Intestinal Rupture Research Articles

Intestinl fragility during ochratoxicosis and aflatoxicosis in broiler chickens.

Graded concentrations of dietary ochratoxin (0, 0.5, 1.0, 2.0, 4.0, and 8.0 microgram/g) and aflatoxin (0, 0.625, 1.25, 2.5, 5.0, and 10.0 microgram/g) were fed to broiler chicks from hatching to 3 weeks of age. The breaking strength of the large intestines was decreased significantly (P < 0.05) by ochratoxin (2, 4, and 8 microgram/g), but not by aflatoxin. This fragility was accompanied by an increase in the weight of the large intestine relative to body weight of birds fed ochratoxin (4.0 and 8.0 microgram/g), whereas aflatoxin had no significant (P < 0.05) effect on this parameter. Lipid content of the large intestine was decreased significantly (P < 0.05) by aflatoxin (10.0 microgram/g) and increased by ochratoxin (8.0 microgram/g). Microscopic examination of cross sections of large intestines stained for collagen gave the impression of a great decrease in collagen content of birds fed ochratoxin, but not aflatoxin. The radial length of the collagenous longitudinal folds of the large intestine was decreased significantly (P < 0.05) by ochratoxin (2.0, 4.0, and 8.0 microgram/g). These observations, plus a field case characterized by intestinal ruptures causing carcass condemnations on the processing line and by the occurrence of aflatoxin and ochratoxin in the chicken feed, suggest a novel way in which mycotoxins cause economic loss to agriculture.

Rupture of intestine and mesentery due to fall from height (author's transl)

Twenty-five cases of falls from heights are reported under the aspect of lesions of the intestinal tract depending on height of fall and impact. Rupture of mesentery occurred in five cases, in only one case a rupture of intestinal wall. The results verify the thesis, asserted in a recent investigation of injuries caused by maltreatment: direct and not indirect forces lead to isolated lesions of intestinal tract.

Secondary peritonitis due to rupture of the ileum in a nephrotic patient

PRIMARY OR SPONTANEOUS PERITONITIS is a we/lknown complication of the nephrotic syndrome? Peritonitis secondary to rupture of the small intestine in a child with nephrotic syndrome has not been reported; our experience with such a patient prompted this report.

Rupture of herniated small intestine from blunt abdominal injury: a report of 2 cases

Two cases of perforation of the small bowel following blunt abdominal injury in patients with an abdominal hernia are presented. In one case the bowel was present in a large incisional hernia and the injuring force caused transection of the bowel at three different sites. The bowel was resected and the hernia was repaired at the same time. The patient died of associated chest injuries. In the second case, the bowel was caught in an inguinal hernia; although the injuring force was relatively mild it resulted in two perforations in the herniated terminal ileum. The patient survived following closure of the perforations and simultaneous repair of the hernia.

Inheritance of Ehlers-Danlos type IV syndrome.

The Ehlers-Danlos type IV syndrome is a severe disease with premature death from catastrophic tearing of large arteries and a tendency to intestinal rupture. These patients lack the genetically distinct type III collagen. Here evidence is presented that obligate heterozygotes have lowered levels of type III collagen in their skin and that their cultured fibroblasts produce less than normal amounts of this protein. The inheritance is autosomal recessive.

Spontaneous perforation and closure of the small intestine in association with childhood leukemia

