Peritoneal Irritation Research Articles

Massive enteric necrosis caused by histiocytic sarcoma embolism: a case report

BackgroundHistiocytic sarcoma (HS) is a rare disease characterized by the presence of neoplastic histiocytes. We herein report an unusual case of HS that caused massive tumor embolism-related transmural necrosis of the small intestine.Case presentationA 64-year-old man presented with multiple nodules in the lungs, bone, mediastinum, and subcutaneous tissues that were incidentally detected on preoperative computed tomography for early transverse colon cancer. Approximately two months later, the patient presented with signs of peritoneal irritation suggestive of small intestinal necrosis. Emergency surgery was performed and the necrotic small intestine was resected. Pathological examination revealed small bowel necrosis due to multifocal HS embolism. The postoperative course was uneventful. The patient was unsuccessfully treated with chemotherapy for HS and died 122 days postoperatively.ConclusionsHS can cause massive enteric necrosis due to tumor embolism. Clinicians should be aware of this rare presentation of HS.

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion

IntroductionThere are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe...

"Amr Sign": A Case-Control Study Evaluating the Diagnostic Value of a New Clinical Sign in the Diagnosis of Acute Appendicitis.

Introduction Acute appendicitis, a prevalent cause of acute abdominal pain and a common indication for emergency surgery, presents a diagnostic challenge due to its diverse clinical presentation and variability in appendix location and symptoms. Traditional diagnostic approaches, including physical examination, clinical scoring systems, and imaging techniques, have limitations. This study introduces the "Amr sign," a new diagnostic indicator characterized by sudden reflex hyperextension of the neck upon palpation of the right iliac fossa, which is hypothesized to reflect local peritoneal irritation from an inflamed appendix. Methods We conducted a prospective observational study at Alwakra Hospital from November 2016 to January 2019 that included 195 patients aged 15 years and older with right iliac fossa pain and an Alvarado score of four or more. The "Amr sign" was evaluated alongside standard clinical examination and imaging results. Diagnostic accuracy was assessed via histopathological confirmation, which is the gold standard. Results The "Amr sign" had a sensitivity of 68.6% and a specificity of 67.3%. The positive predictive value (PPV) was 89%, whereas the negative predictive value (NPV) was 45%. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.679 for the "Amr sign" compared with 0.622 for the other imaging modalities, suggesting comparable diagnostic performance. The "Amr sign" demonstrated a higher likelihood ratio of a positive test (2.3) and a lower likelihood ratio of a negative test (0.46). Conclusion The "Amr sign" is a promising diagnostic tool for acute appendicitis, offering a simple, reliable, and quick test that can be performed by less experienced physicians. While its sensitivity and specificity are moderate, its high PPV suggests that it is particularly useful in confirming appendicitis. Further research and validation are needed to fully establish its role in clinical practice.

Pregnancy after advanced ovarian cancer with spontaneous uterine rupture in second trimester: A case report and review of the literature.

Fertility-preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31-year-old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low-grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra-cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long-term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus.

