Ogilvie’s Syndrome - A Complication of Severe COVID-19 Infection

@#A higher rate of gastrointestinal complications has been shown in COVID-19 patients admitted to the intensive care unit than their counterparts without COVID-19. Ogilvie’s syndrome or acute colonic pseudo-obstruction is described as colonic distension without mechanical obstruction, usually caused by infections, opioid use, renal dysfunction, and electrolyte imbalance. We report a patient with Ogilvie’s syndrome probably secondary to COVID-19. The patient was a 51-year-old man diagnosed as category 5 COVID-19, requiring intensive care treatment and mechanical ventilation. He developed transverse colonic perforation following large bowel dilatation, for which laparotomy and colectomy were done. Unfortunately, he succumbed to death due to intrabdominal sepsis with multiorgan failure. Possible pathogenesis of ileus in severe COVID-19 infection includes viral-induced autonomic nervous system dysfunction, viral-induced gut inflammation mediated by ACE-2 receptors located on the enterocytes, and ischaemic endothelialitis.

Risk factors of paralyticileus after simultaneous pancreas-kidney transplantation / 中华器官移植杂志

Objective:To explore the risk factors of paralytic ileus (PI) after simultaneous pancreas-kidney (SPK) transplantation.Methods:From January 2017 to December 2019, clinical data were reviewed retrospectively for 115 cases of SPK transplantation. The risk factors of PI after SPK were analyzed. According to the occurrence of PI, they were divided into two groups of occurrence and non-occurrence. One-way analysis of variance was utilized for analyzing such influencing factors as gender, age, body mass index (BMI), diabetic type, duration of diabetes, mode of dialysis, duration of dialysis, diabetic gastroenterology, history of open surgery, bowel preparation, operative duration, hemorrhagic volume, immunosuppressant and hypoproteinemia. Multivariate Logistic regression analysis was performed for screening the suspected risk factors.Results:Among them, 19 patients (16.5%) had PI. Univariate analysis showed that PI was associated with diabetic gastroenterology, operative duration, history of open surgery, no bowel preparation and hypoproteinemia ( P<0.05). Multivariate Logistic regression analysis revealed that the risk factors of PI after SPK included diabetic gastroenterology, operative duration time, history of open surgery and no bowel preparation ( P<0.05). Conclusions:Diabetic gastroenterology, operative duration, history of open surgery and no bowel preparation are risk factors for PI after SPK. Clinical interventions for the above factors are necessary.

A Clinical Analysis of Acute Small Bowel Obstruction – A Review of Sixty-four Patients in a Tertiary Hospital

