A Rare Case Of Peritonitis Due To Ulcerative Amoebic Colitis - Case Report

ULCERATIVE AMOEBIC COLITIS is a rare complication of amoebiasis that is associated with high mortality. Only 1 to 4 cases are seen per year in India & only few such cases have been reported. This requires early diagnosis and surgical intervention. We recently cared for a patient who presented with acute abdomen with history of Abdominal pain,Fever,Obstipation. Before presenting to our institution he was admitted at outside private hospital for 2 days in view of Left Diabetic FOOT with ACUTE KIDNEY INJURY with SEPSIS and was treated conservatively.On emergency exploration, MULTIPLE CAECAL PERFORATIONS with extensive necrosis of Ascending COLON were seen. SEGMENTAL RESECTION OF 5 CM TERMINAL ILEUM,CAECUM,ASCENDING COLON and 5 CM TRANSVERSE COLON was performed. Postoperative course was marked by septicaemia and multi-organ failure followed by death. This case report emphasizes the importance of early diagnosis and treatment of acute AMOEBIC COLITIS and associated high mortality.

A neonate with meconium peritonitis accompanied by shock caused by colon perforation / 中国实用护理杂志

Nursing care of a neonate with meconium peritonitis accompanied by shock caused by colon perforation was summarized. The prognosis of the neonate could be effectively improved by mastering the indications of operation, correcting the shock before operation and stabilizing the internal environment, active respiratory support and stoma care after operation.

Endoscopic closure for acute colonic perforations with novel successive endoclips in animal model / 中华消化内镜杂志

Objective To evaluate the feasibility and the safety of endoscopic closure for acute colon perforations with novel successive endoclips in animal model. Methods Approximately 1. 5 to 2 cm colonic full-thickness resections were created with an electrotome in 3 Ba-Ma pigs that were under general anesthesia and were closed with the conventional endoclips and novel successive endoclips respectively. The procedure time and the efficacy of each endoclip were recorded. After the procedure,the general condition and physiological indicators were carefully monitored. After a follow-up of 1 week,the pigs were euthanized for an endoscopic observation of the healing condition and the residual endoclips. A postmortem examination was performed to observe the abdominal infection and incision condition. Transverse sections of the colon across the site of perforation were taken for histopathologic examination to assess the healing process. Results All the colonic perforation models in three pigs were established successfully. Endoscopic closure for acute colon perforation with two kinds of endoclips was technically successful in all 3 pigs. The mean time of the procedure with successive endoclip was less than that with the conventional endoclip(54. 0 seconds VS 91. 9 seconds,P<0. 001),but the successful release rate of the successive endoclip was lower than that of the conventional endoclip without significant difference[62. 5%(15/ 24)VS 14/ 16,P= 0. 17].All the ani-mals survived without infection and hemorrhage. Five perforations demonstrated signs of healing,whereas one closed with the novel successive endoclips failed to heal completely. Conclusion Endoscopic closure for a-cute colon perforations with novel successive endoclips is effective and safe. The novel successive endoclip has the advantage of saving time,but it needs to be further improved and perfected to satisfy the clinical need.

Repair of post polypectomy colonic perforation by Endoclip: a case report / Reparo de perfuração de cólon pós-polipectomia por Endoclip: relato de caso

A 73-year-old woman was admitted to evaluate for iron deficiency anemia, increased serum creatinine, and ascites. Her colonoscopy revealed a polyp at the junction of sigmoid and descending colon, and after polypectomy, a 6 mm colonic perforation was seen. The perforation was detected by radiography and CT scan; and beside conservative management and antibiotics, her perforation was closed by using Endoclip. The patient was observed and discharged from hospital without any surgery 5 days later, and in follow-up there was no problem regarding perforation. (AU)

Mulher, 73 anos, internada para avaliação para anemia ferropriva, com aumento da creatinina sérica e ascite. A colonoscopia revelou um pólipo na junção dos colos sigmoide e descendente e, em seguida à polipectomia, foi observada uma perfuração de 6 mm no cólon, comprovada por radiografias e tomografia computadorizada. Além do tratamento conservador e da antibioticoterapia, a perfuração foi ocluída com Endoclip. A paciente ficou sob observação e recebeu alta do hospital sem qualquer cirurgia 5 dias mais tarde. Durante o seguimento, não foram observados problemas com relação à perfuração. (AU)

Undiagnosed Chronic Abdominal Pain and Colonic Perforation: A Rare Cause: Gossypiboma.

