Presence Of Free Fluid Research Articles

RESULTS OF ENDOSCOPIC DIAGNOSIS OF BLEEDING AFTER ABDOMINAL SURGICAL OPERATIONS

The aim of the study is to conduct a comparative analysis of the effectiveness of endovidiosurgical diagnosis techniques to detect gastrointestinal and intra-abdominal bleeding, which may occur after abdominal operations. Materials and methods. The main group included patients (n=408), whose condition was controlled by the endovideosurgical techniques. The control group included patients (n=102) who were controlled by using conventional surgical methods to correct bleeding that may occurred after similar surgical interventions. Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding was observed in 85 patients. In all cases, endoscopic haemostasis was performed by clipping (n=57), submucosal infiltration (n=32), electrocoagulation (n=29), argon-plasma coagulation (n=74), and combined techniques (n=54). Results and discussion. 408 patients with clinical signs of bleeding in the early postoperative period were examined by endoscopic techniques. Patients with alarming clinical and laboratory findings underwent ultrasound examination, which revealed the presence of free fluid in one or more parts of the abdominal cavity. Laparoscopy was performed in the first hours of the postoperative period in 17 cases (n=17); on the first day of the postoperative period (n=36), on the second day (n=19), on the third (n=8), on the fifth (n=3), and on the sixth day (n=2). Complications were excluded in 7 (16.0%) patients, despite a decrease in blood pressure and haemoglobin levels. The volume of blood found in the abdominal cavity, including clots, ranged from 30 ml to 2000 ml. Signs of ongoing bleeding (the predominance of a large amount of liquid blood with a small number of clots) were found in 49 (57.6%) cases, and signs of arrested bleeding (the presence of a large number of clots with a small amount of liquid blood) was detected in 29 (34.1%) cases. Haemostasis was provided by electrocoagulation (n=35), clipping (n=15), suturing (n=12) and tamponade from a mini-laporatomic incision (n=9). Gastrointestinal bleeding was observed in 323 patients, and intra-abdominal bleeding in 85 patients. In 8.4% (n=27) of cases, the suspicious cases of postoperative complication were excluded by endoscopic examinations. In 91.6% (n=296) of clinical cases, early postoperative bleeding or signs of unstable haemostasis with the risk of repeated bleeding were confirmed. In cases of alarming clinical and laboratory findings indicating intra-abdominal bleeding, diagnostic laparoscopy enables to exclude complications in 16.0% of patients, despite a decrease in blood pressure and haemoglobin levels.

Relevance of pneumoperitoneum in the conservative approach to complicated acute diverticulitis. A retrospective study identifying risk factors associated with treatment failure.

The aim of this study is to evaluate the relevance of pneumoperitoneum on the success rate of non-operative management (NOM) of patients with complicated acute diverticulitis (AD), and the risk factors associated with failure. Observational retrospective cohort study of patients attended at the emergency department for AD from January 2015-August 2019. Patient demographics, blood tests, radiological data and initial treatment strategies were registered. NOM, based on intravenous antibiotics (ATB) and bowel rest, was defined as unsuccessful when emergency surgery (ES) and/or infection-related death took place. Patients initially treated with ES were excluded. Analysis was done with the IBM SPSS statistics 23.0.0.2 software. According to modified Hinchey and WSES criteria, 99 (12%) of 826 AD episodes were complicated, with pneumoperitoneum on the CT scan in 89 (90.5%). NOM was undertaken in 93 (94%) cases, with a 91.5% success rate. Multivariate analysis revealed ASA class III-IV, and the presence of fluid collections >3 cm in diameter, but not distant free air, to be associated with NOM failure. However, the success rate of NOM was significantly higher in patients with pericolic pneumoperitoneum (98.5%) than in those with distant free air (80%) (P=0.02). Risk factors of NOM failure were an advanced age, high CRP and WBC values, and the presence of free fluid in >2 abdominal quadrants. NOM in hemodynamically stable patients with complicated AD is a safe and feasible approach, even in the context of distant free air. Nevertheless, patients with isolated pericolic air did better in our series.

Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - Two case reports and a literature review

We report 2 cases of haemoperitoneum due to a bleeding of the uterine artery caused by infiltrating endometriosis. We have also conducted a literature review on endometriosis-related intra-abdominal haemorrhage and wrote a practical guideline on how this entity can be recognized and handled.Case 1: A 49-year-old multiparous woman presented with intense stabbing pain in the lower abdomen during her menstruation. CT angiography showed a bleeding from a side branch of the internal iliac artery. Laparoscopy was performed and an active bleeding from the right uterine artery was confirmed, clearly caused by infiltrating endometriosis lesions. Haemostasis was achieved by bipolar coagulation. Case 2: A 29-year-old nulliparous woman was admitted for observation because of heavy stabbing pain in the right lower quadrant and presence of free fluid on CT abdomen. The day after the admission, laparoscopy was performed because of a decreasing haemoglobin level. An arterial bleeding from the right parametrium was observed, probably originating from the right uterine artery. Histopathological examination of a biopsy of the right parametrium proved the presence of endometriosis. Haemostasis was achieved by bipolar coagulation.Although endometriosis-related haemoperitoneum is a rare entity, this diagnosis should be considered when a patient presents with an intra-abdominal haemorrhage during menstruation or withdrawal bleeding - especially in case of a history or suspicion of endometriosis. Laparoscopy is the cornerstone of the treatment.

Ovarian Torsion in Adolescents with and without ovarian mass: ACross-sectionalStudy.

The aim of this study was to compare the characteristics of adolescents with and without adnexal mass who were diagnosed with ovarian torsion (OT). Retrospective cross-sectional study. Gynecology Department at Tepecik Education and Reseach Hospital, Izmir, Turkey. Adolescent girls who received surgery for OT between March 2012 and October 2020 in our institution. The patients were divided into 2 groups according to the presence or absence of an ovarian mass and compared. Demographic and clinical characteristics, imaging findings, surgery, and pathology reports of the patients were obtained. Differences in initial symptoms, ultrasound findings, the diagnostic process, and the degree of torsion in patients with and without ovarian mass. Seventy-six patients were diagnosed with OT. Of the 76 patients, 41/76 (53.9%) had an ovarian mass (OTwM), and 35/76 (46.1%) had no pathology (OTnP). The admission to surgery interval was longer in the OTnP group (P=.03). Ultrasound findings of ovarian edema and the appearance of free fluid were significant in the OTnP group (P=.001). The largest dimension of the nontorsion ovary in the OTnP group was greater than in the OTwM group (P=.03). In addition, it was found that torsion more than 360° was more common in the OTnP group than in the OTwM group (24/35, 68.5% vs 41/18, 43.9%; P=.03). In symptomatic adolescents without an ovarian mass, the presence of follicle peripheralization suggesting ovarian edema on ultrasound and the presence of free fluid in the abdomen are important in terms of suspicion of torsion for clinicians. In addition, the degree of torsion was increased in these patients.

Are seminal vesicles a potential pitfall during pelvic exploration using point-of-care ultrasound (POCUS)?

