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Hongju H. A giant ovarian cyst torsion: Case report. Medicine (Baltimore) 2024; 103:e33283. [PMID: 38608053 PMCID: PMC11018219 DOI: 10.1097/md.0000000000033283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Adnexal torsion (AT) is one of a gynecological condition characterized by an acute abdomen. Clinically, a giant ovarian cyst torsion with a diameter of 30 cm is rare. Therefore, an accurate and timely diagnosis and treatment are important. PATIENT CONCERNS A 25-year-old unmarried female, presented to the emergency department with intermittent abdominal cramps after a sudden change in position. Considering her symptoms and examination, ultrasound, and magnetic resonance imaging (MRI) results, ovarian cyst torsion was suspected. DIAGNOSIS Giant ovarian cyst torsion. INTERVENTIONS Surgical intervention with exploratory laparotomy was performed immediately. OUTCOMES Intraoperatively, we found a 30-cm left ovarian cyst with a clear root. The left fallopian tube, infundibulopelvic ligament, and ovarian ligament were twisted 900 degrees. Finally, the pathological report revealed mucinous cystadenoma. CONCLUSION Giant ovarian cyst torsion with a diameter of 30 cm is rare. Considering her symptoms and examination, ultrasound, and MRI results, ovarian cyst torsion was suspected. The patient was successfully treated using emergency surgery.
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Affiliation(s)
- He Hongju
- Department of Obstetrics & Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Gebretsion MT, Mergiyaw YA, Shumargaw AT. Spleno-Sigmoid Knotting - An Unfamiliar Cause of Intestinal Obstruction. Am J Emerg Med 2024; 78:241.e1-241.e3. [PMID: 38402100 DOI: 10.1016/j.ajem.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Spleno-sigmoid knotting is the twisting of the spleen around the sigmoid colon, causing obstruction of the sigmoid colon. It is an uncommon cause of intestinal obstruction. To our knowledge, there has been no previous case report of spleno-sigmoid knotting before our case. CASE REPORT Here, we present the case of an 18-year-old female patient who visited the surgical emergency outpatient department with diffuse and progressive abdominal pain lasting for one and a half days. She also experienced obstipation and frequent episodes of vomiting of ingested matter. Upon initial evaluation, she exhibited tachycardia and tachypnea, and her abdomen was grossly distended with diffuse direct and rebound tenderness. Further investigation revealed significant leukocytosis with neutrophil predominance. Emergency laparotomy was performed with a possible diagnosis of generalized peritonitis secondary to gangrenous sigmoid volvulus, which revealed gangrenous spleno-sigmoid knotting. DISCUSSION Various types of intestinal knots have been reported, with ileo-sigmoid knots being the most common and ileo-ileal knots being the rarest. Wandering spleen is a rare congenital anomaly with a variable clinical presentation ranging from asymptomatic to mild abdominal pain or acute abdomen due to torsion or acute pancreatitis. It can also cause intestinal obstruction, which may be the initial presentation. CONCLUSION In patients presenting with acute abdominal pain and features of bowel obstruction, the possibility of spleno-sigmoid knotting should be considered, and early intervention should be instituted to prevent gangrenous progression and sepsis.
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Affiliation(s)
| | - Yimam Ali Mergiyaw
- Department of Surgery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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3
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Tankeng CA, Ekei QM, Ngunyi YL, Yeika EV, Ajabmoh EN, Mokom AA. Successful management of an advanced interstitial ectopic pregnancy in a resource-limited setting: a case report. J Med Case Rep 2024; 18:168. [PMID: 38504338 PMCID: PMC10953172 DOI: 10.1186/s13256-024-04437-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Interstitial ectopic pregnancy is an ectopic gestation developing in the uterine part of the fallopian tube. The condition is rare and presents challenges for clinical as well as radiological diagnosis. This case report presents a rare case of interstitial ectopic pregnancy diagnosed intraoperatively. CASE PRESENTATION A 36-year-old Black woman, referred from a peripheral health facility, presented at the emergency department with severe abdominal pains, vaginal spotting, nausea, and vomiting, with a 2-month history of irregular menstrual flow. Clinical and laboratory findings were suggestive of an acute abdomen likely due to a ruptured ectopic pregnancy (ultrasound was not available). An emergency exploratory laparotomy was done, which revealed a right adnexal ruptured interstitial pregnancy of a lifeless female fetus weighing 500 g (estimated mean gestational age of 22-23 weeks). The left fallopian tube looked normal. The site of rupture was repaired, followed by cleaning and closure of the abdomen. The post-operative period was uneventful, and the patient was discharged on postoperative day 7. CONCLUSION Interstitial pregnancies are uncommon and rarely attain advanced gestational ages, as in this case, compared with other tubal ectopic pregnancies. However, women presenting with signs of hypovolemic shock and acute abdomen, with a positive pregnancy test, warrant a high index of suspicion.
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Affiliation(s)
- Clovis Achassi Tankeng
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Our Lady of Lourdes Medicalized Health Center, Nkar-Jakiri, Cameroon
| | - Quinta Mua Ekei
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Our Lady of Lourdes Medicalized Health Center, Nkar-Jakiri, Cameroon
| | - Yannick Lechedem Ngunyi
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.
- Mbonge District Hospital, Mbonge, Cameroon.
| | - Eugene Vernyuy Yeika
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Hopital Saint Therese de l'enfant Jesus de Nkolbisson, Yaounde, Cameroon
| | - Elvis Nkengasong Ajabmoh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Kahwa Sumbele Medical Clinic, Buea, Cameroon
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Vevaud K, Dallocchio A, Dumoitier N, Laspougeas A, Labrunie A, Belgacem A, Fourcade L, Ballouhey Q. A prospective study to evaluate the contribution of the pediatric appendicitis score in the decision process. BMC Pediatr 2024; 24:131. [PMID: 38373918 PMCID: PMC10875762 DOI: 10.1186/s12887-024-04619-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The objective of this study was to assess the likelihood of acute appendicitis (AA) in children presenting with abdominal symptoms at the emergency department (ED), based on their prior primary care (PC) consultation history. METHODS Between February and June 2021, we prospectively enrolled all children presenting at the ED with acute abdominal pain indicative of possible acute appendicitis (AA). Subsequently, they were categorized into three groups: those assessed by a PC physician (PG), those brought in by their family without a prior consultation (FG), and those admitted after a PC consultation without being assessed as such. The primary objective was to assess the probability of AA diagnosis using the Pediatric Appendicitis Score (PAS). Secondary objectives included analyzing PAS and C-reactive protein (CRP) levels based on the duration of pain and final diagnoses. RESULTS 124 children were enrolled in the study (PG, n = 56; FG, n = 55; NG, n = 13). Among them, 29 patients (23.4%) were diagnosed with AA, with 13 cases (23.2%) from the PG and 14 cases (25.4%) from the FG. The mean PAS scores for AA cases from the PG and FG were 6.69 ± 1.75 and 7.57 ± 1.6, respectively, (p = 0.3340). Both PAS scores and CRP levels showed a significant correlation with AA severity. No cases of AA were observed with PAS scores < 4. CONCLUSIONS There was no significant difference in PAS scores between patients addressed by PG and FG, even though PAS scores tended to be higher for patients with AA. We propose a new decision-making algorithm for PC practice, which incorporates inflammatory markers and pain duration. TRIAL REGISTRATION Institutional Ethics Committee registration number: 447-2021-103 (10/01/2021). CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04885335 (Registered on 13/05/2021).
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Affiliation(s)
- Kevin Vevaud
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Aymeric Dallocchio
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Nathalie Dumoitier
- Département universitaire de médecine Générale, Faculté de médecine de Limoges, 2 rue du Docteur Marcland, Limoges Cedex, 87042, France
| | - Alban Laspougeas
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Anaïs Labrunie
- Biostatistics and Research Methodology (CEBIMER), Limoges University Hospital, 2 rue du Docteur Marcland, Limoges Cedex, 87042, France
| | - Alexis Belgacem
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Laurent Fourcade
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Quentin Ballouhey
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France.
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Koyuncu H, Bükülmez A, Güngör A, Sarıkaya Y. Evaluation of acute terminal ileitis in children before and during the COVID-19 pandemic. J Pediatr Gastroenterol Nutr 2024; 78:197-203. [PMID: 38374549 DOI: 10.1002/jpn3.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The aim of this study was to examine the clinical features of acute terminal ileitis in children and evaluate its rate before and during the COVID-19 pandemic. METHODS This retrospective study was performed in our pediatric emergency department between 2018 and 2022. The records of 5363 patients who required abdominal imaging due to acute abdomen were analyzed, and 143 patients with terminal ileitis were included. The rate and etiological causes were compared during and before the COVID-19 pandemic. RESULTS The rate of acute terminal ileitis has increased over the years. The fastest increase was in 2021, when the COVID-19 pandemic was experienced. While 59 (41.2%) patients showed acute nonspecific ileitis, the most common etiologic cause that could be identified was acute gastroenteritis. It was determined that multisystem inflammatory syndrome in children was among the causes of ileitis after the COVID-19 pandemic and was one of the top three causes. CONCLUSIONS Acute terminal ileitis, which has many etiologies, is one of the rare radiological findings in acute abdominal pain. Examination and laboratory findings are not specific. Guidelines are needed for the investigation of the underlying etiology of acute terminal ileitis in children. The incidence of acute terminal ileitis is increasing, and the increase has been found to be faster after the COVID-19 pandemic.
