Acute Colonic Diverticulitis.

Acute colonic diverticulitis is a gastrointestinal condition that is frequently encountered by primary care and emergency department practitioners, hospitalists, surgeons, and gastroenterologists. Clinical presentation ranges from mild abdominal pain to peritonitis with sepsis. It is often diagnosed on the basis of clinical features alone, but imaging is necessary in more severe presentations to rule out such complications as abscess and perforation. Treatment depends on the severity of the presentation, the presence of complications, and underlying comorbid conditions. Medical and surgical treatment algorithms are evolving. This article provides an evidence-based, clinically relevant overview of the epidemiology, diagnosis, and treatment of acute diverticulitis.

Peritoneal dialysis-associated peritonitis: A case first for Aquamicrobium.

Aquamicrobium is an aerobic gram-negative rod which until recently had only been isolated from wastewater and contaminated soil. In 2021, two cases of Aquamicrobium infection in humans were reported. Both were cases of endophthalmitis following cataract surgery. In this manuscript, we describe the presentation and treatment of a 56-year-old immunocompetent male who has peritoneal dialysis-associated peritonitis caused by Aquamicrobium lusatiense. To our knowledge, this is the third reported case of Aquamicrobium infection in humans and the first example of this agent causing peritonitis.

Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis.

BACKGROUND: The purpose of this study was to improve diagnostic and therapeutic standards by examining the clinical features, treatment, and prognosis of fetal meconium peritonitis (FMP), as well as the diagnostic efficacy of ultrasound for FMP. METHODS: The clinical data of 41 infants and pregnant women diagnosed with meconium peritonitis (MP) and treated at the Fujian Maternal and Child Health Hospital from January 2013 to January 2020 were analyzed retrospectively. Clinical data, imaging data, complications, treatment strategies, pregnancy outcomes, neonatal prognoses, and follow-up outcomes were all analyzed. RESULTS: The MP prenatal diagnosis rate was 56.1% (23/41), the neonatal surgery rate was 53.7% (22/41), and the survival rate was 85.4% (35/41). Intraperitoneal calcification (23 pregnant women, 56.1%), intestinal dilatation (13 pregnant women, 31.7%), peritoneal effusion (22 pregnant women, 53.7%), intraperitoneal pseudocyst (7 pregnant women, 17.1%), and polyhydramnios were diagnosed via prenatal ultrasound (18 pregnant women, 43.9%). Twenty-two pregnant women were assigned to the surgical treatment (operation) group, while 18 were assigned to the conservative treatment group. In the operation group, there were 9 cases of ileal atresia (40.9%), 7 cases of jejunal atresia (31.8%), 2 cases of atresia at the jejunum-ileum junction (9.1%), 2 cases of ileal perforation (9.1%), 1 case of ileal necrosis (4.5%), and 1 case of adhesive obstruction (4.5%). There was no statistically significant difference (p > .05) in the occurrence of various prenatal ultrasound findings by etiology. CONCLUSION: Multiple prenatal ultrasound markers have been identified for MP. To improve the efficacy of newborn treatment for FMP and reduce neonatal mortality, dynamic monitoring of ultrasound image alterations and strengthened integrated perinatal management are necessary.

Chinese guidelines on the management of ascites in cirrhosis : Chinese Society of Hepatology, Chinese Medical Association.

In 2023, Chinese Society of Hepatology of Chinese Medical Association convened a panel of experts to update the Chinese guidelines on the management of ascites and associated complications in cirrhosis which was launched in 2017 and renamed this guidelines as "Guidelines on the Management of Ascites in Cirrhosis." This comprehensive resource offers essential recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome.

Epidemiología, resistencia antimicrobiana y tratamiento antibiótico empírico en peritonitis secundarias de la comunidad en un centro de la prov. de Buenos Aires / Epidemiology and review of antibiotic treatment in secondary community peritonitis in a province Buenos Aires's center

