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

A case is presented of postoperative bile peritonitis from an accessory cholecystohepatic bile ductule after cholecystectomy for acute cholecystitis. Accessory bile ductules (ducts of Luschka) are occasionally encountered in the gallbladder fossa but do not drain directly into the gallbladder fundus. Nevertheless, they may be injured during surgery and may go unrecognized. When recognized intraoperatively, ligation is acceptable; however, when they are actively leaking bile and are greater than 2 mm in diameter, repair of injured cholecystohepatic ducts may be indicated. This case serves to reemphasize one argument for the routine placement of drains after cholecystectomy for acute cholecystitis.
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PMID:Bile peritonitis from a cholecystohepatic bile ductule: an unusual complication of cholecystectomy. 395 74

The development of peritonitis in hospitalized patients, especially those with significant associated illness, can be a difficult and delayed diagnosis. To ascertain the clinical presentation of acute cholecystitis in this group, a retrospective analysis was performed. Over a 10-year period 18 patients were identified who developed either posttraumatic or postoperative acute cholecystitis. The condition occurred in 12 patients admitted for some form of trauma and in six patients after elective surgery. Fever and right upper quadrant pain and tenderness were present in most. These physical findings were generally accompanied by leukocytosis (average = 16,200), hyperbilirubinemia (average = 4.2), and elevated alkaline phosphatase (average = 214). At laparotomy gangrenous cholecystitis was found in the majority, reflecting delayed diagnosis. Eleven patients had acalculous disease, and seven patients calculous cholecystitis. Three patients died, yielding a 17 per cent mortality. The majority with acalculous disease had significant underlying illness. Shock, multiple transfusions, or infection preceded acute cholecystitis in this group. Those with calculous cholecystitis were usually not as ill prior to its development. The morbidity of acute cholecystitis in previously hospitalized patients can be reduced by an awareness of the predisposing factors in those with acalculous disease. Emphasis should be placed on signs and symptoms rather than laboratory values to ensure early diagnosis and treatment of acute cholecystitis in hospitalized patients regardless of the presence or absence of gallstones.
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PMID:Posttraumatic and postoperative acute cholecystitis. 395 69

Aztreonam (AZT), a new synthetic monocyclic beta-lactam antibiotic, which is resistant to beta-lactamase and has a strong and specific activity against aerobic Gram-negative bacteria including Pseudomonas aeruginosa. The patients of 13 cases with localized peritonitis due to acute appendicitis, 3 cases with panperitonitis (1 case with perforative appendicitis, 1 with acute cholecystitis and 1 with pancreatic necrosis) and 4 cases with skin and soft tissue infection (anal fistula and abdominal abscess etc.) were treated by AZT. AZT was administered in a dose of 1 g twice a day by intravenous drip infusion using 100 ml-volume bottle preparation with saline for 4 to 10 days. Clinical efficacy was rated excellent in 2 cases, good in 16 cases, fair in 1 case and poor in 1 case (efficacy rate 90.0%). Adverse effects were small skin rash in 1 case, and increased GOT and GPT in 1 case. No adverse effect was recognized in other cases. Therefore, AZT appears to be very useful drug when used for chemotherapy of infectious diseases in surgery.
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PMID:[Clinical studies on aztreonam following intravenous drip infusion]. 407 96

Fosfomycin (FOM) is a synthetic antibiotic having a unique structural formula and bactericidal mechanism and a broad spectrum of antimicrobial activity against various bacterial species. It has higher activity in vivo than in vitro. As therapy, FOM-Na in a daily dose of 4 g (2 g X 2) was given by intravenous drip infusion for 5 to 10 days to 6 cases with infectious diseases (2 cases of acute cholecystitis, 3 cases of acute localized peritonitis due to phlegmonous appendicitis and 1 case of acute diffuse peritonitis due to perforative appendicitis). The clinical response was rated as "excellent" in 1 case, "good" in 4 cases, "fair" in 1 case and "poor" in none. No adverse effects were observed in any of the patients. Six clinical isolates were obtained, and these consisted of 4 strains of Escherichia coli and 1 strain each of Klebsiella pneumoniae, and Bacteroides fragilis. The MICs of FOM were from 6.25 to 12.5 micrograms/ml for E. coli, 50 micrograms/ml for K. pneumoniae, and 100 micrograms/ml for B. fragilis. FOM-Na was administered to the 6 cases intravenously in a dose of 2 g before surgery, and tissue specimens and body fluid samples were taken during the operation. The FOM concentration was determined by bioassay with a Proteus sp. (MB 838) as the test organism. The mean FOM concentration in bile from the common bile duct was 61.85 +/- 17.13 micrograms/ml (n = 5) at 95 to 108 minutes after FOM-Na intravenous bolus injection. The mean FOM concentration in the gall bladder bile was 80.06 +/- 92.36 micrograms/ml, while that in the gall bladder wall was 146.65 +/- 39.10 micrograms/g. The mean FOM concentration in purulent ascites was 58.20 +/- 13.29 micrograms/ml, 36.22 +/- 14.63 micrograms/g in the appendix wall and 12.64 +/- 11.34 micrograms/ml in pus in the appendix. The FOM concentrations in the infected tissues and body fluids thus exceeded the MICs of FOM for the pathogenic bacteria. Therefore, FOM-Na appears to be a very useful drug when used for chemotherapy of infections encountered in the surgical field.
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PMID:[Clinical studies on fosfomycin sodium following intravenous administration (tissue concentration and clinical efficacy)]. 407

