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1.
Ann R Coll Surg Engl ; 103(5): e151-e155, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33930284

RESUMO

The diagnosis of visceral perforation during pregnancy is often delayed and the management complex. A 32-year-old primigravid woman in her second trimester presented with abdominal pain and a pre-existing ileoanal pouch. Initial imaging was negative but later imaging was suggestive of serious pathology. At laparotomy, a caesarean section was performed. Peritonitis was encountered secondary to two discrete perforations in the small bowel separate from her pouch. Histology found an ischaemic perforation secondary to a pressure effect from the gravid uterus. In pregnancy, ileoanal pouches may make the interconnected bowel vulnerable to the pressure effect of the gravid uterus and perforation. Pregnant women with such a surgical history who develop symptoms suggestive of bowel perforation should have rapid imaging and their clinical team should consider early definitive surgical intervention.


Assuntos
Bolsas Cólicas , Doenças Inflamatórias Intestinais/complicações , Perfuração Intestinal , Isquemia , Complicações na Gravidez , Dor Abdominal , Adulto , Cesárea , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Isquemia/diagnóstico , Isquemia/cirurgia , Laparotomia , Peritonite/diagnóstico , Peritonite/cirurgia , Gravidez
4.
Khirurgiia (Mosk) ; (2): 27-31, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570351

RESUMO

OBJECTIVE: To compare the most common prognostic systems in patients with peritonitis. MATERIAL AND METHODS: The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors. RESULTS: Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis. CONCLUSION: PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.


Assuntos
Peritonite , Sepse , Índice de Gravidade de Doença , APACHE , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/mortalidade , Prognóstico , Curva ROC , Medição de Risco , Sepse/diagnóstico , Sepse/etiologia , Sepse/mortalidade , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/mortalidade
5.
Curr Opin Crit Care ; 27(2): 201-207, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395082

RESUMO

PURPOSE OF REVIEW: Timely and adequate management are the key priorities in the care of peritonitis. This review focuses on the cornerstones of the medical support: source control and antiinfective therapies. RECENT FINDINGS: Peritonitis from community-acquired or healthcare-associated origins remains a frequent cause of admission to the ICU. Each minute counts for initiating the proper management. Late diagnosis and delayed medical care are associated to dramatically increased mortality rates. The diagnosis of peritonitis can be difficult in these ICU cases. The signs of organ failures are more relevant than biological surrogates. A delayed source control and a late anti-infective therapy are of critical importance. The quality of source control and medical management are other key elements of the prognosis. The conventional rules applied for sepsis are applicable for peritonitis, including hemodynamic support and anti-infective therapy. Growing proportions of multidrug resistant pathogens are reported from surgical samples, mainly related to Gram-negative bacteria. The increasing complexity in the care of these critically ill patients is a strong incentive for a multidisciplinary approach. SUMMARY: Early clinical diagnosis, timely and adequate source control and antiinfective therapy are the essential pillars of the management of peritonitis in ICU patients.


Assuntos
Peritonite , Sepse , Estado Terminal , Humanos , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Prognóstico
6.
Vet Surg ; 50(2): 323-335, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33415827

RESUMO

OBJECTIVE: To identify etiology, clinical findings, diagnostic results, treatment, and short- and long-term survival and to report factors associated with nonsurvival and survival in horses with peritonitis. STUDY DESIGN: Retrospective study. ANIMALS: Horses (n = 72). METHODS: Medical records at William R. Pritchard Veterinary Medical Teaching Hospital from 2007-2017 were reviewed for horses diagnosed with peritonitis. The essential inclusion criterion was a peritoneal nucleated cell count of ≥25 000 cells/µL. Gastrointestinal rupture and cases in which peritonitis occurred after abdominal surgery or castration were excluded. Information retrieved from medical records included signalment, history, clinicopathological and peritoneal fluid variables, diagnostic imaging findings, inciting cause, treatment, and short- and long-term survival. Data were analyzed by using Fisher's exact test, Wilcoxon rank sum test, and χ2 test (P < .05). RESULTS: Colic was the most common presenting complaint (34/72 [48%]). A definitive diagnosis could be made in 44 (44/72 [61%]) cases. The most common cause of peritonitis was infectious agents (31/72), followed by trauma (8/72), gastrointestinal thickening (3/72), and eosinophilic peritonitis (2/72). Idiopathic peritonitis was identified in 28 (28/72 [39%]) cases. Sixty (83%) horses survived to hospital discharge. Long-term follow-up was available for 49 horses, with 43 (88%) horses alive 1 year after discharge. Significant differences between nonsurvivors and survivors were history of colic, positive peritoneal fluid culture, and several hematological/peritoneal fluid variables. CONCLUSION: Peritoneal fluid analysis was essential for a definitive diagnosis of peritonitis, and certain variables were useful for predicting outcome. CLINICAL SIGNIFICANCE: Results of this study provide evidence of the value of peritoneal fluid analysis for identification of peritonitis, prediction of outcome, and successful treatment.


