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Intestinal perforation due to an ingested foreign body: laparoscopic management.

The authors report the case of a previously healthy 10-year-old boy who accidentally ingested a toothpick. He presented to the hospital 7 days after the incident with left lower quadrant abdominal pain and fever; there was evidence of localized peritoneal irritation by exam. He had mild leukocytosis. An abdominal CT scan showed the toothpick in the sigmoid colon with extension through the bowel wall. Laparoscopic exploration was undertaken and an 8-cm toothpick was identified and removed from the perforation site in the sigmoid colon. Via a small suprapubic incision the sigmoid was delivered and repaired. The patient had an uneventful recovery and was discharged home 2 days after the procedure.Laparoscopic exploration can be diagnostic and therapeutic in the management of ingested foreign bodies with suspected intestinal perforation.

Child

[Spontaneous intestinal perforation in newborn infants. A form of necrotizing enterocolitis].

The present study comprised twelve premature infants with "spontaneous" gastrointestinal perforations studied retrospectively during a period of three years. This problem was found to be more frequent in extremely premature babies affected with respiratory distress syndrome and patent ductus arteriosus and accompanied with very high mortality. A clinical-pathological correlation was done with the intestinal biopsy or postmortem studies and according to these findings, it is suggested that "spontaneous" intestinal perforations probably represent a form of necrotizing enterocolitis.

Enterocolitis, Pseudomembranous

Intestinal perforation from gastrointestinal histoplasmosis in acquired immunodeficiency syndrome. Case report and review of the literature.

Gastrointestinal involvement with histoplasmosis in patients with the acquired immunodeficiency syndrome is a rare but documented phenomenon. Most patients present with diarrhea, fever, and abdominal pain. We present a case of a woman who tested positive for the human immunodeficiency virus antibody who developed an intestinal perforation due to Histoplasma capsulatum of the ileum. The patient, whose only risk factor was a blood transfusion 8 years earlier, had been previously diagnosed as having disseminated histoplasmosis with gastrointestinal involvement. While receiving oral antifungal treatment (itraconazole), she developed two separate areas of ileal perforation due to H capsulatum. Complications from gastrointestinal involvement with histoplasmosis, such as perforation, should be considered in patients infected with the human immunodeficiency virus with signs and symptoms suggesting abdominal disease.

Acquired Immunodeficiency Syndrome

alpha-Chain disease causing kaliopenic nephropathy and fatal intestinal perforations.

A case of alpha-chain disease (alpha-CD) is described presenting as a malabsorption syndrome complicated by severe kalipenic nephropathy. Antibiotics and cyclophosphamide were effective in controlling the malabsorption and thr renal dysfunction but did not affect the basic pathological lesion. Eventually the disease became generalized, affected lymph nodes, liver and bone marrow and caused multiple intestinal perforations. Detailed histological studies failed to demonstrate the development of reticulum-cell sarcoma as a terminal complication of the disease and are suggestive of a single malignant plasmacytic cell process.

Adult

[A successful repair of anomalous origin of right pulmonary artery from ascending aorta complicated with subdural hematoma, MRSA infection and postoperative intestinal perforation].

A 2-month-old male infant with anomalous origin of right pulmonary artery from ascending aorta who had subdural hematoma and MRSA infection due to the hemodynamic deterioration after cardiac catheterization was reported. The cardiac anomaly was successfully corrected by bypass grafting between the right pulmonary artery and the pulmonary trunk with an expanded polytetrafluoroethylene tube. This procedure without cardiopulmonary bypass was selected because of the presence of subdural hematoma and poor general conditions, and no signs of mediastinitis were noticed postoperatively in spite of the use of artificial material. But he had colostomy and drainage due to postoperative intestinal perforation. The complicated postoperative course of this patient recommends us the surgical correction of this anomaly without cardiac catheterization.

Aorta

Value of cultures of tissue samples taken at operation for lower intestinal perforation.

Tissue cultures from perforations of the lower intestinal tract commonly yield both aerobes (coliform organisms) and anaerobes (Bacteroides sp. and Clostridium sp.). To determine the consistency of this pattern and the value of intraoperative cultures, the authors reviewed the hospital records of 115 patients with perforation of the appendix (100 patients) or colon (15 patients), treated between 1987 and 1990, in whom organisms were cultured from tissue samples taken intraoperatively. Attention was paid to the organisms cultured, their distribution and antibiotic sensitivity in initial samples and in subsequent samples obtained when there were septic complications. On average, 4.7 bacterial isolates per patient were obtained. The common organisms were as expected: Bacteroides fragilis, Escherichia coli and Clostridium sp. Although the culture results did not affect the management of these patients, the sensitivity of Bacteroides fragilis to cefoxitin was found to be lower than expected, indicating a shift in sensitivity.

Adolescent

Intestinal perforation. A common complication of scleroderma.

The known intestinal complications of systemic sclerosis (SSc) stem mainly from motor disturbances. Autopsy findings were studied to identify anatomic abnormalities that may be associated with this disease. Descriptions of intestinal organs at autopsy were compared in 16 patients with SSc and 18 patients with systemic lupus erythematosus (SLE), a related disease control. There was a high incidence of perforation in SSc (7 of 16 patients) compared to SLE (1 of 18 patients) (P < 0.05). In SSc, perforations involved all parts of the bowel: transmural esophageal fibrosis (after heater probe cautery), dehiscence of suture line after gastric resection, perforated duodenal ulcers (N = 2), terminal ileal ischemia, and diverticulitis (N = 2). Two of the perforations in SSc were silent and were discovered at autopsy. The one perforation in SLE was due to full-thickness necrosis from vasculitis. This study suggests that the intestinal walls of patients with SSc are inherently weak; the gastroenterologist should keep this in mind when performing invasive procedures.

Adult