1/1382. Tension pneumoperitoneum: a report of 4 cases. Four cases of tension pneumoperitoneum are described. In 3 patients this condition followed a perforation of a grossly distended caecum. In 2 of these patients there was an associated malignant neoplasm of the pelvic colon with obstruction. The third patient had a pseudo-obstruction of the transverse colon. The fourth patient had a tension penumoperitoneum with associated surgical emphysema in the neck and subcutaneous tissues of the abdomen and chest walls, following perforation of a duodenal ulcer. The aetiology, presentation and management, together with the mechanism of tension pneumoperitoneum, are discussed. ( info) |
2/1382. paraplegia, a severe complication to epidural analgesia. We report four cases where continuous epidural analgesia resulted in epidural abscesses (EA) causing spinal cord damage and paraplegia. The first symptom of EA was intense back pain, which developed 0-20 days after removal of the epidural catheter. The diagnosis of EA was not made prior to the development of severe neurologic disturbances in any of the patients. In all cases there was a time lag of 2-4 days between the first symptoms and institution of the appropriate treatment. ( info) |
3/1382. Two complications of diagnostic colonoscopy. Two complications of diagnostic colonoscopy are reported. One patient had a perforation which was recognized immediately, and the other had a serosal tear discovered fortuitously at elective surgery. Previous reports of colonoscopic complications are reviewed, and factors predisposing to such complications are discussed. ( info) |
4/1382. Duodenal perforation following blunt abdominal trauma: case report. A case of severe duodenal injury in a 20-year-old female due to blunt abdominal trauma secondary to road traffic accident is presented. The difficulty and hence delay in making a diagnosis of duodenal injury is discussed. ( info) |
5/1382. Multiple tubercular ulcer perforation of ileum in an AIDS patient: case report. intestinal perforation is an extremely uncommon complication of mycobacterium tuberculosis (MTB) infection. We report a case of hiv infection in a male injecting drug user (IDU) with intestinal tuberculosis complicated with multiple ileal perforations at the Regional Institute of Medical Sciences Hospital, Imphal, Manipur. The emergency surgical therapy supported by antitubercular drugs (ATT) and parenteral nutrition saved the life of this patient who presented in a critical state of shock. The patient manifested with extrapulmonary tuberculosis, which is one of the criteria of AIDS. The authors stress the possibility that in future, tubercular complication till now considered atypical, may become more frequent. ( info) |
6/1382. Spontaneous gastrointestinal perforation in patients with lymphoma receiving chemotherapy and steroids. Report of three cases. Spontaneous gastrointestinal perforations in three patients with lymphoma were considered to be treatment-related conditions. All three were diagnosed as having malignant lymphoma by histological examination, and treated with chemotherapy and steroids. Four to 14 days after the start of chemotherapy, they complained of abdominal pain and plain roentgenograms revealed pneumoperitoneum. The interval between the onset of peritonitis and operation was almost 24 h. Emergency operations were carried out; one patient with a jejunal perforation underwent resection of the jejunum, another with a gastric perforation received a simple closure with omental patch, and the third with a gastric perforation underwent gastrectomy. Two patients recovered from the surgery, while the gastrectomy patient died due to sepsis. The favorable outcome of the surgical intervention is attributed to early diagnosis, prompt exploration, and selective operative procedures. We recommended a simple closure with omental patch for gastroduodenal perforation. Resection and primary anastomosis are possible only in the small bowel. ( info) |
7/1382. Pericardial injury following severe sepsis from faecal peritonitis--a case report on the use of continuous cardiac output monitoring. We report on a case of a 43-year-old man who developed reversible myocardial depression and pericarditis related to severe sepsis secondary to rectosigmoid colonic perforation. The management of this patient was aided by the use of a continuous thermodilution cardiac output catheter and monitor, recently introduced in clinical practice. ( info) |
8/1382. Paracolic abscesses from spontaneous perforation of granulomatous colitis. Three cases of spontaneous perforation of granulomatous colitis are presented. The typical features are those of acute right iliac fossa pathology mimicking appendicitis. Differential diagnosis is difficult in our locality but includes essentially Crohn's colitis although tuberculous and other inflammatory colitis could not be definitively excluded. In the absence of facilities for laparoscopy or even ultrasound-guided percutaneous drainage the results of open laparotomy with right hemicolectomy were beneficial. As expected in our community follow up responses were poor making it difficult to predict long term outcomes. A plea is made for practitioners to bear unusual pathologies in mind during practice. ( info) |
9/1382. Isolated colonic tuberculous perforation as a rare cause of peritonitis: report of a case. We present herein the rare case of a patient who developed peritonitis due to colonic tuberculosis with perforation. The patient was successfully treated by resectional surgery with delayed restoration of bowel continuity and antitubercular therapy. ( info) |
10/1382. Serologic examinations in acute appendicitis. Authors studied the formation of endotoxic antibody level in healthy adults and in patients with appendicitis with a technique (indirect haemagglutination) not used till now. They found the antibody level against endotoxin to be increased in 91% of their patients in the postoperative period. Decrease in the antibody level against endotoxin was observed in two patients with gangrenous appendicitis and two patients with perforated appendicitis. Summarizing their results, authors consider mixed (aerobic, anaerobic) infection to be of decisive importance in the development of acute appendicitis, contributing to the weakened immune response of the host. ( info) |