scholarly journals 78 A Lockdown Dilemma; Ingestion of Magnetic Beads Presenting as Right Iliac Fossa Pain and Sub-Acute Small Bowel Obstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Oyewole ◽  
A Sandhya ◽  
I Maheswaran ◽  
T Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Radiology Department ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Acute Small Bowel Obstruction ◽  
Operative Findings

Abstract A 13-year-old girl presented with a three-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She represented six days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment as recommended by the radiology department. Intra-operative findings revealed 200mls of serous fluid in the pelvis, normal-looking appendix, dilated stomach, and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetized the laparoscopic instruments. A mini-laparotomy was performed with the extraction of fourteen magnetic beads and the repair of nine enterotomies. Foreign body ingestion is a known cause of abdominal pain, which in some cases might mimic or even be the cause of acute appendicitis. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

2020 ◽  
Vol 13 (11) ◽  
pp. e236429
Author(s):  
Bankole Oyewole ◽  
Anu Sandhya ◽  
Ian Maheswaran ◽  
Timothy Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Serous Fluid ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Multiple Episodes ◽  
Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals Unusual Presentation of Meckel’s Diverticulum: Gangrene due to Axial Torsion

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ahmet Rencuzogullari ◽  
Kubilay Dalci ◽  
Orcun Yalav
Keyword(s):  
Congenital Anomaly ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Preoperative Diagnosis ◽  
Iliac Fossa ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Life Threatening ◽  
Operative Findings ◽  
The Right

Meckel’s diverticulum is the most common congenital anomaly of the small bowel. The majority of cases are asymptomatic; however, life-threatening complications can also take place. We present a case of a 37-year-old male who was admitted with symptoms of acute, severe abdominal pain in the right iliac fossa. The patient was operated on with the preoperative diagnosis of acute appendicitis but the operative findings were consistent with torted Meckel’s diverticulum due to presence of mesodiverticular band and he was treated successfully with surgical resection.

scholarly journals 637 Enterolith Ileus Secondary to Small Bowel Diverticulum: A Rare Cause of Small Bowel Obstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Elmasry ◽  
A Dey ◽  
R Marshall
Keyword(s):  
Small Bowel ◽  
Iliac Fossa ◽  
Gallstone Ileus ◽  
Emergency Laparotomy ◽  
Duodenojejunal Flexure ◽  
Radiological Images ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Small Intestinal ◽  
Abnormal Peristalsis

Abstract Small intestinal diverticula are rare and possibly acquired secondary to bowel dyskinesia, abnormal peristalsis, or high intraluminal pressures. Enterolith formation and obstruction are a less encountered complication of these diverticula. An elderly man, with no history of abdominal surgery, presented with 10 days of colicky right iliac fossa pain and recurrent episodes of bilious vomiting. He initially reported diarrhoea but complained of eventual absolute constipation for last 5 days. Physical examination revealed distended abdomen with right-sided tenderness and no mass or faeces on rectal examination. Abdominal CT revealed a 3.5 cm calculus in the distal ileum causing obstruction initially flagged as gallstone ileus. No gallstones or pneumobilia were identified although some intrahepatic duct dilatation was noted. An emergency laparotomy was conducted, where the radiological findings were reinforced, and the calculus was extracted via enterotomy. There were no abnormal communications between gallbladder and intestinal tract. The small bowel traced from duodenojejunal flexure to terminal ileum did not reveal any further calculi or diverticula. FTIR spectrum analysis of the extracted specimen indicated similarities to enterolith. Retrospective analysis of radiological images revealed a possible duodenal diverticulum. The case highlights the diagnostic conundrum and therapeutic challenges of small bowel diverticular enterolith.

scholarly journals Combination of ectopic pancreas and intestinal malrotation presenting as non-specific right iliac fossa pain in a SARS-CoV-2 positive patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241926
Author(s):  
Woochan Hwang ◽  
Kristof Nemeth ◽  
Annabelle White ◽  
Luca Bonomo
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Infection Risk ◽  
Pancreatic Tissue ◽  
Inflammatory Mass ◽  
Typical History ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Ectopic Pancreatic Tissue ◽  
Mini Laparotomy

We describe the case of a 31-year-old man who presented with a 3-day history of right iliac fossa pain with associated nausea and vomiting. He denied any previous incidents of abdominal pain and had no relevant medical history or family history to note. Given the typical history, examination findings of localised peritonism and infection risk, he was taken to theatre for laparoscopic appendicectomy without diagnostic imaging. Intraoperatively, we noted gut malrotation and an inflammatory jejunal mass which was resected after converting to a mini-laparotomy. The inflammatory mass was reported to be an ectopic pancreatic tissue from histology. Given that this patient had tested positive for SARS-CoV-2 on admission, we propose a possible case of SARS-CoV-2 infection triggering inflammation of the ectopic pancreatic tissue.

scholarly journals Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain

2020 ◽  
Vol 13 (2) ◽  
pp. e232549
Author(s):  
Adam James Crellin ◽  
Omar Musbahi ◽  
Natasha Onwu ◽  
Sandeep Singh
Keyword(s):  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Crohn's Disease ◽  
Iliac Fossa ◽  
Right Hemicolectomy ◽  
Emergency Unit ◽  
Good Recovery ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right

A 30-year-old man with a history of severe right iliac fossa pain was referred to the surgical emergency unit. His symptoms began 3 days prior as mild, non-specific abdominal pain which progressively localised to the right iliac fossa and worsened in severity. Investigations were suggestive of acute appendicitis, and therefore a laparoscopic appendicectomy was planned. Laparoscopy revealed a thickened, necrotic appendix with a mass at the base of the appendix, in keeping with the appearance of an appendiceal malignancy. Subsequently a right hemicolectomy was performed. Histology revealed active chronic inflammation and granulomas highly suggestive of appendiceal Crohn’s disease. Since, the patient has made a good recovery and presently shows no further signs of Crohn’s disease. This case is demonstrative of one of many rare findings on histological examination of the appendix. It emphasises the need for a wide differential when investigating right iliac fossa pain.

scholarly journals Right iliac fossa pain from a grossly enlarged and torted appendix in a patient with known colitis

2016 ◽  
Vol 98 (7) ◽  
pp. e136-e137
Author(s):  
A Seager ◽  
M Gill ◽  
LS Jones
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Iliac Fossa ◽  
Midline Laparotomy ◽  
Surgical Emergency ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right

A 27-year-old man with a background of well controlled colitis presented with a 12-hour history of central abdominal pain, nausea, vomiting and fever. A diagnostic laparoscopy revealed an extremely large, gangrenous appendix, which had descended into the pelvis posterior to adhesions in the right iliac fossa and was torted 720°. The decision was taken to convert to a lower midline laparotomy and as the base appeared healthy, a standard appendicectomy was performed. The patient recovered well and was discharged after two days. The appendix measured 104mm x 53mm x 51mm. Histology revealed acute haemorrhagic and necrotising appendicitis with foci of impending perforation. There was no malignancy or mucocoele. Acute torsion (or volvulus) of the appendix is an unusual cause of this common general surgical emergency.

scholarly journals Phytobezoar induced small bowel obstruction: an uncommon cause of intestinal occlusion

2020 ◽  
Vol 7 (5) ◽  
pp. 1648
Author(s):  
Savas P. Deftereos ◽  
Eleni I. Effraimidou ◽  
Soultana Foutzitzi ◽  
Panagiota Cristodoulou ◽  
Maria Aggelidou ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Subtotal Gastrectomy ◽  
First Feeding ◽  
Ultrasound Findings ◽  
History Of ◽  
Acute Small Bowel Obstruction ◽  
Operative Findings

