Perforated colonic carcinoma mimicking perforated peptic ulcer: an argument for full exploration of the stomach and duodenum.

Perforated peptic ulcer is one of the commonest types of hollow-viscus perforation. Because many of these ulcers are found at laparotomy to be sealed off, some authors believe it is unnecessary to dissect the surrounding tissue from the presumed site of perforation. A patient with a long history of peptic ulcer disease experienced the sudden onset of signs and symptoms of perforated peptic ulcer. On exploration, the omentum appeared to be densely adherent to the pylorus and duodenum. However, no perforation was found when the omentum was dissected free from the stomach and duodenum. Further exploration revealed a walled-off, perforated carcinoma of the transverse colon adjacent to the mesenteric border. As a result of this experience, the authors emphasize that when the findings at operation do not fit the clinical presentation in a patient with a presumed perforated peptic ulcer, a thorough exploration of the abdominal viscera is mandatory to identify the pathologic process.

A simple method for endoscopic placement of a nasoduodenal feeding tube.

The key to short-term enteral feeding in patients with gastroparesis is to deliver the nutrition beyond the pylorus. Endoscopic assisted methods allow the precise placement of the feeding tube to the small bowel. However, the main difficulty in association with these procedures is feeding-tube migration into the stomach during the withdrawal of the endoscope. We have developed an endoscopic method with a high success rate which prevents this problem. A reusable angiocatheter guidewire was threaded through the feeding tube, passing beyond the distal opening prior to the withdrawal of the scope. Counterpressure was applied to the feeding tube during the withdrawal of the endoscope. We have successfully placed feeding tubes in 22 out of 23 patients with no complications.

Intra-arterial fibrinolytic treatment for mesenteric arterial embolus: a case report.

The diagnosis of mesenteric ischemia is based on acute clinical awareness of the condition and confirmed by angiography or laparotomy. The standard treatment is abdominal exploration with resection of the gangrenous segment of the bowel or embolectomy of the superior mesentery artery, or both. Alternative treatment such as intra-arterial thrombolysis may be considered in selected patients. A 66-year-old man with a history of atrial fibrillation presented with abdominal pain. Angiography documented an embolus in both the ileocolic artery and a branch of the right renal artery. The patient was treated with selective intra-arterial infusion of streptokinase. The abdominal pain resolved. Repeat angiography showed lysis of both emboli.

Traumatic pseudoaneurysm of the hepatic artery after percutaneous liver biopsy and laparoscopic cholecystectomy in a patient with biliary cirrhosis: a case report.

Hemobilia is a rare but recognizable complication of percutaneous transhepatic diagnostic or therapeutic procedures. The diagnosis is sometimes difficult because of the time lag between the procedure and the first symptoms, which can be intermittent. A 35-year-old woman had hemobilia after percutaneous Trucut biopsy of the liver followed by laparoscopic cholecystectomy. The diagnosis of hemobilia was made on clinical grounds, and a pseudoaneurysm of the right hepatic artery was detected on selective angiography. The patient was successfully treated with arterial embolization during angiography.