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Affiliation(s)
- Hilal Koyuncu
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşegül Bükülmez
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Ayşe Güngör
- Department of Child Health and Diseases, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Zhao Z, Chen J, Wu R, Ren J. A case of acute abdominal pain caused by small-intestine duplication. Asian J Surg 2024; 47:1133-1134. [PMID: 37996379 DOI: 10.1016/j.asjsur.2023.10.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Affiliation(s)
- Ziming Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, PR China; Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, PR China; Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, PR China
| | - Jianhua Chen
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, PR China
| | - Rongfan Wu
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, PR China; Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, PR China; Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, PR China
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, PR China; Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, PR China; Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, PR China.
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7
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Cikwanine JPB, Alumeti DM, John Mutendela K, Ise-Somo PK, Yoyu JT, Ciza PM, Raha M, Kalau WA. Epidemiological, clinical and prognosis aspects of acute generalized peritonitis in South-Kivu Province: descriptive observational study of 278 cases. Pan Afr Med J 2024; 47:1. [PMID: 38371644 PMCID: PMC10870158 DOI: 10.11604/pamj.2024.47.1.38288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/22/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction the aim was to determine epidemiological, clinical, therapeutic, and prognostic aspects of acute generalized peritonitis (AGP). Methods we conducted an observational, cross-sectional and multicentre study over 2 years of 278 cases of acute generalized peritonitis operated in semi-urban and urban hospitals in South-Kivu Province, Democratic Republic of Congo. Results the population of this study was young with a mean age was 28.9 ± 16.1 years with extremes of 1.3 years to 80 years with a sex ratio M: F of 0.8. Peritonitis aetiology was dominated by intestinal perforation 132 cases (47.4%), the admission time in 65, 5% was more than 72 hours. Acute abdominal pain was the most reason for consultation in 93.2% of cases, 11.9% of patients were in hypovolemic shock. In 40.6%, the treatment of patients consisted in intestinal resection with terminal anastomosis, or ileostomy in 32.7%. About the outcomes, 32.4% of the patients had a surgical reoperation and 15.8% of the digestive fistulas were reported. The average duration of the hospitalization was 23.4 ± 20.3 days. Morbidity rate was 14.7%. Conclusion the AGP remains one of the abdominal emergencies observed in different semi-urban and urban hospitals of the province of South-Kivu, causing some problems of medical and surgical management, starting from the delay of admission, the severity of the symptoms related to the etiology of the intestinal perforation. In all cases, AGP requires a well-executed resuscitation procedure and surgical technique to improve the prognosis and reduce mortality, which seems to be high in this study.
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Affiliation(s)
| | - Désiré Munyali Alumeti
- Department of Surgery, Evangelical University in Africa Panzi Hospital, Bukavu, Democratic Republic of Congo
| | | | - Prisca Kavira Ise-Somo
- Department of Surgery, Evangelical University in Africa Panzi Hospital, Bukavu, Democratic Republic of Congo
| | - Jonathan Tunangoya Yoyu
- Department of Medical Works and Research, Progressive Medical Systems, Goma, Democratic Republic of Congo
| | | | - Maroyi Raha
- Department of Surgery, Evangelical University in Africa Panzi Hospital, Bukavu, Democratic Republic of Congo
| | - Willy Arung Kalau
- Department of Surgery, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
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Ishihara T, Matsui T, Katoh T, Kobayashi K, Sekigawa K, Suzuki T, Mitsui H. Pancreaticoduodenal Artery Aneurysm Rupture Presenting as Duodenal Obstruction Successfully Treated with Early Transcatheter Arterial Embolization: A Case Report of Suspected Segmental Arterial Mediolysis. Intern Med 2023; 62:3479-3482. [PMID: 37062731 PMCID: PMC10749823 DOI: 10.2169/internalmedicine.1278-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/05/2023] [Indexed: 04/18/2023] Open
Abstract
Visceral aneurysms are a rare but important form of abdominal vascular disease. Rupture of the aneurysms leads to serious symptoms, such as acute abdomen or abdominal bleeding. However, duodenal obstruction due to arterial rupture of an aneurysm is very rare. We herein report a 50-year-old woman with suspected segmental arterial mediolysis (SAM) who was first diagnosed with acute abdomen and duodenal obstruction. Rupture of a pancreaticoduodenal artery aneurysm was confirmed, and she was treated with transcatheter arterial embolization. In cases of acute abdomen, SAM is a rare but important possibility to consider as a differential diagnosis.
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Affiliation(s)
| | - Toru Matsui
- Department of Gastrohepatology, Tokyo Teishin Hospital, Japan
| | - Tomoji Katoh
- Department of Gastrohepatology, Tokyo Teishin Hospital, Japan
| | | | | | - Takeo Suzuki
- Department of Intervention Radiology, Tokyo Teishin Hospital, Japan
| | - Hiroshi Mitsui
- Department of Gastrohepatology, Tokyo Teishin Hospital, Japan
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9
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Spencer BL, Lotakis DM, Imel S, Hirschl RB, Gadepalli SK. Malrotation in Adult and Adolescent Patients. J Gastrointest Surg 2023; 27:2557-2559. [PMID: 37259017 DOI: 10.1007/s11605-023-05718-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Malrotation in children presents with bilious emesis and can be life threatening. Data on adults is lacking. METHODS Single institution, retrospective 20-year data collection on adult (>18 years) and adolescent patients (12-18) with symptomatic malrotation. We evaluated demographics, surgical approach, hospital stay, time to feed, and type of surgeon with descriptive statistics to analyze each group. RESULTS Adult (n=17) and adolescent patients (n=8) primarily presented with acute abdominal pain (82% adult, 100% adolescent), and non-bilious emesis (0%), and had elective repair. CT scan was diagnostic for 82% adults and 71% adolescents. Overall, 88% had improvement in symptoms. CONCLUSION In this single institution series comparing adults and adolescent patients with malrotation, 88% have resolution of pain after repair, despite atypical presentations. CT scan is diagnostic and laparoscopic approach should be considered.
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Affiliation(s)
- Brianna L Spencer
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, 48109, MI, US.
| | - Dimitra M Lotakis
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, 48109, MI, US
| | - Sydni Imel
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, 48109, MI, US
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, 48109, MI, US
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, C.S. Mott Children's Hospital, 1540 E Hospital Dr, Ann Arbor, 48109, MI, US
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Taylor A, Elliott BM, Atkinson J, Roberts S, Voss L, Best EJ, Webb R. Group A Streptococcus Primary Peritonitis in Children, New Zealand. Emerg Infect Dis 2023; 29. [PMID: 37878292 PMCID: PMC10617357 DOI: 10.3201/eid2911.230211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Group A Streptococcus (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. We discuss 20 additional cases of pediatric primary peritonitis caused by GAS among patients at Starship Children's Hospital, Auckland, New Zealand, during 2010-2022. We compare identified cases of GAS primary peritonitis to cases described in the existing pediatric literature. As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen.
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Schwaitzberg S. Celebrating 100 years of Cope's Early Diagnosis of the AcuteAbdomen. Surgery 2023; 174:874-879. [PMID: 37487826 DOI: 10.1016/j.surg.2023.06.029] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/03/2023] [Accepted: 06/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND No list of the iconic books in surgery would be complete without The Early Diagnosis of the Acute Abdomen by Sir Vincent Zachary Cope, MS, MD. First published in 1921, few books have stood the test of time like this treatise on the acute abdomen. It is also fitting that, after Mr Cope's passing, William Silen would assume the mantle with the 15th edition and maintain his legacy work through the 22nd and final edition. METHODS Each edition of The Early Diagnosis of the Acute Abdomen and The Acute Abdomen in Rhyme was curated and reviewed in detail within the historical context of the era in which the book was printed. RESULTS The tenets of physical diagnosis and history did not change during the 100 years through the current printing; however, the emphasis on related medical diseases evolved due to antibiotic therapy and the prevalence of nonsurgical diseases that evolved across this period. Early editions highlighted the value of plain radiography as it came into common use, whereas later editions included cross-sectional imaging as a valuable diagnostic tool. CONCLUSION The context and evolution of this masterpiece are fundamental to the legacy of the abdominal surgeon. Cope's lessons on the value of dedication and attention to detail to formulate clinical diagnoses by engaging with the patient rather than excessive use of laboratory testing and imaging still apply in today's rapidly evolving and increasingly value-based world.
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Affiliation(s)
- Steven Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Science, University at Buffalo, The State University of New York, NY.
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12
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Ethiraj S, Sahoo AK, Das BM. Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series. Indian J Tuberc 2023; 70:422-429. [PMID: 37968048 DOI: 10.1016/j.ijtb.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/14/2022] [Accepted: 01/11/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Abdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. METHODS This was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. RESULTS A total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. CONCLUSION Abdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.
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Affiliation(s)
- Suraj Ethiraj
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India.
| | - Ashok Kumar Sahoo
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India
| | - Bhuban Mohan Das
- Department of Surgery, SCB Medical College and Hospital, Cuttack, India
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Obleagă CV, Ahmet RAM, Florescu DN, Popescu DM, Meşină C, Streba L, Vere CC, Constantin C. Post-COVID-19 enterocolitis - a cause of rebellious diarrhea, acute abdomen and liver failure. Rom J Morphol Embryol 2023; 64:527-533. [PMID: 38184833 PMCID: PMC10863687 DOI: 10.47162/rjme.64.4.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
Currently, worldwide, the coronavirus disease 2019 (COVID-19) pandemic, which first appeared in Wuhan, China, in December 2019, is capsizing the medical system and turning the attention of the entire healthcare system through the many aspects it presents, both from a pathophysiological and from a semiological view, insufficiently studied aspects. With a high rate of morbidity and mortality, the COVID-19 pandemic was initially observed as a pathology leading to a severe acute respiratory syndrome, but over time gastrointestinal and hepatic manifestations have been reported. The study includes an analysis of 21 patients in the stage of the clinical disease of COVID-19 or in the stage of recovery, hospitalized in the Departments of General Surgery II or Gastroenterology, Emergency Clinical County Hospital of Craiova, Romania, with predominantly digestive symptoms, with the clinical expression of infectious enterocolitis, although stool culture was negative for pathogenic bacteria. The evolution of patients was influenced by the appearance of peritonitis through colonic necrosis or remission of clinical symptoms under empirical therapy.
