Abdominal Scan Research Articles

Acute Calculus Cholecystitis Misdiagnosed As Ileocecal Tumor in an Elderly Male: Review of the Ultrasonographic Findings: A Case Report

Gallstones present as acute calculus cholecystitis in about 20% of individuals with symptomatic disease, having a wide range of symptom severity. The adult population is most often affected in about 10-15% within the developed countries. This is a 75-year-old man that was referred for a confirmatory ultrasonography from a peripheral health centre on account of an entertained ileocecal tumor following an abdominal ultrasound scan done in a local health care facility. The patient had an abdominal ultrasonography that showed an impacted calculus in the infundibulum of the gallbladder measuring about 30mm x 30mm in dimension with associated distended gall bladder; this shows thick and trabeculated wall, heterogenous content with circumferential hypoechoic halo of acute cholecystitis. The patient had percutaneous cholecystectomy in the peripheral care facility and was reported to have done considerably well for discharge. We report the ultrasonographic findings of acute calculus cholecystitis due to its peculiarity and presentations.

A rare case of hyalinising cholecystitis with calcification – A case report

Hyalinising cholecystitis is a rare type of chronic cholecystitis characterised by dense, paucicelluar hyaline fibrosis, often with extensive effacement of normal histologic structures, relatively sparse inflammation, and minimal to no dystrophic calcification. We report a 64-year-old female who underwent routine health screening including an abdominal ultrasound scan. The gallbladder was noted to have mural calcification which was interpreted to represent porcelain gallbladder, and the patient was counselled for surgery in view of the risk of malignancy.

Noninvasive Aortic Ultrafast Pulse Wave Velocity Associated With Framingham Risk Model: in vivo Feasibility Study.

BackgroundAortic pulse wave velocity (PWV) enables the direct assessment of aortic stiffness, which is an independent risk factor of cardiovascular (CV) events. The aim of this study is to evaluate the association between aortic PWV and CV risk model classified into three groups based on the Framingham risk score (FRS), i.e., low-risk (<10%), intermediate-risk (10~20%) and high-risk (>20%).MethodsTo noninvasively estimate local PWV in an abdominal aorta, a high-spatiotemporal resolution PWV measurement method (>1 kHz) based on wide field-of-view ultrafast curved array imaging (ufcPWV) is proposed. In the ufcPWV measurement, a new aortic wall motion tracking algorithm based on adaptive reference frame update is performed to compensate errors from temporally accumulated out-of-plane motion. In addition, an aortic pressure waveform is simultaneously measured by applanation tonometry, and a theoretical PWV based on the Bramwell-Hill model (bhPWV) is derived. A total of 69 subjects (aged 23–86 years) according to the CV risk model were enrolled and examined with abdominal ultrasound scan.ResultsThe ufcPWV was significantly correlated with bhPWV (r = 0.847, p < 0.01), and it showed a statistically significant difference between low- and intermediate-risk groups (5.3 ± 1.1 vs. 8.3 ± 3.1 m/s, p < 0.01), and low- and high-risk groups (5.3 ± 1.1 vs. 10.8 ± 2.5 m/s, p < 0.01) while there is no significant difference between intermediate- and high-risk groups (8.3 ± 3.1 vs. 10.8 ± 2.5 m/s, p = 0.121). Moreover, it showed a significant difference between two evaluation groups [low- (<10%) vs. higher-risk group (≥10%)] (5.3 ± 1.1 vs. 9.4 ± 3.1 m/s, p < 0.01) when the intermediate- and high-risk groups were merged into a higher-risk group.ConclusionThis feasibility study based on CV risk model demonstrated that the aortic ufcPWV measurement has the potential to be a new approach to overcome the limitations of conventional systemic measurement methods in the assessment of aortic stiffness.

