|
1
|
Mehta N, Laitman AP, Brookfield RB, Harris LA. Treatment of Opioid-Induced Constipation: Inducing Laxation and Understanding the Risk of Gastrointestinal Perforation. J Clin Gastroenterol 2025; 59:491-496. [PMID: 40434810 PMCID: PMC12165528 DOI: 10.1097/mcg.0000000000002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
Abstract
Patients receiving opioid analgesics may experience constipation [ie, opioid-induced constipation (OIC)], require treatment to induce laxation, and may be at risk for gastrointestinal perforation, an uncommon but potentially life-threatening condition. Management of OIC includes treatment with over-the-counter laxatives and peripherally acting μ-opioid receptor antagonists (PAMORAs; methylnaltrexone, naloxegol, naldemedine). In patients receiving treatment for OIC, gastrointestinal perforation may result from the laxation process, causing disruption of the gastrointestinal lining that may already have compromised integrity. A PubMed literature review and a search of the US Food and Drug Administration Adverse Event Reporting System database identified several cases of gastrointestinal perforation (life-threatening or with mortality) across the range of agents administered for the treatment of OIC or other constipation types. Methylnaltrexone in the subcutaneous form was the first PAMORA approved for OIC. Its real-world use in the ∼6 years before the availability of another OIC-indicated PAMORA helped establish the adverse-event profile of the class, and experience has been gained in identifying and treating appropriate patient populations. Class labeling of PAMORAs includes a contraindication in patients with known or suspected gastrointestinal obstruction or increased risk of recurrent obstruction. Appropriate patient selection during laxation therapy for OIC, regardless of treatment plan, involves consideration of the overall risk versus benefit in patients at increased risk of perforation due to comorbid medical conditions, concurrent medications, or recent gastrointestinal procedures. After initiating treatment for OIC, clinicians should assess the effectiveness of laxation therapy and carefully monitor for signs of gastrointestinal perforation.
Collapse
|
|
2
|
Harada T, Watari T, Watanuki S, Kushiro S, Miyagami T, Syusa S, Suzuki S, Hiyoshi T, Hasegawa S, Nabeshima S, Aihara H, Yamashita S, Tago M, Yoshimura F, Kunitomo K, Tsuji T, Hirose M, Tsuchida T, Shimizu T. Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study. Int J Emerg Med 2024; 17:192. [PMID: 39702011 DOI: 10.1186/s12245-024-00781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 12/06/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND Lower gastrointestinal perforation (LGP) is an acute abdominal condition associated with a high mortality rate. Timely and accurate diagnosis is crucial. Nevertheless, a diagnostic delay has been estimated to occur in approximately one-third of the cases, and the factors contributing to this delay are yet to be clearly understood. This study aimed to evaluate the diagnostic process for appropriate clinical reasoning and availability of image interpretation in cases of delayed diagnosis of LGP. METHODS A secondary data analysis of a large multicenter retrospective study was conducted. This descriptive study analyzed data from a multicenter, observational study conducted across nine hospitals in Japan from January 2015 to December 2019. Out of 439 LGP cases, we included 138 cases of delayed diagnosis, excluding patients with traumatic or iatrogenic perforations, or those secondary to mesenteric ischemia, appendicitis, or diverticulitis. Clinical history and computed tomography (CT) imaging information were collected for 138 cases. Additionally, information on the clinical course of 50 cases, which were incorrectly diagnosed as gastroenteritis, constipation, or small bowel obstruction, was also collected. RESULTS In 42 (30.4%) cases of delayed diagnosis of LGP, CT imaging was performed before diagnosis, indicating a missed opportunity for timely diagnosis. Moreover, 33 of the 50 patients initially diagnosed with gastroenteritis, constipation, or small bowel obstruction at the time of initial examination had atypical findings that were not consistent with the initial diagnosis. Of the 138 cases with delayed diagnosis in our study, 67 cases (48.6%) showed problems with either the interpretation of CT scans or with the process of clinical reasoning. CONCLUSION Our retrospective study results indicate that approximately half of the cases with delayed diagnosis of LGP were due to problems in interpreting CT images or in clinical reasoning. This finding suggests that clinical reasoning and image interpretation by radiologists are important in improving the diagnostic process for LGP.
Collapse
Affiliation(s)
- Taku Harada
- Division of General Medicine, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka Nerima-ku, Tokyo, 179-0072, Japan.
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan.
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Enya‑cho, Shimane, Japan
| | - Satoshi Watanuki
- Division of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Seiko Kushiro
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Taiju Miyagami
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Syunsuke Syusa
- Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Satoshi Suzuki
- Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Tetsuya Hiyoshi
- General Medicine of Department, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigeki Nabeshima
- General Medicine of Department, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Fumitaka Yoshimura
- Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan
| | - Kotaro Kunitomo
- Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan
| | - Takahiro Tsuji
- Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan
| | - Masanori Hirose
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoya Tsuchida
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| |
Collapse
|
|
3
|
Flores M, Moughnyeh MM, Lekanides A, Parker L. Acute Constipation and A Stercoral Perforation: A Case Report. SAGE Open Med Case Rep 2024; 12:2050313X241263756. [PMID: 39055668 PMCID: PMC11271129 DOI: 10.1177/2050313x241263756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/06/2024] [Indexed: 07/27/2024] Open
Abstract
Stercoral perforation typically arises as a sequela of chronic constipation and can lead to bowel perforation due to fecal impaction. While uncommon, maintaining a high clinical suspicion in the appropriate setting is crucial. We present a case report involving a 52-year-old female with no history of chronic constipation, who presented with an unexplained large bowel obstruction. Subsequent extensive diagnostic workup revealed stercoral perforation, necessitating diagnostic laparoscopy and sigmoidectomy. This case underscores that while stercoral perforation can be life-threatening, clinical stability permits the use of minimally invasive techniques without compromising patient safety or health.
