Case Of Peritonitis Research Articles

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.

Apache II Score as a Predictor of Mortality and Length of Treatment for Generalized Peritonitis Patients at Dr. Kariadi General Hospital Semarang Indonesia

Peritonitis can cause sepsis and septic shock, which can lead to death. The existence of a prognostic assessment to assess the progression of cases of peritonitis becomes urgent. This is due to the fact that peritonitis progresses very quickly, and delays in treatment and action will cause the patient's death. This study is a preliminary study with the aim of assessing the potential for developing the APACHE II score as a predictor of mortality in generalized peritonitis patients at Dr. Kariadi General Hospital Semarang Indonesia. This study is an observational study with as many as 22 research subjects, peritonitis patients at Dr. Kariadi General Hospital Semarang Indonesia. Univariate and bivariate analysis was conducted to determine the relationship between APACHE II score with mortality and length of treatment. The results of the study showed that the APACHE II score was positively correlated with moderate strength and statistically significant to the mortality of generalized peritonitis patients. APACHE II score is able to predict mortality but is not able to predict the length of treatment for generalized peritonitis patients at Dr. Kariadi General Hospital Semarang Indonesia.

Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in-hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study

BackgroundThe majority of the prognostic scoring tools for peritonitis are impractical in low resource settings because they are complex while others are quite costly. The quick Sepsis-related Organ Failure Assessment (qSOFA) score and the Physiologic Indicators for Prognosis in Abdominal Sepsis (PIPAS) severity score are two strictly bedside prognostic tools but their predictive ability for mortality of peritonitis is yet to be compared. We compared the predictive ability of the qSOFA criteria and the PIPAS severity score for in-hospital mortality of peritonitis.MethodThis was a prospective cohort study on consecutive peritonitis cases managed surgically in a tertiary hospital in Uganda between October 2020 to June 2021. PIPAS severity score and qSOFA score were assessed preoperatively for each case and all cases were then followed up intra- and postoperatively until discharge from the hospital, or up to 30 days if the in-hospital stay was prolonged; the outcome of interest was in-hospital mortality. We used Receiver Operating Characteristic curve analysis to assess and compare the predictive abilities of these two tools for peritonitis in-hospital mortality. All tests were 2 sided (p < 0.05) with 95% confidence intervals.ResultsWe evaluated 136 peritonitis cases. Their mean age was 34.4 years (standard deviation = 14.5). The male to female ratio was 3:1. The overall in-hospital mortality rate for peritonitis was 12.5%. The PIPAS severity score had a significantly better discriminative ability (AUC = 0.893, 95% CI 0.801–0.986) than the qSOFA score (AUC = 0.770, 95% CI 0.620–0.920) for peritonitis mortality (p = 0.0443). The best PIPAS severity cut-off score (a score of > = 2) had sensitivity and specificity of 76.5%, and 93.3% respectively, while the corresponding values for the qSOFA criteria (score > = 2), were 58.8% and 98.3% respectively.ConclusionsThe in-hospital mortality in this cohort of peritonitis cases was high. The PIPAS severity score tool has a superior predictive ability and higher sensitivity for peritonitis in-hospital mortality than the qSOFA score tool although the latter tool is more specific. We recommend the use of the PIPAS severity score as the initial prognostic tool for peritonitis cases in the emergency department.

Molecular Detection of Feline Coronavirus in Captive Non-Domestic Felids from Zoological Facilities.

