Intestinal perforation as a form of presentation of a small bowel calcifying fibrous tumor.

Calcifying fibrous tumor (CFT) is a rare, benign, mesenchymal tumor. It has a slight female predominance, and it can appear in any range of age. It can be in the extremities, neck, and gastrointestinal tract, but it has also been described in other locations. Even though it is a benign lesion, recurrence has been described in some cases in the literature. A free-margin surgical resection is the recommended treatment. We present a 56 -year-old woman who underwent surgery for an intestinal obstruction associated with middle jejunum perforation. Histopathological study described the presence of a calcifying fibrous tumor. Spindle cells were positive for CD34, Factor XIIIa and vimentin. To our knowledge, this is the first case of intestinal perforation secondary to a calcifying fibrous tumor described in the literature.

HARTMANN PROCEDURE OR RESECTION WITH PRIMARY ANASTOMOSIS FOR TREATMENT OF PERFORATED DIVERTICULITIS? SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. AIM: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. METHOD: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. RESULTS: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. CONCLUSION: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

Hartmann procedure or resection with primary anastomosis for treatment of perforated diverticulitis? systematic review and meta-analysis / Procedimento de hartmann ou ressecção com anastomose primária para tratamento da diverticulite perfurada? revisão sistematizada e metanálise

ABSTRACT Background: The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

RESUMO Racional: O procedimento a Hartmann permanece sendo o tratamento de escolha da maioria dos cirurgiões para o tratamento cirúrgico de urgência da diverticulite perfurada, entretanto está associado com altas taxas de não reversão da ostomia e de morbidade pós-operatória. Objetivo: Estudar os resultados após o procedimento de Hartmann vs. ressecção com anastomose primária, com ou sem ileostomia, para o tratamento da diverticulite perfurada com peritonite purulenta ou fecal (grau de Hinchey III ou IV), e comparar as vantagens entre as duas formas de tratamento. Método: Busca sistemática na literatura de artigos observacionais e randomizados comparando ressecção com anastomose primária vs. procedimento de Hartmann no tratamento de urgência da diverticulite perfurada. Analisar como desfechos primários a mortalidade após a operação de urgência e a morbidade geral após ela; como desfechos secundários, a morbidade severa após a operação de urgência, as taxas de não reversão da ostomia, a morbidade geral e severa após a reversão. Resultados: Não houve diferenças significativas entre os procedimentos cirúrgicos para mortalidade, morbidade geral e morbidade severa. Contudo, as diferenças foram significativas estatisticamente favorecendo anastomose primária na comparação com procedimento de Hartmann nos desfechos taxas de não reversão do estoma, morbidade geral e morbidade severa após reversão. Conclusão: A anastomose primária apresenta-se como boa alternativa ao procedimento de Hartmann, sem aumento de mortalidade e morbidade, e com melhores resultados na operação de reconstrução do trânsito intestinal.

[Stercoral perforation of the colon: case report and literature review]. / Perforación estercórea de colon: caso clínico y revisión del tema.

INTRODUCTION: Colon perforation has several causes, including stercoral perforation of the colon, which was first described in 1894. Currently, reported cases are fewer than 100. CASE REPORT: Male patient of 67 years old, treated at Huichapan General Hospital, Hidalgo, Mexico, with abdominal pain, bloating and no bowel movements. He referred being constipated for the last ten years. Imaging revealed an extremely dilated sigmoid colon with fecal matter as well as free gas in the peritoneal cavity. The suspicion of stercoral colonic perforation is established. Exploratory laparotomy was performed immediately, finding a perforation and a hard scybalum protruding in the ascending colon. Colectomy, ileostomy and Hartmann's pouch are performed. After surgery, the condition of the patient worsened and progressed to septic shock and respiratory failure. The patient died four hours after surgery, with the diagnosis of organ failure due to sepsis. LITERATURE REVIEW: Stercoral perforation accounts for 3.2% of all colon perforations and is caused by a rupture of the intestinal wall through direct pressure of a fecaloma on the colon. It occurs especially in patients older than 70 years with severe chronic constipation, weakened and/or are hospitalized with multiple medications and immobilized. CONCLUSIONS: Stercoral perforation of the colon is a rare cause of bowel perforation, which should be suspected in patients with a history of chronic constipation, acute abdominal pain, bloating and sepsis, in order to intervene in a timely fashion.

