Jejunal Perforation Research Articles

Spontan Jejunal Ülser Perforasyonu

Spontaneous perforation of the nonspecific small bowel ulcer is a rarely seen condition that causes acute abdomen and mostly diagnosed perioperatively. A 72-year old female patient was admitted to emergency service with abdominal pain. Her physical examination was compatible with acute abdomen and peritonitis. Abdomen computerized tomography showed free air under the right diaphragm. She was operated with a presumptive diagnosis of gastrointestinal perforation. An isolated jejunal perforation on the opposite side of the mesentery was found perioperatively. A biopsy was taken, and the perforation was repaired with primary sutures. The patient died in the intensive care unit due to pulmonary complications on the fifth postoperative day. Although the biopsy was taken from the superficial tissue, it was consistent with an ulcer. Nonspecific jejunal ulcer perforations can be life-threatening because of the delayed diagnosis. Especially in elderly patients, it should be kept in mind as a cause of acute abdomen.

Living Donor Liver Transplantation for Biliary Atresia: a Single-Center Experience with First 30 Cases

The aim of this study is to present our institutional experience in living donor liver transplantation (LDLT) as a treatment for end-stage liver disease in children with biliary atresia (BA). A retrospective study of pediatric patients who have undergone liver transplantation from January 2011 to December 2016 was performed. Thirty patients underwent liver transplant for biliary atresia out of 67 total pediatric transplants during this period. The records of these patients and their follow-up were retrospectively analyzed on recipient and donor demographic data, operative details, outcome, and complications. The mean follow-up period was 53.5 months. Eighteen recipients were males(60%). The mean age of recipients was 21 months. The mean preoperative weight and height were 11.2 kg and 72.5 cm, respectively. The mean PELD score was 17.57. Twenty-three (77%) had underwent previous Kasai procedure prior to transplant at mean age of 13 weeks. Twenty-two patients (73%) were nonbleeders. The mean operative time was 468 min. The mean intraoperative blood loss was 315 ml. Six did not require blood/blood component transfusion. The left lateral segment graft was used in 28 patients. The mean graft to recipient weight ratio was 2.08. Everyone received tacrolimus and prednisolone as immunosuppressants postoperatively as per protocol. There were 6 re-explorations which included 1 patient for bleeding, 1 for jejunal perforation, 1 for transverse colon perforation, 2 re-explored for hepatic artery thrombosis, and one retransplantation for primary nonfunction. There were 2 bile leaks which were managed conservatively. Two (6.6%) recipients died during their hospital stay. The overall rejection rate was 10%. The 3-year actual recipient survival rate was 90%. This improved survival is due to judicious preoperative donor and recipient selection, meticulous surgical technique, immediate detection and prompt intervention for complications, and keen postoperative surveillance.

Acute peritonitis: A clinical study

In this study we have tried to find out the incidence of acute peritonitis in relation to age group and sex of the patient and evaluate the relative incidence of various causes of acute peritonitis including trauma. We have also found out the relative incidence of complications and its relation to the primary cause and analyzed the various causes of mortality and morbidity and the factors influencing it. Methods: 50 cases of acute peritonitis due to traumatic and non-traumatic causes admitted in tertiary care center was included in this study. After detailed medical history and clinical examination the patients were taken up for treatment as per the proforma for acute peritonitis. Results: In this series maximum number of cases was seen between the age group of 15-50 years with male patients accounting for 80% of cases. Mean age of patients was 36 years. Pain abdomen (100%), vomiting (56%) and fever (50%) were most common presenting symptoms in all cases of peritonitis. Tenderness and rigidity were present in all the cases. In this series duodenal perforation was the most common cause of acute peritonitis followed by appendicular perforation (16%), ileal (8%), intestinal gangrene (8%), jejunal perforation (6%), gastric perforation (4%) and colonic perforation (2%). All the patients were taken for surgery. Wound infection was must commonest complication (10%) seen in the post-operative period. This was followed by fecal fistula (6%) and pelvic abscess (4%). In general complications septicemia (12%) was the most common. Mortality rate was (12%) in this study with septicemia and multi organ failure being the commonest cause of mortality. Mean age of patients who expired was 51 years. Mortality was clearly more in patients who presented more than 24 hours duration after the onset of symptoms. Conclusion: Duodenal perforation was the most common cause of acute peritonitis, having male predominance. Laparotomy was the treatment of choice.

