Post Caesarean Caecal Perforation with Fecal Peritonitis

Alexandria Journal of Medicine

Postoperative fluid accumulation is a very rare complication of caesarean delivery. We present an unusual case of peritonitis of unknown origin following a caesarean delivery. Emergency surgery was performed. On exploration there was a large amount of clear fluid which was removed. No signs of iatrogenic injury or any abnormality was detected. Fluid cultures of fluid drained from the abdomen did not grow any organisms. The working diagnosis was reactive peritonitis. Post exploratory laparotomy sepsis developed which was managed conservatively. The patient was discharged after full recovery.

Jrsm Short Reports, 2010

International Journal of Medical Reviews and Case Reports, 2022

Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed by clinical and radiological investigations were included in the study and studied prospectively. On admission to the hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented in an advanced stage developed complications. The majority of patients were males. The interval between the onset of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process, were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication. Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.

International Surgery Journal, 2019

Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency in India .1 In spite of advances in perioperative care, antimicrobial therapy, and intensive care support, perforation peritonitis still has high morbidity and mortality. 2,3 Perforation is defined as an abnormal opening in a hollow organ or viscus. It is derived from the Latin perforatus, meaning "to bore through." The spectrum of etiology of perforation is different between developing and developed countries, and there is a paucity of data from India regarding its etiology, prognostic indicators, morbidity, and mortality patterns. 4-6 The signs and symptoms of almost all cases of perforation peritonitis are typical and clinical diagnosis of peritonitis can be made in all patients. X-ray chest and abdomen, ultrasound whole abdomen and CT scan are the investigations that can confirm the diagnosis. Peritonitis usually presents as an acute abdomen. Local findings include generalised abdominal tenderness, guarding, rigidity, abdominal distension, decreased bowel sounds. Systemic findings include fever with chills or rigor, restlessness, tachycardia, tachypnea, dehydration, ABSTRACT Background: Generalized peritonitis as a result of gastrointestinal perforation is a common surgical emergency in India. The present study was conducted to understand the spectrum of perforation peritonitis in terms of etiology, clinical presentation, site of perforation, surgical treatment, postoperative complications, and mortality encountered at

Cureus

Perforation peritonitis is one of the most common emergency presentations in Indian hospitals. Stercoral perforations are rare due to increased intraluminal pressure on the gut wall from impacted feces. This is associated with transmural necrosis. We present a 31-year-old pregnant woman who reported abdominal pain and vomiting at 34 weeks of gestation. The diagnosis was unclear from examination and imaging studies, and a provisional diagnosis of acute appendicitis was made. The patient underwent laparotomy and was found to have fecal contamination and multiple stercoral ileal perforations. The bowel segment was resected and exteriorized as a stoma.

Journal of Clinical Medicine

Perforation of the ileum in the antepartum period resulting in meconial peritonitis is a condition that, although rare, is burdened by several complications. In 80–90% of cases, meconial ileus is the first manifestation of a disease, cystic fibrosis. In the remaining 10–20% of cases, it is caused by other situations, such as prematurity. In most cases, the diagnosis of meconial ileus occurs after birth, although in some cases it can be suspected prenatally, with the finding of a hyperechoic intestine on second trimester ultrasound. The prognosis depends on the gestational age, the location of the obstruction and the presence of fetal abnormalities. Mortality is very high and the recovery of intestinal function in the postoperative course is very high risk. In this case series, we describe two meconial peritonitis and our experience at the center.

Journal of Medical Case Reports, 2017

Background: Spontaneous colonic perforations are scarce, and cecal perforations even more so. Preoperative diagnosis of the latter in a pregnant woman is particularly difficult because of physiologic changes and restrictions on some diagnostic imaging techniques, such as X-rays. Furthermore, management of these patients is a big challenge. Case presentation: We present a case of a spontaneous cecal perforation in a 40-year-old pregnant black woman in the Regional Hospital of Bafoussam in Cameroon. The results of clinical examination and ultrasonography on admission were in line with acute generalized peritonitis in a woman at 20 weeks of a viable pregnancy, indicating an urgent laparotomy. Operative findings were a 1 × 1-cm perforation on a distended cecum with minimal fecal contamination. The treatment consisted of excision of the edges, primary suture of the perforation, and omentoplasty. The recovery of the patient was uneventful. Conclusions: The management of spontaneous cecal perforation in a pregnant woman was a big challenge. The perforation was repaired by primary suture and omentoplasty. Further studies comparing this approach with right hemicolectomy are recommended.

