The Development of a Liver Abscess after Screening Colonoscopy: A Calculated Risk?

We present the case of a patient who developed a liver abscess following screening colonoscopy. A colorectal screening program was introduced in the Netherlands in 2014 in order to reduce mortality from colorectal cancer. The patient in this report, a 63-year-old man with no significant medical history, underwent polypectomy of two polyps. Four days afterwards he presented to our emergency department with fever, nausea and vomiting. He was diagnosed with a Klebsiella pneumoniae liver abscess and was successfully treated with antibiotics for 6 weeks. This case highlights one of the risks of screening colonoscopy. Given the high number of colonoscopies due to the colorectal screening programs, we should be aware of complications in this mostly asymptomatic group of patients

Spontaneous bacterial peritonitis : pathogenesis, diagnosis and management

Conclusie: Gedurende de periods 1987 -1992 werden 60 episoden van spontane bacteria Ie peritonitis geregistreerd bij 52 patienten. S8P bleak aen ernstige complicatie t6 zijn bij patienten met levercirrose en ascites met aen hoge mortaliteit en een lage 1 jaars overleving van 23% (Betrouwbaarheids interval 17%-35%). Dria van de 12 patienten die meer dan 1 jaar overleefden ontvingen een levertransplantatie. Toegenomen alertheid en bekendheid met het ziektebeeld van S8P, en aen lagere drempel om paracentese te verrichten met hierdoor vraagere behandelingsmogelijkheden hebben mogelijk geresulteerd in aen iets betera overleving dan gemeld in hoofdstuk 7. Verbeterde kweek tBchnieken en aen precieze leucocyten telling met differentiatie in de ascites dragsn bij tot een juiste diagnose stelling. Uit de literatuur zijn gegevens bekend dat het gebruik van selectieve darm decontaminatie, met als doel de gram negatieve flora te verminderen met het relatief sparen van de resterende anaerobe flora, bij patienten met een hoog risico op het krijgen van SSP, de incidentie van SSP doet afnemen. Echter, een episode van SSP dient geinterpreteerd te worden als een symptoom van ernstig levertalen en bij patienten die een dergelijke infectieuze complicatie ontwikkelen moet het verrichten van een levertransplantatie ernstig overwogen worden. Als zodanig is een doorgemaakte episode van SSP een van de vele factoren die meegenomen moeten worden in de vaak moeilijke besluitvorming over de noodzaak tot, en het tijdstip van een levertransplantatie.This thesis describes several aspects of spontaneous bacterial peritonitis in patients with cirrhosis of the liver and ascites. Most of the data discussed and submitted in this thesis are based on clinical studies during the years 1987-1992 at the Department of Internal Medicine II, University Hospital Rotterdam-Dijkzig

Life-threatening hypokalaemia and quadriparesis in a patient with ureterosigmoidostomy

We report quadriparesis as a result of severe hypokalaemia and acidosis in a 50-year-old man who had undergone ureterosigmoidostomy for bladder extrophy 48 years earlier. Aggressive suppletion with intravenous potassium and bicarbonate combined with potassium-sparing diuretics and ACE inhibitors resulted in complete restoration of the serum potassium and resolution of the neurological symptoms. The underlying mechanism as well as the treatment of hypokalaemia and hyperchloraemic metabolic acidosis after ureterosigmoidostomy are briefly discussed

Levels of soluble intercellular adhesion molecule 1, eicosanoids and cytokines in ascites of patients with liver cirrhosis, peritoneal cancer and spontaneous bacterial peritonitis

The levels of the eicosanoids leukotriene B4, prostaglandin E2, prostacycline and thromboxane B2, the cytokines interleukin-1β, interleukin-6 and tumour necrosis factor-α and soluble intercellular adhesion molecule 1 were measured in ascites and plasma samples of patients with liver cirrhosis (53), peritoneal cancer (26) and spontaneous bacterial peritonitis (10) to assess their value as a possible diagnostic and prognostic parameter in the course of the disease. Soluble intercellular adhesion molecule 1, of the eicosanoids prostaglandin E2 and leukotriene B4, and the protein concentration in ascites were all significantly elevated in ascites of patients with peritoneal cancer in comparison to ascites of patients with liver cirrhosis. In ascites of patients with spontaneous bacterial infection interleukin-6 concentration was significantly elevated and the protein concentration was significantly lower in comparison to the other two groups. None of these parameters, however, seems to be of practical use as a diagnostic parameter, as there is an overlap between all the levels of these mediators in ascites of liver cirrhosis, peritoneal cancer and spontaneous bacterial peritonitis group. Soluble intercellular adhesion molecule 1 levels were much higher in plasma than in ascites, in contrast to interleukin-6 levels which were much higher in ascites than in plasma. Soluble intercellular adhesion molecule 1 in ascites correlated with soluble intercellular adhesion molecule 1 in plasma (r = 0.6926, P = 0.0001). Soluble intercellular adhesion molecule 1, interleukin-6 and the number of polymorphonuclear cells in peritoneal fluid correlated during episodes of infection in patients with a peritonitis. For this reason soluble intercellular adhesion molecule 1 and interleukin-6 could be of prognostic value for patients with peritonitis