RESUMEN
Vascular pythiosis is a rare, neglected, life-threatening disease with mortality of 100% in patients with incomplete surgical resection or patients with persistently elevated serum ß-d-glucan (BDG). The study was conducted to understand the clinical outcomes of new treatment protocols and potential use of erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) as alternative monitoring tools, given recent favorable minimum inhibitory concentrations (MICs) of antibacterial agents and prohibitive cost of serum BDG in Thailand. A prospective cohort study of patients with vascular pythiosis was conducted between February 2019 and August 2020. After diagnosis, patients were followed at 0.5, 1, 1.5, 3, and 6 months. Descriptive statistics, Spearman's correlation coefficient, and general linear model for longitudinal data were used. Amongst the cohort of ten vascular pythiosis patients, four had residual disease after surgery. Among four with residual disease, one developed disseminated disease and died, one developed relapse disease requiring surgery, and two were successfully managed with antimicrobial agents. The spearman's correlation coefficients between BDG and ESR, and between BDG and CRP in patients without relapse or disseminated disease were 0.65 and 0.60, respectively. Tetracyclines and macrolides had most favorable minimum inhibitory concentrations and synergistic effects were observed in combinations of these two antibiotic classes. Adjunctive use of azithromycin and doxycycline preliminarily improved survival in vascular pythiosis patients with residual disease. Further studies are needed to understand the trends of ESR and CRP in this population.
RESUMEN
INTRODUCTION: Omental torsion is an unusual cause of acute abdominal pain. This condition may mimic other common pathologies, for instance, appendicitis or colonic diverticulitis. As a result, the diagnosis of omental torsion could be challenging to achieve preoperatively. PRESENTATION OF CASE: A 63-year-old male patient of secondary omental torsion accompanied by the left inguinal hernia was described. The patient presented to the hospital with a painful mass occupying in the left lower quadrant of his abdomen. A computed tomography scan with intravenous contrast administration demonstrated a whirling sign of intraabdominal fatty mass extending to the left inguinal canal. Therefore, emergency laparotomy was performed. Hemorrhagic infarction of the greater omentum was observed, and double-twisting points were identified at both ends of the greater omentum. Then, the strangulated omental portion was resected. The patient recovered uneventfully and was able to be discharged home on postoperative day 4. DISCUSSION: Secondary omental torsion has been reported more frequently than primary omental torsion. However, most of the patients were right-sided torsion. Precise diagnosis might not be possible by only clinical examination and plain abdominal radiography. The computed tomography scan, demonstrating classic whirling pattern, is useful in suspected cases. The treatment was straightforward by resection of the affected omentum. CONCLUSION: The omental torsion is a rare cause of acute abdominal pain and could mimic other intra-abdominal pathologies.
