Perforation Of Transverse Colon Research Articles

Management of 52 small bowel perforations following gunshot injury: A case report

Abstract Small bowel injury is one of the most common abdominal injuries following penetrating injuries and is usually secondary to gunshot, stab, or impalement injuries to the abdomen. We report a case of shotgun injury to the abdomen in a hemodynamically stable man. He had an emergency exploratory laparotomy, during which 52 small bowel perforations and 1 transverse colon perforation were found. He was managed by damage control surgery involving a temporary nonclosure of the anterior abdominal wall with resuscitation and a second look laparotomy after 48 h.

S2250 Perforation of Transverse Colon by Ventriculoperitoneal Shunt

S2250 Perforation of Transverse Colon by Ventriculoperitoneal Shunt

Damage control surgery by transverse colon perforation: case report

Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The outcomes of these different resections when performed in acute clinical situations remain substantially unexplored. Case report: 65 years old diabetic and obese female, with abdominal pain accompanied by the absence of channeling of flatus and bowel movements as well as countless vomiting of low intestinal content, wich is why its refer to the emergency of the IAHULA, Merida Venezuela. Physical examination: tachycardic, tachypneic, with, HR: 130 TA: 90/60, FR: 28m oxygen saturation 89%. Abdomen distended, diminished hydro aerial sounds, painful on palpation, with voluntary muscular defense. An emergency laparotomy show: general fecal peritonitis, perforations of the transverse colon, stenosing sigmoid tumor. For this reason, phase 1 damage control surgery was performed by transversectomy + placement of proximal and distal threads, requiring phase II in an intensive care unit, ventilatory support and vasopressor drugs. Phase III was planned in 48 to 72 hours for probable complete left colectomy, however, the patient died after 18 hours of postoperative. Discussion: damage control surgery has been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. Conclusion: Abdominal sepsis and a septic shock are both possible as a critical scenarios in patients with perforation and obstruction of the colon secondary tumors and carcinomas, for that reason it is important to know which patient can be selected to a damage control surgery in orden to improve the morbimortality.

Repeated intestinal perforations in vascular Ehlers-Danlos syndrome: a case report of a novel mutation in the COL3A1 gene

BackgroundEhlers-Danlos syndrome is an inherited connective-tissue disorder characterized by skin hyperextensibility, joint hypermobility, and tissue fragility. Intestinal perforation is one of the fatal manifestations of this syndrome, and its management is complicated.Case presentationA 58-year-old woman with a familial history of Ehlers-Danlos syndrome visited the emergency department due to a sudden onset of lower abdominal pain. Plain abdominal computed tomography showed abdominal free air. We found a perforated descending colon and subsequently resected this lesion and performed ileostomy. Fifty-one days after this first operation, the patient had transverse colon perforation and thus underwent the Hartmann procedure as the second operation. In addition, she was diagnosed with small bowel perforation 53 days after the first operation and consequently underwent a third operation—partial resection of the jejunum with functional end-to-end anastomosis. Fifty-eight days after the first operation, she complained of acute abdominal pain. Plain abdominal computed tomography showed fluid collection near the jejunojejunal anastomosis. We detected dehiscence at the entry hole of the linear stapler during the operation and thus performed partial resection of the affected jejunum, followed by jejunostomy. The postoperative course of the fourth operation was uneventful. Genetic testing revealed a novel missense mutation (c.2095G>T, p.Gly699Cys) in the COL3A1 gene, which is presumed to be a pathogenic variant of vascular Ehlers-Danlos syndrome.ConclusionVascular Ehlers-Danlos syndrome should be considered in the case of repeated intestinal perforation. The identified missense mutation in the COL3A1 gene (c.2095G>T, p.Gly699Cys) might be a novel pathogenic variation causing vascular Ehlers-Danlos syndrome. Careful postoperative screening and multidisciplinary management are required.

Life-threatening bowel complications following anti-tumor necrosis factor antibody therapy for patients with inflammatory bowel disease

Incidence of inflammatory bowel disease (IBD) in Taiwan and the experience of the management of serious complications is much lower than in Western countries. The authors just want to alert readers that anti-tumor necrosis factor (TNF) is not without life-threatening complications. Three serious complications were described, including surgical management and outcomes following the application of anti-TNF monoclonal antibody therapy for IBD. Case 1 involved a 25-year-old man treated with five doses of adalimumab for moderate control of Crohn's disease (CD). Six months later, he experienced severe intestinal obstruction, which necessitated right hemicolectomy with ileocolic anastomosis. He recovered postsurgery. Case 2 involved a 54-year-old man treated with adalimumab for intractable ulcerative colitis. Ten days after the second dose of adalimumab, an emergent subtotal colectomy with ileostomy was performed for a transverse colon perforation with peritonitis. The patient underwent an ileal pouch operation a year later. Case 3 was based on a 16-year-old male patient treated with six doses of an infliximab biosimilar for CD; thereafter, an emergent subtotal colectomy with ileostomy and Hartmann's pouch was performed for peritonitis with the presence of a perforated gastrocolic fistula tract. He had no serious complications following an uneventful recovery period. Creating awareness of serious complications associated with biologic treatments and offering appropriate patient management, including surgical treatment, is beneficial to patients.

