Concept: Gastrointestinal perforation
INTRODUCTION: Although blunt trauma to a hernia-containing bowel is known to cause bowel perforation, this report documents the first incident of a small bowel transection following a non-traumatic event. CASE PRESENTATION: We report the case of a 49-year-old African American man with a chronic incarcerated inguinal hernia awaiting elective repair. He presented to the Emergency Department with abdominal pain following an episode of coughing. On examination, he was found to have peritonitis. He underwent exploratory laparotomy, and had a complete small bowel transection. A bowel resection with primary anastomosis was performed, as well an inguinal hernia repair. CONCLUSION: Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.
Colonic perforation with fecal peritonitis is a life-threatening clinical condition. For these patients, a two-stage operation of fecal diversion and a postponed colostomy closure is generally recommended. Accordingly, a simple and feasible primary repair technique was explored.
OBJECTIVE: The goal of this study was to evaluate the effects of crust formation on the healing of traumatic, dry, and minor-sized tympanic membrane perforations (TMPs) in humans. STUDY DESIGN: Case series with a chart review. SETTING: Tertiary university hospital. MATERIALS AND METHODS: The clinical records of patients with traumatic TMPs who met the case selection criteria were retrieved and categorized according to the presence of a crust and the timing of crust formation into three groups: no crust, early crust formation, and late crust formation. Healing outcomes (i.e., healing rate and time) in the three groups were analyzed. RESULTS: In total, 83 patients were analyzed. The perforation closure rates were 92%, 100%, and 78% in the groups with no-crust, early crust formation, and late crust formation, respectively. No significant difference was seen between the groups with no-crust and with late crust formation (p>0.05). By contrast, closure rates differed significantly between the early and late crust formation groups (p<0.05). Overall, the no-crust and early crust formation groups showed shorter healing times compared with the late crust formation group (p<0.05). However, closure times did not differ significantly between groups with early crust formation and no crust (p>0.05). CONCLUSIONS: Crust formation at the margin of a traumatic TMP may serve as a predictor of healing outcome. Compared with perforations with early crust formation or no crust, late crust formation can result in delayed healing and failure to close completely.
BACKGROUND: The use of examination gloves is part of the standard precautions to prevent medical staff from transmission of infectious agents between patients. Gloves also protect the staff from infectious agents originating from patients. Adequate protection, however, depends on intact gloves. The risk of perforation of examination gloves is thought to correlate with duration of wearing, yet, only very few prospective studies have been performed on this issue. METHODS: A total number of 1500 consecutively used pairs of examination gloves of two different brands and materials (latex and nitrile) were collected over a period of two months on two ICU’s. Used gloves were examined for micro perforations using the “water-proof-test” according to EN 455–1. Cox-regression for both glove types was used to estimate optimal changing intervals, RESULTS: Only 26% of gloves were worn longer than 15 min. The total perforation rate was 10.3% with significant differences and deterioration of integrity of gloves between brands (p<0.001). Apart from the brand, "change of wound dressing" (p = 0.049) and "washing patients" (p = 0.001) were also significantly associated with an increased risk of perforation. CONCLUSION: Medical gloves show marked differences in their durability that cannot be predicted based on the technical data routinely provided by the manufacturer. Based on the increase of micro perforations over time and the wearing behavior, recommendations for maximum wearing time of gloves should be given. Changing of gloves after 15 min could be a good compromise between feasibility and safety. HCWs should be aware of the benefits and limitations of medical gloves. To improve personal hygiene hand disinfection should be further encouraged.
Sarcina ventriculi is an increasingly common gram-positive coccus, recognized in gastric biopsies, particularly of patients with delayed gastric emptying. It occurs most commonly in adult women and can be identified easily by its characteristic morphologic features, such as basophilic staining, cuboid shape, tetrad arrangement, red blood cell-sized packets, flattened cell walls, and refractile nature on light microscopy. Although the pathogenesis of the organism is debated, it has been implicated in cases of gastric perforation, emphysematous gastritis, and peritonitis as well as occurring in the background of gastric adenocarcinomas. This review of the literature discusses the clinical features, endoscopy findings, histopathology, ancillary studies, microbiology, pathogenesis, differential diagnosis, treatment, and prognosis of this bacterium based on 19 published cases.
Spontaneous gastrointestinal (GI) perforation is a well-known complication occurring in patients suffering from Type IV vascular Ehlers-Danlos syndrome (EDS IV). The aim of the present study was to review the current literature on spontaneous GI perforation in EDS IV and illustrate the surgical management and outcome when possible. A systematic review of all the published data on EDS IV patients with spontaneous GI perforation between January 2000 and December 2015 was conducted using three major databases PUBMED, EMBASE, and Cochrane Central Register of Controlled Trails. References of the selected articles were screened to avoid missing main articles. Twenty-seven published case reports and four retrospective studies, including 31 and 527 cases, respectively, matched the search criteria. A case from our institution was added. Mean age was 26 years (range 6-64 years). The most frequent site of perforation was the colon, particularly the sigmoid, followed by small bowel, upper rectum, and finally stomach. The majority of cases were initially managed with Hartmann’s procedure. In recurrent perforations, total colectomy was performed. The reperforation rate was considerably higher in the “partial colectomy with anastomosis” group than in the Hartmann group. Colonic perforation is the most common spontaneous GI perforation in EDS IV patients. An unexpected fragility of the tissues should raise the possibility of a connective tissue disorder and prompt further investigation with eventual management of these high-risk patients with a multidisciplinary team approach in dedicated centres. In the emergency setting, a Hartmann procedure should be performed.
Obesity is a growing global epidemic with tremendous financial burden and health care costs worldwide. Restrictive surgery has emerged as the definitive treatment option to combat morbid obesity and its associated comorbidities. The advent of endoscopy has new grounds in obesity with the introduction of inflatable balloon placed in the stomach that decreases satiety by volume restriction.
Perforation of the colon is a rare complication for patients with colon cancer and usually requires emergent surgery. The characteristics of perforation differ based on the site of perforation, presenting as either perforation at the cancer site or perforation proximal to the cancer site. Peritonitis due to perforation tends to be more severe in cases of perforation proximal to the cancer site; however, the difference in the outcome between the two types remains unclear. Surgical treatment of colon cancer with perforation has changed over time. Recently, many reports have shown the safety and effectiveness of single-stage operation consisting of resection and primary anastomosis with intraoperative colonic lavage. Under certain conditions, laparoscopic surgery can be feasible and help minimize the invasion. However, emergent surgery for colon cancer with perforation is associated with a high rate of mortality and morbidity. The long-term prognosis seems to have no association with the existence of perforation. Oncologically curative resection may be warranted for perforated colon cancer. In this report, we perform a literature review and investigate the characteristics and surgical strategy for colon cancer with perforation.
A 7-month-old intact male domestic shorthair cat was presented 4 h after being hit by a car. It had bilateral inguinal hernias and a mesenteric rent that were repaired surgically and a hematoma in the left retroperitoneal space. No other intra-abdominal abnormalities were identified on abdominal surgical exploration. Approximately 72 h after presentation, the cat started vomiting and developed severe abdominal discomfort. A sudden decrease in mentation and elevation of respiratory rate and effort ensued. Abdominal radiographs showed loss of detail in the abdominal cavity, and abdominocentesis confirmed septic peritonitis. The cat was euthanized, and post-mortem evaluation of the bowel revealed two 1 cm perforations of the jejunum.
Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality.