Cases reported "Orbital Myositis"

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1/14. Perforation of acute calculous Meckel's diverticulitis: a rare cause of acute abdomen in elderly.

    Complications of the Meckel's diverticula are well-known and defined. However, acute inflammation and perforation secondary to a calculus is a rare clinical presentation. A case of acute calculous Meckel's diverticulitis with perforation in a 58-year old man is presented and possible pathological conditions are discussed. Location of the perforation, apical microscopic focal ulcers, and ischaemic changes in the diverticulum remind the pathogenesis comparable to that of acute calculous cholecystitis. This case report with major complications related to Meckel's diverticulum strengthens the concept of prophylactic resection of Meckel's diverticulum in adults, incidentally discovered at laparotomy.
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2/14. Progressive bouts of acute abdomen: pet the peritoneum.

    The recent discovery of the mutated gene responsible for familial mediterranean fever (FMF) is supposed to facilitate its diagnosis which up till now is a clinical one because there are no specific laboratory tests. The sensitivity of genetic testing is limited because these tests search only for known mutations. In this case report we describe a patient with periodic abdominal pain in whom the diagnosis of FMF was wrongly discarded because of lack of a durable effect of colchicine and negative genetic testing. Diffuse peritoneal inflammation was nicely demonstrated by a FDG-PET (fluoro-deoxy-glucose positron-emission tomography) performed during a typical crisis. We discuss the possible diagnostic pitfalls and conclude that a crisis-PET might upgrade the level of diagnostic certainty in equivocal cases.
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3/14. 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.
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4/14. Primary epiploic appendagitis: MRI findings.

    Primary epiploic appendagitis (PEA) occurs secondary to inflammation of an epiploic appendage, and is considered to be a rare cause of acute abdomen. In this case report, we describe the magnetic resonance imaging (MRI) findings of PEA correlated with computed tomographic (CT) findings. MRI findings included an oval shaped fat intensity mass with a central dot on T1- and T2-weighted images, which possessed an enhancing rim on postgadolinium T1-weighted fat saturated images. The lesion was best visualized on postcontrast T1-weighted fat saturated images. MRI findings of PEA should be considered in the differential diagnosis with the other causes of acute abdominal pain.
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5/14. Ruptured appendicitis after laparoscopic Roux-enY gastric bypass: pitfalls in diagnosing a surgical abdomen in the morbidly obese.

    A recent gastric bypass can mask the symptoms of an acute abdomen. physical examination is generally unreliable and subtle clinical symptoms or signs should alert clinicians to a significant postoperative problem. In morbidly obese patients, the presence of overt peritoneal findings is usually ominous, leading to sepsis, organ failure and death. We report a case of ruptured appendicitis following a laparoscopic Roux-en-Y gastric bypass. The patient developed tachycardia, fever, and leukocytosis in the absence of abdominal pain or positive upper GI contrast studies. Eventually, a CT scan revealed a large pelvic abscess and inflammation. A subsequent exploratory laparotomy confirmed a perforated appendicitis with pelvic peritonitis. Her recovery was rapid and uneventful. This case highlights the pitfalls in promptly diagnosing an unrelated acute surgical abdomen postoperatively in the morbidly obese patient. The need for extreme vigilance and a low threshold for aggressive intervention in the period after bariatric surgery is emphasized.
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6/14. Acute epiploic appendagitis in hernia sac: CT appearance.

    We describe an unusual cause of acute abdomen due to acute epiploicappendagitis located within an incisional hernia sac. The contrast-enhanced CT showed an oval fat density structure with surrounding inflammation in the transverse mesocolon. The contrast-enhanced CT findings of the inflammation of appendices epiploicae of the transverse colon were diagnostic in this case.
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7/14. Visceral larva migrans presenting as acute abdomen in a child.

    An unusual presentation of visceral larva migrans observed in a patient is reported. A 5-year-old boy suffering fever, abdominal pain, tenderness, and rigidity in the right lower and upper quadrant of the abdomen was operated on, with the false diagnosis of acute abdomen, and exploratory surgery was carried out. The pathological examination of the liver biopsy revealed eosinophil-rich necrotizing granulomatous inflammation with toxocara spp larva. The diagnosis was also confirmed by serologic results. Clinicians should remember that toxocaral visceral larva migrans may rarely mimic an acute abdomen and cause unnecessary operations.
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8/14. Segmental defect of intestinal musculature: a rare cause of intestinal obstruction in children.

    A 3 years old female child was brought to the emergency department with acute abdomen. laparotomy disclosed multiple segmental dilatations in the middle third of the ileum which was resected and anastomosed. Post-operative recovery was uneventful. Histopathological findings showed lack of smooth and longitudinal muscles in dilated segments of the intestine with intact mucosa without any evidence of necrosis and inflammation.
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9/14. Iliofemoral thrombophlebitis presenting as an acute abdomen: report and literature review.

    Iliofemoral thrombophlebitis characteristically presents as acute inflammation and swelling of the affected extremity. We report a patient in whom the presenting complaints of high fever, nausea and left lower quadrant pain mimicked an acute abdomen. The diagnosis was confirmed by venogram after gallium scan and computer tomographic scan revealed abnormalities consistent with iliofemoral thrombophlebitis. This is the first report of abnormal gallium uptake in iliofemoral thrombophlebitis. Current methods of diagnosing this disorder are discussed and the literature reviewed.
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10/14. Pancreatic heterotopia as a cause of an acute abdomen.

    A 6-year-old boy with fever, vomiting, abdominal pain, and leucocytosis was found to have a small nodule of heterotopic pancreatic tissue in the wall of the jejunum. Leakage of pancreatic enzymes caused inflammation and hemorrhagic necrosis of adjacent smooth muscle. Excision of the lesion was followed by prompt and permanent relief of all signs and symptoms. Small intestinal pancreatic rests can cause acute and chronic abdominal complaints and should be carefully sought at laparotomy when no other etiology is encountered.
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