Cases reported "Torsion Abnormality"

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1/82. Disseminated cystic lymphangiomatosis presenting with acute abdomen: report of a case and review of the literature.

    lymphangioma is an uncommon tumor. Lymphangiomatosis, a benign tumor consisting of a cluster of dilated lymphatic channels, is very unusual. Most lymphangiomatoses are found in the neck and head area. Less than 5% are diagnosed intraabdominally and they are very infrequently encountered in the retroperitoneal area. Herein, we report a rare case of a 32 year-old woman who had disseminated intra-abdominal and retroperitoneal cystic lymphangiomatosis, which presented as acute abdomen. She received exploratory laparotomy due to the suspicion of malignancy, which was finally confirmed as cystic lymphangiomatosis. The clinical manifestations, imaging features, and management of this patient are discussed and compared with previous literature.
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2/82. Accidentally delayed diagnosis of ruptured ovarian carcinoma in a young woman: a care report.

    Ovarian carcinoma commonly occurs in postmenopausal women and often presents with an insidious course. Acute abdomen is rarely an initial symptom. When these patients present with abdominal discomfort, the disease has already spread throughout the peritoneal cavity. We present a case of mucinous cystadenocarcinoma in a young woman who presented with acute abdomen and intra-abdominal bleeding. This 24-year-old woman was previously diagnosed with a ruptured left ovarian cystic tumor at a primary clinic. She underwent emergency exploratory laparotomy, followed by unilateral salpingo-oophorectomy at the clinic. No thorough examination of the peritoneal cavity was done during surgery. The diagnosis of mucinous cystadenocarcinoma was accidentally over-looked until one month later when she returned for routine follow-up. Upon referral to our clinic, the patient underwent a repeat laparotomy. The surgicopathologic diagnosis was intraperitoneal carcinomatosis stage IIIC that could not be excised completely, even though rigorous staging surgery including washing cytology, total abdominal hysterectomy, salpingo-oophorectomy, retroperitoneal lymphadenectomy, appendectomy, infracolic omentectomy and excision of any suspicious and removable lesions were performed. This case alerts us to consider the possibility of ovarian malignancy when a young woman presents with an acute abdomen secondary to ruptured ovarian cystic tumor and intraperitoneal hemorrhage. Careful preoperative preparation and thorough intrasurgical examination of the peritoneal cavity along with a prompt pathologic diagnosis of suspicious lesions will prevent missed diagnoses.
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3/82. gallbladder torsion: case report and review of 245 cases reported in the Japanese literature.

    We report here a case of torsion of the gallbladder in a 73-year-old woman. The patient was admitted to our hospital with right hypochondralgia. ultrasonography and computed tomography demonstrated a distended gallbladder, with a multilayered wall, which contained no stones. Since the symptoms did not respond to antibiotics, laparotomy was performed. The gallbladder was found to be twisted around its pedicle and to be gangrenous. cholecystectomy was performed, and the patient had an uneventful postoperative course. We also reviewed 245 cases reported in the Japanese literature. The clinical features of gallbladder torsion, which include low frequency of fever and jaundice, poor response to antibiotic therapy, and acute onset of abdominal pain, may be helpful in the differential diagnosis from acute cholecystitis. Moreover, a highly suggestive sign of gallbladder torsion observed by ultrasonography or computed tomography is a markedly enlarged "floating" gallbladder with a continuous hypoechoic line indicating edematous change in the wall.
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4/82. Retroperitoneal teratoma presenting as acute abdomen in an elderly person.

    A 56-year-old man presented with acute abdomen. Clinically, he was diagnosed as having perigastric abscess. On exploration, a retroperitoneal cystic teratoma was encountered. Postoperatively, he recovered uneventfully and has no residual disease two years later.
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5/82. 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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6/82. Cecal duplications: a rare cause for secondary intussusception.

    Duplications of the alimentary tract are rare congenital anomalies that may occur at any level from mouth to anus. While the oesophagus and the ileum are the most common sites, duplications of the colon are rare. Two cases of ileocolic intussusceptions in 8-month-old girl and 6-month-old boy who were admitted to our hospital with acute abdomen findings are presented. Intraoperatively, cecal cystic duplications leading intussusception were revealed. intussusception is one of the most important surgical emergence in infancy and typically, it does not involve a lead point in childhood. Although duplication cyst may act as lead point, the review of literature reveals its rarity.
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7/82. Perforation of acute calculous Meckel's diverticulitis: a rare cause of acute abdomen in elderly.

    Complications of the Meckel's diverticula are well-known and defined. However, acute inflammation and perforation secondary to a calculus is a rare clinical presentation. A case of acute calculous Meckel's diverticulitis with perforation in a 58-year old man is presented and possible pathological conditions are discussed. Location of the perforation, apical microscopic focal ulcers, and ischaemic changes in the diverticulum remind the pathogenesis comparable to that of acute calculous cholecystitis. This case report with major complications related to Meckel's diverticulum strengthens the concept of prophylactic resection of Meckel's diverticulum in adults, incidentally discovered at laparotomy.
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8/82. 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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9/82. 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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10/82. Omental infarction as a delayed complication of abdominal surgery.

    Omental infarction, an uncommon cause of acute abdominal pain, is the result of compromised perfusion to the greater omentum. Although its etiology remains uncertain, predisposing factors include obesity [Surg. Today 30 (2000) 451], strenuous activity [N. Z. Med. J. 111 (1998) 211], trauma, and idiopathic omental torsion. Often confused with acute appendicitis or cholecystitis on clinical grounds [Surg. Today 30 (2000) 451], its diagnosis has traditionally been one of exclusion, based on intraoperative and pathologic findings. This diagnosis can be made radiologically based on the characteristic findings of an inflammatory mass containing fat and fluid. We describe a case of right lower quadrant omental infarction temporally related to bowel surgery.
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