Deferred anastomosis in severe secondary peritonitis using a temporary intestinal shunt – case report

Introduction: As part of the damage control surgery concept applied to the treatment of sepsis due to severe secondary peritonitis following intestinal perforation and/or in high-risk patients we describe the novel "temporary intestinal shunt" (TIS) technique with delayed intestinal anastomosis, as an alternative to primary anastomosis or enterostomy.
 Material and Methods: We present three patients in whom urgent laparotomy was performed due to intestinal perforation, with intestinal resection and TIS.
 Case reports:Case 1: A 39-year-old male presented with acute myeloid leukemia M3 and generalized peritonitis, sigmoid colon perforation and secondary jejunal loop involvement. In view of these findings, we performed 10 cm jejunal resection with TIS placement, sigmoid colon resection, and negative pressure therapy (NPT). Reoperation after 48 hours showed no evidence of peritonitis, so a manual jejuno-jejunal anastomosis and terminal colostomy were performed. Case 2: A 65-year-old woman treated with corticosteroids presented with a pneumoperitoneum secondary to a road traffic accident. Urgent laparotomy revealed a 2 cm jejunal perforation. Resection of the jejunal segment and TIS with NPT was performed. Exploration of the peritoneal cavity 96 hours later showed clinical improvement and a jejuno-ileal anastomosis was performed. Case 3: A 73-year-old male was admitted due to intestinal subocclusion. Clinical deterioration occurred rapidly and we performed an urgent laparotomy diagnosing jejunal perforation secondary to torsion and ischemia of the affected loop, and generalized peritonitis. Intestinal resection and TIS with NPT placement were thus decided. Anastomosis and closure of the abdominal appendage were deferred until 96 hours after the first surgery. 
 Conclusion: Although the evidence we present is limited, we believe TIS to be an additional tool in damage control surgery. This staged management strategy allows definitive reconstruction with the patient in a more favorable physiological condition.

Isolated Jejunal Perforation and Mesentery Injury following a Kick on the Abdomen of a College Student: A Case Report from a District Hospital in Northern Ghana

Introduction. Isolated jejunal perforation from blunt abdominal trauma is an extremely rare intra-abdominal injury that poses a huge diagnostic challenge. Delay in diagnosis and initiation of treatment often leads to significant morbidity and mortality. Diagnosis particularly in resource-poor settings may be extremely challenging and often relies on a high index of suspicion. This is due to lack of adequate diagnostic facilities and human resource to deal with the condition with resulting high occurrence of adverse outcomes. Case Presentation. We report a case of isolated jejunal perforation with associated mesentery injury in a young college student who sustained a kick to his abdomen while playing soccer. This is an unusual presentation since most reported cases often resulted from motor vehicular accidents, bicycle handlebar, and fall from a height. We emphasized the role of critical level of suspicion with a good history and physical examination as the major source of diagnosis since diagnostic procedures, such as abdominal ultrasonography and computed tomography, are largely unavailable in most resource-constraint settings. Early surgical intervention following diagnosis leads to good recovery and reduced mortality. Conclusion. Sufficient vigilance and suspicions of small bowel perforation should always be considered after blunt trauma even when symptoms and physical findings are minimal and when diagnostic capacity is limited.

EUS-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): The First Learning Curve.

Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) is a minimally invasive option for pancreaticobiliary access in patients with Roux-en-Y anatomy. The procedure involves creating a fistulous tract between the remnant stomach or jejunum and the bypassed stomach with the deployment of a lumen-apposing metal stent (LAMS), followed by the advancement of an endoscope through the LAMS to perform an ERCP or EUS. It is a technically challenging procedure, requiring skills in EUS, fluoroscopy, and LAMS deployment. The aim of this study was to determine the learning curve for EDGE. Consecutive patients undergoing EDGE by a single operator were included from a prospective registry over 3 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum analyses were conducted for the learning curve. Technical success was defined as the successful creation of the fistulous tract. Clinical success was defined as successful EUS or ERCP via the LAMS. Nineteen patients were included (21% male, mean age 58.7 y). Indication included symptomatic biliary stricture (n=6, 32%), choledocholithiasis (n=5, 26%), pancreatitis (n=3, 16%). Technical success was 100%. All patients had a 15 mm LAMS placed, 3 (16%) had cautery-enhanced LAMS. Clinical success was achieved in 18/19 (95%) patients. Fourteen patients had an ERCP, 1 patient had a EUS, and 3 patients had both. Adverse events included 2 cases of bleeding, 1 case of post-ERCP pancreatitis, and 1 jejunal perforation during duodenoscope insertion managed endoscopically.Median procedure time was 54.5 minutes (range: 31 to 88 min). Cumulative sum chart shows a 54-minute procedure time was achieved at the ninth procedure hence indicating efficiency. Apart from 2 outliers, the procedure duration further reduced with consequent procedures with the last 3 being under 40 minutes indicating that after 25 to 35 procedures a plateau may be reached indicating mastery (nonlinear regression P<0.0001). Endoscopists experienced in EDGE are expected to achieve a reduction in procedure time over successive cases, with efficiency reached 54.5 minutes and a learning rate of 9 cases. After 25 to 35 procedures, a plateau may be reached indicating mastery.

Jejunal Perforations in Zollinger-Ellison Syndrome: Expect the Unexpected

Jejunal Perforations in Zollinger-Ellison Syndrome: Expect the Unexpected

Jejunal perforation by fishbone

Foreign body ingestion is a common presentation in clinical practice. Although most ingested foreign bodies pass uneventfully across the gastrointestinal tract, sharp elongated objects pose a greater risk of intestinal perforation. We report here a case of jejunal perforation following the ingestion of fishbone. A 78-year-old female presented with acute onset of generalised abdominal pain for few hours. Examination revealed tenderness, guarding and rigidity all over the abdomen. Erect Abdominal X-ray findings were inconclusive. However, contrast-enhanced computed tomography (CT) showed a thin, linear hyperdense foreign body perforating through the jejunum. Exploratory laparotomy was done, and a fishbone piercing the small bowel 50 cm distal to the ligament of Treitz was retrieved. The perforation hole was closed with primary suture. Postoperatively, the patient recovered well. Small bowel perforation is a life-threatening emergency that necessities urgent surgical intervention. Fishbones are commonly associated with perforations and the most common site of perforation is the terminal ileum. The most important risk factor associated with intestinal perforation by fishbones is the use of dentures which impair protective sensory mechanisms. Clinical presentation can be non-specific, and contrast-enhanced CT is required to establish diagnosis. Intestinal perforation associated with foreign body ingestion should be considered when evaluating patients with acute abdomen.

Bowel Perforation due to COVID-19: A Mini Review

ABSTRACT Background The severe acute respiratory syndrome coronavirus-2 was initially believed to be an infection of only the respiratory system. It is now known to have many extrapulmonary affections including gastrointestinal symptoms associated with high mortality rates. An unusual presentation of bowel perforation in a patient who had recently undergone cesarean delivery prompted us to report this mini review of bowel perforations attributed to coronavirus. Case Our patient, a 19-year-old primigravida, underwent an emergency cesarean section under spinal anesthesia. Intraoperative events and postoperative period were uneventful, and the patient was discharged on postoperative day 5. On the 10th postoperative day, the patient presented in septic shock to the emergency department with complaints of acute epigastric pain, vomiting, loose stools, and bilious discharge from the wound site. Oral contrast computed tomography was done, which revealed a proximal jejunal perforation. The patient was taken up for laparotomy followed by bowel repair with placement of intraperitoneal drains. Immediate postoperatively, the patient developed high-grade fever for which reverse transcription polymerase chain reaction (RT-PCR)_ for COVID-19 was sent. The result for the same turned out to be positive. Twenty-four hours after the laparotomy, the intraperitoneal drains again started draining copious bilious discharge along with the deterioration of general condition of the patient. She expired on the third postoperative day. This was followed by a thorough research of the literature into possible etiologies for bowel perforation. In this mini review, we shall be discussing various case reports to determine the cause of such unusual presentation in our patient. How to cite this article Ramani MV, Saxena RK, Indrani C. Bowel Perforation due to COVID-19: A Mini Review. J South Asian Feder Obst Gynae 2020;12(6):427–431.

