scholarly journals Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Adriá Rosat ◽  
Ayaya Alonso ◽  
Javier Padilla ◽  
Pablo Sanz ◽  
M. Aránzazu Varona ◽  
...  

Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient’s condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhicheng Zhang ◽  
Xiaowei Huang ◽  
Qian Chen ◽  
Demin Li ◽  
Qi Zhou ◽  
...  

Abstract Background Small intestine duplication cysts (SIDCs) are rare congenital anatomical abnormalities of the digestive tract and a rare cause of hematochezia. Case presentation We describe an adult female presented with recurrent hematochezia. The routine gastric endoscope and colonic endoscope showed no positive findings. Abdominal CT scan indicated intussusception due to the "doughnut" sign, but the patient had no typical symptoms. Two subsequent capsule endoscopes revealed a protruding lesion with bleeding in the distal ileum. Surgical resection was performed and revealed a case of SIDC measuring 6 * 2 cm located inside the ileum cavity. The patient remained symptom-free throughout a 7-year follow-up period. Conclusion SIDCs located inside the enteric cavity can easily be misdiagnosed as intussusception by routine radiologic examinations.


Trauma ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 194-202
Author(s):  
El Yamani Fouda ◽  
Alaa Magdy ◽  
Sameh Hany Emile

Background and aim Selective non-operative management of patients with penetrating abdominal stabs is the preferred treatment strategy. The present study aimed to assess the efficacy and safety of non-operative management with emphasis on the value of follow-up abdominal CT scanning in management of patients with penetrating anterior abdominal stab. Patients and methods This is a retrospective chart review of stable patients with anterior abdominal stab wounds. Patients were divided in terms of initial decisions into two groups: laparotomy group and non-operative management group. Abdominal CT scan was performed for patients in the non-operative management group on admission and follow-up CT scanning was performed in cases of clinical and/or biochemical deterioration. Results The laparotomy group included 82 patients and 68.2% of them had unnecessary laparotomies. The non-operative management group comprised 97 patients and 90.7% of them did not require subsequent laparotomy. Abdominal CT scan had a sensitivity of 88.9% and specificity of 100% in detection of intra-abdominal injuries. Follow-up CT scanning detected bowel injuries missed by initial CT scan in three patients. The non-operative management group had significantly lower post-operative complication rate than the laparotomy group (4.1% vs. 18.3%), with a significantly shorter length of stay. Conclusions Non-operative management is the optimal management strategy for stable patients with penetrating anterior abdominal stab to decrease unnecessary laparotomy rates, hospital stay and costs. Follow-up abdominal CT scanning facilitated the decision making for patients selected for non-operative management and is highly sensitive in the diagnosis of patients who require subsequent exploration.


2019 ◽  
Vol 07 (02) ◽  
pp. E308-E309
Author(s):  
Thomas Walter

AbstractFor the management of diminutive duodenal neuroendocrine tumors (d-NETs), Harshit et al. have proposed – in the work accompanying this editorial – an interesting approach, the endoscopic banding without resection (BWR) technique. Given the risks associated with classic endoscopic resections and surgical procedures, and the likely favorable natural history of diminutive d-NETs, BWR may be an option for these selected patients with a very low risk of LN + and recurrence. However, a close follow-up (endoscopic, EUS and thoraco-abdominal CT scan) is then required to guarantee the safety of this policy.


2015 ◽  
Vol 81 (10) ◽  
pp. 1057-1060 ◽  
Author(s):  
Mohammad Alnoor ◽  
Joshua A. Boys ◽  
Stephanie G. Worrell ◽  
Daniel S. Oh ◽  
Jeffrey A. Hagen ◽  
...  

Gastric adenocarcinoma has a high recurrence rate. The goal of this study was to determine the timing and pattern of recurrence after gastrectomy. A retrospective review was performed of patients with gastric adenocarcinoma having curative partial or total gastrectomy with R0/D2 lymph node resection from 1999 to 2013. Follow-up included CT scans of the chest, abdomen, and pelvis at 3-month intervals for the first three years, at 6-month intervals for the next two years, and annually thereafter. There were 62 patients, 38 males and 24 females, with a median age of 65 years. Median follow-up was 29 months and recurrence was identified in 21 per cent of patients. Median time to recurrence was 12 months and 92 per cent of recurrences occurred within two years. The last recurrence was identified at 34 months. Abdominal CT scan identified all patients with recurrence, although some patients had disease elsewhere in addition to the abdominal disease. There were no extra-abdominal isolated recurrences. In conclusion, recurrence after complete resection for gastric adenocarcinoma typically occurs within the first two years, and can be found by abdominal CT scan. Close cancer follow-up appears unnecessary after three years because all recurrences were identified within 34 months of resection.


Author(s):  
Merab Kiladze ◽  
◽  
Murat Kilic ◽  

Postoperative delayed diaphragmatic hernia (DH) is a rare and uncommon event after adult orthotopic liver transplantation (OLT), which however could be potentially life-threatening complication, especially in the absence of early and correct diagnosis and appropriate surgical treatment. We present a case of 48 year-old male with left diaphragmatic herniation of left part of transverse colon, who thirty nine months before underwent OLT with right-sided allograft implantation and which was recently successfully managed by open abdominal approach in our institution. The postoperative course was uneventful and he was discharged at the 8th day after surgery. Our case illustrates, that delayed DH after the OLT in adults could be a new problem, which affect transplant recipients with long-term follow-up period. Hence, we consider, that once the diagnosis of DH is confirmed, the patient should be operated immediately, in order to avoid the possible life-threatening complications.


