Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Gastric perforation caused by Candida infection：Report of a case

An 89-year-old female was admitted to our hospital because of fever and abdominal pain. The patient had used an antihypertensive agent, but had not used either antibiotics, steroids, or potent antacids. An abdominal CT scan revealed free air and ascites. An emergency operation was performed for acute peritonitis caused by a gastrointestinal perforation. A perforated ulcer was observed at the posterior wall of the gastric body. A distal gastrectomy with intraperitoneal drainage and a Billroth II reconstruction was performed. A histological examination demonstrated a perforated ulcer surrounded by Candida infection. The patient developed an abscess in the abdominal cavity, but was discharged on the 52nd postoperative day. Although gastrointestinal Candida infection is commonly seen in immunocompromised host with diabetics or malignant diseases, habitual use of strong antacids can also cause severe Candida infection of the stomach in healthy persons. In this case, it was thus concluded that there may have been a decrease in immunity in this patient because of her advanced age 89 years old and malnutrition

A Metastatic Jejunal Tumor from Squamous Cell Carcinoma of the Lung Found in an Intestinal Perforation

An 85-year-old male with advanced squamous cell carcinoma of the lung, who was diagnosed about 10 years prior to his current presentation, suddenly complained of abdominal pain and underwent an abdominal computed tomography scan, which revealed free air and massive ascites. He was admitted to our hospital for acute peritonitis and emergency surgery was performed. During the surgical procedure, a perforation of the jejunum was diagnosed and repaired. He was diagnosed to have a metastatic tumor originating from a squamous cell carcinoma of the lung. He improved and was transferred to the former hospital on the 27th postoperative day. Jejunal metastasis from squamous cell carcinoma of the lung is rare, and the prognosis of peritonitis due to a perforated intestinal metastasis from lung cancer is poor. There have been 10 reports of jejunal metastasis of squamous cell carcinoma of the lung reported in Japan between 2000 and 2011. Therefore, when patients with advanced lung cancer present with acute abdomen, it is necessary to keep in mind the possibility of a gastrointestinal metastatic tumor

Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Perforated Ileal Diverticulum: Report of a Case

An 80-year-old male was admitted to our hospital on February 16, 2009, complaining of having suffered right lower quadrant pain for a period of 4 days. Abdominal computed tomography (CT) showed amesenterial abscess adjacent to the terminal ileum, and the possibility of acute appendicitis was excluded from the preoperative diagnosis by this imaging. Upon surgery, the appendix and cecum revealed normal appearance, without the presence of ascites. However, ileocecal resectionwas performed because of abscess formation that appeared to originate from the terminal ileum or the cecum. Resected specimens showed ileal diverticula, including one that was perforated. Perforation of ileal diverticula should be a candidate for the differential diagnosis of an inflammatory process near the ileocecal region

ASSESSMENT OF BASILAR ARTERY HEMODYNAMICS IN TYPE 2 DIABETIC PATIENTS WITH NO HISTORY OF CEREBROVASCULAR DISEASE BY USING TRANSCRANIAL DOPPLER ULTRASOUND

We compared intracranial hemodynamics in 121 type 2 diabetic patients who had no history of cerebrovascular disease with findings in 123 matched control subjects. Mean blood flow velocity (MFV) and Fourier pulsatility index were determined by using transcranial Doppler ultrasonography (TCD). MFV in the basilar artery was significantly lower in diabetic than in nondiabetic subjects (p＜0.01), while Fourier PI of the basilar artery was significantly higher in diabetic than in nondiabetic subjects (p＜0.01). In multivariate regression analysis, increased Fourier PI and decreased MFV were associated with higher age, female gender, and longer duration of diabetes. Decreased MFV was also associated with microalbuminuria. These findings demonstrated deterioration of basilar artery hemodynamics in patients with type 2 diabetes who have no stroke history. Additionally, repeated TCD may prove to be useful for monitoring cerebrovascular impairments in these patients