Clinicopathological study of ileal perforation in tertiary centre

Background: Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Materials and methods: Patients underwent emergency explorative laparotomy for hollow viscus perforation surgery in general surgery department was included in present study. Edge biopsy specimen was sent to histopathological examination. All patients were tested for widal positivity and were started on anti- salmonella treatment if it was positive. Based on intra- operative finding and histopathological reports, ATT was started for those who are positive for tuberculosis. All patients were monitored in the post-operative period for complications. All patients were followed up for a period of six months. Results: A total of 60 patients with Ileal perforation were included in the study of which 50 were males and 10 were females accounting for 83.33% and 16.67 % respectively. The most common symptom was pain abdomen which was present in all the patients (100%). The next common symptom was vomiting seen in 44 out of 60 patients (73.33%) followed by fever seen in 38 out of 60 patients (63.33%). Absent bowel sounds was found in 36 out of 60 patients (60%). Air under diaphragm on erect X-ray abdomen was found in 56 patients (93.33%). Conclusion: Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests are expensive. And administration of ATT helped to treat the patients successfully. A high index of suspicion for intestinal tuberculosis is needed in patients who are on immunosuppression.

Study of profile of cases and complications of ileal perforation at KMCH, Katihar

Background: Bowel perforation is an important cause of acute abdomen. It carries high morbidity and mortality. Materials and methods: The present descriptive study included 48 patients with ileal perforation admitted at the department of surgery. Data regarding clinical features, management and complications was noted. Results: Mean age of the patients was 34.4 ± 8.8 years with male preponderance. Abdominal pain and distension (100%) and constipation (87.5%) were the common symptoms seen. Single perforation was commoner (64.6%) than multiple perforations. It was caused by typhoid in 39.6% cases, due to tuberculosis in 16.7%, due to injury in 10.4% and other causes in 33.3% cases. Surgical site infection was the commonest complication. Conclusion: Ileal perforation is caused by typhoid or tuberculosis in majority of the cases and presents with pain abdomen and distension. Rates of infection are high in these cases.

Delayed Terminal Ileal Perforation in a Relapsed/Refractory B-Cell Lymphoma Patient with Rapid Remission Following Chimeric Antigen Receptor T-Cell Therapy / Journal of the Korean Cancer Association, 대한암학회지

Chimeric antigen receptor T-cell strategy targeting CD19 (CART19) has prominent anti-tumor effect for relapsed/refractory B-cell lymphomas. CART19-associated complications have been gradually recognized, however, late-onset complications have not been extensively studied. Herein, for the first time we report a diffuse large B-cell lymphoma patient with terminal ileum involvement obtained rapid remission and developed spontaneous terminal ileal perforation 38 days following CART19 infusion. The late-onset perforation reminds us that, for the safety of CART treatment, more cautions are warranted for the management of delayed GI complications.

A Study of subcutaneous negative pressure closure versus simple closure in laparotomy wound of Ileal perforation.

Background: Ileal perforation is a surgical emergency. It has very high morbidity and also mortality. As patients are commonly presented with peritonitis and fecal contamination, wound infection rate is very high. Wound infection is major issue in such condition, where related complications are frequently seen. If wound infection is controlled then many complication related to it could be prevented. And it finally affects the morbidity of patient. Aims & Objective: To compare a role of negative pressure closure versus simple closure of laparotomy wound in ileal perforation. Material and Methods: 60 cases, in period of Nov 2012 to June 2013 at SMIMER hospital, Surat presented with ileal perforation were included in the study. After a surgical treatment of all cases, they were divided in two groups. One group A was closed with Negative pressure closure (By putting subcutaneous Negative Suction Drain) at the time of laparotomy wound closure and other group B with simple closure. And the outcome compared in the form of wound infection, hospital stay, second surgery and morbidity. Total 10 cases were expired within 3 day after surgery, excluded from study (6 from group A and 4 from group B). Results: In study average rate of wound infection (SSI-Surgical Site Infection) was 25% (8/24) in group A and 57.7% (15/26) in group B. Average hospital stay for group A was 12 day and 18 day for group B. Second surgery needed in 4 cases in group A and for 8 cases in group B. Second surgery was in form of secondary suturing of wound or wound dehiscence and burst abdomen repair. Mortality in group A was 6 and in group B was 4 but it was not related to SSI because all death occurred within 3 days after surgery mainly due delay presentation and to poor general condition pre-operatively. Overall morbidity was less with Negative pressure closure in compare to simple closure and it highly affects the morbidity and somehow mortality also. Conclusion: One of the common complications of typhoid is typhoid ulcer and perforation. There is more chance of wound infection in such laparotomy wound because of highly contamination of the peritoneal fluid with fecal material. Such wound constantly leads to serous discharge and bacterial colonization. But negative pressure closure removes that collection and avoids wound infection. And it helps in reducing hospital stay and morbidity.

Tubercular ileal perforation - atypical, acute presentation in a renal transplant recipient - a case report.

Summary: Extrapulmonary tuberculosis (TB) is more common than pulmonary TB in immuno-suppressed renal transplant recipients. Atypical presentation of TB and disseminated TB is known in transplant recipients. Usually intestinal TB presents with pain abdomen, intermittent subacute intestinal obstruction, diarrhoea and/or constitutional symptoms like fever and weight loss. Here we report a case of renal allograft recipient on regular hospital follow up, presented with acute abdomen with no previous symptoms of fever, weight loss or abdominal symptoms and was diagnosed to have tubercular ileal perforation on exploratory laporatomy and confirmed by histopathological examination. This patient succumbed to the illness due to sepsis despite timely surgery, broad spectrum antibiotics and antitubercular therapy.

Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation

Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.

Immunoblot analysis of sera in uncomplicated typhoid fever & with typhoid ileal perforation.

Background & objectives: Ileal perforation is a serious complication of typhoid fever. The exact reasons for the development of perforation in only a few of those infected with Salmonella Typhi is unknown, and it is likely that immunological factors are involved. Therefore we undertook this study to compare the antibody profile in patients with uncomplicated typhoid fever with those having ileal perforation by immunoblotting. Methods: Two groups of patients were included in the study. Group II comprised patients with uncomplicated typhoid fever (n=47), and group I with typhoid ileal perforation (n=33). The flagellar (H), lipopolysaccharide (LPS) and outer membrane protein (OMP) antigens of Salmonella Typhi were extracted and used to test patient sera for antibodies by immunoblotting Results: Immunoblotting using S. Typhi antigens enabled the detection of S. Typhi antibodies in the two groups of patients. A significant difference was seen in the response of these two groups of patients with respect to antibodies to flagella, lipopolysaccharide and outer membrane proteins. Antibodies to flagella were more pronounced among patients with uncomplicated typhoid fever, while anti-OMP antibodies were significantly associated with typhoid ileal perforation. Interpretation & conclusions: A comparison of antibodies in patients with uncomplicated typhoid fever and with ileal perforation revealed the differences in the antibody profiles of the two groups. Our study suggests that the difference in antibody response may in some way play a role in the pathogenesis of typhoid ileal perforation which can also potentially be exploited to develop suitable diagnostic tests.

Ileal Perforation Caused by Ingestion of Multiple Magnets

Ingestion of foreign bodies is a common clinical problem encountered in early childhood. But ingestion of multiple magnets can cause serious lethal complications. Magnets located within another bowel loop may attract each other across the intestinal walls, resulting pressure necrosis, bowel perforation, fistula formation, intestinal obstruction, and death. Clinicians who care for children should be aware of this unexpected risk of magnetic ingestion. We report a case of ileal perforation caused by ingestion of multiple magnets in a child.

Spontaneous Ileal Perforation in Very Low Birth Weight Infant without Evidence of Necrotizing Enterocolitis

Ongoing advances in the treatment of very-low-birth-weight infants have confronted us with a growing number of infants susceptible to acquired illnesses of the gastrointestinal tract. Although necrotizing enterocolitis has been regarded as the major cause of gastrointestinal perforation in preterm infants, the incidence of spontaneous perforation occurred in an apparently normal bowel is increasing. The risk factors for spontaneous intestinal perforation include prematurity, twin pregnancies, perinatal asphyxia, prior use of umbilical artery catheter, use of indomethacin and/or steroid, and bacterial or fungal sepsis. We report a case of spontaneous ileal perforation occurred in very low birth weight infant who was successfully treated with emergency operation.

Ileal Perforation due to Cytomegalovirus Infection in a Patient with Acquired Immunodeficiency Syndrome

Cytomegalovirus (CMV) infection is prevalent worldwide, although the symptomatic illness is usually confined to immunocompromised individuals. It can produce stomatitis, esophagitis, gastritis, duodenitis, and ulceration of the esophagus, stomach, duodenum, ileum, and colon within the gastrointestinal tract. Bleeding and perforation can also occur at these sites. The most common site of intestinal perforation is the colon, followed in frequency by the distal ileum and appendix. Herein, a recently experienced case of ileal perforation due to a CMV infection, in a patient with acquired immunodeficiency syndrome is reported, with a review of the literature.

A Case of Intestinal Perforation in Henoch-Sch nlein Purpura

Henoch-Sch nlein purpura(HSP) is one of the most common vasculitic diseases of childhood, referred to as a leukocytoclastic vasculitis affecting small vessels. Although HSP related gastrointestinal symptoms are seen in up to 80% of patients during acute illness, these symptoms are usually transient. However, some patients with HSP have gastrointestinal major surgical complications such as intussusception, bowel infarction, necrosis, stricture, and perforation. We experienced a rare case of HSP-related ileal perforation developed after corticosteroid treatment. We report a case with HSP-related intestinal perforation and assess the effect of corticosteroid on the outcome of abdominal pain in children with HSP.

A Case of Ileal Perforation Associated with Cytomegaloviral Enteritis in a Patient with Acquired Immune Deficiency Syndrome / 대한소화기내시경학회지

We report a case of ileal perforation associated with Cytomegaloviral enteritis in a 62 years old man who was diagnosed as AIDS lately. The perforated lesian was located at distal ileum approximately 50 cm above ileo-cecal valve. The lesion was simply closed by surgery. There were numerous erythematous patches on the serosal surface of jejunoileum. His gastrofiberscopic examination revealed multiple shallow ulcers in distal esophagus and stomach. Mieroscopic findings of both surgical and endoscopic specimens showed characteristic cytonegalic cells with inclusion bodies. There were numerous cytomegalic endothelial cells found in the ileal specimen without direct evidence of vasculitis. The diagnosis was confirmed by colorimetric detection of cytomegalovirus DNA using in situ hybridization.