AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) unde...AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.展开更多
We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations,therefore,we ...We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations,therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two endoloops.Finally we chose to use a fibrin glue injection to obtain a complete sealing.Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ.Inspection of the sigma showed complete repair of the perforation.This report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.展开更多
Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis...Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.展开更多
Colonic perforation during endoscopic diagnostic or therapeutic procedures,represents an uncommon occurrence even if,together with haemorrhage,it is still the most common complication of colonoscopy,with an incidence ...Colonic perforation during endoscopic diagnostic or therapeutic procedures,represents an uncommon occurrence even if,together with haemorrhage,it is still the most common complication of colonoscopy,with an incidence ranging between 0.1% and 2% of all colonoscopic procedures. The ideal treatment in these cases remains elusive as the endoscopist and the surgeon have to make a choice case by case,depending on many factors such as how promptly the rupture is identified,the condition of the patient,the degree of contamination and the evidence of peritoneal irritation. Surgical interventions both laparotomic and laparoscopic,and other medical non-operative solutions are described in the literature. Only three cases have been reported in the literature in which the endoscopic apposition of endoclips was used to repair a colonic perforation during colonoscopy. Ours is the first case that the perforation itself was caused by the improper functioning of a therapeutic device.展开更多
Isolated pancreatic tuberculosis is an extremely rare condition, more so in an immunocompetent individual. Its presentation as pancreatic abscesses with colonic perforation has not been reported so far. This condition...Isolated pancreatic tuberculosis is an extremely rare condition, more so in an immunocompetent individual. Its presentation as pancreatic abscesses with colonic perforation has not been reported so far. This condition poses difficulties in clinical diagnoses. Herein we report a case who was operated in another hospital for pancreatic abscesses, and referred to our institution later when he developed fecal peritonitis due to colonic perforation. Re-laparotomy, resection and exteriorisation of the colon were done. Acid fast bacilli was seen in the histopathological examination of the resected colon. The patient responded remarkably to anti-tuberculous therapy and two sittings of debridement. Post procedure the patient developed pancreatic fistula, which was managed successfully with stenting. Pancreatic tuberculosis should be considered as a differential diagnosis when pancreatitis is atypical.展开更多
Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction.Once passed through the ileo-cecal valve,a retained sponge can be propelled forward by peri...Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction.Once passed through the ileo-cecal valve,a retained sponge can be propelled forward by peristaltic activity and eliminated with feces.We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain and constipation.On physical examination,a generalized resistance was observed with tenderness in the right flank.Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with several out-pouchings at the level of the ascending colon and evidence of free air in the right parieto-colic gutter along with an air-fluid collection within the mesentery.In addition,a ring-shaped hyperdense intraluminal material was also noted.At surgery,the ascending colon appeared irregularly thickened and folded with a focal wall interruption and a peri-visceral abscess at the level of the hepatic flexure,but no diverticula were found.A right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.展开更多
A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet＇s syndrome （BS）. He developed an acute abdomen and was found to have air under the diaphragm on...A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet＇s syndrome （BS）. He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.展开更多
Diagnoses Background: Delirium is a common finding in elderly patients with sepsis. Early identification of the cause of delirium and treatment is important to avoid any worsening of mental or physical status. Sepsis ...Diagnoses Background: Delirium is a common finding in elderly patients with sepsis. Early identification of the cause of delirium and treatment is important to avoid any worsening of mental or physical status. Sepsis secondary to colonic micro-perforation (CMP) in a patient with a history of diverticulosis should be high on the list of differential diagnosis. Case Report: We present a case of a patient who presented with hyperactive sepsis-associated delirium (SAD). Six days after the presentation, the patient started complaining of abdominal pain. An abdominal and pelvic computed tomography (CT) scan showed free air in the abdomen. The patient underwent surgical intervention and treatment with intravenous antibiotics. Pathological examination showed CMP connected to the patient’s history of diverticulosis. Delirium superimposed on dementia (DSD) resulted in the worsening of both the mental and physical status of our patient with the need for placement in a nursing home.展开更多
This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of py...This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis,which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2,an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess.Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation.A Hartmann operation was then performed.Histopathological findings wereconsistent with decidualization of the rectal wall.Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature.This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy,and it shows the potential occurrence of serious and unexpected complications of the disease.展开更多
Pneumoscrotum is uncommon and also rarely reported as a complication associated with colonic perforation. A case of colonic perforation in delayed fashion associated with EMR, revealed by pneumoscrotum, is reported an...Pneumoscrotum is uncommon and also rarely reported as a complication associated with colonic perforation. A case of colonic perforation in delayed fashion associated with EMR, revealed by pneumoscrotum, is reported and the associated literatures are reviewed. A 52-year-old male received piecemeal EMR for a laterally spreading tumor 35 mm in size in our hospital. He complained of enlargement of the scrotum and revisited our hospital the day alter the procedure. A diagnosis of pneumoscrotum was made, and as most such cases have been reported to be associated with pneumoperitoneum, colonic perforation was suspected. Free air but no fluid collection was found by abdominal computed tomography, and delayed colonic perforation was diagnosed. However, as there were no clinical signs of peritoneal irritation, conservative treatment was administered and the patient recovered uneventfully. Pneumoscrotum could be a sign of colonic perforation alter EMR, and treatment should be carefully chosen.展开更多
Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this ...Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this study was to improve the short-term postoperative outcomes of patients operated upon for perforated colon cancer, by identifying factors associated with complications occurring within 30 days after surgery. Patients and methods: We carried out an analytical observational study, with a retrospective collection of data from the files of patients operated upon for an in situ tumoral colon perforation. This was done in four referral hospitals in the city of Yaoundé. The period was from the 1<sup>st</sup> of January, 2012 to the 31<sup>st</sup> of December, 2021. Cox regression identified the factors associated with postoperative morbidity and mortality. Results: We collected files of 46 patients. The mean age was 54.7 ± 19.9 years with a sex ratio of 1.4. The clinical presentation on admission was dominated by the presence of signs of peritoneal irritation (91.3%) and bowel obstruction (28.3%). The diagnosis was made preoperatively in 16 cases (34.8%). The surgical procedures consisted of colectomy with anastomosis in 28 cases (60.9%) and without anastomosis in 14 cases (30.4%). Postoperative morbidity was 60.9% dominated by surgical site infection (37%). Postoperative mortality was 39.1%. The existence of generalized peritonitis was associated with the occurrence of postoperative complications (p = 0.019). The main factors associated with postoperative mortality were resection with primary anastomosis (p = 0.027), enterocutaneous fistula (p = 0.005). Conclusion: Colic resection with primary anastomosis or ideal colectomy is associated with an increased risk of mortality and should therefore not be performed in this setting.展开更多
AIM： To define the clinical characteristics, and to as- sess the management of colonoscopic complications at a local clinic. METHODS： A retrospective review of the medical re- cords was performed for the patients wi...AIM： To define the clinical characteristics, and to as- sess the management of colonoscopic complications at a local clinic. METHODS： A retrospective review of the medical re- cords was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic be- tween April 2006 and December 2010. Data obtained from a tertiary hospital in the same region were also analyzed. The underlying conditions, clinical presenta- tions, perforation locations, treatment types （operative or conservative） and outcome data for patients at the local clinic and the tertiary hospital were compared. RESULTS： A total of 10 826 colonoscopies, and 2625 therapeutic procedures were performed at a local clinic and 32 148 colonoscopies, and 7787 therapeutic proce-dures were performed at the tertiary hospital. The clinic had no perforations during diagnostic colonoscopy and 8 （0.3%） perforations were determined to be related to therapeutic procedures. The perforation rates in each therapeutic procedure were 0.06% （1/1609） in polyp- ectomy, 0.2% （2/885） in endoscopic mucosal resection （EMR）, and 3.8% （5/131） in endoscopic submucosal dis- section （ESD）. Perforation rates for ESD were significantly higher than those for polypectomy or EMR （P 〈 0.01）. All of these patients were treated conservatively. On the oth- er hand, three （0.01%） perforation cases were observed among the 24 361 