Background: Acute small bowel obstruction (SBO) is an ever increasing clinical problem. Successful management depends on comprehensive knowledge of the aetiology and patho-physiology of SBO, familiarity with imaging methods, good clinical judgment, and sound technical skills. Aim of the Study: To study the incidence, clinical features, and operative findings of small bowel obstruction in a Tertiary Hospital of Kerala. Materials and Methods: Aprospective cross-sectional analytical study was conducted in the Department of General Surgery, Medical College, Kerala, including 64 patients. Inclusion criteria: (1) Patients aged between 18 and 87 years were included in the study. (2) Patients with complaints of vomiting, pain in the abdomen, fever, and abdominal distension were included. (3) Patients who had hernia with recent onset of irreducibility, pain, vomiting, and constipation were included in the study. Exclusion criteria: (1) Patients who were aged below 18 and above 80 years were excluded from the study. (2) Patients with signs and symptoms of subacute intestinal obstruction (IO) and paralytic ileus were excluded from the study. The following data were collected: Adetailed record of the patient’s history, physical examination, and necessary investigations such as baseline, X-ray abdomen erect and supine in all cases, and ultrasound abdomen was recorded based on the requirement for each case. The pro forma was used to record the age, sex, and symptom duration, past surgical and medical history of all patients. All patients were subjected to surgery as their clinical presentation was of acute nature. The patients were stabilized from shock, fluid-electrolyte imbalances, and nasogastric aspiration before taking them to the operation theater. All the patients were followed postoperatively for 2–4 months from the time of discharge. The events of post-operative period and complications were noted and tabulated. All the data were analyzed using standard statistical methods. Observations and Results: A total of 64 patients presenting with acute IO were included in the study. Among the 64 patients, there were 49 male (76.56%) and 15 female (23.43%) with a male to female ratio of 3.26:1. The mean age of the patients was 49.36 ± 3.14 years. The youngest patient was aged 19 years and the eldest one was 76 years. It was observed that pain in the abdomen accounted for the most common symptom with 60/64 patients presenting with the symptom, followed by abdominal distension 49/64 (76.56%), vomiting in 43/64 (66.15%), and absent bowel sounds in 28/64 (43.75%) of the patients. Among the causes for small bowel obstruction (50/64), intussusceptions were noted in 13/64 (20.31%), volvulus in 10/64 (15.62%), adhesions in 8/64 (12.50%), hernia in 7/64 (10.93%), appendicitis in 6/64 (9.37%), and intestinal tuberculosis in 6/64 (9.37%) of the patients. Among the large bowel obstructions, volvulus was noted in 7/64 (10.93%), intussusceptions in 4/64 (06.25%), and large bowel tumor in 3/64 (4.68%) of the patients. Paralytic ileus was noted in 10/64 (15.62%) of the patients. Conclusions: Acute IO is a common surgical emergency requiring timely intervention to reduce morbidity and mortality. Acute IO is more common in small bowel when compared to large bowel. Males are more commonly affected than females. The clinical presentation varies on the level of obstruction and hence the incidence of symptoms varies from study to study. Intussusceptions, volvulus, herniae, and adhesions account for more than 50% of the causes of IO. Laparotomy was the most common means of IO management, while bowel resection and anastomosis were the most common intraoperative procedure. Early recognition and timely intervention are important to prevent the bowel going for gangrenous changes. Mortality increases with the delay in the institution of surgical or medical treatment.

Clinical study on Radish Seed Chengqi Decoction combined with glutamine for treatment of patients with septic secondary paralytic ileus / 中国中西医结合急救杂志

Objective To investigate the therapeutic effect of Radish Seed Chengqi Decoction combined with glutamine for treatment of patients with sepsis complicated with paralytic ileus. Methods Sixty patients with septic ileus admitted to the Department of Emergency Intensive Care Unit (EICU) of Tianjin Medical University General Hospital from August 2017 to January 2019 were enrolled. The Western medicine treatment group (30 cases) received routine Western medical methods including intravenous drip of glutamine, etc. for symptomatic treatment, and the Radish Seed Chengqi Decoction group (30 cases), based on the treatment in the Western medicine group, were additionally given the decoction by nasal feeding and retention enema twice a day, once 100 mL with the course of 7 days in both groups. The herbal prescription of Radish Seed Chengqi Decoction contained rhubarb 24 g (decocted later), sodium sulfate 15 g (mixed with water to take), magnoliae cortex 15 g, orange frui 10 g, aucklandiae 10 g, henan achyranthes root 10 g and radish seed 15 g, constituting one dose, two doses one day given to a patient, making one dose of herbal medicine to 200 mL of decoction for nasal feeding and retention enema, once 100 mL respectively, twice a day for 7 days. After treatment, the changes of survival rate in ICU, the total effective rate and the level of procalcitonin (PCT) were observed in both groups. Results After treatment, the total effective rate in Radish Seed Chengqi Decoction group was significantly higher than that in the Western medicine treatment group [83.33% (25/30) vs. 66.67% (20/30), P < 0.05], and the ICU 7-day survival rate in Radish Seed Chengqi Decoction group was also significantly higher than that in Western medicine treatment group [90.00% (27/30) vs. 76.67% (23/30), P < 0.05]. After treatment, the levels of PCT (μg/L) in both groups were significantly decreased compared with those before the treatment (Western medicine treatment group: 3.38±1.72 vs. 6.43±3.29, and Radish Seed Chengqi Decoction group: 2.39±1.24 vs. 6.78±2.31, both P < 0.05), and the degree of decrease of PCT in radish seed chengqi decoction group was more obvious than that in Western medicine treatment group (μg/L: 2.39±1.24 vs. 3.38±1.72, P < 0.05). Conclusion Applying alanyl glutamine combined with Radish Seed Chengqi Decoction for treatment of patients with sepsis complicated with paralytic ileus can significantly improve the clinical symptoms, reduce the PCT level and elevate the survival rate of patients.