Assuntos
Doenças dos Cavalos , Peritonite/veterinária , Animais , Cólica/diagnóstico , Cólica/etiologia , Cólica/terapia , Cólica/veterinária , Feminino , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/etiologia , Doenças dos Cavalos/terapia , Cavalos , Masculino , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Prognóstico , Estudos Retrospectivos
8.
Cir Pediatr ; 34(1): 3-8, 2021 Jan 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33507637

RESUMO

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.


Assuntos
Abdome Agudo/diagnóstico , Dor Abdominal/etiologia , /diagnóstico , Abdome Agudo/cirurgia , Abdome Agudo/virologia , Dor Abdominal/virologia , Adolescente , Apendicite/diagnóstico , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Peritonite/diagnóstico , Estudos Retrospectivos , Vômito/epidemiologia , Vômito/etiologia
11.
BMC Infect Dis ; 20(1): 717, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993529

RESUMO

BACKGROUND: Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). CASE PRESENTATION: An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. CONCLUSION: H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/diagnóstico , Peritonite/etiologia , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Ásia , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/microbiologia , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Falência Renal Crônica/terapia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Resultado do Tratamento
12.
Ther Umsch ; 77(4): 171-176, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32772698

RESUMO

Clinical Manifestations and Therapeutic Implications of Peritonitis Abstract. Peritonitis is a heterogenous disease, commonly classified into three types. Primary peritonitis, defined by the absence of another directly related intraabdominal abnormality, can often be treated conservatively and is thus distinguished from secondary peritonitis, which results from an independent diagnosis like the perforation or necrosis of an intraabdominal organ and usually requires surgical therapy. The more recently defined tertiary peritonitis is a form of secondary peritonitis that relapses or persists after 48 hours of adequate therapy with no surgically removable focus. This article addresses three important clinical manifestations of peritonitis and their therapeutic implications: spontaneous bacterial peritonitis as the mayor manifestation of primary peritonitis; postoperative peritonitis as a severe subform of secondary peritonitis; and peritoneal dialysis-associated peritonitis as a distinctive clinical picture.


Assuntos
Infecções Bacterianas , Diálise Peritoneal , Peritonite/diagnóstico , Peritonite/terapia , Humanos , Complicações Pós-Operatórias/diagnóstico , Recidiva
13.
Am J Nephrol ; 51(8): 669-674, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32731215

RESUMO

BACKGROUND: The COVID-19 pandemic has affected the end-stage kidney disease (ESKD) population, with high mortality rates reported among patients on hemodialysis. However, the degree to which it has affected the peritoneal dialysis (PD) population in the United States has not yet been elucidated. In this report, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19. METHODS: We describe the characteristics, presentation, and outcomes of adult ESKD patients on chronic PD hospitalized with CO-VID-19 in our 13 major hospitals in the NY health system using descriptive statistical analysis. RESULTS: Of 419 hospitalized patients with ESKD, 11 were on chronic PD therapy (2.6%). Among those 11, 3 patients required mechanical ventilation, 2 of whom died. Of the entire cohort, 9 of the 11 patients (82%) were discharged alive. While fever was a common presentation, more than half of our patients also presented with diarrhea. Interestingly, 3 patients were diagnosed with culture-negative peritonitis during their hospitalization. Seven patients reported positive SARS-CoV-2 exposure from a member of their household. CONCLUSION: Hospitalized patients on PD with COVID-19 had a relatively mild course, and majority of them were discharged home.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus/genética , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias , Peritonite/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/isolamento & purificação
14.
Acta Gastroenterol Belg ; 83(2): 279-284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603047

RESUMO

Objective: In this study, we aimed to investigate the diagnostic availability of oxidant and antioxidant parameters in ascites for spontaneous bacterial peritonitis (SBP). Material and Methods: This study was carried out between July and October 2018 with 25 patients with SBP and 24 patients without SBP. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking and drinking alcohol, and patients without ascites culture were excluded from the study. Results: In patients with SBP compared those without SBP median paraoxonase (3.1 vs 15.6 ; p <0.001), median stimulated paraoxonase (12.6 vs 53.1 ; p <0.001), median arylesterase (769,9 vs 857,5 ; p = 0,003) and median catalase (10 vs 22,2 ; p = 0,003) were found to be lower and median myeloperoxidase (8.1 vs 1.1 ; p <0.001) were found to be higher. There was a positive correlation between paraoxonase levels and stimulated paraoxonase levels, arylesterase levels and catalase levels, there was a negative correlation between paraoxonase levels and myeloperoxidase levels. Paraoxonase levels 3.7 and lower, stimulated paraoxonase levels 25.8 and lower, arylesterase levels 853.4 and lower, catalase levels 11.8 and lower and myeloperoxidase levels 2.7 and more predicted the the presence of SBP with high specificity and high sensitivity. Paraoxonase and stimulated paraoxo-nase levels were found to have superior performance in predicting the presence of SBP compared to arylesterase levels (p <0.05). Conclusion: In this study it was shown that paraoxonase, stimulated paraoxonase, arylesterase, catalase and myeloperoxidase activities can be used for the diagnosis and severity of SBP.