Perforation peritonitis: a clinical study regarding etiology, clinical presentation and management strategies

Background: Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency in India. The present study was conducted to understand the spectrum of perforation peritonitis in terms of etiology, clinical presentation, site of perforation, surgical treatment, postoperative complications, and mortality encountered at Shyam Shah Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.) India.Methods: The study was a prospective observational study conducted from July 2018 to June 2019 in the Department of General Surgery, S. S. Medical College and Sanjay Gandhi Memorial Hospital Rewa (M.P.). A total of 280 patients with perforation peritonitis were included in the study and underwent exploratory laparotomy.Results: Out of 280 patients, there were 234 males (83.57%) and 46 females (16.43%). Most common affected age group was 21 to 30 years (19.64%). Doudenal perforation was the most common type (35%), which were mainly due to Acid peptic disease (48.92%) followed by Jejunal and Ileal perforations (34.95%). In our study, a variety of operative procedures were performed depending on the patients general condition, peritoneal contamination, site of perforation, gut viability, and surgeon’s decision. Wound infection was the most common complication (29.64%). Mortality rate was 7.5% (21 patients).Conclusions: Perforation is diagnosed on clinical grounds immediately as patient reaches emergency department, time lost due to delayed hospitalization affects the outcome of standard surgical procedure. Selection of appropriate surgical procedure and postoperative care is helpful in early and uneventful recovery.

Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group.

Considering the large and increasing population of women of childbearing age with history of bariatric surgery, surgical complications of bariatric surgery during pregnancy may become more frequent in the future. The aim of this study was to analyze the clinical presentation, diagnostic procedures, and treatment of surgical complications of bariatric surgery during pregnancies. A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines to identify all studies published up to and including December 2018 that included women with previous bariatric surgery undergoing emergency surgery during pregnancy. Sixty-eight studies were selected, including 120 women with previous bariatric surgery undergoing emergency surgery during pregnancy. Fifty cases were reported as case reports and 70 in case series. Included patients had previous history of Roux-en-Y gastric bypass (n = 99), laparoscopic adjustable gastric banding (n = 17), Scopinaro procedure (n = 2), vertical banded gastroplasty (n = 1), or one-anastomosis gastric bypass (n = 1). Final diagnosis in 50 case reports was internal hernia in 26 cases, bowel intussusception in 10, intestinal obstruction in 2, laparoscopic adjustable gastric banding slippage in 3, bowel volvulus in 3, gastric or jejunal perforation in 2, and other complications in 4 cases. Maternal and fetal death occurred in 3 (2.5%) and 9 cases (7.5%), respectively. In the case series, the majority of women were operated for internal hernia and laparoscopic adjustable gastric banding slippage. Surgical complications of previous bariatric surgery during pregnancy have potentially severe outcomes. Availability of multidisciplinary expertise, including bariatric/digestive surgeons, and education of healthcare providers and women on clinical signs that require urgent surgical examination are recommended in this setting. Prompt diagnosis is fundamental and based on clinical and laboratory findings and on radiologic examinations if needed, including computed tomography scan or magnetic resonance if available. Rapid surgical exploration is mandatory in case of high clinical and/or radiologic suspicion.

