1/44. pneumoperitoneum caused by a perforated peptic ulcer in a peritoneal dialysis patient: difficulty in diagnosis.peritonitis due to viscus perforation in peritoneal dialysis (PD) patients can be catastrophic. We describe the first reported case of perforated peptic ulcer (PPU) in a PD patient. This 78-year-old man presented with a 1-day history of mild abdominal pain. He had been receiving nocturnal intermittent PD for 2 years and had ischemic heart disease and cirrhosis of the liver. pneumoperitoneum and peritonitis were documented, but the symptoms were mild. The "board-like abdomen" sign was not noted. air inflation and contrast radiography indicated a perforation in the upper gastrointestinal tract, and laparotomy disclosed a perforation in the prepyloric great curvature. Unfortunately, the patient died during surgery. This case illustrates that the "board-like abdomen" sign may be absent in PD patients with PPU because of dilution of gastric acid by the dialysate. Free air in the abdomen, although suggestive of PPU, is also not uncommon in PD patients without viscus perforation. Because PD has to be discontinued after laparotomy and exploratory laparotomy may be fatal in high-risk patients, other diagnostic methods should be used to confirm viscus perforation before surgery. PPU, which can be proved by air inflation and contrast radiography, should be suspected in PD patients with pneumoperitoneum and peritonitis.- - - - - - - - - - ranking = 1keywords = abdominal pain, upper (Clic here for more details about this article) |
2/44. Sonographic diagnosis of a small fistulous communication between a subphrenic abscess and a perforated duodenal ulcer.We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess.- - - - - - - - - - ranking = 0.030012640955984keywords = upper (Clic here for more details about this article) |
3/44. Perforated peptic ulcer in an infant.We describe a case of perforated peptic ulcer (PPU) in a 9-month-old boy. Abdominal distension was the first clinical sign of PPU. Before he developed abdominal distension, the patient had suffered from an upper respiratory tract infection with fever for about 2 weeks, which was treated intermittently with ibuprofen. A plain abdominal radiograph revealed pneumoperitoneum with a football sign. At laparotomy, a 0.8-cm perforated hole was found over the prepyloric area. Simple closure with omental patching was performed after debridement of the perforation. Pathologic examination showed chronic peptic ulcer with helicobacter pylori infection. The postoperative course and outcome were satisfactory. The stress of underlying disease, use of ibuprofen, blood type (A), and H. pylori infection might have contributed to the development of PPU in this patient. PPU in infancy is rare and has a high mortality rate; early recognition and prompt surgical intervention are key to successful management.- - - - - - - - - - ranking = 0.030012640955984keywords = upper (Clic here for more details about this article) |
4/44. death from hypovolemic shock caused by perforation of duodenal ulcer in a patient with angiosarcoma of the scalp.We report a case of an 86-year-old woman with angiosarcoma on the scalp, who died from hypovolemic shock caused by perforation of a duodenal ulcer. A purple-red macule was first noticed on her left temporal scalp, and over a 1-month period this macule rapidly grew to a 6 cm purple-red indurated plaque with hematomas. The diagnosis of angiosarcoma was made based on the clinical features and histopathological finding of the lesional skin. Perilesional injections of recombinant interleukin 2 (rIL-2) were followed by surgical resection of the lesion and graft repair. However, 5 months later, new hematomas appeared and increased in number and size to cover her cheek, left temporal scalp and around the grafted area. Electron-beam radiotherapy showed only a temporary effect and the skin lesions with spontaneous severe bleeding extended rapidly again toward a wide region of the left half of the scalp and cheek. The patient died of hypovolemic shock after acute abdominal pain with intestinal hemorrhage. The surgical pathology revealed the presence of a perforated duodenal ulcer which might have been the direct cause of hypovolemic shock.- - - - - - - - - - ranking = 0.96998735904402keywords = abdominal pain (Clic here for more details about this article) |
