89 results on '"Abdomen, Acute surgery"'
Search Results
2. Die extrauterine Gravidität – ein ungewöhnlicher Fall in der Notfallradiologie.
- Author
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Nadem Boueini N, Kamper L, and Haage P
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute etiology, Abdomen, Acute surgery, Adolescent, Diagnosis, Differential, Female, Hemoperitoneum diagnostic imaging, Hemoperitoneum surgery, Humans, Laparoscopy, Pregnancy, Pregnancy, Tubal surgery, Rupture, Spontaneous, Tomography, X-Ray Computed, Ultrasonography, Prenatal, Emergency Service, Hospital, Pregnancy, Tubal diagnostic imaging, Radiology Department, Hospital
- Abstract
Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.
- Published
- 2019
- Full Text
- View/download PDF
3. Eine seltene Differenzialdiagnose zystischer Mesenterial-Tumoren.
- Author
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Röhnert A, Kuithan F, Riediger C, and Schaab F
- Subjects
- Abdomen, Acute pathology, Abdomen, Acute surgery, Adult, Colon, Ascending pathology, Colon, Ascending surgery, Diagnosis, Differential, Female, Humans, Jejunum diagnostic imaging, Jejunum pathology, Jejunum surgery, Laparoscopy, Mesenteric Cyst pathology, Mesenteric Cyst surgery, Peritonitis diagnostic imaging, Peritonitis pathology, Peritonitis surgery, Rupture, Spontaneous, Abdomen, Acute diagnostic imaging, Colon, Ascending diagnostic imaging, Image Interpretation, Computer-Assisted, Mesenteric Cyst diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
- Published
- 2019
- Full Text
- View/download PDF
4. Innere Hernierung des Zökums durch das Foramen epiploicum (Winslowi) in die Bursa omentalis.
- Author
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Makra GM, Dechantsreiter G, and Holzapfel K
- Subjects
- Abdomen, Acute surgery, Adult, Cecal Diseases surgery, Diagnosis, Differential, Female, Hernia, Ventral surgery, Humans, Image Interpretation, Computer-Assisted, Peritoneal Cavity surgery, Abdomen, Acute diagnostic imaging, Cecal Diseases diagnostic imaging, Hernia, Ventral diagnostic imaging, Peritoneal Cavity diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
- Published
- 2019
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- View/download PDF
5. [What does the visceral surgeon need to know about computed tomography in the diagnostic work-up of the acute abdomen?].
- Author
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Wybranski C, Pech M, and Fischbach K
- Subjects
- Abdomen, Acute etiology, Contrast Media adverse effects, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Radiation Dosage, Sensitivity and Specificity, Ultrasonography, Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Specialties, Surgical education, Tomography, X-Ray Computed, Viscera diagnostic imaging, Viscera surgery
- Abstract
The acute abdomen is a very serious yet common condition of patients presenting in the emergency department. The clinical symptoms of patients with acute abdomen are often unspecific. The responsibility of the surgeon in charge is to differentiate acute life-threatening from less serious conditions with a high level of diagnostic accuracy in a minimal period of time. Imaging represents a cornerstone in the diagnostic work-up of patients with acute abdomen. Computed tomography (CT) is increasingly utilised to detect emergency conditions in patients with acute abdomen. In this review article we aim to elaborate the role of CT in the imaging strategy for acute abdomen in comparison to conventional radiography, ultrasonography and magnetic resonance imaging. In addition, relevant factors pertaining for the indication of CT such as exposure to ionising radiation and safety of iodinated contrast media are discussed., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2015
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6. [Complications after secondary large intestine perforation: expert testimony and court decision].
- Author
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Thiede A and Zimmermann HJ
- Subjects
- Abdomen, Acute diagnosis, Abdomen, Acute surgery, Colectomy legislation & jurisprudence, Delayed Diagnosis legislation & jurisprudence, Diagnostic Errors legislation & jurisprudence, Germany, Humans, Intestinal Perforation diagnosis, Intestinal Perforation surgery, Male, Middle Aged, Peritonitis diagnosis, Peritonitis etiology, Peritonitis surgery, Postoperative Complications diagnosis, Postoperative Complications surgery, Reoperation legislation & jurisprudence, Sepsis diagnosis, Sepsis etiology, Sepsis surgery, Abdomen, Acute etiology, Colon injuries, Colonic Polyps surgery, Colonoscopy adverse effects, Colonoscopy legislation & jurisprudence, Expert Testimony legislation & jurisprudence, Intestinal Perforation etiology, Malpractice legislation & jurisprudence, Medical Errors legislation & jurisprudence, Postoperative Complications etiology
- Published
- 2014
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7. [Increased requirements for the challenging abdominosurgical management of morbid obesity - what does the abdominal surgeon need to know?].
- Author
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Stroh C, Meyer F, and Manger T
- Subjects
- Abdomen, Acute surgery, Bariatric Surgery, Cross-Cultural Comparison, Emergencies, Female, Germany, Hernia, Abdominal etiology, Hernia, Abdominal surgery, Humans, Male, Minimally Invasive Surgical Procedures, Obesity, Morbid epidemiology, Patient Positioning methods, Postoperative Care methods, Postoperative Complications etiology, Postoperative Complications prevention & control, Preoperative Care methods, Reoperation, Surgical Equipment, Surgical Instruments, Surgical Wound Dehiscence etiology, Surgical Wound Dehiscence surgery, Treatment Outcome, Abdomen surgery, Obesity, Morbid complications, Obesity, Morbid surgery
- Abstract
In the international comparison and in Europe, the Federal Republic of Germany belongs to the countries with a very high prevalence of obesity (men, 67.1 %; women, 53 %). Among the European countries, the incidence of diabetes mellitus type 2 is also high ("Study of the health of adults in Germany" [DEGS]) - Robert Koch Institute). Not only for surgeons, this can be considered as a great challenge even in usual abdominosurgical interventions. 1. Surgical equipment needs to be adapted to the requirements for obese patients. 2. Minimally invasive surgery reduces not only complication rates with regard to postsurgical wound infection and hernia in such patients, it allows a competent assessment of the peritoneal cavity. 3. A great number of surgical tools and instruments can be used in normal weight as well as morbidly obese patients with no limitations - for conventional (open) surgical interventions, retractor systems should be available. 4. With regard to emergency surgery in patients who had formerly undergone bariatric surgery, a competent basic knowledge on the usual bariatric surgical interventions and the subsequent anatomic consequences as well as the more frequent mid- and long-term complications is necessary, which need to be partially approached with the surgical intervention. 5. For numerous oncosurgical interventions, no differences in postoperative outcome were found between normal weight and morbidly obese patients., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2013
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8. [Volvulus of the small intestine - diagnostic and therapeutic management of a rare surgical finding in adults demonstrated with an entity-specific modern imaging using impressive CT scan-based video sequence].
- Author
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Balgon S, Wex C, Rapp L, Lippert H, and Meyer F
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- Aged, Gastrointestinal Motility, Humans, Male, Mesentery diagnostic imaging, Mesentery surgery, Peritoneal Diseases diagnostic imaging, Peritoneal Diseases surgery, Postoperative Complications therapy, Torsion Abnormality diagnostic imaging, Torsion Abnormality surgery, Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Image Enhancement methods, Image Interpretation, Computer-Assisted methods, Imaging, Three-Dimensional methods, Intestinal Volvulus diagnostic imaging, Intestinal Volvulus surgery, Intestine, Small diagnostic imaging, Intestine, Small surgery, Tomography, X-Ray Computed methods, Video Recording methods
- Published
- 2013
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9. [Leakage of the right main bile duct].
