1/9. Old and new infarction of an epiploic appendage: ultrasound mimicry of appendicitis.Epiploic appendagitis is a self-limiting disease. Depending on its location, it may simulate nearly any acute abdominal condition. The ultrasound and computed tomographic (CT) features are characteristic, enabling ready diagnosis and thus preventing an unnecessary laparotomy. We describe a patient with acute abdominal pain in the right lower quadrant, in whom the combination of an old and fresh infarction of an epiploic appendage simulated appendicitis on ultrasound. Subsequent CT examination made the correct diagnosis.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/9. A penny for your thoughts: small bowel obstruction secondary to coin ingestion.We report a case of small bowel obstruction secondary to coin ingestion. A 22-year-old woman presented to the Emergency Department (ED) with a 3-week history of abdominal pain. Upon initial history the patient denied any foreign body ingestion. Only after computed tomography (CT) scanning of the abdomen and pelvis did the patient admit to deliberate ingestion of a single united states penny coin. During surgical evaluation it was found that the coin had lodged near the ileocecal valve and an inflammatory mass had formed around the intraluminal coin, causing a 10 x 7 cm fibrous tumor to completely obstruct the small bowel. It is thought that oxidation of the coin, with subsequent exposure of its high zinc content, instigated the inflammatory cascade.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/9. Acute abdominal pain in a separated conjoined twin.Complications of conjoined twins are typically events surrounding the birth and surgical separation. We report an unusual late-onset complication, a grade IV duodenal disruption of the accessory system in a formerly conjoined twin. Because conjoined twins have unique anatomy based on the junction and division of organs, one must always consider a multitude of causes for common complaints. Basic operative principles apply: the acute abdomen must be explored. Finally, to avoid these complications, removal of all or nearly all parasitic structures must be considered at the initial separation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/9. Giant T-shaped duplication of the transverse colon. A case report.A case of long diverticular colonic duplication producing acute abdominal pain in a 6-year-old girl is presented. physical examination showed no signs of acute abdomen at the initial presentation. After a pain-free interval, there was a sudden onset of severe abdominal pain and a large tumor in the lower abdomen was observed. A plain x-ray showed an enormously dilated colonic pouch filled with gas. Excision of the T-shaped duplication and small part of the transverse colon was successful. Because of extensive fibrotic changes in the colon near the opening of duplication, a resection margin of at least 2 cm is recommended.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/9. Cystic lymphangioma of Retzius space manifested as acute abdomen.The authors describe a rare pediatric case of cystic lymphangioma arising from the Retzius space. A 9-year-old boy underwent an appendectomy in a nearby hospital after a sudden onset of severe hypogastralgia. When laparotomy revealed a retroperitoneal mass, he was referred to our hospital. After diagnosis of a multicystic mass in the Retzius space, extirpation of the cystic lesion was performed. Histological evaluation of the resected specimens revealed cystic lymphangioma. The patient has been free of symptoms for 6 years since the operation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/9. death, after swallowing and aspiration of a high number of foreign bodies, in a schizophrenic woman.A 46-year-old woman who had had a long-term schizoid psychosis collapsed on the street. Upon admission to the hospital, she was determined to have an acute abdomen. The chest radiograph showed metallic foreign bodies in both main bronchi; foreign bodies in the stomach were not observed clinically. The woman died from repeated cardiac arrest shortly after hospital admission. At the autopsy a screw and a nail were found in both main bronchi. The abdominal cavity contained 2 L of greenish purulent fluid and a massive fibrinoid peritonitis was observed. Two perforations of the stomach, each 1 cm in diameter, were detected. The stomach was completely filled with a mass of metallic foreign bodies, greenish fluid, and a bezoar of a total weight of 1,400 g; 422 distinguishable and mostly metallic foreign bodies were counted. death was attributed to cardiac arrest in delayed shock after massive purulent peritonitis caused by two gastric perforations combined with obstruction of the airways by aspirated foreign bodies. Cases of massive swallowing of foreign bodies are mainly restricted to mentally handicapped persons, especially schizophrenics, whereas acute impaction of the larynx by large food particles occurs nearly exclusively in heavily intoxicated adults.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/9. syndrome of the rectus abdominis muscle mimicking the acute abdomen.The syndrome of the rectus abdominis muscle is a disorder of unknown etiology that produces rupture or tear of the epigastric artery, and stretches the rectus cutaneous medialis nerve, producing excruciating pain. The disorder is misdiagnosed in 60% to 93% of cases. We report two cases that presented as acute abdomen. One helpful diagnostic test was the lidocaine test, accomplished by subcutaneous injection of lidocaine into the sheath of the rectus abdominis muscle near the rectus cutaneous medialis nerve; the procedure provided immediate pain relief and the patients remained asymptomatic. In addition to helping establish a diagnosis quickly the lidocaine test may spare the patient the unnecessary morbidity or mortality of more invasive procedures.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/9. Combination of "patch, drain, and wait" and home total parenteral nutrition for midgut volvulus with massive ischemia/necrosis.The successful use of a combination of "patch, drain, and wait" (PDW) and home total parenteral nutrition (TPN) in the management of a case of acute, catastrophic midgut volvulus in a 2-year-11-month-old boy with near-total ischemia/necrosis of his small intestine is reported. The PDW approach to the highly effective management of acute midgut ischemia/necrosis in infancy and childhood (necrotizing enterocolitis and midgut volvulus) involves maximum gut salvage by avoidance of resection, stoma formation, or both through the use of extensive peritoneal cavity drainage by Penrose drains, TPN, and broad-spectrum antibiotics. The extensive peritoneal drainage fosters capture of enteric fistulas with the formation of enterostomies at drain exit sites, while adhesions and ischemia/inflammation-induced hypervascular obliteration of the peritoneal cavity diminish the potential for peritonitis (no peritoneal cavity, no peritonitis) and facilitate impressive salvage of seemingly hopelessly lost ischemic/necrotic gut (a simulation of the in utero ischemic gut process leading to atresias and some varying, but generally mild, gut loss) while simultaneously contributing to the resorption of absolutely non-salvageable gut and the creation of a remarkably clean and adhesion-free peritoneal cavity resembling that of a newborn infant with midgut intestinal atresia.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/9. ascaris lumbricoides--a reminder.A Vietnamese refugee was admitted to the hospital with signs and symptoms of an acute condition within the abdomen. Examination ultimately led to the roentgenographic diagnosis of an ascaris lumbricoides infestation. The patient recovered after medical treatment with intravenous fluids and nasogastric suction, followed by piperazine citrate administration. This ubiquitous parasite has the potential for causing many serious abdominal complications. An awareness of this disease is particularly timely, in view of the recent influx of nearly 150,000 Indo-Chinese into north america.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |