Multiple Intestinal Perforations Research Articles

A Case Report of Ingestion of Multiple Bead Magnets Presenting With Multiple Intestinal Perforations.

A Case Report of Ingestion of Multiple Bead Magnets Presenting With Multiple Intestinal Perforations.

Rapunzel Syndrome: A Rare Presentation with Multiple Small Intestinal Bands and Perforation

Rapunzel Syndrome: A Rare Presentation with Multiple Small Intestinal Bands and Perforation

Non-resection management of intestinal perforation associated with neutropenic enterocolitis in adolescent leukemia

Neutropenic enterocolitis (NE) is a necrotizing inflammatory disease of the cecum or colon that develops during severe neutropenia. We present a leukemic patient who developed multiple intestinal perforations associated with NE and recovered by surgical intervention without bowel resection. A 16-year-old girl was diagnosed with acute lymphoblastic leukemia. During induction therapy, she had been developing severe neutropenia and started to complain of abdominal pain. On day 36, she was experiencing severe abdominal pain with distention, and computed tomography showed abdominal free air and the thickened cecum wall. Emergency surgery revealed multiple perforations on the cecum with patchy necrosis. Abdominal drainage by tube-cecostomy and ileostomy were performed, and the patient gradually recovered. Two months later, the affected cecum was found recovered on second surgery, the ileostomy was closed, and the cecostomy was removed. Eight months after the first surgery, the patient was discharged after maintenance therapy. NE must be suspected in neutropenic patients with abdominal pain. In cases presenting severe complications such as intestinal perforation, abdominal drainage with ostomy can be a promising and minimally invasive option which may contribute to the bowel salvage and avoiding unnecessary bowel resection. • A report of neutropenic enterocolitis associated with multiple intestinal perforations. • Successful abdominal drainage avoided unnecessary bowel resection. • Abdominal drainage with ostomy can be a promising and minimally invasive option.

A Case of Multiple Small Intestinal Perforations Caused by Cholesterol Crystal Embolization

A Case of Multiple Small Intestinal Perforations Caused by Cholesterol Crystal Embolization

Epstein Barr Virus-Associated Lymphoproliferative Disorder during Maintenance Therapy of Childhood Acute Lymphoblastic Leukemia

