Need For Urgent Surgical Intervention Research Articles

Emergency surgical decompression of the orbit may rescue impaired vision even in a patient presenting late with a retrobulbar haematoma: A case report from rural southwestern Uganda.

Retrobulbar haematoma is a rare emergency that can potentially lead to blindness. Common causes include facial trauma and surgery. Timely surgical evacuation of the haematoma improves visual outcomes. In rural communities, patients often present to hospital after many hours and this increases the risk of poor visual outcomes. Radiological evaluation which is often not available in rural communities, results in further delay in surgical treatment. This case report highlights the need for urgent surgical intervention over radiological evaluation in patients with retrobulbar haematoma and orbital compartment syndrome.

Current insights into the possible role of laboratory monitoring of effectiveness and safety of direct oral anticoagulants

The article is devoted to the discussion of modern approaches to the use of laboratory methods to improve the tactics of using direct oral anticoagulants (DOACs) therapy. Clinical situations in which it may be reasonable to use data on the blood concentration of DOACs are given, including very old age, a marked deviation from the norm of body weight or impaired renal function. Data on the role of measuring the blood level of DOACs are considered in cases of the development of diseases or complications in which information is required on the preservation of the anticoagulant effect of DOACs, for example, in the development of severe bleeding or the need for urgent surgical intervention. The advantages and limitations of modern laboratory methods for assessing the blood concentration of DOACs are discussed. It is emphasized that one of the main advantages of using DOACs is the absence of the need to monitor laboratory parameters in most patients. Data from pharmacological studies are presented that may be useful in explaining the mechanisms that determine the higher safety of some DOACs compared to others. Promising methods for assessing the blood level of DOACs, as well as the possibility of using less specific reagents for assessing the concentration of DOACs, are considered. The possibility of using less specific, but more accessible methods for assessing the blood concentration of factor Xa inhibitors, in particular, a reagent for assessing the level of the antifactor, which is used to determine the blood level of heparin, is being considered. The opinions of experts on the role of assessing the blood level of DOACs and the possibility of tactics for selecting doses of DOACs based on laboratory analysis data are given.

S195 Is There a "Golden Window" for Endoscopic Reduction of Acute Sigmoid Volvulus: A Multicenter Retrospective Study

Introduction: Colonic volvulus accounts for around 2% of all bowel obstructions in the United States. the involvement of the sigmoid colon consists of the overwhelming majority of colonic volvulus cases, possibly 60.9–80%. [1]. Per the American Society of Gastrointestinal endoscopy guidelines (ASGE), Non-operative detorsion with flexible sigmoidoscopy is considered first-line therapy in the management of sigmoid volvulus in patients without signs of peritonitis, perforation, or with recurrent or unsuccessful nonoperative decompression [2][3][4]. Despite this recommendation, the ideal timing for endoscopic intervention remains unclear. Methods: We conducted a retrospective study in adult patients admitted for acute sigmoid volvulus in 4 academic centers from January/2010-January/2020. 47 Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria included adult patients who were initially managed with endoscopic detorsion. The time interval between diagnosis and endoscopic intervention was collected. Primary outcomes included the need for subsequent urgent surgical intervention within 30 days of the endoscopic intervention. Secondary outcomes were hospital length of stay and mortality. Results: A total of 47 patients met the inclusion criteria. 33 patients were males (70.2%). The mean age of the sample was 71.0 (±16.5) years. Successful non-surgical reduction was achieved in 43 patients (91.5%). Endoscopic intervention was aborted in 4 patients for concerns of bowel ischemia or nonviable mucosa. 31 (66%) patients required urgent surgical intervention within 30 days of the endoscopic reduction, with an average interval period of 7 (±8.5) days. Surgical interventions included Hartmann’s procedure, sigmoid colectomy with primary colorectal anastomosis, and total abdominal colectomy. Early endoscopic reduction resulted in fewer subsequent urgent and emergent surgical interventions (p-value = 0.013). Using the ROC curve, a cut-off point of 8.5 hours was determined to be predic table of favorable outcomes with a sensitivity and specificity of 74.2%, and 75%, respectively. (Figure) Early endoscopic intervention was associated with shorter hospitalization (p-value = 0.001). Conclusion: Endoscopic decompressive intervention within 8.5 hours of diagnosis of acute sigmoid volvulus decreased early volvulus recurrence, bowel ischemia and subsequent need for urgent surgical interventions. This in return decreased hospital length of stay and allowed for planned prophylactic surgical resection.Figure 1

