Objective To summarize the experience of diagnosis and treatment of acute abdominal pain caused by hepatic hydatid. Methods The preoperative diagnosis, the surgical methods and the curative effect after operation of 297 patients with acute abdominal pain caused by hepatic hydatid who were treated in our hospital from 1960 to 2004 were analyzed. Results The healing rate was 95.96% (285/297 cases), and the death rate was 4.04% (12 /297 cases). Six out of 12 cases of death were caused by diffusive biliary peritonitis and allergic shock attributable to the rapture of hydatid into abdominal cavity. Two patients died of malnutrition caused by the spreading of Echinococcus and the correspondingly repeated operations. Another 4 patients with giant hydatid containing 7 000-12 000 ml fluid, died of hepatic insufficiency caused by the postoperative infection in the cyst. Conclusion The acute abdominal pain caused by hepatic hydatid should be treated mainly through emergency operation and the necessary antianaphylaxis, anti-infection and antishock therapies should also be used at the same time.
ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.
Objective To approach the clinical values of computer tomography (CT) examination technique and imaging features in abdominal cavity parenchymal organs injury. Methods One hundred and fifty-nine patients with abdominal cavity parenchymal organs injury were examined by CT of plain scan and (or) contrast enhancement, the enhancement included arterial phase, parenchymal phase and the kidney scanning delay phase, the results of CT scanning were compared. Results Ninty-eight cases among 159 patients were diagnosed as the abdominal cavity parenchymal organs injury by the CT, the diagnosis accordance rate was 98.1% (156/159) by operation and follow-up, 22 cases were simple viscus damage or back bone and pelvic fracture, 39 cases were negative, the examination positive rate was 75.5% (120/159). Conclusion The CT can display the parenchymal organ traumatic condition, subcapsule hematoma, retroperitoneal hematoma, seroperitoneum and injured grade. It is the first selective examination to use CT scanning in abdominal cavity parenchymal organ damage, and it has important clinic values to use correct scanning techniques in abdominal injury examination.
ObjectiveTo investigate the feasibility of laparoscopy in the diagnosis and treatment of acute abdomen. MethodsThe clinical data of 81 patients with acute abdomen treated in our hospital from January 2012 to December 2013 were retrospectively analyzed. ResultsOf the 81 patients with acute abdomen, there were 38 cases of acute appendicitis, 15 cases of gastric perforation, 10 cases of duodenal ulcer perforation, 10 cases of acute cholecystitis, 1 case of mesenteric artery embolism, 2 cases of internal hernias, 2 cases of ileocecal tumor, 2 cases of sigmoid colon rupture, 1 case of intestinal adhesion. The 81 cases were treated by laparoscopy, including 79 cases (97.5%) were clearly diagnosed; 73 cases were succeeded by laparoscopy, and 8 cases converted to laparotomy. The operation time were 35-191 minutes, with an average of 76 minutes; the intraoperative blood loss were 20-130 mL, with an average of 43 mL; the postoperative hospital stay were 3-13 days, with an average of 5.6 days. Seventy-six patients received followed-up for 2-24 months, and the median time were 14 months, no special complications occurred during follow-up period, but 1 case of ileocecal tumor suffered from lung metastases in 12 months after operation. ConclusionsLaparoscopy can be used in the preferred way of diagnosis and treatment of acute abdomen.
Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.