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PubMed1989

Traumatic perforation of ileal pouch. Report of a case.

A 28-year-old woman with a previous history of restorative proctocolectomy for complicated ulcerative colitis had acute onset of severe abdominal pain that was diagnosed at another hospital as a perforated peptic ulcer. Careful history-taking revealed that she had blunt trauma to the abdomen one day before admission. Laparotomy detected a perforation hole at the afferent loop of the ileal pouch. Debridement and primary closure of the perforation, with temporary decompression of the pouch, resulted in a good outcome. With the increasing popularity of selecting restorative proctocolectomy for the treatment of polyposis coli and ulcerative colitis, more and more pouches will be constructed. Possible perforation of the ileal pouch should be considered when such patients present with a perforated hollow viscus. With appropriate management, the pouch can be saved. Review of the literature revealed no similar reports.

Adult↗
PubMed1980

Perforation of the peptic ulceration in the elderly.

A retrospective survey of elderly patients admitted with perforation of a duodenal ulcer showed that some presented with typical symptoms and signs of a perforation, while others presented as a gastro-intestinal bleed or with confusion or malaise. Diagnosis tended to be delayed in the latter group and mortality was higher. Earlier diagnosis may be helped by taking a chest radiograph or lateral decubitus films of the abdomen with a repeat film in a few hours if the diagnosis is still being considered.

Aged↗
PubMed1992

[Preventive or therapeutic parathyroidectomy in primary hyperparathyroidism].

The only causal treatment of primary hyperparathyroidism (PHPT) is parathyroidectomy. There are indications in the literature that despite operation expectation of life is shortened because of an increased frequency of cardiovascular and malignant diseases leading to the recommendation for early surgery even in uncomplicated PHPT. It is easier to convince an asymptomatic patient of an operation when he is informed about complications and consequences of an expectative attitude. Therefore, we reviewed our 71 patients operated upon during a 4-year-interval, 58 of whom were followed-up. During 82 operations 115 pathologically altered parathyroid glands were removed. Two persistent paralyses of the recurrent nerve occurred, however, without alteration of the voice. Follow-up of 82% of patients revealed 2 cases of recurrent nephrolithiasis (1 hypercalcaemia, 1 normocalcaemia). Three (5%) true recurrences were found, but neither a pancreatitis nor a peptic ulcer was noted during long-term follow-up. None of the 137 patients operated for a bleeding or perforated peptic ulcer during the last 10 years and 1 of 55 patients with acute pancreatitis during the past 8 years suffered from a PH-PT. However, morbidity and mortality of these two conditions was high. Although correlation to PHPT was low we recommend early operation of PHPT because of the low morbidity rate, zero lethality and reduced expectation of life.

Adenoma↗
PubMed1992

Perforation and obstruction of the gastrointestinal tract. Assessment by conventional radiology.

Proliferation of new imaging modalities has changed the way abdominal emergencies are evaluated in medical centers where ready access to equipment and personnel make emergency CT, ultrasonography, interventional radiology, and endoscopy available at all hours of the day or night. In many cases, plain abdominal radiography is being relegated to an ancillary diagnostic role. Conversely, in medical centers with fewer resources, plain radiography remains a primary screening modality for most acute abdominal conditions. Even in centers with unlimited resources, plain films supplemented by gastrointestinal contrast studies as needed remain the modern standard for evaluation of patients who have suspected gastrointestinal perforation and mechanical obstruction. These widely available, easy to perform, and relatively inexpensive procedures are relatively sensitive and specific for evaluation of these problems. It is, therefore, crucial for radiologists to be familiar with the often subtle signs of gastrointestinal perforation and obstruction on plain films. Skills of plain film interpretation should not be permitted to erode in the environment of newer technologies.

Duodenal Ulcer↗