scholarly journals 282 Cholecystoappendicular Fistula- 1st Ever Reported Case

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Prakash Narayan ◽  
B Oyewole ◽  
A Mandal ◽  
A Belgaumkar ◽  
T Campbell-Smith
Keyword(s):  
Acute Cholecystitis ◽  
Serum Bilirubin ◽  
White Cell Count ◽  
Fistulous Tract ◽  
Acute Attack ◽  
Cholecystoduodenal Fistula ◽  
Serous Fluid ◽  
En Bloc ◽  
Biliary Tract Surgery ◽  
History Of

Abstract A 30-year-old male presented with a history of recurrent episodes of acute cholecystitis; first acute attack associated with fever and nausea was 18 months prior to this presentation, for which he was managed conservatively for acute cholecystitis with antibiotics and analgesia following an ultrasound that showed features of acute cholecystitis with no obvious gallstones. The patient had further episodes of acute cholecystitis with no signs of obstructive jaundice and subsequent ultrasound showed multiple small gallstones. Due to the severity of his symptoms, he was scheduled for a planned cholecystectomy. During surgery (right subcostal incision)- findings were that of a contracted gall bladder with dense adhesions, after careful dissection a fistulous tract between the appendix and gallbladder was identified along with a cholecystoduodenal fistula. An en-bloc cholecystectomy plus appendicectomy was performed with the duodenotomy repaired. On the first day post op there was approximately 300 ml of bilious effluent in drain, a white cell count-8.1 x 109 and hemoglobin -12.1 g/dL, Serum bilirubin-1.4mg/dL, ALP-104mg/dL. The second and third post-operative days were uneventful with minimal bile mixed serous fluid in drain respectively with no other complains, following which the drains were removed and patient discharged home. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10–20%), and the least common is the cholecystogastric fistula accounting for the remainder of cases. No case of cholecystoappendicular fistula has been reported so far.

scholarly journals Whirl Sign and Midgut Volvulus: An Unusual Cause of an Acute Abdomen in an Adult Patient

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Eoghan P. Burke ◽  
Munir Saeed ◽  
Maham Mahmood ◽  
Cathal Hayes ◽  
Mohamed Salama ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Cholecystitis ◽  
White Cell Count ◽  
Free Fluid ◽  
Midgut Volvulus ◽  
Blood Tests ◽  
Initial Impression ◽  
Abdomen Ct ◽  
Whirl Sign ◽  
History Of

We report the case of a 50-year-old lady who presented to the emergency department complaining of a two-day history of colicky right upper quadrant (RUQ) pain, which radiated through to her back, associated with nausea, anorexia, and two episodes of vomiting that day. She was found to be tender in the RUQ. Her blood tests were notable for an elevated white cell count. Initial impression was of acute cholecystitis. Ultrasound of her abdomen did not identify any features of acute cholecystitis; however, a large volume of free fluid was identified within the abdomen. CT of the abdomen/pelvis was obtained which identified dilated loops of small bowel, interloop ascites, and a whirl sign highly suggestive of midgut volvulus. During laparoscopy, the midgut volvulus was found to have resolved. No cause for the volvulus could be identified, and the patient was discharged home well on postoperative day two.

scholarly journals Fístulas Biliares em Combinação Espontânea Interna e Externa Associadas a Cálculos e Glimatose de Vesícula Biliar

2001 ◽  
Vol 47 (3) ◽  
pp. 273-276
Author(s):  
Cícero de Andrade Urban ◽  
Linei Augusta Brolini Dellê Urban ◽  
Rubens Silveira de Lima ◽  
Luiz Fernando Bleggi-Torres
Keyword(s):  
Acute Cholecystitis ◽  
Rare Complication ◽  
Fistulous Tract ◽  
Biliary Tract Disease ◽  
Gallbladder Wall ◽  
Biliary Fistula ◽  
Ovarian Teratoma ◽  
History Of ◽  
Tract Disease ◽  
Gallbladder Inflammation

Spontaneous combined internal and external biliary fistula is a very rare complication of biliary tract disease. Only two previous cases have been reported so far, and all of them with previous episodes of acute cholecystitis, treated without surgery. We describe a 27-year-old female patient (the younger reported to date) who presented with a long history of neglected gallbladder inflammation complicated by neuroglial implants on the peritoneum and on the gallbladder wall due to an ovarian teratoma. She had spontaneous cholecystocutaneous fistula and cholecystocolic fistula that were successfully treated by cholecystectomy and excision of the fistulous tract.

