Use Of Abdominal Ultrasonography Research Articles

Clinical significance of incidental common bile duct dilatation in children: A 10-year single medical center experience

BackgroundWith the widespread use of abdominal ultrasonography (US), incidental detection of common bile duct (CBD) dilatation is common in pediatric populations. This study investigated the causes and clinical significance of CBD dilatation in children without biliary symptoms, jaundice, or causative lesions in US. MethodsWe retrospectively reviewed pediatric patients with CBD dilatation from July 2013 to June 2023. All cases were detected via abdominal US. We analyzed the patients’ clinical manifestations, laboratory data, diagnosis, underlying diseases, and clinical course. ResultsIn a total of 687 patients enrolled, 338 met inclusion criteria (90 in hepatobiliary, 248 in CBD dilatation group). Of 128 patients with incidental CBD dilatation who underwent regular US examinations, 91 (71.1%) experienced resolution during follow-up. The proportion of patients with intrahepatic duct dilatation was significantly higher in the non-resolution group (p = 0.038). General health examination group had significant smaller CBD diameter compared to the gastrointestinal and infection groups. Correlation analysis found starting point of resolution decline at 3.24 mm (all-inclusive) and 2.51 mm (infant group) CBD diameter. ConclusionsMost children with incidental CBD dilatation did not have abnormal hepatobiliary function or other sonographic abnormalities. They usually remained asymptomatic and experienced uneventful clinical courses.

Normal and pathological aspects in gastrointestinal ultrasonography in horse

The evaluation of abdominal organs in horses represents a stringent necessity in the case of gastrointestinal emergencies (e.g., intestinal ileus). Even though physical examination represents a fundamental component of the medical assessment in these pathological conditions, the diagnostic efficiency of this method is sometimes limited by the anatomic and topographical peculiarities of the abdominal organs. The use of abdominal ultrasonography helps overcome this inconvenience by significantly reducing the areas that are clinically inaccessible. Moreover, it supplies precise information regarding the extension, severity and nature of the organ lesion in question. The ultrasonographic technique described in this article is transcutaneous, a simple, noninvasive, repetitive and relevant method for the majority of the gastrointestinal segments. The results offer a comparative perspective over the normal and pathological echotopographical and echostructural aspects of the equine gastrointestinal organs. The precise identification of the extension and severity of the lesions facilitates choosing between conservative or surgical methods of treatment.

Efficacy of Abdominal Ultrasonography for Differentiation of Gastrointestinal Diseases in Calves.

Simple SummaryGastrointestinal diseases represent one of the common causes of bovine acute abdomen, such as abdominal distention, abdominal pain, and cessation of defecation. In addition to the observable signs when performing routine auscultation, rectal palpation, and biochemical examinations of ruminal fluid and blood, these clinical observations can provide evidence suggestive of these diseases, but they generally result in an inconclusive diagnosis. Therefore, exploratory laparotomy is often used because it facilitates both diagnosis and therapeutic decisions. For bovines, abdominal ultrasonography is frequently utilized as a convenient imaging modality to assist accurate diagnosis and contribute to subsequent appropriate therapeutic choices for bovine gastrointestinal diseases. According to recent trends in human medicine and small animal practice, technical improvements have led to developments in the diagnostic value of abdominal ultrasonography, including scanning methods and the establishment of valuable diagnostic signs specific to a particular disease, e.g., a target sign for intussusception.This study investigated the clinical efficacy of abdominal ultrasonography for abomasal dilation in three calves, intestinal volvulus in five calves, intussusception in one calf, and internal hernia in one calf. In the abdominal ultrasonograms of the abomasal dilation cases, this disease was commonly characterized by severely extended lumens, including heterogeneously hyperechoic ingesta without intraluminal accumulations of gas. In the animals with intestinal volvulus and intussusception, a to-and-fro flow was observed to be a common ultrasonographic characteristic that led to suspicion of an intestinal obstruction. The use of abdominal ultrasonography for five cases with intestinal volvulus gave no reason to suspect this disease, despite its efficacy in one case, based on an acutely angled narrowing. Although three of five animals with intestinal volvulus had intestinal ruptures, no ultrasonographic evidence could be obtained. When abdominal ultrasonography was used for one case with intussusception, this pathological condition could be strongly suspected, as a “target” sign was observed. This finding supported surgical intervention for this case, followed by treatment with manual reduction, resulting in a favorable outcome. In terms of the differential and definitive diagnosis for various intestinal diseases, abdominal ultrasonography may be poor at providing indicative evidence, but very helpful for confirming intestinal obstruction.

