1/16. Abdominal pregnancy in a 67-year-old woman undetected for 37 years. A case report.BACKGROUND: Abdominal pregnancy is an exceedingly rare occurrence, but even more unusual is prolonged retention of an advanced abdominal pregnancy with lithopedion formation. We present the case of prolonged retention of an advanced abdominal pregnancy in an elderly women. CASE: A 67-year-old, white woman presented to the emergency department with abdominal pain. An acute abdominal series revealed a fetal skeleton extending from the patient's pelvis to her lower costal margins. Pelvic examination revealed a normal postmenopausal uterus, and human chorionic gonadotropin was negative. On further questioning the patient reported that she had become pregnant 37 years earlier and was diagnosed as having a "missed" pregnancy. She refused intervention at that time but suffered no untoward consequences. She reported having had later a healthy intrauterine pregnancy, delivered vaginally at term. No attempt was made to remove the prior missed abdominal pregnancy. The acute pain episode resolved, and there was no surgical intervention. CONCLUSION: Abdominal pregnancies can have a complex course, and management decisions can be difficult. This case presents an unusual outcome of an advanced abdominal pregnancy and illustrates a unique approach to management.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
2/16. Case report: portal vein thrombosis associated with hereditary protein c deficiency: a report of two cases.protein c deficiency is one of the causes of curable or preventable portal vein thrombosis. We report two patients of portal vein thrombosis associated with hereditary protein c deficiency. The first patient presented with continuous right upper quadrant pain and high fever. The abdominal sonography revealed normal liver parenchyma but portal vein and superior mesenteric vein thrombosis. Based on a 55% (normal 70-140%) plasma protein C level, he was diagnosed as having protein c deficiency. A trace of his family history showed that his elder brother also had protein c deficiency with a 50% plasma C level. Both patients received anticoagulant therapy. The younger brother showed good response. Unfortunately, the elder one suffered from recurrent episodes of variceal bleeding and received a life-saving splenectomy and devascularization. We herein remind clinicians that early screening and therapy are helpful in preventing late complications of protein c deficiency with portal vein thrombosis.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
3/16. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit.Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
4/16. Synchronous first manifestation of an idiopathic eosinophilic gastroenteritis and bronchial asthma.Eosinophilic gastroenteritis is a rare disease of the gastrointestinal tract in which the eosinophils seem to play an important role in the inflammation of the gut wall. We report on a case with a synchronous first manifestation of eosinophilic gastroenteritis and bronchial asthma, which also occurred synchronously in all further episodes. The diagnosis was first made at the end of the second episode during which the patient lost more than 13 kg in weight. Under steroid therapy, symptoms of both diseases disappeared quickly in the third episode. We assume that participation of the gastrointestinal tract in patients with bronchial asthma occurs more frequently than expected. In asthma patients with abdominal symptomatology, eosinophilic gastroenteritis should also be considered.- - - - - - - - - - ranking = 3keywords = episode (Clic here for more details about this article) |
5/16. Antiretroviral-induced hepatic steatosis and lactic acidosis: case report and review of the literature.As the prevalence of human immunodeficiency virus (hiv) infection continues to rise the clinician is encountered with a diagnostic challenge. Nonsurgical diseases such as acute colitis or enteritis can appear similar to such true surgical emergencies as abscess, perforation, or mesenteric ischemia. We report a case of fulminant hepatic failure associated with didanosine and masquerading as a surgical abdomen and compare the clinical, biologic, histologic, and ultrastructural findings with reports described previously. This entity should be kept in mind when evaluating the acute abdomen in the hiv-positive patient.- - - - - - - - - - ranking = 1466.4524668046keywords = lactic acidosis, acidosis (Clic here for more details about this article) |
6/16. A rare cause of acute abdomen: splenic infarction.splenic infarction is a rare disorder. We have treated 4 patients during the last year. abdominal pain in the left upper quadrant was the common complaint. Other complaints were fever, nausea and vomiting. Computed tomography showed infarcted areas in the spleen in all of the patients. splenectomy was applied to three of the patients with recurring symptoms. The other patient had the first episode treated medically. pulmonary embolism in one and surgical wound infection occurred in another patient during postoperative follow-up for nine (range: 4-14) months.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
7/16. Rectus sheath hematoma in an elderly woman under anti-coagulant therapy.Rectal sheath hematoma has been a well-known clinical entity from the ruin of the ancient greece. It is relatively rare, however, to encounter this abdominal disorder in the clinical setting. Furthermore, the initial symptoms of rectus sheath hematoma are often similar to those of acute abdominal disorders. Therefore, the majority of the patients with rectus sheath hematoma have been treated with operative procedures because of the difficulty of a differential diagnosis from other abdominal disorders. We recently treated a 74-year female diagnosed with rectus sheath hematoma with the anticoagulants after an episode of cerebral infarction. From the findings of the physical examinations, ultrasound, and computed tomography, we could correctly diagnose, and could treat her with completely conservative methods without any invasive techniques. It is stressed that it is important to recognize this entity of rectus sheath hematoma when patients are examined, after complaining of acute abdominal pain and with evidence abdominal masses in the clinical setting.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
8/16. Strangulated umbilical hernia including a mesenteric cyst: a rare cause of acute abdomen.Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen. In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
9/16. Severe acute necrotizing pancreatitis associated with lipoprotein lipase deficiency in childhood.An 11-year-old girl with lipoprotein lipase deficiency experienced recurring episodes of abdominal pain. She initially underwent appendectomy for suspected appendicitis; however, the appendix was normal. pancreatitis was subsequently identified as the cause of her pain.- - - - - - - - - - ranking = 1keywords = episode (Clic here for more details about this article) |
10/16. Hemorrhagic episodes in hemophiliacs simulating abdominal surgical emergencies.Hemophiliacs are subjected to develop episodes of spontaneous bleeding at different sites of the body, primarily the knees. On occasions, such episodes affect the abdomen. The picture engendered in such cases may mimic that of an abdominal emergency requiring surgical intervention. Such ill advised and unwarranted intervention may end with the patient's death. With the proper employment of radiology, the correct diagnosis may be reached and consequently, conservative treatment, in which factor viii plays the major role, instituted. Here, we describe the clinical course of 2 patients with hemophilia a who suffered bleeding in the abdomen and were treated conservatively with a successful outcome.- - - - - - - - - - ranking = 6keywords = episode (Clic here for more details about this article) |
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