Epstein Barr virus (EBV)-associated lymphoproliferative disorder (LPD) is a major cause of morbidity and mortality in immunodeficient patients. This disorder has been extensively described after hematopoietic stem cell (SCT) or solid organ transplant. Since the 1980's, there have been isolated case reports of pediatric patients with acute lymphoblastic leukemia (ALL), who developed EBV-LPD during ALL therapy, without undergoing SCT. Comprehensive information is unavailable regarding the prevalence, clinical manifestations, treatment, outcome and pathogenesis of such disorders in this setting.In this retrospective survey, national coordinators of International BFM (I-BFM) ALL study groups were asked to report patients ≤ 18 years of age who developed EBV-LPD during childhood ALL therapy since 2000. Patients with LPD following SCT were excluded. Complete information was requested regarding patient characteristics, leukemia and LPD characteristics, treatment and outcome. In addition, a literature search was performed, and patients described in previously published case reports were added to the series.Ten cases of EBV-LPD during childhood ALL therapy were reported by I-BFM national coordinators. Another 16 case reports were identified by a literature search, thus forming a series of 26 patients. None of the patients reported a previous history of immune deficiency or cancer in the family. Eighteen of 26 patients were male. Median age was 4.5 years (range: 2 months-16 years). Eighteen patients were diagnosed with B-ALL, 3 with T-ALL (data unavailable for 5 cases). Only 2 cases received ALL treatment according to the high-risk (HR) arm of their respective protocols. All cases were diagnosed during maintenance therapy, or 1-2 months after its cessation. The median duration of maintenance exposure until LPD diagnosis was 12.5 months (range: 3-30 months). Patients presented with a diverse and often aggressive clinical picture, with frequent extra-nodal involvement (fig. 1). Of 26 patients, 22 patients presented with fever, 12 had an infectious mononucleosis (IMN)-like prodrome days to weeks before LPD diagnosis, 13 presented with pulmonary nodules (fig. 2) and 6 had multiple intestinal perforations (fig. 3). Pathology showed a spectrum of heterogenous lesions, as defined by the World Health Organization 2008 criteria for post-transplant LPD (PTLD), including only one case with an LPD of T-cell origin. In all cases maintenance treatment was discontinued. Other treatment modalities included chemotherapy, rituximab, EBV cytotoxic T-cell lymphocytes (CTLs) and SCT (fig. 4). In 5 patients maintenance was resumed, without LPD recurrence. Three patients died of EBV-LPD, 4 had an ALL relapse, 19 experienced continued remission from both ALL and LPD.In this survey we describe the clinical manifestations, treatment and outcome of 26 patients who developed EBV-LPD during childhood ALL therapy. This is a very rare life-threatening disorder, but its exact incidence is difficult to estimate due to under-reporting, even among patients treated on clinical trials. The clinical presentation, range of pathological findings and treatment modalities were similar to PTLD. Most patients were diagnosed at a progressive stage of their disorder. Remarkably, all 26 cases were diagnosed during the maintenance phase of ALL treatment, after a median duration of 12.5 months. The majority were treated according to non-HR arms of therapy, where exposure to maintenance is usually of longer duration. There is limited information regarding immune function during maintenance therapy. EBV-LPD is a disorder resulting from proliferation of infected B-cells in the setting of deficient cytotoxic T-cell surveillance. Our findings suggest that the pathogenesis of this disorder is related to an immune dysregulation which occurs specifically under exposure to maintenance therapy, and that the B-cell and T-cell compartments may be differentially affected during this phase of therapy. These rare cases may enhance our understanding of the biology of EBV infection in immunodeficient patients. The vast majority of children with ALL do not develop EBV-LPD during maintenance therapy, suggesting a role for host genetic predisposition, which may be further investigated in future. [Display omitted] DisclosuresSchrappe:JAZZ Pharma: Consultancy, Research Funding; Baxalta: Consultancy, Research Funding; Medac: Consultancy, Research Funding; SigmaTau: Consultancy, Research Funding; Novartis: Consultancy, Research Funding.

A 49-Year-Old Woman with Suspected COVID-19 related Multiple Intestinal Perforations

A 49-Year-Old Woman with Suspected COVID-19 related Multiple Intestinal Perforations

Disseminated Talaromyces marneffei infection presenting as multiple intestinal perforations and diffuse hepatic granulomatous inflammation in an infant with STAT3 mutation: a case report

BackgroundTalaromyces marneffei is a highly pathogenic fungus that can cause life-threatening fatal systemic mycosis. Disseminated Talaromycosis marneffei affects multiple organs, including the lungs, skin, and reticuloendothelial system. However, T. marneffei infection has rarely been reported in human immunodeficiency virus (HIV)-negative infants with multiple intestinal perforations and diffuse hepatic granulomatous inflammation.Case presentationWe present the case of an HIV-negative 37-month-old boy who has had recurrent pneumonia since infancy and was infected with disseminated Talaromycosis. Contrast-enhanced computed tomography of the whole abdomen showed hepatomegaly and intestinal wall thickening in the ascending colon and cecum with mesenteric lymphadenopathy. Colonoscopy showed a cobblestone pattern with erosion, ulcer, polypoid lesions, and lumen deformation ranging from the colon to the cecum. T. marneffei was isolated from the mucous membrane of the colon, liver, and bone marrow. After antifungal treatment and surgery, his clinical symptoms significantly improved. Whole-exome sequencing using the peripheral blood of the patient and his parents’ revealed a heterozygous missense mutation in exon 17 of the STAT3 gene (c.1673G>A, p.G558D).ConclusionsIn T. marneffei infection-endemic areas, endoscopic examination, culture, or histopathology from the intestine tissue should be performed in disseminated Talaromycosis patients with gastrointestinal symptoms. Timely and systemic antifungal therapy could improve the prognosis. Immunodeficiency typically should be considered in HIV-negative infants with opportunistic infections.

