Differential Diagnosis Of Acute Abdomen Research Articles

Mid-jejunal diverticulitis with closed-loop bowel obstruction, strangulation, and contained perforation.

Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and should be included in the differential diagnosis of acute abdomen. The association between polymyalgia rheumatica and diverticular disease requires further research but may prompt clinicians to consider appropriate therapies in patients with both diseases. Jejunal diverticulosis is a sac-like outpouching of the intestinal wall that can cause complications such as diverticulitis, obstruction, abscess, perforation, or fistula formation. Complicated jejunal diverticulosis may present with acute abdomen and nonspecific symptoms which can lead to misdiagnosis and delayed treatment. A 76-year-old male with a remote history of polymyalgia rheumatica (PMR) presented with sudden onset abdominal pain, fever, nausea, vomiting, and inability to pass flatus. Physical exam revealed a distended and diffusely tender abdomen with signs of peritonitis. Laboratory test results were significant for neutrophil-dominant leukocytosis and elevated inflammatory markers. CT scan of the abdomen with IV contrast revealed a contained perforation and a closed-loop small bowel obstruction in the mid-abdomen. The patient underwent emergent exploratory laparotomy and resection of 100 cm of mid-jejunum which was found to have numerous diverticula surrounding the closed-loop obstruction and contained perforation. Pathology findings showed evidence of acute on chronic jejunal diverticulitis. Jejunal diverticulosis with complications may present with an acute abdomen and peritonitis. Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is uncommonly thought of and should be considered in the differential diagnosis. Additionally, the association between PMR and diverticular disease is notable. While the patient had a remote history but no active PMR on presentation, studies suggest a possible association between gut inflammation and rheumatologic disease. This association should prompt clinicians to consider appropriate therapies and bear in mind the potential risk for diverticular perforation if glucocorticoids are given to treat PMR. Jejunal diverticulosis with multiple complications such as closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and may present with an acute abdomen and nonspecific symptoms. Including rare pathologies as such in the differential diagnosis may prevent misdiagnosis and delayed treatment. While further investigation is needed, the association between diverticulosis and PMR is noteworthy as patients who present with both diseases would require mindful management due to the potential risk of diverticular perforation after treatment with steroids.

A UTERINE RUPTURE NOT TO OVERLOOK IN THE CONTEXT OF RETROPLACENTAL HEMATOMA

Objective: To report a rare case of uterine rupture in the context of a Couvelaire uterus in a patient with no history of uterine surgery or manipulation and to discuss the clinical challenges and management strategies for such cases. Case Summary: A 34-year-old multiparous woman presented at 34 weeks gestation with intrauterine fetal death (IUFD) and preeclampsia. Despite an unremarkable history with no prior cesarean deliveries or intrauterine interventions, she developed sudden hemodynamic instability and was diagnosed with uterine rupture during an emergency laparotomy. Intraoperatively, a large posterior uterine rupture was identified and repaired. Postoperatively, the patient experienced uterine atony and significant hemorrhage, necessitating additional surgical interventions including Tsirulnikov ligation and the B-Lynch uterine compression technique. The patient recovered well following intensive care management. Discussion: Uterine rupture in an unscarred uterus is an exceedingly rare event, particularly in the absence of classic risk factors. This case occurred in the context of a Couvelaire uterus, where extensive intramyometrial hemorrhage due to placental abruption may have weakened the uterine wall. The nonspecific clinical presentation, including the absence of abdominal pain or vaginal bleeding, poses diagnostic challenges. Immediate surgical intervention is crucial, especially in low-resource settings where advanced treatment options may be limited. This case underscores the importance of maintaining a high index of suspicion for uterine rupture, even in patients without typical risk factors, and highlights the need for adaptable management strategies. Conclusion: Uterine rupture should be considered in the differential diagnosis of acute abdomen in pregnancy, regardless of the patients obstetric history. Early recognition, prompt surgical management, and flexible treatment strategies are essential for optimizing outcomes in such rare but potentially life-threatening situations. Further studies are needed to improve understanding and management of this rare complication.

