Idiopathic Perforation Research Articles

Retroperitoneal Rectal Perforation Due to Pomegranate Seed Bezoar: A Rare Case

Various causes are involved in rectal perforation aetiology, including: Iatrogenic perforations, traumatic perforations, malignant or diverticular disease perforations, stercoral perforations, and idiopathic perforations. Rectosigmoid perforations are life-threatening and require immediate diagnosis and surgical treatment. Bezoars are accumulations of indigestible foreign matter that accumulate in the gastrointestinal tract. Seed vesicles are a subset of phytobizzars produced by plant seeds or undigested fruit kernels. Most Intestinal bezoura occur in the rectum, causing constipation or nonspecific abdominal or rectal pain. The following is a report of a case of pomegranate seeds in the rectum that resulted in retroperitoneal rectal perforation.

USING OF ROTATIONAL NASAL MUCOSA FLAPS IN POSTOPERATIVE NASAL SEPTAL PERFORATION REPAIR

Background. Postoperative nasal septum perforation (PNSP) is one of the complication of the nasal septum (NS) surgery, with an incidence of 1–8 %. Surgical repair of the nasal septum improves the patients' quality of life. The most effective techniques are the ones using two rotation flaps of the nasal mucosa, which are used for the plasty of traumatic and idiopathic perforations. The results of implementing this technique for the closure of PNSP require a comprehensive study Aim. To evaluate the effectiveness of rotary flaps of the nasal mucosa in postoperative nasal septum perforation repair. Materials and Methods. 18 patients with postoperative nasal septum perforation were operated on. The number of the patients depending on the area (S) of the PNSP was S <1cm2 — 4, S 1-2 cm2 — 10, S > 2cm2 — 4. The criterion for the technique efficiency was the fact of intraoperative complete closure of the PNSP, and the absence of recurrences of the PNSP within 1 year. We analysed the cause-and-effect relationships between the structural features of the PNSP (6 types were identified) with the technique of execution and long-term results. Results. Complete intraoperative closure of PNSP in 13 of 18 patients (72 %). In 5 patients, an additional sampling of temporal autofascia was performed with subsequent implantation between the flaps for intraoperative complete closure of the PNSP. In 4 out of 13 patients (30 %) with PNSP S 1-2 cm2 the PNSP relapse (type 3, 4) was noted. There was 1 relapse (type 5) with PNSP S > 2cm2 in 1 out of 5 patients (20 %), to whom autofascia was additionally used. Conclusions. The surgery of the PNSP according to the specified technique is effective with the PNSP S <1cm2; at S 1-2 cm2 it leads to distant relapses in 30 % of the cases, S > 2 cm2 is not effective. The use of a temporal fascia autograft allows to increase the efficiency of the postoperative nasal septum perforation regardless the area of it.

Diagnostic and therapeutic procedures of small bowel perforation: A retrospective monocentric cohort study

Background: Free perforation of the small bowel often has a rapid onset, and if left it untreated, can seriously affect a patient’s prognosis. Therefore, in order to fully understand the etiology, diagnosis, and treatment of small bowel perforation (SBP), a classification of SBPs or treatment recommendations should be performed. Subjects and Methods: A retrospective, monocentric analysis of patients with SBPs was performed for the period of 2018–2022. Results: Over a 5-year period, 65 cases of SBP were documented. Perforation’s localization was duodenal, jejunal, ileal, and undocumented. Eight etiologies were differentiated: obstructive (16.9%), ischemic (7.7%), diverticula-related (9.2%), inflammatory (9.2%), malignant (12.4%), traumatic (7.7%), foreign body (3.1%), and idiopathic (33.8%) perforations. Surgery combined with antibiotics was the most commonly used treatment (97.6%). The mortality rate was 6.2%, with a high rate for patients with ischemic and malignant perforations. Discussion: We have established the mature diagnostic and therapeutic treatment. Furthermore, it was found that the shorter the time between admission and operation, the better the prognosis, the better quality of life, with 12.3% ostomy rate. Conclusion: We have presented a comprehensive analysis of 65 patients treated for SBP over a 5year period, suggested a classification system of SBP according to the etiology, and described diagnostic and therapeutic steps for treatment.

Colonic contained perforation of unknown etiology treated conservatively in a 34 year old female patient: a case report

A colon perforation is defined as a disruption in the continuity of the gastrointestinal wall. A contained perforation is a situation where the perforation is self-limited, usually by adhesion to other structures in the abdominal cavity. Many conditions can cause perforation, including cancer, diverticular disease, or iatrogenic perforation such as during an endoscopy procedure. Less commonly, the cause may be inflammatory bowel disease or the presence of a foreign body in gastrointestinal tract. Furthermore, there are also publications describing situations of spontaneous rupture of the intestinal wall, i.e. spontaneous perforations. This group includes spontaneous perforation caused by fecal stones and idiopathic perforation. In this article we present a case report of a 34 year old woman with perforation of the large intestine without any apparent cause. We discuss the differential diagnosis of patients with conservatively treated perforation with unknown colonoscopy result.

