151
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Abstract
Variations in intestinal knot syndromes have been described in the past, including ileoileal knots, ileosigmoid knots and appendico-ileal knots. We report a new type of intestinal knot syndrome, an ileocaecal knot, which, to our knowledge, has not been reported before in the world literature. Features on CT that may raise suspicion of an ileal knot syndrome are described.
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Affiliation(s)
- Tulsi Menon
- Department of General Surgery, Royal Perth Hospital, Western Australia, Australia.
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152
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Tanaka S, Kubota D, Oba K, Lee SH, Yamamoto T, Uenishi T, Tanaka H, Kubo S, Matsuyama M. Gallbladder torsion-induced emphysematous cholecystitis in a 16-year-old boy. J Hepatobiliary Pancreat Surg 2007; 14:608-610. [PMID: 18040631 DOI: 10.1007/s00534-007-1211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 02/27/2007] [Indexed: 05/25/2023]
Abstract
The patient was a 16-year-old boy who had turned to the right rapidly as he fielded a baseball that had come to him quickly. Two days after this event, which occurred in July 2004, he was admitted to hospital with repeated vomiting and increasing right hypochondralgia. Laboratory examination on admission showed elevation of the white blood count and of serum C-reactive protein and total bilirubin. Computed tomography on admission demonstrated an enlarged gallbladder and a thickened wall without gallstones, and magnetic resonance imaging performed 1 day later showed air within the gallbladder wall. His symptoms worsened, with a positive Murphy's sign, and emergency laparotomy was performed, with a diagnosis of emphysematous cholecystitis. Intraoperatively, the gallbladder was dark red, necrotic, distended, and enlarged. The cystic duct was attached only to the mesentery, and the gallbladder was floating freely, with the neck of the gallbladder having rotated 180 degrees counterclockwise, leading to a definitive diagnosis of gallbladder torsion with emphysematous cholecystitis. Cholecystectomy was performed, and analysis of bile showed Escherichia coli to be the causative organism. Histopathologic examination revealed necrotized cholecystitis. The patient is doing well 25 months after surgery, with an uneventful postoperative course.
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Affiliation(s)
- Shogo Tanaka
- Department of Surgery, Joto Central Hospital, Osaka, Japan
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153
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Abstract
We report a case demonstrating intense FDG uptake in the ovary, which was diagnosed to be a hemorrhage and congestion due to painless torsion. An asymptomatic retropelvic mass was detected in a 51-year-old female by echography. FDG-PET demonstrated intense uptake in the mass, thus suggesting an ovarian tumor. A resection of the tumor was performed, and histopathological examination revealed hemorrhage and congestion in the ovary due to ovarian torsion. An ovarian hemorrhage due to painless torsion should be considered in the differential diagnosis of intrapelvic masses demonstrating high FDG uptake, even in asymptomatic patients.
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Affiliation(s)
- Kentaro Takanami
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
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154
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Abstract
Omental torsion is a very rare cause of acute abdomen. Its primary diagnostic modality is CT. The whirl sign visible in CT images is pathognomonic. The whirl sign is not present in all cases. When no whirl sign is seen, omental torsion is rather difficult to be differantieted radiologically from omental infarct and epiploic appendicitis. The diagnosis of these three entites is clinically important due to their different treatments. We present in this paper an omental torsion case where whirl sign was not present and diagnosis was made by other suggestive CT image findings.
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Affiliation(s)
- T Ergun
- Department of Radiology, Alanya Teaching and Medical Research Center, Baskent University, Alanya, Turkey.
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155
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Gurses B, Ekci B, Akansel S, Kabakci N, Kucuk S, Kovanlikaya I. Primary epiploic appendagitis: the role of computed tomography in diagnosis. Australas Radiol 2007; 51 Spec No.:B155-7. [PMID: 17875142 DOI: 10.1111/j.1440-1673.2007.01782.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Primary epiploic appendagitis is a rare entity that occurs due to torsion and inflammation of the epiploic appendages. Clinically, this entity may be mistaken for acute abdomen with resultant unnecessary surgery. In contrast to acute surgical abdomen, epiploic appendagitis usually does not require surgical treatment; most of the patients resolve with conservative management. Diagnosis can be achieved with imaging modalities of which computed tomography is the gold standard procedure. Herein, a patient who presented with acute abdomen like clinical picture, with the computed tomography demonstration of primary epiploic appendagitis, is presented.
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Affiliation(s)
- B Gurses
- Yeditepe University Hospital, Department of Radiology, Istanbul, Turkey.
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156
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Abstract
A 6-year-old desexed female German Shepherd dog was referred to the Murdoch University Veterinary Hospital for assessment and management of acute onset vomiting, diarrhoea, polydipsia and lethargy of 2 days duration. Surgical, microbiological and histological findings were consistent with necrotising cholecystitis secondary to gall bladder torsion, resulting in gall bladder rupture and secondary non-septic bile peritonitis. A chronic peritoneopleural perforation resulting from an abdominal cavity foreign body and congenital peritoneopericardial hernia were also present. The dog made a full recovery following cholecystectomy, foreign body removal, repair of the peritoneopleural perforation and peritoneopericardial herniorrhaphy. This is the first recorded case of gall bladder torsion in the dog.
