[Ileocecal pathology. Commentary on several cases].
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On the basis of a large number of cases the occurrence of displacement of the caecum is reported in calves fed reconstituted milk. This displacement, a classification of which is given, occurs with the movement of the caecum into the left half of the abdomen in contrast to what occurs in animals fed a different diet. After a description of the various clinical and diagnostic aspects, details are given of the surgical technique used for treatment, and an aetiopathogenic hypothesis is formulated to explain the disease process.
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We report a case of eleven years old child with an acute lymphoblastic leukemia who developed an acute abdomen while in haematological relapse. He had an acute appendicitis with leukemic infiltration of the coecum. The early surgical intervention and the coecum irradiation were successful: the following chemiotherapy achieved remission. A more aggressive surgical approach to the acute abdomen, combined with careful supportive measures, might improve the usually grim prognosis in patient whose leukemia offers a chance for remission.
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Fecal concretions adherent to the caecal mucosa and an appendicular mucocele may present as a palpable mass in the right iliac fossa. The authors report a case of a young man with mucoviscidosis who presented with these two signs and they propose a non-invasive diagnostic approach consisting of a plain X-ray of the abdomen, an ultrasound examination and a hypertonic, hydrosoluble contrast enema. Fecal concretions do not produce any specific features on the plain X-ray or on ultrasound but they are seen as a constant filling defect on the contrast enema and they may be evacuated with this technique, thus avoiding the need for surgery. The mucocele is rarely calcified on the plain abdominal film and ultrasound reveals a liquid contents. It should be treated by limited excision of the appendix. The discovery of an appendicular mucocele at any age should lead to the investigation for mucoviscidosis.
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A series of 19 patients who had amebic peritonitis secondary to rupture of an amebic liver abscess is presented. This represents 2.4% of the patients treated for ALA during an 18.5-year period. Eighty-four percent were men and ages ranged from 6 to 70 years. Rupture occurred prior to admission in 17 patients. Abdominal pain and fever were the most common symptoms. Abdominal tenderness, liver enlargment, distention, and jaundice were the predominant physical findings. All patients underwent operation. Removal of necrotic and purulent material combined with wide drainage were carried out. In two patients with amebic cecal disease, intestinal bypass was also done. The mortality rate was 42%. It was significantly increased in patients over 50 years of age and in those in whom a correct preoperative diagnosis was not made.
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