Obstructed ileocaecal tuberculosis with splenic tuberculosis and solid pseudopapillary tumour of tail of pancreas in an immunocompetent woman

2020 ◽  
Vol 13 (9) ◽  
pp. e235195
Author(s):  
Surendran Paramasivam ◽  
Magesh Murali ◽  
Parimuthukumar Rajappa
Keyword(s):  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Emergency Laparotomy ◽  
Solid Pseudopapillary Tumour ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Splenic Tuberculosis ◽  
Ileocaecal Junction ◽  
Time Of Admission

A 22-year-old young woman presented with fever, lower abdominal pain and vomiting for 20 days. She had persistent fever and abdominal pain. Fever panel was negative. Clinical features were suggestive of subacute small bowel obstruction. Contrast-enhanced CT abdomen showed thickening of distal ileum, ileocaecal junction and caecum with conglomerate necrotic nodal mass in the ileocolic mesentry along with a lesion in the tail of pancreas. Patient was discussed with multidisciplinary team and decided to undergo a single-stage procedure after adequate nutritional optimisation. During optimisation, she underwent acute obstruction and hence taken up for emergency laparotomy proceeded to right haemicolectomy with distal pancreatectomy and splenectomy 4 weeks after the time of admission. Histopathology showed ileocaecal tuberculosis and solid pseudopapillary tumour with margins free of tumour. Approach of obstructed ileocaecal tuberculosis in the setting of incidental diagnosis of solid pseudopapillary tumour of pancreas in a moribund patient was challenging.

scholarly journals Spontaneous Intraluminal Migration of Gossypiboma

2011 ◽  
Vol 02 (01) ◽  
pp. 022-024
Author(s):  
Sebastian Saji
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
Sigmoid Colon ◽  
Chronic Diarrhea ◽  
Lower Abdominal Pain ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Intraluminal Migration

ABSTRACTRetained surgical mops following surgery is an avoidable but serious complication. They are seldom reported because of medicolegal implications but clinicians need to be aware about varied presentations of this entity to avoid unnecessary morbidity. We report a case of a 28-year-old woman who presented with chronic diarrhea and lower abdominal pain due to intraluminal migration of the surgical mop into the sigmoid colon 6 months after myomectomy of the uterus. The possibility of gossypiboma was suggested by the contrast-enhanced CT scan of the abdomen. Flexible sigmoidosocpy showed the remnants of the mop inside the lumen of the sigmoid colon. She underwent laparotomy and removal of the surgical mop and became completely asymptomatic. Though gossypiboma is rare clinicians should keep it in mind in patients who had undergone laparotomy previously. (J Dig Endosc2011;2(1):22-24)

scholarly journals Ectopic Perforated Appendicitis in Supraumbilical Region in a Case of Incomplete Intestinal Rotation

2021 ◽  
Vol 10 (31) ◽  
pp. 2521-2524
Author(s):  
Bhimarao Bhimarao ◽  
Rashmi Mysore Nagaraju ◽  
Lingaraj B. Patil
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Perforated Appendicitis ◽  
Intestinal Malrotation ◽  
Emergency Laparotomy ◽  
Markers Of Inflammation ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Common Causes ◽  
Uncommon Condition

Acute appendicitis is one of the most common causes of acute abdominal pain and the most common condition requiring emergency surgery. Intestinal malrotation is a relatively uncommon condition. Depending upon the location of the cecum and appendix, patients with acute appendicitis in intestinal malrotation present atypically with abdominal pain localized on the site of appendicitis. Due to atypical presentation of central abdominal pain, other differentials presenting in this region should be excluded and accurate diagnosis should be made. We present a patient who came with central abdominal pain with elevated markers of inflammation. Contrast enhanced CT of abdomen in this patient revealed ectopic appendicitis located in supraumbilical region with signs of incomplete rotation of the bowel. CT played a pivotal role in identifying the underlying rotational abnormality of bowel, in localizing the inflamed appendix, identifying complications (perforation) and excluding other possible intra-abdominal pathologies. It was also helpful in surgical planning. Emergency laparotomy with appendectomy and lavage were performed on this patient who subsequently recovered.

scholarly journals The feasibility of deep learning-based synthetic contrast-enhanced CT from nonenhanced CT in emergency department patients with acute abdominal pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Se Woo Kim ◽  
Jung Hoon Kim ◽  
Suha Kwak ◽  
Minkyo Seo ◽  
Changhyun Ryoo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Deep Learning ◽  
Acute Abdominal Pain ◽  
Point Scale ◽  
Contrast Enhanced Ct ◽  
Underlying Malignancy ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Emergency Department Patients

AbstractOur objective was to investigate the feasibility of deep learning-based synthetic contrast-enhanced CT (DL-SCE-CT) from nonenhanced CT (NECT) in patients who visited the emergency department (ED) with acute abdominal pain (AAP). We trained an algorithm generating DL-SCE-CT using NECT with paired precontrast/postcontrast images. For clinical application, 353 patients from three institutions who visited the ED with AAP were included. Six reviewers (experienced radiologists, ER1-3; training radiologists, TR1-3) made diagnostic and disposition decisions using NECT alone and then with NECT and DL-SCE-CT together. The radiologists’ confidence in decisions was graded using a 5-point scale. The diagnostic accuracy using DL-SCE-CT improved in three radiologists (50%, P = 0.023, 0.012, < 0.001, especially in 2/3 of TRs). The confidence of diagnosis and disposition improved significantly in five radiologists (83.3%, P < 0.001). Particularly, in subgroups with underlying malignancy and miscellaneous medical conditions (MMCs) and in CT-negative cases, more radiologists reported increased confidence in diagnosis (83.3% [5/6], 100.0% [6/6], and 83.3% [5/6], respectively) and disposition (66.7% [4/6], 83.3% [5/6] and 100% [6/6], respectively). In conclusion, DL-SCE-CT enhances the accuracy and confidence of diagnosis and disposition regarding patients with AAP in the ED, especially for less experienced radiologists, in CT-negative cases, and in certain disease subgroups with underlying malignancy and MMCs.

scholarly journals Idiopathic Spontaneous Rupture of Renal Pelvis in a Single Functioning Kidney

2021 ◽  
pp. 221-226
Author(s):  
Maciej Tylski ◽  
Katarzyna Muras-Szwedziak ◽  
Michał Nowicki
Keyword(s):  
Abdominal Pain ◽  
Renal Pelvis ◽  
Spontaneous Rupture ◽  
Urinary Tract Obstruction ◽  
Rare Condition ◽  
Inflammatory Infiltration ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Functioning Kidney

Spontaneous rupture of renal pelvis (SRRP) is a rare condition resulting in an extravasation of urine into retroperitoneal space. Due to the uncharacteristic symptoms, often mimicking renal colic, its diagnosis may be complicated. Herein, we report a case of a 73-year-old male with a solitary functioning kidney who presented with malaise and right-sided abdominal pain, rapidly followed by anuria. Laboratory tests showed the signs of AKI. Contrast-enhanced CT performed soon after the admission showed nonspecific abnormalities in the right middle abdomen suspected to be either inflammatory infiltration or surgical scarring. Symptomatic treatment was started, and an acute hemodialysis treatment was commenced. After a temporal improvement, the patient’s general condition worsened significantly, with exacerbated pain and massive increase in plasma creatinine. A second contrast-enhanced CT was performed with an addition of urography phase, revealing the extravasation of the contrast media in the location suggesting the rupture of the renal pelvis. The patient was treated successfully by the placement of a double-J ureteral stent into the ureter. Usually, a clear etiology of SRRP can be determined, that is, urinary tract obstruction, but in this case, we could not find a definite cause. It is important to remember that in the presence of a nonspecific abdominal pain and laboratory signs of AKI, a rare cause like SRRP should be taken into consideration. Performing a contrast CT scan with urography phase can save time in establishing a diagnosis and enable immediate urological intervention.

scholarly journals Benign Cystic Mesothelioma in a Girl

2017 ◽  
Vol 8 (5) ◽  
pp. 31
Author(s):  
Aditya Pratap Singh ◽  
Arun Kumar Gupta ◽  
Dinesh Kumar Barolia ◽  
Vinay Mathur
Keyword(s):  
Abdominal Pain ◽  
Cystic Lesion ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Cystic Mass ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Cystic Mesothelioma ◽  
Uncommon Tumor

Benign cystic mesothelioma (BCM) is an uncommon tumor. A 9-year-old girl presented with acute abdominal pain and vomiting for the last 24 hours. Ultrasound abdomen and contrast enhanced CT scan were suggestive of cystic lesion. At laparotomy, a cystic mass arising from the peritoneum was found, which was excised completely. On histopathological examination it was diagnosed as benign mesothelioma.

scholarly journals Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Toshiaki Watanabe ◽  
Tadatsugu Kinjo ◽  
Yoshino Kinjyo ◽  
Hayase Nitta ◽  
Hitoshi Masamoto ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Sigmoid Colon ◽  
Intestinal Resection ◽  
Lower Abdominal Pain ◽  
Sigmoid Volvulus ◽  
Primiparous Woman ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Computed Tomography Scanning

Sigmoid volvulus requires urgent treatment, and it is particularly rare among pregnant women without a history of laparotomy. A delay in diagnosis may lead to serious consequences for the mother and fetus, and a rapid diagnosis and treatment in this setting is essential. The patient was a 19-year-old primiparous woman. She complained of repeated exacerbations and remissions of abrupt lower abdominal pain for the past 2 days and was transported to our hospital at 33 weeks of gestation. Ultrasonography revealed no placental thickening, and maternal bowel dilation was difficult to identify. Plain abdominal X-ray showed a dilated colon on the left side of the abdomen. Contrast-enhanced CT scan of the abdomen revealed a volvulus on the dorsal side of the uterus. The proximal end of the transverse to sigmoid colon was markedly dilated, and the distal end was collapsed. The elevated lactate level on blood gas analysis suggested intestinal ischemia. She was suspected of having a sigmoid volvulus at 33 weeks and 3 days of gestation. We decided to perform a cesarean section to secure the operative field for an intestinal resection following delivery. A male weighing 1840 g with Apgar scores 8/8 was delivered. The sigmoid colon was approximately 80 cm in length. A 360-degree clockwise rotation of was observed with a very distended but viable sigmoid loop. Following reduction of the volvulus, the sigmoid colon was fixed to the left side of the peritoneum. The mother had an uneventful postoperative course, and the infant was discharged without any sequelae. This case demonstrates two important lessons. First, sigmoid volvulus can occur in pregnant women even if they never had a laparotomy. Second, abdominal contrast-enhanced CT is useful for rapid diagnostic and treatment decisions relative to this pathology.

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