Sudden Onset Of Abdominal Pain Research Articles

Case Report: Dichorionic twins pregnancy with placenta abruption

Pregnancies involving dichorionic twins have been recognized for their distinct difficulties and complications. The care and outcomes of such pregnancies are further complicated by placental abruption, an uncommon but significant obstetric event. We describe a case of placental abruption in a dichorionic twin pregnancy, including the clinical manifestations, diagnosis, treatment, and prognosis of the mother and fetus. Pregnancies with two separate chorions, or dichorionic pregnancies, are a special type of multiple gestation. Early separation of the placenta from the uterine wall is a potentially fatal event that can have a major influence on the health of both the mother and fetus. It is a key complication of placental abruption. We describe a 32-year-old primigravida who complained of sudden onset abdominal pain and vaginal bleeding at 28 weeks of gestation. She had dichorionic twin pregnancy after 10 weeks of gestation, as determined by ultrasonography. The patient remained stable, and repeated ultrasounds verified that there was no further placental separation. The patient underwent an elective caesarean section at 35 weeks of gestation because of a higher risk of recurrent abruption. Two healthy newborns were delivered, and their weights were consistent with their gestational age.

A spontaneous acute abdomen revealing testicular torsion of an undescended testicle

Torsion of an ectopic testicle is an exceptional condition, occurring mainly in young adults. Its etiopathogenesis is still poorly understood. The clinical picture consists of the sudden onset of abdominal pain without fever, associated with a palpable inguinal mass and an empty scrotum. Medical imaging appears to play a limited role. The management of torsion of an undescended testicle involves urgent surgical exploration. An inguinal incision allows diagnosis, detorsion, reduction and orchidopexy in dartos after lowering the testicle if the testicle is viable and the spermatic cord is of sufficient length.

Secondary iatrogenic duedonum perforation: a rare complication

The incidence of perforations resulting from Endoscopic Retrograde Cholangiography (ERCP) is observed to be less than 1%. In this case report, we aim to present our unique experience as a mechanism, which is even more uncommon. A 68-year-old male with an ASA score of 2 was prediagnosed with a distal common bile duct tumor. ERCP was performed for therapeutic and diagnostic purposes and a 9F 10 cm plastic stent was placed to relieve obstruction. The patient, who had the sudden onset of abdominal pain within the initial 24-hour period following the procedure, underwent surgical intervention subsequent to a computed tomography assessment. In the third portion of the duodenum, an approximately 4 mm perforation originating from the stent was observed during the examination. It was repaired with a 3.0 prolene suture, followed by omentopexy. He was discharged uneventfully on the eighth day. Although duodenal perforation due to the placement of a plastic biliary stent with ERCP is a very uncommon complication, the patient's clinical and imaging findings are essential for treatment planning.

Wunderlich syndrome: A case report

· Wunderlich syndrome is defined as a clinical manifestation secondary to sudden spontaneous rupture of the renal parenchyma outside of trauma resulting in hemoretroperitoneum. This spontaneous renal hemorrhage is often attributed to renal angiomyolipomas, arterial venous fistulas, immunovasculitis and other phlogoses of the kidney. · We describe the case of a 17-year-old girl, who presented to the emergency department with sudden onset of abdominal pain without any significant medical history. Imaging findings and clinical history led to the diagnosis of Wunderlich syndrome. The patient was admitted to the intensive care unit for close monitoring, and recovered without any complications. She is currently doing well

Adolescent Female with Acute-onset Abdominal Pain

Background: Sigmoid volvulus is a more common cause of abdominal pain in geriatric patients. It is an uncommon cause for a pediatric patient, especially when dealing with an adolescent patient. Here we discuss an uncommon presentation of sigmoid volvulus.
 Case Description: A 14-year-old female presents with sudden-onset abdominal pain found to have sigmoid volvulus on CT imaging. She eventually underwent sigmoidoscopy for reduction and was monitored for 24 hours post-procedure.
 Conclusion: This case demonstrates the importance of having a high index of suspicion when a patient presents with volvulus, especially with adolescence. Although rare, it should always be on the differential due to its high rate of mortality if diagnosed late.

Aortic Thrombus with Bilateral Renal Infarcts: A Case Report.

