[Non-occlusive Mesenteric Ischemia caused by Diabetic Ketoacidosis - Pneumatosis intestinalis and Portal Venous Gas as an Indication of Mesenteric Ischemia]. / Nicht-okklusive Mesenterialischämie bei diabetischem Koma.

HISTORY: A 67-year-old woman was found lying naked on the bathroom floor for at least the last 12 hours. She had a medical history of insulin-dependent diabetes mellitus type 2 and a resection of the cecal pole. EXAMINATIONS: The patient was hypotonic (60/40 mmHg), hypothermic (29 °C) and hyperglycemic. The bowel sounds were sparse. There was a severe metabolic acidosis (pH 6.7). A Urinalysis showed a high concentration of ketone bodies. An abdominal ultrasonography revealed air reflexes in the liver parenchyma. A computer tomography was used to diagnose an acute mesenteric ischemia (AMI) with pneumatosis intestinalis and portal venous gas. TREATMENT: In an exploratory laparotomy the finding of necrotic bowl made it necessary to resect 160 cm of the small intestine as well as the remaining ileum and right hemikolon during a second surgery on the following day. Histopathologically there was no evidence for an occlusive genesis in the resected specimen. CONCLUSION: The clinic of the AMI is manifold - with fatal consequences in case of delayed diagnosis. Serum parameters are often overestimated. In this case report a diabetic coma was responsible for the AMI. The diagnosis was based on sonographic imaging followed by computed tomography, so that the life-saving operation could be performed. Therefore, sonography should be considered as a mandatory examination of critically ill patients.

Do antibacterial skin sutures reduce surgical site infections after elective open abdominal surgery? - Study protocol of a prospective, randomized controlled single center trial.

BACKGROUND: Surgical site infections (SSI) remain one of the most common complications in conventional abdominal surgery with an incidence between 4% and 19% (Sandini et al., Medicine (Baltimore) 95:e4057, 2016) in the literature. It is unclear whether the use of coated suture material for skin closure reduces the risk of SSI. In line with in-vitro results, we hypothesize that the use of antibacterial skin sutures (triclosan-coated poliglecaprone 25) reduces the rate of SSI after open abdominal surgery. METHODS/DESIGN: To prevent SSI, triclosan-coated poliglecaprone 25 sutures will be tested against un-coated suture material for skin closure after elective open abdominal surgery of 364 patients. The study is planned as a single-center, prospective randomized controlled trial. Patients will be followed for 30 days after surgery to detect and document wound complications. The rate of SSI after 30 days will be analyzed in both groups. DISCUSSION: If we can confirm the proposed hypothesis in our study, this could be a promising and feasible approach to lower SSI after open abdominal surgery. By lowering the rate of SSI this might offer a cost-saving and morbidity-reducing procedure. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00010047 . Registered on 05.01.2017.