Ultraschalldiagnostik des nichttraumatischen akuten Abdomens: die Ursachen außerhalb des Gastro-Intestinaltraktes

Abdominal fistula caused by an ingested wooden spit, which penetrated the intestinal wall and remained in the abdominal wall: a laparascopy was performed in a 41-year-old man suffering from acute appendicitis and an inflamed Meckel's diverticulum. After removal of the appendix and the diverticulum, a fistula developed in the excision channel of the left quadrant of the abdominal wall post-operatively. Despite repeated incision of the abscess in the course of 2 months, the fistula did not heal. Ultrasound examination of the abdominal wall was therefore performed. The postoperative status was without conspicuous findings. We could, however, detect a foreign body, a few centimetres long and 2-3 mm thick, displaying a smooth surface, deep down in the abdominal wall. A fistulography confirmed the diagnosis. After removal of the wooden spit, complete healing of the fistula in the abdominal wall was observed. Subsequently, the patient reported to have eaten a beef roulade, fixed with a wooden spit, 7 weeks before the abdominal operation.

Section: Diskussionunclassified

Ungewöhnliche postoperative Bauchwandfistel, verursacht durch einen mit der Nahrung ingestierten, nach Darmperforation in die Bauchwand eingewanderten Holzspieß

Weiler

Weimann²,

Kersjes³

2006

“…Obwohl präoperativ lediglich der hochgradige Verdacht auf eine Choledochuszyste bestand -sonografisch lag keine erkennbare Ursache eines akuten Abdomens vor [22,23] -, erfolgte intraoperativ durch den Chirurgen die korrekte Einschätzung der Situation und der entsprechende resektive Eingriff mit Anlage einer Hepatojejunostomie und Roux-Anastomose. Die durchgeführte Operationsmethode entsprach dem Vorgehen der Wahl [24,25].…”

Section: Histologieunclassified

Choledochuszyste mit akutem Abdomen

Gottschalk

Boden²,

Schröder³

et al. 2004

Congenital cysts of the bile duct are well-documented anomalies of the biliary tree. Choledochal cysts frequently cause malignant changes in the epithelial lining. In such patients, the prognosis is very poor mainly because of the lack of typical symptoms in the early stages. The incidence of carcinoma in patients with bile duct cysts is estimated at 2.5 % to 15 %, compared to an incidence of 0.012 % to 0.48 % in patients without bile duct cysts. We report the case of a 32-year-old Vietnamese woman with a history of acute epigastric pain. Exploratory surgery was performed, and the segment containing the cyst and the ectopic pancreas was resected. Sonography pointed the way, and resection would have been necessary even without the abdominal symptoms.

“…Der vorliegende Fall belegt den hohen Stellenwert der Notfallsonographie beim akuten Abdomen [10,11]. Während mit der Röntgenübersichtsaufnahme die Perforation eines Hohlorgans ausgeschlossen werden konnte, zeigte die Sonographie mit hinreichender Sicherheit die Perforationsstelle des subkapsulär in der Leber gelegenen Echinokokkus und die vorhandene freie Flüssigkeit.…”

Section: Introductionunclassified

Perforation eines Leberechinokokkus mit Todesfolge

Ivaniš¹,

Zeidler²,

Sever-Prebilić³

et al. 2003

A 50-year-old man is admitted to the hospital emergency service because of a 24-hour history of right abdominal pain. Ultrasound examination and laboratory tests suggest the perforation of an Echinococcal cyst situated in the subcapsular area of the right hepatic lobe. The patient and his family refuse the recommended hospitalisation and operation and leave the hospital on their own responsibility. 60 hours later the patient dies. Post-mortem examination confirms the diagnosis of a perforated hydatid cyst of the right hepatic lobe. The cause of death was a partly fibrino-purulent, partly nodular peritonitis including the area of liver rupture.