ACUTE HEMORRHAGIC ABDOMEN IN YOUNG PATIENTS: CLINICAL MANIFESTATIONS AND SURGICAL TREATMENT

Acute hemorrhagic abdomen represents a surgical emergency that requires rapid diagnosis and immediate treatment. In young patients, the most common causes include perforated peptic ulcer, ruptured ectopic pregnancy, ovarian cyst torsion, and abdominal trauma. The clinical presentation is variable, but intense and sudden abdominal pain, associated with signs of hypovolemic shock (hypotension, tachycardia, pallor), is characteristic. Delay in diagnosis and treatment can lead to serious complications, such as hemodynamic instability, infection and death. Objective: The objective of this systematic review was to synthesize the available scientific evidence on the clinical manifestations and surgical treatment of acute hemorrhagic abdomen in young patients, with the aim of assisting health professionals in decision-making and therapeutic planning. Methodology: A systematic review of the literature was carried out, following the PRISMA checklist criteria. The PubMed, Scielo and Web of Science databases were searched using the following descriptors: “acute abdomen”, “hemorrhagic abdomen”, “young people”, “surgery”, “emergency”. Original articles published in the last 10 years were included, which addressed young patients diagnosed with acute hemorrhagic abdomen and described the clinical manifestations of the disease and the results of surgical treatments. Case studies, narrative reviews and articles that were not available in full were excluded. Results: The review identified a total of 17 studies that addressed acute hemorrhagic abdomen in young patients. The results demonstrated that intense and sudden abdominal pain is the most common symptom, often associated with nausea, vomiting and bloating. The presence of signs of peritoneal irritation, such as muscle guarding and pain upon sudden decompression, is suggestive of peritonitis. Complementary tests, such as blood count, coagulogram and computed tomography, are essential for diagnosing and staging the disease. The treatment of acute hemorrhagic abdomen is surgical and aims to control bleeding, remove the cause of hemorrhage and repair tissue damage. Exploratory laparotomy remains the gold standard for treatment, although laparoscopy has become increasingly popular in specialist centers. Conclusion: Acute hemorrhagic abdomen in young patients is a surgical emergency that requires a quick and effective approach. Early diagnosis and surgical treatment are essential for the patient's survival. High clinical suspicion, associated with the performance of appropriate complementary tests, allows diagnosis and initiation of treatment in a timely manner. Exploratory laparotomy remains the procedure of choice, but laparoscopy has proven to be a safe and effective alternative in many cases.

Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report

BACKGROUND Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of < 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture. CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency > 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection. CONCLUSION After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.

Idiopathic superior mesenteric venous thrombosis requiring bowel resection: a report of four cases

BackgroundSuperior mesenteric venous thrombosis (SMVT) is mostly treated with anticoagulation therapy; however, SMVT can lead to irreversible bowel ischemia and require bowel resection in the acute or subacute phase.Case presentationWe report four cases of SMVT that required careful observation and bowel resection. Case 1: A 71-year-old man presented with abdominal pain, diarrhea, and vomiting that showed a completely occluded SMV with thrombus and small bowel ischemia. Case 2: A 47-year-old man presented with abdominal pain, peritoneal irritation symptoms, and a completely occluded SMV with thrombus, ischemia of the small bowel, and massive ascites. Case 3: A 68-year-old man presented with abdominal pain and vomiting for several days and showed a partially occluded SMV with a thrombus, bowel ischemia, and massive ascites. Case 4: A 68-year-old man presented with acute abdominal pain and a partially occluded SMV with thrombus and bowel edema without ischemic changes. Anticoagulation therapy was administered; however, 3 days later, abdominal pain and bowel ischemia worsened. Bowel resection was performed in all cases.ConclusionsMost idiopathic SMVT cases can be treated with anticoagulation therapy or endovascular thrombectomy. However, in cases with peritoneal irritation signs, these treatments may be ineffective, and bowel resection may be required.

Development and organization of omental milky spots.

The milky spots in omentum are atypical lymphoid tissues that play a pivotal role in regulating immune responses in the peritoneal cavity. The milky spots act as central hubs for collecting antigens and particles from the peritoneal cavity, regulating lymphocyte trafficking, promoting the differentiation and self-renewal of immune cells, and supporting the local germinal centre response. In addition, the milky spots exhibit unique developmental characteristics that combine the features of secondary and tertiary lymphoid tissues. These structures are innately programmed to form during foetal development; however, they can also be formed postnatally in response to peritoneal irritation such as inflammation, infection, obesity, or tumour metastasis. In this review, I discuss emerging perspectives on homeostatic development and organization of the milky spots.

