Paradoxical response to anti-tuberculosis treatment, defined as clinical or radiologic worsening of pre-existing lesions or the development of new lesions while ongoing treatment, poses diagnostic dilemma. Intestinal perforation as a paradoxical response is rare. We report a 10-year-old female who presented with recurrent abdominal pain, anorexia, and bloody diarrhea, and was diagnosed with disseminated tuberculosis. She had marked improvement after one month of anti-tuberculosis treatment but developed a recurrence of initial symptoms on the third month of therapy and was treated for cecal perforation. Histopathology of cecum revealed chronic granulomatous inflammation. The patient improved after the surgery and the resumption of anti-tuberculosis medications. Recognition of paradoxical reactions and differentiating it from drug resistance of other pathology is important as these necessitates different management strategies.

Paradoxical response to anti-tuberculosis treatment, defined as clinical or radiologic worsening of pre-existing lesions or the development of new lesions while ongoing treatment, poses diagnostic dilemma. Intestinal perforation as a paradoxical response is rare. We report a 10-year-old female who presented with recurrent abdominal pain, anorexia, and bloody diarrhea, and was diagnosed with disseminated tuberculosis. She had marked improvement after one month of anti-tuberculosis treatment but developed a recurrence of initial symptoms on the third month of therapy and was treated for cecal perforation. Histopathology of cecum revealed chronic granulomatous inflammation. The patient improved after the surgery and the resumption of anti-tuberculosis medications. Recognition of paradoxical reactions and differentiating it from drug resistance of other pathology is important as these necessitates different management strategies.
Human ; Female ; Child: 6-12 yrs old ; intestinal perforation

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by purpura, arthritis, abdominal pain, and nephritis. Gastrointestinal involvement can manifest as pain, intussusception, intestinal bleeding, and intestinal perforation. We report a case of fulminant HSP at an age of eight in 1994, with multiple complications of intra-thoracic bleeding, massive intestinal perforation, nephritis, and various skin rashes. The brisk bleeding findings of intestinal on Technetium-99m-labeled red blood cell scan (99mTc RBC scan) were well matched to those of the emergency laparotomy and the resected intestine. The patient's abdominal conditions improved gradually but nodular skin eruptions developed newly apart from improving preexisting lower limb rashes and the urine findings continued abnormal, so skin and kidney biopsy were done for the diagnosis. After cyclosporine therapy, skin eruptions and urine findings returned to normal gradually. On a follow-up after 25 years in 2019, the patient is 33-year-old, healthy without any abnormality on blood chemistries and urine examination.
Abdominal Pain ; Adult ; Arthritis ; Biopsy ; Cyclosporine ; Diagnosis ; Emergencies ; Erythrocytes ; Exanthema ; Follow-Up Studies ; Hemorrhage ; Humans ; Intestinal Perforation ; Intestines ; Intussusception ; Kidney ; Laparotomy ; Lower Extremity ; Nephritis ; Purpura ; Skin ; Systemic Vasculitis

Colonoscopy is one of the most useful procedures for making the diagnosis and treating various colorectal diseases, but this procedure rarely causes serious complications such as perforation. The incidence of colon perforation during colonoscopy is low. However, as the demand for screening and surveillance colonoscopy has gradually increased and colonoscopic polypectomy has become a commoner procedure in daily clinical practice, endoscopists should pay attention to prevent and manage colonoscopy-related perforation. The purpose of this review is to briefly summarize the guidelines from the World Journal of Emergency Surgery for the management of colonoscopy-related perforation.
Colon ; Colonoscopy ; Diagnosis ; Emergencies ; Incidence ; Intestinal Perforation ; Mass Screening

PURPOSE: Bevacizumab has been used as a promising drug for metastatic colorectal cancer in combination with chemotherapeutic agents. However, it has a few serious adverse effects, such as intestinal bleeding or perforation. The purpose of this study is to identify the clinical characteristics of intestinal perforation induced by bevacizumab in colorectal cancer patients.METHODS: From January 2007 to June 2018, a total of 488 patients underwent chemotherapy with bevacizumab for metastatic colorectal cancer. Medical records were reviewed retrospectively.RESULTS: Nine patients (1.8%) were identified with intestinal perforation induced with bevacizumab. The median age was 59 years (range, 36–68 years). The primary tumor site was the sigmoid colon in six patients, the rectum in three patients. The liver was the most common metastatic organ (7 patients). Perforation sites were primary tumor site of the colorectum in four patients and the small bowel in five patients. Intestinal perforation was developed after a median of 3 chemotherapy cycles (range, 1–15 cycles), and a median of 7 days (range, 3–32 days) after chemotherapy. One patient expired due to sepsis.CONCLUSION: Bevacizumab induced intestinal perforation is a lethal adverse effect in patients with colorectal cancers. The characteristics of intestinal perforation varied according to perforation site, previous chemotherapy cycles, and clinical course. Careful monitoring is necessary with the use of bevacizumab in conjunction with chemotherapeutic agents.
Bevacizumab ; Colon, Sigmoid ; Colorectal Neoplasms ; Drug Therapy ; Hemorrhage ; Humans ; Intestinal Perforation ; Liver ; Medical Records ; Rectum ; Retrospective Studies ; Sepsis

