Small Bowel Perforation Research Articles

Surgery for non-Meckel’s small-bowel diverticular perforation: two case reports and a literature review

BackgroundSimilar to colonic diverticula, small-intestinal diverticula are often asymptomatic, but may cause life-threatening acute complications. Non-Meckel’s small-bowel diverticular perforation is rare, and the rate of mortality is high. However, there is currently no consensus regarding its therapeutic management.Case presentationCase 1: A 73-year-old Japanese man with localized lower abdominal pain was referred to our hospital. Enhanced computed tomography (CT) revealed diverticulitis of the small intestine, which was managed conservatively. Four days after admission, abdominal pain worsened, and repeat CT revealed extraintestinal gas. Emergency surgery was performed for the segmental resection of the perforated jejunum with anastomosis. Case 2: A 73-year-old Japanese woman was transferred to our hospital with small-bowel perforation. CT revealed scattered diverticula in the small intestine and extraintestinal gas around the small-intestinal diverticula. Emergency surgery was performed for the segmental resection of the perforated jejunum with anastomosis.ConclusionsConservative treatment for small-bowel diverticular perforation may be attempted in mild cases; however, surgical intervention should not be delayed. Segmental resection of the affected intestinal tract with an anastomosis is the standard treatment. Residual diverticula should be documented because of the possibility of diverticulosis recurrence.

Validity of laparoscopic surgery for lower gastrointestinal perforations.

This study aimed to clarify the validity of laparoscopic surgery for lower gastrointestinal perforation by comparing the clinical outcomes of laparoscopic and open emergency surgery. We reviewed the data of patients who underwent surgery for lower gastrointestinal perforation. Patients were categorized into two groups: the laparoscopic group who underwent laparoscopic surgery, and the open group who underwent laparotomy. Clinical and operative outcomes between the two groups were evaluated. A total of 219 patients were included in the study. There were 66 and 153 patients with small bowel and colorectal perforations, respectively. The median operative time in the laparoscopic group was shorter than that in the open group (126 min vs. 146 min, p = .049). The mean amount of intraoperative blood loss was significantly lower in the laparoscopic group (50.4 mL vs. 400.1 mL, p < .001). The incidence of postoperative complication was higher in the open group (20.0% vs. 66.5%, p < .001), especially wound infection (0% vs. 26.3%, p = .002). Median hospital stays were 14 days and 24 days in the laparoscopic and open groups, respectively (p < .001). In the laparoscopic group, hospital mortality was 0%. The laparoscopic approach for small bowel and colorectal perforation in an emergency setting is a safe procedure in carefully selected patients and may contribute to decreased intraoperative blood loss, shortened hospital stay, and decreased incidence of postoperative complications, especially wound infection.

S2842 Outpatient Management of Small Bowel Perforation: A Case Report and Review of Literature

S2842 Outpatient Management of Small Bowel Perforation: A Case Report and Review of Literature

S4858 Small Bowel Perforation as Initial Presentation of Duodenal-type Follicular Lymphoma After Ten-year Remission: A Case Report

S4858 Small Bowel Perforation as Initial Presentation of Duodenal-type Follicular Lymphoma After Ten-year Remission: A Case Report

Iatrogenic small bowel perforation during elective laparoscopic intraperitoneal onlay meshplasty leading to intraoperative change of plan: a case report with review of literature

Iatrogenic bowel injury during any surgery, be it open or laparoscopic; is associated with significant morbidity. Moreover, if the said injury occurs in a surgery in which a foreign material is planned to be implanted in the patient’s body as a prosthesis e.g., hernia surgery; the surgical team may have to deviate from its original plan of action. Even in the best of hands, iatrogenic bowel trauma can occur inspite of following best recommended practices. This usually occurs in the setting of dense adhesions of bowel to the parietes. Herein, we present one such case of a 72-year-old lady who was planned for laparoscopic incisional mesh hernioplasty, but had to be subjected to an intraoperative change in plan, due to iatrogenic enterotomy.

