Epidemiology of intra-abdominal infiltrates and abscesses in patients with concomitant diseases and diabetes mellitus

The purpose ofthe work — to study the epidemiological factors in the development of primary and secondary intra-abdominal infiltrates, abscesses and fluid formations in patients with concomitant diseases and diabetes. Material and methods. In the clinic of the Department of Surgical Diseases No. 1, on the basis of the Center of Surgery of the Kiev City Clinical Hospital No. 1 from 2006 to 2019,218patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 male patients (49.08 %), 111 female patients (50.92 %). X-ray examination was performed in 112 (51.38 %) patients, computed tomography (CT) in 25 (11.48 %),ultrasound examination of the abdominal organs for 105 (4816 %) patients. Anterior abdominal wall thermometry was performed in 76 (34.86 %) patients. Resultsand discussion. Depending on the cause of the development of intra-abdominal infiltrates, abscesses and fluid formations, the patients were divided into 4 groups. Patients of the first, second and third groups had primary intra-abdominal complications, and in the fourth group patients had secondary postoperative complications. The first group included 74 (33.94 %) patients suffering from a complicated course of destructive appendicitis. The second group included 48 (22.02 %) patients suffering from perforated gastric ulcer and 12 duodenal ulcer. The third group included 69 (31.65 %) patients suffering from cholecystitis and various types of complications. The fourth group included 27 (12.39 %) patients who underwent urgent surgery due to strangulated hernias, adhesive obstruction. The study of the scales showed that: in 87 (39.91 %) the weight was within normal limits, and in 131 (60.09 %) patients were overweight and obese. It was found that 126 (57.80 %) patients wore glasses. Diseases of the cardiovascular system and arterial pressure disorders according to the data of case histories and anamnesis had 123 (56.42 %) patients. Diabetes was diagnosed in 38 (17.43 %) patients. Diseases of the musculoskeletal system were diagnosed in 27 (12.38 %) patients, and 48 (22.02 %) patients suffered from flat feet of various stages. Primary intra-abdominal complications(infiltrates and abscesses) were diagnosed in 191 (3.48 %) patients out of 5483 urgent hospitalizations and operations, of which 74 (1.35 %) with appendicitis, 69 (1.26 %), perforated gastric ulcer and 12 duodenal ulcer in 48 (0.87 %) patients. Secondary postoperative infiltrates, abscesses and fluid formations were found in 27 (18.12 %) of 149 patients who had undergone urgent abdominal surgery (adhesive obstruction, incarcerated and postoperative hernias, etc.), and in 29 (15.18 %) of 191 patients who underwent surgery for primary intra-abdominal complications of the underlying disease and urgent surgery. Diabetes mellitus was diagnosed in 38 (17.4 3%) patients, and therefore all patients who are hospitalized in an urgent and planned manner must undergo a comprehensive clinical and laboratory examination with the determination of blood sugar. The presence of established diabetes mellitus requires the consultation of an endocrinologist, and during the operation it is advisable and necessary to correct glycemic and volemic disorders, which continues until the restoration of vital functions and stabilization of the general condition of the patient. Intra-abdominal complications occurred on the background of concomitant diseases: overweight in 28.44 %, visual impairment in 57.80 %, diseases of the cardiovascular system and arterial pressure disorders in 56.42 %, diseases of the musculoskeletal system in 12.38 %, which indicates the need for an individual approach in the treatment of each patient.

Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

SURGICAL TREATMENT OF PRIMARY INTRA-ABDOMINAL COMPLICATIONS: ABSCESSES AND INFILTRATES

Purpose of the work. improving the results of surgical treatment of patients with primary intra-abdominal infiltrates and abscesses. Material and methods. From 2006 to 2019, 191 patients with primary intra-abdominal infiltrates and abscesses were treated. The patients' age ranged from 16 to 85 years. There were 96 male patients (50.26%), 95 female patients (49.74%). Results. The patients were divided into 3 subgroups depending on the underlying disease. The first group included 74 (38.74%) patients with destructive appendicitis, of which 39 (20.42%) were in the control group, and 35 (18.32%) were studied. The second group included 48 (25.13%) patients suffering from perforated gastric ulcer and 12 duodenal ulcer, of which the control group was 26 (13.61%), and the studied group was 22 (11.52%). The third group included 69 (36.13%) patients with cholecystitis, of which 37 (19.37%) were in the control group, and 32 (16.76%) were studied. All patients were operated on. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and 12 duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis from 69 (36.13%) in 48 (25.13%) laparotomic and in 21 (11.00%) laparoscopically. The use of water-jet technologies in 64 (33.51%) patients made it possible to minimize damage to the serous membrane and cleanse the peritoneum from acquired formations.

Complicated Ventral Hernia: A Perquisite for Perforated Peptic Ulcer—Unusual Clinical Scenario

Introduction Peptic ulcer usually presents to the emergency in the form of an acute abdomen, which is usually diagnosed easily either clinically or radiologically. Although its incidence has decreased with the introduction on proton pump inhibitors it is still one of the most common emergencies encountered by a surgeon. Case Presentation A 60-year-old woman complained of epigastric swelling for 6 months which gradually increased and became irreducible over the last 2 months. The patient also complained of pain associated with vomiting. Radiological investigations revealed a epigastric hernia with omentum and stomach as content along with fluid collection in the right perihepatic region, with tiny air foci. The patient was explored for the same. Discussion Perforated peptic ulcer is a serious complication and carries high risk of morbidity and mortality. Early diagnosis with immediate resuscitation and surgical intervention is essential to improve outcomes. This is a rare case of perforated gastric ulcer which was masked under the complicated ventral hernia.

Perforated gastric ulcer as the initial manifestation of hyperparathyroidism

Primary hyperparathyroidism is characterised by autonomous production of parathyroid hormone resulting in hypercalcaemia. It is estimated that 12% of these patients present with peptic ulcer-related symptoms. The pathophysiological mechanism is not well established, but studies reveal serum calcium activating gastrin cell calcium receptors ultimately resulting in increased gastric acid production leading to peptic ulcer disease. A patient presented acutely to our service with peptic ulcer perforation in the context of incidentally elevated serum calcium levels. Further inpatient investigations lead to the diagnosis of primary hyperparathyroidism as the first manifestation of this patient’s disease.

Laparoscopic Repair of Perforated Gastric Ulcer by Forming a “Covered Perforation”

Performing video endoscopic operations on patients with emergency surgical pathology in order to increase the efficiency and reduce the duration of surgical intervention, as well as to prevent postoperative complications, stimulates the continuous development and implementation of new minimally invasive technologies in emergency surgery. The aim of the study was to develop a new method for laparoscopic suturing of a perforated gastric ulcer (PGU) with the formation of a “covered perforation.” The proposed method uses a fold-duplicator from the anterior wall of the stomach to close the perforation of the stomach wall, thus expanding the possibilities of using minimally invasive technologies for PGU.