[Gas embolism during laparoscopy for cholecystectomy].
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Biomedical subjects
Publications and source records attributed to E Lebois.
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Venous thrombosis of the portal system following splenectomy for haematological diseases is uncommon, being reported with an incidence of 0.2 to 6%. Diagnosis may be difficult and the clinical presentation varies greatly. We report 4 cases, included in a consecutive series of 350 splenectomies for hematological diseases. Case 1: a man of 22 years, operated on for autoimmune hemolytic anemia developed severe and generalized abdominal pain 20 days after splenectomy. The coeliac arteriography showed a thrombosis of the portal system. The laparotomy revealed segmentary small bowel necrosis. Outcome after intestinal resection was uneventful. Case 2: a man of 56 years, operated on for essential thrombocythemia had the laboratory findings of acute hepatic failure 28 days after splenectomy. Doppler ultrasonography revealed a portal vein thrombosis. He was treated with heparin. Case 3: a man of 69 years, operated on for acquired idiopathic anemia, developed asthenia and fever 23 days after splenectomy. The ultrasonography showed a portal vein thrombosis. He was successfully treated with heparin. Case 4: a man of 20 years, operated on for Minkowsky-Chauffard hemolytic anemia developed a severe and generalized abdominal pain and fever 13 days after splenectomy. The CT-scan showed a thrombosis of the portal system. Outcome after thrombectomy and regional thrombolysis was uneventful. The aim of this presentation is to review the pathophysiological diagnosis, therapeutic and prophylactic aspects of this serious complication of splenectomy.
The aim of this paper is to analyse retrospectively the data of our patients over 60 years old who had an acute peritonitis, localized or diffuse, to establish prognostic factors. They were 216 patients, who underwent surgical treatment between 1971 and 1990. We observed 243 variables and its significance using the chi 2 test. We divided our study in two stages: from 1.10.71 to 30.09.80 (group I = 93 patients) and from 1.10.80 to 31.01.90 (group II = 123 patients). Group I was composed by 51 men and 42 women with a mean age of 71.9 +/- 5.3 years. General mortality of this group was 36% (33 patients). Group II corresponded to 55 men and 68 women with a mean age of 74.26 +/- 7.1 years. Mortality was 23% (28 patients). Age, sex and associated clinical disorders were not significant on prognosis, meanwhile the clinical and biological form of presentation were not adequate to establish a severity index. The most common ethiologies were: biliar (24 patients = 26%) in group I and appendicular (41 patients = 32.2%) In group II. Significant factors on mortality rates in group II were: delay between onset of symptoms and surgical treatment (over 96 hs, p less than 0.05), generalized or purulent peritonitis operated after 96 hs from onset of the attack (p less than 0.05) and malignancy (p less than 0.01).
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