Cases reported "Peritonitis"

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1/73. Outcome following staphylococcal peritonitis.

    OBJECTIVE: staphylococcus spp predominate as the causative pathogen of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis.This study evaluated the difference in morbidity and mortality between peritonitis caused by S. aureus and coagulase-negative staphylococci (CoNS). DESIGN: Prospective observational study. SETTING: A single regional dialysis unit in a teaching hospital. patients: Thirty-seven patients had S. aureus peritonitis and 65 patients had CoNS peritonitis between July 1990 and November 1995. MAIN OUTCOME MEASURES: Using the first recorded episode of peritonitis, survival analysis was performed for time to (1) death, (2) removal of peritoneal dialysis catheter, and (3) change to hemodialysis. Abdominal complications were recorded for the first and subsequent episodes. RESULTS: No difference in time to death was demonstrated for the two groups (p = 0.79), although two deaths that occurred during therapy for peritonitis were attributable to S. aureus infection. In addition, 5 patients developed serious abdominal complications related to an episode of S. aureus peritonitis. patients with S. aureus peritonitis had a shorter time to both peritoneal dialysis catheter removal (p = 0.004) and change to hemodialysis (p = 0.014). The change in mode of dialysis was independent of catheter loss. CONCLUSION: This study highlights the serious nature of S. aureus peritonitis and confirms the need for effective preventive measures against infection by this pathogen.
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2/73. Spontaneous uterine perforation of pyometra. A report of three cases.

    BACKGROUND: Spontaneous perforation of pyometra is a rare cause of generalized peritonitis; only 17 cases have been reported. CASES: Three cases of spontaneous perforation of pyometra occurred; two were associated with carcinoma of the cervix. All were treated with exploratory laparotomy and drainage. The first patient died of recurrent carcinoma of the cervix five months after laparotomy. The second patient died of septic shock shortly after the operation. The third patient made a good postoperative recovery. CONCLUSION: pyometra is a serious medical condition, because of both its association with malignant disease and the danger of spontaneous perforation, which carries significant morbidity and mortality. Although rare, ruptured pyometra should be considered in the differential diagnosis of acute abdomen in elderly women, especially those with malignant disorders of the genital tract. The treatment of pyometra rupture is immediate laparotomy, peritoneal lavage and drainage, or simple hysterectomy.
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3/73. Acute complications of jejuno-ileal pseudodiverticulosis: surgical implications and management.

    Acute inflammatory complications of jejuno-ileal pseudodiverticulosis that necessitate surgical intervention are attended by excessive mortality rates of 20 to 40 per cent primarily because of delay in diagnosis. early diagnosis is confused by the frequent coexistence of other gastrointestinal pathology, most commonly perforated gastric or duodenal ulcers, colonic pseudodiverticulitis, and acute appendicitis with rupture. Resection of pseudodiverticula-containing segments with primary reanastomosis is the preferred method of surgical management for perforation, bleeding, and obstruction. Recommendations are made for more accurate and earlier detection and management.
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4/73. Streptococcal toxic shock syndrome revealed by a peritonitis. Case report and review of the literature.

    Group A streptococcus (GAS) or streptococcus pyogenes cause a variety of life-threatening infectious complications including necrotizing fasciitis, purpura fulminans and streptococcal toxic shock syndrome (STSS). exotoxins that act as superantigens are felt to be responsible for STSS. These exotoxins are highly destructive to skin, muscle and soft tissue. This syndrome has a rapid and fulminant course with frequently fatal outcome. GAS remains sensitive to penicillin but in serious infection a combination of clindamycin and ceftriaxone or meropenemum is recommended. Several studies have shown that mortality was dramatically reduced in STSS patients treated with immunoglobulin g given intravenously (IVIG). Early recognition of this most rapidly progressive infection and prompt operative debridement are required for successful management. This report presents a female patient at two month post-partum with a peritonitis and multi-organ failure.
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5/73. Emergency laparotomy in patients on continuous ambulatory peritoneal dialysis.

    peritonitis is the most common complication of chronic ambulatory peritoneal dialysis (CAPD). It is often a diagnostic challenge to differentiate those patients with CAPD-associated infections from those who have unrelated gastrointestinal pathology as the cause of peritonitis and would benefit from surgical exploration. A retrospective chart review was performed on all patients at a single institution who were on CAPD between the years 1990 and 1998 and who underwent laparotomy for peritonitis. Six patients underwent laparotomy. Four were male and two were female; ages ranged from 34 to 80 years. Perforated appendicitis was the cause of peritonitis in three patients, perforated diverticulitis was present in two, and one was without any suppurative intra-abdominal process. In each case CT scan of the abdomen was nondiagnostic. There was a delay in diagnosis of 10 days (range 3-21 days) and an operative mortality of 16 per cent.
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6/73. Gastric necrosis and perforation as a complication of splenectomy. Case report and related references.

    necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patient's clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.
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7/73. Right lobar pneumonia complicated by sub-phrenic abscess in a child.

