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Wang Z, Jiang T, Mu M, Shen C, Cai Z, Chen H, Zhang B. Small bowel intramural hematoma caused by warfarin: case report and literature review. Scand J Gastroenterol 2024:1-7. [PMID: 38597576 DOI: 10.1080/00365521.2024.2337830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Intramural hematoma of the small bowel is a rare yet acute gastrointestinal condition typically linked with impaired coagulation function, often posing diagnostic challenges. It is principally encountered in patients undergoing prolonged anticoagulant therapy, specifically warfarin. CASE PRESENTATION We reported a case of intramural hematoma associated with warfarin use. The patient was admitted to hospital with abdominal pain and had received anticoagulant therapy with warfarin 2.5 mg/day for 4 years. Laboratory examination showed decreased coagulation function, abdominal CT showed obvious thickening and swelling of part of the jejunal wall, and abdominal puncture found no gastroenteric fluid or purulent fluid. We treated the patient with vitamin K and fresh frozen plasma. The patient was discharged after the recovery of coagulation function. Then we undertaook a comprehensive review of relevant case reports to extract shared clinical features and effective therapeutic strategies. CONCLUSION Our analysis highlights that hematoma in the small intestinal wall caused by warfarin overdose often presents as sudden and intense abdominal pain, laboratory tests suggest reduced coagulation capacity, and imaging often shows thickening of the intestinal wall. Intravenous vitamin K and plasma supplementation are effective non-surgical strategies. Nevertheless, in instances of severe obstruction and unresponsive hemostasis, surgical resection of necrotic intestinal segments may be necessary. In the cases we reported, we avoided surgery by closely monitoring the coagulation function. Therefore, we suggest that identifying and correcting the impaired coagulation status of patient is essential for timely and appropriate treatment.
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Affiliation(s)
- Zihao Wang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haining Chen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Todorovic Đ, Stojanovic B, Filip M, Đorđevic Đ, Stankovic M, Jovanovic I, Spasic M, Milosevic B, Cvetkovic A, Radovanovic D, Jovanovic M, Stojanovic BS, Pantic D, Cvetkovic D, Jovanovic D, Markovic V, Stojanovic MD. Small Bowel Perforation Due to Renal Carcinoma Metastasis: A Comprehensive Case Study and Literature Review. Diagnostics (Basel) 2024; 14:761. [PMID: 38611674 PMCID: PMC11011689 DOI: 10.3390/diagnostics14070761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
This case report presents a unique instance of small bowel perforation caused by solitary metastasis from renal cell carcinoma (RCC), a rare and complex clinical scenario. The patient, a 59-year-old male with a history of RCC treated with nephrectomy four years prior, presented with acute abdomen symptoms. Emergency diagnostic procedures identified a significant lesion in the small intestine. Surgical intervention revealed a perforated jejunal segment due to metastatic RCC. Postoperatively, the patient developed complications, including pneumonia and multi-organ failure, leading to death 10 days after surgery. Histopathological analysis confirmed the metastatic nature of the lesion. This case underscores the unpredictable nature of RCC metastasis and highlights the need for vigilance in post-nephrectomy patients. The rarity of small bowel involvement by RCC metastasis, particularly presenting as perforation, makes this case a significant contribution to medical literature, emphasizing the challenges in the diagnosis and management of such atypical presentations.
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Affiliation(s)
- Đorđe Todorovic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Milutinovic Filip
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Đorđe Đorđevic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
| | - Milos Stankovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Aleksandar Cvetkovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Dragce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Bojana S. Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Damnjan Pantic
- Department of Urology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (Đ.T.); (M.F.); (Đ.Đ.); (D.P.)
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.S.); (B.M.); (A.C.); (D.R.)
| | - Danijela Cvetkovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Dalibor Jovanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.J.); (M.D.S.)
| | - Vladan Markovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (D.J.); (M.D.S.)
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Abe E, Ishida T, Osuga T, Kakuyama S, Ogawa H, Nabeshima K. Double balloon enteroscopy in the detection and removal of jejunal anisakiasis: Case report. DEN Open 2024; 4:e339. [PMID: 38352969 PMCID: PMC10863477 DOI: 10.1002/deo2.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Abstract
A 53-year-old Japanese man presented to the emergency department with epigastric pain and bloating. Computed tomography revealed a thickening of the jejunal wall and proximal dilation. Double-balloon enteroscopy was performed to investigate the jejunal thickening, which revealed an anisakis larva in the jejunum with an associated ulcer. The larva was removed using endoscopic forceps, after which there was immediate improvement of symptoms. Further patient interview determined that he had consumed marinated mackerel the day before the onset of symptoms. After diagnosis of small intestinal anisakiasis, he was successfully treated using double-balloon enteroscopy. Its use for small intestinal anisakiasis is rare, and this case may be the first instance in the jejunum. Removal of the anisakis larva led to a clear diagnosis and a quick resolution of symptoms. A history of raw fish consumption a few days before the onset of abdominal symptoms and abnormal findings on computed tomography scans are key to the diagnosis of small intestinal anisakiasis. Double-balloon enteroscopy was thought to be a safe means of making accurate diagnoses and appropriate treatment of our patients.
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Affiliation(s)
- Erika Abe
- Department of GastroenterologyAkashi Medical CenterHyogoJapan
| | - Tsukasa Ishida
- Department of GastroenterologyAkashi Medical CenterHyogoJapan
| | - Tatsuya Osuga
- Department of GastroenterologyTakatsuki General HospitalOsakaJapan
| | - Saori Kakuyama
- Department of GastroenterologyTakatsuki General HospitalOsakaJapan
| | - Hirofumi Ogawa
- Department of GastroenterologyTakatsuki General HospitalOsakaJapan
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Molina GA, Ludeña C, Arcia AC, Parrales DE, Heredia AE, Nuñez KD, Narvaez NB. When a gastrostomy tube goes missing, acute bowel obstruction due to a migrated Foley catheter. J Surg Case Rep 2024; 2024:rjae233. [PMID: 38650974 PMCID: PMC11034986 DOI: 10.1093/jscr/rjae233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
A gastrostomy is a common procedure for patients with swallowing problems or inability to maintain regular oral nutrition. These gastrostomy tubes need special attention, as complications can occur if the tubes are left unattended. In rare scenarios, these tubes can migrate and cause severe life-threatening difficulties such as bowel obstruction and pancreatitis. We present the case of a 76-year-old quadriplegic woman who had a gastrostomy tube. Suddenly, the tube was missing, and after urgent medical care, the gastrostomy tube was found within her bowel. After successful surgery, she recovered from this incident.
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Affiliation(s)
- Gabriel A Molina
- Department of General Surgery, Hospital Metropolitano, Av. Mariana de Jesús 170521, Quito, Ecuador
- USFQ (Universidad San Francisco de Quito), Diego de Robles 170901, Quito, Ecuador
| | - Carolina Ludeña
- PGY3 UDLA (Universidad de las Américas) Facultad de Ciencias de la Salud, Cristóbal Colón E9-241 170902, Quito, Ecuador
| | - Alberto C Arcia
- Department of Surgery, IESS Quito Sur, Moraspungo 170111, Quito, Ecuador
| | - Diana E Parrales
- Department of Surgery, IESS Quito Sur, Moraspungo 170111, Quito, Ecuador
| | - Andrea E Heredia
- Department of Surgery, IESS Quito Sur, Moraspungo 170111, Quito, Ecuador
| | - Karen D Nuñez
- PGY1 UDLA (Universidad de las Américas) Facultad de Ciencias de la Salud, Cristóbal Colón E9-241 170902, Quito, Ecuador
| | - Nicole Berenice Narvaez
- School of Medicine, USFQ (Universidad San Francisco de Quito), Diego de Robles 170901, Quito, Ecuador
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5
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Gizewska-Kacprzak K, Nicieja K, Gajek B, Babiak-Choroszczak L. Removal of Multiple Ingested Magnets Through Laparoscopic Appendectomy in an Adolescent: A Report of Two Cases. Cureus 2024; 16:e58825. [PMID: 38654962 PMCID: PMC11037925 DOI: 10.7759/cureus.58825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Magnet ingestion can lead to serious health issues, including inflammation, gastrointestinal tract perforation, and even life-threatening complications. Despite legislative actions and numerous reports on the dangers of magnet ingestion in children, it remains a significant public health concern. Physicians must remain vigilant in cases of acute abdomen with ambiguous symptoms or unclear history in young patients. Prompt diagnosis and surgical intervention in case of multiple magnet swallowing are crucial to prevent complications. We present two cases of successful removal of ingested magnetic spheres through laparoscopic appendectomy in adolescents. This study aimed to highlight the technical aspects of the procedure to share the benefits of minimally invasive surgery (MIS) in the management of magnetic foreign bodies (FBs) located in the appendix or cecum.
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Affiliation(s)
- Kaja Gizewska-Kacprzak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Karol Nicieja
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Bartosz Gajek
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
| | - Lidia Babiak-Choroszczak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, POL
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6
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El-Menyar A, Naqvi SGA, Al-Yahri O, Abusal AM, Al-Shaikhli A, Sajid S, Abdelrahman H, Kloub AG, Ibnas M, Latifi R, Toble YMR, Al-Thani H. Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases. World J Surg 2024. [PMID: 38558004 DOI: 10.1002/wjs.12161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Syed G A Naqvi
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Omer Al-Yahri
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Sadia Sajid
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad G Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Muhamed Ibnas
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Rifat Latifi
- Kosova College of Surgeons, Prishtina, Kosova, and University of Arizona, Tucson, Arizona, USA
| | - Yasser M R Toble
- Department of Anesthesiology and Pain Management, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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7
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Cheng NLS, Wong CW, Yu WM, Tsang KH. Bladder Perforation and Vesico-Haematoma Fistula: An Uncommon Complication of Rectus Sheath Haematoma. Eur J Case Rep Intern Med 2024; 11:004362. [PMID: 38584897 PMCID: PMC10997403 DOI: 10.12890/2024_004362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures, resulting in early treatment and a better outcome. Case description We described a case of a spontaneous RSH with intraperitoneal extension and formation of a vesico-haematoma fistula, which was initially misdiagnosed as a urinary tract infection. The diagnosis was made ten days after admission, when a CT scan showed an over-16 cm RSH with intraperitoneal extension, bladder perforation and a vesico-haematoma fistula. The patient was managed conservatively. Discussion RSH accounts for less than 2% of acute abdomen cases and is often unrecognised. Its presentation can mimic other intra-abdominal pathologies, and the diagnosis is often delayed or missed. Complications can arise from an RSH although it is generally viewed as a self-limiting condition. Conclusion RSH has become increasingly common, and we would like to highlight the need to include abdominal wall pathologies in the initial differential diagnoses of acute abdomen to avoid delay in diagnosis. LEARNING POINTS Rectus sheath haematoma has become increasingly common due to the use of anticoagulants.The presentation can be non-specific and mimic other intra-abdominal pathologies. Misdiagnosis or delayed diagnosis can result in complications and unnecessary invasive procedures.Abdominal wall pathologies including rectus sheath haematomas should be included in initial differentials of acute abdomen.
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Affiliation(s)
- Novena Lin Sing Cheng
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
| | - Chung Wai Wong
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
| | - Wen Ming Yu
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
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Yadav DK, Shah SK, Poudel S, Parajuli B, Bhattarai A, Adhikari D. Ileosigmoidal knotting: a case report and literature review of a rare cause of acute abdomen in children. J Surg Case Rep 2024; 2024:rjae142. [PMID: 38476453 PMCID: PMC10930186 DOI: 10.1093/jscr/rjae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/18/2023] [Indexed: 03/14/2024] Open
Abstract
Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging.
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Affiliation(s)
- Dipak K Yadav
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Sanjay K Shah
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Saurav Poudel
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Bivusha Parajuli
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Amit Bhattarai
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Dinesh Adhikari
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
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Eleiwi M, Atatri Y, Younis O, Zuhd J, Awadghanem A, Qashoo A, Sholi S, Bustame S. Wandering Spleen Torsion: A Diagnostic Challenge. Cureus 2024; 16:e53552. [PMID: 38445142 PMCID: PMC10913703 DOI: 10.7759/cureus.53552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity, primarily affecting children, with a higher prevalence among adult females in the active reproductive age group. Manifestations may include an asymptomatic abdominal mass or intermittent abdominal discomfort due to the torsion and subsequent spontaneous detorsion of the spleen. This case report details the presentation of a 14-year-old female initially misdiagnosed as having gastroenteritis who later experienced acute abdomen. Subsequent ultrasonography and computed tomography scan revealed splenic torsion, confirmed during exploratory laparotomy, which demonstrated an infarcted spleen. The definitive therapeutic intervention was a total splenectomy. This clinical entity should be taken into account in the differential diagnosis of acute abdominal pain in order to aid in early diagnosis and management. This could allow us to avoid splenectomy whenever possible and instead do splenopexy, especially in pediatric cases, as the spleen plays a crucial role in the reticuloendothelial system.
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Affiliation(s)
- Malak Eleiwi
- Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Yazid Atatri
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Omar Younis
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Jehad Zuhd
- Anesthesia, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmed Awadghanem
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmad Qashoo
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Suha Sholi
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Samer Bustame
- Pediatric Surgery, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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10
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Koyuncu H, Bükülmez A, Güngör A, Sarıkaya Y. Evaluation of acute terminal ileitis in children before and during the COVID-19 pandemic. J Pediatr Gastroenterol Nutr 2024; 78:197-203. [PMID: 38374549 DOI: 10.1002/jpn3.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The aim of this study was to examine the clinical features of acute terminal ileitis in children and evaluate its rate before and during the COVID-19 pandemic. METHODS This retrospective study was performed in our pediatric emergency department between 2018 and 2022. The records of 5363 patients who required abdominal imaging due to acute abdomen were analyzed, and 143 patients with terminal ileitis were included. The rate and etiological causes were compared during and before the COVID-19 pandemic. RESULTS The rate of acute terminal ileitis has increased over the years. The fastest increase was in 2021, when the COVID-19 pandemic was experienced. While 59 (41.2%) patients showed acute nonspecific ileitis, the most common etiologic cause that could be identified was acute gastroenteritis. It was determined that multisystem inflammatory syndrome in children was among the causes of ileitis after the COVID-19 pandemic and was one of the top three causes. CONCLUSIONS Acute terminal ileitis, which has many etiologies, is one of the rare radiological findings in acute abdominal pain. Examination and laboratory findings are not specific. Guidelines are needed for the investigation of the underlying etiology of acute terminal ileitis in children. The incidence of acute terminal ileitis is increasing, and the increase has been found to be faster after the COVID-19 pandemic.
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Affiliation(s)
- Hilal Koyuncu
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşegül Bükülmez
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşe Güngör
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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11
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Eltahir BA, Abdelhameed ME, Abdulla Ghaleb WE. Lateral Abdominal Wall Hematoma Mimicking Aortic Dissection Presentation: A Case Report. Cureus 2024; 16:e54717. [PMID: 38524083 PMCID: PMC10960730 DOI: 10.7759/cureus.54717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Lateral abdominal wall hematoma is a rare clinical entity but a great mimicker of other diseases' clinical presentations. In this case report, we present a 42-year-old male patient with a constellation of signs and symptoms that were mistaken for aortic dissection before the lateral abdominal wall hematoma diagnosis was confirmed with computed tomography (CT) imaging. Uncontrolled hypertension and persistent cough were most likely predisposing factors; the patient was managed conservatively and discharged in a stable condition.
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Affiliation(s)
- Babiker A Eltahir
- Department of Emergency, NMC Royal Hospital, Khalifa City, Abu Dhabi, ARE
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12
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El Nogoomi I, Jumah R, Zaidan KO, Agha A. Primary Midgut Volvulus: An Unusual Case of a Young Adult Necessitating Extensive Bowel Resection. Cureus 2024; 16:e54472. [PMID: 38510899 PMCID: PMC10954040 DOI: 10.7759/cureus.54472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Primary small bowel volvulus (SBV), commonly known as midgut volvulus, is an uncommon condition in which the small intestine rotates around its own mesenteric axis. This case report details the diagnostic and management challenges encountered in a rare presentation of primary SBV in a previously healthy 19-year-old male. Our patient presented with acute abdominal pain, vomiting, and signs of shock, prompting urgent medical attention. He was sent for exploratory laparotomy and underwent extensive resection of the gangrenous bowel. Diagnosis involved an abdominal computed tomography scan revealing the characteristic "whirl sign." According to the World Society of Emergency Medicine, surgical intervention should be done to address the SBV through resection of the gangrenous bowel segments. Despite efforts, the patient's prognosis remained guarded, necessitating ongoing supportive measures. This case highlights the complex challenges associated with primary SBV, emphasizing the need for continued research to enhance diagnostic precision and refine management strategies.
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Affiliation(s)
| | - Rania Jumah
- General Practice, Al Kuwait Hospital, Sharjah, ARE
| | | | - Ammar Agha
- General Practice, Al Kuwait Hospital, Sharjah, ARE
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13
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Yu Z, Alhamadani MA, Chehade M, Wright DB. Idiopathic pseudoaneurysmal omental bleeding, a rare cause of life-threatening acute abdomen. J Surg Case Rep 2024; 2024:rjae048. [PMID: 38389512 PMCID: PMC10881295 DOI: 10.1093/jscr/rjae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Mesenteric aneurysms and their complications can be a life-threatening presentation of acute abdomen to the emergency department. The majority of mesenteric artery aneurysms are incidentally detected on imaging investigations and are asymptomatic. Symptomatic mesenteric aneurysms manifest as hemoperitoneum or abdominal pain. In addition, treatment of symptomatic aneurysms is delayed due to the infrequent consideration of the diagnosis in patients presenting with abdominal pain. Timely and accurate diagnosis is of paramount importance as any delay in definitive surgical management can lead to increased patient's mortality and morbidity with up to 25% of mesenteric aneurysms may be complicated by rupture.
