Acute Abdominal Distension Research Articles

A rare case of infected urachal cyst leading to intestinal obstruction in a 3-month-old boy with febrile urinary tract infection: Case report.

Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst. A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension. Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction. Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed. The day after surgery, the patient was discharged without any complications. Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.

Small bowel obstruction due to a meat bolus bezoar: the second case report in literature

Introduction: Small bowel obstruction is a difficult emergency condition that may be caused due to many factors. However, bezoar-induced small bowel obstruction accounts for only 0.4–4.8% of all intestinal impaction patients. Bezoars are an entity of undigested materials classified into four types: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar. Meat bolus bezoar is not named under any of these classifications. Case presentation: A 75-year-old man presented with abdominal distention, vomiting, and constipation. On radiological imaging, a mass in the terminal ileum was detected. After 2 days of ineffective conservative therapy, the authors decided to perform an open surgery. Enterotomy approach was chosen after failing to milk the object into the colons. The foreign body impacting the bowels was identified as a meat bolus bezoar. The patient improved after the surgery. The authors recorded no recurrence or complications with our patient after 18 months of follow-up. Discussion: Patients with small bowel obstruction usually present with acute abdominal pain and distension despite the blockage cause. Computed tomography is the most effective diagnostic tool in such cases. In bezoar-induced intestinal blockage, surgical management is mandatory if conservative therapy fails. Conclusion: It is important to consider bezoar-induced small bowel obstruction as a potential cause of impaction in cases of acute abdominal pain accompanied with risk factors of bezoar formation, despite the bezoar type.

Ruptured Parasitic Dermoid Cyst in Blunt Abdominal Trauma.

Ruptured parasitic dermoid cyst is one of the rare conditions that results from auto-amputation and re-implantation following torsion from the ovary and omentum, among other sites. Due to trauma to the abdomen, it may rupture, resulting in spillage of its contents and causing chemical peritonitis. The diagnosis is based on clinical presentation complimented by abdominal ultrasound in low resource settings. A case of a 44-year-old (Iraqw by tribe) who presented with clinical features of acute generalized abdominal pain and distension for two days following blunt abdominal trauma. The abdominal ultrasound revealed a mass of mixed echogenicity with intraperitoneal free fluid. She underwent laparotomy, revealing ruptured parasitic dermoid cyst adhered to the anterior abdominal wall and urinary bladder, then excised. The high degree of suspicion of ruptured parasitic dermoid cyst is justified in adult patient with chemical peritonitis manifestation. The laparotomy is surgical management of choice in low-resource settings followed by prolonged follow-up.

Acute abdominal distension in an one year old due to ingestion of unknown foreign body

No abstract available

S3178 Toxic Positivity: An Incidental Discovery of Crohn’s Disease in Acute Abdominal Distention

S3178 Toxic Positivity: An Incidental Discovery of Crohn’s Disease in Acute Abdominal Distention

Fatal necro‐haemorrhagic gastroenteritis and multifocal microthrombi secondary to food engorgement in a dog

AbstractA previously healthy 5‐year‐old, female, spayed, mixed breed dog presented for acute abdominal distension and non‐productive retching after consuming a large volume of kibble dog food. Abdominal radiographs confirmed food engorgement, and standard medical therapy was initiated with intravenous fluids and analgesics. After 36 hours of persistent abdominal distension and progressive hyperlactatemia, an exploratory laparotomy revealed generalised ischaemia throughout the gastrointestinal tract, spleen, and liver. Due to a poor prognosis, humane euthanasia was elected. Postmortem examination confirmed severe necro‐haemorrhagic gastroenteritis and multifocal microthrombi. Clostridium perfringens was cultured from the small intestines, which may represent either an underlying cause or an opportunistic proliferation.

Chylolymphatic cyst of abdomen in a toddler: a rare case report

Cystic lesion of abdomen in a toddler is a rare condition. It can be developmental, infectious, benign or malignant in nature. The site of origin may be from intrabdominal organs, omentum, mesentery, retroperitoneum, vasculature and lymphatics. They often present as acute abdominal pain, abdominal distension or constipation. Radiology and histopathology helps to arrive at diagnosis. We report a rare case of chylolymphatic mesenteric cyst in a 2 year old male child diagnosed by histopathology.