Pericardial Effusion Caused by Renal Carcinoma of Clear Metastatic Cells: A Rare Cause of Cardiac Tamponade

Objective: To report the case of a patient with renal cell carcinoma of the clear cell type with the presence of metastatic disease at diagnosis, affecting the adrenal, lung and pericardium. Evolving with cardiac tamponade and need for urgent surgical intervention, being performed through thoracoscopy, a pericardiectomy for making a pericardial window. Method: The information was obtained by reviewing the medical record, interviewing the patient, photographic record of the diagnostic methods to which the patient was submitted and literature review. Final considerations: The reported case brings to light the description of a common clinical condition in medical centers in this case, cardiac tamponade, caused by renal carcinoma of which cardiac metastatic presentation represents a low index, and the need for urgent surgical intervention as an outcome.

Free gas in the peritoneal cavity after colonoscopy. Indication for immediate action or incidental finding in imaging tests after uncomplicated colonoscopy? Literature review.

Colonoscopy is a routine diagnostic and therapeutic procedure. Along with the increase in the complexity of the procedures performed, the risk of complications increases. In 2017, WSES (World Society of Emergency Surgery) published the principles of safe colonoscopy. Intestinal perforation is one of the most common complications. The risk of perforation in treatment procedures such as mucosectomy or endoscopic dissection is significantly greater than the risk of diagnostic colonoscopy. The basic rule of the procedure in case of suspected perforation is close supervision over the patient's condition and the soonest possible repair of damage. The role of the endoscopist is not only early recognition, but also early treatment of damage. Immediate endoscopic treatment of lesions is an effective, final and acceptable management strategy. In patients who have undergone imaging diagnostics for another reason, free gas in the peritoneal cavity can be recognized. It does not have to mean the need for urgent surgical intervention. Patients with asymptomatic pneumoperitoneum after colonoscopy should, however, be treated as patients with suspected perforation of the large intestine and undergo careful clinical observation in accordance with WSES recommendations. Colonoscopy is a procedure with a risk of complications, which should be reported to patients qualified for endoscopy, but appropriate management reduces the risk of morbidity and mortality associated with this procedure.

Features of postoperative therapy in patients with type ІІ diabetes

Type 2 diabetes mellitus (DM) is one of the most common diseases in the world. According to data of the International Diabetes Federation, there are more than 425 million people suffering from this disease in the world. The course of type II DM is accompanied by a progressive lesion of the macrovasculature, which is associated with an increase in the risk of developing atherosclerosis in this category of patients by 4-5 times in comparison with patients without diabetes. This in turn leads to some complications such as blindness, strokes, vascular damage of the limbs and chronic renal failure (CRF), which is often the leading cause of death. The occurrence of any inflammatory process against the background of diabetes is a significantly aggravating factor for the patient, as the body’s reserves are reduced, especially in the presence of CRF. The need for urgent surgical intervention in a patient with an inflammatory process against the background of diabetes is another stress factor. In addition, patients with DM are constantly taking hypoglycemic drugs, the effect of which in a stressful situation is not always predictable for the patient and therefore these drugs should be canceled. However, if the patient has CRF and long-term administration of drugs, their effect does not immediately stop. The combination of all the above points puts the patient with DM at a high risk group for the development of serious complications requiring intensive care (IT). Such complications in the early postoperative period may be lactic acidosis, persistent hypoglycemia, electrolyte disorders, cerebral edema. In the clinical case the pathogenesis of the development of these conditions and IT methods are described. Conclusions have been drawn regarding the need for close attention of anesthetists and intensive care physicians during perioperative therapy in patients with DM, complicated CRF, and which are receiving metformin.

