scholarly journals Spontaneous Pneumoperitoneum due to Constipation

2015 ◽  
Vol 9 (3) ◽  
pp. 361-365 ◽  
Author(s):  
Ippei Yamana ◽  
Tomoaki Noritomi ◽  
Shinsuke Takeno ◽  
Tatsuya Hashimoto ◽  
Keisuke Sato ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Exploratory Laparotomy ◽  
Mucosal Injury ◽  
Pertinent Literature ◽  
Free Air ◽  
Japanese Male ◽  
Spontaneous Pneumoperitoneum ◽  
Old Japanese ◽  
Colon And Rectum ◽  
Bowel Mucosa

We report a rare case of spontaneous pneumoperitoneum. An 82-year-old Japanese male patient was referred to our hospital because of constipation and abdominal pain. Abdominal computed tomography revealed a large amount of feces in the colon and rectum, and free air in the abdomen. Based on these findings, the patient was diagnosed with gastrointestinal perforation. Emergency exploratory laparotomy was performed. Neither perforation nor ischemic changes were recognized in the digestive tract. The patient's defecation was managed postoperatively until discharge on the 13th postoperative day. The authors assumed that free air, which was released after a mucosal injury due to the internal pressure caused by the presence of a large amount of feces in the colon and rectum, had penetrated the bowel wall through the bowel mucosa. We herein report the present case while also reviewing the pertinent literature.

scholarly journals Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takeshi Ueda ◽  
Tetsuya Tanaka ◽  
Takashi Yokoyama ◽  
Tomomi Sadamitsu ◽  
Suzuka Harada ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Abdominal Cavity ◽  
Vital Signs ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
Case Presentation ◽  
Free Air ◽  
Spontaneous Pneumoperitoneum ◽  
Upper Abdominal ◽  
Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

scholarly journals Protein C Gene Mutation in an Older Adult Patient with Clostridium perfringens Septicemia-Related Visceral Vein Thrombosis

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e171-e173
Author(s):  
Kiyoko Kanosue ◽  
Satomi Nagaya ◽  
Eriko Morishita ◽  
Masayoshi Yamanishi ◽  
Shinsaku Imashuku
Keyword(s):  
Gene Mutation ◽  
Clostridium Perfringens ◽  
Protein C ◽  
Later Life ◽  
Heterozygous Mutation ◽  
Protein C Deficiency ◽  
Vein Thrombosis ◽  
Thrombosis Risk ◽  
Japanese Male ◽  
Old Japanese

AbstractA 78-year-old Japanese male with Clostridium perfringens septicemia and cholecystitis was found to have thrombosis in the left branch of intrahepatic portal vein as well as superior mesenteric vein. Visceral vein thrombosis (VVT) in this case was associated with protein C deficiency, due to a heterozygous mutation, p. Arg185Met. Our experience emphasizes that VVT, or other thromboembolic events, may occur in later life, triggered by environmental thrombosis risk factors, together with underlying hereditary protein C gene mutation.

scholarly journals A rare benign genitourinary tumor in a Japanese male: urinary retention owing to aggressive angiomyxoma of the prostate

Rare Tumors ◽  
2010 ◽  
Vol 2 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Yugo Sawada ◽  
Fumio Ito ◽  
Hayakazu Nakazawa ◽  
Nobuhiko Tsushima ◽  
Hikaru Tomoe ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Urinary Retention ◽  
Bladder Neck ◽  
English Literature ◽  
Pathological Examination ◽  
Aggressive Angiomyxoma ◽  
Urethral Meatus ◽  
First Case ◽  
Japanese Male ◽  
Old Japanese

Close examination of a 67-year-old Japanese man, who complained of persistent nocturia, revealed that a semitransparent polypoid tumor had developed from the bladder neck to the prostatic urethra obstructing the internal urethral meatus, which resulted in excessive urinary retention and post-renal dysfunction. The tumor was resected by a transurethral procedure and a pathological examination of specimens revealed aggressive angiomyxoma (AAM) of the prostate. AAM usually develops in the intrapelvic and perineal organs of females. So far as we know, this is the second case of primary prostatic AAM reported in the English literature, and is the first case where the patient encountered urethral obstruction.

scholarly journals Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

2016 ◽  
Vol 98 (8) ◽  
pp. e197-e199 ◽  
Author(s):  
P Das ◽  
R Mukherjee ◽  
D Pathak ◽  
A Gangopadhyay ◽  
S Halder ◽  
...  
Keyword(s):  
Rare Complication ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Gangrenous Appendicitis ◽  
Free Air ◽  
Tension Pneumoperitoneum ◽  
Emergency Measure ◽  
Intraperitoneal Free Air ◽  
Needle Decompression

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.

scholarly journals Repeated Enterocutaneous Fistula in a Munchausen Syndrome Patient

2019 ◽  
Vol 13 (1) ◽  
pp. 173-177
Author(s):  
Toshiaki Hagiwara ◽  
Shinya Munakata ◽  
Shun Ishiyama ◽  
Goto Michitoshi ◽  
Rina Takahashi ◽  
...  
Keyword(s):  
Enterocutaneous Fistula ◽  
The Self ◽  
Munchausen Syndrome ◽  
Rare Type ◽  
Wound Site ◽  
Fistula Surgery ◽  
Self Mutilation ◽  
Japanese Male ◽  
Old Japanese ◽  
Self Harm

Munchausen syndrome is a rare type of mental disorder in which the patient fakes illness to gain attention and sympathy. Patients may lie about symptoms, make themselves appear sick, or make themselves purposely unwell. We describe a case of repeated enterocutaneous fistula in Munchausen syndrome. A 53-year-old Japanese male was admitted to our hospital for the treatment of a high-flow enterocutaneous fistula. Surgery was performed two times, but the fistula recurred each time. Chopsticks with blood on them were coincidentally detected in the trash in the patient’s room. It was revealed that the enterocutaneous fistula was caused by self-mutilation. A psychiatrist was consulted, and the patient was diagnosed with Munchausen syndrome. The psychiatrist initiated treatment and the patient admitted the self-harm. His prolonged wound site was closed and he was able to be discharged. There has been no recurrence of the self-harm as of this writing, 3 years later. The treatment of Munchausen syndrome is difficult and early detection is important.

scholarly journals  Atresia coli in a Japanese black calf diagnosed by a barium sulphate enema contrast radiograph in the standing position: a case report

2012 ◽  
Vol 57 (No. 7) ◽  
pp. 376-379
Author(s):  
K. Abouelnasr ◽  
M. Ishii ◽  
H. Inokuma ◽  
Y. Kobayashi ◽  
K. Lee ◽  
...  
Keyword(s):  
Small Intestine ◽  
Case Report ◽  
Abdominal Distension ◽  
Standing Position ◽  
Barium Sulphate ◽  
Radiographic Examination ◽  
Anal Opening ◽  
Old Japanese ◽  
History Of ◽  
Colon And Rectum

A three day-old Japanese black calf was admitted with a history of abdominal distension and absence of defecation. Dilated loops of the small intestine and hypoplasia of the colon and rectum was observed upon a contrast radiographic examination in the standing position. At necropsy atresia coli with undeveloped rectum and patent anal opening was found. We conclude that a contrast radiograph in the standing position is useful for diagnosing atresia coli in such cases.  

scholarly journals A Case of Unresectable Rectal Necrosis

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Mohammed Nassif ◽  
Ahmed Ameer ◽  
Sarkis H. Meterissian ◽  
Ari-Nareg Meguerditchian
Keyword(s):  
Exploratory Laparotomy ◽  
Distal Colon ◽  
Left Colon ◽  
Technical Feasibility ◽  
Acceptable Alternative ◽  
Colon And Rectum ◽  
Diverting Ostomy ◽  
Good Drainage ◽  
Extensive Necrosis ◽  
Mucus Fistula

Introduction. Necrosis of the rectum is an uncommon finding due to abundant collateral vasculature. Its management remains challenging, without clear consensus in the literature.Case Report. We describe a case of a 53-year-old woman with multiple medical comorbidities that presented in septic shock and hematochezia. Colonoscopy revealed ischemic colitis. Conservative management was instituted. At two weeks, she presented evidence of peritonitis. Exploratory laparotomy revealed extensive necrosis of the left colon and rectum. Due to dense inflammation, resection was deemed unsafe. Therefore, a transverse ostomy with mucosal fistula was preformed. Multiple drains were left in place. The patient healed uneventfully.Conclusion. This case illustrates that, if extensive dissection of the distal colon and rectum is unsafe due to the patient's critical condition or technical feasibility, then a diverting ostomy of the proximal viable bowel along with a mucus fistula and good drainage of the abdomen represents an acceptable alternative.

