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BMJ (Clinical Research Ed.) Jun 2018Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally.... (Review)
Review
Secondary peritonitis accounts for 1% of urgent or emergent hospital admissions and is the second leading cause of sepsis in patients in intensive care units globally. Overall mortality is 6%, but mortality rises to 35% in patients who develop severe sepsis. Despite the dramatic growth in the availability and use of imaging and laboratory tests, the rapid diagnosis and early management of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. In this article, we review the pathophysiology of peritonitis and its potential progression to sepsis, discuss the utility and limitations of the physical examination and laboratory and radiographic tests, and present a paradigm for the management of secondary peritonitis.
Topics: Abdominal Cavity; Disease Management; Disease Progression; Early Medical Intervention; Humans; Peritonitis; Sepsis
PubMed: 29914871
DOI: 10.1136/bmj.k1407 -
World Journal of Emergency Surgery :... 2018Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious,... (Review)
Review
Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.
Topics: Abdomen; Abdominal Cavity; Abdominal Wound Closure Techniques; Guidelines as Topic; Humans; Intra-Abdominal Hypertension; Negative-Pressure Wound Therapy; Postoperative Complications; Prophylactic Surgical Procedures; Resuscitation
PubMed: 29434652
DOI: 10.1186/s13017-018-0167-4 -
Diagnostic and Interventional Imaging Feb 2015The retroperitoneum is a space situated behind the parietal peritoneum and in front of the transversalis fascia. It contains further spaces that are separated by the...
The retroperitoneum is a space situated behind the parietal peritoneum and in front of the transversalis fascia. It contains further spaces that are separated by the fasciae, between which communication is possible with both the peritoneal cavity and the pelvis, according to the theory of interfascial spread. The perirenal space has the shape of an inverted cone and contains the kidneys, adrenal glands, and related vasculature. It is delineated by the anterior and posterior renal fasciae, which surround the ureter and allow communication towards the pelvis. At the upper right pole, the perirenal space connects to the retrohepatic space at the bare area of the liver. There is communication between these two spaces through the Kneeland channel. The anterior pararenal space contains the duodenum, pancreas, and the ascending and descending colon. There is free communication within this space, and towards the mesenteries along the vessels. The posterior pararenal space, which contains fat, communicates with the preperitoneal space at the anterior surface of the abdomen between the peritoneum and the transversalis fascia, and allows communication with the contralateral posterior pararenal space. This space follows the length of the ureter to the pelvis, which explains the communication between these areas and the length of the pelvic fasciae.
Topics: Humans; Magnetic Resonance Imaging; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 25547251
DOI: 10.1016/j.diii.2014.06.015 -
Critical Care (London, England) Mar 2020This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at... (Review)
Review
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Topics: Abdominal Cavity; Compartment Syndromes; Critical Illness; Disease Management; Humans; Intensive Care Units; Intra-Abdominal Hypertension
PubMed: 32204721
DOI: 10.1186/s13054-020-2782-1 -
EBioMedicine Jun 2023Peritoneal metastasis is a challenging aspect of clinical practice for gastric cancer. Animal models are crucial in understanding molecular mechanisms, assessing drug... (Review)
Review
Peritoneal metastasis is a challenging aspect of clinical practice for gastric cancer. Animal models are crucial in understanding molecular mechanisms, assessing drug efficacy, and conducting clinical intervention studies, including those related to gastric cancer peritoneal metastasis. Unlike other xenograft models, peritoneal metastasis models should not only present tumor growth at the transplant site, but also recapitulate tumor cell metastasis in the abdominal cavity. Developing a reliable model of gastric cancer peritoneal metastasis involves several technical aspects, such as the selection of model animals, source of xenograft tumors, technology of transplantation, and dynamic monitoring of the tumor progression. To date, challenges remain in developing a reliable model that can completely recapitulate peritoneal metastasis. Thus, this review aims to summarize the techniques and strategies used to establish animal models of gastric cancer peritoneal metastasis, providing a reference for future model establishment.
Topics: Animals; Humans; Peritoneal Neoplasms; Stomach Neoplasms; Peritoneum; Transplantation, Heterologous; Heterografts; Cell Line, Tumor
PubMed: 37182268
DOI: 10.1016/j.ebiom.2023.104601 -
World Journal of Emergency Surgery :... Jul 2023Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI)... (Review)
Review
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
Topics: Female; Humans; Male; Surgeons; Abdominal Cavity; Intraabdominal Infections
PubMed: 37480129
DOI: 10.1186/s13017-023-00509-4 -
BMJ Case Reports Jan 2018A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident...