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Affiliation(s)
- Zirong Yu
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Mohammed Ali Alhamadani
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Marthe Chehade
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Danette B Wright
- Clinical Network Director Surgery, Western Sydney Local Health District, Blacktown, New South Wales, Australia
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14
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Aly MS, Jamal Z. Spontaneous Perforation of Meckel's Diverticulum in a Young Adult Male: A Case Report and Review of the Literature. Cureus 2024; 16:e53598. [PMID: 38449992 PMCID: PMC10915699 DOI: 10.7759/cureus.53598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Meckel's diverticulum, a congenital defect that affects about 2% of the population, is a remnant of the embryologic vitelline duct. Perforated Meckel's diverticulum, a rare consequence of an already rare disease process, frequently presents and is diagnosed as a perforated appendix. We report a case of a 28-year-old male who presented with a two-day history of right-sided lower abdominal pain associated with nausea. The abdominal examination revealed a soft, nondistended abdomen with tenderness in the right iliac fossa. A CT scan of the abdomen showed a normal appendix and inflammation of Meckel's diverticulum without any signs of perforation. Bowel exploration through a small midline incision indicated the presence of a highly inflamed Meckel's diverticulum with localized perforation 75 cm from the ileocecal valve. A resection of 15 cm of the small bowel and an end-to-end primary anastomosis were performed. The patient had an uncomplicated recovery and was discharged after a five-day admission to a surgical ward. This case report illustrates the significance of keeping Meckel's diverticulum as a differential diagnosis in all the patients who present with an acute abdomen.
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Affiliation(s)
- Mahmoud S Aly
- Department of Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
| | - Zohaib Jamal
- Department of Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
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15
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Islam S, Shah A, Naraynsingh V. Isolated Perforation of Multiple Jejunal Diverticulae: A Very Rare Cause of Acute Abdomen. Cureus 2024; 16:e52228. [PMID: 38352077 PMCID: PMC10861364 DOI: 10.7759/cureus.52228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Isolated jejunal diverticular (JD) perforation is extremely rare; it usually presents as a diagnostic dilemma and is often discovered incidentally on laparotomy. Most of these perforations are single. Literature has revealed only one case of multiple small bowel diverticular perforations. We report the first case of simultaneous perforation of four jejunal diverticulae in an 85-year-old male. Small bowel resection and primary anastomosis were performed. The patient had an uneventful post-operative recovery. This case highlights the importance of prompt diagnosis and timely management to reduce the morbidity and mortality of these patients. It should be included in the differential diagnosis in all elderly patients presenting with acute abdomen.
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Affiliation(s)
- Shariful Islam
- General Surgery/Oncoplastic Breast Surgery, San Fernando General Hospital, San Fernando, TTO
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
| | - Aneela Shah
- General Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
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16
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Manso M, Agostinho L. A Case Report of Falciform Ligament Appendagitis. Cureus 2024; 16:e51965. [PMID: 38333502 PMCID: PMC10852996 DOI: 10.7759/cureus.51965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Falciform ligament appendagitis is an extremely rare form of intra-abdominal focal fat infarction. It usually presents with vigorous abdominal pain and mimics other more common acute abdominal pain-associated diseases. Better recognition of this entity avoids misdiagnoses and unnecessary surgical treatment. We present the case of a 73-year-old woman admitted to the emergency department for abdominal pain, nausea, and vomiting. She had a fever and a diffuse tender abdomen with upper right quadrant pain. Laboratory investigation showed leukocytosis and high C-reactive protein. CT revealed a heterogeneous increased density of fat adjacent to the falciform ligament. Falciform ligament appendagitis was diagnosed and antibiotic and anti-inflammatory treatment resulted in complete recovery. This case highlights the need to raise awareness and better recognize falciform ligament appendagitis to avoid unnecessary surgical interventions.
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Affiliation(s)
- Marta Manso
- Department of Radiology, Hospital Beatriz Ângelo, Lisbon, PRT
| | - Lisa Agostinho
- Department of Radiology, Hospital Beatriz Ângelo, Lisbon, PRT
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17
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Daba SA, Belete AW, Getachew GD. Ileocecal Knotting Causing Intestinal Obstruction on Early Postpartum Period: Case Report. Int Med Case Rep J 2023; 16:867-871. [PMID: 38146343 PMCID: PMC10749554 DOI: 10.2147/imcrj.s448334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Intestinal knotting syndromes are rare causes of mechanical bowel obstruction, ileo-sigmoid knotting being the most common type. Ileocecal knotting is the rarest type among knot syndromes and there are few case reports across the world. Case Presentation We present a case of ileocecal knotting in a postpartum patient with abdominal distention, vomiting and failure to pass feces and flatus. Plain abdominal radiograph revealed dilated small bowel loops with multiple air fluid levels. Exploratory laparotomy was performed with intra-operative finding of ileocecal knotting with viable bowel, mobile cecum and ascending colon and gangrenous tip of appendix. We untied the knot and performed an appendectomy. Due to intra-operative instability of the patient's vital signs, right hemicolectomy was differed and cecum as well as ascending colon were fixed to right posterolateral abdominal wall. Clinical Discussion Ileocecal knotting is a very rare finding, and few case reports have been published. The intra-operative findings of the mobile cecum and ascending colon are consistent with previous reports and it is a predisposing factor for knot besides low BMI and young age of our patient. Surgical management is dictated by intra-operative conditions such as viability of the bowel, intra-operative stability of the patient, extent of resection and length of the remaining bowel. Surgical options include en bloc resection of knot with gangrenous bowel and end to end anastomosis or end ileostomy with closure of distal end. Conclusion Ileocecal knotting should be considered as a differential diagnosis for patients presenting with intestinal obstruction with unusual radiographic findings. Early diagnosis and prompt surgical intervention prevents bowel infarction and enhance the prognosis. Preoperative abdominal CT scan is helpful in such cases with unusual radiographic findings.
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Affiliation(s)
- Shimelis Abegaz Daba
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Aderajew Walle Belete
- Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gelila Dejene Getachew
- Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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18
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Albejais R, Alharbi G, Al-Ali E, Aldawsari N, Johar T. Omental Cyst With Torsion: A Rare Culprit of Pediatric Acute Abdomen. Cureus 2023; 15:e50606. [PMID: 38226121 PMCID: PMC10788700 DOI: 10.7759/cureus.50606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Acute abdominal pain in pediatric patients poses a diagnostic challenge due to diverse etiologies, ranging from benign to life-threatening conditions. Omental cysts, though rare, constitute a distinctive subset characterized by a fluid-filled sac arising from the greater omentum. We present the case of a three-year-old male who presented with severe abdominal pain localized to the right upper quadrant, progressively worsening over 24 hours. Physical examination revealed tenderness and a palpable mass. Laboratory investigations indicated mild leukocytosis. Contrast-enhanced computed tomography identified an omental cyst with torsion. Intraoperatively, the cyst arising from the greater omentum exhibited torsion, leading to ischemic changes. Surgical excision successfully corrected the torsion and removed the cyst. Omental torsion is a rare complication of omental cysts. Prompt recognition and surgical intervention are crucial, emphasizing the importance of considering diverse etiologies in acute pediatric abdominal pain.
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Affiliation(s)
- Reem Albejais
- General Practice, King Faisal University, Hofuf, SAU
| | | | - Eman Al-Ali
- General Practice, King Faisal University, Hofuf, SAU
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19
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AlAli MN, Alsweed NI, Alshehri A, Essa MS, Aldeghaither SK, Meaigel MA, Alrashed M, Al-Shoaibi AM, Amer SM, Alsubaih MH. Is Appendiceal Diverticulitis Mimicking Acute Appendicitis? Cureus 2023; 15:e51214. [PMID: 38283468 PMCID: PMC10819125 DOI: 10.7759/cureus.51214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Appendicular diverticulitis (AD) is a rare entity characterized by the inflammation of the arising diverticulum of the appendix. It has been reported to carry a high risk of perioperative complications, such as bleeding and perforation. Furthermore, multiple articles have highlighted the importance of diagnosing AD early due to its strong association with malignancies. Limited published cases concerning AD in our country and globally are available in the literature. Hence, we present in this article a case series of five exciting cases of incidental findings of AD that were initially diagnosed as acute appendicitis based on clinical evaluation and imaging findings. In our series, we performed a retrograde evaluation of the computed tomography scans of all five cases that showed diverticula. In conclusion, histopathological evaluation remains the method of choice to reach the definitive diagnosis; however, it is essential to highlight the relevance of imaging in diagnosing AD preoperatively in the early stages to reduce morbidity and mortality.
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Affiliation(s)
- Mohammed N AlAli
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Nardeen I Alsweed
- Department of Clinical Surgery, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Ameen Alshehri
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Mohamed S Essa
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Saud K Aldeghaither
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Mohammad A Meaigel
- Department of Surgery/Acute Care and Trauma Surgery, King Khalid University Hospital, King Saud University, Riyadh, SAU
| | - Muath Alrashed
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Abdulbaset M Al-Shoaibi
- Department of Radiology, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Sadiq M Amer
- Department of Pathology, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
| | - Mohammed H Alsubaih
- Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health (MOH), Riyadh, SAU
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20
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Guevara S, Miyara SJ, Aronsohn J, Homsi JT, McCann-Molmenti A, Mumford JM, Keber B, Shore-Lesserson L, Morales L, Metz CN, Cho YM, Molmenti CLS, Loto R, Pesce MM, Zafeiropoulos S, Giannis D, Pipolo DO, Jacque F, Montorfano L, Shinozaki K, Shoaib M, Choudhary RC, Nishikimi M, Takegawa R, Endo Y, Hayashida K, Fontan FM, Becker LB, Molmenti EP. COVID-19-Associated Portal Vein Thrombosis Post-Cholecystitis. Int J Angiol 2023; 32:262-268. [PMID: 37927847 PMCID: PMC10624542 DOI: 10.1055/s-0042-1743409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This case study describes a 45-year-old Caucasian male with a past medical history of obesity, hypertension, and non-insulin-dependent diabetes mellitus, who in the setting of coronavirus disease 2019 (COVID-19) pneumonia, developed portal vein thrombosis (PVT) presenting as an acute abdomen after hospital discharge from a cholecystitis episode. PVT is a very infrequent thromboembolic condition, classically occurring in patients with systemic conditions such as cirrhosis, malignancy, pancreatitis, diverticulitis, autoimmunity, and thrombophilia. PVT can cause serious complications, such as intestinal infarction, or even death, if not promptly treated. Due to the limited number of reports in the literature describing PVT in the COVID-19 setting, its prevalence, natural history, mechanism, and precise clinical features remain unknown. Therefore, clinical suspicion should be high for PVT, in any COVID-19 patient who presents with abdominal pain or associated signs and symptoms. To the best of our knowledge, this is the first report of COVID-19-associated PVT causing extensive thrombosis in the portal vein and its right branch, occurring in the setting of early-stage cirrhosis after a preceding episode of cholecystitis.
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Affiliation(s)
- Sara Guevara
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Santiago J. Miyara
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | - Judith Aronsohn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York
| | - Joseph T. Homsi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - James M. Mumford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Barbara Keber
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Linda Shore-Lesserson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York
| | - Luis Morales
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Christine N. Metz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | - Young Min Cho
- Department of Internal Medicine, Northeast Georgia Medical Center, Gainesville, Georgia
| | | | - Rodrigo Loto
- Department of Radiology, Delta Sanatorium, Rosario, Santa Fe, ARG
| | - Martin M. Pesce
- Department of Radiology, Delta Sanatorium, Rosario, Santa Fe, ARG
| | - Stefanos Zafeiropoulos
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | | | - Derek O. Pipolo
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Francky Jacque
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | | | - Koichiro Shinozaki
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Muhammad Shoaib
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Mitsuaki Nishikimi
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Yusuke Endo
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Fermin M. Fontan
- Department of Surgery, Memorial Medical Center, Las Cruces, New Mexico
| | - Lance B. Becker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Ernesto P. Molmenti
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Surgery, North Shore University Hospital, Manhasset, New York
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21
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Yuan T, Sun J, Ma Q. Extensive ischemic gastroduodenal necrosis caused by antihypertensive drug overdose in a young man. Clin Case Rep 2023; 11:e8348. [PMID: 38144263 PMCID: PMC10740334 DOI: 10.1002/ccr3.8348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
To raise the awareness of the rare and life-threatening clinical entity, we report a 23-year-old male presenting with acute abdomen who was finally diagnosed with gastroduodenal necrosis due to gut hypoperfusion after antihypertensive drug overdose.
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Affiliation(s)
- Tao Yuan
- Department of Anesthesiology, West China HospitalSichuan UniversityChengduChina
| | - Ji Sun
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan UniversityChengduChina
| | - Qin Ma
- Division of Gastrointestinal Surgery, Department of General Surgery, West China HospitalSichuan UniversityChengduChina
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22
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Turan B, Eroğlu H, Sultanoğlu B, Demirbakan K. Methamphetamine-related peptic ulcer perforation: a growing medical concern. ULUS TRAVMA ACIL CER 2023; 29:1357-1363. [PMID: 38073456 PMCID: PMC10767286 DOI: 10.14744/tjtes.2023.53146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/26/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Many studies have been done in the literature on perforations due to substance abuse, and there are limited publications on perforations related to inhaled methamphetamine. Recently, in our clinic, we observed an increase in the number of patients with perforated peptic ulcer, which we think is secondary to a significant increase in the consumption of this drug. The main purpose of this study is to determine whether the use of inhaled methamphetamine known as 'fire and ice' is a factor directly related to peptic perforation and its complications and also to determine the demographic variables of patients with peptic ulcer perforation due to this substance use, in the context of the literature. METHODS A retrospective study was conducted by examining the medical records of 29 gastric perforation patients who underwent surgical treatment in our clinic in 2021. Data were transferred to SPSS.23 (IBM Inc., Chicago, IL, USA) program and evaluated with statistical analysis. Normality assumptions of continuous variables were examined with Kolmogorov-Smirnov test, and variance homogeneity was examined with Levene's test. Bi-level comparisons, t-test if the data are normally distributed and Mann-Whitney U-test for bi-level comparisons where the data are not normally distributed were used. Relationships between categorical variables were examined by Chi-square test analysis. P<0.05 was accepted as the level of significance in all analyzes. RESULTS Twenty-nine patients were divided into two groups as methamphetamine users (n=13) and non-users (n=16). There was a statistically significant difference according to the lower age in the group using methamphetamine (31.69-48.8-P=0.025). The pres-ence of PU history differed significantly between the groups (P=0.009). Interestingly, aspartate transaminase alanine aminotransferase values were lower in substance dependents (P=0.020). Furthermore, there was a significant difference in localization between groups (P<0.001). There was no statistically significant difference between the two groups in terms of gender, clinical presentation, and other laboratory values. CONCLUSION Methamphetamine consumption, known as fire and ice, is an important risk factor for ulcer development and subsequent perforation, especially in young patients and long-term consumption of this narcotic substance. It has been determined that this risk factor, which is currently considered rare, has been seen in a very large number in a short time in our clinic. The use of this substance, which is considered a major social threat, is becoming more and more widespread, and this study is only a small part of the iceberg reflected in the general surgery clinic of a hospital.
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Affiliation(s)
- Bilal Turan
- General Surgery Clinic, Dr Ersin Arslan Training and Research Hospital, Gaziantep-Türkiye
| | - Hakan Eroğlu
- General Surgery Clinic, Dr Ersin Arslan Training and Research Hospital, Gaziantep-Türkiye
| | - Bülent Sultanoğlu
- General Surgery Clinic, Dr Ersin Arslan Training and Research Hospital, Gaziantep-Türkiye
| | - Kenan Demirbakan
- Department of General Surgery, Sanko University Faculty of Medicine, Gaziantep-Türkiye
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23
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She X, Chen J, Zhou YN, Guo J, Zhao FH, Yi C. Kawasaki Disease Associated Acute Abdomen: Most Require No Surgery. J Inflamm Res 2023; 16:5157-5162. [PMID: 38026259 PMCID: PMC10644836 DOI: 10.2147/jir.s434982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To summarize the clinical features and treatment experiences of patients with Kawasaki disease (KD)-associated acute abdomen (KD-AA). Methods We conducted a retrospective case-control study of patients with KD-AA treated at our hospital between January 2006 and November 2022. Results Of the 917 children with KD, 43 (4.7%) presented with AA. Of these, 33 with complete information were included in the KD-AA group. Patients with KD-AA were significantly older, with higher neutrophil rate, C-reactive protein, procalcitonin, and alanine transaminase levels and lower hemoglobin, albumin, and serum sodium levels. Additionally, more patients with KD-AA presented with aseptic meningitis and KD shock syndrome than those with KD alone (all p<0.05). The two groups did not differ in the incidence of intravenous immunoglobulin (IVIG) resistance, incomplete KD, or coronary artery abnormalities. All patients received aspirin and IVIG therapy, with nine receiving a second dose of IVIG and 11 receiving corticosteroids. Only two patients with KD-AA underwent surgery, and the prognosis of all patients with KD-AA was good. Conclusion KD-AA should be suspected in febrile children with abdominal symptoms. Prompt diagnosis of KD-AA is important for early effective treatment to avoid unnecessary surgical harm. KD, complicated by acute abdomen, has a good prognosis.
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Affiliation(s)
- Xiang She
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Jia Chen
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Yu-Neng Zhou
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Jun Guo
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Feng-Hua Zhao
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Cong Yi
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
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Aloini ME, Manella S, Biondo I, Maggio R, Roberto G, Ricci F, Lardo P, Addario Chieco P, Stigliano A. Bilateral adrenal hemorrhage: learning notes from clinical practice and literature review. Front Endocrinol (Lausanne) 2023; 14:1233710. [PMID: 38027193 PMCID: PMC10656610 DOI: 10.3389/fendo.2023.1233710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Adrenal hemorrhage is a rare, but important, diagnosis to recognize, in particular when there is involvement of both adrenal glands. Bilateral adrenal hemorrhage can in fact lead to adrenal insufficiency, with dramatic consequences if not promptly recognized and treated. It is normally caused by systemic conditions that lead to the vasoconstriction and thrombosis of the adrenal vein. Oftentimes, the clinical diagnosis of this condition can be very challenging, as its signs and symptoms are generalized and nonspecific (abdominal pain, nausea, and fatigue). Here, we present the cases of two patients admitted to the Emergency Department in 2016 and 2022 with acute abdominal pain, having recently undergone surgery and subsequently prescribed low-molecular-weight heparin. In both cases, laboratory results revealed neutrophilic leukocytosis and an unexplained anemia. Due to the persistence of abdominal pain despite medication, a CT scan was performed, showing an enlargement of both adrenal glands suggestive of bilateral adrenal hemorrhage. Adrenal function was tested that correlated with a diagnosis of adrenal insufficiency, and both patients were promptly treated with parenteral hydrocortisone as a result. On 5 years' follow-up from the acute event, the second patient's adrenal function had returned to normal, and he has not needed further adrenal replacement therapy; the first patient however demonstrated persistence of adrenal failure requiring replacement therapy. In this paper, through our experience and a literature analysis, we will aim to outline some clues to identify patients at potential risk of bilateral adrenal hemorrhage.
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Affiliation(s)
- Maria Elena Aloini
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Sara Manella
- Surgery, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Irene Biondo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Maggio
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Guido Roberto
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesca Ricci
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pina Lardo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Paola Addario Chieco
- General Surgery, Department of Surgical Sciences, Sant’Andrea University Hospital, Rome, Italy
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
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Mansoor A, Shaukat R. Inguinal hernia leading to omental torsion: Role of CT in differentiating from other clinical mimics - a case report and literature review. J Radiol Case Rep 2023; 17:8-17. [PMID: 38638552 PMCID: PMC11022751 DOI: 10.3941/jrcr.v17i11.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Omental torsion is a very rare cause of acute abdomen. Clinically, it mimics other common pathologies such as acute appendicitis, acute diverticulitis and acute cholecystitis. It is therefore no surprise, that it was rarely diagnosed pre operatively before the advent and easy availability of modern imaging techniques. CT scan, in particular, can diagnose omental torsion with confidence pre operatively. This can make conservative treatment possible in cases of primary omental torsion and guide regarding the appropriate treatment in cases of secondary torsion. We present a case of a young male patient who presented to Emergency department with symptoms of acute abdomen. Clinical and laboratory findings were non-specific for any specific cause of acute abdomen. CT scan, however, showed omental fat stranding with whirlpool sign representing omental torsion which was seen to be secondary to left inguinal hernia. Patient was operated in emergency and necrotic omentum was resected and hernia repaired. Post-operative recovery was uneventful.
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Affiliation(s)
- Ali Mansoor
- Department of Radiology, Post Graduate Medical Institute, Ameer-Ud-Din Medical College, Lahore General Hospital, Pakistan
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26
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Basu S, Pratap A, Bhartiya SK, Shukla VK. Wandering Spleen and Acute Gastric Volvulus in an Elderly Woman with Acute Abdomen: A Case Report. Clin Exp Gastroenterol 2023; 16:181-185. [PMID: 37904894 PMCID: PMC10613404 DOI: 10.2147/ceg.s428679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023] Open
Abstract
Gastric volvulus is an uncommon clinical condition with the potentially life-threatening complication of acute gastric necrosis. A wandering spleen may also be associated with gastric volvulus and can produce a diagnostic dilemma as the cause of an acute abdomen. We present a case of an elderly woman who presented with acute abdominal symptoms. She did not have the classical Borchardt triad to diagnose gastric volvulus and had a coexisting wandering spleen. Although torsion and ischemia of the wandering spleen were initially thought to be the cause of acute abdomen, a subsequent contrast-enhanced CT (CECT) scan confirmed a coexistent mesenteric-axial gastric volvulus with gangrenous changes. We present this case to highlight a rare combination of pathologies, either of which can confuse the diagnosis or cause a delay in management. Early diagnosis with CECT is emphasized, and segmental resection is feasible when the rest of the viscus can be preserved.
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Affiliation(s)
- Somprakas Basu
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Satyanam Kumar Bhartiya
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vijay Kumar Shukla
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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27
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Viterbo L, Hughes J, Milner PI, Bardell D. Arterial Blood Gas, Electrolyte and Acid-Base Values as Diagnostic and Prognostic Indicators in Equine Colic. Animals (Basel) 2023; 13:3241. [PMID: 37893965 PMCID: PMC10603645 DOI: 10.3390/ani13203241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
The study aimed to investigate if arterial blood analysis in conscious horses presenting with signs of colic and breathing ambient air had diagnostic or prognostic value. Arterial blood samples from 352 horses presenting with colic at a university equine referral hospital were analysed for pH, partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), concentrations of sodium (Na+), potassium (K+), ionised calcium (Ca2+) and chloride (Cl-), actual and standardised plasma bicarbonate concentration (HCO3- (P) and HCO3- (P, st)), blood and extracellular fluid base excess (Base (B) and Base (ecf)) and anion gap (AG). Results were compared to previously reported values for healthy horses, and comparisons were made between final diagnosis, treatment and survival to hospital discharge. Significant differences were found between colic cases and healthy reference values between some primary aetiologies. Overall, surgical and non-surgical colic cases differed in Ca2+ and Cl- concentrations and Ca2+ differed between cases that survived to discharge and those that did not. PaO2 differed between small intestinal surgical cases that survived and those that did not. From these results, we developed regression models that demonstrated excellent or good predictive value in identifying the likelihood of surgical versus medical management and survival to hospital discharge.
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Affiliation(s)
- Luisa Viterbo
- North Downs Specialist Referrals, Part of Linnaeus Veterinary Limited, The Fresian Buildings 3–4, Dairy Business Park, Brewer Street, Bletchingley RH1 4QP, UK;
| | - Jodie Hughes
- North Downs Specialist Referrals, Part of Linnaeus Veterinary Limited, The Fresian Buildings 3–4, Dairy Business Park, Brewer Street, Bletchingley RH1 4QP, UK;
| | - Peter I. Milner
- Department of Equine Clinical Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK; (P.I.M.); (D.B.)
| | - David Bardell
- Department of Equine Clinical Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK; (P.I.M.); (D.B.)
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Abore KW, Bacha T. Intrabiliary Ascariasis: A Case Report of an Uncommon Cause of Acute Abdomen and Obstructive Jaundice in Children. Int Med Case Rep J 2023; 16:689-692. [PMID: 37854709 PMCID: PMC10581008 DOI: 10.2147/imcrj.s432931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background Intrabiliary ascariasis is an uncommon cause of biliary colic and obstructive jaundice among children due to the small size of the ampullary orifice. A high index of suspicion for patients living in an endemic area and radiologic examination are crucial for diagnosis and treatment. Case Presentation A 12-year-old male Ethiopian child presented with colicky right upper quadrant pain, nausea, and vomiting for 3 days. Physical examination showed slightly icteric sclera and slightly tender hepatomegaly. Laboratory and ultrasound examinations were suggestive of obstructive jaundice secondary to intra-biliary ascariasis. The child was admitted and followed by conservative management including maintenance fluid, nil per mouth, and analgesics. The abdominal pain and icterus resolved on his second and third day of admission, respectively. A follow-up ultrasound showed that the worm had migrated from the common bile duct. The patient was dewormed with a single dose of oral albendazole 400mg and discharged home. Currently, the patient is well and attending school. Conclusion Although biliary ascariasis is an uncommon cause of acute abdomen and obstructive jaundice, it should be suspected among patients from endemic areas presenting with suggestive clinical and laboratory features. Conservative treatment is the treatment of choice for uncomplicated biliary ascariasis patients.
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Affiliation(s)
| | - Tigist Bacha
- Department of Pediatrics and Child Health, St. Paul Millennium Hospital Medical College, Addis Ababa, Ethiopia
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29
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Alotaibi S, Alotaibi O, Sharaf R, Qaheri R, Alshamrani R. A Rare Case of Vaginal Atresia in an Adolescent Girl Presenting With Abdominal Pain. Cureus 2023; 15:e46571. [PMID: 37936994 PMCID: PMC10626199 DOI: 10.7759/cureus.46571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Vaginal atresia, an infrequent congenital anomaly characterized by the absence or underdevelopment of the vaginal canal, presents significant complexities in pediatric and adolescent gynecological practice. Its diverse range of clinical presentations, including primary amenorrhea and cyclic abdominal discomfort, creates diagnostic challenges, highlighting the need for timely intervention to relieve symptoms and preserve future reproductive health. This case underscores the essential role of a collaborative, multidisciplinary approach involving pediatricians, gynecologists, and surgeons in ensuring comprehensive care and optimizing patient outcomes. In this report, we present the case of a 10-year-old female who initially presented with chronic abdominal pain, which had been occurring intermittently over the course of several months. This ultimately led to the diagnosis of hematometra secondary to vaginal atresia. Utilizing magnetic resonance imaging, we confirmed the diagnosis without exposing the patient to radiation, prioritizing her safety. A successful surgery was performed to create a working vaginal canal. The patient received careful postoperative care, and we closely followed her progress to support a smooth recovery.
