Cause Of Small Bowel Perforation Research Articles

A rare cause of small-bowel perforation

A rare cause of small-bowel perforation

Multiple spontaneous jejunal and ileal perforations: a diagnostic challenge

Spontaneous multiple jejunal perforations are rare. In India, the commonest cause of small bowel perforation is typhoid fever followed by tuberculosis. We report a case of multiple jejunal and ileal perforations in a 23-year-old young woman who was known to have ulcerative colitis on medical therapy including steroids. She was then diagnosed to have active pulmonary tuberculosis and commenced on anti-tuberculosis therapy. She presented with generalised peritonitis and underwent emergency bowel resection with proximal enterostomy and creation of mucous fistula of the distal ileum. Post-operative course was stormy due to sepsis and she eventually succumbed on the 3rd post-operative day. Histopathological examination revealed non-specific changes and was not contributory to diagnosis. Possible causes of spontaneous jejunal perforations are discussed and the literature is reviewed. This case, despite a fatal outcome, is being reported to highlight the need for high index of suspicion in such situations.

Clinical profile and histopathological correlation of non-traumatic small bowel perforations

Non-traumatic perforation of small intestine is a common cause of peritonitis in developing countries requiring early surgical intervention. Various etiological factors have been proposed as the cause of small bowel perforation. It is difficult to diagnose cause of non-traumatic perforation of small bowel pre- operatively, so histopathology is a very important diagnostic tool. In this study consisting 40 patients, non-traumatic perforations were more common in males (72.5%) than females (27.5%) with maximum number of non-traumatic perforations (42.5%) occurring in the age group of 21-40 years and the minimum number (12.5%) occurring in the age group of ≤ 20years and >60 years, each. The most common etiology was nonspecific ileitis followed by tuberculosis, neoplasms and then, enteric fever.

Clinical study and management of small bowel perforation in a tertiary care teaching institute

Background: Small bowel perforation is one of the most common abdominal surgical emergencies encountered in present study region. Late presentation makes them a diagnostic and treatment dilemma. The aim of present study was to determine the age, sex, incidence, etiological factors, clinical features and various surgical procedures for small bowel perforations and its complications in the setup.Methods: Present study is a prospective observational study of 100 cases, conducted in a single teaching institute from October 2015 to December 2016. Various data such as presentation by the patient, age and sex incidence, etiologies, pathological features, morbidity and mortality associated with the causation and management were evaluated, tabulated and assessed. By analyzing the data, common etiologies of small bowel perforation, the most appropriate modality of investigation, treatment, and complications associated with different methods of management and possible ways to prevent them were studied.Results: Among all small bowel perforation, duodenal perforation (70%) was the commonest cause of small bowel perforation followed by ileal (23%) and jejunal (7%) perforations. The most common causes of ileal perforation was typhoid (47.8%) followed by tuberculosis (13%) and traumatic (13%). Overall mortality in small bowel perforation was 15%, with ileal perforation (39%) showing higher mortality rate than duodenal perforation (8.5%). Wound infection, toxaemia, uraemia, hypotension, and respiratory complications were common complications, more commonly noted in cases of ileal perforation.Conclusions: The study showed that effective pre-operative management with adequate fluid resuscitation, immediate operative intervention and good post-operative care led to better outcomes in these cases. Hence timely diagnosis and prompt management is the gold standard for favourable outcome in patients with small bowel perforation.

Observational study of small bowel perforation in a tertiary care hospital

Background: Perforation of the small intestine causing peritonitis is the most common abdominal surgical emergency encountered in study region. Late presentations with sepsis and septic shock makes evaluation and management of these patients a formidable surgical challenge. The aim of this study was to identify the etiologies, clinical presentation, diagnostic dilemmas and modalities of treatment of the small bowel perforation of diverse etiology in this study region. Objective was to study the demography, etiology, pathology, clinical presentation and various surgical procedures in treatment of small bowel perforation in hospital.Methods: This study was a prospective observational study conducted in the department of general surgery Rohilkhand medical college Bareilly, Uttar Pradesh, India from November 2015 to December 2016. 90 patients admitted in the emergency of this hospital who eventually turned out to be those of small bowel perforation were included in this study and an analysis of the demographic data, clinical presentations, radiological findings, site of perforation, surgical procedure performed, surgical complications and duration of hospital stay was done.Results: Duodenal perforation was the commonest cause of small bowel perforation, contributing to 51 (56.66%) patients. Peptic ulcer disease accounted for 49 (96.07%) patients and blunt trauma abdomen for 2 (3.9%) of these patients. Jejunal perforations accounted for 9 (10%) patients and ileal perforations for 30 (33.34%) patients. Typhoid fever was the commonest cause of ileal perforation in 24 (80%) patients Blunt trauma abdomen was the commonest cause in 5 (55.55%) patients of jejunal perforations.Conclusions: Indiscriminate use of NSAIDS/Steroids accounted for most of the peptic ulcer perforation in our region. The other additive factors include alcohol consumption and smoking.

