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3.
Ann R Coll Surg Engl ; 102(5): e100-e101, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32159372

RESUMO

Anastomotic dehiscence following colonoscopy for routine surveillance after anterior resection for colorectal cancer is unreported in the English literature. It is a potentially fatal complication requiring awareness, quick recognition and management. We present the case of a 45-year-old woman who presented 12 hours after a routine follow-up colonoscopy with peritonitis due to anastomotic rupture diagnosed on computed tomography. The patient was taken to theatre for emergency laparotomy and formation of an end colostomy. Her postoperative recovery and follow-up were optimal.


Assuntos
Colonoscopia/efeitos adversos , Ileostomia/efeitos adversos , Peritonite/diagnóstico , Neoplasias Retais/cirurgia , Deiscência da Ferida Operatória/diagnóstico , Anastomose Cirúrgica/efeitos adversos , Colostomia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/cirurgia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Tomografia Computadorizada por Raios X
4.
BMC Infect Dis ; 20(1): 36, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931740

RESUMO

BACKGROUND: Hantavirus infection is worldwide epidemic and can cause life-threatening consequences. With more and more cases reported in countries with atypical morbidity, it is necessarily urgent to know some atypical symptoms and signs of Hantavirus infection. CASE PRESENTATION: Here we report the case of a 44-year old male with a complaint of fever and diffuse abdominal pain, initially suspiciously diagnosed with acute peritonitis. The patient was eventually diagnosed as hemorrhagic fever with renal syndrome and enhanced CT scan showed peritonitis. The clinical condition of the patient was relatively mild and he was recovered 9 days later. CONCLUSION: Peritonitis secondary to hemorrhagic fever with renal syndrome is rare in clinically practice. When confronted with atypical celialgia, it is important to make differential diagnosis of hantavirus infection.


Assuntos
Hantavirus/imunologia , Febre Hemorrágica com Síndrome Renal/complicações , Febre Hemorrágica com Síndrome Renal/diagnóstico , Peritonite/diagnóstico , Peritonite/etiologia , Adulto , Antibacterianos/uso terapêutico , China , Diagnóstico Diferencial , Técnica Direta de Fluorescência para Anticorpo/métodos , Febre Hemorrágica com Síndrome Renal/tratamento farmacológico , Febre Hemorrágica com Síndrome Renal/virologia , Humanos , Masculino , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (12): 100-105, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825349

RESUMO

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.


Assuntos
Ascite Quilosa/cirurgia , Peritonite/cirurgia , Complicações na Gravidez/cirurgia , Ascite Quilosa/diagnóstico , Ascite Quilosa/etiologia , Ascite Quilosa/fisiopatologia , Feminino , Humanos , Laparoscopia , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/fisiopatologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez
6.
Ulus Travma Acil Cerrahi Derg ; 25(6): 575-579, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31701503

RESUMO

BACKGROUND: A rare cause of acute abdomen or intestinal obstruction, the abdominal cocoon syndrome is also described in the literature as sclerosing peritonitis or sclerosing encapsulating peritonitis. Abdominal cocoon is characterized by the total or partial wrapping of the abdominal organs by a fibrous membrane. Although it is usually observed in young women, the etiology is unknown. The diagnosis is usually made during laparotomy. In this case series, we aimed to present seven patients diagnosed with abdominal cocoon syndrome during operation. METHODS: The records of patients who underwent laparotomy for abdominal pain and/or intestinal obstruction in our hospital and diagnosed as abdominal cocoon during operation between January 2012 and November 2018 were retrospectively reviewed. The demographic characteristics of the patients, etiologic factors, surgical procedures, operative findings and follow-up of the patients were recorded. RESULTS: Four out of seven patients who were operated for abdominal cocoon were male and 3 of them were female. The median age of patients was 61 (57-63) years in male and 39.6 (28-49) years in female. Six of the patients were operated in emergency conditions with the diagnosis of an acute abdomen or ileus. One of the patients was operated with the diagnosis of an intra-abdominal mass in elective conditions. In five out of seven patients, all of the small intestines were wrapped with a fibrous collagen capsule, while two of the patient intestines were partially wrapped with a fibrous collagen capsule. Four of the patients had no underlying disease, while one of the patients had Familial Mediterranean Fever (FMF), one had Endometriosis and one had beta-blocker medication. One patient who had small bowel necrosis and septic peritonitis were observed during the operation and died post operative 6th days. Postoperative complications were not observed in the follow-up of other patients and reoperation was not required due to recurrence. CONCLUSION: Abdominal cocoon is a condition that is usually diagnosed during operation in patients that were operated for reasons, such as the acute abdomen or intestinal obstruction. When the diagnose delayed, death can be seen due to small bowel necrosis and septic complications. High clinical suspicion and radiological imaging are important in the preoperative diagnosis. Treatment is required adhesiolysis and excision of the fibrous membranes.


