scholarly journals Meckel’s Diverticulitis as a Cause of an Acute Abdomen in the Second Trimester of Pregnancy: Laparoscopic Management

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ivilina Pandeva ◽  
Sumit Kumar ◽  
Atif Alvi ◽  
Hema Nosib
Keyword(s):  
Acute Abdomen ◽  
Clinical Presentation ◽  
Abdominal Cavity ◽  
Diagnosis Delay ◽  
Laparoscopic Management ◽  
Delay In Diagnosis ◽  
Stapler Technique ◽  
Meckel’S Diverticulitis ◽  
Purulent Fluid ◽  
In Pregnancy

Introduction. Meckel’s diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision.Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel’s diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique.Discussion. Meckel’s diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective.

scholarly journals A case report: ruptured primary ovarian abscess in pregnancy

2021 ◽  
Vol 10 (9) ◽  
pp. 3627
Author(s):  
Dinesh D. Pratapwar ◽  
Namdev M. Bhure ◽  
Sarika P. Zunjare
Keyword(s):  
Diagnostic Laparoscopy ◽  
Clinical Presentation ◽  
Definitive Diagnosis ◽  
Rare Entity ◽  
Diagnostic Dilemma ◽  
Minimally Invasive Surgical Procedure ◽  
Delay In Diagnosis ◽  
Minimally Invasive Surgical ◽  
Ovarian Abscess ◽  
In Pregnancy

Primary ovarian abscess during pregnancy is a very rare entity.  The clinical presentation is very vague and hence can be a diagnostic dilemma. Diagnostic laparoscopy gives a definitive diagnosis and an opportunity to treat the entity in same settings. Herein we discussed a case of a ruptured primary ovarian abscess in pregnancy which was successfully managed by laparoscopy. Ovarian abscess is different from tubo-ovarian abscess. A delay in diagnosis may be associated with risk of maternal death and can be detrimental to the fetus also. Surgical drainage of ovarian abscess and conservative and minimally invasive surgical procedure under antibiotics are recommended during pregnancy.

scholarly journals Small Bowel Obstruction due to Meckel's Diverticulitis Presenting in pregnancy

The Physician ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. 1-4
Author(s):  
Chaitra Naik Khanna ◽  
Paul Richard Harris ◽  
Gemma Faulkner
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Gravid Uterus ◽  
Second Trimester ◽  
Ileal Loop ◽  
Stapling Device ◽  
Delay In Diagnosis ◽  
Meckel’S Diverticulitis ◽  
In Pregnancy

Meckel’s diverticulitis is an extremely rare cause of acute abdomen during pregnancy. Depending on the clinical presentation it can be managed either by laparoscopy or laparotomy. We report the case of a 29-year-old pregnant female, presenting with abdominal pain and distension in the early second trimester. The abdominal ultrasound was inconclusive. Magnetic resonance imaging showed small bowel obstruction with a dilated ileal loop due to an inflamed Meckel’s diverticulum adherent to the fundus of the gravid uterus was identified during laparotomy. Diverticular resection was carried out with a stapling device. The diagnosis of Meckel’s diverticulitis can be challenging, especially in pregnancy, and a delay in diagnosis can be detrimental to the mother and foetus. Although laparoscopic management has been reported to be safe in the second trimester, in this case, the abdominal distension would have made access challenging and unsafe, and hence the decision to perform a laparotomy was taken. 

scholarly journals Acute abdomen in pregnancy: a case series on clinical presentation and diagnostic dilemma

2021 ◽  
Vol 10 (2) ◽  
pp. 742
Author(s):  
G. R. Abhirami ◽  
Chennaiahgari Sathyavani ◽  
Ravi N. Patil
Keyword(s):  
Pregnant Women ◽  
Acute Abdomen ◽  
Clinical Presentation ◽  
Case Series ◽  
Diagnostic Dilemma ◽  
Pain Abdomen ◽  
Fetal Complications ◽  
Magnetic Resonance Imaging Mri ◽  
Challenging Situation ◽  
In Pregnancy

Acute abdomen in pregnancy remains one of the most challenging situation in regard with the diagnosis and management. Pregnancy is a unique state in which the female body undergoes both anatomical and physiological changes which can pose a challenge in diagnosis. This may result in delay in management and increase in maternal and fetal morbidity and mortality. This study was to identify the spectrum of causes, the clinical presentation and diagnostic dilemma of acute abdomen in pregnancy. It was an observational study was done over a period of 3 years which included all the pregnant women who presented with acute abdomen. In this study, eighteen pregnant women presented with acute abdomen. Among the study group, 5.5%, 50% and 44.5% presented in first, second and third trimester respectively. The diagnosis included acute appendicitis in 11.1%, acute cholecystitis in 16.6%, acute pancreatitis in 16.6%, malrotation in 11.1%, uterine rupture 11.1%, rudimentary horn rupture in 22.4% and ovarian cyst torsion in 11.1%. The clinical presentation included pain abdomen (16.6%), pain abdomen and vomiting (44.4%), pain abdomen in shock (39%) and abdominal tenderness (33.3%). The diagnosis was confirmed with ultrasonography in 55.6%, 11.1% women required higher imaging like magnetic resonance imaging (MRI) and 33.3% women were diagnosed on table. Majority of them had good outcome, but there was one maternal mortality (6%). Diagnosis and treatment of acute abdomen in pregnancy should be individualized. Good clinical acumen is essential for ordering early diagnostic test in acute abdomen in pregnancy. Appropriate intervention should be undertaken at the earliest to reduce the maternal and fetal complications. 

