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1.
Medicine (Baltimore) ; 99(5): e18884, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000391

RESUMO

INTRODUCTION: Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient. PATIENT CONCERNS: A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain. DIAGNOSIS: Infected urachal cyst. INTERVENTIONS: The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization. OUTCOMES: The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery. CONCLUSION: We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.


Assuntos
Abdome Agudo/etiologia , Cisto do Úraco/diagnóstico por imagem , Abdome Agudo/diagnóstico por imagem , Pré-Escolar , Humanos , Masculino , Cisto do Úraco/complicações , Cisto do Úraco/patologia , Cisto do Úraco/cirurgia , Úraco/patologia
2.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676053

RESUMO

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Assuntos
Colectomia/métodos , Hemorragia Gastrointestinal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Anastomose Cirúrgica , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Perfuração Intestinal/fisiopatologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Prognóstico , Medição de Risco , Resultado do Tratamento
3.
Prensa méd. argent ; 105(10): 678-679, oct 2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1025946

RESUMO

Diagnostic laparoscopy is a surgical diagnostic procedure used to examine the organs inside the abdomen by mean of an optic fiber. The patient with acute abdominal pain and with a not clearly etiology, can represent a great challenge at the moment to perform a definitive diagnosis at urgency. The paraclinic studies must be required considering the particular characteristics of each patient and its clinical presentation at the moment of the medical attention. Considering the more frequent indications for the laparoscopic approach, the diagnostic laparoscopy, occupies the third place after the acute appendicitis and the acute cholecistitis. The aim of this report was to consider a casuistic of 356 patients with acute abdominal pain of uncertain etiology, studied by the authors. Of these patients, the 88% were females. From the rsults obtained, it becomes evident that the video diagnostic laparoscopy proved to be an effective technique in the emergency department with benefit for the patients, mainly for acute cases


Assuntos
Humanos , Epidemiologia Descritiva , Estudos Retrospectivos , Laparoscopia/reabilitação , Emergências , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/terapia
4.
J Radiol Case Rep ; 13(5): 10-14, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31558954

RESUMO

Both epiploic appendagitis and femoral herniae are rare diagnoses individually. No radiological cases of a patient having epiploic appendagitis within a femoral hernia have been documented in the literature. We present a case of a 65-year-old patient who underwent clinical work-up for a tender left groin lump. When undergoing a CT scan for investigating possible lymphadenopathy, she was found to have epiploic appendagitis contained within an incarcerated left sided femoral hernia. In this case report, we review the relevant anatomy, aetiology, patient demographics, as well as clinical and imaging findings and management.


Assuntos
Hérnia Femoral/diagnóstico por imagem , Abdome Agudo/etiologia , Idoso , Colite/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Magy Seb ; 72(3): 112-114, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544481

RESUMO

Introduction: Lymphomas are rare entities in the gastrointestinal tract. The so-called Burkitt-like lymphoma belongs to the non-Hodgkin lymphoma group, and it is quite an aggressive, rapid-growing, but potentially curable disease. Surgeons mostly encounter with this tumor as a solid mass which causes abdominal pain, or as a cause of bowel obstruction or perforation. Our aim was to present a case, when Burkitt-like lymphoma caused acute abdominal symptoms without alarming complaints, obstruction or perforation. Furthermore we review and summarize the relevant literature data on this topic. Regarding our case we can claim that histological investigation and multidisciplinary approach are essential to make the diagnosis and to start the treatment as early as possible.


Assuntos
Abdome Agudo/etiologia , Linfoma de Burkitt/patologia , Dor Abdominal/etiologia , Humanos , Obstrução Intestinal/etiologia
6.
BMC Surg ; 19(1): 132, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500608

RESUMO

BACKGROUND: Foreign body ingestion is a scenario occasionally encountered in the emergency room. Pediatric and psychiatric patients are the two most common populations suffering from accidental or in some cases intentional ingestion of foreign bodies. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Less than 1% of the cases complicates with gastrointestinal tract perforation, which are often caused by sharp objects, which warrants surgical intervention. The average time from foreign body ingestion to development of perforation was noted at 10.4 days in previous reports. These cases often present in rapidly progressing peritonitis and are subsequently managed by emergent laparotomy. In this case report, we describe an accidental chopstick ingestion of a patient who initially was misdiagnosed and remained asymptomatic for nine months, then presented with acute abdomen. CASE PRESENTATION: A 27-year-old man accidentally ingested a wooden chopstick and sought consult at a clinic. Negative abdominal plain film misled the physician to believe ingested chopstick was digested into fragments and passed out unnoticed. The patient presented acute abdomen caused by duodenal perforation nine months later and was subsequently treated with emergency laparotomy with primary duodenorrhaphy. CONCLUSIONS: Negative plain films are not sufficient to conclude a conservative treatment in foreign body ingestion. Computed tomography scan or endoscopic examinations should be done to rule out retained foreign body within gastrointestinal tract.


