Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bowel perforation is a life-threatening complication of operative laparoscopy that warrants immediate treatment. The classic radiographic signs of a ruptured viscus may be indistinguishable from intraperitoneal CO2 introduced during insufflation. To examine whether abdominal radiology could be useful in diagnosing a ruptured viscus after laparoscopy, we obtained upright abdominal films on 31 patients 24 hours after operative laparoscopy. The laparoscopic procedures ranged from lysis of adhesions to radical hysterectomy with lymph node dissection. Twenty-eight of the patients had no radiologic evidence of free air 24 hours postoperatively. Of the three patients who were found to have free air, one was asymptomatic, one had an acute abdomen that resolved, and another died after multiple surgeries to resolve what was found to be an unrecognized bowel perforation from a prior laparoscopic lysis of adhesions. Based on our findings, we believe that the presence of free air 24 hours after laparoscopy to be presumptive evidence of a ruptured viscus until proven otherwise.
 ...
PMID:Resolution of Free Intraperitoneal Air after Laparoscopy: Utility of Abdominal Radiography in the Diagnosis of Bowel Injury 907 65

We evaluated the outcomes of pregnancies in nine women who underwent removal of an adnexal mass by operative laparoscopy during pregnancy. These patients, who would otherwise have undergone exploratory laparotomy, were treated by diagnostic and operative laparoscopy using the carbon dioxide laser and electrocoagulation. Gestational ages ranged from 12 to 22 weeks (mean 15 wks). Indications for the surgery were persistent complex or enlarged adnexal mass (7), painful adnexal mass (1), and acute abdomen and intraabdominal hemorrhage (1). Procedures performed were ovarian cystectomy (7), paratubal cyst removal (1), and evacuation of pelvic hematoma (1). Operating time ranged from 55 to 150 minutes (mean 101 min). Peritoneal washings were always obtained. No tocolytics were used during or after surgery. Normal fetal heart tones were auscultated postoperatively in the recovery room. There were no complications secondary to the surgery. Six women delivered at term with weight appropriate for gestational age (AGA). One patient had premature rupture of membranes at 31 weeks' with delivery of a viable AGA infant by emergency cesarean section. Two patients' pregnancies at 26 and 29 weeks are progressing normally. Operative laparoscopy for certain pelvic pathology may be performed safely with no complications to the pregnancy.
 ...
PMID:Removal of Adnexal Masses by Operative Laparoscopy During Pregnancy 907 48

A patient undergoing emergency laparotomy for an acute abdomen developed fatal air embolism as a result of surgical manipulation of a cavitating metastatic lesion of the liver. The diagnosis was made at postmortem examination. This cause of air embolism has apparently not been reported before. The causes and management of air embolism are briefly reviewed. It is concluded that in exceptional circumstances when intubated patients are sent to a recovery area, the continuation of CO2 monitoring into the post-operative period should be considered.
 ...
PMID:Fatal air embolism: a complication of manipulation of a cavitating metastatic lesion of the liver. 965 2

The development of the laparoscopic technique in surgery was so overwhelming that scientific evaluation could not keep in step. While investigators were still discussing the effects of the pneumoperitoneum on the healthy organism, laparoscopy was already performed in patients with an acute abdomen due to trauma or disease. Therefore, there is an urgent need of further experimental and clinical studies with relevant endpoints to gain external evidence concerning the benefits of diagnostic or therapeutic laparoscopy for critically ill patients. In experiments with pigs we have shown that even in a healthy organism perfusion and energy metabolism of the small bowel is impaired by a pneumoperitoneum with carbon dioxide. Under the conditions of a systemic inflammatory response syndrome induced by infusion of endotoxin, the negative effects of the pneumoperitoneum were significantly amplified. Furthermore, we found that the increased intracranial pressure as caused by a head injury was further enhanced during a pneumoperitoneum but not by the alternative method of mechanical wall retraction. The current literature dealing with the effects of a pneumoperitoneum in critically ill patients is still controversial. Our data support the results of those authors who hold the opinion that creating a pneumoperitoneum in patients with acute abdominal problems means an additional serious burden that in single cases may lead to a disaster. As evidence is lacking, the current extension of laparoscopy into the field of intensive care medicine is still a human experiment that must be performed with high responsibility, extensive monitoring, and according to the rules of a clinical study.
 ...
PMID:CO(2) pneumoperitoneum: what we know and what we need to know. 1041 5