Vague Abdominal Pain Research Articles

S1668 Pancreaticoportal Vein Fistula: A Very Rare Complication of Pancreatitis

Introduction: Pancreatic pseudocyst formation is a well-known complication of pancreatitis. Fistualization between a pancreatic pseudocyst and the portal system is a very rare complication of pancreatitis. Presentation varies from vague abdominal pain and elevated LFTs to systemic lipolysis, septic shock and death. It carries a high mortality risk if not identified promptly and managed. Case Description/Methods: 52-year-old male with a history of lymphoma s/p chemotherapy and splenectomy and HTN presented with 3 days of abdominal pain, decreased PO intake, and bilious emesis. He drinks half a bottle of vodka daily. His labs were notable for a significantly elevated lipase, lactic acidosis, severe AKI and elevated LFTs. CT abdomen was performed which was consistent with acute pancreatitis. He was admitted and treated conservatively. RUQ US revealed no gallstones. Pancreatitis was likely secondary to alcohol use. During this hospitalization he developed leukocytosis, fever, and worsening nausea and pain. An MRCP was obtained which revealed acute pancreatitis without definite focal pancreatic lesion, no cholelithiasis or choledocholithiasis. An MRI abdomen with contrast was obtained which revealed acute pancreatitis with necrosis in the pancreatic neck. There was no discrete abscess identified. He did not require surgical intervention. His course was complicated by C. difficile which was treated with oral vancomycin. The patient clinically improved and was discharged in stable condition after 11 days. About 1 month later the patient again presented with abdominal pain and "bulging" of his stomach. A CT and MRI of the abdomen revealed a massive pancreatic pseudocyst with communication with the porta hepatis. He was started on broad spectrum IV antibiotics and underwent a robotic cystgastrostomy. It was noted the pseudocyst was mostly fluid filled with small necroma component. Intraoperative cultures of the necroma remained without growth. The remainder of his hospital course was complicated by fever, leukocytosis and a pleural effusion with LLL collapse. The effusion was drained via chest tube. Pleural fluid cultures were negative. He was discharged in stable condition on IV antibiotics. Discussion: PPVF carries a high mortality risk and should be identified promptly. MRI/MRCP and ERCP aid in the diagnosis of PPVF. Treatment options include supportive medical management, surgical or endoscopic drainage of pseudocysts, fistula embolization, or partial pancreatectomy.Figure 1.: Multiloculated pseudocyst with fingerlike extensions into the porta hepatis.

