[A case of acute chylous peritonitis treated with ultrasound-guided intranodal lymphangiography].

An 80-year-old woman presented with acute abdominal pain and distention. A diagnosis of acute chylous peritonitis was made via contrast-enhanced computed tomography and abdominal paracentesis. She underwent ultrasound-guided intranodal lymphangiography with Lipiodol® (IL with Lipiodol), and her persistent abdominal pain was significantly reduced within a day. Moreover, her ascitic fluid showed marked improvement and paracentesis was no longer needed. Based on the findings of the study, IL with Lipiodol could be a promising minimally invasive approach in the treatment of acute chylous peritonitis.

Intussusception in children: experience with 105 patients in a department of paediatric surgery, Turkey.

AIM: The aim of this study was to present our experience in patients with intussusception (IN). MATERIALS AND METHODS: One hundred and five cases of IN treated between 1991 and 2007 were analysed. Age, gender, symptoms, signs, diagnostic and treatment methods, types of IN including leading point, and postoperative complications were evaluated. RESULTS: The mean age of the patients was 2.5 years (range 1 month - 15 years). Fifty-nine per cent (62/105) were under 1 year of age, and of these 28% were receiving therapy for upper respiratory tract infection. The most common symptom was colicky abdominal pain. Rectal bleeding was present in all patients under 2 years of age. In 23 children (21.9%) leading points were detected. Thirty per cent of the patients were older than 4 years, and 76.6% of these had leading points. Ultrasonography demonstrated the invaginated segment in 93 patients. Hydrostatic reduction was attempted in 71.4% (75) of the patients and was successful in 48% (36), 70% of whom were under 1 year of age. Of the patients with unsuccessful hydrostatic reduction, 11 required intestinal resection and primary anastomosis and 35 manual reduction. Twenty-four patients were diagnosed by means of ultrasonography and were operated on immediately. Ten of these patients had signs of peritonitis on admission and were treated by resection-primary anastomosis. CONCLUSION: In patients with IN under 2 years of age, hydrostatic or pneumatic reduction may be successful. Considering the high incidence of leading points in older children, one should not persist with reduction but should rather design a treatment plan accordingly, i.e. laparotomy with manual reduction or resection.

Radiographic findings before and after oral administration of a magnet in cows with traumatic reticuloperitonitis.

OBJECTIVE: To evaluate by use of radiography the efficacy of oral administration of magnets in the treatment of traumatic reticuloperitonitis in cows. ANIMALS: 90 cows referred because of indigestion. PROCEDURE: Radiography of the reticulum was performed. In all cows, radiographic findings revealed a metal foreign body in the reticulum. A magnet was administered orally, and the reticulum was again radiographed to assess the position of the magnet and to determine whether the foreign body was attached to the magnet. RESULTS: The magnet was observed in the reticulum in 75 cows and in the cranial aspect of the dorsal sac of the rumen in 9 cows; in 6 cows, the magnet was not observed. The foreign body was fully attached to the magnet in 49 cows. In 6 cows, the foreign body was in contact with the magnet but still penetrated the reticulum. In 24 cows, the foreign body did not contact the magnet, and in 11 cows, it was not clear whether the foreign body was attached to the magnet. A foreign body at an angle to the ventral aspect of the reticulum of > 3 degrees was less likely to become attached to a magnet, compared with a foreign body situated horizontally on the ventral aspect of the reticulum. A foreign body with no contact to the ventral aspect of the reticulum or a perforating foreign body was also less likely to become attached to a magnet. CONCLUSIONS AND CLINICAL RELEVANCE: Position of the foreign body within the reticulum greatly influences the efficacy of treatment with a magnet.

Value of sonography including color Doppler in the diagnosis and management of long standing intussusception.

15 cases of intussusception with presenting symptoms of more than 24 h duration were studied by sonography and Doppler. The aim of the study was to determine the validity of the sonographic criteria of peritonitis and bowel ischaemia in order to reduce the risk of colonic perforation and to increase confidence in achieving a successful hydrostatic reduction. The results were reviewed retrospectively and cases divided into 2 groups. Cases in group 1 were reducible by barium enema while those in group 2 required surgical intervention. Sonographic features of peritonitis were absent in all cases of group 1 and 3 cases of group 2. These 3 cases were reduced manually at surgery while the other 5 cases in group 2 with positive features of peritonitis required bowel resection. Blood flow was documented by colour flow Doppler in all cases except the 3 cases with gangrenous bowel in group 2. When sonographic features of peritonitis and loss of blood flow to the intussusception are present in late intussusception, surgical intervention is required. On the other hand, enema reduction should be pursued when such features are absent.

The initial management of left lower quadrant peritonitis.

The majority of patients admitted to the hospital with left lower quadrant peritonitis and suspected acute diverticulitis are treated empirically without colon radiography either for the duration of their hospital course, or until such time as it is deemed safe to perform a barium enema to confirm this diagnosis. Unlike barium, a water-soluble contrast agent such as Gastrografin can be used safely and accurately immediately on hospitalization. Early establishment of an accurate diagnosis can help eliminate complications, morbidity, mortality, and lengthy hospitalizations. Seventy-one patients admitted with left lower quadrant peritonitis, temperatures above 99.5 degrees F, and leukocytosis were evaluated. Treatment either was based on a diagnosis established by results of a barium enema or water-soluble contrast enema, or was empiric in nature. The early use of a water-soluble contrast enema in the elucidation of the cause of left lower quadrant peritonitis proved to be the most accurate and also the most cost-effective means of diagnosis.

The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis.

The traditional work-up of patients with lower left quadrant peritonitis often includes the eventual use of barium-enema radiography. Diagnosis is usually delayed until adequate patient stabilization allows diagnostic contrast enemas. Delay of accurate diagnosis may, at times, have serious clinical sequelae. The use of barium enema in acute lower left quadrant peritonitis has both theoretic and actual disadvantages. These include extravasation of barium, with resultant barium cellulitis and peritonitis, precipitation of acute obstruction, and delay in evaluation by endoscopy, sonography, computerized tomography, and angiography. Forty recent cases of lower left quadrant peritonitis were evaluated on admission by water-soluble contrast enema. Water-soluble contrast enemas appear to be safe and accurate and avoid the aforementioned disadvantages of barium.

Barium peritonitis.

A case of generalized peritonitis, secondary to a rupture of the rectosigmoid portion of the colon is presented. The surgical management is discussed, a basic part of which is the use of a Baker tube to splint the small intestine while adhesions form in a pattern along the tube, as a substitute method for a Nobel plication, to prevent chronic small intestinal obstruction. Extensive lavage of the peritoneal cavity should also be carried out. Energetic fluid replacement with careful monitoring of the fluid and electrolyte balance is essential before, during and after the surgical procedure. Adequate broad spectrum antibiotic coverage is important. We believe that the management of these cases should be by surgical intervention and institution of the above mentioned measures and not by expectant therapy and treatment of complications.