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1.
Medicine (Baltimore) ; 98(50): e18111, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852071

RESUMO

RATIONALE: Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract. PATIENT CONCERNS: The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months DIAGNOSIS:: A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve. INTERVENTIONS: A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing. OUTCOMES: The patient was discharged three days after colonoscopy with normal laboratory results and without any pain. LESSONS: In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.


Assuntos
Doenças do Ceco/cirurgia , Ceco , Colonoscopia/métodos , Corpos Estranhos/cirurgia , Perfuração Intestinal/cirurgia , Idoso , Doenças do Ceco/diagnóstico , Doenças do Ceco/etiologia , Ingestão de Alimentos , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Perfuração Intestinal/diagnóstico , Tomografia Computadorizada Multidetectores/métodos
3.
Medicine (Baltimore) ; 98(47): e17835, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764778

RESUMO

INTRODUCTION: An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term. PATIENT CONCERNS AND DIAGNOSIS: A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts. INTERVENTIONS: We performed a laparotomy to remove the IVC filter. OUTCOMES: Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge. LESSONS: There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.


Assuntos
Duodeno/lesões , Perfuração Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Idoso , Remoção de Dispositivo , Duodeno/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/cirurgia , Veia Cava Inferior/cirurgia
4.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676053

RESUMO

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Assuntos
Colectomia/métodos , Hemorragia Gastrointestinal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Anastomose Cirúrgica , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Perfuração Intestinal/fisiopatologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Prognóstico , Medição de Risco , Resultado do Tratamento
5.
J Ayub Med Coll Abbottabad ; 31(3): 464-465, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535530

RESUMO

Tuberculosis continues to be a fatal infectious disease in developing countries. Despite the advances in medical sciences and introduction of potent therapeutic regimes tuberculosis has still managed to survive and prevail worldwide. It can affect many organs of body. Isolated splenic tuberculosis is uncommon in immunocompetent host and only some cases are reported internationally. Extrapulmonary tuberculosis with splenic involvement is also rare and only comes after lungs and liver. We present a case of patient presented with complaints of prolonged fever, cough and insidious onset of abdominal pain and sepsis. Exploratory laparotomy revealed spleenic abscess as incidental finding associated with tuberculous perforation of colon. She underwent double barrel colostomy and spleenectomy followed by intensive care unit admission. Measures such as awareness about the disease, early medical assistance and good compliance regarding treatment can produce positive results in combating tuberculosis and its complications.


Assuntos
Abscesso/microbiologia , Doenças do Colo/complicações , Perfuração Intestinal/microbiologia , Esplenopatias/microbiologia , Tuberculose/complicações , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Doenças do Colo/cirurgia , Colostomia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Esplenectomia , Esplenopatias/cirurgia , Tuberculose/cirurgia
6.
Chirurgia (Bucur) ; 114(4): 518-521, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511138

RESUMO

Duodenal injury is an unusual complication of laparoscopic cholecystectomy, mostly caused by direct injury of the duodenum by laparoscopic instruments, either mechanical or thermal. The management is usually surgical, with satisfactory results, as long as the complication is detected early. We report two cases of duodenal perforations during laparoscopic cholecystectomy. One was treated with primary closure of the defect, while the other was managed conservatively with abdominal drainage and food deprivation. Both techniques proved successful in the management of that complication.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Duodeno/lesões , Perfuração Intestinal/terapia , Tratamento Conservador , Drenagem , Duodeno/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
7.
Dis Colon Rectum ; 62(10): 1153-1156, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31490823

RESUMO

CASE SUMMARY: A healthy 65-year-old woman presents to the emergency department with a 12-hour history of sudden-onset severe lower abdominal pain. This is her first episode. She reports nausea, vomiting, and anorexia. Her last colonoscopy was at age 60, and was normal, except for diverticulosis of the sigmoid colon. Physical examination is significant for fever, tachycardia, and generalized abdominal pain with rebound tenderness. Pertinent laboratory findings include a leukocytosis and metabolic acidosis. A CT scan is obtained and is consistent with freely perforated diverticulitis, including a thickened sigmoid colon, free fluid in the pelvis, and free air noted near the diaphragm (). The surgeon completes the patient evaluation, recommends initiation of intravenous fluid resuscitation and antibiotics, and plans to go immediately to the operating room for surgical resection.


