RESUMEN
Late perforation of the ileum is a rare and potentially life-threatening complication following intestinal resection. We present a unique case of a woman in her 60s with a history of appendiceal carcinoid tumour, who underwent a right hemicolectomy. Positron emission tomography and surveillance CTs showed normal surgical changes and no recurrent malignancy. Three years postoperatively, she presented with severe abdominal pain. CT revealed a perforation along the ileal wall of the ileocolonic anastomosis. She underwent emergent resection and repeat ileocolonic anastomosis. We conclude that the patient had subclinical ischaemia of the anastomosis, which eventually progressed to perforation 3 years later. We discuss a literature review on late small intestinal anastomotic perforations and their associated risk factors. Our case and literature review emphasise the importance of considering delayed anastomotic leak in postoperative patients with a history of intestinal cancer, inflammatory bowel disease, Roux-en-Y enteroenterostomy or side-to-side anastomosis.
Asunto(s)
Anastomosis Quirúrgica , Íleon , Perforación Intestinal , Humanos , Femenino , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Perforación Intestinal/diagnóstico por imagen , Anastomosis Quirúrgica/efectos adversos , Persona de Mediana Edad , Íleon/cirugía , Colectomía/efectos adversos , Tumor Carcinoide/cirugía , Neoplasias del Apéndice/cirugía , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Fuga Anastomótica/cirugía , Fuga Anastomótica/etiología , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiologíaAsunto(s)
Resección Endoscópica de la Mucosa , Tomografía Computarizada por Rayos X , Humanos , Resección Endoscópica de la Mucosa/efectos adversos , Neoplasias Gastrointestinales/cirugía , Neoplasias Gastrointestinales/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Factores de Tiempo , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiologíaRESUMEN
Spontaneous, iatrogenic or surgical perforation of the whole gastrointestinal wall can lead to serious complications, resulting in increased morbidity and mortality. Optimal patient management requires early clinical appraisal and prompt imaging evaluation. Both radiologists and referring clinicians should recognize the importance of choosing the ideal imaging modality and the usefulness of oral and rectal contrast medium. Surgeons and radiologists should be familiar with CT and fluoroscopy findings of the normal and pathologic anatomy after esophageal, stomach or colon surgery. Specifically, they should be able to differentiate innocuous from clinically-relevant, life-threatening postoperative complications to guide appropriate treatment. Advantages of esophagram, CT-esophagram, CT after rectal contrast enema and other imaging modalities are discussed.
Asunto(s)
Perforación Intestinal , Humanos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Tomografía Computarizada por Rayos X , Medios de Contraste/administración & dosificación , Fluoroscopía , Perforación del Esófago/diagnóstico por imagen , Perforación del Esófago/etiologíaRESUMEN
OBJECTIVE: We analyzed the incidence and mortality rate of gastrointestinal (GI) tract perforation after radiofrequency ablation (RFA) for hepatic tumors and assess its risk factors. METHODS: This retrospective cohort study included 4799 patients with malignant tumors who underwent RFA (n = 7206). Sixty-nine cases of thermal injury to the GI tract were identified via a search of the electronic medical record system using index terms and divided into two groups according to the thermal injury with (n = 8) or without (n = 61) GI tract perforation based on follow-up CT reports. The risk factors for GI tract perforation were identified via multivariable logistic regression analysis using clinical, technical, and follow-up CT findings. RESULTS: The incidence of thermal injury to the GI tract and GI tract perforation was 0.96 % (69/7206) and 0.11 % (8/7206), respectively. The type of adjacent GI tract and history of diabetes mellitus differed significantly between the two groups (p < 0.05). The index tumor being located around the small intestine was the only significant risk factor for GI tract perforation after ablation (Odds ratio, 22.69; 95 % confidence interval, 2.59-198.34; p = 0.005 [reference standard, stomach]). All perforations were not identified on CT images immediately after RFA. The median time to detection was 20 days (range, 3-41 days). Two patients (25 %, 2/8) died due to perforation-related complications. CONCLUSION: GI tract perforation after RFA for hepatic tumors is rare; however, it is associated with high mortality. Thus, careful follow-up is required after RFA if the index tumor is located around the small intestine.