Case report of rare cause of small bowel obstruction: distal migration of metal biliary stent requiring enterotomy

Endoscopic biliary stent placement is a mainstay in the management of biliary strictures both malignant and benign. Distal stent migration is a known complication of metal biliary stents, however small bowel obstruction or perforation are rare. In this report from a tertiary referral centre, we detail a mid-small bowel obstruction caused by covered metal stent migration requiring a laparotomy and enterotomy for definitive management. A 69-year-old male was admitted to the Sunshine Coast University Hospital with obstructive jaundice on a background of previous metal biliary stent placement. On day 3 of his admission, he developed worsening abdominal pain. Cross-sectional imaging demonstrated distal migration of his stent to his mid-jejunum, causing a high-grade small bowel obstruction. He underwent laparotomy to retrieve the stent. He recovered well and underwent a percutaneous transhepatic cholangiogram with stent replacement. In this case, distal biliary stent migration causes a small bowel obstruction. Whilst uncommon, risk factors including previous intra-abdominal operation can be used to identify patients unlikely to achieve successful expectant management of distal migration.

Small Bowel Perforation by a Toothpick: A Case Report and Literature Review

Abstract This case report and literature review present a rare case of small bowel perforation caused by an accidental ingestion of a toothpick. The patient’s subtle presentation with nonspecific symptoms posed diagnostic challenges, emphasizing the need for a high index of suspicion for foreign body ingestion in similar clinical scenarios. A 17-year-old male presented to the emergency department with a long history of abdominal pain, which had worsened over the past three days and localized to the right iliac fossa. The initial suspicion was acute appendicitis; however, an abdominal CT scan revealed a toothpick penetrating the small bowel wall. The patient underwent a diagnostic laparoscopy, during which the toothpick was removed and the perforated segment of the bowel was sutured intracorporeally. The patient had an uneventful postoperative recovery course and was discharged on the third postoperative day. Toothpick perforation poses diagnostic challenges due to its subtle presentation and lack of recollection of ingestion. Imaging plays a crucial role in identifying the foreign body and guiding appropriate treatment. Prompt surgical management involving removal of the foreign body and repair of the perforation is recommended, as nonoperative approaches generally have poor outcomes. Laparotomy or diagnostic laparoscopy is the most common and effective treatment depending on surgical experience and availability. Resection of the affected bowel segment may be required in cases of significant inflammation or large perforations. Overall prognosis is good with early diagnosis and intervention. This case emphasizes the importance of maintaining a high index of suspicion for perforations caused by sharp foreign bodies in patients with cryptogenic intra-abdominal pathology. A thorough history, physical examination, imaging studies, and timely surgery are crucial in preventing morbidity and mortality. Increased awareness of this rare but dangerous complication can lead to improved patient outcomes.

Euglycemic diabetic ketoacidosis due to small bowel perforation: a case report

Diabetic Ketoacidosis (DKA) is a potentially life-threatening condition that complicates diabetes mellitus. Euglycemic DKA (eDKA) is emerging as a variant in both type 1 and type 2 diabetes mellitus. The rise in its presentation is being caused by newer medicines using SGLT-2 inhibitors, with a complex underlying pathophysiology. Here we report a case of a 70-year-old woman presenting to the emergency department complaining of shortness of breath and abdominal pain. She suffers from type 2 diabetes mellitus and is on oral therapy, including the SGLT-2 inhibitor empagliflozin. Further testing revealed a high-anion-gap metabolic acidosis without elevation of lactate levels and a glucose level of 160 mg/dL. CT imaging of the abdomen showed a small bowel perforation. The case required aggressive medical therapy before surgical repair in the operating room. EDKA is a medical emergency that can be challenging to identify due to its atypical presentation compared to the traditional DKA (which is hyperglycemic). These characteristics can delay effective and timely treatment.

Bowel Perforation During Percutaneous Nephrolithotomy: Diagnosis, Management, and Follow-up

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for large kidney stones, but serious complications such as bowel perforation may occur. We discuss the diagnosis and management of colonic and small-bowel perforations due to PCNL and suggest principles for care and prevention. We emphasize the significance of imaging tools to direct percutaneous access, the importance of early diagnosis, and the relatively high success rate for conservative management. Patient summaryLarge kidney stones are usually treated with a keyhole surgery procedure called percutaneous nephrolithotomy (PCNL). A rare but serious complication of this procedure is puncture of the bowel. We discuss how to prevent, diagnose, and treat this complication in patients undergoing PCNL.