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Affiliation(s)
| | | | - Dan Nicolae Florescu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Romania
| | - Dragoş Marian Popescu
- Department of Extreme Conditions Medicine, University of Medicine and Pharmacy of Craiova, Romania
| | - Cristian Meşină
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Liliana Streba
- Department of Medical Oncology, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Cristian Constantin
- Department of Medical Imaging, University of Medicine and Pharmacy of Craiova, Romania
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14
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Chang C, Wang Y, Shi W, Xu H, Huang X, Jiao Y. Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen? Medicine (Baltimore) 2023; 102:e34662. [PMID: 37656996 PMCID: PMC10476726 DOI: 10.1097/md.0000000000034662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
Patients with acute acalculous cholecystitis (AAC) often present with acute abdominal symptoms. However, recent clinical studies have suggested that some patients with AAC and an acute abdomen, especially when caused by viruses or rheumatic disease, may not require cholecystectomy and that conservative treatment is adequate. Whether cholecystectomy is superior to conservative treatment for patients with AAC presenting with a severe acute abdomen is still uncertain. This was a case series study of AAC-related literature published between 1960 and 2022. In total, 171 cases (104 viral infection-associated AAC and 67 rheumatic disease-associated AAC) were included. The prognoses of patients receiving cholecystectomy or conservative treatment were compared. To account for confounding factors, etiological stratification and logistic regression were performed. The prognosis was similar for patients undergoing cholecystectomy and conservative treatment (P value .364), and virus infection-associated AAC had a better prognosis than rheumatic disease-associated AAC (P value .032). In patients with AAC caused by viruses or rheumatic disease, the acute abdomen can be adequately managed by conservative treatment of the underlying etiology and does not mandate surgical intervention.
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Affiliation(s)
- Chuheng Chang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Youyang Wang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Shi
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoming Huang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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15
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Thapa R, Pokharel M, Paudel S, Khadka T, Sapkota P, Rana R, Pokharel M, Chhetri D. Acid Peptic Disease among Patients with Acute Abdomen Visiting the Department of Emergency Medicine in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:636-638. [PMID: 38289821 PMCID: PMC10566611 DOI: 10.31729/jnma.8228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Acid peptic disease is caused by excessive acid secretion or weakened mucosal defense. Symptoms include epigastric pain, bloating, and nausea. Factors like gastric acid, Helicobacter pylori infection, alcohol consumption, smoking, and stress contribute to peptic ulcers. Imbalances between offensive and defensive factors can lead to ulcers. Acid-related disorders impact the quality of life and mortality. Accurate diagnosis and prompt treatment are vital. This study aimed to find out the prevalence of acid peptic disease among patients with acute abdomen in the Department of Emergency Medicine in a tertiary care centre. Methods A descriptive cross-sectional study was conducted from 2 April 2022 and 2 April 2023 among the patients presented in the Department of Emergency Medicine in a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee. All patients presenting with acute abdominal pain in the Emergency Department were included in the study. Patients not giving consent were excluded from the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Out of the 400 patients with acute abdomen, the prevalence of acid peptic disease was found to be 87 (21.75%) (17.71-25.79, 95% Confidence Interval). Conclusions The prevalence of acid peptic disease among patients with acute abdomen was found to be lower than in other studies performed in similar settings. Keywords acute abdomen; gastroenteritis; Helicobacter pylori; peptic ulcer.
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Affiliation(s)
- Rashmi Thapa
- Department of Emergency Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Mohir Pokharel
- Department of Emergency Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Saroj Paudel
- Department of Emergency Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Tunam Khadka
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Priyanka Sapkota
- Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal
| | - Rohit Rana
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Moneec Pokharel
- Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
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16
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Henn J, Hatterscheidt S, Sahu A, Buness A, Dohmen J, Arensmeyer J, Feodorovici P, Sommer N, Schmidt J, Kalff JC, Matthaei H. Machine Learning for Decision-Support in Acute Abdominal Pain - Proof of Concept and Central Considerations. Zentralbl Chir 2023; 148:376-383. [PMID: 37562397 DOI: 10.1055/a-2125-1559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/12/2023]
Abstract
Acute abdominal pain is a common presenting symptom in the emergency department and represents heterogeneous causes and diagnoses. There is often a decision to be made regarding emergency surgical care. Machine learning (ML) could be used here as a decision-support and relieve the time and personnel resource shortage.Patients with acute abdominal pain presenting to the Department of Surgery at Bonn University Hospital in 2020 and 2021 were retrospectively analyzed. Clinical parameters as well as laboratory values were used as predictors. After randomly splitting into a training and test data set (ratio 80 to 20), three ML algorithms were comparatively trained and validated. The entire procedure was repeated 20 times.A total of 1357 patients were identified and included in the analysis, with one in five (n = 276, 20.3%) requiring emergency abdominal surgery within 24 hours. Patients operated on were more likely to be male (p = 0.026), older (p = 0.006), had more gastrointestinal symptoms (nausea: p < 0.001, vomiting p < 0.001) as well as a more recent onset of pain (p < 0.001). Tenderness (p < 0.001) and guarding (p < 0.001) were more common in surgically treated patients and blood analyses showed increased inflammation levels (white blood cell count: p < 0.001, CRP: p < 0.001) and onset of organ dysfunction (creatinine: p < 0.014, quick p < 0.001). Of the three trained algorithms, the tree-based methods (h2o random forest and cforest) showed the best performance. The algorithms classified patients, i.e., predicted surgery, with a median AUC ROC of 0.81 and 0.79 and AUC PRC of 0.56 in test sets.A proof-of-concept was achieved with the development of an ML model for predicting timely surgical therapy for acute abdomen. The ML algorithm can be a valuable tool in decision-making. Especially in the context of heavily used medical resources, the algorithm can help to use these scarce resources more effectively. Technological progress, especially regarding artificial intelligence, increasingly enables evidence-based approaches in surgery but requires a strictly interdisciplinary approach. In the future, the use and handling of ML should be integrated into surgical training.
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Affiliation(s)
- Jonas Henn
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Simon Hatterscheidt
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Anshupa Sahu
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | - Andreas Buness
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | - Jonas Dohmen
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Jan Arensmeyer
- Division of Thoracic Surgery, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Philipp Feodorovici
- Division of Thoracic Surgery, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Nils Sommer
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Joachim Schmidt
- Division of Thoracic Surgery, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
- Department of Thoracic Surgery, Helios Hospital Bonn Rhein-Sieg, Bonn, Germany
| | - Jörg C Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
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17
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Erginel B, Mustafayeva N, Karadağ ÇA, Yanar F, Kebudi R, Tanyıldız HG, Tuğcu D, Berker N, İlhan B, Soysal FG. A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon. ULUS TRAVMA ACIL CER 2023; 29:798-805. [PMID: 37409928 PMCID: PMC10405033 DOI: 10.14744/tjtes.2023.64257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. METHODS We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. RESULTS Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. CONCLUSION Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.
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Affiliation(s)
- Basak Erginel
- Department of Pediatric Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Naila Mustafayeva
- Department of Pediatric Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Çetin Ali Karadağ
- Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul-Türkiye
| | - Fatih Yanar
- Department of General Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, İstanbul University, Oncology Institute, İstanbul-Türkiye
| | | | - Deniz Tuğcu
- Department of Pediatric Hematology-Oncology, İstanbul University, İstanbul-Türkiye
| | - Neslihan Berker
- Department of Pathology, İstanbul University, İstanbul Medical Faculty, İstanbul-Türkiye
| | - Burak İlhan
- Department of General Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
| | - Feryal Gün Soysal
- Department of Pediatric Surgery, Istanbul University, Istanbul Medical Faculty, İstanbul-Türkiye
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18
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Shaish H, Ream J, Huang C, Troost J, Gaur S, Chung R, Kim S, Patel H, Newhouse JH, Khalatbari S, Davenport MS. Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department. JAMA Surg 2023; 158:e231112. [PMID: 37133836 PMCID: PMC10157504 DOI: 10.1001/jamasurg.2023.1112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/04/2023] [Indexed: 05/04/2023]
Abstract
Importance Intravenous (IV) contrast medium is sometimes withheld due to risk of complication or lack of availability in patients undergoing computed tomography (CT) for abdominal pain. The risk from withholding contrast medium is understudied. Objective To determine the diagnostic accuracy of unenhanced abdominopelvic CT using contemporaneous contrast-enhanced CT as the reference standard in emergency department (ED) patients with acute abdominal pain. Design, Setting, and Participants This was an institutional review board-approved, multicenter retrospective diagnostic accuracy study of 201 consecutive adult ED patients who underwent dual-energy contrast-enhanced CT for the evaluation of acute abdominal pain from April 1, 2017, through April 22, 2017. Three blinded radiologists interpreted these scans to establish the reference standard by majority rule. IV and oral contrast media were then digitally subtracted using dual-energy techniques. Six different blinded radiologists from 3 institutions (3 specialist faculty and 3 residents) interpreted the resulting unenhanced CT examinations. Participants included a consecutive sample of ED patients with abdominal pain who underwent dual-energy CT. Exposure Contrast-enhanced and virtual unenhanced CT derived from dual-energy CT. Main outcome Diagnostic accuracy of unenhanced CT for primary (ie, principal cause[s] of pain) and actionable secondary (ie, incidental findings requiring management) diagnoses. The Gwet interrater agreement coefficient was calculated. Results There were 201 included patients (female, 108; male, 93) with a mean age of 50.1 (SD, 20.9) years and mean BMI of 25.5 (SD, 5.4). Overall accuracy of unenhanced CT was 70% (faculty, 68% to 74%; residents, 69% to 70%). Faculty had higher accuracy than residents for primary diagnoses (82% vs 76%; adjusted odds ratio [OR], 1.83; 95% CI, 1.26-2.67; P = .002) but lower accuracy for actionable secondary diagnoses (87% vs 90%; OR, 0.57; 95% CI, 0.35-0.93; P < .001). This was because faculty made fewer false-negative primary diagnoses (38% vs 62%; OR, 0.23; 95% CI, 0.13-0.41; P < .001) but more false-positive actionable secondary diagnoses (63% vs 37%; OR, 2.11, 95% CI, 1.26-3.54; P = .01). False-negative (19%) and false-positive (14%) results were common. Interrater agreement for overall accuracy was moderate (Gwet agreement coefficient, 0.58). Conclusion Unenhanced CT was approximately 30% less accurate than contrast-enhanced CT for evaluating abdominal pain in the ED. This should be balanced with the risk of administering contrast material to patients with risk factors for kidney injury or hypersensitivity reaction.
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Affiliation(s)
- Hiram Shaish
- Department of Radiology, Columbia University, New York, New York
| | - Justin Ream
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Chenchan Huang
- Department of Radiology, New York University Langone, New York
| | - Jonathan Troost
- Michigan Institute for Clinical and Translational Research, Ann Arbor
| | - Sonia Gaur
- Department of Radiology, Michigan Medicine, Ann Arbor
| | - Ryan Chung
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Sooah Kim
- Department of Radiology, New York University Langone, New York
| | - Hanisha Patel
- Department of Radiology, Columbia University, New York, New York
| | | | | | - Matthew S. Davenport
- Department of Radiology and Urology, Michigan Medicine, Ann Arbor
- Michigan Radiology Quality Collaborative, Michigan Medicine, Ann Arbor
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19
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Rodriguez Tebar A, Panza-Nduli J, Gubin B, Rogghe PA, Oriot P. An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage. Acta Gastroenterol Belg 2023; 86:495-498. [PMID: 37814568 DOI: 10.51821/86.3.11251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Bilateral adrenal hemorrhage (BAH) is a rare condition that can lead to acute adrenal insufficiency and death if not recognized and treated promptly. We report the case of a 30-year-old male who presented to the emergency department with acute abdominal pain, nausea, and vomiting. On emergency room admission, the first abdominal CT revealed normal adrenal glands without enlargement, but with the development of hypotension and hypoglycemia, a second CT performed four days later showed enlargement due to hemorrhage in both adrenals. The diagnosis of BAH associated with acute adrenal insufficiency was retained. Prompt treatment with intravenous and oral corticosteroids resulted in successful conservative management. We describe the clinical, biological, radiological and etiological features of this condition based on a review of the literature.
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Affiliation(s)
- A Rodriguez Tebar
- Department of Endocrinology, Mouscron Hospital Centre, Mouscron, Belgium
| | - J Panza-Nduli
- Department of Emergency, Mouscron Hospital Center, Mouscron, Belgium
| | - B Gubin
- Department of Radiology, Mouscron Hospital Centre, Mouscron, Belgium
| | - P-A Rogghe
- Department of Critical Care Unit, Mouscron Hospital Centre, Mouscron, Belgium
| | - P Oriot
- Department of Endocrinology, Mouscron Hospital Centre, Mouscron, Belgium
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20
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Meira MD, Oliveira FDESC, Coutinho LR, Leão LHDEA, Vasconcelos GDEP, Siqueira LTDE, Ferraz ÁAB. Long-term evaluation of patients with BMI = 50kg/m2 who underwent Bariatric Surgery. Rev Col Bras Cir 2023; 50:e20233397. [PMID: 37162040 PMCID: PMC10508685 DOI: 10.1590/0100-6991e-20233397-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 05/11/2023] Open
Abstract
PURPOSE to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. METHODS retrospective cohort that included a study group of 178 patients with SO and a control group of 181 patients with BMI 35-49.9Kg/m2. The groups were formed in a 1:1 nearest neighbor matching. The main variables were pre- and postoperative BMI and comorbidities, occurrence of severe postoperative complications, bowel obstruction, marginal ulcer, fistulae and 30-day death, besides the necessity of emergency room (ER) admission and abdominal computed tomography (CT) scans in the postoperative period due to acute abdomen. RESULTS the study group comprised 74.0% of women while the control group had 56.7%. The mean follow-up time was similar between both groups (5.48 x 6.09 years, p=0.216). There was no statistically significant difference on the prevalence of hypertension and T2D between the groups according to the surgical technique. All deaths occurred in the Study group (BMI = 50kg/m2) who underwent RYGB. There was no difference between the groups regarding the occurrence of severe complications. Data on ER admissions and the need for abdominal CT to investigate postoperative abdominal pain did not show statistically significant difference between the groups. CONCLUSION despite the high risk related to bariatric surgery in patients with SO, the benefits related to the remission of comorbidities are significant; although being lower than those found in patients with milder grades of obesity.
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Affiliation(s)
- Matheus Duarte Meira
- - Universidade Federal de Pernambuco (UFPE), Pós-graduação em Cirurgia - Recife - PE - Brasil
- - Hospital dos Servidores do Estado (HSE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | - Fernando DE Santa Cruz Oliveira
- - Universidade Federal de Pernambuco (UFPE), Pós-graduação em Cirurgia - Recife - PE - Brasil
- - Hospital dos Servidores do Estado (HSE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | | | | | - Géssica DE Paula Vasconcelos
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | - Luciana Teixeira DE Siqueira
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
- - Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia - Recife - PE - Brasil
| | - Álvaro Antônio Bandeira Ferraz
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
- - Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia - Recife - PE - Brasil
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21
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Petrucciani N, Di Segni M, Silecchia G. Acute abdominal pain 5 years after right colectomy. ANZ J Surg 2023; 93:702-703. [PMID: 35790064 DOI: 10.1111/ans.17898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Mattia Di Segni
- Division of Radiology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianfranco Silecchia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
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22
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Nie C, Chen X, Wang L, Li L, Rao D, Wei X, Zhang G. The effect of seamless nursing combined with Roy adaptive psychological nursing on self-efficacy and bad mood of patients after acute abdomen surgery. Medicine (Baltimore) 2023; 102:e32720. [PMID: 36749260 PMCID: PMC9901985 DOI: 10.1097/md.0000000000032720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
To explore the effect of seamless nursing combined with Roy adaptive psychological nursing on self-efficacy and bad mood of patients after acute abdomen surgery. According to the digital table method, 120 patients with acute abdomen who were treated and nursed in our hospital from June 2019 to June 2021 were selected as prospective research objects, and they were divided into a control group and an observation group with 60 cases each. Among them, the control group carried out seamless nursing, and the observation group carried out Roy adaptive psychological nursing on this basis, and compared the effects of self-efficacy, nursing ability and bad mood of the 2 groups of patients after surgery. Before nursing, the self-efficacy scale, quality of life scores, nursing ability scores, as well as bad mood were not statistically significant between the 2 groups ( P > .05). After nursing, the self-efficacy scale and nursing ability scores in the observation group were significantly higher than that in the control group ( P < .05); the social interaction score, anxiety score and depression score were significantly lower than that in the control group ( P < .001). Seamless nursing combined with Roy adaptive psychological nursing can effectively improve the quality of life of patients after acute abdomen surgery, reduce unhealthy emotions, and improve the nursing ability and self-efficacy of patients after surgery. It has a certain reference for the nursing of patients after acute abdomen surgery.
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Affiliation(s)
- Chang Nie
- Department of Gynaecology, WuHan NO.1 Hospital, WuHan, Hubei, China
| | - Xiaoxue Chen
- Department of Gynaecology, WuHan NO.1 Hospital, WuHan, Hubei, China
| | - Lifei Wang
- Department of Gynaecology, WuHan NO.1 Hospital, WuHan, Hubei, China
| | - Ling Li
- Department of Gynaecology, WuHan NO.1 Hospital, WuHan, Hubei, China
| | - Danfeng Rao
- Department of Gynaecology, WuHan NO.1 Hospital, WuHan, Hubei, China
| | - Xi Wei
- Department of Operating Room, The Second Hospital of Yinzhou District, Ningbo, Zhejiang, China
| | - Guilian Zhang
- Department of Operating Room, The Second Hospital of Yinzhou District, Ningbo, Zhejiang, China
- * Correspondence: Guilian Zhang, Department of Operating Room, The Second Hospital of Yinzhou District, Ningbo, Zhejiang 315199, China (e-mail: )
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23
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Ziani I, Ibrahimi A, Bellouki O, Zouidia F, El Sayegh H, Benslimane L, Nouini Y. Secreting retroperitoneal latero-aortic paraganglioma revealed by acute abdominal pain: a case report. Pan Afr Med J 2023; 44:39. [PMID: 37034483 PMCID: PMC10080299 DOI: 10.11604/pamj.2023.44.39.24768] [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] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/22/2022] [Indexed: 01/20/2023] Open
Abstract
We report the case of a retroperitoneal paraganglioma in a 35-year-old man discovered by abdominal pain. The abdomino-pelvic computed tomography (CT) showed a retro-peritoneal latero-aortic mass compatible with a paraganglioma, confirmed by the 24-hour urinary metanephrines and normetanephrines test. After an adequate pharmacological preparation, we decide to perform a laparoscopic resection of the paraganglioma. The surgery went without any complication. Blood pressure and urinary catecholamines were normal after the surgery. Our observation presents the particularity of the mode of discovery which is atypical, as well as the particularity of the therapeutic management, which is the laparoscopic resection of the mass.
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Affiliation(s)
- Idriss Ziani
- Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
- Corresponding author: Idriss Ziani, Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco.
| | - Ahmed Ibrahimi
- Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Omar Bellouki
- Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Fouad Zouidia
- Department of Anatomopathology and Cytology, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Hachem El Sayegh
- Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Lounis Benslimane
- Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
| | - Yassine Nouini
- Department of Urological Surgery A, Ibn Sina University Hospital, Faculty of Medicine of Rabat, Mohammed V University in Rabat, Rabat, Morocco
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Yasui H, Harada A, Kurobe M. Laparoscopic resection of ectopic Sertoli cell tumor with torsion in an adolescent girl. Pediatr Int 2023; 65:e15414. [PMID: 36346189 DOI: 10.1111/ped.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Hayato Yasui
- Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Atsushi Harada
- Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, Saitama, Japan
- Department of Surgery, Division of pediatric Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masashi Kurobe
- Department of Surgery, Division of pediatric Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Afzal S, Masroor I, Fatima K, Aziz AB. Asynchronous Bilateral Ovarian Torsion: A Case Report and Review of Literature. J Coll Physicians Surg Pak 2023; 33:71-73. [PMID: 37710946 DOI: 10.29271/jcpspcr.2023.71] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/20/2023] [Indexed: 09/16/2023]
Abstract
Ovarian/adnexal torsion is a rare gynaecological emergency presenting with nonspecific signs and symptoms mimicking other causes of acute abdomen. Asynchronous bilateral ovarian torsion is even rarer but has serious implications as it may potentially lead to castration. Traditionally, ovarian torsion has been treated by surgical resection; however, there is growing evidence that the ovary regains its function when detorsed and left in situ. We report a case of a bilateral asynchronous ovarian torsion in a young female that occurred after an interval of 8 years, which was managed by untwisting the pedicle and preserving the ovary. Key Words: Ovarian torsion, Castration, Bilateral, Gynaecological emergency.
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Affiliation(s)
- Shaista Afzal
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Imrana Masroor
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Kulsoom Fatima
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aliya Begum Aziz
- Department of Obstetrics and Gynaecology, The Aga Khan University Hospital, Karachi, Pakistan
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26
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Ouranos K, Almperis A, Kourti A, Kaselas C, Spyridakis I. Post-appendectomy abdominal pain attributed to incidental ovarian cyst: a case report. Pan Afr Med J 2023; 44:33. [PMID: 37034490 PMCID: PMC10080294 DOI: 10.11604/pamj.2023.44.33.36316] [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] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023] Open
Abstract
Acute abdominal pain in adolescents has a multitude of diagnoses to consider ranging from life-threating ones to other less obvious. In this case report, a 15-year-old girl presented with right lower quadrant abdominal pain and tenderness one month after successful surgical management of acute appendicitis. Post-appendectomy abdominal pain could easily be attributed to post-operative complications, while, in reality, a different disease state may be the cause of the pain. Physicians should have a high index of clinical suspicion, even though the temporal association of events may suggest otherwise. Hemorrhagic ovarian cyst (HOC) should be included in the differential, as it was confirmed with imaging in our case. A conservative treatment approach with progesterone was chosen, with menses resuming 2 days later, leading to regression of the cyst. The clinical significance of this case relies on the timely recognition of a disease entity, in order to distinguish it from complications arising postoperatively.
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Affiliation(s)
- Konstantinos Ouranos
- 4 Medical Department, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristarchos Almperis
- 2 Department of Obstetrics and Gynaecology, Gynaecologic Oncology Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Kourti
- 2 Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece
| | - Christos Kaselas
- 2 Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece
- Corresponding author: Christos Kaselas, 2 Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece.
| | - Ioannis Spyridakis
- 2 Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Thessaloniki, Greece
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Dunphy L, Wood F, Hallchurch J, Douce G, Pinto S. Ruptured ovarian ectopic pregnancy presenting with an acute abdomen. BMJ Case Rep 2022; 15:e252499. [PMID: 36535732 PMCID: PMC9764627 DOI: 10.1136/bcr-2022-252499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
An ectopic pregnancy occurs in 2% of all pregnancies. A primary ovarian ectopic (OP) is a rare entity and occurs in <2% of all ectopic gestations. It may present in those individuals who take ovulatory drugs, use an intrauterine device or have undergone in vitro fertilisation or embryo transfer. Multiparity and a younger age are other recognised risk factors. Diagnosing an OP pregnancy remains a challenge and it may be misdiagnosed as a bleeding luteal cyst, a haemorrhagic ovarian cyst or a tubal pregnancy by ultrasound scan. The diagnosis is often only established at laparoscopy following histopathological examination. A ruptured OP is a potentially life-threatening condition due to its potential for haemorrhage and hemodynamic collapse. Hence, early diagnosis is crucial to prevent serious morbidity and mortality. The authors present the case of a multiparous woman in her late 30s presenting with a seizure and lower abdominal pain at 6 weeks gestation. Her beta human chorionic gonadotropin was >9000 Miu/mL. A transvaginal ultrasound scan showed no evidence of an intrauterine pregnancy. There was free fluid in the pelvis. She was hemodynamically stable. She underwent a diagnostic laparoscopy, which showed hemoperitoneum and a ruptured left OP pregnancy. She underwent a left oophorectomy. Histology confirmed chorionic villi within the ovarian stroma. This case demonstrates the challenges in preoperative diagnosis of a ruptured OP pregnancy and acts as a cautionary reminder that individuals can present with hemodynamic stability. Rarely, as in this case, an OP pregnancy can occur without the presence of risk factors. Despite its rarity, a ruptured OP pregnancy should be considered in the differential diagnosis of women of reproductive age presenting to the emergency department with acute abdominal pain and a positive pregnancy test.
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Affiliation(s)
- Louise Dunphy
- Department of Obstetrics, Leighton Hospital, Crewe, UK
| | - Frances Wood
- Department of Obstetrics, Leighton Hospital, Crewe, UK
| | - Joanne Hallchurch
- Department of Histo-Pathology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, UK
| | - Gill Douce
- Department of Histo-Pathology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, UK
| | - Shanthi Pinto
- Department of Obstetrics, Leighton Hospital, Crewe, UK
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Li Y, Gao C, Zhu X, Zhu J, Ding Z, Han Z. Application of SPARK teaching in acute abdomen radiography teaching for undergraduate medical students. BMC Med Educ 2022; 22:881. [PMID: 36536422 PMCID: PMC9762863 DOI: 10.1186/s12909-022-03957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Acute abdomen is a series of acute and severe abdominal diseases commonly encountered in clinic. It is important to strengthen the image teaching of acute abdomen for undergraduates. AIM This study aimed to explore the application effect of SPARK[sub-speciality (S), problem-based learning (P), assessment (A), report (R) and reading skill (K)] teaching mode in the experimental teaching of acute abdomen for undergraduate medical students. METHODS We selected a total of 58 third year medical students for observation. The students were divided into experimental group and control group. Among them, 29 students in the experimental group studied in SPARK teaching mode, 29 students in the control group studied in traditional teaching mode. The two groups of students were tested after the theory class, before and after the experimental class, and one week after the experimental class, to compare the application effects of the two teaching modes. After the test one week after the experimental class, the two groups of students jointly adopted SPARK mode to learn, and were tested again one month after the experimental class to compare whether the two groups of students achieved the same results. The total score of all tests was 150. RESULTS The average scores of the experimental group and the control group after theory class were (69.0 ± 26.4) and (72.1 ± 24.1) respectively, with no statistical difference (t = 0.468, P = 0.642). The average scores of the experimental group before, after and one week after the experimental class were higher than those of the control group. The experimental group was (84.5 ± 23.1), (109.7 ± 23.8), (105.5 ± 31.0) respectively, and the control group was (52.8 ± 15.1), (93.8 ± 17.0), (80.0 ± 22.8) respectively. The differences were statistically significant (t = -6.195, P = 0.00; t = -2.919, P = 0.05; t = -3.569, P = 0.01). The average scores of the experimental group and the control group after one month were (99.0 ± 31.0) and (95.5 ± 25.6) respectively, and there was no significant difference between the two groups (t = -0.462, P = 0.646). CONCLUSIONS The SPARK teaching mode was helpful for undergraduate medical students to consolidate image foundation, improve image reading skills.
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Affiliation(s)
- Yangsheng Li
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006, Hangzhou, Zhejiang, China
| | - Chengcheng Gao
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006, Hangzhou, Zhejiang, China
| | - Xiangwen Zhu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006, Hangzhou, Zhejiang, China
| | - Jiying Zhu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006, Hangzhou, Zhejiang, China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006, Hangzhou, Zhejiang, China
| | - Zhijiang Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006, Hangzhou, Zhejiang, China.
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Salahuddin SM, Ayaz O, Jaffer M, Naeem R, Tikmani SS, Mian AI. Pediatric Appendicitis Score for Identifying Acute Appendicitis in Children Presenting With Acute Abdominal Pain to the Emergency Department. Indian Pediatr 2022; 59:774-777. [PMID: 35959758] [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: 06/15/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan. METHODS This validation study was through retrospective chart review of children between 4-18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC). RESULTS 104 children (76% boys) with mean (SD) age of 10.9 (3.5) years met the eligibility criteria. 91% (n=95) patients had moderate to high PAS (score ³4), and 95% (n=99) had biopsy-proven appendicitis. The likelihood ratio calculated for low, equivocal and high-risk PAS was 0.10, 2.17 and 2.53, respectively. An equivocal PAS (score 4-6) showed a sensitivity of 96.8%, specificity of 80%, positive predictive value of 98.9% and AUC of 0.84 for predicting acute appendicitis. CONCLUSION PAS showed good diagnostic accuracy in predicting acute appendicitis in children presenting to the ED.
