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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Operations were fulfilled in 420 patients with acute cholecystitis, 132 of them having obstructive jaundice. Only two patients were operated urgently due to peritonitis. In the other 130 patients forced diuresis and rational antiinflammatory therapy with antibiotics were used resulting in subsiding acute phenomena and liquidation of jaundice. It created the conditions for valuable examination of the patients and for performing operations under favourable conditions with respect to the cold period. The postoperative lethality in the cold period was 3.1%.
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PMID:[Surgical procedures in acute cholecystitis complicated by obstructive jaundice]. 742 87

A two-step procedure for percutaneous transhepatic drainage (PTD) of the biliary tract was attempted on 101 patients with obstructive jaundice, 29 with benign and 71 with malignant lesions, and was successful in 100. With this procedure, marked clinical improvement, with reduction in levels of serum bilirubin, SGOT, SGPT and alkaline phosphatase, was achieved after 1-2 weeks as a preoperative step or for continuous drainage in inoperable cases. In one patient 8 dys after PTD, however, a complicating large intrahepatic hematoma proved fatal. Emergency operation was necessary in three of the four patients who developed bile peritonitis due to dislocation of the catheter and in one with intra-abdominal bleeding. Our results suggest that this procedure is very useful in the diagnosis and management of certain obstructive diseases of the biliary tract.
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PMID:Percutaneous transhepatic drainage: experience in 100 cases. 745 29

Over the last ten years (1984-1994), 124 patients undergo one-stage operations for diseases of the heart valves and coronary arteries and other surgical conditions. This makes 3.38 per cent of the total of 3661 patients subjected to open-heart surgery in the observation period. The indications for undertaking surgical treatment in the series of 124 patients reviewed are classified in three groups, as follows: Group A. Life-threatening conditions due to concomitant surgical disease (bleeding from the gastrointestinal tract, acute calculus cholecystitis, obstructive jaundice, peritonitis, end-stage pregnancy)--16 patients. Group B: Serious non-heart surgical diseases (malignancy, hypersplenism, aneurysm of the abdominal aorta)--47 patients. Group C. Non-heart diseases giving rise to serious complaints and life style deterioration (advanced inguinal hernia, hiatal hernia with gastroesophageal reflux, duodenal ulcus, thyroidism, etc.)--61 patients. The early postoperative mortality and complications rates--2.41 per cent and 3.22 per cent, respectively--do not differ essentially from those in patients with open-heart surgery alone. One-stage surgical procedures after careful assessment of the indications are recommended.
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PMID:[One-stage operations in pathology of the heart valves and coronary vessels and other general surgical diseases in 124 patients]. 747 57

Many patients with acquired immune deficiency syndrome (AIDS) and abdominal pain are evaluated by the surgeon, and the majority have gastroenteritis, which can be treated with specific antimicrobials. There are some, however, who need more extensive investigation or who have an intra-abdominal infective process that requires surgical treatment. The one and a half decades of experience with human immunodeficiency virus (HIV) and AIDS has defined the role of the surgeon in treating patients with HIV. Major infective processes that may require surgical involvement include cytomegalovirus infection of the intestinal tract; appendicitis, which may be due to opportunistic infections; spontaneous bacterial peritonitis; cholecystitis; and obstructive jaundice with underlying sclerosis of the biliary tree. Early diagnosis and prompt surgical treatment are critical in the management of HIV-infected patients. For example, cytomegalovirus affecting the gastrointestinal tract may lead to perforation with the development of generalized fecal peritonitis; the clinical presentation of acute appendicitis in HIV patients may not include the usual rise in white blood cell count; and bacterial peritonitis in patients with AIDS may be caused by opportunistic pathogens or, as in the classical case, a single gram-negative bacillus or pneumococcus. This review article focuses on intra-abdominal infections in patients with HIV and AIDS.
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PMID:Surgical infections in AIDS patients. 775 66

Most surgeons performing in laparoscopic cholecystectomy have opted for the use of metal clips to secure the cystic duct before division. Accordingly, we have been using double proximal clipping of the cystic duct for our patients. Certain disadvantages of clips are well known, among them, their ability to slip. We report one case of clip migration into the common bile duct, which led to obstructive jaundice. The clip was recovered after endoscopic sphincterotomy. Slipping of the second metal clip lead to biliary peritonitis necessitating surgical drainage. The case presented raises the question of whether suture ligation of the proximal end of the cystic duct should be preferred to clipping.
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PMID:Migration and slipping of metal clips after celioscopic cholecystectomy. 826 71

The authors had 51 patients with iatrogenic injuries to the bile ducts. This complication occurred most frequently in cholecystectomy (45 patients). The injury was localized in the distal segment of the supraduodenal part of the hepaticocholedochus in 11, at the junction of the cystic and hepatic ducts in 15, and in the region of the opening of the hepatic ducts in 23 patients; the lobar hepatic ducts were injured in 2 patients. Injury to the bile ducts was recognized during the first operative intervention in 13 patients, in 8 of them restorative operations could be performed. After the first operation peritonitis developed in 2, obstructive jaundice in 16, a complete external biliary fistula in 14, and obstructive jaundice and an incomplete external biliary fistula in 6 patients. The biliary tract was reconstructed in all of them by forming a bilio-digestive anastomosis with an isolated jejunal loop after Roux. The authors prefer using a changeable transhepatic drain. Six patients died in the early postoperative period.
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PMID:[Injury to the bile ducts during surgery]. 833 48

