The authors describe a false aneurysm of the profunda femoris artery caused by a bony fragment from the lesser trochanter after a proximal femoral fracture. False aneurysm as a complication of a hip ...fracture is rare; however it is essential to consider the possibility, more even so if there is inexplicable persisting pain after internal fixation. Symptoms are sometimes diffi-cult to judge, as they can be almost identical to usual symptoms after an operated hip fracture. In this case we present a female patient with persistent pain after a surgically fixed proximal femoral fracture. CT scan showed a false aneurysm caused by a bony fragment of the lesser trochanter. Because of the persisting mechanical stress from the bony fragment we decided to explore the false aneurysm and to remove the bony fragment. It is essential to be aware of adjacent vascular and neurological structures when a fracture is seen and operated on.
Objective: To assess the results of twelfth rib resection as a direct posterior surgical approach to subphrenic abscesses in case of failure of percutaneous drainage, abandonment of percutaneous ...drainage in view of a too high risk of perforation of adjacent organs, or contamination of the pleural space, or an inaccessible abdomen. Design: Retrospective study. Setting: University hospital, The Netherlands. Patients: 17 patients who required rib resection for subphrenic abscesses that developed after infected necrotising pancreatitis, splenectomy, or anastomotic disruption. Interventions: 18 rib resections. Main outcome measures: Outcome and morbidity. Results: Twelfth rib resection was successfully in 13 of 17 patients. Four patients died from multiple organ failure despite subsequent (re) laparotomies for additional surgical drainage. Conclusion: Twelfth rib resection can be useful for the treatment of subphrenic abscesses in selected patients.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
An invasive process in the pancreas was found in a 60-year-old woman and a 50-year-old man with abdominal symptoms. Generally, such findings turn out to be adenocarcinoma. However, these patients had ...lymphoma. Primary pancreatic lymphoma or localization of lymphoma in the pancreas are rare and chemotherapy may be curative. Therefore, obtaining tissue for histopathological confirmation of the diagnosis is very important. Both patients underwent chemotherapy. The first patient was in complete remission one month after the last chemotherapy cycle. In the second, the disease went into remission, but he suddenly died of sepsis after the fourth chemotherapy cycle.
Objective: To develop a standardised and reproducible model of intra-abdominal infection and abscess formation in rats.
Design: Experimental study.
Setting: University hospital, The Netherlands.
...Subjects: 36 adult male Wistar rats.
Interventions: In 32 rats, peritonitis was produced using two different concentrations of Escherichia coli (E. coli) and Bacteroides fragilis (B. fragilis) incorporated in fibrin clots (E. coli: 1 x 105 colony forming units (CFU) /ml or 1 x 108 CFU/ml, B. fragilis: 1 x 108 CFU/ml). Four rats with fibrin clots without bacteria served as uninfected controls.
Main outcome measurements: Macroscopy and bacterial counts in peritoneal fluid, blood, and fibrin clots after 24 hours, 4 days, 7 days, and 4 weeks.
Results: Macroscopically, there were signs of intra-abdominal infection and abscesses. With the higher starting concentration of E. coli, macroscopic signs were more pronounced and in nearly all rats bacterial counts in peritoneal fluid and fibrin clots showed persistently high numbers of E. coli and B. fragilis for at least 7 days (E. coli = 2 x 103 to 1 x 106 CFU/ml and 5 x 107 to 9 x 108 CFU/clot; B. fragilis = 1 x 103 to 1 x 106 CFU/ml and 5 x 107 to 6 x 108 CFU/clot).
Conclusion: This standardised and reproducible model of intra-abdominal infection and abscess formation seems well suited for further use and development in experiments on the pathophysiology of intra-abdominal infection and abscesses.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: To assess a scoring system for predicting recurrence of fulminant bacterial peritonitis after discontinuation of antimicrobial treatment in patients being treated by open management of the ...abdomen for persistent bacterial peritonitis after perforation of the digestive tract, anastomotic disruption, or necrotising pancreatitis.
Design: Retrospective study.
Setting: University Hospital, The Netherlands.
Subjects: 58 consecutive patients.
Main outcome measurements: Recurrence of fulminant bacterial peritonitis and survival.
Results: 13 of the 58 patients (22%) died during the initial course of antimicrobial drugs. 14 of the remaining 45 patients had a recurrence of fulminant bacterial peritonitis after discontinuation of antimicrobial drugs, 4 of whom died. Predictive criteria included raised white cell count (WCC) (p ≥ 0.02), duration of initial antibiotic treatment (p ≥ 0.05), and deterioration in Simplified Acute Physiology Score (p ≥ 0.05). Using the WCC and the duration of initial antimicrobial treatment together with other variables that showed a predictive trend (body temperature, percentage band cells, underlying disease, and use of inotropic agents), in a new scoring system (012), fulminant bacterial peritonitis did not recur when the score was 0-3, but in 9 of 11 patients with a score of 6 or more it did (p < 0.001).
Conclusion: Patients at increased risk of recurrence of fulminant bacterial peritonitis during open management of the abdomen can be identified at the time of discontinuation of antimicrobial treatment by a new scoring system; antimicrobial treatment should not be discontinued in patients with a score of 6 or more.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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