The presence of a hypercoagulable state predisposes to venous and arterial thrombi. While the relationship between protein C and S deficiencies with venous thrombus formation is clear, the relationship to arterial thrombi formation is less common. Thromboembolic disease of the renal arteries may result in renal infarction. The development of simultaneous bilateral renal infarction is rare and can lead to significant morbidity and mortality. This is a case of a 48-year-old male with known protein C deficiency who presented to the emergency department with sudden onset abdominal pain. A computed tomography angiogram of the abdomen showed bilateral renal infarctions. The patient required significant analgesia and developed acute kidney injury. He was treated conservatively, and dialysis was not required. There are no reports in the emergency medicine literature of bilateral renal infarction secondary to protein C and S deficiency. Prompt evaluation with definitive imaging is necessary for patients who are at high risk for arterial thrombi and present with symptoms suggestive of the diagnosis.

Spontaneous splenic rupture associated with scrub typhus: a case report

BackgroundScrub typhus, an acute febrile disease with mild to severe, life-threatening manifestations, potentially presents with a variety of complications, including pneumonia, acute respiratory distress syndrome, cardiac arrhythmias (such as atrial fibrillation), myocarditis, shock, peptic ulcer, gastrointestinal bleeding, meningitis, encephalitis, and renal failure. Of the various complications associated with scrub typhus, splenic rupture has rarely been reported, and its mechanisms are unknown. This study reports a case of scrub typhus-related spontaneous splenic rupture and identifies possible mechanisms through the gross and histopathologic findings.Case presentationA 78-year-old man presented to our emergency room with a 5-day history of fever and skin rash. On physical examination, eschar was observed on the left upper abdominal quadrant. The abdomen was not tender, and there was no history of trauma. The Orientia tsutsugamushi antibody titer using the indirect immunofluorescent antibody test was 1:640. On Day 6 of hospitalization, he complained of sudden-onset left upper abdominal quadrant pain and showed mental changes. His vital signs were a blood pressure of 70/40 mmHg, a heart rate pf 140 beats per min, and a respiratory rate of 20 breaths per min, with a temperature of 36.8 °C. There were no signs of gastrointestinal bleeding, such as hematemesis, melena, or hematochezia. Grey Turner's sign was suspected during an abdominal examination. Portable ultrasonography showed retroperitoneal bleeding, so an emergency exploratory laparotomy was performed, leading to a diagnosis of hemoperitoneum due to splenic rupture and a splenectomy. The patient had been taking oral doxycycline (100 mg twice daily) for 6 days; after surgery, this was discontinued, and intravenous azithromycin (500 mg daily) was administered. No arrhythmia associated with azithromycin was observed. However, renal failure with hemodialysis, persistent hyperbilirubinemia, and multiorgan failure occurred. The patient did not recover and died on the fifty-sixth day of hospitalization.ConclusionsClinicians should consider the possibility of splenic rupture in patients with scrub typhus who display sudden-onset abdominal pain and unstable vital signs. In addition, splenic capsular rupture and extra-capsular hemorrhage are thought to be caused by splenomegaly and capsular distention resulting from red blood cell congestion in the red pulp destroying the splenic sinus.Graphical abstract

Late Vaginal Cuff Dehisence and Evisceration After Prolapse Surgery: Case Report

Introduction: Vaginal cuff dehiscence (VCD) is rare and may be associated with evisceration of the small bowel. It’s a rare life-threatening condition that is usually seen in postmenopausal women with past history of gynecological surgery. Presentation of Case: A 55-year-old woman presented with sudden-onset abdominal pain and protrusion of a mass through the vagina without triggering factor after two years of a reconstructive prolapse surgery. Physical examination revealed small bowel in the vagina. Laparotomy was performed and the vagina closed. post-op wall sepsis has been controlled. Discussion: Less than 200 cases of VCD have been reported. Most often this event this event occurs acutely; sometimes a triggering factor is found, the most important risk factor being a history of total hysterectomy. Diagnosis is easy Immediate surgery is necessary to reduce the risk of intestinal ischemia and necrosis. Conclusion: VCD must be suspected in any woman with surgical history of total hysterectomy presenting with sudden-onset abdominal/ pelvic pain or swelling. Emergency surgery is necessary to avoid complications which can be serious.

