1/80. Multiple intestinal ulcerations and perforations secondary to methicillin-resistant staphylococcus aureus enteritis in infants.PURPOSE: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. methods: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. RESULTS: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of gram-positive cocci. (4) methicillin-resistant staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. CONCLUSIONS: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/80. Acute abdomen and lupus enteritis: thrombocytopenia and pneumatosis intestinalis as indicators for surgery.Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enteric complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complicated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pneumatosis intestinalis. These findings suggested necrotizing enteritis and prompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis, and submucosal vasculitis were present in the resected specimen. Persistent SLE activity responded to cyclophosphamide, which is indicated in patients with digestive symptoms who fail to respond to high-dose steroids.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
3/80. Ileal duplication presenting as perforation: report of a case.We describe herein the case of a 10-year-old boy in whom generalized peritonitis was caused by perforation of a tubular communicating ileal duplication cyst. Alimentary tract duplication cysts are rare congenital malformations, found primarily in children under the age of 15 years. The perforation was caused by heterotopic gastric mucosa within the duplication, giving rise to peptic ulceration in the adjacent intestinal mucosa. The presence of heterotopic gastric tissue is a primary cause of perforation that has been reported in as many as one third of patients with small intestine duplications; however, the detection of such ectopic tissue is time-consuming, and there is no readily available method of diagnosing tubular duplications. Although very few patients present with peritonitis as the initial manifestation, the possibility should be borne in mind when diagnosing and planning therapy for such emergencies, particularly in children.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
4/80. mucocele of the appendix secondary to endometriosis. Report of two cases, one with localized pseudomyxoma peritonei.This report documents 2 cases of obstructive mucocele of the appendix secondary to endometriosis of the appendix. In 1 case, the tip of the mucocele was ruptured and associated with localized pseudomyxoma peritonei. Mucoceles of the appendix usually are associated with hyperplastic or neoplastic mucosal proliferation; obstruction, particularly that due to endometriosis, is an infrequent cause. Occurrence of localized pseudomyxoma peritonei associated with appendiceal endometriosis and mucocele has not been reported previously.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
5/80. Colonic perforation associated with slow-release diclofenac sodium.upper gastrointestinal tract complications due to non-steroidal anti-inflammatory drugs are well recognised. However, adverse effects on large intestinal mucosa are less common and less well recognised, even though they carry a significant morbidity and mortality. Here we report a case of colonic perforation in a healthy woman without any underlying colonic pathology associated with ingestion of slow release diclofenac sodium.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
6/80. Rectal carcinoma with stercoral ulcer perforation.We report a case of ruptured stercoral ulceration due to chronic constipation which is caused by rectal carcinoma. This case suffered from difficulty of stool passage for 5 months. Periumbilical pain and current-jelly stool were experienced before his admission. physical examination revealed diffuse abdominal rebounding pain and laboratory data showed leukocytosis. Computed tomography demonstrated marked dilatation of the sigmoid colon with stool impaction due to neoplastic growth in the rectosigmoid junction. Thickening and edematous change of the colonic wall were noted. There was amorphous material with gas in the mesocolon, which indicated fecal peritonitis. Emergent operation with Hartman's procedure and left colostomy was performed. Diffuse pressure gangrene of the sigmoid colon wall with a perforating hole was identified. Pathologically, the resected colon specimen showed non-specific-acute and chronic inflammatory change. The perforating hole was surrounded by a necrotic border of ulcerative mucosa. After the operation, pelvic drainage was undertaken for 1 month and then the patient was discharged uneventfully.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
7/80. churg-strauss syndrome with perforating ulcers of the colon.We report a case of a 72-year-old woman with churg-strauss syndrome, who presented with intestinal perforation. She has had bronchial asthma with peripheral blood eosinophilia for 30 years. Gross findings of a resected colon showed multiple ulcers with perforation. Histologic findings demonstrated transmural inflammation infiltrated with large numbers of eosionophils, neutrophils and lymphoplasma cells, and characteristic extravascular granuloma in the subserosa. There were multifocally-distributed transmural vasculitis showing all stages of activity in medium and small-sized arteries and veins located in the submucosa, and proper muscle and subserosal layers of the colon, some of which revealed granulomatous inflammation. Histologic finding of liver showed chronic viral hepatitis B with mild inflammatory activity and macronodular cirrhosis. Immunohistochemical findings, acid fuschin orange G staining and electromicroscope found no evidence of hepatitis b virus infection contributing to the pathogenesis of this lesion.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
8/80. Laparoscopic-assisted coloscopic polypectomy.PURPOSE: patients with colorectal polyps often display a large kink or distinct mucosal fold in the area where the polypectomy is to take place. As a result, there is a higher risk of perforation or partial ablation during an endoscopic polypectomy. Is it safer to perform an endoscopic polypectomy using the control and assistance of a laparoscope? Can a segment resection of the colon that would otherwise be necessary be avoided? methods: An endoscopic polypectomy using a laparoscope was conducted on six patients whose colorectal polyps were in an anatomically unfavorable location. The need for an open or laparoscopic segment resection or colotomy was indicated in all cases. The growth was located in the rectosigmoidal transition in five patients and in the region of the left flexure in one patient. We decided that an endoscopic polypectomy using the assistance of a laparoscope would be the most comfortable and technically elegant method, as well as easy. Except the well-known risks of laparoscopy and endoscopic polypectomy, no other risks have been seen in our patients. The affected area of the colon, the sigma, and the left flexure were mobilized and stretched as much as possible to enable a simultaneous and low-risk endoscopic polypectomy. In one case, we had to conduct a fractionated ablation because of a very wide-based finding. RESULTS: The operation averaged 57 minutes, and no operation-specific complications were observed. Postoperative recovery in the hospital was very short and averaged 2.5 days. The histopathologic findings were benign in all cases, but a serious dysplasia was diagnosed in one patient. CONCLUSIONS: The laparoscopic-assisted polypectomy is a safe method to remove even complicated polyps in anatomically unfavorable locations.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
9/80. Delayed colon perforation after palliative treatment for rectal carcinoma with bare rectal stent: a case report.In order to relieve mechanical obstruction caused by rectal carcinoma, a bare rectal stent was inserted in the sigmoid colon of a 70-year-old female. The procedure was successful, and for one month the patient made good progress. She then complained of abdominal pain, however, and plain radiographs of the chest and abdomen revealed the presence of free gas in the subdiaphragmatic area. Surgical findings showed that a spur at the proximal end of the bare rectal stent had penetrated the rectal mucosal wall. After placing a bare rectal stent for the palliative treatment of colorectal carcinoma, close follow-up to detect possible perforation of the bowel wall is necessary.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
10/80. Multiple perforated ulcers of the small intestine associated with allergic granulomatous angiitis: report of a case.Although allergic granulomatous angiitis (AGA) is occasionally associated with gastrointestinal lesions, multiple perforated ulcers of the gastrointestinal tract are uncommon. We report herein a case of AGA associated with multiple perforated ulcers that erupted in the small intestine during corticosteroid therapy. A 31-year-old Japanese man was admitted to our hospital with epigastralgia, edema of the bilateral lower extremities, and general malaise. He had a persistent high fever, abdominal pain, and watery diarrhea. Laboratory data showed remarkable eosinophilia. The abdominal pain became exacerbated after the administration of oral prednisolone. physical examination indicated positive signs of peritoneal irritation in the entire abdomen, and abdominal computed tomography scanning showed intra-abdominal free air, suggesting generalized peritonitis due to intestinal perforation. laparotomy revealed multiple perforated ulcers in the jejunum and ileum. Histological examination indicated remarkable eosinophilic infiltration in the surrounding area of the small arteries and arterioles located in the submucosal layer, which was compatible with AGA. Although the association of intestinal perforation with AGA is relatively infrequent, intensive perioperative management is essential to ensure a favorable clinical outcome, particularly during the period on corticosteroid therapy.- - - - - - - - - - ranking = 0.5keywords = mucosa (Clic here for more details about this article) |
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