Mimickers of Acute Appendicitis
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Food. Its Destiny Was Presumably Cooking Purposes,In Minutes, and Appears to Think Ill of the Method
827 importance of washing out the stomach to There could be little doubt of its rancidity get rid of irritating matter that causes the since the analyst reported that it contained pylorospasm, while others think this unnecessary ; 3’16 per cent. of fatty acids compared with a the administration of warm water enemas is often figure for fresh butter of well under 0’5 per cent. advised. In Germany the passage of sounds or The magistrate, after hearing chiefly chemical and catheters through the contracted pylorus to dilate practically no physiological evidence, decided that it mechanically has been widely advocated during the butter was fit for human consumption, and so the last five years. Hess argues that if a No. 15 no order was made under the regulations and the catheter will pass the pylorus there is no organic consignment was released. It does not appear to be stenosis. Dr. Delprat has tried this mode of treat- disputed that the butter was rancid, the question to ment several times, but could not make sure of decide being whether in that case it was unfit for passing the sound into the duodenum within 15 food. Its destiny was presumably cooking purposes,in minutes, and appears to think ill of the method. which its rancidity would become more or less Finally, the treatment of pylorospasm by drugs is obscured. Having regard to the nature of the process discussed. Among the drugs used have been opiates of rancidity, we may be wise in entertaining a and antispasmodics, such as cocaine, atropine sul- suspicion that rancid butter is not a wholesome phate, or novocaine (1 milligramme five times a day food. -
Acquired Diverticula, Diverticulitis, and Peridiverticulities of the Large Intestine
468 THE BRITISH JOURNAL OF SURGERY ACQUIBED DIVERTICULA, DIVEBTICULITIS, AND PEBIDnrERTICULITlS OF TEE LARGE INTESTINE. BY W. H. MAXWEZL TELLING AND 0. C. GRUNER, LEEDS. SUMMARY OF CONTENTS. I.-HISTORICAL AND INTRODUCTORY: Definition of the term ‘ diverticula ’- Distribution of diverticula over the intestma1 tract. 11.-ETIOLOGY. Usually pulsion diverticula and not congenital. 111.-SECONDARYPATHOLOGICAL PROCESSES : General considerations-Histology and bacteriology-Classificat.ion. IV.-CLINICAL ASPECTS,WITA SPECIAL REFEEENCE TO * The nature of perisig- molditis-Cases with right-sided symptoms-Fistula-The pelvic syndrome --Minucry of carcinoma. V.-DIAGNOSIS. VL-SOME UNUSUALCOMPLICATIONS. VII .-TREAT~NT. VIII.--GENERAL SURVEY. IX.-sCAEMA TO LINK W THE -4NATOMY OF THE DIVERTICULUMWITR ITS SECONDARYPATHOLOGY AND RESULTINGCLINICAL MANIFESTATIONS. X.-A SELECTEDLIST OF ILLUSTRATIVECASES. XI.-BIBLIOGRAPHY J.-HISTORICAL AND INTRODUCTORY. DIVERTICULITISis a condition which has now passed out of the realm of doubt and uncertainty into that of. proved and accepted fact. It has an important place in medical ’literature, and in the experience of every operating surgeon of large practice. This last statement is not as yet true of all clinicians, some of whom are still apparently unaware of the condition, and not a few of its frequency and clinical importance. Not until a morbid condition is described in all the ordinary student’s tcxt-books of medicine and surgery can it be said to have attained complete recognition, and this is not as yet the case with diverticulitis. - Diverticula of the intestinal tract have been noted by vanous observers for more than a century, but for the most part as isolated cases, often obscurely ‘buried’ in the literature. -
Intraperitoneal Haemorrhagefrom Anterior Abdominal
490 CLINICAL REPORTS Postgrad Med J: first published as 10.1136/pgmj.69.812.490 on 1 June 1993. Downloaded from Postgrad Med J (1993) 69, 490-493 © The Fellowship of Postgraduate Medicine, 1993 Intraperitoneal haemorrhage from anterior abdominal wall varices J.B. Hunt, M. Appleyard, M. Thursz, P.D. Carey', P.J. Guillou' and H.C. Thomas Departments ofMedicine and 1Surgery, St Mary's Hospital Medical School, Imperial College, London W2 INY, UK Summary: Patients with oesophageal varices frequently present with gastrointestinal haemorrhage but bleeding from varices at other sites is rare. We present a patient with hepatitis C-induced cirrhosis and partial