Etiology of Juandice and Associated Liver Diseases Among Hiv Patients

Background and Aim: Jaundice and associated liver disease are frequently diagnosed in patients with acquired immunodeficiency syndrome (AIDS). The assessment of jaundice causes, etiology, and outcomes in human immunodeficiency virus (HIV)-infected patients with liver disease have not been addressed. The present study aimed to evaluate jaundice and associated liver disease in human immunodeficiency virus (HIV)-infected patients. Materials and Methods: This cross-sectional study was conducted on 272 human immunodeficiency virus(HIV)-infected patients with liver disease at the Department of Gastroenterology AK CMH/ Sheikh Khalifa bin Zayad Al Nahyan Hospital Rawalakot, Medicine Medical Unit A, Hayatabad Medical Complex, Peshawar and department of Medicine, Fauji Foundation Hospital Rawalpindi for duration between 5th January 2020 and 5th December 2020. Jaundice was defined as a serum bilirubin concentration of 3 mg/dL or higher. The etiology of jaundice was determined using a pattern of liver disease biochemistry test, radiographic studies, liver biopsy and clinical follow-up. Results: About 272 HIV-infected patients were evaluated liver disease; the prevalence of jaundice was 46 (16.9%). Drug-induced hepatitis was the more prevalent cause in Jaundice 19 (41.3%) followed by neoplasms in 14 (30.4%) patients. Out of 14 neoplasms, the extrahepatic and intrahepatic disease was present in 8 and 6 patients respectively. Alcoholic liver disease was present in 5 (10.9%). Various potential causes were present in three patients. The use of abdominal ultrasonography and CT was beneficial in determining the fundamental cause of the infection. five of these patients died as a result of liver disease. Conclusion: Jaundice is rare and can be caused by a number of opportunistic and non-opportunistic etiologies in AIDS. The most common cause is drug-induced hepatitis, which can be fatal. Long-term survival was dismal. Keywords: Jaundice, Liver Disease, Human immunodeficiency virus (HIV)

Laparoscopic Deroofing and Excision of a Large Left Renal Cyst Mimicking Chest Infection: Case Report

Background: The routine use of abdominal ultrasonography and computed tomography scan has increased the detection of asymptomatic renal cysts. Laparoscopy is usually suitable for treating large symptomatic renal cysts. Objective: To report a case of laparoscopic treatment of a man with large left renal cyst mimicking chest infection. Case presentation: A 75-year-old man, known hypertensive who had empirical treatment for chest infection without resolution of symptoms of cough and chest pain. He was on treatment for storage and voiding lower urinary tract symptoms with 10mg alfuzocin. Abdominal ultrasound and computed tomography scan confirmed a large left renal cortical cyst that measured 380mls. He subsequently had transperitoneal laparoscopic deroofing and excision of the renal cyst with operation finding of 300mls of straw coloured fluid excluding spillage. The immediate postoperative period was uneventful, and he was discharged home in a stable condition on the second day. The aspirate yielded no growth while the cytology report of cystic fluid was acute-on-chronic inflammation. Histology was reported as chronic pyelonephritis with cystic degeneration. Conclusion: Large renal cyst should be considered as differential diagnosis of unresolved chest infection and is safely treated by laparoscopic deroofing and excision.

