1/42. Ruptured metastatic ovarian carcinoma presenting as acute abdomen.Acute abdomen is a challenge to first-line physicians because of frequently missed diagnoses and potential follow-on legal problems. Improving the management of these patients is of paramount importance, not only for saving lives, but also for reducing untoward problems associated with improper management. We present a case of a patient with acute abdomen due to intraperitoneal hemorrhage secondary to rupture of an ovarian tumor. Following emergency surgery, the patient was diagnosed with metastatic ovarian carcinoma. Because of improper preparation of the gastrointestinal tract, the patient underwent repeat exploratory laparotomy for colon carcinoma. Although this situation did not affect the outcome of the patient in this case, we are concerned that the patient did not benefit from a single operation, with primary complete excision of the tumor plus a colostomy. The outcome of patients with pelvic malignancy, especially those with ovarian carcinoma, might be better if initial surgery achieved optimal tumor debulking. This is possible with good preoperative planning and preparation. We emphasize the importance of preoperative preparation in spite of urgently needed care. Furthermore, every first-line physician should communicate the possibility of malignancy to patients and their families.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
2/42. Laparoscopically assisted treatment of acute abdomen in systemic lupus erythematosus.The incidence of abdominal pain in patients with systemic lupus erythematosus (SLE) is very high. Most patients do not require surgical treatment (serositis). Some cases such as appendicitis, perforated ulcer, cholecystitis or, rarely, intestinal infarction are surgical. Differential diagnosis is difficult, partly because noninvasive examinations do not provide enough evidence to rule out a diagnosis. On the other hand, in patients with SLE who have acute abdomen, it is dangerous to delay surgery by attempting conservative therapy. In fact, a better survival rate has been associated with early laparotomy. We report a case of acute abdomen in a patient affected by SLE, in which the diagnostic problem was solved by means of laparoscopy and the treatment was laparoscopically assisted. A 45-year-old woman with a 25-year history of SLE was admitted with abdominal pain and fever. Her physical examination revealed a painful right iliac fossa with rebound tenderness. Her WBC count was normal. Abdominal x-ray, ultrasonography, paracentesis, and peritoneal lavage did not provide a diagnosis. A diagnostic laparoscopy was performed, showing segmentary small bowel necrosis. The incision of the umbilical port site was enlarged to allow a small laparatomy, and a small bowel resection was performed. The histopathologic finding was "leucocytoclasic vasculitis, with infarction of the intestinal wall." The patient recovered uneventfully. In conclusion, this case report shows that emergency diagnostic laparoscopy is feasible and useful for acute abdomen in SLE. Currently, this diagnostic possibility could be considered the technique of choice in these cases, partly because, when necessary, it also can allow for mini-invasive treatment therapy.- - - - - - - - - - ranking = 1100.2505710334keywords = umbilical (Clic here for more details about this article) |
3/42. Laparoscopic management of colonoscopic perforations.Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second patient, localized peritonitis was found in the left iliac fossa due to a microperforation of the sigmoid colon. It was repaired with a single absorbable suture. The postoperative course was unremarkable in both cases. In patients with an emergency abdomen due to a postcolonoscopy perforation, we consider the laparoscopic approach feasible and safe in experienced hands. It allowed us to avoid an unnecessary laparotomy and other time-consuming and expensive diagnostic investigations. This approach represents an excellent means of managing this type of emergency abdominal situation.- - - - - - - - - - ranking = 1101.2505710334keywords = umbilical, single (Clic here for more details about this article) |
4/42. Ruptured true aneurysm of the splenic artery: an unusual cause of haemoperitoneum.True aneurysm of the splenic artery is rare. Two cases of ruptured true splenic artery aneurysms are presented. The first patient was a 62-year-old female who presented within 6 hours of the onset of symptoms. The other was a 27-year-old non-alcoholic male patient who was admitted in a state of shock after 2 days of observation in a peripheral hospital. Both patients had haemoperitoneum and were subjected to exploratory laparotomy. Aneurysmectomy was performed in both the patients in addition to left splenopancreatectomy in the first case and splenectomy in the second. However, due to the prolonged preoperative shock, the second patient succumbed on the third postoperative day.- - - - - - - - - - ranking = 6.7955351534494keywords = artery (Clic here for more details about this article) |