Collapse
Affiliation(s)
- Martha Flores
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Mohamad M. Moughnyeh
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Athena Lekanides
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Lisa Parker
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| |
Collapse
|
|
4
|
Laparoscopic Management of Spontaneous Colonic Perforation: A Single Institution Study of 52 Patients. Surg Laparosc Endosc Percutan Tech 2022; 32:431-434. [PMID: 35583567 DOI: 10.1097/sle.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spontaneous colonic perforation (SCP) is associated with an devastating result. The use of laparoscopy for SCP remains controversial. This study aimed to compare the postoperative outcomes of patients who received either laparoscopic or open surgery and to evaluate the efficacy of laparoscopic surgery and the risk factors affecting prognosis. PATIENTS AND METHODS A retrospective study of patients who underwent surgery for SCP from January 2005 to December 2020 was performed. Demographic data, intraoperative variables, length of stay, and surgical complications were retrieved. RESULTS A total of 52 patients were postoperatively diagnosed with SCP. Thirty (57.69%) procedures were performed using laparoscopic surgery (group A) and 22 (42.31%) were performed using open surgery (group B). There were no significant differences between groups A and B in terms of age, sex, chronic concomitant disease, chronic constipation, incentives, imaging findings, preoperative diagnosis, American Society of Anesthesiologists (ASA) score, Mannheim Peritonitis Index (MPI), operation time, days to resumption of liquids, site of perforation, surgical procedures, or types of perforation (P>0.05). The incidence of wound infection in group A was significantly lower than that in group B (P<0.05), but there was no significant difference in the incidence of abdominal abscess between the 2 groups (P>0.05). Significant differences were found in days to start walking and days to resumption of solids between the 2 groups (P<0.05). Group B had a longer length of hospital stay than group A (P<0.05). After multivariate analysis, the independent variables associated with worse perioperative complications were an age of 65 years and older, an ASA score of ≥3, and an MPI of >26. CONCLUSIONS The prognosis of SCP is poor. The operation should follow principles that are simple, rapid, and effective. If there are no contraindications, laparoscopy may be the preferred method. Hartmann procedure is a promising surgical strategy. The age, ASA score, and MPI may indicate the severity and prognosis of SCP.
Collapse
|
|
5
|
Harada T, Watari T, Watanuki S, Hiroshige J, Kushiro S, Miyagami T, Syusa S, Suzuki S, Hiyoshi T, Hasegawa S, Nabeshima S, Aihara H, Yamashita S, Tago M, Yoshimura F, Kunitomo K, Tsuji T, Hirose M, Tsuchida T, Shimizu T. Diagnostic error rates and associated factors for lower gastrointestinal perforation. Sci Rep 2022; 12:1028. [PMID: 35046455 PMCID: PMC8770624 DOI: 10.1038/s41598-021-04762-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023] Open
Abstract
Lower gastrointestinal perforation is rare and challenging to diagnose in patients presenting with an acute abdomen. However, no study has examined the frequency and associated factors of diagnostic errors related to lower gastrointestinal perforation. This large-scale multicenter retrospective study investigated the frequency of diagnostic errors and identified the associated factors. Factors at the level of the patient, symptoms, situation, and physician were included in the analysis. Data were collected from nine institutions, between January 1, 2015 and December 31, 2019. Timely diagnosis was defined as diagnosis at the first visit in computed tomography (CT)-capable facilities or referral to an appropriate medical institution immediately following the first visit to a non-CT-capable facility. Cases not meeting this definition were defined as diagnostic errors that resulted in delayed diagnosis. Of the 439 cases of lower gastrointestinal perforation identified, delayed diagnosis occurred in 138 cases (31.4%). Multivariate logistic regression analysis revealed a significant association between examination by a non-generalist and delayed diagnosis. Other factors showing a tendency with delayed diagnosis included presence of fever, absence of abdominal tenderness, and unavailability of urgent radiology reports. Initial misdiagnoses were mainly gastroenteritis, constipation, and small bowel obstruction. In conclusion, diagnostic errors occurred in about one-third of patients with a lower gastrointestinal perforation.
Collapse
Affiliation(s)
- Taku Harada
- Division of General Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-ku, Tokyo, 135-8577, Japan. .,Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan.
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Enya-cho, Japan
| | - Satoshi Watanuki
- Division of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Juichi Hiroshige
- Division of General Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-ku, Tokyo, 135-8577, Japan
| | - Seiko Kushiro
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Taiju Miyagami
- Department of General Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Syunsuke Syusa
- Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Satoshi Suzuki
- Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Tetsuya Hiyoshi
- General Medicine Department, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigeki Nabeshima
- General Medicine Department, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Kotaro Kunitomo
- Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan
| | - Takahiro Tsuji
- Department of General Medicine, Kumamoto Medical Center, Kumamoto, Japan
| | - Masanori Hirose
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoya Tsuchida
- Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan
| |
Collapse
|
|
6
|
Tsuyuki T, Satou A, Takahara T, Nakajima K, Tsuzuki T. Prevalence and Clinicopathologic Features of Intestinal Perforation Caused by Segmental Absence of the Intestinal Musculature in Adults. Am J Surg Pathol 2021; 45:803-811. [PMID: 33481390 DOI: 10.1097/pas.0000000000001671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Segmental absence of the intestinal musculature (SAIM) can cause intestinal perforation in adults. However, its prevalence and clinicopathologic features have not been well-described. This study aimed to determine the prevalence of SAIM-associated perforation and characterize its clinicopathologic features. We retrospectively examined 109 cases of intestinal perforation that underwent surgical resection from January 2009 to December 2019. SAIM was defined as the complete absence of the muscularis propria without extensive inflammation and fibrinous exudation around the perforation. SAIM was the second most frequent cause of perforation (26 cases: 24%), the most frequent cause being related to diverticulitis (39 cases: 36%). The most common site was the sigmoid colon (12 cases: 46.2%). The younger group (aged below 65 y) exhibited more frequent perforation of the upper segments of the gastrointestinal tract (from the duodenum to the descending colon) than the older group (65 y and above) (P=0.0018). No patients developed recurrence. The most common gross features were well-defined circular or small punched-out lesions, and the histologic features were complete absence of the muscularis propria and absence of hemorrhage and necrosis around the area of perforation. The characteristic features of SAIM were unique and their prevalence was higher than previously reported. The precise recognition of SAIM can aid in understanding the cause of perforation and avoiding further unnecessary examinations.
Collapse
Affiliation(s)
- Takuji Tsuyuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| | - Kosei Nakajima
- Department of Surgical Pathology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute
| |
Collapse
|
|
7
|
Fecal Scrotal Abscess Secondary to Spontaneous Retroperitoneal Perforation of Ascending Colon. Case Rep Med 2021; 2021:6658083. [PMID: 33859700 PMCID: PMC8024077 DOI: 10.1155/2021/6658083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Fecal abscess or enterocutaneous fistulas of the scrotum are rare and are invariably the result of incarcerated bowel loop in inguinal hernia. Spontaneous perforation of the colon (SPC) having no definite cause is also rare. Much rarer is posterior colonic perforations causing an extensively large retroperitoneal abscess. Similarly, spread of retroperitoneal abscess to the thigh or scrotum has rarely been reported. We report a case of spontaneous posterior perforation of ascending colon resulting in large retroperitoneal abscess eventually causing scrotal abscess, which resolved on conservative treatment and drainage of the scrotal fecal abscess. Case Presentation. A 20-year-old male presented with gradually increasing noncolicky pain right side abdomen with nonprojectile vomiting, obstipation, and progressive abdominal distension. Clinically, the abdomen was tender with guarding over the right side with signs of inflammation on the right side back with no associated hernia. On conservative treatment, he was gradually improved but developed right side scrotal abscess a week later. CT abdomen showed a large retroperitoneal collection having multiple internal air lucencies, displacing ascending colon and caecum medically with discontinuity in the posterior wall of ascending colon. The large retroperitoneal collection was extending from right pararenal and posterior perihepatic soft tissue planes to the right iliac fossa and thigh. On drainage of the scrotal abscess, about 350 ml of fecal contents was evacuated. The patient gradually recovered and was discharged on conservative treatment with an uneventful 4-year follow-up. Conclusion Diagnosis of retroperitoneal perforation of the colon is often delayed due to the absence of peritoneal irritation. An extensively large retroperitoneal abscess may spread the infection to the scrotum and thigh due to extreme pressure, possibly by dissecting away the transversalis fascia through a deep ring along the side of the spermatic cord. Timely performed CT/MRI can avoid delay in the diagnosis of retroperitoneal abscess and further spread of infection.
