Axial Torsion and Infarction of Meckel\'s Diverticulum in the 3rd Trimester of Pregnancy.

Meckel's diverticulum is a congenital anomaly which can become complicated or remain asymptomatic throughout life. During pregnancy, however, diverticulum infection could become a serious complication. Diverticulum necrosis and perforation are complications that increase morbidity in pregnancy, both maternal and fetal. The rarity of the condition and the maternal physiological changes in pregnancy make the diagnosis difficult. We present the case of a Meckel's diverticulum gangrene in third trimester pregnancy, atypical case due to advanced pregnancy where the risk-benefit balance was carefully evaluated on one hand because of the risk of infection associated with expectant management and on the other hand the risk and complications of iatrogenic preterm premature birth. The outcome was favorable for both mother and newborn.

Unusual cause of acute abdomen in a child--torsion of greater omentum: report of two cases.

INTRODUCTION: Torsion of the omentum is twisting along its long axis and a rare cause of acute abdomen. Depending on associated conditions, it is classified as primary and secondary. It may mimic different pathologies presenting as acute abdomen, most common of them being acute appendicitis. Current choice for management of omental torsion is laparoscopic surgery. CASE PRESENTATION: We present two cases of omental torsion of two boys who presented with abdominal pain, nausea and vomiting and underwent emergency laparoscopy. CONCLUSION: Omental torsion is very rare, and its diagnosis is usually made only after surgery. At laparoscopy, omental torsion is suspected when the appendix is normal and the symptoms and findings of torsion are present. Laparoscopy is a safe and effective approach for the diagnosis and management of omental torsion, with the advantages of reduced postoperative pain and hospital stay.

Isolated torsion of the fallopian tube: a case report and review of the literature.

Isolated torsion of the fallopian tube is a rare medical emergency, especially in premenarchal girls. We present a 9-year-old girl with right-sided lower abdominal pain. Isolated torsion of the fallopian tube was suspected preoperatively because of the clinical presentation combined with the results of ultrasound and magnetic resonance imaging (MRI). At emergency laparoscopy, the isolated torsion of the fallopian tube could be reduced, and the tube could be salvaged. This case report shows that the use of ultrasonography and MRI or CT is a helpful diagnostic tool to recognize this condition at an early stage. Especially in young girls presenting with abdominal pain, this should be kept in mind, as digital vaginal examination and vaginal ultrasound most often cannot be used in the diagnostic process. In conclusion, because prompt surgical intervention is required to preserve the tube and prevent progression to peritonitis and possible detrimental effects on future fertility, isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain in all female patients regardless of age.

Acute abdominal pain: the importance of genital examination.

Torsion of an intra-abdominal testis is a rare cause of acute abdominal pain. The purpose of this report is to highlight a case of torsion of an abdominal testis in a patient with an unusual clinical presentation, with the fortuitous diagnosis of a "carcinoma in situ" and to emphasize the role of routine genital examination when investigating patients with abdominal pain.

Isloated tubal torsion in a fourteen year old girl.

Isolated torsion of fallopian tube is a rare event and often difficult to diagnose. This report describes such a condition in a patient who presented with pain lower abdomen and underwent laproscopy primarily by surgeons with the suspicion of appendicitis but eventually ended up in right salpingectomy because of isolated right tubal torsion. The issue of future fertility was obviously considered but unfortunately the tube could not be preserved because of necrosis and haemorrhage inside it. Tubal torsion should however be kept in mind in the differential diagnosis of lower abdominal pain in women of all ages.

Uncommon cause of acute abdomen: volvulus of gallbladder with necrosis. Case report and review of literature.

Gallbladder volvulus is a rare condition which can mimic an acute cholecystitis. This condition is characterized from a rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. Preoperative diagnosis is difficult. This is an acute surgical emergency that must be treated with immediate detorsion and cholecystectomy. We report a case of acute gallbladder torsion in an elderly man and review the clinical aspects of the disease in the context of the available literature.

[Isolated fallopian tube torsion in a teenager--a case report]. / Izolowany skret jajowodu u nastolatki--opis przypadku.

Adnexal torsion belongs to the group of urgent cases in gynecology Early diagnosis and management can prevent the loss of an ovary and the Fallopian tube. The case of the 14.5-year-old girl was described by the authors. The symptoms were moderate and caused diagnostics problems. During clinical assessment current literature knowledge, differentiation and treatment of the adnexa were taken into account.

[Characteristics of hydronephrosis due to obstruction of the pyeloureteral segment combined with dorsal rotation of the kidney].

Rotation of the kidney is caused by its dystopia and abnormal blood circulation. Dorsal rotation of the kidney in normal position is a rare anomaly. We studied a clinical course, evidence obtained at renosonography, excretory urography, computed tomography, radionuclide investigation, anatomic variants of pyeloureteral segment obstruction in female patients with right-side hydronephrosis in the presence of dorsal rotation of the kidney before and after pyeloplasty. We made pyeloplasty for obstruction of the pyeloureteral segment in 266 patients in 2001-2009. Hydronephrosis was accompanied with dorsal rotation of the kidney in 21 (7.9%) cases. Surgical approaches to the pelviureteral segment are characterized. The dorsal approach is a good alternative to standard subcostal approach, provides good visualization in creation of anastomosis, significantly reduces distance from the skin cut to pyeloureteral segment and offers the best cosmetic result. In subcostal approach mobilization of the pelvis and pyeloureteral segment is preferable on the posterior surface of the kidney. A laparoscopic transperitoneal approach is not justified as it implies wide mobilization of the kidney, the anastomosis is created in extremely limited space.

Autoamputation of an ovarian cyst: a case report.

BACKGROUND: Torsion of adnexa usually manifests with severe abdominal pain and is treated as an acute surgical emergency. Asymptomatic torsion, necrosis and amputation of an ovary, and sometimes with other adnexal structures as well, are extremely rare. CASE: A 69-year-old Japanese woman presented to her practitioner complaining of dull lower abdominal pain. She was referred to us for presumed uterine tumor. Pelvic examination, ultrasonography and magnetic resonance imaging revealed a 7-cm, multicystic ovarian mass with solid component, and her serum CA125 and CA19-9 were elevated to 110.5 and 92 U/mL, respectively. Two months after the onset of abdominal pain, laparotomy was performed. In the cul-de-sac, the patient was found to have a mass with no ligamentous or direct connection with the pelvic organs. The right ovary seemed atrophic, with a rough surface. These findings were interpreted as an autoamputation of an ovarian cyst arising from the right ovary. CONCLUSION: Physicians should bear in mind the possibility of an autoamputated ovarian cyst even if the preoperative radiograph shows no calcification.

Torsion of a wandering spleen presenting as a case of acute abdomen.

Wandering spleen is a rare cause of acute abdomen. Generally, it remains asymptomatic, it may present clinically as a painless mobile mass or rarely as an acute abdomen when the wandering spleen twists on its pedicle, resulting in splenic congestion, infarction with or without involvement of neighbouring visceras. Here, we present an unusual case of torsion of a wandering spleen, which resulted in congestive splenomegaly and small bowel obstruction as a rare case of acute abdomen.

Primary torsion of the greater omentum: report of a case.

This is a case report of primary omental torsion that occurred in a 21-year-old man who presented with right lower quadrant abdominal pain. His provisional diagnosis was appendicitis. He was explored for appendicitis but the finding was twisted omentum.

Primary torsion of the greater omentum. An obscure and unusual cause of acute abdomen.

A 36-year-old man was admitted with a 3-day history of severe abdominal pain in the right upper abdomen and was initially diagnosed with acute cholecystitis or acute retrocecal appendicitis. The patient was transferred to the department of surgery for close surgical observation. CT of the entire abdomen was performed just before the operation, which demonstrated inflammation in the omental fat. Surgery revealed primary omental torsion and subsequent resection of the infarcted segment offered a rapid recovery. We report a case of primary segmental omental torsion and discuss the diagnostic and therapeutic implications of this unusual entity.

Bilobate wandering spleen with doble torsion of the vascular pedicle. A case report.

INTRODUCTION: Wandering spleen is a rare clinical condition which is often an incidental finding. It is characterized by excessive mobility and displacement of the spleen within the abdomen; although the spleen is usually of normal size it has an elongated vascular pedicle . CASE STUDY: We present the case of an adult woman who complaining of abdominal pain who was brought to our institution for emergency treatment. She later developed an acute abdomen due to infarction of a wandering spleen caused by double torsion of the vascular pedicle. Emergency splenectomy was performed. RESULTS: Surgical treatment of a wandering spleen is generally conservative and consists in splenoplexy. In our case, complicated by ischemia leading to irreversible damage of the spleen, splenectomy was the solution. DISCUSSION: The long vascular pedicle of a migrant spleen is at risk of torsion which can cause irreversible acute ischemia of the spleen. Therefore a timely diagnosis with the use of modern imaging techniques is of primary importance. CONCLUSIONS: Early interpretation of the symptoms and computed tomography angiography can prevent the complications that result from torsion of the elongated pedicle. KEY WORDS: Acute abdomen, Bilobate wandering spleen, Splenectomy.