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Affiliation(s)
- Syed Maaz Salahuddin
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan. Correspondence to: Dr Syed Maaz Salahuddin, Instructor, Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Omair Ayaz
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Mehtab Jaffer
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Asad I Mian
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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30
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Qi BX, Zhu L, Sheng LP, Wen NN, Cheng X, Hu SS, Qian T. [Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study]. Zhongguo Dang Dai Er Ke Za Zhi 2022; 24:812-816. [PMID: 35894198 PMCID: PMC9336631 DOI: 10.7499/j.issn.1008-8830.2203098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen. METHODS A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications. RESULTS There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (P>0.05). Compared with the control group, the observation group had significantly lower serum levels of ET-1, ACTH, and cortisol on days 1 and 5 after surgery (P<0.05) and significantly higher levels of motilin and gastrin on day 5 after surgery (P<0.05). Compared with the control group, the observation group had significantly shorter time to first passage of flatus, first bowel sounds, and first defecation after surgery, as well as a significantly shorter length of hospital stay (P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (6% vs 24%, P<0.05). CONCLUSIONS In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.
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Affiliation(s)
- Bo-Xiang Qi
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Lei Zhu
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Li-Ping Sheng
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Na-Na Wen
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Xiao Cheng
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Shuang-Shuang Hu
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Tong Qian
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
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31
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Giordano G, La Mirata E, Politi V, Veroux M, Meli GA, Evola G, Palmucci S, Basile A, Basile G. Left Paraduodenal Hernia in a Young Patient with Recurrent Abdominal Pain: A Case Report and Short Literature Review. Am J Case Rep 2022; 23:e935413. [PMID: 35660720 PMCID: PMC9175513 DOI: 10.12659/ajcr.935413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/30/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Internal hernias are a rare cause of small bowel obstruction in patients, which usually have a long history of mild abdominal symptoms, sometimes leading to emergency surgery due to acute abdominal pain. Occasionally, it takes a long time to make the correct diagnosis because of symptoms vagueness and transience of typical imaging findings; at times, a definitive diagnosis is possible only through surgery, especially in cases of acute presentations in a low-resource setting where high-performance diagnostic equipment may be unavailable. CASE REPORT We report the case of a young male patient with a long history of mild abdominal symptoms and some episodes of acute abdominal pain. Following one of these episodes, several diagnostic examinations were performed and he was diagnosed with left paraduodenal hernia after typical signs were found on imaging exams, both CT and MRI; the patient underwent laparotomy with reduction of intestinal loops in the peritoneal cavity and suturing of the sac and was eventually discharged with no further symptoms whatsoever. CONCLUSIONS Among internal hernias, left paraduodenal hernias account for the major part and are characterized by the protrusion of bowel loops through the fossa of Landzert; herniated loops produce a sac-like appearance (typical imaging sign on both CT and MRI) and may cause partial displacement of other organs and blood vessels. Internal hernias should always be considered as a rare differential diagnosis in the workup of a patient with abdominal pain or intestinal obstruction: knowledge of both typical imaging features and specific surgical techniques are mandatory so that these patients may be properly cared for.
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Affiliation(s)
- Gabriele Giordano
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Elena La Mirata
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Valentina Politi
- UOC MCAU (Urgent Surgery), University Teaching Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplantation Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Gaetano Alfio Meli
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Giuseppe Evola
- Department of General and Emergency Surgery, Garibaldi Hospital, Catania, Italy
| | - Stefano Palmucci
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Turhan N, Arıcan ÇD. The effects of COVID-19 pandemic on patients with acute appendicitis. ULUS TRAVMA ACIL CER 2022; 28:756-761. [PMID: 35652875 PMCID: PMC10443006 DOI: 10.14744/tjtes.2021.53929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effects of the COVID-19 infection on the world's health system began to be reported in a short time, with the spread of the infection all over the world and it gained a global acceptance as a pandemic. It was predicted that patients who require urgent surgical procedures may not be able to access appropriate treatment during this period and may suffer from this process. In this process, we planned to report the effects of the pandemic process to this patient group by evaluating patients with acute appendicitis, which is the most common cause of acute abdomen among general surgery emergencies. METHODS In our study, we compared the patients who applied to the Training and Research Hospital we collaborated, whose clinics were compatible with acute appendicitis, between March 11, 2020, and May 21, 2020, with those applied within the same time period with the year before. We evaluated clinical and pathological findings of the patients and the treatment applied. RESULTS In this study, there were 103 patients diagnosed with acute appendicitis before pandemic and 61 in pandemic period. We found that during the pandemic period, patients with acute appendicitis were admitted to the hospital less often, and in a later period, and more complicated clinical pictures were determined. Complicated appendicitis patients were higher in pandemic period compared with previous year (33.96% vs. 8.00% of patients, respectively; p<0.05). CONCLUSION We emphasized that diseases that need to be treated urgently should not be left behind during the pandemic. Furthermore, we shared our clinical practice to ensure early discharge of patients with acute appendicitis during the pandemic process.
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Affiliation(s)
- Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
| | - Çiğdem Dicle Arıcan
- Department of Medical Pathology, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
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33
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Avcu G. Acute Acalculous Cholecystitis due to EBV Infection Presenting as Acute Abdomen. J Coll Physicians Surg Pak 2022; 32:662-664. [PMID: 35546706 DOI: 10.29271/jcpsp.2022.05.662] [Citation(s) in RCA: 1] [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] [Received: 03/05/2020] [Accepted: 04/22/2020] [Indexed: 06/15/2023]
Abstract
Epstein-Barr Virus (EBV) is a herpes virus with a high seropositivity rate among the adult population throughout the world. Primary EBV infection is usually asymptomatic among young children. As age increases, it begins to manifest as infectious mononucleosis. Gastrointestinal involvement is often mild and elevations in liver function tests are common in most cases. Here, we report a case of acute acalculous cholecystitis in a 15-year girl during the course of a primary EBV infection which is a very rare presentation in the pediatric population. Our patient recovered without any antibiotic or surgical treatment - parallel to the clinical improvement of the primary disease. Key Words: Epstein-barr virus (EBV) infection, Acute acalculous cholecystitis, Children, Antibiotics.
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Affiliation(s)
- Gulhadiye Avcu
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Balikesir Ataturk City Hospital, Balikesir, Turkey
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34
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Toader JF, Kleinert R, Dratsch T, Fettweis L, Jakovljevic N, Graupner M, Zeeh M, Kroll AC, Fuchs HF, Wahba R, Plum P, Bruns CJ, Datta RR. Effect of phone call distraction on the performance of medical students in an OSCE. BMC Med Educ 2022; 22:295. [PMID: 35443638 PMCID: PMC9020121 DOI: 10.1186/s12909-022-03215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The usage of smartphones in the daily clinical routine is an essential aspect however it seems that they also present an important distractor that needs to be evaluated. The aim of this prospective study was the evaluation of the influence of phone calls as distractors on the performance levels of medical students during an objective structured clinical examination (OSCE), simulating the normal clinical practice. METHODS As the goal of an OSCE presents the examination of clinical skills of medical students in a realistic setting, more than 100 students recruited from the university hospital of Cologne participated in either OSCE I or II. During the OSCE I intravenous cannulation was simulated while OSCE II simulated an acute abdominal pain station. Participants had to perform each of these stations under two circumstances: a normal simulated OSCE and an OSCE station with phone call distraction. Their performance during both simulations was then evaluated. RESULTS In OSCE I students achieved significantly more points in the intravenous cannulation station if they were not distracted by phone calls (M=6.44 vs M=5.95). In OSCE II students achieved significantly more points in the acute abdominal pain station if they were not distracted by phone calls (M=7.59 vs M=6.84). While comparing only those students that completed both stations in OSCE I/II participating students achieved significantly more points in both OSCE I and II if they were not distracted by phone calls. CONCLUSION The presented data shows that phone call distraction decreases the performance level of medical students during an OSCE station. Therefore, it is an indicator that distraction especially for younger doctors should be held to a minimum. On a second note distraction should be integrated in the medical education system as it plays an important role in clinical routine.
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Affiliation(s)
- Justus F Toader
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany.
| | - Robert Kleinert
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld, Germany
| | - Thomas Dratsch
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Louisa Fettweis
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Nadja Jakovljevic
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Martina Graupner
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Moritz Zeeh
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Anna C Kroll
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Hans F Fuchs
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Roger Wahba
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Patrick Plum
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
| | - Rabi R Datta
- Department of General, Visceral, Cancer And Transplant Surgery, University of Cologne, Cologne, Germany
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35
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Moekotte J, Bos ME, Bolmers MDM. [A woman with an abdominal swelling after coughing]. Ned Tijdschr Geneeskd 2022; 166:D6698. [PMID: 35499610] [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: 06/14/2023]
Abstract
We present the case of a 79-year old woman with acute abdominal swelling and pain after coughing. She was in hemorrhagic shock and received blood transfusion after which hemodynamic stabilization occured. This case illustrates that a rectus sheath hematoma can be the (uncommon) cause of acute abdominal pain and shock.
