Sudden Onset Of Abdominal Pain Research Articles

Abstract #1407180: Drug Induced Acute Pancreatitis Secondary to Ezetimibe

Drug induced acute pancreatitis (DIAP) is a rare clinical entity with incidence of <2% in general population. Most cases are typically mild and have excellent prognosis but prompt diagnosis and cessation of offending drug is important to avoid adverse outcomes. A 58-year-old female former smoker with history of COPD and hyperlipidemia presented to the hospital with sudden onset abdominal pain radiating to the back associated with nausea and vomiting for 12 hours. On arrival vitals were normal and physical examination showed epigastric tenderness with negative murphy’s sign. Labs showed normal CBC and CMP with elevated serum lipase (2469 U/L – Normal 16 - 61 U/L) concerning for acute pancreatitis. CT abdomen and pelvis showed normal biliary tract. US of the abdomen showed no evidence of gall stone or biliary sludge. Serum lipid panel showed total cholesterol of 193, HDL of 66, LDL of 111 and triglyceride of 87. Serum Calcium was normal. Detailed history revealed no alcohol but that patient recently started ezetimibe 10 mgs daily 8 weeks prior to present due to history of statin intolerance. Her only other medication was inhaled Albuterol taken as needed. Immune panel include IgG-4 was negative. Patient was diagnosed with drug induced acute pancreatitis secondary to ezetimibe, and was managed conservatively cessation of ezetimibe, pain meds and bowel rest. Her overall condition improved in 48 hours and diet was progressed. She was discharged with outpatient follow up. Serum lipase dropped to 74 U/L prior to discharge. Drug induced pancreatitis account for ∼ 5% of all cases of pancreatitis. There is limited data on the exact mechanism by which drugs can induce pancreatitis as most evidence is bases on case reports or meta-analysis. On the basis of these case reports drugs are classified from class I-IV depending on the probability to cause pancreatitis. Some proposed mechanisms include immunologic reactions, direct toxic effect, accumulation of a toxic metabolite, ischemia, intravascular thrombosis, and an increased viscosity of pancreatic juice. Though most cases are mild the identification of the offending drug is crucial to prevent ongoing damage and recurrence. However, in most instances the diagnosis of drug induced pancreatitis and identification of offending drug can be challenging due to the presence of multiple agents. Current proposed criteria for identification include: 1) Pancreatitis develops during treatment with the drug, 2) Other likely causes of pancreatitis are not present 3) Pancreatitis resolves upon discontinuation of the drug and 4) Pancreatitis usually recurs upon re-administration of the drug. Our patient fulfilled 3 of the above criteria which suggest Ezetimibe induced Pancreatitis. Prior to this case there is one more case reported cases of Ezetimibe induced Pancreatitis but in both the cases there is no re-challenge of Ezetimibe which makes it a Class IV drug to cause pancreatitis.

A case report on surgeon’s perseverance: post ileal type appendicular perforation with concealed abscess-laparoscopic appendectomy

In humans, the vermiform appendix is not a vestigial organ, but rather a lymphoid structure that, when inflamed, causes major problems. Acute appendicitis is characterized by pain and soreness in the right iliac fossa, along with nausea and anorexia. Depending on the location of the appendix, it may appear in an unusual manner. In post-ileal type appendicitis, pain is more concentrated around the umbilicus, and pain shifting may be absent. In this scenario, an ultrasound of the abdomen may not be particularly useful, but a CT scan of the abdomen may aid in the diagnosis. A delay in diagnosing and treating acute appendicitis can have disastrous consequences. We now present the case report of a 20-year-old male patient with chief complaints of sudden onset of abdominal pain over umbilical region, squeezing type radiating to right lumbar region, for 3 days. On clinical examination, the patient had presence of tenderness at McBurney’s point over the right iliac fossa and periumbilical area. The diagnostic investigations of GI endoscopy report showed grade A esophagitis and hemorrhagic gastropathy. CT report shows acute appendicitis with contained perforation and appendiceal abscess. Post ileal appendicular perforation with concealed abscess was treated with laparoscopic appendectomy under general anesthesia.

