An evaluation of diagnostic paracentesis in the acute abdomen.
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Marked hypertrophy of the psoas muscle in a bodybuilder produced a unilateral extrinsic mass effect upon the medial cecum and adjacent small bowel. The patient had presented with right lower quadrant pain and leukocytosis. Routine contrast studies of the abdomen were misleading, but a computed tomogram suggested the correct diagnosis.
A 12-year-old boy was admitted to hospital for abdominal pain, vomiting and fever. On physical examination he had râles on the lower right hemithorax without any respiratory complaints. Chest X-ray revealed a condensation in the right lower chest. Abdominal findings were secondary to lobar pneumonia. Treatment of pneumonia with antibiotics showed no improvement over 2 days. On bronchoscopy no foreign body was seen, but pus was aspirated. Two days later a mass appeared on the right hemithorax and fistulized. An organic foreign body, Hordeum murinum, with 3-5 ml of pus was observed. Chest X-ray taken at the day of fistulization showed no pneumothorax or subcutaneous emphysema. Less than 11 cases of pneumocutaneous fistulas secondary to aspiration of grasses have been reported in literature. Why an ear of Hordeum murinum can migrate only in a forward direction and why a pneumothorax had not developed is discussed.
Cyclic neutropenia, a rare blood disorder, may be complicated by spontaneous necrosis of the cecum and ascending colon. We describe one such case, where a staged surgical approach achieved a successful outcome. The importance of recognition of this disorder is stressed, since this allows both performance of appropriate surgery and consultation with hematologic colleagues.
Emergency peritoneoscopy (laparoscopy) to evaluate a suspected intraabdominal catastrophe was performed in ten critically ill patients over a 3-year period. The examination was negative in six cases, thereby avoiding celiotomy in this high-risk group. The examination was positive in four cases and, on this basis, celiotomy was recommended. Verification of the peritoneoscopic findings by clinical follow-up, operative findings, or autopsy was obtained in eight out of the ten cases. Based on our experience, we feel that peritoneoscopy is of value in defining the indications for celiotomy in this high-risk group of patients.
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Torsion of an intraabdominal testicular tumor is a rare preoperative diagnosis. An increased diagnostic yield is dependent on an expedient and comprehensive preoperative evaluation. This consists of a detailed past surgical history, a thorough physical examination, and close inspection of the preoperative abdominal films. An illustrated case report is presented.
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Even among the uncommon aneurysms of the visceral arteries the aneurysm of the pancreaticoduodenalis artery is considered a rarity. Etiologically, numerous factors must be taken into account, the most significant one being arteriosclerosis. The clinical presentation is unspecific and ambiguous. CT and, above all, intra-arterial DSA allow for a diagnosis. A generous consideration of indicating operative intervention, even in asymptomatic patients, is especially justified because of the imminent risk of rupture. The preferable therapy consists of elimination of the aneurysm either conventionally by proximal and distal ligature of the pancreaticoduodenalis artery or endovascularly by embolization. In the future a treatment with coated stents (TPEG) would also seem possible. Special attention must be paid to concomitant occlusive disease in other visceral arteries since measures for vessel reconstruction may be required because of intraoperative impairment of the collateral circulation. We report on the rupture of an aneurysm of the pancreaticoduodenal inferior artery in association with celiac axis occlusion.
Focal nodular hyperplasia (FNH) is a benign tumor of the liver. It is most frequently found in women of reproductive age. An association with oral contraceptives and sexual hormones is therefore possible. FNH lesions are frequently discovered incidentally. Spontaneous complications are rare. When the diagnosis is known with reasonable accuracy, a nonoperative approach is in common use. We report here the rare case of spontaneous intraabdominal bleeding from FNH.
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