Perforated gastric ulcer causing mediastinal emphysema: A case report

BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.

Productivity Prediction Model of Perforated Horizontal Well Based on Permeability Calculation in Near-Well High Permeability Reservoir Area

To improve the productivity of oil wells,perforation technology is usually used to improve the productivity of horizontal wells in oilfield exploitation.After the perforation operation,the perforation channel around the wellbore will form a near-well high-permeability reservoir area with the penetration depth as the radius,that is,the formation has different permeability characteristics with the perforation depth as the dividing line.Generally,the permeability is measured by the permeability tester,but this approach has a high workload and limited application.In this paper,according to the reservoir characteristics of perforated horizontal wells,the reservoir is divided into two areas:the original reservoir area and the near-well high permeability reservoir area.Based on the theory of seepage mechanics and the formula of open hole productivity,the permeability calculation formula of near-well high permeability reservoir area with perforation parameters is deduced.According to the principle of seepage continuity,the seepage is regarded as the synthesis of two directions:the horizontal plane elliptic seepage field and the vertical plane radial seepage field,and the oil well productivity prediction model of the perforated horizontal well is established by partition.The model comparison demonstrates that the model is reasonable and feasible.To calculate and analyze the effect of oil well production and the law of influencing factors,actual production data of the oilfield are substituted into the oil well productivity formula.It can effectively guide the technical process design and effect prediction of perforated horizontal wells.

Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

Surgical Management of Perforated Colon Tumours in Yaoundé: A Multicentre Retrospective Review of 30-Day Postoperative Outcome

Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this study was to improve the short-term postoperative outcomes of patients operated upon for perforated colon cancer, by identifying factors associated with complications occurring within 30 days after surgery. Patients and methods: We carried out an analytical observational study, with a retrospective collection of data from the files of patients operated upon for an in situ tumoral colon perforation. This was done in four referral hospitals in the city of Yaoundé. The period was from the 1st of January, 2012 to the 31st of December, 2021. Cox regression identified the factors associated with postoperative morbidity and mortality. Results: We collected files of 46 patients. The mean age was 54.7 ± 19.9 years with a sex ratio of 1.4. The clinical presentation on admission was dominated by the presence of signs of peritoneal irritation (91.3%) and bowel obstruction (28.3%). The diagnosis was made preoperatively in 16 cases (34.8%). The surgical procedures consisted of colectomy with anastomosis in 28 cases (60.9%) and without anastomosis in 14 cases (30.4%). Postoperative morbidity was 60.9% dominated by surgical site infection (37%). Postoperative mortality was 39.1%. The existence of generalized peritonitis was associated with the occurrence of postoperative complications (p = 0.019). The main factors associated with postoperative mortality were resection with primary anastomosis (p = 0.027), enterocutaneous fistula (p = 0.005). Conclusion: Colic resection with primary anastomosis or ideal colectomy is associated with an increased risk of mortality and should therefore not be performed in this setting.

Mediastinal emphysema in the context of perforated gastric ulcer

In the context of mediastinal emphysema/pneumomediastinum,the main aetiologies are associated with oesophageal perforation,lung pathology or post head and neck surgery related.The main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase imaging.The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic.Oesophageal perforation(Boerhaave syndrome)is associated with Mackler’s triad in upto 50%of patients(severe retrosternal chest pain,pneumomediastinum,mediastinitis).Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.

Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.

Blast disruption using 3D grids/perforated plates for vehicle protection

In this work, blast disruption and mitigation using 3D grids/perforated plates were tested for underbelly and side protection of vehicles. Two vehicle simulants were used: a small-scale one for side vehicle protection assessment and a true-to-scale simulant for underbelly protection testing. The deformation of target plates was assessed. These were either unprotected or protected by three different types of disruptors. The first disruptor was made of a sandwich structure of two perforated plates filled with a thin aluminum structure allowing the air to pass through. The two other disruptors were made of pieces of cast metallic foam. Two different kinds of foams were used: one with large cells and the second one with small cells. Beforehand, the mitigation efficiency of the disruptors was evaluated using an explosivedriven shock tube(EDST). The experiments showed that blast disruption/mitigation by 3D grid/perforated plate structures was not suitable for vehicle side protection. However, 3D grids/perforated structures proved to be relatively effective for underbelly protection compared to an equivalent mass of steel.

