1/8. Acute abdominal pain and urgency to defecate in the young and the old: a useful symptom-complex?In the belief that "pattern recognition" is an important first step of the diagnostic process, we report our observation of an uncommon and heretofore poorly documented symptom-complex in 10 patients, and suggest that the constellation of abdominal pain and urgency to defecate in the acutely ill surgical patient should raise the diagnostic possibility of intra-abdominal bleeding. In our experience, this is statistically likely to be associated with a ruptured abdominal aortic aneurysm in the old and a ruptured ectopic pregnancy in the young.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/8. Abdominal pregnancy in a 67-year-old woman undetected for 37 years. A case report.BACKGROUND: Abdominal pregnancy is an exceedingly rare occurrence, but even more unusual is prolonged retention of an advanced abdominal pregnancy with lithopedion formation. We present the case of prolonged retention of an advanced abdominal pregnancy in an elderly women. CASE: A 67-year-old, white woman presented to the emergency department with abdominal pain. An acute abdominal series revealed a fetal skeleton extending from the patient's pelvis to her lower costal margins. Pelvic examination revealed a normal postmenopausal uterus, and human chorionic gonadotropin was negative. On further questioning the patient reported that she had become pregnant 37 years earlier and was diagnosed as having a "missed" pregnancy. She refused intervention at that time but suffered no untoward consequences. She reported having had later a healthy intrauterine pregnancy, delivered vaginally at term. No attempt was made to remove the prior missed abdominal pregnancy. The acute pain episode resolved, and there was no surgical intervention. CONCLUSION: Abdominal pregnancies can have a complex course, and management decisions can be difficult. This case presents an unusual outcome of an advanced abdominal pregnancy and illustrates a unique approach to management.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
3/8. Ruptured tuboovarian abscess causing peritonitis in a postmenopausal woman. A difficult diagnosis on imaging.pelvic inflammatory disease with tuboovarian abscess is rare in postmenopausal women. Clinical and sonographic findings are usually sufficient to recognize pelvic inflammatory disease in premenopausal women, but in the elderly the disease may easily be overlooked, largely by unexpectedness. Computed tomography can be helpful when the clinical and sonographic findings are complex or equivocal. However, when the level of suspicion is low, it can be very difficult to interpret, especially when complicated with peritonitis, as illustrated in the present case report.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
4/8. Malrotation with midgut volvulus: CT findings of bowel infarction.Midgut volvulus, the most common serious complication of malrotation, can be diagnosed using conventional contrast fluoroscopy, US or CT. CT is a quick and comprehensive examination in the evaluation of complex acute abdominal pathology in children. Contrast-enhanced CT can readily help the radiologist recognize perfusion abnormalities of the bowel, which is vital for reducing morbidity and mortality in affected children. Our case emphasizes and demonstrates additional CT features of bowel infarction in a child with a proven malrotation with midgut volvulus.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
5/8. Superficial femoral artery transposition repair for isolated superior mesenteric artery dissection.Isolated dissection of the superior mesenteric artery is an uncommon event, but many new cases have been reported recently, reflecting the progress of imaging and suggesting that this pathology is not as rare as previously thought. Here we report a case of superior mesenteric artery dissection where we performed, after failure of conservative medical management, an original surgical technique for mesenteric revascularization using a superficial femoral artery transposition. To the best of our knowledge, this is the first report of the use of this technique for complex mesenteric revascularization.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
6/8. Intestinal invasion and disseminated disease associated with penicillium chrysogenum.BACKGROUND: Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts. CASE PRESENTATION: A 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for penicillium chrysogenum and the patient completed a 6 week course of amphotericin b lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection. DISCUSSION: penicillium chrysogenum is a rare cause of infection in immunocompetent patients. diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin b. The clinical utility of newer antifungal agents remains to be determined.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
7/8. The laparoscopic approach of a torsion of a benign mature ovarian teratoma: a case report and review of the literature.Benign mature teratomas account for approximately 10-15% of all ovarian neoplasms. Many patients with these dermoid cysts are asymptomatic. The most frequent complication is torsion of the teratoma (in 3,5% of the cases). In a 26-year female patient admitted for severe, acute abdominal pain, a computerized abdominal tomography in accordance with the clinical characteristics of the abdominal examination, was highly suggestive for a torsion of a teratoma. The diagnose was confirmed by a celioscopic operative approach and the teratoma with the left tubo-ovarian complex was successfully removed laparoscopically.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
8/8. Acute abdominal pain secondary to a urachal cyst abscess.Primary care physicians often see patients with complaints of acute abdominal pain. The differential diagnosis for the acute abdomen is complex and requires not only precise clinical skills but also a high index of suspicion for a specific disease state. Uncommon disorders must be considered when the signs and symptoms observed are unusual or the pathologic entity suspected is not found on diagnostic workup or during surgery. A urachal cyst abscess, although rare, may have the signs and symptoms of an acute abdomen.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |