1/16. 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 = vein (Clic here for more details about this article) |
2/16. Acute abdomen due to torsion of a pedunculated mesenteric fibroma.A case history of a boy with an acute abdomen due to torsion of a pedunculated mesenteric fibroma is presented. A review of the literature shows that only a relatively small number of mesenteric fibromata have been reported. In these cases the tumor was described as growing between the two leaves of the mesentery. The symptoms these tumors gave usually were due to the size of the tumor and compression of adjacent organs. The present case is unusual because of the pedunculated nature of the fibroma and its presentation as an acute abdomen.- - - - - - - - - - ranking = 0.55460989937962keywords = compression (Clic here for more details about this article) |
3/16. Spontaneous rupture of a dissection of the left ovarian artery.A 53-year-old female was suddenly hospitalized with acute left lateral abdominal pain. There was no history of trauma to the abdomen. She had received no abdominal operation. X-ray showed a soft tissue shadow in the left flank which displaced the bowel shadows medially. Plain abdominal CT showed a left retroperitoneal hematoma. Dynamic abdominal CT showed an outflow of medium from a blood vessel in the hematoma. At laparotomy, the source of bleeding was found to be the left ovarian artery. The ovarian artery was dilated and meandered remarkably. The ovarian artery and vein were ligated proximally and left adenectomy was performed. The patient made an uneventful recovery. Histological examination suggested a spontaneous rupture of a dissection of the left ovarian artery.- - - - - - - - - - ranking = 0.11111111111111keywords = vein (Clic here for more details about this article) |
4/16. Portal venous air in an adult patient with obstructive small bowel volvulus.BACKGROUND: diagnosis of small bowel volvulus is frequently delayed often resulting in bowel ischaemia and infarction and impairing clinical outcome. Instant and correct diagnosis and subsequent adequate surgery may improve the outcome. methods: We describe a 19-year-old female with small bowel obstruction due to volvulus in whom the diagnosis was suspected based on the finding of air in the bowel wall and in the portal vein on a plain abdominal radiograph. CONCLUSIONS: air, present in the portal vein and bowel wall on a plain abdominal X-ray, suggests bowel ischaemia or necrosis and that the need for laparotomy is urgent.- - - - - - - - - - ranking = 0.22222222222222keywords = vein (Clic here for more details about this article) |
5/16. Midgut volvulus in an adult patient.The authors report on a case of midgut volvulus in a 27-year-old man who presented with bilious vomiting and acute abdominal pain. US demonstrated a reversal of the normal relationship between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). A clockwise whirlpool sign, diagnostic for midgut volvulus, was not visualised. In a further assessment, upper gastrointestinal series demonstrated obstruction in the second part of the duodenum highly suspicious of Ladd's bands. Malpositioning of bowel structures, as already suggested by the reversal of the SMA and SMV on ultrasound, and a distinctive whirl pattern due to the bowel wrapping around the SMA was demonstrated on CT. Furthermore angiography revealed focal twisting of the SMA. US is the first imaging modality to perform in suspicion of midgut volvulus. When inconclusive, CT is in our opinion the next stage in the diagnostic work-up.- - - - - - - - - - ranking = 0.11111111111111keywords = vein (Clic here for more details about this article) |
6/16. Antiphospholipid antibodies and splenic thrombosis in a patient with idiopathic myelofibrosis (antiphospholipid antibodies and thrombosis).A case of idiopathic myelofibrosis and hepatosplenic myeloid metaplasia associated with antiphospholipids antibodies is described. The patient developed a lethal complete splenic vein thrombosis in spite of an intravenously heparin treatment had been started soon after a clinical pattern of "acute abdomen".- - - - - - - - - - ranking = 0.11111111111111keywords = vein (Clic here for more details about this article) |
7/16. Conservative laparoscopic management of ovarian teratoma torsion in a young woman.Benign cystic tumors, specifically dermoid or mucinous cysts, are the most frequent causes of ovarian torsion. In clinical practice, adnexal torsion is usually subjected to adnexectomy to prevent embolism of thrombosed ovarian veins and its sequelae. However, this intervention is unsatisfactory for young women who want to preserve their fertility. In such situations, conservative management with untwisting of the adnexa, followed by cystectomy to preserve part of the ovary, would be a better option. In this report, we present a case of adnexal torsion due to cystic teratoma. A 25-year-old unmarried woman with lower abdominal pain and nausea was referred to our emergency room with suspicion of an ovarian mass. ultrasonography showed a left ovarian mass measuring 9.7 x 6.5 x 6.2 cm with heterogeneous components within it. laparoscopy showed an enlarged, dusky left ovary with torsion. Detorsion was performed and followed by cystectomy. The pathology revealed cystic teratoma of the ovary. We report this case to emphasize that untwisting of potentially viable adnexa, followed by cystectomy, in patients with adnexal torsion appears to be a safe procedure. This conservative approach should be encouraged in women of childbearing age to reduce the possibility of premenopausal loss of ovarian function.- - - - - - - - - - ranking = 0.11111111111111keywords = vein (Clic here for more details about this article) |