Idiopathic colonic and gastric perforation in a full term newborn

Idiopathic Perforation of the transverse colon in neonate is a rare finding in clinical practice. We reported a case of Idiopathic neonatal colonic perforation, colic perforation is an extremely rare condition and very few cases have been reported in a full term new-born. We reported the first case of a new born at 39 weeks of gestation, who, twelve days after birth, had pneumoperitoneum without any demonstrable cause. Surgical exploration showed a transverse colonic perforation, the perforation was closed primarily. The postoperative course was simple, the following up was made every two weeks during six months. The second case Spontaneous neonatal gastric perforation is rare. We report the case of a full term 4-day old newborn who required resuscitation at birth. On the second day of life he had extensive abdominal distension. Abdominal x-ray without preparation showed pneumoperitoneum. Laparotomy showed a perforation at the level of the antrepyloric, measuring 1,5 cm in diameter, treated by simple surgical suture. The patient dead on the first post-operative day.

Sandwich graft technique outcomes in medium and large size nasal septal perforations

IntroductionSurgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used. ObjectiveThe aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results. MethodsWe retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2 cm, Group B: ≥ 2 cm). ResultsWe reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659). ConclusionThis study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.

A Case of Idiopathic Perforation of the Small Intestine into Both the Abdominal Cavity and the Mesentery

A Case of Idiopathic Perforation of the Small Intestine into Both the Abdominal Cavity and the Mesentery

A Case of Idiopathic Perforation in the Stoma Limb 19 years after Colostomy

A Case of Idiopathic Perforation in the Stoma Limb 19 years after Colostomy

Spontaneous colonic perforation in adults: Evaluation of a pooled case series.

Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann's operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features (p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication (p = 0.012, p = 0.044) and mortality (p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication (p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.

Idiopathic perforation of the common bile duct: a case report

Idiopathic perforation of the common bile duct: a case report

A Case of Idiopathic Perforation of the Small Intestine

A Case of Idiopathic Perforation of the Small Intestine

Idiopathic oesophageal perforation mimicking complicated oesophageal duplication cyst

Idiopathic oesophageal perforation mimicking complicated oesophageal duplication cyst

Necrosis of the small intestine leading to a diagnosis of polyarteritis nodosa: a case report

BackgroundPolyarteritis nodosa is a disease that presents with necrotizing vasculitis in small and medium-sized arteries. It may occur in various organs, but approximately half of cases have gastrointestinal involvement. Prognosis is not favorable once organ dysfunction begins as evidenced by gastrointestinal symptoms; thus, treatment with steroids should be promptly initiated. We report the case of a patient who presented with necrosis of the small intestine, which was pathologically diagnosed as polyarteritis nodosa and treated successfully with steroids.Case presentationAn 18-year-old Japanese woman reported a sudden onset of abdominal pain and vomiting that led her to visit our emergency department, where she was evaluated by a physician. On physical examination, tenderness to palpation in the upper umbilical region was noted, and diagnostic imaging with computed tomography showed emphysema of the wall of her small intestine. She was diagnosed as having necrosis of the small intestine requiring urgent surgery. No strangulations were noted intraoperatively but approximately 20 cm of her small intestine was necrotized. The surrounding arteries were examined and no palpable pulse was observed; therefore, segmentectomy of the necrotized regions was performed. Pathological findings revealed active vasculitis with fibrinoid necrosis, as well as destruction, fibrogenesis, and luminal stenosis of the elastic lamina found in the muscular arteries. A diagnosis of polyarteritis nodosa was confirmed as the cause of the necrosis of her small intestine. No recurrence of polyarteritis nodosa symptoms was observed when she was administered 40 mg of prednisolone daily.ConclusionIn cases of idiopathic intestinal necrosis or perforation, systemic diseases such as polyarteritis nodosa should be considered in the differential diagnosis.

A Patient who Experienced Two Idiopathic Perforations of the Colon Within Five Months

A Patient who Experienced Two Idiopathic Perforations of the Colon Within Five Months

Clinical predictors of bevacizumab-associated intestinal perforation in non-small cell lung cancer.

