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21/693. Abdominal distention and shock in an infant.

    Acute abdominal distention in the pediatric patient may be attributable to extraperitoneal fluid, masses, organomegaly, air, an ileus, a functional or mechanical bowel obstruction, or injury and blood secondary to trauma. An infant who presents to the emergency department with acute abdominal distention and shock is a true emergency for which the differential diagnosis is extensive. An unusual case of abdominal distention, ascites, hematochezia, and shock in an infant, subsequently found to have spontaneous perforation of the common bile duct is reported. This uncommon cause of abdominal distention and shock in an infant is many times left out of the differential diagnosis of an acute abdomen. The presentation may be as an uncommon acute form or a classis subacute type. This patient had hematochezia, which had not been previously reported in association with this entity. Failure to recognize and treat an acute abdomen can result in high mortality. ( info)

22/693. Perforated jejunal diverticulitis as a rare cause of acute abdomen.

    Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed. ( info)

23/693. Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.

    We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed. ( info)

24/693. Fishbone perforation through a Meckel's diverticulum: a rare laparoscopic diagnosis in acute abdominal pain.

    The use of diagnostic laparoscopy in acute abdominal pain, especially when patients have been admitted for acute pain in the lower abdominal quadrants, improves the accuracy of diagnosis and leads to improvements in treatment procedures. A case is reported of a 24-year-old woman admitted under suspicion of appendicitis. The appendix was found to be normal, and a perforation caused by a fishbone was discovered in a Meckel's diverticulum. The diverticulum was resected by a combined laparoscopic and open procedure. Diagnostic laparoscopy should be performed routinely in cases of acute abdominal pain in the lower quadrants of suspected appendiceal origin to avoid overlooking other causes of the symptoms. ( info)

25/693. Severe gastrointestinal bleeding resulting in total gastrectomy in a patient with major burns--a case report.

    gastrointestinal hemorrhage is a known but rare complication of major burns. This case report describes the management of this potentially life threatening problem in a young adult with 45% body surface area burns who developed massive gastrointestinal-tract bleeding. The patient required a total gastrectomy that was complicated by a burst abdomen. Despite undergoing a series of major insults. the patient survived and was eventually discharged from hospital with an acceptable level of morbidity. The problems faced by the burn centre team and the issues involved in the decision making process are discussed in the management of this unusually devastating complication. ( info)

26/693. Epiploic appendagitis: adding to the differential of acute abdominal pain.

    We report a patient with epiploic appendagitis who presented with acute abdominal pain. Emergency Department and discharge courses are described. The pathophysiology, presentation, diagnosis, and treatment of this disorder are discussed. knowledge of this uncommonly diagnosed entity and its usual benign course may allow the Emergency Physician to order the appropriate studies to help avoid unnecessary surgical treatment. ( info)

27/693. Inflammatory (pseudosarcomatous) myofibroblastic tumor of the urinary bladder causing acute abdominal pain.

    Inflammatory myofibroblastic tumor is a reactive proliferation of myofibroblasts that rarely involves the urinary bladder. The cause of inflammatory myofibroblastic tumor is unknown but may represent an initial reactive process to an infectious agent or trauma that transforms into neoplastic growth. Cases reported in children, however, often lack any preexisting bladder pathology. The authors present a case in a young child that presented as acute abdominal pain. In general, these tumors follow a benign clinical course after resection, although close monitoring is essential given the rarity of this bladder lesion. ( info)

28/693. Rectus sheath hematoma.

    We describe 3 patients with rectus sheath hematoma presenting to the emergency department. Prompt consideration of this uncommon cause of abdominal pain may prevent more expensive and invasive diagnostic tests and, in some cases, unnecessary hospitalization and laparotomy. ( info)

29/693. 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. ( info)

30/693. Purulent pericarditis presenting as acute abdomen in children: abdominal imaging findings.

    Purulent pericarditis is rapidly fatal if untreated [1,2]. With increased development of bacterial resistance to antibiotics, severe bacterial infections in children are becoming more frequent [3,4]. We report two children with purulent pericarditis who presented in a 1-month period for evaluation of acute abdominal distention and signs of sepsis. In both, one evaluated with computed tomography (CT) and one with ultrasound, abdominal findings included periportal edema, gallbladder wall thickening, and ascites secondary to right heart failure from cardiac tamponade. Radiologists should be aware that children with purulent pericarditis may have a normal heart size on radiographs, present with acute abdominal symptoms, and demonstrate findings of right sided heart failure on abdominal imaging. ( info)
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