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PubMedDate not supplied

[A case of multiple intestinal perforations due to TBC in a female patient with HIV-1 infection].

The authors report a case of HIV-1 infection, primary miliary tuberculosis of the lung and secondary intestinal tuberculosis complicated with multiple intestinal perforations. The surgical emergency therapy, supported by specific antitubercular drugs, antibiotics, and total parenteral nutrition, consisted in suturing seven perforative sites of the small and large intestine. The Authors stress the possibility that in the future tubercular complications up till now considered atypical may become more and more frequent because of the HIV-1 infection association.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Clinical analysis of necrotizing enterocolitis with intestinal perforation in premature infants.

To identify the prognostic factors correlating with the outcome of the perforated necrotizing enterocolitis (NEC), the charts of 20 premature infants with perforated NEC were reviewed. Eight patients had long-term survival and 12 died. Infants in the survival group had significantly lower incidence of starting to feed before perforation, patent ductus arteriosus, indomethacin use, acidosis, and shock. Sepsis was only found in the group of infants that died The survival group were diagnosed with NEC and intestinal perforation at an earlier age than the infants that died. The time from diagnosis of NEC to intestinal perforation was longer in the infants that died. The localization of necrosis from operativefindings were all confined to the ileum-cecum area in survival group. The infants in the survival group were likely to have a single perforation. In addition, according to the operative management, they were divided into three groups: Group I consisted of six patients who received peritoneal drainage only, group II consisted of three patients who received peritoneal drainage followed by laparotomy, and group In consisted of 11 patients who received primary laparotomy. Infants in groups I and II had significantly lower gestational ages and birth weights than group III. There were no significant differences in mortality rates among infants in groups I, II and III. We concluded that the factors including prior enteral feeding, patent ductus arteriosus, indomethacin use, acidosis, sepsis, shock, delayed onset of NEC and perforation, multiple perforation, and diffuse necrotic changes were significant prognostic factors of poor outcome. Peritoneal drainage was a resuscitative procedure in critical condition and laparotomy should mostly be considered as the final treatment in the infants with perforated NEC.

Enterocolitis, Necrotizing↗
PubMed2003

Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis.

UNLABELLED: Spontaneous intestinal perforation (SIP) has been increasingly reported in very-low-birthweight (VLBW) infants, although it is still less common than necrotizing enterocolitis (NEC). In around one-third of cases, SIP is associated with systemic candidiasis. We describe a case of SIP and Candida peritonitis in a VLBW infant, which was mistakenly diagnosed as NEC during the infant's short life. At laparotomy, the bowel surface was black and thought to be necrotic. As the infant was thought to have whole-bowel necrosis due to NEC, her condition was deemed incompatible with survival. At postmortem, however, the bowel wall was found to be healthy apart from a very localized patch of necrosis associated with a single perforation. The bowel was covered by a thick, black, serosal exudate consisting of fungal elements from Candida albicans. CONCLUSION: This case reinforces the fact that a markedly discoloured bowel is not necessarily necrotic and that the discoloration can potentially recover.

Adult↗
PubMed1988

[Intestinal perforation in abdominal contusions in children. 16 cases].

16 cases of intestinal perforation following blunt abdominal trauma in children (14 boys and 2 girls from 3, 5 to 15 years old) are recorded in a 18 years period. We found 12 injuries of the small bowel, 2 of the colon and 2 of the duodenum. Except in the cases with hypovolemia or traumatic coma, the diagnosis is often made on abdominal physical findings and clinical evolution. Laboratory and radiological data were often useless. Then, surgical management was often delayed, principally in the most recent period with the non operative management of most pediatric blunt trauma. Simple closure (7 cases), resection and anastomosis (7 cases) or resection and double ostomy (2 cases) were performed. The result summarize 2 death and one complication (fistula). Complications do not increase with delay.

Abdominal Injuries↗
PubMed1998

Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis.

