Isolated perforation of fourth part of Duodenum following Blunt Abdominal Trauma

Introduction: Isolated duodenal injuries are rare in blunt abdominal trauma. These present a significant challenge for management because of the associated injuries and its difficult anatomical accessibility. Case presentation: A 20years male presented to the Emergency department following a bike accident sustaining injury over face, chest and abdomen, 6hours after the incident. His vitals were unstable so he was resuscitated and admitted in Intensive Care Unit. He had generalized abdominal tenderness without rigidity. Contrast enhanced computed tomography of abdomen and pelvis was suggestive of hollow viscus perforation. He underwent exploratory laparotomy and primary repair for isolated perforation at fourth part of duodenum. He was discharged on his ninth postoperative day. Conclusion: Rare injuries following blunt abdominal trauma should be considered and early intervention is necessary.

Small Bowel Internal Herniation through Acquired Defect of Vesicouterine Pouch- A Late Complication following Oophorectomy

Hollow viscus herniation through a defect between vesicouterine pouch following previous pelvis surgery is exceedingly rare. There was only 1 similar case reported in the English literature. In this current report, we describe a 84-year-old woman presented with lower abdominal pain. She had a history of previous gynecology surgery. Computed tomography of abdomen showed small bowel obstruction with transition zone at the pelvis. Laparotomy revealed small bowel loops trapped in the vesico-uterine space via a narrow defect about 1.5cm. The detailed clinical summary and operative management are described in the report.

HISTOMORPHOLOGICAL FINDINGS AND CLINICO-RADIOLOGICAL CORRELATION OF INTESTINAL ATRESIA AT A TERTIARY CARE CENTRE

Background: An atresia is a congenital defect of a hollow viscus that results in complete obstruction of the lumen. Intestinal atresia is one of the most frequent causes of bowel obstruction in the newborn and can occur at any point in the gastrointestinal tract. This study was undertaken to study the histomorphological findings of intestinal atresia and to correlate it with different subtypes and clinico-radiological feature. Material and methods: This was a prospective observational study conducted in 24 months on the resected gastrointestinal tract of 40 neonatal intestinal obstruction cases admitted in Pediatric surgery ward received in the Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna. Control Group- A total of 5 cases of vitello-intestinal duct patency were taken as control and compared with the study group. Results: With respect to total 40 cases, there were six, i.e. 15.0% female babies and 34, i.e. 85.0% male babies studied. Out of that, 15 i.e. 37.50% were full term and 25, i.e. 62.5% were premature. Mucosa showed oedema, ulceration and flattening in 9 cases. Apart from flattening and oedema, mucosa was denuded at some places and also showed congestion and extravasated blood in 6 cases each. Abnormal villus configuration, calcium deposition in 4 cases each and hypertrophied mucosa were found in 3 cases. Luminal narrowing, loss of mucosa, duplication of mucosa and gangrenewere found in one case each. Sub mucosal changes showed congestion in 33 cases, oedema in 15, Fibrosis in 4, thickened submucosa in 2 cases and dilated irregular branching blood vessels, extravasted blood, calcification in 1 case each. Muscularispropria having changes i.e. thinning in 16 cases, congestion, hypertrophy in 4 cases each, focal loss in 3 cases, calcification in 2 cases and thinning in 2 cases. Similarly, histopathological changes in serosa shows serositis in 16 cases, congestion in 11 cases and thinning in 3 cases. Oedema and congestion were present in 2 cases, hypertrophy and calcification in 1 case each. Conclusion:In this study spectrum of histomorphological changes in the atretic segment has been described. Histomorphological changes at atretic segment can be valuable to surgeons in deciding the type of surgery and minimizing the postoperative intestinal dysmotility, which remains the most common complication of intestinal atresia.

Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia

BackgroundHollow viscus perforation and acute mesenteric ischemia are life-threatening conditions that must be recognized and managed appropriately. Computed tomography (CT) helps to visualize the bowel wall directly, as well as in the timely diagnosis of secondary signs of bowel ischemia.Case PresentationA young male presented with blunt trauma to the upper abdomen. A supine radiograph was suspicious of pneumoperitoneum and CT was performed to rule out perforation. The above finding was confirmed on CT, in addition, lack of enhancement of a segment of colon and non-occlusive mesenteric ischemia was evident. He was managed with exploratory laparotomy and repair of the perforation with partial colectomy.ConclusionsThe radiologist should be familiar with signs of pneumoperitoneum on supine radiographs for detection of hollow viscus perforation. These must be viewed with an index of high suspicion in symptomatic patients, post-trauma, and, further cross-sectional imaging may still be required.

