Colon, Ascending ; injuries ; Foreign Bodies ; complications ; Humans ; Intestinal Perforation ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Seafood

Duodenal diverticula are common, but perforated duodenal diverticulum is rare. Because of the disease rarity, there is no standard management protocol for perforated duodenal diverticulum. To properly manage this rare complication, a clear preoperative diagnosis and clinical disease severity assessment are important. An abdomino-pelvic CT is an unquestionably crucial diagnostic tool. Perforation is considered a surgical emergency, although conservative treatment based on fasting and broad-spectrum antibiotics may be offered in some selected cases. Herein, we report two cases of perforated duodenal diverticulum, one case managed with surgical treatment and one with conservative treatment.
Aged ; Diverticulum/complications/*diagnosis/surgery ; Duodenal Diseases/complications/*diagnosis/surgery ; Endoscopy, Digestive System ; Humans ; Intestinal Perforation/*diagnosis/etiology/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVEThe study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications.

METHODSClinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively.

RESULTSA total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients (3.4%) with distal colorectal cancer and 6/126 cases (4.8%) of distal colorectal cancer (P > 0.05). The overall perioperative complications in the two groups were not significantly different (P = 0.794). Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups (P = 0.002). ASA scores (grade 3 - 4), elderly age (≥ 70 years) and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self-expandable metallic stent (SEMS) group had a significantly shorter hospital stay (25.4 ± 8.3) d than that in the emergency surgery group (32.8 ± 16.4) d, (P = 0.039).

CONCLUSIONSEndoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.

Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; diagnosis ; surgery ; Colostomy ; Endoscopy ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intestinal Perforation ; etiology ; Intraoperative Complications ; Length of Stay ; Male ; Middle Aged ; Palliative Care ; methods ; Peritonitis ; etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Young Adult

Endoscopic variceal ligation (EVL) can be performed as an optional therapy for gastric variceal bleeding if endoscopic sclerotherapy (ES) is not readily available or if practitioners lack experience. EVL using an endoscopic pneumo-activated ligating device was performed on a 53-year-old male patient with liver cirrhosis who presented with hematemesis. Follow-up esophagogastroduodenoscopy (EGD) performed two days after the EVL showed gastric perforation at the EVL-procedure site on the gastric fundus. However, the patient refused emergency surgery, and therefore received only supportive management, including intravenous antibiotics. EGD 10 days later showed healing of the perforation site. This is the first report of a case of gastric variceal bleeding with development of a gastric perforation soon after EVL, which showed complete recovery with conservative therapy and without surgical intervention.
Endoscopy, Digestive System ; Esophageal and Gastric Varices/*surgery ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Perforation/etiology ; Ligation/adverse effects ; Liver Cirrhosis/diagnosis ; Male ; Middle Aged ; Tomography, X-Ray Computed

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Peutz-Jeghers syndrome has an incidence of approximately 1 in 25,000 to 300,000 births. Crohn's disease is a chronic inflammatory bowel disease that typically manifests as regional enteritis with its incidence ranging from 3.1 to 14.6 cases per 100,000 person-years in North America. Herein, we report a case of a 30-year-old male patient who had both Peutz-Jeghers syndrome and Crohn's disease. We believe that this is the first case in Korea and the second report in the English literatures on Peutz-Jeghers syndrome coincidentally accompanied by Crohn's disease.
Adult ; Crohn Disease/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Intestinal Polyps/pathology/surgery ; Male ; Peutz-Jeghers Syndrome/complications/*diagnosis/genetics ; Protein-Serine-Threonine Kinases/genetics

Sunitinib as a multitarget tyrosine kinase inhibitor is one of the anti-tumor agents, approved by the United States Food and Drug Administration to use treat gastrointestinal stromal tumor and metastatic renal cell carcinoma. The agent is known to commonly induce adverse reactions such as fatigue, nausea, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity, reduciton in cardiac output of left ventricle, and hypothyroidism. However, it has been reported to rarely induce adverse reactions such as nephrotic syndrome and irreversible reduction in renal functions, and cases of intestinal perforation or pneumatosis interstinalis as such reactions have been consistently reported. In this report, a 66-year old man showing abdominal pain had renal cell carcinoma and history of sunitinib at a dosage of 50 mg/day on a 4-weeks-on, 2-weeks-off schedule. Seven days after the third cycle he was referred to the hospital because of abdominal pain. Computed tomography showed pneumoperitoneum with linear pneumatosis intestinalis in his small bowel. The patient underwent surgical exploration that confirmed the pneumatosis intestinalis at 100 cm distal to Treitz's ligament. We report a rare case of intestinal perforation with pneumatosis intestinalis after administration of sunitinib to a patient with metastatic renal cell carcinoma.
Aged ; Antineoplastic Agents/adverse effects/*therapeutic use ; Carcinoma, Renal Cell/*drug therapy ; Drug Administration Schedule ; Humans ; Indoles/adverse effects/*therapeutic use ; Intestinal Perforation/*diagnosis/etiology/surgery ; Kidney Neoplasms/*drug therapy ; Lung/radiography ; Male ; Pneumatosis Cystoides Intestinalis/*diagnosis/etiology ; Positron-Emission Tomography ; Pyrroles/adverse effects/*therapeutic use ; Tomography, X-Ray Computed

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
Bile Ducts, Extrahepatic ; Biliary Tract Diseases/complications/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenal Diseases/*diagnosis/etiology/therapy ; Female ; Gallbladder Neoplasms/diagnosis ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Plastics ; Stents/*adverse effects ; Tomography, X-Ray Computed

BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.
Aged ; Aged, 80 and over ; Colon, Sigmoid/pathology ; Colonic Diseases/*diagnosis/radiography/surgery ; Female ; Humans ; Intestinal Perforation/*diagnosis/radiography/surgery ; Middle Aged ; Postoperative Complications ; Respiratory Distress Syndrome, Adult/etiology ; Retrospective Studies ; Sepsis/etiology ; Tomography, X-Ray Computed

Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.
Aged ; Aged, 80 and over ; Aorta, Abdominal/*surgery ; Aortic Aneurysm, Abdominal/complications/*surgery ; Aortic Diseases/*diagnosis/surgery/virology ; Cytomegalovirus Infections/*complications/diagnosis/pathology ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/*diagnosis/surgery/virology ; Intestinal Perforation/*diagnosis/virology ; Male ; Vascular Fistula/*diagnosis/surgery/virology

Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.
Aged ; Aged, 80 and over ; Aorta, Abdominal/*surgery ; Aortic Aneurysm, Abdominal/complications/*surgery ; Aortic Diseases/*diagnosis/surgery/virology ; Cytomegalovirus Infections/*complications/diagnosis/pathology ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Fistula/*diagnosis/surgery/virology ; Intestinal Perforation/*diagnosis/virology ; Male ; Vascular Fistula/*diagnosis/surgery/virology