Las peritonitis secundarias constituyen una causa frecuente de internación y de uso de antibioticoterapia dentro de las infecciones intraabdominales. Realizamos un estudio retrospectivo, descriptivo y observacional de centro único desde enero a diciembre de 2021. El objetivo del estudio fue conocer la epidemiología local y adecuar el tratamiento empírico de las peritonitis secundarias de la comunidad. Se incluyeron pacientes mayores a 16 años con peritonitis secundaria, intervención quirúrgica, envío de material a cultivo y desarrollo microbiano de bacterias aerobias a través de la revisión de historias clínicas. Se analizaron cultivos de 36 pacientes, 64% de sexo masculino con una media de edad de 48,8 años. El 22% requirió internación en unidad de cuidados intensivos. La principal causa fue apendicitis aguda en el 61%, seguido por perforación secundaria a tumores. Se aislaron 43 bacterias aerobias (1,2 bacterias por episodio) siendo E. coli el microorganismo más frecuente. En la institución se utiliza piperacilina-tazobactam como tratamiento empírico. De acuerdo a las recomendaciones de la Sociedad Argentina de Infectología de 2018, en infecciones no complicadas podría utilizarse aminoglucósidos + metronidazol, optando por piperacilina-tazobactam en casos graves. No es recomendado como tratamiento empírico el uso de ampicilina-sulbactam y ciprofloxacina para infecciones graves o con difícil control del foco por la alta tasa de resistencia. En base a nuestro estudio podemos concluir que la epidemiología de los pacientes coincide con lo descrito en publicaciones nacionales, lo que nos lleva a reconsiderar el tratamiento empírico en casos leves, pudiendo optar por aminoglucósidos + metronidazol.

Secondary peritonitis is a frequent cause of hospital admission and an usual cause of use of antibiotic therapy in abdominal infections. We did a retrospective and observational study in one health center between January 2021 and December 2021. The aim of the study was to analyze the local epidemiology and adapt antibiotic empirical therapy of secondary community peritonitis. Patients aged 16 years and older with secondary peritonitis were included in this study. These patients needed surgical intervention and they had a positive culture with aerobic microorganism. We analyzed abdominal cultures from 36 patients, 64% men with a median age of 48.8 years. Twenty- two percent of these patients were admitted to intensive care unit. Acute appendicitis was the principal cause of secondary peritonitis in 61% of cases, followed by tumors. We found 43 aerobic bacterias (1.2 bacteria/episode), E.coli was the most frequent microorganism. In our hospital we use piperacillin- tazobactam for empirical treatment. According to the 2018 recommendations from the Argentine Society of Infectious Diseases, aminoglycosides + metronidazole can be used for uncomplicated intra-abdominal infections, and piperacillin-tazobactam should be used only in severe cases. However, ampicillin-sulbactam or ciprofloxacin is not recommended for severe cases or complicated infections due to the high resistance rates. Based on the finding of the study, it could be said that the epidemiology of the patients coincides with what was described in other national medical journals. Therefore, we should reconsider the use of aminoglycosides + metronidazole as empirical treatment for mild cases.

Peritonitis esclerosante primaria y secundaria: estudio comparativo / Primary and secondary sclerosing peritonitis: comparative study

Resumen Introducción: Existen dos tipos de peritonitis esclerosante (PE): primaria o idiopática y secundaria, generalmente a diálisis peritoneal (DP), y con menor frecuencia a otras patologías abdominales o sistémicas. Su mortalidad es alta. Objetivo: Comparar las características clínicas, estudios diagnósticos y tratamiento de pacientes con Peritonitis Esclerosante Primaria y Secundaria, definir si existen diferencias y determinar los principales elementos clínicos e imagenológicos que permitan hacer un diagnóstico precoz y mejorar los resultados terapéuticos. Material y Métodos: Se analizan 18 casos de PE diagnosticados en nuestro hospital, entre los años 2001-2014. Incluye una serie retrospectiva de 15 casos de PE secundaria (13 por diálisis peritoneal y 2 por cirrosis hepática). Se compara con un estudio prospectivo que incluye 3 pacientes con PE primaria. Resultados: Las principales diferencias se evidencian en la presentación clínica: PE primaria: se presenta con cuadro de obstrucción intestinal y baja de peso de distinta magnitud. PE secundaria: predominan el dolor abdominal, peritonitis recurrente y la falla de ultrafiltración. La tomografía computada de abdomen es útil, sobre todo cuando hay obstrucción intestinal. Ha hecho posible el diagnóstico preoperatorio. Conclusiones: Se requiere un alto índice de sospecha para el diagnóstico precoz de PE, sobre todo para la forma primaria. Debe sospecharse en todo paciente con dolor abdominal, vómitos recurrentes y baja de peso de cualquier magnitud; y en aquellos en diálisis peritoneal durante 5 años o más, que presenten dolor abdominal y/o peritonitis recurrente y/o falla de ultrafiltración.

Introduction: There are two types of sclerosing peritonitis (SP): primary or idiopathic and secondary, generally to peritoneal dialysis, and less frequently, to other abdominal or systemic pathologies. Mortality related to this is high. Objective: To compare the clinical feature, diagnostic studies and treatment of patients with Primary and Secondary Sclerosing Peritonitis, to define whether there are any differences and to establish the main clinical and imaging elements allowing for an early diagnosis and improving the therapeutic results. Material and Methods: An analysis of 18 SP cases diagnosed at our hospital between 2001-2014 was carried out. This includes a retrospective series of 15 cases of secondary SP (13 to peritoneal dialysis and 2 to liver cirrhosis). This is compared against a prospective study that includes 3 patients with primary SP. Results: The main differences became evident in the clinical presentation: Primary SP: occurs in an intestinal obstruction and a loss of weight scenario of varying degrees. Secondary SP: abdominal pain and recurrent peritonitis as well as ultrafiltration failure prevail. CT of the abdomen has proven to be useful, in particular in those cases where there is intestinal obstruction. It has made preoperative diagnostic possible. Conclusions: A high degree of suspicion is required for an SP early diagnosis, especially for the primary form. All patients presenting abdominal pain, recurrent vomiting and any degree of weight loss and those with five or more years of peritoneal dialysis presenting abdominal pain and/or recurrent peritonitis and/or ultrafiltration failure should raise a diagnosis suspicion.

Evaluación de opciones terapéuticas para la enfermedad diverticular del colon / Evaluation of therapeutic options for diverticular disease of the colon

Introducción: La enfermedad diverticular del colon es una entidad de reciente aparición, con un aumento manifiesto en el siglo XX. El manejo quirúrgico más apropiado ha sido siempre controvertido con respecto a su estado más grave: la diverticulitis. Existen principalmente dos opciones terapéuticas: la cirugía de Hartmann y la resección con anastomosis primaria. Objetivo: Evaluar las opciones terapéuticas para la peritonitis diverticular de colon izquierdo Grado III de Hinchey. Métodos: Se realizó un estudio descriptivo, de serie de casos, a partir de la discusión e implementación de un método de tratamiento estándar aplicado a esa patología en el Hospital Clínico Quirúrgico de Holguín desde 2014 hasta 2016. El universo y la muestra coinciden con 78 pacientes intervenidos. Resultados: El proceder quirúrgico más utilizado fue la resección con anastomosis primaria. La mayor parte de las intervenciones tuvo una duración de más de 2 horas. El proceder de Hartmann fue el que más complicaciones y mortalidad posoperatorias presentó. Conclusiones: Se determinó que entre las técnicas quirúrgicas actuales para el tratamiento de la diverticulitis Grado III de Hinchey. El proceder de RAP constituye la terapéutica más adecuada(AU)

Introduction: The diverticular disease of the colon is a recent ailment having remarkable increase in the 20th century. The most appropriate surgical management of this disease has always been a topic of controversy about its most severe condition, that is, diverticulitis. There are two main therapeutic options: Hartmann's surgery and primary anastomosis resection. Objective: To evaluate the therapeutic options for Hinchey III left-sided colon diverticular peritonitis. Methods: A descriptive case-series study was conducted on the basis of discussion and implementation of a standard method of treatment used for this pathology in the Clinical and Surgical Hospital of Holguin from 2014 to 2016. The universe and the sample were the same, with 78 surgical patients. Results: The most used surgical procedure was primary anastomosis resection. Most of the interventions lasted more than 2 hours. Hartmann's procedure was the one with more complications and high postoperative mortality. Conclusions: Among the current surgical techniques for the treatment of Hinchey III diverticulitis, it was established that the primary anastomosis resection is the most adequate therapy(AU)

Caso Clínico: Manejo del Abdomen Abierto Séptico Mediante Sistema VAC / Case Report: Management of Septic Abdomen Using VAC System