- Author
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Thiede A and Zimmermann HJ
- Subjects
- Abdomen, Acute surgery, Adult, Anastomotic Leak diagnosis, Anastomotic Leak surgery, Bile Ducts, Extrahepatic abnormalities, Bile Ducts, Extrahepatic surgery, Biliary Fistula diagnosis, Biliary Fistula surgery, Cholangiopancreatography, Endoscopic Retrograde, Diagnosis, Differential, Female, Guideline Adherence, Humans, Hyperbilirubinemia etiology, Hyperbilirubinemia surgery, Laparoscopy, Peritonitis diagnosis, Peritonitis surgery, Postoperative Complications diagnosis, Postoperative Complications surgery, Reoperation, Stents, Abdomen, Acute etiology, Anastomotic Leak etiology, Bile Ducts injuries, Biliary Fistula etiology, Cholecystectomy, Laparoscopic legislation & jurisprudence, Cholecystitis surgery, Expert Testimony legislation & jurisprudence, Gallstones surgery, Malpractice legislation & jurisprudence, Peritonitis etiology, Postoperative Complications etiology
- Published
- 2013
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10. [Diverticulitis of the small intestine as a rare differential diagnosis in patients with upper abdominal pain].
- Author
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Cziupka K, Kunath H, Seidel U, and Mirow L
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute surgery, Abdominal Pain surgery, Adult, Cholecystectomy, Laparoscopic, Combined Modality Therapy, Comorbidity, Female, Gallstones diagnosis, Gallstones surgery, Humans, Intestinal Perforation diagnosis, Intestinal Perforation surgery, Laparoscopy, Male, Middle Aged, Peritonitis diagnosis, Peritonitis surgery, Tomography, X-Ray Computed, Ultrasonography, Abdominal Pain etiology, Diverticulitis diagnosis, Diverticulitis surgery, Intestine, Small pathology, Intestine, Small surgery
- Published
- 2013
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11. [Traumatic retroperitoneal perforation of a juxtapapillary duodenal diverticulum].
- Author
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Wedemeyer C and Brüstle N
- Subjects
- Aged, Diagnosis, Differential, Duodenum pathology, Duodenum surgery, Female, Humans, Intestine, Small abnormalities, Intestine, Small surgery, Rupture, Surgical Stapling, Abdomen, Acute diagnosis, Abdomen, Acute surgery, Ampulla of Vater pathology, Ampulla of Vater surgery, Diverticulum diagnosis, Diverticulum surgery, Duodenal Diseases diagnosis, Duodenal Diseases surgery, Intestinal Perforation diagnosis, Intestinal Perforation surgery, Retroperitoneal Space pathology, Retroperitoneal Space surgery, Tomography, X-Ray Computed, Ultrasonography, Wounds, Nonpenetrating pathology, Wounds, Nonpenetrating surgery
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- 2012
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12. Ostomy creation in neonates with acute abdominal disease: friend or foe?
- Author
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van Zoonen AG, Schurink M, Bos AF, Heineman E, and Hulscher JB
- Subjects
- Female, Gestational Age, Humans, Infant, Newborn, Intestinal Diseases surgery, Male, Ostomy mortality, Reoperation statistics & numerical data, Retrospective Studies, Abdomen, Acute surgery, Ostomy adverse effects
- Abstract
Background: An ostomy seems a safe alternative in neonates with an acute abdomen when immediate restoration of bowel continuity is deemed undesirable. Faced with several complications in our center, and the feeling we are not the only center with these complications, we decided to assess the rate and type of complications after both ostomy creation and closure., Methods: All data regarding neonates (<30 days of age) who underwent a laparotomy for a suspected abdominal emergency in the period 2000 to 2010 were retrospectively analyzed. These data included demographics such as gender, gestational age, and birth weight. Disease etiology was defined and various features of the enterostomy were analyzed. These features included type, location, time to ostomy take down, and complications and mortality directly related to both creation and closure of the ostomy., Results: A total of 155 patients who underwent a laparotomy for suspect acute abdomen were identified. Median gestational age was 33 weeks (range 25 to 40) and median birth weight was 1926 g (range 560 to 4380). Median age at laparotomy was 8 days (range 0 to 30). Indications for surgery were necrotizing enterocolitis (n = 38), spontaneous intestinal perforation (n = 11), intestinal atresia (n = 9) or obstruction (n = 5), and volvulus (n = 4). An ostomy was created in 67 patients (67/155: 43%): 38 boys and 29 girls. There were 8 jejuno-, 49 ileo-, and 10 colostomies created. In almost all cases (94%), a mucous fistula was also constructed.In 23 patients (23/67: 34%) ostomy-related complications occurred. Most frequent were high output ostomy (n = 10) and necrosis of the enterostomy (n = 7). Due to either one of the complications, nine patients (9/67: 13%) needed a reoperation.In this study, 11 patients died before ostomy closure could occur. In 53 patients, the ostomy was closed after a median of 107 days (range 4 to 299).After ostomy closure, complications occurred in 13 cases (13/53: 25%). Seven patients (7/53: 13%) needed another reoperation because of anastomotic leakage (n = 4), adhesions (n = 2), or incisional hernia (n = 1). There was no closure-related mortality., Conclusion: Although creating a temporary ostomy in newborns is preferable in certain situations, there is a considerable occurrence of complications and reoperations., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)
- Published
- 2012
- Full Text
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13. [A rare diagnosis of acute abdomen in a young adult - monstrous megarectum].
- Author
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Sabou T, Kamusella P, and Andresen R
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Contrast Media administration & dosage, Diagnosis, Differential, Diatrizoate Meglumine, Dilatation, Pathologic diagnostic imaging, Dilatation, Pathologic surgery, Fecal Impaction diagnostic imaging, Fecal Impaction surgery, Humans, Ileostomy, Laparoscopy, Male, Megacolon surgery, Proctoscopy, Young Adult, Abdomen, Acute etiology, Megacolon diagnostic imaging, Rectum pathology, Tomography, Spiral Computed
- Published
- 2012
- Full Text
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14. [What must the (abdominal) surgeon know about paediatric surgery - paediatric surgical aspects in general (abdominal) surgery].
- Author
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Krause H, Rissmann A, Hass HJ, Kroker S, and Meyer F
- Subjects
- Abdomen, Acute congenital, Abdomen, Acute surgery, Anus, Imperforate surgery, Esophageal Atresia surgery, Gastroschisis surgery, Hernia, Umbilical surgery, Humans, Infant, Newborn, Intestinal Atresia surgery, Pylorus abnormalities, Pylorus surgery, Abdominal Wall abnormalities, Abdominal Wall surgery, Gastrointestinal Tract abnormalities, Gastrointestinal Tract surgery, Hernia, Diaphragmatic surgery, Hernias, Diaphragmatic, Congenital, Infant, Premature, Diseases surgery, Pediatrics
- Abstract
Due to the advances in neonatal intensive care medicine, prenatal ultrasound-guided diagnostic measures and paediatric surgical options, conditions have been established to achieve long-term survival in newborns with severe diseases. In addition, this means that the "non-paediatric" physician can be increasingly confronted with patients who would not have survived childhood some decades ago. Therefore, the article summarises concisely selected diseases of premature infants and newborns, e. g., congenital abdominal wall defects, and outlines possible long-term consequences based on the surgical interventions and their basic diseases, respectively, which need to be adequately cared for in the case of a surgical disease of the former patient of paediatric surgery. The overview cannot be considered as a complete revision course; however, it might constitute a basic outline for thought-provoking impulses for personal professional skills and expertise in managing such patients in later age from a surgical perspective., (© Georg Thieme Verlag KG Stuttgart ˙ New York.)
- Published
- 2011
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15. Massive necrosis of the upper gastrointestinal tract with acute gastric perforation and metabolic acidosis after hydrochloric acid (HCl) ingestion.
- Author
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Jurisic D, Samardzic J, Hreckovski B, Bano V, Jakovina T, and Held R
- Subjects
- Abdomen, Acute chemically induced, Abdomen, Acute pathology, Abdomen, Acute surgery, Acidosis surgery, Burns, Chemical, Esophagectomy, Esophagus surgery, Fatal Outcome, Female, Gastrectomy, Gastric Mucosa surgery, Humans, Middle Aged, Necrosis, Peptic Ulcer Perforation surgery, Peritonitis chemically induced, Peritonitis pathology, Peritonitis surgery, Spleen drug effects, Spleen pathology, Splenectomy, Stomach Ulcer surgery, Acidosis chemically induced, Acidosis pathology, Esophagus drug effects, Esophagus injuries, Esophagus pathology, Gastric Mucosa drug effects, Gastric Mucosa injuries, Gastric Mucosa pathology, Hydrochloric Acid poisoning, Peptic Ulcer Perforation chemically induced, Peptic Ulcer Perforation pathology, Stomach Ulcer chemically induced, Stomach Ulcer pathology, Suicide, Attempted
- Published
- 2011
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16. [Acute abdominal pain in the emergency department - a clinical algorithm for adult patients].
