Gastric perforation secondary to Rapunzel syndrome

2021 ◽  
Vol 14 (2) ◽  
pp. e240100
Author(s):  
Jamaall Jackman ◽  
Gael R Nana ◽  
James Catton ◽  
Ioannis Christakis
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Gastric Perforation ◽  
Uneventful Recovery ◽  
Free Fluid ◽  
Rapunzel Syndrome ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Rapunzel syndrome is rare and describes a trichobezoar that extends through the pylorus into the jejunum, ileum or even the colon. Due to the large intraluminal size and weight they can attain, acute presentations of obstruction or perforation may occur. We report a case of a 17-year-old girl who presented to the emergency department following a syncopal episode. On examination, a left upper quadrant mass was appreciated with no signs of peritonism. Contrast-enhanced CT demonstrated a giant trichobezoar with resulting gastric perforation and intra-abdominal free fluid. Laparotomy and gastrotomy were performed and the patient had an uneventful recovery with psychiatric review prior to discharge. Though uncommon, bezoars should be included in our differential diagnosis as they can present in various ways owing to their size and weight. This case illustrates the risk of gastric perforation with large gastric bezoars.

scholarly journals Chest Pain of Uncertain Aetiology: Role of Contrast Enhanced Computed Tomography in the Emergency Department

2016 ◽  
Vol 10 (1) ◽  
pp. 205-211
Author(s):  
Firas Yassin ◽  
Chris Sawh ◽  
Pankaj Garg
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Coronary Event ◽  
Computed Tomographic ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Enhanced Computed Tomography

There is increasing role of computed tomographic (CT) in the assessment of acute chest pain in the emergency department especially when the diagnosis is not clear. We report a case where non ECG gated contrast enhanced CT in the emergency department for rule-out of pulmonary embolus guided to the actual diagnosis, which was, acute coronary event, as evidenced by the presence of perfusion defect.

scholarly journals Giant Renal Angiomyolipoma by the Example of Clinical Cases

2021 ◽  
Vol 102 (5) ◽  
pp. 304-310
Author(s):  
S. V. Yadrentseva ◽  
N. V. Nudnov ◽  
Emil’ G. Gasymov
Keyword(s):  
Differential Diagnosis ◽  
Morphological Characteristics ◽  
High Sensitivity ◽  
Renal Angiomyolipoma ◽  
Distinctive Features ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Diagnostic Difficulties ◽  
Clinical Cases

The paper presents two clinical cases of patients with giant renal angiomyolipomas (AML), in one of whom its course was complicated by intratumoral hemorrhage. It describes key diagnostic criteria for computed tomography (CT), as well as the distinctive features of other neoplasms that should undergo a differential diagnosis. The similar clinical presentations and morphological characteristics of different renal neoplasms can cause certain diagnostic difficulties; however, the carefully collected historical data and distinctive criteria allow AML to be identified. Due to its high sensitivity and specificity, abdominal contrast-enhanced CT is an effective imaging technique in the detection and differential diagnosis of giant renal AML.

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 Gastric Bezoar - A Rare Presentation in Infant

2016 ◽  
Vol 6 (1) ◽  
pp. 24-27
Author(s):  
MTH Siddiqui ◽  
Mohammad Mahabubul Alam ◽  
AM Shahinur ◽  
AKM Zahid Hossain ◽  
Gazi Zahirul Hasan
Keyword(s):  
Differential Diagnosis ◽  
Ct Scan ◽  
Contrast Medium ◽  
Medium Study ◽  
Rare Presentation ◽  
Contrast Enhanced Ct ◽  
Gastric Bezoar ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Upper Abdominal

Gastric bezoar in neonate is a rare presentation. Because of rarity of phytobezoar and lactobezoar are not considered as the differential diagnosis of a lump and vomiting commonly. A 7 month female presented with left upper abdominal undifferentiated hard mobile lump and post prandial occasional vomiting. Diagnosis was non-conclusive with USG, contrast medium study of stomach and duodenum and contrast enhanced CT scan. After laparotomy and gastrostomy mass was removed and diagnosed as phytolactobezoar on macroscopic appearance.J. Paediatr. Surg. Bangladesh 6(1): 24-27, 2015 (Jan)

scholarly journals A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kazumasa Emori ◽  
Nobuhiro Takeuchi ◽  
Junichi Soneda
Keyword(s):  
Emergency Department ◽  
Celiac Artery ◽  
Splenic Infarction ◽  
Artery Dissection ◽  
Emergency Setting ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
History Of ◽  
Enhanced Computed Tomography

A 46-year-old male with a history of hypertension visited the emergency department (ED) by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG) performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT) revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD) was diagnosed. Because his blood pressure was high (159/70 mmHg), antihypertensive medicine was administered (nicardipine and carvedilol). After his blood reached optimal levels (130/80 mmHg), symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting.

Limited added utility of performing follow-up contrast-enhanced CT in patients undergoing initial non-enhanced CT for evaluation of flank pain in the emergency department

2014 ◽  
Vol 22 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Monica D. Agarwal ◽  
Robin B. Levenson ◽  
Bettina Siewert ◽  
Marc A. Camacho ◽  
Vassilios Raptopoulos
Keyword(s):  
Emergency Department ◽  
Flank Pain ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

scholarly journals 412 Polytetrafluoroethylene(PTFE) Pledgets Masquerading As A Pseudo-Aneurysm Of Left Ventricle Apex. A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Moawad ◽  
S Asopa ◽  
C Lloyd
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Ct Scan ◽  
Median Sternotomy ◽  
Thoracic Wall ◽  
Uneventful Recovery ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Pseudo Aneurysm

Abstract Background TransCatheter Aortic Valve Implantation (TAVI) is now established as an alternative for open aortic valve replacement in high-risk patients with severe calcified degenerative aortic stenosis. Case presentation Here we report a case of a 78 tears old female patient who presented six months following transapical TAVI with a pulsatile mass over the left anterior mini thoracotomy wound. Transthoracic echocardiography showed suspicion of a left ventricular apical aneurysm with no evidence of free pericardial fluid.Contrast enhanced CT reported a large pseudo-aneurysm arising from the apex of the left ventricle extending through the left anterior thoracic wall. She was scheduled for emergency surgical exploration via median sternotomy. Upon median sternotomy there were dense pericardial adhesions limiting the mobilization of the heart specially the apex, which necessitated establishment of cardiopulmonary bypass. The heart was arrested, and the dissection was completed. The cavity in connection with the ventricular apex had purulent contents and the site of the TAVI ventriculotomy was secure with the PTFE pledgets in place with no evidence of leakage. Samples of the cavity fluids had pus cells, but no organisms were grown. The patient made an uneventful recovery and was discharged home 6 days postoperatively. Discussion PTFE pledgets are frequently used in cardiac surgery to support surgical closure. These pledgets on a contrast enhanced CT scan can make it difficult to correctly diagnose and may mimic anastomotic leaks as both give similar hyper-dense appearance on contrast enhanced CT scan

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