BuDOMINAL C O M P L I C A T I O N S of leukemia in childhood are relatively ncommon. Kuffer et al? encountered intraabdominal complications in 13 of 259 children with leukemia (5~). These complications included intraabdominal abscesses in nine patients (appendiceal, liver, and renal abscesses), intestinal obstruction in two patients, pancreatitis in one, and gallstones in one. Prolla and Kirsner, 2 in a review of autopsy findings in 148 cases of leukemia in children and adults, found necrotic lesions in 8 of 75 evaluable patients (11%) and bacterial peritonitis in 10 of the 148 cases (7%). The bacterial peritonitis was due to ruptured appendicitis in three cases, rupture of the large intestine in three cases, rupture of liver abscesses in two cases, and perforation of agranulocytic abscesses of the terminal ileum in two cases. Prolla and Kirsner stated that these complications tended to be fatal because of the poor condition of the patients. When possible, it is desirable to avoid major or extensive abdominal surgery in the leukemic child. This report is of an unusual instance in which a formal laparotomy was avoided in a leukemic child with roentgen evidence of free air in the peritoneal cavity at a time when the findings on physical examination suggested spontaneous closure of the perforation and the absence of ongoing peritonitis. The patient, a 5-yr-old Oriental female with a 33-mo history of acute lymphocytic leukemia with treatment, was admitted to the UCLA-Harbor General Hospital with a 3-day complaint of abdominal pain, fever, and anorexia. The symptoms had appeared to diminish in severity 1 day prior to admission to the hospital. Intraabdominal testes had been removed in the first week of life because of male pseudohermaphrodit ism. Karotype analysis at birth and at the time of the onset of leukemia had revealed 46 chromosomes and an XY karotype. She had experienced six complete or partial relapses of her leukemic state and had been given one or more of the following chemotherapeutic agents: prednisone, methotrexate, vincristine, 6-mercaptopurine, cyclophosphamide, l-asparaginase, and cytosine arabinoside. Her antileukemia therapy for the sixth relapse had been started 4 wk prior to the onset of her abdominal symptoms and consisted of prednisone 10 mg three times daily and vincristine 1 mg i.v. once a week. On admission to the hospital, her white blood count was 6100 with 80% granulocytes, 18% lymphocytes, and 2% monocytes. A bone marrow aspiration

INTESTINAL COMPLICATIONS OF NASOJEJUNAL FEEDING

Recently Cheek and Staub reported no serious complications in 46 infants given continuous nasojejunal tube feeding. We observed serious disturbances in 4 of 13 low-birth-weight infants fed in the same manner. In the 13 infants, mean gestational age was 29.61±1.68 wks and mean birth weight was 1, 176.15±208.23 gm. All except one had respiratory distress syndrome and/or other problems. None was able to be fed orally or by nasogastric tube. Nasojejunal tube feeding was initiated from 2 to 9 days of age. Average duration was 16.0±11.78 days. At the termination of nasojejunal feeding, 8 infants were heavier and 5 lighter than their respective birth weight. Six died. In 2 the cause of death was unrelated to nasojejunal feeding. In 4 the causes of death were as follows: (1) necrotizing gastroentero-colitis with possible rupture of intestine, (2) jejunal perforation with diffuse peritonitis, (3) aspiration pneumonia due to distention of jejunum and ilium and vomiting, (4) jejunojejunal intussusception. The safety of this procedure requires careful evaluation by controlled studies before it can be recommended for routine purposes in small low-birth-weight infants.

A case of duodenal atresia.

Congenital atresia of the intestines and colon is an uncommon malformation in which there is complete obstruction of the alimentary tract. It rapidly produces vomiting, severe dehydration, and possibly rupture of the blind intestine. If no surgical relief is given, death supervenes in most cases in the first week of life, but surgical therapy is followed by high mortality. Prompt recognition of the obstruction and immediate operation give the only hope of survival (Gross, 1953). Vidal (1915) as cited by Young (1966) is the first who report the successful treatment of neonatal duodenal obstruction.

Post-traumatic blind-loop syndrome

Summary A blind-loop syndrome with steatorrhoea and proteinlosing enteropathy developed 2 weeks after a 40-year-old man had driven his car into a tree. The patient reported only mild transient abdominal symptoms immediately after the accident. The patient died 1 year later. Autopsy revealed pulmonary embolism, extensive retroperitoneal bleeding, a blind loop secondary to subperitoneal rupture of the small intestine, and scar tissue compressing the inferior vena cava.

Two cases of rupture of the large intestine in the mare associated with unassisted parturition.

Two cases of rupture of the large intestine in the mare associated with unassisted parturition.

Dynamic aspects of small intestinal rupture with special consideration of anastomotic strength.

THE INTRINSIC resistance of the gut to rupture from intraluminal pressure increase is of importance to surgeons from several points of view, particularly when considered in relation to the strength of healing anastomoses. The pattern of events in the healing process in general is well documented in reviews. 1,2,3 Healing of intestinal anastomoses has been studied in some detail and tends to follow a characteristic pattern. Sandblom 3 and Harvey and Howes 4 reported that the healing intestinal wound has an initial lag period during which it has no intrinsic strength. Each day thereafter there was a rapid increase in strength up to the tenth day, at which time the wound was as strong as normal bowel. Harvey's 5 data indicate a strength of 50% to 60% of eventual maximum on the seventh day. Only Sandblom gives credit to Chlumsky 6 for his pioneering work on the strength of

COMPLICATIONS FOLLOWING ECT OVER A THREE-YEAR PERIOD IN A STATE INSTITUTION.