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Affiliation(s)
- Jiri Moekotte
- Dijklander Ziekenhuis, Hoorn. Afd. Spoedeisende Hulp
- Contact: Jiri Moekotte
| | - Marly E Bos
- Dijklander Ziekenhuis, Hoorn. Afd. Spoedeisende Hulp
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Torun BC, Gök AFK, İlhan M, Yegen G, Başaran S, Ertekin C, Günay MK, Yanar H. A rare cause of acute abdominal pain: Actinomyces infection of colon mimicking a malignant neoplasm due to intrauterine device. ULUS TRAVMA ACIL CER 2022; 28:537-540. [PMID: 35485507 PMCID: PMC10520999 DOI: 10.14744/tjtes.2020.45672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 11/20/2022]
Abstract
Actinomycosis is a rare, chronic granulomatous disease that is challenging to diagnose because the clinical symptoms and signs are nonspecific. Usage of intrauterine device (IUD) or being immunocompromised is facilitating factors. Clinical and radiological findings can mimic malignant neoplasm, inflammatory bowel disorder, or acute diverticulitis. We report a case of actinomyces infection of the colon secondary to IUD, which is a rare cause of acute abdominal pain and can mimic a malignant neoplasm. We also provide a review of the literature. Unnecessary surgery can be avoided with the correct diagnosis of granulomatous infectious diseases that can be treated with antibiotics.
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Affiliation(s)
- Bahar Canbay Torun
- Department of General Surgery, Sultangazi Haseki Training and Research Hospital, İstanbul-Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mehmet İlhan
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Gülçin Yegen
- Department of Pathology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Seniha Başaran
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Cemalettin Ertekin
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mustafa Kayıhan Günay
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Hakan Yanar
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
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Zheng F, Yang C, Cui Y, Zhang Y, Coccolini F. [Interpretation of acute abdomen in the immunocompromised patients: WSES/SIS-E/WSIS/AAST/GAIS guideline]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2022; 34:239-244. [PMID: 35574738 DOI: 10.3760/cma.j.cn121430-20211008-01440] [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: 06/15/2023]
Abstract
World Society of Emergency Surgery (WSES), in conjunction with Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) developed guideline about the management of acute abdomen in immunocompromised patients, which was published in the World Journal of Emergency Surgery (WJES) on August 9, 2021. The guidelines elaborate on the definition, classification, diagnosis and treatment of immunocompromised patients. In addition, based on evidence-based medicine, it provides guidance and suggestion on the management of specific acute abdominal infections in immunocompromised patients, common acute abdominal infections in transplanted patients, patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), as well as perioperative steroid management. An interpretation of the guideline was performed to accomplish a better understanding the current status and recommendations for the management of acute abdominal conditions in immunocompromised patients, and to make forward suggestions on its limitations.
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Affiliation(s)
- Feibo Zheng
- Department of Surgery, Tianjin Occupational Diseases Precaution and Therapeutic Hospital, Tianjin 300011, China
- Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300070, China
| | - Chunyong Yang
- Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300070, China
- Department of General Surgery, Affiliated Hospital of Chifeng College, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Yunfeng Cui
- Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300070, China
- Department of Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
| | - Yamin Zhang
- Department of Hepatobiliary Surgery, Tianjin First Central Hospital, Tianjin 300100, China
| | - Federico Coccolini
- General, Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa 56124, Italy. Corresponding author: Cui Yunfeng, ; Zhang Yamin, ; Federico Coccolini,
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Abid S, Dhaou GB, Abdelmoula G, Smida AB, Abdesslem MRB, Mrad O, Derouiche M, Lassoued L. Complete non-puerperal uterine inversion caused by uterine hemangioma: a case report. Pan Afr Med J 2022; 42:156. [PMID: 36187039 PMCID: PMC9482224 DOI: 10.11604/pamj.2022.42.156.35583] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Uterine inversion is a rare postpartum complication. It is a rare condition in which the internal surface of the uterus protrudes through the vagina. Non-puerperal uterine inversion (NPUI) is extremely rare. In most instances, it is linked to uterine tumors. Among these tumors, leiomyoma is the most frequent cause reported in data. This condition may not be noticed until time of surgery. Malignancy is suspected in most cases. Nevertheless, uterine inversion can be diagnosed preoperatively using radiology. Difficulties in diagnosing NPUI makes this clinical case a challenge in gynaecology and not commonly reported in literature. We report our experience in the diagnosis and treatment of a complete non-puerperal uterine inversion associated with uterine angioleiomyoma. The patient's age was 44, gravida 2 para 1 presented with intermittent vaginal bleeding for four months and an acute abdominal cramping pain. On examination, a large mass lesion was observed which occupies the vaginal cavity and the contour of the uterine cervix could not be reached. Biopsies and Immunohistochemistry matched with an angioleiomyoma. She underwent a transvaginal surgical reposition technique: Spinelli’s. It is important to diagnose accurate non-puerperal uterine inversion. Surgery provides good prognosis and it is necessary. We report a case of NPUI caused by angioleiomyoma. Nevertheless, malignancy must be eliminated in first place.
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Affiliation(s)
- Skander Abid
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
- Corresponding author: Skander Abid, University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia.
| | - Ghassen Ben Dhaou
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
| | - Ghada Abdelmoula
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
| | - Ahmed Ben Smida
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
| | - Mohamed Raouf Ben Abdesslem
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
| | - Ons Mrad
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
| | - Mouna Derouiche
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
| | - Latifa Lassoued
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- Farhat Hached University Hospital of Sousse, Department of Obstetric Gynecology, 4000, Sousse, Tunisia
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Chang YC, Lai JN, Chiu LT, Wu MC, Wei JCC. Epidemiology of Meckel's diverticulum: A nationwide population-based study in Taiwan: Characteristics of the cases from surgery between 1996 and 2013. Medicine (Baltimore) 2021; 100:e28338. [PMID: 34918715 PMCID: PMC8678020 DOI: 10.1097/md.0000000000028338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
The diverse presentation of Meckel's diverticulum (MD) is a diagnostic challenge for clinicians and most previous studies consist of single institutional case series. The aim of this study was to review the related diagnoses of MD and to investigate the epidemiological characteristics using Taiwan's National Health Insurance Research Database.We conducted an observational study using a population-based database. Patients diagnosed with MD who concurrently received intestinal surgery were identified. We analyzed the patients' demographic characteristics and relevant diagnoses using χ2 test and 2-sample t test.We identified 2453 newly diagnosed MD patients from 1996 to 2013 and 1227 patients (50%) with intestinal obstruction, gastrointestinal bleeding, and acute appendicitis (acute abdominal pain) were defined as symptomatic. The male to female ratio was 2.4:1 with half of the patients experiencing symptomatic MD before the age of 20 years' old. The age-specific and annual incidence were calculated for all MD and symptomatic MD. Among the symptomatic MD patients, intestinal obstruction was present in 583 (48%), acute appendicitis was present in 464 (38%), and gastrointestinal bleeding was present in 283 (23%) patients. Intestinal obstruction was the most common preoperative diagnosis in the 0 to 10 years and >20 years' age groups, and acute appendicitis (acute abdominal pain) was the most common diagnosis in the 11 to 20 years' age group.This population-based 18 years' epidemiologic study described the distributions of MD symptoms among different age groups, which may help clinicians gain a better understanding of this diagnostically challenging gastrointestinal anomaly.
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Affiliation(s)
- Yu-Chuan Chang
- Department of Pediatrics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Lu-Ting Chiu
- Management office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Meng-Che Wu
- Division of Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Abstract
ABSTRACT Children with abdominal pain are frequently seen in emergency departments. Physicians and parents worry about appendicitis; physicians are also concerned about intussusception and bowel obstruction in patients with previous surgical procedures. Sometimes the patient is ill, and the diagnosis is elusive. In a 6-month period at our pediatric emergency department with an annual census of 57,400 patients, we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum. None presented with painless rectal bleeding, the complication of which physicians are most aware. We are reporting these patients to raise awareness of Meckel's diverticulum as a cause of acute abdomen in children. Meckel's diverticulum may masquerade as appendicitis, an abdominal mass, intussusception, or a complication of severe constipation.
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Affiliation(s)
- Deborah L Callanan
- From the Division of Emergency Medicine, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX
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42
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Abstract
Acute appendicitis is an important differential diagnosis in patients with right lower quadrant pain during pregnancy. Endometriosis, a hormone-related pathology, is another possibility. Patients with endometriosis are typically symptomatic before pregnancy. Stromal endometriosis is a variant of endometriosis that presents no symptoms before pregnancy but which occasionally presents with the new onset of symptoms during pregnancy. We report the case of a 35-year-old woman in her 8th month of pregnancy who presented with impending appendiceal rupture due to deciduosis of the appendix, a progesterone-related condition, during pregnancy. This case suggests that deciduosis/stromal endometriosis should be considered as a differential diagnosis of acute abdomen during pregnancy, even if the patient is asymptomatic before pregnancy.
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Affiliation(s)
- Ayako Tsunemitsu
- Department of General Internal Medicine, Takatsuki General Hospital, Japan
| | - Takahiko Tsutsumi
- Department of General Internal Medicine, Takatsuki General Hospital, Japan
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Ide A, Tokunaga M, Yoshikawa S, Kondo A, Nishiura N, Inoue S, Morita T, Tominaga N, Maeda T. [Chronic myeloid leukemia with an in-frame exon 4 deletion in ABL1 with acute abdomen due to an intrapelvic bulky mass as the initial symptom]. Rinsho Ketsueki 2021; 62:1615-1622. [PMID: 34866085 DOI: 10.11406/rinketsu.62.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 23-year-old woman was admitted to our hospital because of rapidly developing lower abdominal pain. Computed tomography revealed ascites, splenomegaly, and a huge mass that occupied the pouch of Douglas and surrounded her uterus. A markedly elevated white blood cell count of 495×109/l and the identification of the BCR-ABL1 fusion gene led to the diagnosis of chronic myeloid leukemia (CML). Although neither an increase in the blast percentage nor any additional chromosomal abnormality was observed in the patient, CML was considered in the blast phase because of extramedullary disease infiltration. Dasatinib was administered with the temporal use of hydroxyurea and VP-16, which resulted in rapid disappearance of her intrapelvic mass and complete hematologic response within 1 month. She refused to undergo allogeneic hematopoietic stem cell transplantation and continued to take dasatinib, achieving complete cytogenetic and major molecular responses within 5 and 11 months, respectively. CML cases initially presenting with extramedullary tumors are rare. Furthermore, in our case, a mutational analysis at diagnosis revealed an in-frame exon 4 deletion in ABL1, which is reported to decrease cell proliferation. This fact is intriguing because her clinical outcome was relatively favorable.
