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Aim Multisystem inflammatory syndrome in children (MIS-C), a rare severe complication of SARS-CoV-2 infection, has been recently reported to mimic acute abdomen and lead to surgical interventions, posing challenges for clinicians. In this systematic review, we evaluated the rate of acute abdomen and abdominal surgical emergencies in children with MIS-C. Methods Systematic review of all MIS-C cases presented with acute abdomen. Results A total of 385 patients with MIS-C, from 38 studies were included. Gastrointestinal manifestations were prominent in 233/385 (60.5%) children. Acute abdomen was noted in 72/385 (18.7%) of MIS-C cases and in 72/233 (30.9%) of MIS-C cases with gastrointestinal symptoms. Final diagnoses were mostly non-surgical (55/72, 76.4%), such as mesenteric lymphadenitis (23/72, 31.9%), terminal ileitis/ileocolitis (19/72, 26.4%), free abdominal fluid/ascites (8/72, 11.1%) and paralytic ileus (3/72, 4.2%). Laparotomy was performed in 35/72 (48.6%) of children with MIS-C and acute abdomen and was proven unnecessary in 18/35 (51.4%) cases. True abdominal surgical emergencies, such as appendicitis and obstructive ileus, were confirmed in 17/72 (23.6 %) cases. Conclusion MIS-C often presents with acute abdomen, mostly due to non-surgical intestinal inflammatory pathology. However, surgical complications occur in patients with MIS-C, therefore a high index of suspicion should remain.

OBJECTIVE (1) To report an unusual etiology for nontraumatic hemoabdomen in cats, and (2) to describe onset and recovery from severe, unexpected pancytopenia seen after surgical removal of a large intra-abdominal myelolipoma. CASE SUMMARY A 14-year-old neutered male domestic shorthair cat was presented for emergent treatment of suspected nontraumatic hemoabdomen. A hyperechoic mass, with ultrasonographic echogenicity similar to fat, was found in the right cranial abdomen and believed to be associated with the mesentery. Cytological examination of abdominal fluid identified marked extramedullary hematopoiesis within the hemorrhagic effusion. Exploratory laparotomy identified a hepatic mass, which was resected, and revealed to be a hepatic myelolipoma on histopathological examination. The patient's initial recovery was uneventful. However, continued hyporexia resulted in readmission 4 days postoperatively, at which time the patient was found to have a profound, tri-lineage pancytopenia, and cytological evidence indicative of bone marrow recovery. The pancytopenia resolved with continued medical management and supportive care. NEW OR UNIQUE INFORMATION PROVIDED Ruptured myelolipoma is not a commonly considered differential for nontraumatic hemoabdomen in cats. Furthermore, severe pancytopenia is unexpected following surgical resection of a myelolipoma. This case provides a unique clinical presentation of both nontraumatic hemoabdomen and bone marrow recovery.

Point-of-care ultrasonography as part of the physical examination is becoming considered a core skill. AFAST includes 5 acoustic windows over the abdomen and serves as a rapid screening test for free fluid (ascites, retroperitoneal, pleural and pericardial effusion) and soft tissue abnormalities (target-organ approach), and has an abdominal fluid scoring system (semiquantitating volume). Moreover, add-on skills are possible without additional views that include characterizing the caudal vena cava and hepatic veins (volume status), measuring the urinary bladder (volume estimation and urine output), screening for free air (pneumoperitoneum, pneumoretroperitoneum), and assessing gastrointestinal motility.

Study Objective The risks to surgeons of carrying out aerosol-generating procedures during the coronavirus disease 2019 (COVID-19) pandemic are unknown. To start to define these risks, in a systematic manner, we investigated the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the abdominal fluid and lower genital tract of patients undergoing surgery. Design Prospective cross-sectional observational study. Setting Single, large United Kingdom hospital. Patients Total of 113 patients undergoing abdominal surgery or instrumentation of the lower genital tract. Interventions We took COVID-19 swabs from the peritoneal cavity and from the vagina from all eligible patients. Results were stratified by preoperative COVID-19 status. Measurements and Main Results In patients who were presumed COVID-19 negative at the time of surgery, SARS-CoV-2 virus RNA was detected in 0 of 102 peritoneal samples and 0 of 98 vaginal samples. Both cohorts included 4 patients who were antibody positive but nasopharyngeal swab test negative at the time of surgery. Peritoneal and vaginal swabs were also negative in 1 patient who had a positive nasopharyngeal swab immediately before surgery. Conclusion The presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic surgery at a time when COVID-19 is endemic in the population.

Most of the small bowel obstruction (SBO) are caused by postoperative adhesions and resolved spontaneously. Findings of intra-abdominal fluid on abdominal computerized tomography (CT) may predict failure of non-operative management (NOM). In this study, we aim to evaluate the correlation between the amount of intra-abdominal fluid and NOM failure. Data of all the patients admitted with adhesional SBO between years 2015 and 2019 were retrospectively collected. Only those who underwent CT as part of the management were included in the study. Patients were divided in 2 groups. Group I included patients that failed NOM, and patients with spontaneous resolution of SBO were included in group II. Both groups were compared. Overall, 197 patients met the inclusion criteria. Group I included 78 patients. The rest of the patients were included in group II. No differences were observed in demographics, number of previous abdominal operations, laboratory tests, CT findings of increased bowel diameter, and presence of fecal sign. In multivariate analysis, only a large amount of intra-abdominal fluid remained significant. NOM failure is more prevalent in patients with adhesional SBO with large amounts of intra-abdominal fluid on CT.

Fluid analysis is an important part of the diagnostic work-up of equine patients presenting with disorders of the nervous system, musculoskeletal system, and abdominal cavity. Proper specimen handling and processing are paramount for complete and accurate interpretation of fluid samples. Normal cerebrospinal fluid is a low-cellularity, low-protein fluid requiring specific sample handling to ensure accurate results. Joint and abdominal fluid analyses are completed in practice or submitted for analysis to a reference laboratory. This article discusses fluid sample handling and processing considerations for the equine practitioner and reviews cytologic evaluation of normal and abnormal cerebrospinal, synovial, and peritoneal fluid samples.

Background Ultrasonography (US) is highly dependent on operators’ skills. It is not only a matter of correct scan techniques; there are anatomical structures and variants, as well as artifacts, which can produce images difficult to interpret and which, if not properly understood, can be causes of errors. Objectives This paper will review relatively common US pitfalls and artifacts that can be encountered in trauma patients and will offer tips to recognize and avoid them. Discussion Normal anatomical structures and anatomical variants can mimic fluid collections or perisplenic lesions. Examination along multiple scan planes, real-time observation of movements or repetition of the study after the patient has drunk some fluid or after placing a finger on her/his body wall can help proper identification. The term artifact in US imaging refers to display phenomena not properly representing the imaged structures. This can result in images suggesting fracture lines within organs or at their borders, lung consolidations, or pleural effusions, and abdominal fluid collections. Their knowledge is the first step to recognize them; then, use of multiple scan planes or repetition of the study after voiding or changes of equipment setting can make them disappear or clarify their nature. Conclusion We present possible anatomic pitfalls and artifacts that may affect correct interpretation of US images in patients with abdominal trauma and suggest how to avoid or to clarify them during the examination. Knowing their existence, their appearances, and the reasons why they are produced is important for proper use of this diagnostic technique.

