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In a prospective study 500 patients were examined sonographically following laparoscopic cholecystectomy, 183 on several occasions. In the majority of patients (79.4%) there were no remarkable findings, either clinically or sonographically. In 102 patients (20.4%) there were sonographic abnormalities such as fluid collections in the gallbladder bed (13%), postoperative dilatation of the biliary passages (9.4%), free abdominal fluid (2%) or pleural effusions (1.2%). Only 25 patients (5%) showed clinical symptoms; there was complete agreement with the findings on ultrasound.

Extrapulmonary tuberculosis is least common form of tuberculosis in pregnancy, early diagnosis of which will help to reduce maternal and neonatal morbidity and mortality. My patient is 25 years old primigravida admitted with Ascitis, Anorexia, low grade fever on and off. Diagnosed as peritoneal tuberculosis after abdominal fluid sent for AFB culture. Patient was given Antitubercular treatment. Ascitic fluid gradually declined and pregnancy moved on but patient landed up in preterm labour and delivered baby which the pediatrician was unable to save because of extreme prematurity. DOI: http://dx.doi.org/10.3126/ijasbt.v2i3.11117Int J Appl Sci Biotechnol, Vol. 2(3): 371-372

A new method to image and quantify intra-abdominal haemorrhage using electrical impedance tomography (EIT) was tested in vivo. Supine peritoneal dialysis patients were monitored using an 8-electrode hemiarray placed on the anterior abdomen. EIT measurements were recorded using the EPack II data acquisition system before, during, and after the administration of dialysate. The amount of dialysate infused was recorded synchronous with EIT measurements and used as a control. Tomographic images of impedance change were reconstructed using a weighted, sensitivity-based method and then post-processed to obtain a quantitative estimate of the total dialysate volume added and the rate of dialysate administration. Our preliminary study included two subjects, one male and one female, each of whom participated for two sessions spaced about 6 months apart. Data collected from these sessions indicated that with an in vivo SNR of about 35 dB the EPack II can detect accumulations larger than about 100 ml, with a quantification uncertainty of about 50 ml. The rate of accumulation was determined in less than 2 min. This method shows promise for automated detection of other pathologies, eg ascites, and is adaptable to detecting conductive accumulations in other anatomy.

We report the case of a 25-year-old patient with systemic lupus erythematosus (SLE) pancreatitis which was complicated by pseudocyst and pseudoaneurysm formation. The pseudoaneurysm progressed to intra-abdominal bleeding requiring endovascular coil embolization of the gastroduodenal artery. The pseudocyst and hematoma formed two large abdominal fluid collections causing symptoms due to a mass effect. These fluid collections were treated conservatively, while active SLE was treated with steroids, azathioprine, and immunoglobulins. She finally made a full recovery. To the best of our knowledge, this is the first report of a bleeding pseudoaneurysm complicating SLE pancreatitis. Although anecdotal, this case may serve as a useful example of the possible complications of SLE pancreatitis, including considerations on optimal management. Lupus (2011) 20, 305-307.

Introduction: Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). This case series describes episodes of peritoneal dialysis (PD) related fungal or Pseudomonas peritonitis that were complicated by the formation of encysted intra abdominal fluid collections despite prompt catheter removal and appropriate therapy. Case series: The first patient presented with fever and abdominal pain two weeks after removing his PD catheter because of fungal peritonitis. Examination revealed fluid collection in the former catheter tunnel. This turned out to be pus on surgical drainage. Abdominal computed tomography (CT) scan revealed another extensive encysted extra-peritoneal fluid collection that was aspirated and found to be clear transudate fluid. The second patient presented with abdominal pain and distention seven weeks after removing her PD catheter because of fungal peritonitis. She had a large intra abdominal encysted fluid collection that was drained under ultra sound guidance. The third patient presented with painless abdominal distention one month after removing the PD catheter because of Pseudomonas peritonitis. He had two encysted extra peritoneal fluid collections that were aspirated under ultra sound guidance. This occurred despite three weeks of treatment with oral fluconazole in the case of the first two patients and appropriate antibiotic therapy in the case of the third patient. Key Words: CAPD, Fungal peritonitis, Pseudomonas peritonitis, Encysted abdominal fluid collection, Sudan

Background Differential counting and morphological analysis of nucleated cells in body fluids (eg, cerebrospinal fluid and pleural fluid) are of great diagnostic importance to the clinician. A recent development in this field was the introduction of an application for an automated microscopy system, the DM96 Body Fluid module, enabling the automated analysis of body fluid samples. This computerised system provides an automated morphological analysis of body fluids, including an automated classification of all nucleated cells. Aims To investigate the ability of the digital microscopy system, DM96, to automatically classify cells in different types of body fluids. Methods A total of 177 body fluids (including cerebrospinal fluid, abdominal fluid and continuous ambulant peritoneal dialysis fluid) were analysed on the DM96, and results were compared with the manual microscopy method. Results A study in 177 samples demonstrates an overall preclassification accuracy of 90% in spinal fluid and 83% in other body fluids using the automated system. Correlation coefficients for postclassification as compared with manual review range from 0.92 to 0.99 for spinal fluid sample analyses and from 0.83 to 0.98 for other body fluids. The within-run variation of automated classification is less than 6% for all cell categories (4% excluding macrophages). Conclusion The DM96 has proven to be reliable and efficient, contributing to overall quality improvement in morphological analysis and automated cell classification of peripheral blood and other body-fluid samples.

Percutaneous abscess drainage (PAD) is now standard therapy for patients with intraabdominal abscess who do not have other indications for surgery. The vast majority of collections or abscesses can be managed with an appropriately sized and positioned catheter. This section will deal with some general principles of abscess drainage as well as look into some specific locations like perihepatic (subphrenic and subhepatic), gall bladder bed, splenic bed, lesser sac, paracolic, and retroperitoneal abscesses.

A 67-year-old man with a liver transplant 1 year before developed stenosis of the biliary anastomosis that required stent placement by ERCP He was admitted for cholangitis, and the stent was removed. He was readmitted for fever without an apparent focus of infection. Abdominal CT showed a gas-containing collection in the left liver lobe.