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Affiliation(s)
- G S Corfield
- School of Veterinary and Biomedical Sciences, Division of Health Sciences, Murdoch University.
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157
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Green P, Swischuk LE, Hernandez JA. Delayed presentation of malrotation and midgut volvulus: imaging findings. Emerg Radiol 2007; 14:379-82. [PMID: 17710454 DOI: 10.1007/s10140-007-0662-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 07/28/2007] [Indexed: 10/22/2022]
Abstract
Midgut volvulus presenting outside the neonatal period often manifests with less than classic findings. One must be ever vigilant for any deviation from normal when imaging the gastrointestinal tract in these patients. Plain films often are noncontributory, and gastrointestinal imaging findings frequently are subtle and not exactly the same as those seen in classic cases in the neonatal period. Cases are presented illustrating the following: abnormal but less than classic small bowel location and configuration, malabsorption and fortuitous spiraling of a nasogastric tube, viral gastroenteritis and pseudo intussusception, intractable vomiting and dehydration with abnormal cecal position, and duodenal obstruction: pseudo SMA syndrome. Fortunately, one now can confirm one's suspicions with computed tomography and ultrasound in terms of determining whether the superior mesenteric artery and superior mesenteric vein positions are normal or reversed.
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Affiliation(s)
- Page Green
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555-0709, USA
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158
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Aharoni A, Leibovitz Z, Levitan Z, Degani S, Ohel G. Complication of laparoscopic detorsion of adnexal mass. Gynecol Obstet Invest 2007; 65:39-40. [PMID: 17703093 DOI: 10.1159/000107459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 03/20/2007] [Indexed: 11/19/2022]
Abstract
Detorsion of an ischemic adnexal mass has recently been advocated for most cases of twisted adnexa. Usually, the affected ovary regains some or all of its vitality and function. However, when the ovary is completely necrotic, it may form an abscess if it contains tissue components that cannot be eliminated by the peritoneal immune system. We report a case of pelvic abscess formation in a detorsed ovary that previously contained an unsuspected dermoid cyst. We call for an extensive inspection of the detorsed ovary before ending the laparoscopic operation, and if it remains necrotic and is suspected of containing a dermoid cyst, it should be removed promptly.
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Affiliation(s)
- A Aharoni
- Gynecology and Obstetrics Department, Bnai-Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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159
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Grover S. Torsion causing interruption of the ampullary portion of the fallopian tube. Fertil Steril 2007; 88:968.e13-4. [PMID: 17678908 DOI: 10.1016/j.fertnstert.2006.11.159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 11/27/2006] [Accepted: 11/27/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To present a description of a young girl who presented acutely with symptoms and findings that are consistent with acute adnexal torsion, where resultant outcome would have led to perception of a congenital anomaly. DESIGN Case report. SETTING Tertiary pediatric hospital. PATIENT(S) A young girl who presented acutely with symptoms consistent with adnexal torsion but who was found to have a torsion affecting a paratubal cyst and the midsegment of her fallopian tube. INTERVENTION(S) A salpingectomy was performed because of damage involving the ischemic paratubal cyst and tubal segment that left too little residual tube to allow for a future anastomosis of the residual unaffected components. MAIN OUTCOME MEASURE(S) Operative findings, which give an explanation for midsegmental tubal absence. RESULT(S) This case challenges previous reports that absent midsegment of a tube is a rare congenital anomaly. CONCLUSION(S) Absent midsegment of a tube can be explained as an acquired anomaly, rather than proposing an unusual congenital anomaly.
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Affiliation(s)
- Sonia Grover
- Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Australia.
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160
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Patel VG, Rao A, Williams R, Srinivasan R, Fortson JK, Weaver WL. Cecal epiploic appendagitis: a diagnostic and therapeutic dilemma. Am Surg 2007; 73:828-30. [PMID: 17879696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Acute epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. Though a benign and often self-limiting condition, EA's ability to mimic other disease processes makes it an important consideration in patients presenting with acute abdominal symptoms. Careful evaluation of abdominal CT scan findings is crucial in the accurate diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention. We report a case of a 29-year-old male presenting with a two day history of generalized abdominal pain. Physical exam revealed a diffusely tender abdomen with hypoactive bowel sounds. The patient had a leukocytosis of 18,000 and abdominal CT scan revealed right lower quadrant inflammatory changes suggestive of acute appendicitis. Laparoscopic exploration revealed an inflamed gangrenous structure adjacent to the ileocecal junction. Pathologic evaluation revealed tissue consistent with epiploic appendagitis. Retrospective review of the CT scan revealed a normal appearing appendiceal structure supero-lateral to the area of inflammation. The patient recovered uneventfully with resolving leukocytosis. We present a case of cecal epiploic appendagitis mimicking acute appendicitis and review the current literature on radiographic findings, diagnosis, and treatment of this often misdiagnosed condition. General surgeons should be aware of this self-limiting condition and consider this in the differential diagnosis.
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Affiliation(s)
- Vijaykumar G Patel
- Department of Surgery, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30311, USA.
