RESUMEN
Pancreaticoduodenectomy (PD) is recognized as one of the most intricate abdominal surgical procedures, often accompanied by high morbidity rates. The occurrence of an anastomotic ulcer at the gastrojejunal anastomosis post-pancreaticoduodenectomy surgery is a relatively uncommon complication, albeit potentially leading to severe, life-threatening consequences. The predominant symptomatology manifests as acute abdominal pain accompanied by peritonitis. Conventionally, diagnosis is achieved through computed tomography (CT) scans, facilitating subsequent management, and surgical management is recommended in the majority of instances. Herein, we present a rare case of a patient who experienced ulcer perforation at the gastrojejunal anastomosis site after undergoing pancreaticoduodenectomy with stomach preservation, and we reviewed the available literature to gain more comprehension of this rare complication of this type of surgical intervention.
Asunto(s)
Anastomosis Quirúrgica , Pancreaticoduodenectomía , Tomografía Computarizada por Rayos X , Humanos , Pancreaticoduodenectomía/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Dolor Abdominal/etiología , Masculino , Úlcera Péptica Perforada/cirugía , Úlcera Péptica Perforada/etiología , Peritonitis/etiología , Peritonitis/cirugía , Peritonitis/diagnóstico , Yeyuno/cirugía , Persona de Mediana Edad , Estómago/cirugíaRESUMEN
Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis, and the prevention and treatment of this condition are important for improving the long-term survival and quality of life of patients. However, peritoneal dialysis-associated peritonitis due to Mycobacterium tuberculosis infection is relatively rare and not easily diagnosed. Here, we present a case of peritoneal dialysis-associated peritonitis caused by Mycobacterium tuberculosis identified by pathogenic microbial DNA high-throughput genetic sequencing. This case demonstrates that pathogenic microbial DNA high-throughput genetic sequencing could be used to improve the detection rate of pathogenic microorganisms in patients with complex conditions, thereby allowing for earlier initiation of treatment.
Asunto(s)
ADN Bacteriano , Secuenciación de Nucleótidos de Alto Rendimiento , Mycobacterium tuberculosis , Diálisis Peritoneal , Peritonitis Tuberculosa , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Diálisis Peritoneal/efectos adversos , ADN Bacteriano/análisis , Peritonitis Tuberculosa/diagnóstico , Masculino , Peritonitis/microbiología , Peritonitis/diagnóstico , Persona de Mediana Edad , FemeninoRESUMEN
The penetration of a peritoneal dialysis catheter into the intestinal cavity is a clinically rare complication. In the present retrospective clinical case series, 11 patients with uraemia who received continuous ambulatory peritoneal dialysis and attended hospital between 2019 and 2023 are described. The median patient age was 61.91 ± 11.33 years. All patients had previously experienced peritoneal dialysis-related peritonitis and were clinically cured by infusing sensitive antibiotics into the abdominal cavity. Colonoscopy was utilised to locate the penetrating catheter and close the perforation with a titanium clip once the catheter had been removed via an external approach. Following a 2-4-week fast, the perforations healed in all 11 patients. The present authors' experience illustrates that directly removing the catheter and clamping the perforation opening under the guidance of colonoscopy is simple to operate with few complications compared with traditional open surgery.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua , Humanos , Persona de Mediana Edad , Masculino , Femenino , Anciano , Estudios Retrospectivos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/instrumentación , Catéteres de Permanencia/efectos adversos , Colonoscopía/métodos , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Peritonitis/etiología , Peritonitis/diagnóstico , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/efectos adversos , AdultoRESUMEN
Pseudomyxoma peritonei (PMP) is a rare neoplastic condition characterised by gelatinous ascites, which generally arise from mucin-producing appendiceal tumours. Presentation is variable but requires prompt recognition to ensure appropriate specialist management due to risk of malignancy.A male in his 40s presented with a 1-day history of sudden onset, non-migratory abdominal pain, worse in the right iliac fossa. He had no significant medical history nor known drug allergies. Examination revealed right iliac fossa peritonism and blood tests revealed raised inflammatory markers. CT scan showed a right-sided abdominal collection. Intraoperatively, a diagnostic laparoscopy was performed, which revealed extensive mucin in the abdominal cavity. This was washed out and a laparoscopic appendectomy was performed; histopathology confirmed PMP from the ruptured appendix.
Asunto(s)
Neoplasias Peritoneales , Peritonitis , Seudomixoma Peritoneal , Tomografía Computarizada por Rayos X , Humanos , Masculino , Seudomixoma Peritoneal/diagnóstico , Seudomixoma Peritoneal/cirugía , Seudomixoma Peritoneal/complicaciones , Peritonitis/diagnóstico , Peritonitis/cirugía , Peritonitis/etiología , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/cirugía , Neoplasias Peritoneales/complicaciones , Adulto , Apendicectomía , Laparoscopía , Dolor Abdominal/etiología , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/cirugía , Neoplasias del Apéndice/complicaciones , Diagnóstico DiferencialRESUMEN
We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.
Asunto(s)
Colecistectomía , Vesícula Biliar , Ultrasonografía , Humanos , Masculino , Niño , Vesícula Biliar/lesiones , Vesícula Biliar/cirugía , Colecistectomía/métodos , Rotura , Ultrasonografía/métodos , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/cirugía , Resultado del Tratamiento , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/cirugía , Bazo/lesiones , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico , Peritonitis/etiología , Peritonitis/diagnóstico , Peritonitis/cirugíaRESUMEN
Despite available armored personal protection in troops, the incidence of abdominal wounds in modern wars is 6.6-9.0%. Of these, penetrating abdominal injuries comprise 75-80%. Thoracoabdominal injuries occupy a special place with incidence up to 88%. We present the first case of the "Koblenz algorithm" in the treatment of a patient with mine explosion wound, combined injury of the head, limbs, thoracoabdominal trauma, widespread peritonitis, small intestinal obstruction and septic shock in a military hospital. This algorithm was implemented under import substitution considering the peculiarities of abdominal adhesive process in a patient with thoracoabdominal wound. This case demonstrates the advantage of this algorithm for patients with severe combined wounds of the chest and abdomen complicated by diffuse purulent peritonitis. Clinical status of these patients does not allow not only open laparostomy, but also "classical" redo laparotomies.
Asunto(s)
Traumatismos Abdominales , Algoritmos , Hospitales Militares , Laparotomía , Traumatismos Torácicos , Humanos , Traumatismos Abdominales/cirugía , Traumatismos Abdominales/diagnóstico , Traumatismos Torácicos/cirugía , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/complicaciones , Masculino , Laparotomía/métodos , Peritonitis/cirugía , Peritonitis/etiología , Peritonitis/diagnóstico , Traumatismos por Explosión/cirugía , Traumatismos por Explosión/diagnóstico , Adulto , Resultado del Tratamiento , Traumatismo Múltiple/cirugía , Traumatismo Múltiple/diagnóstico , Choque Séptico/etiología , Choque Séptico/cirugía , Choque Séptico/diagnósticoRESUMEN
The human gut microbiota significantly impacts health, including liver conditions like liver cirrhosis (LC) and spontaneous bacterial peritonitis (SBP). Immunoglobulin A (IgA) plays a central role in maintaining gut microbial balance. Understanding IgA's interplay with gut microbiota and liver health is crucial. This study explores the relationship between fecal IgA levels, gut microbiota, and liver injury severity. A total of 69 LC patients and 30 healthy controls were studied. Fecal IgA levels were measured using ELISA, and IgA-coated bacteria were quantified via flow cytometry. Microbiota diversity and composition were assessed through 16S rRNA sequencing. Liver injury severity was graded using the Child-Pugh score. Statistical analyses determined correlations. LC patients had higher fecal IgA levels than controls, correlating positively with liver injury severity. Microbiota diversity decreased with severity, accompanied by shifts in composition favoring pro-inflammatory species. Ralstonia abundance positively correlated with liver injury, whereas Faecalibacterium showed a negative correlation. Specific microbial markers for SBP were identified. Functional profiling revealed altered microbial functionalities in LC and SBP. Elevated fecal IgA levels, coupled with microbiota alterations, correlate with liver injury severity in LC patients. Modulating gut microbiota could be a promising strategy for managing liver-related conditions. Further research is needed to understand underlying mechanisms and translate findings into clinical practice, potentially improving patient outcomes.