5/42. Ruptured aneurysm of the visceral artery: report of two cases.We present herein two cases of a ruptured aneurysm of the visceral artery. The first case involved a 74-year-old man with abdominal pain who was admitted to our hospital with a tentative diagnosis of intra-abdominal bleeding of unknown origin. Computed tomography revealed a hematoma in the greater curvature of the stomach. At surgery, a hematoma along the right gastroepiploic artery was found and totally removed. Histological examination showed a pseudo-aneurysm of unknown etiology. The second case involved a 68-year-old man with progressive anemia who presented with spontaneous intra-abdominal bleeding. A ruptured aneurysm of the accessory middle colic artery was diagnosed by superior mesenteric angiography. The ruptured aneurysm was ligated and totally resected without a colectomy. Histological examination showed a pseudoaneurysm of unknown etiology. The postoperative courses were uneventful, and both patients were doing well at the time of writing.- - - - - - - - - - ranking = 7.9281243456909keywords = artery (Clic here for more details about this article) |
6/42. Spontaneous heterotopic pregnancy presenting with tubal abortion.Heterotopic pregnancies are rarely spontaneous. We present the case of a woman who presented with acute abdominal pain. Emergency laparotomy was performed. Intraoperative finding showed right tubal pregnancy and right salpingectomy was performed. Six weeks post-operation, the patient's symptoms and signs of pregnancy persisted and ultrasound showed an intrauterine single viable fetus. The pregnancy was continued to term and a healthy female baby was delivered.- - - - - - - - - - ranking = 1keywords = single (Clic here for more details about this article) |
7/42. Acute abdomen during adjuvant chemotherapy: superior mesenteric artery thrombosis associated with CMF chemotherapy.We report a case of superior mesenteric artery thrombosis in a 57-year-old woman undergoing chemotherapy for T1N1M0, breast cancer. Although cancer itself is associated with an increased risk of thrombotic events, treatment with chemotherapy and/or tamoxifen in breast cancer patients increases this risk. Most cases reported are of venous thromboembolism; arterial events are rare.- - - - - - - - - - ranking = 5.6629459612078keywords = artery (Clic here for more details about this article) |
8/42. Unusual petal-like fibromuscular dysplasia as a cause of acute abdomen and circulatory shock.fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory segmental arterial occlusive disorder that involves primarily the renal and carotid arteries, and less often the coronary, iliac, and visceral arteries. We report the case of 78-year-old Japanese woman who presented with acute abdomen complicated by shock. autopsy revealed hemorrhagic necrosis of the small intestine due to severe narrowing of the mesenteric arteries. Histologically, smooth muscles showed in-bundle hyperplasia surrounding the adventitia together with medial and perimedial fibrodysplasia of these arteries, forming the characteristic petal-like appearance of FMD. No occlusive thrombus was observed. Further, another medial fibrodysplasia type of FMD was also seen in the renal and left circumflex coronary arteries. Unusual proliferation of smooth muscles resulted in the petal-like atypical FMD at the superior mesenteric artery.- - - - - - - - - - ranking = 1.1325891922416keywords = artery (Clic here for more details about this article) |
9/42. Spontaneous rupture of a dissection of the left ovarian artery.A 53-year-old female was suddenly hospitalized with acute left lateral abdominal pain. There was no history of trauma to the abdomen. She had received no abdominal operation. X-ray showed a soft tissue shadow in the left flank which displaced the bowel shadows medially. Plain abdominal CT showed a left retroperitoneal hematoma. Dynamic abdominal CT showed an outflow of medium from a blood vessel in the hematoma. At laparotomy, the source of bleeding was found to be the left ovarian artery. The ovarian artery was dilated and meandered remarkably. The ovarian artery and vein were ligated proximally and left adenectomy was performed. The patient made an uneventful recovery. Histological examination suggested a spontaneous rupture of a dissection of the left ovarian artery.- - - - - - - - - - ranking = 9.0607135379325keywords = artery (Clic here for more details about this article) |
10/42. rupture of noncommunicating rudimentary uterine horn pregnancy.BACKGROUND:We present a rare case of pregnancy in a noncommunicating rudimentary horn that ruptured at 20 weeks.CASE:A 30-year-old woman presented with a history of two spontaneous abortions. An ultrasound scan showed a bicornuate uterus, with one normal and one hypoplastic horn. hysterosalpingography revealed a single uterine cavity with only one tube, suggesting a unicornuate uterus. hysteroscopy and laparoscopy were recommended but declined.She presented again 2 months later at 7 weeks' gestation. A single intrauterine pregnancy in the hypoplastic right horn was diagnosed. A transvaginal scan showed a single cervical canal in continuity with the left uterine horn, which led to the suspicion of a pregnancy in a rudimentary horn. The option of pregnancy termination was offered. A laparoscopy was repeatedly suggested but declined. Excision of a ruptured noncommunicating rudimentary horn and ipsilateral salpingectomy were performed after an emergency laparotomy at 20 weeks because of the sudden onset of abdominal pain and signs of shock.CONCLUSION:Although a rudimentary horn pregnancy had been suspected before the laparotomy, the patient presented as a clinical emergency. This report, like others, indicates that prompt diagnosis and immediate removal of the rudimentary horn is lifesaving.- - - - - - - - - - ranking = 3keywords = single (Clic here for more details about this article) |
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