diagnostic procedures performed, and these cases were treated with surgery in a tertiary hospi- tal. Six perforations occurred with therapeutic endoscopy （perforation rate, 0.08%; 1 per 1298 procedures）. Perfo- ration rates for specific procedure types were 0.02% （1 per 5500） for polypectomy, 0.17% （1 per 561） for EMR, 2.3% （1 per 43） for ESD in the tertiary hospital. There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital. The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital. No procedure-related mortalities occurred. Performing closure with endoscopic clipping reduced the C-reactive protein （CRP） titers. The mean maximum CRP titer was 2.9：1：1.6 mg/dL with clipping and 9.7 ＋ 6.2 mg/dL without clipping, respectively （P 〈 0.05）. An operation is indicated in the presence of a large perforation, and in the setting of generalized peritonitis or ongoing sepsis. Although we did not experience such case in the clinic, patients with large perforations should be immediately transferred to a tertiary hospital. Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained. CONCLUSION： It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.展开更多
Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation o...Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.展开更多
In 2010 the World Health Organisation estimated the number of infections with Entamoeba histolytica at about 50 million cases including 100000 fatal courses. In most cases this infection is a subclinical event with fe...In 2010 the World Health Organisation estimated the number of infections with Entamoeba histolytica at about 50 million cases including 100000 fatal courses. In most cases this infection is a subclinical event with few or none symptoms noticeable for the patient. Courses of this disease and incidence of this parasite in industrialised nations are not yet fully investigated. Our case reports about a 68-year-old male patient from Turkey who lives for more than 30 years in Germany and had not been abroad during the past 2 years. Resistant asymptomatic amoebic dormant bodies caused an emergency-laparoscopy and revealed the seldom complication of a colon perforation. In the age of globalisation all providers in the health care systems are urged to acquaint themselves also with non-typical syndromes for the countries they work in order to reduce preventable morbidity respectively mortality rates.展开更多
We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the ...We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the diagnosis and treatment and resulted in colon perforation. After computed tomography confirmed the diagnosis, an emergency operation was performed. During the operation, we found colon perforation. Because pollution of thoracic cavity was serious, we performed proximal end colon neostomy. The patient recovered and discharged with active treatment 35 days after operation. We consider surgical repair of the diaphragmatic hernia is recommended to avoid the potentially disastrous complications, such as strangulation or perforation of the herniated contents, which can threaten the life of the patient if diagnosis is delayed.展开更多
Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after ...Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 too. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.展开更多
Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly co...Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly coincidental, may develop with collagenous colitis. Distinctive inflammatory disorders of the gastric mucosa have been described, including lymphocytic gastritis and collagenous gastritis. Celiac disease and collagenous sprue （or collagenous enteritis） may occur. Colonic ulceration has been associated with use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn＇s disease, may evolve from coUagenous colitis. Submucosal ＂dissection＂, colonic fractures or mucosal tears and perforation from air insufflation during colonoscopy may occur and has been hypothesized to be due to compromise of the colonic wall from submucosal collagen deposition. Similar changes may result from increased intraluminal pressure during barium enema contrast studies. Finally, malignant disorders have also been reported, including carcinoma and lymphoproliferative disease.展开更多
Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has...Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.展开更多
Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon per...Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation.The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis.Splenic abscess has a high rate of mortality when it is diagnosed late.Computed tomography resolved any diagnostic doubt,and subsequent surgery confirmed the diagnosis.展开更多
Nail guns are widely used in powerful tools.Injuries with these devices may be devastating due to the significant force they can deploy.A unique case of a 55-year-old male with accidental nail gun injury to the abdome...Nail guns are widely used in powerful tools.Injuries with these devices may be devastating due to the significant force they can deploy.A unique case of a 55-year-old male with accidental nail gun injury to the abdomen,which was managed by laparoscopic colostomy creation using the puncture site with secondary reversal after several months is reported.展开更多
文摘AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.