scholarly journals AB0664 DIAGNOSIS DELAY IN ANKYLOSING SPONDYLITIS PATIENTS IN EGYPT: FACTORS, SOCIOECONOMIC AND CLINICAL OUTCOME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1627.2-1627
Author(s):  
F. I. Abdelrahman ◽  
M. Mortada
Keyword(s):  
Ankylosing Spondylitis ◽  
Social Life ◽  
Activity Index ◽  
Diagnostic Delay ◽  
Disease Activity Index ◽  
Diagnosis Delay ◽  
Functional Index ◽  
Delay In Diagnosis ◽  
Significant Difference ◽  
The Mean

Background:Ankylosing spondylitis (AS) is a destructive inflammatory disease which was reported to have the longest diagnostic delay among the inflammatory rheumatic disease. This lag period have a great impact on the clinical outcome and socioeconomic state of the patients. With the advent of tumor necrosis factor-α (TNF-α) inhibitors, early diagnosis in AS has become important(1).Objectives:to evaluate the period from symptom onset to diagnosis of AS in Egyptian patients and to examine possible reasons for delayed diagnosis and its impact on the economic and social life of the patients.Methods:The study included 87 AS patients diagnosed according to the Assessment of Spondyloarthritis international Society (ASAS) criteria (2). A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first AS symptom and correct diagnosis of AS. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated by Egyptian pound.Results:The study included 87 AS patients with mean age (30.03±8.3), 70 male (80.5%) and 17 female (19.5%).Mean delay in diagnosis was(5.7 ±4.9) years. Mean of diagnostic delay for patient diagnosed before 2010 is (14±4.4) and that of patients diagnosed after 2010 is (3.5±1.8) with significant difference between both (p value<0.0001). The main cause of delay was incorrect diagnosis as follow degenerative disc disease (43/87, 49.4%), non-specific back pain (31/87, 35.6%), rheumatoid arthritis (10/87,11.5%), rheumatic fever (2/87, 2.3%) and tuberculosis of spine (1/87, 1.1%). The mean of the medical visits was (6±5.4). Most incorrect initial diagnoses were made by orthopedicians (57.9%), followed by neurologists (22.2%) followed by rheumatologist (10%) and general phyisicians (9.9%). Absence of extra-articular manifestations, negative family history and juvenile age are significantly associated with diagnostic delay. Delay in diagnosis is significantly associated with higher disease activity index(BASDAI), functional index (BASFI), and damage index(BASMI). The mean of the costs during years of delay is (15671.3±546.1) with the mean of cost per each year delay (660.9±6.6) with high significant association between the cost and longer delay in diagnosis (<0.0001). Regarding work ability, we found that(32.2%) are fit for work, unfit (29.9%), partially fit (37.9%) with high significant difference between ability of work and shorter delay. Regarding social effect, 40.2 % of patients developed negative effect on social life with significant association to diagnostic delay (0.004).Conclusion:Our study confirmed the importance of early diagnosis of AS due to its impact on patient’s health outcome and socioeconomic state.We recommend to increase the awareness about the disease among healthcare professionals in our region.References:[1]Sykes M. et al: Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; Ann Rheum Dis.2015;74:e44.[2]Rudwaleit M. et al: The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis; Ann Rheum Dis, 68 (2009), pp.777-783.Disclosure of Interests:None declared

scholarly journals Subungual Glomus Tumor- Clinical Presentation And Treatment

2014 ◽  
Vol 3 (2) ◽  
pp. 45-48 ◽  
Author(s):  
Shyamal Chandra Debnath ◽  
Suman Kumar Roy ◽  
RR Kairy
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Tumor ◽  
Clinical Presentation ◽  
Glomus Tumor ◽  
Rare Condition ◽  
Surgical Excision ◽  
Tissue Mass ◽  
Delay In Diagnosis ◽  
Nail Deformity

Glomus tumor is a rare condition and constitutes only 1 % of all soft tissue tumor of body. Glomus tumor is familiar for its unusual presentation and long standing symptoms due to delay in diagnosis. Authors have presented the clinical behavior and treatment of 7 patients with subungual soft tissue mass. Following surgical excision, all patients cured of symptoms, at the end of follow up, no recurrence occurred; post operative nail deformity was insignificant. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18250 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 45-48

scholarly journals A rare acute abdomen case in pregnancy: myoma torsion

2018 ◽  
Vol 1 (2) ◽  
pp. 23-25
Author(s):  
Kemal Dinç ◽  
Tekin Ekinci ◽  
Barış Çıplak ◽  
Rezzan Erguvan Önal ◽  
Mustafa Şahin
Keyword(s):  
Acute Abdomen ◽  
In Pregnancy

scholarly journals Perforated Meckel’s Diverticulitis in a Patient with Unknown Intestinal Malrotation: Clinical Pitfall