BackgroundTrauma is a major cause of death among the working population. Many countries have now adopted a structured approach to trauma management in which ultrasound is used as a primary evaluation tool. While its use has direct therapeutic benefits, many artifacts and pitfalls are inherent to the technique. Knowledge of the most frequently encountered pitfalls in practice could thus help reduce the risk of error and lead to more accurate trauma assessments.ObjectiveThis study evaluates a potential pitfall caused by seminal vesicles during focused assessment with sonography for trauma examinations of the male pelvis performed by an emergency physician with experience in point-of-care ultrasound.MethodsWe took five static and five dynamic (3-s loops) transverse ultrasound images of the pelvis in five healthy males. The images and videos were then incorporated into an online survey and emailed through the World Interactive Network Focused On Critical UltraSound (WINFOCUS) in France and the Ultrasound and Emergency Medicine (UEM) Organization in Belgium. A questionnaire asked anonymous participants to assess the presence of free fluid in the static and dynamic images and to share information about their training and experience in point-of-care ultrasound. To validate the static and dynamic images, the survey was sent to three external radiologists for independent verification.ResultsA total of 191 individuals responded fully or partially to the survey, 114 of whom completed it. Among the 114 participants who completed the survey, the misinterpretation rate was 0.55 (95CI 0.51–0.60) for all static and dynamic ultrasound transverse pelvic views. The misinterpretation rate was 0.61 (95CI 0.55–0.66) and 0.50 (95CI 0.45–0.55) for static and dynamic ultrasound transverse pelvic views, respectively. The three external radiologists answered the questionnaire correctly without misinterpreting the survey ultrasound views.ConclusionsSeminal vesicles are a potential pitfall when interpreting transverse ultrasound images of the male pelvis in the context of point-of-care ultrasound.

True Infection by Capillaria hepatica in a Dog

Background: Capillaria hepatica is a nematode, zoonotic, with worldwide distribution. The main hosts are rodents, nevertheless other mammals can be affected. Although the parasite has high affinity for the liver, it rarely causes a hepatic disease in domestic animals and humans. The diagnosis is difficult and usually a biopsy is required. The treatment is difficult and is based in anti-helminthic and corticoid, but prevention is the best strategy against the disease. The aim of the present report is to describe a case of hepatic capillariosis in a dog approaching the clinical signs, diagnosis and therapeutic. Case: A 12-year-old Brazilian Terrier bitch, with a history of visit to the farm and regular hunting of rats, frogs, birds and other wild animals, was attended with hyporexia and apathy. At the physical exam the dog presented elevation of rectal temperature, intense jaundice and abdominal pain. In the biochemical exams was noticed a slight increase in globulins and a sharp increase in alkaline phosphatase (AP), total, direct and indirect bilirubin, suggesting a liver injury. In the ultrasonographic exam, hepatomegaly with dispersed hyperechoic areas were observed, suggesting hepatic steatosis. The patient was treated with ursodesoxicolic acid and S-adenosil metionin for 30 consecutive days, showing a clinic improvement. Two months after the end of the treatment the animal worsened, showing jaundice, ascites, motor incoordination, weakness, difficulty in food and water ingestion and changes in the mental state. In the complete blood count was observed a macrocytic hypochromic regenerative anemia, leukocytosis with neutrophilia and monocytosis and thrombocytopenia. In biochemical exams was detected decrease in creatinine and albumin and increase in alanine aminotransferase and AP, suggesting hepatopathy by biliary obstruction. There were performed exams for leishmania and ehrlichiosis that tested negative. In the ultrasonographic exam it was noticed that the liver had the same alterations and the presence of free fluid in the abdominal cavity. Due to the deterioration of the clinical picture a blood transfusion was necessary, however the patient worsened and presented respiratory difficulty for a bilateral pleural effusion. Then, the fluid was drained and a treatment with S-adenosil metionin, silymarin, ursodesoxicolic acid, doxycycline and prednisolone was started. After 17 days, a hepatic biopsy was performed, but the patient died at the surgery desk. Samples from the liver were collected for histopathologic exam. The diagnosis was confirmed in hepatic capillariosis and periportal chronic hepatitis, with the visualization of numerous parasites structures with bioperculated barrel shape. Discussion: Due to the nonspecific clinical alterations observed in the patient and the low prevalence of C. hepatica in domestic animals, there was a difficulty in the diagnosis which lead to a symptomatic, nonspecific and inefficient treatment that culminate with the death of the patient. The histopathologic exam of the liver is the best manner to find the correct diagnosis of C. hepatica infection, once the parasites eggs remains in the liver parenchyma wrapped by fibrosis and aren´t eliminate in the feces. The eggs elimination in the environment just occur after the death of the animal. Although there didn't exist a consensus about hepatic capillariosis treatment yet, if the diagnosis were done earlier, a specific treatment with better chances of a good result could be performed. We concluded that hepatic capillariosis should be included in differential diagnosis for patients with hepatic syndrome, mainly if the animal had a hunting habit and if it had access to surroundings with high rats’ infestation.

