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1.
J Med Case Rep ; 15(1): 457, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34526110

RESUMO

BACKGROUND: Intra-abdominal desmoid tumors are rare soft tissue tumors that arise mainly in the mesentery and pelvis. Their etiology may include genetic mutations, estrogen-associated changes after childbirth, and mechanical factors such as a history of abdominal surgery. However, there are cases of intra-abdominal desmoid tumors that develop in the absence of such causes. Since they are rare, diagnosis is often difficult based on clinical findings. We encountered two cases of patients with sporadic intra-abdominal desmoid tumors with a very unusual onset and contrasting features. CASE PRESENTATION: The first patient was a 51-year-old asian man who presented with sudden onset of abdominal pain. He was referred to our department because of a giant tumor detected on abdominal ultrasonography. Imaging revealed a 19-cm tumor with internal tumoral hemorrhage; however, no definitive diagnosis was made. Tumor resection was performed for diagnostic and therapeutic purposes. The second patient was a 41-year-old asian man, and right hydronephrosis was detected on abdominal ultrasonography during a periodic medical checkup. We diagnosed invasion of the primary mesenteric tumor into the right ureter using diagnostic imaging and performed ileocecal resection with partial right ureteral resection for a definitive diagnosis and therapeutic purposes. Although the tumors of both patients had developed from the ileal mesentery, the tumors were substantially different from each other based on their imaging findings, macroscopic morphology, and progression pattern. Meanwhile, they showed similar pathological characteristics. Both consisted of bundles of collagen fibrils of spindle-shaped fibroblasts with low cell atypia. Moreover, they were diagnosed as desmoid tumors using positive immunohistochemical staining for ß-catenin. CONCLUSIONS: Neither patient had susceptibility factors for desmoid tumors, and to our knowledge, there have been very few reports to date of intra-abdominal desmoid tumors that were diagnosed because of acute abdominal pain caused by tumoral hemorrhage or asymptomatic obstructive uropathy. Furthermore, it is clinically interesting that the two patients showed contrasting progression patterns and imaging findings. Intra-abdominal desmoid tumors are rare and may present with various symptoms and findings similar to those observed in our patients. Diagnosis therefore requires experience and knowledge that is not bound by preconceptions.


Assuntos
Fibromatose Abdominal , Fibromatose Agressiva , Dor Abdominal/etiologia , Adulto , Colectomia , Fibromatose Abdominal/diagnóstico por imagem , Fibromatose Abdominal/cirurgia , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/cirurgia , Humanos , Masculino , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Pessoa de Meia-Idade
2.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479894

RESUMO

An 81-year-old woman with no history of immunocompromise presented with 2 days of upper abdominal pain associated with nausea. On arrival, her physical examination was unremarkable apart from mild epigastric and right hypochondriac tenderness, and laboratory investigations were unremarkable apart from mild thrombocytopenia and transaminitis. A CT scan performed on the day of admission revealed a tiny 0.3 cm stone in the common bile duct, with no upstream dilatation. On day 2 of admission, she developed a vesicular rash and with acutely worsening transaminitis. She deteriorated rapidly and demised from complications of acute liver failure within the next 24 hours. The diagnosis of varicella was confirmed with antibody testing. Fulminant varicella hepatitis is an extremely rare and lethal condition with only a handful of reported cases in the current literature. We aim to share our clinical experience and summarise the salient points from existing case reports.


Assuntos
Varicela , Hepatite , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Ducto Colédoco , Feminino , Hepatite/diagnóstico , Hepatite/etiologia , Herpesvirus Humano 3 , Humanos
3.
J Med Case Rep ; 15(1): 445, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34482823

