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Ventriculoperitoneal Shunt Infections Cause Acute Abdomen and Peritonitis: A Case Series.

脑室腹腔分流术感染引起急腹症和腹膜炎: 病例系列。

  • 影响因子:2.01
  • DOI:10.1016/j.jss.2019.11.029
  • 作者列表:"Kaestner S","Fraij A","Fass J","Deinsberger W
  • 发表时间:2020-04-01
Abstract

BACKGROUND:Patients with ventriculoperitoneal shunt (VPS) often present to emergency departments with acute abdomen. It is challenging to distinguish between the abdominal problems caused by a VPS and acute surgical abdomen having another cause because VPS infections occasionally cause peritonitis. The frequencies and clinical features of acute abdomen caused by VPS infection are unknown. METHODS:This was a retrospective analysis of all patients with a VPS who presented with acute abdomen to emergency department for a 10-year period. Clinical data, diagnostic workflow, and subsequent treatment were assessed using patient medical records. RESULTS:In total, 1679 patients presented with acute abdomen; of these, 24 (1.4%) had a VPS at the time of presentation. Of the 24 patients, 12 had an acute surgical abdomen related to gastrointestinal sources with subsequent therapy. In the remaining 12 patients (50%), peritonitis was caused by a VPS infection; seven of these had erroneous abdominal surgeries because of misdiagnosis. Patients with shunt infections as a source of peritonitis underwent shunt surgeries within the past 10 wk (mean, 58 d). Patients with an acute surgical abdomen with gastrointestinal sources had their most recent shunt surgery at a mean of 4.7 y before presentation to the emergency department. CONCLUSIONS:Acute abdomen and peritonitis are challenging in the presence of a VPS. Shunt infections frequently mimic acute surgical abdomen and may lead to misdiagnosis, unnecessary diagnostic procedures, unnecessary surgery, and delay in receiving the appropriate treatment. Shunt surgery in recent patient history is suggestive of VPS infection, and a shunt tap should be performed to confirm the diagnosis.

摘要

背景: 脑室腹腔分流术 (VPS) 患者常出现急腹症。区分由VPS引起的腹部问题和具有另一原因的急性外科腹部是具有挑战性的,因为VPS感染偶尔引起腹膜炎。由VPS感染引起的急腹症的频率和临床特征是未知的。 方法: 回顾性分析10年间因急腹症到急诊科就诊的所有VPS患者。使用患者医疗记录评估临床数据,诊断工作流程和后续治疗。 结果: 共有1679例患者出现急腹症; 其中24例 (1.4%) 在出现急腹症时有VPS。在24名患者中,12名患者患有与胃肠来源相关的急腹症,随后接受治疗。在其余12例患者 (50%) 中,腹膜炎是由VPS感染引起的; 其中7例由于误诊而进行了错误的腹部手术。分流感染作为腹膜炎来源的患者在过去10周 (平均58 d) 内接受分流手术。有胃肠来源的急腹症患者在急诊就诊前进行了最近一次平均4.7岁的分流手术。 结论: 急腹症和腹膜炎在VPS的存在下具有挑战性。分流感染通常模仿急腹症,并可能导致误诊、不必要的诊断程序、不必要的手术和延迟接受适当的治疗。在最近的患者病史中,分流手术提示VPS感染,应进行分流tap以确定诊断。

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DOI:10.1245/s10434-019-07425-5
作者列表:["Ali YM","Sweeney J","Shen P","Votanopoulos KI","McQuellon R","Duckworth K","Perry KC","Russell G","Levine EA"]

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DOI:10.1245/s10434-019-07385-w
作者列表:["Bayat Z","Taylor EL","Bischof DA","McCart JA","Govindarajan A"]

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腹膜疾病方向

腹膜疾病是一类病因复杂的疾病,包括累及腹膜的各种炎性病变,以结核性腹膜炎多见。由于创伤和炎症导致的粘连,大部分为后天性,表现为腹膜皱襞重叠;还包括原发性和继发性肿瘤,良性原发性肿瘤少见,继发性恶性肿瘤多见,腹膜间皮瘤是唯一原发于腹膜间皮细胞的肿瘤。

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