Abscesso esplênico amebiano: um relato de caso

Objetivo: Relatar um caso clínico de abscesso esplênico amebiano e discutir suas características clínicas, seu difícil diagnóstico, seu manejo clínico e cirúrgico. Apresentação do caso: Paciente masculino 39 anos foi admitido com queixa de dor abdominal em região de flanco esquerdo, náuseas e inapetência, negando febre, vômitos e alterações do hábito intestinal. Ao exame físico abdominal evidenciou um abdome tenso, reativo, com dor à palpação de flanco esquerdo, com sinal de descompressão brusca positiva e Giordano positivo à esquerda. Na admissão foi realizada tomografia computadorizada de abdome que evidenciou coleções hipodensas no baço e presença de líquido livre na cavidade abdominal, com hipótese de abscesso esplênico. Foram realizadas esplenectomia e pancreatectomia caudal e iniciado ceftriaxona e metronidazol. Após a cirurgia foi solicitada cultura da secreção com resultado positivo no dia 05/07/2019 para pesquisa direta de Entamoeba histolytica, definindo o diagnóstico de abscesso esplênico por ameba. Paciente recebeu alta no dia 06/07/2019 com receita de metronidazol para término do tratamento. Considerações finais: O abscesso esplênico amebiano é uma patologia raríssima com poucos dados na literatura, havendo uma dificuldade e demora no diagnóstico e no tratamento dessa patologia o que implica diretamente no prognostico do paciente. Portanto, é necessário que mais casos sobre a patologia sejam relatados para melhor entendimento sobre o diagnóstico e manejo do abscesso esplênico amebiano.

Embarazo ectópico tubárico seis años después de una histerectomía

El embarazo ectópico en pacientes histerectomizadas es un evento poco común y rara vez se considera en el diagnóstico diferencial en mujeres con esa condición. Se comunica el caso de una paciente de 30 años con antecedentes de histerectomía realizada hacía 6 años, que se presentó en el servicio de urgencias con evolución de tres días de dolor abdominal bajo. La ecografía mostró un saco gestacional con embrión y presencia de líquido libre en el fondo de saco Douglas. El examen histológico de la muestra operatoria reveló vellosidades coriónicas y un embrión dentro de la trompa uterina.

Predictive Model for Operative Intervention after Blunt Abdominal Trauma in Children with Equivocal CT Findings: A Pilot Study

BackgroundTo study the clinical and radiologic factors predicting the need for surgical intervention after blunt abdominal trauma (BAT) in children with equivocal computed tomography (CT) scan findings. MethodsWe performed a retrospective review of the trauma database at our level I pediatric trauma center between 2011 and 2019. We selected patients with BAT and equivocal findings for surgical intervention on CT scan. We studied five factors: abdominal wall bruising (AWB), abdominal pain/tenderness (APT), thoracolumbar fracture, the presence of free fluid (FF), and the presence of solid organ injury, all previously reported in the literature to predict the need for operative intervention. We used t-test, the Kruskal-Wallis test and logistic regression to study the association of these factors with the need for operation in our pediatric cohort. ResultsOf 3044 blunt trauma patients, 288 had abdominal CT scans with 61 patients demonstrating equivocal findings. Operation was performed for 12 patients (19.7%) confirming surgically correctable traumatic injuries. The need for surgical intervention was significantly associated with the age of the patients (P = 0.03), the presence of APT (P = 0.001), AWB (P = 0.01), and FF (P = 0.04). The presence of thoracolumbar fracture and solid organ injury were not significantly associated with the need for operation. For the subset of 37 patients who were injured in a motor vehicle crash, five (13.5%) required surgical intervention, which was significantly associated with the presence of AWB (P = 0.04), APT (P = 0.01), and FF (P = 0.03). A predictive model that used these factors produced a receiver operating characteristic curve of 0.86. ConclusionsIn cases of equivocal abdominal CT scan findings to evaluate BAT in children, the presence of abdominal wall tenderness, AWB, or FF may be significant factors predicting more accurately the need for operative intervention. A predictive model using the combination of clinical and image findings might determine with more certainty, the need for surgical intervention in children with BAT and equivocal CT findings. Validation on a larger multi-institutional data set should be done.

The Role of Saline Enema in Reduction of Intussusception Under Ultra Sonographic Guide a Study of 40 Patients in Alkarama Teaching Hospital

Background: enema reduction of the intussusception under US guide is widely used as a useful alternative to surgical management. This procedure is simple with no radiational effect , less complication rate with good outcome and the parents can stay with their child during the whole procedure. Aim of study : We tried to present our experience in HRIUSG by the use of normal saline enema and to evaluate its safety, outcome and to identify the risk variables for enema failure. Methodology : From the 1st of June 2016 to 1st of January 2017, we received about 45 children at children welfare hospital (medical city complex) that confirmed sonographically to have intussusception. Five patients were excluded from the study because of contraindications (peritonitis, perforation and shock). 40 children were developed enema reduction under sonographic guide. Results : From 40 children underwent HRIUSG their age presentation range from 3 months to 32 month, 67.4 % had respiratory infection while 32.6 % had gastroenteritis. We had a successful rate about 79 % with a median of 1 trial and only 3 patients (9.3 %) developed recurrence within 1st 24 hr. from the 9 patients underwent surgery we had 8 patients had manual reduction and one patient underwent resection of the bowel. Only 3 patients had PLP. 1 patient ( 2.3% ) was reported to have complication ( perforation over sewn ). Age , gender , duration of symptoms not significantly affect the outcome P value < 0.05 while bleeding with stool, initial mass in the left colon and rectum , presence of free fluid and more trial numbers were a bad prognostic factors for enema failure . Conclusion: 1. HRIUSG is simple, safe, less costly, practical, less messy ,no radiational exposure with a low complication rate 2. Age, gender, Duration of symptoms did not affect the outcome significantly. 3. Although bleeding with stool, left colon intussusception mass and free peritoneal fluid is a risk factor for failure of HRIUSG but they are not absolute contraindication. 4. The better scenario for enema reduction success is a patient presented with symptoms < 24 hr. with no bleeding stool and a mass in the cecum and ascending colon with no free peritoneal fluid. Keywords: saline enema; reduction; intussusception ; ultrasound guide . DOI: 10.7176/JHMN/73-04 Publication date: April 30 th 2020

ANALYSIS OF CASES OF DIAGNOSTIC DIFFICULTIES WITH RUPTURE OF THE SPLEEN

Summary. Objective: to describe two cases of clinical observation of undiagnosed preoperative rupture of the spleen, in order to analyze errors.&#x0D; Material and methods. Two cases of undiagnosed preoperative spleen rupture are analyzed. Patients were treated in general surgical departments of the Kharkiv City Clinical Hospital for Emergency and Emergency Medicine, named after Professor Alexander Ivanovich Meshchaninov, in 2016 and 2019.&#x0D; Results: two almost identical patients, both in history and in the course of disease, as well as the volume of surgical intervention and treatment results, were treated at the hospital in 2016 and 2019, respectively. It was revealed that the causes of diagnostic errors were primarily the lack of a history of trauma and the erroneous interpretation of ultrasound data in favor of acute pancreatitis.&#x0D; Conclusions: the absence of a history of trauma and an erroneous interpretation of the causes of the appearance of free fluid in the abdominal cavity recorded during ultrasound examination are the main causes of diagnostic errors in this pathology. The presence of free fluid in the abdominal cavity, shown during ultrasound examination, is the reason for questioning the patient concerning incidence of injury.

