A prospective observational study on feasibility of laparoscopic perforation repair in patients presenting with intestinal perforation at a tertiary care superspeciality hospital in Chhattisgarh

Background: Bowel perforation is one of the common emergencies faced by the surgeons in the developing world. It carries a high morbidity and mortality rate even today. In the present era, laparoscopy is being used as a better treatment alternative across the world. Various reports in literature are now available regarding the feasibility of laparoscopic repair of bowel perforation. The purpose of this study was to assess the feasibility of laparoscopic primary suture repair as the initial modality in treating a bowel perforation and to analyze the pattern of bowel perforation in relation to age, sex and etiology in Chhattisgarh state.Methods: This study included the data of relevant patients who got admitted in Ramkrishna Care Hospital Raipur from 1st October 2017 to 31st September 2019 (24 months).Results: Most commonly affected mean age group in this study was 39±15.82 years with male predominance. Statistically  significant findings in favour of laparoscopic repair in our study were early return of bowel activity, less incidence of surgical site infection, early return to work (less hospital stay), less post-operative pain as compared to open surgery (p<0.05).Conclusions: In this study it was found that laparoscopy in patients with bowel perforation who are hemodynamically stable and present early (<72 hours) to the hospital is feasible and safe and gives many benefits including reduction in perioperative morbidity and mortality.

Surgical management and post-operative complications in abdominal tuberculosis patients

Background: Abdominal tuberculosis is a diagnostic and therapeutic challenge in resource limited countries. The vague clinical presentation is a barrier to early diagnosis. Aim of the study was to highlight the role of operative procedures and post-operative complications in patients suffering from abdominal tuberculosis.Methods: This is a descriptive study of abdominal tuberculosis cases, which were operated in the Department of Surgery, Lal Lajpath Rai hospital Kanpur, Uttar Pradesh, India, and associated hospitals. Informed and written consent was obtained from each patient prior to commencement of the study. Detailed data of each patient was entered on a Microsoft excel. Data were presented in number and percentages.Results: Most of the patient’s lumps were present in right ileac fosa, 70.37% followed by lymph node mass. Rolled omentum and appendicular showed minimum percentage of cases. In operative finding on exploratory laparotomy, the most common site of involvement was ileocaecal, and less commonly involved site in abdomen tuberculosis are duodenum and appendix. Surgical procedures, intestinal resection in the form of right hemicolectomy (21 cases), small bowel resection (58 cases). Appendicectomies were done only in 3 cases. Post-operative complications were found in 64 cases. Most of the complication developed in patients those were operated in emergency.Conclusions: Most of the surgeons were preferred conservative surgery rather than extensive resection of the active lesion. Commonest post-operative complication was broncho pulmonary complication.

Therapeutic effect of extralevator abdominoperineal excision in combination with conventional abdominoperineal excision on distal rectal cancer:A Meta-analysis / 西安交通大学学报(医学版)

Objective To explore the short and long-term efficacy of extralevator abdominoperineal excision (ELAPE)vs.conventional abdominoperineal excision (APE)on distal rectal cancer.Methods Relevant studies were identified by search of Medline,EMBASE,and Web of Science published between January 1,2008 and February 28,2015,and included in the systematic review and meta-analysis with Stata software (version 12.0). Results Our Meta-analysis included 14 studies involving 3278 patients,of whom 1843 (56.2%)underwent ELAPE and 1435 (43.8%)underwent APE.Compared with patients undergoing APE,those undergoing ELAPE had a significantly reduced risk of intraoperative bowel perforation (IBP)involvement (OR=0 .55 ,95% CI= 0 .37-0 .85 ),but no significant reduction in the occurrence of CRM positivity (OR=0 .81 ,95% CI=0 .52-1 .25 ), local recurrence (LR)(OR=0.49,95% CI=0.18-1.30),wound complications (WCs)(OR=0.93,95% CI=0.65-1.35)or in-hospital death (IHD)(OR=0.89,95% CI=0.47-1.71).Conclusion ELAPE can reduce the risk of IBP but not for CRM positivity or LR when compared with APE.Therefore,more higher-quality studies are needed to verify the short-and long-term effects of ELAPE procedure on distal rectal cancer.