Evaluation of diagnostic and prognostic usefulness of abdominal ultrasonography in dogs with clinical signs of acute pancreatitis.

To report abdominal ultrasonography (AUS) findings in dogs with clinical signs of acute pancreatitis (AP) during the first 2 days of hospitalization and to compare AUS findings with severity of disease and mortality rate. 37 client-owned dogs with clinical signs of AP. Dogs suspected of having AP with complete medical records, AUS examinations performed throughout the first 2 days of hospitalization, and available frozen surplus serum samples for quantitative measurement of canine pancreatic lipase (cPL) concentrations at hospital admission met the criteria for study inclusion. Dogs were grouped as AUS+ or AUS- on the basis of positive or negative findings for AP on AUS, respectively. Abdominal ultrasonography findings of AP were stratified (as mild, moderate, or severe) by use of an AUS severity index, and a canine acute pancreatitis severity score was calculated. 24 of 37 (64.8%) dogs had AUS findings of AP at hospital admission, whereas 10 had positive findings for AP on AUS within 2 days of hospitalization. Three (8%) dogs were AUS- but had serum cPL concentrations > 400 μg/L (ie, values considered diagnostic for AP). On the AUS severity index, 5 of 34 (14.7%) AUS+ dogs had mild findings, 18 (52.9%) AUS+ dogs had moderate findings, and 11 (32.4%) AUS+ dogs had severe findings. Severe findings were associated with a higher risk of death than mild and moderate findings. A significant association was found between canine acute pancreatitis severity scores and mortality rates. For dogs with clinical signs of AP, repeated AUS examinations during hospitalization should be performed, severe findings on the AUS severity index may indicate an increased risk of death, and serum cPL concentrations may increase earlier than findings on AUS of AP.

ISOLATED ILIAC ARTERY ANEURYSM- 10 YEARS INSTITUTIONAL EXPERIENCE

Objective: To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated IAA) in the last 10 years. Introduction: Unlike abdominal and combined aortoiliac artery aneurysms, isolated iliac artery aneurysms (IIAAs) are uncommon. An isolated iliac artery aneurysm is dened as a twofold increase in the diameter of the iliac artery without a coexisting aneurysm at another location. IIAA was encountered infrequently in the past, comprising 0.9% to 4.7% of all intra-abdominal aneurysms according to a review of previous studies; however, in recent times, many asymptomatic IIAAs have been detected incidentally because of the widespread use of abdominal ultrasonography and computed tomography. Methods: The medical records of patients who underwent isolated IAA repair at Institute of vascular sciences, MMC and RGGGH, Chennai, India, were reviewed, to obtain information on patients' demographics, vascular risk factors, type of treatment and outcome Results: A total of 13 patients with 18 aneurysms, 11 men(84.6%) 2 women(15.4%), with a mean age of 58.1±6 years, and two paediatric patients of age 11yrs (Female) and 3 months (Male) were treated. The mean diameter was 4.6 ± 1.0 for non-ruptured at elective repair; 5.5±2.1 cm on the emergency cases. The majority of aneurysms were at the common iliac artery. All of them except one, underwent open repair.Ten (84%) had elective operations, and two (16%) emergency repair for ruptured aneurysm. Hypertension and diabetes were seen as the most common risk factors with most of the patients were smokers. One was a known case of CKD and the paediatric female was a known case of RHD. There was one postoperative death in this series, patient succumbed on POD 1. Conclusion: This case series reviews the literature with regard to the natural history, diagnostic workup, and treatment of iliac artery aneurysms. For patients undergoing elective repair, preoperative imaging with computed tomography or magnetic resonance is advocated. Repair is recommended for good-risk patients with aneurysms larger than 3.5 cm as there is high chances of rupture with increasing diameter.

A novel segmental absence of intestinal musculature with small intestinal stenosis: a case report

BackgroundSegmental absence of intestinal musculature (SAIM) is a rare cause of intestinal obstruction and perforation due to partial or complete defects in the intestinal muscularis propria in neonates and is occasionally observed in adulthood.Case presentationThe first case of small intestinal stenosis derived from SAIM, which was difficult to differentiate from Crohn’s disease (CD), is reported. A 4-year-old girl presented with abdominal pain, anemia, and a positive fecal occult blood test. She was initially diagnosed with CD and started on treatment. Because her gastrointestinal symptoms persisted, her previous pediatricians tried to carry out capsule endoscopy, but it was not possible because the patency capsule was retained. Therefore, she was referred to our institute and re-evaluated. The patency capsule examination was repeated to re-evaluate small intestinal passage, but it stagnated again. Abdominal ultrasonography showed a poorly deformable intestinal tract that narrowed rapidly from the dilated segment and had a thin wall with an irregular laminar structure. In addition, unlike the typical ultrasonic CD findings, the power Doppler signal enhancement at the intestinal wall and “creeping fat sign” were not found. The patient was referred for laparoscopic observation to pediatric surgeons, who confirmed a prominently dilated intestinal tract 40 cm proximal to the ileocecal valve, which was resected. Histopathological findings showed longitudinal muscle hypoplasia of the resected, dilated intestinal tract and fat replacement of the muscle layer. At the stenosis site, the muscle layer was fibrotic and showed incomplete muscle arrangement. Because of these findings, she was diagnosed with SAIM. After the surgical treatment, no gastrointestinal symptoms relapsed, and the fecal occult blood test has remained negative for 2 years. Moreover, 8 months after surgery, double-balloon endoscopy showed no abnormalities, such as a longitudinal ulcer and cobblestone appearance.ConclusionsIn the present case, SAIM involved not only intestinal ileus and perforation, but also small intestinal stenosis. Although no other reports have demonstrated the usefulness of abdominal ultrasonography for the diagnosis of SAIM, the present report suggests that ultrasonography may be useful for differentiating SAIM from CD by close observation of the area around the small intestinal stenosis.

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

BackgroundThe widespread use of abdominal ultrasonography in children documented increased detection rate of gallstones. The aim of this study was to assess the possible risk factors of gallstones and to detect the complication rate and outcome of the disease in Egyptian infants and children from a hepatologist perspective. This prospective study included 35 cases, with ultrasound-detected gallstones, who presented to the Pediatric Hepatology Unit from July 2015 to October 2017. All patients were initially evaluated by full history, general and abdominal examination, laboratory assessment, and ultrasound findings to detect possible risk factors of gallstones. Management approach was individualized for each patient according to his/her condition, and the patients were followed up at 3 months interval.ResultsThe patients’ ages ranged from 3.5 months up to 17 years. The median age of gallstone detection was 2 years. Gallstones were symptomatic in 62.9% with abdominal pain in 51.4%. Complications in the form of choledocholithiasis were detected in 7 patients (20%). Laparoscopic cholecystectomy was done for 7 patients while conservative management was applied for 24 patients. Complete resolution occurred in 8.3% and partial resolution in 33.3%. Chronic hemolytic anemia was the most commonly identified risk factor for gallstones. Patients needed surgical intervention had significant higher serum cholesterol and LDL levels (P = 0.006 and P = 0.002 respectively).ConclusionRisk factors for gallstones could be identified in most of pediatric cases. Symptomatic presentation is common among the pediatric population. Conservative management is recommended for asymptomatic cases of gallstones in children. Laparoscopic cholecystectomy is a safe and recommended procedure for complicated and symptomatic cases of gallstones.

薬剤包装シートPress Through Package（PTP）誤飲による小腸穿通に対し腹部超音波検査が診断に有用であった1例

薬剤包装シートPress Through Package（PTP）誤飲による小腸穿通に対し腹部超音波検査が診断に有用であった1例

Can Non-Invasive Methods Be Clinically Useful for Diagnosis and Severity of Portal Hypertension?

