Perforated rectal lymphoma in a renal transplant recipient: report of a case

PURPOSE: We report the case of a renal transplant recipient with rectal lymphoma manifested by sudden onset of abdominal pain from a perforated rectum who was treated successfully with prompt surgical resection and reduction of immunosuppressants. METHODS: An emergent anterior resection with Hartmann's procedure was done. Immunosuppressants were drastically reduced by discontinuation of cyclosporine. RESULTS: Pathologic examination showed diffusely infiltrated large-cell malignant lymphoma with an immunoblastic feature. The patient has been followed-up for four years, with no tumor recurrence or graft rejection. CONCLUSION: Rectal lymphoma, although rare, should be kept in the list of differential diagnoses for transplant recipients who exhibit lower gastrointestinal bleeding, intestinal obstruction, or abdominal pain.     

Perforated appendicitis within an inguinal hernia: case report and review of the literature

The finding of the vermiform appendix within an inguinal hernia sac is not uncommon. However, it is rare to find a perforated appendix within an inguinal hernia. An unusual case of an incarcerated and perforated appendix within an inguinal hernia complicated by an intra-abdominal abscess is reported herein. Perforated appendix as a cause of abscess was revealed during abdominal exploration. Clinicians are encouraged to be aware of this unusual entity, which is rarely recognized before exploration.     

Laparoscopic cholecystectomy in the densely scarred abdomen

Extensive intra-abdominal adhesions are a possible contraindication to laparoscopic cholecystectomy and are known to occur after peritonitis because of perforated hollow viscus or multiple abdominal operations. Four such patients, who had undergone three or more previous abdominal operations, and had additional complicating factors, were successfully treated by laparoscopic cholecystectomy. An initial subxiphoid incision with blunt finger dissection was used to place the primary port. This approach achieves greater success and is safer than the traditional open umbilical dissection, because it avoids extensive lysis of small bowel and transverse colon adhesions from the anterior abdominal wall.     

Perforated solitary ulcer of the colon. Report of a case

PURPOSE: A patient with a solitary colonic ulcer had sudden onset of crampy abdominal pain, anorexia, fever, and vomiting, with signs of positive peritoneal irritation. METHODS: The diagnosis was proved by histopathologic examination of right hemicolectomy material. RESULTS: An emergency laparotomy, with right hemicolectomy and ileotransversostomy, gave complete relief from symptoms. The patient was still asymptomatic at the two-year follow-up, and control colonoscopic examinations performed at 6 and 18 months after the operation were normal. CONCLUSION: Preoperative diagnosis of perforated solitary colonic ulcers localized at the right hemicolon may mimic acute appendicitis, and intraoperative findings may mimic colonic carcinoma. If the preoperative diagnosis is not certain, right hemicolectomy and ileotransversostomy, with regular colonoscopic controls, is a safe procedure in the treatment and follow-up of these patients.     

Hemihypertrophy with a liver cyst: a case report

An 8-month-old girl with a right-sided hemihypertrophy was found to have a large abdominal mass. At exploration, the mass, arising from the antero-inferior edge of the right lobe of the liver, was pedunculated and measured 17 cm x 12.5 cm x 12.5 cm. This was excised and histology confirmed it to be a benign single cyst of the liver.     

Alternative laparoscopic management of perforated peptic ulcers

Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.     

Human substance P receptor expressed in Chinese hamster ovary cells directly activates G(alpha q/11), G(alpha s), G(alpha o)

BACKGROUND: Abdominal pain is a common finding in patients with systemic lupus erythematosus (SLE), occurring in as many as half of all SLE patients in the course of their disease. The rheumatology and gastroenterology literature emphasizes etiologies of abdominal pain in patients with SLE such as peritonitis from polyserositis, dyspepsia from reflux, nausea and vomiting from bowel edema, ascites, mesenteric ischemia, pancreatitis, pneumatosis intestinalis from necrotizing enterocolitis, and hepatobiliary abnormalities. But in clinical practice, caring for SLE patients in a community teaching hospital, these seem to be rare entities. PATIENTS AND METHODS: A chart review study was performed of all patients with SLE with the diagnosis of abdominal pain admitted to a community teaching hospital between 1980 and 1995. RESULTS: Of 13 patients who presented with abdominal pain, 9 required surgical intervention for cholecystitis, perforated ulcer, colonic perforation, diverticulitis, and adhesions. There were no negative laparotomies for polyserositis or bowel edema, or cases of mesenteric infarction or ascites. CONCLUSION: Despite some unusual diagnostic possibilities in abdominal pain in SLE such as polyserositis and mesenteric infarction, and despite the superimposed problems of steroid therapy in most of the patients in this study, the majority of lupus patients with abdominal pain presenting at community hospitals have relatively conventional illnesses.     