The medical records of 75 horses with duodenitis-proximal jejunitis (DPJ) were reviewed. Ages, physical parameters, laboratory values, and treatment data were compared between horses surviving DPJ and horses not surviving DPJ (Table 1). Fifty of 75 horses (66.6%)survived. Sixty-six horses (88.0%)were managed with medical treatment alone and nine horses (12.0%) were managed with medical treatment plus surgical intervention. Using a logistic regression model, the association of each of the 19 physical and laboratory parameters with death was evaluated retrospectively in the 75 horses. Three parameters (anion gap, abdominal fluid total protein concentration, and volume of gastric fluid for the first 24 hours of hospitalization) were significantly associated with death by univariate analysis. Using a stepwise multiple logistic regression, two parameters remained significantly associated with death (P> 0.05), anion gap and abdominal fluid total protein concentration. (Journal of Veterinary Internal Medicine 1992; 6:307–311)

A patient with a post-traumatic retroperitoneal urinoma is presented. On admission, there was a clinical suspicion of retroperitoneal hematoma and ultrasonography (US) was performed which showed a hypoechoic fluid collection suggesting retroperitoneal hematoma. In order to determine the nature of the fluid, radionuclide angiography and renal scan were performed successively with 99mTc-DTPA. Demonstration of urinary leakage into the mass in the delayed renal scintigraphic images suggested a urinoma. At laparotomy, total transection of the left ureter in the uretero-pelvic region was found and the diagnosis of urinoma was confirmed.

Disruption of the biliary tree after laparoscopic cholecystectomy has been reported in 0-7% of cases, and likely represents the most significant postoperative complication. Documenting the presence and extent of a bile leak is often difficult. We reviewed the first 264 laparoscopic cholecystectomies performed at our institution and found seven cases of bile extravasation and/or biloma formation (prevalence, 2.7%). All patients were first seen in the early postoperative period with abdominal pain and low-grade fever. Sonography was performed in five of seven, CT in five of seven, hepatobiliary scintigraphy with diisopropyliminodiacetic acid in five of seven, and ERCP in four of seven cases. While sonography and CT were initially helpful in determining the presence of abdominal fluid collections, they were unable to differentiate between postoperative seroma, lymphocele, hematoma, and bile leak. Hepatobiliary scintigraphy was useful in demonstrating continuity of these fluid collections with the biliary tree and guiding further therapy. Four cases were managed with endoscopic biliary decompression, with the use of sphincterotomy or nasobiliary stent placement, with good clinical result. The other three cases were treated surgically with T-tube or external drainage. All patients did well clinically, without evidence of bile reaccumulation. Our experience suggests that sonography and CT are useful in detecting postoperative fluid collections, but cannot differentiate bile from other fluids. Hepatobiliary scintigraphy is valuable as a noninvasive means of investigating possible bile leaks and in guiding further therapy.

Background: Different micro-organisms can be cultured from abdominal fluid obtained from patients with intra-abdominal infection resulting from a perforated digestive tract. We evaluated a cohort of patients with abdominal sepsis admitted to the intensive care with the aim of obtaining more insight into the type of microorganisms involved and the efficacy of treatment.Materials and Methods: A 5-year prospective observational cohort study was performed in patients admitted to the intensive care unit with abdominal sepsis syndrome, defined as a perforation of the digestive tract and inflammatory response with organ failure. Abdominal fluid was obtained for microbial culture during the surgical procedures and from abdominal drains. The initial treatment protocol was cefotaxim, ciprofloxacin, metronidazole, and amphotericin 8, tailored according to microbiological results. Selective decontamination of the digestive tract was administered to prevent secondary endogenous infections.Results: Abdominal fluid was taken for microbial culture from 221 of the 239 patients admitted with abdominal sepsis. Aerobic Gram-negative bacteria (AGNB) were found in 52.9% of the cultures of abdominal fluid taken at the time of operation, of which 45% were Escherichia coli; in 36% of patients more than one AGNB was found. The incidence of AGNB was highest in colorectal perforations (68.6%) and perforated appendicitis (77.8%) and lowest in gastroduodenal perforations (20.5%). Gram-positive bacteria were found in 42.5% of the abdominal fluid cultures and most frequently in colorectal perforations (50.0%). Candida was found in 19.9% of patients, with 59.1% of these cultures being Candida albicans. The incidence of Candida was 41.0% in gastroduodenal perforations and 11.8% in colorectal perforation. Anaerobic bacteria were cultured in 77.8% of patients with perforated appendicitis. Over time, the prevalence of AGNB in abdominal fluid decreased from 117 patients (52.9%) in the first culture to one patient (6.7%) in week 4 (efficacy 87%). The prevalence of Gram-positive bacteria increased from 42.5% to 86.7% in a 4-week period.Conclusion: The composition of the intra-abdominal flora found in critically ill patients with abdominal sepsis varies depending on the location of the perforation. The efficacy of combined surgical and antibiotic treatment was 87% in 4 weeks for AGNB.

Giant intra-abdominal cysts masquerading as ascites are rare. We present three cases with giant intra-abdominal cysts (one mesenteric cyst, two ovarian) that were initially misdiagnosed as refractory ascites in another hospital. On ultrasound examination, displacement of bowel loops to outside the fluid without dispersion of fluid around the liver and spleen were the main findings suggesting the possibility of giant intra-abdominal cysts in our patients. In all three patients, the diagnosis of giant intra-abdominal cysts was confirmed after their total excision. Clinicians must consider processes other than ascites in the differential diagnosis of large abdominal fluid accumulation.

Objectives: To review aetiology, clinical signs and outcome of cats surgically treated for septic peritonitis (2000-2007). Methods: A retrospective study. Inclusion criteria were the identification of intracellular bacteria and degenerate neutrophils and/or a positive culture from abdominal fluid and exploratory coeliotomy. Aetiology, clinical signs, haematological and biochemical parameters, surgical treatment and outcome were recorded and analysed. Results: Twenty-six cats fulfilled the inclusion criteria. Abdominal pain was reported in 10 (38 per cent) and vomiting was reported in 11 (42 per cent) of the cats. The most common aetiology was trauma (31 per cent). The principal source of contamination was the gastrointestinal tract. Hyperlactataemia, hypoproteinaemia and hyperglycaemia were reported in 9, 13 and 14 of the 26 cases, respectively. Non-survivors had significantly higher blood lactate concentrations than survivors (P=0·02). Nineteen cats were managed with primary closure, two with closed suction drains and three with open peritoneal drainage. Twelve (46 per cent) cats survived to discharge. Clinical Significance: In cats, lethargy, depression and anorexia were more common clinical signs than abdominal pain. Lactate level at the time of diagnosis may be a useful prognostic indicator in cats. The proportion of cats that survived was lower than previously reported and owners should be given a guarded prognosis.

Rationale: Myeloid-related protein-8 (MRP8) and MRP14 can form heterodimers that elicit a variety of inflammatory responses. We showed that MRP8/14 is a ligand for Toll-like receptor-4, and that mice deficient in MRP8/14 are protected against endotoxic shock-induced lethality. Objectives: To determine (1) the extent of MRP8/14 release in patients with sepsis and/or peritonitis and in healthy humans exposed to LPS and (2) the contribution of MRP8/14 to the host response in murine abdominal sepsis. Methods: MRP8/14 was measured in 51 patients with severe sepsis, 8 subjects after intravenous injection of LPS, and 17 patients with peritonitis. Host responses to sepsis were compared in mrp74 gene-deficient (and thereby MRP8/14-deficient) and wild-type mice intraperitoneally injected with Escherichia coli. Measurements and Main Results: Patients with sepsis displayed elevated circulating MRP8/14 concentrations on both Days 0 and 3, and LPS injection resulted in systemic MRP8/14 release in healthy humans. In patients with peritonitis, MRP8/14 levels in abdominal fluid were more than 15-fold higher than in plasma. MRP14-deficient mice displayed improved defense against E. coli abdominal sepsis in an early phase, as indicated by diminished dissemination of the bacteria at 6 hours. In addition, MRP14-deficient mice demonstrated decreased systemic inflammation, as reflected by lower cytokine plasma concentrations, and less severe liver damage. Conclusions: Human sepsis and endotoxemia are associated with enhanced release of MRP8/14. In abdominal sepsis, MRP8/14 likely occurs primarily at the site of the infection, facilitating bacterial dissemination at an early phase and liver injury.

A 2-year-old male Labrador Retriever was presented for sudden abdominal distension. Abdominal ultrasonography revealed abundant abdominal fluid and a hepatic mass, which was removed by total lobectomy. Histologic evaluation of the mass supported a vascular hepatic hamartoma. Vascular hamartomas are rare malformations in animals and only two cases have been reported in the dog. This is the first recorded case of a canine vascular hepatic hamartoma treated surgically and having a successful long-term outcome.

This paper describes three cases of liver lobe torsion in rabbits presenting with anorexia, lethargy, jaundice and abdominal pain. This condition was associated with anaemia and elevation of alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase. Abnormal radiological findings included hepatomegaly, gas-filled intestinal loops consistent with gastrointestinal ileus and ascites. Ultrasonographic findings included heterogeneous liver parenchyma, free abdominal fluid and reduced bowel motility. Diagnosis was confirmed by histopathological examination of the liver in all three cases.

The aim of this prospective study was to establish a protocol for fast localised abdominal sonography of horses (FLASH) admitted for colic. The FLASH protocol was then presented to clinicians without extensive ultrasound (US) experience to determine whether they could learn to use it in less than 15 min. The clinical subjects comprised 36 horses that had been referred for colic over a 2 month period. Each horse was examined at admission and FLASH findings at seven topographical locations were compared to serial clinical examinations, surgical and non-surgical outcomes, or with post-mortem reports. FLASH was able to show free abdominal fluid and abnormal intestinal loops, with a mean time of 10.7 min required to complete the protocol. The positive and negative predictive values of requirement for surgery of dilated turgid small intestinal loops using FLASH were 88.89% and 81.48%, respectively. The results suggested that FLASH is a technique that can be used in an emergency setting by veterinarians without extensive US experience to detect major intra-abdominal abnormalities in horses with colic.

Because pregnancy is rare in women with end-stage renal disease, dialysis patients have not been reported to present with acute abdominal symptoms related to pregnancy including ectopic pregnancy. A 41-year-old woman treated with hemodialysis for over 18 years was brought to the emergency room at our institution because of acute abdominal pain. Ultrasonography detected an abdominal fluid collection, and her anemia had worsened (hematocrit 18%). Emergency laparoscopic exploration disclosed a hemorrhagic corpus luteum of pregnancy, causing ovarian bleeding on the left. Coagulation of bleeding points was carried out. At this time, pregnancy at 7 weeks of gestation was discovered. After the procedures, hemodialysis frequency was increased to 5 times weekly, and an erythropoietin derivative was administered to maintain a hematocrit above 30%. The patient developed no hypertension. At 33 weeks of gestation, cesarean section was performed because of a decrease in amniotic fluid and frequent late deceleration of the fetal heart rate. A live baby girl weighing 1,422 g was born. The successful pregnancy reflects remarkable progress in dialysis technology. Pregnancy, then, can underlie an acute abdomen in childbearing-age women (14 - 44 years old) undergoing long-term dialysis.

identification of patients with ongoing abdominal infection after emergency surgery for abdominal sepsis is difficult. The purpose of this study was to evaluate whether plasma and abdominal fluid sTREM-1 levels can adequately select patients with ongoing abdominal infection. In a single center retrospective observational study, plasma and abdominal fluid samples were collected every 24 h for 4 days in patients who underwent an emergency laparotomy for severe secondary peritonitis. Patients after elective esophagus surgery served as controls. sTREM-1 levels were measured with an ELISA. Plasma sTREM-1 levels were not elevated compared to controls. Abdominal fluid sTREM-1 levels were initially high (median (246 [IQR 121-4551 pg/ml), and declined 24 h after surgery (P = 0.01). On day 2 and 3, patients with ongoing infection had significantly higher abdominal fluid sTREM-1 levels (319 [180-671] and 245 [173-541] pg/ml, respectively) compared to patients without infection (85 [49-306] and 121 [20-196] pg/ml, respectively). sTREM-1 levels were moderately predictive for persistent infection but had a high negative predictive value (0.86 (95% Cl 0.69-0.94) below a cut-off level of 160 pg/ml. In clinical practice, abdominal fluid sTREM-1 levels may be useful for exclusion but not detection of ongoing abdominal infection after surgery for secondary peritonitis. (C) 2008 Elsevier Ltd. All rights reserved

Objectives Chest X-ray (CXR), abdominal ultrasound, cardiac ultrasound, and abdominal X-ray are the most frequently used imaging modalities to radiologically evaluate patients with penetrating torso trauma. The aim of this study was to evaluate the accuracy of these imaging modalities. Methods From January 2001 until January 2005, all consecutive patients with penetrating torso injuries presenting at the emergency department of a level 1 trauma center were included. Imaging modalities (chest/abdominal X-ray, abdominal/cardiac ultrasound), were compared retrospectively with a 'gold standard' (i.e. computed tomography or surgery within 2 h after arrival) or outcome of conservative treatment. The accuracy of the imaging modalities was calculated. Results Three hundred and eighteen patients were included. On the basis of 299 CXRs, the sensitivity for diagnosing pneumothorax, hemothorax, and subcutaneous emphysema was 71, 63, and 61%, respectively. The sensitivity of abdominal ultrasound (N=229) to detect free abdominal fluid and/or intra-abdominal injury was 65%. The specificity, positive predictive value, negative predictive value, and accuracy of the two imaging modalities to detect any of the diagnoses mentioned were >=: 87%. Cardiac ultrasound (N=31) did not show any false positive or negative results for detecting cardiac effusion. Pneumoperitoneum was not seen on abdominal X-ray in eight of 11 patients with perforation of a hollow organ. Conclusion Despite high specificity, positive predictive value, and negative predictive value, a considerable number of lesions remain undetected after CXR and abdominal ultrasound because of moderate-to-inadequate sensitivity. Abdominal X-ray hardly provides additional information. Careful clinical monitoring of patients is mandatory, particularly when computed tomography scan or operative treatment is not indicated. European Journal of Emergency Medicine 16:305-311 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Percutaneous aspiration and drainage of post-operative abdominal fluid collections is a well established standard technique. However, some fluid collections are not amenable to percutaneous drainage either due to location or the presence of surrounding visceral structures. Endoscopic Ultrasound (EUS) has been widely used for the drainage of pancreatitis-related abdominal fluid collections. However, there are no reports on the use of this technique in the post-operative setting. We report a case where the EUS-guided technique was used to drain a percutaneously inaccessible post-operative collection which had developed after Whipple's resection.

To evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media. In this prospective study, 62 women between 21 and 38 years with a history of at least 1 year of infertility who underwent hysteroscopy and hysterosalpingography (HSG) on two consecutive cycles were studied. Transvaginal ultrasonography carried out before and after hysteroscopy in order to measure the abdominal fluid (in ml) in the peritoneal cavity of the cul-de-sac. The difference between the two results was calculated. A next cycle HSG was performed and patients were divided into three groups according to whether there was no tubal occlusion (group 1), a unilateral occlusion (group 2) or a bilateral occlusion (group 3): Peritoneal fluid measurements were compared among the three groups. Finally, pain and discomfort were recorded at the end of the process. According to the HSG, 34 women were in group 1, 13 in group 2 and 9 in group 3. Peritoneal fluid measurements were 6.88 ± 2.7 ml in group 1, 4.21 ± 0.9 ml in group 2 and 1.08 ± 0.7 ml in group 3. Statistical differences were found between groups 1 and 3 and between groups 2 and 3 (P

Objective To determine the incidence, management, and outcome of patients diagnosed with a pancreatic leak after a distal pancreatectomy during primary surgical cytoreduction for ovarian, peritoneal, or tubal cancer. Methods We performed a retrospective chart review of all patients who had a distal pancreatectomy at the time of primary surgery. Charts were reviewed to identify those patients who developed a persistent left upper quadrant abdominal fluid collection with elevated amylase levels. Results A total of 17 patients had a distal pancreatectomy; of these, 4 patients (24%) developed a postoperative pancreatic leak. In these patients, persistent leukocytosis prompted evaluation with a computed tomography scan, which subsequently revealed a fluid collection. The median time from surgery to drainage of this collection was 9 days (range, 8–66). The drain remained in situ for a median of 29 days (range, 22–82). The median amylase level of the fluid was 22,945 U/L (range, 763–47,250). The median length of hospital stay for those patients with a leak was 33 days (range, 25–44), which was longer than those without a leak. However, the median time from surgery to treatment with systemic chemotherapy was 31 days (range, 16–43), which was equivalent to those without a pancreatic leak. Conclusion Twenty-four percent of patients who had undergone a distal pancreatectomy developed a pancreatic leak. This complication, which usually presents early in the postoperative period, can be managed conservatively with percutaneous drainage. Oral intake may be resumed, and total parenteral nutrition is not needed in the majority of cases. Systemic chemotherapy can be administered without significant delay.

Contains fulltext : 71524.pdf (Publisher’s version ) (Closed access) The association of fetal hydrops with Congenital Disorders of Glycosylation (CDG) has been reported previously. Pericardial fluid accumulation and ascites were also observed in a few young patients with CDG type Ia. Here we describe the clinical and biochemical features in three children developing life-threatening extravascular fluid accumulation. All patients carried severe PMM2 mutations comparable to the earlier reported patients with fetal hydrops. One patient was successfully treated with a pericardial-pleural shunt placement. Pericardial fluid accumulation and generalized oedema resolved temporarily in the other two children on regular albumin infusions and the use of diuretics. Sequential abdominal punctures were unsuccessful in the treatment of the extensive ascites production. The use of non-steroid anti-inflammatory agents and the application of high dose steroids had no clinical effect. Severe extravascular fluid accumulation progressed to decompensation and death. Biochemical investigations of the abdominal fluid and pericardial fluid demonstrated a high extracellular protein concentration, increased cytokine concentrations and an abnormal transferrin isoelectric focusing pattern characteristic of CDG type I. Our results are consistent with a local activation of the cytokine pathways and subsequent protein transport through the endothelial surface to the extravascular space. Normal glycosylation of cell surface proteins is essential for the normal fluid balance and protein transport through the pericardial and peritoneal membrane. Future therapeutic efforts should be directed to inhibit the abnormal immune response and excessive protein transport in this life-threatening complication of CDG syndrome.

Introduction : Management of the open abdomen is a challenge, certainly when fistulisation is present. This paper presents a new treatment modality for this specific situation. Methods : Abdominal sepsis increases the net flow across the peritoneum to 300-500 ml/h. This flow was used to clean and flush the abdomen. Meropenem was administered, as antibiotic concentration in the peritoneal cavity is known to reach therapeutic levels after 8 hours. The abdominal fluid was captured using the abdominal VAC system and additional drains. The total amount of drained fluid was compensated intravenously. Thus, the concept was named "Systemic Peritoneal Cavity Lavage" (SPCL). Results : Four patients with an open abdomen and severe abdominal sepsis were treated with SPCL and got out of their septic state within two weeks despite fistulisation and ongoing bowel leakage in three patients. A partial enterectomy with removal of the fistulas could be performed six weeks later. Conclusion : SPCL is a promising method to treat patients with severe abdominal sepsis. In combination with the fistula isolation technique it permits delayed treatment of fistulas in a hostile abdomen where immediate removal of the septic focus is impossible.

Introduction Labia minora adhesions (LMA) are a common finding in young girls. Usually, this condition is asymptomatic and spontaneously disappears during adolescence. We report on a case revealed by infected urocolpos and peritonitis and whose treatment finally required surgical reduction labioplasty. Case report A 9-year-old girl presented with a 2-day history of abdominal pain and fever. Urinary continence had never been obtained, with diurnal leaks. Physical examination showed signs of peritoneal irritation and a subtotal vulvar obstruction due to LMA. At surgery, after LMA lysis, a large amount of cloudy urine-like fluid emptied under pressure from the vagina. Laparoscopy showed generalized peritonitis without any intraabdominal cause. The same Escherichia coli was identified in the infected urocolpos and the abdominal fluid. Postoperative course was uneventful. Because of recurrent LMA, the patient underwent several courses of local estrogen therapy. Labia minora hypertrophy with LMA developed 2 years after peritonitis, requiring surgical reduction labioplasty. We used a new technique with interposition of skin flaps. The girl is now well, without LMA or infection, 4 years after labioplasty. Conclusion Although rare, subtotal vulvar obstruction because of LMA may lead to infected hydrocolpos and peritonitis. Recurrent LMA may necessitate surgical labioplasty.

Background: Ectopic pregnancies are frequently present in women who present to the emergency department with pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention. Objectives: To prospectively determine if emergency physician (EP)-performed transabdominal pelvic ultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted the need for operative intervention. Methods: Patients who were suspected to have an ectopic pregnancy were prospectively enrolled over a ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of the hepatorenal space (Morison’s pouch) for free fluid. The EP US was classified as intrauterine pregnancy (IUP) or no definitive IUP, with Morison’s pouch classified as positive or negative. The majority of patients had a subsequent transvaginal pelvic US performed by the Department of Radiology. Patients were followed up for radiology results, need for operative intervention, and ultimate outcome of the pregnancy. Results: There were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27 seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operative intervention. Free fluid in Morison’s pouch was identified in ten patients, nine of whom underwent operative intervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) for patients with suspected ectopic pregnancy who required operative intervention. Conclusions: Free intraperitoneal fluid found in Morison’s pouch in patients with suspected ectopic pregnancy may be rapidly identified at the bedside by EP-performed US and predicts the need for operative intervention. ACADEMIC EMERGENCY MEDICINE 2007; 14:755‐758 a 2007 by the Society for Academic Emergency

Sonography is widely used in the initial diagnostic assessment of blunt abdominal trauma in adults and children. It has been formally incorporated worldwide into the routine armamentarium available for emergency diagnosis and treatment as a means of rapid detection of free abdominal fluid, normally referred to as FAST (Focused Assessment with Sonography in Trauma). However, there is some controversy regarding its value because free abdominal fluid may be lacking in patients with abdominal organ injuries from blunt trauma. More recently, a new ultrasound technique has been developed using contrast agents. Contrast-enhanced ultrasound performs better than the non-contrast-enhanced technique for the detection of abdominal solid organ injuries and can play an important role in the prompt evaluation of patients with blunt trauma. Furthermore, contrast-enhanced ultrasound can be used in the follow-up of patients who have solid organ lesions and are managed with nonoperative treatment, avoiding radiation and iodinated contrast medium exposure.

Two cases of bilateral ureteric rupture in dogs are reported. Both dogs were presented following road traffic accidents with signs of depression and abdominal distension. Both animals were azotaemic and abdominal fluid analysis was consistent with uroabdomen. In case 1, the injuries affected the proximal portion of both ureters and the dog was euthanased. In case 2, the ruptures were located more distally and a ureteroneocystostomy was performed, with contralateral ureteronephrectomy. This dog is clinically normal 16 months postoperatively.

Alveolar echinococcosis (AE), a parasitic disease primarily of the liver caused by the larval stage of Echinococcus multilocularis, is highly endemic in Switzerland. In contrast to well-established management protocols in people, little is known with regard to optimal treatment strategies in dogs. The objective of this study was to describe the clinical signs and diagnostic procedures in dogs with AE and to evaluate outcome following medical treatment alone or surgery and medical treatment. Of 23 putative AE cases between 2004 and 2014, 20 were classified as confirmed (n=18) or probable (n=2) AE, based on abdominal ultrasound, serology, cytology, histology and/or PCR. Most dogs presented with abdominal distension in an advanced stage of disease. Dogs receiving specific treatment (radical or debulking surgery together with medical treatment, or medical treatment alone) survived longer than dogs left untreated, but no difference was found between treatment types. Survival at one year was associated with absence of free abdominal fluid, absence of abdominal distension and treatment of any type. However, dogs treated with debulking surgery all faced relapse. Findings of this study suggest that in AE-affected dogs for which a therapeutic approach is regarded appropriate by owners and veterinarians, radical surgical resection and medical treatment or, if total resection is not possible, medical treatment alone should be considered. However, studies on larger numbers of dogs are necessary before definitive treatment recommendations can be made.

CONGENITAL diaphragmatic hernias have been well documented in shar-pei dogs (Callan and others 1993). The presenting signs are usually regurgitation, vomiting and hypersalivation. Ascites has not been reported in congenital or acquired diaphragmatic hernias. This short communication describes a congenital hiatal hernia in a shar-pei dog that presented with ascites caused by a mechanical obstruction of the caudal vena cava (Budd–Chiari-like syndrome [BCLS]) (Van der Linde-Sipman and Stokhof 1974). A six-month-old male shar-pei dog was referred with a two-week history of regurgitation, abdominal enlargement and lethargy. There was no history of trauma. Physical examination revealed marked fluid distension of the abdomen, pitting oedema of the pelvic limbs (Fig 1), enlarged prescapular lymph nodes and a slight pyrexia (39·0°C). The initial diagnostic evaluation included serum biochemistry, haematology, urinalysis and analysis of abdominal fluid following paracentesis. Serum biochemistry demonstrated panhypoproteinaemia (albumin 20 g/l, reference range 29 to 36 g/l, globulin 19 g/l, reference range 28 to 42 g/l) and hypocalcaemia that was probably due to the hypoalbuminaemia. Mild hyperglycaemia and leucocytosis (monocytosis and neutrophilia), which were attributed to stress, were also identified. The urinalysis was unremarkable. The abdominal fluid was found to have a protein content of 28 g/l and a cell count of 0·375 x 109/l consisting of non-degenerate neutrophils, occasional eosinophils and a few macrophages. The enlarged lymph nodes were attributed to vascular congestion and were not investigated. A radiograph of the thorax demonstrated a large, soft tissue opacity containing some gas shadows in the caudo dorsal right thorax. An area of alveolar infiltrate partially obscured the cardiac silhouette. Loss of abdominal serosal detail secondary to a peritoneal effusion was evident (Fig 2). Abdominal ultrasonography confirmed the presence of moderately echogenic free fluid within the abdomen. The diaphragm appeared indistinct at the mid-ventral level. One liver lobe was identiVeterinary Record (2006) 159, 322-323

A 7-year-old, male neutered Rhodesian Ridgeback dog was referred to the University of California-Davis Veterinary Medical Teaching Hospital with a 4-month history of peritonitis and episodic abdominal discomfort, lethargy, and weakness. Marked abdominal distension with a prominent fluid wave was noted on physical examination. Cytologic analysis of the abdominal fluid indicated a septic exudate with mixed bacteria and many protozoal zoites. Differentials for the identity of the protozoal zoites included Toxoplasma gondii, Sarcocystis neurona, and Neospora caninum. Indirect latex agglutination antigen testing, standard indirect fluorescent antibody testing, and PCR analysis were performed to identify the zoites. The dog's serum antibody titer for N caninum tachyzoites was 1:20,480, known polysera to N caninum reacted against zoites in the abdominal fluid, and PCR analysis of the abdominal fluid was positive for the presence of a known gene of N caninum. Based on the morphologic, immunologic, and molecular findings, the zoites were identified as N caninum. It remains unclear how the tachyzoites gained access to the peritoneal cavity. To the authors' knowledge, there are no reports of free N caninum in abdominal fluid of any species.

The timely diagnosis of perforations or dead gut can be extremely difficult in micropremmies with necrotizing enterocolitis. A negative laparotomy is just as detrimental as failure to recognize early perforation in this group of patients. We have been exploring the role of microlaparoscopy using a needlescope to determine if this modality is feasible and useful in the surgical management of these patients. We report our technique and initial experience with needlescopic diagnosis. Four patients (weight >500 to

Enterotoxemia caused by Clostridium perfringens type D is a highly lethal disease of sheep, goats and other ruminants. The diagnosis of this condition is usually confirmed by detection of epsilon toxin, a major exotoxin produced by C. perfringens types B and D, in the intestinal content of affected animals. It has been suggested that other body fluids can also be used for detection of epsilon toxin. This study was performed to evaluate the usefulness of intestinal content versus other body fluids in detecting epsilon toxin in cases of sheep enterotoxemia. Samples of duodenal, ileal and colon contents, pericardial and abdominal fluids, aqueous humor and urine from 15 sheep with experimentally induced enterotoxemia, were analysed for epsilon toxin using a capture ELISA. Epsilon toxin was detected in 92% of the samples of ileal content, 64% of the samples of duodenal content, 57% of the samples of colon content and in 7% of the samples of pericardial fluid and aqueous humor. No epsilon toxin was found in samples of abdominal fluid or urine from the animals with enterotoxemia or in any samples from six clinically healthy sheep used as negative controls. The results of this study indicate that with the diagnostic capture ELISA used, intestinal content (preferably ileum) should be used for C. perfringens type D epsilon toxin detection in suspected cases of sheep enterotoxemia.

AIM: To investigate the sonographic features at time of diagnosis and follow-up in patients with neutropenic enterocolitis. METHODS: The sonographic findings in 14 patients with neutropenic enterocolitis were described and evaluated regarding symptoms and clinical outcome. RESULTS: In all patients with neutropenic enterocolitis, the ileocoecal region was involved with wall thickening >10 mm. A transmural inflammatory pattern, hypervascularity of the thickened bowel wall and free abdominal fluid were the common findings. The sonographically revealed thickness of the bowel wall was associated with lethal outcome (P

