Site Of Perforation Research Articles

Characterization of radial artery perforation patterns using optical coherence tomography

BackgroundThe characterization of radial artery perforation (RAP) patterns using optical coherence tomography (OCT) has not been well established. This study aimed to identify the characteristic RAP patterns in patients diagnosed through post-procedural OCT examination. MethodsThis retrospective study included 1936 consecutive patients who underwent radial artery (RA) OCT following OCT-guided transradial coronary intervention (TRI) from January 2016 to July 2022. Data regarding RAP characteristics were collected through OCT, including the perforation site as well as dimensions such as the length, width, and arc. Furthermore, RAP types were classified as small or large perforations, with a cut-off arc value of ≤90°. ResultsRAP, as identified by RA angiography (RAA) during TRI and on post-procedural OCT, was found in 16 out of 1936 patients (0.83 %). RA OCT imaging showed that the median distance between the RA ostium and the perforation site, the perforation length, width, and arc were 30.6 (14.4–42.2) mm, 1.55 (1.03–1.92) mm, 0.74 (0.60–1.14) mm, and 42.5 (25.0–58.1) °, respectively. Small perforations (arc ≤90°) were observed in 14 out of the 16 (87.5 %) patients with RAP. Post-procedural RAA revealed that 15 out of the 16 (93.7 %) patients with RAP had sealed perforations, with the remaining patient requiring external compression. ConclusionsOur findings demonstrated that RAP is uncommon during TRI, with clearly defined characteristic patterns on OCT. Most RAPs are small and tend to spontaneous seal through catheter tamponade.

Analyzing Mushroom Structural Patterns of a Highly Compressible and Expandable Hemostatic Foam for Gastric Perforation Repair.

Nature presents the most beautiful patterns through evolving. Here, a layered porous pattern in golden ratio (0.618) is reported from a type of mushroom -Dictyophora Rubrovalvata stipe (DRS). The hierarchical structure shows a mathematical correlation with the golden ratio. This unique structure leads to superior mechanical properties. The gradient porous structure from outside to innermost endows it with asymmetrical hydrophilicity. A mathematical model is then developed to predict and apply to 3D printed structures. The mushroom is then explored to repair gastric perforation because the stomach is a continuous peristaltic organ, and the perforated site is subject to repeated mechanical movements and pressure changes. At present, endoscopic clipping is ineffective in treating ulcerative perforation with fragile surrounding tissues. Although endoscopic implant occlusion provides a new direction for the treatment of gastric ulcers, but the metal or plastic occluder needs to be removed, requiring a second intervention. Decellularized DRS (DDRS) is found with asymmetric water absorption rate, super-compressive elasticity, shape memory, and biocompatibility, making it a suitable occluder for the gastric perforation. The efficacy in blocking gastric perforation and promoting healing is confirmed by endoscopic observation and tissue analysis during a 2-month study.

Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Small Bowel Perforation Due to an Unusual Foreign Body

Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty. However, gastrointestinal perforation due to ingestion of foreign body is rare and is usually encountered in children, psychiatric patients and in alcoholics. Most of the foreign bodies pass through the GI tract without any complications. Only about 1% are known to cause complications such as perforation. Fish or chicken bones, dentures, toy parts, coins, toothpicks are the most commonly encountered foreign bodies. In this report, we present a case of a 60-year-old male who presented to the emergency department with acute abdomen secondary to ingestion of an unusual foreign body that lead to perforation and underwent exploratory laparotomy for removal of the foreign body.
 Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty that needs a timely surgical intervention.[1] Important sites of gastrointestinal perforation are stomach, duodenum, small bowel (jejunum, small intestine), appendix, colon and rectum.
 The most common causes of gastrointestinal perforation include peptic ulcer disease, diverticulitis, carcinomas, IBD, ischemia of bowel wall and infrequently foreign bodies.[2]
 Foreign body ingestion as seen in children is unintentional and can be deliberate in psychiatric patients.[3] In general, many of these foreign bodies travel through the gastrointestinal tract without causing complications. Only about 1% cases of ingested foreign bodies cause complications such as hollow viscus obstruction and/ or perforation which are usually life threatening and have poorer outcomes if diagnosis is delayed.[4,5] CT is the imaging tool of choice. Such conditions require immediate surgical intervention such as exploratory laparotomy or laparoscopic or endoscopic removal can be attempted in case of stomach or duodenal foreign bodies.
 Here in the following case report, we present an atypical case who arrived at the emergency room with acute abdomen following a foreign body consumption and underwent exploratory laparotomy for retrieval of foreign body.

