Enteroaggregative and Enteroinvasive Escherichia coli as a Cause of Pediatric Acute Abdomen: A Report of Two Cases.

Abdominal pain stands as one of the foremost reasons for consultation among pediatric patients, presenting a diagnostic challenge owing to its diverse underlying causes. The manifestation of abdominal pain varies according to age, associated symptoms, and pain localization. While frequently self-limited, certain conditions exist that endanger life and require urgent intervention. Acute abdomen denotes severe, non-traumatic abdominal pain resulting from inflammatory, ischemic, obstructive, infectious, gynecological, or metabolic etiologies, warranting immediate therapeutic intervention.  Infectious processes that mimic acute abdominal conditions are relatively uncommon. Consequently, the identification of infectious gastroenteritis as a probable etiology of acute abdomen can prevent unnecessary surgical interventions in patients. This report details two cases: a 14-year-old pediatric patient presenting with acute abdominal pain, in whom appendiceal involvement was ruled out through ultrasonographic and computed tomography (CT) examinations, confirming the presence of enteroaggregative Escherichia coli, and a 10-year-old pediatric patient presenting with a sudden onset of abdominal pain. CT findings revealed an appendiceal fecalith without concurrent inflammation but accompanied by mesenteric adenitis. Even though conservative treatment did not improve the pain, it was later determined that the patient was a carrier of enteroinvasive E. coli. In both cases, antimicrobial treatment with rifaximin 200 mg every eight hours was administered, leading to the resolution of the conditions without the need for hospital readmission or additional therapy.  Infectious conditions stemming from enteroaggregative and enteroinvasive E. coli can mimic acute abdomen and should be regarded as potential infectious etiologies when other more common causes have been ruled out.

Bilateral Pregnancy Luteoma Presenting as Acute Abdomen in a Young Female: A Case Report.

Pregnancy luteoma (PL) is a rare, non-neoplastic ovarian lesion that can mimic malignant ovarian tumors, posing significant diagnostic challenges. PL typically presents as asymptomatic, unilateral, or bilateral ovarian masses and is often discovered incidentally. Its development is linked to hormonal fluctuations during pregnancy, particularly elevated human chorionic gonadotropin (hCG) levels. While PL generally resolves postpartum, complications such as torsion may necessitate surgical intervention. We report the case of a 23-year-old primigravida presenting with acute abdominal pain, vomiting, and abdominal distention at 13 weeks gestation. Imaging revealed large, bilateral multicystic ovarian masses. Elevated CA-125 levels raised suspicion for malignancy, leading to a laparotomy and bilateral oophorectomy. Histopathological analysis confirmed the diagnosis of pregnancy luteoma.

Gallstone ileus presenting in an elderly patient: A case report.

INTRODUCTION AND IMPORTANCE: Biliary ileus is a rare yet significant cause of mechanical intestinal obstruction, which occurs when a gallstone enters the gastrointestinal tract through a bilioenteric fistula, leading to intestinal blockage. This condition primarily affects elderly patients and is associated with high morbidity and mortality if not diagnosed and treated promptly. CASE PRESENTATION: We present the case of a 94-year-old female with a history of hypertension and chronic venous insufficiency. The patient was admitted with severe abdominal pain, nausea, and vomiting, with clinical findings suggestive of intestinal obstruction. Computed tomography revealed Rigler's triad, confirming the diagnosis of biliary ileus. An exploratory laparotomy was performed, identifying three gallstones in the small intestine. The patient underwent enterotomy for stone extraction and had a favorable immediate postoperative outcome. CLINICAL DISCUSSION: Biliary ileus presents a diagnostic challenge due to its nonspecific symptoms. While Rigler's triad (pneumobilia, intestinal obstruction, and ectopic gallstone) is diagnostic, it is not always apparent in imaging. Surgical intervention remains the standard of care for resolving the obstruction, though appropriate preoperative management and timely surgery are crucial for improving outcomes. CONCLUSION: This case emphasizes the importance of considering biliary ileus in the differential diagnosis of intestinal obstruction, particularly in elderly patients. Early surgical intervention is essential to prevent severe complications. Evidence based medicine ranking: Level IV.

Ileal intussusception due to heterotopic pancreas in the ileum: a case report.

