Erect Abdominal X-ray Research Articles

Gastric Volvulus with Hiatal Hernia in a Young Male: A Case Report

Background: Gastric volvulus, a rare surgical emergency mimics common presentations like acute pancreatitis. Intestinal obstruction and hollow viscous perforation. Clinical Description: A young male without any co-morbidities presenting with acute pain in the abdomen with vomiting for 5 days with stable vitals. Management: Erect abdominal X-ray with diagnostic endoscopy was done on an emergency basis. Laparoscopic repair of the hiatal hernia with anterior gastropexy was performed immediately. Conclusion: Early diagnosis of acute abdominal pain is crucial as misdiagnosis delays proper treatment. Aspiring surgeons should acknowledge that while diagnosing rare disorders may often be challenging, there is a possibility of accuracy in specific cases.

Rare Case of Caecal Non Hodgkins Lymphoma Presented as Intussusception – Case Report and Literature Review

A 68-year-old man presented at Pacific institute of medical sciences emergency department in May 2023 with pain in the epigastric region. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine. CT scan shows ileo-colic intussusception. During laparotomy a large mass of 5x5 cm in size was detected in the caecum. It is very important to do CT scan for patients with long- standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.

Epidemiologic factors associated with neonatal bowel perforations in Uganda: experience from a single tertiary referral hospital

BackgroundNeonatal bowel perforations pose a significant disease burden for pediatric surgeons around the world. However, very little is known about these perforations in low-income settings. This study aims to investigate the epidemiology of neonatal perforations at a tertiary hospital in Uganda.ResultsTwenty neonates with bowel perforation who were admitted to a single national referral hospital from May 2020 to April 2021 were included. Fifty-five percent (n = 11) of the neonates in this cohort were male, and 16 were term with birth weight above 2.5 kg. Thirteen were below 1 week of age and all maternal ages were less than 40 years. Pneumoperitoneum was the most common finding on erect abdominal X-ray and colon was the frequent site of perforation. Forty percent of the babies in this cohort had blood group O+. Fifty-five percent of our patients died before discharge.ConclusionOutcomes for neonatal bowel perforations are still dismal. Health workers taking care of neonates should have a high index of suspicion for neonatal gastrointestinal perforations.

Endoscopic removal of a tablespoon retained in the stomach - A case report


 
 
 Even if the ingestion of foreign bodies is common, it is not a common practice to remove endoscopically a big foreign body retained in the stomach. We describe a 27 years old schizophrenic woman transferred to the Kigali University Teaching Hospital (CHUK) after four days of ingesting a tablespoon. An erect abdominal X-ray revealed the teaspoon in the abdomen and was confirmed by an endoscopy. The spoon was successfully removed endoscopically using a polypectomy snare. There were no post-procedure complications, and the patient was discharged after two days of observation.
 The upper gastrointestinal endoscopy is a feasible and safe procedure for removing big retained foreign bodies in carefully selected patients.
 
 

Case report on colo-colic intussusception

Background: Intussusception is a serious condition in which part of the intestine slides into an adjacent part of the intestine. It is rare in adults, and symptoms of the disorder often overlap with the symptoms of other disorders; it is more challenging to identify. Case Presentation: A 55-year-old female patient was admitted with complaints of colicky abdominal pain and loose stools mixed with blood. The erect abdominal X-rays revealed dilated large bowel distension. A digital rectal examination revealed red currant jelly stools, and the anal canal was found to be ballooned. Colo-colic anastomosis surgery was performed. The histopathological examination of the resected specimen diagnosed it to be mucinous adenocarcinoma of the colon. Conclusion: Colo-colonic intussusception is a rare cause of intestinal obstruction in adults.

A double Meckel's diverticulum in a 5-year-old girl

Although Meckel's diverticulum (MD) is the most common congenital anomaly in the GI tract, it is usually located as one true diverticulum at the antimesenteric side of the small intestine. It is very rare to find MD as a double diverticulum. In literature, only four cases of a double MD were reported in pediatric population. A 5-year-old girl was brought to the emergency department complaining of periumbilical abdominal pain associated with frequent bilious vomiting. The only abnormal lab result was leukocytosis with neutrophilia. An erect abdominal X-ray revealed multiple air-fluid levels in the upper abdomen. On laparotomy, the intestinal loops were extensively dilated and adhesions were noticed. After releasing the adhesions, two different Meckel diverticula were surprisingly discovered, a small one located 15 cm from the ileocecal valve, and a large one causing the obstruction and located 35cm proximal to the ileocecal valve. A double diverticulectomy along with a primary repair was undertaken followed by an unremarkable postoperative course. Double MD is a rare and extraordinary entity that may be seen during the surgical practice, so it is crucial to trace the entire intestine during an exploratory laparotomy, especially the last 100 cm of the terminal ileum, to detect the associated congenital anomalies such as duplication or diverticula to avoid future mishaps.