2634 Small Bowel Lymphoma Presenting With Perforation: A Case Report

INTRODUCTION: Lymphoma account for only 1 to 4 % of neoplasms in the gastrointestinal tract (GIT), with the stomach being the most common location (68 to 75%) and the small bowel as the second most common (30 %). Among the possible presentations of GIT lymphomas, small bowel perforation is one of the most lethal and rare. Here we present a case of a patient that had a perforated jejunum secondary to lymphoma. CASE DESCRIPTION/METHODS: 57 year old female with history of diabetes, presented with 2 days of severe abdominal pain and vomiting. Physical exam revealed peritoneal signs and absent bowel sounds. CT showed multifocal small bowel thickening, pneumoperitoneum and extraluminal contrast indicating perforation. The patient was rushed to have explorative laparotomy which revealed multiple masses along the small bowel and had resection of a perforated jejunum. Pathology revealed lymphoma. Immunohistochemical staining was positive for CD20 and CD5, and was negative for Bcl-6 and CD10. FISH analysis was negative for translocation t(11,14), t(14,18), and MYC. The patient’s wounds healed and she was eventually treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) along with rituximab for 6 cycles and Intrathecal (IT) chemotherapy. DISCUSSION: The WHO classify small bowel lymphomas (SBL) into B-cell subtypes (90 % of cases), T-Cell subtypes and Hodgkins Lymphoma.The most common symptoms are abdominal pain (70% of cases), ileus, and weight loss. Perforation was only found in approximately 16% of cases. CT may show polypoid lesions, multiple masses, and small bowel thickening. Usually, SBL is surgically resected for both diagnosis and treatment. Historically, endoscopy has been difficult because of the location. However, with the advent of capsule endoscopy and double balloon techniques, endoscopy can potentially avoid invasive surgeries. Our patient had an acute abdomen and therefore underwent surgical evaluation. Presence of CD20 and CD5, indicated a CD5 positive B-Cell lymphoma. FISH did not show any genetic rearrangements for Cyclin D- t(11,14), a marker for Mantle cell lymphoma, nor Myc and Bcl, markers for Burkitt’s and Follicular cell lymphomas, leading to the diagnosis of DLBCL. Localized tumors undergo surgical resection followed by radiation. TNM stage IIIE or higher is treated with combination chemotherapy, CHOP and rituximab, as was our patient. SBL is a rare entity; this case provides some insight and we hope such knowledge can only improve the management of patients to come.

2548 Jejunal Perforation: A Very Rare Presentation of Jejunal Adenocarcinoma

INTRODUCTION: Small bowel malignancies constitute less than 5% of all gastrointestinal malignancies. The most common histological types of small bowel cancer are adenocarcinoma, neuroendocrine cancer, lymphoma and sarcoma. Adenocarcinoma represents 25-40% of primary small bowel malignancies, with the highest incidence in the duodenum and the incidence progressively decreasing down the small intestine. CASE DESCRIPTION/METHODS: A 69 year old previously healthy women presented with periumbilical pain for four weeks. She also reported early satiety but no weight loss. The night prior to presentation abdominal pain became severe with one episode of vomiting. There was no history of chronic NSAIDs use. She had a 40 pack-years smoking history. She had two cesarean sections and a total abdominal hysterectomy with bilateral salpingo-opherectomy. She did not have routine colorectal cancer screening. On abdominal examination she had a distended abdomen and mild periumbilical tenderness. Laboratory testing revealed leukocytosis of 15000/µL and a hemoglobin level of 10.2 g/dl with a low MCV 78.6 fl. Noncontrast CT of the abdomen showed wall thickening and focal perforation in a loop of jejunum. There was no bowel obstruction and no free intraperitoneal air seen. Exploratory laparotomy revealed a large inflammatory mass in the proximal jejunum densely adherent to the mid-transverse colon. There was a large perforation (3.5 cm of greatest dimension) of a jejunal mass. The mucosa surrounding the defect was hyperemic and thickened. Microscopic examination showed a well-differentiated adenocarcinoma invading into muscularis propria. There was no lymphovascular invasion and no metastasis were identified in 13 excised regional lymph nodes. Immunostains were negative for cytokeratin 7 (expressed in lung and pancreatic adenocarcinomas), focally positive for cytokeratin 20 (colorectal adenocarcinoma) and were positive for CDX2. CDX2 is a highly sensitive and specific marker of adenocarcinoma of intestinal origin. DISCUSSION: Jejunal adenocarcinoma is an extremely rare GI malignancy. The clinical presentation is often with abdominal pain and distension; only 10% present as a bowel perforation. Surgical resection is considered curative treatment for localized adenocarcinoma. Oxaliplatin-based adjuvant chemotherapy is suggested for patients with lymphovascular invasion. In our patient perforation per se was considered a high-risk feature and the patient was advised to have post-operative adjuvant chemotherapy.

