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Sample records for intestinal perforation

  1. Intestinal perforation by an ingested foreign body*

    PubMed Central

    Nicolodi, Gabriel Cleve; Trippia, Cesar Rodrigo; Caboclo, Maria Fernanda F. S.; de Castro, Francisco Gomes; Miller, Wagner Peitl; de Lima, Raphael Rodrigues; Tazima, Leandro; Geraldo, Jamylle

    2016-01-01

    Objective To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation. PMID:27818542

  2. Spontaneous free perforation of the small intestine in adults

    PubMed Central

    Freeman, Hugh James

    2014-01-01

    Spontaneous free perforation of the small intestine is uncommon, especially if there is no prior history of visceral trauma. However, free, even recurrent, perforation may complicate a defined and established clinical disorder, such as Crohn’s disease. In addition, free perforation may be the initial clinical presentation of an occult intestinal disorder, such as a lymphoma complicating celiac disease, causing diffuse peritonitis and an acute abdomen. Initial diagnosis of the precise cause may be difficult, but now has been aided by computerized tomographic imaging. The site of perforation may be helpful in defining a cause (e.g., ileal perforation in Crohn’s disease, jejunal perforation in celiac disease, complicated by lymphoma or collagenous sprue). Urgent surgical intervention, however, is usually required for precise diagnosis and treatment. During evaluation, an expanding list of other possible causes should be considered, even after surgery, as subsequent management may be affected. Free perforation may not only complicate an established intestinal disorder, but also a new acute process (e.g., caused by different infectious agents) or a longstanding and unrecognized disorder (e.g., congenital, metabolic and vascular causes). Moreover, new endoscopic therapeutic and medical therapies, including use of emerging novel biological agents, have been complicated by intestinal perforation. Recent studies also support the hypothesis that perforation of the small intestine may be genetically-based with different mutations causing altered connective tissue structure, synthesis and repair. PMID:25110427

  3. Systemic lupus erythematosus with intestinal perforation: A case report

    PubMed Central

    GU, YUQING; ZHU, TAO; WANG, YIQING; XU, HONGXING

    2015-01-01

    Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease, which can affect almost all systems and organs. Gastrointestinal disorder is one of the most noteworthy complications of patients with SLE. However, gastrointestinal disorder with intestinal perforation is rare, but potentially life-threatening if not treated promptly. The present study reported a case of SLE with intestinal perforation, where surgical intervention was performed and a crevasse (~3 cm in diameter) was detected in the ileum, ~60 cm from the ileocecal valve. Following surgery, the patient suffered from difficult ventilator weaning, septic shock and intestinal obstruction. The patient was successfully treated and discharged from the hospital after ~4 months of treatment. Intestinal perforation in SLE patients is potentially life-threatening; early diagnosis and prompt treatment are crucial to the management of this rare complication of SLE. PMID:26622471

  4. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

    PubMed Central

    Shin, Rumi; Lee, Sang Mok; Sohn, Beonghoon; Lee, Dong Woon; Song, Inho; Chai, Young Jun; Lee, Hae Won; Ahn, Hye Seong; Jung, In Mok; Chung, Jung Kee

    2016-01-01

    Purpose An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. Methods We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. Results The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. Conclusion Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites. PMID:28119865

  5. [Intestinal perforation due to multiple magnet ingestion: a case report].

    PubMed

    Cevizci, Mehmet Nuri; Karadağ, Cetin Ali; Demir, Mesut; Dokucu, Ali Ihsan

    2012-03-01

    Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.

  6. Tuberculosis infection causing intestinal perforations in 2 patients with systemic lupus erythematosus.

    PubMed

    González, Luis A; Muñoz, Carolina; Restrepo, Mauricio; Vanegas, Adriana Lucía; Vásquez, Gloria

    2014-08-01

    Patients with systemic lupus erythematosus (SLE) have a higher incidence rate of tuberculosis and a more frequent extrapulmonary involvement than the general population. We present 2 SLE patients who developed gastrointestinal tuberculosis complicated with intestinal perforation, a rare but serious complication that could be confused with lupus-associated intestinal vasculitis. Opportunistic infections such as tuberculosis must be suspected in SLE patients with abdominal symptoms on immunosuppressive therapy because its early recognition could prevent catastrophic complications such as intestinal perforation and subsequent peritonitis.

  7. Intestinal perforations in a premature infant caused by Bacillus cereus.

    PubMed

    Girisch, M; Ries, M; Zenker, M; Carbon, R; Rauch, R; Hofbeck, M

    2003-06-01

    Although Bacillus cereus is a ubiquitous bacterium, the incidence of neonatal infections is very low with only a few cases of B. cereus infections in neonates reported in the literature. We report the case of a premature infant with multiple intestinal perforations and an abdominal B. cereus infection. The initial course was characterized by severe cardiovascular shock, anemia, thrombocytopenia and disseminated intravascular coagulation, leading to periventricular leukomalacia, alopecia capitis and toxic epidermal necrolysis. The possible role of B. cereus-associated enterotoxins for the clinical manifestations are discussed. Our case confirms previous reports of severe clinical symptoms in B. cereus infection in premature neonates. We speculate that the systemic complications of B. cereus infection are at least partly related to the effect of B. cereus-associated enterotoxins.

  8. Successful treatment of extensive intestinal perforations from Behcet's disease involving the whole gut: a case report.

    PubMed

    Zhang, Shu-Cheng; Wang, Wei-Lin

    2013-10-01

    Intestinal perforation resulting from Behcet's disease has been previously well recognized. To date, fewer than 100 cases of this nature have been reported. Nearly the entire digestive system can be involved, including esophageal, gastric, duodenal, ileum, colon and anal tissues. Most of the reported perforations are single or assembled. Herein, an 8-year-old Chinese girl who developed Behcet's disease with extensive intestinal perforations throughout the gut was successfully treated and is presented. The diagnosis of Behcet's disease was established based on the typical presentations of recurrent oral aphthous ulcers, genital ulcers, typical eye lesions and a positive skin prick test. The extensive intestinal perforations were confirmed by laparotomy. Taking her developmental requirements into consideration, a simple perforation repair was carried out, followed by routine administration of immunosuppressive treatment, and the symptoms were temporarily relieved. Unfortunately, another ileocecal perforation occurred after 1.5 years, and an ileocolectomy was carried out. After the procedure, the girl recovered well. Clinicians should be aware of Behcet's disease as a unique source of intestinal perforation. Although it is encountered rarely in clinical settings, this condition should be considered in each case of intestinal perforation. An ileocolectomy was the necessary choice for radical treatment, even in the case of a pediatric patient.

  9. Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants with Spontaneous Intestinal Perforation or Surgical Necrotizing Enterocolitis

    PubMed Central

    Wadhawan, Rajan; Oh, William; Hintz, Susan R; Blakely, Martin L; Das, Abhik; Bell, Edward F.; Saha, Shampa; Laptook, Abbot R.; Shankaran, Seetha; Stoll, Barbara J.; Walsh, Michele C.; Higgins, Rosemary D.

    2013-01-01

    Objective To determine if extremely low birth weight infants with surgical necrotizing enterocolitis have a higher risk of death or neurodevelopmental impairment and neurodevelopmental impairment among survivors (secondary outcome) at 18–22 months corrected age compared to infants with spontaneous intestinal perforation and infants without necrotizing enterocolitis or spontaneous intestinal perforation. Study Design Retrospective analysis of the Neonatal Research Network very low birth weight registry, evaluating extremely low birth weight infants born between 2000–2005. The study infants were designated into 3 groups: 1) Spontaneous intestinal perforation without necrotizing enterocolitis; 2) Surgical necrotizing enterocolitis (Bell's stage III); and 3) Neither spontaneous intestinal perforation nor necrotizing enterocolitis. Multivariate logistic regression analysis was performed to evaluate the association between the clinical group and death or neurodevelopmental impairment, controlling for multiple confounding factors including center. Results Infants with surgical necrotizing enterocolitis had the highest rate of death prior to hospital discharge (53.5%) and death or neurodevelopmental impairment (82.3%) compared to infants in the spontaneous intestinal perforation group (39.1% and 79.3%) and no necrotizing enterocolitis/no spontaneous intestinal perforation group (22.1% and 53.3%; p<0.001). Similar results were observed for neurodevelopmental impairment among survivors. On logistic regression analysis, both spontaneous intestinal perforation and surgical necrotizing enterocolitis were associated with increased risk of death or neurodevelopmental impairment (adjusted OR 2.21, 95% CI: 1.5, 3.2 and adjusted OR 2.11, 95% CI: 1.5, 2.9 respectively) and neurodevelopmental impairment among survivors (adjusted OR 2.17, 95% CI: 1.4, 3.2 and adjusted OR 1.70, 95% CI: 1.2, 2.4 respectively). Conclusions Spontaneous intestinal perforation and surgical necrotizing

  10. Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

    PubMed Central

    Contini, Sandro

    2017-01-01

    Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation (TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical- and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short- to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient’s conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality. PMID:28373758

  11. A Rare Case of Mycosis Fungoides in the Oral Cavity and Small Intestine Complicated by Perforation

    PubMed Central

    Emge, Drew Arthur; Bassuner, Juri; Lewis, Daniel J.; Duvic, Madeleine

    2016-01-01

    Extracutaneous involvement in mycosis fungoides (MF) carries a poor prognosis. Oral and gastrointestinal (GI) tract lesions are both rare locations of disease. We describe the clinical findings of one case with oral and GI MF complicated by perforation after systemic antineoplastic treatment, and review the relevant literature. The patient had a 1-year history of MF before development of tongue and palate tumors. He was treated with local electron beam radiation, but re-presented to the hospital after what was found to be small intestine perforation following systemic antineoplastic therapy. The case reveals key insights into the progression and complications of lymphomas with GI tract involvement. PMID:27920681

  12. Intestinal obstruction and perforation--the role of the gastroenterologist.

    PubMed

    Díte, Petr; Lata, Jan; Novotný, Ivo

    2003-01-01

    Intestinal obstruction belongs to highly severe conditions in gastroenterology, namely from the viewpoint of quick and correct diagnosis as well as at determining rational and effective therapy. Etiological multifactorial characteristics leading to processes resulting in mechanical or dynamic obstruction of the intestine, often referred to as paralytic ileus, are undoubtedly serious factors influencing the accuracy of diagnosis and therapeutic approach. Digestive endoscopy is a mandatory method in the diagnosis of intestinal obstructions. Diagnostic endoscopy, colonoscopy in the involvement of the large intestine or enteroscopy in the case of incomplete obstruction of the small intestine are the methods indicated in the majority of obstructive intestinal lesions. Besides their diagnostic importance, they also enable an effective therapeutic approach which may immediately follow the diagnostic intervention. Besides endoscopy that--due to the nature of performance--belongs to invasive methods, the diagnosis of obstructive intestinal processes is unthinkable without the use of non-invasive imaging methods. Abdominal ultrasound examination, a widely applied method, provides--under optimal examination conditions--information, e.g., about the width of the intestinal lumen or about the intestinal wall thickness; however, the specificity of investigation is not always sufficient. Both specificity and sensitivity of exploration are increased by a plain X-ray of the abdomen supplementing the ultrasound examination. Better results are achieved when the abdominal cavity is inspected by means of spiral CT examination that is nowadays not fashionable but highly effectively applied in the modification of the so-called CT enteroclysis or CT colonography. The usage of magnetic resonance (e.g. virtual colonography) is similar, but its efficacy is lower than that of CT examination. From a gastroenterologist's perspective, endoscopic examination is the fundamental diagnostic and

  13. Intestinal Perforation Due to Foreign Body Ingestion in a Schizophrenic Patient

    PubMed Central

    Zarei, Mina; Shariati, Behnam; Bidaki, Reza

    2016-01-01

    Introduction Ingestion of foreign bodies has been previously reported in some patients with schizophrenia. This behavior may be a manifestation of delusional beliefs or a response to command hallucinations and can lead to severe complications. Case Presentation This paper reports a patient with schizophrenia who, as a manifestation of his illness, ingested a metallic skewer to kill ademon inside his abdomen that he believed was controlling him. As a result, he developed an acute intestinal perforation and underwent surgery. Conclusions It is of a great importance to closely monitor the therapy compliance of patients suffering from mental illnesses. This will benefit them by preventing some of the serious complications of their disease, which may include life-threatening conditions such as intestinal perforation that needs surgical intervention. PMID:27803892

  14. Fetal intestinal perforation and meconium peritonitis associated with maternal autoimmune hepatitis.

    PubMed

    Charlagorla, P; Sublett, S; Sy, F; Kessler, E; Gad, A

    2014-01-01

    Autoimmune hepatitis (AIH) in pregnancy can affect both fetal and maternal outcomes. Little is known regarding the fetal outcomes of AIH in pregnancy. The major risks include spontaneous abortions, fetal mortality, perinatal mortality and prematurity. Two common drugs used in the management of AIH, azathioprine and prednisone, may also be associated with adverse fetal outcomes. We present the case of perinatal focal intestinal perforation with a meconium pseudocyst in a preterm infant of a mother with autoimmune hepatitis on azathioprine and methylprednisone.

  15. A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child.

    PubMed

    Baheti, Akshay D; Otjen, Jeffrey P; Phillips, Grace S

    2017-03-01

    Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation. Our case illustrates a constellation of complications in association with a long-standing trichobezoar.

  16. Henoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review

    PubMed Central

    Lerkvaleekul, Butsabong; Treepongkaruna, Suporn; Saisawat, Pawaree; Thanachatchairattana, Pornsri; Angkathunyakul, Napat; Ruangwattanapaisarn, Nichanan; Vilaiyuk, Soamarat

    2016-01-01

    Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications. PMID:27468201

  17. A rare case of perforation of the subhepatic appendix by a toothpick in a patient with intestinal malrotation: laparoscopic approach

    PubMed Central

    GRASSI, V.; DESIDERIO, J.; CACURRI, A.; GEMINI, A.; RENZI, C.; CORSI, A.; BARILLARO, I.; PARISI, A.

    2016-01-01

    Foreign body ingestion is not an uncommon problem in clinical practice. While most ingested foreign bodies pass uneventfully through the gastrointestinal tract, sharp foreign bodies such as toothpicks should cause intestinal perforation. We reported the case of a perforation of the appendix caused by a toothpick, which also pierced the liver without hepatic damages, in a male with an intestinal malrotation and subhepatic appendix. The patient was admitted to our hospital for abdominal pain in the right upper quadrant. An abdominal computed tomography scan revealed the anomalous position of the first portion of the large intestine with inflamed appendix. A laparoscopic appendicectomy and the exploration of the abdominal cavity was performed using minimally invasive technique. PMID:27938532

  18. [Intestinal perforation in a Tunisian woman: peritonitis due to a fishbone].

    PubMed

    Abid, M; Derbel, R; Annabi, S; Guirat, A; Mzali, R; Frikha, M F; Ben Amar, M; Beyrouti, M I

    2010-02-01

    Diagnosis of foreign body perforation of the gastrointestinal tract can be difficult. The purpose of this report is to describe a case of acute peritonitis after perforation of the ileum by a fish bone that was detected by computed tomography.

  19. Small bowel and colon perforation.

    PubMed

    Brown, Carlos V R

    2014-04-01

    For patients with small bowel and colonic perforations, a definitive diagnosis of the cause of perforation is not necessary before operation. Bowel obstruction and inflammatory bowel disease are the most common causes of nontraumatic intestinal perforations in industrialized countries, whereas infectious causes of intestinal perforations are more common in developing countries. Treatment of small bowel and colonic perforations generally includes intravenous antibiotics and fluid resuscitation, but the specific management of the bowel depends on the underlying cause of the perforation.

  20. Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants

    PubMed Central

    Kelleher, John; Salas, Ariel A.; Bhat, Ramachandra; Ambalavanan, Namasivayam; Saha, Shampa; Stoll, Barbara J.; Bell, Edward F.; Walsh, Michele C.; Laptook, Abbot R.; Sánchez, Pablo J.; Shankaran, Seetha; VanMeurs, Krisa P.; Hale, Ellen C.; Newman, Nancy S.; Ball, M. Bethany; Das, Abhik; Higgins, Rosemary D.; Peralta-Carcelen, Myriam

    2014-01-01

    OBJECTIVE: Prophylactic indomethacin reduces severe intraventricular hemorrhage but may increase spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants. Early feedings improve nutritional outcomes but may increase the risk of SIP. Despite their benefits, use of these therapies varies largely by physician preferences in part because of the concern for SIP. METHODS: This was a cohort study of 15 751 ELBW infants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 1999 to 2010 who survived beyond 12 hours after birth. The risk of SIP was compared between groups of infants with and without exposure to prophylactic indomethacin and early feeding in unadjusted analyses and in analyses adjusted for center and for risks of SIP. RESULTS: Among infants exposed to prophylactic indomethacin, the risk of SIP did not differ between the indomethacin/early-feeding group compared with the indomethacin/no-early-feeding group (adjusted relative risk [RR] 0.74, 95% confidence interval [CI] 0.49–1.11). The risk of SIP was lower in the indomethacin/early-feeding group compared with the no indomethacin/no-early-feeding group (adjusted RR 0.58, 95% CI 0.37–0.90, P = .0159). Among infants not exposed to indomethacin, early feeding was associated with a lower risk of SIP compared with the no early feeding group (adjusted RR 0.53, 95% CI 0.36–0.777, P = .0011). CONCLUSIONS: The combined or individual use of prophylactic indomethacin and early feeding was not associated with an increased risk of SIP in ELBW infants. PMID:25349317

  1. Intestinal Obstruction

    MedlinePlus

    ... Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of the Digestive ... Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of the Digestive ...

  2. A rare cause of small bowel perforation by intestinal and peritoneal tuberculosis.

    PubMed

    Uranüs, S

    1990-02-01

    Tuberculosis of the intestine and peritoneum has become a rare disease. This is the result of a general decrease in pulmonary and extrapulmonary tuberculosis, rigorous BCG vaccination programs, and the eradication of tuberculosis in cattle. A case of tuberculosis in this frequent location, which was discovered unexpectedly during an emergency laparotomy, is reportet.

  3. Magnet-associated intestinal perforation results in a new institutional policy of ferromagnetic screening prior to MRI.

    PubMed

    Baines, Hayley; Saenz, Nicholas C; Dory, Christopher; Marchese, Sara M; Bernard-Stover, Laurie

    2012-12-01

    Foreign body ingestions are common and the vast majority pass through the gastrointestinal tract without complication. Some ingestions, however, result in serious morbidity and mortality. We present a case in which the patient's chief complaint of severe posterior neck pain was unrelated to his foreign body ingestion (multiple magnets). The ingestion of magnets was not disclosed by the child to either the providing medical team or to the patient's family. In order to evaluate the patient's complaint of severe focal neck pain, MRI of the neck was performed. The authors believe it to be feasible that the MRI scan resulted in intestinal perforations that might not have occurred during the natural course of the ingestion. This complication might have been prevented if the patient had undergone screening with a ferromagnetic detector prior to entering the MRI suite. Because of the serious complications related to this case, all pediatric patients at our institution are now screened with ferromagnetic detectors prior to entering the MRI suite. We encourage nationwide policy revision to prevent further incidents similar to the one described in this case.

  4. [A case of fixing an anastomotic site to the abdominal wall out of the abdominal cavity for a small intestinal perforation during chemotherapy].

    PubMed

    Takahashi, Kazutaka; Harano, Masao; Kato, Takuya; Yoshida, Kazuhiro; Sato, Daisuke; Choda, Yasuhiro; Tokumoto, Noriaki; Kanazawa, Takashi; Matsukawa, Hiroyoshi; Ojima, Yasutomo; Idani, Hitoshi; Shiozaki, Shigehiro; Okajima, Masazumi; Ninomiya, Motoki

    2014-11-01

    A 53-year-old man presented with a continuous high fever and was diagnosed with diffuse large B-cell lymphoma with metastasis to the lung, spleen, and mesenterium. He was treated with cyclophosphamide and prednisolone followed by administration of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy 20 days later. Two days after initiation of CHOP therapy, the patient complained of severe abdominal pain. Perforative peritonitis was diagnosed using abdominal computed tomography. A perforation of the small intestine approximately 160 cm distal to the Treitz ligament was uncovered during emergency laparotomy. The risk of leakage was considered too high for anastomosis of the small intestine to be performed. Further, construction of an intestinal stoma could result in a high-output syndrome that could lead to difficulty in resuming chemotherapy. Based on these considerations, we fixed the anastomotic region to the abdominal wall using a technique similar to construction of an intestinal stoma. Post-operative anastomotic leakage did not occur. Nine days later, a perineal hernia was noted near the anastomotic site and a second operation was performed. The anastomotic site was placed back into the abdominal cavity during this operation. CHOP therapy was resumed 16 days after the first operation.

  5. Subcutaneous Facial and Neck Emphysema as First Sign of Intestinal Perforation in a Female Patient After a Routine Colonoscopy

    PubMed Central

    Anyfantakis, Dimitrios; Kastanakis, Miltiades; Karona, Paraskevi; Papadomichelakis, Alexandros; Bobolakis, Emmanouil

    2016-01-01

    Colonoscopy is a safe procedure for the diagnosis and management of colorectal diseases. Colonic perforation due to colonoscopy represents an uncommon complication. Here we present an unusual case of iatrogenic bowel perforation resulting in subcutaneous facial and neck emphysema, pneumomediastinum and pneumoretroperitoneum. Taking a detailed recent medical history information is always required when encountering patients with subcutaneous emphysema after invasive examination procedures. Alertness on iatrogenic complication eventualities may improve prognosis and avoid life-threatening conditions. PMID:28149153

  6. A case of pneumoperitoneum and retropneumoperitoneum without bowel perforation due to extensive intestinal necrosis as a complication to chemotherapy: CT evaluation

    PubMed Central

    Antonopoulos, Petros; Siaperas, Petros; Demonakou, Maria; Alexiou, Kostas; Economou, Nikos

    2013-01-01

    Acute intestinal ischemia continues to be a challenging diagnostic problem with high mortality. We describe a rare case of acute intestinal necrosis, due to vasculitis, related with chemotherapy. A patient was examined in our emergency department, presenting with abdominal pain. Three months before he had undergone an operation for lung carcinoma (lobectomy) and received chemotherapy. CT of the abdomen demonstrated free air in 10 different locations: hepatic part of the portal vein, branches of mesenteric veins, femoral and iliac veins, the bowel wall, peritoneal cavity and retroperitoneal space, abdominal muscles, inguinal canals, meso-sigmoid space, and in the para-rectal space. Moreover, pathological findings revealed that the free air in the peritoneum and retropneumoperitoneum occurred without intestinal perforation, but with transudation through the necrotic bowel wall. This is a rare complication of chemotherapy. This case refers to the unusual CT findings which appeared in this patient. The key to a better outcome is early diagnosis of this condition and the CT examination of the abdomen plays an important role. PMID:24349710

  7. Comparative MiRNA Expressional Profiles and Molecular Networks in Human Small Bowel Tissues of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

    PubMed Central

    Tam, Yuk Him; Ma, Terence Ping Yuen; Lam, Hugh Simon; Cheung, Hon Ming; Lee, Kim Hung; To, Ka Fai; Li, Karen

    2015-01-01

    Background Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are acute intestinal conditions which could result in mortality and severe morbidity in preterm infants. Our objective was to identify dysregulated micro-RNAs (miRNAs) in small bowel tissues of NEC and SIP, and their possible roles in disease pathophysiology. Methods We performed differential miRNA arrays on tissues of NEC (n = 4), SIP (n = 4) and surgical-control (Surg-CTL; n = 4), and validated target miRNAs by qPCR (n = 10 each group). The association of target miRNAs with 52 dysregulated mRNAs was investigated by bioinformatics on functional and base-pair sequence algorithms, and correlation in same tissue samples. Results We presented the first miRNA profiles of NEC, SIP and Surg-CTL intestinal tissues in preterm infants. Of 28 validated miRNAs, 21 were significantly different between NEC or SIP and Surg-CTL. Limited overlapping in the aberrant expression of miRNAs between NEC and SIP indicated their distinct molecular mechanisms. A proposed network of dysregulated miRNA/mRNA pairs in NEC suggested interaction at bacterial receptor TLR4 (miR-31, miR-451, miR-203, miR-4793-3p), mediated via key transcription factors NFKB2 (miR-203), AP-1/FOSL1 (miR-194-3p), FOXA1 (miR-21-3p, miR-431 and miR-1290) and HIF1A (miR-31), and extended downstream to pathways of angiogenesis, arginine metabolism, cell adhesion and chemotaxis, extracellular matrix remodeling, hypoxia/oxidative stress, inflammation and muscle contraction. In contrast, upregulation of miR-451 and miR-223 in SIP suggested modulation of G-protein-mediated muscle contraction. Conclusions The robust response of miRNA dysregulation in NEC and SIP, and concerted involvement of specific miRNAs in the molecular networks indicated their crucial roles in mucosa integrity and disease pathophysiology. PMID:26274503

  8. [Free perforation in Crohn's disease].

    PubMed

    Patti, R; Arcara, M; Daví, V; Leo, P; Di Vita, G

    2004-01-01

    Free perforation in abdominal cavity in patients with Crohn's disease is a rare entity as attested from the data reported in the literature. It is a very dangerous event and requires a surgical urgency management. The Authors reported two cases of free perforation, in patients with Crohn' disease, undergoing surgical operation in urgency. Analyzing pathogenesis, difficulty in diagnosis making and therapeutic choices, they underline that CT is very useful in the diagnosis, while resection of the perforated intestinal tract represent the best surgical treatment.

  9. Intestine.

    PubMed

    Smith, J M; Skeans, M A; Horslen, S P; Edwards, E B; Harper, A M; Snyder, J J; Israni, A K; Kasiske, B L

    2016-01-01

    Intestine and intestine-liver transplant plays an important role in the treatment of intestinal failure, despite decreased morbidity associated with parenteral nutrition. In 2014, 210 new patients were added to the intestine transplant waiting list. Among prevalent patients on the list at the end of 2014, 65% were waiting for an intestine transplant and 35% were waiting for an intestine-liver transplant. The pretransplant mortality rate decreased dramatically over time for all age groups. Pretransplant mortality was highest for adult candidates, at 22.1 per 100 waitlist years compared with less than 3 per 100 waitlist years for pediatric candidates, and notably higher for candidates for intestine-liver transplant than for candidates for intestine transplant without a liver. Numbers of intestine transplants without a liver increased from a low of 51 in 2013 to 67 in 2014. Intestine-liver transplants increased from a low of 44 in 2012 to 72 in 2014. Short-gut syndrome (congenital and other) was the main cause of disease leading to both intestine and intestine-liver transplant. Graft survival improved over the past decade. Patient survival was lowest for adult intestine-liver recipients and highest for pediatric intestine recipients.

  10. Spontaneous Intestinal Perforation in Extremely Low Birth Weight Infants: Association with Indometacin Therapy and Effects on Neurodevelopmental Outcomes at 18-22 months Corrected Age

    PubMed Central

    Wadhawan, Rajan; Oh, William; Vohr, Betty R.; Saha, Shampa; Das, Abhik; Bell, Edward F.; Laptook, Abbot R.; Shankaran, Seetha; Stoll, Barbara J.; Walsh, Michele C.; Higgins, Rosemary D.

    2013-01-01

    Background Spontaneous intestinal perforation (SIP) is associated with the use of postnatal glucocorticoids and indometacin in extremely low birth weight (ELBW) infants. We hypothesized: 1) an association of SIP with the use of antenatal steroids (ANS) and indometacin either as prophylaxis for IVH (P Indo) or for treatment of PDA (Indo/PDA) and 2) an increased risk of death or abnormal neurodevelopmental outcomes in infants with SIP at 18-22 months corrected age. Design/Methods We retrospectively identified ELBW infants with SIP in the Neonatal Research Network’s generic database. Unadjusted analysis identified the differences in maternal, neonatal and clinical variables between infants with and without SIP. Logistic regression analysis identified the adjusted odds ratio for SIP with reference to ANS, P Indo and Indo/PDA. Neurodevelopmental outcomes were assessed among survivors at 18 to 22 months corrected age. Results Indo/PDA was associated with an increased risk of SIP (adjusted OR 1.61; 95% CI 1.25,2.08), while P Indo and ANS were not. SIP was independently associated with an increased risk of death or NDI (adjusted OR−1.85; 95% CI 1.32,2.60) and NDI among survivors (adjusted OR−1.75, 95% CI 1.20,2.55). Conclusion Indometacin used for IVH prophylaxis and ANS were not associated with the occurrence of SIP in ELBW infants. Indometacin used for treatment of symptomatic PDA was however associated with an increased risk of SIP. ELBW infants with SIP have an increased risk of poor neurodevelopmental outcomes. PMID:22684157

  11. Bowel perforation detection using metabolic fluorescent chlorophylls

    NASA Astrophysics Data System (ADS)

    Han, Jung Hyun; Jo, Young Goun; Kim, Jung Chul; Choi, Sujeong; Kang, Hoonsoo; Kim, Yong-Chul; Hwang, In-Wook

    2016-03-01

    Thus far, there have been tries of detection of disease using fluorescent materials. We introduce the chlorophyll derivatives from food plants, which have longer-wavelength emissions (at >650 nm) than those of fluorescence of tissues and organs, for detection of bowel perforation. To figure out the possibility of fluorescence spectroscopy as a monitoring sensor of bowel perforation, fluorescence from organs of rodent models, intestinal and peritoneal fluids of rodent models and human were analyzed. In IVIS fluorescence image of rodent abdominal organ, visualization of perforated area only was possible when threshold of image is extremely finely controlled. Generally, both perforated area of bowel and normal bowel which filled with large amount of chlorophyll derivatives were visualized with fluorescence. The fluorescence from chlorophyll derivatives penetrated through the normal bowel wall makes difficult to distinguish perforation area from normal bowel with direct visualization of fluorescence. However, intestinal fluids containing chlorophyll derivatives from food contents can leak from perforation sites in situation of bowel perforation. It may show brighter and longer-wavelength regime emissions of chlorophyll derivatives than those of pure peritoneal fluid or bioorgans. Peritoneal fluid mixed with intestinal fluids show much brighter emissions in longer wavelength (at>650 nm) than those of pure peritoneal fluid. In addition, irrigation fluid, which is used for the cleansing of organ and peritoneal cavity, made of mixed intestinal and peritoneal fluid diluted with physiologic saline also can be monitored bowel perforation during surgery.

  12. Stercolith perforation.

    PubMed

    Yasin, Malik M Amjad; Nasreen, Ghazala; Rathore, Farooq Azam; Malik, Sikandar Ali

    2012-07-01

    A 62-year-old diabetic bed ridden woman, presented to the emergency department with symptoms suggestive of peritonitis. She had been taking oral laxatives and enemas to relieve her chronic constipation for last 6 years. Hard impacted stools and pelvic tenderness were found on digital rectal examination. Her X-ray abdomen showed soft tissue shadows in the colon but there was no gas under the diaphragm on chest X-ray. Sonography found free fluid in pelvis. She was resuscitated, and her hyperglycemia was controlled by use of regular insulin as per sliding scale. Operative findings revealed free fluid in pelvis and very hard faecalomas lying free in peritoneal cavity. There was a 2 x 3 cm perforation at the anterior wall of the recto-sigmoid junction. Peritoneal toilet was carried out followed by Hartmann's procedure. Histopathology of perforation side showed no evidence of malignancy.

  13. Perforated monolayers

    SciTech Connect

    Regen, S.L.

    1992-01-01

    Our research over this past grant period has focused on (1) developing methods for making in situ permeation measurements at the air-water interface, (2) defining the structural and conformational behavior of selected calix(4)arenes, (3) defining the metal complexation properties of certain upper-rim functionalized calix(4)arenes, and (4) synthesizing a broad series of polymerizable calixarenes, to be used for constructing perforated monolayers and multilayers.

  14. Perforated monolayers

    SciTech Connect

    Regen, S.L.

    1992-12-01

    Goal of this research program is to create ultrathin organic membranes that possess uniform and adjustable pores ( < 7[angstrom] diameter). Such membranes are expected to possess high permeation selectivity (permselectivity) and high permeability, and to provide the basis for energy-efficient methods of molecular separation. Work carried out has demonstrated feasibility of using perforated monolayer''-based composites as molecular sieve membranes. Specifically, composite membranes derived from Langmuir-Blodgett multilayers of the calix[6]arene-based surfactant shown below plus poly[l-(trimethylsilyl)-l-propyne] (PTMSP) were found to exhibit sieving behavior towards He, N[sub 2] and SF[sub 6]. Results of derivative studies that have also been completed are also described in this report.

  15. An Unusual Etiology of Spontaneous Pyometra Perforation; A Case Report

    PubMed Central

    Agarwal, Rachna; Suneja, Amita; Sharma, Abha; Vaid, Neelam Bala

    2011-01-01

    Introduction By presenting this case we aimed to describe an uncommon complication of generalized peritonitis following spontaneous pyometra perforation in untreated cervical carcinoma. Case Presentation This report describes a 60-year-old postmenopausal woman presenting with clinical features mimicking intestinal perforation who was later diagnosed as cervical carcinoma with pyometra perforation at exploratory laparotomy. The patient had good post-operative recovery following drainage and peritoneal lavage. Conclusion Spontaneous pyometra perforation in a case of untreated carcinoma of cervix is a rare condition, yet it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women. PMID:23926508

  16. Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation?

    PubMed

    Paran, H; Neufeld, D; Shwartz, I; Kidron, D; Susmallian, S; Mayo, A; Dayan, K; Vider, I; Sivak, G; Freund, U

    1996-03-01

    Blast injuries are rare, and although blast-induced perforations of the bowel have been described in the past, the entity of a delayed perforation caused by an evolving injury has not been reported. We report three men injured by the explosion of a terrorist bombing in open air. They suffered primary blast injuries, which resulted in isolated perforations of the terminal ileum. They were operated at different times after the blast event. The resected specimens were examined under light microscopy. One patient was operated immediately, and had three perforations in the terminal ileum. In the other two patients, abdominal complaints appeared only 24 and 48 hours later. These two patients were found to have hematomas in the wall of the terminal ileum, and small perforations therein, with almost no contamination of the peritoneal cavity. On histological examination, there were small perforations with disruption of all intestinal layers. In the vicinity of the perforations, the mucosa was necrotic and disorganized. The submucosa showed edema and vascular thrombi, and at several points mucus was shown dissecting through the muscularis propria, thus creating minute microperforations. Because of the findings in these patients, we suggest a mechanism of evolving damage to the bowel wall and delayed perforation rather than delayed diagnosis, after blast injuries. We suggest that patients exposed to a significant blast should be watched carefully for at least 48 hours.

  17. Perforation of Meckel's diverticulum with enteroliths.

    PubMed

    Nishikawa, Takeshi; Takei, Yoshiki; Tsuno, Nelson H; Maeda, Mamoru

    2012-08-01

    Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 90 cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient's postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel's diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.

  18. Ventriculoperitoneal shunt perforations of the gastrointestinal tract.

    PubMed

    Thiong'o, Grace Muthoni; Luzzio, Christopher; Albright, A Leland

    2015-07-01

    OBJECT The purposes of this study were to evaluate the frequency with which children presented with ventriculoperitoneal (VP) shunt perforations of the gastrointestinal (GI) tract, to determine the type of shunts that caused the perforations, and to compare the stiffness of perforating catheters with the stiffness of catheters from other manufacturers. METHODS Medical records were reviewed of 197 children who were admitted with VP shunt malfunction. Catheter stiffness was evaluated by measuring relative resistance to cross-sectional compression, resistance to column buckling, and elasticity in longitudinal bending. Catheter frictional force was measured per unit length. RESULTS Six children were identified whose VP shunts had perforated the GI tract; 2 shunts subsequently protruded through the anal orifice, 1 protruded through the oral cavity, and 3 presented with subcutaneous abscesses that tracked upward from the intestine to the chest. All perforating shunts were Chhabra shunts. Catheter stiffness and resistance to bending were greatest with a Medtronic shunt catheter, intermediate with a Codman catheter, and least with a Chhabra catheter. Frictional force was greatest with a Chhabra catheter and least with a Medtronic catheter. CONCLUSIONS The frequency of perforations by Chhabra shunts appears to be higher than the frequency associated with other shunts. The increased frequency does not correlate with their stiffness but may reflect their greater frictional forces.

  19. Segmental absence of intestinal muscle with ileal web in an extremely low birth weight infant: case report.

    PubMed

    Buyuktiryaki, Mehmet; Kanmaz, Hayriye G; Okur, Nilüfer; Ates, Ufuk; Sirvan, Ali L; Uras, Nurdan

    2016-04-01

    Spontaneous intestinal perforations are localized perforations without the typical clinical, radiological, and histopathological features of necrotizing enterocolitis. Spontaneous intestinal perforation is a recently defined clinical entity. The best-known risk factor is prematurity. It is seen 2-3% in very low birthweight infants and 5 % of extremely low birthweight infants. Herein we report an extremely low birthweight infant with spontaneous intestinal perforation, segmental absence of intestinal muscle and an ileal web as an underlying cause. We aimed to draw attention to the segmental absence of intestinal muscle which is rare but increasingly reported cause of spontaneous intestinal perforation and the importance of histopathologic examination of surgical specimens.

  20. Gastric Perforation by Ingested Rabbit Bone Fragment.

    PubMed

    Gambaracci, Giulio; Mecarini, Eleonora; Franceschini, Maria Silvia; Scialpi, Michele

    2016-01-01

    The majority of accidentally ingested foreign bodies is excreted from the gastrointestinal (GI) tract without any complications. Sometimes sharp foreign bodies - like chicken and fish bones - can lead to intestinal perforation and may present insidiously with a wide range of symptoms and, consequently, different diagnoses. We report the case of a 59-year-old woman presenting with fever and a 1-month history of vague abdominal pain. Computed tomography (CT) showed the presence of a hyperdense linear image close to the gastric antrum surrounded by a fluid collection and free peritoneal air. At laparotomy, a 4-cm rabbit bone fragment covered in inflamed tissue was detected next to a gastric wall perforation. Rabbit bone fragment ingestion, even if rarely reported, should not be underestimated as a possible cause of GI tract perforation.

  1. Nontraumatic terminal ileal perforation

    PubMed Central

    Wani, Rauf A; Parray, Fazl Q; Bhat, Nadeem A; Wani, Mehmood A; Bhat, Tasaduq H; Farzana, Fowzia

    2006-01-01

    Background There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. Methods This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. Results There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%), nonspecific inflammation(26%), obstruction(6%), tuberculosis(4%) and radiation enteritis (1%). Simple closure of the perforation (49%) and end to side ileotransverse anastomosis(42%) were the mainstay of the surgical management. Conclusion Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula. PMID:16759405

  2. Management of endodontic perforations.

    PubMed

    Martin, L R; Gilbert, B; Dickerson, A W

    1982-12-01

    1. Perforations in the floor of the pulp chambers of molars offer an improved prognosis when treated aseptically and quickly. 2. Perforations in the apical third of the root canal, when made with a reamer or file that leaves 2 mm. or less of unfilled root canal space, have a good prognosis. 3. If a perforation, either mechanical or resorptive in etiology, occurs on the lingual surface and requires surgical management, prognosis is poor. 4. Recent advances in the use of calcium hydroxide to treat endodontic perforations show promise.

  3. [Small bowel perforation caused by magnetic toys].

    PubMed

    Schroepfer, E; Siauw, C; Hoecht, B; Meyer, T

    2010-06-01

    Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets.

  4. Jejunoileal perforation and volvulus caused by multiple magnet ingestion.

    PubMed

    Arslan, Serkan; Basuguy, Erol; Zeytun, Hikmet; Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arslan, Mehmet Serif

    2015-03-01

    Foreign body ingestion is a common problem in children, but magnet ingestion is relatively rare. However, when it occurs, it tends to have a high rate of complications. This is a case report of a 3-year-old child who swallowed multiple magnetic toys, subsequently developing jejunoileal perforation and volvulus. This case report indicates that it is best to surgically remove multiple ingested magnets without delay to avoid intestinal perforation, fistula, and other complications such as volvulus.

  5. Idiopathic Neonatal Colonic Perforation

    PubMed Central

    Tuncer, Oğuz; Melek, Mehmet; Kaba, Sultan; Bulan, Keziban; Peker, Erdal

    2014-01-01

    Though the perforation of the colon in neonates is rare, it is associated with more than 50% mortality in high-risk patients. We report a case of idiopathic neonatal perforation of the sigmoid colon in an 8-day-old, healthy, male neonate without any demonstrable cause. PMID:26023477

  6. Integrating geology and perforating

    SciTech Connect

    Araujo, P.F. de; Souza Padilha, S.T.C. de

    1997-02-01

    Perforating is a very common well completion operation. Usually, it is considered to be as simple as making holes in casing. Actually, perforating is one of the most critical tasks for establishing a path from reservoir rock to borehole form which hydrocarbons can flow to surface. The objective of this article is to relate perforating technology with geological aspects and completion type to determine the best shooting equipment (gun type, charge and differential pressure) to perform the most efficient perforating job. Several subjects related to formation geology are taken into account for a shooting job, such as: compressive strength, reservoir pressure and thickness, lithology type, porosity and permeability, ratio between horizontal and vertical permeabilities, and fluid type. Gun geometry used in the oil industry incorporates several parameters, including shot density, hole entrance diameter, gun phase and jet penetration. API tests are done on perforating guns to define applicability and performance. A new geometrical parameter is defined as the relative angle of the jet, which is the angle between the jet tunnel and formation dip. GEOCAN is a methodology which relates geology to gun geometry and type to define the most efficient gun system for perforated completions. It uses the intelligent perforating technique with the SPAN (Schlumberger Perforating Analysis) program to confirm optimum gun choice.

  7. Perforating Thin Metal Sheets

    NASA Technical Reports Server (NTRS)

    Davidson, M. E.

    1985-01-01

    Sheets only few mils thick bonded together, punched, then debonded. Three-step process yields perforated sheets of metal. (1): Individual sheets bonded together to form laminate. (2): laminate perforated in desired geometric pattern. (3): After baking, laminate separates into individual sheets. Developed for fabricating conductive layer on blankets that collect and remove ions; however, perforated foils have other applications - as conductive surfaces on insulating materials; stiffeners and conductors in plastic laminates; reflectors in antenna dishes; supports for thermal blankets; lightweight grille cover materials; and material for mockup of components.

  8. Prepacking perforations improves gravel packs

    SciTech Connect

    Hall, B.E.; Pace, J.R. )

    1990-05-21

    Productivity can be increased by prepacking perforations with gravel before a major gravel pack is pumped. The main gravel-pack treatment follows immediately after the prepack. This procedure can increase perforation permeability due to a more complete gravel fill of the perforation. The gravel pack prevents perforations from collapsing or filling with formation sand.

  9. Treatment of stripping perforations.

    PubMed

    Allam, C R

    1996-12-01

    Strippings are problems that are frequent on thin and concave roots. Treatment and prognosis differ from that of a lateral root perforation because of the size, oval shape, and thin edges of the striping. We propose a two-step technique: an endodontic phase in which the root canal system is sealed with gutta-percha overflowing through the stripping perforation and a surgical second step that will allow elimination of this excess.

  10. Perinatal risk factors in newborns with gastrointestinal perforation

    PubMed Central

    Prgomet, Sandra; Lukšić, Boris; Pogorelić, Zenon; Jurić, Ivo; Čapkun, Vesna; Arapović, Adela; Boban, Nataša

    2017-01-01

    AIM To investigate correlation of perinatal risk factors in newborns with gastrointestinal perforation (GIP). METHODS Single-center retrospective cohort study was conducted between January 1990 and December 2012. Medical records on all newborns with GIP were reviewed (n = 35). Surgical records and histopathologic examination of all perforated intestine samples were also reviewed. RESULTS The most common cause of GIP was necrotizing enterocolitis (51.4%). The most common site of perforation was large intestine. Mortality rate was 31%. Infants with GIP more frequently had very low birth weight (< 1500 g), especially birth weight below 10th percentile according to gestational age. Ponderal index was not differing between infants with GIP and control subjects. In infants with GIP anemia was more frequently found than in control group. CONCLUSION GIP in newborns is mostly disease of infants with birth weight below 10th percentile according to gestational age. GIP occurs more often in infants with anemia. PMID:28289509

  11. The Versatile Modiolus Perforator Flap

    PubMed Central

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    Background: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. Methods: A cohort case series of 14 modiolus perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. Results: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted. The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps based on it can be recommended for several indications from the reconstruction of defects in the perioral area, cheek and nose. Conclusions: The modiolus is a well-described anatomical area containing a sizeable perforator that is consistently present and readily visualized using color Doppler ultrasonography. We have used the modiolus perforator flap successfully for several indications, and it is our first choice for perioral reconstruction. PMID:27257591

  12. Ileal J-Pouch Perforation: Case Report.

    PubMed

    Dogan, U; Dogan, B; Habibi, M; Erol, M K; Mayir, B; Aslaner, A; Bulbuller, N

    2015-01-01

    A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.

  13. Gastroduodenal perforation after open heart surgery.

    PubMed

    Shocket, E; Boruchow, I B; Rotbart, A; Ciment, L; Jude, J R

    1977-11-01

    During a thirty month period, 319 patients underwent open heart operations, and of these, three experienced a life-threatening explosive abdominal catastrophe. Aggressive radiographic maneuvers established the diagnosis of gastroduodenal perforation. Appropriate abdominal surgery with plication of the perforation and, whenever possible, the establishment of tube gastrostomy for decompression and a tube jejunostomy for feeding is desirable. All three patients required mechanical ventilatory support and tracheostomy prior to the abdominal catastrophe. Prophylactic antacids and sedation seem appropriate, particularly for selected patients (those with a prior peptic history and those with pulmonary dysfunction). Pulmonary toilet for those identified by preoperative pulmonary screening may circumvent the need for postoperative ventilatory support, which increases the risk of stress ulceration. Of the three patients described, all survived the gastrointestinal surgery but only one left the hospital. One died twenty days and another forty-eight days after the intestinal surgery, both of pneumonitis and septicemia.

  14. Synchronous Perforation of the Ileum and Meckel’s Diverticulum Due to Tuberculosis

    PubMed Central

    Zachariah, Sanoop K.

    2010-01-01

    Perforation of the Meckel’s diverticulum due to tuberculosis is a rare phenomenon. A 45 years old male who presented with perforation peritonitis was found to have a synchronous dual perforation involving the ileum and the Meckel’s diverticulum, due to intestinal tuberculosis. In addition to this, the Meckel’s diverticulum was found to have a daughter diverticulum (diverticulum within diverticulum), which was probably pulsion or traction diverticulum as it did not have all layers of the intestinal wall. Such daughter diverticulum associated with a Meckel’s diverticulum is very unusual. All these factors make this a unique case which is hence reported here. PMID:27956994

  15. Multiple perforations and fistula formation following corticosteroid administration: A case report

    PubMed Central

    He, Jing-Ni; Tian, Zhong; Yao, Xu; Li, Hang-Yu; Yu, Yun; Liu, Yuan; Liu, Jin-Gang

    2017-01-01

    Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small- and medium-sized-vessel vasculitis. The literature contains only a few reports of gastrointestinal perforation with this condition. We report a patient with EPGA treated with high-dose steroid who underwent emergency surgery for intestinal perforations. We performed a simple repair of the 11 perforations. Intestinal fistulas developed 8 d postoperatively; they healed well after 60 d of continuous washing and negative pressure suction. The clinical data of 14 additional patients with EGPA or Churg-Strauss syndrome complicated with gastrointestinal perforation, which were reported from 1996 to 2014, were also collected and compared. The formation of multiple perforations and fistulas following high dosage steroid administration can have a good outcome with appropriate management. Meticulous attention to abdominal symptoms and appropriate interventions can result in timely management. Corticosteroid administration remains a very important perioperative procedure for EPGA. PMID:28255551

  16. Spontaneous Perforation of Pyometra

    PubMed Central

    Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-01-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted. PMID:27152313

  17. Spontaneous Perforation of Pyometra.

    PubMed

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-04-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.

  18. Asymptomatic Tuberculosis-Induced Ileal Perforation in an HIV- Infected Individual; A Case Report

    PubMed Central

    Tahmasebi, Sedigheh; Moslemi, Sam; Tahamtan, Maryam; Taheri, Lohrasb; Davarpanah, Mohammad Ali

    2013-01-01

    The co-existence of acquired immune deficiency syndrome (AIDS) and tuberculosis is a major cause of morbidity and mortality because of a widespread organ involvement. The gastrointestinal tract is a common site for localization of opportunistic microorganisms in AIDS. However, surgical abdominal emergencies such as intestinal perforation resulted from tuberculosis are uncommon in these patients. The asymptomatic occurrence of such intestinal perforation has not been reported our knowledge. We represent an HIV and HCV co-infected man with miliary tuberculosis and an incidentally detected free air under  diaphragm in the chest X-ray eventually resulting in exploratory laparotomy which then revealed two tubercular-induced intestinal perforations. It seems that as the tuberculosis is increasing in incidence, mostly due to reactivation in HIV-infected patients especially in developing countries, we should not underestimate its acute abdominal emergencies such as bowel perforation. PMID:27162854

  19. Caecal perforation from TB and the Law of Laplace

    PubMed Central

    Khan, Amad N.; Khalid, Salema; Chaudhry, Mohammad Naushad; Ho, Cherrie

    2015-01-01

    A 43-year-old man presented to the hospital with haemoptysis. When worked up, his history and examination were highly suggestive of pulmonary tuberculosis (TB). He subsequently developed a massive upper gastrointestinal bleed and underwent an emergency laparotomy, which revealed a massively dilated caecum measuring ∼20 cm in diameter. The caecum had perforated due to acute decompensation of intestinal TB. Though common in developing countries, TB is rare in the UK, especially the intestinal kind. The most striking feature of this case is, however, the size of the caecal distension caused by the tubercular inflammation and subsequent perforation—something unheard of in the literature. This massive caecal distention would be explained by the Law of Laplace. In conclusion, massive distension and caecal perforation are possible consequences of intestinal TB, especially in the 48–72 h immediately after starting anti-tubercular therapy. PMID:25972412

  20. Perforated diode neutron sensors

    NASA Astrophysics Data System (ADS)

    McNeil, Walter J.

    A novel design of neutron sensor was investigated and developed. The perforated, or micro-structured, diode neutron sensor is a concept that has the potential to enhance neutron sensitivity of a common solid-state sensor configuration. The common thin-film coated diode neutron sensor is the only semiconductor-based neutron sensor that has proven feasible for commercial use. However, the thin-film coating restricts neutron counting efficiency and severely limits the usefulness of the sensor. This research has shown that the perforated design, when properly implemented, can increase the neutron counting efficiency by greater than a factor of 4. Methods developed in this work enable detectors to be fabricated to meet needs such as miniaturization, portability, ruggedness, and adaptability. The new detectors may be used for unique applications such as neutron imaging or the search for special nuclear materials. The research and developments described in the work include the successful fabrication of variant perforated diode neutron detector designs, general explanations of fundamental radiation detector design (with added focus on neutron detection and compactness), as well as descriptive theory and sensor design modeling useful in predicting performance of these unique solid-state radiation sensors. Several aspects in design, fabrication, and operational performance have been considered and tested including neutron counting efficiency, gamma-ray response, perforation shapes and depths, and silicon processing variations. Finally, the successfully proven technology was applied to a 1-dimensional neutron sensor array system.

  1. Anisakiasis and intestinal endometriosis: under-recognized conditions in the differential diagnosis of acute abdomen.

    PubMed

    Sánchez Justicia, Carlos; Granero Peiró, Lucia; Arabe Paredes, Jorge Ali

    2017-01-01

    Anisakiasis and endometriosis is rare cause of intestinal obstruction and even perforation, the latter being extremely rare. We report the case of a patient with intestinal obstruction that progress to perforation and whose differential diagnosis is complex. The interest in this clinical case lies in the unexpected histology of the surgical specimen after the intervention of the patient, because the intestinal endometriosis as intestinal anisakiasis are rare entities that make diagnosis difficult.

  2. Fishbone Perforated Appendicitis.

    PubMed

    Beh, Joey Chan Yiing; Uppaluri, Anandswaroop Srinivas; Koh, Beatrice Fang Ju; Cheow, Peng-Chung

    2016-07-01

    Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author's knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature.

  3. Rat Endovascular Perforation Model

    PubMed Central

    Sehba, Fatima A.