文摘We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations,therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two endoloops.Finally we chose to use a fibrin glue injection to obtain a complete sealing.Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ.Inspection of the sigma showed complete repair of the perforation.This report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.
文摘Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.
文摘Colonic perforation during endoscopic diagnostic or therapeutic procedures,represents an uncommon occurrence even if,together with haemorrhage,it is still the most common complication of colonoscopy,with an incidence ranging between 0.1% and 2% of all colonoscopic procedures. The ideal treatment in these cases remains elusive as the endoscopist and the surgeon have to make a choice case by case,depending on many factors such as how promptly the rupture is identified,the condition of the patient,the degree of contamination and the evidence of peritoneal irritation. Surgical interventions both laparotomic and laparoscopic,and other medical non-operative solutions are described in the literature. Only three cases have been reported in the literature in which the endoscopic apposition of endoclips was used to repair a colonic perforation during colonoscopy. Ours is the first case that the perforation itself was caused by the improper functioning of a therapeutic device.
文摘Isolated pancreatic tuberculosis is an extremely rare condition, more so in an immunocompetent individual. Its presentation as pancreatic abscesses with colonic perforation has not been reported so far. This condition poses difficulties in clinical diagnoses. Herein we report a case who was operated in another hospital for pancreatic abscesses, and referred to our institution later when he developed fecal peritonitis due to colonic perforation. Re-laparotomy, resection and exteriorisation of the colon were done. Acid fast bacilli was seen in the histopathological examination of the resected colon. The patient responded remarkably to anti-tuberculous therapy and two sittings of debridement. Post procedure the patient developed pancreatic fistula, which was managed successfully with stenting. Pancreatic tuberculosis should be considered as a differential diagnosis when pancreatitis is atypical.
文摘Transmural migrated retained sponges usually impact at the level of the ileo-cecal valve leading to a small bowel obstruction.Once passed through the ileo-cecal valve,a retained sponge can be propelled forward by peristaltic activity and eliminated with feces.We report the case of a 52-year-old female with a past surgical history and recurrent episodes of abdominal pain and constipation.On physical examination,a generalized resistance was observed with tenderness in the right flank.Contrast-enhanced multi-detector computed tomography findings were consistent with a perforated right colonic diverticulitis with several out-pouchings at the level of the ascending colon and evidence of free air in the right parieto-colic gutter along with an air-fluid collection within the mesentery.In addition,a ring-shaped hyperdense intraluminal material was also noted.At surgery,the ascending colon appeared irregularly thickened and folded with a focal wall interruption and a peri-visceral abscess at the level of the hepatic flexure,but no diverticula were found.A right hemi-colectomy was performed and on dissection of the surgical specimen a retained laparotomy sponge was found in the bowel lumen.
文摘A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet＇s syndrome （BS）. He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.
文摘Diagnoses Background: Delirium is a common finding in elderly patients with sepsis. Early identification of the cause of delirium and treatment is important to avoid any worsening of mental or physical status. Sepsis secondary to colonic micro-perforation (CMP) in a patient with a history of diverticulosis should be high on the list of differential diagnosis. Case Report: We present a case of a patient who presented with hyperactive sepsis-associated delirium (SAD). Six days after the presentation, the patient started complaining of abdominal pain. An abdominal and pelvic computed tomography (CT) scan showed free air in the abdomen. The patient underwent surgical intervention and treatment with intravenous antibiotics. Pathological examination showed CMP connected to the patient’s history of diverticulosis. Delirium superimposed on dementia (DSD) resulted in the worsening of both the mental and physical status of our patient with the need for placement in a nursing home.
基金Supported by A grant from the University of Cagliari,Italy
文摘This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy.A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis,which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2,an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess.Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation.A Hartmann operation was then performed.Histopathological findings wereconsistent with decidualization of the rectal wall.Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature.This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy,and it shows the potential occurrence of serious and unexpected complications of the disease.
文摘Pneumoscrotum is uncommon and also rarely reported as a complication associated with colonic perforation. A case of colonic perforation in delayed fashion associated with EMR, revealed by pneumoscrotum, is reported and the associated literatures are reviewed. A 52-year-old male received piecemeal EMR for a laterally spreading tumor 35 mm in size in our hospital. He complained of enlargement of the scrotum and revisited our hospital the day alter the procedure. A diagnosis of pneumoscrotum was made, and as most such cases have been reported to be associated with pneumoperitoneum, colonic perforation was suspected. Free air but no fluid collection was found by abdominal computed tomography, and delayed colonic perforation was diagnosed. However, as there were no clinical signs of peritoneal irritation, conservative treatment was administered and the patient recovered uneventfully. Pneumoscrotum could be a sign of colonic perforation alter EMR, and treatment should be carefully chosen.
文摘Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this study was to improve the short-term postoperative outcomes of patients operated upon for perforated colon cancer, by identifying factors associated with complications occurring within 30 days after surgery. Patients and methods: We carried out an analytical observational study, with a retrospective collection of data from the files of patients operated upon for an in situ tumoral colon perforation. This was done in four referral hospitals in the city of Yaoundé. The period was from the 1<sup>st</sup> of January, 2012 to the 31<sup>st</sup> of December, 2021. Cox regression identified the factors associated with postoperative morbidity and mortality. Results: We collected files of 46 patients. The mean age was 54.7 ± 19.9 years with a sex ratio of 1.4. The clinical presentation on admission was dominated by the presence of signs of peritoneal irritation (91.3%) and bowel obstruction (28.3%). The diagnosis was made preoperatively in 16 cases (34.8%). The surgical procedures consisted of colectomy with anastomosis in 28 cases (60.9%) and without anastomosis in 14 cases (30.4%). Postoperative morbidity was 60.9% dominated by surgical site infection (37%). Postoperative mortality was 39.1%. The existence of generalized peritonitis was associated with the occurrence of postoperative complications (p = 0.019). The main factors associated with postoperative mortality were resection with primary anastomosis (p = 0.027), enterocutaneous fistula (p = 0.005). Conclusion: Colic resection with primary anastomosis or ideal colectomy is associated with an increased risk of mortality and should therefore not be performed in this setting.
文摘AIM： To define the clinical characteristics, and to as- sess the management of colonoscopic complications at a local clinic. METHODS： A retrospective review of the medical re- cords was performed for the patients with iatrogenic colon perforations after endoscopy at a local clinic be- tween April 2006 and December 2010. Data obtained from a tertiary hospital in the same region were also analyzed. The underlying conditions, clinical presenta- tions, perforation locations, treatment types （operative or conservative） and outcome data for patients at the local clinic and the tertiary hospital were compared. RESULTS： A total of 10 826 colonoscopies, and 2625 therapeutic procedures were performed at a local clinic and 32 148 colonoscopies, and 7787 therapeutic proce-dures were performed at the tertiary hospital. The clinic had no perforations during diagnostic colonoscopy and 8 （0.3%） perforations were determined to be related to therapeutic procedures. The perforation rates in each therapeutic procedure were 0.06% （1/1609） in polyp- ectomy, 0.2% （2/885） in endoscopic mucosal resection （EMR）, and 3.8% （5/131） in endoscopic submucosal dis- section （ESD）. Perforation rates for ESD were significantly higher than those for polypectomy or EMR （P 〈 0.01）. All of these patients were treated conservatively. On the oth- er hand, three （0.01%） perforation cases were observed among the 24 361 diagnostic procedures performed, and these cases