Assuntos
Colo Sigmoide/cirurgia , Colostomia/métodos , Gerenciamento Clínico , Doença Diverticular do Colo/cirurgia , Perfuração Intestinal/cirurgia , Laparoscopia/métodos , Idoso , Anastomose Cirúrgica/métodos , Colo Sigmoide/diagnóstico por imagem , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Ultrassonografia
8.
BMC Surg ; 19(1): 132, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500608

RESUMO

BACKGROUND: Foreign body ingestion is a scenario occasionally encountered in the emergency room. Pediatric and psychiatric patients are the two most common populations suffering from accidental or in some cases intentional ingestion of foreign bodies. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Less than 1% of the cases complicates with gastrointestinal tract perforation, which are often caused by sharp objects, which warrants surgical intervention. The average time from foreign body ingestion to development of perforation was noted at 10.4 days in previous reports. These cases often present in rapidly progressing peritonitis and are subsequently managed by emergent laparotomy. In this case report, we describe an accidental chopstick ingestion of a patient who initially was misdiagnosed and remained asymptomatic for nine months, then presented with acute abdomen. CASE PRESENTATION: A 27-year-old man accidentally ingested a wooden chopstick and sought consult at a clinic. Negative abdominal plain film misled the physician to believe ingested chopstick was digested into fragments and passed out unnoticed. The patient presented acute abdomen caused by duodenal perforation nine months later and was subsequently treated with emergency laparotomy with primary duodenorrhaphy. CONCLUSIONS: Negative plain films are not sufficient to conclude a conservative treatment in foreign body ingestion. Computed tomography scan or endoscopic examinations should be done to rule out retained foreign body within gastrointestinal tract.


Assuntos
Abdome Agudo/etiologia , Corpos Estranhos/complicações , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Abdome Agudo/cirurgia , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Serviço Hospitalar de Emergência , Endoscopia/métodos , Humanos , Masculino , Radiografia , Tomografia Computadorizada por Raios X
10.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401575

RESUMO

Intestinal perforation is a rare and life-threatening complication in granulomatosis with polyangiitis (GPA). A 55-year-old Japanese man who had been undergoing maintenance haemodialysis was diagnosed with GPA via a pathologically proven nasal granuloma and proteinase 3-antineutrophil cytoplasmic antibody-positive status. He was started on 60 mg prednisolone. Haematochezia was observed due to the colon ulcer after treatment initiation. Two doses of intravenous cyclophosphamide were administered every 2 weeks. Despite the treatment, there were two episodes of severe abdominal pain with peritonitis within a week. Perforation of descending colon and severe ischaemia of the ascending colon was observed during each emergency laparotomy, and ileostomy was performed. Vasculitis in the small vessels was confirmed. In conclusion, patient with severe intestinal involvement and who was unresponsive to conventional therapy was treated with surgery followed by rituximab administration, and remission was achieved.


Assuntos
Granulomatose com Poliangiite/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Perfuração Intestinal/etiologia , Rituximab/uso terapêutico , Colo Descendente/cirurgia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Humanos , Perfuração Intestinal/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Indução de Remissão
11.
Am J Case Rep ; 20: 1189-1194, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31402351

RESUMO

BACKGROUND Much of the medical literature regarding injury from the ingestion of wire bristles from grill brushes has been published only in the last decade. Grill brushes are often used to clean grills, and small wire bristles may break off of the brush during the scrubbing process and subsequently become embedded into food and are accidently ingested. Fewer reports have been published on abdominal presentations with injuries past the gastroesophageal sphincter, yet perforation and subsequent need for operative management has been shown to be more prevalent in these types of cases. CASE REPORT Herein, we report on 3 unique cases of accidental ingestion of grill brush wire bristles. Case 1 involved a 55-year-old male who presented to the Emergency Department (ED) for evaluation after experiencing 2 days of abdominal pain while working in the yard. He was found to have a small bowel perforation secondary to a metallic foreign body. Case 2 involved a 61-year-old female who presented to the ED with gradual-onset, sharp epigastric pain radiating to her right side. She was found to have a fistula between her stomach and gallbladder secondary to a contained perforation with a metallic foreign body. Case 3 involved a 41-year-old male who presented to the ED after known ingestion of a grill brush bristle. He was found to have a small metallic foreign body protruding into the abdominal wall. CONCLUSIONS To avoid these injuries, there must be increased awareness among consumers, manufacturers, retailers, and medical professionals to promote prevention, timely diagnosis, and appropriate treatment.


Assuntos
Fístula Biliar/etiologia , Utensílios de Alimentação e Culinária , Ingestão de Alimentos , Corpos Estranhos/complicações , Fístula Gástrica/etiologia , Perfuração Intestinal/etiologia , Dor Abdominal , Parede Abdominal/cirurgia , Adulto , Fístula Biliar/cirurgia , Feminino , Fístula Gástrica/cirurgia , Humanos , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade
12.
Pan Afr Med J ; 33: 51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448014

RESUMO

Typhoid fever and tuberculosis, considered rare diseases in western countries, is still considered a notable problem of health issue in developing countries. The gastrointestinal manifestations of typhoid fever are the most common and the typhoid intestinal perforation (TIP) is considered the most dangerous complication. Abdominal localization of tuberculosis is the 6th most frequent site for extra pulmonary involvement, it can involve any part of the digestive system, including peritoneum, causing miliary peritoneal tuberculosis (MPT). This is the case report of a 4 years old girl with multiple jejunal perforations in a setting of contemporary miliary peritoneal tuberculosis and typhoid fever occurred in "Hopital Saint Jean de Dieu" in Tanguietà, north of Benin. The patient was admitted in the emergency department with an acute abdomen and suspect of intestinal perforation, in very bad clinical conditions, underwent emergency laparotomy. The finding was a multiple perforations of the jejunum in a setting of combined abdominal typhoid fever and miliary peritoneal tuberculosis. Typhoid intestinal perforations and peritoneal tuberculosis are a very rare cause of non-traumatic peritonitis in western country, but still common in developing country. Considering the modern migratory flux and the diffusion of volunteer missions all around the world, the western surgeon should know this pathological entities, and the best treatments available, well known by surgeons with experience of working in developing countries. The combination of both TIP and MPT in the same patient, is a very rare finding which can worsen the outcome of the patient itself.


Assuntos
Perfuração Intestinal/diagnóstico , Peritonite Tuberculosa/diagnóstico , Tuberculose Miliar/diagnóstico , Febre Tifoide/diagnóstico , Abdome Agudo/etiologia , Benin , Pré-Escolar , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Jejuno/patologia , Laparotomia/métodos , Peritonite Tuberculosa/complicações , Tuberculose Miliar/complicações , Febre Tifoide/complicações
13.
Tokai J Exp Clin Med ; 44(3): 40-44, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31448394

RESUMO

Bevacizumab is an effective drug for recurrent/advanced cervical cancer. A 59-year-old patient diagnosed with FIGO stage I B2 squamous cell carcinoma of the cervix at our hospital was treated with concurrent chemoradiotherapy as initial treatment. The outcome was judged as close to CR. Local recurrence in the irradiation field and paraaortic lymph node metastasis were noted 2 months after completion of this treatment. Chemotherapy of bevacizumab combined with paclitaxel plus carboplatin (TC) was initiated for recurrent cervical cancer. At 17 days after the 4th cycle, abdominal pain suddenly developed, and a close examination detected free air on abdominal CT, based on which intestinal perforation was diagnosed. Laparoscopic surgery performed to investigate the intraabdominal cavity showed that the small intestine was perforated at 2 sites. These were treated with laparoscopy-assisted partial resection of the small intestine and functional end-to-end anastomosis. Drug therapy for the recurrent cervical cancer was considered, but the primary disease rapidly aggravated and the patient died of the primary disease 11 months after completion of the initial treatment.