Inverted Meckel’s diverticulum as a cause of intestinal intussusception in a child: A case report

One of the causes of intussusception is the presence of Meckel’s diverticulum. Although Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract, isolated cases of intussusception caused by the inversion of Meckel’s diverticulum into the lumen of the ileum have been described in world literature. Description of case. The patient was a 2-year-11-month boy who was transported by an ambulance team, with complaints of paroxysmal abdominal pain and single vomiting. Palpation revealed lower abdominal pain without signs of peritoneal irritation. The child underwent an ultrasound examination of the abdominal cavity, which revealed a layered structure consisting of the wall of the large and small intestines in the right lower quadrant. Thus, a diagnosis of intussusception was established. An attempt to conservatively straighten the intussusception during pneumoirrigoscopy was ineffective. Emergency laparoscopy was performed, and ileocecal intussusception was diagnosed, which was eliminated without technical difficulties. During the inspection of the ileum, a crater-shaped depression with a dense formation extending from it into the intestinal lumen was discovered on its antimesenteric edge 30 cm from the ileocecal angle. The operation was continued with a minilaparotomy in the right iliac region. Meckel’s diverticulum was manually inverted from the ileum, tied at the base, and cut off with the stump immersed in a purse-string suture. The postoperative period was event-free. On day 5 after the operation, the child was discharged home in a satisfactory condition. For any intussusception in children aged 1 year, the anatomical causes must be excluded, except for the possibility of an inverted Meckel’s diverticulum. Therefore, after successful intestinal disinvagination, a thorough revision of the ileum is necessary.

Anemic Gastrointestinal Bleeding in Campylobacter Jejuni Infection

We present a 13-month-old male with a history of multiple diarrheal episodes with mucus and blood due to Campylobacter Jejuni infection. He was admitted in the last of them due to mucosanguinous stools, fever and oral intolerance. He was treated with amoxicillin/clavulanic acid and a blood test was performed without leukocytosis (14 x109/L) but with neutrophilia (10.2 x109/L) and elevated CRP (85mg/L), in addition to abdominal ultrasound with minimal fluid tab in the right iliac fossa. On the second day of hospitalization, he presented an anemizing and painless gastrointestinal bleeding that required transfusion (hemoglobin 6.3g/dL), however, he was hemodynamically stable, with slightly painful abdomen in lower quadrants, but without peritoneal irritation.

Expulsion of a Hydatid Cyst from the Liver with Intact Proligerous Membrane into the Peritoneal Cavity in Children: About 01 Cases

Introduction: Peritoneal hydatid disease (HP) is a parasitic condition secondary to seeding of the peritoneal serosa, primary or secondary, by Echinococcus granulosus larvae. Observation: Child aged 06, male, with no known history, admitted for diffuse abdominal pain lasting for 3 days in a context of fever; in whom the clinical examination revealed a peritoneal irritation syndrome. Ultrasound and abdominal CT showed the presence of a hypogastric cystic mass. Surgical exploration revealed a hydatid cyst with intact proligerous membrane free in the peritoneal cavity. Conclusion: Peritoneal hydatidosis with expulsion of a hydatid cyst from the liver with intact proligerous membrane into the peritoneal cavity is rare. Its treatment is surgical and the outcome is most often favorable.

Spontaneous heterotopic pregnancy resulting in tubal rupture and complete spontaneous abortion: a case report in Tiko, Cameroon

Introduction and importance: A heterotopic pregnancy (HP) following spontaneous conception is a rare and potentially life-threatening condition. Its diagnosis can be overlooked, hence remaining one of the challenging gyneco-obstetrical emergencies, especially in the low-resource setting. Case presentation: A 24-year-old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. An abdominopelvic ultrasound showed retained products of conception, and the presence of a left adnexal mass suggestive of an extrauterine gestational sac at ~6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the hemodynamic stability of the patient prompted an emergency laparotomy to be done. The patient was transfused, postsalpingectomy counseling done and was discharged on oral analgesics, blood tonics, and antibiotics on day 6 postoperation. Clinical discussion: HP following spontaneous conception is a rare and potentially life-threatening condition. This case reports on the management of spontaneous HP resulting in a ruptured ectopic pregnancy (EP) and a complete spontaneous abortion managed in a low-resource setting. This case emphasizes the importance of a systematic ultrasound to be done for all patients with a clinically confirmed abortion to rule out an associated EP. Conclusion: A spontaneous abortion without signs of peritoneal irritation can be associated with an EP. Ultrasound can help in the early diagnosis, and laparotomy can be life-saving.

