computed tomography (CT) attenuation values of the peritoneum and to relate these values to the severity of peritonitis in patients with upper gastrointestinal tract (UGI) perforations. A total of 27 consecutive patients with UGI perforations who underwent CT and emergency laparotomy in our hospital were enrolled in this study. The CT attenuation values of the peritoneum were measured at a workstation by 2 independent investigators, and these values were analyzed in relation to the severity of illness. There were significant negative correlations between the peritoneal CT attenuation values and the sequential organ failure assessment score, acute physiology and chronic health evaluation II score, and the Mannheim peritonitis index. There was a significant negative correlation between the peritoneal CT attenuation values and the length of stay in the intensive care unit. Furthermore, patients with dysfunctions in ≥3 organs had significantly lower peritoneal CT attenuation values than those with dysfunction in ≤2 organs. In conclusion, evaluation of peritoneal CT attenuation values in peritonitis patients is simple and can be employed for objective assessment of the severity of peritonitis. (author)

  16. Triple leaflet perforation due to endocarditis in aortic valve complicated by pneumonia and exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Elton Soydan

    2015-09-01

    Full Text Available Valve perforation complicating infective endocarditis has been for decades a bad sign leading to severe valve destruction, intractable heart failure and even death if surgical therapy is not administered in time. Here we present a 57 years old male patient inadvertently diagnosed with pneumonia and chronic obstructive pulmonary disease exacerbation in another hospital. After 20 days of broad spectrum antibiotics and bronchodilator therapy no improvement was achieved. During examination a severe aortic regurgitation was recognized. Immediately after, patient was transferred to our hospital for aortic valve surgery evaluation. Transthorasic echocardiography (TTE showed a severe aortic regurgitation and vegetation like echogenicity over the noncoronary leaflet. An aortic valve replacement surgical therapy was decided. During the aortic valve excision underneath the vegetations, multiple small perforations in all the three leaflets were noticed. The destructed valve was excised and a mechanical aortic prosthesis (St Jude No: 23, MN, USA was successfully replaced. After 14 days of treatment patient was healthily discharged.

  17. Postoperative Bowel Perforation due to Heterotopic Ossification (Myositis Ossificans Traumatica: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Victoria Valinluck Lao

    2011-01-01

    Full Text Available Heterotopic ossification (HO is the ectopic development of normal bone within soft tissue that can occur after traumatic injury. It is uncommon and may be missed or misdiagnosed, which can lead to complications. We report the case of an 84-year-old male with a previous history of a laparotomy who underwent resection of an intra-abdominal tumor through a midline incision. On postoperative day six, the patient was taken to the operating room, as succus was draining from the incision. Upon re-exploration, sharp bone-like material was found in the wound directly adjacent to an enterotomy. Pathology confirmed mature lamellar bone and the diagnosis of HO. This is the first report of postoperative intestinal perforation secondary to HO in a midline wound. We report this case to encourage accurate reporting of HO and its morbidity and complications for the benefit of appropriate surgical planning and epidemiologic tracking of outcomes.

  18. Wandering Fish Bone: a Case of Pelvic Abscess due to Rectum Perforation Resulting from an Accidental Fish Bone Ingestion

    Directory of Open Access Journals (Sweden)

    Sirous Abbasi

    2010-09-01

    Full Text Available Fish bone is the most common foreign body that is ingested accidentally and can be caused gastrointestinal complications such as perforation, abstraction, and abscess. We describe a 75-year-old man who suffered from constipation, diarrhea, and fever and chills for 3 months. He had mild tenderness in hypogasteric region and also mild tenderness and swelling on anterior rectal wall and prostate upon clinical examination. The abdominal and pelvic sonography and CT scan findings suggested existence of abscess in the space of between bladder and rectum. The patient underwent laparotomy to drainage the pelvic abscess. The surgeon found a 6-cm fish bone which was embedded in the abscess. The presented case indicated the importance of accidental fish bone ingestion and its possible complications. In addition, the patients with abdominal pain, GI bleeding, and fever of unknown origin living in the seaside regions, the wandering fish bone as a differential diagnosis should be kept in mind.

  19. A case of bowel perforation due to traumatic hernia at a pelvic fracture site: a case report and review of the literature.

    Science.gov (United States)

    Tanaka, Ryota; Nagahara, Hisashi; Maeda, Kiyoshi; Ohtani, Hiroshi; Shibutani, Masatsune; Tamura, Tatsuro; Ikeya, Tetsuro; Sugano, Kenji; Iseki, Yasuhito; Sakurai, Katsunobu; Yamazoe, Sadaaki; Kimura, Kenjiro; Toyokawa, Takahiro; Amano, Ryosuke; Kubo, Naoshi; Tanaka, Hiroaki; Muguruma, Kazuya; Hirakawa, Kosei; Ohira, Masaichi

    2017-07-12

    Common complications of pelvic fractures include visceral injury, large-volume hemorrhage, genitourinary injury, rectal injury, and pulmonary embolism. On the other hand, traumatic hernia is a rare complication, especially in association with pelvic fractures. We report a case of bowel perforation due to traumatic hernia at a pelvic fracture site. A 65-year-old female was presented at our hospital for further examination and treatment of ileus. She was diagnosed with bowel perforation due to traumatic hernia at a pelvic fracture site, and an emergency operation was thus immediately performed. We performed segmental jejunum resection and constructed jejunostomy, and the iliac bone fracture was fixed with four pins. In the postoperative course, she received antibiotics and vasopressors for septic shock. However, there was no need for either a ventilator, dialysis or admission to the ICU. At seven days after the operation, a residual abscess was detected in the pouch of Douglas. We performed percutaneous drainage (Clavien-Dindo IIIa) and jejunostomy closedown 35 days after the first operation. The postoperative course was without complication, but she received rehabilitation until she was able to walk unaided. She was discharged 64 days after the first operation. The occurrence of traumatic hernia is rare, especially in association with pelvic fractures. Although its rarity, traumatic hernia follows a severe course. Thus, proper diagnosis and effective treatment are necessary. Surgeons treating patients with pelvic injuries should consider the possibility of any complications and perform a work-up examination in order to achieve an accurate diagnosis at an earlier time point.

  20. Colonic perforation following endoscopic retrograde ...

    African Journals Online (AJOL)

    She developed severe upper abdominal pain after the ... non-surgical management of pancreatitis and associated complications, colonic perforation should be considered in patients who deteriorate ... To our knowledge this is the first case of a secure pre-operative diagnosis of colonic perforation due to to pancreatitis.

  1. Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation.

    Science.gov (United States)

    Al-Zubaidi, Ali M; Alghamdi, Hassan U; Alzobydi, Abdu H; Dhiloon, Irshad A; Qureshi, Laeeque A

    2015-04-16

    A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances.

  2. Esophageal perforation

    Science.gov (United States)

    ... esophagus into the space around the lungs. Collapsed lung. X-rays taken after you drink a non-harmful dye can help pinpoint the location of the perforation. You may also have chest CT scan look for an abscess in the chest or esophageal cancer.

  3. Tricholithobezoar Causing Gastric Perforation

    Directory of Open Access Journals (Sweden)

    Juliana Santos Valenciano

    2012-01-01

    Full Text Available A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment.

  4. Spectrum of perforation peritonitis in delhi: 77 cases experience.

    Science.gov (United States)

    Yadav, Dinesh; Garg, Puneet K

    2013-04-01

    Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8 months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4 %) and ileal typhoid perforation (26.4 %), each followed by small bowel tuberculosis (10.3 %) and stomach perforation (9.2 %), perforation due to acute appendicitis (5 %). The highest number of perforations was seen in ileum (39.1 %), duodenum (26.4 %), stomach (11.5 %), appendix (3.5 %), jejunum (4.6 %), and colon (3.5 %). Overall mortality was 13 %. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup.

  5. Spontaneous external gallbladder perforation

    International Nuclear Information System (INIS)

    Noeldge, G.; Wimmer, B.; Kirchner, R.

    1981-01-01

    Spontaneous perforation of the gallbladder is one complication of cholelithiasis. There is a greater occurence of free perforation in the peritoneal cavity with bilary pertonitis, followed by the perforation into the stomach, small intestine and colon. A single case of the nowadays rare spontaneous perforation in and through the abdominal wall will be reported. Spontaneous gallbladder perforation appears nearly asymptomatic in its clinical course because of absent biliary peritonitis. (orig.) [de

  6. Management of biliary perforation in children

    Directory of Open Access Journals (Sweden)

    Mirza Bilal

    2010-01-01

    Full Text Available Background: To study the aetiology, management and outcome of biliary perforations in paediatric age group. Patients and Methods: In a retrospective study, the records of patients presented with biliary peritonitis due to biliary perforations, managed from March 2006 to July 2009, are reviewed. Results: Eight male patients with biliary peritonitis due to biliary perforation were managed. These patients were divided in two groups, A and B. Group A, (n = 3 patients, had common bile duct (CBD perforation, and Group B (n=5 patients had gallbladder perforation. The presenting features were abdominal pain, fever, abdominal distension, vomiting, constipation, jaundice and signs of peritonism. The management of CBD perforations in Group A was by draining the site of perforation and biliary diversion (tube cholecystostomy. In Group B, the gallbladder perforations were managed by tube cholecystostomy in four patients and cholecystectomy in one patient, however, one patient had to be re-explored and cholecystectomy performed due to complete necrosis of gall bladder. There was no mortality in our series. All patients were asymptomatic on regular follow-up. Conclusion: Early optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.

  7. Laparoscopic Primary Colorrhaphy for Acute Iatrogenic Perforations during Colonoscopy

    Directory of Open Access Journals (Sweden)

    Eric M. Haas

    2013-01-01

    Full Text Available Purpose. We present our experience with laparoscopic colorrhaphy as definitive surgical modality for the management of colonoscopic perforations. Methods. Over a 17-month period, we assessed the outcomes of consecutive patients presenting with acute colonoscopic perforations. Patient characteristics and perioperative parameters were tabulated. Postoperative outcomes were evaluated within 30 days following discharge. Results. Five female patients with a mean age of 71.4 ± 9.7 years (range: 58–83, mean BMI of 26.4 ± 3.4 kg/m2 (range: 21.3–30.9, and median ASA score of 2 (range: 2-3 presented with acute colonoscopic perforations. All perforations were successfully managed through laparoscopic colorrhaphy within 24 hours of development. The perforations were secondary to direct trauma (n=3 or thermal injury (n=2 and were localized to the sigmoid (n=4 or cecum (n=1. None of the patients required surgical resection, diversion, or conversion to an open procedure. No intra- or postoperative complications were encountered. The mean length of hospital stay was 3.8 ± 0.8 days (range: 3–5. There were no readmissions or reoperations. Conclusion. Acute colonoscopic perforations can be safely managed via laparoscopic primary repair without requiring resection or diversion. Early recognition and intervention are essential for successful outcomes.

  8. Let's perforate

    International Nuclear Information System (INIS)

    2002-01-01

    Two discoveries and the increase of reserves in 2002 they are the first results of the new exploratory campaign of the country. After turnaround in contracts, this year they sound with. The potential ascends to 47.000 million barrels. Colombia, after ten years of an uninterrupted fall of its reserves of raw, announced at the beginning of 2002 two new discoveries of hydrocarbons that, together to the results of Guando, they guarantee for the first time from 1992 the country incorporated to its reserves of barrels of raw. These new barrels in surface are the first concrete result of reactivation of the exploratory activity that began two years ago and that it could throw other fruits in next months, when the perforations of the new exploratory map of Colombia are completed and the country finishes picking up the crop that began to sow in the year 2000 with the record in association contracts and that it reinforced later one year with the duplication of the seismic activity

  9. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience

    Directory of Open Access Journals (Sweden)

    Ur-Rahman Shafiq

    2008-11-01

    Full Text Available Abstract Background Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. Methods A prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK Pakistan, from 1st September 2005 – 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. Results The most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6% and gastric ulcer 1.3%. followed by small bowel tuberculosis (21% and typhoid (17%. large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%. Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%. Conclusion The spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular

  10. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience.

    Science.gov (United States)

    Afridi, Shahida Parveen; Malik, Faiza; Ur-Rahman, Shafiq; Shamim, Shahid; Samo, Khursheed A

    2008-11-08

    Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. A prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK) Pakistan, from 1st September 2005 - 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6%) and gastric ulcer 1.3%. followed by small bowel tuberculosis (21%) and typhoid (17%). large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%). Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%). The spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular. Malignant perforations are least common in our setup.

  11. Investigation on the Acoustic Absorption of Flexible Micro-Perforated Panel with Ultra-Micro Perforations

    Science.gov (United States)

    Li, Guoxin; Tang, Xiaoning; Zhang, Xiaoxiao; Qian, Y. J.; Kong, Deyi

    2017-11-01

    Flexible micro-perforated panel has unique advantages in noise reduction due to its good flexibility compared with traditional rigid micro-perforated panel. In this paper, flexible micro-perforated panel was prepared by computer numerical control (CNC) milling machine. Three kinds of plastics including polyvinylchloride (PVC), polyethylene terephthalate (PET), and polyimide (PI) were taken as the matrix materials to prepare flexible micro-perforated panel. It has been found that flexible micro-perforated panel made of PET possessing good porosity and proper density, elastic modulus and poisson ratio exhibited the best acoustic absorption properties. The effects of various structural parameters including perforation diameter, perforation ratio, thickness and air gap have also been investigated, which would be helpful to the optimization of acoustic absorption properties.

  12. Microbial community composition of the ileum and cecum of broiler chickens as revealed by molecular and culture-based techniques.

    Science.gov (United States)

    Bjerrum, L; Engberg, R M; Leser, T D; Jensen, B B; Finster, K; Pedersen, K

    2006-07-01

    The microbial communities of the ileum and cecum of broiler chickens from a conventional and an organic farm were investigated using conventional culture techniques as well as cloning and sequencing of 16S rRNA genes. Eighty-five percent of the 557 cloned sequences were <97% related to known cultured species. The chicken ileum was dominated by lactobacilli, whereas the cecum harbored a more diverse microbial community. The cecum was dominated by a large group of bacteria with hitherto no close cultured relatives but most closely related to Faecalibacterium prausnitzii. Approximately 49 and 20% of the cecal clones belonged to this cluster in conventional and organic broiler chickens, respectively. We were, however, able to recover a number of these phylotypes by cultivation, and the isolates were shown to be butyric acid producers. The investigation was a descriptive rather than a comparative study of 2 different rearing systems; however, several differences were observed. For instance, Clostridium perfringens was found in significantly higher numbers in the birds from the organic farm compared with the conventional broilers, probably due to the addition of salinomycin to the conventional feed. In the ileum, the abundance of the different Lactobacillus species differed between the 2 broiler types. The culture-based and culture-independent techniques complemented each other well. Strengths and limitations of the different methods are discussed.

  13. [Saphenous perforator flap].

    Science.gov (United States)

    Winkel, R; Tajsic, N; Husum, H; Schlageter, M; Hanebuth, G; Hoffmann, R

    2013-04-01

    Replacement of full thickness soft tissue defects in the lower leg and ankle, appropriate to the defect and following the course of blood vessels feeding the skin of a distally hinged fasciocutaneous flap most reliably based on the individual anatomy of distal perforators of the posterior tibial artery. Full thickness soft tissue defects, up to 12 cm in length and up to 8 cm in width. Sufficient vascularization of the foot required, in osteomyelitis, and when joints, fractures, implants and tendons are exposed and when a split skin graft, a local flap, a suralis perforator flap or a free flap is not indicated. For patients, in whom a 1-2 h operation is not possible; necessity of angioplasty; decollement or scars around the distal perforators of the posterior tibial artery; local infection or necrosis of soft tissues and/or bone, which cannot be totally excised. Radical debridement; flap dissection without tourniquet; microdissection; design of the flap on the skin: pivot point ~ 10 cm (6-14 cm) proximal of the tip of the medial malleolus; base ~ 5 cm in width, between the course of the saphenous nerve and of the great saphenous vein and the Achilles tendon; adipofascial pedicle up to 15 cm in length sited over the septum between soleus and flexor digitorum muscles, following the course of the saphenous nerve, with a central skin stripe, which expands into a proximal skin island; skin island is outlined similar to the defect, but larger by 1 to 2 cm, surrounded by an adipofascial border: adjustment of the planning as well as of the elevation of these flaps according to the individual position and the caliber of perforators requires in each case the search for a perforator at the estimated pivot point. Delay of transposition, if the division of more than one perforator proximal to the pivot point obviously diminishes circulation. No "tunnelling "of the pedicle; defects of skin due to the elevation of the flap are replaced by split and meshed skin grafts or temporary

  14. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap...... to reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized...... adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  15. Reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Yadav Mukesh

    2009-01-01

    Full Text Available Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  16. LaPlace's law revisited: Cecal perforation as an unusual presentation of pancreatic carcinoma

    Directory of Open Access Journals (Sweden)

    Cason Frederick D

    2007-02-01

    Full Text Available Abstract Background Pancreatic cancer is often locally and distally aggressive, but initial presentation as cecal perforation is uncommon. Case presentation We describe a patient presenting with pneumoperitoneum, found at initial exploration to have a cecal perforation believed to be secondary to a large cecal adenoma, after palpation of the remainder of the colon revealed hard stool but no distal obstruction. Postoperatively, however, the patient progressed to large bowel obstruction and upon reexploration, a mass could now be delineated, encompassing the splenic flexure, splenic hilum, and distal pancreas. Histological evaluation determined this was locally invasive pancreatic adenocarcinoma, and therefore the true etiology of the original cecal perforation. Conclusion Any perforation localized to the cecum must be highly suspicious for a distal obstruction, as dictated by the law of LaPlace.

  17. Spontaneous neonatal gastrointestinal perforation: surgical or ...

    African Journals Online (AJOL)

    ... cases of spontaneous gastrointestinal perforation in neonates at the University of Benin Teaching Hospital, Benin City. The perinatal stress factors were caesarian delivery, prematurity and fetal distress due to prolonged obstructed labour.

  18. Faecal loading in the cecum as a new radiological sign of acute appendicitis

    International Nuclear Information System (INIS)

    Petroianu, Andy

    2005-01-01

    Purpose: Although the radiological features of acute appendicitis have been well documented, the value of the plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis and images of faecal loading in the cecum. Methods: Plain abdominal radiographs of 100 consecutive adult patients operated on acute appendicitis were assessed. The presence of faecal loading was registered. Results: The presence of faecal loading in the cecum occurred in 97 of the cases of acute appendicitis. Conclusion: This study seems to demonstrate that the presence of radiological images of faecal loading in the cecum may be a useful sign of acute appendicitis

  19. Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps.

    Science.gov (United States)

    Manahan, Michele A; Prucz, Roni B; Shridharani, Sachin M; Baltodano, Pablo A; Rosson, Gedge D

    2014-11-01

    As the science of breast reconstruction evolves, significant changes in reconstruction strategies and outcomes are expected. The purpose of this study is to determine the changes in breast reconstruction trends and outcomes that occurred at a multidisciplinary academic institution during the last decade. We compared 265 patients over two distinct 6-month intervals separated by 5 years (2002 vs. 2007) and performed long-term follow-up (4.75 ± 3.38 years 2002, 2.99 ± 2.25 years 2007). We studied patients seeking prophylactic mastectomy, patients with early breast cancer, and patients with locally advanced disease. We analyzed demographic data, breast cancer history and treatment, type and timing of reconstruction, and complications. Implant to flap reconstruction ratio was 48:49 in 2002 and 76:102 in 2007. Use of transverse rectus abdominis myocutaneous flap declined from 57 to 4%; conversely, deep inferior epigastric perforator flap increased from 27 to 91% (P < 0.001). Correspondingly, donor site chronic pain (4 vs. 0, P = 0.012) and postoperative abdominal wall bulge (9 vs. 3, P = 0.004) rates decreased. Timing of reconstruction showed increased staged cases in 2007 compared to 2002 (P = 0.045). Post-final reconstruction radiation therapy was reduced in 2007 (P = 0.016), with subsequent lower rates of implant rupture (P < 0.001). At our institution and over the last decade, increasing staged reconstructions have successfully reduced the rates of post-final reconstruction radiotherapy with optimized outcomes. Contrary to national trends, the rates of autologous flap reconstructions have increased with reduced donor site morbidity. This suggests that academic breast reconstruction trends are independent from national trends. © 2014 Wiley Periodicals, Inc.

  20. Nontraumatic terminal ileal perforation

    Directory of Open Access Journals (Sweden)

    Wani Rauf A

    2006-03-01

    Full Text Available Abstract Background There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. Methods This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. Results There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%, nonspecific inflammation(26%, obstruction(6%, tuberculosis(4% and radiation enteritis (1%. Simple closure of the perforation (49% and end to side ileotransverse anastomosis(42% were the mainstay of the surgical management. Conclusion Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula.

  1. Optimization of geometrical characteristics of perforated plates

    International Nuclear Information System (INIS)

    Radisavljevic, Igor; Balos, Sebastian; Nikacevic, Milutin; Sidjanin, Leposava

    2013-01-01

    Highlights: ► Perforated plate are tested against 12.7 mm API projectile. ► Perforations similar to the projectile diameter offer more efficient core fracture. ► Larger perforations gave a more efficient core fragmentation. ► SEM microscopy analysis has shown a ductile fracture mode at impact point. - Abstract: In this paper, an attempt was made to design effective non-homogenous armor in form of perforated plate mounted at close distance from basic armor plate. Perforated plate with three perforation diameters: 9, 10 and 11 mm, two ligaments length: 3.5 and 4.5 mm ligaments, set at 0° and 28° angles, were combined to 13 mm basic plate and tested against 12.7 mm API ammunition. It has been shown that larger perforations gave a more efficient core fragmentation, while angled specimens were the only ones that offer full protection against five API shots when the perforated plate was placed at 100 mm from the basic plate. Perforations that are similar in size to the penetrating core diameter offer a more efficient core fracture, leading to a faster fragment separation. This may enable a smaller distance between the add-on perforated and basic plate to be used. Scanning electron microscopy analysis has shown a ductile fracture mode at impact point, with hardness values on plate basic level. On the other hand, a brittle fracture mode with a rise in local hardness measured near impact point is a result of intensive high speed plastic deformation produced by bending stresses. A drop in local hardness measured near impact point, may be the result of intensive cracking that occur due to repeated projectile impact

  2. Perforations during contrast enema

    International Nuclear Information System (INIS)

    Vogel, H.; Steinkamp, U.; Grabbe, E.; Allgemeines Krankenhaus Ochsenzoll, Hamburg

    1983-01-01

    During contrast enema, perforation into the retroperitoneal space can be differentiated from perforation into the peritoneum and perforation into the intestinal wall associated with formation of barium granulomas or submucosal spreading of the contrast medium. Other special forms are perforation with contrast medium embolism of diverticula; of the processus vermiformis; penetration of contrast medium into fistulous systems and from the operated areas. Risk factors are: balloon catheter, intestinal tubes with a hard tip, preternatural anus, excessive enema pressure, contrast medium additions, preceding manipulations, intestinal diseases, advanced age and delegation of manipulations to assistants and unskilled staff. Children are particularly at risk. (orig.) [de

  3. Typhoid Intestinal Perforation: 24 Perforations in One Patient

    African Journals Online (AJOL)

    Intestinal perforation is a common cause of peritonitis necessitating emergency surgical intervention. Perforation ... Mortality rates of typhoid intestinal perforation (TIP) cases are ... may be obscured clinical features with resultant delays in.

  4. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

    Science.gov (United States)

    Elliott, Jason E; Maslow, Ken D

    2012-02-01

    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

  5. CLINICAL STUDY AND MANAGEMENT OF BENIGN GASTROINTESTINAL PERFORATIONS

    Directory of Open Access Journals (Sweden)

    Kishan

    2016-05-01

    Full Text Available INTRODUCTION Peritonitis due to gastrointestinal perforation is one of the commonest surgical emergencies encountered by a general surgeon. (1,2 Mortality and morbidity is still very high despite early diagnosis and intensive management. This study is aimed to find common causes of perforations, its presentations, mode of investigations and treatment done and outcome of patients. METHODS Case records of all patients, in exclusion and inclusion criteria, who were admitted in emergency surgical ward with suspected GI perforation and peritonitis were included in study and diagnosis confirmed by either investigations preoperatively or by laparotomy and results analysed over a period of 16 months. RESULTS GI perforations due to benign causes are most common causes of peritonitis, of which gastroduodenal perforations are commonest followed by appendicular perforation closely followed by infective perforations. CONCLUSION Benign causes of upper gastroduodenal perforations are common causes of peritonitis (2,3. Mortality increases with delay in presentation and treatment. Abdominal signs like guarding rigidity are present in majority of cases. X-ray erect abdomen was effective in detecting perforation in majority of cases. Surgery is the treatment in all cases of perforation.

  6. The Versatile Modiolus Perforator Flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    BACKGROUND: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our...... experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. METHODS: A cohort case series of 14 modiolus...... perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. RESULTS: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted...

  7. Perforated duodenal diverticulum caused by Bezoar: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Dept. of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2013-11-15

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

  8. Perforated duodenal diverticulum caused by Bezoar: A case report

    International Nuclear Information System (INIS)

    Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae

    2013-01-01

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

  9. Peptic ulcer perforation

    African Journals Online (AJOL)

    FinePrint

    2015-06-01

    Jun 1, 2015 ... Peptic ulcer perforation is one of the surgical complications of peptic ulcer ... Treatment can be operative or non-operative followed by proton .... chronic gastritis without evidence of ... inhibits pancreatic bicarbonate secretion.

  10. Bladder perforations in children

    African Journals Online (AJOL)

    2014-11-20

    Nov 20, 2014 ... Mean recovery time for patients was 15 days. ... fracture.[1,2] Isolated bladder perforations are rare, and they .... PA, perineal injury, pelvic fracture. Trauma .... Lower genitourinary injury and pelvic fractures in pediatric patients.

  11. Perforated peptic ulcer

    DEFF Research Database (Denmark)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M

    2015-01-01

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter...... need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research....

  12. Spectrum of Perforation Peritonitis

    Science.gov (United States)

    Chakma, Sujit M.; Singh, Rahul L.; Parmekar, Mahadev V.; Singh, K.H. Gojen; Kapa, Buru; Sharatchandra, K.H.; Longkumer, Amenla T.; Rudrappa, Santhosh

    2013-01-01

    Introduction: Perforation peritonitis mostly results from the perforation of a diseased viscus. Other causes of perforation include abdominal trauma, ingestion of sharp foreign body and iatrogenic perforation. The diagnosis is mainly based on clinical grounds. Plain abdominal X-rays (erect) may reveal dilated and oedematous intestines with pneumoperitoneum. Ultrasound and CT scan may diagnose up to 72% and 82% of perforation respectively. The present study was carried out to study various etiological factors, modes of clinical presentation, morbidity and mortality patterns of perforation peritonitis presented in the RIMS hospital, Imphal, India. Material and Methods: The study was conducted from September 2010 to August 2012 on 490 cases of perforation peritonitis admitted and treated in the Department of Surgery. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Results: A total of 490 patients of perforation peritonitis were included in the study, with mean age of 48.28 years. 54.29% patients were below 50 years and 45.71% patients were above 50 years. There were 54.29% male patients and 45.71% female patients. Only 30% patients presented within 24 hours of onset of symptoms, 31.43% patients presented between 24 to 72 hours and 38.57% patients presented 72 hours after the onset of symptoms. Mean duration of presentation was 54.7 hours. Overall 469 patients were treated surgically and 21 patients were managed conservatively. Overall morbidity and mortality recorded in this study were 52.24% and 10% respectively. PMID:24392388

  13. Current management of peptic ulcer perforations

    International Nuclear Information System (INIS)

    Menakuru, S.R.

    2004-01-01

    Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

  14. Left-sided incarcerated Amyand’s hernia with cecum and terminal ileum: a case report

    Directory of Open Access Journals (Sweden)

    Bekele K

    2017-10-01

    Full Text Available Kebebe Bekele,1 Desalegn Markos2 1Department of Surgery, School of Medicine, Madda Walabu University, Bale Robe, Ethiopia; 2Unit of Neonatology Nursing, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia Background: Amyand’s hernia, which is the presence of a normal or pathological appendix as a part of an inguinal hernia, is a rare clinical entity. We are reporting a very rare case of left-sided incarcerated Amyand’s hernia with cecum and terminal ileum involvement. Case presentation: A 4-year-old male child with left inguinal swelling of 2-year duration presented to Goba Referral Hospital. Two days before the patient visited our hospital, the swelling had become irreducible and caused severe groin pain. He had abdominal cramps, bilious vomiting, and mild abdominal distention, but passed feces. With the diagnosis of left-sided incarcerated inguinal hernia, the patient was investigated and prepared for surgical management. During the operative procedure, we identified the presence of appendix, cecum, and terminal ileum in the scrotum as the herniated component. After the sack was dissected, since there was also appendicitis, an appendectomy was performed. Then, high ligation of sack was done after cecum and ileum were reduced. After 3 uneventful postoperative days in the hospital, the patient was discharged. The patient was followed-up for 6 months, and he did not develop any complications. Conclusion: Left-sided incarcerated Amyand’s hernia with cecum and terminal ileum involvement is a rare clinical entity. Even though it is not common, appendicitis is one of the comorbidities that can be seen in patients with left-sided incarcerated Amyand’s hernia with cecum and terminal ileum. Surgeons should have a high index of clinical suspicion and be aware of the potential involvement of appendix, cecum, and ileum as part of an incarcerated hernia during surgery, even in the left inguinal region. In this case, left

  15. Perforated gastric and duodenal ulcers in an urban African population

    African Journals Online (AJOL)

    Background: Perforations of the stomach and duodenum are frequent causes of acute generalized peritonitis in our environment. This is a prospective study of 331 cases of gastric and duodenal perforations. Study design: A consecutive series of adult patients admitted and treated for acute generalized peritonitis due to ...

  16. Contact lens rehabilitation following repaired corneal perforations

    Science.gov (United States)

    Titiyal, Jeewan S; Sinha, Rajesh; Sharma, Namrata; Sreenivas, V; Vajpayee, Rasik B

    2006-01-01

    Background Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. Method Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. Results Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of ≥ 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 ± 0.13 while the same with contact lens was 0.58 ± 0.26. All the patients showed an improvement of ≥ 2 lines over spectacles in the snellen's acuity chart with contact lens. Conclusion Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries. PMID:16536877

  17. Fetal extraperitoneal rectal perforation: a case report

    African Journals Online (AJOL)

    Buttock swelling from a perineal hernia through a levator ani defect has been reported previously [12]. There have also been similar presentations due to rupture of rectal diverticular duplications [6]. Apart from the embryological causes, rectal perforation has been also reported because of rectal thermometers or probes and ...

  18. Primary non-Hodgkin lymphoma of the cecum. A case report

    International Nuclear Information System (INIS)

    Kropivnik, M.; Jamar, B.; Cernelc, B.

    2002-01-01

    Background. Primary lymphoma of the colon is rare, constituting 0.4% of primary colonic malignancies and usually involves cecum or rectum. The aim of this paper is to present the role and the importance of double contrast barium enema (DCBE) in the diagnostic process. Case report. A 77 years old male was admitted because of suspected inflammation in the area of total endoprosthesis of the left hip, inserted ten years before. Listeria monocytogenes was isolated from the aspirate and the patient treated with antibiotics. Twenty years ago the patient underwent nephrectomy because of hypernephroma of left kidney. At the time of admission he had sideropenic anaemia and he was febrile. Conclusion. The patient underwent many diagnostic procedures: ultrasound (US), computed tomography (CT), double contrast barium enema, which showed a tumour in the cecum, small bowel follow-through and scintigraphy. The diagnosis of primary non-Hodgkin lymphoma was established by histology after biopsy at colonoscopy. (author)

  19. Prognostic significance of adjuvant radiation therapy in adenocarcinoma of the cecum

    Science.gov (United States)

    Hosseini, Sare; Bananzadeh, Ali Mohammad; Mohammadianpanah, Mohammad; Salek, Roham; Taghizadeh-Kermani, Ali

    2018-01-01

    Purpose Local recurrence is a common failure pattern in adenocarcinoma of the cecum. This study aimed to investigate the potential role of adjuvant radiation therapy on oncologic outcomes of patients with adenocarcinoma of the cecum. Materials and Methods This retrospective study was carried out at three large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of 162 patients with adenocarcinoma of the cecum that were treated and followed up between 2000 and 2013. All the patients had undergone a right hemicolectomy and received chemotherapy with (n = 48) or without (n = 114) adjuvant radiation therapy. Results The subjects were 65 females and 97 males with a median age of 56 years (range, 17 to 90 years) at diagnosis. The 5-year local control (LC), disease free survival (DFS), and overall survival (OS) rates were 72.7%, 57.2%, and 62.6% respectively. In a multivariate analysis, age, tumor stage, node stage, and adjuvant radiation therapy were determined to be independent prognostic factors. Age more than 55 years (hazard ratio [HR] = 1.0; 95% confidence interval [CI], 0.06–0.32; p = 0.003], T4 stage (HR = 6.8; 95% CI, 3.07–15.36; p < 0.001), node positive disease (HR = 4.2; 95% CI, 1.94–9.13; p < 0.001), and the absence of adjuvant radiation therapy (HR = 3.0; 95% CI, 1.39–6.46; p = 0.005) had a negative influence on OS. Conclusion Adjuvant radiation therapy significantly improves DFS and OS in patients with adenocarcinoma of the cecum. PMID:29506326

  20. TH17, TH22 and Treg cells are enriched in the healthy human cecum.

    Directory of Open Access Journals (Sweden)

    Martin J Wolff

    Full Text Available There is increasing evidence that dysregulation of CD4(+ T cell populations leads to intestinal inflammation, but the regional distribution of these populations throughout the intestinal tract in healthy individuals remains unclear. Here, we show that T(H17, T(H22 and T(Reg cells are enriched in the healthy human cecum compared to the terminal ileum and sigmoid colon, whereas T(H1 and T(H2 cells do not significantly vary by location. Transcriptional profiling analysis of paired pinch biopsies from different regions of the intestine identified significant differences in the metabolic state of the terminal ileum, cecum, and sigmoid colon. An increased proportion of T(H17 cells was positively associated with expression of resistin (RETN and negatively associated with expression of trefoil factor 1 (TFF1. These results suggest that CD4(+ T helper cells that are important in maintaining mucosal barrier function may be enriched in the cecum as a result of metabolic differences of the surrounding microenvironment.

  1. Perforated peptic ulcer.

    Science.gov (United States)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M; Bingener, Juliane; Møller, Morten H; Ohene-Yeboah, Michael; Søreide, Jon Arne

    2015-09-26

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. Clinical prediction rules are used, but accuracy varies with study population. Early surgery, either by laparoscopic or open repair, and proper sepsis management are essential for good outcome. Selected patients can be managed non-operatively or with novel endoscopic approaches, but validation of such methods in trials is needed. Quality of care, sepsis care bundles, and postoperative monitoring need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. CLINICAL STUDY OF APPENDICULAR PERFORATION IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Venkata Anantha Lakshmi Manabala

    2016-06-01

    Full Text Available INTRODUCTION Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. In early 1900s, Ochsner in Chicago and Sherren at the London Hospital were both advocates of conservative treatment in late cases. Appendicular perforation is a serious complication in view of the ensuing peritonitis with the consequent sequelae and morbidity. AIM To study the incidence, morbidity and sequelae of appendicular perforation. MATERIALS & METHODS This is a prospective study done in our hospital where 110 cases of peritonitis due to appendicular perforation were selected for our study. All the cases where peritonitis was due to appendicular perforation at laparotomy were included. The study period was from January 2014 to December 2015. The cases of peritonitis due to other causes like duodenal, gastric, enteric perforation were excluded. Patients with acute abdominal emergency with clinical diagnosis of peritonitis were examined carefully with detailed history and clinical examination. Necessary investigations were done and patients taken up for emergency surgery. CONCLUSIONS Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. Age incidence of appendicular perforation is maximum in the age group of 21–30 years. Next common age group is 31–40 yrs. Incidence is more in males. Male to female ratio is 2.4:1. Pain abdomen, vomiting, fever and anorexia were common symptoms in all the patients. Majority of the patients came late to the hospital accounting for the cause of perforation and subsequent mortality and morbidity.

  3. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S

    2015-01-01

    BACKGROUND: Perforating vessels are a consistent anatomical finding and well described in the current literature. Any skin flap can be raised on a subcutaneous pedicle as long as it contains at least one supplying perforator. Perforator flaps have been interlinked with microsurgery and generally...... not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled...... perforator flaps for moderate-sized defects of the truncus and extremities. We registered indications, flap size and localization, success rate, and complications. Most importantly, we describe a simple approach to the design of freestyle pedicled perforator flaps and elaborate on technical aspects...

  4. Risk of surgical glove perforation in oral and maxillofacial surgery.

    Science.gov (United States)

    Kuroyanagi, N; Nagao, T; Sakuma, H; Miyachi, H; Ochiai, S; Kimura, Y; Fukano, H; Shimozato, K

    2012-08-01

    Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Perforated peptic ulcer

    Science.gov (United States)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M.; Bingener, Juliane; Møller, Morten H.; Ohene-Yeboah, Michael; Søreide, Jon Arne

    2015-01-01

    Summary Perforated peptic ulcer (PPU) is a frequent emergency condition worldwide with associated mortality up to 30%. A paucity of studies on PPU limits the knowledge base for clinical decision-making, but a few randomised trials are available. While Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are frequent causes of PPU, demographic differences in age, gender, perforation location and aetiology exist between countries, as do mortality rates. Clinical prediction rules are used, but accuracy varies with study population. Early surgery, either by laparoscopic or open repair, and proper sepsis management are essential for good outcome. Selected patients can perhaps be managed non-operatively or with novel endoscopic approaches, but validation in trials is needed. Quality of care, sepsis care-bundles and postoperative monitoring need further evaluation. Adequate trials with low risk of bias are urgently needed for better evidence. Here we summarize the evidence for PPU management and identify directions for future clinical research. PMID:26460663

  6. Regulation of serotonin release from enterochromaffin cells of rat cecum mucosa

    International Nuclear Information System (INIS)

    Simon, C.; Ternaux, J.P.

    1990-01-01

    The release of endogenous serotonin or previously taken up tritiated serotonin from isolated strips of rat cecum mucosa containing enterochromaffin cells was studied in vitro. Release of tritiated serotonin was increased by potassium depolarization and was decreased by tetrodotoxin, veratridine and the absence of calcium. Endogenous serotonin was released at a lower rate than tritiated serotonin; endogenous serotonin release was stimulated by potassium depolarization but was unaffected by tetrodotoxin, veratridine or the absence of calcium. Carbachol, norepinephrine, clonidine and isoproterenol decreased release of tritiated serotonin but had less or reverse effect on release of endogenous serotonin. The results suggest two different serotoninergic pools within the enterochromaffin cell population

  7. CT findings of perforated appendicitis: comparison of child and adult patient

    International Nuclear Information System (INIS)

    Koo, Jin Hoi; Kim, Mi Young; Choi, Young Woo; Joo, Ji Sun; Kim, Won Hong; Suh, Chang Hae; Cho, Young Up

    1998-01-01

    To evaluate the CT findings of patients with surgically confirmed perforated appendicitis and to compare the characteristics between children and adults. Patients in whom complicated appendicitis was clinically suspected underwent contrast enhanced CT scanning. The scans of 50 patients (19 children and 31 adults) with surgically confirmed perforated appendicitis were analysed. Without knowledge of operative findings, we retrospectively analyzed the CT findings with regard to:1) the detection of the appendiceal wall thickening;2) the presence of appendicolith;3) the size, features, and location of periappendical abscess;4) mesenteric fat infiltration and lymphadenopathy;5) wall thickening of the cecum and terminal ileum; and 6) ascites and free air. Appendiceal wall thickening was detected in seven children (37%) and 13 adults (42%) (p>0.05). Appendicolith was detected in 21 patients (42%) and was more frequent in children (13 cases, 68%) than in adults (8 cases, 26%). There were statistically significant differences between the two groups (p 0.05). Periappendiceal abscess with well-defined cyst was more frequent in children (17/19, 89%) than in adults (13/31, 42%) (p<0.05). The most commonly involved site was the midabdomen and pelvis in children (9/19, 47%), and the right lower quadrant in adults (18/31, 58%), (p<.05). Mesenteric lymph nodes were commonly detected in children, and cecal wall thickening in adults. The CT findings of perforated appendicitis included appendiceal wall thickening, appendicolith, periappendiceal abscess, mesenteric fat infiltration and enlargement of mesenteric lymph nodes, and thickening of the cecum wall Periappendiceal abscess with well-defined cyst in the midabdomen or pelvis was more frequent in children, as were appendicolith and enlargement of mesenteric lymph nodes.=20

  8. CT findings of exophageal perforation

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Jeong Nam; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Hahm, Chang Kok [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2002-09-01

    To determine which CT findings are useful for the early disgnosis of esophageal perforation, and on the basis of these findings, to assess the accuracy of prediction of the perforation site. A review of medical records indicated that between January 1995 and December 2001, 36 patients with esophageal perforation were admitted to our hospital. Thirteen of these [M:F=8:5, age; 28-69 (mean, 52.4) years], who had undergone CT chest scanning, were included in this study. The causes of esophageal perforation were trauma (n=5), infectious diseases (n=4), Boerhaave syndrome (n=1), lung cancer (n=1), esophageal cancer (n=1), and idiopathic. Two chest radiologists unaware of the clinical findings reviewed the CT scans and predicted whether the upper or lower esophagus was perforated. The most common CT finding was extraluminal air at the posterior mediastinum (n=11), while other findings included pulmonary consolidation (n=10), pleural effusion (n=7), discontinuity of the esophageal wall (n=6) and subcutaneous emphysema (n=4), fluid collection around the esophagus (n-4), esophageal wall thickening (n=4), pneumothorax (n=2), and lung abscess (n=2). The perforation site was accurately predicted in 76.9% of cases (10/13). The CT findings which help the diagnosis of esophageal perforation, and prediction of the sites at which it occurs, are extraluminal air of fluid collection, focal defect of the esophageal wall, and esophageal wall thickening.

  9. CT findings of exophageal perforation

    International Nuclear Information System (INIS)

    Heo, Jeong Nam; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Hahm, Chang Kok

    2002-01-01

    To determine which CT findings are useful for the early disgnosis of esophageal perforation, and on the basis of these findings, to assess the accuracy of prediction of the perforation site. A review of medical records indicated that between January 1995 and December 2001, 36 patients with esophageal perforation were admitted to our hospital. Thirteen of these [M:F=8:5, age; 28-69 (mean, 52.4) years], who had undergone CT chest scanning, were included in this study. The causes of esophageal perforation were trauma (n=5), infectious diseases (n=4), Boerhaave syndrome (n=1), lung cancer (n=1), esophageal cancer (n=1), and idiopathic. Two chest radiologists unaware of the clinical findings reviewed the CT scans and predicted whether the upper or lower esophagus was perforated. The most common CT finding was extraluminal air at the posterior mediastinum (n=11), while other findings included pulmonary consolidation (n=10), pleural effusion (n=7), discontinuity of the esophageal wall (n=6) and subcutaneous emphysema (n=4), fluid collection around the esophagus (n-4), esophageal wall thickening (n=4), pneumothorax (n=2), and lung abscess (n=2). The perforation site was accurately predicted in 76.9% of cases (10/13). The CT findings which help the diagnosis of esophageal perforation, and prediction of the sites at which it occurs, are extraluminal air of fluid collection, focal defect of the esophageal wall, and esophageal wall thickening

  10. Amyand’s hernia with acute gangrenous appendicitis and cecal perforation: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    William Kromka

    Full Text Available Introduction: An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. Presentation of case: A 46-year-old male with a right inguinal hernia of 2–3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain. The patient was diagnosed with an incarcerated right inguinal hernia and underwent emergent surgical repair. Intraoperatively a reactive fluid was found within the hernia sac that prompted an exploratory laparotomy for suspected bowel perforation. The hernia was then found to contain an inflamed gangrenous appendix with an inflamed and perforated cecum. An ileocecectomy and enteroenterostomy was performed and the hernia defect was repaired without mesh. Discussion: With an estimated incidence of only 1%, Amyand's hernias are rare and lack a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. To avoid potential morbidity and mortality, the surgeon must consider an Amyand's hernia on his or her differential when operating on inguinal hernias and be aware of the associated presentations, complications, and management schemes. Conclusion: There is a paucity of reports describing simultaneous appendicitis and cecal perforation within an Amyand's hernia. In our case, ileocecectomy and Bassini hernia repair with close follow-up led to a favorable outcome. Keywords: Amyand, Hernia, Appendicitis, Surgery, Case report, Ileocecectomy

  11. Perforated Meckel's diverticulum in omphalocele

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    Hanna Jin

    2017-02-01

    Full Text Available Meckel's diverticulum is a rare condition in neonates with reports of concurrent Meckel's diverticulum and omphalocele being few. Herein, we present a case of omphalocele associated with perforated Meckel's diverticulum.

  12. Perforated Meckel's diverticulum in omphalocele

    OpenAIRE

    Jin, Hanna; Han, Ji-Won; Oh, Chaeyoun; Kim, Hyun-Young; Jung, Sung-Eun

    2017-01-01

    Meckel's diverticulum is a rare condition in neonates with reports of concurrent Meckel's diverticulum and omphalocele being few. Herein, we present a case of omphalocele associated with perforated Meckel's diverticulum.

  13. Helicobacter pylori in gastroduodenal perforation

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    Bharat B Dogra

    2014-01-01

    Full Text Available Background:peptic ulcers were earlier believed to be caused by dietary factors, gastric acid, and stress. However, in 1983, Warren and Marshall identified the correlation between Helicobacter pylori (H. pylori and peptic ulcers. It is now well established that most of the peptic ulcers occur as a result of H. pylori infection. But the co-relation between perforated peptic ulcer and H. pylori infection is not yet fully established. Aims and objectives : to study the prevalence of H. pylori infection in patients with perforated peptic ulcer. Materials and methods: this was a prospective study carried out in all cases of perforated peptic ulcer reporting in surgical wards of a medical college during 2008-2010. A total of 50 cases, presenting as acute perforation of duodenum and stomach during this period, formed the study group. After resuscitation, all the cases were subjected to emergency exploratory laparotomy. The exact site of perforation was identified, biopsy was taken from the ulcer margin from 2-3 sites and the tissue was sent for H. pylori culture and histopathological examination. Simple closure of perforation, omentoplasty, thorough peritoneal lavage and drainage was carried out. Results: out of the 50 cases of perforated peptic ulcer, 38 happened to be males, and only 12 were females. The age of the patients ranged from 20 to 70 years. All the patients underwent only emergency laparotomy. As many as 46 cases (92% turned out to be positive for H. pylori and only four cases (8% were negative for this infection. Postoperatively, patients who were found to be positive for H. pylori were put on anti-H. pylori treatment. Conclusion: there was a high prevalence of H. pylori infection in patients with perforated gastroduodenal ulcers.

  14. Delayed Diagnosis of Pharyngeal Perforation following Exploding Tyre Blast Barotrauma

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    Samantha M. Field

    2014-01-01

    Full Text Available Introduction. Pharyngoesophageal perforation secondary to barotrauma is a rare phenomenon that can have serious complications if identified late. It is challenging to detect due to nonspecific symptoms. We present a case in which detection proved difficult leading to delayed diagnosis. Case Report. A 27-year-old mechanic presented with haemoptysis, dysphonia, and odynophagia after a car tyre exploded in his face. Flexible nasoendoscopy (FNE revealed blood in the pharynx, thought to represent mucosal haemorrhage. Initial treatment consisted of IV dexamethasone and antibiotics. After 3 days, odynophagia persisted prompting a CT scan. This revealed a defect in the posterior hypopharynx and surgical emphysema in the deep neck tissues. Contrast swallow confirmed posterior hypopharyngeal leak. NG feeding was commenced until repeated contrast swallow confirmed resolution of the defect. Discussion. Prompt nonsurgical management of pharyngoesophageal perforation has good outcomes but untreated perforation can have serious complications. FNE should be performed routinely, but only a contrast swallow can diagnose a functional perforation. Clinicians should have a high index of clinical suspicion when patients present with barotrauma and odynophagia. Patients should be kept nil by mouth until perforation has been excluded. Conclusion. When faced with cases of facial barotrauma, clinicians should have a low threshold for further imaging to exclude pharyngoesophageal perforation.

  15. Typhoid ileal perforation: a 13-year experience

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    Poras Chaudhary

    2015-07-01

    Full Text Available Typhoid fever is endemic in many developing countries with a high rate of complications. Aim of this study is to analyse epidemiological features, clinical presentations, complications and therapeutic outcomes of enteric perforation peritonitis diagnosed and treated in our hospital. Records of total number of 646 patients, who presented with perforation peritonitis due to enteric fever in the surgical emergency unit of Dr Ram Manohar Lohia hospital, New Delhi between January 2001 and December 2013, were reviewed retrospectively. Descriptive statistics was used to analyze the data. Out of 646 patients, 62 (9.59% presented in shock. Stomal, peristomal, local and systemic complications were high in these patients. Primary closure was done in 212 (33.12 patients, primary ileostomy was created in 410 (64.06 patients, and resection and anastomosis was done in 24 (3.75 patients. Thirteen patients (2.01% died of typhoid intestinal perforation. To prevent complications of typhoid fever, in addition to control sanitation, it is also important to control quackery and malpractices. Awareness and education about the disease, its nature and complications will also be of great help.