Ovarian torsion as an emergency clinical entity

In this study, we aimed to evaluate the diagnostic characteristics of ovarian torsion cases. This study was conducted between December 2017 and December 2019 by examining the records of patients diagnosed with ovarian torsion in Fýrat University Hospital at Emergency Department. Age, number of pregnancy and birth numbers and clinical (symptoms and findings) and laboratory parameters (hemoglobin, hematocrit, platelet and white blood cell count) supporting ovarian torsion were evaluated. Symptoms and symptoms such as preoperative nausea, vomiting, tenderness, defense and rebound presence were recorded. Ultrasonographic parameters (ovarian size, presence of ovarian cysts, peripheral sequenced follicles, presence of vascular flow in doppler ultrasonography, presence of free fluid in the pelvic region) were evaluated. Descriptive statistics were used in the statistical evaluation of the data. In this study, the following parameters of 15 patients were evaluated retrospectively. Mean age, 26.02±5.3 years; mean number of gravidas, 2,21±1.35, mean White blood cell count 13250±2600 (/L), mean hemoglobin and hematocrit values were 12.4±2.5 (gr/dL) and 35.0±4.2 (%) respectively. All patients with ovarian torsion had pelvic pain (100 %) and 61% had nausea and vomiting. The most prominent feature of the examination was defensive rebound with43% and tenderness with 76 %. Enlargement of ovarian (>5 cm) were present in 86 % of the patients and accompanying ovarian cysts and fluid in pelvis were found in 80 % of the cases. Additionally, in 73 % of the patients loss of blood flow on Doppler examination was observed. 5 cases (25 %) were single and 4 patients (25 %) had concomitant pregnancy. Three pregnants were in 1st trimester (7,9 and 13 weeks of gestation), one of them was 34 weeks of gestation. There is no clinical or laboratory findings specific to ovarian torsion. Therefore, all signs and symptoms of the patients should be carefully evaluated. Evaluation of the symptoms, clinical and laboratory findings together will increase the diagnostic accuracy.

Is pocket-size ultrasound a reliable tool for bowel investigation? A study on its feasibility, reproducibility and diagnostic accuracy

BackgroundIntestinal ultrasound (IUS) examination is a first-line non-invasive imaging procedure for patients with suspicion of bowel diseases. AimTo assess the feasibility, reproducibility and diagnostic accuracy of a pocket-size ultrasound device (PUD) in identifying the presence of intestinal alterations in patients consecutively recruited to undergo IUS examination. Methods200 consecutive patients (57% female, 48.8 years) underwent both PUD (two independent investigators) and IUS examination on the same day. Nine ultrasonographic signs were systematically searched for. PUD inter-observer reproducibility was assessed by kappa statistic and ICC. The diagnostic accuracy of PUD as compared to IUS results was assessed by calculating sensitivity, specificity and corresponding positive and negative likelihood ratios. ResultsPUD and IUS examinations were successful in 100% of the patients. PUD reproducibility was good/excellent at evidencing the presence (ICC 0.84) and length (ICC 0.85) of an intestinal tract with thickened wall and abdominal free fluid (ICC 0.87). The diagnostic accuracy of PUD, compared to traditional IUS, was good with regard to the presence of bowel wall thickening (sensitivity 92%, specificity 95%), the length of the thickened bowel (sensitivity 94%, specificity 95%) and the presence of free fluid (sensitivity 81%, specificity 99%). ConclusionsPUD is a feasible, reproducible and accurate first-line screening tool for the assessment of the gastro-intestinal tract.

