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At least 361 records · Page 20Linked to original sources
PubMed2001

[A rare cause of malignant ascites--peritoneal mesothelioma].

HISTORY AND CLINICAL FINDINGS: A 56-year-old patient (case 1) with recurrent haemorrhagic ascites for one year was admitted to our hospital for further investigation. Besides massive ascites he did not show abnormal physical signs. In addition, two 45-year-old patients were admitted (case 2 and 3) with clinical signs of acute abdomen--one having muscular guarding in the epigastric angle, the other in the right lower quadrant. All 3 patients did not have serious illnesses in the past; the first 2 patients had occupational asbestos exposure. INVESTIGATIONS: In patient 1 the ultrasound did not reveal abnormal findings besides ascites. Patients 2 and 3 underwent explorative laparotomy. DIAGNOSIS, TREATMENT AND COURSE: In the first case a diagnostic laparoscopy revealed diffuse tumor proliferations with nodular formations over the entire peritoneum--histologically a malignant peritoneal mesothelioma of the epithelial subtype. Patient 2 showed intraoperatively metastatic spread of tumour formations with infiltration of the peritoneum and transverse mesocolon. The histologic finding was similar to that in the first case. Patient 3 had a perforated sigma diverticulitis which was treated by resection of the sigmoid. Incidentally a well differentiated papillary peritoneal mesothelioma was found in the resected specimen. The first two patients were treated with alpha-interferon subcutaneously resulting in a decrease of ascites production. Because patient 3 showed neither ascites nor evidence for malignancy no interferon was administered. CONCLUSION: In case of haemorrhagic ascites of unknown cause a histological clarification by either laparoscopy or laparotomy is mandatory. Immunomodulation with interferon may be a promising approach.

Antineoplastic Agents↗
PubMed2001

Blunt traumatic injuries of the gastrointestinal and biliary tract in childhood. Analysis of 16 cases.

BACKGROUND: Little attention has been given to abdominal hollow viscus injuries in pediatric literature. The purpose of this report is to describe their main features, and the current methods of diagnosis and treatment. METHODS: We reviewed our experience with 16 cases of blunt injuries involving the gastrointestinal (GI) and biliary tract in the last seven years. RESULTS: Male to female ratio was 0.68 and mean age 9.4 years. The site of injury was the stomach in 2 cases, duodenum in 5, jejunum or ileum in 7, caecum in 2, left mesocolon in 2, and gallbladder in 1. Diagnosis of the 8 perforations was clinically suspected in 6, and confirmed by radiography in 6 or surgery in 2, with a mean delay of 0.42 days. Diagnosis of the 11 hematomas was clinically suspected in 6, and confirmed by radiography in 9 or surgery in 2, with a mean delay of 12.6 days. Hematomas were managed nonoperatively, and perforations were surgically or laparoscopically closed. Mortality was 1/16 by pancreatic injury, and morbidity was 4/16. CONCLUSION: Incidence of blunt hollow viscus injuries is low in children. Hematomas are easily recognized by modern radiography, and simply managed nonoperatively. Diagnosis of perforations still remains difficult. This results in dangerous delays for lesions which need prompt repair.

Adolescent↗
PubMed2006

[Retroperitoneal abscess in a man with severe necrotizing pancreatitis].

HISTORY AND ADMISSION FINDINGS: A 65-year-old man was admitted to the emergency unit of another hospital with severe acute abdominal pain. Medial laparotomy revealed a tear in the lower pole of the capsule of the enlarged spleen. Results of some laboratory tests became available only after the procedure: Lipase and amylase levels were markedly elevated at 5097 U/l (normal range < 100 U/l) and 1776 U/l (normal range < 60 U/l), respectively. These findings suggested acute pancreatitis as cause of the acute abdominal pain. Conservative treatment was initiated, but because of progressive clinical deterioration with fever, dyspnea and tachyarrhythmia he was transferred to our hospital for further treatment. INVESTIGATIONS, DIAGNOSIS AND TREATMENT: Chest X-ray revealed bilateral pleural effusion. Contrast-enhanced abdominal CT scan revealed an acute peripancreatic fluid collection and extensive pancreatic necrosis extending into the perirenal space, hilum of the spleen and transverse mesocolon. Despite the placement of multiple percutaneous pigtail catheters clinical improvement of the severe necrotizing pancreatitis was only temporary and repeated episodes of fever and septicaemia occured. Supported by a multidisciplinary consensus an endoscopic ultrasound (EUS)-guided transgastric drainage of the pancreatic abscess was performed with placement of two double-pigtail catheters and a nasocystic drain for irrigation. After this intervention the patient}s condition rapidly improved, inflammatory parameters normalized and the retroperitoneal abscess gradually resolved. CONCLUSION: A multidisciplinary consensus and modern interventional approaches such as EUS-guided endoscopic therapy are mandatory to successfully approach severe necrotizing pancreatitis and its complications.