  16. Fouling Resilient Perforated Feed Spacers for Membrane Filtration

    KAUST Repository

    Kerdi, Sarah

    2018-04-24

    The improvement of feed spacers with optimal geometry remains a key challenge for spiral-wound membrane systems in water treatment due to their impact on the hydrodynamic performance and fouling development. In this work, novel spacer designs are proposed by intrinsically modifying cylindrical filaments through perforations. Three symmetric perforated spacers (1-Hole, 2-Hole, and 3-Hole) were in-house 3D-printed and experimentally evaluated in terms of permeate flux, feed channel pressure drop and membrane fouling. Spacer performance is characterized and compared with standard no perforated (0-Hole) design under constant feed pressure and constant feed flow rate. Perforations in the spacer filaments resulted in significantly lowering the net pressure drop across the spacer filled channel. The 3-Hole spacer was found to have the lowest pressure drop (50% - 61%) compared to 0-Hole spacer for various average flow velocities. Regarding permeate flux production, the 0-Hole spacer produced 5.7 L.m-2.h-1 and 6.6 L.m-2.h-1 steady state flux for constant pressure and constant feed flow rate, respectively. The 1-Hole spacer was found to be the most efficient among the perforated spacers with 75% and 23% increase in permeate production at constant pressure and constant feed flow, respectively. Furthermore, membrane surface of 1-Hole spacer was found to be cleanest in terms of fouling, contributing to maintain higher permeate flux production. Hydrodynamic understanding of these perforated spacers is also quantified by performing Direct Numerical Simulation (DNS). The performance enhancement of these perforated spacers is attributed to the formation of micro-jets in the spacer cell that aided in producing enough unsteadiness/turbulence to clean the membrane surface and mitigate fouling phenomena. In the case of 1-Hole spacer, the unsteadiness intensity at the outlet of micro-jets and the shear stress fluctuations created inside the cells are higher than those observed with

  17. Vitrectomy in double-perforation gunshot injury

    Directory of Open Access Journals (Sweden)

    Abd El Alim Mohamed A

    2013-11-01

    Full Text Available Ahmed Abd El Alim MohamedOphthalmology department, Ain Shams University, Cairo, EgyptObjective: This study sought to evaluate the result of pars plana vitrectomy in patients with gunshot wounds involving double perforation.Methods: This was a retrospective, noncomparative, interventional case series.Results: Eighteen patients (18 eyes with double-perforation gunshot injuries were treated from February 2010 to March 2012. The group included 16 men (88% and two women (11%; the mean age was 24 (15–33 years. In each case, vitrectomy was scheduled 1–6 weeks after repair of the entrance site. Associated retinal detachments were observed in two eyes (11%, retinal incarceration was observed surrounding the exit site in three eyes (16%, and retention of an intraocular foreign body was observed in two cases. After a follow-up period of 8 ± 2 months, two eyes (11% had achieved visual acuity (VA of 0.5, nine eyes (50% had achieved VA between 0.5 and 0.1, and seven eyes (38% had achieved VA between 0.1 and hand movement. The main reasons for functional failure (VA 0.1 to hand movement were macular dragging (due to fibrosis at the exit site near the macula in seven cases (38%, submacular hemorrhage in four cases (22%, and epimacular fibrosis in five cases (27%. All cases developed postoperative exotropia. One case (5% developed postoperative hemorrhage. No cases exhibited signs of postoperative redetachment.Conclusion: The outcome of pars plana vitrectomy in cases with double perforations is variable. Factors including the surgeon's skill level, the time to surgery, and the efficacy of the intraocular tamponade affect the postoperative outcome.Keywords: pars plana vitrectomy, gunshot injury, double perforation

  18. An unusual presentation of perforated appendicitis in epigastric region☆

    Science.gov (United States)

    Odabasi, Mehmet; Arslan, Cem; Abuoglu, Hasan; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, M.A. Tolga

    2013-01-01

    INTRODUCTION Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation. PRESENTATION OF CASE A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver. DISCUSSION While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality. CONCLUSION Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. PMID:24441442

  19. Genome sequence of Lactobacillus salivarius SMXD51, a potential probiotic strain isolated from chicken cecum, showing anti-campylobacter activity.

    Science.gov (United States)

    Kergourlay, Gilles; Messaoudi, Soumaya; Dousset, Xavier; Prévost, Hervé

    2012-06-01

    We report the draft genome sequence of Lactobacillus salivarius SMXD51, isolated from the cecum of healthy chickens showing an activity against Campylobacter--the food-borne pathogen that is the most common cause of gastroenteritis in the European Union (EU)--and potentially interesting features for a probiotic strain, explaining our interest in it.

  20. Perforated Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Jessa Baker

    2016-09-01

    Full Text Available History of present illness: A 53-year-old male with a history of daily alcohol abuse presented with sudden onset epigastric pain. The pain radiated to the right upper abdominal quadrant and was associated with shortness of breath and nausea. The patient’s vitals were notable for blood pressure of 181/107 and a heart rate of 124. He was in moderate distress and had a firm, distended abdomen with diffuse tenderness to palpation, without rebound or guarding. Significant findings: In the chest radiograph, there was obvious free air under the both the right diaphragm (above the liver and the left diaphragm, consistent with pneumoperitoneum. Discussion: A perforated ulcer is a surgical emergency. Overall mortality has been shown to be approximately 6.2%.1 Rapid diagnosis is essential as prognosis improves if treatment is initiated within the first six hours and worsens after 12 hours.2 The sensitivity for detecting pneumoperitoneum on plain radiography ranges from 50%-80%3-8 with specificity of 53%.7 An upright chest radiograph can detect as little as one to two milliliters of air.9,10 If free air is not seen on a posteroanterior (PA upright chest radiograph, an upright lateral chest radiograph can be obtained, which is more sensitive (98% sensitivity.8,11 About 10%-20% of ruptured ulcers will not present with visible free-air under the diaphragm on plain x-ray.12 In this case, given the free air seen on chest radiograph and peritoneal signs on exam, the patient was taken straight to the operating room for general surgery.

  1. Spectrum of perforation peritonitis in India--review of 504 consecutive cases.

    Science.gov (United States)

    Jhobta, Rajender Singh; Attri, Ashok Kumar; Kaushik, Robin; Sharma, Rajeev; Jhobta, Anupam

    2006-09-05

    Perforation peritonitis is the most common surgical emergency in India. The spectrum of etiology of perforation in Tropical countries continues to be different from its Western counterpart. The objective of the study was to highlight the spectrum of perforation peritonitis as encountered by us at Government Medical College and Hospital (GMCH), Chandigarh. Five hundred and four consecutive cases of perforation peritonitis over a period of five years were reviewed in terms of clinical presentation, operative findings and postoperative course retrospectively at GMCH, Chandigarh. The most common cause of perforation in our series was perforated duodenal ulcer (289 cases) followed by appendicitis (59 cases), gastrointestinal perforation due to blunt trauma abdomen (45 cases), typhoid fever (41 cases) and tuberculosis (20 cases). Despite delay in seeking medical treatment (53%), the overall mortality (10%) was favourably comparable with other published series though the overall morbidity (50%) was unusually high. In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tract perforations constitute the majority of cases in India. The increasing incidence of post-traumatic gastro-enteric injuries may be due to an increase in high speed motor vehicle accidents which warrant early recognition and prompt treatment to avoid serious complications and death.

  2. Spectrum of perforation peritonitis in India-review of 504 consecutive cases

    Directory of Open Access Journals (Sweden)

    Sharma Rajeev

    2006-09-01

    Full Text Available Abstract Background/objective Perforation peritonitis is the most common surgical emergency in India. The spectrum of etiology of perforation in Tropical countries continues to be different from its Western counterpart. The objective of the study was to highlight the spectrum of perforation peritonitis as encountered by us at Government Medical College and Hospital (GMCH, Chandigarh. Methods Five hundred and four consecutive cases of perforation peritonitis over a period of five years were reviewed in terms of clinical presentation, operative findings and postoperative course retrospectively at GMCH, Chandigarh. Results The most common cause of perforation in our series was perforated duodenal ulcer (289 cases followed by appendicitis (59 cases, gastrointestinal perforation due to blunt trauma abdomen (45 cases, typhoid fever (41 cases and tuberculosis (20 cases. Despite delay in seeking medical treatment (53%, the overall mortality (10% was favourably comparable with other published series though the overall morbidity (50% was unusually high. Conclusion In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tract perforations constitute the majority of cases in India. The increasing incidence of post-traumatic gastro-enteric injuries may be due to an increase in high speed motor vehicle accidents which warrant early recognition and prompt treatment to avoid serious complications and death.

  3. Peritonitis Aguda por Diverticulo Apendicular Perforado / Acute perforated diverticulum appendiceal peritonitis

    Directory of Open Access Journals (Sweden)

    Martinez Villalba N

    2015-11-01

    Full Text Available Appendix diverticular disease is a casual finding after appendectomies or pathological studies of surgical samples. Most patients are male adults between the fourth and fifth decade of life. 16 years old male consults for a 48 hours stitch pain in right iliac fossa of moderate intensity radiating to lower abdomen with nausea and fever, without vomiting or diarrhea. Presents lower abdominal pain with muscle guarding and pain on physical examination. Bowel sounds negative. Laboratory routine study shows leukocytosis with neutrophilia. A perforated diverticulum of about 15cm diameter is found during surgery in the middle third of the cecum appendix with 200cc purulent fluid in and multiple adhesions to transverse colon, omentum and small intestine. A conventional appendectomy is performed. Acute appendix diverticulitis is a rare entity and its finding is by casualty. It is important to consider it a differential diagnosis especially in the intraoperative treatment which in most cases does not differ from conventional appendectomy.

  4. CLINICAL STUDY OF DUODENAL PERFORATION

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    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  5. Optimization of the process of steel strip perforation and nickel platting for the purpose of elimination of trichloroethylene from the cleaning process of perforated steel strip

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    Petrović Aleksandra B.

    2009-01-01

    Full Text Available In the production of pocket type electrodes for Ni-Cd batteries perforation of proper steel strips and then nickel platting of perforated steel strips were made. In the nickel platting process, the organic solvent, trichloroethylene, has previously been used for cleaning. Due to the carcinogenic nature of trichloroethylene and the many operations previously required during cleaning, it was considered to do cleaning of perforated steel strips without use of the mentioned organic solvent. In the purpose of elimination of trichloroethylene from the cleaning process of perforated steel strips, the tests of perforation of steel strips with use of oils of different viscosity were made. It was shown that there was no dysfunction during the work of the perforation plants, meaning there was no additional heating of the strips, deterring of the steel filings, nor excessive wearing of the perforation apparatus. The perforation percent was the same irrelevant of the viscosity of the used oil. Before being perforated using the oils with different viscosity, the nickel platting steel strips were cleaned in different degreasers (based on NaOH as well as on KOH. It was shown that efficient cleaning without the use of trichloroethylene is possible with the use of oil with smaller viscosity in the perforated steel strips process and the degreaser based on KOH in the cleaning process, before nickel platting. It also appeared that the alkali degreaser based on KOH was more efficient, bath corrections were made less often and the working period of the baths was longer, which all in summary means less quantity of chemicals needed for degreasing of perforated steel strips.

  6. Foreign body causing perforation of the appendix in an African boy ...

    African Journals Online (AJOL)

    Abstract. Foreign bodies in the appendix are a rare but well described clinical entity and may cause perforation. Presented here is the case of a 13yr old Ugandan boy who had features of acute appendicitis, was sent for appendicectomy and during the operation was found to have perforation of the appendix due to a seed.

  7. A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

    Directory of Open Access Journals (Sweden)

    Kishore Babu

    2016-03-01

    Full Text Available INTRODUCTION Perforated duodenal ulcer, the most catastrophic complication was Associated with high mortality in the past due to late presentation of the patients, delay in surgery and lack of antibiotics. Various authors state that the incidence of peptic ulcer disease and perforation has been declining for the past 3 decades. Because of advances in the medical therapy of peptic ulcer with a wide range of drugs the management of peptic ulcer disease has been changing and the role of surgery has been declining. Perforation is usually seen in 3rd and 4th decades with a male preponderance and the epidemiological trend is not the same worldwide. Incidence is slightly declining in western countries. The present study has been done during the period between 2013 and 2014 in S. V. R. R. Government general hospital Tirupati. AIMS AND OBJECTIVES The aim of the present study is to analyze the probable factors for increase in incidence of duodenal ulcer perforation, with particular emphasis on assessment of impact of H2 receptor antagonists and Proton Pump inhibitors on the incidence of perforation. STUDY SETTING S. V. Medical College, Department of General Surgery, Tirupati. STUDY PERIOD Patients attending S. V. Medical College, Department of General Surgery with perforation during the period from November 2013 to October 2014. INCLUSION CRITERIA Patients between age group of more than 14 years presenting with pain abdomen and who are diagnosed to have peritonitis due to duodenal ulcer perforation. EXCLUSION CRITERIA Patients with peritonitis due causes other than duodenal ulcer. STUDY METHOD Prospective Observational study among the selected patients. Total numbers of peptic ulcer cases that were admitted in this hospital and treated either medically or surgically were noted. The details of their clinical history and findings, investigation reports, operative findings, post-operative complications were recorded. Simple closure was performed for all the

  8. MRI of perforated gall bladder

    International Nuclear Information System (INIS)

    Sood, B.; Jain, M.; Khandelwal, N.; Singh, P.; Suri, S.

    2002-01-01

    Gall bladder perforation is a dreaded complication of acute cholecystitis that, if not diagnosed early in the course, might have a poor prognosis. Both CT and ultrasonography have been used until now extensively for the diagnosis of acute cholecystitis, but diagnosis of perforation is always difficult. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is a better modality and should fare better than ultrasonography and CT, as demonstrated in our case. Magnetic resonance imaging demonstrates the wall of the gall bladder and defects to a much better advantage and more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities. We suggest that in the case of acute cholecystitis, if perforation is suspected and CT and ultrasonography are not conclusive, MR should be the modality of choice. It can be used as a first line of investigation; however, it might not be cost-effective. Copyright (2002) Blackwell Science Pty Ltd

  9. Laparoscopic treatment of perforated appendicitis

    Science.gov (United States)

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  10. Equivalent Young's Modulus of Perforated Shell with Square Penetration Pattern

    Energy Technology Data Exchange (ETDEWEB)

    Jhung, Myung Jo; Ryu, Yong Ho [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2011-05-15

    The analysis of a plate or shell perforated with a large number of holes, by finite element method for instance, was a very costly and time-consuming technique which solves only one particular problem. But it is possible to model the perforated plate or shell and to analyze it and it is no more time-consuming theses days due to the rapid development of the computer and software. However, if a perforated plate or shell is submerged in fluid it is almost impossible to model and analyze it as is and the fluid at the same time, which is needed to investigate the effect of the fluid structure interaction. The simplest way to avoid time consuming and costly analysis of perforated plate or shell submerged in fluid is to replace the perforated plate or shell by an equivalent solid one considering weakening effect of holes. Many authors have proposed experimental or theoretical method to solve this problem for the plate. Slot and O'Donnell determined the effective elastic constants for the thick perforated plates by equating strains in the equivalent solid material to the average strains in the perforated material. O'Donnell also presented those of thin perforated plates. These results are implemented in Article A-8000 of Appendix A to the ASME code Section III, which contains a method of analysis for flat perforated plates when subjected to directly applied loads or loadings resulting from structural interaction with adjacent members. Unfortunately the effective elastic constants for the perforated shell are not found in any references. Therefore in this study the modal characteristics of the perforated shell are investigated and the equivalent material properties of perforated shell are suggested by performing several finite element analyses with respect to the ligament efficiencies

  11. Duodenal perforation during percutaneous nephrolithotomy (PCNL ...

    African Journals Online (AJOL)

    A. Bansal

    2016-06-03

    Jun 3, 2016 ... Calculus;. Duodenum;. Injury;. Paediatric;. Percutaneous nephrolithotomy. Abstract. Introduction: Colonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. Observation: We report the ...

  12. Glove Perforations During Interventional Radiological Procedures

    International Nuclear Information System (INIS)

    Leena, R. V.; Shyamkumar, N. K.

    2010-01-01

    Intact surgical gloves are essential to avoid contact with blood and other body fluids. The objective of this study was to estimate the incidence of glove perforations during interventional radiological procedures. In this study, a total of 758 gloves used in 94 interventional radiological procedures were examined for perforations. Eleven perforations were encountered, only one of which was of occult type. No significant difference in the frequency of glove perforation was found between the categories with varying time duration.

  13. A case report of esophageal perforation: Complication of nasogastric tube placement

    Science.gov (United States)

    Isik, Arda; Firat, Deniz; Peker, Kemal; Sayar, Ilyas; Idiz, Oguz; Soytürk, Mehmet

    2014-01-01

    Patient: Male, 70 Final Diagnosis: Esophageal perforation Symptoms: Abdominal pain • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Esophageal perforation is a well-defined and severe clinical condition. There are several etiologies of esophagus perforation. Case Report: We report the case of a 70-year-old Caucasian man who underwent an emergency cholecystectomy due to acute cholecystitis. Two days after surgery, his condition deteriorated. Thorax computerized tomography revealed an esophageal perforation. Conclusions: Esophageal perforation due to nasogastric application is relatively rare but the consequences are potentially serious. The anatomy of the upper gastrointestinal system should be understood by all healthcare professionals involved in the treatment. PMID:24803977

  14. Study on modal characteristics of perforated shell using effective Young's modulus

    International Nuclear Information System (INIS)

    Jhung, Myung Jo; Yu, Seon Oh

    2011-01-01

    Research highlights: → The effective Young's modulus of perforated shell is proposed for modal analysis. → The penetration pattern is almost negligible for effective elastic constants. → The frequency of perforated shell decreases significantly due to the hole effect. - Abstract: For the perforated cylindrical shell submerged in fluid, it is almost impossible to develop a finite element model due to the necessity of the fine meshing of the shell and the fluid at the same time. This necessitates the use of solid shell with effective material properties. Unfortunately the effective elastic constants are not found in any references even though the ASME code is suggesting those for perforated plate. Therefore in this study the effective material properties of perforated shell are suggested by performing several finite element analyses with respect to the ligament efficiencies.

  15. Study on modal characteristics of perforated shell using effective Young's modulus

    Energy Technology Data Exchange (ETDEWEB)

    Jhung, Myung Jo, E-mail: mjj@kins.re.kr [Korea Institute of Nuclear Safety, 19 Guseong-dong, Yuseong-gu, Daejeon 305-338 (Korea, Republic of); Yu, Seon Oh [Korea Institute of Nuclear Safety, 19 Guseong-dong, Yuseong-gu, Daejeon 305-338 (Korea, Republic of)

    2011-06-15

    Research highlights: > The effective Young's modulus of perforated shell is proposed for modal analysis. > The penetration pattern is almost negligible for effective elastic constants. > The frequency of perforated shell decreases significantly due to the hole effect. - Abstract: For the perforated cylindrical shell submerged in fluid, it is almost impossible to develop a finite element model due to the necessity of the fine meshing of the shell and the fluid at the same time. This necessitates the use of solid shell with effective material properties. Unfortunately the effective elastic constants are not found in any references even though the ASME code is suggesting those for perforated plate. Therefore in this study the effective material properties of perforated shell are suggested by performing several finite element analyses with respect to the ligament efficiencies.

  16. Gastric cancer perforation: experience from a tertiary care hospital.

    Science.gov (United States)

    Kandel, Bishnu Prasad; Singh, Yogendra; Singh, Keshav Prasad; Khakurel, Mahesh

    2013-01-01

    Gastric cancer perforation can occurs in advanced stage of the disease and is often associated with a high morbidity and mortality. Peritonitis due to perforation needs emergency laparotomy and different surgical procedures can be performed for definitive treatment. Surgical procedures largely depend on the stage of the disease and general condition of the patient. This study was carried out to evaluate the outcome and role of different surgical procedures in gastric cancer perforation. Medical record of patients with gastric perforation, who were treated during ten years period, was reviewed retrospectively. Data regarding clinical presentation, surgical procedures, staging and survival of patients were obtained. Features suggestive of diffuse peritonitis were evident in all cases. The majority of the patients underwent emergency surgery except one who died during resuscitation. The majority of patients were in stage III and stage IV. Surgical procedure includes simple closure and omental patch in five patients, simple closure and gastrojejunostomy in nine patients, gastrectomy in six patients and Devine's antral exclusion in one patient. Surgical site infection was the most common (45.5%) postoperative complication. Four patients died within one month of the surgery. Three patients who underwent gastrectomy survived for one year and one patient survived for five years. Although gastric cancer perforation usually occurs in advanced stage of the disease, curative resection should be considered as far as possible.

  17. Early Management Experience of Perforation after ERCP

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    Guohua Li

    2012-01-01

    Full Text Available Background and Aim. Perforation after endoscopic retrograde cholangiopancreatography (ERCP is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations. Patients and Methods. Between November 2003 and December 2011, a total of 8504 ERCPs were performed at our regional endoscopy center. Sixteen perforations (0.45% were identified and retrospectively reviewed. Results. Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and 3 patients had a perforation of an afferent limb of a Billroth II anastomosis. All patients with perforations were recognized during ERCP by X-ray and managed immediately. One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage (ENBD, endoscopic retrograde pancreatic duct drainage (ERPD, gastrointestinal decompression, fasting, broad-spectrum antibiotics, and so on. All patients with perforation recovered successfully. Conclusions. We found that: (1 the diagnosis of perforation during ERCP may be easy, but you must pay attention to it. (2 Most retroperitoneal perforations can recover with only medical conservative treatment in early phase. (3 Most peritoneal perforations need surgery unless you can close the lesion up under endoscopy in early phase.

  18. A perforated diverticulum in Cushing's disease

    OpenAIRE

    de Havenon, Adam; Ehrenkranz, Joel

    2011-01-01

    We report a case of perforated colonic diverticulum in Cushing's disease. Although perforated diverticuli have been described in patients with Cushing's syndrome secondary to exogenous glucocorticoids, this complication has not been described in patients with Cushing's disease. Patients with hypercortisolism, from either exogenous or endogenous sources, should be monitored for diverticular perforation.

  19. Iatrogenic stomach perforation complicating unrecognized ...

    African Journals Online (AJOL)

    We report a case of 21-year-old male patient with traumatic diaphragmatic herniation of the stomach that is misdiagnosed as a hemo-pneumothorax with the resulting insertion of a chest tube causing iatrogenic perforation of the stomach and draining of gastric content into the pleural cavity. An emergency thoracotomy was ...

  20. Stress state in perforated plates

    International Nuclear Information System (INIS)

    Visner, J.

    1977-01-01

    The method is described of photoelastic measurement of stress concentration factors (s.c.f) in plates perforated by a square, triangular and diagonal grid of circular holes and loaded by uniaxial or biaxial tensile stress. A loading equipment which was developed and its modifications are described. Stress concentration factors found are compared with theoretical and experimental results given in references. (author)

  1. Perforated Peptic Ulcer: new insights

    NARCIS (Netherlands)

    M.J.O.E. Bertleff (Marietta)

    2011-01-01

    textabstractMuch has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often

  2. Effect of litter treatment on growth performance, intestinal development, and selected cecum microbiota in broiler chickens

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    Gilaneh Taherparvar

    2016-05-01

    Full Text Available ABSTRACT The objective of this study was to determine whether the type of bedding materials (sand, wood shavings, and paper and of two chemical amendments (lime and bentonite could interfere with litter quality (moisture, pH, and total bacterial counts, thereby influencing also the growth performance and the development of intestinal traits and cecum microbiota of chickens. Two hundred and seventy male Ross 308 broiler chickens were randomly assigned into nine treatment groups with three replicates per treatment. Broiler productive parameters, relative weight of different intestinal segments, content of cecal total bacterial counts (total aerobic bacteria, Lactobacilli, and coliforms, as well as litter moisture, pH, and total aerobic bacteria and coliforms counts, were assessed. Litter material, per se, did not significantly affect the productivity parameters at the end of the experimental period (42 days with the exception of protein efficiency. A significant trend was found among treatments with regard to weight gain and feed intake, with lower performance in birds on sand beddings. Litter pH was relatively homogenous between bedding types and amendments, but the moisture was significantly lower when sand was used. Litter type did not influence the relative weight of the different intestinal segments; however, the type of amendment affected the relative jejunum weight, which was increased in bentonite-treated litter. The use of lime and bentonite treatments may be helpful to decrease the differences in litter moisture associated with particular bedding materials. The tested amendments do not interfere with the productive performance of birds.

  3. Cecum lymph node dendritic cells harbor slow-growing bacteria phenotypically tolerant to antibiotic treatment.

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    Patrick Kaiser

    2014-02-01

    Full Text Available In vivo, antibiotics are often much less efficient than ex vivo and relapses can occur. The reasons for poor in vivo activity are still not completely understood. We have studied the fluoroquinolone antibiotic ciprofloxacin in an animal model for complicated Salmonellosis. High-dose ciprofloxacin treatment efficiently reduced pathogen loads in feces and most organs. However, the cecum draining lymph node (cLN, the gut tissue, and the spleen retained surviving bacteria. In cLN, approximately 10%-20% of the bacteria remained viable. These phenotypically tolerant bacteria lodged mostly within CD103⁺CX₃CR1⁻CD11c⁺ dendritic cells, remained genetically susceptible to ciprofloxacin, were sufficient to reinitiate infection after the end of the therapy, and displayed an extremely slow growth rate, as shown by mathematical analysis of infections with mixed inocula and segregative plasmid experiments. The slow growth was sufficient to explain recalcitrance to antibiotics treatment. Therefore, slow-growing antibiotic-tolerant bacteria lodged within dendritic cells can explain poor in vivo antibiotic activity and relapse. Administration of LPS or CpG, known elicitors of innate immune defense, reduced the loads of tolerant bacteria. Thus, manipulating innate immunity may augment the in vivo activity of antibiotics.

  4. Congenital Infantile Fibrosarcoma Causing Intestinal Perforation in a Newborn

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    Margarita Kaiser

    2017-01-01

    Full Text Available Congenital infantile fibrosarcoma (CIF is a rare malignant mesenchymal tumor and only 14 cases have been reported with gastrointestinal manifestation. We report about a female newborn delivered per emergency cesarean section at 34 weeks of gestation. Postnatally, she rapidly developed an acute abdomen and sonographic evidence of intestinal perforation requiring laparotomy on the first day of life. A perforated 2 × 3 cm sized spherical tumorous structure of the jejunum was identified. Due to unknown histopathology at this point and unclear resectional margins, she received a temporary ileostomy, which was closed two months later. Histopathology revealed a congenital intestinal fibrosarcoma without the characteristic ETV6-NTRK3 fusion transcript. In conclusion, this rare tumor must be considered as differential diagnosis of intestinal perforations in newborns.

  5. A Rare Cause of Acute Abdomen: Jejunal Diverticulosis with Perforation

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    Ibrahim Aydin

    2013-01-01

    Full Text Available Jejunal diverticulosis is generally asymptomatic and is associated with high morbidity and mortality secondary to complications, especially in elderly patients. We present a case report of a 74-year-old female patient with jejunal diverticulosis and perforation due to diverticulitis.

  6. A rare cause of acute abdomen: jejunal diverticulosis with perforation.

    Science.gov (United States)

    Aydin, Ibrahim; Pergel, Ahmet; Yucel, Ahmet Fikret; Sahin, Dursun Ali

    2013-01-01

    Jejunal diverticulosis is generally asymptomatic and is associated with high morbidity and mortality secondary to complications, especially in elderly patients. We present a case report of a 74-year-old female patient with jejunal diverticulosis and perforation due to diverticulitis.

  7. COMPARATIVE ANALYSIS OF PRIMARY REPAIR VERSUS RESECTION AND ANASTOMOSIS IN JEJUNOILEAL PERFORATIONS IN SOUTHERN ODISHA

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    Charan Panda

    2017-11-01

    Full Text Available BACKGROUND Small intestinal perforation remains a major issue in this region of study. Most often, it is caused by either infections due to typhoid, tuberculosis or traumatic due to blunt or penetrating injuries. The mortality reported is related to various factors including age, delayed treatment, sepsis at presentation and inadequate treatment due to lack of resources. Management is therefore complex not only with regards to choose the most suitable surgical treatment, but also as regards an early diagnosis of complications, which is difficult in absence of diagnostic modalities that are often not available. The aim of the study is to compare primary repair versus intestinal resection and anastomosis in case of jejunoileal perforations due to various aetiologies. MATERIALS AND METHODS 60 patients with acute peritonitis underwent emergency laparotomy. Aetiology, number of perforations, size of perforations, site of perforations, surgical procedure undertaken and postoperative complications were recorded. The patients were divided into two groups according to the surgical procedure adapted at laparotomy; primary repair and intestinal resection and anastomosis. Clinical data, intraoperative findings and complications were evaluated and compared. RESULTS 40 out of 60, we found jejunoileal perforations, gastroduodenal in 20 patients. 23 had undergone primary repair and 17 resection and anastomosis. Postoperative complications were compared among both groups in relation to various factors. Conclusion was drawn as to prefer, which surgery in which group of patients. CONCLUSION In our study, detailed analysis of the complication pattern shows primary closure is associated with less number of complications in traumatic cases and resection and anastomosis is associated with lesser complications in infective cases. Primary closure is less complicated for single perforations as compared to multiple perforations. Resection and anastomosis is less

  8. Case of colonic intussusception secondary to mobile cecum syndrome repaired by laparoscopic cecopexy using a barbed wound suture device.

    Science.gov (United States)

    Yamamoto, Tetsu; Tajima, Yoshitsugu; Hyakudomi, Ryoji; Hirayama, Takanori; Taniura, Takahito; Ishitobi, Kazunari; Hirahara, Noriyuki

    2017-09-21

    A 27-year-old man with recurrent right lower quadrant pain was admitted to our hospital. Ultrasonography and computed tomography examination of the abdomen revealed a target sign in the ascending colon, which was compatible with the diagnosis of cecal intussusception. The intussusception was spontaneously resolved at that time, but it relapsed 6 mo later. The patient underwent a successful colonoscopic disinvagination; there was no evidence of neoplastic or inflammatory lesions in the colon and terminal ileum. The patient underwent laparoscopic surgery for recurring cecal intussusception. During laparoscopy, we observed an unfixed cecum on the posterior peritoneum (i.e. a mobile cecum). Thus, we performed laparoscopic appendectomy and cecopexy with a lateral peritoneal flap using a barbed wound suture device. The patient's post-operative course was uneventful, and he continued to do well without recurrence at 10 mo after surgery. Laparoscopic cecopexy using a barbed wound suture device is a simple and reliable procedure that can be the treatment of choice for recurrent cecal intussusception associated with a mobile cecum.

  9. Comparison of differently viscous iodinated and bariumcontaining contrast agents in the detection of pharyngeal perforation

    International Nuclear Information System (INIS)

    Keberle, M.; Wittenberg, G.; Trusen, A.; Hahn, D.; Baumgartner, W.

    2001-01-01

    Purpose: In contrast to esophageal perforations, the more radiopaque barium-suspensions are not as important as iodinated aqueous contrast agents for the detection of pharyngeal perforations. This study was performed to find out whether the highly different viscosities (of iodinated and barium-containing contrast agents with comparable radiopacities) are a reason for this. Methods: Viscosity, subjective difference in contrast, and CT-density of an iodinated aqueous (Telebrix) and a 50 wt/vol% barium-containing contrast agent (Micropaque) were determined. Moreover, to exclude postoperative perforation, 104 patients were prospectively examined by pharyngography using both contrast media. Pharyngographies of patients with perforation were later compared by two independent readers. All patients with perforation were followed up clinically to exclude complications due to barium administration. Results: In-vitro comparison showed comparable radiopacity but the 50 wt/vol% barium-suspension was much more viscous that the iodinated contrast agent. During pharyngography, totally, 14 perforations were clearly delineated with the iodinated aqueous contrast agent. However, two of them were not detected with the barium-suspension. All the other perforations presented equally. Conclusions: Given a sufficient radiopacity, a low viscosity appears to be essential for a contrast agent to detect especially pharyngeal perforations. Thus, we recommend the sole use of an iodinated contrast agent (at suspicion of aspiration as isoosmolar variant) for this purpose. (orig.) [de

  10. Disseminated histoplasmosis presenting with ileal perforation in a renal transplant recipient.

    Science.gov (United States)

    Zainudin, B M; Kassim, F; Annuar, N M; Lim, C S; Ghazali, A K; Murad, Z

    1992-08-01

    A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.

  11. Perforated peptic ulcer - an update

    Science.gov (United States)

    Chung, Kin Tong; Shelat, Vishalkumar G

    2017-01-01

    Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer. PMID:28138363

  12. Perforated peptic ulcer - an update.

    Science.gov (United States)

    Chung, Kin Tong; Shelat, Vishalkumar G

    2017-01-27

    Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer.

  13. Combining rhinoplasty with septal perforation repair.

    Science.gov (United States)

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.

  14. CT in acute perforated sigmoid diverticulitis

    International Nuclear Information System (INIS)

    Lohrmann, Christian; Ghanem, Nadir; Pache, Gregor; Makowiec, Frank; Kotter, Elmar; Langer, Mathias

    2005-01-01

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning

  15. Fouling resilient perforated feed spacers for membrane filtration.

    Science.gov (United States)

    Kerdi, Sarah; Qamar, Adnan; Vrouwenvelder, Johannes S; Ghaffour, Noreddine

    2018-04-24

    The improvement of feed spacers with optimal geometry remains a key challenge for spiral-wound membrane systems in water treatment due to their impact on the hydrodynamic performance and fouling development. In this work, novel spacer designs are proposed by intrinsically modifying cylindrical filaments through perforations. Three symmetric perforated spacers (1-Hole, 2-Hole, and 3-Hole) were in-house 3D-printed and experimentally evaluated in terms of permeate flux, feed channel pressure drop and membrane fouling. Spacer performance is characterized and compared with standard no perforated (0-Hole) design under constant feed pressure and constant feed flow rate. Perforations in the spacer filaments resulted in significantly lowering the net pressure drop across the spacer filled channel. The 3-Hole spacer was found to have the lowest pressure drop (50%-61%) compared to 0-Hole spacer for various average flow velocities. Regarding permeate flux production, the 0-Hole spacer produced 5.7 L m -2 .h -1 and 6.6 L m -2 .h -1 steady state flux for constant pressure and constant feed flow rate, respectively. The 1-Hole spacer was found to be the most efficient among the perforated spacers with 75% and 23% increase in permeate production at constant pressure and constant feed flow, respectively. Furthermore, membrane surface of 1-Hole spacer was found to be cleanest in terms of fouling, contributing to maintain higher permeate flux production. Hydrodynamic understanding of these perforated spacers is also quantified by performing Direct Numerical Simulation (DNS). The performance enhancement of these perforated spacers is attributed to the formation of micro-jets in the spacer cell that aided in producing enough unsteadiness/turbulence to clean the membrane surface and mitigate fouling phenomena. In the case of 1-Hole spacer, the unsteadiness intensity at the outlet of micro-jets and the shear stress fluctuations created inside the cells are higher than those

  16. Intrathoracic Caecal Perforation Presenting as Dyspnea

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    Vincent Granier

    2010-01-01

    Full Text Available Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  17. Spontaneous ileal perforation complicating low anorectal malformation

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    TiJesuni Olatunji

    2015-01-01

    Full Text Available Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.

  18. Perforated peptic ulcer in an adolescent boy with acute appendicitis: a case report

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    Aazam Khorassani

    2013-06-01

    Full Text Available Background: Peptic ulcer disease is one of the most common GI disorders. Perforation has the highest mortality rate of any complication of ulcer disease, while early diagno-sis and emergency treatment save patient life.Case presentation: This paper reports an adolescent boy admitted to the Ziaeian University Hospital. He suffered from severe abdominal pain with dyspnea had been started since past three hours. Periumbilical pain started from past 2-3 days, gradually localized to the right lower quadrant. He had anorexia without nausea and vomiting. He was tachycardic and tachypneic, but he did not have fever. On physical examination, bowel sound was hypoactive, there was generalize tenderness, guarding and rebound tender-ness focused in the right lower quadrant and suprapubic region. Laboratory finding indicated leukocytosis. Chest X-ray showed free air under diaphragm. Once the diagno-sis has been made, the patient was given analgesia and antibiotics, resuscitated with isotonic fluid, and taken to the operating room. Laparotomy was implemented through a midline incision. There was bile secretion in the peritoneal cavity. Appendix was inflamated. Cecum and ileum were normal. A small perforation, 4mm in size was detected in first portion of duodenum. Appendectomy and omental patch repair were done. Ten days later, the patient was discharged in a good state. Serologic test for helicobacter pylori was negative.Conclusion: Stomach and duodenal perforation should be considered in patients with-out peptic ulcer disease, especially in children and adolescents with sudden and severe abdominal pain who are admitted to the hospital for other diseases. Because some patients present with peptic ulcer complications that are seemingly exacerbated by stressful life events.

  19. Perforated Gastric Ulcer Associated with Anti-Angiogenic Therapy

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    Diogo Libânio

    2017-08-01

    Full Text Available Anti-angiogenic therapy with bevacizumab, an inhibitor of vascular endothelial growth factor, is commonly used in metastatic colorectal cancer and is rarely associated with gastrointestinal perforation, perforation being more frequent in the primary tumor site or at the anastomotic level. We present the case of a 64-year-old male with stage IV rectal adenocarcinoma who was on palliative chemotherapy with FOLFOX and bevacizumab. After the 4th chemotherapy cycle, our patient started fever and epigastric pain. He was hemodynamically stable, and signs of peritoneal irritation were absent. There were no alterations in the abdominal X-ray, and C-reactive protein was markedly elevated. A CT scan revealed a de novo thickness in the gastric antrum. Upper digestive endoscopy showed an ulcerated 40-mm lesion in the angulus, with a 20-mm orifice communicating with an exsudative cavity revested by the omentum. A conservative approach was decided including fasting, broad-spectrum intravenous antibiotics, and proton-pump inhibitors. Subsequent gastroduodenal series showed no contrast extravasation, allowing the resumption of oral nutrition. Esophagogastroduodenoscopy after 8 weeks showed perforation closure. Biopsies did not show neoplastic cells or Heliobacter pylori infection. Although the success in the conservative management of perforation allowing the maintenance of palliative chemotherapy (without bevacizumab, the patient died after 4 months due to liver failure. The reported case shows an uncommon endoscopic finding due to a rare complication of anti-angiogenic therapy. Additionally, it reminds clinicians that a history of gastroduodenal ulcers should be actively sought before starting anti-angiogenic treatment and that suspicion for perforation should be high in these cases.

  20. Perforated Sigmoid Diverticular Disease: a Management Protocol

    Science.gov (United States)

    Moin, Thajammul

    2008-01-01

    Background: To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease. Methods: A search of the literature was undertaken. All publications pertaining to perforated sigmoid diverticular disease were analyzed and then categorized according to their level of evidence. Recommendations were then made on the basis of this. Results: Multiple case reports suggest that primary closure of perforation of sigmoid diverticula is safe in the absence of peritoneal contamination. Conclusions: A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease. PMID:18435896

  1. Isolated jejunal perforation following blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Ahmet Pergel

    2012-09-01

    Full Text Available Isolated perforation of the jejunum, following blunt abdominaltrauma, is extremely rare. These injuries aredifficult to diagnose because initial clinical signs are frequentlynonspecific and a delay in treatment increasesmortality and morbidity of the patients. Conventional radiogramsare often inadequate for diagnosing this subsetof trauma. For an accurate and timely diagnosis, thepossibility of bowel perforation and the need for repeatedexaminations should be kept in mind. Herein, we presenta 28-year-old man with isolated jejunal perforation followingblunt abdominal trauma.Key words: Blunt abdominal trauma, isolated jejunal perforation,early diagnosis

  2. Effects of L-glutamine supplementation on the myenteric neurons from the duodenum and cecum of diabetic rats

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    Jacqueline Nelisis Zanoni

    2011-03-01

    Full Text Available CONTEXT: Peripheral neuropathy is one of the chronic complications of diabetes mellitus and is directly related to gastrointestinal consequences of the disease. Myenteric neurons are affected in some pathological conditions such as diabetic neuropathy. The imbalance between cellular antioxidants and free radicals, leading to an increase in oxidative stress, is considered one of the main factors responsible for neuronal damages in diabetes. Drugs that reduce the oxidative stress may play a significant role in the treatment of neurological complications of diabetes mellitus. OBJECTIVE: To evaluate the effect of L-glutamine supplementation on the myenteric neurons from the cecum and duodenum of Wistar rats with streptozotocin-induced diabetes mellitus. METHODS: The animals were divided in four groups (n = 5: non-treated normoglycemics, normoglycemics treated with L-glutamine, non-treated diabetics and diabetics treated with L-glutamine from the 4th day of diabetes induction on. The amino acid L-glutamine was added to their diet at 1%. Giemsa's technique was employed to stain the myenteric neurons. We determined the cell body area of 500 neurons in each group studied. The quantitative analysis was performed by sampling in an area of 16.6 mm² in the cecum and 3.6 mm² in the duodenum of each animal. RESULTS: After the supplementation with L-glutamine in the duodenum, we observed a preservation of neuronal density in groups normoglycemic and diabetic (P<0.05. We also observed a preservation of the cell bodies area in diabetic animals (group treated with L-glutamine (P<0.05. In the cecum, that preservation was not evident. CONCLUSION: Supplementation with L-glutamine (1% promoted a neuroprotective effect on the myenteric neurons from the duodenum of rats, both in terms of natural aging and of diabetes mellitus.

  3. Marked Response in Microbial Community and Metabolism in the Ileum and Cecum of Suckling Piglets After Early Antibiotics Exposure

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    Miao Yu

    2018-05-01

    Full Text Available In modern swine husbandry systems, antibiotics have been used as growth promoters for piglets during suckling or weaning period. However, while early colonization of intestinal microbiota has been regarded crucial for the host’s later life performance and well-being, little is known about the impact of antibiotics on intestinal microbiota in suckling piglets. The present study aimed to investigate the effects of early antibiotics exposure on gut microbiota and microbial metabolism of suckling piglets. Sixteen litters of suckling piglets were fed a creep feed diet with (Antibiotic or without (Control antibiotics from postnatal days 7–23 (n = 8. The ileal and cecal digesta were obtained for microbial composition and microbial metabolites analysis. The results showed that the antibiotics significantly altered the bacterial community composition by decreasing (P < 0.05 the diversity and richness in the ileum. The antibiotics significantly reduced the abundance of Lactobacillus in both the ileum and cecum, increased the abundance of Streptococcus, unclassified Enterococcaceae, unclassified Fusobacteriales, and Corynebacterium in the ileum, and the abundance of unclassified Ruminococcaceae and unclassified Erysipelotrichaceae in the cecum. The antibiotics decreased (P < 0.05 ileal lactate concentration and cecal concentration of total short-chain fatty acids (SCFAs. But the antibiotics enhanced protein fermentation (P < 0.05 in the ileum and cecum, as ileal concentrations of putrescine and cadaverine, and cecal concentrations of isobutyrate, isovalerate, putrescine, cadaverine, spermine, and spermidine were significantly increased (P < 0.05. These results indicated that early antibiotics exposure significantly altered the microbial composition of suckling piglets toward a vulnerable and unhealthy gut environment. The findings provide a new insight on the antibiotics impact on neonates and may provide new framework for designing alternatives to the

  4. Right-sided hemicolectomy in 90-year-old patient with cecum cancer

    Directory of Open Access Journals (Sweden)

    A. M. Sidorenko

    2013-04-01

    Full Text Available A case of the disease and radical cure of colon cancer in woman aged 90 years is described. This case proves that the age of patient is not a contraindication for radical surgical treatment under conditions of the appropriate medical management tactics for such patients. Purpose of the work is to describe a case of radical treatment of cecum cancer in 90-year-old patient. It is generally known that most of the patients with malignant tumors are people of older age groups. According to WHO, men and women over the age of 60 years are considered the elderly ones, the period of old age is between 75 to 90 years, more than 90 years - long-lived persons. Currently, the main treatment of malignant tumors is surgical. The age changes in basal metabolism, reducing of compensatory-adaptive capacity of cardiovascular and respiratory systems, liver and kidney are particularly important for the anesthesiologist. In 70 years the basal metabolic rate is 60% of normal, which means slowing down of metabolism and expression of anesthetics. The total water content of the body is reduced by 20% on average. Aging is accompanied by loss of elasticity of the arterial bed, decreased volume of hemodynamic parameters (cardiac output is 60% of the performance of 30-year-old persons. The cardiovascular system in elderly people loses the ability to adapt to tachycardia, a sudden increase in load. Also, there is the high probability of thromboembolic complications after surgery or prolonged immobilization. Severe stiffness and deformity of the chest, fibrotic changes in the bronchial tree develop in old people, decreased lung compliance leads to poor oxygenation of the body. Pulmonary fibrosis and emphysema with changes in the number of alveoli and lung surface on the whole develop in all the elderly patients, production of surfactant and drainage function of the bronchial tubes deteriorates, which contributes to the development of atelectasis. Reduced lung capacity

  5. Microbial community composition of the ileum and cecum of broiler chickens as revealed by molecular and culture-based techniques

    DEFF Research Database (Denmark)

    Friis-Holm, Lotte Bjerrum; Engberg, R.M.; Leser, T.D.

    2006-01-01

    The microbial communities of the ileum and cecum of broiler chickens from a conventional and an organic farm were investigated using conventional culture techniques as well as cloning and sequencing of 16S rRNA genes. Eighty-five percent of the 557 cloned sequences were ...% of the cecal clones belonged to this cluster in conventional and organic broiler chickens, respectively. We were, however, able to recover a number of these phylotypes by cultivation, and the isolates were shown to be butyric acid producers. The investigation was a descriptive rather than a comparative study...

  6. Possible cause underlying gastric necrosis and perforation: Celiac artery thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet Peker

    2017-12-01

    Full Text Available In this article, we are sharing a case of a 76-year-old woman with known hypertension, atrial fibrillation,diabetes mellitus, coronary artery disease, who is presenting with stomach necrosis and perforation possibly due to celiac artery thrombosis after newly developed abdominal pain and bloody vomiting. In our case, emergency surgery was planned and the patient refused the operation and was lost at 48 hours of clinical follow-up. We aimed to discuss the etiology of celiac artery thrombosis, briefly. We believe that necrosis and perforation of the stomach due to celiac artery thrombosis deserves to be shared because it is a rare and difficult case to manage.

  7. Neurodevelopmental outcome after neonatal perforator stroke

    NARCIS (Netherlands)

    Ecury-Goossen, Ginette M; van der Haer, Marit; Smit, Liesbeth S; Feijen-Roon, Monique; Lequin, Maarten; de Jonge, Rogier C J; Govaert, Paul; Dudink, Jeroen

    AIM: To assess outcome after neonatal perforator stroke in the largest cohort to date. METHOD: Survivors from a cohort of children diagnosed with neonatal perforator stroke using cranial ultrasound or magnetic resonance imaging were eligible for inclusion. Recovery and Recurrence Questionnaire

  8. Hyperbilirubinemia as a predictor for appendiceal perforation

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, H C; Rosenberg, J

    2013-01-01

    Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum...

  9. Performance Study of Solar Air Heater Having Absorber Plate with Half-Perforated Baffles

    OpenAIRE

    Maheshwari, B. K.; Karwa, Rajendra; Gharai, S. K.

    2011-01-01

    The paper presents a detailed mathematical model for performance prediction of a smooth duct solar air heater validated against the experimental results. Experimental study on a solar air heater having absorber plate with half-perforated baffles on the air flow side shows thermal efficiency enhancement of 28%–45% over that of the smooth duct solar air heater, which is attributed to the heat transfer enhancement (of the order of 180%–235%) due to the perforated baffles attached to the absorber...

  10. Intestinal perforation in a two-year-old child with eosinophilic gastroenteritis

    DEFF Research Database (Denmark)

    Agertoft, A; Husby, S; Høst, A

    1991-01-01

    A two-year-old boy underwent a laparatomy for an intestinal perforation due to eosinophilic gastroenteritis. He had marked peripheral blood eosinophilia and a small duodenal biopsy showed heavy eosinophilic infiltration in the mucosa. After 1 1/2 year on a restricted diet, a control duodenal biopsy...... showed only slight eosinophilia. Perforation of the small intestine is a rare but serious complication in eosinophilic gastroenteritis....

  11. Spontaneous gastric ulcer perforation and acute spleen infarction caused by invasive gastric and splenic mucormycosis

    Directory of Open Access Journals (Sweden)

    Mushira Abdulaziz Enani

    2014-01-01

    Full Text Available Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction.

  12. Morphological Studies on the Postnatal Development of the Gut-associated Lymphoid Tissues of the Rabbit Cecum

    Directory of Open Access Journals (Sweden)

    Abdelmohaimen M. Saleh

    2012-10-01

    Full Text Available The macroscopic, morphometric, light and scanning electron microscopic structure of gut-associated lymphoid tissue (GALT of cecum were studied in the rabbits aged from birth to 16 weeks. The GALT were formed of lymph follicles covered by low columnar epithelium containing intraepithelial lymphocytes and leukocytes. They were concentrated at the ileocecal entrance (ileocecal patch and in the blind end of the cecum vermiform appendix. In the ileocecal patch, GALT were in direct contact with the lumen, while those of the appendix were covered by the interval intestinal villi in young rabbits and mucosal folds in the adult rabbits. The lymphoid follicles of the ileocecal patch were composed of dome region and germinal center and were separated by narrow inter-follicular areas. Whereas, the lymphoid follicles of the appendix were composed dome region and germinal center in the newly born rabbits and up to the 2nd week of age, the follicles became composed of four different sites: dome region, germinal center, coronal area, and a wide interfollicular area between neighboring follicles. Morphometrically; the dimensions of the lymphoid follicles of the cecal GALT increased in size with the advancement of the age. By SEM the lymphoid structures covered with special epithelium consisted of two types of cell absorptive enterocytes and M cells. The M cells in the cecal patch were microvilliated and present on the tips and sides of the dome lymphoid regions while in the appendix were non-microvilliated and present only on the sides of the dome regions.

  13. Laparoscopic pyloroplasty for perforated peptic ulcer.

    Science.gov (United States)

    Grišin, Edvard; Mikalauskas, Saulius; Poškus, Tomas; Jotautas, Valdemaras; Strupas, Kęstutis

    2017-09-01

    Peptic ulcer is a common disease affecting millions of people every year. Despite improved understanding and treatment of the disease, the number of patients admitted with duodenal peptic ulcer perforation has not decreased. Deaths from peptic ulcer disease overcome other common emergency situations. Laparoscopic repair of the perforated peptic ulcer (PPU) is the gold standard approach for simple perforation. However, in patients with large perforated chronic ulcers laparotomy with pyloroplasty is the standard treatment. It is generally accepted to perform open surgery in PPU emergencies because of the greater knowledge and experience gathered over the past decades and less potential harm for the patient or surgical complications. We present a case of successful laparoscopic pyloroplasty of a perforated duodenal ulcer with stenosis.

  14. Mobile Cecum in a Young Woman with Ehlers-Danlos Syndrome Hypermobility type: A Case Report and Review of the Literature.

    Science.gov (United States)

    Fukuda, Yoshihisa; Higuchi, Yusuke; Shinozaki, Kanae; Tanigawa, Yuji; Abe, Taro; Hanaoka, Nobuyoshi; Matsubayashi, Sunao; Yamaguchi, Tomomi; Kosho, Tomoki; Nakamichi, Koji

    2017-10-15

    Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is unexpectedly common and is associated with a high rate of gastrointestinal manifestations. We herein report the first documented case of mobile cecum associated with EDS-HT. A 21-year-old woman with repeated right lower abdominal pain was initially diagnosed with EDS-HT. Abdominal examinations performed in the supine position, such as CT and ultrasonography, showed no gross abnormalities. In contrast, oral barium gastrointestinal transit X-ray images obtained with changes in the patient's body position revealed position-dependent cecal volvulus with mobile cecum. She was finally discharged with a dramatic resolution of her symptoms after laparoscopic cecopexy for mobile cecum.

  15. Rectal perforation by compressed air.

    Science.gov (United States)

    Park, Young Jin

    2017-07-01

    As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injury from its improper use. However, damage of large intestine caused by compressed air is uncommon. Herein a case of pneumatic rupture of the rectum is described. The patient was admitted to the Emergency Room complaining of abdominal pain and distension. His colleague triggered a compressed air nozzle over his buttock. On arrival, vital signs were stable but physical examination revealed peritoneal irritation and marked distension of the abdomen. Computed tomography showed a large volume of air in the peritoneal cavity and subcutaneous emphysema at the perineum. A rectal perforation was found at laparotomy and the Hartmann procedure was performed.

  16. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture

    Directory of Open Access Journals (Sweden)

    Han Shuang

    2016-01-01

    Full Text Available Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.

  17. A case of perforating injury of eyeball and traumatic cataract caused by acupuncture.

    Science.gov (United States)

    Shuang, Han; Yichun, Kong

    2016-04-01

    Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.

  18. Real scale experimental study for performance evaluation of unidirectional air diffuser perforated panels

    Science.gov (United States)

    Tăcutu, Laurenţiu; Nastase, Ilinca; Iordache, Vlad; Catalina, Tiberiu; Croitoru, Cristiana Verona

    2018-02-01

    Nowadays, there is an increasing emphasis on indoor air quality due to technological evolution and the fact that people spend most of the time in enclosed spaces. Also, energy efficiency is another related factor that gains more and more attention. Improving air distribution in an enclosure can lead to achieve these goals. This improvement can be done by adjustingthe air terminals position, theredimensions or the air diffuser perforations. The paper presents the study of 8 types of panels with different perforations shapes. The systems were characterized by flow, pressure loss and noise. Usualand special geometries were chosen, all having the same flowsurface. The perforated panels were mounted in a unidirectional air flow (UAF)diffuser, also called a laminar air flow (LAF)diffuser, that is placed in a real scale operating room (OR) in our laboratory.The purpose of this study is to determine whether changing the shape in the perforated panels can improve the technical parameters of the diffuser.

  19. Two cases of bowel perforation associated with sunitinib treatment for renal cell carcinoma.

    Science.gov (United States)

    Hoshino, Yoshinori; Hasegawa, Hirotoshi; Ishii, Yoshiyuki; Endo, Takashi; Ochiai, Hiroki; Okabayashi, Koji; Kaneko, Gou; Mikami, Shuji; Mukai, Makio; Oya, Mototsugu; Kitagawa, Yuko

    2012-08-01

    Sunitinib, a multitargeted tyrosine kinase inhibitor, is widely used in the treatment of carcinoma. Adverse events associated with this treatment, including fatigue, diarrhea, and hematotoxicity, have been reported in clinical trials. Bowel perforation is a surgical emergency that requires immediate treatment depending on the location and progression of the tumor. We report 2 cases of bowel perforation during sunitinib treatment. The patients presented with diffuse peritonitis, and emergency exploratory laparotomy was performed. We speculate that the underlying mechanisms were decrease in capillary density of the normal mucosa in case 1 and tumor shrinkage because of sunitinib treatment in case 2. To the best of our knowledge, this is the first study to report the pathological findings implicating bowel perforation due to sunitinib treatment. Further investigations are needed to clarify the risk factors for intestinal perforations associated with sunitinib treatment.

  20. Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation

    Directory of Open Access Journals (Sweden)

    Nobuaki Fujikuni

    2011-12-01

    Full Text Available Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.

  1. Isolated ileal perforation in infancy: a lethal initial presentation of Hirschsprung’s disease

    Directory of Open Access Journals (Sweden)

    Fadi Iskandarani

    2017-06-01

    Full Text Available A rare case of ileal perforation, as a fatal initial presentation of total colonic aganglionosis (TCA in infancy is reported. A 10-week-old boy, was brought to the emergency department with symptoms of complicated intestinal obstruction. He looked ill, was lethargic, markedly dehydrated and had a severely distended abdomen. An abdominal X-ray revealed multiple air fluid levels seen in a distended small intestine. During exploratory laparotomy the ileum was massively dilated with distal segment perforation. Ileal perforation repair was performed. A totally collapsed microcolon was identified. Biopsies were taken from the high rectum, sigmoid and hepatic flexure. Appendectomy and ileostomy were performed. All biopsies, as well as the appendix, showed absence of ganglion cells. Despite this procedure the patient progressively deteriorated and later died due to sepsis. Ileal perforation in infants is a rare, but potentially fatal initial presentation of TCA. Early detection is essential to prevent life-threatening complications.

  2. Intestinal perforation by an ingested foreign body*

    Science.gov (United States)

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F. S.; de Castro, Francisco Gomes; Miller, Wagner Peitl; de Lima, Raphael Rodrigues; Tazima, Leandro; Geraldo, Jamylle

    2016-01-01

    Objective To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation. PMID:27818542

  3. Intestinal perforation by an ingested foreign body

    International Nuclear Information System (INIS)

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F.S.; Castro, Francisco Gomes de; Miller, Wagner Peitl; Lima, Raphael Rodrigues de; Tazima, Leandro; Geraldo, Jamylle

    2016-01-01

    Objective: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation. (author)

  4. Intestinal perforation by an ingested foreign body.

    Science.gov (United States)

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F S; de Castro, Francisco Gomes; Miller, Wagner Peitl; de Lima, Raphael Rodrigues; Tazima, Leandro; Geraldo, Jamylle

    2016-01-01

    To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

  5. Intestinal perforation by an ingested foreign body

    Energy Technology Data Exchange (ETDEWEB)

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F.S.; Castro, Francisco Gomes de; Miller, Wagner Peitl; Lima, Raphael Rodrigues de; Tazima, Leandro; Geraldo, Jamylle, E-mail: gabrielnicolodi@gmail.com [Hospital Sao Vicente - Funef, Curitiba, PR (Brazil)

    2016-09-15

    Objective: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation. (author)

  6. Intestinal perforation by an ingested foreign body

    Directory of Open Access Journals (Sweden)

    Gabriel Cleve Nicolodi

    Full Text Available Abstract Objective: To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods: This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results: None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases, increased density of mesenteric fat (in all four cases, identification of the foreign body passing through the intestinal wall (in three cases, and gas in the peritoneal cavity (in one case. Conclusion: In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.

  7. ASSESSMENT OF SEVERITY OF PERFORATED PERITONITIS USING MODIFIED APACHE II SCORE

    Directory of Open Access Journals (Sweden)

    L. Rajeswar Reddy

    2016-06-01

    Full Text Available Acute generalised peritonitis from gastrointestinal hollow viscus perforation is a potentially life threatening condition. It is a common surgical emergency in many general surgical units in the developing countries and it is often associated with high morbidity and mortality. Grading the severity of acute peritonitis has assisted in no small way in decision making and has improved therapy in the management of severely ill patients. Empirically based risk assessment for important clinical events has been extremely useful in evaluating new therapies, in monitoring resources for effective use and improving quality of care. MATERIAL AND METHODS A prospective survey of patients with acute generalised peritonitis due to gastrointestinal perforation was carried out in general surgical wards of KIMS Hospital, Amalapuram during the period starting from July 2013-November 2016. The study population consisted of 50 consecutive patients who had laparotomy during the study period for acute peritonitis due to gastrointestinal perforation, after diagnostic conformation. RESULT AND DISCUSSION The most common cause of peritonitis in our study was perforated duodenal ulcer (31 cases, followed by appendicular perforation (7 cases, followed by stomach perforation (7 cases. Despite delay in seeking treatment, the overall mortality rate (14% was favourably comparable with other published series.

  8. Capacity limits in columns pulsed with stain steel perforated plates

    International Nuclear Information System (INIS)

    Maset, E.R.; Acosta, E.; Di Piano, M.; Maymo, J.A.

    1987-01-01

    This paper includes part of the second stage of the pulsed columns development program, using a water-nitric acid system as continuous phase and tri-n-butyl phosphate dissolved in kerosene at 30% v/v as disperse phase. Two kits of different geometry perforated plates (different diameter of perforation and free area percentage) were used. Due to the affinity importance of the plates' material with the continuous phase, in all the cases the continuous aqueous phase was used. The relation of flows varied, thus obtaining in each case a curve of characteristic 'flood'. The influence of the geometrical variables, the relation of flows, the medium acidity and the pulse's amplitude was applied in the capacity of the column. Besides, the dimensional correlation of Swift W.H. on the results obtained from 'flood' with both kits of plates to relate flows 1:1 and a minimum deviation was observed. (Author)

  9. Acute otitis media with spontaneous tympanic membrane perforation.

    Science.gov (United States)

    Principi, N; Marchisio, P; Rosazza, C; Sciarrabba, C S; Esposito, S

    2017-01-01

    The principal aim of this review is to present the current knowledge regarding acute otitis media (AOM) with spontaneous tympanic membrane perforation (STMP) and to address the question of whether AOM with STMP is a disease with specific characteristics or a severe case of AOM. PubMed was used to search for all studies published over the past 15 years using the key words "acute otitis media" and "othorrea" or "spontaneous tympanic membrane perforation". More than 250 articles were found, but only those published in English and providing data on aspects related to perforation of infectious origin were considered. Early Streptococcus pneumoniae infection due to invasive pneumococcal strains, in addition to coinfections and biofilm production due mainly to non-typeable Haemophilus influenzae, seem to be precursors of STMP. However, it is unclear why some children have several STMP episodes during the first years of life that resolve without complications in adulthood, whereas other children develop chronic suppurative otitis media. Although specific aetiological agents appear to be associated with an increased risk of AOM with STMP, further studies are needed to determine whether AOM with STMP is a distinct disease with specific aetiological, clinical and prognostic characteristics or a more severe case of AOM than the cases that occur without STMP. Finally, it is important to identify preventive methods that are useful not only in otitis-prone children with uncomplicated AOM, but also in children with recurrent AOM and those who experience several episodes with STMP.

  10. Medicolegal aspects of iatrogenic root perforations

    DEFF Research Database (Denmark)

    Tsesis, I; Rosen, E; Bjørndal, L

    2014-01-01

    AIM: To retrospectively analyze the medico-legal aspects of iatrogenic root perforations (IRP) that occurred during endodontic treatments. METHODOLOGY: A comprehensive search in a professional liability insurance database was conducted to retrospectively identify cases of IRP following root canal...... treatment (p root perforation is a complication of root canal treatment and may result in tooth extraction...... and in legal actions against the treating practitioner. Mandibular molars are more prone to medico-legal claims related to root perforations. The patient should be informed of the risks during RCT and should get information on alternative treatments and their risks and prognosis...

  11. Experience of endoscopic submucosal dissection (ESD) to colorectal tumor-especially about clinical course of cases with perforation

    International Nuclear Information System (INIS)

    Yoshida, Naohisa; Kanemasa, Kazuyuki; Sakai, Kyoko

    2008-01-01

    Endoscopic submucosal dissection (ESD) to colorectal tumor has not been established widely. One reason is that perforation related with endoscopic therapy is shown more frequently because colorectal wall is thinner than gastric wall. Another reason is that peritonitis after perforation could be fatal because colon is more bacterial. In the current study, we analyzed cases with colorectal tumor performed ESD, especially cases with perforation due to ESD. We have evaluated ESD for colorectal tumor. Thirty one cases, which ESD to colorectal tumor had been performed from April, 2006 to June, 2007 at Nara City Hospital, were analyzed in the current study. We used Flex knife (Olympus, Tokyo, Japan) and Flush knife (FTS, Tokyo, Japan). Tumor size, operation time, and frequency of endoscopic perforation during ESD were examined. Also, abdominal computed tomography (CT) was performed routinely one day after ESD. Vital sign including fever elevation and abdominal findings were examined one day and two days after ESD. White blood cell (WBC) and C reactive protein (CRP) in blood examination were calculated one day and two days after ESD. Median tumor size was 26.8 mm in diameter (range: 10-60 mm). Median operation time was 85 minutes (range: 30-290 minutes). Histological diagnosis was 7 low grade adenomas, 6 high grade adenomas, and 18 cancers. The frequency of endoscopic perforation during ESD was 12.9%, 4 out of 31 cases. The reasons of perforation were that 2 were due to coagulation in muscle layer and one was due to snaring and one was due to clipping to ulceration due to ESD. The frequency of perforation detected by CT was 16.1%, 5 out of 31 cases. Abdominal pain was observed in only one case, which had endoscopic perforation. Clinical course of perforation was that all cases were cured only by endoscopic clipping without urgent surgical operation. In related with blood examinations, CRP elevated in cases with endoscopic perforation two days after ESD statistically. ESD

  12. Salmonella intestinal perforation: (27 perforations in one patient, 14 perforations in another Are the goal posts changing?

    Directory of Open Access Journals (Sweden)

    Adeniran J

    2005-01-01

    Full Text Available The pathology of salmonellosis after a faeco-oral transmission was first clearly described by Jenner in 1850. Over the years, the pathological manifestations in different tissues of the body have been described. The ileum is however mostly involved leading to enlarged Peyer′s patches, ulceration, and sometimes bleeding and perforation. Efforts at control have largely been improvement in public water supply, safe disposal of waste, and general public health measures. Despite these measures, intestinal perforation from salmonellosis remains the commonest cause of emergency operation in children above 3 years. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in facilities in the hospitals. Even more disturbing is that we now see more perforations per patient, and more involvement of the colon. Three recently managed patients with multiple ileal/colonic perforations were reviewed. Presenting problems, delay in referral, choice of antibiotics and postoperative complications were noted. One patient had 27 perforations and another 14 perforations. Both survived. Is salmonella changing? Are our patients changing? Is the environment changing? Are the goal posts changing? This article details our recent experience with this dreadful disease, reviews the new literature and makes suggestions for the way forwards.

  13. Computed tomography (CT) of acute diverticulitis of the cecum and ascending colon; Computertomographie bei akuter rechtsseitiger Kolondivertikulitis

    Energy Technology Data Exchange (ETDEWEB)

    Ferstl, F.J.; Obert, R. [St. Theresienkrankenhaus Nuernberg (DE). Radiologisch-Nuklearmedizinisches Zentrum (RNZ)

    2004-09-01

    Acute diverticulitis of the cecum and ascending colon, also called right-sided diverticulitis, represents a relatively rare disorder in the western hemisphere. Pseudodiverticula and, less frequently, solitary congenital diverticula are regarded as the underlying causes of acute diverticulitis. We report the helical CT findings in four patients with acute right-sided colonic diverticulitis. The CT was performed with a collimation of 8 mm, a pitch of 1.5 and an increment of 8 mm, and with variable administration of intravenous, oral and rectal contrast material. In two of the four patients, the acute diverticulitis was detected in the cecum and ascending colon, respectively. In two patients, the diagnosis could be confirmed during surgery and subsequent histologic examination of the resected specimen. On the initial CT studies, acute diverticulitis was correctly diagnosed in two patients and suspected in one patient without identifying and inflamed diverticulum. In one patient, the offending diverticulum in the ascending colon caused an inflammatory pseudotumor at the level of the ileocecal region. This process was initially mistaken as Crohn's disease. The CT diagnosis of a right-sided colonic diverticulitis is based on an inflamed diverticulum in the center of pericolic inflammatory changes and a preserved wall enhancement (target sign). Other CT findings, such as fatty pericolic infiltration and colon wall thickening, are rather non-specific and can also be found in a number of different ileocolic disorders, especially in colon cancer. In selected cases, the diagnosis can only be established by follow up CT after the pericolic infiltration has markedly subsided and an offending diverticulum has emerged. (orig.)

  14. Stercoral perforation in a 17-year old.

    LENUS (Irish Health Repository)

    McHugh, S

    2012-02-01

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  15. Stercoral perforation in a 17-year old.

    LENUS (Irish Health Repository)

    McHugh, S

    2009-04-02

    INTRODUCTION: Stercoral perforation is a rare cause of perforation. This is the first reported case where a partial eating disorder (ED) is the primary causative differential. CASE PRESENTATION: We present the case of a 17-year-old girl who presented to her local Emergency Department with a 24-h history of left-sided abdominal pain. She subsequently deteriorated and a computed tomography scan of her abdomen showed gross distension of the large bowel with a sigmoid perforation. She underwent total colectomy with end ileostomy. Histology reported stercoral perforation but normal bowel ganglia. While an inpatient she was reviewed by the Psychiatric team who were concerned she was suffering from a partial ED. CONCLUSION: This case highlights the importance of a multidisciplinary approach in optimally treating patients such as these. Aggressive medical management with involvement of a psychiatric team and dietetics addresses any underlying causative psychiatric issues and helps prevent recurrence.

  16. Perforated peptic ulcer: How to improve outcome?

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Adamsen, Sven; Wøjdemann, Morten

    2008-01-01

    Despite the introduction of histamine H(2)-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased...... with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evidential status. Only a few randomized, controlled trials have been published...... to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment Udgivelsesdato: 2008/8/27...

  17. Diagnosis and management of iatrogenic endoscopic perforations

    DEFF Research Database (Denmark)

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc

    2014-01-01

    This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that ea...

  18. [Comparison of iodinated and barium-containing contrast media of different viscosity in the detection of pharyngeal perforation].

    Science.gov (United States)

    Keberle, M; Wittenberg, G; Trusen, A; Baumgartner, W; Hahn, D

    2001-08-01

    In contrast to esophageal perforations, the more radiopaque barium-suspensions are not as important as iodinated aqueous contrast agents for the detection of pharyngeal perforations. This study was performed to find out whether the highly different viscosities (of iodinated and barium-containing contrast agents with comparable radiopacities) are a reason for this. Viscosity, subjective difference in contrast, and CT-density of an iodinated aqueous (Telebrix) and a 50 wt/vol% barium-containing contrast agent (Micropaque) were determined. Moreover, to exclude postoperative perforation, 104 patients were prospectively examined by pharyngography using both contrast media. Pharyngographies of patients with perforation were later compared by two independent readers. All patients with perforation were followed up clinically to exclude complications due to barium administration. In-vitro comparison showed comparable radiopacity but the 50 wt/vol% barium-suspension was much more viscous than the iodinated contrast agent. During pharyngography, totally, 14 perforations were clearly delineated with the iodinated aqueous contrast agent. However, two of them were not detected with the barium-suspension. All the other perforations presented equally. Given a sufficient radiopacity, a low viscosity appears to be essential for a contrast agent to detect especially pharyngeal perforations. Thus, we recommend the sole use of an iodinated contrast agent (at suspicion of aspiration as isoosmolar variant) for this purpose.

  19. Perforated pyloroduodenal peptic ulcer and sonography.

    Science.gov (United States)

    Kuzmich, Siarhei; Harvey, Chris J; Fascia, Daniel T M; Kuzmich, Tatsiana; Neriman, Deena; Basit, Rizwan; Tan, Kai Lee

    2012-11-01

    The purpose of this article is to illustrate the spectrum of sonographic findings in perforated pyloroduodenal peptic ulcer and discuss the potential role of sonography in the diagnosis. Although sonography is not the first-line investigation of choice in suspected perforated peptic ulcer, understanding of the characteristic appearances seen during general abdominal sonography may aid the reader in the diagnosis of this important and sometimes overlooked cause of nonspecific abdominal pain. This may shorten time to the diagnosis and ultimate surgical management.

  20. Soluble Fiber Dextrin and Soluble Corn Fiber Supplementation Modify Indices of Health in Cecum and Colon of Sprague-Dawley Rats

    Directory of Open Access Journals (Sweden)

    Maria R. C. de Godoy

    2013-02-01

    Full Text Available The objective of this study was to evaluate health outcomes resulting from dietary supplementation of novel, low-digestible carbohydrates in the cecum and colon of Sprague-Dawley rats randomly assigned to one of four treatment groups for 21 days: 5% cellulose (Control, Pectin, soluble fiber dextrin (SFD, or soluble corn fiber (SCF. Rats fed Pectin had a higher average daily food intake, but no differences in final body weights or rates of weight gain among treatments were observed. No differences were observed in total short-chain fatty acid (SCFA or branched-chain fatty acid (BCFA concentrations in the cecum and colon of rats fed either SFD or SCF. The SFD and SCF treatments increased cecal propionate and decreased butyrate concentrations compared to Control or Pectin. Pectin resulted in increased BCFA in the cecum and colon. Supplementation of SFD and SCF had no effect on cecal microbial populations compared to Control. Consumption of SFD and SCF increased total and empty cecal weight but not colon weight. Gut histomorphology was positively affected by SFD and SCF. Increased crypt depth, goblet cell numbers, and acidic mucin were observed in both the cecum and colon of rats supplemented with SFD, SCF, and Pectin. These novel, low-digestible carbohydrates appear to be beneficial in modulating indices of hindgut morphology when supplemented in the diet of the rat.

  1. Perforated small intestine in a patient with T-cell lymphoma; a rare cause of peritonitis

    Directory of Open Access Journals (Sweden)

    Petrişor Banu

    2016-04-01

    Full Text Available The nontraumatic perforations of the small intestine are pathological entities with particular aspects in respect to diagnosis and treatment. These peculiarities derive from the nonspecific clinical expression of the peritonitis syndrome, and from the multitude of causes that might be the primary sources of the perforation: foreign bodies, inflammatory diseases, tumors, infectious diseases, etc. Accordingly, in most cases intestinal perforation is discovered only by laparotomy and the definitive diagnosis is available only after histopathologic examination. Small bowel malignancies are rare; among them, lymphomas rank third in frequency, being mostly B-cell non Hodgkin lymphomas. Only 10% of non-Hodgkin lymphomas are with T-cell. We report the case of a 57 years’ old woman with intestinal T-cell lymphoma, whose first clinical symptomatology was related to a complication represented by perforation of the small intestine. Laparotomy performed in emergency identified an ulcerative lesion with perforation in the jejunum, which required segmental enterectomy with anastomosis. The nonspecific clinical manifestations of intestinal lymphomas make from diagnosis a difficult procedure. Due to the fact that surgery does not have a definite place in the treatment of the small intestinal lymphomas (for cases complicated with perforation, and beyond the morbidity associated with the surgery performed in emergency conditions, prognosis of these patients is finally given by the possibility to control the systemic disease through adjuvant therapy.

  2. Improved productivity justifies world record underbalanced perforating operation

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, A. M.; Bakker, E. R. [NAM B.V. (Netherlands); Hungerford, K.

    1998-12-31

    To achieve vertical connectivity with all the layers, and thus long term sustained productivity in a highly stratified reservoir, a one run underbalanced perforating operation was considered necessary. Due to coiled tube limitations in this deep (5136 m along hole, 3700 m true vertical depth, with a maximum deviation of 89 degrees), high pressure well a hydraulic workover unit (HWU) was selected to deploy and retrieve the guns. The operation is considered a world record since this is the longest section (total gross interval of 1026 m perforated) of guns conveyed, fired underbalanced and deployed out of a live well. It is concluded that the improved productivity more than justified the additional time, effort and expenditure; considering the full life cycle of the well it is readily apparent that the operation was an economic and technical success. Details of the considerations leading to the perforating technique selection, the planning and the execution of the operation, and the validation of the technique in terms of productivity gains, are provided. 13 refs., 7 figs.

  3. Endoscope-assisted laparoscopic repair of perforated peptic ulcers.

    Science.gov (United States)

    Lee, Kun-Hua; Chang, Hung-Chi; Lo, Chong-Jeh

    2004-04-01

    Laparoscopic repairs for perforated peptic ulcer (PPU) are likely to fail in patients with shock, gastric outlet obstruction, or large perforations. This prospective study was performed to evaluate a revised approach of laparoscopic repair with endoscopic assistance to treat these patients. Between April 2001 and February 2002, 30 consecutive patients with PPU were enrolled in this study. The mean age was 43.1 +/- 12.2 years. Male to female ratio was 27:2. One patient was excluded from laparoscopic repair due to a gastric outlet obstruction. The other 29 patients were managed according to a protocol of preoperative upper endoscopy and laparoscopic intracorporeal suture repair with an omental patch. The average operative time was 58.1 +/- 13.5 minutes (range, 36-96 min). The average diameter of perforation was 4.2 +/- 2.0 mm (range, 1-12 mm). The average time to resume oral fluids was 3.2 +/- 0.8 days (range, 2-8 days). The average hospital stay was 4.7 +/- 1.1 days (range, 3-10 days). There was no leakage or mortality. Most patients did not receive parenteral analgesics postoperatively. We conclude that endoscope-assisted laparoscopic repair for PPU is safe and effective. This revised technique allows surgeons to exclude patients who are likely to fail the laparoscopic repair.

  4. Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital

    Directory of Open Access Journals (Sweden)

    Yokogawa H

    2014-10-01

    perforation due to the oral anticancer drug S-1 is newly reported. Keywords: corneal perforation, keratoplasty, amniotic membrane transplantation

  5. Ileal perforation induced by acute radiation injury under gefitinib treatment

    International Nuclear Information System (INIS)

    Muraoka, Takayuki; Tsukuda, Kazunori; Toyooka, Shinichi

    2011-01-01

    Enteritis is one of the side effects of radiotherapy to the abdominal cavity. Radiation enteritis involves damage to mucous membranes in the acute phase and to stromal tissues in the late phase. Perforation of the intestine tends to occur in the late phase, and rarely in the acute phase. However, we describe here a case of intestinal perforation occurring in the acute phase after irradiation in a patient who received gefitinib treatment. Gefitinib, one of the epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), is widely used to treat non-small cell lung cancer (NSCLC) patients, but is simultaneously known to inhibit wound healing. We suspect that gefitinib may affect regeneration of the small intestinal mucosa injured by irradiation. A 76-year-old woman had NSCLC with metastases to the 5th lumbar, sacral, and right iliac bones. To control the pain from bone metastasis, anterior-posterior opposing portal irradiation (total 35 Gy) was started, and was completed over 22 days. On day 25 after starting radiotherapy, the patient began to take gefitinib. On day 35, she presented with acute peritonitis, and an emergency laparotomy was performed. The terminal ileum was affected by radiation enteritis and there were two pin-hole perforations. In the surgical specimen, no cancerous lesions were detected, and immunohistochemical staining of phosphorylated EGFR (pEGFR) was negative. pEGFR has an important role in mucous membrane repair after irradiation. Intestinal perforation in the acute phase of radiation enteritis may be associated with impaired mucosal repair mechanisms due to the use of an EGFR-TKI such as gefitinib, as evidenced by the absence of pEGFR. (author)

  6. Rumen and Cecum Microbiomes in Reindeer (Rangifer tarandus tarandus) Are Changed in Response to a Lichen Diet and May Affect Enteric Methane Emissions.

    Science.gov (United States)

    Salgado-Flores, Alejandro; Hagen, Live H; Ishaq, Suzanne L; Zamanzadeh, Mirzaman; Wright, André-Denis G; Pope, Phillip B; Sundset, Monica A

    2016-01-01

    Reindeer (Rangifer tarandus tarandus) are large Holarctic herbivores whose heterogeneous diet has led to the development of a unique gastrointestinal microbiota, essential for the digestion of arctic flora, which may include a large proportion of lichens during winter. Lichens are rich in plant secondary metabolites, which may affect members of the gut microbial consortium, such as the methane-producing methanogenic archaea. Little is known about the effect of lichen consumption on the rumen and cecum microbiotas and how this may affect methanogenesis in reindeer. Here, we examined the effects of dietary lichens on the reindeer gut microbiota, especially methanogens. Samples from the rumen and cecum were collected from two groups of reindeer, fed either lichens (Ld: n = 4), or a standard pelleted feed (Pd: n = 3). Microbial densities (methanogens, bacteria and protozoa) were quantified using quantitative real-time PCR and methanogen and bacterial diversities were determined by 454 pyrosequencing of the 16S rRNA genes. In general, the density of methanogens were not significantly affected (p>0.05) by the intake of lichens. Methanobrevibacter constituted the main archaeal genus (>95% of reads), with Mbr. thaueri CW as the dominant species in both groups of reindeer. Bacteria belonging to the uncharacterized Ruminococcaceae and the genus Prevotella were the dominant phylotypes in the rumen and cecum, in both diets (ranging between 16-38% total sequences). Bacteria belonging to the genus Ruminococcus (3.5% to 0.6%; p = 0.001) and uncharacterized phylotypes within the order Bacteroidales (8.4% to 1.3%; p = 0.027), were significantly decreased in the rumen of lichen-fed reindeer, but not in the cecum (p = 0.2 and p = 0.087, respectively). UniFrac-based analyses showed archaeal and bacterial libraries were significantly different between diets, in both the cecum and the rumen (vegan::Adonis: pseudo-Flichen-fed reindeer.

  7. Perforated marginal ulcers after laparoscopic gastric bypass.

    Science.gov (United States)

    Felix, Edward L; Kettelle, John; Mobley, Elijah; Swartz, Daniel

    2008-10-01

    Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors' center was conducted to determine the incidence of PMU and whether any causative factors were present. A prospectively kept database of all patients at the authors' bariatric center was retrospectively reviewed. The complete records of patients with a PMU were examined individually for accuracy and analyzed for treatment, outcome, and possible underlying causes of the marginal perforation. Between April 1999 and August 2007, 1% of the patients (35/3,430) undergoing laparoscopic gastric bypass experienced one or more perforated marginal ulcers 3 to 70 months (median, 18 months) after LRYGB. The patients with and without perforation were not significantly different in terms of mean age (37 vs 41 years), weight (286 vs 287 lb), body mass index (BMI) (46 vs 47), or female gender (89% vs 83%). Of the patients with perforations, 2 (6%) were taking steroids, 10 (29%) were receiving nonsteroidal antiinflammatory drugs (NSAIDs) at the time of the perforation, 18 (51%) were actively smoking, and 6 of the smokers also were taking NSAIDs. Eleven of the patients (31%) who perforated did not have at least one of these possible risk factors, but 4 (36%) of the 11 patients in this group had been treated after bypass for a marginal ulcer. Only 7 (20%) of the 35 patients who had laparoscopic bypass, or 7 (0.2%) in the entire group of 3,430 patients, perforated without any warning. There were no deaths, but three patients reperforated. The incidence of a marginal ulcer perforating after LRYGB was significant (>1%) and appeared to be related to smoking or the use of NSAIDs or steroids. Because only 0.2% of all patients acutely perforated without some risk factor or warning, long-term ulcer prophylaxis or treatment may be necessary

  8. Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Gyu Chang [Dept. of Radiology, Gumi Hospital, Soonchunhyang University College of Medicine, Gumi (Korea, Republic of)

    2011-07-15

    To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis. The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated. All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively. High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

  9. Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging

    International Nuclear Information System (INIS)

    Rosenbaum, Daniel G.; Kovanlikaya, Arzu; Askin, Gulce; Beneck, Debra M.

    2017-01-01

    The role of magnetic resonance imaging (MRI) in pediatric appendicitis is increasing; MRI findings predictive of appendiceal perforation have not been specifically evaluated. To assess the performance of MRI in differentiating perforated from non-perforated appendicitis. A retrospective review of pediatric patients undergoing contrast-enhanced MRI and subsequent appendectomy was performed, with surgicopathological confirmation of perforation. Appendiceal diameter and the following 10 MRI findings were assessed: appendiceal restricted diffusion, wall defect, appendicolith, periappendiceal free fluid, remote free fluid, restricted diffusion within free fluid, abscess, peritoneal enhancement, ileocecal wall thickening and ileus. Two-sample t-test and chi-square tests were used to analyze continuous and discrete data, respectively. Sensitivity and specificity for individual MRI findings were calculated and optimal thresholds for measures of accuracy were selected. Seventy-seven patients (mean age: 12.2 years) with appendicitis were included, of whom 22 had perforation. The perforated group had a larger mean appendiceal diameter and mean number of MRI findings than the non-perforated group (12.3 mm vs. 8.6 mm; 5.0 vs. 2.0, respectively). Abscess, wall defect and restricted diffusion within free fluid had the greatest specificity for perforation (1.00, 1.00 and 0.96, respectively) but low sensitivity (0.36, 0.25 and 0.32, respectively). The receiver operator characteristic curve for total number of MRI findings had an area under the curve of 0.92, with an optimal threshold of 3.5. A threshold of any 4 findings had the best ability to accurately discriminate between perforated and non-perforated cases, with a sensitivity of 82% and specificity of 85%. Contrast-enhanced MRI can differentiate perforated from non-perforated appendicitis. The presence of multiple findings increases diagnostic accuracy, with a threshold of any four findings optimally discriminating between

  10. Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging.

    Science.gov (United States)

    Rosenbaum, Daniel G; Askin, Gulce; Beneck, Debra M; Kovanlikaya, Arzu

    2017-10-01

    The role of magnetic resonance imaging (MRI) in pediatric appendicitis is increasing; MRI findings predictive of appendiceal perforation have not been specifically evaluated. To assess the performance of MRI in differentiating perforated from non-perforated appendicitis. A retrospective review of pediatric patients undergoing contrast-enhanced MRI and subsequent appendectomy was performed, with surgicopathological confirmation of perforation. Appendiceal diameter and the following 10 MRI findings were assessed: appendiceal restricted diffusion, wall defect, appendicolith, periappendiceal free fluid, remote free fluid, restricted diffusion within free fluid, abscess, peritoneal enhancement, ileocecal wall thickening and ileus. Two-sample t-test and chi-square tests were used to analyze continuous and discrete data, respectively. Sensitivity and specificity for individual MRI findings were calculated and optimal thresholds for measures of accuracy were selected. Seventy-seven patients (mean age: 12.2 years) with appendicitis were included, of whom 22 had perforation. The perforated group had a larger mean appendiceal diameter and mean number of MRI findings than the non-perforated group (12.3 mm vs. 8.6 mm; 5.0 vs. 2.0, respectively). Abscess, wall defect and restricted diffusion within free fluid had the greatest specificity for perforation (1.00, 1.00 and 0.96, respectively) but low sensitivity (0.36, 0.25 and 0.32, respectively). The receiver operator characteristic curve for total number of MRI findings had an area under the curve of 0.92, with an optimal threshold of 3.5. A threshold of any 4 findings had the best ability to accurately discriminate between perforated and non-perforated cases, with a sensitivity of 82% and specificity of 85%. Contrast-enhanced MRI can differentiate perforated from non-perforated appendicitis. The presence of multiple findings increases diagnostic accuracy, with a threshold of any four findings optimally discriminating between

  11. Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rosenbaum, Daniel G.; Kovanlikaya, Arzu [New York-Presbyterian Hospital/Weill Cornell Medicine, Division of Pediatric Radiology, New York, NY (United States); Askin, Gulce [Weill Cornell Medical College, Division of Biostatistics and Epidemiology, New York, NY (United States); Beneck, Debra M. [New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology, New York, NY (United States)

    2017-10-15

    The role of magnetic resonance imaging (MRI) in pediatric appendicitis is increasing; MRI findings predictive of appendiceal perforation have not been specifically evaluated. To assess the performance of MRI in differentiating perforated from non-perforated appendicitis. A retrospective review of pediatric patients undergoing contrast-enhanced MRI and subsequent appendectomy was performed, with surgicopathological confirmation of perforation. Appendiceal diameter and the following 10 MRI findings were assessed: appendiceal restricted diffusion, wall defect, appendicolith, periappendiceal free fluid, remote free fluid, restricted diffusion within free fluid, abscess, peritoneal enhancement, ileocecal wall thickening and ileus. Two-sample t-test and chi-square tests were used to analyze continuous and discrete data, respectively. Sensitivity and specificity for individual MRI findings were calculated and optimal thresholds for measures of accuracy were selected. Seventy-seven patients (mean age: 12.2 years) with appendicitis were included, of whom 22 had perforation. The perforated group had a larger mean appendiceal diameter and mean number of MRI findings than the non-perforated group (12.3 mm vs. 8.6 mm; 5.0 vs. 2.0, respectively). Abscess, wall defect and restricted diffusion within free fluid had the greatest specificity for perforation (1.00, 1.00 and 0.96, respectively) but low sensitivity (0.36, 0.25 and 0.32, respectively). The receiver operator characteristic curve for total number of MRI findings had an area under the curve of 0.92, with an optimal threshold of 3.5. A threshold of any 4 findings had the best ability to accurately discriminate between perforated and non-perforated cases, with a sensitivity of 82% and specificity of 85%. Contrast-enhanced MRI can differentiate perforated from non-perforated appendicitis. The presence of multiple findings increases diagnostic accuracy, with a threshold of any four findings optimally discriminating between

  12. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations.

    Science.gov (United States)

    Smallwood, Nathan R; Fleshman, James W; Leeds, Steven G; Burdick, J S

    2016-06-01

    Upper intestinal leaks and perforations are associated with high morbidity and mortality rates. Despite the growing experience using endoscopically placed stents, the treatment of these leaks and perforations remain a challenge. Endoluminal vacuum (E-Vac) therapy is a novel treatment that has been successfully used in Germany to treat upper gastrointestinal leaks and perforations. There currently are no reports on its use in the USA. E-Vac therapy was used to treat 11 patients with upper gastrointestinal leaks and perforations from September 2013 to September 2014. Five patients with leaks following sleeve gastrectomy were excluded from this study. A total of six patients were treated with E-Vac therapy; these included: (n = 2) iatrogenic esophageal perforations, (n = 1) iatrogenic esophageal and gastric perforations, (n = 1) iatrogenic gastric perforation, (n = 1) gastric staple line leak following a surgical repair of a traumatic gastric perforation, and (n = 1) esophageal perforation due to an invasive fungal infection. Four patients had failed an initial surgical repair prior to starting E-Vac therapy. All six patients (100 %) had complete closure of their perforation or leak after an average of 35.8 days of E-Vac therapy requiring 7.2 different E-Vac changes. No deaths occurred in the 30 days following E-Vac therapy. One patient died following complete closure of his perforation and transfer to an acute care facility due to an unrelated complication. There were no complications directly related to the use of E-Vac therapy. Only one patient had any symptoms of dysphagia. This patient had severe dysphagia from an esophagogastric anastomotic stricture prior to her iatrogenic perforations. Following E-Vac therapy, her dysphagia had actually improved and she could now tolerate a soft diet. E-Vac therapy is a promising new method in the treatment of upper gastrointestinal leaks and perforations. Current successes need to be validated through future

  13. Management of Esophageal and Pharyngeal Perforation as Complications of Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Kang, Moo Sung; Kim, Kyung Hyun; Park, Jeong Yoon; Kuh, Sung Uk; Chin, Dong Kyu; Jin, Byung Ho; Kim, Keun Su; Cho, Yong Eun

    2017-06-01

    To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. Six patients with esophageal injury and one patient with pharyngeal injury after anterior cervical spinal surgery, managed at our department between 2000 and 2015, were analyzed retrospectively. During the study period, 7 patients (6 male and 1 female; mean age, 45 years) presented with esophageal perforation. The original anterior cervical spinal surgery was performed due to trauma in 2 patients and because of a degenerative cervical disorder in 5. Early esophageal perforation was diagnosed in 2 patients, and delayed esophageal injury due to chronic irritation with the cervical implants was noted in 5. Three of the five delayed perforation cases were related to cervical instrument displacement. Two patients showed no definite signs of infection, whereas 5 patients had various symptoms, including fever, neck pain, odynophagia, neck swelling, and upper extremity weakness. Two patients with a large defect underwent surgical repair and three with minimal perforation due to chronic irritation from the implants underwent instrument removal without direct repair of defect. Two asymptomatic patients received no intervention. Six patients with infection completely recovered from esophageal injury after treatment for a mean duration of 5.2 weeks (range, 4-8 weeks). One patient died because of postoperative pneumonia and sepsis after implant removal. Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

    Directory of Open Access Journals (Sweden)

    Psaila Josephine

    2009-10-01

    Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

  15. Acquired perforating dermatosis in a patient with chronic renal failure.

    Science.gov (United States)

    Fernandes, Karen de Almeida Pinto; Lima, Lourenço de Azevedo; Guedes, Juliana Chaves Ruiz; Lima, Ricardo Barbosa; D'Acri, Antônio Macedo; Martins, Carlos José

    2016-01-01

    Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure.

  16. Experimental perforation of tubing with a hydraulic sand jet

    Energy Technology Data Exchange (ETDEWEB)

    Semenov, Yu V

    1970-01-01

    A series of field tests has shown that perforation with a hydraulic sand jet improves the quality of well completion. The sand jet does not crack the cement sheath or the casing, and the perforations are larger and deeper than perforations formed by explosive charges. Fluid circulation during sand jet perforation can safely be stopped for at least 10 min. Water containing a surfactant can be used as a sand carrier. Sand jet perforation allows successful completion of wells cased by 2 tubing strings. Sand jet perforation can be used to clean the borehole well and to remove foreign objects from the well.

  17. [Perforation of the appendix and observation of Enterobius vermicularis].

    Science.gov (United States)

    Schou-Jensen, Katrine; Antipina, Elena Nikolaevna; Brisling, Steffen Kirstein; Azawi, Nessn

    2014-12-15

    A nine-year-old girl was admitted to the paediatric ward due to fever and lower abdomen pain through a day. Acute laparoscopic exploration showed a large necrotic perforation at the distal end of the appendix. During the appendectomy multiple small, live Enterobius vermicularis (pinworms) were observed. The patient was admitted for three days of observation and received relevant treatment with intravenous antibiotics and antihelminthic treatment. The histology showed numerous pinworms in the lumen of the appendix and invasion of the pinworms of the submucosal layer and the wall of the appendix.

  18. Retinal detachment secondary to ocular perforation during retrobulbar Anaesthesia

    Directory of Open Access Journals (Sweden)

    Gopal Lingam

    1995-01-01

    Full Text Available The clinical characteristics and the retinal breaks associated with rhegmatogenous retinal detachments secondary to accidental globe perforation during local infiltration anaesthesia in five highly myopic eyes are presented. Retinal detachment was total with variable proliferative vitreoretinopathy. The pattern of retinal breaks was rather typical and predictable. Management involved vitreous surgery with internal tamponade by silicone oil in four eyes and perfluoropropane gas in one eye. At the last follow-up, all eyes had attached retina. One eye did not recover useful vision due to possible concurrent optic nerve damage.

  19. Intussusception due to a cecal duplication cyst: a rare cause of acute abdomen. Case report.

    Science.gov (United States)

    Corroppolo, M; Zampieri, N; Erculiani, E; Cecchetto, M; Camoglio, F S

    2007-01-01

    Duplications of the alimentary tract are rare congenital anomalies. The ileum is the most common site, whereas rectal, duodenal, gastric and cecal duplications are extremely rare. Duplication cysts of the cecum, in a neonate, are even rarer, with only 19 cases reported in medical literature to date. We report a case of intestinal intussusception due to a cecal duplication cyst.

  20. Oriented cluster perforating technology and its application in horizontal wells

    Directory of Open Access Journals (Sweden)

    Huabin Chen

    2016-11-01

    Full Text Available An oriented cluster perforating technology, which integrates both advantages of cluster and oriented perforating, will help solve a series of technical complexities in horizontal well drilling. For realizing its better application in oil and gas development, a series of technologies were developed including perforator self-weight eccentricity, matching of the electronic selective module codes with the surface program control, axial centralized contact signal transmission, and post-perforation intercluster sealing insulation. In this way, the following functions could be realized, such as cable-transmission horizontal well perforator self-weight orientation, dynamic signal transmission, reliable addressing & selective perforation and post-perforation intercluster sealing. The combined perforation and bridge plug or the multi-cluster perforation can be fulfilled in one trip of perforation string. As a result, the horizontal-well oriented cluster perforating technology based on cable conveying was developed. This technology was successfully applied in unconventional gas reservoir exploitation, such as shale gas and coalbed methane, with accurate orientation, reliable selective perforation and satisfactory inter-cluster sealing. The horizontal-well oriented cluster perforating technology benefits the orientation of horizontal well drilling with a definite target and direction, which provides a powerful support for the subsequent reservoir stimulation. It also promotes the fracturing fluid to sweep the principal pay zones to the maximum extent. Moreover, it is conductive to the formation of complex fracture networks in the reservoirs, making quality and efficient development of unconventional gas reservoirs possible.

  1. Perforated peptic ulcer in an infant.

    Science.gov (United States)

    Feng, C Y; Hsu, W M; Chen, Y

    2001-02-01

    We describe a case of perforated peptic ulcer (PPU) in a 9-month-old boy. Abdominal distension was the first clinical sign of PPU. Before he developed abdominal distension, the patient had suffered from an upper respiratory tract infection with fever for about 2 weeks, which was treated intermittently with ibuprofen. A plain abdominal radiograph revealed pneumoperitoneum with a football sign. At laparotomy, a 0.8-cm perforated hole was found over the prepyloric area. Simple closure with omental patching was performed after debridement of the perforation. Pathologic examination showed chronic peptic ulcer with Helicobacter pylori infection. The postoperative course and outcome were satisfactory. The stress of underlying disease, use of ibuprofen, blood type (A), and H. pylori infection might have contributed to the development of PPU in this patient. PPU in infancy is rare and has a high mortality rate; early recognition and prompt surgical intervention are key to successful management.

  2. Arrangement for formation perforating and fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Belyaev, B M; Vitsenii, E M; Zheltov, Yu P; Nikolaev, S I

    1962-03-06

    An arrangement for perforating and hydraulic fracturing, to be lowered on a wire line, consists of a chamber with a shaped charge, a head and a nozzle. This arrangement enables carrying out, simultaneously, the operations of perforating and fracturing. The device may be equipped with separate sections with shaped charges and a powder chamber in which powder charges are placed, designed to be ignited in sequence by slow- acting electric igniters. For controlling the gas pressure and strengthening the arrangement in the zone of perforation, the device is equipped with rubber seals which release the ring elements under pressure of explosive gas. Between the walls of the casing and the rubber seals is an annular space through the gas escapes.

  3. Gastric Perforation by Ingested Rabbit Bone Fragment

    Directory of Open Access Journals (Sweden)

    Giulio Gambaracci

    2016-04-01

    Full Text Available The majority of accidentally ingested foreign bodies is excreted from the gastrointestinal (GI tract without any complications. Sometimes sharp foreign bodies – like chicken and fish bones – can lead to intestinal perforation and may present insidiously with a wide range of symptoms and, consequently, different diagnoses. We report the case of a 59-year-old woman presenting with fever and a 1-month history of vague abdominal pain. Computed tomography (CT showed the presence of a hyperdense linear image close to the gastric antrum surrounded by a fluid collection and free peritoneal air. At laparotomy, a 4-cm rabbit bone fragment covered in inflamed tissue was detected next to a gastric wall perforation. Rabbit bone fragment ingestion, even if rarely reported, should not be underestimated as a possible cause of GI tract perforation.

  4. Fast track pathway for perforated appendicitis.

    Science.gov (United States)

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Peritonitis following gastroduodenal ulcer perforation disease in children: report of 4 cases].

    Science.gov (United States)

    Ndour, O; Bansouda, J; Fall, A F; Alumeti, D M; Diouf, C; Ngom, G; Ndoye, M

    2012-10-01

    Peritonitis due to gastroduodenal ulcer perforation disease is a rare entity in pediatric surgery. In Senegal, no study has been dedicated to ulcer complications in children. The aim of this study was to describe the epidemiology, diagnosis, and treatment of perforated peptic ulcer in patients less than 15 years old. This retrospective study was conducted in the Surgical Emergencies and Paediatric Surgery Department at Aristide Le Dantec University Hospital Center in Dakar, Senegal, during a period of 11 years (January 1999 to December 2010). We found 4 children who presented perforated gastroduodenal ulcer: 3 females and 1 male. The average age of these patients was 9 years (range, 7-14 years). No family history was found. We noted 3 cases of perforated duodenal ulcer and one perforated gastric ulcer. The clinical diagnosis was suspected based on a peritoneal irritation syndrome. A plain x-ray of the abdomen was taken in all patients, which objectified a pneumoperitoneum image in 3 cases. The leukocytosis was constant. Treatment in all patients consisted on pre-, intra-, and postoperative intensive care, supra- and infraumbilical midline laparotomy, which allowed us to perform a debridement-suture of the gap followed by epiploplasty and extensive washing with lukewarm physiologic serum. Adjuvant therapy based on anti-ulcer and antibiotic therapy was initiated. Bacteriological examination of peritoneal fluid isolated a polymicrobial flora. Helicobacter pylori was not isolated. Histological examination of the biopsied perforation edges showed a benign ulcer in all cases. The follow-up endoscopy was performed 4 weeks after surgery and showed cicatrization of the ulcer in all patients. After a mean of 2 years, no recurrence was noted. The gastric or duodenal ulcer in children is rare. It is often discovered at the stage of perforation, a complication for which the essential treatment is surgery. Routine screening would certainly help to reduce the risk of this

  6. Candida albicans and bacterial microbiota interactions in the cecum during recolonization following broad-spectrum antibiotic therapy.

    Science.gov (United States)

    Mason, Katie L; Erb Downward, John R; Mason, Kelly D; Falkowski, Nicole R; Eaton, Kathryn A; Kao, John Y; Young, Vincent B; Huffnagle, Gary B

    2012-10-01

    Candida albicans is a normal member of the gastrointestinal (GI) tract microbiota of healthy humans, but during host immunosuppression or alterations in the bacterial microbiota, C. albicans can disseminate and cause life-threatening illness. The bacterial microbiome of the GI tract, including lactic acid bacteria (LAB), plays a vital role in preventing fungal invasion. However, little is known about the role of C. albicans in shaping the bacterial microbiota during antibiotic recovery. We investigated the fungal burdens in the GI tracts of germfree mice and mice with a disturbed microbiome to demonstrate the role of the microbiota in preventing C. albicans colonization. Histological analysis demonstrated that colonization with C. albicans during antibiotic treatment does not trigger overt inflammation in the murine cecum. Bacterial diversity is reduced long term following cefoperazone treatment, but the presence of C. albicans during antibiotic recovery promoted the recovery of bacterial diversity. Cefoperazone diminishes Bacteroidetes populations long term in the ceca of mice, but the presence of C. albicans during cefoperazone recovery promoted Bacteroidetes population recovery. However, the presence of C. albicans resulted in a long-term reduction in Lactobacillus spp. and promoted Enterococcus faecalis populations. Previous studies have focused on the ability of bacteria to alter C. albicans; this study addresses the ability of C. albicans to alter the bacterial microbiota during nonpathogenic colonization.

  7. Bladder perforation in a peritoneal dialysis patient

    Directory of Open Access Journals (Sweden)

    M Ounissi

    2012-01-01

    Full Text Available The dysfunction of the catheter in peritoneal dialysis (PD is a frequent compli-cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re-quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.

  8. Does Ramadan Fasting Increase duodenal ulcer perforation?

    Directory of Open Access Journals (Sweden)

    Abdoulhossein Davoodabadi

    2016-03-01

    Full Text Available Introduction: In Ramadan, healthy adult Muslims are obliged to fast. Prolonged fasting increase gastric acid and pepsin levels, which promote the risk of duodenal ulcer perforation (DUP. Effects of Ramadan fasting on DUP have not been thoroughly studied yet, and the limited number of studies investigating the impact of Ramadan fasting on DUP yielded discrepant results. This study aimed to evaluate DUP frequency during Ramadan 2011-2015 and compare it with other months. Methods: This cross-sectional study was performed in 82 patients undergoing surgery due to DUP during July 2011-September 2015. The demographics, history of addiction, use of nonsteroidal and antiinflammatory drugs, previous history of acid peptic disease, as well as complications and outcomes of treatment were recorded and analyzed, and the obtained results were compared between Ramadan and other lunar months. Results: The majority of patients were male (86.6%, 71 patients, with a mean age of 43.9±16.5 years (age range: 20-75 years. Male to female ratio was 6:1. Cases with less than 30 years of age were less frequent (22%, 18 patients. DUP was more frequent during Rajab with nine cases (11%, while during Ramadan, six cases were reported, the difference between Ramadan and other months regarding the incidence of DUP was not significant (P=0.7. Risk factors such as smoking (60% and addiction (44%; especially to crystal and crack were noted. Consumption of nonsteroidal antiinflammatory drugs in 20 (24% patients, and use of antacids in 17 (25% patients. Distribution of DUP in different blood types was as follows: O+=41%, A+=28%, B+=23%, AB=5%, and O-=3%; moreover, post-operative Helicobacter pylori antibody was present in 67% of the patients. Conclusion: Ramadan fasting did not escalate DUP incidence, and those with DUP risk factors can fast with the use of antacids.

  9. Duodenal perforation precipitated by scrub typhus

    Directory of Open Access Journals (Sweden)

    Raghunath Rajat

    2015-01-01

    Full Text Available Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  10. Surgical management of perforated peptic ulcer disease.