Segmental absence of intestinal musculature -presentation in a 10-year-old boy with an extensive involved segment.

Segmental absence of the intestinal musculature is a rare cause of acute abdomen most likely associated with intestinal perforation and sepsis in neonates and adults. We present a case of a 10-year-old boy who developed acute abdomen and was treated with right hemicolectomy and partial resection of the ileum. The ileum showed a 20-cm-long stenotic segment showing prominent thinning of the intestinal wall. This case occurred in an older child, which appears to be rare when comparing the literature. The bowel defect was also the largest described to date, indicating the potential effect of an atonic segment leading to obstructive disease.

Ischemia-reperfusion and neonatal intestinal injury.

We review research relating ischemia/reperfusion to injury in the neonatal intestine. Epidemiologic evidence suggests that the most common form of necrotizing enterocolitis is not triggered by a primary hypoxic-ischemic event. Its late occurrence, lack of preceding ischemic events, and evidence for microbial and inflammatory processes preclude a major role for primary hypoxic ischemia as the sentinel pathogenic event. However, term infants, especially those with congenital heart disease who have development of intestinal necrosis, and those preterm infants with spontaneous intestinal perforations, are more likely to have intestinal ischemia as a primary component of their disease pathogenesis.

Colonic perforation: a lethal consequence of cannabis body packing.

Body packing is one method of smuggling cannabis across international borders. The practice is prevalent in Jamaica. There has been one reported death from this practice in medical literature. We report a second fatal case of cannabis body packing, reinforcing the dangerous nature of this practice.

Lack of effect of dopaminergic antagonists in a rodent model of peritoneal sepsis.

Central nervous system dopaminergic mechanisms have been implicated in the cytokine response to stress and sepsis. We here describe the effects of haloperidol or clozapine in the treatment of sepsis induced by cecal ligation and puncture. Male Wistar rats were subjected to the CLP procedure were treated with haloperidol or clozapine and plasma cytokines, myeloperoxidase activity, markers of organ injury and survival was analyzed. The addition of haloperidol or clozapine to basic support did not diminished hepatic, renal, pancreatic or muscular damage observed after sepsis. Neither haloperidol, nor clozapine, modulates pro and antiinflammatory cytokines after sepsis induction. In addition, haloperidol treatment did not diminished myeloperoxidase activity in the kidney, lung or liver, or altered BALF markers of lung damage or inflammatory infiltration. Our data did not support a role of haloperidol or clozapine as an immunomodulator agent in the treatment of sepsis in an animal model of peritonitis.

Ileal perforation caused by congenital or perinatal cytomegalovirus infection.

Enteritis developed in a 42-day-old female infant, and during hospitalization ileal perforation occurred unexpectedly. Serologic data, urinary viral culture, and pathologic studies of the resected ileal segment all suggested cytomegalovirus infection. Gastrointestinal involvement in congenital or perinatal infection with this virus may be relatively more common than previously recognized.

Linfomas intestinales: informe de 10 casos / Intestinal lymphomas: a report of 10 cases

Los linfomas del tubo digestivo son los linfomas extraganglionares más frecuentes y constituyen del 1 al 4 por ciento de las neoplasias malignas del tubo digestivo. En este trabajo se analizan las caracteristicas clínicas y patológicas de 10 linfomas del intestino delgado y grueso en pacientes del Hospital General de México, que se obtuvieron después de revisar 8 años del material quirúrgico y 5 años del de autopsias de los archivos de la Unidad de Patología de este hospital. Seis casos fueron hombres y 4 mujeres. La edad varió de 3 a 94 años, con un promedios de 50.3 años. Las manifestaciones clínicas incluyeron dolor abdominal (83 por ciento), vómito (50 por ciento), pérdida de peso (50 por ciento), pérdida de peso, constipación (33 por ciento) e ictericia (16 por ciento). La perforación intestinal fue la complicación más frecuente (30 por ciento). Seis casos se localizaron en intestino delgado, dos en intestino delgado y colon, uno en colon y uno en recto. Microscópicamente 7 fueron de bajo grado y tres de alto grado, 55 por ciento correspondieron a linfomas B y 45 por ciento a linfomas T. Dos casos se consideraron primarios y cuatro por tener infiltración extraintestinal, fueron secundarios. En ningún caso se encontraron datos sugestivos de linfoma asociado a mucosas ni datos de enteropatía asociada a mala absorción intestinal.

