Acute Abdominal Findings Research Articles

Demographic, Clinical and Radiological Characteristics of Pediatric Cases Diagnosed As Transient Intussusception As A Result of Spontaneous Reduction

Objectives: Transient intussusception (TI) is a condition in which part of the small intestine is identified to enter the anterior part of the intestine telescopically, but this condition spontaneously reduces during follow-up. The observation of this situation has increased with the widespread use of ultrasonography among diagnostic tools. In this study, the aim was to present cases of intussusception that resulted in spontaneous reduction in our clinic. Materials and Methods: The records of cases diagnosed with intussusception between 01.01.2014 and 01.09.2022 were scanned. The files of the patients who were diagnosed with TI as a result of observation were investigated. Age, gender, clinical findings, duration of admission, ultrasonography findings, treatment options and results were analyzed retrospectively. Results: A total of 71 cases diagnosed with intussusception included 50 males and 21 females, with a mean age of 22.3 months. Intussusception was ileo-colic in 36 patients, ileo-ileal in 32 patients, and jejuno-jejunal in three patients. Clinical observation with physical examination and ultrasonography (US) was performed in 33 (21%) patients with SBI who did not have signs of peritoneal irritation and had short segment involvement. Surgical reduction was performed in four patients because intussusception persisted after observation. Control US performed on the remaining 29 patients showed that intussusception disappeared. The age range of 29 patients diagnosed with TI ranged from 10 to 122 months (mean 46.2 months). Of the cases, 19 (65.5%) were male and 10 (34.4%) were female. The length of the invaginated segment ranged from 1-2.2 cm (mean 1.8 cm). Conclusion: Spontaneous reduction of SBI, which does not have acute abdominal findings and progresses with short segment involvement on US, may occur during clinical observation. For this reason, close follow-up of suitable cases that may develop spontaneous reduction is important to avoid unnecessary surgical interventions and consequences.

Mesh infection after umbilical hernia repair in a pregnant female

Introduction: Acute abdominal findings occur in about 1 in 500 pregnancies. Diagnosis of acute abdominal findings in pregnancy can be difficult due to the physiologic and anatomic changes that are intrinsic to pregnancy. In pregnancy, the presence or recurrence of umbilical hernia is common and should be included in the differential diagnosis for acute abdominal findings. Few cases have been reported of complications post-hernia repair during subsequent pregnancies. Case Report: We report the case of a 31-year-old female with a history of an umbilical hernia repair who presented with acute abdominal findings at 22 weeks gestation attributed to delayed infection of surgical mesh. Conclusion: This patient’s presentation of acute abdominal findings during pregnancy with a history of umbilical hernia repair one year prior required exclusion of both obstetric and non-obstetric causes to determine diagnosis. There is little published evidence to guide Ob/Gyn physicians in counseling patients on the impact of pregnancy on prior umbilical hernia mesh repair. This case emphasizes the need for surveillance for mesh related complications during subsequent pregnancies in women with a history of mesh umbilical hernia repair.

Mesenteric lipoma in a child: A case report

Lipoma is a benign tumor of mature fat cells. It quite rarely occurs in the intestinal mesentery in children. Mesenteric lipomas usually do not cause gastrointestinal symptoms unless they affect the intestinal passage. However, as the mass grows, symptoms suggestive of partial intestinal obstruction, such as abdominal pain, vomiting, and abdominal distension, may be observed, or total intestinal obstruction may develop due to volvulus. In our study, a case with mesenteric lipoma with acute abdominal findings was presented. A four-year-old male patient presented with abdominal pain and vomiting. On physical examination, the patient was agitated and dehydrated, the abdomen was distended, and there was widespread tenderness; however, the mass was not palpable. Computed Tomography (CT) revealed a suspicious appearance for leiomyosarcoma with a size of 102x79x87 mm in fat density containing septa. In the exploration, a 120x120x70 mm encapsulated, lobular mass was detected 50 cm proximal to the ileocecal valve, covering the 10 cm ileal segment. The mass was excised totally together with a 10 cm small intestine segment, and ileal anastomosis was performed. The diagnosis of mesenteric lipoma was confirmed histopathologically. As a result, mesenteric lipoma, which is rare in children, is a benign pathology, and its treatment is total surgical excision. In children with signs of intestinal obstruction, mesenteric lipoma should be considered in the differential diagnosis, whether the mass is palpated or not.

