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Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Eric M. Pauli, Robert E. Cilley
The endoscopic procedure itself may be performed on an outpatient basis. Concurrent or underlying disease may necessitate hospitalization. A chest radiograph is obtained whenever significant manipulation of the esophagus has occurred, such as during a dilatation procedure. The finding of mediastinal air or pneumothorax mandates esophagography with a water-soluble contrast medium to assess the degree of injury. Minor, self-contained perforations may be treated conservatively with antibiotics and hospitalization and possibly pleural drainage. Large perforations with significant pleural or mediastinal communication should be primarily repaired and drained.
The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
Major causes ofneonatal perforation include necrotizing enterocolitis, Hirschsprung’s disease, bowel atresia, imperforate anus and meconium ileus. Idiopathic and iatrogenic (oxygen connected to nasogastric tube) cases have been reported.
General Medical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Request a plain AXR to look particularly for the following: Ulcerative colitis: extensive mucosal ulceration may leave normal mucosal islands (pseudopolyps) visible on plain film. Dilation of the transverse colon >6 cm indicates the presence of a megacolon. Perforation is a major risk.Crohn's disease: free air associated with perforation may be seen. Stenotic regions of small bowel are best visualized with barium follow-through studies, or on colonoscopy.
Air under the diaphragm—perforation or Chilaiditi sign?
Published in Baylor University Medical Center Proceedings, 2022
Shobha Mandal, Sneha Singh, Barun Kumar Ray, Rahul Kumar Thakur, Anish Kumar Shah, Victor Kolade
Management depends on presentation. Patients with radiographic evidence of Chilaiditi sign without any symptoms do not require any further treatment. In symptomatic patients, an immediate meticulous abdominal examination is needed to rule out acute abdomen requiring surgical intervention. Initial management of patients includes conservative management like bowel rest, intravenous fluid, nausea, and pain control. An abdominal x-ray should be performed to look for signs of perforation. A CT scan of the abdomen can better visualize these signs in stable patients.11–13 For diagnosis, the patient must have the following findings on the abdominal x-ray or CT scan (erect position: abdomen): distended bowel, a depressed superior margin of the liver below the level of the left hemidiaphragm, and elevation of the right hemidiaphragm above the liver by the intestine in between.14 As it can easily be misdiagnosed as bowel perforation, patients are at high risk of unwarranted surgical interventions.1,13,15
Perforation of the excluded segment without pneumoperitoneum following Roux-en-Y gastric bypass surgery: case report and literature review
Published in Acta Chirurgica Belgica, 2021
Maxime Peetermans, Jana Vellemans, Guido Jutten, Pieter D’hooge, Peter Delvaux, Frederik Huysentruyt, Anneleen Van Hootegem, Jos Callens, Olivier Peetermans
Moreover, mucosal damage of the excluded segment could be caused by non-steroidal anti-inflammatory drugs (NSAIDs) and possibly also by excessive alcohol consumption, although these substances do not come into direct contact with the excluded segment. In the case we present, the recent intake of ibuprofen is most likely the main cause of the perforation. This emphasises the importance of the systemic effects of NSAIDs [35]. According to the guidelines, NSAIDs should be avoided completely after bariatric surgery, and alternative pain medication should be used [36]. Nevertheless, the use of NSAIDs remains popular among RYGB patients, despite explicitly informing the patients and their general practitioner [37]. The excessive alcohol consumption in our patient may also have contributed to the development of the perforation due to an increased gastric acid secretion [38].
Rectal neoplasia extending to the dentate line: clinical outcomes of endoscopic submucosal dissection
Published in Scandinavian Journal of Gastroenterology, 2020
Gianluca Andrisani, Takehide Fukuchi, Cesare Hassan, Jun Hamanaka, Giulio Antonelli, Guido Costamagna, Francesco Maria Di Matteo, Kingo Hirasawa
Perianal pain, bleeding, perforation, and anorectal stricture were considered to be adverse events related to the procedure. Bleeding during ESD was considered as a complication if it caused the resection to stop with failure of hemostasis systems. Delayed bleeding was defined as the presence of clinically significant bleeding (rectal bleeding or Hb level drop > 2 g/L) after the completion of ESD procedure [17]. Perforation observed during procedure or detected by X-ray imaging or abdominal computerized tomography (CT) was considered as a complication. Postoperative anorectal stricture was defined as a clinically significant stenosis developed after ESD, requiring balloon dilations (Figure 2). Follow-up protocol consisted in colonoscopy after 6 and 12 months, and yearly thereafter.