Collapse
|
|
8
|
Prado A, Cruz RP. Spontaneous Perforation of the Colon - A possible Third Classification. Rev Assoc Med Bras (1992) 2021; 67:347-348. [DOI: 10.1590/1806-9282.20200897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
|
|
9
|
Al-Balas H, Al-Balas M, Al-Wiswasy M. Idiopathic spontaneous cecal perforation: A rare pathology with high mortality. Ann Med Surg (Lond) 2020; 60:518-521. [PMID: 33294185 PMCID: PMC7695924 DOI: 10.1016/j.amsu.2020.11.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Spontaneous perforation of the colon (SPC) is a rare disease characterized by sudden perforation of a clinically healthy colon in the absence of underlying disease or trauma. The aim of reporting this case is to highlight this surgical emergency in terms of clinical presentations, surgical management and outcomes. Presentation of case A 68 year-old male with history of diabetes mellitus, hypertension and chronic constipation on daily laxatives presented to the emergency department with a diffuse abdominal pain and distention for 4 days associated with vomiting and absence of defecation where he was prescribed phosphate rectal enemas. Patient was in sepsis with generalized abdominal tenderness and distention. Intraoperative findings of feculent peritonitis with isolated cecal perforation was identified, for which a right hemicolectomy with end ileostomy was performed. Discussion The first case was described in a woman presented with spontaneous rectum rupture by Brodie in 1827, with a less than 100 cases being reported in literature. In 1984, spontaneous perforations were classified into either "stercoral" or "idiopathic" perforations. More than 60% of colonic perforations were reported in the sigmoid or at the recto-sigmoid junction, mainly at the anti-mesenteric border, making spontaneous cecal perforation a very uncommon condition. Cecal perforation is associated with high mortality in the range of 30%-72%. Conclusion The outcome of SPC depends on multiple factors like onset of perforation, peritoneal contamination, and time of intervention. Regardless the surgical technique, early detection and surgical management are the main strategies associated with improving the outcomes.
Collapse
Affiliation(s)
- Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Jordan.,Department of Surgery, Prince Hamza Hospital, Amman, Jordan
| | - Mohammad Al-Wiswasy
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Jordan
| |
Collapse
|
|
10
|
Chongxi R, Jinggang J, Yan S, Hongqiao W, Yan L, Fengshuo Y. Spontaneous colonic perforation in adults: Evaluation of a pooled case series. Sci Prog 2020; 103:36850420945462. [PMID: 32993458 PMCID: PMC10451056 DOI: 10.1177/0036850420945462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann's operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features (p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication (p = 0.012, p = 0.044) and mortality (p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication (p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.
Collapse
Affiliation(s)
- Ren Chongxi
- Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, China
| | - Ji Jinggang
- Department of General Surgery, Cangzhou People’s Hospital, China
| | - Shi Yan
- Department of General Surgery, Gucheng County People’s Hospital, China
| | - Wang Hongqiao
- Department of General Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, China
| | - Liu Yan
- Department of Pathology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, China
| | - Yang Fengshuo
- Department of General Surgery, Cangzhou People’s Hospital, China
| |
Collapse
|
|
11
|
Lu WJ, Li G, Gao L. Colonic perforation in a nasopharyngeal carcinoma patient treated with fluorouracil: A case report. World J Clin Cases 2020; 8:1693-1697. [PMID: 32420303 PMCID: PMC7211521 DOI: 10.12998/wjcc.v8.i9.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a commonly encountered type of tumor. Fluorouracil (FU) is an effective treatment providing satisfactory oncologic outcomes in nasopharyngeal carcinoma patients. We describe a unique case of colonic perforation in an NPC patient treated with FU. Thus far, only two cases of intestinal perforation associated with FU treatment have been reported. We hope that the analysis of the relationship between the adverse effects of FU and physiological factors will help to reduce the incidence of colonic perforation in patients with nasopharyngeal carcinoma treated with FU.
CASE SUMMARY A 67-year-old female patient suffered from NPC stage pT3N2M0. She had a history of three surgical procedures: Partial enterectomy, partial sigmoidectomy, and sigmoidostomy. After the administration of 2.75 g FU, a bloody stool appeared and the patient developed abdominal pain. Subsequent examination indicated colitis and intestinal perforation.
CONCLUSION FU is a commonly used drug in NPC chemotherapy. The most common adverse effect of FU is gastrointestinal reaction, and the colonic perforation found here is thought to be caused by gastrointestinal mucosal injury consequential to the FU treatment. When selecting chemotherapy drugs, their side effects and the physical condition of patients should be considered, particularly in patients with a history of gastrointestinal surgery.
Collapse
Affiliation(s)
- Wei-Jia Lu
- Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Gong Li
- Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Lei Gao
- Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| |
Collapse
|
|
12
|
Yabunaka K, Nakagami G, Tabata K, Sugama J, Matsumoto M, Kido Y, Iuchi T, Sanada H. Constipation in the elderly in a Japanese long-term medical facility: An ultrasonographic investigation. Drug Discov Ther 2018; 12:233-238. [PMID: 30224595 DOI: 10.5582/ddt.2018.01033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aims to assess the fecal retention in elderly patients using colonic ultrasonography (US) in Japanese long-term care facility and determine the correlation between nutrition management methods and the fecal retention by US. This cross-sectional, single-center study was conducted in a long-term care facility in Japan. Patients with chronic constipation fulfilled the Rome III criteria for the diagnosis of functional constipation. US was performed on constipation patients with 4-day fecal retention before starting the standard management of constipation. After patients had defecated, nurses checked the outside of feces using King's Stool Chart and Bristol Stool Chart. All of 32 patients underwent the management of suppository laxative, the daily life independence level in grade C. In all cases, the King's Stool Chart did not detect > 200 g of fecal matter; the Bristol Stool Chart revealed type 5-7 in 56.2% of patients. The total parenteral nutrition and tube feeding did not completely detect type 1-2 in 0%. While the fecal retention groups comprised 15.6%, the non-fecal retention groups comprised 84.4%. The total parenteral nutrition did not completely detect the fecal retention in 0%. In the non-fecal retention groups, the King's Stool Chart indicated < 100 g in 81.8%, and the Bristol Stool Chart indicated type 5-7 in 100%. In conclusion, fecal properties of elderly constipation patients with the long-term parenteral nutrition should be assessed in follow-up examination by US, which is possible for personalized medical care by US, to avoid the administered regular management of constipation.