    Science.gov (United States)

    Sweeney, K J; Faolain, M O; Gannon, D; Gorey, T F; Kerin, M J

    2006-01-01

    Surgery for perforated peptic ulcer disease is one of the most common emergency procedures carried out in the western world. The role of postoperative empiric Helicobacter Pylori eradication therapy is controversial. The clinical, operative and postoperative surveillance details of 84 consecutive patients who underwent surgery for perforated peptic ulcer were reviewed. All patients underwent omentopexy +/- simple closure followed by proton pump therapy. Patients were followed-up for an average of 44 +/- 19 months. Females were older than male patients (59 +/- 20 vs. 46 + 17 years; pperforated peptic ulcer is associated with a significant perioperative mortality rate. Elderly female patients are particularly at risk.

  11. [Laparoscopic surgery for perforated peptic ulcer].

    Science.gov (United States)

    Yasuda, Kazuhiro; Kitano, Seigo

    2004-03-01

    Laparoscopic surgery has become the treatment of choice for the management of perforated peptic ulcer. The advantages of laparoscopic repair for perforated peptic ulcer include less pain, a short hospital stay, and an early return to normal activity. Although the operation time of laparoscopic surgery is significantly longer than that of open surgery, laparoscopic technique is safe, feasible, and with morbidity and mortality comparable to that of the conventional open technique. To benefit from the advantages offered by minimally invasive laparoscopic technique, further study will need to determine whether laparoscopic surgery is safe in patients with generalized peritonitis or sepsis.

  12. Primary Closure versus Gastric Resection for Perforated Gastric

    African Journals Online (AJOL)

    Perforated gastric ulcer is one of the most life‑threatening complications of peptic ulcer disease with high .... tubes were removed and oral nutrition resumed. The .... surgical approach for perforated gastric cancer: One‑stage vs. two‑stage ...

  13. A rare manifestation of perforated diverticulitis: parastomal subcutaneous abscess.

    NARCIS (Netherlands)

    Peters, J.H.; Bleichrodt, R.P.; Goor, H. van

    2003-01-01

    Perforation is a serious complication of diverticular disease. The sigmoid is the main affected anatomic site of perforated diverticulitis and sigmoid resection followed either by Hartmann procedure or primary anastomosis are the standard surgical approaches. Surgery, however, does not cure

  14. A Novel Perforator Flap Training Model Using a Chicken Leg.

    Science.gov (United States)

    Cifuentes, Ignacio J; Yañez, Ricardo A; Salisbury, Maria C; Rodriguez, José R; Varas, Julian E; Dagnino, Bruno L

    2016-04-01

    Living animal models are frequently used for perforator flap dissection training, but no ex vivo models have been described. The aim of this study is to present a novel nonliving model for perforator flap training based on a constant perforator in the chicken leg. A total of 15 chicken legs were used in this study. Anatomical dissection of the perforator was performed after its identification using ink injection, and in four of these specimens a perforator-based flap was raised. The anatomical dissection revealed a constant intramuscular perforator with a median length of 5.7 cm. Median proximal and distal vessel diameters were 0.93 and 0.4 mm, respectively. The median dissection time was 77.5 minutes. This study introduces a novel, affordable, and reproducible model for the intramuscular dissection of a perforator-based flap using an ex vivo animal model. Its consistent perforator and appropriate-sized vessels make it useful for training.

  15. PERFORATED PEPTIC ULCER: A CLINICAL ANALYSIS AND OUTCOME

    OpenAIRE

    Bijit

    2016-01-01

    BACKGROUND The incidence of perforated peptic ulcer is approximately 7-10 cases per one lakh population per year. Perforation is seen in about 7% of patients hospitalized for peptic ulcer disease. Peptic ulcer perforation, which can be gastric/duodenal perforation can be a serious life-threatening condition if not detected early and treated urgently. Peptic ulcer disease has decreased considerably worldwide with the advent of potent anti-ulcer medicines, but its complication l...

  16. 16S rRNA gene-based association study identified microbial taxa associated with pork intramuscular fat content in feces and cecum lumen

    OpenAIRE

    Fang, Shaoming; Xiong, Xingwei; Su, Ying; Huang, Lusheng; Chen, Congying

    2017-01-01

    Background Intramuscular fat (IMF) that deposits among muscle fibers or within muscle cells is an important meat quality trait in pigs. Previous studies observed the effects of dietary nutrients and additives on improving the pork IMF. Gut microbiome plays an important role in host metabolism and energy harvest. Whether gut microbiota exerts effect on IMF remains unknown. Results In this study, we investigated the microbial community structure of 500 samples from porcine cecum and feces using...

  17. Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation.

    Science.gov (United States)

    Bruner, David I; Gustafson, Corey

    2011-06-22

    Dyspnea and chest pain are common presenting complaints to the ED, and coupled together can present a challenging diagnostic dilemma in patients in extremis. A thoughtful evaluation is required, giving due diligence to the immediate life threats as well as multiple etiologies which can cause serious morbidity. A perforated peptic ulcer is one such possibility and requires rapid diagnosis and prompt intervention to avoid the associated high risk of morbidity and mortality. We present a case report of a 54 year old man with respiratory distress and chest pain as the initial Emergency Department presentation of a perforated duodenal ulcer. We discuss an unusual presentation of a perforated duodenal ulcer that was recognized in the emergency department and treated promptly. The patient was surgically treated immediately, had a prolonged and complicated post-operative course, but is ultimately doing well. We also provide a brief literature review of the risk factors, imaging choices, and management decision required to treat a perforated ulcer. Perforated ulcers can have highly varied presentations and are occasionally difficult to diagnose in a complicated patient. Knowledge of the risk factors and a thorough history and physical can point to the diagnosis, but timely and appropriate imaging is often required because delays in diagnosis and treatment lead to poor outcomes. Early administration of antibiotics and immediate surgical repair are necessary to limit morbidity and mortality.

  18. Perforation and bacterial contamination of microscope covers in lumbar spinal decompressive surgery.

    Science.gov (United States)

    Osterhoff, Georg; Spirig, José; Klasen, Jürgen; Kuster, Stefan P; Zinkernagel, Annelies S; Sax, Hugo; Min, Kan

    2014-01-01

    To determine the integrity of microscope covers and bacterial contamination at the end of lumbar spinal decompressive surgery. A prospective study of 25 consecutive lumbar spinal decompressions with the use of a surgical microscope was performed. For detection of perforations, the microscope covers were filled with water at the end of surgery and the presence of water leakage in 3 zones (objective, ocular and control panel) was examined. For detection of bacterial contamination, swabs were taken from the covers at the same locations before and after surgery. Among the 25 covers, 1 (4%) perforation was observed and no association between perforation and bacterial contamination was seen; 3 (4%) of 75 smears from the 25 covers showed post-operative bacterial contamination, i.e. 2 in the ocular zone and 1 in the optical zone, without a cover perforation. The incidence of microscope cover perforation was very low and was not shown to be associated with bacterial contamination. External sources of bacterial contamination seem to outweigh the problem of contamination due to failure of cover integrity. © 2014 S. Karger AG, Basel.

  19. Idiopathic gastric perforation in an asplenic infant | Olsen | African ...

    African Journals Online (AJOL)

    Introduction: The cause of idiopathic gastric perforations in neonates remains unknown. Perforations of the abdominal oesophagus, stomach and duodenum in infants and children are the rarest type of intestinal perforations. There are 21 reported cases of an idiopathic gastric rupture in nonneonates. Case Report: A ...

  20. Perforated duodenal ulcer: an unusual complication of gastroenteritis.

    OpenAIRE

    Wilson, J M; Darby, C R

    1990-01-01

    A 7 year old boy was admitted to hospital with gastroenteritis, which was complicated by an acute perforated duodenal ulcer. After oversewing of the perforation he made an uncomplicated recovery. Peptic ulceration is under-diagnosed in childhood and this leads to delay in diagnosis and appropriate management. Ulceration is associated with severe illness and viral infections, but perforation is rare.

  1. Iatrogen perforation of the rectum following barium enema

    International Nuclear Information System (INIS)

    Eggum, R.; Kressner, U.; Haffner, J.

    1998-01-01

    Perforation of the rectum following barium enema is relatively rare, occurring in 1 of 3,000 procedures. Colorectal perforation is a serious condition and early diagnosis is of paramount importance in order to avoid any delay in treating the patient. Direct suture of the perforation, lavage, presacral drainage and stomia are the preferred methods of primary surgical treatment. 10 refs., 1 fig

  2. [Iatrogen perforation of the rectum after colon radiography].

    Science.gov (United States)

    Eggum, R; Kressner, U; Haffner, J

    1998-05-10

    Perforation of the rectum following barium enema is relatively rare, occurring in 1 of 3,000 procedures. Colorectal perforation is a serious condition and early diagnosis is of paramount importance in order to avoid any delay in treating the patient. Direct suture of the perforation, lavage, presacral drainage and stomia are the preferred methods of primary surgical treatment.

  3. Isolation of Campylobacter jejuni from cloaca and cecum content of chicken broilers bred in intensive systems in the Western part of Romani

    Directory of Open Access Journals (Sweden)

    Ada Cean

    2013-10-01

    Full Text Available Campylobacter spp., belongs to the group of thermo-tolerant bacteria, and is the most frequent cause of gastrointestinal diseases in humans following consumption of poorly cooked chicken meat. The aim of our study was to test the common methodology for isolation of Campylobacter jejuni species from cloaca and cecum content of chicken broilers breed in intensive systems in Western part of Romania. The experiments were conducted during July –September 2013. As biological material we used chicken broilers from 6 intensive breeding facilities from the West part of Romania, from which cloaca swabs and cecum content were recovered as samples. Bacteria isolation was performed by inseminating Petri dish with Muller Hinton Agar media, after bacterial growth, they were subculture on Muller-Hinton Agar with Skirrow. The bacteria were tested by Gram staining and Oxidase test. Bacterial growth was detected from all samples when grown on Mueller-Hinton Agar, but when the bacteria was passed on Muller Hinton Agar with selective supplement (Skirrow 27 out of 36 samples remained positive (75,0%. With respect to the sample origin 13 (72.2% samples from cloaca swab and 14 (77.7% from cecum content grown on campylobacter selective media. All samples from Muller-Hinton supplemented with Skirrow tested negative for Gram staining and positive for oxidase test. We have successfully isolated Campylobacter spp., strains from farms and private producers in the western part of Romania.

  4. Equivalent material properties of perforated plate with triangular or square penetration pattern for dynamic analysis

    International Nuclear Information System (INIS)

    Jhung, Myung Jo; Jo, Jong Chull

    2006-01-01

    For a perforated plate, it is challenging to develop a finite element model due to the necessity of the fine meshing of the plate, especially if it is submerged in fluid. This necessitates the use of a solid plate with equivalent material properties. Unfortunately, the effective elastic constants suggested by the ASME code are deemed not valid for a model analysis. Therefore, in this study the equivalent material properties of a perforated plate are suggested by performing several finite element analyses with respect to the ligament efficiencies

  5. A Rare Case of Acute Abdomen: Perforation Secondary to Intramural Hematoma at Rectosigmoid Region

    Directory of Open Access Journals (Sweden)

    Orhan Yagmurkaya

    2013-06-01

    Full Text Available Intramural hematoma is a clinical situation which is secondary to anticoagulant therapy. In this study, a chronic atrial fibrilation patient taking anticoagulant, had perforation at rectosigmoid region which was secondary to intramural hematoma, is presented. Our case was a eighty-three-year-old male presented with acute abdomen at emergency room. In computerized tomography, intraabdominal free air and hematoma at rectosigmoid region were seen. Due to these, the decision of immidiate exploration was made. This should be noted that intramural hematoma can emerge in patientd on anticoagulant theraphy without trauma. Additionally, it shold be considered that intramural hematoma can lead to lethal complication such as perforation.

  6. Peritoneal drainage for newborn intestinal perforation: primary ...

    African Journals Online (AJOL)

    Keywords: intestinal perforation in newborn, necrotizing enterocolitis, primary peritoneal drainage. Department of Surgery, Paul L. Foster School of Medicine, Texas Tech University. HSC, El Paso, Texas, USA. Correspondence to Donald E. Meier, MD, Department of Surgery, Paul L. Foster. School of Medicine, Texas Tech ...

  7. Spontaneous cecal perforation secondary to acute fulminant ...

    African Journals Online (AJOL)

    Furthermore, frequent occurrence of diarrhea has been often misinterpreted as gastroenteritis, and this has made early diagnosis a challenge, especially in children [3]. Chang et al. [3] reported a mean lag of 6.19 days between the onset of symptoms and the diagnosis of colon perforation in their series, which highlights the ...

  8. Traumatic tympanic membrane perforations: characteristics and ...

    African Journals Online (AJOL)

    Objective: To characterize traumatic tympanic membrane perforation (TTMP) in terms of distribution, mechanisms, and outcome of treatment. To assess the factors influencing such outcome. Study design: Prospective analytical study, assessing outcomes post-injuries. Setting: Clinical department of a tertiary referral hospital.

  9. Acute Perforated Schistosomal Appendicitis: A Case Report ...

    African Journals Online (AJOL)

    Appendicitis is occasionally the first clinical manifestation of schistosomal infestation which may require treatment. A rare case of perforated schistosomal appendicitis in a 12 –year old Nigerian boy diagnosed on the basis of histological evaluation of the appendectomy specimen is reported to highlight the clinical ...

  10. Pneumoperitoneum: an unusual presenting finding of perforated ...

    African Journals Online (AJOL)

    Here, we present a case of a 2-year-old boy with perforated appendicitis ... it will result in the patient's immediate surgical exploration and cure. ... abdominal pain, vomiting, and anorexia that had gone ... consistent with the study of Kumar et al.

  11. Perforated membrane-type acoustic metamaterials

    International Nuclear Information System (INIS)

    Langfeldt, F.; Kemsies, H.; Gleine, W.; Estorff, O. von

    2017-01-01

    This letter introduces a modified design of membrane-type acoustic metamaterials (MAMs) with a ring mass and a perforation so that an airflow through the membrane is enabled. Simplified analytical investigations of the perforated MAM (PMAM) indicate that the perforation introduces a second anti-resonance, where the effective surface mass density of the PMAM is much higher than the static value. The theoretical results are validated using impedance tube measurements, indicating good agreement between the theoretical predictions and the measured data. The anti-resonances yield high low-frequency sound transmission loss values with peak values over 25 dB higher than the corresponding mass-law. - Highlights: • A new membrane-type acoustic metamaterial exhibiting negative density is presented. • The metamaterial design contains a ring mass with a perforation through the membrane. • The sound transmission loss exhibits narrow-band peaks much higher than the mass-law. • The emergence of the peaks is explained using a simple theoretical model. • Impedance tube measurements are used to validate the theoretical predictions.

  12. Perforated membrane-type acoustic metamaterials

    Energy Technology Data Exchange (ETDEWEB)

    Langfeldt, F., E-mail: Felix.Langfeldt@haw-hamburg.de [Department of Automotive and Aeronautical Engineering, Hamburg University of Applied Sciences, Berliner Tor 9, D-20099 Hamburg (Germany); Kemsies, H., E-mail: Hannes.Kemsies@haw-hamburg.de [Department of Automotive and Aeronautical Engineering, Hamburg University of Applied Sciences, Berliner Tor 9, D-20099 Hamburg (Germany); Gleine, W., E-mail: Wolfgang.Gleine@haw-hamburg.de [Department of Automotive and Aeronautical Engineering, Hamburg University of Applied Sciences, Berliner Tor 9, D-20099 Hamburg (Germany); Estorff, O. von, E-mail: estorff@tu-harburg.de [Institute of Modelling and Computation, Hamburg University of Technology, Denickestr. 17, D-21073 Hamburg (Germany)

    2017-04-25

    This letter introduces a modified design of membrane-type acoustic metamaterials (MAMs) with a ring mass and a perforation so that an airflow through the membrane is enabled. Simplified analytical investigations of the perforated MAM (PMAM) indicate that the perforation introduces a second anti-resonance, where the effective surface mass density of the PMAM is much higher than the static value. The theoretical results are validated using impedance tube measurements, indicating good agreement between the theoretical predictions and the measured data. The anti-resonances yield high low-frequency sound transmission loss values with peak values over 25 dB higher than the corresponding mass-law. - Highlights: • A new membrane-type acoustic metamaterial exhibiting negative density is presented. • The metamaterial design contains a ring mass with a perforation through the membrane. • The sound transmission loss exhibits narrow-band peaks much higher than the mass-law. • The emergence of the peaks is explained using a simple theoretical model. • Impedance tube measurements are used to validate the theoretical predictions.

  13. Intestinal perforation caused by multiple magnet ingestion

    Directory of Open Access Journals (Sweden)

    Nergul Corduk

    2014-01-01

    Full Text Available Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.

  14. Sonographic templates of newborn perforator stroke.

    Science.gov (United States)

    Abels, Lyanne; Lequin, Maarten; Govaert, Paul

    2006-07-01

    Many paediatric strokes occur in the perinatal period. Improvement in neuroimaging has increased detection in newborns with neurological symptoms. To define sonographic templates of neonatal stroke in the territory of perforators of the anterior choroidal artery (AChA) and the anterior (ACA), middle (MCA) and posterior (PCA) cerebral arteries. In 24 neonates with perforator stroke, we retrospectively studied antenatal and perinatal events. Brain sonography was performed with an 8.5-MHz probe. Only hyperechoic lesions in the thalamus and/or striatum and/or centrum semiovale were included. MRI was obtained using a 1.5-T machine. We detected 28 perforator strokes in 24 infants (6 preterm): 5 MCA medial striate, 8 MCA lateral striate, 3 MCA centrum semiovale, 4 ACA Heubner's, 5 PCA thalamic arteries, 1 AChA, and 2 hypothalamic perforators. We attributed clinical seizures to stroke in two infants only. Catheter-related embolism (certain in three, possible in six others) and birth trauma (two) were probable causes. Specific conditions were found in six others. Only one infant (in nine evaluated) had an increased prothrombotic risk (fII mutation). In describing the lesions, we focused on the templates of infarction as seen in a parasagittal US sweep. Infarcts were confirmed by MRI in 21 patients. Our study showed that infarct topography can be evaluated reliably with brain sonography. This is important given the asymptomatic character of most lesions.

  15. Discriminating between simple and perforated appendicitis

    NARCIS (Netherlands)

    Bröker, Mirelle E. E.; van Lieshout, Esther M. M.; van der Elst, Maarten; Stassen, Laurents P. S.; Schepers, Tim

    2012-01-01

    Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. All consecutive patients who have undergone an appendectomy in the

  16. Infantile perforated appendicitis: A forgotten diagnosis

    Directory of Open Access Journals (Sweden)

    Katherine W. Gonzalez

    2015-04-01

    Full Text Available Acute appendicitis in the infant is a rare surgical diagnosis despite its frequency in older patients. The clinical presentation is often vague and can be misleading. We present the successful diagnosis and treatment of a 3 month old female with perforated appendicitis.

  17. Conservative Management of Duodenal Perforation with Toothpick in a 9- Year Old Girl; a Case Report

    Directory of Open Access Journals (Sweden)

    Shahsanam Gheibi

    2016-10-01

    Full Text Available Background Foreign body ingestion is a relatively common in children. Most ingested foreign bodies spontaneously pass out of the body via the gastrointestinal (GI system but sharp materials may perforate the GI tract and need to surgical intervention. Case Presentation  The patient was a 9-year-old girl with progressive abdominal pain for one month and admitted with acute abdomen impression. She underwent esogastroduodenoscopy (EGD due to severe epigastric tenderness. Upper GI endoscopy revealed duodenal ulceration and perforation by a toothpick while she had no history of foreign body ingestion. Toothpick was removed by endoscopy. She was successfully managed conservatively and had no abdominal pain during the one month follow-up period. Conclusion We recommend the endoscopic approach as the preferable method for the extraction of duodenal foreign bodies in children, even in the case of intestinal perforation.

  18. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain

    International Nuclear Information System (INIS)

    Bakhshaeekia, Alireza; Hosseini, Seyed M.V; Razmi, Tannaz; Shamsaeefar, Alireza

    2009-01-01

    Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis. (author)

  19. Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

    Science.gov (United States)

    Yoo, Ri Na; Kye, Bong-Hyeon; Kim, Gun; Kim, Hyung Jin; Cho, Hyeon-Min

    2017-10-01

    Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

  20. Surface modification of silica particles with gold nanoparticles as an augmentation of gold nanoparticle mediated laser perforation

    Science.gov (United States)

    Kalies, Stefan; Gentemann, Lara; Schomaker, Markus; Heinemann, Dag; Ripken, Tammo; Meyer, Heiko

    2014-01-01

    Gold nanoparticle mediated (GNOME) laser transfection/perforation fulfills the demands of a reliable transfection technique. It provides efficient delivery and has a negligible impact on cell viability. Furthermore, it reaches high-throughput applicability. However, currently only large gold particles (> 80 nm) allow successful GNOME laser perforation, probably due to insufficient sedimentation of smaller gold nanoparticles. The objective of this study is to determine whether this aspect can be addressed by a modification of silica particles with gold nanoparticles. Throughout the analysis, we show that after the attachment of gold nanoparticles to silica particles, comparable or better efficiencies to GNOME laser perforation are reached. In combination with 1 µm silica particles, we report laser perforation with gold nanoparticles with sizes down to 4 nm. Therefore, our investigations have great importance for the future research in and the fields of laser transfection combined with plasmonics. PMID:25136494

  1. Wave Reflection and Loss Characteristics of an Emerged Quarter Circle Breakwater with Varying Seaside Perforations

    Science.gov (United States)

    Binumol, S.; Rao, Subba; Hegde, Arkal Vittal

    2017-09-01

    Breakwaters are one of the most important harbour structures constructed to withstand and dissipate the dynamic energy due to the action of the waves. Due to fast growing need of the universe and advances in technology different types of breakwaters are being developed. Quarter circle breakwater is a new type of breakwater emerged from semi circular breakwater and the first model was developed in Peoples Republic of China (2006). Quarter circle breakwater with perforations posses merits of caisson as well as perforated breakwaters such as low weight, requires less materials, suited for poor soil conditions, easily transported, handled and placed at the site, aesthetically pleasing, cost effective, eco-friendly and stable. Therefore it is necessary to carry out detailed studies on hydrodynamic characteristics to investigate the suitability and applicability of various types of quarter circle breakwaters. The present study investigates the wave reflection and loss characteristics of an emerged seaside perforated quarter circle breakwater of radius 55 cm and with varying ratios of spacing to diameter of perforations, for different water depths and wave conditions. The tests were conducted in the two-dimensional monochromatic wave flume available in Marine Structures laboratory of Department of Applied Mechanics and Hydraulics of National Institute of Technology, Surathkal, Karnataka, India. The results were plotted as non-dimensional graphs and it was observed that the reflection coefficient increases with increase in wave steepness for all values of ratio of height of breakwater structure to water depth. For a constant water depth, wave reflection increases with increase in ratio of spacing to diameter of perforations. It was also found that the loss coefficient decreases with increase in wave steepness for all values of ratio of height of breakwater structure to water depth, and ratio of spacing to diameter of perforations.

  2. Rumen and Cecum Microbiomes in Reindeer (Rangifer tarandus tarandus Are Changed in Response to a Lichen Diet and May Affect Enteric Methane Emissions.

    Directory of Open Access Journals (Sweden)

    Alejandro Salgado-Flores

    Full Text Available Reindeer (Rangifer tarandus tarandus are large Holarctic herbivores whose heterogeneous diet has led to the development of a unique gastrointestinal microbiota, essential for the digestion of arctic flora, which may include a large proportion of lichens during winter. Lichens are rich in plant secondary metabolites, which may affect members of the gut microbial consortium, such as the methane-producing methanogenic archaea. Little is known about the effect of lichen consumption on the rumen and cecum microbiotas and how this may affect methanogenesis in reindeer. Here, we examined the effects of dietary lichens on the reindeer gut microbiota, especially methanogens. Samples from the rumen and cecum were collected from two groups of reindeer, fed either lichens (Ld: n = 4, or a standard pelleted feed (Pd: n = 3. Microbial densities (methanogens, bacteria and protozoa were quantified using quantitative real-time PCR and methanogen and bacterial diversities were determined by 454 pyrosequencing of the 16S rRNA genes. In general, the density of methanogens were not significantly affected (p>0.05 by the intake of lichens. Methanobrevibacter constituted the main archaeal genus (>95% of reads, with Mbr. thaueri CW as the dominant species in both groups of reindeer. Bacteria belonging to the uncharacterized Ruminococcaceae and the genus Prevotella were the dominant phylotypes in the rumen and cecum, in both diets (ranging between 16-38% total sequences. Bacteria belonging to the genus Ruminococcus (3.5% to 0.6%; p = 0.001 and uncharacterized phylotypes within the order Bacteroidales (8.4% to 1.3%; p = 0.027, were significantly decreased in the rumen of lichen-fed reindeer, but not in the cecum (p = 0.2 and p = 0.087, respectively. UniFrac-based analyses showed archaeal and bacterial libraries were significantly different between diets, in both the cecum and the rumen (vegan::Adonis: pseudo-F<0.05. Based upon previous literature, we suggest that the

  3. APPENDICULAR INVAGINATION DUE TO ENDOMETRIOSIS

    Directory of Open Access Journals (Sweden)

    Vasja Kruh

    2003-12-01

    Full Text Available Background. Invagination of the vermiform appendix is a very rare occurrence. We summarize epidemiologic and etiologic factors, types of classification, symtomatology, diagnostic features and treatment.Patients and treatment. The authors present 49-years old female with long-standing abdominal pains, who came in our hospital due to acute exacerbation with sever abdominal pain. Because of progressive symptoms and sensitivity in the right-lower abdominal quadrant a diagnostic laparoscopy was performed. An anomaly of cecum and the absence of appendix vermiformis have forced us to proceed with laparotomy in McBurnay point. After cecotomy an invaginated gangrenous appendix was found. The histological examination revealed endometriosis.Conclusions. By presenting this extremely rare pathology we also want to emphasize the important role of diagnostic laparoscopy in front of acute abdomen.

  4. Use of pulsed neutron logging to evaluate perforation washing

    International Nuclear Information System (INIS)

    Dimon, C.A.

    1986-01-01

    This invention relates to the use of pulsed neutron logging techniques before and after perforation washing operations are performed to evaluate the degree of success of the perforation washing operations. Well logging operations of a type designed to respond to the difference between a formation immediately behind the well sheath and voids in the formation are performed both before and after the perforation washing operation. differences between the two resulting logs are then indicative of voids created by perforation washing. In a preferred embodiment, pulsed neutron logging is used as the logging technique, while a weighted brine having a high absorption cross section to pulsed neutrons is used as the perforation washing fluid

  5. DETERMINATION OF THE TEMPERATURE DISTRIBUTION THE PERFORATED FINS UNDER

    Directory of Open Access Journals (Sweden)

    Aziz7 M. Mhamuad

    2015-02-01

    Full Text Available This work treats the problem of heat transfer for perforated fins under natural convection. The temperature distribution is examined for an array of rectangular fins (15 fins with uniform cross-sectional area (100x270 mm embedded with various vertical body perforations that extend through the fin thickness. The patterns of perforations include 18 circular perforations (holes. Experiments were carried out in an experimental facility that was specifically design and constructed for this purpose. The heat transfer rate and the coefficient of heat transfer increases with perforation diameter increased. 

  6. Duodenal perforation: an unusual complication of sickle cell anemia.

    Science.gov (United States)

    Acıpayam, Can; Aldıç, Güliz; Akçora, Bülent; Çelikkaya, Mehmet Emin; Aşkar, Hasan; Dorum, Bayram Ali

    2014-01-01

    Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia.

  7. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis

    Science.gov (United States)

    Masood, Irfan; Majid, Zain; Rafiq, Ali; Rind, Waqas; Zia, Aisha; Raza, Sajjad

    2015-01-01

    Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations of the small bowel extending 10–15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6–8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before. PMID:26798540

  8. Multiple, Pan-Enteric Perforation Secondary to Intestinal Tuberculosis

    Directory of Open Access Journals (Sweden)

    Irfan Masood

    2015-01-01

    Full Text Available Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90% perforations are solitary. Herein, we describe a case of a 25-year-old male who presented with generalized peritonitis requiring an emergency exploratory laparotomy, which revealed pan-enteric perforation characterized by multiple perforations of the small bowel extending 10–15 cm from the DJ flexure up to the terminal ileum. The perforations were primarily closed, while 6–8 cm of the diseased terminal ileum was resected and the two ends were brought out as double-barreled ostomy. To the best of our knowledge, such an extensive tuberculous perforation of the small bowel has not been previously reported in the literature before.

  9. Radiologic Study of Meniscus Perforations in the Temporomandibular Joint

    International Nuclear Information System (INIS)

    Kim, Kee Duck; Park, Chang Seo

    1990-01-01

    Thirty-nine patients (forty-four joints) who had been diagnosed as having meniscus perforation of the temporomandibular joint by inferior joint space arthrography and had been treated by surgical procedures were evaluated retrospectively. Information of clinical findings, arthrotomographic findings and surgical findings was collected on a standardized form and evaluated. The results were as follows: 1. On the 34 patients of 38 joints which were surgically confirmed perforation of meniscus or its attachments of the temporomandibular joint, there were 29 females and 5 males (5.8:1). The average age was 36 years (range 17 to 70). 2. The common clinical findings of group that had meniscus displacement without reduction and with perforation were pain on the affected joint and limitation of mouth opening. In the group showing meniscus displacement with reduction and with perforation the common clinical findings were pain and clicking on the affected joint. 3. 32 joints (84.2%) were arthrotomographically anterior meniscus displacement without reduction and with perforation, 6 joints (15.8%) showed anterior meniscus displacement with reduction and with perforation. 4. Joints categorized arthrotomographically as having meniscus displacement without reduction and with perforation were less likely to have full translation of the condyle in comparison with the normal or meniscus displacement with reduction and with perforation groups (p<0.05) 5. The arthrographic findings of 44 joints having meniscus perforation were compared with surgical findings, there were 6 false positive findings of meniscus perforation, the reliability of arthrographic findings of meniscus perforation was a 86.4% correlation with surgical findings. 6. On the site of perforations of 38 joints which were surgically confirmed perforation of meniscus or its attachments, twenty-three of perforations (60.5%) were in location at the junction of the meniscus and posterior attachment, fourteen (36.9%) were

  10. The management of large perforations of duodenal ulcers

    Directory of Open Access Journals (Sweden)

    Sharma Rajeev

    2005-06-01

    Full Text Available Abstract Background Duodenal ulcer perforations are a common surgical emergency, but literature is silent on the exact definition, incidence, management and complications of large perforations of duodenal ulcers. Methods The case files of 162 patients who underwent emergency laparotomy for duodenal ulcer perforations over a period of three years (2001 – 2003 were retrospectively reviewed and sorted into groups based on the size of the perforations – one group was defined as 'small 'perforations (less than 1 cm in diameter, another 'large' (when the perforation was more than 1 cm but less than 3 cms, and the third, 'giant'(when the perforation exceeded 3 cm. These groups of patients were then compared with each other in regard to the patient particulars, duration of symptoms, surgery performed and the outcome. Results A total of 40 patients were identified to have duodenal ulcer perforations more than 1 cm in size, thus accounting for nearly 25 % of all duodenal ulcer perforations operated during this period. These patients had a significantly higher incidence of leak, morbidity and mortality when compared to those with smaller perforations. Conclusion There are three distinct types of perforations of duodenal ulcers that are encountered in clinical practice. The first, are the 'small' perforations that are easy to manage and have low morbidity and mortality. The second are the 'large' perforations, that are also not uncommon, and omental patch closure gives the best results even in this subset of patients. The word 'giant' should be reserved for perforations that exceed 3 cms in diameter, and these are extremely uncommon.

  11. The Perforation-Operation time Interval; An Important Mortality Indicator in Peptic Ulcer Perforation.

    Science.gov (United States)

    Surapaneni, Sushama; S, Rajkumar; Reddy A, Vijaya Bhaskar

    2013-05-01

    To find out the significance of the Perforation-Operation Interval (POI) with respect to an early prognosis, in patients with peritonitis which is caused by peptic ulcer perforation. Case series. Place and Duration of the Study: Department of General Surgery, Konaseema Institute of Medical Sciences and RF Amalapuram, Andhra Pradesh, India from 2008-2011. This study included 150 patients with generalized peritonitis, who were diagnosed to have Perforated Peptic Ulcers (PPUs). The diagnosis of the PPUs was established on the basis of the history , the clinical examination and the radiological findings. The perforation-operation interval was calculated from the time of onset of the symptoms like severe abdominal pain or vomiting till the time the patient was operated. Out of the 150 patients 134 were males and 16 were females, with a male : female ratio of 9:1. Their ages ranged between 25-70 years. Out of the 150 patients, 65 patients (43.3%) presented within 24 hours of the onset of severe abdominal pain (Group A), 27 patients (18%) presented between 24-48 hours of the onset of severe abdominal pain (Group B) and 58 patients (38.6%) presented after 48 hours. There was no mortality in Group A and the morbidity was more in Group B and Group C. There were 15 deaths in Group C. The problem of peptic ulcer perforation with its complication, can be decreased by decreasing the perforation -operation time interval, which as per our study, appeared to be the single most important mortality and morbidity indicator in peptic ulcer perforation.

  12. Dimensional changes of alginate impression by using perforated and non-perforated ring trays

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    Sumadhi Sastrodihardjo

    2010-03-01

    Full Text Available Dimensional changes are a common occurrence in impressions, either during or after impression taking. It produces a difference in the dimensions of the object and the model, which leads to the restoration being ill-fitted. Several causal factors have been proposed such as friction between the impression material and the teeth, the bulk of the impression material, the type of impression materials used, the impression technique, the pouring time and many others. The exact causal factor is still unknown and the dimensional change mechanism is still poorly understood. The objective of this research was to investigate the role of the perforation on the ring trays in producing dimensional changes in the impression by using perforated and non-perforated ring trays. Alginate impressions were made on the frustum of cone metal master die with a 7.08 mm base diameter, 7.03 mm top diameter and 9.23 mm height using perforated and non-perforated ring trays with 9.40 mm in diameter and 14.17 mm in height. The dimensional change was determined by comparing the dimension of the dental stone die and its metal master die. The results showed that the percentage of dimensional changes that occurred by using perforated ring tray were (+ 0.56±0.40 on the top area, (- 3.54±2.92 on base area and (+ 1.54±0.83 in height, respectively. As compared to using non-perforated ring trays, the percentage of dimensional changes that occurred were (- 0.49±0.49 on top area, (- 8.76±3.95 on base area and (+ 1.19±0.71 in height, respectively. There was a significant difference in the direction of the dimensional changes on both the top areas, but not in the base areas and height.

  13. Simulation of air velocity in a vertical perforated air distributor

    Science.gov (United States)

    Ngu, T. N. W.; Chu, C. M.; Janaun, J. A.

    2016-06-01

    Perforated pipes are utilized to divide a fluid flow into several smaller streams. Uniform flow distribution requirement is of great concern in engineering applications because it has significant influence on the performance of fluidic devices. For industrial applications, it is crucial to provide a uniform velocity distribution through orifices. In this research, flow distribution patterns of a closed-end multiple outlet pipe standing vertically for air delivery in the horizontal direction was simulated. Computational Fluid Dynamics (CFD), a tool of research for enhancing and understanding design was used as the simulator and the drawing software SolidWorks was used for geometry setup. The main purpose of this work is to establish the influence of size of orifices, intervals between outlets, and the length of tube in order to attain uniformity of exit flows through a multi outlet perforated tube. However, due to the gravitational effect, the compactness of paddy increases gradually from top to bottom of dryer, uniform flow pattern was aimed for top orifices and larger flow for bottom orifices.

  14. Primary Report of Totally Tubeless Percutaneous Nephrolithotomy Despite Pelvi-calyceal Perforations.

    Science.gov (United States)

    Aghamir, Seyed Mohammad Kazem; Salavati, Alborz; Hamidi, Morteza; FallahNejad, Asghar

    2017-07-02

    Nephrostomy tube insertion and/or a ureteral stent placement is advised when pelvi-calyceal perforations are encountered during percutaneous nephrolithotomy (PNL) nevertheless totally tubeless PNL is a possible exit strategy in percutaneous renal surgery therefore case series on the short term clinical outcomes of noninvasive management of iatrogenic pelvicalyceal perforations encountered during PNL is presented. During retrospective analysis of 1271 PNL procedures, 25 incidents of accidental ureteral catheter/ jj stent dislodgement during first 24 post-operative hours were identified in patient who had pelvi calyceal perforations and had no nephrostomy tube (tubeless). Thirteen patients could not be re-stented nor a nephrostomytube could have been placed for them mainly due to patient refusal or comorbid conditions. The main outcome was rate of successful noninvasive management. Eighteen Patients bearing mucosal tears (grade I trauma) or visible peri-pelvic fat (grade II) successfully recovered without need for ureteral stenting or nephrostomy (72.0%). In seven (28.0%) cases of extension of the perforation into the peri-pelvic fat (grade III), either nephrostomy insertion or JJ stenting was needed for resolution of fever and urinoma. The major limitation was the necessity to exclude patients and manage them in the standard fashion according to clinical guidelines. Iatrogenic perforations of the collecting system are quite diverse in terms of severity that result in different natural histories and not all might need urinary diversion via nephrostomy or ureteral stenting.Low grade perforations may be successfully managed in totally tubeless fashion nevertheless further prospective investigations seem warranted.

  15. Premixed Combustion of Kapok (ceiba pentandra seed oil on Perforated Burner

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    I.K.G. Wirawan

    2014-05-01

    Full Text Available Availability of fossil fuels in the world decrease gradually due to excessive fuel exploitation. This situations push researcher to look for alternative fuels as a source of renewable energy, one of them is kapok (ceiba pentandra seed oil. The aim this study was to know the behavior of laminar burning velocity, secondary Bunsen flame with open tip, cellular and triple flame. Premixed combustion of kapok seed oil was studied experimentally on perforated burner with equivalence ratio (φ varied from 0.30 until 1.07. The results showed that combustion of glycerol requires a large amount of air so that laminar burning velocity (SL is the highest at very lean mixture (φ =0.36 in the form of individual Bunsen flame on each of the perforated plate hole.  Perforated and secondary Bunsen flame both reached maximum SL similar with that of ethanol and higher than that of hexadecane. Slight increase of φ decreases drastically SL of perforated and secondary Bunsen flame. When the mixture was enriched, secondary Bunsen and perforated flame disappears, and then the flame becomes Bunsen flame with open tip and triple flame (φ = 0.62 to 1.07. Flame was getting stable until the mixture above the stoichiometry. Being isolated from ambient air, the SL of perforated flame, as well as secondary Bunsen flame, becomes equal with non-isolated flame. This shows the decreasing trend of laminar burning velocity while φ is increasing. When the mixture was enriched island (φ = 0.44 to 0.48 and petal (φ = 0.53 to 0.62 cellular flame take place. Flame becomes more unstable when the mixture was changed toward stoichiometry.

  16. Acute Myocardial Infarction with Simultaneous Gastric Perforation

    Directory of Open Access Journals (Sweden)

    Alon Kaplan

    2017-05-01

    Full Text Available Acute myocardial infarction and perforated peptic ulcer disease with associated peritonitis are both medical emergencies requiring urgent intervention. This patient presented with both emergencies simultaneously. Current literature is devoid of guidance as to which should be addressed initially. A multidisciplinary discussion was conducted leading to a unanimous decision for initiating percutaneous coronary intervention (PCI. After successful PCI, the patient was immediately taken to the operating room for laparoscopic repair of the perforated viscous. Subsequent to the operative repair, the patient became hemodynamically unstable and a repeat electrocardiogram demonstrated complete right coronary occlusion. Shock ensued and the patient died in the intensive care unit despite this plan of care. It is our opinion that this case reveals the need for expert panels to devise decision algorithms for concomitant presentations of life-threatening diseases.

  17. Thyroid storm precipitated by duodenal ulcer perforation.

    Science.gov (United States)

    Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Ando, Takao; Kawakami, Atsushi

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  18. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    Directory of Open Access Journals (Sweden)

    Shoko Natsuda

    2015-01-01

    Full Text Available Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  19. Perforated peptic ulcer in southeastern Taiwan.

    Science.gov (United States)

    Li, Chin-Hsien; Chang, Wen-Hsiung; Shih, Shou-Chuan; Lin, Shee-Chan; Bair, Ming-Jong

    2010-09-01

    No studies focus on the population with perforated peptic ulcer in southeastern Taiwan. The present study aimed to assess the differences between the different races and the risk factors related to mortality and morbidity in postoperative patients in southeastern Taiwan. The medical records of 237 patients were reviewed retrospectively. The following factors were analyzed: patient profiles, coexisting illnesses, diagnostic method, fever, preoperative shock, clinical data at emergency room, delay operation, site of perforation, operative method, positive ascites culture, species of microbes in ascites culture, postoperative complications, death and the length of hospital stay. Aborigines were significantly different from non-aborigines in the ratio of female cases and in the habits of alcohol drinking and betel nut chewing. There were also four significantly different variables between them: fever, hemoglobin value, site of perforation and operative method. Total postoperative complication rate was 41.3% and 39 patients (16.6%) died. In multivariate analysis, age > or = 65 years, lipase > upper normal limit and preoperative shock were independent predictors of mortality. Significant risk factors associated with morbidity were NSAIDs use, creatinine > 1.5 mg/dL and preoperative shock. Aborigines were different from non-aborigines in several categories. In southeastern Taiwan, NSAIDs use, creatinine > 1.5 mg/dL and preoperative shock were independent risk factors of morbidity, and age > or = 65 years, lipase > upper normal limit and preoperative shock were independent risk factors of mortality in postoperative perforated peptic ulcer. Lipase > upper normal limit is needed for further research on the influence on mortality.

  20. High Temperature Perforating System for Geothermal Applications

    Energy Technology Data Exchange (ETDEWEB)

    Smart, Moises E. [Schlumberger Technology Corporation, Sugar Land, TX (United States)

    2017-02-28

    The objective of this project is to develop a perforating system consisting of all the explosive components and hardware, capable of reliable performance in high temperatures geothermal wells (>200 ºC). In this light we will focused on engineering development of these components, characterization of the explosive raw powder and developing the internal infrastructure to increase the production of the explosive from laboratory scale to industrial scale.

  1. Diagram of the uranium prospection perforation

    International Nuclear Information System (INIS)

    Perrin, J.

    1982-01-01

    We call diagrams to the drawn up one continuous of parameters physicists of the formation trimmed by a perforation based on the depth. The method is interesting not only for the putting in evidence of the mineralized levels but also it stops to determine the variations of lithology had by one part to the intrinsic properties of minerals (quartz, clays, carbonates) and to their variation of tenor and by another one, to variations of porosity and permeability of the formation

  2. Urosepsis complicated by a spontaneous bladder perforation.

    Science.gov (United States)

    Lutwak, Nancy; Dill, Curt

    2011-11-08

    The authors present a case of a 72-year-old diabetic male s/p pelvic irradiation for prostate carcinoma who arrived in the emergency department with complaints of shaking chills. After admission for urosepsis, he developed severe abdominal pain and examination revealed a diffusely tender abdomen. The patient was diagnosed with spontaneous urinary bladder perforation and underwent surgery. After several weeks of intravenous antibiotics, he was discharged with multiple drains in place and bilateral nephrostomy tubes.

  3. Liquid nitrogen ingestion followed by gastric perforation.

    Science.gov (United States)

    Berrizbeitia, Luis D; Calello, Diane P; Dhir, Nisha; O'Reilly, Colin; Marcus, Steven

    2010-01-01

    Ingestion of liquid nitrogen is rare but carries catastrophic complications related to barotrauma to the gastrointestinal tract. We describe a case of ingestion of liquid nitrogen followed by gastric perforation and respiratory insufficiency and discuss the mechanism of injury and management of this condition. Liquid nitrogen is widely available and is frequently used in classroom settings, in gastronomy, and for recreational purposes. Given the potentially lethal complications of ingestion, regulation of its use, acquisition, and storage may be appropriate.

  4. Surgical therapeutic management of perforated peptic ulcer

    OpenAIRE

    Ana Karla de Sousa Almeida; Clara Rafael Silva Xavier; Lucas de Faria Barros Medeiros; Joanna de Andrade Cordeiro; Amália Cínthia Menezes Rêgo; Irami Araújo-Filho

    2016-01-01

    Perforated peptic ulcer is an emergency should be readily corrected by surgical approach to reduce potential damage and the risk of mortality associated with the extension frame. The option of handling most commonly used by surgeons is laparotomy, however, there is evidence pointing to approach laparoscopically like a viable, safe and with good results for their treatment. Therefore, it is appropriate to evaluate the data about each management and minimally invasive procedure, lap...

  5. Perforated Solitary Diverticulitis of the Ascending Colon

    Science.gov (United States)

    2005-06-01

    postoperative day 6. DISCUSSION Diverticuli of the right colon exist in approximately 1% to 5% of patients with diverticular disease .1-3 They are...ORIGINAL REPORTS Perforated Solitary Diverticulitis of the Ascending Colon CPT David S. Kauvar, MC, USA, MAJ, Jayson Aydelotte, MC, USA, and MAJ...Michael Harnisch, MC, USA Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas KEY WORDS: solitary colon diverticulum

  6. Postvaginal Delivery Caecal Volvulus and Perforation

    Directory of Open Access Journals (Sweden)

    M. M. Abdullah Agha

    2012-01-01

    Full Text Available Intestinal obstruction is an uncommon complication of pregnancy and pueperium. It has different etiologies and voluvlus is one of the common causes. High index of suspicion is needed to diagnose it as initial presentation is nonspecific and that is critical to avoid adverse outcomes. We presented here one of these cases that followed vaginal delivery and ended with caecal perforation and hemicolectomy.

  7. Analysis of the influence of the cutting edge geometry on parameters of the perforation process for conveyor and transmission belts

    Directory of Open Access Journals (Sweden)

    Wojtkowiak Dominik

    2018-01-01

    Full Text Available Perforated belts, which are used in vacuum conveyor belts, can have significantly different mechanical properties like strength and elasticity due to a variety of used materials and can have different thickness from very thin (0,7 mm to thick belts (6 mm. In order to design a complex machine for mechanical perforation, which can perforate whole range of belts, it is necessary to research the influence of the cutting edge geometry on the parameters of the perforation process. Three most important parameters, which describe the perforation process are the cutting force, the velocity and the temperature of the piercing punch. The results presented in this paper consider two different types of punching (a piercing punch with the punching die or with the reducer plate and different cutting edge directions, angles, diameters and material properties. Test were made for different groups of composites belts – with polyurethane and polyester fabric, polyamide core or aramid-fibre reinforced polymers. The main goal of this research is to specify effective tools and parameters of the perforation process for each group of composites belts.

  8. Overcoming the Obstacles of the Ilizarov Device in Extremity Reconstruction: Usefulness of the Perforator as the Recipient Vessel.

    Science.gov (United States)

    Kim, Kyu Nam; Hong, Joon Pio; Park, Sung Woo; Kim, Sang Woo; Yoon, Chi Sun

    2015-07-01

    When patients using the Ilizarov device need a free-flap procedure for their thigh and leg, it is difficult to isolate the major vessels as the recipient vessel due to the limited working space around the Ilizarov rings and pins. The usefulness of a perforator as the recipient vessel to allow minimally invasive surgery was investigated in this study. Between October 2011 and December 2013, 77 patients using the Ilizarov device needed free flap reconstruction using an anterolateral thigh perforator flap or superficial circumflex iliac artery perforator flap. The perforator was used as a recipient vessel in 50 cases, with which end-to-end anastomosis was performed using a perforator-to-perforator approach, and major vessels were used as a recipient vessel in 27 cases (n = 20, anterior tibial vessel; n = 7, posterior vessel). When the perforator was used as the recipient vessel, total loss developed in one case and marginal necrosis in four cases. When the major vessel was used as the recipient vessel, whole necrosis developed in one case and marginal necrosis in two cases. The procedure increased the freedom of hand movement, decreased the recipient vessel dissection time, and reduced the recipient dissection scar. The use of perforators as recipients overcomes the obstacles associated with the Ilizarov device and allows convenient and rapid reconstruction, with similar success as microsurgery using major vessels. Further studies are needed to address the limitations of this approach, which include perfusion physiology and the viable limit of the flap dimension. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Profunda Femoris Artery Perforator Propeller Flap: A Valid Method to Cover Complicated Ischiatic Pressure Sores.

    Science.gov (United States)

    Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Pierangeli, Marina; Di Benedetto, Giovanni

    2015-08-01

    We report the case of a 50-year-old paraplegic man with a complicated grade III/IV ischiatic pressure sore treated with a propeller flap based on the first perforator of the profunda femoris artery. Our aim was to surgically reconstruct an ischiatic pressure sore in a patient with ankylosis using a fasciocutaneous perforator propeller flap obtained from the posterior region of the thigh. Our decision to perform a profunda femoris artery perforator propeller flap reconstruction was mainly due to the anatomical contiguity of the flap with the site of the lesion and the good quality of the skin harvested from the posterior region of the thigh. The use of the perforator fasciocutaneous flap represents a muscle-sparing technique, providing a better long-term result in surgical reconstruction. The choice of the 180-degree propeller flap was due to its ability to provide a good repair of the pressure ulcer and to pass over the ischiatic prominence in the patient in the forced decubitus position. The operatory course did not present any kind of complication. Using this reconstructive treatment, we have obtained complete coverage of the ischiatic pressure sore.

  10. Conservative treatment of perforated upper gastrointestinal tract

    International Nuclear Information System (INIS)

    Naoi, Daishi; Sano, Wataru; Nakata, Yasuyuki; Yano, Kentaro; Suzuki, Takeshi; Chiku, Tsuyoshi; Tashiro, Tsuguhiko

    2009-01-01

    In order to clarify the validity of indication criteria of the conservative treatment for perforated upper gastrointestinal tract, a retrospective study was carried out. We enrolled 28 patients with perforation of the gastrointestinal tract who were determined to receive conservative treatment at the time of hospitalization from January 2000 to December 2007. When the following criteria were satisfied, we treated the patients by the conservative treatment after informed consent was gained from them and their families: stable condition of vital signs; peritoneal signs localized in the upper abdomen; and no or slight fluid collection at the Douglas' pouch determined by computed tomography. Patients who showed changes for the worse of peritonitis or increased fluid collection during follow-up were promptly converted to surgery. Six patients were converted to surgery, but all of them were discharged very much improved. We compared patient's data of the conservative treatment group and the converted surgery group at the time of consultation. All data were not statistically different between two groups. If all criteria are satisfied, it seemed that we can start conservative treatment for perforated gastrointestinal tract with careful observation and the system of prompt conversion to operation for patients who showed changes for the worse of peritonitis or increased fluid collection. (author)

  11. Marginal ulcer perforation: a single center experience.

    Science.gov (United States)

    Natarajan, S K; Chua, D; Anbalakan, K; Shelat, V G

    2017-10-01

    Marginal ulcer (MU) is defined as ulcer on the jejunal side of the gastrojejunostomy (GJ) anastomosis. Most MUs are managed medically but those with complications like bleeding or perforation require intervention. It is recommended that GJ anastomosis be revised in patients with MU perforation (MUP). The aim of this case series is to study the clinical presentation and management of MUP. Three hundred and thirty-two patients who underwent emergency surgery for perforated peptic ulcer at a single center were studied over a period of 5 years. Nine patients (2.7 %) presented with MUP. GJ was previously done for either complicated peptic ulcer (n = 4) or for suspected gastric malignancy (n = 5). Two patients had previously completed H. pylori therapy. None of the patients presented with septic shock. MU was on the jejunal side of GJ in all patients. The median MUP size was 10 mm. Four patients (44.4 %) had omental patch repair, three (33.3 %) had primary closure, and one each had revision of GJ and jejunal serosal patch repair. There were no leaks, intra-abdominal abscess or reoperation and no malignancies. MUP patients do not present with septic shock. Omental patch repair or primary closure is sufficient enough. Revision of Billroth-II-GJ into Roux-en-Y-GJ is not mandatory.

