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Introduction: Point-of-care ultrasound (POCUS) is a screening and diagnostic modality frequently used in the emergency department to assess patients with abdominal pain.Case Report: We present a case describing the unusual finding of intraperitoneal fluid with loculations visualized in the right upper quadrant of the abdomen in a patient ultimately diagnosed with pelvic inflammatory disease (PID) with ruptured tubo-ovarian abscess caused by group A streptococcus (GAS), a pathogen rarely implicated in the disease.Conclusion: Uncommon findings on abdominal POCUS should trigger further investigation. In a patient not responding to antibiotics administered for typical PID coverage, GAS should be considered as a possible etiology and a penicillin-based antibiotic administered to prevent progression to tubo-ovarianabscess formation, peritonitis, and sepsis.

•Chronic chemical peritonitis caused by spontaneous rupture of a mature cystic teratoma may result in prolonged hospitalization and respiratory decline and can mimic a gynecologic malignancy.•Earlier surgical intervention for mature teratoma may prevent morbidity.•Inclusion of a gynecologic oncologist is advised for management discussions and/or surgical back-up.•Complex benign gynecologic surgeries may have some benefit for gynecologic oncologic trainees, which can be used for later oncologic cases.

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession Patient or Public Contribution This study aimed to explore the risk factors related to home‐based operation management leading to the occurrence of peritoneal dialysis‐associated peritonitis (PDAP).An observational research was conducted.A retrospective analysis was conducted among patients with maintenance peritoneal dialysis (PD) between 1 January 2019 and 31 December 2022. The patients were grouped according to the occurrence of PDAP. General characteristics and home operational data were collected and logistic regression analysis was performed to identify independent risk factors for PDAP associated with home operations. This study complied with the Appendix S1.Of 458 PD patients included in this study, 82 were in the peritonitis group. Their average age was 53.34 ± 13.62 years, and the average dialysis vintage was 35.57 ± 32.74 months, with males accounting for 54.6%. Multivariate logistic regression analysis revealed that age; primary disease, such as diabetes mellitus; dialysis vintage; improper storage of dialysis fluid; failure to verify the quality of protective‐caps with povidone‐iodine; and improper handwashing were risk factors of PDAP. Daytime ambulatory PD mode was significantly negatively associated with PDAP.Improper storage of dialysis fluid, failure to check the quality of protective‐caps and improper handwashing at home are independent risk factors for PDAP caused by home‐based operation management. Nurses should strengthen relevant training or retraining to address this.These findings serve to highlight the key areas for training in PD management and aim to empower patients to effectively conduct self‐management practices.We appreciate the patient's understanding and support. [ABSTRACT FROM AUTHOR]

Objectives: This multicenter longitudinal study investigated the prevalence of gastrointestinal (GI) manifestations in lupus patients and determined the risk factors associated with mortality. Methods: This study is part of the Oman Lupus Study, which included 1160 patients who met the classification criteria for systemic lupus erythematosus (SLE) from January 2006 to February 2020. All patients were screened for GI symptoms and involvement. Results: We identified 91 patients with GI manifestations, with a prevalence rate of 8.53% in the pediatric group and 7.75% in the adult group, and this difference was not statistically significant (p =.755). Ischemic colitis was significantly associated with longer disease duration (p <.001) and positivity for B2-glycoprotein I (B2GPI) autoantibodies (p <.0001). Moreover, a significant correlation was found between ischemic colitis and hematologic manifestations (p =.001), lupus nephritis (p =.007), pulmonary complications (p =.000-.039), and some cardiac complications (p =.012-.269). Mortality rates were greater in patients with GI involvement (24.37%), including those with ischemic colitis (p =.005), chronic peritonitis (p <.001), and spleen/liver infarction (p =.001). Sepsis, thrombocytopenia, and different internal organ involvement rates were significantly associated with increased mortality. Conclusion: This research provides significant insights into GI manifestations in lupus patients. A higher mortality rate was found to be associated with organ involvement, disease duration, autoantibody profile, and specific complications. Considering this fact, it is vital to prioritize management strategies to improve clinical outcomes in this group of patients. [ABSTRACT FROM AUTHOR]

Gut bacterial translocation contributes to immune dysfunction and spontaneous bacterial peritonitis (SBP) in cirrhosis. We hypothesized that exposure of peritoneal macrophages (PMs) to bacterial DNA results in type-I interferon (IFN) production, shaping subsequent immune responses, inflammasome activation, and the release of damage-associated molecular patterns (DAMPs). PMs from patients with cirrhosis were stimulated with E. coli single-stranded DNA (ssDNA), lipopolysaccharide and IFN, or infected with E. coli , S. aureus, and Group B streptococcus in vitro. Cytokine release, inflammasome activation, and DAMP release were quantified by quantitative-PCR, ELISA, western blots, and reporter cells employing primary PMs, monocytes, and caspase-deficient THP-1 macrophages. Serum progranulin concentration was correlated with transplant-free survival in 77 patients with SBP. E. coli ssDNA induced strong type-I IFN activity in PMs and monocytes, priming them for enhanced lipopolysaccharide-mediated tumor necrosis factor production without inducing toll-like receptor 4 tolerance. During in vitro macrophage bacterial infection, type-I IFN release aligned with upregulated expression of IFN-regulatory factors (IRF)1/2 and guanylate binding proteins (GBP)2/5. PMs upregulated inflammasome-associated proteins and type-I IFN upon E. coli ssDNA exposure and released interleukin-1β upon bacterial infection. Proteomic screening in mouse macrophages revealed progranulin release as being caspase-11-dependent during E. coli infection. PMs and THP-1 macrophages released significant amounts of progranulin when infected with S. aureus or E. coli via gasdermin D in a type-I IFN- and caspase-5-dependent manner. During SBP, PMs upregulated IRF1, GBP2/5 and caspase-5 and higher serum progranulin concentrations were indicative of lower 90-day transplant-free survival after SBP. Type-I IFN shapes peritoneal immune responses and regulates caspase-5-mediated progranulin release during SBP. Patients with cirrhosis exhibit impaired immune responses and increased susceptibility to bacterial infections. This study reveals that type-I interferon responses, triggered by pathogen-associated molecular patterns, are crucial in regulating macrophage activation and priming them for inflammatory responses. Additionally, we elucidate the mechanisms by which type-I interferons promote the release of progranulin from macrophages during spontaneous bacterial peritonitis. Our findings enhance understanding of how bacterial translocation affects immune responses, identify novel biomarkers for inflammasome activation during infections, and point to potential therapeutic targets. [Display omitted] • Bacterial translocation contributes to immune dysfunction in patients with cirrhosis. • Bacterial single-stranded DNA drives type-I IFN release and primes peritoneal macrophages. • Peritoneal macrophages upregulate IRF1, GBP2/5 and caspase 5 during spontaneous bacterial peritonitis. • IFN permits the release of the DAMP progranulin in a caspase 5-dependent fashion. • Peritoneal macrophage-derived progranulin associates with outcome in spontaneous bacterial peritonitis. [ABSTRACT FROM AUTHOR]

Congenital portosystemic shunts (CPSS) are rare congenital vascular anomalies characterized by abnormal connections between the portal vein and systemic circulation, bypassing the liver. They can lead to complications such as recurrent encephalopathy, liver nodules, portopulmonary hypertension, and neurocognitive issues due to hyperammonemia and rarely kidney involvement. Hepatic hemodynamic changes can lead to liver nodules and hepatocellular carcinoma, particularly in extrahepatic shunts. We describe here an 11-year-old girl with type 1 intrahepatic portosystemic shunt with focal nodular hyperplasia in the liver, presenting with nephrotic syndrome that was diagnosed as membranoproliferative glomerulonephritis on kidney biopsy and that responded partially to therapy with immunosuppressants. [ABSTRACT FROM AUTHOR]

Introduction: Peritoneal dialysis (PD) – associated peritonitis is a serious complication of peritoneal dialysis (PD). The 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for treatment of Enterococcal PD – associated peritonitis. To date, there is no in vivo data to support use of IP ampicillin for the treatment of Enterococcus faecalis. Case Description: A 69-year-old man with a past medical history of end stage kidney disease (ESKD) requiring continuous cycling peritoneal dialysis (CCPD) was admitted to the hospital and treated for peritonitis with E. faecalis. The patient's CCPD prescription was 2.5% Dianeal with 5 total exchanges. IP ampicillin was added to the first 4 exchanges and additional ampicillin was added to the last fill. The patient successfully completed the treatment course with clinical cure. Discussion: The use of IP ampicillin for E. faecalis peritonitis is controversial and previously lacked compelling clinical evidence for or against its use. This case demonstrates treatment of peritonitis using a modified dosing strategy with ampicillin added to each CCPD exchange and last fill. The loss of ampicillin antimicrobial activity reported in vitro with E. faecalis was not supported by this case. [ABSTRACT FROM AUTHOR]

Background: Peritonitis is a frequent complication of PD that can lead to technique discontinuation and increase morbidity and mortality. It is caused mainly by gram-positive bacteria (up to 70%); however, gram-negative organisms usually have relatively poor outcomes. Among gram-negative bacteria, Acinetobacter is rare, especially Acinetobacter ursingii. Case report: We report the third case of PD peritonitis caused by Acinetobacter ursingii, treated with directed intraperitoneal antibiotics with good clinical response and favorable outcome. Conclusion: Although Acinetobacter ursingii is rare, it is potentially harmful because of its challenging identification and antibiotic resistance with therapeutic consequences, requiring at least two antibiotics and careful follow up. Keeping in mind that it is ubiquitous, careful technique, training/retraining seems highly recommended. [ABSTRACT FROM AUTHOR]

