Differential Diagnosis Of Acute Abdomen Research Articles

Stump appendicitis in two adolescent boys: Rare presentations and alternative approaches in pediatrics

Abstract Stump appendicitis is a rare complication that results from reinflammation of the residual part of the appendix, after incomplete appendectomy. Factors that may contribute to inadequate identification of appendicular base are subserosal or retrocecal position, extensive inflammation or inadequate surgical exposure. The length of the appendiceal stump after ligation is likely a major predisposing factor. The presentation of stump appendicitis is similar to acute appendicitis, but this diagnosis is often dismissed because of the surgical history. Computed tomography and ultrasonography are the imaging modalities of choice. The usual recommended treatment for stump appendicitis is completion appendectomy. Stump appendicitis must be considered in the differential diagnosis of acute abdomen despite the patient's appendectomy history. A delayed diagnosis may lead to an increase in morbidity. We present two cases of stump appendicitis in adolescents after laparoscopic appendectomies, one being a case of recurrent stump appendicitis. We report two alternative therapeutic approaches: interval appendectomy and non-operative management. We conclude that these alternative approaches may be suitable for some patients with stump appendicitis. A review of the pertinent literature was done.

Meckel's diverticulum perforation by a wooden toothpick in a child: A case report

Abstract Perforation of Meckel's diverticulum (MD) by ingested foreign body (FB) is an extremely uncommon cause of acute abdomen in children. We report on a 13-year-old boy who presented with right iliac fossa pain associated with anorexia, tenderness, guarding and rebound tenderness. Abdominal ultrasound showed findings of acute appendicitis. However, laparoscopy revealed a wooden toothpick perforating MD and a hyperemic appendix. The FB was removed and laparoscopic diverticulectomy and appendectomy performed. Perforation of MD by a FB is a diagnostic challenge and it should be included in the differential diagnosis of acute abdomen in children.

2075 A Case of Acute Abdomen Caused by Torsion of Parasitic Leiomyoma

Study Objective The reports of parasitic leiomyoma increase with the spread of the laparoscopic surgery. The origin is considered spontaneous or iatrogenic. In iatrogenic cases, many reports mention that the cause of parasitic leiomyoma is the using morcellator for laparoscopic myomectomy or hysterectomy of leiomyoma. This condition shows various symptoms, and it may develop acute abdomen. We describe the management of this condition and discuss about parasitic leiomyoma together with a review of the literature. Design A case report. Setting A tertiary care hospital. Patients or Participants A 46-year-old, gravida 1, para 1, Japanese woman. Her past history is a laparoscopic myomectomy and excision of endometriosis in several years ago. Interventions Laparoscopic surgery. Measurements and Main Results The patient visited a practicing physician with a chief complaint of acute abdominal pain. Transabdominal ultrasound showed huge pelvic mass, and she referred to our hospital. MRI scan of the pelvic revealed a 15 cm diameter polycystic mass contained with water in the right adnexal region. Since she complained severe pain at the point of the mass, we suspected torsion of ovarian tumor, and we performed emergency laparoscopic surgery. During the procedure, we found the huge mass in the pelvis without connecting to right ovary. The mass was fed by vessels extending from the mesocolon of sigmoid colon and was twisted 1.5 rotations clockwise around the stalk. The mass was resected by the surgeon because GIST was suspected. A histopathological examination showed a leiomyoma. In immune-histological examination, c-kit was negative. Her postoperative course was uneventful. Conclusion It is important to include torsion of parasitic leiomyoma in the differential diagnosis of acute abdomen, especially, for the patients who had medical history of laparoscopic myomectomy.

Inflamed Invaginated Meckel’s Diverticulum, as a Cause of Acute Abdomen: Case Report

Meckel’s diverticulum (MD) is a remnant of the omphalomesenteric duct attached to the small bowel. It is the most common congenital abnormality of the small intestine, occurring in approximately 2% of the population of whom 4% are symptomatic. We are presenting a case of invaginated Meckel’s diverticulum in a 32-year-old male who presented with right iliac fossa pain and tenderness. In spite of the fact that invaginated Meckel’s diverticulum is a rare entity, it should still be included in the differential diagnosis of acute abdomen as well as bleeding per rectum.