To compare the clinical outcome of needle aspiration versus percutaneous catheter drainage of sterile fluid collections in patients with acute pancreatitis. We reviewed the clinical and imaging data of patients with acute pancreatic fluid collections from 1998 to 2003. Referral for fluid sampling was based on elevated white blood cell count and fevers. Those patients with culture-negative drainages or needle aspirations were included in the study. Fifteen patients had aspiration of 10–20 ml fluid only (group A) and 22 patients had catheter placement for chronic evacuation of fluid (group C). We excluded patients with grossly purulent collections and chronic pseudocysts. We also recorded the number of sinograms and catheter changes and duration of catheter drainage. The CT severity index, Ranson scores, and maximum diameter of abdominal fluid collections were calculated for all patients at presentation. The total length of hospital stay (LOS), length of hospital stay after the drainage or aspiration procedure (LOS-P), and conversions to percutaneous and/or surgical drainage were recorded as well as survival. The CT severity index and acute Ransom scores were not different between the two groups (p = 0.15 and p = 0.6, respectively). When 3 crossover patients from group A to group C were accounted for, the duration of hospitalization did not differ significantly, with a mean LOS and LOS-P of 33.8 days and 27.9 days in group A and 41.5 days and 27.6 days in group C, respectively (p = 0.57 and 0.98, respectively). The 60-day mortality was 2 of 15 (13%) in group A and 2 of 22 (9.1%) in group C. Kaplan–Meier survival curves for the two groups were not significantly different (p = 0.3). Surgical or percutaneous conversions occurred significantly more often in group A (7/15, 47%) than surgical conversions in group C (4/22, 18%) (p = 0.03). Patients undergoing catheter drainage required an average of 2.2 sinograms/tube changes and kept catheters in for an average of 52 days. Aspirates turned culture-positive in 13 of 22 patients (59%) who had chronic catheterization. In group A, 3 of the 7 patients converted to percutaneous or surgical drainage had infected fluid at the time of conversion (total positive culture rate in group A 3/15 or 20%). There is no apparent clinical benefit for catheter drainage of sterile fluid collections arising in acute pancreatitis as the length of hospital stay and mortality were similar between patients undergoing aspiration versus catheter drainage. However, almost half of patients treated with simple aspiration will require surgical or percutaneous drainage at some point. Disadvantages of chronic catheter drainage include a greater than 50% rate of bacterial colonization and the need for multiple sinograms and tube changes over an average duration of about 2 months.

Objective—To establish a focused assessment with sonography for trauma (FAST) protocol in dogs, determine whether FAST can be performed by veterinary clinicians without extensive ultrasonographic experience, and assess the frequency of free fluid (as determined via FAST) in the abdominal cavity of dogs following motor vehicle accidents (MVAs).Design—Prospective study.Animals—100 client-owned dogs evaluated within 24 hours of an MVA.Procedure—Dogs were placed in lateral recumbency for the FAST examination. To detect fluid in the abdomen, 2 ultrasonographic views (transverse and longitudinal) were obtained at each of 4 sites (just caudal to the xiphoid process, on the midline over the urinary bladder, and at the left and right flank regions).Results—In the 100 dogs evaluated via FAST, free abdominal fluid was detected in 45 dogs. In 40 of those 45 dogs, abdominocentesis was performed; hemoperitoneum and uroperitoneum were diagnosed in 38 and 2 dogs, respectively. Compared with dogs that had no free abdominal fluid detected via FAST, dogs that had free abdominal fluid detected via FAST had significantly higher heart rates and serum lactate concentrations and significantly lower PCVs and total solid concentrations.Conclusions and Clinical Relevance—Results indicate that FAST is a simple and rapid technique that can be performed on dogs in an emergency setting to detect intra-abdominal free fluid and can be performed by veterinary clinicians with minimal previous ultrasonographic experience. (J Am Vet Med Assoc2004;225:1198–1204)

Abdominal pseudocyst (APC) is an uncommon complication of ventriculoperitoneal shunts. Various predisposing factors have been attributed to it, including the presence of infection and multiple shunt revisions. We reviewed the records of shunt revisions performed over a 20-year period. During that time, 64 cases of APC were found in 36 patients. The records were then reviewed for the presence of infection, history of necrotizing enterocolitis, prior abdominal surgery, and treatment performed. Of the cases of APC, 46 were primary and 18 were recurrent. A history of prior abdominal surgery other than shunt revision was found in 47% of patients and a history of necrotizing enterocolitis was found in 19% of patients. The average number of prior shunt revisions was 4.1 per patient. Shunt infection as defined by positive cultures of either cerebrospinal fluid or abdominal fluid was present in only 23% of cases of APC. A history of prior shunt infection was present in 30% of patients. Infection was treated by shunt removal, external ventricular drainage, and appropriate antibiotics. After the infection was cleared or if no infection was present, treatment consisted of: (1) repositioning the distal catheter into the peritoneum, (2) repositioning the distal catheter into the pleural space, the atrium, or the gallbladder, (3) exploratory laparotomy with lysis of adhesions and repositioning the peritoneal catheter, (4) APC aspiration only, or (5) shunt removal or disconnection. Because of the complexity of APC management, we analyzed the outcomes of our cases and outlined an algorithm to simplify this process.

Lymphocele can be a difficult diagnosis to establish and may be confused for other abdominal fluid collections. Conversely, pancreatic pseudocysts may occur inadvertently from upper abdominal surgery and must be included in the differential diagnosis of virtually all peripancreatic fluid collections. We report the unusual occurrence of an unsuspected postoperative peripancreatic lymphocele that was thought to be a pancreatic pseudocyst. In retrospect, CT findings were evident and diagnostic. The lymphocele responded well to percutaneous drainage.

A 6-year-old castrated male Dalmatian was evaluated because of hematemesis. The dog had lived its entire life in South Dakota and Wyoming and had never traveled outside of these states. Results of laboratory testing were compatible with iatrogenic acute renal failure and gastrointestinal tract ulceration secondary to previous nonsteroidal anti-inflammatory drug and corticosteroid administration. Differential diagnoses for clinical signs and laboratory abnormalities that existed prior to these treatments included multisystemic infectious or inflammatory disease and neoplasia. Four-quadrant abdominocentesis did not yield any fluid, but because intra-abdominal disease was still suspected, diagnostic peritoneal lavage was performed. Fluid that was obtained was markedly cellular, and there were numerous extracellular structures with a round to oval shape; a 1-microm-thick, clear-staining capsule; a basophilic interior; and broad-based budding. Organisms were consistent with Blastomyces spp, and fungal culture yielded Blastomyces dermatitidis. Treatment with liposomal amphotericin B and itraconazole was recommended but could not be initiated because of the client's financial constraints. At necropsy, disseminated blastomycosis involving the stomach, small intestines, urinary bladder, omentum, mesentery of the small intestine, and abdominal wall musculature was seen. To our knowledge, peritoneal involvement has not been reported in dogs with blastomycosis, and gastrointestinal tract involvement has only rarely been reported. Findings in this dog suggest that diagnostic peritoneal lavage may be a useful technique in determining the cause of infectious peritonitis when the amount of abdominal fluid is below the limit of detection for abdominocentesis.