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161
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Yamashiro T, Inamine M, Kamiya H, Kinjo A, Murayama S, Aoki Y. Massive ovarian edema with torsion: unusual hemorrhage and the recovery of contrast enhancement. Emerg Radiol 2007; 15:115-8. [PMID: 17593407 DOI: 10.1007/s10140-007-0648-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 06/10/2007] [Indexed: 10/23/2022]
Abstract
We report a case of massive ovarian edema due to left adnexal torsion. On initial magnetic resonance (MR), unusual hemorrhages were demonstrated as several hypointense areas on T2-weighted images. The lack of contrast enhancement was also observed in the left adnexa. Abdominal pain resolved spontaneously, and then follow-up MR demonstrated the recovery of enhancement and hemorrhages as hyperintense signals on T1-weighted images.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan.
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162
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Uslu Tutar N, Ozgül E, Oğuz D, Cakir B, Tarhan NC, Coşkun M. An uncommon cause of acute abdomen--epiploic appendagitis: CT findings. Turk J Gastroenterol 2007; 18:107-10. [PMID: 17602359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Epiploic appendagitis, which is an uncommon cause of acute abdomen, is a benign self-limiting inflammatory process of epiploic appendices. It has primary and secondary types. Computed tomography findings of the primary type are specific but are demonstrated rarely. Herein, we present pre- and post-treatment computed tomography findings of two cases who admitted to the emergency clinic with acute abdominal pain and were diagnosed to have epiploic appendagitis. Follow-up computed tomography features correlated well with clinical improvement.
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Affiliation(s)
- Nihal Uslu Tutar
- Department of Radiology, Başkent University, School of Medicine, Ankara.
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163
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Cho S, Sato N, Furuya Y. [Clinical study on operative treatment of acute scrotum]. Hinyokika Kiyo 2007; 53:381-5. [PMID: 17628935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Between July 1986 and March 2006, 102 patients underwent an operation for acute scrotum. Median age was 12.0 years old (range 0-51). Post-operative diagnosis revealed 50 cases (49%) of spermatic cord torsion, 29 cases (28%) of epididymal appendix torsion, and 13 cases (13%) of acute epididymitis. Spermatic cord torsion was most frequent in the age between 0 and 5, and 11 and 20, while epididymal appendix torsion was most frequent between 6 and 10. Moreover, acute epididymitis was most frequently seen in the age over 20. There were no apparent differences in the clinical symptoms such as scrotal pain, scrotal swelling, and abdominal pain. In the physical examinations, pyuria was the only finding to indicate acute epididymitis. In case of spermatic cord torsion, 'golden time' is defined as the time from onset to operation when testicular function can be expected for preservation. In this study golden time was defined as 8 hours because the testes was preserved in all 23 patients receiving the operation within 8 hours, but in only 10 (37%) out of 27 patients receiving the operation after 8 hours. Moreover, the operation within 24 hours saved the testes in approximately 90% of the patients. In patients with acute scrotum, emergency operation should be performed as speedily as possible for preservation of testicular function.
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Affiliation(s)
- Shuko Cho
- The Department of Urology, Teikyo University Chiba Medical Center
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164
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Beal S, Bhabra K. Progress over 32 years of a survivor of giant exomphalos and outcome of pregnancy. J Pediatr Surg 2007; 42:E11-3. [PMID: 17560188 DOI: 10.1016/j.jpedsurg.2007.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the progress of a female survivor of ruptured giant exomphalos over 32 years. Two-stage repair was performed at birth, resulting in a giant ventral hernia, which was repaired at 31 months. She developed gross benign ascites at 24 years, not previously described in association with congenital abdominal wall defects. This was associated with a misleading radiologic finding of a complex ovarian cyst and led to laparotomy. There were dense adhesions. Benign ascites and loculated pelvic fluid were drained, but the ovaries appeared healthy. A further laparotomy was performed for acute abdominal pain 2 years later. She subsequently had a successful pregnancy complicated by urinary retention. The abdomen expanded without difficulty, unlike the only other such case reported in the literature. A healthy baby girl was delivered by cesarean section at 37 weeks' gestation, which was necessary because of a footling breech presentation.
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Affiliation(s)
- Sophia Beal
- Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, LS9 7TJ West Yorkshire, UK.
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165
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García-Candel A, Hernández-Palazón J, García-Ferreira J, Sánchez-Ortega JL. [Managing anesthesia for a woman with Donohue syndrome]. Rev Esp Anestesiol Reanim 2007; 54:256-7. [PMID: 17518181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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166
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Eguchi T, Koike S, Maeno K, Nakamura T, Iwasa T, Nakazawa K, Furuta K. [A case of nonocclusive mesenteric ischemia (NOMI) which occurred in a patient with torsion of gallbladder]. Nihon Shokakibyo Gakkai Zasshi 2007; 104:555-60. [PMID: 17409665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report a case of nonocclusive mesenteric ischemia (NOMI) which occurred in a patient with torsion of gallbladder. A 91-year-old woman was admitted to the hospital and was diagnosed of acute cholecystitis. The next day, she went into shock. Then, we diagnosed her illness as torsion of gallbladder by computed tomography and ultrasonography, and performed an emergency operation. After cholecystectomy, it was recognized that the wide range of the small intestine had become necrotic sporadically. We diagnosed it as NOMI, and performed the wide resection of the small intestine followed by making double stomas. There is no previous report of NOMI associated with torsion of gallbladder. We guess the cause of NOMI in this case would be dehydration because of gallbladder torsion. NOMI has high mortality. Early diagnosis and early treatment are of great importance in NOMI.
