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[Intestinal perforations in the newborn infant].

Between 1976 and March 1985 16 neonates with gastrointestinal perforations were treated. The most common site of perforation was the ileo-coecal region, the most frequent causes of perforation were due to intestinal obstruction, necrotising enterocolitis and so-called spontaneous perforations (ischemic perforations). The surgical procedure depended on the site and cause of the perforation, taking the general condition into account. 7 out of the 16 newborns (44%) died due to sepsis and septic complications.

Enterocolitis, Pseudomembranous↗

Intestinal perforations in a premature infant caused by Bacillus cereus.

Although Bacillus cereus is a ubiquitous bacterium, the incidence of neonatal infections is very low with only a few cases of B. cereus infections in neonates reported in the literature. We report the case of a premature infant with multiple intestinal perforations and an abdominal B. cereus infection. The initial course was characterized by severe cardiovascular shock, anemia, thrombocytopenia and disseminated intravascular coagulation, leading to periventricular leukomalacia, alopecia capitis and toxic epidermal necrolysis. The possible role of B. cereus-associated enterotoxins for the clinical manifestations are discussed. Our case confirms previous reports of severe clinical symptoms in B. cereus infection in premature neonates. We speculate that the systemic complications of B. cereus infection are at least partly related to the effect of B. cereus-associated enterotoxins.

Abnormalities, Multiple↗

[Early establishment of bone marrow hypoplasia by antileukemic chemotherapy with concurrent rhG-CSF in a case of acute myelogenous leukemia complicated with intestinal perforation].

We report a case of 53-year-old man with acute myelogenous leukemia (M2) showing a karyotype of t(7;11) (p15;p15), del(10) (q11;q12), who was complicated with perforation of a duodenal ulcer during the antileukemic chemotherapy using behenoyl ara-C, daunorubicin, 6-mercaptopurine and prednisolone. As his bone marrow still showed high cell density and leukemic proliferation at the time of intestinal perforation, the therapeutic regimen was changed to a combination of behenoyl are-C and mitoxantrone, and daily rhG-CSF was concurrently administered for the purpose of early establishment of bone marrow hypoplasia. On the 8th day after the therapeutic regimen had been changed, his bone marrow became nearly aplastic, and complete remission was obtained on the 24th day. This case may indicate that the concurrent administration of cell-cycle specific antileukemic drugs and rhG-CSF is available for AML patients with emergent need of leukemic cell reduction.

Antineoplastic Combined Chemotherapy Protocols↗

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↗

Repeated intestinal perforation caused by an incomplete form of Behçet's syndrome.

Behçet's disease, as initially described, is a triad of recurrent oral and genital ulcers and relapsing uveitis. The incomplete form, in which there is no ocular involvement, has been described in Japan and Korea, but this is not commonly recognized in the southern Chinese. We reported herein a rare case of repeated intestinal perforations caused by an incomplete form of Behçet's syndrome in a southern Chinese man.

Aged↗

[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↗