Background Bevacizumab (Bev) is generally well-tolerated, and Bev-associated intestinal perforation (BAP) is a rare albeit serious side effect in cases of non-small cell lung cancer (NSCLC). Therefore, the present study aimed to identify clinical predictors of BAP to help predict and manage the development of life-threatening intestinal complications among patients receiving Bev. Methods This retrospective study evaluated demographic, clinical, and treatment factors for patients with NSCLC who were treated with Bev between February 2010 and August 2015 at our center. Results We identified 314 regimens (208 patients; median age: 65years; 115 women) for analysis, which included 119 first-line regimens, 74s-line regimens, and 121 third-line or later regimens. BAP occurred in 7 cases (2.23% among all regimens and 3.37% among all patients), which generally occurred during first- or second-line treatment and was caused by ulcerative colitis (1 case), colon diverticulitis (1 case), and idiopathic perforations (5 cases). Univariate analyses revealed that BAP was significantly associated with deteriorating PS during the first cycle of chemotherapy (odd ratio [OR]: 11.07, 95% confidence interval [CI]: 2.37-51.63, p = 0.0022), grade ≥ 3 diarrhea (OR: 11.37, 95% CI: 2.37-54.50, p = 0.0024), febrile neutropenia (OR: 9.16, 95% CI: 1.98-42.49, p = 0.0047), and stomatitis (OR: 4.60, 95% CI: 1.01-21.04, p = 0.0492). Conclusions Among patients with NSCLC, BAP was associated with deteriorating PS during the first cycle of chemotherapy, grade ≥ 3 diarrhea, febrile neutropenia, and stomatitis. Therefore, careful observation is needed for patients with NSCLC who receive Bev in any line of treatment, especially if they develop serious side effects that affect their PS or mucous membrane.

A Case of Idiopathic Perforation of the Small Intestine Operated on Successfully in Early Onset

A Case of Idiopathic Perforation of the Small Intestine Operated on Successfully in Early Onset

Idiopathic Perforation of the Sigmoid Colon in a 2.5 Years Old Girl: A Case Report

Idiopathic colon perforation is rare in children. It is more common at the extremes of age. Splenic flextures, ileocecal and lower sigmoid regions are the most common sites of perforation. Delay in proper management of this condition is associated with high mortality and morbidity rate. We report on the case of a 2.5 years old girl who presented with fever, diarrhea, nausea and vomiting and progressive abdominal distention.Finally, she underwent an exploratory laparotomy for suspected peritonitis because of the patient's worsening condition. An area of perforation was found in the sigmoid colon that segmental resection and an end double barrel colostomy was done.

Unusual Causes of Large Bowel Perforation – A Report of Three Cases

Large bowel perforations are commonly caused due to malignancy and inflammatory disorders. Large bowel perforations due to causes like stercoral perforation, idiopathic perforation and spontaneous perforation associated with rectal prolapse are very rare. Though uncommonly seen, these perforations are managed clinically in a similar way as perforations due to other causes with differences in managing the underlying condition. The type of surgical intervention required depends on a variety of factors like the duration, amount of fecal contamination, patient’s general condition and the underlying pathology. We report such three cases of very rare causes of perforation of large bowel with review of literature.

Review of 31 cases of neonatal gastrointestinal perforations

Background: Despite the recently improved neonatal intensive management, gastrointestinal perforation during the neonatal period is still a major challenge for pediatric surgeons.Objective: To review the effects of different clinical and operative parameters on the mortality of neonatal intestinal perforations.Patients and Methods: A retrospective study was done to 31 cases of neonatal intestinal perforation at the neonatal intensive care unit of Basrah children speciality hospital during the past four and half years (July 2011 to December 2015). Information regarding the age, sex, gestational age, birth weight, clinical examination, x-rays value in diagnosis, causes and sites of perforations, types of operative procedures, and their effects on prognosis are all studied.Results: Males were affected more than females (a ratio of 3.4: 1); birth weight has a significant association with the prognosis (P-value of 0.045). Hirschsprung`s disease was the commonest cause for perforation (29%), followed by necrotizing enterocolitis and jejunoileal atresia (16.1%, each). Idiopathic perforations constituted only 12.9%. Ileum was the commonest site of perforation (58.1%), followed by cecum (16.1%). Stoma creation was the commonest operative procedure performed. Other procedures like, primary anastomosis, and primary peritoneal drainage followed by laparotomy were also used. This study revealed high mortality rate (45.2%). Complications like sepsis, anastomotic leaks, or burst abdomen carried a high risk of death.Conclusions: High mortality rate is encountered, especially for necrotizing enterocolitis. In contrast to other study, Hirschsprung`s disease is the commonest cause of perforation rather than necrotizing enterocolitis. Radiology has a relatively good accuracy in the diagnosis of intestinal perforations, although some cases were discovered intra-operatively. In this series, prompt accurate treatment with stoma creation harbored the best prognostic results; furthermore no benefits obtained from primary peritoneal drainage.

Case report of idiopathic cecal perforation presenting as acute appendicitis on ultrasound

Abstract Cecal perforation is an uncommon phenomenon in a pediatric population. It has been linked to a number of underlying medical conditions, which may result in focal inflammation or relative ischemia including hematologic malignancy, infection, and inflammatory bowel disease. We present an otherwise healthy 16-year-old male diagnosed with acute uncomplicated appendicitis on ultrasound, who was found to have cecal perforation with normal appendix intraoperatively, ultimately requiring ileocectomy. With this report, we aim to present the numerous pathophysiologic etiologies of cecal perforation, and to promote a comprehensive differential diagnosis despite the clinical and radiologic findings consistent with uncomplicated appendicitis.