1.Sclerosing Encapsulating Peritonitis (Abdominal Cocoon) after Abdominal Hysterectomy.
Won Na SUH ; Sang Kil LEE ; Hyun CHANG ; Hye Jin HWANG ; Woo Jin HYUNG ; Young Nyun PARK ; Tae Il KIM
The Korean Journal of Internal Medicine 2007;22(2):125-129
Sclerosing encapsulating peritonitis (SEP) is a poorly understood and rarely documented cause of small bowel obstruction. Although recurrent peritonitis has been reported as the main contributory factor leading to secondary SEP, the pathogenesis of primary (idiopathic) SEP is still uncertain. A 40-year-old woman with a history of total abdominal hysterectomy due to gestational trophoblastic disease presented with progressive lower abdominal pain and abdominal distension. Ultrasonography and contrast-enhanced abdomen-pelvis computed tomography of the abdomen revealed encapsulation of the entire small bowel with a sclerotic capsule. At laparotomy, a fibrous thick capsule encasing small bowel loops was revealed. Extensive adhesiolysis and removal of the capsule from the bowel loops were performed. The patient recovered uneventfully; she was discharged without complications. SEP is a rare cause of small bowel obstruction. We treated a case of abdominal cocoon with intestinal partial obstruction in a woman with a history of abdominal hysterectomy due to gestational trophoblastic disease. Surgical treatment was effective and the patient recovered without complication.
Adult
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Female
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Humans
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Hysterectomy/*adverse effects
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Intestinal Obstruction/diagnosis/*etiology
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Intestine, Small/*pathology
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Peritonitis/diagnosis/*etiology/surgery
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Sclerosis/*pathology
2.Occult Intraperitoneal Bladder Injury after a Tension-Free Vaginal Tape Procedure.
Byung Soo CHUNG ; Tack LEE ; Jun Sig KIM ; Hun Jae LEE
Yonsei Medical Journal 2005;46(6):874-876
Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.
Vagina/surgery
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Urologic Surgical Procedures/adverse effects
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Urinary Incontinence, Stress/*surgery
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Urinary Bladder/*injuries/radiography
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*Postoperative Complications
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Peritonitis/diagnosis/etiology
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Humans
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Female
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Cystoscopy
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Adult
3.Clinical Features of Abdominopelvic Actinomycosis: Report of Twenty Cases and Literature Review.
Myung Min CHOI ; Jeong Heum BEAK ; Jung Nam LEE ; Sanghui PARK ; Won Suk LEE
Yonsei Medical Journal 2009;50(4):555-559
PURPOSE: Intrabdominal actinomycosis is difficult to diagnose preoperatively. This chronic infection has a propensity to mimic many other diseases and may present with a wide variety of symptoms. The aim of this study was to evaluate the characteristic clinical features with review of the literature. MATERIALS AND METHODS: We retrospectively analyzed 22 patients with intrabdominal actinomycosis between January 2000 and January 2006. RESULTS: There were two men and 20 women with a mean age of 42.8 years (range, 24 - 69). Twelve patients presented with masses or abdominal pain, whereas 3 patients presented with acute appendicitis. The rate of performing an emergency surgery was 50% due to symptoms of peritonitis. The mean size of tumor was 5.5 cm (range, 2.5 - 11.0). Sixty percent (n = 12) of female patients had intrauterine device (IUD). The average time to definite diagnosis was 10.6 days. CONCLUSION: Intrabdominal abdominal actinomycosis must first be suspected in any women with a history of current or recent IUD use who presents abdominal pain. If recognized preoperatively, a limited surgical procedure, may spare the patient from an extensive operation.
Abdominal Pain/*etiology/microbiology
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Actinomycosis/*diagnosis/pathology
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Adult
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Aged
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Female
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Humans
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Intrauterine Devices
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Male
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Middle Aged
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Peritonitis/pathology/surgery
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Young Adult
4.Biliary Peritonitis after Radiofrequency Ablation Diagnosed by Gadoxetic Acid-Enhanced MR Imaging.
Akihiro FURUTA ; Hiroyoshi ISODA ; Takashi KOYAMA ; Giro TODO ; Yukio OSAKI ; Kaori TOGASHI
Korean Journal of Radiology 2013;14(6):914-917
This study describes the first case of biliary peritonitis after radiofrequency ablation diagnosed by magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), a hepatocyte-specific MR imaging contrast agent. The image acquired 300 minutes after the administration of Gd-EOB-DTPA was useful to make a definite diagnosis and to identify the pathway of bile leakage. It is important to decide on the acquisition timing with consideration of the predicted location of bile duct injury.
Aged, 80 and over
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Bile Duct Diseases/*diagnosis/etiology
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Carcinoma, Hepatocellular/diagnosis/surgery
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Catheter Ablation/*adverse effects
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Contrast Media/diagnostic use
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Diagnosis, Differential
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Follow-Up Studies
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Gadolinium DTPA/*diagnostic use
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Hepatectomy/adverse effects/methods
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Humans
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Liver Neoplasms/diagnosis/*surgery
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Magnetic Resonance Imaging/*methods
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Male
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Peritonitis/*diagnosis/etiology
5.Analysis of the diagnosis, treatment and prognosis in acute obstruction of proximal and distal colorectal cancers.
Zhong-lin WANG ; Jie PAN ; Zhong-liang PAN ; Wei SUN
Chinese Journal of Oncology 2013;35(1):59-62
OBJECTIVEThe study aimed to review the treatment and prognosis of acute obstruction of colorectal cancers and to compare different treatment strategies of those cancers, and to evaluate the risk factors affecting perioperative complications.
METHODSClinical data of 184 patients with acute obstruction of colorectal cancer undergone operation were analyzed retrospectively.
RESULTSA total of 184 patients with acute obstruction of colorectal cancer was collected in this study, including 58 patients with proximal and 126 patients of distal colorectal cancers. Perioperative death occurred in 2/58 patients (3.4%) with distal colorectal cancer and 6/126 cases (4.8%) of distal colorectal cancer (P > 0.05). The overall perioperative complications in the two groups were not significantly different (P = 0.794). Among the 58 patients with proximal colorectal cancer, one patient underwent colostomy, but among the 126 patients with distal colorectal cancer, 41 patients underwent colostomy, showing a significant difference between the two groups (P = 0.002). ASA scores (grade 3 - 4), elderly age (≥ 70 years) and colon perforation peritonitis were independent prognostic factors associated with perioperative mortality and morbidity. Patients in the self-expandable metallic stent (SEMS) group had a significantly shorter hospital stay (25.4 ± 8.3) d than that in the emergency surgery group (32.8 ± 16.4) d, (P = 0.039).
CONCLUSIONSEndoscopic stent implantation provides an acceptable modality of palliation for acute proximal large bowel obstruction caused by malignancies. In acute colorectal cancer obstruction, SEMS can provide a minimally invasive management compared with surgical intervention.
Acute Disease ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; diagnosis ; surgery ; Colostomy ; Endoscopy ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intestinal Perforation ; etiology ; Intraoperative Complications ; Length of Stay ; Male ; Middle Aged ; Palliative Care ; methods ; Peritonitis ; etiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Young Adult