Remarks on the Surgery of the Right Upper Abdominal Quadrant

We report the case of a 48-year-old man with spina bifida and history of previous ventriculoperitoneal (VP) shunt placement for hydrocephalus. On attempted removal of the shunt 2 years prior to presentation at a neurosurgical unit, the peritoneal component was left in situ due to difficulties with removal. He presented acutely to our general surgical department with an enterocutaneous fistula precipitated by the retained fragment discharging to the right upper abdominal quadrant that required urgent surgical intervention. Although abdominal complications of VP shunts are documented, there is minimal literature as to the risks of remnant catheters being left in situ. This case demonstrates the possible risks with retained VP shunt catheters and the necessity to remove any redundant foreign bodies to prevent significant delayed complications.

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Primary squamous cell carcinoma of the liver: a case report

Journal of International Medical Research ◽

10.1177/03000605211021275 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110212

Author(s):

Yu Sun ◽

Guangyu Jin

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Imaging Features ◽

Primary Squamous Cell Carcinoma ◽

History Of ◽

Loss Of Appetite ◽

Upper Abdominal ◽

The Right ◽

Abdominal Quadrant

Primary squamous cell carcinoma of the liver is extremely rare, very difficult to diagnose, and carries an extremely poor prognosis. In this study, we discuss the imaging features of a patient with primary hepatic squamous cell carcinoma. The patient was admitted to hospital owing to discomfort in the right upper abdominal quadrant and a loss of appetite. He had no previous risk factors associated with hepatic squamous cell carcinoma and no history of systemic squamous cell carcinoma. We diagnosed primary hepatic squamous cell carcinoma by pathological analysis. Primary hepatic squamous cell carcinoma is rare, and its histological features are controversial, which makes the clinical and imaging diagnosis difficult. Therefore, it is urgent to improve the understanding of this disease in clinical practice to avoid misdiagnosis, and to identify the best treatment. This case provides a basis for the clinical diagnosis of primary hepatic squamous cell carcinoma.

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Clinical patterns and causes of post-cholecystectomy syndrome

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20212826 ◽

2021 ◽

Author(s):

Muhammed Ihsan Muhammad ◽

Abdullah Hasem Alhassan ◽

Abdulmohsen Yaseer Alkhars ◽

Rayan Abdulkhaliq Alzahrani ◽

Mohammed Hamad Al Mansour ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Gastrointestinal Symptoms ◽

Physiological Changes ◽

Postcholecystectomy Syndrome ◽

The Common ◽

Clinical Patterns ◽

Irritable Bowel ◽

Upper Abdominal ◽

The Right ◽

Abdominal Quadrant

Post-cholecystectomy syndrome is suspected when the patients complain about the persistent presence of pain in the right upper abdominal quadrant. Other symptoms might appear which are related to the gastrointestinal tract. These symptoms appear after performing cholecystectomy. The manifestations are usually similar to those experienced before the procedure. In this study, the aim to conduct a literature review to increase the knowledge and to explore facts related to the clinical patterns and causes of post-cholecystectomy syndrome. The most commonly reported cause of this syndrome is the prior development of an extra-biliary disorder, which includes many modalities as peptic ulcer, reflux esophagitis, chronic pancreatitis, irritable bowel syndrome, and biliary-related disorders. However, the etiology of postcholecystectomy is hugely variable across the different studies in the literature. Patients that develop postcholecystectomy syndrome usually present with non-specific gastrointestinal symptoms that may or may not be similar to the symptoms that were exhibited before conducting the surgery. Some of the common physiological changes that have been reported with postcholecystectomy syndrome include the disruption of cholecysto-antral reflex, the cholecystosphincter of oddi reflex, and the cholecysto-esophageal related reflexes. In addition, the development of other changes that can significantly affect the normal physiology of the gastrointestinal tract leads to the development of significant symptoms and clinical patterns.

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A Bullet Injury to the Liver Complicated by Biliary Broncho Pleural Fistula and IVC Thrombosis: Case Presentation and Review for Management Guidelines

Surgical Case Reports ◽

10.31487/j.scr.2020.07.07 ◽

2020 ◽

pp. 1-4

Author(s):

Arwa El Rifai ◽

M. Zorkot ◽

S. Emsieh ◽

G. Abi Saad

Keyword(s):

Hepatic Duct ◽

Left Hepatic Duct ◽

Case Presentation ◽

Management Guidelines ◽

Upper Abdominal ◽

The Right ◽

Abdominal Quadrant ◽

Chest Tube Drain ◽

Bullet Injury

This is a case report of a 20-year-old male who presented to our hospital after sustaining a gunshot to the left upper abdominal quadrant with an exit right below the right scapula. On investigation, he was found to have a large right sided hemothorax and an extensive laceration in the liver. A right chest tube drain was inserted, initially drained blood and days later started draining bile. Consequently, the patient started coughing up bile and diagnosis of a biliary-broncho-pleural fistula was made. ERCP with sphincterotomy and stenting of a left hepatic duct injury was subsequently performed. The patient also developed an IVC thrombus that was discovered incidentally on follow up imaging and was treated with anticoagulation