AN EXTENSIVE WARFARIN-INDUCED JEJUNAL HEMATOMA

The most common adverse event associated with oral anticoagulation (OAC) is bleeding in general that is seen in 5 to 48% of patients and gastrointestinal bleeding (GIB) in particular which occurs in 2–4% of patients. Intramural hematoma (IMH) is a rare variant of GIB, occurring in 1 in every 2500 patients and is treated with OACs. IMHs are rarely fatal and the current data suggest conservative medical therapy and clinical follow-up for management of IMHs. GIB and intestinal IMH is becoming a more common clinical problem because of increasing number of patients taking OACs. This report describes a 91-year-old woman who was presented with abdominal discomfort for 2 days. The patient had been under anticoagulant therapy with warfarin because of atrial fibrillation. She was found to have an inappropriately prolonged international normalized ratio level of 8.1. IMH was confirmed with abdominal ultrasound and computed tomography (CT) scan. The patient was treated conservatively with fluid resuscitation, nasogastric decompression, bowel rest and reversal of anticoagulation. Follow-up CT scans, approximately one month after medical treatment, demonstrated complete resolution of the IMH. Intestinal IMH should be considered in the differential diagnosis of acute abdomen in any anti-coagulated patient with abdominal complaints.

Jejunal diverticulosis complicated with perforation: A rare acute abdomen etiology

IntroductionJejunal diverticulosis is a rare intestinal pathology with an incidence of 0.5–1%. While most cases are asymptomatic, 30–40% of the cases may become symptomatic with chronic abdominal pain, malabsorption, hemorrhage, diverticulitis, obstruction, abscess formation and, rarely, diverticula perforation. It is generally localized on the mesenteric side and it develops from the entry points of the vessels into the jejunum. Case presentationCase 1 – A 36-year Case 2 a 75 old female patient patient was admitted to the emergency department with the complaint of widespread abdominal pain, Case 1 8 diverticules, one with diverticule perforation, was observed in the jejunum segment between the 50th and 90th centimeters after the Treitz Ligament. Case 2 – In the diverticulum 100 cm distal from the Treitz ligament, mesenteric perforation area of 4–5 mm were observed. ResultsSegmentary small bowel resection and side-by-side anastomosis were performed in these cases. In the histopathological examination, the Diverticula were seen to be pseudodiverticullar lesions including herniation of the mucosa and submucosa. ConclusionJejunoileal diverticulosis is a rare disease with life-threatening complications such as perforation, obstruction and bleeding, it is usually asymptomatic or presents with nonspecific symptoms. It should be considered in the differential diagnosis of acute abdomen.

English

Small bowel diverticulitis is a rare condition that is often excluded in the differential diagnosis of acute abdomen. We herein present two cases of patients with small bowel diverticulitis who presented with acute abdomen. First case was a 72-year-old lady who presented to emergency with 2 days of sudden-onset worsening generalized abdominal pain. The computed tomography (CT) revealed a segment of abnormally thickened jejunum with marked adjacent inflammatory mesenteric fat stranding and adjacent extraluminal gas locules, in keeping with complicating perforation. The patient was subsequently taken to the operating theater for an emergency laparotomy which revealed a contained perforation of the proximal jejunum secondary to a ruptured diverticulum. 20 cm of proximal jejunum containing the perforation was resected. The patient recovered uneventfully and was discharged day 7 following the operation. Second case was a 78-year-old lady who presented with 12 h of sudden-onset right-sided abdominal pain. The CT revealed the presence of multiple diverticula in the jejunum associated with diffuse wall thickening and marked peridiverticular inflammatory changes. This was most in keeping with small bowel diverticulitis, however, there was no definite extraluminal gas to suggest any evidence of perforation. The patient was managed conservatively with intravenous antibiotics and bowel rest. The patient’s pain improved with improving inflammatory markers during the hospital stay. The patient was discharged day 4 following the admission. We believe that there is a need to devise a comprehensive treatment guidelines specific for small bowel diverticulitis. In the meantime, it is deemed safe to conservatively manage uncomplicated cases without perforation. Key words: Intestine, small, abnormalities, abdomen, acute, diverticulosis, colonic, diverticulitis, colonic, clinical protocols, tomography, computed.

