Spontaneous bacterial peritonitis is caused by infection of ascitic fluid without any apparent intraabdominal source of infection. The disease most commonly occurs in patients with cirrhosis and 70% of cases of infections are caused by pathogenes from gastrointestinal tract. The article presents the case of 38-year-old patient with spontaneous peritonitis who was treated surgically. The primary nature of the disease was confirmed by laparotomy and bacteriological examination results (Streptoccocus pneumonia) of ascitic fluid. After 54 days of hospitalisation and undergoing re-laparotomy, he was discharged in good condition.
Background. An endoleak is a typical complication of endovascular aneurysm repair (EVAR). It is characterized by persistent blood flow between a stent graft and the aneurysm sac. Usually, it can be visualized during primary EVAR, but in many cases, this remains impossible. Therefore, other methods of endoleak assessment are urgently needed. The measurement of aneurysm sac pressure (ASP) seems to be a promising direction of research in this area.Objectives. We aimed to evaluate the safety and efficacy of a new method for invasive pressure measurement inside the abdominal aortic aneurysm (AAA) during EVAR. We also assessed a correlation between pressure values and early angiographic occurrence of an endoleak after the procedure.
Materials and methods.A total of 20 patients with AAA were included in this experimental prospective study. During EVAR, systolic, diastolic and mean pressure values were recorded both for ASP and aortic pressure (AP) before procedure, after stent graft opening and after final stent graft ballooning.Results. The measurements were successfully obtained in all participants without any complications. There were no significant differences between all ASP and AP before procedure. After the procedure, blood pressure significantly decreased in the aneurysm sac but not in the aorta. Systolic ASP was significantly lower than systolic AP both after stent graft opening (80.4 ±20.9 mm Hg compared to 110.7 ±21.6 mm Hg, p < 0.01) and after its balloon post-dilatation (65.6 ±26. 1 mm Hg compared to 107.4 ±22. 1 mm Hg, p < 0.001). Diastolic ASP decreased significantly in comparison to diastolic AP only after stent graft ballooning (48.0 ±14.6 mm Hg compared to 56.4 ±13.6 mm Hg, p < 0.05).
Conclusions.Our study confirmed that the novel method for the measurement of ASP during EVAR, using a thin pressure wire, is feasible and safe.
Introduction: Aortic aneurysm rupture is defined as bleeding beyond tunica adventitia of a dilated aortic wall. The incidence of ruptured abdominal aortic aneurysm (rAAA) varies between 5.6 and 17.5 per 100,000 inhabitants per year and seems to have decreased over the past two decades. The aim of the work was to assess the results of treatment of patients with ruptured abdominal aortic aneurysm. Material and methods: Analysis encompassed patients who had undergone surgery for ruptured abdominal aortic aneurysm between 2011 and 2017. A total of 140 patients were operated on due to ruptured abdominal aortic aneurysm. Evaluation of treatment outcomes was based on a retrospective analysis of patients' medical records, assessing the results of treatment based on the following parameters: peri-and postoperative mortality, serious peri-and postoperative complications (acute coronary syndrome, gut ischemia, renal failure, respiratory failure, lower limb ischemia). Results: Results confirm that peri-and postoperative mortality due to ruptured abdominal aortic aneurysm remain high despite continuous progress. Further development of intravascular repair techniques (EVAR) and anesthesiologic management may facilitate better treatment outcomes. However, this requires a great deal of organizational effort to ensure 24/7 availability of multi-specialist teams (vascular surgeon, anesthesiologist, radiology technician, nursing staff) capable of performing intravascular procedures. Conclusions: Surgical management of patients with ruptured abdominal aortic aneurysm continues to be associated with high mortality rates and a significant number of postoperative complications.
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