PULMONARY EPITHELIOID HEMANGIOENDOTHELIOMA: A RARE ENTITY WITH INSIDIOUS ONSET

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sarcomas are rare, malignant tumors of connective tissue origin. Epithelioid hemangioendothelioma (EHE) is an exceedingly rare vascular sarcoma of endothelial origin, with an incidence of less than one per one million. Patients are typically asymptomatic or manifest symptoms related to organ involvement. We present a case of an asymptomatic woman with an incidental discovery of pulmonary EHE. CASE PRESENTATION: A 26 year old woman with no smoking history presented with vague abdominal pain. Her exam and initial labs were unremarkable. Abdominal imaging revealed nodules at the lung bases, and subsequent thoracic imaging revealed innumerable nodules throughout the lung parenchyma without pleural involvement. CT-guided transthoracic biopsy revealed filling and distension of alveolar spaces by a neoplastic proliferation of small, bland cells with perinuclear vacuoles within a hyalinized stroma. Immunohistochemical staining showed the neoplastic cells to be positive for ERG and CD31. These imaging and pathology findings were consistent with stage IV metastatic pulmonary EHE. She was referred to a sarcoma center of excellence, and surveillance was recommended. DISCUSSION: EHE is a vascular subtype of sarcoma of low-grade malignancy most commonly involving the liver and lungs. Pulmonary EHE can be asymptomatic or present with non-specific symptoms of dyspnea, cough, hemoptysis, or weight loss. Diagnosis is made with histopathologic epithelioid morphology and immunohistochemical vascular characteristics. Our patient's biopsy tissue stained positive for markers of vascular differentiation. CD34 and Factor VIII-related antigen are additional markers that may be used to identify vascular features of EHE. Disease course is unpredictable, and factors associated with a poor prognosis include pleural effusion and hemoptysis. Disease rarity precludes established treatment guidelines. Surgical resection should be considered for solitary lesions. Past reports have shown some responsiveness to taxane, anthracycline, or IFN-2a therapy. Anti-VEGF therapies show promise for eliciting partial response or as maintenance therapy. Still, many cases are indolent and a surveillance strategy may be reasonable. In our patient, surveillance was supported by her asymptomatic disease without poor prognostic factors. The development of significant symptoms or progressive disease would prompt further consideration of treatment. CONCLUSIONS: EHE is an extremely rare sarcoma subtype most commonly affecting the liver or lungs. Diagnosis is made on immunohistopathology and treatment options include surgical resection, surveillance, or anti-angiogenic agents. It is an important, albeit uncommon diagnosis to consider for diffuse pulmonary nodules seen on imaging. REFERENCE #1: Semenisty V, Naroditsky I, Keidar Z, Bar-Sela G. Pazopanib for metastatic pulmonary epithelioid hemangioendothelioma—a suitable treatment option: case report and review of anti-angiogenic treatment options. BMC Cancer. 2015;15(1):402. doi:10.1186/s12885-015-1395-6 REFERENCE #2: Chevreau C, Le Cesne A, Ray-Coquard I, et al. Sorafenib in patients with progressive epithelioid hemangioendothelioma: A phase 2 study by the French Sarcoma Group (GSF/GETO). Cancer. 2013;119(14):2639-2644. doi:10.1002/cncr.28109 REFERENCE #3: Agulnik M, Yarber JL, Okuno SH, et al. An open-label, multicenter, phase II study of bevacizumab for the treatment of angiosarcoma and epithelioid hemangioendotheliomas. Ann Oncol. 2013;24(1):257-263. doi:10.1093/annonc/mds237 DISCLOSURES: No relevant relationships by Mohammad Ahmed, source=Web Response No relevant relationships by Gustavo Cumbo-Nacheli, source=Web Response No relevant relationships by Connor Kerndt, source=Web Response No relevant relationships by Ranuka Sinniah, source=Web Response

VP08.04: Clinicosonographic changes within six months after initial diagnosis in women with pelvic tuberculosis: a cohort study

To describe the significant changes in clinical characteristics and sonographic features within 6 months of treatment after diagnosis among women with pelvic tuberculosis. A cohort of 5 women diagnosed with pelvic tuberculosis based on tissue biopsy and ultrasound findings were followed up at 2, 4 and 6 months after the diagnosis to describe the clinical characteristics and sonographic features while on treatment. A total of 12 women were recruited but only 6 consented as study participants. Five participants completed the study protocol while one participant died 2 weeks after the initial diagnosis. All participants were underweight, with a history of secondary infertility and positive exposure to TB. From baseline to 6 months of treatment, there was a significant change on the following clinical characteristics: fever (P = 0.014), weight loss (P = 0.001), abdominopelvic pain (P = 0.016), vaginal discharges (P = 0.036) and abdominal distention or bloatedness (P = 0.007). There was no statistically significant change on chronic cough (P = 0.849) and menstrual disorder (P = 0.490). For sonographic features, only ascites showed a significant change (P = 0.040) over the 6-month follow-up. Other sonographic characteristics such as peritoneal involvement, renal cortex thickening, adhesions/pseudocyst, matted bowel loops, complex adnexal mass, thin endometrium, and fallopian tube involvement did not show any significant change over the 6-month period. Majority of women with pelvic tuberculosis will present with fever, weight loss, vague abdominal or pelvic pain, abdominal distention/bloatedness, menstrual irregularities and abnormal vaginal discharges. There was significant clinical improvement as early as 2 months into anti-TB treatment except for the chronic cough and menstrual irregularities. Among the sonographic features, only ascites showed significant change. These findings confirm the residual effects of tuberculosis on the pelvic organs despite clinical improvement after treatment.

Gossypiboma Transduodenal Migration Causing Partial Gastric Outlet Obstruction

The term “gossypiboma” denotes a mass of cotton that is retained in the body following surgery. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 46-year-old female who presented with vague upper abdominal pain associated with postprandial fullness and occasional vomiting. She had a history of open cholecystectomy 16 years ago. Abdominal X-ray and ultrasonogram examination of the abdomen were inconclusive. Her contrast-enhanced computed tomography of the abdomen revealed thickening of the wall of the pyloric antrum with air containing thick-walled structure in relation to the pyloric antrum and the first part of the duodenum possibility of the duodenal diverticulum with inflammatory/neoplastic thickening was suggested. Her esophagogastroduodenoscopy revealed large cotton sponge embedded in the anterior wall of the first part of the duodenum. On exploratory laparotomy, she was found to have a large gossypiboma embedded in the first part of the duodenum with dense adhesions to surrounding structures. Although rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain even years after the operation.