Mesenteric polycystic lymphangiomatosis in a pediatric patient. Case report

Introduction: Mesenteric polycystic lymphangiomas are rare cystic tumors, with a 5% incidence compared to their incidence in the neck and axillae (95%), seen more frequently in pediatric patients, rare in patients over 20 years of age.Clinical case: A 3-year-old male patient presents with a clinical picture of one day of evolution, reporting abdominal pain of moderate intensity, temperature rises and vomiting. Physical findings show abdominal distension, with ultrasound showing a polycystic lesion, and contrast-enhanced tomography corroborating a lobulated multi-separated cystic formation. Exploratory laparotomy revealed a polycystic tumor at the level of the ileum mesentery. The anatomopathological study describes a polycystic mesenteric lesion. Exeresis is performed and the postoperative evolution is satisfactory.Conclusions: Polycystic mesenteric lymphangiomatosis is a rare tumor that mainly affects the mesentery of the small intestine and/or colon. In pediatric age, this condition should be considered as a differential diagnosis of acute abdomen. Conventional or laparoscopic surgery is the cornerstone of treatment

Bladder Perforation and Vesico-Haematoma Fistula: An Uncommon Complication of Rectus Sheath Haematoma.

Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures, resulting in early treatment and a better outcome. We described a case of a spontaneous RSH with intraperitoneal extension and formation of a vesico-haematoma fistula, which was initially misdiagnosed as a urinary tract infection. The diagnosis was made ten days after admission, when a CT scan showed an over-16 cm RSH with intraperitoneal extension, bladder perforation and a vesico-haematoma fistula. The patient was managed conservatively. RSH accounts for less than 2% of acute abdomen cases and is often unrecognised. Its presentation can mimic other intra-abdominal pathologies, and the diagnosis is often delayed or missed. Complications can arise from an RSH although it is generally viewed as a self-limiting condition. RSH has become increasingly common, and we would like to highlight the need to include abdominal wall pathologies in the initial differential diagnoses of acute abdomen to avoid delay in diagnosis. Rectus sheath haematoma has become increasingly common due to the use of anticoagulants.The presentation can be non-specific and mimic other intra-abdominal pathologies. Misdiagnosis or delayed diagnosis can result in complications and unnecessary invasive procedures.Abdominal wall pathologies including rectus sheath haematomas should be included in initial differentials of acute abdomen.

Perforated Jejunal Diverticulitis: A Rare Cause of Abdominal Pain

Cases of small intestinal diverticulosis are rare and mostly asymptomatic. Occasionally, a small bowel diverticulum may perforate. We describe the case of an 80-year-old male who presented with abdominal pain and signs of localized peritonitis. The ultimate diagnosis was confirmed to be perforated jejunum diverticula. Perforation of the jejunal diverticulum should be considered as part of the differential diagnosis of acute abdomen in elderly patients, and appropriate treatment options, ranging from early surgery to conservative measures, should be tailored to the patient's presenting condition and their overall physiology.

Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound

BackgroundTo assess the frequency of appearance of various signs (isolated and grouped) in emergency imaging tests in patients with anisakiasis, according to the location of gastrointestinal tract involvement.MethodsRetrospective review by two experienced radiologists of emergency ultrasounds and CTs performed on patients admitted in the Emergency Department of our hospital with later confirmed anisakiasis (2010–2021), assessing the presence of signs suggesting anisakiasis. Calculation of the frequency of appearance according to the gastric or intestinal location, as well as the most common grouped signs.ResultsOut of 231 total patients with anisakiasis, imaging studies were performed in 144: abdominopelvic ultrasound in 43 cases and CT in 111 (both techniques in 31). In cases with gastric occurrence (34), in CT the wall stratification (100%), wall thickening (97%), fat stranding (91%) and ascitic fluid (82%) were predominant. In the intestinal cases (105), in CT (95) the wall thickening (100%), fat stranding (92%) and mesenteric vessel engorgement (83%) were usual; in ultrasound (40), ascitic fluid and wall thickening (70% in both cases) were frequently observed. The frequency of grouped appearance of the mentioned signs was 82% in gastric cases, 80% in intestinal cases and 50% in ultrasounds. Multisegment involvement in CT reached 28% (gastric + intestinal) and 11% (only intestinal) of cases.ConclusionsThe most frequent CT findings in patients with gastric anisakiasis are wall stratification and thickening, fat stranding and ascitic fluid. In the intestinal cases, wall thickening, fat oedema and vessel engorgement are the most often observed findings.Critical relevance statementThe presence of different radiological signs makes it advisable to include anisakiasis in the differential diagnosis of acute abdomen. Intestinal and multifocal involvement rates are greater than previously reported.Key points• In gastric anisakiasis, CT frequently shows wall stratification and thickening, fat stranding and ascitic fluid.• In intestinal anisakiasis, CT often presents wall thickening, fat stranding and vessel engorgement.• In intestinal anisakiasis, ultrasounds most frequently show ascitic fluid and wall thickening.Graphical

Primary Epiploic Appendagitis: Not Rare But Rarely Diagnosed Pathology.

