Rare Cause Of Acute Abdomen Research Articles

A rare cause of acute abdomen in a young immunocompetent woman

Streptococcus pyogenes is ahuman pathogenic, gram positive bacterium that primarily leads to pharyngitis or soft tissue infections. Primary peritonitis caused by S.pyogenes infection is rare and there are only afew published cases worldwide. Primary peritonitis due to other pathogens occurs in immunosuppressed conditions such as HIV or other chronic diseases. However, younger, healthy women are more likely to be affected by S.pyogenes peritonitis. At present, the underlying molecular mechanisms can only be speculated on. One possibility is that, similar to the clinical picture of streptococcal toxic shock syndrome (STSS), aspecific serotype of the Mprotein in combination with inhibition of the cell response of neutrophil granulocytes could play arole. In addition to peritonitis, the clinical picture may include other organ manifestations such as acute kidney damage or circulatory dysregulation. In terms of treatment, rapid pathogen-directed empirical antibiotic therapy is the treatment of choice. If there is no indication of secondary peritonitis, diagnostic laparoscopy can be dispensed with in the further diagnostic work-up.

AN UNUSUAL CAUSE OF ACUTE SMALL BOWEL OBSTRUCTION

Up to 20% of admissions with severe acute abdomen are due to intestinal obstruction, a common surgical emergency. Paraduodenal hernia is a rare entity of congenital internal hernia which is an unusual cause of small bowel obstruction. This case report describes the case of a 29-year-old woman with acute pain abdomen and vomiting without other significant past history. Radiological investigations revealed mechanical bowel obstruction and gangrenous bowel loops was evident on surgical exploration. Non-viable small bowel loop was resected and peritoneal defect was sutured. Left paraduodenal hernia is a rare cause of acute abdomen and high index of suspicion is required for early diagnosis and management.

A very rare cause of acute abdomen in children: Peptic or duodenal ulcer perforations

A very rare cause of acute abdomen in children: Peptic or duodenal ulcer perforations

Omental Infarction, a Rare Case of Abdominal Pain: A Case Report and Literature Revue

Omental infarction is a rare cause of acute abdomen resulting from vascular compromise of the greater omentum. This condition has a non-specific clinical presentation that mimics other causes of acute abdomen, namely, acute appendicitis and cholecystitis. A confident diagnosis can usually be made on computed tomography (CT) and the typical natural history is one of spontaneous resolution. We present a case of a 59-year-old female patient, who has undergone surgery twice for a white line hernia, with the most recent operation having been performed one year ago. She presented to the emergency department with recent worsening of chronic abdominal pain. Omental infarction should be included in the differential diagnosis list of acute abdominal pain because it can occur at any site. In addition, because this disease runs a self-limited course, conservative care is recommended. Thus, unnecessary operations can be avoided in cases where omental infarction is diagnosed by imaging studies.

Treatment with direct thrombolytic infusion via mesenteric catheter and thrombectomy in superior mesenteric vein thrombosis due to synthetic drug use

Mesenteric vein thrombosis (MVT) is a rare cause of acute abdomen and accounts for only 5-15% of all acute mesenteric ischaemia cases. MVTs are classified as either primary MVT, in which the underlying cause can not be determined, or secondary MVT, in which the etiology can be determined. Symptoms usually begin with nonspecific abdominal pain. Progressively increasing abdominal pain is often accompanied by nausea, vomiting and bloody diarrhea. In severe cases, sepsis and septic shock are seen. As the cases usually present with nonspecific symptoms, diagnosis and treatment may be delayed. Despite advanced diagnostic techniques, high mortality rates are seen. We aimed to present a case with a complaint of abdominal pain who underwent interventional thrombectomy and thrombolysis with the diagnosis of superior MVT.