Diagnostic Accuracy of Computed Tomography for the Prediction of the Need for Laparotomy for Traumatic Hollow Viscus Injury: Systematic Review and Meta-Analysis

Background: Traumatic hollow viscus injury (THVI) is one of the most difficult challenges in the trauma setting. Computed tomography (CT) is the most common modality used to diagnose THVI; however, various performance outcomes of CT have been reported. We conducted a systematic review and meta-analysis to analyze how precise and reliable CT is as a tool for the assessment of THVI. Method: A systematic review and meta-analysis were conducted on studies on the use of CT to diagnose THVI. Publications were retrieved by performing structured searches in databases, review articles and major textbooks. For the statistical analysis, summary receiver operating characteristic (SROC) curves were constructed using hierarchical models. Results: Sixteen studies enrolling 12,514 patients were eligible for the final analysis. The summary sensitivity and specificity of CT for the diagnosis of THVI were 0.678 (95% CI: 0.501–0.809) and 0.969 (95% CI: 0.920–0.989), respectively. The summary false positive rate was 0.031 (95% CI 0.011–0.071). Conclusion: In this meta-analysis, we found that CT had indeterminate sensitivity and excellent specificity for the diagnosis of THVI.

Surgical management and perioperative complications of peritonitis secondary to hollow viscus perforation in a tertiary care centre

Background: High mortality and morbidity is associated with peritonitis secondary to hollow viscus perforation, proving it a most common life threatening condition which needs emergency surgical care. Hence a proper evaluation was needed regarding appropriate management to have a better outcome, which was a challenge to operating surgeon.Methods: A serial study of 96 cases of peritonitis secondary to hollow viscus perforation was conducted at tertiary care centre, department of general surgery, Mysore medical college and research institute, Mysore, Karnataka from the period of August 2020 to July 2021. Data related to aetiology, surgical intervention and its peri-operative complications were noted. Appropriate statistical analyses were done to draw the inference.Results: Out of 96 cases studied, 74 were male, 22 were female with mean age of 45.53 years. Most common cause of peritonitis was GU perforation, followed by idiopathic, infective, malignancy, appendicular perforation and Trauma.Conclusions: Hollow viscus perforation being most common surgical emergencies, surgical outcomes and its related complications depends on age, general condition, site, co-morbidities and aetiologies.

Spectrum of gastrointestinal perforation peritonitis in 462 consecutive patients in tertiary care institute of North India

Background: Gastrointestinal perforation is one of the common surgical emergencies in developing countries. The diagnosis is mainly clinical and is aided by radiological investigations. This study was designed to highlight the spectrum of hollow viscus perforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgical treatment, postoperative complications, and mortality.Methods: The study was a hospital‑based observational study and included 462 patients of perforation peritonitis (diffuse or localized) who were studied retrospectively in terms of cause, site of perforation, surgical treatment, complications, and mortality. Only those patients who underwent exploratory laparotomy for management of perforation peritonitis were included.Results: Overall stomach was the most common site of perforation (33%). Ileum (26%) was the second common site of perforation. Duodenal perforations were seen in 88 (19%) cases whereas appendicular perforations were seen in 46 (10%) cases. Colonic perforations were least common. Acid peptic disease was the most common etiology of stomach perforations. Enteric fever (63%) was the most common etiology of jejuno-ileal perforation. Other causes include tuberculosis (23%), trauma (8%), malignancy (3%) and idiopathic in rest. Males were six times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life.Conclusions: Spectrum of perforation peritonitis cases in developing world is different from developed countries The Western literature suggests that foreign body, ischemia, radiotherapy, diverticula, and Crohn’s disease are the main causes of perforations. In contrast to this, infection is the most common cause for perforations in developing countries.

Ruptured liver abscess mimicking perforated viscus

Background: Liver abscesses are common in the Emergency Department. A cross-sectional study conducted in Qatar showed pyogenic liver abscesses were more common than amebic abscesses. Spontaneous rupture of pyogenic liver abscess is a rare entity with serious complications. A rupture resulting in peritonitis requires urgent surgical intervention whereas localized abscesses are managed with surgical or image-guided percutaneous drainage in addition to appropriate antibiotics. We report a case of spontaneous rupture of liver abscess presented to our Emergency Department that mimicked perforated hollow viscus. Methods/Case presentation: A 58-year-old male patient presented with fever, generalized weakness, anorexia, and abdominal discomfort for 2 weeks. The patient had a history of Type 2 diabetes mellitus and taking oral hypoglycemics. His initial vital signs revealed a temperature of 38.2°C, heart rate of 104 beats per minute, blood pressure of 150/74 mmHg, respiratory rate of 26 breaths per minute, oxygen saturation of 96% on room air. He appeared sick and dehydrated. Pertinent findings on abdominal examination were epigastric and right upper quadrant tenderness. The laboratory report showed leucocytosis and elevated transaminase. A chest X-ray was ordered and revealed air under the diaphragm . Point of care ultrasound showed a right liver lobe hypoechoic lesion with internal echoes and surrounding free fluid. A computed tomography of the abdomen showed a large hepatic lesion (11.5 x 8.5 x 9 cm), subcapsular in location, containing gas with dependent fluid, suggesting a gas-forming hepatic abscess, with the possibility of rupture and pneumoperitoneum. Results/Findings/Recommendations: The patient was admitted and underwent ultrasound guided drainage of the abscess. His blood and pus culture showed Klebsiella pneumonia and he received Ceftriaxone and Metronidazole intravenously (IV) for 14 days. He was discharged after 15 days with a favorable outcome. Conclusion: To the best of our knowledge, spontaneous liver abscess rupture resulting in pneumoperitoneum is rare. Chest X-ray findings may mimic perforated hollow viscus.