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

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

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

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

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

Background Ultrasonographically detected gallbladder wall edema (GBWE) is a marker for anaphylaxis in dogs. Cardiac disease can cause GBWE with similar signs and should be included as a differential diagnosis to prevent interpretation errors. Hypothesis/objectives Document GBWE associated with cardiac disease. Animals Fourteen client-owned animals. Methods Prospective case series with abdominal focused assessment with abdominal sonography in trauma, triage and tracking (AFAST), and thoracic focused assessment with abdominal sonography in trauma, triage, and tracking (TFAST) performed at triage. Animals with GBWE and cardiac disease were enrolled. A board-certified radiologist reviewed images to confirm cardiac disease, GBWE, and characterize the caudal vena cava (CVC) and hepatic veins. Results Thirteen dogs and 1 cat had GBWE associated with cardiac disease. Gallbladder findings included mural thickness ranging from 3 to 5 mm, mild to moderate sludge (n = 3), and mild to moderate luminal distension (n = 6). CVC and hepatic venous distension were found in 5/6. Cardiac diagnoses in dogs included 11 with pericardial effusion (PCE) and 1 each with dilated cardiomyopathy and right-sided myocardial failure. Severity of PCE was rated as mild (n = 1), moderate (n = 6), or severe (n = 4). Seven of 11 had pericardiocentesis performed. Nine of 13 had ascites with 4 having abdominal fluid scores of 1 (n = 2), 2 (n = 2), 3 (n = 1), and 4 (n = 0). Lung ultrasound findings were as follows: dry lung (n = 6), B-lines (n = 4), and nodules (n = 1). The cat had moderate PCE, ascites scored as 1, and severe right-sided ventricular enlargement associated with a ventricular septal defect. Primary presenting complaints included acute weakness (n = 9), acute collapse (n = 5), gastrointestinal signs (n = 3), respiratory distress (n = 2), and need for cardiopulmonary resuscitation (n = 1). Conclusions and clinical importance Ultrasonographically detected GBWE was associated with PCE in this small cohort of cases.

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

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

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

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

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

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

Background Subcapsular hematoma of the liver is a potentially life-threatening but extremely rare condition. It is often caused by a blunt trauma or other predisposing conditions such as a liver tumor, intra-tumor hemorrhage, surgery, preeclampsia, liver biopsy, and hemodialysis. Predisposing causes of liver hematoma include its large size and proximity to fixed structures. To date, there have been no reported cases of subcapsular liver hematoma caused by tight clothing such as corsets. Our case report is about an extremely rare case of subcapsular hematoma of the liver caused by wearing a tight faja corset in a young healthy female. Case presentation A forty-five-year-old Spanish female without any underlying health problems presented with sudden onset epigastric and right upper quadrant abdominal pain after wearing a faja corset the night prior to the hospital presentation. CT abdomen was noted for subcapsular hematoma of the liver. Her symptoms persisted and repeat CT abdomen showing worsening of the liver hematoma. Patient had interventional radiology (IR) guided drainage and was subsequently discharged home. Conclusions Subscapular liver hematomas need to be considered in patients presenting with acute onset abdominal pain after wearing certain tight clothing. The necessity of an early and accurate diagnosis is vital for management as hemodynamically stable patients can be managed conservatively. Our patient was managed with IR-guided aspiration drainage of the hematoma. Surgery can be considered a last resort in case of life-threatening hemodynamic instability, peritoneal signs, free abdominal fluid, and failure of arterial embolization. Our case highlights the importance of early recognition of traumatic subcapsular hematomas to prevent life-threatening complications.

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

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

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

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

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

Background Postoperative pancreatic fistula (POPF) is one of the most harmful complications after pancreatic resection. Efficient drainage affects the clinical outcome of POPF. Inefficient drain of the fluid collection should contribute greatly to the need of additional interventional drainage, secondary morbid complications, and death. Methods A rat model of POPF was established by distal pancreatosplenectomy. A novel active drain system (ADS) for POPF was developed by wrapping polyvinyl alcohol sponges (PVA) to an end of the drainage tube. Passive drain system (PDS), ADS and ADS with PVA were used for POPF in rat models. The volume and amylase of ascites were measured. CT scan was applied to assess abdominal fluid collection. Rats pancreatic transection stumps were stained by hematoxylin and eosin (H&E). Results The volume of drainage of ADS with PVA group was less than that of PDS group and ADS group at late stage. CT scan showed obvious abdominal fluid collections in 2/8, 2/8 and 0/8 rats in PDS, ADS and ADS with PVA group separately. Macrofindings showed significant intra-abdominal adhesions and inflammation in PDS and ADS group but not in ADS with PVA group. H&E staining showed less inflammatory cells and destroyed pancreatic glands in ADS with PVA group. Conclusion ADS with PVA drained ascites effectively in the rat model of POPF. The effective drainage of pancreatic juice reduced the inflammation of abdominal organs and pancreatic resection stumps, and might promote the healing of POPF., Highlights • The first experiment for active drain system with reticulated open-pore foam-surface dressing for postoperative pancreatic fistula (POPF). • The drain system drained ascites effectively. The effective drainage of pancreatic juice reduced the inflammation of abdominal organ and pancreatic resection stumps, and may promote the healing of POPF. • The drain system has great potential of clinical use to improve the outcome of POPF.

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

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

Background Non-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19–9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19–9 level. Case presentation The patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient’s serum levels of CA19–9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19–9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19–9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery. Conclusion Laparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.

Introduction We evaluated the diagnostic reliability of serum polymerase chain reaction (PCR) versus blood culture, abdominal fluid or both (composite measure) in patients receiving empirical antifungal treatment for suspected invasive candidiasis. Methods This observational, prospective, non-interventional, multicentre study in Spain enrolled 176 critically ill patients admitted to the intensive care unit. Separate blood samples for culture and serum PCR were taken before the start of antifungal therapy. Patient assessment was performed according to each site’s usual clinical practice. The primary end point was concordance between serum PCR and blood culture. Secondary end points were concordance between serum PCR and a positive abdominal fluid sample or the composite measure. Quality indices included sensitivity, specificity, positive/negative predictive values (PPV/NPV) and kappa indices. Results Among 175 evaluable patients, rates of Candida detection were similar for serum PCR (n = 16/175, 9.1%) versus blood culture (n = 14/175, 8.0%). Quality indices for serum PCR relative to blood culture were: sensitivity 21.4%; specificity 91.9%; PPV 18.8%; NPV 93.1%; kappa index 0.125. Thirty-two abdominal fluid samples were positive. Quality indices for serum PCR versus abdominal fluid were: sensitivity 31.3%; specificity 83.0%; PPV 15.6%; NPV 92.3%; kappa index 0.100. Quality indices for serum PCR versus the composite measure were: sensitivity 15.8%; specificity 92.7%; PPV 37.5%; NPV 79.9%; kappa index 0.107. Conclusion The sensitivity of serum PCR for Candida detection was low and the rate of concordance was low between serum PCR and the other diagnostic techniques used to identify Candida infections. Hospital-based diagnostic tests need optimising to improve outcomes in patients with suspected invasive candidiasis. Funding Astellas Pharma Inc. Electronic supplementary material The online version of this article (10.1007/s40121-019-0248-z) contains supplementary material, which is available to authorized users.

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

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

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

Background Tuberculous appendicitis is a rare extrapulmonary manifestation of tuberculosis without clear summarization or consensus on its management. Data sources Case reports were gathered from several online literature databases by searching terms “tuberculosis”, “tuberculous”, and “appendicitis”. Report eligibility criteria: Cases of appendicitis due to M. tuberculosis identified on operative histology. Exclusion criteria: appendicitis caused by a mycobacterium other than M. tuberculosis, and appendiceal tuberculosis identified incidentally during procedures for other reasons. Results Thirty four patients were identified. Twenty five patients presented with acute right lower quadrant abdominal pain. Eleven patients described chronic symptoms of tuberculosis (cough, night sweats, or weakness/fatigue). Four patients had a known diagnosis of TB. Seven of 24 cases reported peri-operative chest imaging which demonstrated pulmonary lesions. AFB were present in tissue or fluid samples of 6 patients, and negative in 15 patients. All patients underwent pharmacotherapy on a WHO-recommended anti-tuberculous treatment (ATT) with RIPE or an alternative. The average duration of treatment was 7.2 ± 1.7 months. Limitations Data was gathered from case reports without complete uniformity in diagnostic work-up. The potential for larger scale study is limited due to disease rarity. Conclusions Tuberculous appendicitis cannot be diagnosed prior to histologic evaluation. Several data points may suggest the disease on a clinician's differential diagnosis if they present with a combination of the following: born in a country with endemic tuberculosis; chronic cough, weakness/fatigue, or nausea prior to onset of abdominal pain; pulmonary lesions on chest X-ray; white studding of the mesentery or peritoneum in a young patient; positive AFB stain of abdominal fluid or peritoneal tissue.

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

Background : The term “rabbit gastrointestinal syndrome” (RGIS) refers to a decrease in peristaltic movements, which in some cases can progress to absolute inactivity of the digestive apparatus. This condition is mostly secondary to others that promote changes in gastrointestinal motility, such as dehydration, fiber deficiency, excess carbohydrates in diets, stress, and acute or chronic painful processes. Clinical manifestations are mostly nonspecific. Thus, a case of RGIS resulting from environmental change in a domestic rabbit ( Oryctolagus cuniculus ) is reported. Case : A 4-month-old male domestic rabbit weighing 0.962 kg was referred to a university veterinary hospital. The patient had a history of absence of defecation and anorexia for the past two days. The owner reported that the patient was apathetic but became aggressive when manipulated. The changes started after a move of residence. On physical evaluation, an increase in abdominal volume and a painful response to touch on the abdomen were observed. Complementary examinations were performed, such as a blood count and an ultrasound study. The blood tests showed no alterations, but the ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic structure associated with acoustic shading in the small intestine, all findings suggestive of obstruction. Given the failure of clinical management, the patient was referred for an exploratory laparotomy procedure followed by enterotomy. The obstruction point was located near the ileocecal junction. After surgery, analgesics, antibiotics, fluid therapy, anti-inflammatory drugs, intestinal motility inducers, and probiotics were prescribed. One week after the surgical procedure, the patient showed improvement in the clinical condition, with normal appetite, defecation, and docility. Discussion : RGIS is diagnosed based on the clinical history, clinical manifestations, and complementary examinations. In the reported case, the patient presented apathy, anorexia, absence of defecation, and aggressiveness on manipulation, which were associated with abdominal pain. In cases of RGIS, hematological changes may or may not be present, which matches the findings in this report. Imaging exams provide important information, such as the patient’s condition and evolution. Ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic, immobile acoustic shading structure in the small intestine. Ultrasound findings were compatible with those found in cases of foreign-body obstructions, a common complication in RGIS. Initially, a clinical approach was taken, but in view of the unfavorable evolution of the case, with worsening motility and alterations in the imaging examination, a surgical approach was instituted. Intestinal obstructions in rabbits are usually found either in the proximal duodenum or near the ileocecal junction. In the presently reported patient, an obstruction was identified in the ileocecal junction region and the content found was composed of hair and dehydrated food. There are several conditions that can alter intestinal peristalsis in rabbits; in the present case, it was considered that the distress caused by moving to a new household led to a condition of RGIS. Despite the reserved prognosis associated with surgical interventions in the gastrointestinal system of rabbits, as described in the literature, in the present case this approach made it possible to preserve the patient’s life, which returned to its normal activities and behavior.

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

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

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

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

Background:The extravasation of fluid into the intra-abdominal space is recognized as a possible complication of hip arthroscopic surgery/endoscopy. The exposure of anatomic areas to elevated pump pressures and high volumes of irrigation fluid increases the risk of fluid leakage into anatomic spaces around the hip joint, especially to the abdomen and pelvis.Purpose:To estimate the incidence and risk factors related to intra-abdominal fluid extravasation (IAFE) after hip endoscopy or arthroscopic surgery.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective study was carried out between June 2017 and June 2018. A total of 106 hip procedures (endoscopy or arthroscopic surgery) performed for extra- or intra-articular abnormalities were included. Before and after surgery, in the operating room, ultrasound was performed by a trained anesthesiologist to detect IAFE. The hepatorenal (Morison pouch), splenorenal, retroaortic, suprapubic (longitudinal and transverse), and pleural spaces were examined. Patients were monitored for 3 hours after surgery to assess for abdominal pain. The data collected included maximum pump pressure, duration and volume of irrigation fluid (Ringer lactate), total surgical time, and traction time.Results:The incidence of IAFE was 31.1% (33/106; 95% CI, 23.1%-40.5%). The frequency of IAFE was 52.9% (9/17) in cases with isolated extra-articular abnormalities and 15.9% (7/44) in cases with isolated femoroacetabular impingement; in cases with both extra- and intra-articular abnormalities, the frequency was 37.8% (17/45). An intervention in the subgluteal space was identified as a risk factor for IAFE (odds ratio, 3.62 [95% CI, 1.47-8.85]). There was no statistically significant difference between groups (with vs without IAFE) regarding total surgical time, maximum pump pressure, or fluid volume. Postoperative abdominal pain was found in 36.4% (n = 12) of cases with IAFE compared with 2.7% (n = 2) of cases without extravasation ( P < .001). No patient with IAFE developed abdominal compartment syndrome.Conclusion:IAFE was a frequent finding after hip arthroscopic surgery/endoscopy in patients with extra-articular abnormalities. Exploration of the subgluteal space may increase the risk of IAFE. Pain and abdominal distension during the immediate postoperative period were early warning signs for IAFE. These results reinforce the need for careful intraoperative and postoperative monitoring by the surgeon and anesthesiologist to identify and avoid complications related to IAFE.

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

IntroductionNecrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases ahead of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in diagnosing and managing NEC.Methods and analysisThe hypothesis being tested is that preforming an AR in patients with clinical symptoms of NEC, but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at Ethics and disseminationThe Bioethical Committee of the Medical University of Warsaw has approved the study (KB 130/2017). We plan to submit our findings to international peer-reviewed journals. Abstract will be submitted to local and international conferences.Trial registration numberNCT03188380; Protocol version: V.2.08.2019; Pre-results.

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