1/4. Laparoscopic closure of mesenteric defects after Roux-en-Y gastric bypass.Two case reports are presented of incarcerated small-bowel internal hernias through mesenteric defects following Roux-en-Y gastric bypass surgery (one case each of open and laparoscopic). Both patients first presented to physicians unfamiliar with bariatric surgery complaining of vague, cramping midabdominal pain, and the correct diagnosis was not revealed until laparoscopic surgery was performed. Treatment then resulted in quick recoveries. This type of hernia can evade radiologic testing. Prompt clinical recognition and treatment is necessary to prevent small-bowel infarction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Peritoneal schistosomiasis: an unusual laparoscopic finding.Laparoscopic surgery is now a common procedure for the cure of appendicitis. Unexpected other laparoscopic findings can be a diagnostic challenge. The authors present a case in which, in addition to typical appendicitis, multiple whitish nodules were found diffusely on the peritoneal surfaces suggesting a differential diagnosis including miliary tuberculosis and carcinoma metastases. The final diagnosis of schistosomiasis, made by histology and serology, had not been suspected. This uncommon and rare presentation deserves to be reported, especially to physicians of nonendemic areas, in an era in which people travel extensively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Spontaneous abdominal hematoma in a patient treated with clopidogrel therapy: a case report.Clopidogrel is a new antiplatelet agent. To date, no case of a spontaneous abdominal hematoma during clopidogrel therapy has been reported. We report a case of a 70-year-old woman who developed a spontaneous abdominal hematoma following clopidogrel treatment. The patient has been suffering from a progressive swelling in the abdominal wall for 1-2 weeks and noticed a purple discoloration of the skin over the swelled abdominal region the week before hospitalization. There was a palpable mass in the right upper quadrant of the abdomen and ecchymoses surrounding the umbilicus. At abdominal ultrasonography, the mass was found to be consistent with the hematoma. The hematoma was drained under local anesthesia. The patient was discharged with no complication. She was advised to submit herself to regular physical examinations. Although adverse reactions are generally rare, we suggest that physicians prescribing clopidogrel should be aware of the possibility of this adverse reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. 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) |