  12. Medical image of the week: eosphageal perforation

    Directory of Open Access Journals (Sweden)

    Bilal J

    2015-04-01

    Full Text Available No abstract available. Article truncated after 150 words. A 74 year old man with a past medical history of esophageal strictures status post dilatation, coronary artery disease status post CABG, and atrial fibrillation presented to hospital with complaints of severe chest pain that began after the consumption of tortilla chips one hour prior to presentation. Electrocardiogram and cardiac enzymes were not consistent with acute coronary syndrome. Chest X-ray was consistent with a widened mediastinal silhouette. Contrast esophogram was negative for extra luminal extravasation. CT scan of the chest with oral contrast demonstrated thickening of the mid-thoracic esophagus with an extra-luminal focus of gas in the mediastinum along with fluid along the inferior aspect of the esophagus (Figures 1 and 2. These findings were concerning for esophageal perforation. The patient was taken to the operating room for endoscopy which showed micro perforation in mid-esophagus. Esophageal perforation remains a highly morbid condition. Mortality rates are based predominantly on time of ...

  13. Research on the Perforating Algorithm Based on STL Files

    Science.gov (United States)

    Yuchuan, Han; Xianfeng, Zhu; Yunrui, Bai; Zhiwen, Wu

    2018-04-01

    In the process of making medical personalized external fixation brace, the 3D data file should be perforated to increase the air permeability and reduce the weight. In this paper, a perforating algorithm for 3D STL file is proposed, which can perforate holes, hollow characters and engrave decorative patterns on STL files. The perforating process is composed of three steps. Firstly, make the imaginary space surface intersect with the STL model, and reconstruct triangles at the intersection. Secondly, delete the triangular facets inside the space surface and make a hole on the STL model. Thirdly, triangulate the inner surface of the hole, and thus realize the perforating. Choose the simple space equations such as cylindrical and rectangular prism equations as perforating equations can perforate round holes and rectangular holes. Through the combination of different holes, lettering, perforating decorative patterns and other perforated results can be accomplished. At last, an external fixation brace and an individual pen container were perforated holes using the algorithm, and the expected results were reached, which proved the algorithm is feasible.

  14. Tezosentan reduces the microvascular filtration coefficient in isolated lungs from rats subjected to cecum ligation and puncture.

    Science.gov (United States)

    Kuklin, Vladimir; Sovershaev, Mikhail; Andreasen, Thomas; Skogen, Vegard; Ytrehus, Kirsti; Bjertnaes, Lars

    2005-01-01

    We recently demonstrated that the non-selective endothelin-1 (ET-1) receptor blocker tezosentan antagonizes ovine acute lung injury (ALI) following infusion of endotoxin or ET-1 by reducing the enhanced lung microvascular pressure, although we could not exclude the possibility of a simultaneous decline in microvascular permeability. In the present study, our aim was to find out if tezosentan reverses the rise in microvascular filtration coefficient (Kfc) in rat lungs that have been isolated and perfused 12 h after cecum ligation and puncture (CLP) or infusion of ET-1. Wistar rats (n = 42) were subjected to CLP. Postoperatively, rats were randomized to a CLP group (n = 7) and a CLP + tezosentan group (n = 7); the latter received tezosentan 30 mg/kg. A sham-operated group (n = 5) underwent laparotomy without CLP. Twelve hours postoperatively, the lungs were isolated and perfused with blood from similarly treated rats that also were used to assess plasma concentration of ET-1 and protein kinase Calpha (PKCalpha) in lung tissue. Additionally, isolated blood perfused lungs from healthy rats were randomized to a control group (n = 8), an ET-1 group (n = 7) subjected to pulmonary arterial injection of ET-1 10 nM, and an ET-1 + tezosentan group (n = 7) that received tezosentan 30 mg/kg. All lung preparations received papaverine 0.1 microg/kg added to the perfusate for vasoplegia. Pulmonary hemodynamic variables, Kfc and lung compliance (CL) were assessed. After CLP, the plasma concentration of ET-1 increased. Papaverine abolished the vasoconstrictor response to ET-1 and the pulmonary vascular pressures remained close to baseline throughout the experiments. Both CLP and injection of ET-1 caused significant changes in Kfc and CL that were prevented in tezosentan-treated rats. Compared to sham-operated animals, CLP increased the content of PKCalpha by 50% and 70% in the cytosolic and the membrane fractions of lung tissue homogenates, respectively. Tezosentan prevented the

  15. Acute perforated peptic ulcer: on clinical experience in an urban tertiary hospital in south east Nigeria.

    Science.gov (United States)

    Ugochukwu, A I; Amu, O C; Nzegwu, M A; Dilibe, U C

    2013-01-01

    Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in our environment. There is a paucity of published reports on acute perforated peptic ulcers in our environment. This study was conducted to evaluate the different pattern of risk factors clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer in our setting and to highlight the factors that continue to account for the high mortality and morbidity as seen here. A retrospective study where data of seventy-six (76) patients managed for generalized peritonitis due to acute peptic ulcer perforation over a five year period (January 2006-December 2010) were retrieved from medical records of Enugu State University of Science and Technology Hospital (ESUTH). The patients' biodata, clinical and operative findings and treatment outcome were extracted and analysed, after institutional ethical approval was secured. All other cases of generalized peritonitis not traceable to acute peptic ulcer perforation were excluded from the study. There were76 patients; 58 males and 18 females (M:F = 3.2:1) Their ages ranged from 20 to 80years with a mean of 39.5yr and SD ± 13.10years. Majority of the patients 49(64.4%) were 40years of age and below and only 24 (31.6%) had a previous history suggestive of chronic peptic ulcer disease. Twenty five (32.9%) patients presented within 24 h of onset of symptoms of perforation with a mortality of 8.0%. Slightly more than half of our patients 39(51.3%) presented between 24 and 48 h with mortality of 17.9%. Twelve patients (15.8%) presented between 48 and 72 h and the mortality in this group was 58.3%. The latter two groups accounted for most of the mortality in our series. All perforations were anterior perforations within the first 2.5 cm of the duodenum and all had simple closure with pedicled omental patch and peritoneal toilet with copious volumes of warm

  16. Gallbladder perforation complicating typhoid fever: report of two cases.

    Science.gov (United States)

    Gali, B M; Ali, N; Agbese, G O; Duna, V D; Dawha, S D; Ismai, G I; Mohammed, M

    2011-01-01

    Gallbladder perforation (GBP) is rare and as a complication of typhoid fever is extremely rare. We present two consecutive patients with GBP diagnosed incidentally at laparotomy. Information on the management of two patients with gallbladder perforation seen at Federal Medical Centre Azare in June and October 2008 was extracted from their case records. The two patients were both males aged 13 years and 16 years. They both presented with high fever of more than 2 weeks duration; and abdominal pain and distension. Both patients had features of generalised peritonitis. Pre-operative diagnoses of typhoid enteric perforation were made based on a positive Widal test. Intra-operative findings however, were that of bile peritonitis and gallbladder perforation. Both had cholecystectomy. Culture of the bile aspirate yielded Salmonella typhi. Gallbladder perforation secondary to typhoid fever should be considered as a differential diagnosis in patients with suspected typhoid enteric perforation in typhoid fever endemic region.

  17. Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Khanna Rahul

    2006-09-01

    Full Text Available Abstract Background Carcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare. Case presentation A 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy. Conclusion Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel.

  18. Duodenal perforation: an unusual complication of sickle cell anemia

    OpenAIRE

    Acıpayam, Can; Aldıç, Güliz; Akçora, Bülent; Çelikkaya, Mehmet Emin; Aşkar, Hasan; Dorum, Bayram Ali

    2014-01-01

    Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presente...

  19. Clinicopathological Analysis of Factors Related to Colorectal Tumor Perforation

    OpenAIRE

    Medina-Arana, Vicente; Martínez-Riera, Antonio; Delgado-Plasencia, Luciano; Rodríguez-González, Diana; Bravo-Gutiérrez, Alberto; Álvarez-Argüelles, Hugo; Alarcó-Hernández, Antonio; Salido-Ruiz, Eduardo; Fernández-Peralta, Antonia M.; González-Aguilera, Juan J.

    2015-01-01

    Abstract Colorectal tumor perforation is a life-threatening complication of this disease. However, little is known about the anatomopathological factors or pathophysiologic mechanisms involved. Pathological and immunohistochemical analysis of factors related with tumoral neo-angiogenesis, which could influence tumor perforation are assessed in this study. A retrospective study of patients with perforated colon tumors (Group P) and T4a nonperforated (controls) was conducted between 2001 and 20...

  20. Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience

    OpenAIRE

    Ur-Rahman Shafiq; Malik Faiza; Afridi Shahida; Shamim Shahid; Samo Khursheed A

    2008-01-01

    Abstract Background Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. Methods ...

  1. Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

    OpenAIRE

    Yadav, Dinesh; Garg, Puneet K.

    2012-01-01

    Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 co...

  2. Rhodotorula mucilaginosa Bloodstream Infection in a Case of Duodenal Perforation

    Directory of Open Access Journals (Sweden)

    Rajmane

    2016-08-01

    Full Text Available Introduction Rhodotorula species are widespread in nature and can be isolated from a variety of sources, including air, soil, seawater, plants, and the household environment. They are also widely distributed in hospitals, and their presence could be considered a risk factor for hospitalized patients. These commensal yeasts have emerged as a cause of life-threatening fungemia in patients with depressed immune systems. Case Presentation We report a case of duodenal perforation with peritonitis in a 36-year-old female who was scheduled immediately for exploratory laparotomy followed by closure of perforation and omentopexy. The peritoneal fluid was sent to the microbiology laboratory for routine investigations. On the 4th postoperative day, the patient had a fever that did not subside with antipyretics; hence, blood cultures were sent the next day. The peritoneal fluid and blood culture reports both yielded Rhodotorula mucilaginosa after 3 days of incubation. The patient was started on IV amphotericin B therapy, which resulted in a favorable outcome. Conclusions In humans, Rhodotorula species have been recovered as commensal organisms from the nails, the skin, and the respiratory, gastrointestinal (GI, and urinary tracts. Due to their presence in the GI flora, broad-spectrum antibiotics could contribute to their overgrowth in the GI tract. Localized infections, such as peritonitis, due to Rhodotorula species following infected peritoneal dialysis catheters have been reported in the literature. However, in our case, it seems possible that the fungus might have entered the bloodstream through disruption of the GI mucosa, and to prove this, further study is mandatory. It should also be noted that both amphotericin B and flucytosine have good activity against Rhodotorula in vitro, whereas fluconazole is inactive.

  3. Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

    International Nuclear Information System (INIS)

    Jamieson, D.H.; Babyn, P.S.; Pearl, R.

    1996-01-01

    Objective. To assess the role of imaging, in particular CT, in the early detection of GI perforation. Subjects and methods. In a 10-year period, 43 patients with surgically confirmed GI perforation were identified from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT studies were particularly assessed for extraluminal air, free intraperitoneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients were identified who had CT studies demonstrating the above findings, but who had hypovolemic shock bowel or nondisrupting bowel injury without perforation evident. Results. Extraluminal air was demonstrated in 47 % of the imaged perforations. There was one false-positive extraluminal air. Perforation was confirmed in patients who had all five of the above CT findings, but this was the case for only 18 % of patients with perforation. One or more of the five specified CT findings were present in all CT studies reviewed. No false-negative CT study was performed in the study period. Conclusion. Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims. (orig.). With 4 figs., 1 tab

  4. Perforator anatomy of the ulnar forearm fasciocutaneous flap.

    Science.gov (United States)

    Mathy, Jon A; Moaveni, Zachary; Tan, Swee T

    2012-08-01

    The ulnar forearm fasciocutaneous flap (UFFF) is a favourable alternative to the radial forearm flap when thin and pliable tissue is required. The precise anatomy of the cutaneous perforators of UFFF has not been previously reported. The position of cutaneous perforators>0.5 mm was recorded while raising 52 consecutive free UFFFs in 51 patients at our Centre. Three (6%) UFFFs in two patients demonstrated direct cutaneous supply through a superficial ulnar artery, a known anatomic variance. There was no cutaneous perforator>0.5 mm in one flap. Among the remaining 48 dissections, an average of 3 (range, 1-6) cutaneous perforators were identified. Ninety-four percent of these forearms demonstrated at least one perforator>0.5 mm within 3 cm, and all had at least one perforator within 6 cm of the midpoint of the forearm. Proximal perforators were more likely to be musculo-cutaneous through the edge of flexor carpi ulnaris or flexor digitorum superficialis, while mid- to distal perforators were septo-cutaneous. UFFF skin paddle designed to overlie an area within 3 cm of the midpoint between the medial epicondyle and the pisiform is most likely to include at least one cutaneous perforator from the ulnar artery, without a need for intra-operative skin island adjustment. This novel anatomic finding and other practical generalisations are discussed to facilitate successful elevation of UFFF. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Delayed esophageal perforation from stereotactic body radiation therapy for locally recurrent central nonsmall cell lung cancer

    Directory of Open Access Journals (Sweden)

    Sandeep Sainathan

    2014-01-01

    Full Text Available Stereotactic body radiation therapy (SBRT is a novel form of external beam radiation therapy. It is used to treat early and locally recurrent nonsmall cell lung cancer (NSLC in medically inoperable patients. It uses high dose, hypofractionated radiotherapy, with targeting of the tumor by precise spatial localization, thus minimizing injury to surrounding tissues. It can be safely used to ablate NSLC in both central and peripheral locations. We present two cases of delayed esophageal perforation after SBRT for locally recurrent central NSLC. The perforations occurred several months after the therapy. They were treated with covered esophageal stents, with mortality, due to the perforation in one of the patients. SBRT should be judiciously used to ablate centrally located NSLC and patients who develop episodes of esophagitis during or after SBRT, need to be closely followed with endoscopy to look for esophageal ulcerations. These ulcers should be closely followed for healing as these may degenerate into full thickness perforations several months after SBRT.

  6. Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

    Science.gov (United States)

    Lotti, Marco

    2017-06-01

    Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Perforated Duodenal Ulcer: Has Anything Changed?

    Science.gov (United States)

    Koskensalo, Selja; Leppäniemi, Ari

    2010-04-01

    To assess the current management and outcome of perforated duodenal peptic ulcer managed with open repair, a focused analysis was conducted, excluding gastric, traumatic and iatrogenic perforations. A retrospective study of a 6-year period identified 61 patients. Mean age was 59 (range 19-87) years and 33 (54%) were male. Medical history included nonsteroidal anti-inflammatory drugs in 46%, smoking in 30%, atherosclerosis in 26% and excessive alcohol use in 23%. Generalized abdominal tenderness was recorded in 64% of the cases. The mean (SD) C-reactive protein value was 100 (141) g/l and white blood cell count was 12.8 (7.9) E9/l. Plain abdominal X-ray was positive for air in 87% (41/47) and CT scan in 86% (18/21). Four patients (7%) were operated without radiological imaging. There were 31 patients (51%) with a delay of 24 h or more from the start of symptoms to surgery. The mean (SD) delay from admission to surgery was 9 (3) (range 3-12) h. The treatment consisted of open suture repair in 92%, peritoneal lavage in 92%, external drainage in 80% and nasogastric decompression in 92%. The overall hospital mortality and morbidity rates were 11 and 21%, respectively. The duodenal suture leak rate was 7% and intra-abdominal abscess rate was 2%. The majority of patients with perforated duodenal ulcer can be diagnosed with conventional clinical and radiological methods, and treated according to established surgical principles. The mortality and duodenal morbidity rates have remained unchanged for the last decade. Shortening preoperative delay could improve the prognosis.

  8. Frequency of wound infection in non-perforated appendicitis with use of single dose perforative antibiotics

    International Nuclear Information System (INIS)

    Ali, K.; Latif, H.; Ahmad, S.

    2015-01-01

    Antibiotics are used both pre and post-operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of post-operative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. The aim of this study was to see the frequency of wound infection in non-perforated appendicitis with single dose preoperative antibiotics only. Method: This observational study was conducted at the Department of Surgery, Ayub Medical College, Abbottabad from May to November 2014. A total of 121 patients with non-perforated appendicitis were included in the study. Only single dose preoperative antibiotics were used. The patients were followed for wound infection till 8th post-operative day. Results: 121 patients, 56(46.28%) male and 65(53.72%) female were included in the study. The mean age of patients was 27.41 ± 7.12 years with an age range of 18 to 45 years. In the entire series, 7(5.78%) patients developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic antibiotics were found efficacious in 114(94.21%) patients. There was no significant association between wound infection and age and gender. Conclusion: Single dose preoperative antibiotics were found effective in controlling post-operative wound infection without the need of extending the antibiotics to post-operative period in cases of non-perforated appendicitis. (author)

  9. Scoring system for differentiating perforated and non-perforated pediatric appendicitis.

    Science.gov (United States)

    Blumfield, Einat; Yang, Daniel; Grossman, Joshua

    2017-10-01

    Appendicitis is the most common indication for emergency pediatric surgery and its most significant complication is perforation. Perforated appendicitis (PA) may be managed conservatively, whereas non-perforated appendicitis (NP) is managed surgically. Recent studies have shown that ultrasound (US) is effective for differentiating between PA and NP, and does not expose pediatric patients to ionizing radiation. The purpose of this study is to enhance the accuracy of differentiation with a novel scoring system based on clinical, laboratory, and US findings. This retrospective study included 243 patients aged 2-17 years who presented between 2006 and 2013 with surgically proven appendicitis, of whom 60 had perforation. Clinical and laboratory data were collected and US images evaluated by a pediatric radiologist. To create the scoring system, point values were assigned to each parameter. A randomly selected training sample of 137 subjects was used to create a scoring prediction model. The model was tested on the remaining 106 patients. Scores of ≥6, ≥11, and ≥15 yielded specificities of 64, 91, and 99%, and sensitivities of 96, 61, and 29%, respectively (p < 0.001). We have designed a scoring system incorporating clinical, laboratory, and sonographic findings which can differentiate PA from NP with high specificity.

  10. Surgical therapeutic management of perforated peptic ulcer

    Directory of Open Access Journals (Sweden)

    Ana Karla de Sousa Almeida

    2016-03-01

    Full Text Available Perforated peptic ulcer is an emergency should be readily corrected by surgical approach to reduce potential damage and the risk of mortality associated with the extension frame. The option of handling most commonly used by surgeons is laparotomy, however, there is evidence pointing to approach laparoscopically like a viable, safe and with good results for their treatment. Therefore, it is appropriate to evaluate the data about each management and minimally invasive procedure, laparoscopy if overcomes the open surgical approach regarding the laparotomy regarding the treatment of patients with this condition.

  11. Appendicular perforation in dengue fever: our experience

    Directory of Open Access Journals (Sweden)

    Gunjan Desai

    2014-09-01

    Full Text Available Dengue viral infections have become one of major emerging infectious diseases in the tropics. Acute abdomen occurring in dengue viral infection is not uncommon. The spectrums of acute surgical emergencies which raise suspicion of an abdominal catastrophe in patients presenting with dengue fever include acute pancreatitis, acute acalculous cholecystitis, non-specific peritonitis and very rarely acute appendicitis. The presence of low white cell count and platelet count can raise suspicion of a diagnosis of dengue in a patient presenting with acute abdominal pain, during a dengue epidemic. We herein report three patients with dengue fever who had appendicular perforation during the course of their viral fever.

  12. High-Resolution Ultrasonography (US) of Appendiceal Specimens: Differentiation of Acute Non-perforated Appendicitis from Perforated Appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Gyo Chang; Kim, Suk; Im, Han Hyeok; Lee, Sang Jin; Yang, Seung Boo; Lee, Seung Woo; Kim, Il Young [Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of); Lee, Hae Kyung [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kwon, Kui Hyang; Shin, Hyung Chul [Soonchunhyang University, College of Medicine, Seoul (Korea, Republic of)

    2007-09-15

    To analyze surgical specimens from patients with acute non-perforated and perforated appendicitis using high-resolution ultrasonography (US), and to correlate the US features with the pathologic findings. One hundred and six surgical appendix specimens obtained from patients with suspected acute appendicitis were evaluated. The following US features were evaluated for differentiating acute non-perforated appendicitis from perforated appendicitis: circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, the sum of opposing walls {>=} 9 mm and the presence of appendicoliths. The sensitivity and specificity of the US findings for diagnosing perforated appendicitis were determined. All US features were detected significantly more often in the perforated appendicitis group of specimens. The disruption of the serosal layer was the most significant independent predictor of perforation (p < .001). The sensitivity for circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, wall thickness {>=} 9 mm, and the presence of appendicoliths individually was 84.6%, 69.2%, 61.5%, 73.1% and 46.2%, respectively. The specificity for all of these findings was 86.3%, 98.7%, 95.0%, 85.0% and 85.0%, respectively. High-resolution US of appendiceal specimens was very useful for differentiating acute non-perforated from perforated appendicitis

  13. The value of CT in detecting pathologic bowel perforation

    International Nuclear Information System (INIS)

    Chang, Jong Wun; Shin, Joo Yong; Kim, Hong; Rhee, Chang Soo; Lee, Sung Moon; Joo, Yang Goo; Suh, Soo Jhi

    1997-01-01

    To evaluate the usefulness of CT for assessing the location and cause of pathologic gastrointestinal perforation. A retrospective analysis of abdominal CT was performed in 27 perforations of 26 patients with underlying gastrointestinal pathology. Fifteen benign and 12 malignant perforations consisted of five gastric cancers, one gastric ulcer, ten duodenal bulb ulcers. two bowel adhesions, one jejunal metastasis from lung cancer, one ileocolic Crohn's disease, one radiation colitis and six colon cancers. CT scans were evaluated for 1) diagnosis of bowel perforation, 2) assessment of the cause and site of perforation, and, in particular, differentiation between benignancy and malignancy, and 3) complications and their extent. CT easily detected varying amounts of free air or fluid collection, and infiltration or abscess formation adjacent to the main lesion, and the diagnosis of gastrointestinal perforation was therefore easy. In 11 of the 12 malignancies (92%), primary tumor was diagnosed, but detection of the site of perforation was possible in only seven cases(7/12, 58%). The 15 benign lesions revealed nonspecific CT findings, and the perforation site could be presumed in six (6/15, 40%). In one case of Crohn's disease, the primary cause was visualized. Among six colonic cancers, four pericolic abscesses and two fistulas to adjacent organs were found, but there was no evidence of diffuse peritonitis. CT was helpful to lead to optimal treatment of pathologic gastrointestinal On CT the detectability of perforation, primary benign or malignant lesion, perforation site and extent of complication was high, and this modality was therefore a useful indicator of the optimal treatment for pathologic gastrointestinal perforations.=20

  14. The value of CT in detecting pathologic bowel perforation

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Jong Wun; Shin, Joo Yong; Kim, Hong; Rhee, Chang Soo; Lee, Sung Moon; Joo, Yang Goo; Suh, Soo Jhi [Keimyung Univ. School of Medicine, Taegu (Korea, Republic of)

    1997-10-01

    To evaluate the usefulness of CT for assessing the location and cause of pathologic gastrointestinal perforation. A retrospective analysis of abdominal CT was performed in 27 perforations of 26 patients with underlying gastrointestinal pathology. Fifteen benign and 12 malignant perforations consisted of five gastric cancers, one gastric ulcer, ten duodenal bulb ulcers. two bowel adhesions, one jejunal metastasis from lung cancer, one ileocolic Crohn's disease, one radiation colitis and six colon cancers. CT scans were evaluated for (1) diagnosis of bowel perforation, (2) assessment of the cause and site of perforation, and, in particular, differentiation between benignancy and malignancy, and (3) complications and their extent. CT easily detected varying amounts of free air or fluid collection, and infiltration or abscess formation adjacent to the main lesion, and the diagnosis of gastrointestinal perforation was therefore easy. In 11 of the 12 malignancies (92%), primary tumor was diagnosed, but detection of the site of perforation was possible in only seven cases(7/12, 58%). The 15 benign lesions revealed nonspecific CT findings, and the perforation site could be presumed in six (6/15, 40%). In one case of Crohn's disease, the primary cause was visualized. Among six colonic cancers, four pericolic abscesses and two fistulas to adjacent organs were found, but there was no evidence of diffuse peritonitis. CT was helpful to lead to optimal treatment of pathologic gastrointestinal On CT the detectability of perforation, primary benign or malignant lesion, perforation site and extent of complication was high, and this modality was therefore a useful indicator of the optimal treatment for pathologic gastrointestinal perforations.=20.

  15. STUDY OF CLINICAL OUTCOMES OF SUBFASCIAL PERFORATOR LIGATION SURGERY IN PERFORATOR INCOMPETENCE

    Directory of Open Access Journals (Sweden)

    Vasuki Rajam

    2017-02-01

    Full Text Available BACKGROUND Chronic venous insufficiency presents with a spectrum of clinical features ranging from pain or heaviness of affected limbs to non-healing ulcers over the lower limbs and usually require some form of surgical intervention, performing direct perforator vein division preferably by subfascial endoscopic perforator ligation surgery for perforator incompetence, as despite aggressive conservative therapy including compression, lifestyle modification and venotonic medications which are of high cost treatment with increased risk of increasing symptoms. MATERIALS AND METHODS A prospective longitudinal clinical study of 30 patients selected by systematic sampling method from November 2014 to September 2015 at our institution was conducted to determine the results of subfascial endoscopic perforator vein surgery (SEPS in perforator incompetence. RESULTS For venous clinical severity scoring pre operatively and after 3 weeks post-surgery, the mean for VCSS pre-operatively was 6.66 and a standard deviation of 2.399. The T value was calculated and was found to be 4.9321 and p value of 0.00001(p value less than 0.05 is significant. Similarly for the cases with active ulcer, the size assessment pre-operatively and post-SEPS was again analysed using student t test and the mean ulcer size prior to surgery was found to be 3.3 and standard deviation of 1.984. The T value was calculated and was found to be 1.789009 and a p value of 0.04 (p value less than 0.05 is significant. CONCLUSION Our study concluded that favourable and significant ulcer healing rate with improvement and reduction in clinical severity suggests that SEPS plays an important role in surgical management of advanced stages of venous insufficiency.

  16. Dynamic characteristics of a perforated cylindrical shell for flow distribution in SMART

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seungho; Choi, Youngin; Ha, Kyungrok [Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749 (Korea, Republic of); Park, Kyoung-Su, E-mail: pks6348@yonsei.ac.kr [Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749 (Korea, Republic of); Park, No-Cheol; Park, Young-Pil [Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749 (Korea, Republic of); Jeong, Kyeong-Hoon; Park, Jin-Seok [Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yuseong, Daejeon 305-303 (Korea, Republic of)

    2011-10-15

    Highlights: > A 1/12 scaled-down flow skirt is manufactured and a modal test is performed. > A finite element model predicts the added mass effect of the perforated cylindrical shell. > Modal characteristics are extracted by considering the fluid-structure interaction. - Abstract: The System-integrated Modular Advanced ReacTor (SMART) is a small nuclear reactor under development in Korea. It is equipped with a perforated cylindrical shell, which is called a flow skirt, in the lower plenum of the reactor for uniform flow distribution and to prevent inflow of debris into the core. This perforated cylindrical shell can be excited by external forces such as seismic or pump pulsation loads. The dynamic characteristics of the perforated cylindrical shell must be identified for further dynamic analysis. This research explores the modal analysis of the scaled-down flow skirt model submerged in coolant water. For the numerical simulation, finite element analysis is carried out to extract modal characteristics of the structure considering the fluid-structure interaction and we introduce the NAVMI factor for similarity analysis. In the finite element model, the whole shape of the perforated cylindrical shell is simulated instead of using the effective material properties. In addition, a 1/12 scaled-down flow skirt is manufactured, and an experiment is designed using an exciter and waterproof accelerometers for the modal test. Due to excellent agreement between the modal test results and the finite element analysis results such as natural frequencies and mode shapes, the finite element model is validated and can be used to predict the dynamic characteristics of the real flow skirt. Moreover, the natural frequency of the real flow skirt can be calculated from the NAVMI factor and is in good agreement with the FEM result.

  17. [Structure of maxillary sinus mucous membrane under normal conditions and in odontogenic perforative sinusitis].

    Science.gov (United States)

    Baĭdik, O D; Logvinov, S V; Zubarev, S G; Sysoliatin, P G; Gurin, A A

    2011-01-01

    Methods of light, electron microscopy and immunohistochemistry were used to study the samples of maxillary sinus (MS) mucous membrane (MM) under normal conditions and in odontogenic sinusitis. To study the normal structure, the samples were obtained at autopsy from 26 human corpses 12-24 hours after death. Electron microscopic and immunohistochemical study was performed on biopsies of grossly morphologically unchanged MS MM, obtained during the operations for retention cysts in 6 patients. MS MM in perforative sinusitis was studied using the biopsies obtained from 43 patients. The material is broken into 4 groups depending on perforative sinusitis duration. Under normal conditions, MS MM is lined with a pseudostratified columnar ciliated epithelium. Degenerative changes of ciliated epithelial cells were already detected at short time intervals after MS perforations and become apparent due to reduction of specific volume of mitochondria and, rough endoplasmic reticulum, and increase of nuclear-cytoplasmic ratio. In the globlet cells, the reduction of nuclear-cytoplasmic ratio was associated with the disturbance of the secretory product release. At time intervals exceeding 3 months, epithelium underwent metaplasia into simple cuboidal and stratified squamous keratinized, while in MS MM lamina propria, cellular infiltration was increased. CD4+ cell content in sinus MM gradually increased, while at late periods after perforation occurrence it decreased. Low CD4+ cell count within the epithelium and the absence of muromidase on the surface of MS MM was detected. With the increase of the time interval since MS perforation, the number of CD8+ and CD20+ cells in MS MM was found to increase.

  18. AN OBSERVATIONAL STUDY OF CHANGING EPIDEMIOLOGICAL TRENDS IN INCIDENCE OF PEPTIC PERFORATION IN AGE GROUP 15-45 YEARS IN M. Y. HOSPITAL, INDORE

    Directory of Open Access Journals (Sweden)

    Devendra Chouhan

    2016-07-01

    Full Text Available AIM To investigate the recent change in epidemiology of benign peptic perforation in young adults. METHODS This is a prospective population-based single centre observational study of all patients diagnosed with benign perforated peptic ulcer; included were both gastric and duodenal ulcer patients admitted to Maharaja Yeshwantrao Hospital, Indore, between September 2013 and September 2015. Ulcers with a malignant neoplasia diagnosis verified by histology after biopsy, traumatic perforation, and perforation of age group >45 and 40 years, the incidence increased over 4 times and mortality more than 12 times compared to younger age <20 years. After 1 month followup, out of 172 discharged patients, 145 (84% patients came with symptoms resolved or having no complication. After 2 months followup, 158 (92% patients came with symptoms resolved and 166 (96% patients changed their dietary habits and lifestyle. CONCLUSION The incidence rate and mortality rate was stable. In our study, we found male preponderance, may be due to their lifestyle changes. Maximum number patients are found in age group 41-45 years. As in all previous studies, as age advances, incidence of peptic perforation also increases. Also, found strong relationship between consumption of oily or spicy food and non-vegetarian food with incidence of peptic perforation. Relation of peptic perforation with NSAIDs, smoking, and alcoholism follows same trends as in previous studies.

  19. [Gastric perforation by MALT lymphoma. Case report].

    Science.gov (United States)

    López-Zamudio, José; Ramírez-González, Luis Ricardo; Núñez-Márquez, Julia; Fuentes Orozco, Clotilde; González Ojeda, Alejandro; Leonher-Ruezga, Karla Lisseth

    2015-01-01

    Gastric non-Hodgkin lymphoma is a rare tumour that represents approximately 7% of all stomach cancers and 2% of all lymphomas. The most frequent location of gastric MALT (mucosa associated lymphoid tissue) lymphomas is in the antrum in 41% of the cases, and 33% can be multifocal. The risk of spontaneous perforation of a gastric MALT lymphoma is 4-10%. 24 year old male patient carrying the Human Immunodeficiency Virus, who began with signs and symptoms of acute abdomen and fever 72 hours before arriving in the emergency room. A computed tomography was performed that showed free fluid in the cavity, and gastric wall thickening. The patient underwent a laparotomy, finding absence of the anterior wall of the stomach, sealed with the left lobe of the liver, colon and omentum. Total gastrectomy, with oesophagosty and jejunostomy tube, was performed. Gastric perforation secondary to a MALT lymphoma is rare, with high mortality. There is limited information reported of this complication and should be highly suspected in order to provide appropriate treatment for a complication of this type. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  20. Perforated choledochal cyst in a Jehovah's Witness patient.

    Science.gov (United States)

    Jones, V S; Philip, C

    2007-07-01

    Perforation is a rare presentation of a choledochal cyst. The case reported is a 9-month-old female baby with a perforated choledochal cyst. Being a Jehovah's Witness, blood tranfusion was refused. Apart from highlighting this social dilemma, the suitability of a cystojejunostomy as a temporary measure in the above scenario is evaluated and discussed.

  1. Perforate on CHO cell membranes induced by electromagnetic ...

    African Journals Online (AJOL)

    STORAGESEVER

    2009-06-17

    Jun 17, 2009 ... Key words: Electromagnetic pulse (EMP), atomic force microscope, CHO cell, cell membrane. INTRODUCTION .... of perforation ranges from 390 to 660 nm and the depth is. 392.95 nm. ... cell membrane perforations increased when both the field intensity and ..... Melatonin and a spin-trap compound block.

  2. Posterior perforation of gastric ulcer: a rare surgical emergency ...

    African Journals Online (AJOL)

    BACKGROUND:Gastric ulcer perforation is a rare surgical emergency.Posterior gastric ulcer is even rarer and usually has a delayed presentation with attendant greater morbidity and mortality. AIM:To report a case of posterior perforation of gastric ulcer and review the literature. CASE REPORT:A 65yr old driver was seen in ...

  3. Spontaneous bile duct perforation in an infant, managed with simple ...

    African Journals Online (AJOL)

    Spontaneous bile duct perforation is a very rare but important cause of surgical jaundice in pediatric patients and one of the most common causes of surgical jaundice during infancy after biliary atresia. Preoperative diagnosis may not be possible in most of the cases. The exact cause of the perforation remains unclear.

  4. Acute spontaneous gastric perforation in neonates: A report of three ...

    African Journals Online (AJOL)

    Gastric perforation in neonates is a rare, serious and life-threatening problem. The precise aetiology is obscure in most cases. By virtue of its high mortality rate, it requires prompt recognition and surgical intervention. We report three cases of neonatal gastric perforation managed by early resuscitation and primary repair.

  5. Fatal Gastrointestinal Perforations in sudden death cases in Last 10 ...

    African Journals Online (AJOL)

    Pathology unit of University Malaya, Kuala Lumpur in the year 2006 by reviewing the autopsy reports. There were 61 cases of GIT perforation out of 5579 autopsies conducted during a period of ten years (1996-2005). The incidence rate of fatal gastrointestinal perforation was 1.09% during this period. Out of these 61 cases, ...

  6. Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.

    Science.gov (United States)

    Sivaram, P; Sreekumar, A

    2018-04-01

    Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation. This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed. Female gender, older age group, perforation surgery interval more than 36 h, and size of perforation more than 1 cm 2 were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay. An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.

  7. Experience with Acute Perforated Duodenal Ulcer in a West African ...

    African Journals Online (AJOL)

    Plain chest x-rays demonstrated gas under the diaphragm in 21(65.6%) of the patients. After adequate resuscitation, all the patients underwent laparotomy where the abdomen was explored, the diagnosis of perforated duodenal ulcer was confirmed and 29(70.7%) had simple closure of the perforation with omentum (after ...

  8. Preoperative CT angiography reduces surgery time in perforator flap reconstruction

    NARCIS (Netherlands)

    Smit, Jeroen M.; Dimopoulou, Angeliki; Liss, Anders G.; Zeebregts, Clark J.; Kildal, Morten; Whitaker, Iain S.; Magnusson, Anders; Acosta, Rafael

    The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in

  9. Case report: Stercoral sigmoid colonic perforation with fecal peritonitis

    International Nuclear Information System (INIS)

    Sharma, Monika; Agrawal, Anjali

    2010-01-01

    Chronic constipation can lead to fecal impaction. It can also rarely lead to catastrophic complications like perforation, colonic obstruction, and fecal peritonitis. We report a rare case of stercoral sigmoid colonic perforation with fecal peritonitis and pneumoperitoneum, which was diagnosed on preoperative CT scan

  10. Perforation af rectum med faekal peritonitis efter staplet haemorideoperation

    DEFF Research Database (Denmark)

    Beuke, Anna-Christina; Pedersen, Mark Ellebaek; Qvist, Niels

    2008-01-01

    Rectal perforation and faecal peritonitis after stapled operation for grade IV haemorrhoids is described. The complication is rare, but surgeons performing the procedure must be familiar with potential risk factors.......Rectal perforation and faecal peritonitis after stapled operation for grade IV haemorrhoids is described. The complication is rare, but surgeons performing the procedure must be familiar with potential risk factors....

  11. Diaphragmatic eventration complicated by gastric volvulus with perforation

    OpenAIRE

    Gupta, V; Chandra, A; Gupta, P

    2012-01-01

    Eventration of the diaphragm with gastric volvulus is uncommon. Gastric perforation in these cases is rare and usually associated with acute gastric volvulus with strangulation. We describe a case of diaphragmatic eventration with chronic gastric volvulus with gastric perforation without strangulation in an elderly man.

  12. The "stamp method" : a new treatment for perforated peptic ulcer?

    NARCIS (Netherlands)

    Bertleff, M.J.O.E.; Liem, RSB; Robinson, PH; Bonjer, HJ; Lange, J. F.; Bartels, H.; van der Werf, J.F.A.

    Background: The aim of this study was to develop a simple method for closure of a perforated peptic ulcer, making it more accessible for laparoscopic surgery. Methods: An experimental pilot study was performed using five male Wistar rats. The perforation was closed by a bioabsorbable patch made of

  13. The Heidelberg Appendicitis Score Predicts Perforated Appendicitis in Children.

    Science.gov (United States)

    Boettcher, Michael; Günther, Patrick; Breil, Thomas

    2017-10-01

    In the future, surgical management of pediatric appendicitis might become limited to nonperforating appendicitis. Thus, it becomes increasingly important to differentiate advanced from simple appendicitis and to predict perforated appendicitis among a group of children with right-sided abdominal pain, which was the aim of this study. An institutionally approved, single-center retrospective analysis of all patients with appendectomy from January 2009 to December 2010 was conducted. All diagnostic aspects were evaluated to identify predictors and differentiators of perforated appendicitis. In 2 years, 157 children suffered from appendicitis. Perforation occurred in 47 (29.9%) of the patients. C-reactive protein (CRP) levels higher than 20 mg/dL ( P = .037) and free abdominal fluid on ultrasonography ( P = .031) are the most important features to differentiate perforated from simple appendicitis. Moreover, all children with perforation had a positive Heidelberg Appendicitis Score (HAS). A negative HAS excludes perforation in all cases (negative predictive value = 100%). Perforated appendicitis can be ruled out by the HAS. In a cohort with right-sided abdominal pain, perforation should be considered in children with high CRP levels and free fluids or abscess formation on ultrasound.

  14. Perforated appendicitis: Risk factors and outcomes of management ...

    African Journals Online (AJOL)

    The case files of patients with perforated appendicitis were analysed in relation to age, sex, clinical presentation, management and outcome of management. The aim was to detect the main factors that contributed to the perforation of the appendix in these patients and assess the effectiveness of the treatment offered.

  15. Jejunal perforation by swallowed ibuprofen caplet | Njoku | Nigerian ...

    African Journals Online (AJOL)

    We present a case of jejunal perforation caused by an unusual foreign body, an ibuprofen caplet in its blister packing believed to be the first of its kind, perforation of the intestine caused by an ingested medication. The patient eventually developed an enterocutaneous fistula through the weak wall of a preexisting incisional ...

  16. Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer.

    Science.gov (United States)

    Maghsoudi, Hemmat; Ghaffari, Alireza

    2011-01-01

    Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Seventeen (4%) patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention.

  17. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non-perforated appendicitis in the elderly.

    Science.gov (United States)

    Shin, Dong Hyuk; Cho, Young Suk; Kim, Yoon Sung; Ahn, Hee Cheol; Oh, Young Taeck; Park, Sang O; Won, Moo-Ho; Cho, Jun Hwi; Kim, Young Myeong; Seo, Jeong Yeol; Lee, Young Hwan

    2018-01-01

    Delta neutrophil index (DNI) is a new inflammatory marker and the present study aimed to evaluate the predictive value of the DNI for the presence of a perforation in elderly with acute appendicitis. This retrospective observational study was conducted on 108 consecutive elderly patients (≥65 years old) with acute appendicitis treated over a 24-month period. Sixty-nine of the 108 patients (median, IQR: 72, 67-77 years) were allocated to the perforated appendicitis group (63.9%) and 39 to the non-perforated appendicitis group (36.1%). WBC, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and DNI were significantly higher in the perforated group. In multiple logistic regression analyses, initial DNI was the only independent marker that can significantly predict the presence of perforation in multiple regression [odds ratio 9.38, 95% confidence interval (2.51-35.00), P=.001]. Receiver operator characteristic curve analysis showed that DNI is a good predictor for the presence of appendiceal perforation at an optimal cut-off for DNI being 1.4% (sensitivity 67.7%, specificity 90.0%, AUC 0.807). Clinicians can reliably differentiate acute perforated appendicitis from non-perforated appendicitis by DNI level of 1.4 or more in elderly patients. © 2017 Wiley Periodicals, Inc.

  18. Delayed colonic perforation following stent placement for colorectal obstruction: a description of two cases with stent palliation.

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    Jalal Vahedian Ardakani

    2013-10-01

    Full Text Available Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.

  19. Perforator based rectus free tissue transfer for head and neck reconstruction: New reconstructive advantages from an old friend.

    Science.gov (United States)

    Kang, Stephen Y; Spector, Matthew E; Chepeha, Douglas B

    2017-11-01

    To demonstrate three reconstructive advantages of the perforator based rectus free tissue transfer: long pedicle, customizable adipose tissue, and volume reconstruction without muscle atrophy within a contained space. Thirty patients with defects of the head and neck were reconstructed with the perforator based rectus free tissue transfer. Transplant success was 93%. Mean pedicle length was 13.4cm. Eleven patients (37%) had vessel-poor necks and the long pedicle provided by this transplant avoided the need for vein grafts in these patients. Adipose tissue was molded in 17 patients (57%). Twenty-five patients (83%) had defects within a contained space, such as the orbit, where it was critical to have a transplant that avoided muscle atrophy. The perforator based rectus free tissue transfer provides a long pedicle, moldable fat for flap customization, and is useful in reconstruction of defects within a contained space where volume loss due to muscle atrophy is prevented. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

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    Mahalu William

    2011-09-01

    Full Text Available Abstract Background Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa, where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. Case Presentation We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. Conclusion In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations.

  1. Clinical applications of the superior epigastric artery perforator (SEAP) flap: anatomical studies and preoperative perforator mapping with multidetector CT.

    Science.gov (United States)

    Hamdi, Moustapha; Van Landuyt, Koenraad; Ulens, Sara; Van Hedent, Eddy; Roche, Nathalie; Monstrey, Stan

    2009-09-01

    Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging thoracic defects. We present an anatomical study based on multidetector computerized tomography (MDCT) scan findings of the SEA perforators in addition to the first reported clinical series of SEAP flaps in anterior chest wall reconstruction. (a) In the CT scan study, images of a group of 20 patients who underwent MDCT scan analysis were used to visualise bilaterally the location of musculocutaneous SEAP. X- and Y-axes were used as landmarks to localise the perforators. The X-axis is a horizontal line at the junction of sternum and xyphoid (JCX) and the Y-axis is at the midline. (b) In the clinical study, seven pedicled SEAP flaps were performed in another group of patients. MDCT images revealed totally 157 perforators with a mean of 7.85 perforators per patient. The dominant perforators (137 perforators) were mainly localised in an area between 1.5 and 6.5 cm from the X-axis on both sides and between 3 and 16 cm below the Y-axis. The calibre of these dominant perforators was judged as 'good' to 'very good' in 82.5% of the cases. The average dimension of the flap was 21.7x6.7 cm. All flaps were based on one perforator. Mean harvesting time was 110 min. There were no flap losses. Minor tip necrosis occurred in two flaps. One of them was treated with excision and primary closure. Our clinical experience indicates that the SEAP flap provides a novel and useful approach for reconstruction of anterior chest wall defects. CT-based imaging allows for anatomical assessment of the perforators of the superior epigastric artery (SEA).

  2. A patient with metastatic melanoma presenting with gastrointestinal perforation after dacarbazine infusion: a case report

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    Hospers Geke AP

    2010-01-01

    Full Text Available Abstract Introduction We report a rare case of gastrointestinal perforation following dacarbazine infusion for metastatic melanoma. The condition is attributed to a responding malignant melanoma in the gastrointestinal tract. Case presentation A 52-year-old Caucasian man presented with abdominal pain and distension, malaise, night sweats, dysphagia and early satiety. A computed tomography scan showed massive ascites, lymphadenopathy and liver lesions suspect for metastases. An upper gastrointestinal endoscopy was performed and revealed multiple dark lesions of 5 mm to 10 mm in his stomach and duodenum. When his skin was re-examined, an irregular pigmented lesion over the left clavicle measuring 15 mm × 8 mm with partial depigmentation was found. Histological examination of a duodenal lesion was consistent with a diagnosis of metastatic melanoma. The patient deteriorated and his level of lactate dehydrogenase rapidly increased. The patient was started on systemic treatment with dacarbazine 800 mg/m2 every three weeks and he was discharged one day after the first dose. On the sixth day he was readmitted with severe abdominal pain. A chest X-ray showed the presence of free intraperitoneal air that was consistent with gastrointestinal perforation. His lactate dehydrogenase level had fallen from 6969U/L to 1827U/L, supporting the conclusion that the response of gastrointestinal metastases to dacarbazine had resulted in the perforation of the patient's bowel wall. A laparotomy was discussed with the patient and his family but he decided to go home with symptomatic treatment. He died 11 days later. Conclusion Melanoma can originate in, as well as metastasize to, the gastrointestinal tract. Gastrointestinal perforations due to responding tumors are a well-known complication of systemic treatment of gastrointestinal lymphomas. However, as the response rate of metastatic melanoma to dacarbazine is only 10% to 20%, and responses are usually only partial

  3. Spontaneous Perforation of Pyometra: A Case Report

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01–0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy. Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

  4. Crizotinib-induced Rectal Perforation with Abscess.

    Science.gov (United States)

    Yanagisawa, Asako; Hayama, Noriko; Amano, Hiroyuki; Nakamura, Makoto; Hirano, Satoshi; Nakamura, Sukeyuki; Tabeta, Hiroshi

    2017-12-01

    An 86-year-old Japanese man was diagnosed with stage IV lung adenocarcinoma. The patient was treated with crizotinib after echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) rearrangement was detected from his pleural effusion. He subsequently developed abdominal pain and rebound tenderness in the right lower abdomen. Contrast-enhanced abdominal CT showed a low-density area in the abdominal cavity. The size of the abscess was decreased by drainage and the administration of antibiotics. Fistulography revealed a fistula from the rectum to the abscess, and a diagnosis of lower intestinal tract perforation with abscess formation was made. Crizotinib was discontinued and treatment with alectinib was initiated. The patient remains under treatment as an outpatient at our department without adverse effects.

  5. The Bloch Approximation in Periodically Perforated Media

    International Nuclear Information System (INIS)

    Conca, C.; Gomez, D.; Lobo, M.; Perez, E.

    2005-01-01

    We consider a periodically heterogeneous and perforated medium filling an open domain Ω of R N . Assuming that the size of the periodicity of the structure and of the holes is O(ε),we study the asymptotic behavior, as ε → 0, of the solution of an elliptic boundary value problem with strongly oscillating coefficients posed in Ω ε (Ω ε being Ω minus the holes) with a Neumann condition on the boundary of the holes. We use Bloch wave decomposition to introduce an approximation of the solution in the energy norm which can be computed from the homogenized solution and the first Bloch eigenfunction. We first consider the case where Ωis R N and then localize the problem for abounded domain Ω, considering a homogeneous Dirichlet condition on the boundary of Ω

  6. 16S rRNA gene-based association study identified microbial taxa associated with pork intramuscular fat content in feces and cecum lumen.

    Science.gov (United States)

    Fang, Shaoming; Xiong, Xingwei; Su, Ying; Huang, Lusheng; Chen, Congying

    2017-07-19

    Intramuscular fat (IMF) that deposits among muscle fibers or within muscle cells is an important meat quality trait in pigs. Previous studies observed the effects of dietary nutrients and additives on improving the pork IMF. Gut microbiome plays an important role in host metabolism and energy harvest. Whether gut microbiota exerts effect on IMF remains unknown. In this study, we investigated the microbial community structure of 500 samples from porcine cecum and feces using high-throughput 16S rRNA gene sequencing. We found that phylogenetic composition and potential function capacity of microbiome varied between two types of samples. Bacteria wide association study identified 119 OTUs significantly associated with IMF in the two types of samples (FDR microbiome associated with IMF might be caused by the IMF-associated microbial taxa. This study firstly evaluated the contribution of gut microbiome to porcine IMF content. The results presented a potential capacity for improving IMF through modulating gut microbiota.

  7. Laser-mediated perforation of plant cells

    Science.gov (United States)

    Wehner, Martin; Jacobs, Philipp; Esser, Dominik; Schinkel, Helga; Schillberg, Stefan

    2007-07-01

    The functional analysis of plant cells at the cellular and subcellular levels requires novel technologies for the directed manipulation of individual cells. Lasers are increasingly exploited for the manipulation of plant cells, enabling the study of biological processes on a subcellular scale including transformation to generate genetically modified plants. In our setup either a picosecond laser operating at 1064 nm wavelength or a continuous wave laser diode emitting at 405 nm are coupled into an inverse microscope. The beams are focused to a spot size of about 1.5 μm and the tobacco cell protoplasts are irradiated. Optoporation is achieved when targeting the laser focal spot at the outermost edge of the plasma membrane. In case of the picosecond laser a single pulse with energy of about 0.4 μJ was sufficient to perforate the plasma membrane enabling the uptake of dye or DNA from the surrounding medium into the cytosol. When the ultraviolet laser diode at a power level of 17 mW is employed an irradiation time of 200 - 500 milliseconds is necessary to enable the uptake of macromolecules. In the presence of an EYFP encoding plasmid with a C-terminal peroxisomal signal sequence in the surrounding medium transient transformation of tobacco protoplasts could be achieved in up to 2% of the optoporated cells. Single cell perforation using this novel optoporation method shows that isolated plant cells can be permeabilized without direct manipulation. This is a valuable procedure for cell-specific applications, particularly where the import of specific molecules into plant cells is required for functional analysis.