Numerical Analysis of Residual Strength in the Perforated Casing of Ultra Deep Wells

A three-dimensional model for the numerical simulation of casing-cement behavior is used to investigate residual strength in the perforated casing of ultra deep wells.The influence of the hole diameter,hole density and phase angle on the residual strength of the casing under non-uniform stress and fracturing conditions is revealed through the consideration of different perforation parameters.It is shown that the residual strength of the casing increases with the hole diameter and periodically changes with the hole density;the phase angle is the main factor that affects the residual strength of the perforated casing,and the perforation should be avoided in the direction of the minimum principal stress to reduce stress concentration at the perforation hole.Moreover,as shown by a companion orthogonal experiment,the descending order of influence of the different influential parameters is:phase angle,hole diameter,hole density and the thickness of casing.

Calculation and Analysis of Acoustic Characteristics of Straight-Through Perforated Pipe Muffler Based on Multilayer Sound Absorbing Material

Using the multi-physical field simulation software COMSOL,the acoustic characteristics of the multilayer sound absorbing material straight-through perforated pipe muffler are studied by the finite element method.The results show that the finite element calculation of the multilayer sound absorbing material straight-through the perforated pipe muffler agrees well with the experimental measurement results.The reliability of the finite element method for studying the acoustic performance of the straight-through perforated pipe muffler with multilayer sound absorbing materials is shown.Furthermore,the influence of some structural parameters of porous sound absorbing material and micro-perforated plate on the acoustic performance of the multilayer sound absorbing material straight-through perforated pipe muffler is analyzed.The muffler based on multilayer sound absorbing material is different from the traditional muffler.After applying the multilayer sound absorbing material to the straight-through perforated pipe muffler,the transmission loss value greatly increases,which provides new ideas and directions for future research on the muffler.

Epidemiology of perforated peptic ulcer:Age-and gender-adjusted analysis of incidence and mortality

AIM:To investigate the epidemiological trends in inci-dence and mortality of perforated peptic ulcer(PPU)in a well-defined Norwegian population. METHODS:A retrospective,population-based,single-center,consecutive cohort study of all patients diag-nosed with benign perforated peptic ulcer.Included were both gastric and duodenal ulcer patients admitted to Stavanger University Hospital between January 2001 and December 2010.Ulcers with a malignant neoplasia diagnosis,verified by histology after biopsy or resection,were excluded.Patients were identified from the hospitals administrative electronic database using pertinent ICD-9 and ICD-10 codes(K25.1,K25.2,K25.5, K25.6,K26.1,K26.2,K26.5,K26.6).Additional searches using appropriate codes for relevant laparoscopic and open surgical procedures(e.g.,JDA 60,JDA 61,JDH 70 and JDH 71)were performed to enable a complete identification of all patients.Patient demographics,presentation patterns and clinical data were retrieved from hospital records and surgical notes.Crude and adjusted incidence and mortality rates were estimated by using national population demographics data. RESULTS:In the study period,a total of 172 patients with PPU were identified.The adjusted incidence rate for the overall 10-year period was 6.5 per 100 000 per year(95%CI:5.6-7.6)and the adjusted mortality rate for the overall 10-year period was 1.1 per 100 000 per year(95%CI:0.7-1.6).A non-significant decline in ad-justed incidence rate from 9.7 to 5.6 occurred during the decade.The standardized mortality ratio for the whole study period was 5.7(95%CI:3.9-8.2),while the total 30-d mortality was 16.3%.No difference in in-cidence or mortality was found between genders.However,for patients≥60 years,the incidence increased over 10-fold,and mortality more than 50-fold,compared to younger ages.The admission rates outside office hours were high with almost two out of three(63%) admissions seen at evening/night time shifts and/or during weekends.The observed seasonal variations in admissions were not statistically significant. CONCLUSION:The adjusted incidence rate,seasonal distribution and mortality rate was stable.PPU fre-quently presents outside regular work-hours.Increase in incidence and mortality occurs with older age.