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167
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Abstract
We report an unusual case of acute abdomen due to axial torsion and infarction of a Meckel's diverticulum in a 13-year-old boy and illustrate the versatility of laparoscopy in the diagnosis and management of acute surgical abdomen in children. We believe that this is only the third case reported in a child of torsion of a Meckel's diverticulum and the first to be managed by laparoscopic resection.
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Affiliation(s)
- T R Sai Prasad
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
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168
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Pinedo-Onofre JA, Guevara-Torres L. [Omental torsion. An acute abdomen etiology]. GAC MED MEX 2007; 143:17-20. [PMID: 17388092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
INTRODUCTION Omental torsion is an uncommon cause of acute abdomen, usually mimicking acute appendicitis; almost all described cases are diagnosed with laparotomy. It can be a primary or secondary condition. Primary torsion occurs without evidence of intrabdominal abnormalities. MATERIAL AND METHODS Retrospective, observational, longitudinal, descriptive study carried out between January 2001 and December 2005. Patients diagnosed as acute appendicitis were included and we assessed diagnostic accuracy by means of anatomopathology and omental torsion incidence. RESULTS 2135 patients were included; diagnostic accuracy was 91.71%. Eight omental torsion cases were identified, with an incidence of 0.37% and all diagnosed with laparotomy. Patients in the first and fourth decades of life were mostly affected; 75% of the cases were observed in adults, and 62.5% displayed secondary torsion. DISCUSSION Omental torsion is a rare cause of acute abdomen. Acute appendicitis is a frequent differential diagnosis that should be taken into account. In our series, we found a two-fold higher incidence of omental torsion, compared with previously reported incidence data. We also found a difference in age and sex distribution among patients with this diagnosis.
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169
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Papaziogas B, Dragoumis D, Tsiaousis P, Giakoustidis D, Atmatzidis S, Sarlis G, Atmatzidis K. Primary torsion of the greater omentum. An obscure and unusual cause of acute abdomen. Chirurgia (Bucur) 2007; 102:95-8. [PMID: 17410738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A 36-year-old man was admitted with a 3-day history of severe abdominal pain in the right upper abdomen and was initially diagnosed with acute cholecystitis or acute retrocecal appendicitis. The patient was transferred to the department of surgery for close surgical observation. CT of the entire abdomen was performed just before the operation, which demonstrated inflammation in the omental fat. Surgery revealed primary omental torsion and subsequent resection of the infarcted segment offered a rapid recovery. We report a case of primary segmental omental torsion and discuss the diagnostic and therapeutic implications of this unusual entity.
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Affiliation(s)
- B Papaziogas
- 2nd Surgical Clinic of the Aristotle University of Thessaloniki, Greece.
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170
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Abstract
OBJECTIVE Torsion of adnexa is relatively common, but isolated torsion of the fallopian tube is rare. It should be considered in all adolescents who present with acute pelvic pain. Laparoscopy or laparotomy is often necessary to establish the diagnosis. This report focuses on a 14-year-old girl with isolated tubal torsion who presented with acute pelvic pain. CASE REPORT A 14-year-old adolescent was admitted to our hospital because of acute right-sided abdominal pain without vomiting and diarrhea. Pelvic ultrasound showed an adnexal mass. Conservative treatment was given but did not improve her condition. Emergent laparoscopy was performed due to persistent symptoms, which later confirmed the diagnosis of isolated torsion of the fallopian tube. Pathology showed hemosalpinx with necrosis. CONCLUSION Isolated torsion of the fallopian tube is an uncommon event, especially in adolescents. It must be kept in mind whenever a young girl presents with low abdominal pain and pelvic mass on ultrasound. Prompt laparoscopic intervention may allow for early diagnosis, treatment and preservation of the tube if possible.
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Affiliation(s)
- Hei-Yu Lau
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
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171
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Jalaguier A, Simon J, Berrod JL, Boulay-Coletta I, Jullès MC, Zins M. Torsion d’un appendice épiploïque au sein d’une hernie de Spigel : premier cas rapporté en imagerie. ACTA ACUST UNITED AC 2006; 87:1891-3. [PMID: 17213775 DOI: 10.1016/s0221-0363(06)74171-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present the first case illustred in imaging of an epiploic appendage torsion inside a Spigelian hernia.
