A Sharp Lesson: Duodenal Perforation 2 Months after Ingestion of a Pin.
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ABSTRACT:
SUBMITTER: Dalrymple RA
PROVIDER: S-EPMC5473309 | biostudies-other | 2017 Jul-Sep
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:Foreign body ingestion is a scenario occasionally encountered in the emergency room. Pediatric and psychiatric patients are the two most common populations suffering from accidental or in some cases intentional ingestion of foreign bodies. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Less than 1% of the cases complicates with gastrointestinal tract perforation, which are often caused by sharp objects, which warrants surgical intervention. The average time from foreign body ingestion to development of perforation was noted at 10.4?days in previous reports. These cases often present in rapidly progressing peritonitis and are subsequently managed by emergent laparotomy. In this case report, we describe an accidental chopstick ingestion of a patient who initially was misdiagnosed and remained asymptomatic for nine months, then presented with acute abdomen. CASE PRESENTATION:A 27-year-old man accidentally ingested a wooden chopstick and sought consult at a clinic. Negative abdominal plain film misled the physician to believe ingested chopstick was digested into fragments and passed out unnoticed. The patient presented acute abdomen caused by duodenal perforation nine months later and was subsequently treated with emergency laparotomy with primary duodenorrhaphy. CONCLUSIONS:Negative plain films are not sufficient to conclude a conservative treatment in foreign body ingestion. Computed tomography scan or endoscopic examinations should be done to rule out retained foreign body within gastrointestinal tract.
| S-EPMC6734462 | biostudies-literature
Project description:INTRODUCTION:Esophageal perforation (EP) is a rare, severe and challenging surgical emergency which can be caused by several factors. This report presents the case of a patient with EP caused by ingestion of a Tilapia fish bone. PRESENTATION OF CASE:A 41-year-old male patient presented with a six-day history of painful right-sided neck swelling, associated with a progressive dysphagia, regurgitation, fever and chills. Physical examination revealed an axillary temperature of 39?°C and a subcutaneous emphysema in the neck. Cervical spine x-ray and ultrasound scan revealed a neck foreign body with abscess. The case was managed by a right cervicotomy. DISCUSSION:Despite over 20-years of clinical experience in Ghana, this was the first case of EP caused by a 2?cm long Tilapia fish bone, to be treated by the authors. This is significant because tilapia consumption is very popular in Ghana and it would be predicted that such cases would be more common. It is suggested that such cases do occur more frequently but are not reported to hospitals due to cultural-spiritual beliefs. CONCLUSION:Ingestion of Tilapia fish bones can cause significant damage to the esophagus and Tilapia should be consumed with care. Ultrasound is a very useful tool with high diagnostic accuracy for EP. Further studies are needed to establish the prevalence of EP from fish bone ingestion in Ghana and the factors accounting for the mismatch between the high consumption of Tilapia across the population and the low occurrence of patients presenting with EP from fish bone ingestion.
| S-EPMC7242979 | biostudies-literature
Project description:Posterior perforation of duodenal ulcers is very rare; the infection may spread from the retroperitoneal space to the scrotum. A 75-year-old male presented with painful right scrotal swelling for 2 days associated with fever. During abdominal examination there was abdominal tenderness and scrotal swelling and tenderness. CT scan of the abdomen showed large amount of air collection in the retroperitoneal space extending to the right scrotum with contrast media passing to the retroperitoneum and right scrotum. Laparotomy done and there was a perforation in the posterior wall of the duodenum, suturing done and right scrotal abscess drained.
| S-EPMC6734181 | biostudies-literature
Project description:Endoscopic treatment for superficial non-ampullary duodenal tumors is technically difficult and challenging due to the anatomical characteristics of the duodenum. It is frequently complicated by procedural accidents, such as perforation. Surgical repair has long been the standard treatment for acute iatrogenic gastrointestinal perforation. However, endoscopic closure has recently emerged as an attractive alternative. In the patient presented herein, the over-the-scope-clipping system (OTSC system) was found to be useful for closing a duodenal perforation that had occurred during endoscopic submucosal dissection. For endoscopists who perform endoscopic treatment of the duodenum, endoscopic closure with the OTSC system is considered to be a technique that is necessary to master.
| S-EPMC5140861 | biostudies-other
Project description:We report a rare case of incomplete congenital duodenal obstruction (Type 1 duodenal atresia) in association with situs inversus totalis presenting with gastric perforation in a neonate. The infantogram was suggestive of perforation with air under diaphragm along with dextrocardia. On exploration, a pin point perforation at fundus near lesser curvature along with situs inversus was noted. Primary closure of gastric perforation was done. Patient was then discharged on full breast feeds but was readmitted with intolerance to feeds and recurrent bilious vomiting. Further, upper GI contrast study revealed partial duodenal obstruction. On re-exploration, duodenal web with central aperture was seen and duodeno-duodenostomy was done.