Reflection of Oblique Incident Waves by Breakwaters with Partially-Perforated Wall

The reflection of oblique incident waves from breakwaters with a partially-perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigenfunction expansion method is applied to expand velocity potentials in each domain. In the eigen-expansion of the velocity potential, evanescent waves are included. Numerical results of the present model are compared with experimental data. The effect of porosity, the relative chamber width, the relative water depth in the wave absorbing chamber and the water depth in front of the structure are discussed.

A method to study interactions between narrow-banded random waves and multi-chamber perforated structures

A time-domain method, based on linear velocity potential theory, is presented to study the interaction between narrow-banded random waves and perforated structures. A simple relation is derived to estimate the jet length of flows through the perforated wall. The reflection coefficient of narrow banded random waves from perforated structures is calculated by assuming a Rayleigh distribution of the heights of incident random waves. For reflection of narrow-banded waves from a single-chamber perforated breakwater, a comparison of the predicted and measured reflection coefficients shows that the method presented in this paper can provide a prediction better than that of regular waves. Numerical results are also reported on the reflection of narrow-banded waves from multi-chamber perforated breakwaters.

Damping and Mechanical Properties of Cocured Composite Laminates with Embedded Perforate Viscoelastic Layer

The composite laminates with embedded acrylonitrile butadiene rubber （NBR） layer were fabricated by cocuring process. The embedded layers were perforated with a series of small holes to allow resin to flow through the damping layer and completely couple the structure to improve bending stiffness and interlaminar shearing strength of these cocured composite laminates. The damping, bending stiffness and shearing strength of these composite laminates with different perforation diameters were investigated. The experimental results show that increasing the perforation diameter leads to significant decreases in damping and significant increase in bending stiffness up to an area ratio of 7.065%. The area ratio here is defined as the ratio of perforation area to the total damping area. Beyond the area ratio of 7.065%, increasing the diameter to an area ratio of 50.24% results in only a slight variation in damping and bending stiffness. Moreover, increasing the perforation diameter does not always increase the shearing strength of the embedded viscoelastic layer. The shearing strength of embedded viscoelastic layer increases only when the area ratio is greater than 19.625%; instead, it will decrease.

Effects of Perforated Baffle on Reducing Sloshing in Rectangular Tank:Experimental and Numerical Study

A liquid sloshing experimental rig driven by a wave-maker is designed and built to study liquid sloshing problems in a rectangular liquid tank with perforated baffle. A series of experiments are conducted in this experimental rig to estimate the free surface fluctuation and pressure distribution by changing external excitation frequency of the shaking table. An in-house CFD code is also used in this study to simulate the liquid sloshing in three-dimensional （3D） rectangular tank with perforated baffle. Good agreements of free surface elevation and pressure between the numerical results and the experimental data are obtained and presented. Spectral analysis of the time history of free surface elevation is conducted by using the fast Fourier transformation.

Wave Diffraction on Arc-Shaped Floating Perforated Breakwaters

An analytical method is developed to study the sheltering effects on arc-shaped floating perforated breakwaters. In the process of analysis, the tloating breakwater is assumed to be rigid, thin, vertical, and immovable and located in water with constant depth. The fluid domain is divided into two regions by imaginary interface. The velocity potential in each region is expanded by eigenfunction in the context of linear theory. By satisfying continuity of pressure and normal velocity across the imaginary fluid interface, a set of linear algebraic equations can be obtained to determine the unknown coefficients for eigenfunction expansions. The accuracy of the present model was verified by a comparison with existing results for the case of arc-shaped floating breakwater. Numerical results, in the form of contour maps of the non-dimensional wave amplitude around the breakwater and diffracted wave amplitude at typical sections, are presented for a range of wave and breakwater parameters. Results show that the sheltering effects on the arc-shaped floating perforated breakwater are closely related to the incident wavelength, the draft and the porosity of the breakwater.

