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At least 1,405 records · Page 78Linked to original sources
PubMed2006

[Acute abdomens of parasitic origin: retrospective analysis of 135 cases].

OBJECTIVE: To assess acute abdomens incidence of parasitic origin at Yaounde (Cameroon) and evaluate their different management modalities. MATERIALS AND METHODS: Retrospective study from January 1973 to December 2002 of patients managed at Department of Surgery, Central Hospital, Yaounde (Cameroon). RESULTS: Among 3464 acute abdomens managed by laparotomy during this period, 135 patients (3.9%) had a parasitic origin. Ninety-seven patients (79%) were operated on before 1990. Among these 135 patients, 63 (47%) had peritonitis secondary to liver amoebic abscess intraperitoneal rupture, 24 (18%) had acute intestinal obstruction due to an ascaridioma, 21 (15%) had appendicitis of parasitic origin, 15 (11%) had amoebic typhlitis, 4 (3%) had pancreatitis and/or angiocholitis caused by the obstruction of ampulla of Vater by an adult ascaris worm, 4 (3%) had intestinal perforation by ascaris, and 4 (3%) had intussusception (tricocephalus). CONCLUSIONS: Incidence of abdominal emergencies of parasitic origin is unfrequent but not rare at Central Hospital, Yaounde, Cameroon. This incidence is decreasing over time. However, liver amoebic abscess intraperitoneal rupture is the most common cause of peritonitis and is still associated with postoperative high mortality rate. Preoperative diagnosis could lead to non-operative management that may be associated with better prognosis.

Abdomen, Acute↗
PubMed2004

Oral arsenic trioxide poisoning and secondary hazard from gastric content.

In a suicide attempt, a 54-year-old man ingested arsenic trioxide. Gastric lavage was performed, but most of the poison remained as a mass in his stomach. A total gastrectomy was also performed to avoid intestinal perforation and arsenic poisoning. After the operation, he developed ventricular fibrillation. At one point, his circulation recovered spontaneously, but he later died from refractory circulatory failure. Many medical staff members were exposed to fumes from the patient's stomach. Some of the staff were diagnosed with corneal erosion or laryngitis. Because arsenic trioxide reacts with acid to produce arsine, the symptoms experienced by medical staff are directly attributable to arsine produced as a result of the reaction of arsenic trioxide with gastric acid. This case highlights the need for the introduction of protective measures to safeguard medical staff from exposure to arsine gas during the treatment of patients poisoned from ingested arsenic trioxide.

Arsenic Trioxide↗
PubMed2005

The surgical management of necrotising enterocolitis.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonates. The disease affects mainly premature neonates. The pathogenesis is still unknown but predisposing factors are prematurity, formula feeding and sepsis. The disease can lead to gangrene and intestinal perforation requiring surgery. The options for surgery are between primary peritoneal drainage or laparotomy. However, the optimum choice between peritoneal drainage and laparotomy remains controversial, particularly in low-birth-weight infants (<1000 g). Peritoneal drainage offers temporary decompression, drainage and stabilization of patients whilst awaiting surgery, or in patients too unstable to be able to tolerate surgery or anaesthesia. Those weighing >1000 g who have no associated morbidities and are clinically stable are preferentially treated by primary laparotomy. The principal surgical objectives of laparotomy in acute NEC are to control sepsis and removal of gangrenous bowel preserving as much bowel length as possible. The surgical options at laparotomy include resection with enterostomy, resection with primary anastomosis, proximal jejunostomy and "clip and drop" technique. The option exercised is influenced by the clinical status of the patient and the extent of the disease.

Anastomosis, Surgical↗
PubMed2004

Pneumoretroperitoneum after a therapeutic video enteroscopy.

A 68-year-old woman with repeated episodes of bleeding due to small bowel angiodysplasia developed a pneumoretroperitoneum after a video enteroscopic examination with electrocoagulation of both duodenal and jejunal lesions using a bipolar device. Pneumoretroperitoneum was probably related to intestinal perforation during the therapeutic procedure. Pneumoretroperitoneum completely resolved with conservative measures and there were no additional complications.