- Author
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Trentzsch H, Werner J, and Jauch KW
- Subjects
- Abdomen, Acute economics, Abdomen, Acute surgery, Adult, Aged, Analgesics therapeutic use, Analgesics, Opioid therapeutic use, Cost-Benefit Analysis, Decision Support Techniques, Diagnosis, Differential, Diagnostic Errors, Documentation economics, Early Diagnosis, Evidence-Based Medicine economics, Germany, Humans, Middle Aged, National Health Programs economics, Pain Measurement drug effects, Physical Examination economics, Tomography, X-Ray Computed economics, Unnecessary Procedures economics, Workflow, Abdomen, Acute etiology, Algorithms, Emergency Service, Hospital economics
- Abstract
Acute abdominal pain represents the cardinal symptom behind a vast number of possible under-lying causes including several ones that re-quire surgical treatment. It is the most common sur-gical emergency, the most common cause for a surgical consultation in the emergency department and the most common cause for non-trauma related hospital admissions. The golden mis-sion statement is to rapidly identify whether the underlying cause requires an urgent or even immediate surgical intervention. However, behind the same cardinal symptom one may encounter harmless or non-urgent problems. By employing diagnostic means cost effectively and with the aim to avoid unnecessary exposure of the patient to X-rays in mind, the challenge remains to identify patients with an indication for emergency surgery from those who suffer from a less serious condition and thus can be treated conservatively and without any pressure of time. Dealing with such a highly complex decision-making process calls for a clinical algorithm. Many publications are available that have scrutinised the different aspects of the initial assessment and the emergency management of acute abdominal pain. How-ever, the large body of evidence seems to miss articles that describe a formally correct priority- and problem-based approach. Clinical algorithms apply to complex disease states such as acute abdominal pain and translate them into one clearly laid out, logically coordinated and systematic overall process. Our intention is to devel-op such an algorithm to approach acute abdominal pain from the surgeon's point of view. Based on daily practice and with reference to available literature, it is the aim of this study to define a work flow that simply summarises all steps in-volved and defines the required decision process in order to form the intellectual basis for an evidence-based clinical algorithm. The result is illustrated as a first draft of such an evidence-based algorithm to allow emergency evaluation of adult patients with acute abdominal pain., (© Georg Thieme Verlag KG Stuttgart ˙ New York.)
- Published
- 2011
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17. [Acute appendicitis - changes in epidemiology, diagnosis and therapy].
- Author
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Sahm M, Pross M, and Lippert H
- Subjects
- Abdominal Abscess epidemiology, Adolescent, Age Factors, Appendicitis diagnosis, Child, Cross-Sectional Studies, Germany, Humans, Incidence, Laparoscopy statistics & numerical data, Magnetic Resonance Imaging, Postoperative Complications epidemiology, Sex Factors, Tomography, X-Ray Computed, Ultrasonography, Utilization Review statistics & numerical data, Young Adult, Abdomen, Acute epidemiology, Abdomen, Acute surgery, Appendectomy statistics & numerical data, Appendicitis epidemiology, Appendicitis surgery
- Abstract
Appendicitis is the most common cause of an -acute abdomen. Around 135 000 patients undergo appendectomy in Germany every year. Acute -appendicitis shows changes in epidemiology, -diagnosis and therapy. Epidemiological data indicate a continuing decrease in the incidence of acute non-perforated appendicitis. The incidence of perforated appendicitis has remained constant despite laparoscopy and imaging diagnostics. The status of sonography and CT scanning is increasing in the diagnosis of appendicitis. But there are differences between the sensitivity and specifity of study results and the clinical routine. The in-crease of imaging diagnostics does not correlate with a decrease in the incidence of perforated -appendicitis. Laparoscopic appendectomy has -developed as a dominant method for operative therapy. There is no proof of a higher rate of postoperative intraabdominal abscesses any more. The use of a stapler is mostly required for appendical stump closure., (© Georg Thieme Verlag Stuttgart ˙ New York.)
- Published
- 2011
- Full Text
- View/download PDF
18. [Cocaine-related gastric perforation].
- Author
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Ring A, Stein E, and Stern J
- Subjects
- Abdomen, Acute diagnosis, Abdomen, Acute surgery, Adult, Diagnosis, Differential, Humans, Laparoscopy, Male, Peptic Ulcer Perforation diagnosis, Peptic Ulcer Perforation surgery, Peritonitis chemically induced, Peritonitis diagnosis, Peritonitis surgery, Pylorus pathology, Pylorus surgery, Stomach Ulcer diagnosis, Stomach Ulcer surgery, Abdomen, Acute chemically induced, Cocaine toxicity, Cocaine-Related Disorders complications, Heroin toxicity, Heroin Dependence complications, Narcotics toxicity, Peptic Ulcer Perforation chemically induced, Stomach Ulcer chemically induced, Vasoconstrictor Agents toxicity
- Abstract
Since the 1980s the abuse of cocaine has been -associated with gastroduodenal perforations in the United States. Here, we report the case of a 28-year-old man who came to our hospital with severe abdominal pain after smoking cocaine. Physical examination revealed generalised abdominal guarding. His X-ray did not show any free intraperitoneal air. However, there was a slightly elevated white blood cell count. Upon laparoscopic exploration of the abdomen, the -patient was found to have a generalised peritonitis secondary to a perforation of the prepyloric anterior wall. The operative procedure consisted of ulcer excision and primary closure with a pyloroplasty as well as an extensive abdominal irrigation after laparotomy., (Georg Thieme Verlag Stuttgart, New York.)
- Published
- 2010
- Full Text
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19. [Small bowel perforation caused by magnetic toys].
- Author
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Schroepfer E, Siauw C, Hoecht B, and Meyer T
- Subjects
- Abdomen, Acute surgery, Colon, Sigmoid, Diagnosis, Differential, Foreign-Body Migration surgery, Humans, Ileocecal Valve, Ileum surgery, Infant, Male, Abdomen, Acute etiology, Foreign-Body Migration complications, Ileum injuries, Intestinal Perforation etiology, Magnetics, Play and Playthings
- Abstract
Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets., (Georg Thieme Verlag Stuttgart, New York.)
- Published
- 2010
- Full Text
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20. [Duodenal perforation after blunt abdominal trauma].
- Author
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Schneider R, Moebius C, Thelen A, and Jonas S
- Subjects
- Abdomen, Acute diagnosis, Abdomen, Acute surgery, Abdominal Abscess diagnosis, Abdominal Abscess surgery, Abdominal Injuries surgery, Anastomosis, Roux-en-Y, Diagnosis, Differential, Duodenum surgery, Female, Humans, Intestinal Perforation diagnosis, Middle Aged, Postoperative Complications diagnostic imaging, Postoperative Complications therapy, Retroperitoneal Space surgery, Tomography, X-Ray Computed, Wounds, Nonpenetrating surgery, Abdominal Injuries complications, Duodenum injuries, Intestinal Perforation surgery, Wounds, Nonpenetrating complications
- Abstract
Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominal pain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis., (Georg Thieme Verlag Stuttgart-New York.)
- Published
- 2009
- Full Text
- View/download PDF
21. [Incidental finding of an acute appendicitis in a premature newborn with haematochezia].
