Intrahepatic type II gall bladder perforation by a gall stone in a CAPD patient

Introduction

Perforation of the gall bladder represents a rare, but life-threatening complication of cholecystitis. Clinical presentation may vary between severe peritonism in acute perforation and absence of symptoms in subacute or chronic progression of perforation. Abdominal imaging like ultrasound or CT-scan are important tools for immediate diagnose of gall bladder perforation.

Case presentation

We report a case of a 30-year old female patient with end-stage kidney disease treated by continuous ambulatory peritoneal dialysis (CAPD) who was admitted to the emergency room with fever and mild abdominal pain. A type II gall bladder perforation by a solitary gall stone with development of a liver abscess was detected by abdominal ultrasound.

Conclusion

Gall bladder perforations are rare but have to be considered in patients with abdominal pain and fever. Abdominal ultrasound is a reliable tool to establish diagnosis.     

Enteric perforation of the gall bladder

A case of enteric perforation of the gall bladder in a 20-year-old male is reported. The patient recovered after cholecystostomy with closure of the perforation.     

Isolated perforation of the gall bladder following blunt abdominal trauma.

Isolated perforation of the gall bladder as a consequence of blunt abdominal injury is rare. A single case is described which illustrates several features which may characterize this lesion.     

老年人急性穿孔性胆囊炎的相关因素及治疗分析

目的探讨老年人急性胆囊炎胆囊穿孔的危险因素及治疗方法。方法回顾性分析鄞州医院2007年1月—2012年1月收治的共277例65岁以上的老年急性胆囊炎患者接收胆囊切除术的一般情况、并存疾病、围手术期情况及转归等临床资料。其中并发穿孔31例（11．2％）,急诊行胆囊切除术19例,胆囊穿刺引流后择期胆囊切除术12例。采用非条件Logistic回归分析方法筛选胆囊穿孔相关危险因素。穿孔组与非穿孔组进行比较,急诊胆囊切除组与穿刺引流组的围手术资料进行比较,数值变量采用t检验,分类变量采用X2检验。结果穿孔组的年龄、糖尿病合并率、白细胞计数均高于非穿孔组（P〈0．05）,穿孔组体温显著高于非穿孔组（P〈0．01）,穿孔组的畏寒寒战的发生率显著高于非穿孔组（P〈0．01）。因素分析糖尿病（P=0．02）、畏寒寒战（P=0．00）、体温（P=0．01）和白细胞计数（P=0．03）是影响胆囊穿孔的指标;急诊手术的并发症高于胆囊穿刺后择期手术组（切口感染P=0．00,肺不张及肺部感染P=0．03）。结论以体温（≥38．5℃）、畏寒寒战、白细胞计数升高（≥15．0×109／L）,并存糖尿病基础疾病,来判断老年人急性胆囊炎穿孔是可行的。对于病情较重的老年患者,胆囊穿刺能明显减少术后的并发症发生率。     

An unusual presentation of typhoid fever causing aseptic meningitis, acute pancreatitis, acute glomerulonephritis, acute hepatitis

To the editor:Typhoid fever is a very common infective disease in Asian and underdeveloped countries.1,2 Typhoid fever in its first week of illness manifest with fever,headache,abdominal pain,gastrointestinal symptom like anorexia,nausea,vomiting,constipation;with or without specific signs like relative bradycardia,hepatomegaly,splenomegaly and abdominal tenderness developing in second week of illness.Complications like acute abdomen,intestinal perforation,pneumonia,psychosis,ataxia,altered sensorium,pancreatitis,hepatitis and nephritis are likely to develop in third to fourth week of illness.3,4 Initial presentation with aseptic meningitis,pancreatitis,hepatitis,glomerulonephritis and thrombocytopenia is a very rare manifestations of typhoid fever.5     

PFRFORATION OF GAIJI.BLADDER IN TYPHOID REPORT OF A CASE

It is not uncommon for typhoid to cause inflammations to the biliary system, but it is very rare for the gallbladder to perforate in typhoid. In going over the Quarterly Cumulative Index Medicus be tween 1927 and 1939,I have been able to find that Tongs (1) reportec] a case of perforation of gallbladder in a patient who had an attack of typhoid fever two months previously. Likewise Notti (2) reported a case of peritonitis due to pcrforation of galIloladder during typhoid, Boclnar (3) in the same year, a similar case in a looy of 7 years old, and Costa (4) another case in a child of 6 years of age. Due to the scarcity of this particular condition as is evident from the literature it may be worthwhile to record the following case.     

Typhoid perforation of the gut

One-hundred consecutive patients with typhoid perforation of the gut admitted in the same surgical unit of the University Hospital have been studied. The cases were diagnosed on the basis of history, clinical examination, exploratory findings, histopathological examination, Widal test and blood culture. Forty-six patients had perforation in the second week of fever. Sixty-one patients presented 48-96 hr after perforation. All the patients were subjected to surgery, 16 under local anesthesia. Mortality rate increased from 25% to 83% as the duration between perforation and operation increased.     