RESUMO

BACKGROUND: Phlegmonous gastritis is a rare and fatal infectious disease of the stomach, presenting varied and nonspecific endoscopic images, which are therefore difficult to diagnose. This report discusses three cases of phlegmonous gastritis, each with unique endoscopic images, and considers the differential diagnosis of this disease. These cases were initially suspected of scirrhous gastric cancer, gastric syphilis, and acute gastric mucosal lesion. CASE PRESENTATION: Case 1 A 32-year-old Asian man visited our hospital complaining of upper abdominal pain. Endoscopy raised suspicion of scirrhous gastric cancer. However, a histopathological examination showed no malignant cells, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, which was effective. Case 2 A 33-year-old Asian man visited our hospital complaining of epigastralgia. Endoscopy raised suspicion of gastric syphilis. However, the serum test for syphilis was negative, and Streptococcus viridans was detected in the biopsy specimen culture, which led to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in significant improvement in the endoscopic image after 2 weeks. Case 3 A 19-year-old Asian man visited our hospital complaining of epigastric pain. Endoscopy raised suspicion of acute gastric mucosal lesion. A gastric juice culture showed Pseudomonas aeruginosa and Streptococcus viridans, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in the disappearance of the gastric lesions. CONCLUSION: In severe cases of phlegmonous gastritis, immediate surgical treatment is generally required. However, the endoscopic images are varied and nonspecific. These three cases suggest that clinicians need to consider the differential diagnosis of phlegmonous gastritis and make accurate diagnoses at an early stage.


Assuntos
Gastrite , Abdome , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Adulto , Antibacterianos/uso terapêutico , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Humanos , Masculino , Adulto Jovem
4.
Isr Med Assoc J ; 23(9): 590-594, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472237

RESUMO

BACKGROUND: Among dialysis patients, occlusive mesenteric vascular disease has rarely been reported. OBJECTIVES: To report on the experience of one center with regard to diagnosing and treating this complication. METHODS: The retrospective case-series involved six patients (3 females, 3 males; age 52-88 years; 5/6 were smokers) on chronic hemodialysis at a single center. All patients with symptoms suggestive of occlusive mesenteric disease and a subsequent angiographic intervention were included. Demographic, clinical, and laboratory data were collected from patient charts for the period before and after angioplasty and stenting of the mesenteric vessels. A Wilcoxon signed-rank test was used to compare the relevant data before and after the intervention. RESULTS: All participants had variable co-morbidities and postprandial abdominal pain, food aversion, and weight loss. CT angiography was limited due to heavy vascular calcifications. All underwent angioplasty with stenting of the superior mesenteric artery (4 patients) or the celiac artery (2 patients). All procedures were successful in resolving abdominal pain, malnutrition, and inflammation. Weight loss before was 15 ± 2 kg and weight gain after was 6 ± 2 kg. C-reactive protein decreased from 13.4 ± 5.2 mg/dl to 2.2 ± 0.4 mg/dl (P < 0.05). Serum albumin increased from 3.0 ± 0.2 g/dl to 3.9 ± 0.1 g/dl (P < 0.05). Two patients underwent a repeat procedure (4 years, 5 months, respectively). Follow-up ranged from 0.5-7 years. CONCLUSIONS: Occlusive mesenteric ischemia occurs among dialysis patients. The diagnosis requires a high degree of suspicion, and it is manageable by angiography and stenting of the most involved mesenteric artery.


Assuntos
Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Diálise Renal/efeitos adversos , Stents , Dor Abdominal/etiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Artéria Celíaca/fisiopatologia , Artéria Celíaca/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Artérias Mesentéricas/fisiopatologia , Artérias Mesentéricas/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
JNMA J Nepal Med Assoc ; 59(235): 303-304, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506443

RESUMO

"Three more hours", I tell myself as I find my way to the exam hall. I see a bunch of my classmates cramming for the last minute, and here I am, in a corner, reminding myself that it's just three more hours till I get away from this horror. Irritable Bowel Syndrome is a gastrointestinal disorder in which there is dull achy lower abdominal pain associated with either diarrhea or constipation. Though it has high prevalence, it is still an underrated disease which can be easily missed in clinical settings.


Assuntos
Síndrome do Intestino Irritável , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Constipação Intestinal/etiologia , Diarreia/etiologia , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Prevalência
6.
BMJ Case Rep ; 14(9)2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511413

RESUMO

A 20-year-old nulliparous patient with acute-onset abdominal pain and imaging suggestive of haemoperitoneum was admitted for observation. Though, initially, haemodynamically stable, her clinical picture worsened throughout her hospitalisation and warranted two separate laparoscopies that revealed 1200 mL and 50 mL of haemoperitoneum, respectively, without an identifiable bleeding source. After serial ß-human chorionic gonadotropin levels and ultrasound confirmation of a viable pregnancy 23 days later, the patient underwent a normal antenatal course and delivered a healthy infant at 37 weeks gestation. This unusual case highlights the need to consider spontaneous haemoperitoneum in pregnancy as a diagnosis, particularly in the setting of pregnancy of unknown location, even at an early stage of pregnancy.