Asunto(s)
Perforación Intestinal , Neoplasias Hepáticas , Ablación por Radiofrecuencia , Humanos , Masculino , Femenino , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/epidemiología , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Factores de Riesgo , Incidencia , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Ablación por Radiofrecuencia/efectos adversos , Adulto , Anciano de 80 o más Años , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Ablación por Catéter/efectos adversosRESUMEN
A 47-year-old woman was referred to our hospital with recurring lower abdominal pain persisting for more than 2 weeks. Imaging modalities showed small bowel obstruction caused by a mass lesion in the terminal ileum. Despite undergoing fasting, rehydration, and decompression through an ileus tube, her symptoms persisted. Furthermore, the condition deteriorated on day 4, with the onset of her menstrual period. An emergency surgery was conducted on the 7th day after hospitalization. Surgical observations indicated severe stenosis around the ileocecal valve and ileal perforation approximately 40cm from the oral stricture. As a result, ileocecal resection was performed. Pathological examination revealed endometrial tissue infiltration through the mucosal lamina propria to the ileal subserosa. Thus, the patient was identified with intestinal endometriosis of the ileocecum. Endometriosis of the small bowel is an uncommon condition that eventually causes intractable bowel obstruction. Although preoperative diagnosis is considered challenging, intestinal endometriosis should be included in the differential diagnosis in cases of bowel obstruction in women of childbearing age.
Asunto(s)
Endometriosis , Enfermedades del Íleon , Obstrucción Intestinal , Perforación Intestinal , Humanos , Femenino , Endometriosis/complicaciones , Persona de Mediana Edad , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Enfermedades del Íleon/diagnóstico por imagenRESUMEN
RATIONALE: Barium peritonitis is an inflammatory response that occurs when barium accidentally enters the abdominal cavity during a barium test. In extreme circumstances, it has the potential to harm various organs and even result in death. PATIENT CONCERNS: A 3-month-old infant was diagnosed with multiple organ failure after severe barium peritonitis. DIAGNOSIS: Multiple organ dysfunction is associated with barium peritonitis. INTERVENTIONS: The infant underwent surgical intervention and received ventilator support, anti-infection therapy, myocardial nutrition, liver and kidney protection, rehydration, circulation stabilization, and other symptomatic supportive care. OUTCOMES: The patient experienced clinical death after treatment and resuscitation was unsuccessful. LESSONS: Barium enema perforation complications are uncommon, but can lead to fatal injuries with a high mortality rate. This case highlights the importance of raising awareness among clinicians about the risks of gastroenterography in infants and children and actively preventing and avoiding similar serious complications. The mortality rate can be reduced by timely multidisciplinary consultation and joint management once a perforation occurs.
Asunto(s)
Perforación Intestinal , Insuficiencia Multiorgánica , Humanos , Lactante , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico por imagen , Insuficiencia Multiorgánica/etiología , Resultado Fatal , Peritonitis/etiología , Masculino , Enema Opaco/efectos adversos , Enema Opaco/métodos , Sulfato de Bario/efectos adversos , Medios de Contraste/efectos adversosRESUMEN
An 8-year-old cat was presented for an acute history of anorexia, marked abdominal pain, and hyperthermia. Ultrasonography showed a cecal perforation with focal steatitis and adjacent free gas bubbles, consistent with focal peritonitis. Surgery confirmed the imaging findings. An enterectomy was performed with the removal of the cecum and ileocolic valve, and anastomosis between the ileum and colon was performed. Histology revealed transmural enteritis and chronic severe pyogranulomatous peritonitis with intralesional plant fragments.
