| A case of terminal ileitis, mesenteric lymphadenitis and appendicitis is reported. Serological studies indicated infection with yersinia pseudotuberculosis type VA. The patient's illness ran a chronic course necessitating resection of the terminal ileum. Histological examination of the appendix and a mesenteric lymph node in the acute stage revealed granulomas with central necrosis. This is the first human case in which the subtype VA has been identified. ( info) |
2/39. Acute postoperative dermatosis at the site of the electrocautery pad: sweet diagnosis of a burning issue. Acute febrile neutrophilic dermatosis or Sweet's syndrome is a well-described acute condition with possible paraneoplastic and inflammatory associations. A case of a 49-year-old man with a prior history of Hodgkin's disease is described, who underwent a laparotomy for operative treatment of a small intestinal stricture and therapy-refractory gastroesophageal reflux. Incidentally, mild mesenteric lymphadenopathy was encountered, and a biopsy confirmed the presence of a new, unrelated low-grade follicular lymphoma. Two weeks postoperatively, the patient developed a tender erythematous plaque at the site of the Bovie electrocautery pad on the proximal thigh. Over the following week, the affected area extended in size, and became markedly edematous and infiltrated, with hemorrhagic surface studding. Multiple small plaques, some with annular arrays of pustules, were found on the opposite lower extremity, the lower back, and the arms. A skin biopsy suggested the presence of Sweet's syndrome, and corticosteroid treatment was initiated. All cutaneous manifestations disappeared within 48 h except for the presence of postinflammatory erythema. Acute neutrophilic dermatoses have not been previously described in this postoperative presentation. The differential diagnostic importance of this emergent entity and the potential for it being caused by surgical trauma are discussed. ( info) |
3/39. Agenesis of the vermiform appendix. Agenesis of the vermiform appendix is very rare. The incidence is estimated to be one in 100,000 laparotomies for suspected appendicitis. Several criteria have to be met before the investigator can conclude that the appendix is congenitally absent. This case is reported to bring this entity to the attention of surgeons who may encounter a similar situation during celioscopy. A 29-year-old patient was admitted through the emergency room with the chief complaint of abdominal pain. Acute appendicitis was suspected, and he was accordingly prepared for celioscopy. This report presents a patient with vermiform appendix agenesis diagnosed at celioscopy with concomitant mesenteric lymphadenitis. Agenesis of the vermiform appendix is very rare, and the diagnosis should not be made unless the ileocecal and retrocecal area are thoroughly explored. ( info) |
4/39. Acute mesenteric and retroperitoneal lymphadenitis in systemic lupus erythematosus: case report. In a young woman with clinical evidence of acute cutaneous, musculoskeletal, and neurologic manifestations of systemic lupus erythematosus, computed tomography (CT) showed enlarged, centrally hypoattenuating mesenteric and retroperitoneal lymph nodes. After treatment with steroids, the CT appearance of the lymph nodes returned to normal. The differential diagnosis of lymph nodes with central hypoattenuation includes mycobacterium tuberculosis infection, metastatic disease (especially squamous cell carcinoma and germ cell tumor), Whipple's disease, and celiac disease in addition to lupus lymphadenitis. ( info) |
| Salmonella spp. infections can be particularly challenging when they manifest as acute abdominal problems and lead to emergency surgery. Examples of such serious conditions are Salmonella-related intestinal perforation, gallbladder involvement, salpingitis, and peritonitis. mesenteric lymphadenitis associated with salmonella typhimurium mimics acute appendicitis and can make it difficult to establish a timely and definitive diagnosis in young patients who present with right lower abdominal pain. Paralytic ileus is a fairly common manifestation of Salmonella infection at all ages, but complete intestinal obstruction requiring surgical intervention is very rare. Because of the nature of the diagnostic process, a significant number of patients with Salmonella infection present with acute abdomen and undergo needless operations. This report describes the cases of 2 pediatric patients who underwent surgery to address persistent pain in the right lower abdominal quadrant and complete intestinal obstruction, respectively. The first patient had inflamed mesenteric lymph nodes that caused appendicitislike symptoms, and the second had dense adhesions between the mesentery and the terminal segments of the ileum that led to intestinal blockage. serology results showed that both patients' titers for BO ("B and O agglutinating [BO]") antibodies rose to 1:640 in the week after their admission to hospital, a pattern and level that is indicative of S typhimurium infection. J Pediatr Surg 36:1849-1852. ( info) |
6/39. appendicitis-like syndrome owing to mesenteric adenitis caused by Salmonella typhi. We report a 14-year-old girl who presented with signs of appendicitis and had her appendix removed. She subsequently proved to have mesenteric adenitis owing to Salmonella typhi which responded to treatment with ceftriaxone. ( info) |
7/39. Mesenteric tuberculosis with jejunal infiltration. A 69-year-old female was admitted to our hospital because of asthenia, anorexia and 20 kg weight loss. An ultrasound study and computerized tomography (CT) imaging revealed a mesenteric mass and laparotomy was performed. The diagnosis was mesenteric tuberculosis with jejunal involvement. This represents an atypical onset of tuberculosis in a non-immunosuppressed patient. ( info) |
| An unusual case of chronic intussusception, without any digestive sign, secondary to mesenteric lymphadenitis caused by yersinia enterocolitica is reported. Operative reduction by taxis was performed but ileopexy and antibiotic treatment were also carried out to reduce chances of recurrent intussusception. ( info) |
9/39. A palpable right lower abdominal mass due to Yersinia mesenteric lymphadenitis. infection by yersinia pseudotuberculosis has become of increasing pathological importance. This report describes the case of a 12-year-old female with mesenteric lymphadenitis due to yersinia pseudotuberculosis. The patient presented with fever, abdominal pain, and a palpable right abdominal mass. Abdominal ultrasonic imaging and computerized axial tomography (CT) revealed a mass. An exploratory laparotomy was performed, followed by appendectomy and mesenteric lymph node biopsy. The diagnosis of Yersinia infection was confirmed by serology and bacterial culture of the biopsy material. This condition should be considered in patients with a right lower abdominal mass and symptoms similar to those of appendicitis. ( info) |
10/39. pneumonia and mesenteric lymphadenopathy caused by disseminated penicillium marneffei infection in a cadaveric renal transplant recipient. A38-year-old cadaveric kidney transplant recipient presented with fever, pneumonia, and mesenteric lymphadenopathy 9 months after transplant. blood culture, bone marrow culture, and fine-needle aspiration cytology of mesenteric lymph nodes confirmed the diagnosis of disseminated penicillium marneffei infection. He recovered after receiving parenteral amphotericin b followed by oral itraconazole therapy. P. marneffei infection is a dimorphic fungal opportunistic infection endemic in Southeast asia, southern china, taiwan, and hong kong. It has been well reported in human immunodeficiency virus (hiv)-positive patients in the endemic areas, and also in other immunocompromised patients. This diagnosis must be considered for all febrile transplant recipients who have the relevant clinical features and travel history to Southeast asia. Prompt treatment with anti-fungal therapy improves the survival and outcome of these patients. ( info) |