Salvage endoscopic resection for perforation site recurrence of colonic polyp

Video 1Salvage endoscopic resection for perforation site recurrence.

Complication Patterns of Loop Ileostomy

Background: Loop ileostomy is a temporary diversion of small intestinal contents towards exterior through anterior abdominal wall. Though it is a good procedure for a better outcome of primary surgery it has itself many complications. Objective: To determine the clinical spectrum of loop ileostomy complications. Materials and method: This prospective study was conducted from January, 2017 to December, 2017. Consecutive 30 patients requiring loop ileostomy were enrolled in the study by purposive sampling and were categorized into Group A requiring emergency surgery and Group B planned for elective surgery. Data regarding sociodemographic, clinical, surgical and outcome profile were recorded in a pre-structured, interview and observation based, peer reviewed data collection sheet. Data were compiled, edited and analyzed with SPSS version 23. Data were presented as mean and standard deviation, frequency percentage and median with range. Results: The mean age of the patients were 32.79±5.19 years (age range: 20-43 years) and 49.16±6.17 years (age range: 28-76 years) in Group A and Group B respectively with sex ratio of male to female of 4:1 and 3:1. Out of 10 patients in Group A, 4(40%) patients underwent resection anastomosis with ileostomy and primary repair with loop ileostomy whereas 2(20%) patients underwent exteriorization of multiple perforation site. In Group B among 20 patients, 9(45%) underwent low anterior resection with loop ileostomy and 5(25%) patients underwent left hemicolectomy with loop ileostomy. Out of 10 patients in Group A, 5(50%) patients each suffered from skin excoriation and major wound infection. On the contrary, among 20 patients in Group B, 11(55%) and 4(20%) patients suffered from skin excoriation and stomal obstruction. Only skin excoriation was evident as statistically significantly higher in Group B than in Group A (p 0.03). Among the general complications, electrolyte imbalance (60% vs 40% in Group A and B respectively) and respiratory tract infection (10% each in Group A and B) were evident. Conclusion: Skin discoloration, skin edema, major and minor wound infection, prolapse, skin excoriation and stomal obstruction are the different spectrum of loop ileostomy complications in our perspective. Among them skin excoriation is much higher in routine cases than emergency surgery. Delta Med Col J. Jan 2021;9(1):17-22

Usefulness of the hybrid technique of interventional radiology and endoscopic treatment for intestinal bleeding after pancreaticoduodenectomy: a case report

Introduction and importance: In endovascular treatment of ruptured pseudoaneurysm after pancreaticoduodenectomy (PD) with gastrointestinal bleeding, treatment for vasospasm of the culprit vessel from haemorrhagic shock and subsequent reperfusion has not been determined before. Case presentation: The authors hereby present you with a case of a 59-year-old man with unknown operative method upon arrival at the Emergecy room and who had hematemesis and collapse 6 months post-PD surgery. Clinical discussion: An initial contrast-enhanced computed tomography (CT) revealed no obvious source of bleeding, so an upper gastrointestinal endoscope was performed. Rebleeding occurred during the examination, and interventional radiology was performed because haemostasis was difficult. Coil embolization was performed for leakage of contrast material from the gastroduodenal artery stump into the gastrointestinal tract. However, because the embolization was uncertain due to vasospasm of the common hepatic artery, endoscopic clipping of the perforation site was also performed to prevent rebleeding due to reperfusion after improvement of vasospasm. A CT scan 5 days later showed reperfusion of the coil-implanted vessel. No rebleeding or hepatic infarction occurred postoperatively. Conclusion: In this case, the haemostasis by coil embolization was uncertain due to the presence of vasospasm, and clipping was used in combination with the procedure to prevent rebleeding.

Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation.

Intestinal perforation during acute lymphoblastic leukemia (ALL) treatment in children is rare, but represents a severe complication with possible long-term consequences. In this study, we aim to provide an overview of the epidemiology and clinical characteristics of these patients; analyze surgical pathology findings for possible causes; and determine its impact on patients' therapy, nutritional status, and outcome. Historical chart review from January 2000 to October 2020 of children with ALL and intestinal perforation during therapy diagnosed at a single institution. Data collected included patient demographics, anthropometric measurements, ALL characteristics, diagnosis and surgery of intestinal perforation, pathology, adjustments to treatment plan, and outcome. Of 1840 ALL patients, 13 (0.7%) presented with intestinal perforation during treatment. Perforation occurred during induction phase in 91% of cases. Most patients underwent laparotomy with ostomy creation, and no patient died from the intervention or developed malnutrition. Pathology mainly revealed inflammation at the perforation site. Two samples showed leukemic infiltration and presence of microorganisms. Patients were able to resume ALL therapy in all cases. A total of eight patients (73%) were in first remission at last follow-up, with a median follow-up time of 42months (interquartile range=42). Early surgical intervention is a successful treatment approach for intestinal perforation in ALL patients. There is a clear predilection for induction phase in the occurrence of intestinal perforation in ALL patients. No specific cause was identified. Patients can receive bridging chemotherapy during surgical recovery and proceed with their treatment without apparent impact on outcome.

What is the Ideal Surgical Approach for Perforated Gastro-Duodenal Ulcer?

This is a single-center, non-randomized retrospective study that compares various clinical and evolutionary aspects of patients with perforated gastro-duodenal ulcers in order to determine the best surgical approach. The study included 35 patients who underwent surgical treatment for a perforated gastro-duodenal ulcer at Brașov County Emergency Clinical Hospital (SCJU BV) between January 2021 and January 2023. They were then divided into two groups based on whether the surgery was laparoscopic or traditional. A variety of clinical and paraclinical data were collected and compared. There were no variations in gender distribution, age, or site of the ulcer perforation across the groups. Patients who underwent a laparoscopic procedure had a smaller ulcer perforation, a faster resumption of intestinal transit, and a shorter hospital stay than those who underwent a standard procedure. At 3 days postoperatively, the Neutrophil-to-Lymphocyte Ratio (NLR) and the Systemic Inflammation Response Index (SIRI) were significantly lower in the laparoscopic group. Patients who underwent traditional surgery had a higher Boey score, needed more complex interventions, and had a higher rate of postoperative complications and mortality. In perforated gastro-duodenal ulcer cases, the laparoscopic approach is a viable option with numerous advantages, particularly in patients with a low Boey score. Meanwhile, the traditional approach may be reserved for cases with a high Boey score and complex surgical interventions.

Comparison of the Impacts of Different Middle Ear Mucosal Conditions on Type I Tympanoplasty Outcomes.