Tuberculosis: A rare cause of acute abdomen in pediatric patients - surgical considerations

BackgroundAbdominal tuberculosis (ATB) is a rare presentation of tuberculosis (TB) in pediatric patients, and its diagnosis can be challenging. This study aimed to analyze the role of surgery in patients with ATB presenting with acute abdomen. MethodsWe conducted a retrospective analysis of pediatric patients under 18 years of age who underwent surgical intervention for acute abdomen (AA) and were diagnosed with ATB at a tertiary-care center in Latin America between June 2003 and March 2023. The diagnosis was confirmed through histopathology or bacteriological analysis. Demographics, clinical presentation, diagnostic methods, and operative findings were collected, and surgical procedures and postoperative outcomes were assessed. ResultsFifteen patients were included in the study. Symptoms and signs were nonspecific. Imaging studies revealed ascites, adenopathies, and intestinal wall thickening, among other findings. Histopathological examination with identification of caseating granulomas proved essential for diagnosis. The peritoneal form was the most frequent presentation, followed by the intestinal type. There were no differences between stoma reversal surgery performed during or after treatment. Complications were observed in 73 % of cases, with intestinal perforation being the most common one. ConclusionAccurate diagnosis of ATB in pediatric patients with acute abdomen is crucial to avoid unnecessary surgeries. Surgery in acute ATB is indicated to manage intestinal complications however surgical management should be approached cautiously. Conservative procedures, such as biopsies and drainage, are recommended when intraoperative findings reveal ATB. Level of evidenceLevel III, Retrospective study

FRI234 A Pregnancy With Two Special Surprises A Baby And A Nonhemorrhagic Adrenal Infarction During Pregnancy

Abstract Disclosure: S. Idriss: None. N. Barua: None. I. Jamal: None. A. Jabiev: None. Introduction: Unilateral Acute adrenal infarction (AAI) is a rare cause of acute abdomen in pregnancy, with a reported incidence of 1.3%. It usually presents with sudden, severe, and unremitting flank pain. The most common cause of AAI is adrenal vein thrombosis. We present a 26-year-old pregnant female who presents with right flank and back pain, found to have AAI without hemorrhage. Case: 26-year-old female Primigravida without significant past medical history presented to the emergency room at 33 weeks of gestation with sudden onset of RUQ flank and back pain. She was afebrile and normotensive. Physical exam was positive for right flank point tenderness. She underwent multiple investigations including an abdominal US which did not reveal an acute pathology. She was admitted and started on opioids which failed to control her pain. An abdominal MRI was obtained subsequently revealing 4.6cm right adrenal gland lesion suspicious for AAI without hemorrhage and normal left adrenal gland. The pain was poorly controlled warranting Dilaudid drip and repeat imaging/CT showed adrenal gland mass with density of 41-52 HU suspicious for lipid poor adenoma versus adrenal hematoma on CT scan. Initial AM Cortisol level was 46 ug/dl, then it trended down to 31.7. DHEAS was low at 94.2 ug/dl. Plasma metanephrines and normetanephrines were normal. Course was complicated with hypotension and worsening pain on day 10 of admission, repeat MRI showed increase in right adrenal lesion size and cystic transformation, containing some T2 hypointense septations and debris without notable intrinsic T1 hyperintensity to suggest blood products, and restricted diffusion which is a finding compatible with AAI. Repeat AM Cortisol and DHEAS were low at 12 and 61.3 respectively. Despite normal left adrenal gland, clinical picture was consistent with adrenal insufficiency and she was started on stress steroids. Thrombophilia workup was negative. She ultimately underwent c-section on day 13 of admission. She was discharged on physiologic dose of steroids with a pending repeat MRI and outpatient follow up. Discussion: Adrenal glands, especially with preexisting nodules are predisposed to micro-vascular thrombosis and infarction during procoagulable states. Pregnancy is a hypercoagulable state that predisposes patients to thrombotic events. The relative risk of thrombosis is 5-6 times higher in pregnant than non-pregnant females of the same age. Our patient had evidence of adrenal insufficiency and required steroid replacement. Anticoagulation was not started due to possible subtle hematoma on CT scan on initial imaging. Follow up imaging is planned. Conclusion: Adrenal infarction is a rare cause of abdominal pain during pregnancy, and if missed, it can result in devastating clinical consequences for the mother and the child. Adrenal insufficiency if found should be addressed to prevent circulatory collapse. Presentation: Friday, June 16, 2023

Bladder malignancy as a cause of spontaneous bladder rupture: A systematic review.

