1/23. Abdominal distention and shock in an infant.Acute abdominal distention in the pediatric patient may be attributable to extraperitoneal fluid, masses, organomegaly, air, an ileus, a functional or mechanical bowel obstruction, or injury and blood secondary to trauma. An infant who presents to the emergency department with acute abdominal distention and shock is a true emergency for which the differential diagnosis is extensive. An unusual case of abdominal distention, ascites, hematochezia, and shock in an infant, subsequently found to have spontaneous perforation of the common bile duct is reported. This uncommon cause of abdominal distention and shock in an infant is many times left out of the differential diagnosis of an acute abdomen. The presentation may be as an uncommon acute form or a classis subacute type. This patient had hematochezia, which had not been previously reported in association with this entity. Failure to recognize and treat an acute abdomen can result in high mortality.- - - - - - - - - - ranking = 1keywords = class (Clic here for more details about this article) |
2/23. A new etiology of acute abdominal emergencies in cirrhotic patient: secondary pneumococcal peritonitis with jejunitis.We report the first case of secondary pneumococcal peritonitis associated with acute jejunitis in a 52-year-old homeless child-Pugh C cirrhotic man without ascitis. The patient was admitted with clinical signs of peritonitis, and jaundice. Morphologic examination was unremarkable. A laparotomy revealed a diffuse peritonitis, and an acute jejunitis with prenecrotic lesion. The lesion was located within the first centimeters of the jejunum, immediately after the duodeno-jejunal angle, extented on 15 cm. A resection of the first 15 cm of the jejunum was performed with duodeno-jejunal side-to-side manual anastomosis. Gram-stain and cultures of blood, peritoneal pus, and jejunal mucosa revealed a penicillin-sensitive streptococcus pneumoniae. Appropriate parenteral antibiotic treatment was initiated (aminopenicillin). The postoperative course was marked by a transient hepatic failure associated with an ascitis controlled by diuretics. The patient was discharged on the 26th day after surgery. This case reports a new etiology of acute abdominal emergencies in cirrhotic patients.- - - - - - - - - - ranking = 0.039321652124222keywords = angle (Clic here for more details about this article) |
3/23. Unusual duplication of appendix and cecum: extension of the Cave-Wallbridge classification.Duplicated appendix has, to date, been classified into 3 types. The authors present a type of duplicated appendix not previously described. Surgical exploration was done in a 14-year-old girl who had an acute abdomen. Surgical exploration showed a duplicated appendix that arose from the normal appendix and ended in a thick-walled, inflamed, perforated muscular pouch. Duplicated appendix is a treatable condition that rarely occurs with colonic duplication and which should be considered in the differential diagnosis of lower abdominal pain.- - - - - - - - - - ranking = 5keywords = class (Clic here for more details about this article) |
4/23. Untraditional glucose fermenting actinomycetes as human pathogens. Part I: actinomyces naselundii as a cause of abdominal actinomycosis.actinomyces naeslundii was proved as a primary pathogen in the case of a fulminant abdominal infection of a 74 aged woman. The preliminary diagnosis of actinomycosis based on direct microscopical findings of microgranules in the pus was confirmed by the results of cultivation and casuistry in addition. The case was of a typical course for actinomycosis and penicillin following surgery was of life saving effect for the patient who was dismissed asymptomatic after 55 days of hospitalization. Actinomycotic microgranules were demonstrated in the pus from the natural infection and from experimentally infected mice and the causative agent actinomyces naeslundii TR 91/67 was defined. Nevertheless it was concluded that the judgment of the pathogenicity of actinomyces naeslundii and of the other members of the heterogenous group of etiological agents of human actinomycosis still remains a matter of delicacy in any actual case of their isolation. In practice however, the presumption of actinomycotic etiology of an actual infection may be supported in retrospect by the dramatical effect of penicillin without regard to the presence of concomitant microflora not necessarily sensitive to penicillin.- - - - - - - - - - ranking = 0.061495742899923keywords = ii (Clic here for more details about this article) |
5/23. Adnexal torsion presenting as an acute abdomen in a patient with bilateral cystic teratoma of the ovary.Benign cystic teratomas are the most common ovarian neoplasms in women. Teratomas are usually benign, unilateral, and most often found in young and premenopausal women. Most are 5 cm to 10 cm in diameter when diagnosed, and on sectioning, they usually contain thick sebaceous material, tangled hair, and various dermal structures. One of the major complications seen in cystic teratoma is torsion, a partial or complete twisting of the ovarian suspensary pedicle causing severe pain, nausea, and tissue necrosis. The patient described had bilateral cystic teratomas, one uncommonly large and torsed, causing an acute abdomen. Discussion includes the diagnosis, operative management, and postoperative findings.- - - - - - - - - - ranking = 0.039321652124222keywords = angle (Clic here for more details about this article) |
