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1.
Med J Malaysia ; 76(2): 254-257, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33742640

RESUMO

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.


Assuntos
Abdome Agudo/cirurgia , /prevenção & controle , Colecistectomia , Colecistite/cirurgia , Laparotomia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Colecistite/diagnóstico , Colecistite/etiologia , Gangrena , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Equipamento de Proteção Individual
3.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500302

RESUMO

Salpingitis isthmica nodosa (SIN) is the nodular swelling or diverticulum of the isthmus of the fallopian tube. It is most commonly identified when investigating female infertility or in association with ruptured ectopic pregnancies. We experienced a rare and atypical presentation of SIN. A 33-year-old woman presented with a 1-hour history of acute lower abdominal pain associated with nausea and vomiting. CT and pelvic ultrasound revealed haemoperitoneum with no radiological evidence for its aetiology. Initial beta-human chorionic gonadotropin excluded ectopic pregnancy. A diagnostic laparoscopy was performed following clinical deterioration of the patient. Active bleeding of the right fallopian tube was identified and managed with a right partial salpingectomy, with subsequent histopathology revealing ruptured SIN. There have been no reported cases of SIN being a primary cause for an acute abdomen or haemoperitoneum in the absence of an ectopic pregnancy, making this case a surgical novelty.


Assuntos
Doenças das Tubas Uterinas/complicações , Hemoperitônio/etiologia , Salpingite/complicações , Abdome Agudo/etiologia , Adulto , Doenças das Tubas Uterinas/patologia , Doenças das Tubas Uterinas/cirurgia , Feminino , Humanos , Laparoscopia , Ruptura Espontânea , Salpingectomia , Salpingite/patologia , Salpingite/cirurgia
4.
Br J Radiol ; 94(1117): 20200383, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32822245

RESUMO

Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.


Assuntos
Corpo Lúteo/diagnóstico por imagem , Hemoperitônio/etiologia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico por imagem , Ultrassonografia/métodos , Abdome Agudo/etiologia , Diagnóstico Diferencial , Feminino , Hemoperitônio/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Imagem Multimodal , Tomografia Computadorizada por Raios X
5.
BMJ Case Rep ; 13(12)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361138

RESUMO

Heterotopic pregnancy (HP) is a rare, potentially life-threatening complication of an intrauterine pregnancy with a simultaneous ectopic pregnancy. There is a higher incidence with assisted reproduction techniques (ART) and radiology can be pivotal in its diagnosis. A 28-year-old woman underwent ART and at 7 weeks' gestation presented with acute right iliac fossa pain. Transvaginal ultrasound (US) imaging confirmed a viable intrauterine pregnancy. The patients' pain persisted however, and transabdominal US demonstrated a complex, heterogeneous right adnexal mass. Subsequent magnetic resonance imaging (MRI) confirmed an HP with a ruptured ectopic and haemoperitoneum. Emergency laparoscopic surgery and right salpingo-oopherectomy were performed without complication. We highlight the importance of considering HP as a diagnosis in the acute gravid abdomen, especially when initial investigations have confirmed a viable intrauterine pregnancy. Furthermore, this case highlights MRI as a useful modality in complex cases due to its high soft tissue contrast resolution using non-ionising radiation.


Assuntos
Abdome Agudo/diagnóstico , Anexos Uterinos/diagnóstico por imagem , Hemoperitônio , Imagem por Ressonância Magnética/métodos , Gravidez Heterotópica , Salpingo-Ooforectomia/métodos , Abdome Agudo/etiologia , Anexos Uterinos/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Gravidez , Resultado da Gravidez , Gravidez Heterotópica/diagnóstico , Gravidez Heterotópica/fisiopatologia , Gravidez Heterotópica/cirurgia , Técnicas de Reprodução Assistida/efeitos adversos , Ruptura , Resultado do Tratamento , Ultrassonografia/métodos
7.
Medicine (Baltimore) ; 99(37): e22063, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925740

RESUMO

RATIONALE: Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the spleen in its normal position. Due to abnormal attachment, the spleen is predisposed to torsion and a series of complications. Pediatric WS is mostly reported in children aged <10 years, especially among infants aged <1 year; it is uncommon among toddlers between 1 and 3 years. To the authors' knowledge, only seven cases of WS have been described previously. Herein, we present the case of a 3-year-old toddler with WS and splenic torsion. PATIENT CONCERNS: A 3-year-old boy was presented to the pediatric emergency room with a 2-day history of abdominal pain and vomiting. The ultrasonographic examination revealed a mass in the left upper abdomen cavity and absence of spleen in its normal position. Computed tomography showed an enlarged displaced spleen occupying the left abdomen cavity with an elongated splenic vascular pedicle (whirl sign), suggesting splenic torsion. DIAGNOSES: The patient was diagnosed that had WS and splenomegaly, with or without complications due to splenic torsion. INTERVENTIONS: The patient underwent emergency laparotomy and splenectomy due to nonviability after detorsion. OUTCOMES: The postoperative course was uneventful, and the patient was discharged on the 7th day postoperatively without complications. The patient had favorable outcome over a 1-year follow-up. LESSONS: Herein, we reported the case of a toddler with WS with splenic torsion. Moreover, after reviewing relevant studies in literature, we presented our findings on the diagnosis and treatment of toddlers with WS. Toddlers with WS are characterized by acute abdominal pain, unclear history description, examination restrictions, and high rates of life-threatening complications. High level of suspicion, careful physical examination, detailed history collection, and objective investigation are crucial in the management of toddlers with WS.


Assuntos
Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/etiologia , Baço Flutuante/complicações , Baço Flutuante/diagnóstico por imagem , Abdome Agudo/etiologia , Pré-Escolar , Humanos , Masculino , Esplenectomia , Esplenopatias/cirurgia , Tomografia Computadorizada por Raios X , Anormalidade Torcional/cirurgia , Ultrassonografia , Vômito/etiologia
8.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32805726

RESUMO

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Assuntos
Abdome Agudo , Infecções por Coronavirus , Tratamento de Emergência , Gastroenteropatias , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Operatórios , Abdome Agudo/diagnóstico , Abdome Agudo/epidemiologia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Idoso , Betacoronavirus/isolamento & purificação , Testes de Coagulação Sanguínea/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/tendências
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 421-437, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842420

RESUMO

Malignant tumor-associated acute abdomen refers to a non-perioperative acute abdominal disease caused by malignant tumors or caused by various anti-tumor treatments with acute abdominal pain as the main clinical manifestation. It is often critical and even life-threatening. For patients with malignant tumor-associated acute abdomen, the occurrence and development of tumors and the evolution of acute complications are often causal to each other. Therefore, diagnosis and treatment of malignant tumor-associated acute abdomen usually require the surgery-based multidisciplinary treatment (MDT). According to imaging features and access to medical resources, oncologists and surgeons, working with other relevant professional teams need to develop the most appropriate treatment strategy through hierarchical management based on different oncology assessments and treatment goals. Yet there is no consensus on diagnosis and treatment of malignant tumor-associated acute abdomen. Therefore, Chinese College of Surgeons, Chinese Society for Clinical Oncologists, Chinese Society of Multidisciplinary Team, and the Chinese Journal of Gastrointestinal Surgery gathered multidisciplinary experts in China to discuss and develop the Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen. This consensus consists of three parts, namely multidisciplinary diagnosis and evaluation, multidisciplinary prevention and treatment, and specific treatment of common malignant tumor-associated acute abdomen. The diagnosis and evaluation section mainly includes oncology, imaging diagnosis and surgical perioperative evaluation. The prevention and treatment section mainly includes the prevention of malignant tumor-associated acute abdomen, the principle of treatment based on surgery, anti-tumor therapy-induced acute abdomen, as well as the prevention and management of special biological types of malignant tumor-associated acute abdomen. The last part discusses specific treatment of malignant tumor-associated acute abdomen such as gastrointestinal obstruction (surgery, palliative care, endoscopic or interventional surgery), gastrointestinal perforation (perioperative and surgical treatment), gastrointestinal bleeding (medical treatment, endoscopic surgery, interventional surgery, and surgical treatment), biliary system-associated acute abdomen (treatment of acute cholangitis, acute cholecystitis, and gallbladder perforation), and rupture of liver cancer (general treatment, transarterial embolization, and surgical treatment). We hope this consensus will help clinicians to understand the multidisciplinary standardized diagnosis and treatment of patients with malignant tumor-associated acute abdomen and to serve as a practical reference.


Assuntos
Abdome Agudo/terapia , Neoplasias/complicações , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , China , Consenso , Humanos , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto
10.
Intern Med ; 59(12): 1565-1570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32536679

RESUMO

We herein report a 24-year-old male construction worker with occupational lead poisoning who presented with acute abdomen and normocytic anemia. The levels of urinary delta-aminolevulinic acid and free erythrocyte protoporphyrin were elevated without any increase in the level of urine porphobilinogen. Detection of an elevated blood lead level of 100 µg/dL confirmed a diagnosis of lead poisoning. Chelation therapy with calcium disodium ethylenediaminetetraacetate resulted in prompt improvement of the clinical symptoms and the blood lead level. Clinicians should be aware that lead poisoning caused by occupational exposure can still occur sporadically in construction workers in Japan.


