Spontaneous Small Bowel Perforation Research Articles

Spontaneous small bowel perforation: a rare GI manifestation of type IV Ehlers-Danlos syndrome

Isolated small bowel perforation is low in the differential diagnosis of abdominal pain in the young, relatively healthy patient. It is, however, a rare manifestation of type IV (vascular) Ehlers-Danlos syndrome (EDS). In addition, there is no general consensus on the management of GI manifestations in patients with type IV EDS. We present the case of a 31-year-old male with history of type IV EDS, presenting with acute onset abdominal pain. Imaging was notable for intra-abdominal free air and thickened loops of small bowel in the pelvis. The patient underwent exploratory laparotomy with resection of the small bowel perforation with enteroenteric anastomosis. In our literature review, we evaluated gastrointestinal manifestations observed in patients with type IV EDS, management recommendations and potential complications to be mindful of in this population.

A rare complication of inguinal hernia: Small bowel perforation due to falling down while walking

Small bowel perforation can occur either spontaneously or due to traumatic causes. Non-traumatic spontaneous small bowel perforation can be caused by various reasons including infectious, inflammatory, congenital, metabolic, vascular or neoplastic origins. Small bowel injury due to blunt trauma is a rare phenomenon compared to other intraperitoneal organ injuries, and frequently appears in high-energy trauma. Yet, even low-energy trauma can cause small bowel perforation in the presence of an inguinal hernia. Several cases of small bowel perforation after abdominal trauma or direct trauma to the hernia site are previously reported, however perforation of the small bowels following a low-energy trauma, such as a fall while marching, is a rare condition. A 65-year-old male admitted to the ER following a sudden onset of severe abdominal pain after 4hours following a fall while marching. Physical examination revealed a reduced right indirect inguinal hernia. There was diffuse tenderness and defense in the abdomen. The patient was operated due to the acute abdomen after 6hours following a falling down, and primary repair was performed. The patient was discharged on the fifth postoperative day. With this case report, it is aimed to increase the awareness of the surgeons regarding this rare complication.

Spontaneous Small Bowel Perforation during Preoperative Progressive Pneumoperitoneum for Incisional Hernia Repair: Risk Zero Does Not Exist

Spontaneous Small Bowel Perforation during Preoperative Progressive Pneumoperitoneum for Incisional Hernia Repair: Risk Zero Does Not Exist

Sudden Death Due to Spontaneous Small Bowel Perforation within an Incarcerated Umbilical Hernia

Umbilical hernias are estimated to occur in up to 20% of patients with long-standing cirrhosis and ascites. Complications such as strangulation and infarction of the bowel or rupture of the bowel loops and/or hernia sac are uncommon but potentially life-threatening consequences. Often these events happen in association with abdominal trauma or after procedures such as paracentesis. Spontaneous rupture is more likely in cases where strangulation and subsequent necrosis of the bowel has weakened and thinned the incarcerated intestinal wall. We report a case of a 63-year-old male with a history of alcohol abuse complicated by cirrhosis and ascites who was found dead in his home approximately 30 minutes after last being seen alive. He was found at rest in a seated position without evidence of recent trauma. At autopsy, an ulcerated umbilical hernia was present containing a loop of perforated, necrotic small bowel. There was evidence of peritonitis including one liter of yellow-red fluid accumulation in the peritoneal cavity, multifocal areas of fibrinopurulent debris adherent to the small bowel, and a dull gray discoloration to the peritoneal lining. The case was signed out as death due to peritonitis and spontaneous perforation of small intestine due to strangulated and infarcted small intestinal umbilical hernia and the manner, natural. Although spontaneous perforation of the bowel within a hernia sac is uncommon, it may contribute to sudden death in patients lacking a history of trauma or recent medical procedures and physicians certifying these deaths should be aware of the possibility.