Rare causes of acute abdomen and review of literature: Primary/secondary omental torsion, isolated segmental omental necrosis, and epiploic appendagitis.

Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain. The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature. The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings. POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient's clinical condition.

A Rare Cause of Acute Abdomen: Non-Hodgkin’s Lymphoma which Causes Spontaneous Splenic Rupture

Introduction: Non-traumatic spleen rupture is a very rare clinical case. While infectious and traumatic ruptures are so frequent, spontaneous ruptures due to hematological and oncological malignities are very rare. The patients with splenic rupture generally admitted to emergency department because of the acute abdomen. In this case report our aim was to demonstrate that in a patient admitting to the emergency department with acute abdominal findings the typical clinical features of spontaneous splenic rupture caused by a malignant lymphoma. Case Presentation: Sixty two years old Caucasian female patient seek medical advice with the complaint of constantly growing stomach ache on last ten days. There were symptoms of acute abdomen on her physical examination. Contrast-enhanced abdomino-pelvic computed tomography scan has been conducted emergently for the patient. On computed tomography, splenomegali and the findings of ischemia and infarction in an area of 5 cm of the splenic hilus and in widespread perisplenic free fluid were found. Patient urgently underwent a surgery. So, splenectomy was performed due to spontaneous splenic rupture. This patient diagnosed with malign lymphoma on histopathological evaluation. The patient discharged from the hospital due to the recovery, during 4th postoperative day. Conclusion: Non-traumatic splenic ruptures are observed rarely. Spontaneous splenic ruptures due to hematological and oncological diseases are very rare. When making differential diagnosis of acute abdomen, splenic ruptures shall also be in mind. Computed tomography and ultrasonography can be important when making diagnosis. Splenectomy shall be applied emergently during the treatment of spontaneous splenic rupture. Keywords: Non-Hodgkin’s Lymphoma, acute abdomen, spontaneous, splenic rupture

Value of Including CT Chest in the Management of Acute Abdominal Emergencies: Experience During First Wave of COVID-19 Pandemic at a UK District General Hospital.

AimsCOVID-19 can present with abdominal pain and affects the management of emergency surgical patients. The aim of this retrospective study was to assess the incidence of positive findings on CT chest in patients presenting with acute abdomen, who underwent CT thorax as part of the Intercollegiate General Surgical Guidance on COVID-19 during the first wave. To correlate CT chest findings with confirmed cases on reverse transcription polymerase chain reaction (RT-PCR), and to determine its influence on surgical management of abdominal emergencies.MethodsA retrospective observational study of adult emergency surgical referrals (excluding trauma) for acute abdomen over a 10-week period was performed. COVID-19 changes on CT chest were categorized as per the British Society of Thoracic Imaging (BSTI) CT reporting criteria. Patient demographics, COVID-19 RT-PCR, management and outcome were recorded. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, USA) with p-value significant at ≤0.05.ResultsOf the 160 patients included, 111 (69.38%) had COVID-19 RT-PCR. Twenty-four patients had CT chest findings suggestive of COVID-19. Amongst these, 45.83% demonstrated classic/probable CT features of COVID-19, of which 36.36% had positive RT-PCR. Most patients who had acute abdominal findings had a normal CT chest (p=0.03). Twenty-five (15.63%) patients presenting with abdominal pain had normal CT abdomen and seven (28%) of these had CT features of COVID-19. Only 43 (34.4%) patients needed a surgical intervention, of which 18.6% had COVID-19 changes on CT, confirmed by positive RT-PCR in 12.5%.ConclusionCT chest is an important investigation during the COVID-19 pandemic in suspected cases to help assess the severity of lung involvement. CT chest as an additional investigation modality in acute abdomen had clinically helped in triaging of patients to appropriate specialties but did not influence emergency surgical management.

