Retroperitoneal abscess and extensive subcutaneous emphysema in perforated appendicitis: a case report.

Most of the time, the diagnosis and treatment of appendicitis are straightforward. However, a missed diagnosis can sometimes lead to life-threatening complications. A fatal case of appendicitis in a 76-year-old man who presented with progressive abdominal pain, retroperitoneal abscesses and extensive subcutaneous emphysema, is described. Eventually, laparotomy showed appendicitis perforated into the retroperitoneum without any signs of peritonitis. Despite multiple operations the patient died two months after admission due to multiple organ failure.

Bimalleolar ankle fracture with proximal fibular fracture.

A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular fracture was initially not found. Pathogenesis of the fracture seems most likely to be a pronation-eversion trauma, with an additional direct proximal fibular fracture. By reviewing this unusual case, it becomes clear that thorough examination of a trauma patient is very important. Secondary survey might be useful, since additional findings might appear. Treatment just using AO basic principles, will likely result in a satisfactory patient outcome.

Emboli rate during and early after carotid endarterectomy after a single preoperative dose of 120 mg acetylsalicylic acid--a prospective double-blind placebo controlled randomised trial.

PURPOSE: To investigate whether a single pre-operative dose of 120 mg acetylsalicylic acid (ASA) decreased either (1) emboli rate, as detected by transcranial Doppler (TCD), during and early after carotid endarterectomy (CEA) and (2) clinical intra- and post-operative signs suggestive of embolism or increased bleeding tendency. DESIGN: Prospective, double-blind placebo controlled trial. PATIENTS AND METHODS: One-hundred consecutive patients were randomised to receive either 120 mg ASA (n = 48) or placebo (n = 49) by suppository on the night before CEA; three patients were excluded. Emboli were counted and expressed as emboli rate (ER). The incidence of bleeding complications was assessed. Surgeons were asked to indicate which patients had received ASA or placebo. RESULTS: There were no significant differences between the ASA and placebo groups in ER in the intraoperative and postoperative periods. ER higher than 0.9 min(-1) was associated with a significantly increased risk of complications (26 vs. 0%, P < 0.01). No extra bleeding complications were observed in the ASA group. Surgeon assessment of whether or not ASA had been administered had a sensitivity of 42% and a specificity of 70%. CONCLUSION: A single pre-operative dose of ASA (120 mg) did not reduce significantly the emboli rate during and after CEA and surgeons could not correctly identify whether or not ASA had been administered.

Results of split-ileostomy in Crohn's disease of the colon.

In a period of seven years split-ileostomies were performed in 30 patients with Crohn's disease of the colon. Patients with the previous resection of the bowel were excluded. The indications for the diverting-ileostomy were: 1 toxic colitis unresponsive to intensive conservative therapy, and 2 long standing colitis, with or without perianal fistulae, not adequately responding to conservative treatment. Regarding the results, a split-ileostomy would seem to be indicated in debilitated patients in whom a resection at the time of the primary laparotomy carries too great a risk. None of our nine patients died. In long-standing disease a split-ileostomy for the purpose of healing or limiting the ultimate resection is not satisfactory. In only four out of 21 electively performed ileostomies this goal was achieved. We have too little experience with split-ileostomies in the treatment of extensive perianal and rectovaginal fistulae.