Simple SummaryNon-domestic felids are well-known threatened species, and are susceptible to several diseases that also affect domestic cats. Among viral infections, fatal outbreaks of feline infectious peritonitis, caused by a feline coronavirus, have been reported in captive settings. Considering the devastating effects that this pathogen could have in non-domestic felids, the aim of this study was to assess the prevalence of feline coronavirus in captive non-domestic felids from Northern Italy, since in the literature, this information is not currently available. The overall prevalence of feline coronavirus in captive non-domestic felids from Northern Italy was 7.9%. Results of the present study highlight the need of control programs for feline coronavirus infection to prevent pathogen introduction into a naïve group of animals, which may lead to devastating effects on animal welfare and conservation programs.Cases of feline infectious peritonitis (FIP), a disease with a high mortality rate caused by the feline coronavirus (FCoV), have been reported in non-domestic felids, highlighting the need for surveys of FCoV in these endangered species. With the aim of adding information on FCoV prevalence in captive non-domestic felids, samples (feces or rectal swabs and, when available, oral swabs, blood, and abdominal effusion) collected between 2019 and 2021 from 38 non-domestic felids from three different zoological facilities of Northern Italy were tested for evidence of FCoV infection via RT-qPCR. Three animals were found to be FCoV positive, showing an overall 7.9% FCoV prevalence ranging from 0% to 60%, according to the zoological facility. FCoV infection was detected in tiger cubs of the same litter, and all of them showed FCoV-positive oral swabs, with low viral loads, whereas in one animal, FCoV presence was also detected in rectal swabs at low FCoV copy numbers. Future studies should be carried out, including samplings from a higher number of captive non-domestic felids, in order to gain a deeper knowledge of FCoV epidemiology within these populations.

Card9 protects fungal peritonitis through regulating Malt1-mediated activation of autophagy in macrophage

Fungal peritonitis is an inflammatory condition of the peritoneum which occurs secondary to peritoneal dialysis. Most cases of peritonitis are caused by microbial invasion into the peritoneal cavity, resulting in high morbidity and mortality. Unlike bacterial peritonitis, little is known on fungal peritonitis. Card9, an adapter protein, plays a critical role in anti-fungal immunity. In this study, by using zymosan-induced peritonitis and C. albicans-induced peritonitis mouse model, we demonstrated that fungal peritonitis was exacerbated in Card9-/- mice, compared with WT mice. Next, we found the autophagy activation of peritonealmacrophages was impaired in Card9-/- peritonitis mice. The autophagy agonist, MG132, ameliorated peritonitis in Card9-/- mice. The result of microarray analysis indicates Malt1 was significantly decreased in Card9-/- peritonitis mice. Furthermore, we demonstrated that Malt1 interacts with P62 and mediates the function of P62 to clear ubiquitinated proteins. After overexpression of Malt1, impaired autophagy activation caused by Card9 deficient was significantly rescued. Together, our results indicate that Card9 protects fungal peritonitis by regulating Malt1-mediated autophagy in macrophages. Our research provides a new idea for the pathogenesis of fungal peritonitis, which is of great significance for the clinical treatment of fungal peritonitis.

Socio-demographic Characteristics and its Association with Outcome in Secondary Peritonitis cases in a Tertiary Care Hospital

Background: Peritonitis still poses major problem for surgeons as far as morbidity and mortality is concerned. The aim of this study is to evaluate the Socio-demographic characteristics and its association with outcome in Secondary Peritonitis cases in a tertiary care Hospital. Material and Methods: This study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla over a period of twelve months from January 2022 – December 2022 and with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria were recruited. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: In this study, a total of 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99 (39.6%) patients were age less than 40 years while 151 (60.4%) patients were aged &gt; 40 years. Among the total, 32 (12.80%) were expired while 218 (87.20%) were discharged after treatment. Among the total 205 males, 19 (9.3%) were expired and 186 (90.7%) were discharged while among total 45 females 13 (28.9%) were expired and 32 (71.1%) were discharged. There was significant difference in mortality among males and females. Mean age of 32 expired patients was 59.16±13.32 years while mean age of 218 discharged patients was 45.49± 16.96 years. There was significant difference in mortality according to age. Among the total 205 Males mean BMI was 21.93±3.00 while among the total 45 females mean BMI was 20.68±2.46. Among the total 32 expired patients mean BMI was 22.69±3.54 while among the total 218 discharged patients mean BMI was 21.76 ±2.80. There was no significant difference in mortality according to BMI. Conclusion: In the present study maximum patients of secondary peritonitis were males and less than 40 years old. There was significant association of mortality with gender and age group.

Surgical Management of Secondary Peritonitis Patients in a Tertiary Care Hospital

Background: In the majority of general surgical units around the world, Secondary Peritonitis is the common surgical emergency and has high risk of morbidity and mortality. The present study was done to evaluate the surgical management among Secondary Peritonitis cases in a tertiary care Hospital. Material and Methods: This cross sectional study was conducted by Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 among patients with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: A total of 250 individuals with a diagnosis of perforation peritonitis were assessed in the current study. Males made up 205 (82%) of the total while females made up 45 (18%). The patients' average age was 47.28 17.34 years, ranging from 18 to 87. In the study, 99 (39.6%) of the total patients were under the age of 40, while 151 (60.4%) were beyond the age of 40. Of the total, 32 (12.80%) passed away while 218 (87.20%) were discharged after receiving treatment. In the present study, most of patients 89 (35.6%) of secondary peritonitis were managed by Cellan jones repair followed by Loop ileostomy in 43 (17.2%) patients End ileostomy in 27 (10.8%) patients and rest by other procedures. Conclusion: The study concluded that most of patients of secondary peritonitis were managed by Cellan jones repair followed by Loop ileostomy and End ileostomy.

Evaluation of Site of Perforation among Secondary Peritonitis Cases and its Association with Outcome in a Tertiary Care Hospital

Background: The present study was carried out to evaluate the Site of Perforation among Secondary Peritonitis cases and its association with outcome in a tertiary care Hospital. Material and Methods: This cross sectional study was conducted by Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 among patients with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: A total of 250 individuals with a diagnosis of perforation peritonitis were assessed in the current study. Males made up 205 (82%) of the total while females made up 45 (18%). The patients' average age was 47.28 17.34 years, ranging from 18 to 87. In the study, 99 (39.6%) of the total patients were under the age of 40, while 151 (60.4%) were beyond the age of 40. Of the total, 32 (12.80%) passed away while 218 (87.20%) were discharged after receiving treatment. The Most common cause was Duodenal perforation among 91 patients (36.4%), Gastric perforation among 83 patients (33.2%), Ileal perforation among 32 patients (12.8%), Jejunal perforation among 16 patients (6.4%) and Other among 28 patients (11.2%). Among the patients who expired due to Secondary Peritonitis, maximum 12(37.5%) had Gastric Perforation followed by Duodenal Perforation in 9 (28.1%) patients. Conclusion: The study concluded that most of patients of secondary peritonitis had Duodenal perforation followed by Gastric perforation. The most common type of perforation among patients who died from secondary peritonitis was gastric followed by duodenal.

ASA Grading and Duration of Stay among Secondary Peritonitis Cases and its Association with Outcome in a Tertiary Care Hospital

Background: The present study was carried out to evaluate the ASA Grading and Duration of stay among Secondary Peritonitis cases and its association with outcome in a tertiary care Hospital. Material and Methods: This study was a longitudinal, prospective study in which all patients presenting to the Department of Surgery, IGMC, Shimla over a period of twelve months from January 2021 – December 2021 and with a diagnosis of secondary peritonitis after fulfilling the inclusion and exclusion criteria were recruited. Relevant information was collected and further analysed by using IBM SPSS Statistics. Results: In the present study a total of 250 patients with diagnosis of perforation peritonitis were evaluated. Among the total Males were 205 (82%) and Females were 45 (18%). Mean age of the patients was 47.28±17.34 years with range from 18 to 87 years. Among the total, 99(39.6%) patients were age less than 40 years while 151(60.4%) patients were aged &gt; 40 years. Among the total, 32(12.80%) were expired while 218(87.20%) were discharged after treatment. Among the total, 114(45.60%) patients were in grade 1 according American Society of Anesthesiologists (ASA) scoring system, 107 (42.80%) were in grade 2, 22(8.80%) were in grade 3 and 7(2.80%) were in grade 4. Among the total 32 patients who were expired, 2(6.3%) were in grade 1, 19(59.4%) were in grade 2, 9(28.1%) were in grade 3 and 2(6.3%) were in grade 4 while among the total 218 patients who were discharged, 112(51.4%) were in grade 1, 88(40.4%) were in grade 2, 13(6.0%) were in grade 3 and 5(2.3%) were in grade 4 according American Society of Anesthesiologists (ASA) scoring system. There was found significant association between ASA Grading and mortality. The mean duration of hospital stay among study participants was 8.99±6.07 days with range 1 to 40 days. The mean duration of hospital stay among 32 expired patients was 9.19± 8.26 days while among 218 discharged patients was 8.96±5.70 days. There was no significant association between duration of hospital stay and mortality. Conclusion: The present study concluded that most of patients of secondary peritonitis were in grade 1 of American Society of Anesthesiologists (ASA) scoring system old and there was significant association of mortality with ASA Grading but not with duration of stay in hospital.