    2014-01-01

    Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The Rat endovascular perforation model (EVP) replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH. This paper presents a brief review of historical development of the EVP model, details the technique used to create SAH and considerations necessary to overcome technical challenges. PMID:25213427

  4. Perforated jejunal diverticulum: a rare case of acute abdomen

    PubMed Central

    Sehgal, Rishabh; Cheung, Cherry X.; Hills, Tristram; Waris, Aqueel; Healy, Donagh; Khan, Tahir

    2016-01-01

    Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen. PMID:27765806

  5. Radiologic diagnosis of gastrointestinal perforation.

    PubMed

    Rubesin, Stephen E; Levine, Marc S

    2003-11-01

    Perforations of the gastrointestinal tract have many causes. Holes in the wall of gastrointestinal organs can be created by blunt or penetrating trauma, iatrogenic injury, inflammatory conditions that penetrate the serosa or adventitia, extrinsic neoplasms that invade the gastrointestinal tract, or primary neoplasms that penetrate outside the wall of gastrointestinal organs. This article provides a radiologic approach for investigating the wide variety of gastrointestinal perforations. General principles about contrast agents and studies are reviewed, and then perforations in specific gastrointestinal organs are discussed.

  6. Pacemaker leads and cardiac perforation

    PubMed Central

    Prasad, Rachana; Andrews, Richard

    2017-01-01

    This case series highlights the rare but potentially life threatening complication of ventricular perforation caused by pacemaker leads and discusses appropriate investigations and management strategies. PMID:28321317

  7. Transverse colon perforation due to carcinoma rectum: an unusual presentation against Laplace's law.

    PubMed

    Sahoo, Manash Ranjan; Kumar, Anil; Jaiswal, Sunil; C, Basavaraja

    2013-08-16

    We present a case of distal large bowel obstruction, in the setting of a competent ileocaecal valve, the caecum is the most common site of perforation (for Laplace's law). We describe a case of obstruction at the rectum due to constricting carcinomatous growth, presenting with perforation of transverse colon (against Laplace's law). A 60-year-old women presented to the emergency department with acute abdominal pain. The pain was preceded by 3 days of intestinal obstruction. Clinically there was guarding and rigidity. Straight X-ray of the abdomen revealed free gas under diaphragm. Surgical exploration revealed transverse colon perforation with carcinoma of rectum. Loop transverse colostomy was performed as the patient was very sick. The patient improved slowly in the intensive care unit. To conclude, even though the caecum is the most common site for perforation in case of distal obstruction, perforation of transverse colon can occur otherwise as a unique presentation.

  8. Gallstone impacted in the rectosigmoid junction causing a biliary ileus and a sigmoid perforation.

    PubMed

    Van Kerschaver, O; Van Maele, V; Vereecken, L; Kint, M

    2009-01-01

    A gallstone ileus is an unusual form of bowel obstruction. Colonic gallstone ileus is rare, difficult to diagnose, and still has a high mortality rate. We present a case of biliary ileus caused by an impacted gallstone, causing necrosis and perforation of the rectosigmoid junction. A Hartmann's procedure was performed to treat the perforation and the obstruction. Cholecystectomy and closure of the cholecysto-colonic fistula were delayed until restoration of the intestinal continuity.

  9. The sternocleidomastoid perforator flap.

    PubMed

    Avery, C M E

    2011-10-01

    The conventional pedicled sternocleidomastoid (SCM) flap has a poor arc of rotation, limited volume and precarious vascularity. This report describes a new technique for raising a SCM flap based on the perforating vessels of the superior thyroid vascular pedicle. The upper and lower attachments of the sternocleidomastoid muscle are divided. Four medically and/or surgically compromised patients have successfully undergone reconstruction of hemiglossectomy (1), partial glossectomy (1) and rim of mandible (2) defects for malignancy. The arc of rotation of the SCM flap is greatly increased and the potential applications for the flap expanded.

  10. Fishbone Perforated Appendicitis

    PubMed Central

    Beh, Joey Chan Yiing; Uppaluri, Anandswaroop Srinivas; Koh, Beatrice Fang Ju; Cheow, Peng-Chung

    2016-01-01

    Ingested foreign bodies tend to pass through the gastrointestinal tract without incidence, and vast majority of cases do not need intervention. Rarely, these foreign bodies drop into the appendix and not likely to re-enter the normal digestive tract. We describe a case of a 72-year-old male patient who presented with right iliac fossa pain of 3-day duration. Clinical examination suggested classic acute appendicitis. Blood test results revealed leukocytosis. Computed tomography of the abdomen and pelvis showed evidence of acute appendicitis and a linear hyperdensity (foreign body) perforating the appendix. The patient was managed successfully with prompt laparoscopic appendectomy and removal of the foreign body which was confirmed to be a fish bone measuring about 10mm. While imaging diagnosis of fishbone in the appendix has been published, reports are few. To the best of the author’s knowledge, fishbone induced perforated appendicitis has been described only in 2 cases (including this case) in the literature. PMID:27761185

  11. Perforation of jejunal diverticulum with ectopic pancreas.

    PubMed

    Shiratori, Hiroshi; Nishikawa, Takeshi; Shintani, Yukako; Murono, Koji; Sasaki, Kazuhito; Yasuda, Koji; Otani, Kensuke; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Ishihara, Soichiro; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Perforation of jejunal diverticulum is a rare complication. Here, we report a case of jejunal diverticulum penetration with surrounding ectopic pancreas. An 83-year-old female patient was admitted to our department with acute onset of severe abdominal pain lasting for half a day. Abdominal computed tomography showed outpouching of the small intestine that contained air/fluid, with multiple surrounding air bubbles in the mesentery of the small intestine. She was diagnosed with penetration of the small intestine, and an emergency laparotomy was indicated. The penetrated jejunal diverticulum was identified ~20-cm distal to the ligament of Treitz. Partial resection of the jejunum was performed, and her postoperative course was uneventful. The pathological findings confirmed diverticulum penetration into the mesentery and severe inflammation at the site, with surrounding ectopic pancreas. Furthermore, the pancreatic ducts were opened through the penetrated diverticulum. This rare case shows that the ectopic pancreas might have caused penetration of jejunal diverticulum owing to the pancreatic duct opening through the diverticulum.

  12. Intrathoracic caecal perforation presenting as dyspnea.

    PubMed

    Granier, Vincent; Coche, Emmanuel; Hantson, Philippe; Thoma, Maximilien

    2010-01-01

    Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

  13. Intrathoracic Caecal Perforation Presenting as Dyspnea

    PubMed Central

    Granier, Vincent; Coche, Emmanuel; Hantson, Philippe; Thoma, Maximilien

    2010-01-01

    Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis. PMID:21331329

  14. Spontaneous Perforation of Pyometra

    PubMed Central

    Yildizhan, Begüm; Uyar, Esra; Şişmanoğlu, Alper; Güllüoğlu, Gülfem; Kavak, Zehra N.

    2006-01-01

    Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01−0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture. PMID:17093350

  15. Rett syndrome and gastric perforation.

    PubMed

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  16. Acquired reactive perforating collagenosis

    PubMed Central

    Fei, Chengwen; Wang, Yao; Gong, Yu; Xu, Hui; Yu, Qian; Shi, Yuling

    2016-01-01

    Abstract Background: Reactive perforating collagenosis (RPC) is a rare form of transepithelial elimination, in which altered collagen is extruded through the epidermis. There are 2 types of RPC, acquired RPC (ARPC) and inherited RPC, while the latter is extremely rare. Here we report on 1 case of ARPC. Methods: A 73-year-old female was presented with strongly itchy papules over her back and lower limbs for 3 months. She denied the history of oozing or vesiculation. A cutaneous examination showed diffusely distributed multiple well-defined keratotic papules, 4 to 10 mm in diameter, on the bilateral lower limbs and back as well as a few papules on her chest and forearm. Scratching scars were over the resolved lesions while Koebner phenomenon was negative. The patient had a history of type 2 diabetes for 15 years. Laboratory examinations showed elevated blood glucose level. Skin lesion biopsy showed a well-circumscribed area of necrosis filled with a keratotic plug. Parakeratotic cells and lymphocytic infiltration could be seen in the necrosed area. In dermis, sparse fiber bundles were seen perforating the epidermis. These degenerated fiber bundles were notarized as collagen fiber by elastic fiber stain, suggesting a diagnosis of RPC. Results: Then a diagnosis of ARPC was made according to the onset age and the history of diabetes mellitus. She was treated with topical application of corticosteroids twice a day and oral antihistamine once a day along with compound glycyrrhizin tablets 3 times a day. And the blood glucose was controlled in a satisfying range. Two months later, a significant improvement was seen in this patient. Conclusion: Since there is no efficient therapy to RPC, moreover, ARPC is considered to be associated with some systemic diseases, the management of the coexisting disease is quite crucial. The patient in this case received a substantial improvement due to the control of blood glucose and application of compound glycyrrhizin tablets. PMID

  17. Perforation of the small bowel due to metastasis from tongue cancer.

    PubMed

    Aoyagi, Yoshiko; Matsuda, Keiji; Shimada, Ryu; Horiuchi, Atsushi; Shibuya, Hajime; Nakamura, Keisuke; Iinuma, Hisae; Hayama, Tamuro; Yamada, Hideki; Nozawa, Keijiro; Ishihara, Soichiro; Watanabe, Toshiaki

    2011-01-01

    Distant small bowel metastases from head and neck squamous cell carcinomas are extremely rare, and tongue cancer metastasizing to the small bowel has not been previously reported. We describe a 40-year-old male patient who underwent subtotal gross laryngectomy for squamous cell carcinoma of the tongue in February 2007 and then presented in November 2008 with severe abdominal pain. Abdominal computed tomography (CT) and X-rays revealed free air, suggesting intestinal perforation. Emergency surgery revealed a 10-mm perforation at the ileum and a palpable hard tumor at the perforation site. The ileum was resected, and pathologic findings showed squamous cell carcinoma at the perforation site, which was consistent with metastasis from tongue cancer.

  18. Thoracic osteophyte: rare cause of esophageal perforation.

    PubMed

    Rathinam, S; Makarawo, T; Norton, R; Collins, F J

    2010-01-01

    Esophageal perforation is a difficult problem in thoracic surgery. Esophageal perforations can be spontaneous, iatrogenic, or malignant. We report two cases of esophageal perforations caused by thoracic osteophytes and different management strategies leading to successful outcomes. An 80-year-old male presented with chest pain and dysphagia following a fall. On endoscopy, an esophageal perforation and foreign body was noted which was confirmed as a thoracic osteophyte on computed tomography scan. He was managed conservatively as he declined surgery. A 63-year-old male was admitted with dysphagia following a food bolus obstruction. Following esophagoscopy and dilatation, there was clinical and radiological evidence of perforation. During surgery, a thoracic osteophyte was identified as the cause of perforation. The perforation was closed in layers and the osteophyte was trimmed. Both patients recovered well. Thoracic osteophytes are a rare cause of esophageal perforations and a high index of suspicion is required in patients with osteoarthritis who present with esophageal perforations.

  19. Semianalytical productivity models for perforated completions

    SciTech Connect

    Karakas, M.; Tariq, S.M. )

    1991-02-01

    This paper discusses the effects of various perforation and reservoir parameters on the productivity (or injectivity) of perforated completions. Because of the complex, 3D flow into a spiral system of perforations, productivity analysis of perforated completion is not easily amenable to analytical treatment. This paper presents a semianalytical solution for the estimation of skin in perforated completions. Results are presented for two separate cases: the 2D-plane-flow problem, which is essentially valid at small dimensionless perforation spacings (large perforation penetrations or high perforation shot densities) and the general 3D problem, where the vertical convergent flow into perforations is significant. In these analyses, the wellbore and vertical-flow effects are quantified in terms of pseudoskins obtained by accurate finite-element simulations. The effects of perforation damage and formation anisotropy are also included. The results provide a better understanding of the relative role of various perforation parameters in affecting well productivity. Because they are based on theoretical considerations, the correlations allow reliable estimates of the skin in perforated completions. New relations are provided for estimating productivity of perforated completions with formation permeability damage. Results indicate the importance of angular phasing, in addition to perforation penetration, in overcoming the effects of formation damage on well productivity.

  20. Intussusception in Premature Baby: Unusual Cause of Bowel Obstruction and Perforation

    PubMed Central

    Tepmalai, Kanokkan; Naowapan, Thanyaluck; Singhavejsakul, Jesda; Laohapensang, Mongkol; Khorana, Jiraporn

    2017-01-01

    Intussusception in a premature baby is a rare condition. We report a male preterm infant, who developed abdominal distension and abdominal wall erythema. He was operated with suspicion of NEC but an ileo-ileal intussusception and intestinal perforation were encountered at operation. PMID:28083499

  1. Diffuse perforated necrotising amoebic colitis with histoplasmosis in an immunocompetent individual presenting as an acute abdomen

    PubMed Central

    Badyal, Rama Kumari; Gupta, Rajesh; Vaiphei, Kim

    2013-01-01

    Perforated necrotising amoebic colitis associated with intestinal histoplasmosis has rarely been reported in an immunocompetent individual. Radiology and preoperative features are non-specific and requires histopathological examination for a definitive diagnosis. Hence, this condition needs to be considered in the differential diagnosis of complicated infective colitis. PMID:23814195

  2. Colonic Perforation in a Young Tetraplegic Male Caused by Zucchini

    PubMed Central

    Pigac, Biserka; Masic, Silvija

    2016-01-01

    Introduction: Colonic perforation is a clinical condition which occurs due to variety of reasons, such as intrinsic disorders of the intestine, extrinsic causes, but also due to presence of foreign bodies. Foreign objects enter gastrointestinal tract by oral or transanal introduction. Case report: we present an uncommon case of a 26- year-old tetraplegic male, whose death was a consequence of a widespread purulent peritonitis provoked by colonic perforation inflicted by an unusual foreign body, transanally introduced 28 centimeters long zucchini (Cucurbita pepo L.). Conclusions: we share our experience in order to emphasize the importance of consideration and early recognition of foreign body presence in the alimentary tract as possible diagnosis. PMID:27994305

  3. A case report of small bowel perforation secondary to cytomegalovirus related immune reconstitution inflammatory syndrome in an AIDS patient.

    PubMed

    Gutiérrez-Delgado, Eva María; Villanueva-Lozano, Hiram; García Rojas-Acosta, Miguel J; Miranda-Maldonado, Ivett C; Ramos-Jiménez, Javier

    2017-01-01

    Non-traumatic small bowel perforation is rare in adults but carries a high morbidity and mortality. The diagnosis is made on clinical suspicion, and the most common causes in developing countries are infectious diseases, being cytomegalovirus infection in immunocompromised patients the main etiology. We describe a patient with a recently diagnosed advanced stage HIV infection and an intestinal perforation associated with cytomegalovirus immune reconstitution inflammatory syndrome after highly active antiretroviral therapy initiation.

  4. Successful endoscopic closure of a colonic perforation one day after endoscopic mucosal resection of a lesion in the transverse colon

    PubMed Central

    Inoki, Kazuya; Sakamoto, Taku; Sekiguchi, Masau; Yamada, Masayoshi; Nakajima, Takeshi; Matsuda, Takahisa; Saito, Yutaka

    2016-01-01

    A 73-year-old man underwent endoscopic mucosal resection (EMR) of a 20-mm flat elevated lesion on the transverse colon. The morning after the procedure, he started to have severe right upper quadrant pain after his first meal. A computed tomography scan revealed free air and a stomach filled with food. He was diagnosed to have delayed post-EMR intestinal perforation. He underwent emergent colonoscopy and clipping of the perforated site. He was discharged 8 d after the endoscopic closure without the need for surgical intervention. The meal was not the cause of the colon transversum perforation. PMID:27574613

  5. Triple gastric peptic ulcer perforation.

    PubMed

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran

    2016-03-01

    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

  6. Spontaneous Perforation of Gallbladder: Case Report

    PubMed Central

    Sheoran, Satish Kumar; Sahai, Rajiv Nandan; Indora, Jagmohan; Biswal, Upender Chand

    2016-01-01

    The main cause of perforation of the gallbladder is cholecystitis with or without cholelithiasis. In old age, spontaneous perforation of gallbladder can be due to decrease in its blood supply, which can be due to atherosclerosis, focal vasospasm or localized vasculitis. Perforation of gallbladder is associated with high morbidity and mortality, if left untreated. Here we report a case of a 60-year-old male with perforation of gallbladder. PMID:27785327

  7. Perforated Meckel’s diverticulum in an adult due to faecolith: A case report and review of literature

    PubMed Central

    Modi, Sunny; Kanapathy Pillai, Shant; DeClercq, Stefaan

    2015-01-01

    Meckel’s diverticulum (MD) is a persistent remnant of the vitelointestinal duct and is present in 2% of population [1]. It is the most common congenital malformation of the gastrointestinal tract. It can present clinically as haemorrhage, diverticulitis, intussusception, chronic ulceration, intestinal obstruction and perforation. Complicated presentation, especially bleeding, tends to be more common in the paediatric group, whereas intestinal obstruction is more common in adults [2]. Patients with a perforation of Meckel’s diverticulum by an enterolith are rare and may present with right iliac fossa pain, which mimics acute appendicitis. PMID:26363105

  8. Intestinal Cancer

    MedlinePlus

    ... connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet ... increase your risk. Possible signs of small intestine cancer include Abdominal pain Weight loss for no reason ...

  9. Intestinal leiomyoma

    MedlinePlus

    Leiomyoma - intestine ... McLaughlin P, Maher MM. The duodenum and small intestine. In: Adam A, Dixon AK, Gillard JH, Schaefer- ... Roline CE, Reardon RF. Disorders of the small intestine. In: Marx JA, Hockberger RS, Walls RM, et ...

  10. Intestinal obstruction

    MedlinePlus

    Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus ... objects that are swallowed and block the intestines) Gallstones (rare) Hernias Impacted stool Intussusception (telescoping of 1 ...

  11. Intestinal Obstruction

    MedlinePlus

    An intestinal obstruction occurs when food or stool cannot move through the intestines. The obstruction can be complete or partial. ... abdomen Inability to pass gas Constipation A complete intestinal obstruction is a medical emergency. It often requires surgery. ...

  12. Fishbone-induced perforated appendicitis.

    PubMed

    Bababekov, Yanik J; Stanelle, Eric J; Abujudeh, Hani H; Kaafarani, Haytham M A

    2015-05-20

    We review the literature and describe a case of fishbone-induced appendicitis. A 63-year-old man presented with abdominal pain. Work up including a focused history and imaging revealed fishbone-induced perforated appendicitis. The patient was managed safely and successfully with laparoscopic removal of the foreign body and appendectomy.

  13. A Review on Perforation Repair Materials

    PubMed Central

    Veeramachaneni, Chandrasekhar; Majeti, Chandrakanth; Tummala, Muralidhar; Khiyani, Laxmi

    2015-01-01

    Perforation is an artificial communication between the root canal system and supporting tissues of the teeth. Root perforation complicates the treatment and deprives the prognosis if not properly managed. A wide variety of materials to seal the perforations have been suggested in literature. There are many comparative studies showing the efficacy of one material over the other. Literature shows many reviews on diagnosis, treatment plan and factors affecting prognosis of perforation repair; but none of these articles elaborated upon various materials available to seal the perforation. The present article aims at describing all the materials used for perforation repair from the past till date; it also offers a literature review of all the articles published over last four decades referred to the treatment of perforation with various root repair materials. PMID:26501031

  14. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions.

  15. The medial sural artery perforator free flap.

    PubMed

    Cavadas, P C; Sanz-Giménez-Rico, J R; Gutierrez-de la Cámara, A; Navarro-Monzonís, A; Soler-Nomdedeu, S; Martínez-Soriano, F

    2001-11-01

    The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.

  16. Combining rhinoplasty with septal perforation repair.

    PubMed

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.

  17. Intraperitoneal explosion following gastric perforation.

    PubMed

    Mansfield, Scott K; Borrowdale, Roderick

    2014-04-01

    The object of this study is to report a rare case of explosion during laparotomy where diathermy ignited intraperitoneal gas from a spontaneous stomach perforation. Fortunately, the patient survived but the surgeon experienced a finger burn. A literature review demonstrates other examples of intraoperative explosion where gastrointestinal gases were the fuel source. Lessons learned from these cases provide recommendations to prevent this potentially lethal event from occurring.

  18. Colonic perforation in Behcet's syndrome.

    PubMed

    Dowling, Catherine-M; Hill, Arnold-Dk; Malone, Carmel; Sheehan, John-J; Tormey, Shona; Sheahan, Kieran; McDermott, Enda; O'Higgins, Niall-J

    2008-11-14

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  19. Perforated peptic ulcer - an update

    PubMed Central

    Chung, Kin Tong; Shelat, Vishalkumar G

    2017-01-01

    Peptic ulcer disease (PUD) affects 4 million people worldwide annually. The incidence of PUD has been estimated at around 1.5% to 3%. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with acute abdomen that carries high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries a mortality ranging from 1.3% to 20%. Thirty-day mortality rate reaching 20% and 90-d mortality rate of up to 30% have been reported. In this review we have summarized the current evidence on PPU to update readers. This literature review includes the most updated information such as common causes, clinical features, diagnostic methods, non-operative and operative management, post-operative complications and different scoring systems of PPU. With the advancement of medical technology, PUD can now be treated with medications instead of elective surgery. The classic triad of sudden onset of abdominal pain, tachycardia and abdominal rigidity is the hallmark of PPU. Erect chest radiograph may miss 15% of cases with air under the diaphragm in patients with bowel perforation. Early diagnosis, prompt resuscitation and urgent surgical intervention are essential to improve outcomes. Exploratory laparotomy and omental patch repair remains the gold standard. Laparoscopic surgery should be considered when expertise is available. Gastrectomy is recommended in patients with large or malignant ulcer. PMID:28138363

  20. Totally Laparoscopic Repair of an Ileal and Uterine Iatrogenic Perforation Secondary to Endometrial Curettage

    PubMed Central

    Vecchio, Rosario; Marchese, Salvatore; Leanza, Vito; Leanza, Antonio; Intagliata, Eva

    2015-01-01

    Small bowel perforation is a unique, serious complication during endometrial biopsy. The authors report a case of a double uterine-ileal perforation totally managed by primary laparoscopic repair. A 63-year-old female was admitted with acute abdomen 2 days after an endometrial curettage. Abdominal X-ray shows signs of pneumoperitoneum. Emergency diagnostic laparoscopy was performed and a uterine-ileal perforation was identified. Repair was accomplished by a totally laparoscopic intracorporeally suturing of the 2 breaches. Postoperative course showed only a delayed ileus and the patient was discharged after 5 days with no complications. When acute abdomen arises following uterine biopsy, a potential iatrogenic intestinal laceration always has to be ruled out. Laparoscopic approach is a quick and safe technique in these cases. Totally laparoscopic primary closure of the iatrogenic ileal laceration may be accomplished with low morbidity. PMID:25692425

  1. Jejunal perforation after abdominal liposuction, bilateral breast augmentation and facial fat grafting

    PubMed Central

    Coronado-Malagón, Martin; Tauffer-Carrion, Luis Tomas

    2012-01-01

    A 54-year-old woman presented to the emergency department 24 h after undergoing abdominal liposuction, bilateral breast augmentation and facial fat grafting at a private plastic surgery clinic. She presented with the classic evolution of a bowel perforation secondary to abdominal liposuction. A computed tomography (CT) scan found free air in her abdominal cavity. Based on the CT scan and the persistent pain experienced by the patient, an abdominal laparatomy was urgently performed. A jejunum perforation was found and was treated with a resection of the affected segment followed by intestinal anastomosis. The patient had a successful recovery and was discharged seven days later. The present article also reviews the classical presentation of a bowel perforation following abdominal liposuction. PMID:23997589

  2. Jejunal perforation after abdominal liposuction, bilateral breast augmentation and facial fat grafting.

    PubMed

    Coronado-Malagón, Martin; Tauffer-Carrion, Luis Tomas

    2012-01-01

    A 54-year-old woman presented to the emergency department 24 h after undergoing abdominal liposuction, bilateral breast augmentation and facial fat grafting at a private plastic surgery clinic. She presented with the classic evolution of a bowel perforation secondary to abdominal liposuction. A computed tomography (CT) scan found free air in her abdominal cavity. Based on the CT scan and the persistent pain experienced by the patient, an abdominal laparatomy was urgently performed. A jejunum perforation was found and was treated with a resection of the affected segment followed by intestinal anastomosis. The patient had a successful recovery and was discharged seven days later. The present article also reviews the classical presentation of a bowel perforation following abdominal liposuction.

  3. Asymptomatic Cecal Perforation in a Renal Transplant Recipient After Sodium Polystyrene Sulfonate Administration.

    PubMed

    Singla, Montish; Shikha, Deep; Lee, Sunggeun; Baumstein, Donald; Chaudhari, Ashok; Carbajal, Roger

    2016-01-01

    Sodium polystyrene sulfonate (SPS) is a medication commonly used for the treatment of hyperkalemia. There have been many cases of colonic necrosis and perforation associated with administration of SPS. There are very few such cases reported in renal transplant patients. We present a case of renal transplant recipient who developed cecal perforation after a single oral dose of SPS. She had no signs or symptoms suggestive of intestinal perforation and was incidentally diagnosed with it on abdominal imaging performed to find cause of acute blood loss anemia. This case underlines the importance of recognizing this severe and potentially life-threatening complication associated with SPS. The clinicians should also consider renal/solid organ transplant and immunosuppression as potential risk factors.

  4. Surgical Management of Perforated Gastrointestinal Posttransplantation Lymphoproliferative Disorder After Heart Transplantation

    PubMed Central

    Osawa, Hideki; Uemura, Mamoru; Nishimura, Junichi; Hata, Taishi; Takemasa, Ichiro; Mizushima, Tsunekazu; Yamamoto, Hirofumi; Doki, Yuichiro; Mori, Masaki

    2015-01-01

    Posttransplantation lymphoproliferative disorder (PTLD) is a relatively rare and life-threatening complication after organ transplantation. From 1999 to 2012, 45 adult patients underwent heart transplantation at our hospital. Two of the patients developed PTLD after transplantation and required emergency surgery due to intestinal perforation. These cases were informative regarding the adequate surgical management of such cases. Both cases revealed Epstein-Barr virus-related PTLD. The optimal treatment of PTLD remains controversial, and PTLD with gastrointestinal perforation could be critical because the patients are already debilitated and immunocompromised after transplantation. Therefore, the nonspecific abdominal symptoms can be diagnostic for PTLD, and proper surgical intervention should be performed immediately. We present these two suggestive and rare cases in regard to the management of perforation with PTLD and a review of literature. PMID:25692442

  5. Ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose calcium polystyrene sulfonate.

    PubMed

    Kao, Chih-Chin; Tsai, Yi-Chiun; Chiang, Wen-Chih; Mao, Tsui-Lien; Kao, Tze-Wah

    2015-10-01

    A rare but severe complication, intestinal necrosis, has been reported after sodium polystyrene sulfonate (SPS; Kayexalate) and sorbitol intake. Some case reports described bowel perforation following calcium polystyrene sulfonate (CPS; Kalimate) administration. We report a case of ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose Kalimate in a 59-year-old female patient. The patient had a history of hypertension, diabetes mellitus, and end-stage renal disease (ESRD). During hospitalization for peritoneal dialysis-related peritonitis, she developed hyperkalemia, and Kalimate was administered orally. However, severe abdominal distension and pain occurred just one day after Kalimate intake. An urgent surgery disclosed several perforations in the ileum and sigmoid colon. Pathology of the resected gut showed transmural necrosis and perforation with basophilic angulated crystals. The patient finally expired during hospitalization due to refractory septic shock.

  6. Dimensions of stabident intraosseous perforators and needles.

    PubMed

    Ramlee, R A; Whitworth, J

    2001-09-01

    Problems can be encountered inserting intraosseous injection needles through perforation sites. This in vitro study examined the variability and size compatibility of Stabident intraosseous injection components. The diameters of 40 needles and perforators from a single Stabident kit were measured in triplicate with a toolmakers microscope. One-way ANOVA revealed that mean needle diameter (0.411 mm) was significantly narrower than mean perforator diameter (0.427 mm) (p < 0.001). A frequency distribution plot revealed that needle diameter followed a normal distribution, indicating tight quality control during manufacture. The diameter of perforators was haphazardly distributed, with a clustering of 15% at the lower limit of the size range. However on no occasion was the diameter of a perforator smaller than that of an injection needle. We conclude that components of the Stabident intraosseous anaesthetic system are size-compatible, but there is greater and more haphazard variability in the diameter of perforators than injection needles.

  7. Freestyle Local Perforator Flaps for Facial Reconstruction.

    PubMed

    Lee, Jun Yong; Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  8. "Death by a thread"--peritonitis due to visceral perforation by a guide wire, during proximal femur osteosynthesis with DHS: a fatal case and legal implications.

    PubMed

    Durão, Carlos; Barros, André; Guerreiro, Rui; Pedrosa, Frederico

    2015-04-01

    Iatrogenic intestinal perforations in orthopaedic surgery are very rare. Reports of iatrogenic lesions caused by a guide wire during femur fracture osteosynthesis are even scarcer. There are no similar reports in recent literature. As opposed to what is normally described the lesion documented in this case report was not identified on time resulting in death by peritonitis. The forensic autopsy allowed the identification of an intestinal perforation with faecal leakage to peritoneal space in association with a vesical perforation enabling the reproduction of the guide wire path. In view of the increasing number of osteosynthesis it is essential for the surgeon to be aware of possible complications due to guide wire perforations. Cases like this go unnoticed if the forensic pathologist is not familiarized with the surgical technique which may explain the rarity of such descriptions in literature.

  9. Abdominal CT findings in small bowel perforation.

    PubMed

    Zissin, R; Osadchy, A; Gayer, G

    2009-02-01

    Small bowel perforation is an emergent medical condition for which the diagnosis is usually not made clinically but by CT, a common imaging modality used for the diagnosis of acute abdomen. Direct CT features that suggest perforation include extraluminal air and oral contrast, which are often associated with secondary CT signs of bowel pathology. This pictorial review illustrates the CT findings of small bowel perforation caused by various clinical entities.

  10. Minimally invasive treatments for perforator vein insufficiency

    PubMed Central

    Salazar, Gloria Maria; Prabhakar, Anand M.; Ganguli, Suvranu

    2016-01-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease. PMID:28123979

  11. Management of Esophageal Perforation in Adults

    PubMed Central

    Kaman, Lileswar; Iqbal, Javid; Kundil, Byju; Kochhar, Rakesh

    2010-01-01

    Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. The ideal treatment is controversial. The main causes for esophageal perforation in adults are iatrogenic, traumatic, spontaneous and foreign bodies. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours. Primary closure of the perforation site and wide drainage of the mediastinum is recommended if perforation is detected in less than 24 hours. Treatment option for delayed or missed rupture of esophagus is not very clear and is controversial. Recently a substantial number of patients with esophageal perforation are being managed by nonoperative measures. Patients with small perforations and minimal extraesophageal involvement may be better managed by nonoperative treatment Major prognostic factors determining mortality are the etiology and site of the injury, the presence of underlying esophageal pathology, the delay in diagnosis and the method of treatment. For optimum outcome for management of esophageal perforations in adults a multidisciplinary approach is needed. PMID:27942303

  12. Medical treatment for a fish bone-induced ileal micro-perforation: a case report.

    PubMed

    Kuo, Chein-Chung; Jen, Tsu-Kang; Wen, Cheng-Hsin; Liu, Chih-Ping; Hsiao, Hai-Sung; Liu, Yao-Chi; Chen, Kuan-Ho

    2012-11-07

    Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification. Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations. We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation. The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient. Medical treatment was elected to manage the patient's condition instead of surgical intervention. The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication. Factors affecting clinical treatment decisions include the nature of micro-perforation, the patient's good overall health condition, and the early diagnosis before sepsis signs develop. Micro-perforation means the puncture of intestine wall without CT evidence of free air, purulent peritoneum or abscess. We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

  13. Diagnostic Colonoscopy Leading to Perforated Appendicitis: A Case Report and Systematic Literature Review

    PubMed Central

    Michalopoulos, Antonios

    2016-01-01

    Introduction. Intestinal perforation is a known complication after colonoscopy. However, appendiceal involvement with inflammation and perforation is extremely rare and only 37 cases of postcolonoscopy appendicitis have been reported so far. We describe a case of perforated appendicitis 24 hours after colonoscopy that was treated successfully in our Department. Case Report. A 60-year-old female patient underwent a colonoscopy during the investigation of nontypical abdominal pain without pathologic findings. 24 hours after the examination she presented gradually increased right lower quadrant abdominal pain and a CT scan was performed, showing an inflammation of the appendiceal area with free peritoneal air. Through laparotomy, perforated appendicitis was diagnosed and an appendectomy was performed. The patient was discharged on the tenth postoperative day in good health condition. Discussion. The characteristics of all cases reported in the literature are described, including our case. Perforated appendicitis soon after a colonoscopy is a rare, but serious complication; therefore, it is crucial to be included in the differential diagnosis of postcolonoscopy acute abdominal pain. PMID:27980869

  14. Small bowel perforations due to deliberate ingestion of injurious foreign bodies--a personal experience.

    PubMed

    Malik, Arshad M

    2008-01-01

    Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature.

  15. [Recurrent anal abscess and cecal perforation as a first presentation of Behçet's disease].

    PubMed

    Haller, Claude; Guenot, Cécile; Odman, Micaela; Bruttin, Jean-Marie; Rosso, Raphaël

    2003-10-01

    Intestinal involvement during Behçet's disease (entero-Behçet) is rare in Europe (<1%). We report the case of a 33-year-old Chad woman with Behçet's disease revealed by recurrent anal abscess and cecal perforation. We discuss the diagnosis of this atypical presentation and the different therapeutic strategies in severe attacks of Behçet's disease.

  16. Contrast agent free detection of bowel perforation using chlorophyll derivatives from food plants

    NASA Astrophysics Data System (ADS)

    Han, Jung Hyun; Jo, Young Goun; Kim, Jung Chul; Lee, Jee-Bum; Kim, Yong-Chul; Kang, Hoonsoo; Hwang, In-Wook

    2016-01-01

    Chlorophylls occur abundantly in food plants and show bright emission bands at long-wavelength regions (∼675 and ∼720 nm) compared to the autofluorescence of animal organs and peritoneal fluids. The use of these emissions as biomarkers for monitoring bowel perforation with a modality that does not involve synthetic contrast agents seems promising. To validate this, we measured the fluorescence spectra of rat organs, human peritoneal and intestinal fluids, and human intestinal fluids diluted with physiological saline. The developed technique showed a high detection sensitivity (∼50 ppm) under irrigation for abdominal surgery, highlighting the potential of this tool in the surgical setting.

  17. High power laser perforating tools and systems

    SciTech Connect

    Zediker, Mark S; Rinzler, Charles C; Faircloth, Brian O; Koblick, Yeshaya; Moxley, Joel F

    2014-04-22

    ystems devices and methods for the transmission of 1 kW or more of laser energy deep into the earth and for the suppression of associated nonlinear phenomena. Systems, devices and methods for the laser perforation of a borehole in the earth. These systems can deliver high power laser energy down a deep borehole, while maintaining the high power to perforate such boreholes.

  18. Dimensional scaling for impact cratering and perforation

    NASA Technical Reports Server (NTRS)

    Watts, Alan; Atkinson, Dale; Rieco, Steve

    1993-01-01

    This report summarizes the development of two physics-based scaling laws for describing crater depths and diameters caused by normal incidence impacts into aluminum and TFE Teflon. The report then describes equations for perforations in aluminum and TFE Teflon for normal impacts. Lastly, this report also studies the effects of non-normal incidence on cratering and perforation.

  19. Cyanoacrylate glue for type iii lad perforation.

    PubMed

    Trehan, V K; Nigam, Arima

    2008-01-01

    Coronary artery perforation especially type III is a rare and catastrophic complication of percutaneous coronary intervention. It mandates emergency open heart surgery if hemostasis is not achieved promptly. We report a case of type III left anterior descending artery (LAD) perforation which was managed successfully with cyanoacrylate glue.

  20. Unusual presentation of gallbladder perforation

    PubMed Central

    Jayasinghe, G.; Adam, J.; Abdul-Aal, Y.

    2015-01-01

    Introduction Gall bladder perforation is associated with high mortality rates and therefore must be recognised and managed promptly. We present an unusual presentation of spontaneous gall bladder perforation. Case presentation An elderly lady with multiple medical co-morbidities was admitted with sepsis following a fall. Initial assessment lead to a diagnosis of pneumonia, however a rapidly expanding right flank mass was incidentally noted during routine nursing care. Imaging studies were inconclusive, however incision and drainage of the mass revealed bile stained pus draining cutaneously from an acutely inflamed gallbladder. The patient made a good recovery following surgery, and was discharged with outpatient follow-up. Discussion Despite focussed post-hoc history taking she denied any prodromal symptoms of cholecystitis. In addition to reporting an unusual cause for a common presentation, we highlight the importance of a full body examination in the context of sepsis, regardless of whether the source has been identified. In addition, we advocate that surgical intervention in sepsis should not be delayed by imaging in cases where an abscess is suspected. Conclusions Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified. PMID:26686488

  1. Extreme overbalance perforating improves well performance

    SciTech Connect

    Dees, J.M.; Handren, P.J.

    1994-01-01

    The application of extreme overbalance perforating, by Oryx Energy Co., is consistently outperforming the unpredictable, tubing-conveyed, underbalance perforating method which is generally accepted as the industry standard. Successful results reported from more than 60 Oryx Energy wells, applying this technology, support this claim. Oryx began this project in 1990 to address the less-than-predictable performance of underbalanced perforating. The goal was to improve the initial completion efficiency, translating it into higher profits resulting from earlier product sales. This article presents the concept, mechanics, procedures, potential applications and results of perforating using overpressured well bores. The procedure can also be used in wells with existing perforations if an overpressured surge is used. This article highlights some of the case histories that have used these techniques.

  2. Flexible CO2 laser and submucosal gel injection for safe endoluminal resection in the intestines

    PubMed Central

    Au, Joyce T.; Mittra, Arjun; Wong, Joyce; Carpenter, Susanne; Carson, Joshua; Haddad, Dana; Monette, Sebastien; Ezell, Paula; Patel, Snehal

    2012-01-01

    Background The CO2 laser’s unique wavelength of 10.6 µm has the advantage of being readily absorbed by water but historically limited it to line-of-sight procedures. Through recent technological advances, a flexible CO2 laser fiber has been developed and holds promise for endoluminal surgery. We examined whether this laser, along with injection of a water-based gel in the submucosal space, will allow safe dissection of the intestines and enhance the potential of this tool for minimally invasive surgery. Methods Using an ex vivo model with porcine intestines, spot ablation was performed with the flexible CO2 laser at different power settings until transmural perforation. Additionally, excisions of mucosal patches were performed by submucosal dissection with and without submucosal injection of a water-based gel. Results With spot ablation at 5 W, none of the specimens was perforated by 5 min, which was the maximum recorded time. The time to perforation was significantly shorter with increased laser power, and gel pretreatment protected the intestines against spot ablation, increasing the time to perforation from 6 to 37 s at 10 W and from 1 to 7 s at 15 W. During excision of mucosal patches, 56 and 83% of untreated intestines perforated at 5 and 10 W, respectively. Gel pretreatment prior to excision protected all intestines against perforation. These specimens were verified to be intact by inflation with air to over 100 mmHg. Furthermore, excision of the mucosal patch was complete in gel-pretreated specimens, whereas 22% of untreated specimens had residual islands of mucosa after excision. Conclusion The flexible CO2 laser holds promise as a precise dissection and cutting tool for endoluminal surgery of the intestines. Pretreatment with a submucosal injection of a water-based gel protects the intestines from perforation during ablation and mucosal dissection. PMID:21898027

  3. Ileal Trichobezoar Presenting as Intestinal Obstruction and Peritonitis

    PubMed Central

    Rattan, Kamal Nain; Yadav, Vikas; Singh, Jasbir

    2017-01-01

    Trichobezoar is less common in boys. We are reporting a case of isolated ileal trichobezoars in a 4-year old boy causing intestinal obstruction and gut ischemia with perforation and peritonitis. The case was managed surgically with ileal resection and anastomosis. Postoperative period was uneventful.

  4. Spontaneous Gastric Perforation in Two Adolescents

    PubMed Central

    Akalonu, Amaka; Yasrebi, Mona; Rios, Zarela Molle

    2016-01-01

    Case series Patients: Female, 11 • Male, 15 Final Diagnosis: Spontaneous gastric perforation Symptoms: Abdominal pain • distention • vomiting • leukocytosis Medication: — Clinical Procedure: Both patients had surgery Specialty: Gastroenterology Objective: Rare etiology Background: Spontaneous gastric perforation is a rare clinical disorder. The majority of the available data have been reported in the neonatal age group. There are a few cases of spontaneous gastric perforation in preschool children. To our knowledge, there is no published information on spontaneous gastric perforation in older children and adolescents. Case Report: We describe the presentation and clinical course of two adolescent children who presented with spontaneous gastric perforation. Both children presented with acute onset abdominal pain, which progressively worsened. In both cases, the patient were taken urgently to the operating room after imaging studies had shown pneumoperitoneum. In both cases, surgery revealed gastric perforation with no obvious etiology, specifically no ulcer, inflammation, or other pathology. Conclusions: These two cases highlight the importance of including spontaneous gastric perforation, not just the typical duodenal/gastric ulcer, in the differential of a patient with severe abdominal pain and distension, who has imaging showing pneumoperitoneum. PMID:27686129

  5. Lifesaving Embolization of Coronary Artery Perforation

    SciTech Connect

    Katsanos, Konstantinos; Patel, Sundip; Dourado, Renato; Sabharwal, Tarun

    2009-09-15

    Coronary artery perforation remains one of the most fearsome complications during cardiac catheterization procedures. Although emergent bypass surgery is the preferred treatment for cases with uncontrollable perforation, endovascular vessel sealing and arrest of bleeding with a combination of balloons, covered stents, or embolic materials have also been proposed. The authors describe a case of emergent lifesaving microcoil embolization of the distal right coronary artery in a patient with uncontrollable grade III guidewire perforation resulting in cardiac tamponade. The relevant literature is reviewed and the merits and limitations of the endovascular approach are highlighted.

  6. Perforated membrane-type acoustic metamaterials

    NASA Astrophysics Data System (ADS)

    Langfeldt, F.; Kemsies, H.; Gleine, W.; von Estorff, O.

    2017-04-01

    This letter introduces a modified design of membrane-type acoustic metamaterials (MAMs) with a ring mass and a perforation so that an airflow through the membrane is enabled. Simplified analytical investigations of the perforated MAM (PMAM) indicate that the perforation introduces a second anti-resonance, where the effective surface mass density of the PMAM is much higher than the static value. The theoretical results are validated using impedance tube measurements, indicating good agreement between the theoretical predictions and the measured data. The anti-resonances yield high low-frequency sound transmission loss values with peak values over 25 dB higher than the corresponding mass-law.

  7. Transpiration effects in perforated plate aerodynamics

    NASA Astrophysics Data System (ADS)

    Szwaba, R.; Ochrymiuk, T.

    2016-10-01

    Perforated walls find a wide use as a method of flow control and effusive cooling. Experimental investigations of the gas flow past perforated plate with microholes (110μm) were carried out. The wide range of pressure at the inlet were investigated. Two distinguishable flow regimes were obtained: laminar and turbulent regime.The results are in good agreement with theory, simulations and experiments on large scale perforated plates and compressible flows in microtubules. Formulation of the transpiration law was associated with the porous plate aerodynamics properties. Using a model of transpiration flow the “aerodynamic porosity” could be determined for microholes.

  8. Delayed jejunal perforation after laparoscopic cholecystectomy

    PubMed Central

    Browne, Ikennah L.; Dixon, Elijah

    2016-01-01

    Bowel perforation is a rare complication of laparoscopic cholecystectomy, which if left undiagnosed can have fatal consequences. In addition, isolated small bowel perforation is extremely rare and should be considered in patients presenting with sudden onset abdominal pain in the postoperative period. A 57-year-old male with symptomatic gallstones underwent urgent laparoscopic cholecystectomy and was discharged home on postoperative day (POD) 1 without complications. He presented to the emergency department on POD 11 complaining of sudden onset abdominal pain. A CT scan did not confirm a diagnosis and he was admitted for observation. On post admission day 2, he became significantly peritonitic and laparotomy revealed jejunal perforation. Bowel resection with hand-sewn anastomosis was completed and he was discharged on POD 10. Follow-up at 6 weeks revealed no further issues. We review the literature on small bowel perforation post laparoscopic cholecystectomy. PMID:26908534

  9. Successful endoscopic hemoclipping of an esophageal perforation.

    PubMed

    Sung, H Y; Kim, J I; Cheung, D Y; Cho, S H; Park, S-H; Han, J-Y; Kim, J K; Han, S W; Choi, K Y; Chung, I S

    2007-01-01

    We describe a case of esophageal perforation that resulted from a fishbone. A 71-year-old man had had a fishbone impacted in the lower esophagus for 2 days. At presentation, the bone was dislodged at endoscopy; one round opening in a deep ulceration was detected when the fishbone was removed. The perforation was closed by endoscopic hemoclipping, after the removal of the fishbone. A thoracic computed tomography revealed air around the esophagus, aorta and bronchus and the presence of a pleural effusion. These findings suggested mediastinal emphysema and mediastinitis due to the esophageal perforation after the removal of the fishbone. Esophagography revealed a focal esophageal defect and linear contrast leakage at the distal esophagus. The mediastinal emphysema and pleural effusion successfully resolved after the endoscopic hemoclip application and conservative management of the perforation.

  10. Intestinal Parasitoses.

    ERIC Educational Resources Information Center

    Lagardere, Bernard; Dumburgier, Elisabeth

    1994-01-01

    Intestinal parasites have become a serious public health problem in tropical countries because of the climate and the difficulty of achieving efficient hygiene. The objectives of this journal issue are to increase awareness of the individual and collective repercussions of intestinal parasites, describe the current conditions of contamination and…

  11. Perioperative management for a patient with hypermagnesemia-induced shock with perforative peritonitis.

    PubMed

    Kikuchi, Toshihiro; Kumakura, Seiichiro; Tanabe, Yutaka

    2010-06-01

    We present a case of hypermagnesemia accompanied by perforative peritonitis. A 79-year-old woman took magnesium citrate as part of the pretreatment on the day before a scheduled colonoscopy. She developed nausea and muscle weakness, and she was complaining of left abdominal pain. Consciousness gradually worsened and she developed shock. Intestinal obstruction was recognized on abdominal X-ray and computed tomography (CT), and peritonitis was suspected. An exploratory laparotomy was scheduled for diagnosis and treatment. In the operating room, arterial blood gas analysis showed metabolic acidosis and hypermagnesemia (Mg: 2.75 mmol/l, normal range: 0.1-1.5 mmol/l). On laparotomy, adhesion around the sigmoid colon and turbid ascites were recognized. But we could not detect the apparent region of perforation. Based on these findings and the presence of hypermagnesemia, we diagnosed that the shock was caused by peritonitis due to intestinal micro-perforation, and by hypermagnesemia due to absorption of laxative. We started to treat for metabolic acidosis, and to manage the hypermagnesemia by calcium hydrochloride administration and by continuous hemodiafiltration after the operation. On day 4 of the illness, the plasma Mg level was normalized. She was extubated on day 12, and discharged on day 84. This case with complicated clinical symptoms reaffirms the difficulty and importance of making a diagnosis quickly by collecting various data.

  12. Mucosal perforators from the facial artery.

    PubMed

    Coronel-Banda, Mauricio E; Serra-Renom, Jose M; Lorente, Marian; Larrea-Terán, Wendy P

    2014-07-01

    The cutaneous perforators of the facial artery have been well described, but to our knowledge the oral mucosal perforators have not. We studied 10 facial arteries from 10 hemifaces in 5 cadavers. The arteries were injected with latex, and we studied all perforators that extended from the facial artery and headed directly to the oral mucosa. The diameter and length of the facial artery and its mucosal perforators were measured and compared. We found 52 oral mucosal perforators in the 10 facial arteries injected with latex. Their mean (SD) diameter was 0.5 (0.2) mm and the mean (SD) number/facial artery was 5.2 (1.1). Their mean (SD) length was 16.4 (5.3) mm. Most of those to the cheek were localised between the branching-off points of the inferior and superior labial arteries. The facial artery has perforators to the oral mucosa of the cheek, most of them between the points at which the labial arteries emerge.

  13. Major intestinal complications of radiotherapy. Management and nutrition

    SciTech Connect

    Deitel, M.; To, T.B.

    1987-12-01

    Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome.

  14. Gallstone ileus with jejunum perforation managed with laparoscopic-assisted surgery: rare case report and minimal invasive management.

    PubMed

    Lee, Cheng-Hung; Yin, Wen-Yao; Chen, Jian-Han

    2015-05-01

    Gallstone ileus is an uncommon complication of cholelithiasis. Most patients affected by gallstone ileus are elderly and have multiple comorbidities. Symptoms are vague and insidious, which may delay the correct diagnosis for days. Here we are reporting an uncommon complication of gallstone ileus. We report on a 70-year-old man with small bowel obstruction at the jejunum due to an impacted stone, which led to necrosis and perforation of the proximal bowel wall. Laparoscope-assisted small bowel resection with enterolithotomy was used to successfully treat the patient's perforation and obstruction. His recovery was uneventful. Gallstone ileus commonly presents with bowel obstruction, but intestinal perforation occurs very rarely. A laparoscopic approach can provide both diagnostic and therapeutic roles in management.

  15. Intestinal injury mechanisms after blunt abdominal impact.

    PubMed

    Cripps, N P; Cooper, G J

    1997-03-01

    Intestinal injury is frequent after non-penetrating abdominal trauma, particularly after modern, high-energy transfer impacts. Under these circumstances, delay in the diagnosis of perforation is a major contributor to morbidity and mortality. This study establishes patterns of intestinal injury after blunt trauma by non-penetrating projectiles and examines relationships between injury distribution and abdominal wall motion. Projectile impacts of variable momentum were produced in 31 anaesthetised pigs to cause abdominal wall motion of varying magnitude and velocity. No small bowel injury was observed at initial impact velocity of less than 40 m/s despite gross abdominal compression. At higher velocity, injury to the small bowel was frequent, irrespective of the degree of abdominal compression (P = 0.00044). Large bowel injury was observed at all impact velocities and at all degrees of abdominal compression. This study confirms the potential for intestinal injury in high velocity, low momentum impacts which do not greatly compress the abdominal cavity and demonstrates apparent differences in injury mechanisms for the small bowel and colon. Familiarity with injury mechanisms may reduce delays in the diagnosis of intestinal perforation in both military and civilian situations.

  16. Volar perforators of common digital arteries: an anatomical study.

    PubMed

    Gasiunas, V; Valbuena, S; Valenti, P; Le Viet, D

    2015-03-01

    The palmar triangle is an area vascularized by perforator arteries arising from the common digital palmar arteries. The aim of this article was to perform an anatomical study of common digital palmar arteries perforators. Twelve injected specimens were included in this study. The purpose was to quantify the number of perforator arteries of each common digital palmar arteries in the 2nd, 3rd, and 4th intermetacarpal space, measure distances between them, between the distal perforator and corresponding commissure, and the distance between the proximal perforator and the superficial palmar arch. Four to eight perforators were arising from common digital palmar arteries of the 2nd, 3rd, and 4th intermetacarpal space. The average distance between perforator arteries was 6.5 mm, between superficial palmar arch and proximal perforator artery - 8.2 mm, between the distal perforator artery and corresponding commissure - 6.3 mm.

  17. Coronary perforation and covered stents: an update and review.

    PubMed

    Al-Mukhaini, Mohammed; Panduranga, Prashanth; Sulaiman, Kadhim; Riyami, Abdulla Amour; Deeb, Mohammed; Riyami, Mohamed Barkat

    2011-04-01

    Coronary perforation is a rare complication of percutaneous coronary intervention. We present two different types of coronary intervention, but both ending with coronary perforation. However, these perforations were tackled successfully by covered stents. This article reviews the incidence, causes, presentation, and management of coronary perforation in the present era of aggressive interventional cardiology. Coronary perforations are classified as type I (extraluminal crater), II (myocardial or pericardial blushing), and III (contrast streaming or cavity spilling). Types I and II coronary perforations are caused by stiff or hydrophilic guidewires. Type I has a benign prognosis, whereas type II coronary perforations have the potential to progress to tamponade. Type III coronary perforations are caused by balloons, stents, or other intracoronary devices and commonly lead to cardiac tamponade necessitating pericardial drainage. However, type III perforations can be managed with covered stents without need for surgical intervention.

  18. Clipping prevents perforation in large, flat polyps

    PubMed Central

    Luba, Daniel; Raphael, Mona; Zimmerman, Dayna; Luba, Joseph; Detka, Jon; DiSario, James

    2017-01-01

    AIM To determine if prophylactic clipping of post-polypectomy endoscopic mucosal resection (EMR) mucosal defects of large, flat, right sided polyps prevents perforations. METHODS IRB approved review of all colonoscopies, and prospective data collection of grasp and snare EMR performed by 2 endoscopists between January 1, 2010 and March 31, 2014 in a community ambulatory endoscopy center. The study consisted of two phases. In the first phase, all right-sided, flat polyps greater than or equal to 1.2 cm in size were removed using the grasp and snare technique. Clipping was done at the discretion of the endoscopist. In the second phase, all mucosal defects were closed using resolution clips. Phase 2 of the study was powered to detect a statistically significant difference in perforation rate with 148 EMRs, if less than or equal to 2 perforations occurred. RESULTS In phase 1 of the study, 2121 colonoscopies were performed. Seventy-five patients had 95 large polyps removed. There were 4 perforations in 95 polypectomies (4.2%). The perforations occurred in polyps ranging in size from 1.5 cm to 2.5 cm. In phase 2, there were 2464 colonoscopies performed. One hundred and sixteen patients had 151 large polyps removed, and all mucosal defects were clipped. There were no perforations (P = 0.0016). There were no post-polypectomy hemorrhages in either phase. An average of 2.15 clips were required to close the mucosal defects. The median time to perform the polypectomy and clipping was 13 min, and the median procedure duration was 40 min. Five percent of all patients undergoing colonoscopy in our community based, ambulatory endoscopy center had flat, right sided polyps greater than or equal to 1.2 cm in size. CONCLUSION Prophylactic clipping of the mucosal resection defect of large, right-sided, flat polyps reduces the incidence of perforation. PMID:28360975

  19. Intestinal Capillariasis

    DTIC Science & Technology

    1987-12-01

    bhIll inenais, the tiny nematode causing Intestinal capillariasis In humans, Is a Iunique parasite. It is one of the newest parasites that has been...Capillariaphilippinensis, the tiny nematode causing intestinal capillariasis in humans, is a unique parasite. It is one of the newest parasites that has been shown to...stichocytes surrounding the oesophagus. The posterior half of the nematode is wider than the anterior half and contains the digestive tract and the

  20. Isolation of Cokeromyces recurvatus, initially misidentified as Coccidioides immitis, from peritoneal fluid in a cat with jejunal perforation.

    PubMed

    Nielsen, Cheri; Sutton, Deanna A; Matise, Ilze; Kirchhof, Nicole; Libal, Melissa C

    2005-07-01

    Cokeromyces recurvatus, a zygomycete, was isolated by fungal culture from the peritoneal fluid of a cat with jejunal perforation secondary to intestinal lymphosarcoma. This organism has not been recovered previously from a veterinary patient. The tissue form of C. recurvatus is morphologically similar to those of Coccidioides immitis and Paracoccidioides brasiliensis and may be misdiagnosed as 1 of these organisms on the basis of cytologic or histopathologic specimens, particularly in geographic regions where these organisms are not endemic.

  1. Perforated peptic ulcer in an adolescent girl.

    PubMed

    Schwartz, Shepard; Edden, Yair; Orkin, Boris; Erlichman, Matityahu

    2012-07-01

    A perforated peptic ulcer in a child is a rare entity. Severe abdominal pain in an ill-appearing child with a rigid abdomen and possibly with signs of shock is the typical presenting feature of this life-threatening complication of peptic ulcer disease. We present a case of a 14.5-year-old adolescent girl who developed abdominal and shoulder pain that resolved after 1 day. She was then completely well for 2 days until the abdominal and shoulder pain recurred. On examination, she appeared well, but in pain. A chest radiograph revealed a large pneumoperitoneum. She underwent emergent laparoscopic omental patch repair of a perforated ulcer on the anterior wall of her stomach. Result of a urea breath test to detect Helicobacter pylori was negative. The differential diagnosis of pneumoperitoneum in children is discussed, as are childhood perforated peptic ulcer in general, and the unique clinical features present in this case in particular.

  2. Traumatic Forefoot Reconstructions With Free Perforator Flaps.

    PubMed

    Zhu, Yue-Liang; He, Xiao-Qing; Wang, Yi; Lv, Qian; Fan, Xin-Yv; Xu, Yong-Qing

    2015-01-01

    The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.

  3. Evaluation of urgent esophagectomy in esophageal perforation

    PubMed Central

    de AQUINO, José Luis Braga; de CAMARGO, José Gonzaga Teixeira; CECCHINO, Gustavo Nardini; PEREIRA, Douglas Alexandre Rizzanti; BENTO, Caroline Agnelli; LEANDRO-MERHI, Vânia Aparecida

    2014-01-01

    Background Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. Aim To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation. Methods A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon. Results Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes. Conclusions Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures. PMID:25626932

  4. Clinical evaluation of cyanoacrylate glue in corneal perforations.

    PubMed

    Bansal, D C; Sandhu, P S; Khosla, A D

    1987-01-01

    Our experience of the use of Cyanoacrylate glue in 50 cases of perforation or impending perforation of cornea has been presented. The method of application has been described. Quite encouraging and useful results have been obtained.

  5. Tissue adhesives: new perspectives in corneal perforations.

    PubMed

    Hirst, L W; Stark, W J; Jensen, A D

    1979-03-01

    In corneal perforations associated with extensive progressive corneal disease, a technique using tissue adhesive closure of the perforation site and reformation of the anterior chamber before penetrating keratoplasty or conjunctival flap mobilization has been described. Over the past year, six eyes have been successfully treated in this manner. This method allows reformation of the eye under local anesthesia as an emergency procedure without incarceration or injury of the intraocular contents and without pain to the patient. The definitive surgical procedure can then be performed safely under retrobulbar anesthesia.

  6. Pneumoperitoneum Secondary to Spontaneously Perforated Pyometra

    PubMed Central

    2017-01-01

    Pyometra, by definition, is a collection of purulent fluid within the uterine cavity. Incidence has been estimated to range from 0.1% to 0.5%. Typically, this is linked to postmenopausal women; however, it has been linked to premenopausal women with concordant use of intrauterine devices. Based on our knowledge, there have been less than 50 recorded cases reported in the English literature regarding perforation of pyometra resulting in acute abdomen and fewer than 25 resulting in pneumoperitoneum. We report a patient who was evaluated for diffuse peritonitis caused by perforated pyometra who was successfully treated with surgical intervention. PMID:28357145

  7. Laser skin perforator with focal point detection

    NASA Astrophysics Data System (ADS)

    Ponce, L.; Arronte, M.; Cabrera, J. L.; Flores, T.

    2006-02-01

    The development of laser skin perforator device for obtaining blood samples is presented. The use of photoelectric proximity photoelectric sensor permits to determine the focal point eliminating any contact and them avoiding the risk of contamination. Perforation of about 0.2 mm - 0.5 mm in diameter can be obtained in order to take the sample of blood. The method permits to make the blood analysis not only avoiding the contamination risk but also diminishing the pain sensation in comparison with metal lancet.

  8. Select fire perforating system application in Norway

    SciTech Connect

    1995-11-01

    Phillips Petroleum Co. Norway, used the special features of the Halliburton Selector Fire (HSF) System to perforate selected reservoir sections over very long intervals in horizontal wells in Greater Ekofisk Area fields in the Norwegian North Sea. Basic operations of the tool and three case history applications were presented at Offshore Europe `95 in Aberdeen by E. Kleepa and R. Nilson, Halliburton Norway (Inc.) and K. Bersaas, Phillips Petroleum Co. Norway, in paper SPE 30409 ``Tubing conveyed perforating in the Greater Ekofisk Area using the Halliburton Select Fire System.`` Highlights are summarized here.

  9. Duodenal Perforation Precipitated by Scrub Typhus.

    PubMed

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  10. Postoperative Gastric Perforation in a Newborn with Duodenal Atresia

    PubMed Central

    Antabak, Anko; Bogović, Marko; Vuković, Jurica; Grizelj, Ruža; Babić, Vinka Barbarić; Papeš, Dino; Luetić, Tomislav

    2016-01-01

    Gastric perforation (GP) in neonates is a rare entity with high mortality. Although the etiology is not completely understood, it mostly occurs in premature neonates on assisted ventilation. Combination of duodenal atresia and gastric perforation is very rare. We present a case duodenal atresia who developed gastric perforation after operetion for duodenal atresia. Analysis of the patient medical record and histology report did not reveal the etiology of the perforation. PMID:27896170

  11. Spontaneous perforation of a pyometra presenting as generalized peritonitis.

    PubMed Central

    Hosking, S. W.

    1985-01-01

    Eleven cases of spontaneous perforation of a pyometra have previously been reported. All were associated with, and probably secondary to, cervical occlusion. A further case is described, but differs in that the cervical canal was patent. In the absence of other possible causes of uterine perforation, the aetiology of the perforation in this case remains uncertain. Images Figure 1 PMID:4040634

  12. Acute phlegmonous gastritis complicated by delayed perforation.

    PubMed

    Min, Sun Young; Kim, Yong Ho; Park, Won Seo

    2014-03-28

    Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient's clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient's condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.

  13. Perforation of woven fabric by spherical projectiles

    SciTech Connect

    Shim, V.P.W.; Tan, V.B.C.; Tay, T.E.

    1995-12-31

    Rectangular specimens of Twaron{reg_sign} fabric, clamped on two opposite sides, are subjected to impact perforation by 9.5 mm diameter spherical steel projectiles at speeds ranging from 140 m/s to 420 m/s. This plain woven fabric, comprising PPTA (poly-paraphenylene terepthalamide) fibers, is commonly employed in flexible an-nor applications. Its perforation response is examined in terms of residual velocity, energy absorbed and resulting deformation patterns. The existence of a critical or transition impact velocity, beyond which there is a significant reduction in energy absorbed by perforation, is observed. Differences in creasing and deformation induced in specimens are also demarcated by this transition impact velocity. Effects of difference in boundary conditions (clamped and free) on yarn breakage are also noted. A numerical model, based on an initially orthogonal network of pin-jointed bars interconnected at nodes, is formulated to simulate the fabric. Fiber yam mechanical properties are represented via a three-element spring-dashpot model which encapsulates viscoelastic behavior and fiber failure. Numerical results exhibit good correlation with experimental observations in terms of prediction of threshold perforation velocity, energy absorbed, occurrence of a transition critical velocity and fabric deformation characteristics.

  14. Necrotizing fasciitis following gall-bladder perforation.

    PubMed

    Rehman, A; Walker, M; Kubba, H; Jayatunga, A P

    1998-10-01

    Necrotizing fasciitis continues to carry a very high mortality and prolonged morbidity. Gallstones have previously not been reported as a cause of this condition. We report a patient who presented with gallbladder perforation leading to necrotizing fasciitis of the anterior abdominal wall. The only organism isolated was Escherichia Coli, cultured from necrotic issue.

  15. Perforated stomach following the Heimlich maneuver.

    PubMed

    Cowan, M; Bardole, J; Dlesk, A

    1987-03-01

    The use of infradiaphragmatic abdominal pressure for relief of airway obstruction caused by food was first described by Henry Heimlich in 1974. Since that time, several complications have been reported. We report a case of gastric perforation occurring in a choking victim following the application of the Heimlich maneuver.

  16. Optimal design of perforating completion for gas well

    SciTech Connect

    Tang, Y.; Pan, Y.; Wang, Y.

    1995-10-01

    The productivity characteristics of perforated gas well are investigated for the first time under real conditions considering drilling damage, perforation compacted zone and anisotropy in this paper. A non-linear finite element model for non-Darcy flow in perforated gas reservoir is built to consider the effects of twelve factors on productivity ratio (PR) of perforated gas well. The nomographs for two cases are presented in this paper. Compared with previous works, the following results are found: (1) the effects of drilling damage and perforation diameter on PR of gas well are more remarkable than that in oil well; (2) any perforation phase may be the best or the worst as to perforating gas well, which depends on anisotropy, drawdown and that whether or not perforations are beyond drilling damage zone; (3) the increase in perforation length hardly improve PR of gas well when perforations have been beyond drilling damage zone. The new method is suggested to predict or determine the turbulent flow co-efficient D{prime}, total skin S, pseudo skin St{prime}, and individual skin factors (Sp, Sd, Sdp) in perforated gas well. The minimum underbalance required to obtain a zero perforating skin is discussed as well. Some drawbacks of the equation proposed by Tariq (SPE 20636) are analyzed and a new Reynold`s number criterion is established. The critical Reynold`s number for clean perforation is dependent on formation permeability. Based on this research, the principle and the program for optional design of perforating completion in gas well are highlighted. These new concepts, results and conclusions would be of importance to both gas well perforating and gas reservoir engineering.

  17. Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

    PubMed Central

    2010-01-01

    Background Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal. PMID:20529382

  18. Clinical outcome in patients with small-intestinal non-Hodgkin lymphoma.

    PubMed

    Kako, Shinichi; Oshima, Kumi; Sato, Miki; Terasako, Kiriko; Okuda, Shinya; Nakasone, Hideki; Yamazaki, Rie; Tanaka, Yukie; Tanihara, Aki; Kawamura, Yutaka; Kiyosaki, Hirokazu; Higuchi, Takakazu; Nishida, Junji; Konishi, Fumio; Kanda, Yoshinobu

    2009-10-01

    The clinical features and outcome of small intestinal lymphoma remain unclear. We retrospectively analyzed 23 patients who had non-Hodgkin lymphoma with a small intestinal lesion. With a median follow-up of 37 months, the 5-year overall survival and failure-free survival (FFS) were 64% and 60%, respectively. In a univariate analysis, a worse performance status at the start of treatment and the occurrence of abdominal symptoms or perforation during treatment were associated with poor survival. Perforation often resulted in a dismal prognosis in patients with uncontrollable lymphoma, but not in patients with lymphoma in remission. The role of surgery in small intestinal lymphoma remains equivocal. In the current study, surgery before other therapies favorably influenced FFS, and all patients who underwent complete resection of the small intestinal lesion had extremely favorable results. Further studies are warranted to establish optimal therapeutic strategies.

  19. Aesthetic and functional abdominal wall reconstruction after multiple bowel perforations secondary to liposuction.

    PubMed

    Di Candia, Michele; Malata, Charles M

    2011-04-01

    This report describes a case of aesthetic and functional abdominal wall reconstruction performed to salvage a deformed, scarred, and herniated anterior abdomen after severe peritonitis and partial rectus muscle necrosis secondary to multiple bowel perforations sustained during liposuction performed in a cosmetic clinic. The diagnosis of intestinal perforation was missed intraoperatively and in the immediate postoperative period. The patient was admitted 4 days after the surgery to the intensive therapy unit in septicemic shock. After resuscitation and stabilization, she was treated by debridement of the abdominal wall, bowel resection, and temporary jejunostomy and colostomy (reversed 10 months later). She was referred 18 months after liposuction to the Plastic Surgery Service with a large central midline abdominal incisional hernia presenting with thinned out skin (14 × 11 cm) overlying adherent bowel. A components separation technique was successfully used to reconstruct the abdominal wall, with no recurrent herniation 2 years later. Survivors of bowel perforations sustained during abdominal liposuction may later present with challenging aesthetic and functional problems, as described in this report. These long-term sequelae have not been addressed hitherto in the literature.

  20. Perforation of the mesenteric small bowel: etiologies and CT findings.

    PubMed

    Hines, John; Rosenblat, Juliana; Duncan, Dameon R; Friedman, Barak; Katz, Douglas S

    2013-04-01

    The purpose of this article is to illustrate and discuss the various etiologies of perforation of the mesenteric small bowel and associated findings on abdominal CT. Perforation of the mesenteric small bowel is an uncommon cause of an acute abdomen and can be due to various etiologies. In underdeveloped countries, infection is probably the most common cause, while in industrialized nations, perforation may be due to Crohn disease, diverticulitis, foreign body, trauma, tumor, mechanical obstruction, primary ischemic event, or iatrogenic causes. CT is usually the initial imaging examination in patients with an acute abdomen and is sensitive in diagnosing small bowel perforation. CT findings in the setting of small bowel perforation are often subtle, but when present, may help the radiologist determine a specific cause of perforation. The aims of this pictorial essay are to review the various causes of mesenteric small bowel perforation and to discuss and illustrate the CT findings that can help arrive at the diagnosis.

  1. The one-stage rhinoplasty septal perforation repair.

    PubMed

    Foda, H M

    1999-08-01

    A combined septal perforation repair and rhinoplasty was performed in 20 patients (12 males, eight females; age range 16-36, mean age 29.6) presenting with septal perforations (size 1-4 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. The perforation was totally closed in 18 cases (90 per cent) with complete resolution of the pre-operative symptoms occurring in 16 (80 per cent). Cosmetically, 19 cases (95 per cent) were very satisfied with their aesthetic result. The exposure provided by the external approach proved to be very helpful in the process of septal perforation repair. Our results show that septal perforation repair could safely be combined with rhinoplasty and that some of the rhinoplasty manoeuvres used could even facilitate the process of septal perforation repair.

  2. A plausible explanation for male dominance in typhoid ileal perforation.

    PubMed

    Khan, Mohammad

    2012-01-01

    The phenomenon of consistent male dominance in typhoid ileal perforation (TIP) is not well understood. It cannot be explained on the basis of microbial virulence, Peyer's patch anatomy, ileal wall thickness, gastric acidity, host genetic factors, or sex-linked bias in hospital attendance. The cytokine response to an intestinal infection in males is predominantly proinflammatory as compared with that in females, presumably due to differences in the sex hormonal milieu. Sex hormone receptors have been detected on lymphocytes and macrophages, including on Peyer's patches, inflammation of which (probably similar to the Shwartzman reaction/Koch phenomenon) is the forerunner of TIP, and is not excluded from the regulatory effects of sex hormones. Hormonal control of host-pathogen interaction may override genetic control. Environmental exposure to Salmonella typhi may be more frequent in males, presumably due to sex-linked differences in hygiene practices and dining-out behavior. A plausible explanation of male dominance in TIP could include sex-linked differences in the degree of natural exposure of Peyer's patches to S. typhi. An alternative explanation may include sexual dimorphism in host inflammatory response patterns in Peyer's patches that have been induced by S. typhi. Both hypotheses are testable.

  3. Analyses and applications of pressure, flow rate, and temperature measurements during a perforating run. [Measurement while perforating

    SciTech Connect

    Tariq, S.M. ); Ayestaran, L.C. )

    1991-02-01

    Perforating technology has undergone significant advances during the last decade. Tubing-conveyed perforating, underbalanced perforating, high-shot-density guns, better shaped charges, and improved gun systems have contributed to safer operations and improved productivity of the perforated completions. A recent development described in this paper is a perforating tool that makes real-time downhole measurements (including pressure, flow rate, temperature, gamma ray, casing-collar locator (CCL), and cable tension) during a perforating run and can selectively fire a number of guns at different depths or times. In addition to providing better control of the perforating process, the simultaneous downhole measurements can provide in a single trip a production log, conventional well tests before and after perforating, and a fill-up or slug test soon after perforating for underbalanced conditions. Thus, the completion can be evaluated in real time and any needed remedial reperforating can be performed while the gun is still in the hole. Other applications include limited-entry perforating, monitoring of bottomhole pressure (BHP) during minifracture jobs, better depth control with a gamma ray detector, fluid-level monitoring, and underbalance control. The applications of these measurements, with field data obtained with the Measurement While Perforating (MWP{sup SM}) tool, are the subject of this paper. Examples show the capabilities and the versatility of the MWP tool.

  4. [Intestinal microbiota].

    PubMed

    Debré, Patrice; Le Gall, Jean-Yves

    2014-12-01

    The human body normally lives in symbiosis with a considerable microscopic environment present on all interfaces with the external environment; it hosts ten times more microbes (microbiota) that it has somatic or germ cells, representing a gene diversity (microbiome) 100-150 times higher than the human genome. These germs are located mainly in the gut, where they represent a mass of about one kilogram. The primary colonization of the gastrointestinal tract depends on the delivery route, the bacterial flora rewarding then depending on the environment, food hygiene, medical treatments. The intestinal microbiota plays an important role in the maturation of the immune system and in different physiological functions: digestion of polysaccharides, glycosaminoglycans and glycoproteins, vitamins biosynthesis, bile salt metabolism of some amino acids and xenobiotics. Quantitative and qualitative changes in the microbiota are observed in a wide range of diseases: obesity, colorectal cancer, liver cancer, inflammatory bowel disease, autoimmune diseases, allergies... pharmacobiotics aim to modify the intestinal microbiota in a therapeutic goal and this by various means: prebiotics, probiotics, antibiotics or fecal transplants. Intestinal flora also plays a direct role in the metabolism of certain drugs and the microbiota should be considered as a predictive parameter of response to some chemotherapies.

  5. Rapunzel syndrome resulting in gastric perforation.

    PubMed

    Parakh, J S; McAvoy, A; Corless, D J

    2016-01-01

    We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review.

  6. Overbalance perforating and stimulation method for wells

    SciTech Connect

    Dees, J.M.; Handren, P.J.; Jupp, T.B.

    1992-07-21

    This patent describes a method for decreasing the resistance to fluid flow in a subterranean formation around a well having unpreforated casing fixed therein, the casing extending at least partially through the formation. It comprises providing a liquid in the casing opposite the formation to be treated; placing perforating means in the casing at a depth opposite the formation to be treated; injecting gas into the well until the pressure in the liquid opposite the formation to be treated will be at least as large as the fracturing pressure of the formation when the liquid pressure is applied to the formation; activating the perforating means; and at a time before pressure in the well at the depth of the formation to be treated has substantially decreased, injecting fluid at an effective rate to fracture the formation.

  7. [Duodenal perforation after blunt abdominal trauma].

    PubMed

    Schneider, R; Moebius, C; Thelen, A; Jonas, S

    2009-12-01

    Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis.

  8. Thyroid storm precipitated by duodenal ulcer perforation.

    PubMed

    Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Ando, Takao; Kawakami, Atsushi

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  9. Ileal perforation by an odd foreign object

    PubMed Central

    Abdullayev, Ruslan; Aslan, Mahmut

    2015-01-01

    Perforation of the gastrointestinal system by a foreign body is seldom observed in clinical practice; however, it has great importance because it is preventable and can usually be easily treated. In this case report, we present a young male patient, who mistakenly swallowed a foreign body and presented to the emergency service one day later with acute abdomen. The 23-year-old patient was diagnosed with acute appendicitis and underwent emergency laparotomy. During the operation, a plastic object that perforated the terminal ileum lumen and protruded into the abdominal cavity was identified. Along with appendectomy, the foreign body was removed and the ileum was repaired. The detailed history of the patient revealed that he had mistakenly swallowed something one day before the onset of abdominal pain. The patient was discharged on the postoperative seventh day following an uneventful course. PMID:26170746

  10. Contained colonic perforation due to cecal retroflexion.

    PubMed

    Geng, Zhuo; Agrawal, Deepak; Singal, Amit G; Kircher, Stephen; Gupta, Samir

    2016-03-21

    Complications of cecal retroflexion performed during colonoscopy have not previously been reported to occur. We report a case of contained colonic perforation secondary to using cecal retroflexion technique to examine the colon, and review available published reports of complications associated with this technique. We conclude that complications may rarely occur with use of cecal retroflexion, and that the clinical benefit of this technique is uncertain.

  11. Chronic Gastric Ischemia Leading to Gastric Perforation

    PubMed Central

    Lundsmith, Emma; Zheng, Matthew; McCue, Peter

    2016-01-01

    A 69-year-old man with diabetes, peripheral vascular disease, and hypertension presented with 3 months of diffuse abdominal pain that worsened with meals, weight loss, and dysphagia. Esophagogastroduodenoscopy and computed tomography revealed findings consistent with chronic gastric ischemia secondary to atherosclerosis. Gastric ischemia eventually led to perforation. We discuss causes, symptoms, diagnosis, and management of gastric ischemia, an underdiagnosed and potentially fatal condition that requires urgent diagnosis and treatment. PMID:28119945

  12. Urosepsis complicated by a spontaneous bladder perforation.

    PubMed

    Lutwak, Nancy; Dill, Curt

    2011-11-08

    The authors present a case of a 72-year-old diabetic male s/p pelvic irradiation for prostate carcinoma who arrived in the emergency department with complaints of shaking chills. After admission for urosepsis, he developed severe abdominal pain and examination revealed a diffusely tender abdomen. The patient was diagnosed with spontaneous urinary bladder perforation and underwent surgery. After several weeks of intravenous antibiotics, he was discharged with multiple drains in place and bilateral nephrostomy tubes.

  13. Predictable Pattern Digital Artery Perforator Flap

    PubMed Central

    Epameinondas, Kostopoulos; Christos, Agiannidis; Petros, Konofaos; Avraam, Dounavis; Othon, Papadopoulos; Vincent, Casoli

    2016-01-01

    Background: The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutano-tendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest. Methods: From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function. Results: Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient. Conclusions: Authors introduced the concept of a “predictable pattern” in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option. PMID:27418896

  14. Perforating devices for use in wells

    DOEpatents

    Jacoby, Jerome J.; Brooks, James E.; Aseltine, Clifford L.

    2002-01-01

    The perforating device for use in completing a well includes a case, an explosive charge contained in the case, and a generally bowl-shaped liner. The liner is positioned adjacent the explosive charge and has non-uniforrn thickness along its length. The liner further includes a protruding portion near its tip. In another configuration, the liner includes a hole near its tip to expose a portion of the explosive charge.

  15. Occult glove perforation during ophthalmic surgery.

    PubMed Central

    Apt, L; Miller, K M

    1992-01-01

    We examined the latex surgical gloves used by 56 primary surgeons in 454 ophthalmic surgical procedures performed over a 7-month period. Of five techniques used to detect pinholes, air inflation with water submersion and compression was found to be the most sensitive, yielding a 6.80% prevalence in control glove pairs and a 21.8% prevalence in postoperative study glove pairs, for a 15.0% incidence of surgically induced perforations (P = 0.000459). The lowest postoperative perforation rate was 11.4% for cataract and intraocular lens surgery, and the highest was 41.7% for oculoplastic procedures. Factors that correlated significantly with the presence of glove perforations as determined by multiple logistic regression analysis were oculoplastic and pediatric ophthalmology and strabismus surgical procedures, surgeon's status as a fellow in training, operating time, and glove size. The thumb and index finger of the nondominant hand contained the largest numbers of pinholes. These data suggest strategies for reducing the risk of cross-infection during ophthalmic surgery. PMID:1494836

  16. Lateral perforation in parallel post space preparations.

    PubMed

    Tinaz, A Cemal; Alaçam, Tayfun; Topuz, Ozgur; Er, Ozgur; Maden, Murat

    2004-08-15

    This study evaluates the amount of remaining tooth structure and possibility of producing lateral perforation following the use of different diameters of parallel-sided Parapost drills in groups of different canal curvatures (0 degrees-15 degrees, 16 degrees-25 degrees, 26 degrees <) in distal canals of first and second mandibular molar teeth. After enlargement of root canals using the crown-down pressureless technique, Parapost drills #1, #2, and #3 were used in the different canal groups for the preparation of a post space. Standardized digital radiographs were taken before the post space preparation and after each Parapost drill application. Four horizontal lines (a, b, c, and d) were drawn at equal distances on these images, starting from the pulp chamber floor moving apically at 2 mm increments. There were no significant differences between the different curvature groups at the a, b, c, and d levels for the critical level of the remaining tooth structure (multiple comparison test; p>0.05). However, in considering root perforation, both at the inner and outer side of the roots, there were statistically significant differences at "c" and "d" levels in group 3 (#3 drill) without taking into account the root curvature (ANOVA; p< 0.5). None of the specimens showed strip perforation.

  17. Acquired perforating dermatosis in a patient with chronic renal failure*

    PubMed Central

    Fernandes, Karen de Almeida Pinto; Lima, Lourenço de Azevedo; Guedes, Juliana Chaves Ruiz; Lima, Ricardo Barbosa; D'Acri, Antônio Macedo; Martins, Carlos José

    2016-01-01

    Perforating dermatoses are a group of skin diseases characterized by transepidermal elimination of dermal material. The disease is divided into two groups: the primary group and the secondary group. The classical or primary perforating dermatoses are subdivided into four types according to the eliminated dermal materials: Kyrle disease, perforating reactive collagenosis, elastosis perforans serpiginosa, and perforating folliculitis. The secondary form is known as acquired perforating dermatosis. The term was proposed in 1989 by Rapini to designate the perforating dermatoses affecting adult patients with systemic disease, regardless of the dermal materials eliminated. This report describes a case of the disease with elimination of collagen and elastic fibers in a patient with chronic renal failure. PMID:28300880

  18. Peptic ulcer perforation: sonographic imaging of active fluid leakage.

    PubMed

    Minardos, Ioannis; Ioannis, Minardos; Ziogana, Dimitra; Dimitra, Ziogana; Hristopoulos, Hristos; Hristos, Hristopoulos; Dermitzakis, Ioannis; Ioannis, Dermitzakis

    2006-01-01

    Sonography is not the method of choice for the evaluation of suspected peptic ulcer perforation (PUP). However, indirect sonographic signs and direct visualization of PUP have been reported by several authors in recent years. We report a case of an elderly woman who presented with severe abdominal pain and positive rebound sign, in whom abdominal sonography demonstrated indirect signs of PUP, the site of perforation, and active air fluid leakage through the perforated anterior prepyloric antral wall.

  19. Neonatal Sleeve Gastrectomy for Multiple Gastric Perforations: A Case Report

    PubMed Central

    Reyna-Sepulveda, Francisco

    2017-01-01

    Neonatal gastric perforation (NGP) may be spontaneous, secondary to necrotizing enterocolitis (NEC), or due to distal obstruction. A 27-week old premature male newborn presented with pneumoperitoneum. A single perforation of stomach was found at surgery. Primary repair and gastrostomy were performed. On fifth postoperative day, pneumoperitoneum was again detected. At reoperation, multiple gastric perforations of the greater curvature were found. Sleeve gastrectomy was performed. The patient responded well to the treatment. PMID:28083496

  20. Gallbladder perforation in a patient on steroid therapy.

    PubMed

    Andrabi, Syed Imran; Ahmad, Jawad; Rathore, Munir A; El-Hakeem, Ahmed A

    2007-08-24

    Gallbladder perforation is a serious clinical condition. A definitive diagnosis is contentious before surgery. We discuss a case where a young patient with Crohn's disease taking oral steroids presented with an acute abdomen. CT scan demonstrated a perforated gallbladder without evidence of gallstones. The patient underwent an emergency cholecystectomy and peritoneal lavage. The history and clinical findings of this patient are reviewed to highlight perforation of the gallbladder in relation to steroid therapy.

  1. Conservative Treatment of a Large Facial Midroot Perforation

    PubMed Central

    Bronnec, François

    2015-01-01

    Aim. To report on the endodontic and periodontal management of a root and alveolar process perforation in a maxillary front tooth. Summary. Perforation during access cavity preparation is an infrequent complication during endodontic therapy, leading to potential periodontal tissue breakdown. The case described the two-stage management of a massive facial root perforation requiring a connective tissue graft to correct a mucosal fenestration persisting after orthograde repair of the root defect with MTA. PMID:25838948

  2. Strategies for preserving intestinal length in the short-bowel syndrome

    SciTech Connect

    Thompson, J.S.

    1987-03-01

    Total parenteral nutrition now permits long-term survival in patients after massive intestinal resection. Surgical therapy for the short-bowel syndrome is still largely experimental and cannot be recommended routinely. Thus, prevention of intestinal resection and conservation of intestinal length, when resection is necessary, should be emphasized. Strategies are presented that can be employed to preserve intestinal length when surgery is required in patients with a shortened bowel. These include strictureplasty, minimal resection, serosal patching, and intestinal tapering. In suitable candidates strictureplasty can relieve obstruction from strictures while avoiding resection. Minimal resection of involved intestine can be performed safely in selected patients with radiation injury or Crohn's disease. Serosal patching is an alternative to resection for the treatment of perforation or strictures of the intestine. Intestinal tapering can improve the function of dilated intestinal segments and eliminate the need for resection in intestinal atresia. The judicious use of these procedures can preserve intestinal length and obviate the need for long-term parenteral nutrition in patients after massive intestinal resection.

  3. Reentrant cannulation of the small intestine in sheep: cannula and surgical method.

    PubMed

    Ivan, M; Johnston, D W

    1981-04-01

    The function, design and production of a reentrant cannula for the small intestine of sheep and the corresponding surgical procedure are described. The cannula is molded in one piece from polyvinylchloride plastisol. It consists of a curved intestinal tube joined to a stem with an external elliptical ring on the distal end and a perforated flange that encircles the stem above the intestinal tube. A circular perspex valve with two curved channels was made to fit into the interior of the cannula, making it capable of either a "maintenance" or a "collection" function. The cannula was inserted into the proximal duodenum and(or) terminal ileum of sheep via a 5-cm incision on the antimesenteric side of the intestine. The intestine was attached to the cannula by a Dacron straight arterial graft. This reentrant cannulation method does not require an intestinal transection and a mesenteric incision under the transection. Therefore, little damage was done to the blood and nervous system.

  4. Treatment of Strip Perforation Using Root MTA: A Case Report

    PubMed Central

    Froughreyhani, Mohammad; Salem Milani, Amin; Barakatein, Behnaz; Shiezadeh, Vahhab

    2013-01-01

    Root perforations are an undesired complication of endodontic treatment which result in loss of integrity of the root, and adversely affect the prognosis of the treatment. Recently, Iranian mineral trioxide aggregate [Root MTA] has been introduced as an ideal material for perforation repair. In this article a successful repair of strip root perforation of mandibular molar using Root MTA is presented with 15-month follow-up. This case suggests that Root MTA may be a substitute material for the treatment of strip perforation; however, more clinical studies with larger sample size and longer follow-ups are needed. PMID:23717336

  5. Allopurinol in the treatment of acquired reactive perforating collagenosis*

    PubMed Central

    Tilz, Hemma; Becker, Jürgen Christian; Legat, Franz; Schettini, Antonio Pedro Mendes; Inzinger, Martin; Massone, Cesare

    2013-01-01

    Acquired reactive perforating collagenosis is a perforating dermatosis usually associated with different systemic diseases, mainly diabetes mellitus and/or chronic renal insufficiency. Different therapies have been tried but treatment is not standardized yet and remains a challenge. In the last few years, allopurinol has been reported as a good therapeutic option for acquired reactive perforating collagenosis. We describe the case of a 73-year-old man affected by acquired reactive perforating collagenosis associated with diabetes type 1 and chronic renal failure with secondary hyperparathyroidism. The patient was successfully treated with allopurinol 100mg once/day p.o.. PMID:23539010

  6. Perforations of cortical bone allografts improve their incorporation.

    PubMed

    Delloye, Christian; Simon, Patrick; Nyssen-Behets, Catherine; Banse, Xavier; Bresler, Franck; Schmitt, Daniel

    2002-03-01

    The incorporation of perforated cortical bone allografts was compared with non-perforated allografts. A 5-cm circumferential defect in the middiaphysis at the tibia was created in adult sheep. A frozen tibial allograft was implanted and fixed with a locked nail for 6 months. There was no postoperative immobilization. Group I consisted of eight sheep with non-perforated allografts, whereas Group II was comprised of 10 sheep with perforated allografts. Union was evaluated radiographically, whereas the central part of the allograft had a densitometric evaluation. Creeping substitution was assessed on microradiographs from cross-sections of the central 3 cm of graft by measurement of porosity and percentage of new and old bone area within the confines of the graft. The width of periosteal and endosteal callus also was determined. There was no statistical difference between both groups for the union score and bone density. However, the cortical bone graft porosity and the amount of new bone within the cortical bone differed significantly between the perforated allografts and the non-perforated ones. Periosteal callus was similar in both groups, whereas endosteal callus was significantly more wide and extended in the perforated allografts. Perforation of a cortical bone substantially improved the amount of newly formed bone by the host when compared with a non-perforated bone. The creation of channels seemed to increase the interface between living soft tissues of the host and the allografted bone with a resulting enhanced incorporation.

  7. Management of iatrogenic colorectal perforation: From surgery to endoscopy

    PubMed Central

    Cai, Shi-Lun; Chen, Tao; Yao, Li-Qing; Zhong, Yun-Shi

    2015-01-01

    Iatrogenic colon perforation is one the most pernicious complications for patients undergoing endoscopic screening or therapy. It is a serious but rare complication of colonoscopy. However, with the expansion of the indications for endoscopic therapies for gastrointestinal diseases, the frequency of colorectal perforation has increased. The management of iatrogenic colorectal perforation is still a challenge for many endoscopists. The methods for treating this complication vary, including conservative treatment, surgical treatment, laparoscopy and endoscopy. In this review, we highlight the etiology, recognition and treatment of colorectal iatrogenic perforation. Specifically, we shed light on the endoscopic management of this rare complication. PMID:26191347

  8. Endoluminal vacuum therapy for iatrogenic perforation of the proximal oesophagus.

    PubMed

    Möschler, O; Müller, M K

    2014-03-01

    Iatrogenic perforation of the upper gastrointestinal tract is one of the most serious complications of upper gastrointestinal endoscopy, with high rates of morbidity and mortality. Treatment is challenging because stent placement or surgical repair of the perforation in this area is often impossible. We report on two cases of iatrogenic perforations of the very proximal oesophagus and distal hypopharynx which could be successfully closed by using an endoluminal vacuum sponge treatment for 5 days. Thus, the endoluminal vacuum therapy may be a useful alternative to surgery in such cases of difficultly managable perforations of the upper oesophagus.

  9. Duodenal ulcer perforation: the effect of H2 antagonists?

    PubMed Central

    Gillen, P.; Ryan, W.; Peel, A. L.; Devlin, H. B.

    1986-01-01

    One hundred and two patients with perforated duodenal ulcers over a 13 year period (1970 to 1982) have been prospectively followed-up at a special gastric clinic. Of the 37 patients with perforation of their acute ulcer, 34 were treated by oversew and three had an initial definitive operation (vagotomy and drainage). The remaining 65 patients presented with perforation of a chronic ulcer and 54 were treated by oversew and 11 underwent definitive surgery--nine had vagotomy and drainage and two had partial gastrectomies. Seven of the 34 patients (20.5%) with acute ulcer perforation treated by simple oversew subsequently required definitive ulcer surgery at a mean 17.5 months after perforation and 31 of the 54 patients (57.4%) with chronic ulcer perforations required definitive surgery at a mean 27.4 months after perforation. The introduction of H2 antagonists in 1977 did not alter the re-operation rate in patients with chronic ulcer perforation managed by oversew. Results of this study provide further evidence in favour of treating patients with perforation of their chronic duodenal ulcer by definitive surgery whenever possible. PMID:3789618

  10. Bowel perforation in the newborn: diagnosis with metrizamide

    SciTech Connect

    Cohen, M.D.; Weber, T.R.; Grosfeld, J.L.

    1984-01-01

    Although the diagnosis of bowel perforation is frequently straightforward, it may be difficult in the neonate. Clinical signs may be limited to abdominal distension. If the patient is on assisted ventilation, pneumoperitoneum may be due to air tracking down from the chest rather than perforation. Perforation in infants in whom the diagnosis could not readily be made from the clinical findings and plain radiographs was apparent when oral metrizamide was employed. This suggests that metrizamide can be a valuable adjunct in some cases of neonatal bowel perforation.

  11. Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation

    PubMed Central

    Zuluaga, Claudia Patricia; Aluja Jaramillo, Felipe; Velásquez Castaño, Sergio Andrés; Rivera Bernal, Aura Lucía; Granada, Julio Cesar; Carrillo Bayona, Jorge Alberto

    2016-01-01

    Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone) with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT) with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation. PMID:26977330

  12. Intestinal capillariasis.

    PubMed Central

    Cross, J H

    1992-01-01

    Intestinal capillariasis caused by Capillaria philippinensis appeared first in the Philippines and subsequently in Thailand, Japan, Iran, Egypt, and Taiwan, but most infections occur in the Philippines and Thailand. As established experimentally, the life cycle involves freshwater fish as intermediate hosts and fish-eating birds as definitive hosts. Embryonated eggs from feces fed to fish hatch and grow as larvae in the fish intestines. Infective larvae fed to monkeys, Mongolian gerbils, and fish-eating birds develop into adults. Larvae become adults in 10 to 11 days, and the first-generation females produce larvae. These larvae develop into males and egg-producing female worms. Eggs pass with the feces, reach water, embryonate, and infect fish. Autoinfection is part of the life cycle and leads to hyperinfection. Humans acquire the infection by eating small freshwater fish raw. The parasite multiplies, and symptoms of diarrhea, borborygmus, abdominal pain, and edema develop. Chronic infections lead to malabsorption and hence to protein and electrolyte loss, and death results from irreversible effects of the infection. Treatment consists of electrolyte replacement and administration of an antidiarrheal agent and mebendazole or albendazole. Capillariasis philippinensis is considered a zoonotic disease of migratory fish-eating birds. The eggs are disseminated along flyways and infect the fish, and when fish are eaten raw, the disease develops. Images PMID:1576584

  13. Intestinal capillariasis.

    PubMed

    Cross, J H

    1992-04-01

    Intestinal capillariasis caused by Capillaria philippinensis appeared first in the Philippines and subsequently in Thailand, Japan, Iran, Egypt, and Taiwan, but most infections occur in the Philippines and Thailand. As established experimentally, the life cycle involves freshwater fish as intermediate hosts and fish-eating birds as definitive hosts. Embryonated eggs from feces fed to fish hatch and grow as larvae in the fish intestines. Infective larvae fed to monkeys, Mongolian gerbils, and fish-eating birds develop into adults. Larvae become adults in 10 to 11 days, and the first-generation females produce larvae. These larvae develop into males and egg-producing female worms. Eggs pass with the feces, reach water, embryonate, and infect fish. Autoinfection is part of the life cycle and leads to hyperinfection. Humans acquire the infection by eating small freshwater fish raw. The parasite multiplies, and symptoms of diarrhea, borborygmus, abdominal pain, and edema develop. Chronic infections lead to malabsorption and hence to protein and electrolyte loss, and death results from irreversible effects of the infection. Treatment consists of electrolyte replacement and administration of an antidiarrheal agent and mebendazole or albendazole. Capillariasis philippinensis is considered a zoonotic disease of migratory fish-eating birds. The eggs are disseminated along flyways and infect the fish, and when fish are eaten raw, the disease develops.

  14. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    PubMed

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  15. Pressure enhanced penetration with shaped charge perforators

    DOEpatents

    Glenn, Lewis A.

    2001-01-01

    A downhole tool, adapted to retain a shaped charge surrounded by a superatmospherically pressurized light gas, is employed in a method for perforating a casing and penetrating reservoir rock around a wellbore. Penetration of a shaped charge jet can be enhanced by at least 40% by imploding a liner in the high pressure, light gas atmosphere. The gas pressure helps confine the jet on the axis of penetration in the latter stages of formation. The light gas, such as helium or hydrogen, is employed to keep the gas density low enough so as not to inhibit liner collapse.

  16. A case of hard palate perforation

    PubMed Central

    Saroch, Atul; Pannu, Ashok Kumar

    2016-01-01

    Tuberculosis (TB) is a major public health problem in developing countries. Lung is most common affected organ, however extra pulmonary tuberculosis (EPTB) is also not uncommon. The clinical manifestations of EPTB may be non-specific that mimics other diseases and is usually misdiagnosed. Therefore, high clinical suspicion of EPTB infection is important, especially in endemic areas. Here, we present a case of hard palate perforation that proved to be tuberculous in origin. The diagnosis was made by histo-pathological examination and positive TB Polymerase chain reaction (PCR). PMID:28349008

  17. Choroidal detachment in perforated corneal ulcers: frequency and management

    PubMed Central

    Singh, R; Umapathy, T; Abedin, A; Eatamadi, H; Maharajan, S; Dua, H S

    2006-01-01

    Aims To determine the frequency of choroidal detachment (CD) in eyes with non‐traumatic corneal ulcer perforation and, also, to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations. Methods 18 eyes of 17 patients were studied. Inclusion criterion was any patient with a non‐traumatic perforated corneal ulcer. All patients had a thorough history taken and complete ophthalmic examination including B‐scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed. Results Eight of the 18 eyes (44%) were documented to have a CD. Among perforations of >2 mm2, six eyes (75%) were documented to have CD compared with two eyes (20%) with perforations of ⩽2 mm2 (p = 0.054). No correlation could be determined between perforation duration and incidence of CD. Of the 15 eyes that underwent gluing, there were 13 successes (87%) and two failures (13%). Within the successes four patients (27%) required re‐gluing because of infection (one patient) or progression of melt and glue loosening (three patients). Failure was the result of severe progression of melting (one patient) and a very large perforation (one patient). Conclusion Choroidal detachment following corneal ulcer perforation is common and is more likely in larger corneal perforations. Preoperative B‐scan should be considered in cases of large corneal perforations requiring therapeutic keratoplasty to document choroidal detachment, which if large may require drainage. Cyanoacrylate glue is an effective and safe method for sealing small corneal perforations. A vigil must be maintained for infection while the glue and bandage contact lens are in situ. PMID:16723362

  18. Intestinal protozoa.

    PubMed

    Juckett, G

    1996-06-01

    Giardia is the best known cause of protozoal gastrointestinal disease in North America, producing significant but not life-threatening gastrointestinal distress and diarrhea. Although diagnosis of giardiasis may be challenging, treatment is usually successful. Entamoeba histolytica poses a rarer but far more difficult clinical challenge. Dysentery caused by E. histolytica may be the most feared intestinal protozoal infection, although Cryptosporidium parvum, Balantidium coli, Isospora belli, Sarcocystis species and other newly described protozoa also may cause diarrhea in healthy individuals and may result in intractable, life-threatening illness in patients with acquired immunodeficiency syndrome or other immunosuppressive diseases. Certain protozoa once considered relatively unimportant, such as Cryptosporidium, are now recognized as significant causes of morbidity even in the United States, since transmission readily occurs through contaminated water.

  19. Epstein–Barr Virus-Positive T/NK-Cell Lymphoproliferative Disorders Manifested as Gastrointestinal Perforations and Skin Lesions

    PubMed Central

    Xiao, Hai-Juan; Li, Ji; Song, Hong-Mei; Li, Zheng-Hong; Dong, Mei; Zhou, Xiao-Ge

    2016-01-01

    Abstract Systemic Epstein–Barr virus (EBV)-positive T-cell lymphoproliferative disorders (LPDs) of childhood is a highly aggressive EBV-positive T/natural killer (NK)-cell LPD, which emerges in the background of chronic active EBV infection (CAEBV) or shortly after primary acute EBV infection. The clinical presentations of CAEBV are varied; patients with atypical manifestations are easily misdiagnosed. We described a 14-year-old boy suffering from digestive disorders and intermittent fever for 1 year and 9 months, whose conditions worsened and skin lesions occurred 2 months before hospitalization. He was diagnosed as inflammatory bowel diseases (IBD) and treated accordingly. His other clinical features, hepatosplenomegaly, lymphadenopathy, anemia, hypoalbuminemia, and elevated inflammatory marks, were found in hospitalization. The boy suffered from repeatedly spontaneous intestinal perforations shortly after hospitalization and died of intestinal hemorrhea. The pathological results of intestine and skin both showed EBV-positive T/NK-cell LPD (lymphoma stage). There are rare studies reporting gastrointestinal perforations in EBV-positive T/NK-cell LPD, let alone repeatedly spontaneous perforations. Based on the clinical features and pathological results of this patient, the disease progressed from CAEBV (T-cell type) to systemic EBV-positive T-cell LPD of childhood (lymphoma). Not all the patients with CAEBV could have unusual patterns of anti-EBV antibodies. However, the presence of high EBV loads (EBV-encoded early small ribonucleic acid (RNA) (EBER) in affected tissues and/or EBV deoxyribonucleic acid (DNA) in peripheral blood) is essential for diagnosing CAEBV. Maybe because of his less common clinical features for CAEBV and negative anti-EBV antibodies, the boy was not diagnosed correctly. We should have emphasized the test for EBER or EBV-DNA. Meanwhile, for the IBD patients whose manifestations were not typical, and whose conditions were not improved by

  20. Photoelastic stress analysis in perforated (Rochette) resin bonded bridge design.

    PubMed

    Ziada, H M; Orr, J F; Benington, I C

    2000-05-01

    Rochette described the perforated cast metal bonded design for splinting periodontally compromised teeth. The design was later used for replacing missing teeth. The main causes of failure of the perforated (Rochette) type design were attributed to inappropriate case selection and erosion of the composite from perforations. The aim of this study was to analyse the effect of stress magnitude and direction on failure of perforated resin bonded bridges (RBBs). The objective was to compare stress magnitudes in this design with those reported on the non-perforated RBBs. Photoelastic modelling materials were selected to represent the relative stiffnesses of a posterior mandibular and an anterior maxillary perforated (Rochette) type design. The sizes of the models were scaled to x 2.5 in order to enhance visual analysis of the stress patterns. Stress magnitudes were quantified from isochromatic fringes and stress directions were evaluated from stress trajectories. These revealed a high-stress concentration around the perforations, particularly for those at the proximo-lingual/palatal (connector) areas. This experimental study revealed that the main reason for failure of Rochette designs is deformation at the perforations.

  1. [Hyaluronidase as a therapeutic alternative in perforated tympanum].

    PubMed

    Sánchez-Alcón, M D; Alamar, A; Pérez, H; Sancho-Miñana, P; Sánchez, S; Morera, C

    1995-01-01

    There are many causes of tympanic perforation but usually only one treatment, surgical. However, many patients cannot or will not undergo surgery. In such cases, treatment with sodium hyaluronidate may be satisfactory. In our group of 20 patients with 21 tympanic perforations who underwent this treatment, 15 evolved favorably. The drawbacks and patient selection are discussed.

  2. Evaluation of the Relative Importance of Parameters Influencing Perforation Cleanup

    SciTech Connect

    Detwiler, R L; Morris, J P; Karacan, C O; Halleck, P M; Hardesty, J

    2003-10-22

    Completion of cased and cemented wells by shaped-charge perforation results in damage to the formation, which can significantly reduce well productivity. Typically, underbalanced conditions are imposed during perforation in an effort to remove damaged rock and shaped-charge debris from the perforation tunnel. Immediately after the shaped-charge jet penetrates the formation, there is a transient surge of fluid from the formation through the perforation and into the well bore. Experimental evidence suggests that it is this transient pressure surge that leads to the removal of damaged rock and charge debris leaving an open perforation tunnel. We have developed a two-stage computational model to simulate the perforation process and subsequent pressure surge and debris removal. The first stage of the model couples a hydrocode with a model of stress-induced permeability evolution to calculate damage to the formation and the resulting permeability field. The second stage simulates the non-Darcy, transient fluid flow from the formation and removes damaged rock and charge debris from the perforation tunnel. We compare the model to a series of API RP43 section 4 flow tests and explore the influence of fluid viscosity and rock strength on the final perforation geometry and permeability.

  3. [Retroperitoneal perforations of the colon. Apropos of 2 cases].

    PubMed

    Jurczak, F; Likholatnikov, D; Courant, O; Hamy, A; Visset, J; Paineau, J

    1994-01-01

    The retroperitoneal perforation of the colon is rare and our observations illustrate its two modes of revelation: a retroperitoneal suppuration; it must be traited quickly in order to decrease the mortality. Note that the abscess of the thigh is exceptional. Retroperitoneal perforations during colonoscopy whose treatment (initially medical) become surgical if there is no clinical improvement.