The term gossypiboma is used to describe as a mass due to retained surgical sponge after surgery. It is rare, but serious complication that is seldom reported because of the legal implications. The present study was carried out at the tertiary health center from January 2013 to April 2015. Five cases were studied prospectively. Gossypiboma usually has a varied and a vague presentation that makes it difficult to detect on radiological investigations. Sometimes, it can remain quiescent and could even present years after the operation. Though rare, gossypiboma should be kept in mind as a differential diagnosis in post-operative cases presenting as vague pain or recurrent chronic abdominal pain or long term foul smelling sinus discharge even years after the operation. Four out of five cases had colonic perforation, which was managed by primary closure. Fecal diversion was not required in any of the patient. Gossypiboma is avoidable, but serious rare post-operative complication. It is usually asymptomatic and has non-specific radiological findings. Hence, the diagnosis is often delayed. Gossypiboma can cause wide variety of complications like perforation and adhesion to the adjacent structures.

Comparative Analysis Between Laparoscopic and Traditional Open Operation for Acute Perforation of Colon / 中国微创外科杂志

Objective To compare effects between laparoscopic operation and laparotomy in the treatment of acute colonic perforation, and to explore the safety of laparoscopic surgery. Methods A retrospective analysis was conducted on clinical data of 42 cases of acute colonic perforation treated in our hospital from January 2008 to December 2014, including 22 cases of laparoscopic surgery and 20 cases of traditional open surgery.The surgical treatment effects were compared between the two groups. Results As compared with the open group, the laparoscopic group had shorter operation time [(160.5 ±25.4) min vs.(210.3 ±45.6) min, t=-4.426, P=0.000], less amount of blood loss [(112 ±21) ml vs.(220 ±53) ml, t=-8.834, P=0.000], earlier enterostomy exhaust time [(4.2 ±1.2) d vs.(7.3 ±3.4) d, t=-4.016, P=0.000], less pulmonary infections [9.1% (2/22) vs.40.0%(8/20),χ2 =3.945, P=0.047], shorter total hospitalization time [(10.3 ±2.6) d vs.(15.6 ±2.4) d, t=-6.839, P=0.000], and lower costs of hospitalization [(2.26 ±0.45) ×104 yuan vs.(3.16 ±0.38) ×104 yuan, t=-6.966, P=0.000]. There was no significant difference in the perioperative mortality and wound infection rate between the two groups (P >0.05). Conclusion Laparoscopic surgery for acute colonic perforation has advantages of little surgical trauma, less bleeding, quick postoperative intestinal function recovery, low pulmonary infection rate, short hospitalization time, and low hospitalization costs, being an effective, safe, and feasible method worthy of clinical promotion.

Colonic Perforations Caused by Migrated Plastic Biliary Stents

No abstract available.

Perfuração do colo por colite amebiana invasiva durante terapia anti-TNF para espondiloartrite / Colonic perforation due to invasive amebic colitis during anti-TNF therapy for spondyloarthritis

O bloqueio do TNF tem tido sucesso no tratamento de algumas doenças reumáticas, como a espondiloartrite. Relatam-se muitas complicações infecciosas com a terapia anti-TNF, principalmente infecções bacterianas, micobacterianas, virais e fúngicas. A Entamoeba histolytica é um protozoário extracelular que causa principalmente colite e abscesso hepático, sendo que a perfuração intestinal é uma complicação rara, com alta mortalidade. O TNF é considerado o principal mediador da imunidade celular contra a amebíase. Inicialmente, é quimiotático para a E. histolytica, potencializando sua adesão ao enterócito por meio da lectina galactose-inibível, e depois ativando os macrófagos para matarem a ameba pela liberação de NO; assim, o bloqueio do TNF poderia ser prejudicial, aumentando a virulência amebiana. Descreve-se o caso de uma mulher de 46 anos com espondiloartrite que apresentou uma perfuração do colo por colite amebiana invasiva durante uso de anti-TNF.

TNF blockade has been successful in the treatment of some rheumatic diseases such as spondyloarthritis. Many infectious complications have been reported with anti-TNF therapy, mainly bacterial, mycobacterial, viral and fungal infections. Entamoeba histolytica is an extracellular protozoan parasite that mainly causes colitis and hepatic abscess; bowel perforation is an uncommon complication with high mortality. TNF is considered the principal mediator of cell immunity against amebiasis. Initially, it is chemotactic to E. histolytica, enhancing its adherence to enterocyte via galactose inhibitable lectin, and then activating macrophages to kill ameba though the release of NO, so that TNF blocking could be harmful, increasing amebic virulence. We describe the case of a 46-year-old woman with spondyloarthritis who presented a colonic perforation due to invasive amebic colitis during anti-TNF use.

Sigmoid Colonic Perforation with Faecal Peritonitis due to Faecaloma.

Colon perforation is an uncommon event usually caused by malignancy, diverticular disease, amoebic colitis, steroid therapy, trauma and ulcerative colitis, but stercoral perforation is very rare. Severe chronic constipation is considered to be the main causative factor in development of stercoral perforation of colon. Sometimes it can also produce catastrophic complications like colonic obstruction, faecal peritonitis and septicaemia. We report a rare case of sigmoid colonic perforation with faecal peritonitis and pneumoperitonium due to faecaloma which was diagnosed after exploratory laparotomy.

A Case of Colonic Perforation after Acute Necrotizing Pancreatitis / 대한내과학회지

Colonic perforation after acute necrotizing pancreatitis is a very rare but critical complication. The mortality rate is greater than 50%. Therefore, a high index of suspicion is needed for early detection of the complication. We present a case of a 50-year-old man diagnosed as colonic perforation after acute necrotizing pancreatitis. During the treatment course, fecal material was drained via a pleural drainage tube. Colonic perforation was confirmed on CT scan. The pathogenesis of colonic perforation in this case involved direct spread of pancreatic enzymes and inflammatory exudate. He was treated successfully with colectomy, ileostomy, debridement of necrotic tissue, and drainage.

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Apendicite aguda e perfuração colônica provocada por DIU com abordagem videolaparoscópica / Appendicitis and colonic perforation caused by intrauterine contraceptiv e device with a videolaparoscopic approch

A perfuração uterina é uma das principais complicações relacionadas à inserção de dispositivo intrauterino (DIU), podendo provocar danos a órgãos intra-abdominais. O artigo tem como objetivo descrever o caso de uma paciente tratada por videolaparoscopia após o diagnóstico de apendicite e perfuração colônica, causadas por DIU em cavidade abdominal. A perfuração uterina deve sempre ser considerada nos casos de dor pélvica em pacientes que fazem uso de DIU, sendo a videolaparoscopia um método seguro para a retirada do corpo estranho e tratamento das lesões de órgãos intracavitários.

Uterus perforation is one of the major complications caused by insertion of Intrauterine Contraceptive Device (IUD), being able to provoke injury to intraabdominal organs. This article describes the case of a patient treated laparoscopically after having the diagnosis of appendicitis and colonic perforation caused by IUD within abdominal cavity. The uterus perforation must always be considered in cases of pelvic pain in female patients using IUD, and videolaparocopy is a safe procedure to remove the device and treat abdominal organs damages.

Hypermagnesemia Accompanied with Colonic Perforation in a Hemodialysis Patient

We report a case of a chronic hemodialysis patient who developed hypermagnesemia due to an overdose of magnesium-containing laxative and paralytic ileus resulting in colonic perforation. Despite intravenous calcium infusion and daily hemodialysis, the patient developed ischemic colitis and intestinal perforation. Colonic perforation accompanied with hypermagnesemia in hemodialysis patients has rarely been reported. This case suggests that hypermagnesemia should be considered in renal failure patients as this can result in life-threatening events despite prompt treatment.

Laparoscopically Assisted Hartmann's Procedure Followed by Laparoscopic Reversal in a Patient with Peritonitis Induced by Colonic Perforation / 대한내시경복강경외과학회지

Although laparoscopic surgery has been adopted for the treatment of peritonitis since the time laparoscopy was introduced for emergency operations, a laparoscopic Hartmann's procedure has not been described. We report on a Hartmann's procedure and its reversal for the treatment of peritonitis from colonic perforation by laparoscopic surgery. A 43-year-old female was diagnosed with fecal peritonitis due to a colonic perforation in the rectosigmoid colon. Five trocars were used and a Lapdisc(R) (Hakko medical, Japan) was placed at the previous Phannelstiel incision site. One hundred sixty minutes were needed for the laparoscopic Hartmann's procedure following peritoneal lavage. An oral diet was started at the postoperative 6th day and the patient was discharged on the 20th day with complete recovery. Hartmann's reversal was laparoscopically performed 3 months later. A Lapdisc was placed at the colostomy site following colostomy take-down. Four trocars were inserted at the same area as the first operation. The operative time was 180 minutes. There were no postoperative complications.

