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Colonic Perforation

Colon Perforation


Presentation

  • A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign.[ncbi.nlm.nih.gov]
Rapidly Progressive Glomerulonephritis
  • We reported the case of a patient affected with upper airways-limited GPA who developed acute renal failure from rapidly progressive glomerulonephritis and then experienced colonic perforation due to CMV colitis a few weeks after immunosuppressive treatment[ncbi.nlm.nih.gov]
Inguinal Mass
  • He was initially treated for presumed Clostridium difficile colitis, but later developed a left inguinal mass with spreading erythema. A CT scan showed gas within the retroperitoneal tissues, with surgical emphysema of the left groin.[ncbi.nlm.nih.gov]
Limb Pain
  • A 67-year-old man presented with abdominal pain, sub-occlusion, left groin mass, left groin, and lower limb pain during walking, negative Blumberg sign.[ncbi.nlm.nih.gov]
Acute Abdomen
  • Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.[ncbi.nlm.nih.gov]
Abdominal Distension
  • They may also suffer from abdominal distension due to the penetration of gas through the perforation and the entry of this gas into the abdomen. A perforated colon can be diagnosed clinically or radiologically.[labome.org]
  • Abdominal examination was significant for diminished bowel sounds, diffuse abdominal distension, rigidity, and tenderness with light palpation.[mdedge.com]
  • . :: Case report A 3.2 kg, new born, mate child was referred after 24 hours, for increasing abdominal distension. The antenatal as well as perinatal course was normal and uncomplicated.[jpgmonline.com]
  • The most common presenting symptoms are poor oral feeding, progressive abdominal distension with bilious vomiting, tachypnea, failure or delayed passage of meconium or bleeding per rectum [6, 7].[jpss.eu]
Chronic Watery Diarrhea
  • Collagenous colitis is a clinicopathologic syndrome characterized by chronic watery diarrhea and unique histopathologic features.[ncbi.nlm.nih.gov]
Pelvic Mass
  • Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa.[ncbi.nlm.nih.gov]
Tachycardia
  • Her electrocardiogram showed sinus tachycardia with a rate of 154 beats/min, a QTc within normal limits, and no ST elevations or depressions.[mdedge.com]
  • Arrhythmia Cardiac arrhythmias including bradycardia, less often tachycardia, atrial premature contractions, paroxysms of atrial fibrillation, and ventricular premature contractions have been documented during procedural sedation.[intechopen.com]
  • Presenting signs and symptoms of bowel perforation in 24 patients treated with bevacizumab. 12 *Specific signs included mental status changes, fever, tachycardia ( 120 beats per minute), and leukocytosis.[jaoa.org]
  • Lung and heart sounds were normal but heart rhythm was tachycardia. The abdomen was distended and tenderness was noted to direct and rebound palpation with guarding in all quadrants.[omicsonline.org]
Chorea
  • ) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea[ncbi.nlm.nih.gov]

Workup

  • Serum carcinoembryonic antigen and carbohydrate antigen 19-9 values were not measured during his initial workup.[edoriumjournals.com]
  • Workup revealed a synchronous colonic perforation. After multidisciplinary discussion she was managed with total colectomy and end ileostomy .[omicsonline.org]
Pneumoperitoneum
  • Abdominal computed tomography scan showed extensive pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and leftsided pneumothorax.[ncbi.nlm.nih.gov]
  • Chest X-ray showed a pneumoperitoneum, which was an indication for emergency surgery. The patient had a laparotomy approach five hours after perforation. The peritoneal cavity was clean.[ghrnet.org]
  • On the other hand, this patient underwent same-day colonoscopy before CTC, and thus it is not possible to exclude the possibility that pneumoperitoneum might have occurred at colonoscopy.[karger.com]

Treatment

  • One of the patients who received Verres needle desufflation underwent secondary surgery because of failure of nonsurgical treatment.[ncbi.nlm.nih.gov]

Prognosis

  • High-anesthetic risk patients with colonic perforation have a longer hospital stay and a poor prognosis.[ncbi.nlm.nih.gov]
  • Chawla LS, Chinna JS, Dilawari JB, Sood A (1990) Course and prognosis of ulcerative colitis. J Indian Med Assoc88:159-160.[omicsonline.org]
  • However, no studies evaluated the prognosis of patients presenting with bowel perforation compared to non-perforated patients.[edoriumjournals.com]
  • The idiopathic type is less common than stercoral type but the prognosis is better because of the minimum degree of fecal contamination. The stercoral type is associated with chronic constipation and the use of NSAIDs.[omjournal.org]

Etiology

  • The broad differential diagnosis for abdominal pain requires a high index of suspicion to make an accurate diagnosis of foreign body ingestion as the etiology.[ncbi.nlm.nih.gov]
  • […] colonic perforation. 2 Regardless of the etiology, the critical actions for any colonic perforation are quick recognition, medical stabilization, and surgical evaluation.[mdedge.com]
  • Etiology (Exemples) Cystic fibrosis digestive cystic fibrosis colonic cystic fibrosis neontatal necrotizing enterocolitis neonatal digestive mucormycosis (gastrointestinal mucormycosis) ( 17986761 ) Hirschsprung disease immature ganglia imperforate anus[humpath.com]
  • E.: Perforation of the colon from necrotizing colitis in the newborn: report of a survival and a new etiologic concept. Surgery, 58: 436-441, 1965. 6. Kaufman, R. A., Kuhns, L. R., Poznanski, A. K. and Holt, J.[jpgmonline.com]

Epidemiology

  • In the case that we present, MA fit the epidemiologic profile of severe BD very well. He is male, first developed symptoms of BD at age 18, and originates from the Middle East.[austinpublishinggroup.com]
  • Reference article This is a summary article ; read more in our article on bowel perforation . epidemiology depends on the cause presentation history may depend on the location of the perforation severe and generalised abdominal pain (upper) gradual and[radiopaedia.org]
  • This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition.[pmj.bmj.com]
  • The relationship between abdominal pain regions and specific diseases: An epidemiologic approach to clinical practice. J Epidemiol 1997 Mar;7(1):27–32. [ Pubmed ] Locker GY, Hamilton S, Harris J, et al.[edoriumjournals.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death.[elsevier.es]
  • The purpose of this study was to examine the pathophysiology of colonic perforations in diagnostic colonoscopies caused by looping of the colonoscope in the sigmoid colon. We discuss the findings in relation to those of the current literature.[labome.org]
  • […] surgery for low ARM can be done at the same time. [1] The overall mortality of perforated ARM is 19%. [1] Sepsis and disseminated intravascular coagulation were frequent causes of death. [1] Early diagnosis of ARM in neonates, better understanding of the pathophysiology[jcnonweb.com]
  • The pathophysiology of stercoral perforation is thought to result from bowel distension around the fecaloma, which causes intraluminal pressure to increase to a point that exceeds the capillary perfusion pressure within the bowel wall. 7 This process[hcplive.com]
  • […] location of the perforation severe and generalised abdominal pain (upper) gradual and localised pain (lower) anorexia, nausea and vomiting examination rigid abdomen and generalised tenderness guarding and rebound bowel sounds range from quiet to absent pathophysiology[radiopaedia.org]

Prevention

  • In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.[ncbi.nlm.nih.gov]
  • You will also be given antibiotics to prevent infection in the abdominal cavity.[health.cvs.com]
  • On the other hand, stercoral perforation of colon and rectum can be prevented.[omjournal.org]
  • CTLA-4 prevents T-cell activation by competing for binding of surface proteins on antigen presenting cells that would normally cause T-cell activation.[cureus.com]

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