This study aimed to evaluate the hematologic response and the serum and peritoneal fluid (PF) proteinogram of cattle affected by digestive diseases. Twenty-seven animals were distributed in two groups: GI (intestinal diseases) and GII (traumatic reticuloperitonitis, TRP). The animals were previously submitted to a physical exam. Subsequently, blood samples were collected to perform the complete blood count, determine the plasma protein and fibrinogen, and obtain the serum for proteinogram in polyacrylamide gel (SDS-PAGE). Simultaneously, PF was collected to perform physical and chemical evaluation and the electrophoretic profile (SDS-PAGE). ANOVA at the 5% probability level was used to compare the groups. The animals showed signs of apathy, dehydration, and gastrointestinal hypomotility in both groups. However, GI animals showed more significant clinical changes. The blood count of both groups (P > 0.05) showed leukocytosis due to neutrophilia and a regenerative left shift with hyperfibrinogenemia. The proteinogram of both body fluids allowed the identification of proteins albumin (ALB), transferrin (TRF), ceruloplasmin, haptoglobin, ?1-acid glycoprotein (?1-AGP), MW 23000 Da, ?1-antitrypsin, IgA, and IgG. The [PT] PF/[PT] blood serum ratio of each of the identified proteins increased, showing statistical differences between groups (P < 0.05) regarding PT, ALB, TRF, ?1-AGP, and IgG values, with GI animals showing the highest ratio. Intestinal diseases and TRP triggered a systemic and local response characterized by clinical, hematological, and serum and PF proteinogram alterations. The proteins ?1-GPA, haptoglobin, and TRF measured in PF were good inflammation biomarkers and useful as an auxiliary tool for the diagnosis and prognosis of digestive diseases in cattle. O objetivo deste estudo foi avaliar a resposta hematológica e o proteinograma sérico e do líquido peritoneal (LP) de bovinos acometidos com doenças digestivas. Foram avaliados 27 bovinos distribuídos em dois grupos, GI (enfermidades intestinais) e GII (reticuloperitonite traumática-RPT). Os animais foram previamente submetidos ao exame físico. Posteriormente foram colhidas amostras de sangue para realização do hemograma, determinação plasmática da proteína e do fibrinogênio e obtenção do soro para realização do proteinograma em gel de poliacrilamida (SDS-PAGE). Simultaneamente foi colhido o LP para avaliação física e química, assim como a realização do perfil eletroforético (SDS-PAGE). Empregou-se a análise de variância ao nível de 5% de probabilidade visando à comparação entre os grupos. Em ambos os grupos os animais demonstraram sinais de apatia, desidratação e hipomotilidade gastrointestinal, no entanto, os animais do GI apresentaram alterações clínicas mais expressivas. No hemograma observou-se em ambos os grupos (P > 0,05) leucocitose por neutrofilia e desvio à esquerda regenerativo com hiperfibrinogenia. O proteinograma de ambos os fluidos corpóreos permitiu a identificação das proteínas albumina (ALB), transferrina (TRF), ceruloplasmina, haptoglobina, ?-1 glicoproteína ácida (?1-GPA), PM 23.000 Da, ?-1 anti-tripsina, IgA e IgG. Os valores da relação [PT] LP / [PT] soro sanguíneo de cada uma das proteínas identificadas demonstrou elevação dos mesmos, bem como diferença estatística entre grupos (P < 0,05) nos valores da PT, ALB, TRF, ?1-GPA e IgG, nos quais a relação foi mais elevada nos animais do GI. As enfermidades intestinais e a RPT desencadearam resposta sistêmica e local caracterizada pelas alterações clínicas, hematológicas, e do proteinograma sérico e do LP. A ?1-GPA, a haptoglobina e a TRF, mensuradas no LP se mostraram bons biomarcadores de inflamação, sendo úteis como recurso auxiliar de diagnóstico e prognóstico das doenças digestivas dos bovinos.

Background Removal of urinary catheters depends on accurate noninvasive measurements of bladder volume. Patients with acute kidney injury often have low bladder volumes/ascites, possibly causing measurement inaccuracy. Objective To evaluate the accuracy of bladder volumes measured with bladder scanning and 2-dimensional ultrasound (US) compared with urinary catheterization among different types of clinicians. Methods Prospective correlational descriptive study of 73 adult critical care patients with low urine output receiving hemodialysis or unable to void. Bladder volumes were independently measured by (1) a physician and an advanced practice registered nurse using US, (2) an advanced practice registered nurse and a bedside nurse using bladder scanning, and (3) urinary catheterization (cath). Bland-Altman and χ2 analyses were conducted. Results Mean (SD) cath volume was 171.7 (269.7) mL (range, 0-1100 mL). Abdominal fluid was observed in 28% of patients. Bias was −1.3 mL for US vs cath and 3.3 mL for bladder scanning vs cath. For patients with abdominal fluid and cath volume less than 150 mL, decisions to not catheterize patients were accurate more often when based on US measurements (97%-100%) than when based on bladder scanning measurements (86%-89%; P = .02). In patients with cath volume of 300 mL or more, decisions to catheterize patients were accurate more often when based on bladder scanning measurements (94%-100%) than when based on horizontal US measurements (50%-56%; P = .001). Conclusions Bladder volume can be measured accurately with bladder scanning or US, but abdominal fluid remains a confounding factor limiting accuracy of bladder scanning.

Objective To describe the unique complication of hemoperitoneum associated with anaphylaxis. Design Retrospective case series from September 2012 to August 2017. Setting Two private emergency and specialty referral hospitals. Animals Eleven client-owned dogs diagnosed with anaphylaxis and hemoperitoneum upon presentation or referral. Interventions None. Measurements and main results Inclusion criteria included clinical signs consistent with anaphylaxis (hypotension, tachycardia, vomiting, diarrhea, weakness, collapse, with or without the presence of dermal signs) due to witnessed or unwitnessed presumed bee sting, an elevated alanine aminotransferase (ALT), performance of abdominal FAST (AFAST) examination with an abdominal fluid score, the sonographic presence of gallbladder wall edema, and hemoperitoneum. All dogs (n=11) were managed medically without surgical intervention. 91% (n=10) of dogs survived to discharge. Conclusions Hemoperitoneum development can be seen with anaphylactic reactions, though the exact mechanism remains to be fully understood. Medical therapy is warranted and can be successful in these patients; surgery is not indicated to address hemoperitoneum.

A domestic shorthair cat was presented to the Veterinary Teaching Hospital at The University of the West Indies with a history of anorexia, ataxia, and lethargy. On physical examination, moderate abdominal distension and a palpable abdominal fluid wave were noted. Dark yellow, cloudy fluid was collected via abdominocentesis. Fluid analysis indicated that the effusion was a transudate containing low numbers of macrophages and occasional neutrophils. Some of the macrophages contained rod-shaped nonstaining structures of variable length (2-4 um). These structures were also seen extracellularly in low numbers. The morphology of the structures was suggestive of Mycobacterium. The cat's condition continued to deteriorate, and it died within a few hours of being admitted. Further diagnostic tests revealed feline immunodeficiency virus (FIV) infection with concurrent Mycobacterium avium subsp hominissuis infection. To the authors' knowledge, this is the first reported case of nontubercular mycobacterial-related ascites in a cat.

