Pooled sensitivity and specificity for diagnosis in adults were 83% and 93%, respectively, for ultrasound studies and 94% and 94%, respectively, for CT studies. From the diagnostic performance perspective, CT has a significantly higher sensitivity than US in studies of children and adults; from the safety perspective, however, the radiation associated with CT, especially in children, should be always considered [67]. Treatment Schematically intra-abdominal infections have been divided into three groups. Community acquired extrabiliary

intra-abdominal infections Community acquired biliary intra-abdominal infections Hospital www.selleckchem.com/products/Bortezomib.html acquired intra-abdominal infections Extra-Biliary Community-Acquired Intra-Abdominal Infections Source control

Gastro-duodenal perforation In the case of a perforated peptic ulcer, surgery is the treatment of choice. In selected cases (pts younger than 70 ys old, no shock, no peritonitis, lack of spillage of the water-soluble contrast medium at gastroduodenogram) non-operative management may be attempted. After initial non operative management, no improvement of conditions within 24 hours is indication to surgery (Recommendation 1 A). In case of perforated peptic ulcer, surgery is considered the standard method of source control [68, 69], also because postoperative mortality and morbidity rates have improved significantly [70]. Studies about the natural history of gastroduodenal click here ulcer perforation between the second half of 19th and the first half of 20th century [71, 72] reported that perforations of the stomach Carnitine palmitoyltransferase II were sealed by adhesions to the surrounding viscera preventing leakage from the stomach into the peritoneum. In 1946, Taylor presented the first series of successful outcome of patients with perforated peptic ulcer conservatively treated [73]. Nowadays conservative treatment, also known as “”Taylor method”", consists of naso-gastric aspiration, antibiotics, intravenous fluids and H. pylori

eradication therapy [74–76]. Patients older than 70 years old are significantly less like to respond to conservative treatment than younger patients [77]; also major medical illness, shock on admission and longstanding perforation (>24 hrs) are significantly associated with higher mortality rate in case of perforated peptic ulcer [78–80]. During non operative management, rapid deterioration or no improvement of clinical conditions within 24 hours from starting treatment are absolute indications to surgical treatment [81, 82]. Finally, delaying the time point of operation beyond 12 h after the onset of clinical symptoms will worsen the outcome in perforated peptic ulcer [83]. Simple closure with or without omental patch is an effective and safe operation in case of small perforated ulcers (<2 cm). H.