P164 Assessment of awareness and compliance with the recommendations of primary and secondary prevention of cancer in patients with Inflammatory Bowel Disease

Abstract Background Patients with Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are at risk of developing malignancies, so prevention and adherence to cancer screening may improve its detection. The aim of this study was to asses the compliance with medical recommendations, especially primary and secondary prevention of cancer. Methods This prospective, one-center study was carried out between June and October 2021r. amongst patients from Department of Internal Medicine and Gastroenterology with IBD Division, Central Clinical Hospital of Ministry of Interior Affairs and Administrations, Warsaw, Poland. Patients were asked to complete anonymous questionnaire which included 42 questions concerning lifestyle, cancer risk factors, cancer history, and checkups in patients with IBD. Results A total of 190 patients with IBD were included in survey. 117 (61.6%) had CD, 67 (35.3%) UC and 6 (3.2%) unclassified disease. 43.7% were women and more than a half of them had &amp;gt;8 years of the length of the disease. In total 84.2% were taking mesalazine, 48.4% immunosupresive medication and 77.9% biological treatment. Statistically significantly (p=0.034) more patients with CD than those with UC practiced regular physical activity (respectively 65.8% and 48.5%). Patients with UC more often were non-smokers (76.7% vs 92.5% for CD and UC respectively; p=0.007). 39.7% of patients with CD and 27.3% with UC declared alcohol consumption (p=0.128). Only 6% of patients responded not to use sun protection measures when sun-bathing but 24.8% with CD and 34.4% with UC didn’t have regular full-body skin examinations. 78.7% of patients had abdominal ultrasound scan performed in the last year. Out of 52.7% who had colonoscopy recommended, 49.3% of patients declared that the examination was carried out (36.8% of CD and 65.5% of UC; p= 0.038) and another endoscopy was scheduled (18.6% of CD and 48.4% of UC; p&amp;lt;0.001). According to respondents cholangio-MRI was recommended to 14.3% patients with CD and 6.2% with UC (p=0.219). Only 1 patient in both groups did not perform this examination. Most of the examinations were recommended by gastroenterologists. Moreover, in the last 12 months 59.6% of female answerer declared to have ultrasound imagining of the breast and 98.7% gynecological examination performed (65.4% had regular Pap-test screening). 82.3% of respondents knew about HPV vaccination but only 25% were vaccinated. Conclusion Our study reveals that many of IBD patients are exposed on risk factors of malignancies. Screening for cancer and regular checkups should be regularly performed. Primary prevention, such as HPV vaccinations, should be reminded to all patients.

Woman With Abdominal Pain

A previously healthy 41-year-old woman presented to the emergency department with acute epigastric pain and vomiting 3 hours after eating raw mackerel caught by her husband. Her pulse rate was 69 beats/min and temperature was 36.5 °C (97.7 °F). Findings of laboratory studies were normal. An abdominal ultrasound scan showed localized edema of the gastric mucosa (Figure 1).

Spontaneous Reduction of Intussusception in Infants: Is the Glass Half Empty or Half Full?

Background: Intussusception is not an uncommon abdominal surgical emergency in children. However, spontaneous reduction of intussusception is possible, though uncommon. Materials and Methods: This was a retrospective study of the characteristics of infants who had spontaneous reduction of intussusception at a tertiary hospital in Enugu, Nigeria. The study covered a 5-year period. Diagnosis of intussusception was made and confirmed based on clinical features and imaging (ultrasound) findings respectively. Results: A total of 383 cases of intussusception in infants were confirmed during the study period. Out of this number, 12 infants had spontaneous reduction. These gave a spontaneous reduction rate of 3.1% and form the basis of this report. The mean age of the patients was 6 months and there was male predominance. Abdominal pain was the most common symptom and the patients had abdominal ultrasound scan. Majority of the patients had normal serum electrolyte values. Two-thirds of the spontaneous reduction occurred preoperatively while one-third of the reductions were noticed intra-op. No definitive operative procedure was performed because the intussusception had resolved spontaneously. www.wjclinicalsurgery.com 1 Conclusion: Spontaneous reduction of intussusception is an uncommon event that may occur without stimulation. This study has shown that about 3 in 100 cases of intussusception in infants may reduce spontaneously. However, it must be emphasized that all efforts should be geared towards nonoperative or operative treatment of intussusception, as spontaneous reduction is not an option of treatment.

An evaluation of patients with abdominal pain after lateral lumbar interbody fusion.