Clinically Suspected Segmental Arterial Mediolysis of the Splanchnic Arteries: A Report of 2 Rare Cases

Case seriesPatients: Female, 89-year-old • Male, 52-year-oldFinal Diagnosis: Segmental arterial mediolysisSymptoms: Abdominal pain • bleedingMedication: —Clinical Procedure: —Specialty: RadiologyObjective:Rare diseaseBackground:Segmental arterial mediolysis (SAM) is an uncommon vascular pathology characterized by arteriopathy, mainly of medium-sized abdominal splanchnic vessels, without an atherosclerotic, inflammatory, infectious, or autoimmune underlying etiology. Segmental arterial mediolysis is clinically heterogeneous and symptoms may be completely nonspecific. The knowledge of radiological features of segmental arterial mediolysis and the exclusion of other pathologies should direct early diagnosis and refer patients for correct treatment.Case Report:In the last 2 years, we treated 2 different adult patients (an 89-year-old woman and a 52-year-old man) with spontaneous visceral bleeding, admitted to the Emergency Department due to acute onset of abdominal pain, anemia, and computed tomographic angiography (CTA) evidence of aneurysmatic, and stenotic alterations of splanchnic arteries. Based on clinical, laboratory, and radiological features, segmental arterial mediolysis was suspected. These 2 patients were referred to our Interventional Radiology Department and treated with super-selective transcatheter arterial embolization (TAE), performed by a minimally invasive approach, allowing an immediate clinical improvement with regression of symptoms and avoiding major surgical treatment.Conclusions:In patients with clinical, laboratory, and radiological signs of acute and/or chronic abdominal bleeding and radiological findings suggesting segmental arterial mediolysis, mini-invasive endovascular treatment is a safe, extremely reliable, and secure procedure and appears to be the first-choice treatment when available. Since abdominal bleeding could have fatal consequences in these patients, timely diagnosis and endovascular therapy are essential to treat visceral vascular alterations due to segmental arterial mediolysis.

Delayed Diagnosis of Spontaneous Intraperitoneal Rupture of Hydatid Cyst of the Liver

Intrabiliary rupture is the most common complication of liver hydatid cysts, intraperitoneal rupture is rarely seen, but it can be life-threatening. A 57-year-old female patient complained of abdominal pain and a hydatid cyst was found in the left liver lobe, as well as an intra-abdominal cystic mass due to intraperitoneal rupture. The patient's medical history showed that she was admitted to the emergency department with complaints of abdominal pain two months earlier, the liver hydatid cyst and intra-abdominal fluid were detected. However, there were no acute abdominal findings, so no emergency intervention was done. She was operated on electively. Surgical exploration showed a ruptured hydatid cyst of the left liver lobe, with a cystic mass that limited itself perfectly in the peritoneal cavity. Especially in endemic regions, primary care and emergency physicians should consider ruptured disease for patients with abdominal pain and liver hydatid cyst. The aim of this article, in light of the literature, is to emphasize that the rupture of hydatid cysts may not represent catastrophic clinical signs.

Perforated colorectal cancers: clinical outcomes of 18 patients who underwent emergency surgery.

IntroductionAlthough colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment.AimIn this study, the clinical results of patients who were operated in emergency conditions due to colorectal cancer perforation were evaluated.Material and methodsThe data of 18 patients treated for colorectal cancer perforation in our clinic between February 2014 and February 2017 were retrospectively reviewed. The following data were evaluated: demographic features of the patients, location of the tumour, metastasis, stage of the tumour, number of lymph nodes dissected, survival, type, and prognosis of the surgery.ResultsEight (44%) of 18 patients with perforated colon cancers were female and 10 (56%) were male. The mean age was 65.2 (31–104) years. Four of the patients had liver metastasis only, and 5 had multiple metastases. All cases had sudden abdominal pain and acute abdominal clinical findings. Fourteen of the patients underwent full resection, and 4 of them underwent partial resection and trephine stoma (colostomy). Perioperative mortality was not observed. The long-term mortality rate in our study was 77.7% (n = 14), and the operative mortality rate was 44% (n = 8). Additional organ injuries occurred during resection in 2 patients.ConclusionsColorectal cancer perforation seen in advanced ages is one of the causes of acute abdominal syndrome, which can be fatal. The general condition of the patient and the size and localization of the perforation should be taken into consideration in the choice of treatment. Curative surgery can also be performed in perforated colorectal cancers. However, partial resection and trephine colostomy should be performed in patients with multiple metastases and poor general condition.

Transmigration Of An Intrauterine Device Which Presents Abscess In Sigmoid Mesocolon

The intrauterine device (IUD) is an effective, reversible, widely used contraception method. After RIA placement, rare, serious complications such as migration to abdominopelvic viscera, pelvis, bladder, rectum and colon can be observed. A 33-year-old female had a previous history of IUD insertion in an external center presented emergency service with abdominal pain. Due to the presence of acute abdominal findings, explorative laparotomy was performed. The exploration revealed a RIA with a limited abscess formation migrated to the sigmoid colon wall and mesocolon. IUD was excised with limited mesocolon of sigmoid and primary suturing was performed. The patient was discharged uneventfully on the 7th postoperative day. Transmigration of IUD to sigmoid colon is a rare condition. Physicians should keep in mind that patients with a history of IUD who had changes in bowel habits and chronic pelvic pain symptoms may be a sign of colonic migration of IUD.

Abdominal pelvic CT findings compared between COVID-19 positive and COVID-19 negative patients in the emergency department setting.

PurposeManifestations of COVID-19 are primarily respiratory based, however, gastrointestinal symptoms are now recognized as an important component of the disease. The purpose of this study is to evaluate differences in abdominal pelvic CT findings in the emergency department by COVID-19 test result.MethodsThis retrospective study identified patients tested by PCR for COVID-19 infection who underwent abdominal pelvic CT scan in the ED across an academic health system from March 15 to April 15, 2020. Radiology reports were reviewed for the presence of ground glass opacity in the lungs and acute abdominal pathology. A subset of patients with acute abdominal pathology were identified with inflammatory pathology in organs with high ACE2 receptor expression including bowel, pancreas, urinary bladder, and kidney. CT findings for COVID positive versus negative patients were compared with Chi-square test.Results597 patients tested by PCR for COVID-19 infection underwent abdominal pelvic CT scan, 44% were COVID-19 positive. COVID-19 positive patients demonstrated significantly more ground glass opacity at the lung bases, 65.1%, (222/341) versus 12.4% (33/266), p < 0.001), and significantly less acute abdominal findings, 23.8% (81/341) versus 45.5% (121/266), p ≤ 0.001). When abdominal pathology was present, COVID-19 positive patients had higher rate of inflammatory pathology 58% (47/81) versus 29.8% (36/121).ConclusionsIn patients undergoing abdominopelvic CT from the ED, COVID-19 positive patients are more likely to have ground glass opacities at the lung bases and less likely to have acute abdominal pathology compared with COVID-19 negative patients. Further, COVID-19 positive patients are more likely to have inflammation of organs with high expression of ACE2 receptors than other types of acute abdominal pathology.

Case report title information: Adnexal torsion in a premenarchal female with absence of contralateral ovary and fallopian tube

Abstract We report the case of a 9-year-old pre-menarchal female who presented with acute onset abdominal pain and findings concerning for left adnexal torsion. At the time of surgical intervention the patient was found to have absence of the contra-lateral ovary and fallopian tube. Awareness of the possibility of concomitant adnexal torsion and contralateral tubo-ovarian absence would help clinicians manage patients who present with similar symptoms. In such cases, early surgical intervention and ovarian preservation is critical, while delay in treatment can render the patient infertile.

Pneumatosis Cystoides Intestinalis: Three Case Reports

Pneumatosis cystoides intestinalis (PCI) is a rare presentation, characterized by air-filled cysts within the submucosa or subserosa layers of the bowel wall. It may either occur idiopathically or secondary to many conditions such as pyloric stenosis, endoscopic trauma, using antineoplastic agents, surgery, and COPD. It generally proceeds asymptomatically and it is determined incidentally during the imaging procedures implemented for another purpose or during colonoscopy. Here in this report, we present a series of three cases, namely the patient who applied with rectal bleeding and acute abdominal findings (case 1), another patient who was diagnosed with PCI after nonspecific abdominal pain (case 2), and an asymptomatic case who was previously operated due to colon cancer where PCI was determined in control colonoscopy (case 3).

Evaluation of an AI-Based Detection Software for Acute Findings in Abdominal Computed Tomography Scans: Toward an Automated Work List Prioritization of Routine CT Examinations.

