Ileal Perforation Research Articles

Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation

Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation

Ileal Perforation Induced by a Wire From a Metal Scouring Pad in an Infant

Foreign body ingestion is a common occurrence in the pediatric population. We present the case of a 1-year-old infant boy who presented with abdominal distention and shock. At laparotomy, he was found to have an ileal perforation caused by a wire from an aluminum scouring pad that his parents were not aware he had ingested. To our knowledge, this is the first case report of a scouring pad-related perforation. This report emphasizes the danger of ingesting fragments of a metal scouring pad and the importance of considering foreign body impaction in the workup of pediatric gastrointestinal perforation.

Decorative crystal balls causing intestinal perforation

Crystal jelly balls are used for decorative purpose in homes and offices. They swell on contact with water. We managed a patient with a clinical diagnosis of acute abdomen. At surgery, there was fecal peritonitis and three ileal perforations caused by previously ingested decorative crystal balls.

Exploratory laparotomy for acute intestinal conditions in children: A review of 10 years of experience with 334 cases

The aim of this study was to review 10 years of experience in the management of children with acute intestinal conditions requiring exploratory laparotomy. This retrospective study included 334 children (244 boys and 90 girls) who underwent laparotomy for acute intestinal conditions between Jan 1, 2000 to Dec 31, 2009. Patients were grouped into two categories: group A (n = 44) included patients who needed laparotomy with terminal ileostomy and group B (n = 290) included patients who needed laparotomy without terminal ileostomy. We excluded neonates and patients with jejunoileal and colonic atresias, anorectal malformations, congenital pouch colon, neonatal necrotising enterocolitis, Hirschsprung's disease, appendicitis, abdominal trauma and gastrointestinal tumours. During the last 10 years, 334 laparotomies were performed in children under 12 years: 59.88% for intestinal obstruction and 40.11% for perforation peritonitis. Causes in order of frequency were: ileal perforations 34.13%; intussusceptions 26.34%; Meckel's obstruction 10.17%; congenital bands and malrotation 6.88%; postoperative adhesions 5.98%; miscellaneous peritonitis 5.68%; miscellaneous intestinal obstructions 4.79%; abdominal tuberculosis 4.19% and roundworm intestinal obstruction 1.79%. Ileostomy closures (n = 39) was tolerated well by all except one. The mortalities were 28 (8.38%) in group B and 6 (1.79%) in group A. The need for re-exploration not only increases the morbidity but also increases mortality as well. Diverting temporary ileostomy adds little cumulative morbidity to the primary operation and is a safe option for diversion in selected cases. The best way to further reduce the mortality is to create ileostomy at first operation.

Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation

Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation

Omental patch technique for the ileal perforation secondary to typhoid fever

Background/Aim:Enteric perforation is a grave complication of typhoid fever. Laparotomy with primary closure is the treatment of choice depending upon the bowel condition. Fecal fistula formation is the main concern in primary closure and the incidence of this complication dramatically decreases when omentum is used as a patch over primary closure.Materials and Methods:A total of 176 patients underwent laparotomy for enteric perforation and they were divided into two groups randomly; Group I–Primary closure with omental patch and GroupII– –Only primary closure. The outcomes were measured in relation to hospital stay, wound infection, septicemia, fecal fistula, and mortality.Results:The incidence of complications including fecal fistula and mortality is significantly lower in the group I patients. Fecal fistula occurs in 7.7% in group II, while in only 1.1% in group I. The mortality is also lower 3.3% in group II, while 1.1% in group I.Conclusion:Primary closure with omental patch is a better option as compared with only primary closure in enteric perforation patients. It can be recommended as an alternative method to primary closure only in enteric perforation patients.

Asymptomatic Ileal Perforation Due To Dislocated Intrauterine Device (IUD) And Treated With Minilaparotomy: A Case Report

Asymptomatic Ileal Perforation Due To Dislocated Intrauterine Device (IUD) And Treated With Minilaparotomy: A Case Report

