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Sample records for intestinal perforation

  1. 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.

  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. 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 ...

  8. 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.

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

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    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.

  10. 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

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

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    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.

  12. 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.

  13. 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.

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

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    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.

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

    Science.gov (United States)

    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.

  16. 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 ...

  17. 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)

  18. Typhoid fever complicated by intestinal perforation: a persisting fatal disease requiring surgical management

    NARCIS (Netherlands)

    Butler, T.; Knight, J.; Nath, S. K.; Speelman, P.; Roy, S. K.; Azad, M. A.

    1985-01-01

    In Bangladesh, clinical records of 323 patients with typhoid fever were reviewed to study the incidence, fatality, and optimal therapy of the complication of intestinal perforation. Fifteen patients (4.6%) developed intestinal perforation. Case-fatality rates were six of nine patients treated

  19. Pneumoperitoneum without Intestinal Perforation in a Neonate: Case Report and Literature Review

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    Prabhavathi Gummalla

    2017-01-01

    Full Text Available Pneumoperitoneum in a preterm neonate usually indicates perforation of the intestine and is considered a surgical emergency. However, there are cases of pneumoperitoneum with no evidence of rupture of the intestine reported in the literature. We report a case of pneumoperitoneum with no intestinal perforation in a preterm neonate with respiratory distress syndrome who was on high frequency oscillatory ventilation (HFOV. He developed bilateral pulmonary interstitial emphysema with localized cystic lesion, likely localized pulmonary interstitial emphysema, and recurrent pneumothoraces. He was treated with dexamethasone to wean from the ventilator. Pneumoperitoneum developed in association with left sided pneumothorax following mechanical ventilation and cardiopulmonary resuscitation. Pneumoperitoneum resolved after the pneumothorax was resolved with chest tube drainage. He died from acute cardiorespiratory failure. At autopsy, there was no evidence of intestinal perforation. This case highlights the fact that pneumoperitoneum can develop secondary to pneumothorax and does not always indicate intestinal perforation or require exploratory laparotomy.

  20. Intestinal volvulus and perforation caused by multiple magnet ingestion: report of a case.

    Science.gov (United States)

    Ilçe, Zekeriya; Samsum, Hakan; Mammadov, Emil; Celayir, Sinan

    2007-01-01

    Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.

  1. 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....

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

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    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.

  3. Colorectal cancer with intestinal perforation - a retrospective analysis of treatment outcomes.

    Science.gov (United States)

    Banaszkiewicz, Zbigniew; Woda, Łukasz; Tojek, Krzysztof; Jarmocik, Paweł; Jawień, Arkadiusz

    2014-01-01

    Colorectal cancer (CRC) is one of the leading cause of death in European population. It progresses without any symptoms in the early stages or those clinical symptoms are very discrete. The aim of this study was a retrospective analysis of treatment outcomes in patients with colorectal cancer complicated with intestinal perforation. A retrospective analysis of patients urgently operated upon in our Division of General Surgery, because of large intestine perforation, from February 1993 to February 2013 has been made. Results were compared with a group of patients undergoing the elective surgery for colorectal cancer in the same time and Division. Intestinal perforation occurred more often in males (6.52% vs. 6.03%), patients with mucous component in histopathological examination (9.09% vs. 6.01%) and with clinicaly advanced CRC. Patients treated because of perforation had a five-fold higher 30 day mortality rate (9.09% vs. 1.83%), however long-term survival did not differ significantly in both groups. After resectional surgery in 874 patients an intestinal anastomosis was made. Anastomotic leakage was present in 23 (2.6%) patients. This complication occurred six-fold more frequently in a group of patients operated upon because of intestinal perforation (12.20% vs. 2.16%). In patients with CRC complicated with perforation of the colon in a 30-day observation significantly higher rate of complications and mortality was shown, whereas there was no difference in distant survival rates.

  4. Colorectal cancer with intestinal perforation – a retrospective analysis of treatment outcomes

    Science.gov (United States)

    Woda, Łukasz; Tojek, Krzysztof; Jarmocik, Paweł; Jawień, Arkadiusz

    2014-01-01

    Aim of the study Colorectal cancer (CRC) is one of the leading cause of death in European population. It progresses without any symptoms in the early stages or those clinical symptoms are very discrete. The aim of this study was a retrospective analysis of treatment outcomes in patients with colorectal cancer complicated with intestinal perforation. Material and methods A retrospective analysis of patients urgently operated upon in our Division of General Surgery, because of large intestine perforation, from February 1993 to February 2013 has been made. Results were compared with a group of patients undergoing the elective surgery for colorectal cancer in the same time and Division. Results Intestinal perforation occurred more often in males (6.52% vs. 6.03%), patients with mucous component in histopathological examination (9.09% vs. 6.01%) and with clinicaly advanced CRC. Patients treated because of perforation had a five-fold higher 30 day mortality rate (9.09% vs. 1.83%), however long-term survival did not differ significantly in both groups. After resectional surgery in 874 patients an intestinal anastomosis was made. Anastomotic leakage was present in 23 (2.6%) patients. This complication occurred six-fold more frequently in a group of patients operated upon because of intestinal perforation (12.20% vs. 2.16%). Conclusions In patients with CRC complicated with perforation of the colon in a 30-day observation significantly higher rate of complications and mortality was shown, whereas there was no difference in distant survival rates. PMID:25784840

  5. Segmental absence of intestinal musculature with metachronous bowel perforations in an infant

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    Noboru Oyachi

    2018-03-01

    Full Text Available Segmental absence of intestinal musculature is a rare condition. A female patient was born at 39 weeks gestational age with birth weight of 2,900 g. The patient was prenatally diagnosed as having segmental bowel distension in the fetal stage. She manifested bilious emesis with abdominal distension at day 1. Although excretion of viscous meconium was observed by gastrografin enema, gastrointestinal perforation developed. Emergency laparotomy and peritoneal drainage was required at that time and further laparotomy was performed on day 15. Multiple perforations were recognized discontinuously from the jejunum to the transverse colon, and jejunostomy was constructed. Additional bowel perforations occurred and re-exploration was required at day 43. We found newly formed small perforations in the proximal jejunum, ileum and the transverse colon and a tube jejunostomy and a colostomy were established. The patient required prolonged TPN management, which induced correlated cholestasis and liver failure, and died at day 143. Pathologic findings showed partial hypoplasia of the intrinsic muscle layer in the small intestine and diagnosed as segmental absence of intestinal musculature. Her disorder was unusual in its presentation, which included prenatal bowel dilatation, metachronous superimposed bowel perforation, and extensive discrete lesions from the jejunum to the transverse colon.

  6. Functional Impairments at School Age of Children With Necrotizing Enterocolitis or Spontaneous Intestinal Perforation

    NARCIS (Netherlands)

    Roze, Elise; Ta, B.D.; van der Ree, Meike H.; Tanis, Jozien C.; van Braeckel, Koenraad N. J. A.; Hulscher, Jan B. F.; Bos, Arend F.

    2011-01-01

    We aimed to determine motor, cognitive, and behavioral outcome at school age of children who had either necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). This case-control study included infants with NEC Bell's stage IIA onward, infants with SIP, and matched controls

  7. Synchronous perforation of non-Hodgkin's lymphoma of the small intestine and colon: a case report

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    Baidoun Fadi

    2011-02-01

    Full Text Available Abstract Introduction Primary non-Hodgkin's lymphoma of the small and large bowel presenting as a perforated viscus entity with peritonitis is extremely rare. A thorough literature review did not reveal any cases where primary lymphoma of the jejunum presented with perforation and peritonitis synchronously with primary lymphoma of the descending colon. Case presentation This report concerns a 64-year-old Caucasian woman admitted with severe abdominal pain and fever. An emergency laparotomy revealed a large mass with perforation in the proximal jejunum with intense mesenteric thickening and lymphadenopathy. The descending colon was edematous and covered with fibrinous exudate. Histopathological examination of the resected segment of jejunum revealed a T cell non-Hodgkin's lymphoma. On post-operative day 10, a computed tomography scan of our patient's abdomen and pelvis showed leakage of contrast into the pelvis. Re-exploration revealed perforation of the descending colon. The histopathology of the resected colon also showed T cell non-Hodgkin's lymphoma. Her post-operative course was complicated by acute renal and respiratory failure. The patient died on post-operative day 21. Conclusions Lymphoma of the small intestine has been reported to have a poor prognosis. The synchronous occurrence of lesions in the small intestine or colon is unusual, and impacts the prognosis adversely. Early diagnosis and treatment are important to improve the prognosis of bowel perforation in patients with non-Hodgkin's lymphoma.

  8. A Rare Case of Mycosis Fungoides in the Oral Cavity and Small Intestine Complicated by Perforation

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    Drew Arthur Emge

    2016-11-01

    Full Text Available Extracutaneous involvement in mycosis fungoides (MF carries a poor prognosis. Oral and gastrointestinal (GI tract lesions are both rare locations of disease. We describe the clinical findings of one case with oral and GI MF complicated by perforation after systemic antineoplastic treatment, and review the relevant literature. The patient had a 1-year history of MF before development of tongue and palate tumors. He was treated with local electron beam radiation, but re-presented to the hospital after what was found to be small intestine perforation following systemic antineoplastic therapy. The case reveals key insights into the progression and complications of lymphomas with GI tract involvement.

  9. 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

  10. 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

  11. Gastro-jejunostomy tube related intestinal perforation in an infant presenting incidentally with a splenic abscess

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    Kathryn Bell

    2018-07-01

    Conclusion: While complications from GJTs are well described, this case uniquely highlights the risk of intestinal perforation from GJT, with a delayed and subtle presentation. We suggest that patients, specifically those under 12 months of age and weighing under 10 kg, be monitored closely for complications post-operatively, and the use of modified GJTs with jejunal limbs employing smaller/thinner feeding tubes that are placed well beyond LOT be strongly considered.

  12. [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.

  13. Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome) Complicated by Perforation of the Small Intestine and Cholecystitis.

    Science.gov (United States)

    Ohnuki, Yoichi; Moriya, Yusuke; Yutani, Sachiko; Mizuma, Atsushi; Nakayama, Taira; Ohnuki, Yuko; Uda, Shuji; Inomoto, Chie; Yamamoto, Soichiro; Nakamura, Naoya; Takizawa, Shunya

    2018-03-01

    We report a case of eosinophilic granulomatosis with polyangiitis (EGPA; formerly known as Churg-Strauss syndrome) complicated by perforation of the small intestine and necrotizing cholecystitis. A 69-year-old man with a history of bronchial asthma was admitted with mononeuritis multiplex. The laboratory findings included remarkable eosinophilia. He was treated with corticosteroids and his laboratory indices showed improvement; however, his functional deficits remained. His neuropathy gradually improved after the addition of intravenous immunoglobulin (IVIG). He was subsequently treated with oral prednisolone (40 mg/day) as maintenance therapy. Within a month after finishing IVIG, he developed perforation of the small intestine and necrotizing cholecystitis. Intestinal perforation has often been reported as a gastrointestinal complication of EGPA. In contrast, cholecystitis is a rare complication. We report this case because the manifestation of more than one complication is extremely rare. Gastrointestinal symptoms may be a complication of EGPA itself and/or immunosuppressive treatment.

  14. Neonatal ovarian torsion complicated by intestinal obstruction and perforation, and review of the literature.

    Science.gov (United States)

    Jeanty, Cerine; Frayer, Elizabeth A; Page, Renee; Langenburg, Scott

    2010-06-01

    We present a case of neonatal ovarian torsion complicated by bowel obstruction and perforation and review the literature regarding the incidence of bowel obstruction in neonatal ovarian cysts, the presentation, and treatment. A term neonate was prenatally diagnosed with a cystic abdominal mass palpable on physical examination. A postnatal abdominal x-ray showed paucity of gas in the left hemiabdomen with rightward displacement of bowel loops. Exploratory laparotomy on day 2 of life revealed a large cystic mass in the left lower quadrant consistent with a torsed left ovary, an omental band causing strangulation of the bowel mesentery, and a perforation of the distal ileum. Our literature search revealed 19 reported cases of neonatal ovarian cysts resulting in bowel obstruction. Infants may present with a palpable abdominal mass, respiratory distress, as well as signs and symptoms of intestinal obstruction. Two mechanisms exist for bowel obstruction: adhesions caused by a torsed necrotic ovary and mass effect of a large ovarian cyst, often measuring 9 to 10 cm in diameter. Options to treat ovarian cysts include antenatal or postnatal aspiration, laparoscopy, and laparotomy. Cysts less than 4 to 5 cm can be observed, whereas operative intervention is indicated in symptomatic cases and in persistent or enlarging ovarian cysts. Copyright 2010 Elsevier Inc. All rights reserved.

  15. Antenatal magnesium sulfate and spontaneous intestinal perforation in infants less than 25 weeks gestation.

    Science.gov (United States)

    Rattray, B N; Kraus, D M; Drinker, L R; Goldberg, R N; Tanaka, D T; Cotten, C M

    2014-11-01

    Evaluate spontaneous intestinal perforation (SIP)/death among extremely low birthweight (ELBW) infants before, during and after initiation of an antenatal magnesium for neuroprotection protocol (MgPro). We tested associations between SIP/death and magnesium exposure, gestational age (GA) and interactions with GA and magnesium exposure in a cohort of inborn ELBW infants before, during and after MgPro. One hundred and fifty-five ELBW infants were included, 81 before, 23 during and 51 after MgPro. ELBW infants (78.3%) were exposed to Mg during MgPro compared with 50.6% and 60.8% before and after, respectively. Incidence of SIP on protocol was 30.4% vs 12.9% off protocol (P=0.03). GA was strongly associated with SIP (PSIP/death regardless of epoch (odds ratio 9.3 (1.04-104.6)), but increased SIP/death was limited to those SIP and death risk among infants with the lowest birthweights. Validation of this observation in larger populations is warranted.

  16. 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

  17. Multiple intestinal perforations as a primary manifestation of abdominal tuberculosis in a HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Amir Hossein Sarrami

    2010-12-01

    Full Text Available Abdominal tuberculosis (TB is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Perforation is a serious and uncommon complication of abdominal tuberculosis which can occur even during the treatment. A 30-year-old man was admitted with a three-day history of abdominal pain who had emergency surgery for multiple perforations of the distal ileum.

  18. Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin.

    Science.gov (United States)

    Caronna, Roberto; Boukari, Alassan Kadiri; Zaongo, Dieudonnè; Hessou, Thierry; Gayito, Rènè Castro; Ahononga, Cesar; Adeniran, Sosten; Priuli, Giambattista

    2013-06-19

    The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications. 111 patients with acute peritonitis underwent emergency laparotomy: number of perforations, distance of perforations from the ileocaecal valve, and type of surgery performed were recorded. A laparostomy was then created and explored every 48 to 72 hours. The patients were then divided into two groups according to the surgical technique adopted at the initial laparotomy: primary repair (Group A) or intestinal resection with anastomosis (Group B). Clinical data, intraoperative findings, complications and mortality were evaluated and compared for each group. In 104/111 patients we found intestinal perforations, multiple in 47.1% of patients. 75 had primary repair (Group A) and 26 had intestinal resection with anastomosis (Group B). Group B patients had more perforations than patients in Group A (p = 0.0001). At laparostomy revision, the incidence of anastomotic dehiscence was greater than that of primary repair dehiscence (p = 0.032). The incidence of new perforations was greater in Group B than in Group A (p = 0.01). Group B correlates with a higher morbility and with a higher number of laparostomy revisions than Group A (p = 0.005). Resection and anastomosis shows greater morbidity than primary repair. Laparostomy revision makes it possible to rapidly identify new perforations and anastomotic or primary repair dehiscences; although this approach may seem aggressive, the number of operations was greater in patients who had a favourable outcome, and does not correlate with mortality.

  19. 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

  20. 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.

  1. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-03-01

    Full Text Available Abstract Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1. Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8% perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2% patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5% patients. The majority of patients (84.6% had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (P Conclusion

  2. Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015.