ContextAbdominal pain after surgery can occur for numerous reasons. Postoperative radiographs may be indicated to evaluate for ileus or other reasons for the pain. Whether outcomes are significantly different based on whether patients get radiographs following lateral lumbar interbody fusion (LLIF) are unclear.Aims:To investigate the postoperative outcomes of patients experiencing abdominal pain after LLIF.Settings and Design:This retrospective cohort study included patients at a tertiary academic medical center and surrounding affiliated hospitals.Materials and Methods:Patients >18 years of age who underwent elective LLIF at a single institution were retrospectively identified. Patients were stratified into two groups depending on whether they received a postoperative abdominal radiograph or computed tomography (CT) scan for postoperative abdominal pain.Statistical Analysis:Patient demographics, surgical characteristics, and surgical outcomes were compared between groups utilizing independent t-tests or Mann–Whitney U-tests for continuous variables or Pearson's Chi-square tests for categorical variables.Results:A total of 153 patients (18 with abdominal scans, 135 without) were included. Patients who received a postoperative abdominal radiograph or CT scan were more likely to undergo exploratory laparotomy (11.1% vs. 0.00%, P = 0.013). Ultimately, patients with abdominal scans had a longer hospital length of stay (6.67 vs. 3.79 days, P = 0.002) and were discharged home less frequently (71.4% vs. 83.7%, P = 0.002).Conclusions:Patients who received abdominal imaging after LLIF were more likely to undergo exploratory laparotomy, experience longer hospital length of stay, and were discharged home less frequently. Intra-abdominal air on postoperative imaging without corresponding physical exam findings consistent with bowel injury is not an appropriate indication for surgical intervention.

Isolated Jejunal Crohn's Disease: a challenging diagnosis.

A 27-year-old Nepalese male presented with recurrent abdominal pain accompanied by a lower stool consistency over the past 2 years. These episodes occurred several times a year, lasting 1 to 2 weeks, and resolved spontaneously, after adjustment of diet and/or medication for symptomatic control (e.g., antispasmodics, probiotics). Over the last year, the patient had undergone an extensive diagnostic investigation, which revealed no alterations in the laboratory workup, abdominal scan, esophagogastroduodenoscopy, and colonoscopy, including biopsies of the duodenum, and colon, so the symptoms have been attributed to irritable bowel syndrome. However, the symptoms had become more frequent, so the patient was referred to our gastroenterology department. We repeated and extended the work-up. Laboratory investigations showed an elevated erythrocyte sedimentation rate and faecal calprotectin. The remaining laboratory as well an extensive stool workup for infection were unremarkable. Esophagogastroduodenoscopy and ileocolonoscopy were normal. Small bowel capsule endoscopy revealed jejunal mucosa with lymphangiectasias, pseudopolypoids formations and superficial longitudinal ulcers, these findings were corroborated by the double-balloon enteroscopy, and biopsies showed marked architectural distortion, chronic inflammatory infiltrate, and an epithelioid granuloma. The clinical, endoscopic, biochemical, and histological findings were consistent with isolated jejunal Crohn's disease. The patient started adalimumab with complete remission after one year. We present this case given its exuberant endoscopic findings and due to the difficulty in making the diagnosis due to its rarity, location, and unspecific presentation.

Real Time Landmark Detection for Within- and Cross Subject Tracking With Minimal Human Supervision

Landmark detection plays an important role for a variety of image processing and analysis tasks. Current methods rely on either supervised or semi-supervised learning which often requires large labeled training datasets. Also, retrospective addition of further target landmarks after completion of training is difficult in current methods. In this paper we propose a framework that addresses these limitations and allows for landmark detection based on only few examples and for definition of target landmarks after completed training without retraining. Our proposed approach relies on self-supervised training on a within-image template matching task with regularization by data augmentation. The trained network generalizes to cross-image matching and can thus be extended to example-based landmark detection and tracking. We extensively evaluate the proposed framework on chest X-ray images and abdominal MRI scans and demonstrate high accuracy with only few or even only one labeled example. Additionally we apply it to the task of liver and liver lesion tracking in CINE MRI scans.

Paratesticular rhabdomyosarcoma in a 30 months old child at the Lagoon Mother and Child Teaching Hospital (CHUMEL) in Cotonou

INTRODUCTION: Paratesticular rhabdomyosarcoma is a rare and aggressive tumor. We report here a case in a 30 months old boy. OBSERVATION: The parents would have noticed a small, painless and rapidly evolving testicular mass in the six months old child. Not having health insurance, they went to the hospital only five months later. This was followed by a total ablation of the mass (without orchidectomy) and an anatomopathological investigation concluding to a pleiomorphic rhabdomyosarcoma. No chemotherapy was performed and the mass recurred two months later. This time, its ablation was followed by a series of non-adapted chemotherapy sessions with irregular follow-ups leading eight months later to the child’s admission at our department. He presented with a degraded general condition, associating an infectious and anemic syndrome, an important increase of the scrotal mass and the occurrence of a tumoral mass in the left iliac fossa. The tumoral nature of these masses was confirmed on abdominal ultrasound and scan. The tumor was classified stage II (AJCC Prognostic stages). The multidisciplinary medical staff indicated a total ablation of the two masses, followed by a new session of adapted chemotherapy, in the absence of radiotherapy means. The child died in the immediate surgery follow-ups due to cardiac arrest. CONCLUSION: In our context of insufficient technical facilities, only early detection and adapted imperative chemotherapy, would have enabled a durable remission in front of the paratesticular rhabdomyosarcoma.

Paratesticular Rhabdomyosarcoma in a 30 Months Old Child at the Lagoon Mother and Child Teaching Hospital (CHUMEL) in Cotonou

Introduction: Rhabdomyosarcoma is the most common soft tissue tumor in children. Modern multidisciplinary approaches make it possible to better characterize the different entities and to adapt the treatment accordingly. Paratesticular localization is rare and aggressive. We report here a case of paratesticular localization in a 30 months old boy. Observation: The parents would have noticed a small, painless and rapidly evolving testicular mass in the 6 months old child. Not having health insurance, they went to the hospital only 5 months later. This was followed by a total ablation of the mass (without orchidectomy) and a pleiomorphic rhabdomyosarcoma had been concluded. No chemotherapy was performed and the mass recurred 2 months later. This time, its ablation was followed by a series of non-adapted chemotherapy sessions with irregular follow-ups leading 8 months later to the child’s admission at our department. He presented with a degraded general condition, associating an infectious and anemic syndrome, an important increase of the scrotal mass and the occurrence of a tumoral mass in the left iliac fossa. The tumoral nature of these masses was confirmed on abdominal ultrasound and scan. The tumor was classified stage II (TNM: initial Tumors, Nodes, Metastasis). The multidisciplinary medical staff indicated a total ablation of the two masses, followed by a new session of adapted chemotherapy, in the absence of radiotherapy means. The child died in the immediate surgery follow-ups due to cardiac arrest. Conclusion: In our context of insufficient technical facilities, only early detection and adapted imperative chemotherapy, would have enabled a durable remission in front of the paratesticular rhabdomyosarcoma.

A 5-year multidisciplinary care outcomes in children with wilms' tumour managed at a tertiary centre: A retrospective observational study.

Background:Over the last two decades, there has been significant improvement in the outcomes of children with Wilms’ tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT.Methodology:This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients’ case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant.Results:Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1–7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant.Conclusion:The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.

With 3 Types of Respiratory Acquisition: 3.0 T Respiratory Triggered Acquisition Can Obtain Higher Quality DWI Images of the Upper Abdomen.