Neonatal Posterior Urethral Valves as a cause of Acute Abdominal Distention

Introduction: An 18-day-old term, male presented to the emergency department (ED) for 1-2 days of progressive abdominal distention. Case Report: Over the past week the infant had been spitting more, but it was non-bilious and non-projectile. He had no fevers. On examination, he was ill appearing with a distended abdomen. A flat-plate of his abdomen was obtained that was concerning for possible partial small bowel obstruction, which led to extensive imaging with an upper and lower gastro-intestinal contrast studies that were negative. Ultimately, an ultrasound was performed that revealed marked bladder distention with hydronephrosis. A urinary catheter was placed to relieve his bladder obstruction. Avoiding cystourethrogram confirmed a diagnosis of posterior urethral valves. Conclusion: Posterior urethral valves (PUVs) as a cause of abdominal distention in the neonate is a rare presentation. PUVs have an incidence of 1/4000 male births; of which 1/3rd are detected in-utero, 1/3rd in the first year of life. Most infants with PUVs will present with a urinary tract infection, others present with failure to thrive, poor urine stream and or grunting while urinating. The neonate with acute abdominal distention warrants a thorough and expedited evaluation for possible acute surgical etiologies, such as midgut volvulus due to malrotation. Early identification of bladder obstruction by point of care ultrasound would have helped focus the evaluation and lead to earlier relief of his bladder obstruction. PUVs should be considered on all male infants with urinary tract infection, failure to thrive, poor urinary stream or abdominal distention.

Survival After Ruptured Spontaneous Hepatic Subcapsular Hematoma Following Heparin Initiation for Submassive Pulmonary Embolism

Hepatic subcapsular hematomas (HSHs) are rare outside the context of trauma, endoscopic retrograde cholangiopancreatography, and pregnancy. Ruptured HSHs present with abdominal pain and hypotension, with high mortality. We present the patient case of a 69-year-old man readmitted with deep venous thrombosis and pulmonary embolus after uncomplicated laparoscopic prostatectomy. Soon after receiving heparin, he experienced acute abdominal distention and right upper quadrant pain. A large ruptured subcapsular hematoma with focal active bleeding was identified and eventually controlled surgically. We highlight that HSHs can complicate anticoagulant therapy. Awareness and prompt intervention can be lifesaving.

29-Year-Old Man With Acute Gastric Distention

29-Year-Old Man With Acute Gastric Distention

Laparoscopic Assisted Percutaneous Anterior Gastropexy for the Management of Acute and Chronic Gastric Volvulus in Infants

Acute and chronic gastric volvulus (ACGV) is a rare event in infants and children. Its prompt treatment is needed to avoid gastric ischemia and perforation. A laparotomy or a laparoscopic/endoscopic reduction with or without the gastrostomy formation has been described to treat this condition. We wanted to report our experience and describe the surgical technique used to perform the percutaneous laparoscopic assisted anterior gastropexy in neonates presenting with this condition. We perform a retrospective review of a single institution’s experience with laparoscopic assisted percutaneous anterior gastropexy over a seven-year period (2015–2022). Procedures were performed under general anesthesia and the anterior gastropexy was performed using a modified extracorporeal knotting technique as described for the laparoscopic assisted repair of inguinal hernias via percutaneous internal ring suturing. Thirteen patients underwent surgery for ACGV at our institution over a seven-year period. The median age at diagnosis was 57 days, 7/13 patients presented with acute vomiting and regurgitation (54%), 1/13 (8%) presented with mainly feeding difficulties and 1/13 (8%) presented with acute abdominal distension. Data were not available for 4/13 patients. All of the patients underwent laparoscopic assisted anterior gastropexy using extracorporeal knotting technique; no gastrostomy insertion was needed. The median operative time was 50 min (40–95 min). No intraoperative complications were reported. Post-operatively patients were started on feeds on day 3 (2–5 days). Only one patient (8%) developed a postoperative complication: subcutaneous granuloma at the extracorporeal knot site. Although rare, acute GV is an important cause of gastric outlet obstruction with a detrimental outcome if not promptly recognized and treated. Laparoscopic assisted percutaneous anterior gastropexy is an attractive and safe alternative for the management of this condition in both infants and older children. This technique does not require gastrostomy placement and it has a very low morbidity rate with no mortality reported.

Decoding the changing etiology and management protocols of intestinal obstruction: A prospective clinical study

Background: Obstruction of the bowel is one of the most common problems intra-abdominally seen by surgeons in their practice. The reasons associated with these obstructions are biochemical disturbances correlated to adhesion, neoplasms, and/or hernia. Obstruction of either the large intestine or small intestine remains the major cause of mortality and morbidity. Methods: The study included a total of 48 subjects having intestinal obstruction within the age range of 18-87 years. The diagnosis was made based on hematologic parameters, radiologic parameters, physical examination, and clinical history of the subjects. Results: Most common complication seen in 14.58% (n=7) study subjects, followed by the surgical site infection seen in 10.41% (n=5) study subjects. Respiratory tract infection was seen in 8.33% (n=4) of study subjects. The least common reported complication was faecal fistula seen in 4.16% (n=2) of study subjects. On assessing the mortality rate of the present study, it was seen that 12.5% (n=6) subjects died following surgical management of acute abdominal distension, whereas, 87.5% (n=42) subjects survived and were cured Conclusion: The present study concludes that the most common reason behind intestinal obstruction was postoperative adhesion which can be accurately diagnosed with operative, radiological, and clinical assessment.

Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience

BackgroundImperforate hymen (IH) is the most common obstructive anomaly of female genital tract. Hymen saving has a great importance for both cultural and religious reasons. Conventional surgical treatment for this condition is cruciate incision hymenotomy or hymen-saving central annular hymenotomy (HSCAH). This study aimed to review presentations and management of neonate and adolescents with IH at one tertiary hospital over 12 year’s period. The aim also was to stress upon importance of hymen saving to our Muslim community and improve knowledge, enable targeted education, and reduce unnecessary tests and diagnostic delay for this condition.MethodsTwenty-five patients with IH were diagnosed and treated in this retrospective cohort study over 12 years, from January 2010 till December 2021. Demographic characteristics of the patients, their symptoms and signs, investigations, type of operations, recurrence, and infections were recorded and analyzed.ResultsSaudi accounted for the majority of IH cases (88%). There were fifteen adolescents, and ten were neonates. Bulging imperforate hymen, pelvic/abdominopelvic mass, constipation, acute urine retention, abdominal discomfort, and lower abdominal distension were among the signs and symptoms. All 25 patients had HSCAH, 21 of whom had primary HSCAH and four of whom had secondary HSCAH due to recurrence. To avoid recurrence, HSCAH was performed with suturing of the inner vaginal mucosa to the exterior vestibular mucosa.ConclusionEarly diagnosis of imperforate hymen for neonate and adolescent girls and prompt definitive HSCAH could have positive impact on treatment outcome and decrease complications and fulfill integrity of hymen as virginity of high importance in our Muslim community and other similar culture, where hymen-sparing procedure is preferred by most of these patients and families.

Midgut volvulus due to congenital malrotion in adults: A case report

Intestinal malrotation is a rare congenital anomaly. It may occurs in adult but it is very rare. Our case is 20 year old male from Khartoum (Sudan) presented to emergency department with acute onset abdominal pain, vomiting and abdominal distension diagnosed as having intestinal obstruction due to congenital malrotation complicated by Midgut volvulus. Midgut volvulus secondary to congenital malrotation in adults is a very rare condition, abdominal CT scan with IV contrast, are helpful for preoperative diagnosis, treatment is by Ladd procedure.

Acute Abdominal Distention in a Premature Low-birthweight Infant.

Acute Abdominal Distention in a Premature Low-birthweight Infant.

Pseudomyxoma peritonei presenting with port site hernia

Pseudomyxoma peritonei (PMP) is a rare disease with an incidence of two per million. Acute appendicitis, ovarian mass, and abdominal distension are the most common presentations. A 72-year-old male patient with a history of laparoscopic cholecystectomy was admitted to the hospital with abdominal pain and increased supraumbilical port site swelling. Radiological examination revealed a mass in the terminal ileum and severe intraabdominal mucinous fluid. Intraabdominal gelatinous fluid protruding from the port site defect and a mass in the distal ap-pendix were observed during operation. He underwent a right hemicolectomy, ileocolic anasto-mosis and peritoneal debridement; cytoreductive surgery was administered two months later due to mucinous tumor of the appendix. There are only a few case reports describing PMP presen-ting with an incisional hernia after open surgical procedures. To the best of our knowledge, this report describes the first case of PMP presenting with a port site hernia after a laparoscopic in-tervention.

Ruptured splenic artery pseudoaneurysm: is surgery always required?

Splenic artery aneurysms are extremely rare, and pseudoaneurysms are even rarer. More often than not, the aetiology is acute or chronic pancreatitis, although blunt trauma to abdomen and previous endovascular procedure (iatrogenic) are also known causes. The condition can have a wide spectrum of clinical presentations ranging from incidental finding to severe uncompensated circulatory shock. Splenic artery pseudoaneurysm (SAP) is frequently misdiagnosed as a pseudocyst pancreas with haemorrhage in it, as was the case with one of the present patients. In this case series, we discuss two patients of SAP. A young 33-year-old male patient, known case of pancreatitis, who presented with severe hypotension and ultrasonography (USG) suggestive of hemoperitoneum and pseudocyst pancreas with hematoma. The second patient was a 42-year-old male who presented with acute onset upper abdominal pain, vomiting, abdominal distension and giddiness. Both these patients were resuscitated by giving fluids and blood transfusions. Their diagnosis of SAP was confirmed on computed tomography (CT) of abdomen. Both these patients underwent endovascular coiling of SAP. Present report highlights the role of endovascular intervention in managing a bleeding SAP as long as emergency surgical team are kept on stand-by.