Four fatalities are reviewed: 1. Cerebral hemorrhage, 2. Coronary occlusion, 3. Aspiration pneumonia and 4. Pulmonary embolism. Two other complications are also reviewed, one a result of ECT and the other an incidental complication; namely, rupture of an abdominal viscus and acute suppurative appendicitis. Kalinowsky(2) states that coronary complications may arise following ECT. He states that cerebral hemorrhage has not occurred in his experience. Kalinowsky(3) also states intestinal ruptures have occurred as has pulmonary embolism from pelvic thrombosis. Clinically, the occurrence of the described unusual complications following the use of ECT over a 3-year period in one institution has resulted in a broadening of the staff's education and experience in this field and have tested their mettle in coping with these complications. However, in spite of the fact that complications do arise, the value of this form of treatment is in no way disputed.

RECURRENT SPONTANEOUS RUPTURE OF THE BOWEL MANIFESTED BY HEMOPERITONEUM.

To the Editor:— Spontaneous rupture of the normal bowel is a rare event. Perforation of the normal colon is less frequent than rupture of the small intestine. In a recent article, Noussias 1 reports two cases of ruptured large intestine and discusses 34 other cases from the literature, 22 of them without apparent associated muscular straining. All of these had a complete rupture of the intestinal wall. Hemoperitoneum as a presenting feature with partial rupture of the colon has been reported only once, as far as we can determine. Howe 2 reports a case with partial rupture after severe straining at stool. The wall of the sigmoid flexure showed a rupture of the serosa and muscularis, with the mucosa remaining intact. Our case has several unusual features: It is the only reported case with primary resection, the youngest reported case, and the only case with a recurrence. Case Report.— A

Retroperitoneal rupture of the duodenum due to blunt non-penetrating abdominal trauma.

Intestinal rupture due to blunt abdominal trauma is relatively uncommon. The diagnosis can never be more than suspected clinically but can frequently be proved roentgenographically. Although less than 10 per cent of such perforations occur in the duodenum, the mortality of inadequately treated duodenal perforation is 75 to 90 per cent. Therefore, any aid in pinpointing such a perforation for the clinician deserves emphasis. Mechanism of Injury: A crushing injury to the upper abdomen or back is the usual cause. The classical insult is the “steering-wheel injury” of head-on automobile collisions. Anatomy: The post-bulbar duodenum is retroperitoneal in position, firmly attached to the posterior abdominal wall and lying anterior to the lumbar vertebrae. Even in the normal fasting state it contains a large amount of gastrointestinal secretions. This fluid distention, together with its firm attachment and acutely angulated flexures, makes the duodenum less evasive and resilient to external trauma, with compress...

Rupture of Intestine Due to Non-penetrating Injury

Rupture of Intestine Due to Non-penetrating Injury

Symposium ON PEDIATRIC SURGERY

There are a surprisingly large number of anatomic and developmental defects that result in urinary incontinence in infancy and childhood. While most cases of "enuresis" are merely the result of inadequate or improper training, the doubtful case should receive careful neurologic and urologic studies before psychiatric therapy in its various forms is undertaken. It is particularly important to study such cases in instances where urinary control has already been established and then the symptoms of incontinence develop. The most dangerous cases of all are those due to some defect which results in the "dribbling incontinence" of an overdistended bladder. These are particularly dangerous, in that the "incontinence" may be regarded during the first year or two of life as only the normal lack of training on the part of the child. The difference between this and pathologic lack of control is usually easily apparent. The normal child allows his bladder to become full, empties it all at once, and then will remain dry for varying periods of time. In obstruction, with overdistention of the bladder, the lack of control is constant, is small in amount and, if this possibility is considered, diagnosis of an obstructive lesion is easy. Urethral valves may be removed, but bladder tumor has a grave prognosis. Neurologic cord lesions also present a constant, though variable degree of incontinence day and night, and careful history will bring this out. Ordinary enuresis is inconstant. The experience at the Hospital Infantil of Mexico City in dealing with intestinal perforations and rupture of the gall bladder in typhoid fever is presented. Four hundred and fifty-seven cases of typhoid fever among 15,688 general admissions in 3 years, with 29 cases of intestinal perforations and 4 ruptured gall bladders form the basis of this report. Twenty-one were operated on, with a survival of 9 (43% survivals with operation), 8 were not operated on. Seven of these died (85% mortality). Of four cases of rupture of the gall bladder all were operated on and one survived. It has been pointed out in this paper that most technics which are employed successfully in adult anesthesia can be used to a large extent with the same advantages in infants and children. Therefore, in pediatric centers one finds preanesthetic medication, inhalation, intravenous, rectal, spinal and regional anesthesia employed safely and with advantage to both patient and surgeon.

