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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 58 year old Chinese male, one week after arriving in Canada from Hong Kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by Escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of Strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome (MARCIAL-ROJAS, 1971). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). Similarly, in patients on steroid (CRUZ et al., 1966; WILLIS and MWOKOLO, 1966; NEEFE et al., 1973) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response (ROGERS and NELSON, 1966; RIVERA et al., 1970), systemic strongyloidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.
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PMID:Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis. 122 84

This paper reports on a patient who was treated by percutaneous aspiration, instillation of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic pseudocyst. Five weeks after admission to hospital for the first episode of an acute necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent fluid collection led to a second puncture, combined with the injection of polidocanol (15 ml; 1%) into the cyst cavity. Since this treatment failed, a percutaneous cystogastric drain ("double--pigtail") was inserted five days later. After developing acute abdominal pain and incipient sepsis, the patient was sent for surgical intervention twelve days after the second treatment with percutaneous aspiration and injection of polidocanol. During the operation an infected pancreatic pseudocyst with extensive contaminated necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed, followed by continuous lavage of the omental bursa. Intensive care therapy was necessary for one week. Duodenal leakage persisted for nearly three weeks, the stopped spontaneously. The patient was discharged in quite a good state of health after 33 days of postoperative treatment. Although spontaneous development of infected pancreatic pseudocysts and pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement of the drainage procedures, especially in combination with the injection of a sclerosant must be considered.
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PMID:Infected pancreatic necrosis possibly due to combined percutaneous aspiration, cystogastric pseudocyst drainage and injection of a sclerosant. 205 2

Twenty-five patients were operated on at the Brigham and Women's Hospital for colonic diverticulitis complicating treated renal failure during the period 1951 to 1983. Twelve patients had functioning renal allografts (eight cadaver, four living-related); 13 were on dialysis therapy. Six patients had polycystic kidney disease. The majority of patients had acute abdominal pain. Four had histories of chronic abdominal pain; nondiagnostic exploratory laparotomies were performed on two of these patients, who developed localized tenderness. The overall mortality in this series was 28 percent, with sepsis being the most common cause of death. Six of seven patients who died had free colonic perforations at surgery. Mortality correlated with age, with six of 14 patients (43 percent) over age 50 dying, as compared with one of 11 patients (9 percent) under age 50. There was no correlation between survival rate and type of surgery performed, dose of prednisone or azathioprine used, or type of treatment received for renal failure.
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PMID:Surgery for diverticulitis in renal failure. 390 14

Idiopathic segmental infarction of the greater omentum seldom enters into the differential diagnosis of acute abdominal pain, and diagnosis is usually not made until laparotomy. A preoperative clue to the diagnosis may be the lack of systemic gastrointestinal symptoms in the presence of impressive abdominal findings. Intraoperative clues are serosanguineous peritoneal fluid but normal appendix, distal small bowel, and mesentery. In this setting, careful examination of the omentum through the initial incision is recommended. Once identified, the infarcted omentum should be completely excised to prevent formation of adhesions and possible sepsis. In the case reported here, the serendipitous discovery of edematous omentum prompted a thorough--but technically difficult--exploration of the greater omentum, which eventually led to the correct diagnosis.
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PMID:Idiopathic segmental infarction of the greater omentum. Report of a case mimicking appendicitis. 396 Jul 95