scholarly journals Nanoparticle Albumin-Bound Paclitaxel- and/or Gemcitabine-Induced Scleroderma Accompanied by Acanthosis Nigricans-Like Skin Changes

2019 ◽  
Vol 11 (3) ◽  
pp. 273-277 ◽  
Author(s):  
Sei-ichiro Motegi ◽  
Mai Ishikawa ◽  
Akiko Sekiguchi ◽  
Osamu Ishikawa
Keyword(s):  
Acanthosis Nigricans ◽  
Basal Layer ◽  
Accurate Diagnosis ◽  
Skin Changes ◽  
Hyperkeratotic Lesion ◽  
Dermal Fibrosis ◽  
First Case ◽  
Skin Sclerosis ◽  
Japanese Male ◽  
Old Japanese

We herein present the first case of nanoparticle albumin-bound paclitaxel (nab-paclitaxel)- and/or gemcitabine-induced scleroderma accompanied by acanthosis nigricans-like skin changes in a 54-year-old Japanese male. He was diagnosed with pancreatic cancer and received 17 courses of nab-paclitaxel and gemcitabine chemotherapy. Edema and skin sclerosis in his legs appeared after the first and third course, respectively. Histological examination of the hyperkeratotic lesion of the ankle revealed hyperkeratosis, acanthosis, papillomatosis, increased number of melanocytes in the basal layer, and dermal fibrosis. Awareness of the clinical characteristics of nab-paclitaxel- and/or gemcitabine-induced scleroderma accompanied by acanthosis nigricans-like skin changes is important for dermatologists to establish an accurate diagnosis.

scholarly journals Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

2018 ◽  
Vol 64 (6) ◽  
pp. 543-548 ◽  
Author(s):  
Sujin Ko ◽  
Seong Sook Hong ◽  
Jiyoung Hwang ◽  
Hyun-joo Kim ◽  
Yun-Woo Chang ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Statistical Significance ◽  
Pneumatosis Intestinalis ◽  
Bowel Distension ◽  
Wall Defect ◽  
Ct Findings ◽  
Free Air ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Ct Features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

scholarly journals A case of planar-type GIST of the sigmoid colon showing diverticular structure with perforation

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Yuka Shintaku ◽  
Yuya Asano ◽  
Takahiro Watanabe ◽  
Takako Kihara ◽  
Eri Ishikawa ◽  
...  
Keyword(s):  
Sigmoid Colon ◽  
Mutational Analysis ◽  
Muscularis Propria ◽  
Normal Mucosa ◽  
Sudden Onset ◽  
Surrounding Tissue ◽  
Spindle Cells ◽  
Japanese Male ◽  
Old Japanese ◽  
Exon 11

Abstract Background Gastrointestinal stromal tumors (GISTs) generally form well-defined mass lesions. However, some cases of the flatly distributed and muscularis propria-replacing GISTs have been reported so far. We experienced an additional case of planar-type GIST of the sigmoid colon accompanied by a diverticulum with perforation. Case presentation A 68-year-old Japanese male with sudden onset of abdominal pain was clinically diagnosed with gastrointestinal perforation, and an emergency abdominal operation was performed. A diverticulum with rupture was found in the sigmoid colon, but no apparent tumor was observed. Histological examination revealed bland spindle cells flatly proliferating and diffusely replacing the muscularis propria at the diverticular structure. The spindle cells were positive for KIT, DOG1, and CD34. Mutational analysis of the c-kit gene revealed that the lesion had a heterozygous deletion of 2 amino acids at codons 557 and 558 of exon 11. The mutation was not observed in the normal mucosa of the surrounding tissue. Conclusion We diagnosed this case as an unusual planar-type GIST. Some similar cases have been reported in the sigmoid colon and other sites. We discuss the mechanism of development of the planar-type GISTs associated with the diverticulum.

Sign in / Sign up

Export Citation Format

Share Document