Assuntos
Abdome Agudo/etiologia , Corpos Estranhos/complicações , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Abdome Agudo/cirurgia , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Serviço Hospitalar de Emergência , Endoscopia/métodos , Humanos , Masculino , Radiografia , Tomografia Computadorizada por Raios X
7.
Pan Afr Med J ; 33: 51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448014

RESUMO

Typhoid fever and tuberculosis, considered rare diseases in western countries, is still considered a notable problem of health issue in developing countries. The gastrointestinal manifestations of typhoid fever are the most common and the typhoid intestinal perforation (TIP) is considered the most dangerous complication. Abdominal localization of tuberculosis is the 6th most frequent site for extra pulmonary involvement, it can involve any part of the digestive system, including peritoneum, causing miliary peritoneal tuberculosis (MPT). This is the case report of a 4 years old girl with multiple jejunal perforations in a setting of contemporary miliary peritoneal tuberculosis and typhoid fever occurred in "Hopital Saint Jean de Dieu" in Tanguietà, north of Benin. The patient was admitted in the emergency department with an acute abdomen and suspect of intestinal perforation, in very bad clinical conditions, underwent emergency laparotomy. The finding was a multiple perforations of the jejunum in a setting of combined abdominal typhoid fever and miliary peritoneal tuberculosis. Typhoid intestinal perforations and peritoneal tuberculosis are a very rare cause of non-traumatic peritonitis in western country, but still common in developing country. Considering the modern migratory flux and the diffusion of volunteer missions all around the world, the western surgeon should know this pathological entities, and the best treatments available, well known by surgeons with experience of working in developing countries. The combination of both TIP and MPT in the same patient, is a very rare finding which can worsen the outcome of the patient itself.


Assuntos
Perfuração Intestinal/diagnóstico , Peritonite Tuberculosa/diagnóstico , Tuberculose Miliar/diagnóstico , Febre Tifoide/diagnóstico , Abdome Agudo/etiologia , Benin , Pré-Escolar , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Jejuno/patologia , Laparotomia/métodos , Peritonite Tuberculosa/complicações , Tuberculose Miliar/complicações , Febre Tifoide/complicações
8.
Rozhl Chir ; 98(8): 328-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462056

RESUMO

Surgical treatment of gastrointestinal solid tumors is the basic method with a curative potential. However, the first-line treatment modalities in lymphomas are systemic oncology therapy (chemotherapy, immunotherapy and hematopoietic stem cell transplantation), radiotherapy or their combination. Surgery in lymphomas is predominantly associated with acute disease and dominantly, surgery is still used mainly in diagnosing lymphomas. Acute abdomen associated with lymphoma can be divided into 3 groups: bleeding, obstruction and perforation of GIT due to lymphoma. All these conditions might be caused by both gastrointestinal (extranodal) lymphomas or advanced nodal lymphomas that directly infiltrate or compress gastrointestinal tract (GIT) as well. Perforation is also often associated with the effect of systemic chemotherapy administration. When treating acute abdomen conditions caused by lymphomas, multidisciplinary cooperation with all participating experts is necessary. From the surgical point of view, minimizing the risk of postoperative complications is crucial to ensure the possibility of early systemic oncological treatment administration.


Assuntos
Abdome Agudo , Neoplasias Gastrointestinais , Linfoma , Abdome Agudo/etiologia , Abdome Agudo/terapia , Neoplasias Gastrointestinais/complicações , Humanos , Linfoma/complicações
9.
BMC Surg ; 19(1): 73, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266494

RESUMO

BACKGROUND: Diagnosis and management of acute abdomen secondary to systematic lupus erythematosus (SLE) has always been a clinical challenge. CASE PRESENTATION: A 21-year-old lady, with BMI 17.7, presented to our department with acute abdomen. Laparoscopy was carried out to exclude surgical emergency when conservative regimen failed. The patient revealed a history of purpuric changes and lupus test was positive for SLE. CONCLUSION: Based on our experience, early laparoscopy to alleviate acute abdomen has shown to improve the prognosis of the patient.


