Case Of Intestinal Perforation Research Articles

Clinical characteristics and risk factors of IgA vasculitis with intussusception and intestinal perforation.

Intussusception is the most common surgical complication of IgA vasculitis (IgAV), and intestinal perforation is usually associated with intussusception. If they are not recognised and treated in a timely manner, serious consequences may occur. The objective is to summarise the clinical features of IgAV complicated by intussusception and intestinal perforation and explore its risk factors. The clinical data of 32 patients with IgAV complicated by surgical complications (25 cases of intussusception and 7 cases of intestinal perforation) were retrospectively analysed. A total of 160 IgAV children with gastrointestinal (GI) involvement but without surgical complications were randomly selected as a control group. Binary logistic regression analysis was performed to explore the risk factors for IgAV with intussusception and intestinal perforation. Compared with the intussusception group, the intestinal perforation group had a significantly higher number of patients with GI symptoms prior to skin purpura and GI bleeding, a significantly higher number of days of abdominal pain, a significantly higher Wong-Baker score, and a significantly higher white blood cell count. Multivariate logistic regression analysis indicated that age ≤7 years, GI symptoms prior to skin purpura, abdominal pain intensity (Wong-Baker scale) and timing of glucocorticoid treatment were independent risk factors of IgAV with intussusception and intestinal perforation. Age less than 7 years, severe abdominal pain, and GI symptoms prior to skin purpura were risk factors for IgAV with intussusception and intestinal perforation. Early use of glucocorticoids may prevent intussusception and intestinal perforation.

Sharp-Pointed Foreign Body Ingestion in Pediatric Age.

To assess the clinical complications reported after the ingestion of sharp/pointed foreign bodies (FBs) in pediatric age, their incidence among all FB ingestions, and the features and clinical presentation of children. We have recruited all consecutive patients aged 0-14 years, admitted for sharp/pointed FB ingestion. Clinical data until hospital discharge were accurately recorded, including both children with esophagogastric FB retention who underwent endoscopic removal and children who were radiologically followed-up till spontaneous FB expulsion. Clinical outcomes were recorded for each patient, with special reference to possible prolonged retention and wall perforation during the intestinal passage. We have enrolled 580 children (males/females: 292/288; age range: 11-180 months; mean age ± standard deviation: 50.5 ± 42 months). Sharp/pointed FBs mainly included fragments of metal 270 of 580 (46.55%) and glass 180 of 580 (31%). FBs were endoscopically removed in 79 of 580 (13.6%) children whereas the remaining FBs passed through the gastrointestinal tract over an overall mean time of 29 hours. No cases of intestinal perforation nor prolonged retention were observed. In 3 of 65 (4.6%) procedures the endoscopist faced an uncomfortable endoscopic removal due to the shape and size of the FB which hampered the retrograde passage through the esophageal sphincters. Our original and extensive data emphasize that accidental ingestion of sharp/pointed FB ingestion is a current issue in pediatric age, especially in toddlers. Metal and glass objects are the most involved FBs and their endoscopic retrieval may not be easy in about 5% of cases. Fortunately, in our pediatric sample no surgical intervention was needed.

Intestinal perforation on an incarcerated incisional hernia secondary to an ingested foreign body. Report of a rare case

Ingestion of foreign bodies (FBs) is common and rarely has consequences for the patient, but sometimes it can originate gastrointestinal perforation and lead to devastating consequences if unrecognized. Therefore, whenever present, bowel perforation demands immediate surgical treatment.An 89-year-old woman with an incarcerated incisional hernia, whose imaging study was consistent with intestinal occlusion and perforation within the hernia sac was treated at our hospital. A segmental enterectomy and direct correction of the hernial defect were performed. A perforation in the mesenteric border due to a FB, which seemed to be a toothpick, was identified in the surgical specimen. Nine months after surgery, the patient was without complaints, with adequate healing, and without evidence of hernial recurrence.To the best of our knowledge, this is the first case of intestinal perforation on an incarcerated incisional hernia, due to an ingested FB, reported in the literature.

A rare case of intestinal perforation in patient with acute decompensated pulmonary artery hypertension and acquired coagulopathy

A rare case of intestinal perforation in patient with acute decompensated pulmonary artery hypertension and acquired coagulopathy

Modern opportunities of early diagnostics and minimally invasive surgical treatment of intestinal perforation by a foreign body

The article presents two cases of intestinal perforation by a foreign body rarely being the cause for “acute abdomen”. In both cases the disease resembled acute appendicitis. The introduction of endovideosurgical technologies into surgical practice contributes to early diagnostics of a gut wall perforation by a foreign body and allows performing only low-invasive surgical treatment.

