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We report a new case of eosinophilic enteritis whose first manifestation was acute abdomen and the diagnosis was done postoperatively. After surgery the patient hasn't had recurrence of the symptoms and he hasn't required esteroids.
Fatal granulomatous disease of childhood is a rare disorder of phagocytic function. We report a 6-year-old boy who presented with acute abdomen. The diagnosis was established by mesenteric lymph node biopsy obtained at laparotomy. The boy succumbed within hours of surgery.
Authors describe an unusual case of acute abdomen after the traffic injury. They remind correct diagnosis of delayed splenic rupture and compare it with other literature findings.
We examined the fact that 12 years old obese girl who applied to our clinic with acute abdomen symptoms and we determined primer omental torsion (POT) at laparotomy in this case. This disease is rare in childhood and imitates the signs of acute appendicitis. Obesity and anatomic variations ofthe omentum are predisposingfactorsfor POI ln this study we wanted to share our experiences in diagnosis and treatment ofPOI
Reference to the literature is made in an account of extragenital external endometriosis, with particular attention to intestinal varieties. A case of ovarian and appendicular endometriosis with the clinical picture of acute abdomen is presented. Lastly, an evaluation is made of the views put forward concerning the aetiopathogenesis of this conditions.
Para-oesophageal hiatus hernia, a condition in which the fundus and part of the body of the stomach wrapped in a peritoneal sac herniate into the mediastinum, is a relatively uncommon entity. It tends to grow progressively and may become so large as to lead to symptoms of intrathoracic organ compression. In some exceptional cases, the entire stomach together with other abdominal viscera might herniate through the hiatus into the thorax. Paraesophageal hiatus hernias are characterised clinically by vague symptomatology, absent gastro-oesophageal reflux, and possible onset of gastric volvulus, generally without consequent incarceration of the portion of the herniated organ. Such an event is uncommon but dangerous and life-threatening. These cases often require resection of the incarcerated viscera, followed by hiatoplasty and Nissen fundoplication. The authors report on the case of a patient presenting with acute abdomen as a result of incarcerated and perforated para-oesophageal hiatus hernia.
The author reports three cases of acute hematogenic osteomyelitis, in which the symptoms of "acute abdomen" were predominant. In the first patient an erroneous laparotomy was performed. Some characteristic features in diagnosis of acute hematogenic osteomyelitis with such clinical picture are analysed.
We report a 72-year-old man with sporadic intra-abdominal desmoid tumor manifesting as acute abdomen. CT scan revealed an air-containing tumor 7 cm in diameter; three weeks later, the tumor had shrunk to 4 cm on antibiotics. At surgery, a tumor arising from the transverse colon mesentery and infiltrating the jejunum was resected. No recurrence occurred over a 1-year follow-up.
An interesting case of pelvic actinomycosis with paculiar clinical manifestation is presented. A 42 years-old patient came to our emergency service for an abdominal pelvic pain and fever. Past history showed IUD in situ for over 15 years. The patient was submitted to a ultrasonographic scan and a complete hematological screening was performed. The diagnosis was of subacute abdomen, and an exploratory laparotomy was carried out. During laparotomy an atypical reactive tissue and a suppurative cavity were found. The histological finding of tissue biopsy showed pelvic actinomycosis. On the basis of these findings the conclusion is drawn that a better prevention of pelvic actinomycosis is necessary of its diffusion in the last years due to sexual habit changes.
Wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. Wandering spleen can migrate to the lower abdomen or pelvis, and can be either congenital or acquired. It is most commonly found in women of reproductive age, and may be misdiagnosed as an abdominal or adnexal mass. It is usually asymptomatic, but may present with acute, chronic, or intermittent abdominal pain. Here, we report a case of torsion of a huge congenital pelvic wandering spleen and microscopic isolated pancreatic tissue (disconnected from the pancreas) with impending splenic rupture in a 23-year-old female patient. Progressively severe chronic or intermittent torsion of the vascular pedicle of the wandering spleen caused progressive intermittent lower abdominal pain. The patient underwent splenectomy with resection of the long pedicle and the postoperative course was uneventful. The pathognomonic computerized tomography features of this case, including absence of the spleen in the left upper quadrant and the presence of a whirl-like structure running down to the central portion of the distally located large soft-tissue mass and with a notched- (hilar-) like contour, are also described.
Torsion of a wandering spleen is rare and has been diagnosed in about 0.2%-0.3% of a large group of patients who required splenectomy. Abnormalities in the ligamentous structures that fix the spleen are thought to be responsible for its abnormal position and for its torsion. Patients may present with various symptoms ranging from mild intermittent abdominal pain to an acute abdomen. Computed tomography leads to correct diagnosis.
The acute abdomen (AA) is a typical but very rare complication of idiopatic haemochromatosis (IH). The possible mechanisms are not sufficiently clarified. We report a case with IH who died with clinical features of (AA) 20 hours after gastroscopy was performed. The histological examination established nonspecific damage of visceral peritoneum and ascites. Fulminant form of spontaneous bacterial peritonitis (SBP) as a reason of death is discussed, nevertheless endoscopic esophageal varices sclerotherapy was not performed. The role of pulmonary infection and intestinal bacterial overgrowth with possible bacterial translocation in mesenterial lymph nodes, ascitic fluid, and blood is also discussed. The source of infection is usually unknown. The iron is important factor for bacterial growth. The pluriglandular deposition of iron including the suprarenal glands is precondition to development of collapse. The possible pathogenesis of SBP in IH is discussed. It is important to mention that unlike SBP the clinical course of IH AA might appear which does not necessary require surgical management.
Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder. Although liver involvement is the most frequent extra-renal manifestation, serious complications due to liver cysts are very rare. We report the occurrence of an acute abdomen caused by massive haemoperitoneum resulting from rupture of a giant liver cyst in ADPKD. Data suggest that chronic anticoagulation therapy should be avoided where possible in the presence of a giant liver cyst.
The use of laparoscopy in diagnosis, investigation, and therapy is very important. The paper describes the laparoscopic technique of correction of a retroflexed uterus. This technique is based on sewing the round ligaments of the uterus to the abdomen fascia. Both simplicity and usefulness of the method are demonstrated.
Some situations in which endocrinological diseases and their complications (diabetic ketoacidosis, acute adrenal failure, pheochromocytoma, thyrotoxicosis, thyrotoxic crisis, hyperparathyroidism crisis) give the picture of false acute abdomen are analyzed.
The natural history of Peutz-Jeghers syndrome (PJS) is characterized by gastrointestinal complications (occlusion, invagination or bleeding), often the first clinical manifestation in young patients. Surgical treatment consists of treating the complication, exploring the bowel and cleaning out all polyps to prevent further emergency operations at brief intervals. For this purpose both the laparotomic and laparoscopic approaches have been proposed, especially in young patients. A 15-year-old girl was admitted for investigation of colicky abdominal pains. When she was 5 years old, PJS was diagnosed. On admission to our department, the patient underwent emergency esophagogastroduodenoscopy and colonoscopy, both negative. At 24 hours after admission peritonitis developed. Given her clinical history, we rejected the laparoscopic approach proposed at admission and decided for an open laparotomy. Laparotomy disclosed a long jejunoileal invagination that caused irreversible ischemic damage of the bowel. We resected about 130 cm of the ileum and did an end-to-end ileo-ileal anastomosis. Meticulous palpation and transillumination of the residual bowel identified no other polyps. In young patients with acute abdomen and with proven or suspected PJS instead of laparoscopy, open laparotomy is a unique occasion to explore the residual bowel thoroughly, manually and, if possible, endoscopically.
We report a 65-year-old man presenting with acute pain in the abdomen. Diagnostic laparoscopy revealed gangrenous torsion in one of the appendices epiploicae in the ascending colon. This was excised with harmonic scalpel.
We present a retrospective study based on 50 diabetic patients with acute abdominal diseases. Usually, clinical features were not typical, without defining signs of acute abdomen, despite frequent severe anatomo-pathological forms (6 of 12 acute appendicitis were gangrenous, with generalised or localised peritonitis; 15 of 22 acute colecystitis were gangrenous). In diabetic patients, with metabolic disorders and cetoacidosis, positive diagnosis and the decision of laparotomy are difficult problems, often delated, with a negative influence on the evolutions and prognosis of these patients.