PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “INTESTINAL PERFORATION”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2006

The role of laparotomy for intestinal perforation in very low birth weight infants.

BACKGROUND/PURPOSE: The management of intestinal perforation in very low birth weight (VLBW) infants (less than 1500 g) is controversial. Current practice favors peritoneal drainage (PD) with or without a delayed laparotomy over primary laparotomy (PL). We compared the outcomes of PD +/- delayed laparotomy vs PL in VLBW infants using the Score for Neonatal Acute Physiology with Perinatal Extension (SNAPPE-II) as a validated predictor of mortality. METHODS: A retrospective analysis (1998-2003) of VLBW infants with intestinal perforation at 2 pediatric centers was undertaken. Data retrieval included neonatal demographics and parameters for SNAPPE-II calculation. The primary end point was 30-day mortality. Other outcome measures included in-hospital mortality, days fasting, days to extubation, and length of stay. Statistical analysis was performed with either Student's t test or chi2 analysis. Subgroup and multivariate analyses were also performed. P values < .05 were considered significant. RESULTS: Fifty-two neonates (25 PD, 27 PL) were reviewed. Overall, 10 (19.2%) infants died. Observed 30-day mortality rates in PD and PL groups were 32% and 7.4% (P = .028), respectively. Average SNAPPE-II scores for PD (42.5 +/- 20.8) and PL (25.1 +/- 14.6) groups yielded predicted mortality rates of 15.7% and 4.9% (P = .001), respectively. PD group 30-day mortality far exceeded the rate predicted by the SNAPPE-II score. Days fasting (13.7 vs 20.4; P = .0001), days to extubation (26.7 vs 51.5; P = .014), and length of stay (56.1 vs 83.6; P = .031) all favored the PL group despite incorporating SNAPPE-II score as a covariate into the multivariate analysis. Of the 25 patients receiving drainage, 9 underwent PD alone (SNAPPE-II = 46.6 +/- 27.9), whereas 16 patients underwent delayed laparotomy (SNAPPE-II = 37.8 +/- 17.6). The PD-only group had a greatly elevated mortality rate (77.8% vs 15.7% predicted), whereas the delayed laparotomy group had a reduced mortality rate (6.3% vs 9.3% predicted). CONCLUSION: Our data suggest that laparotomy, either alone or after PD, provides an improved outcome in VLBW infants with intestinal perforation. PD should be used as a temporizing measure until laparotomy can be performed.

Drainage↗
PubMed2000

Intestinal perforation by foreign bodies.

OBJECTIVE: To present our experience of patients who presented with intestinal perforation by foreign bodies to our hospital between 1980 and 1998. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 21 patients who presented with intestinal perforation by foreign bodies. MAIN OUTCOME MEASURES: Size of perforations, nature of foreign bodies, clinical symptoms, radiological findings, treatment and outcome. RESULTS: The most common location was the terminal ileum (n = 11), followed by the rectosigmoid junction (n = 5). The objects were mainly bone fragments and toothpicks. The diagnosis was generally made at operation, and only 4 of the 21 patients had signs of pneumoperitoneum on the preoperative abdominal film. The most common treatment was simple suture of the defect. CONCLUSIONS: Intestinal perforation by a foreign body is uncommon, and normally affects the ileocaecal and rectosigmoid regions, in which it is unusual to find pneumoperitoneum preoperatively. It must be considered in the differential diagnosis of such conditions as acute appendicitis and diverticulitis.

Adolescent↗
PubMed2004

Spontaneous intestinal perforation after oral ibuprofen treatment of patent ductus arteriosus in two very-low-birthweight infants.

AIM: To discuss intestinal side effects of ibuprofen in the treatment of patent ductus arteriosus, after having observed two cases of spontaneous intestinal perforation following ibuprofen treatment. METHODS: Clinical and laboratory records of two preterm infants, who developed intestinal perforation after ibuprofen administration, were evaluated. RESULTS: Gestational ages of infants were 29 wk (male) and 30 wk (female). Both infants developed intestinal perforations without signs of necrotizing enterocolitis. The perforations cured with Penrose drainage alone. CONCLUSION: Although ibuprofen is a reasonable treatment alternative to indomethacin, randomized controlled trials, which address potential adverse effects including spontaneous intestinal perforation, are needed.

Administration, Oral↗
PubMed2000

Can falls on stairs result in small intestine perforations?

