Case report: Colon ischemia and perforation as a result of Norovirus infection.

INTRODUCTION: Norovirus (NoV) gastroenteritis has been documented as the worldwide leading cause of the majority of acute cases of viral gastroenteritis. Here, we present a Case of NoV that progressed into colon perforation. PRESENTATION OF CASE: A 47-year-old woman was admitted via the emergency unit with diarrhoea, lower abdominal pain, vomiting and fever. The virological testing of her stool revealed a NoV infection. The abdominal CT scan showed massive pneumatosis intestinalis. Following the scan findings, the patient was admitted for a diagnostic laparotomy the same day. A side-to-side ileosigmoidostomy was performed. We performed two clinical re-evaluations of the patient, the first one took place 2 weeks after we discharged the patient and another one-year later. The patient is in perfect health. DISCUSSION: To the best of our knowledge and following a thorough bibliographical search, this is the first case report in Germany and the first case report of colon perforation due to NoV infection in adults in the European Union. CONCLUSION: A NoV infection could, along with the typical symptoms, indicate a life-threatening bowel ischemia and/or necrosis.

[Open abdomen 2009. A national survey of open abdomen treatment in Germany]. / Offenes Abdomen 2009. Umfrage zu Behandlungsstrategien des offenen Abdomens in Deutschland.

BACKGROUND: Open abdomen (OA) treatment has been established worldwide. This survey examines the current status of OA treatment in Germany. MATERIAL AND METHODS: A national survey was conducted between October 2008 and September 2009 by questionnaires sent to 1,219 surgical departments. Data were evaluated descriptively. RESULTS: The response rate was 38% overall and 69% for university departments. Open abdomen treatment is used by 94% of all respondents. Most commonly used are staged abdominal lavage (87%), a commercial abdominal dressing system (82%), planned ventral hernia (69%), and other intra-abdominal dressings (e.g. vacuum pack 15%, Bogotá bag 5%). Nearly half of the respondents (46%) indicated a modification of their strategy towards vacuum techniques during the last 5 years. CONCLUSIONS: Open abdomen procedures are widely used in German surgical departments. This survey indicates a shift of treatment strategies towards vacuum techniques but even though predominant, the effectiveness and safety of these techniques must still be confirmed by prospective controlled trials. This survey helps to identify relevant clinical questions and enables focused trial networking.

Enteral vs parenteral nutrition in reconstructive anal surgery--a prospective-randomized trial.

OBJECTIVE: Early defecation after reconstructive anal surgery may influence the outcome negatively. Different methods are used to avoid bowel movements in the early postoperative period. We questioned whether stool behaviour is influenced by total parenteral nutrition as opposed to enteral nutrition with resorbable sip feeds. Furthermore, satisfaction of patients with each nutrition regime, cost differences and influence of the postoperative outcome were evaluated. METHOD: Between January and October 2004, 32 patients were evaluated in a prospective randomized, surgeon-blinded trial. The parenteral group (PG, n = 16) received 1250 ml Nutriflex lipid basal (B. Braun Comp., Melsungen, Germany) intravenously. The enteral group (EG, n = 16) was offered a total amount of three cups of Clinutren fruit (Nestle Nutrition GmbH, Frankfurt, Germany), two boxes of OPD (oligopeptide diet) Elemental 028 extra (SHS, Liverpool, UK) and two cups of OPD Peptamen (Nestle Nutrition GmbH). Both groups received 1000 ml of isotonic cristalloid solution and were allowed to drink up to 1000 ml of tea or water per 24 h. RESULTS: The satisfaction of patients was significantly higher in the EG. In regard to stool behaviour both groups showed no differences, in the number of bowel movements or in the time to the first postoperative defecation. Enteral feeding resulted in a minimum saving of 220 euros. Postoperative results in the case of plastic fistula closure did not differ between both groups. CONCLUSIONS: Sufficient bowel confinement during the early postoperative period after anal reconstructive surgery may be achieved by using resorbable sip feeds rather than parenteral nutrition.