Abdomen, Acute↗
PubMed1990

[Fetus in fetu: a case report of an extremely rare cause of abdominal tumors in the infant].

Fetus in fetu is an extremely uncommon cause of an abdominal mass in the neonate. A 6-week-old female was brought to our hospital because of an upper abdominal mass. A plain x-ray demonstrated a mass of structured bones that suggested a teratoma or fetus in fetu. At operation a 20 cm mass was found in the mesocolon covered by a membrane. The mass corresponded to a fetus in fetu connected by an umbilical-like cord to the host in the depth of the radix mesocoli. The fetus in fetu weighed 150 g and had severe malformations, such as internal hydrocephalus, a left side anotia, a descended right ear, anophthalmia, a right-sided amelia, a micromelia on the left side with 4 fingers, a sympus with 5 and 7 toes on the left and right side, respectively. There was also an almost complete aplasia of the internal organs with some remnants of intestine near the umbilical cord.

Abdominal Neoplasms↗
PubMed1990

[Chronic intermittent duodenal obstruction in childhood].

Chronic intermittent duodenal obstruction caused by stenosis of the distal duodenum is a rare disease. Tight fixation of the ligament of Treitz, compression due to mesenteric lymphomatas or abnormal attachment of the mesocolon can cause intermittent impairment of intestinal passage. It will be necessary to differentiate this against genuine arterio-mesenteric duodenal obstruction as well as nerve motility disorders. History in the appropriate cases reports on postprandial episodes of regurgitation, sensation of fullness, nausea, vomiting and paroxysmal upper abdominal colicky pain. Radiograms always reveal gastroptosis and a varying degree of duodenal obstruction, usually with retroperistalsis. The passage is markedly delayed, with an impairment sometimes at the site of the duodenojejunal flexure. Therapy is always surgical. 8 own cases were cured by leftsided duodenal mobilisation according to Clairmont with additional caudad positioning and fixation of the duodenojejunal flexure.

Child↗
PubMed1980

[Diagnostic value of abdominal plain films in acute pancreatitis (author's transl)].

Duodenal distension is in connection with corresponding clinical symptoms--the pathognomonic symptom of acute pancreatitis, provided that the film is taken in left lateral decubitus position. In 90% of 192 cases of acute pancreatitis, proven by surgery or high amylase concentration, duodenal distension was diagnosed on the film taken in left lateral decubitus position. If there is the temptative diagnosis of acute pancreatitis and no duodenal distension is demonstrable, this may result from a fluidfilled stomach without air after vomiting or a stomach tube, through which the air may escape. In these cases we give an effervescent powder to demonstrate duodenal distension. The combination of duodenal atony and distension of the small or large bowel is found very often as a sign of spread pancreatic enzymes along definite anatomic planes in the abdomen like transverse mesocolon and small bowel mesentery. The abdominal plain film taken in supine and left lateral decubitus position gives many important informations solving differential diagnostic problems concerning processes in the upper abdomen and determines further diagnostic and therapeutic proceedings considerably.

Acute Disease↗
PubMed2004

The emergence of Clostridium difficile as a pathogen of food animals.