Multiple magnet ingestion: The attractive hazards

Foreign body ingestion among children is common and most usually pass through the gastrointestinal tract without requiring any intervention. Magnets, however, pose a greater threat especially when more than one are ingested. We report a case of multiple bowel perforation secondary to ingestion of magnetic beads in a 3-year-old.

Tuberculous intestinal perforation in a case of Burkitt lymphoma on chemotherapy - A case report.

Intestinal perforation induced by chemotherapy in a patient of Burkitt lymphoma is a known potential complication which carries high mortality. Perforation may also occur as a result of the transmural nature of the tumour. Patients on chemotherapy are prone to contract infectious diseases due to a compromised immune system. Pulmonary tuberculosis has been reported in these patients, but abdominal tuberculosis has not. We report the case of a five year old boy on chemotherapy for Burkitt lymphoma, and who developed a tuberculous jejunal perforation. The patient underwent drain insertion and stabilization followed by exploratory laparotomy with resection of the pathological segment and closure of the duodenal stump at the fourth part. Bowel continuity was re-established by gastrojejunostomy. Histopathologic examination of the resected segment revealed intestinal tuberculosis. Anti -tubercular therapy was started and continued for nine months. The last cycle of chemotherapy was administered 1 month after surgery. At 1 year of follow up the patient is asymptomatic and thriving well.

Posttransplant Lymphoproliferative Disorder without Epstein-Barr Virus Presented as Small Bowel Perforation in Renal Transplant Recipient: A Case Report / 대한이식학회지

Posttransplant lymphoproliferative disorder (PTLD) is documented as one of the serious complications leading to mortality particularly in organ transplant recipients receiving immunosuppressive therapy. Extant literature confirms beyond doubt that the most common site of involvement of PTLD is lymph nodes, and rarely involved is the gastrointestinal tract. It is a well-known fact that Epstein-Barr virus (EBV) is a risk factor for PTLD development. In this study, we report a case of PTLD presented as small bowel perforation without EBV infection after long-term immunosuppressive therapy in a renal transplant recipient.

Wandering Distal End of Ventriculo-Peritoneal Shunt: Our Experience with Five Cases and Review of Literature.

Ventriculo-peritoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. Although shunts have improved the morbidity and mortality associated with disordered Cerebrospinal fluid (CSF) mechanics over the past 30 years, they still are associated with many potentially avoidable complications in clinical practice. However, extrusion of VP shunt catheter is an unusual complication of VP shunt Surgery. We are presenting this unusual complication in five patients. The lower end of the shunt was seen extruding from anal opening in one patient, umbilicus in one, urethra in one, inguinal hernia sac in one and oral cavity in one patient. All of these patients were managed by shunt removal, intra venous antibiotics followed by shunt replacement on the other side except the patient with inguinal hernia sac.

Clinical Aspects and Prognostic Factors Of Small Bowel Perforation After Blunt Abdominal Trauma

PURPOSE: The incidence of abdominal trauma with intra-abdominal organ injury or bowel rupture is increasing. Articles on the diagnosis, symptoms and treatment of small bowel perforation due to blunt trauma have been reported, but reports on the relationship of mortality and morbidity to clinical factors for prognosis are minimal. The purposes of this study are to evaluate the morbidity and mortality of patients with small bowel perforation after blunt abdominal trauma on the basis of clinical examinationand to analyze factors associated with the prognosisfor blunt abdominal trauma with small bowel perforation. METHODS: The clinical data on patients with small bowel perforation due to blunt trauma who underwent emergency surgery from January 1994 to December 2009 were retrospectively analyzed. The correlation of each prognostic factor to morbidity and mortality, and the relationship among prognostic factors were analyzed. RESULTS: A total of 83 patients met the inclusion criteria: The malewas 81.9% .The mean age was 45.6 years.The mean APACHE II score was 5.75.The mean time interval between injury and surgery was 395.9 minutes.The mean surgery time was 111.1 minutes. Forty seven patients had surgery for ileal perforations, and primary closure was done for 51patients. The mean admission period was 15.3 days, and the mean fasting time was 4.5 days. There were 6 deaths (7.2%), and 25 patientssuffered from complications. CONCLUSION: The patient's age and the APACHE II score on admission were important prognostic factors that effecteda patient's progress. Especially, this study shows that the APACHE II score had effect on the operation time, admission period, the treatment period, the fasting time, the mortality rate, and the complication rate.

