Perforation Of Sigmoid Colon Research Articles

Perforation of the Sigmoid Colon in Vasculitis in COVID-19 Patients

The aim of the study was to investigate the main manifestations and pathological changes in the tissues under the sigmoid colon perforation in patients with COVID-19. Materials. The study involved analysis of medical histories of 40 patients with sigmoid colon perforation associated with COVID-19. All patients showed similar symptoms (increasing respiratory failure, dyspnea, high body temperature), followed by the development of the sigmoid colon perforation due to the violation of intravascular hemostasis. In 25% of patients, perforation developed already on the second or third day from the onset of ARVI symptoms, in 75% - on the fifth or sixth day from the onset of the disease. Results. The analysed case histories and the results of histological examination of biopsy or pathological material demonstrated similarities in the clinical presentation of the disease and morphological changes in the affected area of the sigmoid colon. The main symptoms and syndromes are presented using the example of a clinical case. Conclusion. The patient developed complications at the final stage of COVID-19 disease and this was associated with inflammation of the mesentery arteriole walls and the formation of occlusive blood clots in their lumen, which led to the development of the sigmoid colon perforation.

Perforation of Sigmoid Colon by Transanal Decompression Tube Successfully Treated Using Over-The-Scope Clip System.

Perforation of Sigmoid Colon by Transanal Decompression Tube Successfully Treated Using Over-The-Scope Clip System.

12361 An Unusual Case of Myxedema Coma

Abstract Disclosure: N. Hasan: None. D. Yang: None. T. Othman: None. J. Dai-Ju: None. Background: Most cases of Myxedema Coma are associated with primary hypothyroidism with significantly elevated TSH levels. However the presence severe illness can contribute to decreased TSH release even in the absence of central lesions. Case: 60 year old female was found down covered in feces. She was hypothermic to 89°F, with a pulse of 62. Physical exam revealed hair loss, thick tongue, non-pitting edema, and delayed relaxation of brachial reflexes. Labs showed Sodium of 123, blood glucose of 80. Thyroid function testing revealed only a mildy elevated TSH of 13 with free T4 <0.025. Anti-TPO antibodies were elevated at 157. MRI of the Sella was negative any lesions. Thyroid ultrasound showed atrophic bilateral thyroid lobes. Assessment for hypopituitarism did not show any significant deficiencies with Cortisol 45, ACTH 11, LH 0.5, FSH 8.5, IGF-33, and Total Testosterone 10. She was found to have septic shock secondary to perforated sigmoid colon requiring colectomy. She was initially loaded with Dexamethasone 4mg followed by IV Levothyroxine 100mcg, with steroids being discontinued after AI was ruled out. After treating her sepsis she was transitioned to 150mcg of oral Synthroid with improvement of her thyroid function tests to TSH of 2.7 and free T4 of 1.56. Discussion: The majority of Myxedema Coma is associated with primary hypothyroidism. In these cases, TSH levels are markedly elevated, often greater than 100. When the TSH is not as elevated as we would expect, many factors must be considered, the greatest being central hypothyroidism where TSH secretion may be impaired from pituitary tumors, surgery, radiation, and other causes. Our patient however did not have any central lesions on imaging and was found to have anti TPO antibodies with atrophic thyroid lobes on ultrasound suggestive of primary hypothyroidism. This brings us to the effect of acute illness on the balance of thyroid hormones. Conditions such as sepsis stimulates elevations in inflammatory cytokines which disrupt the physiologic response to release TSH. Previous studies involving sepsis revealed the main cytokines implicated are TNF alpha, Interferon gamma, IL-1, and IL-6. The degree of inadequate TSH secretion is often times proportional to the severity of illness and improves after recovery from the illness. Conclusion: Our body's response to critical illness involves complex hormonal changes which affect the HPA axis and can decrease TSH secretion, even in myxedema coma without central lesions. Presentation: 6/1/2024

EP267 - Patient with Pneumomediastinum and Pneumoperitoneum – Importance of Human Factors

Abstract Clinical assessment 70-year-old lady presents with one-day history of dyspnoea, chest and abdominal pain. She was recently discharged following a three-week hospital admission with fall related traumatic rib fractures and hospital acquired pneumonia. Her abdomen was soft and non-tender. CT scan with oral and IV contrast demonstrates pneumomediastinum and pneumoperitoneum with connection at diaphragmatic crura. Management Patient was managed conservatively however two days after admission her CRP climbed to 150 and clinical suspicion remained high. Repeat CT scan over the weekend demonstrated increase in the pneumoperitoneum and decrease in the pneumomediastinum with a collection around sigmoid colon. Trainee raised concern to consultant and a laparotomy was done. Operative findings showed perforated sigmoid colon with faeculent peritonitis of unclear cause. Hartmann’s procedure was done and patient continued post recovery in ITU. Discussion This case demonstrates the complex varying presentations of our elderly co-morbid population. The presence of air in thoracic and abdominal cavities with unknown cause weeks after the fall was suspicious. Hence, the team communicated well from top-down and likewise from weekday to weekend. Low threshold for escalation and high index of suspicion enabled a re-scan which proved to be life-saving for this patient. Identifying complicated cases where errors can occur is a critical first step. Clear communication among staff, accurate documentation and addressing the patient concerns enabled the surgical team to navigate the complex disease process and ensure safe patient care.

Pneumomediastinum and pneumoretroperitoneum after COVID-19: concealed intestinal perforation

BackgroundWith the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications.Case presentationA 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease.ConclusionsClinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.

Isolated Sigmoid Colon Perforation Secondary to Blunt Abdominal Trauma

Isolated Sigmoid Colon Perforation Secondary to Blunt Abdominal Trauma

Clinicopathological Features of Elderly Patients with Colonic Volvulus

Objective: Sigmoid volvulus is most commonly seen in patients between 60 and 80 years old. The management of volvulus depends on its location and clinical presentation. The fundamental aspects of treatment include evaluating the viability of the colon, relieving the obstruction, and preventing the possibility of recurrence. We aimed to present the clinicopathological characteristics of geriatric colonic volvulus patients treated in a single center. Methods: Patients diagnosed with colonic volvulus and treated in this hospital were included in the study. Mortality rates of patients who underwent and did not undergo preoperative colonoscopic detorsion were compared statistically. In addition, diseases that affect the quality of life and cause deterioration in bowel movements and habits were determined, and these diseases' effect on mortality was evaluated. Results: Forty-four patients who underwent emergency surgery due to volvulus were included in our study. There was sigmoid colon perforation in two patients and cecum perforation in 1 patient. Two patients had cecal volvulus, and right hemicolectomy was performed in these patients; anastomosis was performed in one, and ileostomy was performed in the other. Sigmoid resection was performed in 36 patients, subtotal colectomy in 5 patients, right hemicolectomy in 2 patients, and sigmoidopexy with laparotomy and reduction in 1 patient. Thirteen patients (29.5%) underwent preoperative colonoscopy, and in eight cases, the procedure was conducted a day before the surgery, with the operation being carried out semi-urgently the next day. Conclusion: Intestinal volvulus is a rare condition that can occur in any part of the large intestine. However, it is a severe medical issue that requires prompt diagnosis and treatment due to the possibility of intestinal damage and mortality.

Successful management of splenic artery dissection after sigmoid colon perforation in vascular Ehlers–Danlos syndrome