Two Cases of Intestinal Perforation After Examination of Intestinal Obstruction Using Gastrografin

Two Cases of Intestinal Perforation After Examination of Intestinal Obstruction Using Gastrografin

Intestinal perforation in one of monochorionic twins: a report of two cases and literature review

Objective To report two cases of intestinal perforation in one of monochorionic twins and to analyze relevant clinical manifestations based on literature review. Methods Both cases were admitted to the Obstetrics and Gynecology Hospital of Fudan University in 2017. Relevant articles were retrieved from PubMed, OVID, Elsevier, Full-text Database of China National Knowledge Infrastructure(CNKI) and Wanfang Database from their release dates to February 2018. Clinical manifestations were analyzed through a literature review. Results In case 1, twin boys were born by cesarean section because of selective intrauterine growth restriction (sIUGR) Ⅲ at 31+3 gestational weeks. Signs of abdominal distention were found in one boy the day after birth, whose birth weight was 1 440 g and Apgar scores was all 9 at 1, 5 and 10 min after birth. A large amount of intra-abdominal gas was shown on abdominal X-ray. He was cured after surgery and discharged later. The other boy was fine. In case 2, twin girls were born by cesarean section because of twin-twin transfusion syndrome (TTTS)Ⅲ at 29+1 gestational weeks. The one suffered from intestinal perforation was 810 g at birth and her Apgar scores was all 8 at 1, 5 and 10 minutes. Pneumoperitoneum were observed on abdominal X-ray 16 h after birth. The baby died because of refusal to further treatment after surgery. The other girl was in good condition. Literature search found no relevant report in mainland China, but ten cases had been reported aboard and five of them died. Most cases of TTTS complicated by intestinal perforation occurred in the recipients. Conclusions Complications of monochorionic twins such as TTTS and sIUGR might be potentially associated with intestinal perforation. Early intervention and evaluation is the key to improve the outcomes. Key words: Twin, monochorionic; Diseases in twins; Intestinal perforation; Premature birth

The modified laparoscopic keyhole parastomal hernia repair with in situ re-ostomy has low recurrence rate

This study aimed to present a modified laparoscopic keyhole parastomal hernia repair technique with in situ re-ostomy and show its safety and feasibility at a mid-term follow-up. The technique begins with adhesiolysis during laparoscopy. An annular incision is made between the skin and stomal mucosa. Then, after all adhesions of the stomal bowel and its mesentery are separated from the hernial sac, the stomal bowel is delivered through the keyhole mesh. The mesh is then stitched to the stomal bowel and placed intraperitoneally. The hernial ring is narrowed, and the mesh is further stitched to the hernial ring and stomal tube. After the mesh is fixed, the redundant stomal bowel is shortened, and a new in situ stoma is matured in the conventional way. Altogether, 65 consecutive patients underwent successful hernia repair via a modified laparoscopic keyhole with in situ re-ostomy. Two of the patients had recurrent parastomal hernias. No mortalities occurred during the perioperative period. Morbidities included two cases of seroma and three of ileus, all of which were cured with conservative treatment. In addition, one case of intestinal perforation was rescued by intestinal resection and enteroenterostomy. Median follow-up was 29 months (range 3-60 months). No complications of mesh-related infection or patch erosion were noted during the follow-up. Modified laparoscopic keyhole parastomal hernia repair with in situ re-ostomy is a safe procedure with a low recurrence rate at the mid-term follow-up.

Clinical analysis of 31 cases of Pcutz-Jeghers syndrome

Objective To investigate the clinical features, complications, treatment and prognosis of patients with Pcutz-Jeghers syndrome. Methods The clinical data of thirty-one cases of Pcutz-Jeghers syndrome treated in the First Hospital of Shanxi Medical University from January 1998 to December 2016 was analyzed retrospectively. Results There were11 cases with definite family history (35%, 11/31). There were 21 cases of mucocutaneous pigmentation (67.7%, 21/31), 31 cases of gastrointestinal polyps (100%, 31/31), including 8 cases of canceration (25.0%, 8/31), 24 cases of digestive tract bleeding (77.4%, 24/31), 20 cases of intussusception (64%, 20/31), and 1 case of intestinal perforation (3.2%, 1/31).6 cases were treated with endoscopic high frequency electrocoagulation, 12 cases received polypectomy, 17 cases underwent resection of intestinal tract.3 patients with intractable intussusception underwent plication of small intestine, and 4 patients with colon cancer underwent total colectomy combined with lymph node dissection. Conclusion Peutz-Jeghers syndrome often induce intractable intestinal obstruction and gastrointestinal tumor, resection of intestinal lesions should be favorable.For small intractable intussusception, the plication of small intestine has certain value; for its potential malignancy, it should be strictly monitored and actively treated.Gene therapy and drug therapy will guide for the future development. Key words: Pcutz-Jeghers syndrome; Tumor; Plication of intestine

