1/59. 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.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/59. Multiple spontaneous small bowel perforations due to systemic cholesterol atheromatous embolism.A-65-year-old man was admitted for coronary and peripheral angiography to evaluate angina pectoris and peripheral vascular disease. Following angiography, he suffered from blue toes, livedo reticularis and progressive renal failure. The patient's condition continued to deteriorate, including the development of malnutrition. Four months later he suddenly developed panperitonitis, went into shock and died. The autopsy verified multiple perforations of the small bowel with disseminated cholesterol atheromatous embolism. The other organs including kidney were also invaded by atheroembolism. This was a rare case of multiple spontaneous perforations of small bowel due to systemic cholesterol atheromatous embolism.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/59. Malakoplakia of the caecum in a kidney-transplant recipient: presentation as acute tumoral perforation and fatal outcome.Malakoplakia is a rare pseudotumoral inflammatory disease known to affect immunocompromised subjects, mainly with a history of recurrent escherichia coli infection. The urinary tract is the most frequent site of the disease, although all organs can be involved. In the present article, we report a case of malakoplakia of the caecum, that developed in a 52-year-old man, who had received a kidney transplant 9 years before and had a history of recurrent E. coli urinary tract infections. Malakoplakia presented as acute intestinal perforation, and, despite aggressive surgical and medical management, disease progressed toward a fatal outcome due to sepsis and multiple organ failure 9 months later. A defect in the macrophagic activity was demonstrated.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
4/59. Perforation of jejunal lymphoma--ultrasonographic diagnosis of free air over left flank area.Acute abdomen due to perforation of one of the hollow organs is one of the major challenges for clinicians. Traditionally, pneumoperitoneum shown on x-ray film taken of the decubitus view or in the standing position, is the major key to making a diagnosis of perforation. However, free air is not shown on x-ray film in about one third of cases and sometimes, a standing X-ray cannot be taken in weak patients or for various reasons. In such conditions, abdominal ultrasonography (US) plays a complementary role. Free air is usually detected between the anterior surface of the liver and the anterior abdominal wall by US. However, if free air is not detected on an erect X-ray or not demonstrated over the anterior surface of the liver by US, the diagnosis of perforation of the hollow organ will be difficult. We treated a patient with perforation of a small intestinal lymphoma, which presented as free air over the left flank area by US rather than the anterior surface of liver as is usually the case. Moreover, we located the perforated site pre-operatively by US, which detected focal thickening of a segment of small intestine with intramural slits. lymphoma of the jejunum with perforation was finally diagnosed after surgery. The value of US is justified in such a condition.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
5/59. amyloidosis--an unusual case of recurrent intestinal bleeding and sigmoid perforation: case report with review of the literature.We describe a patient with recurrent intestinal bleeding and sigmoid perforation due to amyloidosis. Hartmann's procedure was carried out with resection of the diseased sigmoid colon and by performing a terminal colostomy. The postoperative course was uneventful, but the patient died 3 months later of lobar pneumonia and multiple organ system failure.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/59. schistosoma japonicum infection presenting with colon perforation: case report.colon perforation can be caused by a variety of entities, including iatrogenic trauma, tumors, ischemia, inflammatory bowel disease, and steroid use. Parasitic infection rarely leads to colon perforation. Secondary peritonitis results from mixed microorganism infection, including enterococci, enteric bacilli, and anaerobes. A combination of an optimal antibiotic regimen and surgical intervention is of paramount importance. Nevertheless, intra-abdominal infections usually have a high mortality rate. schistosomiasis occurs worldwide. S. japonicum infection is endemic in asia. The most common complications of gastrointestinal schistosomiasis are periportal fibrosis, intestinal polyposis, and bowel stricture. Rarely, schistosomiasis results in colon perforation. The diagnosis of schistosome infections is based on ova in stool or tissue specimens, and/or immunologic diagnostic tests. The most effective anti-schistosomiasis agent is praziquantel. Herein, we describe an unusual case of colon perforation associated with schistosoma japonicum infection, which resulted in severe peritonitis and led to the patient's death.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/59. hyperemia of the intraperitoneal organs associated with scald burn.A 65-year-old man with a history of cerebral infarction sustained scald burns over 54% of the body surface. In spite of adequate fluid therapy, respiratory management with an artificial ventilator, and continuous hemodiafiltration, the patient died on day 5 post-admission. autopsy revealed necrotic change on the surface of the liver, and necrosis and perforation of the ileum. Histologic examination showed necrosis of the hepatocytes lining the surface and necrosis of the hepatocytes and congestion in the central area of the liver. We speculated that systemic responses to the extensive burn resulted in hyperemia of the intraperitoneal organs, thereby inducing acute liver failure and the subsequent development of multiple organ failure.- - - - - - - - - - ranking = 6keywords = organ (Clic here for more details about this article) |
8/59. Atraumatic splenic rupture simulating ruptured sigmoid diverticulitis: report of a case and review of the literature.A case of atraumatic rupture of the spleen originally presenting as ruptured sigmoid diverticulitis is described. The underlying disease was found to be myelofibrosis. Although progressive splenomegaly is always associated with this disease, spontaneous rupture of this organ is not reported in the literature. We also reviewed the literature in regard to unusual presentation of splenic rupture and we could not find any case simulating acute sigmoid diverticulitis. It is suggested that awareness and familiarity with this disease may enable the surgeon to suspect this diagnosis when dealing with an unusual acute abdominal emergency.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/59. abdominal pain in a child after blunt abdominal trauma: an unusual injury.We report a case of perforation of a walled off appendiceal abscess in a 5-year-old boy who sustained blunt abdominal trauma. The past medical history was significant only for a 4-day episode of abdominal pain 1 month prior to this presentation. Initial laboratory studies were unremarkable, and radiographic studies showed free fluid in the pelvis with no evidence of solid organ injury, but inflammation of the right colon. The final diagnosis was made at laparotomy. We emphasize this unique presentation and review the literature on traumatic appendicitis in children.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/59. Hydroblast intra-abdominal organ trauma.Hydroblast injuries of the extremities are not uncommon. Hydroblast injuries involving intra-abdominal organs are more unusual. Usually there are subtle findings on the abdominal wall with severe intra-abdominal trauma and undue delay in appropriate treatment may occur, resulting in increased morbidity. In addition to a review of the literature, this article presents a case of intestinal perforation due to hydroblast trauma.- - - - - - - - - - ranking = 5keywords = organ (Clic here for more details about this article) |
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