Multiple Small Intestinal Perforations in a Patient with Granulomatosis with Polyangiitis

Multiple Small Intestinal Perforations in a Patient with Granulomatosis with Polyangiitis

Improvised Laparostomy Pack to Manage Laparostomy for Injuries due to Improvised Explosive Devices (IEDs).

Splinters of improvised explosive devices [IEDs] cause multiple intestinal perforations and random pattern visceral injuries causing contamination of peritoneal cavity. This necessitates multiple peritoneal toilets and relook surgeries. Surgical management is to perform laparostomy to avoid life threatening complication, like abdominal compartment syndrome and fulminant sepsis. "Peshawar pack" is a three-layer temporary abdominal dressing pack for managing laparostomy. It is prepared in operation room and applied on patients with ease. Patients with abdominal injuries due to blasts of IEDs, managed with Peshawar pack during June 2014 to June 2016, were studied to determine the effectiveness and practical utility of Peshawar pack. Data was analysed by SPSS version 22. Total numbers, means +SD and frequencies with percentages were described. In fifty-five patients selected for the study, effective drainage of peritoneal cavity and control of peritoneal sepsis was achieved in all cases. Mobilisation out of bed was possible in 38 cases [70%] within 3-5 days and evisceration during mobilisation occurred in 02 cases [3.6%]. There was no case of iatrogenic gut injury. Complete fascial closure in staged manner was achieved in 53 cases [96%]. Peshawar pack is a simple, practical, and effective method for laparostomy care in abdominal injuries due to blast of IEDs.

Typhoid intestinal perforation: Analysis of the outcome of surgical treatment in Kano, Nigeria

Background: Intestinal perforation is a serious complication of typhoid fever with high case fatality rates in developing countries. This study aims to determine the factors associated with an adverse clinical outcome among patients managed for typhoid intestinal perforation (TIP) in our hospital. Materials and Methods: We retrospectively reviewed the records of all patients presenting to our general surgery unit with TIP between January 2012 and December 2015. The patients were categorized based on postoperative outcome status and the patient-related variables were compared and analyzed for determinants of outcome, using the Chi-square test. A statistical significance was assigned to a P 1000 ml was significantly associated with having a postoperative fecal fistula (P = 0.011) and postoperative mortality (P = 0.002). A number of intestinal perforations were not significantly associated with an adverse outcome (P > 0.05). Conclusion: Postoperative fecal fistula adversely affected the outcome of the patients in our series. Multiple intestinal perforations did not seem to affect the outcome in our patients.

Determinants of postoperative morbidity and mortality in children managed for typhoid intestinal perforation in Kano Nigeria.

Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality. We retrospectively reviewed the records of all children presenting to our unit with typhoid intestinal perforation (TIP) between March 2009 and December 2013. The patients were grouped based on postoperative outcome status and were compared with respect to patient related variables, using chi square test. Multivariate analysis was performed using a binary logistic regression model. Significance was assigned to a p-value <0.05. The records of 129 children were analyzed. There were 78 (60.5%) boys and 51 (39.5%) girls. The male/female ratio was 1.53:1. Their ages ranged from 3years to 13years (mean 8.14years; SD 2.61years). A single intestinal perforation was seen in 73.4% (94/128) of them, while 26.6% (34/128) had two or more. Mortality rate was 10.9%. Multivariate analysis showed that multiple intestinal perforations significantly predicted postoperative mortality (p=0.005) and development of postoperative fecal fistula (p=0.013), while serum albumin <32g/L was a predictor of postoperative surgical site infection (p=0.002). Multiple intestinal perforations, a postoperative fecal fistula and hypoalbuminemia adversely affected outcome in our patients. III (Retrospective study). Type of study-Prognosis study.