BackgroundEhlers–Danlos syndrome (EDS) is a genetic disorder that causes fragility of the systemic connective tissues. Of the 13 subtypes, vascular EDS (vEDS) is associated with abnormalities in collagen production, resulting in arterial rupture and intestinal perforation. Herein, we report the case of a man with confirmed vEDS who survived a ruptured dissected splenic artery aneurysm triggered by perforation of the sigmoid colon.Case presentationA 48-year-old man presented to our hospital with sudden severe lower abdominal pain. The patient was genetically diagnosed with vEDS at the age of 43 years. Abdominal computed tomography (CT) showed fluid and free air surrounding the sigmoid colon. These findings suggested sigmoid colon perforation, and emergency surgery was needed. Hartmann’s procedure was performed. The resected specimen showed a 2-cm-sized depression around the perforation. Histopathological findings showed an abscess and exudate in the serosa of the perforation and thinning of the intrinsic muscular layer in the depressed area. The patient was doing well postoperatively; however, on the ninth postoperative day, sudden upper abdominal pain developed. CT revealed an intra-abdominal hemorrhage due to rupture of a dissecting splenic artery aneurysm. The aneurysm was not observed on preoperative CT and was distant from the surgical site. Urgent transcatheter arterial embolization was performed. Although embolization of the splenic artery was attempted during the procedure, the arterial dissection spread to the common hepatic artery. Moreover, the proper hepatic and gastroduodenal arteries were poorly visualized, probably due to vasospasm. Although complications associated with extensive embolization were a concern, embolization of the splenic and common hepatic arteries was necessary to save the patient’s life. After embolization, angiography showed that the left hepatic blood flow was maintained from the inferior phrenic artery, and the right hepatic inflow was maintained from the superior mesenteric artery via the peribiliary vascular plexus in the hilar area. The patient recovered well and was discharged on the 19th postoperative day.ConclusionsvEDS can cause arterial rupture after intestinal surgery. Therefore, careful post-operative management is necessary. Moreover, cooperation with interventional radiologists is important for prompt treatment of vascular complications.

Gastrointestinal perforations induced by long-term non-steroidal anti-inflammatory drugs use: a case series analysis and discussion

Non-steroidal anti-inflammatory drugs (NSAIDS) are used in a wide range but may cause harm to the gastrointestinal mucosa, which leads to various complications. This study shows the impact of long term NSAID use on small and large intestine and presents 2 cases of patients with NSAID induced perforations. The first case involves a 62-year-old male patient with RA on long term Ibuprofen use, presented with abdominal pain, vomiting, and lower limbs pain. Laparotomy revealed a 5 mm perforation in the proximal jejunum. The second case, a male patient of 65 years of age using diclofenac without a prescription, which lead to a 4×4 cm sigmoid colon perforation. The comparison of both the cases presents a difference in examination and laboratory findings. Long-term NSAID use has been associated with various GI complications, including perforations. The case presents the importance of considering NSAID related complications, mainly in older patients and the persons with ulcers. Combining NSAIDS with other drugs, like misoprostol may minimize the risk of the GI complications. NSAIDs are also linked with cardiovascular events, and heart related issues. This study shows the need of careful NSAID prescription, with their association with preventable adverse effects. 30% of hospitalizations for adverse drug reactions are only by the NSAIDs. PPIs and H2 receptor antagonist are commonly used to protect the gastrointestinal mucosa which minimizes the occurrence of ulcers. Healthcare professionals should be careful particularly in case of high risk patients to minimize the NSAID related complications.

Cavitary lung lesions in COVID-19 associated pneumonia: a single-center study of 40 cases

To demonstrate clinical features and outcomes in patients with cavitary lung lesions and COVID-19 associated pneumonia. A retrospective analysis of electronic medical records of 8261 patients with COVID-19 was performed. We selected 40 patients meeting the inclusion criteria. Sex, age, hospital-stay, lung tissue lesion, comorbidities, treatment, methods of respiratory support, complications and outcomes were evaluated. Cavitary lung lesions were more common in men (67.5%). Age of patients ranged from 28 to 88 (mean 64.9±13.7) years. Hospital-stay in patients with cavitary lung lesions was 9-58 (median 27.5) days. There were 18 complications in 14 (35%) patients. Pneumothorax, isolated pneumomediastinum, pleural empyema, hemoptysis and sigmoid colon perforation were considered as complications of cavitary lung lesions. Nine (22.5%) patients died (5 of them with complications). Three patients died after surgical treatment. Long-term results were analyzed in 8 (25.8%) patients. Patients were followed-up for 3 months after discharge. Shrinkage of lesions occurred after 7-60 (mean 23) days, and complete obliteration of cavities came after 32 (range 14-90) days. Cavitary lung lesions are a rare complication of COVID-19 pneumonia. There was no significant correlation of complications with age, sex, therapy, volume of lung lesions and non-invasive ventilation (NIV). Despite more common fatal outcomes in older patients undergoing NIV, the last one was prescribed exclusively due to disease progression and respiratory failure. Further research on this problem is necessary to identify possible risk factors of cavitary lung lesions.

Use of Endoscopy to Remove Fish Bone That Caused Sigmoid Colon Perforation.

An 87-year-old man experiencing lower abdominal discomfort resulting from the ingestion of a fish bone underwent conservative management involving endoscopic extraction of the fish bone lodged in the sigmoid colon. Most patients with lower gastrointestinal tract perforations typically develop peritonitis or abscesses, necessitating surgical intervention. Notably, endoscopic management of lower gastrointestinal tract perforations is infrequently employed. Patients presenting with localized abdominal symptoms along with a stable overall health condition may benefit from conservative therapeutic approaches that utilize endoscopic methods. Notably, the transition from endoscopic procedures for foreign body removal to surgical intervention requires close collaboration with a surgeon and must be executed judiciously.

A Case of Sigmoid Colon Perforation Caused by Barium that was Treated by Laparoscopic Surgery

A Case of Sigmoid Colon Perforation Caused by Barium that was Treated by Laparoscopic Surgery

Pneumo-mediastinum, pneumoperitoneum, and pneumo-scrotum with extensive increasing subcutaneous emphysema: a rare presentation of colonic perforation

BackgroundColonic perforation usually presents with classical signs of peritonitis. However, isolated retroperitoneal colonic perforation can present with varied clinical signs and symptoms and pose diagnostic challenges. Pneumo-mediastinum and abdominal subcutaneous emphysema can be one of the presenting signs of colonic perforation.Case reportA 33-year-old male presented with abdominal distension and extensive subcutaneous emphysema over the abdomen, pneumo-mediastinum, and pneumo-scrotum secondary to sigmoid colon perforation from a foreign body. The patient did not have classical signs of peritonitis.ConclusionBeing vigilant about the potential of colonic perforation is crucial when observing a significantly increasing subcutaneous emphysema across different parts of the body. Attending clinicians should always keep intraabdominal pathology in mind when a direct cause for these symptoms cannot be found and the patient’s symptoms become progressive.

S2026 A Rare Case of Sigmoid Colon Perforation in Severe Acute Pancreatitis

S2026 A Rare Case of Sigmoid Colon Perforation in Severe Acute Pancreatitis

WTP7.13 Simultaneous pneumoperitoneum and pneumomediastinum- would you guess sigmoid diverticular perforation? A Case Report

Abstract Introduction Simultaneous pneumoperitoneum and pneumomediastinum is a rare radiological finding. There are only 6 reported cases in the literature of this being due to a diverticular perforation. Case report A 78-year-old male presented with worsening shortness of breath, lower back pain and lower abdominal pain. Past medical history included myasthenia gravis, for which he took pyridostigmine. A computed tomography (CT) abdomen and pelvis with contrast identified pneumoperitoneum, pneumomediastinum and subcutaneous emphysema of the neck. The site of the perforation was unclear radiologically. Urgent diagnostic laparoscopy revealed a sigmoid colon perforation secondary to sigmoid diverticulitis. The procedure was subsequently converted to an open Hartmann’s Procedure. Extensive emphysema within in the mesentery was noted intra-operatively. Post-operative recovery was complicated by a chest infection but the patient recovered well and was discharged home on day 15. Discussion Colonic diverticular disease is increasing in prevalence worldwide. The most common site of diverticulitis is the sigmoid colon (an intraperitoneal structure). Perforation of diverticulitis is a serious complication that can require urgent surgery. Pneumoperitoneum is a well-recognised sign of sigmoid diverticular perforation, however pneumomediastinum is far rarer. Posterior perforations of the sigmoid colon have the potential to enter the posterior para-renal space, penetrate the diaphragmatic hiatus and present with pneumomediastinum. Conclusion Simultaneous pneumoperitoneum and pneumomediastinum is rarely caused by colonic perforation. This can lead to a delayed diagnosis and poorer patient prognosis.

A case of sigmoid colon perforation due to segmental absence of intestinal musculature (SAIM) accompanied by vascular Ehlers–Danlos syndrome: a case report

BackgroundSegmental absence of intestinal musculature (SAIM) is a partial defect of the intrinsic muscular layer of the intestinal tract. In this report, we describe a case of perforation of the sigmoid colon due to SAIM accompanied by vascular Ehlers–Danlos syndrome (vEDS), which was successfully treated by surgical therapy.Case presentationA male in his 30 s was being followed up for vEDS diagnosed by genetic testing. He had undergone two major vascular surgeries, abdominal aortic artery revascularization and thoracic endovascular aortic repair for a residual dissection and enlarging abdominal aortic aneurysm. On postoperative day 11, the patient developed perforation of the sigmoid colon for which intraperitoneal lavage and drainage, Hartmann surgery, and transverse colostomy were performed. Histological findings showed no disturbance of blood flow or diverticulum but did show a defect in the intrinsic muscular layer around the perforation site, leading to the pathological diagnosis of SAIM and associated perforation of the sigmoid colon. Postoperatively, the patient had no complications and was discharged on postoperative day 18. The patient is being followed as an outpatient and has experienced no relapse.ConclusionsBoth SAIM and vEDS, which may be related diseases, are associated with the presence of tissue fragility and have a high potential to cause intestinal perforation Caution should be exercised during surveillance in patients with constipation and examinations that cause increased intestinal pressure.

Large bowel perforation due to cytomegalovirus colitis in a post-cardiac surgical patient on chronic hemodialysis

BackgroundCytomegalovirus (CMV) colitis with colonic perforation is an exceedingly rare but life-threatening condition. The most comorbid diagnosis in patients with perforated CMV colitis is human immunodeficiency virus in the setting of advanced immunosuppression associated with CD4 < 50 cells/μL.Case presentationA 75-year-old female with a ≥ 30-year history of hemodialysis presented with progressive dyspnea on exertion. Transthoracic echocardiography showed moderate mitral stenosis and severe aortic stenosis. Although she was a high-risk candidate with a risk for mortality of 17.17% and morbidity and mortality both of 35.63% in The Society of Thoracic Surgeons risk calculator, we performed mitral and aortic valve replacement with both biological valves. Postoperative course was complicated with a high dose of inotropic support, cardiac tamponade requiring open drainage, and the need for a tracheostomy. Abdominal distension was observed, and enhanced computed tomography demonstrated free air and a suspected perforated sigmoid colon. Emergency laparotomy revealed a 20-cm longitudinal perforation in the sigmoid colon. A left hemicolectomy with stoma was performed. Immunostaining of a sample of her colon showed cytomegalovirus-positive cells.ConclusionsCardiac surgeons should consider cytomegalovirus colitis as a differential diagnosis during the course of cardiac surgery even in immunocompetent patients.

Status post colonoscopy diagnosis of sigmoid colon perforation in a morbidly obese patient: a case report

Status post colonoscopy diagnosis of sigmoid colon perforation in a morbidly obese patient: a case report

Rare Complication of Sigmoid Colon Perforation by Migrated Plastic Biliary Stent: Two Case Reports and Literature Review

Rare Complication of Sigmoid Colon Perforation by Migrated Plastic Biliary Stent: Two Case Reports and Literature Review

Management of Perforated Sigmoid Colon Cancer in an Incarcerated Inguinal Hernia Using a Combined Abdominal and Inguinal Approach.

The ideal management of perforated colorectal cancer in the hernia sac remains a challenge for general surgeons. We report such a case requiring a combined-incision surgical approach and two-stage operation. A male patient in his 80s presented with fatigue and a bulge in his left groin. Contrast-enhanced CT scan revealed a sigmoid colon perforation within the left inguinal hernia sac. A combination of midline abdominal and inguinal incisions was performed for the iliopubic tract repair and Hartmann procedure. Six months later, the recurrent inguinal hernia was repaired using the Kugel mesh. The treatment strategy for colonic perforation into the inguinal hernia remains nonstandardized, compared to those for nonperforated cases. Combined inguinal and midline abdominal incisions might be necessary for infected lesion removal and colon mesentery resection; using mesh to repair hernia is a rare option. Hernia repair using mesh can be performed in two stages when recurrence occurs.