Spontaneous Bowel Perforation Research Articles

Spontaneous bowel perforation due to norovirus: a case report

Norovirus is the leading cause of epidemic gastroenteritis worldwide but the disease is usually self-limiting and generally only causes serious health problems in the young, elderly and immunocompromised. The authors report a case of bowel perforation in an elderly Caucasian lady with confirmed infection with Norovirus genogroup II and no other presumptive cause. To the authors' knowledge this is the first such case of bowel perforation due to Norovirus. Viral gastroenteritis should be considered in the list of differentials when no obvious cause of bowel perforation can be identified to minimise morbidity and mortality.

Spontaneous rectovaginal fistula during bevacizumab therapy for ovarian cancer: a case report

Recent studies have demonstrated efficacy of bevacizumab for recurrent ovarian cancer, but few data on its use and gastrointestinal potential complications when administered as adjuvant chemotherapy after cytoreductive surgery are available. In this study, we report the first case of a rectovaginal fistula in this indication.

Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report

Ventriculoperitoneal shunt placement is an effective treatment of hydrocephalus diverting the cerebrospinal fluid into the peritoneal cavity. Unfortunately, the shunt devices have a high incidence of malfunction mainly due to catheter obstruction or infection and are associated with various complications, 25% of which are abdominal. Spontaneous bowel perforation is a rare potentially fatal complication of ventriculoperitoneal shunt occurring anytime, few weeks to several years, after the placement of the ventriculoperitoneal shunt device. A 54-year-old Greek man with spontaneous perforation of sigmoid colon as a complication of distal ventriculoperitoneal shunt migration was treated successfully by antibiotic prophylaxis and abdominal surgery. Clinicians managing patients with ventriculoperitoneal shunt must be familiar with its possible complications and be aware for early recognition of them.

Spontaneous perforation of the terminal ileum in an AIDS patient on highly active antiretroviral therapy with disseminated non-tuberculous mycobacterial infection

Despite the impact of highly active antiretroviral therapy (HAART), mycobacterial infections in patients with AIDS remain a frequent complication. In disseminated cases, both tuberculous and non-tuberculous mycobacterial infections may involve the gastrointestinal system and cause abdominal pain and diarrhea. While there have been cases of small bowel perforation in AIDS patients with Mycobacterium tuberculosis (MTB) infection, no case of bowel perforation in non-tuberculous mycobacterial (NTM) infection has been reported to date. We report a case of spontaneous perforation of the terminal ileum in an AIDS patient with disseminated non-tuberculous mycobacterial infection who was responding to HAART. Non-tuberculous mycobacteria can lead to spontaneous bowel perforation in patients with AIDS who are responding to HAART.

Successful ERCP and sphincterotomy in a patient with Ehlers-Danlos syndrome and a history of spontaneous bowel perforation

Successful ERCP and sphincterotomy in a patient with Ehlers-Danlos syndrome and a history of spontaneous bowel perforation

Repeated Bowel Perforations with Ibuprofen Lysine: A Case Report

Non-steroidal anti-inflammatory drugs (NSAID) have been used to close the patent ductus arteriosus in neonates for over two decades. Ibuprofen lysine, a parenteral NSAID, is labeled for the treatment of patent ductus arteriosus in neonates who do not respond to conventional medical management. While sharing many of the same adverse effects as indomethacin, spontaneous bowel perforation has not been reported. We describe a premature infant that experienced isolated bowel perforations after treatment with ibuprofen lysine for symptomatic patent ductus arteriosus.

A different type of spontaneous bowel perforation caused by ventriculoperitoneal shunt catheter: a case report

A different type of spontaneous bowel perforation caused by ventriculoperitoneal shunt catheter: a case report

A case of bowel perforation after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

Background. Bowel perforation is a rare complication of chemotherapeutic treatment of cancer, and may result from tumor necrosis within involved bowel or as a function of the mechanism of the chemotherapeutic agent itself. Case. We present a case of a 71-year-old woman who experienced a spontaneous bowel perforation after a single cycle of carboplatin and paclitaxel during neoadjuvant treatment of advanced epithelial ovarian cancer. This is, to our knowledge, the first reported case of a gastrointestinal perforation with neoadjuvant chemotherapy for ovarian cancer. The clinical circumstances were highly suggestive of a tumor lysis mechanism for the perforation. Conclusion. Bowel perforation can occur as a direct consequence of cytotoxic neoadjuvant chemotherapy for advanced ovarian cancer. This potential serious complication may be worthy of consideration when deciding between neoadjuvant chemotherapy and primary surgical management.