INTRODUCCIÓN: El abdomen abierto es una estrategia quirúrgica que ha permitido realizar un manejo quirúrgico de infecciones intraabdominales; una de las patologías intraabdominales que puede ser manejada como abdomen abierto es la diverticulitis. El manejo de la diverticulitis con un cuadro clínico séptico es quirúrgico y se pueden requerir de terapias que no son de aplicación frecuente. CASO CLÍNICO: Se trata de un paciente de sexo masculino de 46 años de edad que luego de ser diagnosticado con diverticulitis y tras una serie de intervenciones tuvo un desenlace con abdomen abierto, fistula biliar, ileostomía, colostomía, estado séptico y desnutrición severa. EVOLUCIÓN: El paciente fue manejando en forma integral, para el tratamiento quirúrgico se recurrió a la técnica de presión negativa (TPN) o sistema «vaccum¼, requirió varias cirugías para cambio del sistema vaccum y revisión de ostomías; el cierre definitivo de cavidad se realizó junto con el servicio de Cirugía Plástica. CONCLUSIÓN: El manejo adecuado del cuadro abdominal sin duda fue la clave para la recuperación del paciente, la utilización de técnicas innovadoras y con fundamento científico asegura una evolución adecuada del paciente.(AU)

BACKGROUND: Open abdomen is a surgical strategy which has being used to manage severe abdominal infections; one of those pathologies that can be managed is diverticulitis. Management of diverticulitis with an associated septic abdomen must be surgical and infrequent therapies may be required to treat it. CASE REPORT: It is about a 43-years old male patient who was diagnosed with diverticulitis and after many surgical procedures came with an open abdomen, biliary fistula, ileostomy, colostomy, septic shock and severe malnutrition. EVOLUTION: A complete management and Negative-Pressure Therapy or «vaccum¼ system was used for initial surgical treatment, the patient required additional procedures to change the system and check the ostomies. Definitive closure was performed with the collaboration of Plastic Surgery service. CONCLUSION: A proper management of this case was the key of the patient's recovery undoubtedly. Use of innovative and science-based techniques ensures and adequate patient outcome.(AU)

Diagnóstico y seguimiento de 12 casos de peritonitis esclerosante asociada a diálisis peritoneal crónica en Chile: Experience in 12 patients on peritoneal dialysis / Encapsulating peritoneal sclerosis

Background: Encapsulating peritoneal sclerosis (EPS) is a complication of peritoneal dialysis (PD) with a low prevalence but high mortality. It is characterized by peritoneal inflammation and fibrosis with subsequent development of intestinal encapsulation. It is associated with a long lapse on PD, frequent episodes of peritonitis, high glucose solution use, and high peritoneal transport status. Aim: To report the clinical features of patients on PD, who developed EPS. Material and Methods: Review of medical records of 12 patients aged 43 ± 10 years (eight women) who developed EPS. Results: The mean time spent on PD was 98 months. The main clinical manifestations were abdominal pain in 82% and ultrafiltration failure in 63%. In 92%, there was a history of peritonitis and 75% had high peritoneal transport at the time of diagnosis. The main findings in computed tomography were peritoneal calcification and thickening. There was a biopsy compatible with the diagnosis in 10 cases. Treatment consisted in withdrawal from PD, removal of PD catheter and the use of corticoids and tamoxifen. After withdrawal from PD 50% of patients became asymptomatic. The rest had intermittent abdominal pain and altered bowel movements. Two patients died (17%). Conclusions: EPS is a serious complication of PD, which should be suspected in any patient with compatible clinical symptoms, long time on PD, multiple episodes of peritonitis and high peritoneal transport profile.

Evaluación de la realización de paracentesis en pacientes cirróticos ingresados a dos servicios de medicina interna de hospitales mediana complejidad / Assessment of the fulfillment of paracentesis in cirrotic patients admited in two services of internal medicine in hospitals of median complexity

La peritonitis bacteriana espontánea (PBE) es una complicación severa de la cirrosis hepática (CH). Su pronóstico depende del momento de inicio de la terapia para lo que se requiere un diagnóstico oportuno. Objetivo: Evaluar la realización de paracentesis diagnóstica (PD) en cirróticos con ascitis durante su hospitalización. Materiales y métodos: Estudio observacional, analítico y prospectivo, realizado en un período de 11 meses consecutivos. Resultados: Se registraron 92 ingresos, el promedio de edad fue de 60,3 años (DE 11,7), correspondiendo un 57,6% a hombres, la etiología de CH más frecuente fue alcohólica (48,9%). Se realizaron 40 PD (43,5%), de ellas 35% con PBE positiva. Del total de PD, un 47,5% se efectuaron al ingreso y/o al presentar signos de alarma. El promedio de días de hospitalización fue mayor en aquellos en que se realizó la PD tardíamente. El MELD (Model for the End stage Liver Disease) tanto al ingreso como egreso es significativamente mayor en los pacientes puncionados al ingreso. Conclusión: Se realiza PD en menos de la mitad de los cirróticos hospitalizados, siendo su realización oportuna solo en 1 de cada 5 de los ingresos. El realizar PD en el momento adecuado disminuye los días de hospitalización y morbimortalidad.

