REzumatInfecţia cu Clostridium difficile a devenit frecvent asociată cu îngrijirile medico-chirurgicale în ultimii ani. Managementul defectuos al antibioterapiei profilactice a pancreatitei acute, în ciuda protocolizării tratamentului, a dus la lărgirea spectrului de rezistenţă la antibiotice. Acesta este un studiu retrospectiv incluzând 19 pacienţi diagnosticaţi cu infecţie cu C. difficile după tratamentul pancreatitei acute internaţi în clinica de Chirurgie Generală a Spitalului Clinic de Urgenţă București în perioada ianuarie 2015 -decembrie 2018. Din totalul de 1.283 cazuri de pancreatită acută, doar 19 pacienţi (1,48%) au prezentat proba pozitivă (test pentru toxina a/b Cl. difficile). Prezenţa toxinei în materiile fecale s-a identificat în medie în ziua 13 de la internare, iar probele s-au negativat în 7 cazuri (36,8%) în cursul internării, 9 pacienţi externându-se la cerere, fără negativarea probei la testele de laborator (42,1%) și s-au înregistrat 6 decese (31,5%). 13 pacienţi (68,4%) au primit tratament antibiotic cu spectru larg anterior depistării toxinei în materiile fecale, 3 pacienţi au avut cel puţin încă un episod de pancreatită acută în antecedente. 5 pacienţi (26,3%) au primit tratament doar cu vancomicină, 3 pacienţi (15,8%) doar cu metronidazol și 11 pacienţi (57,9%) cu vancomicină și metronidazol. Trei cazuri de infecţie au fost prin contact intraspitalicesc. Astfel, infecţia cu Clostridium difficile reprezintă un factor agravant al pancreatitei acute, necesitând atât diagnostic prompt, cât și tratament adecvat.Cuvinte cheie: Clostridium difficile, antibioterapie, pancreatită acută, pancreas aBStRaCt Clostridium infection has become a common healthcare-associated infection over the past few years. The faulty management of prophylactic antibiotherapy, despite the existence of management protocols has contributed to the increase on antibiotic resistant pattern. The retrospective study included a number of 19 patients (1.48%) diagnosticated with Clostridium infection, out of a total of 1,283 patients with acute pancreatitis admitted into the General Surgery Ward of the Clinical Emergency Hospital in Bucharest, between January 2015 and December 2018. Out of a total of 1,283 cases of acute pancreatitis, only 19 patients (1.48%) were tested positive (stool test for Clostridium difficile toxine a/b).The presence of toxin a/b in the stool was identified in average on the 13th day after admission and the samples came back negative in 7 cases (36.8%) prior to the discharge, 9 patients requested to be discharged without being tested negative after treatment (42.2%) and 6 deaths were reported (31.5%). 13 patients previously received broad spectrum antibiotherapy (68.4%), 3 patients had a history of at least one episode of acute pancreatitis. 5 patients received antibiotherapy with sole vancomycin (26.3%), 3 sole with metronidazole (15.8%) and 11 patients received vancomycin and metronidazole (57.9%). Three cases were reported as hospital-acquired infection (15.7%). Conclusion. Clostridium difficile infe...

Acute recurrent pancreatitis may have a indication for surgical treatment? dr. eduard cristian Popa 1 , dr. alexandra Popa 1 , drd. dr. Mihai ierima 1 , dr. cristina Pîrvulescu 1 , dr. ruxandra avram 1 , conf. dr. Sorin Păun 1,2 , Şef Lucr. dr. Bogdan Gaspar 1,2 , asist. univ dr. ioan tănase 1,2 , dr. alexandru Laurențiu chiotoroiu 1

The ingestion of foreign bodies is a common cause for presentation in the emergency department by pediatric, adult, or elderly psychiatric patients. Swallowed foreign bodies sometimes represent a great challenge for surgeons due to the obstruction or perforation of the digestive tube’s upper or lower segments. Occasionally, the foreign bodies detected in the lower parts of the digestive tube (colon and rectum) could be introduced through the anal route with the risk of perforation of the rectum or sigmoid colon. In this report, we describe a unique case of a foreign body located in the sigmoid colon, where it arrived due to backstabbing and was retained for 7 years without acute symptoms. The 43-year-old male patient came to the emergency department with pain in the left iliac fossa. Before his presentation, a computerized tomography (CT) scan examination had suggested a foreign body. A surgical approach was decided. The surgery started as an exploratory laparoscopy and was converted to a xiphoid-pubic incision to extract the foreign body (a piece of glass about 8 cm long) through a sigmoid colotomy followed by a double-layer sigmoidorrhaphy. The postoperative evolution of the patient was uneventful. As far as we know, this is the first case of a patient with a foreign glass body positioned in the sigmoid colon that got there by stabbing and not by ingestion or introduced per anum. In conclusion, we suggest that aggressive behavior and abdominal wall penetration by different sharp objects should be considered when foreign bodies are detected in the abdomen.