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Affiliation(s)
| | - Ola Alotaibi
- Pediatrics, King Fahad Medical City, Riyadh, SAU
| | - Roweim Sharaf
- General Practice, King Abdulaziz University, Jeddah, SAU
| | - Raja Qaheri
- General Practice, First Moscow State Medical University, Moscow, RUS
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30
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Alyami HS, Almasaabi SM, Al Swaidan HA, Dhaen H. Omental Infarction Mimicking Acute Appendicitis: A Case Report. Cureus 2023; 15:e47232. [PMID: 38022033 PMCID: PMC10654046 DOI: 10.7759/cureus.47232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Acute abdominal pain is a common presentation in emergency departments, often attributed to a myriad of potential causes. Among these, acute appendicitis remains a frequently diagnosed culprit. However, this case report presents a 32-year-old male who arrived at the emergency department with severe right lower quadrant abdominal pain, characterized by localized tenderness and guarding. The initial clinical diagnosis pointed to acute appendicitis. Before surgical intervention, a computed tomography scan was conducted and revealed a focal area of fat stranding, consistent with omental infarction, while the appendix appeared normal. The patient's management involved pain control and supportive care, leading to a complete resolution of abdominal pain at a two-week follow-up. This case emphasizes the significance of including omental infarction in the spectrum of diagnoses for acute abdominal pain, underlining the potential to prevent unnecessary surgical interventions.
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Affiliation(s)
- Hadi S Alyami
- College of Medicine, King Faisal University, Hofuf, SAU
| | | | | | - Hassan Dhaen
- College of Medicine, Arabian Gulf University, Manama, BHR
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31
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Njoum Y, Barqawi AD, Maree M. Spontaneous rupture of a splenic artery aneurysm causing acute abdomen in a 19-year-old male patient: a case report. Front Surg 2023; 10:1223271. [PMID: 37790992 PMCID: PMC10544323 DOI: 10.3389/fsurg.2023.1223271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction A splenic artery aneurysm is considered an abnormal dilatation of the splenic artery layers greater than 1 cm in diameter. First described by Beaussier in 1770, it affects 1% of the population but carries a major risk for life-threatening complications of rupture in 3%-10% of cases regardless of its congenital or acquired etiology. The presentation is highly variable, from asymptomatic incidental discovery during routine imaging to aneurysmal rupture causing acute abdomen, massive gastrointestinal bleeding, and hemorrhagic shock. Case presentation Herein, we present a 19-year-old male patient who presented with epigastric pain and abdominal rigidity associated with a moderate amount of free peritoneal fluid that was found to be a ruptured SAA after immediate laparoscopy, which was successfully managed with splenectomy. Conclusion SAAs are a rare etiology of acute abdomen and hemorrhagic shock but have a very high risk of mortality even upon immediate intervention, requiring a very high level of vigilance and a low threshold for surgical intervention in unstable patients presenting with abdominal pain.
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Affiliation(s)
- Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Mohammed Maree
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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32
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Alvi AT, Santiago LE, Lopez-Medal M. Acute Pancreatitis-Induced Thrombosis of Celiac Artery: An Unusual Complication of Acute Pancreatitis. Cureus 2023; 15:e46249. [PMID: 37908938 PMCID: PMC10614078 DOI: 10.7759/cureus.46249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Acute pancreatitis can lead to both local and systemic complications, including pseudocysts, biliary obstruction, duodenal obstruction, sepsis, necrosis, vascular complications, and multiorgan failure. Vascular complications following acute pancreatitis are associated with a high risk of morbidity and mortality due to their thrombotic and hemorrhagic effects. When thrombosis is present, it usually involves the splanchnic venous system, but it is rarely seen in the arterial system. Celiac artery thrombosis is rare with only a few cases reported in the literature. In this case, we present a 65-year-old Hispanic female who presented to the emergency department with abdominal pain and nausea, with computed tomography angiography (CTA) of the abdomen revealing acute pancreatitis with thrombosis of the celiac artery, which was managed with anticoagulation.
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Affiliation(s)
- Ali Tariq Alvi
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Luis E Santiago
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
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33
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Bayissa BB, Borena AM. Transverse colon and omental incarceration in femoral hernia: a case report. J Surg Case Rep 2023; 2023:rjad496. [PMID: 37701449 PMCID: PMC10493078 DOI: 10.1093/jscr/rjad496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
A femoral hernia is one of the groin hernias with a high chance of incarceration and strangulation due to its narrow neck. Here, we report a case of transverse colon incarceration. A 65-year-old female patient presented with groin mass that failed to reduce and a dragging pain. Elective open femoral herniorrhaphy was done with the finding of viable incarcerated massive momentum along with transverse colon. Femoral hernias have a female-to-male ratio of about 10:1. Postmenopausal, increasing age, and constipation were some of the risk factors identified in our patient. Various types of organs can be found in the femoral hernia sac but one of the rarely reported organ was found in our case: a transverse colon. Femoral hernia with a large bulky soft mass can get incarcerated easily but relatively less prone to strangulation.
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Affiliation(s)
- Badhaasaa Beyene Bayissa
- Department of Surgery, College of Public Health and Medical Sciences, Haramaya University, Harar 251, Ethiopia
| | - Ayantu Mekonnon Borena
- Department of Obstetrics and Gynecology, College of Public Health and Medical Sciences, Haramaya University, Harar 251, Ethiopia
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34
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Angelopoulos P, Katsimperis S, Manolitsis I, Bellos TT, Tzelves L, Berdempes M, Skolarikos A. Gangrenous Cystitis Secondary to a Spontaneous Hematoma of the Lesser Pelvis. Cureus 2023; 15:e45502. [PMID: 37868537 PMCID: PMC10584663 DOI: 10.7759/cureus.45502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Gangrenous cystitis is considered a life-threatening but rather rare clinical entity due to the widespread use of antibiotics. We herein report a case of a 78-year-old female with gangrenous cystitis secondary to a spontaneous expanded hematoma of the lesser pelvis who underwent partial cystectomy followed by bilateral ureterostomies with no favorable outcome.
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Affiliation(s)
- Panagiotis Angelopoulos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
| | - Stamatios Katsimperis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
| | - Ioannis Manolitsis
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
| | - Themistoklis T Bellos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
| | - Marinos Berdempes
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
| | - Andreas Skolarikos
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, GRC
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35
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Caixeiro L, Varanda J, Morais J, Ferreira A, Rios L. Petersen Hernia After Abdominoplasty: A Provocative Factor or a Coincidence? Cureus 2023; 15:e45014. [PMID: 37829960 PMCID: PMC10565598 DOI: 10.7759/cureus.45014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Abdominal contouring procedures are frequently performed following massive weight loss after a Roux-en-Y gastric bypass. This last procedure can be associated with late complications like the development of internal hernias (e.g., Petersen hernia). The purpose of this article is to present a case of Petersen hernia after complete abdominoplasty. A 42-year-old female presented to the emergency department with acute abdominal pain three days after undergoing a complete abdominoplasty following massive weight loss post laparoscopic gastric bypass (Roux-en-Y). The patient was diagnosed with a mechanical small bowel obstruction, likely due to an internal hernia (Petersen hernia) and underwent surgical correction. Gastric bypass surgery may be associated with small bowel obstruction from internal herniation. A sudden rise in abdominal pressure, as occurs with abdominoplasty with rectus plication and subsequent use of compression garments, may result in strangulation and intestinal ischemia. A high degree of suspicion of intra-abdominal complications after abdominoplasty is essential, particularly in the setting of post-bariatric surgery.
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Affiliation(s)
- Leonor Caixeiro
- Plastic and Reconstructive Surgery, Centro Hospitalar V.N.Gaia/Espinho, Vila Nova de Gaia, PRT
| | - João Varanda
- General Surgery, Centro Hospitalar V.N.Gaia/Espinho, Vila Nova de Gaia, PRT
| | - João Morais
- Plastic and Reconstructive Surgery, Hospital da Prelada, Porto, PRT
| | - António Ferreira
- General Surgery, Centro Hospitalar V.N.Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Leonor Rios
- Plastic and Reconstructive Surgery, Centro Hospitalar V.N.Gaia/Espinho, Vila Nova de Gaia, PRT
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36
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II. Wideochir Inne Tech Maloinwazyjne 2023; 18:379-400. [PMID: 37868279 PMCID: PMC10585467 DOI: 10.5114/wiitm.2023.127884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
| | - the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Lima MIDE, Fonseca Neto OCLDA. Acute abdomen in patients with covid-19: an integrative review. Rev Col Bras Cir 2023; 50:e20233576. [PMID: 37646728 PMCID: PMC10508665 DOI: 10.1590/0100-6991e-20233576-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients. METHODOLOGY this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective. RESULTS the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions. CONCLUSION the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.
