Ileal Perforation
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Khalilah Alhuda Binti Kamilen ◽  
Mohd Yusran Othman

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

Bibek Man Shrestha ◽  
Suraj Shrestha ◽  
Sanjeev Kharel ◽  
K.C. Ajay ◽  
Sujan Shrestha ◽  

2021 ◽  
Parackrama Karunathilake ◽  
Thilak Jayalath ◽  
Shamali Abeygunawardena ◽  
Udaya Ralapanawa

Abstract Background Patients with HIV infection often develop multiple complications and comorbidities, including malignancies and opportunistic infections. The association of HIV infection with typhoid fever remains unclear, though there is a clear risk of typhoid in HIV infected persons. Therefore, the diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea. Case Presentation A 38-year-old gentleman presented with fever with significant weight loss and anorexia for eight months. He had worked abroad in a middle east country and had recently returned to Sri Lanka. On examination, he was thinly built with a BMI of 18 kg/m2. The initial full blood count revealed lymphopenia, anaemia and thrombocytopenia. He also had mild hyponatremia. His HIV Ag/Ab combo assay became positive, and he was found to have a low CD4 count. While on antiretroviral therapy, he developed nausea, vomiting and diarrhoea while continuing the preexisting fever followed by severe dyspnoea and epigastric pain and tenderness associated with tachypnoea, tachycardia and hypotension. The urgent chest X-ray revealed gas under the diaphragm. An urgent exploratory laparotomy was done, and he was found to have distal ileal perforation with a typhoid ulcer which was histologically confirmed later. During the postoperative period, the patient developed severe pneumonia, scummed despite all the resuscitation care given. Conclusion Fever in HIV patients could be due to HIV itself, opportunistic infections or malignancies. The diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea, constipation or bowel perforation. Salmonella typhi infection in HIV/AIDS patients may cause life-threatening complications, where the case fatality rate of typhoid significantly increase when present concurrently with HIV, and the mortality further increases with delayed diagnosis.

Emmanuel Ameyaw ◽  
Alhassan Abdul-Mumin ◽  
Abiboye Cheduko Yifieyeh ◽  
Akua Afriyie Ocran ◽  
Naana Ayiwa Wereko Brobbey

We report on a 15-year-old Ghanaian boy, who presented to a district hospital with diabetic ketoacidosis (DKA) but was diagnosed wrongly as a small bowel perforation due to typhoid fever. He presented with weakness, poor feeding, vomiting, and severe abdominal pain. General examination revealed a lethargic, drowsy, and severely dehydrated patient. His abdomen was diffusely tender more in the right ileac fossa. Investigations including complete blood count, blood smear for malaria parasites, urinalysis, and abdominal ultrasound yielded unremarkable results. Hemoglobin level was 12.4 grams per decilitre. He was diagnosed as typhoid ileal perforation and laparotomy was done, but the bowels and all other intra-abdominal organs were found to be normal. A blood glucose test was done intraoperatively, and it found very high hyperglycaemia. This led to the suspicion of DKA, which was confirmed through urine dipstick testing for high urine ketones and a high glycated hemoglobin (HbA1C) test result. He was then treated for DKA, which resolved on the second day of admission, but the surgical wound healed after twelve days.Our account emphasizes the need for testing for blood glucose in critically ill children and adolescents with suspected severe infections or acute medical conditions that require admission or surgical intervention. This owes to the fact that the clinical features of undiagnosed diabetes, especially if it progresses to DKA, are similar to those of infections and disorders managed via surgical treatment, which are rather more common in Ghana and Africa.

2021 ◽  
Vol 8 (5) ◽  
pp. 1466
Pradeep M. Wagh ◽  
Samadhan Patil

Background: The mortality of perforation peritonitis is highly dependent on early approach to the hospital, quick diagnosis and prompt surgical treatment as it correlates with the duration and degree of peritoneal contamination, the patient's age, the general health of the patient and the nature of the underlying aetiology. The present study was done to assess the role of various prognostic factors which have a bearing on the final outcome of the patients.Methods: This prospective observational cross-sectional study was conducted in the at a tertiary level hospital in Maharashtra, in which 47 patients who presented a surgical emergency of perforation peritonitis and underwent an exploratory laparotomy were included. We compared different variables between patients who survived and those who died. Results: High mortality was also found in patients who presented after 24 hours of developing symptoms. Ileal perforation was significantly more common among dead patients (50%) as compared to patients who survived (20%), p-value<0.05. There were significantly higher proportion of patients who had shock on day 1 who died (67%) as compared to those who survived (12%), p-value<0.05. Also, the group of patients who died, had significantly higher MPI (p-value<0.01), higher proportion of patients with multiple perforations (p-value<0.05), larger perforations (p-value<0.01) and contamination more than 1000 ml (p-value<0.05).  Conclusions: High mortality was observed in patients who presented late, had ileal perforations, multiple and large perforation and developed shock on day one.

Farhana Khanam ◽  
Thomas C. Darton ◽  
Allen G. P. Ross ◽  
K. Zaman ◽  
Andrew J. Pollard ◽  

Intestinal perforation is one of the most dangerous complications of typhoid fever and demands urgent hospitalization, diagnosis, and surgical management to reduce morbidity and prevent mortality. Here, we report a case of typhoidal intestinal perforation in a 19 year-old young man detected by passive surveillance during a cluster-randomized trial with Vi-tetanus toxoid conjugate vaccine (Typhoid Vaccine Acceleration Consortium: TyVAC) in an urban slum area in Mirpur, Dhaka, Bangladesh. The patient presented with a high-grade fever, lower abdominal pain, and vomiting and was admitted to a healthcare facility. Physical examination and preoperative investigations of the patient suggested a presumptive diagnosis of intestinal perforation, and the patient was transferred to a tertiary-level hospital for surgical management. A positive blood culture, intraoperative findings, and histopathology of an intestinal biopsy confirmed ileal perforation due to typhoid fever. This case report highlights the need for prompt diagnosis and appropriate pre- and postoperative management of patients who appear with the symptoms of typhoidal intestinal perforation. This report further demonstrates the importance of systematic surveillance and proper evaluation to determine the true incidence rate of typhoid fever and intestinal perforation in Bangladesh.

2021 ◽  
pp. 1-3
Shesh Kumar ◽  
Rajesh Kumar ◽  
Anil Kumar ◽  
Vikilesh Kumar Sharma ◽  
Ram Lakhan Singh Verma

Objective:To study the epidemiological prole of perforation peritonitis in a tertiary care hospital in western Uttar Pradesh. Methods: This was a cross-sectional study. The study was conducted on 127 patients of hollow viscus perforation resulting in peritonitis. Patients admitted were examined during pre-operative period and followed during intra-operative and post-operative period. All the required data were collected like demographic, clinical and radiological examinations at pre and post-operative period. Results: About one third of patients were between 15-30 years (31.5%) and majority of patients were males (80.3%). Ileal anatomical site of perforation was most common (43.3%). Distension was most common symptom (95.3%). REPAIR+ PROX LOOP (32.7%) and PERF AS LOOP (30.9%) surgical procedure was performed among about one third of patients for ileal perforation. Fever, seroma and infection post-operative complication was among all patients whom number of ileal perforation was >3. The mortality was higher among whom number of ileal perforation was >3 (40%) than 2-3 (25%) and 0-1 (4.8%). The duration of hospital stay was insignicantly (p>0.05) higher among whom number of ileal perforation was >3 (14.26±4.13 days) than 2-3 (13.60±3.14 days) and 0-1 (11.86±2.36 days). Conclusion: Early diagnosis, resuscitation with uids, antibiotic, and timely surgical intervention are the most important factors deciding the fate of the patient with perforation peritonitis.

2021 ◽  
Tian Yong ◽  
Zhang Zheng Xiang ◽  
Chuan Fang Li ◽  
Tian Qing Ming ◽  
Ye Gang ◽  

Abstract Background Non-Hodgkin Lymphoma (NHL) of the ileum presenting as perforation and peritonitis is a rare disease, derived from intestinal intraepithelial T lymphocytes.The degree of malignancy is extremely high. The pathogenic factors of ileal perforation caused by NHL are not clear yet, Chromosome and immune system abnormalities, which may be related to the NHL, are indistinguishable from other benign and malignant conditions and clinically nonspecific. Case presentation Here,We described an 84 year old male with abdominal pain for four days and aggravating for three hours. The pain was initially considered as gastrointestinal perforation, and was initially located at the upper abdomen area.The persistent insidious pain,and was accompanied by nausea, vomiting and fever. According to the abdominal physical examination, the patient had pain all over his abdomen, rebound pain and muscle tension, and bowel sounds were reduced on auscultation. The abdominal CT scan showed abdominal cavity free gas.We diagnosed the patient with peritonitis due to the perforation of the hollow viscus. We promptly performed exploratory laparotomy.Intraoperative findings,showed perforations in the ileum that were approximately 40 cm from the ileocecal region and had a size of 3~8 mm. Segmental distribution was observed, and the intestinal contents overflowed with purulent moss around the perforation surface. Resection and ileostomy were performed as intervention, and the clinical histopathological examination showed the T-cell lymphoma. Conclusion:Timely emergency surgery is the key to the treatment of the ileal perforation caused by T-cell lymphoma.Resection and ileostomy were performed as intervention, and the subsequent histopathological examination showed T-cell lymphoma. Clinical follow-up was performed, and the patient was advised to go to the oncology department for further chemotherapy.

Daniel Barranco Castro ◽  
Reyes Aparcero López ◽  
Antonio Domínguez Amodeo ◽  
Angel Caunedo Álvarez

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