Document Detail


Is computerized tomography useful in identifying abdominal catastrophes in patients presenting with peritonitis?
MedLine Citation:
PMID:  18556381     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Peritonitis is a significant source of morbidity and mortality in patients on peritoneal dialysis (PD). Symptoms may persist, requiring an emergency laparotomy. Although increasingly used, we find that, in PD patients, abdominal computerized tomography (CT) is ineffective in determining significant pathology. This study was undertaken to assess the diagnostic utility of CT for the identification of intra-abdominal collections in PD patients presenting with peritonitis. METHODS: A retrospective chart review was undertaken of all patients that underwent abdominal CT scanning in the context of severe PD peritonitis in the past 2 years. All of these patients had at least one CT scan preoperatively. RESULTS: 133 patients presented with PD peritonitis; 19 patients had a contrast CT procedure (12 females, 7 males). Average age was 59.2 years; mean duration on PD was 43.8 months. 13 of 19 patients had gram-negative bacillary peritonitis, 6 of whom had polymicrobial peritonitis; 4 patients had fungal peritonitis and 2 had Staphylococcus aureus peritonitis. 26 CT scans were done in 19 patients an average of 10 days after presentation. 21 of 26 scans revealed no collections of surgical interest. 12 laparotomies were performed, with an average delay of 10.4 days from presentation to laparotomy. Of the 12 laparotomies, 6 found a drainable collection not seen on CT. Seven of the 19 patients died (37%) and no patient was able to return to PD. CONCLUSION: PD patients requiring emergency laparotomy following PD peritonitis have a high mortality rate. A negative abdominal CT in the setting of ongoing symptoms should not be taken as reassuring, nor should it delay proceeding to emergency laparotomy.
Authors:
Maha Yehia; Janak R de Zoysa; John F Collins
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  28     ISSN:  0896-8608     ISO Abbreviation:  Perit Dial Int     Publication Date:    2008 Jul-Aug
Date Detail:
Created Date:  2008-06-16     Completed Date:  2008-12-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  385-90     Citation Subset:  IM    
Affiliation:
Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand. MahaY@adhb.govt.nz
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / pathology,  radiography*
Anti-Bacterial Agents / therapeutic use
Bacterial Infections / drug therapy,  etiology*,  microbiology
False Negative Reactions
Female
Humans
Kidney Failure, Chronic / complications,  therapy
Laparotomy
Male
Middle Aged
Peritoneal Dialysis / adverse effects*
Peritoneum / pathology
Peritonitis / etiology,  microbiology,  radiography*,  surgery
Retrospective Studies
Tomography, X-Ray Computed*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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