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Affiliation(s)
- A Jalaguier
- Service de radiologie, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674 Paris Cedex 14
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172
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Nakai H, Takeuchi M, Nishikage T, Kokumai M, Otani S, Lang RM. Effect of aging on twist-displacement loop by 2-dimensional speckle tracking imaging. J Am Soc Echocardiogr 2006; 19:880-5. [PMID: 16824997 DOI: 10.1016/j.echo.2006.02.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Indexed: 12/27/2022]
Abstract
BACKGROUND Newly developed 2-dimensional (2D) speckle tracking imaging provides simultaneous information on both cardiac rotation and radial displacement throughout the cardiac cycle, thus, providing the opportunity to noninvasively construct twist-displacement loops. The aim of this study was to examine the effect of aging on twist-displacement loops. METHODS Basal and apical 2D left ventricular (LV) short-axis images with high frame rates were acquired in 59 asymptomatic healthy volunteers. Using commercially available software, LV rotation and radial displacement were obtained at each plane by 2D speckle tracking analysis. LV twist was defined as apical LV rotation relative to the base. To adjust intersubject differences in heart rate, the time sequence was normalized to the percentage of systolic and diastolic duration. Volunteers were divided into 3 groups according to age. RESULTS Twist-displacement loops were characterized by a figure of 8 configuration. There was a linear relation between twist and displacement during systole (r = 0.97), with its slope being significantly larger in the older group compared with the young group. During early diastole, a substantial degree of untwisting developed despite a relatively small reversal of systolic radial displacement, resulting in a much steeper twist-displacement relationship observed in all groups. Subsequent diastolic expansion occurred with more gradual additional untwisting. CONCLUSION We found that 2D speckle tracking imaging successfully provides twist-displacement loop, noninvasively. Aging affects the systolic component of the twist-displacement loop. The assessment of twist-displacement loop may be useful for evaluating LV function.
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Affiliation(s)
- Hiromi Nakai
- Department of Cardiology and Internal Medicine, Tane General Hospital, Osaka, Japan
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173
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Abstract
OBJECTIVE Hydatids of Morgagni are common embryonal remnants of the müllerian duct and among the infrequent causes of adnexal torsion. The purpose of this study was to investigate the occurrence of adnexal torsion involving hydatids of Morgagni, as well as its possible mechanisms. METHODS A database search was conducted for cases of adnexal torsion treated in our institution from January 2002 to July 2005. These cases were analyzed, focusing on a subgroup of adolescents with adnexal torsion involving the hydatids of Morgagni. RESULTS There were 76 patients with adnexal torsion. The rate of hydatid of Morgagni torsion was 26% (4 of 15 cases, 95% confidence interval [CI] 0.15-0.51) in the adolescent subgroup (10-19 years old), compared with 0% (0 of 61 cases, 95% CI 0-0.048) in the adult subgroup. The difference between the hydatid torsion rates in the two subgroups was statistically significant (P = .01, 95% CI 0.001-0.532). The four patients with hydatid torsion (postmenarchal girls, aged 13-18 years) were managed with laparoscopic adnexal detorsion and cystectomy of the affected hydatid of Morgagni. At surgery, we noted three different mechanisms of hydatid torsion: torsion of the adnexa together with torsion of the hydatid of Morgagni, torsion of the hydatid of Morgagni with intact adnexa (n = 2), and entanglement of the hydatid's pedicle around the distal fallopian tube. The hydatids of Morgagni were observed on the preoperative transabdominal ultrasonogram in only one patient and appeared as a simple cyst. CONCLUSION Adnexal torsion involving the hydatids of Morgagni appears to be more common in adolescents than previously thought. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Moty Pansky
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel.
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174
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Purnichescu V, Cheret-Benoist A, Von Theobald P, Mayaud A, Herlicoviez M, Dreyfus M. Prise en charge cœlioscopique des masses latéro-utérines pendant la grossesse. ACTA ACUST UNITED AC 2006; 35:388-95. [PMID: 16940907 DOI: 10.1016/s0368-2315(06)76410-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy. MATERIAL and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique. RESULTS The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases. CONCLUSION Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.
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Affiliation(s)
- V Purnichescu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, avenue Georges-Clemenceau, 14033 Caen Cedex
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175
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Abstract
Torsion of the free end of the falciform ligament is an extremely rare cause of localized peritonitis. A surgically proven case is presented here, with ultrasound and CT findings and a review of the published work.
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Affiliation(s)
- T Lloyd
- Department of Radiology, Logan Hospital, Brisbane, Queensland, Australia.
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176
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Klainguti G, Tran HV, Nguyen C, Bremart-Strickler J. [Surgical correction of subjective excyclotorsion by tucking the anterior part of the superior oblique muscle tendon]. Klin Monbl Augenheilkd 2006; 223:386-9. [PMID: 16705511 DOI: 10.1055/s-2006-926831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Asymmetrical folding of the anterior portion of the superior oblique muscle is a simplified variant of the Harada-Ito procedure that is supposed to selectively correct ocular torsion. PATIENTS AND METHODS This surgical technique was applied to 22 patients suffering from bilateral acquired IV nerve palsy. Ocular torsion was evaluated with the Harms tangent screen. Pre- and post-operative torsional values were compared. Post-operative follow-up was 12 months. RESULTS Pre-operatively, mean excyclotropia was 8.8 degrees in primary position and 15.9 degrees in downgaze. Post-operatively, these values decreased to 1.5 degrees and 4.1 degrees, respectively. An enlarged field of binocular single vision, extending beyond 10 degrees inferiorly, was obtained in 17/22 patients. CONCLUSIONS The selective technique of superior oblique muscle anterior tendon tucking allows one to efficiently correct the ocular torsion induced by acquired bilateral IV nerve palsy.
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Affiliation(s)
- G Klainguti
- Hôpital Ophtalmique Jules Gonin, Lausanne, Suisse.