A PROSPECTIVE CLINICAL STUDY ON PREGNANCY WITH ABRUPTIO PLACENTAE IN WOMEN ATTENDING A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- Placental abruption is a relatively rare but serious complication of pregnancy and placed the well-being of both mother and fetus at risk. Placental abruption is also called abruptio placentae. The estimated incidence is around 1% of all pregnancies. Despite being a relatively rare occurrence, placental abruption needs urgent intervention. Most placental abruptions happen before 37 weeks of pregnancy. Maternal morbidity and neonatal mortality are primarily caused by placental abruption. Despite the fact that blood transfusions are available, maternal deaths are nonetheless uncommon and higher than the overall maternal mortality rate. Preterm birth, low birth weight, perinatal hypoxia, stillbirth, and neonatal mortality are all neonatal consequences. Even with better prenatal care and monitoring methods, the rate of placental abruption has been rising in several nations. The present study Material and Method- is a prospective study done in the Department of Obstetrics and Gynecology, M.G.M Medical College and M.Y Hospital, Indore, over a period of 1 year from March 2021 to February 2022.. All cases are admitted in Department of Obstetrics and Gynaecology, M.G.M Medical College and M.Y Hospital, Indore. The study will include prospective cases for 1 year from ethics committee Inclusion Criteria- 1. All cases of concealed and revealed abruption with gestational age &gt; 28 weeks till term. 2. All abruption with clinical symptoms of sudden onset abdominal pain, vaginal bleeding and uterine tenderness 3. All patients of abruptio placentae diagnosed on USG ndings. Exclusion Criteria- 1. All patients who come with the history of Ante partum hemorrhage but are having local (vaginal/cervical)causes excluded. 2. All patients referred to the hospital for the management of post-partum complications. 3. All other causes of APH like placenta previa and other extra placental causes. Result- Majority of the study population were booked multigravida in the age group of 26-30 years of low socioeconomic status with B+ blood group with anemia and gestational hypertension as risk factors.Most of them underwent LSCS with Shock and sepsis as complications 80% study participants had live and healthy baby. 20% had perinatal death. 47.9% of the babies were low birth weight and 25% required resuscitation Without a doubt, abruptio placent Conclusion- ae is a potentially serious obstetric condition that has the potential to threaten mother health and wellbeing, foetal viability, neonatal mortality, and morbidity. We found that important risk factors for abruptio placenta are multiparty, unbooked status, living in a rural area, maternal anaemia, and hypertension and also it is independent risk factor for perinatal mortality. From the present study we conclude that to prevent and lessen the severity of the situation early intervention, prompt delivery, and strengthening of safe motherhood services, particularly in remote regions will be helpful.

When the Spleen Breaks: A Rare Case of Spontaneous Splenic Rupture and the Diagnostic Significance of CT Scan

Purpose: This case report aims to discuss the rare occurrence of spontaneous splenic rupture and the utility of CT scans in its diagnosis and management. Presentation of Case: A 58-year-old chronic smoker presented to the emergency department with sudden-onset abdominal pain. He was diagnosed with splenic rupture based on clinical presentation and imaging findings, including an enlarged spleen and abdominal fluid on CT scan. The patient underwent splenectomy, with histological examination confirming the diagnosis. Discussion: CT scan is a commonly used imaging technique in the diagnosis of splenic masses, providing a high resolution, cross-sectional view of the spleen and surrounding structures. The use of contrast agents enhances the differentiation between vascular and non-vascular lesions and improves the accuracy of diagnosis. Other imaging techniques such as ultrasound, MRI, and PET-CT may also be used. The treatment of splenic masses depends on the underlying etiology and the clinical status of the patient. Conclusion: The CT scan findings in this case suggest a splenic mass, which was confirmed to be a decapsulated spleen on histological examination after splenectomy. The use of imaging techniques such as CT scan is important in the diagnosis and management of splenic masses, aiding in preoperative planning and postoperative monitoring. Postoperative management of splenic rupture typically involves pain control, antibiotic therapy, and lifelong prophylactic antibiotics and vaccinations to reduce the risk of infection. This case report discusses a rare case of spontaneous splenic rupture and highlights the diagnostic and management utility of CT scans. The patient, a 58-year-old chronic smoker.