A case of laparoscopic assisted suture of small bowel perforation / 대한산부인과내시경학회지

The use of laparoscopic surgical techniques is now being applied to a variety of operations traditionally performed in an open fashion. The indication for surgery included polyps, obstruction, bleeding, and perforation. Small bowel perforation was usually treated with open surgery, but now, laparoscopic-guided bowel surgery is technically feasible and should translate into shorter hospitalization and less patient discomfort. Recently, we successfully treated a case of laparoscopic assisted suture of small bowel perforation. Here we report this case with a brief review of literature.

A Case of Recurrent Bowel Perforation in a Patient with Churg-Strauss Syndrome / 대한류마티스학회지

Churg-Strauss syndrome is a rare systemic disorder characterized by asthma, eosionphilia and necrotizing vasculitis affecting small-to-medium-sized vessels. Although it is frequently associated with gastrointestinal mucosal lesions, recurrent bowel perforation is rare and potentially life threatening. We report a case of a 66-year-old man with Churg-Strauss syndrome, who presented with recurrent small bowel perforation. He was admitted with abdominal pain developed previous night, who had a previous small bowel perforation history treated with laparoscopic closure 5 months ago. Laboratory data showed remarkable eosinophilia. Physical examination indicated positive signs of peritoneal irritation in the entire abdomen, and abdominal computed tomography scanning showed edematous small bowel with intra-abdominal free air, suggesting intestinal perforation. He underwent laparoscopic small bowel closure and was treated with steroid.

The Experience of Surgical Treatment of Necrotizing Enterocolitis

PURPOSE: Necrotizing enterocolitis (NEC) is a severe inflammatory disorder of the intestine, causing high mortality and morbidity. We investigated the single center experience about the operative indication, treatment method, and mortality in NEC. METHODS: The medical records of infants (<1 year old) who underwent the operation due to complications of NEC at the Asan Medical Center from Jan 1997 to Dec 2007 were retrospectively reviewed. RESULTS: Among 49 patients (M:F = 34:15), 37 underwent the operation at acute phase of NEC, average 26.43+/-35.43 days after birth (3~168), due to pneumoperitoneum in 23, clinical deterioration in 12 and abdominal mass in 2. Average gestational age was 234.64+/-38.27 days (161~279) and birth weight was 2,061.38+/-999.49 g (563~3,740). The extent of necrosis was classified grossly as focal in 14 cases, multifocal in 14 and panintestinal in 9 and the operative methods were enterostomy in 30 patients, resection and anastomosis in 6 and open drainage in 1. Thirteen patients (35.1%) were expired - 8 (21.6%) died of necrotizing enterocolitis and 5 died of other causes. The other 12 patients underwent operation for stricture after NEC at average 81.17+/-77.22 days after birth (32~317). Average gestational age was 240.83+/-34.4 days (173~280) and birth weight was 2,089.83+/-862.47 g (710~3,200). Eight patients underwent resection and anastomosis including stricture and 4 patients underwent enterostomy. CONCLUSION: Resection and enterostomy was the preferred procedure but resection and anastomosis did not increase morbidity or mortality. Quite a number of patients suffered from the stricture after NEC.

A Case of Colon Cancer Coexisting with Colonic Tuberculosis and This Presented as Bowel Perforation / 대한소화기내시경학회지

Tuberculosis can involve any part of the body and there are case reports of tuberculosis coexisting with malignancy in most body organs. However, cases of intestinal tuberculosis associated with colon cancer have rarely reported. Inflammatory bowel diseases can progress to malignant diseases due to mucosal dysplastic change. Similarly, intestinal tuberculosis can cause chronic inflammation, but the exact relationship between intestinal tuberculosis and colon cancer is currently obscure. A 71-year-old woman visited our hospital because of abrupt right lower abdominal pain that progressed to rebound tenderness and abdominal rigidity. Abdominal computed tomography showed a polypoid mass in the cecum and a distended terminal ileum. Right hemicolectomy was performed and the surgical specimen revealed extremely well differentiated adenocarcinoma combined with intestinal tuberculosis and bowel perforation in the cecum. We report here on a rare case of colon cancer coexisting with colonic tuberculosis and this presented as bowel perforation. We also include a review of the relevant literature.

