Gastrointestinal tract perforation

Hainaux B, Agneessens E, Bertinotti R et al (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol 187 1179-1183 Kara AK, Leighton JA, Virender K et al (2005) Imaging of small bowel disease comparison of capsule endoscopy,... 

The primary routes of entry for animal exposure to chromium compounds are inhalation, ingestion, and, for hexavalent compounds, skin penetration. This last route is more important in industrial exposures. Most hexavalent chromium compounds are readily absorbed, are more soluble than trivalent chromium in the pH range 5 to 7, and react with cell membranes. Although hexavalent compounds are more toxic than those of Cr(III), an overexposure to compounds of either oxidation state may lead to inflammation and irritation of the eyes, skin, and the mucous membranes associated with the respiratory and gastrointestinal tracts. Skin ulcers and perforations of nasal septa have been observed in some industrial workers after prolonged exposure to certain hexavalent chromium compounds (108—110), ie, to chromic acid mist or sodium and potassium dichromate. 

In severe cases, or those refractory to treatment, truncal and limb weakness may be accompanied by involvement of masticatory, bulbar, and respiratory muscles. However the most life-threatening clinical manifestations are those affecting the gastrointestinal tract, since stomach ulceration can occur and death from perforation and peritonitis are not unknown. Medication with steroidal antiinflammatory agents is necessary but weakens the childrens resistance to infection, so that systemic spread of usually self-limiting disorders, such as candidiasis, may occasionally occur. 

As lewisite is a vesicant, emesis is not recommended in those species that can vomit (dogs, cats, swine, and ferrets). Dilution with milk or water is recommended. Activated charcoal is not recommended as severe irritation/vesication of the esophagus or gastrointestinal tract is likely to occur. Endoscopy can be performed very carefully to determine the extent of injury. Esophageal perforation and/or stricture formation may occur. 

An increase in the number of deaths of all body packers in New York has been associated with an increase in deaths among opiate body packers of 50 deaths among body packers from 1990 to 2001, 42 were due to opiates (260). Four were related to cocaine and four to both opiates and cocaine. In 37 cases open or leaking drug packets in the gastrointestinal tract resulted in acute intoxication and death. Five cases involved intestinal obstruction or perforation, one a gunshot wound, one an intracerebral hemorrhage due to hypertensive disease,... 

Osmosin, a formulation that contains potassium bicarbonate and releases indometacin osmoticaUy, was withdrawn because of reports of intestinal irritation, bleeding, perforation, and even death. These adverse effects were most probably caused by the very high local concentrations of indometacin and potassium in the lower part of the gastrointestinal tract produced by the tablet, which shifted the adverse reactions from the stomach to the intestine (SEDA-8,103) (26). 

Amidotrizoate enemas are still sometimes used to treat meconium ileus or constipation, and it is important to give intravenous fluids so as to avoid dehydration. Hypomagnesemia can also occur (150). Osmotic effects lower in the gastrointestinal tract have even led to distention and cecal perforation (151). Stasis of amidotrizoate in dilated loops of bowel can cause inflammatory changes or necrosis (152,153). 

Potassium chloride is irritating to the gastrointestinal tract, even to the extent of causing perforation (4). In a retrospective study at surgical clinics in Stockholm County there were 22 cases of small-bowel ulceration in which a connection with slow-release potassium chloride tablets was probable (5). Most of the ulcers had caused stenosis of 1-2 cm of gut, and in four cases there was also perforation of the bowel wall. Five patients had perforation without signs of stenosis. Mortality was 27%. The pathology of the ulcers was similar to that described after use of enteric-coated potassium chloride tablets. The frequency of potassium-induced ulceration is low (about 3 cases per 100 000 patient-years of slow-release tablet use), but this complication can be serious. 

Oral exposures to liquid chlorofluorocarbons are rare but have resulted in severe frostbite to the upper respiratory system and gastrointestinal tract. Necrosis and perforation of the stomach have been reported. Thus, emesis, activated charcoal, and gastric lavage are not recommended. 

Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/ perforation An overview of epidemiologic studies pubhshed in the 1990s. Arch Intern Med 2000 160 2093-2099. 

The most common adverse effects of NSAIDs involve the gastrointestinal tract. Minor complaints (nausea, dyspepsia, anorexia, and abdominal pain) are common (up to 60% of patients). Serious GI complications associated with NSAIDs including perforations, gastric outlet obstruction, and GI bleeding, occur in 1.5% to 4% of patients per year. 

The ingestion of either solutions (> 0.02%) or crystals of KMn04 causes local corrosion and necrosis similar to that produced by an acid. Dyspnea and stridor are clinical effects which indicate edema of the epiglottis and trachea, hemolysis, hemorrhage and perforation of the gastrointestinal tract (Barceloux 1999). 

Ileus may also be caused by mechanical factors such as injury to the gastrointestinal tract with perforation and peritonitis or mechanical obstmc-tion by a swallowed foreign body. 

A. Iron has a direct corrosive effect on mucosal tissue and may cause hemorrhagic necrosis and perforation. Fluid loss from the gastrointestinal tract results in severe hypovolemia. 

Meconium peritonitis is a condition that is the result of in utero perforation of the fetal gastrointestinal tract during the last 6 months of pregnancy. Sterile meconium escapes through the perforation into the peritoneal cavity producing a marked reaction with dense adhesions, which usually calcify rap-... 

Clinical manifestations of PMC classically include watery or bloody diarrhoea (Ros et al. 1996). The patients have moderate fever, abdominal cramps, leukocytosis, and hypoalbuminaemia. Severe forms can cause electrolyte disturbances, dehydratation, hypoalbuminaemia (with anasarca), and even life-threatening conditions such as toxic megacolon and perforation of the colon. Hypoalbuminaemia is due to the rapid loss of protein in the gastrointestinal tract (Merine et al. 1987). 

Gastrointestinal Dental erosion, shock, anuria burning in the mouth, throat, and abdomen nausea, vomiting of blood and eroded tissue perforation of gastrointestinal tract and albumin, blood, and casts in urine. 

Complications are more likely (a) where the tumour is superficial (within 1 cm of the liver capsule) or close to hilar structures, (b) with prolonged ablation time and (c) when several lesions are treated during the same session. Perforation of a viscus is more likely in patients with advanced cirrhosis and/or poor performance status, when the tumour is adjacent to the gastrointestinal tract and when there has been previous right upper quadrant surgery or chronic cholecystitis, due to the increased development of adhesions in this latter group. 

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