• Journal of Yeungnam Medical Science
• /
• 제26권1호
• /
• pp.49-55
• /
• 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
• /
• 제39권2호
• /
• pp.133-140
• /
• 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
• /
• 제14권2호
• /
• pp.174-183
• /
• 2010

목 적 : 복막염의 원인균과 항생제 감수성은 지역이나 병원에 따라 다양하다. 따라서 이에 대한 자료가 치료 지침의 수립에 반드시 필요하다. 본 연구는 최근 10년동안 복막 투석을 받은 소아 환자들에서 발생한 복막염의 발생 빈도와 원인균의 특성의 변화를 알아보기 위해 수행되었다. 방 법 : 2000년부터 2010년까지 서울대학교 어린이병원에서 복막 투석을 받은 110명의 소아 환자들을 대상으로 하여 의무기록을 후향적으로 분석하였다. 결 과 : 복막 투석을 받은 환자 110명 중 57명에서 140례의 복막염이 발생하였다. 복막염의 발생 빈도는 0.43회/환자 년이었고, 2003년 이후로는 비슷한 빈도로 발생하고 있다. 60%의 환자가 복막 투석 시작 후 첫 1년 이내에 복막염이 발생하였고, 1세 미만에 복막 투석을 시작한 환아 7명은 모두 복막염을 경험하였다. 원인균으로 그람 양성균, 그람 음성균, 진균이 각각 58%, 38%, 4.1% 였고, 배양 음성률은 13.6% 였다. 그람 양성균 중에는 Staphylococcus, 그람 음성균 중에는Pseudomonas와Acinetobacter가 가장 많이 동정되었다. 그람 양성균중 56%가에는 1세대 cephalosporin에 감수성을 보였고, 그람 음성균 중 91%가 ceftazidime에 감수성을 보였다. 결 론 : 앞으로 복막염의 빈도를 더욱 감소시키기 위한 새로운 돌파구가 필요하다. 영아에서 복막염이 더 잘 발생하였지만, methicillin에 대한 저항성은 2세 미만에서 유의하게 높지 않았다. 전국적인 공동연구를 통해 우리나라 실정에 맞는 경험적 항생제 사용 지침을 정하는 것이 필요하다고 생각된다.

• 한국동물위생학회지
• /
• 제26권1호
• /
• pp.67-71
• /
• 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.

• 한국임상수의학회지
• /
• 제35권1호
• /
• pp.17-18
• /
• 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
• /
• 제12권2호
• /
• pp.213-220
• /
• 2008

목 적 : 최근 소아 복막염에서 methicillin에 대한 저항성을 갖는 균주가 증가하고 있어서 the International Pediatric Peritonitis Registry(IPPR) 가이드라인에 따른 초치료 경험적 약제의 선택의 효용성에 대해서 논란이 되고 있다. 본 연구에서는 소아에서 발생한 복막염을 중심으로 ISPD 가이드라인을 따른 경험적 항균제 선택의 치료 효과적 유용성을 분석하였다. 방 법 : 2001년 1월부터 2007년 12월까지 7년간 삼성 서울 병원에서 복막 투석을 받은 경험이 있는 환자들을 대상으로 복막염을 일으킨 원인 균의 미생물학적 특성과 ISPD 가이드라인에 따라서 복막염을 치료 했을 때의 임상적 경과 등에 대해서 의무 기록을 후향적으로 조사하였다. 결 과: 복막 투석을 받은 42명의 환자 중, 21명에서 48례의 복막염이 발생하였다. 복막염 발생율은 one episode over 35.3 patient-months였으며, 복막염 발생 전까지의 평균 투석 기간은 18.06$\pm$15.81개월이었다. 그람 양성균에 의한 복막염이 전체의 58.3%를 차지하였으며, 이중 S. aureus와 coagulase negative staphylococcus가 가장 많았다. 동정된 그람 양성균들 중 35.7%는 1세대 cephalosporin에 저항성을 보였으나 4세 이하의 환자에서는 50%가 저항성을 보였다. 그람 음성균 중에서는 E. coli가 가장 많았다. 동정된 모든 균들은 현재 사용중인 1세대 cephalosporin과 ceftazidime의 병합 요법에 64.8%가 감수성을 보였다. 결 론: 국내 소아 복막 투석 환자에서 발생한 복막염에서 경험적 항생제 초치료로 현재 사용중인 1세대 cephalosporin과 ceftazidime의 병합 요법은 여전히 효과적이다. 그러나 4세 미만의 환자에서는 경험적 항생제 초치료로 1세대 cephalosporin 대신 glycopeptide를 사용하는 것이 더 효과적일 것으로 생각된다.

• 한국임상수의학회지
• /
• 제1권1호
• /
• pp.63-66
• /
• 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.

• 한국임상수의학회:학술대회논문집
• /
• 한국임상수의학회 2009년도 추계학술대회
• /
• pp.204-204
• /
• 2009

• Advances in pediatric surgery
• /
• 제4권2호
• /
• pp.156-162
• /
• 1998

저자들은 1983년 1월부터 1998년 1월까지 총담관낭 환아 28례 중 4례(14.2 %)에서 자연적으로 발생한 총담관낭 천공에의한 담즙성 복막염을 경험하였고 이 중 3례에서 일차적인 낭종 절제와 간관공장 문합술을 시행하였으며 이 모든 예에서 합병증 없이 회복되었기에 문헌 고찰과 함께 보고하는 바이다. 총담관낭 천공에의한 답즙성 복막염치료는 일차적 낭종 절제와 간관 공장 문합술이 안전하고 효과적인 방법이라고 생각된다.

• 대한수의학회지
• /
• 제47권3호
• /
• pp.315-319
• /
• 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.