379 Communicating a Traumatic Brain Injury Patient's Potential Need for Operative Intervention

INTRODUCTION: Severity scoring systems facilitate communication in many areas of medicine (eg, Glasgow Coma Scale [GCS] in neurological injury). However, there is no widely used scale to provide a tool for communicating the urgency of possible surgical intervention in patients with traumatic brain injury (TBI). This study builds on prior research to develop a scoring system for nonsurgical clinicians to communicate the potential need for surgical decompression in TBI patients. This scoring system, named the Surgical Intervention for Traumatic Injury (SITI), was designed to be comprehensive and easy to use. METHODS: The SITI scale ranks specific radiographic and clinical findings to assess the possible need for urgent surgical intervention. The scale includes: GCS (GCS >12 = 0 points, GCS 9-12 = 1 point, and GCS <9 = 2 points), pupil examination (unilateral enlarged pupil = 2 points), computed tomography findings (midline shift <5 mm = 0 points, 5-10 mm = 2 points, and >10 mm = 4 points), the presence of temporal pathology (1 point), and epidural hematoma (hematoma = 10 mm = 2 points). To validate the scale, the patient database for the Progesterone for the Treatment of Traumatic Brain Injury III Trial (PROTECT III) was used, and 871 patients were included in the analysis. We used the area under the receiver operating characteristic curve (ie area under the curve analysis) to further validate the SITI scale. RESULTS: Of the 871 patients reviewed, 159 underwent craniotomy, and 712 were treated nonoperatively. The mean SITI score was 5.3 for operative patients and 2.4 for nonoperative patients (P < .001). We found that, applying a cutoff at a SITI score of 3 or greater, resulted in an area under the curve of 0.887. CONCLUSION: The SITI scale was designed to be a simple, objective system for communication between clinical services regarding the potential need for surgical decompression for TBI. Application of the SITI scale to the PROTECT III database demonstrates that a SITI score of 3 or more correlated well with the patient receiving a craniotomy. These results further demonstrate the potential utility of the SITI scale in clinical practice.

Continuous Regional Arterial Infusion of Protease Inhibitors for Treatment of Severe Acute Pancreatitis: Systematic Review and Meta-Analysis.

We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) to assess the benefit and risk of continuous regional arterial infusion (CRAI) of protease inhibitors (CRAIpis) in patients with severe acute pancreatitis (SAP) or acute necrotizing pancreatitis (ANP). The search was performed using the key words "pancreatitis" and "regional arterial infusion." All language studies involving adult cases of SAP or ANP, which assessed the impact of the CRAIpis, were included. Our analysis included 8 observational studies and 2 RCTs from 376 potentially relevant articles. With regard to the observational studies, the CRAIpi was significantly associated with decreased both mortality (odds ratio, 0.40; 95% confidential interval [CI], 0.25-0.64; P = 0.0001) and the need for urgent surgical intervention (odds ratio, 0.22; 95% CI, 0.12-0.3; P < 0.0001). In the RCTs, the application of CRAIpi tends to decrease the mortality but does not reach the significance (risk reduction, -0.12; 95% CI, -0.36-0.12; P = 0.33). The CRAIpi has the potential to reduce the mortality or the need for urgent surgical intervention in cases of SAP or ANP. Further, large multicenter trials are needed to refute or confirm our findings.

Necrotizing fasciitis: The need for urgent surgical intervention and the impact of intravenous drug use

BackgroundNecrotizing fasciitis (NF) is a relatively rare infection of soft tissues. This study reviewed the epidemiology and pathophysiology of admissions to a tertiary referral hospital over a twelve year period comparing outcomes and findings with international norms and to identify potential areas of change to optimise outcomes. Study designA retrospective review of patients diagnosed with NF from Jan 1st 1999 to Dec 31st 2011 was performed. Patient demographics, risk factors, operative procedures, microbiology results and outcomes were recorded. Comparative analysis was performed. Results37 patients were admitted with NF, comprising 30 males and 7 females with a median age of 55 years. The most common site of infection was the perineum (51%). The overall mortality rate was 29% and was significantly associated with age greater than 60 years (p = 0.0018) and the presence of one or more risk factor (p = 0.0046). The number of surgical procedures ranged from one to fifteen with a median length of stay of 35.5 days. There was a significant increase in the number of admissions in 2009–2010 (p < 0.001), coinciding with the emergence of NF in intravenous drug users (IVDU). 43% of patients (n = 16/37) required skin grafting, which was significantly higher in the IVDU group (n = 5/6, p = 0.0232). ConclusionsNecrotizing fasciitis remains a significant life-threatening event. The diversity of causative pathogens emphasises the need for prompt microbiology/infectious diseases consultation. The increased occurrence within the IVDU cohort in this study highlights the need for a heightened level of clinical suspicion in these patients to prompt early surgical intervention.