Gall bladder perforation and biliary peritonitis in a young pregnant lady

A rare event of acute free perforation of gall bladder with biliary peritonitis in a case of calculous cholecystitis in a 28 years old pregnant lady occurring in the absence of the usual factors associated with gall stone disease is reported. The clinical features resembled acute appendicitis and a pre-operative diagnosis could not be made. It is suggested that a thorough attempt should be made to exclude conditions mimicking appendicitis, including those of the biliary system, on finding a normal appendix at emergency appendicectomy without hesitating to convert to full laparotomy if required.     

Spontaneous perforation of the bile duct in a neonate: Drainage or resection?

Spontaneous perforation of the bile duct is a rare disease, and delayed diagnosis without optimal treatment can be fatal. Abdominal drainage with or without repair of perforation seems to be adequate in most case series. We report on a 10-day-old female neonate with spontaneous perforation of the bile duct over the junction of cystic duct and common hepatic duct, who recovered uneventfully with follow-up for 3 years after receiving a single-stage operation of cholecystectomy and biliary reconstruction. Drainage only or resection of the gall bladder or bile duct should depend on the patient's clinical conditions and intraoperative findings.     

Perforated typhoid enteritis in children.

A prospective study of 65 patients with perforated typhoid enteritis managed operatively over a 3 year period at a university hospital is presented. There were 45 males and 20 females with ages ranging from 5 to 15 years. Presenting symptoms were fever, abdominal pain, vomiting and either diarrhoea or constipation. All the patients were subjected to surgery and 56 (86%) underwent two-layer bowel closure after freshening of ulcer margins. The overall mortality rate in this study was 20% and was adversely influenced by the increasing duration of perforation, presence of shock and faecal peritonitis. Early surgery after prompt and adequate resuscitation is life saving. However, prevention of typhoid fever by providing safe drinking water and better sanitary conditions appears to offer the best chance of decreasing the high rates of mortality and morbidity of this deadly disease.     

Typhoid intestinal disease: 32 perforations in 1 patient

Typhoid intestinal perforation is a common complication of typhoid fever in our environment. The occurrence of multiple intestinal perforations that involves both small and large bowel is increasingly being seen in our practice. We report a case of 32 intestinal perforations in a child. This is the highest number of perforations seen in any 1 patient in our search of the English literature. This article details our approach to management of this type of patient.     

伤寒抗体在伤寒早期诊断的价值

由于血培养或肥达氏反应都不能对伤寒作出早期诊断，本文通过对４８例确诊伤寒的患者进行伤寒特异性Ｉｇｍ抗体的检测结果分析，得出伤寒抗体在伤寒早期诊断的应用价值。     

A new look at typhoid vaccination. Information for the practicing physician

Most cases of typhoid fever in the United States occur in international travelers, with the greatest risk associated with travel to Peru, India, Pakistan, and Chile. Laboratory workers and household contacts of long-term carriers are also at greater risk than the general population. Decisions to the use typhoid vaccine involve weighing the risk of illness against the risk of vaccine reactions. Until recently, the only typhoid vaccine commercially available to US civilians was a heat-phenol-inactivated parenteral product that is 51% to 77% effective in preventing typhoid fever but frequently produces local pain and swelling, fever, headache, and malaise. A new orally administered, live-attenuated vaccine, made from the Ty21a strain of Salmonella typhi, has been recently licensed in the United States. This vaccine provides equivalent protection with a much lower incidence of adverse reactions. It is administered in a four-dose series given over 7 days. Since neither vaccine offers total protection, the most important elements in prevention of typhoid fever remain sound biosafety precautions in laboratory workers and care in selecting food and beverages by those traveling to areas where typhoid fever is endemic.     

广西伤寒及副伤寒防治研究60年

广西是全国伤寒及副伤寒流行较严重的省份之一,全年均有伤寒副伤寒病例出现,但1996年以前全区以伤寒流行为主,伤寒病例每年7～10月出现一个流行高峰期。自从1996年发现有副伤寒流行以来,到1999年的监测发现全年出现两个流行高峰期,分别是5月份的甲型副伤寒和10月份的伤寒各一个高峰期。而在2004年—2010年的监测发现两个高峰期时间非常接近,分别在7月和8月。广西从上世纪五十年代到九十年代中期伤寒的人群发病率分别为3.96/10万、8.83/10万、3.55/10万、5.04/10万和9.74/10万。1993年—2002年年均发病率为10.27/10万。2004年—2010年伤寒发病率波动在1.61/10万～5.41/10万之间,甲型副伤寒波动在0.80/10万～4.78/10万之间。目前广西的伤寒及副伤寒得到有效控制,但影响疫情暴发的主要原因仍然是边远农村的农民,及学校饮用水被污染所造成。     