Asunto(s)
Heces , Microbioma Gastrointestinal , Inmunoglobulina A , Cirrosis Hepática , Peritonitis , ARN Ribosómico 16S , Humanos , Cirrosis Hepática/microbiología , Peritonitis/microbiología , Peritonitis/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Heces/microbiología , ARN Ribosómico 16S/genética , Anciano , Adulto , Estudios de Casos y ControlesRESUMEN
In 2023, Chinese Society of Hepatology of Chinese Medical Association convened a panel of experts to update the Chinese guidelines on the management of ascites and associated complications in cirrhosis which was launched in 2017 and renamed this guidelines as "Guidelines on the Management of Ascites in Cirrhosis." This comprehensive resource offers essential recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome.
Asunto(s)
Ascitis , Síndrome Hepatorrenal , Cirrosis Hepática , Humanos , Cirrosis Hepática/complicaciones , Ascitis/terapia , Ascitis/etiología , Ascitis/diagnóstico , China , Síndrome Hepatorrenal/terapia , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/diagnóstico , Peritonitis/terapia , Peritonitis/diagnóstico , Peritonitis/etiología , Sociedades Médicas , Gastroenterología/normasRESUMEN
Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.
Asunto(s)
Hemorragia Gastrointestinal , Encefalopatía Hepática , Síndrome Hepatorrenal , Unidades de Cuidados Intensivos , Cirrosis Hepática , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Cirrosis Hepática/terapia , Cirrosis Hepática/diagnóstico , Encefalopatía Hepática/terapia , Encefalopatía Hepática/diagnóstico , Encefalopatía Hepática/mortalidad , Síndrome Hepatorrenal/terapia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/mortalidad , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/diagnóstico , Peritonitis/mortalidad , Peritonitis/diagnóstico , Peritonitis/terapia , Cuidados Críticos , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/mortalidad , Admisión del Paciente , Hepatopatías/terapia , Hepatopatías/mortalidad , Hepatopatías/diagnóstico , Terapia de Reemplazo Renal , Farmacorresistencia Bacteriana Múltiple , Sepsis/terapia , Sepsis/diagnóstico , Sepsis/mortalidad , PronósticoRESUMEN
OBJECTIVE: To identify the risk factors of refractory peritoneal dialysis related peritonitis (PDRP) and construct a nomogram to predict the occurrence of refractory PDRP. METHODS: Refractory peritonitis was defined as the peritonitis episode with persistently cloudy bags or persistent dialysis effluent leukocyte count >100 × 109/L after 5 days of appropriate antibiotic therapy. The study dataset was randomly divided into a 70% training set and a 30% validation set. Univariate logistic analysis, LASSO regression analysis, and random forest algorithms were utilized to identify the potential risk factors for refractory peritonitis. Independent risk factors identified using multivariate logistic analysis were used to construct a nomogram. The discriminative ability, calibrating ability, and clinical practicality of the nomogram were evaluated using the receiver operating characteristic curve, Hosmer-Lemeshow test, calibration curve, and decision curve analysis. RESULTS: A total of 294 peritonitis episodes in 178 patients treated with peritoneal dialysis (PD) were enrolled, of which 93 were refractory peritonitis. C-reactive protein, serum albumin, diabetes mellitus, PD duration, and type of causative organisms were independent risk factors for refractory peritonitis. The nomogram model exhibited excellent discrimination with an area under the curve (AUC) of 0.781 (95% CI: 0.716-0.847) in the training set and 0.741 (95% CI: 0.627-0.855) in the validation set. The Hosmer-Lemeshow test and calibration curve indicated satisfactory calibration ability of the predictive model. Decision curve analysis revealed that the nomogram model had good clinical utility in predicting refractory peritonitis. CONCLUSION: This nomogram can accurately predict refractory peritonitis in patients treated with PD.