This study aimed to explore the impacts of different middle-ear mucosal conditions on the outcomes of type I tympanoplasty. A retrospective analysis of 164 patients with chronic otitis media was carried out. The patients were divided into 4 groups according to their mucosal condition. Preoperative hearing levels and air-bone gap (ABG) before and after surgery were compared via the Kruskal‒Wallis H test. The chi-squared test and Fisher's exact test were used to assess the postoperative complications and impact factors of functional success. Preoperatively, neither the air conduction nor bone conduction values differed significantly among groups with different mucosal conditions. All of the ABG closed dramatically after type I tympanoplasty (P < .05) regardless of the mucosal conditions. The functional success rates were lower when the intratympanic mucosa was moderately or severely edematous compared with mildly edematous or normal (P < .05). The disease course, perforation site, and perforation size, as well as the status of the opposite ear, were not related to the auditory functional outcome. The differences in postoperative reotorrhea and reperforation among the 4 groups were not statistically significant. Preoperative hearing levels were not affected by middle-ear mucosal conditions. The functional success rate was influenced by mucosal conditions, but hearing levels were significantly enhanced after surgical intervention regardless of the mucosal status. Postoperative complications were not related to the mucosal conditions. Thus, type I tympanoplasty is adoptable for mucosal abnormalities when pharmacotherapy cannot result in a healthy tympanum.

CT findings in seven dogs with perforating wooden skewer foreign bodies from the gastrointestinal tract.

Perforating foreign bodies from the gastrointestinal tract, such as wooden skewers, are reported in the small animal literature producing inflammatory/infectious lesions in the thorax, abdomen, and musculoskeletal system, which can be life-threatening in some instances. Several imaging modalities have been used, and advanced imaging techniques have shown a great advantage in its diagnosis and pre-surgical planning. The objective of this study is to describe the computed tomographic findings in a group of seven medium to large breed dogs with perforating wooden skewers and foreign bodies migrated from the gastrointestinal tract. The medical records database was searched for dogs with a suspected diagnosis of a perforating wooden foreign body migrated from the gastrointestinal tract in which a computed tomographic study was performed. Signalment, history, and clinicopathological findings (when available) were retrieved, and the computed tomographic studies were reviewed. Clinical signs vary depending on the anatomical regions affected through the perforating pathway. All foreign bodies were identified and showed a median attenuation of 79 HU, with the most common localization being the stomach followed by the jejunum. Peritoneal fat stranding surrounding the perforation site was the most frequent computed tomographic finding. The presence of peritoneal free fluid and/or gas was uncommon. Pleural effusion, pulmonary perforation, and pneumothorax were present in most of the cases with the foreign body traversing the pleural space. Pulmonary cavitary lesions were always reported when the ending tip of the wooden skewer was within the pulmonary parenchyma. Soft tissue abscessation was recognized in all cases where the ending tip was lodged in muscular or subcutaneous tissues. Findings supported the variability of the secondary lesions caused by this type of foreign body and the utility of computed tomography in their recognition, as well as in the identification of the wooden skewer.

Small Bowel Perforation at the Duodeno-Jejunal Junction from a Migrated Biliary Stent: A Case Report

Background: The most common sites of reported bowel perforation secondary to migrated biliary stents were duodenal or colonic. However, small bowel perforations were reported in a few cases. Herein we present a case of small bowel perforation secondary to migrated biliary plastic stent at the duodeno-jejunal junction (DJ). We think this peculiar site is the first to be reported as a perforation site secondary to migrated biliary stent. Case Presentation: We present the case of female Egyptian patient with severe abdominal pain and air under diaphragm after Endoscopic Retrograde Cholangiopancreatography (ERCP) for Klatskin tumor. The patient underwent a midline laparotomy. A moderate collection of enteric fluid was encountered with migrated stent causing perforation of the small intestine at DJ. The stent was removed, and primary closure was done. The patient could not be extubated due to bad chest condition and admitted to ICU for 48 hours then extubated after improvement of the chest condition and ability of the patient to maintain good oxygen saturation in room air. Unfortunately, the patient developed massive pulmonary embolism on the fifth postoperative day and died. Conclusion: Suspicion of stent migration should be put in mind in any patient presented with abdominal pain with history of previous ERCP and biliary stenting. Endoscopic removal and mucosal repair are possible in select cases. This is still not available for DJ or small bowel. Further research and future innovations may overcome this challenge.