Ileus as a Sign of Neuroleptic Malignant Syndrome: A Case Report and Review of the Literature

Introduction: Neuroleptic malignant syndrome (NMS) is a rare and unpredictable adverse reaction associated with the use of first-generation and second-generation antipsychotics. Atypical antipsychotics may create atypical forms of NMS due to their different pharmacological characteristics. Decreased dopaminergic tone in the brain is coincided with a dysregulation of autonomic nervous system in this syndrome. This paper reports on an NMS case, in which current views and symptoms that occurred during the course of the disease were rare symptoms that are not usually found in NMS. Case Presentation: The patient was a 43-year-old male with schizoaffective disorder under treatment with clozapine and risperidone. He had lead pipe muscle rigidity, stupor, fever and autonomic dysfunction, increased levels of creatinine phosphokinase, leukocytosis, and microglobulina. Levenson’s criteria is widely accepted for diagnosis of NMS. Six days after admission to the psychosomatic ward, the patient had ileus. Due to lack of response to neomycin and GI rest and embedding NG tube, the patient underwent therapeutic sigmoidoscopy and colonoscopy for decompression. Conclusions: Diagnosis of NMS is largely based on clinical history and the presence of specific clinical symptoms. Antipsychotics polypharmacy increases the NMS risk. Mechanisms underlying the development of ileus in the patient are speculative and multifactorial. Paralytic ileus can be one of the autonomic dysfunctions in NMS. Furthermore, NMS is categorized in differential diagnosis of acute abdomen caused by the pseudo-obstruction. All physicians should be aware of this possibility when faced with patients under treatment with neuroleptics.

Black Widow Spider Envenomation with Elevated Troponin I Levels

Introduction: The black widow spider is found worldwide. Alpha-latrotoxin is responsible for the toxic effects related to the spider bite. We report the case of a patient who presented at the emergency department after being bitten by a black widow spider that later developed increased cardiac enzymes.Case Report: The patient was a 24-year-old male who had been bitten by a black spider inside his shoe while he was working in the garden. The patient was referred to the emergency department of department of emergency medicine Canakkale Onsekiz Mart University Faculty of Training and Research Hospital with nausea, vomiting, and severe rigidity in the abdomen for the differential diagnosis of acute abdomen. With severe sweating, the patient had rales in the lower lung zones, and abdominal examination revealed diffuse abdominal guarding. Blood biochemistry revealed creatine kinase (CK): 1838 U/L, CKMb: 71.6 U/L, and troponin I: 0.14 ng/mL. In follow-ups, the troponin I levels increased to 3.01 ng/mL. Electrocardiography revealed normal sinus rhythm. He was followed with a bedside monitor for 3 days in the emergency department. When the patient’s troponin I and CK levels decreased, at the end of the third day he was discharged..Conclusion: Black widow envenomation should be followed for cardiac toxicity other than symptoms, such as muscle spasms, sweating, anxiety, and headache

Gynecological acute abdomen in patients age under 18: an analysis of 237 cases

Objective: To investigate the constituent ratio, clinical manifestation, diagnosis and treatment of gynecologic acute abdomen in patients age under 18. Methods: A retrospective study was conducted on 237 patients under 18 years old who had been admitted in Rizhao People's Hospital from June 2013 to November 2016. The patients were divided into two groups: groupⅠ (under ten years old, 49 cases) and group Ⅱ (ten to eighteen years old, 188 cases) . The first visit departments, constituent ratio, clinical manifestations and treatment methods of the two groups were summarized and analyzed. Results: The proportion of first visit department was gynecology department in the group Ⅰwas lower than that in group Ⅱ [18.4% (9/49) versus 69.1% (130/188) , P<0.01]. The proportion of diseases in the two groups was different; the proportion of ovarian tumors (59.2%, 29/49) , genital malformations (10.2%, 5/49) and ovarian torsions (10.2%, 5/49) in group Ⅰ were significantly higher than those in group Ⅱ, while the pregnancy related diseases in group Ⅱ (37.2%, 70/188) was significantly higher than that in group Ⅰ (P<0.01) . Conclusions: Clinicians should pay enough attention to the acute abdomen caused by gynecological factors in childhood and adolescence. The differential diagnosis of acute abdomen should pay attention to. In the choice of treatment methods, we should give full consideration to the special age, and try to maintain their normal growth and physiological function.

