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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 -
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 -
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 -
Acta Obstetricia Et Gynecologica... Nov 2019Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure... (Review)
Review
Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure further, causing intra-abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state-of-the-art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra-abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.
Topics: Abdominal Cavity; Adult; Compartment Syndromes; Critical Illness; Female; Fetal Monitoring; Humans; Incidence; Intra-Abdominal Hypertension; Maternal Mortality; Needs Assessment; Peripartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prognosis; Risk Assessment; Treatment Outcome
PubMed: 31070780
DOI: 10.1111/aogs.13638 -
Einstein (Sao Paulo, Brazil) 2016There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results... (Review)
Review
There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results on measurement of vesical intra-abdominal pressure and analyzing the level of evidence were the purposes of this integrative literature review, carried out based on the databases LILACS, MEDLINE and PubMed, from 2005 to July 2012. Twenty articles were identified, in that, 12 literature reviews, 4 descriptive and exploratory studies, 2 expert opinions, one prospective cohort study and one was an experience report. The vesical intra-abdominal pressure measurement was considered gold standard. There are variations in the technique however, but some common points were identified: complete supine position, in absence of abdominal contracture, in the end of expiration and expressed in mmHg. Most research results indicate keeping the transducer zeroed at the level of the mid-axillary line at the iliac crest level, and instill 25mL of sterile saline. Strong evidence must be developed. RESUMO Em pacientes críticos com quadros abdominais agudos a esclarecer é crescente a solicitação da aferição da pressão intra-abdominal. Sintetizar resultados de pesquisas sobre a mensuração da pressão intra-abdominal pela via vesical e analisar o nível de evidência foram os objetivos desta revisão integrativa da literatura, realizada nas bases LILACS, MEDLINE e PubMed, no período de 2005 a julho de 2012. Identificaram-se 20 artigos, sendo 12 revisões de literatura, 4 estudos exploratório-descritivos, 2 opiniões de especialistas, 1 estudo de coorte prospectivo e 1 relato de experiência. O método vesical para mensuração da pressão intra-abdominal foi considerado padrão-ouro. Existem variações na técnica, entretanto pontos em comum foram identificados: posição supina completa, na ausência de contratura abdominal, ao final da expiração e expressa em mmHg. A maioria indica posicionar o ponto zero do transdutor na linha axilar média, ao nível da crista ilíaca e instilar 25ml de solução salina estéril. Evidências fortes precisam ser desenvolvidas.
Topics: Abdominal Cavity; Humans; Intra-Abdominal Hypertension; Medical Illustration; Monitoring, Physiologic; Pressure; Sodium Chloride; Urinary Catheterization
PubMed: 26958978
DOI: 10.1590/S1679-45082016RW3088 -
Biomolecules May 2021Post-surgical adhesions are internal scar tissue and a major health and economic burden. Adhesions affect and involve the peritoneal lining of the abdominal cavity,... (Review)
Review
Post-surgical adhesions are internal scar tissue and a major health and economic burden. Adhesions affect and involve the peritoneal lining of the abdominal cavity, which consists of a continuous mesothelial covering of the cavity wall and majority of internal organs. Our understanding of the full pathophysiology of adhesion formation is limited by the fact that the mechanisms regulating normal serosal repair and regeneration of the mesothelial layer are still being elucidated. Emerging evidence suggests that mesothelial cells do not simply form a passive barrier but perform a wide range of important regulatory functions including maintaining a healthy peritoneal homeostasis as well as orchestrating events leading to normal repair or pathological outcomes following injury. Here, we summarise recent advances in our understanding of serosal repair and adhesion formation with an emphasis on molecular mechanisms and novel gene expression signatures associated with these processes. We discuss changes in mesothelial biomolecular marker expression during peritoneal development, which may help, in part, to explain findings in adults from lineage tracing studies using experimental adhesion models. Lastly, we highlight examples of where local tissue specialisation may determine a particular response of peritoneal cells to injury.
Topics: Gene Expression Regulation, Developmental; Gene Regulatory Networks; Genetic Markers; Humans; Peritoneum; Tissue Adhesions
PubMed: 34063089
DOI: 10.3390/biom11050692 -
Anaesthesiology Intensive Therapy 2015Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open... (Review)
Review
Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure.
Topics: Abdomen; Abdominal Cavity; Humans; Intra-Abdominal Hypertension; Laparotomy; Lower Body Negative Pressure
PubMed: 25973658
DOI: 10.5603/AIT.a2015.0023 -
International Wound Journal Aug 2012The management of complex abdominal problems with the 'open abdomen' (OA) technique has become a routine procedure in surgery. The number of cases treated with an OA has... (Review)
Review
The management of complex abdominal problems with the 'open abdomen' (OA) technique has become a routine procedure in surgery. The number of cases treated with an OA has increased dramatically because of the popularisation of damage control for life-threatening conditions, recognition and treatment of intra-abdominal hypertension and abdominal compartment syndrome and new evidence regarding the management of severe intra-abdominal sepsis. Although OA has saved numerous lives and has addressed many problems related to the primary pathology, this technique is also associated with serious complications. New knowledge about the pathophysiology of the OA and the development of new technologies for temporary abdominal wall closure (e.g. ABThera™ Open Abdomen Negative Pressure Therapy; KCI USA Inc., San Antonio, TX) has helped improve the management and outcomes of these patients. This review will merge expert physician opinion with scientific evidence regarding the total management of the OA.
Topics: Abdominal Cavity; Abdominal Wound Closure Techniques; Humans; Negative-Pressure Wound Therapy
PubMed: 22727136
DOI: 10.1111/j.1742-481X.2012.01018.x