Jejunal Undifferentiated Spindle Cell Sarcoma with Intussusception Revealed by 18F-FDG PET/CT.

Spindle cell sarcoma is a malignant tumor with low incidence. They can occur in the soft tissue, bone, or viscera. The characteristics of morphology, density, and metabolism of spindle cell sarcoma are related to the location of the lesion. A 61-year-old woman presented with vomiting after eating for 2 weeks. Signs of peritoneal irritation were involved, but no response for symptomatic treatment included antiemetic and antispasmodic therapy. Abdominal computed tomography (CT) indicated a mass in the intestinal tract in the pelvic cavity. Then, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT was performed, which interestingly detected a jejunal malignancy mass in the left upper abdomen with annular high uptake of 18F-FDG, which was complicated by intussusception and intestinal obstruction. Finally, the jejunal mass was pathologically clarified as an undifferentiated spindle cell sarcoma.

Management of Perforated Sigmoid Diverticulitis with Associated Retroperitoneal Abscess and Generalized Peritonitis

Introduction: Diverticulitis represents a relatively common pathology within the gastrointestinal tract. While diverticula can occur throughout the digestive system, their prevalence is notably higher in the left colon, particularly in the sigmoid region. This condition predominantly affects middle-aged and elderly males. The most effective diagnostic methods for this disease are colonoscopy and computed tomography (CT) with contrast. Although severe complications of diverticulitis are infrequent, the optimal classification of these complications has been described by Hinchey.
 The article aims to show the case of a young patient with complicated diverticulitis with perforation and generalized peritonitis, classified as stage III-IV, according to Hinchey.
 Case report: A 43-year-old female patient was urgently admitted to the General Surgery Clinic at Tetovo Clinical Hospital, presenting with severe generalized abdominal pain and signs of peritoneal irritation. Comprehensive diagnostic imaging revealed a large retroperitoneal abscess located above the psoas muscle, accompanied by a significant accumulation of free fluid, suspected to be pus, in the abdominal cavity. Following initial resuscitation, surgical intervention was undertaken. Intraoperative findings included advanced inflammatory changes in the sigmoid colon, characterized by thickened fibrotic walls and a partially constricted lumen. A large abscess was also identified in the retroperitoneal space between the spleen and left kidney. Given these findings, resectioning the distal descending colon and most of the sigmoid colon was considered necessary. The retroperitoneal abscess was incised, its contents aspirated, and a thorough cavity debridement was performed. Subsequently, the Hartmann procedure was executed. Postoperatively, due to the patient's deteriorating condition, she was transferred to the intensive care unit for continued treatment. The patient was discharged from the hospital in stable condition on the tenth day following the surgery.
 Conclusion: While complications from sigmoid diverticula are uncommon, they can occasionally be extremely severe and pose a significant risk to patient survival.

Surgical treatment of gallstone ileus caused by cholecystoduodenal fistula – a case report

Background: Gallstone ileus is a rare complication of cholelithiasis caused by a bilioenteric fistula. Besides clinical examination, computer tomography (CT) scan is considered a radiological diagnostic procedure. Case Presentation: A 68-year-old male patient presented with epigastralgia, nausea, and emesis. The abdomen was distended and diffusely painful to palpation with peritoneal irritation. Auscultation showed raised peristaltic sounds. CT scan showed aerobilia, distension of the stomach, duodenum, and proximal jejunum, and inside it a 3.5 cm calcified round foreign body. Exploratory laparoscopy showed jejunum obstruction and chronic inflammation of the gallbladder. Lifting the small bowel through a small laparotomy was performed for gallstone removal. After recovery a delayed cholecystectomy and fistula closure followed. Hospital stays were short and complication-free. Conclusion: There are no guidelines for the management of gallstone ileus yet because of a limited number of reported cases. Most of the bilioenteric fistulas are located between the gallbladder and duodenum. In cases of biliocolonic fistula, causing obstruction in the colon endoscopic or conservative therapy can also be performed with a success rate of 26%. Surgical treatment is still a common procedure in emergency cases.