The aim of this study is to determine the clinical and laboratory parameters which may be suggestive of or even pathognomonic for primary epiploic appendagitis (PEA) and to discuss the diagnostic efficacy of ultrasound (US) compared to computed tomography (CT) in patients with PEA. For this retrospective study, 92 patients diagnosed with PEA using US, CT or both modalities were included. All patient symptoms, clinical findings and laboratory parameters were reviewed. The CT and US images of the PEA were evaluated for lesion size and location, the relationship of the lesion to the colon and the distance of the lesion to the skin. There were 16 female and 76 male patients in the study group. The mean age was 35 years (range: 38-79 years). Well-localized abdominal pain was the primary symptom in all patients. The mean leukocyte count was 7857±1326 mm-3. The most frequent localization of PEA was sigmoiddescending colon junction (79/92). In patients who were examined by both US and CT, the size of the fatty central core was between 15-48 mm (mean:28.10 mm) and 9-22 mm (mean:15.07 mm) in its long-axis and short-axis diameter, respectively on US, whilst that by CT was between 15-46 mm (mean:26.88 mm) and 9-21 mm (mean:14.40 mm) in its long-axis and short-axis diameter, respectively. In patients who were examined by both US and CT, the mean distance of the lesions to the skin was 20.80 mm and 33.97 mm, respectively. All patients were treated conservatively with complete resolution of symptoms within a week of presentation. PEA is an unrare self-limiting condition that should be considered in the differential diagnosis of acute abdomen. To support clinicians and radiologists regarding PEA and its clinical, laboratory and radiological findings, targeted sonographic examination - which is radiation and contrast agent-free - could be highly sufficient for the diagnosis of PEA and may prevent unnecessary further imaging and mistreatment.

Consider Eating Disorders in the Differential Diagnosis of Acute Abdomen in the Ages of Adolescence

Consider Eating Disorders in the Differential Diagnosis of Acute Abdomen in the Ages of Adolescence

Acute appendicitis - One of the causes of peritonitis in newborn - A case report with literature review

INTRODUCTION. Acute appendicitis is the most common reason for abdominal surgery in children however in newborn and infants it’s casuistics. It is also the most common surgical emergency in pregnancy. Right lower abdominal pain, abdominal stiffness, and periabdominal pain radiating to the right lower abdomen are the best signs to diagnose acute appendicitis in adults. Absence Or attenuation of intestinal murmurs, positive sternal muscle signs, positive blunt signs, and positive Rovsing's Sign are the most reliable signs for the diagnosis of acute appendicitis in children. PURPOSE. The aim of the study is to show diagnostic difficulties of acute appendicitis in newborns and infants. It is one of the main differential diagnoses of unclear abdominal conditions. The smaller the child, the less characteristic the symptoms. A CASE REPORT. The study analyzes a male newborn born in the 37th week of pregnancy by caesarean section. Prenatal and family history of siblings' illnesses. In whom, on the 11th day of life, symptoms of food intolerance were found, green deposits were noticed in the stomach probe, and the presence of blood in the stool. Intraoperatively, gangrenous perforated appendix with diffuse peritonitis was found.Acute appendicitis is rarely considered in newborns and infants as the etiological factor of acute peritonitis. However, the presented patient with a genetic defect.CONCLUSION. Acute appendicitis is a common phenomenon in childhood, but this diagnosis is rarely considered in the differential diagnosis of acute abdomen in the neonatal period, is more common in premature babies. The clinical picture of neonatal acute appendicitis is unspecific and may lead to delayed diagnosis and misdiagnosis of necrotizing enterocolitis, which is a much more common condition in the neonatal period. We would like to present the diagnostic difficulties, course of treatment, and complications associated with neonatal appendicitis.