A case of strangulated intestinal obstruction due to ileo-ileal true knot: Peculiar computed tomography findings

Nodule formation of the intestine is a rare disease, and the ileo-ileal type is extremely rare. We herein report a pediatric case of strangulated intestinal obstruction due to an ileo-ileal true knot. A 9-year-old boy with no medical history was referred to our hospital complaining of sudden-onset abdominal pain. An emergent laparotomy was performed under the diagnosis of strangulated intestinal obstruction. Two intestinal loops formed a true knot. After releasing the strangulation, resection of the necrotic intestine and intestinal anastomosis were performed, and the post-operative course was uneventful. On a retrospective examination of computed tomography findings, a particular S-shaped whirl sign was recognized as a feature of imaging findings. This is the youngest case report of ileo-ileal true knot in Japan. The S-shaped whirl sign may be an imaging feature of the disease.

Demons-Meigs Syndrome with a High CA 125 Level: A Case Report at Soavinandriana Center Hospital Antananarivo

Introduction: Demons-Meigs syndrome combines a benign tumor of the ovary with ascites and pleural effusion. It is a rare disease and the pathophysiological mechanism is not yet well understood. The aim of our study is to report a case of Demons-Meigs syndrome, to determine its different characteristics and to make clinicians aware of the malignant predictive value of CA 125 in front of an ovarian tumor. Observation: The patient was 42 years old and had no previous history. She presented with intense abdominal pain of sudden onset, prompting a medical consultation. On clinical examination, the abdomen was distended with signs of peritoneal effusion and right pleural effusion. Ultrasound revealed a well-circumscribed, ovarian mass with an internal fluid component and hypervascularization on Doppler. The CA 125 level was elevated (293.9 U/ml). Exploratory laparotomy revealed two bilateral, firm, solid ovarian tumors without vegetation or peritoneal lesions. Macroscopically, one of the tumors was well circumscribed, lobulated with a smooth outer surface. It measured 20 × 17 × 8 cm and weighed 1400 g. The other tumor measured 19 × 11 × 5 cm, weighed 1090 g and had the same characteristics as the other tumor. Histologically, both tumors were a proliferation of fibroblastic spindle cells organized in short intersecting or storiform bundles, without cyto-nuclear atypia or excess mitoses. The diagnosis retained was bilateral ovarian fibroma in the context of a Demons-Meigs syndrome. Conclusion: Demons-Meigs syndrome is a rare entity. The concomitant elevation of the CA 125 level is not always an indicator of ovarian cancer. The curative treatment is surgical based on tumor removal ensuring the disappearance of peritoneal and pleural effusions.

Gastric volvulus in elderly patient: a case report, approach and literature review

Background: Acute gastric volvulus is a rare condition that can cause significant morbidity and mortality. The presenting complaint is usually due to symptoms related to gastric outlet obstruction, which might include abdominal pain, nausea and vomiting, bowel obstruction, and even perforation or peritonitis. Case Presentation: A case of acute gastric volvulus was presented in a 78-year-old woman with a complaint of epigastric pain. The patient presented with a sudden onset of abdominal pain and vomiting. She was diagnosed with acute gastric volvulus on abdominal imaging and was successfully treated with laparoscopic surgery. Conclusion: This case highlighted the importance of considering gastric volvulus in the differential diagnosis of acute abdominal pain, especially in patients with underlying risk factors.

Acute Mesenteric Ischaemia: A Case Series

Acute Mesenteric Ischaemia (AMI) is a group of disorders characterised by a sudden occlusion of blood supply to varing portions of the small intestine, eventually progressing to ischaemia and peritonitis. The present case series highlights a total of seven cases, three of which are classified as acute superior mesenteric artery thrombosis and four as acute superiormesenteric vein thrombosis. The typically symptoms reported were sudden onset of abdominal pain, distension, and melena (a late finding). Among the seven cases, four patients who received early intervention had favourable outcomes. All patients presented late with peritonitis symptoms, except for one patient. Emergency laparotomy was performed on all patients, except for one who underwent diagnostic laparoscopy. Therefore, although abdominal pain is an uncommon symptom, physicians need to exercise a high level of diligence. If left untreated, the overall mortality rate consistently exceeds 70-90%. This case series emphasises the importance of timely diagnosis, early intervention, and immediate postoperative heparinisation, which significantly decrease morbidity and mortality.

