1/7. A case of abscess caused by a penetrating duodenal ulcer.A case of abscess caused by a penetrating duodenal ulcer in a 34 year-old female patient is presented. She had a past history of duodenal ulcer and presented with a low grade fever which had persisted for 1 month. Abdominal ultrasound confirmed a hypoechoic mass and computed tomography revealed a low density area in the posterior side of the hepatoduodenal ligament. The common bile duct and portal vein were compressed. Mild peripheral enhancement was detected. laparotomy was performed and an abscess in the posterior side of the hepatoduodenal ligament was confirmed. The abscess was firmly adhered to the lesser curvature side of the bulbus and a penetrating duodenal ulcer scar was noted. In conclusion, this report describes a rare event where penetrating duodenal ulcer formed an abscess with only mild complaints.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/7. Ultrasound evidence of gas in the fissure for ligamentum teres: a sign of perforated duodenal ulcer.We present a case of confined duodenal ulcer perforation diagnosed on ultrasound. Locules of gas were visible in the fissure for ligamentum teres along with a small amount of free fluid in Morrison's pouch and thickening of the gall bladder wall. To our knowledge, "free" intraperitoneal gas confined to the fissure for ligamentum teres has not previously been reported as an ultrasound finding in perforated duodenal ulcer.- - - - - - - - - - ranking = 3keywords = ligament (Clic here for more details about this article) |
3/7. Anomalous peritoneal folds of the duodenum--a normal variant simulating disease.The double contrast barium meal appearance of four cases is presented where an anomalous peritoneal fold involves the duodenum. This fold results in a characteristic smooth, extrinsic indentation upon the antero-superior surface of the duodenal cap. This normal variant should be differentiated from distortion of this region due to pathology such as peptic ulceration. Anomalous peritoneal folds which involve the duodenum (cystoduodenal ligament, cysto-gastrocolic ligament) are not believed to cause symptoms (1). However, the recognition of the deformity produced by these folds is important, requiring differentiation from pathological changes.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/7. Extraluminal air bubble on computed tomography.We present two cases of gastrointestinal perforation associated with a tiny extraluminal air bubble on computed tomography (CT). The air bubble was located at the round ligament of the liver in a patient of perforated duodenal ulcer and at the intraperitoneal space adjacent to the perforated site of the anterior gastric wall in the other patient. A small amount of fluid was also seen at the round ligament in the second patient. The region of the round ligament of the liver should be carefully scrutinized for the presence of extraluminal air or fluid in patients with acute abdominal symptomatology.- - - - - - - - - - ranking = 1.5keywords = ligament (Clic here for more details about this article) |
5/7. Gastric aspiration in localization of gastrointestinal hemorrhage.We compared the findings from gastric aspiration for blood with the site of gastrointestinal (GI) hemorrhage ultimately identified by endoscopy or angiography in 1,190 patients whose cases were analyzed retrospectively and prospectively during a six-year period. Gastric aspirates were positive for blood in 837 patients. An upper GI site proximal to Treitz' ligament was identified in 93%, and none had a lower GI site. A negative aspirate was found in 353 patients; a lower GI site was identified in 60%, and 1% (three patients) had an upper GI site. In these three patients, hemorrhage occurred in clinical settings suggesting ulcer disease, and bleeding duodenal ulcers were found in all three. All of the other 180 patients with a bleeding duodenal ulcer had a positive gastric aspirate.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
6/7. Closure of an acute perforated peptic ulcer with the falciform ligament.When management of a perforated peptic ulcer necessitates simple closure, the omentum may not be of adequate quality to buttress such a closure. In this unusual circunstance, we have found the falciform ligament to serve as an effective alternative to satisfactorily peptic perforations.- - - - - - - - - - ranking = 2.5keywords = ligament (Clic here for more details about this article) |
7/7. Alternative laparoscopic management of perforated peptic ulcers.Surgery--namely, suture closure-is still the treatment of choice for perforated peptic ulcers, despite the proven efficacy of Taylor's conservative approach. Such conservative management, however, has been proven less effective in high-risk patients and those with perforations more than 12 h old. Here we suggest alternative laparoscopic treatments for perforated peptic ulcers. We have treated laparoscopically six patients (one F, five M; mean age 57.6 years; range 31-81 years); the mean duration of the operation was 52 min; the median hospital stay was 7 days (6-15 days); H2-blockers, antibiotics, and fluids were administered in the p.o. course; the follow-ups range from 6 to 18 months. On the basis of our experience, the treatment of choice for perforated peptic ulcers is Taylor's conservative procedure and laparoscopic drainage of the abdominal cavity when there is mild peritoneal reaction (usually less than 6 h from the onset of perforation). In case of remarkable peritonitis (usually more than 12 h), it is mandatory to add an accurate lavage. When the site of perforation is concealed by the peritoneal inflammation it should not be searched; when visible, it might be obliterated with the round ligament or an omental tissue strand, particularly if larger than 1 cm in diameter.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |