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PubMed2004

[Bacterial aortitis].

A cohort of 14 patients with bacterial destruction of various segments of the aortic wall is presented. The Salmonella enteritidis strain was predominantly responsible. Most patients had typical history of symptomatic trias of sepsis, abdominal and/or back pain and positive blood cultures. CT scan showed pseudoaneurysm within the thoracic, subphrenic or subrenal aorta as well as acute hemorrhage in three patients. One of these was excluded from invasive treatment due to hopeless prognosis. In one patient primary aortoduodenal phistula was responsible for GI bleeding. Five patients were operated and prosthetic replacement of subrenal or iuxtarenal aortic portion together with aortorenal bypass in a couple of cases was performed. In eight patients stentgrafts (SG) of various types were deployed completed with femorofemoral crossover bypass when necessary. All patients were subject to long-standing antibiotic therapy. Two patients expired following SG insertion, all operated patients survived. Average follow-up has been 1 year (1-22 months) so far. A groin abscess was later drained in one patient. Neither CT nor isotope scanning showed persistent or recurrent infectious or hemorrhagic foci in any survivors whatsoever. The authors review and consider the doubtful indication of aortic SG deployment into the septic terrain in selected cases. Midterm results might justify its use in overly debilitated patients otherwise not eligible for radical operation due to its prohibitive risk.

Aged↗
PubMed1987

Factors affecting the morbidity of elective liver resection.

To identify the determinants of morbidity and mortality after hepatic lobectomy, we studied 17 potential risk factors in 58 consecutive patients who had right hepatic lobectomy (39 patients), left hepatic lobectomy (10 patients), extended right hepatic lobectomy (6 patients), and left lateral segmentectomy (3 patients). The lesions were benign neoplasm (11 patients), primary malignancy (12 patients), metastatic neoplasm (28 patients), and inflammatory conditions, namely, stones, ductal strictures, and abscess (7 patients). Two patients died (3.8 percent), one from operative hemorrhage and the other from sepsis. Major complications occurred in 29 patients (50 percent). The presence of diabetes or pulmonary disease correlated with the development of complications. Infection occurred in four of five patients with diabetes. The incision was extended into the thorax in nine patients, all of whom had complications. The mean weight of the resected specimen did not differ between patients who underwent thoracotomy and those who did not, but the two largest specimens (over 2 kg) were removed without thoracotomy. Minor complications developed in two patients with benign tumors. Biliary fistulas developed in three of seven patients with inflammatory conditions. Infectious complications were decreased in the presence of adequate perioperative antibiotics and closed drainage of the subphrenic space. These data show that in fit patients, elective liver resection can be performed with a low morbidity and mortality; diabetes, pulmonary disease, and inflammatory lesions increase the risk of hepatic resections; adequate antibiotics and closed drainage decrease the risk of infection; and thoracotomy markedly increases the chance of complications. Finally, since elective resection can nearly always be performed without thoracotomy, it should be avoided in most patients.

Adult↗
PubMed1991

Intra-abdominal sepsis: the role of radiology.

A wide range of imaging tools is available for the investigation of abdominal sepsis. Plain films and barium studies alone are generally regarded as inadequate and most patients will require ultrasound, CT or nuclear medicine studies to locate the source of sepsis. The choice of imaging modality depends on several factors, most important of which are the clinical condition of the patient and the presence or absence of localizing signs and symptoms. Ultrasound has the advantage of being portable and is therefore probably the best initial imaging method for the critically ill patient. It should also be the first investigation in patients with signs and symptoms localizing to the right upper quadrant, renal areas, subphrenic spaces or pelvis. Transvaginal ultrasound is particularly useful in examining the pelvis. CT is the imaging modality of choice for the pancreas and retroperitoneum and in patients who are poor candidates for ultrasound or in whom visualization on ultrasound is inadequate. In patients with PUO or evidence of sepsis without localizing signs or symptoms, nuclear medicine studies in the form of 67Ga citrate or labelled white cell scans are useful to localize the septic focus, although in most cases CT or ultrasound will subsequently be required for detailed anatomical definition. Imaging techniques have an increasingly important role to play in the treatment of sepsis, and guided aspiration and drainage may be performed with a high degree of accuracy under ultrasound or CT guidance, eliminating the need for surgical intervention in many individuals.

Abdomen↗