Metastatic Small Bowel Perforation Caused by Intrahepatic Cholangiocarcinoma in a Patient with Combined Hepatocellular-cholangiocarcinoma

Advances in chemotherapy and radiation therapies for malignant tumors have resulted in the identifications of various novel features of intestinal metastasis. The common causes of small bowel metastasis are malignant melanoma and lung cancer, and this has also been rarely reported to uterine cervical cancer, malignant lymphoma of the larynx, malignant lymphoma of soft palate, and hepatocellular carcinoma (HCC). The Combined HCC-cholangiocarcinoma (HCC-CC) is a rare primary liver malignancy, and is composed of cells with the histopathological features of both HCC and CC, but metastatic small bowel perforation by CC in a patient with combined HCC-CC has not been reported previously. The authors describe the case of a 51-year-old man with a metastatic small bowel perforation caused by an intrahepatic CC in combined HCC-CC with a review of the literature.

Analysis of the CT and Clinical Findings of Perforated Blunt Small Bowel Injury according to the Elapsed Time since Accident

PURPOSE: The high mortality and morbidity rates associated with traumatic rupture of the small bowel have been attributed to the clinical difficulty of establishing an early diagnosis. CT scan is the most widely used tool for the diagnosis of blunt abdominal trauma, but its accuracy in diagnosing small bowel perforation is still controversial. This study was conducted to determine the overall and time-dependent diagnostic value of abdominal CT and the clinical findings of small bowel perforation. METHODS: The clinical data and CT images of 21 patients with small bowel perforation after blunt trauma were retrospectively analyzed. The patients were divided into the early and late elapsed time groups based on the elapsed time of 8 hours from the initial trauma to the time of evaluation. RESULTS: Any changes of the vital signs, including hypotension, tachycardia or fever, were observed in only half of the patients. Signs of peritonitis were evident in 7/11 of the early lapse group and in 10/10 of the late lapse group. The most common CT finding of small bowel perforation was free peritoneal air (17 of 21 patients), followed by segmental bowel wall thickening (15/21), high density ascites (14/21), an intermesentric fluid collection (13/21) and mesentic fat obliteration (11/21). Extraluminal air and segmental bowel wall thickening were detected more frequently in the late lapse group (P=0.03 and 0.01, respectively). In the one patient, bowel perforation was not evident at the initial evaluation according to the clinical findings and CT, but the follow-up CT exam showed specific findings for bowel perforation. CONCLUSION: CT scanning is a sensitive and effective modality for the evaluation of small bowel perforation, but this is less sensitive during the earlier post traumatic period. Therefore, careful clinical and radiological follow up is necessary for suspected cases, and even when an initial evaluation shows negative findings for bowel injury.

A Case of Churg-Strauss Syndrome Associated with Small Bowel Perforationfollowing High Dose Systemic Steroid Intravenous Injection / 대한피부과학회지

Churg-Strauss syndrome is an uncommon disorder characterized by bronchial asthma or allergic rhinitis, peripheral eosinophilia, systemic necrotizing vasculitis, and extravascular granuloma formation. It commonly affects the lungs, skin, gastrointestinal tract, peripheral nerve, kidneys and the heart. Gastrointestinal symptoms of Churg-Strauss syndrome are common, mainly shown in abdominal pain, diarrhea, or bleeding. Ulceration, perforation, stenosis can occurr with ischemia induced by vasculitis. Gastrointestinal perforation by Churg-Strauss syndrome has been reported rarely, and was recently discovered to have a close correlation to systemic steroid treatment. Nearly one third of patients infected with a gastrointestinal perforation die. This report covers the interesting case of a 54 year-old woman who was being treated for asthma, and was diagnosed as Churg-Strauss syndrome by multiple polyneuropathy and ulcerative macules. Small intestine perforation was generated 4 days after high dose systemic steroid intravenous injection.

Perforation of the small bowel by a previously inserted intrauterine contraceptive device / 대한산부인과학회지

Intrauterine contraceptive device (IUD) is the most common contraceptive method in the world, but it exists a little risk of uterine perforation and even more severe risk such as a perforation of intra-abdominal organs. In this case, the patient recognized that the previously inserted IUD was translocated but she was asymptomatic without any management. After insertion of the second IUD, she visited our hospital for lower abdominal pain. The abdominal X-ray finding and transvaginal sonography revealed one translocated IUD in peritoneal cavity and another IUD in intrauterine cavity. Thus, we report a case with the laparoscopic diagnosis of small bowel perforation by a previously inserted IUD and its removal by segmental resection of small bowel after mini-laparotomy, along with the brief review.