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Affiliation(s)
| | - Olival Cirilo Lucena DA Fonseca Neto
- - Universidade de Pernambuco, Faculdade de Ciências Médicas - Recife - PE - Brasil
- - Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz (HUOC) - Recife - PE - Brasil
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38
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Hencke J, Loff S. Recurrent Sigmoid Volvulus in Children-Our Experience and Systematic Review of the Current Literature. Children (Basel) 2023; 10:1441. [PMID: 37761402 PMCID: PMC10528811 DOI: 10.3390/children10091441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Sigmoid volvulus (SV) occurs rarely in children. After encountering two cases of recurrent SV, we reviewed the literature to define the recurrence risk, identify outcome predictors and to give treatment recommendations. We found 256 cases reported in children (mean age 10.2 years, gender ratio (m:f) 2.3:1). Associations exist with Hirschsprung disease (HD) in 10%, neurodevelopmental disorders in 10.9% and chronic constipation in 10.2%. Common symptoms and clinical signs were abdominal pain (85%), distension (85%), tenderness (54%) and vomiting (59%). Signs of peritonitis were present in 14% and indicated a gangrenous sigmoid (X2 = 45.33; p < 0.001). A total of 183 had abdominal radiographs, and 65% showed a positive 'coffee-bean-sign'. Contrast enemas were positive in 90%. A total of 124 patients underwent laparotomy; in 41 cases, the sigmoid was gangrenous and associated with more complications (X2 = 15.68; p < 0.001). Non-operative treatment (NOT) like endoscopic, fluoroscopic or rectal tube decompression was performed in 135 patients and successful in 79% with a 38-57% recurrence rate. A total of 73 patients subjected to elective surgery: 50 underwent sigmoid resection; 17 had surgery for HD. Clinicians should consider SV in all children with abdominal pain, distension and vomiting. Gangrene carries a higher morbidity. After successful NOT we recommend counselling about the recurrence risk and definitive surgery should be advised. HD is frequent in newborns but sometimes found in older children.
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Affiliation(s)
- Jonathan Hencke
- Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, 70174 Stuttgart, Germany
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Vincent D, Mietzsch S, Braun W, Trochimiuk M, Reinshagen K, Boettcher M. Abdominal Wall Movements Predict Intra-Abdominal Pressure Changes in Rats: A Novel Non-Invasive Intra-Abdominal Pressure Detection Method. Children (Basel) 2023; 10:1422. [PMID: 37628422 PMCID: PMC10453286 DOI: 10.3390/children10081422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
(1) Background: As increases in intra-abdominal pressure (IAP) result in irreversible tissue damage, monitoring IAP in critically ill patients using the common urinary bladder catheter method is essential. However, this method can result in complications and is not suitable for very low birth weight neonates. The aim of this study was to establish a non-invasive and accurate method to detect IAP changes using an animal model. (2) Methods: IAP changes via intra-abdominal air application (up to 20 mmHg) were measured in 19 Wistar rats via an intra-abdominally placed intracranial pressure probe. Concurrently, abdominal surface tension was measured using a Graseby capsule (GC). (3) Results: A high correlation between abdominal wall distension and IAP (r = 0.9264, CI 0.9249-0.9279) was found for all subjects. (4) Conclusions: IAP changes in rats can be detected non-invasively using a GC. However, further studies are necessary to assess whether IAP changes can be measured using a GC in the neonatal population.
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Affiliation(s)
- Deirdre Vincent
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Mietzsch
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | | | - Magdalena Trochimiuk
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Pediatric Surgery, University Medical Center Mannheim, Heidelberg University, 69117 Heidelberg, Germany
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40
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Soga K, Mazaki M, Takakura S, Kitae H, Akamatsu N. Streptococcus pyogenes Infection-Induced Primary Peritonitis in a Healthy Adult Female: A Very Rare Causative Agent. Cureus 2023; 15:e43330. [PMID: 37700962 PMCID: PMC10493072 DOI: 10.7759/cureus.43330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
A 44-year-old woman with an unremarkable medical history presented to another hospital complaining of lower abdominal pain and nausea. The clinical presentation was consistent with an acute abdomen, raising suspicion of gastrointestinal tract perforation. However, imaging studies failed to provide evidence of perforation. Subsequently, the patient was diagnosed with peritonitis of unknown origin and promptly administered broad-spectrum antibiotics in a fasting state. Although the patient initially exhibited unstable symptoms, hemodynamics, and serology, she gradually improved over three days, with values approaching normal levels. On the sixth day of hospitalization, a follow-up abdominal computed tomography scan revealed pleural effusions, extensive ascites, and intra-abdominal stranding. The thickened wall of the small intestine and intra-abdominal stranding that were suggestive of peritonitis were further exacerbated. On the seventh day of hospitalization, aerobic and anaerobic blood cultures revealed the presence of Gram-positive cocci, later confirmed to be Streptococcus pyogenes, leading to the diagnosis of S. pyogenes infection-induced primary peritonitis. The source of infection was identified as a 10 mm hydrosalpinx in the left fallopian tube, suggesting the possibility of retrograde infection. The patient ultimately made a complete recovery without relapse and has been doing well since. This case report highlights a unique and rare occurrence of primary peritonitis caused by group A Streptococcus associated with infection from a hydrosalpinx in an otherwise healthy and young female patient. The diagnosis of primary spontaneous bacterial peritonitis in such an individual presents an uncommon clinical manifestation, emphasizing the importance of considering atypical sources of peritoneal infection in clinical practice.
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Affiliation(s)
- Koichi Soga
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, JPN
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Mika Mazaki
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Shun Takakura
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Hiroaki Kitae
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
| | - Naoaki Akamatsu
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, JPN
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41
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Maqbool U, Khan MA, Maqbool A, Aslam W, Naseem MA. The Management of Motor Neuropathy With Plasmapheresis in a Patient With Acute Porphyria: A Case Report. Cureus 2023; 15:e43196. [PMID: 37692664 PMCID: PMC10486296 DOI: 10.7759/cureus.43196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Acute porphyria results from a deficiency of enzymes crucial for the heme synthesis process. This deficiency leads to elevated levels of intermediates, resulting in the characteristic symptoms of porphyrias such as abdominal and limb pain, neuropsychiatric issues, and sensitivity to light. In this report, we present the case of a 15-year-old male who experienced deteriorating motor neuropathy and recurrent bouts of abdominal pain. Numerous investigations were conducted, eventually leading to a diagnosis of acute porphyria. Despite attempts with hemin and glucose therapy, his motor neuropathy did not improve. However, significant progress was observed following plasmapheresis sessions. This case emphasizes the importance of considering acute porphyrias as a potential cause when managing patients with acute abdominal problems. By fostering a collaborative approach involving hematologists, physicians, neurologists, and surgeons, timely diagnosis and effective management of this condition can be achieved.
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Mohamed AA, Alharbi M, Mohamed SA. Acute Abdomen Is a Rare Presentation of COVID-19 in the Absence of Respiratory Manifestations: A Case Report. Cureus 2023; 15:e42518. [PMID: 37637652 PMCID: PMC10457470 DOI: 10.7759/cureus.42518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Mild gastrointestinal symptoms and mild abdominal pain often occur in association with COVID-19. However, acute abdomen and severe abdominal pain warranting urgent surgical treatment are rare. Here we present the case of a 40-year-old man who presented with the clinical picture of a perforated duodenal ulcer. He was eventually found to have COVID-19 and was treated conservatively. In this report, we discuss his course of treatment and review the relevant literature.
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Affiliation(s)
- Abbas A Mohamed
- Department of General Surgery, King Salman Specialty Hospital, Hail, SAU
| | - Mohammed Alharbi
- Department of Surgery, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Sarah A Mohamed
- Department of General Surgery, University Hospital of Wales, Cardiff, GBR
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Erginel B, Mustafayeva N, Karadağ ÇA, Yanar F, Kebudi R, Tanyıldız HG, Tuğcu D, Berker N, İlhan B, Soysal FG. A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon. ULUS TRAVMA ACIL CER 2023; 29:798-805. [PMID: 37409928 PMCID: PMC10405033 DOI: 10.14744/tjtes.2023.64257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. METHODS We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. RESULTS Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. CONCLUSION Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.
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Affiliation(s)
- Basak Erginel
- Department of Pediatric Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Naila Mustafayeva
- Department of Pediatric Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Çetin Ali Karadağ
- Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Fatih Yanar
- Department of General Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, İstanbul University, Oncology Institute, İstanbul-Türkiye
| | | | - Deniz Tuğcu
- Department of Pediatric Hematology-Oncology, İstanbul University, İstanbul-Türkiye
| | - Neslihan Berker
- Department of Pathology, İstanbul University, İstanbul Medical Faculty, İstanbul-Türkiye
| | - Burak İlhan
- Department of General Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Feryal Gün Soysal
- Department of Pediatric Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
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44
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Cardoso VS, Sousa M, Campos Costa F, Pinto Gonçalves P, Guerreiro JM. Spontaneous Rupture of a Urinary Bladder Diverticulum in Women: A Rare Cause of an Acute Abdomen. Cureus 2023; 15:e42622. [PMID: 37637520 PMCID: PMC10460264 DOI: 10.7759/cureus.42622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
A bladder diverticulum (BD) is an abnormal pouch protruding from the bladder wall, which can be congenital or acquired. Acquired diverticula are more common, usually secondary to outflow obstruction or neurogenic bladder. Spontaneous rupture of a BD is rare, particularly in women. This report is about a female patient who develops abdominal pain and dysuria, progressing to an acute abdomen. The diagnosis of spontaneous rupture of a BD was suspected in pelvic ultrasound and confirmed in computed tomography (CT) cystography. The patient was submitted to diverticulectomy and bladder wall reconstruction. Although rare, this entity should be considered in patients with acute abdomen with unclear etiology, even in women with no evident risk factors for a BD or its rupture.