- Author
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Sachwitz D, Hass HJ, Aumann V, Herrmann K, and Krause H
- Subjects
- Abdomen, Acute diagnosis, Abdomen, Acute surgery, Appendectomy methods, Appendicitis diagnosis, Appendicitis pathology, Appendix pathology, Diagnosis, Differential, Female, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage pathology, Humans, Infant, Newborn, Infant, Premature, Diseases diagnosis, Infant, Premature, Diseases pathology, Abdomen, Acute congenital, Appendicitis congenital, Appendicitis surgery, Gastrointestinal Hemorrhage congenital, Gastrointestinal Hemorrhage surgery, Incidental Findings, Infant, Premature, Diseases surgery
- Abstract
In newborns, acute appendicitis is a very rare condition associated with significant lethality. Due to mostly non-specific symptoms, it is difficult to find the correct diagnosis preoperatively. Interestingly, rectal bleeding as a clinical sign in neonatal appendicitis is very uncommon. Here, we report on a 4-day-old premature female newborn with rectal bleeding who, therefore, underwent laparotomy because of a suspected volvulus. Except for an acutely inflamed appendix, no other pathological findings were found intraoperatively, leading to appendectomy. Histological investigation of the specimen confirmed acute ulcero-phlegmonous appendicitis. Thus, the rectal bleeding can be attributed to erosions as part of the inflammatory changes in clinically apparent appendicitis. The postoperative course of the patient was unremarkable, in perticular, no further rectal bleeding episode was observed. In spite of the low incidence of neonatal appendicitis, it has to be included in the spectrum of differential diagnoses if unclear abdominal discomfort occurs and whenever non-specific clinical signs are found in newborns. Early surgical intervention is considered the curative treatment approach of choice and can, thus, contribute to a reduction of the potential complications., (Georg Thieme Verlag Stuttgart-New York.)
- Published
- 2009
- Full Text
- View/download PDF
22. [Anesthesiological management of patients with an acute abdomen].
- Author
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Sakka SG and Wappler F
- Subjects
- Abdomen, Acute diagnosis, Abdomen, Acute etiology, Abdomen, Acute physiopathology, Anesthesiology methods, Diagnosis, Differential, Humans, Inflammation, Intraoperative Care, Oxygen therapeutic use, Pain Measurement, Pain, Postoperative therapy, Postoperative Care, Preoperative Care, Abdomen, Acute surgery, Anesthesia methods
- Abstract
Patients with an acute abdomen present with marked deterioration in physiological and pathophysiological conditions, which make general anesthesia to a challenging but also potentially dangerous procedure. A broad and fundamental knowledge of the pathophysiologically involved mechanisms of cardiovascular functions during anesthesia and appropriate anesthesiological approach are crucial for a successful peri-operative management. The anesthesiologist's goal is to perform adequate anesthesia while maintaining cardiovascular stability. Monitoring and management of acid-base-status as well as cardiovascular functions are required to maintain sufficient tissue oxygenation during anesthesia. The postoperative anesthesiological management may also crucially influence the further course and therefore should be considered in the anesthesiological planning. Finally, adequate pain management in all these patients is an important and not to underestimate part in the treatment. This article gives an overview on the major aspects in the different fields in the anesthesiological management of patients with an acute abdomen.
- Published
- 2008
- Full Text
- View/download PDF
23. "Acute abdomen": early laparoscopy or active laparotomic-laparoscopic observation?
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Schietroma M, Cappelli S, Carlei F, Pescosolido A, Lygidakis NJ, and Amicucci G
- Subjects
- Abdomen, Acute surgery, Abdomen, Acute therapy, Adolescent, Adult, Aged, Child, Child, Preschool, Early Diagnosis, Female, Humans, Laparotomy, Male, Middle Aged, Treatment Outcome, Abdomen, Acute diagnosis, Laparoscopy
- Abstract
Background/aims: Acute abdomen accounts for 13-40% of all emergency surgical admissions. The aim of this prospective randomized controlled study was to examine the role of early laparoscopy in the management of acute abdomen compared with the more traditional active observation., Methodology: From July 1993 to August 2004, 522 patients consecutively, admitted with "acute abdomen", were randomized to either early laparoscopy (260 patients) (group 1) or active observation and non-invasive investigation (262 patients) (group 2). Baseline investigations included a full blood count, a pregnancy test in women of reproductive age, chest and/or abdominal radiograph if indicated clinically., Results: Sixty-two patients in the laparoscopy group underwent a total of 116 radiological investigations compared with a total of 558 investigations in all patients in the observation group (P < 0.05). In the observation group 34.7% of patients remained without a clear diagnosis compared with 4.2% of patients in the early laparoscopic group (P < 0.0001). The morbidity rate was 1.1% in group 1 and 27% in group 2 (P < 0.0001). The duration of hospital stay was significantly shorter in group 1 (3.1 vs. 7.3 days) (P < 0.01). Eight patients in group 1 required readmission (total readmission 46 days) compared with 58 patients in group 2 who stayed a total of 201 days (P < 0.05)., Conclusions: Early laparoscopy is valuable in the management of acute abdomen. It provides a significantly higher diagnostic accuracy and a better improvement in quality of life than the more traditional approach observation.
- Published
- 2007
24. [Laparoscopic appendectomy in pregnancy].
- Author
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Schmidt SC, Henrich W, Schmidt M, Neumann U, Schumacher G, and Langrehr JM
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute surgery, Adolescent, Adult, Diagnosis, Differential, Female, Follow-Up Studies, Germany, Humans, Infant, Newborn, Length of Stay, Middle Aged, Obstetric Labor, Premature etiology, Pneumoperitoneum, Artificial, Postoperative Complications etiology, Pregnancy, Appendectomy, Appendicitis surgery, Laparoscopy, Pregnancy Complications surgery
- Abstract
Background: Acute appendicitis is the most common cause of an acute abdomen in pregnancy. However, due to the potential fetal risk associated with the CO2-pneumoperitoneum and various operative technical reasons there is still controversy about the role of laparoscopic appendectomy in pregnant women., Patients and Methods: Between January 2000 and November 2005, 283 women between 17 and 45 years with suspected appendicitis underwent laparoscopic appendectomy at our institution. Fifteen of these patients (5.3 %) were pregnant at the time of surgery (mean age, 28 years; range, 18-40 years; mean gestational age, 21.9 weeks; range, 14-34 weeks). Perioperative obstetric monitoring included fetal ultrasound, including Doppler sonography and cardiotocography. Clinical data were collected prospectively. Complete follow-up data were available in 14 patients., Results: All 15 patients underwent successful laparoscopic appendectomy. Mean operation time was 53 minutes (range, 30-100 minutes). The histologic appendicitis / appendectomy ratio was 73 %. One patient showed a postoperative pyelonephritis, another a cystitis. Average length of hospital stay was 5.5 days (range, 3-10 days). All fourteen pregnancies with complete follow-up resulted in delivery of healthy infants. The mean gestational age at delivery was 39.6 weeks (range, 35-42 weeks). Two patients (14.3 %) had a preterm delivery at 35 weeks with uncomplicated outcome. One patient underwent caesarean section at 41 weeks after chorioamnionitis., Conclusions: Laparoscopic appendectomy is a safe and effective method to treat acute appendicitis in pregnant women regardless of the trimester. For the best outcome the operation should be performed in a center where surgeons, perinatologist, obstetricians and anesthesiologists work together as a part of an interdisciplinary team.
- Published
- 2007
- Full Text
- View/download PDF
25. [Surgical principles in the treatment of diverticular disease].
- Author
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Fischer F and Bruch HP
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute surgery, Algorithms, Anastomosis, Surgical, Colon pathology, Colon surgery, Colonoscopy, Diagnosis, Differential, Diverticulitis, Colonic classification, Diverticulitis, Colonic diagnosis, Diverticulitis, Colonic etiology, Gastrointestinal Hemorrhage diagnosis, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Humans, Intestinal Obstruction diagnosis, Intestinal Obstruction etiology, Intestinal Obstruction surgery, Intestinal Perforation diagnosis, Intestinal Perforation etiology, Intestinal Perforation surgery, Laparoscopy, Recurrence, Reoperation, Tomography, Spiral Computed, Ultrasonography, Diverticulitis, Colonic surgery
- Published
- 2006
- Full Text
- View/download PDF
26. [Solid-pseudo-papillary tumor of the pancreas (SPPT) as sonographic incidentaloma in the context of acute appendicitis].
- Author
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Kramer K, Rebel M, and Kozianka J
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Adult, Appendectomy, Carcinoma, Papillary pathology, Diagnosis, Differential, Female, Humans, Pancreas pathology, Pancreatectomy, Pancreatic Neoplasms pathology, Reoperation, Splenectomy, Ultrasonography, Carcinoma, Papillary diagnostic imaging, Carcinoma, Papillary surgery, Incidental Findings, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms surgery
- Abstract
Objective: Review of the literature (Medline) based on a clinical case., Case: A twenty one year old lady presented with a one day history of acute right sided lower abdominal pain associated with leucocytosis and the clinical signs of an acute abdomen. Sonography showed fluid coincident with cocardal formation in the right lower abdomen. Incidentally a cystic formation in projection to the caudal pancreas was seen. A CT scan confirmed a cystic mass, 5 cm in diameter. An appendectomy was performed immediately after admission. After an interval of ten days an upper laparotomy leading to a left sided resection of the pancreas was performed. Histological findings showed a solid-pseudo-papillary tumor of the pancreas without any signs of metastatic spreading. Four years after the operation the patient is subjectively well and shows no signs of diabetes or of insufficiency of the exocrine pancreas nor of any recurrence. -- Characteristic findings in solid-pseudo-papillary pancreatic tumors (SPPT) are remarkable size at the time of diagnosis, low risk of malignancy, predominance in young female (10 female symbol : 1 male symbol, M = 27 a), association with oral anticonceptive drugs and mostly incidentally detection. Usually the definitive diagnosis is only found after complete radical resection which in 95 % of cases is curative., Conclusion: Abdominal sonography should be performed very thoroughly in any diagnostic query even if, clinically, the diagnosis seems to be obvious.
- Published
- 2006
- Full Text
- View/download PDF
27. [Legal aspects of deadly acute appendicitis].
- Author
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Krukemeyer MG, Pflugmacher I, and Püschel K
- Subjects
- Abdomen, Acute diagnosis, Abdomen, Acute mortality, Abdomen, Acute surgery, Abscess diagnosis, Abscess mortality, Appendicitis diagnosis, Appendicitis mortality, Diagnosis, Differential, Diagnostic Errors mortality, Expert Testimony legislation & jurisprudence, Fatal Outcome, Humans, Liver Abscess diagnosis, Liver Abscess mortality, Liver Abscess surgery, Male, Medical Errors mortality, Middle Aged, Abdomen, Acute etiology, Abscess surgery, Appendicitis surgery, Diagnostic Errors legislation & jurisprudence, Malpractice legislation & jurisprudence, Medical Errors legislation & jurisprudence
- Abstract
Appendicitis is diagnosed by synoptic evaluation of typical symptoms, laboratory tests and sonography. The only therapy is a prompt operation. The main reason for appendicitis mortality is the condition not detected or not detected in time. The case of a 50 year old male who died from a non-detected perityphlitic appendicitis with abscesses in the liver is presented. Only if appendicitis can be reliably ruled out an operation is not indicated. The not performed surgical intervention is often interpreted as a treatment error by the courts. In doubt, an operation should therefore be performed.
- Published
- 2005
- Full Text
- View/download PDF
28. [Celiac trunk compression: angiographic phenomenon or cause of ischemic abdominal complaints?].
- Author
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Walter P
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute etiology, Abdomen, Acute surgery, Abdominal Pain diagnostic imaging, Abdominal Pain etiology, Abdominal Pain surgery, Adult, Blood Flow Velocity physiology, Chronic Disease, Constriction, Pathologic diagnostic imaging, Constriction, Pathologic surgery, Female, Humans, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, Ischemia surgery, Male, Mesenteric Arteries diagnostic imaging, Mesenteric Arteries surgery, Middle Aged, Outcome Assessment, Health Care, Pulmonary Ventilation physiology, Sensitivity and Specificity, Tomography, X-Ray Computed, Ultrasonography, Ultrasonography, Doppler, Duplex, Angiography, Celiac Artery diagnostic imaging, Intestines blood supply, Ischemia diagnostic imaging
- Abstract
Compression of the celiac trunk commonly occurs in young men and women as well. Most of the patients suffering from this rare disease derive from a large pool of people having diffuse and chronic abdominal complaints including epigastric pain, postprandial abdominal pain and diarrhea leading to weight loss. Aim of the study was the finding of true criteria which can guarantee a successful operative procedure. A major issue in preoperative assessment is color flow Duplex imaging of the celiac axis. The most important finding aside from clinical symptoms is a peak flow in the celiac axis of more than 200 cm/s during inspiration and expiration position of the diaphragm. In addition arteriography of the celiac axis and superior mesenteric artery (SMA) showing a steal phenomenon is essential. Because of the rareness of the disease "only" 15 patients were operated on including intraoperative balloon dilatation of the celiac trunk. 93 % had a long term follow up success. Normal values of peak flow velocity in the mesenteric arteries were determined in more than one hundred healthy persons and compared to findings in the literature which were nearly identical. As a result of the study it could be shown that a successful outcome of the operative procedure can be expected when certain essential criteria are observed: 1. peak flow velocity in the celiac trunk higher than 200 cm/s during in- and expiration 2. steal effect via pancreatic arcades from the superior mesenteric artery documented by Duplex ultrasound and arteriography 3. triad of symptoms: epigastric pain, postprandial pain and weight loss of more than 5 kg. Special emphasis is given to the possible occurrence of severe complications after liver transplantations and pancreatic surgery, if the diagnosis "median arcuate ligament compression" is not known.
- Published
- 2005
- Full Text
- View/download PDF
29. Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis -- report of a case.
- Author
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Papalambros E, Felekouras E, Sigala F, Kiriakopoulos A, Giannopoulos A, Aessopos A, Bastounis E, Mirilas P, and Hepp W
- Subjects
- Abdomen, Acute etiology, Colectomy, Colon blood supply, Diverticulum diagnostic imaging, Duodenal Diseases diagnostic imaging, Duodenum surgery, Female, Humans, Intestinal Perforation diagnostic imaging, Middle Aged, Necrosis, Peritonitis diagnostic imaging, Peritonitis surgery, Retroperitoneal Space, Surgical Staplers, Thrombosis diagnostic imaging, Thrombosis surgery, Tomography, X-Ray Computed, Abdomen, Acute surgery, Colon pathology, Diverticulum surgery, Duodenal Diseases surgery, Intestinal Perforation surgery
- Abstract
Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.
- Published
- 2005
- Full Text
- View/download PDF
30. [Acute and chronic progressive abdominal pain: what is the role of radiogical imaging?].
- Author
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Antes G
- Subjects
- Abdomen, Acute surgery, Abdominal Pain surgery, Chronic Disease, Humans, Ischemia surgery, Mesenteric Vascular Occlusion surgery, Retrospective Studies, Sensitivity and Specificity, Abdomen, Acute etiology, Abdominal Pain etiology, Diagnostic Imaging, Intestines blood supply, Ischemia diagnosis, Mesenteric Vascular Occlusion diagnosis
- Abstract
There are many causes for acute or chronic progressive abdominal pain. Although only about one percent of these patients suffer from acute mesenteric ischemia (MI), an efficient diagnostic work-up is mandatory to reduce the high mortality. An overview about the possibilities of conventional and modern imaging modalities is given. Plain films and ultrasonography are still important in the basic work-up, however, its sensitivity is limited. Angiography has a high sensitivity and specitivity. However, angiography is not always available. Modern spiral-CT is widely available and its sensitivity is already similar to angiography. An other advantage of CT is the possibility to detect the most other frequent causes of abdominal pain. Therefore CT should be performed as fast as possible.
- Published
- 2005
- Full Text
- View/download PDF
31. [Phytobezoars: case report and review of the literature].
- Author
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Wilhelmi MH, Simanowski J, Aper T, Mlasowsky B, and Jung D
- Subjects
- Abdomen, Acute etiology, Adult, Bezoars diagnosis, Bezoars etiology, Diagnosis, Differential, Female, Humans, Ileus diagnosis, Ileus etiology, Abdomen, Acute surgery, Bezoars surgery, Diet, Vegetarian, Ileus surgery, Intestine, Small surgery, Stomach surgery
- Abstract
We report on the case of a 40-year-old woman with a long year history of vegetarian lifestyle, who experienced a phytobezoar induced acute abdomen due to a mechanic small bowel ileus. After uncomplicated surgical treatment and post-OP course the patient could be discharged on post-OP day 10. Beside a description of the historical background, relevant diagnostic and therapeutic aspects are mentioned as well as a review of the relevant literature.
