Sigmoid gallstone ileus: a challenging diagnosis

Gallstone ileus is a rare (1%­4%) complication of gallstone disease. Gallstones entering the gastrointestinal tract by penetration may cause obstruction at any point along their course through the tract; however, they have a predilection to obstruct the smaller-caliber lumen of the small intestine (80.1%) or stomach (14.2%). The condition is seen more commonly in the elderly who often have significant co-morbidities. Gallstone ileus causing large bowel obstruction is rare. We report the case of a 95-year-old woman who presented with a history of abdominal pain without fever, nausea, vomiting, or diarrhea. Computed tomography of the abdomen and pelvis with oral contrast revealed a high-density structure within the lumen of the distal sigmoid colon, initially suspected to be a foreign body. Medical management failed and surgical intervention was not possible. Autopsy revealed peritonitis and a rupture of the sigmoid colon at the site of a cylindrical stone found impacted in an area of fibrotic narrowing with multiple diverticula. A necrotic, thick-walled gallbladder had an irregular stone in its lumen that was a fracture match with the stone in the sigmoid. Adhesions, but no discrete fistula, were identified between the gallbladder and the adjacent transverse colon. The immediate cause of death was peritonitis caused by colonic perforation by the gallstone impacted at an area of diverticular narrowing. To our knowledge, such autopsy findings have not been previously reported.

Dispositivo intrauterino parcialmente migrado e incrustado en serosa de rectosigmoides tras 8 años de inserción / Partially migrated intrauterine device embedded in the rectosigmoid serosa after 8 years of insertion

Se presenta el caso clínico de un dispositivo intrauterino parcialmente migrado a cavidad pélvica e incrustado en serosa de rectosigmoides luego de 8 años de su inserción. El diagnóstico se realizó mediante ecografía transvaginal y retiro del dispositivo por laparoscopia. Se realizó rafia de serosa rectal y de útero. La paciente tuvo un postoperatorio sin complicaciones.

It is shown the clinical case of an intrauterine device partially migrated to the pelvic cavity and embedded in the serous rectosigmoid eight years after insertion. The diagnosis was made by transvaginal ultrasound and laparoscopy removal of the device by laparoscopy. Suture of rectum serous and uterus were performed. The patient had an uneventful postoperative course.

Traumatismo cerrado de colon con lesión sigmoidea / Blunt trauma of colon with sigmoid injury

Se trataba de una paciente de 71 años de edad y aparente buen estado de salud anterior, quien sufrió un traumatismo abdominal cerrado a causa de un accidente doméstico (caída de sus pies), que lesionó el sigmoide y trastornó el paso de asas intestinales delgadas a través de él, de modo que estas se exteriorizaron por el ano. Fue intervenida con urgencia para reintroducirle las asas por el mismo trayecto de salida y suturar la lesión colónica. La paciente evolucionó favorablemente, comprobado en varias consultas posoperatorias.

This is a 71 year-old patient with apparent previous good health state who suffered a blunt abdominal trauma due to a domestic accident (fall on her feet) which injured the sigmoid and it resulted in the passing of thin intestinal loops through it, so that these came out through the anus. She had a surgical emergency for reintroducing her loops through the same place and for suturing the colonic injury. The patient had a favorable clinical course and this was checked in several postoperative outpatient visits.

Delayed presentation of colonic perforation after abdominal impalement trauma by sewing needle: a case report and review of literature

Post-traumatic, delayed colonic perforation is a rare but life-threatening cause of acute abdomen. Delayed presentation of colonic perforation is extremely rare, being observed only in patients after blunt abdominal trauma. We encountered an unusual case of delayed colonic perforation in a patient after abdominal impalement trauma. A 45-year-old man sustained abdominal impalement trauma by sewing needle 12 months ago, without getting timely management, and had a delayed perforation of sigmoid colon later. This case reminds surgeons not to overlook the delayed colonic perforation after abdominal impalement trauma

review of 100 cases of colonic injuries admitted to Baghdad teaching hospital according to ACS grading system

