A 37-year-old woman consulted our hospital due to sudden right lower abdominal pain. As a result of the investigation, it was diagnosed as perforative peritonitis and liver abscess caused by a gastrointestinal foreign body. We performed emergency surgery. A corroded spoon in the jejunum was observed and the handle of the spoon had penetrated the intestinal wall. The intestinal perforation was caused by accidental ingestion of a spoon. Partial resection of the jejunum was performed, and the patient was discharged on the 17th postoperative day. The liver abscess was considered to be the result of duodenal penetration by a spoon, but it disappeared with the administration of antibiotics. Foreign bodies, such as spoons, are usually accompanied by awareness when they are swallowed. In a case with a history of mental illness, it is possible to swallow something unawares. This case had no awareness that she had swallowed the spoon by mistake, and there was no history of mental illness. From the shape and state of the spoon, it was thought that the spoon had been swallowed by mistake in infancy and had remained in the gastrointestinal tract for a long time without affecting the body, and led eventually to the present condition.
A 40-year-old woman who had undergone long-term hospitalization for schizophrenia was discharged. Four days later, she impulsively self-injured, was hospitalized with a prolapsed intestinal tract, and underwent emergency surgery. The wound on the left side penetrated the upper jejunum, mesenteric vessels, hilar region of the left kidney, iliopsoas, and a paravertebral nerve. The right involved the duodenum and vena cava. We repaired the each damage and performed left nephrectomy. The deadly triad was inferred, so we closed the wounds and transferred her to the ICU. Hemorrhagic shock continued for 31 hours, improved with massive blood transfusion. She then suffered from liver dysfunction, jaundice, renal insufficiency, hydrothorax and atelectasis, and abscess due to duodenal ruptured suture. Continuing care included dialysis, mechanical ventilation, thoracic and abdominal drainage, and nutritional management worked. The acute and subacute care ceased in week 12, and after rehabilitation, she was discharged by foot. We encountered an alive case suffered from definitive operation for multiple abdominal wound. We report it with inquest of the tactics and strategy.
A 67-year-old man visited our hospital with complaints of swelling and pain of the right lower extremity. Ultrasonography and CT scan found thrombi from the popliteal vein to the common femoral vein. We diagnosed deep vein thrombosis (DVT) in the right lower extremity. Furthermore, CT scan detected a left-sided inferior vena cava and “right-sided” iliac vein compression syndrome. We suspected that the etiology of this DVT was these morphological anomalies.
For many years we have closed wounds using our own suture method and good results have been obtained. The suture method makes penetration ligation to eliminate dead space and to reduce the tension of the skin, and drainage hole creation with the 18 gauge needle. We report herein five cases of wound closure using our method after trauma treatment and removal of a subcutaneous mass.