- Klíčová slova
- abdominální katastrofa,
- MeSH
- akutní bolest břicha * diagnóza etiologie komplikace MeSH
- břišní absces chirurgie etiologie farmakoterapie MeSH
- břišní dutina * chirurgie patologie MeSH
- cholecystitida chirurgie diagnóza farmakoterapie MeSH
- lidé MeSH
- mezenteriální ischemie chirurgie diagnóza komplikace MeSH
- nádory břicha chirurgie diagnóza MeSH
- nitrobřišní hypertenze etiologie farmakoterapie komplikace terapie MeSH
- pankreatitida diagnóza farmakoterapie patofyziologie MeSH
- perforace střeva chirurgie komplikace mortalita MeSH
- prasklé aneurysma chirurgie diagnóza MeSH
- pseudomembranózní enterokolitida etiologie komplikace mortalita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Úvod: Akútna apendicitída patrí k najčastejším náhlym brušným príhodám. Jednou z komplikácii je aj pooperačná tvorba abscesov v peritoneálnej dutine, respektíve v retroperitoneálnom priestore. Za ich vznik sú zodpovedné, okrem iného, aj apendikolity ponechané v peritoneálnej dutine. K ich uvoľneniu z lumenu dochádza predoperačne i počas operácie. Apendikolit, aj s prítomnými baktériami na jeho povrchu, vytvára vhodné miesto pre vznik infekcie. Kazuistika: Autori prezentujú menej častý prípad retroperitoneálneho abscesu, ktorého príčinou bol retinovaný apendikolit. Nezvyčajným je dlhé obdobie medzi apendektómiou a klinickými prejavmi vyformovaného abscesu. Pacientka sa podrobila operačnej liečbe s evakuáciou abscesu a extrakciou apendikolitu. Pooperačný priebeh bol primeraný, hojenie rany bolo podporené podtlakovou terapiou. Záver: Počas apendektómie je nutné pamätať na riziko uvoľnenia apendikolitov a na ich úlohu pri infekčných komplikáciách. Je nutná svedomitá revízia peritoneálnej dutiny a tiež dobrá operačná technika. V prípade neúspechu pri lokalizácii apendikolitu dokážu pooperačne pomôcť zobrazovacie metódy.
Introduction: Acute appendicitis is one of the most common acute abdominal conditions. One of its complications is postoperative formation of abscesses in the peritoneal cavity or in the retroperitoneal space. Among other things, appendicoliths left in the peritoneal cavity are responsible for this process. Their release from the lumen occurs preoperatively and during the operation. An appendicolith, with the bacteria present on its surface, provides an environment that supports the onset of an infection. Case report: The authors present a less common case of a retroperitoneal abscess caused by an incarcerated appendicolith. Unusual is the long period between appendectomy and clinical manifestations of the abscess. The patient underwent surgical treatment with abscess evacuation and extraction of the appendicolith. The postoperative course was adequate; wound healing was supported by negative wound pressure therapy. Conclusion: During appendectomy, it is necessary to keep in mind the risk of releasing appendicoliths and their role in infectious complications. A conscientious revision of the peritoneal cavity is required, as well as a good surgical technique. If necessary, imaging methods can help to locate the appendicolith in the postoperative period.
- MeSH
- absces etiologie MeSH
- akutní nemoc MeSH
- apendektomie metody škodlivé účinky MeSH
- apendicitida * chirurgie komplikace MeSH
- břišní absces * chirurgie etiologie MeSH
- dospělí MeSH
- laparoskopie * MeSH
- lidé MeSH
- pooperační komplikace chirurgie etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. METHODS: A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. RESULTS: The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). CONCLUSION: Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.
- MeSH
- břišní absces * diagnostické zobrazování etiologie chirurgie MeSH
- Crohnova nemoc * komplikace chirurgie MeSH
- dospělí MeSH
- drenáž MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři MeSH
- seznamy čekatelů MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Definovat parametry predikující nutnost opakované drenáže, ovlivňující délku drenáže a nutnost úpravy polohy drénu. Metodika: Do našeho souboru byli zařazeni pacienti, u kterých byla provedena pod CT kontrolou drenáž jaterního abscesu mezi roky 2012-2020 ve Fakultní nemocnici v Brně. Délka drenáže, četnost recidivy a nutnost opakované drenáže abscesu byla korelována s velikostí, objemem, etiologií abscesu a jeho lokalizací v játrech, vlastnostmi drénu, délkou kanálu drénu, odborností rozhodující o extrakci drénu. Výsledky: V naší retrospektivní studii bylo do souboru zařazeno 48 konsekutivních pacientů (48 % žen) s 51 drénovanými abscesy. Průměrný věk pacientů byl 61,8 ? 14,3 let. U šesti (12 %) byla provedena opakovaná drenáž, která byla nutná častěji, pokud byl drén z abscesu extrahován jiným lékařem než radiologem nebo chirurgem (50 % vs. 17 % vs. 0 %, p = 0,006). Drenáž abscesů trvala déle u pacientů s cholangiogenním abscesem oproti abscesu idiopatickému nebo pooperačnímu (17,5 vs. 14 vs. 12 dní, p = 0,033). Častější úpravu polohy drénu bylo nutné provést při delším celkovém kanálu drénu (p = 0, 04). Závěr: Nutnost opakované drenáže byla spojena s extrakcí iniciálně zavedeného drénu jiným lékařem než radiologem nebo chirurgem. Délka drenáže byla ovlivněna patogenezí abscesu, nutnost úpravy polohy drénu délkou drenážního kanálu.