Asunto(s)
Nomogramas , Diálisis Peritoneal , Peritonitis , Humanos , Peritonitis/etiología , Peritonitis/diagnóstico , Diálisis Peritoneal/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Factores de Riesgo , Adulto , Anciano , Curva ROC , Estudios Retrospectivos , Modelos Logísticos , Antibacterianos/uso terapéutico , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Proteína C-Reactiva/análisisRESUMEN
BACKGROUND: In the livestock industry, Foreign Body Syndrome is a devastating disease condition. Feeding management, lacking of food discrimination, and eating chopped food increase the risk of swallowing sharp foreign bodies in bovine species. In addition to the honeycomb cells shape of the reticulum, the contractions of the reticular wall, gravid uterine pressure, and parturition efforts, foreign bodies can penetrate the reticular wall, causing cascade of problems including traumatic reticulitis, traumatic reticuloperitonitis, and traumatic pericarditis. The present study was carried out to evaluate the diagnostic significance of cardiac troponin I rapid test cassette and other cardiac biomarkers including serum cardiac troponin I (cTn I), creatine kinase-myocardial band (CK-MB), lactate dehydrogenase (LDH), and aspartate aminotransferase enzyme (AST), in confirmed cases of traumatic pericarditis (TP) and/or traumatic reticuleoperitonitis (TRP) in cattle and buffaloes. METHODS: A total number of 30 animals (22 cattle and 8 buffaloes) with different signs such as anorexia, jugular distension, brisket edema, and signs of pain (reluctance to move, arching back, and abduction of the forelimbs) were included in the present study. Based on case history, clinical signs, ferroscopic, pericardiocentesis, radiographic and ultrasonographic examinations, TP were confirmed in cattle (n = 10) and buffaloes (n = 8) while TRP were confirmed only in cattle (n = 12). Additionally, 20 clinically healthy animals (n = 10 cattle and 10 buffaloes) were used as a control group. Blood samples were collected for determination of blood level of Tn-I, and activity of CK-MB, LDH, and AST. RESULTS: The obtained results revealed a highly significant increase in serum cTn I in diseased cattle with TP and TRP (P = 0.00), while buffaloes with TP showed no significant changes in serum cTn I (P = 0.111). Both diseased cattle and buffaloes showed increased serum activities of CK-MB, AST, and LDH enzyme. On the other hand, cardiac troponin I rapid test cassette failed to detect cTn I in diseased animals. CONCLUSION: The study concluded that the cardiac troponin I rapid test cassette did not have a diagnostic significance and could not be used as a point-of-care under field condition for diagnosis of TP and TRP in large ruminants. However, the serum troponin I level is helpful in diagnosis of TP and TRP in cattle. Although cardiac biomarkers have some diagnostic values in TP and TRP, the traditional diagnostic methods (clinical, radiography and ultrasonography examinations) are crucial for thorough evaluation of TP/TRP cases in bovine.
Asunto(s)
Biomarcadores , Búfalos , Enfermedades de los Bovinos , Forma MB de la Creatina-Quinasa , Pericarditis , Reticulum , Troponina I , Animales , Pericarditis/veterinaria , Pericarditis/diagnóstico , Pericarditis/sangre , Bovinos , Biomarcadores/sangre , Troponina I/sangre , Enfermedades de los Bovinos/diagnóstico , Enfermedades de los Bovinos/sangre , Forma MB de la Creatina-Quinasa/sangre , Femenino , Peritonitis/veterinaria , Peritonitis/diagnóstico , Peritonitis/sangre , L-Lactato Deshidrogenasa/sangre , Aspartato Aminotransferasas/sangre , Masculino , Cuerpos Extraños/veterinaria , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnósticoRESUMEN
Enteric gram-negative bacteria-associated peritoneal dialysis (PD) peritonitis is common. These organisms are such as Escherichia coli, Klebsiella and Enterobacter species. Pantoea dispersa belongs to the order Enterobacterales, it has known benefits and a role in agricultural and environmental biotechnology. Pantoea dispersa, although still relatively rare, is being increasingly recognised to cause human infections. We are reporting a case of PD peritonitis caused by Pantoea dispersa in a kidney failure patient on continuous ambulatory peritoneal dialysis (CAPD). His peritonitis was treated well with intraperitoneal antibiotics and the patient can resume his CAPD therapy. The increasing reports of Pantoea dispersa-related human infections warrant concerns, both in immunocompromised and immunocompetent patients.
Asunto(s)
Antibacterianos , Infecciones Relacionadas con Catéteres , Infecciones por Enterobacteriaceae , Pantoea , Diálisis Peritoneal Ambulatoria Continua , Peritonitis , Humanos , Pantoea/aislamiento & purificación , Masculino , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/microbiología , Peritonitis/tratamiento farmacológico , Peritonitis/etiología , Peritonitis/diagnóstico , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/diagnóstico , Antibacterianos/uso terapéutico , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Persona de Mediana EdadRESUMEN
Traditional surgical treatment of widespread purulent peritonitis has some disadvantages that emphasizes the need for new approaches to postoperative care. The authors present successful treatment of diffuse purulent peritonitis using a combination of 'open abdomen' technology and VAC therapy. This approach reduces abdominal inflammation and intra-abdominal pressure. Combination of 'open abdomen' technology and VAC therapy provides effective control of inflammation and stabilization of patients with purulent peritonitis.
Asunto(s)
Hipertensión Intraabdominal , Terapia de Presión Negativa para Heridas , Peritonitis , Humanos , Peritonitis/etiología , Peritonitis/cirugía , Peritonitis/diagnóstico , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/diagnóstico , Hipertensión Intraabdominal/cirugía , Resultado del Tratamiento , Terapia de Presión Negativa para Heridas/métodos , Masculino , Femenino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
Streptococcus pyogenes is a human pathogenic, gram positive bacterium that primarily leads to pharyngitis or soft tissue infections. Primary peritonitis caused by S. pyogenes infection is rare and there are only a few published cases worldwide. Primary peritonitis due to other pathogens occurs in immunosuppressed conditions such as HIV or other chronic diseases. However, younger, healthy women are more likely to be affected by S. pyogenes peritonitis. At present, the underlying molecular mechanisms can only be speculated on. One possibility is that, similar to the clinical picture of streptococcal toxic shock syndrome (STSS), a specific serotype of the M protein in combination with inhibition of the cell response of neutrophil granulocytes could play a role. In addition to peritonitis, the clinical picture may include other organ manifestations such as acute kidney damage or circulatory dysregulation. In terms of treatment, rapid pathogen-directed empirical antibiotic therapy is the treatment of choice. If there is no indication of secondary peritonitis, diagnostic laparoscopy can be dispensed with in the further diagnostic work-up.
Asunto(s)
Abdomen Agudo , Peritonitis , Infecciones Estreptocócicas , Streptococcus pyogenes , Humanos , Femenino , Abdomen Agudo/microbiología , Abdomen Agudo/etiología , Abdomen Agudo/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/inmunología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Peritonitis/microbiología , Peritonitis/diagnóstico , Peritonitis/tratamiento farmacológico , Peritonitis/inmunología , Streptococcus pyogenes/aislamiento & purificación , Antibacterianos/uso terapéutico , Inmunocompetencia , Adulto , Diagnóstico DiferencialRESUMEN
Although Blastocystis sp. has been classically considered a commensal parasite with limited pathogenicity, recent studies suggest that its pathogenic potential is high. We report the case of a 9-year-old Spanish male who presented with peritonitis secondary to acute appendicitis with abundant intra-abdominal turbid-free fluid. A standard appendectomy was performed, and a sample of the fluid was taken for microbiological culture. Multimicrobial flora was isolated in peritoneal fluid culture. The antibiotic resistance study showed that all the microorganisms were sensitive to meropenem. On the 5th postoperative day, a control blood test showed relative eosinophilia and a persistently elevated C-reactive protein. A stool parasitological study showed abundant cysts morphologically compatible with Blastocystis hominis . The hematoxylin & eosin and Giemsa study identified abundant parasitic cysts in the appendix. The patient evolved favorably and is currently asymptomatic and under follow-up. Regarding acute appendicitis, there is only one report in the literature of peritonitis of appendiceal origin associated with Blastocystis sp. In conclusion, although infrequent, parasitosis should be considered as a potential etiological agent of acute appendicitis, even in nonendemic areas. Relative eosinophilia or persistently elevated acute phase reactants despite adequate antibiotic coverage should help to establish diagnostic suspicion.
Asunto(s)
Apendicitis , Infecciones por Blastocystis , Blastocystis hominis , Peritonitis , Humanos , Masculino , Niño , Peritonitis/parasitología , Peritonitis/microbiología , Peritonitis/diagnóstico , Peritonitis/tratamiento farmacológico , Infecciones por Blastocystis/parasitología , Infecciones por Blastocystis/diagnóstico , Infecciones por Blastocystis/complicaciones , Infecciones por Blastocystis/tratamiento farmacológico , Apendicitis/parasitología , Apendicitis/cirugía , Blastocystis hominis/aislamiento & purificación , ApendicectomíaRESUMEN
Neisseria gonorrhoeae (Ng) is a major cause of morbidity among sexually active individuals, occasionally leading to serious complications if left untreated. We describe a case of gonococcal peritonitis as a rare complication of Ng infection in a woman presenting with acute abdomen and intestinal subacute occlusion. Due to the rarity of this clinical presentation, we review the scientific literature to identify best practices and inform guidelines.
Asunto(s)
Antibacterianos , Gonorrea , Neisseria gonorrhoeae , Peritonitis , Humanos , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/complicaciones , Gonorrea/microbiología , Peritonitis/microbiología , Peritonitis/tratamiento farmacológico , Peritonitis/diagnóstico , Femenino , Neisseria gonorrhoeae/aislamiento & purificación , Antibacterianos/uso terapéutico , Adulto , Resultado del Tratamiento , Ceftriaxona/uso terapéuticoRESUMEN
BACKGROUND: Metagenomic next-generation sequencing (mNGS) is an emerging technique for the clinical diagnosis of infectious disease that has rarely been used for the diagnosis of ascites infection in patients with cirrhosis. This study compared mNGS detection with conventional culture methods for the on etiological diagnosis of cirrhotic ascites and evaluated the clinical effect of mNGS. METHODS: A total of 109 patients with ascites due to cirrhosis were included in the study. We compared mNGS with conventional culture detection by analyzing the diagnostic results, pathogen species and clinical effects. The influence of mNGS on the diagnosis and management of ascites infection in patients with cirrhosis was also evaluated. RESULTS: Ascites cases were classified into three types: spontaneous bacterial peritonitis (SBP) (16/109, 14.7%), bacterascites (21/109, 19.3%) and sterile ascites (72/109, 66.1%). In addition, 109 patients were assigned to the ascites mNGS-positive group (80/109, 73.4%) or ascites mNGS-negative group (29/109, 26.6%). The percentage of positive mNGS results was significantly greater than that of traditional methods (73.4% vs. 28.4%, P < 0.001). mNGS detected 43 strains of bacteria, 9 strains of fungi and 8 strains of viruses. Fourteen bacterial strains and 3 fungal strains were detected via culture methods. Mycobacteria, viruses, and pneumocystis were detected only by the mNGS method. The mNGS assay produced a greater polymicrobial infection rate than the culture method (55% vs. 16%). Considering the polymorphonuclear neutrophil (PMN) counts, the overall percentage of pathogens detected by the two methods was comparable, with 87.5% (14/16) in the PMN ≥ 250/mm3 group and 72.0% (67/93) in the PMN < 250/mm3 group (P > 0.05). Based on the ascites PMN counts combined with the mNGS assay, 72 patients (66.1%) were diagnosed with ascitic fluid infection (AFI) (including SBP and bacterascites), whereas based on the ascites PMN counts combined with the culture assay, 37 patients (33.9%) were diagnosed with AFI (P < 0.05). In 60 (55.0%) patients, the mNGS assay produced positive clinical effects; 40 (85.7%) patients had their treatment regimen adjusted, and 48 patients were improved. The coincidence rate of the mNGS results and clinical findings was 75.0% (60/80). CONCLUSIONS: Compared with conventional culture methods, mNGS can improve the detection rate of ascites pathogens, including bacteria, viruses, and fungi, and has significant advantages in the diagnosis of rare pathogens and pathogens that are difficult to culture; moreover, mNGS may be an effective method for improving the diagnosis of ascites infection in patients with cirrhosis, guiding early antibiotic therapy, and for reducing complications related to abdominal infection. In addition, explaining mNGS results will be challenging, especially for guiding the treatment of infectious diseases.
Asunto(s)
Ascitis , Secuenciación de Nucleótidos de Alto Rendimiento , Cirrosis Hepática , Metagenómica , Peritonitis , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/microbiología , Masculino , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Femenino , Persona de Mediana Edad , Ascitis/microbiología , Metagenómica/métodos , Peritonitis/microbiología , Peritonitis/diagnóstico , Anciano , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Adulto , Bacterias/aislamiento & purificación , Bacterias/genética , Bacterias/clasificación , Líquido Ascítico/microbiologíaRESUMEN
OBJECTIVE: To describe short-term outcomes of dogs and cats undergoing surgery for traumatic bile peritonitis. ANIMALS: 13 dogs and 4 cats. METHODS: Multi-institutional, retrospective study. Medical records from 6 institutions were reviewed for cases of traumatic bile peritonitis between 2006 and 2022. Clinical presentation, additional injuries, surgical treatment, and outcome were recorded. RESULTS: Trauma occurred a median of 2 (range, 1 to 22) and 4 (range, 1 to 22) days prior to presentation in dogs and cats, respectively. Total bilirubin was increased in 11 of 13 dogs and 2 of 4 cats. Rupture occurred at the common bile duct (CBD) in 10 dogs and 1 cat, gallbladder in 3 dogs, cystic duct in 2 cats, and hepatic duct in 1 dog and 1 cat. The most common surgeries were cholecystoduodenostomy and CBD repair in dogs and cholecystectomy in cats. Eleven of 13 dogs and all cats survived to hospital discharge (88.2% overall survival). Median follow-up in surviving dogs and cats was 35 days (range, 14 to 401) and 30 days (range, 14 to 90), respectively. One dog that underwent cholecystectomy experienced recurrent bile peritonitis 20 days postoperatively. Short-term survival following surgical treatment of traumatic bile peritonitis was excellent and recurrence appears uncommon. The most frequent site of rupture was the CBD in dogs and the cystic duct in cats. CLINICAL RELEVANCE: Measurement of peritoneal bilirubin should be considered in dogs and cats with peritoneal effusion following trauma. Surgeons should be prepared to identify and address ruptures in locations other than the gallbladder.