1/11. Peritoneal implanted hepatocellular carcinoma with rupture after TACE presented as acute appendicitis.We are reporting a rare case of peritoneal implanted hepatocellular carcinoma with rupture after transarterial chemoembolization mimicking acute appendicitis. A 45-year-old male patient presented with fever and manifestations of acute appendicitis. He received transarterial chemoembolization for hepatocellular carcinoma two months before. Emergent exploratory laparotomy revealed a normal appendix, a ruptured nodule located at the serosal surface of the terminal ileum with hemoperitoneum, and ruptured hepatocellular carcinoma at the junction of segments 4 and 8 of the liver. There was no peritoneal carcinomatosis, direct invasion to the surrounding tissue, or lymph node involvement. Postoperative course was uneventful. Histopathological examination of the resected nodule revealed metastatic hepatocellular carcinoma.- - - - - - - - - - ranking = 1keywords = plant (Clic here for more details about this article) |
2/11. Primary ruptured ovarian pregnancy in a spontaneous conception cycle: a case report and review of the literature.Ovarian pregnancy is an uncommon presentation of ectopic gestation, where the gestational sac is implanted within the ovary. Usually, it ends with rupture, which occurs before the end of the first trimester. Its presentation often is difficult to distinguish from that of tubal ectopic pregnancy and hemorrhagic ovarian cyst. We describe a case of primary ovarian pregnancy in a 31-year-old patient who presented to the emergency room with symptoms and signs of peritonism and positive urine hCG test. The gestation sac was demonstrated in the right ovary by transvaginal sonography. MSD (mean sac diameter) was 15 mm corresponding to the sixth gestational week. Free fluid was found in the Douglas pouch. Culdocentesis was positive for hemoperitoneum. Henceforth, emergency laparotomy and wedge resection of the ovary was perfomed. Aetiological, clinical and therapeutical aspects of this rare extrauterine pregnancy are described. Also, the problems of its differential diagnosis are discussed.- - - - - - - - - - ranking = 0.2keywords = plant (Clic here for more details about this article) |
3/11. Cutaneous squamous carcinoma leading to acute abdomen after renal transplantation.skin carcinoma is the commonest malignant complication of renal transplantation. We report the first case of a renal transplant recipient who presented with ileal obstruction as a consequence of squamous cell carcinoma metastases to the small intestine. This complication highlights the unusual presentation of malignancies associated with prolonged exposure to immunosuppression and the need for extra vigilance in such cases.- - - - - - - - - - ranking = 1.2keywords = plant (Clic here for more details about this article) |
4/11. Acute loss of the small bowel in a school-age boy. Difficult choices: to sustain life or to stop treatment?A 9-year-old boy lost almost all his small bowel after an acute volvulus due to a congenital, but previously unsuspected malrotation. survival using total parenteral nutrition is possible in these cases, but the medical burden is heavy. Small intestinal transplantation was performed for the first time in the netherlands in 2001 and this patient was treated 3 years earlier. The results of bowel transplantation are not as good as in kidney or liver transplantation. A method of Ethical Case Deliberation helped to elucidate the importance of each contribution in the discussion and provided space and a broad basis for decision-making. The parents refused to allow parenteral nutrition to be started because of the bad prospects for quality of life in the future and the medical team, after thorough deliberation with specialists throughout the country, and consultation of the literature, agreed. CONCLUSION: Despite the many different opinions, the parents felt accepted in their refusal of treatment for their son and the team accepted the decision.- - - - - - - - - - ranking = 0.6keywords = plant (Clic here for more details about this article) |
5/11. Abdominal actinomycosis presenting as a small-bowel obstruction.A 48-year-old female, presented as a case of acute abdomen with a small-bowel obstruction and a palpable hypogastric mass, was urgently operated. laparotomy revealed a tumor mass of unknown origin that included a loop of the small bowel by compressing it. Resection of the tumor including a portion of the large and small bowel was performed, and pathohistological examination revealed actinomycosis. The cause of abdominal actinomycosis in this patient could be the implantation of an intrauterine device nine years prior to the operation.- - - - - - - - - - ranking = 0.2keywords = plant (Clic here for more details about this article) |
6/11. 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 = 1.2keywords = plant (Clic here for more details about this article) |
7/11. Intestinal invasion and disseminated disease associated with penicillium chrysogenum.BACKGROUND: Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts. CASE PRESENTATION: A 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for penicillium chrysogenum and the patient completed a 6 week course of amphotericin b lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection. DISCUSSION: penicillium chrysogenum is a rare cause of infection in immunocompetent patients. diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin b. The clinical utility of newer antifungal agents remains to be determined.- - - - - - - - - - ranking = 0.2keywords = plant (Clic here for more details about this article) |
8/11. Acute abdomen by varicella zoster virus induced gastritis after autologous peripheral blood stem cell transplantation in a patient with non-Hodgkin's lymphoma.We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's lymphoma with abdominal manifestation undergoing autologous peripheral blood stem cell transplantation after high-dose chemotherapy in April 2003. About 4 months after transplantation, he developed severe upper abdominal pain. Ultrasound examination, X-ray, computed tomography of the abdomen and cardiac diagnostics could not explain the symptoms. While empiric therapy with high-dose acyclovir was started, we could document herpetic lesions in the gastric antrum by endoscopy. The epigastric pain rapidly decreased within several days after the start of acyclovir therapy. No herpetic skin lesions were observed at any time during the disease. This report demonstrates the importance of viral-induced gastritis in the differential diagnosis of severe abdominal pain in patients receiving autologous peripheral blood stem cell transplantation.- - - - - - - - - - ranking = 1.4keywords = plant (Clic here for more details about this article) |
9/11. Posttransplant lymphocele presenting as 'acute abdomen'.Lymphoceles occurring after renal transplantation are frequently asymptomatic and are usually identified on routine ultrasonography of the allograft. A small percentage of them may increase in size and manifest due to their compression effects on adjacent structures or as lymphocutaneous fistula. An infected lymphocele would, in addition, give rise to local and systemic features. A case of infected lymphocele occurring 4.5 months after cadaveric renal transplant is reported. The patient presented in septicemia and features of generalized peritonitis. Emergency diagnostic laparoscopy revealed fluid collection in the peritoneal cavity. However, on exploratory laparotomy no intra-abdominal pathology was detected. Further evaluation revealed a large perigraft lymph collection which was drained percutaneously. Fluid and blood cultures grew staphylococcus aureus. The patient recovered completely following external drainage and antibiotic administration.- - - - - - - - - - ranking = 1.2keywords = plant (Clic here for more details about this article) |
10/11. pneumatosis cystoides intestinalis with abdominal free air in a 2-year-old girl after allogeneic bone marrow transplantation.A 2-year-old girl with acute lymphoblastic leukemia (ALL) showing a t(4;11)(q21;q23) karyotype underwent allogeneic bone marrow transplantation (BMT) with the conditioning regimen of L-PAM (70 mg/m2/d for 3 days), busulfan (140 mg/m2/d for 2 days), and total body irradiation (12 Gy). On day 57, the patient developed pneumatosis cystoides intestinalis (PCI) when she received cyclosporin A and corticosteroids for graft-versus-host disease (GVHD). Because of the presence of massive abdominal free air and the suspicion of peritonitis, she underwent surgical intervention, which, however, revealed neither intestinal perforation nor peritoneal infection. She recovered from PCI in 10 days with nasogastric suction, fasting, and systemic broad-spectrum antibiotics. PCI with massive abdominal free air after BMT should be manageable by conservative therapy alone.- - - - - - - - - - ranking = 1keywords = plant (Clic here for more details about this article) |
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