To characterise cases of spontaneous rupture of the urinary bladder in the context of bladder cancer. A systematic review was performed to characterise cases of spontaneous bladder rupture in patients with bladder cancer. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system was utilised, with databases being searched for relevant cases. Patient characteristics were extracted, including age, sex, presenting signs and symptoms, management modalities, tumour histology and mortality. Thirty cases were included. Seventeen (57%) were male, and the median age of presentation was 59. Abdominal pain and peritonism were the most common presenting symptoms, in 80% and 60% of patients, respectively. Most patients (n = 16, 53%) had urothelial cell carcinoma. Nine patients (30%) died during their initial hospitalisation. Spontaneous bladder perforation in the context of bladder cancer is a rare cause of acute abdomen. The diagnosis is associated withhigh mortality, highlighting the aggressive nature of the malignancies that cause spontaneous bladder rupture. This raises important questions about the role of emergency cystectomy, the timing of systemic therapy and the appropriate involvement of palliative care.

A rare cause of acute abdomen in childhood: coexistence of mesenteric cystic lymphangioma and acute appendicitis

Abdominal cystic lymphangiomas are benign congenital anomalies of the mesenteric and retroperitoneal lymphatics, which are not common in the literature. Diagnosis is usually made by physical examination, ultrasonography, and computed tomography. If a significant portion of adjacent organs is not to be sacrificed, complete surgical removal of the mass is the therapeutic option for symptomatic abdominal cystic lymphangiomas. In this study, a patient with mesenteric cystic lymphangioma who underwent surgical treatment is presented. A result of the radiological examinations performed on a 17-year-old female patient who applied for intermittent abdominal pain and a mass in the abdomen as a result of the well-defined, septated mesenteric cystic lymphangioma and acute appendicitis were detected. The patient underwent a diagnostic laparoscopic procedure and then an open surgical treatment, and excision and resection anastomosis were performed on the mass surrounding the jejunum approximately 100 cm distal to the ligament of Treitz. The patient did not have any postoperative problems and was discharged with recovery on the 5th day after surgery. Mesenteric cystic lymphangiomas should be kept in mind in patients with intermittent abdominal pain and abdominal mass, and surgical treatment should be applied in selected cases, as it may rarely cause serious complications.

A rare cause of acute abdomen in a postmenopausal female: Uterine Torsion

A rare cause of acute abdomen in a postmenopausal female: Uterine Torsion

A Colic Adenocarcinoma as the Primary Cause of Colo-Colic Intussusception: A Rare Case of Obstruction

This article discusses the case of a 70-year-old woman who presented with abdominal pain and vomiting, and was diagnosed with colonic-colonic intussusception caused by a tumor. Colonic intussusception is a rare cause of acute abdomen in adults, and malignant tumors are the most frequent cause of colonic intussusception. The article highlights the importance of imaging, specifically abdominal CT scans, in diagnosing and managing this condition. The CT scan can confirm the site of intussusception and specify the severity signs, and it is more specific than ultrasound and endoscopy. The article also describes the different intussusception patterns seen on CT scans and their significance. Early diagnosis is important in preventing complications such as infarction and perforation. The authors suggest that colonic intussusception may be the result of infiltration of the colonic wall musculature by the malignant tumor despite the colon being devoid of peristaltic activity. Overall, the article emphasizes the importance of a combination of clinical and radiologic data in diagnosing and managing colonic intussusception caused by tumors.