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177
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Daponte A, Pournaras S, Hadjichristodoulou C, Lialios G, Kallitsaris A, Maniatis AN, Messinis IE. Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion. Fertil Steril 2006; 85:1469-72. [PMID: 16616744 DOI: 10.1016/j.fertnstert.2005.10.056] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 10/25/2005] [Accepted: 10/25/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the diagnostic value of preoperative levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and E-selectin in patients with an adnexal mass who had surgery for ovarian torsion. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Fifty consecutive women with adnexal mass who were admitted with a diagnosis of ovarian torsion. INTERVENTION(S) All had a single preoperative measurement of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA. MAIN OUTCOME MEASURE(S) To determine if a single preoperative serum sampling of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA can diagnose ovarian torsion. RESULT(S) Thirteen patients had proven torsion of the ovary. Serum levels of IL-6 were significantly higher in the 13 patients with proven ovarian torsion compared with the 37 without ovarian torsion. Patients with IL-6 serum values > or =10.2 pg/mL had a 16 times higher risk of having ovarian torsion. No significant difference was found in TNF-alpha, IL-8, and E-selectin between the two groups. CONCLUSION(S) The IL-6 levels might assist in the prompt diagnosis of ovarian torsion and allow a timely surgical intervention.
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Affiliation(s)
- Alexandros Daponte
- Department of Obstetrics and Gynaecology, University Hospital of Larissa, Larissa, Greece.
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178
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Abstract
Twisting with infarction of the greater omentum is a rare cause of acute abdominal pain. Depending on the location, clinical symptoms can mimic other acute abdominal pathologies. The etiology remains elusive. Because of its rarity, correct diagnosis is difficult to make, but it can be helped by computed tomographic scan. The laparoscopical approach allows exploration of the abdominal cavity and surgical intervention. The preferred treatment remains resection of the necrotic omentum. We describe two cases of twisting with infarction (one left and one right) of the entire greater omentum managed laparoscopically over a period of two weeks.
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Affiliation(s)
- Th Coppin
- Department of Gastro-intestinal Surgery, Hopital Edith Cavell, Brussels, Belgium.
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179
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Affiliation(s)
- K I Munro
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH1S 5SA, UK
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180
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Cay A, Alver A, Küçük M, Işik O, Eminağaoğlu MS, Karahan SC, Değer O. The effects of N-acetylcysteine on antioxidant enzyme activities in experimental testicular torsion. J Surg Res 2006; 131:199-203. [PMID: 16412470 DOI: 10.1016/j.jss.2005.11.572] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 10/24/2005] [Accepted: 11/09/2005] [Indexed: 01/28/2023]
Abstract
Testicular torsion is a serious problem in male children and, if not treated at the right time, can lead to subfertility and infertility. The main reason for testicular damage is ischemia-reperfusion injury. A number of chemical substances have been used to protect testes against ischemia-reperfusion injury in experimental animals. The possible protective effect of N-acetylcysteine on testicular tissue after testicular detorsion was examined in the current study. Twenty-four rats were divided into four groups: sham operation, torsion, detorsion, and NAC + detorsion groups (n = 6 for each group). Excluding sham operation group, the rats were subjected to unilateral torsion (720-degree rotation in clockwise direction). After torsion (5 h) and detorsion (2 h), unilateral orchidectomy was performed. Malondialdehyde levels and superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase activities were determined in testicular tissue. Administration of N-acetylcysteine caused a decrease in malondialdehyde levels and an increase in glutathione peroxidase levels compared to detorsion group. The results suggest that N-acetylcysteine may be a potential protective agent for preventing the negative biochemical changes related to oxidative stress in testicular injury caused by testis torsion.
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Affiliation(s)
- Ali Cay
- Department of Pediatric Surgery, Karadeinz Technical Unversity, Trabzon, Turkey.
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181
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Lee JH, Kim KS, Cho YG. A case of torsion of a mucinous cystadenoma in triple-X syndrome with pure gonadal dysgenesis. Arch Gynecol Obstet 2006; 274:174-7. [PMID: 16408186 DOI: 10.1007/s00404-005-0116-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 09/05/2005] [Indexed: 10/25/2022]
Abstract
Triple-X female characterized by primary amenorrhea and pure gonadal dysgenesis is extremely rare. We present a patient of triple-X syndrome who has not had menarche or the development of the secondary sexual characteristics. She had a hypoplastic uterus and streaked gonads on both sides with a twisted mucinous cystadenoma in the right adnexa.
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Affiliation(s)
- Jeong-Heon Lee
- Department of Obstetrics and Gynecology, Research Institute of Clinical Medicine, Chonbuk National University Medical School, 634-18 Keumam-dong, Dukjin-gu, 561-712 Jeonju, Jeonbuk, South Korea
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182
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Affiliation(s)
- T Poulose
- Maternity Unit, Scarborough Hospital NHS Trust, Scarborough, UK
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183
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James GA, Strokon D. Cranial strains and malocclusion: IV. Torsion. Int J Orthod Milwaukee 2006; 17:19-24. [PMID: 16617884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The cranial strain known as torsion does not fit within the Angle Classification. This strain is described and how to identify it. Torsion may occur as the only strain or is more commonly superimposed on another strain. Recognizing the presence of a torsion has a significant bearing on treatment sequencing. An approach to treatment is demonstrated.
