Textiloma Intra-abdominal. Reporte de un caso / Textiloma Intraabdominal. Case report

Los cuerpos extraños olvidados en el abdomen después de una operación quirúrgica, también denominados textilomas tienen una incidencia de 1 por cada 1500 laparotomías, aunque resulta muy difícil evaluar la real estadística por los escasos reportes debido a las posibles implicaciones médico-legales que en muchos países traen aparejadas. En el presente trabajo se realiza la presentación de un interesante caso intervenido en el Hospital Universitario "Dr. Mario Muñoz Monroy" del municipio Colón. Se trata de una paciente femenina de 47 años de edad operada inicialmente de Histerectomía Total Abdominal que dos meses después regresa con una Oclusión Intestinal Completa y es llevada al quirófano donde se encuentra un "Plastrón Abscedado". La Evolución clínica post-operatoria fue excelente. El estudio de la pieza anatómica demostró la presencia de una compresa totalmente "enrollada" dentro de la luz del intestino por lo que se deduce que el cuerpo extraño "provocó" una fístula peritoneo-entérica, con el paso total de la compresa hacia la luz del intestino, causando un cuadro oclusivo. Cada uno de los médicos especializados en ramas quirúrgicas está expuesto a la ocurrencia de dicha contingencia que es multicausal y completamente ajena a la voluntad del equipo a cargo del paciente. Por tal motivo resulta vital la exploración cuidadosa de todos los medios usados en cada una de las laparotomías (AU).

Foreign bodies left in the abdomen after surgery, also called gossypibomas have an incidence ranging between 1 in 1500 laparotomy, although it is very difficult to assess the actual statistics for scarce reports due to possible medico-legal implications in They rigged bring many countries. In this paper presenting an interesting case involved the University Hospital "Dr. is done Mario Muñoz Monroy "Columbus Township. This is a female patient of 47 years initially operated total abdominal hysterectomy two months later he returns with a complete intestinal occlusion and is taken to the operating room where there is a "Plastron abscessed". The postoperative clinical evolution was excellent. The study of the anatomical specimen showed a pad completely "wrapped" into the lumen of the intestine so it follows that the foreign body "caused" a fistula peritoneal-enteral, with the full bore of the pad into the light bowel, causing occlusive condition. Each specialized doctors in surgical branches exposed to the occurrence of such a contingency that has multiple causes and completely beyond the control of the team in charge of the patient. Therefore it is vital careful examination of all the media used in each of the laparotomy (AU).

Ascite cirrótica: aspectos clínicos / Cirrhotic ascites: clinical aspects

A ascite é a mais comum das três complicações da cirrose. A sua presença é indicativo de mau prognóstico, e está associada a complicações que aumentam a morbidade e a mortalidade. O gradiente de albumina sérico-ascítico é o método utilizado para se fazer o diagnóstico diferencial da ascite associada à hipertensão portal daquela de outra etiologia. A patogênese da ascite cirrótica revela primordialmente dois fatores: alterações na hemodinâmica portal e retenção de sódio e água. A teoria que explica a formação da ascite e as alterações hemodinâmicas na cirrose é a da vasodilatação. Esta vasodilatação é associada às altas concentrações de substâncias como o óxido nítrico dentre outras. O tratamento da ascite consiste na restrição de sódio, diuréticos orais, paracentese abdominal, derivação peritoneovenosa, TIPS e transplante de fígado.

Ascites is the most common of the three major complications of cirrhosis (the others complications are hepatic encephalopathy and visceral haemorrhage). Its presence is an indicative sign of poor prognosis, predisposing the patient to many complications which increase morbidity and death rate. The serum-ascites albumin gradient is the method which you can differentiate ascites caused by portal hypertension from others etiologies. In ascites pathogenesis there are two factors to be considered: The portal hemodynamic and the sodium and water retainers. The theory which explains the ascites formation and the hemodynamics alterations in cirrhosis is the vasodilatation one. The vasodilatation would be secondary to high serum concentrations of vasodilators, including nitric oxide and others. The treatment of ascites in cirrhotic patients includes clinical and surgical procedures like saline restriction, oral diuretics, abdominal paracentesis, peritoneovenousderivation, TIPS, and liver transplantation.

Sclerosing peritonitis mimicking ovarian carcinoma: Associated with ovarian teratoma / 대한산부인과학회지

Sclerosing peritonitis is an unusual fibrosing condition predominantly involving the omentum and simulating carcinoma. The presenting signs and symptoms, imaging examination and cancer antigen 125 (CA-125) status in sclerosing peritonitis sometimes resemble those of ovarian cancer. Thus, the possibility of sclerosing peritonitis should be considered in the differential diagnosis of ovarian carcinoma. It may occur idiopathically and secondary to chronic peritoneal dialysis, the use of peritoneovenous shunt, practolol therapy, or in association with ovarian tumors such as ovarian teratoma. We report a case of peritonitis initially suspected as ovarian carcinoma but diagnosed as sclerosing peritonitis associated with teratoma.

Denver peritoneovenous shunt in the management of refractory ascites due to chronic liver diseases: impact of patients selection on its outcome

Forty four patients with refractory ascites due to chronic liver diseases that fulfilling the inclusion criteria of selection were divided into 2 groups. The first group [G1, n=24] was subdivided into 2 subgroups according to degree of liver condition; GIa [n=11] with Child-Pugh class B and GIb [n=13] with early class C. The patients were subjected to P-V shunt [Denver group]. Similarly, patients in the second group [GII, n=20] were divided into 2 subgroups GIIa [n=10] and GIIb [n=10] respectively and treated by the repeated tapping and albumin infusion [control group]. Postoperative results revealed a significant increase in urine output [P

Saphenous--peritoneal shunt in refractory ascites: a neglected technique.

Management of intractable ascites has always been a challenge. Peritoneovenous shunt (PVS) plays a major role in the surgery of intractable ascites in patients with liver cirrhosis. Positive pressure gradient between the ascitic fluid and venous pressure leading to one-way drainage of ascitic fluid into venous circulation is the mainstay. Over decades, various modifications of shunting technique have been done. Here we report our experience with this procedure which is safe, easy and effective. Here the long saphenous vein is used as a drainage system. One-way ascites flow is ensured by a natural valve in the saphenous orifice.

Hepatic cerebrospinal fluid pseudocyst: a case report and review of the literature.

An abdominal pseudocyst is a rare, but important complication in patients with a ventriculo-peritoneal (VP) shunt insertion. Several predisposing factors for this complication have been suggested, including infection, obstruction or dislodgement, but the pathophysiology is still unknown. However, the abdominal inflammatory process is accepted widely as a hypothesis for the formation of an abdominal pseudocyst. In this study, we report the case of a 21-year-old male that presented with a high-grade fever, poor appetite, shortness of breath and unconsciousness 1 week after receiving a VP shunt insertion for obstructive hydrocephalus. Ultrasonography and computed tomographic scans of the abdomen revealed a well-defined large hepatic cyst surrounding the peritoneal tube of the VP shunt. A hepatic cerebrospinal fluid (CSF) cyst was diagnosed and Staphylococcus epidermis was cultured via CSF. After externalization of the VP shunt and adequate antibiotic treatment, the hepatic cyst was resolved. There was no recurrence observed in the regular follow up.

Catéter de derivación peritoneo-venosa para el tratamiento de la ascitis refractaria: presentación de un caso / Peritoneal-venous catheter in the treatment of refractory ascitis: one case presentation

En casos de ascitis refractaria que no cede con el manejo médico habitual, el drenaje peritoneo-venoso con el equipo de Denver es una buena solución en pacientes selec¬cionados adecuadamente. Presentamos un caso de una ascitis refractaria exitosamente manejada con esta técnica en un paciente con una leucemia promielocítica aguda.

Efeito da derivação pleuroperitoneal no tratamento de hidrotórax recorrente induzido. Pleurodese em coelhos / Effect of the pleuroperitoneal derivation in the treatment of induced recurrent hydrothorax: pleurodesis in rabbits

OBJETIVO: Verificar a pleurodese, através da histologia hematoxilina - eosina e microscopia eletrônica, obtida após injeção de tetraciclina, em coelhos com uso de derivação pleuroperitoneal no tratamento de hidrotórax recorrente induzido. MÉTODOS: Foram utilizados 30 coelhos New - Zealand, machos e adultos. Empregou-se anestesia dissociativa quetamina e xilazina em injeção intramuscular 0,1 cm3 para cada 100g de peso do animal. Para induzir hidrotórax utilizou-se tetraciclina 7 mg/kg, diluída em 10 cm3 de água destilada (pH 4) injetada via percutânea no 4o espaço intercostal anterior esquerdo. O ato operatório constituiu de laparotomia subcostal à esquerda com 4 cm de extensão e incisão do hemidiafragma na porção muscular de 0,5 cm de diâmetro. No grupo A (controle) realizou-se fechamento da abertura do diafragma com pontos simples e fio monofilamentar 5.0. No grupo B (derivação) após abertura do diafragma introduziu-se prótese cilíndrica com 2 cm de comprimento. No grupo C (drenagem) foi feita uma laparotomia subcostal esquerda com 2 cm de extensão e introdução de cateter no 6. Toracotomia lateral esquerda com 2 cm de extensão e descolamento hipodérmico para aplicação do cateter pleurointercostodermoperitoneal. No pós-operatório realizou-se indução de hidrotórax repetida no 1o, 5o, 8o e 12o dia de pós-operatório nos três grupos de estudo através de injeção intrapleural de tetraciclina 7 mg/kg (pH 4) no 4§ espaço intercostal anterior esquerdo. Foi feita eutanasia no 15§ dia e necropsia para retirada de líquido pleural e histologia pleural, pulmonar e peritônio parietal. RESULTADOS: O acúmulo de líquido pleural resultante foi mais significante nos animais do grupo A. A irritação química resultou no espessamento pleural moderado nos grupos B e C. O índice de pleurodese foi 100 por cento do grupo derivação pleuroperitoneal e 80 por cento do grupo drenagem. CONCLUSÃO: A derivação pleuroperitoneal facilita a formação de pleurodese comprovada histologicamente, mesmo com a utilização de dose baixa de tetraciclina em coelhos.

Evaluation of saphenoperitoneal shunt in hepatic patients with intractable ascites

Portal hypertension is a leading cause of chronic illness in Egypt. It is responsible for a significant proportion of lost days from work and refractory ascites is the most frequent admitting diagnosis in the medicine and hepatology departments. To evaluate the saphenoperitoneal shunt [SPS] in the management of hepatic patients with intractable ascites. Prospective study. Mansoura University Hospital, Department [8], General Surgery. Hepatic patients with intractable ascites. For 15 patients with intractable ascites the great saphenous vein is reversed to form saphenoperitoneal shunt under spinal anaesthesia. Patients morbidity and mortality as reflected by patients outcome, clinical follow up, laboratory follow up [kidney functions - liver functions] Child-Pugh grade and the therapeutic follow up. There was significant relief of symptoms in [86.6%] of patients, shunt stenosis in a single case and partial thrombosis in 2 cases, significant reduction of patients weight, abdominal girth and increased blood pressure, improved liver and kidney functions and upgraded patients scoring with less requirments for diuretics. The saphenoperitoneal anastomosis [SPS] has a wide range safety, cost effective, favorable outcome, less morbidity and mortality. So, it is a definitive treatment but not a palliative one

Cervical lympho-venous shunt versus denver shunt in management of intractable ascites [analysis of 170 cases]

The present study was conducted on 170 patients with intractable ascites secondary to liver cirrhosis. The present study showed that both peritoneo-venous and lympho-venous shunts are technically simple procedures that could be done under local anesthesia in nearly similar time duration. However, Denver shunt is expensive, it costs between LE 4000-6000. Lympho-venous shunt is a biological cheap procedure. It can be concluded from this study that patients with intractable ascites could be offered surgical therapy with either shunts with a high success rate. Cervical lympho-venous shunt appears to be a simple, safe, cheap and effective method for achieving a long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascetic fluid with almost negligible complications. Failure does not interfere with the future use of the expensive peritoneo-venous Denver shunt. Denver peritoneo-venous shunt is a good device to relieve ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. However, its high cost limits its wide scale application. A careful patient selection is mandatory for optimal results

peritoneo-venous [Denver] shunt in the management of intractable ascites in-patients with portal hypertension

The Denver Peritoneo-venous shunt was implanted in 15 patients with intractable ascites. The procedure was safe with no peri-operative mortality. It much improved the quality of life as regard with respiration, sleep and locomotion- in 60% of the patients. It also improved some of the biochemical abnormalities of those patients namely, serum albumin and serum creatinine levels. It avoids the patients the costly frequent hospitalizition, frequent intravenous albumin administration and the hazardous abdominal paracentesis

Complicaciones peritoneales infrecuentes de las derivativas ventrículo peritoneales / Infrequency peritoneal complications of the peritoneal ventricle derivatives

