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1/14. Bowel obstruction caused by dislocation of a suprapubic catheter.

    In patients with a suprapubic catheter, the differential diagnosis of acute lower abdominal pain must include a possible dislocation of this device. We report a case that illustrates such a complication, leading to bowel obstruction in our patient.
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2/14. Acute abdomen in mentally retarded patients: role of aerophagia. Report of nine cases.

    Between 1993 and 1996 nine mentally retarded patients presented because of an acute abdomen. All had the habit of aerophagia, diagnosed previously by a general practitioner. Massive distension of the bowel led to ileus, volvulus, and necrosis. After placement of a percutaneous endoscopic gastrostomy catheter or performing a gastrostomy during laparotomy with the intention to use as a desufflator, no recurrence of the signs and symptoms of an acute abdomen were observed.
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3/14. Acute abdomen due to late retroperitoneal extravasation from a femoral venous catheter in a newborn.

    CONTEXT: The use of parenteral nutrition via a central venous catheter is a common practice in the neonatal intensive care setting. Extravasation of the infusate leading to an acute abdomen is a complication that has only rarely been documented. This report describes the case of a premature infant with a femoral catheter placed in the inferior vena cava, who developed an acute abdomen as a result of late retroperitoneal extravasation of parenteral nutrition. CASE REPORT: A pre-term infant receiving total parenteral nutrition via a femoral venous catheter developed an acute abdomen five days after the catheter placement. Extravascular catheter migration to the retroperitoneal space and extravasation of the infusate was diagnosed by contrast injection. Withdrawal of the catheter was followed by prompt cessation of the signs and full recovery from the acute abdomen, without the need for surgery. A review of the literature is presented, emphasizing the clinical and therapeutic aspects of this unusual complication from femoral venous catheterization and parenteral nutrition.
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4/14. Peritoneoscopic placement of peritoneal dialysis catheter and bowel perforation: experience of an interventional nephrology program.

    BACKGROUND: Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters. methods: The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique. RESULTS: Six (0.8%) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83%) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention. CONCLUSION: Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.
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5/14. Spontaneous rupture of the urinary bladder presenting as oliguric acute renal failure.

    A 64-year-old female was admitted to hospital for acute abdominal pain with ascites. The patient had received postoperative pelvic irradiation for carcinoma of the uterine cervix 7 years previously. serum creatinine (Scr) was elevated to 2.70 mg/dl, and urinary output was reduced to below 200 ml/day. cystoscopy revealed a small perforation from the bladder diverticulum. Following transurethral catheterization, urinary output was promptly increased, and Scr was returned to 0.65 mg/dl 4 days later. This rare case suggested that spontaneous rupture of the urinary bladder following postoperative radiotherapy could occur very late with laboratory features of oliguric acute renal failure.
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6/14. Bladder perforation secondary to clean intermittent catheterization.

    Clean intermittent catheterization has been an effective treatment for the management of patients with a neurogenic bladder during the last 15 years. Reported complication rates have been low and the majority of these problems have been minor. While significant problems are seen only rarely during clean intermittent catheterization, we recently diagnosed 2 potential life-threatening complications: bladder perforation and bladder necrosis. We present our experience with these major problems associated with routine clean intermittent catheterization.
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7/14. Hemorrhagic pancreatitis associated with acetaminophen overdose.

    A 19-yr-old man ingested 25 g of acetaminophen in a suicide attempt. Twenty-one hours after the ingestion the plasma acetaminophen level was potentially hepatoxic at 62 micrograms/ml. The toxicology screen was negative for all other drugs. Thirty-six hours after admission the patient developed an acute abdomen with a serum amylase of 1500 IU. peritoneal lavage revealed a grossly hemorrhagic fluid. Exploratory laparotomy revealed necrotic pancreatitis. Hepatoxicity with the peak SGOT greater than 2000 IU and a mild renal toxicity with the creatinine of 1.9 mg/dl occurred despite late initiation of treatment with n-acetylcysteine. No other etiology for the pancreatitis was found. Peritoneal irrigation was continuously performed through a surgically placed dialysis catheter. pancreatitis associated with acetaminophen overdose has been reported twice in the past. Although the pathophysiology of the pancreatic injury is obscure, the lack of other etiological factors and temporal association of the pancreatitis with acetaminophen-induced hepatic and renal toxicity suggest a causal relationship.
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8/14. Catheter-related injuries as cause of acute surgical condition within abdomen.

    Three cases of an acute surgical condition within the abdomen secondary to complications of chronic urethral catheters are reported. Common factors in the history and varying mechanisms for the injuries are discussed. Need for including catheter-related injuries in the differential diagnosis of an acute surgical condition of the abdomen is emphasized.
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9/14. The acute abdomen in patients with ventriculoperitoneal shunts.

    A rationale for management of the patient with an acute adbomen and a ventriculoperitoneal shunt is presented in relation to eight patients. In two patients peritonitis was due to perforation of an abdominal viscus, not shunt related, and six were due to infections of ventriculoperitoneal shunts. Resolution of abdominal symptomatology occurs within six hours after the distal end of the shunt catheter is removed from the abdomen and placed in a drainage bottle. In four of these six, infection was limited to the peritoneal end of the catheter. The ventricular fluid was sterile.
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10/14. infarction of the gallbladder--an unusual cause of acute abdomen in the neonate.

    infarction of the gallbladder, while rare, must now be included in the growing list of possible and proven complications of umbilical artery catheterization.
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ranking = 0.2
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