Search

SEP is an increasingly seen complication of CAPD; we have the occasion to see again this condition because two patients came under our observation. We have remarked the unknown etiology and pathogenesis, the difficult diagnosis and therapy, and the often poor prognosis.

We present a case report of a 74 year old man, affected by angiodysplasia of the duodenum, which developed in peritonitis and hemoperitoneum. After undergoing two surgical interventions, it is 14 days since he died. First of all, the importance of this case is due to the extreme rarity of the angiodysplasia of the duodenum, specially when it becomes worse in peritonitis and hemoperitoneum, this case having been described only one time till now, then the localization mainly sub-serousal and lastly the presence of a component, characterized by an elastotic nature, disposed in islets and interstitial widespread also among the glands, which we have first described in literature.

A case of twin-to-twin transfusion syndrome with intrauterine death of one twin and meconium peritonitis and intravascular disseminated coagulation in the other twin is reported. Meconium peritonitis follows to bowel perforation, caused by segmental severe hypoplasia of muscular layer. The Authors suggest that this structural alteration of bowel wall could be an expression of inequal distribution of some cells between the two twins, during embrional development.

Background: Early prognostic evaluation of patients affected by acute peritonitis is really desirable to program a correct therapeutic plan, selecting high-risk patients for more aggressive therapeutic procedures. The Mannheim peritonitis index is reliable and easy to apply, so its use is possible without the need of intensive care units., Methods: Between 1991 and 1995 a total of 235 patients were operated on for acute peritonitis. A retrospective study on this group of patients was performed in order to estimate prognostic reliability of Mannheim peritonitis index., Results: The overall mortality was 8.1%; for patients with a score less than 26 the mean mortality rate was 2% and for score greater than 26, 40.5%. This score is the threshold over which the therapeutic approach have to be more aggressive; planned multiple laparotomies or the open abdomen technique could be the best options to explore and clean up the peritoneal cavity from septic debris. In personal experience, all patients who died had residual sepsis in peritoneal cavity.

Minced polyester threads introduced into peritoneal cavity of guinea pigs or rats cause a granulomatous inflammation with evidence of macrophage stimulation. Chemotactic agents play an important role in the inflammatory reaction; they may be exogenous and/or endogenous. These are released locally by the cells involved in inflammation. In this paper the chemotactic effects of the peritoneal fluids from rats bearing the polyester inflammatory process, have been studied on PMN cells "in vitro". The peritoneal cavity fluids were obtained by washing the cavity of untreated rats or rats intraperitoneally injected with polyester, 1, 3, 7, 14 days after the intraperitoneal injection. The chemotactic response was assayed by employing modified chemotaxis Boyden chambers (Blind Well Neuro Probe) and polymorphonuclear leukocytes from normal or treated rats. Quantification of the migration was calculated by chemotactic index (A/B) (B = random migration, A = chemotaxis). The results demonstrated that the peritoneal fluids taken 3 and 7 days after the intraperitoneal polyester injection, elicit an evident chemotaxis response greater than that showed by peritoneal fluids from control rats. It is suggested that chemotactic factors can be produced and released by mononuclear cells involved in the inflammatory process.

Peritonitis encapsulans is a clinical interest on account of its rarity and the diagnostic difficulties caused by its aspecific symptomatology. A personal case is presented and its ambiguous clinical and instrumental picture is discussed. Diagnosis was finally obtained intraoperatively, after repeated episodes of mechanical ileus had made surgery mandatory.