Intestinal Behçet's and suspected intestinal Behçet's disease: a report of four surgical cases.

Intestinal Behçet's disease (BD) is often associated with ulceration that requires surgery, including perforation and abscess formation. However, no consensus has been reached on the optimal extent of resection or treatment strategy. This study reviewed four cases of intestinal or suspected intestinal BD. In Case 1, a 74-year-old woman diagnosed with BD 2years earlier was treated with anti-tumor necrosis factor α antibody (Infliximab) and steroids. She had oral and pubic ulcers. After close investigation of abdominal pain, perforation of the gastrointestinal tract was suspected and surgery was performed. Multiple perforating ulcers and abscesses were found in the distal ileum, and the small intestine was resected. Postoperatively, the patient was treated with an increased steroid dose and symptoms have remained stable. Case 2 involved a 69-year-old woman with oral and pubic ulcers, ocular ulcer, and skin lesions. She experienced sudden onset of abdominal pain during treatment for lymphoma. She showed multiple perforating ulcers throughout the ileum and underwent resection of the small intestine and ileostomy. Upper abdominal pain appeared during postoperative treatment for high-output syndrome. The patient underwent omentoplasty after perforation of the upper gastrointestinal tract was diagnosed. Postoperatively, anti-interleukin-1 beta antibodies (canakinumab) was administered to control the disease. Case 3 involved an 81-year-old, previously healthy woman. She presented to her previous physician with complaints of pubic ulcer, hemorrhage and abdominal pain. Colonoscopy showed multiple ulcers throughout the entire colon. Steroid therapy was started, but bleeding proved difficult to control and total proctocolectomy was performed. Histopathology revealed multiple perforating ulcers and BD was diagnosed. Postoperatively, the patient remains under steroid control. Case 4 involved a 43-year-old man with abdominal pain who showed abscess formation in the ileocecal region. After excision of the ileocecal area, multiple ulcers were diagnosed. Two years later, abdominal pain recurred and free air was found in the abdomen on close imaging. Emergency anastomotic resection was performed due to ulceration and perforation of the anastomosis. Intestinal BD may flare up after surgical treatment and require multiple surgeries. Introducing pharmacotherapy as soon as possible after surgical treatment is important to control the disease.

Peritonitis Due to Haemophilus Influenzae in Peritoneal Dialysis: Report of An Exceptional Case

Case Description: 33-year-old woman with a history of end-stage renal disease on peritoneal dialysis, who came to the emergency department for abdominal pain of sudden onset associated with a change in the color of the peritoneal fluid. Clinical Findings: The patient had signs of systemic inflammatory response and generalized abdominal pain, with marked leukocyte response in peritoneal fluid cytochemistry. Treatment and Outcome: Empirical antibiotic treatment was started targeting the most prevalent microorganisms in abdominal infections associated with peritoneal dialysis, however with poor response to it and subsequent isolation of Haemophilus Influenzae for which antibiotherapy was modified with subsequent progressive clearance of peritoneal fluid and resolution of symptoms. Clinical Relevance: We describe the case of a patient on peritoneal dialysis who presented a bacterial peritonitis caused by H. Influenzae, an extremely infrequent germ in this type of infections. Although the presence of this germ is exceptional in peritoneal dialysis catheter-associated peritonitis, this microorganism should be ruled out in a patient with catheter-associated peritonitis that does not respond to the usual antibiotic therapy. To our knowledge only 8 cases have been reported in the literature and none in our setting.

A Rare Case of Internal Hernia of Partial Volvulus Right Colon through Foramen of Winslow & Its Management by Laparoscopic Approach