5/44. diagnosis of perforated gastric ulcers by ultrasound.patients with a perforation of the gastrointestinal tract need fast confirmation of diagnosis and early treatment to improve outcome. Plain abdominal x-ray does not always prove the perforation particularly at early stage. We report about a 62 year-old woman complaining of consistent abdominal pain with sudden onset. Ultrasound was taken as first diagnostic measure, revealing a perforation. The leakage was located in the stomach. radiography confirmed the pneumoperitoneum without indicating the perforated location. During operation the perforated gastric ulcer was found and sutured. This case report points out the reliability of ultrasound in diagnosing a pneumoperitoneum. Additionally it provides a summary of ultrasound signs seen in perforated gastric and duodenal ulcers and a review of literature.- - - - - - - - - - ranking = 0.96998735904402keywords = abdominal pain (Clic here for more details about this article) |
6/44. Laparoscopic repair of iatrogenic endoscopic perforated peptic ulcer.Iatrogenic perforation is an uncommon but inevitable complication of endoscopy. laparotomy has been the standard treatment for pyloroduodenal perforations caused by endoscopy. Laparoscopic repair is a well-documented treatment modality for spontaneously perforated peptic ulcer. We report our successful laparoscopic suture repair of perforations sustained during upper gastrointestinal endoscopy in two high-risk elderly patients.- - - - - - - - - - ranking = 0.030012640955984keywords = upper (Clic here for more details about this article) |
7/44. peritonitis causing acute limb ischaemia.A patient presented with an acutely ischaemic leg and mild abdominal pain. Arteriography showed an iliac occlusion and some distal occlusive disease. At laparotomy a perforated gastric ulcer was found, and by the end of this operation the foot was well perfused. This case exemplifies the serious reduction in limb blood supply which can be caused by an acute illness, without thrombosis of vessels. It emphasises the importance of general assessment and treatment of any associated acute condition, in cases of acute limb ischaemia.- - - - - - - - - - ranking = 0.96998735904402keywords = abdominal pain (Clic here for more details about this article) |
8/44. Perforation of an abdominal viscus associated with a pneumothorax.pneumothorax is a very unusual presenting complication of a perforated abdominal viscus. We present two such cases. The importance of close scrutiny of chest radiographs taken for abdominal disease is stressed.- - - - - - - - - - ranking = 0.015509468374983keywords = chest (Clic here for more details about this article) |
9/44. Laparoscopic suture repair of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension: first case report.BACKGROUND: Open digestive surgery in cirrhotic patients is associated with high morbidity and mortality. laparoscopy in this setting has the potential to reduce postoperative complications. Laparoscopic treatment of a perforated gastric ulcer in a severely cirrhotic patient with portal hypertension is herein described. methods: A 75-year-old woman affected by cirrhosis of the liver (child class C) and chronic gastric ulcer presented with acute abdominal pain. The diagnosis of perforation was made with plain films of the abdomen and computed tomography. Diagnostic laparoscopy showed intense peritonitis due to a perforated ulcer of the anterior gastric wall, 2 cm proximal to the pylorus. Suture closure and placement of an omental patch were performed laparoscopically. RESULTS: Postoperative recovery was complicated by a minor leak of the gastric suture, managed by total parenteral nutrition. Closure of the gastric wound was demonstrated by Gastrografin studies on the 10th postoperative day. The patient was discharged on the 16th postoperative day. At 3-months follow-up, the patient is alive and free of gastric disease.- - - - - - - - - - ranking = 0.96998735904402keywords = abdominal pain (Clic here for more details about this article) |
10/44. Gastric ulcer perforation in heart-lung transplant patient: a successful case of early surgical intervention and management.Gastrointestinal complications may follow organ transplantation. A patient who underwent heart lung transplantation due to patent ductus arteriosus and Eisenmenger's syndrome had an episode of acute cardiac rejection and was treated with a bolus injection of methylprednisolone followed by a high oral dose of prednisone. On the 22nd postoperative day, the patient complained of acute abdominal pain with muscular rigidity and a plain chest x-ray showed free air in the right subdiaphragmatic area. Under the suspicion of bowel perforation, an emergency laparotomy was performed and the perforated stomach had a wedge-shaped resection that included the perforation. Following the laparotomy, the postoperative course was uneventful and the patient was discharged on post-laparotomy day 10.- - - - - - - - - - ranking = 0.985496827419keywords = abdominal pain, chest (Clic here for more details about this article) |
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