Assuntos
Abdome Agudo/etiologia , Fibrose Peritoneal , Peritonite , Dor Abdominal/etiologia , Adulto , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Fibrose Peritoneal/complicações , Fibrose Peritoneal/diagnóstico , Fibrose Peritoneal/cirurgia , Peritonite/complicações , Peritonite/diagnóstico , Peritonite/cirurgia , Estudos Retrospectivos
7.
Pan Afr Med J ; 33: 276, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692842

RESUMO

Cystic malformations of the bile ducts are rare congenital disorders, with an incidence of 1/2000000 live births. Complication including the angiocholitis, chronic pancreatitis, progressive biliary cirrhosis, portal hypertension or gallbladder lithiases can reveal severe disorder. Spontaneous perforation is one of the rare complications described for the first time in 1934 by Weber. We report the case of an 18-month old baby admitted with subocclusive syndrome with biliary peritonitis. Ultrasound was performed showing abdominal effusion with cystic formation communicating with the bile ducts associated with subcapsular effusion of the liver confirmed by a scanner. Treatment was based on peritoneal toilet with redon drain at the level of the perforation and subhepatic drain without cyst excision. The patient was re-admitted 6 months after this incident to be definitively treated.


Assuntos
Cisto do Colédoco/diagnóstico , Peritonite/diagnóstico , Cisto do Colédoco/terapia , Drenagem/métodos , Humanos , Lactente , Masculino , Peritonite/etiologia , Ultrassonografia
9.
J Med Case Rep ; 13(1): 310, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623685

RESUMO

INTRODUCTION: Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction. CASE PRESENTATION: A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis therapy for 3 months but this did not result in resolution of his symptoms. This time he had diagnostic laparoscopy followed by laparotomy in which a fibrocollagenous membrane, resulting in entrapment of his bowel, was excised and his entire small bowel was freed. Postoperatively he again had a mild episode of partial bowel obstruction but this was relieved with a short course of steroids. DISCUSSION: Sclerosing peritonitis is a rare benign etiology of complete mechanical bowel obstruction. Patients might have suffered recurrent attacks of partial bowel obstruction in the past that were falsely managed on lines of other conditions such as tuberculosis, especially in endemic areas like Pakistan or India. CONCLUSION: Sclerosing peritonitis is a rare benign diagnosis which can manifest as complete bowel obstruction and a high index of suspicion is required to diagnose it. Contrast-enhanced computed tomography of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Diagnostic laparoscopy is usually confirmatory. Peritoneal sac excision and adhesiolysis is the treatment and a short course of steroids in relapsing symptoms.


Assuntos
Obstrução Intestinal/etiologia , Peritonite/diagnóstico , Esclerose/diagnóstico , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Peritonite/patologia , Tomografia Computadorizada por Raios X
10.
Am J Case Rep ; 20: 1526-1529, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31619662

RESUMO

BACKGROUND Spontaneous fungal peritonitis (SFP) is a life-threatening infection which occurs more commonly in patients with liver failure. SFP is not as common as spontaneous bacterial peritonitis (SBP) and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. Spontaneous fungal peritonitis is extremely uncommon in patients with cardiac ascites due to a high protein content, which predisposes to a low risk of infections. CASE REPORT This report presents a rare case of spontaneous fungal peritonitis in a patient with cardiogenic ascites. To the best of our knowledge, this is the second known case of SFP occurring in a patient with cardiac cirrhosis. The patient did not respond to initiation of SBP treatment and after ascitic fluid grew Candida glabrata, the diagnosis of SFP was made. The patient's clinical status improved after initiation of intravenous caspofungin. CONCLUSIONS SFP should be a differential diagnosis in patients who have cardiac or liver cirrhosis, who are not improving with empirical antibiotic therapy for spontaneous bacterial peritonitis.