Asunto(s)
Enfermedades de los Gatos , Enfermedades del Ciego , Perforación Intestinal , Ultrasonografía , Animales , Gatos , Enfermedades de los Gatos/diagnóstico por imagen , Enfermedades de los Gatos/cirugía , Enfermedades de los Gatos/diagnóstico , Enfermedades del Ciego/veterinaria , Enfermedades del Ciego/diagnóstico por imagen , Enfermedades del Ciego/cirugía , Ciego/diagnóstico por imagen , Ciego/cirugía , Ciego/lesiones , Perforación Intestinal/veterinaria , Perforación Intestinal/cirugía , Perforación Intestinal/diagnóstico por imagen , Peritonitis/veterinaria , Peritonitis/diagnóstico por imagen , Peritonitis/etiología , Ultrasonografía/veterinariaRESUMEN
BACKGROUND: The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. METHODS: The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. RESULTS: The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. CONCLUSION: Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.
Asunto(s)
Perforación Intestinal , Peritonitis , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Meconio , Peritonitis/diagnóstico , Peritonitis/terapia , Peritonitis/etiología , Estudios Retrospectivos , Ultrasonografía PrenatalRESUMEN
INTRODUCTION AND IMPORTANCE: Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. CASE PRESENTATION: A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. CLINICAL FINDINGS AND INVESTIGATIONS: The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. INTERVENTION AND OUTCOMES: The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. RELEVANCE AND IMPACT: Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients.
Asunto(s)
Remoción de Dispositivos , Migración de Cuerpo Extraño , Filtros de Vena Cava , Vena Cava Inferior , Trombosis de la Vena , Adulto , Femenino , Humanos , Persona de Mediana Edad , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Perforación Intestinal/diagnóstico por imagen , Flebografía , Diseño de Prótesis , Implantación de Prótesis/instrumentación , Implantación de Prótesis/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Filtros de Vena Cava/efectos adversos , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/lesiones , Vena Cava Inferior/cirugía , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapiaRESUMEN
CASE: An 85-year-old woman with a history of bladder mesh sling placement sustained a pelvic fracture and extraperitoneal bladder rupture after a ground-level fall. The patient underwent cystorrhaphy and percutaneous anterior column screw placement. Free air was identified on abdominal computed tomography scan on postoperative day 5. Exploratory laparotomy revealed a sigmoid colon perforation and extensive bowel adhesions to the anterior pelvis. CONCLUSION: This is the first report describing bowel injury and associated bladder rupture in a pelvic fragility fracture related to a prior bladder mesh sling. This case highlights the importance of obtaining a thorough surgical history when treating pelvic injuries.
Asunto(s)
Traumatismos Abdominales , Fracturas Óseas , Perforación Intestinal , Huesos Pélvicos , Femenino , Humanos , Anciano de 80 o más Años , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/cirugía , Vejiga Urinaria/lesiones , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Fracturas Óseas/complicaciones , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/cirugíaRESUMEN
BACKGROUND/PURPOSE: Encapsulating peritoneal sclerosis (EPS) is a rare and potential lethal complication of peritoneal dialysis characterized by bowel obstruction. Surgical enterolysis is the only curative therapy. Currently, there are no tools for predicting postsurgical prognosis. This study aimed to identify a computed tomography (CT) scoring system that could predict mortality after surgery in patients with severe EPS. METHODS: This retrospective study enrolled patients with severe EPS who underwent surgical enterolysis in a tertiary referral medical center. The association of CT score with surgical outcomes including mortality, blood loss, and bowel perforation was analyzed. RESULTS: Thirty-four patients who underwent 37 procedures were recruited and divided into a survivor and non-survivor group. The survivor group had higher body mass indices (BMIs, 18.1 vs. 16.7 kg/m2, p = 0.035) and lower CT scores (11 vs. 17, p < 0.001) than the non-survivor group. The receiver operating characteristic curve revealed that a CT score of ≥15 could be considered a cutoff point to predict surgical mortality, with an area under the curve of 0.93, sensitivity of 88.9%, and specificity of 82.1%. Compared with the group with CT scores of <15, the group with CT scores of ≥15 had a lower BMI (19.7 vs. 16.2 kg/m2, p = 0.004), higher mortality (4.2% vs. 61.5%, p < 0.001), greater blood loss (50 vs. 400 mL, p = 0.007), and higher incidence of bowel perforation (12.5% vs. 61.5%, p = 0.006). CONCLUSION: The CT scoring system could be useful in predicting surgical risk in patients with severe EPS receiving enterolysis.
