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

Comparative topographoanatomic investigation of parameters of accesses during performance of open and laparoscopic interventions was conducted. There was established, that for an acute cholecystitis, complicated by peritonitis, the upper middle laparotomy constitutes an adequate access. Application of laparoscopic technologies for cholecystectomy performance is expedient if the inflammatory changes are restricted by gallbladder wall.
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PMID:[Topographic-anatomic basis for the access choice during cholecystectomy for acute cholecystitis]. 1295 1

In a recent series of 26 pathologically proven cases of acute cholecystitis, preoperative radiographic examination of the abdomen confirmed the presence of an inflammatory process in 17. The radiographic signs associated with acute suppurative cholecystitis are:1. Enlargement of the gallbladder, as indicated by separation or alteration in position of opaque calculi or indentation of adjacent bowel.2. Localized peritoneal irritation, manifested by (a) ileus of hepatic flexure of colon; (b) ileus of duodenal loop; (c) effacement of haustra of the hepatic flexure or valvulae conniventes of the duodenum; (d) obscuration of fat line marking inferior border of liver.3. Cholecystitis emphysematosa.4. Perforation of gallbladder, which if localized (retroperitoneal) is manifested by bubbles of gas in the gallbladder bed. If generalized (intraperitoneal) the signs are adynamic ileus of small and large bowel, increased intraperitoneal fluid, subdiaphragmatic abscess and plate atelectasis of right lung base. Visualization of the gallbladder and biliary tree after intravenous cholecystography rarely occurred in the presence of acute cholecystitis. Plain film examination of the abdomen aids in establishing the diagnosis of an acute cholecstitis and leads to the early recognition of complications such as perforation and peritonitis.
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PMID:Radiographic signs of acute suppurative cholecystitis. 1362 52

Clinically common oncologic emergencies associated with pancreatobiliary cancer are gastrointestinal bleeding caused by duodenal invasion of pancreatic carcinoma, severe duodenal obstruction due to pancreatic carcinoma, and acute cholangitis accompanied by obstructive jaundice in patients with biliary tract carcinoma. When a patient with gallbladder cancer presents with acute cholecysitis, emergency surgery is sometimes performed on the basis of the latter diagnosis. Emergency procedures can also be required in the perioperative management of pancreatobiliary cancer, for example, in biliary peritonitis caused by detachment of a percutaneous transhepatic biliary drainage (PTBD) tube and in ruptured pseudoaneurysm due to postoperative pancreatic or biliary leakage. Nonsurgical procedures are usually initially selected for oncologic emergencies associated with pancreatobiliary cancer, because patients are likely to develop severe organ dysfunction and it is difficult to access directly and remove the pancreas or biliary tract during emergency surgery. When systemic conditions improve, it is necessary to evaluate the degree of disease progression and systemic conditions, and if feasible, the primary lesion should be surgically resected. When performing emergency cholecystectomy in patients with acute cholecystitis, thorough intraoperative investigation of resected specimens is important, considering the possibility of concomitant gallbladder carcinoma, since thorough examination cannot be performed in such emergency settings. Furthermore, when cholangitis accompanies pancreatobiliary cancer, emergency drainage should be considered as sepsis can develop rapidly.
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PMID:[Oncologic emergencies associated with pancreatobiliary cancer]. 1511 92

Early cholecystectomy for patients with acute cholecystitis is safe, cost effective, and leads to less time off work compared with delayed surgery. This study was designed to assess current practice in the management of acute cholecystitis in the UK. A postal questionnaire was sent to 440 consultant general surgeons to ascertain their current management of patients with acute cholecystitis. Replies were received from 308 consultants who were involved in treating patients with acute cholecystitis of whom 18 transferred these patients on to another team for further management the day after admission. Thirty two consultants (11%) routinely treated patients by early cholecystectomy, with limiting factors stated to be the availability of surgical staff, theatre space, and radiological investigations. The remaining consultants (n = 258) routinely manage their patients conservatively with intravenous antibiotics and allow the inflammation to resolve before undertaking cholecystectomy at a later date. Indications for undertaking early cholecystectomy during the first admission by this latter group included the presence of spreading peritonitis due to bile leak, empyema, and unexpected space on theatre list. The commonest method for both elective and early cholecystectomy is laparoscopic, but the percentage of consultants using an open method rises from 8% in the elective situation to 47% for urgent early cholecystectomy. Despite evidence which strongly advocates early cholecystectomy, this practice is routinely carried out by only 11% of consultants in the UK at present.
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PMID:Management of acute cholecystitis in UK hospitals: time for a change. 1513 21

Gallbladder perforation is an almost exclusive complication of cholecystitis, which accompanies severe inflammation of the gallbladder with or without cholelithiasis. Whether it is of a calculous or acalculous origin, gallbladder perforation, as a complication of acute cholecystitis, has common symptoms, signs, laboratory data, radiological findings and treatment modalities. Even though many reports of gallbladder perforation have been published, there are few reports of gallbladder perforation without any clinical and radiological indications. We experienced a case of a 70-year-old woman with acute abdomen, which was found to be peritonitis caused by spontaneous gallbladder perforation that was devoid of clues suggesting this condition. Although rare and unusual, this case shows that this disorder should be considered in elderly patients presenting with peritonitis with an unknown etiology.
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PMID:A case of spontaneous gallbladder perforation. 1536 46