  8. Endoscopic Ultrasound-Guided Drainage of Intra-Abdominal Abscess after Gastric Perforation in a Patient Receiving Ramucirumab and Paclitaxel for Advanced Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Koichiro Mandai

    2017-01-01

    Full Text Available Gastrointestinal perforation is a serious adverse event that occurs in approximately 1% of patients receiving ramucirumab and paclitaxel. A 67-year-old man with unresectable advanced gastric cancer was admitted to our hospital and treated with ramucirumab and paclitaxel. Gastric perforation occurred during the second cycle of chemotherapy. Although the patient’s condition improved without surgery, an abscess developed in the intra-abdominal fluid collection resulting from the perforation. We performed endoscopic ultrasound-guided abscess drainage. The patient improved and was discharged in satisfactory condition. Endoscopic ultrasound-guided drainage is a treatment option for patients with intra-abdominal abscess following gastric perforation due to ramucirumab.

  9. Premixed Combustion of Coconut Oil on Perforated Burner

    Directory of Open Access Journals (Sweden)

    I.K.G. Wirawan

    2013-10-01

    Full Text Available Coconut oil premixed combustion behavior has been studied experimentally on perforated burner with equivalence ratio (φ varied from very lean until very rich. The results showed that burning of glycerol needs large number of air so that the laminar burning velocity (SL is the highest at very lean mixture and the flame is in the form of individual Bunsen flame on each of the perforated plate hole. As φ is increased the  SL decreases and the secondary Bunsen flame with open tip occurs from φ =0.54 at the downstream of perforated flame. The perforated flame disappears at φ = 0.66 while the secondary Bunsen flame still exist with SL increases following that of hexadecane flame trend and then extinct when the equivalence ratio reaches one or more. Surrounding ambient air intervention makes SL decreases, shifts lower flammability limit into richer mixture, and performs triple and cellular flames. The glycerol diffusion flame radiation burned fatty acids that perform cellular islands on perforated hole.  Without glycerol, laminar flame velocity becomes higher and more stable as perforated flame at higher φ. At rich mixture the Bunsen flame becomes unstable and performs petal cellular around the cone flame front. Keywords: cellular flame; glycerol; perforated flame;secondary Bunsen flame with open tip; triple flame

  10. Perforated gastric carcinoma in a young-age patient

    Directory of Open Access Journals (Sweden)

    Feng-Hsu Wu

    2018-06-01

    Full Text Available Perforation is a rare complication of gastric carcinoma, and it occurs in less than 5% of all gastric carcinoma cases and in less than 1% within all acute abdomen cases. The diagnosis of malignancy is usually not validated preoperatively. In previous reported English literature, all patients with perforated gastric cancer have the feature of old age. This feature might be able to guide the surgeon to impress the differential diagnosis of malignancy before or during the emergent operation of gastric perforation.This 32-year-old male patient suffered from sudden onset of epigastric pain. We performed emergent operation under the impression of hollow organ perforation. The postoperative pathologic report of gastric ulcer revealed gastric carcinoma. We performed second-stage operation of total gastrectomy with D2 lymphadenectomy smoothly 7 days later. As we know, this is the youngest patient having the condition of perforated gastric carcinoma reported in the literature. This case reminds us that it is possible for perforated gastric carcinoma to occur in young-age patients. Keywords: Gastric cancer, Acute abdomen, Gastric perforation

  11. Influence of operating microscope in the sealing of cervical perforations.

    Science.gov (United States)

    Schmidt, Bruna Schwingel; Zaccara, Ivana Maria; Reis Só, Marcus Vinícius; Kuga, Milton Carlos; Palma-Dibb, Regina Guenka; Kopper, Patrícia Maria Poli

    2016-01-01

    Accidental root canal perforations are among the main complications of endodontic treatment. This study evaluated the influence of operating microscope (OM) in the marginal adaptation of mineral trioxide aggregate (MTA) (Angelus(®)) and glass ionomer (Vitremer) inserted into cervical perforations. Perforations were made in the cervical third of the buccal wall of the root canal in mandibular incisors. Next, the teeth were divided into four groups (N = 10): MG - MTA without OM; VG - Vitremer without OM; MOMG - MTA with OM; VOMG - Vitremer with OM. The perforations were sealed according to the group and the teeth were prepared for analysis by confocal laser scanning microscope. Images of perforation region (1,024×) were made and the gap presented by the materials was measured using the Image J program. LEXT OLS4100 three dimensional (3D) measuring laser microscope measured the volumetric misfit. Data of gap were analyzed by Kruskal-Wallis and Dunn's tests. Analysis of variance (ANOVA) and Tukey's tests compared the volumetric misfits. The results showed lower volume and gap in the interface dentin/material in VOMG compared to the other groups (P < 0.05). The use of OM improved the quality of cervical perforations sealed with Vitremer, being indicated in clinical situations of iatrogenic cervical perforations.

  12. Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

    International Nuclear Information System (INIS)

    Chen Haiyan; Ma Xiumei; Ye Ming; Hou Yanli; Xie Huaying; Bai Yongrui

    2014-01-01

    The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0-3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤ 70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose > 100 Gy (biologically effective dose -10 ), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor. (author)

  13. Energy Analysis of Solar Collector With perforated Absorber Plate

    Directory of Open Access Journals (Sweden)

    Ammar A. Farhan

    2017-09-01

    Full Text Available The thermal performance of three solar collectors with 3, 6 mm and without perforation absorber plate was assessed experimentally. The experimental tests were implemented in Baghdad during the January and February 2017. Five values of airflow rates range between 0.01 – 0.1 m3/s were used through the test with a constant airflow rate during the test day. The variation of the following parameters air temperature difference, useful energy, absorber plate temperature, and collector efficiency was recorded every 15 minutes. The experimental data reports that the increases the number of absorber plate perforations with a small diameter is more efficient rather than increasing the hole diameter of the absorber plate with decreasing the perforation numbers. Maximum air temperature difference throughout the solar collector with 3, 6 mm perforations and without perforations are 17, 15, and 12 oC, respectively. Also, it can be concluded that the energy gained from the solar collector with 3 mm perforation absorber plate is 28.2 % more than the energy gained from solar collector without holes per day for 0.1 m3/s airflow rate. The maximum values of the thermal performance curves are 0.67, 0.64, and 0.56 for the solar collector with 3, 6 mm, and without perforations, respectively.

  14. Enteral feeding via jejunostomy as a cause of intestinal perforation and necrosis

    Directory of Open Access Journals (Sweden)

    María Victoria Vieiro-Medina

    Full Text Available Background: Jejunostomy for enteral feeding is excellent for patients who cannot manage oral intake, with a low complication rate. A Foley catheter, Ryle tube, Kerh tube or needle-catheter (Jejuno-Cath® are commonly used. It is a safe procedure but it can lead to severe complications. Case report: We present two cases: firstly, an 80 year old male who was admitted to the Emergency Room with a bowel perforation secondary to Jejuno-Cath® for enteral feeding after a subtotal gastrectomy with Roux-en-Y reconstruction; and secondly, a 53 year old male who was admitted to the Emergency Room due to gastric perforation developing multiple complications, including bowel necrosis and enteral feeding impaction. Discussion: We have reviewed the recent literature with regard to this rare complication.

  15. Perforated Meckel’s Diverticulum Lithiasis: An Unusual Cause of Peritonitis

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    Umasankar Mathuram Thiyagarajan

    2013-01-01

    Full Text Available Meckel’s diverticulum is the commonest congenital malformation of gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, it can present as bleeding, perforation, intestinal obstruction, intussusception, and tumours. These complications, especially bleeding, tend to be more common in the paediatric group and intestinal obstruction in adults. Stone formation (lithiasis in Meckel’s diverticulum is rare. We report a case of Meckel’s diverticulum lithiasis which presented as an acute abdomen in an otherwise healthy individual. The patient underwent an exploratory laparotomy which revealed a perforated Meckel’s diverticulum with lithiasis; a segmental resection with end-to-end anastomosis of small bowel was performed. Patient recovery was delayed due to pneumonia, discharged on day 20 with no further complications at 6 months following surgery.

  16. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

    Directory of Open Access Journals (Sweden)

    S. Fosi

    2014-01-01

    Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.

  17. Intrathoracic drainage of a perforated prepyloric gastric ulcer with a type II paraoesophageal hernia

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    Zonneveld Bas JGL

    2008-12-01

    Full Text Available Abstract Background With an incidence of less than 5%, type II paraesophageal hernias are one of the less common types of hiatal hernias. We report a case of a perforated prepyloric gastric ulcer which, due to a type II hiatus hernia, drained into the mediastinum. Case presentation A 61-year old Caucasian man presented with acute abdominal pain. On a conventional x-ray of the chest a large mediastinal air-fluid collection and free intra-abdominal air was seen. Additional computed tomography revealed a large intra-thoracic air-fluid collection with a type II paraesophageal hernia. An emergency upper midline laparotomy was performed and a perforated pre-pyloric gastric ulcer was treated with an omental patch repair. The patient fully recovered after 10 days and continues to do well. Conclusion Type II paraesophageal hernia is an uncommon diagnosis. The main risk is gastric volvulus and possible gastric torsion. Intrathoracic perforation of gastric ulcers due to a type II hiatus hernia is extremely rare and can be a diagnostic and treatment challenge.

  18. Perforator Flaps after Excision of Large Epidermal Cysts in the Buttocks

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    Sang Wha Kim

    2014-03-01

    Full Text Available Background Epidermal cysts are commonly occurring masses usually less than 5 cm in diameter, but in predisposed patients, epidermal cysts can grow relatively large due to chronic infection. Methods From June 2002 to July 2010, 17 patients received 19 regional perforator-based island flaps to cover defects due to the excision of large epidermal cysts (diameter >5 cm in the buttocks. Eight patients had diabetes, and seven had rheumatoid arthritis. The pedicles were not fully isolated to prevent spasms or twisting. Results All the flaps survived completely, except for one case with partial necrosis of the flap, which necessitated another perforator-based island flap for coverage. There were two cases of wound dehiscence, which were re-closed after meticulous debridement. There were no recurrences of the masses during follow-up periods of 8.1 months (range, 6-12 months. Conclusions In patients with large epidermal cysts and underlying medical disorders, regional perforator-based island flaps can be the solution to coverage of the defects after excision.

  19. Microvascular anatomy of the cerebellar parafloccular perforating space.

    Science.gov (United States)

    Sosa, Pablo; Dujovny, Manuel; Onyekachi, Ibe; Sockwell, Noressia; Cremaschi, Fabián; Savastano, Luis E

    2016-02-01

    The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle-namely, the paraflocculus or parafloccular perforating space-has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle. Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized. A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.11 ± 0.042 mm (mean ± SD) and the average length was 2.84 ± 1.2 mm. Detailed schematics and the surgical anatomy of the perforating vessels at the CPC and their clinical relevance are reported. The parafloccular space is a key entry point for many perforating vessels toward the middle cerebellar peduncle and lateral brainstem, and it must be respected and protected during surgical approaches to the

  20. Parasacral Perforator Flaps for Reconstruction of Sacral Pressure Sores.

    Science.gov (United States)

    Lin, Chin-Ta; Chen, Shih-Yi; Chen, Shyi-Gen; Tzeng, Yuan-Sheng; Chang, Shun-Cheng

    2015-07-01

    Despite advances in reconstruction techniques, pressure sores continue to present a challenge to the plastic surgeon. The parasacral perforator flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. We present our experience of using parasacral perforator flaps in reconstructing sacral defects. Between August 2004 and January 2013, 19 patients with sacral defects were included in this study. All the patients had undergone surgical reconstruction of sacral defects with a parasacral perforator flap. The patients' sex, age, cause of sacral defect, flap size, flap type, numbers of perforators used, rotation angle, postoperative complications, and hospital stay were recorded. There were 19 parasacral perforator flaps in this series. All flaps survived uneventfully except for 1 parasacral perforator flap, which failed because of methicillin-resistant Staphylococcus aureus infection. The overall flap survival rate was 95% (18/19). The mean follow-up period was 17.3 months (range, 2-24 months). The average length of hospital stay was 20.7 days (range, 9-48 days). No flap surgery-related mortality was found. Also, there was no recurrence of sacral pressure sores or infected pilonidal cysts during the follow-up period. Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. Parasacral perforator flaps are durable and reliable in reconstructing sacral defects. We recommend the parasacral perforator flap as a good choice for reconstructing sacral defects.

  1. Sen perforation af tyndtarm efter laparoskopisk gastrisk bypass

    DEFF Research Database (Denmark)

    Spanager, Lene; Sigild, Ulf Henrik; Neuenschwander, Anders Ulrich

    2010-01-01

    We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case......, a massive constipation of the small bowel was most likely a contributing factor. In the second case, the cause was a kink of the entero-entero anastomosis leading to obstruction and finally perforation of the biliary limp. Late perforations are among the rarely reported complications associated with gastric...

  2. External perforated Solar Screens for daylighting in residential desert buildings: Identification of minimum perforation percentages

    KAUST Repository

    Sherif, Ahmed

    2012-06-01

    The desert climate is endowed by clear sky conditions, providing an excellent opportunity for optimum utilization of natural light in daylighting building indoor spaces. However, the sunny conditions of the desert skies, in countries like Egypt and Saudi Arabia, result in the admittance of direct solar radiation, which leads to thermal discomfort and the incidence of undesired glare. One type of shading systems that is used to permit daylight while controlling solar penetration is " Solar Screens" Very little research work addressed different design aspects of external Solar Screens and their influence on daylighting performance, especially in desert conditions, although these screens proved their effectiveness in controlling solar radiation in traditional buildings throughout history.This paper reports on the outcomes of an investigation that studied the influence of perforation percentage of Solar Screens on daylighting performance in a typical residential living room of a building in a desert location. The objective was to identify minimum perforation percentage of screen openings that provides adequate illuminance levels in design-specific cases and all-year-round.Research work was divided into three stages. Stage one focused on the analysis of daylighting illuminance levels in specific dates and times, while the second stage was built on the results of the first stage, and addressed year round performance using Dynamic Daylight Performance Metrics (DDPMs). The third stage addressed the possibility of incidence of glare in specific cases where illuminance levels where found very high in some specific points during the analysis of first stage. The research examined the daylighting performance in an indoor space with a number of assumed fixed experimentation parameters that were chosen to represent the principal features of a typical residential living room located in a desert environment setting.Stage one experiments demonstrated that the screens fulfilled the

  3. External perforated window Solar Screens: The effect of screen depth and perforation ratio on energy performance in extreme desert environments

    KAUST Repository

    Sherif, A.

    2012-09-01

    In hot arid desert environments, the solar radiation passing through windows increases the cooling loads and the energy consumption of buildings. Shading of windows can reduce these loads. Unlike the woven solar screens, wooden solar screens have a thickness that provides selective shading properties. Perforated wooden solar screens were traditionally used for windows shading. Developing modern types of these shading systems can lead to significant energy savings. The paper addresses the influence of changing the perforation percentage and depth of these screens on the annual energy loads, hence defining the optimum depth/perforation configurations for various window orientations. Series of experiments were performed using the EnergyPlus simulation software for a typical residential building in the Kharga Oasis, located in the Egyptian desert. A range of perforation percentages and depths were tested. Conclusions prove that external fixed deep perforated solar screens could effectively achieve energy savings up to 30% of the total energy consumption in the West and South orientations. Optimum range of depths and perforation percentages were recommended. These are: 80-90% perforation rate and 1:1 depth/opening width ratio. These lighter and deeper solar screen configurations were found to be more efficient in energy consumption in comparison with the traditional ones. © 2012 Elsevier B.V. All rights reserved.

  4. Optimizing time management after perforation by colonoscopy results in better outcome for the patients.

    Science.gov (United States)

    Rumstadt, Bernhard; Schilling, Dieter

    2008-01-01

    Perforation during colonoscopy is a rare but severe complication. The aim of this study was to assess the time management and laparoscopic therapy of this complication and to evaluate patient outcomes. A retrospective analysis was done on 15 patients operated for a perforation from colonoscopy between January 2000 and December 2006. Three perforations occurred during diagnostic and 12 perforations during interventional colonoscopy. Two perforations occurred as transmural thermal injury to the colon wall. Peritonitis was found in 4 cases and significantly correlated with the mean time between perforation and operation. Twelve perforations were oversewn laparoscopically and 3 perforations were oversewn by laparotomy. After laparoscopic treatment, hospital stay was significantly shorter than after laparotomy. One patient had a postoperative wound infection, mortality was 0%. Laparoscopic oversewing is a safe and effective method in the treatment of perforation from colonoscopy. Optimizing the time range between perforation and laparoscopic therapy results in a better outcome for the patients.

  5. Corneal perforation after conductive keratoplasty with previous refractive surgery.

    Science.gov (United States)

    Kymionis, George D; Titze, Patrik; Markomanolakis, Marinos M; Aslanides, Ioannis M; Pallikaris, Ioannis G

    2003-12-01

    A 56-year-old woman had conductive keratoplasty (CK) for residual hyperopia and astigmatism. Three years before the procedure, the patient had arcuate keratotomy, followed by laser in situ keratomileusis 2 years later for high astigmatism correction in both eyes. During CK, a corneal perforation occurred in the right eye; during the postoperative examination, an iris perforation and anterior subcapsule opacification were seen beneath the perforation site. The perforation was managed with a bandage contact lens and an antibiotic-steroid ointment; it had a negative Seidel sign by the third day. The surgery in the left eye was uneventful. Three months after the procedure, the uncorrected visual acuity was 20/32 and the best corrected visual acuity 20/20 in both eyes with a significant improvement in corneal topography. Care must be taken to prevent CK-treated spots from coinciding with areas in the corneal stroma that might have been altered by previous refractive procedures.

  6. Preoperative chest x-ray findings in peptic ulcer perforation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, T. H.; Kim, S. W.; Lim, J. S.; Kim, Y. J. [Kyungpook National University School of Medicine, Taegu (Korea, Republic of)

    1981-12-15

    This study was carried out to analyze the distribution of age, sex, chief complaint, physical examination and findings of chest x-ray films before operation in 59 cases of peptic ulcer perforation. The ratio of male to female was 1.7 : 1 and incidence of the ulcer perforation was most common in 5th decades. Thirty five among 59 cases showed pleural effusion, segmental atelectasis and pneumonic infiltration on chest x-ray film. Twenty nine among 50 cases of duodenal ulcer perforation and 6 of 9 cases of stomach ulcer perforation showed positive chest x-ray findings. No relationship was found between fever and preoperative chest x-ray findings.

  7. Risk factors for reintervention after surgery for perforated gastroduodenal ulcer

    DEFF Research Database (Denmark)

    Hasselager, R B; Lohse, N; Duch, P

    2016-01-01

    BACKGROUND: Perforated gastroduodenal ulcer carries a high mortality rate. Need for reintervention after surgical repair is associated with worse outcome, but knowledge on risk factors for reintervention is limited. The aim was to identify prognostic risk factors for reintervention after perforated...... gastroduodenal ulcer in a nationwide cohort. METHODS: All patients treated surgically for perforated gastroduodenal ulcer in Denmark between 2003 and 2014 were included using data from the Danish Clinical Register of Emergency Surgery. Potential risk factors for reintervention were assessed, and their crude...... and adjusted associations calculated by the competing risks subdistribution hazards approach. RESULTS: A total of 4086 patients underwent surgery for perforated gastroduodenal ulcer during the study interval. Median age was 71·1 (i.q.r. 59·6-81·0) years and the overall 90-day mortality rate was 30·8 per cent...

  8. Preoperative chest x-ray findings in peptic ulcer perforation

    International Nuclear Information System (INIS)

    Kim, T. H.; Kim, S. W.; Lim, J. S.; Kim, Y. J.

    1981-01-01

    This study was carried out to analyze the distribution of age, sex, chief complaint, physical examination and findings of chest x-ray films before operation in 59 cases of peptic ulcer perforation. The ratio of male to female was 1.7 : 1 and incidence of the ulcer perforation was most common in 5th decades. Thirty five among 59 cases showed pleural effusion, segmental atelectasis and pneumonic infiltration on chest x-ray film. Twenty nine among 50 cases of duodenal ulcer perforation and 6 of 9 cases of stomach ulcer perforation showed positive chest x-ray findings. No relationship was found between fever and preoperative chest x-ray findings

  9. Patterns and Seasonal Variations of Perforated Peptic Ulcer Disease

    African Journals Online (AJOL)

    multiruka1

    Objective: To describe the socio- demographics of the ... perforated PUD affects young males who are smokers, alcohol users and ... Hence, the main objective of this study is to describe ..... Helicobacter pylori Prevents Recurrence of Ulcer.

  10. Candidiasis, A Rare Cause of Gastric Perforation: A Case Report ...

    African Journals Online (AJOL)

    Most cases of gastric perforation occur as complications of peptic ulcer ... movement on respiration, marked generalized abdominal ... inflammatory cell infiltration consisting of mainly eosinophils, macrophages, plasma cells, and lymphocytes. No Helicobacter pylori like organisms or atypical cellular proliferations were seen.

  11. Perforated Duodenal Ulcer in a Young Child: An Uncommon Condition

    Directory of Open Access Journals (Sweden)

    Rohit Prasad Yadav

    2009-04-01

    Full Text Available Duodenal ulcer is an uncommonly diagnosed entity in children. H. pyloriinfection, blood group ‘O’ or secondary to medications like non steroidal anti-infl ammatory drugs (NSAID and corticosteroids or physiological stress in burns, head injury and mucosal ischemia are implicated as risk factors for their causation. The diagnosis is usually overlooked because of vague and variable symptoms and remote index of suspicion accounted for their low incidence in children. Undiagnosed or mistreated perforations may carry high morbidity and mortality. We report a successfully treated 41/2 year old male child who presented with features of perforation peritonitis and was incidentally found to have a perforated duodenal ulcer. Key Words: duodenal ulcer, laparotomy, perforation

  12. Laparoscopic lavage for perforated diverticulitis: a population analysis.

    LENUS (Irish Health Repository)

    Rogers, Ailín C

    2012-09-01

    Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.

  13. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate

    Directory of Open Access Journals (Sweden)

    Antoinette S. Birs

    2016-01-01

    Full Text Available Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates.

  14. Predictors of appendiceal perforation in an equal access system.

    Science.gov (United States)

    Walker, Avery; Hatch, Quinton; Drake, Thurston; Nelson, Daniel W; Fitzpatrick, Emilie; Bingham, Jason; Black, George; Maykel, Justin A; Steele, Scott R

    2014-07-01

    Discrepancies in socioeconomic factors have been associated with higher rates of perforated appendicitis. As an equal-access health care system theoretically removes these barriers, we aimed to determine if remaining differences in demographics, education, and pay result in disparate outcomes in the rate of perforated appendicitis. All patients undergoing appendectomy for acute appendicitis (November 2004-October 2009) at a tertiary care equal access institution were categorized by demographics and perioperative data. Rank of the sponsor was used as a surrogate for economic status. A multivariate logistic regression model was performed to determine patient and clinical characteristics associated with perforated appendicitis. A total of 680 patients (mean age 30±16 y; 37% female) were included. The majority were Caucasian (56.4% [n=384]; African Americans 5.6% [n=38]; Asians 1.9% [n=13]; and other 48.9% [n=245]) and enlisted (87.2%). Overall, 6.4% presented with perforation, with rates of 6.6%, 5.8%, and 6.7% (P=0.96) for officers, enlisted soldiers, and contractors, respectively. There was no difference in perforation when stratified by junior or senior status for either officers or enlisted (9.3% junior versus 4.40% senior officers, P=0.273; 6.60% junior versus 5.50% senior enlisted, P=0.369). On multivariate analysis, parameters such as leukocytosis and temperature, as well as race and rank were not associated with perforation (P=0.7). Only age had a correlation, with individuals aged 66-75 y having higher perforation rates (odds ratio, 1.04; 95% confidence interval, 1.02-1.05; P<0.001). In an equal-access health care system, older age, not socioeconomic factors, correlated with increased appendiceal perforation rates. Published by Elsevier Inc.

  15. CLINICAL STUDY OF APPENDICULAR PERFORATION IN A TERTIARY CARE HOSPITAL

    OpenAIRE

    Venkata Anantha Lakshmi Manabala; Krishna Mohan Narayanrao

    2016-01-01

    INTRODUCTION Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. In early 1900s, Ochsner in Chicago and Sherren at the London Hospital were both advocates of conservative treatment in late cases. Appendicular perforation is a serious complication in view of the ensuing peritonitis with the consequent sequelae and morbidity. AIM To study the incidence, morbidity and sequelae of appendicular perforation. MATERIALS & METHODS ...

  16. Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation

    OpenAIRE

    Limmer, Alexandra M.; Clement, Zackariah

    2017-01-01

    Caecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient's caecum was ...

  17. Malrotation with midgut volvulus associated with perforated ileal duplication

    Directory of Open Access Journals (Sweden)

    Anand Pandey

    2013-01-01

    Full Text Available Duplication of the alimentary tract is an important surgical condition. It may occur anywhere in the gastrointestinal tract. An important complication of this entity is perforation of the normal or abnormal gut. Malrotation with midgut volvulus can be a surgical emergency. We present a patient, who presented as malrotation with midgut volvulus associated with perforated ileal duplication. The patient was successfully managed.

  18. Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps.

    Science.gov (United States)

    Kim, Chae Min; Yun, In Sik; Lee, Dong Won; Lew, Dae Hyun; Rah, Dong Kyun; Lee, Won Jai

    2014-07-01

    Reconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores. We retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course. All flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months. The combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

  19. [Two Episodes of Colostomy-Associated Intestinal Perforation during Chemotherapy for Metastatic Rectal Cancer].

    Science.gov (United States)

    Tamura, Hiroshi; Otani, Ayaka; Tsukui, Mizuki; Toge, Koji; Otani, Takahiro; Hirose, Yuki; Morimoto, Yuta; Yoshino, Kei; Kido, Tomoki; Endo, Kazuhiko; Kameyama, Hitoshi; Kobayashi, Takashi; Wakai, Toshifumi

    2016-11-01

    A 77-year-old woman with rectal cancer and synchronous liver metastasis underwent a Hartmann operation with D3 lymph node dissection in June 2014. mFOLFOX6 plus bevacizumab(bev)was then administered to treat the liver metastasis.In February 2015, multiple liver metastases were detected and the regimen was changed to FOLFIRI plus bev.After 3 courses, peritonitis due to intestinal perforation around the descending colostomy occurred, and an emergency operation(partial resection of the descending colon and transverse colostomy)was performed.FOLFIRI was then administered from 2 months after the operation.After 3 courses of this regimen, a CT scan showed progression of the hepatic metastases.The regimen was therefore changed to mFOLFOX6.Five months later, another CT scan showed an intestinal perforation of the transverse colostomy at the abdominal wall, and an emergency cecostomy was performed.At this stage, chemotherapy was ceased.This case highlights the risk of intestinal perforation during chemotherapy, regardless of the use of bev.

  20. Fs-laser-induced Ca2+ concentration change during membrane perforation for cell transfection.

    Science.gov (United States)

    Baumgart, J; Bintig, W; Ngezahayo, A; Lubatschowski, H; Heisterkamp, A

    2010-02-01

    Fs-laser based opto-perforation is a gentle method for gene transfer into sensitive cells such as stem cells or primary cells. The high selectivity and the low damage to the cell lead to a high efficiency of transfection. However, there are side effects which induce stress to the cell due to the exchange of intra- and extracellular media as well as the disintegration of the structure of biomolecules resulting from the laser exposure. Moreover, the mechanisms of the optical transfection are still unclear. In this paper, we present our study on calcium (Ca(2+)) homeostasis during cell surgery, especially during laser induced membrane perforation. We show that the manipulation of cells can induce an increase in the cytosolic Ca(2+) concentration. This increase was not observed if the manipulation of the cells was performed in absence of the extracellular calcium indicating the importance of the Ca(2+) uptake. We found, that the uptake of extracellular Ca(2+) strongly depends on the repetition rate and the irradiation time of the laser pulses. The exposure for several seconds to kHz pulses even induces Ca(2+) induced Ca(2+) release. Dependent on the location of perforation, probably in the vicinity of an intracellular Ca(2+) stock, an instantaneous intracellular Ca(2+) release can be induced. Since Ca(2+) could be involved in negative side effect by cell surgery, we propose an application of the optoperforation technique in nominal Ca(2+)-free external solution.

  1. Perforated peptic ulcer following gastric bypass for obesity.

    Science.gov (United States)

    Macgregor, A M; Pickens, N E; Thoburn, E K

    1999-03-01

    Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

  2. Jejunal perforation caused by abdominal angiostrongyliasis Perfuração jejunal causada por angiostrongilíase abdominal

    Directory of Open Access Journals (Sweden)

    Jaques WAISBERG

    1999-09-01

    Full Text Available The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment.Os autores descrevem caso de angiostrongilíase abdominal em doente adulto que se manifestou como abdômen agudo devido à perfuração de alça jejunal, evento raro, uma vez que esta afecção geralmente envolve o íleo terminal, apêndice, ceco ou cólon ascendente. A doença é causada pelo nematódeo Angiostrongylus costaricensis cujos hospedeiros definitivos são roedores silvestres e os hospedeiros intermediários são caracóis e caramujos. A infecção em humanos é acidental e ocorre pela ingestão de secreção mucóide destes invertebrados presentes em vegetais ou por contato direto com o muco. A angiostrongilíase abdominal é clinicamente caracterizada pela presença de febre prolongada, anorexia, dor no quadrante inferior direito do abdômen e eosinofilia periférica. Embora a doença seja de

  3. [Synchronous acute cholecystolithiasis and perforated acute appendicitis. Case report].

    Science.gov (United States)

    Padrón-Arredondo, Guillermo; de Atocha Rosado-Montero, Manuel

    2016-01-01

    Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate on. However, it is rarely described in its synchronous form. A 43 year-old woman attending the clinic for right upper quadrant pain of 11 days duration. The patient refers to intermittent radiating pain in the right side, with positive Murphy, tachycardia, and fever. The laboratory results showed white cells 16,200/mm(3), glucose 345 mg/dl, abnormal liver function tests. Acute cholecystitis was reported with ultrasound. A Masson-type incision was made, noting an enlarged pyogenic gallbladder with thickened walls, sub-hepatic abscess of approximately 300 ml, greenish-yellow colour, and foetid. An anterograde subtotal cholecystectomy is performed due to difficulty in identifying elements of Calot triangle due to the inflammatory process, opening it and extracting stones. The right iliac fossa is reviewed, finding a plastron and a sub-serous retrocaecal appendix perforated in its middle third with free fecalith and an abscess in the pelvic cavity. An anterograde appendectomy was performed and the patient progressed satisfactorily, later being discharged due to improvement. In this patient, with a history of recurrent episodes of gallbladder pain and disseminated acute abdominal pain without peritoneal irritation, clinical suspicion was exacerbated cholecystitis with probable empyema of the gallbladder. Open surgery approach for this patient allowed access to both the appendix and gallbladder in order to perform a complete exploration of the abdominal cavity. The synchronous presentation of cholecystolithiasis and complicated appendicitis has not been reported in the literature. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  4. [Perforation of hollow organs in the abdominal contusion: diagnostic features and prognostic factors of death].

    Science.gov (United States)

    Nicolau, A E; Merlan, V; Dinescu, G; Crăciun, M; Kitkani, A; Beuran, M

    2012-01-01

    Blunt hollow viscus perforations (HVP) due to abdominal contusions (AC), although rare, are difficult to diagnose early and are associated with a high mortality. Our paper analyses retrospectively data from patients operated for HVP between January 2005 and January 2009, the efficiency of different diagnostic tools, mortality and prognostic factors for death. There were 62 patients operated for HVP, 14 of which had isolated abdominal contusion and 48 were poly trauma patients. There were 9 women and 53 men, the mean age was 41.5 years (SD: +17,9), the mean ISS was 32.94 (SD: +15,94), 23 patients had associated solid viscus injuries (SVI). Clinical examination was irelevant for 16 of the 62 patients, abdominal Xray was false negative for 30 out of 35 patients and abdominal ultrasound was false negative for 16 out of 60 patients. Abdominal CT was initially false negative for 7 out of 38 patients: for 4 of them the abdominal CT was repeated and was positive for HVP, for 3 patients a diagnostic laparoscopy was performed. Direct signs for HVP on abdominal CT were present for 3 out of 38 patients. Diagnostic laparoscopy was performed for 7 patients with suspicion for HVP, and was positive for 6 of them and false negative for a patient with a duodenal perforation. Single organ perforations were present in 55 cases, multi organ perforations were present in 7 cases. There were 15 deaths (15.2%), most of them caused by haemodynamic instability (3 out of 6 patients) and associated lesions: SOL for 9 out of 23 cases, pelvic fracture (PF) for 6 out of 14 patients, craniocerebral trauma (CCT) for 12 out of 33 patients.Multivariate analysis showed that the prognostic factors for death were ISS value (p = 0,023) and associated CCT (odds ratio = 4,95; p = 0,017). The following factors were not confirmed as prognostic factors for death: age, haemodynamic instability, associated SVI, thoracic trauma (TT), pelvic fractures (PF), limbs fractures (LF) and admission-operation interval

  5. [Identification of perforating vessels by augmented reality: Application for the deep inferior epigastric perforator flap].

    Science.gov (United States)

    Bosc, R; Fitoussi, A; Pigneur, F; Tacher, V; Hersant, B; Meningaud, J-P

    2017-08-01

    The augmented reality on smart glasses allows the surgeon to visualize three-dimensional virtual objects during surgery, superimposed in real time to the anatomy of the patient. This makes it possible to preserve the vision of the surgical field and to dispose of added computerized information without the need to use a physical surgical guide or a deported screen. The three-dimensional objects that we used and visualized in augmented reality came from the reconstructions made from the CT-scans of the patients. These objects have been transferred through a dedicated application on stereoscopic smart glasses. The positioning and the stabilization of the virtual layers on the anatomy of the patients were obtained thanks to the recognition, by the glasses, of a tracker placed on the skin. We used this technology, in addition to the usual locating methods for preoperative planning and the selection of perforating vessels for 12 patients operated on a breast reconstruction, by perforating flap of deep lower epigastric artery. The "hands-free" smart glasses with two stereoscopic screens make it possible to provide the reconstructive surgeon with binocular visualization in the operative field of the vessels identified with the CT-scan. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. CORRELATION BETWEEN TYMPANIC MEMBRANE PERFORATION AND HEARING LOSS

    Directory of Open Access Journals (Sweden)

    Lidija RISTOVSKA

    2016-04-01

    Full Text Available Introduction: Perforation of the tympanic membrane primarily results from middle ear infections, trauma or iatrogenic causes. The perforation causes conductive hearing loss by reducing the surface area available for sound transmission to the ossicular chain. Objective: The objective was to analyze the characteristics of tympanic membrane perforations in relation to hearing loss and to determine the type and degree of hearing loss. Materials and methods: We analyzed audiometric, otoscopic findings and medical reports of 218 patients, 114 males (52.3% and 104 females (47.7%, aged 9 to 75 years (mean age of 47.9 years, examined during the period of November 2012 to October 2015. For statistical data analysis we used Chi-square test with level of significance p<0.05. Results: Most of the patients had unilateral perforations (89% with right ear predominance and involvement of two quadrants of pars tensa (37.2%. Mean air-bone gap was 23.9 dB. The largest air-bone gap was at frequency of 250 Hz. Most of the patients (73.1% had mixed hearing loss (p=0.032, and average hearing thresholds from 21 to 40 dB. Conclusion: Mean air-bone gap is largest at the lower frequencies, and decreases as frequency increases. Size of the perforation has effect on hearing loss. Mean air-bone gap increases with increasing size of the perforation. There is no big difference between the mean air-bone gap in posterior versus anterior perforations.

  7. Surgical management of perforated duodenal ulcer: the changing scene.

    Science.gov (United States)

    Plummer, J M; McFarlane, M E C; Newnham

    2004-12-01

    To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the following: age, gender, duration of symptoms, non-steroidal anti-inflammatory drug (NSAID) use, smoking status, operative repair duration of hospitalization, Helicobacter pylori status and medical therapy, peri-operative complications, mortality and recurrence. Ninety per cent of the cases were males. All females in whom perforation occurred were age 50 years and older compared to males where 58% of cases presented before age 50 years. Perforations in acute ulcers occurred in 80% of cases. The majority of patients were male smokers. Non-steroidal anti-inflammatory drug use was also an important risk factor in elderly females. Simple surgical closure and standard triple therapy antibiotics to eradicate Helicobacter pylori was the most common treatment offered. Mortality was one per cent and follow-up poor but 11% of patients had documented recurrent peptic ulceration. In this study population, perforated duodenal ulcer occured overwhelmingly in males less than 50 years of age. There is a trend towards exclusive simple surgical closure and H pylori eradication at the UHWI for patients with perforated duodenal ulcer but this needs to be supported by documentation of H pylori prevalence in the population of patients presenting with perforated peptic ulcers.

  8. Factors related to persisting perforations after ventilation tube insertion.

    Science.gov (United States)

    O'Connell Ferster, Ashley P; Tanner, April Michelle; Karikari, Kodjo; Roberts, Christopher; Wiltz, Derek; Carr, Michele M

    2016-02-01

    Over a million ventilation tubes are placed annually in the United States, making this one of the most commonly performed procedures in the field of medicine. Certain factors increase the risk of persistent tympanic membrane perforation following the extrusion of short term ventilation tubes. Persistent perforations may fail to heal on their own, necessitating surgical closure to avoid conductive hearing loss. It is important to detect factors that may predict children who are at increased risk for persistent perforations. This study was a retrospective chart review that involved 757 patients between 2003 and 2008. The patients studied were within the age of 2 months-17 years, and all had short term tubes placed. The chart data also included demographic information, comorbidities, and information related to tube insertion and follow-up care. Chi-square, t-test, and multivariate logistic regression were conducted to compare variables between patients with perforations and those without. Data from 757 patients was analyzed, showing that perforation rate is associated with rhinorrhea, operative tube removal, aural polyps, and otorrhea (OR 1.72, 8.16, 4.69, and 1.72 respectively). The absence of otorrhea decreased the likelihood of TM perforations and no significant differences were found in gender, total number of sets of tubes, type of tube, use of nasal steroids, adenoidectomy, or nasal congestion. Our findings suggest that children with rhinorrhea, otorrhea, aural polyps, or prolonged intubation requiring operative tube removal should be identified clinically as children at risk of persisting perforation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Transgenic Expression of the Vitamin D Receptor Restricted to the Ileum, Cecum, and Colon of Vitamin D Receptor Knockout Mice Rescues Vitamin D Receptor-Dependent Rickets.

    Science.gov (United States)

    Dhawan, Puneet; Veldurthy, Vaishali; Yehia, Ghassan; Hsaio, Connie; Porta, Angela; Kim, Ki-In; Patel, Nishant; Lieben, Liesbet; Verlinden, Lieve; Carmeliet, Geert; Christakos, Sylvia

    2017-11-01

    Although the intestine plays the major role in 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] action on calcium homeostasis, the mechanisms involved remain incompletely understood. The established model of 1,25(OH)2D3-regulated intestinal calcium absorption postulates a critical role for the duodenum. However, the distal intestine is where 70% to 80% of ingested calcium is absorbed. To test directly the role of 1,25(OH)2D3 and the vitamin D receptor (VDR) in the distal intestine, three independent knockout (KO)/transgenic (TG) lines expressing VDR exclusively in the ileum, cecum, and colon were generated by breeding VDR KO mice with TG mice expressing human VDR (hVDR) under the control of the 9.5-kb caudal type homeobox 2 promoter. Mice from one TG line (KO/TG3) showed low VDR expression in the distal intestine (rickets, but less severely than VDR KO mice. These findings show that expression of VDR exclusively in the distal intestine can prevent abnormalities in calcium homeostasis and bone mineralization associated with systemic VDR deficiency. Copyright © 2017 Endocrine Society.

  10. Síndrome do ceco móvel e as doenças gastrintestinais funcionais Mobile cecum sindrome and the functional gastrointestinal illnesses

    Directory of Open Access Journals (Sweden)

    Júlio César Monteiro dos Santos Jr.

    2006-12-01

    several symptoms whose structural and biochemical causes have not been determined. Indeed, although (FGI disorders affect millions of people of all ages, their pathophysiological mechanisms are still unclear, so that no pathological conditions have been proven to be related to this kind of illness, nor biological markers have been found to identify their sufferers. Irritable bowel syndrome (IBS has been shown to be one of the most common FGI illnesses. IBS is characterized by abdominal discomfort or pain and it has at least two of the following three features: pain relieved by bowel movements, more frequent stools with the onset of pain, and looser stools at the onset of pain - with no resultant inflammatory, metabolic or structural abnormalities. Since IBS diagnosis is fundamentally based on the description of symptoms reported by patients, it has been considered to be an exclusion diagnosis, despite the attempt to establish a connection between the origin of the illness and disorders caused by physical or sexual abuse or even by psychological disturbances. Although biochemical and hormone dosages have been performed in routine blood test for IBS, a precise biochemical marker has not been identified. Nevertheless, when the patients of this study were assessed by means of contrast intestinal radiography so as to observe topographic alterations in the cecum, it was possible to detect a mobile cecum in all of them. Would this be a coincident factor or could the mobile cecum - a widespread but misdiagnosed illness- explain the irritable bowel syndrome? The results of our study provide evidence that the majority of patients diagnosed as having IBS do not actually suffer from such illness, but rather from the mobile cecum syndrome.

  11. Perforated Meckel's diverticulitis complicating active Crohn's ileitis: a case report.

    Science.gov (United States)

    Schwenter, Frank; Gervaz, Pascal; de Saussure, Philippe; McKee, Thomas; Morel, Philippe

    2009-01-13

    In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis. We report the case of a 22-year-old woman with Crohn's disease, who was admitted for abdominal pain, fever and diarrhoea. CT scan demonstrated active inflammation of the terminal ileum, as well as a fluid collection in the right iliac fossa, suggesting intestinal perforation. Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis. It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity. Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.

  12. The research progress of acute small bowel perforation

    Directory of Open Access Journals (Sweden)

    Rudolf Schiessel

    2015-08-01

    Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

  13. Rare occupational cause of nasal septum perforation: Nickel exposure.

    Science.gov (United States)

    Bolek, Ertugrul Cagri; Erden, Abdulsamet; Kulekci, Cagri; Kalyoncu, Umut; Karadag, Omer

    2017-10-06

    Many etiologies are held accountable for nasal septum perforations. Topical nasal drug usage, previous surgeries, trauma, nose picking, squamous cell carcinoma, some rheumatological disorders such as granulomatosis with polyangiitis (Wegener granulomatosis), some infectious diseases such as syphilis and leprosy are among the causes of the perforations. Occupational heavy metal exposures by inhalation rarely may also cause nasal septum perforation. Here, we present a 29-year-old patient without any known diseases, who is a worker at a metallic coating and nickel-plating factory, referred for investigation of his nasal cartilage septum perforation from an otorhinolaryngology clinic. The patient questioning, physical examination and laboratory assessment about rheumatic and infectious diseases were negative. There was a metallic smell in the breath during the physical examination. The analysis showed serum nickel level at 31 μg/l and urine nickel at 18 μg/l (84.11 μg/g creatinine). Other possible serum and urine heavy metal levels were within normal ranges. Nickel exposure is usually together with other heavy metals (chromium or cadmium), it is rarely alone. Nickel ingested by inhalation usually leads to respiratory problems such as reduced olfactory acuity, ulcers, septum perforation or tumors of the nasal sinuses. This case demonstrates the importance of occupational anamnesis and awareness of diagnosis. Int J Occup Med Environ Health 2017;30(6):963-967. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  14. Changing trend in emergency surgery for perforated duodenal ulcer

    International Nuclear Information System (INIS)

    Gurteyik, E.

    2003-01-01

    Objective: To evaluate changes in the emergency surgery of the duodenal ulcer. Subjects and Methods: Hospital records of 523 surgically treated patients, with duodenal ulcer perforation, during the period of 25 years 91975-1999) in the same surgical department, was retrospectively analysed. Changing aspects of emergency surgery of peptic ulcer disease, in the recent period, were determined in respect to number of operations per year and in the choice of operative methods. Results: The average number of patients and emergency operations per year was 21. No significant change was observed during the study period. Elective operations gradually decreased in the last ten years, and none was performed in the last 4 years. On the other hand, 226 emergency interventions for duodenal ulcer perforation were performed in the last ten years and 84 interventions in the last 4 years. Definitive anti-ulcer surgery was performed in 42% of patients between 1985 and 1994. Simple closure of the perforation plus treatment with proton pump inhibitors and with anti-Helicobacter pylori medication was the method in 80% during the last year. Conclusion: Emergency surgery for perforated duodenal ulcer preserves its steady rate despite disappearance of elective operations after tremendous progress in medical control of peptic ulcer disease. There is an obvious return from definitive anti-ulcer surgery to simple closure of the perforation followed by antisecretory and antibacterial medications in the recent years. (author)

  15. Reconstruction of pressure sores with perforator-based propeller flaps.

    Science.gov (United States)

    Jakubietz, Rafael G; Jakubietz, Danni F; Zahn, Robert; Schmidt, Karsten; Meffert, Rainer H; Jakubietz, Michael G

    2011-03-01

    Perforator flaps have been successfully used for reconstruction of pressure sores. Although V-Y advancement flaps approximate debrided wound edges, perforator-based propeller flaps allow rotation of healthy tissue into the defect. Perforator-based propeller flaps were planned in 13 patients. Seven pressure sores were over the sacrum, five over the ischial tuberosity, and one on the tip of the scapula. Three patients were paraplegic, six were bedridden, and five were ambulatory. In three patients, no perforators were found. In 10 patients, propeller flaps were transferred. In two patients, total flap necrosis occurred, which was reconstructed with local advancement flaps. In two cases, a wound dehiscence occurred and had to be revised. One hematoma required evacuation. No further complications were noted. No recurrence at the flap site occurred. Local perforator flaps allow closure of pressure sores without harvesting muscle. The propeller version has the added benefit of transferring tissue from a distant site, avoiding reapproximation of original wound edges. Twisting of the pedicle may cause torsion and venous obstruction. This can be avoided by dissecting a pedicle of at least 3 cm. Propeller flaps are a safe option for soft tissue reconstruction of pressure sores. © Thieme Medical Publishers.

  16. Rare occupational cause of nasal septum perforation: Nickel exposure

    Directory of Open Access Journals (Sweden)

    Ertugrul Cagri Bolek

    2017-10-01

    Full Text Available Many etiologies are held accountable for nasal septum perforations. Topical nasal drug usage, previous surgeries, trauma, nose picking, squamous cell carcinoma, some rheumatological disorders such as granulomatosis with polyangiitis (Wegener granulomatosis, some infectious diseases such as syphilis and leprosy are among the causes of the perforations. Occupational heavy metal exposures by inhalation rarely may also cause nasal septum perforation. Here, we present a 29-year-old patient without any known diseases, who is a worker at a metallic coating and nickel-plating factory, referred for investigation of his nasal cartilage septum perforation from an otorhinolaryngology clinic. The patient questioning, physical examination and laboratory assessment about rheumatic and infectious diseases were negative. There was a metallic smell in the breath during the physical examination. The analysis showed serum nickel level at 31 μg/l and urine nickel at 18 μg/l (84.11 μg/g creatinine. Other possible serum and urine heavy metal levels were within normal ranges. Nickel exposure is usually together with other heavy metals (chromium or cadmium, it is rarely alone. Nickel ingested by inhalation usually leads to respiratory problems such as reduced olfactory acuity, ulcers, septum perforation or tumors of the nasal sinuses. This case demonstrates the importance of occupational anamnesis and awareness of diagnosis. Int J Occup Med Environ Health 2017;30(6:963–967

  17. Diagnosing perforated appendicitis in pediatric patients: a new model.

    Science.gov (United States)

    van den Bogaard, Veerle A B; Euser, Sjoerd M; van der Ploeg, Tjeerd; de Korte, Niels; Sanders, Dave G M; de Winter, Derek; Vergroesen, Diederik; van Groningen, Krijn; de Winter, Peter

    2016-03-01

    Studies have investigated sensitivity and specificity of symptoms and tests for diagnosing appendicitis in children. Less is known with regard to the predictive value of these symptoms and tests with respect to the severity of appendicitis. The aim of this study was to determine the predictive value of patient's characteristics and tests for discriminating between perforated and nonperforated appendicitis in children. Pediatric patients who underwent an appendectomy at Spaarne Hospital Hoofddorp, the Netherlands, between January 1, 2009 and December 31, 2013, were included. Baseline patient's characteristics, history, physical examination, laboratory data and results of ultrasounds were collected. Univariate and multivariate logistic regressions were used to determine predictors of perforation. In total, 375 patients were included in this study of which 97 children (25.9%) had significant signs of perforation. Univariate analysis showed that age, duration of complaints, temperature, vomiting, CRP, WBC, different findings on ultrasound and the diameter of the appendix were good predictors of a perforated appendicitis. The final multivariate prediction model included temperature, CRP, clearly visible appendix and free fluids on ultrasound and diameter of the appendix and resulted in an area under the curve (AUC) of 0.91 showing sensitivity and specificity of respectively 85.2% and 81.2%. This prediction model can be used for identification of 'high-risk' children for a perforated appendicitis and might be helpful to prevent complications and longer hospitalization by bringing these children to theater earlier. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

    Science.gov (United States)

    Chertoff, Jason; Khullar, Vikas; Burke, Lucas

    2015-01-01

    The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  19. Perforation of the right ventricle in pulmonalis angiography: Possible causes and how to avoid them

    International Nuclear Information System (INIS)

    Metz, V.; Grabenwoeger, F.; Farres, M.T.

    1989-01-01

    This is a report on a perforation of the myocardium during pulmonalis angiography. The choice of the cather is very important for the occurrence of such complications. We used a Cook 7 French polyethylene multipurpose catheter, which did not guarantee sufficient stabilisation due to its small number of sideholes during injection of contrast medium. On the other hand the straight top of the catheter promoted its penetration into the myocardium to avoid such often lethal complications, catheters with pigtail-configuration should be used. (orig.) [de

  20. A Review on the Perforated Impact Energy Absorption of Kenaf Fibres Reinforced Composites

    Science.gov (United States)

    Ismail, Al Emran; Khalid, S. N. A.; Nor, Nik Hisyamudin Muhd

    2017-10-01

    This paper reviews the potential of mechanical energy absorption of natural fiber reinforced composites subjected to perforated impact. According to literature survey, several research works discussing on the impact performances on natural fiber reinforced composites are available. However, most of these composite fibers are randomly arranged. Due to high demand for sustainable materials, many researches give high attention to enhance the mechanical capability of natural fiber composites especially focused on the fiber architecture. Therefore, it is important to review the progress of impact energy absorption on woven fiber composite in order to identify the research opportunities in the future.

  1. Critical impact energy for the perforation of metallic plates

    International Nuclear Information System (INIS)

    Aly, S.Y.; Li, Q.M.