Primary laparoscopic gastrojejunostomy tubes as a feeding modality in the pediatric population

PurposeOutcomes associated with primary laparoscopic gastrojejunal (GJ) tube placement in the pediatric population were evaluated. MethodsA single-institution, retrospective review examined patients undergoing laparoscopic GJ tube placement between June 2011 and December 2014. Outcomes included gastric feeding tolerance, subsequent fundoplication, complications, and mortality. ResultsNinety laparoscopic GJ tubes were placed. Median follow-up was 342days (interquartile range [IQR]=141–561days). Median patient age was 5months (IQR=3–11months) and weight was 5.2kg (IQR=4–8.4kg). The most common indications for placement were gastroesophageal reflux (n=85, 94.4%) and/or aspiration (n=40, 44.4%). Most common comorbidities included cardiac (n=34, 37.8%) and respiratory (n=29, 32.2%) diseases. The complication rate was 17.8%, including one case of intestinal perforation. Thirty-four (37.7%) patients transitioned to gastric feeding within 1year; time to conversion was 156days (IQR=117–210days); of those, 18.9% patients transitioned to oral feedings. A fundoplication was later performed in 4 children for persistent reflux. Mortality was 23.3% with no procedural-related deaths. ConclusionPrimary laparoscopically placed GJ tubes are a reliable means of enteral access for pediatric patients with gastric feeding intolerance. Many of these children are successfully transitioned to gastric and/or oral feedings over time. Further studies are needed to characterize which patients are best served with a GJ tube versus alternatives such as fundoplication. Level of evidenceIII (treatment) Type of studyRetrospective

脱出腸管に穿孔をきたした仙骨部人工肛門の1例

脱出腸管に穿孔をきたした仙骨部人工肛門の1例

Bevacizumab併用療法中に消化管穿孔をきたした手術不能乳癌の1例

症例は54歳の女性で，手術不能乳癌T2N1M1（PER，PLE），Stage IVと診断され，パクリタキセルが開始された．原発巣は縮小し，胸水は消失するも，腹水は減少せず，審査腹腔鏡を施行した．小腸・結腸・大網は一塊となり，腹膜は肥厚していた．腹膜の一部を病理組織学的検査に提出し，乳癌腹膜播種の所見であった．パクリタキセル・ベバシズマブ併用療法が開始され，腹水は減少したが，2コース目の26日目に消化管穿孔をきたし，開腹術を施行した．一塊となっていた腸管は癒着が解除され全検索が可能で，Treitz靱帯から120cmの小腸に穿孔を認め，単純閉鎖・腹腔内洗浄ドレナージを行った．術後は概ね良好に経過し，術後13日目に腫瘍内科転科となった．総合的に判断して，ベバシズマブが著効し，小腸穿孔をきたしたと考えられた．乳癌でのベバシズマブによる消化管穿孔は本邦初例であり，非常に貴重な症例を経験したので報告する．

Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort.

Study aim: To assess the clinical outcomes of patients who received direct percutaneous endoscopic jejunostomy (DPEJ) for enteral feeding. Materials and methods: This is a 10-year cohort study in a single tertiary center. Main outcome measurements were technical success, and short- and long-term outcomes. DPEJ was attempted in 83 patients (51 men; 55 ± 2 years) for dysphagia (n = 35), gastroparesis with recurrent aspiration (n = 30), and levodopa drug infusion for severe Parkinson’s disease (n = 18). Results: DPEJ was successful in 75 (90 %) patients. All technical failures were related to the inability to find adequate trans-illumination, and were not influenced by BMI, age, gender, or indication. Peri-operative (30-day) adverse events occurred in 11 (13 %) patients, including wound infection (3), leakage around the stoma (4), minor bleeding requiring no intervention (2), and aspiration (1). There was one case (1.2 %) of gastric perforation after PEJ insertion for levodopa drug infusion trial. This 60-year-old woman required an emergency laparotomy with nil complications, and levodopa drug infusion recommenced successfully. One case of intestinal perforation (1.2 %) occurred after jejunostomy tube replacement at 6 months of insertion, which was successfully managed with surgery. There were no peri-operative deaths. Adequate delivery of enteral feeding or Duodopa drug was achieved in 66/73 (90 %) patients, with evidence of weight gain or improvement in Parkinson’s disease. Seven (8 %) continued to have clinical regurgitation but not aspiration. After a median follow-up of 84 months, 27 (33 %) patients died of their underlying diseases. Seven (8 %) had marked improvement in their underlying disease and had PEJ removed after 5 months (range 1 – 8 months). Limitations: Single center study. Conclusions: DPEJ is associated with a high technical success rate (90 %), a relatively low rate of peri-operative adverse events (13 %) and an improvement in long-term nutritional support in the majority of patients (90 %). DPEJ should be the procedure of choice to gain enteral access for feeding or drug delivery prior to considering surgery.