In Iraq nearly 95% of colonic injuries are caused by penetrating trauma [gun shot, blast injuries, stab injuries, or iatrogenic trauma], blunt injuries are rare and commonly result from road traffic accidents or fall from height. While in the rest of the world, penetrating trauma accounts for 80-90% of cases. This higher rate of penetrating trauma in Iraq is due to the high rate of terrorism attacks with low and high velocity missiles. The aim is to study cases with colonic injuries according to ACS [American College of Surgeons] grading system, the surgical management applied and the postoperative outcome of each grade. This prospective study compromise [100] patients with documented colonic injuries admitted to the surgical wards at Baghdad Teaching Hospital spanning the years 2006 to 2008. The parameters used in this study include: age, gender, mechanism of injury, part of the colon involved by injury, the grade of the injury, other associated organ injuries, the method chosen to manage the injury and the outcome [uneventful recovery, postoperative morbidity and death]. Colonic injuries were caused by bullet injuries in 50% of cases, sigmoid colon was the most common involved part [32%], 64% of cases were of grade 2 ACS, the most common associated organ injury was small intestine [60%], colonic injuries were primarily sutured in 48% of cases, while other 48% of vases ended with colostomy. Morbidity postoperatively were recorded in 32% of cases, most frequently with grade 2 and in cases treated by colostomy. Postoperative Death was recorded in 14% of cases. According to our study, ACS grading system proves to be highly beneficial to the applied in the coarse of management of colonic injuries

Lesões abdominais por uso do fio guia em ensaios cirúrgicos do quadril: estudo em cadáver / Abdominal injuries due to the use of guide wire in hip surgery experiments: cadaveric study

OBJETIVO: Avaliar a relação entre lesões abdominais e a introdução de fios guia em ensaios cirúrgicos do quadril, propor um sistema de escorização e conduta médica em função da distância percorrida pelo fio guia a partir da placa quadrilátera e a estrutura anatômica lesionada. MATERIAL E MÉTODOS: Utilizou-se 18 quadris de cadáveres, um fio de Steimann de 3.2 x 300 mm, um perfurador elétrico e um paquímetro. Introduziu-se o fio no centro do colo femoral por via de acesso lateral no quadril sob visualização direta. Por via de acesso abdominal mediana longitudinal estendida à região pélvica, observou-se a placa quadrilátera até o fio a transfixar. A partir deste ponto, prolongou-se a inserção por mais 140 mm, a fim de observar seu trajeto abdominal e descrever as lesões apresentadas em função da distância percorrida. RESULTADOS: Houve cinco (27 por cento) lesões de cólon sigmóide e uma (5 por cento) lesão transfixante do nervo obturador. Artérias e veias ilíacas comuns contra laterais ao quadril fixado não foram lesionadas. CONCLUSÃO: O fio guia não deve ultrapassar a placa quadrilátera. Medidas de prevenção são importantes no pré e intra-operatório e o escore e a conduta médica propostos neste estudo devem ser criteriosamente observados nos casos de lesão comprovada.

OBJECTIVES: Evaluate the relationship between abdominal injuries and the introduction of guide wire in experimental hip surgery, to propose a scoring system and a medical management based on the distance traveled by the guide wire from the quadrilateral plate until the damaged anatomical structure. MATERIAL AND METHODS: 18 cadaveric hips, a Steimann pin of 3.2 x 300mm, an electric drill and a caliper were used. The wire was inserted in the center of the femoral neck through a lateral approach in the hip under direct visualization. Via median abdominal extended approach to the pelvic region, the quadrilateral plate was observed until the wire crossed it. From this point the wire was further inserted 140 mm in order to observe its abdominal path and describe the lesions presented based on the distance traveled. RESULTS: There were five lesions (27 percent) in the sigmoid colon, and one transfixing injury (5 percent) of the obturator nerve. The common iliac arteries and veins from the contralateral hip were not injured. CONCLUSION: The guide wire must not exceed the quadrilateral plate. Preventive measures are important in the pre- and intra-operatory stages and the score and medical management proposed in this study should be carefully observed in cases of injury.