The Spontaneous Bacterial Peritonitis (SBP) is a severe complication of cirrhosis. The prognosis depends on the time of initiation of therapy that is required for early diagnosis. Objective: To evaluate the performance of diagnostic paracentesis (DP) in cirrhotic patients with ascites during hospitalization. Materials and methods: An observational, analytical, prospective, study conducted during October 2009 to June 2010. Results: There were 92 income, average age was 60.3 years (SD 11.7), corresponding to 57.6% men, the most common etiology of CH was alcohol (48.9%). There were 40 PD (43.5%), of which 35% positive SBP. Of the DP, 47.5% were performed on admission and / or submission of warning signs. The average period of hospitalization was higher in those who underwent late DP. The MELD score both at admission and discharge was significantly higher in patients on admission punctured. Conclusion: DP was done in less than half of hospitalized cirrhotic, and its timely completion only 1 in 5 of revenues. The DP perform at the right time reduces hospital days.

Peritonitis secundaria a perforación intestinal en un paciente en diálisis peritoneal / Peritonitis after bowel perforation in a patient on peritoneal dialysis

Paciente masculino de 61 años con insuficiencia renal crónica terminal por nefroangiesclerosis; con tratamiento de diálisis peritoneal desde hace 20 meses. Comenzó con un cuadro de dolor abdominal difuso y tolerable asociado a un líquido de diálisis peritoneal turbio, amarillo verdoso fosforescente; este apareció después de manipular el catéter de diálisis peritoneal porque estaba disfuncional. Se realizó la química del líquido peritoneal y se informó bilirrubina directa sin existir un síndrome ictérico; en el cultivo del líquido peritoneal se encontró Escherichia coli. Al no ser fecaloideo el líquido peritoneal, por el alto riesgo quirúrgico de este paciente y por los antecedentes de peritonitis anteriores, se comenzó un tratamiento médico con antibioticoterapia de amplio espectro intraperitoneal y sistémico, combinado con lavados peritoneales y el cambio a hemodiálisis para continuar su tratamiento depurador. Su evolución fue favorable sin necesidad de tratamiento quirúrgico. Este caso demuestra lo complejo de la valoración clínica en este tipo de paciente, que resulta cada vez más frecuente en las instituciones de salud.

A 61 year-old male patient with chronic terminal renal failure due to nefroangiesclerosis; with peritoneal dialysis for 20 months, began with tolerable diffuse abdominal pain associated with a turbid peritoneal dialysis fluid which was fluorescent yellow-green. This appeared after handling peritoneal dialysis catheter because it was dysfunctional. Chemical study of peritoneal fluid was performed and direct bilirubin was reported to exist without jaundiced syndrome. Escherichia coli were found in the peritoneal fluid culture. Medical treatment was started with intra-peritoneal antibiotic therapy and systemic broad-spectrum since it was not fecaloid peritoneal fluid and due to the high surgical risk of this patient and his previous history of peritonitis. This treatment was combined with peritoneal washings and switching to hemodialysis to continue their scrubber treatment. Its outcome was favorable without surgical treatment. This case shows the complexity of the clinical assessment in this type of patient, which is increasingly prevalent in healthcare institutions.

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350g (321.29±11.31g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.

