[Functional disorder of the small intestine in the genesis of intoxication in acute experimental suppurative peritonitis].
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Lead intoxication
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症例は68歳，男性．主訴は，全身倦怠感，PD排液異常．既往歴に関節リウマチを認める．現病歴：慢性腎不全（原疾患不明）のためSMAP法にてPDカテーテル挿入．その後2006年10月からCAPDにて当院で透析導入．2年9か月のPD歴で，出口部感染や腹膜炎の既往を認めず経過していた．2009年6月X日にエリスロポエチン注射と採血を実施，特に体調不良の訴えもなく帰宅した．後日判明した採血結果でCRPが31.24mg/dLと異常高値を示していた．その前後に腹痛なく，排液混濁も認めなかったが，同年7月10日早朝より「腹痛はないが，突然に透析液の注入途中から肛門より排液する」との訴えで診察依頼があり，独歩にて救急来院した．PDカテーテルから食物残渣を含む混濁した排液を確認，穿孔性腹膜炎を疑い，緊急開腹手術をした．カテーテル周囲で瘻孔形成し，癒着した消化管の剥離に難渋して穿孔部位の同定は困難であった．臨床経過から本症例の穿孔性腹膜炎の機序は次のとおりと推察する．すなわち，憩室炎などを原因にすでに潜在した腹膜炎を約2週間前に発症し，被覆した腸間膜とカテーテルが治癒過程において癒着．その後，機械的刺激によりCAPDカテーテル先端が脆弱箇所を穿通し，腸管内に迷入した．PD患者の穿孔性腹膜炎の診断はしばしば困難である．その理由に，(1)free airや腹水が消化管穿孔の根拠になりにくいこと，(2)腹膜透析液による洗浄効果で腹膜刺激症状が緩和されること，(3)通常のPD腹膜炎との鑑別が困難であること等があげられ，高い死亡率の原因となっている．穿孔性腹膜炎の死亡率が高いことから臨床上，極めて危険な合併症であるといえる．腹膜透析液による洗浄効果で腹膜刺激症状が緩和されるなど発見が遅れる可能性があることを留意し，排液の詳細な観察ならびに炎症所見などのデータの推移には十分注意する必要があると思われた．
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Objective To evaluate the clinical manifestations,treatment and prognosis in peritoneal dialysis patients with fungal peritonitis(FP).MethodsThe clinical data of 23 peritoneal dialysis(PD) patients diagnosed as FP and treated in our hospital from January 2005 to December 2010 were retrospectively analyzed.ResultsAmong 23 patients,9(39.1%) used analgesics due to dramatic abdominal pain.The PD culture in eighteen(78%) patients with FP grew Candida albicans.Among 4 patients who retained catheters and continued to peritoneal dialysis,2 cured.20(87%)out of 23 withdrew peritoneal dialysis to hemodialysis.2(8.7%) died.ConclusionImmediate extubation of PD catheter is advocated in patients with fungal peritonitis.But in special circumstances,it may be appropriate to consider retention catheter in PD patients.However,prospective studies are needed to discuss the details of treatment of PD patients with fungal peritonitis.
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Though peritonitis is a common complication in Continuous Ambulatory Peritoneal Dialysis (CAPD), tuberculous peritonitis has been reported in only twelve CAPD patients in the world English literature to date. Successful outcome in those reported cases involved antituberculous therapy and in the majority, catheter removal and conversion to maintenance haemodialysis. We report in this article our first case of tuberculous peritonitis in a CAPD patient. The diagnosis was made at laparotomy in our patient and she improved with antituberculous therapy. CAPD was continued without interruption. In haemodialysis patients, mortality from tuberculosis is reported to be high due to atypical presentation and delay in diagnosis. To avoid this delay, we recommend that the clinician have high index of suspicion for tuberculous peritonitis in CAPD patients with sterile peritonitis. Early diagnosis carries a good prognosis, and CAPD need not necessarily be discontinued in these patients.
Presentation (obstetrics)
Case presentation
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The aim of the work was to study age related changes of lipid peroxidation and antioxidant system in the wall of the small bowel in patients with severe secondary peritonitis. Group I, control (n=42) was consisted of patients from 30 to 89 years. Age of the group II patients (n=36) was from 30 to 59 years, III (n=43) from 60 to 74 years and IV (n=28) from 75 to 89 years. The obtained results of the study showed a significant increase in the concentration of conjugated dienes in the wall of the small intestine, especially in third grade enteric insufficiency as in patients of the second group, which amounted 0,34±0,03 s.u./mg of lipids, and in elderly patients - 0,38±0,03 cu./mg of lipids and senile patients 0,42±0,04 s.u./mg of lipids. On increasing the concentration of the toxic products of lipid peroxidation in the intestinal wall testified a negative accumulation of malondialdehyde from 6,91±0,38 nmol/g protein in patients of the second group, even with second degree enteral insufficiency to 7,49±0,51 nmol/g of protein for elderly patients (fourth group).
Malondialdehyde
Enteral administration
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Four patients with tuberculous peritonitis were diagnosed at our hospital in one year. In two patients it was only after surgery for iatrogenic bowel perforation that the diagnosis was made. The difficulty in recognizing this illness in those patients prompted a review of cases in Arkansas over the past nine years. A total of 27 cases have been documented; in 14 the diagnosis was made after considerable delay or during surgery for another diagnosis. Tuberculous peritonitis should be considered in any patient with ascites and chronic abdominal pain.
Tuberculous Peritonitis
Perforation
Bowel perforation
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In three patients with abdominal pain, two men aged 63 and 18 years and a woman aged 46 years, the use of NSAIDs reduced the symptoms. They were in fact suffering from peritonitis due to gastrointestinal perforation, but the decision to operate was delayed because of the relatively mild presentation. The strong analgesic, antipyretic and anti-inflammatory properties of NSAIDs can reduce the symptoms, signs and laboratory findings of peritonitis.
Perforation
Antipyretic
Acute abdomen
Presentation (obstetrics)
Acute abdominal pain
Bowel perforation
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Incisional Hernia
Perforation
Abdominal cavity
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