were treated with surgery in a tertiary hospi- tal. Six perforations occurred with therapeutic endoscopy （perforation rate, 0.08%; 1 per 1298 procedures）. Perfo- ration rates for specific procedure types were 0.02% （1 per 5500） for polypectomy, 0.17% （1 per 561） for EMR, 2.3% （1 per 43） for ESD in the tertiary hospital. There were no differences in the perforation rates for each therapeutic procedure between the clinic and the tertiary hospital. The incidence of iatrogenic perforation requiring surgical treatment was quite low in both the clinic and the tertiary hospital. No procedure-related mortalities occurred. Performing closure with endoscopic clipping reduced the C-reactive protein （CRP） titers. The mean maximum CRP titer was 2.9：1：1.6 mg/dL with clipping and 9.7 ＋ 6.2 mg/dL without clipping, respectively （P 〈 0.05）. An operation is indicated in the presence of a large perforation, and in the setting of generalized peritonitis or ongoing sepsis. Although we did not experience such case in the clinic, patients with large perforations should be immediately transferred to a tertiary hospital. Good relationships between local clinics and nearby tertiary hospitals should therefore be maintained. CONCLUSION： It was therefore found to be possible to perform endoscopic treatment at a local clinic when sufficient back up was available at a nearby tertiary hospital.
文摘Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.
文摘In 2010 the World Health Organisation estimated the number of infections with Entamoeba histolytica at about 50 million cases including 100000 fatal courses. In most cases this infection is a subclinical event with few or none symptoms noticeable for the patient. Courses of this disease and incidence of this parasite in industrialised nations are not yet fully investigated. Our case reports about a 68-year-old male patient from Turkey who lives for more than 30 years in Germany and had not been abroad during the past 2 years. Resistant asymptomatic amoebic dormant bodies caused an emergency-laparoscopy and revealed the seldom complication of a colon perforation. In the age of globalisation all providers in the health care systems are urged to acquaint themselves also with non-typical syndromes for the countries they work in order to reduce preventable morbidity respectively mortality rates.
文摘We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the diagnosis and treatment and resulted in colon perforation. After computed tomography confirmed the diagnosis, an emergency operation was performed. During the operation, we found colon perforation. Because pollution of thoracic cavity was serious, we performed proximal end colon neostomy. The patient recovered and discharged with active treatment 35 days after operation. We consider surgical repair of the diaphragmatic hernia is recommended to avoid the potentially disastrous complications, such as strangulation or perforation of the herniated contents, which can threaten the life of the patient if diagnosis is delayed.
文摘Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 too. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.
文摘Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly coincidental, may develop with collagenous colitis. Distinctive inflammatory disorders of the gastric mucosa have been described, including lymphocytic gastritis and collagenous gastritis. Celiac disease and collagenous sprue （or collagenous enteritis） may occur. Colonic ulceration has been associated with use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn＇s disease, may evolve from coUagenous colitis. Submucosal ＂dissection＂, colonic fractures or mucosal tears and perforation from air insufflation during colonoscopy may occur and has been hypothesized to be due to compromise of the colonic wall from submucosal collagen deposition. Similar changes may result from increased intraluminal pressure during barium enema contrast studies. Finally, malignant disorders have also been reported, including carcinoma and lymphoproliferative disease.
文摘Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.
文摘Splenic abscess is a rare entity normally associated with underlying diseases.We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation.The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis.Splenic abscess has a high rate of mortality when it is diagnosed late.Computed tomography resolved any diagnostic doubt,and subsequent surgery confirmed the diagnosis.
文摘Nail guns are widely used in powerful tools.Injuries with these devices may be devastating due to the significant force they can deploy.A unique case of a 55-year-old male with accidental nail gun injury to the abdomen,which was managed by laparoscopic colostomy creation using the puncture site with secondary reversal after several months is reported.