The number of peritoneal dialysis (PD) catheter-related infections and peritonitis caused by nontuberculous mycobacteria (NTM) has been increasing. Nonetheless, the optimal timing for the relocation of the exit site, removal and reinsertion of the PD catheter, prognosis, and duration of antibiotic treatment remain unclear. This literature review aimed to investigate the epidemiology of patient characteristics and evaluate the most effective diagnostic and treatment strategies for PD catheter-related infections and peritonitis caused by NTM. The systematic literature review was conducted on published cases of PD catheter-related infection and peritonitis caused by NTM in PubMed, Embase, and Ichushi databases up to August 2022. A total of 335 cases (64.1%, male; mean age, 53.4 years; mean dialysis duration, 25.4 months) were analyzed. The most common causative agent of infection was Mycobacterium abscessus (40.1%), followed by Mycobacterium fortuitum (24.8%) and Mycobacterium chelonae (16.6%). With respect to diagnosis, 42.9%, 28.1%, and 29.0% of cases were diagnosed as PD catheter-related infection only, peritonitis only, and both, respectively. The initial cultures were positive for NTM only, positive for any other bacteria, and negative for NTM only in 56.5%, 19.8%, and 23.7% of cases, respectively. Ultimately, more than 80% of cases were treated with multiple antibiotics. PD catheter removal was performed in 55.4% of patients with PD catheter-related infections only and 85.5% of those with PD peritonitis. PD continuation or resumption was possible in 62.2% and 16.0% of patients, respectively. In conclusion, our findings indicate that it is advisable to perform acid-fast bacilli stain and culture in order to promptly identify NTM. PD catheter removal may be an essential management strategy during the early stages of NTM infection. [ABSTRACT FROM AUTHOR]

Purpose: The intraperitoneal leak of urine is considered as a major cause of peritoneal inflammatory reaction that could lead to paralytic ileus. Our aim was to document the effect of urine on the peritoneal surface. Methods: Seven white minipigs (one control-six tests) underwent standardized general anaesthesia. In three test pigs urine was aspirated from the bladder and instilled in the peritoneal cavity. In the remaining three pigs a continuous urine leak was created through section of the ureter. At 4 and 10 h laparoscopic harvesting of slices of the parietal peritoneum at the level of the Douglas pouch, lateral pelvic wall and subdiaphragmatic area was performed. Ileum slices were also obtained at 10 h. The slices were microscopically evaluated for inflammatory infiltrate (INI) of the peritoneum according to the Sydney system classification. Results: The presence of urine in the peritoneum induces distention of the ileum. At 4 h, a light-moderate INI was observed to two pigs of both test groups but not to the control pig. At 10 h a light-moderate INI appeared in the peritoneal slices of the control pig. Moreover, three out of six pigs of both test groups showed some degree of INI of the parietal peritoneum. The histologic evaluation of the slices of the distended ileum did not reveal INI. Conclusions: The intraperitoneal urine induces distention of the bowel but no inflammation of the visceral peritoneum in the short term (10 h). Other than inflammation mechanisms through which the urine induces small ileum distention should be investigated. [ABSTRACT FROM AUTHOR]

Objective Case Summary New or Unique Information Provided To describe a case of concurrent septic pyothorax, peritonitis, and cholecystitis due to Staphylococcus pseudintermedius in a dog.A 10‐year‐old neutered male, medium‐sized, mixed‐breed dog presented with an acute abdomen. Initial investigations found the presence of a septic pyothorax, septic peritonitis, and bacterial cholecystitis. Exploratory celiotomy did not identify the source of infection, and no macroscopic communication between pleural and peritoneal space was detected. An abdominal Jackson‐Pratt drain and bilateral small‐bore thoracostomy tubes were placed for further management, with the dog receiving antimicrobial therapy and intensive supportive care. Subsequently, microbiological cultures confirmed scant growth of S. pseudintermedius in bile, pleural, and peritoneal fluid. The dog was discharged after 1 week of hospitalization. Antimicrobial therapy was discontinued 4 weeks after discharge due to an improvement of clinical signs and normalization of C‐reactive protein concentration. A diagnosis of hyperadrenocorticism was made 6 weeks after discharge, and appropriate therapy was initiated.Septic peritonitis and septic pyothorax are both common life‐threatening conditions in veterinary medicine. To the authors’ knowledge, this is the first report describing septic bicavitary effusion associated with a biliary staphylococcal infection in a dog. The exact mechanism by which the infection spread remains unclear, but hematogenous or lymphatic routes are considered the most probable. However, the presence of microscopic diaphragmatic defects and an anicteric gallbladder rupture cannot completely be excluded. The concurrent hyperadrenocorticism may have also contributed to an immunocompromised state, predisposing the dog to the development of infection. [ABSTRACT FROM AUTHOR]

This review outlines the epidemiology, characteristics, risk factors, and prognosis of peritoneal dialysis (PD)-related peritonitis, PD catheter-related infections, and the effects of assisted PD in elderly patients from the Japanese perspective. Based on the literature, the incidence of peritonitis is likely to be higher in elderly patients than in younger patients. The most frequent causative bacteria in elderly patients are Gram-positive bacteria, as in adult PD patients, most commonly due to transcatheter infection. However, elderly patients may have difficulty recognizing cloudy drainage fluid due to decreased visual acuity. Hypokalemia, the use of gastric acid suppressants, prophylactic antibiotic use before endoscopy, biocompatible fluids and hypoalbuminemia considered modifiable risk factors for peritonitis. However, the mechanism by which treatment of hypokalemia prevents peritonitis is unknown. Currently, the relationship between gastric acid suppression therapy and peritonitis in elderly patients is debatable, with no evidence to strongly recommend uniform discontinuation of gastric acid suppression therapy. Exit-site infection (ESI) is a major risk factor for the development of peritonitis, and appropriate prevention and management of ESI may reduce infection-related hospitalizations in PD patients. Currently, no randomized, controlled trials have verified the effectiveness of antibiotic application for ESI in Japan, but results from other countries are awaited. In assisted PD, it is extremely important that family members, caregivers, and nurses who support the procedure receive sufficient education and training from medical professionals familiar with PD. Early detection and treatment of PD-related infections are required because the risk of death increases in elderly patients. [ABSTRACT FROM AUTHOR]

