Treatment results of small bowel perforations due to unusual causes

Uzunoglu, Mustafa Yener; Altıntoprak, Fatih; Dikicier, Enis; Zengin, İsmail

doi:10.12669/pjms.344.14808

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…Our results showed that iatrogenic perforations (41.9%) were the main causes for small bowel perforations. In other studies, ischemic-obstructive causes or inflammatory-associated perforations were found to be the main origins of small bowel perforations [ 2 , 7 , 21 ]. We explain the different rates with geographic facts.…”

Section: Discussionmentioning

confidence: 95%

“…According to the location of the perforation, intestinal secretions may retro- or intraperitoneally leak and result in remaining clinical symptoms [ 2 , 6 ]. Covered perforations of the duodenum are characterized by diffuse pain with positive renal positional palpitation when nerves are affected [ 7 ]. Free perforations into the abdominal cavity show clinically conspicuous symptoms of an acute abdomen and peritonism.…”

Section: Introductionmentioning

confidence: 99%

“…Cross-sectional imaging through computed tomography (CT) has been established as the gold standard to diagnose small bowel perforations [ 12 , 13 , 14 ]. According to the localization, genesis, and extent of the perforation, therapeutic measures may be endoscopic, laparoscopic, or open surgical [ 7 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Onken¹,

Senne²,

Königsrainer³

et al. 2022

JCM

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Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Onken¹,

Senne²,

Königsrainer³

et al. 2022

JCM

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“…Our patient presented to the emergency room with severe respiratory failure following aspiration of high amounts of vomit due to an intestinal obstruction. Other complications of bezoars include intestinal perforation [ 8 ], intestinal intussusception [ 9 ], and obstructive jaundice in patients with biliodigestive anastomosis [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction by a Phytobezoar in a Patient With Previous Antrectomy and Billroth II Reconstruction

Abreu da Silva,

Ricardo,

Ferreira

et al. 2023

Cureus

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A phytobezoar is a conglomerate of improperly digested fruit and vegetable debris, and its development is associated, amongst other factors, with previous gastric surgery. Most phytobezoars remain asymptomatic and are incidentally found during imaging or interventional procedures. However, in some patients, they can cause small bowel obstruction, which can subsequently lead to severe complications. Although the clinical findings are similar to other causes of intestinal obstruction, there are some particular diagnostic and treatment features more specific to phytobezoars. We present a case of an 85-year-old man with a history of previous antrectomy and Billroth II reconstruction who came to the emergency department with bilateral aspiration pneumonia and intestinal obstruction due to a bezoar. The CT scan showed bilateral inferior lobe pulmonary consolidation, as well as a marked dilation of the small bowel with gas-fluid levels and a transition to normal caliber in the terminal ileum, where an oval mottled-appearing mass suggesting a bezoar was present. An urgent laparotomy confirmed the diagnosis, and an enterotomy with removal of the bezoar was performed. Phytobezoars must be considered as a cause of intestinal obstruction, particularly when patients have a history of previous gastric surgery. Its radiological findings, particularly in CT scans, are specific and should be appreciated to establish the diagnosis promptly. The treatment of small bowel obstruction due to a phytobezoar requires surgery most of the time, and the surgeon must bear in mind the need to look for the existence of other bezoars in the gastrointestinal tract to prevent reoccurrence.

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“…No entanto, o único exame específico é a endoscopia digestiva alta, pois avalia a existência direta de corpos estranhos em trato gastrointestinal alto. Porém, este procedimento possui algumas restrições, como a não visualização do duodeno de maneira adequada (Uzunoglu et al, 2018).…”

Section: Introductionunclassified

Bezoar misto gastrojejunal - Relato de caso

Andreza Fidélis Siqueira,

Alvarenga Soares,

Condori Leandro

et al. 2024

Rev. Saber Digital

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Introdução: Bezoar é uma massa indigerível no trato gastrointestinal, com presença de diferentes componentes, normalmente confinado no estômago. Comumente está associada a alterações anatomofisiológicas do estômago e a transtornos psiquiátricos como tricotilomania e tricofagia. A endoscopia digestiva alta é o exame mais específico para o diagnóstico. O tratamento é cirúrgico. Relato do caso: Mulher de 17 anos apresentou quadro de epigastralgia há aproximadamente 6 meses, com piora progressiva, associada a um episódio de vômito e perda ponderal de 13 kg em 4 meses. O diagnóstico foi presumido pela história clínica e tomografia computadorizada de abdome, e confirmado pela cirurgia. Discussão: Os bezoares comumente ocorrem em mulheres e pacientes com idade abaixo de 30 anos. A história clínica e o exame físico, em muitas das vezes, são inespecíficos, sendo necessário utilizar de métodos de imagem e principalmente a endoscopia digestiva alta para elucidação do diagnóstico. O tratamento pode ser obtido pela dissolução, remoção endoscópica, laparoscopia, e preferencialmente a laparotomia. No pós-operatório, o acompanhamento multidisciplinar, com engajamento da família, é indispensável para prevenir a recorrência. Conclusão: No presente caso, o diagnóstico foi feito com base na tomografia computadorizada de abdome e confirmado pela laparotomia exploradora, que também foi o método de tratamento para a retirada do bezoar. O acompanhamento pós-operatório ocorreu nos ambulatórios de Cirurgia Geral e Psiquiatria.

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Treatment results of small bowel perforations due to unusual causes

Cited by 4 publications

References 20 publications

Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Classification und Treatment Algorithm of Small Bowel Perforations Based on a Ten-Year Retrospective Analysis

Small Bowel Obstruction by a Phytobezoar in a Patient With Previous Antrectomy and Billroth II Reconstruction

Bezoar misto gastrojejunal - Relato de caso

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