Ekipa hitne pomoći kao slučajni svedok rituala egzorcizma kod trudnice islamske veroispovesti

Introduction/Aim No known religion in the world has remained immune to the issue of magic, obsession, and exorcism. We present the first recorded case in our country, a religious exorcism ritual performed on a Muslim woman in her third month of pregnancy. The Emergency Medical Team (EMT) was dispatched to deal with sudden-onset abdominal pain which had occurred during the ritual of exorcism, to which the EMT was an unexpected witness. Case report The EMT responded to a call requesting medical assistance for an 18-year-old pregnant woman of Roma nationality and Muslim religion, who had experienced a short-term loss of consciousness accompanied by body tremors. Upon arriving at the scene, the EMT walked in on a religious ritual of exorcism, which was performed by a Muslim priest. After the ritual was completed, the patient was examined by the EMT doctor. The patient gave anamnestic data about sudden onset upper abdominal pain with an urge to vomit, which occurred about 15 minutes before the EMT was called. She associated her current condition with black magic and an evil force (a demon) that had entered her during a short walk. She stated that she had experienced this type of pain before but did not at that time ask for medical help, because the exorcism ritual had worked and resolved the situation. She denied having previous illnesses and medical treatments and stated that everything was fine during regular examinations by her gynaecologist. Upon examination, she was found to be afebrile, eupneic, euglycemic, and normotensive, with a normal heart rate, and naturally darker skin. Upon auscultation, her heart and lung sounds were found to be normal. When palpated, her abdomen was found to be soft and slightly painful in the stomach region. Her peristalsis was audible. The position of her uterus was normal inside the pelvis, the size of a larger orange or grapefruit. Other findings were normal. The patient was transported to a gynaecology and obstetrics hospital with the diagnosis of abdominal pain of unknown cause She was also referred to be examined by a psychiatrist. Conclusion In anticipation of new scientific views on this increasingly common topic, doctors find themselves in a position where they must find a balance between the patients' religious beliefs and realistic clinical diagnoses while caring for such patients, respecting moral, ethical, and legal norms.

7675 Tri-Topic Pregnancy: A Case of Spontaneous Triplets in Three Distinct Locations

<h3>Study Objective</h3> To present a case of spontaneous triplet pregnancy consisting of a single intra-uterine pregnancy and two distinct ectopic pregnancies and review the literature regarding interstitial pregnancy management. <h3>Design</h3> Case report. <h3>Setting</h3> Tertiary care hospital. <h3>Patients or Participants</h3> One patient. <h3>Interventions</h3> 29-y/o G3P2002 at approximately seven weeks gestational age by LMP with history significant for two prior full-term cesarean sections presented to the emergency department with severe, sudden onset abdominal pain. Beta-HCG was greater than 200,000. Bedside transabdominal ultrasound was limited by degree of pain; however, it revealed a fetal pole measuring eight weeks with cardiac activity surrounded by a sizable layer of myometrium, as well as an additional fetal pole with cardiac activity laterally with a thin surrounding layer of myometrium. Given severe pain in early pregnancy, ruptured ectopic pregnancy was presumed and the patient was consented for a diagnostic laparoscopy and removal of ectopic pregnancy. Intraoperatively, approximately 500cc of hemoperitoneum and both an interstitial pregnancy and an ampullary pregnancy were appreciated. Laparoscopic unilateral salpingectomy and cornuectomy were performed. Ultrasound postoperatively surprisingly demonstrated a third remaining viable intrauterine pregnancy. The patient denied any history of ART. <h3>Measurements and Main Results</h3> Pathology confirmed ectopic pregnancies in both specimens. Laparoscopic excision of two ectopic pregnancies was safely performed in this patient with maintenance of a viable, intrauterine pregnancy. Excision of the interstitial pregnancy posed greatest risk to both the patient and concurrent intrauterine pregnancy. Care was taken during cornuectomy to minimize entry depth into surrounding myometrium and blood loss. <h3>Conclusion</h3> The incidence of heterotopic pregnancy without ART is approximately 1 in 30,000. Furthermore, interstitial pregnancies make up only 1-4% of ectopic pregnancies. Laparoscopic management of interstitial pregnancies has been repeatedly demonstrated as a safe approach. We present a rare case of a ruptured triplet heterotopic pregnancy with minimal risk factors managed successfully with laparoscopic removal technique and maintenance of intrauterine pregnancy.