portal vein occlusion who developed spontaneous haemorrhage from anterior abdominal wall varices into the rectus abdominus muscle and peritoneal cavity. Introduction Portal hypertension is most often seen in patients abdominal pain of sudden onset. Over the pre- with chronic liver disease but may also occur in ceding 3 months he had noticed abdominal and those with portal vein occlusion. Thrombosis ofthe ankle Four years earlier chronic active swelling. by copyright. portal vein is recognized in both cirrhotic patients,' hepatitis had been diagnosed in Egypt and treated those with previous abdominal surgery, sepsis, with prednisolone and azathioprine. neoplasia, myeloproliferative disorders,2 protein Examination revealed a well nourished, jaun- C3 or protein S deficiency.4 diced man with stigmata of chronic liver disease Oesophageal varices develop when the portal who was anaemic and shocked with a pulse of pressure is maintained above 12 mmHg.5 Patients 100mm and blood pressure 60/20 mmHg. The with oesophageal varices often present with severe abdomen was distended, diffusely tender and there haematemesis. -
Hemoperitoneum in Peritoneal Dialysis, a Red Flag? Case Report
Rev. Colomb. Nefrol. 2015; 2(1): 70 -75. http//www.revistanefrologia.org Rev. Colomb.Case Nefrol. report 2015; 2(1): 70 - 75 http//doi.org/10.22265/acnef.2.1.200 Hemoperitoneum in peritoneal dialysis, a red flag? Case report. Sylvia Quiñones Sussman1, Carolina Larrarte Arenas1, Freddy Ardila Celis2 1 Department, Unit missing, RTS-Agencia Santa Clara, Bogotá, Colombia. 2 Department, Unit missing, Clinical Development RTS / Baxter Colombia. Abstract Hemoperitoneum is a complication of peritoneal dialysis. Its differential diagnosis is broad and the approach is based on its clinical manifestation and severity. It is important to evaluate all the causes of hemoperito- neum and to consider that it may be life risking. This is a case of a patient on long term peritoneal dialysis with hemoperitoneum, whose study showed calcifying peritonitis as the underlying condition. Key words: hemoperitoneum, peritoneal dialysis, calcifying peritonitis, sclerosing encapsulating peritonitis. ¿Hemoperitoneo en diálisis peritoneal, un signo de alarma? Resumen El hemoperitoneo es una complicación de la diálisis peritoneal. Su diagnóstico diferencial es amplio y el enfoque se basa en el cuadro clínico y su severidad. Es necesario evaluar todas las causas del hemoperitoneo y tener en cuenta que tienen manifestaciones diferentes y que algunas arriesgan la vida del paciente. A con- tinuación se describe un caso de un paciente con largo tiempo en diálisis peritoneal con hemoperitoneo, en quien el estudio sugiere peritonitis calcificante como enfermedad de base. Palabras -
Peritoneal Sclerosis and Massive Hemoperitoneum: Case Report and Short Review
Urology & Nephrology Open Access Journal Case Report Open Access Peritoneal sclerosis and massive hemoperitoneum: case report and short review Abstract Volume 7 Issue 3 - 2019 Secondary Peritoneal Sclerosis has been reported in several cases but is especially frequent Daniel Gonzalez Nunez, Jhordan Guzman, among chronic peritoneal dialysis users, being its most serious complication. Clinical suspicion in chronic PD users is no challenge as intestinal symptoms and hypoalbuminemia Felipe Matteus Acuna, Juan Guillermo Ramos, appear and radiological confirmation is usually achieved before the need for surgery and Juliana Ordonez intra abdominal findings prove confirmatory. A case report of a 37-year-old male patient Department of Surgery, Hospital Universitario Clinica San Rafael, Universidad Militar Nueva Granada, Bogota, Colombia with a 13 year long peritoneal dialysis in whom laparotomy findings were a massive hemoperitoneum, parietal/visceral peritoneum, small/large bowel and mesentery with Correspondence: Daniel Gonzalez Nunez, Department of chronic inflammatory changes, thickening and dark-brown coloration. As a distinctive Surgery, Hospital Universitario Clinica San Rafael, Universidad feature a gastroepiploic artery branch in the gastric curvature was identified with persistent Militar Nueva Granada, Bogota, Colombia, Tel +5713108667653, oozing and hemostasis was achieved. No intestinal obstruction was evident. Postoperative Email was uneventful. In patients undergoing peritoneal dialysis a hemorrhagic effluent from the catheter or -