Assuntos
Gonadotropina Coriônica Humana Subunidade beta , Hemoperitônio , Dor Abdominal/etiologia , Adulto , Feminino , Idade Gestacional , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Humanos , Gravidez , Ultrassonografia , Adulto Jovem
7.
Praxis (Bern 1994) ; 110(12): 689-695, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34521275

RESUMO

CME-Sonography 102: Acute Epigastric Pain Abstract. Acute upper abdominal pain is a common issue in emergency medicine. Next to the anamnesis and laboratory findings, sonography plays a leading role in differentiation. In addition to the direct representation of the respective pathologies (gallstones, duct dilatations, tumors), the clinical-sonographic examination, the so-called palpation under ultrasound view, is also important. In this article we aim to show the way of diagnosing acute epigastric pain.


Assuntos
Dor Abdominal , Cálculos Biliares , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Humanos , Exame Físico , Ultrassonografia
9.
BMJ Case Rep ; 14(8)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362756

RESUMO

We present a case of laparoscopic cholecystectomy with subarachnoid block (SAB) in an opioid-tolerant patient with chronic obstructive pulmonary disease (COPD). A 64-year-old woman presented to the emergency department with acute abdominal pain of biliary colic. Surgery was delayed in favour of conservative management given that she was considered high risk for general anaesthesia. Due to refractory pain, she successfully proceeded to have laparoscopic cholecystectomy with SAB. This case is a timely reminder that SAB is feasible and safe in patients with severe COPD, with the added benefit of increased analgesic effects, fewer postoperative pulmonary complications and quick recovery time.


Assuntos
Raquianestesia , Anestésicos , Colecistectomia Laparoscópica , Dor Abdominal/etiologia , Analgésicos Opioides , Feminino , Humanos , Pessoa de Meia-Idade
10.
Malawi Med J ; 33(1): 68-70, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422237

RESUMO

Gossypiboma refers to foreign bodies left inside the body during surgery, such as sponges and gauze. These foreign bodies represent a significant cause of morbidity and mortality. A 57-year-old female presented to us with right upper abdominal pain. Her past history was non-contributory except for an open cholecystectomy 20 years previously. A physical examination revealed tenderness to palpation on the right of the abdomen, while the remaining examination was normal. An abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed a well-defined calcified mass of 5 cm that was compatible with a mesenteric cyst. During surgery, the mass was found to be adherent to the mesocolon and to have invaded the colon wall. A right hemicolectomy and ileotransverse anastomosis was performed. The pathological mass was considered to be a gossypiboma that had been left behind during the earlier cholecystectomy. The body's reaction to the foreign body was seen to extend beyond the lamina propria and muscularis propria. Gossypiboma is an undesired and life-threatening but preventable surgical complication. This condition may present with non-specific findings and a clinical scenario that mimics various disorders, even after many years. A diagnosis of gossypiboma should be kept in mind for patients with a history of previous operations and undergoing surgery due to the suspicion of a mesenteric cyst.


Assuntos
Abdome/diagnóstico por imagem , Dor Abdominal/etiologia , Colecistectomia/efeitos adversos , Corpos Estranhos , Complicações Pós-Operatórias/diagnóstico por imagem , Tampões de Gaze Cirúrgicos/efeitos adversos , Anastomose Cirúrgica , Colectomia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Ned Tijdschr Geneeskd ; 1652021 05 19.
Artigo em Holandês | MEDLINE | ID: mdl-34346582

RESUMO

BACKGROUND: A wandering spleen is a relatively unknown condition, where the spleen may be enlarged and is located in an aberrant position in the abdomen. It is caused by abnormally constructed or absent ligaments that should keep the spleen in the correct position or an excessively long vascular stem. The pathophysiology is congenital or secondary to trauma, abdominal surgery, pregnancy or splenomegaly. CASE DESCRIPTION: A 21-year-old woman was presented at the emergency department with acute abdominal pain in the left lower quadrant. A CT-scan of the abdomen showed splenomegaly, with the spleen showing reduced blood flow and a location in the lower abdomen. During an emergency laparoscopy, the spleen was found to be ischemic based on a torsion of the vascular pedicle. A splenectomy followed and the patient showed an uncomplicated recovery. CONCLUSION: Splenopexy or splenectomy is the treatment of choice for a symptomatic wandering spleen.


Assuntos
Abdome Agudo , Laparoscopia , Baço Flutuante , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Dor Abdominal/etiologia , Adulto , Feminino , Humanos , Esplenectomia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgia , Baço Flutuante/diagnóstico , Baço Flutuante/diagnóstico por imagem , Adulto Jovem
13.
In Vivo ; 35(5): 2729-2738, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410962

RESUMO

BACKGROUND/AIM: The diagnostic scores (DSs) for patients with non-specific abdominal pain (NSAP) have been rarely evaluated. PATIENTS AND METHODS: In the NSAP study group there were 614 patients (268 females and 346 males) versus 719 patients in the non-NSAP group including 368 females and 351 males. The clinical symptoms (n=22), signs and tests (n=14) and laboratory analyses (n=3) were recorded in each patient. Meta-analytical techniques were used to detect the summary sensitivity (Se) and specificity (Sp) estimates for each data set (symptoms, signs and tests as well as DS models). RESULTS: In receiver operating characteristic (ROC) analysis, the area under curve (AUC) values for i) symptoms ii) signs and tests and iii) DS were as following: i) AUC=0.542 (95% CI=0.512-0.572); ii) AUC=0.625 (95% CI=0.550-0.700), and iii) AUC=0.874 (95% CI=0.850-0.898). The differences between these AUC values are as following: between i and ii, p=0.097; between i and iii, p<0.0001 and between ii and iii, p<0.0001. CONCLUSION: This is the first study to provide evidence that DS may help in the difficult diagnosis of NSAP.


Assuntos
Apendicite , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Feminino , Humanos , Masculino , Curva ROC , Sensibilidade e Especificidade
14.
Ther Umsch ; 78(7): 359-368, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34427112

RESUMO

Smarter Medicine: From the Diagnosis to the Intervention in General and Visceral Surgery Abstract. More is not always a plus. With this slogan, in smarter medicine it is a principle to make a decision together. In general surgery diagnostic or therapeutic interventions have the potential to harm the patient. The admission to the emergency room of a young patient with abdominal pain does not necessarily require a computed tomography. A potential acute appendicitis without typical clinical and laboratory findings could potentially be unmasked by watchful waiting, or even a nonessential operation could be avoided. Possibly, acute cholecystitis or some forms of hollow organ perforation could be treated solely with antibiotics. Is it feasible to treat an acute severe diverticulitis with antibiotics only? In addition, if a colon resection is necessary, could a direct anastomosis be made, and a second operation be avoided? Are there thyroid nodules that do not need removal? The management of diseases in the surgical domain are evaluated with evidence-based medicine in the focus of smarter medicine and newly reconsidered.


Assuntos
Dor Abdominal , Procedimentos Cirúrgicos do Sistema Digestório , Dor Abdominal/etiologia , Doença Aguda , Serviço Hospitalar de Emergência , Humanos , Tomografia Computadorizada por Raios X
16.
Pan Afr Med J ; 39: 52, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422175

RESUMO

Heterotopic pregnancy is a rare obstetrics phenomenon and carries significant maternal morbidity and mortality due to the risk of rupture of the ectopic pregnancy. Physicians tend to feel comfortable and relieved when an intrauterine gestation sac is seen. This results in an inadequate inspection of the adnexae and remaining structures during emergency bedside ultrasound despite a strong initial clinical suspicion of ectopic pregnancy. We present a case report of ruptured ectopic pregnancy and massive hemoperitoneum in a patient with heterotopic pregnancy. The diagnosis was done on bedside ultrasonography in a clinically unstable 32-year-old patient with a history of infertility. She presented with acute abdominal pain, body weakness, and amenorrhea. She underwent emergency laparotomy and salpingectomy. In our context where ultrasound is not readily available, practitioners carrying out salpingectomy for ruptured ectopic pregnancies should bear in mind the plausibleness of heterotopic pregnancy to properly handle the uterus.


Assuntos
Hemoperitônio/etiologia , Gravidez Heterotópica/diagnóstico por imagem , Salpingectomia/métodos , Dor Abdominal/etiologia , Adulto , Camarões , Feminino , Humanos , Laparotomia/métodos , Gravidez , Ruptura Espontânea/diagnóstico por imagem , Ultrassonografia Pré-Natal
18.
Medicine (Baltimore) ; 100(32): e26843, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397890

RESUMO

INTRODUCTION: Secondary amyloidosis is a rare complication of rheumatoid arthritis (RA) that is histologically characterized by the deposition of amyloid fibrils in target organs, such as the kidneys and gastrointestinal tract. Controlling the inflammatory response is essential to prevent organ dysfunction in amyloid A (AA) amyloidosis secondary to RA, and no clear treatment strategy exists. PATIENT CONCERNS AND DIAGNOSIS: A 66-year-old woman with RA, who had been treated with disease-modifying anti-rheumatic drugs for 1 year, presented with recurrent abdominal pain and prolonged diarrhea. Endoscopy showed chronic inflammation, and colon tissue histology confirmed AA amyloidosis. INTERVENTIONS AND OUTCOMES: After tocilizumab therapy was begun, her diarrhea and abdominal pain subsided, and articular symptoms improved. Biologic drugs for RA have been used in patients with secondary AA amyloidosis, including tumor necrosis factor and Janus kinase inhibitors, interleukin 6 blockers, and a T cell modulator. Here, we systematically review existing case reports and compare the outcomes of RA-related AA amyloidosis after treatment with various drugs. CONCLUSION: The data indicate that biologic drugs like tocilizumab might be treatments of choice for AA amyloidosis secondary to RA.


Assuntos
Amiloidose , Anticorpos Monoclonais Humanizados/administração & dosagem , Artrite Reumatoide , Terapia Biológica/métodos , Colo , Proteína Amiloide A Sérica/análise , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Idoso , Amiloidose/etiologia , Amiloidose/imunologia , Amiloidose/fisiopatologia , Amiloidose/terapia , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Produtos Biológicos/administração & dosagem , Colo/imunologia , Colo/patologia , Diarreia/diagnóstico , Diarreia/etiologia , Feminino , Humanos , Interleucina-6/antagonistas & inibidores , Resultado do Tratamento
19.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433526

RESUMO

A 50-year-old woman was admitted to our emergency surgery department with 1-week history of abdominal pain, distension, vomiting and constipation. On examination, she has a distended abdomen with sluggish bowel sounds, but no clinical signs of peritonitis. Blood tests were normal except for the increased white cell count and erythrocyte sedimentation rate (ESR). CT scan with oral as well as intravenous contrast demonstrated the small bowel obstruction without any insight into the aetiology of the disease. Intraoperatively, the right fallopian tube was found to encircle the terminal ileum. A right salpingo-oophorectomy was performed to release the bowel. This case report describes a rare cause of the small bowel obstruction in female patients.


Assuntos
Tubas Uterinas , Obstrução Intestinal , Dor Abdominal/etiologia , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
20.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433530

RESUMO

This report describes a rare case of isolated fallopian tube torsion (IFTT) in a premenarchal 11-year-old girl. The patient presented with subacute abdominal pain, associated with nausea and vomiting. Sonographic findings revealed left tube enlargement with free intraperitoneal fluid. Doppler mapping was not unequivocal. During exploratory laparoscopy, a large pelvic necrotic mass was found to be a twisted left fallopian tube. After detorsion, salpingectomy was performed and the patient recovered promptly, showing no complications 3 months post operation. IFTT should be considered as a differential diagnosis of lower abdominal pain in adolescent girls with normal-appearing ovaries on ultrasound. Conservative management for fertility preservation is the ideal approach. Therefore, avoiding delay in laparoscopy is crucial.


Assuntos
Doenças das Tubas Uterinas , Tubas Uterinas , Dor Abdominal/etiologia , Adolescente , Criança , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças das Tubas Uterinas/cirurgia , Tubas Uterinas/diagnóstico por imagem , Tubas Uterinas/cirurgia , Feminino , Humanos , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Ultrassonografia
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