1/28. Necrotizing fasciitis due to appendicitis.Necrotizing fasciitis, although rare, is one of the more serious, life-threatening complications of missed acute appendicitis. patients who are predisposed to developing necrotizing fasciitis, regardless of the cause, are typically immunocompromised. We present a case of a 49-year-old immunocompetent female whose diagnosis of acute appendicitis was missed and who subsequently developed necrotizing fasciitis of the abdominal wall and flank. She recovered 1 month after admission due to aggressive surgical and medical therapy.- - - - - - - - - - ranking = 1keywords = flank (Clic here for more details about this article) |
2/28. Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma.BACKGROUND: A very rare case of retroperitoneal bleeding due to spontaneous rupture of a large adrenal myelolipoma in a 62-year-old woman is reported. methods/RESULTS: She consulted the emergency room of the Nagano red cross Hospital with a complaint of sudden left flank pain. A computerized tomography (CT) scan revealed a tumor with areas of fat density and hematoma in the left retroperitoneal space. After her general condition improved, an operation was performed. The tumor strongly adhered to the left kidney and a left nephrectomy with the tumor was curative. Histologic diagnosis was adrenal myelolipoma. No blood transfusion was required. CONCLUSIONS: A CT scan is very useful in the pre-operative diagnosis of adrenal myelolipoma with retroperitoneal hemorrhage. Watch and wait treatments before operation and nephrectomy with adhered tumor are safe and curative.- - - - - - - - - - ranking = 5.4480384512952keywords = flank pain, flank (Clic here for more details about this article) |
3/28. Spontaneous rupture of the kidney with perirenal hematoma.Spontaneous rupture of the kidney involves either the collecting system or parenchyma, the latter being associated with a subcapsular or perirenal hematoma. A review was made of 78 cases of spontaneous parenchymal rupture with perirenal hematoma, including 4 of our own. One of these cases is the first description of spontaneous rupture of the kidney secondary to renal vein thrombosis. The patients are usually in the fourth decade of life and present with an acute onset of flank pain, a tender mass and commonly symptoms and signs of shock. hematuria is often present and generally urography reveals a mass, distorted collecting system and/or non-visualization of the kidney. Tumors are the most common cause followed by vascular diseases, infection, nephritis and blood dyscrasias. nephrectomy when possible should be performed expeditiously since conservative therapy is uniformly unsuccessful.- - - - - - - - - - ranking = 5.4480384512952keywords = flank pain, flank (Clic here for more details about this article) |
4/28. Spontaneous rupture of a renal angiosarcoma.Here we describe the clinical, radiologic, histopathological and immunohistochemical features of a rare spontaneous rupture of renal angiosarcoma detected in the left kidney of a 55-year-old male. Due to the rarity of this neoplasm (less than 15 cases have been reported), there is no unanimous consensus for therapy following radical nephrectomy. In our case there was no flank trauma and retroperitoneal haematoma around the left kidney was seen on computed tomography. The patient underwent left radical nephrectomy and died about 3 months after operation due to multiple bone and liver metastases. To our knowledge, this is the first report of spontaneous rupture of renal angiosarcoma and we suggest that it should be borne in mind that renal angiosarcoma may be a cause of retroperitoneal haematomas.- - - - - - - - - - ranking = 1keywords = flank (Clic here for more details about this article) |
5/28. Spontaneous gastroduodenal disruption in neonate.A 2-day-old female presented with massive abdominal distention and respiratory distress. An erect abdominal x-ray film revealed a pneumoperitoneum of saddlebag configuration. The patient was resuscitated and a peritoneal drain was put through the right flank. air and bile drained, and the respiratory distress was relieved. After the patient had stabilised haemodynamically, an exploratory laparotomy revealed a total gastroduodenal disruption. A gastrojejunostomy was done; the pyloric and duodenal ends were closed in two layers. The postoperative course was uneventful. We report this case for its unusual and rare presentation.- - - - - - - - - - ranking = 1keywords = flank (Clic here for more details about this article) |
6/28. Right perinephric abscess: a rare presentation of ruptured retrocecal appendicitis.Perinephric abscess commonly arises from rupture of an intrarenal abscess into the perinephric space. It rarely results from gastrointestinal pathology. We report two pediatric patients with retrocecal appendicitis that presented with perinephric abscess. A 3-year-old girl presented with high fever and right flank pain for more than 1 week. ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system. A perinephric abscess extending from a ruptured retrocecal appendix was diagnosed by abdominal computed tomographic (CT) scan. Her hospital course was complicated with empyema, peritonitis, and pericardial effusion. A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission. ultrasonography showed a right perinephric abscess with a normal renal contour and a fecalith in the enlarged appendix in the right lower quadrant of the abdomen. appendectomy and drainage of the perinephric abscess were performed in both cases. We suggest that a ruptured retrocecal appendix must be considered in cases of perinephric abscess, especially in patients with gas bubbles in the abscess and a normal urogenital appearance. ultrasonography and abdominal CT scan are the preferred diagnostic tools. Prolonged antibiotics and drainage of the abscess are mandatory to decrease morbidity and mortality.- - - - - - - - - - ranking = 1keywords = flank (Clic here for more details about this article) |