A Challenging Case of Bilateral Iliopsoas Abscess

Bilateral iliopsoas abscess is very rare and has never been reported in cases of aortic graft infections. To date, only cases of unilateral abscess have been reported in association with aortic graft infection, and even these are uncommon. Case report and literature review. We present the first report of an infected abdominal aortic graft, secondary to an ileal perforation, in a 76-year-old woman presenting with bilateral iliopsoas abscess. The presence of lumbar spondylodiscitis initially led us to suspect this as the primary cause of the abscess. Hence, she was treated initially with drainage of the abscess, percutaneously and surgically. This proved to be unsuccessful. A laparotomy, excision of the aortic graft, and in situ revascularization with a femoral venous conduit was performed subsequently. The bilateral iliopsoas abscess was found to be caused by a perforation of the ileum. Despite the surgery, the patient finally succumbed. Bilateral iliopsoas abscess secondary to infected aortic graft is extremely rare and challenging. Drainage of the abscess, percutaneously or surgically, and excision of graft with or without revascularization must be considered carefully based on the individual case.

Multiple intestinal perforation in a patient with Wegener's granulomatosis: A case report and review of the literature

Wegener's granulomatosis is a necrotizing vasculitis of unknown etiology characterized mainly by inflammation of the small- and medium-sized arteries and veins that affect any viscera. It may rarely involve the gastrointestinal tract. Only a few cases of multiple focus ileal perforation due to ulcers associated with Wegener's granulomatosis have been reported. Herein we report a case of a 32-year-old man with extensive intestinal small bowel ischaemic perforation due to Wegener's granulomatosis.

A simple prognostic scoring system for typhoid ileal perforation peritonitis

The increasing awareness of the worse than expected outcome after typhoid ileal perforation (TIP) prompted us to prospectively prognosticate patients with the help of the Jabalpur prognostic score (JPS), a simplified scoring system for peptic perforation peritonitis (PPP). Eighty-two consecutive patients with TIP were studied from May 2005 to August 2008 in the Department of Surgery, NSCB Government Medical College, Jabalpur (MP), India. Six parameters used in the JPS were recorded: age, heart rate, mean blood pressure, serum creatinine, any co-morbid illness and perforation-operation interval. JPS correlated with morbidity and mortality in TIP patients and, as the score increased, so did the morbidity and mortality. Survivors had a significantly lower mean score (3.86 ± 2.23) than non-survivors (7.94 ± 3.6; P < 0.001). Expectedly, TIP patients had worse outcome, stage by stage, than PPP patients. JPS can be easily modified for TIP (JPS-TIP) and can be easily used for its prognostication.

Ileal perforation in a child with abdominal tuberculosis

A 6-year-old boy presented with a 1-month history of fever followed by abdominal distension, constipation and bilious vomiting for 2 days. The clinical impression was of intestinal obstruction. At exploratory laparotomy, there was an ileal perforation secondary to tuberculosis. There are many case reports of tubercular ileal perforation in adults but in children it is very rare.

Diffuse infantile hemangiomatosis of the ileum presenting with multiple perforations: a case report and review of the literature

Hemangiomas of the small intestine are rare, accounting for only 0.05% of all intestinal neoplasms (Jarvi et al. J Pediatr Gastroenterol Nutr. 2008;46:593-597). The jejunum is the most common site of involvement in the small intestine (Levy et al. Am J Roentgenol. 2001;177:1073-1081). Small bowel hemangiomas are most commonly manifested by gastrointestinal bleeding, abdominal pain, obstruction, or intussusception. There are very few reported cases in the literature of hemangiomatosis presenting with perforation, and only 1 previously reported case of perforation in the ileum. We present a rare case of a 5-week-old female with diffuse hemangiomatosis of the ileum presenting with multiple ileal perforations and peritonitis.

Seminoma presented with acute abdomen due to ileum perforation

Abstract Germ cell tumors presenting with an acute abdomen are not common. We present a case of seminoma with ileum perforation, which presented in a 48-year-old man. who had been admitted to hospital with a right lower abdominal palpable mass measuring approximately 16 cm. Before an exploratory laparotomy was performed, acute abdomen with signs of hollow viscus perforation had occurred. An ileum perforation was detected and a right hemicolectomy and ileal resection were performed. The pathological examination showed a classic seminoma of undescended testis. In conclusion, this case is interesting with respect to its clinical picture of acute abdomen due to ileal perforation. The possibility of a germ cell tumor should always be kept in mind in male patients with acute abdomen.

Surgical and Gynaecological Abdominal Emergencies in Adults: The Experience of Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria.

