Pseudo-acute abdomen in familial Mediterranean fever. A case report]

The Authors report a case of familial mediterranean fever with pseudo-acute abdomen recently observed and emphasize how a careful anamnesis can avoid unnecessary surgical intervention.     

Intraperitoneal chemo-hyperthermia with "overflow" open abdomen]

The authors report an original procedure of open-abdomen intraperitoneal chemo-hyperthermia. The skin edges are watertightly stapled with a soft "abdominal cavity expander", supported by a Thompson self-retaining retractor positioned over the abdomen. So, the level of the liquid can be widely raised above the level of the skin edges. The anterior wall peritoneum, the wall edges are constantly exposed to the liquid. Large amplitude movements become possible: introduction into the abdomen of two forearms, even two arms, does not induce loss of any liquid. The small bowel, the stomach can be partially exteriorized. It becomes very easy to expose all the peritoneal spaces, to maintain an homogeneous hyperthermia within the abdomen, while using only one inflow drain, and one outflow drain.     

Problems with definitive abdominal closure using "zipper" and after "left open abdomen"

There are many problems associated with definitive closure of "left open abdomen" and abdominal zip. If the assumption can be made that after an operation multiple lavages will be necessary, we recommend a transverse laparotomy because there is much less retraction of the abdominal wall than with longitudinal laparotomy. Definitive closure with split-skin is inadequate as the missing elasticity especially with underlying small intestine loops leads to tearing, besides the mechanical properties of a thiersch as replacement for the abdominal wall is bad. Should the intra-abdominal infection have affected the abdominal wall itself, the implantation of an abdominal zip is useless as it tears away in a short time. Primary laparostoma is then the therapy of choice. The earlier definitive closure is planned, the easier this can be done. Prognosis does not depend on the way of temporary closure but on underlying pathology and on the possibility of resolving problems in adequate time.     

The "left-open abdomen". Technic, indication and results

Critical evaluation of 22 cases with serious diffuse purulent or fecal peritonitis treated by open abdomen following surgical intervention. Seven (32%) patients died, three because of continuing sepsis and one because of acute haemorrhagic necrotizing pancreatitis. The three other died of general complications (1 coma hepaticum, 2 massive embolisms; at autopsy their abdominal cavity was entirely cleaned. The therapeutic principle of "open abdomen" in cases of severe purulent and fecal peritonitis will be recommendable.     

Surgical emergencies and pseudo-surgical syndromes in the course of acquired immunodeficiency syndromes in adults

Numerous abdominal manifestations were noted among 600 patients undergoing treatment at Hospital Laennec for various stages of infection by the acquired immunodeficiency virus. These included violent abdominal pain in 30% of cases, the development of abdominal lymphoma, and occasionally alarming pseudo-surgical syndromes. Diagnosis is difficult, all the more so since authentic emergencies may be aggravated by the immunodeficiency state. 18 cases were collected in 3 years and included 6 cases of acute cholecystitis and 2 of appendicitis. The gangrenous and extensive nature of infection was generally noted and required appropriate antibiotic therapy.     

Leptospirosis caused by Leptospira icterohaemorrhagiae of the pseudo-surgical type: a case

The authors report a case of fatal leptospirosis due to Leptospira icterohaemorrhagiae revealed by typical signs of acute cholecystitis and associated with pancreatitis in a 73 year old patient presenting with gallstones. The initial clinical findings were highly suggestive of severe but typical cholecystitis and the final diagnosis was only considered when the patient's condition worsened despite surgery, with increasing obstructive jaundice and multiple organ failure. Pancreatitis was an autopsy finding. Misleading, especially gastrointestinal symptoms are frequent in leptospirosis. Hence an early diagnosis is an essential condition for a successful antibiotic management in severe cases of leptospirosis. This possibility should be considered whenever a patient presents with infectious obstructive jaundice. The patient has to be questioned concerning possible contact with contaminated animals and, when in doubt, the presence of specific antibodies should be investigated.     

Effectiveness of laparoscopy in the diagnosis of diseases simulating "acute abdomen"

The authors have performed an analysis of results of 242 emergent laparoscopies fulfilled in patients aged from 15 to 89 years. No acute surgical diseases were found in 103 cases. In 56 patients there were chronic diseases of organs of the abdominal cavity, 47 patients had no such pathology. Further examination established diseases of organs of the thoracic cavity, urinary system, diabetes mellitus etc. Functional character of the symptomocomplex was noted in 5.8% of the patients. One patient had a complication. The method is very effective and allows to avoid useless laparotomy in 20.6% of the patients.     

Acute hematogenic osteomyelitis in children, simulating "acute abdomen"]

The author reports three cases of acute hematogenic osteomyelitis, in which the symptoms of "acute abdomen" were predominant. In the first patient an erroneous laparotomy was performed. Some characteristic features in diagnosis of acute hematogenic osteomyelitis with such clinical picture are analysed.