Upper gastrointestinal hemorrhage from a mallory-weiss tear associated with an occult richter's hernia and small bowel obstruction: To see the forest as well as the trees in the emergency department

Scallion, Richard; Wei, John P.

doi:10.1016/0736-4679(94)90340-9

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…4 Physical examination of the obstruction reveals abdominal distension with high-pitched tingling sounds associated with hyperactive peristaltic activity. Absent bowel sound suggest a loss of intestinal motility secondary to prolonged obstruction, 4 whereas oesophageal rupture presents with retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, dyspnoea and toxic appearance of the patient. 5 Patients with vomiting induced pneumomediastinum and Boerhaave syndome have very similar clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

A rare complication of ileostomy obstruction: Boerhaave syndrome

Yap

Mbakada

2018

annals

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Small bowel obstruction is the most common surgical emergency after a patient has had abdominal surgery. However, Boerhaave syndrome secondary to an ileostomy obstruction has not been reported in current literature. We present a rare case of two concurrent surgical emergencies in a patient with Boerhaave syndrome and small bowel obstruction. A 38-year-old woman presented with sudden onset severe central chest pain associated with breathlessness. She had a history of Crohn's disease, which had been treated with pancolectomy and ileostomy. Clinical examination showed an extensive palpable surgical emphysema extending from the neck to the pelvis with a distended abdomen. Computed tomography contrast of the chest and abdomen reported bilateral pneumothoraces, ruptured oesophagus and distended small bowel secondary to obstruction at the ileostomy. She was referred to the nearest cardiothoracic centre for an urgent assessment. Unfortunately she passed away shortly after the scan. Ruptured oesophagus is associated with a high mobidity and mortality if it is not recognised, so early diagnosis and prompt treatment is crucial in reducing the mortality rate. There is a strong association between stoma formation and incidence of small bowel obstruction but no difference between an ileostomy and colostomy. This case helps to illustrate the challenging management of chronic recurring abdominal obstruction and the delicate balance of risk of complication versus benefit of various management being surgical or conservative. All general surgeons should be wary of the potential complication of oesophageal perforation secondary to intestinal obstruction.

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Section: Discussionmentioning

confidence: 99%

A rare complication of ileostomy obstruction: Boerhaave syndrome

Yap

Mbakada

2018

annals

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“…Extranodal involvement, especially of the gastrointestinal tract, is very rare. To our knowledge, only 10 cases have been reported (10,21,23,(27)(28)(29)(30). Clonal relationship between CLL and digestive RS never has been established by molecular analysis.…”

mentioning

confidence: 99%

Primary Digestive Richter's Syndrome

et al. 2001

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The clinical and morphologic transformation of 3 to 5% of chronic lymphocytic leukemia (CLL) to diffuse large-cell lymphoma (DLCL) is commonly referred to as Richter's syndrome. Richter's syndrome occurs mostly in lymph nodes and may represent a second neoplasm or a transformation from the same clonal population. Clinical features in six patients with digestive Richter's syndrome were recorded. Paired samples of CLL and DLCL were investigated by immunohistological analysis (n ‫؍‬ 6) and by polymerase chain reaction (PCR) for immunoglobulin heavy-chain gene rearrangement (n ‫؍‬ 4). Histological examination revealed the involvement of the gastrointestinal tract by DLCL of B-cell phenotype (n ‫؍‬ 6). The same monoclonal rearrangement between CLL and DLCL was demonstrated by PCR and sequencing analyses in two patients. The monoclonal rearrangement was different between CLL and DLCL in only one case. Median survival was 22 months for five patients receiving chemotherapy, suggesting that digestive Richter's syndrome has a better prognosis than nodal Richter's syndrome. Indeed, appropriate surgical resection combined with chemotherapy led to partial or complete remission in four patients.

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Upper gastrointestinal hemorrhage from a mallory-weiss tear associated with an occult richter's hernia and small bowel obstruction: To see the forest as well as the trees in the emergency department

Cited by 2 publications

References 4 publications

A rare complication of ileostomy obstruction: Boerhaave syndrome

A rare complication of ileostomy obstruction: Boerhaave syndrome

Primary Digestive Richter's Syndrome

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