Subject(s)
Burns, Chemical/etiology , Caustics/adverse effects , Esophagus/injuries , Mouth/injuries , Stomach/injuries , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle AgedABSTRACT
Insertion of a peritoneovenous shunt is an effective method of treatment of refractory ascites although not free of complications. The incidence of them varies between 20-50%, being obstruction, infection and disseminated intravascular coagulation the more frequent. We report a case of a patient that presented with ectopic ascites in cellular subcutaneous tissue one year after the placement of the shunt. This complication was due to an increase of ascites. Treated with paracentesis the ascites decreased and the ectopic ascites resolved.
Subject(s)
Ascites/etiology , Peritoneovenous Shunt/adverse effects , Postoperative Complications/etiology , Abdomen , Aged , Ascites/diagnosis , Ascites/surgery , Breast , Humans , Male , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Punctures , Thorax , Time FactorsABSTRACT
The aim of this study was to confirm that ascitic fluid determination of adenosine deaminase activity (ADA) is useful for the diagnosis of tuberculous peritonitis. 109 patients with ascites have been studied; 4 had tuberculous peritonitis and 105 nontuberculous ascites. The mean value of ascitic fluid AQDA was 0.587 +/- 0.2 uKat/l in tuberculous peritonitis and 0.11 +/- 0.1 uKat/l in nontuberculous ascites (p less than 0.001). An ADA value upper than 0.40 uKat/l has a sensitivity of 100% and a specificity of 99% for diagnosing tuberculous peritonitis. Ascitic fluid determination of ADA is simple, cheap and has a good diagnostic accuracy. In countries with high incidence of tuberculosis, measurement of ADA in ascitic fluid should be used as screening test for tuberculosis.
Subject(s)
Adenosine Deaminase/analysis , Ascitic Fluid/enzymology , Clinical Enzyme Tests , Peritonitis, Tuberculous/diagnosis , Ascites/diagnosis , Cross-Sectional Studies , Diagnosis, Differential , Humans , Peritonitis, Tuberculous/epidemiology , Spain/epidemiologyABSTRACT
Eleven episodes of spontaneous bacterial empyema were identified in eight cirrhotic patients with ascites. Criteria for spontaneous bacterial empyema included positive pleural fluid culture or polymorphonuclear cell concentration greater than 500 cells/mm3, evidence of pleural effusion before an infectious episode and transudate characteristics during infection. In five cases, spontaneous bacterial empyema was culture-negative and was associated with spontaneous bacterial peritonitis. Ascitic fluid was culture-negative in two of these cases and culture-positive in three. Blood cultures were negative in all five of these cases. In six cases spontaneous bacterial empyema was culture-positive (Escherichia coli in four, Klebsiella pneumoniae in one and Clostridium perfringens in one). Four of these patients had the same organism in ascites; one had culture-negative spontaneous bacterial peritonitis and one had no infection of ascites. Blood cultures were positive in four of these patients; three died. Death was more frequent in patients with positive cultures than in those with negative ones (p less than 0.05). Patients with hydrothorax are prone to spontaneous bacterial empyema. This infection probably occurs through hematogenous seeding, but transfer of infected ascites from the abdominal cavity through the diaphragm cannot be excluded. Patients with spontaneous bacterial empyema may be asymptomatic or may be seen with fever, chills and dyspnea. Spontaneous bacterial empyema must be differentiated from parapneumonic empyemas. The presence of pleural effusion before the infectious episode, fluid characteristics and the organisms isolated are the clues for differential diagnosis. Treatment includes antibiotics; chest tube insertion probably is not necessary.