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PubMed1980

Spontaneous intestinal perforation in Schönlein-Henoch purpura.

Schönlein-Henoch purpura (SHP) continues to present diagnostic and therapeutic challenges to internists and to surgeons. Indications for operation in this entity are solely for intussusception, ischemic bowel necrosis, and frank bowel perforation. We present two recent cases of spontaneous small bowel perforation in SHP and analyze the previously reported cases. Spontaneous intestinal perforation is often heralded by increase in rectal blood loss, even frank melena, and a worsening or unresponsive abdominal picutre such as progressive distention and loss of bowel sounds. Perforations, usually ileal, may be accompanied by intussusception.

Humans↗
PubMed1990

[Intestinal perforation occurring at the beginning of treatment: a severe complication of bacillary tuberculosis].

We report 2 cases of intestinal perforation caused by tuberculosis and affecting the small intestine in one case and the colon in the other case. The patients were men aged 49 and 51 years respectively. Both were cachectic and presented with advanced open pulmonary tuberculosis. Perforation in free peritoneal cavity occurred 2 and 8 days respectively after an antituberculous treatment was initiated. The outcome was rapidly fatal in both cases. Tuberculous enteritis has become rare, but it can still be observed in patients with severe open pulmonary tuberculosis, where the gastro-intestinal tract is contaminated by the large number of virulent mycobacteria swallowed. In such patients clinicians must be alert to abdominal premonitory signs. Intestinal perforations in free peritoneal cavity are uncommon. Most perforation are small, single or multiple, and located on the antimesenteric side of the terminal ileum. They may occur at any time, and particularly just after an antituberculous therapy has been instituted. Clinical presentation is one of acute peritonitis requiring emergency laparotomy. Mortality has been reduced by technical improvements, notably temporary enterostomy, but perforation remains a serious and often fatal complication of tuberculosis in patients with severe malnutrition.

Antitubercular Agents↗
PubMedDate not supplied

Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus.

Survival of extremely premature infants (< 27 weeks' gestational age) has improved over the past two decades. Indomethacin prophylaxis was used in these infants, who have the highest mortality and morbidity rates, to reduce the incidence of intraventricular hemorrhage and patent ductus arteriosus (PDA). Medical records of 65 extremely premature infants born at our institution between 1995 and 2001 were reviewed retrospectively to determine whether treatment of PDA with indomethacin in the first 48 hours of life reduces the need for PDA ligation or increases neonatal morbidity, when compared to treatment begun later. Thirty infants in the early treatment group (ETG) were treated during the first 48 hours after birth, and 32 infants in the standard treatment group (STG) were managed expectantly for PDA. Three infants died in the first hours of life and were eliminated from further analysis. ETG infants were 24.9 +/- 1.1 (mean +/- SD) weeks' gestation with a birth weight of 678 +/- 143 g. STG infants were 25.3 +/- 1.1 weeks (NS) and 730 +/- 125 g (NS). Hemodynamically significant PDA was diagnosed or confirmed by echocardiography in 19 ETG patients and 17 STG patients. Of the patients with hemodynamically significant PDA, 1 (5%) ETG patient and 6 (35%) STG patients underwent surgical ligation (p = 0.033). Necrotizing enterocolitis (NEC) with intestinal perforation was the most serious morbidity and occurred in 20% of infants in the ETG, but in no STG infant (p = 0.011). Four of the six infants in the ETG with NEC and intestinal perforation died. The overall mortality rate for all infants studied was 28%. We conclude that in extremely premature infants, use of indomethacin during the first 48 hours of life was associated with a reduced need for PDA ligation, but an increased risk of NEC with intestinal perforation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Multiple and recurrent intestinal perforations: an unusual complication of Henoch-Schonlein purpura.

Intestinal perforation, intussusception, and infarction constitute the major surgical complications in Henoch-Schonlein purpura. Early corticosteroid treatment for intestinal complications is recommended. Here the authors describe the case of a 13-year-old boy with Henoch-Schonlein purpura who had multiple and recurrent perforations that occurred under corticosteroid treatment.

