Cases reported "Sarcoma, Ewing"

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11/26. Surgical management of neutropenic enterocolitis.

    Three cases of histologically confirmed neutropenic enterocolitis, each presenting as an acute abdomen in patients with leukaemia are presented. All three patients presented with fever and abdominal pain within 14 days of completing a course of chemotherapy. Signs of peritonitis localized to the right iliac fossa developed in each patient, in spite of aggressive antibiotic therapy and bowel rest. All three patients were found to have non-viable caecum at laparotomy and were treated by right hemicolectomy. Primary ileocolic anastomosis was performed in one patient, who recovered following a stormy postoperative course owing to sepsis. Two patients underwent formation of an ileostomy with distal mucous fistula and each recovered with minimal postoperative complications; secondary anastomosis was performed electively in both cases. The difficulty in diagnosing neutropenic enterocolitis preoperatively is discussed and the place of non-operative management is reviewed but we recommend surgical intervention as a means of ensuring removal of a localized septic focus until marrow regeneration occurs.
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12/26. The acute presentation of intestinal nonrotation.

    Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children. However, it can also be the cause of significant abdominal pain in adults. The pain is recurrent and often associated with a feeling of distention. If the diagnosis is entertained, it often can be made from basic clinical information.
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13/26. Exogastric neurilemmoma presenting as acute abdomen: role of computed tomography in diagnosis.

    A case of subserosal gastric neurilemmoma is hereby presented. This reported case is unique in its clinical presentation including the appearance of acute abdomen and fever subsequent to unremarkable and uneventful upper gastrointestinal endoscopy. The tendency of neurilemmoma to cause mucosal ulceration with fistula formation probably led to this clinical presentation. The role of computed tomography in establishing diagnosis of exogastric tumor is emphasized.
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14/26. Gastric rupture from blunt abdominal trauma.

    Gastric rupture from blunt abdominal trauma is a rare occurrence. Six patients are presented and reviewed with the literature since 1930. Several features of the diagnosis and management of this injury are emphasized, including a strong association with thoracic trauma and a high incidence of intra-abdominal abscess formation which results from massive intraperitoneal contamination. mortality is not usually from gastric rupture per se, but rather from concomitant vascular or neurologic injury. The key to survival for these patients is early operative intervention and an aggressive approach to reoperation and drainage of abscesses.
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15/26. infarction of the greater omentum. Elusive cause of acute abdominal pain.

    Omental infarction may be much more common than the number of cases reported in the literature would imply. The condition should be considered in the differential diagnosis of acute abdominal pain. A thorough search for it should be made in patients whose findings at laparotomy are not consistent with the preoperative diagnosis (usually acute appendicitis), especially when serosanguineous fluid is found in the peritoneal cavity. Treatment is excision of infarcted omentum to prevent formation of adhesions with obstructive and septic complications.
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16/26. Cystic intra-abdominal testicular torsion in an infant.

    We report on a 3-month-old infant with cystic intra-abdominal testicular torsion. He presented with abdominal distension and pain. physical examination showed a movable, well delineated mass in the right iliac and lumbar fossae. Exploration revealed that the mass was connected to the abdominal aorta by a thin vascular cord that was twisted before reaching the mass. The histological study showed that the mass corresponded to a testis with cystic formations. The testicular parenchyma was necrotized, although isolated seminiferous tubules were found. The cystic cavities were filled by hematic and necrotic material, and exhibited no epithelial lining. A fibrous layer in continuity with interstitial hemorrhage surrounded the cysts. The twisted vascular cord corresponded to a spermatic cord with dilated pampiniform plexus veins. The differential diagnosis and the etiopathogenesis of the lesion are discussed.
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17/26. Upper gastrointestinal endoscopy in systemic vasculitis presenting as an acute abdomen.

    Three cases of upper gastrointestinal vasculitis presenting as acute abdominal emergencies highlight an uncommon but often fatal presentation of systemic vasculitis. Although abdominal symptoms are common in such diseases, there may be a doubt during assessment of the patient as to whether the gastrointestinal tract is the prime target organ. radiology is often negative during the acute illness. endoscopy was important in documenting early and more advanced bleeding lesions of polyarteritis nodosa (PAN) and Henoch-Schoenlein disease, both conditions in which upper gastrointestinal lesions are rare. The gastric and duodenal vasculitic lesions demonstrated by endoscopy in such a clinical setting were confirmed histologically. Endoscopic assessment and early aggressive medical therapy contributed significantly towards the overall successful outcome. Gastroduodenoscopy has not been used either routinely or as an emergency investigation for the assessment of patients with vasculitis who present with acute abdominal pain. Involvement of the stomach and duodenum by vasculitis is therefore poorly appreciated, but remains a serious complication of vasculitic disease when the gastrointestinal tract is the prime target organ, and the information gained by endoscopy in a difficult clinical situation might alter the overall outcome of the disease.
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18/26. Segmental infarction of the omentum: a cause of the semi-acute abdomen.

    Segmental infarction of the omentum is an unusual cause of the acute or "semi-acute" abdomen. Because of its rarity, the nonspecificity of its signs and symptoms and the almost total lack of information regarding its natural history, it is very rarely diagnosed correctly prior to laparotomy or autopsy. We report a 51-year old obese woman with chronic hypertension, congestive heart failure and renal insufficiency, who developed recurrent severe abdominal pain. The diagnosis of primary omental disease was entertained because of the triad of persistent localized abdominal pain, lack of grossly disturbed visceral function and the presence of hemoperitoneum. This was confirmed by laparotomy.
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19/26. Tender pulsatile abdominal mass. Abdominal aortic aneurysm or not?

    Twenty-nine patients had symptomatic pulsatile abdominal masses. Initially six patients underwent emergency surgical exploration without prior arteriography. An abdominal aortic aneurysm was found in only one patient. In the next 23 patients, in whom arteriography was performed, no aneurysm was detected and emergency surgery could be avoided. In patients with symptomatic pulsatile abdominal masses, in the absence of hypovolemic shock the initial diagnostic study should be abdominal angiography. It is an accurate and safe procedure, and supplies the necessary preoperative information should abdominal aortic surgery become necessary. If, however, no aneurysm is found, valuable information is still obtained with regard to the underlying disease process.
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20/26. Unusual presentation of acute abdomen in scrub typhus: a report of two cases.

    Two young soldiers presented with acute abdomens, then received surgical procedures under initial impression of acute cholecystitis and acute appendicitis respectively. Operative findings did not confirm the initial diagnosis, and the clinical condition did not improve after operation. scrub typhus was suggested later by clinical manifestations of fever, chills, headache, lymphadenopathy, skin rash and presence of eschar formation; this diagnosis was finally confirmed by positive serologic results of high Weil-Felix OXK agglutination and/or rickettsia tsutsugammushi immunoflorescence titers in paired sera. Both patients rapidly became afebrile after administration of tetracycline. This unusual presentation with acute abdomen in scrub typhus is emphasized, with caution that the possibility of scrub typhus should be taken considered, especially in patients coming from hyperendemic areas.
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