Objective—To identify the most common causes of pneumoperitoneum in dogs and cats and determine history, clinical features, and outcome of affected animals. Design—Retrospective study. Animals—31 dogs and 8 cats. Procedures—Medical records were reviewed for signalment; history; abnormal physical, clinicopathologic, and radiographic findings; results of cytologic analysis and bacterial culture of abdominal fluid; gross and histologic findings at surgery or necropsy; and outcome. Results—Pneumoperitoneum was classified as spontaneous in 25 animals and traumatic in 14. Causes of traumatic pneumoperitoneum included vehicular impact, gunshot wounds, abdominal dog bite wounds, and iatrogenic pneumothorax. Spontaneous pneumoperitoneum was caused by gastrointestinal tract perforation in 23 animals; underlying causes included neoplasia, nonsteroidal anti-inflammatory drug administration, and corticosteroid administration. Two animals developed spontaneous pneumoperitoneum after bladder rupture. Animals with spontaneous pneumoperitoneum were significantly older and had clinical signs of longer duration than those with traumatic pneumoperitoneum. Sixteen animals survived, including 15 of 23 animals that underwent surgery. Animals that survived had significantly higher serum albumin concentrations than did animals that died or were euthanatized. Conclusions and Clinical Relevance—Although pneumoperitoneum is most often attributable to perforation of a hollow viscus, other causes do exist. Early exploration is recommended for diagnosis and treatment of the underlying condition. (J Am Vet Med Assoc 2003;223:462–468)

A 2-year-old intact female mixed-breed dog with a 1-month history of lethargy and anorexia was evaluated for abdominal distension and an abdominal mass. The dog's last heat cycle, her third, was 1 month prior to presentation, and no reproductive cycle abnormalities were noted at any time. Hematologic and serum biochemical abnormalities were consistent with hemorrhage and inflammation. Ultrasonographic examination confirmed a large midabdominal mass and a moderate amount of abdominal fluid. Cytologically, the fluid showed evidence of pyogranulomatous inflammation, hemorrhage, and mesothelial reactivity, as well as ciliated columnar cells and free cilia that were interpreted as likely of oviductal origin. The mass was removed surgically, and the histopathologic interpretation was oviductal hamartoma with marked stroma formation and acute hemorrhage. To the authors' knowledge, this is the first reported case of oviductal hamartoma in any species and the first reported case detailing the finding of ciliated columnar epithelial cells in the abdominal fluid of a dog. Ciliated columnar epithelial cells in abdominal fluid should be considered indicative of a likely underlying oviductal lesion.

OBJECTIVE: The objective of this study is to evaluate the benefits of drainage in the Stoppa procedure for inguinal repair. PATIENTS AND METHODS: The use of a suction drain was randomized at the end of the surgical intervention in 26 male patients undergoing inguinal hernia repair, divided into 2 groups: Group A, 12 patients undergoing drainage, and group B, 14 patients not undergoing drainage. On the second postoperative day, all patients underwent abdominal pelvic computed tomography scan examination to detect the presence of abdominal fluid collection. RESULTS: In group A, no patient developed fluid collection in the preperitoneal space, and 1 patient presented with an abscess in the preperitoneal space on the 15th postoperative day. In group B, 12 patients presented with fluid collections in the preperitoneal space on computed tomography scan evaluation. However, only 3 patients presented minor complications. None of the patients developed a major complication. CONCLUSION: The use of suction drainage with the Stoppa procedure does not provide any benefit. OBJETIVO: O objetivo do presente estudo é avaliar os benefícios da drenagem no procedimento de Stoppa no tratamento da hérnia inguinal. PACIENTES E MÉTODOS: O uso da drenagem de aspiração contínua foi randomizado ao final do procedimento cirúrgico em 26 pacientes submetidos à correção da hérnia inguinal e divididos em dois grupos: Grupo A, com 12 pacientes submetidos à drenagem e Grupo B, com 14 pacientes não submetidos à drenagem. No segundo dia de pós-operatório, todos os pacientes foram submetidos à tomografia computadorizada de abdome para a verificação de coleções abdominais. RESULTADOS: No Grupo A, nenhum paciente apresentou coleção no espaço pré-peritonial. Por outro lado, um paciente desenvolveu abcesso no espaço pré-peritonial no décimo quinto dia de pós-operatório. No Grupo B, 12 pacientes apresentaram coleção pré-peritonial à tomografia. Entretanto, somente três apresentaram complicações menores. Nenhum paciente apresentou complicação maior. CONCLUSÃO: O uso de drenagem de aspiração contínua no procedimento de Stoppa não traz nenhum benefício.

A 5-year-old female spayed Dachshund was evaluated at the Louisiana State University (LSU) Veterinary Teaching Hospital and Clinics for chronic diarrhea, vomiting, weight loss, and decreased appetite for 8 weeks. On physical examination, the dog was bright, alert, and responsive and in poor body condition. Cutaneous lesions were not found, and abdominal palpation was within normal limits. A CBC and serum biochemical profile were performed (Table 1). Abdominal ultrasonographic examination revealed moderate anechoic abdominal effusion, corrugation of the small intestine, including the duodenum, and marked thickening of the muscularis layer with preserved layering of the duodenal wall. The liver was hyperechoic with rounded margins, and the spleen was diffusely heterogeneous. Fineneedle aspirates and a tru-cut biopsy of the liver were collected. Endoscopic examination revealed an irregular and thickened, ulcerated, pale duodenal mucosa, and multiple pinch biopsies of duodenum were obtained. Abdominal fluid was blood-tinged, but cleared after centrifugation, and had a total nucleated cell count of 4800/lL and refractometric total protein concentration of 4.1 g/dL. Smears of concentrated abdominal fluid were examined (Figure 1). Figure 1. Concentrated abdominal fluid from a dog. Wright–Giemsa, bar = 10 lm. Table 1. Selected CBC and serum biochemical results from a Dachshund with abdominal effusion.