Small bowel perforation due to indistinguishable metastasis of angiosarcoma: case report and brief literature review

Intestinal metastasis of angiosarcoma is extremely rare. We herein report a case of intestinal perforation due to intestinal metastasis of angiosarcoma. The patient was a 72-year-old Japanese man with multiple recurrent angiosarcomas of the scalp. He developed acute abdominal pain with guarding, and we performed an emergency exploratory laparotomy. An intestinal perforation was found 80 cm from the ligament of Treitz, and partial jejunectomy was successfully performed. Macroscopic inspection revealed no obvious injury, ulcer, or tumor at or around the perforation site. Pathological examination revealed angiosarcoma cells penetrating through all layers of the jejunum at the site of intestinal perforation. This is the first reported case of intestinal perforation caused by indistinguishable intestinal metastasis of angiosarcoma. This case emphasizes intestinal metastasis of angiosarcoma as a possible cause of small bowel perforation in patients with advanced angiosarcoma, even when no visible tumor is present during surgery.

A Bread Bag Clip causing Small Bowel Perforation diagnosed on Computed Tomography

ABSTRACT Foreign body ingestion is common, and few result in complications. Plastic bread bag clips are an exception, however, and have been associated with small bowel perforation, upper gastrointestinal bleeding and even fatalities. An 85 year-old woman presented with abdominal pain. She was found to have tenderness on abdominal palpation. She underwent an abdominal CT scan, which demonstrated a plastic bread bag clip as the cause of a contained small bowel perforation. A midline laparotomy and small bowel resection with primary anastomosis was performed. Plastic bread bag clips are a rare cause of small bowel perforation. Elderly patients with dentures are at particular risk of ingesting such clips. This case report describes a rare situation where a clip is identified on preoperative imaging as the cause of a contained small bowel perforation. How to cite this article Coventry C, Bautz P. A Bread Bag Clip causing Small Bowel Perforation diagnosed on Computed Tomography. Panam J Trauma Crit Care Emerg Surg 2016;5(3):169-171.

Small intestinal perforation caused by metastatic tumor necrosis after sorafenib (Nexavar®) therapy for advanced hepatocellular carcinoma

Sorafenib (Nexavar®, BAY 43-9006) is a novel multikinase inhibitor that has been recently approved for the treatment of advanced hepatocellular carcinoma (HCC). The increased use of sorafenib has been accompanied by an increase in the number of reports on the adverse effects of this drug. Generally, the adverse effects of sorafenib are well tolerated, and the most common drug-related toxicities are hand-foot skin reaction, diarrhea, fatigue, rash, and hypertension. Here, we report the case of a 54-year-old man who developed small bowel perforation 2 months after receiving sorafenib for advanced HCC. The exact pathogenesis of the perforation is unclear. The cause of small bowel perforation in this patient was most likely metastatic tumor necrosis due to sorafenib. From this case, we can infer that treatment with antiangiogenic multikinase inhibitors may be associated with gastrointestinal (GI) perforations. Physicians should keep the possibility of this rare but potentially serious GI complication related to sorafenib treatment in mind.

Usefulness of Histopathological Examination in Nontraumatic Perforation of Small Intestine

IntroductionNontraumatic perforation of small intestine (NTPSI) is a fairly common cause of peritonitis in developing world requiring early surgical intervention. Various etiological factors have been proposed for the cause of small bowel perforation. This retrospective study was conceded with an aim to determine the prevalence patterns of the different etiologies of NTPSI. Materials and MethodsA total of 164 patients were included in the study who had segments of small intestine removed for perforation during emergency procedures. Preoperative definitive diagnoses were not known in these cases. On gross examination, most of the small intestine perforations, n = 110 (67%), were found in the terminal ileum. On microscopy, the most frequent category was that of ulcers of nonspecific etiology, n = 61 (37.2%), which showed general features like inflammatory granulation tissue, serositis, and foreign body giant cell reaction. ResultsIn cases where a definite opinion could be established, infection was the commonest cause, n = 71 (43.3%), wherein tuberculosis (49, 29.9%) and typhoid (22, 13.4%) constituted the greatest number of cases. There were two cases of lymphoma and one case of metastatic adenocarcinoma involving the small intestine. Thus, histopathological examination of operated specimen is a useful guide for the surgeon to decide further management of the patient especially in the case of infections.

An unusual cause of small bowel perforation: apricot pit

Ingestion of foreign bodies can be a common problem, especially among children, alcoholics, and psychiatric and senile patients. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved immediately may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract uneventfully, and perforation occurs in less than 1%. In this study, we report a case of small bowel obstruction with perforation in a 73-year-old female due to the accidental swallowing of an apricot pit.

An unusual cause of small bowel perforation. Has anything changed?

An unusual cause of small bowel perforation. Has anything changed?

Unusual cause of small bowel perforation: metastasis of a subcutaneous angiosarcoma of the head

Unusual cause of small bowel perforation: metastasis of a subcutaneous angiosarcoma of the head