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Acute abdomen in pregnancy: a retrospective study of pregnant patients hospitalised for abdominal pain

Perspectives in Surgery ◽

10.33699/pis.2020.99.3.131-135 ◽

2020 ◽

Vol 99 (3) ◽

pp. 131-135

Keyword(s):

Abdominal Pain ◽

Clinical Signs ◽

University Hospital ◽

Diagnostic Process ◽

Abdominal Emergency ◽

Lower Abdominal Quadrant ◽

Abdominal Emergencies ◽

The Right ◽

Abdominal Quadrant ◽

In Pregnancy

Introduction: Abdominal emergencies occur in pregnant women with the rate of 1:500−635 pregnancies. Such conditions usually develop from full health and worsen rapidly. Symptoms are often similar to those in physiological pregnancy (abdominal pain, vomiting, constipation). The diagnostic process is thus difficult and both the mother and her child are at risk. Our aim was to evaluate the frequency of abdominal emergencies in the Department of Surgery, University Hospital in Pilsen and to consider their impact on pregnancy and on the newborn. Methods: We acquired a set of patients by retrograde collection of data. We searched for pregnant patients suspected of developing an abdominal emergency admitted to the Department of Surgery, Faculty of Medicine, Pilsen between 2004 and 2015. We evaluated a number of clinical signs to statistically describe the set. Results: The set included 121 patients; 42 of the patients underwent a surgical procedure and 79 received conservative treatment. 38 patients underwent appendectomy; 6 appendixes were with no pathologies. McBurney’s incision was an approach of choice in most cases. The most frequent symptom was pain in the right lower abdominal quadrant. The foetus has been lost in none of the cases. Conclusion: Acute appendicitis was the most frequent abdominal emergency in our set and also the most frequent reason for surgical intervention. The most specific sign was pain in the right lower abdominal quadrant. No impact of appendicitis or appendectomy on the health of the newborn has been observed. Even though abdominal emergencies in pregnancy are relatively rare, the results of the department are very good.

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A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent

Surgical Case Reports ◽

10.1186/s40792-020-00994-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroki Hirao ◽

HiroHisa Okabe ◽

Daisuke Ogawa ◽

Daisuke Kuroda ◽

Katsunobu Taki ◽

...

Keyword(s):

Cystic Duct ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Case Presentation ◽

Endoscopic Nasobiliary Drainage ◽

Subtotal Cholecystectomy ◽

Upper Abdominal ◽

The Right ◽

Nasobiliary Drainage

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

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Primitive Neuroectodermal Tumor of the Liver: A Case Report

Case Reports in Medicine ◽

10.1155/2011/748194 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Eduardo Cambruzzi ◽

Enilde Eloena Guerra ◽

Hamilton Cardoso Hilgert ◽

Herbert Jorge Schmitz ◽

Vinícius Lopes Silva ◽

...

Keyword(s):

Primitive Neuroectodermal Tumor ◽

Soft Tissues ◽

Young Patients ◽

Neuroectodermal Tumor ◽

Solid Mass ◽

Resected Liver ◽

The Central Nervous System ◽

Right Lobe ◽

Upper Abdominal ◽

The Right

Primary liver sarcomas represent a rare group of neoplasias, with angiosarcoma being the most common histological type. Primitive neuroectodermal tumor (PNET) represents a high malignant neoplasia that usually affects the central nervous system and soft tissues. An 18-year-old male patient was admitted with clinical complains of pain in the right upper abdominal quadrant. The clinical evaluation revealed a solid mass in the right hepatic lobe. On the gross examination of the resected liver specimen, the right lobe of the liver was replaced by a yellow-red solid mass measuring 21 cm in its largest dimension. On the histopathology, a tumor composed of small round blue cells with little cytoplasm and round nuclei was identified. The lesion revealed positive immunoexpression for vimentin and CD99 and negative immunostaining for desmin, CD45, cytokeratin, and neuroblastoma protein, suggesting, then, the diagnosis of PNET. Although it is an unusual tumor, it should be considered in the differential diagnosis of liver masses, especially in young patients.