    Science.gov (United States)

    Bulage, Lilian; Masiira, Ben; Ario, Alex R; Matovu, Joseph K B; Nsubuga, Peter; Kaharuza, Frank; Nankabirwa, Victoria; Routh, Janell; Zhu, Bao-Ping

    2017-09-25

    Between January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP. We defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding. Of the 88 TIP cases identified during 2013-2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4-9 days after illness onset (OR adj  = 2.2, 95%CI = 0.83-5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (OR adj  = 11, 95%CI = 1.9-61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (OR adj  = 9.0, 95%CI = 1.1-78). Delay in seeking treatment increased the risk of TIPs

  3. CAPABILITIES OF VIDEO-ASSISTED LAPAROSCOPY IN THE DIAGNOSIS AND TREATMENT OF PERFORATION OF THE SMALL INTESTINE AND MECKEL’S DIVERTICULUM (2 CLINICAL OBSERVATIONS

    Directory of Open Access Journals (Sweden)

    I. I. Kirsanov

    2016-01-01

    Full Text Available BACKGROUND Misdiagnosis of acute appendicitis reaches 40%. Video laparoscopy allows the correct diagnosis to be establishedin 98.1%, and identify the other disease excluding the initial diagnosisin 1.6%, as well as to determine the optimal surgical approach and perform minimally invasive surgery, if possible.MATERIAL Clinical observation of 2 cases of perforation of the small intestine.CONCLUSION The use of laparoscopy in acute surgical disease of abdominal organs allows to establish the correct diagnosis and properly provide a therapy with a minimal surgical trauma.

  4. A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009.

    Science.gov (United States)

    Neil, Karen P; Sodha, Samir V; Lukwago, Luswa; O-Tipo, Shikanga; Mikoleit, Matthew; Simington, Sherricka D; Mukobi, Peter; Balinandi, Stephen; Majalija, Samuel; Ayers, Joseph; Kagirita, Atek; Wefula, Edward; Asiimwe, Frank; Kweyamba, Vianney; Talkington, Deborah; Shieh, Wun-Ju; Adem, Patricia; Batten, Brigid C; Zaki, Sherif R; Mintz, Eric

    2012-04-01

    Salmonella enterica serovar Typhi (Salmonella Typhi) causes an estimated 22 million typhoid fever cases and 216 000 deaths annually worldwide. In Africa, the lack of laboratory diagnostic capacity limits the ability to recognize endemic typhoid fever and to detect outbreaks. We report a large laboratory-confirmed outbreak of typhoid fever in Uganda with a high proportion of intestinal perforations (IPs). A suspected case of typhoid fever was defined as fever and abdominal pain in a person with either vomiting, diarrhea, constipation, headache, weakness, arthralgia, poor response to antimalarial medications, or IP. From March 4, 2009 to April 17, 2009, specimens for blood and stool cultures and serology were collected from suspected cases. Antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) were performed on Salmonella Typhi isolates. Surgical specimens from patients with IP were examined. A community survey was conducted to characterize the extent of the outbreak. From December 27, 2007 to July 30, 2009, 577 cases, 289 hospitalizations, 249 IPs, and 47 deaths from typhoid fever occurred; Salmonella Typhi was isolated from 27 (33%) of 81 patients. Isolates demonstrated multiple PFGE patterns and uniform susceptibility to ciprofloxacin. Surgical specimens from 30 patients were consistent with typhoid fever. Estimated typhoid fever incidence in the community survey was 8092 cases per 100 000 persons. This typhoid fever outbreak was detected because of an elevated number of IPs. Underreporting of milder illnesses and delayed and inadequate antimicrobial treatment contributed to the high perforation rate. Enhancing laboratory capacity for detection is critical to improving typhoid fever control.

  5. 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

  6. Comparative MiRNA Expressional Profiles and Molecular Networks in Human Small Bowel Tissues of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation.

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    Pak Cheung Ng

    Full Text Available Necrotizing enterocolitis (NEC and spontaneous intestinal perforation (SIP are acute intestinal conditions which could result in mortality and severe morbidity in preterm infants. Our objective was to identify dysregulated micro-RNAs (miRNAs in small bowel tissues of NEC and SIP, and their possible roles in disease pathophysiology.We performed differential miRNA arrays on tissues of NEC (n = 4, SIP (n = 4 and surgical-control (Surg-CTL; n = 4, and validated target miRNAs by qPCR (n = 10 each group. The association of target miRNAs with 52 dysregulated mRNAs was investigated by bioinformatics on functional and base-pair sequence algorithms, and correlation in same tissue samples.We presented the first miRNA profiles of NEC, SIP and Surg-CTL intestinal tissues in preterm infants. Of 28 validated miRNAs, 21 were significantly different between NEC or SIP and Surg-CTL. Limited overlapping in the aberrant expression of miRNAs between NEC and SIP indicated their distinct molecular mechanisms. A proposed network of dysregulated miRNA/mRNA pairs in NEC suggested interaction at bacterial receptor TLR4 (miR-31, miR-451, miR-203, miR-4793-3p, mediated via key transcription factors NFKB2 (miR-203, AP-1/FOSL1 (miR-194-3p, FOXA1 (miR-21-3p, miR-431 and miR-1290 and HIF1A (miR-31, and extended downstream to pathways of angiogenesis, arginine metabolism, cell adhesion and chemotaxis, extracellular matrix remodeling, hypoxia/oxidative stress, inflammation and muscle contraction. In contrast, upregulation of miR-451 and miR-223 in SIP suggested modulation of G-protein-mediated muscle contraction.The robust response of miRNA dysregulation in NEC and SIP, and concerted involvement of specific miRNAs in the molecular networks indicated their crucial roles in mucosa integrity and disease pathophysiology.

  7. 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 ...

  8. 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.

  9. Síndrome de compartimento abdominal durante pinçamento por via endoscópica de perfuração intestinal secundária à colonoscopia Síndrome de compartimiento abdominal durante pinzamiento por vía endoscópica de perforación intestinal secundaria a la colonoscopia Abdominal compartment syndrome during endoscopic clamping of an intestinal perforation secondary to colonoscopy

    Directory of Open Access Journals (Sweden)

    Magda Lourenço Fernandes

    2009-10-01

    ópica. El objetivo de este relato de caso, fue avisarles a los expertos sobre el aparecimiento y el tratamiento del síndrome de Compartimiento Abdominal durante el pinzamiento endoscópico de perforación intestinal secundario a la colonoscopia. RELATO DEL CASO: Paciente del sexo femenino, 60 años, estado físico ASA II, sometida a la colonoscopia bajo sedación. Durante el examen se comprobó la perforación accidental del intestino y se optó por tratar de pinzar la perforación por vía endoscópica. La paciente evolucionó con dolor y con una distensión abdominal, neumoperitoneo, síndrome de Compartimiento Abdominal, disnea e inestabilidad cardiovascular. Se realizó la punción abdominal de emergencia, lo que determinó la mejoría clínica de la paciente hasta que se hiciese la laparotomía de urgencia. Después de realizarla con exploración y con sutura de la perforación, la paciente evolucionó bien clínicamente. CONCLUSIONES: El pinzamiento por vía endoscópica de perforación intestinal secundaria a la colonoscopia, puede contribuir a la formación de neumoperitoneo hipertensivo y el síndrome de Compartimiento Abdominal, con repercusiones clínicas graves que exigen un tratamiento inmediato. Los profesionales capacitados y los recursos técnicos adecuados, pueden ser factores determinantes del pronóstico del paciente.BACKGROUND AND OBJECTIVES: Colonoscopy is widely used for diagnosis, treatment, and control of intestinal disorders. Intestinal perforation, although rare, is the most feared complication. Perforations can be treated by endoscopic clamping. The objective of this report was to alert specialists for the development and treatment of abdominal compartment syndrome during endoscopic clamping of an intestinal perforation secondary to colonoscopy. CASE REPORT: This is a 60 years old female, physical status ASA II, who underwent colonoscopy under sedation. During the exam, an accidental intestinal perforation was observed, and it was decided to

  10. 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 ...

  11. 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

  12. 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.

  13. Gastric and intestinal surgery.

    Science.gov (United States)

    Fossum, Theresa W; Hedlund, Cheryl S

    2003-09-01

    Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

  14. Colonic perforation in the first few hours of life associated with rhizomelic chondrodysplasia punctata.

    Science.gov (United States)

    Fairbanks, Timothy; Emil, Sherif

    2005-08-01

    Rhizomelic chondrodysplasia punctata (RCP), a rare autosomal recessive disease characterized by a disorder of peroxisome metabolism, has been shown to affect multiple organ systems. A neonate presenting with a colonic perforation in the first few hours of life was subsequently diagnosed with RCP. A literature search revealed no previous reports of intestinal perforation associated with RCP. Intestinal perforation should be added to the list of medical complications associated with RCP.

  15. 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...

  16. Reactive perforating collagenosis

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    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.

  17. Gastric Perforation by Ingested Rabbit Bone Fragment

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    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.

  18. Nontraumatic terminal ileal perforation

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    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.

  19. Postvaginal Delivery Caecal Volvulus and Perforation

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    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.

  20. 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.

  1. 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...

  2. 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.

  3. 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.

  4. 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....

  5. 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:.

  6. 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 ...

  7. 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.

  8. Typhoid ileal perforation: a 13-year experience

    Directory of Open Access Journals (Sweden)

    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.

  9. 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

  10. 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.

  11. 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.

  12. Intestinal Duplication Cyst presenting as Volvulus: A rare case report with Review of Literatures

    Directory of Open Access Journals (Sweden)

    Prasan Kumar Hota

    2015-03-01

    Full Text Available Intestinal duplication cyst is a rare congenital anomaly occurring any where along the alimentary tract, from mouth to anus. They can present with numerous complications like perforation, bleeding or intestinal obstruction. We report a rare case  of intestinal duplication cyst of ileum with acute intestinal obstruction due to volvulus with review of literature.

  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. 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...

  15. 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.

  16. Colonic perforation with peritonitis in amoebiasis: a tropical disease with high mortality.

    Science.gov (United States)

    Jain, Bhupendra Kumar; Garg, Pankaj Kumar; Kumar, Anjay; Mishra, Kiran; Mohanty, Debajyoti; Agrawal, Vivek

    2013-01-01

    Invasive colonic amoebiasis presents primarily with dysentery; colonic perforation occurs rarely. Cases of amoebic colonic perforations have been reported sporadically over the past 20 years. A retrospective study was done in the surgical unit of a tertiary care hospital in North India. The case records of those patients were reviewed who underwent exploratory laparotomy from January 2011 to September 2012 and were diagnosed with amoebic colonic perforation on histopathological examination. Details concerning the clinical presentation, investigations, intraoperative findings, operative procedures, and postoperative outcomes were retrieved. Amongst, a total of 186 emergency exploratory laparotomies carried out during the study, 15 patients of amoebic colonic perforation were identified. The median age of the patients was 42 years (IQR 32.0-58.0) and the male to female ratio was 13:2. Previous history of colitis was present in only 1 patient. The preoperative diagnosis was perforation peritonitis in 12 patients; and intussusception, intestinal obstruction and ruptured liver abscess in 1 patient each. Ten patients had single perforation while 5 had multiple colonic perforations. All the patients except one had perforations in the right colon. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients and a stoma was constructed in the remaining 13 patients. The overall mortality rate was found to be 40% (6/15). Amoebic colonic perforation is associated with unusually high mortality.

  17. A case of radiation enteritis with perforated peritonitis caused by a piece of eggshell

    International Nuclear Information System (INIS)

    Kitamura, Hirotaka; Maeda, Kazuya; Miyanaga, Tamonn; Doden, Kenji; Hattori, Masakazu; Hashizume, Yasuo

    2011-01-01

    The patient was a woman in her sixties who had received radiation therapy for cancer of uterine cervix 7 years earlier and had been suffering from diarrhea for these several years. The patient was seen at our emergency clinic because of a 5 hour-history of lower abdominal pain at the beginning of July 2010. An abdominal CT scan showed free air and ascites. A high density structure 1.5 cm in size was identified within the small intestine, but its relation with the perforation was obscure. Emergency operation was done with the most likely diagnosis of intestinal perforation and general peritonitis. When the lower abdomen was opened by midline incision, about 200 ml of cloudy ascites was observed and the ileum became white in color and hard resulting from the radiation therapy. A perforation was identified in the ileum about 15 cm distant from the ileocecal valve, and a 1.5-cm sized thin and hard material was palpated within the intestine at the same portion. Ilececal resection including the perforated portion was performed and functional end-to-end anastomosis was made at a grossly normal area. There was a piece of eggshell 1.5-cm in size in the perforated portion in the resected specimen. From this together with histopathologial findings, perforation of the small intestine caused by a piece of eggshell associated with radiation enteritis was finally diagnosed. Small bowel perforation must be kept in mind as a possible late complication of radiation therapy, however, no cases of small bowel perforation caused by eggshell have been reported so far. This rare case is reported here, with a review of the literature. (author)

  18. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. PERFORATION AS A COMPLICATION OF THE DIAGNOSTIC UPPER AND LOWER ENDOSCOPY OF THE GASTROINTESTINAL TRACT

    Directory of Open Access Journals (Sweden)

    Ivailo P. Vazharov

    2012-08-01

    Full Text Available Purpose: The purpose of this examination is to evaluate the risk of perforation during endoscopy of upper and lower gastrointestinal tract.Patients and methods used: 1210 diagnostic gastroduodenoscopies and 412 colonoscopies of hospitalized patients were performed by two experienced endoscopists for the period March 2007 – March 2012 at MHAT Varna, MMA. The endoscopies were performed without premedication and sedation. The patients were examined for complications of the procedure during and after the endoscopy. One of the most serious complications is the perforation of the oesophagus, stomach or the large intestine.Results: We had no perforations caused by the examination during the 1210 upper endoscopies performed. We had 2 perforations (0,48% from the 412 colonoscopies performed, which were treated successfully surgically.Conclusions: The perforation is a rare but serious complication of the endoscopy of gastrointestinal tract, which can be healed completely.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  4. 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

  5. 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.

  6. INTESTINAL OBSTRUCTION

    Science.gov (United States)

    Whipple, G. H.; Stone, H. B.; Bernheim, B. M.

    1913-01-01

    Closed duodenal loops may be made in dogs by ligatures placed just below the pancreatic duct and just beyond the duodenojejunal junction, together with a posterior gastro-enterostomy. These closed duodenal loop dogs die with symptoms like those of patients suffering from volvulus or high intestinal obstruction. This duodenal loop may simulate closely a volvulus in which there has been no vascular disturbance. Dogs with closed duodenal loops which have been washed out carefully survive a little longer on the average than animals with unwashed loops. The duration of life in the first instance is one to three days, with an average of about forty-eight hours. The dogs usually lose considerable fluid by vomiting and diarrhea. A weak pulse, low blood pressure and temperature are usually conspicuous in the last stages. Autopsy shows more or less splanchnic congestion which may be most marked in the mucosa of the upper small intestine. The peritoneum is usually clear and the closed loop may be distended with thin fluid, or collapsed, and contain only a small amount of pasty brown material. The mucosa of the loop may show ulceration and even perforation, but in the majority of cases it is intact and exhibits only a moderate congestion. Simple intestinal obstruction added to a closed duodenal loop does not modify the result in any manner, but it may hasten the fatal outcome. The liver plays no essential role as a protective agent against this poison, for a dog with an Eck fistula may live three days with a closed loop. A normal dog reacts to intraportal injection and to intravenous injection of the toxic substance in an identical manner. Drainage of this loop under certain conditions may not interfere with the general health over a period of weeks or months. Excision of the part of the duodenum included in this loop causes no disturbance. The material from the closed duodenal loops contains no bile, pancreatic juice, gastric juice, or split products from the food. It can be

  7. 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.

  8. Intrathoracic Caecal Perforation Presenting as Dyspnea

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. 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

  11. Ileal perforation caused by the ingestion of a micro battery in a dog

    International Nuclear Information System (INIS)

    Mikawa, K.; Mikawa, M.; Shii, H.

