Peritonitis Due to Perforation of the Small Intestine by a Press-Through-Package
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- Matsumura Hiroomi
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Izumi Hiroshi
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Tsuchihashi Hiroshi
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Kakihara Naoki
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Iizuka Ryoji
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Miyata Keigo
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Ikawa Osamu
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Fujii Koji
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Takahashi Shigeru
- Department of Surgery, Kyoto Second Red Cross Hospital
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- Takenaka Atsushi
- Department of Surgery, Kyoto Second Red Cross Hospital
Bibliographic Information
- Other Title
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- Press-through-package誤飲による回腸穿孔性腹膜炎の1例
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Description
A 77-year-old man with acute onset of lower abdominal pain and generalized peritonitis showed numerous diverticula along the descending and sigmoid colon and ascites in abdominal computed tomography (CT). We diagnosed peritonitis secondary to perforation of the colonic diverticulum and conducted emergency laparotomy. The colon was intact but the small intestine had been perforated by a press-through-package (PTP) still containing a tablet. We removed the PTP and conducted wedge resection to close the perforation. Small intestinal perforation by a PTP is rarely diagnosed because most patients do not realize they have swallowed their medication with the packaging and have no specific complaints or radiologic signs. We conducted an experiment to determine the usefulness of abdominal CT in diagnosing PTP ingestion. We created a sausage-shaped cylinder as a phantom of the intestine, and was inserted an intact PTP, including a tablet in it. The phantom was immersed in a vinyl bag filled with water and CT was conducted. The PTP appeared as a triple-contrasted target lesion, consisting of high, low and slightly lower densities, corresponding to the tablet, air in the dome, and water around the PTP. This unusual sign in the intestine strongly suggests the presence of an ingested PTP and is an indication for surgery when peritonitis is present. Small intestinal perforation following PTP ingestion is relatively rare, and mostly due to carelessness. Improved design to avoid accidental ingestion, particularly in the elderly or impaired, and better training in PTP use should decrease the incidence of this problem.
Journal
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- The Japanese Journal of Gastroenterological Surgery
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The Japanese Journal of Gastroenterological Surgery 35 (3), 317-321, 2002
The Japanese Society of Gastroenterological Surgery
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Details 詳細情報について
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- CRID
- 1390001204916291840
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- NII Article ID
- 130004343711
- 110001344225
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- NII Book ID
- AN00192066
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- ISSN
- 13489372
- 03869768
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- Data Source
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- JaLC
- Crossref
- CiNii Articles
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- Abstract License Flag
- Disallowed