Clinical impact of surgical treatment for the spontaneously ruptured resectable hepatocellular carcinoma: A single institution experience

Spontaneously ruptured hepatocellular carcinoma (srHCC) is a fatal complication of hepatocellular carcinoma (HCC). In addition, emergency treatment is frequently fraught with difficulties. This study aimed to investigate the prognosis and recurrence pattern in patients undergoing hepatectomy for the srHCC. This retrospective study included 11 patients with srHCC treated using either emergency hepatectomy or emergency transarterial embolization (TAE) followed by staged hepatectomy between January 2015 and December 2019. The patients visited the emergency room because of a sudden rupture of HCC without being diagnosed with HCC. We analyzed the prognosis, recurrence rate, and survival in these patients after hepatectomy. Four of the 11 patients in this study were classified as Child–Pugh class A and 7 as Child–Pugh class B. Nine patients visited for sudden onset of abdominal pain, and 2 for sudden onset of shock. The median hemoglobin level at the time of the visit was 11.5 g/dL (interquartile range: 9.8–12.7). Five patients underwent one-stage hepatectomy and 6 underwent emergency TAE hemostasis followed by staged hepatectomy. Median overall survival and recurrence-free survivals were 23 and 15 months, respectively. Recurrence occurred in 7 patients (4 in the one-stage group and 3 in the staged group). Among patients with recurrence, 6 had intrahepatic recurrence and 3 peritoneal metastases. Patients with srHCC who undergo staged hepatectomy can achieve a relatively good prognosis. The most common sites of recurrence after hepatectomy are intrahepatic and peritoneal. Peritoneal metastases are more likely to occur after one-stage hepatectomy.

Anterior Renal Nutcracker Syndrome in an Older Adult Treated with Endovascular Stenting

Anterior nutcracker syndrome occurs when the left renal vein is compressed between the abdominal aorta and the superior mesenteric artery. A 71-year-old woman presented to hospital with sudden-onset intense lower abdominal pain with radiation to the left flank region. Her lab work was significant for hemoglobin 9.8 G/DL (11.7 - 15.0 G/DL), creatinine 1.52 mg/dL (0.50 - 1.10 mg/dL) and microscopic examination of the urine contained red blood cells. Computed tomography scan of the abdomen &amp; pelvis with contrast showed left renal vein narrowing as it crosses between the superior mesenteric artery and the aorta, consistent with nutcracker sydnrome. The patient underwent a venogram study alongside intravascular ultrasound and was treated with left renal vein wall stenting and venoplasty. She tolerated the procedure well and was successfully discharged on daily anticoagulation with rivaroxaban for one month with close follow-up.

A Review on Treatment of Perforated Peptic Ulcer by Minimally Invasive Techniques.

Peptic ulcers are caused by acid peptic damage to the mucosal layer in the gastro-duodenal area of the gut, which results in mucosal erosion that exposes the underlying tissues to the digestive action of gastro-duodenal secretions. This pathology was traditionally related to a hypersecretory acid environment, dietary factors and stress. There are other causes of ulcers such as Helicobacter pylori infection, excessive use of NSAIDs, and smoke and alcohol abuse. Perforation and bleeding are two major complications of the disease. A typical symptom of perforated peptic ulcers (PPU) is a sudden onset of abdominal pain or acute deterioration of the ongoing abdominal pain. Perforated peptic ulcer can be diagnosed by a simple X-ray and CT scan of the abdomen. Laboratory tests are also run to rule out differential diagnosis. Although there are several choices for surgical intervention, minimally invasive techniques have been taking over as a frequent option in feasible cases. Techniques like laparoscopy have been surfacing because of their advantages. But the efficiency of minimally invasive techniques compared to conventional approach is yet to be defined. Hence, the present review of the literature aims to describe and delineate the current perspective on PPU management by minimally invasive and low risk techniques.

