Non-traumatic ruptured splenic abscess presenting with pneumoperitoneum in an immunocompetent patient: a diagnostic dilemma.

Splenic abscess is a rare life-threatening clinical entity. There are only a handful of reported cases of spontaneous splenic abscess rupture with pneumoperitoneum. Rupture of splenic abscess associated with gas-producing pathogens may lead to pneumoperitoneum. We hereby report the case of a ruptured splenic abscess with pneumoperitoneum in a young immunocompetent woman masquerading as hollow viscus perforation peritonitis. Ruptured splenic abscess should be kept in mind for treating surgeons as a differential diagnosis of pneumoperitoneum or peritonitis, particularly for immunocompromised patients.

[Possibilities of surgical treatment for advanced multiresistant pulmonary tuberculosis].

The results of surgical treatment of 37 patients, suffering relatively advanced pulmonary tuberculosis (PT), were analyzed. Chemoresistant PT was revealed in 35 (94.6%) observed patients, and multiresistant one--in 30 (81.1%). Preoperative preparation during 2-3 mo was conducted in two main directions: administration of a line II antibacterial preparations and a pneumoperitoneum (PP) establishment. A main operative procedure was resection. Intrapleural thoracoplasty in our own modification have constituted a seconf direction of treatment, it consisted obligatory of the 5 ribs resection. Initially a rib V was partially resected 8-10 cm in length, and a rib I was excised completely. Complications were absent. The patients were discharged from the hospital in 2-3 mo postoperatively. PP in 34 (91.9%) patients was completed in a same terms. In a remote postoperative period (1-4 yrs) a tuberculosis reactivation was absent. All operated patients were bacilli free.

Severe pneumoperitoneum caused by infected pelvic hematoma: report of a case and review of the literature.

BACKGROUND: Pneumoperitoneum usually is caused by hollow viscus perforation with associated peritonitis. Severe pneumoperitoneum secondary to infection of a hematoma with gas-forming organisms is exceedingly rare. METHODS: Case report and literature review. RESULTS: A 43-year-old man with a history of abdominoperineal resection for rectal cancer developed abdominal distention, fever, and elevated white blood cell count after lysis of adhesions with bowel resection for recurrent small bowel obstruction. Abdominal radiography and a computed tomography scan demonstrated a large amount of free air in the peritoneal cavity. Contrary to expectations, reexploration revealed no signs of viscus perforation or anastomotic leak, but instead a large pelvic hematoma with an odor was identified and evacuated. Cultures from the hematoma yielded anaerobic gram-negative bacilli (not Bacteroides fragilis). The patient recovered uneventfully. CONCLUSION: Infected hematoma should be recognized as a cause of pneumoperitoneum after surgery. Awareness of this rare condition may prevent unnecessary surgical explorations in doubtful situations.

Analysis of the bactericidal effect of ozone pneumoperitoneum / Análise do efeito bactericida do pneumoperitônio de ozônio

PURPOSE: To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS: It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42µg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62µg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS: Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION: Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.

OBJETIVO: Avaliar a ação bactericida do pneumoperitônio de ozônio comparando-o à ação do CO2. MÉTODOS: Foram utilizados 36 ratos Wistar. Após anestesia e inoculação de 2ml de E. coli ATCC na concentração de 10(10) UFC e 1ml de BaSO4 na cavidade peritoneal, os animais foram divididos em três grupos: Grupo 1, realização de pneumoperitônio de CO2 por 15 minutos; Grupo 2, realização de pneumoperitônio de ozônio durante 5 minutos na concentração de 42µg/ml, e Grupo 3, realização de pneumoperitônio de ozônio durante 5 minutos na concentração de 62µg/ml. Seis animais de cada grupo foram sacrificados após experimento e os outros seis foram observados por 24 horas. Em todos os animais colheu-se material da cavidade para estudo microbiológico. RESULTADOS: O ozônio teve maior efeito bactericida em comparação ao CO2 nos animais sacrificados logo após pneumoperitônio. Nos animais estudados após 24 horas não houve diferença do efeito bactericida entre os gases. Também não se observou alteração da mortalidade. CONCLUSÃO: O ozônio tem efeito bactericida mais potente que o gás carbônico, embora não tenha influenciado a sobrevida dos animais.

Effects of pneumoperitoneum on hemodynamic and systemic immunologic responses to peritonitis in pigs.

BACKGROUND: Experimental evidence supporting the safety of laparoscopic intervention during sepsis is limited. The purpose of this study was to evaluate the effects of pneumoperitoneum on immunologic and hemodynamic responses to peritoneal sepsis. MATERIALS AND METHODS: A porcine model of peritonitis was created using an intraperitoneal autologous fecal inoculum. Pigs were then subjected to one of four procedures 24 h postinoculation (n = 6 per group): laparotomy, CO(2) laparoscopy, helium laparoscopy, and anesthesia only (1.5% isoflurane in 100% O(2), mechanical ventilation). Venous blood samples were obtained prior to inoculation, and at 24 (prior to procedure), 30, 48, 72, and 96 h postinoculation to determine white blood count (WBC) with differential, C-reactive protein (CRP), tumor necrosis factor, and bacteremia. Heart rate, end-tidal CO(2) (ETCO(2)), mean arterial blood pressure (MAP), and arterial blood gas variables were also measured at baseline and every 30 min throughout the procedure. RESULTS: Postoperative blood cultures confirmed systemic bacteremia in all groups at all time periods postinoculation. Following inoculation, WBC, band cell count, and CRP remained elevated above baseline in all groups throughout the study (P < 0.01). However, no significant differences in these parameters were observed among groups. In the CO(2) laparoscopy group, MAP, ETCO(2), and arterial pCO(2) were increased above baseline, while pH was decreased throughout the procedure (P < 0.01). CONCLUSIONS: In this animal model of peritonitis, CO(2) pneumoperitoneum induced hypercapnia, acidemia, and systemic hypertension intraoperatively, without a discernable effect on systemic immune function.

Effect of carbon dioxide pneumoperitoneum on bacteraemia and endotoxaemia in an animal model of peritonitis.

Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteraemia. This study examines the effect of carbon dioxide pneumoperitoneum on bacteraemia, endotoxaemia and physiological correlates of sepsis in an animal model of peritonitis. New Zealand white rabbits were assigned to three groups of six animals. Group 1 received an intraperitoneal inoculation of 10(9) colony-forming units of Escherichia coli followed by a 10-cm midline laparotomy. Group 2 received an identical bacterial inoculum followed by a 12-mmHg carbon dioxide pneumoperitoneum for 1 h. Group 3 received no bacteria but had a 12-mmHg carbon dioxide pneumoperitoneum for 1 h. Groups 1 and 2 had significantly higher levels of bacteraemia (P < 0.01) and endotoxaemia (P < 0.01) accompanied by significantly lower mean arterial pressures (P < 0.05) and higher heart rates (P < 0.05) compared with group 3. After 6 h groups 1 and 2 were significantly hypocarbic (P < 0.01), leucopenic (P < 0.01) and thrombocytopenic (P < 0.01). There was no difference between group 1 and group 2. A carbon dioxide pneumoperitoneum of 12 mmHg does not increase bacteraemia or endotoxaemia, nor does it adversely affect physiological or laboratory correlates of sepsis compared with laparotomy in this animal model of peritonitis.