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1.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509856
2.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408103

RESUMO

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.


Assuntos
Dor Abdominal/etiologia , Colecistectomia Laparoscópica , Colecistite Aguda/diagnóstico , Vesícula Biliar/patologia , Anormalidade Torcional/diagnóstico , Administração Intravenosa , Idoso , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Necrose/diagnóstico , Necrose/cirurgia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Ultrassonografia
3.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504515

RESUMO

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.


Assuntos
Calcinose/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Apendicite/diagnóstico , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Leiomioma/cirurgia , Inoculação de Neoplasia , Omento , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Neoplasias Uterinas/cirurgia
4.
Ulus Travma Acil Cerrahi Derg ; 27(1): 154-156, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394461

RESUMO

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.


Assuntos
Abdome Agudo , Anormalidade Torcional , Baço Flutuante , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Adulto , Humanos , Laparoscopia , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico , Baço Flutuante/complicações , Baço Flutuante/diagnóstico , Adulto Jovem
5.
Medicine (Baltimore) ; 99(29): e21104, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702859

RESUMO

RATIONALE: Pulmonary sequestration is a congenital abnormality of the lower airway. It is characterized by a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree or pulmonary arteries and always receives its arterial blood supply from the systemic circulation. Most cases of extralobar pulmonary sequestrations (ELSs) are asymptomatic and found incidentally or in prenatal ultrasound screening. PATIENT CONCERNS: A 10-year-old boy had severe chest pain and vomiting for 2 days. DIAGNOSES: ELS was diagnosed, and torsion of the ELS had developed as a complication. INTERVENTIONS: In video-assisted thoracoscopic surgery, the ELS was resected. OUTCOMES: The clinical symptoms were relieved the 2nd day after surgery and did not recur over a follow-up period of 3 months. LESSONS: In young patients with sudden abdominal pain or chest pain, in whom computed tomography shows a well-defined mass of homogeneous soft-tissue density in the thorax, ELS with torsion should be suspected. The presence of a feeding artery greatly supports the diagnosis of ELS, and the absence of this classic finding may indicate torsion of the pulmonary sequestration.


Assuntos
Sequestro Broncopulmonar/complicações , Anormalidade Torcional/complicações , Sequestro Broncopulmonar/cirurgia , Dor no Peito/etiologia , Criança , Humanos , Masculino , Cirurgia Torácica Vídeoassistida/métodos , Anormalidade Torcional/cirurgia , Vômito/etiologia
6.
J Coll Physicians Surg Pak ; 30(2): 201-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32036831

RESUMO

OBJECTIVE: To study the effects of age and duration of symptoms on the outcomes of scrotal explorations for acute scrotal pain at our institution. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Bradford Teaching Hospital NHS Trust, from January 2006 to December 2017. METHODOLOGY: Retrospective data was collected from electronic case records of the patients who required scrotal exploration for suspected torsion of the testis. Group difference between continuous variables (age and duration of symptoms) were assessed by Kruskal Wallis and independent samples Mann-Whitney U-tests. The Fisher Exact and Chisquare tests were used to analyse relationships between categorical data. RESULTS: In total, 502 patients required scrotal exploration. The median age (years) and duration of symptoms (hours) were 16.4 years (1.3 - 77) and 4 hours (1 - 336), respectively. Torsion of the testis was found in 231 (46%), torsion of the testicular appendix in 126 (25%), epididymal inflammation in 46 (9.2%), and no cause identified in 99 (19.7%). Immediate orchidectomy for non-viable testis performed in 34 (14.7% of TT group and 6.8% of the overall cohort). Duration of symptoms was significantly associated with risk of orchidectomy in torsion patients 4 vs. 27 hours (p <0.0001). Overall 47 (9.3%) patients presented after 12 hours, 22 (46.8%) had TT. There were 13 (2.6%) patients older than 40 years and 8 (61.5%) of these had torsion. CONCLUSION: The most commonest diagnosis for patients presenting with acute scrotal pain was torsion of the testis followed by torsion of appendix testis. Testicular salvage was inversely related to the duration of symptoms. Patient's age did not predict the need for orchidectomy. This data supports the practice of urgent scrotal exploration for acute scrotal pain with a clinical suspicion of torsion regardless of age and duration of symptoms.


Assuntos
Epididimite/diagnóstico , Dor/etiologia , Escroto/fisiopatologia , Doenças Testiculares/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Epididimite/complicações , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Necrose , Orquiectomia , Orquidopexia , Orquite/complicações , Orquite/diagnóstico , Estudos Retrospectivos , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/cirurgia , Doenças Testiculares/complicações , Doenças Testiculares/cirurgia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico , Resultado do Tratamento , Adulto Jovem
11.
J Pediatr Surg ; 55(4): 711-714, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31130349

RESUMO

PURPOSE: The purpose of this study was to quantify the experience of five Italian centers on the diagnosis and management of isolated fallopian tube torsion (IFTT) in children. METHODS: We retrospectively reviewed the data of 20 patients aged 1-16 years of age with surgically diagnosed IFTT between 1991 and 2017 from five Italian centers of pediatric surgery. We analyzed common presenting signs, symptoms, and radiographic findings, as well as surgical interventions to describe management offering further insight into the diagnosis and treatment of this rare entity. RESULTS: Twenty cases of IFTT were collected. Median age was 13.1 years. Menarche was present in 14 cases. A clinical history of abdominal pain was present in 13 patients, whereas in 7 patients the clinical picture was an acute abdomen. Ultrasonography was the first diagnostic examination in 16 cases. Surgical approach was by laparoscopy in 16 cases and laparotomy in 4 cases. In 11 patients IFTT was associated with another pathologic condition. In 7 of the remaining 9 IFTT without pathologic association, the girls played sports. Salpingectomy was performed in 13 patients and de-torsion in 7. CONCLUSIONS: IFTT is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. IFTT should be considered in girls with abdominal pain who practice sports with sudden body movements. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular/cystic structure with adjacent normal ovary. Conservative management is controversial but could be preferred in order to provide the best option for future fertility of these girls. TYPE OF STUDY: Treatment Study (Retrospective Study) - Level IV.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/cirurgia , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgia , Abdome Agudo/etiologia , Adolescente , Criança , Doenças das Tubas Uterinas/complicações , Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Itália , Laparoscopia , Estudos Retrospectivos , Salpingectomia , Esportes , Anormalidade Torcional/complicações , Ultrassonografia
14.
Am J Case Rep ; 20: 1879-1882, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31839673

RESUMO

BACKGROUND Gallbladder torsion is a rare entity of acute abdomen that can be fatal if not diagnosed and treated promptly. It presents in a multitude of ways but the most common is a presentation similar to acute cholecystitis. Diagnosis can be made clinically by abdominal ultrasound with Doppler flow, and treatment is detorsion with cholecystectomy. CASE REPORT A 57-year-old female presented to the emergency department with severe abdominal pain, bilious vomiting, and loose stools. An initial diagnosis of gastroenteritis was made, however, the patient did not respond to symptomatic treatment and continued having pain, nausea and vomiting. Abdominal ultrasound revealed signs of acute cholecystitis and the patient underwent an open cholecystectomy where the gallbladder was found to be black, gangrenous, and voluminous due to torsion. Detorsion and cholecystectomy were performed without any complications. CONCLUSIONS Gallbladder torsion is a rare entity of acute abdomen that can be fatal if not diagnosed and treated promptly. Gallbladder torsion should be a part of the differential diagnosis of any patient presenting with an acute abdomen and unusual symptoms of acute cholecystitis.


Assuntos
Doenças da Vesícula Biliar/etiologia , Doenças da Vesícula Biliar/cirurgia , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Dor Abdominal , Colecistectomia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade
16.
J Pediatr Surg ; 54(12): 2614-2616, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31500875

RESUMO

BACKGROUND/PURPOSE: The aim of this study was to characterize differences between pre- and postmenarchal females with ovarian torsion. METHODS: A single-center review was conducted of all nonneonatal pediatric patients with ovarian torsion from 2011 to 2018. Clinical data were compared between pre- and postmenarchal patients. RESULTS: One hundred and twenty-seven patients were identified, and 25% were premenarchal. Premenarchal patients were more likely to have a delay in diagnosis (38% vs 20%, p = 0.042), develop ovarian necrosis (34% vs 17%, p = 0.036), and present without an associated adnexal mass (44% vs 0%, p < 0.001). All patients without a mass (n = 14) were premenarchal and presented with ovarian asymmetry. Patients without an associated mass underwent oophoropexy in the majority of cases. There were no differences in postoperative complication or recurrence rates between groups. CONCLUSION: Premenarchal females with ovarian torsion can present differently than females postmenarche and often have a delay in diagnosis. Premenarchal females are more likely to undergo torsion without an associated adnexal mass and are at higher risk for ovarian necrosis. Oophoropexy is an appropriate treatment in the absence of an adnexal mass. A high-index of suspicion for ovarian torsion should be maintained for premenarchal females presenting with abdominal pain and an otherwise negative workup. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.


