Previously undiagnosed Morgagni hernia with bowel perforation detected during repeat screening colonoscopy: A case report

BACKGROUND Morgagni hernia(MH)is a form of congenital diaphragmatic hernia(CDH)characterized by an incomplete formation of diaphragm,resulting in the protru-sion of abdominal organs into the thoracic cavity.The estimated incidence of CDH is between 1 in 2000 and 1 in 5000 live births,although the true incidence is unknown.MH typically presents in childhood and can be diagnosed either pre-natally or postnatally.However,it can also be asymptomatic and carry the risk of developing into a life-threatening condition in adulthood.CASE SUMMARY A 76-year-old female with no history of prior abdominal surgeries presented for an elective colonoscopy for polyp surveillance.During the procedure,when approaching the hepatic flexure,the scope could not be advanced further despite multiple attempts.The patient experienced mild abdominal discomfort,leading to the abortion of the procedure.While in the recovery area,she developed increa-sing abdominal pains and hypotension.Urgent abdominal imaging revealed her-niation of the proximal transverse colon through a MH into the chest with evi-dence of perforation.The patient underwent laparoscopic urgent colonic resection and primary hernia repair and was discharged uneventfully 2 d later.CONCLUSION A MH is a rare condition in adults that can present as a life-threatening compli-cation of colonoscopy,even in patients with a history of uneventful colonoscopies.This case highlights the importance of considering congenital and internal hernias when faced with sudden and unexplained difficulties during colonoscopy.If there is a suspicion of MH,the endoscopist should halt the procedure and immediately obtain abdominal imaging to confirm the diagnosis.

Peritonitis with small bowel perforation caused by a fish bone in a healthy patient

Perforation of the gastrointestinal tract by ingested foreign bodies is extremely rare in otherwise healthy patients, accounting for < 1% of cases. Accidentally ingested foreign bodies could cause small bowel perforation through a hernia sac, Meckel’s diverticulum, or the appendix, all of which are uncommon. Despite their sharp ends and elongated shape, bowel perforation caused by ingested fish bones is rarely reported, particularly in patients without intestinal disease. We report a case of 57-year-old female who visited the emergency room with periumbilical pain and no history of underlying intestinal disease or intra-abdominal surgery. Abdominal computed tomography and exploratory laparotomy revealed a small bowel micro-perforation with a 2.7-cm fish bone penetrating the jejunal wall.

Spontaneous small bowel perforation secondary to Vibrio parahaemolyticus infection:A case report

BACKGROUND Vibrio pararhaemolyticus(V.parahaemolyticus),a pathogen that commonly causes gastroenteritis,could potentially lead to a pandemic in Asia.Its pathogenesis and molecular mechanisms vary,and the severity of illness can be diverse,ranging from mild gastroenteritis,requiring only supportive care,to sepsis.CASE SUMMARY We outline a case of a 71-year-old female who experienced an acute onset of severe abdominal tenderness after two days of vomiting and diarrhea prior to her emergency department visit.A small bowel perforation was diagnosed using computed tomography.The ascites cultured revealed infection due to V.parahaemolyticus CONCLUSION Our case is the first reported case of V.parahaemolyticus-induced gastroenteritis resulting in small bowel perforation.

Small bowel perforation from a migrated biliary stent: A case report and review of literature

BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents,but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome,chronic obstructive pulmonary disease,alcoholic liver cirrhosis,portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis.On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention.CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents,with one causing perforation.In addition,we review the relevant literature on migrated stents.

Small bowel perforation secondary to metastatic lung cancer with emphasis on the administration of erlotinib: a case report

Small bowel metastasis from primary lung cancer is rare. Once occurs, the metastasis may cause life-threatening complications, such as bowel perforation, obstruction and bleeding. We reported an 83-year old man who presented with small bowel perforation secondary to metastatic lung cancer after being treated with erlotinib for 2 weeks. We propose that the use of erlotinib may be associated with the small bowel perforation and precautions should be taken by clinicians in initiating edotinib for primary lung cancer when there is bowel metastasis.

Sigmoid Volvulus, Intestinal Obstruction and Bowel Perforation;an Unusual Presentation of Pedunculated Fibroid Torsion. Case Report

Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.

Uterine-ileal perforation post pregnancy related dilatation and curettage managed by laparoscopic small bowel resection and primary anastomosis: A case report

Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.

Has the open surgical approach in colorectal cancer really become uncommon?

Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the oncological quality of laparo-scopic approach for the treatment of patients with colorectal cancer.Randomized non-inferiority trials with good remote control have answered positively to this long-debated question.Early as 1994,first publications demonstrated technical feasibility and compliance with oncological imperatives and,as far as short-term outcomes are concerned,there is no difference in terms of mortality and post-operative morbidity between open and minimally invasive surgical approaches,but only longer operating times at the beginning of the experience.Subsequently,from 2007 onwards,long-term results were published that demonstrated the ab-sence of a significant difference regarding overall survival,disease-free survival,quality of life,local and distant recurrence rates between open and minimally in-vasive surgery.In this editorial,we aim to summarize the clinical and technical aspects which,even today,make the use of open surgery relevant and necessary in the treatment of patients with colorectal cancer.