Surgical treatment of gallstone ileus caused by cholecystoduodenal fistula – a case report

Background: Gallstone ileus is a rare complication of cholelithiasis caused by a bilioenteric fistula. Besides clinical examination, computer tomography (CT) scan is considered a radiological diagnostic procedure. Case Presentation: A 68-year-old male patient presented with epigastralgia, nausea, and emesis. The abdomen was distended and diffusely painful to palpation with peritoneal irritation. Auscultation showed raised peristaltic sounds. CT scan showed aerobilia, distension of the stomach, duodenum, and proximal jejunum, and inside it a 3.5 cm calcified round foreign body. Exploratory laparoscopy showed jejunum obstruction and chronic inflammation of the gallbladder. Lifting the small bowel through a small laparotomy was performed for gallstone removal. After recovery a delayed cholecystectomy and fistula closure followed. Hospital stays were short and complication-free. Conclusion: There are no guidelines for the management of gallstone ileus yet because of a limited number of reported cases. Most of the bilioenteric fistulas are located between the gallbladder and duodenum. In cases of biliocolonic fistula, causing obstruction in the colon endoscopic or conservative therapy can also be performed with a success rate of 26%. Surgical treatment is still a common procedure in emergency cases.

IDIOPATIC SCLEROSING ENCAPSULATING PERITONITIS

ABSTRACT Introduction: Sclerosing Encapsulating Peritonitis (SEP) is a rare syndrome characterized by a chronic inflammatory process that leads to the formation of a thick fibrocollagenous membrane that surrounds and entraps intra-abdominal organs. As a result, although some cases may be asymptomatic, patients commonly develop symptoms of intestinal obstruction, and the diagnosis is often made incidentally during intra-abdominal surgeries. Case report: A 37-year-old male patient, a chronic alcoholic, was admitted with severe abdominal pain for seven days associated with abdominal distension, anorexia, and fever. Abdominal examination revealed signs of peritoneal irritation. Chest X-ray and abdominal computed tomography showed pneumoperitoneum and a large fluid collection, with signs of wall thickening extending through the pelvic cavity, parietocolic gutters, anterior abdominal cavity, and hepatodiaphragmatic space, causing compression of the hepatic parenchyma and displacement of intestinal loops. Due to these findings, the patient underwent an emergency exploratory laparotomy, in which a fibrocollagenous membrane, extensive bowel obstruction, and an abscess were identified. A total of 4.5 liters of purulent secretion were drained, the fibrous membrane was excised, the abdominal cavity was copiously washed, and a drain was placed in the upper right quadrant. He had a satisfactory resolution of the condition, without postoperative complications, and was discharged 11 days after the procedure. Conclusion: Initially, conservative management should be prioritized due to the technical difficulty of surgery and possible complications. However, in case of greater the level of peritoneal involvement and tissue adhesion, there is a higher chance of failure of conservative management, and surgical intervention may become necessary. Keywords: Peritonitis. Fibrosis Peritoneal. Intestinal Obstruction.

Acute Appendicitis situs inversus totalis, Case Report

Acute appendicitis with situs inversus totalis is a rare type of acute abdominal pathology, with a prevalence of 1 in 10,000 births in the population. It has several embryological causes, with the most common being intestinal antirotation due to the involvement of the gene on chromosome 14. This clinical report describes the case of a 15-year-old adolescent patient who experienced 12 hours of abdominal pain, initially starting in the umbilical region and then migrating to the left iliac fossa. The pain was accompanied by an elevated temperature, nausea, and vomiting. During clinical examination, right cardiac auscultation, uncertain appendiceal signs, and peritoneal irritation were noted. Additionally, there was evidence of leukocytosis with neutrophilia. Tomography confirmed the complete dextroposition of abdominal and thoracic organs. An exploratory laparoscopy was performed, revealing macroscopic evidence of dextroposition of abdominal organs and uncomplicated appendicitis in the suppurative phase. The diagnosis of Acute Appendicitis with situs inversus totalis can be challenging due to its low prevalence and the presence of uncertain clinical signs. Therefore, the use of complementary examinations, such as computed axial tomography, is of utmost importance, along with visualization through diagnostic laparoscopy.