Cecal volvulus with intestinal malrotation: a rare cause of bowel obstruction

Introduction:Cecal volvulus is a rare cause of acute abdomen in adults. It accounts for less than 1% of intestinal obstructions and 25-30% of cases of colonic volvulus. Congenital intestinal malrotation is a complex disorder due to incomplete or faulty rotation and fixation of the gut during the fetal life.Cecal volvulus associated with intestinal malrotation is a very rare presentation. Over 16 cases were reported in the literature. Case report:A 44-year-old man with no medical history, presented to the emergency department with a 2-day history of abdominal pain and bloating. On clinical examination, the abdomen was distended and tympanic to percussion, with diffuse abdominal tenderness. Abdominal X-ray (standing) showed a distended large intestine with an airfluid colonic level. CT scan showed a markedly dilated cecum measuring up to 14 cm, which were located in the left hypochondrium. A “whirl sign” and a superior mesenteric pedicle swirl were also noted. Emergency surgery was performed. Intraoperative exploration revealed a cecal volvulus with a largely distended hypermobile cecum located in the left hypochondrium, with preischemic signs within its wall. All the small gut was right-sided and the large gut left-sided, suggestive of mesenterium commune and intestinal malrotation. A right hemicolectomy withileo-transverse anastomosis was done. The postoperative course was uneventful. The patient is on regular follow up and is doing well. Conclusion:We describe a rare case of surgical management of cecal volvulus associated with intestinal malrotation in a middle-aged patient with no medical history. This case highlights the importance of early diagnosis by physical examination and radiological findings to prevent serious complications. Emergent surgery was the key to this successful management and surgical resection could offer better results with lesser recurrence rate. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 445-448

A rare cause of acute abdomen: Ovarian torsion due to dermoid cyst

Dermoid cysts are one of the most common causes of ovarian torsion. The causes of acute abdominal pain are mostly caused by the diagnosis of acute appendicitis, acute pancreatitis, and mesenteric ischemia, and the incidence of ovarian torsion is not known exactly. Although ovarian torsion is very rare, it ranks first among the indications for gynecological emergency surgery. A rare case of a non-ruptured dermoid cyst causing ovarian torsion in the emergency room is presented.

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.

Rectal perforation due to malignancy as a rare cause of acute abdomen in a third trimester pregnant patient: a case report

Anatomical and physiological changes during pregnancy may complicate diagnosis and treatment. While the cause of non-obstetric acute abdomen is encountered in one in 500 pregnancies, the most common one may be acute appendicitis. The incidence of colorectal cancer (CRC) during pregnancy is 0.002%. Common symptoms, such as abdominal pain, nausea, vomiting, and changes in bowel movements, are often observed in a regular pregnancy. Thus, most colorectal cases are overlooked and diagnosed in advanced stages associated with a poor prognosis. This case report presents a 31-year-old female patient at 37 weeks of gestation who applied with an acute abdomen, underwent emergency explorative laparotomy, had a 2 cm perforation detected in the rectum, and was referred to neoadjuvant chemo-radiotherapy due to perforation due to malignancy detected in the examinations performed in the postoperative follow-up. The relevant literature notes that colorectal cancer is rarely seen among expectant mothers. It should be suspected in the diagnosis among patients with gastrointestinal complaints for whom conservative treatment has failed. It should also be noted that bowel perforation, a rare complication of colorectal cancer, may also be present in emergency department applications with an acute abdomen.