Rupture of Small Intestine Complicating Injury of Pelvis

The term “subcutaneous rupture of the small intestine” designates that condition in which there is severance of the continuity of the small bowel beneath an intact abdominal wall. Very frequently this rapidly fatal injury is unattended by even the slightest contusion of the superficial tissues. Ordinarily it has followed a sudden unexpected blow to the unprotected abdominal wall, as in being thrown against the handles of a motorcycle, falling against solid objects, automobile accidents, kicks in the abdomen, or the rapid opening of a parachute (8). It has also resulted from muscular effort (1, 10). Counseller and McCormack (3) state that intestinal rupture can be caused in three ways, by crushing, tearing, or bursting. According to Tinsman and Barrow (8), the rupture is rarely multiple, is located in the upper jejunum or lower ileum, and may be due to impingement of the intestine on the vertebral column or on the promontory of the sacrum. In the presence of other severe injury, the possibility of intestinal rupture may be overlooked. While in many cases of non-penetrating trauma, an immediate diagnosis of intestinal rupture can be made because of signs of rapidly developing peritonitis, and possibly by roentgen demonstration of free air in the peritoneal cavity, one must always bear in mind that in other cases a delusive calm may mark the picture. Metheny (6) points out that, although the manifestations of peritonitis will develop rapidly if there be immediate and gross contamination of the peritoneal cavity, on the other hand, should there be very little contents in the gastro-intestinal tract, signs of peritoneal irritation will not develop until such contamination occurs. Thus gross soiling and board-like rigidity may not be present until twelve to twenty-four hours after rupture; early diagnosis depends on the importance attached to the progress of lesser signs developing during this interval. The ease with which an early diagnosis may be obscured, and operation delayed, has also been stressed by Veal and Barnes (9), who warn that only when the peritonitis is generalized will there be a silent abdomen; that in ruptures of the lower ileum, the intestinal contents may gravitate to the pelvis with the production of only a localized peritonitis, peristalsis being heard elsewhere. The failure to appreciate this possibility may lead to a mistaken sense of security. Thus in one of their cases (as in numerous others recorded in the literature) a fatal result ensued, while in two others the diagnosis was not made until a walled-off abscess had formed, with recovery after drainage. The clinical manifestations of non-penetrating subcutaneous rupture are well described by Counseller and McCormack (3) Veal and Barnes (9) and Hunt and Bowden (4), to whose papers the reader is referred. Vomiting after recovery from shock is a valuable early symptom; rigidity is the most valuable single sign. Various criteria for diagnosis are described.

TRAUMATIC RETROPERITONEAL RUPTURE OF THE DUODENUM

Traumatic surgery at the present time is of great interest to physicians. Traumatic retroperitoneal rupture of the duodenum, though rare, is a condition well worth attention. Reports show plainly that too frequently operation is delayed and that the lesion may be missed at operation, and that the prognosis is poor because of these factors. Thus it behooves every surgeon who is called on. to treat patients as surgical emergencies to have some established knowledge of duodenal ruptures into the retroperitoneal tissues and to be able to find an occult lesion when exploring the peritoneal cavity. He will be helped by knowledge of technical factors gained from reports of successful or unsuccessful cases. Reports 1 from the present conflict have recorded cases of intestinal rupture from immersion blast force. Study of these reveals the mechanics of many of the retroperitoneal duodenal injuries. Experimental and physical data suggest that intestinal rupture caused

A Case of Intramesenteric Rupture of the Small Intestine

A Case of Intramesenteric Rupture of the Small Intestine

Rupture of intestine from forceful protrusion or reduction of hernia

Rupture of intestine from forceful protrusion or reduction of hernia