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11/67. Primary epiploic appendagitis: an etiology of acute abdominal pain.

    Primary epiploic appendagitis has a nonspecific clinical presentation but pathognomonic appearance on computerized tomography. We report a patient who was promptly diagnosed and treated with conservative management, and review the literature. This entity has not been well described in the general medical literature. Epiploic appendagitis should be considered in the differential diagnosis of atypical presentations of acute abdominal pain. Integration of a patient's history and physical exam with laboratory and computerized tomography findings allows a timely and confident diagnosis. Surgery is not necessary, but close follow-up is required.
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12/67. Perforation of acute calculous Meckel's diverticulitis: a rare cause of acute abdomen in elderly.

    Complications of the Meckel's diverticula are well-known and defined. However, acute inflammation and perforation secondary to a calculus is a rare clinical presentation. A case of acute calculous Meckel's diverticulitis with perforation in a 58-year old man is presented and possible pathological conditions are discussed. Location of the perforation, apical microscopic focal ulcers, and ischaemic changes in the diverticulum remind the pathogenesis comparable to that of acute calculous cholecystitis. This case report with major complications related to Meckel's diverticulum strengthens the concept of prophylactic resection of Meckel's diverticulum in adults, incidentally discovered at laparotomy.
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13/67. 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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14/67. Lupus abdominal crisis owing to rupture of an ileocolic aneurysm with successful angiographic treatment.

    There are many causes of acute abdominal pain, or abdominal "crises," in patients with systemic lupus erythematosus (SLE), most frequently the causes are serositis or vasculitis. vasculitis generally causes small vessel abnormalities and may present with symptoms owing to mucosal damage, such as pain, diarrhea, or bleeding. We present a patient with SLE who had the acute onset of severe abdominal pain while hospitalized for a lupus flare and who was found to have a ruptured ileocolic aneurysm with intraperitoneal bleeding. She was successfully managed with angiographic embolization, without further complications. Although angiography is well established as a therapeutic intervention for mesenteric aneurysms of various etiologies, this is the first case of an SLE-related ileocolic aneurysm so managed. This entity should be considered in the differential diagnosis of abdominal pain in patients with lupus, and angiographic embolization should be considered in its management.
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15/67. Progressive bouts of acute abdomen: pet the peritoneum.

    The recent discovery of the mutated gene responsible for familial mediterranean fever (FMF) is supposed to facilitate its diagnosis which up till now is a clinical one because there are no specific laboratory tests. The sensitivity of genetic testing is limited because these tests search only for known mutations. In this case report we describe a patient with periodic abdominal pain in whom the diagnosis of FMF was wrongly discarded because of lack of a durable effect of colchicine and negative genetic testing. Diffuse peritoneal inflammation was nicely demonstrated by a FDG-PET (fluoro-deoxy-glucose positron-emission tomography) performed during a typical crisis. We discuss the possible diagnostic pitfalls and conclude that a crisis-PET might upgrade the level of diagnostic certainty in equivocal cases.
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16/67. Ruptured degenerated uterine fibroid diagnosed by imaging.

    BACKGROUND: We report a ruptured uterine leiomyoma presenting as an acute abdomen. We document computed tomography and magnetic resonance imaging features of a ruptured uterine fibroid. CASE: A woman with a large anterior wall uterine fibroid underwent a dilation and curettage for a threatened abortion. She had an uneventful recovery. Three weeks later, she presented with peritonitis. Computed tomography and magnetic resonance imaging optimally depicted the ruptured fibroid and excluded other causes of acute abdomen. Exploratory laparotomy and myomectomy confirmed the diagnosis. CONCLUSION: This is a report of a ruptured degenerated fibroid causing acute abdomen outside of pregnancy. Computed tomography and magnetic resonance imaging aided in correctly establishing the diagnosis and optimizing the management of this patient.
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17/67. Laparoscopic diagnosis and treatment of idiopathic segmental infarction of the greater omentum. Case report.

    acute pain at the right side of the abdomen rarely is caused by idiopathic segmental infarction of the greater omentum (ISIGO). In most cases the patient is presumed to suffer from appendicitis or cholecystitis. Although some radiologic signs might suggest ISIGO, this rare clinical entity mostly is diagnosed perioperatively and confirmed by postoperative pathologic findings. In the reported case, a patient is described with acute right-side abdominal pain of unknown origin, in whom ISIGO was encountered during diagnostic laparoscopy and successfully resected. Because of this minimally invasive approach, the patient was discharged the day after surgery and returned to work after 5 days. The pathogenesis, symptoms, and treatment methods are discussed.
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18/67. 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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19/67. diaphragm disease of the small bowel--a case report and literature review.

    A 75-year-old man who had an emergency laparotomy for small bowel obstruction was found at operation to have multiple mid-ileal strictures. histology of the resected specimen confirmed diaphragm disease of the bowel. The pathogenesis of this disease remains unclear but it is associated with long-term use of NSAID. diagnosis is often difficult as many clinicians are unaware of this condition. The relevant literature has been reviewed.
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20/67. 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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