BACKGROUND: In our clinical setting, patients with perforative peritonitis are frequently malnourished. Immediate postoperative enteral feeding has been shown effective in reducing septic morbidity in patients with abdominal trauma. This study was designed to investigate the feasibility and efficacy of immediate postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. STUDY DESIGN: A prospective study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis. After laparotomy, patients were assigned randomly to a control or study group. The study group underwent a feeding jejunostomy and received enteral feeding from 12 hours postoperatively. A low-residue, milk-based diet was used. All patients underwent assessment for severity of sepsis and nutritional status at admission. Studies of nutritional status and nitrogen balance were repeated on days 4 and 7. RESULTS: Forty-three patients (21 in the study group; 22 in the control group) were included. The two groups were comparable except for a higher sepsis score in the study group (p < 0.05). Patients in the study group achieved a positive nitrogen balance by the third postoperative day; patients in the control group remained in negative nitrogen balance throughout the study. Abdominal distention (four patients) required temporary withdrawal of feeding. Diarrhea occurred in four patients but was controlled easily. The mortality rate was similar in the control and study groups (18.2% versus 19.1%). The control group had a total of 22 septic complications, versus eight in the study group (p < 0.05). CONCLUSIONS: Immediate postoperative feeding is feasible in patients with perforative peritonitis and reduces septic morbidity.

Adult↗
PubMed1986

Intestinal perforation due to blunt trauma in children in an era of increased nonoperative treatment.

Over the past decade, nonoperative management of most pediatric blunt abdominal trauma has emerged as accepted practice. It is possible that treatment of associated hollow visceral disruption might be missed or delayed because of this nonoperative approach. In a review of all cases of intestinal perforation from blunt trauma seen over the past 6 years, we found 12 cases of intestinal disruption in more than 600 cases of significant blunt trauma. Child abuse caused eight cases and four were motor vehicle related (MVR). Seven of eight battered children had a delay of more than 48 hours from injury to hospital presentation. Three of four MVR patients had an 18-hour delay from injury to operation. Ten of 12 patients survived. The two children who succumbed were both battered and were moribund and unstable when first seen and failed to respond to aggressive stabilization and surgery. Serial physical examinations, contrast radiographic studies, and peritoneal lavage were the most helpful diagnostic modalities. There were no significant complications and no patient required more than one operation (except for ostomy closure). All surviving patients are well at followup and seven of ten have been followed for more than 3 years; two are not yet 1 year from surgery and one is lost to followup. Several principles have emerged from this review: 1) motor vehicle trauma and child abuse are the major etiologic factors in childhood blunt trauma; 2) accurate and rapid diagnosis of intestinal perforation in children is difficult; 3) recovery in the presence of stable vital signs can be expected, even with the long delays; and 4) abused children must be carefully evaluated for abdominal trauma.

Accidents, Traffic↗
PubMed1991

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

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.

Child, Preschool↗
PubMed2001

Neonatal intestinal perforation in a developing country.

Between 1990 and 1999, 14 neonates with intestinal perforation were treated at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Median age at presentation was 9 days and median weight 2.65 kg. Five had high anorectal malformation, three Hirschsprung's disease and two ruptured exomphalos with bowel strangulation. Gastroschisis, strangulated inguinal hernia, ileal atresia and umbilical sepsis with evisceration accounted for one case each. Two of the perforations were iatrogenic during colostomy construction. Seven perforations were in the small bowel and seven in the colorectum. Three neonates had oedema and tenderness of the anterior abdominal wall, and pneumoperitoneum was seen in abdominal radiographs in two. All the infants had laparotomy, four under local anaesthesia, after resuscitation. Three had simple suture of the perforation, five had resection with primary anastomosis and six had exteriorization colostomy. Overall, eight (59%) died, five with colorectal perforation and three with small bowel perforation.

Anastomosis, Surgical↗
PubMed1998

[Two elderly patients with intestinal perforation caused by press-through package].