Collapse
Affiliation(s)
- Koichi Yabunaka
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
| | | | - Junko Sugama
- Institute for Frontier Science Initiative, Kanazawa University
| | - Masaru Matsumoto
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo
| | | | - Terumi Iuchi
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo
| |
Collapse
|
|
13
|
Choi YJ, Cho YH, Kim SH, Kim HY. Clinical implication of spontaneous gastrointestinal perforation in pediatric patients: its difference according to age group. Ann Surg Treat Res 2018; 95:141-146. [PMID: 30182020 PMCID: PMC6121166 DOI: 10.4174/astr.2018.95.3.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Spontaneous gastrointestinal perforations (SGIPs; not associated with injury or disease) occur rarely in pediatric patients. This study aimed to define age-specific features associated with SGIPs in pediatric patients. Methods Retrospectively reviewed the clinical data of children (before adolescence) who received surgery due to a SGIP at a single institution. Thirty-nine patients were enrolled. Characteristics were compared between the 2 age groups: neonates (group A) and beyond neonates (group B). Results Group A included 24 patients (61.5%) an group B included 15 patients (38.5%). Thirteen perforations occurred in the stomach (33.3%), 12 in the small intestine (30.8%), and 14 in the large intestine (35.9%). A significantly higher proportion of perforations occurred in the stomach and small intestine in group A, while more perforations occurred in the large intestine in group B (P = 0.01). Several associated conditions during the preoperative period were identified in both groups. The overall mortality rate was 15.4% (6 of 39). Mortality was relatively high in group A (5 of 24, 20.8%) and for perforations of stomach (3 of 13, 23.1%) and small intestine (3 of 12, 25.0%); however, there were no significant differences with regard to age or perforation site (P = 0.244, P = 0.122, respectively). Conclusion SGIPs in pediatric patients had diverse clinical features and different perforation patterns according to age group. However, no significant group differences in mortality were found. Thus, favorable results regardless of age can be expected with prompt recognition, medical resuscitation, and adequate surgical management.
Collapse
Affiliation(s)
- Young-Jin Choi
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo-Hong Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hae-Young Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
|
14
|
|
|
15
|
Poitras R, Warren D, Oyogoa S. Opioid drugs and stercoral perforation of the colon: Case report and review of literature. Int J Surg Case Rep 2017; 42:94-97. [PMID: 29232630 PMCID: PMC5730425 DOI: 10.1016/j.ijscr.2017.11.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022] Open
Abstract
Patient’s condition was further compounded by splenic rupture. Recovery was complicated by post-op sepsis and intraabdominal abscesses. Constipation may be missed due to encopresis and the analgesic effects of opioids. Introduction Stercoral perforation of the colon is a rare pathology, which is believed to be caused by an increased intraluminal pressure created by a fecaloma. Opioid induced constipation is a rare and often unsuspected cause of colonic perforation. Presentation of case We report the case of a 58-year-old woman, who presented to the emergency department (ED) with severe hypotension, abdominal pain and gastrointestinal bleeding. She was found to have a diffusely tender and distended abdomen. Her history was positive for long-term suboxone use and chronic constipation. Abdominopelvic computed tomography (CT) scan revealed a bowel perforation, ascites and fecal impaction. Emergency laparotomy revealed extensive stool in the peritoneal cavity as well as hemoperitoneum. There was a fecal bolus with perforation located in the sigmoid colon. On postoperative day (POD) six, a second abdominopelvic CT scan was performed and results revealed the necessity of a second exploratory laparotomy. She had multiple loculated abscesses within the small bowel and other areas, which were opened and washed out. Discussion Due to the inflating use of drugs in the opioid class, the recognition of this pathology has become increasingly important. The action of the drug on the mu-opioid receptors, any patients taking opioid medications are at risk for constipation progressing to stercoral perforation and should be monitored closely. Conclusion Patients presenting with chronic constipation, fecal impaction on imaging and clinical signs of peritonitis or sepsis, should consider stercoral perforation in their differential diagnosis since early detection is key to reduce mortality rates in these cases.