Assuntos
Ascite , Peritonite , Arildialquilfosfatase , Ascite/diagnóstico , Biomarcadores , Humanos , Estresse Oxidativo , Peritonite/diagnóstico
15.
Acta Vet Scand ; 62(1): 29, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532360

RESUMO

BACKGROUND: Ultrasonographic documentation of perforated abomasal ulcer has not been published till now. This report describes the clinical, ultrasonographic and postmortem findings in a Jersey cow with type-3 abomasal ulcer and left displacement of the abomasum (LDA). CASE REPORT: The main clinical findings were abnormal demeanour, rumen atony and tympany, positive foreign body tests, positive auscultation and simultaneous ballottement on the left side, abdominal guarding and loss of negative pressure in the abdominal cavity. The tentative diagnosis was peritonitis and LDA. Abdominal ultrasonography produced images typical of LDA, and in one location between the abdominal wall and abomasum there was a layer of fibrin, a fibrin clot, a break in the abomasal contour, suggestive of a perforated ulcer, and partial obstruction of this gap with fibrin. The diagnosis of perforated abomasal ulcer with subsequent peritonitis was confirmed during postmortem examination. CONCLUSIONS: The examination of this case shows that under certain circumstances, ultrasonographic imaging of a perforated abomasal ulcer in a cow is possible. Antemortem diagnosis of type-3 abomasal ulcer is preferable to relying on exploratory laparotomy and/or post-mortem examination.


Assuntos
Abomaso/diagnóstico por imagem , Doenças dos Bovinos/diagnóstico , Peritonite/veterinária , Úlcera Gástrica/veterinária , Abomaso/patologia , Animais , Bovinos , Doenças dos Bovinos/diagnóstico por imagem , Feminino , Peritonite/diagnóstico , Peritonite/diagnóstico por imagem , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/diagnóstico por imagem , Ultrassonografia/veterinária
16.
Intern Med ; 59(10): 1257-1265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32418953

RESUMO

Objective Acute abdominal pain (AAP) of diverse etiology is a common chief complaint of patients who present to the emergency department (ED). AAP may pose a diagnostic challenge to physicians in training. We aimed to evaluate whether or not resident trainee doctors examine patients presenting with AAP in a Japanese acute-care hospital following Kendall's diagnostic algorithm. Methods We conducted a retrospective medical chart review from January 2015 to December 2016. Patients Patients ≥50 years old who presented to the ED within 7 days of the onset of AAP who were evaluated by residents at the ED of an acute care hospital were enrolled in this study. Patients transported by ambulance and referred from other hospitals and classified as level 1 or 2 according to the Japanese version of the Canadian Triage and Acuity Scale were excluded. Data, including the clinical history, location and character of pain, and age and gender of patients as well as the level of experience of residents, were abstracted from charts. We evaluated the concordance rate between the actual diagnostic process followed by residents and Kendall's diagnostic algorithm for AAP. Results We analyzed 466 patients (mean age 67.6 years) in the study who were evaluated and diagnosed by 123 residents. The concordance rate between the diagnostic procedures performed by residents and those suggested by Kendall's diagnostic algorithm was 61.2%. A low concordance rate was observed among patients with peritoneal signs, shock or toxic appearance (25.0%), suggested acute coronary syndromes (ACS) (55.1%), epigastric or right upper-quadrant pain (52.8%), and left upper-quadrant pain (55.6%). Abdominal ultrasonography is one of the recommended examinations for patients with signs of peritoneal irritation, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain, but the rates were relatively low at 25.0%, 34.4%, 31.8%, and 26.7%, respectively. Conclusion Abdominal ultrasonography required by Kendall's diagnostic algorithm was not performed appropriately in patients with symptoms and signs of peritonitis, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain or in female patients by resident trainees. Our findings underscore the importance of providing resident doctors with focused training concerning ultrasonography by attending physicians.


Assuntos
Dor Abdominal/etiologia , Internato e Residência , Dor Abdominal/diagnóstico , Dor Abdominal/diagnóstico por imagem , Síndrome Coronariana Aguda/diagnóstico , Idoso , Algoritmos , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico , Peritonite/diagnóstico por imagem , Exame Físico , Estudos Retrospectivos , Choque Séptico/diagnóstico por imagem , Ultrassonografia
18.
Orv Hetil ; 161(23): 977-979, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32453696

RESUMO

Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.


Assuntos
Peritonite/cirurgia , Abdome Agudo/etiologia , Adolescente , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Laparotomia , Masculino , Peritonite/diagnóstico , Choque Séptico/tratamento farmacológico
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