    2006-01-01

    A 9-month old 3.2 kg of body weight, male Chihuahua was presented with a history of the intermittent vomiting for two days. Abdominal radiograph showed a foreign body in abdominal cavity which was suggested to be a micro battery in small intestine. Although the dog was treated symptomatically for two days, physical condition of the patient worsened, therefore exploratory laparotomy was performed. A large adhesive lesion involved the perforated ileum and large intestines, was found. A micro battery was stuck in the ileum resulting in a intestinal perforation. A whole of the small intestine was resected because of the cranial mesenteric artery damage during separating the adhesion. The dog lost body weight gradually and died 158 days after first admission of short bowel syndrome

  12. Perforated Meckel's diverticulum in omphalocele

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Colorectal cancer complicated by perforation. Specific features of surgical tactics

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    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.

  17. Intestinal Cancer

    Science.gov (United States)

    ... connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet ... increase your risk. Possible signs of small intestine cancer include Abdominal pain Weight loss for no reason ...

  18. Successful Management of Jejunal Perforation in Burkitt’s Lymphoma: A Case Report

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    David A. Finch

    2012-01-01

    Full Text Available Burkitt’s lymphoma (BL is rare, rapidly growing, and highly aggressive. Urgent commencement of chemotherapy is vital to prevent complications and promote a favourable prognosis. Any factor causing a delay in the initiation of chemotherapy will affect prognosis significantly. Intestinal perforation is a well-known complication with devastating consequences. It inevitably leads to a delay in the initiation of chemotherapy. There are few reports in the literature that discuss this complication. Furthermore, there are no reports of patients that have survived intestinal perforation occurring prior to the commencement of chemotherapy. We present a case of a 55-year-old male who survived perforation of advanced sporadic BL of the jejunum occurring prior to the commencement of chemotherapy. Critical aspects of the patients care are discussed.

  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. Perforated Duodenal Ulcer

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    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. 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

  2. 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

  3. 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

  4. 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 ...

  5. 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.

  6. 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

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

    Science.gov (United States)

    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.

  8. 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.

  9. 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.

  10. 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 ...

  11. 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)

  12. 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

  13. Amebiasis intestinal Intestinal amebiasis

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    JULIO CÉSAR GÓMEZ

    2007-03-01

    Full Text Available Entamoeba histolytica es el patógeno intestinal más frecuente en nuestro medio -después de Giardia lamblia-, una de las principales causas de diarrea en menores de cinco años y la cuarta causa de muerte en el mundo debida a infección por protozoarios. Posee mecanismos patogénicos complejos que le permiten invadir la mucosa intestinal y causar colitis amebiana. El examen microscópico es el método más usado para su identificación pero la existencia de dos especies morfológicamente iguales, una patógena ( E. histolytica y una no patógena ( Entamoeba dispar, ha llevado al desarrollo de otros métodos de diagnóstico. El acceso al agua potable y los servicios sanitarios adecuados, un tratamiento médico oportuno y el desarrollo de una vacuna, son los ejes para disminuir la incidencia y mortalidad de esta entidad.Entamoeba histolytica is the most frequent intestinal pathogen seen in our country, after Giardia lamblia, being one of the main causes of diarrhea in children younger than five years of age, and the fourth leading cause of death due to infection for protozoa in the world. It possesses complex pathogenic mechanisms that allow it to invade the intestinal mucosa, causing amoebic colitis. Microscopy is the most used method for its identification, but the existence of two species morphologically identical, the pathogen one ( E. histolytica, and the non pathogen one ( E. dispar, have taken to the development of other methods of diagnosis. The access to drinkable water and appropriate sanitary services, an opportune medical treatment, and the development of a vaccine are the axes to diminish the incidence and mortality of this entity.

  14. Candida perforation of the intestine in an HIVexposed but uninfected ...

    African Journals Online (AJOL)

    Background. Oral and nappy Candida infections are common in neonates and infants, but candidaemia and its consequences are more often seen in children with risk factors for immunosuppression. This case presentation illustrates that exposure to HIV, without infection, should be considered one of those risk factors.

  15. Typhoid glomerulonephritis and intestinal perforation in a Nigerian ...

    African Journals Online (AJOL)

    2013-08-12

    Aug 12, 2013 ... than 1/180 and 1/120 respectively), but blood culture was not done. He also received a .... Southeast. Asian J Trop Med Public Health 2001;32:869‑71. 4. Dhawan A ... Indian Pediatr 1992;29:1039‑41. 5. Ekenze SO, Okoro PE, ...

  16. Meckel's diverticulum: a rare cause of intestinal perforation in a ...

    African Journals Online (AJOL)

    asymptomatic; clinical cases usually present during the first 2 years of age [1]. ... emergency cesarean section for abruptio placentae and breech presentation from a ... was no evidence of peritoneal soiling or peritonitis. Segmental resection of ...

  17. Intestinal Lymphangiectasia

    Science.gov (United States)

    ... Overview of Crohn Disease Additional Content Medical News Intestinal Lymphangiectasia (Idiopathic Hypoproteinemia) By Atenodoro R. Ruiz, Jr., MD, ... Overview of Malabsorption Bacterial Overgrowth Syndrome Celiac Disease Intestinal ... Intolerance Short Bowel Syndrome Tropical Sprue Whipple ...

  18. Intestinal Obstruction

    Science.gov (United States)

    ... Colostomy ) is required to relieve an obstruction. Understanding Colostomy In a colostomy, the large intestine (colon) is cut. The part ... 1 What Causes Intestinal Strangulation? Figure 2 Understanding Colostomy Gastrointestinal Emergencies Overview of Gastrointestinal Emergencies Abdominal Abscesses ...

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. 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.

  8. 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

  9. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

    International Nuclear Information System (INIS)

    Grassi, Roberto; Romano, Stefania; Pinto, Antonio; Romano, Luigia

    2004-01-01

    Introduction: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. Material and methods: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the ''A.Cardarelli'' Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. Results: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24 (16,4%) of them

  10. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; Pinto, Antonio; Romano, Luigia

    2004-04-01

    Introduction: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. Material and methods: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the ''A.Cardarelli'' Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. Results: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24

  11. Chronic intestinal pseudo-obstruction associated with enteric ganglionitis in a Persian cat

    OpenAIRE

    Jeremy Mortier; Estelle Elissalt; Sophie Palierne; Marie Odile Semin; Maxence Delverdier; Armelle Diquélou

    2016-01-01

    Case summary A 7-year-old neutered male Persian cat was presented for acute vomiting and inappetence. Physical examination revealed severe abdominal distension. Radiographs demonstrated pneumoperitoneum, megaoesophagus and generalised gaseous distension of the digestive tract. Exploratory coeliotomy was performed, revealing markedly distended and thickened small and large intestines with no observable peristalsis. No intestinal perforation was present. Bacteriological and cytological analysis...

  12. Intestinal Surgery.

    Science.gov (United States)

    Desrochers, André; Anderson, David E

    2016-11-01

    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines.

    Science.gov (United States)

    Au, Joyce T; Mittra, Arjun; Wong, Joyce; Carpenter, Susanne; Carson, Joshua; Haddad, Dana; Monette, Sebastien; Ezell, Paula; Patel, Snehal; Fong, Yuman

    2012-01-01

    The CO(2) laser's unique wavelength of 10.6 μm has the advantage of being readily absorbed by water but historically limited it to line-of-sight procedures. Through recent technological advances, a flexible CO(2) laser fiber has been developed and holds promise for endoluminal surgery. We examined whether this laser, along with injection of a water-based gel in the submucosal space, will allow safe dissection of the intestines and enhance the potential of this tool for minimally invasive surgery. Using an ex vivo model with porcine intestines, spot ablation was performed with the flexible CO(2) laser at different power settings until transmural perforation. Additionally, excisions of mucosal patches were performed by submucosal dissection with and without submucosal injection of a water-based gel. With spot ablation at 5 W, none of the specimens was perforated by 5 min, which was the maximum recorded time. The time to perforation was significantly shorter with increased laser power, and gel pretreatment protected the intestines against spot ablation, increasing the time to perforation from 6 to 37 s at 10 W and from 1 to 7 s at 15 W. During excision of mucosal patches, 56 and 83% of untreated intestines perforated at 5 and 10 W, respectively. Gel pretreatment prior to excision protected all intestines against perforation. These specimens were verified to be intact by inflation with air to over 100 mmHg. Furthermore, excision of the mucosal patch was complete in gel-pretreated specimens, whereas 22% of untreated specimens had residual islands of mucosa after excision. The flexible CO(2) laser holds promise as a precise dissection and cutting tool for endoluminal surgery of the intestines. Pretreatment with a submucosal injection of a water-based gel protects the intestines from perforation during ablation and mucosal dissection.

  14. 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

  15. 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

  16. 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...

  17. The Functional State of Intestinal Microcirculation in Diffuse Peritonitis

    Directory of Open Access Journals (Sweden)

    A. A. Kosovskikh

    2012-01-01

    Full Text Available Objective: to evaluate the functional state of intestinal microcirculation in diffuse peritonitis caused by hollow organ perforation and to determine its possible relationship to skin microcirculation. Subjects and methods. Seventeen patients with diffuse peritonitis resulting from hollow organ perforation were examined. The patients’ mean age was 58.5±2.8 years; a control group consisted of 35 apparently healthy individuals. The functional state of the intestinal microcirculatory bed (the mid-transverse colon, the ileum at a distance of 60 cm from the ileocecal corner, the small bowel at a distance of 50 cm of the ligament of Treitz, and an area next hollow organ perforation and skin was evaluated by laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association, Russian Federation. Results. Perforation of the affected intestinal portion became worse in patients with diffuse peritonitis. Blood flow stability was ensured by the higher effect of mainly active components of vascular tone regulation on the microvascular bed. Regulatory changes were equally pronounced at both the intraorgan and skin levels. Conclusion. The findings suggest that the patients with diffuse peritonitis have changes in microcirculatory regulation aimed at maintaining tissue perfusion. These changes are universal at both the intraorgan and skin levels. Key words: microcirculation, micro blood flow, intestine, peritonitis, tissue perfusion.

  18. 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

  19. Intestine transplantation

    Directory of Open Access Journals (Sweden)

    Tadeja Pintar

    2011-02-01

    Conclusion: Intestine transplantation is reserved for patients with irreversible intestinal failure due to short gut syndrome requiring total paranteral nutrition with no possibility of discontinuation and loss of venous access for patient maintenance. In these patients complications of underlying disease and long-term total parenteral nutrition are present.

  20. 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.

  1. 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.

  2. 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

  3. Neonatal intestinal obstruction in Benin, Nigeria

    Directory of Open Access Journals (Sweden)

    Osifo Osarumwense

    2009-01-01

    Full Text Available Background: Intestinal obstruction is a life threatening condition in the newborn, with attendant high mortality rate especially in underserved subregion. This study reports the aetiology, presentation, and outcome of intestinal obstruction management in neonates. Materials and Methods: A prospective study of neonatal intestinal obstruction at the University of Benin Teaching Hospital, Benin, Nigeria, between January 2006-June 2008. Data were collated on a structured proforma and analysed for age, sex, weight, presentation, type/date of gestation/delivery, aetiology, clinical presentation, associated anomaly, treatment, and outcome. Results: There were 71 neonates, 52 were males and 19 were females (2.7:1. Their age range was between 12 hours and 28 days (mean, 7.9 ± 2.7 days and they weighed between 1.8 and 5.2 kg (average, 3.2 kg. The causes of intestinal obstruction were: Anorectal anomaly, 28 (39.4%; Hirschsprung′s disease, 8 (11.3%′ prematurity, 3 (4.2%; meconeum plug, 2 (2.8%; malrotation, 6 (8.5%; intestinal atresia, 8 (11.3%; necrotising enterocolitis (NEC, 4 (5.6%; obstructed hernia, 4 (5.6%; and spontaneous gut perforation, 3 (4.2%. Also, 27 (38% children had colostomy, 24 (33.8% had laparotomy, 9 (12.8% had anoplasty, while 11 (15.4% were managed nonoperatively. A total of 41 (57.7% neonates required incubator, 26 (36.6% needed total parenteral nutrition, while 15 (21.1% require d paediatric ventilator. Financial constraint, late presentation, presence of multiple anomalies, aspiration, sepsis, gut perforation, and bowel gangrene were the main contributors to death. Neonates with lower obstructions had a better outcome compared to those having upper intestinal obstruction ( P < 0.0001. Conclusion: Outcomes of intestinal obstruction are still poor in our setting; late presentation, financial constraints, poor parental motivation and lack of basic facilities were the major determinants of mortality.

  4. Intestinal leiomyoma

    Science.gov (United States)

    ... most often found when a person has an upper gastrointestinal (GI) endoscopy or colonoscopy for another reason. Rarely, these tumors can cause bleeding, blockage or rupture of the intestines If this ...

  5. Nasal Septum Perforation due to Methamphetamine abuse

    Directory of Open Access Journals (Sweden)

    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.

  6. 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...

  7. Major intestinal complications of radiotherapy. Management and nutrition

    Energy Technology Data Exchange (ETDEWEB)

    Deitel, M.; To, T.B.

    1987-12-01

    Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome.

  8. Major intestinal complications of radiotherapy. Management and nutrition

    International Nuclear Information System (INIS)

    Deitel, M.; To, T.B.

    1987-01-01

    Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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...

  14. 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...

  15. 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

  16. Small Intestine Disorders

    Science.gov (United States)

    ... disease Crohn's disease Infections Intestinal cancer Intestinal obstruction Irritable bowel syndrome Ulcers, such as peptic ulcer Treatment of disorders of the small intestine depends on the cause.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. 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

  3. 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

  4. 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

  5. Toxic amebic colitis coexisting with intestinal tuberculosis.

    Science.gov (United States)

    Park, S. C.; Jeon, H. M.; Kim, J. S.; Kim, W. W.; Kim, K. W.; Oh, S. T.; Kim, E. K.; Chang, S. K.; Lee, E. J.

    2000-01-01

    A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation. Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen. Subtotal colectomy including segmental resection of ileum, about 80 cm in length, followed by exteriorization of both ends, was performed in an emergency basis. Despite all measures, the patient died on the sixth postoperative day. The exact relationship of fulminant amebic colitis and intestinal tuberculosis is speculative but the possibility of a cause and effect relationship exists. Fulminant amebic colitis may readily be confused with other types of inflammatory bowel disease, such as idiopathic ulcerative colitis, Crohn's disease, perforated diverticulitis and appendicitis with perforation. This report draws attention to the resurgence of tuberculosis and amebiasis in Korea, and the need for the high degree of caution required to detect it. PMID:11194200

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. Non-Meckel Small Intestine Diverticulitis

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    Shamim Ejaz

    2017-08-01

    Full Text Available Non-Meckel small intestine diverticulitis can have many manifestations and its management is not well-defined. We report 4 unselect cases of small intestine diverticulitis; all patients were seen by the same physician at the Emergency Center at The University of Texas MD Anderson Cancer Center between 1999 and 2014. The median age at diagnosis of these patients was 82 years (range, 76–87 years. All 4 patients presented with acute onset of abdominal pain, and computed tomography scans showed characteristics of small intestine diverticulitis unrelated to cancer. Most of the diverticula were found in the region of the duodenum and jejuno-ileal segments of the small intestine. The patients, even those with peripancreatic inflammation and localized perforation, were treated conservatively. Non-Meckel diverticulitis can be overlooked in the initial diagnosis because of the location of the diverticulosis, the age of the patient, and the rarity of the disease. Because patients with non-Meckel small intestine diverticulitis can present with acute abdominal pain, non-Meckel small intestine diverticulitis should be considered in the differential diagnosis of patients with acute abdominal pain, and computed tomography scans can help identify the condition. Because of the rarity of non-Meckel small intestine diverticulitis, few studies have been published, and the data are inconclusive about how best to approach these patients. Our experience with these 4 elderly patients indicates that non-Meckel small intestine diverticulitis can be treated conservatively, which avoids the potential morbidity and mortality of a surgical approach.