OBJECTIVE: Abusive parents often report that a fall on stairs resulted in their children's injuries. This review explores whether there is any evidence in the medical literature that a fall on stairs could be a plausible explanation for a small intestine perforation. METHODOLOGY: The English-language medical literature was searched by Medline, for a 29-year period (1970-1998), for reports of the types of injuries sustained in falls on stairs and for reports of the types of blunt abdominal trauma that result in small intestine perforations. Articles that exclusively focused on infant walker injuries or the elderly were excluded. Duodenal, jejunal, and ileal perforations were included, whereas intestinal hematomas and undescribed intestinal injuries were excluded. All types of injuries to the stomach, colon, and rectum were excluded. RESULTS: Falls on stairs were not reported to be a cause for any of the 312 cases of small intestine perforations reviewed. There were no reports of any intraabdominal injuries, including small intestine perforations, in any of the 677 cases of falls on stairs reviewed. Falls on stairs rarely resulted in any type of truncal injury. CONCLUSIONS: Although falls on stairs have been reported to be the most common cause of injury in childhood, no evidence was found to support the contention that an unobstructed fall on stairs could be consistent with perforation of the small intestine.

Abdominal Injuries↗
PubMed1995

In-utero cocaine exposure and neonatal intestinal perforation: a case report.

This article describes a case of spontaneous neonatal intestinal perforation in a preterm infant with evidence of intrauterine exposure to cocaine. Clinical, laboratory, radiological, surgical, and pathological finds were inconsistent with necrotizing enterocolitis. Three previous case reports had made the association between spontaneous focal neonatal intestinal perforation and prior intrauterine cocaine exposure; however, in each case, there were extenuating circumstances that may weaken the etiological link. The case described here appears to strengthen the association/etiological link. After all other causes of focal neonatal intestinal perforation have been excluded, the possibility of intrauterine exposure to cocaine should be considered.

Adult↗
PubMed1982

An experimental study of the effect of an intestinal perforation at various developmental stages.

The effect of an experimentally induced intestinal perforation was studied in chick embryos. In 5 different groups of embryos a perforation was induced at 5 different developmental stages, while an equal number of sham operations was carried out for each stage. The results demonstrate that the effect of an intestinal perforation is determined by the developmental stage at which this perforation occurs. There was an inverse relationship between the developmental stage at which the perforation was induced and the remaining traces of the perforation site at the end of incubation. A perforation induced at an earlier developmental stage was more likely to lead to intestinal atresia coupled with only microscopic signs of meconium peritonitis. The severity of the adhesions increased concurrently with the developmental stage.

Animals↗
PubMed2005

Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis.

OBJECTIVE: Candida and coagulase-negative staphylococci are emerging pathogens associated with focal intestinal perforation (FIP) and necrotizing enterocolitis (NEC) in neonates. The objective of this study was to determine whether there are significant differences in the predominant pathogens in culture-positive cases of peritonitis associated with FIP compared with NEC in neonates. METHODS: A retrospective cross-sectional study was conducted of neonates with peritoneal culture-positive peritonitis associated with FIP or NEC over a 12-year study period (1989-2000). Cases with peritonitis were identified from a microbiology database. NEC was defined by radiologic evidence of pneumatosis intestinalis or portal venous gas or by pathology reports or surgical operative notes describing large areas of transmural bowel necrosis. FIP was defined as a <1-cm intestinal perforation surrounded by otherwise normal tissue in the absence of NEC. RESULTS: Thirty-six cases of FIP were compared with 80 cases of NEC. Birth weight and gestational age were significantly lower in infants with FIP compared with NEC. Age at intestinal perforation and case fatality rates were similar between FIP and NEC. There were striking differences in the distribution of predominant pathogens associated with peritonitis in NEC and FIP cases. Enterobacteriaceae were present in 60 (75%) of 80 NEC cases compared with 9 (25%) of 36 FIP cases. In contrast, Candida species were found in 16 (44%) of 36 FIP cases compared with 12 (15%) of 80 NEC cases, and coagulase-negative staphylococci were present in 18 (50%) of 36 FIP cases versus 11 (14%) of 80 NEC cases. There were no significant differences between FIP and NEC cases for the presence of Enterococcus species (28% vs 23%) or anaerobes (3% vs 6%). Stratified analysis for birth weight <1200 g found similar significant differences in the predominant pathogens for FIP (n = 29) and NEC (n = 38). Results from peritoneal fluid cultures resulted in changes in antimicrobial therapy in 46 (40%) of 116 cases. CONCLUSIONS: Candida species and coagulase-negative staphylococci were the predominant pathogens in FIP peritonitis in contrast to Enterobacteriaceae in NEC peritonitis. A peritoneal fluid culture should be obtained in all neonates with intestinal perforation, regardless of cause, because it may help to direct the choice of the most effective antimicrobial.