Context: Current gold standard methods of diagnosing portal hypertension (endoscopy and hepatic vein pressure gradient) are not only invasive but also very expensive. Consequently, new non-invasive methods have been studied over the years to assess their Applicability in replacing current invasive procedures. This review explores the current use of abdominal ultrasonography, Doppler ultrasonography, contrast-enhanced ultrasonography, various elastography techniques, computed tomography, and magnetic resonance imaging in evaluating portal hypertension while exploring their advantages and disadvantages. Evidence Acquisition: We gathered data from international papers published in Pubmed/Medline, Cochrane Library, Google Scholar, Web of Science, Wiley Online Library, and Research Gate databases until October 2019. Papers analyzing the associations between non-invasive tests and either portal hypertension or its complications were included in the study. Results: Liver stiffness (LS) and spleen stiffness (SS), regardless of the used elastography method, have shown promising results, with liver stiffness already included in current guidelines to avoid screening endoscopy. Overall, the results suggest that SS is superior to LS for screening for portal hypertension and the presence of EV, but there is a need for additional studies to certify the data and further evaluate which would provide the most accurate assessment and if other parameters need to be included to better diagnose portal hypertension. Conclusions: Liver stiffness and spleen stiffness are the best currently available methods of detecting portal hypertension but require further research. They may reduce the number of hepatic vein pressure gradient measurements and endoscopies needed for the diagnosis and follow-up of patients with portal hypertension in the future.

The Importance of Ultrasound Findings in Children with Acute Abdominal Pain to Prevent Unnecessary Surgery

Background: Abdominal pain is common in children that can manifest as acute or chronic. In some cases, are requires immediate management. The most difficult challenge is to make diagnosis to identify the cause. Objective: This study is aimed to demonstrate the evidence of the use of abdominal ultrasonography (AUS) to determine the cause of pain in relation to surgical decision. Methods: Patients with acute abdominal pain were referred for AUS. Prospective cross- sectional method was done in 268 children aged 5 to 15 years old, in which 116 of them are male. Patients who did not require surgery and outpatients were asked to make a response whether the improvement during and after the treatment. Patient who were required surgical, will be confirmed by histopathology. Results: No abnormalities (53.73%). The abnormal findings were: enterocolitis (13.43%), mesenteric adenitis (12.68%), constipation (6.72%), appendicitis (6.34%), cystitis (5.97%), adrenal tumor (0.07%) and intussusception (0.04%). Findings shows, the use of AUS to deter mine the cause were able to reduce surgical decision from 27.98% to 7.46%. Thus, ultrasonography changed the management plan in 20.52%of patients. Conclusion: The AUS is useful for evaluation abdominal pain in children. An accurate diagnosis is important to prevent unnecessary surgery.

Usefulness of abdominal ultrasonography for diagnosis and follow-up treatment with IgG4-related periaortitis/periarteritis

Usefulness of abdominal ultrasonography for diagnosis and follow-up treatment with IgG4-related periaortitis/periarteritis

Usage of ultrasonography in gallbladder lesions. Analysis of 85 cases: a single centre study