Customized surgical approach to small bowel perforation secondary to biliary stent migration: a case report and review of the literature

Customized surgical approach to small bowel perforation secondary to biliary stent migration: a case report and review of the literature

Identifying Preoperative Clinical Characteristics of Unexpected Gastrointestinal Perforation in Infants-A Retrospective Cohort Study.

Infants presenting with unexpected pneumoperitoneum upon abdominal X-ray, indicating a gastrointestinal perforation (GIP), have a surgical emergency with potential morbidity and mortality. Preoperative determination of the location of perforation is challenging but will aid the surgeon in optimizing the surgical strategy, as colon perforations are more challenging than small bowel perforations. Therefore, the aim of this study is to provide an overview of preoperative patient characteristics, determine the differences between the small bowel and colon, and determine underlying causes in a cohort of infants with unexpected GIP. All infants (age ≤ 6 months) who presented at our center with unexpected pneumoperitoneum (no signs of pneumatosis before) undergoing surgery between 1996 and 2024 were retrospectively included. The differences between the location of perforation were analyzed using chi-squared and t-tests. Bonferroni correction was used to adjust for multiple tests. In total, 51 infants presented with unexpected pneumoperitoneum at our center, predominantly male (N = 36/51) and premature (N = 40/51). Among them, twenty-six had small bowel, twenty-two colon, and three stomach perforations. Prematurity (p = 0.001), birthweight < 1000 g (p = 0.001), respiratory support (p = 0.001), and lower median arterial pH levels (p = 0.001) were more present in patients with small bowel perforation compared with colon perforations. Pneumatosis intestinalis was more present in patients with colon perforation (p = 0.004). All patients with Hirschsprung disease and cystic fibrosis had colon perforation. The final diagnoses were mainly focal intestinal perforations (N = 27/51) and necrotizing enterocolitis (N = 9/51). Infants with unexpected GIP, birthweight < 1000 g, and prematurity have more risk for small bowel perforation. In case of colon perforation, additional screening (for Hirschsprung and cystic fibrosis) should be considered.

Single-stage laparoscopic treatment of a cholecystoduodenal fistula with perforated small bowel ileus and fibrinous purulent peritonitis. A single case study

Gallstone ileus is a rare complication of recurrent cholecystitis and one of the rarest causes of mechanical bowel obstruction, with an increasing incidence in the elderly. We present a case of multiple small bowel perforations of the jejunum due to gallstone obstruction and the incidental finding of high‑grade appendiceal mucinous neoplasia of the appendix. To our knowledge, this is the first such case to be described and completely resolved by a laparoscopic approach.&#x0D; An 83‑year‑old woman presented to our emergency department with severe vomiting, constipation, and deterioration of her general condition. A computed tomography scan revealed thickening of the gallbladder with a continuous aerobe to the duodenum, a mechanical obstruction of the small intestine at the transition to the ileum, and a thickened and calcified appendix. Due to a high suspicion of gallbladder perforation with the formation of a bilio‑duodenal fistula, the patient underwent an emergency exploratory laparoscopy, which revealed a small bowel perforation in three segments with marked local fibrinous, purulent, and stercoral peritonitis of the left hemiabdomen. The gallstone was retrieved through the perforated small bowel, and a partial small bowel resection and a cecal wedge resection were performed laparoscopically. Small bowel continuity was restored with an anisoperistaltic side‑to‑side jejuno‑jejunostomy. The patient was discharged on postoperative day eight.&#x0D; Despite advances in imaging, gallstone ileus remains a diagnostic challenge. Because the disease occurs predominantly in elderly patients, gallstone ileus remains associated with high morbidity and mortality. It remains unclear from the literature whether the optimal surgical management of bilioenteric fistula is best resolved by a single‑stage or a two‑stage approach.&#x0D;

Frequency of Small Bowel Perforation among Neonates Presented with Pneumoperitoneum: A Cross Sectional Study