| S-EPMC5538601 | biostudies-other
Project description:To investigate predictors of perforation after endoscopic resection (ER) for duodenal neoplasms without a papillary portion.This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients (59 lesions) underwent endoscopic mucosal resection (EMR) (n = 36) and endoscopic submucosal dissection (ESD) (n = 23). Clinical features, outcomes, and predictors of perforation were investigated.Cases of perforation occurred in eight (13%) patients (95%CI: 4.7%-22.6%). Three ESD cases required surgical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at an average of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than 20 mm (P = 0.014) and ESD (P = 0.047).ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recommended for tumor treatment, and LECS should be considered as an alternative.
| S-EPMC5545134 | biostudies-other
Project description:Video 1Placing a standard endoclip at the papillary side of a duodenal perforation is a simple and effective technique for prevention of papillary obstruction when using the over-the-scope clip.
| S-EPMC8186264 | biostudies-literature
Project description:IntroductionThe conventional techniques for management of complex duodenal injuries are duodenal diverticularisation, pyloric exclusion or triple tube decompression. We here present a salvage technique of primary reinforcement with pedicled rectus abdominis muscle flap (RAMF) for a tenuous post traumatic duodenal perforation (PTDP). The majority of the studies in the literature are on the use RAMF for the secondary repair of peptic duodenal perforations.Presentation of caseA 38 year old male presented with an acute abdomen, three days after sustaining a blunt abdominal trauma. The clinical and radiological findings in the abdomen were subtle and not contributory. An emergency laparotomy with a high index of suspicion revealed a large perforation in the anterolateral wall of the second portion of the duodenum with a friable unhealthy wall and shearing of the serosa around the perforation site. The entire omentum was unhealthy, contused with areas of gangrene and omentectomy done. The perforation site was closed using 3.0 vicryl and reinforced with a pedicled right RAMF based on the superior epigastric artery. The patient recovered uneventfully and was discharged.DiscussionThe addition of conventional diversion techniques to primary duodenorrhaphy is sophisticated, time consuming and adds morbidity.ConclusionRAMF is a good tissue substitute to buttress tenuous duodenal injuries presenting late with inflamed, friable perforation sites and associated tissue loss, where duodenorrhaphy alone may not be successful. RAMF is a valuable salvage technique when the omentum is not available and the local tissue condition negates the effectiveness of other simpler techniques.
| S-EPMC7452464 | biostudies-literature
Project description:BackgroundST-segment elevation myocardial infarction (STEMI) and peptic ulcer perforation are both medical emergencies that require urgent intervention. In case that these time-sensitive medical emergencies present concomitantly, it remains unclear which one should be treated first.Case summaryAn 85-year-old man with melaena, epigastric pain, and severe anaemia was transferred to our emergency department and diagnosed as having inferior STEMI based on electrocardiogram. Emergency coronary angiography (CAG) revealed severe stenosis with thrombus in the proximal right coronary artery. Immediate oesophagogastroduodenoscopy and abdominal computed tomography detected the presence of duodenal ulcer perforation. Primary percutaneous coronary intervention (PCI) without stenting using excimer laser coronary angioplasty and manual thrombectomy was performed under intravascular ultrasound (IVUS) guidance to avoid dual antiplatelet therapy (DAPT). After successful PCI, the perforated viscus was surgically repaired with a laparoscopic omental patch. On Day 7, endoscopic haemostasis treated the oozing of blood from the duodenal ulcer. On Day 21, follow-up CAG and IVUS showed residual stenosis with organized thrombus in the culprit lesion, in which a drug-coated stent was directly implanted. He was discharged with a favourable clinical course on Day 23.DiscussionWe judged that PCI should take precedence over the surgical repair of perforated duodenal ulcer in our case since STEMI was an immediate life-threatening compared to the perforated viscus which had no active exsanguination. Excimer laser coronary angioplasty with manual thrombectomy might be an adequate option to avoid stent deployment and subsequent DAPT in such complex scenarios.
| S-EPMC7793135 | biostudies-literature
Project description:IntroductionMethanol poisoning is an uncommon life-threatening ingestion associated with significant morbidity and requires prompt diagnosis and management for the best possible outcome. We created a simulation case that challenges learners to analyze case information, construct a differential diagnosis of an anion gap metabolic acidosis, narrow the differential based on reasoning, and empirically initiate management.MethodsThe simulation case was designed for emergency medicine residents and pediatric emergency medicine fellows. The activity began with a brief overview of the monitors, equipment, and simulation experience. First-year residents managed the case as a team of two. Second- and third-year residents and fellows managed the case alone. The learners had 15 minutes to complete a focused history and physical exam, request and interpret labs and studies, provide stabilization of life threats, and initiate specific interventions based on a presumptive diagnosis. The simulation was followed by a 20-minute facilitated debrief session that reviewed key learning points and learner performance based on an evaluation checklist.ResultsResidents completed a six-question, 5-point Likert-scale postparticipation questionnaire. Overall, residents reported a high degree of satisfaction with the simulation experience. The case and debrief were effective in meeting the educational objectives and proved to be an effective modality to fill this educational gap.DiscussionThis simulation experience successfully exposed residents to the uncommon presentation of methanol poisoning. The simulation experience effectively closed the identified educational gap and provided an experiential learning opportunity that accomplished the targeted learning objectives.
| S-EPMC6342378 | biostudies-literature