11/99. Gray-scale and color Doppler sonographic diagnosis of epiploic appendagitis.Depending on its location, epiploic appendagitis may mimic nearly any acute abdominal condition. We present the case of a patient with left lower quadrant pain. Sonography demonstrated an ovoid, hyperechoic, noncompressible lesion at the point of tenderness but no inflammatory changes in the adjacent colonic wall. color Doppler sonography showed no flow in the lesion. Based on the sonographic diagnosis of epiploic appendagitis, conservative treatment was given, with complete recovery in 5 days. awareness of these sonographic findings may aid in the early diagnosis of epiploic appendagitis and avoid unnecessary treatment.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
12/99. Cornelia de lange syndrome associated with cecal volvulus: report of a case.Cornelia de lange syndrome is known to be occasionally associated with gastrointestinal malformation. However, the occurrence of cecal volvulus in such anomalies is very rare. We report a 15-y-old Japanese boy with Cornelia de Lange syndrome associated with a cecal volvulus secondary to non-fixation of the cecum and ascending colon. The patient was admitted to our hospital because of abdominal pain and bilious vomiting. At emergent laparotomy, cecal volvulus with non-fixation of the ascending colon and cecum was diagnosed. Release of the cecal volvulus and the fixation of the cecum and ascending colon to the right retroperitonium were performed. The postoperative course was uneventful, except for sepsis caused by aspiration pneumonia soon after the operation. Conclusion: Clinicians treating patients with this syndrome should be aware that such patients may be at risk for developing severe gastrointestinal anomalies, including cecal volvulus.- - - - - - - - - - ranking = 16.074696500995keywords = abdominal pain, pain (Clic here for more details about this article) |
13/99. US and CT diagnosis of complete cecocolic intussusception caused by an appendiceal mucocele.Appendiceal mucoceles are found in only 0.2-0.3% of all appendectomy materials. Colocolic intussusception of the appendix is also very uncommon. We report the very rare association of these two entities in a 40-year-old patient presenting with intermittent right abdominal pain accompanied by a palpable mass in the right flank. The full diagnosis was made preoperatively by ultrasound and confirmed by helical CT by means of unequivocal signs of intussusception associated with a very suggestive "cup-and-ball" aspect of the mucocele induced by a global mucinous cystadenoma of the appendix. A brief review of the available literature on mucocele is given.- - - - - - - - - - ranking = 16.074696500995keywords = abdominal pain, pain (Clic here for more details about this article) |
14/99. Appendiceal diverticulitis in a youth.Appendiceal diverticulitis as the etiology of right lower quadrant pain is an uncommon entity in younger populations. The incidence is <1 per cent among patients under 30 years of age undergoing appendectomy. Herein, we present a case of a 17-year-old male with perforated appendiceal diverticulitis. The history, physical findings, diagnosis, and treatment are outlined. Additionally the literature concerning appendiceal diverticulitis is reviewed.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
15/99. Cecal herniation through the foramen of Winslow after laparoscopic Nissen fundoplication.Laparoscopic Nissen fundoplication is the treatment of choice for medically refractive gastroesophageal reflux disease. Cecal herniation is an exceedingly rare complication of this procedure. We report the case of a 51-year-old woman who presented 2 months after a successful laparoscopic Nissen fundoplication with heartburn and epigastric pain that radiated to her back. Abdominal films showed an air-filled loop in the left upper quadrant. At surgery, the patient had a redundant loop of cecum, which had herniated through the foramen of Winslow over the stomach and was positioned beneath the left hemidiaphragm. The cecum was not ischemic. A right hemicolectomy was performed to prevent recurrence. The patient recovered fully and has had no further problems. This is the first report of such a case.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
16/99. Cecal diverticulitis: a case report and review of the current literature.We report a case of a female patient with a picture of "atypical appendicitis," with 3 days of abdominal pain, localized to the right lower quadrant with no nausea, vomiting, diarrhea, or anorexia. On examination she was febrile to 38.4 degrees C, had tenderness at McBurney's point, and a leukocyte count of 11,200. A computerized axial tomography (CAT) scan was obtained showing changes consistent with appendicitis. On laparoscopic exploration the patient was found to have cecal masses. Definitive surgical treatment was deferred until after adequate evaluation of the colon. Postoperative colonoscopy demonstrated cecal diverticulitis. Management of cecal diverticulitis found during laparotomy for presumed appendicitis has included right hemicolectomy, ileocolic resection or appendectomy, and conservative treatment with antibiotics. The laparoscopic approach in a patient with an equivocal history and physical examination allows for definitive workup of inflammatory cecal masses found during surgery for appendicitis.- - - - - - - - - - ranking = 16.074696500995keywords = abdominal pain, pain (Clic here for more details about this article) |
17/99. Retroperitoneal perforation of the appendix presenting as right thigh abscess.A case of retroperitoneal perforation of the appendix presenting with a thigh abscess is described. The patient presented with pyrexia (38 degrees C) and abdominal and right thigh pain. There was tenderness in the right loin. His white blood cell count was 22 x 10(9)/L. An intravenous urogram revealed tapering of the right ureter at the L2/L3 level and suggested an infected obstructive uropathy. The patient failed to respond to drainage and antibiotics, so we performed a computed tomography scan, which showed a retroperitoneal abscess extending to the gluteal region and thigh, with signs of small bowel obstruction. This precipitated surgery. The route of extension of infection was through the sacrosciatic notch, which is considered to be a rare way of spread. The patient made a slow but eventual recovery. The overall mortality of this condition is high, but early recognition of an abdominal source of sepsis with appropriate treatment can improve survival.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
18/99. Acute appendicitis after laparoscopic treatment of acute epiploic appendagitis.Epiploic appendagitis (EA) is a rare cause of right lower quadrant (RLQ) abdominal pain. We report an unusual case of acute gangrenous appendicitis that developed after laparoscopic treatment of an EA. A 62-year-old man underwent laparoscopy for RLQ abdominal pain. EA was found and a resection was performed. The appendix, which was macroscopically normal, was left undisturbed. One week later, the patient was operated on for acute gangrenous appendicitis. Histologic examination separately confirmed both diagnoses. The definitive outcome was uneventful. The exact origin of this unusual case is unknown: Could acute appendicitis have been secondary to laparoscopic manipulation or initially missed? We conclude that acute appendicitis may be either missed or induced by laparoscopy for RLQ abdominal pain.- - - - - - - - - - ranking = 48.224089502984keywords = abdominal pain, pain (Clic here for more details about this article) |
19/99. Mobile cecal syndrome in the adult.The mobile cecal syndrome is primarily a disease of children. However, it may be present as a precursor of frank cecal volvulus in approximately 50 per cent of the cases. Symptoms are intermittent colicky right lower quadrant pain with tenderness over McBurney's point and hyperactive high-pitched bowel sounds during the attack. After the attack, the patient is asymptomatic. Three cases of young women with mobile cecal syndrome are presented to illustrate the clinical course and surgical therapy. The mobile cecal syndrome should be considered in the differential diagnosis of right lower quadrant pain from obscure causes.- - - - - - - - - - ranking = 2keywords = pain (Clic here for more details about this article) |
20/99. adult intussusception due to lymphangioma of the colon.We present herein a case report of adult intussusception due to lymphangioma of the colon. On May 27, 2000, a 39-year-old woman with right lower abdominal pain was admitted to our hospital. Preoperative imaging studies, by ultrasonography, computed tomography (CT), and barium enema examination, showed right colon intussusception with a multilocular cystic tumor as a leading point. Emergency operation was performed. During the operation, normograde ileocecal intussusception with a 9 x 6-cm soft submucosal tumor of the cecum was recognized. Ileocecal resection was performed, and the patient's postoperative course was uneventful. Pathological diagnosis of the resected specimen was a cystic type lymphangioma of the cecum. Recently, lymphangioma of the colon has been diagnosed more frequently by colonoscopy and endoscopic ultrasonography. However, only a few cases of colon intussusception due to lymphangioma have been reported in the literature to date. Large lymphangioma of the colon is rare, but it should be taken into consideration that it is one of the organic lesions that causes adult intussusception.- - - - - - - - - - ranking = 16.074696500995keywords = abdominal pain, pain (Clic here for more details about this article) |
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