7/28. Spontaneously ruptured multilocular cystic nephroma.Multilocular cystic nephroma is a relatively rare benign tumor of the kidney. An adult case of spontaneously ruptured multilocular cystic nephroma was reported. A 33-year-old woman who presented with a right flank colic attack. The preoperative diagnosis was spontaneously ruptured renal tumor. A right nephrectomy was performed. A multilocular cystic lesion, 10 cm in diameter, was found in the removed specimen, which had a hematoma inside and direct tumor extension into the renal pelvis. On microscopic examination, the surface of loculi was covered by a layer of hobnail epithelium, and septa were composed of fibrous tissue with dilated vessels, lacking in normal renal components. There were no signs of malignancy. The lesion extending into the renal pelvis showed the same microscopic findings. The final diagnosis was multilocular cystic nephroma. Two respects, spontaneous rupture and tumor extension into the renal pelvis, were unique to the present case. There has been no report of spontaneously ruptured mutilocular cystic nephroma. The tumor extension into the renal pelvis, however, has been found in several reports. This growth pattern might be one of the characteristics of this benign renal tumor.- - - - - - - - - - ranking = 1keywords = flank (Clic here for more details about this article) |
8/28. Spontaneous rupture of the renal pelvis during pregnancy: a case report and review of the literature.We report a case with spontaneous rupture of the renal pelvis during pregnancy. A 34-year-old Japanese woman was referred at 20 weeks' gestation because of sudden severe right flank pain. She had severe colic pain radiating to the right lower abdomen with percussion tenderness at the right costovertebral angle and was initially suspected to have renal/ureteral calculi. ultrasonography and intravenous pyelography showed urine extravasating from the renal pelvis, indicating rupture of the right renal pelvis. Immediately following the insertion of a double-J indwelling catheter, her symptoms and perirenal extravasation ceased. She had no further urological problems during pregnancy and a male infant was delivered at 41 weeks' gestation. Cases with spontaneous rupture of the renal pelvis in pregnancy are reviewed.- - - - - - - - - - ranking = 5.4480384512952keywords = flank pain, flank (Clic here for more details about this article) |
9/28. Spontaneous ureteral rupture: is immediate surgical intervention always necessary? Presentation of four cases and review of the literature.PURPOSE: We report our experience with spontaneous ureteral rupture (SUR) managed conservatively. case reports: Data on three men and one woman 53 to 89 years old (mean age 73) with SUR were retrospectively evaluated. The common complaint was sudden-onset abdominal and concomitant flank pain. On physical examination, all patients had abdominal tenderness and pain with costovertebral angle tenderness on the associated side. One patient had rheumatoid arthritis treated with corticosteroids, and one had carcinoma of the prostate. All patients had urinary extravasation on CT scans. Two patients had ureteral obstruction by stones, and another had bladder outlet obstruction secondary to prostate cancer. Interestingly, irrespective of the obstruction level, the rupture was near the ureteropelvic junction in all patients. The symptoms regressed within hours after basket catheterization and ureteral stent placement in one patient and close follow-up and supportive treatment in three patients. In two patients, disappearance of extravasation and reabsorption of perirenal fluid were confirmed by second- and third-day CT scans. The patients were followed for a mean of 17 (range 14-21) months without any problems. CONCLUSIONS: We believe that SUR cases are more frequent than reported. It is the authors' opinion that if the clinical scenario is suspected in the acute phase and investigated by appropriate radiologic techniques, many more SUR cases will be diagnosed. Careful monitoring with supportive measures may be curative in the majority of the patients, obviating a surgical intervention.- - - - - - - - - - ranking = 5.4480384512952keywords = flank pain, flank (Clic here for more details about this article) |
10/28. kidney rupture: an unusual and oligosymptomatic complication in a dialysis patient with acquired cystic disease.Acquired cystic kidney disease (ACKD) is a complication of end-stage renal disease, the prevalence of which is related to dialysis duration; incidence of ACKD and associated conditions (neoplasia, hemorrhage) have decreased with improvements in renal transplantation and with the ageing of the dialysis population. This report regards spontaneous kidney rupture in a 57-year old patient, on home hemodialysis for 11 years, with ACKD for 5 years. At the end of a dialysis session, the patient reported sudden onset of colicky flank pain, followed by macrohematuria. Pain remitted with low doses of pain relievers, leaving dull flank discomfort. The patient self diagnosed a renal colic, and called the hospital two days later. At referral, two large hemorrhagic renal masses (7 and 2.8 cm) were found at ultrasound and CT scan. At surgery, kidney rupture was diagnosed. This case highlights the life threatening complications associated with ACKD, and underlines that massive renal hemorrhage may occur with relatively minor symptoms.- - - - - - - - - - ranking = 6.4480384512952keywords = flank pain, flank (Clic here for more details about this article) |
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