Role of Laparoscopy in the Diagnosis of Abdominal Tuberculosis in Patients with Vague Abdominal Symptoms

Background and Aim: Tuberculosis continues to be a common disease in Iraq and one of its presentations is abdominal tuberculosis which tends to present with non-specific features that can be hard to diagnose at times. Histopathological confirmation of abdominal tuberculosis is difficult because of suboptional, noninvasive access to the pathology. The aim of this study was to find out the efficacy of diagnostic laparoscopy in establishing the histopathological diagnosis of abdominal tuberculosis. Patients and Methods: A retrospective study conducted on 67patients with vague abdominal pain, with or without ascites, for whom diagnostic laproscopy was performed in Azadi Teaching Hospital in Kirkuk City over a period of six years (January 2007 - December 2012). Data were collected and statistically analyzed using SPSS software version 16. Results: A total of (67) patients with vague abdominal symptoms and an unsettled diagnosis were included in this study, of which 22(32.8%) of the patients were diagnosed with abdominal tuberculosis on laparoscopy. The common symptoms were abdominal pain, changing bowel habits, loss of weight, fever and generalized weakness. The most consistent laboratory finding (>86%) was a high ESR. Macroscopic findings of abdominal tuberculosis were whitish granulations over both peritoneal layers, inflammatory adhesions on the visceral or parietal surface, thickening, hyperemia and retraction of the greater omentum and stalactic band which is characteristic of abdominal tuberculosis. Direct visualization of the peritoneum and obtaining peritoneal biopsies provided the definitive tissue diagnosis to confirm the clinical diagnosis. Conclusion: Although other diagnostic methods of abdominal tuberculosis such as imaging, culture of ascites and polymerase chain reaction (PCR) are used today, laparoscopy with tissue biopsy provided efficient and reliable diagnostic tool for patients suspected with abdominal tuberculosis. Patients were saved from unnecessary laparotomies and were managed on anti-tuberculosis drug therapy.

Gallbladder ascariasis: a case report and review of literature

Ascaris Lumbricoides uncommonly presents as a cholecystitis due to anatomical considerations. Despite that it presents 2.1% of the hepatobiliary ascariasis. Patients usually have vague symptoms of vague abdominal pain sometimes with fever, mimicking cholecystitis. Ultrasonography (USG) helps in definite diagnosis. We present a case of 50 years old female with gallbladder ascariasis for which cholecystectomy was done successfully.

Clinicopathological Features of Gallbladder Carcinoma Managed in a Tertiary Level Hospital of Nepal

Introduction: Gallbladder carcinoma is a relatively rare disease in some parts of the world but is common in countries like Chile, Japan, India, and Nepal. Nepal stands as one of the five countries with the highest mortality. However, there are only a few studies published on this matter from Nepal. This study aims to study the demographic and clinicopathological features of gallbladder carcinoma managed in a tertiary level teaching hospital in Nepal. Methods: A retrospective analysis of all the patients with the diagnosis of gall bladder carcinoma in Tribhuvan University Teaching Hospital from 2018 to 2020 was done. Patient demographics, clinical characteristics, and laboratory parameters including tumor markers were analyzed. Results: Of the 59 patients, there were 33 (56%) females. The median age at diagnosis was 56 years. Among all, the most common presenting symptom was abdominal pain. Curative resection was done in 18 (30%) of the cases. Metastasis was present in 30% of the cases of which the liver was the most frequently involved organ. The mean carcinoembryonic antigen (CEA) level in unresectable cases was 18.65±22.53 nanograms per milliliter (ng/mL) which was higher than in resectable cases being 6.78±12.75 ng/mL. Similarly, the mean carbohydrate antigen 19-9 (CA 19-9) level in unresectable cases was 604.55±671.28 units/milliliter (U/ml), which was higher than the value in the resectable cases 89.44±273.67 U/ml. Conclusion: In this study, gall bladder carcinoma was more common in females below 60 years with vague abdominal pain as the most frequent presenting symptom. One-third of the evaluated cases were resectable. Unresectable cases were associated with high CEA and CA 19-9 levels.