Colonic perforation due to advanced prostate cancer in prostate-specific antigen era

Prostate cancer presentation with perforation peritonitis due to rectal infiltration is quite rare. We report a 53-year-old man who presented with rectal growth resulting in bowel obstruction and transverse colon perforation, for which emergent exploration was performed. Postoperative evaluation with imaging, serum tumor markers, and histopathological examination including immunohistochemistry revealed it to be prostate cancer infiltrating to surrounding structures including the rectum. It is rare to observe such advanced cases in the era of serum prostate-specific antigen screening, but a high index of suspicion is necessary for adequate diagnosis and treatment, eventually benefitting the patient.

Chronic Evolution of a Covered Perforation of Middle Third Transverse Colon by a Toothpick: A Case Report

Background: Foreign bodies (FBs) ingestion is generally rare but they can cause often bowel perforation if they have a sharp form and the patient did not manage to eliminate it naturally in the stools. Sometimes they can pierce the digestive tube wall leading to acute complications. Among the numerous cases of ingestion of FBs presented in the literature, the current case of transverse colon perforation, with chronic evolution, epiploic and pelvic abscess, submesocolic perivisceritis represents a particular one. Case Presentation: We present a case of a 59-year-old female patient, reported episodes of transitory melena in the past 6 months and chronic pain in the right iliac fossa, chronic anemia after ingesting a toothpick. The patient complained of chronic pain in the right iliac fossa, melena, intestinal transit disorders et impaired digestive tolerance. Computerized Tomography (CT) scan suggested peritonitis with pelvic adhesions and possible covered perforation in the right iliac fossa. Surgery started as an exploratory laparotomy to define the final diagnosis since a tumoral pathology couldn’t be eliminated. Colic perforation by a toothpick was found, followed by colporrhaphy and a biosynthetic patch on the great omentum. Conclusion: This paper presents the case of a patient with a sharp foreign body (toothpick) positioned in the transverse colon. The toothpick was ingested a few months ago and had a subtle chronic evolution causing colon perforation, covered peritonitis, intra-abdominal abscess, and chronic anemia because of recurrent episodes of melena. The treatment of choice was surgery with good postoperative evolution.

Transverse Colonic Perforation in Renal Transplant Recipients During the Early Postoperative Period: A Case Series

There are very few cases of nondiverticulitis episodes of colonic perforation in the acute postoperative period following kidney transplantation described in the literature. Various nondiverticular causes of colonic perforations include ischemia, malignancy, cytomegalovirus (CMV) enterocolitis, and nonobstructive colonic dilatation. Immunosuppressive medication can contribute to colonic perforation, placing kidney recipients at risk for these complications. Since 2011, there have been 2 cases of transverse colonic perforation in the early postoperative period following renal transplantation at our institution. Both patients underwent urgent exploratory laparotomy with resection of perforated transverse colon and creation of a proximal colostomy. The aim of this study is to review the cases of colonic perforation following renal transplantation to gain a greater understanding of this rare occurrence. Despite the lack of a clear cause of perforation, it is imperative to have a high index of suspicion for colonic perforations in these immunocompromised patients to provide prompt surgical management and improved outcomes.

Right-Sided Pneumothorax Associated with Pneumoperitoneum Subsequent to Transverse Colon Perforation: Case Report

Pneumothorax can be spontaneous or secondary to a pre-existing disorder or trauma. Pneumothorax associated with pneumoperitoneum without thoraco-abdominal communication is a rare event poorly described in the literature. We report the case of a 73-year-old patient undergoing abdominal debulking surgery for advanced stage ovarian cancer complicated by a pneumoperitoneum and a right-sided pneumothorax without hernia or evidence of diaphragmatic trauma. Several physio-pathological hypotheses have been suggested, including a potential COVID-19 infection without clear etiology. Our case report emphasizes the possible association of pneumothorax with pneumoperitoneum related to a colon perforation without visible diaphragmatic or mediastinal defects.

