scholarly journals Colon perforation as a complication of COVID-19: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Keita Nakatsutsumi ◽  
Akira Endo ◽  
Hiraaki Okuzawa ◽  
Iichiro Onishi ◽  
Anri Koyanagi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intensive Care ◽  
Transverse Colon ◽  
Intestinal Ischemia ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Massive Ascites ◽  
Case Presentation ◽  
Multiple Organs ◽  
Free Air

Abstract Background Coagulopathy induced by COVID-19 has received much attention. Arterial and venous thrombosis of multiple organs due to COVID-19-related coagulopathy is associated with a poor outcome. Case presentation A 67-year-female was transferred to our hospital in need of intensive care for severe COVID-19 pneumonia. On day 7 after admission, despite the treatments, her respiratory and hemodynamic status deteriorated. Computed tomography revealed massive ascites and free air as well as wall defects of the transverse colon. An emergency laparotomy was undertaken in the intensive-care unit, and 17 cm of the transverse colon was resected. Histopathological findings revealed two perforation sites of 25 and 7 mm in diameter, necrosis of the intestinal mucosa around the perforation sites, and the microcirculatory thrombosis in the mesentery vessels which was suspected of having been induced by COVID-19-related coagulopathy. Conclusions The case highlights the risk of intestinal ischemia and perforation induced by COVID-19 coagulopathy. Physicians treating COVID-19 should recognize the risk and evaluate patients carefully.

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.

scholarly journals Successful treatment of hepatic lymphorrhea by percutaneous transhepatic lymphangiography followed by sclerotherapy using OK-432

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Masayuki Kojima ◽  
Masanori Inoue ◽  
Seiichiro Yamamoto ◽  
Toshio Kanai ◽  
Seishi Nakatsuka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Rare Case ◽  
Intraperitoneal Administration ◽  
Lymphatic Vessels ◽  
Hepatoduodenal Ligament ◽  
Massive Ascites ◽  
Case Presentation ◽  
Successful Case ◽  
Leakage Site ◽  
And Control

Abstract Background Conventional lymphangiography cannot detect leakage sites of hepatic lymphatic vessels. Percutaneous transhepatic lymphangiography can be used to visualize leakage sites, and once the leakage site has been confirmed, effective sclerotherapy can be performed. Case presentation A rare case of intractable hepatic lymphorrhea due to injury of the hepatoduodenal ligament following pancreaticoduodenectomy is reported. Drainage of massive ascites from the drainage tube continued after surgery. Percutaneous transhepatic lymphangiography visualized the intrahepatic lymphatic vessels and the leakage site at the hepatic hilum. An 8-Fr drainage catheter was inserted adjacent to the leakage point under fluoroscopic computed tomography guidance. Repeated sclerotherapy using intraperitoneal administration of OK-432 (picibanil) through the catheter was performed, which exposed the leakage site, and control of the ascites was finally achieved. Conclusions To the best of our knowledge, this is the first successful case of detection of a leakage site using intrahepatic lymphangiography, followed by sclerotherapy using OK-432.

scholarly journals Pneumoretroperitoneum and Pneumomediastinum Revealing a Left Colon Perforation

2015 ◽  
Vol 100 (6) ◽  
pp. 984-988 ◽  
Author(s):  
Giulia Montori ◽  
Giacomo Di Giovanni ◽  
Zeineb Mzoughi ◽  
Cedric Angot ◽  
Sophie Al Samman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Laboratory ◽  
Left Thigh ◽  
Left Colon ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Computed Tomography Scan ◽  
End Colostomy ◽  
Retroperitoneal Perforation ◽  
Tomography Scan

Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.

scholarly journals Pneumatosis Cystoides Intestinalis: An Unusual Cause of Intestinal Ischemia and Pneumoperitoneum

2015 ◽  
Vol 100 (2) ◽  
pp. 221-224 ◽  
Author(s):  
Hayri Ogul ◽  
Berhan Pirimoglu ◽  
Abdullah Kisaoglu ◽  
Leyla Karaca ◽  
Nuri Havan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Intestinal Ischemia ◽  
Plain Film ◽  
Intestinal Wall ◽  
Pneumatosis Cystoides Intestinalis ◽  
Unknown Etiology ◽  
Computed Tomography Imaging ◽  
Free Air ◽  
Uncommon Disease

