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This case report discusses the clinical presentation, imaging findings, and successful management of a rare case of intussusception in a 6-month-old female infant referred to a regional hospital in Ghana. The patient presented with vomiting, lethargy, fever, and currant jelly stool. Differential diagnoses considered included Merkel diverticulum, volvulus, lymphadenopathy, and hypertrophic pyloric stenosis. Ultrasound imaging revealed a concentric lesion with characteristic signs of intussusception. Ileo-caeco coli intussusception was confirmed as the diagnosis. Surgical management was used for this patient. The postsurgery phase was without any complications. The patient recovered well and was discharged with a switch to oral medications. Infant intussusception is still a disease with a low morbidity rate.
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INTRODUCTION: Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non-adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes. MATERIAL AND METHODS: A literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case. RESULTS: The literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high-grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71-0.92) to 0.87 (95% CI 0.79-0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low-grade PAS and scar dehiscence on all scoring systems. CONCLUSIONS: Most published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non-adherent placenta from high-grade PAS with excellent diagnostic accuracy, but not for low-grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning.
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Introduction: Cavernous transformation of the portal vein, although a hepatic condition, may manifest with clinical features similar to those in patients with gastrointestinal pathologies. Particularly in young patients with no prior history of alcoholism or hepatic pathology, the diagnosis of cavernous transformation of the portal vein may be missed in an emergency setting where patients' reported symptoms may be mimicking those associated with bleeding peptic ulcer or other gastrointestinal pathologies. Case Report: We present a case of a 22-year-old male with no prior history of hepatic or pancreatic pathology who presented to the emergency room with some episodes of haematemesis, melena and slight dizziness, in whom a cavernous transformation of the portal vein was identified by abdominal duplex ultrasonography. Discussion: The clinical diagnosis of cavernous transformation of the portal vein can be challenging and easily missed especially in instances where a patient with no history of chronic alcoholism, liver cirrhosis, hepatoma, pancreatitis or prior abdominal surgery presents to the emergency room with haematemesis and anaemia. Ultrasonography presents as a reliable radiological tool in the diagnosis of rare and unforeseen conditions like cavernous transformation of the portal vein to allow for prompt management and prevention of adverse patients' outcomes. Conclusion: Abdominal duplex ultrasonography can reliably aid in the prompt diagnosis and management of patients with unforeseen rare hepatic pathologies such as cavernous transformation of the portal vein who present with upper gastrointestinal bleeding.
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In this review, we investigated the diagnostic value of the sonographic "whirlpool sign" in identifying ovarian torsion. This was done by performing a search in PubMed, Scopus, Embase, Web of Science, CINAHL, and Google scholar. Additional search for the grey literature was made in EThOS.bl.uk, explore.bl.uk, opengrey.eu, greylit.org, and clinicaltrials.org. A total of eight studies were included in this meta-analysis. Sensitivity and specificity of whirlpool sign were extracted from the studies and computed into the Metadisc statistical software for pooled analysis. The whirlpool sign showed a high sensitivity and specificity for the diagnosis of ovarian torsion.