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Acute suppurative infection of the sacroiliac joint can mimic the acute abdomen. Experience with a patient who had exploratory laparotomy for acute appendicitis prompted a review of the literature, which indicated that 12.6% of patients with pyogenic sacroiliitis have acute abdominal pain. A high index of suspicion is necessary to establish this diagnosis.
Acute abdomen, irreversible shock and sudden death are a typical although infrequent complication in patients with hemochromatosis. The author presents a further case of this syndrome and discusses the two leading pathogenetic interpretations described in the literature: sudden release of ferritin, and endotoxin shock. Clinical and post-mortem findings from this patient and a review of 19 cases from the literature suggest that most patients with this syndrome die from a primary bacterial peritonitis with gram negative sepsis and endotoxin shock.
The intraperitoneal administration of ADP (150-75 mg/kg/day) to rats on days 1-3 after exposure of abdomen to X-rays (13.5 Gy) enhanced the assimilation of glucose, amino acids and electrolyte introduced with the parenteral feeding and increased considerably the survival rate of animals.
Subperiosteal resection of the eleventh rib with transcostal, extrapleural entrance into the retroperitoneum for exposure of the kidneys or adrenal glands has been well described in the urologic literature. We have used the incision with transperitoneal extension for various procedures in the upper abdomen. The following is a description of our operative technique with suggestions for procedures in which the incision may be used. The incision is ideal for splenectomy, distal splenorenal shunts, resections of the pancreatic body and tail, portacaval shunts, right hepatic lobectomy, and transperitoneal unilateral adrenalectomy.
The case of a man with situs inversus who presented with acute abdomen is reported. Acute left-sided appendicitis was considered before operation, but at laparotomy an omental abscess of unknown aetiology was drained. The appendix, localized in the left iliac fossa, was removed but was normal on histological examination.
From january 1972 to september 1983, 215 patients of eighty and more (60 M. and 155 F.) entered for acute abdomen, have undergone a clinical analysis to principally define the main factors for morbidity and mortality. The authors insist on the poor value of the clinical and biological symptoms which delayed a correct diagnosis and therefore the correct treatment. For 30.7% of the cases, the treatment was medical and for 69.3% surgical. During the medical treatment, the morbidity rated at 12.1% and the mortality at 46.9%. During the first 30 postoperative days the rate of complications was of 61.7% and the rate of mortality of 46.9%. Both are essentially due to associated illnesses: pulmonary, cardiac and renal. The figures are compared with those of the literature. Besides, a progressively aging population is observed: the rate of patients of more than 80 years went from 7.2% in 1972 to 12.4% in 1983. This is probably due to the present quality of pre- and post surgical treatments and the improving of the medico-surgical reanimation technics.
Current Australian Antarctic activities require a unique medical service: a sole medical officer is responsible for the total care of 20 to 30 expeditioners (and of himself) for around nine months a year. A case of "acute abdomen" at Casey, Antarctica, is described and the problems of diagnosis and management, in this isolated medical practice, are discussed.
The authors describe a case of acute abdomen due to retroperitoneal hemorrhage in a patient suffering from perirenal hemangiopericytoma. They emphasize the rareness of such clinical picture and the difficulties involved in the radical surgical extirpation.
Spontaneously perforated pyometra is rare, but the condition must be born in mind in women with acute abdomen. Two cases are reported, one resembling perforated peptic ulcer, the other was mistaken for acute appendicitis.
Four patients with primary disease in the chest are discussed, each coming to laparotomy. The final postoperative diagnoses were empyema, pulmonary tuberculosis, pulmonary embolism and bacterial endocarditis. These cases well illustrate the real risk of confusing an acute chest condition with an acute abdomen.
A rationale for management of the patient with an acute adbomen and a ventriculoperitoneal shunt is presented in relation to eight patients. In two patients peritonitis was due to perforation of an abdominal viscus, not shunt related, and six were due to infections of ventriculoperitoneal shunts. Resolution of abdominal symptomatology occurs within six hours after the distal end of the shunt catheter is removed from the abdomen and placed in a drainage bottle. In four of these six, infection was limited to the peritoneal end of the catheter. The ventricular fluid was sterile.
