Perforation Of Transverse Colon Research Articles

Early Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy in Intensive Care Patients: Sign of Possible Bowel Injury

Although percutaneous endoscopic gastrostomy may be complicated by iatrogenic bowel injury, most clinicians consider a small pneumoperitoneum on radiographs obtained after the procedure a benign finding of little clinical consequence. The possibility of a relationship between findings of early pneumoperitoneum after percutaneous endoscopic gastrostomy and subsequent iatrogenic bowel injury was examined. Charts of 85 patients in a surgical intensive care unit who had undergone percutaneous endoscopic gastrostomy between 2000 and 2005 were retrospectively reviewed. All patients had a follow-up upright chest radiograph obtained after percutaneous endoscopic gastrostomy. The charts of 4 patients with radiographs that showed early pneumoperitoneum were reviewed. Findings were clinically significant in 1 of the 4 patients. That patient had a perforated transverse colon that required surgical repair. The other 3 patients had no complications. Pneumoperitoneum after percutaneous endoscopic gastrostomy may be a sign of possible bowel injury and requires further evaluation. It should not be dismissed as benign. Obtaining a chest radiograph after a patient has undergone percutaneous endoscopic gastrostomy is essential.

Perivascular Epithelioid Cell Tumor (Pecoma) in the Transverse Colon of an Adolescent: A Case Report

Perivascular epithelioid cell tumor (PEComa) is defined as a very rare mesenchymal tumor of histologically and immuno-histochemically distinctive perivascular epithelioid cells. PEComa in the colon is very rare, with only a few reported cases so far. Because of its rarity, the clinical features and biological behavior of PEComa in the colon have yet to be established. A 16-year-old female patient with PEComa in the transverse colon was referred to our hospital for rectal bleeding. Laboratory data showed a hemoglobin level of 6.6 g/dL, WBC of 8,800/mm(3), and platelet count of 191,000/mm(3). Colonoscopy, barium enema, and abdominal computed tomography revealed a 2-cm, smooth-surfaced, round tumor with focal ulceration in the proximal transverse colon. The patient complained of abdominal pain one day after endoscopic polypectomy. She underwent a segmental resection for a perforated transverse colon. Immunohistochemically, the tumor cells showed strong diffuse positivity for HMB-45 while they were negative for c-kit, smooth muscle actin, cytokeratin, S-100, vimentin, desmin, chromogranin, synaptophysin, EMA, and CD-34. The diagnosis of PEComa was based on histological and immunohistochemical staining. The patient did not receive any adjuvant therapy and was discharged on postoperative day 11 without complications. Whole-body fluorine-18 fluorodeoxyglucose fusion positron emission tomography performed 2 months after surgery showed no signs of recurrence or metastasis. There was also no recurrence or metastasis at 24 months' follow-up.

Colonic perforation following prolonged hypovolaemia in a major burns injury

Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.

特発性横行結腸穿孔の１例 本邦特発性大腸穿孔１８７例の文献的考察

特発性大腸穿孔は明らかな原因を認めずに大腸穿孔をきたす比較的稀な疾患で,予後は不良といわれている.今回,その中でも稀な横行結腸穿孔例を経験し救命できたので報告する.症例は49歳,男性で,昼食後心窩部痛を自覚し,しだいに疼痛が増強したたあ当科を受診したところ,胸部単純X線写真にて両側横隔膜下に遊離ガス像を認めたため,消化管穿孔と診断し直ちに緊急手術となった.開腹時所見は横行結腸に直径約8mmの円形の穿孔を認あたため,穿孔部を腹腔外に引き出し,複孔式人工肛門造設術を施行した.穿孔部位の楔状切除標本の病理組織検査より特発性横行結腸穿孔と診断した.術後経過は良好で術後25日目に退院した.本症例を含めた本邦報告例15例について文献的考察を加えた.

A CASE OF PERFORATED DIVERTICULUM OF THE TRANSVERSE COLON AFTER BARIUM STUDY OF THE GASTROINTESTINAL TRACT

We report a very rare case of perforated diverticulum of the transverse colon. A 65-year-old woman was admitted to the hospital because of right lower quadrant abdominal pain and vomiting which developed after barium study of the gastrointestinal tract. An emergency operation was performed with a diagnosis of localized peritonitis caused by acute appendicitis. Laparotomic findings included an almost normal appendix, a few amount of unclear ascites and a pool of barium into the mesentery of the transverse colon with perforation. We resected the part of the perforated transverse colon and made end-colostomy. Histopathological diagnosis was pseudodiverticulum with perforation. There are only three cases of perforated diverticulum of the transverse colon in the Japanese literature as far as we could review.

What Is the Role of Reassessment Laparoscopy in the Management of Gynecologic Cancers in 1995?