Assuntos
Doenças Ovarianas , Anormalidade Torcional , Dor Abdominal/etiologia , Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico , Doenças dos Anexos/fisiopatologia , Criança , Feminino , Humanos , Doenças Ovarianas/complicações , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/fisiopatologia , Estudos Retrospectivos , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/fisiopatologia
17.
Rev. cir. (Impr.) ; 71(3): 257-260, jun. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1058266

RESUMO

INTRODUCCIÓN: El bazo errante, es una entidad clínica poco común. Su espectro clínico varía desde enfermedad asintomática hasta complicaciones asociadas y su manejo es predominantemente quirúrgico. CASO CLÍNICO: Hombre, con cuadro clínico de dolor y masa abdominal palpable, con hallazgos tomográficos sugestivos de patología con asiento en retroperitoneo, con obstrucción intestinal secundaria; por laparotomía se identifica de forma incidental bazo ectópico solo fijado a través de pedículo vascular torsionado y signos de hipertensión portal, realizándose esplenectomía. CONCLUSIONES: La torsión esplénica es la complicación más frecuente del bazo errante, una entidad bastante rara con muy pocos casos publicados en Colombia.


BACKGROUND: The wandering spleen is an uncommon clinical entity. Its clinical spectrum varies from asymptomatic disease to associated complications and its management is predominantly by surgery. CLINICAL CASE: Man with clinical picture of pain and palpable abdominal mass, with tomographic findings suggestive of pathology with retroperitoneal seating, with secondary intestinal obstruction; by laparotomy incidentally, an ectopic spleen is identified, only fixed through a torsioned vascular pedicle and signs of portal hypertension, performing splenectomy. CONCLUSIONS: Splenic torsion is the most frequent complication of the errant spleen, a very rare entity with very few cases published in Colombia.


Assuntos
Humanos , Masculino , Adolescente , Anormalidade Torcional/cirurgia , Baço Flutuante/cirurgia , Esplenectomia , Infarto do Baço/etiologia , Esplenomegalia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Dor Abdominal/etiologia , Baço Flutuante/complicações , Baço Flutuante/diagnóstico por imagem
18.
BMJ Case Rep ; 12(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092484

RESUMO

This is a case of an 8-year-old, Caucasian boy with a complex prior medical history who presented with worsening, acute, left-sided abdominal pain and fever after empiric treatment for a urinary tract infection. Repeat urinalysis was negative for infection. A renal ultrasound assessing for occult perinephric abscess or nephronia revealed normal kidneys but found a tubular structure adjacent to the left kidney. A CT scan further revealed a splenic infarction secondary to torsion. He had a surgical evaluation but was treated empirically with piperacillin/tazobactam for 10 days due to concern for infectious complications following splenic infarction. He had complete resolution of his pain and symptoms. He received routine vaccines for asplenia prior to being discharged home without any further sequelae.


Assuntos
Infarto do Baço/etiologia , Anormalidade Torcional/complicações , Antibacterianos/uso terapêutico , Criança , Humanos , Masculino , Penicilinas/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia , Anormalidade Torcional/diagnóstico por imagem , Ultrassonografia Doppler em Cores
19.
Isr Med Assoc J ; 21(4): 251-254, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31032566

RESUMO

BACKGROUND: When a woman with an endometrioma presents with acute abdominal pain, it is unclear whether ovarian torsion should be suspected. OBJECTIVES: To compare patient characteristics, imaging results, and surgical management of endometriomas in elective versus emergent surgeries. METHODS: This retrospective cohort study included women treated at our institution during the period 1990-2015 who presented with histologically verified endometrioma and who underwent either planned surgery or emergent surgery due to suspected adnexal torsion. RESULTS: Of 225 surgeries performed, 174 were elective and 51 emergent. Patients in the emergent group were significantly younger (33.9 ± 11.1 vs. 39.01 ± 10.9 years, P = 0.004). Abdominal pain was the main complaint of all the emergent surgery patients and the leading complaint in 21% of the elective surgery patients (P < 0.001), with right-sided predominance in both groups. Sonographic parameters were similar in both groups. Bilateral ovarian cysts were noted in 11.7% and 11.0% of emergent and elective patients, respectively (P = 0.87). Laboratory evaluation was notable for a higher white blood cell count and CA125 levels among emergent patients. All patients in the emergent group and 93% of patients in the elective group were managed laparoscopically. No cases of torsion were noted. The rate of intra-pelvic adhesions was similar in both groups (56.8% vs. 66.6%, P = 0.19). CONCLUSIONS: Endometrioma may present with acute abdominal pain. However, adnexal torsion in these patients is rare. These cases can be managed using a minimally invasive approach, assuming an optimal surgical setting.


Assuntos
Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico por imagem , Endometriose/complicações , Endometriose/cirurgia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Dor Aguda/etiologia , Dor Aguda/cirurgia , Doenças dos Anexos/cirurgia , Adulto , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/métodos , Endometriose/diagnóstico por imagem , Feminino , Humanos , Estudos Retrospectivos , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Ultrassonografia/métodos
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