Peritonitis meconial: experiencia clínica / Meconial peritonitis: a clinical experience

Meconial Peritonitis (MP) is a chemical, sterile, inflammatory reaction of the visceral and parietal peritoneum, intestinal loops and mesenterium, produced by a prenatal intestinal perforation. MP can be classified into meconial ascitis, simple, fibroadhesive, and giant cyst. The natural evolution may follow various courses. Objective: Describe the spectrum of clinical presentation and management in a series of patients with MP. Patients and Methods: Retrospective study of patients with MP manageg between 2000 and 2009. Results: 5 patients were found: 1 giant cyst, 2 simple MP and 2 fibroadhesive. 4 required surgery. All required proki-netics and were fed early. Evolution was satisfactory in 4 (80 percent), one died in the neonatal stage. Discussion: Sonography and magnetic resonance (rarely) may provide the prenatal diagnosis. At birth, they must be closely observed to decide surgical management according to evolution. Spontaneous sealing of the perforation is seen in 1 of 5 (20 percent) in our series, reestablishing intestinal continuity without requiring surgery. Early feeding and prokinetics are basic elements in management. Conclusion: MP is a serious neonatal pathology, its morbidity and mortality may be decreased through adequate management in the neonatal period. Clinical observation should determine treatment, which ranges from spontaneous resolution to abdominal surgical repair with intestinal resection, ostomy or primary anastomosis.

La peritonitis meconial (PM) es una reacción inflamatoria de origen químico, estéril, del peritoneo visceral y parietal, asas intestinales y mesenterios, producida por una perforación intestinal prenatal. La PM se clasifica en: ascitis meconial, PM simple, fibroadhesiva y quiste gigante. La evolución natural sigue distintos cursos. El objetivo de este trabajo es describir el espectro de presentación clínica en una serie de pacientes con Peritonitis meconial y su tratamiento. Pacientes y Método: Estudio retrospectivo de pacientes con PM, manejados entre los años 2000 y 2009. Resultados: Muestra de 5 pacientes, 1 con PM tipo quistes gigantes, 2 con PM simple y 2 con el tipo fibroadhesivo. Cuatro requirieron cirugía. Todos requirieron prokinéticos y fueron alimentados precozmente. La evolución inmediata y alejada fue satisfactoria en 4 (80 por ciento). Un paciente fallece en el período neonatal. Conclusión: La PM es una patología grave del período neonatal cuya morbimortalidad asociada puede ser atenuada mediante una adecuada sospecha diagnóstica y un manejo expectante en el período neonatal, para definir la mejor alternativa terapéutica, que va desde la evolución espontánea a la mejoría hasta exploración quirúrgica abdominal con resección intestinal y ostomía o anastomosis primaria.

Causas, tratamiento y complicaciones de la peritonitis difusa en un hospital de la periferia de Luanda / Causes, treatment and complications of the diffuse peritonitis in a hospital of Luanda periphery

Se realizó un estudio descriptivo, longitudinal y retrospectivo de 34 pacientes con peritonitis difusa secundaria, extendida a los 4 cuadrantes de la cavidad peritoneal, intervenidos quirúrgicamente en el Hospital General de Luanda durante el período comprendido desde agosto del 2008 hasta julio del 2009. Las afecciones causales más frecuentes fueron las perforaciones tíficas (en las cuales se utilizó la enterorrafia) y la apendicitis aguda, en tanto la complicación posoperatoria más común resultó ser la dehiscencia de sutura. En la casuística, 6 de sus integrantes experimentaron reintervenciones y 5 fallecieron. La perforación intestinal es una complicación grave de la fiebre tifoidea, cuya frecuencia se incrementa en áreas endémicas y puede ser la primera causa de peritonitis generalizada o difusa aguda

A descriptive, longitudinal and retrospective study of 34 patients with secondary diffuse peritonitis, extended to the 4 quadrants of the peritoneal cavity, surgically treated in the General Hospital of Luanda was carried out from August, 2008 to July, 2009. The most frequent causal affections were the typhic perforations (in which enterorrhaphy was used) and the acute appendicitis, the most common postoperative complication turned out to be the suture dehiscence. In the case material, 6 of its members experienced reinterventions and 5 died. The intestinal perforation is a serious complication of the typhoid fever whose frequency is increased in endemic areas and it can be the first cause of acute diffuse or sistemic peritonitis

Influência do treinamento na evolução da diálise peritoneal / Influence of training on the progression of peritoneal dialysis

Objetivo: Conhecer a influência do cuidador no treinamento da diálise peritoneal (DP) e no tempo livre de peritonite. Método: Estudo retrospectivo com 38 pacientes prevalentes, atendidos na Diálise Ambulatorial do Hospital das Clínicas/Botucatu, que receberam treinamento para DP pela mesma enfermeira. Avaliaram-se: 1) o responsável pela técnica de diálise (paciente ou cuidador); 2) o treinamento (tempo dispensado e desempenho atingido); 3) o tempo livre de peritonite. Foram realizadas regressão logística e análise de sobrevivência por Kaplan-Meyer. Resultado: A DP foi realizada por umcuidador em 71% (N=27) dos pacientes. Dos diabéticos, 89% (N=16) necessitavam de cuidador e 11% (N=2) realizaram o próprio tratamento (p<0,05); quanto à idade, 26% (N=10) apresentavam mais de 65 anos e, destes, 90% (N=9) tinham o cuidador para DP (p=0,05); dos pacientes provenientes de outras localidades (N=23), 74% (N=17) necessitavam do cuidador (p=0,07). O treinamento foi concluído no tempo médio por 71% (N=27), e 79% (N=30) obtiveram desempenho bom, sem diferenças quanto ao responsável pela técnica. A probabilidade de permanecer livre de peritonite no primeiro ano detratamento foi maior quando o cuidador realizava a DP, sendo 54% para o paciente e 78% para o cuidador (p<0,05). Conclusão: Pacientes com mais de 65 anos e diabéticos necessitaram de cuidador na diálise. No treinamento, tempo dispensado e desempenho atingido não diferiram quanto ao responsável pela técnica. O tempo livre de peritonite foi maior para os pacientes em que a diálise foi realizada por cuidador. O responsável pela diálise (paciente ou cuidador) pode influenciar na evolução da DP.

Objective: To evaluate the influence of the caretaker on the training time of peritoneal dialysis (PD) and peritonitis-free time. Method: Retrospective medical record review of 38 patients receiving PD training from the same nurse at the Dialysis Unit of Botucatu Medical School Hospital. Assessment included: 1) home PD provider (patient or caretaker); 2) training (length and performance achieved); 3) peritonitis-free time. Result: In 71% (N=27) of the cases, PD was performed by a caretaker. Among diabetic patients, 89% (N=16) were supported by a caretaker, and 11 % (N=2) performed their own dialysis (p=0.03); 26% (N=10) were over 65 years of age, with 90% (N=10) of them having a PD caretaker (p=0.05). Among patients from other areas (N=23), 74% (N=17) were supported by a PD caretaker (p=0.07). Training was concluded after the mean time by 71% (N=27) and a good performance level was achieved in 79% (N=30) of the cases with no difference between provider type. The probability of the patient remaining peritonitis-free over the first year was higher when PD was performed by a caretaker (patient= 54%; caretaker = 78%; p<0.05). Conclusion: The presence of caretakers was more frequent among the patients who were over 65 years of age or diabetic. With respect to training, length of time and performance did not differ according to the person responsible for technique. Peritonitis-free time was longer among patients supported by caretakers. The PD provider (patient or caretaker) may influence PD results.

Development of a lethal model of peritonitis for assessment of laparoscopic and laparotomic treatments in rats

PURPOSE: Development of a lethal model of peritonitis to assess the results of treating that peritonitis using videolaparoscopy and laparotomy. METHODS: We developed a model of peritonitis in rats using cecal ligation (CLP) against a 2-mm diameter rigid mold and puncture. Two experiments were performed: determination of seven-day lethality; and analysis of white cell counts, blood cultures and cytokines (Interleukin-1 beta, Tumor Necrosis Factor-alpha and IL-6). The animals were divided into four groups: I - Sham surgery; II - CLP; III - CLP + Videolaparoscopy; and IV- CLP + Laparotomy . RESULTS: Seven-day lethality was 0 percent in group I, 80 percent in the group II (p<0.05), 60 percent in group III , and 20 percent in group IV. There was a significant reduction in leukocyte counts and higher levels of serum IL-1 beta, TNF-alpha and IL-6 in the group II compared to controls. The percentages of positive blood cultures were higher after videolaparoscopic compared to laparotomic treatment. CONCLUSION: The experimental model provoked a lethal form of peritonitis and that videolaparoscopic treatment had more bacteraemia than laparotomy.

OBJETIVO: Desenvolvimento de um modelo letal de peritonite para avaliar o tratamento desta peritonite por videolaparoscopia e laparotomia. MÉTODOS: Foi desenvolvido um modelo de peritonite em ratos utilizando ligadura do ceco (CLP) contra um molde rígido de 2mm de diâmetro, seguido de punção do órgão. Dois experimentos foram realizados: determinação da letalidade de 7 dias; e análise da leucometria, hemocultura e dos valores de citocinas (Interleucina-1 beta, TNF-alfa e IL-6). Os animais foram divididos em quatro grupos: I - Cirurgia simulada; II - CLP; III - CLP + Videolaparoscopia; e IV- CLP + Laparotomia . RESULTADOS: A letalidade de sete dias foi de 0 por cento no grupo I, 80 por cento no grupo II (p<0.05), 60 por cento no grupo III , e 20 por cento no grupo IV. Houve uma redução significativa na contagem de leucócitos e maiores níveis de citocinas séricas no grupo II quando comparado com o grupo controle. A porcentagem de hemoculturas positivas foi maior após videolaparoscopia quando comparado com o tratamento por laparotomia. CONCLUSÃO: O modelo experimental provocou uma forma de peritonite letal e que o tratamento por videolaparoscopia apresenta maiores taxas de bacteremia que o tratamento por laparotomia.

Peritonitis purulenta diseminada: tratamiento con lavado peritoneal a gran volumen / Bacterial peritonitis high volumen lavage treatment

Objetivo: definir el tratamiento apropiado de los pacientes con peritonitis purulenta diseminada mediante el uso de lavado peritoneal con gran volumen (LPGV). Características: estudio prospectivo, comparativo. Lugar: Hospital de Emergencias "José Casimiro Ulloa" Lima - Perú. Pacientes: 50 pacientes con peritonitis purulenta diseminada, más heces en cavidad peritoneal, que fueron operados usando la técnica de LPGV. Previamente se evaluaron 100 casos similares operados sin LPGV con la finalidad de comparar nuestros nuevos resultados. Intervención: todos los pacientes recibieron antibióticos pre-operatorios (cloramfenicol y gentamicina), se les practicó laparotomía exploratoria para solucionar la causa de la peritonitis; se usaron en promedio 26 litros (20-42) de agua estéril tibia para lavado peritoneal, logrando erradicar la pus y la fibrina depositada entre las asas intestinales. Evaluación: El LPGV puede curar los caso de peritonitis purulenta diseminada. resultados: Los 50 pacientes del estudio prospectivo tratados con LPGV fueron intervenido una sola vez y no presentaron complicaciones quirúrgicas, asimismo, se disminuyó la estancia hospitalaria. La evaluación de 100 casos de patología similar operados antes de usar este método presentaron 3 por ciento de mortalidad, 81 por ciento de morbilidad y 19 por ciento de re-operaciones. Conclusiones: El LPGV puede curar al paciente con peritonitis purulenta diseminada en la primera intervención, sin complicaciones quirúrgicas.

Peritonitis difusas: actualización y tratamiento / Diffuse peritonitis: updating and treatment

A pesar de los progresos alcanzados en el tratamiento intensivo del paciente quirúrgico, la introducción de nuevos antimicrobianos, y el perfeccionamiento de las técnicas quirúrgicas, la mortalidad por peritonitis difusa permanece alarmantemente elevada. La mejor comprensión de los fenómenos fisiopatológicos que acompañan al proceso infeccioso peritoneal y el conocimiento de los mediadores químicos inflamatorios, no han logrado una mejoría sustancial en la supervivencia de estos pacientes. El diagnóstico se basa fundamentalmente en la valoración clínica, auxiliado por métodos complementarios e índices predictivos. El manejo quirúrgico precoz en cualquiera de sus formas, constituye el pilar fundamental de un tratamiento exitoso, complementado con un soporte general efectivo. El fracaso del tratamiento se debe a la persistencia de la infección peritoneal y dehiscencia de suturas intestinales. Las primeras causas de muerte son las fístulas, disfunción múltiple de órganos y sangramiento digestivo alto(AU)

Despite the progress made in the intensive treatment of operated patients, the introduction of new antimicrobials and the betterment of surgical techniques, mortality rates from diffuse peritonitis are still alarmingly elevated. A better understanding of physiopathological phenomena which accompany an infective peritoneal process and knowledge of the chemical inflammatory mediators have not yet led to a substantial improvement in the survival rate of these patients. The diagnosis is mainly based on a clinical assessment aided by supplementary methods and predictive indexes. Early surgical managment in any form is a basic foundation for a successful treatment backed up by an effective general support. The treatment fails due to a persistent peritoneal infection and dehiscence in intestinal sutures. The first causes of death are fistulae, multiple organ failure and .high digestive bleeding(AU)