Pneumothorax, Pneumomediastinum, and Cervical and Facial Massive Emphysema Secondary to Colonoscopy: A Rare Complication of Colonoscopy

Background. Colonoscopy is a resource used for the diagnosis, treatment, and monitoring of benign and malignant colorectal pathologies. The incidence of perforation is 0.03%–0.65% in diagnostic colonoscopy; however, the incidence can be up to 10 times higher in therapeutic interventions, such as polypectomies, increasing the risk of complications up to 0.07–2.1%. Materials and methods. Case report of a 71‐year‐old female who presents a rare complication due to a perforation in the sigmoid which developed pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema as a complication of a diagnostic colonoscopy where a biopsy of a friable lesion was performed. Results. A 71‐year‐old female that went to the emergency room due to acute generalized abdominal colic spasm pain with a duration of 7 hours, associated with significant abdominal distension, malaise, diaphoresis, progressive dyspnea, and massive subcutaneous emphysema that developed after performing panendoscopy and colonoscopy for diverticulosis follow‐up. An abdominal CT scan with double contrast was performed, reporting suggestive data of hollow viscus perforation, pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema in the thorax, neck, and skull base. She underwent an exploratory laparotomy finding a perforation in the sigmoid for which sigmoidectomy was performed, and for the pneumothorax and pneumomediastinum, endopleural tubes were placed in both hemithoraxes. The massive subcutaneous emphysema subsided with observation and oxygen. Conclusion. A rare complication of the use of colonoscopy as a diagnostic and therapeutic method is presented. The purpose of presenting this case is for the doctor who performs these interventions to suspect this complication in a timely manner, not delaying the diagnosis and carrying out an urgent therapeutic approach as in this case with exploratory laparotomy, finding the perforation site and carrying out the corresponding surgical management. We demonstrated that massive subcutaneous emphysema can be managed with observation if there is no other alarm data evident that required another surgical approach.

The outcome of type I tympanoplasty in patients with chronic otitis media

Background. Tympanoplasty type 1 is a reconstruction of tympanic membrane perforation with an examination of the middle ear to ensure normality. Aim. Assess the effect of the age of the patient, site, and size of tympanic membrane perforation on hearing gain and graft uptake in patients with chronic otitis media. Patients and method. Thirty patients with type 1 tympanoplasty aged between 10 years and 50 years. Patients had been submitted for audiological tests and examination pre-operatively and at 1, 3 and 6-month intervals postoperatively. Results. Improvement was 57% in 10-25 years, 59% in 25-40 years, and 56% in 40-50 years. While graft uptake was 90% in the three groups. Hearing improvement in anterior perforation was (60%), ost. perforation (41.5%), inferior perforation (43%). While the take rate is 100% in the post, perforation, 80% in anterior perforation and 83.3% in inferior perforation, hearing gain was 40% in large perforation, 66% in medium size and 77% in small size. While the take rate in small perforation was 100%, in medium perforation 90% and large perforation 80%. About 70% of patients had closure of the air-bone gap to within 15 dB and 83 % to within 20 dB. Conclusion. Age had no impact on hearing gain and graft uptake. Size of perforation affects hearing gain and graft uptake where they are better in small and medium size perforation than large perforation. The site of perforation affects hearing gain and graft uptake where hearing gain was better in anterior perforation, while graft up was better in posterior perforation.

Efficacy of Robot-Assisted Ureteroureterostomy in Patients with Complex Ureteral Stricture after Ureteroscopic Lithotripsy.