陰圧閉鎖療法 (NPWT) 施行中に生じた腸管穿孔の 1 例

陰圧閉鎖療法 (NPWT) 施行中に生じた腸管穿孔の 1 例

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry.

Continuous infusion of levodopa/carbidopa intestinal gel (LCIG) is an effective treatment for patients with advanced Parkinson Disease (PD) that cannot be further improved by oral therapy. We conducted an observational, prospective, and multicenter study to collect, in a large sample of PD treated with LCIG, long-term information about the outcome and safety of the treatment. The assessments were performed before LCIG, 1, 3, 6 months after, and ever since, every 6 months. We studied 72 patients with a mean observation time of 22 months and a maximum of 48 months. During follow-up 28 patients discontinued the treatment, especially for lack of efficacy or adverse events related to the drug. We obtained a significant improvement of motor and non-motor fluctuations, mean off time and some non-motor symptoms. A significant increase in the percentage of time with dyskinesias was found in patients having less than 50% of the day with dyskinesias before LCIG. However, patients having already many dyskinesias before LCIG experienced a significant decrease of the troublesome dyskinesias, meaning that outcomes might be different depending on specific clinical characteristics. Adverse effects were in general minor but one case of intestinal perforation and one of abdominal cellulite were observed. We confirmed that LCIG is a very effective treatment option for advanced PD; however considering the findings that dyskinesia can increase and the potential for serious side effects, we suggest the necessity for development of guidelines that better define the profile of responders.

Phase II study to evaluate efficacy and safety of irinotecan, capecitabine, and bevacizumab in metastatic colorectal cancer (mCRC) patients.

501 Background: XELIRI regimen biweekly (combination of capecitabine and irinotecan) is an active and well tolerated treatment for mCRC. Bevacizumab provides significant clinical benefits in previously treated patients with mCRC. On this basis, the aim of this study is to evaluate the efficacy and safety of this combination. Methods: Multicentric, prospective, open-label phase II trial. Treatment scheme: irinotecan (iri) (175mg/m2 d1 q2w) + capecitabine (xel)(1,000mg/m2bid d 2-8) + bevacizumab (bev) (5mg/kg, d1 q2w). Results: 77 patients (p) were evaluated (66.2%, male) with a median age of 65.1 years (41.1-81.1). ECOG performance status was ≤1 in 96.1%. Primary tumor locations were: colon (53.2%), rectum (31.2%), and rectum/colon (15.6%). 27 p (35.1%) received adjuvant chemotherapy. Metastases were detected in liver (62.3%) and lung (54.5%). Mean time in treatment was: 7.1±4.9 months and median of cycles administered was 12(1-43). Median relative dose intensity was 89% for xel and bev and 85% for iri. Best response confirmed were: complete response (5.2%), partial response (32.5%), stable disease (46.8%). After a median of follow-up of 23.3 (0.4-39.6) months, median overall survival (OS) and progression free survival (PFS) was 24.8 and 11.8 months respectively. Analysis on Kras status was done in 71 p. There were no significant differences in OS or in PFS between WT and MUT p. 17 p (22.1%) underwent salvage surgery, 12 of whom had an R0 resection. The most frequent G3-4 toxicities were: diarrhea (18.2%), asthenia (16.9%), pulmonary embolism (13%; in eight of 10 p were asymptomatic), neutropenia (10.4%), febrile neutropenia (6.5%) and HFS (5.2%). Three treatment related deaths were reported (2 cases of multi-organ failure, and 1 case of intestinal perforation). Conclusions: Bevacizumab combined with biweekly XELIRI is an active first-line regimen for mCRC treatment with a feasible and manageable safety profile. Bevacizumab treatment efficacy was independent on Kras status. Clinical trial information: NCT00875771. [Table: see text]

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

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.