Assuntos
Ascite/complicações , Fibrose/complicações , Micoses/diagnóstico , Micoses/etiologia , Miocárdio/patologia , Peritonite/diagnóstico , Peritonite/etiologia , Antifúngicos/uso terapêutico , Candida glabrata/efeitos dos fármacos , Caspofungina/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Peritonite/tratamento farmacológico , Fatores de Tempo
11.
Clin Nephrol ; 92(6): 312-318, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31661062

RESUMO

BACKGROUND: Rapid and accurate microbiological detection is crucial for effective treatment of peritonitis patients with peritoneal dialysis (PD). Although centrifugation of dialysis effluents can increase the pathogen culture-positive rate, a lack of both centrifugation facilities and experienced staff has prevented its widespread implementation, particularly in basic-level hospitals in developing countries. Thus, we developed a simple peritoneal sediment-collecting method, suspension precipitation method, for microbiological diagnosis of peritonitis. MATERIALS AND METHODS: In the suspension precipitation method, drained effluent bags from individual patients were hung for 1 hour to allow the suspension to drip to the bottom layer of the bag for sediment collection. Sediments obtained by centrifugation from the same batch of dialysis effluent were used as positive controls. Both sediment sample types were then cultured in blood-culture bottles. Subsequent analysis of the pathogen-positive detection rate and species comparison between the two methods were undertaken. RESULTS: Among 90 PD patients, the pathogen positive-detection rate between methods was comparable, as demonstrated by 75 (83.33%) with the suspension precipitation method and 77 (85.56%) by the centrifugation method. Their positive pathogen species were also similar, and the concordance rate was 97.78%. CONCLUSION: The suspension precipitation method is a simple, convenient, and reliable peritoneal sediment-collecting method that is suitable for a wide array of uses, particularly in basic-level hospitals without centrifugation technology.


Assuntos
Técnicas Microbiológicas/métodos , Diálise Peritoneal/efeitos adversos , Peritonite/diagnóstico , Precipitação Química , Humanos , Estudos Prospectivos , Suspensões
12.
J Ovarian Res ; 12(1): 95, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615543

RESUMO

BACKGROUND: Large cell neuroendocrine carcinoma is a very rare ovarian neoplasm that has a poor clinical outcome even in the early stage, and there is as yet no established treatment. Diagnostic laparoscopy has been used to determine the possibility of primary optimal cytoreductive surgery or neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. However, the role of diagnostic laparoscopy is still unclear in large cell neuroendocrine carcinoma due to its rarity. CASE PRESENTATION: A 31-year-old woman with abdominal distention was referred to our hospital. She was strongly suspected of having advanced ovarian cancer because of a huge pelvic mass, massive ascites, and their appearance on medical imaging. However, cytological examinations from ascitic fluid by abdominal paracentesis did not show any malignant cells. She underwent diagnostic laparoscopy to evaluate the possibility of primary optimal cytoreductive surgery, and only tissue sampling was performed for pathological diagnosis because of the countless disseminated lesions of various sizes in the intraperitoneal organs. The patient had no postoperative complications, leading to the early start of postoperative chemotherapy. CONCLUSIONS: To date, there have been no systematic reviews that focused on determining the treatment strategy using laparoscopy. Diagnostic laparoscopy can be helpful to determine the optimal treatment, including primary debulking surgery, neoadjuvant chemotherapy, or best supportive care, assisting in decision-making particularly for patients with advanced large cell neuroendocrine carcinoma with carcinomatous peritonitis.


Assuntos
Abdome/patologia , Carcinoma de Células Grandes/diagnóstico , Carcinoma Neuroendócrino/diagnóstico , Ovário/patologia , Adulto , Líquido Ascítico/patologia , Carcinoma de Células Grandes/patologia , Carcinoma de Células Grandes/cirurgia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/cirurgia , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Ovário/diagnóstico por imagem , Paracentese/métodos , Peritonite/diagnóstico , Peritonite/patologia
13.
Cir. pediátr ; 32(4): 185-189, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184107