Assuntos
Anastomose Cirúrgica/métodos , Anti-Inflamatórios não Esteroides/efeitos adversos , Bevacizumab/efeitos adversos , Carcinoma de Células Escamosas/terapia , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Laparoscopia/métodos , Recidiva Local de Neoplasia/terapia , Neoplasias do Colo do Útero/terapia , Anti-Inflamatórios não Esteroides/administração & dosagem , Bevacizumab/uso terapêutico , Quimiorradioterapia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade
15.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31431798

RESUMO

Background and Objectives: The applications of laparoscopic surgery are expanding, but there is still controversy about its application in patients with peritonitis resulting from diverticulitis perforation. This study aimed to investigate the factors affecting the postoperative mortality rate in patients undergoing surgery for perforated diverticulitis. Further, we compared the recovery courses of patients between open and laparoscopic surgeries. Methods: We analyzed the medical records of adult patients with peritonitis caused by perforated diverticulitis from six hospitals of Hallym University Medical Center from January 2006 to December 2016. Results: A total of 166 patients were identified. In the univariate analysis, the statistically significant factors associated with postoperative mortality were age ≥ 60 years, body mass index ≥ 23 kg/m2, American Society of Anesthesiologists score ≥ 3, hypertension, serum blood urea nitrogen ≥ 23 mg/dL, creatinine ≥ 1.2 mg/dL, albumin < 3.0 g/dL, modified Hinchey score ≥ grade III, formation of stoma, and laparoscopic surgery. In multivariate analysis, serum albumin < 3.0 g/dL was the only factor associated with mortality. After case-control matching, we compared postoperative hospital course and prognosis between open and laparoscopic surgery groups. There was no significant difference in the clinical course between the groups. No significant difference was observed in the complication rate, reoperation rate, readmission rate, and mortality. Conclusion: Low preoperative serum albumin level (<3.0 g/dL) affects the mortality rate of patients after surgery. The hospital course and prognosis after laparoscopic surgery and conventional open surgery are comparable in patients with peritonitis caused by diverticulitis perforation.


Assuntos
Doença Diverticular do Colo/cirurgia , Perfuração Intestinal/cirurgia , Laparoscopia , Laparotomia , Adulto , Idoso , Estudos de Casos e Controles , Doença Diverticular do Colo/sangue , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/mortalidade , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/sangue , Peritonite/etiologia , Peritonite/mortalidade , Peritonite/cirurgia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Reoperação , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/metabolismo , Taxa de Sobrevida
16.
World J Emerg Surg ; 14: 32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31338117

RESUMO

Introduction: Surgical management of Hinchey III and IV diverticulitis utilizes either Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. The aim of this meta-analysis is to determine which of the two procedures has a more favorable outcome. Methods: A systematic review of the existing literature was performed using the PRISMA guidelines. A meta-analysis was carried out using a Mantel-Haenszel, random effects model, and forest plots were generated. The Newcastle-Ottawa and Jadad scoring tools were used to assess the included studies. Results: A total of 25 studies involving 3546 patients were included in this study. The overall mortality in the HP group was 10.8% across the observational studies and 9.4% in the randomized controlled trials (RCTs). The mortality rate in the PRA group was lower than that in the HP group, at 8.2% in the observational studies and 4.3% in the RCTs. A comparison of PRA vs HP demonstrated a 40% lower mortality rate in the PRA group than in the HP (OR 0.60, 95% CI 0.38-0.95, p = 0.03) when analyzing the observational studies. However, meta-analysis of the three RCTs did not demonstrate any difference in mortality, (OR 0.44 (95% CI 0.14-1.34, p = 0.15). Wound infection rates between the two groups were comparable (OR 0.75, 95% CI 0.20-2.78, p = 0.67). Conclusion: Analysis of observational studies suggests that PRA may be associated with a lower overall mortality. There were no differences in wound infection rates. Based on the current evidence, both surgical strategies appear to be acceptable.


Assuntos
Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/normas , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/complicações , Humanos , Perfuração Intestinal/cirurgia , Peritonite/cirurgia
17.
Am J Case Rep ; 20: 1057-1062, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31324749

RESUMO

BACKGROUND Ehlers-Danlos Syndrome (EDS) is a group of connective tissue disorders with heterogeneous clinical features associated with varying genetic mutations. EDS type IV, also known as vascular EDS (vEDS), is the rarest type but has fatal complications, including rupture of major vasculature and intestinal and uterine perforation. Intestinal perforation can be spontaneous or a consequence of long-standing constipation, a common symptom among patients with EDS. CASE REPORT We present a case of a 6-year-old boy with the previous diagnosis of vEDS who presented with colonic perforation from a stercoral ulcer. He underwent diagnostic laparoscopy and loop colostomy, with an uneventful postoperative course. Unfortunately, he developed a second colonic perforation 14 months after the initial episode and underwent total abdominal colectomy with end ileostomy. CONCLUSIONS Intestinal perforation is a well-documented and devastating complication of vEDS. However, spontaneous intestinal perforation is extremely rare in a young child. Therefore, the diagnosis of vEDS should be included in the differential diagnosis if a child presents with intestinal perforation. There is no clear guideline available for surgical management of colonic perforation in patients with vEDS, but total abdominal colectomy appears to provide the best chance of preventing recurrent perforation.


Assuntos
Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Criança , Doenças do Colo/cirurgia , Diagnóstico Diferencial , Humanos , Perfuração Intestinal/cirurgia , Masculino
19.
Pediatr Surg Int ; 35(9): 989-997, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278480

RESUMO

PURPOSE: Fetal extraperitoneal rectal perforation (FERP) is an extremely rare entity. The objective of this report is to review the available literature on this condition and to add our experience with four additional cases managed at our institution. METHODS: A literature search was performed for journal articles addressing this condition. Management strategies and outcomes were then analysed, together with additional information provided from retrospective record review of four cases managed at our institution. RESULTS: A total of 18 patients were identified and included, 14 from the literature and 4 from our records. Initial investigations varied between authors with contrast enema being the most frequently performed study (7/18). All patients were treated with faecal diversion via colostomy formation. Exploratory laparotomy was performed in 6 cases, perineal debridement and washout in 9 cases while drains were left in situ in 14 cases. At 3-6 months of age, a distal contrast study was performed before closure of colostomy. CONCLUSION: Although FERP is a rarely encountered clinical condition, timely recognition and appropriate management can result in good outcomes. Diagnosis can be achieved based on clinical and abdominal X-ray features alone. General management principles involve a diverting colostomy and extended drainage with closure of the colostomy 3-6 months later.


Assuntos
Perfuração Intestinal/cirurgia , Doenças Retais/cirurgia , Reto/cirurgia , Adulto , Colostomia/métodos , Desbridamento , Drenagem , Feminino , Humanos , Recém-Nascido , Laparotomia , Masculino , Gravidez , Radiografia Abdominal , Estudos Retrospectivos
20.
In Vivo ; 33(4): 1329-1332, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280226

RESUMO

BACKGROUND/AIM: The aim of this study was to identify a critical predictor of postoperative sepsis in patients with peritonitis due to colorectal perforation. PATIENTS AND METHODS: Between 2009 and 2014, fifty-three patients who underwent emergency surgery for peritonitis due to colorectal perforation in our hospital were examined retrospectively to identify the critical predictor of postoperative sepsis. Between 2016 and 2017, twelve patients with peritonitis due to colorectal perforation were enrolled in a prospective study to validate the critical predictor obtained by the previous retrospective study. RESULTS: Mechanical ventilation for more than two days after surgery seemed to be a critical predictor of postoperative sepsis. In the prospective study, six patients who were withdrawn from mechanical ventilation within one day after surgery did not develop sepsis. CONCLUSION: Respiratory disorders at the end of surgery for peritonitis due to colorectal perforation seem to be a critical predictor of postoperative sepsis.


Assuntos
Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Peritonite/complicações , Peritonite/cirurgia , Complicações Pós-Operatórias , Doenças Respiratórias/etiologia , Sepse/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias Colorretais/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Prognóstico , Respiração Artificial , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/terapia , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/terapia , Resultado do Tratamento
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