- Published
- 2005
- Full Text
- View/download PDF
32. [Inflammatory alterations of the greater omentum--a difficult preoperative diagnosis].
- Author
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Knoop M and Vorwerk T
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute surgery, Adult, Aged, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Omentum pathology, Peritoneal Diseases diagnosis, Peritonitis diagnosis, Torsion Abnormality, Omentum surgery, Peritoneal Diseases surgery, Peritonitis surgery
- Abstract
Isolated inflammatory alterations of the greater omentum are rare diseases. Since the preoperative diagnosis is difficult these changes are usually ascertained upon laparotomy. Between 1999 and 2001 four patients (44-88-years-old, 2 males) underwent laparotomy for an inflammatory tumor mass or an acute abdomen, respectively. C-reactive protein was elevated in all cases. In two cases a primary torsion of the greater omentum was found, in the other two a paracolic pseudotumorous omentitis. Resection of the diseased omental parts led to complete recovery. Torsion of the greater omentum and omentitis cause abdominal symptoms with an inflammatory component that often mimics other more common diseases such as acute appendicitis and urges laparotomy. Partial omentectomy is the therapy of choice.
- Published
- 2002
- Full Text
- View/download PDF
33. [Visceral artery aneurysms].
- Author
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Lauschke H, Rudolph J, Textor J, Strunk H, and Remig J
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute mortality, Aged, Aneurysm diagnosis, Aneurysm mortality, Aneurysm, Ruptured diagnosis, Aneurysm, Ruptured mortality, Angiography, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Survival Rate, Abdomen, Acute surgery, Aneurysm surgery, Aneurysm, Ruptured surgery, Viscera blood supply
- Abstract
The purpose of this article is to review the etiology, clinical presentation and treatment options of visceral artery aneurysms (VAA) on the basis of our experiences. Visceral artery aneurysms are uncommon lesions with a frequency of 0,1-0,2 % in autopsy statistics. In fact many visceral artery aneurysms still present first with a rupture (22 %) and despite emergency laparotomies the mortality rate is about 8,5 %. The course of disease often is disastrous due to rupture of the aneurysms or thromboembolic complications, emphasizing the importance to be aware of this differential diagnosis of abdominal pain. This article covers 9 patients with VAA. 3 patients each revealed an a. lienalis aneurysm and a. gastrica aneurysm, resp. In the other 3 patients an aneurysm of the a. gastroepiploica, the a. pancreatico-duodenalis and the a. mesenterica superior resp. was proven. In 8 of 9 patients a surgical therapy of the VAA took place. Only 2 patients (22 %) were interventionally treated. 1 patient deceased due to postoperative hemorrhage. Both the surgical and the radiological intervention therapy are available for treatment of the VAA. The decision on the choice of the therapeutic procedure should be made on an individual basis.
- Published
- 2002
- Full Text
- View/download PDF
34. [Acute abdomen (1)].
- Author
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Vogel P and Jauch KW
- Subjects
- Abdomen, Acute etiology, Diagnosis, Differential, Humans, Predictive Value of Tests, Abdomen, Acute surgery
- Published
- 2001
35. Idiopathic segmental infarction of the greater omentum as a cause of acute abdomen report of two cases and review of the literature.
- Author
-
Pérez Saborido B, Jiménez Romero C, Marqués Medina E, Gimeno Calvo A, Rey Pérez P, Alonso Casado O, Arce Milla L, and Moreno González E
- Subjects
- Abdomen, Acute surgery, Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Infarction surgery, Male, Necrosis, Omentum pathology, Omentum surgery, Tomography, X-Ray Computed, Ultrasonography, Abdomen, Acute etiology, Infarction diagnosis, Omentum blood supply
- Abstract
The segmental infarction of the greater omentum is a rare cause of acute abdomen. Its etiology is uncertain although several predisposing factors have been underlined such as congenital venous anomalies, sudden change of position and substantial meal. The clinical picture simulates an appendicitis or cholecystitis, thus being difficult to make a preoperative diagnosis. However, ultrasonography or computed tomography scan can help us make this diagnosis and then we alternatively perform a conservative treatment, laparoscopic approach or resection by laparotomy. We present two cases, preoperatively diagnosed by ultrasonography and computed tomography scan that were treated by laparotomy resection. We also review the published cases in the medical literature.
- Published
- 2001
36. Experience of laparoscopic management in 100 patients with acute abdomen.
- Author
-
Ahmad TA, Shelbaya E, Razek SA, Mohamed RA, Tajima Y, Ali SM, Sabet MM, and Kanematsu T
- Subjects
- Abdomen, Acute etiology, Adolescent, Adult, Aged, Appendicitis diagnosis, Appendicitis surgery, Diagnosis, Differential, Female, Follow-Up Studies, Gastrointestinal Diseases diagnosis, Gastrointestinal Diseases surgery, Gastrointestinal Neoplasms diagnosis, Gastrointestinal Neoplasms surgery, Humans, Male, Middle Aged, Ovarian Cysts diagnosis, Ovarian Cysts surgery, Postoperative Complications etiology, Pregnancy, Pregnancy, Ectopic diagnosis, Pregnancy, Ectopic surgery, Abdomen, Acute surgery, Laparoscopy
- Abstract
Background/aims: The decision to operate on a patient with acute abdominal pain comes to the mind of the surgeon if routine investigations fail to identify the cause. A negative laparotomy may have complications, while laparoscopy appears to be a valuable way to improve the accuracy of diagnosis of acute abdominal pain and offers a promising modality of treatment., Methodology: The study included 100 patients with provisional diagnosis of acute abdomen after clinical examination and conventional diagnostic aids. All the patients have been subjected to diagnostic laparoscopy., Results: Eight cases (8%) were managed by laparotomy following diagnosis by laparoscope (disturbed ectopic pregnancy), while 92 cases (92%) were managed laparoscopically which resulted in 81 cases (81%) of successful laparoscopic procedure (31 appendectomies, 19 cholecystectomies, 12 ovarian cyst accident, and others) and 11 cases (11%) were converted to open surgery (4 gallbladder empyema, 2 appendicular mass, 2 intestinal obstruction, and others). Postoperative complications were two cases of wound infection managed conservatively (perforated appendix). The postoperative follow-up for six months was uneventful., Conclusions: Laparoscopic management of acute abdomen is a safe and effective method with the advantages of small scar, short hospital stay and early recovery.
- Published
- 2001
37. [Mono-contrast distension study of the small intestine. Comparison of conventional small bowel follow-through with enteroclysis].
- Author
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Piroth W, Haage P, Schmitz-Rode T, Wildberger JE, and Günther RW
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Adult, Aged, Enema, Female, Humans, Inflammatory Bowel Diseases surgery, Intestinal Obstruction surgery, Intestine, Small surgery, Male, Middle Aged, Postoperative Complications diagnostic imaging, Postoperative Complications surgery, Predictive Value of Tests, Radiography, Viscosity, Contrast Media, Inflammatory Bowel Diseases diagnostic imaging, Intestinal Obstruction diagnostic imaging, Intestine, Small diagnostic imaging
- Abstract
Purpose: Development of a new monocontrast examination of the small bowel., Material and Methods: The new examination was applied to 20 patients with suspected bowel obstruction or inflammatory bowel disease. A contrast mixture, containing gelatin, a water-soluble contrast medium (Peritrast) and water (GPW-mixture) was given over an intestinal tube. The viscosity of the new contrast mixture was measured by rotation and flow viscosimetry. The diagnostic value and the degree of small bowel distension were determined independently by 3 examiners. By comparison 20 randomized selected small bowel follow-through examinations (SBFT) and 20 small bowel enemas were examined. Special questionnaires were used to determine subjective compatibility and discomfort., Results: Due to the viscosity of the new contrast medium and the administration over an intestinal tube, a good bowel distension was achieved with the GPW mixture. The bowel distension (p: < 0.01) and the diagnostic value (p: < 0.01) of the new examination in comparison to the SBFT was characterized as being significantly better. In comparison to the small bowel enema, distension was not significantly better (p: 0.31-1.0). The diagnostic value of the small bowel enema was characterized as significantly better by one of the three examiners in comparison to the new monocontrast-distenson examination (p-level < 0.01)., Conclusion: The monocontrast-distension examination is a potential alternative in patients in whom a small bowel enema with barium sulfate is contraindicated.
