Open Peritoneal Drainage Research Articles

The residual cavity after hepatic hydatid endocystectomy:acomparative clinical study of the surgical options

Background: hydatid cyst remains an important public health problem in endemic area. The liver is the organ most frequently infested by hyclatid disease and medical therapy alone is ineffective in eliminating the parasite. The surgical treatment technique for liver hydatid cyst can not be standardized, and the surgical technique should be tailored according co the extent of the cyst and any adjunct complications of hydatid disease. Objectives of the surgical intervention is evacuation ·and obliteration of the cystic caviry. Recurrent hydatid cyst is defined as a new growth of an echinococcal cyst after complete surgical removal of the primary one and irrespective to the surgical technique. Material and methods: A prospective study was including (90) patients who were surgically treated for hepatic hydatid cysts, during the period March 2005 to October 2009 in Baghdad and Tiksit Teaching Hospital. 49 patients (54%) were female and the remaining 41 patients (46%) were male. This gives female: males ratio of l.2: I. The surgical procedures were performed for all patients were endocystectomy ± omentoplasty or open peritoneal drainage or capitonnage; that's compared with regard of early and late postoperative complications and hydatid disease recurrence. The follow up was made in early and late postoperative period by abclom inal ultrasound up to 2 years (6 montbly intervals). Conclusion: abdominal ultrasound is useful easy tech.nique in postoperative fo[low-up. Bndocystectomy +Omentoplasty procedure had not comp I icated by recurrence. Prevention and control remain the best weapons lo eliminate hydati.dosis.

The residual cavity after hepatic hydatid endocystectomy:acomparative clinical study of the surgical options

Background: hydatid cyst remains an important public health problem in endemic area. The liver is the organ most frequently infested by hyclatid disease and medical therapy alone is ineffective in eliminating the parasite. The surgical treatment technique for liver hydatid cyst can not be standardized, and the surgical technique should be tailored according co the extent of the cyst and any adjunct complications of hydatid disease. Objectives of the surgical intervention is evacuation ·and obliteration of the cystic caviry. Recurrent hydatid cyst is defined as a new growth of an echinococcal cyst after complete surgical removal of the primary one and irrespective to the surgical technique. Material and methods: A prospective study was including (90) patients who were surgically treated for hepatic hydatid cysts, during the period March 2005 to October 2009 in Baghdad and Tiksit Teaching Hospital. 49 patients (54%) were female and the remaining 41 patients (46%) were male. This gives female: males ratio of l.2: I. The surgical procedures were performed for all patients were endocystectomy ± omentoplasty or open peritoneal drainage or capitonnage; that's compared with regard of early and late postoperative complications and hydatid disease recurrence. The follow up was made in early and late postoperative period by abclom inal ultrasound up to 2 years (6 montbly intervals). Conclusion: abdominal ultrasound is useful easy tech.nique in postoperative fo[low-up. Bndocystectomy +Omentoplasty procedure had not comp I icated by recurrence. Prevention and control remain the best weapons lo eliminate hydati.dosis.

Severe accidental colchicine poisoning by the autumn crocus: A case of successful treatment

The common garden plant autumn crocus contains colchicine and its derivatives. Colchicine poisoning causes abdominal cramps and diarrhea within hours. Several days later, multiorgan failure, pancytopenia, and cardiovascular collapse occur. 1 , 2 Severe colchicine poisoning is associated with high mortality. A 63-year-old woman who accidentally ingested an autumn crocus, which contained ∼0.38 mg colchicine, had severe vomiting and was taken to an emergency center. She presented with symptoms of gastroenterocolitis within 1 hour of ingestion, and bone marrow hypoplasia with pancytopenia developed on the 3 rd day after ingestion. We continued administration of granulocyte colony-stimulating factor (300 μg) for 5 days until we confirmed that the patient's white blood cell count was increasing. Also, there was focal and segmental intestinal ischemia and some cakes of charcoal remained in the intestinal tract. Therefore, we presumed that nonocclusive mesenteric ischemia was caused by hypotension with severe dehydration, although pseudo-obstruction due to the activated charcoal may have been a contributing factor. We were able to promptly intervene to treat paralytic ileus and gastrointestinal edema before anticipated worsening of abdominal compartment syndrome, by conducting open peritoneal drainage. Despite severe poisoning, our patient survived with intensive care. Conclusion: Colchicine intoxication may lead to a sudden and extreme critical course. Therefore, as there is no means to predict prognosis from initial severity of symptoms at onset, we suggest that all patients suspected of colchicine intoxication should be managed in hospital with continuous vital sign monitoring and frequent laboratory testing for at least a few days after ingestion.

Open Peritoneal Drainageにより治癒せしめた汎発性腹膜炎の1例

Open Peritoneal Drainageにより治癒せしめた汎発性腹膜炎の1例

腹腔開放ドレナージ (OPD) で救命可能となった症例

腹腔開放ドレナージ (OPD) で救命可能となった症例

Nursing patients with open peritoneal drainage

ABSTRACT:Open peritoneal drainage is not a common procedure, but may be used in severe cases of septic peritonitis as an alternative to closing the abdomen and placing active suction drains. The veterinary nurse's role becomes important as these patients require intensive monitoring and nursing. This article aims to explain the procedure, and the role of the nurse to make sure the patient has the best outcome possible.

Uterine Rupture and Septic Peritonitis Following Dystocia and Assisted Delivery in a Great Dane Bitch

A Great Dane bitch was treated for presumed primary uterine inertia with repeated doses of oxytocin and manually assisted whelping. She was diagnosed with uterine rupture and septic peritonitis the following day. The uterine rupture is hypothesized to have occurred as a result of the management strategy used to treat dystocia. The dog underwent ovariohysterectomy, and the septic peritonitis was managed with open peritoneal drainage. The dog recovered well and was discharged 5 days later. No previous reports of canine uterine rupture associated with manual intervention appear to have been published. This report highlights the potential dangers involved in such an approach.

A retrospective study of surgically treated cases of septic peritonitis in the cat (2000–2007)

To review aetiology, clinical signs and outcome of cats surgically treated for septic peritonitis (2000-2007). A retrospective study. Inclusion criteria were the identification of intracellular bacteria and degenerate neutrophils and/or a positive culture from abdominal fluid and exploratory coeliotomy. Aetiology, clinical signs, haematological and biochemical parameters, surgical treatment and outcome were recorded and analysed. Twenty-six cats fulfilled the inclusion criteria. Abdominal pain was reported in 10 (38 per cent) and vomiting was reported in 11 (42 per cent) of the cats. The most common aetiology was trauma (31 per cent). The principal source of contamination was the gastrointestinal tract. Hyperlactataemia, hypoproteinaemia and hyperglycaemia were reported in 9, 13 and 14 of the 26 cases, respectively. Non-survivors had significantly higher blood lactate concentrations than survivors (P=0.02). Nineteen cats were managed with primary closure, two with closed suction drains and three with open peritoneal drainage. Twelve (46 per cent) cats survived to discharge. In cats, lethargy, depression and anorexia were more common clinical signs than abdominal pain. Lactate level at the time of diagnosis may be a useful prognostic indicator in cats. The proportion of cats that survived was lower than previously reported and owners should be given a guarded prognosis.

Treatment for pancreatic abscesses via omentalization with abdominal closure versus open peritoneal drainage in dogs: 15 cases (1994–2004)

To compare survival rate, duration of hospitalization, and complications in dogs with pancreatic abscesses treated with omentalization with abdominal closure versus open peritoneal drainage and evaluate a pancreatitis severity score for potential prognostic value. Retrospective case series. 15 dogs with pancreatic abscesses. Data regarding species, breed, age, initial clinical signs, CBC, serum biochemical abnormalities, pancreatitis severity score, anatomic location of the abscess, intraoperative bacteriologic culture results, treatment modality, postoperative complications, outcome (dismissed alive from the hospital, died in the postoperative period, or euthanized at surgery), and duration of hospitalization were evaluated. 6 dogs survived, 6 dogs died or were euthanized after surgery, and 3 were euthanized during surgery. Five of 8 dogs treated with omentalization and abdominal closure survived, and 1 of 4 dogs treated with open peritoneal drainage survived. In several dogs, treatment required additional surgical procedures, which did not appear to affect outcome. Postoperative complications were similar among survivors and nonsurvivors. Mean duration of hospitalization for dogs treated with omentalization and abdominal closure was less than that of dogs treated with open peritoneal drainage. Neither pancreatitis severity score nor any individual components of the score were associated with outcome. Omentalization is a viable treatment option for pancreatic abscess in dogs. Furthermore, shorter hospitalization and better survival outcomes may make omentalization preferred over open peritoneal drainage.