Pathology of the large intestine in patients with vascular type Ehlers-Danlos syndrome

The vascular type of Ehlers-Danlos syndrome (type IV) is an infrequent disease caused by heterozygous germline mutations in the procollagen 3A gene (COL3A1). Clinical signs include characteristic facial features, easy bruising, and a translucent skin. These signs are less obvious than the hyperflexibility of skin and joints seen in other types of Ehlers-Danlos syndrome. Therefore, diagnosis of Ehlers-Danlos syndrome type IV is usually not considered until complications have occurred. Complications include spontaneous ruptures of vessels and hollow organs, particularly the colon. We, herein, report pathologic findings in colon specimens from related Ehlers-Danlos syndrome type IV patients. Thorough examination revealed abnormalities of the large bowel architecture including abrupt changes in the caliber of the lamina muscularis, secondary diverticula formation, and strongly reduced expression of abnormal collagen 3. These findings are not seen in other diseases of the colon and should prompt the pathologist to include Ehlers-Danlos syndrome type IV in the differential diagnosis of spontaneous bowel perforation in younger patients.

Small bowel infarcts in Degos disease

Degos disease is a rare idiopathic vasculopathy with multisystem involvement. We present a previously healthy 40-year-old woman who developed spontaneous small bowel infarctions and perforations 17 months after presentation with characteristic skin lesions. The abdominal CT findings of Degos disease, which have not been previously depicted in the radiology literature, are discussed.

Pathologie und Pathogenese des Enteropathie-assoziierten T-Zell-Lymphoms

Enteropathy type T-cell lymphomas (ETL) are the most frequent T-cell lymphomas arising in the gastrointestinal tract. Commonly, the neoplasm is clinically associated with symptoms of malabsorption, and it frequently manifests as a spontaneous bowel perforation. Among ETL, two types can be distinguished by morphology, immunophenotype and, possibly, by pathogenesis. A total of 80% of ETL are characterized by a close association with celiac disease, pleomorphic cytomorphology and the rare expression of CD8 and CD56. In contrast, 20% of ETL show a monomorphic small to medium size cytomorphology and frequent expression of CD8 and CD56, an association with celiac disease is rare in the latter cases. Genetically, ETL is characterized by frequent and recurrent chromosomal gains of 9q33-q34.

Primary Repair of Esophageal Atresia in Extremely Low Birth Weight Infants: A Single-Center Experience and Review of the Literature

Background: Advances in neonatal intensive care have led to an increased survival of very low birth weight (VLBW, <1,500 g) and extremely low birth weight infants (ELBW, <1,000 g). Several abnormalities may occur in these children, e.g. esophageal atresia (EA), imperforate anus or abdominal wall defects. Correction of EA is often performed as a staged procedure in this group of patients. Objectives: To evaluate the feasibility of a primary correction of EA in 4 ELBW and VLBW infants. Methods: Between 2002 and 2004, 4 infants below 1,200 g were operated on in our institution with a diagnosis of EA with lower tracheoesophageal fistula. Birth weight ranged from 780 to 1,120 g (median: 920 g), gestational age from 28 to 30 weeks. Treatment included closure of the tracheoesophageal fistula and primary anastomosis of the esophagus in a one-step procedure. Results: Primary correction of EA and fistula repair was feasible in all children. Initially, all children had a normal passage of the esophagus as observed in barium swallowing. One child suffering from a leakage of the anastomosis was managed conservatively. Another infant suffered from spontaneous small bowel perforation 6 days after surgery, which was treated by laparotomy. One child developed stenosis of the esophagus and required a single dilatation 14 months after initial treatment. In the 4th child, a type II cleft syndrome was subsequently diagnosed, requiring secondary cleft repair together with semifundoplication. This child eventually died from cytomegalovirus pneumonia. Conclusions: Primary repair of EA and closure of a tracheoesophageal fistula is technically feasible and offers a good treatment option for ELBW and VLBW infants. Staged repair can be avoided. Infants with cleft syndrome are still a diagnostic and therapeutic challenge.

