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Das rupturierte Bauchaortenaneurysma (BAA) ist eine seltene, jedoch vital bedrohliche Erkrankung, die eine rasche Diagnostik erforderlich macht. Wir berichten im Folgenden von einem Patienten, der mit den Symptomen einer Nierenkolik und eines akuten Abdomens aufgenommen worden war. Die Ultraschalluntersuchung bei Aufnahme bestatigte eine rechtsseitige Harnstauungsniere. Als Ursache derselben fand sich jedoch ein nach pararenal rechtsseitig rupturiertes BAA, das sekundar zur Kompression des Harnleiters gefuhrt hatte. Die primare Ultraschalluntersuchung stellt daher unserer Ansicht nach ein wichtiges Instrument in der Differentialdiagnose dar.

Intraabdominelle Lymphangiome und Mesenterialzysten sind benigne zystische Tumoren, die, obwohl sie selten vorkommen, in der Differential-diagnose abdomineller Beschwerden berucksichtigt werden mussen. Vor allem aufgrund ihres unterschiedlichen biologischen Wachstumsverhaltens ist es wichtig, beide Lasionen voneinander abzugrenzen. In unserer Chirurgischen Klinik wurden zwischen 1979 und 1993 4 Patienten mit intraabdominellen zystischen Lymphangiomen und 2 Patienten mit Mesenterialzysten operiert. Von diesen 6 Patienten waren 5 klinisch auffallig. Die Symptomatik reichte von unspezifischen Abdominalbeschwerden bis zum akuten Abdomen. Die endgultige Diagnose konnte bei allen Patienten erst nach der Laparotomie und feingeweblicher Untersuchung der exzidierten Zysten gestellt werden.

The ruptured abdominal aortic aneurysm is a rare, but life-threatening disease that demands fast diagnosis. We report in the following about a patient who was admitted with symptoms of urinary obstruction and an acute abdomen. Ultrasound investigation at admission confirmed urinary obstruction of the right kidney. Causative for that however was a right pararenal ruptured abdominal aortic aneurysm, which led secondarily to ureter compression. Thus, in our opinion, primary ultrasound examination represents an important instrument in differential diagnosis.

In the era of routinely used ultrasound techniques intrasplenic tumors are diagnosed more frequently. Usually these findings are not combined with specific symptoms. However, large cysts can lead to malfunctions of nearly located organs by displacing. Etiopathogenetic findings in our region are mainly non parasitic, epithelial and traumatic cysts or tumors of the spleen. We describe a large splenic mass of a 44 years old female patient. Pathological dignity remained unclear after using sonographic, radiological and clinical techniques. After uncomplicated total splenectomy the histopathological diagnosis revealed a benign, pseudoinflammatory tumor of the spleen. Inflammatory pseudotumors are a benign response to an unknown cause. It must be a main objective of preoperative diagnostics to distinguish them from malignant processes.

To determine the factors causing wound infections after splenectomy, 211 patients undergoing surgery during 1982-1991 were studied in two groups:--Patients with clean-contaminated or contaminated operations with additional splenectomy in the same session;--Patients with elective splenectomy only. While in the first group the rate of disorders of wound healing (DWH) was 31.6%, the second group had a rate of 8.15%. This rate was higher than for other clean operations in our hospital and was as high as for clean-contaminated operations such as cholecystectomy. Among the patients older than 60 years, 38.2% had DWH, as against 8.9% of the patients younger than 60 years. The mean operating time in patients with wound infections was 223 min, while the mean operating time in patients without infections was 125 min. In patients with wound infections the gamma-GT was higher than in patients who had no infection. After these results we have given 2 g ceftriaxon as single-shot prophylaxis before every splenectomy. Since starting this, we have performed 28 splenectomies, and DWH has been observed in only 1 (3.57%). We therefore recommend antibiotic prophylaxis.

Although intra-abdominal lymphangioma and mesenteric cysts are rare benign tumours, they have to be considered in the differential diagnosis of abdominal pain. Differentiation of these lesions is important, because lymphangiomas may follow a proliferative and invasive course. From 1979 to 1993 four patients with intra-abdominal cystic lymphangiomas and two with mesenteric cysts underwent operations in our surgical department. Five of these six patients had abdominal symptoms, ranging from unspecific abdominal pain to acute clinical abdomen. In all cases surgical enucleation or resection and histological classification were necessary before final diagnosis was possible.

In a prospective study we evaluated patients with the diagnosis of 1. groin hernia (n1 = 57), 2. gall bladder stones (n2 = 80) and 3. carcinoma of the colon (n3 = 76). The whole group included 213 patients who underwent clean, clean-contaminated or contaminated operations. All wound infections and post-operative bacterial infections like pneumonia or urinal infection were registered. The patients were asked for risk factors at the time of hospitalisation. 7.1% of all patients admitted an intake of alcohol of more than 60 g/day and 15.6% of the patients smoked more than 20 cigarettes a day. We found a four times higher risk to get a postoperative infection for patients with an intake of more than 60 g alcohol a day. The rate of infection for smokers of more than 20 cigarettes a day is two times higher than for non smokers or persons who smoke less than 20 cigarettes a day.

In a prospective study we evaluated patients with diagnoses of (1) inguinal hernia (n = 57), (2) gall bladder stones (n = 80), and (3) carcinoma of the colon (n = 76). The whole group included 213 patients who underwent clean, clean-contaminated or contaminated operations. All wound infections and postoperative bacterial infections such as pneumonia or urinary infection, were recorded. The patients were asked for risk factors at the time of hospitalization: 7.1% of all patients admitted an intake of alcohol of more than 60 g/day, and 15.6% of the patients smoked more than 20 cigarettes/day. We found a four times higher risk of postoperative infection for patients with an intake of more than 60 g alcohol/day. The rate of infection for smokers of more than 20 cigarettes/day is twice as high as for non-smokers or persons who smoke fewer than 20 cigarettes/day.