RESUMO

Introducción. El índice neutrófilo-linfocito (INL) se ha postulado como marcador inflamatorio en distintas patologías abdominales como la apendicitis aguda (AA). Sin embargo, existen pocos estudios que determinen su asociación con el grado de severidad de la AA. Este es el primer estudio que analiza la utilidad del INL como factor predictor de peritonitis en la AA en niños. Material y métodos. Estudio observacional retrospectivo en pacientes intervenidos de AA durante los años 2017 y 2018. Se distribuyeron en dos grupos según el diagnóstico intraoperatorio (AA no complicada y AA con peritonitis). Se analizaron variables demográficas y analíticas. Se definió el INL como el cociente entre los valores absolutos de neutrófilos y linfocitos. Se determinó mediante curvas ROC la sensibilidad y especificidad para el diagnóstico de peritonitis de distintos parámetros analíticos. Resultados. Se incluyeron un total de 398 pacientes (AA no complicada n= 342 y AA con peritonitis n=56), con una edad media de 10,5±2,9 años. El INL presentó un área bajo la curva (AUC) de 0,78, significativamente superior a la determinación de leucocitos (AUC 0,71; p=0,002) y de neutrófilos (AUC 0,74; p=0,009). No se observaron diferencias al compararlo con la determinación de la proteína C reactiva (AUC 0,79; p=0,598). Se estimó el punto de corte de INL>8,75 con una sensibilidad y especificidad de 75,0 y 72,2% respectivamente. Conclusión. El INL se postula como una herramienta útil para predecir la presencia de peritonitis en AA, y podría considerarse una alternativa a otras determinaciones de mayor coste como la proteína C reactiva


Aim of the study. The neutrophilto-lymphocyte ratio (NLR) has been postulated as an inflammatory marker in several abdominal pathologies such as acute appendicitis (AA). However, there are few studies that determine its association with the degree of severity of AA. This is the first study that analyzes the usefulness of NLR as a predictor of peritonitis in children with AA. Methods. Retrospective observational study in patients treated of AA during the years 2017 and 2018. They were divided into two groups according to the intraoperative diagnosis (uncomplicated AA and AA with peritonitis). Demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. The sensitivity and specificity for the diagnosis of peritonitis of different analytical parameters were determined by ROC curves. Results. A total of 398 patients were included (uncomplicated AA n=342 and AA with peritonitis n=56), with a mean age of 10.5±2.9 years. The NLR had an area under the curve (AUC) of 0.78, significantly higher than the determination of leukocytes (AUC 0.71, p=0.002) and of neutrophils (AUC 0.74, p=0.009). No differences were observed when compared to the determination of C-reactive protein (AUC 0.79, p=0.598). A cut-off point of NLR>8.75 was estimated with a sensitivity and specificity of 75.0 and 72.2% respectively. Conclusions. The NLR is a useful tool to predict the presence of peritonitis in AA, and could be considered an alternative to other higher cost determinations such as C-reactive protein


Assuntos
Humanos , Masculino , Feminino , Criança , Apendicite/diagnóstico , Peritonite/diagnóstico , Linfócitos/fisiologia , Contagem de Leucócitos/métodos , Valor Preditivo dos Testes , Apendicite/sangue , Índice de Gravidade de Doença , Curva ROC , Estudos Retrospectivos
14.
Rev. pediatr. electrón ; 16(3): 28-32, oct. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1046286

RESUMO

INTRODUCCIÓN La peritonitis meconial (PM) es una peritonitis localizada o generalizada, aséptica, química o de cuerpo extraño; producto del paso de meconio a la cavidad peritoneal y esta correlacionada con la perforación prenatal del tracto digestivo. Se presenta en 1 de cada 30.000 recién nacidos (RN). El diagnostico ecográfico prenatal mejora los resultados perinatales, el hallazgo más frecuente es la ascitis. La PM requiere un tratamiento multidisciplinario urgente, la mayoría es de resolución quirúrgica. OBJETIVO Dar a conocer una patología infrecuente, que requiere un alto grado de sospecha diagnostica para otorgar un manejo perinatal específico y oportuno. Caso clínico Primigesta de 29 años sin antecedentes mórbidos, cursando embarazo controlado de 36+5 semanas. En control ecográfico se evidencia ascitis fetal. Se hospitaliza en alto riesgo obstétrico, descartando patología metabólica e infecciosa. A las 37 semanas por cesárea de urgencia, se obtiene RN con distensión abdominal y hepatomegalia. En laparotomía exploradora se evidencia asas intestinales indemnes. En re intervención se encuentra hernia de íleon distal perforada, se confecciona ostomia, evoluciona favorablemente y es dado de alta. DISCUSIÓN Es fundamental considerar la PM dentro de los diagnósticos diferenciales de ascitis fetal. Un diagnóstico oportuno mejora los resultados perinatales y permite prevenir posibles complicaciones.