Bacteria, Anaerobic↗
PubMed2006

[Pseudo-"isolated" intestinal perforation in a very low birth weight infant: exceptional presentation of Hirschsprung's disease].

Intestinal perforations in preterm newborn are characterized with high morbidity and mortality rates. They often are associated with necrotizing enterocolitis and seldom correspond to idiopathic spontaneous intestinal perforation. Perforations upstream of an intestinal organic obstruction (atresia), or of a functionnal obstruction (meconium-ileus, Hirschsprung disease) have been considered to be rare in preterm newborns. We report a case of caecal perforation with a pneumoperitoneum which occurred at 5 days of life, in a 28-week gestational age infant, that was treated by cecostomy. There were no signs of necrotizing enterocolitis. At 43 days of life, the preoperative contrast enema study revealed a left colon transition zone, suggesting a Hirschsprung disease, which was confirmed by rectal biopsies. Transanal pull-through was performed. There were no postoperative complication. This case demonstrates that an isolated intestinal perforation in very preterm newborn can reveal a Hirschsprung disease, especially if it occurs in the caecum.

Cecum↗
PubMed1966

Radiographic diagnosis of intestinal perforation in early infancy.

Records of 25 patients with intestinal perforation in early infancy who were treated at the Los Angeles County General Hospital in a period of 15 years were reviewed. Sixteen had roentgen evidence of pneumoperitoneum, and nine did not. The mortality rate was 94 per cent in the group with pneumoperitoneum, 78 per cent in the other, and 88 per cent overall. Multiple sites in the gastrointestinal tract were involved, and the causes of the lesions were diverse and frequently obscure. Prematurity, obstetrical and iatrogenic complications, and congenital anomalies were factors often associated with intestinal perforation. Roentgen features appeared to offer the best hope for diagnosis and appropriate treatment.

Female↗
PubMed2005

Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age.

OBJECTIVE: To compare growth and neurodevelopment in surviving very low birth weight (VLBW) infants with an intestinal perforation (IP) caused by necrotizing enterocolitis (NEC) versus spontaneous intestinal perforation (SIP). STUDY DESIGN: Retrospective, observational cohort study. Infants born between January 1996 and December 1999 with birth weight <1500 g and a diagnosis of intestinal perforation were identified and data extracted from NICU, surgical and hospital databases. RESULTS: IP was identified in 62 of 1357 VLBW infants (5%); 39 infants (63%) had surgical NEC and 23 (37%) had SIP. Among survivors, 21/28 with surgical NEC (75%) and 13/18 with SIP (72%) returned for follow-up. At 1-year adjusted age, there were no differences in growth parameters but the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) were lower in survivors with NEC versus SIP (mean difference in MDI=15; 95% confidence limits=3, 28; p=0.02; mean difference in PDI=14; 95% confidence limits=0.4, 28; p=0.04). CONCLUSIONS: Intestinal perforation caused by NEC, as compared to SIP, is associated with worse neurodevelopmental outcome at 1 year.

Child Development↗
PubMed1977

Scleroderma and intestinal perforation.

We report four cases of scleroderma and intestinal perforation. There were three instances of colonic perforations, two associated with fecal impaction and stercoral ulceration and one with evidence of vasculitis. The fourth patient was an unusual instance of spontaneous perforation of the small intestine in scleroderma.

Adolescent↗
PubMedDate not supplied

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

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 medically and one of four patients treated surgically for whom the postoperative courses were known. A literature review of 57,864 cases of typhoid fever in developing countries in the antibiotic era revealed that perforation developed in 2.5% of patients, a percentage that was similar to the incidence of 2.8% reported in the preantibiotic era. The median of case-fatality rates in these reports was 43% and the proportion of all reported typhoid deaths attributable to perforation was 25%. The case-fatality rates for patients with perforation were 70% for 410 patients managed medically and 26% for 1,835 patients managed surgically. Although some reports were biased toward placing patients at lower risk into surgical treatment, the large number of patients treated successfully by surgery suggests real improvement in surgical techniques in countries with endemic typhoid fever. These results indicate that intestinal perforation persists as a major cause of death in cases of typhoid fever in developing countries in the antibiotic era and that surgical treatment with use of antibiotic therapy is optimal for this complication.

Adolescent↗
PubMedDate not supplied

[Late intestinal perforations after alloplastic repair of postoperative eventrations].