  4. Duodenal perforation caused by a bird feather.

    PubMed

    Sahoo, Manash Ranjan; Kumar, Anil

    2013-02-15

    Ingestion of gastrointestinal (GI) foreign bodies represents a challenging clinical scenario. The greater risk is at extremes of age, in those wearing dentures, alcoholics and mentally handicapped. We present a case of duodenal perforation caused by a bird feather. A 64-year-old man was presented with abdominal pain for 4 days. Abdominal examination showed signs of peritonitis. The erect abdominal x-ray showed free gas under diaphragm. Exploratory laparotomy showed purulent fluid, but no definite site of perforation could be found. So the abdomen was closed with a drain in Morison's pouch. The postoperative recovery was uneventful. He came for a repeat check-up at 4 weeks with dull aching pain in the upper abdomen and was advised for a routine upper GI endoscopy which revealed a feather penetrating the first part of the duodenum, which was removed with a foreign body removing forceps. GI foreign bodies represent a significant problem and an increased level of suspicion is important for timely diagnosis and treatment.

  5. Active Control of Liner Impedance by Varying Perforate Orifice Geometry

    NASA Technical Reports Server (NTRS)

    Ahuji, K. K.; Gaeta, R. J., Jr.

    2000-01-01

    The present work explored the feasibility of controlling the acoustic impedance of a resonant type acoustic liner. This was accomplished by translating one perforate over another of the same porosity creating a totally new perforate that had an intermediate porosity. This type of adjustable perforate created a variable orifice perforate whose orifices were non-circular. The key objective of the present study was to quantify, the degree of attenuation control that can be achieved by applying such a concept to the buried septum in a two-degree-of-freedom (2DOF) acoustic liner. An additional objective was to examine the adequacy of the existing impedance models to explain the behavior of the unique orifice shapes that result from the proposed silding perforate concept. Different orifice shapes with equivalent area were also examined to determine if highly non-circular orifices had a significant impact on the impedance.

  6. Optimal conditions for tissue perforation using high intensity focused ultrasound

    NASA Astrophysics Data System (ADS)

    Mochizuki, Takashi; Kihara, Taizo; Ogawa, Kouji; Tanabe, Ryoko; Yosizawa, Shin; Umemura, Shin-ichiro; Kakimoto, Takashi; Yamashita, Hiromasa; Chiba, Toshio

    2012-10-01

    To perforate tissue lying deep part in body, a large size transducer was assembled by combining four spherical-shaped transducers, and the optimal conditions for tissue perforation have studied using ventricle muscle of chicken as a target. The ex vivo experiments showed that ventricle muscle was successfully perforated both when it was exposed to High Intensity Focused Ultrasound (HIFU) directly and when it was exposed to HIFU through atrial muscle layer. Moreover, it was shown that calculated acoustic power distributions are well similar to the perforation patterns, and that the acoustic energy distributes very complexly near the focus. Lastly, perforation on the living rabbit bladder wall was demonstrated as a preliminary in vivo experiment.

  7. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    PubMed Central

    Geranpayeh, Loabat; Fadaei-Araghi, Mohsen; Shakiba, Behnam

    2006-01-01

    Spontaneous perforation of the uterus is rare, its incidence being about 0.01% − 0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain. PMID:17485806

  8. Necrotizing fasciitis secondary to carcinoma of the gallbladder with perforation.

    PubMed

    Okada, Ken-ichi; Shatari, Tomoo; Yamamoto, Tatsuma; Sasaki, Takahiro; Suwa, Tatsushi; Furuuchi, Takayuki; Takenaka, Yoshifumi; Hori, Masao; Sakuma, Masayoshi

    2007-01-01

    We present an unusual case of necrotizing fasciitis in the upper abdominal wall caused by penetrating perforation of the gallbladder. It was manifested as an elastic and reddish abdominal swelling with severe tenderness, but no peritoneal irritation. Computed tomography (CT) demonstrated water density with a slightly elevated CT value and air bubbles in the subcutaneous space. The preoperative diagnosis was subcutaneous abscess with fasciitis. At surgery, necrotizing fasciitis and subcutaneous abscess secondary to penetrating perforation of the gallbladder were revealed. Cholecystectomy and peritoneal irrigation were performed. Although no tumor was evident during surgery, a tumor located close to the perforation site was found just after the operation. Pathological examination revealed gallbladder carcinoma without stones. There have been very few previous reports of necrotizing fasciitis following gallbladder perforation. The presentation, diagnosis, and management of fasciitis, as well as carcinoma of the gallbladder with perforation, are discussed.

  9. Experimental study on reflection coefficient of curved perforated plate

    NASA Astrophysics Data System (ADS)

    Hodaei, Sayed Mohammad Reza; Chamani, Mohammad Reza; Moghim, Mohammad Navid; Mansoorzadeh, Shahriar; Kabiri-Samani, Abdoreza

    2016-12-01

    A set of experiments is carried out in a towing tank to study the effects of the curvature of perforated plates on the wave reflection coefficient ( C r ). The curvature of a perforated plate can be changed by rotating a reference perforated plate aboutits origin according to the parabolic equation y=- x 2. A plunger-type wave maker is used to generate regular waves. The reflection coefficients are calculated using Goda and Suzuki's (1976) method. The results are compared with those of vertical or sloped passive wave absorbers. The comparison shows that a perforated plate with a curved profile is highly efficient in terms of reducing the wave reflection coefficient. A correlation is established to estimate the reflection coefficient of curved perforated plates as a function of both flow and geometry characteristics.

  10. Laparoscopic Removal of Migrated Intrauterine Device Embedded in Intestine

    PubMed Central

    Rahnemai-Azar, Amir A.; Apfel, Tehilla; Naghshizadian, Rozhin; Cosgrove, John Morgan

    2014-01-01

    Introduction: The intrauterine device (IUD) is a popular family planning method worldwide. Some of the complications associated with insertion of an IUD are well described in the literature. The frequency of IUD perforation is estimated to be between 0.05 and 13 per 1000 insertions. There are many reports of migrated intrauterine devices, but far fewer reports of IUDs which have penetrated into the small intestine. Case Description: Herein we report a case of perforated intrauterine device embedded in the small intestine. By using a wound protector retraction device, and fashioning the anastomosis extra-corporeally, we were able to more easily perform this laparoscopically. This left the patient with a quicker recovery, and a better cosmetic result. Discussion: IUD perforation into the peritoneal cavity is a known complication, and necessitates close follow-up. Most, if not all, should be removed at the time of diagnosis. In the majority of previously reported cases, removal was done through laparotomy. Even in cases where removal was attempted laparoscopically, many were later converted to laparotomy. Surgeons should be aware of different techniques, including using a wound protector retraction device, in order to facilitate laparoscopic removal. PMID:25419105

  11. [Multiple perforation in cryogenically preserved bone allografts. Comparative histological and microradiographic study of perforated and non-perforated allograft in sheep].

    PubMed

    Simon, P; Babin, S R; Delloye, C; Schmitt, D

    1993-01-01

    Incorporation of massive cortical bone allografts in the human is slow and remains incomplete. Late biopsies of implanted allografts or histological studies of explanted allografts always show the partial substitution of necrotic bone by new bone from the host. The aim of the present study was to evaluate the value of drilling the massive deep-frozen cortical allografts in order to induce osteogenesis. Thirteen sheep were operated on and a standard segment of the proximal ulna was removed and the gap filled either by an unperforated allograft or by a perforated one. Based on histological and microradiographic examination, a complete substitution of the perforated allografts was observed but in this model no statistically significant difference was observed between perforated and unperforated allografts. Further study is needed to assess the effect of the perforations.

  12. Segmental Absence of Intestinal Musculature in a 64-Year-Old Female: Case Report and Literature Review

    PubMed Central

    Nawar, Nariman A.; Sawyer, Phyllis R.

    2016-01-01

    Patient: Female, 64 Final Diagnosis: Segmental absence of intestinal musculature Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Colectomy Specialty: Diagnostics, Laboratory Objective: Rare disease Background: Segmental absence of intestinal musculature is a well described entity in premature infants. It presents with peritonitis, bowel perforation, and obstruction. The diagnosis is based on pathologic observation of absence of intestinal musculature. Researchers hypothesized that this entity is a result of a vascular accident during embryogenesis. However, segmental absence of intestinal musculature is no longer limited to the pediatric population. Recently, a few cases have been described in adults with and without significant vascular diseases. This change in the age of the affected population with segmental absence of intestinal musculature makes the understanding of the pathogenesis of this entity even more challenging. Case Report: Here, we report a case of segmental absence of intestinal musculature in a 64-year-old female. The patient presented to the emergency room with sudden onset of abdominal pain and signs of peritonitis. Abdominal computed tomography showed free air in the abdomen. Laparotomy was performed, and a perforation involving the descending colon was identified. Left hemicolectomy was performed. Pathologic examination of the resected colon showed segmental absence of intestinal musculature. Conclusions: Although the pathologic diagnosis of segmental absence of intestinal musculature is straightforward, the assumption that this condition is limited to the pediatric population is a major player in overlooking this diagnosis in adults. Pathologists should be aware that this condition can present in adults and is segmental. Gross and microscopic examination of perforated intestine is required to reach the correct diagnosis. To our knowledge, twelve cases of this entity have been described in adults. Here we present the

  13. [Intestinal microbiota].

    PubMed

    Perez, Horacio Joaquín; Menezes, Maria Elisabeth; d'Acâmpora, Armando José

    2014-01-01

    There is accumulative evidence on the multiple functions of the intestinal microflora in relation to the homeostasis of the host. At first considered as a simple mutualism, today this relationship proves to be essential to the health and to pathologic processes, particularly metabolic (eg, obesity) and gastrointestinal (eg, inflammatory bowel disease and functional disorders). The first studies were conducted on the microbiota from fecal material cultured anaerobically. With the advent of molecular biology, it has become possible to determine qualitative and quantitatively the dominant, subdominant and transients species. In recent years, there were advances in the understanding of the relationship betwen the microbiota and the host, as well as among the microorganisms in their respective niches. These advances result from translational integration of microbiology with specialities such as molecular biology, cell phisiology, immunology and ecology. There are few studies on the spatial distribution of the microflora in the gut. Unravelling the topography of the microflora in mammals is a way to validate new animal models for the study of microflora.

  14. Characterization and literature review of bowel perforation injuring using argon beam coagulation

    NASA Astrophysics Data System (ADS)

    Barnes, Kelli S.; Merchel, Renée. A.; Taylor, Kenneth D.

    2015-03-01

    INTRODUCTION: Argon Beam Coagulation (ABC®) technology is used in conjunction with the ConMed ABCFlex® Probe to provide non-contact hemostasis, coagulation, and tissue devitalization during endoscopic procedures. ABC provides a superficial tissue effect; however, there is a risk of bowel perforation. To better understand the settings that lead to perforation, this study reviews the literature and provides an ex vivo characterization of the ABCFlex Probe tissue effect at different settings when used at small distances. METHODS: Depth of thermal tissue effect was characterized to determine the effect of three parameters: power (W), distance from probe tip to tissue (mm) and application duration (s). 3 ABCFlex Probes were used to create 15 samples on ex vivo porcine small intestine for each combination of parameters. The depth of tissue effect for each sample was measured using a light microscope. RESULTS: Depth of tissue effect increases as power and application time increases. An increase of distance from the probe tip to the tissue results in a decrease in depth of tissue effect from a near contact to 1mm distance. Depth of tissue effect doesn't significantly change from 1mm to 3mm distance. CONCLUSION: ABCFlex Probe can be used to achieve hemostasis in endoscopic procedures. Increasing power and application time increases the depth of thermal effect while increasing distance from the probe time to the surface of the tissue decreases the depth of tissue effect.

  15. Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis

    PubMed Central

    Chaudhary, Poras; Nabi, Ishaq; Ranjan, Gyan; Tiwari, Alok Kumar; Kumar, Sanjay; Kapur, Arun; Arora, Mohinder P.

    2015-01-01

    Background To determine the indications, nature, and rate of early complications of temporary loop ileostomy created in emergency for benign diseases, their management, and to find out the associated risk factors. Methods A total of 630 patients undergoing temporary loop ileostomy for benign diseases were studied prospectively over a period of 6 years. Stoma-related early complications occurring within 6-8 weeks were analyzed. Only emergency cases were included in this study. Descriptive statistics were used to summarize the data and statistical significance was evaluated by applying the Pearson’s chi-square test. Results Typhoid perforation (n=402) was the most commonpathology, followed by tuberculosis (n=106); trauma (n=81); and intestinal obstruction with gangrenous bowel (n=41). 299 patients had no stoma-related complications. Skin excoriation was the most commonstoma-related complication. Age more than 50 years; shock at presentation; delay in presentation; delay in surgery; presence of comorbidities; and surgery done out of working hours, were associated with increased complications. Conclusion Temporary loop ileostomy for perforation peritonitis due to benign systemic diseases like typhoid fever and tuberculosis confers a very high morbidity. PMID:25609137

  16. Palatopharyngeal wall perforation during Glidescope intubation.

    PubMed

    Leong, W L; Lim, Y; Sia, A T H

    2008-11-01

    We report a case of palatopharyngeal wall perforation during intubation with a GlideScope laryngoscope. The likely mechanism was advancing and rotating the endotracheal tube against a taut palatopharyngeal fold. This was missed during the initial laryngoscopy, because there is a potential blind-spot in the oropharynx when attention is focused on the GlideScope" monitor Fortunately, there were no sequelae other than minor bleeding and a mild sore throat and no surgical intervention was necessary. The use of unnecessary force during the endotracheal tube insertion, the use of too large a laryngoscope blade and the use of a rigid stylet could possibly also have been contributory factors to this complication.

  17. Tension pneumothorax due to perforated colon.

    PubMed

    Abdullah, Muhammad; Stonelake, Paul

    2016-05-31

    A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation.

  18. Detection of Perforators Using Smartphone Thermal Imaging.

    PubMed

    Hardwicke, Joseph T; Osmani, Omer; Skillman, Joanna M

    2016-01-01

    Thermal imaging detects infrared radiation from an object, producing a thermogram that can be interpreted as a surrogate marker for cutaneous blood flow. To date, high-resolution cameras typically cost tens of thousands of dollars. The FLIR ONE is a smartphone-compatible miniature thermal imaging camera that currently retails at under $200. In a proof-of-concept study, patients and healthy volunteers were assessed with thermal imaging for (1) detecting and mapping perforators, (2) defining perforasomes, and (3) monitoring free flaps. Preoperative, intraoperative, and postoperative thermograms can assist in the planning, execution, and monitoring of free flaps, and the FLIR ONE provides a low-cost adjunct that could be applied to other areas of burns and plastic surgery.

  19. Viscous damping of perforated planar micromechanical structures

    PubMed Central

    Homentcovschi, D.; Miles, R.N.

    2008-01-01

    The paper gives an analytical approximation to the viscous damping coefficient due to the motion of a gas between a pair of closely spaced fluctuating plates in which one of the plates contains a regular system of circular holes. These types of structures are important parts of many microelectromechanical devices realized in MEMS technology as microphones, microaccelerometers, resonators, etc. The pressure satisfies a Reynolds’ type equation with coefficients accounting for all the important effects: compressibility of the gas, inertia and possibly slip of the gas on the plates. An analytical expression for the optimum number of circular holes which assure a minimum value of the total damping coefficient is given. This value realizes an equilibrium between the squeeze-film damping and the viscous resistance of the holes. The paper also provides analytical design formulas to be used in the case of regular circular perforated plates. PMID:19365579

  20. Dimensional scaling for impact cratering and perforation

    NASA Technical Reports Server (NTRS)

    Watts, Alan J.; Atkinson, Dale

    1995-01-01

    POD Associates have revisited the issue of generic scaling laws able to adequately predict (within better than 20 percent) cratering in semi-infinite targets and perforations through finite thickness targets. The approach used was to apply physical logic for hydrodynamics in a consistent manner able to account for chunky-body impacts such that the only variables needed are those directly related to known material properties for both the impactor and target. The analyses were compared and verified versus CTH hydrodynamic code calculations and existing data. Comparisons with previous scaling laws were also performed to identify which (if any) were good for generic purposes. This paper is a short synopsis of the full report available through the NASA Langley Research Center, LDEF Science Office.

  1. Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

    PubMed Central

    Rho, Bong Il; Lee, In Ho

    2016-01-01

    There are two general categories of lateral osteotomy techniques—the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization. PMID:26848452

  2. Influence of operating microscope in the sealing of cervical perforations

    PubMed Central

    Schmidt, Bruna Schwingel; Zaccara, Ivana Maria; Reis Só, Marcus Vinícius; Kuga, Milton Carlos; Palma-Dibb, Regina Guenka; Kopper, Patrícia Maria Poli

    2016-01-01

    Context: Accidental root canal perforations are among the main complications of endodontic treatment. Aim: This study evaluated the influence of operating microscope (OM) in the marginal adaptation of mineral trioxide aggregate (MTA) (Angelus®) and glass ionomer (Vitremer) inserted into cervical perforations. Materials and Methods: Perforations were made in the cervical third of the buccal wall of the root canal in mandibular incisors. Next, the teeth were divided into four groups (N = 10): MG — MTA without OM; VG — Vitremer without OM; MOMG — MTA with OM; VOMG — Vitremer with OM. The perforations were sealed according to the group and the teeth were prepared for analysis by confocal laser scanning microscope. Images of perforation region (1,024×) were made and the gap presented by the materials was measured using the Image J program. LEXT OLS4100 three dimensional (3D) measuring laser microscope measured the volumetric misfit. Data of gap were analyzed by Kruskal-Wallis and Dunn's tests. Analysis of variance (ANOVA) and Tukey's tests compared the volumetric misfits. Results: The results showed lower volume and gap in the interface dentin/material in VOMG compared to the other groups (P < 0.05). Conclusion: The use of OM improved the quality of cervical perforations sealed with Vitremer, being indicated in clinical situations of iatrogenic cervical perforations. PMID:27099422

  3. Risk of surgical glove perforation in oral and maxillofacial surgery.

    PubMed

    Kuroyanagi, N; Nagao, T; Sakuma, H; Miyachi, H; Ochiai, S; Kimura, Y; Fukano, H; Shimozato, K

    2012-08-01

    Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects.

  4. Integration of Perforated Subretinal Prostheses With Retinal Tissue

    PubMed Central

    Adekunle, Adewumi N.; Adkins, Alice; Wang, Wei; Kaplan, Henry J.; de Castro, Juan Fernandez; Lee, Sang Joon; Huie, Philip; Palanker, Daniel; McCall, Maureen; Pardue, Machelle T.

    2015-01-01

    Purpose To investigate the integration of subretinal implants containing full-depth perforations of various widths with rat and pig retina across weeks of implantation. Methods In transgenic P23H rhodopsin line 1 (TgP23H-1) rats and wild-type (WT) pigs, we examined four subretinal implant designs: solid inactive polymer arrays (IPA), IPAs with 5- or 10-μm wide perforations, and active bipolar photovoltaic arrays (bPVA) with 5-μm perforations. We surgically placed the implants into the subretinal space using an external approach in rats or a vitreoretinal approach in pigs. Implant placement in the subretinal space was verified with optical coherence tomography and retinal perfusion was characterized with fluorescein angiography. Rats were sacrificed 8 or 16 weeks post-implantation (wpi) and pigs 2, 4, or 8 wpi, and retinas evaluated at the light microscopic level. Results Regardless of implant design, retinas of both species showed normal vasculature. In TgP23H-1 retinas implanted with 10-μm perforated IPAs, inner nuclear layer (INL) cells migrated through the perforations by 8 wpi, resulting in significant INL thinning by 16 wpi. Additionally, these retinas showed greater pseudo-rosette formation and fibrosis compared with retinas with solid or 5-μm perforated IPAs. TgP23H-1 retinas with bPVAs showed similar INL migration to retinas with 5-μm perforated IPAs, with less fibrosis and rosette formation. WT pig retina with perforated IPAs maintained photoreceptors, showed no migration, and less pseudo-rosette formation, but more fibrosis compared with implanted TgP23H-1 rat retinas. Conclusions In retinas with photoreceptor degeneration, solid implants, or those with 5-μm perforations lead to the best biocompatibility. PMID:26290776

  5. Spontaneous Uterine Perforation Caused by Pyometra: A Case Report

    PubMed Central

    Yousefi, Zohreh; Sharifi, Noorieh; Morshedy, Maryam

    2014-01-01

    Introduction: Pyometra is an accumulation of purulent material or pus in the uterine cavity. Spontaneous perforation of uterus by pyometra is rare. This is a clinical presentation and management of a spontaneous perforation of uterine caused by pyometra. Case Presentation: This is a case report on spontaneously perforated associated with pyometra secondary to cervical malignancy. The patient underwent exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy. Conclusions: Spontaneous rupture of pyometra duo to cervical cancer in cases of acute abdomen in elderly patients should be considered. PMID:25593714

  6. Perforated duodenal ulcer in a young child: an uncommon condition.

    PubMed

    Yadav, R P; Agrawal, C S; Gupta, R K; Rajbansi, S; Bajracharya, A; Adhikary, S

    2009-01-01

    Duodenal ulcer is an uncommonly diagnosed entity in children. H. pylori infection, blood group 'O' or secondary to medications like non steroidal anti-inflammatory drugs (NSAID) and corticosteroids or physiological stress in burns, head injury and mucosal ischemia are implicated as risk factors for their causation. The diagnosis is usually overlooked because of vague and variable symptoms and remote index of suspicion accounted for their low incidence in children. Undiagnosed or mistreated perforations may carry high morbidity and mortality. We report a successfully treated 41/2 year old male child who presented with features of perforation peritonitis and was incidentally found to have a perforated duodenal ulcer.

  7. Small Intestine Disorders

    MedlinePlus

    Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach to ... many times to fit inside your abdomen. Your small intestine does most of the digesting of the foods ...

  8. Small intestine (image)

    MedlinePlus

    The small intestine is the portion of the digestive system most responsible for absorption of nutrients from food into the ... the duodenum. This short first portion of the small intestine is followed by the jejunum and the ileum. ...

  9. Simple closure of a perforated duodenal diverticulum: "a case report".

    PubMed

    Yokomuro, Shigeki; Uchida, Eiji; Arima, Yasuo; Mizuguchi, Yoshiaki; Shimizu, Tetsuya; Kawahigashi, Yutaka; Kawamoto, Masao; Takahashi, Ken; Arai, Masao; Arima, Yasuo; Tajiri, Takashi

    2004-10-01

    Spontaneous perforation of a duodenal diverticulum is a rare but serious complication with significant mortality rates. Just over 100 cases have been reported in the world literature. One case of perforated duodenal diverticulum treated by simple closure is reported. An elderly female was admitted to our hospital with an acute abdomen. Computed tomography of the abdomen showed retroperitoneal air around the duodenum and right kidney. Laparotomy with a Kocher maneuver disclosed a perforated diverticulum in the second portion of the duodenum. Although diverticulectomy is the most common treatment, simple closure of the perforated duodenal diverticulum with drainage was performed to avoid injury to the distal common bile duct and ampulla of Vater, which were close to the diverticulum. The patient has fully recovered and has been asymptomatic with no signs of recurrence for 25 months.

  10. Spontaneous bladder perforation: a rare complication of tuberculosis.

    PubMed

    Kong, Christopher Ho Chee; Ali, Siti Aishah Md; Singam, Praveen; Hong, Goh Eng; Cheok, Lee Boon; Zainuddin, Zulkifli Md

    2010-09-01

    Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

  11. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization

    SciTech Connect

    Tajima, Hiroyuki Murata, Satoru; Kumazaki, Tatsuo; Abe, Yutaka; Takano, Teruo

    2006-02-15

    A distal pulmonary artery perforation was successfully occluded by percutaneous microcoil embolization via a microcatheter. Microcoil embolization is a reasonable alternative therapeutic approach for this rare complication of pulmonary interventional procedures.

  12. Perforation repair and one-step apexification procedures.

    PubMed

    Kratchman, Samuel I

    2004-01-01

    As with any dental treatment, procedural mishaps can occur during root canal therapy. One such occurrence is the perforation of a root or pulpal floor. After a perforation occurs, the goals are to "sterilize" (decontaminate) the site and then seal the perforation. The material most widely used in endodontics to seal perforations is mineral trioxide aggregate (MTA). MTA us extremely biocompatible, and it has been shown historically that osteoidlike material grows right into MTA. The technique of one-step apexification offers an alternative to draw-out cases with several medicament-changing appointments that often result in a failed attempt at root-end closure. With the favorable histologic response of MTA, this material is the best current choice for this procedure. Completion of these cases in an effective and efficient way allows for permanent restorations to be done in a more timely manner, prolonging the longevity of these teeth.

  13. Pressure radiation from a perforated duct exit region

    NASA Astrophysics Data System (ADS)

    Wang, Honglin; Vardy, Alan E.; Pokrajac, Dubravka

    2015-09-01

    The influence of a perforated extension region on pressures radiated from the end of a duct is studied numerically using CFD. Planar 2-D geometry is considered and particular attention is paid to the case of pressure disturbances radiated from railway tunnels in cut-and-cover regions. The mechanism that causes this behaviour is described and it is shown to have an important influence of the effectiveness of a perforated extension region. It is found that such regions can strongly reduce the pressures radiated from a duct outlet, but that this benefit is offset by pressures radiated directly from the holes along the perforated region itself. In the particular case of tunnel design, practical studies of wave transmission are usually based on 1-D, plane-wave, analyses. Accordingly, attention is paid to assessing the limitations of such approaches in the case of wave propagation along a perforated region.

  14. New devices and techniques for endoscopic closure of gastrointestinal perforations

    PubMed Central

    Li, Yue; Wu, Jian-Hua; Meng, Yan; Zhang, Qiang; Gong, Wei; Liu, Si-De

    2016-01-01

    Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences. PMID:27672268

  15. Endoscopic Management of Esophageal Perforations: Who, When, and How?

    PubMed

    Saxena, Payal; Khashab, Mouen A

    2017-03-01

    Esophageal perforations can be spontaneous or iatrogenic. Although they are a rare occurrence, they are associated with a significant morbidity and mortality. Traditionally, management of esophageal perforation consisted of surgery. However, endoscopic management is now emerging as the primary treatment modality and is less invasive and morbid than surgery. Endoscopic modalities include through-the-scope clips (TTS), over-the-scope clips (OTSC), placement of covered stents, and suturing. Suturing can be used for primary closure of the perforation as well as anchoring of stents to prevent migration. Smaller defects (<2 cm) can be closed with clips (TTS or OTSC), whereas larger defects require a stent placement or suturing to achieve closure. If the perforation is associated with a mediastinal collection, drainage is mandatory and can be done via CT-guided percutaneous drainage, surgery, or endoscopic vacuum therapy.

  16. Perforation forces of the intact porcine anterior lens capsule.

    PubMed

    Ullrich, Franziska; Lussi, Jonas; Felekis, Dimitrios; Michels, Stephan; Petruska, Andrew J; Nelson, Bradley J

    2016-09-01

    During the first step of cataract surgery, the lens capsule is perforated and a circular hole is created with a sharp instrument, a procedure called capsulorhexis. To develop automated systems that can assist ophthalmologists during capsulorhexis, the forces required must be quantified. This study investigates perforation forces of the central anterior lens capsule in porcine eyes, which are used as a conservative model for the human eye. A micro-mechanical characterisation method is presented that measures capsular bag perforation forces with a high precision positioning and high-resolution force sensing system. The force during perforation of the anterior lens capsule was measured with various sized needles and indentation speeds and is found to be 15-35mN. A bio-mechanical model is identified that describes an exponential correlation between indentation force and depth, indicating strain hardening behaviour of the porcine anterior lens capsule.

  17. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis.

    PubMed

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-03-04

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices.

  18. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis

    PubMed Central

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-01-01

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices. PMID:25739796

  19. Plastic Deformation and Perforation of Metal using Metallic Jet

    NASA Astrophysics Data System (ADS)

    Sarkar, Partha; Chaturvedi, Shashank; Shyam, Anurag; Kumar, Rajesh; Lathi, Deepak; Chaudhari, Vilas; Verma, Rishi; Sonara, Jaswant; Shah, Kunal; Adhikary, Biswajit

    2002-12-01

    Pulsed underwater electrical discharges have been used in the past to generate pressures of the order of several tens of kilobars, for applications such as rock fragmentation and metallic jet production. Preliminary results for a metallic jet system have been reported earlier. A modified design for a metallic jet production system is reported here. With this arrangement, we are able to perforate 11 mm thick aluminium sheet. Such a system, at higher energy levels, could be used for oil and gas well perforation.

  20. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate

    PubMed Central

    Perez, Jose A.; Rich, Mark A.; Swana, Hubert S.

    2016-01-01

    Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates. PMID:27747129

  1. Perforated-Layer Implementation Of Radio-Frequency Lenses

    NASA Technical Reports Server (NTRS)

    Dolgin, Benjamin P.

    1996-01-01

    Luneberg-type radio-frequency dielectric lenses made of stacked perforated circular dielectric sheets, according to proposal. Perforation pattern designed to achieve required spatial variation of permittivity. Consists of round holes distributed across face of each sheet in "Swiss-cheese" pattern, plus straight or curved slots that break up outer parts into petals in "daisy-wheel" pattern. Holes and slots made by numerically controlled machining.

  2. Clinicopathological Analysis of Factors Related to Colorectal Tumor Perforation

    PubMed Central

    Medina-Arana, Vicente; Martínez-Riera, Antonio; Delgado-Plasencia, Luciano; Rodríguez-González, Diana; Bravo-Gutiérrez, Alberto; Álvarez-Argüelles, Hugo; Alarcó-Hernández, Antonio; Salido-Ruiz, Eduardo; Fernández-Peralta, Antonia M.; González-Aguilera, Juan J.

    2015-01-01

    Abstract Colorectal tumor perforation is a life-threatening complication of this disease. However, little is known about the anatomopathological factors or pathophysiologic mechanisms involved. Pathological and immunohistochemical analysis of factors related with tumoral neo-angiogenesis, which could influence tumor perforation are assessed in this study. A retrospective study of patients with perforated colon tumors (Group P) and T4a nonperforated (controls) was conducted between 2001 and 2010. Histological variables (differentiation, vascular invasion, and location) and immunohistochemical (CD31, Growth Endothelial Vascular Factor (VEGF) and p53) related with tumor angiogenesis were analyzed. Of 2189 patients, 100 (4.56%) met the inclusion criteria. Of these, 49 patients had nonperforated (2.23%) and 51 had perforated tumors (2.32%). The P group had lower number of right-sided tumors (7/51, 13.7%) compared with controls (13/49, 36.7%) (P = .01). The high-grade tumors (undifferentiated) represented only 3.9% of the perforated tumors; the remaining 96.1% were well differentiated (P = .01). No differences between groups in the frequency of TP53 mutation or VEGF and CD31 expression were found. In the P group, only 2 (3.9%) had vascular invasion (P = .01). Of the 12 tumors with vascular invasion, only 2 were perforated (16.6%). The median number of metastatic lymph-nodes in P Group was 0 versus 3 in controls (Z = −4.2; P < .01). Pathological analysis of variables that indirectly measure the presence of tumor angiogenesis (differentiation, vascular invasion, and the number of metastatic lymph nodes) shows a relationship between this and the perforation, location, and tumor differentiation. We could not directly validate our hypothesis, by immunohistochemistry of TP53, VEGF, and CD31, that perforated tumors exhibit less angiogenesis. PMID:25881846

  3. An unusual presentation of colon perforation following percutaneous nephrolithotomy

    PubMed Central

    Chubak, Barbara; Stern, Joshua M.

    2014-01-01

    Colon perforation is a rare but serious complication of percutaneous nephrolithotomy (PCNL), meriting particular attention to its signs and symptoms for prompt diagnosis and treatment. We report an unusual presentation of colon perforation following tubeless PCNL, characterized by sore throat, pneumomediastinum, and neck and shoulder crepitus. In addition to the details of this case, we review the current literature on bowel injury during PCNL and its management. PMID:25485017

  4. Clinical experience of esophageal perforation occurring with endoscopic submucosal dissection.

    PubMed

    Sato, H; Inoue, H; Ikeda, H; Grace R Santi, E; Yoshida, A; Onimaru, M; Kudo, S

    2014-01-01

    Esophageal perforation occurring during or after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is a rare, but serious complication. However, reports of its characteristics, including endoscopic imaging and management, have not been fully detailed. To analyze and report the clinical presentation and management of esophageal perforations occurred during or after EMR/ESD. Four hundred seventy-two esophageal neoplasms in 368 patients were treated (171 EMR; ESD 306) at Northern Yokohama Hospital from 2003 to 2012. Esophageal perforation occurred in a total of seven (1.9%) patients, all of whom were male and had undergone ESD. The etiology of perforation was: three (42.9%) intraoperative; three (42.9%) balloon dilatation for stricture prevention; one (14.2%) due to food bolus impaction. All cases were managed non-operatively based on the comprehensive assessment of clinical severity, extent of the injury, and the time interval from perforation to treatment onset. Conservative management included (i) bed rest and continuous monitoring to determine the need for operative intervention; (ii) fasting and intravenous fluid infusion/ tube feeding; and (iii) intravenous antibiotics. All defects closed spontaneously, save one case where closure was achieved by endoscopic clipping. Surgery was not required. Conservative management for esophageal perforation during advanced endoscopic resection is may be possible when there is no delay in diagnosis or treatment. Decision-making should be governed purely by multidisciplinary discussion.

  5. Percutaneous catheter drainage of abdominal abscesses associated with perforated viscus.

    PubMed

    Flancbaum, L; Nosher, J L; Brolin, R E

    1990-01-01

    Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.

  6. Perforator Flaps for Reconstruction of Lower Limb Defects

    PubMed Central

    Yasir, Mir; Wani, Adil Hafeez; Zargar, Haroon Rashid

    2017-01-01

    BACKGROUND Reconstruction of soft tissue defects in the lower third of the leg remains challenging. Anatomical constraints limit the local options available for complex defects especially lower third of leg. Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. We present our experience with perforator flaps for reconstruction of soft tissue defects in the lower limb. METHODS The study was carried prospectively and 23 patients with lower limb defects treated with various perforator flaps (both elective as well as emergency) were included in the study. A hand-held ultrasound Doppler was used preoperatively and intraoperatively to detect the perforator vessels. RESULTS Out of 23 patients, we witnessed partial flap loss in 1 and distal flap necrosis in 3 patients. Four patients had minor complications which included infection, wound dehiscence and congestion of flap. CONCLUSION Perforator flaps may represent a good alternative to the free flaps in the areas were other local reconstructive procedures are not possible. This is a versatile technique and with decreased donor site morbidity limited to a single body area. There is a specific like to like soft tissue replacement leading to a better cosmetic and reconstructive outcome. The main drawback of the perforator flaps however is the higher risk of venous congestion. PMID:28289617

  7. Factors That Influence Perforator Thrombosis and Predict Healing Perforator Sclerotherapy for Venous Ulceration Without Axial Reflux

    PubMed Central

    Kiguchi, Misaki M.; Hager, Eric S.; Winger, Daniel G.; Hirsch, Stanley A.; Chaer, Rabih A.; Dillavou, Ellen D.

    2014-01-01

    OBJECTIVES Refluxing perforators contribute to venous ulceration. We sought to describe patient characteristics and procedural factors that (1) impact rates of incompetent perforator vein (IPV) thrombosis with ultrasound-guided sclerotherapy (UGS) and (2) impact the healing of venous ulcers (CEAP 6) without axial reflux. METHODS Retrospective review of UGS of IPV injections from 1/2010–11/2012 identified 73 treated venous ulcers in 62 patients. Patients had no other superficial/axial reflux and were treated with standard wound care and compression. Ultrasound was used to screen for refluxing perforators near ulcer(s), and these were injected with sodium tetradecyl sulfate or polidocanol foam and assessed for thrombosis at 2 weeks. Demographic data, comorbidities, treatment details and outcomes were analyzed. Univariate and multivariable modeling was performed to determine covariates predicting IPV thrombosis and ulcer healing. RESULTS 62 patients with active ulcers for an average of 28 months with compression therapy prior to perforator treatment had an average age of 57.1 years, were 55% male, 36% had a history of DVT and 30% had deep venous reflux. 32 patients (52%) healed ulcers, while 30 patients (48%) had non-healed ulcer(s) in mean follow-up of 30.2 months. Ulcers were treated with 189 injections, with average thrombosis rate of 54%. Of 73 ulcers, 43 ulcers healed (59%), and 30 ulcers did not heal (41%). Patients that healed ulcers had an IPV thrombosis rate of 69 % vs. 38% in patients who did not heal (P<.001). Multivariate models demonstrated male gender and warfarin use negatively predicted thrombosis of IPVs (P=.03, P=.01). Multivariate model for ulcer healing found complete IPV thrombosis was a positive predictor (P=.02), while large initial ulcer area was a negative predictor (P=.08). Increased age was associated with fewer ulcer recurrences (P=.05). Hypertension and increased follow-up time predicted increased ulcer recurrences (P=.04, P=.02). Calf

  8. Simulating perforation permeability damage and cleanup

    SciTech Connect

    Morris, J P; Lomov, I N; Glenn, L A

    2000-12-15

    Completion of cased and cemented wells by shaped charge perforation causes its own damage to the formation, potentially reducing well productivity. In practice it is found that underbalance conditions clean up the damaged zone to some extent, however, the mechanisms of these processes are poorly understood. Most hydrocodes typically used to simulate rock response to shaped charge penetration do not provide permeability estimates. Furthermore, the time scales for formation clean up are potentially much longer than the period of jet penetration. We have developed a simple, yet accurate model for the evolution of porosity and permeability which can easily be incorporated into existing hydrocodes using information from the history of each cell. In addition, we have developed a code that efficiently simulates fines migration during the post-shot surge period using initial conditions taken directly from hydrocode simulations of jet penetration. Results from a one-dimensional model simulation are in excellent agreement with measured permeability distributions. We also present two-dimensional numerical results which qualitatively reproduce experimentally obtained permeability maps for different values of underbalance. Although initial results have been promising, further comparison with experiment is essential to tune the coupling between the hydrocode and fines migration simulator. Currently the permeability model is most appropriate for high permeability sandstones (such as Berea), but with little effort, the model can be extended to other rock types, given sufficient experimental data.

  9. Gallbladder perforation by absorbable spiral tacker

    PubMed Central

    Wirsching, A; Vonlanthen, R

    2014-01-01

    Introduction Mesh fixation with tacker systems is common in laparoscopic and open hernia repair. Complications due to absorbable tackers are rare and have not been described in the literature. However, we report a case of gallbladder erosion due to tacker dislocation. Methods An open hernia repair was performed using an intraperitoneal onlay mesh for a recurrent parastomal hernia after two previous mesh repairs in a 67-year-old patient. Results On postoperative day 2, the patient was reoperated because of a dislocated tacker that eroded and perforated the fundus region of the gallbladder. Putatively, tacker dislocation occurred owing to imbalanced traction forces. Initially, the mesh was fixed with absorbable tackers around the stoma on the right and transmuscular suture fixation was carried out on the left abdominal side. On revision surgery, tension forces to the right were therefore neutralised by additional transmuscular sutures on the right side. Conclusions Absorbable tackers in open hernia repair provide a safe and effective mesh fixation if tension forces are carefully avoided. PMID:25245719

  10. A hypervelocity projectile launcher for well perforation

    SciTech Connect

    Albright, J.N.; Fugelso, L.E.; Lagner, G.C.; Burns, K.L.

    1989-01-01

    Current oil well perforation techniques use low- to medium-velocity gun launchers for completing wells in soft rock. Shaped-charge jets are normally used in harder, more competent rock. A device to create a much higher velocity projectile was designed. This launcher will provide an alternative technique to be used when the conventional devices do not yield the maximum well performance. It is an adaptation of the axial cavity in a high explosive (HE) annulus design, with the axial cavity being filled with a low density foam material. Two configurations were tested; both had an HE annulus filled with organic foam, one had a projectile. Comparison of the two shots was made. A time sequence of Image Intensifier Camera photographs and sequential, orthogonal flash x-ray radiographs provided information on the propagation of the foam fragments, the first shock wave disturbance, the projectile motion and deformation, and the direct shock wave transmission from the main HE charge. DYNA2D calculations were made to assist in the experimental interpretation. 25 refs., 9 figs.

  11. Establishment of Intestinal Bacteriology

    PubMed Central

    MITSUOKA, Tomotari

    2014-01-01

    Research on intestinal bacteria began around the end of the 19th century. During the last 5 decades of the 20th century, research on the intestinal microbiota made rapid progress. At first, in my work, I first developed a method of comprehensive analysis of the intestinal microbiota, and then I established classification and identification methods for intestinal anaerobes. Using these methods I discovered a number of ecological rules governing the intestinal microbiota and the role of the intestinl microbiota in health and disease. Moreover, using germfree animals, it was proven that the intestinal microbiota has a role in carcinogenesis and aging in the host. Thus, a new interdisciplinary field, “intestinal bacteriology” was established. PMID:25032084

  12. Analyses and applications of pressure, flowrate, and temperature measurements during a perforating run

    SciTech Connect

    Tariq, S.M.; Ayestaran, L.

    1986-01-01

    Perforating technology has undergone significant advances during the last decade. Tubing conveyed perforating (TCP), underbalanced perforating, high shot density guns, better shaped charges, and improved gun systems are some of the developments that have contributed to safer operations and improved productivity of the perforated completions. A recent development, described in this paper, is a perforating tool that makes real-time downhole measurements during a perforating run and has the capability of selectively firing a number of guns at different depths or times. These measurements include pressure, flow rate, temperature, GR, CCL, and cable tension. The simultaneous downhole measurements, in addition to providing better control of the perforating process, can in a single trip provide a production log, conventional well tests before and after perforating, and a fill-up or slug test soon after perforating for underbalanced conditions.

  13. Dysplastic intestinal-type metaplasia of appendiceal endometriosis: a mimic of low grade appendiceal mucinous neoplasm

    PubMed Central

    2014-01-01

    We report an example of dysplastic intestinal-type metaplasia involving endometriosis of the appendix in a 45 year old woman. One other example of this phenomenon has been reported. As it occurs within the muscular wall of the appendix, confusion with low grade appendiceal mucinous neoplasm (LAMN) may occur. Evidence supporting the metaplastic nature of the intestinal epithelium is offered. As the initial pathological diagnosis was of invasive cancer with perforation of the appendix treatment consisted of peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1068246472111756. PMID:24559059

  14. Intestinal pseudo-obstruction as a complication of paragangliomas: case report and literature review.

    PubMed

    Osinga, T E; Kerstens, M N; van der Klauw, M M; Koornstra, J J; Wolffenbuttel, B H R; Links, T P; van der Horst-Schrivers, A N A

    2013-12-01

    Intestinal pseudo-obstruction is a rare and relatively unknown complication of phaeochromocytoma÷ paraganglioma (PCC÷PGL). Its pathophysiology can be explained by the hypersecretion of catecholamines, which may reduce the peristaltic activity of the gastrointestinal tract. Clinically, this can result in chronic constipation, intestinal pseudo-obstruction or even intestinal perforation. We conducted a comprehensive literature search and retrieved 34 cases of pseudo-obstruction caused by either benign or malignant PCC÷PGL. We also included a case from our centre that has not been described earlier. We conclude that intestinal pseudo-obstruction is a rare but potentially life-threatening complication of PCC÷PGL. Intravenous administration of phentolamine is the most frequently described treatment when surgical resection of the PCC÷PGL is not feasible.

  15. Jet screech reduction with perforated flat reflector

    NASA Astrophysics Data System (ADS)

    Khan, Md. Tawhidul Islam; Teramoto, Kenbu; Matsuo, Shigeru; Setoguchi, Toshiaki

    2008-09-01

    In the present experimental study, investigations have been carried out to evaluate the performance of the new control technique of jet screech with different perforated flat reflectors. Mainly two types of porous flat reflectors had been used in the experiment. One reflector (reflector-V) designed for placing the reflector surface vertical to the jet axis, when, another type of reflector (reflector-H) designed for placing the reflecting surface horizontal to the jet axis. In both cases the reflectors had been placed at the nozzle (base tube with uniform cross-sectional area) exit. The diameter of the reflector-V was 15D when the diameter of the reflector-H was 10D. The porous area of the reflector-V was 6D and 4.5D for reflector-H where D indicated the diameter of the nozzle exit. The placement of the reflector at the exit of the nozzle reduces the sound pressure at the nozzle exit. Thus the muted sound can not excite the unstable disturbance at the nozzle exit and the loop of the feedback mechanism disappeared, finally, the generation of jet screech be cancelled. The suction space located at the back side of the porous surface of the reflector-V improves the efficiency of the screech control technique. However, in the case of reflector-H, the receptivity process of feedback loop had been controlled by reducing the disturbances at the effective shock fronts as well as at the nozzle exit. The performance of the proposed method was verified with a flat reflector concept and good performance in jet screech suppression has been confirmed in the case of porous reflector.

  16. Synovial fluid dynamics with small disc perforation in temporomandibular joint.

    PubMed

    Xu, Y; Zhan, J; Zheng, Y; Han, Y; Zhang, Z; Xi, Y; Zhu, P

    2012-10-01

    The articular disc plays an important role as a stress absorber in joint movement, resulting in stress reduction and redistribution in the temporomandibular joint (TMJ). The flow of synovial fluid in the TMJ may follow a regular pattern during movement of the jaw. We hypothesised that the regular pattern is disrupted when the TMJ disc is perforated. By computed tomography arthrography, we studied the upper TMJ compartment in patients with small disc perforation during jaw opening-closing at positions from 0 to 3 cm. Finite element fluid dynamic modelling was accomplished to analyse the pattern of fluid flow and pressure distribution during the movements. The results showed that the fluid flow in the upper compartment generally formed an anticlockwise circulation but with local vortexes with the jaw opening up to 2 cm. However, when the jaw opening-closing reached 3 cm, an abnormal flow field and the fluid pressure change associated with the perforation may increase the risk of perforation expansion or rupture and is unfavourable for self-repair of the perforated disc.

  17. Characterizing flow through a perforation using ultrasonic Doppler

    SciTech Connect

    Razi, M.; Morriss, S.L.; Podio, A.L.

    1995-12-31

    The flow velocity of the one dimensional, single phase flow within an individual perforation is determined using an ultrasonic Doppler technique. This new technique takes advantage of the fact that flow in an individual perforation is often single phase even when flow in the wellbore is not. Existing techniques for determining multi-phase flow rates in a well bore have many limitations, due in large part to the complexity of the many possible flow regimes. An innovative approach which partially circumvents this problem has been investigated experimentally. Work has been done using an experimental set-up simulating a well bore, with water as the fluid. Since the diameter of perforations for a known gun type and casing can be reasonably estimated, flow rate within an individual perforation can be determined from velocity. Comparison of the calculated flow rates with actual flow rates are encouraging, both in turbulent and laminar flows. It is envisioned that a televiewer-like tool could be developed to scan the entire perforated interval while logging, providing a complete description of flow entries and exits.

  18. Displacements and stresses in bending of circular perforated plate

    NASA Astrophysics Data System (ADS)

    Atanasiu, C.; Sorohan, St.

    2016-08-01

    The flat plates, perforated by a large number of holes are widely used in the engineering, especially in the component of the process equipment. Strength calculations and experimental methods used in the actual literature for study perforated plates, do not present the problem in all its complexity for stress distribution and displacements. Research and doctoral theses in last decades, with methods characteristic of the respective periods were engaged either perforated plates considered infinite and requested the median plane or rarely, plate loaded normal to the median plane, with a small number of holes. In this work the stress distribution and displacement is presented for a circular plate perforated by 96 holes arranged in a grid of squares, simply supported on the outline and loaded through a central concentrated force or by uniformly distributed load. It conducted a numerical analysis by finite element method (FEM) with a proper meshing of the plate and an experimental study by holographic interferometry. Holographic interferometry method permits to measure, with high accuracy, extremely small displacements and comparing the results with those obtained by FEM becomes sustainable. Supplementary, an analysis of a non-perforated plate with the same dimensions and stiffness, similar loaded, was performed, determining the coefficient of stress concentration for a particular arrangement of holes.

  19. Perforated duodenal ulcer: a rare complication of deferasirox in children.

    PubMed

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  20. Cascaded Perforates as One-Dimensional, Bulk Absorbers

    NASA Technical Reports Server (NTRS)

    Parrott, T. L.; Jones, M. G.

    2006-01-01

    Porous cell honeycomb liners for aircraft engine nacelles offer the possibility of exploiting extended reaction effects to improve liner attenuation bandwidth as generally attributed to the performance of bulk absorbers. This paper describes an analytical procedure, starting with an impedance prediction model for a single perforated plate, to estimate the bulk-absorber parameters for a cascade of such perforates - a first step to modeling a porous wall honeycomb structure. The objective is to build confidence in a lumped element impedance model, when applied to a uniformly-spaced set of porous plates to predict its .bulk. absorber properties. The model is based upon a modified version of the two-parameter flow resistance model of the form A + BV(sub inc), where A and B are physics-based, semi-empirical parameters that are adjusted to provide an optimum fit to a composite dataset from three plate porosities of 2.5, 5 and 10%. The composite dataset is achieved by reformulating the two-parameter flow resistance model into a .reduced pressure drop coefficient. dependency on perforate hole Reynolds number. The resulting impedance model is employed to calculate surface impedance spectra for N and 2N-layer perforate cascades. The well-known two-thickness method for experimental determination of bulk-absorber parameters is then applied to these .synthesized. data sets to predict the characteristic impedance and propagation constant for the perforate cascades. These results are then compared with experimental results reported in a companion paper.

  1. Intestinal M cells

    PubMed Central

    Ohno, Hiroshi

    2016-01-01

    We have an enormous number of commensal bacteria in our intestine, moreover, the foods that we ingest and the water we drink is sometimes contaminated with pathogenic microorganisms. The intestinal epithelium is always exposed to such microbes, friend or foe, so to contain them our gut is equipped with specialized gut-associated lymphoid tissue (GALT), literally the largest peripheral lymphoid tissue in the body. GALT is the intestinal immune inductive site composed of lymphoid follicles such as Peyer’s patches. M cells are a subset of intestinal epithelial cells (IECs) residing in the region of the epithelium covering GALT lymphoid follicles. Although the vast majority of IEC function to absorb nutrients from the intestine, M cells are highly specialized to take up intestinal microbial antigens and deliver them to GALT for efficient mucosal as well as systemic immune responses. I will discuss recent advances in our understanding of the molecular mechanisms of M-cell differentiation and functions. PMID:26634447

  2. Pure Primary Ovarian Squamous Cell Carcinoma Perforating the Rectum

    PubMed Central

    Okada, Aiko; Haraguchi, Naotsugu; Tomimatsu, Takuji; Kimura, Tadashi

    2017-01-01

    Rectal perforation is uncommon in ovarian cancer, even in advanced stages. Pure primary ovarian squamous cell carcinoma is a very rare subtype of ovarian cancer and has not been reported to cause rectal perforation. A 50-year-old woman presented with rectal bleeding. Rectosigmoidoscopy suggested perforation of a pelvic tumor into the rectum. Abdominopelvic magnetic resonance imaging revealed a 9 cm heterogeneous mass in the pouch of Douglas. We performed complete cytoreduction, including an en-bloc resection of the tumor and rectosigmoid colon. Histopathology showed squamous cell carcinoma of the left ovary penetrating the rectal wall. A common symptom of rectal bleeding was caused by a very rare entity of ovarian cancer penetrating the rectal wall, but thorough evaluation led to its accurate diagnosis and appropriate treatment. PMID:28316851

  3. Spontaneous, idiopathic urinary bladder perforation--case report.

    PubMed

    Wieloch, Maria; Bazylińska, Kamila; Ziemniak, Piotr

    2013-12-01

    Spontaneous, idiopathic urinary bladder rupture is a very rare disease entity, which may face the problem of proper preoperative diagnosis. In many cases the medical history, physical examination, and additional tests raise false suspicion of gastrointestinal perforation. The study presented a case of a female patient with spontaneous urinary bladder perforation, paying particular attention to the diagnostic difficulties associated with the above-mentioned pathology. The aim of the study was to analyse the presence of symptoms and imaging and laboratory results observed in case of spontaneous urinary bladder rupture, as well as differentiate the above-mentioned pathology with gastrointestinal perforation. Whenever diagnosing a patient with acute peritonitis symptoms, in whom the predominating symptoms include sudden abdominal pain, peritoneal cavity fluid presence, hematuria, oliguria, and coexisting increased urea, creatinine, and potassium levels, one should consider the possibility of urinary bladder rupture.

  4. Distally based perforator sural flaps for foot and ankle reconstruction

    PubMed Central

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-01-01

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage. PMID:25893175

  5. Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

    PubMed Central

    Strauss, Dirk C; Tandon, Ruchi; Mason, Robert C

    2007-01-01

    Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition. PMID:17374175

  6. Acoustic Liner Drag: Measurements on Novel Facesheet Perforate Geometries

    NASA Technical Reports Server (NTRS)

    Howerton, Brian M.; Jones, Michael G.

    2016-01-01

    Interest in characterization of the aerodynamic drag of acoustic liners has increased in the past several years. This paper details experiments in the NASA Langley Grazing Flow Impedance Tube to quantify the relative drag of several perforate-over-honeycomb liner configurations at flow speeds of centerline flow Mach number equals 0.3 and 0.5. Various perforate geometries and orientations are investigated to determine their resistance factors using a static pressure drop approach. Comparison of these resistance factors gives a relative measurement of liner drag. For these same flow conditions, acoustic measurements are performed with tonal excitation from 400 to 3000 hertz at source sound pressure levels of 140 and 150 decibels. Educed impedance and attenuation spectra are used to determine the impact of variations in perforate geometry on acoustic performance.

  7. Microsporidium infection and perforation peritonitis: A rare association.

    PubMed

    Tanveer, Nadeem; Barman, Sandip

    2015-01-01

    Enteric protozoan infections are a well-documented cause of diarrhea in immunocompromised patients. Special stains on stool specimens are routinely performed in such patients to diagnose these protozoa namely cryptosporidium, microsporidium, and isospora. Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis. We report a case of microsporidium enteritis diagnosed on histopathological examination of small bowel resection specimen in a case of perforation peritonitis. The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months. This case report highlights the importance of carefully screening the resection specimens for protozoal infections in immunocompromised individuals. The association of perforation peritonitis and microsporidium is rare. Hence, the possibility that untreated microsporidium infection can lead to perforation cannot be ruled out.

  8. Increased incidence of perforated appendicitis in children with obesity.

    PubMed

    Blanco, Felix C; Sandler, Anthony D; Nadler, Evan P

    2012-10-01

    Based on their clinical impression, the authors hypothesized that children with obesity may more commonly present with perforated appendicitis. Therefore, the authors reviewed their experience from 2008 to 2010 to determine whether obesity affected the clinical presentation of appendicitis. Variables studied were height, weight, use of diagnostic imaging, and clinical findings of appendicitis at presentation. Outcomes assessed were length of stay and complication rate. The study identified 319 patients with appendicitis. Children with obesity were more likely (P = .026) to present with perforation (28/62, 45%) than nonobese patients (78/257, 30%). Neither length of stay nor complication rate was affected by the presence of obesity. The data suggest that children with obesity are more likely to present with perforated appendicitis. This finding suggests that the diagnosis of appendicitis may be more difficult in obese patients or their presentation may be delayed. Practitioners should have heightened awareness in children with obesity and symptoms of abdominal pain.

  9. Inferior vena caval filter strut perforation causing intramural duodenal haematoma

    PubMed Central

    Williams, Zoheb Berry; Organ, Nicole M.; Deane, Stephen

    2016-01-01

    We present a case of intramural duodenal haematoma caused by inferior vena caval (IVC) filter strut perforation requiring innovative open and endovascular retrieval. A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. Computed tomography demonstrated strut perforation into the second part of the duodenum, causing intramural haematoma and duodenal obstruction. Laparotomy facilitated evacuation of the duodenal haematoma, while the IVC filter was retrieved by endovascular means. Causes of duodenal haematoma include blunt trauma, haematologic malignancy, coagulopathy, percutaneous or endoscopic procedures, pancreatic pathology, peptic ulcer disease and aortoenteric fistula. Duodenal haematoma is rare and is usually managed conservatively or by percutaneous drainage. While this patient had a typical presentation, IVC filter strut perforation has not been described in the literature as a cause for duodenal haematoma. PMID:27887016

  10. Pedicled perforator flaps in the head and neck.

    PubMed

    Hofer, Stefan O P; Mureau, Marc A M

    2010-10-01

    Perforator flaps, since their first description in 1989, have in many ways revolutionized reconstructive surgery. Whereas little more than a decade ago many surgeons were still hesitant to fully trust perforator flaps to be a reliable option, nowadays these flaps are often first choice. Investigators have to remain critical, however, of their advances and realize that not every reconstruction will require or benefit from a perforator flap, as previously well-established, nonperforator flaps still have their indication and can give excellent results. The most important skill in reconstructive surgery of the head and neck is not cutting the flap but assessing the defect, planning the reconstruction, and choosing wisely from the ever-increasing options available.

  11. Selectively fired, tubing-conveyed perforating guns save rig time

    SciTech Connect

    Snider, P.M. ); Bond, P.L. )

    1993-07-19

    Selective firing of tubing-conveyed perforating (TCP) guns during drill stem tests (DSTs) added flexibility and saved costs for Marathon Oil Co. As an example, in the Garland field in Wyoming, the guns allowed perforating multiple zones in one trip. This saved 1 1/2--2 days/well in rig time and $25,000--30,000/well in electric wire line and DST tool charges. For international offshore operations, savings of $200,000/well appear possible. Savings result not only from perforating multiple zones, but also from arbitrarily setting firing patterns with or without zone isolation. The paper describes the testing of equipment, the design of the guns, firing heads, crossover assembly, pressure isolation sub, control line, and select-fire sub, and applications for the guns.

  12. [A case of jejunal perforation in gallstone ileus].

    PubMed

    Taira, Akiko; Yamada, Masami; Takehira, Yasunori; Kageyama, Fujito; Yoshii, Shigeto; Murohisa, Gou; Yoshida, Kenichi; Iwaoka, Yasushi; Terai, Tomohiro; Uotani, Takahiro; Watanabe, Shinya; Noritake, Hidenao; Ikematu, Yoshito; Kanai, Toshikazu

    2008-04-01

    Gallstone ileus is a rare but important cause of small bowel obstruction in the geriatric population. A 65-year-old man with a twenty year history of cholecystolithiasis was admitted to our hospital with abdominal pain and vomiting. Physical exams showed abdominal defence and rebound tenderness. A plain abdominal X-ray suggested a small bowel obstruction and pneumobilia. CT scan revealed a 2.5-cm gallstone at the jejunum and air in the biliary tree. The patient underwent a emergency laparotomy based on a diagnosis of panperitonitis with a perforation associated with gallstone ileus. Operative findings revealed a jejunal perforation and a impacted stone on the anal side of perforation. Enterolithotomy and jejunal resection were performed with cholecystectomy and repairment of the cholecystoduodenal fistula.

  13. [A case of perforated xanthogranulomatous cholecystitis presenting as biloma].

    PubMed

    Ahn, Yeon Jeong; Kim, Tae Hyo; Moon, Sung Won; Choi, Su Nyoung; Kim, Hyun Jin; Jung, Woon Tae; Lee, Ok Jae; Ko, Gyung Hyuck

    2011-09-25

    Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

  14. Intestinal lymphangiectasia in children

    PubMed Central

    Isa, Hasan M.; Al-Arayedh, Ghadeer G.; Mohamed, Afaf M.

    2016-01-01

    Intestinal lymphangiectasia (IL) is a rare disease characterized by dilatation of intestinal lymphatics. It can be classified as primary or secondary according to the underlying etiology. The clinical presentations of IL are pitting edema, chylous ascites, pleural effusion, acute appendicitis, diarrhea, lymphocytopenia, malabsorption, and intestinal obstruction. The diagnosis is made by intestinal endoscopy and biopsies. Dietary modification is the mainstay in the management of IL with a variable response. Here we report 2 patients with IL in Bahrain who showed positive response to dietary modification. PMID:26837404

  15. Intestinal transplantation: a review.

    PubMed

    Desai, Chirag Sureshchandra; Khan, Khalid Mahmood; Girlanda, Raffaele; Fishbein, Thomas M

    2012-09-01

    Parenteral nutrition is a life-saving therapy for patients with intestinal failure. Intestinal transplantation is now recognized as a treatment for patients who develop complications of parenteral nutrition and in whom attempts at intestinal rehabilitation have failed. Patients with parenteral nutrition related liver disease will require a liver graft typically part of a multivisceral transplant. Isolated intestinal transplants are more commonly performed in adults while multivisceral transplants are most commonly performed in infants. Isolated intestinal transplants have the best short-term outcome, with over 80 % survival at 1 year. Patients requiring multivisceral transplants have a high rate of attrition with a 1 year survival less than 70 %. Prognostic factors for a poor outcome include patient hospitalization at the time of transplant and donor age greater than 40 years while systemic sepsis and acute rejection are the major determinant of early postoperative outcome. For patients surviving the first year the outcome of transplantation of the liver in addition to intestine affords some survival advantage though long-term outcome does not yet match other abdominal organs. Outcomes for intestinal retransplantation are poor as a result of immunology and patient debility. Overall intestinal transplantation continues to develop and is a clear indication with cost and quality of life advantages in patients with intestinal failure that do not remain stable on parenteral nutrition.

  16. Position paper: management of perforated sigmoid diverticulitis

    PubMed Central

    2013-01-01

    Over the last three decades, emergency surgery for perforated sigmoid diverticulitis has evolved dramatically but remains controversial. Diverticulitis is categorized as uncomplicated (amenable to outpatient treatment) versus complicated (requiring hospitalization). Patients with complicated diverticulitis undergo computerized tomography (CT) scanning and the CT findings are used categorize the severity of disease. Treatment of stage I (phlegmon with or without small abscess) and stage II (phlegmon with large abscess) diverticulitis (which includes bowel rest, intravenous antibiotics and percutaneous drainage (PCD) of the larger abscesses) has not changed much over last two decades. On the other hand, treatment of stage III (purulent peritonitis) and stage IV (feculent peritonitis) diverticulitis has evolved dramatically and remains morbid. In the 1980s a two stage procedure (1st - segmental sigmoid resection with end colostomy and 2nd - colostomy closure after three to six months) was standard of care for most general surgeons. However, it was recognized that half of these patients never had their colostomy reversed and that colostomy closure was a morbid procedure. As a result starting in the 1990s colorectal surgical specialists increasing performed a one stage primary resection anastomosis (PRA) and demonstrated similar outcomes to the two stage procedure. In the mid 2000s, the colorectal surgeons promoted this as standard of care. But unfortunately despite advances in perioperative care and their excellent surgical skills, PRA for stage III/IV diverticulitis continued to have a high mortality (10-15%). The survivors require prolonged hospital stays and often do not fully recover. Recent case series indicate that a substantial portion of the patients who previously were subjected to emergency sigmoid colectomy can be successfully treated with less invasive nonoperative management with salvage PCD and/or laparoscopic lavage and drainage. These patients

  17. Cause rare d'une perforation de la cloison nasale

    PubMed Central

    Jahidi, Ali; Hemmaoui, Bouchaïb; Itoua, Wulfran Rosaire; Errami, Noureddine; Benariba, Fouad

    2014-01-01

    Les perforations de la cloison nasale constituent une pathologie fréquente en ORL. Leurs causes sont multiples et restent dominées par les traumatismes chirurgicaux. Les étiologies infectieuses et notamment la tuberculose sont rares. Nous présentons le cas d'une patiente ayant bénéficié d'une méatotomie bilatérale et chez laquelle une perforation de la cloison nasale a été découverte lors d'un examen systématique à un an de son intervention. D'abord considérée comme une complication de la chirurgie, la biopsie des berges de la perforation a permis de déterminer son origine tuberculeuse. La présentation clinique des perforations de la cloison nasale n'est pas spécifique. Elles sont souvent asymptomatiques et de découverte fortuite. Les traumatismes notamment chirurgicaux sont le plus siuvent en cause. L′orogine tuberculeuse resta très rare. Le diagnostic de certitude de tuberculose repose sur la biopsie des berges de cette perforation. Le but de ce travail est de mettre en avant l'intérêt de la biopsie dans le diagnostic de la tuberculose de la cloison nasale. Cette biopsie doit être systématique même en cas d'antécédents de chirurgie endonasale qui est le plus souvent en cause dans les perforations de la cloison nasale. PMID:24932334

  18. Gastric perforation secondary to metastasis from breast cancer.

    PubMed

    Wong, Chee Siong; Gumber, Ashutosh; Kiruparan, Pasupathy; Blackmore, Alexander

    2016-07-18

    Gastric perforation secondary to metastasis from breast cancer occurs infrequently. We present the case of a 72-year-old postmenopausal female patient with a known history of lobular carcinoma of the breast who presented to a district general hospital with a clinical diagnosis of an acute abdomen. Further contrast-enhanced CT scan demonstrated free gas and fluid in the abdomen. She underwent emergency exploratory laparotomy and onlay Graham's omentopexy patch due to 1×1 cm prepyloric gastric perforation. Final histopathology proved the presence of metastatic malignant cells in the breast origin. We discuss the issues involved in postoperative investigation and management.

  19. Furcal perforation repair using calcium enriched mixture cement

    PubMed Central

    Asgary, Saeed

    2010-01-01

    This case describes a furcal perforation in a mandibular first molar accompanied by furcal lesion which has been managed after one month. Root canal treatment was performed; subsequently, the defect was repaired with calcium enriched mixture (CEM) cement. The endodontically treated tooth was restored with amalgam. A 24-month recall showed no evidence of periodontal breakdown, no symptoms, in addition to completes healing of furcal lesion. According to physical and biological properties of the newly introduced CEM cement, this novel material may be suitable for sealing and repairing the perforations. The present case report supports this hypothesis. PMID:21116393

  20. [Does trunk varicosity precede insufficiency of the perforating veins?].

    PubMed

    Bernink, B P

    1983-01-01

    The author discusses the theoretical question of precedence of trunk, or perforator, incompetency. Whatever the case, the treatment is always the same. Drawing attention to the laws published in 1970 determining the opening and closing of small vessels, the author mainly discusses the so-called "balloon effect": of which the "physiological valvule" is a derivation, concluding that trunk varicosity precedes perforating vein incompetence. When the deep system is intact, the author prefers to use the term "blow down", reserving the term "blow out" for secondary varices, the deep system being damaged.

  1. Spontaneous Urinary Bladder Perforation: An Unusual Presentation of Diabetes Mellitus☆

    PubMed Central

    Kabarriti, Abdo E.; Ramchandani, Parvati; Guzzo, Thomas J.

    2014-01-01

    Spontaneous urinary bladder perforation is a rare event, which requires immediate medical attention due to its extremely high morbidity and mortality. We report a case of a 36-year-old man who presented with acute-onset abdominal pain without any inciting events. His glucose level at the time of presentation was 1107 mg/dL. On initial abdominal imaging, it was believed that he had a large pelvic mass likely originating from the bladder. On further workup at our hospital, it was discovered that he had an intraperitoneal perforation after which he underwent an exploratory laparotomy and a cystorrhaphy. PMID:26955559

  2. Reconstruction of Thermographic Signals to Map Perforator Vessels in Humans.

    PubMed

    Liu, Wei-Min; Maivelett, Jordan; Kato, Gregory J; Taylor, James G; Yang, Wen-Chin; Liu, Yun-Chung; Yang, You-Gang; Gorbach, Alexander M

    2012-01-01

    Thermal representations on the surface of a human forearm of underlying perforator vessels have previously been mapped via recovery-enhanced infrared imaging, which is performed as skin blood flow recovers to baseline levels following cooling of the forearm. We noted that the same vessels could also be observed during reactive hyperaemia tests after complete 5-min occlusion of the forearm by an inflatable cuff. However, not all subjects showed vessels with acceptable contrast. Therefore, we applied a thermographic signal reconstruction algorithm to reactive hyperaemia testing, which substantially enhanced signal-to-noise ratios between perforator vessels and their surroundings, thereby enabling their mapping with higher accuracy and a shorter occlusion period.

  3. Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty.

    PubMed

    D'Arpa, Salvatore; Colebunders, Britt; Stillaert, Filip; Monstrey, Stan

    2017-01-01

    The anterolateral thigh (ALT) perforator flap for phalloplasty is gaining popularity because it avoids the well-known scars of the radial forearm flap. However, scars are not eliminated, just moved to a different location, the thigh, that can for some patients be of great sexual value. Preexpansion of the ALT flap allows primary donor site closure, thus avoiding not only the unsightly appearance of a skin grafted ALT donor site, but also the skin graft donor site scar. Preoperative perforator location by means of computed tomography angiography allows safe expander placement through 2 small remote incisions.

  4. Esophageal perforation associated with noninvasive ventilation: a case report.

    PubMed

    Van de Louw, Andry; Brocas, Elsa; Boiteau, Richard; Perrin-Gachadoat, Dominique; Tenaillon, Alain

    2002-11-01

    Noninvasive positive-pressure ventilation (NIPPV) is widely used to treat acute respiratory failure, the goal being to avoid exposing patients to the morbidity associated with tracheal intubation. NIPPV may reduce the rates of intubation, morbidity, and mortality in selected patient subgroups. Although time-consuming for physicians and nurses, NIPPV is fairly easy to use, and few severe complications have been reported. Esophageal perforation is a well-recognized complication of tracheal intubation but has not been described in association with NIPPV. We report a case of fatal esophageal perforation associated with NIPPV after a surgical procedure.

  5. Intestinal or bowel obstruction - discharge

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000150.htm Intestinal or bowel obstruction - discharge To use the sharing features on this ... your bowel (intestine). This condition is called an intestinal obstruction . The blockage may be partial or total (complete). ...

  6. Treatment of Distal Left Anterior Descending Artery Perforation with Fat Embolization

    PubMed Central

    Abushahba, Galal Ahmed; Abujalala, Salem; Butt, Mehmood S.

    2016-01-01

    Coronary perforation is a potentially fatal complication during percutaneous coronary intervention. Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. Although the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we present a case of distal coronary perforation, and review the management of coronary perforation in the current practice.

  7. Perforated Meckel’s Diverticulum in a 3-day-old Neonate; A Case Report

    PubMed Central

    Frooghi, Mehdi; Bahador, Ali; Golchini, Alireza; Haghighat, Mahmood; Ataollahi, Maryam; Javaherizadeh, Hazhir

    2016-01-01

    Perforation of Meckel’s diverticulum is a rare complication in neonatal period. A 3-dayold term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel’s diverticulum was detected. Pathological report of the tissue showed inflamed diverticulum with heterotopic gastric mucosa. This is the first report of Meckel’s diverticulum perforation in a neonate in our country PMID:27957297

  8. Spontaneous Perforation of Pyometra Presented as an Acute Abdomen: A Case Report

    PubMed Central

    Saha, Pradip Kumar; Gupta, Pratiksha; Mehra, Reeti; Goel, Poonam; Huria, Anju

    2008-01-01

    Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality. PMID:18324325

  9. Management of radial artery perforation during transradial catheterization using a polytetrafluoroethylene-covered coronary stent.

    PubMed

    Chatterjee, Arka; White, Jeremy S; Leesar, Massoud A

    2017-03-01

    An 88-year-old woman underwent attempted percutaneous coronary intervention (PCI) through a right radial approach. Catheterization was complicated by radial artery perforation. Conservative therapeutic options including external compression, advancement of a diagnostic catheter distal to the perforation, and balloon tamponade failed to control the bleeding requiring deployment of a Polytetrafluoroethylene (PTFE)-covered stent to seal the perforation. We describe the stepwise approach advocated for managing a radial perforation and summarize relevant literature available for the same.

  10. Spontaneous Intraperitoneal Bladder Perforation Associated with Urothelial Carcinoma with Divergent Histologic Differentiation, Diagnosed by CT Cystography.

    PubMed

    Lee, Jee Han; You, Hyun Wook; Lee, Choong-Hyun

    2010-04-01

    Spontaneous bladder perforation is a very rare event. Prompt diagnosis of this injury is very important, particularly with intraperitoneal perforation, because mortality increases if surgical repair is delayed. Previous studies have reported that plain cystography is the primary modality of imaging study rather than relatively insensitive computed tomography (CT) when bladder perforation is suspected. We report here a rare case of spontaneous intraperitoneal perforation of the bladder associated with urothelial carcinoma with divergent histologic differentiation, as diagnosed with CT cystography.

  11. Granulocyte migration in uncomplicated intestinal anastomosis in man

    SciTech Connect

    Keshavarzian, A.; Gibson, R.; Guest, J.; Spencer, J.; Lavender, J.P.; Hodgson, H.J.

    1986-03-01

    We have investigated the presence, duration, and clinical significance of granulocyte accumulation, using indium-111 granulocyte scanning, in patients following uncomplicated intestinal anastomosis. Eight patients underwent intestinal resection and anastomosis (right hemicolectomy, 5; sigmoid colectomy, 2; ileal resection, 1) for carcinoma, angiodysplasia, or perforation. All patients had an uneventful postoperative course, with no evidence of any leakage or infection. Indium-111 granulocyte scan and abdominal ultrasound were performed 7-20 days (12 +/- 4.7 means +/- SD) following surgery. Indium-111 granulocyte scan showed the presence of labeled granulocytes at the site of anastomosis in all patients. In three of eight, cells subsequently passed into the lumen of the bowel. In contrast, granulocytes were not visualized along the abdominal incision. Thus, in contrast to skin wounds, granulocytes continue migrating into the intestinal wall in areas of anastomosis for at least up to 20 days following surgical trauma. They may play a significant role both in healing the anastomosis and in preventing systemic bacterial infection. Moreover, indium-111 granulocyte scans following intestinal surgery should be interpreted with care, and the presence of labeled granulocytes around anastomoses does not necessarily indicate abscess formation.

  12. Intestinal obstruction repair - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100116.htm Intestinal obstruction repair - series—Normal anatomy To use the sharing ... M. Editorial team. Related MedlinePlus Health Topics Adhesions Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  13. Intestinal obstruction (pediatric) - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100165.htm Intestinal obstruction (pediatric) - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  14. Effectiveness of degradable and non-degradable implants to close large septal perforations in an experimental model.

    PubMed

    Hernández Martinez, Victor M; Garcia Benavides, Leonel; Totsuka Sutto, Sylvia E; Cardona Muñoz, Ernesto G; Campos Bayardo, Tania Isabel; Pascoe Gonzalez, Sara

    2016-08-01

    Background Reparation of large nasal septum perforations continues to be challenging. Bipedicled mucoperichondrial and inter-positional grafts currently show the most promising results. New implants have emerged to be used as a support membrane to carry on the mucosal cells, taking advantage of the innate proliferative properties of the mucosal tissue. Objective To compare the effectiveness of two kinds of material; non-absorbable dimethylsiloxane (silicone elastomers) and absorbable porcine small intestinal submucosa (Surgisis), both used as an inter-positional graft without neighbouring flaps to close nasal septal perforations in an experimental model. Methods Fifteen dogs were divided into three groups. One group received Surgisis, the other sheets of dimethylsiloxane and the last group a sham group. The dogs were followed for 6 weeks. Results The initial perforation of the nasal septum showed complete mucosal closure in the dimethylsiloxane group. The Surgisis group, on the other hand, had a smaller reduction than that at the beginning (final mean area = 23.0 ± 5.4 mm(2) (p < 0.05); however, complete closure was not achieved. Sham animals showed an inconstant and slight reduction in dimension from 100 mm(2) to 70 ± 16 mm(2) of mucosa and cartilage, but closure was not achieved. A significantly higher number of capillaries were observed in the Surgisis group compared to the dimethylsiloxane group (p < 0.05) without differences in inflammation, fibrosis, or necrosis. Conclusions The non-absorbable implant; dimethylsiloxane facilitates a better closure of the nasal septum.

  15. Intestinal Barrier and Behavior.

    PubMed

    Julio-Pieper, M; Bravo, J A

    2016-01-01

    The intestinal barrier function contributes to gut homeostasis by modulating absorption of water, electrolytes, and nutrients from the lumen into the circulation while restricting the passage of noxious luminal substances and microorganisms. Chronic conditions such as rheumatoid arthritis, inflammatory bowel disease, and celiac disease are associated to intestinal barrier dysfunction. Here, the hypothesis is that a leaky intestinal wall allowing for indiscriminate passage of intraluminal compounds to the vascular compartment could in turn lead to systemic inflammation. An increasing number of studies are now investigating the association between gut permeability and CNS disorders, under the premise that translocation of intestinal luminal contents could affect CNS function, either directly or indirectly. Still, it is unknown whether disruption of intestinal barrier is a causative agent or a consequence in these situations. Here, we discuss the latest evidence pointing to an association between increased gut permeability and disrupted behavioral responses.

  16. An unusual cause of death: spontaneous urinary bladder perforation.

    PubMed

    Limon, Onder; Unluer, Erden Erol; Unay, Fulya Cakalagaoglu; Oyar, Orhan; Sener, Aslı

    2012-11-01

    Spontaneous urinary bladder perforation is a rare and life-threatening condition similar to traumatic and iatrogenic perforation. The connection with the underlying bladder damage due to previous radiotherapy, inflammation, malignancy, obstruction, or other causes can be found in almost all cases. The symptoms are often nonspecific, and misdiagnosis is common. Here, we present a case of spontaneous urinary bladder perforation due to bladder necrosis in a diabetic woman. She presented to the emergency department with abdominal pain. Exploratory laparotomy was performed by surgeons and revealed necrosis of the anterior and lateral walls of the urinary bladder. Microscopic examination revealed necrotic changes throughout the bladder wall. Ghost-like cellular outlines were compatible with coagulative necrosis. Clusters of bacteria were also present in some necrobiotic tissues. Malignant cells were not present. It appears probable that the infection was due to local interference with the blood supply (arterial, capillary, or venous) combined with the systemic metabolic upset that led to the bladder condition. In our case, we observed partial necrosis of the bladder rather than distortion of the entire blood supply to the bladder as consequences of the microvascular effects of diabetes. Urinary bladder perforation must be considered in the differential diagnosis of patients presenting with free fluid in the abdomen/peritonitis, decreased urine output, and hematuria, and in whom increased levels of urea/creatinine are detected in serum and/ or peritoneal fluid aspirate.

  17. Laparoscopic repair in children with traumatic bladder perforation.

    PubMed

    Karadag, Cetin Ali; Tander, Burak; Erginel, Basak; Demirel, Dilek; Bicakci, Unal; Gunaydin, Mithat; Sever, Nihat; Bernay, Ferit; Dokucu, Ali Ihsan

    2016-01-01

    Here, we report two patients with a traumatic intraperitoneal bladder dome rupture repaired by laparoscopic intracorporeal sutures. The first patient was a 3-year old boy was admitted with a history of road accident. He had a traumatic lesion on his lower abdomen and a pelvic fracture. Computed tomography (CT) scan revealed free intraabdominal fluid. The urethragram showed spreading contrast material into the abdominal cavity. Laparoscopic exploration revealed a 3-cm-length perforation at the top of the bladder. The injury was repaired in a two fold fashion. Post-operative follow-up was uneventful. The second case was a 3-year-old boy fell from the second floor of his house on the ground. He had traumatic lesion on his lower abdomen and a pelvic fracture. Due to bloody urine drainage, a cystography was performed and an extravasation from the dome of the bladder into the peritoneum was detected. On laparoscopy, a 3-cm long vertical perforation at the dome of the bladder was found. The perforation was repaired in two layers with intracorporeal suture technique. The post-operative course was uneventful. Laparoscopic repair of traumatic perforation of the bladder dome is a safe, effective and minimally invasive method. The cosmetic outcome is superior.

  18. Intrathoracic gastric perforation secondary to corrosive ingestion: a rare complication.

    PubMed

    Arora, Richa; Varma Gunturi, Surya Ramachandra; Arora, Abhishek; Parmar, Abhijot

    2016-04-01

    This case report describes a rare and serious case of acid ingestion in a 50-year-old man who developed necrosis and perforation of gastric fundus and diaphragm with extension of air and fluid collection in the thorax. To the best of our knowledge, this complication has not been described so far in the literature.

  19. Rumen perforation caused by horn injury in two cows.

    PubMed

    Braun, Ueli; Gerspach, Christian; Stettler, Manuela; Grob, Daniela; Sydler, Titus

    2016-01-20

    Post-operative complications of trocarisation and rumenotomy are the most common causes of peritonitis associated with a rumen disorder. Since horn injury leading to rumen perforation has not previously been reported in the literature, two cows with this condition are reported. Small superficial skin lesions were observed in one of the cows and the other had a perforating skin lesion in the left abdomen. Both cows had signs of hypovolaemic shock. Ultrasonography revealed hypoechoic fluid, echoic lesions and occasional fibrinous septa caudoventral to the reticulum. Caudally the fluid extended to the left flank fold and occupied about one third of the peritoneal cavity. The area of the skin perforation in the left abdomen was swollen and the muscle layers could not be differentiated using ultrasonography. Diffuse fibrino-purulent peritonitis was diagnosed in both cows, and because of a poor prognosis, they were euthanased and necropsied. Perforation of the abdominal wall and rumen with diffuse fibrino-purulent peritonitis was present. Ultrasonography is a suitable tool to characterise the inflammatory lesions between the rumen and left abdominal wall and objectify the interpretation of clinical findings. Horn injury should be included in the rule outs for cattle with left abdominal skin wounds and diffuse peritonitis.

  20. Percutaneous peritoneal drainage in isolated neonatal gastric perforation.

    PubMed

    Aydin, Mustafa; Deveci, Ugur; Taskin, Erdal; Bakal, Unal; Kilic, Mehmet

    2015-12-07

    A comment on the article by He et al, "Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review", published on World Journal of Gastroenterology that reported a case of idiopathic neonatal pneumoperitoneum, possibly due to gastric perforation, with a favorable outcome without surgical intervention.

  1. Percutaneous peritoneal drainage in isolated neonatal gastric perforation

    PubMed Central

    Aydin, Mustafa; Deveci, Ugur; Taskin, Erdal; Bakal, Unal; Kilic, Mehmet

    2015-01-01

    A comment on the article by He et al, “Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review”, published on World Journal of Gastroenterology that reported a case of idiopathic neonatal pneumoperitoneum, possibly due to gastric perforation, with a favorable outcome without surgical intervention. PMID:26668521

  2. Techniques for application of tissue adhesive for corneal perforations.

    PubMed

    Erdey, R A; Lindahl, K J; Temnycky, G O; Aquavella, J V

    1991-06-01

    We describe a modified technique of using cyanoacrylate adhesive to seal corneal perforations. Easily performed at the slit lamp, its advantages over previously described methods include a smooth, contoured collagen surface overlying the adhesive, which is easily wet by the tear film. Even greater comfort and protection are provided by the addition of a hydrophilic bandage lens or collagen shield.

  3. Jejunal perforation due to porcupine quill ingestion in a horse

    PubMed Central

    Anderson, Stacy L.; Panizzi, Luca; Bracamonte, Jose

    2014-01-01

    An 8-month-old Andalusian filly was treated for jejunal perforations due to ingestion of a porcupine quill. During exploratory laparotomy, 2 separate stapled side-to-side jejunojejunal resection and anastomoses were performed. Post-operative complications after 2 years follow-up included mild incisional herniation following incisional infection and chronic intermittent colic. PMID:24489394

  4. Gossypiboma: An Unusual Presentation as Perforation and Intraluminal Migration

    PubMed Central

    Mahey, Rajesh Kumar; Patil, Rajesh; Bakale, Nilesh; Suryawanshi, Sachin

    2016-01-01

    Gossypiboma is a mass formed around cotton material acting as foreign body in visceral cavity. In our study, we present a case of gossypiboma following open cholecystectomy. A surgical sponge left in the peritoneal cavity following cholecystectomy, caused inflammatory reaction, perforation and intraluminal migration. It is a relatively rare presentation. This patient underwent emergency laparotomy with Billroth II anastomosis and sponge removal. PMID:27790511

  5. Ascaris lumbricoides: an unusual aetiology of gastric perforation

    PubMed Central

    Gupta, Shahana; Kumar, Sanjeev; Satapathy, Ayusman; Ray, Udipta; Chatterjee, Souvik; Choudhury, Tamal Kanti

    2012-01-01

    Gastrointestinal (GI) infestation with Ascaris lumbricoides is common in the tropical countries, particularly in children. A wide range of clinical presentations are reported for GI ascariasis in both adults and children. We report a case of gastric perforation due to Ascaris, a rare presentation. PMID:24968395

  6. Performance evaluation of perforated micro-cantilevers for MEMS applications

    NASA Astrophysics Data System (ADS)

    Swamy, Kenkere Balashanthamurthy Mruthyunjaya; Mukherjee, Banibrata; Ali Syed Mohammed, Zishan; Chakraborty, Suman; Sen, Siddhartha

    2014-04-01

    Miniaturized cantilevers are one of the elementary structures that are widely used in many micro-devices and systems. The dynamic performance of micro-cantilevers having process dictated through perforations is investigated. High-aspect ratio, long silicon cantilevers, intended for improved performance through lowered stiffness are designed with a series of through holes and simulated along with similar nonperforated/solid cantilevers for comparison. A few perforated structures are also fabricated using silicon-on-insulator-based multiproject MEMS processes from MEMSCAP Inc. (Durham, North Carolina) by reduced mask level and eliminating complex substrate trenching step. The dynamic behavior of these fabricated structures is experimentally studied for both in-plane and out-of-plane directions. It is shown that, due to the presence of perforations, stiffness in planar direction is lightly affected, whereas in out-of-plane direction it is significantly reduced by >35%. Similarly, the variation of damping in both perforated and nonperforated beams, too, is thoroughly analyzed for the first few modes of vibration. Nevertheless, their frequency response variation of <10% for modal frequencies in both planar and out-of-plane directions as compared to the nonperforated counterparts, points to potential applications in several micro-systems including those based on comb drives.

  7. CHARACTERIZATION OF CLEAN AND FOULED PERFORATED MEMBRANE DIFFUSERS

    EPA Science Inventory

    Laboratory analyses were conducted on plasticized PVC perforated membrane tube diffusers after varying periods in service at two different municipal wastewater treatment facilities. One set of diffusers from Cedar Creek, NY, was in service for 26 months. The other set from the ...

  8. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    PubMed

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

  9. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    PubMed Central

    Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts. PMID:25057420

  10. Spontaneous uterine perforation of pyometra presenting as acute abdomen.

    PubMed

    Kitai, Toshihiro; Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

  11. Duodenal perforation with an unusual presentation: a case report.

    PubMed

    Sarmast, Arif Hussain; Parray, Fazl Q; Showkat, Hakim Irfan; Lone, Yasir A; Bhat, Naseer A

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation.

  12. Duodenal Perforation with an Unusual Presentation: A Case Report

    PubMed Central

    Sarmast, Arif Hussain; Parray, Fazl Q.; Showkat, Hakim Irfan; Lone, Yasir A.; Bhat, Naseer A.

    2011-01-01

    A young female presented with classical complaints suggestive of peptic ulcer disease leading to signs of peritonitis. The said patient after being subjected to baseline workup was subjected to laparotomy which proved to be a surgical surprise. A live ascaris lumbricoides worm was seen pouting out of a duodenal perforation. PMID:22567473

  13. Traumatic perforation of the sigmoid colon through schistosomal ulcerations.

    PubMed

    Culliford, A; Ibrahim, I; Worth, M H

    1975-06-01

    A case is presented in which the colon was perforated through a S. mansoni ulcer after blunt abdominal trauma. This is believed to be a unique situation. The colonic complications of schistosomiasis are discussed, and it is expected that they will be seen more frequently in the United States.

  14. Jejunal perforation due to porcupine quill ingestion in a horse.

    PubMed

    Anderson, Stacy L; Panizzi, Luca; Bracamonte, Jose

    2014-02-01

    An 8-month-old Andalusian filly was treated for jejunal perforations due to ingestion of a porcupine quill. During exploratory laparotomy, 2 separate stapled side-to-side jejunojejunal resection and anastomoses were performed. Post-operative complications after 2 years follow-up included mild incisional herniation following incisional infection and chronic intermittent colic.

  15. Laparoscopic repair in children with traumatic bladder perforation

    PubMed Central

    Karadag, Cetin Ali; Tander, Burak; Erginel, Basak; Demirel, Dilek; Bicakci, Unal; Gunaydin, Mithat; Sever, Nihat; Bernay, Ferit; Dokucu, Ali Ihsan

    2016-01-01

    Here, we report two patients with a traumatic intraperitoneal bladder dome rupture repaired by laparoscopic intracorporeal sutures. The first patient was a 3-year old boy was admitted with a history of road accident. He had a traumatic lesion on his lower abdomen and a pelvic fracture. Computed tomography (CT) scan revealed free intraabdominal fluid. The urethragram showed spreading contrast material into the abdominal cavity. Laparoscopic exploration revealed a 3-cm-length perforation at the top of the bladder. The injury was repaired in a two fold fashion. Post-operative follow-up was uneventful. The second case was a 3-year-old boy fell from the second floor of his house on the ground. He had traumatic lesion on his lower abdomen and a pelvic fracture. Due to bloody urine drainage, a cystography was performed and an extravasation from the dome of the bladder into the peritoneum was detected. On laparoscopy, a 3-cm long vertical perforation at the dome of the bladder was found. The perforation was repaired in two layers with intracorporeal suture technique. The post-operative course was uneventful. Laparoscopic repair of traumatic perforation of the bladder dome is a safe, effective and minimally invasive method. The cosmetic outcome is superior. PMID:27279407

  16. Management of endoscopic retrograde cholangiopancreatography-related perforations

    PubMed Central

    Kim, Byung Seup; Kim, In-Gyu; Ryu, Byoung Yoon; Kim, Jong Hyeok; Yoo, Kyo Sang; Baik, Gwang Ho; Kim, Jin Bong

    2011-01-01

    Purpose The purpose of this study is to analyze the treatment strategies of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. This is a retrospective study. Methods We experienced 13 perforations associated with ERCP. We reviewed the medical recordsand classified ERCP-related perforations according to mechanism of injury in terms of perforating device. Injury by endoscopic tip or insertion tube was classified as type I, injury by cannulation catheter or sphincterotomy knife as type II, and injury by guidewire as type III. Results Of four type I injuries, one case was managed by conservative management after primary closure with a hemoclip during ERCP. The other three patients underwent surgical treatments such as primary closure orpancreatico-duodenectomy. Of five type II injuries, two patients underwent conservative management and the other three cases were managed by surgical treatment such as duodenojejunostomy, duodenal diverticulization and pancreatico-duodenectomy. Of four type III injuries, three patients were managed conservatively and the remaining patient was managed by T-tube choledochostomy. Conclusion Type I injuries require immediate surgical management after EPCP or immediate endoscopic closure during ERCP whenever possible. Type II injuries require surgical or conservative treatment according to intra- and retro-peritoneal dirty fluid collection findings following radiologic evaluation. Type III injuries almost always improve after conservative treatment with endoscopic nasobilliary drainage. PMID:22066121

  17. Auxetic Perforated Mechanical Metamaterials with Randomly Oriented Cuts.

    PubMed

    Grima, Joseph N; Mizzi, Luke; Azzopardi, Keith M; Gatt, Ruben

    2016-01-13

    Perforated systems with quasi-disordered arrays of slits are found to exhibit auxetic characteristics almost as much as their traditional ordered "rotating-squares" counterparts. This provides a highly robust methodology for constructing auxetics that may be used for various practical applications such as skin grafting, where a high degree of precision may not always be achievable.

  18. Parametric study of wave propagation in hierarchical auxetic perforated metamaterials

    NASA Astrophysics Data System (ADS)

    Billon, K.; Ouisse, M.; Sadoulet-Reboul, E.; Scarpa, F.; Collet, M.

    2016-04-01

    The understanding of wave propagation in a metamaterial with hierarchical, auxetic rectangular perforations is presented in this work. The metamaterial is a 2D structure with chaining horizontal and vertical perforations exhibiting auxetic in-plane behaviour. The unit cell of this lattice is identified as the reference level 0. Hierarchical structures are composed of structural elements which themselves have structure. At level 0, 4 rigid squares are present in the unit cell. In each square, the reference structure is used by applying a scale ratio to obtain the level 1. The same strategy is used to reach the upper level in each subunit. A geometric parametric investigation of these rectangular perforations using a numerical asymptotic homogenisation finite element approach is done. Some numerical eigenvalue tools are used for the dispersion analysis of this structure. It is first observed that the total width of Band gaps increases with the hierarchy. The porosity induced by the perforations is taken into account in the mechanical properties. The symmetry of the geometry in the x-y plane allow to define the entire geometry of the unit cell using only 2 parameters: the void aspect ratio, the intercell spacing and the hierarchy level. When decreasing the intercell spacing, the total width of Band gaps increases and the effective stiffness in x and y directions decrease, allowing for increased rotations of the rigid squares, so auxetic behaviour is greater. Hierarchical levels shift from isotropic to orthotropic, hierarchical levels are always auxetic.

  19. Metastatic Gas gangrene and Colonic Perforation: a case report

    PubMed Central

    Powell, Matthew J; Sasapu, Kishore K; Macklin, Christopher

    2008-01-01

    Clostridium septicum myonecrosis is associated with diabetes, colorectal and haematological malignancies. We present a case of metastatic myonecrosis in a diabetic patient with a perforated caecal tumour. The literature since 1989 is reviewed and 28 cases of Clostridium septicum myonecrosis are discussed. PMID:18373865

  20. The Deltopectoral Flap Revisited: The Internal Mammary Artery Perforator Flap.

    PubMed

    Ibrahim, Amir; Atiyeh, Bishara; Karami, Reem; Adelman, David M; Papazian, Nazareth J

    2016-03-01

    Pharyngo-esophageal and tracheostomal defects pose a challenge in head and neck reconstruction whenever microanastomosis is extremely difficult in hostile neck that is previously dissected and irradiated. The deltopectoral (DP) flap was initially described as a pedicled flap for such reconstruction with acceptable postoperative results. A major drawback is still that the DP flap is based on 3 perforator vessels leading to a decreased arc of rotation. The DP flap also left contour deformities in the donor site. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the DP flap, giving it the benefit of having a wide arc of rotation. It is both thin and pliable, with good skin color match and texture. The donor site can be closed primarily with no esthetic deformity and minimal morbidity. The procedure is relatively simple and does not require microvascular expertise. In this report, the authors describe a patient in whom bilateral internal mammary artery perforator flaps were used for subtotal pharyngo-esophageal reconstruction and neck resurfacing. The flaps healed uneventfully bilaterally with no postoperative complications.

  1. Meckel's diverticulum perforated by a fishbone. An unusual presentation.

    PubMed

    Fonseca Sosa, Fernando Karel

    2017-02-27

    Finding a Meckel's diverticulum during a laparotomy is rare, operating on a patient for a complication of diverticulum is rare, but if this complication is the result of a perforation of the diverticulum by a foreign body, then we are in the presence of a medical curiosity.

  2. Role of endoscopic clipping in the treatment of oesophageal perforations

    PubMed Central

    Lázár, György; Paszt, Attila; Mán, Eszter

    2016-01-01

    With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions. PMID:26788259

  3. Intestinal congenital/infantile fibrosarcoma: a new clinico-pathological entity?

    PubMed

    Berrebi, Dominique; Fournet, Jean-Christophe; Boman, Françoise; Fabre, Monique; Philippe-Chomette, Pascale; Branchereau, Sophie; Fréneaux, Paul; Bouron-Dal Soglio, Dorothée; Michon, Jean; Peuchmaur, Michel

    2015-04-01

    Congenital/infantile fibrosarcoma (IFS) is a relatively rare form of fibrosarcoma diagnosed at birth or during early years of life and that differs from its adult counterpart because of a more favorable behavior. IFS is also known as cellular congenital mesoblastic nephroma, when it affects the kidney and is often but not always characterized by the ETV6-NTRK3 fusion transcript. We report herein the first series of an exceptional tumor of the small intestine occurring in newborns. The four patients shared a stereotyped clinico-pathological presentation with early and acute onset, intestinal perforation, and an infiltration by a highly cellular spindle cell tumor within the dilated intestinal wall exhibiting pathologic features typical of IFS. Molecular studies for the ETV6-NTRK3 translocation were negative in the three cases tested. Patients were treated by surgical wide resection alone and are alive and well (follow-up: 36 months-25 years). Thus, this new clinico-pathological entity, even with lack of documented evidence of the ETV6-NTRK3 translocation, should be included in the differential diagnosis of congenital bowel perforation or obstruction and may represent an intestinal counterpart of IFS.

  4. Intestinal permeability, leaky gut, and intestinal disorders.

    PubMed

    Hollander, D

    1999-10-01

    A major task of the intestine is to form a defensive barrier to prevent absorption of damaging substances from the external environment. This protective function of the intestinal mucosa is called permeability. Clinicians can use inert, nonmetabolized sugars such as mannitol, rhamnose, or lactulose to measure the permeability barrier or the degree of leakiness of the intestinal mucosa. Ample evidence indicates that permeability is increased in most patients with Crohn's disease and in 10% to 20% of their clinically healthy relatives. The abnormal leakiness of the mucosa in Crohn's patients and their relatives can be greatly amplified by aspirin preadministration. Permeability measurements in Crohn's patients reflect the activity, extent, and distribution of the disease and may allow us to predict the likelihood of recurrence after surgery or medically induced remission. Permeability is also increased in celiac disease and by trauma, burns, and nonsteroidal anti-inflammatory drugs. The major determinant of the rate of intestinal permeability is the opening or closure of the tight junctions between enterocytes in the paracellular space. As we broaden our understanding of the mechanisms and agents that control the degree of leakiness of the tight junctions, we will be increasingly able to use permeability measurements to study the etiology and pathogenesis of various disorders and to design or monitor therapies for their management.

  5. Polypropylene mesh for nasal septal perforation repair: an experimental study.

    PubMed

    Yücebaş, Kadir; Taşkın, Ümit; Oktay, Mehmet Faruk; Tansuker, Hasan Deniz; Erdil, Mehmet; Altınay, Serdar; Kozanoğlu, Erol; Kuvat, Samet Vasfi

    2017-01-01

    The aim of this study is to determine the effectiveness and biocompatibility of polypropylene mesh for the repair of nasal septal perforations in an animal model on rabbits. A full-thickness nasal septal perforation with a diameter of nearly 10 × 10 mm was created on 12 rabbits, and then the perforation was reconstructed with two different methods. We used mucosal flaps and polypropylene mesh as an interpositional graft in group 1. Only mucosal flaps were used for reconstruction and are identified as group 2. After 4 weeks, we removed the nasal septum of the rabbits and performed histopathological examinations for acute rejection, infection, inflammatory response, fibrosis, and granuloma formation. We found perforation closure rates of 75 and 25 % in groups 1 and 2, respectively. Inflammatory response was seen in all specimens of group 1 (100 %). The inflammatory response was +1 in five of the specimens (62.5 %), +2 in one specimen (12.5 %), and +3 in two specimens (25 %). Mild fibrosis around the mesh was detected in four specimens (50 %), medium-level fibrosis was detected in one (12.5 %), and no fibrosis was detected in three (37.5 %). Severe fibrosis was not seen in any specimens. The foreign-body reaction was limited to a few giant cells, and granuloma formation was seen in two specimens (25 %). The propylene mesh showed excellent biocompatibility with the septal mucosa, and it can, therefore, be used for the repair of septal perforation as an interpositional graft safely.

  6. Successful treatment of gastric perforation with thyrotoxic crisis.

    PubMed

    Ogiso, Satoshi; Inamoto, Susumu; Hata, Hiroaki; Yamaguchi, Takashi; Otani, Tetsushi; Koizumi, Kinya

    2008-11-01

    Patients with thyrotoxic crisis presenting with another emergency are at a considerable risk. We report the successful treatment of a 55-year-old woman having gastric perforation with thyrotoxic crisis; the principle of treatment was delayed surgery after rapid preoperative restoration of thyroid function and cardiovascular status. The patient was admitted for severe abdominal pain and nausea with delirium, exophthalmos, diffuse goiter, tremulousness, diaphoresis, tabescence, pretibial edema, and atrial fibrillation. Computed tomography revealed free air over the liver surface. She had been diagnosed with uncontrolled hyperthyroidism 3 days before admission, with a free liothyronine (T(3)) of 23.2 pg/mL, a free levothyroxine sodium (T(4)) of greater than 7.78 ng/dL, and thyrotropin of less than 0.01 ng/mL. She was diagnosed with gastroduodenal perforation and thyrotoxic crisis, and we planned nonoperative management comprising nasogastric aspiration, cefmetazole sodium, omeprazole, thiamazole, and Lugol's solution. We also used landiolol, an ultrashort-acting beta(1)-adrenoceptor antagonist, and hydrocortisone. On the third day of admission, her thyroid function had improved with a free T(3) of 4.7 pg/mL and a free T(4) of 2.9 ng/dL; however, perforative peritonitis had worsened, and hence, omental patch repair was performed. She recovered uneventfully and was discharged after radioiodine administration. We discuss the management of a thyrotoxic patient with gastric perforation and focus on the importance of changing the management according to the patient's clinical course considering his thyroid function status and comparing the stress of surgery with that of perforative peritonitis in nonoperative management.

  7. Severe stomatitis and ileocecal perforation developed after all-trans retinoic acid monotherapy in an HLA-B51-positive patient with acute promyelocytic leukemia.

    PubMed

    Kimura, Kenji; Takeuchi, Masahiro; Hasegawa, Nagisa; Togasaki, Emi; Shimizu, Ryoh; Kawajiri, Chika; Muto, Tomoya; Tsukamoto, Shokichi; Takeda, Yusuke; Ohwada, Chikako; Sakaida, Emiko; Sakai, Shio; Mimura, Naoya; Ota, Satoshi; Iseki, Tohru; Nakaseko, Chiaki

    2016-06-01

    A 34-year-old man who had been referred to our hospital was diagnosed with acute promyelocytic leukemia (APL). All-trans retinoic acid (ATRA), oral administration, was initiated. On day 25, he developed fever and respiratory distress with bilateral pulmonary infiltrates, suggesting differentiation syndrome (DS) caused by ATRA. These symptoms showed amelioration after discontinuing ATRA and initiating methylprednisolone. ATRA was re-started on day 29 at half the original dose because of residual APL blasts. The patient subsequently developed fever, severe stomatitis, and oropharyngeal ulcers, which persisted even after discontinuing ATRA. On day 48, he suddenly developed severe abdominal pain with free air, observable on an abdominal X-ray, and underwent emergency ileocecal resection. Pathological examination of the resected ileocecal intestines revealed multiple ulcers and perforations. No leukemic cell infiltration was observed. In this case, only ATRA was administered for APL treatment. These findings suggest that ileocecal ulcerations and perforations, as well as oropharyngeal ulcers, might have been caused by DS or ATRA. Furthermore, DNA typing of the HLA-B locus revealed that the patient had HLA-B51 associated with Behçet's disease. Therefore, hypercytokinemia with DS might have induced Behçet's disease-like symptoms, including stomatitis and ileocecal perforation, complications that are particularly observed in patients with HLA-B51.

  8. Experimental investigation of the influence of perforating on gravel-pack impairment

    SciTech Connect

    Blok, R.H.J.; Welling, R.W.F.; Venkitaraman, A.

    1996-12-31

    Analysis of the performance of perforated, gravel-packed wells compared with openhole gravel-packed wells has indicated that the perforation could be responsible for the low productivity of internally gravel-packed wells. A series of laboratory experiments on weak rock (UCS = 1200 psi) was conducted to quantify this. Castlegate sandstone rock samples, 7 in. in diameter and 18 in. long, were perforated with shaped charges under downhole conditions. The perforations were gravel packed by circulating a gravel slurry past the tunnel entrance while applying a differential pressure. The preperforation, post-perforation and post-gravel-pack productivities of the core samples were monitored at different flow rates (5 to 20 b/d/perf). Sectional photographs of the core samples were taken at post-gravel-pack conditions for qualitative analysis. Performance evaluation of gravel-packed {open_quotes}realistic perforations{close_quotes} (debris and loose sand in the tunnel removed by drawdown-induced flow) versus {open_quotes}ideal perforations{close_quotes} (debris and loose sand removed by external means) showed the post-gravel-pack productivities of realistic perforations to be much lower than ideal perforations in oil-phase as well as water-phase experiments. Injection of fluid after gravel packing only temporarily unplugged the perforation tunnel. The study shows the importance of fines-and debris-free perforation tunnels in maintaining the productivities; of gravel-packed completions.