Effluent microscopy is a useful adjuvant diagnostic tool in peritoneal dialysis-associated peritonitis.

Infectious complications are the leading cause of technical failure in peritoneal dialysis (PD); however, targeted anti-infective therapy is not feasible at the onset, as effluent cultures take days and may be inconclusive. Although recommended by the guidelines, divergent positivity rates of Gram-stained effluent microscopy question the value of its usefulness. This study aimed to evaluate if microscopy of cell types serves as an additional and timely diagnostic approach. This single-center retrospective analysis included prevalent PD patients (n=250) between 2007 and 2017. Automated quantitative cell count, cytological analysis of Hemacolor and Gram-stained effluent sediment, and effluent cultures were conducted during peritonitis episodes. We calculated the rate of peritonitis, positivity rate of effluent cultures, and effluent microscopy. There were 155 at-risk cases of peritonitis in 662.7 years during the observation period. The culture positivity rate was 73.5%. In neutrophilic culture-negative peritonitis (CNP), effluent Gram staining yielded the identification of the microbial species in 51.6% cases. In 24.4% of CNP, effluent microscopy showed eosinophilic peritonitis, which occurred with less initial effluent leucocytes and showed better PD survival. In PD-associated peritonitis, Gram-stained dialysate with effluent microscopy supplements culture results in CNP. Hemacolor staining is crucial for differentiating eosinophilic peritonitis, showing a divergent clinical course and outcome.

A case of spontaneous gastric perforation in a 3 years old male child

A 3 years old boy attended emergency department with history of abdominal distension, fever, vomiting, loose stools for 5 days. The boy was suffering from epilepsy from last 1 year of age and was under treatment. From history and clinical examination, it seemed to be a case of peritonitis. Abdominal ultrasound revealed debrigenous free fluid in peritoneal cavity. Emergency exploratory laparotomy done and pyloric perforation was noted and repaired by modified graham’s patch. The child, post-operatively, suffered from dys-electrolytemia and wound site infection and recovered with treatment.

Repeated streptococcal peritoneal dialysis-related peritonitis following stomatitis and gingival bleeding: a case report

BackgroundIdentification of the pathogenesis of peritoneal dialysis (PD)-related peritonitis is important. However, identification of endogenous peritonitis, especially hematogenous infection, is difficult, and there are few reports of endogenous peritonitis via the bloodstream. We report a case of PD-related peritonitis presumed to be caused by hematogenous infection through the oral mucosa.Case presentationA 65-year-old woman commenced PD at the age of 52. Over the next 13 years, she developed two episodes of streptococcal peritonitis caused by Streptococcus salivarius, a commensal bacteria of the human oral mucosa, and all episodes occurred following stomatitis and gingival bleeding in the early summer. At the age of 65, she again suffered from stomatitis followed by gingival bleeding in early summer, and 2 weeks later, developed a third case of peritonitis caused by Streptococcus salivarius. The streptococcal peritonitis improved immediately following 2 weeks of antibiotic treatment. We surmise that the patient is subject to weakened immunity in the early summer, causing repeated oral problems with gingival bleeding, and subsequently leading to oral streptococcal peritonitis.ConclusionsOur findings suggest that oral streptococcal peritonitis following oral problems such as stomatitis and gingival bleeding results from a hematogenous infection via the oral mucosa.

