Abdominal apoplexy during pregnancy

2020 ◽  
Vol 13 (10) ◽  
pp. e235946
Author(s):  
Jasmeet Kumari ◽  
Rosemary Harkin
Keyword(s):  
Iliac Fossa ◽  
Unknown Origin ◽  
Breech Presentation ◽  
Sudden Onset ◽  
Left Iliac Fossa ◽  
Safe Delivery ◽  
Uterine Contractions ◽  
Early Labour ◽  
Increased Risk ◽  
High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

scholarly journals First-trimester rupture of a gravid bicornuate uterus after prior vaginal deliveries, simulating a ruptured ectopic pregnancy: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Joel Noutakdie Tochie ◽  
Landry Wakheu Tcheunkam ◽  
Collince Tchakounté ◽  
Nkengafac Nyiawung Fobellah ◽  
Samuel Nambile Cumber
Keyword(s):  
Ectopic Pregnancy ◽  
Iliac Fossa ◽  
First Trimester ◽  
Sudden Onset ◽  
Left Iliac Fossa ◽  
Bicornuate Uterus ◽  
Vaginal Deliveries ◽  
Future Fertility ◽  
Operative Findings ◽  
High Index Of Suspicion

Abstract The first-trimester rupture of a bicornuate uterus (BU) is a rare obstetrical emergency, especially following previous normal vaginal deliveries where it is often misdiagnosed. A 24-year-old G3P2002 woman presented at 11 weeks of gestation with sudden onset of severe left iliac fossa pain without other symptoms. On examination, she was fully conscious and hemodynamically unstable with signs of peritoneal irritation, a distended pouch of Douglas and a slightly enlarged uterus and a tender left adnexal mass. The diagnosis of a ruptured ectopic pregnancy was made and a laparotomy was done. Intra-operative findings were hemoperitoneum, a left ruptured BU and a dead fetus. Surgical management entailed hysterorrarphy, left salpingectomy and conservation of both ovaries. Her postoperative course was uneventful and future fertility was preserved. We recommend a high index of suspicion of ruptured BU as a differential diagnosis of acute abdomen in the first trimester in women with previous term vaginal deliveries.

Left iliac fossa pain

2015 ◽  
Author(s):  
Hugo Farne ◽  
Edward Norris-Cervetto ◽  
James Warbrick-Smith
Keyword(s):  
Ovarian Cyst ◽  
Acute Diverticulitis ◽  
Iliac Fossa ◽  
Sudden Onset ◽  
Left Iliac Fossa ◽  
Ureteric Calculi ◽  
Right Iliac Fossa Pain ◽  
Colicky Pain ◽  
Menstruating Women ◽  
Irritable Bowel

In Figure 17.1 the differential diagnosis is arranged in order of likelihood in a woman of this age, with more likely diagnoses in larger font and less likely diagnoses in smaller font. Pathologies that should be excluded at the earliest possible opportunity are shown in bold. There are a number of gynaecological pathologies that can cause acute LIF pain. Some, such as ectopic pregnancy, mittelschmerz (mid-cycle pain), or haemorrhage into a functional ovarian cyst, can only occur in menstruating women. Others, such as pelvic inflammatory disease or torsion/rupture of an ovarian cyst, are far more likely to be seen in women younger than Mrs Hamilton, but can be kept in mind as rare differentials for someone of her age. Testicular torsion can cause referred pain to either the left or right iliac fossa and tends to occur in boys and young men. Haemorrhage into a testicular tumour can also cause left or right iliac fossa pain. Thus, don’t forget to examine the testes. You should ask the standard array of questions about the pain—remember the mnemonic SOCRATES: Site: Where is the pain, and has it always been there? Pain that is initially poorly localized, midline, and colicky but which then migrates to the LIF and becomes constant is highly suggestive of acute diverticulitis (akin to left-sided appendicitis). Pain that migrates down the left flank and iliac fossa is more consistent with the migration of a ureteric stone. Onset: Gradual or sudden? Sudden onset of pain is suggestive of perforation of a viscus, or of acute haemorrhage (e.g. into an ovarian cyst or from a ruptured AAA) or torsion (of an ovary or testis). Character: Is the pain colicky or constant? Is it sharp or dull? Acute diverticulitis is often preceded by colicky midline pain. Ureteric calculi may result in colicky pain. Established diverticulitis, and the other differential diagnoses from our list would all produce constant abdominal pain. Sharp pain is most suggestive of haemorrhage, perforation, or torsion. Radiation: Does the pain radiate to the groin (typical of ureteric pain)? Alleviating factors: Does anything make the pain better? Discomfort due to irritable bowel syndrome (IBS) may be relieved by defecation.

scholarly journals The interplay of Clostridioides difficile infection and inflammatory bowel disease

2021 ◽  
Vol 14 ◽  
pp. 175628482110202
Author(s):  
Kanika Sehgal ◽  
Devvrat Yadav ◽  
Sahil Khanna
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Molecular Tests ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Pros And Cons ◽  
Inflammatory Bowel ◽  
High Index Of Suspicion

Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatments for the management of CDI in IBD. Microbiota restoration therapies effectively prevent recurrent CDI in IBD patients. Immunosuppression for IBD in IBD patients with CDI should be managed individually, based on a thorough clinical assessment and after weighing the pros and cons of escalation of therapy. This review summarizes the epidemiology, pathophysiology, the diagnosis of CDI in IBD, and outlines the principles of management of both CDI and IBD in IBD patients with CDI.