Open Peritoneal Drainage Versus Primary Closure for the Treatment of Septic Peritonitis in Dogs and Cats: 42 Cases (1993–1999)

To determine survival rates in dogs and cats with septic peritonitis treated with open peritoneal drainage (OPD) versus primary closure (PC) after laparotomy. Retrospective analysis of medical records from Colorado State University Veterinary Teaching Hospital from 1993 to 1999. Thirty-six dogs and 6 cats with septic peritonitis documented by cytological examination or microbiological culture of abdominal fluid. Medical records of dogs and cats with septic peritonitis treated by OPD or PC were reviewed. Age, weight, species, white blood cell (WBC) count, band neutrophil count, platelet count, serum glucose concentration, heart rate, body temperature, duration of hospitalization, and clinical outcome were recorded for each animal. Differences in treatments administered between the OPD and PC groups as well as the underlying cause of septic peritonitis were determined. There was no significant difference in survival between animals in the OPD versus PC groups (P =.26) with an overall survival rate of 71%. White blood cell count, band neutrophil count, platelet count, serum glucose and total bilirubin concentrations, heart rate, age, and weight were not significantly different between groups (P >.05). A significantly greater number of animals in the OPD group received plasma (P =.009), blood (P =.037), and a jejunostomy tube (P =.02) than animals in the PC group. There was a significant difference in the number of days spent in critical care unit with a mean of 6.0 +/- 4.1 days for the OPD group and 3.5 +/- 2.3 days for the PC group (P =.02). Open peritoneal drainage for the management of septic peritonitis in dogs and cats is an acceptable alternative to PC.

Potential Prognostic Indicators in Diffuse Peritonitis Treated with Open Peritoneal Drainage in the Canine Patient

SummaryThe purpose of this study was to identify prognostic indicators that may help to predict outcome in clinical cases of diffuse peritonitis treated with open peritoneal drainage. Medical records from 19 canine patients with generalized peritonitis treated with open peritoneal drainage between 1990 and 1996 were reviewed. The signalment, preoperative complete blood count (CBC), preoperative biochemical profiles, and number of days of open peritoneal drainage of surviving patients (n = 15) were compared to nonsurviving patients (n = 4). Significant differences were noted between the surviving and nonsurviving groups in the ALT (p = 0.02) and GGT (p = 0.01) values. Seventy‐nine percent of the patients in this study survived.

A CASE OF AMEBIC LIVER ABSCESS IN A HOMOSEXUAL MAN WITH NO EFFECT OF PERCUTANEOUS DRAINAGE

We experienced a case of amebic liver abscess in a 39-year-old homosexual man. The patient was admitted to the hospital because of tenderness on the right hypochondrium and fever. Ultrasound and CT revealed a liver cyst 8cm in diameter in S 7. An ultrasound-guided percutaneous liver drainage was unsuccessful and the abscess ruptured into the peritoneal cavity two days after the percutaneous liver drainage. Open peritoneal drainage was performed. Their administration of metronidazole was started with good outcome; the patient was upgraded to good condition. A retrograde bacterial infection developed through the drainage tube. Antibiotics were administrated, which controlled the infection, and the tube was subsequently removed. The patient was discharged and left the hospital on foot. There was a rapid increase in the number of reported cases of amebiasis in Japan after 1980. Most of these patients were thought to be homosexual men, and this disease is thought to be a prevalent sexually transmitted amebiasis. The serologic test is the most reliable option for diagnosis. An amebic abscess must be suspected if an abscess is found in the patient's liver. Metronidazole must be administrated to the patient as soon as possible, and the drainage procedure should be avoided except some special cases.

Open peritoneal drainage in horses with experimentally induced peritonitis.

Peritonitis was induced in 12 horses by median celiotomy and 1 hour of small intestinal ischemia. Six horses had primary closure of the incision, whereas six horses had a plastic mesh sutured to the ventral abdominal wall leaving the abdomen open for ventral drainage. The mesh was removed after 5 days and the abdominal wall was closed by apposition of the linea alba and subcutaneous tissues and approximation ef the skin edges. Peritoneal fluid was collected and analyzed for nucleated cell count and total protein concentration on days 0 and 5. Serum biochemical profiles, serum electrolyte concentrations, and complete blood counts were performed on days 0, 1, 2, 5, 6, 10, and 14. Body weight, rectal temperature, and physical examination findings were recorded daily for 30 days, then horses were euthanatized and the abdominal cavity was examined for the presence of adhesions. Histological examination was performed to assess the inflammatory response of the healing body wall; inflammation scores were significantly lower in horses that had primary closure of the incision. The mesh was well tolerated by all horses and allowed egress of peritoneal fluid for 5 days. Adhesions were present in four control horses and in two horses that had open peritoneal drainage. All horses that had open drainage developed incisional infections after mesh removal. Abdominal wall herniation did not occur in any of the horses. The mild peritonitis induced in this study was insufficient to establish the efficacy of open peritoneal drainage for an established peritonitis in horses; however, the results of this study indicate that open peritoneal drainage is feasible in horses.