Gastric‐acid suppressants (GASs) are commonly prescribed to patients undergoing peritoneal dialysis for various gastrointestinal disorders. However, long‐term GAS use has been linked with the risk of enteric peritonitis in this patient population. To assess the association between the enteric peritonitis risk and GAS use in patients undergoing peritoneal dialysis for end‐stage renal disease, we conducted a systematic search for relevant articles published until December 2023 in PubMed, Embase, and the Cochrane Library databases. We included 11 articles on the association between GAS use and enteric peritonitis risk in patients undergoing peritoneal dialysis. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed and random‐effects models to obtain overall effect estimates. We also explored potential sources of heterogeneity through subgroup analyses. We qualitatively analyzed data from 11 studies (n = 1993 participants), out of which, nine studies were included in meta‐analysis. The overall results revealed a significant association between the enteric peritonitis risk and the use of GASs (OR, 1.61; 95% CI, 1.26–2.05; p < 0.00001). The analysis of study design subgroups showed a significant association in retrospective cohort studies (OR, 1.70; 95% CI, 1.42–2.03; p < 0.00001) but not in case–control studies. Histamine‐2 receptor antagonist (H2RA) use was significantly associated with enteric peritonitis (OR, 1.49; 95% CI, 1.05–2.11, p = 0.03), whereas proton pump inhibitor use was not (OR, 1.13; 95% CI, 0.72–1.77, p = 0.28). Our findings suggest a significant association between the development of enteric peritonitis and GAS use in patients undergoing peritoneal dialysis. However, the observed heterogeneity in study characteristics warrants caution in interpreting the results. [ABSTRACT FROM AUTHOR]

• We report data on immunocompromised ICU patients with intra-abdominal infections. • Compared to an immunocompetent cohort in a large multinational cohort study. • Community-acquired infections were less frequent and septic shock more frequent. • Mortality was not higher. • Risk factors for death are septic shock and source control failure. We compared epidemiology of intra-abdominal infection (IAI) between immunocompromised and non-immunocompromised ICU patients and identified risk factors for mortality. We performed a secondary analysis on the " AbSeS " database, a prospective, observational study with IAI patients from 309 ICUs in 42 countries. Immunocompromised status was defined as either neutropenia or prolonged corticosteroids use, chemotherapy or radiotherapy in the past year, bone marrow or solid organ transplantation, congenital immunodeficiency, or immunosuppressive drugs use. Mortality was defined as ICU mortality at any time or 28-day mortality for those discharged earlier. Associations with mortality were assessed by logistic regression. The cohort included 2589 patients of which 239 immunocompromised (9.2 %), most with secondary peritonitis. Among immunocompromised patients, biliary tract infections were less frequent, typhlitis more frequent, and IAIs were more frequently healthcare-associated or early-onset hospital-acquired compared with immunocompetent patients. No difference existed in grade of anatomical disruption, disease severity, organ failure, pathogens, and resistance patterns. Septic shock was significantly more frequent in the immunocompromised population. Mortality was similar in both groups (31.1% vs. 28.9 %; p = 0.468). Immunocompromise was not a risk factor for mortality (OR 0.98, 95 % CI 0.66–1.43). Independent risk factors for mortality among immunocompromised patients included septic shock at presentation (OR 6.64, 95 % CI 1.27–55.72), and unsuccessful source control with persistent inflammation (OR 5.48, 95 % CI 2.29–12.57). In immunocompromised ICU patients with IAI, short-term mortality was similar to immunocompetent patients, despite the former presented more frequently with septic shock, and septic shock and persistent inflammation after source control were independent risk factors for death. [ABSTRACT FROM AUTHOR]

Background: Training caregivers performing PD is an important measure to prevent peritonitis. A low literacy rate hinders training in low-resource settings. We designed a structured training initiative (STI) and objective structured assessment (OSA) using visual and kinesthetic resources with minimal use of written resources. We studied the impact of STIs on caregivers' knowledge and practical skills and the rate of peritonitis. Methods: This prospective study conducted initial STI (iSTI) for caregivers of children initiating PD and retraining STI (rSTI) for those already on PD. OSA was administered after completion of training, and those scoring < 95% were retrained. Re-assessment was done at 3, 6, and 12 months, and those who scored < 95% underwent re-training. The rate of PD peritonitis and the time to first peritonitis were compared between the STI group and the cohort on PD in our center who received standard training before STI (controls). Results: Caregivers of 40 children were included. The median duration of iSTI and rSTI was 19.5 (18, 20) and 9 (9, 9.5) hrs, and the OSA scores were 97% (97%, 98%) and 96% (96%, 98%), respectively. Only 5% required retraining. There was a significant reduction in the rate of PD peritonitis (0.29 vs. 0.69 episodes/patient-year; p < 0.001) and longer time to peritonitis (189 vs. 69 days; p < 0.001) in the STI group when compared to the controls (n = 32). Conclusions: STI was effective in training caregivers for peritoneal dialysis. There was a reduction in the rate of peritonitis and a longer time to first peritonitis in the STI cohort. [ABSTRACT FROM AUTHOR]

