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1

Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation – case report

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Khuat D., Julkowska A., Chamarczuk F., Flont A., Horbacka K.

Polish Journal of Surgery

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2020

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vol. 92(5)

57-59

EN

Introduction: Chest pain is one of the most common symptoms with which patients report to the doctor. The reason for this is the fear of the sick, who often equate this symptom with dangerous diseases such as heart attack. The primary source of pain does not always have to be located within the chest. Colon perforation is a rare but possible complication of colonoscopy, which may result in free gas entering the mediastinum which is accompanied by chest pain. Case report: We present the case of a 78-year-old woman who reported to the hospital emergency department with chest pain, shortness of breath and abdominal pain. On the basis of imaging examinations, perforation of sigmoid affected by diverticulosis, complicated by pneumomediastinum and retroperitoneal emphysema, was suspected. The aforementioned ailments were caused by iatrogenic perforation of the sigmoid during diagnostic colonoscopy performed on an outpatient basis a few hours before reporting to the hospital. The patient was urgently qualified for laparotomy. Intraoperatively, perforation was confirmed at the rectosigmoid junction, which was the cause of retroperitoneal and pneumomediastinum with rightsided emphysema of the lateral neck region. No fluid or intestinal contents were found in the abdomen. The sigmoid colon and upper rectum were resected via double-stapled anastomosis performed between the descending colon and rectum. The patient was discharged home in good condition on the 7th postoperative day. Conclusions: Colonoscopy is a diagnostic and therapeutic procedure that is considered relatively safe, but also carries complications such as bleeding or perforation of the large intestine. Diverticular disease is a common condition which most often affects the sigmoid colon. In areas of the weakest resistance, diverticulum formation occurs as a result of increased intra-abdominal pressure, which is an additional risk factor for perforation during colonoscopy. It is important to remember the possible different clinical presentation of gastrointestinal perforation, which may also manifest as chest pain. With early detection and surgical treatment, life-threatening complications associated with the development of pneumothorax can be avoided.

2

Neuroendocrine Carcinoma Responsible For Gastrointestinal Tract Perforation

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Domurat M., Juchimiuk M., Kędra B.

Polish Journal of Surgery

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2010

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vol. 82

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issue 10

577-580

EN

In terms of their clinical and histopathologic presentation, neuroendocrine gastrointestinal tumours constitute an extremely diversifed group of malignancies and thus are difficult to diagnose. Late and often accidental diagnosis means a multistage therapeutic process. The authors present the case of a 78-year-old female patient with clinical symptoms of visceral perforation followed by diffuse peritonitis. The patient was immediately operated. Intraoperative presentation revealed annular narrowing of the intestinal lumen by a tumour located in the cecum just above Bauhin's valve. The free tenia was microperforated in the described lesion area and had been the primary cause of diffuse fibrinous and pyogenic peritonitis. In addition, choleliths were found in the gallbladder. Right hemicolectomy with regional lymphadenectomy and cholecystectomy were performed. No postoperative complications. Histopathologic examination of resected specimen returned carcinoma neuroendocrinale. The authors argue, that the uncommon clinical course and circular, closing growth of the small cecum-located tumour with coincident perforation may originally suggest non-epithelial disease background.

3

Duodenal diverticulum perforation mimicking acute cholecystitis- case reports and literature review

100%

Łącka M., Hać S.

European Journal of Translational and Clinical Medicine

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2022

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vol. 5

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issue 1

64-70

EN

Background Duodenal diverticula affect a large part of the population. It is a congenital abnormality that develops over time. The incidence of duodenal diverticulum is estimated at 22% of the population in autopsies. Only 5% of patients present symptoms, and of those only 1%–2% require surgery.Material and methodsTwo patients are described who underwent surgery due to duodenal diverticulum perforation mimicking acute cholecystitis.ResultsPerforation of the duodenal diverticulum, combined the difficulty of treatment and potential for complications, is a disease with a high mortality rate. It is subtle and difficult to diagnose due to the lack of generalized peritonitis and unspecific symptoms. The rarity and the wide spectrum of the disease, in combination with additional factors to be considered in treating this disease, mean there is no standard treatment. Depending on the patient's general condition, disease advancement, age and pathological findings observable only during surgery, we can choose between conservative treatment and a wide spectrum of surgeries.ConclusionsDuodenal diverticular disease rarely gives any symptoms. However, even after the onset of symptoms, only 1-2% of patients require surgery. Our work is unique because we present two cases, each featuring different approaches - conservative and surgical.

4

Perforated gist of Meckel’s diverticulum

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Mitura K., Blicharz P., Romańczuk M.

Polish Journal of Surgery

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2012

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vol. 84(5)

258-261

EN

Meckel diverticulum is the most common congenital abnormality of gastrointestinal track (2-4%), however complications occur rarely (4-16%). We describe a case of 63- years old female presenting simultaneously two serious complications of Meckel diverticulum. Operated patient was diagnosed with perforated tumor of Meckel diverticulum. Segmental resection of small bowel including tumor was performed. Pathology examination revealed gastrointestinal stromal tumor (GIST) in Meckel diverticulum. No significant malignancy risk factors were found (low mitotic count). Consequently, computed tomography periodic surveillance was implemented. We report the possibility of simultaneous presentation of two serious complications of Meckel diverticulum. Tumors of Meckel diverticulum may mimic other abdominal pathologies and thus, they should be considered in differential diagnosis of abdominal tumors.