A Rare Case of Intravascular Fibroid Incidentally Diagnosed Intraoperatively

A 47-year-old Parity 2 Living 2 presented with complaints of abdominal distension and vague abdominal pain for 8 months. Ultrasound revealed a large intramural fibroid, and she was consented for a total laparoscopic hysterectomy.

Hepatic focal nodular hyperplasia in a five-year-old healthy boy: A case report and literature review

Introduction: Focal nodular hyperplasia is unusually seen in a pediatric age group, with few reported cases in the literature. We report the case of a 5-year-old boy not known to have medical illnesses, who was found to have a liver mass, underwent right trisectionectomy. The purpose of this report is to familiarize the healthcare community with similar events, review the literature, and discuss recommendations for future similar cases. Case Report: A case of focal nodular hyperplasia (FNH) in a 5-year-old healthy boy who was found to have a huge liver lesion on ultrasound imaging due to a vague abdominal pain and distension. The patient underwent surgical excision of the mass due to abdominal pain, distension, and atypical features of FNH in radiological examinations. Histopathological analysis revealed a focal nodular hyperplasia. Conclusion: Focal nodular hyperplasia considered a benign lesion that has no malignant transformation. The presenting symptoms are variable, usually asymptomatic. Laboratory tests have of little significance. Imaging modalities mainly ultrasound scan initially then magnetic resonance imaging (MRI) are useful to obtain more accurate characteristic features of the lesion. Uncertain diagnostic lesion needs to be biopsied and examined under microscopy. Confirming the diagnosis will follow an acceptable conservative management approach. Surgical resection is the preferred method in uncertain, questionable, or atypical features observed in radiological imaging.

Radiological evaluation of metastatic lymph nodes in carcinoma cervix with emphasis on their infiltrative pattern

Background & objectives:Imaging has been added to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system of cervical carcinoma. This study was performed to assess the impact of imaging in staging and to ascertain the prevalence and pattern of nodal metastasis on contrast-enhanced computed tomography (CECT) in patients with cervical carcinoma who were treated based on FIGO 2009 staging system.Methods:This retrospective study was conducted to evaluate all patients with biopsy-proven cervical carcinoma who underwent CECT of abdomen at a tertiary cancer centre in north India from April 2017 to April 2019 and for whom either baseline or follow up scans were available. In patients with enlarged or necrotic lymph nodes, the location, size and pattern of infiltration of adjacent organs were recorded.Results:A total of 602 patients of cervical carcinoma had undergone CT during the study period, of whom 138 (22.9%) underwent CT at baseline and 464 (77.1%) patients during follow up. The FIGO (2009) stage distribution at the time of presentation was stage IB: 109 (18.1%); stage IIA: 14 (2.3%), stage IIB: 118 (19.6%), stage IIIA: 12 (2%), stage IIIB: 277 (46%), stage IVA: 20 (3.3%) and stage IVB: 52 (8.6%). Ninety of the 138 (65.22%) patients underwent a stage shift according to the FIGO 2018 because of the presence of enlarged lymph nodes at baseline scan. Sixteen (2.7%) patients had infiltrative nodal masses most commonly involving the blood vessels (n=14) followed by ureter (n=8), bones (n=5), muscle and bowel (n=3, each). The majority (14/16) of these patients presented with vague abdominal pain, discomfort and vomiting, while two had bone pain.Interpretation & conclusions:CECT at baseline helps in accurately assessing the stage in cervical carcinoma. It helps in the identification of lymph node metastasis in cervical carcinoma, which is crucial for guiding accurate management.