Aim: To define parameters predicting the need for repeated drainage, influencing the duration of drainage and the necessity to adjust the position of the drain. Methods: Patients who underwent CT-guided drainage of a hepatic abscess between 2012 and 2020 at the University Hospital Brno were included. The duration of drainage, recurrence rate and need for repeated drainage of the abscess were correlated with the size, volume, etiology of the abscess and its localization in the liver, drain characteristics, length of the drain channel, expert deciding on drain extraction. Results: 48 consecutive patients (48% women) with 51 drained abscesses were included in our retrospective study group. The mean age of the patients was 61.8 ± 14.3 years. In 6 (12%), repeat drainage was performed, which was necessary more often if the drain was extracted from the abscess by a physician other than a radiologist or surgeon (50% vs. 17% vs. 0%, p = 0.006). Drainage of abscesses took longer in patients with cholangiogenic abscesses compared to idiopathic or postoperative abscesses (17.5 vs. 14 vs. 12 days, p = 0.033). More frequent adjustment of the drain position was necessary with a longer total drain channel (p = 0.04). Conclusion: The need for repeat drainage is associated with extraction of the initially inserted drain by a physician other than a radiologist or surgeon. The duration of drainage was influenced by the pathogenesis of the abscess, and the necessity to adjust the drain position by the length of the drain channel.
Distant abscesses are uncommon during the episode of acute pancreatitis (AP). However, these are possible sequalae of necrotizing pancreatitis and should be treated appropriately to prevent serious septic complications. We demonstrate a case of a 56-year-old male patient who presented with severe necrotizing pancreatitis and distant retroperitoneal abscess that reached femoral region and was detected on diagnostic imaging scans. Combination of surgical and supportive therapy was employed, and the patient recovered well with no permanent consequences. Our article highlights the importance of quick and accurate diagnosis and timely intervention in this rare type of pancreatitis complication.
- MeSH
- akutní nekrotizující pankreatitida komplikace MeSH
- břišní absces diagnostické zobrazování etiologie terapie MeSH
- drenáž MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retroperitoneální prostor MeSH
- stehno diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Úvod: Gastroenteritidy považujeme za nechirurgická onemocnění, vzácně však mohou vést ke komplikacím, které si vyžádají chirurgickou léčbu. Kazuistika: Prezentovaná pacientka podstoupila akutní resekci tenkého střeva pro nitrobřišní absces, který se vyvinul při salmonelové enteritidě.
Introduction: Although gastroenteritis is considered to be a non-surgical disease, rare complications necessitating surgical intervention may occur. Case report: We present a patient who underwent acute small bowel resection due to an abdominal abscess, which developed in association with Salmonella enteritis.
- MeSH
- akutní bolest břicha chirurgie etiologie MeSH
- antibakteriální látky terapeutické užití MeSH
- břišní absces * chirurgie diagnóza etiologie MeSH
- břišní stěna mikrobiologie patologie MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- rizikové faktory MeSH
- Salmonella enteritidis patogenita MeSH
- salmonelóza * MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Appendicitis is one of the most common diagnoses in pediatric populations. Although new recommendations for the treatment of pediatric appendicitis were published, management varies among different institutions. OBJECTIVES: To determine current practices in 4 (n = 4) representative pediatric surgical departments in Central Europe. MATERIAL AND METHODS: One department from each of the 4 countries was surveyed using an online questionnaire. Questions focused on preoperative, operative and postoperative practices in 2018, particularly those related to antibiotic (ATB) therapy and laparoscopy. RESULTS: A total of 519 appendectomies were performed, among which 413 (79.6%) were laparoscopic appendectomies (LAs), with a conversion rate of 5.1%. Appendectomy, as an elective procedure, was performed in 43 (8.3%) patients. One-quarter (129 patients) had complex appendicitis and 72.3% of these were operated laparoscopically. In 3 departments, ATB prophylaxis was administered, based on the decisions of the operating surgeon. One department used standard ATB prophylaxis (metronidazole). Whenever phlegmonous appendicitis was detected, ATB were administered therapeutically in 2 departments. Two other departments administered ATB based on surgeon decision. The choice of ATB was not standardized. If complex appendicitis was detected, all sites administered ATB therapeutically. The type of ATB treatment was standardized in complex cases in 2 departments. Thirty-four complications (6.6%) at surgical sites were recorded - 4.1% (16/390) after uncomplicated and 14% (18/129) after complex appendicitis. Thirty-two occurred after acute surgeries and 26 of these followed laparoscopic procedures. Postoperatively, intra-abdominal abscesses occurred in 3.5% of laparoscopic and in 2.9% of open appendectomy (OA) cases. CONCLUSIONS: This questionnaire study showed that treatment outcomes for appendicitis in children in Central Europe are comparable with data reported in the literature. Laparoscopic appendectomy is the predominant surgical method, but there is a little consensus for ATB treatment in the management of appendicitis at our 4 pediatric surgical departments.