Clostridium difficile causes pseudomembranous colitis in humans, usually after disruption of the bowel flora by antibiotic therapy. Factors mediating the frank disease include the dose and toxigenicity of the colonizing strain, its ability to adhere to colonic epithelium, the concurrent presence of organisms that affect multiplication and toxin production or activity, and the susceptibility of the host. Toxins A (an enterotoxin) and B (a cytotoxin) play the major role in pathogenesis and the detection of toxins in gut contents is the gold standard for diagnosis. Disease in horses takes the form of often-fatal foal hemorrhagic enteritis. Nosocomial, antibiotic-associated, disease is increasingly common in adult horses. Enteric clinical signs are reported in ostriches, companion animals and recently calves. Clostridium difficile colitis is now a common diagnosis in neonatal pigs in the USA and elsewhere. Clinical features include onset at 1-5 days of age, sometimes with dyspnea, mild abdominal distension and scrotal edema, and commonly with yellow, pasty diarrhea. There is mesocolonic edema grossly, with microscopic diffuse colitis, mucosal edema, crypt distension, epithelial necrosis and superficial mucosal erosion. Neutrophil infiltration of the lamina propria is common, and fibrin and numerous rod-shaped bacteria are observed on the surface. About two-thirds of litters and one-third of piglets will be affected (based upon positive toxin tests), although this appears to vary with the season. The case fatality rate is probably low if considering only direct effects of C. difficile infection. The significance of toxin-positive non-diarrheic pigs and the nature of the interaction of toxins A and B with enterocytes are unknown. Given the widespread occurrence of the disease, there is substantial effort to develop immunoprophylactic products.

Animals↗
PubMedDate not supplied

Paraduodenal hernia evoking intermittent abdominal pain.

PURPOSE: Description of a very rare case of internal abdominal hernia, namely herniation of the proximal jejunum in the Landzert fossa, through a hole in the mesocolon transversum. MATERIAL AND METHODS: Based on preoperative history, clinical state and radiological findings, the diagnosis of internal hernia was strongly suspected. RESULTS: Suspected diagnosis was confirmed during laparotomy. After reduction of the jejunum and closure of the hernia orifice, the patient recovered promptly. CONCLUSION: The diagnosis of internal herniation should always be considered in every patient who presents with an acute abdomen, signs of (sub)obstruction and non-typical history. The most important diagnostic tool is computer tomography, that is accurate in 77%.

Abdomen, Acute↗
PubMedDate not supplied

Preoperative and postoperative administration of hyperbaric oxygen improves biochemical and mechanical parameters on ischemic and normal colonic anastomoses.

Colonic anastomotic leaks are a major postoperative complication, causing increased mortality and morbidity. Tissue ischemia is one of the most important factors that disrupt anastomotic healing. It is possible to reverse inadequate tissue oxygenation by using increased atmospheric pressure and hyperoxia, which are obtained from hyperbaric oxygen treatment (HBO). Our aim was to investigate the effects of preoperative and postoperative HBO treatment on normal and ischemic colonic anastomoses in rats. Eighty male Wistar Albino rats, weighing between 180 and 240 g, were divided into 8 equal groups. A 1-cm segment of left colon was resected 3 cm proximal to the peritoneal reflection in all groups and colonic anastomosis was performed. In groups 2, 4, 6 and 8, colonic ischemia was established by ligating 2 cm of mesocolon on either side of the anastomosis. Control groups (1 and 2) received no HBO. HBO treatment was given preoperatively in groups 3 and 4, postoperatively in groups 5 and 6, and both preoperatively and postoperatively in groups 7 and 8. HBO treatment was applied for 2 days in the preoperative period and 4 days in the postoperative period. Relaparotomy was performed on postoperative day 5 and a perianastomotic colon segment 2 cm in length was excised for detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. HBO treatment increased tissue hydroxyproline levels in all groups, and this difference was significant in normal anastomosis groups receiving preoperative HBO compared to controls (p = .013 for group 1 vs. group 3; p = .023 for group 1 vs. group 5). This improvement was more evident in ischemic and normal groups treated by administration of combined pre- and postoperative HBO (p = .021 and p = .013). HBO treatment also increased the mean bursting pressure values in all groups, and again, a statistically significant increase was noted in the ischemic groups compared to controls (p = .002 for group 2 vs. group 6; p = .001 for group 2 vs. group 8). Histopathological evaluation of anastomotic line fibrosis was not found to show significant differences between the groups. Adequate tissue oxygenation is the main factor in wound and anastomosis healing. HBO treatment has a positive effect on biochemical and mechanical parameters of ischemic and normal colon anastomoses in rats. It is possible to see this effect more clearly with combined HBO treatment applied before and after ischemic anastomosis.

Anastomosis, Surgical↗
PubMed2006

Transmittance photoplethysmography with near-infrared laser diodes in intra-peritoneal organs.