Complicated pseudodiverticulosis of small intestine: a rare case report

Diverticular disease though being a common entity in large bowel is recently noted to occur more proximally as well. In the jejunum, the mucosal outpouchings, called as pseudo-diverticulae, occurs with an incidence of 0.5-1.5%.Diagnosed incidentally as majority of them remain asymptomatic. When they are symptomatic, dyspepsia and bloating, recurrent abdominal cramping, malabsorption and megaloblastic anemia occurs. On occasions it is not uncommon for patients to present with hemorrhage, infections, obstruction or perforation. Perforation, being a rare presentation occurs in less than 6% of the cases. We present a case of a 70 year old male, who presented as acute abdomen, found to have isolated jejunal diverticular perforation intraoperatively.

Jejunal perforation secondary to trichobezoar (Rapunzel syndrome): a rare presentation

Trichobezoar is a rare disorder. It usually occurs in young and adolescent females associated with some psychiatric illness. Trichobezoar usually accumulate in the GI tract and most commonly in stomach but it can migrate through the pylorus into the jejunum, ileum and colon. Once the bezoars extends from the stomach into the jejunum or further on, it is referred to as “Rapunzel syndrome”. Though initially asymptomatic but over a period of time it may cause gastric mucosal erosion, ulceration, and perforation of the stomach or the small intestine. If unrecognized, tichobezoar may present with intussusceptions, obstructive jaundice, protein-losing enteropathy, pancreatitis and even death. Small trichobezoar may be extracted by endoscopic fragmentation but bezoars like Rapunzel Syndrome, on the other hand, need open surgical removal. Counseling by a psychiatrist is an important part of management to prevent recurrence.

Feasibility and Outcome of Laparoscopic Approach for Acute Generalized Peritonitis in Africa: Single Low-Center Results After 25 Consecutive Cases in Cameroon

surgery is associated with lower morbidity and mortality. However, the laparoscopic approach to the management of peritonitis remains marginalized in low and middle-income countries (LMICs) due to financial and technical limitations.Methods: We conducted a seven-year prospective study on patients with acute generalized peritonitis in Yaounde, Cameroon. Inclusion criteria were an age range of between 5 to 55 years, admission within 48 hours after the onset of symptoms, hemodynamic stability, and no major comorbidities. Excluded from this study were patients with colonic perforation, prior history of abdominal surgery, or primary and localized peritonitis after proper resuscitation. The patients included were managed via laparoscopy; operative and postoperative data were collected and analyzed. Some technical artifices were used to circumvent the lack of standardequipment. Results: The study involved twenty-five patients with a mean age of 32.1 years. The etiology of peritonitis was identified as appendicitis in 20 cases, perforated duodenal ulcer in 2 cases, gastric ulcer perforation in 2 cases, and jejunal perforation in 1 case. In two cases (8%), the operation was onverted to laparotomy. The postoperative course was uneventful in 21 cases (84%), whereas morbidity was seen in 4 cases (16%); no mortality was recorded. The mean length of hospital stay was 5.5 days.Conclusions: This study demonstrates that the laparoscopic management of acute generalized peritonitis in African LMICs is afeasible, safe, and effective surgical option in properly selected patients.

Post traumatic jejunal perforation: A series of 3 cases and literature review

Background: Isolated jejunal perforation caused by blunt abdominal trauma is uncommon and most often seen after motor vehicle accidents. We present 3 cases of “blowout” perforation of the jejunum who were admitted to Dhiraj hospital with intense abdominal pain following a blunt abdominal trauma. Conclusion: Although diagnosis of traumatic jejunal perforation is challenging a high index of clinical suspicion with physical examinations and the available appropriate imaging modalities we can arrive at diagnosis.

