11/1382. Multiple intestinal ulcerations and perforations secondary to methicillin-resistant staphylococcus aureus enteritis in infants. PURPOSE: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. methods: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. RESULTS: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of gram-positive cocci. (4) methicillin-resistant staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. CONCLUSIONS: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment. ( info) |
12/1382. Duodenal perforations after laparoscopic cholecystectomy. Duodenal perforations after laparoscopic cholecystectomies are rarely reported. The aim of this study is to focus on this complication and to suggest ways to reduce its occurrence and avoid diagnostic mistakes and therapeutical delays that could be fatal. We reviewed four personal cases and a number of others reported in the literature. Duodenal perforations are caused by improper use of the irrigator-aspirator device when retracting the duodenum, or by electrosurgical and laser burns. A duodenal perforation should be suspected in cases of bile leakage, peritonitis, intraabdominal or retroperitoneal collections, high serum or drainage amylase concentration, absence of bile leakage from the biliary tree, and the existence of a retroduodenal mass. Diagnosis requires a gastrografin upper GI series. Differential diagnosis is mainly with biliary lesions and other causes of peritonitis. Relaparoscopy may require intraoperative upper GI endoscopy or Kocher's duodenal mobilization to detect the perforation. early diagnosis allows primary repair, usually by laparoscopy. Perforations of the duodenal cap are easier to diagnose and have a better prognosis than those of the descending duodenum. A lumbar abscess is a frequent complication. ( info) |
13/1382. Colonoscopic perforation: its emergency treatment. One of the accepted complications of colonoscopy is perforation. This is known to occur in greater frequency in patients having undergone previous pelvic or colonic surgery, as well as patients suffering from diverticulosis. A case is presented of colonic perforation during diagnostic examination in an area of adhesions secondary to pelvic surgery. Immediately after the perforation, the patient entered into vascular collapse and respiratory distress, with a distended abdomen. The introduction of a large bore intravenous catheter into the abdominal cavity with the release of the pneumoperitoneum resulted in an instantaneous return of vital signs and the patient subsequently underwent surgery and recovered. It is felt that this method of emergency treatment can be life-saving in a patient perforating during colonoscopy. ( info) |
14/1382. Vasculitic small bowel perforation masquerading as spontaneous bacterial peritonitis in a patient with decompensated liver disease. We report on a young patient with decompensated alcohol-induced liver disease (child-Pugh score C) who presented with clinical, biochemical and radiological evidence suggestive of spontaneous bacterial peritonitis. She was however subsequently found to have multiple small bowel perforations, which were diagnosed only at laparotomy. The histology of the bowel showed evidence of vasculitis. This case illustrates two important points. Firstly, even if a patient has all the prerequisites to develop spontaneous bacterial peritonitis, a secondary cause of peritonitis (eg. bowel perforation or intra-abdominal abscess) must always be considered as a differential diagnosis and a repeat ascitic tap is mandatory after 48 h of antibiotic therapy to confirm a decrease in the white cell count. Secondly, it shows the rare co-existence of alcoholic liver disease and vasculitis. ( info) |
15/1382. Malignant hemangioendothelioma of the small intestine: report of a case. A case of malignant hemangioendothelioma (MH) of the small intestine in a 27-year-old woman is reported herein. The patient developed acute abdominal symptoms during investigations for anemia, weight loss, anorexia, and recurrent gastrointestinal bleeding. An emergency laparotomy revealed perforation of a jejunal tumor. The results of a histopathological study of the resected small bowel segment were interpreted as MH with lymph node involvement. Following this case report, a review of the relevant literature on small intestinal MH is presented. ( info) |
16/1382. Granulocytic sarcoma (chloroma) of the small intestine. Granulocytic sarcoma or Chloroma may develop before, at the time or after presentation of acute myeloid leukemia. We report the case of a 66-year old man presenting with intermittent abdominal pain during one month before developing a peritonitis due to perforation of small bowel followed by irreversible shock and death. Nearly the entire length of small bowel and bone marrow were infiltrated by giant promyelocytic cells. Abnormal circulating cells were never discovered. The literature is briefly reviewed. ( info) |
17/1382. Experience with duodenal necrosis. A rare complication of acute necrotizing pancreatitis. Duodenal necrosis is a rare, but very serious complication of acute necrotizing pancreatitis that most likely is the result of vascular compromise and ischemia of the peri-Vaterian aspect of the duodenal wall. In this article, we present three patients with duodenal necrosis complicating acute necrotizing pancreatitis. The diagnosis was made at the time of necrosectomy. Management options of this challenging complication of necrotizing pancreatitis are discussed. ( info) |
| Two patients are presented who were admitted with acute abdominal pain for which they underwent laparotomy. No clear-cut diagnosis could be established during operation. Eventually, eosinophilic gastroenteritis was diagnosed and treated with corticosteroids. The heterogeneous presentation of eosinophilic gastroenteritis is discussed, ranging from mild non-specific gastrointestinal symptoms to an acute abdominal emergency prompting surgical intervention. The pathogenesis and treatment of eosinophilic gastroenteritis are discussed. ( info) |
19/1382. A lethal ectopic denture: an unusual case of sigmoid perforation due to unnoticed swallowed dental plate. We describe a case of generalised peritonitis due to sigmoid perforation caused by an unnoticed swallowed dental plate during sleep three months previously. ( info) |
20/1382. Posttraumatic intestinal stenosis presenting as a perforation: report of a case. A 78-year-old woman was admitted to the hospital after falling into a ditch approximately 1 m deep and sustaining a blunt abdominal trauma with a left femur fracture. On the tenth day after admission, symptoms of a small bowel obstruction occurred. A nasogastric tube was inserted, and the symptoms thus improved. She sometimes complained of abdominal pain during the 12 months after the fall, but recovered with conservative management. The next year, she was readmitted to the hospital for a pin extraction of the left femur bone. During this admission, 15 months since her admission after her fall, she again complained of abdominal pain. abdominal pain increased with a muscular defense, and abdominal x-rays revealed free air. She was referred to our hospital with a diagnosis of perforative peritonitis, and emergency surgery was performed. Upon laparotomy, circumferential stenoses of the small bowel were recognized in the proximal segments about 40cm, 80cm, and 100cm from the ileocecal region. In addition, a perforation and prominent dilatation of the bowel segment was observed just proximal to the stenosis about 100cm from the ileocecal region. She underwent a small intestinal resection at two sites. There were no findings of an intestinal specific ulcer, such as Crohn's disease, intestinal tuberculosis, or malignancy, based on the results of a histopathological examination. ( info) |