Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.
Abdominal Pain ; Antigens, CD20/metabolism ; Antigens, CD45/metabolism ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Gastrectomy ; Humans ; Intestinal Perforation/diagnostic imaging ; Lymphoma, Large B-Cell, Diffuse/*diagnosis/drug therapy/pathology ; Lymphoma, Non-Hodgkin/*diagnosis/drug therapy/pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Stomach Neoplasms/*diagnosis/drug therapy/pathology ; Tomography, X-Ray Computed

No abstract available.
Aged ; Chronic Disease ; Colitis/complications/*diagnosis/pathology ; Colonoscopy ; Female ; Fistula/complications/diagnosis ; Humans ; Intestinal Perforation/diagnosis/surgery ; Tomography, X-Ray Computed ; Uterine Cervical Neoplasms/*radiotherapy

A 66-year-old male with dyspepsia and weight loss was referred to our hospital for evaluation. On laboratory examination, anti-saccharomyces cerevisiae (ASCA)-IgA was positive and iron deficiency anemia was present. PET/CT and abdominal CT scan images showed multiple small bowel segmental wall thickening and inflammation. Capsule endoscopy images showed multiple small bowel ulcerative lesions with exudates. Based on laboratory test results and imaging studies, the patient was diagnosed with Crohn's disease and treated with prednisolone and 5-aminosalicylic acid (5-ASA). However, the patient underwent second operation due to small bowel perforation within 2 month after initiation of treatment. Pathology report of the resected specimen was compatible to primary small bowel diffuse large B cell lymphoma and pertinent treatment was given to the patient after recovery. Herein, we describe a case of primary small bowel diffuse large B cell lymphoma that was mistaken for Crohn's disease.
Aged ; Antibodies/blood ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Capsule Endoscopy ; Crohn Disease/diagnosis/drug therapy ; Diagnostic Errors ; Humans ; Immunoglobulin A/blood ; Intestinal Perforation/surgery ; Lymphoma, Large B-Cell, Diffuse/*diagnosis/drug therapy/pathology ; Male ; Mesalamine/therapeutic use ; Positron-Emission Tomography ; Saccharomyces cerevisiae/immunology ; Tomography, X-Ray Computed

No abstract available.
Colon/pathology/surgery ; Colonoscopy ; Female ; Humans ; Intestinal Perforation/*etiology ; Plastics ; Stents/*adverse effects

Animals ; Duodenal Diseases ; diagnosis ; parasitology ; pathology ; Duodenum ; parasitology ; pathology ; Humans ; Intestinal Perforation ; diagnosis ; parasitology ; pathology ; Male ; Middle Aged ; Taenia saginata ; pathogenicity

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for the pathological diagnosis of pancreatic masses, but patients are susceptible to severe bleeding and perforation. Because the incidence and severity of these complications have not been fully evaluated. METHODS: We aimed to evaluate severe bleeding and perforation after EUS-FNA for pancreatic masses using large-scale data derived from a Japanese nationwide administrative database. RESULTS: In total, 3,090 consecutive patients from 212 low- to high-volume hospitals were analyzed. Severe bleeding requiring transfusion or endoscopic treatment occurred in seven patients (0.23%), and no perforation was observed. No patient mortality was recorded within 30 days of EUS-FNA. The rate of severe bleeding in low-volume hospitals was significantly higher than that in medium- and high-volume hospitals (0.48% vs 0.10%, p=0.045). CONCLUSIONS: Severe bleeding and perforation following EUS-FNA for pancreatic masses are rare, and the procedure is safe.
Blood Transfusion/statistics & numerical data ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*adverse effects ; Female ; Fibrinolytic Agents/adverse effects ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestinal Perforation/*etiology ; Male ; Middle Aged ; Pancreatic Neoplasms/*pathology

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.
Abdominal Cavity ; Abdominal Injuries ; Aged ; Aged, 80 and over ; Anal Canal ; Causality ; Female ; Humans ; Intestinal Perforation ; Intestine, Small ; Lacerations* ; Pathology ; Pelvis ; Rectal Prolapse ; Rectum

Animals ; Duodenal Diseases ; diagnosis ; Duodenum ; parasitology ; pathology ; Humans ; Intestinal Perforation ; diagnosis ; Male ; Taenia saginata ; pathogenicity

OBJECTIVETo improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC), imaging assessment of neonates with NEC was analyzed retrospectively.

METHODData of 211 cases of NEC were retrospectively collected from the Department of Neonatology, Children's Hospital of Chongqing Medical University between Jan.1(st) 2006-Dec.31(st) 2011.

RESULTAnalysis of abdominal X-ray of 211 cases showed that there were 40 cases (19.0%) who had no changes on each X-ray, 47 cases (22.3%) had improvement and 23 cases (10.9%) became worse. In the group of no changes, positive rate with good prognosis was 97.5% and with poor prognosis, it was 2.5%. In the group of improvement, positive rate with good prognosis was 97.9%, and the contrary was 2.1%. Positive rate with good prognosis was 56.5%, and the contrary was 43.5% in worse group. Chi-square analysis of the three groups showed χ(2) = 31.742, P < 0.01. Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0%, 12/75) and Doppler US (1.3%, 1/75), χ(2) = 10.191, P < 0.05, portal pneumatosis on abdominal X-ray(1.3%, 1/75) versus Doppler US (12.0%,9/75), χ(2) = 6.857, P < 0.05. Surgical timing mostly corresponded to pneumoperitoneum (OR = 19.543) and intestinal obstruction (OR = 19.527) of abdominal X-ray. The logistic regression equation is y = -2.915-1.588x1+2.972x4+2.973x7 + 1.711x9 (χ(2) = 101.705, P < 0.01).

CONCLUSIONAbdominal X-ray is the most important method of diagnosis of NEC, the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group. Comparison with abdominal X-ray and Doppler US, the former in pneumoperitoneum positive rate was higher than the latter, at the same time, portal pneumatosis on Doppler US is more sensitive to abdominal X-ray, the value of two imaging assessments both supplement each other. Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.

Abdomen ; diagnostic imaging ; surgery ; Birth Weight ; Enterocolitis, Necrotizing ; diagnosis ; pathology ; surgery ; Female ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; diagnosis ; pathology ; surgery ; Infant, Premature ; Intestinal Perforation ; diagnostic imaging ; surgery ; Logistic Models ; Male ; Pneumoperitoneum ; diagnosis ; diagnostic imaging ; Portal Vein ; diagnostic imaging ; pathology ; Predictive Value of Tests ; Prognosis ; Radiography, Abdominal ; Retrospective Studies ; Severity of Illness Index ; Ultrasonography, Doppler, Color

Crohn's disease is characterized by chronic transmural inflammation of the bowel and is associated with serious complications, such as bowel strictures, abscesses, fistula formation, and perforation. As neither medical nor surgical therapy provides a cure for Crohn's disease, the primary goals of therapy are to induce and maintain remission and prevent complications. As a biologic agent, infliximab, a monoclonal antibody to tumor necrosis factor, is indicated for refractory luminal and fistulizing Crohn's disease that does not respond to other medical therapies or surgery. Infliximab has proven to be very effective for inducing and maintaining remission in Crohn's disease; however, infliximab treatment has several potential complications. Here, we report a case of free perforation following a therapeutic response after an initial dose of infliximab for Crohn's disease. This is the first case report describing a free perforation in a Crohn's disease patient after an initial dose of infliximab.
Adolescent ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/*therapeutic use ; Antibodies, Monoclonal/*adverse effects/*therapeutic use ; Colonoscopy ; Crohn Disease/*drug therapy ; Dietary Fiber ; Female ; Fibrosis/pathology ; Humans ; Ileum/surgery ; Intestinal Perforation/*chemically induced/surgery ; Tomography, X-Ray Computed