• Journal of Yeungnam Medical Science
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• v.26 no.1
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• pp.49-55
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• 2009

Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumalosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

• Journal of Yeungnam Medical Science
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• v.39 no.2
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• pp.133-140
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• 2022

Background: Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. Methods: A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes. Results: The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery. Conclusion: Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

• Childhood Kidney Diseases
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• v.14 no.2
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• pp.174-183
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• 2010

Purpose : The organisms causing peritonitis and their antibiotic sensitivities vary in different regions and centers, and these data are necessary to establish regional treatment guidelines. The aim of this study was to investigate the changes in incidence and characteristics of the organisms that cause peritonitis in children undergoing peritoneal dialysis (PD) during recent 10 years. Methods : We retrospectively collected and analyzed the data from medical records of 110 children on PD during the period from 2000 to 2010. Results : One hundred and forty episodes of peritonitis have occurred in 57 patients. The overall incidence of peritonitis was 0.43 episodes/patient year, and similar incidence have been maintained since 2003. Sixty percent of the patients experienced peritonitis within 1 year of PD, and all patients commencing PD in infancy experienced peritonitis. Gram positive (G (+)), gram negative (G (-)) organisms and fungi were cultured in 58%, 38%, and 4.1% respectively and cultures were negative in 13.6%. Staphylococcus was the most common G (+) organism, and Pseudomonas and Acinetobacter were 2 most frequent G (-) organisms isolated. Fifty-six percent of the G (+) organisms were sensitive to first generation cephalosporin and 91% of G (-) pathogens were sensitive to ceftazidime. Methicillin-resistance rate was not higher in children less than 2 years of age than in those more than 2 years. Conclusion : An additional breakthrough has to be made to further reduce the incidence of peritonitis. Treatment guideline customized for peritonitis in Korean children on PD need to be established through a nationwide co-work.

• Korean Journal of Veterinary Service
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• v.26 no.1
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• pp.67-71
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• 2003

A 8 months old, female domestic Shorthair cat with long-term signalment of anorexia, lacrimation, uveitis and coughing was submitted to the Pathology and Diagnosis Reference Division, NVRQS, Korea, for necropsy. Main gross lesions were characterized by ascities, some grayish-white nodular formation and fibrous adhesion on the surface of visceral organs including liver and kidney. Principle histopathological findings were fibrinous serositis, multifocal granuloma and necrosis, vasculitis, perivasculitis in various pharenchymal organs. Paraffin-embedded tissue sections taken from most of organs with granulomatous lesions were confirmed specific reaction to the monoclonal antibody of feline infectious peritonitis virus in the cytoplasm of many infiltrating macrophages by immunohistochemistry. The report was to describe the pathological lesions of the first naturally-occuring FIP case in companion cat of Korea.

• Journal of Veterinary Clinics
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• v.35 no.1
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• pp.17-18
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• 2018

A 12-year-old spayed female Cocker Spaniel was presented with vomiting, diarrhea, depression, and hyporexia of 3-day duration. Microscopic examination of the abdominal fluid from a dog showed basophilic, amorphous to fibrillar materials without bile pigments or crystals. Total bilirubin concentration of the fluid was 19 times higher than the serum bilirubin concentration and exploratory laparotomy revealed a ruptured gallbladder and mucoceles in the abdominal cavity. Rupture of gallbladder mucoceles may cause atypical bile peritonitis in which mucinous material is observed instead of bile pigment.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.213-220
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• 2008

Purpose : This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis(ISPD) guide among Korean children. Methods : We have collected data on peritonitis from January 2001 to December 2007 in Samsung Medical Center. Results : Of the 42 patients, 48 episodes of peritonitis had occurred in 21 patients. The rate of peritonitis was one episode over 35.3 patient-months. Mean dialysis duration before peritonitis was 18.06$\pm$15.81 months. Gram-positive organisms accounted for 58.3% of all episodes. Of the gram-positive organisms, the most common pathogen was Staphylococcus aureus(29.2%), the next common pathogens were Coagulase negative staphylococcus(14.6%) and Streptococcus species(6.3%). 35.7% of gram-positive pathogens were resistant to 1st cephalosporin. However, in patients younger than 4 years old, 50% of gram-positive pathogens were resistant to 1st generation cephalosporin. 10 episodes of peritonitis were methicillin-resistant and were treated by vancomycin. Of the gram-negative organisms, E. coli was the most common (8.3%). 64.8% of all pathogens were sensitive to cephalothin or ceftazidime. Conclusion : The empirical therapy with 1st generation cephalosporin and ceftazidime can be also effective to peritoneal dialysis associated peritonitis in Korean children. However, in patients younger than 4 years old, glycopeptide should be considered as the first empirical therapy in Korean children.