Bacterial Peritonitis Caused by Tsukamurella inchonensis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

BackgroundTsukamurella is an environmental saprophyte that potentially causes various infections in humans. It has been reported to cause rare opportunistic infections in immunocompromised patients or patients with indwelling foreign bodies.Case PresentationWe report a case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis caused by Tsukamurella inchonensis (T. inchonensis). The patient was admitted to our hospital while demonstrating a cloudy peritoneal dialysate. Peritoneal fluid sample culturing yielded yellow-greyish, dry and membrane-like colonies. Gram staining showed straight, gram-positive rods. The organism was identified to be Tsukamurella species by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). It was then characterized to be homologous to T. inchonensis in the GenBank database by 16S Ribosomal RNA Sequencing. The strain was susceptible to quinolones, carbapenems and linezolid, but intermediately resistant to vancomycin in drug susceptibility testing. Eventually, the peritonitis was controlled with meropenem and the patient discharged from the hospital.ConclusionHere, we describe the first case of CAPD-related peritonitis caused by T. inchonensis in China. Importantly, T. inchonensis show resistance to cephalosporins and heterogeneous resistance to vancomycin, guideline-based empiric therapy occasionally fails. Further analyses of similar cases are required to understand the characteristics and formulate appropriate therapy regimen for T. inchonensis infections.

Clinical features and treatment response to differentiate idiopathic peritonitis from non-strangulating intestinal infarction of the pelvic flexure associated with Strongylus vulgaris infection in the horse

BackgroundPeritonitis in horses secondary to non-strangulating infarction (NSII) has a guarded prognosis, even after intestinal resection. In contrast, horses with idiopathic peritonitis respond well to medical treatment. Affected horses in both cases often show signs of both colic and systemic inflammation, but early diagnosis is crucial for optimal treatment and an accurate prognosis. One cause of NSII is thrombus formation secondary to Strongylus vulgaris larval migration. There has been a documented increase in S. vulgaris prevalence in Sweden since the implementation of selective anthelmintic treatment in 2007, which subsequently could result in a rise in NSII cases. In a retrospective clinical study, medical records from cases diagnosed with NSII of the pelvic flexure or idiopathic peritonitis from three equine referral hospitals in Sweden during 2017–2020 were reviewed. Information including demographic data, relevant medical history, and clinical- and laboratory parameters were obtained from patient records. To facilitate the differentiation between cases of idiopathic peritonitis and cases with confirmed NSII of the pelvic flexure, the aim of the study was to compare clinical and laboratory parameters, clinical progression and initial response to antimicrobial treatment. A secondary aim was to compare survival-rates.ResultsHorses with NSII (n = 20) were significantly more likely to present during the winter months with a poorer response to medical treatment within 48 h. Cases of idiopathic peritonitis (n = 107) had a 100% survival rate with medical treatment, although one case required surgical correction of a colon displacement. In comparison, all confirmed NSII cases were non-responsive to antimicrobial treatment, with a survival rate to discharge of 50% after colon resection. Specific rectal findings and peripheral blood neutropenia were strongly associated with NSII.ConclusionsIn Sweden, idiopathic peritonitis cases still predominate over S. vulgaris associated NSII cases and have an excellent survival rate with antimicrobial treatment. However, horses presenting with septic peritonitis during the winter months with a palpable rectal mass and displaying fever and colic signs beyond 48 h of medical treatment are likely to suffer from NSII of the pelvic flexure and should be considered for abdominal surgery.

