Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology

AbstractGastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis.Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations.The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.
Source: Insights into Imaging - Category: Radiology Source Type: research

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We report the first case of PD-associated peritonitis secondary to Mycobacterium septicum. The patient is a 53-year-old Caucasian man who developed end-stage kidney disease due to systemic sclerosis. He was initially started on intermittent hemodialysis and was then switched to PD 10 months later. He presented with generalized abdominal pain and an increase in the number of nucleated cells and neutrophils in the dialysate effluent sample (854 total nucleated cells/µL and 512 neutrophils/µL). Ten days later, the fluid grew M. septicum, a rapidly growing nontuberculous mycobacterium (NTM). Once the organism was i...
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
Conclusion Abdominal ultrasonography required by Kendall's diagnostic algorithm was not performed appropriately in patients with symptoms and signs of peritonitis, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain or in female patients by resident trainees. Our findings underscore the importance of providing resident doctors with focused training concerning ultrasonography by attending physicians. PMID: 32418953 [PubMed - in process]
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
Chronic liver diseases (CLD) are a worldwide clinical problem, as they are related to high morbidity and mortality. The principal causes include viral, alcoholism, cholestatic, autoimmune and metabolic diseases such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). These CLD can evolve into cirrhosis and hepatocellular carcinoma (HCC) [1]. Patients with CLD showed significant health problems like ascites, spontaneous bacterial peritonitis, hepatic encephalopathy and persistent variceal bleeding concomitant with a decrease in health-related quality of life [1-3].
Source: Prostaglandins, Leukotrienes and Essential Fatty Acids - Category: Biomedical Science Authors: Source Type: research
CONCLUSIONS: Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible. PMID: 32400280 [PubMed - as supplied by publisher]
Source: Peritoneal Dialysis International - Category: Urology & Nephrology Tags: Perit Dial Int Source Type: research
In conclusion, we suggest that in the presence of intolerance or resistance to colchicine, interleukin (IL)-1 inhibition could suppress peritoneal inflammation and prevent MSTs.
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Conclusion: The study demonstrated a new possible infectious cause of SBP by C Coli, which was rarely seen in liver cirrhosis but mostly found in immunocompromised patients. Thus, it might raise an idea of microorganism screening of broader types that might also induce SBP for immunocompromised patients.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusions Pneumoperitoneum resulting from vaginal intercourse in an otherwise healthy adolescent female is a rare cause of peritonitis. Although it has been described in the adult literature, this case illustrates the importance of considering sexual history as a contributory factor in pediatric patients presenting with an acute abdomen.
Source: Pediatric Emergency Care - Category: Emergency Medicine Tags: Illustrative Cases Source Type: research
We describe one case of abdominal angioedema in a patient with known HAE that were diagnosed by ultrasound. PMID: 32338026 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Authors: Guaitoli E, Gallo G, Cardone E, Conti L, Famularo S, Formisano G, Galli F, Giuliani G, Martino A, Pasculli A, Patini R, Soriero D, Pappalardo V, Casoni Pattacini G, Sparavigna M, Meniconi R, Mazzari A, Barra F, Orsenigo E, Pertile D Abstract Background: Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, which increase patients' morbidity and mortality. Diagnosis of AA can be difficult, and evaluation of clinical signs, la...
Source: Journal of Investigative Surgery - Category: Surgery Tags: J Invest Surg Source Type: research
Discussion: The Z-track method minimizes fluid leakage from the puncture site. Injecting medication into the skin using this method is important to preventing post-procedure leaking. Once a needle has entered subcutaneous tissue and muscle, it opens a track that may not reseal immediately. There are also studies suggesting that Z tracks may reduce pain during injection. We suggest using the method during your paracentesis procedure.Z tracks are used for all kinds of intramuscular injections and can be applied to other sites on the body. Pull and press the skin and tissue 2 cm caudad to the deep abdominal wall and insert th...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
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