Multiple tissue samples were obtained during emergent abdominal surgery in 4 patients with coronavirus disease 2019 (COVID-19) to examine for tissue involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first patient underwent a laparoscopic cholecystectomy for gallbladder empyema and died from severe respiratory failure. The second patient with Crohn disease underwent emergent laparotomy for a perforation in the terminal ileum and recovered. The third patient underwent an open appendectomy and recovered. The fourth patient underwent emergent laparotomy for a perforated peptic ulcer and died from sepsis. Although the SARS-CoV-2 RNA was found in the feces of 3 patients and in the duodenal wall of the patient with perforated peptic ulcer, real time reverse transcriptase polymerase chain reaction (RT-PCR) examination of abdominal fluid was negative for the virus. The RT-PCR did not detect viral RNA in the wall of small intestine, appendix, gallbladder, bile, liver, and urine. Visceral fat (omentum) and abdominal subcutaneous fat of 4 patients were also not infected with the SARS-CoV-2. Although this limited experience did not show direct involvement of abdominal fluid and omentum, assessment in large series is suggested to provide answers about the safety of abdominal surgery in patients with COVID-19.

Although hydrothorax may accompany abdominal ascites in women with severe ovarian hyperstimulation syndrome (OHSS), there are few cases reported with isolated pleural effusion. Herein, we report two patients with isolated hydrothorax without any significant abdominal fluid following infertility treatment, along with a systematic review of the literature to describe risk factors for this rare entity. Two women with isolated pleural effusion without significant abdominal ascites were reported. The available literature was screened from Ovid-SP and PubMed to review OHSS cases with isolated hydrothorax. Two women aged 28 and 31 years were admitted to hospital with chest pain, tachypnea, and tachycardia after infertility treatment. They had right pleural effusion without abdominal fluid and the symptoms relieved after thoracentesis. Similar to our cases, we identified 24 case reports (n=41 women) in the literature according to eligible criteria. On the day of triggering, estradiol (E2) level was

Background: More than 145,500 abdominal abscesses occur annually in the U.S. Percutaneous catheter drainage (PCD) is the primary treatment for clinically significant intra-abdominal collections (IACs), but only approximately 90% of all IACs are treatable with PCD. This leaves a significant number of patients facing long courses of management, including multiple interventions. Minimally invasive debridement techniques are now employed regularly for the treatment of infected necrosis caused by acute pancreatitis. We describe the use of minimally invasive videoscopic debridement techniques employed as part of a "step-up" approach to resolve IACs of other etiologies that are unresponsive to PCD. Methods: Data of all patients undergoing this procedure at a tertiary referral academic center from 2015 to 2017 after failure of different PCD techniques were analyzed retrospectively. Results: Four men and two women, mean age 54.6 years (range 26-70 years), with refractory IACs (mean drainage time 91.3 days; mean number of drainage procedures 4.6) following a variety of surgical interventions and inflammatory conditions underwent either video-assisted retroperitoneal debridement or sinus tract endoscopic debridement with a rigid or flexible endoscope. Technical success was achieved in all cases, and clinical success was observed in five cases. No immediate procedural complications were detected. The mean hospital stay and post-procedure drainage times were 5.5 and 25.2 days, respectively. There were no recurrent IACs. Conclusion: Minimally invasive debridement techniques can safely resolve IACs refractory to standard PCD techniques. Employment of these techniques as part of a step-up approach may reduce the morbidity and duration of drainage for the thousands of patients treated annually who have refractory IACs, whatever their etiology.

Rationale and Objectives To assess the feasibility of paired catheter drainage for management of complex abdominal abscesses. Materials and Methods This was a single-center retrospective study of 54 patients (35 males; mean age 48.9 years) that underwent paired catheter insertion for complex abdominal fluid collections in an 18-month period. Complex collections were defined as abscesses ≥6 cm in diameter with septations, high viscosity fluid or necrotic debris, or abscesses with an associated fistula. Abscess etiologies included postoperative (n = 28), pancreatitis (n = 12), perforated bowel (n = 7), liver abscess (n = 4), and perihepatic from gallbladder perforation (n = 3). Paired catheter insertion was defined two catheters co-located within one collection through the same skin incision or two closely spaced insertion sites. Paired catheter insertion was used primarily as initial drainage for complex intraabdominal abscesses and for salvage drainage in collections that could not be evacuated by a single catheter. Primary paired catheter insertion was used in 45 patients and as salvage in nine patients. Results Abscess resolution occurred in 51 (94.4%) patients. Patients had a median of three drainage procedures. Median duration of paired catheterization was 22 days. Seven abscesses recurred and all resolved with repeated drainage. Complications included one hemorrhage that was taken for surgical exploration. Overall, 48 patients had good clinical outcome, 3 patients died (multiorgan failure, n = 2; sepsis, n = 1), and 3 patients were lost to follow-up. Conclusion Percutaneous paired catheter drainage is a feasible technique for the treatment of both complex intraabdominal abscesses and abscesses unresponsive to single catheter drainage.

Objective To evaluate the relationship between the intraoperative monitoring factors with intra-abdominal fluid extravasation (IAFE) in patients who underwent hip arthroscopy. The secondary purpose was to describe the main intraoperative variables between cases with and without IAFE. Methods We carried out a prospective observational study of 106 hip arthroscopies between June 2017 and June 2018. Within procedures, 54 cases with deep gluteal syndrome (DGS) were included. Ultrasonography was performed by a trained anesthesiologist before and after the surgery to identify the presence of fluid. The hepatorenal (Morison's pouch), splenorenal, retroaortic, suprapubic (longitudinal and transverse), and pleural spaces were examined. During the surgery, the blood pressure, heart rate, temperature, peak inspiratory pressure (PIP), pulmonary compliance, oxygen saturation, and end-tidal carbon dioxide were registered. Results The incidence of IAFE was 31.1% (33/106; 95% confidence interval 23.0%-40.5%). IAFE in cases with isolated FAI was 15.9% (7/44) in comparison with 52.9% (9/17) of the cases with isolated DGS. Maximum values of PIP greater than 20 mm Hg were associated with fluid extravasation (odds ratio 3.22; 95% confidence interval 1.07-9.68). No statistically significant relationship was found in blood pressure, heart rate, temperature, oxygen saturation, end-tidal carbon dioxide, and pulmonary compliance between cases with and without IAFE. Conclusions Asymptomatic IAFE, as measured by ultrasound, is a frequent event in patients who underwent hip arthroscopy, mainly in cases with DGS. PIP was found to be a useful intraoperative monitoring parameter for the early identification of IAFE in hip arthroscopy. Level of Evidence Level II, observational prospective cohort study.