Anaesthetic Implications of Vascular Type Ehlers-Danlos Syndrome

Vascular type Ehlers-Danlos syndrome is an inherited connective tissue disease, which is typified by tissue fragility, joint hypermobility, a tendency to bleed excessively and rupture of the uterus, the bowel and arteries. Two case reports are presented which describe the anaesthetic management of patients with spontaneous bowel perforations due to vascular type Ehlers-Danlos syndrome. Both cases were associated with relatively minor problems. The implications of this condition for anaesthesia include difficulty (and risk of complications) with vascular access, a risk of spontaneous arterial rupture in the perioperative period, possible cervical spine instability and airway trauma on intubation. There is also a risk of excessive bleeding, potentially difficult neuraxial anaesthesia and an increased risk of epidural haematoma. There also may be associated cardiac or pulmonary disease. However, these two cases and the limited previously published literature suggest that such potential complications are actually rare and that anaesthesia may be conducted in a relatively standard manner in most circumstances.

An Extremely Low-Birthweight Infant Who Has Scrotal Discoloration

### Prenatal History: ### Birth History: ### Hospital Course: The infant had respiratory distress syndrome that required mechanical ventilation and three doses of exogenous surfactant; he was extubated to nasal continuous positive airway pressure on the eighth postnatal day. Additionally, he received three doses of prophylactic indomethacin during the first 72 hours after birth. His ductus arteriosus was closed upon completion of indomethacin treatment. He was treated with cefotaxime and ampicillin for the first eight postnatal days for culture-negative presumed sepsis. Within the first 24 hours of birth, he received dopamine, an insulin infusion to treat hyperkalemia, and nitric oxide for 36 hours due to refractory hypoxemia. His nutritional requirements were delivered with total parenteral nutrition; enteral feedings had not been started. He did not receive postnatal steroids. Nine days after birth, he developed inguinal and scrotal discoloration (Fig. 1). These findings were associated with hypotension (mean arterial pressure, 20 mm Hg), decreased urine output (0.13 mL/kg per hour), hypothermia (core body temperature of 96.4°F [35.8°C]), and five episodes of …

Perforated small bowel in omphalocele at birth

The rupture of an omphalocele sac during birth is a well recognized entity. The associated lesions due to vascular compromise can result in necrosis of the bowel with perforation. Spontaneous bowel perforation in an omphalocele at birth is not reported in the literature. We describe a case with bowel perforation at the fundus of an omphalocele in a newborn.

Spontaneous Small Bowel Perforations Due to Intestinal Tuberculosis Should Not Be Repaired by Simple Closure

Intestinal tuberculosis is a major problem in many regions of the world. The incidence of it is rising in Western countries due to immigration from Third World countries and human immunodeficiency virus infection. The difference between the simple closure and resection and anastomosis was evaluated in this study. Retrospectively, 12 patients with intestinal tuberculosis diagnosed histopathologically among 50 patients with free intestinal perforations operated on between 1995 and 2003 at Turgut Ozal Medical Center were evaluated. Each patient underwent routine laboratory tests and radiologic studies. The most common symptoms of patients were abdominal pain, night sweats, and weight loss. Sites of perforation were ileum in 10 patients (multiple perforation in 4) and jejunum in 2 patients (both had multiple perforations). The perforation was closed by primary closure in 7 patients. Resection-anastomosis was performed in 5 patients. Leaks occurred in overall 3 of 7 patients with primary closure. Three of the 7 patients with leaks due to septicemia died. The mortality rate among all patients was 25%. Intestinal tuberculosis should be kept in mind as a cause in free intestinal perforations. Because of high mortality rate, the resection of the affected area and anastomosis may be the treatment of choice rather than primary closure.