Intestinal Rehabilitation in a Patient with Crohn Severe Disease and Short Bowel Syndrome

Introduction: Crohn's disease (CD) is uncommon in Peru and may be a cause of short bowel syndrome (SBS), mainly the severe form in young patients. Medical and surgical management is complex. We present the case of a young patient with CD operated by the Intestinal Failure Unit (IFU) with 2-year follow-up. Case Description: Male of 25 years. In 2014 he performed a laparoscopy for adhesion release and biopsy suture in wedge for intestinal obstruction. Two days later, relaparotomy, intestinal resection and jejunostomy (at 120 cm of the Treitz ligament) are performed by jejunal suture dehiscence and multiple intestinal perforations. Curses with massive low digestive hemorrhage; patient is submitted to a new intestinal resection under an endoscopic guide, leaving 50 cm of ostomized jejunum and 70 cm of ostomized ileum. The pathological anatomy reports compatible with EC. Control of intra-abdominal infection was achieved and received Parenteral Nutrition (PN) for 1 year 5 months. During this period he presented digestive hemorrhage of medical management, Central Venous Catheter infections, pneumonia, myelodysplastic syndrome with pancytopenia. He also received biological therapy from Infliximab. Seven months later the autologous gastrointestinal reconstruction (AGIR) was performed and failed. Administration of glutamine by nasojejunal probe and through a jejunal re-infusion resulted in partial intestinal adaptation and allowed the administration of mixed nutrition (domiciliary for 3 months), then AGIR (jejunum 45 cm and ileum 70 cm) was successfully performed. At 3 weeks, he developed a low-flow intestinal fistula that was cured with enteral nutrition. Conclusion: Patients with complicated CD may require massive bowel resection and cause SBS. They are more susceptible to infections due to background disease and immunosuppressive treatment. It is difficult to achieve medical intestinal rehabilitation due to multiple infectious intercurrences. The best anti-infection conditions were achieved with the home management of Parenteral Nutrition and allowed AGIR. The management of these patients must be in charge of the IFU.

Gastroschisis with single, large intestinal perforations in a preterm neonate: A very rare case

Several cases of bowel perforation in patients with intestinal atresia have been reported in the literature. Gastroschisis is known to be associated with multiple intestinal perforations. We report the case of a preterm neonate with gastroschisis who presented with single large perforation in the ileum with no associated intestinal atresia.

A Case of Multiple Intestinal Perforations Resulting from Vascular Injury due to Systemic Lupus Erythematosus

A Case of Multiple Intestinal Perforations Resulting from Vascular Injury due to Systemic Lupus Erythematosus

An unusual case of multiple intestinal perforations secondary to pica

Habitual ingestion of non-nutritive substances is the characteristic feature of a medical condition known as pica. It is usually associated with nutritional deficiency state, mental illness and at times with pregnancy. Most of the ingested foreign bodies pass through the digestive tract without causing complications however in about 1% cases, it can result in fatal complications such as intoxication, gastrointestinal perforation etc. Here we report a case of multiple intestinal perforations in a 28 year old patient secondary to his psychiatric illness Pica. The aim of this case report is to demonstrate its unusual presentation and to discuss the management of this rare case.

Bullet injury to great vessels of abdomen - a case report and review of literature

Bullet injury to the great vessels of abdomen is uncommon and has high mortality and morbidity including amputation. Many times there are other associated organ injuries. Though hypotension and absent or feeble peripheral pulse are good indicators of vascular injury, there can be normal blood pressure with palpable pulses initially when there are hematoma formation in a closed space and adequate fluid resuscitation. We report this uncommon presentation in a 26 years old gentleman who had bullet injury in the right lower flank of abdomen causing a longitudinal tear on the medial aspect of right external iliac vein (zone III injury) with multiple small intestinal perforations.