Adolescent↗
PubMed2006

Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations.

OBJECTIVE: To examine discharge outcomes of extremely low birth weight infants (ELBW) with spontaneous intestinal perforation (SIP). STUDY DESIGN: A single-center retrospective cohort study of all ELBW infants admitted to the University of Virginia neonatal intensive care unit between July 1996 and June 2004. RESULTS: We found 35 patients with SIP (incidence 8.4%). The median gestational age was 25 weeks, median birth weight was 722 g, and 71% of the infants were male. Most infants (n=28) with SIP were diagnosed secondary to pneumoperitoneum; however, one-third (7) of infants<25 weeks had occult presentations without pneumoperitoneum. When controlled for gestational age, gender, multiple gestation, indomethacin, and glucocorticoid exposure, infants with SIP have a higher risk of PVL and death than infants without perforation. SUMMARY: Periventricular leukomalacia and death are significantly associated with SIP in ELBW after adjusting for gestational age, multiple gestation, indomethacin, and glucocorticoid exposure.

Birth Weight↗
PubMed1997

Intestinal perforation after suction lipoplasty: a case report and review of the literature.

Intrabdominal penetration with intestinal perforation is a relatively uncommon complication after liposuction. Seven cases have been reported in the literature, with a mortality rate > 50%. Here we present a case of a perforated viscus after suction lipoplasty of the abdomen using the tumescent technique. Multiple small-bowel enterotomies were made with the suction cannula. It is our hope that a heightened awareness of this potentially life-threatening complication will promote early and aggressive diagnosis and treatment of liposuction patients who present with gastrointestinal complaints in the early postoperative period.

Abdominal Abscess↗
PubMedDate not supplied

Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion.

A case of a patient who developed an intestinal perforation secondary to a charcoal stercolith is reviewed. The case involves a young female on methadone maintenance who received multiple-dose charcoal therapy for an amitriptyline ingestion. Peritoneal signs developed several days after admission, and an exploratory laparotomy was done. A perforation measuring 4 cm in diameter was found in the posterior wall of the sigmoid colon. A 120-gm obstructing charcoal mass was found at the site of the perforation. Previous reports of intestinal obstruction secondary to charcoal inspissation are noted, and case similarities are discussed. All reported cases of charcoal obstruction involve the administration of multiple-dose-activated charcoal in the treatment of ingestions of medications known to have antiperistaltic activity. With a rare potential of mechanical obstruction, the decision to use repetitive-dose charcoal therapy should be made judiciously when the ingested toxin or coincident therapeutic medications have antiperistaltic activity.

Adult↗
PubMed2002

Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive value of radiologic findings.

BACKGROUND/PURPOSE: Given the current controversy over the appropriate surgical management (peritoneal drainage versus exploratory laparotomy) of advanced necrotizing enterocolitis and focal intestinal perforation, the authors examined the predictive value of radiologic findings. METHODS: The medical records of 80 infants undergoing exploratory laparotomy for presumed advanced necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) were reviewed. Radiologic criteria were evaluated as predictors of NEC (pneumatosis intestinalis, portal venous gas) or perforation (free air, gasless abdomen). The standard epidemiologic measures were calculated for each criterion. RESULTS: For pneumatosis intestinalis, the sensitivity was 44% (n = 27) and specificity, 100% (n = 19). For portal venous gas, the sensitivity was 13% (n = 8) and specificity, 100% (n = 19). The sensitivity and specificity calculated for free air was 52% (n = 23) and 92% (n = 33), respectively. The sensitivity and specificity calculated for a gasless abdomen was 32% (n = 14) and 92% (n = 33), respectively. CONCLUSIONS: While demonstrating high specificity, the radiologic signs traditionally associated with NEC and FIP have unexpectedly low sensitivities. Although positive radiologic findings are of great predictive value, negative radiologic findings acquired while determining the need for and specific type of surgical intervention in suspected NEC or FIP must be interpreted with extreme caution.

Enterocolitis, Necrotizing↗
PubMed2005

Intestinal perforation in Crohn's disease. Factors predictive of surgical resection.

UNLABELLED: New medical therapeutic options challenge the usual surgical management of Crohn's disease patients with intestinal perforation. OBJECTIVES: To determine factors predictive of surgery for perforation in Crohn's disease and define a group of patients that may benefit from non-surgical treatment. METHODS: One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn's disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. RESULTS: One hundred and fifty-one patients (93%) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 +/- 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 +/- 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. CONCLUSION: A significant proportion of patients with intestinal perforation complicating Crohn's disease, particularly those with a fistula, might benefit from non-surgical treatment.

Abscess↗
PubMed1988

[Cytomegalovirus infection as a cause of intestinal perforation].

Three male patients with the acquired immunodeficiency syndrome revealed perforations of the intestine (jejunum-ileum; colon ascendens; coecum). The cause was necrosis due to cytomegalovirus infection. The characteristic findings were cytomegalic inclusion bodies in endothelial cells of the capillaries. These lesions caused alterations of the microcirculation. Therefore it seems reasonable to conclude that in these cases necrosis and perforation were due to ischemia. Cytomegalovirus infection must be taken into consideration in any patient with the acquired immunodeficiency syndrome and gastrointestinal ulcerations.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Spontaneous, isolated intestinal perforations in neonates with birth weight less than 1,000 g not associated with necrotizing enterocolitis.

From January 1986 through December 1988, we have seen 7 cases of isolated intestinal perforation in 250 infants with birth weights less than 1,000 g (3% incidence) without histological or clinical evidence of necrotizing enterocolitis (NEC). Patients had a mean birth weight of 670 g, gestational age of 25.1 weeks, and sustained a perforation at a chronological age of 10.4 days. No infants had been fed. A definite, blue-discolored abdomen was the only consistent clinical sign (n = 7). Free intraperitoneal air on radiograms was rarely observed (n = 1). Abdominal ultrasounds (n = 3) and metrizamide contrast studies (n = 3) were not diagnostic. The presence of an umbilical artery catheter (7/7), falling hematocrit (6/7), thrombocytopenia (5/7), and a positive diagnostic paracentesis were most commonly found. In 6 of 7 patients, this perforation was associated with coagulase-negative staphylococcal sepsis. Surgical or histological diagnosis showed focal perforation in either the terminal ileum (n = 4) or the transverse and descending colon (n = 3). Survival was 3 of 7; 2 patients died of intracranial hemorrhage and 2 died of Candida sepsis. We conclude that (1) intestinal perforation can occur in the absence of NEC; (2) bluish discoloration of the abdomen is the most reliable clinical finding; and (3) perforation may be associated with coagulase-negative staphylococcal infection.

Colonic Diseases↗
PubMed1995

Intestinal perforations in infants with a very low birth weight: a disease of increasing survival?

Seventeen infants with a very low birth weight (VLBW) and spontaneous, non-necrotizing enterocolitis (NEC), intestinal perforations are presented; 14 of them were seen in the past 3 years. A comparison with 16 surgically treated NEC infants (< 1,000 g) is provided. At our institution, the yearly survival of VLBW infants increased from 54% to 90% over the past 6 years. All 17 non-NEC patients were operated on, and 15 (88.2%) survived. Ileal perforations were observed frequently. Initial enterostomies were followed by reanastomosis at an average age of 3 months. A 22.6-month follow-up was attained for all survivors. Non-NEC intestinal perforations in tiny neonates are increasing and constitute a challenging but treatable group. The improving survival rate of VLBW infants will probably be accompanied by a variety of complications.

Enterocolitis↗
PubMedDate not supplied

[Henoch-Schönlein purpura and intestinal perforation].

Schönlein-Henoch purpura is one of the most common forms of vasculitis in childhood, and intestinal perforation, necrosis and intussusception constitute the major surgical conditions. We present one recent case of spontaneous small bowel perforation without intussusception. An intestinal resection and ileostomy were performed. Perforation, usually ileal, frequently is accompanied by intussusception. We believe the the perforation is secondary to deep ischemic phenomenon of the bowel.

Child↗