Bowel perforation

Gl obstruction gastric retention bowel perforation toxic colitis, megacolon, or ileus. 

Indomethacin (Indocin) Renal Failure, bowel perforation... 

X-ray is to exclude toxic dilation of the colon or bowel perforation, which would require urgent surgical attention. 

Deakin M. Small bowel perforation associated with an excessive dose of slow release diclofenac sodium. BMJ 1988 297(6646) 488-9. 

The rectal administration of Gastrografin 400-1000 ml in patients with suspected diverticular disease before CT examination of the abdomen has been investigated in 308 patients (aged 19-97 years) (147). None of the CT scans showed extravasated contrast material in the peritoneal cavity as a sign of bowel perforation. No patient had sudden clinical deterioration after the examination. All tolerated the contrast medium well and there were no allergic reactions. High-quality diagnostic examinations were obtained in all patients. 

The adverse effects of high-dose intravenous melphalan have been reviewed (2). Two patients who received less than 100 mg/m recovered from marrow aplasia within 3 weeks without major complications. A third patient died 6 days after injection of 290 mg/m, probably because of a cardiac dysrhythmia before complete marrow failure had become established. After intravenous administration of more than 125 mg/m, gastrointestinal adverse effects, such as hemorrhagic diarrhea, or bowel perforation, can occur. These, together with reduced ADH secretion and electrolyte disturbances are the predominant clinical problems and the reasons for early death before the occurrence of infectious or bleeding complications from prolonged marrow aplasia. 

Langman MJ, Morgan L, Worrall A. Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. BMJ (Clin Res Ed) 1985 290(6465) 347-9. 

Hypersensitivity reactions nausea and vomiting bowel perforation (rare)... 

Although advanced age is not an absolute contraindication for relatively aggressive therapies, a consideration of the age of the patient, concomitant disease states, lifestyle factors, and the patient s preferences are incorporated into the treatment planning process. Special or emergent conditions, such as bowel perforation, spinal cord compression, and severe pain, anemia, or other symptomatic problems, need to be addressed acutely, after which time a more long-term disease-specific plan can be developed. The treatment approaches for colorectal cancer reflect two primary treatment goals curative therapy for localized disease, and palliative therapy for metastatic cancer. 

The nurse must assess the client to determine if the pain is pain expected with diverticulitis or if it is a result of a complication of diverticulitis, such as bowel obstruction or bowel perforation. Remember that the first intervention is assessment. 

Fig. 1.26. Meconium peritonitis with intrauterine bowel perforation. Free air within the peritoneal cavity is observed (arrows) in this neonate with ileal atresia. No bowel distension is observed. A patent bowel perforation was found at surgery...

Contrast-enema usually reveals a microcolon distal to the atresia, with obstruction to the retrograde flow of barium at the site of the atresia (Fig. 1.29). A wind-sock appearance may be observed with membranous atresias (Winters et al. 1992). Calcification of meconium peritonitis due to in utero bowel perforation is present in about 12% of atresia cases, and can be diagnosed antenatally by sonography. 

Fig. 1.42a,b. Necrotizing enterocolitis, a Horizontal beam decubitus radiograph that shows pneumoperitoneum (arrows) due to bowel perforation in a premature infant, b Same patient. Contrast enema performed 6 months after surgery demonstrates a solitary, short stricture at the transverse colon... 

Although there are reports of spontaneous reduction of intussusception (Swischuck etal. 1994 Navarro and Daneman 2004a), chronic and recurrent intussusceptions, and rare cases of spontaneous sloughing of the gangrenous intussusceptum through the rectum (Ravitch 1986), the usual course of an untreated intussusception is bowel obstruction followed by bowel perforation with peritonitis and septic shock. Currently, the overall perforation rate in developed countries is low (0%-3%). 

Miller SF, Seibert JJ, Kinder DL et al (1993) Use of ultrasound in detection of occult bowel perforation in neonates. J Ultrasound Med 12 531-535... 

If bowel perforation or predisposition for pulmonary aspiration is suspected, barium is contraindicated because of the risk of granuloma formation in both lungs and the peritoneal cavity, in the abdomen adhesions or peritonitis. The reported side-effects of water-soluble contrast media such as hypothyroidism in neonates and allergic reaction in later life are rare. 

Figure 1 IL-8 concentrations in BAL fluid and plasma of patients at risk for ARDS after severe trauma, pancreatitis, or bowel perforation, (a) BAL fluid (b) plasma. Patients who developed ARDS had significantly higher initial IL-8 concentrations in BAL fluid, hut not in plasma BAL (p =. 0006) blood p =. 31). (From Ref. 14.)...

Only iodinated and, sometimes, no oral contrast medium at all should be given if the potential differential diagnosis includes bowel perforation. 

For the treatment of nausea and vomiting ondansetron or metoclopramide is often useful. For management of constipation one should consider that tolerance does not usually develop for the constipating effects of opioids. Laxatives and/or stool softeners should be used prophylactically from the beginning of opioid therapy. Agents that increase gastrointestinal propulsion should not be used as it may increase the risk of bowel perforation, if the patient has ileus and impacted stool. 

Peptic ulcer disease Bowel perforation Neuropsychiatric Euphoria Dysphoria Psychosis Insomnia... 

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