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184
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Tarasenko SV, Lun'kov IA, Natal'skiĭ AA. [Strangulated hernia of omental bursa]. Khirurgiia (Mosk) 2006:65-6. [PMID: 17058341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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185
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Kies D, Garcia-Covarrubias L, Corsetti RL. Omental torsion mimicking acute appendicitis: a case report. J La State Med Soc 2006; 158:36-8. [PMID: 16602484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Primary omental torsion is an uncommon cause of an acute abdomen that can mimic acute appendicitis. Herein we report a case of suspected acute appendicitis that proved to be a distal segment of infarcted omentum secondary to primary torsion.
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Affiliation(s)
- Darren Kies
- Tulane University School of Medicine, New Orleans, LA, USA
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186
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Tamamoto F, Ishizaki H, Takanashi T, Shimoji K, Okamura T, Yoshimura T, Maehara T. Omental torsion with right-sided inguinal hernia. Radiat Med 2005; 23:566-9. [PMID: 16555566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Omental torsion is a rare cause of acute abdomen. The diagnosis is usually not established before surgery, but recently some reports have described the usefulness of computed tomography (CT) for the detection of this condition. We encountered a 58-year-old man with torsion of the greater omentum secondary to right-sided inguinal hernia, and present the characteristic CT findings of a whirl-like mass with hyperattenuated fatty tissue.
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Affiliation(s)
- Fumihiko Tamamoto
- Department of Radiology, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo 170-8476, Japan
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187
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Abstract
Abdominal pain often occurs in patients receiving chemotherapy. The authors describe a patient with osteosarcoma who developed severe right-sided abdominal discomfort several days after being admitted for fever, neutropenia, and mucositis. Unexpectedly, the patient's pain was not therapy-related, but rather was caused by a midline pelvic mass.
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Affiliation(s)
- Paul T Jubinsky
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, NY 10461, USA.
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188
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Abstract
INTRODUCTION Osteochondral (OC) fractures of the trochlea of the PIP joint are rare but the treatment of these fractures can be challenging [2, 5, 6, 10]. And the therapeutic guideline is not determined. MATERIALS AND METHODS All of the three cases were male. Two were delayed union with minimal displacement and the other was a fresh displaced fracture. All cases were treated with ORIF using small K-wires. In delayed union cases, bone grafting was added. RESULTS Although bone union was obtained in all cases, rotation of the fragment due to the absorption of the grafted bone resulted in deformity of the trochlea in one of the delayed union cases. The functional recovery at the 2-year follow-up was satisfactory in all cases. CONCLUSION Although OC fracture of the trochlea of PIP joint carry significant fixation implications, successful treatment could be done with ORIF using small K-wire fixation technique.
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Affiliation(s)
- Yoshiyuki Ohno
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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189
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Tan KP, Sargent MA, Poskitt KJ, Lyons CJ. Ocular overelevation in adduction in craniosynostosis: is it the result of excyclorotation of the extraocular muscles? J AAPOS 2005; 9:550-7. [PMID: 16414522 DOI: 10.1016/j.jaapos.2005.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 07/08/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We sought to determine whether radiological evidence supports excyclorotation of the extraocular muscle cone as a cause of overelevation in adduction in children with craniosynostosis. METHODS This was a retrospective case series of 40 patients with craniosynostosis. Ophthalmic findings were assessed for incomitant vertical strabismus in particular excessive elevation in adduction. Computed tomography and magnetic resonance imaging scans were reviewed. Those scans with adequate coronal imaging of their orbits to assess the position and angulation of the horizontal extraocular muscles were identified, and the degree of rotation of the muscles formally measured along with aged matched controls. These groups were analyzed for the association between presence of overelevation in adduction and degree of excyclorotation of the extraocular muscle cone. RESULTS The identified updrift on adduction that mimics inferior oblique muscle overaction was present in 63% (25/40) of patients. Imaging that permitted accurate measurement of the muscles positions was available in 10 of the 40 patients. Of these 10, 8 had the updrift, and 7 of these 8 (88%) demonstrated more excyclorotation than their aged matched controls. Comparison of scan measurements of patients revealed a significant difference in degree of excyclorotation (mean difference = 16.2, 95% confidence interval 6.2-31.5; P = 0.006) between patients with and without excess elevation in adduction. CONCLUSION Overelevation in adduction is significantly associated with excyclorotation of the extraocular muscle cone in children with craniosynostosis. We demonstrate a simple method to assess for the excyclorotation. Our findings support the importance of imaging of the orbits in these children before strabismus surgery.
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Affiliation(s)
- Kimberley P Tan
- Department of Ophthalmology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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190
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Abstract
BACKGROUND Simultaneous pregnancy in each horn of a uterus didelphys is a rare and complex clinical situation. CASE Torsion of one horn of a gravid didelphic uterus during a twin pregnancy was diagnosed during cesarean delivery after erroneous diagnosis of abruptio placentae. CONCLUSION Localization of the placenta in a pregnancy complicated by uterine didelphys may improve the ability to diagnose hemiuterus torsion.
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Affiliation(s)
- Fabien Demaria
- Service de Gynécologie-Obstétrique, Hôpital Rothschild, Paris VI University, France.
