scholarly journals An unusual case of caecal perforation following ileostomy reversal

2019 ◽  
Vol 12 (8) ◽  
pp. e229961 ◽  
Author(s):  
Gamze Aksakal ◽  
Suat Ng ◽  
Vinna An
Keyword(s):  
Unusual Case ◽  
Bowel Perforation ◽  
Loop Ileostomy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Colonic Perforation ◽  
Emergency Laparotomy ◽  
Ileostomy Reversal ◽  
History Of ◽  
Long Course ◽  
Caecal Perforation

A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.

scholarly journals A case report: spontaneous postpartum rupture of unscarred uterus

2018 ◽  
Vol 7 (8) ◽  
pp. 3420
Author(s):  
Swati Singh ◽  
Ravinder Ahlawat
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Emergency Laparotomy ◽  
Full Thickness ◽  
Uterine Incision ◽  
History Of ◽  
Rupture Of Uterus ◽  
Specific Symptoms

Rupture of uterus is characterized by a breach in the wall of the uterus involving its full thickness. An unscarred uterus rupture is uncommon. It has non-specific symptoms and presentation differs according to site and time of rupture. Authors report an unusual case of spontaneous rupture of unscarred uterus. A 32-year-old, pregnant woman, developed postpartum bleeding with no history of prior uterine incision. She was diagnosed as a case of rupture of uterus and emergency laparotomy was done. Early diagnosis and immediate surgical intervention may significantly improve the prognosis. Differential diagnosis of uterine rupture should always be kept in mind in all patients with or without risk factors.

scholarly journals An unusual haemorrhagic complication of an anastomotic leak and a novel method of controlling the haemorrhage

2017 ◽  
Vol 99 (3) ◽  
pp. e116-e119 ◽  
Author(s):  
S Martin ◽  
A Armstrong
Keyword(s):  
Anastomotic Leak ◽  
Loop Ileostomy ◽  
Prolonged Release ◽  
Foreign Object ◽  
Haemorrhagic Complication ◽  
Ileostomy Reversal ◽  
Anal Bleeding ◽  
History Of ◽  
Novel Method ◽  
Cook Medical

Introduction Restorative proctocolectomy (RP) is undertaken for patients with familial adenomatous polyposis (FAP) and ulcerative colitis, but is associated with a risk of anastomotic leak. Case history A 20-year-old male with a family history of FAP had a RP with a double-stapled J-pouch and covering loop ileostomy. At ileostomy reversal 21 months later, he presented with significant anal bleeding. He proceeded to theatre for endoscopy. Pouchoscopy showed a pouch full of blood and a foreign object trapped in a diverticulum. The foreign object (an undigested tablet) was removed with grasping forceps and the bleeding spot identified. Hemospray® (Cook Medical, Winston-Salem, NC, USA) was deployed in the bleeding cavity to enable immediate control of haemorrhage. Recovery was uneventful and he was discharged home 72 hours later. Conclusions This case: (i) demonstrates a successful and novel method of controlling haemorrhage not amenable to use of conventional haemostatic mechanisms; (ii) highlights the potential problems of using prolonged-release medications in patients with gastrointestinal strictures/diverticulae.

Free Colonic Perforation in a Patient With Crohn's Disease and Loop Ileostomy: Report of a Case

2011 ◽  
Vol 96 (2) ◽  
pp. 159-161 ◽  
Author(s):  
Soichiro Ishihara ◽  
Toshiaki Watanabe ◽  
Hirokazu Nagawa
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Rare Complication ◽  
Bowel Perforation ◽  
Loop Ileostomy ◽  
Disease Patient ◽  
Perianal Abscess ◽  
Colonic Perforation ◽  
Fecal Diversion ◽  
Unusual Complication

Abstract Free bowel perforation in Crohn's disease is a relatively rare complication. In this report, we present a case of free colonic perforation in a Crohn's disease patient with loop ileostomy previously constructed for intractable perianal abscess. Normally, fecal diversion by ileostomy results in an improvement in Crohn's colitis. However, in some cases, fecal diversion is reported to adversely affect the inflammation of the diverted bowel, and it is this unusual complication of Crohn's disease that we discuss here.

scholarly journals Spontaneous bowel perforation in the setting of colonic involvement with scleroderma

2020 ◽  
Vol 13 (1) ◽  
pp. e233220
Author(s):  
Weronika Stupalkowska ◽  
Betania Mahler-Araujo ◽  
John Bennett ◽  
Stavros Gourgiotis
Keyword(s):  
Bowel Perforation ◽  
Multiorgan Failure ◽  
Colonic Perforation ◽  
Source Control ◽  
Emergency Laparotomy ◽  
Colonic Involvement ◽  
Abdominal Symptoms ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Physiological Reserve

Here we present a rare case of spontaneous colonic perforation in a middle-aged woman affected by systemic sclerosis (SSc). In spite of maximal medical support and prompt emergency laparotomy for source control the patient died due to multiorgan failure within 48 hours of admission. This case emphasises that although rarely, patients with scleroderma can present with colonic perforation which unfortunately due to their decreased physiological reserve, can lead to rapid and irreversible deterioration and subsequent death. It is therefore essential that clinicians faced with abdominal symptoms and signs in patients affected by SSc are able to quickly differentiate acute visceral perforation from benign causes.

scholarly journals Bowel Obstruction and Perforation as Emergency Presenting Sign of Colorectal Cancer with Peritoneal Carcinomatosis: A Case Report and Review

2020 ◽  
Vol 21 (3) ◽  
pp. 235-240
Author(s):  
Randy Adiwinata ◽  
Linda Rotty ◽  
Michael Tendean ◽  
Bradley Jimmy Waleleng ◽  
Fandy Gosal ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Peritoneal Carcinomatosis ◽  
Bowel Obstruction ◽  
Large Bowel ◽  
Bowel Perforation ◽  
Colorectal Cancer Patient ◽  
Large Bowel Obstruction ◽  
Emergency Laparotomy ◽  
History Of ◽  
Colorectal Cancer Patients

Colorectal cancer patient may present with variable clinical presentation. In few cases, colorectal cancer may present as emergency such as uncontrollable gastrointestinal bleeding, large bowel obstruction and in rarer fashion is bowel perforation. Worse prognosis is linked with emergency presenting colorectal cancer. Peritoneal carcinomatosis may occur in 10-35% of colorectal cancer patients and may develop bowel obstruction along with the primary colorectal cancer. Here, we report a-62-year-old man presented with large bowel obstruction leading to perforation without known history of colorectal cancer before. On emergency laparotomy, we found colorectal cancer and peritoneal carcinomatosis as the underlying cause. Prompt diagnosis and urgent management is warranted to improve the prognosis.

scholarly journals Faecopneumothorax due to missing diaphragmatic hernia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Resul Nusretoğlu ◽  
Yunus Dönder
Keyword(s):  
Computed Tomography ◽  
Diaphragmatic Hernia ◽  
Colon Resection ◽  
Emergency Laparotomy ◽  
Hernia Sac ◽  
Case Presentation ◽  
Abdominal Tenderness ◽  
History Of ◽  
Diaphragmatic Hernias ◽  
Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

Extended duration of faecal diversion is associated with increased ileus upon loop ileostomy reversal

2021 ◽  
Author(s):  
Keegan Guidolin ◽  
Flora Jung ◽  
Richard Spence ◽  
Fayez Quereshy ◽  
Sami Chadi
Keyword(s):  
Loop Ileostomy ◽  
Ileostomy Reversal ◽  
Faecal Diversion ◽  
Extended Duration

scholarly journals A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

2019 ◽  
Vol 12 (5) ◽  
pp. e228050
Author(s):  
Andrew James Brown ◽  
Thomas Whitehead-Clarke ◽  
Vera Tudyka
Keyword(s):  
Small Bowel ◽  
Bowel Perforation ◽  
Linear Structure ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Small Bowel Perforation ◽  
Chicken Bone ◽  
Abdomen Ct ◽  
Distal Migration ◽  
The Right

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!

A Case of Multiple Chemical Sensitivities: Cognitive Therapy for Somatization Disorder and Metaworry

2003 ◽  
Vol 17 (3) ◽  
pp. 267-277 ◽  
Author(s):  
Scott Temple
Keyword(s):  
Cognitive Therapy ◽  
Unusual Case ◽  
Clinical Presentation ◽  
Somatization Disorder ◽  
Case Conceptualization ◽  
Marital Problems ◽  
Multiple Chemical Sensitivities ◽  
Common Clinical Presentation ◽  
History Of ◽  
Multiple Chemical

“Multiple chemical sensitivities” has become an increasingly common clinical presentation to physicians, though it is infrequently seen by psychotherapists. This case report describes a 61-year-old woman who presents with a long history of chemical sensitivities, that led to a somatization disorder with debilitating agoraphobia, depression, and marital problems. Features of a variety of anxiety disorders are present, as are metacognitions that required an unusual case conceptualization. A cognitive therapy case conceptualization and treatment are described, which address the highly idiosyncratic clinical presentation of this patient.

Unusual case of hyperemesis in a pregnant patient with prior antireflux surgery

2021 ◽  
Vol 14 (8) ◽  
pp. e241935
Author(s):  
Abimbola Obisesan ◽  
Eleanor Lucy Townsend ◽  
John Lin Hieng Wong ◽  
Vinod Menon
Keyword(s):  
Decision Making ◽  
Abdominal Pain ◽  
Antireflux Surgery ◽  
Unusual Case ◽  
Nissen Fundoplication ◽  
Hyperemesis Gravidarum ◽  
Pregnant Patient ◽  
Emergency Laparotomy ◽  
Laparoscopic Nissen ◽  
Upper Abdominal

A 33-year-old, 8 weeks pregnant, presented with severe upper abdominal pain with vomiting on a background of a previous laparoscopic Nissen fundoplication for reflux disease. An urgent MRI had shown herniation of the fundoplication wrap through the diaphragmatic hiatus. The cause of her symptoms was attributed to hyperemesis gravidarum. The plan was to manage this patient conservatively until the conclusion of her pregnancy. This plan was revised when she presented for the second time and developed worsening pain and haematemesis. An emergency gastroscopy showed ischaemic changes in most of the stomach requiring the patient to undergo an emergency laparotomy. In pregnant patients, presenting with abdominal pain, vomiting as well as haematemesis, having had previous antireflux surgery, incarceration of the stomach must be considered as a differential. Prompt assessment and early senior decision-making is extremely important in avoiding a potentially catastrophic outcome for such patients.

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