Laparoscopic Approach to a Patient with Omental Infarction: A Case Report

Background: Omental infarction is an entity that seldom manifests with gastrointestinal symptoms and often presents a diagnostic challenge. Due to its nonspecific presentation, it is usually not included as a differential diagnosis of acute abdomen, especially in an emergency setting. Case Presentation:: We present the case of a 38-year-old overweight female, seen in the emergency department, with a complaint of sudden onset of worsening epigastric abdominal pain for four days. The pain became more localized at the right iliac fossa two days before the admission. A physical examination revealed severe right iliac fossa tenderness and positive rebound tenderness. : A computed tomography of the abdomen was done and showed a localized area of mesenteric fat stranding in the right lumbar region reaching up to the inferior border of the right lobe of the liver with adjacent peritoneal fold thickening, likely suggesting inflammatory etiology. However, the appendix was visualized normally with a mild enhancement of the distal part suggesting secondary mild acute appendicitis. : A decision for diagnostic laparoscopy was made, where we found a 4x4 cm infarcted greater omental segment, which was excised and sent for histopathology. Conclusion:: Idiopathic omental infarction is a rare cause of acute abdomen in adults and needs to be considered as a potential differential diagnosis, especially if the clinical finding does not correspond with common conditions, like acute appendicitis.

Spontaneous splenic rupture secondary to salmonella bacteraemia: a case report and review of literature

INTRODUCTION Spontaneous splenic rupture without any history of trauma is a rare and under-recognized entity in patients presenting with acute abdomen. This is a life threatening condition seen in association with various haematological malignancies, medications and blood stream infections. CASE PRESENTATION We report the case of a ninety-four-year-old male who presented to a regional Australian Hospital with abdominal pain, fever and hypotension. Imaging revealed splenic rupture. Salmonella Typhi was isolated on blood and peritoneal cultures. The patient’s Salmonella exposure was likely related to frequent consumption of raw eggs. He was managed conservatively with intravenous antibiotics to treat salmonella bacteraemia. Unfortunately, the patient died prior to discharge. DISCUSSION Salmonella bacteraemia is an uncommon cause of splenic rupture. Timely diagnosis and identification of the underlying aetiology of splenic rupture is essential for targeted management of such patients. CONCLUSION Spontaneous splenic rupture is a rare and potentially life threatening disorder which should be considered in the differential diagnosis of acute abdomen, regardless of any occurrence of trauma. Early recognition of this condition is essential to prevent the associated morbidity and mortality.

A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon.

Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.

Accessory spleen. A diagnostic challenge. Case Study.

Introduction: Accessory spleen, also called supernumerary spleen, is a generally benign and asymptomatic condition, characterized by the location of splenic tissue outside the spleen. Its prevalence has been reported between 10% to 30% of the population. Materials and Methods: Patient evaluated for recurrent urinary tract infection in which a computed tomography urography without contrast was requested, incidentally finding an accessory spleen. Results: Clinical case report and diagnostic imaging challenge. Conclusions: The accessory spleen is a condition of congenital origin, relatively frequent for which it should be considered in the spectrum of the differential diagnosis of acute abdomen and intra-abdominal masses since its timely diagnosis can avoid unnecessary surgeries.

Acute epiploic appendagitis - a rare differential diagnosis of acute abdomen.