Background: Neonatal pneumoperitoneum, characterized by the presence of free gas within the peritoneal cavity, is a critical condition often signaling intestinal perforation. While necrotizing enterocolitis (NEC) has been predominantly associated with this condition, various other etiologies contributing to neonatal intestinal perforations necessitate further exploration. The management of such conditions, particularly in resource-limited settings, remains a challenge, often resulting in significant morbidity and mortality. Objective: This study aims to investigate the frequency of small bowel perforation among neonates presenting with pneumoperitoneum and to examine the association between neonatal weight and the occurrence of small bowel perforation. Methods: A cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from July 2023 to December 2023. Seventy neonates aged 5 to 25 days presenting with radiological evidence of pneumoperitoneum were included. Demographic details were collected, and the infants underwent primary peritoneal drainage followed by exploratory laparotomy if necessary. Data analysis was performed using SPSS version 25, employing Chi-Square tests for categorical variables, with a significance level set at p &lt; 0.05. Results: Of the 70 neonates, 20 (28.6%) were diagnosed with small bowel perforation. A significant association was found between small bowel perforation and neonatal weight; 13 (65%) of the perforation cases were among neonates weighing less than 2.5 kg (p = 0.0001). The overall mortality rate observed was 35%, with 20 neonates succumbing shortly after peritoneal drain insertion due to sepsis. Conclusion: Small bowel perforation is a significant complication in neonates with pneumoperitoneum, with a higher incidence observed in those with lower birth weights. This study highlights the critical need for immediate diagnosis and intervention in such cases, particularly in under-resourced settings, to improve outcomes.

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.&#x0D; 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.&#x0D; The most common causes of gastrointestinal perforation include peptic ulcer disease, diverticulitis, carcinomas, IBD, ischemia of bowel wall and infrequently foreign bodies.[2]&#x0D; 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.&#x0D; 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.

P643 Magnifying Endoscopy with Narrow Band Imaging for Graft Failure and Disease Recurrence in Patients with Crohn’s Disease after Intestinal Transplantation

Abstract Background Crohn’s disease (CD) is one of the common causes of short bowel syndrome (SBS) and intestinal failure (IF). Intestinal transplantation (IT) is sometimes needed for patients with CD who develop IF after multiple intestinal resections due to CD-related complications, such as uncontrollable bleeding and penetrating diseases. However, there have been limited case reports concerning the endoscopic surveillance of CD patients after IT. Methods We retrospectively investigated two patients with CD who underwent IT because of SBS-IF after multiple intestinal resection. We administered post-transplantation immunosuppressants and conducted regular magnifying endoscopy with narrow-band imaging (ME-NBI) via ileostomy chimney for surveillance of grafte rejection. Endoscopic prediction of rejection were based on our previously published "VENCH" score which is composed of five parameters: "V" (villi appearance), "E" (erythema), "N" (capillary network), "C" (crypt widening), and "H" (heterogeneity). Endoscopic biopsy were taken for histologic confirmation of graft rejection severity. Results Case 1 was a 60-year-old male patient with CD who received three times of intestinal resection for small bowel stricture and perforation, followed by IT due to SBS-IF. He lived uneventful until seven years thereafter with bloody diarrhea presented. Endoscopic surveillance revealed normal VENCH score of background mucosa but deep longitudinal ulcers which was indicative of recurrence of CD rather than graft rejection. Anti-tumor necrosis factor alpha with adalimumab was prescribed and his diarrhea and graft ulcers improved. Case 2 was a 39-year-old male patient with CD who received extensive intestinal resection due to multiple perforations, followed by IT because of SBS-IF. Endoscopic surveillance revealed normal VENCH score without histologic graft rejection two years thereafter. Both enrolled cases demonstrated favorable outcomes after endoscopic surveillance of intestinal graft with ME-NBI and management accordingly. Conclusion The post IT follow-up of CD patients remains challenging. We highlight the usefulness of the ME-NBI using VENCH score for early detection of graft rejection and its value in monitoring CD patients after IT. Additionally, ulcerations without changes in morphology of surrounding villi should take into consideration the disease recurrence of underlying CD. Further research is needed in endoscopic follow-up and molecular genetics to better understand CD after IT.