Acute Abdomen Presenting with Spontaneous Small Bowel Perforation Due to a Gastrointestinal Stromal Tumor: A Case Report

Acute Abdomen Presenting with Spontaneous Small Bowel Perforation Due to a Gastrointestinal Stromal Tumor: A Case Report

Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis in Patients with Spontaneous Small-Bowel Perforation

Background/Aims: Spontaneous small-bowel perforation caused by Crohn's disease (CD) or intestinal tuberculosis (ITB) is a rare disease entity. We investigated the clinical features and radiologic findings of patients with CD or ITB who presented with a spontaneous small-bowel perforation. Methods: Between January 2001 and December 2010, sixty-two patients underwent surgery due to a spontaneous small-bowel perforation, including 21 (33.9%) CD patients and 18 (29.0%) ITB patients. Clinical and radiologic features were compared between CD and ITB patients. Results: The mean age was significantly lower in CD patients than in ITB patients (p = 0.014). Diarrhea was more common in CD. By contrast, night sweating and a previous history of tuberculosis were more common in ITB. Only 27.8% of patients with ITB had a positive QuantiFERON-TB Gold test. CT findings such as bowel wall thickening of more than 10 mm, omental thickening, and intra-abdominal lymphadenopathy larger than 10 mm were more common among perforations caused by ITB. Mesenteric fat infiltration was a more frequent finding in CD than in ITB. Conclusions: Clinical symptoms and radiologic findings may aid in the differential diagnosis between CD and ITB in patients presenting with spontaneous small-bowel perforation.

Outcomes of Rurally Treated Small-Bowel Perforations Compared to a Tertiary Centre

Introduction: Small-bowel perforation is a rare event but outcomes can be significantly influenced by treatment delay and mechanism of perforation. The aim of this study was to investigate the causative factors and outcomes of patients with a small- bowel perforation treated at a rural hospital. Distance from treating hospital and stabilisation by a remote hospital were correlated with outcomes. Methods: A retrospective analysis of all patients diagnosed with a small-bowel perforation between September 2004 and September 2009 was performed. Severity of abdominal sepsis and the grade of complications were assessed by established validated scoring systems. Outcomes were compared against those from a large tertiary hospital. Results: Thirty-two patients, with median age 44.5 (8-92) were treated for small-bowel perforation. Six patients were treated conservatively with twenty-six requiring surgical intervention. Eleven (34.3%) had presented to an outlying hospital for treatment prior to transfer. There was no significant difference in outcomes for those living within one hundred kilometres and those who did not. The overall mortality rate was 8.33% (n=2), one was treated conservatively and one surgically. In patients with a spontaneous small-bowel perforation, there was no significant difference in outcomes between those treated at a small rural hospital when compared to those treated at a tertiary centre. Causative mechanisms for spontaneous small-bowel perforations included, foreign body ingestion, adhesions, trauma, and Crohns disease. Conclusion: The outcomes are comparative between patients treated in rural and non-tertiary hospitals when compared to large tertiary referral centres in this two-centre analysis.

Spontaneous Small Bowel Perforations in Patients Receiving Radiotherapy or Chemotherapy for Advanced Head and Neck Cancer

ABSTRACTGastroduodenal perforations are known to occur due to various causes. However, such problems involving small bowel and manifesting spontaneously, especially in a head and neck cancer patient, undergoing chemoradiation has never been described in the literature. We report three cases of head and neck cancer that were undergoing treatment (one case curative and two cases palliative), during which small bowel perforation manifested requiring urgent surgical intervention. We seek to highlight this problem, so as to ascertain the possible mechanisms of its causation, identify a group of patients at risk, evolve possible preventive strategies and facilitate earlier diagnosis and treatment.

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.

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.

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.

Small Bowel Lymphoma Associated With AIDS

Patients with the Acquired Immunodeficiency Syndrome (AIDS) are known to be at increased risk for developing malignancy; however, The spectrum that these malignancies encompass has not been fully defined. An unusual case of a 32 year old homosexual male with AIDS who developed two spontaneous small bowel perforations is presented. The diagnosis of primary histiocytic lymphoma of the small intestine was established only after his second operation.