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

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.

scholarly journals Gas-filled urachal abscess with a pinging sound in a heifer calf

2019 ◽  
Vol 64 (No. 8) ◽  
pp. 362-366 ◽  
Author(s):  
R Sato ◽  
K Yamada ◽  
Y Shinozuka ◽  
H Ochiai ◽  
K Onda
Keyword(s):  
Fistulous Tract ◽  
Failure To Thrive ◽  
Abdominal Distension ◽  
Intravenous Urography ◽  
University Hospital ◽  
Growth Depression ◽  
Poor Growth ◽  
History Of ◽  
Heifer Calf ◽  
Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽  
2021 ◽  
Vol 64 (4) ◽  
pp. 778-794 ◽  
Author(s):  
Matthieu Wargny ◽  
◽  
Louis Potier ◽  
Pierre Gourdy ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hospital Discharge ◽  
Microvascular Complications ◽  
White Cell Count ◽  
Symptom Duration ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
History Of ◽  
Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

scholarly journals Paraspinal gossybipoma: A case report and review of the literature

2010 ◽  
Vol 01 (02) ◽  
pp. 102-104 ◽  
Author(s):  
Baris Kucukyuruk ◽  
Huseyin Biceroglu ◽  
Bashar Abuzayed ◽  
Mustafa O Ulu ◽  
Ali M Kafadar
Keyword(s):  
Clinical Presentation ◽  
Review Of The Literature ◽  
Disk Herniation ◽  
Serous Fluid ◽  
Lumbar Disk Herniation ◽  
Radiologic Findings ◽  
Initial Surgery ◽  
History Of ◽  
Retained Surgical Sponges ◽  
Operation Wound

ABSTRACTSpinal or paraspinal retained surgical sponges (gossybipoma or textiloma) are rare incidents and mostly asymptomatic in chronic cases, but can be confused with other masses such as a hematoma, an abscess or a tumor. In chronic cases, the presentation can be as late as decades after the initial surgery; however, some gossybipomas cause infection or abscess formation in the early stages. The authors report a 40-year-old woman with a history of operation for lumbar disk herniation before 8 months, and got admitted with a complaint of serous fluid leakage from the operation wound. In this report, the authors discuss the clinical presentation, the radiologic findings and the differential diagnosis of gossybipoma.

Inverse Relationship Between Serum Bilirubin and Atherosclerosis in Men: A Meta-Analysis of Published Studies

2003 ◽  
Vol 228 (5) ◽  
pp. 568-571 ◽  
Author(s):  
Ladislav Novotný ◽  
Libor Vítek
Keyword(s):  
Inverse Relationship ◽  
Serum Bilirubin ◽  
Linear Trend ◽  
Meta Analysis ◽  
Negative Relationship ◽  
Epidemiological Studies ◽  
Atherosclerotic Disease ◽  
Categorical Variables ◽  
History Of ◽  
Stratified Analysis

Bilirubin, a major intravascular product of heme catabolism, is a potent antioxidant compound. Numerous studies have been published showing the relationship between serum bilirubin levels and atherosclerosis. In the present investigation all the epidemiological studies available on the effect of serum bilirubin levels and atherosclerotic disease were analyzed. Studies on the epidemiology of atherosclerotic diseases in relation to serum bilirubin levels were searched in the MEDLINE database. Selected studies were subdivided according to serum bilirubin levels and severity of atherosclerotic disease. Because of the limited number of females involved in the studies, only males were included into meta-analysis. Associations for ordered categorical variables (bilirubin and natural history of graded atherosclerosis) were assessed to find correlation and linear trend between analyzed variables. A stratified analysis was conducted to compare risks of clinical outcomes. Eleven relevant studies were used for analysis. A close negative relationship was found between serum bilirubin levels and severity of atherosclerosis (Spearman rank coefficient r = −0.31, P < 0.0001). The linear trend was confirmed in analysis of proportions with x2 values for both disease conditions to be very significant ( P < 0.0001). Unambiguous inverse relationship between serum bilirubin levels and atherosclerosis was demonstrated in this preliminary meta-analytic study. These results indicate the importance of hem oxygenase-related products in the prevention of oxidative stress-mediated diseases.

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