    A 14-year old boy presented with chest and abdominal pain and fever for one week. He had been treated with several antibiotics at home and in a peripheral hospital for respiratory infection. physical examination showed features of right lobar pneumonia and peritonitis. Chest radiograph showed consolidation in the right lower lung field and abdominal ultrasonography showed a subphrenic collection. At exploratory laparotomy, a right subphrenic abscess and general peritonitis without an intra-abdominal focus were found. The abscess was drained and broad-spectrum antibiotics given. death, however, occurred from overwhelming infection. subphrenic abscess complicating pneumonia is unusual but can be the cause of poor response to treatment. The diagnosis should be excluded in a child with pneumonia and persisting abdominal symptoms. Prompt treatment is necessary to avoid morbidity and mortality.
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8/73. Spontaneous perforation of the right hepatic duct.

    Spontaneous perforation of the biliary ductal system is a rare cause of peritonitis with a high morbidity and mortality rate. We present a case of an 80-year-old female who presented to the Emergency Department with acute onset abdominal pain and peritoneal signs. She was taken to the operating room for exploratory laparotomy and discovered to have a perforation of her right hepatic duct. Several risk factors were found to play a role in her biliary perforation: biliary calculi, infection, and vessel thrombosis. She underwent a cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation, and placement of a T-tube. She had a prolonged recovery in the intensive care unit and was eventually discharged to a skilled nursing facility. We conclude that the management of this unique and highly fatal disease can be applied with an excellent outcome.
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9/73. crack cocaine-related prepyloric perforation treated laparoscopically.

    Perforation, which occurs in seven to 10 patients per 100,000 population annually, complicates 5-10% of peptic ulcers. crack cocaine has been associated with many gastrointestinal disorders, including ulcer perforation. Crack-related gastroduodenal perforations, typically prepyloric, have been on the rise in the last decade. Suggested mechanisms include ischemia, motility disorders, increased air swallowing, platelet-related thrombosis, and increased ACTH and corticosterone secretion. A 28-year-old man presented with vomiting and sudden generalized abdominal pain 3 h after smoking a "rock" (a 100-mg cube of crack). physical examination revealed generalized guarding, and plain films showed free intraperitoneal air. laparoscopy confirmed the diagnosis of generalized peritonitis secondary to a 5-mm perforation of the prepyloric anterior wall of the gastric antrum. omentum-patched primary closure and thorough abdominal irrigation were undertaken. The postoperative course was uneventful. omeprazole and anti-H. pylori treatment, including erythromycin and metronidazole, were maintained for 8 weeks and 1 week, respectively. Although drug addicts are not easily compliant with long-term medical treatment, in the particular case of crack addiction, the vasoconstrictive and dismotility effects of cocaine may precipitate gastric necrosis and paralysis, respectively, in the case of vagotomy. Although distal gastrectomy was the wisest choice when open ulcer surgery was adopted, the laparoscopic treatment of perforated ulcer, with either suture or sutureless techniques, has been found to be comparable to open surgery with regard to postoperative morbidity, reoperation rates, and mortality. The potential advantages of laparoscopy include the avoidance of large incisions, less attendant pulmonary morbidity, less wound infection, and possibly fewer postoperative adhesions.
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10/73. vancomycin-resistant peritonitis associated with peritoneal dialysis: a cause for concern.

    BACKGROUND: peritonitis resulting from peritoneal dialysis (PD) remains a serious cause of morbidity and even mortality among dialysis patients. AIM: To highlight the danger of antibiotic resistance in patients on dialysis who have received multiple courses of antibiotics. methods: Two cases are reported in which the patients developed peritonitis resistant to vancomycin. CONCLUSIONS: Multi-drug resistance is a growing danger. It is imperative to use the most appropriate antibiotics in the proper dosage. If infections persist, early removal of the catheters is essential. The use of antibiotics in PD patients needs to be limited. Sensitivity patterns of the cultured organisms must be monitored regularly as the lack of vigilance may help accelerate the development of the so-called 'super bug' resistant to all antibiotics.
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