A case report of refractory congenital chylous ascites in infant – surgical treatment with Fibrin glue

Congenital chylous ascites is a rare disease that results from abnormal development of the intra-abdominal lymphatic system. No gold standard treatment has been described so far, however, a combination of medium–chain triglyceride based diet or total parenteral nutrition along with octreotide and abdominal paracentesis is considered as a conservative management. This treatment is often a challenge to physicians since chylous ascites is often refractory and result in malnutrition and immune deficiency because of the loss of proteins and lymphocytes. We report a four-month old boy with congenital chylous ascites who was refractory to medical treatment with prolonged bowel rest, total parenteral nutrition, octreotide and repeated paracentesis. The baby well responded to surgical treatment with application of fibrin glue on the surface area of the leak site and was discharged after 2 month of hospitalization. When following up the patient had no recurrence of the ascites and he was growing up normally.

Combined effect of ultrasound-guided percutaneous abdominal paracentesis drainage and ulinastatin on severe acute pancreatitis

Purpose: To study the clinical effect of a combination of ultrasound-guided percutaneous abdominal paracentesis drainage (APD) and ulinastatin on severe acute pancreatitis (AP).Methods: A total of 94 patients with severe AP in Intensive Care Unit, Jiaozhou Central Hospital, Qingdao, from December 2017 to December 2018 were selected as the research subjects. They were divided into control and study groups, with 47 patients in each group. Patients in the control group underwent laparotomy drainage, while patients in the study group underwent ultrasound-guidedpercutaneous APD. Patients in both groups received ulinastatin perfusion. Subsequently, clinical effectsand other relevant indicators were determined.Results: Overall response was significantly higher in the study group than in the control group (p < 0.05). The times taken for disappearance of postoperative symptoms, normalization of serum amylase level, and hospitalization were significantly shorter in the study group than in the control group (p < 0.05). For every indicator, the study group exhibited more benefits after than before treatment; however, post-treatment levels of blood glucose, hemodiastase and urinary amylase were better than those in the control group (p < 0.05). Incidence of postoperative complications was lower in the study group than in control group (p < 0.05).Conclusion: The combination of ultrasound-guided percutaneous APD with ulinastatin produces marked beneficial effects on severe AP patients. It facilitates the remission of adverse symptoms, and enhances normalization of indicator levels. Moreover, it displays low incidence of complications, better prognosis and recovery, and absence of post-operation infections.

Inferior epigastric artery pseudoaneurysm following abdominal paracentesis in a patient with chronic kidney failure: a case report and review of literature

Inferior epigastric artery pseudoaneurysm is a rare complication following abdominal wall procedures near the artery. This is a case of Inferior epigastric artery pseudoaneurysm after therapeutic paracentesis for large volume ascites caused by chronic kidney failure. The patient was operated on, and the artery was ligated.

Pericardial Tamponade and Elevated Serum CA-125 Level in Inadequately Treated Hypothyroidism

Cardiac tamponade is a medical emergency and must be managed promptly, and reaching a diagnosis is imperative to prevent recurrence. Herein, we present a case of a young female patient that presented with progressive shortness of breath and abdominal distension and was found to have cardiac tamponade with the finding of elevation of a blood tumor marker, CA-125, in the setting of nonadherence to thyroid replacement therapy. She was managed by surgical pericardial window and abdominal paracentesis, with replacement of thyroid hormones leading to resolution of the tamponade and ascites. CA-125 elevation associated with cardiac tamponade and myxedema ascites due to hypothyroidism is very rare, and we aim to shed light on the importance of having a broad differential when approaching cardiac tamponade and understand the association between CA-125 and hypothyroidism.

Practical procedures

This chapter assesses the practical procedures in surgery. It begins with airway procedures, including the anaesthesia face mask, laryngeal mask airway (LMA), and endotracheal intubation. It also looks at percutaneous dilatational tracheostomy (PDT) and cricothyroidotomy, before differentiating between non-invasive and invasive ventilation. The chapter then turns to circulation procedures, including venepuncture and intravenous cannulation; interosseous access; central venous cannulation; arterial puncture and arterial cannulation; cardioversion; and defibrillation. It also considers the insertion and management of chest drain, which is used to drain pneumothoraces or pleural effusions. Finally, the chapter deals with pericardiocentesis; nasogastric tube insertion; urethral and suprapubic catheterisation; abdominal paracentesis; rigid sigmoidoscopy; and local and regional anaesthesia.