Pneumatosis cystoides intestinalis (PCI), with an unknown etiology, is an uncommon disease characterized by the presence of multiple gas-filled cysts within the submucosa or subserosa of the intestinal wall. Intestinal obstruction and/or perforation are relatively uncommon complications associated with PCI. The patients are often prone to misdiagnosis or mistreatment. The diagnosis of PCI is based on plain radiography or endoscopy. Multidetector computed tomography (MDCT) provides data on other intra-abdominal pathologies. Therefore, it is an important modality for the diagnosis of PCI. We present a case of PCI in a 58-year-old man affected by peritoneal free air with multidetector computed tomography imaging findings. We performed the plain film of the abdomen, and MDCT studies that showed numerous, diffuse, bubble-like intramural gas collections into the jejunum, ileum, and colon walls at the left-upper quadrant of the abdomen. MDCT findings were confirmed by surgical exploration.

scholarly journals Blunt abdominal injury resulting in a belly full of candy after a motocross accident, a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Floris B. Poelmann ◽  
Frank F. A. IJpma
Keyword(s):  
Ct Scan ◽  
Abdominal Cavity ◽  
Delayed Diagnosis ◽  
Abdominal Injury ◽  
Pelvic Cavity ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
Blunt Abdominal Injury ◽  
Free Air ◽  
Gastric Rupture

Abstract Background Blunt traumatic gastric perforations in children are rare. Delayed diagnosis will lead to abdominal contamination and may result in morbidity and even mortality. We present a case of an adolescent who sustained blunt abdominal injury in a motocross accident and presented with remarkable hyperdense spherical shaped structures on the computed tomography (CT). Case presentation A 15-year-old boy arrived at the emergency room with an acute abdomen after a motocross accident. A CT scan of the abdomen demonstrated free air and hyperdense round structures in the stomach, pelvic cavity and right paracolic gutter. During emergency laparotomy a traumatic gastric perforation was sutured, a splenic rupture was treated with a vicryl mesh and multiple spherical food scraps were removed from the abdomen. After surgery, the boy clarified that he had eaten a whole bag of colorful and spherical shaped candy just before the accident. Conclusions Traumatic gastric rupture in children is rare but physicians should be aware of this diagnosis in case of blunt abdominal trauma with free air on the CT scan. Gastric contents, in this case candy, can present as hyperdense shaped structures in the abdominal cavity on the CT scan.

scholarly journals A case of sigmoid colon perforation presenting with pneumomediastinum

2019 ◽  
Vol 2019 (12) ◽  
Author(s):  
Yukihito Kuroda ◽  
Katsuji Hisakura ◽  
Yoshimasa Akashi ◽  
Tsuyoshi Enomoto ◽  
Tatsuya Oda
Keyword(s):  
Computed Tomography ◽  
Sigmoid Colon ◽  
Gastrointestinal Endoscopy ◽  
Abdominal Cavity ◽  
Colon Perforation ◽  
Upper Gastrointestinal Endoscopy ◽  
Free Air ◽  
Oral Steroids ◽  
Sigmoid Colon Perforation ◽  
Upper Gastrointestinal

Abstract A 62-year-old woman had developed polymyositis 12 years previously and had taken oral steroids. Chest and abdominal computed tomography showed pneumomediastinum and free air in the abdominal cavity. Although a colon perforation was suspected, the perforation site could not be identified on the image. In addition, a diagnosis of oesophageal rupture could not be excluded from the findings of pneumomediastinum. After general anaesthesia, an upper gastrointestinal endoscopy was performed before surgery. Because there was no obvious perforation in the oesophagus, a laparotomy approach was used. A perforation was found on the mesentery side of the sigmoid colon, and a perforation of the sigmoid colon’s diverticulum towards the mesentery was diagnosed. A Hartmann’s procedure was performed. Colon perforations are rarely associated with pneumomediastinum. Preoperative endoscopy is useful to help diagnose and determine the surgical procedure if an obvious perforation cannot be identified.

scholarly journals Possible involvement of Syndecan-1 in the state of COVID-19 related to endothelial injury

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Keiko Suzuki ◽  
Hideshi Okada ◽  
Hiroyuki Tomita ◽  
Kazuyuki Sumi ◽  
Yoshinori Kakino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Disease State ◽  
Endothelial Injury ◽  
Endothelial Glycocalyx ◽  
Case Presentation ◽  
Disease Condition ◽  
Coronavirus Infection ◽  
D Dimer