Neonatal gastro-intestinal tract perforation in Mosul city

Background: Gastro-intestinal perforation (GIP) of neonates considered as one of the foremost emergency problems faced by pediatric surgeons around the world. It represents important challenges with a high mortality of 15-70% has been reported. Despite enhancements in anesthesia, as well as, intensive care, mortality has remained high, especially in premature babies. Patients and Methods: A retrospective series study including 50 patients diagnosed as GIT perforation were admitted to the neonatal pediatric surgery center in Al-Khansaa teaching hospital, allocated over the period extending from April 2017 to June 2019. Records were reviewed for the age, sex, gestational age, weight, duration of symptoms, associated anomalies, causes of GIT perforation, procedure done, mortality, amorbidity, and hospital stay period. Leak from intestinal anastomosis secondary to resection as surgical interference were excluded from the study. Results: The presentation age varied between 12 hours to 27 days with a median age of 3.5 days. The weight mean is 2.93 kg. The mean gestation age was 34 weeks, ranging from 30-42 weeks. The majority had the symptoms before 30 hours. Most of the sample is within the 1st week representing 86.0%. The males are representing 76.0% while the females are 24.0% with a ratio about of (3:1). About 56.0% of the perforations occur in the small bowel and only 4.0% in appendix. The large bowel represents 28.0% and the stomach 12.0%. The positive findings of abdominal X-Ray are found in 80.0% of patients. 40.0% of patients are died. The frequent site is the ileum, found in 8 patients (40.0%) of all deaths. Next are the Jejunum and colon, representing 20.0% for each. The stomach pathology found in 10.0%, as well as, the cecum 10.0%. Conclusion: The commonest site of perforation is small bowel. History, clinical picture and erect abdominal X-ray are very important for the diagnosis. The risk factors raise the mortality rate include malnutrition, the appearance of complications, lack of certain drugs, delayed diagnosis, prematurity, and associated anomalies. The outcome is improved with early identification, diagnosis, and treatment. AIM OF THE STUDY : To study the causes and outcome of neonatal GIT perforations in Mosul city and its drainage areas in the north of Iraq.

Spontaneous passage of accidentally ingested metallic nail in an adult: A case report.

Introduction and importanceForeign body ingestion is most common in children, as well as adults with neurodevelopmental and psychiatric problems. The most commonly swallowed foreign bodies in adults include fish bones, chicken bones, toothpicks, and dentures. Sharp and elongated ones are the most typical causes of gastrointestinal perforation among the aforementioned. In about 1% of cases, foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation.Case presentationA 23-year-old male construction laborer presented to the Emergency Surgical Unit of Debre Markos Hospital 7 h after he accidentally swallowed a nail while at work. He didn't have abdominal pain, vomiting, or rectal bleeding. On exams his vital signs were stable. His chest and abdominal exams as well as the digital rectal examination were unremarkable. He was evaluated with a plain erect abdominal x-ray based on his complaint, which revealed a long nail lying longitudinally in the right lower quadrant of the abdomen. Twenty-nine hours after swallowing the iron nail, he passed it through his rectum spontaneously.ConclusionPlain radiography should be performed to locate and follow-up on radiopaque foreign entities before sophisticated imaging and invasive procedures. When treating people who have accidentally ingested a sharp foreign body, clinicians should find a balance between prompt action and careful follow-up.

Sigmoid volvulus; a rare complicated presentation of Hirschsprung's disease: A case report.

