FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1993926705> ?p ?o ?g. }

• W1993926705 endingPage "1435" @default.
• W1993926705 startingPage "1433" @default.
• W1993926705 abstract "A 73-year-old woman presented to the emergency department complaining of neck swelling and malaise for 1 day. Her past medical history was noncontributory except for a diagnostic colonoscopy performed 3 days before to investigate disturbed bowel habit. She had been under observation for 24 hours, and because no specific diagnoses were made, an evaluation from the surgical team was requested. The colonoscopy report revealed that a rectal polypectomy had been performed and was complicated by bleeding, controlled using an endoclip (Figure 1). Physical examination showed bilateral neck emphysema with crepitus. Abdominal pain without signs of peritoneal irritation was located mainly on the left iliac fossa. White cell count and C-reactive protein levels were within normal limits. Chest and abdominal radiographs demonstrated pneumomediastinum and pneumoretroperitoneum (Figure 1). In view of the clinical findings (patient's good general condition, hemodynamic stability, absence of peritoneal irritation signs or inflammatory syndrome), she was managed conservatively (bowel rest, intravenous fluids, broad-spectrum intravenous antibiotics). She recovered uneventfully and was discharged on the tenth day after admission. There are reports on the safety and cost-effectiveness of colonoscopy, but complications (e.g., bleeding and perforation) cannot be overlooked.1-3 Although colonoscopic perforation is rarely reported, it is associated with high morbidity and mortality.1, 2 Causes of perforation (excessive air insufflation, instrumental trauma, improper use of electrocautery) and risk factors for perforation (advanced age; medical comorbidity; therapeutic procedures such as polypectomy, pneumatic dilation, and endoscopic mucosal resection) have been described.1-3 Most perforations occur in the sigmoid colon1, 2 and less frequently in the rectum.4 Colonoscopic perforation can be intraperitoneal or extraperitoneal. Extraperitoneal colonoscopic perforation is most likely to occur in the lower rectum (usually below the middle valve of Houston),5 as reported here. Clinically, individuals with colonoscopic perforation could present with symptoms and signs of peritonitis (mainly abdominal pain and tenderness).1 As in the current report, extraperitoneal perforation can be present in the absence of peritonitis.6-9 More rarely, perforation can result in the presence of free air in soft tissue planes.10 Retroperitoneal air results from direct extraperitoneal colonic perforation or from dissection of air through the colonic wall (pneumatosis coli) and subsequent passage along the mesentery to the retroperitoneum.10 Once in the retroperitoneum, air may travel along the fascial planes to enter the mediastinum and the subcutaneous.10 The elderly woman was diagnosed with a rectal perforation accompanied by pneumomediastinum, pneumoretroperitoneum, and subcutaneous emphysema. Although there are cases in elderly people,10 according to a comprehensive literature review (Medline and Embase databases), to the best of the knowledge of the authors, this is one of the few reports of extraperitoneal rectal colonoscopic perforation in an elderly adult who was successfully treated conservatively.6-9 Although perforations usually occur during colonoscopic examination or within 24 hours after the procedure, delayed colorectal perforation has been reported.1 In the current report, the first symptoms appeared just 48 hours postcolonoscopy. Postpolypectomy perforations result from thermal injury of the submucosa and can progress to transmural lesions over time.2, 4 Because the fat tissue of the mesentery or omentum encapsulates the lesion, such lesions are smaller, have less peritoneal effect, and are diagnosed later and are therefore more susceptible to a conservative approach.2, 4 Colonoscopic perforation is usually diagnosed in the emergency department,2 and promptness of diagnosis is the main prognostic factor of postcolonoscopic perforation.3 In the current report, there was a delay of 24 hours before the correct diagnosis was made because there was lack of an appropriate diagnostic examination. To avoid this, emergency physicians should suspect a colonoscopic perforation if an individual has fever, abdominal pain, or distention after colonoscopic examination, even if the individual presents these symptoms several days after the procedure.1, 4 When perforation is suspected, a plain roentgenogram of the abdomen should be taken to exclude extra- or intraperitoneal air.1 The management of colonoscopic perforations remains controversial, because there are no specific guidelines.1, 2, 4 Historically, surgery was the mainstay of treatment for the majority of patients,1, 2, 4 but the likelihood of nonsurgical treatment has increased.2, 4 Conservative management (intravenous fluids, absolute bowel rest, and broad-spectrum intravenous antibiotics) should be reserved for individuals with good general health, no signs of diffuse peritonitis, perforation unnoticed by the endoscopist, proper colonic preparation, and perforation produced by a different mechanism of pressure and traction maneuvers, as in the current report.1, 2, 4 If conservative treatment is successful, the individual's clinical appearance should improve gradually within 24 to 48 hours,1 but when pain worsens, or a systemic inflammatory response such as fever occurs, prompt surgical treatment should be considered.1, 4 Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Rafael Denadai: concept, intellectual and scientific content of the study and manuscript writing. Ciro Carneiro Medeiros: collection of data. Antonio F. Carvalho Jr: analysis and interpretation of data. Carlos Alberto Salomão Muraro: manuscript writing and critical revision. Sponsor's Role: None." @default.