The aim of this study was to test the diagnostic performance of a deep learning-based triage system for the detection of acute findings in abdominal computed tomography (CT) examinations. Using a RIS/PACS (Radiology Information System/Picture Archiving and Communication System) search engine, we obtained 100 consecutive abdominal CTs with at least one of the following findings: free-gas, free-fluid, or fat-stranding and 100 control cases with absence of these findings. The CT data were analyzed using a convolutional neural network algorithm previously trained for detection of these findings on an independent sample. The validation of the results was performed on a Web-based feedback system by a radiologist with 1 year of experience in abdominal imaging without prior knowledge of image findings through both visual confirmation and comparison with the clinically approved, written report as the standard of reference. All cases were included in the final analysis, except those in which the whole dataset could not be processed by the detection software. Measures of diagnostic accuracy were then calculated. A total of 194 cases were included in the analysis, 6 excluded because of technical problems during the extraction of the DICOM datasets from the local PACS. Overall, the algorithm achieved a 93% sensitivity (91/98, 7 false-negative) and 97% specificity (93/96, 3 false-positive) in the detection of acute abdominal findings. Intra-abdominal free gas was detected with a 92% sensitivity (54/59) and 93% specificity (39/42), free fluid with a 85% sensitivity (68/80) and 95% specificity (20/21), and fat stranding with a 81% sensitivity (42/50) and 98% specificity (48/49). False-positive results were due to streak artifacts, partial volume effects, and a misidentification of a diverticulum (each n = 1). The algorithm's autonomous detection of acute pathological abdominal findings demonstrated a high diagnostic performance, enabling guidance of the radiology workflow toward prioritization of abdominal CT examinations with acute conditions.

Neonatal Appendicitis: Difficult Diagnosis with Enterocolitis

The clinical presentation of appendicitis in the newborn is nonspecific. The diagnosis was always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis. We report the case of acute appendicitis in a newborn diagnosed intraoperatively after neonatal occlusion symptoms.

Mesenteric Side Perforation of Strangulated Sigmoid Colon Within A Left Inguinal Hernia: An Uncommon Case

A 83 years old man was operated due to the acute abdominal findings and left strangulated inguinal hernia. On the exploration, trapping of sigmoid colon in the left inguinal canal observed and colonic wall was partly necrotic. After reduction, when the peritoneum covering the mesentery of the colon was opened, posterior wall defect and colonic content was seen in the mesentery. This view explained the CT that shows free air without free fluid in the abdomen. End Colostomy with Hartmann's Pouch was the choice of the operation.

Perforated acute appendicitis with no peritonitis in a premature baby: a case report

BackgroundAcute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis.Our reported case is a premature baby who had a perforated appendix with no evidence of peritonitis.Case presentationWe describe the case of a premature Bahraini girl born at 29 weeks of gestation by spontaneous vaginal delivery to a 39-year-old G6P5 mother. She was kept on a ventilator for the first 6 days of life, and had an uneventful Neonatal Intensive care stay until her 47th day of life when she developed sepsis that required ventilator support for 3 days. At day 51 she developed abdominal distension and was referred to a pediatric surgeon by day 54 with pneumoperitoneum. Her abdomen was soft with minimal tenderness and no evidence of erythema or edema. In view of pneumoperitoneum and previously reported sepsis, she was taken for exploratory laparotomy. The findings were consistent with a perforated appendix with no evidence of peritonitis or necrotizing enterocolitis. An appendectomy was performed. She had a smooth postoperative recovery.ConclusionsNeonatal appendicitis continues to be a diagnostic challenge. Only with a high index of clinical suspicion and teamwork can these cases be managed successfully and mortality and morbidity rates may reduce.