IntroductionSigmoid volvulus (SV) is a rare complication of Hirschsprung's disease (HD) with only 31 cases have been reported in the English literature. Although its diagnosis is challenging, unrecognized SV is a life-threatening condition requiring early recognition to decrease morbidity and mortality.Presentation of caseA 14-year-old male presented to our emergency department with massive abdominal distention. Plain erect abdominal X-ray showed massive colonic distention with multiple fluid levels. Colonoscopy failed to pass beyond 15 cm after entering dilated sigmoid loop. Open surgical exploration was done through a lower midline incision and revealed SV with massive distention of the entire colon. After detorsion, we found a markedly dilated sigmoid colon with an evident discrepancy at the lower sigmoid. Due to massive colonic dilatation, the decision was made for terminal ileostomy. Histopathological examination of biopsy from the narrow segment demonstrated aganglionosis and hypertrophic submucosal neural fibers confirming the diagnosis of HD.DiscussionSV is a rare serious complication of HD. Unrecognized SV is a serious life-threatening condition, so it should be considered in children with acute or recurrent abdominal pain, distension, constipation and vomiting as early recognition and management of volvulus is essential to decrease morbidity.ConclusionThe presented case highlights the possibility of SV as a rare complication of HD should be considered especially in children with a history of chronic constipation and abdominal distension who present with acute colonic distension and failure to decompress despite rectal washes.

Use of the Water-Soluble Contrast Medium Gastrografin in Treatment of Adhesive Small Bowel Obstruction in Patients with and Without Chronic Radiation Enteropathy: A Single-Center Retrospective Study.

BackgroundThis retrospective cohort study from a single center aimed to compare patient outcomes following the use of the water-soluble contrast medium Gastrografin in the treatment of adhesive small bowel obstruction (ASBO) in patients with and without a history of chronic radiation enteropathy (CRE).Material/MethodsFifty-nine patients with CRE-induced small bowel obstruction (SBO) and 53 patients with ASBO at Jinling Hospital between April 2014 and February 2018 were enrolled. The patients were given 100 ml Gastrografin through a naso-jejunal tube, and erect abdominal X-rays were taken. Risk factors were found to be correlated with successful non-operative management (SNM) through statistical analyses.ResultsThe success rate of conservative treatment was higher in the Gastrografin group than in the control group (P<0.05). The Gastrografin challenge test is predictive of need for surgery in CRE-induced SBO and ASBO (AUC=0.860 and 0.749, respectively). The predictors associated with SNM in the CRE-induced SBO group were the total dose of radiotherapy, the Gastrografin challenge test, and previous operations for SBO. In the ASBO group, the predictors were the Gastrografin challenge test and previous operations for SBO. The operation rate of SBO patients with Gastrografin treatment was significantly lower than that in the control group (P<0.05).ConclusionsThe findings from this study showed that the use of Gastrografin effectively resolved ASBO in patients with and without a history of CRE, but a long-term requirement for surgery could not be avoided. The Gastrografin challenge may be a useful test to predict surgical outcomes.

Gastrojejunal fistula caused by magnet beads ingestion in a 2 -year-old boy

Abstract Foreign body (FB) ingestions are common events in infants and toddlers. Magnet ingestion increases in the last decades among children and it may be catastrophic if not detected. A 2-year-old-boy was brought to an emergency department for bilious vomiting for five days associated with abdominal pain and constipation. An erect abdominal X-ray showed a radiopaque chain of beads in the upper abdomen, gastric and duodenal gas bubbles with air fluids levels, and a gasless abdomen. Exploratory laparotomy through upper midline incision was performed. In our case, the magnet beads were just beyond the ligament of Treitz and made the jejunal loop as an omega shape that fistulized to the posterior wall of the stomach through the mesentery of the transverse colon. All magnet beads were extracted and the perforations in the jejunum and posterior wall of the stomach were both closed primarily. Conclusion It is crucial to intervene early in symptomatic patients with multiple magnets ingestion, especially if it is located beyond the stomach, to prevent future complications like hollow viscus perforations, fistula formation, and even short bowel syndrome.

