[Internalherniationof colon ascendens and terminal ileumthrough the foramenof Winslow].

This is a case report of a 90-year-old woman with non-specific, upper abdominal pain, nausea, vomiting, and normal laboratory results. An ultrasound scan of the abdomen showed no sign of cholelithiasis or cholecystitis. Due to persisting pain a CT was performed, and it showed an internal herniation of caecum, terminal ileum and colon ascendens through the foramen of Winslow. An explorative laparotomy was performed with a gentle retraction of the involved bowels, without any resection.

Chronic Pain, Quality of Life and Functional Impairment After Emergency Laparotomy.

BACKGROUND: Emergency laparotomy is a high-risk procedure with increased morbidity and mortality rates. The long-term outcomes are poorly investigated.The aim was to describe the frequency of chronic postsurgical pain (CPSP), pain-related functional impairment, to evaluate the gastrointestinal quality of life (QoL) and identify risk factors for CPSP after emergency laparotomy. METHOD: A questionnaire study was conducted from Copenhagen University Hospital Herlev. Population area: 435.000. Patients undergoing emergency midline laparotomy from May 2009-May 2013 and June 2014-November 2015 were included. The survey consisted of five parts exploring the extent of acute and chronic postsurgical pain. Pain-related functional impairment and quality of life were measured using the activity assessment scale and the gastrointestinal quality of life questionnaire, respectively. Primary outcomes were rates of CPSP and pain-related functional impairment. Gastrointestinal QoL was compared between patients with or without CPSP. Multivariate regression analysis was performed to estimate risk factors for CPSP. RESULTS: The primary emergency laparotomy population consisted of 1573 patients. A total of 605 patients were eligible for inclusion, and 440 patients completed the survey. Response rate: 73%. Median age was 69 years (range 18-95), 56.4% female. Median follow-up was 60 months (IQR 47). 19% (85/440) experienced CPSP and had low gastrointestinal QoL. We identified APSP OR 5.0 95%CI (2.4-10.5), p < 0.01 and age < 60 OR 2.1 95%CI (1.2-3.8), p = 0.01 as independent risk factors for CPSP. 45% (199/440) of all patients experienced moderate-severe functional impairment. CONCLUSION: CPSP (19%) and low gastrointestinal QoL were common after emergency laparotomy and almost every second patient had moderate-severe functional impairment on long-term follow-up.

[Diet consisting mainly of sunflower seeds and chicken as the cause of small bowel obstruction in a bodybuilder].

Diet-induced small bowel obstruction is a rare condition in young, healthy patients. We describe a case of a 26-year-old man, who presented with acute small bowel obstruction. During a period of eight days prior to admission the patient had been eating an extremely restricted diet along with a regulated intake of fluids. The diet was part of a preparation for a major fitness contest. We chose a conservative treatment of IV fluids and laxatives, and the patient recovered uneventfully.

[Ectopic varices in the terminal ileum causing gastrointestinal bleeding]. / Ektopiske varicer i den distale ileum som årsag til gastrointestinal blødning.

Varices of the terminal ileum are not a common complication to portal hypertension but we describe a case where a 60-year-old male patient had massive, recurrent intestinal bleeding due to collateral blood supply from umbilical veins to varicose veins of the terminal ileum.

Use of 'non-medical' ultrasound imaging before mid-pregnancy in Copenhagen.

We have investigated prospectively how many pregnant women purchase ultrasound imaging before week 20, why they purchase scans, and which professional skills and certifications women expect the person performing the scan to have. In addition, we wanted to investigate whether the women were aware of any professional authorization procedures. Women attending the second trimester malformation scan of the Danish Prenatal Screening Program (n = 645) filled in a questionnaire about their use of non-medical ultrasound scans. Of these women, 154 (24%) had bought ultrasound scans: 50% wanted to have the fetal health and development checked and 49% wanted to find out the gender of the fetus. In addition, 68% felt that they received an evaluation of the fetal health state and 58% believed that there was legislation demanding a professional authorization needed to perform ultrasound imaging. This study shows that there is a significant demand among pregnant women for commercial ultrasound imaging of their fetus for various reasons. Knowledge of certifications and requirements for legal authorization is, however, sparse.

[Giant xanthomas of all four extremities as a result of hyperlipidaemia in a 24-year-old]. / Ekstreme xantomer på alle ekstremiteter som følge af hyperlipidæmi hos en 24-årig.

A young male had giant xanthomas of all four extremities. We chose surgical treatment and as a result he was able to wear shoes again. Aggressive treatment of xanthomas and the underlying heart disease is essential in treating young patients.