This article outlines the benefits and risks of peritoneal dialysis, such as oxidative stress. The article also discusses the role of antioxidant supplementation [ABSTRACT FROM AUTHOR]

This study aims to evaluate the management of acute diverticulitis complicated by hernia and the role of electroacupuncture in managing postoperative ileus. The case involved a 51-year-old male patient who presented with left lower abdominal pain, fever, and defecation disorder. Physical examination showed signs of infection with localized peritonitis, while laboratory tests revealed neutrophilia. CT scan showed diverticulitis with abscesses in the descending and sigmoid colon, as well as free air around the colon and perihepatic region, and paraesophageal hernia. The patient underwent left hemicolectomy with Hartmann's procedure. Postoperatively, the patient developed ileus which was treated using electroacupuncture. The results showed that the relationship between diverticulosis and hernia is due to connective tissue changes. Approximately 10-20% of diverticulosis cases progress to acute diverticulitis. CT scan is the gold standard for diagnosis, staging and management of diverticulitis. In cases of Hinchey III diverticulitis, laparoscopic washing does not give better results compared to colonic resection. The Hartmann procedure is recommended for patients with multiple comorbidities. Electroacupuncture proved to be an effective adjunctive therapy in managing postoperative ileus. The conclusion of this study is that a multimodal approach, including surgery and complementary therapies such as electroacupuncture, is essential in the management of diverticulitis and its complications. The implication of this study is the need for a holistic approach in managing patients with acute diverticulitis, especially in cases with multiple comorbidities and risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most frequent surgical emergency encountered worldwide. Diagnostic errors are common resulting in median incidence of perforation 20% and negative appendicectomy 15% to 20%.. Removing normal appendix is an economic burden on both patients and health resources. Mis-diagnosis and delay in surgery can lead to complications like Perforation and finally Peritonitis. Objective. To compare the Validity of Modified Alvarado Score and Tzanaki’s Score in Diagnosing Acute Appendicitis. Methods: An Observational* study conducted at District Hospital, Dharwad in the Department of General Surgery which included 100 Clinically, Laboratory and Radiologically diagnosed cases of acute appendicitis who underwent Appendicectomy (Open/ Lap) from January 2021 to April 2022. Both Modified Alvarado Score and Tzanaki’s score are done for all the patients. Final diagnosis was based on Histological findings given by the Pathologist. Data was analysed to compare the Validity* of both scoring systems in diagnosing Acute appendicitis. Results: The Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value of Modified Alvarado score was 47.87%, 66.67%, 95.74% and 75.5% respectively and Tzanaki’s score of was 87.27%, 16.67%, 94.25% and 76.9% respectively. Negative appendicectomy in Tzanaki’s scoring was 6% and in M. Alvarado scoring was 6%. Overall negative appendicectomy was 6%.. Conclusion: This study shows that Tzanaki’s scoring system can be used as an effective modality in the establishment of accuracy in diagnosis of acute appendicitis. There is increased Sensitivity, PPV & Diagnostic Accuracy in Tzanaki’s scoring when compared to Modified Alvarado score. Tzanaki’s score is an effective modality to establish the accurate diagnosis of AA and helps in reducing complications, morbidity, mortality of Appendicitis & negative Appendicectomy rate. [ABSTRACT FROM AUTHOR]

Introduction: Peritonitis due to Hollow viscus perforation is the commonest cause for the acute abdomen next to Acute appendicitis. It is the most common emergency surgery done for a case of acute abdomen. Among the cases of hollow viscus perforation Duodenal and Gastric perforations are the commonest, followed by Ileal, Appendicular, and large bowel. The incidence of Gastric perforation is on the rise followed by the Ileal perforation accounting for about 20% of total hollow viscus perforation. Among the causes for Enteric perforation, Typhoid ileal perforation is common. Aim: To study the Enteric Perforation due to Typhoid. Objectives: 1. To study the incidence of Ileal perforation in relation to age and sex. 2. To evaluate the mode of clinical presentation in patients with ileal perforation due to typhoid. 3. To study the management and outcome of patients with ileal perforation due to typhoid. Study Design: Prospective observational study. Study Population: All patients presenting to emergency and surgical OPD with symptoms of peritonitis (hollow viscus perforation). Materials And Methods: This study was done in the Department of General Surgery, SVRRGGH, Tirupathi. The materials for the study were collected from patients presenting to the surgical outpatient department and emergency with features of hollow viscus perforation during the period of December, 2020- December 2021 were included in the study. Inclusion Criteria: 1. Patients with age above 18 years present with features of hollow viscus perforation. 2. Patients with intraoperative findings of ileal perforation. 3. Patient who gave consent for emergency exploratory laparotomy. Exclusion Criteria: 1. Patients with the intraoperative finding of hollow viscus perforation other than ileal perforation. 2. Patients with cardiovascular, pulmonary disease. Observation And Results: This study shows the common etiology of Ileal perforation was Typhoid (Enteric fever) accounting for 83% followed by Tuberculosis 8%. The average age of presentation was between 20 and 40 years. There was a male preponderance with 70%. The majority of the cases accounting for 53% were seen during the 3rd and 4th week of the typhoid fever. The predominant symptoms were abdominal pain and vomiting. The most common sign elicited was guarding and rigidity in all cases 100%. The most reliable test that identified perforation was x-ray 100%. The biopsy culture of the perforated ulcer edge had yielded positive results of 73% when compared to blood culture and serum widal tests. All the perforations in the present study were found within 50cm of the terminal ileum. None were noted beyond 50 cm from the ileocecal junction, due to the presence of more Peyer’s patches in the terminal ileum. 77% of ileal perforations were single in number. The primary closure and peritoneal lavage were the procedure done in 70% of cases. Postoperative complications were seen in 37%. The most common complication encountered was the Wound infection accounting for 30% overall. The re-exploration rate was 6% done in 2 cases. The mortality in the present study was 6.66%. [ABSTRACT FROM AUTHOR]