Assuntos
Abdome Agudo/diagnóstico , Abdome Agudo/cirurgia , Ascite/etiologia , Lúpus Eritematoso Sistêmico/complicações , Mesentério/irrigação sanguínea , Vasculite/cirurgia , Abdome Agudo/tratamento farmacológico , Abdome Agudo/etiologia , Administração Intravenosa , Administração Oral , Antirreumáticos/administração & dosagem , Ascite/diagnóstico por imagem , Ascite/tratamento farmacológico , Ascite/cirurgia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hidroxicloroquina/administração & dosagem , Laparoscopia , Mesentério/diagnóstico por imagem , Metilprednisolona/administração & dosagem , Prognóstico , Vasculite/diagnóstico por imagem , Vasculite/tratamento farmacológico , Vasculite/etiologia , Adulto Jovem
10.
Rev Gastroenterol Peru ; 39(2): 171-174, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31333235

RESUMO

Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.


Assuntos
Abdome Agudo/diagnóstico , Anisaquíase/diagnóstico , Abdome Agudo/etiologia , Idoso , Diagnóstico Diferencial , Emergências , Serviço Hospitalar de Emergência , Feminino , Humanos
11.
Dan Med J ; 66(7)2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256781

RESUMO

INTRODUCTION: Although not supported by evidence, there may be a risk of overlooking pathological findings at patients' return visit after emergency admission for non-specific abdominal pain (NSAP). The primary aim of this study was to evaluate the risk of missed acute pathology in patients primarily discharged with NSAP and re-admitted within three months. METHODS: This was a retrospective review of hospital records within a three-month period (1 September-30 November, 2014) in a university hospital with unrestricted referral of abdominal emergency patients. Patients fulfilling the criteria for NSAP were included in the study. RESULTS: Among the 1,474 patients admitted with acute abdominal pain, 390 (26%) were discharged with NSAP; 16% of the patients who were discharged with NSAP were re-admitted for abdominal pain. At their return visit, 39% received a verified specific diagnosis, corresponding to 6% of all patients with the NSAP diagnosis. A total of 40% of the early re-admissions of patients with NSAP were related to the biliary tract (cholelithiatis, cholangitis and cholecystitis). Co-morbidity, nausea, vomiting and increased white blood cell count at the primary admission were significantly associated with a risk of missing a specific diagnosis (p < 0.05). CONCLUSIONS: This study found that only 6% of the patients who were admitted for acute abdominal pain and were discharged with no diagnosis had a somatic condition. However, risk of pathological findings at the return visit was relatively high among patients discharged with NSAP. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Abdome Agudo/diagnóstico , Dor Abdominal/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Abdome Agudo/etiologia , Abdome Agudo/terapia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adulto , Dinamarca , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exame Físico , Recidiva , Encaminhamento e Consulta , Estudos Retrospectivos
12.
Pan Afr Med J ; 32: 70, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223361

RESUMO

Ophidian envenomations are a public health problem in Africa, causing 20.000 annual deaths. This mortality reflects the difficulties in the management of these complications, in particular of bleeding complications. We report the case of Mr SL, aged 35 years, farmer, victim of snake bite causing haemorrhagic syndrome followed by a progressive onset of acute abdomen. Ultrasound objectified high abundant effusion. Effusion puncture was performed which showed unclotting blood. Given the re-establishment of the hemoperitoneum after three doses of antivenin serum as well as the coagulation of the samples collected using drying tube, exploratory laparotomy was performed on day 9. It showed retroperitoneal hematoma, with bulging appearance, in the mesocolon which flowed in the peritoneal cavity. Aspiration of 1500ml of blood and rinsing with physiological serum were performed. The postoperative course was uneventful. The patient was transferred to the department of surgery three days after surgery and was discharged on day 19.


Assuntos
Antivenenos/administração & dosagem , Hematoma/etiologia , Mordeduras de Serpentes/complicações , Abdome Agudo/etiologia , Abdome Agudo/terapia , Adulto , Hematoma/cirurgia , Hemoperitônio/etiologia , Hemoperitônio/terapia , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Recidiva , Espaço Retroperitoneal
15.
BMJ Case Rep ; 12(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092482

RESUMO

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!


Assuntos
Migração de Corpo Estranho/diagnóstico , Íleo/cirurgia , Perfuração Intestinal/cirurgia , Reto/cirurgia , Abdome Agudo/etiologia , Migração de Corpo Estranho/cirurgia , Humanos , Íleo/diagnóstico por imagem , Fístula Intestinal/diagnóstico , Fístula Intestinal/terapia , Perfuração Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/métodos , Reto/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Medicine (Baltimore) ; 98(20): e15491, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096449

RESUMO

RATIONALE: Uterine rupture is a rare incidence but can lead to catastrophic maternal and fetal consequences. We still need to place a high premium on these cases. PATIENT CONCERNS: The patients all showed hemodynamic shock with complaints of serious pain in the abdomen. They all had a history of laparoscopy or hysteroscopy procedures. DIAGNOSES: Case 1 and 2 were diagnosed during surgery. Case 3 was diagnosed by an urgent abdominal ultrasonogram before surgery. INTERVENTIONS: We performed emergency surgeries for the 3 cases. OUTCOMES: Three patients all recovered well. But only the child in case 2 survived. LESSONS: It must be emphasized that pregnant women with a history of such surgeries should be aware of uterine rupture during pregnancy.