2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Asma Ben Ali ◽  
Mohamed Ali Cherif ◽  
Walid Mhajba ◽  
Hamdi Hamdène Doghri ◽  
Malek Hassouna ◽  
...  

Introduction. Mural intestinal hematoma (MIH) is an uncommon complication of anticoagulant therapy. Hemorrhagic shock has been rarely reported as a revealing modality.Results. We report two cases of shock induced by mural intestinal hematoma in patients under oral anticoagulant for aortic prosthetic valve and atrial fibrillation. Patients were admitted to the ICU for gastrointestinal tract bleeding associated with hemodynamic instability. After resuscitation, an abdominal CT scan has confirmed the diagnosis showing an extensive hematoma. Medical treatment was sufficient and there was no need for surgery.Conclusion. Gastrointestinal bleeding associated with shock in patients treated by oral anticoagulant should alert physicians to research a probable MIH. Urgent diagnosis and appropriate medical treatment can avoid surgical interventions.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Rutger Franken ◽  
Martijn Möllers ◽  
Alexander de Mol van Otterloo ◽  
Julien Puylaert

Duodenal diverticula are relatively frequent but complications are uncommon. The mortality rate of perforated duodenal diverticulitis is high, and its management is controversial. We report three patients with a perforated duodenal diverticulitis who were successfully treated with conservative antibiotic therapy. The clinical presentation in all three patients was acute onset of pain in the upper abdomen. In all cases, ultrasound showed no abnormalities, but computed tomography revealed the correct diagnosis. All three were treated with broad-spectrum antibiotics and total parenteral nutrition. They recovered clinically and laboratory findings normalized. During follow-up visit, all patients were asymptomatic. This study contributes another three patients to the small number of successful conservatively treated cases of perforated duodenal diverticulitis described in literature. We suggest that in patients in good condition with no septic signs, conservative treatment with close clinical follow-up should be the treatment of choice.


2020 ◽  
Vol 7 (2) ◽  
pp. 47-53
Author(s):  
Angga Hendro Priyono ◽  
Exsa Hadibrata

ABSTRACT  Background: The incidence of nephrolithiasis in children increases over time. It has been reported an increase of 6 to 10% per year for the last twenty-five years. Research in developing country showed that urinary tract infection and metabolic disorders were the caused of nephrolithiasis. Illustration Case: Three years 10 months old boy had a complaint of pain in plank region followed by tea-like urine since two months ago. Physical examination showed that he appeared to be moderately ill and compos mentis. His physical examinations were normal except positive ballotement and positive costoverebral angle (CVA) pain in the right flank region. Laboratory finding showed positive eritrocyte in urinalysis. Ultrasonography and abdominal CT-scan consistent with nephrolithiasis. Management: Pyelolitotomy was performed under general anesthesia. Postoperatively, patient treated in a pediatric surgery room and observation was carried out. He was given  D5NS 500 ml administered 20 drops per minute microdrip IV, paracetamol 3 x 225 mg IV, and cefotaxime injection 2 x 500 mg IV after a skin test first.  Result and Follow Up: An irregular stone 1,5 cm x 1 cm in size consist of 45% ammonium urate, 31% sodium urate monohydrate, and 24% amorphous calcium phosphate carbonate was found. Discussion: Nephrolithiasis in children occurs due to several related conditions such as genetics, ethnicity, climate, and nutrition. Complications can be prevented by managing and controlling appropriate risk factors.


2017 ◽  
Vol 89 (2) ◽  
pp. 62-65 ◽  
Author(s):  
Arkadiusz Spychała ◽  
Piotr Nowaczyk ◽  
Aleksandra Budnicka ◽  
Ewa Antoniewicz ◽  
Dawid Murawa

The article presents a case report of a patient with an intramural gastric hematoma. Diagnostic examinations were suggestive of a suspected gastrointestinal stromal tumor Normal image was observed in gastroscopic examination while abdominal CT scan revealed a nodular lesion along the greater curvature of the stomach extending from the posterior wall and adjoining the pancreas and the spleen. The patient was qualified for surgical treatment. Laparotomy was performed followed by total gastric resection and Roux-en-Y reconstruction of the gastrointestinal tract. Post-operative histopathological examination revealed the presence of an extensive hematoma penetrating the perigastric fat tissue along with numerous hemosiderinophages and segmental indicators of formation of inflammatory granulation tissue suggestive of a chronic nature of the lesion. Immunohistochemical GIST assays (CD117, DOG-1, CD34, CD31, SMA, S-100, CKAE1/AE3, Ki-67) were negative. No complications were observed in the post-operative course. Patient is subject to continued follow-up and observation. Follow-up gastroscopy and abdominal CT scan performed 6 months after the surgery revealed an unremarkable image.


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