Digestive System Part۱
deudenum • ار و Retroperitoneal.. • : ، و، ا، د.. • از LL11 وع و در ف ن ((L(L22) د . • ١.. -- ، از ر دن ا.. ..Sup. Duodenal flexure در ف را LL11.. ورت:: ا و -- و ا.. ..portal v. & gastroduodenala. -- -- و دن اس.. ام ر و ام رگ ر . • ٢ . و : ، از دن ا LL33.. ..Inf. Duodenal flexure • • ورت : ا-- ب را و ا، ن ، رود ر.. -- را.. دا-- اس دو :: minor & . major duodenal papilla • ٣ . ا : از LL33 ف .. • ورت : -- IVC & aorta.. ا-- .sup. Mesentric v. & a.. -- اس -- رود ا.. . د : در ف رت و ذات LL22.. ..Duodenaojejunal flexure Suspensory lig. Of duodenum ن را دا.. ورت : ا-- ون .. -- Duodenal fossa ((clinically important )) • Inf. Duodenal fossa - در دـدم رو و LL33.. .(.( )) • Sup. Duodenal fossa-- در دـدم رو و LL22.. (( در ٠٠% ااد ).). • DuodenoDuodeno--jejunaljejunalfossa-- در رت و ..duodeno-mesentricmesentric • Paraduodenal fossa-- در دـدم رو و ز ل . و ور ا (?thrombosis) . • Retroduodenal fossa-- در ا ددم . Small Intestine • Jejunum & ileum در -- .. • از duodenojejunal junction • ileocecal ار او.. Large intestine • از ileocecal valve وع و anus د.. • Sigmoid colon از وع و در SS33 در ااد رم وا .. • وت رود :: ١.. .. ٢٢.. ٣ ار (( رم taeniataenia)).. ٣٣.. Epiploic appendix ( م ). م، ، رم E. Appendix.. ن ار.. • ت (( free, lateral, medial ) اد haustra coli د Cecum • وا در ز ileocecal valve.. • در : اس، اب رال و -- ر ران.. • Taenia coli : وع از . • ileocecal valve ٢ و .. • Sup. Ileocecal recess : و و ام.. • Inf. Ileocecal recess : ال و ..mesoappendix • Retrocecal recess : در م . Mesoappendix Triangular mesentery - • extends from terminal part of ileum to appendix Appendicular artery runs • in free margin of the mesoappendix • ت :: • درد در ف اس د • ا در retrocecal هم ا ه درد اد اه colon Ascending • • دا و ا : رود ا و ام رگ. -
Spontaneous Hemoperitoneum, Due to Bleeding from Retroperitoneal Varices, in a Cirrhotic Patient
CASE REPORT Spontaneous hemoperitoneum, due to bleeding from retroperitoneal varices, in a cirrhotic patient: a case report Ahmad Abutaka1, Renol Mathew Koshy1, Abdulrahman Abu Sabeib1, Adriana Toro2 & Isidoro Di Carlo1,3 1Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha Qatar 2Department of Surgery, Barone Romeo Hospital, via Mazzini 14, 98066 Patti, Italy 3Department of Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, via Santa Sofia 78, 95100 Catania, Italy Correspondence Key Clinical Message Renol Mathew Koshy, Department of General Surgery, Hamad General Hospital, Al Hemoperitoneum from retroperitoneal varices in cirrhotic is very rare. This Rayyan Road, 3050 Doha, Qatar. condition should be taken into account based on anamnesis, clinical features, Tel: +974 55748825; and laboratory findings; but due to the unstable presentation, diagnosis remains E-mail: [email protected] a challenge. Emergency laparotomy could be effective treatment, but the prog- nosis remains poor related to the hepatic reserve. Funding Information No sources of funding were declared for this study. Keywords Cirrhosis, hemoperitoneum, hemorrhagic shock, portal hypertension, varices. Received: 26 July 2015; Revised: 26 August 2015; Accepted: 28 September 2015 Clinical Case Reports 2016; 4(1): 51–53 doi: 10.1002/ccr3.427 Introduction his body had a strong smell of alcohol. The patient was intubated and ventilated. His abdomen was found to be Spontaneous hemoperitoneum is a rare and catastrophic distended and tense, with an everted umbilicus; his bowel complication of portal hypertension [1], mainly affecting sounds were negative and a digital rectal examination patients with liver cirrhosis. Rupture of retroperitoneal showed no blood or masses. -
Irreducible Paraumbilical Hernia with Free Fatty Body and Strangulated Appendix Epiploica in the Sac