The effect of a new antibiotic peptomide A-70 on changes in the mesenterial lymph nodes caused by experimental peritonitis was studied. Differences in the morphological changes in rat lymph nodes in peritonitis and against the background of antibiotic therapy were revealed. Lymph nodes responded to peritoneal inflammation by reducing the area of cortical structures and expansion of the sinus system, which indicates a decrease in drainage-detoxification and immune function and determines unfavorable outcome of peritonitis. Antibiotic therapy reduced inflammatory manifestations and toxic pressure on the lymph system and potentiated the reactive response of the mesenteric lymph nodes: the size of lymphoid nodes and the paracortical T-dependent zone increased against the background of shrinkage of the sinus system, which attested to activation of the lymphopoietic function and immune response of lymph nodes in peritonitis. The observed changes attested to favorable prognosis of peritonitis treated with antibiotic peptomide A-70. [ABSTRACT FROM AUTHOR]

The article describes the case of a 37-year-old woman at 35 weeks of gestation who presented to the clinic for evaluation due to decreased perceived fetal movements. Her ultrasonography revealed findings of slightly hyperechoic fetal ascites associated with hyperechogenic intestinal loops and without peritoneal calcifications. She underwent an emergency caesarean section due to decreased fetal movements and abnormal fetal tracing. The detection of fetal isolated ascites is discussed.

AIM: To study the efficacy of Mannheim's peritonitis index in predicting the outcome in a patient of peritonitis. OBJECTIVES: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the morbidity and mortality in patients with peritonitis due to hollow viscus perforation. MATERIALS AND METHODS: Prospective study of 53 patients operated for perforation peritonitis in Oxford Medical College, Bengaluru from October 2020 to August 2022. Mannheim Peritonitis Index score was calculated for each patient. RESULTS: Mean age group was 35.19 ± 12.77. Male predominant with 38 (71.7%) and female were 15 (28.3%) Duration of peritonitis was <24 hours in 25 (47.2%) cases and >24 hours in 28 (52.8%) cases. Peritonitis was localized in 8(15.1%) cases and diffuse in 45(84.9%) cases. Exudate was clear in 7 (13.2%) cases, cloudy and purulent in 43 (81.1%) cases and fecal in 03 (5.7%) cases. MPI score was <21 in 36 (67.92%) cases, 21-29 in 06 (11.32%) cases and >29 in 11 (20.75%) cases. Perforated appendix was 21 (39.62%), peptic ulcer perforation 17 (32.07%) and duodenal perforation was 09 (16.98%) were common causes of perforation peritonitis. Organ failure was present in 12 (22.6%) cases. Malignancy was present in 8 (15.1%) cases. Colonic origin of sepsis was in 16 (30.2%) cases. Mortality was in 5 (9.43%) cases out of which 3 (5.66%) were male and 2 (3.77%) were females. Mannheim Peritonitis Index scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 0%, 0%, and 9.43% respectively. Presence of generalized peritonitis, organ failure at time of admission, type of intra peritoneal exudates carried more significance in predicting the mortality and morbidity in the post op period than other variables. CONCLUSION: Mannheim Peritonitis Index is a simple and specific scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management. [ABSTRACT FROM AUTHOR]

Aim: Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD‐associated peritonitis in the past decades. Methods: This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups. Results: A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000–2008 period, the 2‐year peritonitis‐free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009–2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000–2008 period. However, this was not evident in the 2009–2017 period. Conclusions: The incidence of PD‐associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD‐associated peritonitis. [ABSTRACT FROM AUTHOR]

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease. We aimed to investigate the potential similarities and differences regarding the disease among Arabs and Jews. Retrospective study included all patients older than 18 years with NAFLD diagnosis according to ICD-10 codes. Data regarding demographics, comorbidities, and outcomes were retrieved using the MdClone platform from "Clalit" in Israel. Data concerning 34,090 Arab patients and 173,500 Jewish patients with NAFLD were included. Arab patients were significantly younger at diagnosis (35.0 ± 13 years vs. 43.6 ± 15 years, p < 0.001) and had higher rates of obesity and diabetes mellitus (69.5% vs. 56.5% and 27.0% vs. 22.7%, p < 0.001, respectively). Arab patients had higher rates of cirrhosis and portal hypertension-related complications (2.5% vs. 2.0%, p < 0.001), esophageal varices (0.9% vs. 0.5%, p < 0.001), spontaneous bacterial peritonitis (0.3% vs. 0.1%, p < 0.001), and hepatorenal syndrome (0.3% vs. 0.1%, p < 0.001). There was no significant difference in the prevalence of hepatocellular carcinoma between study groups (0.4% vs. 0.5%, p = 0.156). Liver transplantation was performed in 0.2% of Arab NAFLD patients compared to 0.07% of Jewish NAFLD patients (p < 0.001). Lower rates of all-cause mortality were found among the Arab NAFLD patients versus Jewish NAFLD patients (7.7% versus 11.5%, p < 0.001). According to the Cox regression model, Arab ethnicity is a risk factor for death with OR of 1.36. Significant differences regarding comorbidities, complications, liver transplantations rates, and all-cause mortality were found among NAFLD patients of different ethnicities, hence specific population need specific consideration in prevention, early diagnosis and follow up. [ABSTRACT FROM AUTHOR]