We present a case of dramatic radiation enterocolitis inducing portal venous air diagnosed by Doppler sonography only. The sonographic pattern consisted of multiple irregular hyperechoic areas into the liver, with internal repetitive noisy bidirectional peaks superimposed on the usual continuous Doppler display of the portal flow. Although portal hyperechoic moving foci alone may reflect only slow portal velocity, they do not create any Doppler distortion as do moving bubbles. Portal air may have multiple causes such as abdominopelvic abscesses, sepsis, intestinal distension, fulminant hepatitis, cholangitis, cholecystitis, diabetic acidosis..., but mesenteric infarct, necrotic enterocolitis, and radiation enteritis are life-threatening conditions that have to be diagnosed as soon as possible. Although large quantities of portal air may be demonstrated on plain film of the abdomen or by computed tomography, Doppler sonography may detect smaller quantities, allowing earlier diagnosis of intestinal pathology requiring immediate surgical treatment. Therefore, Doppler sonography of the liver should be performed in any patient with acute abdominal pain or distension, especially if being treated by abdominal radiotherapy.
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PMID:[diagnostic ultrasonography of air in the portal venous system: apropos of a case of colonic radionecrosis and literature review]. 782 61

Neutropenic colitis is a complication of the treatment of hematologic malignancies and, less commonly, of other disease entities. The septic, inflammatory process has a predilection for the terminal ileum and right colon. While the pathogenesis is not clear, mucosal injury caused by several different mechanisms and local opportunistic infection play significant roles. An association has been recognized between neutropenic colitis and sepsis caused by C. septicum. Patients present with fever, diarrhea, and acute abdominal pain and tenderness often localized in the right lower quadrant. Sonography and CT are helpful in demonstrating colonic wall thickening and pericolic fluid. Peritoneal lavage has been used to exclude perforation in these critically ill patients. Although there has been debate about whether medical or operative management is best, the optimal initial therapy includes supportive care with gastric decompression, fluid and blood product replacement, and broad-spectrum antibiotics. The indications for surgery include continued intestinal bleeding despite correction of coagulopathy and pancytopenia, free intraperitoneal air, and uncontrolled sepsis. At operation, a right colectomy with ileostomy and mucous fistula or, in selected patients, primary anastomosis is the procedure of choice. Timely return of functioning neutrophils and the eventual prognosis of the primary disease are crucial to the overall success or failure of treatment of neutropenic colitis.
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PMID:Collagenous colitis, eosinophilic colitis, and neutropenic colitis. 837 36

Jejunal diverticular (JD) perforation is an uncommon cause of acute abdominal pain in the elderly. From 1971 to 1994 we treated 13 such patients, 9 men and 4 women, with a mean age of 68 years. All patients experienced sudden onset of abdominal pain, nausea and vomiting, and leukocytosis (range of white blood cell counts, 14,000-21,000). On physical examination, three patients had localized peritonitis, were thought to have appendicitis, and underwent immediate laparotomy and segmental jejunal resection for perforated JD. The remaining 10 patients had abdominal tenderness without peritoneal signs. They were hospitalized and managed expectantly. All experienced worsening signs and symptoms and underwent exploratory laparotomy and resection of the involved jejunal segment 13 hours to 8 days after admission. Although 6 of 13 patients had had JD documented previously, in only 2 patients was perforated JD diagnosed preoperatively. In 8 of 13 patients peritoneal contamination was minimal and was contained within the leaves of the mesentery. Soilage was severe with abscess formation in 5 patients. The longer the delay in operative intervention, the greater the peritoneal soilage. The 3 patients undergoing immediate surgery had minimal contamination. Of the 10 patients initially observed, the mean interval before operation was 74 hours in the 5 patients with severe soilage versus 21 hours in those with minimal contamination. The postoperative course was uneventful in 11 patients. Two patients died. Surgical consultation was delayed (8 days, 12 days) in both patients, who had severe peritoneal contamination and died of sepsis. In conclusion, JD perforation is an uncommon and frequently overlooked cause of acute abdominal pain in elderly patients. Timely operative intervention and resection of the involved jejunum are the keys to a successful outcome. Because the presentation and physical findings of perforated JD can be highly variable, a history of preexisting JD should arouse suspicion for JD perforation as the etiology of acute abdominal pain in the elderly.
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PMID:Perforated jejunal diverticula. 854 Jun 41

A 39-year-old man with a known history of end-stage renal disease presented with hypovolaemic shock and acute abdominal pain. Blood-stained peritoneal fluid was present. Right perirenal and extensive mesenteric haematomas were seen at laparotomy and CT. Right renal arteriography demonstrated a small renal artery pseudoaneurysm, and embolization was performed. The patient later developed intractable sepsis and died despite nephrectomy and drainage of the infected haematomas. Although there is an increasing trend towards conservative management of spontaneously ruptured kidneys from benign causes, embolization followed by early surgery should be considered in cases of extensive intraabdominal haemorrhage.
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PMID:Spontaneous renal pseudoaneurysm rupture presenting as acute intraabdominal haemorrhage. 953 14

Bladder drainage of exocrine secretions during pancreas transplantation can be associated with significant complications. We present a proactive approach to these complications consisting of early cystoenteric conversion (CEC). Although 81 patients underwent pancreas transplant between March 1985 and May 1995; 26 (32%) required CEC. Complications presented as urine leaks, other complications, and refractory metabolic acidosis. There were 13 patients who presented with a urine leak: 12 with acute abdominal pain, and 1 asymptomatic. Serum amylase and creatinine rose a mean of 823 IU and 0.61 mg/dl, respectively. The interval to CEC ranged from 2 to 45 months. One patient died of fungal sepsis. Postoperative complications included duodenojejunal anastomotic bleed (n = 1), negative relaparotomy (n = 1), myocardial infarction (n = 1), graft pancreatitis (n = 1), and wound infection (n = 1). Twelve patients presented with other complications: three women with cystitis (n = 2) or hematuria (n = 1), and nine men with urethritis (n = 6), scrotal edema (n = 2), or dysuria (n = 1), The interval to conversion ranged from 1 to 108 months. There were no deaths. One patient required relaparotomy for anastomotic bleed. One patient was converted because of refractory metabolic acidosis. Admissions and inpatient days were significantly reduced. Overall mortality was 3.8%, morbidity 23.1%, and graft salvage rate 96.1%. Leak-associated mortality was 7.7%, morbidity 38.5%, and graft salvage rate 92.3%. For other complications the mortality was 0, morbidity 7.7%, and graft salvage rate 100%. CEC is a safe, effective treatment for urologic complications of pancreas transplantation. Morbidity and mortality were acceptable; admissions and hospital days were decreased. Early CEC results in superior outcomes and improved quality of life. It is preferable to nondefinitive measures for management of urologic complications of pancreatic transplantation.
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PMID:Early operative intervention for urologic complications of kidney-pancreas transplantation. 967 65

A 32 years old female was admitted to hospital due to acute abdominal pain, nausea, vomiting and liquid stools. Physical examination was normal except for pain on her left inferior abdominal quadrant without peritoneal irritation signs. An abdominal CAT-scan suggested thrombosis at celiac trunk, although the echo Doppler showed no alterations except for signs of ischemia in the distal branch of the superior mesenteric artery. An exploratory laparotomy was performed disclosing a necrosis of the distal ileum and cecum, diffuse peritonitis and thrombosis of the ileocecoapendiculocolic artery. No vasculitis lesions were found in the arteries of medium size examined. A history of intermittent claudication for the past 3 years as well as acrocyanosis, asymmetry of pulses and blood pressure in the superior extremities was ascertained after the surgery. A MRI angiogram showed multiple stenoses and irregularities at the celiac trunk, hepatic, superior mesenteric and fibular arteries. No abnormalities at the aortic arch and its main branches were documented. A sepsis due to Candida sp complicated her postoperative period. After recovery, prednisone 1 mg/kg/day was started and the anticoagulation continued. The abdominal pain, intermittent claudication and superior limb acrocyanosis disappeared. This is an unusual case of type IV Takayasu's arteritis with acute abdominal signs as the first manifestation.
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PMID:[Intestinal necrosis as clinical presentation of Takayasu arteritis]. 1249 34


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