Case Report Open Access J Surg Volume 6 Issue 5 - November 2017 Copyright © All rights are reserved by Ganesh Shenoy K DOI: 10.19080/OAJS.2017.06.555698 Irreducible Paraumbilical Hernia with Free Fatty Body and Strangulated Appendix Epiploica in the Sac Ganesh Shenoy K*, Tulip and Makam Ramesh Department of Minimal Access and Bariatric Surgery, AV Hospital, India Submission: October 21, 2017; Published: November 10, 2017 *Corresponding author: Ganesh Shenoy K, Department of Minimal Access and Bariatric Surgery, AV Hospital, No 9, Patalamma temple street, Basavanaagudi, Bangalore-560004, India, Tel: ; E-mail: Abstract Hernias have a nature to surprise surgeons with their unexpected contents. Twisted and strangulated appendix epiploica of transverse colon and free fatty body as content of irreducible paraumbilical hernia is a rare entity to encounter. We report a 52 year old female with complaints of irreducible paraumbilical swelling associated with pain of one day duration. An ultrasound scan of abdomen showed 2x2 sq.cm defect with features of strangulated omentum in the hernial sac. To our surprise, the content of the sac was a free fatty body with twisted and strangulated appendix epiploica. It was reduced, resected and retrieved laparoscopically. An intraperitoneal composite mesh repair of the paraumbilical hernia was performed at the same sitting. The patient had an uneventful postoperative stay. Keywords: Appendix Epiploica; Paraumbilical hernia; Laparoscopic mesh repair Introduction abdomen showed 2x2 sq.cm defect with features of strangulated The common contents in paraumbilical hernia are omentum omentum in the hernia sac. She was admitted for emergency and small bowel loops. Very rarely there can be colon, appendix laparoscopic hernia repair under general anesthesia (Figures 1 or appendix epiploica as content of the sac. -
Spontaneous Hemoperitoneum from a Ruptured Gastrointestinal Stromal Tumor
Open Access Case Report DOI: 10.7759/cureus.9338 Spontaneous Hemoperitoneum From a Ruptured Gastrointestinal Stromal Tumor Jordan Shively 1 , Charles Ebersbacher 2 , William T. Walsh 1 , Matthew T. Allemang 1 1. General Surgery, Cleveland Clinic South Pointe Hospital, Warrensville Heights, USA 2. General Surgery, Ohio University Heritage College of Osteopathic Medicine, Warrensville Heights, USA Corresponding author: Jordan Shively, [email protected] Abstract This is a case report of a ruptured gastrointestinal stromal tumor (GIST) presenting as spontaneous hemoperitoneum. The patient was a 63-year-old female with a past medical history of hypertension and ulcerative colitis who presented to the emergency department with worsening epigastric pain. The patient denied history of trauma, previous surgeries, or forceful vomiting. She was not on anticoagulation. Vital signs at presentation were stable. A CT scan of abdomen/pelvis revealed a large amount of fluid in the upper abdomen with high attenuation material adjacent to the greater curvature of the stomach concerning for hemoperitoneum. Diagnostic laparoscopy revealed a significant amount of blood along the upper abdominal viscera. The procedure was converted to an upper midline laparotomy after identifying a necrotic, extremely friable 7 x 6 x 3 cm pedunculated mass with active hemorrhage on the posterior aspect of the greater curvature. A wedge resection was performed to remove the mass with grossly negative margins. An intraoperative frozen section revealed a stromal tumor with spindle cells. Final pathology revealed a pT3N0M0 stromal tumor with histologic spindle cells and a high mitotic rate (24/5 mm2) consistent with a high-grade GIST. Given tumor rupture at presentation, the patient was started on imatinib therapy for a minimum duration of three years. -
Abdominal Eventration of an Epiploic Appendix: an Unusual Presentation
Volume 1 Issue 1 www.escientificlibrary.com ES Journal of Case Reports Abdominal Eventration of an Epiploic Appendix: An Unusual Presentation Case report Gallego Rodríguez P*, Guillen-Astete C, Vaello Jodra V, Campos Ferrer M.C, Romio de las Heras E and Penedo Alonso R Emergency department, Ramón y Cajal University Hospital, Spain Received: Jan 27, 2020; Accepted: Feb 10, 2020; Published: Feb 11, 2020 *Corresponding author: P Gallego, MD, Emergency department, Ramón y Cajal University Hospital, Ctra Colmenar Viejo Km 9,1 28034 Madrid, Spain Copyright: © 2020 P Gallego. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords Epiploic appendix; eventration Clinical presentation An 83-year-old woman, with no previous abdominal surgical history, presented to the emergency department of our hospital due to a mass of tissue that pierced the abdominal wall from the inside and protruded several centimetres outward. According to the patient, in the place of the exit of the abdominal contents, the previous days, thinning of the thickness of the skin and intestinal movements were noticed. The patient had no abdominal pain or fever. She also Figure 1: A: Ectoscopic aspect of the abdominal wall showing the exit had no alterations in the rhythm of intestinal transit. of abdominal contents through cutaneous dehiscence. B: Adipose tis- sue from omentum with a fibro inflammatory reaction and presence of On physical examination, the patient had normal vital foreign body granulomatous reaction. -
Primary Epiploic Appendagitis
DOI:10.24938/kutfd.529130 Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 2019;21(1): 102-107 Review Derleme THE INFLAMMATION OF EPIPLOIC APPENDIX: PRIMARY EPIPLOIC APPENDAGITIS Epiploik Apendiks Enflamasyonu: Primer Epiploik Apandajit Sevilay VURAL1, Figen COŞKUN2 1Yozgat Bozok Uygulama ve Araştırma Hastanesi, Acil Tıp A.D., YOZGAT, TÜRKİYE 2Dokuz Eylül Üniversitesi Tıp Fakültesi, Acil Tıp A.D., İZMİR, TÜRKİYE ABSTRACT ÖZ Epiploic appendices are extensions of omentum which covers most Epiploik apendiks kolonun çoğunu kaplayan omental of the colon. Most of the pathologic changes are related with uzantılardır. Patolojik değişikliklerin çoğu spontan torsiyon spontaneous torsion or venous thrombosis culminating with veya venöz tromboz sonrası oluşan enflamasyon ile inflammation and is referred as primary epiploic appendagitis ilişkilidir ve primer epiploik apandajit olarak adlandırılır. (PEA). There is no pathognomonic symptom, finding or laboratory Nispeten nadir görülen bu intra-abdominal patoloji için test for this relatively rare intra-abdominal inflammation. A non- herhangi bir patognomonik semptom, bulgu veya toxic patient with acute onset localized abdominal pain in the right laboratuvar testi yoktur. Sağ veya sol alt kadranda akut or left lower quadrant is the typical presentation. Imaging studies başlangıçlı lokalize karın ağrısı olan non-toksik such as ultrasound and tomography with the awareness of PEA in görünümdeki hasta tipik prezentasyondur. İntra-abdominal differential diagnoses of intra-abdominal pathologies are the key to patolojilerin ayırıcı tanısında primer epiploik apandajit correct diagnosis. Since the conservative treatment is sufficient in farkındalığı ile ultrason ve tomografi gibi görüntüleme most of cases, accurate and timely diagnosis can ensure the çalışmaları doğru tanı koymada anahtar role sahiptir. appropriate patient management and can prevent unnecessary Konservatif tedavi çoğu durumda yeterli olduğundan doğru hospitalizations and interventions. -
Spontaneous Hemoperitoneum in Sigmoid Diverticular Disease
ACS Case Reviews in Surgery Vol. 2, No. 5 Spontaneous Hemoperitoneum in Sigmoid Diverticular Disease AUTHORS: CORRESPONDENCE AUTHOR: Sukhmine Nedopil, MD; Sukhmine Nedopil, MD Shahin Foroutan, MD, FACS Department of Surgery 500 West Hospital Rd French Camp, CA 95231 Email: [email protected] Phone: 916-835-5368 Background A 52-year-old man presented with acute abdominal pain and hemoperitoneum. Summary Intraperitoneal hemorrhage from colonic diverticulum is rare. We report a case of a 52-year-old man with hemoperitoneum diagnosed by computed tomography scan of the abdomen and pelvis with intravenous contrast. Postoperative histopathological findings revealed the cause of hemoperitoneum as erosion of sigmoid diverticulum into a serosal vessel. This subsequently caused the vessel to bleed intraperitoneally. The operation included sigmoid resection and temporary colostomy placement. Postoperative colonoscopy did not find any dysplastic pathology in the rectal stump or colon. Patient was anastomosed three months later. Conclusion Diverticular disease has a spectrum of presentation. Hemorrhage from diverticular disease is more commonly intraluminal presenting with lower gastrointestinal bleed. We present a case of extraluminal hemorrhage in diverticular disease. This highlights a rare but potentially life-threatening complication of colonic diverticular disease. Keywords hemoperitoneum, diverticulum, sigmoid colon, bleeding DISCLOSURE STATEMENT: The authors have no conflicts of interest to disclose. To Cite: Nedopil S, Foroutan S. Spontaneous Hemoperitoneum in Sigmoid Diverticular Disease. ACS Case Reviews in Surgery. 2020;2(5):48–51. American College of Surgeons – 48 – ACS Case Reviews. 2020;2(5):48-51 ACS Case Reviews in Surgery Nedopil S, Foroutan S Case Description A 52-year-old man presented to the emergency department with severe abdominal pain that progressed over three days associated with nausea and chills.