Se presenta una serie de 7 pacientes portadores de pseudoquistes peritoneales o compromiso inflamatorio extenso peritoneal. Se utilizó manejo agresivo de las lesiones peritoneales en los casos en que predominó la obstrucción intestinal. Nosotros proponemos retirar de la cavidad peritoneal el sistema derivativo, idealmente por medio de una neuroendoscopía o derivación ventriculo atrial. Se discuten las diferentes variables en el manejo de estos enfermos

Echocardiographic changes after peritoneovenous shunt for treatment of refractory ascites

Refractory ascites is frequently a manifestation of end stage liver disease, and is most often associated with a poor prognosis. The efficacy and complications of peritoneovenous shunt have given conflicting results. The use of Denver shunt as a line of therapy is expected to add a more preload to the heart in such patients. The aim of the present echocardiographic study is to evaluate such expected changes in cardiac function in those patients. Ten patients with tense, refractory ascites [age ranged 36-52 years] were carefully selected for Denver peritoneovenous shunt and followed up clinically, and echocardiographically in the period from January 1998 to January 2000. The left ventricular outflow tract diameter was found to be sign increased after shunt operation [P<0.05], reflecting a deleterious effect on left ventricular function. In addition the right ventricular diastolic diameter as well as the tricuspid valve excursion were sign increased [p < 0.05, < 0.01 respectively]. Moreover the right ventricular function showed a sign reduction in right ventricular pre-ejection period / right ventricular ejection time RVPEP / RVET [p<0.05], reflecting both increased tricuspid valve flow as well as pulmonary hypertension with de creased right ventricular systolic function. It could be concluded that the major hemodynamic changes in cirrhotic patients with refractory ascites early after Denver shunt consist of exaggeration of hyperkinetic state and a minor rise of pulmonary artery pressure. Therefore it may be recommended that a preoperative echocardiographic evaluation of both cardiac function and pulmonary artery pressure determination is mandatory in cirrhoticpatients with refractory ascites

Shunt peritoneo venoso en el tratamiento de ascitis maligna: reporte preliminar / Peritoneal venous shunt in the treatment of malignant ascitis: preliminary report

El presente reporte, menciona el uso de una válvula de drenaje de líquido ascítico, conocida como Shunt Peritoneo Venoso como tratamiento de paliación en los pacientes oncológicos terminales. Lo realizamos en cuatro pacientes portadores de carcinomatosis diseminadas, de distintas neoplasias primarias, con una calidad de vida poco favorable, ya que al momento de admitirlos en nuestro servicio presentaban un cuadro de dificultad respiratoria, saciedad precoz, aletargamiento e imposibilidad para desenvolverse adecuadamente en sus labores habituales. Es un reporte de casos, aunque poco extenso muy alentador, la evolución de los pacientes es adecuada, la calidad de vida, nuestro objetivo principal, es mejorada.

Evaluation of portal hemodynamics in patients with refractory ascites before and after periteneo-venous shunt

Twenty patients with tense refractory ascites due to bilharzial and/or posthepatic cirrhosis [age ranged 30-60 years] were carefully selected for Denver peritoneojugular shunt [PJS] and followed up clinically and the portal vein was examined before and after shunt for evaluation of portal hemodynamics. The shunts were effective in relieving medically resistant ascites. The portal pressure increased, especially in the early postoperative period and then gradually decreased to the preoperative value. Denver peritoneovenous shunt has a higher patency rate and it is associated with fewer complications. Partial paracentesis, potent diuretics and beta blocker was recommended immediately before operation to minimize the incidence of variceal hemorrhage after shunt due to increase in portal pressure

Un cuidado singular / A singular care

La experiencia de una enfermera es utilizada para sugerir un procedimiento paliativo novedoso en el medio, aplicado a un cuadro de ascitis maligna. El objetivo de este procedimiento es mejorar la calidad de vida de la paciente. En relación al caso, se hace referencia a la técnica de colocación de la válvula de derivación peritoneo-venosa, a su funcionamiento en los casos de ascitis por metástasis peritoneal

Acquired nevus flammeus

This is the case of a 55-year-old male with cirrhosis who required a LeVeen shunt for relief of refractory ascites. After eight months he developed recurrence of the ascites and a erythematous patch around the surgical scar. Skin biopsy revealed a proliferation of small and medium-sized vessels throughout the dermis. The acquired form of nevus flammeus is rare an is usually preceded by trauma. This is the report of a patient with an acquired nevus flammeus associated to an obstructed peritoneovenous shunt