Interval appendectomy as a safe and feasible treatment approach after conservative treatment for appendicitis with abscess: a retrospective, single-center cohort study

Emergency appendectomy (EA) is the gold standard management for acute appendicitis (AA). However, whether EA or interval appendectomy (IA) after conservative treatment is the optimal approach in AA with abscess remains controversial. This study compared IA and EA in patients presenting with AA accompanied by abscess. This was a retrospective single-center study including 446 consecutive patients undergoing appendectomy between April 2009 and March 2023. AA with abscess was defined as a pericecal abscess observed by computed tomography or abdominal ultrasonography, and patients with signs of peritoneal irritation were excluded. Perioperative outcomes were compared between the patients who directly underwent EA and those who underwent IA after conservative treatment. Among 42 patients (9.4%) with AA and abscess, 34 and 8 patients underwent IA and EA, respectively. The rates of ileocecal resection and postoperative complications were lower in the IA group than in the EA group (3% vs. 50%, P < 0.001 and 9% vs. 75%, P < 0.001, respectively). Colonoscopy before IA was performed in 16 of the 17 patients aged ≥ 40 years in the IA group, and one patient underwent ileocecal resection because of suspicious neoplasm in the root of the appendix. IA after conservative treatment might be considered as the useful therapeutic option for AA with abscess. Colonoscopy during the waiting period between the initial diagnosis and IA should be considered in patients aged ≥ 40 years who may have malignant changes. Implementing IA as a first-line treatment will be beneficial to both patients and healthcare providers.

Ventriculoperitoneal shunt for tuberculous meningitis-associated hydrocephalus: long-term outcomes and complications

BackgroundHydrocephalus is a frequent complication of tuberculous meningitis (TBM), and ventriculoperitoneal shunt (VPS) has been shown to improve short-term prognosis for patients with TBM-associated hydrocephalus. However, questions remain about long-term prognosis and shunt-related complications. This study aims to provide a comprehensive assessment of both long-term prognosis and shunt-related complications in patients with TBM-induced hydrocephalus who have undergone VPS treatment.MethodsThis retrospective study analyzed the clinical data of TBM patients with hydrocephalus treated with VPS at Peking Union Medical College Hospital between December 1999 and February 2023. Both short-term outcomes at discharge and long-term outcomes during follow-up were examined. Prognosis and shunt-related complications were assessed using the modified Rankin Scale (mRS) and the Activity of Daily Living (ADL) score to evaluate neurological function and autonomic living ability, respectively.ResultsA total of 14 patients with TBM-associated hydrocephalus were included in this study. Of these, 92.9% (13/14) exhibited favorable short-term outcomes, while 57.1% (8/14) showed positive long-term outcomes. Initial results indicated 6 complete recoveries (CR), 7 partial recoveries (PR), and 1 treatment failure. No catheter-related complications were observed initially. Long-term results included 4 CRs, 4 PRs, and 6 treatment failures. A variety of shunt surgery-related complications were noted, including three instances of catheter obstruction, one of incision infection, one of catheter-related infection, one of acute cerebral infarction, and one of transient peritoneal irritation accompanied by diarrhea.ConclusionsVPS appears to be an effective and well-tolerated treatment for TBM-associated hydrocephalus, efficiently alleviating acute intracranial hypertension. Nonetheless, continuous long-term monitoring and proactive management are essential to mitigate the risk of catheter-related complications.