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MESH Headings
- Abdomen, Acute
- Adult
- Blast Crisis
- Exons/genetics
- Female
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Young Adult
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Affiliation(s)
- Ayaka Ide
- Clinical Education Center, Suita Municipal Hospital
| | | | | | | | | | - Shinya Inoue
- Department of Hematology, Suita Municipal Hospital
| | | | | | - Tetsuo Maeda
- Department of Hematology, Suita Municipal Hospital
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Räty P, Mentula P, Lampela H, Nykänen T, Helanterä I, Haapio M, Lehtimäki T, Skrifvars MB, Vaara ST, Leppäniemi A, Sallinen V. INtravenous Contrast computed tomography versus native computed tomography in patients with acute Abdomen and impaired Renal functiOn (INCARO): a multicentre, open-label, randomised controlled trial - study protocol. BMJ Open 2020; 10:e037928. [PMID: 33028554 PMCID: PMC7539602 DOI: 10.1136/bmjopen-2020-037928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION CT is the primary imaging option for acute abdominal pain in adults. Intravenous (IV) contrast media use improves CT quality but may cause post-contrast acute kidney injury (PC-AKI). Retrospective studies show no association between reduced baseline renal function and IV contrast CT, but, to our knowledge, no data from randomised controlled trials exist. METHODS AND ANALYSIS The INCARO (INtravenous Contrast computed tomography versus native computed tomography in patients with acute Abdomen and impaired Renal functiOn) trial is a multicentre, open-label, parallel group, superiority, individually randomised controlled trial comparing IV contrast-enhanced CT to native CT in patients requiring emergency abdominal or body CT with impaired renal function defined as an estimated glomerular filtration rate (eGFR) of 15 to 45 mL/min/1.73 m2. The primary outcome is a composite of all-cause mortality or renal replacement therapy (RRT) within 90 days from CT. Secondary outcomes are AKI measured by KDIGO (The Kidney Disease: Improving Global Outcomes) criteria within 72 hours from CT, organ dysfunction defined by mSOFA (modified Sequential Organ Failure Assessment) criteria after 48 hours from CT, alive and hospital-free days within 90 days after CT, and time from imaging to definitive treatment. All-cause mortality, need for RRT and renal transplant in long-term follow-up are also measured. The calculated sample size is 994 patients. Patient recruitment is estimated to take 3 years. ETHICS AND DISSEMINATION The Ethics Committee of Helsinki University Hospital approved the study. The findings will be disseminated in peer-reviewed academic journals. TRIAL REGISTRATION NUMBER NCT04196244.
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Affiliation(s)
- Panu Räty
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Panu Mentula
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lampela
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Nykänen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | - Ilkka Helanterä
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Haapio
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Lehtimäki
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi T Vaara
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ari Leppäniemi
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Blanco-Colino R, Vilallonga R. Authors response to: «About the scientific letter: Suspected Acute Abdomen as an Extrapulmonary Manifestation of Covid-19 Infection». Cir Esp 2020; 98:424-425. [PMID: 32408993 PMCID: PMC7174189 DOI: 10.1016/j.ciresp.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ruth Blanco-Colino
- Servicio de Cirugía general y del aparato Digestivo. Hospital Universitari Vall Hebron. Universitat Autònoma de Barcelona, Barcelona, España
| | - Ramón Vilallonga
- Unidad de Cirugía endocrina, bariátrica y metabólica. Hospital Universitari Vall Hebron. Universitat Autònoma de Barcelona, Barcelona, España.
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Şerban C, Constantin GB, Firescu D, Rebegea L, Manole CP, Truş C, Voicuş D, Bîrlă R. Perforated Ileal GIST Associated with Meckel Diverticulum - A Rare Pathological Entity of Surgical Acute Abdomen. Chirurgia (Bucur) 2020; 115:404-409. [PMID: 32614297 DOI: 10.21614/chirurgia.115.3.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
Introduction: The GIST tumors are very rare entities ( 1% of all tumors). They originate in the Cajal interstitial cells, which are part of the autonomic nervous system of the intestine. Their most common location is the stomach, followed by the small intestine. The aim of this paper is to present a very rare case of perforated ileal GIST, associated with Meckel diverticulum. Case report: A 71 years old patient with comorbidities is admitted in emergency for symptoms and signs of acute surgical abdomen. The exploratory laparotomy reveals generalized acute peritonitis due to perforated ileal tumor and Meckel's diverticulum. A segmental enterectomy is performed, with favorable postoperative evolution. The histological examination of the resection piece shows the appearance of GIST, confirmed immunohistochemically. Conclusions: The GIST tumors of the small intestine are unusual tumors and the spontaneous perforation and life-threatening hemorrhage are a rarity. The main treatment for this form of GIST is the resection, with a favorable clinical outcome.
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Lim PPC, Dasgupta K, Wheeler T. Wandering Spleen in a 1-Year-Old Girl: An Enigmatic Journey to Find the Hiding Necrotic Spleen. S D Med 2019; 72:459-463. [PMID: 31816207] [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: 06/10/2023]
Abstract
Wandering spleen, otherwise known as ectopic spleen, is a rare congenital or acquired condition, especially in pediatric patients, characterized by elongated splenic pedicle due to congenital or acquired laxity of suspensory splenic ligaments resulting in exaggerated splenic mobility that predisposes it to torsion and often to subsequent infarction. We present a case of a 1-year old Caucasian female who presented with acute abdomen showing infarcted ectopic spleen on imaging. Most patients with infarcted spleen require surgery as the standard intervention. However, our patient was managed medically and had an excellent outcome in the absence of surgery.
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Affiliation(s)
- Peter Paul C Lim
- Department of Pediatrics, Avera Queen of Peace Hospital, Mitchell, South Dakota
- Rainbow Babies Children's Hospital
| | - Kingshuk Dasgupta
- Avera McKennan Children's Hospital and University Health Center, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tamara Wheeler
- Avera Queen of Peace Hospital, Department of Radiology, Mitchell, South Dakota
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48
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Abstract
CLINICAL/METHODICAL ISSUE Diagnostic imaging plays a crucial role in the assessment and stratification of pathologic conditions causing acute abdomen. This report provides information on etiology, clinical manifestations and therapeutic options for six common diseases resulting in acute abdomen-appendicitis, cholecystitis, bowel obstruction, diverticulitis, acute pancreatitis, and viscus perforation. PERFORMANCE Besides initial ultrasound, CT scans often represent the imaging gold standard for the diagnostic evaluation of acute abdomen. PRACTICAL RECOMMENDATIONS Depending on the underlying pathologic condition, sonography or CT is suitable for the stratification of the gastrointestinal disease causing acute abdomen.
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Affiliation(s)
- V Schwarze
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - C Marschner
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland
| | - C Schulz
- Medizinische Klinik und Poliklinik II, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - F Streitparth
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland
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49
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Schernthaner RE, Loewe C. [Vascular causes of clinically unclear acute abdomen]. Radiologe 2019; 59:133-138. [PMID: 30635690 DOI: 10.1007/s00117-018-0489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CLINICAL ISSUE Vascular abnormalities are a rare cause of an acute abdomen. They include arterial bleeding and ischemia, the latter being either in the arterial or venous system. The most common cause of an acute ischemic abdomen is acute mesenteric ischemia caused by a thromboembolic occlusion of the superior mesenteric artery, followed by thrombotic occlusion of the portal vein, the mesenteric vein as well as the hepatic veins and the suprahepatic part of the inferior vena cava. In the case of an acute abdomen due to internal bleeding, all abdominal arteries can be the source but most common are ruptures of aortic aneurysms and inflammatory-driven bleeding from the superior mesenteric artery. PRACTICAL RECOMMENDATIONS Due to the high mortality, vascular causes should be diagnosed as soon as possible. For this purpose, computed tomography (CT) has evolved into the preferred tool due to its high availability and speed. To differentiate various vascular causes of an acute abdomen, it is important to incorporate a CT protocol without contrast media as well as contrast-enhanced series in arterial and venous phases. Conventional angiography has been replaced by CT for the diagnosis of vascular pathologies causing an acute abdomen; however, it plays an increasing role in the treatment of these pathologies.
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Affiliation(s)
- R E Schernthaner
- Klinische Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - C Loewe
- Klinische Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Abstract
CLINICAL/METHODICAL ISSUE Acute, non-traumatic abdominal pain is one of the main reasons for medical consultation in pediatric patients. Knowledge of different diseases and their age dependence is essential for correct diagnosis and treatment. STANDARD RADIOLOGICAL METHODS Ultrasonography is the imaging method of choice. X‑ray is only used in case of emergency, e. g., suspected perforation. METHODICAL INNOVATIONS Contrast-enhanced ultrasonography (CEUS) and elastography complement ultrasonography. PERFORMANCE Magnetic resonance imaging is of increasing relevance for differential diagnosis of unclear sonographic results. PRACTICAL RECOMMENDATIONS The primary imaging modality in pediatric patients is ultrasonography. Cross-sectional imaging should only be used in cases of unclear sonographic findings.
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Affiliation(s)
- P C Krüger
- Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - H J Mentzel
- Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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