Abdominal wall reconstruction is indicated when 1 or more of the abdominal wall components (skin, fascia, or muscle) are either injured or absent. When faced with defects requiring flap reconstruction, the decision regarding flap choice should take into consideration the volume of soft tissue required, the extent of the defect, donor site morbidity, and prior surgical scars that affect flap vascularity. We present a case of an abdominal wall defect with limited reconstructive options in which a spare ileal bowel segment was filleted to create a seromuscular flap for improving the abdominal wall blood supply. The postoperative course was complicated by abdominal fluid collection, which resolved following an ultrasound-guided drain. The patient had normal wound healing and recovery without further postoperative complications at the 7-month follow-up. Seromuscular flaps are a practical option in the armamentarium of plastic surgeons performing abdominal wall reconstruction, especially when other alternatives are limited.

Ultrasonography-guided percutaneous drainage is an effective and safe procedure to treat abdominal fluid collections. However, bleeding complications can sometimes occur. Ultrasonography can document the presence of hematomas, but it cannot detect whether the bleeding is still ongoing. Contrast-enhanced ultrasonography has been reported to enable the detection of active extravasation and is increasingly used when active abdominal bleeding is suspected. In this case report, contrast-enhanced ultrasonography played a key role not only in the depiction of active bleeding following the percutaneous drainage of a tubo-ovarian abscess, but also in the real-time demonstration of the spontaneous stop of the bleeding, suggesting that it can play at least an intermediate role between ultrasonography and contrast-enhanced computed tomography.

The vascular endothelial growth factor (VEGF) is a multifunctional cytokine stimulating the growth of vascular endothelial cells, survival and proliferation, inhibiting apoptosis. It is one of the most potent stimulants of vascular permeability. VEGF is found at high levels in inflammatory and tumour-associated pleural and abdominal effusions and is involved in their occurrence. In the present study, the blood plasma and abdominal fluid VEGF levels were assayed in thirty-one client-owned dogs with neoplastic and non-neoplastic diseases by means of enzyme-linked immunosorbent assay (ELISA). The VEGF concentration in abdominal fluid of dogs (n=6) with ascites was 190.70±34.35 pg/ml, in dogs (n=6) with peritonitis: 1449.81±365.42 pg/ml and in dogs (n=9) with tumour-associated effusion: 1993.13±202.56 pg/ml. Blood plasma VEGF of healthy dogs (control group, n=10) was 36.79±5.72 pg/ml, in dogs with ascites: 57.92±2.88 pg/ml, in dogs with peritonitis: 76.98±7.24 pg/ml and in dogs with tumour-associated effusion: 173.50±40.9 pg/ml. There were substantial differences between blood plasma and abdominal fluid VEGF levels.

To compare the utility of abdominopelvic fluid volume measurements with established computed tomography signs for refractory post-traumatic abdominal compartment syndrome. This retrospective observational cohort study included 64 consecutive adult trauma patients with preoperative CT and diagnosis of refractory abdominal compartment syndrome requiring decompressive laparotomy at a level I trauma referral center between 2004 and 2014. We hypothesized that abdominal fluid volume measurements would be more predictive of the need for early laparotomy than previously described conventional CT signs of refractory ACS. Abdominopelvic fluid volumes were determined quantitatively using semi-automated segmentation software. The following conventional imaging parameters were recorded: abdominal anteroposterior:transverse ratio (round belly sign); infrahepatic vena cava diameter; distal abdominal aortic diameter; largest single small bowel wall diameter; hydronephrosis, inguinal herniation; and mesenteric and body wall edema. For outcome analysis, patients were stratified into two groups: those who underwent early (

Multiple-component inflatable penile prostheses (IPPs) consist of paired intracorporal cylinders, a scrotal pump, and an abdominal fluid reservoir. In recent years, ectopic (e.g., non-space of Retzius) reservoir insertion techniques have become more popular among implanting urologists. The aim of this study was to describe our technique of sub-external oblique (SEO) placement of IPP reservoirs, and to review our initial experience with this technique. We carried out a retrospective review of the first 50 patients who underwent insertion of a Coloplast Titan® IPP via a scrotal incision, employing a newly developed SEO reservoir insertion technique. All procedures were carried out by a single high-volume surgeon (BBG), and retrospective chart review was carried out. Patients were seen and evaluated on the first post-operative day, then at 2 weeks, 6 weeks, as needed, and periodically thereafter. All 50 patients were available for short-term post-operative follow-up (average 6.6 months, range 3–12 months). The SEO technique was only used if there was no prior inguinal canal surgery, and no evidence of an inguinal hernia. The SEO technique was easy to carry out, and there were no instances of bowel, bladder, blood vessel, nerve, or spermatic cord injury. There were also no cases of reservoir herniation, intraperitoneal insertion, or reservoir visibility. One patient had prolonged pain (4 weeks) related to the reservoir; however, this completely resolved after treatment with non-steroidal analgesics. In asthenic patients, the reservoir could be detected with deep, careful palpation. However, no patients have required or requested IPP revision or removal to date. With short-term follow-up, we found that SEO reservoir insertion has been an easily-performed and safe option for ectopic reservoir insertion. The SEO method has avoided the infrequent but severe complications seen with previously described reservoir insertion techniques. Longer duration of follow-up, and trials by other implanting urologists, will be required to confirm or refute these initial promising results.

BACKGROUND: The safety of surgery in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients remains unclear. On the basis of data from other viral diseases, it has been assumed that coronavirus disease 2019 (COVID-19) has the potential risk of transmission during surgery. The presence of the virus within the peritoneal fluid and the peritoneal tissues is not known. MATERIALS AND METHODS: This is a prospective cross-sectional study including adult patients with confirmed COVID-19 who underwent surgery at a single institution. Using specific real-time reverse transcriptase-polymerase chain reaction, the presence of SARS-CoV-2 was determined in abdominal fluid samples. RESULTS: Six patients with COVID-19 underwent abdominal surgery. Five patients were asymptomatic, and 1 had severe disease. SARS-CoV-2 was tested in 20 different samples, all of which resulted negative. CONCLUSIONS: SARS-CoV-2 was not found in the peritoneal cavity of 6 patients undergoing abdominal surgery. The risk of transmissibility of COVID-19 during surgery is still unclear.

65-year-old patient with a history of ischemic stroke with residual ophthalmoparesis, positive in fecal occult blood screening, pending colonoscopy, who attended the emergency room due to 3 days with pain, abdominal distension and diarrhea. In the emergency room, he presented with diffuse abdominal pain, hemodynamic instability with acute renal failure and metabolic acidosis, with severe elevation of acute phase reactants. Abdominal fluid resuscitation and CT (computed tomography) were performed, which reported dilatation of the loops of the small intestine to the distal ileum with thickening of the wall of the right colon and gas, dissecting intrahepatic portal branches and splanchnic veins. An exploratory laparotomy was indicated, showing findings of non-transmural right colitis without ischemia or perforation, significant dilation of the small intestine and intra-abdominal serous fluid, without the need for intestinal resection. Salmonella enterica, sensitive to Ciprofloxacin, was isolated in stool culture. He remained in the ICU for 23 days with a slow but favorable evolution with targeted antibiotic therapy. Acute renal failure was corrected, vasoactive drugs were suspended and non-invasive mechanical ventilation and oxygen therapy were needed He presented postoperative ileus and periumbilical laparotomy skin dehiscence with good evolution after initiating negative pressure therapy. On postoperative day 32, she was transferred to the convalescent center for rehabilitation due to myopathy of the critical patient, being discharged after 22 days of stay.