Heterotopic pancreas (HP) is a rare condition where pancreatic tissue is found outside its usual location, usually within the gastrointestinal tract. While typically asymptomatic, HP can cause complications like gastrointestinal bleeding and intussusception, especially in adults, posing diagnostic and therapeutic challenges. A 31-year-old male presented with severe abdominal pain, nausea, and vomiting. Initial imaging revealed significant ileal and cecal wall thickening. Despite antibiotic therapy, his condition worsened, necessitating exploratory laparotomy. Intraoperative findings showed ileal intussusception near the cecum, leading to ileocecal resection and ileo-colic anastomosis. Pathological examination confirmed HP as the cause of intussusception. This case underscores the importance of considering HP in adult intussusception. Timely surgical intervention is critical to prevent severe complications. At a two-year follow-up, he remained symptom-free, highlighting the necessity for prompt diagnosis and management.

Perforated Jejunal Diverticulum Mimicking Diverticulitis: A Case Report of Acute Abdominal Pain in an Elderly Patient.

Jejunal diverticulosis is a rare form of diverticulosis characterized by acquired pseudodiverticula in the small bowel. Although most cases are asymptomatic, the condition can present diagnostic challenges due to its atypical presentation. Complications such as perforation can lead to acute abdomen, significantly increasing morbidity and mortality. We report a rare case of perforated jejunal diverticulitis in an 84-year-old female with a known history of diverticular disease. The patient presented to the emergency department with worsening left lower quadrant abdominal pain. A computed tomography (CT) scan revealed a focus of air adjacent to the mesentery, indicative of bowel perforation. An urgent exploratory laparotomy was performed, which identified a 4-cm perforated jejunal diverticulum. The affected segment of the small bowel was resected, followed by primary side-to-side jejunal anastomosis. The patient was discharged home in stable condition following uneventful postoperative recovery. This case highlights the importance of including jejunal diverticulosis in the differential diagnosis of acute abdomen, particularly in elderly patients with a history of diverticular disease. Due to the nonspecific presentation, prompt imaging is crucial for diagnosis. Surgical intervention is often necessary in cases of perforation. Increased clinical awareness of this rare condition may help reduce diagnostic delays and improve patient outcomes.

A Case Report of Axial Torsion of Meckel's Diverticulum: An Acute Abdomen Without Mechanical Bowel Obstruction in a Child.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is commonly silent but can cause multiple complications. The rarest presentation of Meckel's diverticulum is axial torsion around its base without involving the main gut lumen. This can lead to acute abdomen without bowel obstruction. Here we present a case of an eight-year-old boy who was found to have a huge Meckel diverticulum with axial torsion causing necrosis of the cyst without involving the bowel's main lumen. This paper discusses potential diagnostic and therapeutic pitfalls of the axial torsion of an MD.

Tuberculosis of gastrointestinal tract revealed by acute abdomen due to ileocecal perforation in an HIV-infected patient: A case report.

INTRODUCTION: Gastrointestinal tuberculosis (TB) is a rare condition, but it poses significant diagnostic and management challenges, especially in immunocompromised individuals. This case report discusses the diagnostic complexities and therapeutic strategies for managing gastrointestinal TB in an HIV-positive patient, emphasizing the importance of considering TB in differential diagnoses. CASE PRESENTATION: A 33-year-old male with no significant medical history presented with a five-day history of severe abdominal pain, initially epigastric and later localized to the right lower quadrant (RLQ). Physical examination revealed RLQ tenderness, and elevated inflammatory markers were observed in laboratory tests. Imaging studies suggested splenomegaly and signs consistent with acute appendicitis. Laparotomy uncovered a perforated cecal mass and diffuse white lesions across the small intestine. Histopathological analysis confirmed necrotizing granulomatous colitis, and PCR identified Mycobacterium tuberculosis (MTB). During hospitalization, the patient was diagnosed with HIV. CLINICAL DISCUSSION: This case underscores the diagnostic challenge of abdominal TB, particularly in HIV-infected patients where clinical presentation can mimic other conditions like Crohn's disease or appendicitis. Effective management requires timely surgical intervention, followed by appropriate anti-tuberculous and antiretroviral therapies. The multidisciplinary approach ensures comprehensive care and better patient outcomes. CONCLUSION: Effective recognition and diagnosis of gastrointestinal TB in HIV-positive patients are critical for successful treatment. This report highlights the necessity for heightened clinical suspicion and a collaborative approach in managing such complex cases, ultimately improving patient prognosis and care.

Small bowel obstruction on food impaction after binge eating.

Small bowel obstruction is a relatively prevalent surgical condition, with the most common underlying cause being postoperative adhesions. However, in patients with no previous history of abdominal surgery, one needs to think more outside the box. In this case study, we have a young and athletic man who presented to the emergency department with an acute abdomen, shortly after binge eating a large amount of food. Obstruction due to food impaction, such as in our case, should always be on the differential list, especially in those without significant medical history and with binge eating pattern where uncontrolled and extreme amounts of food are eaten alternating with restrictive dieting.

Torsion of Tubo-Ovarian Complex during Pregnancy: A Case Report.

Introduction: Adnexal torsion is characterised by the rotation of the ovary and, occasionally, the fallopian tube around their supporting ligaments by more than 45 degrees. It predominantly occurs during the first and second trimesters of pregnancy, with an incidence of up to 0.1% in the third trimester. Dermoid and functional ovarian cysts, most commonly associated with benign serous cystadenomas, are frequently identified among the torted adnexal masses. Case Presentation: We report the case of a 32-year-old primigravida with a known ovarian cyst diagnosed in the first trimester, which was managed conservatively throughout the pregnancy. At 36 weeks of gestation, she presented with abdominal pain and was subsequently managed with an emergency caesarean section at 37 weeks due to the development of an acute surgical abdomen. During the procedure, a torted left tubo-ovarian complex was excised, with partial preservation of the healthy-appearing ovarian tissue. Histopathological examination identified the mass as a benign serous cystadenoma. Conclusions: Ovarian torsion during pregnancy poses a significant diagnostic challenge. The decision between conservative management and surgical intervention is primarily guided by a high index of suspicion for torsion.

Malrotated subhepatic caecum with subhepatic appendicitis: Diagnostic dilemma: A case report.

INTRODUCTION: Acute appendicitis is among common surgical emergency. Subhepatic appendicitis is rare and difficult to diagnose and manage. There are few case reports across the world. CASE PRESENTATION: We presented a case of 7 year's old child with no known medical illness presented with acute onset vague abdominal pain experienced for three days. he was symptomatically treated as Acute gastroenteritis and dyspepsia later diagnosed with acute appendicitis and underwent laparotomy. He has malrotated subhepatic cecum with Subhepatic gangrenous appendicitis Open appendectomy done and discharged improved. CLINICAL DISCUSSION: Subhepatic appendicitis is a condition where the appendix is abnormally located in the upper right abdomen. This atypical placement often leads to delayed diagnosis and complications due to its similar symptoms to other abdominal diseases. While ultrasound is a valuable tool for diagnosis, laparoscopic appendectomy is the preferred treatment method when available. However, in resource-limited settings without laparoscopic capabilities, open surgery is necessary. CONCLUSION: Subhepatic appendicitis is a rare occurrence and its infrequent location makes it difficult to diagnose. Awareness of various location of appendix, a high index of suspicion and radiological imaging is required for prompt diagnosis and management. Appendicitis in subhepatic appendix and high up cecum creates a lot of confusion in both diagnosis and surgical exploration which may lead in complication and delay in treatment.

Early recognition of pain: improving colic outcomes in horses in Senegal.

Background: Limited knowledge exists on recognition and treatment of equine abdominal pain in low- and middle-income countries. This study aimed at finding indicators for recognizing abdominal pain, evaluating responses to clinical and behavioral changes, and assessing the impact of timely referral on colic outcomes in a suburban region of Senegal. The final goal was to identify factors that may be leveraged to improve the outcome of horses presented for abdominal pain in Senegal. Study design: Retrospective, observational cohort study. Methods: Data from 26 foals and 40 adult horses referred for acute abdomen between 2013 and 2014 and the first semester of 2023 were reviewed. Signs of abdominal pain were grouped into behavioral, posture modification and animal interactions with the environment. Time to referral was defined as the time between the recognition of abdominal pain and referral. The association of time to referral and the outcome was calculated for each subpopulation and compared using logistic regression analysis as appropriate. Results: A significant proportion of owners (47%) and veterinarians (77.8%) relied on behavioral changes to detect abdominal pain in foals. Most owners referred foals within 24 h, while veterinarians referred within 12 h. Mortality in foals exceeded 50% when referral was delayed by 12 h or more. In adult horses, groomers often were the first noticing behavioral changes (79%), and they referred the horse within three hours, whereas owners typically delayed referral for 24 h or longer, leading to increased hospitalization expenses. Limitations: The study considered a limited cohort in an suburban area of Senegal. Sourcing complete data was challenging. Additionally, accurately assessing owner experience was difficult due to the participant group's heterogeneity. Absence of a reliable system to measure daily horse-owner interaction time and logistical challenges in the abdominal pain symptom alert chain were also limiting factors. Conclusions: Early detection is critical for positive colic outcomes in both foals and adult horses. Therefore, raising awareness and providing training to horse owners for prompt recognition of symptoms and referral is essential. This proactive approach aims to improve overall outcomes and reduce the financial burden of equine hospitalization in Senegal.

Hereditary angioedema presented as isolated ascending and transverse colon swelling mimicking acute abdomen.

Hereditary angioedema (HAE) is a rare autosomal dominant condition characterized by C1-INH gene mutations, leading to recurrent angioedema episodes affecting various body parts, including the gastrointestinal tract. This case report describes a 24-year-old female presenting with symptoms mimicking an acute abdomen, characterized by severe abdominal cramps, anorexia, and diarrhea, with a significant past medical history of angioedema flares and emergency intubation for asphyxiation at age 11. Despite initial treatment with antihistamines showing no improvement, her symptoms spontaneously resolved. Further investigation revealed low complement C4 levels and reduced C1-INH function, confirming HAE with an unusual isolated involvement of the ascending and transverse colon. This case underscores the importance of considering HAE in patients presenting with acute abdominal symptoms, especially with a history suggestive of angioedema. It highlights the need for emergency physicians and gastroenterologists to be aware of HAE's clinical manifestations to avoid misdiagnosis and unnecessary interventions. Moreover, the case emphasizes the significance of patient education on recognizing symptoms and seeking timely medical attention to prevent severe complications. This report adds to the existing literature by detailing an uncommon presentation of HAE, aiming to enhance early diagnosis and management of this potentially life-threatening condition.

Laparoscopic Management of an Early Postoperative Pelvic Abscess Caused by Prevotella bivia Following a Deep Infiltrating Endometriosis Surgery.

Surgery for deep-infiltrating endometriosis (DIE) carries a high risk of complications, including pelvic abscesses. We would like to present the laparoscopic management of a pelvic abscess caused by Prevotella bivia following a radical hysterectomy in a DIE laparoscopic surgery. A 43-year-old G2P2 lady underwent a laparoscopic hysterectomy, bilateral ureterolysis, bilateral parametrial nodule extirpation, and rectal shaving following complaints of severe dysmenorrhea, dyspareunia, and chronic pelvic pain due to deep-infiltrating endometriosis (ENZIAN score: P2; 02/3; T2/2; A3; B3/2; C2; FA) (American Association of Gynecologic Laparoscopists (AAGL) score: 72, Stage 4). She received intravenous antibiotic treatment at the hospital with a diagnosis of pelvic inflammatory disease one month before the endometriosis surgery. After the extensive laparoscopic surgery, the early postoperative period was uneventful; however, starting on the fourth postoperative day, she was complaining of abdominal pain. On the seventh postoperative day, severe left-sided abdominal pain, fever, nausea, vomiting, rising levels of C-reactive protein (CRP > 200 mg/dL), and signs of septicemia were observed. The vaginal examination revealed a purulent discharge. Bacterial cultures were obtained from the vaginal cuff and peripheral vein. On the computerized tomography scan, neither a bowel nor ureter injury was found, but a pelvic abscess above the vaginal cuff and left ureteral compression below the pelvic brim were observed. Due to the clinical deterioration of the patient despite receiving piperacillin/tazobactam antibiotic therapy, the decision was made to perform a repeat laparoscopy to prevent septic shock and ureteral stent application for urinary tract obstruction. During the laparoscopy, purulent fluid was discovered around the pelvic peritoneum, and it was noted that the rectosigmoid colon was edematous and tightly adherent to the pelvic sidewalls. The rectosigmoid colon was carefully detached from the pelvic sidewalls; the left ureter was released, and the purulent abscess material from the vaginal cuff was aspirated. Every effort was made to remove as many yellowish plaques covering the pelvic peritoneum and rectum serosa as possible. Recovery following surgery was rapid. P. bivia was detected in the blood culture, and the patient was treated with piperacillin/tazobactam for an additional seven days, resulting in a complete resolution of the illness. Pelvic abscess is a rare but serious complication that can occur following laparoscopic deep-infiltrating endometriosis surgery. To prevent ending up with septicemia and septic shock, further laparoscopic surgery may be necessary.

Comparison of ultrasound assisted and intraoperative diameter measurement in acute appendicitis.

Detailed anamnesis and systematic physical examination are often relevant in the diagnostic routine of acute appendicitis. However, physicians are increasingly motivated to obtain radiological approval. Inherent limitations due to radiologists' experience and the presenting anatomy may result in contradictory outcomes between the described and intraoperative findings. In this study, a comparison of anthropometric measurements of the appendix vermiformis obtained by radiologists and surgeons in children with acute appendicitis is discussed. The external appendiceal diameter in 53 patients who underwent surgery between April 2022 and January 2024 was measured at three different anatomical locations during preoperative ultrasound and intraoperatively with the help of Vernier calipers. Appendectomy materials were classified into negative, acute, and complicated appendicitis subgroups on the basis of histopathological results. The widest median diameter, expressed in millimeters, was analyzed statistically in terms of diagnostic accuracy. Histopathological analysis revealed negative appendectomy in 15.1%, acute appendicitis in 66%, and complicated appendicitis in 18.8% of the patients. The median age at presentation was 11.4 years (4-17.3 years), and 45.3% of the patients were females. The average median appendiceal diameter was 7.8 ± 2.4 mm according to the caliper and 7.9 ± 2.7 mm according to ultrasound (p > 0.05). The evaluation by the caliper revealed a much smaller diameter in 19 patients than did ultrasound. The appendiceal diameter of eight documented negative appendectomy samples was 7 mm or greater. US failed to identify the presence of an appendicolith in 11 cases (20.8%), all of which were disclosed during histopathological evaluation. It is possible to conclude that ultrasound and intraoperative anthropometric measurements correlate according to our study. Diagnostic accuracy, however, which is individually based on ultrasound appendix diameter values greater than 6 mm, is controversial. It is clear that comparison and further reinterpretation of such anthropometric measurements in light of histopathological consequences may help diminish the frequency of negative and perforated appendectomies.

Sigmoid Perforation by an Ingested Foreign Body Mimicking Acute Appendicitis: A Case Report.

Lower abdominal pain is a common complaint for patients presenting for evaluation in the emergency department. Among other life-threatening complications, acute appendicitis needs to be ruled out in the case of right-lower quadrant pain (RLQ). Sigmoid perforation caused by an ingested foreign body is an uncommon cause of RLQ pain. This report presents the case of an otherwise healthy, 29-year-old male who presented to the emergency department with RLQ pain. His initial evaluation raised concern for acute appendicitis. However, during his exploratory laparoscopy, he was found to have a perforated sigmoid colon due to a skewer stick; the patient had no recollection of having ingested any foreign body. This paper highlights the importance of considering the possibility of sigmoid perforation by an ingested foreign body as a possible cause of RLQ pain. The article also reviews the most common causes of ingested foreign bodies, their potential complications and management.

Clinical and Epidemiological Profile of Patients Presenting With Acute Abdomen to the Emergency Department of a Tertiary Care Hospital.

BACKGROUND:  Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital. OBJECTIVE: To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen. METHODS:  This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management. RESULTS: The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001). CONCLUSION:  The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen.

Demographic, Clinical, Radiological, and Surgical Outcome of Patients with Intestinal Tuberculosis: A Single-Center Retrospective Study.

Background: Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome. Methods: This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed. Results: 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%). Conclusion: Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up.

Unmasking a Rare Cause of Acute Abdomen in Adults: A Case Report of an Infected Urachal Cyst.

The urachus is a remnant of the fetal duct that typically obliterates and becomes a fibrous cord after birth. However, in rare cases where this process fails, urachal cysts and other abnormalities can form, often remaining undiagnosed due to their asymptomatic nature. Infection is the primary complication and can be misdiagnosed due to the cyst's obscurity and varied presentations. Delayed diagnosis can lead to severe complications such as sepsis, fistula formation, and cyst rupture, potentially causing peritonitis. This paper discusses a 48-year-old male who consulted in the emergency department with acute abdominal symptoms, was diagnosed with an infected urachal cyst via imaging and successfully treated with antibiotics and subsequent surgical excision.