Congenital chylous as cites in a 3-month-old infant in Zaria: A case report

Congenital chylous ascites (CCA) is a rare disease that results from the maldevelopment of the intra-abdominal lymphatic system. Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A 3-month-old girl diagnosed with congenital chylous ascites. She was managed initially with nil per oral, parenteral nutrition, medium chain triglyceride (MCT) containing oil and abdominal paracentesis, followed by octreotide. Medium chain triglyceride formula, the main stay of management was discontinued with gradual reintroduction of breast feeds. This case was selected due to the rarity of CCA and the lack of standards in the diagnosis and therapy.

Safety and feasibility of a nurse-led ambulatory abdominal paracentesis service.

63 Background: Ascites is a common complication of cancer. Symptomatic ascites contributes to cancer-related morbidity and is distressing for patients (pts). Therapeutic abdominal paracentesis (TAP) provides symptom relief but requires specialized procedural knowledge and is usually performed in the inpatient setting with several days of hospitalization. Additionally, high hospital bed occupancy during the COVID-19 pandemic prevented timely admission for TAP. An Advanced Practice Nurse (APN)-led ambulatory TAP service was introduced at our center, with the aim of improving access to TAP and reducing hospital bed occupancy. Methods: A multidisciplinary team developed workflows and safety guidelines for TAP to enable right-siting of pts in a cancer day care unit. Pts were scheduled for radiologically guided insertion of abdominal drains in the morning before 10am to allow adequate time for drainage. Pre-procedure clinical examination and safety checks were performed by APNs in the day unit. Following the procedure, abdominal fluid was drained with concurrent administration of 20% IV albumin. Drains were removed by the APN and pts were examined before discharge on the same day. Data for all cancer pts requiring TAP in the day unit and hospital from 1 Jan to 30 Nov 2020 were extracted from the electronic medical record system. The primary outcome was length-of-stay (LOS). The primary safety outcome was adverse events in the day unit. Continuous data were compared using the t-test. Data analysis was done in SPSS version 22. Results: The number of TAPs performed in the day unit and general ward requiring hospitalization were 102 and 133, respectively. There was a significant reduction in average LOS with TAPs performed in the day unit vs. hospitalization (1.48 vs. 5.82 days, p<0.001) (Table). The mean difference was 4.34 (95% confidence interval 3.33 - 5.34) days saved per pt, or a saving of 443 inpatient bed days. The TAP day unit service encountered 10 adverse events (AEs) requiring admission to the ward for continued drainage. AEs were borderline baseline blood pressure, pt frailty and inability to care for an indwelling catheter. There were no infective or bleeding complications. The majority of TAPs (86.8%) were performed in one day, with the remainder over 2-days with the abdominal drain left in-situ and reattendance at the day unit the next day for further drainage. Differences in average length-of-stay with TAP in the hospital vs. day unit. Conclusions: An APN-led ambulatory abdominal paracentesis service is a safe alternative to inpatient paracentesis. Optimal utilization of a day unit enabled reduced LOS for pts with advanced cancer. This reduction in LOS was critical during a pandemic where bed demand was high. This was possible from advanced scheduling and control over the day unit capacity.[Table: see text]

Diagnostic Challenge in a Patient Presenting with Ascites and Hypergammaglobulinemia

Ascites is defined as the accumulation of intra-peritoneal fluid that can be caused by several diseases. We described a 47-year-old female presenting with low serum-ascites albumin gradient (SAAG) and a markedly high level of serum globulin. Serum protein electrophoresis revealed an M spike in the gamma region. Other laboratory results showed a marked increase in aspartate aminotransferase and alanine aminotransferase and predominantly conjugated hyperbilirubinemia without a sign of dilatation of bile ducts from abdominal ultrasonography examination. Furthermore, the follow-up showed a positive result for the anti-nuclear antibody test. The patient was assessed with autoimmune hepatitis, and the cause of ascites was suggested from portal hypertension although the level of SAAG was low. The ascites condition got improved after salt restriction, diuretics treatment, and abdominal paracentesis. However, the patient passed away because of the intracranial hemorrhage as a result of prolonged INR and APTT due to liver failure.