Ureteral stricture (US) postureteroscopic lithotripsy (URSL) has emerged as a severe complication with the widespread use of laser technology. Furthermore, managing a complex US is challenging. Therefore, this study evaluated the efficacy of robot-assisted ureteroureterostomy (RAUU) in addressing US post-URSL and analyzed the pathology of transected ureteral tissues to identify the risk factors for US. we conducted a prospective cohort study on patients who underwent RAUU for URSL-induced US from April 2021 to May 2023. A total of 14 patients with a mean age of 49.8 years were included in this study. The mean stricture length on radiography was 22.66 ± 7.38 mm. Nine (64.2%) patients had experienced failure with previous interventions. The overall success rate was 92.9%, both clinically and radiographically, without major complications, at a mean follow-up of 12.8 months. The pathological findings revealed microcalcifications and a loss of ureteral mucosa in 57.1% and 28.6% of patients, respectively. The RAUU technique shows promise as a viable option for US post-URSL in appropriately selected patients despite severe pathological changes in the ureter. Therefore, the migration of microcalcifications to the site of ureteral perforation may be a significant factor contributing to US development.

Embolization of Perforated Coronary Artery with a Fragment of Balloon Catheter (Cut Balloon Technique)-Multicenter Study.

Iatrogenic distal coronary artery perforation can be a life-threatening complication. While there are different dedicated devices for the embolization of distal perforations, there are scarce data about the embolization using the fragmented balloon catheter, the so-called cut balloon technique (CBT). We included consecutive patients with distal coronary perforations treated with CBT in four cardiac centers between 2017 and 2023. Clinical, angiographic and procedural characteristics as well as in-hospital outcomes were recorded. Twenty-six patients (68% men, mean age: 71 ± 10.6 years) with 25 distal coronary perforations and one septal collateral perforation were included. Eleven patients (42%) had elective percutaneous coronary intervention, while fifteen patients (58%) were treated for acute coronary syndrome. The site of perforation was most frequently distributed in the left anterior descending artery (40%), followed by the circumflex artery (28%) and right coronary artery (24%). The diameter of balloons for CBT ranged from 1.5 to 4.0 mm, with most balloons (76%) being either 2.0 or 2.5 mm in diameter. Most balloons (88%) were previously used for lesion predilatation. The numbers of cut balloons needed to seal the perforation were 1, 2 and ≥3 in 48%, 20% and 32% of cases, respectively. The in-hospital prognosis was favorable, with cardiac tamponade requiring pericardiocentesis in only four (16%) patients. Neither emergency surgery nor cardiac death occurred. CBT is a safe, efficient and easy-to-implement technique for the embolization of coronary perforations. Most distal coronary perforations can be sealed with one or two fragments of cut balloons, obviating the need for additional devices.

The Incidence of Acute Peritonitis Secondary to Different Sites of Viscus Perforation.

Objective The incidence of peritonitis secondary to viscus perforation will be examined to determine the most common sites of perforation and associated comorbidities. Methods This is a retrospective observational study based on data collected from the King Fahad Hospital of the University (KFUH). This research targeted patients who had viscus organ perforation and the relation of peritonitis secondary to it. The sample was taken from patients under the care of the General Surgery Department from the first of Feb 2016 to the 12th of Sep 2022. The final sample consisted of 450 patients. The method of diagnosis of peritonitis was mainly clinical, and the surgical approach was either through an exploratory laparotomy or a diagnostic laparoscopy. Incidental findings of viscus organ perforation were noted in addition to certain postoperative complications (e.g., adhesions) and hospital stay. Results Analysis of the results showed a significant relation (p<0.001) between viscus organ perforation and peritonitis. The most common comorbidities associated with secondary peritonitis were hypertension (12, 24.5%), diabetes mellitus (10, 20.4%), any abdominal mass (3, 6.1%), and inflammatory bowel disease (1, 2%). However, a chi-square analysis has shown no significant association between peritonitis and the targeted associated comorbidities. Conclusion Perforation of the small intestine carries the biggest association with peritonitis incidence, in addition to comorbidities such as hypertension and diabetes mellitus. Further study to establish the value of these factors might contribute to decreasing the morbidity and mortality of secondary peritonitis.

