Torsion of para-ovarian cyst: a cause of acute abdomen.
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Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of fallopian tube has also been reported in literature. However, torsion of para ovarian cyst is a very rare. We report a rare case of twisted para ovarian cyst resulting in secondary torsion of the fallopian tube. Torsion of fallopian tube and para ovarian cyst are usually seen in the reproductive age group. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain. (+info)
Diagnostic abdominal aspiration.
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Aspiration of the abdominal cavity to withdraw fluid that collects in almost all cases of intra-abdominal disease that necessitates operation is a relatively easy and safe procedure that can help in deciding for or against operation in borderline cases. Diagnostic aid is given by observing the color, odor and cell content of the fluid. Inability to obtain fluid, although in general reassuring, cannot be trusted absolutely, for there may be severe disease without aspirable exudate. Sometimes the intestine may be punctured by the aspirating needle, which contaminates the aspirate but apparently does not bring about leakage of bowel content. (+info)
Acute appendicitis mimicking infectious enteritis: diagnostic value of sonography.
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OBJECTIVE: To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS: One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS: Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS: Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever. (+info)
Laparoscopic diagnosis and treatment in gynecologic emergencies.
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OBJECTIVE: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. METHODS: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. RESULTS: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. CONCLUSION: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies. (+info)
Strongyloidiasis associated with amebiasis and giardiaisis in an immunocompetent boy presented with acute abdomen.
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Strongyloides stercoralis (SS) is an intestinal nematode that is mainly endemic in tropical and subtropical regions and sporadic in temperate zones. SS infection frequently occurs in people who have hematologic malignancies, HIV infection and in individuals undergoing immunosuppressive therapy. In this study, we report a 12- year-old immunocompetent boy who was admitted to our hospital with acute abdomen. Laboratory evaluation showed strongyloidiasis, amebiasis and giardiasis. Clinical and laboratory findings immediately improved with albendazole therapy. Therefore, when diarrhea with signs of acute abdomen is observed, stool examinations should be done for enteroparasitosis. This approach will prevent misdiagnosis as acute abdomen. Complete clinical improvement is possible by medical therapy without surgical intervention. (+info)
A case of a ruptured pheochromocytoma with an intratumoral aneurysm managed by coil embolization.
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Although the spontaneous rupture of adrenal pheochromocytoma is rare, it can be lethal because it can induce serious changes in the circulation. We describe a 32 year old man with bilateral pheochromocyroma presenting as abdominal pain. In the emergency room, an abdominal MRI showed an aneurysmal vessel in the right adrenal mass and accompanying hemorrhage around the tumor capsule. The bleeding site was found by transfemoral abdominal angiography. Coil embolization was done in the bleeding vessels, specifically branches of the right adrenal artery. The hemorrhage was successfully controlled and vital signs of the patient were restored. Following emergency care, biochemical and imaging studies showed compatible findings of a bilateral adrenal pheochromocytoma. Postoperative histologic findings confirmed these observations. A ruptured pheochromocytoma should be considered as a cause of acute abdomen in cases of a concomitant adrenal mass. Intratumoral aneurysmal bleeding may be a cause of ruptured tumor, and careful angiographic intervention will help to ensure safe control of bleeding in such an emergency situation, even in cases of bilateral tumor. (+info)
Are we overusing ultrasound in non-traumatic acute abdominal pain?
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BACKGROUND: Ultrasound is being used increasingly in the assessment of acute non-traumatic abdominal pain as it is non-invasive and does not carry the risk of radiation. However, the inappropriate use of ultrasound can lead to a delayed or incorrect diagnosis, more work for the personnel involved, and increased hospital costs. METHODS: A prospective study was conducted to analyse the clinical indications for requesting an ultrasound in those admitted to a district general hospital with acute non-traumatic abdominal pain, and to assess whether there is a correlation between clinical and laboratory findings and ultrasound results. A total of 110 patients were studied during a three month period. RESULTS: The results suggest that ultrasound is useful in the investigation of suspected biliary colic and abdominal masses. However, the yield of ultrasound in other patients with acute non-traumatic abdominal pain is low. This study also suggests that the yield of "positive" reports on ultrasound is significantly higher in patients with localised abdominal pain and tenderness and in those with acute abdominal pain and a raised white cell count or raised liver function tests. The yield of positive reports in patients with acute abdominal pain was found to be lower those less than 25 years of age than in older patients. (+info)
Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction.
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Small bowel volvulus is an uncommon but important cause of small intestinal obstruction. It often results in ischemia or even infarction. Delay in diagnosis and surgical intervention increases morbidity and mortality rates. Based on cause, small bowel volvulus can be divided into primary and secondary type. Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention. The presentation and subsequent management of 35 patients with small bowel volvulus confirmed by laparotomy are reviewed and discussed. The incidence of small bowel volvulus in the adult European and North American is low. The resultant mortality rate, however, makes diagnosis critically important. The cardinal presenting symptom is abdominal pain. There is no single specific diagnostic clinical sign or abnormality in laboratory or radiologic finding. In practice, the diagnosis can only be made by laparotomy. The failure to perform an exploratory laparotomy cannot be justified. Early diagnosis and early surgery are the keys for successful management of strangulation obstruction of the small bowel. (+info)