Gastrointestinal disorders in Down syndrome.

Gastrointestinal disorders in Down syndrome.

Bowel Gangrene From Strangulated Petersen's Space Hernia After Gastric Bypass

BackgroundPatients with internal herniation after Roux-en-Y gastric bypass might present with normal laboratory values, minimal physical examination findings, and nonspecific radiographic results, making early diagnosis difficult and resulting in catastrophic bowel necrosis. ObjectiveOur purpose is to increase awareness so physicians of all specialties caring for these patients have a heightened suspicion and low threshold to obtain early surgical consultation in bypass patients with unexplained abdominal pain. Case ReportA 36-year-old female had a delayed presentation of internal herniation 4 years after laparoscopic retrocolic Roux-en-Y gastric bypass for morbid obesity. Initially, she had unremarkable physical examination, laboratory results, and plain x-ray findings, which made diagnosis challenging. During emergent exploratory laparotomy, she was found to have a strangulated Petersen's space hernia with volvulus, necessitating extensive gastric, small bowel, and colonic resection. She was referred for small bowel transplantation and has survived more than 8 years. ConclusionsThe occurrence of Petersen's hernias has increased with laparoscopic Roux-en-Y gastric bypass due to less postoperative adhesions. Whether days or several years after gastric bypass, patients with intermittent abdominal pain, nausea, or vomiting need to be carefully evaluated. These herald signs of internal herniation should prompt early surgical consultation. Pain out of proportion to physical examination often indicates need for urgent surgical intervention. Physicians need to be educated about this potentially life-threatening complication so early diagnosis and treatment can avoid catastrophic bowel gangrene.

Concurrent amoebic and histoplasma colitis: A rare cause of massive lower gastrointestinal bleeding

Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later, the patient developed massive lower gastrointestinal bleeding with hemorrhagic shock. Emergency total colectomy with end-ileostomy was performed. However, he deteriorated and died on the second postoperative day. Histopathological examination revealed multiple deep ulcers at the hepatic flexure where fungal bodies of mycelial and yeast forms were noted. Isolated lymph nodes showed abscess formation with fungal bodies. Infective fungal colitis with Histoplasma capsilatum was diagnosed. In vitro, amoebic parasites can increase virulence and pathogenicity of histoplasma which may account for the fulminant presentation in this patient. Although rare, this unusual dual infection should be considered in the differential diagnosis of infective colitis, as appropriate antimicrobial treatment may prevent progression to massive lower gastrointestinal bleeding, obviating the need for urgent surgical intervention.

Pulmonary valve replacement in repaired tetralogy of Fallot: Determinants of early postoperative adverse outcomes

We sought to examine the frequency of early postoperative complications and preoperative predictors of prolonged hospitalization in adults with repaired tetralogy of Fallot undergoing pulmonary valve replacement. This was a retrospective study of consecutive adult patients undergoing surgical intervention between 1995 and 2006. A multivariate logistic regression model was used to identify determinants of prolonged hospitalization. One hundred sixteen patients (mean age, 36 +/- 11 years) underwent 118 pulmonary valve replacements. Most (95%) operations included additional procedures, such as pulmonary artery/outflow tract reconstruction or tricuspid valve annuloplasty. The early postoperative mortality (<30 days) was 2.5%. The majority of the patients (60%) had no postoperative complications. The postoperative adverse events included postoperative arrhythmias (19%), respiratory complications (13%), reoperation during admission (13%), renal dysfunction (13%), and myocardial infarction (3%). Postoperative adverse events were associated with prolonged hospitalization (14 +/- 12 vs 7 +/- 3 days, P = .001). In the multivariate analysis age at reoperation of greater than 45 years (odds ratio, 6.1; 95% confidence interval, 1.6-23.6; P = .009), the number of previous sternotomies (odds ratio, 3.8; 95% confidence interval, 1.4-10; P = .007), and the need for urgent surgical intervention (odds ratio, 5.7; 95% confidence interval, 1.1-27.8; P = .03) were predictors of prolonged hospitalization. Pulmonary valve replacement in adults with repaired tetralogy of Fallot has a low mortality risk. The most common early postoperative complications are arrhythmias and respiratory and renal complications. Although most early postoperative complications do not result in long-term sequelae, they are associated with prolonged hospitalization. Patients undergoing urgent interventions, older patients, and those with multiple previous sternotomies are at the highest risk for prolonged hospitalization.

Multidetector Row Computed Tomography of Small Bowel Obstruction

Small bowel obstruction (SBO) is a common clinical problem, and clinical signs and symptoms often do not provide sufficient information for diagnosis or to guide management. During the past two decades, computed tomography has become a mainstay in the evaluation of patients with known or suspected small bowel obstruction. Computed tomography scans should be performed and interpreted with attention to establishing the diagnosis of small bowel obstruction, locating the transition point indicating the site of obstruction, and determining the cause of the obstruction. Complications that suggest the need for urgent surgical intervention, such as closed loop obstruction with superimposed ischemia and/or volvulus, should be sought in every case. Current generation multidetector row computed tomography scanners, with their isotropic resolution, now permit high-quality reformatted images to be obtained in multiple planes and facilitate identification of the transition point and other findings in SBO. Radiologists should be familiar with the myriad features of uncomplicated and complicated small bowel obstruction, which are reviewed in this article.

Drug eluting stents for below the knee lesions in patients with critical limb ischemia

The purpose of this study was to assess the long-term limb preservation and/or healing of ulcers in patients with critical limb ischemia (CLI) and severe infrapopliteal atherosclerotic disease treated with drug eluting stents (DES). Percutaneous revascularization has become an effective treatment for CLI in patients with infrapopliteal atherosclerotic disease. Recent reports using DES in patients with CLI have documented excellent short-term infrapopliteal vessel patency. Higher primary patency rates in infrapopliteal vessels treated with DES could translate into better long-term clinical outcomes and improved limb salvage rates. Twenty-four consecutive patients with CLI (defined as rest pain, nonhealing ulcers, or gangrene) because of severe infrapopliteal disease were treated with DES from August 2004 to June 2006. Procedural success was achieved in 96% (27/28) of targeted lesions. There were no procedure-related deaths, acute vessel thrombosis events, or need for urgent surgical intervention. There was one case of distal embolization. Clinical follow up, ranging 8-34 months, is available for 100% of patients of which 83% (20/24) achieved limb preservation and healing. Angiographic and/or sonographic follow up, ranging 6-34 months, is available in 79% (19/24) of patients of which 95% (18/19) had patent target vessels. DES is a safe and effective long-term option for CLI due to severe infrapopliteal arterial disease. Long-term vascular patency led to a high rate of limb preservation and low amputation rate. A multicenter trial should further elucidate the role of DES in the treatment of CLI.

CYTOKINES IN NECROTIZING ENTEROCOLITIS

Necrotizing enterocolitis (NEC) is a devastating intra-abdominal emergency in the newborn period. The disease involves bowel wall inflammation, ischemic necrosis, eventual perforation, and the need for urgent surgical intervention. Unrecognized or left untreated, the neonate can decompensate quickly, often progressing to shock, multisystem organ failure, and eventual death. During the past several years, a number of basic science and clinical trials have been established in an attempt to understand the pathophysiology of NEC. As many researchers feel that NEC develops as an uncontrolled inflammatory response that leads to intestinal ischemia, a large number of studies have been focused on the inflammatory cascade and the role that cytokines play within that cascade. Although a large amount of data has been generated from these studies, the events leading to the ischemic injury of the intestine are still not fully understood. This article will therefore focus on the key cytokines involved with NEC, in an attempt to present the current literature and studies that support their involvement.

Streptococcal fasciitis with toxic shock syndrome in the pediatric patient.

Necrotizing fasciitis (NF) is a distinctive soft tissue infection usually caused by Group A beta-hemolytic streptococcus, often seen in association with varicella in the previously healthy child. Its fulminant course is associated with great morbidity and high case-fatality rates, especially when it occurs in conjunction with streptococcal toxic shock syndrome. It differs from simple cellulitis in clinical presentation, appearance on examination, and need for urgent surgical intervention. The patient is irritable and complains of severe pain in the involved site, which is usually the extremity. On examination, exquisite pain on palpation of the involved site is confirmed, which is out of proportion to the cutaneous findings. Shock, multiorgran failure, and death will ensue if the diagnosis is not promptly recognized. The five keys to management include fluid management, aggressive debridement of necrotic tissues, anticipation and management of multisystem organ failure, appropriate parenteral antimicrobial therapy using penicillin and clindamycin, and use of intravenous immunoglobulin (IVIG).

