How to deal with an open abdomen?

Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure

A prospective randomised control trial to study the role of intra-peritoneal instillation of ropivacaine versus normal saline irrigation in reduction of post-operative pain in patients undergoing laparoscopic cholecystectomy.

The study was done to compare the effect of intra-peritoneal instillation of ropivacaine versus normal saline irrigation on post operative abdominal pain and shoulder pain in laparoscopic cholecystectomy. Ninety patients with symptomatic gall stones disease undergoing laparoscopic cholecystectomy were randomized in three groups. In study group A (n=30 patients) 0.5% of 30 ml (150 mg) of ropivacaine was instilled at gall bladder bed, and in study group B (n=30) 0.9% of 25 – 30 ml/kg of normal saline irrigation was done at gall bladder bed and sub-diaphragmatic space or control group C (n=30) none of above two intervention was done. Pain abdomen is worse during first 24 hours after laparoscopic cholecystectomy. At 6 hours pain abdomen was significantly less in group A compared to group B (p<.035). At 12 hours pain abdomen was less in group A and group B compared to control group. Intensity of shoulder tip pain was almost similar in group A and group B. Group A experienced significantly reduced shoulder tip pain at 6hours and 12 hours as compared to group C. Group B experienced less shoulder tip pain during first postoperative day as compared to control group. Intra-peritoneal instillation of ropivacaine is more effective than normal saline irrigation at early post-operative hours in reducing post-operative pain abdomen after laparoscopic cholecystectomy. However, intra-peritoneal instillation of ropivacaine and normal saline irrigation are comparable in its effect on shoulder tip pain

An Annotated List of the Spittlebugs of Michigan (Homoptera: Cercopidae)

Excerpt: Representatives of the family Cercopidae are commonly known as spittlebugs because the nymphs cover themselves with saliva-like frothy masses composed of bubbles of air trapped by motions of the abdomen in fluids discharged from the alimentary canal. Spittle protects nymphs from desiccation, but they are able to abandon it for brief periods while migrating to new feeding sites or to other host plants where new masses are produced. Gas exchange by nymphs immersed in spittle is accomplished through spiraculae situated in a protective chamber formed on the ventral side of the abdomen by extended tergites

Splenic Trauma: should we treat differently?

A 36 year old male was admitted to Accident and Emergency Department following a motor vehicle accident. Clinical examination revealed a haemodynamically stable patient. Abdominal examination showed tenderness in right upper quadrant. Ultrasonography of the abdomen was normal. Haemoglobin on admission was 13 gm/dl. A repeated haemoglobin six hours later revealed a Hb of 10 gm/dl. Computerized tomography(CT) of the abdomen showed a ruptured spleen. As the patient was haemodynamically stable, it was decided to treat the patient in the HDU setting. His condition remained stable and he was fit to be discharged home on the fifth post-operative day.peer-reviewe

EFFICACY OF PNEUMATIC DILATATION FOR THE TREATMENT OF IDIOPATIC ACHALASIA: A SINGLE-CENTRE EXPERIENCE

Pneumatic dilatation (PD) and surgical miotomy (SM) are presentely the best treastments for untreated achalasia, with similar efficacy. There is no information on the relative efficacy of PD in younger compared to older patients. Aim of our study was to compare success rate and safety of PD patients under fifty years old in our Unit with graded PD under fluoroscopic view. Five male and 15 female with a median age of 47 years were treated. Twelve patients were less than fifthy years old (group I) while 8 were older (group II). Median dysphagia questionnaire score was 14 and 13 in group I and II respectively. Technical success was achieved in all patients. Seven patients were previously treated through other techniques. In group I all patients achieved a complete remission of symptoms with significant decrease of the dysphagia questionnaire (3). in group II all patients achieved a complete remissionof symptoms with significant decrease of the dysphagia questionnaire score (4,5) but 3 of them repeated the procedure. In boths groups the efficacy of the dilation was radiologically confirmed. Neither early nor late complications were reported in either groups. In our experience PD was an effective and safe procedure both in young and old patients although the older group had more recurrences, all successfully re-dilated

Contrast-enhanced ultrasonography in hepatosplenic sarcoidosis

We report a case of a 38-year-old woman with atypical pain in the left lower hemi-abdomen. On abdominal B-mode ultrasonography the liver was normal; the spleen showed multiple subcentimetric hypoechoic nodules. A multidetector CT-examination revealed multiple small low-attenuation nodules in the liver and the spleen, suggestive for metastatic disease. Contrast-enhanced ultrasound (CEUS) revealed two hypoechoic nodules in the liver that were visible in the portal phase and disappeared in the late phase. The focal splenic lesions were visible as irregular hypo-enhancing nodules. An MRI examination, including T1, T2 and contrast-enhanced images, could not confirm the exact nature of the lesions. A core biopsy of a splenic nodule yielded non-caseating epithelioid cell granulomas. Different complementary examinations were normal and hepatosplenic sarcoidosis was diagnosed. The pain in the left lower hemi-abdomen was ascribed to irritable bowel syndrome

Penetrating Abdominal Injury by a Large Stone

Penetrating trauma can be commonly caused by sharp objects. We report a case of penetrating injury of abdomen caused by a fairly large sized stone which is used for sharpening the objects or weapons. It pierced through the abdominal wall musculature and caused ileal transection, mesenteric tear and gastric perforation

Unusual cause of mechanical ileus: abdominal cocoon syndrome

A 38-year-old black male patient was admitted with diarrhea and nausea over two days and aggravating pain in the meso- and epigastium that resolved after urination. He had no surgical history and only an episode of pulmonary tuberculosis five years earlier, for which he was properly treated. Physical examination revealed a tender and distended abdomen with clangorous sounds. His temperature was 36.1°C. Routine laboratory blood analyses were normal. An abdominal ultrasound revealed diffuse distention of the small intestine. A computed tomography (CT) scan showed a conglomerate of dilated small bowel loops in the meso- and hypogastrium, suggestive for a supravesical mechanical small bowel obstruction. Peritoneal thickening was seen in the right epigastrium (Figure A, white arrow). An explorative laparoscopy revealed a whitish, thickened membrane encapsulating the small bowels as a ‘cocoon’ (Figure B). Extensive adhesiolysis released an intestinal kinking in the lower abdomen, just above the bladder. No resection was needed. Histopathology of the membrane showed fibrocollagenous tissue with mixed inflammatory infiltrate

Cornual Abscess Rupture: A Rare Etiology of Acute Abdomen

Ruptured cornual abscess or pyometra can resemble other more common causes of acute abdomen, including appendicitis, diverticulitis, tubo-ovarian abscess, and perforated viscus. Despite its rarity, the diagnosis of ruptured pyometra should always be considered in females presenting with acute abdominal pain, particularly in the setting of a retained intrauterine device