Anorectal Conditions Requiring Urgent or Emergency Intervention
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Diagnosis is made on history and examination. Though patients often have a history of chronically progressive rectal prolapse, some may not endorse any prior symptoms or episodes of prolapse.23 Visual inspection of the anus will reveal the concentric folds of the rectal wall, indicating a full-thickness prolapse. Once incarcerated, the rectum will become more oedematous, which can be made worse by spasm of the anal sphincter. Depending on the severity of prolapse and the time course of incarceration, strangulation may occur, resulting in ulceration or even necrosis of the rectum on presentation (Figures 80.5 and 80.6). Though the diagnosis is typically evident on simple inspection, an abdominal examination is required in order to detect peritonitis if present.21,23–26
Clinical Spectrum of Amebiasis in Children
Roberto R. Kretschmer in Amebiasis: Infection and Disease by Entamoeba histolytica, 2020
This is an infrequent form of amebic disease that affects mainly children under 2 years of age that are severely malnourished. It is characterized by a rapidly evolving clinical picture of multiple ulceronecrotic lesions affecting the complete colon and reaching down to all layers of the intestinal wall. Frequent, scarce stools with abundant mucus and blood are produced, accompanied by intense abdominal pain and hematochezia. Intestinal perforation and peritonitis are very frequent complications that become ominously evident by the general deterioration of the patient’s condition, high fever, and septic shock.31 Dehydration and intercurrent systemic infections are usually present as well. Mortality rates are as high as 80%, and survivors may occasionally present stenotic scarring of the colon.
Medical and Surgical Treatment of Intra-abdominal Infections
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Postoperative intensive care monitoring and ventilatory support are often needed in unstable and frail patients. Besides fluids and blood products, inotropic agents may be required to achieve hemodynamic stability. Antibiotics are given for 7 days or longer depending on the resolution of peritonitis. Antimicrobial therapy is adjunctive to a definitive operation in management of peritonitis. The tripartite role of antibiotics is: first, to control preoperative sepsis; second, to combat bacteremia caused by intraoperative manipulation; and third, to speed resolution of peritoneal cellulitis. Source control is best achieved by operation or percutaneous drainage. Evidence of a favorable clinical response in the elderly includes reduction in fever and leukocytosis; resolution of ileus; satisfactory urine output; and return of sense of well-being, cognition, and basic functions. The risk of secondary infection is reduced by removal of all nonessential catheters as well as drains once drainage diminishes or becomes more serous. Early feeding and discontinuation of antibiotics are vital in controlling proximal gut colonization with candida, Enterococcus faecium, pseudomonas, MRSA, and coagulase-negative staphylococci, which cause secondary nosocomial infection with subsequent multiple organ failure.
Methotrexate induced peritonitis: diagnosis per exclusionem
Published in Journal of Obstetrics and Gynaecology, 2021
Raphaël Rienstra, Eva A.S. Koster, Catharina C.A.H. Janssen
Gastritis (Helicobacter pylori).Gastric ulcer.Stomach perforation.Cholecystitis.Pancreatitis.Pulmonary embolism.Peritonitis.Pericarditis.Molar metastasis.Coeliac disease.
Effects of prophylactic antibiotics before peritoneal dialysis catheter implantation on the clinical outcomes of peritoneal dialysis patients
Published in Renal Failure, 2019
Xihui Liu, Xiaoyan Zuo, Xia Sun, Zhao Hu
The primary outcome measure was early complications which were examined in the first 30 days following the insertion of PD catheter. Infectious complications included peritonitis, exit-site/tunnel infection. Mechanical complications included leakage, catheter blockage, and catheter migration. Complications were defined in accordance with the ISPD guidelines [11,13]. Peritonitis was defined as the presence of at least two of the following conditions: abdominal pain or tenderness; presence of white blood cells (≥100 cells/mL) in the peritoneal effluent, with at least 50% polymorphs; and positive dialysate culture results. The secondary outcome measures were long-term outcomes including technique survival, patient survival, and peritonitis-free survival (time to first episode of peritonitis) which were recorded following the catheter insertion until the censored time or the end of the study. In the technique survival analysis, permanent conversion to HD was a final event and patients were censored at other events. In the patient survival analysis, only death was considered as a final event and patients were censored when PD was stopped for any other reason, including transfer to HD, renal transplantation, recovery of renal function, or at the end of the observation period. We analyzed the outcome following catheter placement until February 2014 or until discontinuation of PD.
CD64 expression on neutrophils as a potential biomarker for bacterial infection in ascitic fluid of cirrhotic patients
Published in Infectious Diseases, 2023
Elena González-López, Aitor Odriozola Herrán, Mónica Renuncio García, Adriel Roa-Bautista, Ángela Antón Rodríguez, Alejandra Comins-Boo, Juan Irure Ventura, Ángela Puente, Marcos López-Hoyos, José Igancio Fortea, David San Segundo
The microbiologic culture of ascitic fluid is an important tool in diagnosing bacterial infections. Some cirrhotic patients develop bacterascites, defined by a positive culture and PMN count < 250 cells/mm3 in the absence of an evident intra‐abdominal, surgically treatable source of infection [2]. Moreover, a small proportion of patients could develop secondary bacterial peritonitis due to perforation or inflammation of the intra-abdominal organ. In this case, the diagnosis is suspected in those with localised abdominal symptoms or signs, very high ascitic neutrophil count, multiple organisms on ascitic culture, or those with inadequate response to treatment [2]. Regarding microbiological culture for the diagnosis of bacterial infections, it may take several days until results are obtained, and it could be influenced by handling processes, transport, and treatment, increasing the false negative results [3].
Related Knowledge Centers
- Acute Respiratory Distress Syndrome
- Cirrhosis
- Inflammation
- Pelvic Inflammatory Disease
- Peritoneum
- Abdomen
- Pancreatitis
- Shock
- Gastrointestinal Perforation
- Peptic Ulcer Disease