Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience

Background COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution’s surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period. Methods All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included. Data from the medical records were analyzed. Results Twenty patients were included. Eighty percent had a new or increasing vasopressor requirement, 70% had abdominal distension, and 50% had increased gastric residuals. Intra-operatively, ischemia affected the large bowel in 80% of cases, the small bowel in 60%, and both in 40%. Sixty five percent had an initial damage control laparotomy. Most of the resected bowel specimens had a characteristic appearance at the time of surgery, with a yellow discoloration, small areas of antimesenteric necrosis, and very sharp borders. Histologically, the bowel specimens frequently have fibrin thrombi in the small submucosal and mucosal blood vessels in areas of mucosal necrosis. Overall mortality in this cohort was 33%. Forty percent of patients had a thromboembolic complication overall with 88% of these developing a thromboembolic phenomenon despite being on prophylactic pre-operative anticoagulation. Conclusion Bowel ischemia is a potentially lethal complication of COVID-19 infection with typical gross and histologic characteristics. Suspicious clinical features that should trigger surgical evaluation include a new or increasing vasopressor requirement, abdominal distension, and intolerance of gastric feeds.

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Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v32i1.5446 ◽

2012 ◽

Vol 32 (1) ◽

pp. 73-75

Author(s):

R Hamid ◽

AH Shera ◽

NA Bhat ◽

A Baba ◽

A Rashid

Keyword(s):

Intestinal Obstruction ◽

Sigmoid Colon ◽

Transverse Colon ◽

Late Onset ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Uneventful Recovery ◽

Colonic Stenosis ◽

Colonic Atresia ◽

Mucous Fistula

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or partial intestinal obstruction. Key words: Colonic Stenosis; Perforation; Obstruction DOI: http://dx.doi.org/10.3126/jnps.v32i1.5446 J. Nepal Paediatr. Soc. Vol.32(1) 2012 73-75

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Correlation between surgical site infection and obesity after exploratory laparotomy in trauma patients

QJM ◽

10.1093/qjmed/hcab097.012 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Abdelaziz ◽

Ahmed Sabry ◽

Mohamed Fayek

Keyword(s):

Surgical Site Infection ◽

Abdominal Trauma ◽

Damage Control ◽

Exploratory Laparotomy ◽

Fascial Closure ◽

Wound Complications ◽

Trauma Patients ◽

Obese Patients ◽

Site Infection ◽

University Hospitals

Abstract Background Obesity has become a major contributor to the global burden of chronic disease and disability. Understanding the effect of obesity on the incidence of wound infections and other wound complications remains incomplete despite considerable attention to both the growing ‘‘epidemic’’ of obesity and the frequent occurrence of surgical site infection (SSI) after surgical procedures. Damage-control laparotomy specifically has been associated with a higher rate of infectious complications and a lower rate of primary fascial closure in obese patients. Aim of the work The aim of the study is to evaluate the correlation between obesity and surgical site infection (SSI) in patients undergoing exploratory laparotomy after abdominal trauma. Patients and methods A retrospective study performed on obese patients of both genders aged between 18 and 60 years old undergoing exploratory laparotomy after abdominal trauma at the surgery departments of Ain Shams University Hospitals, Al-Bank Al-Ahly Hospital, Al-Mataria Hospital and Al-Salam Hospital, Cairo, Egypt for two years (1st of January 2018 to 1st of January 2020). Patients with infected wounds, receiving antibiotic therapy at the time of injury, those with a known immunodeficiency, who died within 48 hours after injury, who had sustained burn injuries, who underwent surgery at another institution before admission to our hospital were excluded. The rate of 30-day SSI post-operatively among obese and non-obese patients were compared. Statistical analysis was also done. Results Out of 782 patients, only 480 of those patients for whom BMI data were available, 360 (75%) were males and 120 (25%) were females. Out of the 480 patients: 168 patients had BMI more than 30; 114 patients (67.8%) had SSI (P < 0.05), 312 patients had BMI less than 30; 61 patients (19.5%) had SSI. All of the included patients were fulfilling the inclusion and the exclusion criteria. On multivariate analysis, obesity was the strongest predictor of SSI (odds ratio = 1.59; 95% confidence interval, 1.32-1.91) after adjustment for sex and age. Obese patients with SSI compared with the non-obese had longer hospital stays (mean, 9.5 vs 8.1 days, respectively; P < .001) and markedly higher rates of hospital readmission (27.1% vs 6.5%, respectively; P < .001). Conclusion Obesity is considered as one of the risk factors in causing surgical site infection. Thus, this study showed the relation of BMI and obesity with surgical site infection in case of exploratory laparotomy after abdominal trauma.