• Journal of Veterinary Clinics
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• v.1 no.1
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• pp.63-66
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• 1984

A 6 yers old German Shepherd dog was diagnosed to a ruptured gallbladder subsquently causing a diffuse peritonitis with bile-contaminated ascites. Surgical exploration could not determine its causes of pathogenesis. A marked leukocytosis and increased alkaline phosphotase were the pronounced clinical pathologic features. Delayed surgical exploration was critical therapeutic failure of this particular case. An immediate surgical intervention could be a life saving therapy of choise. The author report an uncommon clinical case presentation of the ruptured gallbladder in a dog and an importance of immediate surgical correction.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2009.10a
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• pp.204-204
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• 2009

• Advances in pediatric surgery
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• v.4 no.2
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• pp.156-162
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• 1998

Choledochal cyst is rare in the western countries, but common in oriental countries. Complicatioins include ascending cholangitis, recurrent pancreatities, progressive biliary cirrhosis, portal hypertension, stone formation and later malignant transformation. Bile peritonitis secondary to rupture is one of the rarest complications, with an incidence of 1.8 % to 18 %. The anomalous arrangement of the pancreatobiliary ductal system with a long common channel may cause inflammation leading to perforation of the cyst. The authors found 4 cases (14.2 %) of bile peritonitis among 28 cases of choledochal cyst treated from Jan. 1983 to Jan. 1998. The patients ages ranged from 6 months to 3 years and three were female. The perforation sites were located on the common bile duct at its junction with the cystic duct in 2 cases, the distal cyst wall in 1 case and the left hepatic duct at its junction with cyst in 1 case. The types of choledochal cysts by Todani's classification were Type IVa in 3 cases and type I in 1 case. By the new Komi's classification utilizing operative cholangiogram there were 2 cases of Type Ia, 1 case of type IIb and 1 case of type III. One stage cyst excision and hepaticojejunostomy(Roux-en Y type) was done in 3 cases, and two staged operation in 1 case. All patients had an uneventful course postoperatively. The average day of discharge was 9.8th postoperatively. In conclusion, primary excision of the choledochal cyst and biliary reconstruction is a safe and effective treatment of ruptured choledochal cyst in infants.

• Korean Journal of Veterinary Research
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• v.47 no.3
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• pp.315-319
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• 2007

Fibrinopurulent peritonitis and abdominal abscesses associated with Streptococcus (S.) equi subsp. zooepidemicus is reported in a 1-year-old female thoroughbred horse. The horse died after showing 5-day history of the cold, severe abdominal distention, abdominal breathing, hyperthermia, anorexia, and loss of intestinal sound. At necropsy, several liters of turbid yellowish green fluid were seen in the abdominal cavity. Yellowish creamy and fibrinous or bloody materials were presented on the serosa of various abdominal organs that were intensively adhered with each other. Spleen and mesenteric lymph node were remarkably enlarged. Affected lobes of the lung showed severe congestion, hemorrhage and doughy consistency. Histologically, the lung showed hemorrhagic pneumonia with diffuse congestion and edema. Severe diffuse fibrinopurulent peritonitis with Gram-positive bacterial cocci and adjacent fibrosis were showed in the serosa of various abdominal organs such as liver, spleen, stomach, and intestine. And multifocal abscess pouches were presented in the granulation tissue of abdominal viscera. S. equi subsp. zooepidemicus was isolated from the peritoneal swab, abdominal organs, and lung. Hematogenous dissemination of bacteria from hemorrhagic pneumonia is proposed as the route of infection in this case.