1/14. Tuberculous enteritis: a case report.Tuberculous enteritis is an unusual diagnosis in the united states. Because this entity is rare and the symptoms are not specific, the physician must have a high index of suspicion. We report the case of a young man with tuberculous involvement of the gastrointestinal tract who required surgical intervention for small bowel obstruction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. Laparoscopic resection of Meckel's diverticulum: report of two cases.Symptoms of Meckel's diverticulum (MD) are present in only 4% of all cases and are often aspecific. The diagnostic modalities for the distal ileum are also often ineffective. We report herein two cases of MD's complications, intestinal obstruction and diverticulitis, which were managed laparoscopically. In both cases laparoscopy allowed the physician not only to make an accurate diagnosis but, at the same time, to perform a tangential resection of the MD.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Acquired C1-esterase inhibitor deficiency: a rare cause of episodic acute abdominal pain and ascites.C1-esterase inhibitor deficiency is a rare yet classic medical cause of acute abdominal pain mimicking a surgical emergency. A hereditary form and a very rare acquired form of the disease exist, and both give rise to a similar clinical syndrome despite a different pathogenic mechanism. We describe a typical case of acquired C1-esterase inhibitor deficiency in a 65-year-old woman presenting with recurrent acute abdomen and ascites who had undergone two negative surgical interventions before diagnosis was eventually established. Both the diagnostic and therapeutic approach to this rare condition should be known by emergency physicians for two reasons: (1) it may present as an acute abdominal emergency resulting in unnecessary surgical intervention; and (2) it may cause life-threatening upper airway obstruction as a result of laryngeal oedema.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Obstructive colitis proximal to partially obstructive colonic carcinoma: a case report and review of the literature.BACKGROUND: Obstructive colitis refers to ulceroinflammatory lesions that occur in the colon proximal to an obstructing lesion. As this condition is not widely appreciated by pathologists or clinicians, we describe herein a case of colonic polyposis and sigmoid colonic carcinoma with obstructive colitis. PATIENT PRESENTATION: A 47-year-old Taiwanese woman presented to Cardinal Tien Hospital with a 3-day history of acute onset of abdominal pain, vomiting, and watery diarrhea. A lower gastrointestinal series using water-soluble contrast medium revealed annular narrowing of the sigmoid colon and showed polyposis at the rectosigmoid colon and regional colitis over the proximal descending colon. She was treated by total colectomy. Microscopic sections showed poorly differentiated adenocarcinoma, tubular adenomas, and a segment of obstructive colitis measuring 25 cm in length 5 cm proximal to the colon tumor. The tumor was also retrieved for simultaneous analyses of replication error and loss of heterozygosity. A total of three instances of loss of heterozygosity were demonstrated at the P53, MET, and D8S254 gene loci. No examples of replication error were detected. CONCLUSION: Obstructive colitis can cause diagnostic and therapeutic problems. colitis areas may be a source for septicemia or may perforate and lead to peritonitis. The frequently normal appearance at surgery may lead to involved segments of colon being used for anastomoses with consequent complications. awareness of the features and incidence of obstructive colitis should help physicians avoid these diagnostic and therapeutic problems.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. failure to thrive in a ten-year-old girl.A 10-year-old girl was followed over an 18-month period for vague gastrointestinal complaints, failure to thrive, and anemia. She was evaluated by several primary care physicians and consultants who failed to diagnose her problem or alleviate her symptoms. The treatment of an acute illness, a consequence of her presenting problem, resulted in the diagnosis of an unusual entity with important psychological and somatic features.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. diabetes mellitus and autonomic dysfunction after vacor rodenticide ingestion.A case of N-3 pyridylmethyl-N' 4 nitrophenyl urea (Vacor) rodenticide poisoning in a 52-year-old man is presented. Vacor is structurally related to alloxan and streptozotocin, agents that have been used extensively to produce diabetes mellitus in laboratory animals. Seven days after ingestion of Vacor, the patient presented in diabetic ketoacidosis complicated by postural hypotension and adynamic ileus. The patient recovered from ketoacidosis but has continued to require insulin. With infusion of arginine, glucagon rose from 185 to 650 pg./ml. and c-peptide from 0.5 to 3.4 ng./ml. Six weeks after onset of diabetes, no anti-islet-cell antibodies were detected. Muscle capillary basement membrane thickness on electron microscopy was found to be 1,918 /- 194 A. The absence of hyperglycemia after Vacor ingestion should not lead to complacency on the part of the attending physician. The patient must be observed closely for development of ketoacidosis and treated prophylactically with nicotinamide, the suggested antidote.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Traumatic diaphragmatic hernia and intestinal obstruction due to penetrating trunk wounds.We have reported two cases of intestinal obstruction due to traumatic diaphragmatic hernia, both resulting from apparently trivial knife wounds. When TDH is due to a penetrating injury, it tends to produce symptoms of intestinal obstruction. A high index of suspicion, a chest x-ray film, and barium studies of the gastrointestinal tract are usually needed to make the diagnosis, though CT scans, ultrasonography, laparoscopy, and radionuclide scanning may also be useful. Surgeons and emergency physicians should be aware of the potential for TDH when there is a history of a penetrating wound of the chest or abdomen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/14. 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 = 2keywords = physician (Clic here for more details about this article) |
9/14. Indiscretion enteritis. A Rabelaisian syndrome.A 76-year-old man had small bowel obstruction and organic small bowel disease following a series of bizarre massive gustatory insults that involved food, medications, and mega-mineral-vitamin supplements. intestinal obstruction required partial small bowel resection. The dietary indiscretions resulted in severe enteritis (indiscretion enteritis). The sequence has been termed a Rabelaisian syndrome after the great French writer and physician, Francois Rabelais, who vividly described bizarre gustatory habits. Gut injury may result from unwise oral intake of various foods and mineral supplements.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Inadvertent inflation of the balloon: a rare but serious complication of Miller-Abbott intubation.Inadvertent injection of contrast medium or tube feedings into the wrong port of a Miller-Abbott tube can be catastrophic. Four cases are reported, three of which required emergency surgery and two resulted in small-bowel infarction. This complication can easily be avoided if the attending physician and radiologist are aware of the entity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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