Rare bacterial causes of small bowel perforations (SBP) in Europe: Report of two cases

Abstract text (incl. references and figure legends)

In developed countries, adult small bowel perforations (SBP) are usually caused by obstruction due to gangrene, strangulated hernias ,trauma injuries, ingested foreign bodies and iatrogenic causes like endoscopic procedures and surgical procedures. Less often, SBP may result from inflammatory diseases, primary and secondary neoplasms, small bowel diverticula. Even though rear SBP secondary to a bacterial and parasites infection should be considered. We reported 2 cases of SBP due to bacterial infection in Europe. Case 1: a 43 y.o. woman transferred to our hospital for miliary tuberculosis; after 10 days, the patient complained vomit, abdominal pain and distension. CT scan revealed an ileum wall thickening and fluid distension with multiple hydro-air levels and abdominal free fluid. At emergency laparotomy, intestinal free fluid and a centimetric perforation, about 10 cm from the ileocecal valve, were found. A resection of greater omentum and 30 centimeters of ileum with an ileo-ileum anastomosis was realized. The microscopic and microbiologic exams on the surgical specimen revealed the tuberculosis nature of the lesion. Post operative course was 37 days long and uneventful. Case2: a 39 y.o man admitted to a medical department for prolonged fever, coming back from a trip to Senegal. At the objective examination he had only conjunctival jaundice and diarrhea. Blood test showed elevated inflammatory markers and Salmonella typhi at blood cultures. After 5 days of antibiotic therapy patient complained vomit, ague abdominal pain and contracture. The CT scan showed free air and fluid in all abdominal quadrants. At the emergency laparotomy, a centimetric perforation on a typhoid granuloma of the last ileal loop was found, An ileocolic resection and packaging of ileo-colostomy was performed. 7 days post-operative course was regular. In conclusion it is mandatory to keep in mind rare causes of SBP to accomplish quick, appropriate and effective treatment of these diseases.

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