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Affiliation(s)
- Vasco S Cardoso
- General Surgery, Hospital de São Francisco Xavier, Lisbon, PRT
| | - Marta Sousa
- General Surgery, Hospital das Forças Armadas, Lisbon, PRT
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45
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Jarrad B, Ayasa LA, Abboushi MB, Judeh KA, Almasry N, Hamayel KA, Khader A. Intestinal Obstruction Unraveled: A Rare Case of Primary Sclerosing Encapsulating Peritonitis. Cureus 2023; 15:e42289. [PMID: 37609084 PMCID: PMC10441163 DOI: 10.7759/cureus.42289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
Primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon syndrome, is a rare condition characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. It is an uncommon cause of intestinal obstruction, as less than 300 cases have been reported from all over the world. We present the case of a 57-year-old male patient who presented with acute abdominal pain, nausea, vomiting, and constipation. A trial of conservative management failed, which warranted surgical intervention. Adhesiolysis was done, resulting in the relief of the intestinal obstruction caused by cocoon syndrome. The patient experienced excellent clinical improvement postoperatively and remained symptom-free during follow-up. Primary sclerosing encapsulating peritonitis poses a diagnostic challenge due to its rarity and nonspecific clinical presentation. A high index of suspicion, a thorough history review, a physical examination, and imaging studies are crucial for an accurate diagnosis. This case report emphasizes the importance of recognizing abdominal cocoon syndrome as a potential cause of intestinal obstruction and highlights the successful management of the condition. This is the first case of such a disease entity to be reported from Palestine.
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Affiliation(s)
- Bashar Jarrad
- General Surgery, Palestine Medical Complex, Ramallah, PSE
| | - Laith A Ayasa
- Internal Medicine, Al-Quds University, Jerusalem, PSE
| | - Mohammed B Abboushi
- Internal Medicine, An Najah National University Faculty of Medicine, Nablus, PSE
| | - Khaled A Judeh
- General Surgery, Palestine Medical Complex, Ramallah, PSE
| | - Nadeem Almasry
- General Surgery, Palestine Medical Complex, Ramallah, PSE
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Abramov D, Daniel R, Pellegrini JR, Rivera AP. Bacteremia Secondary to Epiploic Appendagitis (EA). Cureus 2023; 15:e41648. [PMID: 37565111 PMCID: PMC10411651 DOI: 10.7759/cureus.41648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Epiploic appendages are fat-filled sacs that are generally located along the surface of the large intestine. In most cases, epiploic appendagitis (EA) is described as an ischemic infarction of an epiploic appendage as the result of torsion or spontaneous thrombosis of the central draining vein of the epiploic appendage. The patient described in this report presented with a sudden onset of diffuse abdominal pain, nausea, and fever. CT scan of the abdomen and pelvis with oral contrast revealed EA of the sigmoid colon. Along the course of the admission, the patient became septic with blood cultures growing E. coli. In this case, we present a rare presentation of E. coli sepsis in the setting of EA, a usually uncomplicated and self-resolving presentation of abdominal pain.
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Affiliation(s)
- Daniella Abramov
- Plastic Surgery and General Surgery, New York Institute of Technology College of Osteopathic Medicine, New York, USA
| | - Rachel Daniel
- Internal Medicine, American University of the Caribbean School of Medicine, East Meadows, USA
| | | | - Ana P Rivera
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
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47
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Chaves C, Reigota C, Vilão F. Rare Cause of Cough-Induced Abdominal Pain. Cureus 2023; 15:e42530. [PMID: 37637526 PMCID: PMC10458406 DOI: 10.7759/cureus.42530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Rectus sheath hematoma is a rare cause of acute abdomen, and its clinical diagnosis is challenging without any imaging methods. We describe a case of a 50-year-old woman with no significant medical history who developed a sudden abdominal pain following a cough paroxysm. On physical examination, there was intense pain after light percussion and tenderness on palpation. Laboratory findings were within normal range. The imaging findings allowed us to diagnose a spontaneous rectus sheath hematoma. A conservative approach was opted. The patient had a favorable course. Accurate diagnosis is of the utmost importance as it may avoid unnecessary interventions, and in some cases, especially for elderly people, it can be fatal. This case alerts us to a rare cause of acute abdomen.
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Affiliation(s)
- Carlos Chaves
- Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Catarina Reigota
- Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Filipe Vilão
- Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
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48
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Tena Shale W, James Oriho L. A Rare Case of Ileo-Ileal Knotting: A Case Report. Cureus 2023; 15:e41903. [PMID: 37583747 PMCID: PMC10423849 DOI: 10.7759/cureus.41903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Small bowel obstruction due to ileo-ileal knotting is rare. Ileo-ileal knotting usually presents with clinical features of small bowel obstruction with rapid deterioration to bowel necrosis, and the management includes prompt surgical intervention. Here, we present a case of a 35-year-old patient who presented to our emergency room with severe non-radiating crampy abdominal pain for 18 hours. The patient underwent an emergency laparotomy as an intervention. Ileo-ileal knotting preoperative diagnosis is challenging due to its nonspecific presentation, the diagnosis is usually done intraoperatively, and the overall management of gangrenous ileo-ileal knotting is urgent laparotomy and en bloc resection of the gangrenous ileo-ileal knotting and anastomosis of the remaining viable bowel. If the bowel is viable, careful untying of the loops usually suffices. Ileo-ileal knotting should be considered in patients presenting with features of small bowel obstruction having rapid deterioration with signs of gangrenous bowel, and it requires urgent surgical intervention after adequate resuscitation.
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Affiliation(s)
- Wongel Tena Shale
- College of Public Health and Medical Sciences, Department of Surgery, Jimma University, Jimma, ETH
| | - Langa James Oriho
- College of Public Health and Medical Sciences, Department of Surgery, Jimma University, Jimma, ETH
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Al Jabran HA, Aljawad H, Chour M. Rectal Perforation Secondary to a Self-Administered Water-Hose Enema: A Case Report and Literature Review. Cureus 2023; 15:e42244. [PMID: 37605687 PMCID: PMC10440025 DOI: 10.7759/cureus.42244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Chronic functional constipation is a common condition that can have a significant impact on a patient's quality of life and healthcare costs. Hydrostatic enemas are a commonly observed practice among patients with chronic constipation. Rectal perforation is a rare yet serious complication that can be fatal if not diagnosed and treated promptly. Here, we present the case of an elderly lady with Parkinson's disease who presented with upper rectal perforation after using a hydrostatic enema and was treated with Hartmann's procedure. This case highlights the importance of having a low threshold for suspecting and diagnosing colorectal perforation in patients presenting with abdominal pain after receiving a hydrostatic enema.
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Wardeh AM, Sattout GIA, Mansour M, Suliman M, Alloush AM, Salloum R. Intussusception-induced acute abdomin caused by a giant lipoma in the transverse colon: a rare case report. Ann Med Surg (Lond) 2023; 85:3630-3633. [PMID: 37427163 PMCID: PMC10328658 DOI: 10.1097/ms9.0000000000000919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/14/2023] [Indexed: 07/11/2023] Open
Abstract
Intussusception is a common finding among children. Conversely, it is infrequent in adults. Colonic lipomas are generally clinically silent making them a very rare aetiology of intussusception. Presentation of case The authors present a case of a 48-year-old male who presented to the emergency department suffering from severe abdominal pain. Following examination and investigations, a giant lipoma (GL) in the transverse colon was identified via ultrasound which showed the classical "target sign" Intussusception among adults is unusual as it accounts for only 1% of bowel obstruction cases. Being colo-colonic makes it even more unlikely since it occurs only in 17% of intestinal obstruction cases. GLs exceeding 5 cm in size can present with a variety of symptoms. Intussusception is an uncommon presentation of a GL. Preoperative diagnosis of GL-induced intussusception is highly improbable and surgical resection is the treatment of choice. Conclusion Despite the dominance of the asymptomatic presentation of lipomas, considering its diagnosis in the case of an intussusception-induced acute abdomen should cross physicians' minds.
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Affiliation(s)
| | | | - Marah Mansour
- Faculty of Medicine, Tartous University, Tartous, Syria
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo clinic Hospital, Rochester, MN
| | - Mahmoud Suliman
- Department of General Surgery, Tishreen University Hospital, Lattakia
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