Diagnostic laparoscopy in acute abdominal pain

Background: Acute Abdominal pain is an important surgical problem in all age groups. Early diagnosis is needed to rule out life threatening conditions. Diagnostic laparoscopy is a modern useful tool in giving proper treatment for all needed individuals. The aim of the present endeavor is to study the use of laparoscope in patients with acute pain over the abdomen, to diagnose and confirm conditions like acute appendicitis, appendicular abscess, doudenal perforation, ileal perforation. Ovarian torsion. mass formation, etc. where clinical and imaging studies are inconclusive.Methods: This study was conducted in the tertiary care hospital and the Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research, Melmaruvathur. The period of study was from June 2017 to May 2018. All patients coming to the hospital with acute abdominal pain in the age group of ten years to seventy years were included in this study. Results: Majority of the patients had the findings relevant to the correct clinical diagnosis. However significant number of patients had unexpected findings and so the diagnosis was changed, and treatment also changed. Total 100 patients were included in this prospective study. 79 patients were found to have acute appendicitis. Duodenal perforation seen in 7 patients. Jejunal perforation seen in 2 patients. Mesenteric ischemia seen in 1 patient. Acute cholecystitis seen in 3 patients. Gall bladder perforation seen in 1 patient. Ectopic pregnancy was seen in 2 patients. Ovarian torsion seen in 3 patients. Ileocecal tuberculosis seen in 1 patient. No abnormality seen in 1 patient.Conclusions: The best approach in abdominal pain is to do diagnostic laparoscopy and proceed, rather than going for open laparotomy. Diagnostic laparoscopy gives all benefits of minimal invasive surgery. Not much of pain, shorter period of hospitalization, small scars, low infection rates and most importantly, accurate diagnosis and the correct treatment of most of the intra-abdominal conditions are the gifted things.

Jejunal MALT (Mucosa Associated Lymphoid Tissue) Lymphoma: A Case Report

Background: MALT (Mucosa Associated Lymphoid Tissue) Lymphoma is an uncommon condition. It is an involvement of extranodal site in hematologic malignancy, Non-Hodgkin Lymphoma.Case Presentation: Pondok Indah, Puri Indah Hospital Jakarta treated a 38-year-old female with acute abdomen due to jejunal MALT Lymphoma perforation, one meter from treitz ligament. Emergency laparotomy was performed, the patient had a resection and end to end anastomose. She was hospitalized in intensive care unit for 4 days after the surgery and died because of prolonged septic shock.Conclusions: MALT lymphoma is an uncommon condition which is often encountered in emergency conditions due to acute abdominal pain caused by intra-abdominal perforation of the hollow viscus. Late diagnosis and treatment may cause severe outcome such as perforation and hypovolemic shock. This case report is expected to provide insight and to increase the awareness of the incidence of jejunal MALT lymphoma in Indonesia.

Role of CT scan in Diagnosis of Patients with Suspected Subacute Intestinal Obstruction

Background: Intestinal obstruction is defined as mechanical or functional obstruction of the intestines which prevents the normal passage of the products of digestion. Present study was performed to study the role of Computerized Tomography (CT) in Diagnosis of patients with suspected subacute intestinal obstruction (SAIO), to find out site & cause of obstruction and to diagnose complications of obstruction. Subjects and Methods: This study was conducted at Department of Radiodiagnosis, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. Total number of 15 patients with SAIO having equivocal findings on USG was included in this study. All the statistical tests were performed in SPSS version 15 software. Results: Age of the patients in the study range between 14 to 70 years. Out of 15 were 8 male & 7 female patients. On CT scan all 15 patients were found to have obstruction with 12 patients having mechanical obstruction & 3 patients having pseudo obstruction secondary to appendicitis, jejunal perforation. CT scan correctly diagnosed intestinal obstruction with its cause in 14 out of 15 patients. Most common cause of SAIO was ileal stricture followed by intussusceptions. Conclusion: The findings of the study show that CT is a valuable diagnostic procedure in patients with subacute intestinal obstruction with high sensitivity. It is a problem-solving tool in equivocal cases.