Asunto(s)
Perforación Intestinal , Fibrosis Peritoneal , Humanos , Fibrosis Peritoneal/diagnóstico por imagen , Fibrosis Peritoneal/etiología , Fibrosis Peritoneal/cirugía , Estudios Retrospectivos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Esclerosis/complicacionesAsunto(s)
Enteritis , Fístula , Fístula Intestinal , Obstrucción Intestinal , Perforación Intestinal , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Enteritis/complicaciones , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugíaAsunto(s)
Apendicitis , Perforación Intestinal , Laparoscopía , Animales , Apendicitis/diagnóstico por imagen , Apendicitis/etiología , Apendicitis/cirugía , Apendicectomía , Enfermedad Aguda , Laparoscopía/efectos adversos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Accidental ingestion of foreign bodies is a common problem in children. Fortunately, the gastrointestinal tract is quite resilient to foreign bodies. On the other hand, the ingestion of magnets can result in enormous morbidity. Because of their natural tendency to firmly adhere they can cause intestinal obstruction, pressure necrosis, fistula formation or perforation. With this case report, we aim to raise awareness of the risks that these magnets pose to children. METHODS: We describe a case of intestinal perforation caused by the separate ingestion of multiple magnets from a children's toy (buckyballs, Neodymium spheres) by a two-year-old boy. A search in the Pubmed database showed some publications and varied management guidelines. RESULTS: The boy was treated with an exploratory laparoscopy converted to a mini-laparotomy. We removed the four magnets through separate enterotomies. Postoperative recovery was uneventful. The boy was discharged on a postoperative day five and had no complications at three months follow-ups. CONCLUSION: Accidental ingestion of multiple magnets is rare but can create a life-threatening situation in children. If the magnets are still in the stomach, endoscopic retrieval is needed. If they are beyond the stomach, in asymptomatic cases close clinical and radiographic vigilance is mandatory. When symptomatic we advise urgent removal. If treated on time, the surgical outcome is good and fast recovery is expected.
Asunto(s)
Cuerpos Extraños , Obstrucción Intestinal , Perforación Intestinal , Masculino , Niño , Humanos , Preescolar , Imanes/efectos adversos , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/etiología , Cuerpos Extraños/cirugía , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugíaAsunto(s)
Fascitis Necrotizante , Hernia Inguinal , Perforación Intestinal , Humanos , Fascitis Necrotizante/etiología , Fascitis Necrotizante/complicaciones , Hernia Inguinal/complicaciones , Hernia Inguinal/diagnóstico , Hernia Inguinal/cirugía , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/etiologíaAsunto(s)
Hemorragia Gastrointestinal , Perforación Intestinal , Humanos , Colitis/complicaciones , Colitis/diagnóstico , Colitis/etiología , Colonoscopía , Impactación Fecal/complicaciones , Impactación Fecal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Perforación Intestinal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
We describe a case of a premature 24 weeks gestation infant who presented with clinical lability and abdominal distention with initial concerns of necrotising enterocolitis. On further examination, a right inguinal hernia was noted and serial abdominal X-rays showed bowel loop dilatation with intramural air and no perforation. However, the hernia was recurrent and later found to be not reducible. He underwent right groin exploration. Intraoperatively, distal ileal perforation was noted and he was found to have an additional five sites of perforation. He had a stoma sited at the left iliac fossa as well as primary anastomosis at the site of the second to fifth perforations. He had a stormy postoperative period but is currently doing well. Although obstructed hernias are rare in the initial course of an extreme preterm infant, it should not be missed as a cause of intestinal obstruction and early surgical opinion should be sought.