A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident and emergency department with Glasgow Coma Scale of 13. On examination, he had distended and tense abdomen. CT Thorax, Abdomen, and Pelvis confirmed massive tension pneumoperitoneum. A 14 Fr intravenous cannula was inserted through the umbilicus to relieve the intra-abdominal pressure. An emergency laparotomy showed petechia along the anterior gastric wall, haematoma of lesser omentum but showed no evidence of gastrointestinal perforation or organ injury. Air leak test performed by insufflating air into the stomach via nasogastric tube and abdomen filled with normal saline showed no leak. On-table oesophagogastroduodenoscopy showed mild oesophagitis and petechia of cardiac gastric mucosa. He was treated with intravenous antibiotics and discharged on the fifth postoperative day with adequate analgesia.
Topics: Abdominal Cavity; Adult; Analgesia; Anti-Bacterial Agents; Cannula; Cardiopulmonary Resuscitation; Decompression, Surgical; Drug Overdose; Heroin; Humans; Laparotomy; Male; Peritonitis; Pneumoperitoneum; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29386215
DOI: 10.1136/bcr-2017-223069 -
BMJ Case Reports Feb 2019Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the...
Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.
Topics: Abdominal Cavity; Adult; Antitubercular Agents; Diagnosis, Differential; Epididymitis; Humans; Lymphadenopathy; Magnetic Resonance Imaging; Male; Mycobacterium tuberculosis; Orchitis; Pain; Testicular Diseases; Testicular Hydrocele; Testis; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Urogenital
PubMed: 30787023
DOI: 10.1136/bcr-2018-226697 -
JSLS : Journal of the Society of... 2019Creating and maintaining a pneumoperitoneum to perform laparoscopy is governed by gas laws and the limiting physical constraints of the abdomen. (Review)
Review
BACKGROUND AND OBJECTIVES
Creating and maintaining a pneumoperitoneum to perform laparoscopy is governed by gas laws and the limiting physical constraints of the abdomen.
METHODS
A review of how gas, biomechanical and physical properties affect the abdomen and a systematic structured Medline and PubMed search was conducted to identify relevant studies related to the topic.
RESULTS
Abdominal compliance is a measure of ease of abdominal expansion and is determined by the elasticity of the abdominal wall and diaphragm. It is the change in intra-abdominal volume per change in intra-abdominal pressure. Caution should be exercised with pressures exceeding 12 millimeters mercury since this is defined as intra-abdominal hypertension.
CONCLUSIONS
Abdominal compliance has its limits, is unique for each patient and pressure-volume curves cannot be easily predicted. Using the lowest possible pressure to accomplish the surgical task without compromising surgical outcome is the desired goal. The clinical importance is caution and knowing there is a point where more pressure does not increase working space and only increases pressure.
Topics: Abdominal Cavity; Carbon Dioxide; Compliance; Humans; Insufflation; Laparoscopy; Pneumoperitoneum, Artificial; Pressure
PubMed: 30828242
DOI: 10.4293/JSLS.2018.00080 -
United European Gastroenterology Journal Dec 2022Creeping fat (CrF), also known as fat wrapping, is a significant disease characteristic of Crohn's disease (CD). The transmural inflammation impairs intestinal integrity... (Review)
Review
Creeping fat (CrF), also known as fat wrapping, is a significant disease characteristic of Crohn's disease (CD). The transmural inflammation impairs intestinal integrity and facilitates bacteria translocation, aggravating immune response. CrF is a rich source of pro-inflammatory and pro-fibrotic cytokines with complex immune microenvironment. The inflamed and stricturing intestine is often wrapped by CrF, and CrF is associated with greater severity of CD. The large amount of innate and adaptive immune cells as well as adipocytes in CrF promote fibrosis in the affected intestine by secreting large amount of pro-fibrotic cytokines, adipokines, growth factors and fatty acids. CrF is a potential therapeutic target for CD treatment and a promising bio-marker for predicting response to drug therapy. This review aims to summarize and update the clinical manifestation and application of CrF and the underlying molecular mechanism involved in the pathogenesis of intestinal inflammation and fibrosis in CD.
Topics: Humans; Crohn Disease; Mesentery; Inflammation; Cytokines; Fibrosis
PubMed: 36507842
DOI: 10.1002/ueg2.12349