1/454. Intraluminal duodenal diverticulum in a child: incidental onset possibly associated with the ingestion of a foreign body.Funnel-type intraluminal duodenal diverticulum (windsock web) is a rare congenital malformation. A 4-year-old boy with vomiting and abdominal pain for several weeks was referred to the hospital. A plain abdominal X-ray on admission disclosed a double bubble sign. Abdominal echography and CT disclosed a foreign body lodged in the alimentary tract. After the foreign body was removed with a fibrescope, endoscopy showed a stenotic descending portion where the foreign body was located. An upper gastro-intestinal contrast study demonstrated a post-bulbar duodenal stenosis with a barium-filled pear-shaped sac in the descending portion of the duodenum. Surgical exploration was done under the diagnosis of windsock web of the duodenum. A simple excision of the web at its base was carried out. A hole 7 mm in diameter was found at the edge of the web. The microscopic appearance of the resected specimen was characterized by the duodenal mucosa with an extensive chronic inflammation lining both sides of the diverticulum and the lack of muscular layer of mucosa. CONCLUSION: If an ingested material is not excreted in the stool, possible clogging in the intestinal tract should always be considered and a further intensive examination is warranted.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/454. liver abscess secondary to fish bone penetration of the gastric wall: a case report.An unusual case of liver abscess caused by fish bone perforation of the stomach is presented in this report. A 65-year-old woman was admitted to the Far Eastern Memorial Hospital for abdominal pain, fever and chills. physical examination revealed anemia and tenderness in the epigastrium. Laboratory data showed leukocytosis and abnormal liver function. Computerized tomography of the abdomen disclosed a huge abscess in the left lobe of the liver. Exploratory laparotomy was performed and a fish bone, 3.7 cm in length, was found perforating the stomach with penetration into the left lobe of the liver, resulting in a hepatic abscess. drainage of the liver abscess with removal of the fish bone and simple closure of the gastric perforation were performed. The patient recovered uneventfully.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
3/454. Hepatic abscess due to gastric perforation by ingested fish bone demonstrated by computed tomography.Perforation of the gastrointestinal tract by ingested foreign bodies is rare. Preoperative diagnosis of complications due to foreign bodies in the gastrointestinal tract can rarely be achieved because the conventional radiographic appearance is nonspecific. This report describes a 69-year-old woman who presented with vague clinical manifestations, intermittent abdominal pain, and low-grade fever. Hepatic abscess, secondary to a foreign body penetrating the gastric wall, was diagnosed preoperatively using computed tomography findings. On exploration, the foreign body turned out to be a fish bone. The abscess was confirmed and drained during surgery and a partial gastrectomy was performed. This case illustrates the value of CT in the evaluation of this condition.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
4/454. Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.During the last 14 years, 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery.- - - - - - - - - - ranking = 5.3027251079781keywords = chest (Clic here for more details about this article) |
5/454. Extraction of a rubber bullet from a bronchus after 1 year: complete resolution of chronic pulmonary damage.inhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose. The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe. Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia. The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchoscopy can be avoided.- - - - - - - - - - ranking = 0.18363218749332keywords = area (Clic here for more details about this article) |
6/454. Surgical treatment of recurrent trigeminal neuralgia.In this retrospective investigation 7 patients operated on for recurrent trigeminal neuralgia via a suboccipital enlarged burr hole trepanation were evaluated. The intraoperative findings indicate that neo-compressive effects due to foreign material used during prior surgery are more important than adhesions around the nerve. Furthermore, the results of recurrent operations are encouraging as 6 of the 7 patients were painfree without additional neurological deficits.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/454. Retrieval of a broken needle in the pterygomandibular space.BACKGROUND: Dental needle breakage can be a devastating experience for both practitioners and patients. The authors describe the surgical management for localizing a broken dental needle in the pterygomandibular space and how to prevent needle breakage. CASE DESCRIPTION: The authors present the case of a 35-year-old man who had a chief complaint of pain and the ability to feel a broken needle during mandibular movements after receiving an inferior alveolar nerve block from his general dentist before dental treatment. Surgical management involved localizing the broken needle using radiographs and removing the broken needle under general anesthesia. CLINICAL IMPLICATIONS: Preventing needle breakage is important, as it can be a traumatic experience for the patient. Practitioners should establish the patient's cooperation by explaining to him or her what to expect before injection. Practitioners also should routinely inspect dental needles before administering injections and minimize the number of repeated injections using the same needle.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
8/454. An unusual presentation of a foreign body in the urinary bladder: A migrant intrauterine device.A 35-year-old woman, who had had an intrauterine device inserted 7 years earlier, presented with dysuria, pollakiuria, suprapubic pain and urethral irritation. The intrauterine device was found in the bladder with stone formation and was removed by endoscopy.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/454. A surgical gauze appearing as a retrocardiac mass in a patient after coronary artery bypass surgery.Five years after open chest surgery because of three vessel coronary artery disease a patient was referred for progressing dyspnea and recent onset of atrial fibrillation. A retrocardiac mass was detected on chest X-ray and echocardiography. On CT-scan, the inhomogenous tumor made the diagnosis of a retained surgical gauze likely. Through a left incision the sponge was removed uneventfully and the dyspnea resolved.- - - - - - - - - - ranking = 10.605450215956keywords = chest (Clic here for more details about this article) |
10/454. Thoracoscopic retrieval of foreign body after penetrating chest injury: report of two cases.Video-assisted thoracic surgery has proved to be valuable in many settings in thoracic surgery. The use of video-assisted thoracic surgery in trauma has recently rapidly increased. It is useful in acute or delayed management of patients with blunt and penetrating chest trauma. It is safe for removal of clotted hemothorax, treatment of thoracic empyema, treatment of persistent pneumothorax, treatment of chylothorax, and for diagnosis of diaphragmatic injury. We report two cases using thoracoscopy to remove intrathoracic metal fragments and avert the need for thoracotomy. In the first patient, a metal fragment injury was sustained via a penetrating wound from the supraclavicular notch to the right upper lung. The metal fragment was retrieved and the lung was repaired thoracoscopically using conventional suturing techniques. A second patient sustained a broken pin injury to the left upper mediastinum via a low neck wound. The pin was successfully removed under videothoracoscopy. Both patients recovered uneventfully and had shortened hospital stays. We feel that thoracoscopy offers a therapeutic as well as diagnostic benefit in stable patients with penetrating chest trauma.- - - - - - - - - - ranking = 31.816350647868keywords = chest (Clic here for more details about this article) |
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