11/256. Fishbone perforation through a Meckel's diverticulum: a rare laparoscopic diagnosis in acute abdominal pain.The use of diagnostic laparoscopy in acute abdominal pain, especially when patients have been admitted for acute pain in the lower abdominal quadrants, improves the accuracy of diagnosis and leads to improvements in treatment procedures. A case is reported of a 24-year-old woman admitted under suspicion of appendicitis. The appendix was found to be normal, and a perforation caused by a fishbone was discovered in a Meckel's diverticulum. The diverticulum was resected by a combined laparoscopic and open procedure. Diagnostic laparoscopy should be performed routinely in cases of acute abdominal pain in the lower quadrants of suspected appendiceal origin to avoid overlooking other causes of the symptoms.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
12/256. Jejunal perforation caused by abdominal angiostrongyliasis.The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment.- - - - - - - - - - ranking = 0.33021586289558keywords = abdominal pain, pain (Clic here for more details about this article) |
13/256. Bowel perforation during chemotherapy for non-hodgkin's lymphoma.Bowel perforation in patients with primary malignant lymphoma usually occurs at the site of tumor. A 78 year-old man underwent chemotherapy for malignant lymphoma. He presented with abdominal pain. An emergency operation was performed under a diagnosis of panperitonitis. At laparotomy, an anal-side perforation approximately 20 cm from the Treiz ligament was observed. drainage and partial resection of the jejunum was performed. Histopathologic examination demonstrated that there was no characteristic finding of malignant lymphoma around the perforation site in the case. Perforation of the small intestine is one of the most critical complications during the chemotherapy for malignant lymphoma. In cases of chemotherapy for malignant lymphoma, especially systemic administration, we should keep in mind the possibility of perforation of the small intestine. Fortunately, emergency surgery saved the patient presented in this report. Early diagnosis and treatment are important to improve prognosis of bowel perforation in patients with primary malignant lymphoma.- - - - - - - - - - ranking = 0.16510793144779keywords = abdominal pain, pain (Clic here for more details about this article) |
14/256. Mechanic intestinal obstruction--a possible presentation of perforated appendicitis.A 61-year-old man presented with diffuse abdominal pain, diarrhea, vomiting and fever. On the initial diagnosis of gastroenteritis the patient received the antibiotic ofloxacine for one week. On admission plain abdominal radiograph suggested a mechanic intestinal obstruction. In computed tomography a conglomerate tumor in the ileocecal region was seen and the patient underwent laparotomy. The conglomerate tumor was mobilized and an abscess opened, which was caused by a perforated appendicitis. After the operation the patient improved immediately and had an uneventful postoperative course. He was released and did not suffer from gastrointestinal symptoms the following 16 months of follow-up. The present case shall set forth that perforated appendicitis can clinically present as intestinal obstruction. Although a rare complication, perforated appendicitis should therefore even be considered in cases of mechanic intestinal obstruction of unknown cause.- - - - - - - - - - ranking = 0.16510793144779keywords = abdominal pain, pain (Clic here for more details about this article) |
15/256. Perforation of jejunal diverticulum: case report and review of literature.We report the case of a 90-year-old woman, previously diagnosed with jejunal and colonic diverticula, who presented with left lower quadrant abdominal pain suggesting either colonic diverticulitis or ischemic colitis. A computed tomography scan revealed a perforated jejunal diverticulum with abscess formation. The patient promptly was treated surgically without complications. A review of the literature indicates the rarity of perforation of jejunal diverticula and the difficulty of early diagnosis. We discuss the etiology, pathogenesis, diagnosis, and management of this rare entity. It is important for primary care physicians to be familiar with this disease. Delay in work-up often results in catastrophic consequences.- - - - - - - - - - ranking = 0.16510793144779keywords = abdominal pain, pain (Clic here for more details about this article) |
16/256. abdominal pain secondary to stump appendicitis in a child.We report a case of an 11-year-old male who presented with abdominal pain and vomiting. The patient had a notable past medical history of having had an appendectomy at our institution 1 year previously. Because of progressive clinical signs of peritonitis, an exploratory laparotomy was performed and the patient was found to have stump appendicitis. The entity of stump appendicitis is always possible when evaluating patients with abdominal pain who have a history of appendectomy.- - - - - - - - - - ranking = 0.36762550814866keywords = abdominal pain, pain (Clic here for more details about this article) |
17/256. Small bowel perforation caused by a sharp bone: laparoscopic diagnosis and treatment.Small bowel perforation caused by sharp or pointed foreign bodies rarely is diagnosed preoperatively because clinical symptoms usually are nonspecific and can mimic other surgical conditions such as appendicitis and cecal diverticulitis. We report the case of a 57-year-old man who underwent diagnostic laparoscopy for abdominal pain of unknown etiology. Swelling and erythema were noted in a segment of small bowel in the right lower abdomen. A tiny sharp-pointed object was found penetrating the inflamed portion of the bowel. This foreign body was removed and the perforation immediately repaired under laparoscopic guidance. The postoperative course was uneventful. We believe that in cases of lower abdominal pain with peritoneal irritation, laparoscopy can provide not only a wide field of examination to localize intraabdominal pathology, but in some instances it can aid in case management.- - - - - - - - - - ranking = 0.33021586289558keywords = abdominal pain, pain (Clic here for more details about this article) |
18/256. Malignant peritoneal mesothelioma with mimicry of pseudomyxoma peritonei in a patient with a history of perforated sigmadiverticulitis.We describe a 57-year-old man who presented with diffuse abdominal pain, abdominal enlargement, vomitus, dyspnea and a weight loss of 30 kg within 6 months. These acute symptoms were preceded by an episode of ascites and an acute sigmadiverticulitis 7 months ago. ultrasonography and computed tomography were suggestive of pseudomyxoma peritonei. However, malignant mesothelioma peritonei was diagnosed by open surgery with biopsy for histological examination. Despite R-2-resection of the tumor and following open hyperthermic intraperitoneal chemotherapy with initial remarkable recovery the patient died 5 months after therapeutical intervention. Malignant peritoneal mesothelioma is an extremely rare tumor with great diagnostic and therapeutic difficulties. We report a case including diagnostical work up and the medical surgical therapy of this disease.- - - - - - - - - - ranking = 0.16510793144779keywords = abdominal pain, pain (Clic here for more details about this article) |
19/256. Peripheral primitive neuroectodermal tumor of the small bowel mesentery: a case showing perforation at onset.A case of peripheral primitive neuroectodermal tumor of the small bowel mesentery with an uncommon clinical onset is reported. A 40-year-old man was admitted to hospital because of acute severe abdominal pain. Chest X-ray revealed a free air sign beneath the diaphragm. At emergency surgery a mass measuring 11.0 x 8.0 cm with perforation was located in the jejunal mesenteric region. Histologically the resected lesion consisted of sheets of undifferentiated small round cells forming abortive Homer Wright rosettes. Some spindle-shaped cells showed perivascular pseudorosettes. Immunohistochemical study revealed that the tumor cells expressed positivity against CD99 (MIC2), neuron-specific enolase, synaptophysin and vimentin. To the authors' knowledge this is the first documentation of peripheral primitive neuroectodermal tumor of the small bowel mesentery with perforation at onset.- - - - - - - - - - ranking = 0.16510793144779keywords = abdominal pain, pain (Clic here for more details about this article) |
20/256. Ileal perforation caused by cytomegalovirus infection in a critically ill adult.cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract is common and is most often seen in patients with acquired immunodeficiency syndrome (AIDS), inflammatory bowel disease, or those receiving immunosuppressive therapy. CMV infection of the small bowel accounts for only 4.3% of all CMV infections of the GI tract. Isolated cases of small bowel perforation due to CMV have been reported in AIDS patients, and all but one patient has died. This article reports the first case of an ileal perforation due to transfusion-associated CMV infection in a critically-injured non-AIDS patient. Immediate surgical resection and antiviral therapy led to complete recovery. The development of abdominal pain, fever, watery diarrhea, and GI bleeding in a critically ill patient should prompt the clinician to consider the diagnosis of CMV enteritis. If standard stool pathogens and clostridium difficile toxin studies are nondiagnostic, endoscopic evaluation and CMV serology should be obtained. If CMV infection is confirmed, ganciclovir therapy should be initiated without delay. If bowel perforation occurs. prompt surgical resection is indicated. A heightened level of suspicion for CMV infection in multiply injured trauma victims and other critically ill patients, with earlier recognition of potential small bowel involvement, can hopefully decrease the incidence of bowel perforation, which is usually a fatal event.- - - - - - - - - - ranking = 0.16510793144779keywords = abdominal pain, pain (Clic here for more details about this article) |
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