Small bowel obstruction and covered perforation in childhood caused by bizarre bezoars and foreign bodies. (17/625)

BACKGROUND: Small bowel obstruction with perforation is an unusual and rare complication of bezoars. OBJECTIVE: To describe our use of emergency laparotomy to treat intestinal obstruction caused by bizarre bezoars. CONCLUSIONS: An aggressive surgical approach to intestinal obstruction in the pediatric disabled or mentally retarded population is recommended.  (+info)

Histoplasmosis of the small bowel in patients with AIDS. (18/625)

Two cases of jejunal strictures caused by Histoplasma capsulatum in AIDS patients are presented. Both patients were intravenous drug abusers. One patient, who was being treated for Pneumocystis carnii pneumonia, presented with jejunal perforation and the other presented with lower gastrointestinal bleeding and intestinal obstruction. On exploration, both patients were found to have jejunal strictures; one had intestinal perforation, and the other had intestinal obstruction with ulcers and strictures resulting in gastrointestinal bleeding. In areas where it is endemic, histoplasmosis is rarely disseminated. Dissemination is most commonly seen in immunosuppressed patients. Dissemination and extrapulmonary histoplasmosis is now included in the case definition of AIDS.  (+info)

The impact of diagnostic delay on the course of acute appendicitis. (19/625)

BACKGROUND: The diagnosis of acute appendicitis is often delayed, which may complicate the further course of the disease. AIMS: To review appendectomy cases in order to determine the incidence of diagnostic delay, the underlying factors, and impact on the course of the disease. METHODS: Records of all children who underwent appendectomy from 1994 to 1997 were reviewed. The 129 cases were divided into group A (diagnostic period within 48 hours) and group B (diagnostic period 48 hours or more). RESULTS: In the group with diagnostic delay, significantly more children had first been referred to a paediatrician rather than to a surgeon. In almost half of the cases in this group initial diagnosis was not appendicitis but gastroenteritis. The perforation rate in group A was 24%, and in group B, 71%. Children under 5 years of age all presented in the delayed group B and had a perforation rate of 82%. The delayed group showed a higher number of postoperative complications and a longer hospitalisation period. CONCLUSIONS: Appendicitis is hard to diagnose when, because of a progressing disease process, the classical clinical picture is absent. The major factor in diagnostic delay is suspected gastroenteritis. Early surgical consultation in a child with deteriorating gastroenteritis is advised. Ultrasonographs can be of major help if abdominal signs and symptoms are non-specific for appendicitis.  (+info)

Mucocele of the appendix secondary to endometriosis. Report of two cases, one with localized pseudomyxoma peritonei. (20/625)

This report documents 2 cases of obstructive mucocele of the appendix secondary to endometriosis of the appendix. In 1 case, the tip of the mucocele was ruptured and associated with localized pseudomyxoma peritonei. Mucoceles of the appendix usually are associated with hyperplastic or neoplastic mucosal proliferation; obstruction, particularly that due to endometriosis, is an infrequent cause. Occurrence of localized pseudomyxoma peritonei associated with appendiceal endometriosis and mucocele has not been reported previously.  (+info)

Aerobic and anaerobic microbiology in intra-abdominal infections associated with diverticulitis. (21/625)

The aerobic and anaerobic microbiology of intra-abdominal infections associated with diverticulitis was studied in 110 specimens from the peritoneal cavity after intestinal perforation and in 22 specimens from abdominal abscesses. Anaerobic bacteria only were isolated from 17 (15%) of the peritoneal specimens, aerobic bacteria only from 12 (11%) and mixed aerobic and anaerobic flora from 81 (74%). A total of 339 bacterial isolates was detected in peritoneal cultures (3.1 per specimen), comprising 155 aerobes (1.4 per specimen) and 184 anaerobes (1.7 per specimen). Anaerobic bacteria only were isolated in 4 (18%) abscesses, aerobes alone in one (5%) and mixed aerobic and anaerobic flora in 17 (77%). A total of 72 bacterial isolates (3.3 per specimen) was detected in abdominal abscesses - 35 aerobes (1.6 per specimen) and 37 aerobes (1.7 per specimen). The predominant aerobic and facultative bacteria in abdominal infections were Escherichia coli and Streptococcus spp. The most frequently isolated anaerobes were Bacteroides spp. (B. fragilis group), Peptostreptococcus, Clostridium and Fusobacterium spp.  (+info)

Small bowel perforation: an unusual presentation for child abuse. (22/625)

Hollow viscus perforation due to inflicted blunt abdominal injury is uncommon. Diagnosis is frequently delayed because of inaccurate or absent history, nonspecific or delayed physical findings or both, and laboratory tests with low sensitivity. Computed tomographic scanning of the abdomen is the best diagnostic test available. A high index of suspicion is essential to diagnose visceral perforation early, as significant morbidity and mortality results from diagnostic delay.  (+info)

Ultrasound examination of gastrointestinal tract diseases. (23/625)

With recent technical advances, increasing use of sonography in the initial evaluation of patients with abdominal disease may allow the detection of unexpected tumor within the abdominal cavity. Easiness of sonographic detection of bowel pathology, purposely or unexpectedly, warrants the inclusion of bowel loops during ultrasound examination when a patient complains of symptoms indicating diseases of the bowel. In patients complaining of acute abdominal symptoms or nonspecific gastrointestinal symptoms and showing signs such as abdominal pain, diarrhea, hematochezia, change of bowel habit, or bowel obstruction, sonography may reveal the primary causes and may play a definitive role in making a diagnosis. On ultrasonography, abnormal lesions may appear as fungating mass with eccentrically located bowel lumen (pseudokidney sign) or symmetrical or asymmetrical, encircling thickening of the colonic wall (target sign). In patients with mass or wall thickening detected on ultrasonography, additional work-up such as barium study, CT or endoscopy would be occasionally necessary for making a specific diagnosis.  (+info)

Acute bowel perforation in a fetus with gastroschisis. (24/625)

Gastroschisis is a congenital anomaly with a reported incidence of 1 in 10,000 live births. Although prenatal diagnosis is more common with the widespread use of biochemical markers and obstetric ultrasound, the role of ultrasound in the identification of the fetus that might need early intervention has not been established. Acute bowel perforation was diagnosed by ultrasound at 34 weeks gestation in a fetus with gastroschisis. An immediate Cesarean section was performed, followed by repair with primary closure. The neonatal outcome was favorable. The post-partum findings, including bowel pathology, confirmed the antenatal diagnosis. Acute bowel perforation can be diagnosed antenatally. Immediate intervention, before further bowel injury occurs, might enhance the ability of the surgeon to perform primary closure and obtain a favorable outcome.  (+info)