1/11. Laparoscopic management of colonoscopic perforations.Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second patient, localized peritonitis was found in the left iliac fossa due to a microperforation of the sigmoid colon. It was repaired with a single absorbable suture. The postoperative course was unremarkable in both cases. In patients with an emergency abdomen due to a postcolonoscopy perforation, we consider the laparoscopic approach feasible and safe in experienced hands. It allowed us to avoid an unnecessary laparotomy and other time-consuming and expensive diagnostic investigations. This approach represents an excellent means of managing this type of emergency abdominal situation.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
2/11. Invasive enteritis by strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy.Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from Sao Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
3/11. Untraditional glucose fermenting actinomycetes as human pathogens. Part I: actinomyces naselundii as a cause of abdominal actinomycosis.actinomyces naeslundii was proved as a primary pathogen in the case of a fulminant abdominal infection of a 74 aged woman. The preliminary diagnosis of actinomycosis based on direct microscopical findings of microgranules in the pus was confirmed by the results of cultivation and casuistry in addition. The case was of a typical course for actinomycosis and penicillin following surgery was of life saving effect for the patient who was dismissed asymptomatic after 55 days of hospitalization. Actinomycotic microgranules were demonstrated in the pus from the natural infection and from experimentally infected mice and the causative agent actinomyces naeslundii TR 91/67 was defined. Nevertheless it was concluded that the judgment of the pathogenicity of actinomyces naeslundii and of the other members of the heterogenous group of etiological agents of human actinomycosis still remains a matter of delicacy in any actual case of their isolation. In practice however, the presumption of actinomycotic etiology of an actual infection may be supported in retrospect by the dramatical effect of penicillin without regard to the presence of concomitant microflora not necessarily sensitive to penicillin.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
4/11. Ruptured heterotopic pregnancy: a report of unusual acute abdominal syndrome in two cases.A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy. Prompt diagnosis, rapid fluid and blood resuscitation, heart-sparing anesthesia and gentle, expeditious surgery collectively contribute to a favorable outcome for the mother and fetus in patients with a ruptured tubal pregnancy. In this report we present two cases of heterotopic pregnancies with ruptured tubal components; one spontaneous and the other one after clomiphene citrate treatment. Explorative laparotomy and salpingectomy were performed in both patients. After surgery, the intrauterine pregnancies were not damaged, and were still healthy on progression.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
5/11. Idiopathic segmental infarction of right sided greater omentum. Case report and review of the literature.Idiopathic right segmental infarction of the greater omentum is an uncommon cause of acute abdomen. The aetiology is still unclear and the symptoms mimick acute appendicitis. We present a case of a 77-year old man with unsignificant medical history, admitted with an acute abdomen, in whom the clinical diagnosis was unknown until an infarcted segment of right side of the greater omentum was found at laparoscopy, and successfully resected. As the aetiology is unknown, we highlighted some of the possible theories, and emphasize the importance of considering omental infarction in the differential diagnosis of right iliac fossa syndrome in cases of acute abdomen.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
6/11. Abdominal inflammatory masses mimicking neoplasia in children-experience of two centers.Despite progress in modern imaging, some inflammatory masses are difficult to distinguish clinically from neoplastic processes. In such cases the pathology report has a great distinctive value, but even then the final diagnosis may be difficult to reach. Eight patients with abdominal tumors of inflammatory origin were treated in two institutions, the Department of Pediatric Surgery of the Medical University of Gdansk, poland, and Helios Center of Pediatric Surgery in berlin, germany, during the last 10 years. Four tumors were located in the pelvis, two in the liver, and two in the colonic mesentery. Five of them were inflammatory pseudotumors (two subclassified as inflammatory fibrosarcoma), one had nonspecific inflammatory changes, one was diagnosed as idiopathic retroperitoneal fibrosis, and one was diagnosed as bacillary angiomatosis. All patients underwent surgical tumor biopsy, excisional in four and incisional in four. All but two children underwent macroscopically complete tumor excision (four primarily, two secondarily). In one case the tumor resolved with antibiotherapy. Surgery in retroperitoneal masses was often extensive and associated with significant complications because of invasive tumor growth. In conclusion, intraabdominal inflammatory lesions may closely mimic neoplasia in children. Clinical doubts result in repeated biopsies, and for this reason excisional biopsy should be preferred. In some cases, when excisional biopsy is not feasible due to invasive growth of the tumor, delayed complete mass excision should follow, despite occasional significant morbidity. The etiology and exact nature of inflammatory pseudotumors are still obscure, and it is unknown whether they represent inflammatory lesions or true neoplasia.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
7/11. intestinal obstruction at the onset of acute lymphoblastic leukemia in a child.Surgical complications need not be fatal in acute leukemia. If these are promptly diagnosed and properly treated, the prognosis will improve. This report deals with a case of acute lymphoblastic leukemia presenting with an acute abdomen following surgery for choledochal cyst. A peripheral blood smear and examination of the bone marrow revealed acute lymphoblastic leukemia. The child received transfusions of blood and platelets. Pretreatment with prednisolone was started as therapy for leukemia, and 2 days later, the patient underwent surgery. Therapy was continued until the general condition allowed a more aggressive form of treatment. Complete remission was achieved, and the patient is still in good health 48 months after diagnosis and 15 months after discontinuation of treatment. The favorable outcome in this child shows that prompt surgery is sometimes an essential step in the treatment of childhood leukemia.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
8/11. Appendiceal stump abscess ten years after appendectomy.A case of an appendiceal stump abscess occurring 10 years after appendectomy is presented. Although appendiceal stump abscess rarely appears years after an appendectomy, the possibility still exists and should be considered in the differential diagnosis of right lower quadrant abdominal pain.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
9/11. Repetitive bleeding from a pheochromocytoma presenting as an abdominal emergency. Case report.Recurrent abdominal pain was the only subjective manifestation in a case of pheochromocytoma with retroperitoneal bleeding. At emergency laparotomy the tumor, showing signs of fresh and earlier bleeding, was extirpated. Sinus-type tachycardia was treated with beta-blockade peroperatively, while the diagnosis was still obscure, but hypertension did not follow. Meta-oxedrine and dopamine infusion was continued for 48 hours to sustain the blood pressure. Recovery was uneventful.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
10/11. Tender pulsatile abdominal mass. Abdominal aortic aneurysm or not?Twenty-nine patients had symptomatic pulsatile abdominal masses. Initially six patients underwent emergency surgical exploration without prior arteriography. An abdominal aortic aneurysm was found in only one patient. In the next 23 patients, in whom arteriography was performed, no aneurysm was detected and emergency surgery could be avoided. In patients with symptomatic pulsatile abdominal masses, in the absence of hypovolemic shock the initial diagnostic study should be abdominal angiography. It is an accurate and safe procedure, and supplies the necessary preoperative information should abdominal aortic surgery become necessary. If, however, no aneurysm is found, valuable information is still obtained with regard to the underlying disease process.- - - - - - - - - - ranking = 1keywords = still (Clic here for more details about this article) |
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