Cases reported "Acute Radiation Syndrome"

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1/15. Peripheral primitive neuroectodermal tumor of the small bowel mesentery: a case showing perforation at onset.

    A case of peripheral primitive neuroectodermal tumor of the small bowel mesentery with an uncommon clinical onset is reported. A 40-year-old man was admitted to hospital because of acute severe abdominal pain. Chest X-ray revealed a free air sign beneath the diaphragm. At emergency surgery a mass measuring 11.0 x 8.0 cm with perforation was located in the jejunal mesenteric region. Histologically the resected lesion consisted of sheets of undifferentiated small round cells forming abortive Homer Wright rosettes. Some spindle-shaped cells showed perivascular pseudorosettes. Immunohistochemical study revealed that the tumor cells expressed positivity against CD99 (MIC2), neuron-specific enolase, synaptophysin and vimentin. To the authors' knowledge this is the first documentation of peripheral primitive neuroectodermal tumor of the small bowel mesentery with perforation at onset.
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2/15. intestinal obstruction caused by an ectopic fallopian tube in a child: case report and literature review.

    The authors present the case of a prepubertal 14-year-old girl who was admitted for an acute abdominal pain, fever, and vomiting. She was in a poor general state, having recently suffered a weight loss of 5 kg. A plain abdominal x-ray disclosed signs of mechanical ileus. An abdominal ultrasound scan showed a normal uterus, a normal right-sided ovary, but no left ovary. An emergency laparoscopy found a normal uterus with complete absence of the left ovary and salpinx, the upper left dome of the uterus being smooth with no visible horn. The right ovary and salpinx were normal. intestinal obstruction was caused by a strangulating cordlike structure of unclear origin. After converting to a laparotomy, we found an abnormal fallopian tube inserted in the left parieto-colic groove. The tube extended next on the lateral sigmoid mesentery and wrapped itself around the ileum, provoking a local strangulation and an ischemic covered bowel perforation. The bowel perforation was treated by a segmental bowel resection. Careful dissection of the cordlike structure disclosed a true rudimentary fallopian tube with hypotrophic fimbriae and a small distal round structure containing ovarian tissue. These structures were removed entirely. A review of the literature on this rare situation is presented and discussed.
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3/15. 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.
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4/15. Gall stone: a rare cause of acute abdomen in a seven years old girl.

    Jamila Khatun a seven years old girl from Shurjunagar, Rajbari, presented with acute pain in the right side of her abdomen. Blood test was normal except mild elevation of serum bilirubin. Chest X-ray reveals no fluid level & no gas under the dome of diaphragm. Ultrasonogram of the abdomen reveled multiple stone in the gallbladder.
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5/15. 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.
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6/15. Portal venous air in an adult patient with obstructive small bowel volvulus.

    BACKGROUND: diagnosis of small bowel volvulus is frequently delayed often resulting in bowel ischaemia and infarction and impairing clinical outcome. Instant and correct diagnosis and subsequent adequate surgery may improve the outcome. methods: We describe a 19-year-old female with small bowel obstruction due to volvulus in whom the diagnosis was suspected based on the finding of air in the bowel wall and in the portal vein on a plain abdominal radiograph. CONCLUSIONS: air, present in the portal vein and bowel wall on a plain abdominal X-ray, suggests bowel ischaemia or necrosis and that the need for laparotomy is urgent.
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7/15. diagnosis of perforated gastric ulcers by ultrasound.

    patients with a perforation of the gastrointestinal tract need fast confirmation of diagnosis and early treatment to improve outcome. Plain abdominal x-ray does not always prove the perforation particularly at early stage. We report about a 62 year-old woman complaining of consistent abdominal pain with sudden onset. Ultrasound was taken as first diagnostic measure, revealing a perforation. The leakage was located in the stomach. radiography confirmed the pneumoperitoneum without indicating the perforated location. During operation the perforated gastric ulcer was found and sutured. This case report points out the reliability of ultrasound in diagnosing a pneumoperitoneum. Additionally it provides a summary of ultrasound signs seen in perforated gastric and duodenal ulcers and a review of literature.
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8/15. intestinal obstruction from a forgotten artery forceps: a case report.

    A 43-year-old multiparous patient p2 0 all alive who had abdominal hysterectomy secondary to ruptured uterus 2 1/2 years prior to presentation, was seen with acute (surgical) abdomen. An artery forceps was seen on plain abdominal X-ray and subsequent laparotomy revealed gangrenous ileum. The entire length of the ileum was involved, including the ileocecal valve and part of the cecum. The patient had limited right hemicolectomy and anastomosis of the distal part of the jejunum with the proximal section of the transverse colon. The post-operative period was uneventful and she was discharged to outpatient clinic 2 weeks post operatively.
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9/15. 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.
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10/15. Acute abdomen by varicella zoster virus induced gastritis after autologous peripheral blood stem cell transplantation in a patient with non-Hodgkin's lymphoma.

    We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's lymphoma with abdominal manifestation undergoing autologous peripheral blood stem cell transplantation after high-dose chemotherapy in April 2003. About 4 months after transplantation, he developed severe upper abdominal pain. Ultrasound examination, X-ray, computed tomography of the abdomen and cardiac diagnostics could not explain the symptoms. While empiric therapy with high-dose acyclovir was started, we could document herpetic lesions in the gastric antrum by endoscopy. The epigastric pain rapidly decreased within several days after the start of acyclovir therapy. No herpetic skin lesions were observed at any time during the disease. This report demonstrates the importance of viral-induced gastritis in the differential diagnosis of severe abdominal pain in patients receiving autologous peripheral blood stem cell transplantation.
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