Omental torsion mimicking acute appendicitis: a case report.

Primary omental torsion is an uncommon cause of an acute abdomen that can mimic acute appendicitis. Herein we report a case of suspected acute appendicitis that proved to be a distal segment of infarcted omentum secondary to primary torsion.

[Axial torsion and gangrene of Meckel's diverticulum: case report].

INTRODUCTION: Meckel's diverticulum (MD) is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients. CASE OUTLINE: An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with end-to-end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days. CONCLUSION: Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.

Isolated Fallopian Tube Torsion - A Challenge for the Timely Diagnosis and Treatment.

INTRODUCTION: Isolated torsion of the fallopian tube is a rare cause of acute lower abdominal pain and infrequent indication for surgical treatment. CASE OUTLINE: A 16-year-old girl was referred to the hospital due to the non-specific symptoms over period of a few months and pain acutization in the right infraumbilical region lasting for two days. Complete laboratory analyses were normal. Ultrasound examination revealed a round mass (23x14 mm) within the right fallopian tube with color Doppler whirlpool sign, normal ovary, and a simple ipsilateral paratubal cyst (50x40 mm). Laparoscopy showed a dilated and two times torquated right fallopian tube, as well as signs of chronic appendicitis. The tube was twisted about its longitudinal axis and it was livid, but not gangrenous. After appendectomy, fallopian tube was detorquated, cyst extracted and preservation of the tube was performed. Postoperatively, antibiotic therapy was administered based on antibiogram. On follow-up examinations within the next four months postoperative course was uneventful. CONCLUSION: Since there are no pathognomonic symptoms, clinical or laboratory findings, diagnosis of this condition is challenging. Familiarity with Doppler whirlpool sign can enable a timely diagnosis and treatment of isolated fallopian tube torsions. However, the diagnosis is rarely made before operation. Unlike in our case, surgery is often performed too late, and delay of intervention may result in failure to save the fallopian tube.

ANOMALOUS HEAD POSTURES IN STRABISMUS AND NYSTAGMUS DIAGNOSIS AND MANAGEMENT.

UNLABELLED: Abnormal head positions are adopted in order to improve visual acuity, to avoid diplopia or to obtain a more comfortable binocular vision. The head can be turned or tilted toward right or left, with the chin rotated up or downwards or combination of these positions. The ophthalmologic examination including the assessment of versions leads to the diagnosis. When versions are free, the cause may be congenital nystagmus or strabismus with large angle. When versions are limited we suspect paralytic or restrictive strabismus. The head tilted to one shoulder suggests cyclotropia (IV Nerve Palsy) or congenital nystagmus. We present few of the above cases. An adequate surgical treatment can improve or correct the ocular deviation, diplopia and the abnormal head posture. CONCLUSIONS: The abnormal head posture must be assessed and treated early in order to correct the ocular position and head posture. All patient presenting abnormal head position HAD TO BE investigated by an ophthalmologist.

Laparoscopic treatment of acute mesenteric torsion.

Acute torsion of the small bowel mesentery is a diagnostically challenging cause of acute abdominal pain, which most commonly afflicts pediatric patients with midgut malrotation. We describe a case of mesenteric torsion in an adult patient that had manifested as acute abdominal pain. The patient had a remote history of prior abdominal surgery, presenting on multiple occasions with undiagnosed acute intermittent abdominal pain. Diagnosis of mesenteric torsion was made by contrast enhanced CT and the ailment was successfully treated with laparoscopic surgery without recurrence.

[Volvulus of the gallbladder]. / Volvolo della colecisti.

The gallbladder volvulus is a very rare but extremely dangerous event. Described for the first time by Wendel in 1898, it affects more frequently the female sex, particularly in old age. The clinical case of a patient affected by this pathology, personally observed, is presented and the initial symptoms, diagnostic procedures and surgical intervention are described in detail. The anatomical and physiological backgrounds that permit the gallbladder to twist on its axis are analysed and finally the importance of an early diagnosis to avoid the complications of a bilious peritonitis is underlined. In any case the definite diagnosis is made more frequently during surgical intervention. An early intervention allows a rapid resolution of the clinical picture preventing the perforation of the viscus into the peritoneal cavity and the complication of a bilious peritonitis besides the spreading of the biliary stones into the abdominal cavity.