Subject(s)
Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Meckel Diverticulum/complications , Meckel Diverticulum/diagnosis , Adolescent , Diagnosis, Differential , Diagnostic Imaging , Gastrointestinal Hemorrhage/surgery , Humans , Male , Meckel Diverticulum/surgery , Polyps/diagnosisABSTRACT
Perforation of Meckel's diverticulum (MD) during the neonatal period may occur in the presence of distal colon obstruction. Herein, we describe a unique case of a 2-day-old infant that presented with pneumoperitoneum, in which a perforated MD was induced by distal intestinal obstruction secondary to total colonic aganglionosis. In the setting of neonatal perforated MD found intraoperatively, the determination of the possible precipitating etiology is necessary. The clinical history of delayed passage of meconium is emphasized, and either a rectal or colon biopsy is recommended intraoperatively to avoid overlooking the associated presence of Hirschsprung's disease.
Subject(s)
Hirschsprung Disease/complications , Intestinal Obstruction/etiology , Intestinal Perforation/etiology , Meckel Diverticulum/complications , Colostomy , Digestive System Surgical Procedures/adverse effects , Female , Hirschsprung Disease/surgery , Humans , Infant, Newborn , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , Meckel Diverticulum/surgery , Precipitating Factors , ReoperationABSTRACT
BACKGROUND: The incidence of postoperative fungal infection is increasing and the gastrointestinal tract is the major source, but antifungal therapy in perforated peptic ulcer (PPU) is still controversial. The aim of this study was to determine the significance of intraoperative peritoneal fluid culture of fungus and establish the indications for treatment. METHODS: Between July 1997 and September 2001, all patients admitted with a PPU were studied. Clinical data and peritoneal fluid for culture were collected. Risk factors for a positive peritoneal fluid culture of fungus and outcome were evaluated, and related to the development of surgical site infection, duration of hospital stay and mortality rate. RESULTS: One hundred and forty-five patients with a PPU were included; 63 (43.4 per cent) had positive peritoneal fluid fungal culture. Age, preoperative organ failure, delay in operation, high Mannheim Peritonitis Index (MPI) and Acute Physiology And Chronic Health Evaluation (APACHE) II scores, and preoperative antibiotic therapy were risk factors for a positive fungal culture. Sex and an MPI score of 20 or more remained significant in multivariate analysis (P < 0.001). Patients with a positive fungal culture had a higher incidence of surgical site infection, a longer hospital stay and a significantly higher mortality rate, especially when this was combined with a high MPI score. CONCLUSION: Positive peritoneal fungal culture was common and was a significant risk factor for adverse outcome in patients with a PPU. A high MPI score could be used as an indicator for prophylactic antifungal therapy.
Subject(s)
Ascitic Fluid/microbiology , Fungi/isolation & purification , Mycoses/drug therapy , Peptic Ulcer Perforation/microbiology , Postoperative Complications/drug therapy , APACHE , Aged , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Female , Humans , Length of Stay , Male , Middle Aged , Multivariate Analysis , Mycoses/microbiology , Peritonitis/microbiology , Postoperative Complications/microbiology , Risk Factors , Surgical Wound Infection/microbiology , Survival Analysis , Treatment OutcomeABSTRACT
A symptomatic Meckel's diverticulum (MD) may manifest as an intestinal obstruction secondary to a volvulus. We describe a case of a meconium-impacted MD associated with inflammatory adhesions to adjacent viscera that presented as an intestinal obstruction in a 4-h-old infant secondary to an ileal volvulus with resultant infarction of the diverticulum and ileal segment.
Subject(s)
Ileal Diseases/complications , Intestinal Obstruction/complications , Meckel Diverticulum/complications , Humans , Infant, Newborn , Male , Meckel Diverticulum/diagnosisABSTRACT
Chyloperitoneum is rare condition that can occur in response to various pathologic process. The authors described a newborn baby who had chyloperitoneum after primary surgical repair of esophageal atresia with tracheoesophageal fistula (Gross type C). This probably resulted from iatrogenic damage of the thoracic duct during ligation of azygous vein resulting in leaking lacteal within the intestinal wall. Biochemical analysis of ascitic fluid, plasma, and milk formula for triglyceride and cholesterol level can differentiate neonatal gastric intestinal perforation.
Subject(s)
Chylous Ascites/etiology , Postoperative Complications , Tracheoesophageal Fistula/surgery , Chylous Ascites/diagnosis , Chylous Ascites/surgery , Esophageal Atresia/surgery , Humans , Infant, Newborn , Male , Thoracic Duct/injuriesABSTRACT
The preoperative diagnosis of a cecal perforation associated with Salmonella infection as a cause of abdominal-wall necrotizing fasciitis (AWNF) is clinically difficult. Computed tomography of the abdomen is helpful, and can detect the combined presence of a pneumoscrotum and pneumoperitoneum. Its presence indicates a patent processus vaginalis, which acts as the primary route for the spread of the intra-abdominal infectious process into the abdominal wall. An exploratory laparotomy should be done to confirm the presence of intra-abdominal pathology in order to avoid delayed treatment.
