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1/10. Acute abdomen as an atypical presentation of meningococcal septicaemia.

    The clinical manifestations and course of meningococcal disease have been well described, but atypical presentations may, if unrecognized, lead to a delay in treatment. We describe here an unusual case of this disease in a 21-y-old woman who presented with an acute rigid abdomen, clinical and laboratory features of sepsis, shock and early DIC with no indication of meningococcal infection. She developed a rapidly spreading purpuric rash, conjunctival haemorrhages, hypotension and tachycardia and a low urine output. Laboratory investigations showed a low platelet count, low haemoglobin and normal WBC. A presumptive diagnosis of meningococcal septicaemia was made and recovery followed treatment with cefotaxime, fluids and inotropes. A fully sensitive neisseria meningitis Group C, type 2a, subtype NT was isolated from blood cultures, but not from CSF obtained after antibiotic treatment.
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ranking = 1
keywords = haemorrhage
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2/10. Intramural haemorrhage of the colon.

    Two cases of acute abdominal crisis due to intramural haemorrhage of the colon are presented with a review of the literature. One was a 10-year-old Nigerian boy; the haemorrhage occurred in the caecum and ascending colon. The other was a 69-year-old Caucasian woman with a haemorrhage in the colonic splenic flexure and descending colon. Both had a one-stage resection with anastomosis. The child survived; the woman died two days after the operation. The preoperative diagnosis of bleeding colonic lesions remains difficult especially when facilities for investigation are scarce. It is re-emphasized that in patients with acute abdomen it is not necessary to insist on accurate preoperative diagnosis before offering appropriate treatment.
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ranking = 7
keywords = haemorrhage
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3/10. A case of "silent" pheochromocytoma presenting as spontaneous retroperitoneal hematoma.

    pheochromocytoma of the adrenal gland can be the cause of massive and lethal retroperitoneal haemorrhage presenting as acute abdomen. Here we report a case of retroperitoneal hematoma, with concomitant peritoneal spillage, due to the spontaneous rupture of a silent pheochromocytoma. The main clinical findings of this disease will be described. Therapy and prognosis will be also discussed.
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ranking = 1
keywords = haemorrhage
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4/10. Acute myeloid leukemia presenting as splenic rupture.

    We describe a rare case of acute myeloid leukemia presenting primarily as an acute abdomen due to spontaneous splenic rupture in a 19 years male patient. He was treated with splenectomy after failure of conservative management for splenic preservation but later succumbed to an intracerebral haemorrhage.
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ranking = 1
keywords = haemorrhage
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5/10. focal nodular hyperplasia presenting as acute abdomen.

    focal nodular hyperplasia (FNH) is a benign liver tumour with an asymptomatic course, rarely causing complications. When the diagnosis is certain, only watchful observation is necessary. We highlight an interesting case of a 42-year-old woman with a FNH that ruptured and became haemorrhagic, thus presenting as an acute surgical abdomen. The diagnosis was only established after surgical resection with histopathological confirmation. Although haemorrhage of hepatic FNH is extremely rare, this case highlights the small risk of rupture in large lesions.
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ranking = 1
keywords = haemorrhage
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6/10. intestinal obstruction at the onset of acute lymphoblastic leukemia in a child.

    Surgical complications need not be fatal in acute leukemia. If these are promptly diagnosed and properly treated, the prognosis will improve. This report deals with a case of acute lymphoblastic leukemia presenting with an acute abdomen following surgery for choledochal cyst. A peripheral blood smear and examination of the bone marrow revealed acute lymphoblastic leukemia. The child received transfusions of blood and platelets. Pretreatment with prednisolone was started as therapy for leukemia, and 2 days later, the patient underwent surgery. Therapy was continued until the general condition allowed a more aggressive form of treatment. Complete remission was achieved, and the patient is still in good health 48 months after diagnosis and 15 months after discontinuation of treatment. The favorable outcome in this child shows that prompt surgery is sometimes an essential step in the treatment of childhood leukemia.
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ranking = 3.0023682235105
keywords = transfusion
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7/10. Tension pneumoperitoneum.

    A 26-year-old woman developed the adult respiratory distress syndrome after a post-partum haemorrhage. After mechanical ventilation was started the signs of a tense and distended acute abdomen developed. The aspiration and subsequent analysis of copious intra-peritoneal gas confirmed the diagnosis of a tension pneumoperitoneum secondary to pulmonary barotrauma.
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ranking = 1
keywords = haemorrhage
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8/10. Spontaneous rupture of the kidney.

    Two cases of spontaneous rupture of the kidney manifesting as acute abdomen are described. In both cases urgent transabdominal nephrectomy was carried out. The whole distal half of the kidney was tumorous and rupture, with extensive perirenal and retroperitoneal haemorrhage. Histological findings showed in the first instance renal liposarcoma, in the second instance an atypical lipoma of the kidney. The first patient survives 4 years, the second one year, after the operation both are in a good condition.
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ranking = 1
keywords = haemorrhage
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9/10. Acute surgical abdomen caused by thrombocytopenia in patients with acute leukemia and multiple myeloma.

    One patient with multiple myeloma and four patients with acute leukemia presented with severe abdominal pain. Pertinent findings included numerous petechiae in the skin and buccal cavity, and diffuse abdominal guarding and tenderness, suggesting peritoneal involvement. Severe thrombocytopenia was found in all patients. laparotomy was performed in the patient with multiple myeloma, and revealed numerous petechiae throughout the peritoneum. All five patients responded to platelet transfusions with disappearance of the abdominal signs and symptoms. Severe thrombocytopenia should be considered among the causes of acute surgical abdomen in patients with malignant hematological disorders, and platelet transfusions should be administered before any surgical intervention.
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ranking = 6.004736447021
keywords = transfusion
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10/10. Acute presentation of tuberous sclerosis: case report.

    Incomplete form of tuberous sclerosis (TS) may present with acute complications such as haematuria, retroperitoneal haemorrhage or pneumothorax. Such cases may pose diagnostic difficulty. A patient with incomplete form of TS without any cerebral impairment who presented as an acute surgical abdomen is reported. The diagnostic criteria of TS are reviewed. Visceral manifestations of TS including acute complications are discussed. The importance of recognising such presentations is stressed.
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ranking = 1
keywords = haemorrhage
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