Successful thrombolysis in essential thrombocythemia-related acute ischaemic stroke

2021 ◽  
Vol 14 (5) ◽  
pp. e242925
Author(s):  
Ishita Desai ◽  
Ashutosh Tiwari ◽  
Mritunjai Kumar Singh ◽  
Niraj Kumar
Keyword(s):  
Ischaemic Stroke ◽  
Essential Thrombocythemia ◽  
Acute Ischaemic Stroke ◽  
Jak2 V617f ◽  
Preliminary Evidence ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Interesting Case ◽  
Increased Risk ◽  
Successful Thrombolysis

Essential thrombocythemia (ET)-related acute ischaemic stroke (AIS) may account for approximately 0.25%–0.5% of all ischaemic strokes. If left undiagnosed and untreated, patients with ET carry an increased risk of recurrent thrombosis involving major organs including the brain. We report an interesting case of a 67-year-old man, who was successfully thrombolysed for AIS resulting from ET. He presented with sudden onset of left-sided hemiparesis with a left-ventricular clot. His subsequent investigations including positive JAK2 V617F mutation confirmed the diagnosis of ET. He made a significant recovery with thrombolysis, anticoagulation, antiplatelet and hydroxyurea. A fear of post-thrombolytic haemorrhagic complications appears the major reason for the lack of reports of thrombolysis in ET-related AIS. Although the diagnosis of ET was confirmed on subsequent investigations, successful thrombolysis in our case provides preliminary evidence that ET-related AIS cases can undergo successful thrombolysis using tenecteplase. To date, ours is only the second case of ET-related AIS being thrombolysed.

Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

2021 ◽  
Vol 14 (3) ◽  
pp. e238547
Author(s):  
Victoria Rose Russell ◽  
Mohamed Ibrahim ◽  
Georgina Phillips ◽  
Tom Setchell ◽  
Sanjay Purkayastha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Female Genital Tract ◽  
Delayed Diagnosis ◽  
Rare Presentation ◽  
Left Iliac Fossa ◽  
Imperforate Hymen ◽  
Retrograde Menstruation ◽  
Low Incidence

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

scholarly journals Prurigo Pigmentosa: A Clinicopathological Report of Three Middle Eastern Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
N. Almaani ◽  
A. H. Al-Tarawneh ◽  
H. Msallam
Keyword(s):  
Middle Eastern ◽  
Sudden Onset ◽  
Clinicopathological Features ◽  
Inflammatory Disorder ◽  
Histological Features ◽  
The Third ◽  
Strict Diet ◽  
Postinflammatory Hyperpigmentation ◽  
High Index Of Suspicion ◽  
Distinct Features

Prurigo pigmentosa is a unique cutaneous inflammatory disorder characterized by a sudden onset of pruritic and erythematous macules, urticarial papules, and plaques that may coalesce to form a reticulated pattern. Lesions typically heal within weeks leaving a reticulated and mottled postinflammatory hyperpigmentation. The majority of reported cases originate from Japan with much fewer cases described worldwide without predominant ethnicity. The histopathological features of prurigo pigmentosa can be nonspecific; however, distinct features exist for each stage of the disease. The aetiology of prurigo pigmentosa is not fully understood. However, ketoacidosis has been implicated in the pathogenesis and indeed prurigo pigmentosa has been associated with ketoacidotic states such as diabetes mellitus, fasting, dieting, and anorexia nervosa. In this report, we present 3 Jordanian patients with prurigo pigmentosa and describe their clinicopathological features. One patient developed prurigo pigmentosa while fasting during the month of Ramadan and another was undertaking a strict diet. No associations were identified in the third patient. In view of the largely nonspecific clinical and histological features, a high index of suspicion is required as many cases of prurigo pigmentosa are probably undiagnosed.

scholarly journals A young lady with inflammation of unknown origin

2018 ◽  
Vol 18 (2) ◽  
pp. 67-71
Author(s):  
Chiu Sum Chu ◽  
Chi Hung To ◽  
Chi Chiu Mok
Keyword(s):  
Young Women ◽  
Systemic Vasculitis ◽  
Unknown Origin ◽  
Young Lady ◽  
Imaging Studies ◽  
Biochemical Tests ◽  
Vascular Stenosis ◽  
High Index Of Suspicion ◽  
Anemia Of Chronic Inflammation ◽  
Delay In Treatment