  9. Biochemistry of intestinal development.

    PubMed Central

    Henning, S J

    1979-01-01

    In biochemical terms, the rat small intestine is relatively immature at birth and for the first two postnatal weeks. Then during the third week a dramatic array of enzymic changes begins, and by the end of the fourth week the intestine has the digestive and absorptive properties of the adult. Selective examples of these changes are discussed with emphasis on their implications for toxicological studies. The review also includes a detailed consideration of the roles of the dietary change of weaning and of glucocorticoid and thyroid hormones in the regulation of intestinal development. PMID:575507

  10. [Treatment of thoracic and abdominal cavity perforation complicated by Henoch-Schonlein purpura nephritis in a patient with high-voltage electric burn].

    PubMed

    Zhang, Wei; Xie, Wei-guo; Min, Wei-xiong; Wang, De-yun; Zhang, Jia; Wan, Shi-yong

    2013-10-01

    A 55-year-old male patient suffered from severe high-voltage electric burn with an area of 20%TBSA full-thickness injury. The injury involved the distal end of left upper limb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perforation of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was performed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin grafting. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppressive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocutaneous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.

  11. Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report.

    PubMed

    Bhutia, Kincho Lhasong; Dey, Subhajeet; Singh, Varun; Gupta, Amlan

    2011-01-01

    Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

  12. FOCUSED ASSESSMENT WITH SONOGRAPHY AS AN AID FOR THE DIAGNOSIS OF GASTROINTESTINAL PERFORATION IN A BOBCAT ( FELIS RUFUS ).

    PubMed

    Mejia-Fava, Johanna; Mayer, Jörg; Divers, Stephen J; Cohen, Eli B; Schmiedt, Chad; Holmes, Shannon P

    2015-12-01

    A 10-yr-old female spayed bobcat (Felis rufus) presented with a 3-day history of lethargy, anorexia, and two episodes of vomiting. An emergency field visit was scheduled to perform abdominal radiography and ultrasonography. The bobcat was assessed to be approximately 5-10% dehydrated, on the basis of decreased skin turgor and tacky mucous membranes. Free peritoneal gas, reduced abdominal serosal detail, and an abnormal-appearing right-sided intestinal segment were identified in the abdominal radiographs. However, the emergency field clinicians were not knowledgeable of these abnormalities, because the radiographs could not be processed in the field. During an initial complete abdominal ultrasound evaluation, a nondependent hyperechoic interface with reverberation artifact suggestive of intestinal or free gas and focal intestinal changes indicative of marked enteritis or peritonitis were identified. Free peritoneal fluid was not present on initial examination. In a focused abdominal sonography for trauma (FAST) scan, made after subcutaneous fluid administration, a small volume of anechoic free fluid was present in the peritoneal space. With ultrasound guidance, the fluid was aspirated and appeared grossly turbid. This fluid was subsequently confirmed as septic suppurative effusion, secondary to a foreign body-associated intestinal perforation. The use of a FAST scan is well described in human medicine, and to a limited degree in veterinary literature. This case represents a novel application of FAST scanning in an emergency field setting in a nontraumatized patient. This case report illustrates the utility of the FAST scan in yielding critical clinical information after fluid resuscitation in a zoological setting.

  13. Intestinal Complications of IBD

    MedlinePlus

    ... that only affects the colon). LOCAL COMPLICATIONS OF CROHN’S DISEASE INTESTINAL OBSTRUCTION The most common complication of Crohn’s disease, obstruction may arise from swelling and the formation ...

  14. Intestinal pseudo-obstruction

    MedlinePlus

    ... Taking drugs that slow intestinal movements. These include narcotic (pain) medicines and drugs used when you are ... that may have caused the problem (such as narcotic drugs) may help. In severe cases, surgery may ...

  15. Intestinal parasitic infection.

    PubMed

    Park, Mi-Suk; Kim, Ki Whang; Ha, Hyun Kwon; Lee, Dong Ho

    2008-01-01

    In general, gastrointestinal tract is the primary involvement site of parasites during their life cycle. In this article, we will describe amebiasis, ascariasis, and anisakiasis among the many common intestinal parasitic diseases. We will review the epidemiology, life cycles, clinical manifestations and complications, and illustrate detailed imaging findings of intestinal parasites. Recognizing features of parasitic infection is important to establish an early diagnosis that leads to prompt treatment and helps avoid unnecessary surgery.

  16. Intestinal adaptation following resection.

    PubMed

    Tappenden, Kelly A

    2014-05-01

    Intestinal adaptation is a natural compensatory process that occurs following extensive intestinal resection, whereby structural and functional changes in the intestine improve nutrient and fluid absorption in the remnant bowel. In animal studies, postresection structural adaptations include bowel lengthening and thickening and increases in villus height and crypt depth. Functional changes include increased nutrient transporter expression, accelerated crypt cell differentiation, and slowed transit time. In adult humans, data regarding adaptive changes are sparse, and the mechanisms underlying intestinal adaptation remain to be fully elucidated. Several factors influence the degree of intestinal adaptation that occurs post resection, including site and extent of resection, luminal stimulation with enteral nutrients, and intestinotrophic factors. Two intestinotrophic growth factors, the glucagon-like peptide 2 analog teduglutide and recombinant growth hormone (somatropin), are now approved for clinical use in patients with short bowel syndrome (SBS). Both agents enhance fluid absorption and decrease requirements for parenteral nutrition (PN) and/or intravenous fluid. Intestinal adaptation has been thought to be limited to the first 1-2 years following resection in humans. However, recent data suggest that a significant proportion of adult patients with SBS can achieve enteral autonomy, even after many years of PN dependence, particularly with trophic stimulation.

  17. Claudins in intestines

    PubMed Central

    Lu, Zhe; Ding, Lei; Lu, Qun; Chen, Yan-Hua

    2013-01-01

    Intestines are organs that not only digest food and absorb nutrients, but also provide a defense barrier against pathogens and noxious agents ingested. Tight junctions (TJs) are the most apical component of the junctional complex, providing one form of cell-cell adhesion in enterocytes and playing a critical role in regulating paracellular barrier permeability. Alteration of TJs leads to a number of pathophysiological diseases causing malabsorption of nutrition and intestinal structure disruption, which may even contribute to systemic organ failure. Claudins are the major structural and functional components of TJs with at least 24 members in mammals. Claudins have distinct charge-selectivity, either by tightening the paracellular pathway or functioning as paracellular channels, regulating ions and small molecules passing through the paracellular pathway. In this review, we have discussed the functions of claudin family members, their distribution and localization in the intestinal tract of mammals, their alterations in intestine-related diseases and chemicals/agents that regulate the expression and localization of claudins as well as the intestinal permeability, which provide a therapeutic view for treating intestinal diseases. PMID:24478939

  18. Managing bleeding, fluid absorption and uterine perforation at hysteroscopy.

    PubMed

    Istre, Olav

    2009-10-01

    Hysteroscopy is the current gold standard for evaluating intrauterine pathology, including submucous fibroids, polyps, hyperplasia and cancer. However, there are still problems and complications connected to hysteroscopy. Fluid overload of 1-2l occurs in approximately 5.2% and >2l in 1% of cases. This article discusses the physiology, implications and treatment of these cases. Uterine perforation is encountered in nearly 1% of cases. We describe the precautions to avoid this perforation and the methods to treat it. The article also discusses excessive bleeding, which occurs in 3% of operative hysteroscopies and describes strategies to avoid and to deal with this complication. Emergency hysterectomy and other surgical interventions are rarely indicated and are seen in 2% of cases. Finally, death due to septicaemia or fluid overload has been reported only very rarely (0.1%). These different complications are discussed in detail.

  19. Magnetic resonance angiography in perforator flap breast reconstruction

    PubMed Central

    Levine, Joshua L.

    2016-01-01

    Magnetic resonance angiography (MRA) is an extremely useful preoperative imaging test for evaluation of the vasculature of donor tissue to be used in autologous breast reconstruction. MRA has sufficient spacial resolution to reliably visualize 1 mm perforating vessels and to accurately locate vessels in reference to a patient’s anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast. The use of a blood pool contrast agent and the lack of radiation exposure allow multiple studies of multiple anatomic regions in one examination. The following article is a detailed description of our MRA protocol developed with our radiologists with examples that illustrate the utility of MRA in perforator flap breast reconstruction. PMID:27047787

  20. [Radical operative treatment of perforative gastroduodenal ulcer disease].

    PubMed

    Gostishchev, V K; Evseev, M A; Golovin, R A

    2009-01-01

    Data of 363 patients operated on for perforated gastric or duodenal ulcers were analyzed. Immediate and follow-up results were obtained after simple suture plication, Jadd's ulcer excision combined with stem vagotomy and after distal gastric resection. Predictors of the unfavourable outcome were determined. These are: Mannheim peritonitis index >20, surgical risk of IV-V grade, signs of multiple organ failure and symptomatic character of the ulcer. The comparison of long-term results revealed that patients after suture plication experienced the ulcer recurrence in 78,4% and necessity of further operation occurred in 21,5%. Every third patient after stem vagotomy experienced postvagotomic disorders and ulcer recurrence. Primary gastric resection demonstrated the best long-term results concerning ulcer disease. The algorithm of treatment modalities of the perforative ulcer desease was worked. The algorithm is based on stage-by stage determination of indications and contraindications to gastric resection.

  1. Effect of matrix placement on furcation perforation repair.

    PubMed

    Jantarat, J; Dashper, S G; Messer, H H

    1999-03-01

    Furcation perforations are a serious complication during endodontic treatment, and a matrix to aid placement of repair material has been recommended. This study tested the sealing ability of amalgam and Ketac silver placed with and without plaster of Paris as a matrix. A bacterial penetration technique was used to test the seal. Perforations created in the pulpal floor of extracted human mandibular molars were repaired as follows: group 1, amalgam; group 2, amalgam plus plaster as a matrix; group 3, Ketac silver; and group 4, Ketac silver plus plaster (17 teeth/group). Leakage was measured by placing bacteria (Streptococcus sobrinus) in the pulp chamber, and recording the time taken for bacterial growth in a medium bathing the root surface. A plaster of Paris matrix improved the seal with amalgam, but not with Ketac silver. Ketac silver provided the best seal, but all materials showed complete leakage within 22 days.

  2. Apparatus and method for sealing perforated well casing

    DOEpatents

    Blount, C.G.; Benham, R.A.; Brock, J.L.; Emerson, J.A.; Ferguson, K.R.; Scheve, D.F.; Schmidt, J.H.; Schuler, K.W.; Stanton, P.L.

    1997-03-25

    Perforations and other openings in well casings, liners and other conduits may be substantially blocked or sealed to prevent fluid flow between the casing or liner interior and an earth formation by placing a radially expansible sleeve adjacent the perforations or openings and urging the sleeve into forcible engagement with the casing or inner wall using an explosive charge. An apparatus including a radially contracted sleeve formed by a coiled plate member or a tubular member having flutes defined by external and internal folds, may be deployed into a well casing or liner through a production or injection tubing string and on the end of a flexible cable or coilable tubing. An explosive charge disposed on the apparatus and within the sleeve may be detonated to urge the sleeve into forcible engagement with the casing inner wall. 17 figs.

  3. Ventricular perforation by pacemaker lead repaired with two hemostatic devices

    PubMed Central

    Prestipino, Filippo; Nenna, Antonio; Casacalenda, Adele; Chello, Massimo

    2014-01-01

    INTRODUCTION Cardiac perforation is a rare, but potentially serious, complication of pacemaker implantation that may develop days or weeks after implantation. PRESENTATION OF CASE In the current case, 92-year-old man underwent permanent pacemaker implantation, but he presented 3 weeks later with severe symptoms. Computed tomography showed protrusion of the tip of the ventricular electrode through the right ventricle and into the chest wall. During an urgent surgical intervention, the lead was disconnected and extracted. A sealing hemostatic device and an hemostatic patch were applied to repair the ventricle; the procedure was uneventfull. DISCUSSION This case demonstrates how the correct diagnosis of ventricular perforation is crucial, and should be followed immediately by surgical planning. CONCLUSION The hemostatic patch is a valuable alternative to sutures in patients with thin and fragile ventricular wall, unable to undergo stitching. PMID:25460433

  4. [Gonococcal conjunctivitis complicated by perforating corneal abscess in an adult].

    PubMed

    Gambrelle, J; Ponceau, B; Duquesne, N; Crepet, H; Fleury, J; Burillon, C; Grange, J D; Kodjikian, L

    2007-09-01

    We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

  5. Apparatus and method for sealing perforated well casing

    DOEpatents

    Blount, Curtis G.; Benham, Robert A.; Brock, Jerry L.; Emerson, John A.; Ferguson, Keith R.; Scheve, Donald F.; Schmidt, Joseph H.; Schuler, Karl W.; Stanton, Philip L.

    1997-01-01

    Perforations and other openings in well casings, liners and other conduits may be substantially blocked or sealed to prevent fluid flow between the casing or liner interior and an earth formation by placing a radially expansible sleeve adjacent the perforations or openings and urging the sleeve into forcible engagement with the casing or inner wall using an explosive charge. An apparatus including a radially contracted sleeve formed by a coiled plate member or a tubular member having flutes defined by external and internal folds, may be deployed into a well casing or liner through a production or injection tubing string and on the end of a flexible cable or coilable tubing. An explosive charge disposed on the apparatus and within the sleeve may be detonated to urge the sleeve into forcible engagement with the casing inner wall.

  6. Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury

    PubMed Central

    Rabie, M. Ezzedien; Al Faris, Saad; Nasser, Ali; Shahir, Abdul Aziz; Al Mahdi, Yasser; Youssef Al Asmari, Mansour

    2015-01-01

    ERCP is attended with certain complications, the majority of which are well known to the medical community. Other less-known complications also exist. Guidewire injury to the hepatic or pancreatic parenchyma represents one of the much less appreciated, albeit preventable, complications. In this report, we present the clinical course of three patients who sustained guidewire perforation of the pancreatic or hepatic parenchyma. In one patient, the clinical deterioration was confidently attributed to guidewire perforation of the pancreatic parenchyma. Conservative treatment was successful and unnecessary emergency surgery was thus avoided. In the other two, in whom the cause of the clinical deterioration was unclear, an emergency surgery was performed. Guidewire injury to the hepatic parenchyma was then confirmed which needed only intraperitoneal drainage, with successful outcome. PMID:26693377

  7. Care of patients with deep inferior epigastric perforator reconstruction.

    PubMed

    Long, Laura; Israelian, Amy

    2013-01-01

    Recent trends reflect greater numbers of women opting for mastectomy for invasive breast cancer. Breast reconstruction, either at the time of mastectomy or later, is increasingly an option patients prefer. Although many women opt for implants, reconstruction using autologous tissue offers several advantages including tissue that feels more natural and will age naturally with the patient. The deep inferior epigastric perforator flap has emerged as an alternative to the transverse rectus abdominis myocutaneous flap and allows for preservation of the underlying abdominal muscle. As greater numbers of surgeons are able to offer this microvascular alternative, nurses will care for these postoperative patients in the intensive care unit and medical/surgical settings. This article reviews the evaluation of patients for deep inferior epigastric perforator reconstruction and the unique complexities of postoperative nursing care for these patients.

  8. The management of lens damage in perforating corneal lacerations.

    PubMed Central

    Muga, R.; Maul, E.

    1978-01-01

    Lens damage is present in 30% of perforating injuries of the anterior segment of the eye. There is no consensus on whether the cataractous lens should be removed at the initial repair of the corneal laceration or later, when the eye has recovered from injury. Twenty-seven consecutive cases with a perforating corneal injury and lens damage were alternatively treated either with simultaneous corneal suturing and cataract removal or with corneal suturing and delayed cataract removal several weeks later. The difference in the frequency of complications between the 2 groups was significant. The 1-step procedure was technically easier to perform, the period of postoperative irritation was shorter, complications due to the presence of an injured lens were prevented, and visual rehabilitation occurred earlier. PMID:568933

  9. Intestinal lymphangiectasia in adults.

    PubMed

    Freeman, Hugh James; Nimmo, Michael

    2011-02-15

    Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed more extensive changes along the length of the small intestine. A critical diagnostic element in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders (e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following initial

  10. Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study.

    PubMed

    Tamburino, Serena; Menez, Tiphaine; Laloze, Jérôme; Michot, Audrey; Paillet, Pierre; Perrotta, Rosario Emanuele; Casoli, Vincent

    2017-02-24

    Perforator flaps have become very popular in reconstructive surgery. The thoracodorsal and lateral thoracic artery perforator flaps are highly studied, and successful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vascular anatomy needs yet to be clarified. We describe a case of free serratus anterior artery perforator flap for the reconstruction of a dorsal defect of the foot, followed by an anatomic and radiological study. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle accident. After the osteosynthesis treatment, a perforator was identified through a handheld Doppler in the lateral chest area and a cutaneous paddle was designed. Retrograde dissection revealed the perforator's direct link to the serratus anterior pedicle. In our knowledge, an elucidated method to preoperatively visualize the perforating vessel of the serratus anterior artery has not yet been described. Thus, an anatomic study on 8 hemithorax and a radiological study on 33 computed tomographic angiographies of the chest were carried out to clarify the vascular anatomy of the serratus anterior artery perforators and to verify the possibility of their preoperative visualization. The authors believe that the serratus anterior artery perforator could be preoperatively investigated, thus making this flap a valuable option when harvesting a perforator flap in the lateral chest area.

  11. Surgical Audit of Patients with Ileal Perforations Requiring Ileostomy in a Tertiary Care Hospital in India

    PubMed Central

    Verma, Hemkant; Pandey, Siddharth; Sheoran, Kapil Dev; Marwah, Sanjay

    2015-01-01

    Introduction. Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries. The choice of a procedure for source control depends on the patient condition as well as the surgeon preference. Material and Methods. This was a prospective observational study including 41 patients presenting with perforation peritonitis due to ileal perforation and managed with ileostomy. Demographic profile and operative findings in terms of number of perforations, site, and size of perforation along with histopathological findings of all the cases were recorded. Results. The majority of patients were male. Pain abdomen and fever were the most common presenting complaints. Body mass index of the patients was in the range of 15.4–25.3 while comorbidities were present in 43% cases. Mean duration of preoperative resuscitation was 14.73 + 13.77 hours. Operative findings showed that 78% patients had a single perforation; most perforations were 0.6–1 cm in size and within 15 cm proximal to ileocecal junction. Mesenteric lymphadenopathy was seen in 29.2% patients. On histopathological examination, nonspecific perforations followed by typhoid and tubercular perforations respectively were the most common. Conclusion. Patients with ileal perforations are routinely seen in surgical emergencies and their demography, clinical profile, and intraoperative findings may guide the choice of procedure to be performed. PMID:26247059

  12. Effect of narcotic premedication of scintigraphic evaluation of gallbladder perforation

    SciTech Connect

    Sefczek, D.M.; Sharma, P.; Isaacs, G.H.; Brodmerkel, G.J. Jr.; Adatepe, M.H.; Powell, O.M.; Nichols, K.

    1985-01-01

    A case of gallbladder perforation is presented in which a small bile leak was demonstrated by cholescintigraphy while the patient was receiving meperidine, but not after meperidine was discontinued. The scintigrams obtained during meperidine therapy also showed a pattern of bile-duct obstruction. It is suggested that increased biliary pressure secondary to meperidine admininstration permitted visualization of the leak. Use of narcotic drugs may be a useful pharmocologic intervention in cases of peritonitis due to small obscure bile leaks.

  13. Colonic perforation during percutaneous nephrolithotomy: An 18-year experience

    PubMed Central

    AslZare, Mohammad; Darabi, Mohammad Reza; Shakiba, Behnam; Gholami-Mahtaj, Leila

    2014-01-01

    Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large, extracorporeal lithotripsy failure stones and those in the inferior calyx. Despite the development of new techniques and the increasing experience in recent decades, complications may still occur. Colonic perforation is one of the most dangerous and rare complications of PCNL, which may lead to peritonitis and sepsis. We present our 18-year experience on the diagnosis and management of colonic perforation during PCNL Methods: We retrospectively reviewed the data of 5260 PCNL procedures performed between May1995 and August 2013. Preoperative and operative factors, such as age, sex, history of previous ipsilateral stone intervention, stone side, stone location, site of skin puncture and punctured calyx, were reviewed in patients with colonic injury. Results: Colonic perforation was found in 11 patients (5 males and 6 females) and the mean age was 40.4 ± 22.2 years (range: 4 to 71). All injuries were retroperitoneal. The left side was affected in 5 patients and the right side was injured in 6 cases. Conservative management was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, complete healing of the colon was achieved in all patients. Conclusion: Early diagnosis and conservative management of colonic perforation can minimize patient morbidity and mortality and result in excellent healing of the fistulous tract without any serious complications. PMID:24940458

  14. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement

    PubMed Central

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-01-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment. PMID:27761183

  15. Combined Gastric and Duodenal Perforation Through Blunt Abdominal Trauma

    PubMed Central

    Kaur, Adarshpal; Singla, Archan Lal; Kumar, Ashwani; Yadav, Manish

    2015-01-01

    Blunt abdominal traumas are uncommonly encountered despite their high prevalence, and injuries to the organ like duodenum are relatively uncommon (occurring in only 3%-5% of abdominal injuries) because of its retroperitoneal location. Duodenal injury combined with gastric perforation from a single abdominal trauma impact is rarely heard. The aim of this case report is to present a rare case of blunt abdominal trauma with combined gastric and duodenal injuries. PMID:25738037

  16. Cerebral Aneurysm Perforations during Treatment with Detachable Coils

    PubMed Central

    Layton, K.F.; Cloft, H.J.; Kallmes, D.F.

    2006-01-01

    Summary Perforation of intracranial aneurysms during endovascular treatment with platinum microcoils is a well-known and serious complication reported to occur in 2-4% of patients. Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis. In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture. PMID:20569548

  17. Temperature Driven Annealing of Perforations in Bicellar Model Membranes

    SciTech Connect

    Nieh, Mu-Ping; Raghunathan, V.A.; Pabst, Georg; Harroun, Thad; Nagashima, K; Morales, H; Katsaras, John; Macdonald, P

    2011-01-01

    Bicellar model membranes composed of 1,2-dimyristoylphosphatidylcholine (DMPC) and 1,2-dihexanoylphosphatidylcholine (DHPC), with a DMPC/DHPC molar ratio of 5, and doped with the negatively charged lipid 1,2-dimyristoylphosphatidylglycerol (DMPG), at DMPG/DMPC molar ratios of 0.02 or 0.1, were examined using small angle neutron scattering (SANS), {sup 31}P NMR, and {sup 1}H pulsed field gradient (PFG) diffusion NMR with the goal of understanding temperature effects on the DHPC-dependent perforations in these self-assembled membrane mimetics. Over the temperature range studied via SANS (300-330 K), these bicellar lipid mixtures exhibited a well-ordered lamellar phase. The interlamellar spacing d increased with increasing temperature, in direct contrast to the decrease in d observed upon increasing temperature with otherwise identical lipid mixtures lacking DHPC. {sup 31}P NMR measurements on magnetically aligned bicellar mixtures of identical composition indicated a progressive migration of DHPC from regions of high curvature into planar regions with increasing temperature, and in accord with the 'mixed bicelle model' (Triba, M. N.; Warschawski, D. E.; Devaux, P. E. Biophys. J.2005, 88, 1887-1901). Parallel PFG diffusion NMR measurements of transbilayer water diffusion, where the observed diffusion is dependent on the fractional surface area of lamellar perforations, showed that transbilayer water diffusion decreased with increasing temperature. A model is proposed consistent with the SANS, {sup 31}P NMR, and PFG diffusion NMR data, wherein increasing temperature drives the progressive migration of DHPC out of high-curvature regions, consequently decreasing the fractional volume of lamellar perforations, so that water occupying these perforations redistributes into the interlamellar volume, thereby increasing the interlamellar spacing.

  18. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement.

    PubMed

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-06-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

  19. Perforated monolayers. Progress report, July 1, 1991--Mar 31, 1992

    SciTech Connect

    Regen, S.L.

    1992-05-01

    Our research over this past grant period has focused on (1) developing methods for making in situ permeation measurements at the air-water interface, (2) defining the structural and conformational behavior of selected calix[4]arenes, (3) defining the metal complexation properties of certain upper-rim functionalized calix[4]arenes, and (4) synthesizing a broad series of polymerizable calixarenes, to be used for constructing perforated monolayers and multilayers.

  20. Risk factors for colonoscopic perforation: A population-based study of 80118 cases

    PubMed Central

    Hamdani, Uzair; Naeem, Raza; Haider, Fyeza; Bansal, Pardeep; Komar, Michael; Diehl, David L; Kirchner, H Lester

    2013-01-01

    AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t-test and Pearson’s χ2 test, as appropriate. RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P-value < 0.1 were checked for inclusion in a multivariable log-binomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn’s disease as indications for colonoscopy. CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn’s disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy

  1. The intestine is a blender

    NASA Astrophysics Data System (ADS)

    Yang, Patricia; Lamarca, Morgan; Kravets, Victoria; Hu, David

    According to the U.S. Department of Health and Human Services, digestive disease affects 60 to 70 million people and costs over 140 billion annually. Despite the significance of the gastrointestinal tract to human health, the physics of digestion remains poorly understood. In this study, we ask a simple question: what sets the frequency of intestinal contractions? We measure the frequency of intestinal contractions in rats, as a function of distance down the intestine. We find that intestines Contract radially ten times faster than longitudinally. This motion promotes mixing and, in turn, absorption of food products by the intestinal wall. We calculate viscous dissipation in the intestinal fluid to rationalize the relationship between frequency of intestinal contraction and the viscosity of the intestinal contents. Our findings may help to understand the evolution of the intestine as an ideal mixer.

  2. The intestine is a blender

    NASA Astrophysics Data System (ADS)

    Yang, Patricia; Lamarca, Morgan; Hu, David

    2015-11-01

    According to the U.S. Department of Health and Human Services, digestive disease affects 60 to 70 million people and costs over 140 billion annually. Despite the significance of the gastrointestinal tract to human health, the physics of digestion remains poorly understood. In this study, we ask a simple question: what sets the frequency of intestinal contractions? We measure the frequency of intestinal contractions in rats, as a function of distance down the intestine. We find that intestines contract radially ten times faster than longitudinally. This motion promotes mixing and, in turn, absorption of food products by the intestinal wall. We calculate viscous dissipation in the intestinal fluid to rationalize the relationship between frequency of intestinal contraction and the viscosity of the intestinal contents. Our findings may help to understand the evolution of the intestine as an ideal mixer.

  3. An aerodynamic performance analysis of a perforated wind turbine blade

    NASA Astrophysics Data System (ADS)

    Didane, D. H.; Mohd, S.; Subari, Z.; Rosly, N.; Ghafir, M. F. Abdul; Mohd Masrom, M. F.

    2016-11-01

    Wind power is one of the important renewable energy sources. Currently, many researches are focusing on improving the aerodynamic performance of wind turbine blades through simulations and wind tunnel testing. In the present study, the aerodynamic performance of the perforated Eqwin blade (shell type blade) is investigated by using numerical simulation. Three types of slots namely circular, horizontal rectangular and vertical rectangular were evaluated. It was found that the optimum angle of attack for a perforated shell type blade was 12° with maximum Cl/Cd value of 6.420. In general, for all the perforated blade cases, Cl/Cd tended to decrease as the slot size increased except for the circular slot with 5 mm diameter. This was due to the disturbance of the airflow in lower side region which passed through the bigger slot size. Among the modified slots; the circular slot with diameter of 5 mm would be the best slot configuration that can be considered for blade fabrication. The Cl/Cd obtained was 6.46 which is about 5% more than the value of the reference blade. Moreover, the introduced slot would also reduce the overall weight of the blade by 1.3%.

  4. Acute otitis media with spontaneous tympanic membrane perforation.

    PubMed

    Principi, N; Marchisio, P; Rosazza, C; Sciarrabba, C S; Esposito, S

    2017-01-01

    The principal aim of this review is to present the current knowledge regarding acute otitis media (AOM) with spontaneous tympanic membrane perforation (STMP) and to address the question of whether AOM with STMP is a disease with specific characteristics or a severe case of AOM. PubMed was used to search for all studies published over the past 15 years using the key words "acute otitis media" and "othorrea" or "spontaneous tympanic membrane perforation". More than 250 articles were found, but only those published in English and providing data on aspects related to perforation of infectious origin were considered. Early Streptococcus pneumoniae infection due to invasive pneumococcal strains, in addition to coinfections and biofilm production due mainly to non-typeable Haemophilus influenzae, seem to be precursors of STMP. However, it is unclear why some children have several STMP episodes during the first years of life that resolve without complications in adulthood, whereas other children develop chronic suppurative otitis media. Although specific aetiological agents appear to be associated with an increased risk of AOM with STMP, further studies are needed to determine whether AOM with STMP is a distinct disease with specific aetiological, clinical and prognostic characteristics or a more severe case of AOM than the cases that occur without STMP. Finally, it is important to identify preventive methods that are useful not only in otitis-prone children with uncomplicated AOM, but also in children with recurrent AOM and those who experience several episodes with STMP.

  5. On the level-dependent attenuation of a perforated device.

    PubMed

    Chen, Lan; Sang, Jinqiu; Li, Xiaodong

    2009-05-01

    To investigate the physical principle governing the level-dependent attenuation of a perforated earplug, a mathematical model is first established with the transfer-matrix method to calculate the noise reduction through a simplified device, one perforated panel with back cavity, mounted in an impedance tube. The model prediction is compared with the measured noise reduction through two series of large-scale devices and one device with the dimensions of the ear canal under continuous noise and sinusoidal excitations. The model helps to improve significantly the level-dependent attenuation of the large-scale device. It also illustrates that the attenuation is not solely determined by the resistance of the orifice, which has been a well accepted design concept, but resulted from an incorporated effect of the acoustic filter comprised of the acoustic impedance of the orifice and other elements in the earplug-ear-canal system. This mechanism can interpret a resonance at low incident levels on improper design and reveal approaches to eliminate it. Finally, the model's potential contributions to the design of a perforated earplug are discussed, along with the threshold of level-dependent attenuation supported with experimental evidence.

  6. Micro-mechanical modeling of perforating shock damage

    SciTech Connect

    Swift, R.P.; Krogh, K.E.; Behrmann, L.A.; Halleck, P.M.

    1997-11-17

    Shaped charge jet induced formation damage from perforation treatments hinders productivity. Manifestation of this damage is in the form of grain fragmentation resulting in fines that plug up pore throats along with the breakdown of inter-grain cementation. The authors use the Smooth Particle Hydrodynamic (SPH) computational method as a way to explicitly model, on a grain pore scale, the dynamic interactions of grains and grain/pores to calculate the damage resulting from perforation type stress wave loading. The SPH method is a continuum Lagrangian, meshless approach that features particles. Clusters of particles are used for each grain to provide representation of a grain pore structure that is similar to x-ray synchrotron microtomography images. Numerous damage models are available to portray fracture and fragmentation. In this paper the authors present the results of well defined impact loading on a grain pore structure that illustrate how the heterogeneity affects stress wave behavior and damage evolution. The SPH approach easily accommodates the coupling of multi-materials. Calculations for multi-material conditions with the pore space treated as a void, fluid filled, and/or clay filled show diverse effects on the stress wave propagation behavior and damage. SPH comparisons made with observed damage from recovered impacted sandstone samples in gas gun experiments show qualitatively the influence of stress intensity. The modeling approach presented here offers a unique way in concert with experiments to define a better understanding of formation damage resulting from perforation completion treatments.

  7. Numerical solution of acoustic scattering by finite perforated elastic plates

    NASA Astrophysics Data System (ADS)

    Cavalieri, A. V. G.; Wolf, W. R.; Jaworski, J. W.

    2016-04-01

    We present a numerical method to compute the acoustic field scattered by finite perforated elastic plates. A boundary element method is developed to solve the Helmholtz equation subjected to boundary conditions related to the plate vibration. These boundary conditions are recast in terms of the vibration modes of the plate and its porosity, which enables a direct solution procedure. A parametric study is performed for a two-dimensional problem whereby a cantilevered perforated elastic plate scatters sound from a point quadrupole near the free edge. Both elasticity and porosity tend to diminish the scattered sound, in agreement with previous work considering semi-infinite plates. Finite elastic plates are shown to reduce acoustic scattering when excited at high Helmholtz numbers k0 based on the plate length. However, at low k0, finite elastic plates produce only modest reductions or, in cases related to structural resonance, an increase to the scattered sound level relative to the rigid case. Porosity, on the other hand, is shown to be more effective in reducing the radiated sound for low k0. The combined beneficial effects of elasticity and porosity are shown to be effective in reducing the scattered sound for a broader range of k0 for perforated elastic plates.

  8. Primary closure of contaminated wounds in perforated appendicitis.

    PubMed

    Burnweit, C; Bilik, R; Shandling, B

    1991-12-01

    We studied the clinical course of 506 children consecutively admitted with appendicitis at The Hospital for Sick Children from 1985 to 1989. One hundred eighty-one children (35%), ranging in age from 1 to 17 years, presented with perforation verified by histological examination. Ninety-six of them (53%) had generalized peritonitis, 47 (26%) had localized peritonitis, and 38 (21%) had abscess formation. Usually, triple antibiotics were begun preoperatively if perforation was suspected; otherwise, cefoxitin was started. Triple antibiotics were used postoperatively for 5 to 7 days in almost all children in the perforated group. Neither abdominal nor subcutaneous drainage was routinely used even in cases of intraabdominal abscess. The skin was closed primarily with steri-strips (63%), staples (20%), subcutaneous Dexon (11%), or silk (4%). Postoperative wound infection arose in 20 children (11%). Wound infections were noted from 1 to 14 days postoperatively (mean, 5.9 days). Whereas 9 of these were treated with local therapy only, 11 delayed the child's discharge or necessitated readmission. No patient suffered major complications from wound infection in that there were no cases of necrotizing fasciitis, reoperation for debridement, sepsis, or death. The intraabdominal abscess rate in this group of 181 children was 6% (n = 11). The low rate of infective complications fully justifies the policy of primary closure in contaminated wounds. This policy eliminates the necessity for painful and time-consuming dressing changes, shortens hospitalization, and obviates the trauma of delayed suturing of wounds in children.

  9. Bowel perforation complicating an ACTH-secreting phaeochromocytoma

    PubMed Central

    Flynn, Elise; Liu, Dorothy; Ekinci, Elif I; Farrell, Stephen; Zajac, Jeffrey D; De Luise, Mario; Seeman, Ego

    2016-01-01

    Summary ACTH-secreting phaeochromocytoma (ASP) is a rare cause of ACTH-dependent Cushing’s syndrome (CS). We report the case of a 63-year-old female presenting with CS secondary to an ASP complicated by bowel perforation. This case report highlights ASP as an uncommon but important cause of ectopic ACTH secretion (EAS). There have been 29 cases of ASP, all of which were unilateral and benign, but associated with significant complications. Patients presenting with ASP have the potential for cure with unilateral adrenalectomy. Given this promising prognosis if recognised, ASP should be considered in the diagnostic workup of ACTH-dependent CS. As this case demonstrates, gastrointestinal complications can arise from severe hypercortisolaemia associated with CS. Early medical and surgical intervention is imperative as mortality approaches 50% once bowel perforation occurs. Learning points Consider phaeochromocytoma in the diagnostic workup of ACTH-dependent CS; screen with plasma metanephrines or urinary catecholamines. Serial screening may be required if ACTH-secreting phaeochromocytoma is suspected, as absolute levels can be misleading. Early catecholamine receptor blockade and adrenal synthesis blockade may avoid the need for rescue bilateral adrenalectomy in ACTH-secreting phaeochromocytoma. Consider early medical or surgical management when gastrointestinal features are present in patients with CS, as bowel perforation due to severe hypercortisolaemia can occur and is associated with significant mortality. PMID:28203371

  10. Perforated plates for cryogenic regenerators and method of fabrication

    DOEpatents

    Hendricks, J.B.

    1994-03-29

    Perforated plates having very small holes with a uniform diameter throughout the plate thickness are prepared by a [open quotes]wire drawing[close quotes] process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er[sub 3]Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans containing erbium and nickel metals in a stacked array with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er[sub 3]Ni. Perforated plates having two sizes of perforations, one of which is small enough for storage of helium, are also disclosed. 10 figures.

  11. Perforated plates for cryogenic regenerators and method of fabrication

    DOEpatents

    Hendricks, John B.

    1994-01-01

    Perforated plates (10) having very small holes (14) with a uniform diameter throughout the plate thickness are prepared by a "wire drawing" process in which a billet of sacrificial metal is disposed in an extrusion can of the plate metal, and the can is extruded and restacked repeatedly, converting the billet to a wire of the desired hole diameter. At final size, the rod is then sliced into wafers, and the wires are removed by selective etching. This process is useful for plate metals of interest for high performance regenerator applications, in particular, copper, niobium, molybdenum, erbium, and other rare earth metals. Er.sub.3 Ni, which has uniquely favorable thermophysical properties for such applications, may be incorporated in regions of the plates by providing extrusion cans (20) containing erbium and nickel metals in a stacked array (53) with extrusion cans of the plate metal, which may be copper. The array is heated to convert the erbium and nickel metals to Er.sub.3 Ni. Perforated plates having two sizes of perforations (38, 42), one of which is small enough for storage of helium, are also disclosed.

  12. Strongyloides stercoralis hyperinfection associated with impaired intestinal motility disorder

    PubMed Central

    Figueira, Cláudia Frangioia; Cos, Lynda Dorene; Ussami, Edson Yassushi; Otoch, José Pinhata; Felipe-Silva, Aloisio

    2015-01-01

    Infection by Strongyloides stercoralis is a highly prevalent helminthiasis, which is mostly distributed in the tropical and subtropical regions of the world. Although a substantial number of cases are asymptomatic or paucisymtomatic, severe and life-threatening forms of this infection still occur and not infrequently is lately diagnosed. Gram-negative bacteria septicemia, which frequently accompanies the severe helminthiasis, contributes to the high mortality rate. Severe infection is invariably triggered by any imbalance in the host's immunity, favoring the auto-infective cycle, which increases the intraluminal parasite burden enormously. Clinical presentation of severe cases is varied, and diagnosis requires a high suspicion index. Acute abdomen has been reported in association with S. stercoralis infection, but intestinal necrosis is rarely found during the surgical approach. The authors report the case of a man who sought the emergency unit with recent onset abdominal pain. Clinical and imaging features were consistent with obstructive acute abdomen. Scattered adhesions and a necrotic ileal segment with a tiny perforation represented the surgical findings. The patient outcome was unfavorable and respiratory distress required an open lung biopsy. Both surgical specimens showed S. stercoralis infection. Unfortunately the patient underwent multiple organ failure and septicemia, and subsequently died. The authors call attention to the finding of intestinal necrosis and impaired intestinal motility disorder as possibilities for the diagnosis and risk factor, respectively, for a severe infection of S. stercoralis. PMID:26484331

  13. Emergency Oesophagectomy for Oesophageal Perforation after Chemoradiotherapy for Oesophageal Cancer

    PubMed Central

    Solymosi, N; Dubecz, A; Posada Gonzalez, M; Stadlhuber, RJ; Ofner, D; Stein, HJ

    2015-01-01

    Introduction Oesophageal perforation following chemoradiotherapy for oesophageal cancer is a devastating condition but there have been no studies investigating the role of emergency oesophagectomy for this life threatening situation. Methods This retrospective study comprised all cases of emergency oesophagectomy for oesophageal perforation after chemoradiotherapy for oesophageal carcinoma at a major centre for oesophageal surgery in Germany between 2004 and 2013. Results A total of 13 patients (mean age: 58.9 years) were identified. During the same time period, 356 elective oesophagectomies were performed. Tumour entities were squamous cell carcinoma (n=12) and adenocarcinoma of the oesophagus (n=1). Alcoholism (odds ratio [OR]: 25.79, 95% confidence interval [CI]: 6.70–121.70, p<0.0001) and chronic pulmonary disease (OR: 3.76, 95% CI: 1.06–14.96, p=0.027) were more common among the emergency cases. Oesophageal rupture was caused by perforation of an oesophageal stent (10 cases) or perforation during implantation of a percutaneous endoscopic gastrostomy tube (3 cases). Emergency oesophagectomy was carried out either as discontinuity resection (10/13) or oesophagectomy with immediate reconstruction (3/13). Compared with the elective cases, patients undergoing emergency oesophagectomy had significantly higher odds for sustaining perioperative sepsis (OR: 4.42, 95% CI: 1.23–16.45, p=0.01), acute renal failure (OR: 6.49, 95% CI: 1.57–24.15, p=0.005) and pneumonia (OR: 24.33, 95% CI: 3.52–1,046.65, p<0.0001). Furthermore, slow respiratory weaning was more common and there was a significantly higher tracheostomy rate (OR: 4.64, 95% CI: 1.14–16.98, p=0.02). Oesophageal discontinuity was eventually reversed in eight patients. Emergency oesophagectomy patients had odds that were three times higher for fatal outcome (OR: 3.59, 95% CI: 0.77–13.64, p=0.05). The overall mortality was 4/13. The remaining nine patients had a mean survival of 25.1 months (range: 5

  14. Intestinal and multivisceral transplantation

    PubMed Central

    Meira, Sérgio Paiva; Guardia, Bianca Della; Evangelista, Andréia Silva; Matielo, Celso Eduardo Lourenço; Neves, Douglas Bastos; Pandullo, Fernando Luis; Felga, Guilherme Eduardo Gonçalves; Alves, Jefferson André da Silva; Curvelo, Lilian Amorim; Diaz, Luiz Gustavo Guedes; Rusi, Marcela Balbo; Viveiros, Marcelo de Melo; de Almeida, Marcio Dias; Epstein, Marina Gabrielle; Pedroso, Pamella Tung; Salvalaggio, Paolo; Meirelles, Roberto Ferreira; Rocco, Rodrigo Andrey; de Almeida, Samira Scalso; de Rezende, Marcelo Bruno

    2015-01-01

    Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990’s, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run. PMID:25993080

  15. Endoscopic fibrin sealant closure of duodenal perforation after endoscopic retrograde cholangiopancreatography.

    PubMed

    Yang, Hsin-Yeh; Chen, Jui-Hao

    2015-12-07

    Traditionally, perivaterian duodenal perforation can be managed conservatively or surgically. If a large volume of leakage results in fluid collection in the retroperitoneum, surgery may be necessary. Our case met the surgical indication for perivaterian duodenal perforation after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic papillary balloon dilatation. The patient developed a retroperitoneal abscess after the procedures, and a perivaterian perforation was suggested on computed tomography (CT). CT-guided abscess drainage was performed immediately. We unsuccessfully attempted to close the perforation with hemoclips initially. Subsequently, we used fibrin sealant (Tisseel) injection to occlude the perforation. Fibrin sealant injections have been previously used during endoscopy for wound closure and fistula repair. Based on our report, fibrin sealant injection can be considered as an alternative method for the treatment of ERCP-related type II perforations.

  16. Combined use of an amniotic membrane and tissue adhesive in treating corneal perforation: a case report.

    PubMed

    Su, C Y; Lin, C P

    2000-01-01

    We report a new method combining the use of an amniotic membrane and cyanocrylate tissue adhesive to seal a corneal perforation. A 47-year-old male suffered from an alkali injury complicated with corneal melting and perforation in the left eye. We placed an amniotic membrane of optimal size in the anterior chamber directly under the corneal perforation lesion. The cyanocrylate tissue adhesive was then applied over the perforation site and sealed successfully. Three weeks later, the tissue adhesive had dislodged. The amniotic membrane had sealed the perforated lesion and was well adhered to the surrounding corneal tissue with complete epithelial covering. Vision was 20/25 six months after the operation. The combined use of an amniotic membrane and tissue adhesive is a promising method in the treatment of corneal perforation.

  17. The effect of high-amplitude sound on the attenuation of perforated tube silencers

    PubMed

    Dickey; Selamet; Novak

    2000-09-01

    A time-domain computational approach is applied to investigate the behavior of perforated tube silencers at high sound levels. The one-dimensional computational technique employs a lumped parameter model for the perforate flows. The lumped parameter perforate model is based on time-invariant approximations for the equivalent length l(eq) and resistance R, consistent with the use of a nonlinear perforate impedance. Empirical expressions for l(eq) and R are developed experimentally using nondimensional scaling parameters. The model is applied to geometries representative of automotive resonators and multiple-duct mufflers. Conditions are simplified from those in an actual automotive system by considering single-frequency excitation and zero mean flow. Simulations with linear perforate behavior are compared to experimental data obtained with an extended impedance tube system. Simulations with nonlinear perforate behavior for one concentric tube resonator are compared to published experimental data.

  18. Intestinal anisakidosis (anisakiosis).

    PubMed

    Takei, Hidehiro; Powell, Suzanne Z

    2007-10-01

    A case of intestinal anisakidosis in a 42-year-old man in Japan is presented. His chief complaint was an acute onset of severe abdominal pain. Approximately 12 hours before the onset of this symptom, he had eaten sliced raw mackerel ("sashimi"). Upper endoscopy was unremarkable. At exploratory laparotomy, an edematous, diffusely thickened segment of jejunum was observed, which was resected. The postoperative course was uneventful. The segment of small intestine showed a granular indurated area on the mucosal surface, and microscopically, a helminthic larva penetrating the intestinal wall, which was surrounded by a cuff of numerous neutrophils and eosinophils, as well as diffuse acute serositis. A cross section of the larva revealed the internal structures, pathognomonic of Anisakis simplex. Although anisakidosis is rare in the United States, with the increasing popularity of Japanese cuisine, the incidence is expected to increase, and pathologists should be familiar with this disease.

  19. A case of ampullary perforation treated with a temporally covered metal stent.

    PubMed

    Park, Woo Young; Cho, Kwang Bum; Kim, Eun Soo; Park, Kyung Sik

    2012-06-01

    Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is classified into three or four types based on anatomical location and the mechanism of injury. Although ampullary injury, among them, may be managed nonsurgically, surgical management is required in cases of perforation with retroperitoneal fluid collection and severe condition. Here, a patient with ERCP-related severe ampullary perforation with retroperitoneal fluid collection that was treated nonsurgically with a covered stent is presented.

  20. Perforated appendix in hernial sac mimicking torsion of undescended testis in a neonate.

    PubMed

    Kumar, Renu; Mahajan, J K; Rao, K L N

    2008-04-01

    In pediatric surgical practice, finding of the vermiform appendix in an inguinal hernia sac is not that uncommon; however, a perforation is rare. There are only a few case reports of a perforated appendix with periappendicular abscess in the inguinal hernial sac in a neonate. We report an unusual case of inguinal hernia containing a perforated appendix that was clinically mimicking testicular torsion of the undescended testis.

  1. First report of perforation of ligamentum flavum by sequestrated lumbar intervertebral disc

    PubMed Central

    Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersegun; Erturk, Cihangir; Celiker, Fatma Beyazal; Guvercin, Ali Riza; Yazar, Ugur

    2017-01-01

    Disc fragments are well known to migrate to superior, inferior, or lateral sites in the anterior epidural space, posterior epidural migrated lumbar disc fragments is an extremely rare disorder, 61 cases have been reported to date. However, there were no cases with perforated ligamentum flavum (LF). We report a different case with perforation of ligamentum ligamentum by disc fragment. To the best of our knowledge, this is the first report of perforation LF by a posterior epidural migrated sequester disc. PMID:28250640

  2. Intestinal microbiota and ulcerative colitis.

    PubMed

    Ohkusa, Toshifumi; Koido, Shigeo

    2015-11-01

    There is a close relationship between the human host and the intestinal microbiota, which is an assortment of microorganisms, protecting the intestine against colonization by exogenous pathogens. Moreover, the intestinal microbiota play a critical role in providing nutrition and the modulation of host immune homeostasis. Recent reports indicate that some strains of intestinal bacteria are responsible for intestinal ulceration and chronic inflammation in inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). Understanding the interaction of the intestinal microbiota with pathogens and the human host might provide new strategies treating patients with IBD. This review focuses on the important role that the intestinal microbiota plays in maintaining innate immunity in the pathogenesis and etiology of UC and discusses new antibiotic therapies targeting the intestinal microbiota.

  3. Small intestine contrast injection (image)

    MedlinePlus

    ... and throat, through the stomach into the small intestine. When in place, contrast dye is introduced and ... means of demonstrating whether or not the small intestine is normal when abnormality is suspected.

  4. Intestinal Failure (Short Bowel Syndrome)

    MedlinePlus

    ... N Vitamin deficiencies as a result of poor absorption in the intestine N Electrolyte and mineral deficiencies ... N Kidney stones or gallstones due to poor absorption of calcium or bile How is intestinal failure ...

  5. Small intestine aspirate and culture

    MedlinePlus

    ... ency/article/003731.htm Small intestine aspirate and culture To use the sharing features on this page, please enable JavaScript. Small intestine aspirate and culture is a lab test to check for infection ...

  6. Coronary artery perforation complicated by recurrent cardiac tamponade: a case illustration and review.

    PubMed

    DePersis, Michael; Khan, Safi U; Kaluski, Edo; Lombardi, William

    2017-03-07

    Coronary artery perforation during percutaneous intervention is a rare but potentially life threatening complication. The treatment of coronary perforation can be challenging in view of potential life threatening consequences such as cardiac tamponade or myocardial infarction. Presented is a clinical course of a 69year-old female who developed cardiac tamponade as a result of presumed wire related perforation of the posterolateral branch of the right coronary artery. Her clinical course was further complicated by recurrent tamponade, atrial fibrillation, stress induced cardiomyopathy, heparin induced thrombocytopenia and cardiogenic pulmonary edema. Based on review of the medical literature a treatment algorithm for wire perforation is suggested.

  7. [Effectiveness of perforated film mulching on maize field in rainfall reception and soil ventilation].

    PubMed

    Chi, Baoliang; Huang, Xuefang; Zhang, Dongmei

    2006-04-01

    To improve the light rain availability and soil ventilation in semi-arid area, this paper studied the effectiveness of perforated plastic film mulching on maize field. The results showed that perforated plastic film mulching had the benefits of receiving rainfall and supplementing soil moisture. Soil CO2 content increased with increasing area of mulching, and was lower under perforated plastic film mulching than under common plastic film mulching. A negative correlation was observed between maize root vitality and soil CO2 content. The maize yield under perforated film mulching was 8.98% higher than that under common film mulching.

  8. Treatment of pulp floor and stripping perforation by mineral trioxide aggregate.

    PubMed

    Tsai, Yi-Ling; Lan, Wan-Hong; Jeng, Jiiang-Huei

    2006-06-01

    Mineral trioxide aggregate (MTA) has been widely used to repair various kinds of tooth perforations, but its use for obturation of the entire root canal has not been reported. We report two cases of tooth perforation successfully repaired with MTA. The first patient was a 78-year-old male with calcified canal and pulp floor perforation in the left maxillary first premolar. After bypass of the calcified palatal canal, both buccal and palatal canals were filled with gutta percha, and the pulp floor perforation was repaired with MTA. Clinical success with no evident radicular lesion was found at the 18-month follow-up. The second patient was a 51-year-old female with a stripping perforation in a C-shaped root canal of the right mandibular second molar detected after removal of a post. Following root canal debridement and calcium hydroxide therapy to control inflammation at the stripping perforation site, apical and furcation bone healing were observed by radiographic examination. The stripping perforation was repaired by obturation of the entire C-shaped root canal with MTA. Observation at the 9-month follow-up revealed bone healing without any clinical symptoms and signs. These cases suggest that MTA is an alternative root canal obturation material for treatment of stripping perforation in a C-shaped root canal and for repair of pulp floor perforation.