- MeSH
- apendektomie * statistika a číselné údaje MeSH
- apendicitida * chirurgie MeSH
- břišní absces * MeSH
- délka pobytu MeSH
- dítě MeSH
- laparoskopie * MeSH
- lidé MeSH
- pooperační komplikace MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Interventional (or therapeutic) inflammatory bowel disease (IBD) endoscopy has an expanding role in the treatment of disease and surgical adverse events. Endoscopic therapy has been explored and used in the management of strictures, fistulas/abscesses, colitis-associated neoplasia, postsurgical acute or chronic leaks, and obstructions. The endoscopic therapeutic modalities include balloon dilation, stricturotomy, stent placement, fistulotomy, fistula injection and clipping, sinusotomy, EMR, and endoscopic submucosal dissection. With a better understanding of the disease course of IBD, improved long-term impact of medical therapy, and advances in endoscopic technology, we can foresee interventional IBD becoming an integrated part of the multidisciplinary approach to patients with complex IBD.
- MeSH
- biologické přípravky terapeutické užití MeSH
- břišní absces etiologie chirurgie MeSH
- endoskopická mukózní resekce MeSH
- gastrointestinální endoskopie * MeSH
- idiopatické střevní záněty komplikace farmakoterapie chirurgie MeSH
- kolorektální nádory etiologie chirurgie MeSH
- lidé MeSH
- netěsnost anastomózy chirurgie MeSH
- stenóza MeSH
- střevní obstrukce etiologie chirurgie MeSH
- střevní píštěle etiologie chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Úvod: Perkutánna endoskopická gastrostómia (PEG) patrí medzi efektívne spôsoby zabezpečenia dlhodobej enterálnej výživy u pacientov s nemožnosťou orálneho príjmu. Komplikácie zavedenia sú pomerne časté. Medzi najčastejšie patrí peristomálna infekcia rany v mieste zanorenia a presakovanie obsahu pozdĺž kanyly. Menej časté sú kolo-kutánne fistuly a peritonitída. Veľmi zriedkavou komplikáciou je absces pečene. Kazuistika: Autori popisujú prípad 51 ročného muža s hepatálnym abscesom a s inoperabilným karcinómom faryngu so zavedenou PEG. Pacient bol prijatý do nemocnice s rozvíjajúcim sa septickým stavom, ktorého príčinou bol absces pečene. Absces pečene vznikol na základe zanorenia disku PEG a jeho následnou úplnou dislokáciou do oblasti ľavého laloka pečene. Uvedený stav bol riešený chirurgickou revíziou s drenážou abscesu a konštrukciou klasickej gastrostómie. Záver: Syndróm zanoreného disku PEG s komplikáciou ako je absces pečene, je pomerne zriedkavá komplikácia, no prináša výzvy v podobe diagnostiky aj terapie samotného syndrómu. Manažment liečby vyžaduje úzku spoluprácu gastroenterológa a chirurga. Včasné rozpoznanie a riešenie môže zabrániť progresii stavu do sepsy, resp. až do septického šoku, čo môže viesť až ku smrti.
Introduction: Percutaneous endoscopic gastrostomy (PEG) is one of the most effective methods of providing long-term enteral nutrition in patients with the impossibility of oral intake. Complications are relatively common. The most common is peristomal wound infection at the site of the insertion and leakage along the cannula. Lesscommon complications are colo-cutaneous fistulas and peritonitis. A very rare complication is liver abscess. Case report: The authors describe a case of a 51-year-old man with a hepatic abscess with inoperable pharyngeal carcinoma with PEG. The patient was admitted to hospital with a developing septic condition due to a liver abscess. The liverabscess resulted from the buried bumper syndrome of the PEG and subsequent complete dislocation of the bumper into the left liver lobe area.. This condition was treated by a surgical review with abscess drainage and the construction of classical gastrostomy. Conclusion: Buried bumper syndrome with its complications, such as a liver abscess is a relatively rare complication, but challenges both the diagnosis and therapy of the syndrome itself. Its management requires a close cooperation between a gastroenterologist and a surgeon. Early recognition and treatment can prevent the progression of the condition to sepsis or a septic shock, which can lead to death.
- Klíčová slova
- syndrom zanořeného disku, PEG,
- MeSH
- absces jater * etiologie chirurgie MeSH
- chirurgie trávicího traktu metody MeSH
- gastrostomie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hltanu komplikace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