Stercoral perforation of the normal colon: report of five cases

A series of five consecutive patients with stercoral perforation of the colon is presented. Four of the patients had free perforation and one had an abscess between the splenic flexure, spleen and surrounding organs, a yet unreported entity. All patients underwent emergency surgery including laparostomy with repeated explorations and lavages in two of them. The ethiology, pathophysiology and treatment of the condition are updated. A graphic algorithm for decision-making in appropriately dealing with stercoral perforation of the colon is proposed.

Stercoral perforation of the normal colon: report of five cases.

A series of five consecutive patients with stercoral perforation of the colon is presented. Four of the patients had free perforation and one had an abscess between the splenic flexure, spleen and surrounding organs, a yet unreported entity. All patients underwent emergency surgery including laparostomy with repeated explorations and lavages in two of them. The ethiology, pathophysiology and treatment of the condition are updated. A graphic algorithm for decision-making in appropriately dealing with stercoral perforation of the colon is proposed.

[Intestinal perforation by Angiostrongylus costaricensis. A report of 2 cases]. / Perforación intestinal por Angiostrongylus costaricensis. Presentación de dos casos.

Two cases of abdominal angiostronylosis with terminal ileum perforation are reported. The first two cases diagnosed in Panama of a well established eosinophilic granulomatous process which affects mostly children in Costa Rica. The parasite Angiostrongylus costaricensis has been demonstrated in cases with a geographic range, from Mexico down to Brazil. The parasite has been found in rodents in Panama (Sigmodon hispidus and Rattus rattus) with an still pending further epidemiological and serological studies in order to determine the true disease morbidity.

Poliarterite nodosa: comprometimento intestinal / Polyarteritis nodosa: intestinal compromising

Os autores descrevem um caso de poliarterite nodosa (PAN) evoluindo com abdome agudo e óbito por necrose e perfuraçäo de alça intestinal. Paciente do sexo masculino, com manifestaçöes clínicas iniciais de febre, emagrecimento e fraqueza muscular, foi diagnosticado como polimiosite (PM). Após dois anos de evoluçäo, apresentou manifestaçöes de abdome agudo por necrose segmentar de alça intestinal, cujo histopatológico foi compatível com PAN. Os autores discutem as diversas manifestaçöes clínicas da PAN, enfatizando o comprometimento muscular e gastrintestinal, neste com mortalidade de 75 a 100 por cento dos casos

Abdome agudo em paciente com poliarterite nodosa: relato de um caso / Acute abdomen in a patient with polyarteritis nodosa: report of a case

Os autores apresentan o caso de uma mulher de 31 anos, internada com quadro de dor abdominal, febre, emagrecimento e hipertensäo arterial maligna. O exame ultra-sonográfico, realizado por ocasiäo da admissäo, mostrou a imagem sugestiva de nefropatia crônica. No 3§ dia de internaçäo, apresentou abdome agudo, sendo a paciente submetida a laparotomia exploradora, quando se evidenciou peritonite purulenta e segmento ileal com múltiplas perfuraçöes, que foi ressecado. O resultado do exame anatomopatológico do íleo ressecado revelou poliarterite nodosa. A paciente evoluiu com falência de multiplos órgäos e óbito. Comenta-se a dificuldade do diagnóstico e, com base em experiência de literatura, sugerem tratamento através de plasmaferese, tendo em vista que a terapêutica convencional com metilprednisolona e ciclosfosfamida mostrou-se, mais uma vez, insuficiente em casos graves

[Acute abdomen in a patient with polyarteritis nodosa: report of a case]. / Abdome agudo em paciente com poliarterite nodosa: relato de um caso.

The authors present the case of a 31 year old woman admitted with abdominal pain, fever, weight loss and malignant hypertension. The ultrasonographic examination showed an image suggesting chronic nephropathy. On the 3rd day of hospitalization an exploratory laparotomy was performed with the diagnosis of acute abdomen. There was purulent peritonitis and a segment of ileum with multiple perforations, which was resected. The anatomopathologic finding of the surgical specimen revealed polyarteritis nodosa. The patient developed multiple organ failure and evolved to death. The difficulty in establishing the diagnosis is commented and, the authors according with some studies suggest treatment with plasmapheresis because the conventional therapy with methylprednisolone and cyclophosphamide proved to be insufficient in severe cases.