Detection of 16S rRNA gene for rapid identification of bacterial pathogens causing peritonitis in patients on continuous ambulatory peritoneal dialysis

PurposePeritonitis is the most important complication with high rate of morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD) despite the success and advances. Rapid and accurate identification of pathogens causing peritonitis in a CAPD patient is essential for early targeted treatment. The aim of the study was to evaluate the role of 16S rRNA gene and ITS region PCR and sequencing in detecting bacterial and fungal pathogens from the dialysate of patients undergoing CAPD. MethodsFifty eight peritoneal dialysate from suspected cases of peritonitis on CAPD were subjected to conventional culture as per the ISPD guidelines and automated culture system. A conventional PCR was performed to detect the 16S rRNA gene and ITS region. Sequencing and analysis were performed to identify the etiological agent from the remaining dialysate. ResultsAmong the 58 dialysate fluid, the etiological agents were identified in 8(14%) samples by conventional culture, 28(48%) by automated culture and 47(81%) by 16S rRNA sequencing and analysis. In 8 samples there was discordance in the results of the culture and 16S rRNA PCR. BLAST search of nine sequences obtained from 16S rRNA PCR revealed that these sequences matched best with uncultured bacterial clones. In eleven samples the sequence failed. ConclusionThe molecular tool 16S rRNA gene and ITS region PCR and sequencing cannot be used as a standalone test as it lacks sensitivity to identify some bacterial species due to high genetic similarity in some cases and inadequate database in GenBank. However, it could be used as a supplementary test to the culture method especially in the diagnosis of culture negative peritonitis.

Resolution of severe eosinophilic peritonitis in a patient on continuous ambulatory peritoneal dialysis by changing from Dianeal peritoneal dialysis solution to Stay-Safe Balance solution: a case report

BackgroundEosinophilic peritonitis is a well-known complication at the initiation of peritoneal dialysis. It is often due to an allergic reaction to peritoneal dialysis solution or sometimes to the peritoneal dialysis catheter itself. Most cases are self-limiting with expected spontaneous resolution within a few weeks. Treatment is necessary for severe or persistent cases. However, the optimal treatment has not yet been defined. There have been only a few case reports on the use of anti-histamines and/or steroids for the treatment of eosinophilic peritonitis. We reported a case of severe eosinophilic peritonitis successfully treated by switching the brand of peritoneal dialysis fluid (same glucose concentration). To the best of our knowledge, this is the first reported case employing such a treatment strategy.Case presentationAn eighty-two-year-old man with end-stage renal failure was started on continuous ambulatory peritoneal dialysis with Dianeal® (Baxter) peritoneal dialysis solution. He developed eosinophilic peritonitis 19 days after initiation of peritoneal dialysis. Infectious causes were ruled out by bacterial, fungal and tuberculosis smears and cultures. In view of the persistent and severe symptoms, we intervened by switching from Dianeal® (Baxter) peritoneal dialysis solution to Stay-Safe Balance® (Fresenius) solution with the same glucose concentration. His eosinophilic peritonitis resolved 5 days after switching the peritoneal dialysis solution.ConclusionIn severe or persistent cases of eosinophilic peritonitis requiring treatment, other than the use of steroids and anti-histamines, switching to a different brand of peritoneal dialysis solution can be considered.

Chylous Peritonitis and Chylothorax Presenting with Acute Abdomen after Heavy Lifting

Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition often mistaken for other disorders. Diagnosis is rarely definite preoperatively. Acute chylous peritonitis is generally idiopathic and diagnosed with laparoscopy or laparotomy. Intra-abdominal lavage and drainage are often used as treatment methods. We report a case of spontaneous chylous peritonitis due to elevated intra-abdominal pressure, which was diagnosed intraoperatively by observation of chylous fluid leakage from the retroperitoneum. The patient was treated with peritoneal lavage and drainage with primary suture ligation at the level of leakage.

Predictive Factors, Treatment, and Outcomes of Coagulase-Negative Staphylococcal Peritonitis in Malaysian Peritoneal Dialysis Patients: A Single-Center Study.