Background: New pharmaceutical forms of natural compounds such as curcumin can be an effective intervention to control peritonitis and abdominal adhesion. Objectives: This study investigates the effects of slow-release curcumin-loaded selenium nanoparticles (Cur@S.N) on some inflammatory biomarkers in experimental peritonitis. Methods: After synthesizing selenium nanoparticles (S.N) and (Cur@S.N), experimental peritonitis was surgically induced in 80 adult male rats. The control group received no treatment, whereas the other groups received single intraperitoneal doses of 0.25 mg/kg S.N, 50 mg/kg curcumin, and 0.25+50 mg/kg (Cur@S.N). Blood malondialdehyde (MDA), nitric oxide (NO), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNFα) were measured on days 3, 7 and 14, and also intra-abdominal adhesion assessment was done. Results: On day 3, NO levels in all treatment groups significantly decreased (P>0.05), while the lowest level was seen on day 14 in the S.N group (P˂0.05). MDA was significantly lower in the S.N and Cur@S.N groups than in the control on days 3, 7 and 14 (P˂0.05). TNF-α levels in S.N and Cur@S.N groups were significantly lower than in the control group on day 3 (P≤0.05). Meanwhile, the S.N group had the lowest level on day 14. IL-6 significantly decreased on days 3 and 7 in the Cur@S.N and curcumin groups compared to the control group (P˂0.05). Conclusion: Cur@S.N group possesses significant anti-inflammatory efficacy by reducing MDA, NO, IL-6 and TNF-α, decreasing peritonitis and intra-abdominal adhesion. [ABSTRACT FROM AUTHOR]

Abstract Effects of the initial peritoneal dialysis (PD) prescription on clinical outcomes are unknown in Japan. We conducted a cohort study using data from Peritoneal Dialysis Outcomes and Practice Patterns Study. The patients were divided into two groups by the volume of the initial PD prescription (≤ 4 L/day or > 4 L/day). Cause-specific Cox proportional hazards survival models were used to model the association between different PD prescriptions and the clinical outcomes. The outcomes included transfer to HD, mortality, the composite of mortality and transfer to HD, peritonitis, hospitalization, and the patient-reported outcomes (PROs). Of the 342 patients, 98 were prescribed ≤ 4 L/day, and 244 were prescribed > 4 L/day. Patients prescribed ≤ 4 L/day were older with a lower percentage being male, had more cardiovascular and cerebrovascular disease but lower diabetes prevalence, were more likely to be receiving CAPD, used more assisted PD, and had lower BMI and mean serum creatinine levels. There were no significant differences between groups in terms of transfer to HD, mortality, transfer to HD or mortality, hospitalization, incidence of peritonitis, and PROs. Patients with initial PD prescriptions of ≤ 4 L/day compared to > 4 L/day had similar clinical outcomes. This practice may provide health economic benefits in Japan.

Background and Objective: Peritonitis following hollow viscus perforation is commonly encountered in surgical emergency, which needs prompt and aggressive management. Unlike foreign nations, no score is routinely used in most tertiary medical colleges of India for prognostication of these patients preoperatively, leading to delay in adequate management and poor outcome. The aim of this research is to compare the accuracy of Mannheim peritonitis index (MPI) and Jabalpur score in prediction of mortality of patients presenting with perforative peritonitis. Materials and Methods: Fifty-one patients presenting with perforative peritonitis between November 2022 and April 2024 were scored using the two scoring systems and patients followed up over 30 days. Mortality based on scores of the scoring systems was analyzed. Results: Both scores had a significant P value, suggesting that both are efficient scoring systems. Receiver operating characteristic curves for both scores were plotted, and the area under the curve was calculated. Chi-square test showed no significant difference between the two scoring systems. Conclusion: Jabalpur score and MPI are both efficient scoring systems. Utilization of either of the scoring systems depends on the availability of resources in the health-care setup.

