1/6. 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 = stable (Clic here for more details about this article) |
2/6. Inguinal mass due to an external supravesical hernia and acute abdomen due to an internal supravesical hernia: a case report and review of the literature.Although supravesical hernias were described as early as 1804, there have been fewer than 100 cases reported in the literature. The supravesical fossa is a triangular area bounded laterally and above by median and medial umbilical ligaments, and below by the peritoneal reflection that passes from the anterior abdominal wall to the dome of the bladder. A hernia starting in this fossa usually protrudes through the abdominal wall as a direct inguinal hernia (external supravesical hernia). Less commonly, it remains within the abdomen, passing into spaces around the bladder (internal supravesical hernia). A 43-year-old mill worker presented with an enlarged painful mass in the left groin. He underwent a surgical repair of a direct inguinal hernia without addressing an unrecognized supravesicular component. Eight hours after his discharge next morning, he presented with acute abdomen, nausea, vomiting, and abdominal distention. The second surgery revealed the presence of a left lateral internal supravesical hernia with incarcerated small bowel. This was also repaired, and the patient was discharged in stable condition. This report aims to review and discuss the surgical anatomy of these rare supravesical hernias and calls attention to this type of hernia as an unusual cause of small bowel obstruction.- - - - - - - - - - ranking = 0.25keywords = stable (Clic here for more details about this article) |
3/6. Small bowel obstruction by the silicone tube of the gastric band.A wide range of operations are used today for morbid obesity. Adjustable gastric banding (AGB) is one of the most widespread. Numerous complications after AGB are known, namely gastric perforation, band slippage, penetration of the band into stomach, port disconnection, port-site infection, etc. The authors present a case of small bowel obstruction caused by the intra-abdominal silicone tube of the gastric band in a woman with AGB performed 9 years before, with a very good result and considerable weight loss. She was operated as an emergency, and part of the terminal ileum was found incarcerated around and between the silicone tube and the anterior abdominal wall. Bowel resection for intestinal necrosis, with terminal ileostomy, was performed, followed 1 month later by an end-to-end ileo-ileal anastomosis. The patient recovered without sequelae.- - - - - - - - - - ranking = 0.25keywords = stable (Clic here for more details about this article) |
4/6. Diagnostic peritoneal lavage for assessing acute abdomen in pediatric oncology and stem cell transplantation patients.Diagnostic peritoneal lavage (DPL) is a technique designed to sample the peritoneal cavity for evidence of catastrophic pathology, while incurring minimum risk. The authors describe two unstable pediatric patients, one with acute lymphoblastic leukemia and shock and one with fanconi anemia on high-frequency oscillation after stem cell transplantation, both presumed to have intra-abdominal perforation. DPL was uneventfully performed at the bedside in both patients. The authors suggest DPL be considered as an alternative to laparotomy in critically ill pediatric oncology and stem cell transplantation patients.- - - - - - - - - - ranking = 0.25keywords = stable (Clic here for more details about this article) |
5/6. Abdominal catastrophes.The patient in our case report presented with an acute abdomen but stable vital signs and ABCs. The differential diagnosis initially included most of the entities discussed in this chapter. The ECG ruled out an acute MI. The patient improved with IV hydration and oxygen administration. Abdominal x-ray films ruled out a bowel obstruction, and chest x-ray films ruled out a pulmonic process. Laboratory tests revealed hemoconcentration and leukocytosis. No other laboratory test results were abnormal. While waiting for the surgeon to arrive, the patient remains stable, so the ED physician orders a CT scan of the abdomen. Taking another look at the plain x-ray films, the emergency physician in our case presentation sees a suggestion of free air under the right hemidiaphragm above the liver on the CXR and between the liver and the right abdominal wall on the decubitus ABD x-ray. The CT scan confirms the presence of free air within the peritoneal cavity, and the patient is taken to surgery for an exploratory laparotomy. The final diagnosis is perforated peptic ulcer. With hindsight, the patient and wife recall a previous diagnosis of a possible ulcer in the past.- - - - - - - - - - ranking = 0.5keywords = stable (Clic here for more details about this article) |
6/6. Emergency laparotomy immediately after coronary bypass.Eight patients required emergency laparotomy in the immediate postoperative period after coronary artery bypass (CAB). Cardiac complications were few and minor. sepsis was the major cause of mortality. In the two patients who died, delay in operative management contributed to their deaths. The lack of cardiac causes of morbidity and mortality in our series and others suggests that a stable postoperative coronary bypass patient represents a better surgical risk than the same patient preoperatively. Therefore, aggressive management, including early laparotomy, for suspected intra-abdominal pathology after CAB is recommended to avoid uncontrollable sepsis and death.- - - - - - - - - - ranking = 0.25keywords = stable (Clic here for more details about this article) |