Perforated pyometra is a misleading cause of acute abdomen in elderly women: case report and review of literature

Even if acute abdomen is associated with gastrointestinal (GI) perforation in more than 90% of cases, spontaneously perforated pyometra is a rare and misleading cause that gynecologists and general surgeons should suspect in elderly postmenopausal women. We report one case of diffuse peritonitis caused by spontaneous uterine perforation. A 94-year-old postmenopausal female was admitted to emergency department with signs of diffuse peritonitis and seven days history of abdominal pain. Abdominal contrast- enhanced CT-scan showed a large amount of ascites and a small amount of intraperitoneal free-air. One hour after the admission septic shock developed and emergency laparotomy was performed for suspected GI perforation. During laparotomy about 1500 mL of purulent, malodorous but not-fecaloid fluid was found in peritoneal cavity, without evidence of GI perforation. A 10 mm perforation on the anterior part of the uterine fundus was found. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Patients died on postoperative day four despite intensive care for multi-organ failure due to septic shock. The hysto-pathology examination showed absence of cancer. Pyometra perforation is a rare cause of acute abdomen with a not negligible mortality and it should be considered in the differential diagnosis of acute abdomen, especially in elderly patients. The aim of the study is to report our personal experience and a review of the literature of spontaneous perforation of pyometra in patients with no evidence of malignancy.

Clinical Application and Value of Ultrasound in Diagnosis of Acute Abdomen—A Single Center Experience

&lt;p&gt;&lt;em&gt;This study is an analysis of the clinical value of ultrasonic diagnostic technique in the differential diagnosis of acute abdomen of the liver and gallbladder. Methods from July 2010 to October 2015, 641 cases of acute abdomen admitted to Macao &lt;/em&gt;&lt;em&gt;Conde de Sao Januario&lt;/em&gt;&lt;em&gt; Hospital were retrospectively analyzed. Among 641 cases of acute abdomen, 280 cases (43.7%) were diagnosed as acute appendicitis, 168 cases (26.3%) had acute pancreatitis, 79 cases (12.3%) had acute cholecystitis, 65 cases (10.1%) had urinary stones, 49 cases (7.6%) had liver abscesses. In 641 cases of acute abdominal disease, 584 cases were consistent with the results of ultrasonic examination and final diagnosis, which accounted for 91.1% of the total number of cases. Therefore, ultrasound diagnostic technology has a good clinical value in identifying acute abdomen, which helps to make correct pathological diagnosis, reduce misdiagnosis rate, and has no radiation and noninvasive. Therefore, it is worth further use in clinical application.&lt;/em&gt;&lt;/p&gt;

Hemoperitoneum from Spontaneous Rupture of Corpus Luteal Cyst: A Case Report and Literature Review

Hemoperitoneum resulting from various gynecological emergencies can be life threatening and ruptured corpus luteal cyst is one of the causes Here we are reporting a case of yrs women with history acute pain abdomen on th day of her mentstrual cycle Ultrasound showed collection in pelvic cavity mainly around right adnexa After few hours of observation she was taken for laparotomy because of tense and tender abdomen Intraoperative there was hemoperitoneum of around cc with ruptured corpus luteal cyst of right ovary Ruptured corpus luteum cyst should be kept in differential diagnosis of acute abdomen in women of reproductive age group especially in secretory phase Timely diagnosis and management can save patient life

Krukenberg Tumor from Gastric Carcinoma presented as Acute Abdomen: A Unique Presentation

ABSTRACT Krukenberg tumor is an ovarian metastatic tumor from the digestive tract accounting for 10% of all ovarian malignancies. The uniqueness of this tumor is its morphology disguising as the primary tumor. We present a case of gastric carcinoma in a 36-year-old woman, who presented as acute abdomen to the emergency department. Abdominal examination revealed tender, cystic to firm mass of size 14 × 10 × 8 cm in the left lower quadrant. The abdominal ultrasonography revealed the ovarian mass of the above-mentioned size with minimal free fluid in the peritoneal cavity. An explorative laparotomy disclosed bilateral ovarian masses. Histological findings of both ovarian masses were consistent with metastatic adenocarcinoma of stomach. The survival rate of the patients can be improved by tumor-free surgery and a novel platinum-based chemotherapy. Krukenberg tumor should be considered in differential diagnosis of acute abdomen. How to cite this article Jarathi A, Ramamoorthy S, Mohan J. Krukenberg Tumor from Gastric Carcinoma presented as Acute Abdomen: A Unique Presentation. J South Asian Feder Menopause Soc 2017;5(1):66-68.