The objective of this study is to highlight the clinical spectrum of surgical and gynaecological abdominal emergencies in an urban teaching hospital in Nigeria. All emergency abdominal operations carried out in LASUTH between July, 2004 and December, 2006 were retrospectively studied. Data extracted from case files of patients, theatre operation registers and ward registers were analyzed. A total of 803 patients were reviewed. There were 254(31.6%) males and 549(68.4%) females. Ectopic pregnancy accounted for 44% of the emergencies. Acute appendicitis and intestinal obstruction were the reasons for surgery in 22% and 17% of the patients respectively. Less common indications were trauma(5.4%), septic abortion(3.6%), typhoid ileal perforation(3%) and gastroduodenal perforation(2.6%). Obstructed external hernia was the leading cause of intestinal obstruction while complicated appendicitis was the major cause of generalized peritonitis. Mortality rate was 4.5%. Ectopic gestation is the commonest indication for emergency exploratory laparotomy in our centre and should be considered in the diagnosis of acute abdomen in females. Early elective surgery for external hernia and prompt surgical treatment of acute appendicitis may decrease the burden of intestinal obstruction and generalized peritonitis in our practice.Key words: abdominal emergencies, gynaecological emergencies, acute abdomen, surgical abdomen.

Management of an iatrogenic ileal perforation by temporary transileostomy placement of a fully covered esophageal self-expanding metal stent

Fully covered self-expanding metal stents (SEMSs) offer an alternative to the self-expanding plastic stent (SEPS) for the endoscopic management of benign leaks, perforations, and fistulae. Currently, fully covered SEMSs are available only for the esophagus and biliary tree. However, the use of esophageal SEMSs can be expanded elsewhere. We report a case of a patient with a postoperative ileal perforation that was successfully treated by temporary transileostomy placement of a fully covered esophageal SEMS.

Isolierte Ileumperforation nach stumpfem Bauchtrauma

Perforating injuries to the small bowel due to a blunt abdominal trauma are rare. Especially in the case of an isolated injury where diagnostic investigations have failed, it may result in delayed therapy and a prolonged clinical course. Here, we report on an isolated ileal perforation caused by a blunt abdominal trauma in setting of a domestic accident.

Causes and treatment outcome of perforation peritonitis in north eastern Nigeria

Background: Intestinal perforations cause generalized peritonitis and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to review the causes and treatment outcome of non‐traumatic perforation peritonitis in a government referral hospital in north‐eastern Nigeria.Patients and Methods: In a retrospective study, the clinical records of 153 patients with intraoperative diagnosis of non‐traumatic perforation associated peritonitis managed in the Federal Medical Centre, Azare, Nigeria between June 2004 and May 2009 were reviewed.Results: One hundred and fifty‐three patients, comprising 112 males (73.2%) and 41 females were operated for perforation peritonitis, including 31 (20.3%) children. The mean age was 21.88 years ± 14.51 (range 4–70). The mean time lapse between onset of symptoms and presentation to hospital was 5.4 ± 3.7 days (range 0.75–21). Forty‐eight (31.4%) of the patients were operated within 24 h of presentation and 105 (68.3%) after 24 h. The main symptoms were abdominal pain in 150 (98.9%), fever in 108 (70.6%), and abdominal distention in 108 (70.6%). The main causes of perforation peritonitis were typhoid ileal perforation in 98 (64.0%), perforated peptic ulcer in 25 (16.3%) and perforated appendix in 22. Tuberculous ileal perforation was seen in one (0.6%) patient. Wound infection 39 (25.5%) and wound dehiscence 15 (9.8%), were the most common postoperative complications. Enterocutaneous fistula was seen in 21 (13.7%) of the patients and was associated with mortality in nine (42.8%) patients. The overall mortality rate was 26.1%, mainly from overwhelming sepsis and severe electrolyte derangement.Conclusion: The outcome of perforation peritonitis depended on the underlying cause, the duration of symptoms before treatment, and the general health of the patient. Typhoid ileal perforation is the most common cause of perforation peritonitis in our environment.

