1/288. Use of polyglactin 910 mesh (Vicryl) in pelvic oncologic surgery. Various synthetic materials have been shown to be useful surgical adjuncts in shielding the small intestine from pelvic radiation or in creating a new pelvic floor after major radical resections. Promising preliminary results with a polyglactin 910 (Vicryl) mesh in preventing radiation enteropathy prompted the authors to evaluate its clinical usefulness in reconstruction of the pelvic floor. Use of this mesh in pelvic exenterations (five total, one posterior) for advanced or recurrent gynecologic malignancies was associated with one enteroperineal fistula but no pelvic infection. In comparison with other pelvic reconstruction devices, this absorbable mesh significantly reduced intestinal morbidities in pelvic exenterations. This procedure appears to be feasible, reproducible, and safe, especially in patients who have undergone previous irradiation or those with an unsuitable omentum. ( info) |
| A previously healthy 43-y-old man, who had spent 2 weeks in northern india, was admitted to hospital after a 2-day history of pyrexia, confusion and frontal headache. Cranial computerized tomography (CT) showed an abscess in the right parietal lobe. Spinal fluid and blood cultures gave growth of salmonella enteritidis within 24 h. Treatment with cefotaxime was initiated, but ceased after 3 weeks due to drug fever, and ciprofloxacin was then given orally for 4 months. After 6 months, the patient was considered cured. Cases of salmonella brain abscesses are reviewed. ( info) |
3/288. Fatal ulcerative panenteritis following colectomy in a patient with ulcerative colitis. A 37-year-old man, previously submitted to colectomy for ulcerative pancolitis unresponsive to medical therapy, presented with nausea, vomiting, epigastric pain, and bloody diarrhea. An upper gastrointestinal endoscopy revealed mucosal friability, petechiae, and erosions throughout the duodenum, whereas prestomal ileum showed large ulcers and pseudopolyps. Histologically, a dense inflammation chiefly composed of lymphocytes and plasma cells with few neutrophils was detected. No bacteria, protozoa, and fungi could be detected. Despite intensive care, intra-1194 venous antibiotics and steroids, the patient died of diffuse intravascular coagulation and multiorgan failure. At post-mortem examination severe ulcerative lesions were observed scattered throughout the duodenum up to the distal ileum. The dramatic clinical presentation with fatal outcome, the widespread ulcers throughout the intestine, and the histological picture are peculiar features in our patient which can not be ascribed to any type of the ulcerative jejunoenteritis so far reported. patients with pancolitis and diffuse ileal involvement do not necessarily have Crohn's disease but rather may have ulcerative colitis. ( info) |
4/288. Histopathology of typhoid enteritis: morphologic and immunophenotypic findings. Enteric fever is a systemic illness caused by Salmonella infection, with S. typhi, S. paratyphi, and S. enteritidis being the most common serotypes. humans are the only reservoir for S. typhi, and its predilection for the ileum is due to the fact that organisms enter the body by translocation across specialized Peyer's patch epithelium and then proliferate in the mucosal macrophages. The lesions in bowel and mesenteric lymph nodes are distinctive and mimic Kikuchi-Fujimoto disease and Rosai-Dorfman disease as well as infections caused by some non-salmonella bacteria. The four cases presented in this report, two culture-confirmed, all exhibited ileal mucosal hypertrophy caused by a neutrophil-poor monocyte/macrophage-rich hyperplasia. Though diffuse areas were present, much of the lesional proliferation was nodular, representing macrophage infiltration and colonization by the monocytes and macrophages. Immunophenotypic studies, which showed a CD68 , lysozyme , UCHL-1 , OPD4-, CD4-, s100- profile, were helpful in distinguishing these lesions from other processes, including Kikuchi-Fujimoto disease and Rosai-Dorfman disease. Although rare in developed countries, enteric fever should be considered in any patient with recent travel to endemic areas and in the context of illness thought to be related to contaminated foods. ( info) |
5/288. Two simultaneous cases of cyclospora cayatensis enteritis returning from the dominican republic. According to the "International Passenger Survey," published in 1996 by the Office of Trading Standards, 534,000 British people traveled to the Caribbean area (personal communication, ABTA, 1998). The dominican republic, the eastern end of a large Caribbean island, has become in recent years one of the most popular destinations for UK holidaymakers as well as for travelers from many other countries. cyclospora cayatensis has been firmly identified as a cause of gastroenteritis among international travelers,1 including human immunodeficiency virus (hiv)-positive individuals,2 but it has not been previously reported in the literature in British individuals returning from this increasingly popular vacation destination. ( info) |
6/288. Acute abdomen and lupus enteritis: thrombocytopenia and pneumatosis intestinalis as indicators for surgery. Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enteric complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complicated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pneumatosis intestinalis. These findings suggested necrotizing enteritis and prompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis, and submucosal vasculitis were present in the resected specimen. Persistent SLE activity responded to cyclophosphamide, which is indicated in patients with digestive symptoms who fail to respond to high-dose steroids. ( info) |
| The case of a young woman presenting with fever, abdominal distention, and diarrhea is presented. While hospitalized, she developed peritonitis, and a laparotomy was performed emergently. Intraoperative and pathologic examinations are highly suggestive of salmonella typhi as an etiology for her symptoms and eventual perforation. Salmonella enteritis can be a difficult diagnosis to make, but in most cases it is a self-limited disease process. In a minority of cases, multidrug antibiotic therapy may be required secondary to an increasing prevalence of resistant strains. patients who perforate require prompt operation to limit morbidity and mortality. Outcome is significantly improved in those patients by directed resection of the affected segment of bowel and by aggressive perioperative care. ( info) |
8/288. Emphysematous gastritis in a leukemic child. Emphysematous gastritis associated with gram-negative sepsis is described in a leukemic child on chemotherapy and steroids. Bubbly-appearing air and thickening of the gastric wall were radiographically demonstrated. This is analogous to the demonstration of air within the thickened bowel wall in necrotizing enterocolitis, which is not unusual in seriously ill leukemic children. Gastric involvement has not been previously reported. ( info) |
9/288. Halophilic, lactose-positive Vibrio in a case of fatal septicemia. A halophilic Vibrio species was isolated from blood cultures from a 59-year-old male with enteritis. The strain differed from vibrio parahaemolyticus and Vibrio alginolyticus by its ability to ferment lactose, its production of beta-galactosidase, and its lower NaCl tolerance. A report of this infection and a description of the isolate is presented. ( info) |
10/288. A case of enteritis necroticans in pregnancy. This report describes a case of enteritis necroticans in pregnancy and comments on the surgical aspects of treatment. ( info) |