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Marie Burgard ◽  
Floryn Cherbanyk ◽  
François Pugin ◽  
Bernhard Egger
Keyword(s):  
Acute Appendicitis ◽  
Clinical Presentation ◽  
Final Diagnosis ◽  
Intestinal Malrotation ◽  
Radiological Imaging ◽  
Atypical Clinical Presentation ◽  
Lower Abdominal Quadrant ◽  
Meckel’S Diverticulitis ◽  
The Right ◽  
Abdominal Quadrant

Symptomatic Meckel’s diverticulum is rare in adults. The most frequent complications are intestinal obstruction and diverticulitis. Diagnosis of Meckel’s diverticulitis can be challenging due to nonspecific clinical manifestation of pain in the right lower abdominal quadrant, mimicking acute appendicitis. If associated with congenital malformation, such as intestinal malrotation, the anomalous anatomy makes the diagnosis even more challenging. In such cases, radiological imaging is essential to guide further management. We present a case of Meckel’s diverticulitis in which physicians were initially misguided because of the atypical clinical presentation. Yet, anamnestic details directed to a potential underlying malformation, leading to supplementary radiological examination and the final diagnosis.

scholarly journals Huge symptomatic pedunculated uterine fibroid in pregnancy: Antepartum myomectomy and term delivery at a specialist hospital in Kano, Nigeria

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Iman Usman Haruna ◽  
Jamilu Tukur ◽  
Idris Usman Takai ◽  
Abdullahi Mustapha Miko Mohammed ◽  
Ali Abdurrahman Bunawa
Keyword(s):  
Caesarean Section ◽  
Acute Abdomen ◽  
Live Birth ◽  
Uterine Fibroid ◽  
Recent Literature ◽  
Caesarian Section ◽  
Term Delivery ◽  
In Pregnancy

Myomas are common in pregnancy and can go unnoticed. One in ten patients, however, develops complications that would necessitate their removal. Myomectomy performed at caesarian section had come to the lime light over the last decade and recent literature have shown its safety. There is still paucity of literature on myomectomy performed during pregnancy. Our case was a 25 years old primigravida at 21 weeks with features of acute abdomen secondary to uterine fibroid which was diagnosed during pregnancy. She subsequently had antepartum myomectomy and a live birth at term via caesarean section.

scholarly journals Necrotizing sarcoid granulomatosis with clinical presentations of recurrent acute abdomen. Case report and literature review

2017 ◽  
Vol 89 (11) ◽  
pp. 60-68 ◽  
Author(s):  
V I Vasilyev ◽  
S G Palshina ◽  
B D Chaltsev ◽  
S G Radenska-Lopovok ◽  
T N Safonova
Keyword(s):  
Acute Abdomen ◽  
Clinical Laboratory ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
High Dose ◽  
Drug Induced ◽  
Serological Tests ◽  
Surgical Interventions ◽  
First Case ◽  
Clinical Presentations

The authors have described the world’s first case of necrotizing sarcoid granulomatosis (NSG) in a 22-year-old woman with the clinical presentations of acute abdomen, which are associated with abdominal lymph nodal infiltration and necrosis, obvious constitutional disturbances (fever, nocturnal sweats, and significant weight loss), high inflammatory activity (anemia, leukocytosis, high erythrocyte sedimentation rates and C-reactive protein levels), the gradual appearance of splenic and hepatic necrotic foci, and infiltration into the lung and lacrimal glands with the development of unilateral uveitis. The patient underwent five surgical interventions, several needle biopsies for recurrent abdominal syndrome, and long-term antibiotic treatment for presumed sepsis, which had caused drug-induced hepatitis. Bacteriological examination of blood, puncture samples, and removed abdominal cavity tissues, serological tests, and immunomorphogical study of biopsy samples and removed tissues yielded negative results for the presence of bacterial, fungal, and tuberculosis infections. NSG was diagnosed on the basis of the systemic nature of the lesion, the presence of granulomas with severe abdominal lymph nodal necrosis and necrotizing granulomatous/lymphocytic vasculitis in the mesentery and removed spleen, as well as the absence of granulomas in the spleen, appendix, and biopsy materials of the liver, colonic mucosa, and parotid gland. Fludarabine therapy was first used in world practice due to the inefficient treatment with high-dose glucocorticoids and cyclophosphamide and to a disease relapse when reducing their doses. The paper gives a detailed review of the literature on the clinical, laboratory, radiological, and morphological manifestations of the disease, which allow the differential diagnosis of NSG with different variants of granulomatous lesions. Based on the 5-year follow-up of the patient and on the analysis of clinical, laboratory, radiological, and morphological changes, the authors uphold the concept that the disease is an independent nosological entity: necrotizing angiitis with sarcoid reactions, rather than the entity of nodular or classic sarcoidosis.

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