    2008-01-01

    This paper investigates the empirical formulae used in engineering practice to predict the critical perforation energy of metallic plates struck by rigid projectiles in the sub-ordnance regime. Main factors affecting the critical perforation energy are identified and valid conditions for each empirical formula are compared. Dimensional analysis is conducted to show the dependence of the non-dimensional critical impact energy on other influential non-dimensional numbers. Available empirical formulae are re-expressed in non-dimensional forms. A modified Jowett/AEA equation is proposed to predict the critical perforation energy of a flat-ended short projectile. The present work increases the confidence of using these empirical formulae and can be regarded as a quick guide for ballistic protection design of metallic shields and steel armour plates

  2. Conservative Management of Colonoscopic Perforation: A Case Report.

    Science.gov (United States)

    Parsa, Hossein; Miroliaee, Arash; Doagoo, Zafar; Sina, Saeed

    2017-07-01

    Colonoscopy is widely used for the diagnosis, treatment and a follow up of colorectal diseases. Perforation of the large bowel during elective colonoscopy is rare but serious life threatening complication. We report a 51-year-old woman who experienced recto sigmoid perforation during diagnostic colonoscopy. During 8 days of total hospitalization, she spent 3 days in ICU with gastrointestinal rest. The patient was hydrated and took intravenous antibiotics. In take-output and temperature were closely monitored. Serial abdominal examinations were performed to rule out peritonitis. After transferring to surgery ward in the day 4, liquid diet started slowly, and she was ambulated. At the day 8, she was discharged with the good clinical condition. Conservative management of the patients with early diagnosis of perforation and no signs and symptoms of peritonitis or sepsis could be the modality of choice.

  3. Risk factors in patients surgically treated for peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Shah, Kamran; Bendix, Jørgen

    2009-01-01

    OBJECTIVE: The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing...... the treatment and to improve the outcome of patients with perforated peptic ulcer. MATERIAL AND METHODS: Three hundred and ninety-eight patients undergoing emergency surgery in four university hospitals in Denmark were included in the study. Information regarding the pre-, intra- and postoperative phases were...... insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon...

  4. Acoustic Liner Drag: Measurements on Novel Facesheet Perforate Geometries

    Science.gov (United States)

    Howerton, Brian M.; Jones, Michael G.

    2016-01-01

    Interest in characterization of the aerodynamic drag of acoustic liners has increased in the past several years. This paper details experiments in the NASA Langley Grazing Flow Impedance Tube to quantify the relative drag of several perforate-over-honeycomb liner configurations at flow speeds of centerline flow Mach number equals 0.3 and 0.5. Various perforate geometries and orientations are investigated to determine their resistance factors using a static pressure drop approach. Comparison of these resistance factors gives a relative measurement of liner drag. For these same flow conditions, acoustic measurements are performed with tonal excitation from 400 to 3000 hertz at source sound pressure levels of 140 and 150 decibels. Educed impedance and attenuation spectra are used to determine the impact of variations in perforate geometry on acoustic performance.

  5. Computational analysis of acoustic transmission through periodically perforated interfaces

    Directory of Open Access Journals (Sweden)

    Rohan E.

    2009-06-01

    Full Text Available The objective of the paper is to demonstrate the homogenization approach applied to modelling the acoustic transmission on perforated interfaces embedded in the acoustic fluid. We assume a layer, with periodically perforated obstacles, separating two half-spaces filled with the fluid. The homogenization method provides limit transmission conditions which can be prescribed at the homogenized surface representing the "limit" interface. The conditions describe relationship between jump of the acoustic pressures and the transversal acoustic velocity, on introducing the "in-layer pressure" which describes wave propagation in the tangent directions with respect to the interface.This approach may serve as a relevant tool for optimal design of devices aimed at attenuation of the acoustic waves, such as the engine exhaust mufflers or other structures fitted with sieves and grillages. We present numerical examples of wave propagation in a muffler-like structure illustrating viability of the approach when complex 3D geometries of the interface perforation are considered.

  6. Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation.

    Science.gov (United States)

    Limmer, Alexandra M; Clement, Zackariah

    2017-01-01

    Caecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient's caecum was decompressed in the emergency department using a needle under local anaesthetic. The patient subsequently underwent laparoscopic hernia repair and had an uncomplicated recovery. When conducted safely and with precision in an appropriate patient, percutaneous needle caecostomy can provide immediate symptom relief, reduce risk of caecal perforation, and allow a laparoscopic surgical approach.

  7. Percutaneous Emergency Needle Caecostomy for Prevention of Caecal Perforation

    Directory of Open Access Journals (Sweden)

    Alexandra M. Limmer

    2017-01-01

    Full Text Available Caecal perforation is a life-threatening complication of large bowel obstruction with a reported mortality of 34% to 72%. This case describes the novel use of percutaneous needle caecostomy as a life-saving measure to prevent imminent caecal perforation in a 68-year-old lady with large bowel obstruction secondary to an incarcerated incisional hernia. After careful review of computed tomography images and measurement of distances from the abdominal wall to the caecum, the patient’s caecum was decompressed in the emergency department using a needle under local anaesthetic. The patient subsequently underwent laparoscopic hernia repair and had an uncomplicated recovery. When conducted safely and with precision in an appropriate patient, percutaneous needle caecostomy can provide immediate symptom relief, reduce risk of caecal perforation, and allow a laparoscopic surgical approach.

  8. Laparoscopic lavage for perforated diverticulitis with purulent peritonitis

    DEFF Research Database (Denmark)

    Thornell, Anders; Angenete, Eva; Bisgaard, Thue

    2016-01-01

    Background: Perforated diverticulitis with purulent peritonitis has traditionally been treated with open colon resection and stoma formation with risk for reoperations, morbidity, and mortality. Laparoscopic lavage alone has been suggested as definitive treatment. Objective: To compare laparoscopic...... lavage with open colon resection and colostomy (Hartmann procedure) for perforated diverticulitis with purulent peritonitis. Design: Randomized, controlled, multicenter, open-label trial. (ISRCTN registry number: ISRCTN82208287) Setting: 9 hospitals in Sweden and Denmark. Patients: Patients who have...... confirmed Hinchey grade III perforated diverticulitis with purulent peritonitis at diagnostic laparoscopy. Intervention: Randomization between laparoscopic lavage and the Hartmann procedure. Measurements: Primary outcome was the percentage of patients having 1 or more reoperations within 12 months. Key...

  9. Primary tubercular caecal perforation: a rare clinical entity

    Directory of Open Access Journals (Sweden)

    Moses Sonia

    2010-03-01

    Full Text Available Abstract Background Intestinal tuberculosis is a common problem in endemic areas, causing considerable morbidity and mortality. An isolated primary caecal perforation of tubercular origin is exceptionally uncommon. Case presentation We report the case of a 39 year old male who presented with features of perforation peritonitis, which on laparotomy revealed a caecal perforation with a dusky appendix. A standard right hemicolectomy with ileostomy and peritoneal toileting was done. Histopathology revealed multiple transmural caseating granulomas with Langerhans-type giant cells and acid-fast bacilli, consistent with tuberculosis, present only in the caecum. Conclusions We report this extremely rare presentation of primary caecal tuberculosis to sensitize the medical fraternity to its rare occurrence, which will be of paramount importance owing to the increasing incidence of tuberculosis all over the world, especially among the developing countries.

  10. Cause rare d'une perforation de la cloison nasale

    Science.gov (United States)

    Jahidi, Ali; Hemmaoui, Bouchaïb; Itoua, Wulfran Rosaire; Errami, Noureddine; Benariba, Fouad

    2014-01-01

    Les perforations de la cloison nasale constituent une pathologie fréquente en ORL. Leurs causes sont multiples et restent dominées par les traumatismes chirurgicaux. Les étiologies infectieuses et notamment la tuberculose sont rares. Nous présentons le cas d'une patiente ayant bénéficié d'une méatotomie bilatérale et chez laquelle une perforation de la cloison nasale a été découverte lors d'un examen systématique à un an de son intervention. D'abord considérée comme une complication de la chirurgie, la biopsie des berges de la perforation a permis de déterminer son origine tuberculeuse. La présentation clinique des perforations de la cloison nasale n'est pas spécifique. Elles sont souvent asymptomatiques et de découverte fortuite. Les traumatismes notamment chirurgicaux sont le plus siuvent en cause. L′orogine tuberculeuse resta très rare. Le diagnostic de certitude de tuberculose repose sur la biopsie des berges de cette perforation. Le but de ce travail est de mettre en avant l'intérêt de la biopsie dans le diagnostic de la tuberculose de la cloison nasale. Cette biopsie doit être systématique même en cas d'antécédents de chirurgie endonasale qui est le plus souvent en cause dans les perforations de la cloison nasale. PMID:24932334

  11. Single center experience in laparoscopic treatment of gallbladder perforation.

    Science.gov (United States)

    Sahbaz, Nuri Alper; Peker, Kivanc Derya; Kabuli, Hamit Ahmet; Gumusoglu, Alpen Yahya; Alis, Halil

    2017-12-01

    Gallbladder perforation (GBP) is a rare disease with potential mortality. Previous series have reported an incidence of approximately 2-11% and it still continues to be a significant problem for surgeons. To present our clinical experience with gallbladder perforation. The records of 2754 patients who received surgical treatment for cholelithiasis between 2010 and 2016 were reviewed retrospectively. One hundred thirty-three patients had gallbladder perforation. Age, gender, time from the onset of symptoms, diagnostic procedures, surgical treatment, morbidity and mortality rates were evaluated. 15.78% of patients had a body mass index > 35. 6.76% had chronic obstructive pulmonary disease, 6.76% had cardiac disease, 10.52% had diabetes and 4.51% had sepsis. American Society of Anesthesiology scores were I in 54.13%, II in 35.33%, III in 6.01% and IV in 4.51% of the patients. 27.81% of patients were diagnosed during surgery. The perforation site was the gallbladder fundus in 69.17%, body in 17.30%, Hartman's pouch in 10.53% and cystic duct in 3% of patients. Treatment modalities were laparoscopic cholecystectomy in 82.71%, open cholecystectomy in 3%, percutaneous drainage catheters + laparoscopic cholecystectomy in 3%, laparoscopic cholecystectomy + fistula repair in 10.53% and open cholecystectomy + fistula repair in 0.75% of patients. Mean length of hospital stay was 1.69 days. Mortality and morbidity rates were 8.27% and 10.52%, respectively. Histopathology results were acute cholecystitis in 69.93%, chronic cholecystitis in 20.30% and acute exacerbation over chronic cholecystitis in 9.77% of patients. Appropriate classification and management of perforated cholecystitis is essential. Laparoscopic cholecystectomy is a safe and feasible method to decrease morbidity in gallbladder perforations.

  12. Role of Spiral and Multislice Computed Tomography in the evaluation of traumatic and spontaneous oesophageal perforation. Our experience

    International Nuclear Information System (INIS)

    De Lutio di Castelguidone, Elisabetta; Pinto, Antonio; Merola, Stefanella; Stavolo, Ciro; Romano, Luigia

    2005-01-01

    Purpose: To assess the role of CT in the evaluation of traumatic and spontaneous oesophageal perforation. Materials and methods: From March 2001 to May 2003, we studied 12 patients (7 males and 5 females; age range: 25-66 years, mean age: 43.5 years) with suspected oesophageal perforation due to motor-vehicle accidents (4 cases), stab wound (one case), post-intubation (2 cases), foreign body ingestion (2 cases) and spontaneous (3 cases). Five patients underwent standard chest and cervical radiography; two patients with suspected foreign body ingestion also underwent a gastrografin swallow study; all of the 12 patients underwent CT of the neck, chest and abdomen before and after intravenous, and in four cases oral, administration of contrast material. Results: In 5 patients with cervical, thoracic and abdominal trauma, the CT examination showed the presence of pleuroparenchymal injury (pneumothorax, pleural effusion and subcutaneous emphysema) as well as findings suggestive of oesophageal perforation: peri-oesophageal air (5 cases), peri-oesophageal fluid (4 cases), oesophageal wall thickening (3 cases), oesophageal wall laceration (2 cases) with abnormal course of the nasogastric tube in one of them and extraluminal extravasation of oral contrast material (2 cases). In two patients with post-intubation complications, CT showed the presence of a small peri-oesophageal fluid collection containing small gas bubbles in one case, and a gross peri-oesophageal abscess-like collection in the second case. In the 2 patients with foreign body ingestion, the plain radiography associated with CT showed the presence of a thin metal object in the cervical region (fragment of a dental plate) and a small extraluminal extravasation of gastrografin in one case, whereas in the other case CT showed the presence of a foreign body (chicken bone) in the hypopharynx with oesophageal wall thickening and peri-oesophageal oedema. In the remaining three patients with suspected spontaneous

  13. Impact of Right-Sided Aneurysm, Rupture Status, and Size of Aneurysm on Perforator Infarction Following Microsurgical Clipping of Posterior Communicating Artery Aneurysms with a Distal Transsylvian Approach.

    Science.gov (United States)

    Tanabe, Jun; Ishikawa, Tatsuya; Moroi, Junta; Sakata, Yoshinori; Hadeishi, Hiromu

    2018-03-01

    Posterior communicating artery (PCoA) aneurysms are among the most common aneurysms. Because blockage of the PCoA and perforators can cause adverse outcomes, occlusion of these arteries by surgical clipping should be avoided. The impact of factors on PCoA perforator infarction when using a distal transsylvian approach for PCoA aneurysms was examined. A total of 183 patients underwent PCoA aneurysm clipping, excluding application of fenestrated clips. Patients were divided into 2 groups: patients with PCoA perforator infarction (infarction group) and patients without infarction (noninfarction group). Multiple factors were analyzed in the 2 groups. Twenty-two of the 183 patients (12.0%) showed perforator infarction, mainly on magnetic resonance imaging evaluation, resulting in permanent deficits in 2 patients (1.1%). The proportion of right-sided operations (86.4% vs. 53.4%; P = 0.005) and surgery for rupture (90.9% vs. 55.9%; P = 0.002) were significantly higher in the infarction group than in the noninfarction group. Aneurysms were significantly larger in the infarction group (8.4 ± 3.8 mm) than in the noninfarction group (6.3 ± 3.0 mm; P = 0.02). Ruptured status (odds ratio [OR], 7.35; P = 0.01), right side (OR, 5.19; P = 0.01), and aneurysm size (OR, 1.18; P = 0.02) remained independent predictors of perforator infarction on multivariate logistic regression analysis. Ruptured status, right side, and large PCoA aneurysm were independent predictors of PCoA perforator infarction. Symptoms due to PCoA perforating infarction were mostly transient and rarely affected outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Gastric Perforation and Phlegmon Formation by Foreign Body Ingestion

    Directory of Open Access Journals (Sweden)

    Albert Alejandro Avila Alvarez

    2014-08-01

    Full Text Available This is a case report of foreign body ingestion in a suicide attempt resulting in gastric perforation and phlegmon formation during a subsequent 6 month period that eventually required surgical intervention. The patient had a prolonged course because she did not report a history of foreign body ingestion and the initial evaluating physicians had no suspicion about possible foreign body ingestion and may have missed important findings on physical examination. Gastric perforation by a foreign object  may have a slow course rather than presenting acute abdomen. The realization of a proper physical examination in the emergency department is key to an accurate diagnosis.

  15. Pseudolipomatosis in Endometrial Specimens Does Not Represent Uterine Perforation.

    Science.gov (United States)

    Heller, Alexis

    2017-02-01

    Specimens of endometrial biopsies can sometimes present with an artifact within blood, composed of optically clear vacuoles mimicking adipose tissue, pseudolipomatosis. This artifact can be mistaken for adipose tissue and lead to an overdiagnosis of uterine perforation. We describe the case of pseudolipomatosis seen within the evacuated products of conception from a missed abortion. Areas of vacuolization in the blood clot mimicked adipose tissue. However, the vacuoles varied in size and did not contain adipocytes. Familiarity with this artifact will lead to avoidance of overdiagnosis of adipose tissue and uterine perforation in curettage specimens.

  16. Perforation of the sinus membrane during sinus floor elevation

    DEFF Research Database (Denmark)

    von Arx, Thomas; Fodich, Ivo; Bornstein, Michael M

    2014-01-01

    PURPOSE: To analyze the frequency of perforation of the sinus membrane during maxillary sinus floor elevation (SFE) and to assess possible risk factors. MATERIALS AND METHODS: Seventy-seven cases of SFE performed with a lateral window approach were evaluated retrospectively. Clinical and radiogra......PURPOSE: To analyze the frequency of perforation of the sinus membrane during maxillary sinus floor elevation (SFE) and to assess possible risk factors. MATERIALS AND METHODS: Seventy-seven cases of SFE performed with a lateral window approach were evaluated retrospectively. Clinical...

  17. Non-operative management of perforated peptic ulcer

    International Nuclear Information System (INIS)

    Rahman, M.M.; Ahsan, H.N.; Hossain, M.D.

    2003-01-01

    Objective: The aim of this study was to see the morbidity and mortality in peptic ulcer perforation cases by non-operative management in selected cases. Results: In the selected 54 patients, male: female were 49:05. Nine had history of NSAID intake. There was no mortality. Morbidity analysis showed that three had hepatic abscess, four had pelvic abscess, six took prolonged time for improvement, in two cases conservative treatment had to be abandoned and laparotomy was done in the same hospital admission. Conclusion: Non-operative procedure is a safe and effective measure for the management of perforated peptic ulcer in selected cases. (author)

  18. Directional bending wave propagation in periodically perforated plates

    DEFF Research Database (Denmark)

    Andreassen, Erik; Manktelow, Kevin; Ruzzene, Massimo

    2015-01-01

    We report on the investigation of wave propagation in a periodically perforated plate. A unit cell with double-C perforations is selected as a test article suitable to investigate two-dimensional dispersion characteristics, group velocities, and internal resonances. A numerical model, formulated...... using Mindlin plate elements, is developed to predict relevant wave characteristics such as dispersion, and group velocity variation as a function of frequency and direction of propagation. Experimental tests are conducted through a scanning laser vibrometer, which provides full wave field information...... for the design of phononic waveguides with directional and internal resonant characteristics....

  19. Oral antibiotics for perforated appendicitis is not recommended

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2010-01-01

    In the majority of surgical departments in Denmark, the postoperative treatment for acute perforated appendicitis comprises three days of intravenous antibiotics. Recently, it has been proposed that such antibiotic regimen should be replaced by orally administered antibiotics. The aim of this paper...... was to give an overview of studies on acute perforated appendicitis with postoperative oral antibiotics. Five studies were found in a database search covering the 1966-2009 period. There is no evidence to support a conversion of the postoperative antibiotic regimen from intravenous to oral administration...

  20. Perforated ileal duplication cyst with haemorrhagic pseudocyst formation

    International Nuclear Information System (INIS)

    Hwang, Im Kyung; Kim, Bong Soo; Kim, Heung Chul; Lee, In Sun; Hwang, Woo Chul; Namkung, Sook

    2003-01-01

    Duplication cysts of the gastrointestinal tract are rare congenital abnormalities. Ectopic gastric mucosa, which can be found in duplications, may cause peptic ulceration, gastrointestinal bleeding or perforation. We report a 1-year-old boy with a perforated ileal duplication cyst with haemorrhagic pseudocyst formation caused by peptic ulceration of the duplication cyst. It presented a snowman-like appearance consisting of a small, thick-walled, true enteric cyst and a large, thin-walled haemorrhagic pseudocyst on US and CT. It is an unusual manifestation of a duplication cyst, which has not been reported in the English language literature. (orig.)

  1. Photothermal IR spectroscopy with perforated membrane micromechanical resonators

    DEFF Research Database (Denmark)

    Kurek, Maksymilian

    -IR method. In order to overcome them, string resonators were replaced by membranes. A reliable sampling technique was maintained by adding perforation to membranes and thereby essentially getting membrane porous filters. Membranes gave also access to fully integrated magnetic transduction that allowed...... for significant shrinkage and simplification of the system. An analytical model of a locally heated membrane was developed and confirmed through FEM simulations. Then, low stress silicon nitride perforated membranes were fabricated and characterized using two different experimental setups that employed optical...

  2. Non-invasive vascular imaging in perforator flap surgery

    International Nuclear Information System (INIS)

    Saba, Luca; Piga, Mario; Atzeni, Matteo; Ribuffo, Diego; Rozen, Warren Matthew; Alonso-Burgos, Alberto; Bura, Raffaella

    2013-01-01

    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered

  3. Esophageal perforation associated with cervical spine surgery: Report of two cases and review of the literature

    NARCIS (Netherlands)

    Vrouenraets, B. C.; Been, H. D.; Brouwer-Mladin, R.; Bruno, M.; van Lanschot, J. J. B.

    2004-01-01

    Background/Aims: Esophageal perforation after anterior cervical spine surgery is a rare complication with various clinical presentations and treatments. Methods: Two cases of esophageal perforation after anterior cervical spine surgery are described, one occurring in the immediate postoperative

  4. Intraabdominal contamination after gallbladder perforation during laparoscopic cholecystectomy and its complications.

    Science.gov (United States)

    Kimura, T; Goto, H; Takeuchi, Y; Yoshida, M; Kobayashi, T; Sakuramachi, S; Harada, Y

    1996-09-01

    Gallbladder perforation often occurs during laparoscopic cholecystectomy. The frequency and causes of gallbladder perforation as well as the relevant clinical background factors were investigated in 110 patients undergoing laparoscopic cholecystectomy. We also evaluated intraperitoneal contamination by bacteria and gallstones at the time of gallbladder perforation and investigated whether perforation caused early or late postoperative complications. Intraoperative gallbladder perforation occurred in 29 of the 110 patients (26.3%). It was caused by injury with an electric knife during dissection of the gallbladder bed, injury during gallbladder retraction with grasping forceps, injury during gallbladder extraction from the abdomen, and slippage of cystic duct clips (potentially causing bile and stone spillage). Perforation was more frequent in patients with positive bile cultures and in those with pigment stones (p gallbladder perforation is sometimes unavoidable during laparoscopic cholecystectomy, the risk of severe complications appears to be minimized by early closure of perforation, retrieval of as many of the spilled stones as possible, and intraperitoneal lavage.

  5. Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis

    DEFF Research Database (Denmark)

    Angenete, Eva; Thornell, Anders; Burcharth, Jakob

    2016-01-01

    OBJECTIVE: To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial. BACKGROUND: Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection...

  6. Avaliação morfológica do abomaso e ceco-cólon de bovinos Morphologic evaluation of the abomasum and cecum-colon of bovines

    Directory of Open Access Journals (Sweden)

    M.G. Cardoso

    2013-04-01

    Full Text Available A morfofisiologia relacionada à absorção de ácidos graxos voláteis (AGV ao longo do trato gastrintestinal de ruminantes não é totalmente caracterizada. Desse modo, os objetivos deste trabalho foram mensurar a extensão da superfície de absorção e determinar o índice mitótico (IM do abomaso, do ceco e da alça proximal do cólon ascendente (APCA. Dez bovinos mestiços adultos tiveram seu estômago e intestino grosso removidos imediatamente após o abate. A área total da superfície de absorção foi mensurada por meio de digitalização e análise de imagens. Cortes histológicos foram feitos para determinação do IM. A superfície absortiva do abomaso, 0,58m², foi menor (PThe morphology and physiology related to volatile fatty acid (VFA absorption throughout the gastrointestinal tract of ruminants is not totally characterized. The purpose of this work was to measure the abomasum and cecum-colon absorptive surface extension and determine the mitotic index (MI. Ten adult crossbred bovine had their stomach and large intestine removed after slaughter. The total area of the absorptive surface was measured through image capture and analysis. Histological sections were performed to measure the MI. The abomasum absorptive surface (0.58m² was lower (P<0.01 than that of the rumen (6.53m² and omasum (2.31m². The cecum-colon absorptive surface (0.23m² corresponded to 3.5% of the rumen and 10% of the omasum. The MI observed was 0.48%; 0.14%; 0.36% and 0.41% for the regions of spiral folds, pyloric, cecum and proximal loop of ascending colon, respectively. A positive correlation between abomasum tissue mass and the abomasum absorptive surface was observed. This phenomenon has also occurred in the cecum and colon. It was possible to establish regressions to facilitate measurements of the absorptive surface of the abomasum and cecum-colon.

  7. Comparative research of finite element methods for perforated structures of nuclear power plant primary equipment

    International Nuclear Information System (INIS)

    Xiong Guangming; Deng Xiaoyun; Jin Ting

    2013-01-01

    Many perforated structures are used for nuclear power plant primary equipment, and they are complex, and have various forms. In order to explore the analysis and evaluation method, this paper used finite element method and equivalent analytic method to do the comparative analysis of perforated structures. The paper considered the main influence factors (including perforated forms, arrangements, and etc.), obtaining the systematic analysis methods of perforated structures. (authors)

  8. Abdominal wall perforation in a patient with recurrent epithelial ovarian cancer after bevacizumab treatment

    Directory of Open Access Journals (Sweden)

    Efnan Algin

    2016-08-01

    Full Text Available Bowel perforation is a rare but well-described complication of bevacizumab, a VEGF monoclonal antibody. However, bevacizumab associated abdominal wall perforation is a more serious complication. In here, a patient with recurrent epithelial ovarian cancer developing both bowel and abdominal wall perforation after bevacizumab treatment is reported with review of the literature to point out the clinical significance of this rare complication. To our knowledge, this is the first case with bevacizumab associated abdominal wall perforation.

  9. Spectrum of perforation peritonitis in India-review of 504 consecutive cases

    OpenAIRE

    Jhobta, Rajender Singh; Attri, Ashok Kumar; Kaushik, Robin; Sharma, Rajeev; Jhobta, Anupam

    2006-01-01

    Abstract Background/objective Perforation peritonitis is the most common surgical emergency in India. The spectrum of etiology of perforation in Tropical countries continues to be different from its Western counterpart. The objective of the study was to highlight the spectrum of perforation peritonitis as encountered by us at Government Medical College and Hospital (GMCH), Chandigarh. Methods Five hundred and four consecutive cases of perforation peritonitis over a period of five years were r...

  10. Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

    2016-01-01

    Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

  11. Temporal relationships exist between cecum, ileum and litter bacterial microbiomes in a commercial turkey flock, and subtherapeutic penicillin treatment impacts ileum bacterial community establishment

    Directory of Open Access Journals (Sweden)

    Jessica L Danzeisen

    2015-11-01

    Full Text Available Gut health is paramount for commercial poultry production, and improved methods to assess gut health are critically needed to better understand how the avian gastrointestinal tract matures over time. One important aspect of gut health is the totality of bacterial populations inhabiting different sites of the avian gastrointestinal tract, and associations of these populations with the poultry farm environment, since these bacteria are thought to drive metabolism and prime the developing host immune system. In this study, a single flock of commercial turkeys was followed over the course of twelve weeks to examine bacterial microbiome inhabiting the ceca, ileum, and corresponding poultry litter. Furthermore, the effects of low-dose, growth-promoting penicillin treatment (50 g/ton in feed on the ileum bacterial microbiome were also examined during the early brood period. The cecum and ileum bacterial communities of turkeys were distinct, yet shifted in parallel to one another over time during bird maturation. Corresponding poultry litter was also distinct yet more closely represented the ileal bacterial populations than cecal bacterial populations, and also changed parallel to ileum bacterial populations over time. Penicillin applied at low dose in feed significantly enhanced early weight gain in commercial poults, and this correlated with predictable shifts in the ileum bacterial populations in control versus treatment groups. Overall, this study identified the dynamics of the turkey gastrointestinal microbiome during development, correlations between bacterial populations in the gastrointestinal tract and the litter environment, and the impact of low-dose penicillin on modulation of bacterial communities in the ileum. Such modulations provide a target for alternatives to low-dose antibiotics.

  12. Ceramic microsieves: influence of perforation shape and distribution on flow resistance and membrane strength

    NARCIS (Netherlands)

    Kuiper, S.; Brink, R.; Nijdam, W.; Krijnen, Gijsbertus J.M.; Elwenspoek, Michael Curt

    2002-01-01

    Ceramic microsieves with slit-shaped perforations were compared to sieves with circular-shaped perforations, regarding flow resistance and membrane strength. Destructive tests show that the highest strength is obtained if the perforations are placed in a non-alternating pattern. Especially for

  13. Perforation of the Esophagus Secondary to Insertion of Covered Wallstent Endoprostheses

    International Nuclear Information System (INIS)

    Farrugia, Mark; Morgan, Robert A.; Latham, Jennifer A.; Glynos, Michael; Mason, Robert C.; Adam, Andreas

    1997-01-01

    Perforation of the esophagus is a very rare complication of metallic esophageal stent insertion. Two cases are presented in which esophageal perforations were caused by the sharp ends of metallic stents impinging on the esophageal wall. In retrospect, both perforations might have been prevented by additional stent insertion

  14. Iatrogen perforation of the rectum following barium enema; Iatrogen perforasjon av rectum ved roentgen colon

    Energy Technology Data Exchange (ETDEWEB)

    Eggum, R.; Kressner, U.; Haffner, J. [Buskerud Central Hospital, Drammen (Norway)

    1998-05-01

    Perforation of the rectum following barium enema is relatively rare, occurring in 1 of 3,000 procedures. Colorectal perforation is a serious condition and early diagnosis is of paramount importance in order to avoid any delay in treating the patient. Direct suture of the perforation, lavage, presacral drainage and stomia are the preferred methods of primary surgical treatment. 10 refs., 1 fig.

  15. Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Carolyn L. Mulvey, BS

    2013-05-01

    Conclusions: Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

  16. Perforation of the jejunum-an unusual mechanism | Iribhogbe | Port ...

    African Journals Online (AJOL)

    seater bus conveying several passengers and an unrestrained coffin. The bus was involved in a roll-over vehicle crash during which the patient suffered a severe impact to the abdomen from the coffin with perforation of the jejunum. She had a ...

  17. Mitral valve perforation appearing years after radiofrequency ablation

    DEFF Research Database (Denmark)

    Fisch-Thomsen, Marie; Jensen, Jesper K; Egeblad, Henrik

    2011-01-01

    The case is reported of a young adult with Wolff-Parkinson-White (WPW) syndrome who, three years after a complicated radiofrequency (RF) catheter ablation procedure, developed dyspnea on exertion. Echocardiography revealed severe mitral valve regurgitation caused by a perforation of the posterior...

  18. Colonic perforations caused by migrated plastic biliary stents

    International Nuclear Information System (INIS)

    Virgilio, Edoardo; Pascarella, Agauido; Scandavini, Chiara Maria; Frezza, Barbara; Bocchetti, Tommaso; Balducci, Genoveffa

    2015-01-01

    Endoscopic insertion of plastic endoprostheses has become an integral part of the management of many benign and malignant diseases affecting the hepatobiliary and pancreatic system. Clogging and dislocation into the duodenum are the most frequently described complications following stent placement. Distal migration with or without perforation of the colon is an exceedingly rare phenomenon and the treatment is not well defined, as discussed below.

  19. Small bowel obstruction following perforation of the uterus at ...

    African Journals Online (AJOL)

    BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had ...

  20. An investigation of the damaged zone created by perforating

    International Nuclear Information System (INIS)

    Pucknell, J.K.; Behrmann, L.A.

    1991-01-01

    This paper reports on underbalance perforation flow experiments performed on reservoir and outcrop sandstones to investigate the perforation damaged zone. Cores from several different formations were perforated under reservoir conditions. After perforating, the cores were examined using CAT scans (Computer Aided tomography), thin sections and mercury porosimetry. In conjunction with these measurements, permeabilities in the damaged zone were measured using a minipermeameter and radial flow permeameter or were estimated from pore size distribution. The density and porosity of the damaged zone (at least for saturated rocks) is essentially the same as that in the undamaged rock. The damaged zone is not compacted, contrary to suggestions made in earlier work. However, the creation of this zone involves the destruction of large pores. The volume lost from these pores is replaced by microfractures created when rock grains are fractured by penetration of the shaped charge jet. This reduction in the average pore size causes a reduction in the permeability with the damaged zone. Although direct measurement of this permeability was made difficult by naturally occurring permeability variations, unambiguous measurements were obtained

  1. Colorectal cancer complicated by perforation. Specific features of surgical tactics

    Directory of Open Access Journals (Sweden)

    S. N. Shchaeva

    2015-01-01

    Full Text Available Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation.Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation.Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 % cases whereas after symptomatic surgery there were 11 (67.8 % deaths. A fatal outcome was noted in 1 case (7.7 % after multistage surgery.Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

  2. Case Study: Small bowel perforation secondary to ileal tuberculosis ...

    African Journals Online (AJOL)

    intestinal tuberculosis, other common causes of ileal perforation include typhoid ... Barré syndrome are the same as those for any other critically ill patient. .... Grade II protein-energy malnutrition (PEM): An estimated body ... of > 2 litres/24 hours, current clinical practice guidelines on its ..... Recognizing malnutrition in adults:.

  3. Perforate on CHO cell membranes induced by electromagnetic ...

    African Journals Online (AJOL)

    Atomic force microscopy (AFM) has been used to visualize the morphological change on the surface of Chinese hamster ovary (CHO) cell membranes before and after electromagnetic pulses (EMP) irradiation. The results show that there were different sizes and shapes of membrane perforate (width ranging from 0.39 - 0.66 ...

  4. Perforated appendicitis presenting as a thigh abscess: A lethal ...

    African Journals Online (AJOL)

    Typical cases of acute appendicitis have excellent treatment outcomes, if managed appropriately.1 We discuss an unusual case of perforated retrocaecal appendicitis that presented as a right thigh abscess without prominent abdominal symptoms, which highlights the lethal nature of advanced appendicitis even when ...

  5. RESEARCH NOTE THE PERFOR]\\IANCE DURING WINTER, OF ...

    African Journals Online (AJOL)

    THE PERFOR]\\IANCE DURING WINTER, OF HETFERS FED GRASS SILAGE, MADE UNDER. UNFAVOURABLE WEATHER CONDITIONS AND E. curvula HAY, PRODUCED. FROM THE SAME SWARD. Receipt of MS: 06-10-1981. A. van Niekerk. Cedara Agriculrural Research Station, PlBag X9059, Pietermaritzburg ...

  6. Non-obstructive cecal dilatation and perforation after cesarean section

    DEFF Research Database (Denmark)

    Sperling, Lene; Schantz, A L; Toftager-Larsen, K

    1990-01-01

    A case of non-obstructive cecal dilatation and perforation after cesarean section is reported, with a review of the literature on the diagnosis and management of this entity. Fifteen cases have been described. Attention is called to this rare complication and to the accompanying pseudo...

  7. Perforated peptic ulcer associated with abdominal compartment syndrome.

    Science.gov (United States)

    Lynn, Jiun-Jen; Weng, Yi-Ming; Weng, Chia-Sui

    2008-11-01

    Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation.

  8. Laparoscopic management of duodenal ulcer perforation: is it advantageous?

    Science.gov (United States)

    Palanivelu, C; Jani, Kalpesh; Senthilnathan, P

    2007-01-01

    Surgery is the mainstay of treatment of patients with peptic duodenal perforation. With the advent of minimal access techniques, laparoscopy is being used for the treatment of this condition. Retrospective analysis of 120 consecutive patients (mean age 44.5 years; 111 men) with duodenal ulcer perforation who had undergone laparoscopic surgery. 87 patients had history of tobacco consumption, 12 were chronic NSAID users, 72 had Helicobacter pylori infection and 36 had a co-morbid condition. The mean time to surgery from onset of symptoms was 28.4 hours. The median operating time was 46 minutes. All patients underwent laparoscopic closure of the perforation with Graham's patch omentopexy; 12 patients underwent additional definitive ulcer surgery. The morbidity rate was 7.5%; no patient needed conversion to open surgery or died. The mean postoperative hospital stay was 5.8 days. Results of laparoscopic management of perforated peptic ulcer are encouraging, with no conversion to open surgery, low morbidity and no mortality.

  9. [Operative laparoscopy in the management of perforated peptic ulcer].

    Science.gov (United States)

    Schirru, Angelo; Cavaliere, Davide; Caristo, Ilario; Bianchi, Massimo; Cosce, Umberto; Mariani, Federica; Scarimbolo, Monica; Cavaliere, Paolo

    2004-01-01

    The aim of this retrospective study was to assess the feasibility, safety and efficacy of the laparoscopic approach in the management of perforated peptic ulcers. From January 1997 to December 2002, all patients referred to our community hospital for abdominal surgical emergencies were routinely managed by laparoscopic surgery. A review was carried out on 39 consecutive patients suffering from perforated peptic ulcers with or without generalised peritonitis. The study population comprised 24 male and 15 female patients, aged 30 to 94 years (mean age: 62 +/- 18). Laparoscopic repair was attempted in all patients. Laparoscopy afforded the correct diagnosis in all cases. Laparoscopic peritoneal washout (irrigation and suction of the entire abdominal cavity) with simple suture of the perforation proved successful in 34 patients. An additional omental patching was performed in 15 of these cases. Conversion to conventional open surgery was necessary in 5 patients. The morbidity and mortality rates were 13% and 10%, respectively. The mean operative time was 77 minutes (range: 40-120) and the mean hospital stay 9 days (range: 3-22). Laparoscopic repair of perforated ulcers is technically feasible but requires sound experience in laparoscopic abdominal emergencies. This study shows that the mini-invasive procedure is safe and effective, offering a valid alternative to traditional laparotomy.

  10. Percutaneous drainage in conservative therapy for perforated gastroduodenal ulcers.

    Science.gov (United States)

    Oida, Takatsugu; Kano, Hisao; Mimatsu, Kenji; Kawasaki, Atsushi; Kuboi, Youichi; Fukino, Nobutada; Kida, Kazutoshi; Amano, Sadao

    2012-01-01

    The management of peptic ulcers has dramatically changed and the incidence of elective surgery for gastroduodenal peptic ulcers has markedly decreased; hence, the incidence of emergency surgery for perforated peptic ulcers has slightly increased. In select cases, conservative therapy can be used as an alternative for treating perforated gastroduodenal ulcers. In this study, we evaluated the efficacy of percutaneous abdominal drainage for the conservative treatment of perforated gastroduodenal ulcers. We retrospectively studied 51 patients who had undergone conservative therapy for perforated gastroduodenal ulcers. These patients were divided into 2 groups on the basis of the initial treatment with conservative therapy with or without percutaneous drainage: group PD included patients who had undergone percutaneous drainage and group NPD, patients who had undergone non-percutaneous drainage. In the PD group, 14.3% (n=3) of the patients did not respond to conservative therapy, while this value was 43.3% (n=13) in the NPD group. The 2 groups differed significantly with respect to conversion from conservative therapy to surgery (pperforated gastroduodenal ulcers should be performed only in the case of patients meeting the required criteria; its combination with percutaneous intraperitoneal drainage is effective as initial conservative therapy.

  11. Colonic perforations caused by migrated plastic biliary stents

    Energy Technology Data Exchange (ETDEWEB)

    Virgilio, Edoardo; Pascarella, Agauido; Scandavini, Chiara Maria; Frezza, Barbara; Bocchetti, Tommaso; Balducci, Genoveffa [Faculty of Medicine and Psychology ' Sapienza' , St. Andrea Hospital, Rome (Italy)

    2015-04-15

    Endoscopic insertion of plastic endoprostheses has become an integral part of the management of many benign and malignant diseases affecting the hepatobiliary and pancreatic system. Clogging and dislocation into the duodenum are the most frequently described complications following stent placement. Distal migration with or without perforation of the colon is an exceedingly rare phenomenon and the treatment is not well defined, as discussed below.

  12. Intestinal perforation caused by multiple magnet ingestion | Corduk ...

    African Journals Online (AJOL)

    Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.

  13. Spontaneous perforation of a choledochal cyst, clues for diagnosis

    African Journals Online (AJOL)

    The diagnosis is often delayed because of its nonspecific presentation; hence, it is very rarely made preoperatively. The presenta- tion of CM perforation may be .... biliary atresia and. Table 1 Patient profile and clinical features at the time of presentation. Patients. Age/sex. Abdominal distension. Clinical jaundice. Acholic.

  14. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Toshihiro Kitai

    2014-01-01

    Full Text Available Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

  15. Aspiration of a perforated pen cap: complete tracheal obstruction ...

    African Journals Online (AJOL)

    Keywords: children, flexible bronchoscopy, Fogarty catheter, foreign body aspiration, pen cap, rigid ... plastic foreign body with central perforation occluding the trachea in supracarinal ... venous steroids and was discharged home on postoperative day 1 without ... history may not be as reliable, if not witnessed by an adult.

  16. Traumatic upper cervical esophageal perforation in childhood with ...

    African Journals Online (AJOL)

    rae. The next step was an upper gastrointestinal series, in which posterior oropharyngeal and cervical esophageal perforation draining to the posterior mediastinum was detected (Fig. 1). Emergency laryngobronchoscopy and esophagoscopy were performed. The upper and lower airways were normal except mild laryngeal ...

  17. Single-layer closure of typhoid enteric perforation: Our experience ...

    African Journals Online (AJOL)

    Materials and Methods: We retrospectively studied the effects of single versus double layer intestinal closure after typhoid enteric perforation with peritonitis in 902 pediatric patients from September 2007 to April 2012. All the patients underwent laparotomy after resuscitation and antibiotic cover. The patients were divided ...

  18. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review

    NARCIS (Netherlands)

    Toorenvliet, Boudewijn R.; Swank, Hilko; Schoones, Jan W.; Hamming, Jaap F.; Bemelman, Willem A.

    2010-01-01

    Aim This systematic review aimed to evaluate the efficacy, morbidity and mortality of laparoscopic peritoneal lavage for patients with perforated diverticulitis. Method We searched PubMed, EMBASE, Web of Science, the Cochrane Library and CINAHL databases, Google Scholar and five major publisher

  19. A review of typhoid perforation in a rural African hospital ...

    African Journals Online (AJOL)

    Apart from the patients who had resection and primary anastomosis, 95(90.5%) had 2 layered closure of the perforation. The most common complications were wound infections (26.7%). Intra-abdominal abscesses (9.5%) and would dehiscence (7.6%). The mortality rate was 16.2% showing a remarkable improvement in ...

  20. Numerical method for wave forces acting on partially perforated caisson

    Science.gov (United States)

    Jiang, Feng; Tang, Xiao-cheng; Jin, Zhao; Zhang, Li; Chen, Hong-zhou

    2015-04-01

    The perforated caisson is widely applied to practical engineering because of its great advantages in effectively wave energy consumption and cost reduction. The attentions of many scientists were paid to the fluid-structure interaction between wave and perforated caisson studies, but until now, most concerns have been put on theoretical analysis and experimental model set up. In this paper, interaction between the wave and the partial perforated caisson in a 2D numerical wave flume is investigated by means of the renewed SPH algorithm, and the mathematical equations are in the form of SPH numerical approximation based on Navier-Stokes equations. The validity of the SPH mathematical method is examined and the simulated results are compared with the results of theoretical models, meanwhile the complex hydrodynamic characteristics when the water particles flow in or out of a wave absorbing chamber are analyzed and the wave pressure distribution of the perforated caisson is also addressed here. The relationship between the ratio of total horizontal force acting on caisson under regular waves and its influence factors is examined. The data show that the numerical calculation of the ratio of total horizontal force meets the empirical regression equation very well. The simulations of SPH about the wave nonlinearity and breaking are briefly depicted in the paper, suggesting that the advantages and great potentiality of the SPH method is significant compared with traditional methods.

  1. Esophageal perforation following foreign body ingestion in children ...

    African Journals Online (AJOL)

    Esophageal perforation following foreign body ingestion in children: report of three cases. O Abdelhadi, AE Ali, O Taha, A Abdalla, F Nugud. Abstract. We report three cases of foreign body esophagus, in two of them the foreign body was a coin, and the third child ingested a disc battery. In all three cases the foreign body ...

  2. Non-operative Management of Gallbladder Perforation After Blunt ...

    African Journals Online (AJOL)

    management of isolated traumatic gallbladder perforation in a patient that was ... A transthoracic echocardiogram 2 days later revealed a right ventricular .... EPUB is an open e-book standard recommended by The International Digital Publishing Forum which is designed for reflowable content i.e. the text display can be ...

  3. Pattern of perforating ocular injuries at Menelik II hospital, Addis ...

    African Journals Online (AJOL)

    Abstract. Background: Eye injury is the most common cause of monocular blindness worldwide including Ethiopia. It is common in young and active people, and has economic as well as health implication. ... A questionnaire was developed and all patients diagnosed to have perforating type of ocular injuries were included.

  4. Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula

    Directory of Open Access Journals (Sweden)

    Antonios Panagidis

    2015-07-01

    Full Text Available Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.

  5. Peritoneal Drains in Perforated Appendicitis without Peritonitis: A ...

    African Journals Online (AJOL)

    All of the 90 patients included in the study had histological confirmation of an inflamed perforated appendix. Postoperatively, 18 patients had wound sepsis and 6 patients had other complications including faecal fistula, abdominal abscess, and paralytic ileus. Out of those with wound sepsis, the majority (83%) were in the ...

  6. Treatment of Ischial Pressure Sores with Both Profunda Femoris Artery Perforator Flaps and Muscle Flaps

    Directory of Open Access Journals (Sweden)

    Chae Min Kim

    2014-07-01

    Full Text Available Background Reconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores. Methods We retrospectively analyzed data from 14 patients (16 ischial sores whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course. Results All flaps survived the entire follow-up period. Seven patients (50% had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years. The mean follow-up period was 27.9 months (range, 3-57 months. In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%, wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%, but resolved with conservative treatment. Among 16 cases, there was only one (6% recurrence at 34 months. Conclusions The combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

  7. Management strategies, early results, benefits, and risk factors of laparoscopic repair of perforated peptic ulcer.

    Science.gov (United States)

    Lunevicius, Raimundas; Morkevicius, Matas

    2005-10-01

    The primary goal of this study was to describe epidemiology and management strategies of the perforated duodenal ulcer, as well as the most common methods of laparoscopic perforated duodenal ulcer repair. The secondary goal was to demonstrate the value of prospective and retrospective studies regarding the early results of surgery and the risk factors. The tertiary goal was to emphasize the benefits of this operation, and the fourth goal was to clarify the possible risk factors associated with laparoscopic repair of the duodenal ulcer. The Medline/Pubmed database was used. Review was done after evaluation of 96 retrieved full-text articles. Thirteen prospective and twelve retrospective studies were selected, grouped, and summarized. The spectrum of the retrospective studies' results are as follows: median overall morbidity rate 10.5 %, median conversion rate 7%, median hospital stay 7 days, and median postoperative mortality rate 0%. The following is the spectrum of results of the prospective studies: median overall morbidity rate was slightly less (6%); the median conversion rate was higher (15%); the median hospital stay was shorter (5 days) and the postoperative mortality was higher (3%). The risk factors identified were the same. Shock, delayed presentation (> 24 hours), confounding medical condition, age > 70 years, poor laparoscopic expertise, ASA III-IV, and Boey score should be considered preoperative laparoscopic repair risk factors. Each of these factors independently should qualify as a criterion for open repair due to higher intraoperative risks as well as postoperative morbidity. Inadequate ulcer localization, large perforation size (defined by some as > 6 mm diameter, and by others as > 10 mm), and ulcers with friable edges are also considered as conversion risk factors.

  8. Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis.

    Science.gov (United States)

    Sohn, M; Agha, A; Heitland, W; Gundling, F; Steiner, P; Iesalnieks, I

    2016-08-01

    The best surgical strategy for the management of perforated diverticulitis with generalized peritonitis of the sigmoid colon is not clearly defined. The aim of this retrospective cohort study was to evaluate the value of a damage control strategy. All patients who underwent emergency laparotomy for perforated diverticular disease of the sigmoid colon with generalized peritonitis between 2010 and 2015 were included. The damage control strategy (study group), included a two- stage procedure: limited resection of the diseased colonic segment, closure of proximal colon and distal stump, and application of an abdominal vacuum at the initial surgery followed by second-look laparotomy 24-48 h later At this point a choice was made between anastomosis and Hartmann's procedure. The control group consisted of patients receiving definitive reconstruction (anastomosis or Hartmann's procedure) at the initial operation. Thirty-seven patients were included in the study. Damage control strategy was applied in 19 patients and the control group consisted of 18 patients. Both groups were comparable in terms of demographics, severity of peritonitis, and comorbidities. The overall postoperative mortality was 11 % (n = 4). There were no statistically significant differences between both groups regarding postoperative morbidity and mortality; however, a significantly higher proportion of patients in the control group had a stoma after the initial hospital stay (83 vs. 47 %, p = 0.038). This difference was still significant after adjustment for sex, age, Mannheim Peritonitis Index, American Society of Anesthesiologists class and presence of septic shock at presentation. At the end of the follow-up period, 15 of 17 survivors in the study group and 13 of 16 survivors in the control group had their intestinal continuity restored (p = 0.66). Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate

  9. Perforator plus flaps: Optimizing results while preserving function and esthesis

    Directory of Open Access Journals (Sweden)

    Mehrotra Sandeep

    2010-01-01

    Full Text Available Background: The tenuous blood supply of traditional flaps for wound cover combined with collateral damage by sacrifice of functional muscle, truncal vessels, or nerves has been the bane of reconstructive procedures. The concept of perforator plus flaps employs dual vascular supply to flaps. By safeguarding perforators along with supply from its base, robust flaps can be raised in diverse situations. This is achieved while limiting collateral damage and preserving nerves, vessels, and functioning muscle with better function and aesthesis. Materials and Methods: The perforator plus concept was applied in seven different clinical situations. Functional muscle and fasciocutaneous flaps were employed in five and adipofascial flaps in two cases, primarily involving lower extremity defects and back. Adipofascial perforator plus flaps were employed to provide cover for tibial fracture in one patients and chronic venous ulcer in another. Results: All flaps survived without any loss and provided long-term stable cover, both over soft tissue and bone. Functional preservation was achieved in all cases where muscle flaps were employed with no clinical evidence of loss of power. There was no sensory loss or significant oedema in or distal to the flap in both cases where neurovascular continuity was preserved during flap elevation. Fracture union and consolidation were satisfactory. One patient had minimal graft loss over fascia which required application of stored grafts with subsequent take. No patient required re-operation. Conclusions: Perforator plus concept is holistic and applicable to most flap types in varied situations. It permits the exercise of many locoregional flap options while limiting collateral functional damage. Aesthetic considerations are also addressed while raising adipofascial flaps because of no appreciable donor defects. With quick operating times and low failure risk, these flaps can be a better substitute to traditional flaps and at

  10. Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

    OpenAIRE

    Alexander Abreu; Ndivhuwo Michael Ndwambi; Fermín Luis Martínez

    2017-01-01

    Resumen El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica...

  11. Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

    Directory of Open Access Journals (Sweden)

    Alexander Abreu

    2017-07-01

    Full Text Available Resumen El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica aguda, infección del tracto urinario, restos ovulares post aborto y definitivamente se concluyó como embarazo ectópico abdominal mediante ecografía abdominal. Se le realizó laparotomía exploradora y se extrajo el feto y la placenta sin dificultades con una evolución postoperatoria favorable hacia la curación. Se concluyó que la perforación uterina durante el curetaje de la cavidad pudo pasar inadvertida, llevando a implantación abdominal secundaria del embarazo con un cuadro clínico variable. En dicho cuadro, el ultrasonido juega un papel fundamental para su diagnóstico, siendo el manejo laparotómico el más apropiado en estos casos.

  12. The Peptic Ulcer Perforation (PULP) score: a predictor of mortality following peptic ulcer perforation. A cohort study

    DEFF Research Database (Denmark)

    Møller, M H; Engebjerg, M C; Adamsen, S

    2012-01-01

    Accurate and early identification of high-risk surgical patients with perforated peptic ulcer (PPU) is important for triage and risk stratification. The objective of the present study was to develop a new and improved clinical rule to predict mortality in patients following surgical treatment...