Acute epiploic appendagitis is a rare differential diagnosis of unclear or acute abdomen. To describe - by means of a scientific case report - the extraordinary diagnosis of acute epiploic appendagitis along with contained diverticulitis and incarcerated herniation of the greater omentum into the hernial sac of a former trocar site (medical history, significant for laparoscopic ovarian cyst removal) in a 29-year-old female based on experiences obtained in the successful clinical case management, and on selective references from medical scientific literature. Medical history: A 29-year-old female was admitted with abdominal pain in the lower left quadrant. She reported a laparoscopic ovarian cyst removal 3 years prior. Physical examination of the abdomen revealed tenderness in the lower left quadrant without a palpable mass.Leading diagnoses were found using transabdominal ultrasound and confirmed by an abdominal CT scan; namely, incarcerated trocar hernia, diverticulitis of sigmoid colon, and acute epiploic appendagitis. Therapeutic approach was comprised of an explorative laparoscopy (because of the incarcerated hernia), adhesiolysis, removal of a tip of the greater omentum out of the hernial sac, closure of the hernial orifice, and removal of an unclear, inflamed, and bloody fatty tissue from the wall of the descending colon (histopathological investigation confirmed acute epiploic appendagitis). This was flanked by conservative treatment of diverticulitis of the sigmoid colon.Further clinical course was uneventful, with discharge on the 3rd postoperative day with favorable long-term outcome, characterized by no further complaints for 15 months. Acute epiploic appendagitis is an inflammatory, usually self-limiting condition of the epiploic appendages of the colon. It typically manifests with abdominal pain in the lower left quadrant. Imaging is an important diagnostic tool to determine whether the patient has, in fact, acute epiploic appendagitis, so recognizing the characteristic oval lesions with the surrounding inflammation and central fat attenuation on CT, as well as the hyperechoic oval lesions with a hypoechoic peripheral band on ultrasound images is crucial. Nevertheless, it is often overlooked in patients and confused with other differential diagnoses, such as appendicitis or diverticulitis. Although the condition appears infrequently, it is essential to be proficient in the diagnostic evaluation, as a misdiagnosis may lead to unnecessary treatment and even surgical intervention. , the patient was initially diagnosed with an incarcerated abdominal hernia, and therefore subsequently underwent surgery. The inflamed epiploic appendage was discovered in laparoscopic exploration, removed, and confirmed through the histopathology report. This is an approach to be performed with great caution so as not to 1. : misinterpret an inflamed diverticula or covered perforation of it as well as not 2. : overlooking a peritoneal tumor lesion.

Phlegmonous gastritis as the initial presentation of acute myeloid leukaemia.

A 74-year-old Japanese man who had received one cycle of azacitidine for myelodysplastic syndrome and regularly used proton pump inhibitors was hospitalised with sudden-onset stomach ache and fever. He had been administrated meropenem and micafungin for febrile neutropenia during the azacitidine therapy until 3 days before admission. Clinical laboratory data on admission showed: white blood cell count, 0.7 × 109/L (neutrophils 33.4%, blasts 1.0%); haemoglobin, 10.2 g/dl; platelet count, 84 × 109/L; and C-reactive protein, 32.7 mg/dl. Computed tomography revealed diffuse oedematous thickening of the whole gastric wall, despite the absence of duodenum obstruction and a small amount of ascites (Figure 1). He had started immediate empirical administration of meropenem and micafungin because of the neutropenia and remained nil-by-mouth after admission. Bone marrow aspiration revealed an increase in myeloid blasts (41.5%), and acute myeloid leukaemia (AML) was diagnosed. Upper gastrointestinal endoscopy on day 2 of hospitalisation showed oedematous thickening of the folds of the whole gastric body and multiple ulcers with irregular margins from the corpus of the stomach to the fornix (Figure 1). Gastric mucosal biopsy was performed due to the possibility of leukaemia involvement. Fever and stomach ache persisted despite 5 days of antibiotic therapy, so low-dose cytarabine (20 mg/body/day) and etoposide (50 mg/body/day) were administrated intravenously for 10 days as induction therapy. Gastric mucosal biopsy showed necrotic tissue with numerous internal bacterial masses. No leukaemic blasts showing CD34 or KIT positivity were identified, and a diagnosis of phlegmonous gastritis (PG) was finally made. Blood and gastric biopsy tissue cultures yielded negative results. The patient showed gradual clinical improvement under continued antibiotic therapy during chemotherapy. On follow-up 5 weeks later, repeated upper gastrointestinal endoscopy showed improvement of the endoscopic findings. The patient made a complete recovery with no relapse. PG is a rare entity as a differential diagnosis of acute abdomen and often lethal acute infection of the stomach. Prompt antibiotic therapy based on early diagnosis is required. As mucosal injury due to gastric cancer, peptic ulcer or endoscopic procedure is regarded as the main cause of PG, few cases of PG with haematological malignancies have been reported. Even in this patient who was regularly using proton pump inhibitors and had no history of endoscopic manipulation, the initial onset of AML can on rare occasions cause fatal infection such as PG due to neutropenia. As with our patient, a rare but potentially fatal gastric infection can be an initial feature of AML, due to the severe neutropenia resulting from AML, despite the continuous use of proton pump inhibitors and the lack of prior endoscopic manipulation. The authors wish to acknowledge Dr. Yusuke Kito for his scientific advice and useful discussion. No funding was recieved. The authors declare that they have no conflict of interest. SL, KF and HT contributed to the conception and the design of the study. SL contributed to the literature review and the writing of the manuscript. MK, HM, TH, and HT contributed to the revision of the manuscript. KF contributed to figure creation. SL and KF confirm the authenticity of all the raw data. All authors approved of the final manuscript version submitted for publication. In accordance with our institution's ethics board, written consent forms are not required as less than 10 cases are reported.