Emergency abdominal surgery in Zaria, Nigeria

Background. The causes of abdominal surgical emergencies in a particular setting may change because of alterations in demographic, socio-economic or geographical factors. We present the pattern, management and outcome of such emergencies in Zaria, Northern Nigeria. Methods. This is a retrospective review of prospectively collected data conducted in a tertiary heath centre between 2001 and 2005. Patients aged 14 years and over with abdominal surgical emergencies were consecutively entered into the study at the time of admission. The frequencies of different diagnoses, management and outcome were recorded. The indications for and outcome of operative treatment were compared with a similar study performed about two decades ago in our institution. Results. There were 3 717 patients, accounting for 29.5% of all emergency surgical admissions. The mean age was 32.5 years. The most common diagnoses were appendicitis (996, 26.8%), nonspecific abdominal pain (871, 23.4%), intestinal obstruction (498, 13.4%) and abdominal trauma (245, 6.6%). In all, 1 788 patients (48.1%) had operations during their emergency admission compared with 37.0% in our previous study. Appendicectomy (903, 50.5%) was the most common operation. Operations for abdominal trauma and typhoid ileal perforation have increased, while operations for strangulated external hernia and perforated duodenal ulcer have decreased. Of the 169 (4.5%) patients who died, 107 (6.0%) died after an operation. Delayed presentation increased mortality. Conclusions. Operations for appendicitis, infectious diseases and trauma have increased while those for strangulated external hernia have decreased. The expense of surgery contributes to late presentation and delayed intervention, which impact negatively on treatment outcome.

Abdominal Tuberculosis in Nepal Medical College Teaching Hospital, Kathmandu

Abdominal Tuberculosis is a common extra pulmonary manifestation of tuberculosis. The wide spectrum of presentation makes abdominal tuberculosis difficult to diagnose and treat. Retrospective review of cases with abdominal tuberculosis presenting to the Surgery Department of Nepal Medical College Teaching Hospital from January 2002- June 2007 was done to describe our experience of abdominal tuberculosis over a 5 year period. We found total 32 patients with abdominal tuberculosis, among which 13 had concurrent pulmonary tuberculosis. The most common clinical presentation, i.e. a triad of abdominal pain, fever and weight loss was present in 13 who had symptoms of pulmonary tuberculosis presented to physicians and the remaining 19 presented acutely to surgeons with symptoms of pain and obstruction. Chest X ray, abdominal ultrasound and barium meal follow through done to find associated abnormalities. Diagnostic Laparoscopy was performed in 10 and 3 patients with peritonitis underwent emergency laparotomy which revealed multiple ileal perforations in 2 cases and one had multiple strictures with small bowel perforation. Diagnosis of tuberculosis, attended at surgeons was confirmed by demonstrating caseating granulomas in histology and Acid Fast Bacilli Positive, culture for M. tuberculosis from peritoneal fluid. All patients were started anti tuberculosis treatment. Abdominal tuberculosis is a relatively common finding and should always be considered in the differential diagnosis of abdominal pain, fever and weight loss. Key Words: Tuberculosis; abdominal tuberculosis; Acid Fast Bacilli; ileocaecal disease DOI: 10.3126/saarctb.v5i1.3083 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(1) 39-42

Typhoid perforation: determinants of outcome in children in Ile-Ife, Nigeria

Background: Ileal perforation can be a fatal complication of typhoid fever in children as its clinical presentation is often atypical. The risk of death from intestinal perforation in typhoid fever is more than four times when compared with patients without perforation. A high index of suspicion therefore, and early intervention are mandatory to reduce morbidities and deaths due to this disease in children. Aim: To highlight the factors that adversely influence treatment outcome following typhoid ileal perforation in a paediatric population and how they could be modified to reduce morbidity and mortality. Methods: This was a retrospective study whereby medical records of children aged 1 to 15 years with typhoid fever admitted to OAUTHC, Ile-Ife, over a 10-year period, 1994-2004. Results: A total of 38 patients, 20 males and 18 females in the ratio 1.1:1, were managed for typhoid perforation during the 10-year study period. Twenty-nine patients (76.3%) survived while 9 (23.7%) died. Of the many factors evaluated, only the duration of time before operation was found to significantly influence treatment outcome adversely (P=0.009), while large single or large multiple perforations (P=0.256), severe peritoneal contamination (P=0.291) and extensive surgery (P=0.089) did not. Conclusion: Typhoid ileal perforation has a poor treatment outcome in children in Ile-Ife, Nigeria. The duration of time before operation was the single most important factor that adversely affected treatment outcome. Therefore, swift preoperative resuscitation and early surgical intervention will enhance overall outcome irrespective of the number of perforations, severity of faecal contamination and extent of surgery. Keywords: Typhoid perforation, Determinants of outcome, Children, Nigeria