Role of grey scale ultrasound and Colour Doppler findings to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy

Introduction: Ectopic pregnancy and corpus luteum cyst are two most common differential diagnosis in a patient with UPT positive and no sonographic evidence of intrauterine pregnancy. Aim: To diagnose ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy on the basis of grey scale ultrasound and colour Doppler findings. Material and Methods: This was a hospital based prospective study carried out on a study group of 40 patients with UPT positive and clinical features suggestive of ectopic pregnancy over a period of two years.Grey scale ultrasound and colour Doppler parameters were studied. Results: Out of 40 patients,30 were diagnosed with ectopic pregnancy and 10 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (80%) and endometrium (60%). Free fluid with echoes was seen in the pelvis in 70% ectopic pregnancies whereas most of the corpus luteum cysts (80%) had no free fluid. Most of the corpus luteum cysts (70%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid.Yolk sac was seen exclusively in ectopic pregnancy (30%). RI &lt;0.4 and RI &gt;0.7 was found to be highly specific for diagnosing ectopic pregnancy. Conclusion: Wall thickness of the mass, echogenicity of the wall as compared to ovaryand endometrium, internal echotexture of the cystic mass, presence of yolk sac and presence of free fluid with echoes are significant ultrasound parameters which help to differentiate between the two. RI &lt;0.4 and RI &gt;0.7 was found to be highly specific for diagnosing ectopic pregnancy.

Cardiac A-lines in fast scan as a sign of pneumopericardium

BackgroundTraumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium.Case presentationA young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis.ConclusionsAlthough FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium.

Retrospective Analysis of Post-Operative Antibiotics in Complicated Appendicitis.

Background: There is no consensus regarding the ideal post-operative antibiotic strategy for surgically managed complicated appendicitis. The goal of this study was to investigate different antibiotic regimens used for this purpose at our institution and their association with post-operative outcomes. Methods: The 1,102 patients underwent appendectomy from 2012 to 2016. A detailed chart review was performed on the 188 with complicated appendicitis based on standardized definitions. Descriptive and inferential statistics were used to analyze post-operative antibiotic use and complications. Results: Of the 188 cases of complicated appendicitis, 143 (76%) were classified as perforated by the operative surgeon. These patients were significantly more likely to be started on antibiotics after appendectomy (83.9% versus 33.3%; p < 0.001) and have a greater length of stay (LOS) (p = 0.006). The development of a surgical site infection (SSI) was significantly associated with a clinical diagnosis of diabetes (p = 0.04); the presence of free fluid, abscess, or perforation on pre-operative imaging (p = 0.002, 0.039, and 0.012, respectively); and a decision by the surgeon to leave a drain (p = 0.001). On multiple logistic regression analysis adjusted for free fluid on pre-operative imaging and an intra-operative decision to leave a drain, patients receiving one day or three or more days of antibiotics had higher odds of developing an SSI than patients who did not receive any post-operative antibiotics. Conclusions: In this cohort, operative surgeons accurately identified patients with complicated appendicitis who did not require post-operative antibiotics. For patients deemed to require them, two days of treatment was associated with reduced odds of SSI compared with shorter or longer antibiotic courses. The optimal course of antibiotics remains to be identified, but these findings suggest that longer post-operative courses do not avert SSI compared with two days of antibiotics. A prospective trial could clarify the optimal duration and route of antibiotic therapy in the setting of surgical complicated appendicitis.

АLGORITHM OF RADIATION EXAMINATION OF HIVINFECTED PATIENTS WITH ACUTE STOMACH SYNDROME

The purpose of the work: development and generalization of the algorithm of radiation examination of HIV-infected patients with acute abdominal syndrome. Materials and methods. The work is based on the results of examination of 92 patients who were on treatment in the surgical department for the period from 2010 to 2017. The specificity and sensitivity of ultrasound diagnostics, radiography, contrast methods and magneto-contrast methods were evaluated. Results. To improve the methods of rendering specialized medical care to HIV-infected patients entering the clinic of an acute abdomen, it is advisable to use the syndromic approach, which provides for the allocation of syndromes of acute intestinal obstruction, a widespread inflammatory process of the abdominal cavity, a limited inflammatory process of the abdominal cavity and perforation syndrome of the hollow organ. Diagnostic possibilities of the survey radiography and ultrasound of the abdominal organs in these patients are limited due to hyperpneumatization of the intestine and the presence of free fluid in the abdominal cavity. Contrast study of the gastrointestinal tract (passage of barium) is contraindicated in case of suspected perforation of the hollow organ, which often occurs in this category of patients. Multispiral computed tomography is the method of choice for examining HIV-infected patients with acute abdominal syndrome, because it allows, and quickly, to answer many tactical questions, provides the possibility of performing therapeutic manipulations under CT control (percutaneous aspiration of pathological fluid accumulations, drainage of abscesses, establishment nephro-, cholecysto-, cholangiostom). The use of the method of magnetic resonance imaging is limited because of the severe condition of patients and is applicable for assessing the effectiveness of the therapy for liver abscesses, diagnosis of heart attacks and abscesses of the spleen, development and description of the survey algorithm.

Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome.

To compare saline infusion sonohysterography (SIS) versus hysterosalpingogram (HSG) for confirmation of tubal patency. Secondary analysis of a randomized controlled trial, Pregnancy in Polycystic Ovary Syndrome II (PPCOS II). Seven hundred fifty infertile women (18-40years old) with polycystic ovary syndrome (PCOS) were randomized to up to 5cycles of letrozole or clomiphene citrate. Prior to enrollment, tubal patency was determined by HSG, the presence of free fluid in the pelvis on SIS, laparoscopy, or recent intrauterine pregnancy. Logistic regression was conducted in patients who ovulated with clinical pregnancy as the outcome and HSG or SIS as the key independent variable. Among women who ovulated, 414 (66.9%) had tubal patency confirmed by SIS and 187 (30.2%) had at least one tube patent on HSG. Multivariable analysis indicated that choice of HSG versus SIS did not have a significant relationship on likelihood of clinical pregnancy, after adjustment for treatment arm, BMI, duration of infertility, smoking, and education (OR 1.14, 95% CI 0.77, 1.67, P = 0.52). Ectopic pregnancy occurred more often in women who had tubal patency confirmed by HSG compared to SIS (2.8% versus 0.6%, P = 0.02). In this large cohort of women with PCOS, there was no significant difference in clinical pregnancy rate between women who had tubal patency confirmed by HSG versus SIS. SIS is an acceptable imaging modality for assessment of tubal patency in this population.

Association between Abdominal Free Fluid and Postoperative Complications and Mortality in Patients with Small-Bowel Obstruction.

Small-bowel obstruction is a frequent cause of hospitalization. The condition is potentially life-threatening, causing many admission days and is a heavy burden socioeconomically. Patients with small-bowel obstruction may develop abdominal free fluid and the quality of this fluid may be predictive of worse outcomes. Our aim was to examine whether the presence of free fluid and its density, measured on computed tomography scans, was associated with severe complications and mortality postoperatively. Patients admitted to the Department of Surgery, Zealand University Hospital with a diagnosis of small-bowel obstruction between January 2010 and December 2015 were included. Medical records were reviewed and preoperative computed tomography scans were examined. A radiologist blinded to the outcomes reviewed all Hounsfield unit values of the free fluid. The primary outcomes evaluated were odds ratios of the severity of complications and hazard ratios of 30- and 90-day mortality postoperatively. A total of 289 patients were included. Analyses revealed an adjusted odds ratio of 1.03 (95%confidence interval = 0.93-1.15) between the presence of free fluid and postoperative complications and an adjusted hazard ratio of 1.28 (95% confidence interval = 0.80-2.05, p = 0.30) of the 30-day mortality in this patient group. Furthermore, the analyses revealed an adjusted odds ratio of 1.22 (95% confidence interval 0.98-1.52) between the density of the free fluid > 20 Hounsfield unit and postoperative complications and an adjusted hazard ratio of 0.85 (95% confidence interval = 0.28-2.63, p = 0.78) of the 30-day mortality. No significant correlation was found between the presence of free fluid nor its density in regard to postoperative complications or mortality in patients with small-bowel obstruction.

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management.

Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.