Prematuro con perforación intestinal espontánea de presentación muy precoz / Preterm neonate with spontaneous intestinal perforation of very early presentation

Resumen Introducción: La perforación intestinal espontánea es una condición que afecta principalmente a neonatos pretérmino. Caso clínico: Se presenta el caso de un neonato pretérmino de 26 semanas de gestación con neumoperitoneo en las primeras 24 horas de vida. Por lo precoz del cuadro y los hallazgos radiológicos, la primera hipótesis diagnóstica fue una perforación gástrica. Sin embargo, en la laparotomía se encontró una perforación ileal única, sin hallazgos de enterocolitis. Conclusiones: La perforación intestinal espontánea se ha asociado con intervenciones médicas, como el uso concomitante de esteroides e indometacina. Otras intervenciones, como el uso de magnesio prenatal y la colocación de surfactante pulmonar de forma mínimamente invasiva, se han propuesto como factores de riesgo para su desarrollo. En la actualidad, deben evaluarse la perforación intestinal espontánea y sus asociaciones. Las presentes y futuras investigaciones podrían contribuir a aclarar el papel de las intervenciones mencionadas en la revisión preliminar de la literatura.

Abstract Background: Spontaneous intestinal perforation is a condition that mainly affects preterm infants. Case report: The case of a preterm infant of 26 weeks of gestation with pneumoperitoneum in the first 24 hours of life is described. Due to the early symptoms and radiological findings, the first diagnostic hypothesis was gastric perforation. However, at laparotomy, a unique ileal perforation was found, without findings of enterocolitis. Conclusions: Spontaneous intestinal perforation is a complication associated with medical interventions such as the concomitant use of steroids and indomethacin. Recently, other interventions, such as the use of prenatal magnesium and treatment with exogenous pulmonary surfactants in a minimally invasive way have been proposed as risk factors for its development. At present, clinicians should evaluate spontaneous intestinal perforation and its associations, and ongoing and future research may clarify the role of the interventions mentioned in the review of preliminary literature.

Ausencia segmentaria del músculo intestinal con membrana ileal en un recién nacido de extremadamente bajo peso al nacer: A propósito de un caso / Segmental absence of intestinal muscle with ileal web in an extremely low birth weight infant: Case report

Las perforaciones intestinales espontáneas son perforaciones localizadas sin las características clínicas, radiológicas e histopatológicas típicas de la enterocolitis necrosante. La perforación intestinal espontánea es una entidad clínica de reciente definición. El factor de riesgo más conocido es la prematurez. Se presenta en el 2-3% de los recién nacidos de muy bajo peso al nacer y en el 5% de los neonatos de extremadamente bajo peso. En este artículo presentamos el caso de un recién nacido de extremadamente bajo peso al nacer con perforación intestinal espontánea, ausencia segmentaria del músculo intestinal y membrana ileal como causas subyacentes. Nuestro objetivo es llamar la atención a la ausencia segmentaria del músculo intestinal, una afección rara pero que se informa cada vez más como causa de perforación intestinal espontánea, y a la importancia del examen histopatológico de las muestras obtenidas durante una cirugía.

Spontaneous intestinal perforations are localized perforations without the typical clinical, radiological, and histopathological features of necrotizing enterocolitis. Spontaneous intestinal perforation is a recently defined clinical entity. The best-known risk factor is prematurity. It is seen 2-3% in very low birthweight infants and 5 % of extremely low birthweight infants. Herein we report an extremely low birthweight infant with spontaneous intestinal perforation, segmental absence of intestinal muscle and an ileal web as an underlying cause. We aimed to draw attention to the segmental absence of intestinal muscle which is rare but increasingly reported cause of spontaneous intestinal perforation and the importance of histopathologic examination of surgical specimens.

Self-administered Enema Related Rectal Perforation / 대한소화기학회지

No abstract available.

Chronic Radiation Colitis with Rectopelvic Fistula Diagnosed 30 Years after Radiation Therapy / 대한소화기학회지

No abstract available.

