ABSTRACT
When our patient presented emergently to labor and delivery at 18 weeks pregnant with severe right abdominal pain, the common diagnoses (such as appendicitis, cholecystitis, etc.) were on the top of the differential. However, US and MRI revealed a rarer cause of her pain, a pedunculated fibroid. The most important question then became whether this fibroid had torsed, which would require surgical intervention to prevent life-threatening sequelae. Unfortunately, presurgical imaging diagnosis of fibroid torsion in pregnancy is difficult. We offer a description of our patient's imaging findings, which align with other radiologic descriptions of fibroid torsion in pregnancy in the literature, to contribute to the radiologist's diagnostic confidence in this patient population.
ABSTRACT
Inguinal hernias containing the stomach are extremely rare, and have never been described in females. We are reporting the case of a 79 year old female who presented in septic shock with a left inguinal hernia containing the stomach, resulting in gastric perforation and loss of abdominal domain. She underwent emergency exploratory laparotomy with manual reduction of the hernia, wedge resection of the perforated gastric segment, abdominal washout, and closure of the abdominal fascia using biological mesh. She had a complicated but successful postoperative course, and was discharged to a rehabilitation center three weeks after hospital admission.
ABSTRACT
CONTEXT: Requests for laboratory testing are canceled after a specimen has already been collected from the patient for many reasons. Regardless of the cause, test cancellation represents a significant resource expenditure for laboratories, and many cancellation events impact patient care by delaying the reporting of test results. OBJECTIVE: To survey a wide variety of hospitals to determine the rate, causes, and circumstances surrounding laboratory test cancellation events. DESIGN: Institutions (N = 52) prospectively monitored their test cancellation events during a 6-week period or until 75 cancellation events occurred. Information regarding the test cancellation was recorded, including the primary reason for canceling the test. The rate of test cancellation was calculated based on laboratory specimen volume. Laboratory policies relevant to test cancellation were also surveyed. RESULTS: A total of 3471 canceled tests were recorded by participating laboratories of 1,118,845 specimens they accessioned, resulting in an aggregate test cancellation rate of 3.1 per 1000 accessions. The most frequently reported reason for test cancellation occurred in the preanalytical phase, and was a duplicate test request, followed by specimen quality reasons including hemolyzed/clotted specimens and insufficient sample quantity for testing. Very few cancellations occurred during the analytical phase of testing. Lower test cancellation rates were reported by larger institutions and by laboratories that received fewer specimens from inpatients. CONCLUSIONS: Cancellation of patient tests after a specimen had been collected and received remains a significant issue for clinical laboratories. Laboratories should monitor causes of test cancellation to identify targets for process improvement efforts and to improve laboratory utilization. Cancellation events due to incomplete identification or poor specimen quality potentially delay patient care. Cancellations due to duplicate orders or excessive frequency of testing represent operational challenges for the laboratory and inefficiency in the health care system. Policies related to test cancellation should be clearly specified and communicated to users of laboratory services.