螺旋CT多期增强在胆囊癌诊断中的作用

目的:探讨螺旋CT多期增强在胆囊癌诊断中的作用价值。方法:回顾性分析28例经病理证实的胆囊癌患者的多期螺旋CT表现。结果:胆囊癌主要CT表现为胆囊壁的不规则增厚和结节状突起以及胆囊内的肿块,增强扫描强化明显且持续时间长。结论:螺旋CT多期增强在胆囊癌的定性诊断及了解胆囊癌的侵犯范围上具有重要作用。     

应用回归法预测贵州省伤寒副伤寒发病

目的预测贵州省伤寒、副伤寒发病趋势,为进一步制定伤寒、副伤寒防控策略和措施提供依据。方法根据贵州省2004-2012年的伤寒、副伤寒发病率数据,用Excel软件建立数据库进行趋势回归模型的选择,然后利用合适的模型对该数据进行拟合,并预测2013、2014年伤寒、副伤寒发病率,分析其变化趋势。结果建立的贵州省2004-2012年伤寒、副伤寒发病率预测模型为二次多项式趋势回归模型,即y=0.3 821x2-5.8 632x＋24.785,决定系数R2=0.9 909,模型拟合效果较好。2013年和2014年预测发病率分别为4.36/10万、6.52/10万。结论贵州省伤寒、副伤寒发病率近年来呈逐年下降趋势,2013年和2014年预测发病率有所升高,需采取综合防治措施。     

红花岗区伤寒主要流行因素研究

目的研究我区伤寒(含副伤寒,下同)传播因素,探寻流行原因,提出针对性干预措施。方法采用病例对照调查及现场调查,对设定的流行因素进行分析,比较其危险程度。结果喝生水习惯、喝冷饮习惯、饮用水源、病前一月在外就餐、病前一月与伤寒病人接触的危险性有统计学意义;诊断是否规范影响伤寒报告的数量。结论2000年以来我区伤寒呈流行态势;不安全的饮水、饮食,不规范的诊断、治疗是我区伤寒流行的主要原因,实施针对性干预后控制效果明显。     

南宁市2004～2007年伤寒副伤寒流行特点分析

目的分析2004～2007年南宁市伤寒副伤寒流行病学特征,为伤寒副伤寒防治提供依据。方法采用描述流行病学方法对2004～2007年南宁市报告的伤寒副伤寒资料进行分析,用Excel及spssl3．0软件进行统计处理。结果2004～2007年南宁市共报告伤寒副伤寒330例,年均发病率1．26／10万,无死亡病例,其中伤寒215例,年平均发病率为0．82／10万、副伤寒115例,年平均发病率为0．44／10万。发病率呈逐年下降趋势,发病率城区高于郊县（P〈0．05）,男性高于女性（P〈0．01）,职业以农民和学生为主,占报告病例数的54．54％。结论南宁市伤寒副伤寒发病呈逐年下降趋势,但仍不能掉以轻心。仍需采取对农民、学生和流动人口等高危人群加强健康教育,加快农村地区改水改厕工作,改善人民群众卫生条件和加强疫情监测等综合措施来进一步降低伤寒副伤寒发病率。     

Results of typhoid perforation management: our experience in Bir Hospital, Nepal

OBJECTIVE: To determine the demographic characteristics, clinical features, operative findings and postoperative complications in patients operated for typhoid enteric perforation. METHODS: A retrospective study was carried out in the Department of General Surgery, Bir Hospital since 2002 to April 2004. Among 189 patients who underwent laparotomy for hollow viscus perforation in two years, ileal perforation was found in 102 patients. RESULTS: The sex ratio of the patients was 4.66:1, in favor of male, with age range of 14-78 years and mean age 28.35 years. Most of the patients (80.39 %) presented with history of fever for two weeks. Half of the patients presented within 24 hours of onset of generalized abdominal pain. Majority (65.67%) had a solitary perforation on the antimesenteric border of terminal ileum. Eighty one percent of patients had trimming of the ulcer margins and primary closure. Complications included wound infection (35.3%), wound dehiscence (17.6%), fecal fistula (7.84%) and hospital mortality (6.86%). CONCLUSION: Typhoid ulcer perforation is common among developing nations, including Nepal. Postoperative complications following surgical management of perforation are high and increases mortality.     

重症肝炎腹腔脏器自发穿孔分析

本组２４６例重症肝炎（重肝）收治中８例发生腹腔脏器穿孔，患者除有重肝表现外还有不同程度腹痛，经腹腔穿刺，彩色Ｂ超、Ｘ线照片及外科手术分别诊断为胆囊、胃、肠穿孔。因该病外科手术成功率极低，８例患者仅１例存活，７例死亡。临床工作者应高度警惕此并发症的发生。