The clinical picture of acute cholecystitis was analyzed in 221 patients. The authors have studied symptoms of the disease in patients older than 60 such as rapid beginning of the disease, early signs of intoxication and peritonitis. They all made the diagnostics difficult. Urgent operations should be recommended in elderly and senile patients more often due to greater probability of destructive forms of cholecystitis in such patients.
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PMID:[Clinical and treatment characteristics of acute cholecystitis in the middle-aged and elderly]. 621 84

Diagnostic peritoneal lavage (DPL) was used to aid in the rapid diagnosis of peritonitis in 138 patients for whom standard diagnostic criteria were not applicable because the patients had altered sensorium, were elderly, or had multiple medical problems. There were abnormal results in 77 patients, and all but one patient had peritonitis. Sixty-five patients had lesions that could be cured only by operative means; 54% of this group of extremely ill patients survived. Of 61 patients with negative results of DPL, only one had intraperitoneal inflammation (acute cholecystitis), which occurred 4 days after DPL. We believe DPL is a useful procedure for the detection of peritonitis in a critically ill subset of patients for whom the standard diagnostic criteria were not available.
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PMID:Peritoneal lavage: a useful diagnostic adjunct for peritonitis. 663 46

426 patients who had undergone cholecystectomy took part in a retrospective study covering four years (1977-1980). 53 patients had gallbladder empyema. The complications in the 373 cholecystectomies without empyema were 4 wound infections (1.1%), 2 other infections, 10 postoperative hemorrhages (2.7%), 3 cases of retained stones (0.8%) and 7 other complications. Only 3 of the total of 6 infections required antibiotic therapy. Since the infection rate in the 373 patients without empyema was very low, and since it is known that bile is sterile in the early stages of acute cholecystitis, there is no indication even for prophylactic antibiotics. Treatment of acute cholecystitis is cholecystectomy within 24-48 h of onset of acute symptoms. The rate of infectious complications in patients with gallbladder empyema was 15.1%. Primary treatment for this disease is surgical removal of the infectious focus (cholecystectomy) and reduction of bacterial spread or treatment of peritonitis if already present.
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PMID:[Complications following cholecystectomy and their therapy]. 685 12

Percutaneous cholecystostomy was performed in 13 patients; five patients had suspected acute cholecystitis and eight patients had suspected obstruction of the common bile duct. An anterior abdominal wall approach was used in nine patients, right anterior axillary line puncture in four. One patient developed peritonitis and fatal septic shock after inadvertent cholecystostomy catheter removal. None of the other patients became septic, developed peritonitis, or had any other complication related to cholecystostomy. Two of the patients had external drainage as outpatients for more than 6 months without complication. Technical and clinical points are reviewed.
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PMID:Percutaneous cholecystostomy. 697 15

Macro- and microscopic alterations of organs in 115 patients dead from acute cholecystitis at the age from 23 to 88 were studied with special reference to clinico-laboratory findings. As a rule, there were changes in several organs, especially in the vessels and heart (99,1%), liver (93,1%), lungs (75,5%), kidneys (63,4%). A conclusion is made that the main causes of death are hepatic insufficiency (65,2%), peritonitis (13,9%), pancreanecrosis (7,8%), thromboembolism (6,1%). Other causes made 7%.
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PMID:[Causes of death in acute cholecystitis]. 715 94

This is a report about an uncommon disease. Three forms of biliary peritonitis without demonstrable perforation are differentiated due to etiology as far as known. While the causes of biliary diffusion in the course of acute cholecystitis or pancreatogenic necrosis of the gall bladder are well known, there is still no information about the genesis of idiopathic biliary peritonitis, which never shows lesions or inflammation of the extrahepatic bile tract or gall bladder. Two cases are reported.
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PMID:[Biliary peritonitis without perforation and idiopathic biliary peritonitis]. 715 11


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