RESUMO
Three cases of overdistension and rupture of the stomach complicating bleeding ulcer are reported. Despite early surgery two of the patients died of multiorgan failure and rebleeding. The pathogenesis, clinical picture and treatment of this rare condition are discussed. The literature is reviewed.
Assuntos
Úlcera Duodenal/complicações , Úlcera Péptica Hemorrágica/complicações , Gastropatias/etiologia , Úlcera Gástrica/complicações , Idoso , Úlcera Duodenal/cirurgia , Humanos , Masculino , Úlcera Péptica Hemorrágica/cirurgia , Ruptura Espontânea , Gastropatias/cirurgia , Úlcera Gástrica/cirurgiaRESUMO
Pyogenic liver abscess is a serious condition with a high mortality rate. New diagnostic techniques have improved the diagnostic accuracy. Alternative therapeutic methods to open surgical drainage, such as percutaneous drainage and in certain cases antibiotics alone, are now available. Have changes in management of liver abscesses at our hospital improved the outcome? Two 5-year periods (I: n = 12; II: n = 14) were compared concerning diagnostic procedures, principles of treatment, and outcome. A shift from scintigraphy in the first period (I) to ultrasonography (US) in the second period (II) as prime diagnostic procedure was obvious. In I open surgical drainage dominated. 4/12, major surgical risks, were treated by anti-aerobic drugs alone, and died. In II US-guided percutaneous drainage was performed in 7/14, together with antibiotics active against aerobes as well as anaerobes, without complications. 4/14 were treated by an antibiotic combination alone and only 3/14 were treated by open surgical drainage. The change in management during these two periods has resulted in improved diagnostic and therapeutic routines as demonstrated by reduction in mortality rate.