Abstract Takayasu’s arteritis (TAK) is a systemic vasculitis mainly affecting the aorta and its first branches. The initial presentation can be very non-specific while its sequelae can be debilitating and fatal. Apart from clinical and biochemical tests, imaging studies remain pivotal for the diagnosis of this rare disease. Delay in treatment may result in vascular stenosis, leading to morbidity and mortality. We report a case of a young woman who presented with anemia with no obvious causes. Subsequently she developed ischemic symptoms and the diagnosis of TAK was established with magnetic resonance angiography (MRA). Our case illustrates the importance of recognition of the possibility of TAK in young women who presented with non-specific systemic upset and anemia of chronic inflammation. A high index of suspicion is needed and imaging studies should be considered early. The treatment of TAK will also be briefly reviewed.

scholarly journals A uterus didelphys with breech presentation in a previously scarred uterus; an incidental finding

2017 ◽  
Vol 6 (8) ◽  
pp. 3706
Author(s):  
Shilpa H. B.
Keyword(s):  
Incidental Finding ◽  
Breech Presentation ◽  
Premature Labor ◽  
Successful Pregnancy ◽  
Fetal Survival ◽  
Increased Risk ◽  
Endometrial Cavity ◽  
Mullerian Ducts ◽  
Uterine Malformations ◽  
Scarred Uterus

A didelphic uterus results from failed fusion of the paired mullerian ducts characterized by two separated uterine horns, each with an endometrial cavity and uterine cervix. Pregnancies develop in one of the two horns, and of the major uterine malformations, the didelphys uterus has the best reproductive prognosis. Improved fetal survival may be secondary to earlier diagnosis, which favors earlier and more intensive prenatal care. Pregnancy is associated with an increased risk of malpresentations and premature labor, although many patients will have no reproductive difficulties. We report a case of successful pregnancy outcome in our institute in a case of didelphys uterus by Caesarean section.

scholarly journals A rare cause of right iliac fossa lump: contained fish bone perforation of caecum

2020 ◽  
Vol 7 (10) ◽  
pp. 3476
Author(s):  
Washim F. Khan ◽  
Sandeep Jain ◽  
Yashwant S. Rathore ◽  
Sunil Chumber
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Iliac Fossa ◽  
Exploratory Laparotomy ◽  
Right Hemicolectomy ◽  
Fish Bone ◽  
Rare Entity ◽  
Radiological Findings ◽  
Generalized Peritonitis ◽  
High Index Of Suspicion

Ingested foreign bodies usually pass uneventfully through the gastrointestinal tract but few of them can cause symptoms. They can get stuck at acute angulations or narrow part of intestine and can perforate leading to localized to generalized peritonitis, collection or abscess formation. We describe a case of 59 year old gentleman who presented with pain in right iliac fossa with fever and a hard, tender lump. Initial investigation revealed a mass in right iliac fossa adherent to anterior abdominal was in right iliac fossa region with a foreign body inside. Patient was managed with exploratory laparotomy, removal of a fish bone from cacecum and limited right hemicolectomy. Fishbone perforation of caecum is a rare entity. Careful corroboration between patient’s presentation and radiological findings with a high index of suspicion is needed for pre-operative diagnosis.

scholarly journals Subcapsular renal hematoma in patients underwent upper ureteroscopic lithotripsy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
Y M Kotb ◽  
M K Abdelfattah ◽  
I M Saleh
Keyword(s):  
Risk Factors ◽  
Controlled Trial ◽  
Elevated Serum ◽  
Ureteral Stones ◽  
Ureteric Stone ◽  
Ureteroscopic Lithotripsy ◽  
Intravenous Contrast ◽  
Subcapsular Hematoma ◽  
Increased Risk ◽  
High Index Of Suspicion

Abstract Objective to demonstrate the risk factors of developing subcapsular renal hematoma ( SRH) in patients who underwent ureteroscopic lithotripsy for upper ureteric stones. Materials and Methods In a randomized controlled trial, 60 patients with an upper ureteric stone underwent URS lithotripsy either by laser or pneumatic. The inclusion criteria were age above 14 years old, of both sexes with an upper ureteric stone about 2 cm in diameter. Exclusion criteria were age below 14 years old, elevated serum creatinine level, patients with coagulopathies and pregnancy. The perioperative and postoperative outcomes were evaluated and postoperative pelvi-abdominal CT with intravenous contrast was done to detect if a subcapsular hematoma has been developed. Results There is no significant association between the formation of subcapsular renal hematoma and degree of hydronephrosis, chronic kidney disease (CKD), body mass index (BMI), diabetes mellitus (DM), hypertension (HTN) and preoperative bacteriuria as risk factors. Conclusions Subcapsular hematoma post-ureteroscopic lithotripsy (URSL) for impacted upper ureteric stones is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after ureteroscopic lithotripsy for obstructing proximal ureteral stones with thin renal cortices. Stone size, degree of hydronephrosis, operation duration, and perfusion pressure of hydraulic irrigation were associated with an increased risk of SRH formation. Management of post-URSL subcapsular hematomas needs to be customized for each patient.

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