Intracapsular prostatic omentalization: a new technique for management of prostatic abscesses in dogs.

Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependent Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.

Open intestinal anastomosis with surgical stapling equipment in 24 dogs and cats.

Surgical stapling equipment was used to perform open antiperistaltic side-to-side ("functional end-to-end") entero-anastomoses in 20 dogs and 4 cats. Twenty-one anastomoses healed uneventfully. Seven animals with severe bacterial peritonitis required open peritoneal drainage and delayed abdominal closure. There was postoperative leakage at the anastomotic site in two dogs and a localized abscess at the staple line in one cat. No long-term complications occurred in follow-up periods of 3 to 29 months.

Intraperitoneal Circulation and Drainage in the Dog

The patterns of dispersion and drainage of a low viscosity, oil-based contrast medium within the peritoneal cavity were examined in 12 normal dogs. Intraperitoneal injection of contrast medium was cranial or caudal and drainage was by the sump-Penrose or open peritoneal method. Radiographs were made over a 96 hour period, before and after peritoneal drainage was established. Each dog was euthanatized and necropsied. The contrast medium was dispersed throughout the peritoneal cavity 15 to 30 minutes after cranial injection and 1 to 2 hours after caudal injection. Most of the contrast medium drained within 6 hours after open peritoneal drainage and within 24 to 48 hours after sump-Penrose drainage. At necropsy, there was complete encasement of all sump-Penrose drains and partial occlusion of all open peritoneal incisions by omentum adhered to the abdominal wound edges. Peritonitis was not grossly evident, but all dogs showed histologic evidence of an acute inflammatory reaction associated with the drain or wound edge.

A STUDY OF OPEN PERITONEAL DRAINAGE AS A TREATMENT FOR ADVANCED PERITONITIS

We performed open peritoneal drainage in four patients who showed septic shock symptoms because of an intraperitoneal abscess due to postoperatively insufficient suture. Mostly the effects and indications of the drainage method were studied. The procedure of this method was simple: In a ward, the surgical wound was opened to the abdominal cavity. The purpose of this method is to drain the main infected lesion. Although it is less effective for a small absces between adhered intestinal canals, it can become an accepted method for improving systemic morbid conditions such as endotoxemia. Indications for this method are restricted to such postoperative cases as severely insufficient suture probably showing endotoxemia. In other cases of advanced peritonitis, a surgical drainage is selected even in the septic condition. Its problems involve a risk of eventration, intestinal atresia due to peristalsis failure of the exposed intestinal tract, etc. None of these problems was observed in our patients. In two of the patients, the exposed intestinal tract had been covered with granulation and epidermis with the control of the infection and the opened wound closed spontaneously except for the enteroproctia.

Open Abdominal Drainage in the Treatment of Generalized Peritonitis in 25 Dogs and Cats

The case records of 20 dogs and 5 cats that were managed by open peritoneal drainage for generalized peritonitis were reviewed. Although the underlying causes varied, diffuse septic peritonitis was present in all animals. The abdominal incision was closed loosely at the time of the first surgical procedure, and a sterile abdominal wrap was maintained throughout the postoperative period. The abdomen was closed completely in a second surgical procedure performed 2 to 9 days later.The overall mortality rate was 48%. Most deaths occurred before secondary closure of the abdomen was performed. Complications of open peritoneal drainage were hypopro‐teinemia and nosocomial contamination.

臓器障害を伴った消化器手術後の腹膜炎に対するOpen Peritoneal Drainageの有用性について

臓器障害を伴った消化器手術後の腹膜炎に対するOpen Peritoneal Drainageの有用性について

Open Peritoneal Drainage in Experimental Peritonitis in Dogs

Peritonitis was induced In 12 dogs by creation of an avascular jejunal loop. After 24 hours, the avascular jejunal loop was removed, and purulent material was removed by aspiration. The abdominal incision in six experimental dogs was left open under a bandage, while the incision was closed in six control dogs. All six open abdomen, and four control, dogs survived the 8 days of the study. The number of bacteria in the peritoneal exudate in experimental animals was less than in control animals. At the end of the 8 day study, experimental animals were more active, had better appetites, and were less likely to have fever, vomition, diarrhea, and dehydration. Experimental animals weighed significantly less than control animals. There were no differences between groups with respect to biochemical and hematologic parameters. At necropsy, experimental animals had fewer adhesions and less peritoneal fluid accumulation than control animals. Complications of open peritoneal drainage included persistent fluid loss, weight loss, adhesions of abdominal viscera to the bandage, and contamination of the peritoneal cavity with cutaneous organisms.