Oesophageal Disorders in Children
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Early patient management should focus on maintaining a patent airway and preventing the aspiration of saliva and upper pouch secretions. The baby should be nursed prone with a sump suction (Replogle) tube in the upper pouch set on continuous aspiration. This tube should be injected regularly with air to prevent blockage. Endotracheal intubation and ventilation should be avoided if possible. Positive pressure ventilation in the presence of a TOF may result in large amounts of gas passing into the stomach and intestine. This trapped gas may have no easy route of escape, especially if the baby has an associated intestinal abnormality, like an atresia or anorectal malformation. Abdominal distension due to gaseous distention may impair ventilation and result in hypoxia, hypercapnia and acid-base upset. Gastrointestinal perforation in such cases can have a devastating outcome.4
Systemic therapy for appendiceal cancer
Wim P. Ceelen, Edward A. Levine in Intraperitoneal Cancer Therapy, 2015
Bevacizumab can be administered IV over 30 minutes and can be added to regimens containing 5-fluorouracil, capecitabine, oxaliplatin, or irinotecan, without adding drastic side effects [27]. Because bevacizumab is a humanized monoclonal antibody, infusion-related reactions are uncommon, and preemptive premedication with histamine antagonists is not necessary. Other adverse reactions seen with bevacizumab include hypertension, headache, and impaired wound healing. Impaired wound healing is an important side effect to keep in mind when patients may be undergoing surgery or have incompletely healed wounds or fistulas. Uncommon, yet severe adverse reactions include hemorrhage, arterial and venous thromboembolism, and gastrointestinal perforation. It is important to be attentive to disease burden and location with regard to gastrointestinal perforation. Patients with appendiceal cancer often have a high disease burden contained within the abdominal cavity, amalgamated with the intestines, and there is a substantial risk of bowel perforation in patients with appendiceal cancer. These patients should be educated and monitored for signs of symptoms of bowel perforation, which include, but are not limited to, abdominal pain accompanied by constipation, nausea and vomiting, or fever [27].
Peritonitis (General Considerations)
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
It is difficult to identify the actual SSI rate of operations for colonic peritonitis. Open appendectomy for perforated appendicitis is currently only performed in a minority of cases in most centres, leaving only the most complex and those that are converted to open operations being left to evaluate. The incision infection rate with any open operation with a colonic perforation of other causes is not well understood because of the practice of leaving the wound open for consideration of delayed primary closure after the operation. When open surgical incisions are primarily closed after exploration for peritonitis secondary to colon perforation, it is likely that infections will exceed 30%.
Percutaneous thermal ablation of hepatic tumors: local control efficacy and risk factors for artificial ascites failure
Published in International Journal of Hyperthermia, 2021
Bo-wen Zhuang, Xiao-hua Xie, Dao-peng Yang, Man-xia Lin, Wei Wang, Ming-de Lu, Ming Kuang, Xiao-yan Xie
There were no severe electrolyte derangements, peritonitis, peritoneal bleeding or gastrointestinal tract injury events directly associated with the AA technique and there were no cardiopulmonary complications due to volume overload. The AA was partially shifted into the right pleural space in 15 (4.4%) of 341 patients as depicted on ultrasound images one day after ablation, and 6 patients underwent drainage. All patients showed complete absorption of AA and a shifted pleural effusion, as confirmed on 1-month follow-up images. The rate of major complications was 1.1% (three of 281 patients) in the AA success group and 1.7% (one of 60 patients) in the AA failure group. The major complication rates were not significantly different between the two groups (p = 0.541). In the AA success group, three major complications were observed in different patients. One patient developed a liver abscess and underwent percutaneous drainage and intravenous antibiotics. Severe hepatic bleeding occurred in one patient and hemostasis was successfully achieved after percutaneous ablation. One patient experienced acute pulmonary infection and recovered after antibiotic therapy. In the AA failure group, major complications occurred in one patient. The patient experienced colon perforation and recovered after emergency surgery. No AA or ablation related deaths occurred in either group.
Clinical characteristics and associating risk factors of gastrointestinal perforation in children with IgA vasculitis
Published in Annals of Medicine, 2021
Qingyin Guo, Xiaolei Hu, Chundong Song, Xianqing Ren, Wensheng Zhai, Ying Ding, Xia Zhang, Meng Yang, Jian Zhang, Miao Jiang
The pathogenesis of GP in IgAV children is still not fully understood. Causes of GP may include diverticulitis, gastric ulcer, and intestinal ischaemia [20]. It was reported that thrombus caused by vasculitis may cause intestinal ischaemia, followed by necrosis and perforation of the intestinal wall [21]. Ultrasonography or CT signs are useful to confirm the diagnosis of GP. The key ultrasonographic finding of gastrointestinal perforation is the free gas under the diaphragm and a small amount of gas and fluid next to the perforation. When the perforation is small, the subphrenic gas is less, or the intestinal perforation is wrapped by other surrounding tissue so that the gas cannot reach the subdiaphragm. Or the patient has a large amount of air in the intestinal loop, which affects the colour ultrasound diagnosis. In our study, 5 patients did not show perforation under ultrasonography, and was diagnosed by CT subsequently. Therefore, GP should not be ruled out with a negative ultrasonography finding. CT examination is highly recommended for GP diagnosis.
The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study
Published in Journal of Investigative Surgery, 2022
Fatih Akgunduz, Alper Sozutek, Oktay Irkorucu, Abit Yaman
DuraSeal® is a 100% synthetic biocompatible adhesive material that is made from polyethylene glycol hydrogel. It offers strong tissue adherence and strength to withstand tissue dehiscence. It is resorbed after 4 to 8 weeks thereby providing a long time for tissue healing. Moreover, because of its blue color, it provides visualization and allows to assess adhesive coverage on the applicated surface [20]. In fact, DuraSeal® has a potent effect on minimizing leaks of cerebrospinal fluid, air and blood thereby commonly used by other surgical units in their clinical practice [12–14,20]. It is interesting that such an effective adhesive material could not find a place in general surgery practice, particularly in the adjunctive treatment of gastrointestinal perforation. To our knowledge, there is only one experimental study that draws attention to adhesive effect of DuraSeal® in duodenal perforation to date, however under normal condition [9]. It is notable that we need the adhesive effect of all adjunctive materials in a condition in which anastomosis may fail to heal thus we designed a delayed condition. To our knowledge, there is no study investigating the adjunctive effect of DuraSeal® on delayed repair of gastric perforation, to date. This study is the first.
Related Knowledge Centers
- Abdominal Pain
- Gastrointestinal Tract
- Mouth
- Peritonitis
- Vomiting
- Nausea
- Bowel Obstruction
- Anus
- Sepsis
- Major Trauma