Cases reported "Peritonitis"

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1/1228. Perforation of the gallbladder: analysis of 19 cases.

    Perforation of the gallbladder occurred in 19 (3.8%) of 496 patients with acute cholecystitis treated at one hospital in an 8-year period. The average age of the 19 patients was 69 years and the female:male ratio was 3:2. Most had a history suggestive of gallbladder disease and most had coexisting cardiac, pulmonary, renal, nutritional or metabolic disease. The duration of the present illness was short, perforation occurring within 72 hours of the onset of symptoms in half the patients; the diagnosis was not suspected preoperatively in any. In the elderly patient with acute cholecystitis who has a long history of gallbladder disease, cholecystectomy should be performed early, before gangrene and perforation of the gallbladder can occur. ( info)

2/1228. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group.

    BACKGROUND: Since the emergence of methicillin-resistant staphylococcus aureus, the glycopeptide vancomycin has been the only uniformly effective treatment for staphylococcal infections. In 1997, two infections due to S. aureus with reduced susceptibility to vancomycin were identified in the united states. methods: We investigated the two patients with infections due to S. aureus with intermediate resistance to glycopeptides, as defined by a minimal inhibitory concentration of vancomycin of 8 to 16 microg per milliliter. To assess the carriage and transmission of these strains of S. aureus, we cultured samples from the patients and their contacts and evaluated the isolates. RESULTS: The first patient was a 59-year-old man in michigan with diabetes mellitus and chronic renal failure. peritonitis due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus peritonitis associated with dialysis. The removal of the peritoneal catheter plus treatment with rifampin and trimethoprim-sulfamethoxazole eradicated the infection. The second patient was a 66-year-old man with diabetes in new jersey. A bloodstream infection due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus bacteremia. This infection was eradicated with vancomycin, gentamicin, and rifampin. Both patients died. The glycopeptide-intermediate S. aureus isolates differed by two bands on pulsed-field gel electrophoresis. On electron microscopy, the isolates from the infected patients had thicker extracellular matrixes than control methicillin-resistant S. aureus isolates. No carriage was documented among 177 contacts of the two patients. CONCLUSIONS: The emergence of S. aureus with intermediate resistance to glycopeptides emphasizes the importance of the prudent use of antibiotics, the laboratory capacity to identify resistant strains, and the use of infection-control precautions to prevent transmission. ( info)

3/1228. peritoneal dialysis-associated peritonitis caused by Propionibacteria species.

    There are an increasing number of reports about unusual causes of peritonitis in peritoneal dialysis (PD) patients. The Propionibacteria species is a microorganism that is a normal skin flora. Under the presence of certain risk factors, it may produce serious infections. patients at risk of having Propionibacteria sp infections have malignancy, diabetes mellitus, foreign bodies, or immunodeficiency. We describe a PD-associated peritonitis in a 51-year-old woman that was caused by Propionibacteria sp. This patient's risk factors for developing Propionibacteria sp peritonitis include a history of crest syndrome, malignancy of the breast, and recent catheter surgery. To our knowledge, this is the first case of a PD-associated peritonitis caused by Propionibacteria sp reported in the literature. ( info)

4/1228. Pericardial injury following severe sepsis from faecal peritonitis--a case report on the use of continuous cardiac output monitoring.

    We report on a case of a 43-year-old man who developed reversible myocardial depression and pericarditis related to severe sepsis secondary to rectosigmoid colonic perforation. The management of this patient was aided by the use of a continuous thermodilution cardiac output catheter and monitor, recently introduced in clinical practice. ( info)

5/1228. Spontaneous bladder rupture: rare cause of peritonitis.

    Spontaneous rupture of the urinary bladder is an uncommon, but important, cause of generalized peritonitis. It is a surgical emergency which may be rapidly fatal if diagnosis and treatment are delayed. Bladder disease or obstruction, coupled with a sudden increase in intra-abdominal pressure usually accounts for the rupture. Characteristic symptoms are acute lower abdominal pain followed by generalized peritonitis. In most cases, the rupture is intra-peritoneal. ( info)

6/1228. Isolated colonic tuberculous perforation as a rare cause of peritonitis: report of a case.

    We present herein the rare case of a patient who developed peritonitis due to colonic tuberculosis with perforation. The patient was successfully treated by resectional surgery with delayed restoration of bowel continuity and antitubercular therapy. ( info)

7/1228. Fetal meconium peritonitis after maternal hepatitis A.

    hepatitis a virus has rarely been implicated in congenital infections. After maternal hepatitis A at 13 weeks' gestation, ultrasonographic examinations revealed fetal ascites (20 weeks) and meconium peritonitis (33 weeks). After delivery, a perforated distal ileum was resected. Elevated levels of hepatitis A immunoglobulin g persisted in the infant 6 months after delivery. ( info)

8/1228. Sclerosing mesenteritis seen clinically as pancreatic pseudotumor: two cases and a review.

    Sclerosing mesenteritis is an uncommon nonneoplastic inflammatory process in the mesentery that is seen as a pseudotumor, usually involving the small bowel mesentery, the mesenteric fat, and less commonly, the mesentery of the large bowel. We report two cases of sclerosing mesenteritis and review the literature on this rare disease. Both patients had pain, profound weight loss, and a mass on computed tomography (CT) scan of the abdomen. The provisional diagnosis was pancreatic neoplasm on the basis of clinical presentation and imaging studies. The diagnosis of sclerosing mesenteritis was established by histologic findings in biopsy material obtained at laparotomy in both cases. Interval histologic studies in one patient who had a high CA 19-9 level, progressive biliary ductal and partial duodenal compression, revealed a transitional histologic pattern from predominant inflammation and fat necrosis to predominant fibrosis. This may explain the varied descriptive terms used in the literature to describe this entity. ( info)

9/1228. immunoblastic lymphadenopathy-like T-cell lymphoma complicated by multiple gastrointestinal involvement.

    We report a rare case of immunoblastic lymphadenopathy (IBL)-like T-cell lymphoma complicated by multiple gastrointestinal involvement, which appeared to be ameliorated by chemotherapy but resulted in perforative peritonitis. A 66-year-old Japanese woman who had generalized lymphadenopathy and eruptions was admitted to our hospital because of bloody stool. Colonoscopic examination revealed hemorrhagic ulcers in the terminal ileum and a saucer-like ulcer in the cecum. Gastrointestinal endoscopy revealed several ulcerative or elevated lesions in stomach and duodenum. biopsy specimens of these lesions and of a lymph node showed characteristic histological features of IBL-like T-cell lymphoma. The initial treatment with prednisolone (PSL) and cyclophosphamide (CPA) was effective. Six months after the treatment, however, she developed bloody stool again caused by multiple ulcerative lesions in the large intestine. The recurrence of the disease was determined histologically, and four courses of CPA, PSL, vinblastine sulfate and doxorubicin hydrochloride (CHOP) therapy were administered. One month after completing the CHOP therapy, she developed intestinal obstruction and then acute peritonitis resulting from perforation at an ulcer scar in the jejunum. Surgical treatment was successful, and histological examination demonstrated no lymphoma cells in the resected specimen. A gastrointestinal perforation should be recognized as a potential complication of IBL-like T-cell lymphoma, even during remission. ( info)

10/1228. Inflammatory cysts of the pelvic peritoneum.

    Three young women with abdominal distension due to pelvic masses were investigated using ultrasound and conventional radiographic techniques. While the latter revealed masses of soft tissue density arising from the pelvis and displacing bowel, the sonogram indicated the morphologic features of thin-walled multiloculated cysts. They were located entirely within the peritoneal cavity and contained serous to serosanguineous fluid. The mesholelial lined walls were infiltrated with chronic inflammatory cells and were adherent to chronically inflamed fallopian tubes. Although these acquired cysts are familiar to pathologists and gynecologists, the literature contains little information about them. ( info)
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