Introduction: Foramen of Winslow hernias is a rare and critical form of internal hernia that can present in individuals with signs and symptoms of bowel obstruction. This case report entails the operative management of a right-side colon herniation through the foramen of Winslow in an elderly female with a previous history of Hysterectomy. The patient presented with worsening abdominal pain, nausea, and multiple episodes of vomiting. Delay in diagnosis often results in higher morbidity and mortality. Case Presentation: A 46 years old female, presented with acute upper abdominal pain, constipation, and loss of appetite for 24 hrs. Computed tomography showed foramen of Winslow hernia with partial volvulus right colon as content with incomplete rotation of gut which was managed laparoscopically without the need for bowel resection. The patient recovered well with no postoperative complications and no immediate technical failure of repair confirmed by a cross-sectional study. The patient is doing well on follow-up. Discussion: Herniation of the bowel through the foramen of Winslow is very rare, comprising only 8% of all internal herniations. Historically, the majority of cases were diagnosed intra-operatively during laparotomy. Bowel resection was often done in cases of ischemia. In recent times, early diagnosis & increasing expertise in minimal access surgery that is resulting in a lower morbidity and mortality rate along with other added benefits of minimal access surgery. Conclusion: Herniation contents through the foramen of Winslow is a rare condition. Patients will present with sudden onset abdominal pain. Early imaging helps to recognise the diagnosis and could prevent bowel ischemia & its management with minimal access surgery leads to early recovery, shorter hospital stay, less pain & early return to work.

SAT543 A Case of Non-iodine-Avid Papillary Thyroid Cancer With a Rare Distant Metastasis to the Pancreas

Abstract Disclosure: A.H. Alcain: None. M.C. Isidro: None. Papillary Thyroid Carcinoma is the most common type of differentiated thyroid cancer. Distant metastasis is rare occurring only in 5% of patients and typically involves the lungs and bones. Metastasis to the pancreas is extremely rare with few cases reported over the years. We present a case of a 65-year-old female, who presented with sudden onset of abdominal pain. A review of the patient’s medical history revealed a history of a non-iodine avid Papillary Thyroid Carcinoma in 2015. The patient underwent Radioactive Iodine (RAI) ablation therapy twice due to elevated Thyroglobulin (Tg) levels. Despite RAI, Tg levels were still elevated with no recurrence nor metastasis noted on scan. Chemotherapy was offered but the patient opted for Tomotherapy. The patient completed Tomotherapy in 2017 but afterward was lost to follow-up. A CT scan of the abdomen showed findings of a pancreatic tail and body mass (10 x 7 cm) with an invasion of the mid-descending colon with pulmonary nodules which are possibly metastatic. The patient underwent an endoscopic ultrasound-guided biopsy, and pathology showed findings of a pancreatic papillary neoplasm (CK and beta-catenin positive, synaptophysin negative). Chemotherapy was given (FOLFOX) and a PET scan was requested to monitor the response to treatment. However, PET-scan showed FDG-avid (SUV 32.1) mass in the pancreatic tail (7.2 x 7.8 x 13.3 cm), FDG-avid (SUV 17.61) nodules in the lungs, and an ill-defined heterogeneous mass in the left surgical site (2.2 x 2.6 x 5.3 cm). Given that patient had a thyroidectomy in 2015, recurrence was considered. The possibility of probable metastasis to the pancreas was entertained hence re-biopsy was done. Serum Tg levels were elevated (4,115 ng/ml NV: 1.59-50.0) and negative for Anti-Tg. Biopsy showed high-grade neoplasm with papillary features. IHC staining showed positive for CK7, Tg, and TTF-1, and negative for CK20 which was consistent with metastatic papillary thyroid carcinoma. The patient was given Lenvatinib and is at present tolerating the treatment well with evidence of decreasing Tg levels suggesting a response to treatment. This is a case of a rare site of distant metastasis of a non-iodine avid papillary thyroid carcinoma. Targeted therapy such as Tyrosine kinase inhibitors can improve the survival rate of patients with Radioiodine Refractory Thyroid cancers. Metastasis should be considered especially in patients with a history of prior malignancy. Presentation Date: Saturday, June 17, 2023

Spontaneous Perforation of Meckel’s Diverticulum: An Unusual Cause of Peritonitis in an Adult

Meckel’s diverticulum (MD) is a congenital gastrointestinal abnormality that rarely causes symptoms but may also cause perforation, obstruction, and gastrointestinal bleeding. It is more common in paediatric population and occurrence of complications like perforation in adults are seldom reported in the literature. We present the case of a 49-year-old male who exhibited sudden onset abdominal pain, distension, and bilious vomiting. Surgical exploration revealed the presence of a gangrenous and perforated Meckel’s diverticulum. The importance of considering MD as a potential source of abdominal symptoms even in adults and the difficulties in diagnosing perforated MD are highlighted in this case.

