Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Jul 2009
Acute abdominal pain in patients with systemic lupus erythematosus.
Patients with Systemic Lupus Erythematosus (SLE) that present with acute abdominal pain (AAP) represent a challenge for the general surgeon. The purpose of this study was to identify the major causes of AAP among these patients and to define the role of disease activity scores and the APACHE II score in identifying patients with an increased perioperative risk. ⋯ This is one of the largest series of AAP and SLE. Most common causes of AAP were pancreatitis and intestinal ischemia. APACHE II score in patients with intestinal ischemia was higher than those with serositis; further studies are needed to examine whether this score may help to differentiate these etiologies when CT findings are inconclusive. APACHE II score was the most important factor associated with mortality. Furthermore, a prompt diagnosis and an appropriate surgical management are essential in order to improve patient outcome.
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J. Gastrointest. Surg. · Jul 2009
Case ReportsHigh jejunal perforation complicating tuberculous abdominal cocoon: a rare presentation in immune-competent male patient.
Tuberculosis (TB) peritonitis is a rare presentation of TB that is typically insidious, presenting with systemic symptoms and nonspecific abdominal pain. In the majority of the cases, this leads to bowel obstruction and rarely causes abdominal cocoon. The disease process predominantly affects the small bowel with a tendency to involve the terminal ileum, leading to perforation on rare occasions. ⋯ TB should be considered in all cases of atypical bowel perforations. Proximal jejunostomy and early use of anti-TB drugs can facilitate primary repair in aggressive TB infection with multiple bowel perforations.
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J. Gastrointest. Surg. · Jul 2009
Comparative StudyPreoperative lower esophageal sphincter manometry data neither impact manifestations of GERD nor outcome after laparoscopic Nissen fundoplication.
Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS. ⋯ The preoperative manometric character of the LES neither impacts the manifestations of GERD nor subjective and objective outcomes after LARS. Patients with GERD and manometrically intact LES have no higher risk for postoperative dysphagia.
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J. Gastrointest. Surg. · Jul 2009
Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit.
Tertiary peritonitis (TP) is defined as a severe recurrent or persistent intra-abdominal infection after adequate surgical source control of secondary peritonitis (SP). The aim of this study was to analyze the characteristics of patients with SP who will further develop TP in order to define early diagnostic markers for TP. ⋯ The MPI at IO as well as CRP and SAPS II at the second postoperative day helps to identify patients at risk for tertiary peritonitis.
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J. Gastrointest. Surg. · Jul 2009
CT scans and acute appendicitis: a five-year analysis from a rural teaching hospital.
Studies examining the relationship between computed tomography (CT) scans and appendiceal perforation have largely been conducted in urban centers. The present study sought to evaluate this relationship in a rural hospital. ⋯ Males undergoing CT scans are significantly more likely to have perforated appendicitis. A protocol-driven rational approach to CT evaluation of suspected appendicitis may lower perforation rates, especially in males.