Laparoscopic cholecystectomy has become the first choice of management for symptomatic cholecystolithiasis. While it is associated with decreased postoperative morbidity and mortality, bile duct injuries are reported to be more severe and more common (0-2.7%), when compared to open cholecystectomy (0.2-0.5%) [New Engl. J. Med. 234 (1991) 1073; Am. J. Surg. 165 (1993) 9; Surg. Clin. N Am. 80 (2000) 1127]. These bile duct injuries include leaks, strictures, transection and removal of (part of) the duct, with or without vascular damage. Bile duct injury might be due to misidentification of the biliary tract anatomy due to acute cholecystitis, large impacted stones, short cystic duct, anatomical variations, but also due to technical errors leading to bleeding with subsequent clipping and coagulation trauma [Ann. Surg. 237 (2003) 460]. Early recognition and adequate multidisciplinary approach is the cornerstone for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature with as consequences biliary peritonitis, sepsis, abscesses, multiple organ failure, a more difficult (proximal) reconstruction and in the long run, secondary biliary cirrhosis, and liver failure. Despite increasing experience in performing laparoscopic cholecystectomy, the frequency of bile duct injuries has not decreased [Ann. Surg. 234 (2001) 549]. Therapy encompasses endoscopic stenting, percutaneous transhepatic dilatation (PTCD) and surgical reconstruction.
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PMID:Endoscopic and surgical management of bile duct injury after laparoscopic cholecystectomy. 1549 81

Results obtained by standard tube agglutination (STA) test which is the most widely used serological method for brucellosis, are often evaluated together with the clinical and microbiological findings, and the titers of > or = 1/160 are generally accepted as an indicator of acute infection. However, cross reactions with some other bacteria may lead to false positive results in this test. In this study, the performance of STA test in the diagnosis of brucellosis has been evaluated by using serum samples obtained from 40 culture positive brucellosis patients, 54 patients with bacterial infections other than brucellosis and 40 healthy blood donors. The distribution of infections and number of patients were as follows; urinary infection (n: 16), salmonellosis (n: 15), bacterial meningitis (n: 5), tuberculosis (n: 4), pneumoniae (n: 3), osteomyelitis (n: 3), infective endocarditis (n: 2), peritonitis (n: 2), diabetic foot infection (n: 2), acute cholecystitis (n: 1), and catheter infection (n: 1). STA were positive in all of the brucellosis patients between the titers of 1/160-1/1280 (mean: 1/640), whereas STA were found negative in all of the healthy subjects. Nevertheless two patients whose stool cultures yielded Salmonella spp., one patient whose urine culture yielded E. coli, one patient whose diabetic foot lesion culture yielded group A beta-hemolytic streptococci, exhibited STA positivity at the titers of 1/160. There was no history of brucellosis or presence of co-infections in the patients with non-brucellosis infections and blood donors. In conclusion, cross reactions due to the presence of other bacterial infections should be considered for the evaluation of Brucella STA test results, together with the endemicity of the country of interest and seropositivity rate of the population.
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PMID:[Evaluation of Brucella tube agglutination test in patients with brucellosis, patients with bacterial infections other than brucellosis and healthy subjects]. 1612 33

Generalized peritonitis in patients over the age of 50 years is a common surgical emergency. This is a retrospective analysis of 98 cases managed surgically. Duodenal ulcer perforations, necrotizing enteritis, acute cholecystitis with perforation and small bowel perforations were the common causes. Most of them presented late, and many had associated conditions. Re-look laparotomies had a definite role to play. While there is significant decrease in the number of typhoid and tubercular peritonitis, there appears to be an increase in the incidence of necrotizing enteritis and acute cholecystitis.
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PMID:Peritonitis in patients over the age of 50 years: 98 cases managed surgically. 1635 92

The consequence of demographic aging is an increase of surgical pathology of the elderly, concerning both number and complexity of the cases. To asses the nature of geriatric surgical pathology and the effect of co-morbidities on surgical outcome, a retrospective study was carried out on a series of 401 patients aged over 75, treated in the IIIrd Surgical Unit in the period 2002-2003. 132 patients were admitted as acute cases and 94 of them were operated: 62 required immediate surgery and 32 required delayed operations. According to the nature of the diseases, benign surgical conditions were encountered in majority of the cases (78 cases). The diagnostics requiring immediate operations were: complicated hernias, perforated peptic ulcer, lower limb acute ischemia. Delayed emergency operations were performed for: acute cholecystitis, biliary lithiasis with angiocholitis and complicated gastric cancer. Cardiovascular pathology was recorded as the most frequent co-morbidity. Hospital mortality rate of 32.9% resulted mainly from cases with mesenteric infarction and generalized peritonitis, as well as from delayed emergencies such as complicated gastric and colon cancer. The most frequent causes of death following surgery were: cardiac failure, sepsis and multiple organ failure.
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PMID:[Acute surgical pathology in elderly patients]. 1660 87

Among 328 patients with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), 14 (4 men and 10 women, median age 44 years) had acute abdomen. DHF/DSS was initially suspected in only 2 of these 14 patients. Presumptive diagnoses of acute cholecystitis (6 acalculus and 4 calculus cholecystitis) were made in 10 patients, non-specific peritonitis in three patients, and acute appendicitis in one patients. Cholecystectomy, percutaneous transhepatic gallbladder drainage, and appendectomy were performed in three patients. Transfused blood in the three patients who underwent invasive procedures and the 11 patients who received supportive treatment included packed red blood cells (24 versus 0 units; P = 0.048), fresh frozen plasma (84 versus 0 units; P = 0.048), and platelets (192 versus 180 units; P = 0.003). Patients who underwent invasive procedures also had prolonged time in the hospital (median = 11 versus 7 days; P = 0.015). To avoid unnecessary invasive procedure-related morbidity and mortality, this report underscores the importance of a careful differential diagnosis in patients with acute abdomen in a dengue-endemic setting.
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PMID:Dengue hemorrhagic fever patients with acute abdomen: clinical experience of 14 cases. 1668 99


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