INTRODUCTION Meconial peritonitis (PM) is localized or generalized peritonitis, aseptic, chemical or strange body; a product of meconium steps to the peritoneal cavity and is correlated with prenatal perforation of the digestive tract. It occurs in 1 in 30,000 newborns. Prenatal ultrasound diagnosis improves perinatal outcomes, the most frequent finding is ascites. PM requires urgent multidisciplinary treatment, most of cases need surgical resolution. OBJECTIVE To present an infrequent pathology, which requires a high degree of diagnostic suspicion to grant a specific and timely perinatal management. Clinical case Pregnant 29 years old woman without morbid history, 36 weeks of controlled pregnancy. Ultrasound control shown fetal ascites. He is hospitalized at high obstetric risk, ruling out metabolic and infectious pathology. At 37 weeks by emergency caesarean section, is obtained a baby boy with abdominal distension and hepatomegaly. In exploratory laparotomy there are undamaged intestinal handles. In re intervention it is noted herniated perforated distal ileum, ostomy is made. Patient evolves favourably and is discharged. DISCUSSION It is essential consider PM within the differential diagnoses of fetal ascites. An opportune diagnosis improves the perinatal results and could avoids possible complications.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Peritonite/diagnóstico , Peritonite/etiologia , Diagnóstico Pré-Natal , Mecônio , Peritonite/cirurgia , Ascite/diagnóstico , Diagnóstico Diferencial
15.
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1518-1524, set.-out. 2019. tab, ilus
Artigo em Português | LILACS, VETINDEX | ID: biblio-1038661

RESUMO

Nocardiose é causada por bactérias do gênero Nocardia do subgrupo Actinomycetos, que são Gram-positivas aeróbicas, filamentosas e podem apresentar ramificações. O diagnóstico baseia-se na presença de lesão inflamatória, com o microrganismo morfologicamente compatível, associada ao isolamento e à identificação microbiológica e molecular. Este trabalho tem por objetivo relatar um caso de nocardiose em canino, que desenvolveu inflamação piogranulomatosa peritoneal seis meses após ovariossalpingo-histerectomia. O animal apresentava hipertermia, distensão abdominal, taquipneia, polidipsia, hiporexia, mucosas hipocoradas e fezes pastosas. Os achados laboratoriais evidenciaram anemia leve e leucocitose por neutrofilia com desvio à esquerda e hipoalbuminemia. Uma massa na região mesogástrica e efusão peritoneal foram evidenciadas por meio da ultrassonografia abdominal. O líquido foi classificado como exsudato piogranulomatoso, e o animal submetido à laparotomia exploratória para lavagem abdominal e remoção da massa. Após procedimentos terapêuticos, ocorreu piora clínica e óbito. Peritonite piogranulomatosa foi a principal alteração anatomopatológica a qual foi associada à Nocardia spp. Molecularmente, a espécie isolada se aproxima da N. concava, por meio da análise filogenética. Essa espécie já foi descrita como causa de infecção em humanos na Ásia, no entanto não há registros na literatura na espécie canina, sendo este o primeiro relato.(AU)


Nocardiosis is caused by an aerobic, gram-positive, ramificated and filamentous bacteria of the Nocardia genus, subgroup Actinomycetos. The diagnosis is based on the presence of the inflammatory lesions with the morphologically compatible microorganism associated with microbiological and molecular isolation and identification. The objective of this work is to report a case of nocardiosis in a canine that developed peritoneal pyogranulomatous inflammation six months after ovariosalpingohisterectomy. The animal had hyperthermia, abdominal distention, tachypnea, polydipsia, hyporexia, hypocorous mucosae and pasty feces. The laboratory findings revealed mild anemia and leukocytosis due to neutrophilia with left deviation and hypoalbuminemia. A mass in the mesogastric region and peritoneal effusion were evidenced by abdominal ultrasonography. The fluid was classified as pyogranulomatous exudate and the animal underwent exploratory laparotomy for abdominal lavage and mass removal. Despite the therapeutic procedures and clinical alterations the dog died. Piogranulomatous peritonitis was the main anatomopathological alteration which was associated with Nocardia spp. Molecularly, the isolated species approaches the N. concava species through phylogenetic analysis. This specie was described as a cause of infection in humans in Asia; however, there are no records in literature on the canine species, being this the first report.(AU)