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191
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Karahan SR, Kayalıbağ E, Özdenkaya Y, Karatepe O. [Gallbladder torsion as a rare cause of acute abdomen; a case report and review of literature.]. ULUS TRAVMA ACIL CER 2005; 11:356-9. [PMID: 16341977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Torsion of the gallbladder is a rare cause of acute surgical abdomen. Less than 300 patients have been reported so far. On the other hand incidence seems to be higher than expected especially in elderly patients. This condition must be suspected in an elderly patient who represents signs and symptoms of toxemia and cholecystitis . Diagnosis is usually established during laparotomy. Torsion occurs at the base of the gallbladder around cystic duct and artery. Treatment is emergent cholecystectomy.
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Affiliation(s)
- Servet Rüştü Karahan
- Ministry of Health 2. Surgical Clinics of Okmeydanı Teaching Hospital, İstanbul, Turkey
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192
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Hsu MC, Lue KH, Lin ZI, Lu KH. Stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a spinner bowler: a case report and a review of the literature. Knee Surg Sports Traumatol Arthrosc 2005; 13:499-504. [PMID: 16170585 DOI: 10.1007/s00167-004-0560-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2003] [Accepted: 06/30/2004] [Indexed: 10/26/2022]
Abstract
Stress fractures of the ulnar shaft are uncommon injuries, which have been documented in a variety of sports. The location of the fracture is influenced by the activity and mechanism of injury with which it is associated. The combined traditional approach of clinical history, physical examination, plain radiographs and nuclear scintigraphy for unusual stress fracture may be troublesome. This report is the first to describe a stress fracture at the junction of the middle and distal third of the ulnar diaphysis in a bowler due to chronic torsional stress. We discuss the possible mechanism of injury and describe the diagnostic imaging. A review of the literature is also given and compared with the findings and data of this case.
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Affiliation(s)
- Ming-Cheng Hsu
- Department of Orthopaedic Surgery, Chung Shan Medical University Hospital, 110 Section 1 Chien-Kuo N. Road, Taichung 402, Taiwan
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193
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194
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Heckmann JG, Marthol H, Bickel A, Dörfler A, Neundörfer B. Hemilingual spasm associated with tortuosity of the extracranial internal carotid artery. Cerebrovasc Dis 2005; 20:208-10. [PMID: 16088119 DOI: 10.1159/000087329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- J G Heckmann
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
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195
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Abstract
A case report of a premenarcheal patient with an ovarian torsion and müllerian agenesis is presented. An 11-year-old prepubertal girl presented with severe left lower quadrant abdominal pain and mild rebound. A computed tomography showed a normal appendix; an ultrasound showed a left ovary measuring 3 x 2 cm with multiple 0.5-mm simple cysts. A diagnostic laparoscopy showed the left ovary tube to be twisted, but the uterus was absent, and the right ovary and tube were not visualized in the appropriate location; instead, a right adnexal structure was buried in the right sidewall. The ovary was untwisted and fixed to the pelvic sidewall. Chromosomes were 46,XX, and her hormonal evaluation was normal. Ovarian torsion and müllerian agenesis are rarely reported. An association between the lax attachment of the adnexa and torsion may be a contributing factor in this condition.
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Affiliation(s)
- Sari L Kives
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario M4W3Y4, Canada
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196
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Abstract
Torsion of the uterus is a rare obstetric complication. This report describes a 270-degree uterine torsion associated with placental abruption, maternal shock, and fetal demise. At laparotomy, the uterus and ovaries were necrotic. This patient presented in a manner typically managed by labor induction, thus delaying her diagnosis of uterine torsion.
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Affiliation(s)
- Kathleen E Cook
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, USA
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197
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Manikoth P, Vaishnav A, Zachariah N, Sajwani MJ, Nair AK, Pai MG. Meconium peritonitis secondary to torsion of fallopian tube cyst and transient central diabetes insipidus in a preterm infant. J Perinat Med 2005; 33:76-8. [PMID: 15841620 DOI: 10.1515/jpm.2005.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.
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198
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Yilmaz C, Esen OS, Colak A, Yildirim M, Utebay B, Erkan N. Torsion of a wandering spleen associated with portal vein thrombosis. J Ultrasound Med 2005; 24:379-382. [PMID: 15723851 DOI: 10.7863/jum.2005.24.3.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Cengiz Yilmaz
- Department of Radiology, Sosyal Sigortalar Kurumu Izmir Teaching Hospital, 35360 Bozyaka, Izmir, Turkey.
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199
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Cavusoglu YH, Karaman A, Karaman I, Erdogan D, Aslan MK, Varlikli O, Cakmak O. Acute scrotum -- etiology and management. Indian J Pediatr 2005; 72:201-3. [PMID: 15812112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation can confidently exclude torsion of testis from the differential diagnosis. METHODS A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983 and March 2003 was performed. RESULTS 195 boys were included in this study. They were divided into 3 groups: group 1-73 with epididymo-orchitis, group 2-63 with torsion of testicular appendages and group 3- 57 with spermatic cord torsion. The patients in group 2 were older than group 1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion, whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was 2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was 37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups. CONCLUSION We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be applied routine surgical exploration.
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Affiliation(s)
- Yusuf Hakan Cavusoglu
- Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Altindag, Ankara, Turkey.
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200
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