Background: The differential diagnosis of gallbladder (Gb) lesions is challenging. The aim of the present study was to evaluated the clinical usefulness of abdominal ultrasonography (US) for differential diagnosis of gallbladder lesions. Methods: We retrospectively assessed US images and pathology reports of 85 patients (57 women, age 63.4±11.2 years) who were admitted to our clinic between January 2014 and December 2017 with primary diagnosis of Gb lesion. Results: All patients at admission had US examination, which resulted in suspicion of different stages of Gb cancer in 63 cases (74.1%), benign Gb lesions in 10 cases (11.8%), biliary duct cancer (BTC) in 3 cases (3.5%) and uncertain diagnosis in 9 cases (10.6%). The correlation of US and histopathology results showed 73.0% compatibility, 16.4% discrepancy and 10.6% uncertainty. Among correct US diagnosis Gb cancer was confirmed in 52 cases (82.5%). Statistical analysis showed significant difference in Gb wall thickness between correctly diagnosed Gb cancer and benign Gb lesion groups (p = 0.001). In descriptive analysis other misdiagnosed features that mimicked Gb cancer were analysed, such as: pathologically changed Gb wall; liver, common hepatic duct (CHD) or other surrounding tissues infiltration; enlargement of lymph nodes. Conclusion: US examination has high sensitivity for detection of advanced Gb cancer what can facilitate treatment decision. Thickness of the Gb wall can be an important factor for distinguishing benign and cancerous process. Misdiagnosis of Gb cancer and BTC is possible when tumor mass is in the middle part of CHD or within liver parenchyma and infiltrate the Gb.

How useful is abdominal ultrasonography in dogs with diarrhoea?

To assess the utility of abdominal ultrasonography in the diagnostic work-up of dogs with diarrhoea. Retrospective cross-sectional study based on a referral population of dogs with diarrhoea. Associations between the clinical signs, use of abdominal ultrasonography, results of abdominal ultrasonography and subsequent work-up were examined. The utility of abdominal ultrasonography was scored as high, moderate, none or counterproductive based on review of medical records. Medical records of 269 dogs were reviewed, of which 149 (55%) had abdominal ultrasonography. The most frequent result was no ultrasonographic abnormalities affecting the intestine in 65 (44%) dogs. Ultrasonography results were associated with subsequent work-up as follows: (1) no detected abnormalities and dietary trial; (2) focal thickening of the intestinal wall, loss of intestinal wall layers or enlarged abdominal lymph nodes and ultrasound-guided fine-needle aspirates; (3) diffuse thickening of the intestinal wall or hyperechoic striations in the small intestinal mucosa and endoscopy; and (4) small intestinal foreign body and coeliotomy. Abdominal ultrasonography was considered to be diagnostic without further testing in only four (3%) dogs: two had a portosystemic shunt identified ultrasonographically, one had a linear foreign body and one had a perforated pyloric ulcer. Abdominal ultrasonography had moderate utility in 56 (38%) dogs and no utility in 79 (53%) dogs. Abdominal ultrasonography was considered counterproductive in 10 (7%) dogs because results were either falsely negative or falsely positive. These results should prompt clinicians to reconsider routine use of abdominal ultrasonography in dogs with diarrhoea.

Mo1692 - Usefulness of Abdominal Ultrasonography for Patency Assessment Using the Patency Capsule

Mo1692 - Usefulness of Abdominal Ultrasonography for Patency Assessment Using the Patency Capsule

P249 Usefulness of abdominal ultrasonography for patency assessment using the patency capsule