Collapse
Affiliation(s)
- Renée Poitras
- Avalon University School of Medicine, Youngstown, OH, United States.
| | - Daun'Lee Warren
- Avalon University School of Medicine, Youngstown, OH, United States
| | - Sylvanus Oyogoa
- Department of General Surgery, Raleigh General Hospital, Beckley, WV, United States
| |
Collapse
|
|
16
|
Aguilera JFC, Lugo REA, Luna AW. [Stercoral perforation of the colon: case report and literature review]. Medwave 2016; 15:e6108. [PMID: 26000348 DOI: 10.5867/medwave.2015.02.6108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Colon perforation has several causes, including stercoral perforation of the colon, which was first described in 1894. Currently, reported cases are fewer than 100. CASE REPORT Male patient of 67 years old, treated at Huichapan General Hospital, Hidalgo, Mexico, with abdominal pain, bloating and no bowel movements. He referred being constipated for the last ten years. Imaging revealed an extremely dilated sigmoid colon with fecal matter as well as free gas in the peritoneal cavity. The suspicion of stercoral colonic perforation is established. Exploratory laparotomy was performed immediately, finding a perforation and a hard scybalum protruding in the ascending colon. Colectomy, ileostomy and Hartmann's pouch are performed. After surgery, the condition of the patient worsened and progressed to septic shock and respiratory failure. The patient died four hours after surgery, with the diagnosis of organ failure due to sepsis. LITERATURE REVIEW Stercoral perforation accounts for 3.2% of all colon perforations and is caused by a rupture of the intestinal wall through direct pressure of a fecaloma on the colon. It occurs especially in patients older than 70 years with severe chronic constipation, weakened and/or are hospitalized with multiple medications and immobilized. CONCLUSIONS Stercoral perforation of the colon is a rare cause of bowel perforation, which should be suspected in patients with a history of chronic constipation, acute abdominal pain, bloating and sepsis, in order to intervene in a timely fashion.
Collapse
|
|
17
|
Kim SH, Cho YH, Kim HY. Spontaneous Perforation of Colon in Previously Healthy Infants and Children: Its Clinical Implication. Pediatr Gastroenterol Hepatol Nutr 2016; 19:193-198. [PMID: 27738601 PMCID: PMC5061661 DOI: 10.5223/pghn.2016.19.3.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 03/28/2016] [Accepted: 05/12/2016] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Spontaneous colon perforations are usually encountered as necrotizing enterocolitis in the neonatal period, but occur rarely in infants and children without pathological conditions. This study was conducted to describe its clinical implication beyond the neonatal period. METHODS Cases of spontaneous colon perforation confirmed after the operation were reviewed retrospectively and the clinicopathological characteristics were analyzed. Clinical data were compared according to the presence of pneumoperitoneum as initial findings. RESULTS Eleven patients were included in the study period and showed a history of hospitalization before transfer due to management for fever, respiratory or gastrointestinal problems. Six patients showed a sudden onset of abdominal distention and only seven patients showed a pneumoperitoneum as initial radiologic findings, however there were no significant clinicopathological differences. Perforation was found evenly in all segments of the colon, most commonly at the sigmoid colon in four cases. There were no specific pathologic or serologic causes of perforation. CONCLUSION When previously healthy infants and children manifest a sustained fever with a sudden onset of abdominal distention during management for fever associated with respiratory or gastrointestinal problems, there is a great likelihood of colon perforation with no pathological condition. Prompt surgical management as timely decision-making is necessary in order to achieve a good progress.
Collapse
Affiliation(s)
- Soo-Hong Kim
- Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea
| | - Yong-Hoon Cho
- Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea
| | - Hae-Young Kim
- Department of Pediatric Surgery, Pusan National University Children's Hospital, Yangsan, Korea
| |
Collapse
|
|
18
|
Verres needle desufflation as an effective treatment option for colonic perforation after colonoscopy. Surg Laparosc Endosc Percutan Tech 2016; 25:e61-4. [PMID: 24752169 DOI: 10.1097/sle.0000000000000058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study aimed to assess the incidence of colonoscopic perforation and the efficacy of minimal invasive management by Verres needle desufflation. MATERIALS AND METHODS All colonoscopies performed between January 2007 and January 2012, at the Maastricht University Medical Centre, were reviewed. RESULTS During the study period, 18,449 colonoscopies were performed. Fourteen colonoscopic perforations were diagnosed. Seven patients underwent immediate surgery, whereas the remaining 7 patients were initially managed conservatively: 5 of these patients also underwent Verres needle desufflation. One of the patients who received Verres needle desufflation underwent secondary surgery because of failure of nonsurgical treatment. Conservative management of colonoscopic perforation, including treatment with Verres needle desufflation, was associated with lower complication rates and shorter hospital stays compared with immediate surgical intervention. CONCLUSIONS Verres needle desufflation in combination with nil per os and antibiotic treatment is a safe option for managing colon perforation after colonoscopy in selected patients lacking clinical signs of peritonitis or sepsis.
Collapse
|
|
19
|
Miller D. Tension Pneumoperitoneum Caused by Obstipation. West J Emerg Med 2015; 16:777-80. [PMID: 26587109 PMCID: PMC4644053 DOI: 10.5811/westjem.2015.6.25283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/13/2015] [Accepted: 06/03/2015] [Indexed: 11/11/2022] Open
Abstract
Emergency physicians are often required to evaluate and treat undifferentiated patients suffering acute hemodynamic compromise (AHC). It is helpful to apply a structured approach based on a differential diagnosis including all causes of AHC that can be identified and treated during a primary assessment. Tension pneumoperitoneum (TP) is an uncommon condition with the potential to be rapidly fatal. It is amenable to prompt diagnosis and stabilization in the emergency department. We present a case of a 16-year-old boy with TP to demonstrate how TP should be incorporated into a differential diagnosis when evaluating an undifferentiated patient with AHC.
