486 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report

Abstract Introduction Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis. Presentation of the case A- 9-year-old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management. Discussion The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment. Conclusions A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases. Key Statement Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.

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EP.FRI.86 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report

British Journal of Surgery ◽

10.1093/bjs/znab312.019 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

May Ting Tan ◽

Mohammad Mahbub Akhter Rahman ◽

Kishore Sasapu

Keyword(s):

Abdominal Pain ◽

Clinical Features ◽

Diagnostic Laparoscopy ◽

Epigastric Pain ◽

Perforated Appendicitis ◽

Paediatric Population ◽

Hemorrhagic Pancreatitis ◽

Spontaneous Hemoperitoneum ◽

Acute Hemorrhagic Pancreatitis ◽

High Index Of Suspicion

Abstract Introduction Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis. Presentation of the case A 9-year old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management. Discussion The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment. Conclusion A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases. Key Statement Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.

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Porphyria Cutanea Tarda Associated With Acute Hemorrhagic Pancreatitis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619852769 ◽

2019 ◽

Vol 7 ◽

pp. 232470961985276

Author(s):

Manasi Singh ◽

Ashley Duckett ◽

Marc Heincelman

Keyword(s):

Abdominal Pain ◽

Physical Examination ◽

Community Hospital ◽

Porphyria Cutanea Tarda ◽

Acute Onset ◽

Laboratory Evaluation ◽

Hemorrhagic Pancreatitis ◽

Acute Hemorrhagic Pancreatitis ◽

Epigastric Abdominal Pain ◽

New Onset

Porphyria cutanea tarda (PCT) is a condition of dysregulated heme synthesis that leads to accumulation of photosensitizing precursors with resultant fragility and blistering of the skin. It can be hereditary or acquired and has been known to be associated with hepatic C virus, alcohol, HIV, and estrogen. In this article, we report an unusual presentation of PCT associated with acute hemorrhagic pancreatitis in a 57-year-old man. He presented initially to a community hospital with acute onset of epigastric abdominal pain and new-onset ascites. Lipase was elevated. Diagnostic paracentesis was grossly bloody. He was then transferred to our institution for concern for acute hemorrhagic pancreatitis. On arrival, physical examination demonstrated vesicles and bullae with erythematous bases, in different stages of healing seen over the dorsal aspects of both hands with scaling, scarring, and hypopigmentation and hyperpigmentation of the skin. Laboratory evaluation and skin biopsy confirmed the diagnosis of PCT. Search for an underlying etiology failed to reveal typical predisposing factors. This report illustrates that acute hemorrhagic pancreatitis may be an underlying etiology for PCT.

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Accessory spleen torsion: a rare cause of acute abdominal pain

International Surgery Journal ◽

10.18203/2349-2902.isj20210465 ◽

2021 ◽

Vol 8 (3) ◽

pp. 991

Author(s):

Madison Bowles

Keyword(s):

Abdominal Pain ◽

Accessory Spleen ◽

Paediatric Population ◽

Haemorrhagic Shock ◽

Splenic Tissue ◽

Main Body ◽

Diagnostic Challenge ◽

High Index Of Suspicion ◽

Prompt Diagnosis ◽

Accessory Spleens

Accessory spleens, which are also known as a splenunculus or a splenule, are a benign developmental anomaly in which nodules of splenic tissue exist separate to the main body of the spleen. It is a reasonably common phenomenon which is present in approximately 10-30% of the population, however they only infrequently become symptomatic. Torsion of an accessory spleen is a rare cause of abdominal pain with few cases reported in the literature, most commonly in the paediatric population. Without treatment, torsion can lead to significant complications including haemorrhagic shock, peritonitis or rupture. The rarity portends a diagnostic challenge and thus a high index of suspicion is crucial for attaining a prompt diagnosis and timely management. This case gives an account of a 43-year-old female who presented with abdominal pain secondary to a torted accessory spleen.

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Consideration of pulmonary thromboembolism in paediatric patients presenting to the emergency department with abdominal pain

BMJ Case Reports ◽

10.1136/bcr-2020-239175 ◽

2021 ◽

Vol 14 (5) ◽

pp. e239175

Author(s):

Wasyla Ibrahim ◽

Farhat Mushtaq

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Abdominal Pain ◽

Lower Limb ◽

Pulmonary Thromboembolism ◽

Signs And Symptoms ◽

Paediatric Population ◽

Limb Trauma ◽

High Index Of Suspicion ◽

Lower Limb Trauma

Venous thromboembolism (VTE) is a recognised complication of lower limb trauma in adult patients and classically presents with cardiopulmonary symptoms. However, the risk of VTE and its presenting signs and symptoms are less well documented in the paediatric population. We report the case of a child who presented to our emergency department with abdominal pain 2 weeks after lower limb fracture, who was subsequently found to have a pulmonary thromboembolism (PTE). This case report highlights the importance of having a high index of suspicion for VTE in the paediatric population if there are predisposing risk factors and to consider PTE as a differential cause of abdominal pain. To the authors’ knowledge, no case has been described in which a child presenting with abdominal pain was consequently found to have a pulmonary embolism.

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Severe Acute Pancreatitis in Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/239068 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Bahiyah Abdullah ◽

Thanikasalam Kathiresan Pillai ◽

Lim Huay Cheen ◽

Ray Joshua Ryan

Keyword(s):

Acute Pancreatitis ◽

Differential Diagnosis ◽

Early Diagnosis ◽

Supportive Care ◽

Acute Abdomen ◽

Review Of Literature ◽

Hemorrhagic Pancreatitis ◽

Acute Hemorrhagic Pancreatitis ◽

High Index Of Suspicion ◽

In Pregnancy

This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.

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An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

Perspectives in Surgery ◽

10.33699/pis.2019.98.8.326-327 ◽

2019 ◽

Vol 98 (8) ◽

pp. 326-327 ◽

Cited By ~ 1

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Portal Hypertension ◽

Liver Disease ◽

Epigastric Pain ◽

Umbilical Vein ◽

History Of ◽

Clinically Significant ◽

Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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THE SELECTIVE PROTEOLYTIC ENZYME INHIBITORY ACTION OF BENZETHONIUM CHLORIDE

Canadian Journal of Biochemistry and Physiology ◽

10.1139/y60-004 ◽

1960 ◽

Vol 38 (1) ◽

pp. 25-32 ◽

Cited By ~ 4

Author(s):

Ivan T. Beck ◽

E. Pinter ◽

R. D. McKenna ◽

H. Griff

Keyword(s):

Subcutaneous Injection ◽

Proteolytic Enzyme ◽

Inhibitory Action ◽

Hemorrhagic Pancreatitis ◽

Benzethonium Chloride ◽

Tryptic Activity ◽

High Concentrations ◽

Acute Hemorrhagic Pancreatitis ◽

Very High

Acute hemorrhagic pancreatitis in humans is thought to be perpetuated by the autolytic processes catalyzed by trypsin and lipase. This study is an integral part of our search for trypsin and lipase inhibitors to be used in the treatment of this disease.Benzethonium chloride was found to inhibit tryptic activity in vitro. The proteolytic activity of rabbit's serum was inhibited, and the inhibition was most pronounced 6 to 12 hours after the subcutaneous injection of the compound. Fibrinolysin was also inhibited in vitro but benzethonium chloride had no inhibitory action on chymotrypsin, pepsin, or lipase.Serum proteins in vitro were precipitated only with very high concentrations of the compound. No significant protein changes were observed in sera of rabbits after the subcutaneous injection of the compound.

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