Ileal perforation

Patients with complicated typhoid fever (i.e., metastatic foci, ileal perforation, etc.) should receive parenteral therapy with ciprofloxacin 400 mg twice daily or ceftriaxone 2000 mg once daily. Antimicrobial therapy can be completed with an oral agent after initial control of the symptoms of typhoid fever. In persons with AIDS and a first episode of Salmonella bacteremia, a longer duration of antibiotic therapy (1-2 weeks of parenteral therapy followed by 4 weeks of oral fluoroquinolone) is recommended to prevent relapse of bacteremia. 

A 28-year-old pregnant woman developed an ileal perforation 4 weeks after the insertion of a Multiload-Cu 375 intrauterine contraceptive device (17). 

Mazzoleni G, deSa D, Gately J, Riddell RH. Yersinia enterocolitica infection with ileal perforation associated with iron overload and deferoxamine therapy. Dig Dis Sci 1991 36(8) 1154-60. 

Fig. 5.11a,b. Pneumoperitoneum in an infant with ileal perforation. Free air outlining the G1 tract. Note the visualized falciform ligament, a Supine film with football sign b cupula sign , free air under the cardiac silhouette... 

Immunologic A 71-year-old man developed a hypersensitivity syndrome associated with ter-binafine and later had peritonitis due to ileal perforation [3 ]. Cytomegalovirus-specific IgG antibodies were significantly increased and pathological examination of the resected ileum confirmed cytomegalovirus infection. The authors attributed the hypersensitivity reaction and the ileal perforation to C3do-megalovirus reactivation by terbinafine. 

Yakushiji Y, Isaka Y, Kawasaki I, Takemura M, Inoue T, Hosoi M. Isolated ileal perforation due to cytomegalovirus reactivation during management of terbina-flne hypersensitivity. World J Gastroenterol 2010 16(26) 3339-42. 

Baroliths are rare complications of barium contrast examinations and are usually seen in colonic diverticula. They are often asymptomatic but may be associated with abdominal pain, appendicitis, and bowel obstruction or perforation. A case of ileal obstruction by a barolith has been reported (12)... 

Plain film shows numerous dilated loops of bowel occupying the entire abdominal cavity, including the pelvic portion, and multiple air-fluid levels in upright film (Fig. 1.19). With this degree of distension the mucosal pattern of the small bowel is effaced and it is impossible to differentiate the small bowel from the colon (Winters et al. 1992). Examination of the colon is then warranted to disclose the presence or absence of a colonic lesion. In ileal atresia, the colon is normally placed but has an abnormally small caliber, the so-called functional microcolon typical of distal small bowel obstruction (Dalla Vecchia et al. 1998) (Fig. 1.19d,e). The presence of pneumoperitoneum indicates that perforation has occurred and a colon examination is contraindicated. Intraperitoneal calcifications, indicative of meconium peritonitis, are not uncommon in ileal atresia. 

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...

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