Assuntos
Animais , Feminino , Cães , Peritonite/cirurgia , Peritonite/diagnóstico , Peritonite/veterinária , Nocardiose/diagnóstico , Nocardiose/veterinária
16.
J Dairy Sci ; 102(11): 10202-10212, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477288

RESUMO

Acute abdominal emergencies in calves due to abomasal disorders, gastrointestinal ileus, or peritonitis are characterized by a rapid disease progression and usually require immediate surgical intervention. Those conditions are associated with a guarded prognosis, and the aim of the present study was to assess the prognostic relevance of preoperatively measured plasma l-lactate concentrations (l-LAC) in a large study population of calves with a broad spectrum of acute abdominal emergencies. For the purpose of this study, the medical records of 587 calves admitted to a veterinary teaching hospital over a 10-yr period were analyzed retrospectively. Plasma l-LAC was measured as part of a routinely performed biochemistry panel before initiation of surgical intervention. Hyper-l-lactatemia (plasma l-LAC >2.2 mmol/L) was evident in 75% of calves, and the overall survival rate until hospital discharge was 31%. Calves with a negative outcome were younger (median: 3.4 vs. 6 wk) and had higher plasma l-LAC (median: 4.96 vs. 3.09 mmol/L) than calves with a positive outcome. At the individual diagnosis level, l-LAC was associated with mortality in calves with a diagnosis of mesenteric torsion, right-sided dilated abomasum, small intestinal volvulus, or paralytic ileus, but not in calves suffering from peritonitis, malformations, abomasal volvulus, bloat, or small intestinal intussusceptions. Considering the whole study population, the area under the receiver operating characteristic (ROC) curve for plasma l-LAC was 0.66 [95% confidence interval (CI): 0.61-0.70]. A classification tree analysis indicated that l-LAC >8.84 mmol/L and age categories of <3 wk and <1 wk were independent predictors of mortality. The area under the ROC curve of this model was 0.75 (95% CI: 0.71-0.79) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.62 were 67.7 and 76.6%, respectively. In conclusion, hyper-l-lactatemia is common in calves suffering from acute abdominal emergencies. Markedly increased plasma l-LAC is associated with an increased mortality risk, but it is not possible to reliably predict the outcome of affected calves based on a single, preoperative measurement. However, a clinically important finding of this study was that the ability to predict a negative outcome is improved when the age of the calf is considered in addition to plasma l-LAC.


Assuntos
Doenças dos Bovinos/diagnóstico , Ácido Láctico/sangue , Peritonite/veterinária , Abomaso/cirurgia , Animais , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/mortalidade , Doenças dos Bovinos/cirurgia , Emergências/veterinária , Feminino , Masculino , Peritonite/diagnóstico , Peritonite/mortalidade , Peritonite/cirurgia , Prognóstico , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
17.
Pan Afr Med J ; 33: 102, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489080

RESUMO

We here report a case of multiple gastrointestinal stromal tumors (GIST) in the small bowel detected in a patient with peritonitis. The peculiarity of this case study is the intraoperative detection of multifocal small bowel tumor masses, suggesting gastrointestinal stromal tumors on postoperative CT scan. Tumor couldn't be suspected clinically on the basis of peritonitis.


Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Peritonite/diagnóstico , Tumores do Estroma Gastrointestinal/patologia , Humanos , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Peritonite/patologia , Tomografia Computadorizada por Raios X
18.
Pan Afr Med J ; 33: 35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384350