  9. Esophageal stent placement as a therapeutic option for iatrogenic esophageal perforation in children

    PubMed Central

    Ahmad, Alsafadi; Wong Kee Song, Louis M.; Absah, Imad

    2016-01-01

    Iatrogenic esophageal perforation (IEP) is a potentially serious adverse event of interventional endoscopy. The approach to IEP varies from surgical repair for large perforations to conservative treatment for small contained perforations. We report a case of an 18-month-old girl with congenital esophageal stenosis suffering a large esophageal perforation after a trial of stricture dilatation, which was successfully managed by the placement of fully covered stent. Hence, in selected cases, esophageal stent placement is a feasible alternative to invasive surgery in managing IEP. PMID:27144142

  10. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma

    PubMed Central

    Noguchi, Masaaki; Yano, Tomonori; Kato, Tomoji; Kadota, Tomohiro; Imajoh, Maomi; Morimoto, Hiroyuki; Osera, Shozo; Yagishita, Atsushi; Odagaki, Tomoyuki; Yoda, Yusuke; Oono, Yasuhiro; Ikematsu, Hiroaki; Kaneko, Kazuhiro

    2017-01-01

    AIM To identify the risk factors and clarify the subsequent clinical courses. METHODS This study retrospectively analyzed consecutive patients with esophageal squamous cell carcinoma (ESCC) treated using endoscopic submucosal dissection (ESD) between April 2008 and October 2012. We divided the ESCC lesions into perforation cases and non-perforation cases, and compared characteristics and endoscopic findings between the two groups. "Intraoperative perforation" was defined as the detection of a perforation site during ESD and the presence of mediastinal emphysema. RESULTS In total, 147 patients with 156 ESCC lesions were treated by ESD. Intraoperative perforation was recorded for nine lesions (5.8%) from nine patients. Multivariate analysis identified mucosal deficiency larger than 75% of the circumference of the esophagus as an independent risk factor for intraoperative perforation (OR = 7.37, 95%CI: 1.45-37.4, P = 0.016). The predominant site of perforation was the left wall [6/9 (67%)]. Six of nine perforation sites were successfully closed by clips during the procedures. Two of nine cases required drainage for pleural effusions; however, all nine cases recovered with conservative treatment and without surgical intervention. At the median follow up of 42 mo after ESD, no cases of local recurrence or distant organ metastasis had been observed. CONCLUSION This study suggests that mucosal deficiency larger than 75% of the luminal circumference is a risk factor for intraoperative perforation during ESD for ESCC. PMID:28210084

  11. [Intestinal microbiocenosis in children with intestinal enzymopathy].

    PubMed

    Kamilova, A T; Akhmedov, N N; Pulatova, D B; Nurmatov, B A

    2001-01-01

    141 children with different kinds of intestinal enzymopathy were examined; of these, 33 had celiac disease, 39--the syndrome of celiac disease, 12--congenital lactase deficiency and 57--the syndrome of disaccharidase insufficiency. In these patients a significant decrease in the average characteristics of the main protective flora and the growth of hemolytic and lactose-negative enterobacteria were established. In all groups of patients increased amounts of Proteus were detected, which was indicative of profound dysbiosis. The content of bifidobacteria was found to be decreased in 89.5-97% of the patients and the content of lactic acid bacteria, in 15.8-33.3%. The decreased content of Escherichia coli with normal enzymatic activity (less than 10(7) colony-forming units) was noted in one-third of the patients with the syndrome of celiac disease and congenital lactase deficiency, in about a half of the patients with the syndrome of disaccharidase insufficiency and least of all in patients with celiac disease (9.1%). The association of opportunistic microbes was detected in 15.6% of the patients, more often in those with celiac disease, the syndrome of celiac disease and congenital lactase deficiency. The severity of disturbances in intestinal eubiosis was found to depend on the gravity of the patients' state.

  12. Gangrene intestine caused by Ascaris lumbricoides; report of 5 cases in children.

    PubMed

    Kawatra, Vibha; Arora, Prerna; Lakshmikantha, Akhila; Varma, Deepali; Khurana, Nita

    2010-05-15

    Ascaris infestation in the gastrointestinal tract is well known in Asian countries. It can be asymptomatic or can present with symptoms of acute abdomen. Perforation and torsion with gangrene are its very rare fatal complications but an important cause of mortality in children. Although ascariasis is very rare in developed countries, clinicians should consider this potentially dangerous, yet treatable, infection in the differential diagnosis of acute abdomen. We herein report a series of five cases of intestinal gangrene secondary to extensive infestation by Ascaris lumbricoides in children aged 1-4 years.

  13. Systemic Inflammation Associated with Severe Intestinal Injury in Extremely Low Gestational Age Newborns

    PubMed Central

    Martin, Camilia R.; Bellomy, Melissa; Allred, Elizabeth N.; Fichorova, Raina N.; Leviton, Alan

    2014-01-01

    To define the role of systemic inflammation in infants with intestinal perforation (IP) and necrotizing enterocolitis (NEC), we measured 25 blood protein concentrations on days 1, 7, and 14 in 939 infants born before 28 weeks’ gestation. On days 7 and 14, infants with NEC had elevated levels of CRP, serum amyloid A (SAA), IL-6, and IL-8. Infants with IP had elevated levels of CRP and insulin growth factor binding protein-1 on day 7 and elevated CRP, SAA, TNF-receptor-2, and matrix metalloproteinase-9 levels on day 14. A better understanding of systemic inflammation might help prevent and treat these disorders. PMID:23002960

  14. Post-stenotic Recirculating Flow May Cause Hemodynamic Perforator Infarction

    PubMed Central

    Kim, Bum Joon; Ha, Hojin; Huh, Hyung Kyu; Kim, Guk Bae; Kim, Jong S.; Kim, Namkug; Lee, Sang-Joon; Kang, Dong-Wha; Kwon, Sun U.

    2016-01-01

    Background and Purpose The primary mechanism underlying paramedian pontine infarction (PPI) is atheroma obliterating the perforators. Here, we encountered a patient with PPI in the post-stenotic area of basilar artery (BA) without a plaque, shown by high-resolution magnetic resonance imaging (HR-MRI). We performed an experiment using a 3D-printed BA model and a particle image velocimetry (PIV) to explore the hemodynamic property of the post-stenotic area and the mechanism of PPI. Methods 3D-model of a BA stenosis was reconstructed with silicone compound using a 3D-printer based on the source image of HR-MRI. Working fluid seeded with fluorescence particles was used and the velocity of those particles was measured horizontally and vertically. Furthermore, microtubules were inserted into the posterior aspect of the model to measure the flow rates of perforators (pre-and post-stenotic areas). The flow rates were compared between the microtubules. Results A recirculating flow was observed from the post-stenotic area in both directions forming a spiral shape. The velocity of the flow in these regions of recirculation was about one-tenth that of the flow in other regions. The location of recirculating flow well corresponded with the area with low-signal intensity at the time-of-flight magnetic resonance angiography and the location of PPI. Finally, the flow rate through the microtubule inserted into the post-stenotic area was significantly decreased comparing to others (P<0.001). Conclusions Perforator infarction may be caused by a hemodynamic mechanism altered by stenosis that induces a recirculation flow. 3D-printed modeling and PIV are helpful understanding the hemodynamics of intracranial stenosis. PMID:26687122

  15. Perforation of the sigmoid colon due to intradiscal spacer dislocation.

    PubMed

    Ruf, Michael; Voigt, Andreas; Kupczyk-Joeris, Dieter; Merk, Harry R

    2011-07-01

    A case of late dislocation of a disc spacer L5/S1 with perforation of the sigmoid colon and transanal passage 4 years after implantation is reported. The objective is to describe an uncommon complication of anterior endoscopic spondylodesis L5/S1. To our knowledge, this is the first report on this rare complication. A 39-year-old patient suffering from a spondylolisthesis L5/S1 (Meyerding grade 2) with bilateral lysis L5 was operated with posterior instrumentation L5/S1 and anterior endoscopic insertion of two disc spacers. 4 years after surgery the patient noticed one of the spacers in the toilet. Radiographic examination of the colon with contrast dye revealed a perforation at the distal sigmoid colon. At the lumbosacral junction there was a bony defect at the site of the absent spacer and an anterior dislocation of the second spacer. A partial resection of the colon at the perforation site with end-to-end anastomosis was performed. The second spacer was removed, and the defect was packed with autologous cancellous bone and local antibiotics. The further course was uneventful. 2 weeks postoperatively the patient was discharged without signs of infection. The radiographic examination after 6 months showed healing of the bone graft with bony fusion L5/S1. In case of incomplete or absent bony fusion the dislocation of intradiscal spacers may arise even years after the primary surgery. In consequence periodical radiographic examinations of spinal instrumentations are recommended until complete bony fusion occurred. Unclear abdominal symptoms following anterior spine surgery require immediate examination.

  16. Acquired perforating dermatosis: a report of 8 cases.

    PubMed

    González-Lara, L; Gómez-Bernal, S; Vázquez-López, F; Vivanco-Allende, B

    2014-01-01

    Acquired perforating dermatosis (APD) is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers. APD affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure. We present 8 cases of APD. Seven patients had concomitant diabetes mellitus with or without chronic renal failure, and 1 had alcoholic cirrhosis. In the patients with chronic renal failure, the onset of APD coincided with transient worsening of renal function. The mean increase in creatinine concentrations above baseline was 1.14mg/dL. Acute deterioration of renal function may be involved in APD. Further studies are needed to investigate this association.

  17. Radiant heat test of Perforated Metal Air Transportable Package (PMATP).

    SciTech Connect

    Gronewald, Patrick James; Oneto, Robert; Mould, John; Pierce, Jim Dwight

    2003-08-01

    A conceptual design for a plutonium air transport package capable of surviving a 'worst case' airplane crash has been developed by Sandia National Laboratories (SNL) for the Japan Nuclear Cycle Development Institute (JNC). A full-scale prototype, designated as the Perforated Metal Air Transport Package (PMATP) was thermally tested in the SNL Radiant Heat Test Facility. This testing, conducted on an undamaged package, simulated a regulation one-hour aviation fuel pool fire test. Finite element thermal predictions compared well with the test results. The package performed as designed, with peak containment package temperatures less than 80 C after exposure to a one-hour test in a 1000 C environment.

  18. Turbulent boundary layer on perforated surfaces with vector injection

    NASA Astrophysics Data System (ADS)

    Eroshenko, V. M.; Zaichik, L. I.; Klimov, A. A.; Ianovskii, L. S.; Kondratev, V. I.

    1980-10-01

    The paper presents an experimental investigation of a turbulent boundary layer on perforated plates with uniform vector injection at various angles to gas flow. It was shown that with strong injection at angles oriented in the flow direction the intensity of turbulent pulsation is decreased, while injection at angles in the opposite direction increase the intensity. A relationship was established between the critical parameters of the boundary layer injection angles; it was concluded that the asymptotic theory of Kutateladze and Leontiev can be used for determining the coefficient of friction of vector injection.

  19. [Perforation of the appendix and observation of Enterobius vermicularis].

    PubMed

    Schou-Jensen, Katrine; Antipina, Elena Nikolaevna; Brisling, Steffen Kirstein; Azawi, Nessn

    2014-12-15

    A nine-year-old girl was admitted to the paediatric ward due to fever and lower abdomen pain through a day. Acute laparoscopic exploration showed a large necrotic perforation at the distal end of the appendix. During the appendectomy multiple small, live Enterobius vermicularis (pinworms) were observed. The patient was admitted for three days of observation and received relevant treatment with intravenous antibiotics and antihelminthic treatment. The histology showed numerous pinworms in the lumen of the appendix and invasion of the pinworms of the submucosal layer and the wall of the appendix.

  20. [Stomach perforation: an unusual complication of gastric bezoars].

    PubMed

    Hani, Mohamed Aziz; Guesmi, Fethi; Bouasker, Ibtissem; Zoghlami, Ayoub; Najah, Nabil

    2003-05-01

    Bezoars are concretions of stagnant swallowed material in digestive tract. The most frequent are trichobezoars made of hair and phytobezoars composed of undigestible fruits and vegetables fibers. We report a case of a 24-year-old female patient who presented in emergency with an acute peritonitis due to a gastric perforation on bezoars. Gastrotomy, extraction of bezoars, gastric stitching and peritoneal lavage were performed. Post operative period was uneventful. A new careful interrogation into the patient's previous habits found glue-eating custom during the four last years.

  1. Pyometra Perforation Caused by Actinomyces without Intrauterine Device Involvement

    PubMed Central

    2013-01-01

    An 86-year-old woman with diabetes mellitus and severe decubitus at the sacral and calcaneal regions stemming from poor daily activity was diagnosed with pyometra perforation caused by Actinomyces. No foreign materials, including an IUD, were found inside the uterus. Pyometra is usually caused by Enterobacteriaceae or anaerobes derived from the gastrointestinal tract. The virulence of Actinomyces is rather low, and, in almost all the reported cases of Actinomyces-related pyometra, an intrauterine device (IUD) was involved. Although rare, Actinomyces may be ascribed as a virulent pathogen that causes pyometra in the absence of foreign materials. PMID:23762685

  2. Pyometra Perforation Caused by Actinomyces without Intrauterine Device Involvement.

    PubMed

    Hagiya, Hideharu

    2013-01-01

    An 86-year-old woman with diabetes mellitus and severe decubitus at the sacral and calcaneal regions stemming from poor daily activity was diagnosed with pyometra perforation caused by Actinomyces. No foreign materials, including an IUD, were found inside the uterus. Pyometra is usually caused by Enterobacteriaceae or anaerobes derived from the gastrointestinal tract. The virulence of Actinomyces is rather low, and, in almost all the reported cases of Actinomyces-related pyometra, an intrauterine device (IUD) was involved. Although rare, Actinomyces may be ascribed as a virulent pathogen that causes pyometra in the absence of foreign materials.

  3. [Acute Meckel's diverticulitis perforated by a foreign body].

    PubMed

    Pahomeanu, M; Anghelide, A; Mandache, F

    1976-01-01

    The authors present the case of a patient with acute, right iliac fossa abdominal syndrome, simulating acute apendicitis. In the course of the intervention it was noted that the syndrome was determined by an acute Meckel diverticulitis, perforated by a foreign body (fish bone). In view of making the diagnosis of acute diverticulitis, that cannot be assessed before surgery, the importance is stressed of the correlation of the clinical aspects with the apendicular lesions found in the course of the operation, and, when there is no satisfactory concordance, careful checking of the cecum becomes necessary, as well as of the right annexe and of the ileon over at least three feet.

  4. Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection

    PubMed Central

    Suzuki, Haruhisa; Oda, Ichiro; Sekiguchi, Masau; Abe, Seiichiro; Nonaka, Satoru; Yoshinaga, Shigetaka; Nakajima, Takeshi; Saito, Yutaka

    2015-01-01

    AIM: To identify the actual clinical management and associated factors of delayed perforation after gastric endoscopic submucosal dissection (ESD). METHODS: A total of 4943 early gastric cancer (EGC) patients underwent ESD at our hospital between January 1999 and June 2012. We retrospectively assessed the actual management of delayed perforation. In addition, to determine the factors associated with delayed perforation, after excluding 123 EGC patients with perforations that occurred during the ESD procedure, we analyzed the following clinicopathological factors among the remaining 4820 EGC patients by comparing the ESD cases with delayed perforation and the ESD cases without perforation: age, sex, chronological periods, clinical indications for ESD, status of the stomach, location, gastric circumference, tumor size, invasion depth, presence/absence of ulceration, histological type, type of resection, and procedure time. RESULTS: Delayed perforation occurred in 7 (0.1%) cases. The median time until the occurrence of delayed perforation was 11 h (range, 6-172 h). Three (43%) of the 7 cases required emergency surgery, while four were conservatively managed without surgical intervention. Among the 4 cases with conservative management, 2 were successfully managed endoscopically using the endoloop-endoclip technique. The median hospital stay was 18 d (range, 15-45 d). There were no delayed perforation-related deaths. Based on a multivariate analysis, gastric tube cases (OR = 11.0; 95%CI: 1.7-73.3; P = 0.013) were significantly associated with delayed perforation. CONCLUSION: Endoscopists must be aware of not only the identified factors associated with delayed perforation, but also how to treat this complication effectively and promptly. PMID:26640340

  5. Use and accuracy of computed tomography scan in diagnosing perforated appendicitis.

    PubMed

    Verma, Richa; Grechushkin, Vadim; Carter, Dorothy; Barish, Matthew; Pryor, Aurora; Telem, Dana

    2015-04-01

    Perforated appendicitis has major implications on patient care. The ability of computed tomography (CT) scan to distinguish perforation in the absence of phlegmon or abscess is unknown. The purpose of this study is to assess the use and accuracy of CT scans in diagnosing perforated appendicitis without phlegmon or abscess. A retrospective chart review of 102 patients who underwent appendectomy from 2011 to 2013 was performed. Patient demographics and operative and postoperative course were recorded. Two radiologists were then blinded to operative findings and CT scans reread and results correlated. Findings on CT scan were also analyzed for correlation with perforation. Univariate and multivariate statistical analysis was performed. Of the 102 patients, 49 were perforated and 53 nonperforated. Analysis of patient populations demonstrated patients with perforation were significantly older (45 vs 34 years, P = 0.002), had longer operative times (132 vs 81 minutes, P = 0.001), and longer length of stay (8.2 vs 1.5 days, P < 0.001). Nineteen perforations (37%) were correctly diagnosed by CT scan. The sensitivity of CT scan to detect perforation was 38 per cent, specificity 96 per cent, and positive predictive value of 90 per cent. After multivariate analysis of significant variables, three were demonstrated to significantly correlate with presence of perforation: presence of extraluminal air (odds ratio [OR], 28.9; P = 0.02); presence of intraluminal fecalith (OR, 5.7; P = 0.03); and wall thickness greater than 3 mm (OR, 3.2; P = 0.02). CT scan has a low sensitivity for diagnosing perforated appendicitis without abscess or phlegmon. Presence of extraluminal air bubbles, increased wall thickness, and intraluminal fecalith should increase suspicion for perforation and are highly correlated with outcomes after appendectomy.

  6. Impact of the calf perforators on the venous hemodynamics in primary varicose veins.

    PubMed

    Recek, C

    2006-12-01

    The hemodynamic significance of the calf perforating veins continues to be the point of controversy. The conception that incompetent perforating veins cause hemodynamic disturbance and are responsible for the formation of leg ulceration has still many adherents prefering perforator surgery, whereas others reject any causal relation between large, incompetent perforators and severe forms of chronic venous insufficiency. In this study well documented facts concerning the impact of the calf perforators on the venous hemodynamics are reviewed. There is a bidirectional flow within calf perforators in healthy subjects enabling a quick equilibration of pressure changes produced during calf muscle contractions and relaxations, so that recordings of the mean pressure display identical values in superficial and deep veins of the lower leg, a feature typical of conjoined vessels. In cases with saphenous reflux, the bidirectional flow within calf perforators has a distinct inward vector directed to the deep veins; this inward component is the more pronounced, the larger the saphenous reflux is. Incompetent calf perforators do not cause ambulatory venous hypertension, exactly the opposite happens: the high hydrostatic pressure found in the quiet standing position drops significantly during ambulation, as soon as the saphenous reflux is interrupted. In primary varicose veins calf perforators can not become the source of reflux because they are situated at the lower pole of the ambulatory pressure gradient, which occurs between thigh and lower leg veins during ambulation. The size of the calf perforators is determined by the amount of saphenous reflux. When the saphenous reflux is abolished (e.g. by high ligation), the enlarged calf perforators diminish.

  7. Intestinal metaplasia of appendiceal endometriosis is not uncommon and may mimic appendiceal mucinous neoplasm.

    PubMed

    Vyas, Monika; Wong, Serena; Zhang, Xuchen

    2017-01-01

    Endometriosis of the appendix can be an incidental finding or a cause of appendicitis, intussusception, perforation or retention mucocele. Intestinal metaplasia of appendiceal endometriosis may occur, which can lead to a misdiagnosis of low-grade appendiceal mucinous neoplasm. On a retrospective search of the pathology database from 2001 to 2015, we identified 78 appendiceal endometriosis cases and intestinal metaplasia was present in 10/78 (13%) cases. In most of the cases (90%), the foci of intestinal metaplasia were mainly localized close to the mucosa. Intestinal and endometrial hybrid glands were present in 9/10 (90%) cases. These cases were often associated with marked appendiceal distortion, luminal obliteration and mass formation, causing concern for a mucinous neoplasm clinically and pathologically. Our findings indicate that intestinal metaplasia in appendiceal endometriosis is not an uncommon phenomenon, which can be mistaken for a mucinous neoplasm. Endometriosis should be kept in mind when a diagnosis of appendiceal mucinous neoplasm is made, especially in a young woman with a clinical history of endometriosis.

  8. Use of T-Tube Enterostomy in Neonatal Gastro-intestinal Surgery.

    PubMed

    Al-Zaiem, Maher; Al-Garni, Abdulhai F; Al-Maghrebi, Abdulrahman; Asghar, Asim A

    2016-01-01

    Aim: To evaluate the results of the use of the T-tube ileostomy in neonatal intestinal surgery cases. Materials and Methods: A retrospective review of sixty two neonates underwent intestinal obstruction surgery by using T-tube ileostomy was conducted between January 1990 and January 2013.The pathologies of the intestinal obstruction were; thirty four of jejunoileal atresia cases, thirteen case meconium ileus, eight cases perforated necrotizing enterocolitis (NEC), three cases meconium peritonitis, three cases with bowel resection due to intestinal volvulus, and one case of gastroschisis. Results: Mean duration of T-tube placement was 13 days (range9-20days) and the sites of T-tube insertion closed spontaneously in 2 days (range 1-4 days). The mean duration for starting oral intake postoperatively in these patients was 9 days (6-16 days). All patients well tolerated the procedure and there were no serious complications related to the T-tube insertion. However, four patients died due to other reasons like sepsis, respiratory failure and prematurity. Conclusion: T-tube enterostomy is an effective and safe technique for treatment of selected cases of neonatal intestinal surgery. It showed less morbidity and mortality rates than the conventional stoma. Therefore, it is considered a helpful approach in cases where there is danger of hypoperistaltic dilated bowel proximal to the anastomosis.

  9. The Role of Muscle Flaps for Salvage of Failed Perforator Free Flaps

    PubMed Central

    2015-01-01

    Background: Despite the most heroic efforts, sometimes free flaps fail. Perforator free flaps are not invincible and can suffer the same fate. The real challenge is how to decide what is the next best choice for achieving the desired outcome. Methods: Over the past decade, 298 free perforator flaps were used in our institution. Total failure occurred in 16 patients, and partial failure requiring a second free flap occurred in an additional 6 patients for a true success rate of 93%. All failures had some form of secondary vascularized tissue transfer, which included the use of muscle flaps in 9 (41%) different patients. Results: Initial flap salvage after a failed perforator free flap was attempted with 12 perforator and 5 muscle free flaps as well as 1 perforator and 2 muscle local flaps. These were not all successful, with loss of 3 muscle free flaps and 3 perforator flaps. Tertiary free flap coverage was successful in 3 cases using 2 muscle flaps and 1 perforator free flap. Local fasciocutaneous flaps or primary wound closure was used in the remaining individuals. Conclusions: Microsurgical tissue transfers can be the most rewarding and at the same time the most challenging reconstructive endeavor. Persistence in achieving the desired outcome can require multiple steps. Perforator flaps are an important asset to obtain this goal. However, muscle flaps can still be a useful alternative, and the message is that they should not be overlooked as sometimes a viable option. PMID:26893989

  10. Delayed right ventricular defibrillation lead perforation presenting as cardiac tamponade and treated surgically.

    PubMed

    Noguchi, Masahiko; Nakai, Toshiko; Kawano, Yuji; Shibayama, Kentaro; Obunai, Kotaro; Tabata, Minoru; Watanabe, Hiroyuki

    2017-04-01

    Right ventricular perforation leading to cardiac tamponade can occur during the chronic phase after cardiac device implantation. Physicians who manage the pacemaker clinic must be alert to the wide range of symptoms and signs that can accompany delayed right ventricular perforation. Surgical rather than percutaneous lead extraction may be prudent.

  11. Double esophageal perforation by ingested foreign body: Endoscopic and surgical approach. A case report.

    PubMed Central

    Ugenti, I.; Digennaro, R.; Martines, G.; Caputi Iambrenghi, O.

    2015-01-01

    Introduction Esophageal perforation in adults is most frequently caused by ingested foreign bodies. They can migrate through the esophageal wall, damaging the nearby organs such as the aorta or the trachea, with fatal outcome. After the diagnosis, the viable treatments for extracting the foreign body and repairing the perforation are several. The appropriate treatment, may be endoscopic, surgical or combined, depending on the level of the perforation, on the co-morbidities of the patient and on the available resources. Presentation of case This paper describes a case of a 68 years old patient with a double EP caused by a meat-bone that perforated the thoracic esophageal wall, approaching the aorta on the left side and the azygos vein on the right side. Discussion Because of the double transfixion and the position near the aorta and the azygos, it was not possible to remove safely the bone during the endoscopy. The management required a combined endoscopic and surgical approach. This way it was possible to detect easily the location of the perforation, to remove safely the foreign body, to repair the perforation both from the outside and from the inside, and to place the nasogastric tube under direct vision. Conclusion Even when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision. PMID:26551553

  12. Transepidermal elimination of urate-like crystals: a new perforating disorder?

    PubMed

    Lucke, T W; Fallowfield, M E; Evans, A; Lowe, J G; MacKie, R M

    1999-08-01

    We report two men who developed a transient perforating disorder characterized by transepidermal elimination of negatively birefringent needle-shaped crystals similar to monosodium urate. This striking clinical presentation has not previously been described and we propose that it be added to the group of diseases known as the primary perforating disorders.

  13. Stercoral perforation of the colon in sigmoid colostomy patients: Two case reports☆

    PubMed Central

    Kim, Young Wan; Kwon, Hyun Jun; Kim, Ik Yong

    2013-01-01

    INTRODUCTION Stercoral perforation of the colon has rarely been reported. Only 3 cases of stercoral perforation of the colon proximal to an end colostomy have been reported. We present two cases of stercoral perforation of the colon in end colostomy patients. PRESENTATION OF CASE A 70-year-old man who had undergone abdomino-perineal excision for anal cancer was referred for left lower quadrant pain and fever. Stercoral perforation was discovered along the distal descending colon, proximal to the end sigmoid colostomy. The patient underwent segmental resection of the colon and revision of the stoma and was discharged on postoperative day 32. A 71-year-old woman who had undergone abdomino-perineal excision for distal rectal cancer with preoperative chemoradiation presented fever with 2 days of low abdominal pain. The patient had sacral bone and lung metastases from rectal cancer and suffered from chronic constipation. Stercoral perforation was found around the sigmoid colon, just proximal to the end sigmoid colostomy. The patient underwent simple repair of the perforated colon through the parastomal incision. On postoperative day 8, leakage occurred at the repair site. Segmental resection of the colon and revision of the stoma were performed. She was discharged 44 days after the initial surgery. DISCUSSION Segmental resection of the perforated colon, rather than simple repair, appears to improve postoperative outcomes. CONCLUSION As the number of cancer survivors increases, appropriate management of constipation is important to prevent stercoral perforation during follow-up. PMID:24121050

  14. Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients.

    PubMed

    Song, Jin Woo; Ben-Nakhi, Muneera; Hong, Joon Pio

    2012-11-01

    Pediatric reconstruction using microsurgery is accepted normal practice, and the use of perforator flaps is slowly increasing. This study presents clinical work using various perforator free flaps by free style approach to reconstruct lower extremity soft tissue defects in pediatric patients and evaluates its efficacy. Between June 2002 and February 2011, 32 cases (mean age: 10.1 years) were reconstructed with free style perforator free flaps. Retrospective evaluations for flap survival, growth character, and other associated morbidities were performed. Flaps used in this series are anterolateral thigh (ALT) perforator, superficial circumflex iliac artery perforator (SCIP), upper medial thigh perforator, and posterior interosseous perforator free flaps. The free style approach for pedicle dissection was successful in all cases. Early postoperative complications were 15.6% from hematoma collection to partial loss of flap. Although there was no total loss in this series, one case needed additional flap coverage to cover the partial loss of the flap. The long-term follow-up showed contracture along the margin, with 16% needing a releasing procedure. Bone growth was not affected by flap contracture. The overall results show perforator flaps using the free style approach to be a reliable and feasible approach for lower extremity reconstruction in the pediatric population.

  15. Thylakoid membrane perforations and connectivity enable intracellular traffic in cyanobacteria

    PubMed Central

    Nevo, Reinat; Charuvi, Dana; Shimoni, Eyal; Schwarz, Rakefet; Kaplan, Aaron; Ohad, Itzhak; Reich, Ziv

    2007-01-01

    Cyanobacteria, the progenitors of plant and algal chloroplasts, enabled aerobic life on earth by introducing oxygenic photosynthesis. In most cyanobacteria, the photosynthetic membranes are arranged in multiple, seemingly disconnected, concentric shells. In such an arrangement, it is unclear how intracellular trafficking proceeds and how different layers of the photosynthetic membranes communicate with each other to maintain photosynthetic homeostasis. Using electron microscope tomography, we show that the photosynthetic membranes of two distantly related cyanobacterial species contain multiple perforations. These perforations, which are filled with particles of different sizes including ribosomes, glycogen granules and lipid bodies, allow for traffic throughout the cell. In addition, different layers of the photosynthetic membranes are joined together by internal bridges formed by branching and fusion of the membranes. The result is a highly connected network, similar to that of higher-plant chloroplasts, allowing water-soluble and lipid-soluble molecules to diffuse through the entire membrane network. Notably, we observed intracellular membrane-bounded vesicles, which were frequently fused to the photosynthetic membranes and may play a role in transport to these membranes. PMID:17304210

  16. Thylakoid membrane perforations and connectivity enable intracellular traffic in cyanobacteria.

    PubMed

    Nevo, Reinat; Charuvi, Dana; Shimoni, Eyal; Schwarz, Rakefet; Kaplan, Aaron; Ohad, Itzhak; Reich, Ziv

    2007-03-07

    Cyanobacteria, the progenitors of plant and algal chloroplasts, enabled aerobic life on earth by introducing oxygenic photosynthesis. In most cyanobacteria, the photosynthetic membranes are arranged in multiple, seemingly disconnected, concentric shells. In such an arrangement, it is unclear how intracellular trafficking proceeds and how different layers of the photosynthetic membranes communicate with each other to maintain photosynthetic homeostasis. Using electron microscope tomography, we show that the photosynthetic membranes of two distantly related cyanobacterial species contain multiple perforations. These perforations, which are filled with particles of different sizes including ribosomes, glycogen granules and lipid bodies, allow for traffic throughout the cell. In addition, different layers of the photosynthetic membranes are joined together by internal bridges formed by branching and fusion of the membranes. The result is a highly connected network, similar to that of higher-plant chloroplasts, allowing water-soluble and lipid-soluble molecules to diffuse through the entire membrane network. Notably, we observed intracellular membrane-bounded vesicles, which were frequently fused to the photosynthetic membranes and may play a role in transport to these membranes.

  17. Perforated Pit Membranes in Imperforate Tracheary Elements of Some Angiosperms

    PubMed Central

    SANO, YUZOU; JANSEN, STEVEN

    2006-01-01

    • Background and Aims The structure of pit membranes in angiosperms has not been fully examined and our understanding about the structure is incomplete. Therefore, this study aims to illustrate the micromorphology of pit membranes in fibres and tracheids of woody species from various families. • Methods Specimens from ten species from ten genera and eight families were prepared using two techniques and examined by field-emission scanning electron microscopy. • Key Results Interfibre pit membranes with an average diameter of <4 µm were frequently perforated or appeared to be very porous. In contrast, pit membranes in imperforate tracheary elements with distinctly bordered pits and an average diameter of ≥4 µm were homogeneous and densely packed with microfibrils. These differences were observed consistently not only among species but also within a single species in which different types of imperforate tracheary elements were present. • Conclusions This study demonstrates that the structure of interfibre pit membranes differs among cell types and the differences are closely associated with the specialization of the fibre cells. It is suggested that perforated pit membranes between specialized fibres contribute to the dehydration of the fibre cells at or soon after maturation. PMID:16520339

  18. Simulation of air velocity in a vertical perforated air distributor

    NASA Astrophysics Data System (ADS)

    Ngu, T. N. W.; Chu, C. M.; Janaun, J. A.

    2016-06-01

    Perforated pipes are utilized to divide a fluid flow into several smaller streams. Uniform flow distribution requirement is of great concern in engineering applications because it has significant influence on the performance of fluidic devices. For industrial applications, it is crucial to provide a uniform velocity distribution through orifices. In this research, flow distribution patterns of a closed-end multiple outlet pipe standing vertically for air delivery in the horizontal direction was simulated. Computational Fluid Dynamics (CFD), a tool of research for enhancing and understanding design was used as the simulator and the drawing software SolidWorks was used for geometry setup. The main purpose of this work is to establish the influence of size of orifices, intervals between outlets, and the length of tube in order to attain uniformity of exit flows through a multi outlet perforated tube. However, due to the gravitational effect, the compactness of paddy increases gradually from top to bottom of dryer, uniform flow pattern was aimed for top orifices and larger flow for bottom orifices.

  19. Endoscopic modalities for upper gastrointestinal leaks, fistulae and perforations

    PubMed Central

    Yee, Gary; Saxena, Payal

    2015-01-01

    Abstract Background Endotherapy techniques are a recent addition to the suite of non‐surgical and minimally invasive strategies to manage patients with perforations, leaks and fistulae. The emergency nature of these conditions and the heterogeneity of pathologies encountered create difficulties when trying to select appropriate tools in these complex situations. The purpose of this article is to review experience at a tertiary academic centre, describe the various endoscopic tools available and the situations where they can be considered for use. Methods Single‐centre series and review of the published literature. Results Of 64 patients, 57 were successfully treated using endoscopic therapy, with surgery used only to provide drainage and suture fully covered metal stents in place to prevent migration. Discussion Selection of an appropriate endotherapy or stent for a patient with an oesophago‐gastric perforation or fistula requires an understanding of the anatomy and physiology underlying the patient's presentation and an understanding of the strengths and weaknesses of the available methods. Standard surgical principles of drainage, avoidance of distal obstruction and nutrition remain central to successful outcomes. A combination of surgical and endoscopic treatments may reduce the number of required treatments and can provide the ability to anchor fully covered stents to prevent them from migrating. PMID:26525773

  20. Perforating oesophageal carcinoma presenting as necrotizing fasciitis of the neck.

    PubMed

    Francque, S M; Van Laer, C; Struyf, N; Vermeulen, P; Corthouts, B; Jorens, P G

    2001-10-01

    A patient with a history of schizophrenia was admitted to our hospital in an already severe stage of necrotizing fasciitis of the neck, complicated with mediastinitis and gangrene. Later on, he also developed a vena cava superior syndrome and sepsis. In the few cases and small series described in the literature, necrotizing fasciitis of the neck is usually associated with surgery or trauma. Less frequently, an orodental or pharyngeal infection, often innocuous, is the underlying cause. None of these causes could be identified in our patient. Initially, on computer-assisted tomography (CT) scan, a tracheal rupture was suspected, but this diagnosis could not be confirmed on bronchoscopic examination. On gastroscopy, a stenotic oesophageal segment was discovered. Biopsy of this segment showed a poorly differentiated squamous cell carcinoma. The patient died in sepsis. Autopsy confirmed the presence of a large proximal oesophageal tumour with perforation. As far as we know, no case of a necrotizing fasciitis of the neck caused by perforation of a formerly unknown oesophageal carcinoma has been reported. Even mediastinitis, with or without gangrene, is rarely associated with oesophageal cancer, and in the few cases reported it is always due to fistulization after surgery.

  1. Intraoperative esophageal Doppler hemodynamic monitoring in free perforator flap surgery.

    PubMed

    Figus, Andrea; Wade, Ryckie G; Oakey, Stephen; Ramakrishnan, Venkat V

    2013-03-01

    Goal-directed fluid therapy optimizes cardiac output and flap perfusion during anesthesia. Intraoperative esophageal Doppler (ED) monitoring has been reported as more accurate and reliable, demonstrating improved surgical outcomes compared with central venous pressure and arterial catheter monitoring. A prospective study of patients undergoing free perforator (deep inferior epigastric artery perforator/anterolateral thigh) flap surgery with intraoperative ED monitoring (51 patients) or central venous pressure monitoring (53 patients) was undertaken. Fluid input included crystalloids, colloids, or blood products. Fluid output included urine, blood, or suctioned fluid. Postoperative fluid balance was calculated as fluid input - output. Fluid input between groups was not different. Fluid output was greater in the ED group (P = 0.008). The ED group showed less fluid balance (P = 0.023), less anesthetic time (P = 0.001), less hospital stay (mean 1.9 days; P = 0.147), less monitoring and flap complications (P = 0.062). ED monitoring demonstrated no monitoring complications, provides a favorable postoperative fluid balance, and may reduce flap complications and hospital stay.

  2. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

    PubMed Central

    Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kajiyama, Kiyoshi; Nakamura, Kazuhiko

    2014-01-01

    AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were

  3. Infectious keratitis with corneal perforation associated with corneal hydrops and contact lens wear in keratoconus.

    PubMed Central

    Donnenfeld, E D; Schrier, A; Perry, H D; Ingraham, H J; Lasonde, R; Epstein, A; Farber, B

    1996-01-01

    BACKGROUND: Corneal perforation is an uncommon complication associated with keratoconus. The first cases of infectious keratitis and corneal perforation associated with corneal hydrops and contact lens wear are reported in two keratoconus patients. METHODS: A retrospective chart review and histopathological examination were carried out. RESULTS: Both patients progressed to corneal perforation and emergency penetrating keratoplasty. One patient cultured Fusarium and the second patient Serratia marcesens. Both patients wore contact lenses against medical advice. CONCLUSIONS: The tear in Descement's membrane, stromal oedema, and epithelial bedewing associated with corneal hydrops results in loss of the epithelial-endothelial barrier of the cornea, creating a conduit for infectious organisms through the cornea. Acute hydrops associated with epithelial keratitis, stromal swelling, and a Descement's membrane tear may be a significant risk factor for infectious keratitis and corneal perforation. Contact lenses should not be worn during an active corneal hydrops owing to the increased risk for severe infectious keratitis and corneal perforation. Images PMID:8695560

  4. Sealing Ability of MTA Used in Perforation Repair of Permanent Teeth; Literature Review

    PubMed Central

    Baroudi, Kusai; Samir, Samah

    2016-01-01

    There were several materials used to seal different types of perforation defects. MTA is one of these restorative materials that is considered the most effective, biocompatible, non-toxic, and non-irritant; promote bone healing and cementum regeneration. The objective of this article was to review and summarize the sealing ability of MTA compared with the other materials used for sealing different types of root perforations of permanent teeth. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2005 to 2015 searching for articles related to sealing ability of MTA. This study found that factors affecting prognosis are the size, site of the perforation and time elapsed as well as the repair material. MTA is an important filling material to be used for sealing different types of perforations when perforated sites sealed immediately with MTA. PMID:27347231

  5. Effect of sinus membrane perforation on dental implant integration: a retrospective study on 128 patients.

    PubMed

    Oh, Eric; Kraut, Richard A

    2011-02-01

    A common complication of sinus augmentation is perforation of the sinus membrane during augmentation and/or implant placement. This retrospective study examines the effect of sinus membrane perforation with regard to graft survival and implant integration. A total of 175 sinuses were augmented with 115 of the membranes being reported intact at the time of surgery. A total of three infections occurred in patients who sustained perforated sinuses and one infection occurred in a patient who had an intact sinus. All four infections resolved after culture sensitivity and placement of the patient on an appropriate antibiotic for 10 days. Of 438 dental implants placed in the augmented sinuses, five implants failed, four of which were associated with perforated sinuses and and which was not associated with a perforated grafted sinus.

  6. Perforation in a patient with stercoral colitis and diverticulosis: who did it?

    PubMed Central

    Bhatt, Vijaya R.; Murukutla, Srujitha; DiPoce, Jason; Gustafson, Steven; Sarkany, David; Mody, Kokila; Widmann, Warren D.; Gottesman, Aaron

    2014-01-01

    Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment. PMID:24596650

  7. Iatrogenic oesophageal perforation during placement of an endoscopic vacuum therapy device.

    PubMed

    Halliday, Edwin; Patel, Anant; Hindmarsh, Andrew; Sujendran, Vijay

    2016-07-28

    Endoscopic vacuum-assisted closure (VAC) is increasingly being used as a means of managing perforations or anastomotic leaks of the upper gastrointestinal (GI) tract. Published outcomes are favourable, with few mentions of complications or morbidity. We present a case in which the management of a gastric perforation with endoscopic vacuum therapy was complicated by cervical oesophageal perforation. The case highlights the risks of such endoscopic therapeutic procedures and is the first report in the literature to describe significant visceral injury during placement of a VAC device for upper GI perforation. Iatrogenic oesophageal perforation is an inherent risk to upper GI endoscopy and the risk increases in therapeutic endoscopic procedures. Complications may be reduced by management under a multidisciplinary team in a centre with specialist upper GI services. There is no doubt that the endoscopic VAC approach is becoming established practice, and training in its use must reflect its increasingly widespread adoption.

  8. Sealing Ability of MTA Used in Perforation Repair of Permanent Teeth; Literature Review.

    PubMed

    Baroudi, Kusai; Samir, Samah

    2016-01-01

    There were several materials used to seal different types of perforation defects. MTA is one of these restorative materials that is considered the most effective, biocompatible, non-toxic, and non-irritant; promote bone healing and cementum regeneration. The objective of this article was to review and summarize the sealing ability of MTA compared with the other materials used for sealing different types of root perforations of permanent teeth. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2005 to 2015 searching for articles related to sealing ability of MTA. This study found that factors affecting prognosis are the size, site of the perforation and time elapsed as well as the repair material. MTA is an important filling material to be used for sealing different types of perforations when perforated sites sealed immediately with MTA.

  9. Shape-based 3D vascular tree extraction for perforator flaps

    NASA Astrophysics Data System (ADS)

    Wen, Quan; Gao, Jean

    2005-04-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.

  10. Evaluation of flow characteristics of perforations including nonlinear effects with the finite-element method

    SciTech Connect

    Tariq, S.M.

    1987-05-01

    This study presents results of finite-element modeling of steady-state flow in perforated natural completions. Use of a mesh chosen carefully by grid sensitivity analysis permits evaluation of flow with more precision than that achieved by previous investigators. Also, for the first time, flow characteristics of perforated completions are evaluated with the non-Darcy effect resulting form converging flow around the perforation taken into account. The results indicate confirmation of Locke's results qualitatively but 5 to 10% overprediction by the nomograph, the importance of angular phasing between adjacent perforations, the uncertainty in generally accepted severe permeability impairment in the compacted zone, and a significant reduction in productivity owing to a non-Darcy effect around the perforation for high-rate gas wells.

  11. Evaluation of flow characteristics of perforations including nonlinear effects using finite-element method

    SciTech Connect

    Tariq, S.M.

    1984-04-01

    This study presents results of finite element modelling of steady-state flow in perforated natural completions. Use of a carefully chosen mesh based on grid sensitivity analysis permits evaluation of flow with more precision than achieved by previous investigators. Also, for the first time, evaluation of flow characterstics of perforated completion is made taking into account the non-Darcy effect due to converging flow around the perforation. The results indicate: (1) confirmation of Locke's findings qualitatively but 5-10% overprediction by the nomograph (2) importance of angular phasing between adjacent perforations, (3) untenability of generally accepted severe permeability impairment in the compacted zone, and (4) significant reduction in productivity due to non-Darcy effect around the perforation for high-rate wells.

  12. Unusual intestinal talcosis.

    PubMed

    Anani, P A; Ribaux, C; Gardiol, D

    1987-11-01

    A case of intestinal talcosis in a 46-year-old man is reported. At the age of 27, the patient was treated for pulmonary tuberculosis with tablets containing talc (183 g talc per 2,670 g total drug intake) over a period of 28 months. Eighteen years later, the patient was hospitalized for abdominal pain that remained refractory to antacids; he subsequently underwent a right hemicolectomy. Light-microscopic examination revealed a prominent fibrosis of the intestinal wall in which birefringent particles were demonstrated by polarized light. Using energy-dispersive spectroscopy, an analysis of these particles showed that they were predominantly composed of silicon and magnesium as well as small amounts of phosphorus, sulphur, calcium, and iron--the spectrum typically associated with talc. We believe that the source of this talc is the tablets ingested by the patient during prior antituberculosis therapy.

  13. Cloacolithiasis and intestinal lymphosarcoma in an African black-footed penguin (Spheniscus demersus).

    PubMed

    Jones, Krista L; Field, Cara L; Stedman, Nancy L; MacLean, Robert A

    2014-06-01

    A 13-yr-old male African black-footed penguin (Spheniscus demersus) presented thrice over 7 mo with gastrointestinal obstruction secondary to cloacolithiasis. Clinical signs consistently resolved with cloacolith removal and supportive care. However, 10 mo after initial presentation, it presented with similar signs, plus significant weight loss. No cloacolith was found, and it subsequently died. Significant gross findings included bilateral cecal masses, colonic perforation, and marked secondary coelomitis, multifocal tan to pale hepatic nodules, and pale kidneys with miliary white foci. Histopathologic diagnoses were intestinal lymphosarcoma with hepatic and renal metastases, secondary intestinal rupture, and subacute severe bacterial coelomitis. To the authors' knowledge, this is the first full report of either cloacolithiasis or lymphosarcoma in a penguin.

  14. [Drug-induced enterocolitis. Important differential diagnosis in the investigation of diarrhea and intestinal hemorrhage].

    PubMed

    Tysk, C

    2000-05-24

    This article is a review of the side-effects of drugs affecting the small and large intestines. Pseudomembranous colitis is caused by antibiotics facilitating an overgrowth of Clostridium difficile. A hemorrhagic colitis, generally self-limiting, can be caused by penicillin, amoxycillin and ampicillin. Toxicity of NSAID may induce intestinal ulcers, diaphragm-like strictures, perforation, colitis and relapse of inflammatory bowel disease. Drug-induced lymphocytic colitis has been reported due to ticlopidine, Cyclo 3 Fort, and occasionally by ranitidine, carbamazepine, vinburnine, tardyferon, and flutamide. Sulphasalazine and 5-ASA can cause relapse of ulcerative colitis. Neutropenic enterocolitis is a severe complication to cytotoxic therapy for cancer. Ischemic colitis can be caused by drugs inducing mesenteric vasoconstriction.

  15. Elenoside increases intestinal motility

    PubMed Central

    Navarro, E; Alonso, SJ; Navarro, R; Trujillo, J; Jorge, E

    2006-01-01

    AIM: To study the effects of elenoside, an arylnaph-thalene lignan from Justicia hyssopifolia, on gastro-intestinal motility in vivo and in vitro in rats. METHODS: Routine in vivo experimental assessments were catharsis index, water percentage of boluses, intestinal transit, and codeine antagonism. The groups included were vehicle control (propylene glycol-ethanol-plant oil-tween 80), elenoside (i.p. 25 and 50 mg/kg), cisapride (i.p. 10 mg/kg), and codeine phosphate (intragastric route, 50 mg/kg). In vitro approaches used isolated rat intestinal tissues (duodenum, jejunum, and ileum). The effects of elenoside at concentrations of 3.2 x 10-4, 6.4 x 10-4 and 1.2 x 10-3 mol/L, and cisapride at 10-6 mol/L were investigated. RESULTS: Elenoside in vivo produced an increase in the catharsis index and water percentage of boluses and in the percentage of distance traveled by a suspension of activated charcoal. Codeine phosphate antagonized the effect of 25 mg/kg of elenoside. In vitro, elenoside in duodenum, jejunum and ileum produced an initial decrease in the contraction force followed by an increase. Elenoside resulted in decreased intestinal frequency in duodenum, jejunum, and ileum. The in vitro and in vivo effects of elenoside were similar to those produced by cisapride. CONCLUSION: Elenoside is a lignan with an action similar to that of purgative and prokinetics drugs. Elenoside, could be an alternative to cisapride in treatment of gastrointestinal diseases as well as a preventive therapy for the undesirable gastrointestinal effects produced by opioids used for mild to moderate pain. PMID:17131476

  16. Role of uterine forces in intrauterine device embedment, perforation, and expulsion

    PubMed Central

    Goldstuck, Norman D; Wildemeersch, Dirk

    2014-01-01

    Background The purpose of this study was to examine factors that could help reduce primary perforation during insertion of a framed intrauterine device (IUD) and to determine factors that contribute in generating enough uterine muscle force to cause embedment and secondary perforation of an IUD. The objective was also to evaluate the main underlying mechanism of IUD expulsion. Methods We compared known IUD insertion forces for “framed” devices with known perforation forces in vitro (hysterectomy specimens) and known IUD removal forces and calculated a range of possible intrauterine forces using pressure and surface area. These were compared with known perforation forces. Results IUD insertion forces range from 1.5 N to 6.5 N. Removal forces range from 1 N to 5.8 N and fracture forces from 8.7 N to 30 N depending upon device. Measured perforation forces are from 20 N to 54 N, and calculations show the uterus is capable of generating up to 50 N of myometrial force depending on internal pressure and surface area. Conclusion Primary perforation with conventional framed IUDs may occur if the insertion pressure exceeds the perforation resistance of the uterine fundus. This is more likely to occur if the front end of the inserter/IUD is narrow, the passage through the cervix is difficult, and the procedure is complex. IUD embedment and secondary perforation and IUD expulsion may be due to imbalance between the size of the IUD and that of the uterine cavity, causing production of asymmetrical uterine forces. The uterine muscle seems capable of generating enough force to cause an IUD to perforate the myometrium provided it is applied asymmetrically. A physical theory for IUD expulsion and secondary IUD perforation is given. PMID:25143756

  17. The allometry of rodent intestines.

    PubMed

    Lovegrove, Barry G

    2010-06-01

    This study examined the allometry of the small intestine, caecum, colon and large intestine of rodents (n = 51) using a phylogenetically informed approach. Strong phylogenetic signal was detected in the data for the caecum, colon and large intestine, but not for the small intestine. Most of the phylogenetic signal could be attributed to clade effects associated with herbivorous versus omnivorous rodents. The herbivorous rodents have longer caecums, colons and large intestines, but their small intestines, with the exception of the desert otomyine rodents, are no different to those of omnivorous rodents. Desert otomyine rodents have significantly shorter small intestines than all other rodents, reflecting a possible habitat effect and providing a partial explanation for the low basal metabolic rates of small desert mammals. However, the desert otomyines do not have shorter colons or large intestines, challenging claims for adaptation to water retention in arid environments. Data for the Arvicolidae revealed significantly larger caecums and colons, and hence longer large intestines, with no compensatory reduction in the length of the small intestine, which may explain how the smallest mammalian herbivores manage to meet the demands of a very high mass-specific metabolic rate. This study provides phylogenetically corrected allometries suitable for future prediction testing.

  18. Comparing Gray and White Mineral Trioxide Aggregate as a Repair Material for Furcation Perforation: An in Vitro Dye Extraction Study

    PubMed Central

    Patel, Kiran; Baba, Suheel Manzoor; Jaiswal, Shikha; Venkataraghavan, Karthik; Jani, Mehul

    2014-01-01

    Introduction: Furcation perforation can have a negative impact on the prognosis of the affected tooth by compromising the attached apparatus. Hence these perforations require immediate repair. A variety of materials have been suggested for repair, of that MTA is the most promising material. The purpose of this study was to compare the ability of Gray and White MTA to seal furcation perforations using a dye extraction method under spectrophotometer. Materials and Methods: A total of 60 permanent mandibular molars were randomly divided into four experimental groups of 15 samples each as follows: Group A: Perforation repaired with White MTA. Group B: Perforation repaired with Gray MTA. Group C: Perforation left unsealed (positive). Group D: without perforation (negative). Dye extraction was performed using full concentration nitric acid. Dye absorbance was measured at 550 nm using spectrophotometer. The data analyzed using one-way-Anova Ratio and Unpaired t-test showing statistically significance difference among the groups. Result: It was seen that Group D samples without perforation showed least absorbance followed by Group A (perforation repaired with White MTA) and Group B (perforation repaired with Gray MTA). Group C (perforation left unsealed) showed highest absorbance. Conclusion: The White and Gray Mineral Trioxide Aggregate performed similarly as a furcation perforation repair material. There was no significant difference between the Gray MTA and White MTA. PMID:25478452

  19. Alcohol and the Intestine

    PubMed Central

    Patel, Sheena; Behara, Rama; Swanson, Garth R.; Forsyth, Christopher B.; Voigt, Robin M.; Keshavarzian, Ali

    2015-01-01

    Alcohol abuse is a significant contributor to the global burden of disease and can lead to tissue damage and organ dysfunction in a subset of alcoholics. However, a subset of alcoholics without any of these predisposing factors can develop alcohol-mediated organ injury. The gastrointestinal tract (GI) could be an important source of inflammation in alcohol-mediated organ damage. The purpose of review was to evaluate mechanisms of alcohol-induced endotoxemia (including dysbiosis and gut leakiness), and highlight the predisposing factors for alcohol-induced dysbiosis and gut leakiness to endotoxins. Barriers, including immunologic, physical, and biochemical can regulate the passage of toxins into the portal and systemic circulation. In addition, a host of environmental interactions including those influenced by circadian rhythms can impact alcohol-induced organ pathology. There appears to be a role for therapeutic measures to mitigate alcohol-induced organ damage by normalizing intestinal dysbiosis and/or improving intestinal barrier integrity. Ultimately, the inflammatory process that drives progression into organ damage from alcohol appears to be multifactorial. Understanding the role of the intestine in the pathogenesis of alcoholic liver disease can pose further avenues for pathogenic and treatment approaches. PMID:26501334

  20. Precision resection of intestine using ultrashort laser pulses

    NASA Astrophysics Data System (ADS)

    Beck, Rainer J.; Gora, Wojciech S.; Jayne, David; Hand, Duncan P.; Shephard, Jonathan D.

    2016-03-01

    Endoscopic resection of early colorectal neoplasms typically employs electrocautery tools, which lack precision and run the risk of full thickness thermal injury to the bowel wall with subsequent perforation. We present a means of endoluminal colonic ablation using picosecond laser pulses as a potential alternative to mitigate these limitations. High intensity ultrashort laser pulses enable nonlinear absorption processes, plasma generation, and as a consequence a predominantly non-thermal ablation regimen. Robust process parameters for the laser resection are demonstrated using fresh ex vivo pig intestine samples. Square cavities with comparable thickness to early colorectal neoplasms are removed for a wavelength of 1030 nm and 515 nm using a picosecond laser system. The corresponding histology sections exhibit in both cases only minimal collateral damage to the surrounding tissue. The ablation depth can be controlled precisely by means of the pulse energy. Overall, the application of ultrafast lasers for the resection of intestine enables significantly improved precision and reduced thermal damage to the surrounding tissue compared to conventional electrocautery.

  1. Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis--further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage.

    PubMed

    Chow, Louis Tsun Cheung

    2014-12-01

    The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation. Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation.

  2. Large retroperitoneal abscess extended to the inferior right limb secondary to a perforated ileal Crohn’s disease: the importance of the multidisciplinary approach

    PubMed Central

    MASCOLINO, A.; SCERRINO, G.; GULLO, R.; GENOVA, C.; MELFA, G.I.; RASPANTI, C.; FONTANA, T.; FALCO, N.; PORRELLO, C.; GULOTTA, G.

    2016-01-01

    The typical complications of Crohn’s disease concerns small and large bowel. The full thickness inflammation of the intestinal wall develops in strictures, fistulas and abdominal abscesses. Nowadays the most accepted therapeutic for intra-abdominal abscess option is antibiotic therapy and, in case of need, percutaneous drainage of the abscess. If the abscess passes through the pelvic foramen the abscess can involve the inferior limbs. We report a case a perforation of terminal ileum in Crohn’s disease complicated by a large abscess of the right iliac fossa reaching the spaces between the anterior lateral muscles of the right thigh as far as the anterior lateral pre-tibial region. We discuss the diagnostic and therapeutic options in a multidisciplinary context. PMID:27142824

  3. How to make an intestine

    PubMed Central

    Wells, James M.; Spence, Jason R.

    2014-01-01

    With the high prevalence of gastrointestinal disorders, there is great interest in establishing in vitro models of human intestinal disease and in developing drug-screening platforms that more accurately represent the complex physiology of the intestine. We will review how recent advances in developmental and stem cell biology have made it possible to generate complex, three-dimensional, human intestinal tissues in vitro through directed differentiation of human pluripotent stem cells. These are currently being used to study human development, genetic forms of disease, intestinal pathogens, metabolic disease and cancer. PMID:24496613

  4. Vision loss after inadvertent corneal perforation during lid anesthesia.

    PubMed

    Parikh, Mansi; Kwon, Young H

    2011-01-01

    A 68-year-old woman was referred for glaucoma management after inadvertent corneal perforation during eyelid anesthesia for upper eyelid blepharoplasty. A mixture of 50:50 2% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine buffered with sodium bicarbonate was injected intracamerally. Decreased vision and uncontrollable intraocular pressure resulted, despite prompt anterior chamber washout. Examination showed corneal edema, inflammation, and secondary angle closure. Intraocular pressure control with seton placement led to an improvement in vision; however, mild corneal haze remained, and specular microscopy showed endothelial cell loss, presumably secondary to local anesthetic toxicity. Inadvertent ocular penetration is a rare but serious complication of local eyelid anesthesia. Prompt recognition is essential to institute appropriate management and minimize subsequent vision loss.

  5. Scaled Long Rod Perforation Experiments Using Multiple Diagnostics

    NASA Astrophysics Data System (ADS)

    Cross, Daniel; Proud, William

    2011-06-01

    A series of angled small-scale reverse ballistic long rod experiments were conducted using mild steel rods (6 mm dia., 90 mm long) against both 3 mm and 6 mm rolled homogeneous armour (RHA) plates at 30°. The impact velocity was varied from 450-780 m s-1 and the response of the system monitored by laser velocimetry, strain gauges and high-speed photography. This provided insight into the flexing of the rod during impact, the acceleration of the rear of the rod and the global penetration process. This experimental series involved ricochet, near-ricochet and full perforation, and so allows the sensitivity of the differing diagnostic outputs for these processes to be compared.

  6. A newborn with duodenal atresia and a gastric perforation.

    PubMed

    Akcora, Bulent; Eris, Ozge

    2010-01-01

    Congenital duodenal atresia complicated by gastric perforation (GP) is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

  7. Endoscopic vacuum therapy for esophageal perforations and leakages

    PubMed Central

    Möschler, Oliver; Nies, Christoph; Mueller, Michael K.

    2015-01-01

    Background and study aims: Injuries to the esophageal wall, such as perforations and anastomotic leaks, are serious complications of surgical and endoscopic interventions. Since 2006, a new treatment has been introduced, in the form of endoscopically placed vacuum sponge therapy. Patients and methods: Between April 2012 and October 2014, 10 patients (5 men and 5 women) aged 57 to 94 years were treated at our institution using endoscopic vacuum therapy (EVT) in the upper gastrointestinal tract. Results: The defect in the esophageal wall was successfully closed in seven of the 10 patients (70 %). No severe complications occurred. Conclusions: EVT is a valuable tool for management of defects in the esophageal wall and should be considered as a treatment option for patients with this condition. PMID:26716111

  8. Duodenal perforation as result of blunt abdominal trauma in childhood.

    PubMed

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-12-23

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.

  9. Mechanical seal having a single-piece, perforated mating ring

    DOEpatents

    Khonsari, Michael M.; Somanchi, Anoop K.

    2007-08-07

    A mechanical seal (e.g., single mechanical seals, double mechanical seals, tandem mechanical seals, bellows, pusher mechanical seals, and all types of rotating and reciprocating machines) with reduced contact surface temperature, reduced contact surface wear, or increased life span. The mechanical seal comprises a rotating ring and a single-piece, perforated mating ring, which improves heat transfer by controllably channeling coolant flow through the single-piece mating ring such that the coolant is in substantially uniform thermal contact with a substantial portion of the interior surface area of the seal face, while maintaining the structural integrity of the mechanical seal and minimizing the potential for coolant flow interruptions to the seal face caused by debris or contaminants (e.g., small solids and trash) in the coolant.

  10. Shock wave strength reduction by passive control using perforated plates

    NASA Astrophysics Data System (ADS)

    Doerffer, Piotr; Szulc, Oskar

    2007-05-01

    Strong, normal shock wave, terminating a local supersonic area on an airfoil, not only limits aerodynamic performance but also becomes a source of a high-speed impulsive helicopter noise. The application of a passive control system (a cavity covered by a perforated plate) on a rotor blade should reduce the noise created by a moving shock. This article covers the numerical implementation of the Bohning/Doerffer transpiration law into the SPARC code and includes an extended validation against the experimental data for relatively simple geometries of transonic nozzles. It is a first step towards a full simulation of a helicopter rotor equipped with a noise reducing passive control device in hover and in forward flight conditions.

  11. Low temperature thermal transport in partially perforated silicon nitride membranes.

    SciTech Connect

    Yefremenko, V.; Wang, G.; Novosad, V.; Datesman, A.; Pearson, J.; Divan, R.; Chang, C. L.; Downes, T. P.; Mcmahon, J. J.; Bleem, L. E.; Crites, A. T.; Meyer, S. S.; Carlstrom, J. E.; Univ. of Chicago

    2009-05-04

    The thermal transport in partially trenched silicon nitride membranes has been studied in the temperature range from 0.3 to 0.6 K, with the transition edge sensor (TES), the sole source of membrane heating. The test configuration consisted of Mo/Au TESs lithographically defined on silicon nitride membranes 1 {micro}m thick and 6 mm{sup 2} in size. Trenches with variable depth were incorporated between the TES and the silicon frame in order to manage the thermal transport. It was shown that sharp features in the membrane surface, such as trenches, significantly impede the modes of phonon transport. A nonlinear dependence of thermal resistance on trench depth was observed. Partial perforation of silicon nitride membranes to control thermal transport could be useful in fabricating mechanically robust detector devices.

  12. Perforated monolayers. Progress report, July 1, 1990--December 31, 1992

    SciTech Connect

    Regen, S.L.

    1992-12-01

    Goal of this research program is to create ultrathin organic membranes that possess uniform and adjustable pores ( < 7{angstrom} diameter). Such membranes are expected to possess high permeation selectivity (permselectivity) and high permeability, and to provide the basis for energy-efficient methods of molecular separation. Work carried out has demonstrated feasibility of using ``perforated monolayer``-based composites as molecular sieve membranes. Specifically, composite membranes derived from Langmuir-Blodgett multilayers of the calix[6]arene-based surfactant shown below plus poly[l-(trimethylsilyl)-l-propyne] (PTMSP) were found to exhibit sieving behavior towards He, N{sub 2} and SF{sub 6}. Results of derivative studies that have also been completed are also described in this report.

  13. Skin friction on a flat perforated acoustic liner

    NASA Technical Reports Server (NTRS)

    Boldman, D. R.; Brinich, P. F.

    1976-01-01

    The report concerns the measurement of friction coefficients of a typical perforated acoustic liner installed in the side of a wind tunnel. The results are compared with measured friction coefficients of a smooth hard wall for the same mean flow velocities in a wind tunnel. At a velocity of 61 m/sec, an increase in the local skin coefficient of only a few percent was observed, but at the highest velocity of 213 m/sec an increase of about 20% was obtained. This velocity is a realistic velocity for turbo-machinery components utilizing such liners, so a loss in performance is to be expected. Some tests were also performed to see if changes in the mean boundary layer induced by imposed noise would result in friction increase, but only at low velocity levels was such an increase in friction noted.

  14. Perforation of Meckel's diverticulum by an intact fish bone

    PubMed Central

    Mouawad, Nicolas J; Hammond, Stephen; Kaoutzanis, Christodoulos

    2013-01-01

    Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, with an overall incidence of approximately 2.2%. It is generally noted incidentally during laparotomy for management of other abdominal pathology. Complications are infrequent, developing in 4% of individuals with this abnormality, and are usually seen in childhood. Herein, we discuss the case of a 52-year-old Caucasian man presenting with a 1-day history of worsening central and right-sided abdominal pain. Initial evaluation posed a broad differential however, following conservative measures and unremarkable plain films, the patient developed peritoneal signs necessitating operative intervention. During diagnostic laparoscopy, a Meckel's diverticulum was noted to be inflamed and perforated by an intact fish bone. The patient was treated successfully with a segmental resection and primary anastomosis, and had an uneventful postoperative recovery. PMID:23429021

  15. [Pharynx perforation caused by fishbone--diagnostic problems].

    PubMed

    Sokołowski, Dariusz; Sosada, Krystyn

    2002-01-01

    The authors presented a case of perforation of the left side of pharynx by fishbone, treated successfully in spite of wrong primary diagnosis and treatment. The fishbone quickly penetrated the pharynx wall and evoked inflammatory process similar to thyroid gland tumor (size 50 x 70 mm). It was the cause of the wrong first diagnosis of thyroid gland tumor. Because of the diagnosis the patient was qualified to surgical intervention--the removal of thyroid tumor. However, the patient suspected the relationship between the tumor and choking with a foreign body. The patient was diagnosed again in another hospital where the proper diagnosis was made. The removal of fishbone from the left subclavian region was performed after 41 days from the day of choking.

  16. Bowel Perforation in Premature Infants with Necrotizing Enterocolitis: Risk Factors and Outcomes

    PubMed Central

    Yu, Lingling; Tian, Jianmei; Zhao, Xingli; Cheng, Ping; Chen, Xiaoqian; Yu, Yun; Ding, Xiaochun; Zhu, Xueping; Xiao, Zhihui

    2016-01-01

    We aim to determine risk factors and clinical outcomes for bowel perforation in premature infants with NEC. We analyzed clinical data of 57 cases of premature infants with NEC at our NICU between January 2010 and December 2012. Based on the presence of bowel perforation, we divided these infants into two groups: perforated NEC group (n = 10) and nonperforated NEC group (n = 47). We compared general information, clinical characteristics, and laboratory findings between groups. The perforated NEC group, compared to the nonperforated NEC group, had significantly lesser gestational age, lower birth weight, higher prevalence of apnea, mechanical ventilation, sepsis and shock, lower blood pH, higher levels of blood glucose, abnormal WBC count and thrombocytopenia, and elevated CRP (all P < 0.05). Moreover, the perforated NEC group had significantly longer durations of fasting and TPN usage, higher incidences of EUGR and cholestasis, longer duration of antibiotics, higher frequency of advanced antibiotics use, and poorer prognosis than the nonperforated NEC group (all P < 0.05). Bowel perforation in premature infants with NEC was associated with multiple risk factors. Early identification of some of these risk factors in premature infants with NEC may help implement early intervention to reduce the incidence of bowel perforation and thereby improve the prognosis. PMID:27375739

  17. Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States

    PubMed Central

    Rush, Sloan W.

    2016-01-01

    Purpose. To compare the long-term outcomes of infectious versus sterile perforated corneal ulcers after therapeutic penetrating keratoplasty in the United States. Methods. The charts of 45 consecutive eyes that underwent primary therapeutic penetrating keratoplasty for a perforated corneal ulcer at a single center were retrospectively reviewed. The perforated ulcers were classified as infectious or sterile and the underlying demographics, clinical features, and 36-month outcomes were compared among the two groups. Results. Mean follow-up among subjects was 38.6 (±6.9) months. Patients presenting with sterile perforated ulcers were more likely to have a peripheral perforation location (p = 0.0333) and recurrence of the underlying disease condition (p = 0.0321), require adjunctive surgical measures in the immediate postoperative period (p < 0.0001), have reperforation after keratoplasty (p = 0.0079), have worse best corrected visual acuity (p = 0.0130), develop no light perception vision (p = 0.0053), and require enucleation/evisceration (p = 0.0252) when compared to the infectious perforated ulcer group. Conclusions. Sterile perforated corneal ulcers have a worse prognosis and may be more frequent than those caused by infectious disease in the United States compared to the developing world. PMID:28070416

  18. Efficacy of the Ovesco Clip for Closure of Endoscope Related Perforations

    PubMed Central

    Angsuwatcharakon, Phonthep; Prueksapanich, Piyapan; Kongkam, Pradermchai; Rattanachu-ek, Thawee; Sottisuporn, Jaksin; Rerknimitr, Rungsun

    2016-01-01

    Aim. To study the efficacy and other treatment outcomes of Ovesco clip closure of iatrogenic perforation. Methods. Retrospective study from 3 tertiary-care hospitals in Thailand. Patients with iatrogenic perforation who underwent immediate endoscopic closure by Ovesco clip were included. Patients' demographic data, perforation size, number of Ovesco clips used, fasting day, length of hospital stay, success rates, and complication rate were recorded. Technical success was defined as closure achievement during endoscopic procedure and clinical success was defined as the patient can be discharged without the need of additional surgical or radiological intervention. Results. There were 6 iatrogenic perforations in 2 male and 4 female patients. The median age was 59 years (range 39–78 years). The locations of perforation were 5 duodenal walls and 1 rectosigmoid junction. The median perforation size was 13 mm (range 10–40 mm). The technical success was 100% and the clinical success was 83.3%. The success rates per locations were 100% in colon and 80% in duodenum, respectively. The median fasting time was 5 days (range 1–10 days) and the median length of hospital stay was 10 days (range 2–22 days). There was no mortality in any. Conclusion. Ovesco clip seems to be an effective and safe tool for a closure of iatrogenic perforation. PMID:27293368

  19. Surgical glove perforation among nurses in ophthalmic surgery: a case-control study.

    PubMed

    Shek, Karen Mei-Yan; Chau, Janita Pak-Chun

    2014-04-01

    Many of the ophthalmic surgical instruments are extremely fine and sharp. Due to the dim light environment required for ophthalmic surgical procedures, the passing of sharp instruments among surgeons and scrub nurses also poses a risk for glove perforations. A case-control study was performed to determine the number and site of perforations in the surgical gloves used by a group of scrub nurses during ophthalmic surgery. All six nurses working in an eye and refractive surgery centre in Hong Kong participated in the study. A total of 100 (50 pairs) used surgical gloves were collected following 50 ophthalmic surgeries. Fifty pairs of new surgical gloves were also collected. Every collected surgical glove underwent the water leak test. The surgical procedure perforation rate was 8%, and none of the perforations were detected by the scrub nurses. No perforations were found in any unused gloves. The findings indicate that glove perforations for scrub nurses during ophthalmic surgery do occur and mostly go unnoticed. Future studies should continue to explore factors contributing to surgical glove perforation.

  20. Assessment of Tissue Perfusion Following Conventional Liposuction of Perforator-Based Abdominal Flaps

    PubMed Central

    Saçak, Bülent; Yalçın, Doğuş; Pilancı, Özgür; Tuncer, Fatma Betül; Çelebiler, Özhan

    2017-01-01

    Background The effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser–Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik). Methods Nine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively. Results The measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures. Conclusions The liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research. PMID:28352599

  1. The perforator-based conjoint (chimeric) medial Sural(MEDIAL GASTROCNEMIUS) free flap.

    PubMed

    Sano, Kazufumi; Hallock, Geoffrey G; Hamazaki, Masahiro; Daicyo, Yoshihiro

    2004-12-01

    The prototypical conjoint or so-called "chimeric" free flap heretofore has been composed of several large independent flaps, each supplied by a separate major branch, that ultimately arise from a common source vessel. The perforator-based type of chimeric flap is a relatively new concept, usually involving multiple muscle perforator flaps each based on a solitary musculocutaneous perforator, but still arising from the same "mother" vessel. This principle of split cutaneous perforator flaps has been now successfully adapted to the medial suralMEDIAL GASTROCNEMIUS perforator free flap on 2 separate occasions. As a chimeric flap, there was greater flexibility in insetting, and overall flap width may be larger but still narrow enough to allow primary donor site closure; and yet, by definition, only a single recipient site was needed for any microanastomoses. This is further proof that the perforator-based chimeric free flap may be an option for any muscle perforator flap donor site, so that potential donor territories for conjoint flaps have become virtually unlimited.

  2. Portland cement use in dental root perforations: a long term followup.

    PubMed

    Borges, Alvaro Henrique; Bandeca, Matheus Coelho; Tonetto, Mateus Rodrigues; Faitaroni, Luis Augusto; Carvalho, Elibel Reginna de Siqueira; Guerreiro-Tanomaru, Juliane Maria; Tanomaru Filho, Mário

    2014-01-01

    Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

  3. Laparoscopic Repair for Perforated Peptic Ulcer in Children.

    PubMed

    Reusens, Helena; Dassonville, Martine; Steyaert, Henri

    2016-07-25

    Introduction A perforated peptic ulcer (PPU) is a rare but major complication of gastroduodenal peptic ulcer disease. Literature is scarce on this subject in the pediatric population and most articles describe a surgical treatment by laparotomy. We aim to review all our cases of pediatric PPU treated over the past 16 years and compare these to literature to deduce potential benefits and disadvantages regarding laparoscopic treatment of PPU in children. Materials and Methods A retrospective study of all cases of PPU treated at the Lenval Hospital in Nice (France) and the Queen Fabiola University Hospital for Children in Brussels (Belgium) between 1998 and 2015 was performed. Results A total of five children were treated for PPU (2 females). The average age was 11 years (range, 3-17). All of them were surgically treated with laparoscopic simple suture of the perforation and placement of an omental patch. There were no mortalities, no conversions, and no extra-abdominal complications or wound dehiscences. Mean operating time was 78.6 minutes (range, 70-115 minutes). Mean duration of intravenous treatment was 6 days (range, 4-12 days). One reintervention was performed for abdominal infection. In one patient, an abdominal drain was left in place for 2 days. The mean time before refeeding was 3.4 days (range, 3-4 days) and mean length of stay was 12 days (range, 7-30 days). Conclusion Laparoscopic repair is safe and feasible for PPU and should be the gold standard for treatment of PPU in children.

  4. Scoring Systems for Outcome Prediction of Patients with Perforation Peritonitis

    PubMed Central

    Litake, Manjusha Madhusudhan

    2016-01-01

    Introduction Peritonitis continues to be one of the major infectious problems confronting a surgeon. Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for en Umeration of Mortality (POSSUM) and Morbidity and sepsis score of Stoner and Elebute have been devised for risk assessment and for prediction of postoperative outcome. Aim The aim of this study was to find the accuracy of these scores in predicting outcome in terms of mortality in patients undergoing exploratory laprotomy for perforation peritonitis. Materials and Methods The prospective study was carried out in 100 diagnosed cases of perforation at our centre in a single unit over a period of 21 months from December 2012 to August 2014. Study was conducted on all cases of peritonitis albeit primary, tertiary, iatrogenic and those with age less than 12 years were excluded from the study. All the relevant data were collected and three scores were computed from one set of data from the patient. The main outcome measure was survival of the patient. The Receiver Operator Characteristics (ROC) curves were obtained for the three scores. Area Under the Curves (AUC) was calculated. Sensitivity and specificity were calculated at a cut off point obtained from the ROC curves. Results POSSUM had an AUC of 0.99, sepsis score had an AUC of 0.98 and MPI had an AUC of 0.95. The cut off point score of 51 for POSSUM had an accuracy of 93.8 and positive predictive value of 70.5, the score of 29 for MPI had an accuracy of 82.8 and positive predictive value of 46 and the score of 22 for sepsis score had an accuracy of 95.9 and positive predictive value of 86.67. Conclusion POSSUM score was found to be superior in prediction of mortality as compared to sepsis score of Stoner and Elebute and MPI. POSSUM and MPI over predicted mortality in some cases. None of these scores are strictly preoperative. PMID:27134924

  5. Color Doppler Ultrasonography-Targeted Perforator Mapping and Angiosome-Based Flap Reconstruction.

    PubMed

    Gunnarsson, Gudjon Leifur; Tei, Troels; Thomsen, Jørn Bo

    2016-10-01

    Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstruction throughout the body. The CDU was used to identify the largest and best-located perforator adjacent to the defect to target the reconstruction. The cutaneous or fasciocutaneous flaps were raised, mobilized, and designed according to the reconstructive needs as rotation, advancement, or turnover flaps. We performed 148 reconstructions in 130 patients. Eleven facial reconstructions, 118 reconstructions in the body, 7 in the upper limbs, and 12 in the lower limbs. The propeller flap was used in 135 of 148 (91%) cases followed by the turnover design in 10 (7%) and the V to Y flap in 3 (2%) cases. The flaps were raised on 1 perforator in 98 (67%), 2 perforators in 48 (33%), and 3 perforators in 2 (1%) flaps. The reconstructive goal was achieved in 143 of 148 reconstructions (97%). In 5 cases, surgical revision was needed. No flaps were totally lost indicating a patent pedicle in all cases. We had 10 (7%) cases of major complications and 22 (15%) minor complications. The CDU-targeted perforator mapping and angiosome-based flap reconstruction are simple to perform, and we recommended its use for freestyle perforator flap reconstruction. All perforators selected by CDU was identified during surgery and used for reconstruction. The safe boundaries of angiosomes remain to be established.

  6. Synthetic Small Intestinal Scaffolds for Improved Studies of Intestinal Differentiation

    PubMed Central

    Costello, Cait M.; Hongpeng, Jia; Shaffiey, Shahab; Yu, Jiajie; Jain, Nina K.; Hackam, David

    2014-01-01

    In vitro intestinal models can provide new insights into small intestinal function, including cellular growth and proliferation mechanisms, drug absorption capabilities, and host-microbial interactions. These models are typically formed with cells cultured on 2D scaffolds or transwell inserts, but it is widely understood that epithelial cells cultured in 3D environments exhibit different phenotypes that are more reflective of native tissue. Our focus was to develop a porous, synthetic 3D tissue scaffold with villous features that could support the culture of epithelial cell types to mimic the natural microenvironment of the small intestine. We demonstrated that our scaffold could support the co-culture of Caco-2 cells with a mucus-producing cell line, HT29-MTX, as well as small intestinal crypts from mice for extended periods. By recreating the surface topography with accurately sized intestinal villi, we enable cellular differentiation along the villous axis in a similar manner to native intestines. In addition, we show that the biochemical microenvironments of the intestine can be further simulated via a combination of apical and basolateral feeding of intestinal cell types cultured on the 3D models. PMID:24390638

  7. Immunoglobulin in intestinal secretions.

    PubMed

    Cutropia de Guirao, C

    1977-12-01

    The objective of the present investigation is the study and interpretation of the role played by the immunoglobulins, especially IgA, during acute diarrhea in children. IgA, IGG and IgM values in serum and IgA in intestinal secretions were studied in a group of children (between 3 months and 5 years of age) during diarrhea, convalescence and in normals. The method of simple radial immunodiffusion according to Mancini was employed. IgA is the immunoglobulin which suffers the greastest alteration in acute diarrhea. The precipitation halos (the average values), were lower during the diarrhea than in convalescence and in normals.

  8. Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment.

    PubMed

    Karatasakis, Aris; Akhtar, Yasir N; Brilakis, Emmanouil S

    2016-09-01

    In patients with prior coronary artery bypass graft (CABG) surgery, distal coronary perforations are commonly considered to be at low risk for causing cardiac tamponade due to a potential protective role of pericardial adhesions, which obliterate the pericardial space. Loculated effusions can however form in such patients, compressing various cardiac structures and causing hemodynamic compromise. We present two cases of distal coronary perforation in prior CABG patients undergoing chronic total occlusion percutaneous coronary intervention. In the first case a distal coronary perforation was initially observed, resulting in a loculated pericardial effusion that caused ST-segment elevation and death, despite successful sealing of the perforation. In the second case a similar perforation was immediately sealed with a covered stent, followed by uneventful patient recovery. A literature review of coronary perforation leading to hemodynamic compromise in patients with prior CABG surgery revealed high mortality (22%), suggesting that prompt sealing of the perforation is critical in these patients.

  9. Spontaneous perforation of choledochal cyst: a case with unusual distribution of fluid in the retroperitoneal space.

    PubMed

    Tani, Chihiro; Nosaka, Shunsuke; Masaki, Hidekazu; Kuroda, Tatsuo; Honna, Toshiroh

    2009-06-01

    Images of perforated choledochal cysts typically show an intraperitoneal fluid collection. We report a case with, in addition to free intraperitoneal fluid, fluid collection in the right-side anterior pararenal and perirenal spaces. Surgery confirmed the presence of a perforation at the junction of the cystic duct and the common bile duct. This perforation may explain the biliary leakage extending into the free peritoneal space as well as into the anterior pararenal space and the hepatoduodenal ligament. Anterior pararenal and perirenal spaces communicate with the infrarenal space, and this may result in extension of the fluid into the perirenal space from the anterior pararenal space.

  10. Perforator arteries of the medial upper arm: anatomical basis of a new flap donor site.

    PubMed

    Perignon, D; Havet, E; Sinna, R

    2013-01-01

    The development of perforator flaps' concept based on knowledge on vascular anatomy of the skin represents a major improvement in reconstructive surgery. Succeeding description about vascular territories and anatomical basics of the main donor sites, the study of hidden donor sites, such as medial upper arm, constitutes a new step and an additional refinement. 20 upper limbs of 10 fresh adult cadavers were studied with colored latex injections. The origin and distribution of the perforator arteries of the superior ulnar collateral artery and the brachial artery were investigated. We have noted constant perforator arteries and described the limits of vascular territories of the medial upper arm.

  11. Cell perforation mediated by plasmonic bubbles generated by a single near infrared femtosecond laser pulse.

    PubMed

    Boutopoulos, Christos; Bergeron, Eric; Meunier, Michel

    2016-01-01

    We report on transient membrane perforation of living cancer cells using plasmonic gold nanoparticles (AuNPs) enhanced single near infrared (NIR) femtosecond (fs) laser pulse. Under optimized laser energy fluence, single pulse treatment (τ = 45 fs, λ = 800 nm) resulted in 77% cell perforation efficiency and 90% cell viability. Using dark field and ultrafast imaging, we demonstrated that the generation of submicron bubbles around the AuNPs is the necessary condition for the cell membrane perforation. AuNP clustering increased drastically the bubble generation efficiency, thus enabling an effective laser treatment using low energy dose in the NIR optical therapeutical window.

  12. Tinea corporis caused by an unusual strain of Microsporum audouinii that perforates hair in vitro.

    PubMed

    Brasch, J; Hügel, R; Lipowsky, F; Gräser, Y

    2010-07-01

    We report on a dermatophyte infection acquired by a young woman from Germany who had worked in Ghana. The strain isolated from her skin lesions showed morphological and physiological features compatible with Microsporum audouinii but a clearly positive hair perforation test made its definite identification by conventional methods equivocal. A genetic analysis finally unambiguously revealed Microsporum audouinii. This is the first observation of a Microsporum audouinii strain with a positive hair perforation test. The ability to perforate hair may be related to attributes favouring an inflammatory host response.

  13. Repair of an Extensive Furcation Perforation with CEM Cement: A Case Study.

    PubMed

    Eghbal, Mohammad Jafar; Fazlyab, Mahta; Asgary, Saeed

    2014-01-01

    Iatrogenic perforation of the furcation area in multi-rooted molars during preparation of the access cavity can potentially lead to tooth extraction. The present case report describes the nonsurgical endodontic management of an extensive pulp chamber floor perforation in a first mandibular molar with calcium enriched mixture (CEM) cement. The perforation was chemically cleaned and then physically sealed with CEM cement. Root canal therapy was completed and the tooth was then restored with amalgam. A one-year follow-up revealed the absence of symptoms of infection/inflammation as well as clinical and radiographic signs/symptoms and therefore, can be interpreted as a favorable treatment outcome.

  14. Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

    PubMed Central

    Shapey, IM; Nasser, T; Dickens, P; Haldar, M; Solkar, MH

    2012-01-01

    Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required. PMID:23131215

  15. [Development of a perforated peptic ulcer in a child during high dose prednisolone treatment].

    PubMed

    Moll Harboe, Kirstine; Midtgaard, Helle; Wewer, Vibeke; Cortes, Dina

    2012-09-24

    Since perforated peptic ulcer is uncommon in children proton pump inhibitor prophylaxis is not routinely recommended when children are treated with high dose steroids. We describe a case of perforated ulcer in a six-year-old patient with nephrotic syndrome treated with high dose prednisolone. Initially, ulcer was not suspected due to uncharacteristic symptoms. The child developed peritoneal signs and surgery revealed a perforated peptic ulcer in the stomach. We recommend treatment with proton pump inhibitors if children, who are treated with high dose steroids develop abdominal symptoms, which can be caused by an ulcus.

  16. An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery

    PubMed Central

    Cayci, Haci Murat; Erdoğdu, Umut Eren; Dilektasli, Evren; Turkoglu, Mehmet Akif; Firat, Deniz; Cantay, Hasan

    2017-01-01

    Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation. PMID:27251836

  17. Repair of an Extensive Furcation Perforation with CEM Cement: A Case Study

    PubMed Central

    Eghbal, Mohammad Jafar; Fazlyab, Mahta; Asgary, Saeed

    2014-01-01

    Iatrogenic perforation of the furcation area in multi-rooted molars during preparation of the access cavity can potentially lead to tooth extraction. The present case report describes the nonsurgical endodontic management of an extensive pulp chamber floor perforation in a first mandibular molar with calcium enriched mixture (CEM) cement. The perforation was chemically cleaned and then physically sealed with CEM cement. Root canal therapy was completed and the tooth was then restored with amalgam. A one-year follow-up revealed the absence of symptoms of infection/inflammation as well as clinical and radiographic signs/symptoms and therefore, can be interpreted as a favorable treatment outcome. PMID:24396381

  18. Intestinal microbiota and obesity.

    PubMed

    Blaut, Michael; Klaus, Susanne

    2012-01-01

    The human gut harbors a highly diverse microbial ecosystem of approximately 400 different species, which is characterized by a high interindividual variability. The intestinal microbiota has recently been suggested to contribute to the development of obesity and the metabolic syndrome. Transplantation of gut microbiota from obese mice to nonobese, germ-free mice resulted in transfer of metabolic syndrome-associated features from the donor to the recipient. Proposed mechanisms for the role of gut microbiota include the provision of additional energy by the conversion of dietary fiber to short-chain fatty acids, effects on gut-hormone production, and increased intestinal permeability causing elevated systemic levels of lipopolysaccharides (LPS). This metabolic endotoxemia is suggested to contribute to low-grade inflammation, a characteristic trait of obesity and the metabolic syndrome. Finally, activation of the endocannabinoid system by LPS and/or high-fat diets is discussed as another causal factor. In conclusion, there is ample evidence for a role of gut microbiota in the development of obesity in rodents. However, the magnitude of its contribution to human obesity is still unknown.

  19. Award Winner in the Young Investigator Category, 2014 Society for Biomaterials Annual Meeting and Exposition, Denver, Colorado, April 16-19, 2014: Periodically perforated core-shell collagen biomaterials balance cell infiltration, bioactivity, and mechanical properties.

    PubMed

    Caliari, Steven R; Mozdzen, Laura C; Armitage, Oliver; Oyen, Michelle L; Harley, Brendan A C

    2014-04-01

    Orthopedic tissue engineering requires biomaterials with robust mechanics as well as adequate porosity and permeability to support cell motility, proliferation, and new extracellular matrix (ECM) synthesis. While collagen-glycosaminoglycan (CG) scaffolds have been developed for a range of tissue engineering applications, they exhibit poor mechanical properties. Building on previous work in our lab that described composite CG biomaterials containing a porous scaffold core and nonporous CG membrane shell inspired by mechanically efficient core-shell composites in nature, this study explores an approach to improve cellular infiltration and metabolic health within these core-shell composites. We use indentation analyses to demonstrate that CG membranes, while less permeable than porous CG scaffolds, show similar permeability to dense materials such as small intestine submucosa (SIS). We also describe a simple method to fabricate CG membranes with organized arrays of microscale perforations. We demonstrate that perforated membranes support improved tenocyte migration into CG scaffolds, and that migration is enhanced by platelet-derived growth factor BB-mediated chemotaxis. CG core-shell composites fabricated with perforated membranes display scaffold-membrane integration with significantly improved tensile properties compared to scaffolds without membrane shells. Finally, we show that perforated membrane-scaffold composites support sustained tenocyte metabolic activity as well as improved cell infiltration and reduced expression of hypoxia-inducible factor 1α compared to composites with nonperforated membranes. These results will guide the design of improved biomaterials for tendon repair that are mechanically competent while also supporting infiltration of exogenous cells and other extrinsic mediators of wound healing.

  20. A late diagnosed case of Spontaneous esophageal perforation in an elderly patient.

    PubMed

    Wei, Lu; Wang, Fei; Chen, Shuyan

    2015-01-01

    Spontaneous esophageal perforation, also known as Boerhaave's syndrome, is a rare but potentially life-threatening condition, especially in elderly patients with more complications, speedy development and higher mortality. Successful handling of the disease depends on a timely diagnosis and the appropriate choice of treatment. Unfortunately, late diagnosis is common because of the non-specific clinical presentation. We here present a 72-year-old patient of spontaneous esophageal perforation who complained of chest pain, but sharply deteriorated with septic shock. With a vomiting history and gastrointestinal-genic bacterium identified in the chest fluid, the patient was highly suspected for esophageal perforation, though the oral methylene blue test was negative for three times. The diagnosis was finally established by esophagoscopy on the 10(th) day. The perforation was successfully healed by active conservative management and the patient was discharged home on the 43(rd) day eating normal diet.

  1. An unusual cause of abdominal distension: intraperitoneal bladder perforation secondary to intermittent self-catheterisation.

    PubMed

    Martin, Jennifer; Convie, Liam; Mark, David; McClure, Mark

    2015-02-25

    We report a strikingly unusual case of traumatic intraperitoneal perforation of an augmented bladder from clean intermittent self-catheterisation (CISC), which presented a unique diagnostic challenge. This case describes a 48-year-old T1 level paraplegic, who had undergone clamshell ileocystoplasty for detrusor overactivity, presenting with abdominal distension, vomiting and diarrhoea. Initial investigations were suggestive of disseminated peritoneal malignancy with ascitic fluid collections, but the ascitic fluid was found to be intraperitoneal urine from a perforation of the urinary bladder. This was associated with an inflammatory response in the surrounding structures causing an appearance of colonic thickening and omental disease. Although the diagnostic process was complex due to this patient's medical history, the treatment plan initiated was non-operative, with insertion of an indwelling urinary catheter and radiologically guided drainage of pelvic and abdominal collections. Overdistension perforations of augmented urinary bladders have been reported, but few have described perforation from CISC.

  2. Peritonitis Following Duodenal Ulcer Perforation in a Newborn: A Case Report

    PubMed Central

    Amouei, Abdolhamid; Ehsani, Fatemeh; Tabatabaei, Seyed Mostafa; Ghodratipour, Zahra

    2016-01-01

    Duodenal ulcer is an uncommon condition in children, that is why it is not usually considered as the differential diagnosis unless it presents with complications including perforation and haemorrhage. Moreover, duodenal ulcer perforation is an uncommon entity in paediatric age group. Early diagnosis and treatment is crucial in order to improve survival. A three-day-old male neonate was admitted to our hospital because of abdominal distension. The neonate was lethargic. He underwent laparotomy. There was a perforated ulcer, 5×5mm in size, on the anterior aspect of the first part of the duodenum. The perforated ulcer was closed with a single layer. Six-month follow-up revealed no abnormality. PMID:28050434

  3. An unusual and fatal case of upper gastrointestinal perforation and bleeding secondary to foreign body ingestion.

    PubMed

    Barranco, Rosario; Tacchella, Tiziana; Lo Pinto, Sara; Bonsignore, Alessandro; Ventura, Francesco

    2016-07-01

    We report a fatal case of gastrointestinal perforation and hemorrhage secondary to the ingestion of a foreign body. While engaged in an amateur futsal competition, an apparently healthy young man suddenly collapsed and his respiration ceased. Autopsy revealed a 3-mm circular perforation on the gastric wall fundus with a significant amount of clotted blood within the gastric lumen. On inspection, a foreign body consisting of a bristle-like hair, later identified via electron microscopy to be a cat vibrissa, i.e. a whisker, was found along the perforation margin. Thus, the inadvertent ingestion of fine, sharp objects (even a cat whisker) can lead to gastric perforation and bleeding, which might prove fatal under given circumstances.

  4. Erratum: Secondary reconstruction of vaginal stenosis using a posterior labial perforator based Falandry flap

    PubMed Central

    2016-01-01

    This erratum corrects article: “Secondary reconstruction of vaginal stenosis using a posterior labial perforator based Falandry flap”, The Pan African Medical Journal. 2015;21:185. doi:10.11604/pamj.2015.21.185.6559. PMID:27377057

  5. Radicular Perforation Repair with Mineral Trioxide Aggregate: A Case Report with 10-Year Follow-up

    PubMed Central

    Cosme-Silva, Leopoldo; Carnevalli, Breno; Sakai, Vivien Thiemy; Viola, Naiana Viana; Franco de Carvalho, Leon; Franco de Carvalho, Elaine Manso Oliveira

    2016-01-01

    Background: Iatrogenic complications such as accidental perforation of the root or the floor of the pulp chamber may occur. Case Report: Patient was referred for root canal retreatment of the mandibular left second molar with periapical lesion evidenced through radiographic examination. During post removal, iatrogenic perforation occurred at the mesial face of the distal root. After clinical localization of the perforation and bleeding control, MTA was applied. In a second appointment, the root canal filling was removed and the chemical-surgical retreatment of the canals was performed, followed by the obturation with gutta-percha and sealer. Patient returned after three days reporting no pain. After 6 months, 3, 7 and 10 years of follow-up. Conclusion: Absence of pain, normal periodontal probing and lack of radiolucent area at the region of perforation and the periapices were detected, which evidenced the successful repair of the tooth. PMID:28217189

  6. Microsurgical confirmation of perforating arteries arising from the fundus of a posterior communicating artery aneurysm.

    PubMed

    Reynolds, Matthew R; Roland, Jarod L; Kamath, Ashwin A; Cross, DeWitte T; Dacey, Ralph G

    2015-07-01

    Perforating arteries rarely project from the fundus of an aneurysm. We present the case of a 35-year-old woman who was found to have a right posterior communicating artery (PCOM) aneurysm via catheter angiography. Superselective microcatheter angiography revealed that perforating arteries arose from the aneurysm fundus that supplied the anterolateral thalamus. Microsurgical exploration confirmed several small perforating arteries arising from the aneurysm dome as well as an atretic distal PCOM artery. Given the complex anatomy, the lesion was unsuitable for clipping. We propose that this aneurysm represents a developmental variant whereby the proximal PCOM artery becomes atretic and terminates in PCOM perforators. The video can be found here: http://youtu.be/iDcp9fsDjq4.

  7. Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties.

    PubMed

    Ma, Shaocheng; Goh, En Lin; Jin, Andi; Bhattacharya, Rajarshi; Boughton, Oliver R; Patel, Bhavi; Karunaratne, Angelo; Vo, Nghia T; Atwood, Robert; Cobb, Justin P; Hansen, Ulrich; Abel, Richard L

    2017-03-06

    Osteoporosis is characterised by trabecular bone loss resulting from increased osteoclast activation and unbalanced coupling between resorption and formation, which induces a thinning of trabeculae and trabecular perforations. Bisphosphonates are the frontline therapy for osteoporosis, which act by reducing bone remodelling, and are thought to prevent perforations and maintain microstructure. However, bisphosphonates may oversuppress remodelling resulting in accumulation of microcracks. This paper aims to investigate the effect of bisphosphonate treatment on microstructure and mechanical strength. Assessment of microdamage within the trabecular bone core was performed using synchrotron X-ray micro-CT linked to image analysis software. Bone from bisphosphonate-treated fracture patients exhibited fewer perforations but more numerous and larger microcracks than both fracture and non-fracture controls. Furthermore, bisphosphonate-treated bone demonstrated reduced tensile strength and Young's Modulus. These findings suggest that bisphosphonate therapy is effective at reducing perforations but may also cause microcrack accumulation, leading to a loss of microstructural integrity and consequently, reduced mechanical strength.

  8. Transanal presentation of a distal ventriculoperitoneal shunt catheter: Management of bowel perforation without laparotomy

    PubMed Central

    Bales, James; Morton, Ryan P.; Airhart, Nathan; Flum, David; Avellino, Anthony M.

    2016-01-01

    Background: Bowel perforation is a serious but rare complication after a ventriculoperitoneal shunt (VPS) procedure. Prior studies have reported spontaneous bowel perforation after VPS placement in adults of up to 0.07%. Transanal catheter protrusion is a potential presentation of VPS bowel perforation and places a patient at risk for both peritonitis and ventriculitis/meningitis via retrograde migration of bacteria. This delayed complication can be fatal if unrecognized, with a 15% risk of mortality secondary to ventriculitis, peritonitis, or sepsis. Case Description: We describe a unique case of a patient with distal VPS catheter protrusion from the anus whose bowel perforation did not cause clinical sequelae of infection. We were able to manage the patient without laparotomy. Conclusions: A subset of patients can be managed without laparotomy and only with externalization of the ventricular shunt with antibiotics until the cerebrospinal fluid cultures finalize without growth. PMID:28194303

  9. Linear and radial flow targets for characterizing downhole flow in perforations

    SciTech Connect

    Deo, M. ); Tariq, S.M. ); Halleck, P.M. )

    1989-08-01

    Two types of sandstone targets are commonly used to test flow efficiency of shaped-charge jet perforations: linear targets, in which flow enters only the unperforated end of the cylindrical sample, and radial targets, in which flow enters through the end and sides of the sample. To determine which of these targets best represents downhole conditions, the flow distribution along the length of a perforation has been studied by three-dimensional (3D) finite-element analyses. Linear and radial laboratory targets have been compared with downhole perforations under varying conditions. For ideal perforations, the low-shot-density (LSD) case is adequately represented by the radial target, while the high-shot-density (HSD) case falls between the two targets. With realistic crushed and damaged zones, the HSD closely matches the linear target, and the LSD case falls between the two targets.

  10. Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease.

    PubMed

    Subasinghe, Duminda; Udayakumara, Edippuli Arachchige Don; Somathilaka, Upul; Huruggamuwa, Milinda

    2016-01-01

    Background. Spontaneous perforation of the extrahepatic biliary system is a rare presentation of gall stones. Very few cases of bile duct perforation have been reported in adults. It is rarely suspected or correctly diagnosed preoperatively. Case Presentation. A 66-year-old female presented at the surgical emergency with 3 days' history of severe upper abdominal pain with distension and repeated episodes of vomiting, as she had evidence of generalized peritonitis and underwent an exploratory laparotomy. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct. A cholecystectomy and the CBD exploration were performed. Conclusion. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones in adults. Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management.

  11. Peritonitis Following Duodenal Ulcer Perforation in a Newborn: A Case Report.

    PubMed

    Amouei, Abdolhamid; Ehsani, Fatemeh; Zarch, Mojtaba Babaei; Tabatabaei, Seyed Mostafa; Ghodratipour, Zahra

    2016-11-01

    Duodenal ulcer is an uncommon condition in children, that is why it is not usually considered as the differential diagnosis unless it presents with complications including perforation and haemorrhage. Moreover, duodenal ulcer perforation is an uncommon entity in paediatric age group. Early diagnosis and treatment is crucial in order to improve survival. A three-day-old male neonate was admitted to our hospital because of abdominal distension. The neonate was lethargic. He underwent laparotomy. There was a perforated ulcer, 5×5mm in size, on the anterior aspect of the first part of the duodenum. The perforated ulcer was closed with a single layer. Six-month follow-up revealed no abnormality.

  12. [Reconstruction of an abdominal wall defect with a superior epigastric perforator propeller flap: case report].

    PubMed

    Lepivert, J-C; Alet, J-M; Michot, A; Pélissier, P; Pinsolle, V

    2014-10-01

    Perforators flaps take a special place in reconstructive surgery. These flaps can be dissected and turned as a propeller blade on its pedicule axis. We report the case of a 54-year-old man presenting a recurrence of a dermatofibrosarcoma in the right hypochondrium. Tumor resection caused a large abdominal wall defect taking the anterior aponeurosis of the rectus abdominis. An angioscanner was realized in preoperative to locate the perforators of the deep superior epigastric artery. We realized a propeller flap based on a perforator of the left superior epigastric artery who allowed to cover the wall defect. We set up a patch of Vicryl® to reconstruct the aponeurosis plan at the same operative time. We didn't note any necrosis and complete healing occurred in 2 weeks. The margins were healthy. The cosmetic result and the low morbidity make this flap a good therapeutic option. This flap seems reliable, arteries perforators are constant with good diameter.

  13. [Gastric metastasis from ovarian carcinoma revealed by a gastro-splenic perforation].

    PubMed

    Dupuychaffray, Jean-Pierre; Auger, Christine; Funes De La Vega, Mathilde; Riche, Agnès; Boulanger, Vincent; Blanchot, Philippe

    2004-05-01

    Metastatic disease involving the stomach is unusual. We report the case of a gastric metastasis from ovarian cancer revealed by gastro-splenic perforation. The gastric metastasis was diagnosed 17 years after the diagnosis of primary cancer.

  14. Cyanoacrylate repair of laser in situ keratomileusis corneal flap perforation by a snake bite.

    PubMed

    Korn, Bobby S; Korn, Tommy S

    2005-11-01

    A 30-year-old man who had laser in situ keratomileusis (LASIK) for myopia 1 year earlier developed a corneal perforation in the left eye from a boa constrictor. The patient presented to the emergency room, and a small corneal perforation just outside the visual axis was diagnosed within the LASIK flap. Cyanoacrylate adhesive was used to close the corneal perforation. The patient went on to full visual recovery with an uncorrected visual acuity of 20/20. This is the first reported case of a penetrating corneal injury from a serpent in an eye that had LASIK. Cyanoacrylate may be used to repair small traumatic corneal perforations with a favorable visual outcome in eyes that have had LASIK.

  15. Delayed presentation of uterine perforation with ovary migration after dilatation and curettage.

    PubMed

    Su, Shili; Tao, Guowei; Dong, Baihua; Shi, Linlin; Dong, Jianchun

    2015-01-01

    We present a rare but serious uterine perforation. A 31-year-old woman was referred to our department for hyperechogenic mass in uterus on ultrasonography after Dilation and curettage (D&C) for the adherent placenta and retained products of conception. Transvaginal ultrasound examination showed that a mass with several follicles measuring 35×29 mm was seen emanating from the right posterior wall of the uterine cavity, and there was absence of the myometrial tissue. A hysteroscopy and laparoscopy showed a uterine perforation with ovary incarceration. The ovary was rehabilitated, and the uterine perforation site was incised. D&C can not be performed when delayed presentation of uterine perforation with migration of an extrauterine organ is suspected, particularly, some of them are asymptomatic after a difficult intrauterine operation.

  16. Veiled right kidney sign in retroperitoneal duodenal perforation after endoscopic retrograde cholangiopancreatography.

    PubMed

    Banerji, John Samuel

    2011-08-01

    Retropneumoperitoneum due to duodenal perforation after endoscopic retrograde cholangiopancreatography is rare. Recognizing the presence of free air, which outlines the right kidney, is essential for its early diagnosis and appropriate management.

  17. Common Post-Op Ear Drops Tied to Eardrum Perforations in Kids

    MedlinePlus

    ... gov/news/fullstory_164372.html Common Post-Op Ear Drops Tied to Eardrum Perforations in Kids Rate ... 2017 (HealthDay News) -- Children who suffer through multiple ear infections are often candidates for ear tube surgery. ...

  18. Gastrointestinal perforation: relation to corticosteroid use and COPD – a case report

    PubMed Central

    Nguyen, Michael H.K.; Isaac, Krista M.; Dougherty, Rebecca

    2016-01-01

    Gastrointestinal perforations are a complication of 2–10% of duodenal ulcers. There are a variety of etiologies associated with duodenal ulcer formation and its complications. Corticosteroid use is associated with an increased risk of duodenal ulcer perforation, with the first documented case in 1950. Other important medications associated with perforation include NSAIDS and opioids. Beyond medication, one of the most common disease processes, chronic obstructive pulmonary disease (COPD), has been found to be associated with peptic ulcer disease. Up to 30% of COPD patients have been found to have peptic ulcers, and COPD frequency in peptic ulcer disease is 2–3 times the general population. We herein present a case of an acute duodenal ulcer perforation in a patient receiving corticosteroid treatment for an acute COPD exacerbation. PMID:27609727

  19. Tectonic deep anterior lamellar keratoplasty in impending corneal perforation using cryopreserved cornea.

    PubMed

    Jang, Ji Hye; Chang, Sung Dong

    2011-04-01

    We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS® solution at -70℃ for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis.

  20. Precautions in using a perforator free flap to treat mandibuloacral dysplasia--a case report.

    PubMed

    Hallock, Geoffrey G

    2014-05-01

    Mandibuloacral dysplasia (MAD) is a rare form of inherited lipodystrophy. The type B pattern is characterized by a generalized absence of subcutaneous tissues. There is also a deficiency of perivascular adiposity that makes the dissection not only of perforators and their source vessels difficult, but the recipient site vasculature as well. Perforator flaps in the MAD patient by definition will never be bulky, and instead a challenge in every respect as the perforators are extremely diminutive and therefore fragile. However, if a large, thin flap with a long pedicle of reasonable caliber is indicated, the attributes of a perforator flap may still be indicated as demonstrated in this case report for a recalcitrant heel pressure sore that had failed the usual conservative medical treatment.