Assuntos
Abdome Agudo/etiologia , Anemia/etiologia , Intoxicação por Chumbo/diagnóstico , Doenças Profissionais/diagnóstico , Abdome Agudo/sangue , Anemia/sangue , Humanos , Japão , Chumbo/sangue , Intoxicação por Chumbo/complicações , Intoxicação por Chumbo/terapia , Masculino , Doenças Profissionais/complicações , Doenças Profissionais/terapia , Adulto Jovem
12.
Ulus Travma Acil Cerrahi Derg ; 26(4): 632-634, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589246

RESUMO

Littre's hernia is a rare condition that involves Meckel's diverticulum in the hernia sac. Meckel's diverticulum is the true diverticulum of the small intestine. Neuroendocrine tumors may develop in it; however, there are very few reported cases. In this study, we present a case of neuroendocrine tumor in strangulated Littre's hernia, on which we did not find a study when we reviewed the relevant literature. A 71-year-old male patient presented to our outpatient clinic with complaints of left groin pain and swelling in the groin. Acute abdomen findings were also present in the abdominal examination of the patient. The patient was operated on immediately and it was observed during the operation that the herniated Meckel's diverticulum was perforated. Segmental small intestine resection was performed. The pathology results of the patient revealed a well-differentiated neuroendocrine tumor with mucosal and submucosal localization in Meckel's diverticulum. We believe that if Meckel's diverticulum is found in the hernia sac in incarcerated hernias, it must be completely resected as a neuroendocrine tumor may develop, even if only rarely.


Assuntos
Neoplasias Abdominais , Hérnia Abdominal , Divertículo Ileal , Tumores Neuroendócrinos , Abdome Agudo/etiologia , Idoso , Humanos , Masculino
15.
Tunis Med ; 98(2): 164-167, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32395808

RESUMO

INTRODUCTION: Intestinal duplications are rare malformations and hail sites are the most common. Today, the diagnosis is made in antenatal because of the performances of antenatal ultrasound. OBSERVATION: This was a 15-month-old male infant received for constant crying, vomiting and increased abdominal volume that had been evolving for two weeks. An abdominal ultrasound was performed and objectified an intraperitoneal cyst formation of 30 x 27 mm, surrounded by a stratified wall and contiguous to a digestive loop. Surgery was performed and confirmed the existence of non-communicating ileal duplication. CONCLUSION: Intestinal duplication is a rare malformation. Ultrasound is often sufficient for diagnosis based on the presence of a characteristic double-walled cystic mass.


Assuntos
Abdome/patologia , Cistos/diagnóstico , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico , Íleo/anormalidades , Doenças Peritoneais/diagnóstico , Abdome/diagnóstico por imagem , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/patologia , Abdome Agudo/cirurgia , Cistos/patologia , Diagnóstico Diferencial , Anormalidades do Sistema Digestório/cirurgia , Humanos , Íleo/cirurgia , Lactente , Masculino , Tamanho do Órgão , Doenças Peritoneais/patologia , Ultrassonografia , Vômito/diagnóstico , Vômito/etiologia , Vômito/cirurgia
16.
Orv Hetil ; 161(23): 977-979, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32453696

RESUMO

Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.


Assuntos
Peritonite/cirurgia , Abdome Agudo/etiologia , Adolescente , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Laparotomia , Masculino , Peritonite/diagnóstico , Choque Séptico/tratamento farmacológico
20.
JAAPA ; 33(5): 28-30, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32345945

RESUMO

Evaluating patients for abdominal pain is common in the ED and can involve many differential diagnoses and treatment options. This case report describes a 35-year-old active duty military man whose abdominal pain evaluation at a military treatment facility led to the diagnosis of epiploic appendagitis.


Assuntos
Abdome Agudo/etiologia , Colite/complicações , Tratamento Conservador/métodos , Manejo da Dor/métodos , Doenças do Colo Sigmoide/complicações , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/tratamento farmacológico , Acetaminofen/uso terapêutico , Adulto , Colite/diagnóstico , Colite/tratamento farmacológico , Humanos , Hidromorfona/uso terapêutico , Cetorolaco/uso terapêutico , Masculino , Naproxeno/uso terapêutico , Doenças do Colo Sigmoide/diagnóstico por imagem , Doenças do Colo Sigmoide/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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