  13. Spectrum of diseases in acute intestinal obstruction

    International Nuclear Information System (INIS)

    Masud, M.; Khan, A.; Gondal, Z.I.; Adil, M.

    2015-01-01

    To determine the etiological spectrum of acute intestinal obstruction in our clinical setup Military Hospital Rawalpindi. Study Design: Descriptive study. Place and Duration of Study: Surgical department of Military Hospital, Rawalpindi from Jul 2012 to Jul 2013, over a period of about 1 year. Material and Methods: A total of 120 patients with acute mechanical intestinal obstruction who underwent laparotomy were included in our study while those with non-mechanical intestinal obstruction like history of trauma and paralytic ileus were excluded from the study. All the patients were selected by non-probability purposive sampling technique. Emergency laparotomy was done and operative findings were recorded. Results: A total of 120 patients with mechanical intestinal obstruction were included in this study out of which 93 (69.17%) were female and remaining 27 (30.83%) were males. Male to female ratio was 1:2.24. Age range of patients was 22-85 years. Out of 120 patients operated for acute intestinal obstruction post-op adhesions were found in 37 (30.83%) patients followed by intestinal tuberculosis in 23 (19.17%) patients, obstructed inguinal hernias in 13 (10.83%), gut malignancies in 15 (12.5%) , Meckel's diverticulum with bands in 7 (5.83%), volvulus in 7 (5.83%), perforated appendix in 6 (5%), intussusception in 2 (1.7%), inflammatory bands in 5 (4.17%), trichobezoar and faecal impaction in 2 (1.7%) while in 3 (2.5%) patients no definite cause was found. Conclusion: Post-op adhesions are the commonest cause of mechanical intestinal obstruction in our setup followed by intestinal tuberculosis as second most common clinical pattern of presentation. (author)

  14. Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

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    Amin Abid

    2010-06-01

    Full Text Available Abstract Background Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.

  15. 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.

  16. Ileocolic Perforation Secondary to Sodium Polystyrene Sulfonate in Sorbitol Use: A Case Report

    Directory of Open Access Journals (Sweden)

    Vincent Trottier

    2009-01-01

    Full Text Available Hyperkalemia is a common condition encountered in medical and surgical patients. It can lead to various complications including cardiac arrhythmias. Sodium polystyrene sulfonate (SPS in sorbitol is an ion-exchange resin that can be used to treat hyperkalemia. It can be used in enema or in oral form. The present article describes the case of an intensive care unit patient who experienced severe, diffuse, intestinal perforation induced by the use of SPS-sorbitol, requiring multiple laparotomies, followed by a brief review of the relevant literature and recommendations regarding the use of SPS-sorbitol.

  17. Ileocolic perforation secondary to sodium polystyrene sulfonate in sorbitol use: A case report

    Science.gov (United States)

    Trottier, Vincent; Drolet, Sébastien; Morcos, Mohib W

    2009-01-01

    Hyperkalemia is a common condition encountered in medical and surgical patients. It can lead to various complications including cardiac arrhythmias. Sodium polystyrene sulfonate (SPS) in sorbitol is an ion-exchange resin that can be used to treat hyperkalemia. It can be used in enema or in oral form. The present article describes the case of an intensive care unit patient who experienced severe, diffuse, intestinal perforation induced by the use of SPS-sorbitol, requiring multiple laparotomies, followed by a brief review of the relevant literature and recommendations regarding the use of SPS-sorbitol. PMID:19826644

  18. 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.

  19. 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.

  20. [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.

  1. Traumatic oesophageal perforation due to haematoma

    DEFF Research Database (Denmark)

    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....

  2. 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 ...

  3. 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

  4. 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.

  5. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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.

  8. 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.

  9. 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

  10. [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.

  11. 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 ...

  12. 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.

  13. 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 ...

  14. 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.

  15. 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 ...

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. [Intestinal volvulus due to yeyunal duplication].

    Science.gov (United States)

    Rodríguez Iglesias, P; Carazo Palacios, M E; Lluna González, J; Ibáñez Pradas, V; Rodríguez Caraballo, L

    2014-10-01

    Duplications of the alimentary tract are congenital malformations. The ileum is the most commonly affected organ. A lot of duplications are incidentally diagnosed but most of patients present a combination of pain or complications such as obstructive symptoms, intestinal intussusception, perforation or volvulus. We report the case of a 6-years-old girl, with intermittent abdominal pain and vomits for two months long. Laboratory work was completely normal and in the radiology analysis (abdominal sonography and magnetic resonance) a cystic image with intestinal volvulus was observed. The patient underwent laparotomy, Ladd's procedure was done and the cyst was resected. In conclusion, if a patient is admitted with abdominal pain and obstructive symptoms, it is important to consider duplication of the alimentary tract as a possible diagnosis.

  2. 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.

  3. Intestinal Anisakiasis Treated Successfully with Prednisolone and Olopatadine Hydrochloride

    Directory of Open Access Journals (Sweden)

    Hideki Toyoda

    2016-02-01

    Full Text Available The clinical characteristic of gastrointestinal anisakiasis is severe abdominal pain after eating raw fish. Intestinal anisakiasis is more uncommon than gastric anisakiasis. Most patients with intestinal anisakiasis need hospitalization because anisakiasis can cause intestinal obstruction, ileus, peritonitis or intestinal perforation. We report a case of intestinal anisakiasis. A 43-year-old woman presented with symptoms of intermittent abdominal pain 2 days after eating raw fish. Her brother had eaten the same food and had been suffering from gastric anisakiasis. Abdominal ultrasonography in this patient showed localized jejunal wall thickening with dilated lumen of proximal jejunum and ascites. According to the clinical course and examinations, she was diagnosed with intestinal anisakiasis. Administration of prednisolone 5 mg/day and olopatadine hydrochloride 10 mg/day improved her symptoms quickly without hospitalization. Prednisolone was administered for 10 days, and olopatadine hydrochloride was administered for a total of 6 weeks according to ultrasonographic findings. Six months after the treatment, the abdominal ultrasonography demonstrated normal findings. This case demonstrates that ultrasonography was quite useful for the diagnosis and surveillance of intestinal anisakiasis. Furthermore, treatment with corticosteroid and an antiallergic agent could be an option for patients with intestinal anisakiasis.

  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. Intestinal myiasis

    Directory of Open Access Journals (Sweden)

    U S Udgaonkar

    2012-01-01

    Full Text Available Purpose: Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces. This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man. They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe. The condition is not uncommon and is often misdiagnosed as pinworm infestation. Correct diagnosis by the clinical microbiologist is important to avoid unnecessary treatment. Materials and Methods: We had 7 cases of intestinal myiasis. In 2 cases the larvae were reared to adult fly in modified meat and sand medium (developed by Udgaonkar. This medium is simple and can be easily prepared in the laboratory. Results: Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans. Conclusions: S. haemorrhoidalis was the commonest maggot involved. A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics. The reason for long duration of illness and recurrence of infestation is baffling. The nearest to cure was colonic wash. We feel prevention is of utmost importance, which is to avoid eating food articles with easy access to flies.

  7. Intestinal myiasis.

    Science.gov (United States)

    Udgaonkar, U S; Dharamsi, R; Kulkarni, S A; Shah, S R; Patil, S S; Bhosale, A L; Gadgil, S A; Mohite, R S

    2012-01-01

    Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces. This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man. They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe. The condition is not uncommon and is often misdiagnosed as pinworm infestation. Correct diagnosis by the clinical microbiologist is important to avoid unnecessary treatment. We had 7 cases of intestinal myiasis. In 2 cases the larvae were reared to adult fly in modified meat and sand medium (developed by Udgaonkar). This medium is simple and can be easily prepared in the laboratory. Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans. S. haemorrhoidalis was the commonest maggot involved. A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics. The reason for long duration of illness and recurrence of infestation is baffling. The nearest to cure was colonic wash. We feel prevention is of utmost importance, which is to avoid eating food articles with easy access to flies.

  8. 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.

  9. Gastrointestinal stromal tumor of Meckel's diverticulum: a rare cause of intestinal volvulus.

    Science.gov (United States)

    Cengız, Fevzi; Sun, Mehmet Ali; Esen, Özgür Sipahi; Erkan, Nazif

    2012-08-01

    Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Most cases are asymptomatic; however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis, and perforation. Tumors within a Meckel's diverticulum are rare. Herein, we present a gastrointestinal stromal tumor arising from the Meckel's diverticulum that led to intestinal obstruction by volvulus.

  10. 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

  11. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  13. [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.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial.

    Science.gov (United States)

    Rees, Clare M; Eaton, Simon; Kiely, Edward M; Wade, Angie M; McHugh, Kieran; Pierro, Agostino

    2008-07-01

    To determine whether primary peritoneal drainage improves survival and outcome of extremely low birth weight (ELBW) infants with intestinal perforation. Optimal surgical management of ELBW infants with intestinal perforation is unknown. An international multicenter randomized controlled trial was performed between 2002 and 2006. Inclusion criteria were birthweight >or=1000 g and pneumoperitoneum on x-ray (necrotizing enterocolitis or isolated perforation). Patients were randomized to peritoneal drain or laparotomy, minimizing differences in weight, gestation, ventilation, inotropes, platelets, country, and on-site surgical facilities. Patients randomized to drain were allowed to have a delayed laparotomy after at least 12 hours of no clinical improvement. Sixty-nine patients were randomized (35 drain, 34 laparotomy); 1 subsequently withdrew consent. Six-month survival was 18/35 (51.4%) with a drain and 21/33 (63.6%) with laparotomy (P = 0.3; difference 12% 95% CI, -11, 34%). Cox regression analysis showed no significant difference between groups (hazard ratio for primary drain 1.6; P = 0.3; 95% CI, 0.7-3.4). Delayed laparotomy was performed in 26/35 (74%) patients after a median of 2.5 days (range, 0.4-21) and did not improve 6-month survival compared with primary laparotomy (relative risk of mortality 1.4; P = 0.4; 95% CI, 0.6-3.4). Drain was effective as a definitive treatment in only 4/35 (11%) surviving neonates, the rest either had a delayed laparotomy or died. Seventy-four percent of neonates treated with primary peritoneal drainage required delayed laparotomy. There were no significant differences in outcomes between the 2 randomization groups. Primary peritoneal drainage is ineffective as either a temporising measure or definitive treatment. If a drain is inserted, a timely "rescue" laparotomy should be considered. Trial registration number ISRCTN18282954; http://isrctn.org/

  17. Repair of Tympanic Membrane Perforations with Customized Bioprinted Ear Grafts Using Chinchilla Models.

    Science.gov (United States)

    Kuo, Che-Ying; Wilson, Emmanuel; Fuson, Andrew; Gandhi, Nidhi; Monfaredi, Reza; Jenkins, Audrey; Romero, Maria; Santoro, Marco; Fisher, John P; Cleary, Kevin; Reilly, Brian

    2018-03-01

    The goal of this work is to develop an innovative method that combines bioprinting and endoscopic imaging to repair tympanic membrane perforations (TMPs). TMPs are a serious health issue because they can lead to both conductive hearing loss and repeated otitis media. TMPs occur in 3-5% of cases after ear tube placement, as well as in cases of acute otitis media (the second most common infection in pediatrics), chronic otitis media with or without cholesteatoma, or as a result of barotrauma to the ear. About 55,000 tympanoplasties, the surgery performed to reconstruct TMPs, are performed every year, and the commonly used cartilage grafting technique has a success rate between 43% and 100%. This wide variability in successful tympanoplasty indicates that the current approach relies heavily on the skill of the surgeon to carve the shield graft into the shape of the TMP, which can be extremely difficult because of the perforation's irregular shape. To this end, we hypothesized that patient specific acellular grafts can be bioprinted to repair TMPs. In vitro data demonstrated that our approach resulted in excellent wound healing responses (e.g., cell invasion and proliferations) using our bioprinted gelatin methacrylate constructs. Based on these results, we then bioprinted customized acellular grafts to treat TMP based on endoscopic imaging of the perforation and demonstrated improved TMP healing in a chinchilla study. These ear graft techniques could transform clinical practice by eliminating the need for hand-carved grafts. To our knowledge, this is the first proof of concept of using bioprinting and endoscopic imaging to fabricate customized grafts to treat tissue perforations. This technology could be transferred to other medical pathologies and be used to rapidly scan internal organs such as intestines for microperforations, brain covering (Dura mater) for determination of sites of potential cerebrospinal fluid leaks, and vascular systems to determine arterial

  18. Intraintestinal drainage as a damage control surgery adjunct in a hypothermic traumatic shock swine model with multiple bowel perforations.

    Science.gov (United States)

    Ji, Wu; Ding, Weiwei; Liu, Xingdong; Kao, Xiaomin; Xu, Xingwei; Li, Ning; Li, Jieshou

    2014-11-01

    Temporary bowel ligation (TL) has been proposed to prevent contamination as a damage control procedure in multiple bowel perforations. However, bacteria translocation and intestinal ischemia may develop in a prolonged duration. We here hypothesized that intraintestinal drainage combined with temporary ligation (D-TL) would decrease intestinal injury and improve survivals in a gunshot multiple bowel perforation swine model in the setting of a damage control surgery. The abdomen was shot one time with an experimental modified gun whereas pigs were hemorrhaged to a mean arterial pressure of 40 mm Hg and maintained in shock for 40 min. Cold lactated Ringer solution was gradually infused to induce hypothermia. Animals were randomized to primary anastomosis, TL and intraintestinal D-TL groups (n = 8). Animals were resuscitated for 12 h with the shed blood and lactated Ringer solution. Delayed anastomosis was performed in TL and D-TL animals after resuscitation. Surviving animals were humanely killed 24 h after operation. Systemic hemodynamic parameters were recorded and blood samples were obtained for biochemical assays. Intra-abdominal pressure, portal vein and peripheral vein bacterial cultures, small intestine hematoxylin-eosin staining, and transmission electron microscopy examination were performed at 0, 2, 6, 12, and 24 h after the surgery. All animals suffered extreme physiologic conditions as follows: hypothermia, severe acidosis, hypotension, and depressed cardiac output. Compared with the primary anastomosis and TL group, D-TL animals required less resuscitation fluid, suffered a lower intra-abdominal hypertension and bacterial translocation, normalized lactate levels faster, had lower serum creatine kinase, aspartate aminotransferase levels and tissue TNF-α level, and nuclear factor-kB activations and thus had greater early survival. Compared with primary intestinal anastomosis and TL, rapid bowel ligation combined with intraintestinal drainage as a damage

  19. Acute Myocardial Infarction with Simultaneous Gastric Perforation

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    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.

  20. 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.

  1. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

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    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.

  2. Roentgenologic diagnosis of perforation of the alimentary tract in neonates and a study of the pathogenesis and the prognosis

    International Nuclear Information System (INIS)

    Zhou Shaoyi; Liu Liwei

    2003-01-01

    Objective: To study the X-ray manifestations of alimentary tract perforation in neonates and investigate the pathogenesis and the prognosis. Methods: In total 65 cases of alimentary tract perforation in neonates were retrospectively studied, including the X-ray manifestations and the pathology. Results: Pneumo-peritoneum was revealed in 59 cases out of 65, including sever pneumo-peritoneum in 19 cases, moderate in 20 cases and mild in 20 cases. Free air was revealed in the sub-diaphragmatic regions in 55 cases. The following manifestations indicated pneumo-peritoneum: football sign (25 cases), falciform ligament sign (36 cases) and pencil-drawing sign (27 cases). Other findings included the absence of the gastric bulb revealed in 11 cases, increased distance between the bowel loops in 28, widen separation of the intestinal wall and the adjacent air filled loop in 34, air-containing bowel wall in 11, and feces air mixture within peripheral loops in 8 case. The primary affection included: defects of gastric musculature (11 cases), congenital malformation of small intestine (11 cases), Hirschsprung disease (8 cases), atresia of the anus (2 cases), meconium peritonitis (5 cases), NEC (24 cases), and other causes (4 cases). Conclusion: In the diagnosis of alimentary tract's perforation in neonates, Roentgenography is still the most important examination and the first choice of imaging. It also helps evaluating the pathogenesis and the prognosis of those disorders

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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...

