A Gallbladder Volvulus Presenting as Acute Cholecystitis in a Young Woman.

Gallbladder volvulus is rare and known to occur when there is a rotation of the gallbladder along the axis of the cystic vascular pedicle. Except for isolated cases reported in childhood, this disease is more frequently encountered in the elderly, especially in women. Therefore, most cases in the literature describe the clinical and radiographic features of gallbladder volvulus in this age group. In this subject, manifestations of abdominal pain are variable. Typically, right upper quadrant pain leads towards the diagnosis of cholecystitis, and diagnosis may be performed on imaging such as computed tomography (CT) scan with multi-plane CT reconstruction. However, preoperative diagnosis of gallbladder torsion remains difficult, and in most cases, especially in young women where it is rare, the clinical and radiographic features seem to differ from gallbladder torsion in the elderly. We report a case of gallbladder volvulus in a 26-year-old woman and review the clinical and radiological aspects of this disease.

Intestinal Obstruction due to Acute Appendicitis.

Acute appendicitis has been proven to be a usual cause of mechanical small bowel obstruction since 1901, but there has been very little specific research on this subject. It usually occurs as an effect of adhesion because of periappendicular inflammation. Although previous studies exist, this presentation of acute appendicitis is not widely identified, which might lead to delays in making the right diagnosis and initiating treatment. We herein report a 17-year-old male patient who presented with the clinical manifestations of intestinal obstruction and fever for 3 days. Preoperative ultrasound and subsequent computed tomography were performed. On laparotomy, an obstructed bowel was seen, and the appendix was recognized to be the cause. We herein report a case of intestinal obstruction due to acute appendicitis and present an overview of the literature.

An Unusual Case of Obturator Hernia Detected in an Elderly Man by Computed Tomography.

Obturator hernia is a rare condition, characterized by the herniation of an intestinal segment between the obturator and the pectineus muscles through the obturator foramen. Obturator hernias usually occur in the elderly and are less common in males than in females, with a male-to-female ratio of about 1/14. In recent years, the use of diagnostic imaging, especially CT, to determine the causes of intestinal obstruction has been improved to allow for an early and accurate diagnosis, even of obturator hernias, which are extremely rare in male patients. We report a thin elderly man, without a history of surgery and with chronic constipation and an unremarkable Howship-Romberg sign, which was correctly diagnosed before surgery as an obturator hernia using CT.

Post-Blunt Traumatic Hemobilia From Pseudoaneurysm Successfully Treated With Embolization.

Hemobilia is an uncommon but serious complication of traumatic liver injury. Diagnosis can be difficult because the presentation of gastrointestinal (GI) bleeding may be minimal or massive, and its delay is quite variable, ranging from a few days to several months. Radiologic evaluation, including ultrasound, CT, endoscopic retrograde cholangiopancreatography, and angiography, can be used for the diagnosis. Once the clinical presentation and diagnosis are considered, diagnostic and therapeutic arteriography must be performed as soon as possible. Here, we present a case of hemobilia two weeks postoperative for blunt traumatic liver injury in a 13-year-old boy who was treated successfully by N-butyl 2-cyanoacrylate (NBCA) embolization of the pseudoaneurysm.

Percutaneous Ultrasound-Guided Access to the Superior Ophthalmic Vein for Embolization of a Cavernous Sinus Dural Arteriovenous Fistula.

The treatment of symptomatic cavernous sinus dural arteriovenous fistula, an unusually occluded cavernous sinus, is by a transvenous approach through the inferior petrosal sinus and superior ophthalmic vein. If these two modes of conventional transvenous access are not possible, surgical exposure and/or direct puncture access to the superior ophthalmic vein or cavernous sinus have been previously described. In a patient with progressive ophthalmological problems, the goal of treatment is to not only cure the ophthalmic symptoms but also to conserve or improve visual acuity, so treatment is needed as soon as possible. We report a 68-year-old woman suffering a Barrow type D cavernous sinus dural arteriovenous fistula. In this case, inadequate, inferior petrosal sinus embolization and lack of access for superior ophthalmic vein via a facial vein preceded percutaneous puncture under sonographic guidance of the superior ophthalmic vein. This permitted venous occlusion without complications and symptom-free for 11 months.