• W1993926705 created "2016-06-24" @default.
• W1993926705 creator A5007287676 @default.
• W1993926705 creator A5010027712 @default.
• W1993926705 creator A5058504785 @default.
• W1993926705 creator A5062401703 @default.
• W1993926705 creator A5020902649 @default.
• W1993926705 date "2013-08-01" @default.
• W1993926705 modified "2023-09-26" @default.
• W1993926705 title "Rectal Perforation After Colonoscopic Polypectomy Presented As Subcutaneous Emphysema, Pneumomediastinum and Pneumoretroperitoneum Successfully Treated Conservatively in an Elderly Adult" @default.
• W1993926705 cites W1516130268 @default.
• W1993926705 cites W1990010343 @default.
• W1993926705 cites W2017222340 @default.
• W1993926705 cites W2039130896 @default.
• W1993926705 cites W2040411404 @default.
• W1993926705 cites W2075581095 @default.
• W1993926705 cites W2162308634 @default.
• W1993926705 cites W2410304548 @default.
• W1993926705 cites W38133088 @default.
• W1993926705 doi "https://doi.org/10.1111/jgs.12374" @default.
• W1993926705 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/23937504" @default.
• W1993926705 hasPublicationYear "2013" @default.
• W1993926705 type Work @default.
• W1993926705 sameAs 1993926705 @default.
• W1993926705 citedByCount "5" @default.
• W1993926705 countsByYear W19939267052015 @default.
• W1993926705 countsByYear W19939267052016 @default.
• W1993926705 countsByYear W19939267052017 @default.
• W1993926705 countsByYear W19939267052018 @default.
• W1993926705 crossrefType "journal-article" @default.
• W1993926705 hasAuthorship W1993926705A5007287676 @default.
• W1993926705 hasAuthorship W1993926705A5010027712 @default.
• W1993926705 hasAuthorship W1993926705A5020902649 @default.
• W1993926705 hasAuthorship W1993926705A5058504785 @default.
• W1993926705 hasAuthorship W1993926705A5062401703 @default.
• W1993926705 hasConcept C121608353 @default.
• W1993926705 hasConcept C126322002 @default.
• W1993926705 hasConcept C141071460 @default.
• W1993926705 hasConcept C191897082 @default.
• W1993926705 hasConcept C192562407 @default.
• W1993926705 hasConcept C2775970820 @default.
• W1993926705 hasConcept C2776870353 @default.
• W1993926705 hasConcept C2777131390 @default.
• W1993926705 hasConcept C2778329176 @default.
• W1993926705 hasConcept C2778435480 @default.
• W1993926705 hasConcept C2778456384 @default.
• W1993926705 hasConcept C2778527123 @default.
• W1993926705 hasConcept C2780581329 @default.
• W1993926705 hasConcept C2781074409 @default.
• W1993926705 hasConcept C526805850 @default.
• W1993926705 hasConcept C71924100 @default.
• W1993926705 hasConceptScore W1993926705C121608353 @default.
• W1993926705 hasConceptScore W1993926705C126322002 @default.
• W1993926705 hasConceptScore W1993926705C141071460 @default.
• W1993926705 hasConceptScore W1993926705C191897082 @default.
• W1993926705 hasConceptScore W1993926705C192562407 @default.
• W1993926705 hasConceptScore W1993926705C2775970820 @default.
• W1993926705 hasConceptScore W1993926705C2776870353 @default.
• W1993926705 hasConceptScore W1993926705C2777131390 @default.
• W1993926705 hasConceptScore W1993926705C2778329176 @default.
• W1993926705 hasConceptScore W1993926705C2778435480 @default.
• W1993926705 hasConceptScore W1993926705C2778456384 @default.
• W1993926705 hasConceptScore W1993926705C2778527123 @default.
• W1993926705 hasConceptScore W1993926705C2780581329 @default.
• W1993926705 hasConceptScore W1993926705C2781074409 @default.
• W1993926705 hasConceptScore W1993926705C526805850 @default.
• W1993926705 hasConceptScore W1993926705C71924100 @default.
• W1993926705 hasIssue "8" @default.
• W1993926705 hasLocation W19939267051 @default.
• W1993926705 hasLocation W19939267052 @default.
• W1993926705 hasOpenAccess W1993926705 @default.
• W1993926705 hasPrimaryLocation W19939267051 @default.
• W1993926705 hasRelatedWork W152781522 @default.
• W1993926705 hasRelatedWork W2035907649 @default.
• W1993926705 hasRelatedWork W2040411404 @default.
• W1993926705 hasRelatedWork W2102523430 @default.
• W1993926705 hasRelatedWork W2250518135 @default.
• W1993926705 hasRelatedWork W2290941510 @default.
• W1993926705 hasRelatedWork W2443642669 @default.
• W1993926705 hasRelatedWork W2575470865 @default.
• W1993926705 hasRelatedWork W2763409358 @default.
• W1993926705 hasRelatedWork W2948143677 @default.
• W1993926705 hasVolume "61" @default.
• W1993926705 isParatext "false" @default.
• W1993926705 isRetracted "false" @default.
• W1993926705 magId "1993926705" @default.
• W1993926705 workType "article" @default.