Tuberculous peritonitis is rare in most Western counties, and can cause significant diagnostic and therapeutic problems. A 28-year-old pregnant female presented with nausea and vomiting, right lower quadrant abdominal pain, fever and intra-abdominal fluid. During surgery for presumed complicated acute appendicitis, many small masses (considered to be 'implants') were found within the peritoneal cavity, with a larger mass in the pelvis, mainly on the right. The clinical intra-operative diagnosis was advanced ovarian cancer and multiple biopsies were taken. The histological diagnosis was peritoneal tuberculosis. The patient was successfully treated conservatively. Hasty decisions to undertake radical and irreversible surgery should be avoided; this type of surgery should be performed only after histological confirmation.
A 80-year-old woman was hospitalized due to anemia and fever. Computed tomography depicted a solitary concentric, sharply marginated lesion of the spleen. Laparotomy identifi ed a creamy-white soft tumor. Histopathological examination confi rmed the diagnosis of non-Hodgkin B-cells anaplastic lymphoma. Extended range of pathological manifestations explains the variety of radiological appearances and diffi culty in accurate diagnostic process of primary splenic lymphoma.
In the greater Athens region, almost a third of motor vehicle collision-related fatalities involved alcohol, illicit drugs or both. Individuals screened positive for alcohol or drugs were 2.6 times more likely to die before hospital admission than those with a negative toxicology screen, despite comparable injury severity. Specific evidence-based management protocols and reassessment of surveillance are required.
Correspondence to Professor Iordanis N Papadopoulos, ipapado@med.uoa.gr
DESCRIPTIONA 76-year-old woman with a history of myelogenous leukaemia was admitted with haematochesia fever (38.3°C) and slight abdominal pain. Haemoglobin was 8 g/l, WBC 8.2×10 9 /l, platelets were 55×10 9 /l and partial thromboplastin time was 23 s. Gastroscopy was normal, colonoscopy did not reveal the source of haemorrhage, but a CT-angiography indicated the source at the ileo-caecal region.Non-surgical therapy including 8 units of blood and 8 units of fresh frozen plasma was performed in 3 days, but haemorrhage continued, (HB 6 g/l).A right hemicolectomy was performed including en-block resection of 40 cm of the terminal ileum. Intraluminal absence of blood and focal thickening around the ulcers guided the extent of resection. The presence of multiple ulcers was confirmed before closing the abdomen, figures 1 and 2. Histology revealed no malignant infiltration, but inflammation with intracellular inclusion bodies and serology consisting of IgG anti-cytomegalovirus (CMV), and IgM anti-CMV indicated the CMV as the aetiology of the ulcers.Postoperatively, the haemorrhage did not recur but the patient developed a low-output entero-cutaneous fistula (3rd week). She initially showed improvement by total parenteral nutrition, antibiotics and ganciclovir.Nevertheless, the patient's haematological status remained poor and she died 70 days after surgery in sepsis due to pneumonia. CMV 1 2 is a herpes virus with a propensity to affect immunocompromised patients as transplant recipients, patients with AIDS, haematological malignancies and inflammatory bowel disease. Pneumonia, gastrointestinal inflammation, ulcerations and haemorrhage, hepatitis and
Learning points▸ The multiplicity and wide spread of ileal and colonic ulcers make the assessment of the extent of surgical resection difficult. ▸ Surgery should be reserved for life-threatening complications as haemorrhage and perforation. ▸ Long-term prognosis is largely determined by the underlying haematologic disease.
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