Aims Coagulase-negative Staphylococci (CoNS) are frequently isolated in peritoneal dialysis (PD)-related peritonitis with a high rate of relapse and repeat peritonitis after initial response to antimicrobials. The optimal treatment regimen for CoNS peritonitis remains debatable. Hence, this study aimed to describe the clinical and microbiologic characteristics of CoNS peritonitis in a PD center and determine predictive factors influencing the outcomes. Methods All cases of CoNS peritonitis in Selayang Hospital between 2011 and 2019 were reviewed retrospectively. Results A total of 906 episodes of peritonitis were recorded; 140 episodes (15%) in 98 patients were caused by CoNS. The oxacillin and gentamicin resistance rates were 47% and 46%, respectively. The overall primary response rate was 90%, and the complete cure rate was 79%. Patients with concomitant exit-site infection (odds ratio (OR) 0.06, 95% confidence interval (CI) 0.01 to 0.40, P < 0.01) and history of recent systemic antibiotic use (OR 0.04, 95% CI 0.01 to 0.82, P=0.04) were less likely to achieve primary response. CoNS episodes that were treated with beta-lactam-based or vancomycin-based therapy had a similar primary response rate and complete cure rate. The rates of relapse and repeat were 12% and 16%, respectively. Relapsed episodes (OR 0.35, 95% CI 0.13 to 0.97, P=0.04) had a significantly lower complete cure rate than the first episodes. Conclusion Relapsed CoNS peritonitis was common and was associated with worse outcomes than the first episode of CoNS peritonitis. Oxacillin resistance was common, but the treatment outcome remained favourable when a beta-lactam-based regimen was used as empirical therapy.

Oral infections and gastric perforation peritonitis: What is the link?

IntroductionThe association of gastric perforation peritonitis with an oral infection is rarely reported in the literature. This work reports two cases of gastric perforation peritonitis associated with facial cellulitis or mandibular osteitis in order to analyze the causal link between these two pathological entities. ObservationsTwo patients, one 25 years old, the other 40 years old, were admitted to the surgical emergency room for epigastric pain with vomiting and cessation of matter and gas. Both patients had been taking nonsteroidal anti-inflammatory drugs for the treatment of dental pain. The clinical investigations concluded to a peritonitis by perforation of a peptic ulcer associated with a parotido-masseterine cellulitis in the first patient and with a mandibular osteitis in the second patient. A laparotomy coupled with antibiotic therapy was performed in both patients. Drainage of the facial collection was performed in the first patient. Treatment of the oral infection entry point was performed in both patients. The evolution was favorable in both patients. ConclusionThe use of anti-inflammatory drugs in the treatment of dental pain without precaution plays a determining role in this association. This work calls for an awareness for a change of behavior in the management of NSAIDs.

Tuberculous peritonitis in peritoneal dialysis: report of three cases

Tuberculous peritonitis is a rare but dreaded complication in peritoneal dialysis.&#x0D; We report three cases of tuberculous peritonitis diagnosed in our PD center at over a period of 15 years.&#x0D; They are a woman and two men aged 50, 45 and 64 respectively.&#x0D; The diagnosis of tuberculous peritonitis was suspected in front of a many of clinical (AEG, abdominal pain, cloudy liquid), biological (inflammatory syndrome, the dialysate liquid with lymphocyte predominance and negative culture) and or radiological (abdominal lymphadenopathy) arguments.&#x0D; It was confirmed by the demonstration of Mycobacterium Tuberculosis in the dialysate by GeneXpert or by culture on LOWENSTEIN Jensen medium in 2 cases, and the characteristic appearance on anatomopathological examination in only 1 case.&#x0D; The evolution under antituberculous treatment was favorable, with recourse to the ablation of&#x0D; The diagnosis of tuberculous peritonitis in peritoneal dialysis is difficult and often late because the clinical signs is non-specific. It should be considered in the presence of any culture-negative peritonitis that is refractory to empirical treatment.&#x0D; Bacteriological or histological confirmation should not delay the start of anti-tuberculosis treatment because early diagnosis and rapid initiation of treatment are the keys to recovery and the only guarantee of a good prognosis.