One hundred cases of acute abdomen in patients over 70 years of age were studied. Mechanical occlusion was the most common cause among these patients, as opposed to acute appendicitis, which is the primary cause of the same condition among young people and adults. Irreducible hernias and visceral neoplasias were the most frequent etiologies among cases of mechanical occlusion. Cholecystitis took second place in our series. Visceral peforations were more often due to localized infections or visceral neoplasias than to gastric or duodenal ulcers. Overall mortality among these patients was 29 percent. Patients with visceral perforations due to localized infections or visceral neoplasias and all of the patients with vascular diseases had a negative prognosis.
The most common nontraumatic acute surgical lesions of the infant abdomen are considered. These abdominal lesions are divided into those which do and do not cause bowel obstruction. Lesions causing bowel obstruction are almost always identified as being surgical and are usually appropriately treated. Most common in this group are incarcerated inguinal hernia and malrotation. Among the non-obstructive lesions, appendicitis is the most common and frequently very difficult to diagnose in this age group. The early use of a barium enema is advocated if appendicitis is a diagnostic possibility. Profound ileus can be seen in a variety of medical conditions and several examples are cited.
The urological diseases which alone or intercurrent with surgical and gynaecologic ailments cause most of the problems in the differential diagnosis of the acute abdomen are reviewed. The necessity of a cooperation between the urologist, surgeon and gynaecologist and the importance of intra-operative diagnosis are stressed.
The so called "burst abdomen" is a very serious complication in the course of wound healing. Local factors are of modifying influence. In our own material the number of wound dehiscences has decreased due to the use of non-absorbable suture material and carefull pre- and postoperative therapy in regard to the compensation of disturbances of protein and electrolyte metabolism. Since a causal influence on processes of wound healing is not possible, these factors are of special importance.
We have examined the electrocardiograms of 516 patients hospitalized for acute abdomen. We have excluded from this research the younger patients than 14 years, those with shock, those with clinical signs of cardiopathy, those with electrolytic alterations and those executing anti-arythmic or anti-depressing therapy. We have found changes of repolarization and of rhythm. The changes of regularization consisted in flottening-inversion of T wave in the precordial and/or limb leads associated sometimes at negative deflection of the ST tract in the same leads. The changes of rhythm consisted in atrial or ventricular extrasystoles, paroxismal atrial tachycardia, paroxysmal atrial fibrillation. Sometimes the changes of repolarization and rhythm were associated. We have discussed the possible pathogenetic mechanisms answerable for these changes; sympathetic adrenergic activation mediate or no from a parasympathetic reflex, reduction of intra-cellular potassium, activation of enzymatic systems, reabsorption of toxic substaces. The Authors have underlined the benignity of these ECG changes, disappearing after resolution of abdominal disease, and the necessity of a correct interpretation of those, to avoid the arising of a iatrogenic disease.
The author presents the evolution of his technique of undermining the major oblique musculature to reduce the diameter of the waist and also reduce the diameter of the superior abdomen by resecting cartilage from the seventh and eighth ribs when the anterior projection is exaggerated. Treatment of the aponeurotic muscle wall plays an important role in obtaining good aesthetic results because this wall will serve as a base for the cutaneous tegument upon healing.
An analysis of the cell lineage of the adult Drosophila abdomen is reported. Genetically marked clones are produced in the tergites in the embryo and in the sternites and pleura during larval life. The spatial disposition of the segment primordia is also studied in a series of 250 gynandromorphs. We conclude that in the embryo the segments are all separate polyclones soon after blastoderm and these are probably adjacent to each other. Gynandromorph analysis suggests that segments 2--6 develop from similarly sized cell groups but that the first tergite develops from a primordium which is equal to that of two other segments. We suggest that presumptive adult and larval cells are not separated at blastoderm. Our estimate from clonal analysis of the number of larval cells (12) which construct the sternites and pleura is equal to the number observed directly in the ventral nest of histoblasts.