- Published
- 2000
- Full Text
- View/download PDF
38. [Value of laparoscopy in acute abdomen].
- Author
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Otte WD and Schneiders K
- Subjects
- Abdomen, Acute economics, Abdomen, Acute surgery, Cost-Benefit Analysis, Diagnosis, Differential, Female, Humans, Male, Abdomen, Acute etiology, Laparoscopy economics
- Abstract
The correct and early diagnosis and treatment are essential for the outcome of the patient with an acute abdomen. In 520 patients with the initial diagnosis of acute abdomen early laparoscopy revealed certain advantages. 183 (35.2%) patients with 11 different diseases could be treated laparoscopically, 129 (24.8%) underwent a laparotomy. In 96.7% of our patients the initial diagnosis was correct, so that these patients received a suitable therapy. The method is economically justified because we have equal costs both with CT/szintiscanning and laparoscopy, whereas the costs of MRI are nearly 400 DM higher.
- Published
- 2000
39. [Invagination of the ileum as the etiology of acute abdomen in adults].
- Author
-
Schmidt SC, Langrehr JM, and Rivas E
- Subjects
- Abdomen, Acute surgery, Aged, Humans, Ileal Diseases surgery, Ileal Neoplasms diagnosis, Ileal Neoplasms surgery, Intussusception surgery, Leiomyoma diagnosis, Leiomyoma surgery, Male, Tomography, X-Ray Computed, Abdomen, Acute etiology, Ileal Diseases diagnosis, Intussusception diagnosis
- Abstract
In contrast to children, intussusception is an unusual cause of an abdominal emergency in adults. We report on a 65-year-old patient who complained of inconstant crampy abdominal pain for a period of over 6 months. He was admitted to our hospital because of acute intestinal obstruction. Sonography and computer tomography suggested an intussusception. At surgery the diagnosis of an ileo-ileal invagination was confirmed and resection of a segment of the ileum was performed. As shown by macroscopic findings intussusception had existed for several days. Histologically, the underlying disease causing the intussusception was a leiomyoma arising from the submucosa.
- Published
- 2000
- Full Text
- View/download PDF
40. [Differential diagnosis and therapy of acute abdomen in sickle cell crisis. A rare case in visceral surgery].
- Author
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Zülke C, Graeb C, Rüschhoff J, Wagner H, and Jauch KW
- Subjects
- Abdomen, Acute surgery, Adult, Anemia, Sickle Cell pathology, Anemia, Sickle Cell surgery, Diagnosis, Differential, Erythrocytes pathology, Humans, Infarction pathology, Infarction surgery, Male, Multiple Organ Failure surgery, Spleen pathology, Splenectomy, beta-Thalassemia surgery, Abdomen, Acute etiology, Anemia, Sickle Cell diagnosis, Infarction diagnosis, Multiple Organ Failure etiology, Spleen blood supply, beta-Thalassemia diagnosis
- Abstract
Surgical therapy of the acute abdomen often allows only limited time for differential diagnosis to confirm the indication for surgery. Under consideration of clinical aspects and case history both common and rare causes of an acute abdomen should be investigated without undue loss of time. Differential diagnostic considerations and eventual therapy are presented in the following case of a 25-year-old Afro-american who developed multiorgan failure after an initial course of lower-back pain. In addition to the clinical setting of an acute abdomen the patient presented with acute respiratory failure and laboratory signs of severe hemolysis in combination with newly detected splenomegaly. The indication for splenectomy was made following CT-proven complete splenic infarction due to repeated acute squestration. Histologic examination of the spleen together with hemoglobin electrophoresis confirmed the clinical assumption of unusually late primary manifestation of a sickle cell crisis. In the underlying case, the hemoglobinopathy was in fact the less common form of combined sickle-cell-beta-thalassemia. A ten-day course of intensive care therapy was necessary to treat ongoing multiorgan failure due to persistent sickle cell crisis. Current diagnostic and therapeutic procedures in connection with sickle cell crisis as a rare cause of an acute abdomen with the necessity for surgical intervention are presented.
- Published
- 2000
41. [Laparoscopy in intra-abdominal infection. Its diagnostic value and therapeutic possibilities].
- Author
-
Coburg AJ, Carus T, and Kempf U
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Humans, Infections surgery, Peritonitis surgery, Ultrasonography, Abdomen, Acute diagnosis, Infections diagnosis, Laparoscopy, Peritonitis diagnosis
- Abstract
In 550 patients with the clinical features of acute abdomen a surgical laparoscopy was performed. In 121 cases there was found an unspecific reason of the acute abdominal disease that did not require surgical therapy. In 349 cases a regional peritonitis was found, 80 times a diffuse peritonitis. The diagnostic validity of laparoscopy was 96% as compared to 42% for sonography. The laparoscopic access resulted in a complication rate of 0.2%. In 239 cases (43%) the disease could be managed laparoscopically, 190 cases (35%) required open surgery.
- Published
- 1999
42. Laparoscopic approach in acute small bowel obstruction. A review of 68 patients.
- Author
-
Navez B, Arimont JM, and Guiot P
- Subjects
- Abdomen, Acute etiology, Adolescent, Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Intestinal Obstruction etiology, Male, Middle Aged, Reoperation, Tissue Adhesions, Abdomen, Acute surgery, Intestinal Obstruction surgery, Intestine, Small surgery, Laparoscopy
- Abstract
Background/aims: Laparoscopic management of acute small bowel obstruction has potential advantages over classical laparotomy. The aims of this study were to assess the feasibility and the safety of this technique, as well as to find any predictive success factors., Methodology: A laparoscopic approach was undertaken in 68 out of 150 patients admitted between 1991 and 1997 for acute small bowel obstruction., Results: The cause of obstruction was bands or adhesions in 80% of the patients. A correct laparoscopic diagnosis was established in 66% of the cases. A laparoscopic treatment was performed successfully in 31 patients (46%), and was assisted by minilaparotomy in 4 patients (6%), and by open herniorraphy in 2 patients (3%). Thirty-one patients (46%) needed a conversion to laparotomy. There were 6 bowel injuries (9%), all recognized during laparoscopy. There were 2 deaths in converted patients and 2 early reoperations for persisting ileus in patients treated by laparoscopy alone or by assisted laparoscopy., Conclusion: Acute small bowel obstruction can be treated by laparoscopy alone, or assisted by minilaparotomy or open herniorraphy with advantages for the patient and few complications despite a high rate of conversion. There were no pre-operative predictive factors for successful laparoscopy, except for an isolated previous scar from an appendectomy. Pre-operative predictive success factors were parietal intestinal adhesions, as the only cause of obstruction. Multiple adhesions will mostly require conversion to laparotomy.
- Published
- 1998
43. Enteritis cystica profunda mimicking acute abdominal picture in a twelve-year-old boy.
- Author
-
Salman AB, Gögüs S, Tanyel FC, Akçören Z, and Hiçsönmez A
- Subjects
- Abdomen, Acute pathology, Abdomen, Acute surgery, Child, Chronic Disease, Cysts pathology, Cysts surgery, Diagnosis, Differential, Humans, Ileitis pathology, Ileitis surgery, Ileum pathology, Ileum surgery, Intestinal Mucosa pathology, Intestinal Mucosa surgery, Male, Abdomen, Acute etiology, Cysts diagnosis, Ileitis diagnosis
- Abstract
Enteritis cystica profunda, an uncommon condition, is characterized by nonneoplastic cystic spaces within the wall of the small bowel. The third case of enteritis cystica profunda in children is presented with special emphasis on diagnosis and treatment. This rare entity may mimic acute abdomen and should be kept in mind in the differential diagnosis. Surgical excision of the involved segment is the appropriate treatment.