Introduction: Perforation peritonitis is associated with significant Morbidity and Mortality (M&M). The predictive performance of blood lactate levels and their clearance varies depending on the timing of measurement, and the optimal time for measurement remains unclear. Aim: To evaluate perioperative lactate levels and their clearance as predictors of in-hospital M&M in bowel perforation surgery. Materials and Methods: The present prospective cohort study was conducted in the Department of Anaesthesiology and Critical Care, Pt. BD Sharma PGIMS, Rohtak, Haryana, India, from March 2023 to December 2023. Study was conducted on 40 adult patients undergoing surgery for bowel perforation, and clinical and various laboratory parameters were observed from admission until discharge. Baseline and perioperative lactate levels were recorded up to 24 hours postoperatively. The association of M&M with different scores such as the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Mannheim Peritonitis Index (MPI), as well as, lactate levels and lactate clearance, was assessed. The diagnostic accuracy of lactate levels and lactate clearance at different time points in the perioperative period to predict M&M was calculated, and finally, the ‘Bidirectional Stepwise Selection’ (BSS) was used to select the most useful predictor of M&M. Results: Total 40 participants were included in the study, of which 34 were males and 6 were females. The overall M&M rates were 50% and 30%, respectively. On univariate analysis, there was a significant difference between non survivors and survivors in terms of age (50.92 vs 38.07 years, p-value=0.004), APACHE II score (10.00 vs 6.46, p-value=0.028), preoperative serum creatinine (1.41 vs 1.13 mg/dL, p-value=0.043), 24-hour postoperative lactate (4.75 vs 1.54 mmol/L, p-value=0.005), and lactate clearance (-28.97 vs 24.83%, p-value=0.03). Patients with or without morbidity showed a significant difference in age (47.7 vs 36.15 years, p-value=0.005), MPI score (22.45 vs 18.6, p-value=0.048), preoperative serum creatinine (1.40 vs 1.03 mg/dL, p-value=0.028), and 24-hour postoperative lactate (3.65 vs 1.35, p-value=0.002). In BSS analysis, age and 24-hour postoperative lactate were identified as good predictors of M&M, with the latter being the best predictor. Conclusion: The incidence of M&M is quite high in perforation peritonitis. Among all predictors, 24-hour postoperative lactate is the strongest predictor of M&M and may be useful in risk stratification and optimising treatment accordingly.

Abstract The number of peritoneal dialysis (PD) catheter-related infections and peritonitis caused by nontuberculous mycobacteria (NTM) has been increasing. Nonetheless, the optimal timing for the relocation of the exit site, removal and reinsertion of the PD catheter, prognosis, and duration of antibiotic treatment remain unclear. This literature review aimed to investigate the epidemiology of patient characteristics and evaluate the most effective diagnostic and treatment strategies for PD catheter-related infections and peritonitis caused by NTM. The systematic literature review was conducted on published cases of PD catheter-related infection and peritonitis caused by NTM in PubMed, Embase, and Ichushi databases up to August 2022. A total of 335 cases (64.1%, male; mean age, 53.4 years; mean dialysis duration, 25.4 months) were analyzed. The most common causative agent of infection was Mycobacterium abscessus (40.1%), followed by Mycobacterium fortuitum (24.8%) and Mycobacterium chelonae (16.6%). With respect to diagnosis, 42.9%, 28.1%, and 29.0% of cases were diagnosed as PD catheter-related infection only, peritonitis only, and both, respectively. The initial cultures were positive for NTM only, positive for any other bacteria, and negative for NTM only in 56.5%, 19.8%, and 23.7% of cases, respectively. Ultimately, more than 80% of cases were treated with multiple antibiotics. PD catheter removal was performed in 55.4% of patients with PD catheter-related infections only and 85.5% of those with PD peritonitis. PD continuation or resumption was possible in 62.2% and 16.0% of patients, respectively. In conclusion, our findings indicate that it is advisable to perform acid-fast bacilli stain and culture in order to promptly identify NTM. PD catheter removal may be an essential management strategy during the early stages of NTM infection.

Abstract Background Peritonitis is a frequent complication of PD that can lead to technique discontinuation and increase morbidity and mortality. It is caused mainly by gram-positive bacteria (up to 70%); however, gram-negative organisms usually have relatively poor outcomes. Among gram-negative bacteria, Acinetobacter is rare, especially Acinetobacter ursingii. Case report We report the third case of PD peritonitis caused by Acinetobacter ursingii, treated with directed intraperitoneal antibiotics with good clinical response and favorable outcome. Conclusion Although Acinetobacter ursingii is rare, it is potentially harmful because of its challenging identification and antibiotic resistance with therapeutic consequences, requiring at least two antibiotics and careful follow up. Keeping in mind that it is ubiquitous, careful technique, training/retraining seems highly recommended.

Abstract Background When peritoneal dialysis (PD)-related peritonitis occurs in PD patients, diagnostic and therapeutic approaches should be started as soon as possible. However, medical attention may be delayed in patients experiencing minimal symptoms with cloudy PD fluid (PDF). This study investigated differences between the first and later episodes of peritonitis and relationships between interval from peritonitis onset to attending hospital and both duration of hospitalization and medical expenses. Methods We retrospectively investigated 36 patients with multiple episodes of PD-related peritonitis among 125 patients receiving PD therapy from January 2016 during a 6-year period at a single center. Results In 50 episodes of PD-related peritonitis among outpatients, median interval from recognition of cloudy PDF to hospital visit was 4.0 h (interquartile range [IQR] 2.0–12.0 h). With the first episode of peritonitis, the median interval was 8.5 h (IQR 3.6–18.0 h), improving to 2.0 h (IQR2.0–3.3 h) with second and subsequent episodes of peritonitis after patients were provided with education in PD-related issues. Median duration of hospitalization associated with PD-related peritonitis was 16.0 days (IQR 14–22 days) when the interval to hospital visit was

Abstract Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient–doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (