Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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A high-risk patient is a challenge to the anaesthesiologist. If surgical intervention is indicated the perioperative anaesthesiological management has to be carefully adapted to the requirements of the patient. If the patient is classified a high-risk at the preoperative anaesthesiological assessment, the therapeutic management has to aim at optimizing the patient's preoperative physical status. ⋯ During the postoperative period each high-risk patient has to be observed in the intensive care unit to continue intraoperative monitoring and therapy. Patients at risk of postoperative myocardial ischaemia or infarction should be closely monitored for 3-5 days postoperatively. The perioperative risk of morbidity and mortality associated with elective surgical procedures has to be evaluated for each patient and the risk-benefit analysis discussed in a interdisciplinary dialogue involving the surgeon, the patient and the patient's family.
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We report on a case of extensive intraabdominal calcifications resulting from previous bacterial peritonitis. The patient suffered from an obstructive ileus. ⋯ To avoid recurrence, radiotherapy (15 Gy) and indomethacin were given. A literature review revealed only two cases of intraabdominal calcifications following peritonitis.
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A 41-year-old patient with liver cirrhosis due to autoimmune hepatitis received an emergency transjugular portosystemic stent shunt for uncontrolled acute variceal hemorrhage. Because of markedly impaired liver function, liver transplantation was considered to be indicated and was performed on the following day. ⋯ The postoperative course was uncomplicated and the displaced stent was left in situ. Eighteen months after the transplantation the patient is well with normal liver function and no pulmonary problems.