Hepato Gastroenterol
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Hepato Gastroenterol · Nov 2008
Case ReportsThe abdominal compartment syndrome (ACS) in general surgery.
The abdominal compartment syndrome is a life threatening clinical entity which can develop within the first 12 hours of intensive care unit admission in high-risk surgical patients. The aim of this paper is to show the definitions, ethiology, pathophysiology, diagnosis and treatment of this serious, not only surgical problem. ⋯ Intraabdominal hypertension and abdominal compartment syndrome are frequent clinical findings among acute general surgical patients. Patients with comparable demographics and acute severity of illness are more likely to die if intraabdominal hypertension or abdominal compartment syndrome is present. We conclude that the early recognition and surgical decompression is urgent.
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Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic approach is still associated with significant morbidity and mortality. Surgical risk in elderly patients is even higher, since these people suffer from frequent comorbidities, resulting in poorer performance status. Whether this type of major cancer surgery is feasible in elderly patients is an ongoing question. ⋯ Incorporating new strategies to reduce morbidity makes aggressive cytoreduction procedure feasible in the majority of elderly patients. Age and advanced peritoneal malignancy should not preclude patients from the maximal surgical effort.
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Hepato Gastroenterol · Nov 2008
Management of sigmoid diverticulitis: a retrospective study of 268 patients.
The therapeutic management of acute diverticulitis has evolved over the last years in favour of an initial conservative approach with laparoscopy rather than a primary anastomosis. We studied the management of sigmoid diverticulitis in the Digestive Surgical Unit to assess it in comparison to actual practice. ⋯ Based on our study and published reviews, we recommend elective colectomy after 2 recurrent episodes of acute diverticulitis, one episode of complicated acute diverticulitis managed conservatively, or if the patient is younger than 50 years-old. This approach would reduce the number of acute operations, which are associated with high morbidity and mortality.