Anastomotic leak management after a low anterior resection leading to recurrent abdominal compartment syndrome: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Low anterior resection is usually the procedure of choice for rectal cancer, but a series of complications often accompany this procedure. This case report describes successful management of an intricate anastomotic leak after a low anterior resection.</p> <p>Case presentation</p> <p>A 66-year-old Caucasian man was admitted to our hospital and diagnosed with a low rectal adenocarcinoma. He underwent a low anterior resection but subsequently developed fecal peritonitis due to an anastomotic leak. He was operated on again but developed abdominal compartment syndrome, multi-organ failure and sepsis. He was aggressively treated in the intensive care unit and in the operating room. Overall, the patient underwent four laparotomies and stayed in the intensive care unit for 75 days. He was discharged after 3 months of hospitalization.</p> <p>Conclusion</p> <p>Abdominal compartment syndrome may present as a devastating complication of damage control laparotomy. Prompt recognition and goal-directed management are the cornerstones of treatment.</p

Persistent omphalomesenteric duct causing small bowel obstruction in an adult

An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction. Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops; an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history. © 2007 The WJG Press. All rights reserved

Paraganglioma of the greater omentum: Case report and review of the literature

Background: Extra-adrenal, intra-abdominal paraganglioma constitutes a rare neoplasm and, moreover, its location in the greater omentum is extremely infrequent. Case presentation: A 46-year-old woman with an unremarkable medical history presented with an asymptomatic greater omentum mass that was discovered incidentally during ultrasonographic evaluation due to menstrual disturbances. Clinical examination revealed a mobile, non-tender, well-circumscribed mass in the right upper and lower abdominal quadrant. Blood tests were normal. Contrast-enhanced abdominal computed tomography (CT) scan confirmed a huge (15 × 15 cm), well-demarcated, solid and cystic, heterogeneously enhanced mass between the right liver lobe and right kidney. Exploratory laparotomy revealed a large mass in the greater omentum. The tumor was completely excised along with the greater omentum. Histopathology offered the diagnosis of benign greater omentum paraganglioma. After an uneventful postoperative course, the patient was discharged on the 4th postoperative day. She remains free of disease for 2 years as appears on repeated CT scans as well as magnetic resonance imaging (MRI) and scintigraphy performed with radiotracer-labeled metaiodobenzyl-guanidine (MIBG) scans. Conclusion: This is the second reported case of greater omentum paraganglioma. Clinical and imaging data of patients with extra-adrenal, intra-abdominal paragangliomas are variable while many of them may be asymptomatic even when the lesion is quite large. Thorough histopathologic evaluation is imperative for diagnosis and radical excision is the treatment of choice. Since there are no definite microscopic criteria for the distinction between benign and malignant tumors, prolonged follow-up is necessary. © 2007 Archontovasilis et al; licensee BioMed Central Ltd

Acinetobacter baumannii infections in a surgical intensive care unit: Predictors of multi-drug resistance

Objectives: This study was designed to evaluate Acinetobacter baumannii infections incidence in our Surgical Intensive Care Unit, clinical features and outcome of these patients, and multi-resistance incidence to identify predictors of such a resistance. Methods: Prospective study of all patients with ICU-acquired Acinetobacter baumannii infection from June 1, 2003 to May 31, 2005. Patients with multi-resistant infection, susceptible exclusively to colistin, were compared with those sustaining non-multi-drug resistant infection. Results: Among 411 patients, 52 (12.6%) developed Acinetobacter infection. Their mean age was 66.3 ± 8.4 years and APACHE II 20.4 ± 7.3 (men: 51.9%). Infection sites were: bloodstream (46.2%), respiratory tract (32.7%), central venous catheter (11.5%), surgical site (7.7%), and urinary tract (1.9%). High multi-resistance (44.2%), morbidity (63.4%), and mortality (44.2%) were identified. Colistin was the most effective antibiotic (100% susceptibility), whereas resistance against all other antibiotics was &gt;60%. Previous septic shock (p = 0.04), previous adult respiratory distress syndrome (ARDS) (p = 0.01), number of previous antibiotics (p = 0.01), previous aminoglycoside use (p = 0.04), and reoperation (p = 0.01) were risk factors for multi-resistance in univariate analysis. Morbidity in the multi-resistant group was significantly higher than the non-multi-resistant group (82.6% vs. 48.2%, p = 0.02). Mortality in the multi-resistant group also was higher; however, this difference did not marginally reach statistical significance (60.8% vs. 31.1%, p = 0.06). Multivariate analysis identified previous septic shock (p = 0.04; odds ratio (OR), 9.83; 95% confidence interval (CI), 1.003-96.29) and reoperation (p = 0.01; OR, 8.45; 95% CI, 1.52-46.85) as independent predictors of multi-resistance. Conclusion: Acinetobacter baumannii infections are frequent and associated with high morbidity, mortality, and multi-resistance. Avoidance of unnecessary antibiotics is a high priority, and specific attention should be paid to patients with previous ARDS and, particularly, previous septic shock and reoperation. When such risk factors are identified, colistin may be the only appropriate treatment. © 2008 Société Internationale de Chirurgie