We have prospectively studied all cholecystectomies performed in one year in our clinic in two groups: 190 cases performed laparoscopically and 98 open. We used standardized records and the EPI 5 program on an IBM compatible computer. There were no significant differences between groups regarding weight, sex and proportion of cases with acute cholecystitis. There were however major differences regarding age, type of habitat, ASA score and association with acute pancreatitis, obstructive jaundice and angiocholitis. Conversion of laparoscopic cholecystectomy to open procedure was imposed in 17 cases (not included in statistical analysis) due to technical difficulties (12 cases), haemorrhagic accidents (6 cases), injury of the common bile duct (1 case), stones lost in the abdominal cavity (3 cases), local peritonitis (5 cases). Laparoscopic cholecystectomy lasted a mean of 74 minutes. We encountered 3 specific complications: one CBD injury recognized intraoperatively and managed by Kehr's procedure (one CBD injury in the open cholecystectomy group), one small bowel perforation and one of biloma. Mortality averaged 0.5% in the LC group (one case of late postoperative stroke considered not related to the procedure) and 1% in the open cholecystectomy group. The hospital admission period was significantly reduced in the LC group (5 days vs. 12 days). LC appears as a safe procedure with a low complication rate. Conversion to open procedure is not a complication. Our study recommend LC as the method of choice in the treatment of gallbladder lithiasis.
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PMID:[The value of laparoscopic cholecystectomy in the treatment of gallbladder pathologies]. 945 51

Initial therapy of acute cholecystitis and cholangitis is directed towards general support of the patient, including fluid and electrolyte replacement, correction of metabolic imbalances and antibacterial therapy. Factors affecting the efficacy of antibacterial therapy include the activity of the agent against the common biliary tract pathogens and pharmacokinetic properties such as tissue distribution and the ratio of concentration in both bile and serum to the minimum inhibitory concentration for the expected micro-organism. Antimicrobial therapy is usually empirical. Initial therapy should cover the Enterobacteriaceae, in particular Escherichia coli. Activity against enterococci is not required since their pathogenicity in biliary tract infections remains unclear. Coverage of anaerobes, in particular Bacteroides spp., is warranted in patients with previous bile duct-bowel anastomosis, in the elderly and in patients in serious clinical condition. In patients with acute cholecystitis or cholangitis of moderate clinical severity, monotherapy with a ureidopenicillin--mezlocillin or piperacillin--is at least as effective as the combination of ampicillin plus aminoglycoside. In severely ill patients with septicaemia, an antibacterial combination is preferable. Therapy with aminoglycosides, mostly for Pseudomonas aeruginosa-related infections, should not exceed a few days because the risk of nephrotoxicity seems to be increased during cholestasis. Relief of biliary obstruction is mandatory, even if there is clinical improvement with conservative therapy, because cholangitis is most likely to recur with continued obstruction. Emergency invasive therapy is reserved for patients who fail to show a clinical response to antibacterial therapy within the first 36 to 48 hours or for those who deteriorate after an initial clinical improvement. Immediate surgery is indicated for gangrenous cholecystitis and perforation with peritonitis. Long-term administration of antibacterials is required for recurrent cholangitis, as seen in bile duct-bowel anastomosis. Oral cotrimoxazole (trimethoprim/sulfamethoxazole) is the preferred agent. Wound infection rates after biliary tract surgery can be significantly reduced by preoperative administration of prophylactic antibacterials. Newer generation beta-lactams have not proven to be of greater benefit than older agents such as cefuroxime or cefazolin. Antibacterial prophylaxis before endoscopic retrograde cholangiopancreatography (ERCP) should be reserved for patients with obstructive jaundice, since the risk of infectious complications seems to be strongly associated with this clinical condition. Failure to achieve full biliary drainage is the most important factor in predicting septicaemia, and prophylaxis should be prolonged until the bile duct is unobstructed. Piperacillin, cefazolin, cefuroxime, cefotaxime and ciprofloxacin are effective for this indication.
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PMID:Biliary tract infections: a guide to drug treatment. 995 53

A case of jaundice due to an obstruction of the afferent loop following a pancreatoduodenectomy is presented. The dilated loop of the jejunum was drained percutaneously with a 12-F gastrostomy tube. Localized peritonitis around the puncture site was managed conservatively and the obstructive jaundice improved. The treatment strategy for this type of jaundice is discussed.
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PMID:Percutaneous bowel drainage for jaundice due to afferent loop obstruction following pancreatoduodenectomy: report of a case. 1055 38

A 72 year-old Japanese man with peritoneal recurrence of carcinoma of the ampulla of Vater after curative pancreatoduodenectomy is presented. He was treated by percutaneous transhepatic biliary drainage (PTBD) for obstructive jaundice. The PTBD catheter dislodged 14 days later. He underwent emergency open peritoneal lavage and external choledochal drainage for diffuse bile peritonitis. Cytologic examination of bile obtained from the T-tube revealed malignant cells. He underwent pancreatoduodenectomy with regional lymph node dissection 2 months later for ampullary carcinoma. Pathologic examination showed a macroscopic protruding, 8 x 7 x 10 mm, papillary adenocarcinoma of the ampulla of Vater. The tumor was classified as stage II with pT2, pN0, and pM0. Eight months later, cytologic examination of ascites demonstrated adenocarcinoma cells. The patient died with peritoneal recurrence 10 months after curative pancreatoduodenectomy.
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PMID:Peritoneal recurrence of ampullary carcinoma following curative pancreatoduodenectomy. 1062


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