Background: The present study was undertaken to evaluate the usefulness of abdominal ultrasonography (US) in patency assessment using the patency capsule (PC). Methods: This study involved 223 patients (139 men, mean age 39.9) for whom patency assessment using the PC was planned for capsule endoscopy (CE) at 2 domestic hospitals between August 2012 and August 2016. We excluded patients with ileus, those found to have small bowel stenosis on x-ray photography (XP) or US, and patients with apparently severe stenosis of the large bowel. Patency was judged on the basis of the morphology of the PC re-collected within 30–33 hours after oral PC intake. In cases in which PC re-collection was not possible, XP was performed approximately 33 hours later and, if localization of the PC by XP was difficult, abdominal computed tomography (CT) was additionally performed. In patients for whom patency was confirmed, CE was carried out within several days after confirmation of patency using PC. Complications, including CE retention, were analyzed. Results: The 223 patients studied included 144 with Crohn's disease, 16 with unexplained enteritis and 63 with other reasons for undergoing this examination. PC tests were performed for 268 sessions in total for the 223 patients. Oral PC intake was not possible in 6 cases. Of these 6 cases, 2 received the PC test with endoscopy and 4 withdrew from the study. Of the 264 cases in whom patency was assessed using the PC, PC excretion was visually documented in 174. There were 12 cases in whom the PC was shown to be present in the large bowel by XP, 51 cases in whom PC localization by XP was difficult, and 27 cases in whom excretion of the PC was confirmed by XP. The latter 27 cases were excluded from analysis because morphological evaluation of the PC was not possible. US was performed on 51 cases for whom localization of the PC had been difficult. Among these 51 cases, US revealed PC within the small bowel in 16 and presence of the PC in the large bowel in 32 cases. In the remaining 3 cases, US assessment was difficult, and CT was additionally performed, allowing confirmation of presence of the PC in the large bowel in all of these cases. CE was skipped in the 16 cases found by US to have PC within the small bowel, and CE was performed in the other 35 cases. Of the 221 cases in whom patency was confirmed with the PC, 220 underwent CE (1 case declined CE). No complications, such as CE retention, occurred in any of these patients. Conclusions: Among the 268 cases receiving the PC test, localization of the PC by XP was difficult in 51, but localization by US was possible in 48 of these 51 cases, allowing avoidance of CT scanning. These results suggest US to be useful for patency assessment using the PC.

Diagnosis and management of liver masses in pregnancy

Key content Liver masses are increasingly detected in pregnancy because of the widespread use of abdominal ultrasonography. Most lesions are benign and can be treated conservatively, although rarely these can lead to clinical symptoms and the potential for significant haemorrhage. Diagnosis of liver masses is made primarily through radiological assessment with blood tests and rarely by direct liver biopsy. Collaboration between the obstetric department and specialist liver multidisciplinary team is essential to ensure optimal management. Learning objectives Review of liver masses in pregnancy. Overview of issues relevant in the prepregnancy and postpartum periods. Interventional management strategies for liver lesions. Ethical issues Should the diagnosis of a liver mass lead to termination of pregnancy? When should ionising radiation be used to aid diagnosis of liver masses? Are doctors aware of the risk of bleeding from a benign liver mass?

Antepartum Hemorrhage as Unusual Presentation of Advanced Abdominal Pregnancy

Abdominal pregnancy carries higher maternal morbidity and mortality both in developed and developing countries particularly in resource limited settings. Its diagnosis is usually missed during antenatal care despite the routine use of abdominal ultrasonography. This case is presented to show that antepartum haemorrhage, one of antenatal complications of intrauterine pregnancy, can be the presenting clinical condition in advanced abdominal pregnancy and to demonstrate the continuing difficulty in diagnosing this rare but serious condition despite advances in obstetric care. The case also demonstrates how management of advanced abdominal pregnancy, particularly delivery of placenta, is difficult. In conclusion, it is important to have high index of suspicion of advanced abdominal pregnancy when antepartum haemorrhage is presented with other clinical clues of abdominal pregnancy due to the fact that making preoperative diagnosis of this form of pregnancy helps the managing team to be ready for grave complications of abdominal pregnancy at laparotomy and subsequently.

A Natural Course of an Infantile Hypertrophic Pyloric Stenosis without Adequate Surgical Procedure

Infantile hypertrophic pyloric stenosis (IHPS) is one of the common surgical abdomen in infancy, characterized by progressive non-bilious vomiting. The etiology is unknown, but it likely develops after birth. The pylorus of the stomach becomes thick and triggers progressive vomiting. Abdominal ultrasonography (US) is widely used as a diagnostic tool. Currently, there is a rare IHPS patient with severe metabolic derangement because of general use of abdominal US and its accuracy. We experienced a natural course of a 62- day-old male infant with IHPS who was suffering from intermittent vomiting, loss of weight but had not been properly treated for 1 month. It is needed to make an effort to diagnose differentially in recurrent vomiting infant and check-up regularly, and also educate parents properly.