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Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0240 ◽

2016 ◽

Vol 98 (8) ◽

pp. e197-e199 ◽

Cited By ~ 2

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.

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HIRSCHSPRUNG’S DISEASE

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.02.2349 ◽

2010 ◽

Vol 17 (02) ◽

pp. 223-231

Author(s):

MUHAMMAD ZAFAR IQBAL ◽

Hammad Azam ◽

MUHAMMAD JAHANGIR ◽

Muhammad Tahir ◽

MUHAMMAD ANWAR ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Case Series ◽

Abdominal Distension ◽

Functional Results ◽

International Studies ◽

Stool Incontinence ◽

Case Series Study ◽

Duhamel Procedure ◽

One Year

Introduction: Hirschsprung’s Disease is one of the most common congenital anomalies that Pediatric Surgeons manage. In spite of the various modifications of pull through procedures available, the long term functional results are less than ideal. However, Modified Duhamel Procedure is one which has relatively good functional results and that is the reason we have selected this procedure for Hirschsprung’s disease in Sheikh Zayed Hospital, Rahim Yar Khan. Objectives: To evaluate the outcome of patients after Modified Duhamel Procedure for Hirschsprung’s Disease. Design: This is case series study. Settings: Department of Pediatric Surgery Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Period: Seventeen cases were studied over a period of two year i.e. from November 2006 to December, 2008. Material and Method: Seventeen (17) cases from both sexes were operated for Hirschsprung’s Disease over a period of one year and Modified Duhamel Procedure was adopted for all these cases. All patients were diagnosed cases of rectosigmoidal aganglionosis and follow up was done over a period of one year according to a comprehensive Proforma. Four parameters like normal stool evacuation, abdominal distension, soiling and stool incontinence were followed and then the results were compared with other national and international studies. Results: Fever 19.4% (n=04), wound infection 19.4% (n=04), vomiting 9.52% (n=02), abdominal distension 4.76% (n=01), and bleeding per rectum 4.76% (n=01), were the immediate post operative complications. Fourteen patients (82.35%), used to pass stool once daily. Abdominal distension was observed occasionally in six patients (28.57%). Soiling was seen in five patients (29.41%). Out of Seventeen, stool incontinence was seen in only three patients (17.64%). Conclusion: Modified Duhamel Procedure with the help of linear cutter stapler device is quite safe, easy and less time consuming. Infact Modified Duhamel is a procedure of choice for Hirschsprung’s Disease.

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ADENEXAL CYSTS

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1855 ◽

2011 ◽

Vol 18 (01) ◽

pp. 32-40

Author(s):

TEHREEN RIAZ ◽

SARWAT JABEEN ◽

WASEEM TALIB ◽

Nabeela Shami

Keyword(s):

Demographic Data ◽

Lower Abdominal Pain ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Ovarian Tumour ◽

Risk Of Malignancy ◽

Histopathologic Evaluation ◽

Operative Findings

Objectives: (1) To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. (2) To determine the relationship of age with type of ovarian tumour. (3) To categorize the management of these cases according to the intra-operative findings. (4) To analyze the occurrence of various histopathological types of tumour. Date Source: Medline Study Design: Single centered prospective descriptive study of 150 cases. Place and Duration of Study: Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to,31st December 2006. Subject and method: 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Results: Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain (53%) followed by menstrual disturbances (30%), abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Conclusions: Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management.