Spontaneous emphysematous splenitis is a life-threatening condition reported rarely in humans; however, published reports in dogs are currently lacking. The aim of this multicentric, retrospective, case series design study was to describe radiographic and ultrasonographic imaging findings in Golden Retriever dogs diagnosed with spontaneous emphysematous splenitis. A total of three dogs were sampled. All dogs had a history of lethargy, diarrhea, and weight loss. Radiographic findings in all dogs included a mass effect with focal or multifocal coalescing "vesicular-like" gas pattern in the splenic region and focal loss of serosal detail. Ultrasonographic findings in all dogs included focal or multifocal irregularly shaped, hypoechoic areas containing a mixture of hyperechoic fluid and gas within the splenic parenchyma, hyperechoic abdominal free fluid, and generalized hyperechoic mesenteric fat without evidence of splenic torsion. Pneumoperitoneum was detected ultrasonographically and radiographically in two dogs. All three dogs underwent splenectomy and splenic torsion was definitively ruled out at surgery. One dog died three days after surgery, whereas the other two dogs recovered uneventfully. Culture of the splenic tissue and free abdominal fluid was positive for Clostridium spp. in all three cases. Findings supported inclusion of spontaneous emphysematous splenitis and septic peritonitis as differential diagnoses for dogs with this combination of clinical and imaging characteristics.

The term Interventional Radiology was coined by Margulis, describing the percutaneous removal of residual gall stones [1, 2]. Hacncke first describes tissue sampling under A-mode ultrasound guidance for pancreatic lesion biopsy [3]. Haaga and Alfridi first used CT scan guidance for pancreatic biopsy and liver abscess drainage [4]. Ultrasound guided interventional procedures began in the early 1970s with Holm et al. and Goldberg et al. who developed special transducers (“bioptic probes”) with central holes in it for needle insertion [5, 6]. Real-time guidance by ultrasound began in the late 1970s and early 1980s, with several publications from Japanese investigators using real-time sonographic guidance for needle puncture [7]. Soon ultrasound guidance for abdominal fluid collections became increasingly popular and thereafter became part of routine management strategy [8].

An adult Highland cow weighing 380 kg presented following a five-day history of inappetence, recumbency and trauma inflicted by herd-mates. Physical exam demonstrated significant swelling of the right ventral abdomen with skin excoriations. Abdominal ultrasound of the bulging area indicated significant oedema within pockets, thinning of the right body wall compared with the left side, as well as accumulation of free abdominal fluid. Severe mastitis was noted in three quarters of its udder. The patient was stabilised with intravenous fluids, electrolytes and a belly band. It developed severe, haemorrhagic diarrhoea over the following days, and an exploratory laparotomy was performed. A complete 50 cm-long abdominal wall laceration in the caudoventral right paralumbar fossa was repaired, and jejunal resection and anastomosis performed. The patient recovered with supportive care. Surgical complications included postoperative pneumonia and development of a surgical site infection. The patient maintains good quality of life.

IntroductionThe risks to surgeons of carrying out aerosol generating procedures during the COVID pandemic are unknown. To start to define these risks, in a systematic manner, we investigated the presence of SARS-CoV-2 virus in the abdominal fluid and lower genital tract of patients undergoing surgery.MethodsWe carried out a prospective cross sectional observational study of 113 patients undergoing abdominal surgery or instrumentation of the lower genital tract. We took COVID swabs from the peritoneal cavity and from the vagina from all eligible patients. Results were stratified by pre operative COVID status.ResultsIn patients who were presumed COVID negative at the time of surgery SARS-CoV-2 virus RNA was detected in 0/102 peritoneal samples and 0/98 vaginal samples. Peritoneal and vaginal swabs were also negative in one patient who had a positive nasopharyngeal swab immediately prior to surgery.ConclusionsThe presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic surgery at a time when COVID19 is endemic in the population.

Characterization of intraabdominal fluid collections as postoperative complication is a challenging task. The aim was to develop and validate a new score to differentiate infected from sterile postoperative abdominal fluid collections and to compare it with a published score. From May to November 2015, all patients with postoperative CT and C-reactive protein (CRP) 24 hours before CT-guided drainage were retrospectively included (Group A). HU, gas entrapment and wall enhancement of fluid collections were evaluated in the CT. All parameters were correlated with microbiology. To validate the score and to compare it with a published score, a second patient cohort was retrospectively recruited (Group B; January 2013–April 2015; December 2015–September 2016). In Group A (50 patients), univariate analysis confirmed that the four parameters were significantly associated with infected fluid collections. Based on binary logistic regression analysis, a score from 0 to 11 was developed (CRP

The differential diagnosis for black ascites include pancreatic ascites (PA). In majority of cases described the ascitic fluid as amber or black-colored. We report the case of a 33-year-old man with a history of alcohol abuse who presented with 24 h of epigastric pain and abdominal distension. Laboratory results showed lipase of 1270 U/l, amylase of 442 U/l and albumin of 2 g/dl. A contrast computed tomography scan of the abdomen showed pancreatic necrosis with atrophy and free abdominal fluid. Paracentesis was performed, yielding opaque black ascitic fluid. An ascitic fluid analysis demonstrated amylase of 2769 U/l, albumin of 1.6 g/dl, was negative for malignant cells and tuberculosis. Serum-Ascites Albumin Gradient was resulted in 0.4. The diagnosis of chronic pancreatitis was suspected, and he received supportive care with pain medication and bowel rest. He was discharged with symptom free on Day 14 after admission.

PURPOSE: To assess the role of intracavitary contrast-enhanced ultrasound (IC-CEUS) as a focused ultrasound (US) examination aimed at supporting a single physician in the management of interventional procedures for abdominal fluid collections/abscesses. METHODS: In 43 patients (27 M/16 F, median age 68 years, range 35–91), a single physician performed catheter drainage (42) or needle aspiration (3) for the following: 14 infected abdominal fluid collections, 11 non-infected abdominal fluid collections, 9 pyogenic liver abscesses, 8 gallbladder empyema, and 3 infected pancreatic fluid collections. IC-CEUS (0.1–0.2 mL of SonoVue in 20 mL of saline) was carried out during catheter/needle placement and during the follow-up for catheters left in place. RESULTS: Immediate IC-CEUS allowed to verify the (1) correct positioning of the needle/catheter inside the target in all cases and (2) communication with adjacent structures so as to choose a proper treatment in 21% of the cases. Follow-up IC-CEUS aided in the management of 40 catheters left in place. Appropriate treatment was implemented in 19.3% of the cases because of the presence of biliary fistulas and gallbladder perforation. IC-CEUS helped the physician with the appropriate timing of catheter removal by providing information on catheter malfunction (due to obstruction/dislodgement) and the size of residual undrained cavities. No side effects were registered following IC-CEUS. CONCLUSION: Even if not strictly performed at bedside, IC-CEUS may represent an example of point-of-care ultrasound since it allows an interventional clinician to assess needle/catheter placement success, make treatment decisions, and choose the optimal timing for catheter removal with low costs and without side effects.

