Diagnosis Of Small Bowel Perforation Research Articles

997 Traumatic Jejunal Rupture Following Gaelic Football Game. Case Report

Abstract Aim Abdominal injury accounts for just 6.3% of injuries in sport. The most common mechanisms are contacts with a player (74.5%), a surface (8.1%) or equipment (0.6%). Only twelve cases of Jejunal rupture are described in the literature. Method This case involves a young Gaelic football player who had significant abdominal contact with other players’ knees. He experienced nausea and left flank pain radiating to the groin. At the Emergency Department the heart rate was 95 beats per minute and blood pressure was 120/70 mmHg. There was bruising in the left flank at the impact site and some guarding. Initial investigations showed normal inflammatory markers and a normal Chest X-ray. Nine hours later the white cell count had increased to 17.85x10^9 and CRP to 106mg/L. Abdominal and Pelvic CT scanning suggested a bowel injury with free fluid in the left flank and pelvis. Management Exploratory laparotomy identified a jejunal rupture 10cm distal to the duodenal-jejunal flexure. A primary two-layer repair was performed. Antibiotic and anti-fungal cover were prescribed, and he was discharged well on day 5. Conclusions Owing to the rarity of bowel injury after blunt trauma, soft peritoneal signs and radiological insensitivity, the diagnosis of small bowel perforation is often delayed and can be associated with marked morbidity and mortality. Serial examinations and a high index of suspicion is required to detect bowel injuries in the case of blunt abdominal trauma in contact sports.

A Case of Delayed Diagnosis of Small Bowel Perforation in a Patient with Head Injury and Open Fracture of the Femur Who Presented with Consciousness Disturbance and Hemorrhagic Shock

A Case of Delayed Diagnosis of Small Bowel Perforation in a Patient with Head Injury and Open Fracture of the Femur Who Presented with Consciousness Disturbance and Hemorrhagic Shock

Management outcome of non-traumatic small intestinal perforation: A prospective study

Background: Small intestinal perforation peritonitis is a surgical emergency which remained a challenge to the surgeons since time immemorial. Independent of its aetiology all the cases of small intestinal perforation have similar clinical features leading to peritonitis with fulminating secondary bacterial infection for which the condition is studied as one entity.Material and Methods: A prospective study of 40 patients presenting to VSSIMAR, Burla with a diagnosis of Small bowel perforation between November 2017 and October 2019 was done. The history, clinical features, the investigations done, the surgical procedure performed, the post-operative ICU care, the complications, the secondary procedures undertaken and mortality rate were recorded.Results: The maximum number of cases were in the age group of 21-30yrs (32.5 %) followed by 31- 40yrs (25 %) with a male to female ratio 7:3. Pain abdomen was the most common symptom. Majority of patients (42.5%) were presented between 24-48 hrs. The most common abdominal findings were guarding / rigidity, abdominal distension each 95%, free gas under diaphragm found in 90% of cases. Widal test was positive in 35% cases. 8 cases (20%) didn’t respond to fluid therapy alone and required vasopressors. 85% were ileal perforation, 15% were jejunal perforation. Simple closure with drainage was the most performed procedure (65% of cases). Typhoid & nonspecific inflammation tops the aetiology (35% each) followed by Tuberculosis (22.5%). The most common complication was wound infection in 14 cases (35%). Seven patients who required critical care and later on also secondary procedure were stayed longest with mean 26.28 days and range 19-36 days. The overall mortality rate was 10%. Elderly (p

CT diagnosis of small bowel perforation by ingestion of a blister pack: Two case reports

CT diagnosis of small bowel perforation by ingestion of a blister pack: Two case reports

The case of the forgotten toothbrush

INTRODUCTIONAlthough foreign body ingestion is relatively common, toothbrush swallowing is rare. A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. PRESENTATION OF CASEWe report a case of a swallowed toothbrush which passed past the pylorus and perforated the terminal ileum. The patient however presented with a fluctuant mass in the left iliac fossa, pyrexia and generalised tenderness mimicking a diverticular abscess. DISCUSSIONIngestion of a foreign body is commonly encountered in the clinic among children, adults with intellectual impairment, psychiatric illness or alcoholism, and dental prosthetic-wearing elderly subjects. However, toothbrush swallowing is rare, with only approximately 40 reported cases. CONCLUSIONBowel perforation by foreign bodies can mimic acute appendicitis and should be considered in differential diagnoses. Clinically, patients often do not recall ingesting the foreign body, which makes the clinical diagnosis more challenging, and a correct diagnosis is frequently delayed. Several radiological investigations, such as small-bowel series, ultrasonography, and computed tomography scans, may lead to the correct diagnosis, but in most patients, the diagnosis is not confirmed until the surgical intervention has been performed.

Jejunal perforation by a foreign body

A 52-year-old woman was referred to our surgical division for a 3-months history of abdominal pain, fever and leucocytosis. The abdominal computed tomography (CT) scanning showed only fluid spillage and minimal bowel dilatation. An explorative laparotomy was necessary with diagnosis of jejunal perforation by a foreign body (fish bone) with subsequent ileal resection. Even if intestinal perforation from foreign body is a really rare event, it should be considered in differential diagnosis of acute peritonitis. INTRODUCTION The diagnosis of small bowel perforation due to foreign bodies or fish bone is a rare event because most of these can pass through the gastrointestinal tract uneventfully. CT scan could help to detect foreign bodies; however, it did not show an optimal sensitivity. Endoscopy and surgery are fundamental for diagnosis and therapy. We report a rare case of jejunal perforation from foreign body (fish bone). CASE REPORT A 52-year-old woman was referred to our surgical division for a 3-months history of abdominal pain, fever and leucocytosis. The abdominal computed tomography (CT) scanning (Figure 1) made in another institution showed only a fluid spillage and minimal bowel dilatation. Furthermore, the patient previously (six weeks before) underwent an explorative laparoscopy for suspected gynaecological disease which resulted negative. Then the patient was admitted to our ward with suspected malignant pathology. An explorative laparotomy was necessary for worsening clinical conditions and diagnosis of jejunal perforation by a foreign body (fish bone) was made (Figure 2, 3). DISCUSSION Most of foreign bodies ingested pass through the gastrointestinal (GI) tract uneventfully within 1 week; the occurrence of bowel perforation is rare (less than 1%). In the present case a jejunal perforation with abscess due to a 4cm fish bone is reported. The patient underwent ileal resection. The diagnosis of small bowel perforation is very difficult. CT scan can really help in pre-operative diagnosis; however, small fish bones or fins are difficult to recognize preoperatively. CT scan showed a sensitivity of 71.4% in the detection of intra-abdominal fish bone. In recent series of gastrointestinal tract perforation by foreign body, numerous risk factors have been reported: alcohol or drug abusers, selected professions such as carpenters or dressmakers, persons who eat rapidly and/or with denture problems. In a special way, this last group without capacity of identifying small or hard items in forming a bolus, have a higher risk of foreign body ingestion. Furthermore, the dietary habits have a relevant role in the type of foreign bodies ingested with chicken bone more frequently reported in Mediterranean countries and fish bone in the Asiatic countries. In the majority of cases reported, ileocecum or recto-sigmoid tract are more frequently affected by perforation as sites of acute angulation. Clinical presentation is extremely variable depending on the site of perforation and extension of peritonitis. It can mimic appendicitis or other acute abdominal conditions. In most of the cases, diagnosis is obtained only with surgery. Laparoscopy has been used in the diagnosis of GI perforation from foreign body but it did not show high success rates. In this case, previous laparoscopy was not able to show any pathology and only final laparotomy identified the fish bone perforation. For this reason, even if intestinal perforation from foreign body is a rare event, it should be considered in differential Jejunal perforation by a foreign body 2 of 3 diagnosis of acute peritonitis. Figure 1 Figure 1. Abdominal computed tomographic scan showed fluid spillage. Figure 2 Figure 2. An intra-operative photograph demonstrating a 2.5cm ileal mass Figure 3 Figure 3. Intra-operative photograph showing the fish bone

Small-bowel perforation caused by fish bone

A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

Perforations du grêle par traumatisme fermé de l’abdomen évaluation par le scanner abdominal et la laparoscopie

Small bowel perforations are the consequences of violent blunt abdominal trauma. Diagnosis of small bowel perforation is suspected in case of acute pain associated with peritoneal signs (tenderness, followed by rigidity). Computed tomographic scan performed in emergency is often specific, showing intraperitoneal fluid without visible solid organ injury, bowel wall thickening, bowel wall discontinuity, extraluminal gas or small pneumoperitoneum. Explorative laparoscopy confirms the diagnosis of blunt bowel injuries and allows usually its treatment. We report herein two cases where we have chosen this strategy.

Small bowel perforation: is urgent surgery necessary?

Controversies regarding how urgent bowel perforation should be diagnosed and treated exist in recent reports. The approach for early diagnosis is also debatable. The purposes of this study were to evaluate the relationship between treatment delay and outcome of small bowel perforation after blunt abdominal trauma and to determine the best assessment plan for the diagnosis of this injury. One hundred eleven consecutive patients with small bowel perforations caused by blunt abdominal trauma were retrospectively reviewed. The patients were divided into four groups according to the time interval between injury and surgery. Hospital stay, time to resume oral intake, and mortality and morbidity rates were compared between groups. Physical signs, laboratory and computed tomographic findings, and the results of diagnostic peritoneal lavage were analyzed to find the most sensitive and specific test for early diagnosis of small bowel perforation. Delay in surgery for more than 24 hours did not significantly increase the mortality with modern method of treatment; however, complications increased dramatically. Hospital stay and time to resume oral intake increased significantly when surgery was delayed for more than 24 hours. Abdominal tenderness was a common finding, but it was not specific for bowel perforation. Only 40% of the computed tomographic scans were diagnostic for bowel perforations: 50% of them showed suggestive signs, and 10% were considered as negative. Persistence of abdominal signs indicated peritoneal lavage. By using cell count ratio in diagnostic peritoneal lavage and/or increased lavage amylase activity, presence of particulate matter and/or bacteria in the lavage fluid, all patients with intraperitoneal bowel perforation were diagnosed accurately before operation. Small bowel perforation has low mortality and complication rates if it is treated earlier than 24 hours after injury. The principle of "rushing to the operation suite" for a stable blunt abdominal trauma patients without detailed systemic examination is not justified. The priority of treatment for the small bowel perforation should be lower than the limb-threatening injuries. Diagnostic peritoneal lavage provides high sensitivity and specificity rates for the diagnosis of small bowel perforation if a specially designed positive criterion is applied.

Small Bowel Perforation Associated With Intraperitoneal And Extraperitoneal Bladder Perforation Caused By Stab Wound To The Penis

We report an unusual case of small bowel and bladder perforation caused by a stab wound to the penis with preservation of intact corporeal penile bodies and urethra. Diagnosis of bladder perforation was made by the urethrogram and diagnosis of small bowel perforation was made by clinical signs even though the initial physical examination suggested neither of these conditions.