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Bilateral ovarian dysgerminoma with metastasis in female dog's mesenteric lymph node: a case report

Brazilian Journal of Case Reports ◽

10.52600/2763-583x.bjcr.2021.1.2.32-41 ◽

2021 ◽

Vol 1 (2) ◽

pp. 32-41

Author(s):

Edgar Tavares de Assis-Neto ◽

Daniel de Araújo Viana ◽

Márcio César Vasconcelos Silva

Keyword(s):

Lymph Node ◽

Histopathological Examination ◽

Present Report ◽

Malignant Neoplasm ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Incisional Biopsy ◽

Mesenteric Lymph ◽

Chemotherapy Protocol ◽

Ovarian Dysgerminoma

Dysgerminoma is a rare malignant neoplasm, associated with hormonal dysfunctions, which occurs in canine and feline females from middle age to elderly, without racial predisposition. In the present report, we described a case of ovarian dysgerminoma in a dog, only abdominal distension, persistent vulvar bloody discharge and apathy. The animal in question underwent exploratory laparotomy, where general neoformations were detected in the ovaries, and a lymph node with abnormal characteristics was also found. Therefore, surgery for ovariosalpingoisterectomy and puncture of a fragment of the lymph node altered for incisional biopsy was performed. The diagnosis was made through histopathological examination of the ovaries of the fragment derived from the lymph node, the result of which indicated the presence of dysgerminoma in both ovaries and in the lymph node, characterizing a metastasis. In view of this result, the chemotherapy protocol with the association of carboplatin and vinblastine was instituted, which proved to be effective and not very toxic to the animal, with no clinical sign of metastasis being identified after its use.

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Mysterious Gelly Belly: a Case Report of Pseudomyxoma Peritonei and Literature Review

Journal of Gastroenterology & Digestive Systems ◽

10.33140/jgds.04.02.02 ◽

2020 ◽

Vol 4 (2) ◽

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Literature Review ◽

Pseudomyxoma Peritonei ◽

Clinical Condition ◽

Imaging Techniques ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Primary Site ◽

Diffuse Abdominal Pain

Pseudomyxoma peritonei (PMP) is a rare clinical condition defined as extensive intraperitoneal spread of mucus associated with a variety of mucinous tumors. Although appendix has usually been implicated as the primary site, some reports found no cause. This case also describes a PMP with no identifiable primary site. A 52-year-old male presented with an abdominal distension evolving for 3 months associated with diffuse abdominal pain, imaging techniques objective intra peritoneal mucoid materials with septated ascites but it failed to identify the primary site. Exploratory laparotomy with Biopsy confirmed PMP but also failed to found the original site.

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Diagnostic Dilemma of a Rare, Giant Retroperitoneal Schwannoma: A Case Report and Review of Literature

Case Reports in Oncological Medicine ◽

10.1155/2014/628538 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Mahendra Singh ◽

Lovekesh Kumar ◽

Rajkumar Chejara ◽

Om Prakash Prasad ◽

Yuvraj Kolhe ◽

...

Keyword(s):

Low Frequency ◽

Surgical Excision ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Postoperative Recovery ◽