Objective To compare the effects of 1.5 T and 3.0 T upper abdominal magnetic resonance diffusion-weighted imaging (DWI) under three acquisition techniques of breath holding, breath triggering, and free breathing, so as to provide a reference for the usage of upper abdominal DWI scanning. Methods Twenty-one healthy subjects were selected from social volunteers and underwent routine magnetic resonance imaging (MRI) and DWI on 1.5 T and 3.0 T, respectively. DWI included three acquisition methods: breath triggering, breath holding, and free breathing, and b values were 100 and 800. The DWI image artifacts, image quality, apparent diffusion coefficient (ADC), and the signal-to-noise ratio (SNR) obtained through the three acquisition methods were compared. Results The 1.5 T free-breathing DWI image quality was the best, while the 3.0 T had the best breath-triggered DWI image quality. The 3.0 T breath-triggered DWI image quality was better than the 1.5 T free-breathing DWI image (P=0.012), and the SNR of free-breathing DWI was the highest. Between the two field intensities, the SNR of the liver in the 3.0 T group was much lower than that in the 1.5 T group, and obvious differences were not observed in ADC values of normal liver, gallbladder, kidney, spleen, and pancreas. Conclusion 3.0 T respiratory-triggered acquisition can obtain higher quality DWI images. But in the case of only 1.5 T field strength, free-breathing acquisition of DWI images should be selected.

Follow-up for a Preterm Infant with Beckwith-Wiedemann Syndrome.

Follow-up for a Preterm Infant with Beckwith-Wiedemann Syndrome.

Ultrasound Demonstration of Hepatic Arterial Buffer Response for Blood Flow Regulation

This is observation analytical case control study deal with assessment of hepatic arterial buffer response for blood flow regulation using ultrasonography taking 300 subjects. 150 normal control group and 150 patients with chronic liver diseases. Several previous studies in various setting has support ultrasound scanning as non-invasive, cost effected, reliable, and accurate tool for measuring portal vein diameter and flow comparing with hepatic artery diameter for assess hepatic artery buffer response for blood flow regulation in chronic liver diseases. The Aim: Importance of the study to help in diagnosis impairment of HABR for blood flow regulation in chronic liver diseases in early stage to avoid the complication. As well as to reduce the cost and time of other examination. Method: The data was collected, analyzed by using Statistical Packaged for Social Studies (SPSS). Ultrasound examinations were performed in Tropical Diseases Teaching Hospital. Omdurman, Khartoum State during the period) from January 2021to August 2022(on 150 patients as study group (85 male and 65 female) and 150 control group with normal abdominal scan (Patient who had previous abdominal surgery was excluded). The Result: In result we found significant correlation (P=0.00) between hepatic artery diameter, liver craniocaudal length CCL\cm, caudate lobe size and portal vein diameter, with direction of flow. Highly significant correlation (r=-0.222; P=0.006) was noticed between portal vein diameter and hepatic artery diameter of patient under investigation. In patient with cirrhosis found dilated portal vein associated with Hepatofugal flow away from liver combined with dilated hepatic artery to compensate the liver supply. In case of fatty liver infiltration, the portal vein decrease diameter and flow associated with increase liver size and hepatic artery diameter to supply the liver. In liver tumor HCC the portal vein decrease diameter and flow associated with increase liver size and hepatic artery diameter. In hepatitis both portal vein and hepatic artery dilated to increase supply to the liver. These were expected and goes with previous study. The study also found that there was significant correlation between Sudanese HABR and international standard. The study recommended further study to measure HABR routinely with chronic liver diseases ultrasound scan

Bartonellosi e D-dimero

The paper reports the case of a 17-year-old immunocompetent boy with persistent fever and elevated D-dimer. The family referred contact with kitten and ingestion of homemade deer salami. Abdominal ultrasound scan and CT showed multiple hepatic and splenic abscesses. High levels of antibody title for Bartonella henselae confirmed the diagnosis of hepatosplenic bartonellosis.

Twinkle artifact in renal ultrasound, is it a solid point for the diagnosis of renal stone in children?

Background: Twinkle artifact, also known as color Doppler comet-tail artifact, occurs behind very strong, granular, and irregular reflecting interfaces such as crystals, stones, or calcification. This is visualized as a random mixture of red and blue pixels in the high-frequency shift spectrum located deep to the interface. Study results have suggested that the sonographic twinkling artifact may aid in the detection of renal stones with a variety of reference standard imaging modalities, including abdominal radiography, excretory urography, gray-scale sonography, and CT. Material and methods: Our retrospective observational study included children who had undergone abdomen/renal ultrasound for kidneys stones in our radiology department between 2013 and 2019. Presence of the twinkle artifact, and stone numbers and sizes were documented. CT examinations done <3 months prior to or after US were retrospectively assessed to confirm the presence of kidney stones as a reference standard. Results: Thirty-three abdominal renal US scans of 33 patients (21 males, 12 females) fulfilled the entry criteria. The interval between the US and CT was <3 months for all patients. The median overall age of the patients was 4 years (IQR: 3.125, range: 1– 165 months), The median number of days between the US and CT was 13 (IQR: 26, range: 0–81 days). US detected 33 hyperechoic foci suspected to be stones; 26 were confirmed as true positive (i.e. showed the twinkle artifact and were seen in CT), 4 were false positive (showed the twinkle artifact but were not seen in CT), and 3 were false negative (did not show the twinkle artifact but were seen in CT). The overall median stone size was 2 mm in the right kidney, and 5 mm in the left kidney (IQR: 6,11 mm), respectively. Twinkle artifact sensitivity was found to be 89.7% (95% CI 39.574%–90%). The twinkle artifact was assessed in all true-positive stones, determining a relatively high PPV of 26/29 (86.7%) for the twinkle artifact. The twinkle artifact was not dependent on stone size. Specificity for the twinkle artifact could not be calculated due to a lack of true negatives. Conclusion: The twinkle artifact is a sensitive US tool for detecting pediatric kidney and ureter stones, but with a small risk of false positive findings.

OV11 GIANT SPIEGEL HERNIA: 3D PLANNING AND MINIMALLY INVASIVE TREATMENT

Abstract Aim Demonstrate the advantages of 3D technology planning in complex cases of hernia surgery and technical tricks for giant Spiegel hernia repair. Material and Methods 71 year old patient, BMI 38, asthma, hypertensive; long history of symptomatic left flank mass. Giant Spiegel hernia was diagnosed, with significant omentum and colon migration to hernial cavity. It was decided to perform minimally invasive surgery. 3D model of the abdominal scan was performed, assessing hernia size, volume and its relationship with the abdominal cavity. We were able to rule out the possibility of compartment syndrome, and foresee that we could probably close the defect. Results preperitoneal transabdominal repair (TAPP) is performed, beginning with herniated content reduction, a delicate step where injuries should be avoided, with careful traction of the colon and omentum. Hernial defect is assessed, coinciding with the 3D model, the peritoneum sac is reduced, taking as much as possible to facilitate its posterior closure. The entire peritoneum of the Spiegel and inguinal region are dissected en bloc. Defect tension-free closure is performed with 2 continuous V-LOOK 2.0, subsequent placement of 15x15cm polypropylene mesh and posterior peritoneum closure. The patient is discharged the same day without incidents. Conclusions The 3D model allows us to assess the actual abdominal and hernia volume to simulate surgery findings. Its benefits are yet to be developed. Laparoscopic preperitoneal repair is an excellent approach for Spiegel's hernia. Complex cases are also candidates for outpatient surgery.

Second trimester Abdominal Pregnancy: A Case Report in a Resource Limited Setting

Introduction: Abdominal pregnancy is a rare form of ectopic pregnancy with very high feto-maternal morbidity and mortality. Diagnosis and management can pose difficulties in low-resource centres. High index of suspicion is vital in making a prompt diagnosis. Case Presentation: A 23year old, gravida 2, para 1, who presented with a two-day history of severe abdominal pain was referred from a satellite clinic. Abdominal ultrasound scan revealed a live 18week 5day intra-abdominal pregnancy. Emergency laparotomy showed an intact gestational sac at the superior aspect of the uterus with massive hemoperitoneum. The placenta was attached to the right ovary, omentum, and fimbriae of the right fallopian tube. Conclusion: Abdominal pregnancy is a rare occurrence and requires a high index of suspicion for prompt diagnosis. Massive hemoperitoneum can be life threatening and prompt surgical intervention is key in saving the life of the mother.

Sarcopenia Is a Clinically Relevant and Independent Predictor of Health Outcomes after Chimeric Antigen Receptor T-Cell Therapy for Lymphoma

Sarcopenia Is a Clinically Relevant and Independent Predictor of Health Outcomes after Chimeric Antigen Receptor T-Cell Therapy for Lymphoma