Numerical Simulation of Wave Interaction with Perforated Caisson Breakwaters

The volume of fluid (VOF) method is presented to determine the reflection coefficient of and the total horizontal wave force on perforated caisson breakwaters. The present numerical model is compared with a linear analytic solution obtained by Sahoo et al. (2000). Also this model is verified with the authors′ laboratory data. It is found that the numerical model is in good agreement with the regression equations obtained from the experimental data. The present numerical method is further discussed to relate porosity, the relative wave absorbing chamber depth, the reflection coefficient of perforated caissons and the total horizontal force on them.

The force of oblique incident wave on the breakwater with a partially perforated wall

Wave forces induced by the interaction between the oblique incident wave and the breakwater with a partially perforated front wall is investigated. The fluid domain is divided into two sub-domains and the eigen-function expansion method is applied to expanding velocity potentials in each domain. In the eigen-expansion of the velocity potential, evanescent waves are included. Numerical results of the present model are compared with other theories and a good agreement can be found between them. Experimental data have been compared with the present theoretical results. The effect of the traverse wall on wave forces has been discussed in detail. On the basis of the linear wave theory, it is shown that in the range Of engineering practice, the incident angle of wave has small influence on wave forces on the unit length of perforated caisson.

Reflection and Transmission of Regular Waves from/Through Single and Double Perforated Thin Walls

In this paper, reflection and transmission coefficients of regular waves from/through perforated thin walls are investigated. Small scale laboratory tests have been performed in a wave flume firstly with single perforated thin Plexiglas plates of various porosities. The plate is placed perpendicular to the flume with the height from the flume bottom to the position above water surface. With this thin wall in the flume wave overtopping is prohibited and incident waves are able to transmit. The porosities of the walls are achieved by perforating the plates with circular holes. Model settings with double perforated walls parallel to each other forming so called chamber system, have been also examined. Several parameters have been used for correlating the laboratory tests’ results. Experimental data are also compared with results from the numerical model by applying the multi-domain boundary element method （MDBEM） with linear wave theory. Wave energy dissipation due to the perforations of the thin wall has been represented by a simple yet effective porosity parameter in the model. The numerical model with the MDBEM has been further validated against the previously published data.

Wave interaction with a new type perforated breakwater

In this study examined is the wave interaction with a new modified perforated breakwater, consisting of a perforated front wall, a solid back wall and a wave absorbing chamber between them with a two-layer rock-filled core. The fluid domain is divided into three sub-domains according to the components of the breakwater. Then by means of the matched eigenfunction expansion method, an analytical solution is obtained to assess the hydrodynamic performance of the new structure. An approach based on a step approach method is introduced to solve the complex dispersion equations for water wave motions within two-layer porous media. Numerical results of the present model are compared with previous limiting cases. The effects of rock fill on the reflec- tion coefficient and the horizontal wave force are discussed.

Wave Interactions with Multiple Semi-Immersed Jarlan-Type Perforated Breakwaters

This study examines wave interactions with multiple semi-immersed Jarlan-type perforated breakwaters. A numerical model based on linear wave theory and an eigenfunction expansion method has been developed to study the hydrodynamic characteristics of breakwaters. The numerical results show a good agreement with previous analytical results and experimental data for limiting cases of double partially immersed impermeable walls and double and triple Jarlan-type breakwaters. The wave transmission coefficient Cv; reflection coefficient CR, and energy dissipation coefficient CE coefficients and the horizontal wave force exerted on the front and rear walls are examined. The results show that CR reaches the maximum value when B/L = 0.46n while it is smallest when B/L=0.46n＋0.24 （n=0, 1, 2,...）. An economical triple semi-immersed Jarlan-type perforated breakwater can be designed with B/L = 0.25 and CR and CT ranging from 0.25 to 0.32 by choosing a relative draft d/h of 0.35 and a permeability parameter of the perforated front walls being 0.5 for an incident wave number kh nearly equal to 2.0. The triple semi-immersed Jarlan-type perforated breakwaters with significantly reduced CR, will enhance the structure＇s wave absorption ability, and lead to smaller wave forces compared with the double one. The proposed model may be used to predict the response of a structure in the preliminary design stage for practical engineering.