One hundred fifty-four patients with a diagnosis of ovarian, primary peritoneal, or fallopian tube carcinoma underwent 181 reassessment procedures to detect persistent or recurrent disease between January 1, 1989 and December 31, 1994 at Cedars-Sinai Medical Center. One hundred four laparoscopic procedures were performed. Eleven of these procedures were converted to laparotomy due to severe adhesions. Therefore, a total of 88 reassessment laparotomies were performed during the study period. Fifty-seven of 93 laparoscopies and 69 of 88 laparotomies were done as second-look procedures. There was no significant difference between the two groups with respect to patient age, tumor histology, degree of primary cytoreduction, and tumor stage or grade. Significant differences were found between laparoscopy and laparotomy groups in the following outcome variables evaluated: estimated blood loss (33.9 ml vs 164.9 ml,P= 0.0001), operative time (81.3 min vs 130.4 min,P= 0.0001), days of hospitalization (0.3 days vs 6.8 days,P= 0.0001), and direct cost/case ($2765 vs $5420,P= 0.0001). Despite obtaining 50% fewer biopsies with laparoscopy than laparotomy, the ability to detect disease was similar between these two groups: 47.3% vs 55.7% for all procedures and 52.6% vs 53.6% in the patients undergoing second-look procedures. Major complications in the laparoscopy group included transverse colon perforation (1), small bowel perforation (2), enterocutaneous fistula (1), and a retroperitoneal hematoma (1). Major complications in the laparotomy group included cystotomy (1), left ureteral injury (1), enterotomy (2), and SBO (4). Laparoscopy, when technically feasible, appears equally as effective as laparotomy in detecting persistent or recurrent malignant disease with less blood loss, less days spent in the hospital, less financial burden, and no increase in patient morbidity.

A CASE OF PERFORATED DIVERTICULUM OF THE TRANSVERSE COLON

A rare case of perforated diverticulum of the transverse colon was experienced. Perforated diverticulum of the transverse colon presented difficulty in diagnosis preoperatively, because it can produce abdominal pains in every area of the abdomen; has no characteristic clinical findings; and our clinical surgeons pay less attention to the existence of the disease as a probable differential diagnosis due to its low frequency. Our case involved an 81-year-old woman complaining of a lower abdominal pain and abdominal disention. Peritoneal signs were minimal and we had difficulty in diagnosis. With barium enema study due to gastrographin, intestinal leakage of contrast medium at the left-sided transverse colon was suspected. Abdominal CT also visualized a pool of the medium out of the intestine. An emergency operation was performed with a diagnosis of perforated transverse colon. Histopathological diagnosis of perforation of the pseudodiverticulum was made. We see 30 reported cases of the disease in the English and none in the Japanese literature as far as we could review. Their clinical features and the diagnosis and treatment of the disease are also discussed in this paper.

Dilation of the colon complicating acute self-limited colitis

Colonic dilatation has been reported as an occasional complication of infectious colitis in single case reports and short series, but no large series has been published. We analysed 19 cases of self-limited colitis complicated by colonic dilatation, with infective agents identified in 14, admitted to a Regional Infectious Diseases Unit. Colonic dilatation, defined as a minimum transverse colonic diameter of 7 cm on plain abdominal X-ray, was associated with approximately 1% of cases of notifiable diarrhoea requiring hospital admission. The clinical course was associated with pyrexia (in 90%), tachycardia (in 90%), hypoalbuminaemia (in 100%), anaemia (in 84%) and reactive thrombocytosis (in 63%). There was a history of antidiarrhoeal agents or opiate analgesia in eighteen patients (95%). Intensive medical management, consisting of intravenous antibiotics, steroids, supplementary nutrition and withdrawal of anti-motility agents, resulted in resolution in 17 patients. Two patients required subtotal colectomy for perforation of the transverse colon, but neither developed severe peritonitis, and both subsequently underwent reversal of ileostomy. With early recognition and close observation of colonic dilatation in patients with acute diarrhoea, most cases can be successfully managed conservatively with preservation of the colon. Surgical intervention should be considered in patients with progressive colonic dilatation despite intensive medical management. There were no clinically useful parameters distinguishing self-limited colitis from inflammatory bowel disease acutely, so initial management should cover both possibilities.

A CASE OF MORGAGNI'S HERNIA ASSOCIATED WITH PANPERITONITIS CAUSED BY PERFORATION OF STRANGULATED TRANSVERSE COLON

We have experienced a case of Morgagni's hernia associated with panperitonitis which was caused by a perforation of strangulated transverse colon. Only 2 cases of Morgagni's hernia caused by perforation of the transverse colon like this case have been reported in the Japanese literature as far as we could review. A 82-year-old woman suddenly suffered from severe abdominal pain 5 hours after an operation of cataract, and emergency operation was carried out. Morgagni's hernia was detected in the right diaphragm, and the transverse colon had been incarcerated into the hernia and perforated. We resected the perforated lesion of the transverse colon and closed the edge of the defect in the diaphragm with simple interrupted sutures, without resecting the sac of the hernia. The patient could recover satisfactorily, however died of formerly contracted uremia three months after the operation. Usually, Morgagni's hernia is asymptomatic and often detected in the routine chest X-ray examination. It is nevertheless important for Morgagni's hernia that radical operation should be performed when it is detected, because 17 cases among 240 reported in Japan had obstruction and/or perforation of the intestine.

FOUR CASES OF TRAUMATIC DIAPHRAGMATIC HERNIA

We repont four cases of traumatic diaphragmatic hernia. All were male, and their ages ranged from 18 to 38 years. The hernias were caused by blunt trauma in three cases and penetrated wound in one. The chief complaints were dyspinea and left chest pain. The correct diagnosis was made by chest X-ray film and roentgenographic examination of the digestive tract. The rupture occurred on the left side in all cases, and the size of the defect was from 10 to 25cm. Ruptured diaphragms were closed by direct sutures through laparotomy in two cases, thoracotomy in one case, and thoracoabdominal approach in one. The contents of the hernia were the stomach, spleen, colon, small bowel and omentum. Accompanying the injury were the stomach perforation, kidney rupture and transverse colon perforation. The prognosis seems to depend on these complicated traumas.

Pneumoperitoneum Due to Perforation of the Transverse Colon in an Umbilical Hernia

Pneumoperitoneum Due to Perforation of the Transverse Colon in an Umbilical Hernia