Journal of Yeungnam Medical Science

Case report

Unusual presentation of asymptomatic subacute lead-related ventricular perforation beyond the pericardium without pericardial effusion: a case report: Jihee Son, Lae-Young Jung; J Yeungnam Med Sci. 2023;40(Suppl):S105-S108. Published online May 31, 2023; DOI: https://doi.org/10.12701/jyms.2023.00171

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Abstract PDF: The clinical manifestations of subacute pacemaker lead-related cardiac perforations are highly variable. Patients with subacute perforations can present with a variety of symptoms, whereas those with acute perforations usually present with cardiac tamponade that necessitates emergent pericardiocentesis. A 32-year-old woman underwent pacemaker implantation for sick sinus syndrome. An active-fixation atrial lead was fixed to the right atrial appendage, and a ventricular lead was fixed to the right ventricle (RV) apex, with acceptable parameters. Two weeks postoperative, the patient visited the clinic for routine examination of the pacemaker parameters. Chest X-ray showed migration of the RV lead beyond the cardiac silhouette. Echocardiography revealed no evidence of pericardial effusion or tamponade. Computed tomography revealed that the RV lead was positioned beyond the RV and pericardium and into the anterior chest wall. Procedural lead revision was performed with cardiothoracic surgery backup. The lead was retracted after loosening the active-fixation screw and inserting the stylet. The lead was placed in the RV septum with active fixation. The procedure was completed without complications, and the patient was discharged after 3 days. Subacute lead perforations can present with various symptoms, and some patients may be asymptomatic without pericardial effusion. Altered lead parameters frequently provide the first indication for the diagnosis of cardiac perforation. Transvenous lead revision with surgical backup is an alternative to surgical extraction.

Original article

Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study: Do-bin Lee, Seonhui Shin, Chun-Seok Yang; J Yeungnam Med Sci. 2022;39(2):133-140. Published online October 29, 2021; DOI: https://doi.org/10.12701/yujm.2021.01445

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2 Web of Science
3 Crossref

Background
Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality.
Methods
A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes.
Results
The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery.
Conclusion
Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

Citations

Citations to this article as recorded by

Colorectal Oncologic Emergencies
Joshua Sullivan, Alec Donohue, Shaun Brown
Surgical Clinics of North America.2024; 104(3): 631. CrossRef
One Year of Experience Managing Peritonitis Secondary to Gastrointestinal Perforation at a Tertiary Care Hospital: A Retrospective Analysis
Muhammad Hasaan Shahid, Faisal I Khan, Zain Askri, Arslan Asad, M. Azhar Alam, Danish Ali, Rabia Saeed, Aun Jamal, Tauseef Fatima, M. Farooq Afzal
Cureus.2022;[Epub] CrossRef
Risk factors for urgent complications of colorectal cancer
S. N. Shchaeva
Pelvic Surgery and Oncology.2022; 12(2): 28. CrossRef

Case Reports

Conservative treatment of cytomegalovirus colitis with bowel perforation in an immunocompetent patient: case report and review of literature: Kyoung Sik Nam, Hee Ug Park, Min Gi Park, Su Ho Park, Ji Yeon Hwang, Dong Kyu Kim, Sung Jun Kim; Yeungnam Univ J Med. 2017;34(1):75-79. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.75

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Abstract PDF: Cytomegalovirus (CMV) colitis, which is rare in an immunocompetent patient, was encountered in a 67-year-old man who was admitted due to persistent diarrhea. The first diagnostic tool was colonoscopy, which showed multiple ulcers from cecum to rectum. The secondary tool was CMV polymerase chain reaction, and CMV colitis was diagnosed. Intravenous ganciclovir therapy was administered, which resulted in improvement of diarrhea and ulcers throughout the colon were healed. Asymptomatic colon perforation was detected during diagnostic testing, which improved over the conventional treatment. CMV colitis is rare in immunocompetent patients, but it is essential for the differential diagnosis.

Rectal perforation caused by a sharp pig backbone in a middle-aged patient with mild depression.: Hyeong Ju Sun, Jeonghun Lee, Dong Min Kim, Myeong Su Chu, Kyoung Sun Park, Dong Jin Choi; Yeungnam Univ J Med. 2015;32(1):31-34. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.31

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Abstract PDF: In Korea, cases of direct insertion of foreign bodies into the rectum are rare in the literature. Most cases of rectal insertion of foreign bodies are associated with sexual acts and psychiatric disorder such as schizophrenia. Objects inserted into the anus are usually blunt and shaped like the male genitalia. The removal method can be varied depending on the size and shape of the foreign object, its anatomical location, and the accompanying complications. In cases wherein attempts to remove the object fail or there are rectal perforation and peritonitis complications, immediate laparotomy may be required in order to prevent serious complications such as sepsis. Here, we report on a case of rectal perforation and peritonitis due to insertion of a foreign body in a middle-aged patient, with a literature review. He inserted a sharp pig backbone in his rectum and he only had depression. The patient underwent a Hartmann's operation as well as psychiatric counseling and treatment. Thus, after removal of foreign bodies, psychiatric counseling and treatment should be carried out in order to prevent similar accidents and to minimize the need for trauma medicine.

Sigmoid Colon Perforation by a Distal Ventriculoperitoneal Shunt Catheter.: Dong Keun Shin, Seong Ho Kim; Yeungnam Univ J Med. 2008;25(2):171-174. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.171

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Abstract PDF: We report an unusual case of a sigmoid colon perforation after ventriculoperitoneal shunt surgery. Distal catheters are known to cause perforation in the setting of colonoscopy. The exact pathogenesis of this complication is not clear, but it can cause serious complications. Hence, patients require prompt and aggressive management, including laparotomy with bowel wall repair, catheter removal, and antibiotic therapy.

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