Cases reported "Leukoencephalopathies"

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1/11. 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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2/11. 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.
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3/11. Acute abdomen due to wandering spleen infarction: a case report.

    We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.
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4/11. Paraduodenal hernia evoking intermittent abdominal pain.

    PURPOSE: Description of a very rare case of internal abdominal hernia, namely herniation of the proximal jejunum in the Landzert fossa, through a hole in the mesocolon transversum. MATERIAL AND methods: Based on preoperative history, clinical state and radiological findings, the diagnosis of internal hernia was strongly suspected. RESULTS: Suspected diagnosis was confirmed during laparotomy. After reduction of the jejunum and closure of the hernia orifice, the patient recovered promptly. CONCLUSION: The diagnosis of internal herniation should always be considered in every patient who presents with an acute abdomen, signs of (sub)obstruction and non-typical history. The most important diagnostic tool is computer tomography, that is accurate in 77%.
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5/11. emergency treatment of the complications of giant liver hemangiomas.

    The authors discuss the problems of emergency treatment of cavernous hemangiomas of the liver. Five cases were observed and treated with different techniques, ligation of the hepatic artery, excision of the mass, embolization of the hepatic artery. The results of these procedures were strongly influenced by the patient's previous state. Treatment was successful in three patients, while the procedure adopted was able to stop the hemorrage in the other two patients. The physical state was very important for the prognosis; the two patients arriving at our Institute in deep shock both died.
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6/11. Missed ectopic pregnancies: a report of three cases.

    Presented here are three cases of missed ectopic pregnancy which occurred within a four month period in alabama. In two cases the patients expired. In the third case, following a D&C, continued pelvic pain prompted a repeat pregnancy test and ultrasound, during which ectopic pregnancy was diagnosed. All three of the patients had state of the art ultrasound examinations. An emphasis is placed on interpretation of the examinations and correlation with clinical data.
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7/11. Small bowel intussusception and brown bowel syndrome in association with severe malnutrition.

    Brown bowel syndrome is a rare condition characterized by deposition of lipofuscin in the smooth muscle cells of the gastrointestinal tract. The number of reported cases is small, but all are associated with malabsorptive states. Despite these small numbers, there is considerable evidence that vitamin e deficiency is important etiologically. We report here the case of a severely malnourished [body mass index 11.7 kg/m (2): normal range 20-25 kg/m (2)] 31-yr-old black male with a longstanding history of alcohol abuse, who was on anti-tuberculosis therapy. The patient presented with an acute abdomen and was found, at operation, to have a mid-ileal intussusception. Histological examination of the resected specimen demonstrated lipofuscin accumulation consistent with brown bowel syndrome, but no tumor. Subsequent investigations revealed no significant quantities of vitamin E in the blood and pancreatic steatorrhea. However, deficiency of other fat-soluble (vitamin a and D) and water-soluble vitamins (vitamin C and thiamine) also were detected. This report supports the association of brown bowel syndrome with vitamin e deficiency but cannot exclude the compounding effects of protein calorie malnutrition, multiple vitamin deficiencies, and chronic alcohol toxicity.
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8/11. A case presentation and review of neutropenic enterocolitis.

    Neutropenic enterocolitis (NE) is an unusual complication of neutropenia. Its presentation is dramatic, treatment is controversial, and the outcome may be devastating. The available literature about this entity is mainly case reports and autopsy studies. We have recently performed a celiotomy on a patient who developed sepsis and an acute surgical abdomen three days following chemotherapy and radiotherapy for a metastatic adenocarcinoma with no known primary tumor. At surgery he was found to have a boggy right and recto-sigmoid colon with a grossly normal transverse colon. Intraoperative colonoscopy revealed mucosal ulceration and necrosis extending from the dentate line to the cecum. A total abdominal colectomy, closure of the rectal stump, and an ileostomy was performed. Postoperatively, the patient recovered from the abdominal septic process only to succumb to multiple system organ failure secondary to pulmonary sepsis. Upon review of the literature, we found 65 cases of NE that were suspected or diagnosed in the antemortem state and confirmed at surgery or autopsy. In this review, we intend to analyze these case reports, summarize the salient features of the disease and outline the optimal therapeutic approach.
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9/11. Acute abdominal pain secondary to a urachal cyst abscess.

    Primary care physicians often see patients with complaints of acute abdominal pain. The differential diagnosis for the acute abdomen is complex and requires not only precise clinical skills but also a high index of suspicion for a specific disease state. Uncommon disorders must be considered when the signs and symptoms observed are unusual or the pathologic entity suspected is not found on diagnostic workup or during surgery. A urachal cyst abscess, although rare, may have the signs and symptoms of an acute abdomen.
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10/11. immunoblastic lymphadenopathy presenting as an acute abdomen and mixed bacteremia with eikenella corrodens and group C streptococci.

    eikenella corrodens and group C streptococci have been noted to occur with increased frequency in patients with underlying malignancies and immunosuppressive states. We report a case where these organisms were isolated from a patient with immunoblastic lymphadenopathy and discuss the possible association between these two conditions.
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