Treatment of Post-stroke Paralytic Ileus by Combining Lai's Tongyuan Needling Treatment with Fuzi Lizhong Decoction / 中国中医药信息杂志

Paralytic ileus is one of the post-stroke familiar complications, belonging to the field of TCM"Changjie".Tongyuan Needling is invented by Professor LAI Xin-sheng,including two laws of promoting governor vessel to nourish spirit and leading qi to its origin, which focuses on regulating original qi and views governor and concept vessels as the key of regulating yin and yang, and then to regulate qi activity and hold the essence through leading qi to its origin,and finally to achieve balance between yin and yang.Fuzi Lizhong Decoction mainly consists of Lizhong Pills and Aconiti Lareralis Radix Praeparata, which is composed of processed Aconiti Lareralis Radix Praeparata, Codonopsis Radix, Atractylodis Macrocephalae Rhizoma, Zingiberis Rhizoma and Glycyrrhizae Radix et Rhizoma, which is an important prescription for warming yang and tonifying kidney, invigorating qi and strengthening the spleen. This article introduced one case adopting the therapy combination of Lai's Tongyuan Needling and Fuzi Lizhong Decoction to treat post-stroke paralytic ileus, and then summarized the experience of clinical acupoint selection and prescription.

Quetiapine Related Acute Paralytic Ileus in a Bipolar I Disorder Patient with Successful Low Dose Amisulpride Substitution: A Case Report

The mechanism of medication-induced gastrointestinal hypomotility is primarily caused by muscarinic cholinergic antagonism. This effect may cause constipation and paralytic ileus, which may lead to fatal complications. A 51-year-old woman was admitted due to manic episode recurrence. She developed paralytic ileus under quetiapine use and treated successfully under low dose amisulpride use. The related mechanism, associated risk factors, and the rationale for medication switch are discussed.

An observation on clinical effect of quadruple therapy of integrated traditional Chinese and western medicine for treatment of paralytic ileus / 中国中西医结合急救杂志

Objective To observe the clinical effect of the quadruple therapy of integrated traditional Chinese and western medicine for treatment of patients with paralytic ileus.Methods A prospective randomized control trial was conducted.Ninty-five patients with paralytic ileus diagnosed by Tianjin First Central Hospital from January 2015 to February 2016 were randomly divided into a control group (47 cases) and a research group (48 cases).Routine western medical treatment was given to the patients in control group;on the basis of western medical routine treatment,quadruple therapy was applied to the patients in the research group,including alprostadil injection 10 μg,intravenous drip,once a day;Xuebijing injection 40 mL,intravenous drip,twice a day;liangge powder with modification (ingredients or their dosages being added and/or subtracted) composed of rhubarb 10 g,mirabilite 10 g,gardenia 15 g,weeping forsythia 20 g,scutellaria 15 g,glycyrrhiza 6 g,mint 6 g,bamboo leaves 10 g,honey 10 g.administered by gastric tube;point selection principle:zusanli (ST36),sanyinjiao (SP6),tianshu (S25),hegu (LI4),yanglingquan (GB34),zhongwan (CV12),xiawan (CV10),dachangshu (C07)etc.No.30 filiform needle was used to be perpendicularly inserted by moderate and equi-librious acupuncture technique,needle retaining being 30 minutes,once a day for 72 hours.The numbers of the patients with abdominal pain,abdominal distension,nausea and vomiting,absence of exhausting and defecation,gurgling sound attenuation or disappearance,abdominal X-ray abnormality,and the first defecation time,gurgling reappearance time,disappearance time of main symptoms were observed.The clinical effects of these two groups were statistically analyzed.Results After treatment in the two groups,the numbers of patients with abdominal pain,abdominal distension,nausea and vomiting,absence of exhausting and defecation,gurgling sound attenuation or disappearance,abdominal X-ray abnormality were all significantly reduced compared with those before treatment,except the nausea and vomiting symptom,the degrees of descent of other indexes were more remarkable in the research group (abdominal pain:7 cases vs.44 cases,abdominal distension:6 cases vs.45 cases,absence of exhausting and defecation:3 cases vs.48 cases,gurgling sound attenuation or disappearance:11 cases vs.43 cases,abdominal X-ray abnormality:12 cases vs.48 cases),the time of first defecation in research group (hours:22.65 ± 6.72 vs.34.35 ± 5.38),gurgling reappearance time (hours:40.36 ± 6.99 vs.51.33 ± 5.80),symptom disappearance time (hours:51.44 ± 9.41 vs.60.10 ± 5.48) in research group were all shorter significantly than those in control group (all P ＜ 0.05).The total effective rate in the research group was obviously higher than that of the control group [93.75％ (45/48) vs.87.37％ (37/47),P ＜ 0.05].Conclusions The therapeutic effects of the quadruple therapy of integrated traditional Chinese and western medicine are remarkable for treatment of paralytic ileus.

Clinical Observation of Modified Xiaohuang Paste in the Treatment of Paralytic Ileus after Thoracolumbar Fractures / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of Modified xiaohuang paste in the treatment of paralytic ileus after thoraeolumbar fractures.METHODS:One hundred and thirty-eight patients with paralytic ileus after thoracolumbar fractures were divided into control group (group A,43 cases),Xiaohuang paste group (group B,47 cases) and Modified xiaohuang paste group (group C,48 cases).Group A was given routine treatment as fasting,gastrointestinal decompression,fluid replacement,nutritional support;group B was additionally given Xiaohuang paste on the basis of group A;group C was additionally given Modified xiaohuang paste on the basis of group A.Group B and C were given relevant paste every 12 h until intestinal peristalsis was recovered and gas exhausted from anus,at the most for 5 days.The improvement time of clinical symptom improvement,VAS score and CRP level were compared among 3 groups as well as the occurrence of ADR.RESULTS:After treatment,the time of gastrointestinal decompression,bowel sound recovery and passage of gas by anus in group B and C were significantly shorter than group A,and group C was significantly shorter than group B,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in VAS score and CRP level among 3 groups (P＞0.05).After treatment,VAS score of abdominal pain and distension,CRP level of 3 groups were decreased significantly compared to before treatment;those of group C were significantly lower than group A and B,and CRP level of group B was significantly lower than that of group A,with statistical significance (P＜0.05).There was no statistical significance in VAS score between group A and B (P＞0.05).No significant ADR was found in 3 groups.CONCLUSIONS:For paralytic ileus after thoracolumbar fracture,Modified xiaohuang paste can significantly shorten treatment duration,relieve abdominal distension and pain,inflammation with good safety.

Neostigmine Treatment of Paralytic Ileus in Critically Ill Patients

Paralytic ileus is a common complication in critically ill patients, and can affect all parts of the gastrointestinal tract. We report a case of paralytic ileus that improved after neostigmine administration. An 80-year-old man was transferred to the intensive care unit after a diagnosis of severe colitis due to Clostridium difficile infection while under conservative treatment for paralytic ileus . The patient's colitis resolved but the ileus did not. This prompted neostigmine administration, resulting in remarkable improvements in the abdominal physical examination and radiographic images. Bowel movements recovered, oral feeding was restarted, and the patient was transferred back to the general ward.

Effect of Acupuncture on Postoperative Ileus after Distal Gastrectomy for Gastric Cancer

PURPOSE: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. MATERIALS AND METHODS: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. RESULTS: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. CONCLUSIONS: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.

Electroacupuncture for severe acute pancreatitis accompanied with paralytic ileus:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy differences between electroacupuncture (EA) and regular treatment for severe acute pancreatitis accompanied with paralytic ileus.</p><p><b>METHODS</b>This was a prospective pragmatic randomized controlled trial. A total of 140 cases of severe acute pancreatitis accompanied with paralytic ileus were randomly assigned into an EA group and a regular treatment group, 70 cases in each one. The patients in the regular treatment group were treated with regular treatment, including intensive care, gastrointestinal decompression, fasting, blood capacity supplement, acid suppression treatment, internal environment maintenance, infection prevention, inhibition of pancreatic exocrine secretion, etc. Based on the regular treatment, patients in the EA group were treated with EA at Zusanli (ST 36) and Zhigou (TE 6), 30 min for each treatment, once a day for totally 5 days. The VAS-based abdominal distension severity scale and abdominal pain severity scale were compared before and during treatment in the two groups, moreover, the number of patients who transferred to surgery or ICU was compared.</p><p><b>RESULTS</b>(1) After the 1st EA, the abdominal pain and distension severity scales were both improved in the EA group, which were superior to those of the regular treatment group (all<0.05); afterwards, the abdominal distension and pain severity scales of each day in the EA group were all significantly superior to those of the regular treatment group (all<0.05). (2) The number of patients who transferred to surgery or ICU was not significantly different between the two groups (>0.05).</p><p><b>CONCLUSIONS</b>EA at Zusanli (ST 36) and Zhigou (TE 6) can significantly reduce the abdominal distension and pain severity scales in patients of severe acute pancreatitis accompanied with paralytic ileus, indicating positive clinical significance; in addition, EA is safe and can be recommended to the treatment of severe acute pancreatitis in combination with treatment plan of integrated Chinese and western medicine.</p>

Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation

PURPOSE: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.

Hypermagnesemia Accompanied with Colonic Perforation in a Hemodialysis Patient

We report a case of a chronic hemodialysis patient who developed hypermagnesemia due to an overdose of magnesium-containing laxative and paralytic ileus resulting in colonic perforation. Despite intravenous calcium infusion and daily hemodialysis, the patient developed ischemic colitis and intestinal perforation. Colonic perforation accompanied with hypermagnesemia in hemodialysis patients has rarely been reported. This case suggests that hypermagnesemia should be considered in renal failure patients as this can result in life-threatening events despite prompt treatment.

Clinical features of elderly patients with severe acute pancreatitis with misdiagnosis as having paralytic ileus / 中华胰腺病杂志

Objective The clinical features of elderly patients with severe acute pancreatitis (SAP) were atypical and these patients were often misdiagnosed as having paralytic ileus. The clinical presentations of elderly patients with SAP whose first diagnosis as paralytic ileus were analyzed. Methods 18 patients of elderly SAP who were misdiagnosed as having paralytic ileus were included and the clinical data were compared with 58 elderly patients with SAP. Results Among the misdiagnosis group, the first symptom onset were fleus, abdominal distension, vomiting, constipation, abdominal pain, diarrhea for 5, 4, 3, 3, 2, 1 case, respectively. Among SAP group, the first symptoms onset were 2, 31, 9, 3, 11, 2 cases, respectively. For misdiagnosis group, 13 cases were correctly diagnosed by CT scan, 3 cases by ultrasound and 2 cases by serum amylase test. For SAP group, 32, 15, 11 cases were diagnosed by CT scan, ultrasound and serum amylase, respectively (P < 0.05). 4 and 13 patients died in misdiagnosis and SAP group, respectively; among these 13 patients, 10 were female and 3 were male. Conclusions The elderly patients with paralytic ileus should consider the possibility of SAP, and CT scan was valuable for correct diagnosis.

Three Cases of Acute Abdomen Treated with Daikenchuto in Emergency Room / 日本東洋医学雑誌

Daikenchuto has been attracting nationwide attention in recent years, with its therapeutic efficacy on posto-perative complaints and complications. We treated three patients with acute abdomen using daikenchuto. They suffered from severe abdominal pains and abdominal radiographs showed small intestine gases. All three recovered from their pains or nausea after taking daikenchuto, and were discharged home without hospital admission. The use of daikenchuto against acute abdomen is recommended in emergency medicine.