Clinical characteristics and risk factors for acute abdomen in patients with abdominal lymphatic malformations.

OBJECTIVE: The diagnosis of abdominal lymphatic malformations (ALMs) is often overlooked in clinical practice. However, reports in the literature about ALMs are limited to case reports/series with small sample sizes. This study aimed to review our currently available data to describe the clinical characteristics of ALMs and evaluate the risk factors for acute abdomen caused by ALMs. METHODS: We reviewed the records of patients with ALMs who were diagnosed between December 2008 and January 2023 in our institution. The associations between acute abdomen and ALMs were analyzed based on single-factor and multivariate logistic regression analyses. RESULTS: This study included 345 patients with pathologically confirmed ALMs, with a slight female predominance of 1:1.4. Approximately 39.1% (135/345) of patients were asymptomatic, and 24.6% (85/345) presented with acute abdomen. Among the ALMs in the cohort, 42.6% (147/345) were retroperitoneal lymphatic malformations (LMs). The maximal lesion dimensions in patients with acute abdomen and nonacute abdomen were 10.0 cm and 7.8 cm, respectively, with no significant difference based on multivariate analyses. Children were more likely to develop acute abdomen than adults were (P=0.002; odds ratio [OR], 5.128; 95% confidence interval [CI], 1.835-14.326). ALMs accompanying acute abdomen were more common for lesions involving the small intestinal mesentery (P=0.023; OR, 2.926; 95% CI, 1.157-7.400). CONCLUSION: ALMs are rare with insidious onset, and retroperitoneal LMs are the most common ALMs, followed by jejunal MLMs. Our retrospective analysis suggested that young age and small intestinal mesenteric lymphatic malformation are independent risk factors for acute abdomen with ALMs.

Diverticulitis aguda del intestino delgado como causa infrecuente de abdomen agudo en el adulto mayor: Reporte de caso / Acute diverticulitis of small bowel as rare cause of acute abdomen inthe elderly: Case report

Introducción. El dolor abdominal es uno de los principales motivos de admisión a urgencias y una de las causas más frecuentes es la enfermedad diverticular, que aumenta su prevalencia en el adulto mayor. Sin embargo, la diverticulitis del intestino delgado es una enfermedad infrecuente y en la mayoría de casos es asintomática. No obstante, la perforación de un divertículo intestinal es una complicación común de esta patología, por lo que debe ser considerado como un diagnóstico diferencial de abdomen agudo en este grupo poblacional. Caso clínico. Paciente masculino de 71 años, quien consultó por dolor abdominal de inicio súbito, con signos de irritación peritoneal al examen físico. Dado su deterioro hemodinámico fue llevado a cirugía y en la laparotomía exploratoria se halló una diverticulitis aguda perforada de yeyuno e íleon distal. Resultados. El paciente cursó con una adecuada evolución postoperatoria, sin reingresos. Conclusión. La diverticulitis aguda yeyuno-ileal es una causa importante, pero no frecuente de perforación intestinal. Hay muy pocos casos reportados en la literatura, lo que la convierte en un reto diagnóstico para el médico de urgencias y el cirujano general. No obstante, debe ser considerado como un diagnóstico diferencial en adultos mayores con abdomen agudo.

Introduction. Abdominal pain is one of the main reasons for admission to the emergency room and one of the most frequent causes is diverticular disease, which increases its prevalence in the elderly. However, diverticulitis of the small bowel is rare and in most cases asymptomatic. However, perforation of an intestinal diverticulum is a common complication of this pathology and should be considered as a differential diagnosis of acute abdomen in this population group. Clinical case. A71-year-old male patient presented with abdominal pain of sudden onset, with signs of peritoneal irritation. Given his hemodynamic deterioration, he was taken to surgery and in the exploratory laparotomy an acute perforated diverticulitis of the jejunum and distal ileum was found. Results. The patient had an adequate postoperative evolution, without readmissions. Conclusion. Acute jejuno-ileal diverticulitis is an important but uncommon cause of intestinal perforation. There are very few cases reported in the literature, which makes it a diagnostic challenge for the emergency physician and general surgeon. However, it should be considered as a differential diagnosis in older adults with acute abdomen.