BACKGROUND The association between bacterial infection and clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) has not been fully elucidated. METHODS Microbiological data for intraoperative bile culture (BC) and drain culture on postoperative day 4 (DC) were collected. The study population was classified into the following three groups: P1 (positive BC and DC), P2 (positive BC and negative DC), and N (negative BC). A total of 209 patients (P1: 38, P2: 72, and N: 99) who underwent PD between May 2013 and May 2018 met the inclusion criteria of the study. RESULTS The rate of CR-POPF was significantly higher in the P1 group (34.2%) than in the P2 (12.5%; P = .007) and N groups (14.1%; P = .008). Between P1 and P2 groups, a significant difference was observed in the proportion of Enterococcus faecalis grown in BC (42.1% vs 4.2%; P

Introduction Intraabdominal fluid collections that previously required surgical intervention can now be drained with less invasive techniques. The use of lumen-apposing metal stents (LAMS) to treat pancreatic pseudocysts and perirectal abscesses has been shown to be a safe and effective technique in adults. We aim to evaluate the indications, outcomes, and complications of the use of LAMS in pediatric patients at our institution. Methods A retrospective chart review was performed to study patients up to 18 years of age at the Children's Hospital at Montefiore who underwent drainage of intraabdominal fluid collections with the use of LAMS. The main outcome measures were technical and clinical success and associated adverse events with LAMS placement. Results Seven patients (2 girls) ranging from 9 to 18 years were identified. Four patients had perirectal abscess postperforated appendicitis and 3 patients had pancreatic pseudocysts. All of the patients had complete resolution of the collections, with no recurrence, and our technical and clinical success rate was 100%. Only 1 patient had mild bleeding after placement that spontaneously resolved. Discussion Our study demonstrates the efficacy and safety of the use of LAMS for the drainage of intraabdominal fluid collections in pediatric patients, although the number of patients included is limited.

Endoscopic ultrasonography (EUS) is an established technique for the diagnosis and staging of gastrointestinal (GI) tumors. In the last years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration (EUS-FNA). The development of EUS-guided drainage of the biliopancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. For instance, techniques using EUS for pancreatic cancer treatment and celiac neurolysis have been described. Moreover, confocal laser endomicroscopy was coupled to EUS for the in vivo histological diagnosis of gastrointestinal, biliopancreatic, and lymph node lesions.

Objective To describe the nonsurgical management of a cat with traumatic pneumoperitoneum. Case series summary A 4-year-old cat was presented following vehicular polytrauma. Thoracic radiographs revealed 4 rib fractures, a scapular fracture, and pneumothorax. Abdominal ultrasound revealed a small volume of free abdominal fluid. Computed tomography showed a mild pneumoretroperitoneum and a pneumoperitoneum in the region of the porta hepatis. The cat was managed conservatively with close monitoring. Exploratory laparotomy was not pursued given patient stability and static serial imaging studies revealing no indications for surgical intervention. After 6 days, the pneumoperitoneum was no longer detectable. New or unique information provided To the authors' knowledge, this is the first report of successful nonsurgical management of traumatic pneumoperitoneum in a cat.

Eosinophilic gastroenteritis (EGE) is a rare disorder and eosinophilic infiltration of the gastrointestinal tract is characteristic for it. Eosinophilic ascites may seen in lymphoma, eosinophilic gastroenteritis, peritoneal dialysis, and parasitic infections too. Depending on the dominant layer of infiltration EGE is classified into three types namely, mucosal, muscularis and serosal. Rarest type is the serosal type characterized by primary serosal disease, peripheral eosinophilia and eosinophilic ascites. Here we report a case of serosal EGE. We have discussed clinical cornerstones for diagnosis and response to treatment.A male patient age of 16 presented to the clinic with complaints of self-limiting diarrhea which stop within three weeks and abdominal distension. In physical examination tachypnea, orthopnea and marked abdominal distension were seen. Contrast-enhanced abdominal computed tomography showed the presence of ascites and diffuse thickening of small bowel wall, but did not detect a primary malignancy in the abdominal cavity; and no signs of portal hypertension or liver disease. In laboratory tests significant eosinophilia in blood and abdominal fluid were seen. Leukocyte count was 16680 /mm3 in the hemogram and 60% eosinophil was detected in the peripheral smear. In paracentesis fluid analysis; eosinophilia (70% eosinophil) were detected. Steroid treatment to be completed in six weeks in total was applied to the patient who was diagnosed with eosinophilic ascites. Therapy with corticosteroids resulted in resolution of both the gastrointestinal symptoms and the ascites without hesitation. He had not any complaint during four months follow-up; ascites regressed and examination was normal. EGE is a rare disorder and it should be flashed in patients who presented with unexplained ascites. Since diagnosis of EGE is a diagnosis of exclusion and, apart from malignancies, there are many other secondary causes of eosinophilic intestinal infiltration that must be excluded.

Canine lymphoma is a commonly reported neoplasia and, in most dogs, arises from lymph nodes before spreading to other organs. Renal lymphoma rarely occurs, and kidneys usually are a secondary site of origin. Primary renal lymphoma is infrequently described in the veterinary literature. In this study, we present a rare case of primary renal lymphoma in a dog and a review of similar cases. A 3-year-old male dog was admitted due to anorexia, weakness and vomiting. Clinical examination revealed bilaterally enlarged kidneys. Imaging demonstrated the presence of multiple renal masses. Cytology of abdominal fluid and kidneys led to the diagnosis of large cell lymphoma. Histopathology and immunohistochemistry on tissue samples taken from the kidneys confirmed the cytological diagnosis of lymphoma and categorized it as primary bilateral renal large B-cell lymphoma (LBCL).

Background: Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections. Methods: Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed. Results: Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31-74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n = 5), and other type of surgery (n = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6-360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2-24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy. Conclusions: The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.

Our study aims to investigate the frequency and patterns of delayed manifestations of abdominal and pelvic injuries which may not be identified or which fail to manifest on the initial abdominopelvic CT in posttraumatic patients. For our institutional review board (IRB)-approved retrospective study, our hospital trauma registry was queried for patients with blunt multitrauma and Injury Severity Score (ISS) ≥ 16 between January 2010 and August 2016, yielding 3735 patients. A total of 203 patients received a follow-up abdominopelvic CT within six months from the initial scan and those with new findings on follow-up CT were identified. A retrospective blinded review of the initial CT examinations was performed by two experienced radiologists. The retrospective readings and original reports were compared to categorize the new abnormalities detected on follow-up CT scans. The categories included missed injuries, late presentations and sequelae of trauma, and complications of surgery, hospital admission, and invasive procedures. The patients’ notes were reviewed for the clinical indications, time interval for repeat CT examination, and subsequent clinical management. The software used for statistical analysis of the extracted data was Microsoft Excel for Mac (version 15.33). Out of 3735 patients, 203 patients received 232 follow-up abdominopelvic CTs. The average elapsed time between the initial CT and the follow-up CT was 15 ± 27 days. Evaluation for an abdominal fluid collection was the most common clinical indication, accounting for 40% of the total number (n = 243) of indications. Delayed manifestations and complications of trauma were present in 41 patients due to 47 abnormalities, most commonly related to solid organ injury, followed by abdominal collections and hematoma. Twenty-nine CT findings (62%) were only detectable on follow-up CT, while nine injuries (19%) were missed on initial CT. The findings on repeated CT warranted eight surgical and 15 interventional procedures. A small percentage of traumatic injuries may be unidentified or fail to manifest on the initial CT, resulting in delayed manifestations of abdominopelvic trauma, which may lead to subsequent readmission, delayed management, and more severe medical complications.