Journal Article↗
PubMed2006

Systemic treatment of patients who have colorectal cancer and inflammatory bowel disease.

Colorectal cancer is the most common malignant complication in patients who have IBD. The disease is difficult to diagnose because there is an overlap in symptoms in patients who have colon cancer and those who have IBD. Much has been learned about the incidence of colorectal cancer in patients who have IBD and its correlation with disease activity, duration, and anatomic location; however, almost no data are available regarding specific therapeutic considerations during adjuvant or palliative chemotherapy for these patients with respect to their underlying disease. Patients who have IBD who develop colorectal cancer are at higher risk for developing severe diarrhea during chemotherapy that may be due to the toxic effects of cytotoxic drugs or a flare of the IBD. Continuous infusional 5-FU alone, in combination with leucovorin, or in combination with oxaliplatin (FOLFOX) seems to be tolerated best. Bolus infusions of 5-FU (Roswell Park or Mayo regimens) and combination therapy of irinotecan with 5-FU should be avoided because of severe diarrhea and the possibility of sepsis. When diarrhea develops or worsens, empiric aminosalicylates may be given. Although it is theoretically possible that anti-EGFR therapies could affect IBD activity adversely, clinical experience with cetuximab in patients who have colorectal cancer has not shown any significant gastrointestinal side effects. Therefore, it seems reasonable to use it in patients who have colorectal cancer and IBD. The administration of bevacizumab has been associated with rare episodes of intestinal perforation; it should be used with great care in patients who have IBD. More studies and an integrative, multidisciplinary approach from oncologists and gastroenterologists are needed to provide optimal care for patients who have IBD during chemotherapy for colorectal cancer

Antineoplastic Agents↗
PubMed2005

Klebsiella pneumoniae peritonitis shortly after kidney transplantation.

We report a case of spontaneous bacterial peritonitis caused by Klebsiella pneumoniae in a 34-year-old male recipient shortly after kidney transplantation. On posttransplant day 10, the patient started complaining of severe abdominal pain and nausea. Body temperature was 38.4 degrees C. The abdomen was diffusely tender with rigidity and rebound. Laboratory data showed a normal erythrocyte sedimentation rate and serum creatinine level but a slightly elevated C-reactive protein concentration and leukocytosis of 36,200 cells/mm(3) with 88% neutrophils. Explorative laparotomy revealed diffuse purulent peritonitis without an intraabdominal source of infection, such as intestinal perforation. The peritoneal fluid revealed greater than 1000/mm(3) white blood cells and many gram-negative bacilli. Fluid cultures yielded growth of Klebsiella pneumoniae. The patient responded to antibiotic therapy; he was discharged in good condition. This case report draws attention to the impaired host defense that may predispose to spontaneous bacterial peritonitis in renal transplant recipients and alerts the clinician to the possibility of this rare disease.

Adult↗
PubMed2006

Nonvascular complications in pediatric liver recipients: multidetector computed tomography evaluation.

In pediatric liver transplantation postoperative diagnosis of complications is crucial for graft salvage. Multidetector computed tomography (MDCT) is a technique to evaluate complications. In this study we present nonvascular abdominal complications encountered in pediatric recipients after liver transplantation. We retrospectively examined 113 MDCT examinations in 43 pediatric patients who underwent liver transplantation between 1997 and 2005. Computed tomography (CT) examinations were made by a 16-detector multislice CT scanner. The pathological findings on CT images were: intraperitoneal free fluid, intrahepatic bile duct dilatation, graft liver infarction, perihepatic and intraperitoneal fluid collections (six biloma), colonic and/or intestinal dilatation, splenic infarction, perihepatic hematoma, right adrenal hemorrhage, perihepatic abscess, incisional hernia, intrahepatic biloma and periportal collar. In one patient intestinal hemorrhage was suspected. Intestinal perforation was suspected in three patients. Among these three patients, one patient died before any surgical intervention. In two patients the diagnosis was confirmed at surgery. In pediatric patients, the short examination time, brief sedation duration, and high-resolution images make MDCT an effective radiological method to evaluate nonvascular transplant complications.

Adolescent↗
PubMed1997

Palisade dorsoventral lavage for neglected peritonitis.

A modification of the procedure of laparostomy with palisade dorsoventral lavage for treating neglected peritonitis is described. It consists of adding a polyethylene foil to cover the intestines and thus avoiding the direct contact between them from one side, and the suction drains and the palisade laparostomy screen from the other. Between 1988 and 1995, 19 patients with neglected peritonitis (APACHE II scores from 12 to 42; mean 22.3) were managed using this modified technique. A total of 81 reexplorations were done (average, 4.3 reexplorations per patient). The technique proved effective (21% mortality, n = 4). No intestinal perforations, fistulas, or residual pus collections occurred among survivors or among those who died. Primary fascial closure was achieved in all survivors and during an 18-months followup, no incisional hernia occurred. Based on these results, we believe this technique is extremely useful when both laparostomy and continuous peritoneal irrigations are considered in patients with neglected peritonitis.

APACHE↗
PubMed2000

Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion.

OBJECTIVE: To determine the frequency of peritoneal and visceral adhesions to the umbilical region according to past surgical history and to estimate the risk of bowel injury with blind insertion of the principal trocar-cannula. DESIGN: Prospective, unicentric study by a single operator. SETTING: Clinique Saint-Sernin and Polyclinique de Bordeaux, Bordeaux, France. PATIENT(S): Eight hundred fourteen patients undergoing diagnostic or operative laparoscopy were classified into four groups based on their history of abdominal surgery: group I (n = 469), no previous abdominal surgery; group II (n = 125), prior laparoscopic surgery; group III (n = 131), previous laparotomy with a horizontal supra-pubic incision; group IV (n = 89), previous laparotomy with a midline incision. INTERVENTION(S): Initial microlaparoscopy performed through the left upper quadrant of the abdomen, inspection of the anterior abdominal wall and particularly the umbilical area for the presence of adhesions. Patients who had adhesions were assessed as to whether or not they were at significant risk of injury from blind insertion of the principal trocar. MAIN OUTCOME MEASURE(S): Incidence of umbilical adhesions and the potential risk of bowel injury with blind insertion of the umbilical (principal) trocar. RESULT(S): Umbilical adhesions were found in 9.82% of the 814 cases. The rates of umbilical adhesions were as follows: group I, 0.68%; group II, 1.6%; group III, 19.8%; and group IV, 51.7%. Severe adhesions with potential risk of bowel injury with blind insertion of the umbilical trocar in the four groups were 0.42%, 0.80%, 6.87%, and 31.46%, respectively. CONCLUSION(S): Women with previous laparotomy have a higher incidence of umbilical adhesions, especially in case of midline incision. Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended for patients at risk for adhesions to reduce complications associated with insertion of the principal (umbilical) trocar.

Adolescent↗
PubMed1980

Complications of fiberoptic endoscopy.

This review summarizes the complications of fiberoptic peroral endoscopy, endoscopic retrograde cholangiopancreatography and colonoscopy gleaned from reports of extensive endoscopic surveys. Unique individual experiences are also included. Means whereby complications can be prevented or remedied are noted.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1988

Enema reduction of intussusception by hydrostatic pressure under ultrasound guidance: a report of 377 cases.

Three hundred seventy-seven pediatric intussusception patients were treated by normal saline hydrostatic enema under ultrasound guidance from October 1985 to April 1987. Before reduction, the rate of correct diagnosis by ultrasonography was 100%, and the rate of successful reduction was 95.5% in this group. With this technique there is no risk of x-ray exposure to the patient. The definite criteria for reduction are discussed. Clear echogram was shown during reduction and the ileo-ileo-coli intussusception can be diagnosed. Intestinal perforation, if any, can be accurately recognized at once. This technique is believed to be one of the most promising methods in nonoperative treatment of pediatric intussusception.