A Mysterious Case of a 33-Year-Old Female Schizophrenic Patient Who Ingested a Kilogram of Metals: A Case Report

Introduction: Globally, 20 million people are affected by schizophrenia. In Uganda, the prevalence is reported to be 710 per 100,000 population. Unlike normal adults who are less likely to have foreign body ingestion, patients with mental illnesses such as schizophrenia are at an increased risk of both intentional and accidental foreign body ingestion. Therefore, health workers must be vigilant while assessing such patients not to miss out on the diagnosis as unwitnessed foreign body ingestion presents a diagnostic challenge. Observation: We received a 33-year-old female diagnosed with schizophrenia four years before this admission as a referral. She presented at MNRH A&E with complaints of abdominal pain, non-bilious vomiting, and progressive weight loss. She had multiple admissions in private hospitals before her referral to MNRH where several investigations were done with inconclusive results. Upper GI endoscopy revealed multiple foreign bodies in the stomach. An erect abdominal x-ray was then done to rule out distal gastrointestinal involvement and/or perforation. An emergency laparotomy was performed and over 170 different metallic objects of varying sizes were completely evacuated. She reported that she ingested them in response to the compelling auditory hallucinations but had no intention of self-harm. Conclusion: Foreign body ingestion presents a diagnostic challenge in adults. The various impairments among mentally ill patients put them at an increased risk hence the need for suspicious diagnostic evaluation of those presenting with abdominal symptoms. Both health workers and families have a role to play in the prevention of such life-threatening emergencies.

Spontan Pnömoperitoneumu Olan Olağan Dışı bir Pediatrik Vaka: Kabızlığın Neden Olduğu Pnömatozis Sistoides Intestinalis

Pneumoperitoneum almost always indicates a perforation. However, perforation is not detected approximately 5% to 15% of all exploratory laparotomies and it is called spontaneous pneumoperitoneum (SP). One of the rare causes of SP is Pneumatosis cystoides intestinalis (PCI). An 11-year-old female patient was transferred to the pediatric emergency department due to suspicion of intestinal perforation. Erect abdominal X-ray revealed pneumoperitoneum below the right diaphragm. Emergent exploratory laparotomy was performed. No perforation was detected during exploratory laparotomy. Both the absence of fever, peritoneal irritation signs and normal biochemical parameters SP must be considered. It should be kept in mind that PCI induced by constipation may be a cause of SP.

Jejunal perforation by fishbone

Foreign body ingestion is a common presentation in clinical practice. Although most ingested foreign bodies pass uneventfully across the gastrointestinal tract, sharp elongated objects pose a greater risk of intestinal perforation. We report here a case of jejunal perforation following the ingestion of fishbone. A 78-year-old female presented with acute onset of generalised abdominal pain for few hours. Examination revealed tenderness, guarding and rigidity all over the abdomen. Erect Abdominal X-ray findings were inconclusive. However, contrast-enhanced computed tomography (CT) showed a thin, linear hyperdense foreign body perforating through the jejunum. Exploratory laparotomy was done, and a fishbone piercing the small bowel 50 cm distal to the ligament of Treitz was retrieved. The perforation hole was closed with primary suture. Postoperatively, the patient recovered well. Small bowel perforation is a life-threatening emergency that necessities urgent surgical intervention. Fishbones are commonly associated with perforations and the most common site of perforation is the terminal ileum. The most important risk factor associated with intestinal perforation by fishbones is the use of dentures which impair protective sensory mechanisms. Clinical presentation can be non-specific, and contrast-enhanced CT is required to establish diagnosis. Intestinal perforation associated with foreign body ingestion should be considered when evaluating patients with acute abdomen.

Case Report: Rare presentation of adult intussusception at Orotta National Referral Hospital, Eritrea

A 38-year-old woman presented at Orotta National Referral Hospital emergency department in May 2017 with pain in the epigastric region and vomiting. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine with multiple layers of “air-fluid levels”. CT scan and MRI were not done due to their temporary unavailability. During laparotomy a large mass of 20x20 cm in size was detected in the mid-jejunum of the small intestine. This leading tumor caused intussusception and coiling of the small intestine. As there are no typical symptoms of intussusception, it is very important to do CT scan for patients with long-standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.

Plastic foreign body appearing as radiopaque in a child: An interesting case

Accidental and unnoticed ingestion of foreign bodies (FBs) is not very uncommon. Most of such FBs pass through the gastrointestinal tract uneventfully and only on rare instances cause obstruction or perforation. We present here a case of unnoticed ingested plastic FB in an 11-month-old male child. The baby was presented to us with the complaint of acute intestinal obstruction. The plastic FB appeared as a radiopaque ring in the plain erect abdominal X-ray. The patient was managed by only sodium phosphate enema, which expelled the FB out through the anus.

Qat-induced intestinal obstruction: A case series of a new entity.