PURPOSE: This study aimed to evaluate the clinical and radiologic findings suggestive of spontaneous intestinal perforation (SIP) in extremely-low-birth-weight infants (ELBWIs) with persistent gasless abdomen, and to investigate the usefulness of abdominal ultrasonography for the diagnosis of SIP. METHODS: In total, 22 infants with birth weights less than 1,000 g who showed persistent gasless abdomen on simple abdominal radiography were included. Perinatal, neonatal, and perioperative clinical findings were retrospectively reviewed, and the risk factors for intestinal perforation were evaluated. Abdominal sonographic findings suggestive of intestinal perforation were also identified, and postoperative short-term outcomes were evaluated. RESULTS: In total, eight of the 22 infants (36.4%) with gasless abdomen had SIP. The number of infants with patent ductus arteriosus who were treated with intravenous ibuprofen or indomethacin was significantly higher in the SIP group than in the non-SIP group (P<0.05). Greenish or red gastric residue, abdominal distension, or decreased bowel sound were more frequent in infants with SIP (P<0.05), in addition to gray or bluish discoloration of abdomen, suggestive of meconium peritonitis (P<0.05). Pneumoperitoneum on simple abdominal radiography was found in only one of the eight infants (12.5%) with SIP. Intramural echogenicity and echogenic extramural material on abdominal ultrasonography were exclusively observed in infants with SIP. Four infants (50%) with SIP died after surgical intervention. CONCLUSION: Intestinal perforation may occur in ELBWIs with gasless abdomen. As intramural echogenicity and extraluminal echogenic materials on abdominal ultrasonography are indicative of SIP, this technique could be useful for diagnosing SIP.
Abdomen ; Birth Weight ; Diagnosis ; Ductus Arteriosus, Patent ; Humans ; Ibuprofen ; Indomethacin ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Intestinal Perforation ; Meconium ; Peritonitis ; Pneumoperitoneum ; Radiography, Abdominal ; Retrospective Studies ; Risk Factors ; Ultrasonography

Colonoscopy is one of the most useful procedures for making the diagnosis and treating various colorectal diseases, but this procedure rarely causes serious complications such as perforation. The incidence of colon perforation during colonoscopy is low. However, as the demand for screening and surveillance colonoscopy has gradually increased and colonoscopic polypectomy has become a commoner procedure in daily clinical practice, endoscopists should pay attention to prevent and manage colonoscopy-related perforation. The purpose of this review is to briefly summarize the guidelines from the World Journal of Emergency Surgery for the management of colonoscopy-related perforation.
Colon ; Colonoscopy ; Diagnosis ; Emergencies ; Incidence ; Intestinal Perforation ; Mass Screening

Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure- related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication.
Colon ; Colorectal Neoplasms ; Constriction, Pathologic ; Gastrointestinal Neoplasms ; Hemorrhage ; Intestinal Perforation ; Recurrence ; Stomach

Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.
Aged, 80 and over ; Bile ; Drainage ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Intestine, Small ; Pneumoperitoneum ; Stents ; Urinary Bladder Neoplasms

OBJECTIVE: In this study, we evaluated the toxicity and clinical efficacy of nivolumab, a programmed cell death protein 1 (PD-1) inhibitor, on patients with platinum resistant ovarian cancer. METHODS: Every second week, 18 patients with platinum resistance ovarian cancer received nivolumab until disease progression occurred. We assessed toxicity, disease control rate, progression free survival (PFS) and overall survival (OS). Radiological response evaluation according to irRECIST was performed every 12th week, while clinical evaluation was done every second week. RESULTS: The disease control rate was 44% (95% confidence interval [CI]=19–87) as 8 showed stable disease, 6 showed progressive disease and 4 died before the first radiological response evaluation. The median OS was 30 weeks (95% CI=14–42; range, 3–95), and PFS was 15 weeks (95% CI=13–17). The median follow-up time was 30 weeks (range, 3–123). The rate of grade 2–5 adverse events was 28% (5 out of 18). Two patients (11%) developed grade 2 and 3 adverse events, respectively, while no grade 4 events were observed. One patient died from intestinal perforation, believed to be caused by concomitant bevacizumab rather than nivolumab. CONCLUSION: This study shows few adverse events, and promising clinical efficacy when using nivolumab for ovarian cancer.
Bevacizumab ; Cell Death ; Disease Progression ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Immunotherapy ; Intestinal Perforation ; Ovarian Neoplasms ; Platinum ; Treatment Outcome