Gastrointestinal and Genitourinary Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
Diverticulae are mucosal herniations through the muscularis layer of the bowel wall. They can occur anywhere in the bowel but are most common in the colon due to raised intraluminal pressures. The incidence of colonic diverticulitis is high in the general population; however, diverticulitis most commonly occurs in the elderly (Baker et al., 2008). Clinical symptoms and signs are varied but typically include pain mainly localising to the left lower quadrant, low-grade fever and constipation/diarrhoea. Leucocytosis and a raised C-reactive protein may also be present. Complications of acute diverticulitis include perforation, collection/abscess, fistula formation and post-inflammatory strictures, which can cause bowel obstruction. Fistula formation, involving either the bladder or vagina, can result in pneumaturia or foul smelling vaginal discharge, respectively. Although symptoms and signs can vary, perforated diverticulitis is a surgical emergency and often requires urgent laparotomy. While the diagnosis can be made clinically, imaging is increasingly being utilised to guide potential surgical management and should be performed without delay if there is clinical suspicion of perforation.
Medical and Surgical Treatment of Intra-abdominal Infections
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Complications include perforation, peritonitis, and appendiceal abscess. Perforation by the time of appendectomy occurs in nearly 50% of patients aged over 50 years resulting in generalized peritonitis to microabscesses (21). Appendiceal abscess develops when localized perforation and periappendiceal infection are walled off by the omentum, mesentery, and viscera. Patients present with clinical appendicitis and RLQ mass. An ultrasound and CT should be performed, and if an abscess is found, percutaneous image-guided drainage may be considered. Operation for appendectomy and abscess drainage may be done if the abscess is known with certainty to be caused by appendicitis. Pylephlebitis is suppurative thrombophlebitis of the portal venous system, which characteristically presents with fever, chills, low-grade jaundice, and eventually hepatic abscesses; however, this presentation is encountered rarely today. CT scan is the best method for detecting thrombosis and gas in portal venous system.
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
Comparing about three types of endoscopic therapy methods for upper gastrointestinal submucosal tumors originating from the muscularis propria layer
Published in Scandinavian Journal of Gastroenterology, 2019
Hui Xiu, Cheng-Ye Zhao, Fu-Guo Liu, Xue-Guo Sun, Hui Sun, Xi-Shuang Liu
Perforation is one of the common and severe complications during procedure. Although the perforation rate in EFTR group was higher than other groups because of active perforation, it is no longer considered as a complication [18]. However, patients with iatrogenic perforations have potential risks of secondary infections or other organ injuries. In EFTR group, there are 1 case suffered from perforation in diaphragm which was suture by clips and 3 cases underwent pneumoperitoneum which resolved spontaneously. Metallic clips and nylon loops purse-string suture, as safe and efficient methods, are widely used when perforation occurs [20]. For small perforation, several metallic clips are sufficient; for larger perforations, purse-string suture with nylon loops and clips are required. However, the site of resection and clip closure in STER are different. Tan et al. [21] reported STER was superior to EFTR in less clips to close the gastric-wall defect. However, the number of clips in our study was no significant difference between EFTR and STER, and median number in both groups was more than in ESE. Meanwhile, fasting time and hospital stay in ESE were also shorter than other groups, and no significance was observed between EFTR and STER.
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].
Long-term follow-up in patients treated with electrochemotherapy for non-melanoma skin cancer in the head and neck area
Published in Acta Oto-Laryngologica, 2019
Stefan Kristiansson, Johan Reizenstein, Mathias von Beckerath, Fredrik Landström
There was one SAE recorded. Six months after ECT, the patient with a BCC in the temporal area had an episode of seizure resulting in loss of consciousness and a laceration of the tongue (patient 1). The subsequent investigation including a CT scan and EEG was normal and the patient has since had no further seizure episodes. Two AEs was also recorded. The patient with a CSSC in the nasal vestibule developed a septal nasal perforation after treatment (patient 4). The perforation has been symptomless. A patient with a large BCC involving the right orbit developed scarring with contracture resulting in ectropion with epiphora (patient 7) (Figure 1). The patient, however, was not interested in reconstructive surgery. There were no recorded malfunctions of the Medpulser system in this study. There was one recorded malfunction with the Cliniporator system: two uncompleted electroporation sequences probably related to diverging electrodes. However, the treatment could eventually be completed successfully.
Related Knowledge Centers
- Abdominal Pain
- Gastrointestinal Tract
- Mouth
- Peritonitis
- Vomiting
- Nausea
- Anus
- Sepsis
- Major Trauma
- Bowel Obstruction