Cystic Mass ◽

Imaging Features ◽

Diagnostic Dilemma ◽

Complete Surgical Excision ◽

Retroperitoneal Schwannoma

Schwannoma is a benign tumour of peripheral nerve sheath. It usually arises from head, neck, and trunk. Retroperitoneal schwannoma is a rare entity, accounting for only 0.3–3% of total schwannomas. Majority of retroperitoneal schwannomas reported in literature have a diameter of 5 to 15 cm. Preoperative diagnosis is difficult due to low frequency, nonspecific clinical course, and nonspecific imaging features. Histology usually provides definitive diagnosis. Schwannomas are solitary, well-circumscribed, and noninvasive, so complete surgical excision provides good result. We report a case of a 23-year-old male, who presented with progressive abdominal distension and intermittent episodes of intestinal obstruction. CECT was suggestive of huge solid-cystic mass in abdominopelvic region. Image guided percutaneous aspiration revealed around 1 litre of frank pus and FNAC was suggestive of abscess. Exploratory laparotomy revealed a large 32 × 28 × 26 cm mass with solid and cystic components containing 1 litre of pus. Histological features of tumour were suggestive of benign schwannoma and immunohistochemistry for S-100 was positive. Postoperative recovery was uneventful. We report this case of a retroperitoneal schwannoma because of giant size, rare location, unusual presentation, and diagnostic dilemma.

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Intrauterine Intussusception Presenting as Fetal Ascites and Meconium Peritonitis

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v5i0-2.336 ◽

2021 ◽

Vol 5 (0-2) ◽

pp. 18

Author(s):

Khalilah Alhuda Binti Kamilen ◽

Mohd Yusran Othman

Keyword(s):

Primary Anastomosis ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Intestinal Atresia ◽

Premature Baby ◽

Abdominal Radiograph ◽

Meconium Peritonitis ◽

Ileal Perforation ◽

Intraabdominal Sepsis ◽

Intrauterine Intussusception

Intussusception is a well-known cause of intestinal obstruction in children. Its occurrence in fetus as an intrauterine incidence is extremely rare and poses a diagnostic difficulty. Intrauterine intussusception may result in intestinal atresia once the gangrenous segment resorbed. However, a very late occurrence of intussusception just prior to delivery may present as meconium peritonitis. We are reporting a case of premature baby who was born at 35 weeks gestation via emergency caesarean for breech in labour. Routine scan 4 days prior to the delivery showed evidence of fetal ascites. She was born with good Apgar Score and weighed 2.5kg. Subsequently she developed respiratory distress syndrome requiring mechanical ventilation. She passed minimal meconium once after birth then developed progressive abdominal distension and vomiting. Abdominal radiograph on day 4 of life revealed gross pneumoperitoneum and bedside percutaneous drain was inserted to ease the ventilation. Upon exploratory laparotomy, a single ileal perforation was seen 20cm from ileocecal junction with an intussusceptum was seen in the distal bowel. Gross meconium contamination and bowel edema did not favour the option of primary anastomosis, thus stoma was created. Reversal of stoma was performed a month later and she recovered well. Fetus with a complicated intrauterine intussusception may present with fetal ascites and their postnatal clinical and radiological findings need to be carefully assessed for evidence of meconium peritonitis; in which a timely surgical intervention is required to prevent the sequelae of prolonged intraabdominal sepsis in this premature baby.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S18

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Resection of a colonic mass following trauma: a diagnostic dilemma

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa226 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Paul Burchard ◽

Alan A Thomay

Keyword(s):

Ct Scan ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Symptomatic Improvement ◽

Diagnostic Dilemma ◽

Vehicle Accident ◽

Abdomen Ct ◽

History Of ◽

Mitotic Figures ◽

The Right

Abstract A 53-year-old Caucasian male presented with a 2-week history of abdominal distension, pain, nausea and lethargy. His symptoms began 1 day after an all-terrain vehicle accident during which he suffered blunt-force trauma to his mid-right abdomen. CT scan demonstrated abnormal thickening of the ascending colon and terminal ilium with surrounding inflammation within the retroperitoneum and colonic mesentery. Given his likely mechanism and symptomatic improvement, he was initially managed conservatively. However, he was readmitted with recurrence of symptoms, and a repeat CT scan demonstrated no interval improvement. An exploratory laparotomy was performed and a firm, fixed mass of the right-colon and colonic mesentery was found. Final histopathology of the mass revealed a diffuse lymphoid infiltrate with numerous mitotic figures and apoptotic cells. Immunohistochemical staining was positive for CD45, CD20, CD10, and BCL-6 and negative for CD3, TdT, and BCL-2, indicating a diagnosis of Burkitt lymphoma.

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