Acute abdomen due to anaphylactic intestinal edema associated with systematic mastocytosis: a case report

BackgroundAmong various anaphylactic conditions resulting in acute abdomen, mast cell activation disorders, although rare, are included in the differential diagnosis.Case presentationThis report describes a 63-year-old Caucasian man who was brought to the emergency room with sudden onset abdominal pain, vomiting, and diarrhea, with breathing difficulty, and with facial swelling after quarrelling with an acquaintance. Computed tomography showed edematous and swollen intestines, consistent with splenomegaly. Physical findings included maculopapular cutaneous mastocytosis. He also had a long history of repeated episodes of anaphylaxis requiring occasional epinephrine auto-injector administration; however, the precise cause of anaphylaxis was previously undetermined. Blood tests showed high serum concentrations of soluble IL-2R and tryptase, suggesting mast cell-related disease. Subsequent biopsies of his bone marrow and cutaneous rash confirmed the diagnosis of systemic mastocytosis (SM).ConclusionSM was diagnosed in a patient with acute abdomen who visited the emergency room.

EP-449 Gall Bladder Torsion - A twist in tale

Abstract Introduction A 90 year old lady presented with history of sudden onset abdominal pain. The pain was continuous, severe with a tender abdomen. Methods Blood investigations were not conclusive. A CT of the abdomen revealed a possible torsion of the gall bladder around its axis with impending gangrene. She went on to have a successful emergency laparoscopic cholecystectomy. Results A work up and successful surgical intervention with an extremely unusual gall bladder presentation of torsion.

Transvaginal small bowel evisceration: Case report and review of literature.

IntroductionTransvaginal evisceration is a rare life-threatening condition that is usually seen in postmenopausal women with past history of gynaecological surgery.Presentation of caseA 54-year-old woman presented with sudden-onset abdominal pain and protrusion of a mass through the vagina after her grandson jumped on her abdomen while at play. She had undergone laparoscopic total hysterectomy and bilateral salpingo-oophorectomy 9 months earlier. Physical examination revealed an intestinal loop in the vagina. She was immediately taken to the operating room. Laparotomy was performed and the prolapsed intestine was reduced. The bowel from the duodenojejunal junction to the ileocecal valve looked healthy, with no areas of ischemia. The rupture in the vaginal vault was repaired with Vicryl. The postoperative course was uneventful, and the patient was discharged on day 5 after the surgery.DiscussionLess than 100 cases of transvaginal evisceration have been reported. The condition, which is more common in postmenopausal women, usually presents with sudden-onset abdominal pain. Some patients may be asymptomatic and only complain of swelling at the introitus. Diagnosis can usually be made by visual examination. Immediate surgery is necessary to reduce the risk of intestinal ischemia and necrosis.ConclusionTransvaginal evisceration must be suspected in any woman presenting with sudden-onset abdominal/pelvic pain. Awareness of this rare condition is necessary to minimize mortality.

Unilateral Adrenal Infarction in Pregnancy: A Case Report

Adrenal infarction is usually associated with bilateral adrenal hemorrhage in the setting of antiphospholipid syndrome or hemodynamic variation. Few cases of unilateral non-hemorrhagic adrenal infarction have been described in the literature. Here, we report a case occurring during pregnancy. A 27-year-old woman was infected by coronavirus four months ago and presented at 35 weeks of gestation with sudden-onset right abdominal pain without contractions. Unilateral adrenal infarction was diagnosed following computed tomography. It showed an enlarged right adrenal, without hyperenhancement. The patient’s adrenal hormonal function was normal. Accurate diagnosis of non-hemorrhagic adrenal infarction remains difficult as its clinical presentation is not specific. It can only be performed with adrenal imaging. Magnetic resonance imaging shows diffuse enlargement of one or both adrenals and edema on T2-weighted images. Anticoagulation therapy may be discussed. Patients should be evaluated between 3 and 6months after the event to assess adrenal size and function. In summary, non-hemorrhagic adrenal infarction during pregnancy is probably underdiagnosed and obstetricians should be aware of this diagnostic difficulty.

Was It a Case of “Flatbush Diabetes” with Severe Hypertriglyceridemia?

AbstractWe present a case of a morbidly obese 27 years male patient who was admitted with sudden onset abdominal pain and crashed into diabetic ketoacidosis as new-onset diabetes and discuss the possible etiology of this combined picture of acute pancreatitis and severe hypertriglyceridemia. Flatbush diabetes was, meanwhile, thought of due to his morbid obesity that in turn raised our suspicion of acute insulin-requiring type 2 diabetes mellitus versus T1 diabetes mellitus. Ketosis-prone diabetes or Flatbush diabetes is a syndrome in which diabetes commences with ketoacidosis in patients who are glutamic acid decarboxylase and antiislet cell antibody negative and have no known precipitating causes. They are usually middle-aged, overweight, or mildly obese, and in many reports, they are likely to be male with a family history of type 2 diabetes mellitus; they present with new-onset severe hyperglycemia and ketosis or frank diabetic ketoacidosis. After intensive initial insulin therapy, many patients become insulin-independent and can be well controlled on diet plus oral medications or, more rarely, diet alone.

Strangulated small bowel obstruction caused by isolated obturator nerve and pelvic vessels after pelvic lymphadenectomy in gynecologic surgery: two case reports

BackgroundAlthough small bowel obstruction (SBO) is a major complication occurring after abdominal surgery, few reports have described strangulated SBO after pelvic lymphadenectomy (PL). This report describes two cases of strangulated SBO caused by a skeletonized obturator nerve and pelvic vessels after laparoscopic PL during gynecologic surgery.Case presentationCase 1: A 57-year-old woman with endometrial cancer underwent a laparoscopic semi-radical total hysterectomy with PL. Nine months after the operation, she visited our emergency room complaining about subacute pain spreading in the right groin, right buttock, and dorsal part of the right thigh. She had no abdominal pain. Although her symptoms were not typical, computed tomography (CT) revealed strangulated SBO in the right pelvis. Laparoscopic surgery revealed that the small bowel was ischemic. Then we converted to open surgery. We transected the right obturator nerve and umbilical artery, which constructed an internal hernia orifice in the right pelvis, followed by resection of the ischemic small bowel. Fortunately, during 6-month follow-up, she showed only slight difficulty in walking as a postoperative complication. Case 2: A 62-year-old woman with cervical cancer underwent laparoscopic radical hysterectomy with PL. Six months after the operation, she visited our hospital emergently because of sudden onset of abdominal pain and vomiting. CT showed strangulated SBO. Urgent laparoscopic surgery exhibited the incarcerated small bowel at the right pelvis. Consequently, we converted to open surgery. The terminal ileum was detained into the space constructed by the right umbilical artery. We cut the umbilical artery and performed ileocecal resection. After the surgery, she was discharged with no complication or sequela.ConclusionWhen examining a patient after PL who complains of severe pain or symptoms, one should consider the possibility of PL-related SBO, even if the pain is apparently atypical for SBO.

Spontaneous Rupture of an Unscarred Non-Laboring Gravid Uterus at Term: A Case Report

Background: Rupture of the pregnant uterus is life-threatening for the mother and fetus. Most ruptures occur in women who have had a previous transmyometrial surgical incision, typically for cesarean delivery. Rupture of the unscarred uterus is rare, but the incidence is increasing. It is associated with higher major maternal and neonatal morbidity than cases of rupture of the scarred uterus. Case presentation: Here we presented a case of 36 years old gravida 4 para3 presented at gestational age of 38 weeks with vomiting of ingested matter mixed with blood and abdominal pain of 12 hours and, initially diagnosed to have Placenta previa, severe anemia secondary to acute blood loss secondary to upper gastrointestinal bleeding, Intrauterine fetal death. Finally diagnosed to have uterine rupture and total abdominal hysterectomy done. Conclusion: A high index of suspicion is needed in pregnant patients presenting with sudden onset of abdominal pain so as not to miss uterine rupture and its complications.