  9. 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

  10. Vitrectomy in double-perforation gunshot injury

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    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

  11. 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)

  12. 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.

  13. 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 ...

  14. 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.

  15. CLINICAL STUDY AND MANAGEMENT OF BENIGN GASTROINTESTINAL PERFORATIONS

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    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.

  16. Surgical results in cases of intestinal radiation injury

    Energy Technology Data Exchange (ETDEWEB)

    Deguchi, Hisatsugu; Ozawa, Tetsuro; Wada, Toshihiro; Tsugu, Yukio (Toho Univ., Tokyo (Japan). School of Medicine)

    1991-05-01

    Surgical procedures were performed on 25 patients suffering from late-phase intestinal tract disorders induced by irradiation. The primary diseases of these cases were almost exclusively gynecological in nature, such as cancer of the uterine cervix. Symptoms observed in these cases were overwhelming ileus followed by melena, fistulation and free perforation, as well as combination thereof. The most common portion involved was the recto-sigmoidal colon, followed by the ileo-cecum and ileum. As for the relationship of symptoms to the disordered portion, ileus was seen mainly in cases of disorders at the ileocecal portion; melena was observed exclusively in cases of disorders at the rectosigmoidal colon; fistulation was manifested mainly as recto-vaginal fistula or ileo-sigmoidal fistula; free perforation was observed at both the ileum and sigmoidal colon. Colostomy was the most frequent surgical method applied. Only 3 cases were able to undergo enterectomy. Other cases were subjected to enteroanastomosis or enterostomy. In most cases it was nearly in possible to excise the disordered portions. As for the effect of surgical procedures on symptoms, cases of melena or fistulation were all subjected to colostomy; the majority of these cases showed improvement in symptoms. Moreover, a high improvement ratio was obtained in cases of ileus which were subjected to enterectomy and enteroanastomosis. Cases of free perforation showed high improvement ratio irrespective of the surgical procedure given. As for postoperative complications, one case of free perforation at the ileum showed anastomotic leakage after partial resection. For cases suffering from late-phase intestinal tract disorders induced by irradiation, immediate resection of the disordered intestinal tract and anastomosis are ideal. However, conservative operations must be considered, based on the focal condition. (author).

  17. Surgical treatment of radiation induced injuries of the intestine

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, E.H.; Symmonds, R.E.

    1981-12-01

    In the patient who has received high dose irradiation of the pelvis and abdomen, all abdominopelvic operations should be avoided, unless it is absolutely essential. Persisting obstruction, hemorrhage, intestinal perforation with peritonitis and with abscess and fistula formation are valid indications for surgical intervention. Ninety-three patients have been operated upon for these complications after irradiation. Some anastomotic dehiscence occurred in ten patients. Six operative deaths occurred. Of the 93 patients, 65 were managed by means of complete resection of the involved segment of intestine, followed by restoration of intestinal continuity by means of an end-to-end anastomosis. This is the treatment of choice when the involved area can be safely resected. In the absence of actual intestinal necrosis and when segments of strictured small intestine are adherent deep in the pelvis, and intestinal bypass procedure may represent the treatment of choice. This was accomplished in 20 patients, two of whom eventually required a second operation for resection of the bypassed segment of intestine.

  18. Surgical treatment of radiation induced injuries of the intestine

    International Nuclear Information System (INIS)

    Schmitt, E.H.; Symmonds, R.E.

    1981-01-01

    In the patient who has received high dose irradiation of the pelvis and abdomen, all abdominopelvic operations should be avoided, unless it is absolutely essential. Persisting obstruction, hemorrhage, intestinal perforation with peritonitis and with abscess and fistula formation are valid indications for surgical intervention. Ninety-three patients have been operated upon for these complications after irradiation. Some anastomotic dehiscence occurred in ten patients. Six operative deaths occurred. Of the 93 patients, 65 were managed by means of complete resection of the involved segment of intestine, followed by restoration of intestinal continuity by means of an end-to-end anastomosis. This is the treatment of choice when the involved area can be safely resected. In the absence of actual intestinal necrosis and when segments of strictured small intestine are adherent deep in the pelvis, and intestinal bypass procedure may represent the treatment of choice. This was accomplished in 20 patients, two of whom eventually required a second operation for resection of the bypassed segment of intestine

  19. Intestinal obstruction: a rare complication of channeling Transurethral Resection of the Prostate (TURP: a case report

    Directory of Open Access Journals (Sweden)

    Popoola AA

    2008-01-01

    Full Text Available Abstract Introduction Channeling transurethral resection of the prostate is a recognized form of adjunctive treatment in the treatment of patients with prostate cancer. Despite the fact that complications arising from the procedure have been on the decline, rare complications like intestinal obstruction may occur. Case presentation This is a case report of a 56 year old man who developed mechanical intestinal obstruction few days after a channeling TURP for advanced CaP. Conclusion The report highlights the possibility of intestinal obstruction as a secondary event following a silent urinary bladder perforation during channeling TURP. Early recognition and intervention were responsible for the good outcome in this patient.

  20. Prenatal diagnosis and management of an intestinal volvulus with meconium ileus and peritonitis.

    Science.gov (United States)

    Takacs, Z F; Meier, C M; Solomayer, E-F; Gortner, L; Meyberg-Solomayer, G

    2014-08-01

    Fetal intestinal volvulus is a rare but serious finding with a high risk of potential life threatening fetal complications. Delay in diagnosis or treatment can increase mortality and morbidity. We report a case of mild fetal bowel dilatation at 30 weeks of gestation and intestinal volvulus presented by the 'whirl-sign', intestinal perforation and meconium peritonitis with fetal ascites and polyhydramnios at 33 weeks of gestation. This case emphasizes the role of examination of the bowel in third trimester ultrasound and the importance of quick decision to delivery and interdisciplinary perinatal management at suspected fetal volvulus with bowel necrosis and intraabdominal bleeding.

  1. 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.

  2. A wound retraction device for laparoscopic-assisted intestinal surgery in dogs and cats.

    Science.gov (United States)

    Gower, Sara B; Mayhew, Philipp D

    2011-06-01

    To report experience with laparoscopic-assisted intestinal resection and anastomosis for treatment of discrete intestinal masses using a novel wound retraction device. Case series. Dogs (n=2) and cats (6). Dogs and cats with discrete intestinal masses identified by ultrasonography without evidence of intestinal perforation or peritonitis, were included. A 2 portal technique was used; 1 portal was enlarged for insertion of the wound retraction device through which the intestine was examined as thoroughly as possible. The diseased portion of the intestine was exteriorized through the wound retractor and resection and anastomosis of the intestinal mass performed. Of the 8 animals, laparoscopic-assisted intestinal resection and anastomosis through the wound retractor was performed in 2 dogs and 3 cats. In 3 cats, based on either location or extent of the lesion, 2 were converted to laparoscopic-assisted intestinal biopsies and 1 to an open colocolostomy. No other intra- or perioperative complications were encountered and all animals survived to discharge. Laparoscopic-assisted intestinal resection and anastomosis can be performed in select canine and feline patients with modestly sized, discrete intestinal masses. © Copyright 2011 by The American College of Veterinary Surgeons.

  3. 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...

  4. 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...

  5. 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.

  6. 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 ...

  7. 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...

  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. 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

  10. 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.

  11. Sigmoid Colonic Perforation with Faecal Peritonitis due to Faecaloma

    Directory of Open Access Journals (Sweden)

    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.

  12. [Adult intestinal malrotation associated with intestinal volvulus].

    Science.gov (United States)

    Hernando-Almudí, Ernesto; Cerdán-Pascual, Rafael; Vallejo-Bernad, Cristina; Martín-Cuartero, Joaquín; Sánchez-Rubio, María; Casamayor-Franco, Carmen

    Intestinal malrotation is a congenital anomaly of the intestinal rotation and fixation, and usually occurs in the neonatal age. Description of a clinical case associated with acute occlusive symptoms. A case of intestinal malrotation is presented in a previously asymptomatic woman of 46 years old with an intestinal obstruction, with radiology and surgical findings showing an absence of intestinal rotation. Intestinal malrotation in adults is often asymptomatic, and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  13. Intestinal Ostomy.

    Science.gov (United States)

    Ambe, Peter C; Kurz, Nadja Rebecca; Nitschke, Claudia; Odeh, Siad F; Möslein, Gabriela; Zirngibl, Hubert

    2018-03-16

    About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired quality of life. Optimal ostomy creation and proper ostomy care are crucially important determinants of the success of treatment and of the patients' quality of life. This article is based on pertinent publications retrieved by a selective search in PubMed, GoogleScholar, and Scopus, and on the authors' experience. Intestinal stomata can be created using either the small or the large bowel. More than 75% of all stomata are placed as part of the treatment of colorectal cancer. The incidence of stoma-related complications is reported to be 10-70%. Skin irritation, erosion, and ulceration are the most common early complications, with a combined incidence of 25-34%, while stoma prolapse is the most common late complication, with an incidence of 8-75%. Most early complications can be managed conservatively, while most late complications require surgical revision. In 19% of cases, an ostomy that was initially planned to be temporary becomes permanent. Inappropriate stoma location and inadequate ostomy care are the most common causes of early complications. Both surgical and patient-related factors influence late complications. Every step from the planning of a stoma to its postoperative care should be discussed with the patient in detail. Preoperative marking is essential for an optimal stoma site. Optimal patient management with the involvement of an ostomy nurse increases ostomy acceptance, reduces ostomy-related complications, and improves the quality of life of ostomy carriers.

  14. Intestinal tract diseases

    International Nuclear Information System (INIS)

    Rozenshtraukh, L.S.

    1985-01-01

    Roentgenoanatomy and physiology of the small intestine are described. Indications for radiological examinations and their possibilities in the diagnosis of the small intestine diseases are considered.Congenital anomalies and failures in the small intestine development, clinical indications and diagnosis methods for the detection of different aetiology enteritis are described. Characteristics of primary malabsorption due to congenital or acquired inferiority of the small intestine, is provided. Radiological picture of intestinal allergies is described. Clinical, morphological, radiological pictures of Crohn's disease are considered in detail. Special attention is paid to the frequency of primary and secondary tuberculosis of intestinal tract. The description of clinical indications and frequency of benign and malignant tumours of the small intestine, methods for their diagnosis are given. Radiological pictures of parasitogenic and rare diseases of the small intestine are presented. Changes in the small intestine as a result of its reaction to pathological processes, developing in other organs and systems of the organism, are described

  15. 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.

  16. 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)

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. [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.

  5. 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.

  6. 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.

  7. 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 ...

  8. 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.

  9. 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 ...

  10. 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.

  11. 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, ...

  12. 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.

  13. 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 ...

  14. 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

  15. 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

  16. 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....

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. Intestinal pseudo-obstruction

    Science.gov (United States)

    ... Staying in bed for long periods of time (bedridden). Taking drugs that slow intestinal movements. These include ... be tried: Colonoscopy may be used to remove air from the large intestine. Fluids can be given ...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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

  5. 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.

  6. Role of damage control enterostomy in management of children with peritonitis from acute intestinal disease

    Directory of Open Access Journals (Sweden)

    Emmanuel A Ameh

    2013-01-01

    Full Text Available Background: Intestinal anastomosis in severely ill children with peritonitis from intestinal perforation, intestinal gangrene or anastomotic dehiscence (acute intestinal disease is associated with high morbidity and mortality. Enterostomy as a damage control measure may be an option to minimize the high morbidity and mortality. This report evaluates the role of damage control enterostomy in the treatment of these patients. Materials and Methods: A retrospective review of 52 children with acute intestinal disease who had enterostomy as a damage control measure in 12 years. Results: There were 34 (65.4% boys and 18 (34.6% girls aged 3 days-13 years (median 9 months, comprising 27 (51.9% neonates and infants and 25 (48.1% older children. The primary indication for enterostomy in neonates and infants was intestinal gangrene 25 (92.6% and perforated typhoid ileitis 22 (88% in older children. Enterostomy was performed as the initial surgery in 33 (63.5% patients and as a salvage procedure following anastomotic dehiscence in 19 (36.5% patients. Enterostomy-related complications occurred in 19 (36.5% patients, including 11 (21.2% patients with skin excoriations and eight (15.4% with hypokalaemia. There were four (7.7% deaths (aged 19 days, 3 months, 3½ years and 10 years, respectively directly related to the enterostomy, from hypokalaemia at 4, 12, 20 and 28 days postoperatively, respectively. Twenty other patients died shortly after surgery from their primary disease. Twenty of 28 surviving patients have had their enterostomy closed without complications, while eight are awaiting enterostomy closure. Conclusion: Damage-control enterostomy is useful in management of severely ill children with intestinal perforation or gangrene. Careful and meticulous attention to fluid and electrolyte balance, and stoma care, especially in the first several days following surgery, are important in preventing morbidity and mortality.

  7. Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?

    Directory of Open Access Journals (Sweden)

    Osifo Osarumwense

    2010-01-01

    Full Text Available Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. Patients and Methods: This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Results: Adhesive intestinal obstruction accounted for 21 (8.8% of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 ± 6.4 years, comprising 13 males and eight females (ratio 1.6:1. Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%, perforated appendix (five, 23.8%, perforated volvulus (three, 14.3%, penetrating abdominal trauma (two, 9.5% and perforated typhoid (two, 9.5% were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6% children due to poor response to nonoperative management, 11-13 days in 12 (57.1% who responded minimally and 2-5 weeks in three (14.3% who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%, multiple bands/adhesions (13, 61.9% and encasement, including one bowel gangrene (six, 28.6%. Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Conclusion: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and

  8. Electrocautery effect on intestinal vascularisation in a murine model.

    Science.gov (United States)

    Tremblay, Jean-François; Sideris, Lucas; Leblond, François A; Trépanier, Jean-Sébastien; Badrudin, David; Drolet, Pierre; Mitchell, Andrew; Dubé, Pierre

    2016-09-01

    The use of electrocautery devices is associated with complications such as perforation or fistulisation when used near intestinal structures. This is likely due to its effect on vascularisation of the bowel wall. To test this hypothesis we established a murine model to quantify the effect of electrocautery injury on the intestinal microvascularisation. Sprague-Dawley rats were subjected to five electrocautery injuries on the small bowel in coagulation mode (30 W intensity) and in cut mode (40 W, 80 W and 200 W intensities) for durations of 1, 2 and 5 s. 5 mg/kg of fluorescein was injected intravenously, the injured bowel segments harvested and the rat sacrificed. The segments were analysed to measure the fluorescence of injured bowel compared to adjacent unharmed tissue. A significant decrease in bowel wall microvascularisation occurred with increasing intensity (coag 30 W/cut 40 W versus cut 200 W 1 s: p electrocautery injury (cut 40 W 1/2 s versus 5 s: p electrocautery injury, a significantly greater microvascularisation decrease was observed in jejunum compared to ileum (p electrocautery use. Unsurprisingly, the decrease in microvascularisation is greater with higher intensity and duration of electrocautery and is associated with more perforations in the experimental model. The jejunum seems more vulnerable to electrocautery injury than the ileum. These observations support caution when using electrocautery devices near intestinal structures.

  9. Perforated mixed carcinoid-adenocarcinoma in transverse colon and at gastroenterostomy site: case report

    Directory of Open Access Journals (Sweden)

    Karakaş Barış R

    2010-12-01

    Full Text Available Abstract Goblet cell carcinoid of the large intestine is a rare neoplasm, usually located in ascending colon and rectum. A 60-year-old male patient underwent surgery after the diagnosis of acute abdomen. Exploratory laparotomy revealed perforation with a diameter of 1 cm at the site of the previously performed gastroenterostomy and dilatation of the right colic flexure, secondary to a solid obstructive mass located in the mid-portion of transverse colon. Histopathological investigation of the biopsies, taken from the gastroenterostomy site and the tumor, revealed mixed carcinoid-adenocarcinoma with carcinoid component, predominantly composed of goblet cells. Three cycles of FOLFOX-4 protocol was administered. Following respiratory distress secondary to pulmonary metastasis, the patient's condition deteriorated and subsequently died in the fourth postoperative month. Our aim with this paper is to point out that more cases should be reported for more effective diagnosis, histopathological study, clinical investigation, treatment and prognosis of this specific neoplasm.