- Published
- 1998
- Full Text
- View/download PDF
44. Gastroenterological surgery for patients with chronic respiratory insufficiency.
- Author
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Shimada M, Kano T, Matsuzaki Y, Miyazaki N, and Ninomiya K
- Subjects
- Abdomen, Acute surgery, Activities of Daily Living, Aged, Contraindications, Elective Surgical Procedures, Female, Gastrointestinal Neoplasms surgery, Humans, Male, Patient Selection, Retrospective Studies, Risk Factors, Digestive System Surgical Procedures, Lung Diseases, Obstructive complications, Respiratory Insufficiency complications
- Abstract
Background/aims: The aim of this study was to clarify the surgical indications for patients with chronic respiratory insufficiency., Methodology: Fourteen patients with chronic respiratory insufficiency who underwent abdominal surgical procedures, were retrospectively studied. The surgical indications were carefully determined based primarily on the performance status (PS) of each patient and cardiopulmonary function tests. A PS of equal to or less than 3, which meant the patient's status required bed rest > 50% of the time, and the need for assistance in performing normal activities were all factors considered for surgical indications., Results: During the period studied, two patients were excluded from the surgical indications due to the fact that one was at a terminal stage of pulmonary disease and was completely bedridden (PS = 4), while the other demonstrated active pneumonia with a considerable amount of purulent sputa. Regarding the pulmonary function tests for patients who underwent surgery, the lowest limits of those examinations were as follows: 810 ml of vital capacity (VC), 23.8% of predicted VC, 610 ml of forced expiratory volume in one second (FEV1.0), 38.6% of predicted FEV1.0, 50.5 mmHg of PaO2 while inhaling 4 liters of oxygen and 73.8 mmHg of PaCO2. No surgery related mortality or hospital death within 30 days after operation was observed. Only two patients had cardiopulmonary complications (consisting of pulmonary edema with atrial fibrillation in one patient, and acute myocardial infarction in another patient). However, neither pneumonia, prolonged ventilatory support for more than 2 days, nor the need for a tracheostomy after surgery was observed., Conclusions: Gastroenterological surgery is thus considered to be indicated even for patients with chronic respiratory insufficiency, as long as the PS can be maintained (PS of equal to or less than 3) and no active pneumonia with a considerable amount of purulent sputa is present.
- Published
- 1998
45. [As lumbago treated, delayed diagnosis of large intestine perforation with extremely severe peritonitis--case report with focus on the value of diagnostic laparoscopy].
- Author
-
Hofmann GO, Nikutta M, Brauns L, Sassen C, and Bühren V
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute surgery, Adult, Colon, Sigmoid surgery, Critical Care, Diagnosis, Differential, Humans, Low Back Pain surgery, Male, Peritoneal Lavage, Peritonitis diagnosis, Postoperative Complications etiology, Postoperative Complications surgery, Reoperation, Rupture, Colon, Sigmoid injuries, Laparoscopy, Low Back Pain etiology, Peritonitis surgery
- Abstract
We report on a colon perforation with peritonitis which remained clinically undetected until the 4th day post trauma although the patient suffered from lumbalgia-like symptoms. He then developed an acute abdomen with sudden onset, being caused by a sigmoidal rupture and a consecutive diffuse peritonitis. A colon resection was performed according to the Hartmann procedure. Almost 36 revisions were necessary due to necrosis and perforation. Having treated the peritonitis successfully it was possible to close the abdomen and to remove the stomata. The case is discussed in relation to standard diagnostic procedures while a special interest is focused on the usage of sonography, explorative laparoscopy and laparotomy. We finally introduce the algorithm being applied to similar cases at our trauma center.
- Published
- 1998
46. [Diagnostic laparoscopy and laparoscopic appendectomy in the diagnosis and therapy concept of abdominal pain of unknown origin].
- Author
-
Lippert V, Zaage J, and Pilz F
- Subjects
- Abdomen, Acute surgery, Adult, Aged, Appendicitis surgery, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Postoperative Complications surgery, Quality Assurance, Health Care, Reoperation, Retrospective Studies, Abdomen, Acute etiology, Appendectomy, Appendicitis diagnosis, Endoscopy, Laparoscopy
- Abstract
The unclear lower abdominal pain can be problematic for the surgeon although modern diagnostics and technical equipment are applied. We present the experiences in a retrospective study carried out in our hospital since beginning of laparoscopy in unclear lower abdominal pain. The laparoscopic diagnostic provides valuable additional informations for the further treatment. We can get important informations about differential diagnosis of appendicitis, especially of young women and old patients. The laparoscopy as a minimal invasive diagnostics goes together with a high benefit for the patients and a low rate of complications.
- Published
- 1998
47. [Acute management of a high risk patient with megacolon in a primary and general care hospital--a plea for endoscopy in surgery].
- Author
-
Wolfsdorf U
- Subjects
- Abdomen, Acute diagnostic imaging, Abdomen, Acute surgery, Aged, Diverticulitis, Colonic diagnostic imaging, Diverticulitis, Colonic surgery, Hospitals, General, Humans, Intestinal Obstruction diagnostic imaging, Intestinal Obstruction surgery, Male, Megacolon diagnostic imaging, Postoperative Complications diagnostic imaging, Postoperative Complications surgery, Radiography, Reoperation, Risk Factors, Laparoscopes, Megacolon surgery
- Abstract
This case demonstrates the importance for surgeons to use the endoscope. A multimorbid patient in nearly dying condition, with a megacolon due to a functional sigmastenosis could be successfully treated by endoscopic intervention. After the patients recompensation, an early elective sigmaresection could be performed. The opportunity of endoscopy, instead of operation helped the patient and improved quality of treatment also economically. Therefore, a plea ist made for more endoscopic education in general surgical training.
- Published
- 1998
48. [Acute surgical intestinal diseases].
- Author
-
Maurer CA, Baer HU, and Büchler MW
- Subjects
- Abdomen, Acute etiology, Diagnosis, Differential, Humans, Intestinal Diseases etiology, Abdomen, Acute surgery, Intestinal Diseases surgery
- Published
- 1998
49. [Acute appendicitis in the child].
- Author
-
Waldschmidt J
- Subjects
- Abdomen, Acute etiology, Abdomen, Acute surgery, Acute Disease, Appendicitis surgery, Child, Child, Preschool, Diagnosis, Differential, Female, Humans, Infant, Laparoscopy, Male, Ultrasonography, Appendicitis diagnosis
- Abstract
The appendicitis is the commonest cause of an acute abdomen in children older 1 year of age. Only 5% of children with appendicitis are younger than 2 years of age. There is a familial preponderance. The younger the child the faster the symptoms of the disease are increasing in intensity. The symptoms starts with unspecific periumbilical or epigastric pain, followed by nausea, vomiting and restlessness at night. Finally the pain moves to the position of the appendix. The position of the appendix shows a high variation in children thus the pain characteristic is not uniform. Laboratory tests are not reliable but ultrasonography is recommended to exclude other diseases and to try to confirm the diagnoses. With the technique of "Graded compression Sonography" the rate of non identified appendicitis has been reduced under 5%. Laparoscopy is another option. Its use just for diagnostic purposes is limited but is recommended widely for primary therapeutic treatment with laparoscopic performed appendectomy. Laparoscopy has a special advantage against conventional appendectomy in the diagnostic of recurrent unspecific abdominal pain in children and in cases with interval appendectomy. Finally in pseudoappendicitis and pseudoperitonitis in children with immunvasculitis and other extraabdominal diseases. Letality of the acute appendicitis is zero.
- Published
- 1998
50. [Value of diagnostic laparoscopy and minimal invasive procedures in acute abdomen].
- Author
-
Waclawiczek HW, Schneeberger V, Bekk A, Dinnewitzer A, Sungler P, and Boeckl O
- Subjects
- Abdomen, Acute surgery, Adolescent, Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Point-of-Care Systems, Postoperative Complications etiology, Postoperative Complications surgery, Reoperation, Surgical Equipment, Surgical Instruments, Abdomen, Acute etiology, Laparoscopes, Minimally Invasive Surgical Procedures instrumentation
- Abstract
During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.
- Published
- 1997
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