Double Blow Injury: Left diaphragmatic eventration with colonic perforation following blunt trauma

This is a 35-year-old male patient who attended the emergency service after presenting assault by third parties 48 hours prior to admission with blunt objects. A chest radiograph was performed with evidence of a left pneumothorax and a radiolucent image in the left basal region. The patient goes to the operating room and under general anaesthesia, a diagnostic laparoscopy is started with evidence of traumatic left diaphragmatic eventration with stomach and colon, the content reduction is performed with evidence of transverse colon perforation and intestinal material in the thorax, thorough cleaning of the thoracic and abdominal cavity is performed, diaphragmatic closure left endopleural tube and terminal colostomy of the transverse colon is performed. Blunt diaphragmatic lesions represent a relatively uncommon event, with an estimated prevalence of 0.2%-7% in patients admitted to an Emergency Department because of blunt trauma. The various mechanisms responsible for traumatic diaphragmatic hernia in blunt injuries include a rapid increase in intracavitary pressure or shearing forces on a stretched diaphragm or an avulsion mechanism from its attachment points. Left-sided ruptures are more often seen than right-sided ones (70– 80% vs. 15–24% cases). Surgical approaches, such as thoracotomy, laparotomy, and thoracotomy with laparotomy, are often used for the treatment of a diaphragmatic rupture. The overall mortality rate reported in the literature ranges from 4.3 to 37% in a series of penetrating and blunt injuries, respectively. Diaphragmatic injuries due to blunt trauma are rare; require a high degree of suspicion from the physician and the performance of specific studies such as a thoracoabdominal computed tomography. Surgical management is necessary for all diaphragmatic lesions and can be performed laparoscopically.

Transverse colon perforation in the mediastinum after esophagectomy: a case report

BackgroundWhile anastomotic leakage, recurrent laryngeal nerve paralysis, and pneumonia are well-known complications of esophagectomy, the incidence of hiatal hernia after esophagectomy for carcinoma has been reported to only be between 0.6 and 10%. We report a very rare case of hiatal hernia with transverse colon rupture in the mediastinum after esophagectomy in a 65-year-old woman.Case presentationThe patient underwent definitive chemoradiotherapy for clinical stage IIA esophageal squamous cell carcinoma and salvage esophagectomy with gastric tube reconstruction through a posterior mediastinum route for residual carcinoma. Three years after the initial surgery, two metastatic nodules in the lateral and posterior segments of the liver were detected on follow-up CT and were treated with oral anticancer drugs. After 6 months, the patient was readmitted for anorexia. Upon admission, computed tomography revealed an ileus caused by a hiatal hernia. Emergent operative repair was performed; an incarcerated herniation of the transverse colon was perforated in the mediastinum, and partial transverse colon resection and colostomy were performed. Intensive care was required to control septic shock after surgery, and the patient was discharged on the 53rd postoperative day.ConclusionsCases of hiatal hernia with digestive tract prolapsing into the mediastinum after esophagectomy with reconstruction through posterior mediastinum are rare but potentially life-threatening complications.

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.

Transverse Colon Perforation Due to Migrated Pancreatic Stent

Transverse Colon Perforation Due to Migrated Pancreatic Stent

Colon perforation during sorafenib therapy for advanced hepatocelluar carcinoma. A case report.

There are no effective conventional systemic cytotoxic therapies for patients with unresectable or advanced hepatocellar carcinoma (HCC). Sorafenib, an oral multi-targeted tyrosine kinase inhibitor, was recently approved for the treatment of patients with HCC. Sorafenib is generally well tolerated and has an acceptable toxicity profile.Gastrointestinal perforation is a rare adverse event. We present a case of transverse colon perforation during sorafenib therapy for advanced HCC. A 68-year-old woman with advanced HCC was treated with sorafenib. Eight weeks later the patient presented with the sudden onset of sharp abdominal pain. Emergency surgery was performed for panperitonitis and a perforation involving the transverse colon.

A Case of Transverse Colon Perforation due to Methotrexate-associated Lymphoproliferative Disorder

A Case of Transverse Colon Perforation due to Methotrexate-associated Lymphoproliferative Disorder

Acute perforated transverse colon diverticulitis simulating acute cholecystitis: case report and literature review

Transverse colon diverticulitis is a rare entity, described for the first time in 1944 by Thompson and Fox. Even more uncommon if presented with diverticular perforation of the colon. When ranking diverticula distribution by their anatomical location site, it has been set up that transverse colon is involved in an average of 10% of the cases, but diverticulitis or inflammation of these sacculations in this anatomical region only occurs in 0.5-2.5% of the cases. Female, 44 years old, who came to emergency room with acute abdominal pain as colic of 24 hours of evolution, Acute cholecystitis was considered as a first diagnostic possibility. Pain persistence and peritoneal irritation lead to an abdominal contrasted tomography (contrast IV). Oval formations protruding from the gut lumen in ascending and transverse colon were found, corresponding to diverticula. Patient was admitted in hospital and maintained in fasting period and with a double antibiotic scheme she was discharged on the 5th day of hospital stay. Transverse colon diverticulitis is a rare entity, there exist less than 50 cases reported in worldwide literature but it has been determined that patients with transverse colon diverticulitis are 15 and 20 years younger than patients with left colon diverticulitis. That is, average age of manifestation is about 45 years old. 85% of the cases have been described in women. Reports managed it successfully with antibiotics. The present report could be achieved favourably with a double antibiotic scheme, with no need of surgery.

宿便性横行結腸穿孔の2例

宿便性横行結腸穿孔の2例

Atypical Presentation of Iatrogenic Colonic Perforation: A Case Report and Review of Previously Reported Cases

Introduction: Iatrogenic perforation is the most feared complication of colonoscopy and may lead to peritonitis, septic shock with a mortality rate upto 25%. Although most colonic perforations are intraperitoneal, extraperitoneal perforations have also been reported. However, a combination of both is extremely rare. Here we present one such case of colonic perforation along with comprehensive literature review of previously reported cases. Case Presentation: A 41-year-old Caucasian female with Ulcerative colitis (UC) presented with fever, watery diarrhea and lower abdominal pain for two days. She was in septic shock and was treated with IV antibiotics & fluids. CT scan of abdomen showed diffuse colitis and right pyelonephritis. After she became stable, colonoscopy was performed which revealed colitis in the descending and sigmoid colon. Biopsies were consistent with UC. Next day, she developed subcutaneous emphysema of the chest wall. CT chest, abdomen and pelvis revealed large pneumoperitoneum, pneumomediastinum & pneumopericardium. She was found to have transverse colon perforation and underwent subtotal colectomy with end ileostomy. Discussion: Vast majority of iatrogenic colonic perforation are intraperitoneal, however very few cases of extraperitoneal perforation have also been reported. We analyzed the duration of symptom onset, clinical features, imaging findings, site of leak and treatment administered in 31 cases of Extraperitoneal perforation reported in English literature. Incidence of perforation was similar after both diagnostic & therapeutic colonoscopies. More than half of perforations were detected within first hour of procedure. Most common presenting clinical feature was subcutaneous emphysema of neck, face or upper chest followed by abdominal pain and dyspnea. Few patients remained asymptomatic. Most common site of perforation was recto-sigmoid followed by cecum. Pneumomediastinum was the most common radiological finding followed by pneumothorax and pneumopericardium. More than half of the patients were treated conservatively while rest needed operative management. Conclusion: Physicians should be cognizant of the possibility of extraperitoneal perforation after colonoscopy. Classical abdominal pain may be absent in majority of cases. Colonic perforation should be considered when a patient presents with facial swelling, chest pain &/or shortness of breath post colonoscopy, as early recognition results in better prognosis.Figure 1Figure 2

Modified Open Laparoscopy Using a 5-mm Laparoscope.

In an effort to minimize injuries associated with closed laparoscopic entry, many surgeons use a 10-mm standard open laparoscopy technique. Disadvantages of this open technique are that it requires a larger incision, fascial sutures, and does not always achieve an airtight seal. Although 5-mm laparoscopics with excellent optics are available, little has been written about open techniques using them. We report a modified 5-mm open laparoscopy technique without fascial sutures. The fascia is elevated with small Kocher forceps and incised in the midline. The peritoneum is bluntly perforated with a hemostat-directed cephalad, and a blunt trocar with a sleeve is inserted in this direction. After rotating the sleeve toward the pelvis, a 5-mm laparoscope is placed into the abdomen before insufflation. We have performed approximately 350 laparoscopies with only one major complication of a perforated transverse colon densely adherent beneath the umbilicus in a woman without previous abdominal surgery. Minor carbon dioxide leakage was uncommon and no wound infections or hernias occurred. This 5-mm modified open laparoscopic entry technique minimizes some of the disadvantages associated with conventional open and closed 10-mm laparoscopic techniques while avoiding blind placement of sharp instruments into the peritoneal cavity.

特発性横行結腸穿孔の1例

症例は58歳，女性．仕事中に突然腹部全体の痛みを自覚し，救急車にて来院．腹部全体に及ぶ反跳痛，腹部CTで横行結腸壁の断裂と近傍の腸間膜内に空気の漏出を認め，横行結腸穿通に伴う汎発性腹膜炎と診断し緊急手術を行った．開腹すると，混濁腹水を認め，脾湾曲部から10cm口側の横行結腸間膜が空気を含み緑色に膨隆しており，腸間膜への穿通所見と考えられた．穿通した横行結腸を切除し機能的端々吻合を行った．術後経過は良好で，第25病日に退院となった．本症例では肉眼的にも病理学的にも穿孔の原因病変は認められず，特発性横行結腸穿孔の診断に至った．特発性横行結腸穿孔の頻度は比較的稀であり，若干の文献的考察を加えて報告する．