A case of recurrent intussusception in young adult female: Peutz Jegher syndrome

Peutz Jegher syndrome (PJS) is an autosomal dominant inherited polyposis syndrome, in which multiple characteristic polyps occur in the gastro-intestinal tract associated with mucocutaneous pigmentation especially of vermillion border of the lips. Small bowel obstruction is presenting complaint in half of the cases-intussusception due to polyp being lead point is the high risk for obstruction. A 21 year old female patient with presented to emergency department with complaining of intermittent episodes of abdominal pain and multiple episodes of billious vomiting since 7 days. Patient had history of exploratory laparotomy 10 years back for similar complaints. On examination, melanocytic pigmentation present over vermillion border and palmar aspect. Enhanced computed tomography reveals telescoping of the distal jejunum to proximal ileal loops s/o jejuno-ileal intussusception with ileo-ileal intussusception were noted. On surgical decision, patient again underwent exploratory laparotomy which revealed intussusception with non-viable small bowel segment were found, Small bowel resection was performed and jejuno-ileal anastomosis was done. Patient follow up was maintained to go with colonoscopic evaluation. In conclusion, recurrent intussusception is a rare cause of acute abdomen in adults. A high index of suspicion and appropriate investigations are helpful in prompt diagnosis. Thorough evaluation intra operative and then regular periodic follow up is required in such cases for early detection of disease before complication occurs.

Omental Necrosis and Mesenteric Ischemia Secondary to Hypercoagulability Due to COVID-19: A Case Report

Background: Omentum necrosis is a rare cause of acute abdomen. Its main etiologies are torsion on its axis, hypercoagulability, and intra-abdominal infections. Its clinical diagnosis is difficult since its symptoms resemble other abdominal pathologies, so diagnostic confirmation when the pain is present in the right abdomen, which occurs most frequently, is usually intraoperative Surgical treatment is more effective than conservative management in reducing hospital stays and does not require follow-up. Case Report: We present the case of a 45-year-old male suspected to be infected with SARS-CoV-2, which potentially triggered hypercoagulability with necrosis of the greater omentum and mesenteric ischemia, requiring multiple surgical interventions. Conclusion: It is a rare cause of acute abdomen and to the best of our knowledge, the description of the first case of necrosis of the omentum secondary to COVID-19.

Superior mesenteric artery embolism after radiofrequency ablation in regularly anticoagulated patients with paroxysmal atrial fibrillation: a case report

BackgroundSuperior mesenteric artery embolism (SMAE) is a rare cause of acute abdomen, and the fatality rate is extremely high if it is not diagnosed and treated in time. Due to the lack of knowledge and experience of nonspecialist physicians, it is easy to misdiagnose. Radiofrequency ablation (RFA) has become the first-line treatment strategy for atrial fibrillation (AF). Thromboembolic events are some of the major complications after RFA, whereas SMAE is rarely reported.Case presentationA 70 year-old woman with paroxysmal AF who regularly took anticoagulant drugs for 3 months experienced abdominal pain after RFA. At the outset, she was misdiagnosed as mechanical intestinal obstruction. When the patient presented with blood in the stool, abdominal enhancement computed tomography was conducted and showed a small bowel perforation. Immediate laparotomy was performed, and the final diagnosis was SMAE.ConclusionIt is suggested that for unexplained abdominal pain after RFA of AF, the possibility of SMAE should be considered, and a targeted examination should be carried out in time to confirm the diagnosis and give appropriate treatment.

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.

Ileal perforation by accidentally ingested animal bone - rare cause of acute abdomen

Introduction. In healthy adults, accidental ingestion of foreign bodies is uncommon. Intestinal perforation by ingested bone fragments is rare, but can be presented as a life-threatening condition, especially when the diagnosis is delayed. Case outline. We present an uncommon case of a 73-year-old female with acute abdominal symptoms due to ileal perforation caused by accidentally ingested animal bone. Pneumoperitoneum revealed by abdominal X-ray and abdominal free fluid revealed by abdominal ultrasound as well as the general condition of the patient required urgent laparotomy, when the diagnosis of ileal perforation was made. A foreign body was removed from the intestine, along with partial resection of the intestine and endto- end anastomosis. Conclusion. Surgical treatment of life-threatening complications arising after ingestion of foreign bodies is the only method of choice in the treatment of such patients.