Cases reported "Peritonitis"

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11/167. A minimally invasive approach to bile peritonitis after blunt liver injury.

    The advent of nonoperative management of liver injuries has made it imperative that surgeons be familiar with the potential delayed complications of this approach. In this report, we describe a minimally invasive strategy for the management of bile peritonitis following nonoperative management of blunt liver injuries. Two cases are presented in which bile peritonitis with massive bile ascites was managed with laparoscopic localization and drainage of the bile leak, irrigation of the peritoneal cavity, and postoperative endoscopic retrograde cholangiography with bile duct stenting. In both cases the bile leak ceased, and the patients recovered without adverse sequelae. The combination of laparoscopic surgery and endoscopic stenting provides a minimally invasive approach to this entity.
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12/167. Emergency stent-graft repair of a ruptured hepatic artery secondary to local postoperative peritonitis.

    PURPOSE: To describe the use of a stent-graft for emergent repair of life-threatening hepatic artery hemorrhage. methods AND RESULTS: A 57-year-old man with a 17-year history of myxoid liposarcoma underwent surgery for a recurrent abdominal mass. Multivisceral resection including a Kausch-Whipple procedure with an extended right hemicolectomy was performed. Three weeks later, an episode of gastrointestinal bleeding prompted surgical repair of the hepatic artery, which had been eroded by infection due to a leaking bilioenteric anastomosis. After 3 weeks of programmed abdominal lavage, bleeding recurred. Angiography documented another rupture of the proximal hepatic artery. After an unsuccessful attempt at coil embolization, a Hemobahn stent-graft was implanted percutaneously during simultaneous cardiopulmonary resuscitation. hemostasis was secured, and the patient recovered. Over the 10-month follow-up, no bleeding or infection has been observed at the site of the repair, and flow through the hepatic artery endograft remains satisfactory. CONCLUSIONS: Percutaneous stent-graft placement can be employed for emergent treatment of visceral artery rupture in patients at high risk for conventional surgical repair.
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13/167. peritonitis fibroplastica incapsulata with superadded post-operative starch powder peritonitis.

    peritonitis fibroplastica incapsulata is not generally accepted as a distinct syndrome. However, characteristic pathological alterations can be identified at laparotomy and by histological examinations. The aetiology of the disease is unknown. In the case reported a second disease arose, i.e. the peritoneal reaction to corn starch powder in the course of the surgical treatment of the peritonitis fibroplastica.
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14/167. 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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15/167. prenatal diagnosis of meconium peritonitis in a twin pregnancy after intracytoplasmic sperm injection. A case report.

    BACKGROUND: meconium peritonitis occurring in pregnancies following artificial reproductive techniques (ART) is rare. We report the first case of meconium peritonitis following intracytoplasmic sperm injection (ICSI). CASE: A 37-year-old woman attended our in vitro fertilization (IVF) program because her husband suffered from hypospermatogenetic azoospermia due to cancer surgery and radiotherapy. The patient achieved a twin pregnancy through ICSI from testicular sperm extraction at our IVF center. meconium peritonitis, fetal ascites, polyhydramnios, bowel dilatation, hydrocele and intraabdominal calcification were noted in one of the twins on ultrasound at 30 weeks' gestation. cesarean section due to breech presentation in labor was performed at 36 weeks' gestation. A normal female and male infant with a distended abdomen were delivered. Emergency laparotomy was performed on the male twin because of dyspnea. A 0.2-cm perforation was found in the terminal ileum. Ileotomy was performed and closed after 27 days. CONCLUSION: prenatal diagnosis of meconium peritonitis is possible through careful ultrasonographic examination, and early surgical intervention and intensive postoperative support are required to improve the prognosis.
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16/167. streptococcus suis peritonitis: case report.

    A 45-year-old Thai man who presented with peritonitis was seen in a tertiary care centre in thailand. An exploratory laparotomy was done because of peritonitis from abdominal trauma. Postoperatively the patient received intravenous ceftriaxone and metronidazole, but he developed rhabdomyolysis and acute renal failure. Hemodialysis was performed. After 8 days, the peritonitis had relapsed with hypotension. The patient was given vasopressives but clinicaly deteriorated and expired on day 11. The peritoniteal fluid culture grew streptococcus suis serotype 2 and the organism was resistant to multiple antimicrobial agents including penicillin (MIC > 32 mcg/ml) but was susceptible to vancomycin.
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17/167. A new etiology of acute abdominal emergencies in cirrhotic patient: secondary pneumococcal peritonitis with jejunitis.

    We report the first case of secondary pneumococcal peritonitis associated with acute jejunitis in a 52-year-old homeless child-Pugh C cirrhotic man without ascitis. The patient was admitted with clinical signs of peritonitis, and jaundice. Morphologic examination was unremarkable. A laparotomy revealed a diffuse peritonitis, and an acute jejunitis with prenecrotic lesion. The lesion was located within the first centimeters of the jejunum, immediately after the duodeno-jejunal angle, extented on 15 cm. A resection of the first 15 cm of the jejunum was performed with duodeno-jejunal side-to-side manual anastomosis. Gram-stain and cultures of blood, peritoneal pus, and jejunal mucosa revealed a penicillin-sensitive streptococcus pneumoniae. Appropriate parenteral antibiotic treatment was initiated (aminopenicillin). The postoperative course was marked by a transient hepatic failure associated with an ascitis controlled by diuretics. The patient was discharged on the 26th day after surgery. This case reports a new etiology of acute abdominal emergencies in cirrhotic patients.
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18/167. 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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19/167. Concomitant acute lupus erythematosus and primary pneumococcal peritonitis.

    The acute surgical abdomen, a synonym for peritonitis requiring surgical intervention, can be mimicked by lupus peritonitis and, in children, by pneumococcal peritonitis. The former is best treated by systemic steroids and, the latter by penicillin; neither is well served by surgical intervention. We have reported here a young woman with the concomitant occurrence of both conditions. If peritoneal tap and immediate bacteriologic gram staining of recovered aspirate were carried out in patients with a history of acute lupus, such similar cases could be detected preoperatively. An attempt at antibiotic treatment could then be instituted as a first measure.
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20/167. peritonitis caused by a ruptured infected mesenteric cyst.

    Perforation of a mesenteric cyst is a very rare complication of a very unusual lesion. Acute presentation is the rule in half of all affected children. ultrasonography and computed tomography are the best preoperative diagnostic tools. The treatment of choice is an urgent laparotomy and complete cyst removal. Results are good in cases that are operated on in a timely manner.
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