Cases reported "Liver Diseases"

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1/217. Delayed hemorrhage after nonoperative management of blunt hepatic trauma in children: a rare but significant event.

    PURPOSE: Nonoperative management of blunt hepatic injury (BHI) has become widely accepted in hemodynamically stable children without ongoing transfusion requirements. However, late hemorrhage, especially after discharge from the hospital can be devastating. The authors report the occurrence of serious late hemorrhage and the sentinel signs and symptoms in children at risk for this complication. methods: Nonoperative management of hemodynamically stable children included computed tomography (CT) evaluation on admission and hospitalization with bed rest for 7 days, regardless of injury grade. Activity was restricted for 3 months after discharge. Hepatic injuries were classified according to grade, amount of hemoperitoneum, and periportal hypoattenuation. RESULTS: Over 5 years, nonoperative management was successful in 74 of 75 children. One child returned to the hospital 3 days after discharge with recurrent hemorrhage necessitating surgical control. review of the CT findings demonstrated that he was the only child with severe liver injury in all four classifications. A second child, initially treated at an outside hospital, presented 10 days after injury with ongoing bleeding and died despite surgical intervention. Only the two children with delayed bleeding had persistent right abdominal and shoulder discomfort in the week after BHI. CONCLUSIONS: Our findings support nonoperative management of BHI. However, late hemorrhage heralded by persistence of right abdominal and shoulder pain may occur in children with severe hepatic trauma and high injury severity scores in multiple classifications.
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ranking = 1
keywords = operative
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2/217. Intrahepatic hemorrhage after use of low-molecular-weight heparin for total hip arthroplasty.

    Low-molecular-weight heparin (LMWH) has become a popular agent for prophylaxis against deep vein thrombosis and thromboembolic disease after total joint arthroplasty. LMWH allows for consistent dosing in postoperative patients without the need for laboratory monitoring. hemorrhage is an uncommon but documented adverse reaction when using LMWH; however, intrahepatic hemorrhage has not been previously reported in conjunction with LMWH therapy. We report the case of a woman who suffered intrahepatic hemorrhage presenting with acute abdominal pain and vomiting after the use of enoxaparin for total hip arthroplasty.
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ranking = 0.125
keywords = operative
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3/217. Combined hepatocellular and cystadenocarcinoma presenting as a giant cyst of the liver--a case report.

    Primary cystic lesions of the liver are very rare. Most of the solid tumours are hepatocellular carcinomas (HCC) with a smaller number being cholangiocarcinomas. The association of HCC with other primary liver malignancies is also extremely rare. This case report is about a 27 year old male patient who presented with a giant cystic lesion of the left liver. A CT scan showed a cystic lesion with internal septations and a thrombus in the main portal vein. The patient underwent an extended left hepatectomy and a portal venotomy with removal of the thrombus. Coexistent hepatocellular and cystadenocarcinoma were reported on histopathological examination. The patient was put on 5-FU postoperatively. He is doing well 11 months after surgery.
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ranking = 0.125
keywords = operative
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4/217. Posttraumatic torsion of accessory lobe of the liver and the gallbladder.

    Torsion of an accessory lobe of the liver and of the gallbladder is a rare etiology for acute abdominal pain in children and infants. We report a case of an 8-year-old girl who was admitted with acute epigastric pain and vomiting, after her brother had jumped on her back. physical examination revealed an afebrile child with a nontender right upper quadrant (RUQ) mass. color Doppler ultrasound and contrast-enhanced CT demonstrated a heterogeneous, avascular mass with displacement of a thickened-wall gallbladder. A contorted, congested accessory lobe of the liver and the gallbladder were resected at laparotomy. Imaging and operative findings are presented and a differential diagnosis is discussed in order to increase awareness of this rare condition.
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ranking = 0.125
keywords = operative
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5/217. Acute acalculous cholecystitis complicated by penetration into the liver after coronary artery bypass grafting.