The purpose of this report is to describe 2 cases of chylous ascites (CA) in ferrets. In the first patient, CA was likely secondary to an obstruction of lymphatic drainage due to lymphoma; and in the second patient, CA developed as a postoperative complication of adrenal carcinoma with multiple metastases. In both cases, CA was diagnosed based on the concentration of triglycerides and cholesterol in the abdominal fluid. Medical treatment resulted in partial remission of the CA in the first case; however, the patient suffered an acute death approximately 3 weeks following its initial presenation. In the second patient, multiple abdominocenteses were required to relieve abdominal discomfort and dyspnea. Five days after the adrenal surgery the ferret developed chylothorax and septic peritonitis, and due to its deteriorating condition was humanely euthanatized. Although the final outcomes in the 2 ferret cases were disappointing, advanced neoplastic disease, usually associated with a poor prognosis, was considered the underlying cause of CA in both patients. More studies are required in ferrets diagnosed with CA to determine proper nutritional and medical management, diagnostic tests, and surgical options. Unfortunately, there is little information describing CA in ferrets and the veterinary medical literature as a whole.

Made available in DSpace on 2018-12-11T17:09:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-09-01 A 6-year-old Labrador with history of hyperpnea, respiratory distress, ascites and paraparesis, presented Dirofilaria immitis microfilariae in the blood smear, cytology of the abdominal fluid and urine. The positive samples were confirmed by multiplex-PCR (COI gene) and sequencing, and presented 98% homology to D. immitis (GenBank accession nos. KC107805.1, EU159111.1, EU163945.1, DQ358815.1, and AJ537512-1). Based on the presented results and the physiopathology of the heartworm disease, molecular techniques may be helpful and accurate in the diagnosis of the disease in vertebrates, and microfilaruria, even uncommon, should be considered on a renal failure evaluation. Department of Pathobiology and Population Medicine College of Veterinary Medicine Mississippi State University, 240 Wise Center Drive Department of Microbiology and Immunology Biosciences Institute Sao Paulo State University Department of Veterinary Clinics School of Veterinary Medicine and Animal Science Sao Paulo State University (UNESP) Department of Microbiology and Immunology Biosciences Institute Sao Paulo State University Department of Veterinary Clinics School of Veterinary Medicine and Animal Science Sao Paulo State University (UNESP)

Highlights • There is anomaly that bile ducts and portal veins of the Spiegel lobe do not run together. • Incidence of bile leakage after hepatic surgery was reported to be 2.6–15.6%. • A number of treatment strategies for excluded bile leakage have been reported. • Surgical treatment for excluded bile leakage is a quick and reliable procedure., Inroduction The treatments of excluded bile duct leakage after hepatectomy are not easy and various strategies have been reported, such as surgery, ethanol or fibrin glue injection, and portal vein embolization. Presentation of case A 72-year-old man with a surgical history of laparoscopic ileocecal resection for diverticular bleeding was diagnosed as having hepatocellular carcinoma. Right hemihepatectomy was performed, and computed tomography examination on postoperative day 9 showed abdominal fluid collection in the right subphrenic space. Percutaneous intra-abdominal fluid drainage was performed and it was diagnosed as bile leakage. After that it was diagnosed as excluded bile leakage from the Spiegel lobe by drip infusion cholangiographic-computed tomography and endoscopic retrograde cholangiography. To improve this clinical condition, we performed the Spiegel lobe excision on postoperative day 48. The postoperative course was uneventful and the patient was discharged. Discussion According to the postoperative examination, it appeared that the bile duct from the Spiegel lobe joined to the right main bile duct or the bile duct of the right posterior section. This bile duct anomaly was not detected preoperatively on imaging examination. It is most likely that the bile duct from the Spiegel lobe was cut when the hepatoduodenal ligament in the hepatic hilum was peeled. To prevent excluded bile leakage, the hepatoduodenal ligament should be carefully peeled and ligated instead of using energy devices. Conclusion We consider that surgical treatment for postoperative excluded bile leakage is both a quick and reliable procedure in patients with acceptable liver function and anatomical subject.

Hip arthroscopy has become the gold standard for the treatment of femoroacetabular impingement syndrome. Intra-abdominal fluid extravasation is the most commonly reported major complication, with variable rates depending on the measurement method. Little is known about the evolution of the fluid extravasation throughout the surgical procedure, and the risk factors for this complication are in need of validation. We recommend performing mitigating actions including keeping the surgical time to a minimum, monitoring core body temperature, performing psoas release (if planned) last, and keeping inflow fluid pressure as low as possible.

Objectives The aims of this study were to compare the core temperature changes between pediatric patients lying on regular operating room linen drapes and a water-repellent sheepskin rug during living donor liver transplantation (LDLT) and to evaluate the effectiveness of using a water-repellent sheepskin rug in preventing profound hypothermia due to fluid overflow from the abdominal cavity during LDLT. Patients and Methods The operative records of pediatric patients who underwent LDLT from June 1994-September 2003 were reviewed retrospectively. The nasopharyngeal temperature (NT) changes during the LDLT procedure between patients lying on regular operating room drapes (GI) and water-repellent sheepskin rug (GII) were compared and analyzed using the Mann-Whitney U test. A P value Results Thirty-two patients were included in GI and 56 in GII. Profound hypothermia was not observed in any recipients lying on a water-repellent sheepskin rug (GII). The NT after induction and the following 4 hours into the LT procedure were significantly higher in GII than GI. Conclusion Pediatric patients lying on water-repellent sheepskin preserved their core temperature better in comparison to patients lying on linen drapes. The use of a water-repellent sheepskin rug seems to be effective in preventing profound hypothermia related to physical contact with abdominal fluid overflow during the LDLT.

A 12-week-old, crossbreed, male entire dog was evaluated for a three-week history of lethargy, nausea, anorexia, haemorrhagic diarrhoea and free abdominal fluid. Abdominal ultrasound revealed multiple cavitated hepatic masses, abdominal lymphadenopathy and marked abdominal effusion. Fine needle aspiration and culture of the hepatic lesions and lymph nodes identified hepatic abscessation and pyogranulomatous lymphadenitis, with a heavy growth of Escherichia coli. Intravenous fluid therapy and antimicrobial therapy were initiated. Persistent hypotension and hypoglycaemia during hospitalisation, despite intensive treatment, were suggestive of systemic inflammatory response syndrome, septic shock and multiple organ dysfunction syndrome. Due to patient morbidity and poor response to treatment, euthanasia was performed.

Trial Design: The aim of this study was to identify independent risk factors for post-pancreatoduodenectomy (post-PD) abdominal fluid collections (AFCs) and evaluate our management protocol on it. Methods: A retrospective analysis of consecutive 2064 cases who underwent PD over the past decade in 1 single center was conducted. The patients were divided into AFCs and non-AFCs group. Univariable and multivariate logistic regression analysis was performed to identify independent risk factors of AFCs. The AFCs group was compared with the non-AFCs group with respect to the incidence of postoperative outcomes. The characteristics of AFCs were further analyzed in terms of clinical manifestations. Results: Two thousand sixty-four cases with pancreaticoduodenectomy were recruited and 15% of them were found AFCs. Diameter of main pancreatic duct ≤3 mm was found to be an independent predictor of AFCs (P 800 mL (P

Background Acute appendicitis in children is the most common condition requiring urgent evaluation and surgery in the emergency department. At times, despite the appendix being seen on ultrasound (US), there can be discrepancy as to whether a patient has clinical appendicitis. Secondary findings suggestive of appendicitis can be helpful in identifying and evaluating these children. Objective The aim of this study was to determine if specific US findings and/or laboratory results are predictive of appendicitis in children with a visualized appendix on US. Methods A prospective study was conducted on children (birth to 18 years) presenting to the pediatric emergency department with suspected appendicitis who underwent right-lower-quadrant US. Ultrasound findings analyzed appendix diameter, compressibility, increased vascularity, presence of appendicolith, inflammatory changes, right-lower-quadrant fluid near the appendix, lower abdominal fluid, tenderness during US, and lymph nodes. Diagnosis was confirmed via surgical pathology. Results There were 1252 patients who enrolled, 60.8 (762) had their appendix visualized, and 39.1 (490) did not. In children where the appendix was seen, 35.2% (268) were diagnosed with appendicitis. Among patients with a visualized appendix, the likelihood of appendicitis was significantly greater if the appendix diameter was 7 mm or greater (odds ratio [OR], 12.4; 95% confidence interval [CI], 4.7-32.7), an appendicolith was present (OR, 3.9; 95% CI, 1.5-10.3), inflammatory changes were seen (OR, 10.2; 95% CI, 3.9-26.1), or the white blood cell (WBC) count was 10,000/μL (OR, 4.8; 95% CI, 2.4-9.7). A duration of abdominal pain of 3 days or more was significantly less likely to be associated with appendicitis (OR, 0.3; 95% CI, 0.08-0.99). The absence of inflammatory changes, WBC count of less than 10,000/μL, and appendix diameter of 7 mm or less had a negative predictive value of 100%. Conclusions When the appendix is seen on US but diagnosis of appendicitis is questioned, the absence of inflammatory changes, WBC count of less than 10,000/μL, and appendix diameter of 7 mm or less should decrease suspicion for appendicitis.

Background : Cholangiocellular carcinoma is a malignant tumor that occurs mainly in elderly dogs and cats. Primary hepatobiliary neoplasms are considered rare in felines, although cholangiocarcinoma is the most common tumor type among malignant liver tumors in the species. The objective of this work is to report two cases of cholangiocarcinoma in young domestic cats, with three years old, and to approach clinical and pathological aspects to promote awareness of this type of injury in young animals, with a focus on prevention of predisposing factors. Cases : A 3-year-old male domestic cat (cat 1) had a history of progressive weight loss, persistent vomiting, diarrhea, and episodes of seizure. At the clinical examination was noted moderate degree of jaundice. In the biochemical exams it was verified as alteration hypoproteinemia, increase of urea and hyponatremia. Abdominal ultrasonography revealed a formation in the left epigastric region measuring 8.0 x 5.0 cm, with a diffusely heterogeneous parenchyma, suggestive of hepatic neoplasia, in addition to the presence of free abdominal fluid. Cavity fluid analysis was suggestive of carcinoma. A 3-year-old male domestic cat (cat 2), with history of hyporexia, emaciation and vomiting was taken to care. Physical examination showed moderate dehydration, hypocorous mucosa and presence of abdominal mass on palpation. The animal's serum biochemical assessment were verified as changes, increasing AST. Ultrasonographic examination showed an abdominal mass, located caudally to the spleen, with irregular shape, measuring approximately 4.7 cm suggestive of hepatic neoplasia, in addition to the presence of abdominal fluid. The hepatic cytology performed by fine needle aspiration was suggestive of carcinoma. After the clinical worsening of two cats and due unfavorable prognosis, euthanasia and necropsy were performed. In the macroscopic analysis of cat 1, numerous nodules of whitish and sometimes "umbilicate" coloration were observed in the liver, measuring up to three cm in diameter, distributed randomly by the hepatic parenchyma and with a soft consistency at cut. An ovoid-wicking mass, measuring 6.0 x 7.0 x 5.0 cm in diameter and coloring ranging from white to light brown was checked together. In the macroscopic evaluation of cat 2, numerous coalescing masses of whitish coloring measuring up to 6.0 cm in diameter were observed covering almost every hepatic parenchyma and also affecting the pancreas, with a soft consistency at cut. The microscopic findings of both cats were compatible with the diagnosis of cholangiocarcinoma. Considering the immunohistochemical profile, in both cases there was positivity for the CK Pan antibody and CEA and negativity for the CK20, TTF-1, Hepatocyte specific antigen, CD10 and CD56 antibodies. Discussion : Cholangiocarcinomas usually occur in elderly animals, with a mean age of 9 years, so it may be suggested that the cause of the disease in cat 1 and 2 was possibly related to the early and continuous presence of carcinogens. The biliary duct trematod Platynosomum fastosum , the chemical agents plutonium and americium, intestinal parasites such as Ancylostoma spp. and Trichuris vulpis , as well as the occurrence of chronic inflammations independent of etiology are commonly involved in the occurrence of cholangiocarcinoma. Clinical and anatomopathological observations made evident that these two young cats, with three years old, had metastatic cholangiocarcinoma. Thus, veterinary providers should be aware that this tumor type can occur in young animals and is mindful of means of prevention and / or recommended treatment of predisposing factors.

A five-month-old Belgian Blue female calf presented with a 72-hour history of depression, anorexia, muscle weakness and severe abdominal distension. Abdominal ultrasonography and abdominocentesis revealed the presence of uroperitoneum due to bladder rupture. Venous blood gas analysis showed haemoconcentration, hyperkalaemia and metabolic acidosis. Electrolytes and fluid balance were corrected with aggressive fluid therapy and peritoneal drainage overnight, and surgery was scheduled for the following day. Intraoperatively, gradual drainage of abdominal fluid was performed to avoid sudden haemodynamic changes, and despite successful bladder reconstruction, near the end of surgery, the patient developed severe bradycardia, atrial standstill, sine waves and pulseless electrical activity, unresponsive to cardiopulmonary resuscitation. Cardiac arrest in this calf was likely caused by a combination of washout of toxic product from previous ischaemic tissues, severe acidosis, severe hypoxaemia and electrolyte disturbances. Clinicians should be prepared to handle possible complications of uroperitoneum.