Enema↗
PubMed1988

Peritoneal drainage for necrotizing enterocolitis.

This study evaluates the role of primary peritoneal drainage (PPD) in the management of neonatal necrotizing enterocolitis (NEC). Of 169 patients with definite NEC, 92 (55%) underwent operation: primary laparotomy, 41 patients (45%); and PPD, 51 patients (55%). Seventeen (33%) of the PPD infants had subsequent laparotomy within seven days. Pneumoperitoneum was the indication for operation in 37% of the primary laparotomy and 67% of the PPD infants. Following PPD, 34 patients (67%) showed clinical improvement. Operative survivals were as follows: primary laparotomy, 83%; PPD, 53%. Infants who had PPD had a significantly lower mean birth weight, gestational age, preoperative pH and platelet count, and a significantly higher incidence of intraventricular hemorrhage and patent ductus arteriosus. For infants weighing less than 1,000 g at birth, the survival was similar following primary laparotomy (57%) and PPD (52%); this occurred in spite of the higher incidence of adverse risk factors in the PPD infants. For infants weighing greater than 1,000 g, the survival was 86% following primary laparotomy and 62% after PPD; in this group, all the early deaths following PPD occurred in critically ill infants who died within 48 hours of drainage. The late survival rates were as follows: primary laparotomy, 76%; PPD, 35%. More than half of the late deaths following PPD were not related to NEC, reflecting the difference between the two patient populations. Primary peritoneal drainage is a useful adjunct to resuscitation of the critically ill infant with complicated NEC, particularly prematures less than 1,000 g birth weight with intestinal perforation. Primary peritoneal drainage is not an alternative to laparotomy, which is recommended when an optimal clinical response has been achieved.

Drainage↗
PubMed1999

Meconium stimulates a pro-inflammatory response in peritoneal macrophages: implications for meconium peritonitis.

BACKGROUND/PURPOSE: Although meconium peritonitis is a rare condition, the mortality rate can be as high as 40%. Meconium peritonitis is a result of intestinal perforation in utero, which leads to dense inflammation in the peritoneal cavity. The fetus has relatively immature peritoneal defense mechanisms, so the cause of this dense inflammation is unclear. The peritoneal macrophage is a key cell in the peritoneal inflammatory response in adults. The purpose of this investigation was to determine if sterile meconium had a direct stimulatory effect on the peritoneal macrophage. METHODS: Peritoneal macrophages were harvested from adult C3H/HEN mice. The cells were placed in microtiter wells at 10(5) cells per well. Sterile human meconium was diluted in media and placed in the wells at varying concentrations for 8 hours. Lipopolysaccharide (LPS) (10 microg/mL) served as a positive control. Supernatants were harvested and assayed for tumor necrosis factor alpha (TNF-alpha) using a commercial ELISA kit. Separate cells were assayed for TNF-alpha message using polymerase chain reaction (PCR). In another series of experiments, procoagulant activity (PCA) was determined on freeze-thawed cells using a two-stage amidolytic assay. To test for the role of protein kinase C (PKC) in the PCA response H7, a PKC inhibitor, was used as well. RESULTS: Meconium stimulation resulted in a significant increase in TNF-alpha compared with negative controls with a peak at 0.1% meconium (121 pg/mL v 11 pg/mL, P<.05). There was a significant increase in PCA, with a 10-fold increase with 1% meconium compared with controls (P<.05). This response was limited to less than 5% by PKC inhibition. CONCLUSIONS: Sterile meconium results in a marked proinflammatory response in the peritoneal macrophage with elevations of both PCA and TNF-alpha. The TNF response is likely mediated at a pretranscriptional level because there is a marked increase in TNF mRNA. These data suggest that the PCA response is regulated by a PKC mechanism similar to LPS. Stimulation of the peritoneal macrophage by meconium is a possible cause of the marked inflammation seen in meconium peritonitis.

Animals↗