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

The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.
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PMID:[Appendectomies by celioscopy. Results in 78 patients]. 141 54

The case history is presented of a 10-year-old boy with a fatal combination of acute appendicitis and infectious mononucleosis, in the literature a particularly rare combination. The boy died of a perforative peritonitis. His appendicitis appeared not to be a complication of the infectious mononucleosis.
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PMID:[Fatal course of acute appendicitis associated with infectious mononucleosis]. 136 48

Scintigraphy with 99mTc-labeled anti-granulocyte antibodies (AGAb) was performed in 50 patients with suspected appendicitis. Sequential and static imaging as well as SPECT of the pelvis and abdomen was performed 2 h p.i. In all patients the diagnosis was confirmed either histologically or by long-term follow-up. 13 patients had histologically proven acute appendicitis. In 11 patients the appendix scan had been positive and in 2 patients the scan had shown no significant tracer uptake in the right lower abdomen. The remaining 37 patients turned out not to have acute appendicitis. 29 out of these patients had negative and 3 had positive scan findings. In 5 patients the scan was equivocal. Out of these patients 2 had pathologic findings on the left side of the abdomen which turned out to be acute diverticulitis in one patient and acute peritonitis in the other. The remaining 3 patients with unclear scintigraphic findings had no acute appendicitis. Scintigraphy with AGAb is fast and easy to perform and thus superior to cell labeling methods for diagnosing acute appendicitis. Sensitivity for the diagnosis of acute appendicitis was 85% with a specificity of 91%. Chronic or scarred non-granulocytic appendicitis--in which there is often no definite indication for surgery--was negative in our study except for two cases.
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PMID:[99mTc-anti-granulocyte antibodies (BW 250/183) in the detection of appendicitis]. 156 Nov 17

Primary pneumococcal peritonitis is an uncommon condition 1st identified in 1885. It occurs when peritoneal inflammation is present in the absence of an intraabdominal source of infection. In the preantibiotic era, the condition accounted for 2% of childhood abdominal emergencies largely among girls aged 2-10 years. Mortality was 42-100%, with death sometimes occurring within 48 hours of the onset of symptoms. This condition now present in female adults, is associated with IUD use, and is comparatively common in India. Consideration should therefore be given to the existence of primary pneumococcal peritonitis when diagnosing and managing abdominal emergencies. The pneumococcus may enter the peritoneal cavity via the female genital tract, blood, or through transmural spread from the gastrointestinal tract. No evidence supports a relationship between type of IUD and/or length of time in place, and the onset of peritonitis. Given pneumococcus' commensal existence in the upper respiratory tract, urogenital sex may facilitate its entrance to the peritoneal cavity through the female genital tract. Abdominal pain, diarrhea, and vomiting generally present, while the patient may also be pyrexial and dehydrated. In diagnosing this condition, the practitioner may confuse it with acute appendicitis, pelvic inflammatory disease, or gastroenteritis if in the early stages of peritonitis. Diagnosis is often confirmed only thorough laparotomy, but abdominal paracentesis and/or abdominal ultrasound may also be employed as diagnostic aids. Laparotomy and a regime of antibiotics is the preferred treatment. 2 case studies are discussed.
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PMID:Primary pneumococcal peritonitis. 159 42

Using a data base of 7,000 acute abdominal pains, we here described the assessed clinical manifestations of the main diseases responsible for right lower quadrant pain. However, percentages of sensibilities have been replaced by adverbs or adjectives, applying a scale of equivalence. The possible modifications of the positive predictive values have been also replaced by verbs or typical expressions. We first described the acute appendicitis syndrome (which covered congestive endoappendicitis and suppurated appendicitis) with the clinical shades or the gathered and gangrenous forms or even of the diffuse peritonitis. Features of the acute appendicitis contrast with those of the so called "non specified abdominal pains" (a new entity), and those of the subacute or chronic appendicitis. We found a good correlation between clinical and pathological findings. One of the difficulties has been to determine if a subgroup of subacute appendicitis should be or not included into the acute appendicitis.
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PMID:[Quantified symptomatology of acute appendicitis in adults. The signs and their value]. 159 20

