1/38. intussusception in infants: an emergency in diagnosis and treatment.intussusception is an important cause of intestinal obstruction and bowel necrosis in infants under 2 years. Most frequently the ileocaecal junction is involved. Various aetiologic factors, such as Meckel's diverticulum and lymphoid hyperplasia have been identified. Hydrostatic reduction of the intussusception should be attempted, but delay in diagnosis frequently leads to surgical intervention, because of failing reduction. We report a case of a 4-month-old boy whose ileocaecal junction was intussuscepted into the rectum, and therefore could be palpated by rectal examination. Unsuccessful hydrostatic reduction and bowel necrosis because of delay in diagnosis, made surgical intervention necessary. A terminal ileostomy was performed. A second case report considers a 10-month-old boy whose ileocaecal junction was intussuscepted into the colon sigmoideum. Because there was no delay in diagnosis, this intussusception could be reduced hydrostatically. The procedure however was difficult because of a dolichosigmoideum. Recent literature is also reviewed.- - - - - - - - - - ranking = 1keywords = alp (Clic here for more details about this article) |
2/38. Ovarian cavernous hemangioma in an 8-year-old girl.The case of an ovarian cavernous hemangioma with torsion in an 8-year-old girl is described. Current literature records less than 50 cases of which only 8 are in children. The presenting symptoms of acute abdomen and the ultrasonographic study led to the preoperative diagnosis of torsion of an ovarian tumor. Salpingo-oophorectomy and appendicectomy were performed with an uneventful postoperative course. The histological pattern of the tumor was that of an entirely cavernous hemangioma. The case is reported in view of its rarity.- - - - - - - - - - ranking = 1keywords = alp (Clic here for more details about this article) |
3/38. Accidentally delayed diagnosis of ruptured ovarian carcinoma in a young woman: a care report.Ovarian carcinoma commonly occurs in postmenopausal women and often presents with an insidious course. Acute abdomen is rarely an initial symptom. When these patients present with abdominal discomfort, the disease has already spread throughout the peritoneal cavity. We present a case of mucinous cystadenocarcinoma in a young woman who presented with acute abdomen and intra-abdominal bleeding. This 24-year-old woman was previously diagnosed with a ruptured left ovarian cystic tumor at a primary clinic. She underwent emergency exploratory laparotomy, followed by unilateral salpingo-oophorectomy at the clinic. No thorough examination of the peritoneal cavity was done during surgery. The diagnosis of mucinous cystadenocarcinoma was accidentally over-looked until one month later when she returned for routine follow-up. Upon referral to our clinic, the patient underwent a repeat laparotomy. The surgicopathologic diagnosis was intraperitoneal carcinomatosis stage IIIC that could not be excised completely, even though rigorous staging surgery including washing cytology, total abdominal hysterectomy, salpingo-oophorectomy, retroperitoneal lymphadenectomy, appendectomy, infracolic omentectomy and excision of any suspicious and removable lesions were performed. This case alerts us to consider the possibility of ovarian malignancy when a young woman presents with an acute abdomen secondary to ruptured ovarian cystic tumor and intraperitoneal hemorrhage. Careful preoperative preparation and thorough intrasurgical examination of the peritoneal cavity along with a prompt pathologic diagnosis of suspicious lesions will prevent missed diagnoses.- - - - - - - - - - ranking = 2keywords = alp (Clic here for more details about this article) |
4/38. Heterotopic pregnancy presenting as an acute abdomen: a diagnostic masquerader.Simultaneous intrauterine and extrauterine pregnancy is called heterotopic pregnancy. It is a rare complication of pregnancy, especially in the absence of predisposing factors. It is known to present with a variety of symptoms and signs often leading to a delay in establishing the correct diagnosis. We report the case of a 29-year-old woman, known to be 14 weeks pregnant, presenting with acute abdominal pain. The confirmation of a viable intrauterine pregnancy led to a general surgery consultation. A heterotopic ruptured right ectopic tubal pregnancy was found. Right salpingectomy was performed. The patient recovered uneventfully. The intrauterine pregnancy was not affected. This case illustrates the variable presentation of heterotopic pregnancy and the need for general surgeons to be suspicious of pregnancy related complications, even in the presence of a viable intrauterine pregnancy.- - - - - - - - - - ranking = 1keywords = alp (Clic here for more details about this article) |
5/38. 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.- - - - - - - - - - ranking = 2keywords = alp (Clic here for more details about this article) |
6/38. Acute abdomen caused by salmonella typhimurium infection in children.Salmonella spp. infections can be particularly challenging when they manifest as acute abdominal problems and lead to emergency surgery. Examples of such serious conditions are Salmonella-related intestinal perforation, gallbladder involvement, salpingitis, and peritonitis. mesenteric lymphadenitis associated with salmonella typhimurium mimics acute appendicitis and can make it difficult to establish a timely and definitive diagnosis in young patients who present with right lower abdominal pain. Paralytic ileus is a fairly common manifestation of Salmonella infection at all ages, but complete intestinal obstruction requiring surgical intervention is very rare. Because of the nature of the diagnostic process, a significant number of patients with Salmonella infection present with acute abdomen and undergo needless operations. This report describes the cases of 2 pediatric patients who underwent surgery to address persistent pain in the right lower abdominal quadrant and complete intestinal obstruction, respectively. The first patient had inflamed mesenteric lymph nodes that caused appendicitislike symptoms, and the second had dense adhesions between the mesentery and the terminal segments of the ileum that led to intestinal blockage. serology results showed that both patients' titers for BO ("B and O agglutinating [BO]") antibodies rose to 1:640 in the week after their admission to hospital, a pattern and level that is indicative of S typhimurium infection. J Pediatr Surg 36:1849-1852.- - - - - - - - - - ranking = 1keywords = alp (Clic here for more details about this article) |
7/38. 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 = alp (Clic here for more details about this article) |
8/38. Foreign matter salpingitis 3 years after typhlitis.This case suggests that typhlitis may cause delayed abdominal pathology. A history of this condition should be considered in the work-up of any patient with gastrointestinal or genitourinary pathology.- - - - - - - - - - ranking = 4keywords = alp (Clic here for more details about this article) |
9/38. Torsion of the fallopian tube in an adolescent female: a case report.BACKGROUND: Torsion of the fallopian tube is an infrequent but significant cause of acute lower abdominal pain in adolescent females that is difficult to recognize preoperatively, although prompt diagnosis and timely surgical treatment are vital to salvage the oviduct. CASE REPORT: A 17-yr-old virgin presented with sudden and severe right-sided lower abdominal pain with guarding and tenderness, fever, nausea, and vomiting at mid-cycle. Ultrasound scan showed a right ovarian cyst measuring 3 cm in diameter and a normal appendix. There was no leucocytosis. Presumptive diagnosis was a cystic ovarian follicle with ovulatory pain. Her condition improved but did not resolve with supportive treatment. At laparotomy, the right fallopian tube was twisted completely, distended with blood, and necrotic, with a small fimbrial cyst. The left tube, ovaries, appendix, and uterus were normal. Right salpingectomy was performed. Histologic examination revealed diffuse hemorrhagic infarction of the tube and a cyst of the hydatid of Morgagni. She remains well at follow-up. CONCLUSION: Unless a high index of suspicion is maintained for torsion of the fallopian tube in adolescent females, this disorder may not be detected until after tubal destruction.- - - - - - - - - - ranking = 1keywords = alp (Clic here for more details about this article) |
10/38. 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 = 2keywords = alp (Clic here for more details about this article) |
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