Abstract Background The coronavirus infection 2019 (COVID-19) is associated with microvascular endothelial injury. Here, we report that syndecan-1, a component of endothelial glycocalyx, may reflect the disease state of COVID-19 related to endothelial injury. Case presentation A patient with COVID-19 was transferred to the intensive care unit of our hospital. Computed tomography of the chest showed bilateral ground glass opacities, which was diagnosed as acute respiratory syndrome. The PaO2/FIO2 ratio gradually increased from 158 on hospitalization to 300 on Day 11, on which day the ventilator was withdrawn. However, serum syndecan-1 (SDC-1) level gradually decreased from 400.5 ng/ml at hospitalization to 165.1 ng/ml on Day 5. On Day 6, serum SDC-1 level increased to 612.9 ng/ml owing to a systemic thrombosis with an increase in D-dimer. Serum SDC-1 level then decreased until 206.0 ng/ml on Day 11 after a decrease in D-dimer. The patient was transferred to another hospital on Day 21 after hospitalization. Conclusions In this case report, changes in serum SDC-1 level closely reflected the change in disease condition in a patient with COVID-19. Serum SDC-1 may be a useful biomarker for monitoring the disease state of critically ill patients with COVID-19.

scholarly journals Toothpick injury mimicking acute cholecystitis

2018 ◽  
Vol 26 (2) ◽  
pp. 127-129
Author(s):  
Duk Hee Lee ◽  
Yoon Hee Choi
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Cholecystitis ◽  
Hepatic Flexure ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Computed Tomography Scan ◽  
Rebound Tenderness ◽  
Upper Abdominal ◽  
Tomography Scan

Introduction: Accidental foreign bodies ingestion is common in emergency department. However, if the objects are sharp, the complication rate is higher. Toothpick can cause severe complications of gastrointestinal tract due to being long, sharp ends on both sides, slender, and resistant to digestion. Case presentation: A 64-year-old man presented to the emergency department with fever and right upper abdominal pain for 3 days. The physical examination revealed severe pain with rebound tenderness in the right upper abdominal quadrant and positive Murphy’s sign. The provisional diagnosis of acute cholecystitis was made. The contrast abdominal-pelvic computed tomography scan revealed linear-shaped lesion penetrating hepatic flexure of colon and proximal transverse colon. The patient showed deterioration of vital sign, and therefore, emergency laparotomy was performed. Colon perforation by wooden toothpick was diagnosed. Discussion and conclusion: Toothpick ingestion without awareness is rare but fatal, especially when physicians failed to suspect foreign body ingestion. We think of this as one of the differential diagnoses, so we use contrast computed tomography scan.

Colon perforation during colonoscopy – the role of an anaesthesiologist in patient management. A case report

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Jacek Wadełek
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Anaesthetic Management ◽  
Successful Outcome ◽  
Colon Perforation ◽  
Emergency Laparotomy ◽  
Good General Condition ◽  
Clinical Signs And Symptoms

Colon perforation is a serious complication of colonoscopy. Clinical signs and symptoms depend on the specific characteristics of the perforation (e.g., size, location, and aetiology) and patient’s general status. The paper presents a case of an 81-year-old man who underwent diagnostic colonoscopy with perforation of the sigmoid diverticulum. The endoscopist was unsuccessful in ceiling the sigmoid perforation by clipping. Therefore, emergency laparotomy was performed, during which the perforation was repaired. Postoperatively, the patient was cared for in an intensive care unit. He was discharged from the intensive care unit to general surgery on day 3 postoperatively in a good general condition. Colon perforation at colonoscopy is one of the most serious complications, with early diagnosis and surgical repair being the key to successful outcome. Proper anaesthetic management is centred around correction of metabolic, cardiovascular and respiratory derangements, which is also crucial for patient outcomes.

scholarly journals Free air after laparoscopic hysterectomy; from sigmoid perforation to upper airway compromise: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Aikaterini Melemeni ◽  
Aliki Tympa Grigoriadou ◽  
Athanasia Tsaroucha
Keyword(s):  
Delayed Diagnosis ◽  
Surgical Techniques ◽  
Upper Airway ◽  
Laparoscopic Hysterectomy ◽  
Common Finding ◽  
Emergency Laparotomy ◽  
Air Entrapment ◽  
Case Presentation ◽  
Sigmoid Perforation ◽  
Free Air

Abstract Background Free air after laparoscopic hysterectomy is a common finding; in rare cases, free air represents gastrointestinal perforation, requiring emergency laparotomy. Ectopic air localizations after pneumoperitoneum have been reported in various laparoscopic surgical techniques. Delayed diagnosis of visceral perforation is associated with high mortality rates. Case presentation We present a white Caucasian female in which dysphonia due to air entrapment in the cervical area, pneumomediastinum and pneumothorax, occured afterlaparoscopic hysterectomy. Conclusions Upon mobilization of the patient, air from sigmoid perforation moved cephalad. Through the same path, pneumoperitoneum, causes subcutaneous emphysema in the neck and face, pneumomediastinum and pneumothorax.

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