Cases reported "Pulmonary Infarction"

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1/55. Old and new infarction of an epiploic appendage: ultrasound mimicry of appendicitis.

    Epiploic appendagitis is a self-limiting disease. Depending on its location, it may simulate nearly any acute abdominal condition. The ultrasound and computed tomographic (CT) features are characteristic, enabling ready diagnosis and thus preventing an unnecessary laparotomy. We describe a patient with acute abdominal pain in the right lower quadrant, in whom the combination of an old and fresh infarction of an epiploic appendage simulated appendicitis on ultrasound. Subsequent CT examination made the correct diagnosis.
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2/55. Fatal polyarteritis nodosa with massive mesenteric necrosis in a child.

    polyarteritis nodosa (PAN) is a rare vasculitic syndrome in childhood. There are few reported cases of ischaemic necrosis of the intestine and even fewer survivors in adults. We report the case of a 10-year-old boy with PAN and an acute abdomen that required operative intervention. Evidence was found of mesenteric arteritis with large ischaemic segments resulting in infarction and perforation.
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3/55. Idiopathic segmental infarction of the greater omentum successfully treated by laparoscopy: report of case.

    Idiopathic or spontaneous segmental infarction of the greater omentum (ISIGO) is a rare cause of acute right-sided abdominal pain. The symptoms simulate acute appendicitis in 66% of cases and cholecystitis in 22%. Progressive peritonitis usually dictates laparotomy, and an accurate diagnosis is rarely made before surgery. The etiology of the hemorrhagic necrosis is unknown, but predisposing factors such as anatomic variations in the blood supply to the right free omental end, obesity, trauma, overeating, coughing, and a sudden change in position may play a role in the pathogenesis. We present herein the case of a 37-year-old man in whom ISIGO, precipitated by obesity and overeating, was successfully diagnosed and treated by laparoscopy. Resection of the necrotic part of the greater omentum is the therapy of choice, and ensures fast recovery and pain control. Serohemorrhagic ascites is a common finding in ISIGO, and careful exploration of the whole abdominal cavity should be performed. The laparoscopic approach allows both exploration and surgical intervention.
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4/55. Segmental infarction of the omentum secondary to torsion: ultrasound and computed tomography diagnosis.

    Segmental infarction of the omentum is a rare clinical entity that is seldom considered in the differential diagnosis for acute abdominal pain, especially as the clinical findings are so non-specific. Consequently, the diagnosis is usually made intraoperatively. The two cases presented here demonstrate the characteristic appearance of omental infarction on ultrasound and CT, which enables preoperative diagnosis. Preoperative radiological diagnosis may prevent unnecessary surgery.
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5/55. Spontaneous uterine perforation from uterine infarction: a rare case of acute abdomen.

    A case of spontaneous uterine perforation from uterine infarction is presented. The authors believe that this is the first reported case.
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6/55. Small intestinal infarction: a fatal complication of systemic oxalosis.

    Primary hyperoxaluria is a rare genetic disorder characterised by calcium oxalate nephrolithiasis and nephrocalcinosis leading to renal failure, often with extra-renal oxalate deposition (systemic oxalosis). Although ischaemic complications of crystal deposition in vessel walls are well recognised clinically, these usually take the form of peripheral limb or cutaneous ischaemia. This paper documents the first reported case of fatal intestinal infarction in a 49 year old woman with systemic oxalosis and advocates its consideration in the differential diagnosis of an acute abdomen in such patients.
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7/55. Primary segmental infarction of the greater omentum: a rare cause of RLQ syndrome: laparoscopic resection.

    The authors report a rare case of a patient with a primary segmental infarction of the greater omentum who reported acute abdominal pain. Despite preoperative clinical studies and imaging evaluation, an etiologic diagnosis could not be determined. The diagnosis of this uncommon disease was determined after initial laparoscopic exploration. A laparoscopic resection was performed. The patient had an uneventful recovery and was discharged within 12 hours. The differential diagnosis of the right lower quadrant syndrome includes several disorders, of which the primary segmental infarction of the greater omentum is not frequent. The authors emphasize the usefulness of routine laparoscopic exploration in patients with RLQ syndrome because it adds the possibility of mini-invasive treatment to the initial diagnosis.
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8/55. 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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9/55. Laparoscopic treatment of two patients with omental infarction mimicking acute appendicitis.

    BACKGROUND: Omental infarction is a rare entity that usually causes symptoms similar to those of appendicitis. Ultrasound or computerized tomography scan can diagnose omental infarction preoperatively. methods: We treated two patients with omental infarction by performing a laparoscopic omentectomy in each one. RESULTS: The pathology verified the operative diagnosis, and both patients were discharged home on the first postoperative day. CONCLUSION: Omental infarction can be accurately diagnosed and safely treated with laparoscopy. Key Words: laparoscopy, Omental infarction, Acute abdominal pain.
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10/55. Idiopathic segmental infarction of the greater omentum as a cause of acute abdomen report of two cases and review of the literature.

    The segmental infarction of the greater omentum is a rare cause of acute abdomen. Its etiology is uncertain although several predisposing factors have been underlined such as congenital venous anomalies, sudden change of position and substantial meal. The clinical picture simulates an appendicitis or cholecystitis, thus being difficult to make a preoperative diagnosis. However, ultrasonography or computed tomography scan can help us make this diagnosis and then we alternatively perform a conservative treatment, laparoscopic approach or resection by laparotomy. We present two cases, preoperatively diagnosed by ultrasonography and computed tomography scan that were treated by laparotomy resection. We also review the published cases in the medical literature.
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