POS-713 TACROLIMUS INDUCED HEPATIC VENO OCCLUSIVE DISEASE IN RENAL TRANSPLANT PATIENT

Tacrolimus is widely used immunosuppressive agent used in solid organ transplant recipients to prevent rejection. It is a calcineurin inhibitor which results in reduced transcription of IL-2 levels thereby mediating the process of preventing rejection. It is extensively metabolized by cytochrome P-450 CYP3A enzymes in the liver and its drug level monitoring is very crucial in managing such patients as it is associated with wide array of adverse effects and multiple drug-drug interactions. Hepatic veno occlusive disease a non thrombotic veno occlusion of hepatic vein is a rare and reversible adverse effect of tacrolimus is being discussed. A 39 year old male with native kidney disease of IgA nephropathy presented 10 months post transplant with fever and cough. He was triple immunosuppression with tac level of 5.8 ng/ml on Tacrolimus 2mg twice daily. He was diagnosed with Aspergillus fumigatus pneumonia for which he was started on Voriconazole. On third day of antifungal he developed acute onset abdominal distension with ascites. Ascitic fluid analysis was suggestive of high SAAG, high protein fluid and contrast enhanced CT abdomen showed significant stenosis of hepatic vein at its confluence of IVC. Concomitantly checked Tacrolimus trough level was greater than 40ng/ml. Gradually tacrolimus dose was reduced and Tacrolimus trough levels were maintained between 2-5 ng/ml. With reduction of tacrolimus dose his ascites reduced and repeat CT abdomen showed opening of hepatic veins.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Hepatic veno occlusive disease is more common in patients with stem cell transplant recipients rather than solid organ transplant patients. HVOD in SOT recipients has been mostly related to the use of Azathioprine and has been rarely reported with pancreas and lung transplant patients. Herewith reporting an rare case of Tacrolimus induced hepatic veno occlusive disease in a renal transplant patient associated with raised tacrolimus trough levels > 40ng/ml due to the concomitant usage of Voriconazole (Known to inhibit metabolism of Tacrolimus). This patient had a complete recovery of symptoms following reduction in dosage of Tacrolimus. In summary, tacrolimus (especially in the event of an overdose), alone or in combination with drugs known to cause VOD (like Azathioprine, valaciclovir) or known to inhibit the metabolism of CNIs may give rise to VOD. It is therefore necessary to monitor tacrolimus levels and liver parameters throughout treatment. In the event of clinical or biochemical abnormalities, appropriate monitoring of drug levels, reduction in dosage of tacrolimus may completely reverse this dreadful life threatening complication.

Uterine rupture and shock: an unusual presentation of gestational trophoblastic neoplasm

We report a case of a 47-year-old woman, gravida 4 para 3, with a history of 3 vaginal deliveries and recent surgical evacuation of complete mole. Five weeks later, an invasive mole was diagnosed because of a raised human chorionic gonadotropin level. Monoagent chemotherapy was planned. She presented to our emergency department with acute abdominal pain and distension. Clinical examination suggested hemorrhagic shock (heart rate was 145 beats per minute and blood pressure was 80/40 mm Hg). Uterine rupture was suspected, and the patient immediately underwent explorative laparotomy.

Antenatal Risk Factors Associated with Spontaneous Intestinal Perforation in Preterm Infants Receiving Postnatal Indomethacin

To determine if antenatal variables affect the risk of spontaneous intestinal perforation (SIP) among preterm infants when prophylactic indomethacin is used. Retrospective case-control study of infants <29weeks of gestational age between January 2010 and June 2018 at one hospital. SIP was defined as acute abdominal distension and pneumoperitoneum without signs of necrotizing enterocolitis at <14days of life. Each case (n=57) was matched with 2 controls (n=114) for gestational age and birth year. Maternal and infant data were abstracted until the SIP or equivalent day for controls. Univariate analyses were followed by adjusted conditional logistic regressions and reported as OR and 95% CI. Mothers of cases were younger, more often delivering multiples (31% vs 14%, P=.007), and less abruptions (15% vs 29%, P=.045) but did not differ in intra-partum betamethasone, magnesium, or indomethacin use. Prophylactic indomethacin was given on day 1 to 99% of infants. SIP was associated with a shorter interval from last betamethasone dose to delivery (46hours vs 96hours, P=.01). Dopamine use (14% vs 4%, P=.02), volume expansion (23% vs 8%, P=.003), and high grade intraventricular hemorrhage (28% vs 8%, P=.0008) were related postnatal factors. The adjusted odds of SIP increased by 1% for each hour decrease between the last dose of betamethasone and delivery (OR 1.01, 95% CI 1.002-1.019) and with multiple births (OR 2.66, 95% CI 1.05-6.77). Antenatal betamethasone given shortly before delivery is associated with an increased risk of SIP. Potential interaction with medications such as postnatal indomethacin needs study.