Extensive subcutaneous emphysema due to colonic perforation following colonoscopy

During colonoscopy, subcutaneous emphysema may occur as a result of colonic perforation into retroperitoneal area. In this report, a 54-year-old woman with sigmoid colon perforation following colonoscopy is described. Subcutaneous emphysema was the first manifestation of the perforation in this case. Initially, the patient received supportive, non-surgical treatment, but due to development of acute abdominal signs and symptoms in later stages, the patient underwent surgical treatment

A case report of drinking glass in rectum.

A fifty years old man was admitted in the Dept. of Surgery of Community Based Medical College, Bangladesh, Hospital with the history of pain and distension of lower abdomen for 4 days with obstipation for the same duration. He gave history of being assaulted and forceful introduction of some foreign body per-rectally 5 days back. History, clinical examination and abdominal X-rays diagnosed the case as impacted foreign body in rectum. He was undergone laparotomy and a big drinking glass was extracted from sigmoid colon. Patient developed subcutaneous stitch infection postoperatively and discharged from the hospital after controlling the infection.

Abdominal Actinomycosis Associated with a Sigmoid Colon Perforation in a Patient with a Ventriculoperitoneal Shunt

Abdominal actinomycosis causing hydronephrosis in a patient with a ventriculoperitoneal shunt is very rare. A 27- year-old female patient was admitted complaining of lower abdominal pain. She had undergone ventriculoperitoneal shunt surgery 10 years ago. Abdominal Ultrasonography and a CT scan demonstrated an inflammatory mass in the lower left quadrant of the abdomen causing obstructive hydroureter and hydronephrosis. Laparotomy revealed a diffusely infiltrating mass involving the small bowel, mesentery, and sigmoid colon, and a 1cm perforation in the sigmoid colon. Actinomycosis was diagnosed upon histological examination. After treatment with antibiotics and surgery, the patient's condition improved.

Traumatismo escrotal: a propósito de una caso / Scrotal traumatism: a purpose of an case

Se presenta un caso de lesión de víscera hueca como resultado de herida por arma de fuego (HAF) en el escroto izquierdo de un paciente que presenta una hernia inguino escrotal. El paciente se mantuvo en observación del Hospital por 20 horas, cuando se decidió tratamiento quirúrgico de emergencia y se evidenció lesión del sigmoides. El tratamiento consistió en sigmoidectomía anterior por técnica de Mickulitz y rescción del saco hernario (sin reparación de la hernia). Se resalta lo excepcional de este caso (un solo caso publicado en la literatura médica mundial de los últimos 15 años); la importancia de una buena anamnesis y examen físico; drenaje independiente de la cavidad abdominal y escroto; diferir la resolución del defecto herniario

Perforación del recto sigmoides, complicación tardía de derivación ventrículo peritoneal en hidrocefalia congénita / Perforation of rectus sigmoides, late complication of ventricle peritoneal derivation in congenital hydrocefalia

La perforación tardía del recto sigmoide y la exposición por el ano del catéter peritoneal en una derivación ventrículo-peritoneal, es una complicación infrecuente. Se describe un caso de hidrocefalia congénita y defecto del tubo neural, que presentó esta complicación siete meses posteriores al implante quirúrgico del sistema de derivación y se revisa la literatura sobre el tema

Perforacion intestinal por hueso de pollo simulando una diverticulitis colonica perforada / Intestinal perforation by chicken bone mimicking a perforated colonic diverticulitis

Los cuerpos extraños intestinales usualmente pasan y son evacuados espontaneamente en las heces fecales sin causar daño. De lodas maneras, la perforación intestinal puede ocurrir en menos del 1 por ciento de los casos. La sospecha clínica es muy importante para obtener el diagnóstico ya que muchos cuadros clínicos pueden simular esta patología. Nosotros presentamos un caso de un hombre de 63 años quien deglutió un hueso de pollo que perforó el sigmoides y produjo un cuadro clínico simulando una diverticulitis colónica complicada. En cirugía, fue removido un hueso de pollo con bordes cortantes de 3 cm del sigmoides sin evidencia alguna de formación de absceso 48 horas después de su ingesta, pero se encontró una reacción inflamatoria aguda. Se realizó una colostomía tipo Hartmann (colostomía proximal y un cierre del muñón rectal) y 3 meses después se realizó la anastomosis. El paciente desarrolló un postoperatorio sin complicaciones y se mantiene asintomático en un período de 9 años. El colon sigmoides es un sitio inusual de perforación, si es que no presentare divertículos, el cual no es el caso de nuestro paciente. Comprobamos que la detección temprana y el tratamiento quirúrgico oportuno diminuye el riesgo de desarrollar complicaciones como es el caso de los abscesos, fístula intestinal y obstrucción; disminuyendo la morbilidad y mortalidad que las mismas producen.