Progress in research towards a world without leprosy. Report of a WHO meeting in Ethiopia, February 1998

Rat cortex synaptosomes have been successfully perforated with high concentrations (> or = 400 U/ml) of Staphylococcus aureus alpha-toxin. The free Ca2+-concentration dependence of [3H]-noradrenaline release was similar to that observed for PC 12 and chromaffin cells. Release from the alpha-toxin perforated synaptosomes was not significantly inhibited by omega-conotoxin GVIA. Initially, Ca2+-dependent release was independent of MgATP (for 0.5 min), but became increasingly dependent on MgATP with time. Lactate dehydrogenase efflux from alpha-toxin-perforated synaptosomes was not different than efflux from control synaptosomes, and an antibody to N-ethylmaleimide-sensitive fusion protein did not enter the synaptosomes. [3H]-noradrenaline release was temperature and alpha-toxin-concentration dependent. Ca2-dependent release was more resistant to rundown from alpha-toxin- than from streptolysin-O-perforated synaptosomes. This preparation of perforated synaptosomes should be useful for studies of regulated exocytosis from nerve endings.     

Racemose angiomatosis. Comments on the article of D.E. Matsko and I.A.Sokolova. Racemose angioma of the nervous system: tumor or developmental defect? Vopr. onkol. 1966. V.42, No.6. p.91-96

Diversion colitis is thought to result from nutritional deficiencies secondary to fecal diversion. Symptoms include hemorrhagic purulent rectal discharge, abdominal pain, and tenesmus. 5-Aminosalicylic acid (5-ASA) and N-butyrate enemas have been reported to help this condition non-spinal cord injury (SCI) patients. We report the case of a 49-year-old C6 ASIA B tetraplegic man who had received colostomy because of intractable ileus 10 years earlier. He presented with a 2-week history of rectal pain and bleeding. Abdominal and rectal examination on admission were unremarkable. Colonoscopy showed a partial stricture 70cm proximally to the rectum. The colonic mucosa appeared granular and friable with evidence of linear ulceration. Histopathologic study was consistent with colitis. The patient developed fever, abdominal distention, and extensive retroperitoneal air after endoscopy, suggesting colonic perforation. He was treated with daily 5-ASA suppository and total parenteral nutrition for the presumed diagnosis of diversion colitis, and intravenous antibiotics for perforated colon. After 6 weeks of treatment with 5-ASA, the patient had decreased rectal pain and bleeding. This experience suggests that diversion colitis may be a cause of abdominal discomfort in SCI patients and that 5-ASA may be used in the management of diversion colitis.     

Rotating-Perforated-Tubes Biofilm Reactor for High-Strength Wastewater Treatment

A rotating-perforated-tubes biofilm reactor was used for treatment of synthetic wastewater at different operating conditions. The biofilm reactor consisted of two sections each having 25 perforated tubes mounted on three perforated discs. The battery of the tubes was rotated with the aid of a shaft and a motor. Effects of major process variables such as feed wastewater flow rate and COD concentration on the system performance were investigated. Kinetics of COD removal was investigated and kinetic constants determined by using the experimental data. An empirical design equation was developed to quantify the system's performance as a function of major process variables.     

Perforated leiomyosarcoma of Meckel's diverticulum

Two cases of perforated leiomyosarcoma of Meckel's diverticulum are presented. There are only 59 cases reported in current literature, including 4 perforations. Although the condition is rare, leiomyosarcoma is the commonest tumour of Meckel's diverticulum. Its clinical presentation include abdominal pain, intestinal bleeding, abdominal mass, intestinal obstruction and less commonly, acute perforations. Both our cases presented with perforations which is unusual. Despite this late presentations both were resectable and both had no distant or local metastasis. One of our patients was 89 years old at presentation and has been disease-free 3 years after resection. The other patient was 69 years old and has also been disease-free.     

Hydatid liver cyst perforation into the digestive tract

Complications of liver hydatid disease include those related to the compression of adjacent viscus, to the infection of the cyst's contents or to the perforation of the cyst. Perforations into hollow abdominal organs are rare, and can occur secondary to the infection of the cyst or to a primary pathology of the perforated organ. We report on 2 cases of perforation of a liver cyst into the duodenum, 1 due to the presence of a duodenal ulcer, and 1 secondary to a hydatid abscess. The surgical treatment of the lesions and their complications was, in both cases, successful.     

Ileal penetration by a Multiload-Cu 375 intrauterine contraceptive device. A case report with review of the literature

A case of a 28-year-old gravida 3 para 2 woman with an ileal penetration by an intrauterine device (IUD) is reported. Four weeks following insertion of a Multiload-Cu 375, the woman underwent laparotomy due to persistent vague abdominal pain and translocation of the IUD. The device had perforated the fundal uterine wall and the two flexible side arms and the copper-bearing rod had completely eroded into the wall of the ileum with only the strings protruding outside the small bowel mesentery. Resection of an ileal segment with end-to-end anastomosis was performed. The woman made an uneventful recovery. It appears that a translocated Multiload-Cu 375 IUD body can penetrate and be entirely embedded within the bowel wall as early as 4 weeks following translocation. This report documents the shortest interval between insertion and proven bowel injury by an IUD.     