6/23. Gastric perforation due to the ingestion of a hollow toothpick: report of a case.A perforation due to the ingestion of a toothpick is a condition seldom seen in the stomach. We herein describe an 80-year-old woman with a perforation of the stomach due to an ingested hollow toothpick. The toothpick was easily removed during a mini-laparotomy. The site of perforation was closed with absorbable sutures and omentum was used to function as an overlying patch. The postoperative course was uncomplicated. The hollow toothpick functioned as a fistula between the contents of the stomach and the peritoneal cavity. This resulted in a very different clinical picture from that observed in "classical wooden" toothpick injury, where the toothpick is not able to function as a fistula. To the best of our knowledge, this is the first description of a hollow toothpick perforating the stomach. A hollow toothpick perforation must be considered in any patient with symptoms of intestinal perforation, even when there is no history of swallowing toothpicks. Removal of a toothpick and subsequent suturing of the puncture site is a simple and relatively minor surgical procedure, which may have a lower morbidity and mortality as compared to other causes of gastric perforation. A precaution to observe, is the potential danger that one of the members of the operating team might perforate a finger.- - - - - - - - - - ranking = 1keywords = class (Clic here for more details about this article) |
7/23. Ruptured ovarian granulosa cell tumors as a cause of the acute abdomen.A rare case of acute abdomen syndrome due to a ruptured ovarian tumor and a penetrated fallopian tube is described. Based on the intraoperative finding and patient's age, a right-sided salpingo-oophorectomy, appendectomy and peritoneal washings were performed. After a histological diagnosis of malignant granulosa cell tumors and FIGO IIA clinical classification, the patient returned 1 month after the procedure. A relaparotomy with a hysterectomy, left-sided salpingo-oophorectomy and omentectomy were then performed. No spread was found during the laparotomy, and the histologic diagnosis pointed to adenomyosis and chronic cervicitis. The patient regularly presents for control examination, and has now been free for 11 years since the surgery from clinical, biochemical or ultrasonographic signs of a relapse of the disease.- - - - - - - - - - ranking = 1keywords = class (Clic here for more details about this article) |
8/23. Syndromes in amoebic liver abscess.A series of 137 patients with amoebic liver abscess has been studied. Recognition of clearly defined but diverse clinical syndromes was found to be necessary not only in diagnosis but also in planned surgical management. The majority of patients had the classic syndrome of fever, right abdominal or chest pain, hepatomegaly, hepatic tenderness and radiological abnormalities. Other syndromes of presentation included the silent abscess, acute amoebic colitis, the acute abdomen, the intraabdominal lump, the external sinus, pyrexia of obscure origin, obstructive jaundice and renal, pleuro-pulmonary and cardiac symptoms. The syndromes due to an abscess in different parts of the right lobe and in the left lobe of the liver are to some extent distinct. In spite of the varied modes of presentation of amoebic liver abscess, the key to diagnosis is an understanding of the chronological sequence of the disease and its progression from one syndrome to another. Diagnostic methods of value and the mortality are discussed.- - - - - - - - - - ranking = 1keywords = class (Clic here for more details about this article) |
9/23. Ruptured phaeochromocytoma--a lesson in acute abdomen.Phaeochromocytoma may present as acute abdomen. This report is of a patient with spontaneous rupture of phaeochromocytoma who presented with abdominal pain and a tender abdominal mass. Ruptured phaeochromocytoma is a rare surgical emergency, with only 30 cases reported in the literature. The classical clinical triad of signs is intense vasoconstriction, tachycardia, and labile blood pressure. Computed tomography scanning of the abdomen is the investigation of choice, and a high index of suspicion is the key to diagnosis. Prompt recognition, appropriate supportive measures, and early surgical intervention can improve the likelihood of survival.- - - - - - - - - - ranking = 1keywords = class (Clic here for more details about this article) |
10/23. Intraperitoneal fat focal infarction of the lesser omentum: case report.Intraperitoneal fat focal infarction (IFFI) represents a relatively rare acute abdominal condition essentially characterized by infarction and/or torsion of the greater omentum or an epiploic appendage. The spontaneous clinical evolution is favorable under medical treatment, and the imaging findings have been proved sufficiently typical to avoid unnecessary surgery in the great majority of cases. To our knowledge, we report the first case of IFFI of the lesser omentum. Despite the absence of definitive histologic proof, the diagnosis was possible through typical imaging findings extremely similar to those of more classic cases of IFFI but also through the spontaneous benign evolution.- - - - - - - - - - ranking = 1keywords = class (Clic here for more details about this article) |
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