Cases reported "Occupational Injuries"

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1/47. Pyogenic liver abscess as a cause of acute upper abdominal pain. A report of two cases.

    The clinical course of 2 patients with acute abdominal pain, which was eventually found to be due to pyogenic hepatic abscesses is described. One patient, operated on late in the course, died; the other, who was operated on early, recovered. The importance of considering this life-threatening disease in the differential diagnosis of acute abdominal pain is emphasized.
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2/47. Case report: portal vein thrombosis associated with hereditary protein c deficiency: a report of two cases.

    protein c deficiency is one of the causes of curable or preventable portal vein thrombosis. We report two patients of portal vein thrombosis associated with hereditary protein c deficiency. The first patient presented with continuous right upper quadrant pain and high fever. The abdominal sonography revealed normal liver parenchyma but portal vein and superior mesenteric vein thrombosis. Based on a 55% (normal 70-140%) plasma protein C level, he was diagnosed as having protein c deficiency. A trace of his family history showed that his elder brother also had protein c deficiency with a 50% plasma C level. Both patients received anticoagulant therapy. The younger brother showed good response. Unfortunately, the elder one suffered from recurrent episodes of variceal bleeding and received a life-saving splenectomy and devascularization. We herein remind clinicians that early screening and therapy are helpful in preventing late complications of protein c deficiency with portal vein thrombosis.
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3/47. intestinal obstruction caused by an ectopic fallopian tube in a child: case report and literature review.

    The authors present the case of a prepubertal 14-year-old girl who was admitted for an acute abdominal pain, fever, and vomiting. She was in a poor general state, having recently suffered a weight loss of 5 kg. A plain abdominal x-ray disclosed signs of mechanical ileus. An abdominal ultrasound scan showed a normal uterus, a normal right-sided ovary, but no left ovary. An emergency laparoscopy found a normal uterus with complete absence of the left ovary and salpinx, the upper left dome of the uterus being smooth with no visible horn. The right ovary and salpinx were normal. intestinal obstruction was caused by a strangulating cordlike structure of unclear origin. After converting to a laparotomy, we found an abnormal fallopian tube inserted in the left parieto-colic groove. The tube extended next on the lateral sigmoid mesentery and wrapped itself around the ileum, provoking a local strangulation and an ischemic covered bowel perforation. The bowel perforation was treated by a segmental bowel resection. Careful dissection of the cordlike structure disclosed a true rudimentary fallopian tube with hypotrophic fimbriae and a small distal round structure containing ovarian tissue. These structures were removed entirely. A review of the literature on this rare situation is presented and discussed.
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4/47. Eosinophilic gastroenteritis mimicking acute appendicitis.

    Eosinophilic gastroenteritis is a rare entity that can be treated successfully with glucocorticoid therapy if the appropriate diagnosis is made. However, it may present with symptomatology mimicking acute surgical conditions. We present the case of a 26-year-old man who presented with diffuse epigastric pain, nausea, vomiting, and diarrhea. Extensive workup including upper endoscopy and imaging study revealed gastritis with ulcer and ascites. The patient developed right lower quadrant pain with localized peritonitis and leukocytosis. He underwent appendectomy and small bowel biopsy. pathology revealed eosinophilic cellular infiltrate of both the appendiceal and small intestinal wall. The unique features of this condition are reviewed and surgical approaches are discussed.
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5/47. A rare cause of acute abdomen: splenic infarction.

    splenic infarction is a rare disorder. We have treated 4 patients during the last year. abdominal pain in the left upper quadrant was the common complaint. Other complaints were fever, nausea and vomiting. Computed tomography showed infarcted areas in the spleen in all of the patients. splenectomy was applied to three of the patients with recurring symptoms. The other patient had the first episode treated medically. pulmonary embolism in one and surgical wound infection occurred in another patient during postoperative follow-up for nine (range: 4-14) months.
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6/47. Giant ureteral stone in association with primary megaureter presenting as an acute abdomen.

    A 20-year-old woman presented with abdominal pain of 4-h duration and of sudden onset. A plain abdominal radiograph showed a giant ureteral stone measuring 12 cm causing ureteral obstruction. Abdominal ultrasound revealed severe dilatation of the two upper thirds of the left ureter and a hydronephrotic ipsilateral kidney. Subsequent renal scan demonstrated that it was a non-functional kidney while the contralateral kidney was normal. A left nephroureterectomy was performed.
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7/47. Isolated gangrene of the round and falciform liver ligaments: a rare cause of peritonitis: case report and review of the world literature.

    Isolated infection and/or gangrene of the round and falciform liver ligaments is among the rarest causes of acute abdomen. The diagnosis is based on demonstrating localized or patchy inflammatory or gangrenous changes in the ligaments without apparent etiology. We report the case of an 18-year-old male who presented with a 24-hour history of generalized abdominal pain and distention, nausea, and vomiting. With a preoperative diagnosis of probable perforated duodenal ulcus and generalized peritonitis the patient underwent emergency surgery. Multiple patchy gangrenous areas of the round and falciform ligaments were found starting from the umbilicus up to the hepatic hilum. The ligaments were resected in toto. The patient's postoperative course was unremarkable. No apparent etiology of the condition was found. We provide the first extensive review of the world literature. Isolated infection and/or gangrene of the round and falciform liver ligaments should be suspected in patients with upper abdominal complaints when imaging studies demonstrate ligament abnormality, tumor, or fluid. Treatment is only surgical. Depending on surgeon's expertise, patient's condition, and severity and extent of disease either open or laparoscopic surgery may be performed.
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8/47. Acute abdomen due to torsion of a pelvic wandering spleen.

    wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. wandering spleen can migrate to the lower abdomen or pelvis, and can be either congenital or acquired. It is most commonly found in women of reproductive age, and may be misdiagnosed as an abdominal or adnexal mass. It is usually asymptomatic, but may present with acute, chronic, or intermittent abdominal pain. Here, we report a case of torsion of a huge congenital pelvic wandering spleen and microscopic isolated pancreatic tissue (disconnected from the pancreas) with impending splenic rupture in a 23-year-old female patient. Progressively severe chronic or intermittent torsion of the vascular pedicle of the wandering spleen caused progressive intermittent lower abdominal pain. The patient underwent splenectomy with resection of the long pedicle and the postoperative course was uneventful. The pathognomonic computerized tomography features of this case, including absence of the spleen in the left upper quadrant and the presence of a whirl-like structure running down to the central portion of the distally located large soft-tissue mass and with a notched- (hilar-) like contour, are also described.
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9/47. Perisplenitis as a cause of acute abdomen: a case report.

    Splenitis can complicate blood-borne sepsis in hemodialysis patients. Symptoms include left upper quadrant pain and tenderness in addition to generalized systemic manifestation of infection. Clinical diagnosis is difficult and there is no specific investigation to confirm it. Computed tomography scan of the spleen can help in identifying a splenic abscess, rupture, or infarction. A splenectomy is the treatment of choice in splenic abscess, in splenitis to avoid spontaneous rupture, and in recurrent perisplenitis.
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10/47. Acute abdomen due to wandering spleen infarction: a case report.

    We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.
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