Peritonitis (i.e. acute inflammation of the peritoneum) from appendicular origin, can be due to acute appendicitis or be observed after appendicectomy. Diagnosis is based on physical examination. Imaging procedures (ultrasound and computed tomography) are particularly useful in localized and postoperative peritonitis. Management includes surgery, antibiotics and intensive care. Early surgical treatment by appendicectomy represents the best way to improve the prognosis of the disease. Mortality is mainly observed in case of delayed diagnosis and in aged patients.
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PMID:[Appendicular peritonitis]. 159 23

The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.
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PMID:Emergency laparotomy in patients with AIDS. 131 Jun 34

The paper reports a case of intestinal malrotation in an adult patient with an anomalous location in the left hypochondrium of the cecum and vermiform appendix. The patient underwent explorative laparotomy for peritonitis due to acute appendicitis. Following a review of the literature, the anomaly was classified in embryological terms as a union defect during the third developmental stage of the umbilical loop. Attention is focused on the importance of an exact knowledge of the embryology of intestinal rotation in order to avoid technical surgical errors. In conclusion, the value of giving the patient precise iconographic documents is stressed in order to inform the surgeon who may have to operate on the patient's abdomen in the future.
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PMID:[Intestinal malrotations in the adult]. 175 38

The authors studied the data concerning 101 patients who had undergone erroneous laparotomy for suspected acute surgical disease; these accounted for 0.4% of all the patients who were operated on for emergency indications in the same period. Eleven patients died. The operation was undertaken for an erroneous diagnosis of acute appendicitis (32 patients), acute cholecystitis (18), perforating gastric ulcer (15), peritonitis of unknown etiology (14), acute intestinal obstruction (5), strangulated hernia (3), destructive pancreatitis (3), tumor of the large intestine complicated by obstruction (3), abdominal abscess (2), thrombosis of the mesenteric vessels (1), ovarian apoplexy (1), closed abdominal trauma with injury to the viscera (4 patients). Diseases simulating the clinical picture of "acute abdomen" but not requiring an emergency operation were as follows: female reproductive (20 patients), pancreatic (11), renal diseases (11), hepatitis, cirrhosis of the liver (10), cardiovascular (9), pulmonary diseases (5), mesoadenitis (5), Crohn's disease (3), chronic colitis (3), carcinomatosis of the peritoneum (3), herpes zoster (3), and other diseases and injuries (20 patients). The main causes of the diagnostic and tactical errors were objective difficulties in the differential diagnosis due to similar symptomatology, as well as errors in the examination of the patient and haste in making a decision to make an operation.
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PMID:[Erroneous laparotomy in emergency surgery]. 177 33

A retrospective study on the microbiology of abdominal pus from acute appendicitis or peritonitis was carried out by the authors. A total of 45 specimens were examined, 38 of them (84.4%) where found to be positive, of which 29 (76.3%) were polymicrobial and 9 (23.7%) were monomicrobial. The most represented species were Escherichia coli (28.4%), Bacteroides fragilis (7.8%), Streptococcus milleri (7.8%), Bacteroides oralis (3.9%) and Pseudomonas aeruginosa (3.9%). The polymicrobial associations more represented include Bacteroidaceae, Enterobacteriaceae and streptococcus genus. The most active drugs in vitro were found to be Piperacillin and Chloramphenicol, Cephalosporin (cefotaxime, ceftriaxone and cefoxitin) showed a good capability of being active against isolated microorganisms although they were less effective when used against anaerobic microorganisms then aerobic ones. On the contrary, Rifampicin, Metronidazole and Clindamycin were found to be quite effective against the anaerobes.
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PMID:[Bacteriology of abdominal pus in 43 cases of acute appendicitis and appendiceal abscess at the Ivrea-Castellamonte Hospital, isolation of aerobic and anaerobic bacteria and drug sensitivity]. 184 22


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