A CASE OF SURVIVAL OF NECROTIZING ENTERITIS WITH HEPATIC PORTAL VENOUS GAS AND PNEUMATOSIS CYSTOIDES INTESTINALIS

Hepatic portal venous gas is an ominous prognostic sign. We report a case of survival of necrotizing enteritis with hepatic portal venous gas and pneumatosis cystoides intestinalis. A 71-year-old man was admitted with a sudden onset of severe abdominal pain and vomiting. Hepatic portal venous gas wasdetected by conventional radiography, ultrasonography, and computed tomography. In an emergency laparotomy, the necrotic bowel was resected, and the patient survived. Hepatic portal venous gas suggests the presence of necrotic bowel, so it usually indicates the need for urgent surgical intervention. Since hepatic portal venous gas is difficult to detect by conventional radiography, computed tomography is a more valuable method for this purpose.

Active hemorrhage in children after thoracoabdominal trauma: clinical and CT features.

We reviewed the clinical features and CT evidence of active hemorrhage in children undergoing CT studies because of closed thoracoabdominal trauma. Our purpose was to evaluate the hypothesis that children with this CT finding have uniformly poor clinical outcomes. The CT records of approximately 3000 children undergoing CT evaluation for trauma at four geographically distinct pediatric trauma centers were reviewed for the presence of active hemorrhage on CT scans. The location and severity of active hemorrhage, accompanying organ injury, initial clinical information, type of treatment (surgical or nonsurgical), and clinical outcome were recorded. Seven CT studies showing acute extravasation of intravascular contrast material in the abdomen (six) or chest (one) were identified. Hemorrhage was caused by severe solid organ injury in four children (three with hepatic injury and one with splenic injury) and by vascular injury to the internal iliac artery, segmental pulmonary artery, and descending colon in one child each. Every child with abdominal injuries had large collections of intraperitoneal fluid, and three children had abdominal CT signs of hypoperfusion. Although all patients were hemodynamically stable initially, four children became hypotensive during CT examination. Six children required surgical intervention because of ongoing blood loss, and two children died. Our results suggest that children with CT evidence of active hemorrhage have a different spectrum of injuries than that seen in adults. Despite the high rate of hemodynamic instability and need for urgent surgical intervention, most children with this CT finding survive.

A clinincal evaluation of abdominal paracentesis in the horse.

This paper evaluates the usefulness of abdominal paracentesis as a diagnostic aid in abdominal disease in the horse and in particular considers whether or not it can be effectively utilised as an indication for surgical intervention in cases of colic. The results are based upon peritoneal fluid samples collected from 20 normal horses and from 20 cases of colic and peritonitis. Peritoneal fluid was collected from standing horses by inserting a bovine teat cannula into the horses abdomen through the linea alba after desensitisation of the skin on the ventral midline with local anaesthetic. Usually, from 3-5 ml of fluid could be collected from a normal horse. This was either clear or cloudy white or yellow in colour and contained 3310 +/- 703 leucocytes/ml consisting of 63.81% neutrophils, 1.4 +/- 1.3% monocytes, 13.5 +/- 4.3% mesothelial cells and 21.25% +/- 6.2% lymphocytes. Protein content was 1.29 +/- .4g/100ml. Changes in the volume, colour, cellular constituents and protein content of fluid, characterised abdominal disease. In cases of colic, discolouration of the abdominal fluid was found to be the most consistent, reliable and useful indication of bowel necrosis. This in turn indicated the need for urgent surgical intervention rather than conservative treatment. Discolouration commenced early in the course of the disease even while the segment of bowel involved was still viable. Increased volume of fluid, elevated leucocyte count (statistically significant at the 5% level), increased neutrophil percentage and elevated protein levels were less useful criteria for determining the integrity of the bowel. Similar changes from the normal were also found in cases of peritonitis. Here, however, microscopic examination of cells in a smear of the fluid was more useful, as phagocytosis and abnormal cell types indicating infection or inflammation could be seen readily, and a diagnosis based upon these findings. It was concluded that abdominal paracentesis, although no substitute for thorough clinical examination, was a valuable diagnostic aid for abdominal conditions of the horse.