Changes of Plasma Somatostatin in Children with Septic Shock / 实用儿科临床杂志

Objective To explore the changes of plasma somatostatin(SST) in children with septic shock.Methods The level of plasma SST in children with septic shock (test group,n=21) on an empty stomach at shock stage,blood pressure and heart rate recovery stage,recovery stage(at that time clinical symptoms and signs disappeared,infection indicators such as blood routine and CRP returned to normal,about 6-12 days after admission) were detected by competive radioimmunassay,the level of SST in healthy children(healthy control group,n=25) on an empty stomach on morning was detected,too.The levels of plasma SST between septic shock concbined with paralytic ileus group and without paralytic ileus group were compared.Results 1.Level of plasma SST of test group at shock stage[(44.60?16.83) ng/L]was significantly lower than that of control group[(123.15?6.57) ng/L](t=-12.16 P0.05).The level of plasma SST of children with paralytic ileus [(28.10?7.0) ng/L] was significantly lower than that of children without paralytic ileus [(56.98?9.44) ng/L](t=-7.70 P

Treating 1 case of gangrenous appendicitis complication with paralytic ileus and ARDS by professor CHAO En-xiang / 中华中医药杂志

Professor CHAO En-xiang thinks that several rules should be obeyed when we treat gangrenous appendicitis complication with paralytic ileus and ARDS.Firstly,we should adhere to the TCM characteristics of the holistic concept and treatment based on syndrome of differentiation.Secondly,we should formulate therapeutic method according to major pathogenesis.Thirdly,we should use drugs flexibly according to the patient's specific situation.Professor CHAO En-xiang considered it was the syndrome of dysfunctional activity of qi,fu qi being obstructed,dysfunction of middle-jiao in transportation.The therapeutical principle was regulating qi activity,dredging intestines and relieving distention.Nasal feeding with Dachengqi decoction adding Agastache rugosa,Tatarian Aster,paste umbilicus with mud of shallot stalk,fresh ginger,fennel and enema with Radix Aucklandiae.

Convulsion, Symptomatic Hyponatremia and Paralytic Ileus Following Tonsillectomy: A case report / 대한마취과학회지

Severe symptomatic hyponatremia shows high mortality in association with cerebral edema and central nervous system dysfunction. Postoperative hyponatremia is usually attributed to administration of hypotonic fluids while antidiuretic hormone is acting. However, we experienced a severe symptomatic hyponatremia in spite of infusion of lactated Ringer's solution perioperatively in a case of 4-year-old girl's tonsillectomy. Inappropriate secretion of ADH caused by pain, stress, anxiety, nausea, vomiting. Paralytic ileus developed several hours after surgery, severe hyponatremia (Na 119 mmol/L) with convulsion notified. After prompt infusion of sodium supplement and fluid restriction, the patient recovered uneventfully.

Spontaneous Bacterial Peritonitis Associated with Cervicomedullary Tumor: A case report

Spontaneous bacterial peritonitis(SBP) is a diffuse bacterial infection of peritoneum without an apparent intra-abdominal source of infection. Initially, it was believed to be associated with an alcholic liver cirrhosis, however, its clinical spectrum has been broadened and now it is thought to be a variant syndrome rather than an unique complication of liver cirrhosis. A 25 year old quadriparetic man with a low-grade astrocytoma of cervicomedullary junction underwent a partial resection of tumor and a course of radiation therapy. While recieving rehabilitation therapy, the patient developed sudden abdominal pain, constipation and fever. The laboratory findings including CBC, plain abdominal X-rays, gastroduodenal endoscopy, abdominal ultrasonography were not specific. Physical examination revealed rebound tenderness over the epigastric region and signs suggesting paralytic ileus. A diagnostic peritoneal lavage was performed and its result was compatible with SBP even though no specific orgnisms were identified. The patient was taken parenteral antibiotics. On the 13th day of treatment, his symptoms and physical signs were subsided and antibiotics were discontinued. The patient remained symptom free until rehabilitation therapies were completed.