English

BACKGROUND There is a wide range of adnexal masses ranging from functional cyst to infection and even malignancy. Epithelial ovarian tumours are the most common benign ovarian lesion. The purpose of this study was to study the pattern of adnexal masses in rural area and plan the preventive steps according to the pattern. METHODS It was a retrospective study of patients who presented with adnexal masses in Bhagat Phool Singh Medical College (Women), Khanpur, Sonepat, Haryana, India over a period of 5.5 years from September 2012 to August 2018. The file records of the patients who underwent surgery for adnexal masse were evaluated to identify the risk factors, presenting complaints, examination findings, serological markers and radiological findings. The histopathological reports were reviewed. The cases excluded were ectopic pregnancies. Frequency distribution tables were used and data was analyzed using percentages. RESULTS Out of total 180 adnexal masses, 167 (92.77 %) cases were of ovarian origin. Out of these, 150 (83.33 %) cases were benign and 17 (9.44 %) were malignant. Among the benign lesions, serous cystadenoma was the most common lesion counting for 54 cases i.e., 30 %. In our study, most common symptom was vague abdominal pain- 63.88 %. Maximum adnexal masses were in the age group of 41 - 50 years i.e., 53 (29.44 %). Different types of surgeries were done. Maximum were bilateral oophorectomies with transabdominal hysterctomy 88 (48.88 %). CONCLUSIONS By proper education about personal and perineal hygiene, use of contraceptives, we can at least prevent some sexually transmitted diseases causing pelvic inflammatory disease (PID) and adnexal masses. KEYWORDS Adnexal Mass, Benign, Malignant, Serous Cystadenoma

Primary left ovarian hydatid cyst presenting as an abdominal mass - Case report.

IntroductionHydatid disease, which is most often caused by Echinococcus granulosus, can occur in virtually all parts of the body. The disease most frequently occurs in the liver followed by the lungs, muscles, and bones respectively. Primary ovarian hydatid cyst is a rare case.Case presentationA 28-year-old woman presented to the emergency department with vague abdominal discomfort of 8-month duration which was located to the left side of lower abdomen and pelvis associated with episodes of low-grade fever. Her past medical and surgical histories were unremarkable with no surgical operation. She had 3 vaginal deliveries and did not smoke.DiscussionHydatid disease is commonly caused by Echinococcus granulosus. The parasite can colonize virtually in every organ or in several organs at one time in the body. Pelvic hydatid cyst most often presents with vague abdominal pain. The diagnosis of the disease is not straightforward most of the time and requires investigations. The gold standard surgical treatment for ovarian hydatid cyst is cystectomy.ConclusionOvarian hydatid cyst should always be considered in the differential diagnosis of pelvic masses, especially in endemic areas. Surgical treatment in the form of radical cystectomy is the treatment of choice and it is necessary to take all precautions not to spill hydatid fluid and daughter cysts inside the abdomen. Anthelmintics adjuvant chemotherapy postoperatively may decrease the recurrence rate of the disease.

Tumoración intraabdominal secundaria a torsión anexial crónica

Mujer de 65 años que consulta por síndrome constitucional y vómitos de 3 meses de evolución. La TC identificó una masa inframesocólica de 25x19x14cm, sólida y heterogénea que desplazaba asas intestinales y vasos mesentéricos (Figura 1).La biopsia percutánea reveló una tumoración mesenquimal de bajo grado indicándose cirugía. Se evidenció una gran tumoración necro-hemorrágica dependiente del ovario izquierdo y la trompa uterina torsionada realizándose anexectomía (Figura 2). El estudio definitivo certificó una tumoración fusocelular con cambios secundarios a torsión tubárica.
 La torsión anexial es una emergencia ginecológica poco frecuente causada por la torsión del ovario o la trompa alrededor del ligamento infundibulopélvico.1 A menudo se presenta de forma aguda como dolor e irritación peritoneal precisando intervención quirúrgica urgente.2 Sin embargo de manera excepcional (1:1,5 mill.)3 su presentación clínica es silente (dolor abdominal vago, vómitos o masa palpable) diagnosticándose tardíamente en pruebas de imagen o estudios anatomopatológicos de piezas quirúrgicas.1

Solid pseudopapillary neoplasm of the pancreas: cytomorphology, pitfalls, and literature review

: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic neoplasm. Clinically it has non-specific presentations like vague abdominal pain. Imaging studies usually shows a mass at the body or tail of the pancreas. It could be a solid or cystic mass. Distant metastasis is uncommon. Generally, it is considered a tumor with uncertain malignant potential. Overall prognosis is well. Activating somatic mutation of β-catenin gene (CTNNB1) is seen in nearly all cases with SPN. Radical resection is the management of choice and if SPN is unresectable, radiotherapy is the next treatment option. This neoplasm has a unique cytomorphology, immunohistochemistry and prognostically outcome compared with other pancreatic cystic neoplasm. Papillary fronds with fibrovascular core on a cytology smear, combined with a cell-block prepared specimen material that stains with β-catenin is diagnostic for this tumor. The proper cytological evaluation and diagnosis could enable appropriate surgical approach and further management. Since this neoplasm has a good prognosis, it is crucial to diagnose this rare tumor cytologically from other pancreatic tumors by its characteristic cytological features and plan appropriately for the surgical management to improve patient care. In this paper, we comprehensively review SPN and focus on cytomorphologic features, the importance of EUS-guided FNA cytology for diagnosis and management.

