Cases reported "Arrhythmias, Cardiac"

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1/12. Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.

    We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed.
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2/12. Perforation due to ileocaecal tuberculosis.

    A 40-year-old male patient was admitted in the intensive care Unit with complicated pulmonary tuberculosis. After 4 days he developed an acute abdomen with free air as demonstrated on plain abdominal films. A laparotomy was performed and an ileal perforation was found, located just before the ileocaecal valve. A right hemicolectomy was carried out and the resected specimen was send for further patho-anatomical examination. Our suspicion of ileocaecal perforation due to tuberculosis was confirmed. Despite further extensive medical treatment, the patient died 15 days after admission to the hospital. At autopsy, the cause of death was confirmed as being due to fulminant pulmonary tuberculosis.
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3/12. A preventable cause of acute abdomen.

    Haemoperitoneum is an extremely rare presentation of hepatocellular carcinoma in the industrialised world. We present the first reported case in the UK. In contrast, up to 10% of hepatocellular carcinomas in africa present in this way, the median time between presentation and death being just six weeks. hepatitis b infection at birth and during childhood is the major cause of hepatocellular carcinoma in the developing world. The world health Organisation, UNICEF and the World Bank have all advocated routine hepatitis b vaccination of children. This can reduce the burden of disease in these communities, among people in their productive years of life.
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4/12. Ruptured appendicitis after laparoscopic Roux-enY gastric bypass: pitfalls in diagnosing a surgical abdomen in the morbidly obese.

    A recent gastric bypass can mask the symptoms of an acute abdomen. physical examination is generally unreliable and subtle clinical symptoms or signs should alert clinicians to a significant postoperative problem. In morbidly obese patients, the presence of overt peritoneal findings is usually ominous, leading to sepsis, organ failure and death. We report a case of ruptured appendicitis following a laparoscopic Roux-en-Y gastric bypass. The patient developed tachycardia, fever, and leukocytosis in the absence of abdominal pain or positive upper GI contrast studies. Eventually, a CT scan revealed a large pelvic abscess and inflammation. A subsequent exploratory laparotomy confirmed a perforated appendicitis with pelvic peritonitis. Her recovery was rapid and uneventful. This case highlights the pitfalls in promptly diagnosing an unrelated acute surgical abdomen postoperatively in the morbidly obese patient. The need for extreme vigilance and a low threshold for aggressive intervention in the period after bariatric surgery is emphasized.
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5/12. Hemorrhagic episodes in hemophiliacs simulating abdominal surgical emergencies.

    Hemophiliacs are subjected to develop episodes of spontaneous bleeding at different sites of the body, primarily the knees. On occasions, such episodes affect the abdomen. The picture engendered in such cases may mimic that of an abdominal emergency requiring surgical intervention. Such ill advised and unwarranted intervention may end with the patient's death. With the proper employment of radiology, the correct diagnosis may be reached and consequently, conservative treatment, in which factor viii plays the major role, instituted. Here, we describe the clinical course of 2 patients with hemophilia a who suffered bleeding in the abdomen and were treated conservatively with a successful outcome.
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6/12. Acute abdomen due to placenta percreta.

    placenta percreta is a rare but serious complication of pregnancy, usually presenting itself in the third trimester. The incidence of fetal death and maternal mortality is high. We report a case presenting as an acute abdomen, due to haemoperitoneum at 33 weeks of pregnancy. incidence, etiology, diagnosis and treatment are discussed, and the literature is reviewed.
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7/12. Emergency laparotomy immediately after coronary bypass.

    Eight patients required emergency laparotomy in the immediate postoperative period after coronary artery bypass (CAB). Cardiac complications were few and minor. sepsis was the major cause of mortality. In the two patients who died, delay in operative management contributed to their deaths. The lack of cardiac causes of morbidity and mortality in our series and others suggests that a stable postoperative coronary bypass patient represents a better surgical risk than the same patient preoperatively. Therefore, aggressive management, including early laparotomy, for suspected intra-abdominal pathology after CAB is recommended to avoid uncontrollable sepsis and death.
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8/12. Surgical implications of infectious mononucleosis.

    A series of 50 consecutive patients admitted to the hospital with a primary diagnosis of infectious mononucleosis is reviewed, with particular emphasis on the abdominal complaints and physical findings. Forty-eight percent of the patients had abdominal pain. Abdominal symptoms were the chief complaint in 24 percent of the patients. Two cases of splenic rupture are presented. One case of spontaneous rupture of the spleen is emphasized, as there are only 18 well-documented cases of true spontaneous rupture of the spleen in infectious mononucleosis. Four young persons with infectious mononucleosis in Portland, oregon, recently bled to death at home from a ruptured spleen. Guidelines are presented to aid the surgeon in evaluating the patient with infectious mononucleosis. The risk of splenic rupture persists after the patient recovers. Recommendations are made regarding the resumption of physical activity in these young, active patients.
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9/12. pulmonary embolism presenting as an acute surgical abdomen.

    pulmonary embolism remains a serious cause of morbidity and mortality. diagnosis based on clinical manifestations remains difficult. Prior reviews have rarely noted the potential for patients to present with abdominal complaints. Presented here is the case of a 28-yr-old woman who had signs and symptoms of an intra-abdominal catastrophe. The patient underwent laparotomy and at surgery had findings suggesting primary intra-abdominal pathology. autopsy results indicated that pulmonary embolism was responsible for the patient's presentation and death.
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10/12. Agnogenic venous mesenteric thrombosis.

    One of the most difficult diagnoses to establish is that of agnogenic venous mesenteric thrombosis (AVMT). This disorder occurs chiefly in elderly patients and, unless diagnosed promptly, leads to death in most instances. AVMT may follow surgical operations or occur during a prolonged illness. In the past five years at St. Clare's Hospital and Health Center in new york city, this diagnosis was established in five patients. In reviewing these cases, it was noted that some of the signs and symptoms such as those due to hypotension and shock with marked leukocytosis, were out of proportion to those usually observed when the preoperative diagnosis is being considered. The pathologic and radiologic characteristics of this disorder are outlined, and the recommended operative procedure for treatment is discussed. The importance is stressed of prompt, vigorous and prolonged anticoagulation therapy in order to minimize the chance of recurrence in the early postoperative period. Anticoagulant therapy is also effective preoperatively, if the disease is diagnosed sufficiently early. As greater numbers of elderly patients are being treated in hospitals, this dire complication should be uppermost in the minds of physicians and surgeons if a fatal outcome is to be avoided following a successful operative procedure.
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