1/4. Perforation due to ileocaecal tuberculosis.A 40-year-old male patient was admitted in the intensive care Unit with complicated pulmonary tuberculosis. After 4 days he developed an acute abdomen with free air as demonstrated on plain abdominal films. A laparotomy was performed and an ileal perforation was found, located just before the ileocaecal valve. A right hemicolectomy was carried out and the resected specimen was send for further patho-anatomical examination. Our suspicion of ileocaecal perforation due to tuberculosis was confirmed. Despite further extensive medical treatment, the patient died 15 days after admission to the hospital. At autopsy, the cause of death was confirmed as being due to fulminant pulmonary tuberculosis.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
2/4. A penny for your thoughts: small bowel obstruction secondary to coin ingestion.We report a case of small bowel obstruction secondary to coin ingestion. A 22-year-old woman presented to the Emergency Department (ED) with a 3-week history of abdominal pain. Upon initial history the patient denied any foreign body ingestion. Only after computed tomography (CT) scanning of the abdomen and pelvis did the patient admit to deliberate ingestion of a single united states penny coin. During surgical evaluation it was found that the coin had lodged near the ileocecal valve and an inflammatory mass had formed around the intraluminal coin, causing a 10 x 7 cm fibrous tumor to completely obstruct the small bowel. It is thought that oxidation of the coin, with subsequent exposure of its high zinc content, instigated the inflammatory cascade.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
3/4. intestinal obstruction from a forgotten artery forceps: a case report.A 43-year-old multiparous patient p2 0 all alive who had abdominal hysterectomy secondary to ruptured uterus 2 1/2 years prior to presentation, was seen with acute (surgical) abdomen. An artery forceps was seen on plain abdominal X-ray and subsequent laparotomy revealed gangrenous ileum. The entire length of the ileum was involved, including the ileocecal valve and part of the cecum. The patient had limited right hemicolectomy and anastomosis of the distal part of the jejunum with the proximal section of the transverse colon. The post-operative period was uneventful and she was discharged to outpatient clinic 2 weeks post operatively.- - - - - - - - - - ranking = 1keywords = valve (Clic here for more details about this article) |
4/4. Combination of "patch, drain, and wait" and home total parenteral nutrition for midgut volvulus with massive ischemia/necrosis.The successful use of a combination of "patch, drain, and wait" (PDW) and home total parenteral nutrition (TPN) in the management of a case of acute, catastrophic midgut volvulus in a 2-year-11-month-old boy with near-total ischemia/necrosis of his small intestine is reported. The PDW approach to the highly effective management of acute midgut ischemia/necrosis in infancy and childhood (necrotizing enterocolitis and midgut volvulus) involves maximum gut salvage by avoidance of resection, stoma formation, or both through the use of extensive peritoneal cavity drainage by Penrose drains, TPN, and broad-spectrum antibiotics. The extensive peritoneal drainage fosters capture of enteric fistulas with the formation of enterostomies at drain exit sites, while adhesions and ischemia/inflammation-induced hypervascular obliteration of the peritoneal cavity diminish the potential for peritonitis (no peritoneal cavity, no peritonitis) and facilitate impressive salvage of seemingly hopelessly lost ischemic/necrotic gut (a simulation of the in utero ischemic gut process leading to atresias and some varying, but generally mild, gut loss) while simultaneously contributing to the resorption of absolutely non-salvageable gut and the creation of a remarkably clean and adhesion-free peritoneal cavity resembling that of a newborn infant with midgut intestinal atresia.- - - - - - - - - - ranking = 2.7745873072646keywords = atresia (Clic here for more details about this article) |