Photoplethysmography and pulse oximetry are techniques based on optical principles, which are widely used in medical practice for non-invasive monitoring. There are some processes which may affect specific organs or parts without a significant repercussion on the information provided non-invasively. Here, we report on the preliminary results obtained by transmittance photoplethysmography in pig intra-peritoneal organs along a surgical intervention, using a measurement system based on two near-infrared laser diodes. Analysis of the signals recorded at 750 nm and 850 nm in the mesentery root, mesocolon, gastric wall and aorta artery has shown the affordability of performing in situ photoplethysmography for visceral perfusion evaluation.

Animals↗
PubMed1995

Laparoscopic unroofing of symptomatic renal cysts: three distinct surgical approaches.

Although they are rarely associated with complaints, benign renal cysts may be the cause of pain, hypertension, or other problems. Simple aspiration is rarely definitive treatment. We have had good results with three laparoscopic approaches to cyst unroofing: transperitoneal, with reflection of the colon medially or dissection through the mesocolon and direct retroperitoneoscopy. We recommend initial percutaneous aspiration with cytology study both to rule out malignancy and to identify those cysts clearly in need of unroofing.

Adult↗
PubMed2006

Transperitoneal, transmesocolic approach for laparoscopic excision of an extra-adrenal pheochromocytoma.

Laparoscopic surgery is an established treatment modality for adrenal disease, especially pheochromocytomas. We describe the successful excision of an extra-adrenal pheochromocytoma using a novel transperitoneal, transmesocolic approach. The tumor was located inferior to the left renal hilum in the para-aortic region and was found bulging through the descending mesocolon at laparoscopy. The tumor was removed without mobilization of the descending colon.

Humans↗
PubMed1991

Laparoscopic segmental resection of the sigmoid colon for endometriosis.

We report a technique for laparoscopic segmental resection of the sigmoid colon. A 30.73-year-old nulligravida complained of pelvic pain, abdominal bloating, intestinal cramping, and painful bowel movements. Examination revealed significant nodularity of the posterior pelvis, so a preoperative bowel prep was given. At laparoscopy, a 5 cm diameter mid-sigmoid lesion was found, as well as a rectal nodule and pelvic endometriosis. The sigmoid lesion was separated from the mesocolon by bipolar electrocoagulation and scissors dissection. The segment was then removed by transection with a needle electrode and extraction through the anus. A stapled end to end anastomosis was performed. This technique can be applied to a variety of benign lesions of the bowel, and can result in decreased patient morbidity and hospital stay.

Adult↗
PubMed1993

Laparoscopically assisted subtotal colectomy.

A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.

Adult↗
PubMed2004

Recombinant adenovirus administration in rat peritoneum: endothelial expression and safety concerns.

BACKGROUND: Initial studies of adenovirus-mediated gene transfer to the peritoneum have shown transgene expression in the mesothelium from the parietal peritoneum. Using a replication-deficient adenovirus encoding beta-galactosidase (Ad beta Gal), we investigated the expression efficiency and the distribution of the transgene to different areas of both visceral and parietal peritoneum and to extra-peritoneal tissues. METHODS: Male Wistar rats received an intraperitoneal injection of 15 ml of 0.9% NaCl alone or containing 1 x 10(9) or 3 x 10(9) p.f.u. of Ad beta Gal. Evaluations of the histology of the peritoneum, the transgene expression and the safety of adenovirus-mediated gene transfer, using measurement of both beta Gal activity and staining, were performed 1, 3 and 5 days post-injection. RESULTS: At 1 day post-injection of 3 x 10(9) p.f.u. of Ad beta Gal, significant beta Gal activity and staining were detected in the omentum and mesenteric peritoneum. beta Gal staining was observed in endothelial cells, mesothelial cells and adipocytes. Focal mononuclear infiltrates restricted to the submesothelial area of the visceral peritoneum were also observed. No expression was detected in the mesocolon and parietal peritoneum, where the mesothelium was damaged. Significant beta Gal activity and staining were observed in lymph nodes, lungs, liver, heart and kidneys, in the absence of inflammatory changes. CONCLUSIONS: Intraperitoneal delivery of adenoviral vectors allows highly efficient transgene expression in mesothelial cells, but also in endothelial cells and adipocytes of the visceral peritoneum. Adverse focal mononuclear infiltrates, as well as spreading of the adenoviral vector from the abdominal cavity to the systemic circulation, were observed in parallel. Transgene expression in endothelial cells is potentially important since the latter play a key role in the alterations of the peritoneal membrane associated with long-term peritoneal dialysis. However, these data emphasize the need for less immunogenic adenoviral vectors, ideally containing an endothelial cell-specific promoter, to overcome immune response-related problems and spreading to extra-peritoneal tissues.

