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Klebsiella pneumoniae and pneumoperitoneum
Clinical Picture
Klebsiella pneumoniae and pneumoperitoneum Lancet 2004; 364: 1172 Department of Endocrinology (S Simsek PhD); and Department of Nephrology (P M ter Wee PhD); VU University Medical Center, Boelelaan 1117, Amsterdam, Netherlands Correspondence to: Dr S Simsek [email protected]
S Simsek, P M ter Wee
A 71-year-old woman presented with a 1-week history of abdominal pain. She had end-stage renal disease due to hypertension, and had been on chronic peritoneal dialysis for 10 years. An abdominal radiograph showed a large amount of intraperitoneal air. We did paracentesis; and obtained turbid ascites with a high leucocyte count. We started antibiotics, but the patient deteriorated rapidly. The next day, CT of the abdomen showed a large pneumoperitoneum (figure A, B). The surgeons did an exploratory laparotomy but found no visceral perforations. The microbiologist noticed that so much air had accumulated during transport of the dialysis bag between the ward and the laboratory, that the bag was about to burst. He identified Klebsiella pneumoniae as the cause of this non-surgical pneumoperitoneum.
Doxazosin in the sigmoid Lancet 2004; 364: 1172 Wirral Hospital NHS Trust (R Morgan FRCP), Arrowe Park Hospital, Wirral, CH49 5PE, UK Correspondence to: Dr Rosemary Morgan [email protected]
1172
Rosemary Morgan
An 82-year-old woman had flexible sigmoidoscopy for investigation of iron deficiency anaemia. At the distal end of the sigmoid colon the endoscopist noticed a lesion which initially looked like a polyp (figure). A snare was introduced into the sigmoid colon in order to do a polypectomy. The snare slid off the lesion which then appeared to move distally. On further inspection it was apparent the lesion was in fact a tablet. When asked, the patient said she was aware of passing tablets rectally and attributed this to doxazosin, having read her drug information leaflet. Cardura XL (doxazosin) is indeed a modified release tablet, and has a non-absorbable shell.
www.thelancet.com Vol 364 September 25, 2004
Klebsiella pneumoniae and pneumoperitoneum Lancet 2004; 364: 1172 Department of Endocrinology (S Simsek PhD); and Department of Nephrology (P M ter Wee PhD); VU University Medical Center, Boelelaan 1117, Amsterdam, Netherlands Correspondence to: Dr S Simsek [email protected]
S Simsek, P M ter Wee
A 71-year-old woman presented with a 1-week history of abdominal pain. She had end-stage renal disease due to hypertension, and had been on chronic peritoneal dialysis for 10 years. An abdominal radiograph showed a large amount of intraperitoneal air. We did paracentesis; and obtained turbid ascites with a high leucocyte count. We started antibiotics, but the patient deteriorated rapidly. The next day, CT of the abdomen showed a large pneumoperitoneum (figure A, B). The surgeons did an exploratory laparotomy but found no visceral perforations. The microbiologist noticed that so much air had accumulated during transport of the dialysis bag between the ward and the laboratory, that the bag was about to burst. He identified Klebsiella pneumoniae as the cause of this non-surgical pneumoperitoneum.
Doxazosin in the sigmoid Lancet 2004; 364: 1172 Wirral Hospital NHS Trust (R Morgan FRCP), Arrowe Park Hospital, Wirral, CH49 5PE, UK Correspondence to: Dr Rosemary Morgan [email protected]
1172
Rosemary Morgan
An 82-year-old woman had flexible sigmoidoscopy for investigation of iron deficiency anaemia. At the distal end of the sigmoid colon the endoscopist noticed a lesion which initially looked like a polyp (figure). A snare was introduced into the sigmoid colon in order to do a polypectomy. The snare slid off the lesion which then appeared to move distally. On further inspection it was apparent the lesion was in fact a tablet. When asked, the patient said she was aware of passing tablets rectally and attributed this to doxazosin, having read her drug information leaflet. Cardura XL (doxazosin) is indeed a modified release tablet, and has a non-absorbable shell.
www.thelancet.com Vol 364 September 25, 2004