添付調味料のプラスチック製袋状容器による腸穿孔の1例

添付調味料のプラスチック製袋状容器による腸穿孔の1例

Ferromagnetic screening prior to MRI

Sir, We read with interest the recent case report titled “Magnet-associated intestinal perforation results in a new institutional policy of ferromagnetic screening prior to MRI” [1]. In that paper, the authors report that in accordance with an institutional policy change, following a case of intestinal perforation after an MRI in a 5-year-old boy who ingested several round magnetic objects, all patients are screened with a ferromagnetic detector prior to the MRI scan. Subsequently, we purchased SuperWand hand-held metal detectors (Garrett, Garland, TX), which we use on some patients prior to MRI. Recently, we had a 17-month-old girl who presented for a MRI of the thoracic and lumbar spine. The localizer demonstrated significant artifact. A thorough physical examination did not reveal any foreign body on the girl. The detector was used, but it did not detect anything. The child was then sent for an abdominal radiograph, which demonstrated a round metallic foreign body that looked like a button battery in the left hemi abdomen (Fig. 1). We then focused the detector on the left hemi abdomen, but once again nothing was detected. The MRI was canceled and the referring physician was informed. The girl reportedly passed a watch battery in the stool the next day. This was confirmed by an abdominal radiograph and the girl was rescheduled for the MRI, which was obtained without the previous artifact. We tested the ferromagnetic detector on a similar button battery that was placed on a technologist’s palm. The detector was able to detect the battery when placed directly above the battery but did not detect it through the hand when the detector was placed below the hand. We think that if one were to screen with a detector and get no response, that should not be construed as a true negative for foreign objects. Detection depends on the depth and the nature of the foreign body. At present, no ferromagnetic device has been approved by the FDA for finding foreign objects within the body.

P-0256 Phase II Study to Evaluate Efficacy and Safety of Irinotecan, Capecitabine and Bevacizumab in Metastatic Colorectal Cancer (MCRC) Patients

ABSTRACT Introduction XELIRI regimen (combination of capecitabine and irinotecan) is an active and well tolerated treatment for mCRC. Bevacizumab provides significant clinical benefits in previously treated patients with mCRC. On this basis, we hypothesized to combine bevacizumab to XELIRI regimen. Therefore the aim of this study is to evaluate the efficacy and safety of this combination in patients with mCRC. Methods This is a multicentric, prospective, and open label phase II clinical trial. Treatment scheme: irinotecan (iri) (175mg/m2 iv infusion, day 1, every 2 weeks)+capecitabine (xel)(1000 mg/m2 bid oral, days 2-8)+bevacizumab (bev) (5mg/kg, iv, day 1, every 2 weeks). Results A total of 77 patients were evaluated (66.2%, male) with a median age of 65.1 years (41.1-81.1). ECOG performance status was ≤1 in 96.1% of patients. Primary tumor locations were: colon (53.2%), rectum (31.2%), and rectum/colon (15.6%).Twenty-seven patients (35.1%) received adjuvant chemotherapy. Mean time to primary tumor diagnosis was 16.4±30.3 months, respectively. Metastases were detected in liver (62.3%) and lung (53.2%). Mean time in treatment was: 7.1±4.8 months and median of cycles administered was 12 (1-42). Median relative dose intensity was 89% for xel and bev and 85% for iri. Best response confirmed were: complete response (5.2%), partial response (29.9%), stable disease (49.4%). After a median of follow-up of 16.3 (0.4-30.6) months, preliminary median overall survival was 24.5 months and progression free survival was 11.8 months. Sixteen patients (20.8%) underwent salvage surgery, 11 of whom had an R0 resection. The most frequent grade 3-4 toxicities registered were: diarrhea (16.9%), asthenia (15.6%), pulmonary embolism (12%; in seven of 9 patients were asymptomatic), neutropenia (9.1%), febrile neutropenia (6.5%) and HFS (5.2%). A total of 74 patients (96.1%) discontinued the study treatment, being the most common reasons: disease progression (20.8%), adverse events (19.5%), and surgery (15.6%). Three treatment related deaths were reported (2 cases of multi-organ failure, and 1 case of intestinal perforation). Conclusion Bevacizumab combined with biweekly XELIRI is an active first-line regimen for mCRC treatment with a feasible and manageable safety profile.