  13. Prediction of inelastic behavior and creep-fatigue life of perforated plates

    International Nuclear Information System (INIS)

    Igari, Toshihide; Setoguchi, Katsuya; Nakano, Shohki; Nomura, Shinichi

    1991-01-01

    Prediction methods of macroscopic and local stress-strain behavior of perforated plates in plastic and creep regime which are proposed by the authors are applied to the inelastic analysis and creep-fatigue life prediction of perforated cylinder subjected to cyclic thermal stress. Stress-strain behavior of perforated cylinder is analyzed by modeling the perforated portion to cylinder with equivalent-solid-plate properties. Creep-fatigue lives at around a hole of perforated plates are predicted by using the local stress-strain behavior and are compared with experimentally observed lives. (author)

  14. Successful Management of Perforated Duodenal Diverticulitis With Intra-abdominal Drainage and Feeding Jejunostomy: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Chin-Fan Chen

    2008-08-01

    Full Text Available We report the clinical experience of one patient with perforated duodenal diverticulitis who was successfully treated by intra-abdominal drainage and feeding jejunostomy. A 53-year-old male patient visited our hospital due to acute onset of abdominal pain and distension. Physical examination revealed tenderness over the epigastric area and right-lower quadrant of the abdomen without obvious rebound tenderness or muscle guarding. Duodenal diverticulitis with a retroperitoneal abscess was identified by abdominal computed tomography scan. Surgical intervention was performed after the failure of conservative treatment. The operative findings were compatible with perforated duodenal diverticulitis, and intra-abdominal drainage of retroperitoneal abscess with simultaneous feeding jejunostomy was undertaken. The patient was doing well at the 4-month postoperative follow-up visit. We suggest the use of a conservative operative method, as opposed to conventional diverticulectomy and duodenorrhaphy, as an alternative approach for the management of this disorder, especially when conservative treatment has failed.

  15. Lack of utility of measuring serum bilirubin concentration in distinguishing perforation status of pediatric appendicitis.

    Science.gov (United States)

    Bonadio, William; Bruno, Santina; Attaway, David; Dharmar, Logesh; Tam, Derek; Homel, Peter

    2017-06-01

    Pediatric appendicitis is a common, potentially serious condition. Determining perforation status is crucial to planning effective management. Determine the efficacy of serum total bilirubin concentration [STBC] in distinguishing perforation status in children with appendicitis. Retrospective review of 257 cases of appendicitis who received abdominal CT scan and measurement of STBC. There were 109 with perforation vs 148 without perforation. Although elevated STBC was significantly more common in those with [36%] vs without perforation [22%], the mean difference in elevated values between groups [0.1mg/dL] was clinically insignificant. Higher degrees of hyperbilirubinemia [>2mg/dL] were rarely encountered [5%]. Predictive values for elevated STBC in distinguishing perforation outcome were imprecise [sensitivity 38.5%, specificity 78.4%, PPV 56.8%, NPV 63.4%]. ROC curve analysis of multiple clinical and other laboratory factors for predicting perforation status was unenhanced by adding the STBC variable. Specific analysis of those with perforated appendicitis and percutaneously-drained intra-abdominal abscess which was culture-positive for Escherichia coli showed an identical rate of STBC elevation compared to all with perforation. The routine measurement of STBC does not accurately distinguish perforation status in children with appendicitis, nor discern infecting organism in those with perforation and intra-abdominal abscess. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Transmural coil embolization—alternative technique for management of arterial perforation during subintimal angioplasty

    Directory of Open Access Journals (Sweden)

    Karthikeyan Damodharan

    2016-01-01

    Full Text Available Subintimal angioplasty of lower limb arterial occlusion carries a relatively higher risk of vessel perforation compared to transluminal angioplasty. Vessel perforation is a potentially life threatening complication which requires prompt recognition and management. They are usually managed by endovascular techniques such as low-pressure balloon tamponade, covered stents, and coil embolization of the ruptured artery. We describe a technique of treating vessel perforation following balloon angioplasty. Patient developed a large perforation of the proximal superficial femoral artery (SFA after balloon inflation during subintimal angioplasty of complete SFA occlusion. Following failure of balloon tamponade in sealing the perforation, we successfully treated it by deploying an embolization coil at the site of perforation through the vessel wall followed by balloon tamponade. Our technique could be a useful relatively inexpensive alternative treatment option in the management of vessel perforation compared to covered stents.

  17. Fatores de risco no tratamento de lesões do ceco com sutura primária em ratos Risk factors on the treatment of cecum injuries with primary suture in rats

    Directory of Open Access Journals (Sweden)

    Gustavo Pereira Fraga

    2004-12-01

    ência de deiscência também foi maior nos ratos que apresentavam contaminação fecal mais intensa da cavidade peritoneal. A intensidade da peritonite no momento da sutura observada no exame histológico não teve associação com a ocorrência de complicações da sutura primária. Conclusão: A sutura primária é um procedimento de risco para tratar ratos, transcorrido intervalo superior a seis horas após o trauma, ou na vigência de contaminação intensa da cavidade por fezes.Purpose: Analyze the results of primary suture in the treatment of cecum traumatic injuries in rats, after the exposure to increasing time intervals between the trauma and the surgery and with different peritonitis degrees. Methods: In a randomized double-blinded study, 96 Wistar male rats, weight ranging between 200 and 250 grams, underwent laparotomy, in which a 5-milimiter-diameter-injury in the contramesenteric edge of the cecum was performed. In 12 animals of the control-group a prompt primary suture was executed, with total and separated stitches, with 7.0 polypropylene thread. In the other groups, with 12 animals each, a laparotomy for repair of the injury was executed after intervals of 30 minutes, 1, 2, 4, 6, 9 and 12 hours. At the time of injury repair, one of its edges was ressected and sent for anatomopathological examination. A daily control after the surgery was done, observing the presence of complications, specially dehiscence of the suture, and the euthanasia of the animals were done in the 1st, 4th, 7th and 14th day after the surgery. Necropsy was executed in all animals, observing the macroscopic and microscopic findings in the area of suture. Results: There was no association between the delay for surgical treatment of the injury and peritonitis degrees. The mortality in the 14 animals with diffuse peritonitis was 100%. Global mortality was 25% (24 animals, and 6 animals (25% died before treatment. None of the animals treated that evolved to death had complications related

  18. Due diligence

    International Nuclear Information System (INIS)

    Sanghera, G.S.

    1999-01-01

    The Occupational Health and Safety (OHS) Act requires that every employer shall ensure the health and safety of workers in the workplace. Issues regarding the practices at workplaces and how they should reflect the standards of due diligence were discussed. Due diligence was described as being the need for employers to identify hazards in the workplace and to take active steps to prevent workers from potentially dangerous incidents. The paper discussed various aspects of due diligence including policy, training, procedures, measurement and enforcement. The consequences of contravening the OHS Act were also described

  19. Perforated gastric corpus in a strangulated paraesophageal hernia: a case report

    Directory of Open Access Journals (Sweden)

    Shafii Alexis E

    2009-05-01

    Full Text Available Abstract Introduction Patients with paraesophageal hernias often present secondary to chronic symptomatology. Infrequently, acute intestinal ischemia and perforation can occur as a consequence of paraesophageal hernias with potentially dire consequences. Case presentation An 86-year-old obtunded male presented to the emergency department with hypotension and severe back and abdominal pain. An emergency abdominal CT scan was ordered with a presumptive diagnosis of ruptured abdominal aortic aneurysm. CT topograms revealed extensive free intra-abdominal air and herniated abdominal viscera into the right hemithorax. Prior to completion of the CT study, the patient sustained a cardiopulmonary arrest. Surgery was consulted, but the patient was unable to be revived. Post-mortem examination revealed gross contamination within the abdomen and a giant, incarcerated, hiatal hernia with organoaxial volvulus and ischemic perforation. Conclusion Current recommendations call for prompt repair of giant hiatal hernias before they become symptomatic due to the increased risk of strangulation. Torsion of the stomach in large hiatal hernias frequently leads to a fatal complication such as this warranting elective repair as soon as possible.

  20. [A Case Where Rectal Cancer Ileus Caused Perforation in the Ascending Colon].

    Science.gov (United States)

    Machida, Tomohiko; Kobayashi, Masayoshi; Sakai, Kazuki; Hiraoka, Kunihiko; Ichihara, Takao

    2016-11-01

    The patient was a 65-year-old man. He had not defecated for a week in early December 2015, and had noticed abdominal pain and abdominaldistension from 4 days prior. The pain and distension worsened, and the patient was rush transported to our hospital. Via abdominal CT we found free air in the upper abdomen, expansion of the small and large intestines, and notably, significant intestinal tract expansion and a gas reservoir in the ascending colon. We found significant narrowing as well as hypertrophy along the entire circumference of the rectum and suspected gastrointestinal perforation due to rectal cancer ileus. Inflammation findings were abnormally high and we performed emergency surgery. We found a laceration on the ascending colon, which had expanded markedly. We elevated that location and installed a colostomy. Following surgery the patient developed mild SSI and ileus, which were alleviated through conservative treatment. A month after the operation we performed a colonoscopy and found a tumor along the entire circumference of the rectum Rs. It was diagnosed as group V tub1-2 via biopsy. We performed surgery in late January 2016(colostomy closure, laparotomy rectal low anterior resection). We are reporting a rare case where rectal cancer ileus caused perforation in the ascending colon.

  1. A case with hypopharyngeal perforation after concurrent chemoradiotherapy for hypopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Yamada, Masato; Kuwahata, Yuko; Sumi, Takuro; Nishio, Ayako

    2012-01-01

    We present a rare case of a hypopharyngeal perforation after concurrent chemoradiotherapy (CCRT). A 69-year-old man with schizophrenia received CCRT with Docetaxel, Cisplatin, and 5-FU following a diagnosis of hypopharyngeal squamous cell carcinoma (T3N2bM0). Complete remission was achieved with CCRT, but four months later, he forcibly swallowed a meat bun (Chinese manju) which led to the perforation of his hypopharynx. He was treated with conservative therapy (intravenous antibiotic, fasting and tube feeding). The swelling gradually subsided and the patient was able to consume food naturally after the 13th day of hospitalization. We considered the composite factors had contributed to the pathogenesis of this case: anatomical weakness, pathological weakness after chemoradiotherapy, physical pressure to the hypopharynx due to the metastasis of the cervical spine, and the powerful deglutition pressure caused by his forcible swallowing of the bun. The possibility that such a serious complication might be caused by CCRT was suggested, and we believe that clinicians should have recognition and understanding of how to treat it because of its severe morbidity. (author)

  2. Nasal septum perforation in patient with pyoderma gangrenosum

    Directory of Open Access Journals (Sweden)

    Maia, Camilla Bezerra da Cruz

    2012-01-01

    Full Text Available Introduction: The cocaine is obtained from the leaves of the coca (Erythroxylon coca. It can be used in many ways, but the most common is the drug inhalation. The Cocaine also causes vasoconstriction at nasal mucous membrane and its chronic use can cause necrosis and nasal septum perforation. Pyoderma gangrenosum is an uncommon idiopathic disease characterized by ulcerations, usually observed on the legs. Its diagnosis is most common an exclusion of others diseases. So far, there is no specific treatment based on evidence by randomized controlled trials. Objective: Describe the rare association between Pyoderma gangrenosum and cocaine. Case Report: E. A., 27-year-old woman with destruction of nasal septum and palate who has been using a big amount of cocaine, been necessary note the difference from which disease cause de damage. Final Comments: Also there are only three cases of Pyoderma gangrenosum complicated with nasal septum perforation in cocaine users.

  3. Buckling Behavior of Cold-Formed Studs with Thermal Perforations

    Directory of Open Access Journals (Sweden)

    Garifullin Marsel

    2016-01-01

    Full Text Available Studies have shown that the optimal structural scheme for low-rise buildings that meets all regulatory requirements is a frame system. In this connection, thin-walled cold-formed steel (CFS profiles seem to be the best material for constructing light steel framed (LSF walls. The framework of LSF walls is usually constructed from CFS C-shaped profiles. To increase the thermal effectiveness of a wall, CFS profiles usually have thermal perforations and thus are called thermoprofiles. However, these openings have a negative impact on bearing capacity of profiles and require accurate evaluation. In this article a relatively new reticular-stretched thermoprofile with diamond-shaped openings is considered. The article deals with the buckling analysis of perforated CFS C-sections subjected to compression.

  4. Proximal duodenal perforation in three dogs following deracoxib administration.

    Science.gov (United States)

    Case, J Brad; Fick, Jennifer L; Rooney, Matthew B

    2010-01-01

    The purpose of this study was to describe the clinical and gross pathological findings, treatment, and outcome in three dogs receiving deracoxib that developed proximal duodenal perforation and subsequent septic peritonitis. Clinical findings were acute vomiting and anorexia following initiation of deracoxib therapy. Deracoxib dosages ranged from 2 to 3 mg/kg per os q 24 hours. In each dog, exploratory laparotomy revealed duodenal perforations approximately 1 cm orad to the major duodenal papilla. Two out of three dogs survived following exploratory laparotomy. Two of three dogs in the present case series received the approved deracoxib dosage. Dogs receiving deracoxib, even at labeled dosages, should be monitored judiciously for signs of gastrointestinal disease.

  5. Targeted steam injection using horizontal wells with limited entry perforations

    Energy Technology Data Exchange (ETDEWEB)

    Boone, T. J.; Youck, D. G.; Sun, S. [Imperial Oil Resources, Calgary, AB (Canada)

    1998-12-31

    An experimental horizontal well using limited-entry perforations as a method for distributing steam to different zones was used to replace ten vertical injection wells. The well was located between rows of vertical wells in a reservoir that has been subjected to more than ten years of operation under cyclic steam stimulation. The limited-entry perforations enabled steam to be targeted at the cold regions of the reservoir. This paper presents an assessment of the well based on theoretical calculations, measured injection pressures and rates and 3-D seismic imaging. All the data collected during the experiment support the conclusion that effective steam distribution along the well has been achieved. It was also concluded that this technology has significant potential for SAGD applications as a mechanism for achieving improved steam distribution at a much reduced cost. 5 refs., 8 figs.

  6. Duodenal perforation: after endoscopic retrograde cholangiopancreatography: when to operate?

    International Nuclear Information System (INIS)

    Garcia Navarrete, Aldhem Francisco

    2014-01-01

    The mainly surgical management of duodenal perforation as the iatrogenicity of endoscopic retrograde cholangiopancreatography (ERCP) is defined and protocolized through the exhaustive review of the most conclusive literature available on the subject. Bibliography on the management of post-ERCP duodenal perforation is reviewed in scientific databases, textbooks, publications of medical journals, MD Consult and Medline. A total of 60 bibliographical citations were reviewed; succeeding in defining the protocol on the management of this type of complications, thanks to the appropriate selection of the most conclusive citations and the greatest consensus on the subject. A total of 60 bibliographical citations were reviewed; succeeding in defining the protocol on the management of this type of complications, based on the appropriate selection of the most conclusive citations and the greatest consensus on the subject [es

  7. Symptomatic duodenal perforation by inferior vena cava filter.

    Science.gov (United States)

    Baptista Sincos, Anna Pw; Sincos, Igor R; Labropoulos, Nicos; Donegá, Bruno C; Klepacz, Andrea; Aun, Ricardo

    2017-01-01

    Objectives Duodenal perforation by an inferior vena cava filter is rare and life threatening. Our objective is to find out number of occurrences and compare diagnosis and treatments. Method The reference list of Malgor's review in 2012 was considered as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE, Web of Sciences, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. Results Most of the patients presented with upper abdominal pain and the use of radiologic studies was crucial for diagnosis. The most common treatment was laparotomy with filter or strut removal plus duodenum repair. However, clinical conditions of patients must be considered and the endovascular technique with endograft deployment into inferior vena cava may be an alternative. Conclusion Duodenal perforation by an inferior vena cava filter is uncommon and in high-risk surgical patients endovascular repair must be considered.

  8. Palatal Perforation: A Rare Complication of Postanesthetic Necrosis

    Science.gov (United States)

    Gargi, Vidisha; Mohan, Ravi Prakash Sasankoti; Kamarthi, Nagaraju; Gupta, Swati

    2017-01-01

    The everyday practice of dentistry relies heavily on achieving adequate local anesthesia. Even though the safety record of local anesthetic agents is high, complications do occur. Palate is a favorable site for soft-tissue lesions. Various factors such as direct effects of the drug, blanching of the tissues during injection, relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate. Among various complications, anesthetic necrotic ulcer is a rare and uncommon condition occurring mostly in the hard palate possibly after a local anesthetic infiltration. The ulceration is often deep and shows spontaneous but delayed healing. If proper treatment is not instituted on time, the necrosis can reach deep into the bone causing sequestrum formation and ultimately leading to palatal perforation. Here, we report a case of palatal perforation in a male patient followed by surgical interventions and follow-up. PMID:29042744

  9. A clinical study of 68 cases of small intestinal perforation

    International Nuclear Information System (INIS)

    Ogura, Masaharu; Tanaka, Nobutaka; Furuya, Takatoshi; Nomura, Yukihiro; Nagai, Motoki; Takahashi, Michiro; Takayama, Toshio; Hirao, Hirofumi

    2010-01-01

    From January 2000 to September 2008 we analyzed the clinical features of 68 patients attending our hospital who had undergone surgery for small intestinal perforations. The nature of the rupture in 51 patients was endogenous, and endogenous in the other 17. Endogenous ruptures included ileus in 16 cases, tumors in 7 cases, of unknown origin in 5 cases, and blunt trauma in 23 cases. Exogenous rupture included iatrogenic in 5, foreign body digestion in 5, and penetrating trauma in 7. Postoperative complications occurred significantly more in the endogenous rupture cases than in the exogenous ones. There were 4 hospital deaths, which were in all endogenous cases. The high complication rate and a certain proportion of poor prognosis in cases of endogenous rupture necessitate imminent treatment as soon as an endogenous perforation is suspected. (author)

  10. Regional variation in rates of pediatric perforated appendicitis.

    Science.gov (United States)

    Sarda, Samir; Short, Heather L; Hockenberry, Jason M; McCarthy, Ian; Raval, Mehul V

    2017-09-01

    While trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown. A retrospective, cross-sectional analysis of the 2006-2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications. National PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (pappendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape. Level III Treatment Study - Retrospective comparative study of appendicitis presentation in children by region of the country. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Reconstruction of hand contracture by reverse ulnar perforator flap

    Directory of Open Access Journals (Sweden)

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  12. Colon Perforations Causing Morgagni Hernia Case

    Directory of Open Access Journals (Sweden)

    Mustafa Ugur

    2014-08-01

    Full Text Available Herniation of the intraabdominal organs through a diaphragmatic defect that occurs due to the joining anomaly of the sternal and costal segments of diaphragm is known as Morgagni Hernia. Although most of the patients with Morgagni Hernia are asymptomatic, intestinal obstruction, incarceration and strangulation can rarely occur. An 83 years old female patient admitted with acute abdomen to our clinic. Morgagni hernia was detected with preoperative thoracic and abdominal computed tomography. We aimed to present our management in Morgagni Hernia in this study.

  13. Temperature driven annealing of perforations in bicellar model membranes.

    Science.gov (United States)

    Nieh, Mu-Ping; Raghunathan, V A; Pabst, Georg; Harroun, Thad; Nagashima, Kazuomi; Morales, Hannah; Katsaras, John; Macdonald, Peter

    2011-04-19

    Bicellar model membranes composed of 1,2-dimyristoylphosphatidylcholine (DMPC) and 1,2-dihexanoylphosphatidylcholine (DHPC), with a DMPC/DHPC molar ratio of 5, and doped with the negatively charged lipid 1,2-dimyristoylphosphatidylglycerol (DMPG), at DMPG/DMPC molar ratios of 0.02 or 0.1, were examined using small angle neutron scattering (SANS), (31)P NMR, and (1)H pulsed field gradient (PFG) diffusion NMR with the goal of understanding temperature effects on the DHPC-dependent perforations in these self-assembled membrane mimetics. Over the temperature range studied via SANS (300-330 K), these bicellar lipid mixtures exhibited a well-ordered lamellar phase. The interlamellar spacing d increased with increasing temperature, in direct contrast to the decrease in d observed upon increasing temperature with otherwise identical lipid mixtures lacking DHPC. (31)P NMR measurements on magnetically aligned bicellar mixtures of identical composition indicated a progressive migration of DHPC from regions of high curvature into planar regions with increasing temperature, and in accord with the "mixed bicelle model" (Triba, M. N.; Warschawski, D. E.; Devaux, P. E. Biophys. J.2005, 88, 1887-1901). Parallel PFG diffusion NMR measurements of transbilayer water diffusion, where the observed diffusion is dependent on the fractional surface area of lamellar perforations, showed that transbilayer water diffusion decreased with increasing temperature. A model is proposed consistent with the SANS, (31)P NMR, and PFG diffusion NMR data, wherein increasing temperature drives the progressive migration of DHPC out of high-curvature regions, consequently decreasing the fractional volume of lamellar perforations, so that water occupying these perforations redistributes into the interlamellar volume, thereby increasing the interlamellar spacing. © 2011 American Chemical Society

  14. Perforated appendicitis: an underappreciated mimic of intussusception on ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Schmitz, Matthew; Gawande, Rakhee; Vasanawala, Shreyas; Barth, Richard [Lucile Packard Children' s Hospital, Department of Radiology, Stanford University, Stanford, CA (United States)

    2014-05-15

    We encountered multiple cases in which the US appearance of ruptured appendicitis mimicked intussusception, resulting in diagnostic and therapeutic delay and multiple additional imaging studies. To explore the clinical and imaging discriminatory features between the conditions. Initial US images in six children (age 16 months to 8 years; 4 boys, 2 girls) were reviewed independently and by consensus by three pediatric radiologists. These findings were compared and correlated with the original reports and subsequent US, fluoroscopic, and CT images and reports. All initial US studies demonstrated a multiple-ring-like appearance (target sign, most apparent on transverse views) with diagnostic consensus supportive of intussusception. In three cases, US findings were somewhat discrepant with clinical concerns. Subsequently, four of the six children had contrast enemas; two were thought to have partial or complete intussusception reduction. Three had a repeat US examination, with recognition of the correct diagnosis. None of the US examinations demonstrated definite intralesional lymph nodes or mesenteric fat, but central echogenicity caused by debris/appendicolith was misinterpreted as fat. All showed perilesional hyperechogenicity that, in retrospect, represented inflamed fat ''walling off'' of the perforated appendix. There were four CTs, all of which demonstrated a double-ring appearance that correlated with the US target appearance, with inner and outer rings representing the dilated appendix and walled-off appendiceal rupture, respectively. All six children had surgical confirmation of perforated appendicitis. Contained perforated appendicitis can produce US findings closely mimicking intussusception. Clinical correlation and careful multiplanar evaluation should allow for sonographic suspicion of perforated appendicitis, which can be confirmed on CT if necessary. (orig.)

  15. Nonoperative management for perforated peptic ulcer: Who can benefit?

    OpenAIRE

    Cao, Feng; Li, Jia; Li, Ang; Fang, Yu; Ya-jun Wang, Ya-jun Wang; Li, Fei

    2017-01-01

    Background: Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. Methods: A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with ...

  16. Internal granuloma with perforation – 2 case report

    Directory of Open Access Journals (Sweden)

    Ioana Suciu

    2015-11-01

    Full Text Available Internal resorption was associated with long-term chronic inflammation of the pulp (chronic granulomatous pulpitis. When internal resorption is radiographically confirmed, endodontic treatment becomes a necessity. Vital teeth internal resorption appears radiographically as an oval enlargement of the pulp chamber and root canal with smooth, symmetrical outline. Internal granuloma is assumed to be an effect of the trauma, or pulp inflammation, the ailment is rare, asymptomatic and might progress rapidly, causing perforation.

  17. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation

    OpenAIRE

    de’Angelis, Nicola; Di Saverio, Salomone; Chiara, Osvaldo; Sartelli, Massimo; Martínez-Pérez, Aleix; Patrizi, Franca; Weber, Dieter G.; Ansaloni, Luca; Biffl, Walter; Ben-Ishay, Offir; Bala, Miklosh; Brunetti, Francesco; Gaiani, Federica; Abdalla, Solafah; Amiot, Aurelien

    2018-01-01

    Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic...

  18. Typhoid intestinal perforation in North Central Nigeria | Ugwu | West ...

    African Journals Online (AJOL)

    L'incidence était élevée en 67% entre novembre et mars - pendant la saison seche au Nigeria. Le rapport homme/femme était 1,9:1 avec un âge moyen de 19 ans et la période d'hospitalisation moyenne de 18 jours. Nous avons eu 167 perforations; quatre concernent l'intestin supérieur er appendice, et dans 72,2% des ...

  19. An Unusual Case of Colon Perforation Complicating Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Anthony A. Aghenta

    2009-08-01

    Full Text Available Colonic complications of severe acute pancreatitis occur rarely. Although there have been several theories on how pancreatic pseudocysts rupture into the colon, the exact pathogenesis remains unknown. We report an unusual case of pseudocysts complicating severe acute pancreatitis presenting with colonic perforation in a 71-year-old man with a history of chronic mesenteric ischemia. Pressure effects from a giant pseudocyst and intravascular volume depletion with acute insult on chronic mesenteric ischemia are highlighted as possible etiologic factors.

  20. Early appendectomy reduces costs in children with perforated appendicitis.

    Science.gov (United States)

    Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

    2017-12-01

    Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier

  1. Perforated appendicitis: an underappreciated mimic of intussusception on ultrasound

    International Nuclear Information System (INIS)

    Newman, Beverley; Schmitz, Matthew; Gawande, Rakhee; Vasanawala, Shreyas; Barth, Richard

    2014-01-01

    We encountered multiple cases in which the US appearance of ruptured appendicitis mimicked intussusception, resulting in diagnostic and therapeutic delay and multiple additional imaging studies. To explore the clinical and imaging discriminatory features between the conditions. Initial US images in six children (age 16 months to 8 years; 4 boys, 2 girls) were reviewed independently and by consensus by three pediatric radiologists. These findings were compared and correlated with the original reports and subsequent US, fluoroscopic, and CT images and reports. All initial US studies demonstrated a multiple-ring-like appearance (target sign, most apparent on transverse views) with diagnostic consensus supportive of intussusception. In three cases, US findings were somewhat discrepant with clinical concerns. Subsequently, four of the six children had contrast enemas; two were thought to have partial or complete intussusception reduction. Three had a repeat US examination, with recognition of the correct diagnosis. None of the US examinations demonstrated definite intralesional lymph nodes or mesenteric fat, but central echogenicity caused by debris/appendicolith was misinterpreted as fat. All showed perilesional hyperechogenicity that, in retrospect, represented inflamed fat ''walling off'' of the perforated appendix. There were four CTs, all of which demonstrated a double-ring appearance that correlated with the US target appearance, with inner and outer rings representing the dilated appendix and walled-off appendiceal rupture, respectively. All six children had surgical confirmation of perforated appendicitis. Contained perforated appendicitis can produce US findings closely mimicking intussusception. Clinical correlation and careful multiplanar evaluation should allow for sonographic suspicion of perforated appendicitis, which can be confirmed on CT if necessary. (orig.)

  2. Comparison of Dorsal Intercostal Artery Perforator Propeller Flaps and Bilateral Rotation Flaps in Reconstruction of Myelomeningocele Defects.

    Science.gov (United States)

    Tenekeci, Goktekin; Basterzi, Yavuz; Unal, Sakir; Sari, Alper; Demir, Yavuz; Bagdatoglu, Celal; Tasdelen, Bahar

    2018-04-09

    Bilateral rotation flaps are considered the workhorse flaps in reconstruction of myelomeningocele defects. Since the introduction of perforator flaps in the field of reconstructive surgery, perforator flaps have been used increasingly in the reconstruction of various soft tissue defects all over the body because of their appreciated advantages. The aim of this study was to compare the complications and surgical outcomes between bilateral rotation flaps and dorsal intercostal artery perforator (DICAP) flaps in the soft tissue reconstruction of myelomeningocele defects. Between January 2005-February 2017, we studied 47 patients who underwent reconstruction of myelomeningocele defects. Patient demographics, operative data, and postoperative data were reviewed retrospectively and are included in the study. We found no statistically significant differences in patient demographics and surgical complications between these two groups; this may be due to small sample size. With regard to complications-partial flap necrosis, cerebrospinal fluid (CSF) leakage, necessity for reoperation, and wound infection-DICAP propeller flaps were clinically superior to rotation flaps. Partial flap necrosis was associated with CSF leakage and wound infection, and CSF leakage was associated with wound dehiscence. Although surgical outcomes obtained with DICAP propeller flaps were clinically superior to those obtained with rotation flaps, there was no statistically significant difference between the two patient groups. A well-designed comparative study with adequate sample size is needed. Nonetheless, we suggest using DICAP propeller flaps for reconstruction of large myelomeningocele defects.

  3. Analytical modeling of injectivity decline in perforated wells; Modelagem analitica da perda de injetividade em pocos canhoneados

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Vanessa Limeira Azevedo; Santos, Adriano dos; Araujo, Juliana Aragao de [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil)

    2012-07-01

    During water injection, reductions of permeability (or formation damage) have been observed in many reservoirs, characterizing the injectivity decline. The permeability reduction exists due to the presence of solid and liquid particles in suspension, which are present in the water injected to be. Like this, during the development of projects for the oil production in the water management area, the phenomenon of injectivity decline must be studied, among other activities. This study includes the theoretical and practical modeling of the injectivity decline. The modeling includes different analytical models (empirical and semi-empirical) and laboratory tests, accordingly. Looking forward to this, a simulator based on the classic filtration theory of porous media was developed in order to prevent the injectivity decline within perforated wells. The formation damage caused during deep filtration and cake formation (after transition time) was included in the modeling of perforated wells; the effect of superposition of the diverse perforations was also considered. Besides that, the injectivity decline forecast was made based on well history data. The simulator allowed to forecast the injectivity decline during water injection showing a good adjustment of field history data, so it could be used to assist in the planning of injection wells stimulation. (author)

  4. Surface dose measurements under stretched, perforated thermoplast sheets and under protective wound dressings for high energy photon radiation

    International Nuclear Information System (INIS)

    Staudenraus, J.; Christ, G.

    2000-01-01

    Patient fixation masks made of perforated thermoplast sheets are widely used in radiotherapy. These masks in particular serve to immobilize the head and neck region during radiation treatment. We placed samples made of differently stretched, perforated mask material on the surface of a white polystyrene (RW3) phantom and measured for high energy photon beams from Co-60 radiation up to 25 MV bremsstrahlung the dose increase resulting from the build-up under the hole and bridge areas. Depending on the energy of the incident beam and the thickness of the stretched mask material we observed a dose increase under the bridges at the phantom surface of 55% up to 140% compared to the dose without a layer of mask material. Under a hole the dose increase is almost half the value found under a bridge. However, deeper than 1 mm under the phantom surface this difference in dose increase under holes and bridges decreases to less than 10%. The mean dose increase under a perforated thermoplast sheet is lower than the dose increase under a homogeneous sheet made of the same material with the same mean thickness. Radiation induced skin lesions or an ulcerating tumour, respectively, may require a protective wound dressing under a patient fixation mask during radiation therapy. Choosing a thin hydrocolloid wound dressing the additional dose increase of the skin, compared to the dose increase due to the fixation mask, can be kept low. (orig.) [de

  5. [A Case of Emergency Resection of Esophageal Cancer Which is on the Brink of Perforation after Neoadjuvant Chemotherapy].

    Science.gov (United States)

    Yasuda, Atsushi; Yasuda, Takushi; Kimura, Yutaka; Kato, Hiroaki; Hiraki, Yoko; Iwama, Mitsuru; Shiraishi, Osamu; Shinkai, Masayuki; Imano, Motohiro; Imamoto, Haruhiko

    2017-11-01

    According to the Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus in Japan, the standard treatment of esophageal cancer with cStage II / III is preoperative chemotherapy and radical resection. But when the tumor has deep ulcer, the perforation of it is sometimes occurred due of the anti-tumor effect and we are forced to change the standard treatment. In this time, we report a case of emergency resection of esophageal cancer which is on the brink of perforation after neoadjuvant chemotherapy. A 62-year-old woman had locally advanced esophageal cancer(cT4N2M0)and performed neoadjuvant chemotherapy(NAC). After 2 courses of NAC, the patient got into critical condition that the esophageal cancer was on the brink of perforation, thus we immediately performed emergency resection of the tumor. Unfortunately, the tumor was not completely resected because of invasion to the Botallo ligament, but we were able to avoid a critical state such as mediastinitis or penetration to the aorta. In multimodality therapy for locally advanced tumor, immediate response to oncologic emergency is significantly required, impacting on the prognosis and quality of life.

  6. What are the risk factors of colonoscopic perforation?

    Directory of Open Access Journals (Sweden)

    Lohsiriwat Darin

    2009-09-01

    Full Text Available Abstract Background Knowledge of the factors influencing colonoscopic perforation (CP is of decisive importance, especially with regard to the avoidance or minimization of the perforations. The aim of this study was to determine the incidence and risk factors of CP in one of the endoscopic training centers accredited by the World Gastroenterology Organization. Methods The prospectively collected data were reviewed of all patients undergoing either colonoscopy or flexible sigmoidoscopy at the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand between January 2005 and July 2008. The incidence of CP was evaluated. Eight independent patient-, endoscopist- and endoscopy-related variables were analyzed by a multivariate model to determine their association with CP. Results Over a 3.5-year period, 10,124 endoscopic procedures of the colon (8,987 colonoscopies and 1,137 flexible sigmoidoscopies were performed. There were 15 colonic perforations (0.15%. Colonoscopy had a slightly higher risk of CP than flexible sigmoidoscopy (OR 1.77, 95%CI 0.23-13.51; p = 1.0. Patient gender, emergency endoscopy, anesthetic method, and the specialty or experience of the endoscopist were not significantly predictive of CP rate. In multivariate analysis, patient age of over 75 years (OR = 6.24, 95%CI 2.26-17.26; p Conclusion The incidence of CP in this study was 0.15%. Patient age of over 75 years and therapeutic colonoscopy were two important risk factors for CP.

  7. Bladder perforation owing to a unipolar coagulating device.

    Science.gov (United States)

    Pakter, J; Budnick, L D

    1981-09-15

    A report on a patient who sustained a burn and perforation of the urinary bladder from visible sparks emanating from a unipolar coagulating device during the couse of laparoscopic sterilization is presented. It is the first report of urinary bladder burns using a unipolar coagulating device. A 24-year-old woman, gravida 10, para 3, abortus 7, underwent a laparoscopic sterilization with a unipolar coagulating device. As the physician was finishing the coagulation, a spark from the device caused a 1-2 cm burn with a central area of perforation into the urinary bladder. Conservative treatment was recommended, and consisted of Foley catheterization and drainage for 5 days. Initial urine culture revealed Klebsiella species, and oral ampicillin was prescribed. Hematuria was noted throughout the patient's hospitalization, and blood clots were present in the urine on Day 2 postoperation. The patient had no abdominal or flank pain, was afebrile, and had a stable hemoglobin level during the hospital stay. Cystography was performed on Day 5 postoperatively and demonstrated no perforation. Foley catheter was removed. Patient was discharged 2 days later and remains in good health 3 months postoperatively.

  8. Pool Boiling Enhancement of R-123 Using Perforated Plates

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nae-Hyun [Incheon Nat’l Univ., Incheon(Korea, Republic of)

    2016-05-15

    In this study, we investigate the pool boiling enhancement caused by perforated plates on top of a smooth surface. We conduct tests using R-123 at atmospheric pressure. It was shown that perforated plates significantly enhanced the pool boiling of the smooth surface. The reason may be attributed to the increased bubble contact area between the plates. The results showed that the enhancement ratio was dependent on the heat flux. At high heat flux, the enhancement ratio increased as the porosity increased. However, at low heat flux, the enhancement ratio decreased as the porosity increased. For the present investigation, the optimum configuration had a pore diameter of 2.0 mm, pore pitch of 2.5 mm×5.0 mm or 5.0 mm×5.0 mm, and a gap width of 0.5 mm, which yielded heat-transfer coefficients that are close to those of GEWA-T. The optimum porosity for R-123 was significantly larger than that of water or ethanol. The reason for this may be the large liquid-to-vapor density ratio along with the small latent heat of vaporization of R-123. The perforated plates yielded smaller boiling hysteresis compared with that of the smooth surface.

  9. Rapid and controllable perforation of carbon nanotubes by microwave radiation

    Science.gov (United States)

    Ojaghi, Neda; Mokhtarifar, Maryam; Sabaghian, Zahra; Arab, Hamed; Maghrebi, Morteza; Baniadam, Majid

    2018-05-01

    This study presents a new controlled approach to deep perforation of millimeter-long carbon nanotube arrays (CNTAs) by fast oxidative cutting. The approach is based on decorating CNTAs with silver (Ag) nanoparticles, followed by heating Ag-decorated CNTAs with microwave radiation (2.48 GHz, 300 W). The perforation was evaluated using different techniques such as transmission electron microscopy, X-ray photoelectron spectroscopy, and Brunauer-Emmett-Teller method. The results of the oxidation of carbonaceous materials indicated that the relative amount of oxygen functional groups increased without total oxidation of carbon up to 60 s. After 60 s, the amount of functional groups decreased as the total oxidation started suddenly. Afterwards, at around 120 and 420 s, the oxidation of Ag-decorated CNTAs reached the point of total perforation and total cutting, respectively. Though carbon decomposition terminated at around 420 s, the total pore volume and surface area increased continuously. This was attributed to the steady growth of Ag nanoparticles located between CNTAs.

  10. Perforated plates for cryogenic regenerators and method of fabrication

    International Nuclear Information System (INIS)

    Hendricks, J.B.

    1994-01-01

    Perforated plates having very small holes with a uniform diameter throughout the plate thickness are prepared by a open-quotes wire drawingclose quotes process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er 3 Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans containing erbium and nickel metals in a stacked array with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er 3 Ni. Perforated plates having two sizes of perforations, one of which is small enough for storage of helium, are also disclosed. 10 figures

  11. A case of delayed cardiac perforation of active ventricular lead

    Directory of Open Access Journals (Sweden)

    Hangyuan Guo

    2011-12-01

    Full Text Available A 65-year-old man was admitted as for one month of repetitive dizziness and one episode of syncope. Electrocardiogram showed sinus bradycardia and his Holter monitoring also showed sinus bradycardia with sinus arrest, sino-atrial block and a longest pause of 4.3 s. Then sick sinus syndrome and Adam-Stokes syndrome were diagnosed. Then a dual chamber pacemaker (Medtronic SDR303 was implanted and the parameters were normal by detection. The patient was discharged 1 week later with suture removed. Then 1.5 month late the patient was presented to hospital once again for sudden onset of chest pain with exacerbation after taking deep breath. Pacemaker programming showed both pacing and sensing abnormality with threshold of?5.0V and resistance of 1200?. Lead perforation was revealed by chest X-ray and confirmed by echocardiogram. Considering the fact that there was high risk to remove ventricular lead, spiral tip of previous ventricular lead was withdrew followed by implantation of a new ventricular active lead to the septum. Previous ventricular lead was maintained. As we know that the complications of lead perforation in the clinic was rare. Here we discuss the clinical management and the possible reasons for cardiac perforation of active ventricular lead.

  12. Outcome and management of invasive candidiasis following oesophageal perforation.

    Science.gov (United States)

    Hoffmann, Martin; Kujath, Peter; Vogt, Florian-M; Laubert, Tilman; Limmer, Stefan; Mulrooney, Thomas; Bruch, Hans-Peter; Jungbluth, Thomas; Schloericke, Erik

    2013-03-01

    The regular colonisation of the oesophagus with a Candida species can, after oesophageal perforation, result in a contamination of the mediastinum and the pleura with a Candida species. A patient cohort of 80 patients with oesophageal perforation between 1986 and 2010 was analysed retrospectively. The most common sources with positive results for Candida were mediastinal biopsies and broncho-alveolar secretions. Candida species were detected in 30% of the patients. The mortality rate was 41% in patients with positive microbiology results for Candida, whereas it was 23% in the remaining patient cohort. This difference did not reach statistical significance (P = 0.124). Mortality associated with oesophageal perforation was attributed mainly to septic complications, such as mediastinitis and severe pneumonia. During the study period we observed a shift towards non-albicans species that were less susceptible or resistant to fluconazole. In selected patients with risk factors as immunosuppression, granulocytopenia and long-term intensive-care treatment together with the finding of Candida, an antimycotic therapy should be started. A surgical approach offers the possibility to obtain deep tissue biopsies. The antimycotic therapy should start with an echinocandin, as the resistance to fluconazole is growing and to cover non-albicans Candida species, too. © 2012 Blackwell Verlag GmbH.

  13. Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

    Directory of Open Access Journals (Sweden)

    Yoshinobu Yamamoto

    2017-01-01

    Full Text Available Background. Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD for early gastric neoplasm (EGN. The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods. A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results. Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%. All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (P<0.01. Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s than at nonperforated points (3.5 s in five patients. Conclusions. Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

  14. The Pacman Perforator-Based V-Y Advancement Flap for Reconstruction of Pressure Sores at Different Locations.

    Science.gov (United States)

    Bonomi, Stefano; Salval, André; Brenta, Federica; Rapisarda, Vincenzo; Settembrini, Fernanda

    2016-09-01

    Many procedures have been proposed for the treatment of pressure sores, and V-Y advancement flaps are widely used to repair a defect. Unfortunately, the degree of mobility of a V-Y advancement flap is dependent on the laxity of the underlying subcutaneous tissue. This is an important disadvantage of traditional V-Y advancement flap and limits its use.We used V-Y advancement flaps as perforator-based to overcome mobility restriction problem, with a further modification (Pacman-like shape) to improve the covering surface area of the flap. Between January 2012 and December 2014, the authors used 37 V-Y Pacman perforator-based flaps in 33 consecutive patients for coverage of defects located at sacral (n = 21), ischial (n = 13), trochanter (n = 1) regions. There were 27 male and 6 female patients with a mean age of 49.9 years (range, 15-74 years). All flaps survived completely (92.3%) except 3 in which one of them had undergone total necrosis due to hematoma and the other 2 had partial necrosis. No venous congestion was observed. The mean follow-up period was 14.9 months (range, 2-38 months). No flap surgery-related mortality or recurrence of pressure sores was noted. The V-Y Pacman perforator-based advancement flaps are safe and very effective for reconstruction of pressure sores at various regions. The advantage of our modification procedure include shorter operative time, lesser pedicle dissection, low donor site morbidity, good preservation of muscle, and offers remarkable excursion to the V-Y flap, which make the V-Y Pacman perforator-based flaps an excellent choice for large pressure sore coverage.

  15. Novel analytical model for optimizing the pull-in voltage in a flexured MEMS switch incorporating beam perforation effect

    Science.gov (United States)

    Guha, K.; Laskar, N. M.; Gogoi, H. J.; Borah, A. K.; Baishnab, K. L.; Baishya, S.

    2017-11-01

    This paper presents a new method for the design, modelling and optimization of a uniform serpentine meander based MEMS shunt capacitive switch with perforation on upper beam. The new approach is proposed to improve the Pull-in Voltage performance in a MEMS switch. First a new analytical model of the Pull-in Voltage is proposed using the modified Mejis-Fokkema capacitance model taking care of the nonlinear electrostatic force, the fringing field effect due to beam thickness and etched holes on the beam simultaneously followed by the validation of same with the simulated results of benchmark full 3D FEM solver CoventorWare in a wide range of structural parameter variations. It shows a good agreement with the simulated results. Secondly, an optimization method is presented to determine the optimum configuration of switch for achieving minimum Pull-in voltage considering the proposed analytical mode as objective function. Some high performance Evolutionary Optimization Algorithms have been utilized to obtain the optimum dimensions with less computational cost and complexity. Upon comparing the applied algorithms between each other, the Dragonfly Algorithm is found to be most suitable in terms of minimum Pull-in voltage and higher convergence speed. Optimized values are validated against the simulated results of CoventorWare which shows a very satisfactory results with a small deviation of 0.223 V. In addition to these, the paper proposes, for the first time, a novel algorithmic approach for uniform arrangement of square holes in a given beam area of RF MEMS switch for perforation. The algorithm dynamically accommodates all the square holes within a given beam area such that the maximum space is utilized. This automated arrangement of perforation holes will further improve the computational complexity and design accuracy of the complex design of perforated MEMS switch.

  16. Vinorelbine induced perforation of a metastatic gastric lesion.

    Science.gov (United States)

    Mullally, W J; O'Súilleabháin, C B; Brady, C; O'Reilly, S

    2017-08-01

    Breast carcinoma metastasis to the gastrointestinal tract is rare and more frequently associated with lobular than ductal carcinoma (Borst and Ingold, Surg 114(4):637-641 [1]). The purpose of this article is to present a case based review of a unique gastrointestinal metastasis and literature review. A 46 year old lady with metastatic invasive ductal breast cancer was admitted to A&E with sudden onset of epigastric and left shoulder pain. She completed the first cycle of capecitabine/vinorelbine 1 week previously. Clinical examination revealed a tender epigastrium with rigidity in the upper abdomen. Free air under the diaphragm and a positive Rigler's sign was radiologically identified. A laparoscopy demonstrated a fibrinous exudate in the left upper quadrant consistent with a walled off lesser curvature gastric perforation. A subsequent oesophagogastroduodenoscopy (OGD) demonstrated a healed gastric ulcer of benign appearance; however the pathology confirmed metastatic breast carcinoma. Literature review confirmed no previously reported cases of vinorelbine induced gastric perforation. Four cases of metastatic breast cancer with gastric metastasis presenting with perforation were identified; three of these cases (Fra et al., Presse Med 25(26):1215 (1996) [2], Solis-Caxaj et al., Gastroenterol Clin Biol 28(1):91-92 (2004) [3], Ghosn et al., Bull Cancer 78(11):1071-1073 (1991) [4]), were in the French medical literature, including one male patient (Fra et al., Presse Med 25(26):1215 (1996) [2]) and at least one ductal breast carcinoma (Solis-Caxaj et al., Gastroenterol Clin Biol 28(1):91-92 (2004) [3]). The fourth case (van Geel et al., Ned Tijdschr Geneeskd 144(37):1761-1763 (2000) [5]), was in the Dutch medical literature and a lobular breast carcinoma. This case represents a rare complication of breast cancer chemotherapy, the subsequent significant benefit the patient received from treatment is consistent with the chemosensitivity to therapy that also resulted

  17. Initiation of protein synthesis by a labeled derivative of the Lactobacillus casei DN-114 001 strain during transit from the stomach to the cecum in mice harboring human microbiota.

    Science.gov (United States)

    Oozeer, R; Mater, D D G; Goupil-Feuillerat, N; Corthier, G

    2004-12-01

    Although studies on the survival of bacteria in the digestive tract have been reported in the literature, little data are available on the physiological adaptation of probiotics to the digestive environment. In previous work, a transcriptional fusion system (i.e., luciferase genes under the control of a deregulated promoter) was used to demonstrate that a derivative of the Lactobacillus casei DN-114 001 strain, ingested in a fermented milk and thus exhibiting initially a very weak metabolic activity, synthesized proteins de novo after its transit in the digestive tract of mice harboring human microbiota (known as human-microbiota-associated mice). With the same genetic system and animal model, we here investigate for the first time the ability of L. casei to reinitiate synthesis in the different digestive tract compartments. In this study, most ingested L. casei cells transited from the stomach to the duodenum-jejunum within 1 h postingestion. No luciferase activity was observed in these digestive tract compartments after the first hour. At later times, the bulk of bacteria had transited to the ileum and the cecum. Luciferase synthesis was detected between 1.5 and 2.0 h postingestion at the ileal level and from 1.5 h to at least 6.0 h postingestion in the cecum, where the activity remained at a maximum level. These results demonstrate that ingested L. casei (derivative of the DN-114 001 strain) administered via a fermented milk has already reinitiated protein synthesis when it reaches the ileal and cecal compartments.

  18. Spontaneous acalculous gallbladder perforation in a man secondary to chemotherapy and radiation: A rare case report.

    Science.gov (United States)

    Zhang, Jungang; Shen, Guoliang; Shi, Ying; Zhang, Chengwu; Hong, Defei; Jin, Li; Yang, Hongguo; Sun, Wei; Cai, Hanhui; Hu, Zhiming; Wu, Weiding

    2018-05-01

    Gallbladder perforation is a serious clinical condition and associated with high morbidity and mortality. A definitive diagnosis is contentious before surgery. We herein report a case of perforation of the gallbladder neck secondary to chemotherapy and radiation for nasopharyngeal carcinoma patient. Gallbladder perforation secondary to chemotherapy and radiation. To decrease the mortality associated with gallbladder perforation, Laparoscopic cholecystectomy and peritoneal lavage were performed followed for gallbladder perforation patient because of chemotherapy and radiation. The patient recovered fully without serious complication and discharged on the 10th postoperative day. A pathological examination of the resected gallbladder revealed cholecystitis in the thinning of the neck. Early diagnosis and surgical intervention of gallbladder perforation in relation to asopharyngeal carcinoma chemotherapy and radiation are of prime importance. The laparoscopic procedure is safe and feasible in the selected patients.

  19. Clinical features and outcomes of delayed perforation after endoscopic submucosal dissection for early gastric cancer.

    Science.gov (United States)

    Hanaoka, N; Uedo, N; Ishihara, R; Higashino, K; Takeuchi, Y; Inoue, T; Chatani, R; Hanafusa, M; Tsujii, Y; Kanzaki, H; Kawada, N; Iishi, H; Tatsuta, M; Tomita, Y; Miyashiro, I; Yano, M

    2010-12-01

    Perforation is a major complication of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). However, there have been no reports on delayed perforation after ESD for EGC. We aimed to elucidate the incidence and outcomes of delayed perforation after ESD. Clinical courses in 1159 consecutive patients with 1329 EGCs who underwent ESD were investigated. Delayed perforation occurred in six patients (0.45 %). All these patients had complete en bloc resection without intraoperative perforation during ESD. Five of six perforations were located in the upper third of the stomach, while one lesion was found in the middle third. Symptoms of peritoneal irritation with rebound tenderness presented within 24 h after ESD in all cases. One patient did not require surgery because the symptoms were localized, and recovered with conservative antibiotic therapy by nasogastric tube placement. The remaining five patients required emergency surgery. There was no mortality in this case series. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Perforant path lesioning induces sprouting of CA3-associated fibre systems in mouse hippocampal formation

    DEFF Research Database (Denmark)

    Drøjdahl, Nina; Hegelund, Iørn V; Poulsen, Frantz R

    2002-01-01

    mice. We found that lesioning led to translaminar sprouting of Timm stained regio inferior hippocampus (CA3)-associated fibre systems into the denervated termination zones of the CA3 and dentate gyrus, from the adjacent non-denervated stratum radiatum of CA3. Differences were seen in the Timm staining...... pattern of the two strains of mice, while the response to lesioning appeared similar albeit less pronounced than that observed in the rat. We also observed an intensified acetylcholine esterase staining reflective of cholinergic sprouting in the denervated perforant path termination zones, which...... was particularly prominent in areas with sprouting of Timm stained CA3-associated fibres. Finally, we showed that some of the sprouting fibres within the CA3 were myelinated, due to an increased density of silver impregnated myelinated fibres in this region after lesioning. These results show that the basic...