  10. 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.

  11. 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.

  12. 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).

  13. 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.

  14. 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

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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)

  2. 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.

  3. A novel and simple method using a transanal intestinal long tube for protecting intestinal anastomosis and decompressing the small bowel

    Science.gov (United States)

    2017-01-01

    Purpose I introduce the use of transanal intestinal long tube (TILT) using nasogastric tube. TILT passes from anus to the anastomosis, helping to decompress a dilated bowel loop. Methods TILT procedure was limited to those patients predicting a severe luminal size discrepancy after intestinal anastomosis, and who had postoperative prolonged ileus. We retrospectively reviewed the medical records of 10 infants (7 male an 3 female patients) who were treated using the TILT procedure between 2012 and 2016. Results Median gestational age was 27+5 weeks and birth weight was 940 g. The first operation was done at a median of 4.5 days after birth due to necrotizing enterocolitis perforation (4 cases), isolated intestinal perforation (3 cases), meconium related ileus (1 case), congenital ileal volvulus (1 case), and ileal atresia (1 case). Nine cases of ileostomy closure were planned at a median of 130.5 days with a body weight of 3,060 g. For the ileal atresia case, TILT procedure without additional small bowel resection was performed to treat postoperative prolonged ileus. Nine out of ten were well functioned and defecation via anus was observed in a median of 4.5 days. Milk feeding began at a median of 6 days and the long intestinal tube was removed in a median of 14.5 days. Conclusion I suggested that TILT procedure could be a noninvasive operative option, predicting of size mismatched anastomosis causing prolonged ileus. Passive drainage of proximal intestinal contents might be helpful for decompress endoluminal pressure during the time of anastomosis healing with bowel movement recovery. PMID:28932729

  4. 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

  5. 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.

  6. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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

  9. 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.

  10. IDIOPATHIC SCLEROSING ENCAPSULATING PERITONITIS CAUSING ACUTE INTESTINAL OBSTRUCTION AND GANGRENE: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Nava

    2016-04-01

    Full Text Available INTRODUCTION Sclerosing encapsulating peritonitis (SEP is a relatively rare cause of intestinal obstruction resulting from encasement of variable lengths of bowel by dense fibro-collagenous membrane. It is more common in young females, and shows tropical and sub-tropical distribution. The idiopathic cases of SEP, which lack any identifiable cause from clinical, radiological and histopathological findings, are also reported under the descriptive term “abdominal cocoon syndrome”. SEP presents with acute or sub-acute intestinal obstruction with or without a mass. In the era of laparoscopic surgery, inadvertent damage to the small bowel at insertion of the trocar and cannula can occur by being unaware of this condition resulting in unnecessary bowel resection. Persistent untreated SEP may advance to bowel gangrene or intestinal perforation, representing life threatening conditions. We report the clinical presentation of a 75-year-old female presenting with signs of intestinal obstruction whose imaging findings revealed abdominal cocoon with bowel gangrene leading to perforation and the same confirmed at surgery. Surgical excision of the fibrotic sac encasing the bowel, resection of gangrenous bowel segment and end ileostomy was performed. Histopathology of the excised membrane confirmed sclerosing encapsulating peritonitis. To our knowledge, only a few cases of abdominal cocoon with perforation have been reported in literature so far. Radiologists should be aware of this relatively rare cause of intestinal obstruction, its imaging findings and complications, as preoperative diagnosis will prevent delay and aid in treatment planning to the surgeon. Identification of soft tissue density membrane encasing congregated small bowel loops into a single area on computed-tomography gives diagnostic clue. Surgical excision of sac, release of bowel loops and adhesions with partial intestinal resection when necessary is the treatment.

  11. 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.

  12. 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.

  13. 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.

  14. 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...

  15. 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

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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 ...

  3. 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

  4. 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 ...

  5. 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.

  6. Intestinal lymphangiectasia in children

    Science.gov (United States)

    Isa, Hasan M.; Al-Arayedh, Ghadeer G.; Mohamed, Afaf M.

    2016-01-01

    Intestinal lymphangiectasia (IL) is a rare disease characterized by dilatation of intestinal lymphatics. It can be classified as primary or secondary according to the underlying etiology. The clinical presentations of IL are pitting edema, chylous ascites, pleural effusion, acute appendicitis, diarrhea, lymphocytopenia, malabsorption, and intestinal obstruction. The diagnosis is made by intestinal endoscopy and biopsies. Dietary modification is the mainstay in the management of IL with a variable response. Here we report 2 patients with IL in Bahrain who showed positive response to dietary modification. PMID:26837404

  7. Intestinal parasites and tuberculosis

    Directory of Open Access Journals (Sweden)

    Anuar Alonso Cedeño-Burbano

    2017-10-01

    Conclusions: The available evidence was insufficient to affirm that intestinal parasites predispose to developing tuberculous. The studies carried out so far have found statistically insignificant results.

  8. 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.

  9. 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.

  10. 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.

  11. Tension pneumothorax due to perforated colon.

    Science.gov (United States)

    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.

  12. Colon Perforations Causing Morgagni Hernia Case

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    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. Successful Kidney and Lung Transplantation From a Deceased Donor With Blunt Abdominal Trauma and Intestinal Perforation

    NARCIS (Netherlands)

    van Smaalen, Tim C.; Krikke, Christina; Haveman, Jan Willem; van Heurn, L. W. Ernest

    2016-01-01

    The number of organ donors is limited by many contraindications for donation and poor quality of potential organ donors. Abdominal infection is a generally accepted contraindication for donation of abdominal organs. We present a 43-year-old man with lethal brain injury, blunt abdominal trauma, and

  14. [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.

  15. Primary intestinal lymphangiectasia.

    Science.gov (United States)

    Suresh, N; Ganesh, R; Sankar, Janani; Sathiyasekaran, Malathi

    2009-10-01

    Primary intestinal lymphangiectasia (PIL) is a rare disease of intestinal lymphatics presenting with hypoproteinemia, bilateral lower limb edema, ascites, and protein losing enteropathy. We report a series of 4 children from Chennai, India presenting with anasarca, recurrent diarrhea, hypoproteinemia and confirmatory features of PIL on endoscopy and histopathology.

  16. Congenital intestinal lymphangiectasia

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    Popović Dušan Đ.

    2011-01-01

    Full Text Available Background. Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. Case report. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and suportive therapy. Conclusion. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

  17. [Congenital intestinal lymphangiectasia].

    Science.gov (United States)

    Popović, Dugan D j; Spuran, Milan; Alempijević, Tamara; Krstić, Miodrag; Djuranović, Srdjan; Kovacević, Nada; Damnjanović, Svetozar; Micev, Marjan

    2011-03-01

    Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortuous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and supportive therapy. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

  18. CORRELATION BETWEEN TYMPANIC MEMBRANE PERFORATION AND HEARING LOSS

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    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.

  19. 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.

  20. 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.

  1. Bladder perforation in a peritoneal dialysis patient

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    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.

  2. Does Ramadan Fasting Increase duodenal ulcer perforation?

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    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.

  3. Granulocyte migration in uncomplicated intestinal anastomosis in man

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    Keshavarzian, A.; Gibson, R.; Guest, J.; Spencer, J.; Lavender, J.P.; Hodgson, H.J.

    1986-03-01

    We have investigated the presence, duration, and clinical significance of granulocyte accumulation, using indium-111 granulocyte scanning, in patients following uncomplicated intestinal anastomosis. Eight patients underwent intestinal resection and anastomosis (right hemicolectomy, 5; sigmoid colectomy, 2; ileal resection, 1) for carcinoma, angiodysplasia, or perforation. All patients had an uneventful postoperative course, with no evidence of any leakage or infection. Indium-111 granulocyte scan and abdominal ultrasound were performed 7-20 days (12 +/- 4.7 means +/- SD) following surgery. Indium-111 granulocyte scan showed the presence of labeled granulocytes at the site of anastomosis in all patients. In three of eight, cells subsequently passed into the lumen of the bowel. In contrast, granulocytes were not visualized along the abdominal incision. Thus, in contrast to skin wounds, granulocytes continue migrating into the intestinal wall in areas of anastomosis for at least up to 20 days following surgical trauma. They may play a significant role both in healing the anastomosis and in preventing systemic bacterial infection. Moreover, indium-111 granulocyte scans following intestinal surgery should be interpreted with care, and the presence of labeled granulocytes around anastomoses does not necessarily indicate abscess formation.

  4. Granulocyte migration in uncomplicated intestinal anastomosis in man

    International Nuclear Information System (INIS)

    Keshavarzian, A.; Gibson, R.; Guest, J.; Spencer, J.; Lavender, J.P.; Hodgson, H.J.

    1986-01-01

    We have investigated the presence, duration, and clinical significance of granulocyte accumulation, using indium-111 granulocyte scanning, in patients following uncomplicated intestinal anastomosis. Eight patients underwent intestinal resection and anastomosis (right hemicolectomy, 5; sigmoid colectomy, 2; ileal resection, 1) for carcinoma, angiodysplasia, or perforation. All patients had an uneventful postoperative course, with no evidence of any leakage or infection. Indium-111 granulocyte scan and abdominal ultrasound were performed 7-20 days (12 +/- 4.7 means +/- SD) following surgery. Indium-111 granulocyte scan showed the presence of labeled granulocytes at the site of anastomosis in all patients. In three of eight, cells subsequently passed into the lumen of the bowel. In contrast, granulocytes were not visualized along the abdominal incision. Thus, in contrast to skin wounds, granulocytes continue migrating into the intestinal wall in areas of anastomosis for at least up to 20 days following surgical trauma. They may play a significant role both in healing the anastomosis and in preventing systemic bacterial infection. Moreover, indium-111 granulocyte scans following intestinal surgery should be interpreted with care, and the presence of labeled granulocytes around anastomoses does not necessarily indicate abscess formation

  5. Zonulin: A Potential Marker of Intestine Injury in Newborns

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    Anna Tarko

    2017-01-01

    Full Text Available Introduction. Zonulin (ZO, a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Material and Methods. Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC, rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns. ZO concentration was compared to C-reactive protein (CRP and procalcitonin (PCT values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS. Results. Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2 and 20.3 (1-3Q: 17.7–28.2 ng/ml, resp. versus controls (3.5 (1-3Q: 2.7–4.8 ng/ml. Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT. Conclusions. Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine.

  6. Zonulin: A Potential Marker of Intestine Injury in Newborns.

    Science.gov (United States)

    Tarko, Anna; Suchojad, Anna; Michalec, Marta; Majcherczyk, Małgorzata; Brzozowska, Aniceta; Maruniak-Chudek, Iwona

    2017-01-01

    Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS). Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0-43.2) and 20.3 (1-3Q: 17.7-28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7-4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT. Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine.

  7. A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

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    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. The research progress of acute small bowel perforation

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    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.

  9. 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.

  10. 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)

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. 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...

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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...

  3. 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

  4. 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.

  5. Intestinal failure in childhood

    African Journals Online (AJOL)

    Insulin influences intestinal structure and absorptive function.36 The favourable effect of .... lipid emulsions, micronutrients provison and cyclic infusion.3 The guidelines on PN .... Classification, epidemiology and aetiology. Best Pract Res Clin ...

  6. 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.

  7. 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.

  8. 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...

  9. 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)

  10. 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

  11. 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....

  12. 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...

  13. 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.)

  14. 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...

  15. 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

  16. 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

  17. 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.

  18. 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...

  19. Intestinal Permeability: The Basics

    Directory of Open Access Journals (Sweden)

    Ingvar Bjarnason

    1995-01-01

    Full Text Available The authors review some of the more fundamental principles underlying the noninvasive assessment of intestinal permeability in humans, the choice of test markers and their analyses, and the practical aspects of test dose composition and how these can be changed to allow the specific assessment of regional permeability changes and other intestinal functions. The implications of increased intestinal permeability in the pathogenesis of human disease is discussed in relation to findings in patients with Crohn’s disease. A common feature of increased intestinal permeability is the development of a low grade enteropathy, and while quantitatively similar changes may be found in Crohn’s disease these seem to predict relapse of disease. Moreover, factors associated with relapse of Crohn’s disease have in common an action to increase intestinal permeability. While increased intestinal permeability does not seem to be important in the etiology of Crohn’s disease it may be a central mechanism in the clinical relapse of disease.

  20. 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)

  1. 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.

  2. 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...

  3. 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.

  4. Intestinal lymphangiectasia in adults.

    Science.gov (United States)

    Freeman, Hugh James; Nimmo, Michael

    2011-02-15

    Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed more extensive changes along the length of the small intestine. A critical diagnostic element in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders (e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following initial

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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 ...

  11. 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...

  12. 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.

  13. 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 ...

  14. 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

  15. 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 ...

  16. 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 ...

  17. 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 ...

  18. 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...

  19. 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.

  20. 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.

  1. [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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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 ...

  8. 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

  9. 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 ...

  10. 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.

  11. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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 ...

  15. 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.

  16. 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.

  17. 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 ...

  18. Perforated Gastric Ulcer Associated with Anti-Angiogenic Therapy

    Directory of Open Access Journals (Sweden)

    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.

  19. 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

  20. Diagnosis of intestinal and extra intestinal amoebiasis

    International Nuclear Information System (INIS)

    Lopez, Myriam Consuelo; Quiroz, Damian Arnoldo; Pinilla, Analida Elizabeth

    2007-01-01

    The objective is to carry out a review of the national and international literature as of the XXth century in order to update the advances for the diagnosis of complex odd Entamoeba histolytic / Entamoeba dispar and that of intestinal and extra intestinal amoebiasis that may be of use to the scientific community. As well as to unify the diagnostic criteria of this parasitosis known as a public health problem, and as a consequence of that, optimize the quality of population care. Data source: there was a systematic search for the scientific literature Publisher in Spanish and English since 1960 until today, this selection started on the first semester of 2006 until 2007, in the development of the line on intestinal and extra-intestinal amoebiasis of the Medical School of the National University of Colombia. A retrospective search process was carried out, systematically reviewing the most relevant articles as well as the products of this research line. In deciding how to make this article, there was a continuous search in different data bases such as Medline, SciELO and other bases in the library of the National University of Colombia, as well as other classical books related to the subject. For that purpose the terms amoebiasis, odd Entamoeba histolytic, Entamoeba, diagnosis, epidemiology, dysentery, amoebic liver abscess, were used. Studies selection: titles and abstracts were reviewed to select the original publications and the most representative ones related to this article's subject. Data extraction: the articles were classified according to the subject, the chronology and the authors according to the scientific contribution to solve the problem. Synthesis of the data: in the fi rst instance, a chronological critical analysis was carried out to order and synthesize the progress made in the diagnosis until confirmation of the experts' agreements in the field of amoebiasis was obtained throughout the world. Conclusion: this article summarizes what has taken place

  1. 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...

  2. 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)

  3. Small intestine diverticuli

    International Nuclear Information System (INIS)

    Pomakov, P.; Risov, A.