Small Bowel Perforation Caused by Taenia Solium Infection

Taenia solium is a cestode parasite that infects various human organ systems and it causes several manifestations after ingestion of raw or undercooked pork that's infected with cysticerci. This infection is being now increasingly diagnosed in the more developed countries owing to immigration of tapeworm carriers from endemic zones, but intestinal perforation by parasite infection is a rare complication worldwide. Taenia solium has a complex two-host life cycle. Human beings are the only definitive host and they harbor the adult tapeworm, whereas both people and pigs can act as intermediate hosts and harbor the larvae or cysticerci. Although the majority of parasite-infected individuals are characterized by mild symptoms or none at all and this disease does no reveal overt morbidity, in certain circumstances this disease can lead to severe manifestations. Herein, we reported on two unusual cases of small bowel perforation caused by Taenia solium infection, and these patients were diagnosed at surgery. Efforts through antiparasitic treatment of endemic populations, development of pig vaccines and other measures that are underway will help control and eliminate this disease.

Non-traumatic Small Bowel Perforation: Comparisons of the Clinical Features of 20 Years Ago with Present

The majority of small bowel perforations are caused by an abdominal trauma. However, non-traumatic causes should not be ignored. The etiology of a non-traumatic small bowel perforation is varies and has chronological characteristics. This retrospective study was undertaken to investigate the chronological changes in non-traumatic small bowel perforations over the past twenty years, according to the clinical features, surgical methods, and the prognosis of those with a non-traumatic small bowel perforation. The results of this study showed that the incidence of a bacterial enteritis induced small bowel perforation has significantly decreased, and inflammatory bowel disease or collagen disease has become the major causes of a non-traumatic small bowel perforation. Moreover, geriatric patients over 70 years of age are more vulnerable to a non-traumatic small bowel perforation.

A Case of Small Bowel Perforation Associated with Sclerosing Encapsulating Peritonitis in Patient with Intermittent Peritoneal Dialysis (IPD) / 대한신장학회잡지

Sclerosing ecapsulating peritonitis (SEP) first described by Gandhi and Humyn at 1980 is generally recognized, but uncommon complication of continous ambulatory peritoneal dialysis (CAPD) and the prognosis is very poor. A 62-year old female was admitted to our hospital with chief complaint of abdominal pain, nausea, vomiting. On physical examination, abdominal pain was not detected. Abdominal CT demonstrated paralytic ileus and adhesion in proximal ileum. She underwent adhesilolysis of ileum and repair of perforated ileum. We experienced one case of SEP presenting small bowel perforation and peritonitis in patient with IPD. We report this case with review of the literature.

The Clinical Course of ERCP-related Bowel Perforation / 대한소화기내시경학회지

BACKGROUND/AIMS: The management of small-bowel perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic sphincterotomy (EST) is still controversial. The purpose of this study was to analyze the treatment and outcome of patients with ERCP-related perforations in a single tertiary medical center. METHODS: Of 18,379 cases of ERCPs performed between January 1990 and December 2003, twenty-six patients (0.14%) with perforation were identified and medical chart were reviewed retrospectively. RESULT: EST were performed in 10,231 patients and perforation occurred in 18 patients. Four out of 18 patients with small-bowel perforation related to EST underwent surgical operation and the rest 14 patients recovered with conservative treatment alone. Of the rest 8 perforation patients unrelated to EST, perforation occurred during the insertion of endoscope in 7 patients and catheter manipulation in 1 patient. All but one perforations associated with mechanical injury by endoscope itself were managed with an emergent laparotomy, and the one patient with perforation related to catheter manipulation recovered with conservative treatment. CONCLUSIONS: A small-bowel perforation related to endoscope per se usually required a surgery, but sphincterotomy related perforations rarely did so. The prevalence and mortality rate of small-bowel perforations associated with ERCP and/or EST were 0.14% and 0%, respectively, in a single tertiary medical center.