Specific but limited role of new imaging techniques in decision-making about intraabdominal abscesses.

Despite the very high accuracy rate of imaging studies (ultrasound, computed tomography, liver-lung-spleen scans and gallium-67 scans) in detecting intraabdominal abscesses, our experience with 80 recent cases indicate that these techniques have not significantly altered traditional methods of decision-making about when and where to drain such abscesses. In only 12.5 percent of cases were such decisions based on special imaging techniques alone, and most of these cases subphrenic abscesses were diagnosed late after surgery. In the remainder, physical examination and routine radiologic studies sufficed, with special imaging techniques primarily corroborating clinical evidence based on these methods. We conclude that the use of special imaging techniques alone in a search for the cause of fever early after abdominal surgery does not provide evidence upon which clinical decisions can be based unless there are already physical signs of an abscess.

Controlled, semielective, segmental resection for massive colonic hemorrhage.

An aggressive diagnostic work-up to determine the site of bleeding was employed in all 25 patients requiring transfusion of over 1,500 cc of blood for colonic hemorrhage in New Haven in 1977 and 1978. A specific bleeding site that permitted segmental colectomy was found in 23 patients (92 percent). The mortality rate was zero, reflecting the rapid improvement in survival that has occurred in the last decade among patients with massive colonic hemorrhage.

Femoral neuropathy secondary to anticoagulant therapy.

Two patients with femoral neuropathy resulting from compression by spontaneous hematoma of the iliopsoas muscle while on anticoagulant therapy, were definitively diagnosed preoperatively by CT scan. Early decompression of the femoral nerve, after correcting the coagulopathy, is recommended to assure optimal chances for relief of pain and recovery of neurological function.