A case report of a low-birth-weight infant with a subcapsular liver hematoma and spontaneous bowel perforation

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Cytoreductive surgery plus intraperitoneal hyperthermic perfusion is an effective treatment for metastasized malignant mixed mesodermal tumours (MMMT)—report of six cases

Background. Malignant mixed mesodermal tumours (MMMT) of the female genital tract are rare and heterogeneous malignancies that impart grim prognosis. These tumours are characterized by an admixture of malignant epithelial and stromal elements comprising carcinomatous and sarcomatous neoplastic cells. Thus far, almost 350 cases of MMMT have been recorded in the international medical literature. Due to its rarity, there is no agreement on the best treatment strategy in women with metastasized MMMT.Methods. Six women (mean age 59 years) with metastasized MMMT defined to the peritoneal cavity have been treated by cytoreductive surgery plus hyperthermic peritoneal perfusion plus postoperative adjuvant chemotherapy. All patients have been pre-treated by surgery for primary tumour and one by systemic chemotherapy. As cytostatics for hyperthermic peritoneal perfusion, we have used Mitomycin in a dosage of 18 mg/m2 plus Melphalan in a dosage of 25 mg/m2. As adjuvant treatment CDDP 40 mg/m2/dl, Mitomycin 7 mg/md2/dl and Ifosfamid 100 mg/kg 24 h/dl was applicated via intraaortic catheter three times with a treatment free interval of 3 weeks.Results. A complete cytoreduction without remnant tumour formations in the peritoneal cavity could be carried out in all six patients. The postoperative course was uneventful in all cases except for one where a spontaneous small bowel perforation and prolonged gall secretion had to be treated by re-operation. One patient died 4 months later by pneumonia without evidence of disease. Four patients are without evidence of disease after 2, 4, 14 and 19 months, whereas one patient developed liver metastases after 9 months still treated by systemic chemotherapy.Conclusion. Complete cytoreduction plus hyperthermic peritoneal perfusion plus adjuvant chemotherapy seems to be an effective treatment for recurrent or metastasized MMMT. Further studies have to define the value of this new treatment strategy for this rare tumour entity.

Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases

BACKGROUND Ventriculoperitoneal shunt surgery is the most widely used procedure in the treatment of hydrocephalus. However, this invasive procedure has been associated with several delayed abdominal complications. Perforation of the bowel is a very rare complication occurring in less than 0.1% of cases. Although infrequent, this delayed complication can be fatal if it goes unrecognized. CASE DESCRIPTION This report presents an adult patient who had undergone ventriculoperitoneal shunt surgery and later presented with rectal protrusion of the shunt tube after asymptomatic perforation of the bowel wall. The shunt was removed without complication and the patient remained asymptomatic. CONCLUSIONS Forty-five similar cases have been reported in the literature. The information provided within this report examines the case at hand, as well as provides an analysis of the literature as it relates to bowel perforation through symptomatic presentation, diagnosis, cultures, management with or without laparotomy, and outcome.

Spontaneous bowel perforation in infants and young children: a clinicopathologic analysis of pathogenesis.

In children beyond the neonatal stage, spontaneous bowel perforation with no specific cause is rare. It has attracted little notice and does not fit into any established clinical category. This often results in treatment delays. To determine the underlying pathogenesis, a clinicopathologic analysis of this group of patients was performed. From 1984 through 1997, 15 previously healthy children (10 boys and 5 girls) with bowel perforations were enrolled in this study. Children in whom the specific cause was established were excluded. The ages of the patients ranged from 3 months to 5 years, 5 months (average age: 2 years, 4 months). Data on clinical course, surgical and pathologic findings, and outcomes were analyzed. All the patients had high fever and acute, watery diarrhea with clinical dehydration. Abdominal distension developed and bowel perforation ensued 5 to 30 days after the onset of diarrhea. In all cases, the perforation consisted of either an isolated patch of bowel (n = 8) or patchy lesions in a segment (n = 7), which was confined to one of the following three anatomic watershed areas: the splenic flexure (n = 7); the lower sigmoid (n = 3); and the ileocecal region (n = 5). One patient died, and three had major sequelae including intra-abdominal abscess, adhesion ileus, and peristomal fistula. Specimens from 13 patients were submitted for histopathologic evaluation. All specimens had acute suppurative inflammation diffusely around the perforation site. Seven had areas of coagulation necrosis of the muscularis propria, especially in the inner circular muscle layer. In acute diarrheal diseases, dehydration may cause bowel ischemia and lead to perforation. Physicians should be alert to the possibility of this abdominal catastrophe when progressive abdominal distension followed by acute diarrheal episodes occurs in children.