Ileum perforation due to accidental chicken bone ingestion a rare cause of the acute abdomen

Ingestion of foreign bodies is not an uncommon occurrence, but most of them will pass through the gastrointestinal tract without consequences. Complication such as perforation is rare. We present a case of small bowel perforation secondary to the accidental ingestion of a chicken bone. The patient presented with abdominal pain, constipation and vomiting. Clinical examination confirmed generalized abdominal tenderness and rebound tenderness. Abdominal radiography showed multiple dilated loops of small bowel, and abdominal ultrasound (US) showed inflammatory changes on small bowel loops, with free fluid and fluid collection around intestinal loops. The patient underwent an emergency laparotomy. Intra operative findings revealed diffuse fibro purulent peritonitis with abscess between central small bowels loops. At about 60 cm from Bauchini valve we found a perforation of ileum at the anti-mesenteric site caused by a sharp chicken wishbone. The patient was treated with resection of the ileum segment (10 cm) and primary end-to-end anastomosis. Even that intestinal perforation by a foreign body is rare, physicians should consider possibility of intestinal perforation by a foreign body in the differential diagnosis of acute abdomen in patients presenting with abdominal pain

Magnets ingestion as a rare cause of ileus in adults: A case report

Introduction. Magnetic foreign bodies are harmless when ingested as a single object. However, if numerous of individual magnets are ingested at certain intervals, one after the other, they may attract each other through the bowel wall and cause severe bowel damage. Case report. We re-ported a case of a man, age 21, who swallowed 2 very small magnets, presented with clinical and radiographic signs of acute bowel obstruction and intestinal fistula. The cause of obstruction was detected during laparotomy. At laparotomy, one magnet was found in the proximal jejunum and the other in the distal ileum, strongly attracting each other followed by small bowel twisting around this point of rotation, causing a complete small bowel obstruction with strangulation and jejuno-ileal fistula. The intestinal segments were devolvulated and both intestine perforations were primarily sutured. The patient recovered successfully after the surgery and was discharged 5 days after the laparotomy. Conclusion. Patients who ingested magnetic objects must be seriously considered and emergency laparotomy should be performed to prevent serious gastrointestinal complications

Intra-abdominal infection and acute abdomen-epidemiology, diagnosis and general principles of surgical management

Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections

INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections

Functional liver anatomy: Surgical impact

The liver is a vital gland with a wide range of functions and complex anatomy. Liver anatomy can be described using different aspects: morphological anatomy and functional anatomy and now, the real anatomy, when ultrasound allows a precise intraoperative display in individual cases. The traditional morphological anatomy is based on the external appearance of the liver and does not show the internal features of vessels and biliary ducts branching which are of obvious importance in hepatic surgery. Functionally the liver is divided into eight functionally independent segments, each segment has its own vascular inflow, outflow and biliary drainage. This description, initiated by J. Cantlie in 1898, was followed by works of J. Healey and P. Schroy, N. Goldsmith and R. Woodburne, C. Couinaud, and H. Bismuth. In 1998. Federative Committee on Anatomical Terminology (FCAT) suggested using the liver Couinaud's classification. In 2000, International Hepato-Pancreato-Biliary Association (IHPBA) in Brisbane presented their recommendations of terminology of liver anatomy and liver resections. A single, worldwide-accepted classification of the liver still does not exist, however progress in the study of functional anatomy of the liver is a powerful impulse for development of modern liver surgery

Mucinous appendiceal adenocarcinoma as a rare cause of ileus: A case report

Although appendiceal tumours are rare, they may be encountered unexpectedly in any emergency abdominal operation. Many of these tumours are not recognized intraoperatively and are diagnosed only during formal histopathological analysis of an appendectomy specimen. We present a rare case of appendiceal adenocarcinoma which caused acute bowel ob struction. The patient presented with abdominal pain, distension and constipation. Abdominal radiography showed large bowel obstruction. On laparotomy the appendix was abnormal, with a tumor growing in to the ileal loop and creating a bowel obstruction. An appendectomy was performed with enbloc bowel segment resection and end ileostomy. Pathology specimens showed that the primary neoplasm was the appendiceal mucinous adenocarcinoma infiltrating the ileal loop. Patient underwent a right hemicolectomy, and recovered afterwards with no evidence of local recurrence or metastatic disease as confirmed by the standard follow-up. Physicians should keep in their minds that appendiceal neoplasm may have various and nonspecific presentations, but only an accurate diagnosis will lead to correct patients treatment, healing and long-term survival

Severe blunt hepatic trauma in polytrauma patient: Management and outcome

Introduction. Despite the fact that treatment of liver injuries has dramatically evolved, severe liver traumas in polytraumatic patients still have a significant morbidity and mortality. Objective. The purpose of this study was to determine the options for surgical management of severe liver trauma as well as the outcome. Methods. In this retrospective study 70 polytraumatic patients with severe (American Association for the Surgery of Trauma [AAST] grade III-V) blunt liver injuries were operated on at the Clinic for Emergency Surgery. Results. Mean age of patients was 48.26±16.80 years; 82.8% of patients were male. Road traffic accident was the leading cause of trauma, seen in 63 patients (90.0%). Primary repair was performed in 36 patients (51.4%), while damage control with perihepatic packing was done in 34 (48.6%). Complications related to the liver occurred in 14 patients (20.0%). Liver related mortality was 17.1%. Non-survivors had a significantly higher AAST grade (p=0.0001), higher aspartate aminotransferase level (p=0.01), lower hemoglobin level (p=0.0001), associated brain injury (p=0.0001), perioperative complications (p=0.001) and higher transfusion score (p=0.0001). The most common cause of mortality in the “early period” was uncontrolled bleeding, in the “late period” mortality was caused by sepsis and acute respiratory distress syndrome. Conclusion. Patients with high-grade liver trauma who present with hemorrhagic shock and associated severe injury should be managed operatively. Mortality from liver trauma is high for patients with higher AAST grade of injury, associated brain injury and massive transfusion score

Spontaneous rupture of giant liver hemangioma: Case report

Introduction. Hemangioma is the most frequent benign solid tumor of the liver. It is well known that a giant liver hemangioma carries the risk of spontaneous rupture, followed by hemoperitoneum and hemorrhagic shock with possible fatal outcome. Case Outline. This is a case report of the spontaneous rupture of a giant cavernous hemangioma of the liver in an 85-year old patient. The patient was presented with abdominal pain and hemorrhagic shock. Emergency ultrasonography and computed tomography of the abdomen showed a heterogeneous ruptured solid tumor of the right liver lobe, multiple cysts in the left lobe and massive hemoperitoneum. The patient was successfully managed by immediate exploratory laparotomy, surgical enucleation of the hemangioma under intermittent inflow vascular occlusion, temporary perihepatic packing and planned second look relaparotomy. Conclusion. Immediate surgical procedure is indicated mandatory in unstable patients with a ruptured giant hemangioma of the liver. Surgical enucleation under intermittent inflow vascular occlusion and temporary perihepatic packing could be a life-saving procedure in those patients

Treatment with cyclosporine A in serpiginous choroiditis: A case report

Serpiginous choroiditis is a rare clinical entity. The clinical course of serpiginous choroiditis is very variable, there is no universal marker of treatment success, and even among experts there is debate about what is the most appropriate treatment. The aim of this paper is to describe a case of serpiginous choroiditis treated with Cyclosporine A at a tertiary uveitis referral centre

Bleeding in trauma: Current diagnostic and therapeutic approach

Recognising shock due to haemorrhage in trauma patients is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The treatment of bleeding patients who have exsanguinating injuries is aimed at two major goals: stopping the bleeding and restoration of the blood volume with correct coagulation. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of multi-sliding computer tomography, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery with 'blind' transfusion or 'damage control resuscitation' in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. Pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. The role of thromboelastography as point-of-care test for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly after the blood sample is taken