1/18. Ruptured metastatic ovarian carcinoma presenting as acute abdomen.Acute abdomen is a challenge to first-line physicians because of frequently missed diagnoses and potential follow-on legal problems. Improving the management of these patients is of paramount importance, not only for saving lives, but also for reducing untoward problems associated with improper management. We present a case of a patient with acute abdomen due to intraperitoneal hemorrhage secondary to rupture of an ovarian tumor. Following emergency surgery, the patient was diagnosed with metastatic ovarian carcinoma. Because of improper preparation of the gastrointestinal tract, the patient underwent repeat exploratory laparotomy for colon carcinoma. Although this situation did not affect the outcome of the patient in this case, we are concerned that the patient did not benefit from a single operation, with primary complete excision of the tumor plus a colostomy. The outcome of patients with pelvic malignancy, especially those with ovarian carcinoma, might be better if initial surgery achieved optimal tumor debulking. This is possible with good preoperative planning and preparation. We emphasize the importance of preoperative preparation in spite of urgently needed care. Furthermore, every first-line physician should communicate the possibility of malignancy to patients and their families.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Acute torsion and necrosis of the greater omentum herniated into a foramen of Morgagni.Computed tomography is mandatory in the investigation of the acute abdomen and can provide the physician with crucial information to decide whether the patient should be treated surgically or conservatively. An unusual cause of acute abdomen is presented. Computed tomography suggested the diagnosis of omental torsion and necrosis. At surgery, the greater omentum and part of the transverse colon were incarcerated in a small diaphragmatic hernia of the Morgagni type.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/18. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit.Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/18. Changes in splenoportal axis calibre and flow in a patient affected by hereditary angioedema.The authors describe a case of hereditary angioedema characterised by abdominal pain accompanied by ascites. Ultrasound (US) examination performed after acute abdominal attack implied the presence of increased splenoportal axis calibre and reduced blood flow. According to the authors, this may confirm the pathogenic role of C1-inhibitor deficiency induced oedema that is capable of creating major haemodynamic involvement also of abdominal vessels. US findings of transient appearance, especially related to the specific treatment, may help physicians make early diagnosis and avoid dangerous invasive procedures resulting from incorrect diagnosis of acute abdomen.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/18. Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review.Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/18. ascariasis mimicking an acute abdomen.infection with the roundworm ascaris lumbricoides is common in children and may mimic an acute abdomen. The cases of two pediatric patients who presented to the emergency department with signs and symptoms of a surgical abdomen are presented to highlight the presentation of this infection. Both cases were diagnosed by physical examination and radiographs and were treated successfully without surgical intervention. These cases illustrate the need for heightened awareness by the emergency physician of ascariasis in the differential diagnosis of acute abdomen.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/18. Abdominal catastrophes.The patient in our case report presented with an acute abdomen but stable vital signs and ABCs. The differential diagnosis initially included most of the entities discussed in this chapter. The ECG ruled out an acute MI. The patient improved with IV hydration and oxygen administration. Abdominal x-ray films ruled out a bowel obstruction, and chest x-ray films ruled out a pulmonic process. Laboratory tests revealed hemoconcentration and leukocytosis. No other laboratory test results were abnormal. While waiting for the surgeon to arrive, the patient remains stable, so the ED physician orders a CT scan of the abdomen. Taking another look at the plain x-ray films, the emergency physician in our case presentation sees a suggestion of free air under the right hemidiaphragm above the liver on the CXR and between the liver and the right abdominal wall on the decubitus ABD x-ray. The CT scan confirms the presence of free air within the peritoneal cavity, and the patient is taken to surgery for an exploratory laparotomy. The final diagnosis is perforated peptic ulcer. With hindsight, the patient and wife recall a previous diagnosis of a possible ulcer in the past.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/18. Acute abdominal pain caused by spontaneous perforation of the urinary bladder.patients with acute spontaneous bladder perforation have the symptoms and signs of an acute condition of the abdomen which, as a surgical emergency, requires prompt operative treatment. Bladder perforation should be suspected as the cause of this abdominal catastrophe if the history and findings indicate a urinary tract disorder. If the surgeon knows preoperatively that the bladder is perforated, he is able to plan and perform the appropriate surgical procedure with greater dispatch and certainty. The correct preoperative diagnosis should be made more frequently if the primary care physician develops a greater awareness of the possibility of spontaneous bladder perforation as the cause of an acute condition of the abdomen. With earlier diagnosis and earlier surgical treatment, the present reported mortality of 25 per cent for those patients with this condition is likely to be reduced.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/18. Unruptured amoebic liver abscess presenting as acute abdomen.Unruptured amoebic liver abscess is usually not regarded as a surgical emergency. At University College Hospital, Ibadan, in a two-year period from June 1975 to May 1977, six cases of unruptured amoebic liver abscess underwent emergency exploratory laparotomy because they presented as cases of acute abdomen. The initial diagnoses made by senior physicians included perforated duodenal ulcer, intestinal obstruction, cholecystitis and appendicitis. All patients had persistent draining sinuses after surgery for periods ranging from one to five months. Neither the trophozoites nor the cystic forms of entamoeba histolytica were present in the "abscess" which was essentially necrotic liver tissue. The diagnosis of amoebic liver abscess was based on clinical features: typical "anchovy" or chocolate-coloured aspirate from the liver, response to anti-amoebic therapy and serological studies.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/18. Eustrongylidiasis--a parasitic infection acquired by eating live minnows.The objective of this study was to heighten physician awareness of eustrongylidiasis by investigating the epidemiology of this parasitic infection. The nematode Eustrongylides ignotus was recovered surgically from our patient, in whom eustrongylidiasis simulated acute appendicitis. The patient had consumed two live minnows obtained from Big Timber Creek of Belmawr, NJ. The authors determined the E ignotus infestation rate of free-living minnows at this creek. With this data, they approximate the probability of human infection with E ignotus after eating live minnows and attempt to evaluate the hypothesis that eating live minnows may lead to eustrongylidiasis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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