5

Perforated Gist of Meckel's Diverticulum

100%

Mitura K., Blicharz P., Romańczuk M.

Polish Journal of Surgery

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2012

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vol. 84

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issue 5

258-261

EN

Meckel diverticulum is the most common congenital abnormality of gastrointestinal track (2-4%), however complications occur rarely (4-16%). We describe a case of 63- years old female presenting simultaneously two serious complications of Meckel diverticulum. Operated patient was diagnosed with perforated tumor of Meckel diverticulum. Segmental resection of small bowel including tumor was performed. Pathology examination revealed gastrointestinal stromal tumor (GIST) in Meckel diverticulum. No significant malignancy risk factors were found (low mitotic count). Consequently, computed tomography periodic surveillance was implemented.We report the possibility of simultaneous presentation of two serious complications of Meckel diverticulum. Tumors of Meckel diverticulum may mimic other abdominal pathologies and thus, they should be considered in differential diagnosis of abdominal tumors.

6

Diverticulitis of the Small Bowel

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Eisold S., Guenther K., Reith H.

Polish Journal of Surgery

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2007

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vol. 79

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issue 5

385-388

EN

In contrast to diverticulosis of the large bowel, diverticular disease of the small bowel is rare. This small bowel disease is predominantly localized to the duodenum. Jejunal and ileal diverticula are rare and occur in the majority of patients without clinical impact. Less than 10% of patients develop serious complications, including obstruction, hemorrhage, perforation and penetration. Here, we present 4 patients with jejunal diverticulitis. Three of these patients experienced perforation.

7

Treatment planning of complicated endodontic cases with the use of CBCT

88%

Tomaszewska I., Szupiany-Janeczek T., Pytko-Polończyk J.

Medicina Internacia Revuo

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2017

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vol. 28

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issue 108

182-188

EN

Cone beam computed tomography (CBCT) imaging is useful in various clinical situations including assessing dental morphology prior to endodontic treatment, locating tooth perforations, separated endodontic files, and resorptions. The aim of this paper was to present the usefulness of CBCT in endodontic treatment planning, through the review of two complicated endodontic cases. Two cases of failed endodontic treatment were presented in which CBCT allowed for correct diagnosis, as well as endodontic treatment qualification and planning. CBCT is especially useful when assessing endodontic treatment complications such as overextended root canal obturation material, separated endodontic instruments, and/or localization of perforations. Having the pros of CBCT in mind, one always has to weigh the added diagnostic value of CBCT with the economic cost of the tool employed, in order to make the best informed decision regarding accurate diagnosis and treatment.

8

Free gas in the peritoneal cavity after colonoscopy. Indication for immediate action or incidental finding in imaging tests after uncomplicated colonoscopy? Literature review

75%

Znamirowski P., Głuszek S.

Polish Journal of Surgery

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2020

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vol. 92(3)

44-50

EN

Colonoscopy is a routine diagnostic and therapeutic procedure. Along with the increase in the complexity of the procedures performed, the risk of complications increases. In 2017, WSES (World Society of Emergency Surgery) published the principles of safe colonoscopy. Intestinal perforation is one of the most common complications. The risk of perforation in treatment procedures such as mucosectomy or endoscopic dissection is significantly greater than the risk of diagnostic colonoscopy. The basic rule of the procedure in case of suspected perforation is close supervision over the patient’s condition and the soonest possible repair of damage. The role of the endoscopist is not only early recognition, but also early treatment of damage. Immediate endoscopic treatment of lesions is an effective, final and acceptable management strategy. In patients who have undergone imaging diagnostics for another reason, free gas in the peritoneal cavity can be recognized. It does not have to mean the need for urgent surgical intervention. Patients with asymptomatic pneumoperitoneum after colonoscopy should, however, be treated as patients with suspected perforation of the large intestine and undergo careful clinical observation in accordance with WSES recommendations. Colonoscopy is a procedure with a risk of complications, which should be reported to patients qualified for endoscopy, but appropriate management reduces the risk of morbidity and mortality associated with this procedure.

9

Selected aspects of numerical analysis of layered flexible structures subjected to impact of soft core projectile

71%

Morka A., Kędzierski P., Gieleta R., Morka A., Kędzierski P., Gieleta R.

Archive of Mechanical Engineering

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2015

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vol. 62

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issue 1

Refine search results

Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation – case report

Neuroendocrine Carcinoma Responsible For Gastrointestinal Tract Perforation

Duodenal diverticulum perforation mimicking acute cholecystitis- case reports and literature review

Perforated gist of Meckel’s diverticulum

Perforated Gist of Meckel's Diverticulum

Diverticulitis of the Small Bowel

Treatment planning of complicated endodontic cases with the use of CBCT

Free gas in the peritoneal cavity after colonoscopy. Indication for immediate action or incidental finding in imaging tests after uncomplicated colonoscopy? Literature review

Selected aspects of numerical analysis of layered flexible structures subjected to impact of soft core projectile