Late intestinal perforation is the most rare and the most serious complication following the repair of abdominal parietal defects with alloplastic material. The authors have gathered in 7 years 6 cases of perforations which occurred between 1 and 10 years after using nonabsorbable synthetic mesh prostheses made of polyester (4 cases) and polypropylene (2 cases) as parietal substitution materials. The perforations were discovered either by the appearance of complete enteric fistulas after exploration of circumscribed parietal suppurations (3 cases) or during surgery of suppurations without external fistulas. All cases involved perforations of the small intestine and in only one case there was also a perforation of the transverse colon. In 4 cases, where eventration relapse co-existed, the polyester prostheses were found partially or totally detached from the abdominal wall. The treatment of enteric perforation consisted of 5 segmental enterectomies (one of those a double one) followed by anastomoses and one enteroraphy. The colic perforation was excised and sutured. The mesh was totally removed in 5 cases and partially removed in 1 case (around the perforation). The postoperative evolution was simple in only 3 cases. In the other 3 cases anastomotic fistulas occurred and one of them (with reduced leakage) was treated by nonoperative management. It did not close spontaneously even after 12 months. The other 2 cases required multiple reinterventions (enterectomies, ileostomies, ileocoloanastomosis). One of these patients has been lost away after 200 days of hospitalization and multiple reinterventions. In all cases, the closure of the abdominal wall was simplificad by cutaneous suture only whereas consecutive relapsed eventrations remain to be treated by subsequent reinterventions.

Hernia, Ventral↗
PubMed2002

A comparison of the clinical presentation and outcome of focal intestinal perforation and necrotizing enterocolitis in very-low-birth-weight neonates.

There is controversy about the identity of focal intestinal perforation (FIP) and necrotizing enterocolitis (NEC). To elucidate the difference between them, we reviewed their clinical presentations. Over the last 20 years, 39 very-low-birth-weight (VLBW) neonates, including 21 extremely-low-birth-weight neonates, underwent a laparotomy for intestinal perforation without mechanical causes. Nineteen patients had typical findings of NEC, and 8 had FIP. FIP is defined as isolated intestinal perforation without gross necrosis. In FIP, the gestational age was significantly lower than in NEC (23.8 +/- 1.8 vs 27.0 +/- 2.5 weeks, P < 0.01). The birth weight (BW) of FIP patients was lower than that of NEC infants (635 +/- 134 vs 883 +/- 256 g, P < 0.05). The incidence of coexistent respiratory distress syndrome (RDS) was higher in FIP compared to NEC (88% vs 37%, P < 0.05). The age at onset was younger in FIP than NEC (7.3 +/- 2.7 vs 14.4 +/- 7.9 days, P < 0.05). All patients except 1 had the sites of perforation exteriorized. There was a trend toward higher survival in FIP compared to NEC (88% vs 58%, P = 0.136). Our data clearly show differences in BW, gestational age, and association of RDS between FIP and NEC. Based on our data, prematurity and RDS appear to be the major etiologic factors of FIP. The present series supports the fact that FIP is a definite clinical entity.

Chi-Square Distribution↗
PubMedDate not supplied

Percutaneous peritoneal drainage in the management of acute intestinal perforation.

This case series describes the use of percutaneous peritoneal drainage when it is performed as the definitive treatment for acute intestinal perforation. Seven extremely low birth weight neonates who were admitted to a neonatal intensive care unit of a regional center between March 1987 and October 1992 had acute intestinal perforation. Six neonates were initially treated with percutaneous peritoneal drainage while they were under local anesthesia. Despite reports that percutaneous peritoneal drainage alone can be curative in intestinal perforation, this approach without adjunctive surgery can delay the recovery of bowel integrity.

Disease-Free Survival↗
PubMed1995

Small intestinal perforation due to cytomegalovirus infection in patients with non-Hodgkin's lymphoma.

We describe two patients with non-Hodgkin's lymphoma (NHL) who suffered cytomegalovirus (CMV)-related small intestinal perforations during the course of chemotherapy. Surgical specimens from both patients revealed histologic evidence of occlusive vasculitis and tissue destruction caused by CMV-affected cells in the submucosa and muscular walls, that may have played an important role in the pathogenesis of these perforations. Although such intestinal perforations are rare complications in NHL patients, CMV infection should be recognized as a primary etiological factor in acute abdominal crises when treating NHL patients with pharmaceutical agents including steroids. Emergency surgery and the anti-CMV agent, ganciclovir, would improve the prognoses of such patients.

Combined Modality Therapy↗
PubMed1979

Multiple intestinal perforation due to Celestin tube.

Two cases of multiple intestinal perforation caused by the nylon from the core of disintegrating oesophageal Celestin tubes migrating down the alimentary tract are described. It is suggested that Celestin tubes should not be used in patients likely to survive for more than a few months.

Aged↗