    1991-01-01

    The routine method of contrast matter passage applied to 850 patients with different gastrointestinal diseases proved inefficient to detect any small-intestinal diverticuli. The following modiffications of the method have been tested in order to improve the diagnostic possibilities of the X-ray: study at short intervals, assisted passage, enteroclysm, pharmacodynamic impact, retrograde filling of the ileum by irrigoscopy. Twelve diverticuli of the small-intestinal loops were identified: 5 Meckel's diverticuli, 2 solitary of which one of the therminal ileum, 2 double diverticuli and 1 multiple diverticulosis of the jejunum. The results show that the short interval X-ray examination of the small intestines is the method of choice for identifying local changes in them. The solitary diverticuli are not casuistic scarcity, its occurrence is about 0.5% at purposeful X-ray investigation. The assisted passage method is proposed as a method of choice for detection of the Meckel's diverticulum. 5 figs., 3 tabs. 18 refs

  4. Chronic intestinal pseudoobstruction syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Yeon, Kyung Mo; Seo, Jeong Kee; Lee, Yong Seok [Seoul National University Children' s Hospital, Seoul (Korea, Republic of)

    1992-03-15

    Chronic intestinal pseudoobstruction syndrome is a rare clinical condition in which impaired intestinal peristalsis causes recurrent symptoms of bowel obstruction in the absence of a mechanical occlusion. This syndrome may involve variable segments of small or large bowel, and may be associated with urinary bladder retention. This study included 6 children(3 boys and 3 girls) of chronic intestinal obstruction. Four were symptomatic at birth and two were of the ages of one month and one year. All had abdominal distension and deflection difficulty. Five had urinary bladder distension. Despite parenteral nutrition and surgical intervention(ileostomy or colostomy), bowel obstruction persisted and four patients expired from sepses within one year. All had gaseous distension of small and large bowel on abdominal films. In small bowel series, consistent findings were variable degree of dilatation, decreased peristalsis(prolonged transit time) and microcolon or microrectum. This disease entity must be differentiated from congenital megacolon, ileal atresia and megacystis syndrome.

  5. Small Intestinal Infections.

    Science.gov (United States)

    Munot, Khushboo; Kotler, Donald P

    2016-06-01

    Small intestinal infections are extremely common worldwide. They may be bacterial, viral, or parasitic in etiology. Most are foodborne or waterborne, with specific etiologies differing by region and with diverse pathophysiologies. Very young, very old, and immune-deficient individuals are the most vulnerable to morbidity or mortality from small intestinal infections. There have been significant advances in diagnostic sophistication with the development and early application of molecular diagnostic assays, though these tests have not become mainstream. The lack of rapid diagnoses combined with the self-limited nature of small intestinal infections has hampered the development of specific and effective treatments other than oral rehydration. Antibiotics are not indicated in the absence of an etiologic diagnosis, and not at all in the case of some infections.

  6. Comparison between strictureplasty and resection anastomosis in tuberculous intestinal strictures

    International Nuclear Information System (INIS)

    Zafar, A.; Qureshi, A.M.; Iqbal, M.

    2003-01-01

    Objective: To compare the effectiveness, safety and morbidity of strictureplasty with resection anastomosis in patients with tuberculous small gut strictures. Subjects and Methods: Thirty patients who presented with intestinal obstruction due to tuberculous strictures, and underwent either resection anastomosis or strictureplasty where included in the study. Data was collected on a proforma and analyzed using software SPSS (version 8.0). Chi-square and t-test were used to test the hypothesis. Main outcome measures included the presence or absence of postoperative leakage anastomosis, wound infection, recurrence of intestinal obstruction and postoperative study. Results: Chi-square test applied to see the effectiveness showed no significant difference (p>0.5) between the two procedures. t-Test on the score of morbidity also showed no significant difference (p>0.5) between the two procedures. Conclusion: Both procedures performed were equally effective and had equal morbidity in cases of intestinal tuberculous strictures. Strictureplasty is superior to resection anastomosis in cases of multiple strictures as it conserves gut length and can even be performed safely in cases with coexistent gut perforation. (author)

  7. 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.

  8. 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.

  9. Small intestine aspirate and culture

    Science.gov (United States)

    ... ency/article/003731.htm Small intestine aspirate and culture To use the sharing features on this page, please enable JavaScript. Small intestine aspirate and culture is a lab test to check for infection ...

  10. 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

    Directory of Open Access Journals (Sweden)

    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.

  11. Intestinal inflammatory myofibroblastic tumour

    African Journals Online (AJOL)

    abdominal X-ray of patients 1, 3 and 4 demonstrated dilated small bowel loops with fluid levels in keeping with intestinal ... myxoid/vascular pattern characterised by a variable admixture of capillary-calibre blood vessels, .... in the present study had a past history of abdominal trauma or surgery. Ancillary histopathological ...

  12. Human Intestinal Spirochaetosis

    NARCIS (Netherlands)

    Westerman, L.J.

    2013-01-01

    Human intestinal spirochaetosis is a condition of the colon that is characterized by the presence of spirochaetes attached to the mucosal cells of the colon. These spirochaetes belong to the family Brachyspiraceae and two species are known to occur in humans: Brachyspira aalborgi and Brachyspira

  13. Intestinal health in carnivores

    NARCIS (Netherlands)

    Hagen-Plantinga, Esther A.; Hendriks, W.H.

    2015-01-01

    The knowledge on the influence of gastro-intestinal (GI) microbiota on the health status of humans and animals is rapidly expanding. A balanced microbiome may provide multiple benefits to the host, like triggering and stimulation of the immune system, acting as a barrier against possible pathogenic

  14. Intestinal Complications of IBD

    Science.gov (United States)

    ... localized pocket of pus caused by infection from bacteria. More common in Crohn’s than in colitis, an abscess may form in the intestinal wall—sometimes causing it to bulge out. Visible abscesses, such as those around the anus, look like boils and treatment often involves lancing. Symptoms of ...

  15. Intestinal volvulus in cetaceans.

    Science.gov (United States)

    Begeman, L; St Leger, J A; Blyde, D J; Jauniaux, T P; Lair, S; Lovewell, G; Raverty, S; Seibel, H; Siebert, U; Staggs, S L; Martelli, P; Keesler, R I

    2013-07-01

    Intestinal volvulus was recognized as the cause of death in 18 cetaceans, including 8 species of toothed whales (suborder Odontoceti). Cases originated from 11 institutions from around the world and included both captive (n = 9) and free-ranging (n = 9) animals. When the clinical history was available (n = 9), animals consistently demonstrated acute dullness 1 to 5 days prior to death. In 3 of these animals (33%), there was a history of chronic gastrointestinal illness. The pathological findings were similar to those described in other animal species and humans, and consisted of intestinal volvulus and a well-demarcated segment of distended, congested, and edematous intestine with gas and bloody fluid contents. Associated lesions included congested and edematous mesentery and mesenteric lymph nodes, and often serofibrinous or hemorrhagic abdominal effusion. The volvulus involved the cranial part of the intestines in 85% (11 of 13). Potential predisposing causes were recognized in most cases (13 of 18, 72%) but were variable. Further studies investigating predisposing factors are necessary to help prevent occurrence and enhance early clinical diagnosis and management of the condition.

  16. Small intestinal motility

    NARCIS (Netherlands)

    Smout, André J. P. M.

    2004-01-01

    PURPOSE OF REVIEW: In the past year, many studies were published in which new and relevant information on small intestinal motility in humans and laboratory animals was obtained. RECENT FINDINGS: Although the reported findings are heterogeneous, some themes appear to be particularly interesting and

  17. An unusual case in which a perforated Meckel's diverticulum became trapped in a pericecal hernia: A rare complication of Meckel's diverticulum

    Directory of Open Access Journals (Sweden)

    Satohiko Yanagisawa

    2015-05-01

    Full Text Available An 11-year-old boy had previously been diagnosed with repeated Meckel's diverticulitis at another hospital. Emergency laparoscopy was performed under general anesthesia, and an inflammatory mass was seen in the ileocecal region of the mesentery. However, no Meckel's diverticulum (MD was observed, and so the patient was diagnosed with lymphadenitis. Three days after the operation, he developed anemia and gastrointestinal bleeding of unknown origin. Thus, he was transferred to our hospital for further investigation and to have his gastrointestinal bleeding treated. Based on imaging scans obtained at the previous hospital, a paraduodenal hernia was suspected, but no paraduodenal hernia was detected during emergency surgery, despite the fact that the full length of the normal small intestine could be traced. However, an inflammatory mass was observed, and the ileum appeared to be incarcerated in a pericecal hernia. We could not identify which portion of the intestine had become entrapped or reduce the hernia due to adhesion. The inflammatory mass was removed by ileocecal resection, and a pathological examination revealed that the entrapped portion of the intestine was an MD that had branched off from the small intestine immediately proximal to the ileocecal valve. The MD had perforated in the hernia sac, which had caused the patient's bleeding.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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)

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. [Intrauterine intestinal volvulus].

    Science.gov (United States)

    Gawrych, Elzbieta; Chojnacka, Hanna; Wegrzynowski, Jerzy; Rajewska, Justyna

    2009-07-01

    Intrauterine intestinal volvulus is an extremely rare case of acute congenital intestinal obstruction. The diagnosis is usually possible in the third trimester of a pregnancy. Fetal midgut volvulus is most likely to be recognized by observing a typical clockwise whirlpool sign during color Doppler investigation. Multiple dilated intestinal loops with fluid levels are usually visible during the antenatal ultrasound as well. Physical and radiographic findings in the newborn indicate intestinal obstruction and an emergency surgery is required. The authors describe intrauterine volvulus in 3 female newborns in which surgical treatment was individualized. The decision about primary or delayed anastomosis after resection of the gangrenous part of the small bowel was made at the time of the surgery and depended on the general condition of the newborn, as well as presence or absence of meconium peritonitis. Double loop jejunostomy was performed in case of two newborns, followed by a delayed end-to-end anastomosis. In case of the third newborn, good blood supply of the small intestine after untwisting and 0.25% lignocaine injections into mesentery led to the assumption that the torsion was not complete and ischemia was reversible. In the two cases of incomplete rotation the cecum was sutured to the left abdominal wall to prevent further twisting. The postoperative course was uneventful and oral alimentation caused no problems. Physical development of all these children has been normal (current age: 1-2 years) and the parents have not observed any disorders or problems regarding passage of food through the alimentary canal. Prompt antenatal diagnosis of this surgical emergency and adequate choice of intervention may greatly reduce mortality due to intrauterine volvulus.

  10. 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

  11. 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.)

  12. 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 ...

  13. 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.

  14. 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...

  15. 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.

  16. 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

  17. 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.)

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  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. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. Non-IPSID small intestinal lymphoma: Evidence for disseminated disease at presentation

    International Nuclear Information System (INIS)

    Milanovic, N.; Jelic, S.; Kovcin, V.; Opric, M.; Marinkovic, M.; Jovanovic, V.

    1994-01-01

    During the period 1984-1989 the authors have observed 20 patients with non-immuno-proliferative small intestinal disease (non-IPSID) small intestinal lymphomas, 11 males and 9 females. In 11 patients the first symptoms were abdominal cramps requiring laparotomy, in 4 ills, and in 5 perforation with peritonitis. Resection of the involved part of the intestine was performed in 17 patients. Lymphoma tissue was present in 4 of 5 retrogradely examined resection lines on macroscopically normal small intestine. According to Working Formulation, 3 patients had low grade, 3 intermediate grade and 14 high grade histology. Affection of extra intestinal/mesenteric structures was found in 18 of 20 patients, with a total of other lymphoma localizations. 8 of 20 affection of the nasopharynx and/or Waldeyer's ring. According to Crowther's classification 55 % patients were in Stage IV, 35 % in Stage III and 10 % in stage Ib. All patients were treated with chemotherapy, 13 with ProMACE regimen and 7 with CHOP-type regimens. Ten of twenty patients are alive and in complete remission for over 5 years (7 of 11 of Stage IV and 3 of 9 of Stage Ib/III; 8 of 14 with high grade and 2 of 6 with intermediate/low grade histology). Our results point to the fact that in non-IPSID lymphoma of the small intestine, lymphoma involvement of the intestinal wall might be present beyond obvious lymphoma lesions. Most patients with apparently primary small intestinal lymphoma have a widespread disease. Thus, local forms of treatment such as surgery and/or radiotherapy can not be expected to be curative in the majority of patients. Data from this study suggest that following initial surgery the chemotherapy is the treatment of choice for these patients. (author)

  10. 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

  11. ACUTE INTESTINAL INFECTION AS A DISGUISE OF ACUTE APPENDICITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Y. Y. Dyakonova

    2016-01-01

    Full Text Available The issue of differential diagnosis of acute appendicitis and acute intestinal infections in contemporary medicine remains relevant for clinical practice of surgeons and pediatricians. Late diagnosis of appendicitis results in development of complicated forms of vermiform appendix inflammation. This prolongs operative intervention, duration of antibacterial therapy and duration of a child’s inpatient stay. The article presents clinical observation of three children treated for perforated appendix and generalized purulent peritonitis. The described cases demonstrate the need in multidisciplinary approach and complex diagnosis of patients with such complaints as abdominal pain, fever and diarrhea.

  12. Small intestinal transplantation.

    LENUS (Irish Health Repository)

    Quigley, E M

    2012-02-03

    The past few years have witnessed a considerable shift in the clinical status of intestinal transplantation. A great deal of experience has been gained at the most active centers, and results comparable with those reported at a similar stage in the development of other solid-organ graft programs are now being achieved by these highly proficient transplant teams. Rejection and its inevitable associate, sepsis, remain ubiquitous, and new immunosuppressant regimes are urgently needed; some may already be on the near horizon. The recent success of isolated intestinal grafts, together with the mortality and morbidity attendant upon the development of advanced liver disease related to total parenteral nutrition, has prompted the bold proposal that patients at risk for this complication should be identified and should receive isolated small bowel grafts before the onset of end-stage hepatic failure. The very fact that such a suggestion has begun to emerge reflects real progress in this challenging field.

  13. 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.

  14. 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.

  15. Chronic intestinal pseudo-obstruction associated with enteric ganglionitis in a Persian cat

    Directory of Open Access Journals (Sweden)

    Jeremy Mortier

    2016-06-01

    Full Text Available Case summary A 7-year-old neutered male Persian cat was presented for acute vomiting and inappetence. Physical examination revealed severe abdominal distension. Radiographs demonstrated pneumoperitoneum, megaoesophagus and generalised gaseous distension of the digestive tract. Exploratory coeliotomy was performed, revealing markedly distended and thickened small and large intestines with no observable peristalsis. No intestinal perforation was present. Bacteriological and cytological analysis of abdominal fluid revealed a septic peritonitis involving Pasteurella multocida . Full-thickness intestinal biopsies demonstrated lymphocytic ganglioneuritis localised to the enteric nervous system, in association with glandular atrophy and muscular layer hypertrophy. Amoxicillin-clavulanate and analgesics were given. The cat’s general condition gradually improved after the addition of pyridostigmine bromide (0.5 mg/kg q12h PO, initiated 3 days postsurgery. Vomiting resolved and did not recur. Follow-up radiographs at 15 days, and 1 and 6 months showed persistent intestinal ileus, milder than on the pretreatment radiographs. Thirty months after presentation the cat is still alive, without clinical signs, and receives 1 mg/kg q12h pyridostigmine. Relevance and novel information To our knowledge, this is the first case of ganglioneuritis of the myenteric plexus described in cats, as well as the first one successfully treated with pyridostigmine. Chronic intestinal pseudo-obstruction is a very rare condition in cats but should be included in the differential diagnosis of generalised gastrointestinal ileus.

  16. Chronic intestinal pseudo-obstruction associated with enteric ganglionitis in a Persian cat.

    Science.gov (United States)

    Mortier, Jeremy; Elissalt, Estelle; Palierne, Sophie; Semin, Marie Odile; Delverdier, Maxence; Diquélou, Armelle

    2016-01-01

    Case summary A 7-year-old neutered male Persian cat was presented for acute vomiting and inappetence. Physical examination revealed severe abdominal distension. Radiographs demonstrated pneumoperitoneum, megaoesophagus and generalised gaseous distension of the digestive tract. Exploratory coeliotomy was performed, revealing markedly distended and thickened small and large intestines with no observable peristalsis. No intestinal perforation was present. Bacteriological and cytological analysis of abdominal fluid revealed a septic peritonitis involving Pasteurella multocida . Full-thickness intestinal biopsies demonstrated lymphocytic ganglioneuritis localised to the enteric nervous system, in association with glandular atrophy and muscular layer hypertrophy. Amoxicillin-clavulanate and analgesics were given. The cat's general condition gradually improved after the addition of pyridostigmine bromide (0.5 mg/kg q12h PO), initiated 3 days postsurgery. Vomiting resolved and did not recur. Follow-up radiographs at 15 days, and 1 and 6 months showed persistent intestinal ileus, milder than on the pretreatment radiographs. Thirty months after presentation the cat is still alive, without clinical signs, and receives 1 mg/kg q12h pyridostigmine. Relevance and novel information To our knowledge, this is the first case of ganglioneuritis of the myenteric plexus described in cats, as well as the first one successfully treated with pyridostigmine. Chronic intestinal pseudo-obstruction is a very rare condition in cats but should be included in the differential diagnosis of generalised gastrointestinal ileus.

