ABSTRACT
BACKGROUND: Laparoscopic surgery has become increasingly popular in treating perforated peptic ulcer (PPU). However, currently it is not recognized as a prognostic factor for mortality within this group of patients. The aim of this study was to investigate whether laparoscopic surgery was an independent mortality risk factor in patients treated surgically for perforated peptic ulcer. MATERIALS AND METHODS: This was a Danish nationwide cohort study based on prospectively collected data of 1008 patients treated surgically for PPU between September 2011 and December 2015. A propensity score matching analysis, considering most of the known prognostic factors for mortality and baseline characteristics, was used to adjust mortality estimates in patients treated with open and laparoscopic surgery. The primary outcome was postoperative 30-day mortality. RESULTS: The study population comprised 1008 patients; 507 were treated laparoscopically and 501 by open surgery. There was significantly higher mean age, and higher ASA scores, as well as other mortality risk factors in the open surgery group. The unadjusted 30-day mortality was significantly lower in patients undergoing laparoscopic surgery compared to open surgery (HRâ¯=â¯0.48, 95% CI: 0.36-0.65). After matching and weighting controls, the adjusted difference in mortality was reduced and was not significant (HRâ¯=â¯0.82, 95% CI: 0.59-1.15). The 30-day mortality was 13.1% for laparoscopy and 14.7% for the matched controls in the open surgery group. CONCLUSIONS: Compared to open surgery, laparoscopic surgery in patients with PPU does not reduce short term mortality. More well powered randomized clinical trials are needed to investigate the role of laparoscopic surgery in treatment of patients with PPU.
Subject(s)
Laparoscopy/mortality , Peptic Ulcer Perforation/surgery , Adult , Aged , Aged, 80 and over , Cohort Studies , Denmark/epidemiology , Female , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Peptic Ulcer Perforation/mortality , Postoperative Complications/mortality , Prognosis , Propensity Score , Prospective Studies , Risk Factors , Treatment OutcomeABSTRACT
A 38-year-old man known with inflammatory bowel disease, received an ileostomy and a blinded colon. Eight years later the patient underwent a painful colonoscopy, performed under suspicion of malignancy in the blinded colon. Two days later the patient was admitted due to hoarseness, throat pain and a feeling of neck swelling but no abdominal pain. A chest X-ray showed subcutaneous emphysema in the neck region and pneumoperitoneum. We conclude, that colonoscopies can give a variety of complications, such as perforation in the colon with secondary subcutaneous emphysema in the neck and throat region.
Subject(s)
Colonoscopy/adverse effects , Pharyngitis/etiology , Pneumoperitoneum , Subcutaneous Emphysema , Adult , Colon/injuries , Humans , Intestinal Perforation/etiology , Male , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/etiology , Radiography , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiologyABSTRACT
Epiphrenic oesophageal diverticula are rare and often asymptomatic. In this case report a 58-year-old woman was diagnosed with an epiphrenic oesophageal diverticulum, which developed an oesophagobronchial fistula leading to a pulmonary abscess in the right lower lobe, septicaemia and acute respiratory failure. The patient underwent right lower lobectomy and the diverticulum was stapled off the oesophagus. The post-operative course was uneventful. This complication is only rarely described previously.
Subject(s)
Bronchial Fistula/diagnosis , Diverticulum, Esophageal/diagnosis , Esophageal Fistula/diagnosis , Lung Abscess/diagnosis , Bronchial Fistula/etiology , Bronchial Fistula/pathology , Bronchial Fistula/surgery , Diverticulum, Esophageal/complications , Diverticulum, Esophageal/diagnostic imaging , Diverticulum, Esophageal/surgery , Esophageal Fistula/etiology , Esophageal Fistula/pathology , Esophageal Fistula/surgery , Female , Humans , Lung Abscess/etiology , Lung Abscess/pathology , Lung Abscess/surgery , Middle Aged , Radiography , Tomography, X-Ray ComputedABSTRACT
A rare cause of acute abdominal pain: lymphoma making its debut by perforation of the small intestine. Lymphomas localised to the gastrointestinal tract are rare. A case is presented where the initial symptom of the disease was acute abdominal pain because of perforation of one of the lymphomas in the small intestine. The diagnostic and therapeutic options in such emergency cases are discussed.
Subject(s)
Intestinal Neoplasms/complications , Intestinal Neoplasms/surgery , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Lymphoma, Large B-Cell, Diffuse/complications , Lymphoma, Large B-Cell, Diffuse/surgery , Abdomen, Acute/etiology , Humans , Intestinal Neoplasms/diagnosis , Intestinal Neoplasms/pathology , Intestinal Perforation/diagnosis , Intestinal Perforation/pathology , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/pathology , Male , Young AdultABSTRACT
We report a case of fatal acute pancreatitis caused by severe hypertriglyceridaemia in a 27-year-old male who was treated with quetiapine. The blood samples were milk-like with markedly elevated triglycerides (> 55 mmol/l). Computer tomography revealed a severe pancreatitis without bile stones or cholestasis. In spite of treatment the patient's condition rapidly worsened and he died 48 hours after admission. We discuss the option of treating hypertriglyceridaemia-induced pancreatitis with apheresis.