We report two cases of intestinal perforation caused by accidental swallowing of Press-Through Packages (PTP). The first case occurred in a 90-year-old woman with moderate dementia. She was admitted to our hospital because of abdominal pain and intestinal obstruction. She showed symptoms and sign of peritonitis and underwent abdominal surgery. The postoperative diagnosis was diffuse peritonitis due to a perforated rectal ulcer caused by the sharp corners of an accidentally swallowed PTP. The second case occurred in an 82-year-old woman with recurrent symptoms and signs of intestinal obstruction. She underwent abdominal surgery and the operation revealed an ileal perforation due to penetration by the sharp edge of a PTP. Both patients were discharged in good condition. PTPs are rapidly becoming popular as packaging for tablets and capsules. However, reports of accidental swallowing of PTPs have recently been increasing. In most cases, the PTPs were found in the esophagus and removed endoscopically. Progression of accidentally swallowed PTPs to the intestines is rare. However, when this occurs, the patient's condition becomes more serious. We propose that drugs should not be dispensed in PTPs but rather handed to the patients, especially to elderly patients, or when impossible, the corners of PTPs should be rounded.

Aged↗
PubMed1992

Multiple cytomegalovirus-related intestinal perforations in patients with acquired immunodeficiency syndrome. Report of two cases and review of the literature.

We present two cases of patients with acquired immunodeficiency syndrome who, in the course of their disease, suffered multiple intestinal perforations that were directly related to cytomegalovirus infection. Biopsy and surgical specimens and autopsy findings in both cases revealed extensive lesions of gastroenteritis; the gastroenteritis was characterized by randomly distributed deep ulcers, resulting in multiple perforations. The main characteristic histopathologic finding was the association of intestinal lesions with a severe form of cytomegalovirus-related occlusive vasculitis. This report provides evidence that supports the contention that cytomegalovirus is the primary causal agent of gastrointestinal lesions affecting immunocompromised patients.

Acquired Immunodeficiency Syndrome↗
PubMed1983

[Intestinal perforation in juvenile abdominal typhoid].

Eight of 19 children with typhus abdominalis who were between 4 and 12 years of age, showed perforation of the intestine. The terminal ileum was always the site of the perforation. Besides the clearly visualized air, meteorism of the small intestine was always seen. In individual cases, segments of the small intestine were seen in close proximity to each other, or an ileus developed. The x-ray film in typhus abdominalis in childhood shows the same signs as an adult x-ray. A characteristic feature of the perforation is its localization in the terminal ileum and the time at which it occurs, namely, between the end of the 2nd and the end of the 4th week of the diseased condition.

Child↗
PubMed2002

Factors effecting morbidity in typhoid intestinal perforation in children.

To determine the factors affecting morbidity in patients with typhoid intestinal perforation (TIP), 42 patients who had been operated upon for TIP between 1990 and 2000 were reviewed. The average age was 10.4 years, the male-to-female ratio 2.5/1. The mean interval from admission to operation was 6 h. Twenty-three children had multiple perforations. Primary closure (PC) was performed in 55% of the patients, ileostomy in 26%, and resection with anastomosis (RA) in 19%. Parenteral nutrition (PN) was available for 22 patients for an average of 9 days. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who received PN and in those who underwent ileostomy. None of the patients developed an enterocutaneous fistula. The 2 deaths (4.8%) resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No operative procedure is likely to be the best in all cases; therapy should be individualized. Ileostomy appears to be an effective procedure, particularly in patients with severe abdominal contamination and delayed presentation. The use of PN in addition to standard medical and surgical therapy in patients with TIP may be beneficial.

Adolescent↗
PubMed1985

Intestinal perforation associated with indomethacin treatment in premature infants.

Within 9 months we observed intestinal perforations in three very low birth weight (VLBW) infants undergoing indomethacin treatment for symptomatic patent ductus arteriosus (sPDA). The three patients exhibited striking similarities in their clinical courses and predisposing factors. Although clinical and histological criteria did not differentiate the perforations from necrotising enterocolitis (NEC), a well-known entity in premature infants, these events were remarkable to us since we had observed no other cases of NEC in recent years. From animal experiments and pathophysiological data, a role for indomethacin in gastrointestinal ischaemic damage must be considered. This communication is not meant to discredit indomethacin treatment. However, awareness of potential complications and careful monitoring during treatment is warranted.

Ductus Arteriosus, Patent↗