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Perforated Meckel’s Diverticulitis in a Patient with Unknown Intestinal Malrotation: Clinical Pitfall

Case Reports in Surgery ◽

10.1155/2021/5595803 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Marie Burgard ◽

Floryn Cherbanyk ◽

François Pugin ◽

Bernhard Egger

Keyword(s):

Acute Appendicitis ◽

Clinical Presentation ◽

Final Diagnosis ◽

Intestinal Malrotation ◽

Radiological Imaging ◽

Atypical Clinical Presentation ◽

Lower Abdominal Quadrant ◽

Meckel’S Diverticulitis ◽

The Right ◽

Abdominal Quadrant

Symptomatic Meckel’s diverticulum is rare in adults. The most frequent complications are intestinal obstruction and diverticulitis. Diagnosis of Meckel’s diverticulitis can be challenging due to nonspecific clinical manifestation of pain in the right lower abdominal quadrant, mimicking acute appendicitis. If associated with congenital malformation, such as intestinal malrotation, the anomalous anatomy makes the diagnosis even more challenging. In such cases, radiological imaging is essential to guide further management. We present a case of Meckel’s diverticulitis in which physicians were initially misguided because of the atypical clinical presentation. Yet, anamnestic details directed to a potential underlying malformation, leading to supplementary radiological examination and the final diagnosis.

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Cyriax syndrome in a young male professional soccer player: A case report

South African Journal of Sports Medicine ◽

10.17159/2078-516x/2020/v32i1a8300 ◽

2020 ◽

Vol 32 (1) ◽

pp. 1-2

Author(s):

Chrislain Tsobgny Panka ◽

Patrick Yvan Tchebegna

Keyword(s):

Soccer Player ◽

Costal Cartilage ◽

Young Male ◽

Therapeutic Modality ◽

Professional Soccer ◽

Chest X Ray ◽

Intercostal Nerves ◽

Upper Abdominal ◽

The Right ◽

Male Soccer Player

Cyriax syndrome is a neglected cause of lower chest or upper abdominal pain. The pain is due to an irritation of the intercostal nerves by the incomplete dislocation of the costal cartilage of the ribs. This study presents a rare case of a young male soccer player with cyriax syndrome and offers medical insight into the clinical diagnosis and one therapeutic modality of this condition. He came to the sports clinic reporting severe pain in the right lower rib cage near the costal cartilage junction which he has experienced for about three weeks. A chest x-ray detected nothing. After the failure of initial conservative measures, persistence of the pain led authors to initiate two separate local infiltrations using 1% lidocaine ten days apart. This resulted in a gradual decrease in pain. Cyriax syndrome is an unrecognised pathology, thus it is important for team physicians to consider this diagnosis when assessing athletes with persistent chest pain.

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Biliary pain in the structure of episodes of right upper abdominal pain

Voprosy detskoj dietologii ◽

10.20953/1727-5784-2020-6-42-52 ◽

2020 ◽

Vol 18 (6) ◽

pp. 42-52

Author(s):

Yu.O. Shulpekova ◽

◽

V.M. Nechaev ◽

V.T. Ivashkin ◽

◽

...

Keyword(s):

Abdominal Pain ◽

Acute Cholecystitis ◽

Heart Diseases ◽

Biliary Colic ◽

Recurrent Pain ◽

Biliary Pain ◽

Abdominal Ultrasonography ◽

Locomotor System ◽

Upper Abdominal ◽

The Right

Acute or recurrent pain in the right upper part of the abdomen is a common cause for visits to physicians. Not less than two thirds of episodes of pain in this area are conditioned by biliary colic and acute cholecystitis. Other most common causes include diseases of the liver, pancreas, prepyloric and pyloric parts of the stomach and the beginning portion of the small intestine, the right kidney, and also subhepatic appendicitis. Some cases of developing pain are associated with the right lung affection and involvement of the diaphragmatic pleura, with heart diseases, involvement of the locomotor system and nerves. Taking into account a high prevalence of cholelithiasis in Russia – around 10–12% – we can conclude that episodes of biliary colic develop every year in 1 of 500–1000 individuals. In Russia, approximately half a million cholecystectomies are performed annually. The prevalence of gall stones among the paediatric population amounts to 2%. As distinct from adults, who in 80% of cases have an asymptomatic course of disease, pain episodes in children manifest themselves in 60–67% of cases. The diiagnosis of acute cholecystitis might meet with considerable difficulties; a scale for assessment of the likelihood of acute cholecystitis has been developed. Unlike in adults, in children a significantly large proportion of cases occur due to acalculous cholecystitis. Differentiating the causes of pain might be difficult, therefore, its character and concomitant symptoms should be thoroughly analysed, and the findings of additional examinations should also be taken into consideration (at the first step – assessment of haematological and biochemical parameters, urinalysis, electrocardiogram and abdominal ultrasonography). Key words: right upper abdominal pain, biliary colic, biliary dyskinesia, cholelithiasis

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