Thoracic esophageal perforation by the use of Magill forceps in infant, success with non-operative treatment: case report

Background Esophageal perforation is a rare surgical pathology in children. Thoracic esophageal perforation is more severe than cervical esophageal perforation. Iatrogenic cause, mainly by endoscopy, is the most common in esophageal perforation. However, perforation induced by “Magill forceps” is exceptional. Case presentation A systematic physical examination revealed pyrexia severe respiratory distress and right-sided pleural effusion. We report the success of non-operative treatment applied to thoracic esophageal perforation due to Magill forceps in a 24-month-old male infant. The immediate and short-term outcomes were excellent. Conclusions Non-operative treatment is possible in iatrogenic perforation of thoracic esophageal in infants. This treatment delivers excellent outcome in carefully selected patients.

Bleeding Duodenal Diverticulum with Iatrogenic Perforated Duodenal Diverticulum: Double Trouble

Background: Duodenal diverticulum is the second most common location following the large bowel. Only 1–5% of patients with DD are symptomatic. Complications of duodenal diverticulum includes obstruction of duodenum, biliary pancreatic duct, pancreatitis, haemorrhage, diverticulitis with or without perforation, and other biliopancreatic manifestations including fistula formation in the bile duct, choledocholithiasis and cholangitis, bezoar formation inside the diverticulum, perforation and bleeding. Surgical or non-surgical treatment are considered in selected patient in treating perforated duodenal diverticulum. Case Presentation: We present a 69 year old gentleman presented to emergency department with complaint of passing out blackish stool for 2 days duration associated with presyncopal attack. On arrival, patient appear pale with class 3 hypovolemic shock symptoms. Abdominal examination revealed mild tenderness over epigastric region without signs of peritonism. Digital rectal examination showed fresh melena. Oesophagogastroduodenoscopy (OGDS) showed a huge diverticulum at duodenum (D3) with pooling of blood and blood clots. In view of bleeding at D3 diverticulum,adrenaline was injected and haemoclipped was applied. Hemostasis from bleeding duodenal diverticulum was successfuly secured. However, patient had iatrogenic perforated duodenal diverticulum. Conclusion: We present a case of upper gastrointestinal bleeding from a D3 diverticulum with iatrogenic perforated duodenal diverticulum due to endoscopic hemostasisinjection.We treated this patient conservatively by keep nil by mouth and started on parentral nutritional support, intravenous antibiotics and serial abdominal examination. We advocate in duodenal diverticulum bleeding the application of endoscopic clips and injection should be use juridiously. In case of iatrogenic perforation of duodenum diverticulum due to endoscopic hemostasis can still be treated conservatively in stable, elderly patients with no signs of diffuse peritonitis and no clinical evidence of sepsis

806 CERVICAL ESOPHAGEAL PERFORATION: MULTIMODAL APPROACH TO A RARE AND MORBID CONDITION

Cervical esophageal perforation (CEP) is an uncommon but serious surgical condition. It is associated with a high morbidity and mortality if not managed timely, partly due to its close proximity with vital structures in the neck and mediastinum. The common causes include trauma, foreign body ingestion and iatrogenic perforation. The diagnosis and management of CEP remain challenging despite advances in surgery. Methods We present a series of 3 cases of CEPs, with multimodal approach for the management. Results In this series of 3 cases of CEPs with different presentations, tailored management strategies resulted with successful outcomes. Post-procedure/operative oral contrast study revealed no contrast leakage. Conclusion The diagnosis and management of CEP remain challenging despite advances in surgery. Contrasted CT scan and endoscopy are the mainstay of investigations. The treatment options of CEP range from conservative management to endoscopic intervention to surgical repair often with drainage procedures due to its frequent association with collections in the neck, pleural or mediastinal cavity. Prompt detection and early management with multimodal intervention ensure a better outcome in these patients.

A STUDY ON INCIDENCE AND FACTORS ASSOCIATED WITH PORT SITE INFECTIONS POST LAPAROSCOPIC CHOLECYSTECTOMY

Today, laparoscopic cholecystectomy is the gold standard for symptomatic gall stones. A port site infection (PSI) is dened as an infection of the skin and subcutaneous tissue at the site of ports created during laparoscopic cholecystectomy which discharges purulent material spontaneously or is opened to drain the same by the surgeon. Increased number of performed cholecystectomies, increased number of port site infections, although rare, it has signicant inuence in overall outcomes of lap cholecystectomy and its nal results like delay in return to work, increase in cost and bad cosmetic results. AIM:To nd out the incidence of Port site infections after laparoscopic cholecystectomy by clinical assessment and conrmed by swab test after culture and sensitivity. MATERIALS AND METHODS: Hospital based prospective observational study was done on patients undergoing laparoscopic surgeries during a period of one year in a tertiary care centre of Eastern India. Patients were examined for infections and if suspected swabs were sent for culture and sensitivity and treated accordingly. For statistical analysis data were analyzed by SPSS software. RESULTS: In our study, 69 patients were females and 31 were males who underwent Laparoscopic cholecystectomy and the mean age of patients was 40 years. The PSI was seen most commonly at epigastric port i.e. 4 among 6 patients, hence the port used for gall bladder retrieval and PSI was statistically signicant. We found that the most common organism was Staphylococcus aureus and all are the cases were supercial site infections. CONCLUSION:We can prevent port site infections by using endo bag for all cases which prevents the spillage of bile during surgery, by reducing the intra-operative time and by preventing iatrogenic perforation of the gall bladder during the surgery.

Iatrogenic perforation of atrial appendage and successful closure with Amplatzer Piccolo Occluder, in a 1-year-old patient

We present the successful transcatheter closure of the perforation of the cardiac wall from atrial appendage in a 1-year-old girl. Although open-heart surgical repair has been the primary option, percutaneous device closure should always be considered before surgery.

Neurodevelopmental outcome of very preterm infants with gastrointestinal tract perforations does not differ compared to controls

Summary Purpose To evaluate gastrointestinal tract (GIT) perforations in very low birth weight infants and the effects on neurodevelopmental outcome. Methods Between 2000 and 2017 all cases with GIT perforation were analyzed regarding causes, associated morbidities and neurodevelopmental outcome and compared with matched (gestational age, birth weight, gender, year of birth) by 1:2 controls. Results The incidence of GIT perforation was 2.0% (n = 38/1878). Diagnoses associated with GIT were meconium obstruction of prematurity (MOP,n = 19/50%), spontaneous intestinal perforation (SIP, n = 7/18%), necrotizing enterocolitis (NEC, n = 6/16%), iatrogenic perforation (n = 3/8%), volvulus (n = 2/5%) and meconium ileus (n = 1/3%). The NEC-associated perforations occurred later compared to those associated with MOP and SIP (median 8 days and 6 days vs. 17 days, p = 0.001 and 0.023, respectively) and main localization was the terminal ileum (84%). Cases had higher rates of late onset sepsis (55% vs. 24%, p = 0.003), longer duration of mechanical ventilation (median 30 days vs 18 days, p = 0.013) and longer stays at the hospital (median 122 days vs 83 days, p < 0.001); mortality rates did not differ. The 2‑year neurodevelopment follow-up revealed no differences between groups (normal development 49% vs. 40%). Conclusion Despite increased morbidities preterm infants with GIT perforation did not have a higher mortality rate and groups did not differ regarding neurodevelopmental outcome at the corrected for prematurity age of 2 years.

Een laattijdige complicatie na het plaatsen van een PEG-sonde

Gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy First described in 1980, percutaneous endoscopic gastrostomies (PEG) have become widely used to provide enteral nutritional support to patients unable to ingest solid or liquid foods. A 46-year-old man presented himself with a malodorous leakage near the insertion site after getting a PEG. The PEG had been placed 6 months earlier in the context of a swallowing disorder, caused by progressive chronic inflammatory demyelinating polyneuropathy. An additional CT scan showed no collection or abscess. Instead, the PEG tube appeared to have perforated the colon transversum, with the tip of the probe still located in the stomach. Damage of intra-abdominal organs after placement of a PEG is described in literature. While in the majority of described cases, damage was caused to large and small intestines, only damage to the liver or spleen was reported occasionally. An iatrogenic perforation of the bowel is more common in an older population due to increased laxity of the mesentery. Excessive insufflation of air into the stomach during the procedure is thought to cause gastric rotation, which can pull the transverse colon toward the stomach. Previous abdominal surgery, as also described in this case report, increases the risk of perforation. Perforation of an intra-abdominal organ usually presents immediately after placement of a PEG probe. This late complication is rare and demonstrates the importance of correct patient selection, periprocedural attention and early detection. When presenting a malodorous loss around the tube, a physician should always be contacted. Vigilance is therefore required, even months after placement.

Frequently affected teeth by different types of iatrogenic perforations made during dental training in Bulgaria

Background: One of the reasons for endodontic treatment failure is iatrogenic perforation. That is why it is important to provide adequate endodontic education for graduating young practitioners. Aim: The aim of this study is to determine the most common locations of the iatrogenic perforations made by last year students in the Dental Faculty in Sofia, Bulgaria, to note the association of particular errors with particular teeth and to determine how this information can improve their education. Methods: All patient records of last-year students for 2015 and 2016 were examined. Perforations were diagnosed by radiography, and also confirmed clinically. Results: From all 778 teeth 30 incidents of root perforations were found: 10 in 2015 and 20 in 2016. More perforations were found in upper posterior teeth- 80% of all the perforations made in 2015, and 45% of all registered perforations in 2016. For the entire period of the research perforation frequency in upper molars, and in upper anterior teeth were found to be significantly higher than in other group of teeth. In academic 2015 year, 8 of the perforations (80%) were furcal. In 2016 year, 11 (55%) of all perforations were apical. Conclusions: More in-depth knowledge of endodontic anatomy , and also more strict supervision on students’ tasks are needed, especially regarding standard root canal treatment on molar teeth.