RESUMO

Introduction: Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of patients with cirrhotic ascites. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. This study aimed to determine the prevalence of SBP among in-patients with cirrhotic ascites attending our facility and to determine the clinical and laboratory parameters associated with SBP. Methods: A cross-sectional study was conducted involving one hundred and three (103) patients admitted at medical block in the Korle-Bu Teaching Hospital (KBTH) with cirrhotic ascites from 25th March, 2016 to 25th November, 2016. Demographic and clinical data were collected using a standardized questionnaire. Ascitic fluid culture and cell count were conducted. Positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte ≥ 250cells/mm3 were diagnostic for SBP. Results: Of the 103 patients with cirrhotic ascites, the mean age was 43.5 ± 12.2 years. There were fifty eight (58) male patients. The prevalence of SBP was 25.24% (26/103). Majority, 5 (55.6%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. Severe ascites and high INR were found to be independent predictors of SBP. Conclusion: SBP is common among patients with cirrhotic ascites admitted at KBTH. Severe ascites and high INR were highly suggestive of SBP. Diagnostic paracentesis should be done immediately on admission to confirm the diagnosis irrespective of the clinical characteristics as part of baseline investigation.


Assuntos
Ascite/epidemiologia , Infecções Bacterianas/epidemiologia , Cirrose Hepática/complicações , Peritonite/epidemiologia , Adolescente , Adulto , Idoso , Ascite/microbiologia , Líquido Ascítico/microbiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico , Peritonite/microbiologia , Prevalência , Adulto Jovem
19.
Emerg Med Clin North Am ; 37(3): 511-527, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262418

RESUMO

Patients with end-stage liver disease (ESLD) who require intensive care unit admission have high rates of mortality. This article reviews the pathophysiology and emergency department assessment and management of the most frequent conditions and complications encountered in critically ill ESLD patients including hepatic encephalopathy, gastrointestinal bleeding, sepsis and bacterial peritonitis, hepatorenal syndrome, severe coagulopathy, and hepatic hydrothorax.


Assuntos
Estado Terminal , Doença Hepática Terminal/complicações , Doença Hepática Terminal/terapia , Manuseio das Vias Aéreas/métodos , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/terapia , Medicina de Emergência , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Hidrotórax/diagnóstico , Hidrotórax/etiologia , Hidrotórax/terapia , Hiperamonemia/etiologia , Hiperamonemia/terapia , Unidades de Terapia Intensiva , Transplante de Fígado , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/terapia , Medição de Risco , Índice de Gravidade de Doença
20.
Acta Gastroenterol Belg ; 82(2): 261-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314186

RESUMO

BACKGROUND AND AIMS: The microbiological characteristics of spontaneous bacterial peritonitis (SBP) are changing worldwide with a shift in patterns of SBP and increasing prevalence of antibiotic-resistant bacteria. We, therefore, conducted this retrospective study aiming to characterise the current patterns and microbiology of SBP in our region. METHODS: We performed a retrospective chart review of patients presenting with their first episodes of SBP. The demographical, clinical and laboratory parameters of all patients at first paracentesis were recorded. RESULTS: The study included 200 cirrhotic patients with SBP. Mean age was 60.4±13.5 years and 116 (58%) patients were males. Liver cirrhosis was predominantly viral in 138 (69%) patients. Ascitic fluid cultures were positive in 103 (51.5%) patients and negative in 97 (48.5%). Ninety-eight (95.1%) patients had monomicrobial bacterial growth. The most common variants of spontaneous ascitic fluid infection were culture negative neutrocytic ascites (CNNA) in 97(48.5%) patients and SBP in 65 (32.5%) patients. E.Coli was most frequently isolated microorganism in 41 (39.8%) patients followed by staphylococcus species in 19 (18.4%) patients, Klebsiella pneumonae in 14(13.6%) patients and streptococcus species in 13 (10.7%) patients. The prevalence of extended spectrum beta-lactamases (ESBL) resistant E.Coli was 29.3%. Antibiotic resistance rate for meropenem, piperacillin\ tazobactam, ceftriaxone and ciprofloxacin was 0%, 22.0%, 29.0%, and 28.6% respectively. CONCLUSIONS: Changes in the patterns and microbiology of SBP are evident in our region with increasing prevalence of culture negative SBP, extended spectrum beta-lactamases resistant E.Coli, and increased resistance rate to first line antibiotics. Our data argue for relying on periodic hospital based antibiotic susceptibility data whenever SBP is treated.


Assuntos
Ascite/microbiologia , Líquido Ascítico/microbiologia , Infecções Bacterianas/microbiologia , Cirrose Hepática/microbiologia , Cirrose Hepática/virologia , Peritonite/microbiologia , Idoso , Infecções Bacterianas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico , Estudos Retrospectivos
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