Clinically Integrated Ultrasound in the Differential Diagnosis of Acute Abdomen

Clinically Integrated Ultrasound in the Differential Diagnosis of Acute Abdomen

Acute abdomen due to vinyl gloves ingestion in a mentally retarded patient: A Case Report

Foreign body ingestion is a common problem, particularly in pediatric age group. Most of these bodies pass unnoticed and without complications. Only 10 – 20% of cases require endoscopic removal. Surgery is indicated in 1% of patients. Vinyl glove ingestion is a rare differential diagnosis of acute abdomen. A detailed history is helpful to reach the diagnosis in case of foreign body ingestion. We report herein a case of vinyl glove ingestion in a mentally retarded patient, who presented with acute abdomen and mandated a surgical intervention.

Right-sided omental torsion with inguinal hernia

A 38 year old man was admitted to our hospital with abdominal pain. He had an untreated right inguinal hernia and the hernia presented as a swelling ball of 4.0×3.0 cm in size. CT showed a large mass of fat density below the Sigmoid colon and incarcerated fat within the right inguinal hernia. Emergent laparotomy revealed four-circle twisted and infarcted greater omentum and a little bloody ascites within the right inguinal hernia. Pathological examination showed hemorrhagic infarction of the greater omentum. Although omental torsion is a rare cause of acute abdominal pain, it should be taken into consideration in the differential diagnoses of acute abdomen, especially in patients with untreated inguinal hernia.

Laparoscopic management of a twisted ovarian leiomyoma in a woman with 10 weeks’ gestation

Background:Primary leiomyoma of the ovary is a rare benign ovarian tumor that only seldom causes acute abdomen.Case summary:A 35-year-old gravida 1, para 0 woman presented with a history of acute lower abdominal pain, and 10 weeks of amenorrhea. The patient's physical examination revealed abdominal tenderness, defense, and rebound. On ultrasonographic examination, a solid mass measuring 9.3 × 7.8 cm was detected adjacent to the uterine fundus. The mass was preoperatively diagnosed as a twisted pedunculated subserosal uterine myoma. Upon entering the pelvic cavity, the mass in the right adnexa appeared twisted clockwise. Therefore, a laparoscopic salpingo-oophorectomy was performed. The tumor was pathologically diagnosed as ovarian leiomyoma. The patient delivered a healthy girl at 40 1/7 weeks of pregnancy.Conclusion:Despite its low incidence, torsion of ovarian leiomyoma should be considered in the differential diagnosis of acute abdomen. Furthermore, laparoscopic exploration should be the preferred way of removing twisted ovarian leiomyoma, even during pregnancy. It seems that primary ovarian leiomyomata have a tendency to grow rapidly during early pregnancy. However, because of the low incidence of ovarian leiomyoma, the effects of estrogen and pregnancy on this condition remain unclear.

An uncommon case of late-onset congenital diaphragmatic hernia with bloody stool

Abstract Late-onset congenital diaphragmatic hernia (CDH) is an uncommon subset of CDH and distinct from neonatal CDH with respect to presenting symptoms, diagnosis, management, and prognosis. In particular, CDH diagnosed after 30 days of age (late-onset CDH) is uncommon and has an atypical presentation and a more favorable prognosis. In the present report, an infantile late-onset CDH case that presented with bloody stool and had a severe clinical course is described. In previous reports, no late-onset CDH case developed bloody stool. After diagnosis with image inspections, emergency surgery was performed. At operation, via the hernia orifice, the jejunum was seen to have prolapsed into the thoracic cavity with focally significant intestinal and mesenteric congestion, but no intestinal necrosis. In general, other disorders such as intussusception may be considered in the differential diagnosis of acute abdomen with bloody stool in patients of this age. However, in such late-onset CDH cases, immediate differentiation from other causes of acute abdomen that present with bloody stool is life-saving.

Ruptured Ectopic Pregnancy after Tubal ligation: A case report

Diagnosis of ectopic pregnancy in a sterilized female may be missed many times and it is associated with greater risk of maternal morbidity and mortality. Risk of ectopic pregnancy after failure of tubal ligation is not only limited to initial years but also seen many years after the procedure. So due consideration should be given to ectopic gestation as a part of the differential diagnosis in acute abdomen of reproductive age group female even in the presence of tubal ligation history. Keywords: Tubal ligation; Ectopic pregnancy; Sterilization failure