  17. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    LENUS (Irish Health Repository)

    O'Kelly, F

    2012-03-01

    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace\\'s theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation.

  18. 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

  19. Peritonitis by jejunal ulcer perforation in a child: a case report

    Directory of Open Access Journals (Sweden)

    Ndèye Aby Ndoye

    2017-01-01

    Full Text Available Ulcer perforation is a rare cause of peritonitis in children. The cases reported in the literature are caused by peptic ulcer. We report on a case of peritonitis caused by jejunal ulcer perforation, discovered in a girl's abdomen during an acute surgical procedure. The treatment consisted of a resection of the perforation followed by an end-to-end anastomosis. Postoperative period was uneventful.

  20. Color Doppler Ultrasonography-Targeted Perforator Mapping and Angiosome-Based Flap Reconstruction

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Tei, Troels; Thomsen, Jørn Bo

    2016-01-01

    Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstr......Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap...

  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. Right ventricular perforation by a passive-fixation pacemaker lead two weeks after implantation

    Directory of Open Access Journals (Sweden)

    Azeem S. Sheikh, BSc, MBBS, FCPS, MRCP

    2014-12-01

    Full Text Available Myocardial perforation is a rare complication of permanent pacemaker implantation. While most of the perforations occur at the time of implantation or within the first 24 h, delayed myocardial perforations are very rare. The clinical course is extremely variable with some patients presenting completely asymptomatic, while others can develop cardiac tamponade and haemodynamic instability. We report an unusual case of a subacute ventricular perforation caused by a passive-fixation lead two weeks after implantation and we successfully managed to extract the lead under local anaesthesia, without the patient undergoing surgery, as recommended in the previously published reports.

  4. Lipo sarcoma in small intestine

    International Nuclear Information System (INIS)

    Rodriguez Iglesias, J.; Pineyro Gutierrez, A.; Taroco Medeiros, L.; Fein Kolodny, C.; Navarrete Pedocchi, H.

    1987-01-01

    A case is presented by primitive liposarcoma in small intestine , an extensive bibliographical review foreigner and national in this case. It detach the exceptional of the intestinal topography of the liposarcomas; and making stress in the relative value of the computerized tomography and ultrasonography in the diagnose of the small intestine tumors . As well as in the sarcomas of another topography, chemo and radiotherapy associated to the exeresis surgery, it can be of benefit [es

  5. Perforating pilomatrixoma showing atypical presentation: A rare clinical variant

    Directory of Open Access Journals (Sweden)

    Nevra Seyhan

    2018-03-01

    Full Text Available Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a rare benign skin tumor arising from hair follicle stem cells. The most common localization is the head and neck region. Female/male ratio is 3/2. It shows deep subcutaneous placement and occurs in the first two decades of life. Its diameter ranges from 0.5 cm to 3 cm. Multiple lesions are rarely seen. Histopathologically it is characterized by basoloid and ghost cells. Perforating type is a rare clinical variant. Treatment is surgical excision. Our case is presented to draw attention to a rare clinical variant of pilomatrixioma.

  6. Expanding Application of Perforated Metal Materials in Construction and Architecture

    Science.gov (United States)

    Mironovs, V.; Tatarinov, A.; Gorbacova, S.

    2017-10-01

    Perforated metal materials (PMM) combine a range of properties, including rigidity, strength, lightweight, small thickness, a dosed transparency and decorative attractiveness. All these bring new application effects in construction industry and architecture. Nowadays, PMM are widely used in design of facades and interiors all over the world, becoming more popular in Latvia as well. The paper touches several aspects of PMM applications, including its decoration function, shadowing of sunlight, sound and noise barrier function and the problem of corrosion when exploited outdoors. Possible perfection may include using different coatings, multi-layer design variants and integration with other constructional materials in order to provide better sound absorption, corrosion resistance and functionality.

  7. Rectum perforation during transanal irrigation: a case story

    DEFF Research Database (Denmark)

    Biering-Sørensen, F; Bing, J; Berggreen, P

    2008-01-01

    STUDY DESIGN: Case report. OBJECTIVES: Report a case of rectum perforation during transanal irrigation (TAI). SETTING: Clinic for Spinal Cord Injuries, and Departments of Gastroenterological Surgery and Radiology. CASE REPORT: A 54-year-old woman with spinal cord lesion for 35 years emptied...... for years her bowel using oral laxative. This became more difficult and took more than 2 h three times a week with reflex stimulation after a chlysma. She wanted to try TAI, and went through the procedure with a nurse one time. The next time she performed the TAI by herself without difficulty. Two hours...

  8. A rare case of familial reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Rajesh Verma

    2013-01-01

    Full Text Available A 4 year old boy presented with history of itchy raised lesions on body of 2 years duration. Though parental consanguinity was not present, his elder brother had similar complaints. Dermatological examination revealed multiple hyperpigmented papules with a central keratotic plug distributed mainly over face and extensors of upper and lower extremities. Koebnerisation was present. Skin biopsy revealed perforating collagen bundles in the upper dermis and epidermis which was confirmed by Van Gieson staining. Patient was being treated with topical retinoids and intralesional corticosteroids with minimal relief.

  9. Large Epiphrenic Diverticulum with Perforation and Leakage below the Diaphragm

    DEFF Research Database (Denmark)

    Brønserud, Majken Munk; Brenøe, Anne-Sofie; Eckardt, Jens

    2015-01-01

    contrast revealed contrast leakage near the minor curvature of the stomach. The following esophagogastroduodenoscopy demonstrated a giant dilatation of the esophagus, as well as a second esophageal lumen originating 25 cm from the incisors. The “false” lumen of the esophagus was located parallel...... to esophagus, ending blindly in a perforation below the diaphragm. The clinical presentation and the patient’s age make it most likely, that it was a long epiphrenic diverticulum of pulsion type. The patient was treated conservatively, discharged after 10 days and has been followed in our outpatient clinic...... for 8 months, until he died of aggressive pulmonary cancer....

  10. [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.

  11. 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.

  12. Imaging findings of perforative appendicitis: a pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Hopkins, K.L.; Patrick, L.E.; Ball, T.I. [Dept. of Radiology, Children' s Healthcare of Atlanta, Egleston, GA (United States)

    2001-03-01

    Appendicitis is common in children. Early diagnosis depends on recognition of characteristic signs and symptoms: right lower quadrant or periumbilical pain, localized tenderness, fever, and leukocytosis. Because these classic features may be difficult to elicit or masked by other complaints, the incidence of perforative appendicitis in children is high. This paper reviews the imaging sequelae with emphasis on CT and sonography findings. Areas of focus include abdominopelvic abscess, peritonitis, pyelephlebitis, pyelethrombosis, and hepatic abscess. Secondary involvement of the urinary and gastrointestinal tracts is also discussed. (orig.)

  13. Endoscopic treatment of colorectal perforations – a systematic review

    DEFF Research Database (Denmark)

    Hassan, Mohamed Ali; Thomsen, Christian Øystein; Vilmann, Peter

    2016-01-01

    invasive therapy. The aim of this systematic review was to assess the existing evidence in this field. METHODS: Literature was searched on PubMed, Embase and the Cochrane databases. Papers found were reported according to the PRISMA guidelines. Trials on animals were excluded. RESULTS: A total of 32...... success rate of 87.8% (standard deviation: ± 13.0%) on average and a median of 92.3% (range: 58.6-100%). The total number of patients needing surgery after attempted clip closure was 30 (14.7%); another four were found to have sealed perforations during surgery. One patient died after clip failure (0...

  14. Endoscopic treatment of colorectal perforations--a systematic review

    DEFF Research Database (Denmark)

    Hassan, Mohamed Ali; Thomsen, Christian Øystein; Vilmann, Peter

    2016-01-01

    invasive therapy. The aim of this systematic review was to assess the existing evidence in this field. METHODS: Literature was searched on PubMed, Embase and the Cochrane databases. Papers found were reported according to the PRISMA guidelines. Trials on animals were excluded. RESULTS: A total of 32...... success rate of 87.8% (standard deviation: ± 13.0%) on average and a median of 92.3% (range: 58.6-100%). The total number of patients needing surgery after attempted clip closure was 30 (14.7%); another four were found to have sealed perforations during surgery. One patient died after clip failure (0...

  15. Pseudotumoural gastric lesion caused by fish bone perforation

    Directory of Open Access Journals (Sweden)

    Walid Al-Deeb

    2009-01-01

    Full Text Available

    We report the case of a 34-year-old previously fit and healthy male who presented to the accident & emergency department with non-specific abdominal pain. The patient proceeded to undergo laparotomy at which a large mass was found adjacent to the stomach. The impression at surgery was of a lymphoma or gastric carcinoma though CT had reported the likelihood of a fish bone or foreign body causing duodenal perforation. Histology later confirmed the presence of a fish bone surrounded by reactive tissue.

  16. Cloacolithiasis and intestinal lymphosarcoma in an African black-footed penguin (Spheniscus demersus).

    Science.gov (United States)

    Jones, Krista L; Field, Cara L; Stedman, Nancy L; MacLean, Robert A

    2014-06-01

    A 13-yr-old male African black-footed penguin (Spheniscus demersus) presented thrice over 7 mo with gastrointestinal obstruction secondary to cloacolithiasis. Clinical signs consistently resolved with cloacolith removal and supportive care. However, 10 mo after initial presentation, it presented with similar signs, plus significant weight loss. No cloacolith was found, and it subsequently died. Significant gross findings included bilateral cecal masses, colonic perforation, and marked secondary coelomitis, multifocal tan to pale hepatic nodules, and pale kidneys with miliary white foci. Histopathologic diagnoses were intestinal lymphosarcoma with hepatic and renal metastases, secondary intestinal rupture, and subacute severe bacterial coelomitis. To the authors' knowledge, this is the first full report of either cloacolithiasis or lymphosarcoma in a penguin.

  17. Evisceration of the intestine following blunt force impact: Highlighting management

    Directory of Open Access Journals (Sweden)

    Rikki Singal

    2015-01-01

    Full Text Available Aims and objectives: Evisceration of the abdominal parts following traumatic injury with high velocity impact is a rare entity. We are reporting five cases of high velocity injury with different findings. Our objectives are to present the potential clinical impact of injury and requirement of early management. Materials and Methods: The present study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Mullana, from March 2010 to March 2013. A total of 150 cases were admitted, diagnosed with blunt and penetrating abdominal wall injury. We are presenting five cases diagnosed as eviscerated abdominal injury. Ultrasonography (USG and computed tomography was done which helped us in their management. Results: A total of five cases were admitted with evisceration of the abdominal parts. One case presented with a rare finding as the stomach and intestine were lying outside and on surgery, multiple perforations of the small intestine were seen. Ultrasonography and computed tomography (CT helped in the management of the patient. Conclusion: High velocity impact due to road side accidents can lead to severe abdominal organ injury or evisceration of the abdominal parts. It can cause morbidity and mortality, if not treated on time. USG and CT scans are the important diagnostic tools for diagnosing and preventing further complications. We came out with better prognosis as cases were operated on time. We treated the patients successfully without any mortality.

  18. Perforated duodenal ulcer; management in a resource poor, semi-urban nigerian hospital.

    Science.gov (United States)

    Oribabor, Felix O; Adebayo, Bamidele O; Aladesanmi, Tunde; Akinola, David O

    2013-01-01

    Perforated duodenal ulcer (PDU) is still seen frequently in the study center inspite of the free use of effective medical curative therapy. We then set out to ascertain the pattern of presentation, peculiar risk factors in the study environment, re-evaluate our method of management, and to see if it is adequate for patients in a developing country. This is a retrospective study of patients admitted and managed for PDUs, between January 2004 and December 2011 at the Federal Medical Centre, IdoEkiti, Southwest Nigeria. The records of patients were retrieved and demographic data relating to age, sex, symptoms, duration, diagnosis, intra-operative findings, and management outcome were extracted. The results were analyzed. A total of 30 patients were admitted and operated during this period. Twenty-eight of them were males and two were females. The mean age was 47 years and the male: female ratio was 14:1. The duration of symptoms before presentation ranged from 2 to 7 days. None of the patients had a prior diagnosis of their ulcers, by an upper gastro intestinal endoscopy before presentation; although most had dyspeptic symptoms, with inadequate or no medical treatment. The notable peculiar risk factor was the abuse of local herbal concoction for body pains by all the patients. Seven patients smokes, 15 consumes alcohol, and only two take non-steroidal anti-inflammatory drugs for body pains. Most of the managed patients; 26 were satisfactorily discharged home and later followed-up at the surgical out-patient department. Four mortality was recorded during the period of study. PDU is still a major complication of chronic peptic ulcer disease. Simple omental patch and H. pylori eradication is no longer appropriate as a mode of treatment for the youths who are mostly affected in the center. We therefore, suggest a more wide spread use of definitive ulcer surgery for most of our patients with no pre-operative risk factors.

  19. Intestinal invagination in children under 24 months: description of 8 years: 2001-2008

    International Nuclear Information System (INIS)

    Mazariegos Zamora, Gabriela

    2010-01-01

    The safety of new rotavirus vaccines has been a worldwide concern, in relation to the association with increased risk of intestinal invagination. Costa Rica is found without published information on the epidemiology of intestinal research, which has been of utmost importance to obtain sufficient comparative data with cases that may occur after the introduction of such vaccines. A retrospective and descriptive study was conducted of all documented cases of intestinal invagination in children under 24 months, during 2001-2008 at the Hospital Nacional de Ninos D r. Carlos Saenz Herrera . 182 children have met the inclusion criteria. 105 (57.7%) of the cases have occurred in males. The average incidence rate of intestinal invagination has been of 31 per 100,000 live births. 85,2% of cases have occurred in children under 12 months, with an average age of 7.7 months. The presence of vomiting has been the most frequent in 84.6% of patients, followed by 58.2% abdominal pain manifestation, and bloody stool in 57.5% of cases. Abdominal ultrasound diagnostic method has been the most frequently used and has confirmed intestinal invagination in 167 cases (97.6%). Underwent gastroscopy was performed to 151 (82.96%) of the 182 patients. Hydrostatic reduction was achieved in 69 patients (45.6%). 103 patients (56.30%) have required to be taken to the operating room, of which 82 patients have had colon enema failed. 160 patients (87.9%) have been presented without complications. Intestinal perforation has been the most frequent complication. The study period has showed without reported deaths. The epidemiology of intestinal invagination in the Hospital Nacional de Ninos in Costa Rica, as research has served as a basis for other projects associated with the introduction of rotavirus vaccines in the vaccination schedule in the country. (author) [es

  20. Intestinal parasites : associations with intestinal and systemic inflammation

    NARCIS (Netherlands)

    Zavala, Gerardo A; García, Olga P; Camacho, Mariela; Ronquillo, Dolores; Campos-Ponce, Maiza; Doak, Colleen; Polman, Katja; Rosado, Jorge L

    2018-01-01

    AIMS: Evaluate associations between intestinal parasitic infection with intestinal and systemic inflammatory markers in school-aged children with high rates of obesity. METHODS AND RESULTS: Plasma concentrations of CRP, leptin, TNF-α, IL-6 and IL-10 were measured as systemic inflammation markers and