Collapse
Affiliation(s)
- Daniel Miller
- University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
| |
Collapse
|
|
20
|
Saturnino PP, Pinto A, Liguori C, Ponticiello G, Romano L. Role of Multidetector Computed Tomography in the Diagnosis of Colorectal Perforations. Semin Ultrasound CT MR 2015; 37:49-53. [PMID: 26827738 DOI: 10.1053/j.sult.2015.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Colonic perforations can be classified into perforations that occur at the site of a localized pathologic process and cecal perforations that occur secondary to distal colonic obstructions. Rectal perforations may result from foreign bodies inserted into the rectum; moreover, deep rectal biopsies, polypectomy, improper cleansing enema, or thermometer placement may also lead to rectal perforation. Correct identification of the cause and site of the perforation is crucial for appropriate management and surgical planning. Multidetector row computed tomography has a pivot role in planning the type of operative treatment, the prognosis, and in assessing those patients who have clinical symptoms of peritonitis but no radiographic signs of perforation.
Collapse
Affiliation(s)
| | - Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | | | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| |
Collapse
|
|
21
|
Yabunaka K, Matsuo J, Hara A, Takii M, Nakagami G, Gotanda T, Nishimura G, Sanada H. Sonographic Visualization of Fecal Loading in Adults. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479314566045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this study was to compare ultrasonographic assessment of fecal loading in adults with that of computed tomography. Ultrasonography (US) was performed on 43 adult patients immediately after abdominal computed tomography images had identified fecal loading in their colons. In 18 of 43 patients (haustrations-visualized cases), fecal loading was detected as crescent-shaped acoustic shadows associated with haustrations behind the strong echoes off the colon wall. In the remaining 25 patients (haustrations-not-visualized cases), fecal loading was detected as attenuating echoes with multiple high echoic spots behind weak high echoes off the colon wall in 17 patients and similar to those seen in the haustrations-visualized cases but without haustrations in 8 patients. US can be used for qualitative assessment of fecal loading in the colon. This new technique is simple and noninvasive and can be used concomitantly with physical examination to assess severity of constipation.
Collapse
Affiliation(s)
- Koichi Yabunaka
- Department of Ultrasound, Katsuragi Hospital, Japan
- Department of Gerontological Nursing/Wound Care Management, the University of Tokyo, Tokyo, Japan
| | - Jyunko Matsuo
- Faculty of Nursing, Osaka Medical College, Osaka, Japan
| | - Akiko Hara
- Faculty of Nursing, Osaka Medical College, Osaka, Japan
| | | | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, the University of Tokyo, Tokyo, Japan
| | - Tatsuhiro Gotanda
- Department of Radiological Science, Junshin Gakuen University, Fukuoka, Japan
| | - Genichi Nishimura
- Department of Surgery, Japanese Red Cross Kanazawa Hospital, Ishikawa, Japan
| | - Hiromi Sanada
- Faculty of Nursing, Osaka Medical College, Osaka, Japan
| |
Collapse
|
|
22
|
Segmental muscular defects of the intestine: a possible cause of spontaneous perforation of the bowel in adults. Hum Pathol 2013; 44:2643-50. [DOI: 10.1016/j.humpath.2013.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/30/2013] [Accepted: 07/03/2013] [Indexed: 12/22/2022]
|
|
23
|
Chakma SM, Singh RL, Parmekar MV, Singh KHG, Kapa B, Sharatchandra KH, Longkumer AT, Rudrappa S. Spectrum of perforation peritonitis. J Clin Diagn Res 2013; 7:2518-20. [PMID: 24392388 DOI: 10.7860/jcdr/2013/5768.3596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 08/14/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Perforation peritonitis mostly results from the perforation of a diseased viscus. Other causes of perforation include abdominal trauma, ingestion of sharp foreign body and iatrogenic perforation. The diagnosis is mainly based on clinical grounds. Plain abdominal X-rays (erect) may reveal dilated and oedematous intestines with pneumoperitoneum. Ultrasound and CT scan may diagnose up to 72% and 82% of perforation respectively. The present study was carried out to study various etiological factors, modes of clinical presentation, morbidity and mortality patterns of perforation peritonitis presented in the RIMS hospital, Imphal, India. MATERIAL AND METHODS The study was conducted from September 2010 to August 2012 on 490 cases of perforation peritonitis admitted and treated in the Department of Surgery. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. RESULTS A total of 490 patients of perforation peritonitis were included in the study, with mean age of 48.28 years. 54.29% patients were below 50 years and 45.71% patients were above 50 years. There were 54.29% male patients and 45.71% female patients. Only 30% patients presented within 24 hours of onset of symptoms, 31.43% patients presented between 24 to 72 hours and 38.57% patients presented 72 hours after the onset of symptoms. Mean duration of presentation was 54.7 hours. Overall 469 patients were treated surgically and 21 patients were managed conservatively. Overall morbidity and mortality recorded in this study were 52.24% and 10% respectively.
Collapse
Affiliation(s)
- Sujit M Chakma
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - Rahul L Singh
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - Mahadev V Parmekar
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - K H Gojen Singh
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - Buru Kapa
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - K H Sharatchandra
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - Amenla T Longkumer
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| | - Santhosh Rudrappa
- Final year PGT, Surgery, Regional Institute of Medical Sciences (RIMS) , Imphal, India
| |
Collapse
|
|
24
|
Gourgiotis S, Liakos N, Gemenetzis G, Seretis C, Aloizos S, Vougas V, Drakopoulos S. Less Common Nontraumatic Bowel Perforations: Diagnosis and Management through a Retrospective Study. Am Surg 2013. [DOI: 10.1177/000313481307900427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nontraumatic bowel perforation has always been a consideration because of associated morbidity and mortality. The aim of this study is to define etiologies, treatment, and outcomes as well as to highlight difficulties in the diagnosis and management of nontraumatic bowel perforation. We conducted a retrospective study of 35 patients with less common nontraumatic bowel perforations hospitalized during a six-year period. The most common cause was ulcerative colitis (34.3%). Abdominal pain was the constant symptom. Physical examination showed signs of peritoneal irritation in 29 cases. The abdominal radiograph failed to reveal abnormal findings in two patients; the abdominal computed tomography scan confirmed the diagnosis in all cases. Twenty patients (57.1%) were operated on within 24 hours of developing perforation, whereas seven patients (20%) were initially misdiagnosed. Most of the perforations were located only in the large intestine (60%). There was only one perforation in 25 patients (71.5%) and two or more perforations in 10 patients (28.5%). Many less common diseases are responsible for the spontaneous perforation of the bowel. Early diagnosis before the patient's general condition deteriorates decreases mortality and morbidity rates. Adequate resuscitation and emergency laparotomy followed by resection with or without anastomosis remains the treatment of choice.
Collapse
Affiliation(s)
- Stavros Gourgiotis
- Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece; and the
| | - Nikolaos Liakos
- Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece; and the
| | - George Gemenetzis
- Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece; and the
| | - Charalampos Seretis
- Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece; and the
| | - Stavros Aloizos
- Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece; and the
| | - Vasilis Vougas
- First Surgical Department, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Spyros Drakopoulos
- First Surgical Department, “Evangelismos” General Hospital of Athens, Athens, Greece
| |
Collapse
|
|
25
|
Ulbricht C, Conquer J, Costa D, Hamilton W, Higdon ERB, Isaac R, Rusie E, Rychlik I, Serrano JMG, Tanguay-Colucci S, Theeman M, Varghese M. An evidence-based systematic review of senna (Cassia senna) by the Natural Standard Research Collaboration. J Diet Suppl 2012; 8:189-238. [PMID: 22432689 DOI: 10.3109/19390211.2011.573186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
An evidence-based systematic review, including written and statistical analysis of scientific literature, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
Collapse
|
|
26
|
|
|
27
|
Kurane SB, Kurane BT. Idiopathic colonic perforation in adult-a rare case. Indian J Surg 2010; 73:63-4. [PMID: 22211042 DOI: 10.1007/s12262-010-0127-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 01/02/2009] [Indexed: 01/17/2023] Open
Abstract
Idiopathic perforation of normal colon in adults is rare. The cause for idiopathic perforation is not known. We report a case of idiopathic colonic perforation in adult who presented with sign and symptoms of perforative peritonitis. On laparotomy patient was diagnosed to have a colonic perforation. There was no causative factor for perforation in the patient. This case is reported because of rarity of this disease.
Collapse
Affiliation(s)
- Sanjot B Kurane
- Ganga Hospital, Miraj Bharati Vidyapeeth Medical College and Hospital Sangli, Sangli, Maharashtra India
| | | |
Collapse
|
|
28
|
Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Yamamichi N, Omata M. Feasibility of endoscopic submucosal dissection for patients with chronic renal failure on hemodialysis. Dig Endosc 2010; 22:45-48. [PMID: 20078664 DOI: 10.1111/j.1443-1661.2009.00927.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is expected as a curative method for node-negative gastrointestinal cancers. Little is known about ESD for patients with end-stage chronic renal failure (CRF) on hemodialysis. We aimed to evaluate the efficacy and safety of ESD for patients with CRF on hemodialysis. METHODS Ten consecutive patients with 12 lesions who underwent ESD (stomach, seven; colorectum, three) between March 2002 and August 2007 were retrospectively investigated in terms of the technical feasibility and complications. RESULTS All the lesions were resected in a single piece and en-bloc and R0 resection rate was 100%. Histology revealed that all the lesions fulfilled the criteria of node-negative cancers. Delayed bleeding requiring blood transfusion on the day after ESD, and shunt occlusion, which necessitated a radiological intervention 7 days after ESD, occurred in one stomach case. Delayed perforation followed by emergency surgery 2 days after ESD occurred in one colorectal case. CONCLUSIONS ESD for CRF patients may be technically feasible, but substantial risks should be considered. Early detection of late-onset complications is essential with intensive medical check-up for at least 1 week in order to prevent complications from becoming severe.
Collapse
Affiliation(s)
- Osamu Goto
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|