Spontaneous free perforation of the small intestine in adults

Spontaneous free perforation of the small intestine is uncommon, especially if there is no prior history of visceral trauma. However, free, even recurrent, perforation may complicate a defined and established clinical disorder, such as Crohn’s disease. In addition, free perforation may be the initial clinical presentation of an occult intestinal disorder, such as a lymphoma complicating celiac disease, causing diffuse peritonitis and an acute abdomen. Initial diagnosis of the precise cause may be difficult, but now has been aided by computerized tomographic imaging. The site of perforation may be helpful in defining a cause (e.g., ileal perforation in Crohn’s disease, jejunal perforation in celiac disease, complicated by lymphoma or collagenous sprue). Urgent surgical intervention, however, is usually required for precise diagnosis and treatment. During evaluation, an expanding list of other possible causes should be considered, even after surgery, as subsequent management may be affected. Free perforation may not only complicate an established intestinal disorder, but also a new acute process (e.g., caused by different infectious agents) or a longstanding and unrecognized disorder (e.g., congenital, metabolic and vascular causes). Moreover, new endoscopic therapeutic and medical therapies, including use of emerging novel biological agents, have been complicated by intestinal perforation. Recent studies also support the hypothesis that perforation of the small intestine may be genetically-based with different mutations causing altered connective tissue structure, synthesis and repair.

Non-operative successful management of a perforated small bowel diverticulum

Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient’s symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.

Fish bone migration to the urinary bladder after rectosigmoid colon perforation

Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.

Ingested bone fragment in the bowel: Two cases and a review of the literature

Generally, ingested foreign bodies are excreted from the digestive tract without any complications or morbidity. In adults, ingestion of foreign bodies frequently occurs in alcoholics and elderly individuals with dentures. The most commonly ingested foreign bodies are food stuffs or their parts, such as fish bones or fragments of bone and phytobezoars. Sharp foreign bodies like fish and chicken bones can lead to intestinal perforation and peritonitis. We report herein two cases, one of bowel perforation and another of anal impaction, both caused by ingested bone fragments. Complications due to ingested bone fragments are not common and preoperative diagnosis remains a challenge and therefore it must be considered in susceptible cases.

Misdiagnosis of food-borne foreign bodies outside of the digestive tract on magnetic resonance imaging:Two case reports

BACKGROUND Patients with foreign bodies in the digestive tract are often encountered,but complete penetration of a foreign body through the gastrointestinal tract is rare,and the choice of imaging method is very important.Improper selection may lead to missed diagnosis or misdiagnosis.CASE SUMMARY An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography(CT)examinations.The pain improved after the patient accepted gamma knife treatment.However,he was admitted to our hospital 2 mo later due to fever and abdominal pain.This time,he received a contrast-enhanced CT scan,which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation,then he went to the superior hospital for surgery.It lasted for more than 2 mo from the onset of the disease to the surgical treatment.A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity.Clinical perianal abscess surgery was performed,and fish bone foreign body was found in perianal soft tissue during the operation.CONCLUSION For patients with pain symptoms,the possibility of foreign body perforation should be considered.Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.

Surgical complications of oncological treatments: A narrative review

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments,including chemotherapy,radiation therapy,and moleculartargeted therapies.Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract,small bowel,colon,and rectum.The mechanisms of action of these therapies are different.Chemotherapy includes cytotoxic drugs,which block the activity of cancer cells by targeting intracellular DNA,RNA,or proteins.Gastrointestinal symptoms are very common during chemotherapy,due to a direct effect on the intestinal mucosa resulting in edema,inflammation,ulceration,and stricture.Serious adverse events have been described as complications of molecular targeted therapies,including bowel perforation,bleeding,and pneumatosis intestinalis,which may require surgical evaluation.Radiotherapy is a local anti-cancer therapy,which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death.Complications related to radiotherapy can be both acute and chronic.Ablative therapies,including radiofrequency,laser,microwave,cryoablation,and chemical ablation with acetic acid or ethanol,can cause thermal or chemical injuries to the nearby structures.Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication.Furthermore,it is important to know the stage and prognosis of the disease,and a multidisciplinary approach is necessary to personalize the surgical treatment.The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.

A rare cause of acute abdomen after a Good Friday

Small bowel perforation caused by an ingested fish bone is rare but can involve the appendix or Meckel’s diverticulum.We report the case of a 25-year-old man who presented to the emergency department with acute abdomen caused by perforation of a Meckel’s diverticulum with a fish bone ingested in a Good Friday.

Assessment of Extent and Severity of Pellet Induced Abdominal Injuries, a Rare Variant of Weapon Violence: A Prospective Study

Background: The use of a Pellet gun, a form of short gun used for mob control in many conflict zones, has posed a serious challenge to the surgeons in assessing the extent of trauma caused by these pellets. Objectives: To study the role of conventional available investigations for trauma like ultrasonography and computed tomography scans in assessing the severity of the injuries caused by the pellets. Methodology: 50 patients having pellet injuries predominantly in abdomen without other associated trauma were included in the study. The decision for surgery was taken on the basis of clinical and CECT (Contrast Enhanced Computed Tomography) findings and these findings were then compared with intra-operative findings. Results: 30/50 patients were decided to be operated on the basis of Clinical and CECT findings. On exploration, it was observed that 18/33 patients really needed exploration while as 15/33 patients could have been managed conservatively. This was observed in next 20/50 patients who were put on conservative management with similar CECT findings. Of these 20 patients, 17 did well while as 3 were explored later in view of developing peritonitis and were found to have small bowel perforations. Conclusion: Conventional investigations for trauma like FAST and CECT abdomen are not ideal for assessing the severity of pellet induced abdominal visceral injuries which result in high rate of unnecessary laparotomies. Also the abdominal pellet trauma patients can be well managed conservatively until hemodynamically stable even though CT scan shows pellet penetration into peritoneal cavity or bowel lumen.