Background: Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. It is often caused by introduction of an infection into the otherwise sterile peritoneal environment through perforation of bowel. This study is an attempt to analyze perforation peritonitis according demography, clinical presentations, investigations, anatomical sites of perforation, complications and outcome of surgical management. Methods: 100 patients of perforation peritonitis visiting the surgery department in last two years, more than 12 years of age, were included. Demographic details, chief complaints, past, personal and family history, general physical and local examination, hematological and radiological investigations were performed. Type of surgical procedure, treatment modalities and details of complications were noted. Results: Mean age at the time of presentation was 36.68 years. Male female ratio was 6.14:1. Most common symptom was pain abdomen (100.00%) followed by vomiting (67%). 28% patients were diabetic and 20% hypertensive. 48.00% were dehydrated, 82.00% had tachycardia while 10.00% patients presented in shock. Most common cause of perforation peritonitis was peptic (44%) followed by appendicular (22%), enteric (15%), traumatic(13%), gall bladder (3%) and ischemic (3%) perforations. Most common site of perforation was duodenum (32%) followed by appendix (22%). Repair with omental patch was the most frequent procedure performed. 25% patients developed wound infection while 12% had chest infection. Septicaemia occurred in 10% cases and 5% patients eventually developed burst abdomen. Mortality rate was 15%. Conclusion: Perforation peritonitis is mostly seen in males during 3 rd and 4 th decade of life & present with pain abdomen, vomiting and distension. History of fever is one of the most useful clinical criteria to differentiate typhoid from other perforations. Peptic perforation is the most common cause followed by appendicular perforation. These cases are managed surgically. Patients may develop complications like wound and chest infection in the post operative period.

Teologando, 2023

Nesse ebook (não publicado) apresento a teologia e o método por trás do texto do Novo Testamento de acordo com Família 35. A proposta é demonstrar que tanto o fundamento teológico quanto a proposição metodológica de Wilbur Pickering não subsiste a uma análise detalhada, seja da interpretação dos textos que dão origem à teologia, seja a análise dos mss que dão originam a forma textual da f35. Baseado em uma investigação detalhada da teoria da f35, esse ebook foi escrito para auxiliar leigos a compreender as falácias e desvios teológicos apresentados por Pickering em seus principais livros em defesa da f35 como texto original do NT. Para o leitor atento, esse ebook será um importante ponto de partida para o estudo do texto do NT.

ABSTRACT This paper takes the structure of proposed shariah governance frame work SGF. The paper will be talk about how to deal with the conflict of interest among difference organs of ABC bank according to the proposed SGF. This essay contributes how the conflict of fatwa’s between shariah committee of ABC bank and shariah committee of the central bank is resolved. This study will also talk about what are the management consequences if SGF is not complied with? The concept of shariah governance framework set out the expectations on an Islamic financial institution’s ,shariah governance structures, processes and arrangements with the goal of ensuring that all operations and business activities are consistent with Shariah principles at all times.(Bank Negara Malaysia) BNM. The paper attempts to explore the agency issues in the special context of ABC bank. According to the proposed shariah governance frame work, the agency problems at Islamic financial institutions deserve separate and widens the issue of separation of ownership and control underlying the agency theory (Archer, Ahmed. and Al-Deehani, 1998). The paper provides conflict of fatwa’s between Central bank and ABC bank. In Shariah, a fatwa is the guidance and instruction given by a Scholar (often called Mufti) who use the principles of Islamic jurisprudence in order to derive rulings from various sources (Quran, Hadith etc).