Multiple Small Intestine Perforations after Organophosphorous Poisoning: A Case Report

Organophosphate poisoning has significant gastrointestinal manifestations including vomiting, diarrhea, cramps and increased salivation. We report an uncommon gastrointestinal complication of multiple small intestinal perforations following organophosphorus poisoning. A 28-year old male presented after ingesting dichlorvos mixed with alcohol. Following the initial cholinergic symptoms, the patient developed severe shock with fever, attributed to aspiration pneumonia. Despite appropriate antibiotics, shock was persistent. Over the next 24-hours, he developed abdominal distension, loose stools and high nasogastric aspirates. Computed tomography showed pneumoperitonium. Exploratory laparotomy revealed six perforations in the jejunum and ileum. The involved portion of the bowel was resected and re-anastomosed, following which only 80-cm of small bowel was left. Postoperatively, shock resolved over 72-hours. However, over the next few days, patient developed features of anastomotic leak. Since only a small portion of the small bowel was preserved, a conservative approach was adopted. He deteriorated further and finally succumbed to the illness.

Bowel perforation in Dego's disease: a lethal surgical scenario

Malignant atrophic papulosis or Dego’s disease is a type of cutaneous disease with involvement of the gastrointestinal and central nervous system. Involvement of the gastrointestinal system by way of perforation invariably leads to a fatal outcome. Awareness of this condition will help in providing a high index of suspicion while managing unexplained multiple intestinal perforations or while dealing with rapidly developing complications in perforative peritonitis.

Pre-Hospital Induced Hypothermia Improves Outcomes in a Pig Model of Traumatic Hemorrhagic Shock.

Extensive preclinical evidence suggests that induced hypothermia can protect tissues from ischemia-reperfusion injury, reduce organ damage, and improve survival in the advanced stages of shock. We assessed the effects of induced hypothermia on the hemodynamic parameters and coagulation capacity during hemorrhagic shock (HS) and fluid resuscitation, in a pig model of HS with multiple intestinal perforations. Pigs (n=16) were randomized into 2 groups: a hypothermia (HT) group (n=8, 34°C) and a normothermia (NT) group (n=8, 38°C). Hypothermia to 34°C was induced with a cold blanket at the pre-hospital stage. Traumatic HS shock was induced using multiple intestinal perforations. Pulse indicator continuous cardiac output (PiCCO) was used to monitor hemodynamic changes. Coagulation capacity was measured using thromboelastography (TEG) at baseline as well as during resuscitation periods. Survival was documented for 72 h post-trauma. Mortality in the hypothermic HS group was low, but there were no significant differences in mortality between the groups (mortality=2/8 HT vs. 5/8 NT, p=0.137). During hypothermia, the heart rate, extravascular lung water index (EVLWI), oxygen uptake index (VO2), and oxygen delivery index (DO2) in the HT group were significantly lower than those in the NT group. There were no significant differences between the 2 groups in the other hemodynamic indices or prothrombin time. Analyses of thromboelastometry at 34°C during hypothermia showed significant differences for reaction time (R) and alpha angle, but not for maximal amplitude (MA). Rewarming reversed the coagulation changes induced by hypothermia. Induced mild hypothermia (34°C) in the pre-hospital stage affects hemodynamic parameters and the coagulation system but does not worsen outcomes in a pig HS model. The hypothermia-induced coagulation changes were reversed during rewarming without evidence of harmful effects. Our results suggest that pre-hospital induced hypothermia can be performed carefully following major trauma.

Intestinal perforation caused by multiple magnet ingestion

Multiple magnet ingestion is rare, but can cause serious gastrointestinal complications. We report a case of 7-year-old girl with multiple intestinal perforations caused by multiple magnet ingestion. The aim of this report is to draw attention to magnetic toys, results of magnet ingestion and the importance of timing of operation.