Isolated Duodenal Varices Without Cirrhosis

A 61-year-old man with a remote history of idiopathic necrotizing pancreatitis complicated by need for multiple pancreatic necrosectomies and ultimately Roux-en-Y reconstruction presented with one day of epigastric pain radiating to the back and chills. He denied any recent trauma, alcohol ingestion, new medications, change in bowel habits, chest pain, palpitations, or dyspnea. On examination, vital signs were significant for a low-grade temperature of 37.6°C. He appeared in to be moderate distress secondary to acute abdominal pain which was worsened with palpitation. Physical exam revealed no stigmata of cirrhotic liver disease. Serum laboratory tests were notable for aspartate aminotransferase 99 U/L, alkaline phosphatase 570 U/L, bilirubin 0.5 mg/dL, and leukocyte count of 21.1x109/L; serum albumin and international normalized ratio were both normal. Computed tomography (CT) did not demonstrate any acute abdominal findings other than mild biliary ductal dilatation. Blood cultures revealed gram negative bacteremia, which in the context of the patient's history of pancreatobiliary disease and his current presentation, prompted referral for endoscopic retrograde cholangiopancreatography. During ERCP, gross pyobilia and a distal common bile duct stricture were found, necessitating biliary balloon dilation, sweeping, and stent placement. In addition, and intriguingly, there was an incidental finding of extensive and nearly circumferential isolated duodenal varices (IDVs; see Figure 1). On review of the patient's contrast-enhanced CT imaging, there was no evidence of cirrhosis or other varices (e.g. esophageal). In addition, abdominal ultrasound demonstrated normal hepatopedal flow in the portal vein. The patient was placed on a non-cardioselective beta blocker for variceal prophylaxis and was doing well at last follow-up six months later.Figure 1Discussion: IDVs are a rare manifestation of portal hypertension whose precise incidence and prevalence remain uncertain. Representing approximately 15% of all ectopic varices, duodenal varices may be subclinical or can present with acute hemorrhage with hematemesis and/or hematochezia and mortality rates approaching 40% per episode. IDVs are typically secondary to cirrhosis-associated portal hypertension, whereas here we report a case of cryptogenic IDVs which were likely consequent to extensive intra-abdominal surgeries resulting in impaired superior mesenteric venous outflow and development of noncirrhotic portal hypertension.

Ultrasound-guided hydrostatic reduction of intussusception with saline: Safe and effective

PurposeThe study was undertaken to assess the efficacy of ultrasound-guided saline enema in reducing intussusception and to determine the role of age and duration of symptoms on this event. MethodsThe case records of patients who were treated for intussusception at our institutions over the past 10years were retrospectively analyzed. A total of 419 patients were treated for intussusception and 375 of them were included into the study. Patients were excluded if they had symptoms and signs of acute abdominal disease and required surgery as an initial treatment. ResultsHydrostatic reduction was successful in 313 of the 375 patients (83.46%). The procedure-related complication rate was nil. There were 29 episodes of recurrences in 23 patients, and recurrence rates did not differ between patients who responded to hydrostatic reduction and those who required surgery. Younger age [median (range); 11months (3–108 months) vs. 20months (1–180 months); p<0.05], rectal bleeding (p<0.01) and long duration of symptoms [mean (range); 1.95days (1–7days) vs. 1.44days (1–10days); p<0.01] were significantly associated with failed hydrostatic reduction. ConclusionUltrasound-guided hydrostatic reduction is an easy, safe and effective method for the treatment of intussusception in the absence of acute abdominal findings.

Acute Fitz-Hugh-Curtis Syndrome in a Man due to Gonococcal Infection

BackgroundFitz-Hugh-Curtis syndrome is a rare extra-pelvic complication of genital infection involving the perihepatic capsule. Most cases have been described in women in association with pelvic inflammatory disease; in rare cases it has been reported in men. Because the main symptom is acute abdominal pain, and laboratory and imaging findings are frequently nonspecific, the differential diagnosis, considering other gastrointestinal or renal diseases, can be difficult in the early stage of the syndrome, leading to frequent misdiagnosis and mismanagement. Case ReportWe report a case of Fitz-Hugh-Curtis syndrome in a 26-year-old man who first presented to the emergency department with acute abdominal pain, vomiting, and fever. Diagnosis was possible on the basis of clinical signs of orchiepididymitis, abnormal ultrasound findings, and specialist consultation with the Sexually Transmitted Infection Clinic. An acute gonoccocal infection was revealed, which was complicated by a collection of free perihepatic fluid and a subcapsular hypoechoic focal lesion. Prompt antibiotic therapy was established, with complete resolution of the symptoms within a few days. Why should an emergency physician be aware of this?Awareness of the clinical presentation, imaging, and laboratory findings during the acute phase of Fitz-Hugh-Curtis syndrome could help emergency physicians to make an early diagnosis and to correctly manage such patients. Improved diagnostic skills could prevent chronic complications that are especially a risk in the case of delayed or minor genitourinary symptoms.