Jejenoileal Perforation Secondary to Kick during Soccer Game with Negative Fast: A Case Report

Small bowel perforation is a rare injury following blunt abdominal trauma, and is rarely reported in a sports setting. Computed tomography (CT) appears to be the diagnostic method of choice to assess hemodynamic stable patients. A delay in diagnosis and definitive treatment of bowel injury may result in increased morbidity and mortality. Our case was a 16 years old male with abdominal blunt trauma, we diagnosed perforation of Jejenum and ileum with Laparatomy and negative FAST. The treatment for small intestine lesions with smaller defects is the primary closure while bowel resection is the treatment of choice for larger lesions and Ischemic segments.

Prevalence, Pattern, Mortality, and Morbidity of Traumatic Small Bowel Perforation at King Abdulaziz Medical City: A Retrospective Cohort Study.

Introduction Bowel perforation, whether from trauma or other causes, presents with diverse clinical scenarios. Small bowel perforation (SBP), a potentially fatal condition often linked to blunt trauma like motor vehicle accidents, necessitates prompt detection and intervention, crucial for improved outcomes. This study investigated the prevalence, predictors, presentation, diagnostic findings, morbidity, and mortality of traumatic SBP for comprehensive insights. Methodology This wasa retrospective cohort studyconducted at King Abdulaziz Medical City, Riyadh. A review of 838 cases, which represent all abdominal trauma patientsfrom January 2017 to March 2023, was done. Forty patients who developed SBP and have complete data were included in this study. One case was excluded due to incomplete medical records. Data were collected with the non-probability convenience sampling technique via the BestCare system using a data collection sheet. Data were analyzed with IBM SPSS 29 (IBM Corp., Armonk, NY). Results Out of all abdominal trauma cases (n=838), 40 patients developed SBP (n=40, 4.77%). Males constituted 87.5%, and the most common mechanism was motor vehicle accidents (57.5%). Complications included cardiac arrest, disseminated intravascular coagulation (DIC), and leak (7.5% each). In motor vehicle accidents, SBP primarily affected patients who were in the driver'sposition(78.3%). Clinical signs at presentation revealed abdominal tenderness (52.5%), abdominal distension (22.5%), and abnormal systolic blood pressure (mean 115.3 mmHg). Linear regression showed gender and age positively associated with morbidity (p=0.474, p=0.543)while BMI exhibited a negative relationship (p=0.314). Logistic regression revealed non-significant predictors of mortality, except for mean initial hematocrit (HCT) (p=0.721, aOR=0.098). Conclusion Our study provides crucial findings on the incidence, patterns, mortality, and morbidity of traumatic bowel perforation, contributing to the existing body of research. The identified prevalence of 4.77% and mortality at 17.5% from the studied populationunderline the serious impact of this condition, and the37.5% complication rateobserved demonstrates the potential risks involved. The average hospital stay is found to be 14 days, adding further to the disease burden. These findings underscore the importance of specific preventative measures, particularly related to motor vehicle accidents (MVAs), and highlight potential markers for predicting outcomes, such as age, gender, and mean initial HCT. This substantiates the need for further research involving larger cohorts and prospective designs to gain comprehensive insights and establish more robust preventative and treatment strategies.

Intestinal Tuberculosis with Small Bowel Perforation in a Patient with AIDS: A Case Report

Tuberculosis is an infection that continues to be a global health problem, mainly in underdeveloped countries. Intestinal presentation is rare but increases in immunocompromised patients. Its symptoms are variable and can mimic chronic inflammatory diseases, leading to a difficult initial diagnosis, complications, and increased mortality. We present the case of a young and recently diagnosed HIV patient with chronic and nonspecific condition of diarrhea and abdominal pain, which was complicated by intestinal perforation triggered by an extrapulmonary infection and Mycobacterium tuberculosis. It was resolved by surgery, leading to a pathological diagnosis by biopsy, followed by effective antibiotic treatment.

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.

Small bowel perforation with Ingestion of a fish bone: case report

Small bowel perforation with Ingestion of a fish bone: case report