Perforación de intestino grueso por un dispositivo intrauterino "medicado" tipo 7 de cobre / Large bowel perforation by a \"medicated\" IUD copper-7 type

Se presenta un caso de perforación de intestino grueso a nivel de sigmoide, secundaria a la aplicación de un Dispositivo Intrauterino (DIU) "medicado" tipo 7 de Cobre. Estas variedades de DIU translocado a cavidad peritoneal puede provocar adherencias omentales o peritoneales vólvulo, fístula uterocutánea y perforación de intestino, lo cual lleva a una morbilidad significativa. El diagnóstico es muchas veces retrasado y difícil de establecer, pero una vez conociendo la exacta localización del DIU ectópico, por sí solo justifica su retiro inmediato desde la cavidad peritoneal por vía laparoscópica o bien laparotomía con utilización de antibióticos profilácticos para la preparación del colon antes de cirugía eleciva.

Hartmann I tiempo en vólvulo de sigmoides con asas viable 1988-1992 / Hartmann I in sigmoid volvulus with normal looking loops

El presente estudio fue realizado en el Hospital Clínico Viedma durante un periódo comprendido de 1988 Agosto de 1992, referente a los pacientes que presentaron OBSTRUCCION INTESTINSAL BAJA por VOLVULO de SIGMOIDES, en un número de 727 pacientes de los cuales 360 pacientes (49,5 por ciento) fueron solucionados mediante Rectosigmoidoscopía en el sector de Emergencia, estos pacientes fueron hospitalizados, dados de alta a solicitud de ellos; 367 pacientes (50,5 por ciento) fueron hospitalizados de los cuales 112 fueron intervenidos luego de la devolvulación restosigmoidoscópica solicitaron alta, correspondiente el 69,5. De los 112 paciente, 78 fueron intervenidos quirúrgicamente mediante ala técnica de Hartmann I tiempo; y 34 pacientes fueron operados por técnica diferente. La edad mas frecuente de presentación esta comprendida entre la 3ª y 5ª década de la vida, con predominio del sexo masculino, provenientes del área rural, los cuales tienen como antecedente 1 a 3 obstrucciones previas y alimentación en base a hidratos de carbono y con el hábito de masticación de coca. El propósito del presente trabajo es el de proponer una alternativa quirúrgica en el Vólvulo de Sigmoides con asa viable, reduciendo: en forma significativa de tiempo de internación, como las erogaciones económicas del paciente e institución ademas de una morbilidad mínima.

Fistula aorto-sigmoide primaria: relato de um caso / Primary aortosigmoid fistula: report of a case

Os autores relatam a conduta terapeutica e o seguimento de uma paciente portadora de tumor carcinoide maligno de reto com metastase hepatica, e fazem uma bibliografia do assunto. Salientam que o tumor retal era assintomatico, embora apresentasse invasao da camada muscular do orgao, tendo sido diagnosticado posteriormente ao achado de sua metastase. Justificam a resseçao local do tumor devido a presença de disseminaçao para o figado. A paciente tem, no momento, um ano de segmento pos-operatorio, e nao apresenta sinais clinicos ou radiologicos de recidiva ou intraperitoneal.

Perforación rectosigmoide asintomática y extrusión peranal de catéter de derivación ventrículoperitoneal / Perforation rectumsigmoid asymptomatic and extrusion peranal of catheter of derivation ventricleperitoneal

Se estudia la historia clínica de un lactante de 10 meses de edad, quien fue hospitalizado por la expulsión a través del ano de la extremidad distal de un catéter de derivación ventrículoperitoneal que había sido implantado por hidrocefalia congénita. Se discute el mecanismo probable de la reducción espontánea del tubo y la forma de abordar el manejo de esta rara complicación