8/16. Traumatic intramural hematoma of the duodenum: report of one case.Traumatic intramural hematoma of the duodenum is a rare entity in children. A high clinical index of suspicion is necessary for early and accurate diagnosis. We report a 10-year-old girl presenting with a sudden onset of epigastralgia after impact on the epigastrium by the edge of a wooden bed while playing on it. Symptoms of high gastrointestinal obstruction were severe, with bilious and large amounts of nasogastric effluent. Image studies revealed a large hematoma extending from the second to the third portion of the duodenum. Her condition was managed successfully by conservative treatments with nasogastric decompression and total parenteral nutrition. Her hospital course was uneventful. This report serves as a reminder to clinicians to consider intramural hematoma of the duodenum in the differential diagnosis of blunt abdominal trauma.- - - - - - - - - - ranking = 0.55460989937962keywords = compression (Clic here for more details about this article) |
9/16. Computed tomography findings in fatal cases of enormous hepatic portal venous gas.AIM: To assess the computed tomography (CT) findings in the patients with hepatic portal venous gas (HPVG) who presented with a short fatal clinical course in our hospital in order to demonstrate if there was any sign for prediction. methods: Between January 1997 and December 2000, CT scan of the abdomen was performed on 949 patients with acute abdominal pain in our emergency department. Five patients were found having HPVG. The CT images and clinical presentations of all these five patients were reviewed. RESULTS: In reviewing the CT findings of the cases, HPVG in bilateral hepatic lobes, abnormal gas in the superior mesenteric veins, small bowel intramural gas, and bowel distension were observed in all patients. Dry gas in multiple branches of the mesenteric vein was also revealed in all cases. All the patients expired due to irreversible septic shock within 48 h after their initial clinical presentation in emergency room. Two patients had acute pancreatitis with grade D and E Balthazar classification and they expired within 24 h due to progressing septic shock under aggressive medical treatment and life support. Two patients with underlying end stage renal disease expired within 48 h even though emergent surgical intervention was undertaken. The excited bowels revealed severe ischemic change. One patient expired only a few hours after the CT examination. CONCLUSION: HPVG is a diagnostic clue in patients with acute abdominal conditions, and CT is the most specific diagnostic tool for its evaluation. The dry mesenteric veins are the suggestive fatal sign, especially for the deteriorating patients, with the direct effect on gastrointestinal perfusion.- - - - - - - - - - ranking = 0.33333333333333keywords = vein (Clic here for more details about this article) |
10/16. Acute abdomen as the first presentation of pseudomembranous colitis.Acute abdomen was the presenting manifestation of pseudomembranous colitis in six men who had previously been treated with antibiotics and presented with abdominal distention, pain, fever, and leukocytosis with absent or mild diarrhea. Plain abdominal radiographs revealed megacolon in two, combined small and large bowel dilation in three, with one of them showing volvuluslike pattern, and isolated small bowel ileus in one. Emergency colonoscopy was performed successfully in all patients and revealed pseudomembranes in five and nonspecific colitis in one. All patients had positive latex test results for clostridium difficile, and two tested positive for cytotoxicity. All patients were treated with IV metronidazole, resulting in resolution of symptoms and abdominal findings. In addition, two patients underwent colonoscopic decompression with improvement. Endoscopically, complete resolution of the pseudomembranes occurred at 4 weeks in all cases. No patient had a recurrence. It is concluded that (a) pseudomembranous colitis may present as abdominal distention mimicking small bowel ileus. Ogilvie's syndrome, volvulus, or ischemia; (b) in such cases, emergency colonoscopy is safe and useful for diagnosis and therapeutic decompression and may obviate the need for surgery; and (c) treatment with IV metronidazole is effective. colitis due to C. difficile should be considered in the differential diagnosis of acute abdomen in patients previously treated with antibiotics.- - - - - - - - - - ranking = 1.1092197987592keywords = compression (Clic here for more details about this article) |
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