Effectiveness of trichloroacetic acid and trichloroacetic acid with gel foam for closure in patients with central perforation of tympanic membrane—a randomized controlled trial

BackgroundThe tympanic membrane (TM) forms the partition between the external auditory canal and the middle ear. Perforations occur as a result of acute otitis media or traumatic causes which undergoes healing spontaneously over 3 to 4 weeks. Non-surgical methods are successful in the closure of small to medium-sized perforations. Chemicals used for the cauterization of the margins of perforation are trichloroacetic acid and silver nitrate. This study was performed in a total of 90 patients. External auditory canal, tympanic membrane, site and size of perforation, and middle ear mucosa status were assessed followed by pure tone audiometry. One group constituting 45 subjects underwent TCA cauterization under sterile precautions. Another group of 45 subjects underwent the same procedure with TCA cautery and gel foam application for perforation closure. The procedure was repeated once a week for about 6 weeks. The effectiveness of these two procedures was compared between the two groups after a waiting period of 2 weeks.ResultsThe mean age of the study population is 41.84 ± 16.71. Of the 90 study participants, 54.4% (N = 49) were less than 40 years of age, gender, cause, and laterality of perforation were not associated with the outcome whereas the size of the perforation was significantly associated with the closure of TM perforation with chi-square value of 7.028 and P value of 0.008 (< 0.05). Overall, TM closure was achieved in 3.56 applications in TCA with gel foam patching whereas in 6.02 applications with TCA alone.ConclusionTCA cauterization with or without gel foam patching can be performed as a first-line treatment in adults with small to medium-sized perforations.

Epidemiologic factors associated with neonatal bowel perforations in Uganda: experience from a single tertiary referral hospital

BackgroundNeonatal bowel perforations pose a significant disease burden for pediatric surgeons around the world. However, very little is known about these perforations in low-income settings. This study aims to investigate the epidemiology of neonatal perforations at a tertiary hospital in Uganda.ResultsTwenty neonates with bowel perforation who were admitted to a single national referral hospital from May 2020 to April 2021 were included. Fifty-five percent (n = 11) of the neonates in this cohort were male, and 16 were term with birth weight above 2.5 kg. Thirteen were below 1 week of age and all maternal ages were less than 40 years. Pneumoperitoneum was the most common finding on erect abdominal X-ray and colon was the frequent site of perforation. Forty percent of the babies in this cohort had blood group O+. Fifty-five percent of our patients died before discharge.ConclusionOutcomes for neonatal bowel perforations are still dismal. Health workers taking care of neonates should have a high index of suspicion for neonatal gastrointestinal perforations.

PAIN ASSOCIATED WITH INTRAOSSEOUS ANESTHESIA WITH QUICKSLEEPER AND POST-OPERATIVE CONDITION OF THE PERFORATION SITE

Purpose: The aim of the study is to determine the pain during intraosseous anesthesia (IA) with the Quicksleeper and the post-operative state of the perforation site. Materials and methods: The subjects of the study were 58 patients who underwent successful intraosseous analgesia, indicated with treatment of caries or irreversible pulpitis of mandibular first and second molars. The Visual Analogue Scale was used to assess the pain during the perforation of the compact bone and during the infiltration of anesthetic solution into the cancellous bone. All 58 patients were followed up at the 24th hour and on the 7th day after the manipulation, and the following parameters were evaluated: condition of the perforation site and presence of palpation pain. Results: Only 10 patients registered mild pain during perforation of compact bone and 8 – during anaesthetic infiltration. At 24 hours after IA, 12 patients registered mild pain, 6 patients registered moderate pain at the perforation site. On the 7th day, we established mild pain in 4 patients. After IA a reactive inflammatory process was registered in 27% of the cases at 24 hours, while on the 7th day, the inflammatory reaction was registered in only 6% of the cases. Conclusion: The intraosseous system Quicksleeper allows painless perforation of the compact bone and infiltration of the anesthetic solution into the cancellous bone due without risk of serious post-operative complications at the site of anesthesia.