Left Abdominal Tenderness Research Articles

An Uncommon Cause of Recurrent Pancreatitis

Introduction: Biliary cysts are important structural anomalies of the biliary tract. While normally found in the pediatric population, 20% of these rare dilations of the biliary tree are found in adults and account for a variety of biliary and pancreatic complications. Case Presentation: A 33-year-old white male with a 3-year history of recurrent pancreatitis presented to our institution with 2 weeks of light stools, dark urine, weight loss, and fatigue. Three days prior to admission, he developed icterus and nausea. He had a cholecystectomy 3 years prior. He took no medications. He drank alcohol socially. There was no family history of gastrointestinal disease. On physical examination, he was afebrile with stable vital signs. Scleral icterus was present. He had left abdominal tenderness. No hepatosplenomegaly was appreciated. He was jaundiced. His initial laboratory evaluation was notable for a total bilirubin of 11.1, direct bilirubin of 8.4, alkaline phosphatase of 346, aspartate aminotransferase of 105, and alanine aminotransferase of 210. Lipase was 29. A serum chemistry and complete blood count were normal. A magnetic retrograde cholangiopancreatography was performed which showed a cystic dilation measuring 2.7 x 2.7 cm in the head of pancreas that was inseparable from the common bile duct and the pancreatic duct. The common bile duct was 1.7 cm dilated. Intrahepatic duct dilation was present. The pancreatic duct was not dilated. An endoscopic retrograde cholangiopancreatography confirmed bulging of the major papilla with cystic dilation of the intra-duodenal portion of the bile duct where the common bile duct and the pancreatic duct drained into the cyst consistent with a type IIIA choledococele. The pancreatic duct was irregular and tortuous in the head of the concerning for chronic pancreatitis. A biliary sphincterotomy was performed and a biliary stent was placed. A pancreatic duct stent was placed. Liver function tests did improve with this intervention and the stents were removed 1 month later. The cholangiogram was normal at that time. Discussion: Biliary cysts, while rare, do cause chronic biliary and pancreatic pathology including cholelithiasis, biliary strictures, acute and chronic pancreatitis, cholangiocarcinoma, secondary biliary cirrhosis, and cholangitis. This case illustrates that importance of keeping in mind rarely seen structural anomalies that can cause biliary and pancreatic disease and can have long term consequences such as cirrhosis, recurrent cholangitis, chronic pancreatitis, and most significantly carcinoma.

Adnexal torsion in the first trimester of pregnancy: A case report

Abstract Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. It is frequently associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. It is uncommon for a normal-sized ovary to undergo torsion. Torsion of the ovary during pregnancy is common during third trimester. Adnexal torsion is rarely bilateral and is more common on the right side, perhaps because the sigmoid colon leaves a limited space for left adnexal mobility. Here we report a case of 23-year-old primigravida with 8 weeks pregnancy presented with sever left abdominal pain. Left abdominal tenderness was detected. Transabdominal ultrasound scan reported left adnexal torsion. Laparotomy and then left salpingo-oophorectomy were performed.

Colon Perforation by an Ingested Bone

A 60-year-old man presented to the Emergency Department (ED) due to progressive left abdominal pain over 1 month. Physical examination showed a temperature of 36.8 C, a heart rate of 84 beats/min, and a blood pressure of 150/80 mm Hg, as well as a soft abdomen with left abdominal tenderness and rebound tenderness. The laboratory evaluation disclosed a white blood cell (WBC) count of 7400/mm with 83.9% segmented neutrophils. Abdominal computed tomography showed focal abscess formation in the left abdomen (Figure 1, white arrow) containing a thin rod-like high-density material (Figure 1, black arrow). Explorative laparotomy revealed an abscess adhesion between the transverse and descending colon. A granulation scar-like lesion was seen at the transverse colon. The pathologist found a suspected fish bone measuring 33 mm in the abscess. Fish bone penetration and a sealed-off perforation were suspected. The patient was discharged uneventfully 7 days postoperatively.