SECOND TRIMESTER UTERINE RUPTURE WITH PLACENTA PERCRETA IN PREVIOUS LOWER SEGMENT CESAREAN SCAR

Rupture of a pregnant uterus is a serious threat to the mother’s life and her unborn child. Most of the reported cases of uterine rupture in scarred uterus are due to dehiscence of previous cesarean scar or a rupture of myomectomy scar and usually occur in the third trimester. Spontaneous uterine rupture in first or second trimester is very rare. Here we report a case of second-trimester spontaneous uterine rupture with a particular emphasis on the etiological factors, discuss the course of events and difficulties in the diagnosis. The lesson learned from this case is that, although uterine rupture is very rare in the second trimester of pregnancy, it should be taken into consideration in the differential diagnosis of acute abdomen, especially if there is a predisposing factor such as previous lower segment caesarean section and fluid in the abdomen.

Case Series of Acute Abdomen with Midgut Malrotation Presenting in Adulthood

Introduction: Intestinal malrotation (IM) is a congenital anomaly due to partial or complete failure of the 270° counter-clockwise rotation of the midgut around the superior mesenteric vessels in 5th to 12th week of fetal life. Midgut malrotation usually presents as an emergency in the 1st month of life or within infancy. Adult cases are rarely reported and usually present with chronic nonspecific symptoms. Here, we present a case series of acute abdomen with midgut malrotation presenting in adulthood that came to the Department of Surgical Gastroenterology of a tertiary hospital in Salem, Tamil Nadu. Case Summary: Four patients presented with acute abdominal complaints, diagnosed, and proceeded with emergency laparotomy. Three patients had abdominal abnormalities unrelated to coexisting IM, and the other one showed sequelae of IM with Ladd's band and obstruction. Except the first patient, all other patients improved well postoperatively and were discharged without complications. Conclusion: IM should be considered in differential diagnosis of acute abdomen and bowel obstruction in adults. IM may be encountered as an incidental imaging/laparotomy finding or be the cause of acute abdomen.

Heterotopic pregnancy in natural conception – A case report

Introduction: Heterotopic pregnancy is the coexistence of living or dead intrauterine pregnancy, single or multiple, and extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or peritoneal cavity. Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. A high index of suspicion can help in timely diagnosis and appropriate intervention.Case report: A 37- year-old primigravida lady with spontaneous pregnancy presented with amenorrhoea of 5 weeks, sudden and increasing lower abdominal pains of 5 days, dizziness of 2 days and vaginal bleeding of 4hours. Transabdominal and Transvaginal ultrasound scan was performed and revealed a non-viable intrauterine gestation at 6 weeks and 3 days, associated with a heterogenous complex right adnexal mass. Laparotomy was done, it revealed a ruptured right fallopian tube with remnant products of conception and hemoperitoneum; and right salpingectomy was done. The specimen was sent for histopathology. The patient tolerated the procedure well, though was resuscitated with normal saline and blood transfusion; she was taken to the recovery room in stable condition. The histopathological report confirmed the diagnosis of ectopic pregnancy.Conclusion: Despite the rarity of heterotopic pregnancy it should be suspected in patients with hemoperitoneum and an adnexal mass, even in the absence of risk factors, and should be included in the differential diagnosis of acute abdomen in the first trimester. The patient should be thoroughly investigated using abdominal and transvaginal ultrasound to exclude this rare diagnosis and allow on-time proper management.

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

Atraumatic Spleen Rupture Presenting as Acute Abdominal Pain: A Case Report

Splenic rupture is a potentially life-threatening condition associated with acute abdominal pain. Although rare, atraumatic spleen rupture (ASR) has been reported. It is not usually considered in the differential diagnosis of acute abdomen so often missed in emergency leading to high morbidity and mortality. We present the case of a 38-year-old male who presented with fever and acute abdominal pain, had atraumatic splenic rupture which was diagnosed early resulting in better outcome of patient.