Management of Perforated Duodenal Diverticulum: Report of Two Cases / 대한소화기학회지

Duodenal diverticula are common, but perforated duodenal diverticulum is rare. Because of the disease rarity, there is no standard management protocol for perforated duodenal diverticulum. To properly manage this rare complication, a clear preoperative diagnosis and clinical disease severity assessment are important. An abdomino-pelvic CT is an unquestionably crucial diagnostic tool. Perforation is considered a surgical emergency, although conservative treatment based on fasting and broad-spectrum antibiotics may be offered in some selected cases. Herein, we report two cases of perforated duodenal diverticulum, one case managed with surgical treatment and one with conservative treatment.

Estudio Multicéntrico Nacional. Análisis de las complicaciones de colonoscopías realizadas por coloproctólogos / National Multicentric Study. Analysis of complications of colonoscopy performed by colorectal surgeons

Introducción: la colonoscopía es el método estándar para el diagnóstico y tratamiento de la patología colorrectal. Su incidencia a nivel nacional entre los cirujanos es desconocido. Objetivo: analizar las complicaciones de la videocolonoscopía en series institucionales. Pacientes y Métodos: se analizaron las videocolonoscopías realizadas entre enero 2009 y diciembre de 2010 Variables: complicaciones, patología previa, sexo y edad, indicación, tipo de endoscopía, complicación, número y sitio de la complicación, clínica, metodología y momento del diagnóstico, tratamiento y evaluación de complicaciones. Resultados: de 6629 colonoscopías, el 58% fueron del sexo femenino. Hubo un 94,7% de llegadas al ciego. El tiempo fue de 28,7’ (20’-45’). La edad promedio fue de 53,5 años (13-92). Fueron ambulatorias en el 90,1%. Se hicieron 4057 (61,2%) estudios diagnósticos y 2572 (38,8%) terapéuticos. Se registraron 17 lesiones (0,25%), 12 (0,18%) estaban relacionadas al procedimiento. Las complicaciones luego de colonoscopías diagnósticas fueron del 0,12% y del 0,31% en procedimientos terapéuticos. Las complicaciones fueron resueltas con expectación en 4, cirugía en 7 y endoscopia en 1. No hubo mortalidad ni morbilidad asociadas. Existieron resultados similares entre los diferentes centros participantes. Discusión: la incidencia de complicaciones, luego de colonoscopía, fue baja. Las más frecuentes fueron la perforación y la hemorragia. La incidencia fue similar tanto en estudios diagnósticos como en terapéuticos. Fue evidente que cuando el diagnóstico fue precoz y el tratamiento oportuno, la morbi-mortalidad fue baja o nula. La relación de equivalencia de resultados entre centros de referencia y centros del interior infiere que la calidad del estudio fue similar entre ambos. Cuando se considera que fueron entrenados en centros similares al de referencia es dable atribuir a la colonoscopía realizada por coloproctólogos los mismos resultados... (TRUNCADO).

Background: colonoscopy is diagnostic standard of colorectal diseases. Its adoption by proctologists is unknown. Objective: to analyze nationwide colonoscopic complications performed by colorectal surgeons. Method: all colonoscopies performed between January 2009 and December 2010 were analyzed by type of colonoscopy and complication, previous pathology, age and gender, number and site of complication, diagnosis and treatment. Results: 6629 colonoscopies were performed, 58% of them were female. Cecum visualization was possible in almost 95% in 20 to 45 minutes. Average age was 53,5 years. Almost 91% were ambulatory. 62% of them were diagnostic procedures. There were 17 complications, 12 after diagnostic procedures. Complications were treated by expectation in 4 and surgery in 7. There was neither morbidity nor mortality in this series. Similar results were found in different centers. Discussion: incidence of complications after colonoscopy is low. Perforation and hemorrhage are the most frequent and its incidence is similar in diagnostic and therapeutic scopes. In early diagnosis, morbidity and mortality were lower. Relation of incidence between high and low volume hospitals were similar, even between colorectal surgeons with same results. Conclusion: colonoscopy is a safe procedure performed by colorectal surgeons, either diagnostic or therapeutic, supported for the first time by nationwide data.

Successful management of colonic perforation with a covered metal stent

Self-expandable stents are widely available for the treatment of perforation of the gastrointestinal tract. Because of the risk of migration, there has been no report of the use of self-expandable stents for the treatment of perforation of the colon or rectum. This is a report of successful treatment of iatrogenic colonic perforation during balloon dilatation of anastomotic stricture with a fully covered stent. Fully covered, self-expandable metallic stents can be considered useful tools for management of this condition.

A Case of Pneumatosis Intestinalis Associated with Sunitinib Treatment for Renal Cell Carcinoma / 대한소화기학회지

Sunitinib as a multitarget tyrosine kinase inhibitor is one of the anti-tumor agents, approved by the United States Food and Drug Administration to use treat gastrointestinal stromal tumor and metastatic renal cell carcinoma. The agent is known to commonly induce adverse reactions such as fatigue, nausea, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity, reduciton in cardiac output of left ventricle, and hypothyroidism. However, it has been reported to rarely induce adverse reactions such as nephrotic syndrome and irreversible reduction in renal functions, and cases of intestinal perforation or pneumatosis interstinalis as such reactions have been consistently reported. In this report, a 66-year old man showing abdominal pain had renal cell carcinoma and history of sunitinib at a dosage of 50 mg/day on a 4-weeks-on, 2-weeks-off schedule. Seven days after the third cycle he was referred to the hospital because of abdominal pain. Computed tomography showed pneumoperitoneum with linear pneumatosis intestinalis in his small bowel. The patient underwent surgical exploration that confirmed the pneumatosis intestinalis at 100 cm distal to Treitz's ligament. We report a rare case of intestinal perforation with pneumatosis intestinalis after administration of sunitinib to a patient with metastatic renal cell carcinoma.

Perforation of Meckel's diverticulum by a peanut presenting as a mesentery abscess

Perforation of Meckel's diverticulum by a foreign body in children is rarely reported and is usually associated with localized or generalized fibropurulent peritonitis. The authors encountered such a case in a 4-year-old boy with perforation of Meckel's diverticulum by a piece of peanut presenting as a mesentery abscess. The diverticulum was wide-based and histology showed a transmural perforation at the tip of the diverticulum. Local inflammation due to irritation of the foreign body and progressive pressure necrosis at the tip of the diverticulum may be the pathogenesis of mesentery abscess. A search of the English literature did not reveal any similar case

A Case of Duodenal Perforation Caused by Biliary Plastic Stent Treated with Approximation using Endoclip and Detachable Snare / 대한소화기학회지

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.

Perfuração intestinal por corpo estranho ingerido: relato de caso e revisão da literatura / Intestinal perforation by ingested foreign body: case report and literature review

Paciente com quadro sugestivo de obstrução intestinal. Submetido à laparotomia exploradora, encontrou-se perfuração de intestino delgado por corpo estranho ingerido (palito de bambu) e abscesso intra-abdominal. Realizadas drenagem de abscesso e enterorrafia. Paciente apresentou evolução complicada com infecção de sítio cirúrgico e deiscência de sutura. A maioria dos corpos estranhos ingeridos passa por todo o trato gastrointestinal sem intercorrências, entretanto, em 1% dos casos ocorrem complicações com perfuração e obstrução. A perfuração pode se manifestar por diversos quadros clínicos como sepse, obstrução e abscessos hepáticos ou abdominais; e o diagnóstico clínico, laboratorial e radiográfico é difícil. Embora rara, o cirurgião geral deve ter sempre em mente a possibilidade de perfuração gastrointestinal em pacientes que apresentam sintomas abdominais agudos atípicos. Em caso de dúvida, deve-se fazer a exploração abdominal.

