ABSTRACT
Three cases of spontaneous umbilical hernia rupture in patients with alcoholic liver disease and ascites are reported. Eighteen cases have been previously reported in the literature. These 21 cases are reviewed in an attempt to determine precipitating events, prognostic factors, complications, and the results of therapy. All patients had significant ascites prior to umbilical rupture. Ulceration of the umbilicus prior to rupture was common (81%). The subsequent presence of peritonitis, hypotension, renal failure, gastrointestinal hemorrhage or hepatic coma was associated with significant mortality (80%). All patients with a serum albumin above 2.4 gm./dl. survived. There were no survivors in those patients who did not receive surgical treatment. Based upon the outcome of these 21 patients optimal treatment of this disorder would seem to be early surgical repair of the umbilical hernia, appropriate fluid and electrolyte replacement, antiobiotics and measures to reduce intraabdominal pressure.
Subject(s)
Hernia, Umbilical/etiology , Liver Cirrhosis, Alcoholic/complications , Ascites/complications , Hernia, Umbilical/blood , Hernia, Umbilical/complications , Hernia, Umbilical/surgery , Humans , Male , Middle Aged , Rupture, SpontaneousABSTRACT
Seventy-nine blood cultures were obtained from 15 patients undergoing diagnostic colonoscopy. Aerobic and anaerobic culture technics showed no evidence of bacteremia during or after the procedure. The colonoscope was passed to the cecum in 12 of the 15 patients. The time of the procedure varied from 15-60 minutes with an average of 30 minutes. The results of this study supplies further evidence that bacteremia during colonoscopy is an infrequent occurrence.
Subject(s)
Colon , Endoscopy/adverse effects , Sepsis/etiology , Humans , Male , Time FactorsABSTRACT
Three cases of acute, free perforation of the colon in Crohn's disease are described and their clinical and pathological features are detailed. Colonic perforation in Crohn's disease bears no definite relationship to obstruction or adrenocorticosteroid therapy. It may occur with or without toxic megacolon, and pathological study has not thus far suggested a common pathogenetic mechanism. Although free perforation has been considered to be extremely rare in Crohn's colitis, it is likely that this complication is more common than previously believed.
