Perforation Of Bowel Wall Research Articles

Bowel Perforation Following Sclerotherapy of a Massive Intra-Abdominal Lymphatic Malformation

Lymphatic malformations are vascular anomalies that often arise from congenital defects and can manifest in a variety of locations, including the abdomen. Such lesions are often targeted with sclerotherapy, which has become the first-line treatment due to the limitations of surgical intervention. Sclerotherapy is associated with side effects including local necrosis and edema, with localized tissue destruction seldom reported. Here we describe the case of a neonate female with bowel wall perforation following sclerotherapy with ethanol and doxycycline for macrocystic abdominal lymphatic malformation.

Transverse colon volvulus post colonoscopy: a case report

Colonic volvulus accounts for 15-20% of large bowel obstructions. A very small percentage of colonic volvulus occur in the transverse colon and splenic flexure (<5%). Colonic volvulus is a surgical emergency and requires urgent decompression to prevent bowel ischaemia and perforation. The incidence of colonic volvulus post colonoscopy is rare, and aetiology is believed to be secondary to insufflation in the context of a non-fixed/mobile segment. We present a case of a 75-year-old man who presented to the emergency department with abdominal pain following a colonoscopy. Computer tomography (CT) imaging of his abdomen demonstrated an acute volvulus of the transverse colon. He proceeded to a diagnostic laparoscopy where the volvulus had resolved. The transverse colon was noted to have redundancy, but both the caecal pole and splenic flexure were fixed. The decision was made not to respect the bowel. Transverse colon volvulus is a rare occurrence, and accurate assessment and investigation of patients presenting with obstructive bowel symptoms is essential to allow prompt surgical management and prevent ischaemia and bowel wall perforation.

Intestinal metastasis from carcinoma cervix: An (un) common occurrence in a common cancer. A series of five cases from a single institution.

Carcinoma cervix usually spreads directly to contiguous structures, such as the vagina, urinary bladder, ureter, and rectum. Intestinal metastasis from cervical cancer is very uncommon and accounts for less than 4% of cases and to date, 24 cases have been reported in Medical literature. These may be asymptomatic or present with features of intestinal obstruction, bowel wall perforation, and mimic acute abdomen. Intestinal metastasis is a late occurrence and carries a poor prognosis, hence a high index of suspicion with prompt diagnosis and management is essential. We report a series of five patients with squamous cell carcinoma (SCC) of the cervix with intestinal metastasis diagnosed in our hospital.

The establishment of a regression model from four modes of ultrasound to predict the activity of Crohn's disease

To establish a multi-parametric regression model from four modes of ultrasound to predict the activity of Crohn's disease (CD) noninvasively. Score of 150 of the Crohn’s Disease Activity Index (CDAI) was taken as the cut-off value to divide the involved bowel segments of 51 patients into the active and inactive group. Eleven parameters from four modes of ultrasound (B-mode ultrasonography, color Doppler flow imaging, contrast-enhanced ultrasonography and shear wave elastography) were compared between the two groups to investigate the relationship between multimodal ultrasonic features and CD activity. P < 0.05 was considered statistically significant. Parameters with AUC larger than 0.5 was selected to establish the prediction model of CDAI. Totally seven ultrasound parameters (bowel wall thickness, mesenteric fat thickness, peristalsis, texture of enhancement, Limberg grade, bowel wall perforation and bowel wall stratification) were significantly different between active and inactive group. A regression model was established based on the seven parameters as followed: CDAI = 211.325 + 3.186BWT − 53.003BWS + 6.280BWP + 0.392MFT + 22.239PS + 79.012LG + 72.793TE. (R2 = 0.72, P = 0.037). The multimodal ultrasound parametric regression model was designed to predict CDAI score invasively. The model has the potential to provide an alternative method for quantifying the CD activity.

Novel device to detect enterotomies in real time during laparoscopy: first in human trial during Roux-en-y gastric bypass.

Undetected bowel perforations occur in 0.3-1% of laparoscopic surgical procedures with an associated mortality rate of 5.3%. The purpose of the study was to evaluate the clinical feasibility of a novel medical device to accurately detect bowel gas, specifically hydrogen (H2) and methane (CH4), from a sample of gas from the abdominal cavity during laparoscopic surgery when a known bowel wall perforation has occurred. University (Academic) Hospital. A prospective single arm study was composed of 8 patients undergoing a standard laparoscopic roux-en-y gastric bypass. At seven time points during the operation intra-abdominal gas was pulled from the abdominal cavity and analyzed using the novel device for H2 and CH4. The time points included after insufflation (T1), after first jejunotomy (T2), after closure of jejunotomy (T3), after recycle of carbon dioxide gas (T4), after gastrostomy (T5), after jejunotomy (T6), at procedure end (T7). Eight patients were enrolled in the study; in 7 (87.5%) patients data from all 7 time points were obtained. After the first opening of the small bowel (T2) mean hydrogen levels were significantly increased compared to baseline hydrogen levels (T1, T4, T7) (p < 0.001). At all time points, there was no significant detection of methane. There were no intra-operative or post-operative complications during the study. Hydrogen gas is released into the intra-abdominal cavity when bowel is opened and can be detected in real time using a novel device during laparoscopic surgery. The presence or absence of hydrogen directly correlates to whether the bowel is open (perforated) or intact. This device could be used in the future to detect unintended bowel perforations during laparoscopic surgery, prior to the conclusion of the operation. This technology could also potentially lead to novel mechanism for detecting postoperative leaks using gas detection technology.

Іnnovation technologies in the gut organs surgery

Objective. To improve the surgical treatment results in patients, suffering the gut organs diseases, due to its sophistication and elaboration of modern innovation technologies.&#x0D; Маterials and methods. In the work the author’s concept and results of the modern innovative technologies while performing surgery on the gut organs for ulcerative hemorrhage, complicated postbulbar, parapapillary ulcers, gastric cancer and polyps, colorectal cancer, ulcerative colitis, Crohn’s disease of large bowel, familial adenomatous polyposis are adduced. Endoscopic operations, methods of atraumatic dissection of tissues, new restoration and reconstructive-restorative operations, using modern staplers for anastomoses formation, laparoscopic operations were applied. The innovative surgical technologies were applied in 2428 patients.&#x0D; Results. Using methods of endoscopic hemostasis a definitive arrest of ulcerative hemorrhage was achieved in 91.1% patients. Еndoscopic polypectomy for the large bowel polyps of significant size and for «spreading» polyps were performed in 90.5% patients. Occurrence of postoperative hemorrhage was reduced to 0.74%, а large bowel wall perforation was not observed. In patients with complicated postbulbar and parapapillary ulcers the postoperative morbidity was reduced tо 24.7%, postoperative lethality - tо 7.6%. More favorable functional results were obtained after gastroplastic operations. Postoperative complications have occurred in 15.8% patients, 1.7% patients died.&#x0D; Conclusion. Modern innovation surgical technologies, including endoscopic, staplers for anastomoses formation, methods of atraumatic dissection of tissues, reconstructive-restorative, laparoscopic surgical interventions are sufficiently effective in the treatment of patients, suffering diseases of the gut organs. Application of modern innovation technologies in the gut organs surgery makes possible to eliminate pathological process, its complications, to reduce significantly the surgical interventions traumaticity, time of their performance, quantity of postoperative complications, lethality, and to improve functional results and quality of life in the patients operated.

Endoscopic Remission After Infliximab Treatment in a Patient with Ipilimumab-Induced Colitis

Biological medications may result in serious side effects. Some effects relate to immunosuppression while others are from immunostimulation. Our case demonstrates severe ipilimumab-induced colitis in a patient being treated for stage 4 malignant melanoma, which responded to treatment with infliximab. A 78 year old man with stage 4 malignant melanoma treated with ipilimumab and radiation was admitted to our hospital with three weeks of abdominal pain and severe refractory bloody diarrhea. Prior to hospitalization he received four infusions of ipilimumab. Stool analysis revealed leukocytosis and no Clostridium difficile toxin, Cryptosporidium, or Giardia. There was a negative serum CMV antigen screen. The patient was started on metronidazole, ciprofloxacin, and prednisone although these did not provide resolution of his symptoms. CT abdomen and pelvis with contrast revealed extensive colonic wall thickening that extended up to the proximal transverse colon. Sigmoidoscopy demonstrated severe colitis with mucosal edema, erythema, and ulceration. Colonic mucosal biopsies were obtained and the results revealed acute colitis with ulceration as well as negative CMV and HSV histochemistries. Despite continued high dose steroids and bowel rest there was no clinical improvement. The patient was started on Infliximab, and he noticed progressive improvement in his diarrhea. The patient was discharged for outpatient GI clinic follow up and continued infusions. The patient's clinical course was complicated by pulmonary embolism and he required anticoagulation. At a three-month follow up sigmoidoscopy, the ulcers showed healing change, normal rectal mucosa, and resolved colitis. The nine-month follow up colonoscopy demonstrated remission. The Infliximab was stopped and patient was followed clinically. Ipilimumab related colitis is the result of hyperactive cytotoxic T lymphocytes. Ensuing necrotizing colitis can cause bloody diarrhea, bowel wall perforation, or toxic megacolon. Aggressive medical management decreases excessive inflammatory reaction in areas of large immunologic cell populations, such as the colon. Infliximab, tacrolimus and corticosteroids have efficacy against the excessive inflammatory side effects of hypersensitivity colitis. Unfortunately, medical management cannot prevent colectomy in all cases which is a last resort for necrotizing colitis. Our case presents the management of complicated colitis with colon-sparing medical management.Figure 1Figure 2

A184 - Novel device to detect enterotomies in real time during laparoscopy - First in human trial during Roux-en-Y gastric bypass

Undetected bowel perforations occur in 0.3–1% of laparoscopic surgical procedures with an associated mortality rate of 5.3%. The purpose of the study was to evaluate the clinical feasibility of a novel medical device to accurately detect bowel gas, specifically hydrogen (H2) and methane (CH4), from a sample of gas from the abdominal cavity during laparoscopic surgery when a known bowel wall perforation has occurred. Setting: University (Academic) Hospital. A prospective single arm study was composed of 8 patients undergoing a standard laparoscopic roux-en-y gastric bypass. At seven time points during the operation intra-abdominal gas was pulled from the abdominal cavity and analyzed using the novel device for H2 and CH4. The time points included after insufflation (T1), after first jejunotomy (T2), after closure of jejunotomy (T3), after recycle of carbon dioxide gas (T4), after gastrostomy (T5), after jejunotomy (T6), at procedure end (T7). Eight patients were enrolled in the study; in 7 (87.5%) patients data from all 7 time points were obtained. After the first opening of the small bowel (T2) mean hydrogen levels were significantly increased compared to baseline hydrogen levels (T1, T4, T7) (p < 0.001). At all time points, there was no significant detection of methane. There were no intra-operative or post-operative complications during the study. Hydrogen gas is released into the intra-abdominal cavity when bowel is opened and can be detected in real time using a novel device during laparoscopic surgery. The presence or absence of hydrogen directly correlates to whether the bowel is open (perforated) or intact. This device could be used in the future to detect unintended bowel perforations during laparoscopic surgery, prior to the conclusion of the operation. This technology could also potentially lead to novel mechanism for detecting postoperative leaks using gas detection technology.

Severe gastrointestinal mucositis following high dose melphalan therapy for multiple myeloma

Mucositis is a known complication following use of chemotherapy, but fatal mucositis is unusual and management of such cases may be challenging. Pathologically there is denudation of mucosa of gastrointestinal tract. Severe cases can develop ileus and even perforation of bowel wall. We report here a case of multiple myeloma who developed World Health Organization grade 4 gut mucositis following the use of high dose melphalan with the expulsion of "intestine-like" material.

Intususpección en el adulto: Diagnóstico por TAC

only 5% of cases are seen in the adult. It represents 1-5% of all causes of bowel obstruction (1). We report the case of a 71year-old woman with a past medical history of fracture to the radius who arrived in our emergency department complaining of 2-day-standing abdominal distension secondary to bowel obstruction. Blood tests revealed a high leukocyte count with neutrophilia, and gas-fluid levels were seen in the small bowel on abdominal radiographs. After spontaneous resolution without surgery a colonoscopy was performed, which revealed a large, 60-cm adenomatous polyp from the anal verge. A sample was taken for biopsy, which showed a tissue compatible with colon adenocarcinoma. A computed tomography scan identified an atypical distribution of the small bowel and stomach, and also clear signs of invagination (Fig. 1). A surgical procedure was performed, which found an ileocecocolic invagination secondary to a voluminous tumor in the cecum. After invagination reduction a right hemicolectomy was performed, with an uneventful post-surgical period. In adults intestinal invagination usually presents in a subacute or chronic form with nonspecific symptoms; abdominal pain is the most frequent symptom (1) and is rarely associated with mechanical bowel obstruction (1,2). Computed tomography has proven to be extraordinarily sensitive for the diagnosis (78%) (3) specially of chronic cases, and may identify the invaginated bowel surrounded by mesenteric fat as well as mesenteric vessels within the invaginating segment (3,4). All authors agree that surgical resection is the treatment of choice (1,5) because there is almost always an organic cause in the adult (80-90%) that acts as an invaginating head (1,2). Malignant tumors, adenocarcinomas or lymphomas arising in the ileocecal valve represent the most frequent cause of invagination (65%) (2,3). There is controversy in the literature reviewed regarding whether mechanical reduction should be attempted prior to or during surgery (2,5). Some authors think that this can cause tumoral embolization or intraluminal dissemination, and also elevates the risk of bowel wall perforation from unnoticed mucosal necrosis (5).

Recurring enteric peritonitis associated with non-perforating colon carcinoma

Peritonitis of enteric origin may occur during treatment with peritoneal dialysis due to visceral perforation or injury or, in the absence of perforation, due to transmural migration of enteric bacteria across the bowel wall into the peritoneal cavity. To the best of our knowledge, peritonitis has not previously been reported associated with carcinomatous colon polyp in the absence of bowel wall perforation. We describe the case of a 31-year-old female who experienced recurring episodes of enteric peritonitis associated with a clinically occult adenocarcinoma of the colon, without having any other known risk factors for peritonitis. A 15 mm carcinomatous polyp was not visible on CT scan but was found at colonoscopy with polypectomy. She proceeded to transverse colectomy; the resected colon showed no evidence of bowel wall perforation. This case demonstrates that a non-perforating carcinomatous polyp of the colon may predispose to enteric peritonitis in the setting of peritoneal dialysis, and it emphasizes the importance of making an aggressive search for underlying pathology, in patients who present with recurring enteric peritonitis or unusual presentations of enteric peritonitis.

Disseminated Histoplasmosis Complicated by Small-Bowel Perforation in a Patient With Acquired Immune Deficiency Syndrome

Disseminated Histoplasmosis Complicated by Small-Bowel Perforation in a Patient With Acquired Immune Deficiency Syndrome

The importance of mesenteric vascular insufficiency in meconium peritonitis

The etiology of bowel perforations leading to meconium peritonitis was investigated in an attempt to explain the occurrence of such perforations in the absence of primary intestinal obstruction. Bowel specimens from 22 patients who had presented with meconium peritonitis during a 15-year period, as well as specimens from five patients with intestinal atresia without associated meconium peritonitis, were re-evaluated microscopically. An extensive review of the literature concerning meconium peritonitis, involving 1,084 patients, was compared with the results of a retrospective study of 69 patients from The Netherlands. In approximately 50 per cent of these cases there was no detectable primary cause of the bowel perforation. The pathologic findings, in combination with earlier experimental studies, indicate that vascular insufficiency may result in bowel wall perforation without prior intestinal obstruction. It is suggested that temporary decrease of mesenteric blood flow could lead to intestinal atresia and/or meconium peritonitis.