    BACKGROUND: Perforation or penetration due to acute acalculous cholecystitis is a rare complication after open-heart surgery. The mortality rate of this disease is high. methods: A 71-year-old woman complained of a sudden onset of right upper abdominal pain with development of peritoneal signs at 21 days after coronary artery bypass grafting. Abdominal ultrasonography and laboratory examination performed at 1 day earlier had revealed no abnormalities. Neither anticoagulants nor antiplatelet agents were administered following the bypass operation. An exploratory laparotomy was performed to locate a presumed embolization to the superior mesenteric artery. RESULTS: laparotomy revealed acute acalculous cholecystitis complicated by penetration into the liver, causing a subserosal hematoma. The hematoma had ruptured into the abdominal cavity. A cholecystectomy was performed. The gallbladder wall which was in contact with the liver was necrotic. Most of the gallbladder mucosa was necrotic. Microscopical examination revealed atherosclerosis of the cystic artery which was partially obstructed by thrombus. CONCLUSIONS: Given the atherosclerotic condition of the cystic artery, hypotension during the bypass in combination with postoperative total parenteral nutrition and hypovolemia may have induced the cystic artery thrombosis. Surgeons who manage patients with cardiovascular disease should be aware of this potentially lethal development.
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ranking = 0.125
keywords = operative
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6/217. Inflammatory pseudotumor of the liver treated surgically.

    This report describes the case of an inflammatory pseudotumor of the liver in a 61 year-old female, diagnosed by an ultrasound scan (USG), computed tomography (CT) and needle biopsy. The right hemihepatectomy has been carried out. There were no complications in the post-operative course.
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ranking = 0.125
keywords = operative
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7/217. Fine-needle aspiration cytology of mesenchymal hamartoma of the liver.

    The cytologic appearance of mesenchymal hepatic hamartoma in a 2-yr-old boy is described. Smears disclosed small groups and isolated, benign-appearing spindle cells admixed with scarce amounts of myxoid stroma and normal ductal cells and hepatocytes. Although the findings were nonspecific, cytology may rule out many other diagnostic possibilities and increases the preoperative capacity of clinical and image studies, leading to a more rational therapeutic decision.
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ranking = 0.125
keywords = operative
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8/217. Resection of liver granulomas under a diagnosis of metastases from breast cancer.

    Three cases of liver granuloma mistakenly diagnosed as metastases from breast cancer are described. No common cause for granuloma formation in the liver was evident among the patients. Although surgical intervention to obtain a definitive diagnosis may occasionally be necessary, care needs to be exercised in the preoperative diagnosis of liver tumors. The growth rate of the lesions may be an important factor to consider.
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ranking = 0.125
keywords = operative
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9/217. Portosystemic shunting in patients with primary biliary cirrhosis: a good risk disease.

    Five patients with primary biliary cirrhosis underwent portosystemic shunting for the control of variceal bleeding. Three procedures were emergencies and two were elective. There was no operative mortality; all patients were followed until the present or until death. One patient is alive 4 years and another, 2 years postoperatively. One patient died 4 years after operation and another died 16 months postoperatively. Another patient survived for 8 years following her shunt and eventually died as a result of a cerebrovascular accident. This group of patients is compared to a larger group undergoing portosystemic shunting because of portal hypertension secondary to other forms of liver disease. The absence of operative mortality and the fact that several of these patients had moderately long postoperative survival despite apparently poor liver function suggest that the usual criteria for the assessment of operative risk are not valid in primary biliary cirrhosis.
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ranking = 0.75
keywords = operative
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10/217. liver hematoma after laparoscopic nissen fundoplication: a case report and review of retraction injuries.

    Laparoscopic fundoplication is a safe and effective alternative to long-term medical therapy in select patients with gastroesophageal reflux disease. Among the technical challenges of laparoscopic fundoplication, retraction of the left lobe of liver can cause significant morbidity. intraoperative complications from retraction injuries have been reported in the literature, but postoperative complications arising from liver retraction have not been published. The authors present a case of a symptomatic liver hematoma requiring hospital readmission for diagnosis and pain control and a review of retraction injuries.
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ranking = 0.25
keywords = operative
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