Complicated acute appendicitis in a child with left atrial isomerism: a case report

BackgroundHeterotaxy syndrome is a rare clinical entity that is characterized by abnormal visceral organ arrangement in the chest and abdomen. Left atrial isomerism is a subcategory of heterotaxy syndrome characterized by the presence of multiple spleens with or without cardiac anomalies. Patients may remain asymptomatic their whole lives until they are diagnosed incidentally. Given that patients with left atrial isomerism might demonstrate atypical presentations of acute intrabdominal pathologies, it is important to keep a high index of suspicion when encountering such cases.Case presentationIn this report, we present a case of a 9-year-old boy with a known history of left atrial isomersim who presented with left lower quadrant pain and positive McBurney, psoas, and obturator signs on the left side. A computed tomography scan of the abdomen confirmed the diagnosis of perforated acute appendicitis on the left, which prompted an emergent laparoscopic appendectomy.ConclusionOur case highlights the importance of keeping a high index of suspicion for a heterotaxy syndrome that is complicated by acute appendicitis in pediatric patients presenting with vague abdominal pain. Planning the location of trocar placement in patients with situs anomalies is of paramount importance to avoid technical difficulties in laparoscopic procedures.

The first known case of vaccine‐induced thrombotic thrombocytopenia in Australia

The first known case of vaccine‐induced thrombotic thrombocytopenia in Australia

Hepatic portal vein gas detected by point of care ultrasound.

IntroductionPortal venous gas is a rare finding in adults and is typically associated with underlying intestinal ischemia. Portal venous gas can be detected by a bedside point of care ultrasound (POCUS) examination in adult patients in critical care units (CCU). Findings include echogenic bubbles flowing centrifugally throughout the portal venous system.Case presentationWe present the case of a 73-year-old female with advanced ischemic cardiomyopathy and cardiorenal syndrome who was managed in the CCU. She developed vague abdominal pain and respiratory depression requiring intubation and dialysis during her course of treatment in the CCU. Her findings were consistent with portal venous gas upon POCUS, prompting computed tomography of her abdomen and surgical consultation. She was ultimately found to have nonobstructive mesenteric ischemia.Clinical discussionPVG is an ominous radiological sign and reflects intestinal ischemia in up to 72% of cases. Acute mesenteric ischemia of the small bowel could be due to occlusive or nonocclusive obstruction of the arterial blood supply or obstruction of venous outflow. Nonocclusive obstruction accounts for 5% to 15% of patients with acute mesenteric ischemia.ConclusionWith the increasing use of POCUS, critical care physicians should be aware of findings consistent with portal venous gas as a bedside tool for directing the treating physician toward an ominous diagnosis in patients with shock.

A pediatric surgeon's dilemma: does cholecystectomy improve symptoms of biliary dyskinesia?

Biliary dyskinesia (BD) is a well-established gallbladder pathology in adult patients and rates of cholecystectomy for BD continue to rise in the United States. Many pediatric patients with vague abdominal pain of variable duration are evaluated for biliary dyskinesia. It remains unknown which cohort of pediatric patients diagnosed with BD are most likely to have sustained improvement in symptoms following laparoscopic cholecystectomy. We aimed to determine whether cholecystectomy resulted in symptom relief and led to a reduction in the number of medical visits related to gastrointestinal (GI) symptoms after surgery. We performed a multi-institution retrospective review of all children < 18 years of age who underwent laparoscopic cholecystectomy for BD between January 2013 and April 2018 in our hospital system. GI symptoms and clinical visits related to a GI complaint were assessed preoperatively. Patients were followed for 2 years after surgery. At 6 months and 2 years postoperatively, symptoms and the rate of medical visits related to a GI complaint were quantified and compared to the preoperative values. In total, 45 patients met our inclusion criteria. Of these, 82% of patients were female. The average age was 14 years old (± 2.6) and 56% of patients met the criteria for being overweight or obese. The mean gallbladder ejection fraction was 13% (± 10.8). All patients had abdominal pain, 82% (37/45) presented with nausea, and 51% (23/45) presented with post-prandial pain. Six months postoperatively, 58% of patients experienced resolution of their abdominal pain which decreased to 38% of patients after 2 years. Similarly, 59% had resolution of their nausea at 6 months compared to 43% at 2 years, and 100% had resolution of their post-prandial pain at 6 months compared to 91% at 2 years. The total number of clinical visits related to a GI complaint decreased from 2.6 (± 2.4) preoperatively to 1.0 (± 1.3) within 6 months postoperatively. When followed to 2 years postoperatively, the 6-month rate of clinical visits related to a GI complaint decreased from a mean of 2.6 preoperatively to 0.71 following surgery. Following cholecystectomy, we observed a high percentage of durable symptom resolution in those patients with BD who presented with post-prandial pain. Patients with non-food-related abdominal pain, with or without nausea and vomiting, had a lower rate of symptom resolution after surgery and the rate declined with time. For patients without post-prandial pain, evaluation and treatment of alternative sources of pain should be considered prior to surgery. Regardless of their presenting symptoms, patients who underwent surgery for BD had fewer clinical GI-related visits after surgery. However, no specific gallbladder ejection fraction or symptom alone was predictive of a lower rate of clinical visits postoperatively.

The giant resectable carcinoma of gall bladder\u2014a case report

BackgroundGall bladder cancer (GBC) is the fifth most common malignancy in the gastrointestinal system and the most common malignancy of the biliary system. GBC is a very aggressive malignancy having a 5 year survival rate of 19%. Giant Gall Bladder (GGB) is an uncommon condition that can result from cholelithiasis or chronic cholecystitis and rarely with malignancy.Case reportA 65 year old lady presented with vague abdominal pain for 12 years and right abdominal lump of size 20 × 8 cms was found on examination. CT scan showed a circumferentially irregularly thickened wall (2.5 cm) of gall bladder indicative of malignancy. Per-operatively a GB of size 24 × 9 cm was noted and patient underwent radical cholecystectomy. It was surprise to find such a giant malignant GB with preserved planes. Histopathology, it was well differentiated adenocarcinoma of gall bladder of Stage II (T2a N0 M0).DiscussionIt is known that mucocoele of GB can attain large size, however chronic cholecystitis will lead to a shrunken gall bladder rather than an enlarged one. A malignant GB of such size and resectable is rare without any lymph node involvement or liver infiltration. Few cases of giant benign gall bladder have been reported in literature, however this appears to be the largest resectable gall bladder carcinoma reported till date as per indexed literature.ConclusionGiant GB is an uncommon finding. They are mostly benign, however malignant cases can occur. Radiological findings may suggest features of malignancy and define extent of disease. Prognosis depends on stage of disease and resectability, irrespective of size.

English

A 22-year-old woman, single, came to Radiodiagnosis Department of North Bengal Medical College and Hospital for ultrasonography examination of whole abdomen for evaluation of amenorrhoea and vague cyclical lower abdominal pain. She had been treated outside the hospital for several years for above symptoms without any fruitful outcome. There was no history of any surgical management to this patient. Careful clinical examination of pelvis revealed an imperforate hymen. No other clinical signs were found except mild lower abdomen tenderness. Routine ultrasound was done with curvilinear probe with frequency of 5 MHz in GE LOGIQ P 9 model ultrasound sonography (USG) Machine. Cervical agenesis was suspected based on sonographic findings, non-visualization of the cervix with a uterus like structure (measuring approx. 30 x 36 x 30 mm.) in right adnexal region. Mild collection seen in pouch of Douglas. Both ovaries and bilateral adnexa were normal. Vagina showed no abnormal collection. Other abdominal organs like liver, gallbladder (GB), common bile duct (CBD), portal vein (PV), pancreas, spleen, both kidneys, and bladder appeared normal. Transvaginal examination as well as transvaginal sonography could not be performed as imperforate hymen. Therefore, the patient underwent magnetic resonance imaging (MRI) examination of whole abdomen which confirmed the ultrasonographic findings and the case diagnosed as congenital atresia of uterine cervix with imperforate hymen.