The American surgeon
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The American surgeon · Sep 2007
Antibiotic therapy and interval appendectomy for perforated appendicitis in children: a selective approach.
The role of initial nonoperative treatment in pediatric perforated appendicitis remains controversial. We examined our outcomes after using this approach in a selective manner. Children with perforated appendicitis treated during a 28-month period were retrospectively reviewed. ⋯ Average total hospital stay was 7.2 +/- 3.0 days. Initial nonoperative treatment is highly successful in selected children who meet specific criteria. Failure is not associated with increased morbidity.
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Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter, and rarely cause symptoms. However, "giant" peritoneal loose bodies, larger than 5 cm in diameter, presenting with various symptoms have been also reported. ⋯ The patient refused any treatment at his first visit but accepted surgical removal of the peritoneal loose body 5 years later. The size of the peritoneal loose body has increased from 7.3 cm to 9.5 cm in diameter during this observation period.
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The American surgeon · Sep 2007
Review Case ReportsEikenella corrodens causing necrotizing fasciitis after an elective inguinal hernia repair in an adult: a case report and literature review.
We report an unusual case of necrotizing fasciitis in a 43-year-old man after elective inguinal hernia repair. The patient presented to the emergency department 9 days postoperatively with high fevers, tachycardia, and crepitus along his abdominal wall. ⋯ Patients can develop necrotizing fasciitis after elective, clean procedures and should be adequately resuscitated, undergo immediate surgical debridement, and receive antibiotics. Laparoscopy can be useful in determining if intraabdominal pathology is the cause of the infection and a wound vacuum-assisted device is a cost-effective way to decrease healing times.
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The American surgeon · Sep 2007
Early selective angioembolization improves success of nonoperative management of blunt splenic injury.
The role of angioembolization in the management of patients with blunt spleen injury is still under debate. Our study examined the impact of splenic artery embolization (SAE) on the outcome of such patients. We reviewed 114 consecutive blunt abdominal trauma patients with isolated splenic injury over a period of 40 months, including 61 patients seen before (Group A) and 53 patients seen after (Group B) the adoption of SAE. ⋯ SAE was successful to control bleeding in 80 per cent of patients. Partial splenic infarction was noted in all patients after the procedure but it resolved by six months. By using criteria developed based on abdominal CT scans for angioembolization, we are able to improve nonoperative splenic salvage rate.
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The American surgeon · Sep 2007
Controlled Clinical TrialIntraabdominal hypertension in patients with septic shock.
Intraabdominal hypertension (IAH) develops frequently in patients with septic shock. Even a moderate increase in intraabdominal pressure (IAP) in this setting could be associated with high lactate levels. The authors conducted a prospective, observational, nonrandomized control trial in the surgical intensive care unit of an academic tertiary center. ⋯ Control patients with and without IAH exhibited comparable peak lactate levels. Intraabdominal hypertension is very common in septic shock and appears to be related to high lactate levels, which diminish as IAP decreases. Future studies should address the usefulness of IAP monitoring in patients with septic shock.