Nontraumatic perforations of the small intestine

Nontraumatic perforation of the small intestine is very rarely found as a cause of abdominal disease. A series of 8 patients admitted to our hospital from 1990-1994 was reviewed. Underlying conditions were typhoid ulcers, (two patients), adhesions (two patients), hemorrhagic ileitis, (one patient), radiation enteritis (one patient) and SLE (one patient). The cause remained unclear in one patient (idiopathic). As surgical therapy, resection and anastomosis were preferred in order to make thorough histologic examination of the perforated bowel possible. One anastomosis leakage with spontaneous closure was observed. There was no operative mortality.     

Perforated duodenal ulcer: an alternative therapeutic plan

An alternative plan for the treatment of a perforated duodenal ulcer is proposed. We will focus on the now-recognized role of Helicobacter pylori in the genesis of the majority of duodenal ulcers and on the high rate of success of therapy with a combination of antibiotics and a proton-pump inhibitor or histamine2 blocker in treatment of such ulcers. Knowledge that half the cases of perforated duodenal ulcer may have securely sealed spontaneously at the time of presentation is incorporated in the therapeutic plan. Patients with a perforated duodenal ulcer who have already been evaluated for H pylori and are not infected or, if infected, have received appropriate therapy should undergo an ulcer-definitive operation if they are suitable surgical candidates. Most authorities recommend surgical closure of the perforation and a parietal cell vagotomy. The remaining patients should have a gastroduodenogram with water-soluble contrast medium. If the perforation is sealed, the patient can be treated nonsurgically. If the perforation is leaking, secure surgical closure of the perforation is necessary. Following recovery from the immediate consequences of the perforation, evaluation for H pylori should be conducted. If the patient is infected, combined medical therapy is recommended. If the patient is not infected, Zollinger-Ellison syndrome should be ruled out and medical therapy is recommended if the ulcer has not been treated previously. Elective ulcer-definitive surgery should be considered for the occasional uninfected patient who has already received appropriate medical therapy for the ulcer.     

Perforated diverticulum of the cecum: a difficult preoperative diagnosis

A patient was admitted for a suspected appendicitis; occasionally, a roentgenogram of abdomen, an echography and a tomography: confirmed the suspect. At laparotomy a perforated diverticulum of cecum is suddenly reported: a segmentary resection of ascending colon is performed. Authors remark, according to literature, that preoperative diagnosis of perforated cecal diverticulum is difficult even today, in spite of diagnostic procedures.     

Colon cancer with a high serum alpha-fetoprotein level

We report on a patient with colon cancer and a very high serum alpha-fetoprotein level. This 75-yr-old man presented with right lower quadrant abdominal pain. An abdominal CT scan as well as ultrasonography showed a tumor in the cecum. Serum alpha-fetoprotein level was extremely high (3,070 ng/ml). At laparotomy, a large mass was found in the cecum, and a right hemicolectomy was performed. Histological examination, including immunohistochemical study, showed an adenocarcinoma of the colon producing alpha-fetoprotein.     

Laparoscopic surgery of perforated duodenal and gastric ulcers

During the period of 13 months, the authors have operated on seven patients with perforated gastroduodenal ulcers. All surgeries were completely performed by the laparoscopic method. The laparoscopic suture of perforated ulcers was performed with lavage and only in one case it involved omentoplasty. The healing process was free of any complications in all patients. The advantage of laparoscopic operations of perforated ulcers resides in fast convalescence and in the fast restoration of working abilities. This method is appropriate in cases when the surgeon performing laparoscopic surgeries has sufficient experience in coincidence with the treatment of perforated ulcers.     

First adult patient with fibrosing colonopathy

An adult patient with cystic fibrosis and chronic abdominal complaints developed symptomatic fibrosing colonopathy several months after the beginning of high dose pancreas enzyme therapy. Despite the absence of a stricture, surgical resection was performed. Since then the abdominal complaints have not recurred.     

Mesenteric involvement of thromboangiitis obliterans (Buerger's disease) in a woman

Although patients with peripheral arterial occlusive disease due to thromboangiitis obliterans (TAO) have been well characterized and the relationship of this disease to tobacco is stressed, little attention has been focused on its ability to involve the mesenteric vasculature and its ability to affect women. We report a rare case of a known TAO female patient who presented with abdominal pain due to inflammatory changes of the mesenteric vessels. The resulting small bowel ischemic changes and formation of intramural gas were demonstrated on a small bowel follow-through and a plain abdominal film. An angiography finally showed a superior mesenteric artery occlusion.