1/20. Abdominal distention and shock in an infant.Acute abdominal distention in the pediatric patient may be attributable to extraperitoneal fluid, masses, organomegaly, air, an ileus, a functional or mechanical bowel obstruction, or injury and blood secondary to trauma. An infant who presents to the emergency department with acute abdominal distention and shock is a true emergency for which the differential diagnosis is extensive. An unusual case of abdominal distention, ascites, hematochezia, and shock in an infant, subsequently found to have spontaneous perforation of the common bile duct is reported. This uncommon cause of abdominal distention and shock in an infant is many times left out of the differential diagnosis of an acute abdomen. The presentation may be as an uncommon acute form or a classis subacute type. This patient had hematochezia, which had not been previously reported in association with this entity. Failure to recognize and treat an acute abdomen can result in high mortality.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/20. Metastasis from small cell carcinoma of the lung producing acute appendicitis.A case of acute gangrenous appendicitis with perforation caused by metastatic small cell carcinoma of the lung in a 65 year old man is reported. The manifestation of appendicitis occurred more than 4 years after the diagnosis of the bronchogenic carcinoma. With longer survival of patients with disseminated tumors it is probable that new manifestations of those malignancies will be discovered. Acute appendicitis due to metastasis from a distant neoplasm should be considered in the differential diagnosis of right lower abdominal pain in the oncology patient.- - - - - - - - - - ranking = 4.2738380044582keywords = lung (Clic here for more details about this article) |
3/20. Sigmoid colon rupture secondary to Crede's method in a patient with spinal cord injury.Crede's method is a manual suprapubic pressure exerted with a clenched fist or fingers, used to initiate micturition, in patients with spinal cord injury (SCI) who have neurovesical dysfunction. It is usually a benign maneuver unassociated with any major complications. This paper will illustrate a case report involving a sigmoid colon rupture secondary to Crede's method in a patient with SCI. Various techniques of Crede's method are briefly described. It is recommended that patients with quadriplegia avoid forceful use of Crede's method, as it may cause contusion of the abdominal wall and injuries to internal viscera, possibly leading to colonic rupture. It is believed that this is the first reported case of such an unusual complication of Crede's method in patients with SCI.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
4/20. pneumonia presenting as acute abdomen in children: a report of three cases.From 10th September 1998 till 5th June 1999, the Paediatric and Cardiothoracic Surgery Units of Sultanah Aminah Hospital Johor Bahru managed three children with lung collapse secondary to pneumonia. The dominant initial clinical presentation in all three cases was acute abdominal pain. Basal pneumonia was diagnosed in two cases post-operatively after surgical contributory causes were excluded intra-operatively. thoracotomy, evacuation of infected debris and decortication of the collapsed lung was done in all three cases. In children presenting with acute abdominal pain, basal pneumonia should be considered as a possible contributory cause.- - - - - - - - - - ranking = 1.7095352017833keywords = lung (Clic here for more details about this article) |
5/20. Delayed splenic rupture: an unusual cause of acute surgical abdomen.Authors describe an unusual case of acute abdomen after the traffic injury. They remind correct diagnosis of delayed splenic rupture and compare it with other literature findings.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
6/20. Fulminant ischaemic colitis with atypical clinical features complicating sickle cell disease.Clinically significant ischaemic bowel injury is an exceedingly rare complication of sickle cell disease. It manifests as acute surgical abdomen and may respond to conservative treatment. An unusual fatal case of ischaemic colitis with minimal abdominal findings in a young male during a sickle cell vaso-occlusive pain crisis is described. This case demonstrates that an acute surgical abdomen should be considered in such patients who fail to respond to conservative management as untreated this condition may be fatal.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
7/20. Gastric perforation due to the ingestion of a hollow toothpick: report of a case.A perforation due to the ingestion of a toothpick is a condition seldom seen in the stomach. We herein describe an 80-year-old woman with a perforation of the stomach due to an ingested hollow toothpick. The toothpick was easily removed during a mini-laparotomy. The site of perforation was closed with absorbable sutures and omentum was used to function as an overlying patch. The postoperative course was uncomplicated. The hollow toothpick functioned as a fistula between the contents of the stomach and the peritoneal cavity. This resulted in a very different clinical picture from that observed in "classical wooden" toothpick injury, where the toothpick is not able to function as a fistula. To the best of our knowledge, this is the first description of a hollow toothpick perforating the stomach. A hollow toothpick perforation must be considered in any patient with symptoms of intestinal perforation, even when there is no history of swallowing toothpicks. Removal of a toothpick and subsequent suturing of the puncture site is a simple and relatively minor surgical procedure, which may have a lower morbidity and mortality as compared to other causes of gastric perforation. A precaution to observe, is the potential danger that one of the members of the operating team might perforate a finger.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
8/20. Pain as a presenting feature of acute abdomen in spinal injuries.The diagnosis of acute abdomen can be difficult in patients with spinal injuries. We reviewed all the 1039 case records of patients admitted with spinal injuries to the Queen Elizabeth National spinal injuries Unit, Glasgow over a 7-year-period and found 5 (0.48%) cases of acute abdomen that required surgical intervention and were not caused by original injury. Their presenting signs and symptoms were analysed. Pain was found to be an unreliable symptom in these patients.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
9/20. diagnosis of the acute abdomen in the neurologically stable spinal cord-injured patient. A case study.The diagnosis of the acute abdomen in the spinal cord injured patient is difficult. Diagnoses are often so delayed that approximately 10% of these patients die of acute abdominal problems. The presentation also varies with the level and duration of injury. An understanding of the functional neuroanatomy of the abdominal wall and viscera aids in timely diagnosis. I present an illustrative case and describe the pertinent functional neuroanatomy.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
10/20. Peritoneoscopic placement of peritoneal dialysis catheter and bowel perforation: experience of an interventional nephrology program.BACKGROUND: Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters. methods: The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique. RESULTS: Six (0.8%) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83%) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention. CONCLUSION: Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
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