Cases reported "Peritoneal Diseases"

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1/6. Primary abscess of the omentum: report of a case.

    We report a case of a primary abscess of the omentum without any obvious etiology. A 62-year-old man was referred to our clinic with lower abdominal pain, and computed tomography showed an intra-abdominal abscess in the left pelvic area. laparotomy revealed that the abscess adhered to the urinary bladder and abdominal wall, but no perforation of the alimentary tract was identified and there was no foreign body in the abscess cavity. A culture of the abscess fluid grew clostridium perfringens. The patient was discharged on the 16th hospital day after an uneventful postoperative course without any complications.
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2/6. Tuberculous peritonitis simulating peritoneal carcinosis.

    Two cases are reported exemplifying the difficulties faced in the clinical diagnosis of peritoneal tuberculosis. Two fertile-aged nulliparous females were admitted with symptoms and signs of an acute abdomen. Both showed a relative intestinal obstruction, abdominal mass and ascitic fluid. A malignant disease was suspected and laparotomy was performed. Tuberculous peritonitis was demonstrated histologically in biopsy and later confirmed by positive culture for tubercle bacilli. In the first case the correct diagnosis was disclosed during operation by frozen section, although the histological picture also indicated possible carcinosis because of a heavy mesothelial hyperplasia. A 9-month chemotherapy with isoniazide and rifampicin, supplemented during the first 2 months by streptomycin or ethambutol, was successful in both cases.
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3/6. Posttransplant lymphocele presenting as 'acute abdomen'.

    Lymphoceles occurring after renal transplantation are frequently asymptomatic and are usually identified on routine ultrasonography of the allograft. A small percentage of them may increase in size and manifest due to their compression effects on adjacent structures or as lymphocutaneous fistula. An infected lymphocele would, in addition, give rise to local and systemic features. A case of infected lymphocele occurring 4.5 months after cadaveric renal transplant is reported. The patient presented in septicemia and features of generalized peritonitis. Emergency diagnostic laparoscopy revealed fluid collection in the peritoneal cavity. However, on exploratory laparotomy no intra-abdominal pathology was detected. Further evaluation revealed a large perigraft lymph collection which was drained percutaneously. Fluid and blood cultures grew staphylococcus aureus. The patient recovered completely following external drainage and antibiotic administration.
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4/6. Be aware of abdominal tuberculosis.

    Abdominal tuberculosis is often diagnosed in a late stage because symptoms are aspecific. Two patients with intestinal tuberculosis and tuberculous peritonitis respectively, both from endemic countries presented with long-standing fever, abdominal pain and weight loss. Acid fast bacilli were present in aspirate and biopsy specimens obtained by colonoscopy and laparoscopy respectively; PCR was positive for M. tuberculosis complex and later M. tuberculosis was cultured. Both patients responded to antituberculous therapy. In one patient AIDS was diagnosed.
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5/6. Omentopexy for empyema due to lung fistula following lobectomy. A case report.

    A case of sustained lung fistula after lung surgery is reported here. This case of a sustained pulmonary fistula was diagnosed by sustained air leak through the chest drain and a positive culture of the drainage fluid. The third re-operation was performed successfully by omentopexy via median sternotomy. Careful postoperative observation with chest radiography, bronchial fiberscopy, and determining whether infection is present in the drainage fluid are important for precise diagnosis and therapy for complications following pulmonary lobectomy.
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6/6. Fungal sacral osteomyelitis as the initial presentation of Crohn's disease of the small bowel: report of a case.

    We report a unique case of candida albicans sacral osteomyelitis in a 48 year-old female with previously undiagnosed Crohn's disease. The patient was ill for one year with fatigue, weakness, and a 60-lb weight loss. At the time of presentation, she developed chills, fever, right lower quadrant abdominal pain, and right knee pain. physical examination was significant for a palpable right lower quadrant abdominal mass. A computed tomographic scan of the abdomen and pelvis identified a large right-sided retroperitoneal mass, severe right hydronephrosis, and air within the right sacrum. Findings at laparotomy included small-bowel changes consistent with Crohn's disease, a multiloculated retroperitoneal abscess, and evidence of sacral osteomyelitis. A right hemicolectomy with sacral debridement and placement of presacral drains was performed. Bone cultures from the sacrum demonstrated a predominance of C. albicans, in addition to coliforms and enterococcus. The patient was placed on amphotericin b and intravenous antibiotics. Because serial computed tomographic scans of her pelvis demonstrated progression of her pelvic osteomyelitis to include the sacrum, right ilium, right acetabulum, and right femoral head, a repeat debridement with resection of the right femoral head was performed. After 12 months of follow-up, she was doing well without medications and had no constitutional symptoms or radiographic evidence of disease progression. This report illustrates a unique case of Crohn's disease presenting as sacral osteomyelitis secondary to small-bowel fistulization. Aggressive multidisciplinary surgical and medical management were the key to the successful management of this difficult case.
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