A case of a 42-year-old female patient with a two-days diffuse colicky abdominal pain, nausea and three episodes of vomiting is presented. Furthermore, patient complained for inability to eat for almost a week. In addition, patient had a history of subtotal gastrectomy Billroth II-type, due to gastric ulcer six years ago. There were no other known co-morbidities. Except for a distended, somewhat painful abdomen and sluggish bowel sounds, the rest clinical examination was unremarkable. Plain abdominal X-ray and ultrasound findings agreed with the clinical suspicion of sub-acute small bowel obstruction probably due to post-operative adhesions. A conservative management was decided. However, the patient after an initial clinical improvement, had a relapse of symptoms with the first feeding attempt. A followed computed tomography of the abdomen revealed a well define, oval, mass-like containing mostly air bubbles lesion, occupying for approximately six centimeters long the jejunum lumen. The diagnosis of jejunal phytobezoar was set. In accordance of computed tomography diagnosis were the intra-operative findings and the post-operative histopathology.

scholarly journals EP.TU.542Enterolith ileus secondary to small bowel diverticulum: a rare cause of small bowel obstruction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Abhishek Dey ◽  
Mohamed Elmasry ◽  
Robert Marshall
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Iliac Fossa ◽  
Gallstone Ileus ◽  
Kidney Injury ◽  
Emergency Laparotomy ◽  
Duodenojejunal Flexure ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Abnormal Peristalsis

Abstract Small intestinal diverticula are rare and possibly acquired secondary to bowel dyskinesia, abnormal peristalsis or high intraluminal pressures. Enterolith formation within these diverticula and intra-luminal bowel obstruction from them are a less encountered complication. A seventy-five year old man, with no history of abdominal surgery, presented with 10 days of colicky right iliac fossa pain and recurrent episodes of bilious vomiting. He initially reported diarrhoea but complained of eventual absolute constipation for last 5 days. Physical examination revealed distended abdomen with right-sided tenderness and no mass or faeces were noted on rectal examination. Biochemistry indicated raised inflammatory markers and an acute kidney injury. Abdominal CT scan revealed a 3.5 cm calculus in the distal ileum causing obstruction initially flagged as gallstone ileus. No gallstones or pneumobilia were identified although some intrahepatic duct dilatation was noted. An emergency laparotomy was conducted, where the radiological findings were reinforced and the calculus was extracted via enterotomy. There were no abnormal communications between gallbladder and intestinal tract suggestive of passage of gallstone to ileum. The small bowel traced from duodenojejunal flexure to terminal ileum did not reveal any further calculi or diverticula. FTIR spectrum analysis of the extracted specimen indicated similarities to enterolith. Retrospective analysis of radiological images revealed a possible duodenal diverticulum. The case highlights the diagnostic conundrum and therapeutic challenges of small bowel diverticular enterolith.

Rare cause of right iliac fossa pain in a UK patient

2020 ◽  
Vol 13 (10) ◽  
pp. e234694
Author(s):  
Khurram Shahzad ◽  
Mohamed Elmedani ◽  
Smitha Mathew ◽  
Ioannis Peristerakis
Keyword(s):  
Small Bowel ◽  
Sedimentation Rate ◽  
Iliac Fossa ◽  
Blood Parameters ◽  
Right Hemicolectomy ◽  
Ascending Colon ◽  
Erythrocyte Sedimentation ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Resected Bowel

A 62-year-old Asian man presented with a 3-month history of right iliac fossa pain which had progressively worsened over the last 3 weeks. All blood parameters were found to be unremarkable except for mildly elevated erythrocyte sedimentation rate. CT imaging demonstrated thickening of the ascending colon and caecum. Colonoscopic biopsies showed submucosal granulomas with features suggestive of schistosomiasis and parasite serology was positive for Schistosoma antibodies. He was treated with praziquantel and showed subsequent symptomatic and radiological improvement. However, he represented nearly 2 years later and underwent a right hemicolectomy for small bowel obstruction. The resected bowel showed an inflammatory caecal mass and a terminal ileal adenocarcinoma.

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