A patient sought help in our emergency department with symptoms suggestive of intestinal obstruction. He was taken to the operating room and an exploratory laparotomy was performed, which revealed an abdominal abscess and intestinal perforation by ingested foreign body, a bamboo toothpick. The perforation was sutured and the abscess drained. The patient had complications in the postoperative period, with surgical site infection and suture dehiscence. The majority of ingested foreign bodies pass through the whole gastrointestinal tract without any problems, in 1% of the cases though there can be complications such as intestinal perforation. Perforations can present with many different clinical manifestations, such as obstruction, sepsis, hepatic or abdominal abscess and diagnosis is usually difficult. The general surgeon must always keep in mind this possibility in patients with atypical acute abdominal symptoms. Whenever in doubt, one should choose to operate.

Caracterización de una población pediátrica con invaginación intestinal diagnósticada en un hospital de referencia durante un periodo de 8 años / Description of a group of children with intestinal intussusception diagnosed in a reference hospital during a period of 8 years

Objetivo: El objetivo general del estudio fue describir todos los casos documentados de invaginación intestinal en niños menores de 24 meses en el HNN durante el periodo 2001-2008. Métodos: estudio retrospectivo y descriptivo, basado en la información de expedientes clínicos y del Servicio de Estadística, de todos los egresos hospitalarios con el diagnóstico de invaginación intestinal en niños menores de 24 meses durante el periodo: enero 2001 a diciembre 2008. Resultados: durante este periodo de estudio la media de la tasa de incidencia de invaginación intestinal en el HNNH fue de 31 por cada 100000 nacidos vivos. La distribución de pacientes por sexo y grupo de edad fue: 57.7 por ciento hombres y 42.3 por ciento mujeres, p:0.003. El 85.2 por ciento de los episodios de invaginación intestinal ocurrió en niños menores de 12 meses, 14.8 por ciento de 12 a 24 meses, 27/182 pacientes. La edad media de presentación fue de 7.7 meses. 103 pacientes requirieron ser llevados a sala de operaciones para desinvaginación por taxis, de los cuales el 79.61 por ciento, 82, tuvieron un colon por enema fallido. La perforación intestinal fue la complicación más frecuente en un 12.6 por ciento de los casos, 13. Se realizó resección intestinal en 16 casos, 15.50 por ciento. Conclusiones: este estudio brinda información sobre la epidemiología de la invaginación intestinal en Costa Rica siendo éste un estudio base para futuras investigaciones asociadas a la introducción de las vacunas del rotavirus en el esquema de vacunación del país.

Clinical Analysis of Stercoral Perforation of the Colon / 대한소화기학회지

BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.

Cytomegalovirus Infection-related Spontaneous Intestinal Perforation and Aorto-enteric Fistula after Abdominal Aortic Aneurysmal Repair / 대한소화기학회지

Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.

Cytomegalovirus Infection-related Spontaneous Intestinal Perforation and Aorto-enteric Fistula after Abdominal Aortic Aneurysmal Repair / 대한소화기학회지

Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.

Small bowel perforation secondary to fish bone ingestion

Two cases of small bowel perforation due to fish bone injury were seen in the last 10 years in the department of surgery, the first was in 2004 and a further one in 2010. The first case was a sixty-two year old Bahraini male who presented to the Emergency Department with acute lower abdominal pain of four hours duration. Abdominal examination revealed, generalized tenderness and distension. There was no guarding or rebound tenderness. Bowel sounds were audible. Abdominal CT scan was not helpful in diagnosis. Conservative treatment failed and the patient needed surgical intervention. The second case was a seventy-five year old Bahraini male, known to have diabetes, hypertension and senile hypertrophy of the prostate. The patient was admitted with acute generalized abdominal pain of one day duration. Abdominal examination showed generalized abdominal tenderness and guarding with absent bowel sounds. CT scan of the abdomen showed free gas under the diaphragm and free fluid but did not show the site of perforation. Both cases needed urgent laparotomy, identification of the bowel perforation, removal of the fish bone, and simple closure of the perforation. The aim of this report is to increase the awareness of fish bone as a possible cause of small bowel perforation particularly in Bahrain, and to advise early surgical intervention and simple closure of the perforation after foreign body removal

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.