Assuntos
Histeroscopia/efeitos adversos , Laparoscopia/efeitos adversos , Choque/etiologia , Ruptura Uterina/etiologia , Útero/patologia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Placenta Acreta/patologia , Gravidez , Gravidez Ectópica/epidemiologia , Choque/diagnóstico , Resultado do Tratamento , Ultrassonografia/métodos , Ruptura Uterina/diagnóstico por imagem , Ruptura Uterina/patologia , Útero/diagnóstico por imagem , Útero/cirurgia
17.
J Med Case Rep ; 13(1): 126, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31029142

RESUMO

INTRODUCTION: Primary peritonitis without an identifiable intra-abdominal source is extremely rare in healthy individuals; it is commonly seen in cases of nephrotic syndrome, cirrhosis and end-stage liver disease, ascites, immunosuppression, and inflamed peritoneum due to pre-existing autoimmune and oncological conditions. CASE PRESENTATION: We present the case of a 68-year-old Caucasian woman operated on due to acute abdomen with a provisional diagnosis of acute appendicitis. During the operation a small amount of free intra-abdominal fluid was found. Her uterus, ovaries, and fallopian tubes were macroscopically normal. Therefore, with the suspicion of appendicitis, appendectomy was performed. Her blood cultures were negative while peritoneal fluid was positive for capsulated form of Streptococcus pneumoniae. A 30-day follow-up was performed and she was asymptomatic without any sign of infection. DISCUSSION: Streptococcus pneumoniae commonly causes upper respiratory tract infection and cutaneous infections. It very rarely causes gastrointestinal infection and it is very rarely responsible for primary peritonitis and septic shock syndrome. CONCLUSION: Pneumococcal peritonitis has a rare occurrence and represents a clinical challenge because of its subtle and non-specific clinical findings. The interest in our case lays in the relatively rare diagnosis of primary peritonitis mimicking acute appendicitis.


Assuntos
Peritonite/etiologia , Pneumonia Pneumocócica/complicações , Abdome Agudo/etiologia , Idoso , Apendicite/diagnóstico , Diagnóstico Diferencial , Humanos , Imunocompetência , Peritonite/diagnóstico , Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/isolamento & purificação
19.
Ugeskr Laeger ; 181(10)2019 Mar 04.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30869072

RESUMO

Pelvic inflammatory disease (PID) is a frequent cause of acute abdomen among sexually active females, although rarely seen in girls prior to their sexual debut. In this case report, a 12-year-old girl was hospitalised due to abdominal pain. She was virgo and premenarcheal. A laparoscopy showed a normal appendix but revealed pyosalpinx. A follow-up with ultrasound of the genitalia interna showed normal relations. PID should be considered in all females with compatible symptoms, irrespective of their age.


Assuntos
Abdome Agudo , Apêndice , Laparoscopia , Doença Inflamatória Pélvica , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Doença Aguda , Criança , Feminino , Humanos , Doença Inflamatória Pélvica/complicações , Comportamento Sexual
20.
Magy Seb ; 72(1): 13-19, 2019 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-30869533

RESUMO

Case review: The authors present a case of a 78-year-old female patient who previously, as a teenager, had been treated for pulmonary tuberculosis. The biological therapy for subsequent inflammatory bowel disease in 2015 caused a flare up of the respiratory symptoms after 60 years of being asymptomatic, and the patient also developed acute abdomen. She required emergency laparotomy and small intestine segment resection was performed due to perforated ileum. Histological examination of the specimen showed intestinal tuberculosis as the cause of perforation. Following pharmacological therapy in the postoperative period the patient eventually became asymptomatic. Discussion: Tuberculosis is a life threatening disease which can virtually affect any organ system. The primary site of tuberculosis is usually the lung, from which it can get disseminated into other parts of the body. With this article we would like to raise the awareness of the potentially lethal side effects of biological and immune modulated therapies and we would also like to emphasize the importance of the cooperation of practitioners in different medical fields.


Assuntos
Terapia Biológica/efeitos adversos , Doenças do Íleo/etiologia , Perfuração Intestinal/cirurgia , Laparotomia , Tuberculose Pulmonar/complicações , Abdome Agudo/etiologia , Feminino , Humanos , Doenças do Íleo/cirurgia , Perfuração Intestinal/etiologia , Pessoa de Meia-Idade , Resultado do Tratamento
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