C4 (Clinical Case) Vascular Ehlers-Danlos Syndrome in the Paediatric Population: A Case Report of an Internal Bleed Caused by Ruptured Pseudoaneurysm

Abstract Introduction/Background Ehlers-Danols syndrome (EDS) is a connective tissue disease characterized by joint hypermobility, skin hyperextensibility and tissue fragility. EDS has six types. Type IV EDS: vascular EDS (vEDS), is rare but also the most malignant. Case Description We report a 15-year-old boy with a previous history of spontaneous colon perforation and two left shoulder dislocations. He presented with sudden onset abdominal pain, vomiting, dizziness, and lethargy with a Glasgow coma scale of 13. His abdomen was soft but mildly tender. He had a capillary refill of 3 seconds with cold extremities, was found to be in a hypotensive shock state requiring resuscitation with fluids and inotropes, as well as intubation and mechanical ventilation. His hemoglobin dropped by 30 g/L in 6 hours. Therefore, an abdominal ultrasound was done, revealing an intrabdominal hematoma. CT scan of the abdomen confirmed a ruptured fusiform pseudoaneurysm of the accessory left hepatic artery. This was successfully managed by coil embolization, see F1 and F2, below. Genetic workup was positive for the pathogenic COL3A1 gene that presents phenotypically as Ehlers-Danlos syndrome, particularly type IV. Discussion COL3A1 encodes pro-alpha1 chains of type III collagen. Inheritance is autosomal-dominant. It can present as a de novo variant with a negative family history, as was the situation for our patient. Estimated affected people with de novo variant vEDS is 33%-50%. Clinical diagnosis of vEDS involves one major and several minor criteria (2017). Major criteria include arterial aneurysms, dissection, or rupture; intestinal rupture; uterine rupture during pregnancy; family history of vEDS. Minor criteria include easy bruising; thin skin and visible veins; facial characteristics including prominent eyes, narrow nasal bridge, thin lips; club foot, congenital hip dislocation; inguinal hernia and pneumothorax. Our patient had two elements from the major criteria: arterial pseudoaneurysm and intestinal rupture. Conclusion vEDS has high morbidity and mortality due to the risk of spontaneous internal organ/vessel injury. This can be mitigated by increased awareness of systemic manifestations of vEDS and a high index of suspicion by both primary care and emergency physicians. Once diagnosed, surveillance is crucial, including regular blood pressure monitoring, frequent non-invasive imaging to identify emerging vascular lesions, and pregnancy counselling for potential uterine rupture and avoiding trauma, collision sports, and lifting heavy items.

414 Renal artery aneurysm after blunt trauma in a pediatric patient- A case report

Abstract Introduction Renal artery aneurysm is a rare complication after renal trauma. Most patients are managed with minimally invasive techniques. However, in case of risk of expansion or rupture, surgical exploration may be warranted. Here we present a case of a 10 year old girl who presented with renal artery aneurysm after blunt trauma. Case report A 10 year old girl presented in ER with sudden onset abdominal pain after history of fall. Fast scan showed free fluid in abdomen and right kidney injury. CT scan of abdomen showed grade V kidney injury and right renal artery aneurysm compressing inferior vena cava anteriorly and ascending colon laterally. CT angiogram was done which confirmed a ruptured renal artery aneurysm. Patient was initially being managed conservatively and angiography was planned. She, however, became vitally unstable and her haemoglobin level dropped. Patient was taken to operation theatre urgently. Per- operatively, a ruptured right renal artery aneurysm was found, 2cm from aorta, causing a large hematoma compressing surrounding structures and dilated renal vein. Right nephrectomy was done. Patient remained stable and was discharged with an uneventful recovery. Discussion Renal artery aneurysm is an extremely rare complication following blunt trauma in paediatric population. Diagnosis is difficult, hence requires high level of clinical suspicion. Angiography is the standard tool for diagnosis and management. However, in case of hemodynamic instability, operative management may be warranted. Conclusion Despite its rarity, renal artery aneurysm may occur in children after blunt trauma. Hence, high suspicion should be kept by the clinicians in these cases.

Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center

BackgroundEarly diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge.MethodsIn this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls).ResultsWe included 137 patients—52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55–74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7–60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2–16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77–0.91), depending on the number of factors.ConclusionsSudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.

Abstract #1407180: Drug Induced Acute Pancreatitis Secondary to Ezetimibe

Drug induced acute pancreatitis (DIAP) is a rare clinical entity with incidence of <2% in general population. Most cases are typically mild and have excellent prognosis but prompt diagnosis and cessation of offending drug is important to avoid adverse outcomes. A 58-year-old female former smoker with history of COPD and hyperlipidemia presented to the hospital with sudden onset abdominal pain radiating to the back associated with nausea and vomiting for 12 hours. On arrival vitals were normal and physical examination showed epigastric tenderness with negative murphy’s sign. Labs showed normal CBC and CMP with elevated serum lipase (2469 U/L – Normal 16 - 61 U/L) concerning for acute pancreatitis. CT abdomen and pelvis showed normal biliary tract. US of the abdomen showed no evidence of gall stone or biliary sludge. Serum lipid panel showed total cholesterol of 193, HDL of 66, LDL of 111 and triglyceride of 87. Serum Calcium was normal. Detailed history revealed no alcohol but that patient recently started ezetimibe 10 mgs daily 8 weeks prior to present due to history of statin intolerance. Her only other medication was inhaled Albuterol taken as needed. Immune panel include IgG-4 was negative. Patient was diagnosed with drug induced acute pancreatitis secondary to ezetimibe, and was managed conservatively cessation of ezetimibe, pain meds and bowel rest. Her overall condition improved in 48 hours and diet was progressed. She was discharged with outpatient follow up. Serum lipase dropped to 74 U/L prior to discharge. Drug induced pancreatitis account for ∼ 5% of all cases of pancreatitis. There is limited data on the exact mechanism by which drugs can induce pancreatitis as most evidence is bases on case reports or meta-analysis. On the basis of these case reports drugs are classified from class I-IV depending on the probability to cause pancreatitis. Some proposed mechanisms include immunologic reactions, direct toxic effect, accumulation of a toxic metabolite, ischemia, intravascular thrombosis, and an increased viscosity of pancreatic juice. Though most cases are mild the identification of the offending drug is crucial to prevent ongoing damage and recurrence. However, in most instances the diagnosis of drug induced pancreatitis and identification of offending drug can be challenging due to the presence of multiple agents. Current proposed criteria for identification include: 1) Pancreatitis develops during treatment with the drug, 2) Other likely causes of pancreatitis are not present 3) Pancreatitis resolves upon discontinuation of the drug and 4) Pancreatitis usually recurs upon re-administration of the drug. Our patient fulfilled 3 of the above criteria which suggest Ezetimibe induced Pancreatitis. Prior to this case there is one more case reported cases of Ezetimibe induced Pancreatitis but in both the cases there is no re-challenge of Ezetimibe which makes it a Class IV drug to cause pancreatitis.

A case report on surgeon’s perseverance: post ileal type appendicular perforation with concealed abscess-laparoscopic appendectomy

In humans, the vermiform appendix is not a vestigial organ, but rather a lymphoid structure that, when inflamed, causes major problems. Acute appendicitis is characterized by pain and soreness in the right iliac fossa, along with nausea and anorexia. Depending on the location of the appendix, it may appear in an unusual manner. In post-ileal type appendicitis, pain is more concentrated around the umbilicus, and pain shifting may be absent. In this scenario, an ultrasound of the abdomen may not be particularly useful, but a CT scan of the abdomen may aid in the diagnosis. A delay in diagnosing and treating acute appendicitis can have disastrous consequences. We now present the case report of a 20-year-old male patient with chief complaints of sudden onset of abdominal pain over umbilical region, squeezing type radiating to right lumbar region, for 3 days. On clinical examination, the patient had presence of tenderness at McBurney’s point over the right iliac fossa and periumbilical area. The diagnostic investigations of GI endoscopy report showed grade A esophagitis and hemorrhagic gastropathy. CT report shows acute appendicitis with contained perforation and appendiceal abscess. Post ileal appendicular perforation with concealed abscess was treated with laparoscopic appendectomy under general anesthesia.

A PROSPECTIVE CLINICAL STUDY ON PREGNANCY WITH ABRUPTIO PLACENTAE IN WOMEN ATTENDING A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- Placental abruption is a relatively rare but serious complication of pregnancy and placed the well-being of both mother and fetus at risk. Placental abruption is also called abruptio placentae. The estimated incidence is around 1% of all pregnancies. Despite being a relatively rare occurrence, placental abruption needs urgent intervention. Most placental abruptions happen before 37 weeks of pregnancy. Maternal morbidity and neonatal mortality are primarily caused by placental abruption. Despite the fact that blood transfusions are available, maternal deaths are nonetheless uncommon and higher than the overall maternal mortality rate. Preterm birth, low birth weight, perinatal hypoxia, stillbirth, and neonatal mortality are all neonatal consequences. Even with better prenatal care and monitoring methods, the rate of placental abruption has been rising in several nations. The present study Material and Method- is a prospective study done in the Department of Obstetrics and Gynecology, M.G.M Medical College and M.Y Hospital, Indore, over a period of 1 year from March 2021 to February 2022.. All cases are admitted in Department of Obstetrics and Gynaecology, M.G.M Medical College and M.Y Hospital, Indore. The study will include prospective cases for 1 year from ethics committee Inclusion Criteria- 1. All cases of concealed and revealed abruption with gestational age &gt; 28 weeks till term. 2. All abruption with clinical symptoms of sudden onset abdominal pain, vaginal bleeding and uterine tenderness 3. All patients of abruptio placentae diagnosed on USG ndings. Exclusion Criteria- 1. All patients who come with the history of Ante partum hemorrhage but are having local (vaginal/cervical)causes excluded. 2. All patients referred to the hospital for the management of post-partum complications. 3. All other causes of APH like placenta previa and other extra placental causes. Result- Majority of the study population were booked multigravida in the age group of 26-30 years of low socioeconomic status with B+ blood group with anemia and gestational hypertension as risk factors.Most of them underwent LSCS with Shock and sepsis as complications 80% study participants had live and healthy baby. 20% had perinatal death. 47.9% of the babies were low birth weight and 25% required resuscitation Without a doubt, abruptio placent Conclusion- ae is a potentially serious obstetric condition that has the potential to threaten mother health and wellbeing, foetal viability, neonatal mortality, and morbidity. We found that important risk factors for abruptio placenta are multiparty, unbooked status, living in a rural area, maternal anaemia, and hypertension and also it is independent risk factor for perinatal mortality. From the present study we conclude that to prevent and lessen the severity of the situation early intervention, prompt delivery, and strengthening of safe motherhood services, particularly in remote regions will be helpful.

When the Spleen Breaks: A Rare Case of Spontaneous Splenic Rupture and the Diagnostic Significance of CT Scan

Purpose: This case report aims to discuss the rare occurrence of spontaneous splenic rupture and the utility of CT scans in its diagnosis and management. Presentation of Case: A 58-year-old chronic smoker presented to the emergency department with sudden-onset abdominal pain. He was diagnosed with splenic rupture based on clinical presentation and imaging findings, including an enlarged spleen and abdominal fluid on CT scan. The patient underwent splenectomy, with histological examination confirming the diagnosis. Discussion: CT scan is a commonly used imaging technique in the diagnosis of splenic masses, providing a high resolution, cross-sectional view of the spleen and surrounding structures. The use of contrast agents enhances the differentiation between vascular and non-vascular lesions and improves the accuracy of diagnosis. Other imaging techniques such as ultrasound, MRI, and PET-CT may also be used. The treatment of splenic masses depends on the underlying etiology and the clinical status of the patient. Conclusion: The CT scan findings in this case suggest a splenic mass, which was confirmed to be a decapsulated spleen on histological examination after splenectomy. The use of imaging techniques such as CT scan is important in the diagnosis and management of splenic masses, aiding in preoperative planning and postoperative monitoring. Postoperative management of splenic rupture typically involves pain control, antibiotic therapy, and lifelong prophylactic antibiotics and vaccinations to reduce the risk of infection. This case report discusses a rare case of spontaneous splenic rupture and highlights the diagnostic and management utility of CT scans. The patient, a 58-year-old chronic smoker.