Manejo laparoscópico de las perforaciones por videocolonoscopía / Laparoscopic approach of colonic perforation due to colonoscopy

Introducción: La perforación durante una videocolonoscopía es la complicación más grave de este procedimiento. La resolución laparoscópica es una alternativa de tratamiento. El objetivo del siguiente trabajo es evaluar la factibilidad del acceso laparoscópico para la resolución de perforaciones por videocolonoscopía y comparar la evolución postoperatoria con pacientes intervenidos por laparotomía. Diseño: Observacional retrospectivo. Pacientes y Métodos: Se incluyeron 20 pacientes que fueron intervenidos quirúrgicamente debido a perforación por videocolonoscopía, desde julio de 1997 a noviembre de 2008. Se dividió la población en dos grupos: Pacientes operados por cirugía laparoscópica (G1) y pacientes operados por laparotomía (G2). Para el análisis de los resultados post operatorios se utilizaron el chi cuadrado y el test de student. Resultados: Se realizaron 14.713 videocolonoscopías (73 por ciento diagnósticas y 27 por ciento operativas). 20 pacientes (0,13 por ciento) requirieron exploración debido a perforación (G1: 14 y G2: 6). Del primer grupo, 13 fueron sometidos a resección del segmento afectado, uno con ileostomía. En el restante se realizó rafia de la perforación e ileostomía. Del segundo grupo, en 4 pacientes se realizó colectomía segmentaria, una rafia de la perforación con ileostomía proximal y una cirugía de Hartmann. Los pacientes del G1 tuvieron una menor estadía hospitalaria y tasa de complicaciones [(G1 4,2 días vs. G2 11,5 días, p=0,007) (G1: 3 eventos vs. G2: 5 eventos, p=0,058)]. Un paciente de cada grupo debíó ser reoperado, del grupo 1 por evisceración en sitio de ingreso del trócar y del grupo 2 por dehiscencia de anastomosis. Conclusiones: El abordaje laparoscópico es útil para resolver una perforación por videocolonoscopía y tiene beneficios cuando se lo compara con el tratamiento laparotómico.

Background: Iatrogenic perforation due to colonoscopy is the most serious complication of this procedure. Laparoscopic approach could be an option to minimize the outcome of this complication. The aim of this study was to assess the effectiveness of laparoscopic approach to treat colonic perforations due to colonoscopy. Methods: A retrospective data collection of colonoscopic perforation was performed from the data base of colonoscopy procedures performed between July 1997 and November 2008. Patients were divided in two groups: G1: laparoscopic colectomy and G2: open colectomy. Morbidity rate and recovery parameters were evaluated between themes. Statistical analysis was performed using student t test and chi square test. Results: 14.713 colonoscopies were performed (73 per cent diagnostics and 26 per cent therapeutics). There were 20 (0,13 per cent) iatrogenic perforations (G1= 14 vs. G2= 6). Thirteen patients from G1 had segmental colectomy and only one patient had a diverting ileostomy associated. Four patients of G2 had segmental colectomy, one primary repair with diverting ileostomy and one Hartmann's procedure. Patients from G1 had lower hospital stay and complications comparing with G2. [(G1 4,2 days vs. G2 11,5, p=0,007)(G1: 3 vs. G2: 5, p=0,058)]. Reexplorative surgery, because of acute ventral hernia and anastomotic leakage was required in G1 and G2 respectively. Conclusions: Laparoscopic colectomy is an effective procedure to resolve colonic perforation due to colonoscospy and might offers benefits when is compared with open approach.

Prognostic Factors for Complication and Mortality of Colonic Perforation

PURPOSE: The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality. METHODS: The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses. RESULTS: Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9). CONCLUSION: Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.

A Case of Iatrogenic Colonic Perforation Repaired by Endoscopic Clipping / 대한소화기내시경학회지

As colonoscopy is widely used as a diagnostic tool in Korea, it produces many complications such as colonic bleeding and perforation. These are considered to be an usual event, not as a concept of complication. Therefore, the adverse events are given the term of incidental events, not as the complications in the recent days. Medical treatment may be offered as an alternative to surgical method for immediate management of these complications. Colonic perforation usually results in fatal and emergent condition requiring surgical intervention. Others described the application of endoclip as a therapeutic endoscopic maneuver twenty years ago, and in 1997, Yoshikane et al. used clips to close a colonic perforation after performing the endoscopic mucosal resection of an early cancer. Since then, endoscopic repairs of iatrogenic perforation have frequently been used in many cases. We report a 69 year-old man who was successfully treated by endoscopic clipping of iatrogenic colonic perforation site during polypectomy without complications.

Perforation of the Hepatic Flexure of Colon by an Ingested Toothbrush

A Foreign body in the gastrointestinal tract is a common clinical problem seen in all age groups and rarely produces symptoms. However, the foreign bodies should be removed if they produce symptoms or remain in the gastrointestinal tract. A 31-year-old man with schizophrenia ingested a 20-cm-sized toothbrush. It passed through the ileocecal valve and penetrated the hepatic flexure of the colon and liver. It was removed successfully by using a surgical procedure. We report this unusual case of colonic perforation by an ingested toothbrush and review the related literature.