Adenoviridae↗
PubMed1994

Follicular dendritic cell tumor and vascular neoplasm complicating hyaline-vascular Castleman's disease.

The localized form of hyaline-vascular Castleman's disease may rarely be complicated by a vascular neoplasm, which appears to arise in a background of vascular hyperplasia. We report a case complicated by follicular dendritic cell tumor, a hitherto undescribed occurrence that is expected from the presence of a "dysplastic" component of follicular dendritic cells in Castleman's disease. The patient had a large tumor mass in the mesocolon, associated with multiple small peritoneal deposits. The lesion showed typical histologic features of follicular dendritic cell tumor with storiform arrangement of spindly cells and admixture of small lymphocytes. The follicular dendritic cell nature of the tumor was confirmed by immunoreactivity with CD21 and CD35 antibodies and by ultrastructural demonstration of cell processes connected by desmosomes. Hyaline-vascular follicles were identified at the peripheral portion or occasionally scattered in the center of the tumor. Rarely, follicle-like structures were formed by tumor cells, possibly representing in situ malignant change. In addition, there was a small focus of vascular neoplasm comprising well-formed pericyte-rich small blood vessels devoid of cellular atypia. This report of the development of follicular dendritic cell tumor in Castleman's disease therefore completes the picture in that tumors corresponding to each cell type that proliferates in Castleman's disease have now been documented.

Adult↗
PubMed1996

The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy.

OBJECTIVE: The purpose of this study was to determine if an endosurgical approach that mimics open exploration would improve the accuracy of simple diagnostic laparoscopy. SUMMARY BACKGROUND DATA; Most patients with peripancreatic malignancy are found at exploration to be unable to undergo resection. Laparoscopy has been suggested as a sensitive method for detecting metastatic disease in this group of patients. However, the ability to assess resectability with simple diagnostic laparoscopy remains relatively low (<40%). METHODS: Between December 1992 and August 1994, 115 patients with radiologically resectable peripancreatic tumors underwent extended laparoscopy before undergoing a planned curative resection. This technique required assessment of the peritoneal cavity, liver, lesser sac, porta hepatis, duodenum, transverse mesocolon, and celiac and portal vessels. RESULTS: Sixty male and 55 female patients were included in the current study. The pancreatic head was involved in 74 patients (64%), followed by the body in 21 (18%), tail in 8 (7%), ampulla in 8 (7%), duodenum in 3 (3%), and distal bile duct in 1 (1%). An abdominal computed tomography (CT) scan was performed for all patients before laparoscopy, ultrasonography for 74 patients (64%), endoscopic retrograde choleangiopancreatography for 59 patients (51%), and mesenteric angiography for 9 patients (8%). Pneumoperitoneum was established successfully in all but 2 cases (98%). A complete examination of 108 patients was performed. Sixty-seven patients were considered to have resectable disease, and 61 resections were performed. Laparoscopy failed to identify hepatic metastases in 5 patients and portal venous encasement in 1 patient. Unresectable disease was identified in 41 patients. Hepatic metastases were observed in 20 patients, mesenteric vascular encasement in 14, extrapancreatic/peritoneal involvement in 16, and celiac or portal lymphatic metastases in 8. There were no intraoperative or postoperative complications related to the laparoscopic procedure. The positive predictive index, negative predictive index, and accuracy of laparoscopy were 100%, 91%, and 94%, respectively. CONCLUSIONS: This study demonstrates that extended laparoscopy is accurate and safe and makes exploration unnecessary in many patients with potentially resectable peripancreatic malignancy. In this series, 76% of patients explored were resected, compared with the authors' experience between 1983 and 1993 of 35%. The authors believe that laparoscopy is an important component in the staging of this group of patients and should be performed before exploration.

Adult↗
PubMed1986

SPECT gallium imaging in abdominal lymphoma.

A case of non-Hodgkin's lymphoma of the abdomen studied by gallium SPECT imaging is reported. The tomographic slices accurately demonstrated the location of residual disease after chemotherapy in the region of the transverse mesocolon. Previous transmission CT had shown considerable persistent retroperitoneal lymphadenopathy, but was not helpful in determining the presence of viable lymphoma.

Abdominal Neoplasms↗