Background:Qat-induced intestinal obstruction is an acute manifestation of qat chewing which was not described previously in the literature. The aim of this case series is to describe the clinical presentation, the diagnostic and therapeutic measures, and the course of the disease.Methods:This retrospective case series included all patients who presented with qat-induced intestinal obstruction between July 1, 2013, and December 31, 2015.Results:The study included seven patients (five males and two females). The mean age was 41.4 years (22–60 years). All patients presented after 8–12 h of prolonged qat chewing with abdominal pain, severe abdominal distension, and inability to pass stool. Laboratory results were normal apart from slight leukocytosis (<15 × 109/L) in three patients. All patients showed air–fluid levels on the erect abdominal X-ray. The management included intravenous fluids and symptomatic therapy. The symptoms resolved in 1–2 days and the follow-up after 1 week showed no residual complaints.Conclusions:Qat-induced intestinal obstruction is associated with the heavy and prolonged consumption of qat. The presentation mimics acute intestinal obstruction, but the course is benign. Spontaneous resolution with supportive inpatient treatment is the rule.

Case Report: Swallowed toothbrush in the stomach of a 56 year female at St Mary’s Hospital Lacor, Uganda

Toothbrush swallowing is a rare occurrence. Toothbrush swallowing presents a risk of impaction and perforation along the gastrointestinal tract. This case report describes a 56 year old female that presented to the emergency unit of St Mary’s Hospital Lacor with a 1 day history of chest pain after a toothbrush was pushed down her throat by a traditional healer who was managing her for pharyngitis. The chest pain was associated with difficulty in breathing. She also reported dull abdominal pain. There was no history of vomiting or drooling of saliva. On examination, we found that she was in pain and had respiratory distress with a respiratory rate of 32 breath/ min and was using accessory muscles. There was no oedema, aneamia or jaundice. Blood pressure of 120/80 mmHg and pulse rate of 87 beats/ min. The abdominal findings were normal, but ultrasound scan suggested that the toothbrush was in the stomach. The plain erect abdominal x-ray was inconclusive. She was admitted to the ward for conservative management. After 2 weeks we decided to do exploratory laparotomy and we found the toothbrush in the stomach, that we removed and closed the abdomen in layers. Post-operatively the patient recovered uneventfully on the ward. Toothbrush swallowing is a rare occurrence. The commonest foreign bodies ingested by adults are bones, spoons and dentures. Toothbrush ingestion occurs commonly among patients with psychiatric conditions like bulimia or anorexia nervosa, schizophrenia and bezoar. Most swallowed toothbrushes have been found in the esophagus or the stomach of affected patients. Most people who swallowed their toothbrushes did so entirely without erotic intent, as with this case where the patient had the brush pushed down her throat by a traditional healer. This is the first case of toothbrush swallowing in this hospital.

Extra-peritoneal air mimicking pneumoperitoneum in an infant

Abstract About 10% of cases of pneumoperitoneum are not associated with a hollow viscus breach. Here we present a rare cause due to a gas-forming organism in a 45 day-old male patient. He presented with severe abdominal distension and poor general condition that started at day 10 of life. Erect abdominal x-rays revealed pneumoperitoneum. A chronic abscess cavity was found on exploration and the underlying gut was healthy. The cavity was evacuated and a drain left in-situ. Culture and sensitivity reported Escherichia coli and Pseudomonas aeruginosa . The baby tolerated full oral feeds 48 h after the procedure. His general condition improved with the appropriate antibiotics.

Supergiant fecaloma as manifestation of chronic constipation

Fecaloma is common in patients with damage to the autonomic nervous system in the large bowel associated with Chagas disease (inflammatory and neoplastic) or Hirschprung's disease, in psychiatric patients and, more commonly, in elderly patients suffering with chronic constipation. Symptoms of fecaloma are usually nonspecific. Clinical examination can give the appearance of an abdominal tumor. Most cases of fecaloma are treated conservatively with digital evacuation and enemas. In severe and unremitting cases, surgery is required to prevent significant complications. Fecaloma should be considered in the differential diagnosis of any patient with history of chronic constipation and abdominal mass. We present the clinical case of an 85-year-old man with a history of chronic constipation presented to the emergency room with vague abdominal pain of 2 days' duration. An erect abdominal X-ray and computed tomography revealed a supergiant faecaloma extending from the pubis up to the diaphragm associated to a megarectum and megacolon. The patient was treated successfully with digital evacuation and enemas.