scholarly journals Gastroduodenal Emphysema with Portal Venous Air due to Congenital Duodenal Web in a Child: A Case Report and Review of Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Mihiri Chami Wettasinghe ◽  
Shanthini Rosairo ◽  
Samantha Kiriwattuduwa ◽  
Nuwan Darshana Wickramasinghe
Keyword(s):  
Duodenal Obstruction ◽  
Gastric Wall ◽  
Abdominal Distension ◽  
Duodenal Wall ◽  
Emergency Laparotomy ◽  
Contrast Study ◽  
Imaging Features ◽  
Rare Presentation ◽  
Duodenal Web ◽  
Portal Venous Air

Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent 
peristalsis against the duodenal membrane, there is progressive stretching of the duodenal web leading to windsock deformity. We describe a rare case of a child with gastroduodenal emphysema and portal venous air due to duodenal obstruction secondary to a duodenal web. An eighteen-month-old male child, who was under investigation for failure to thrive, presented with a history of persistent projectile vomiting and progressive abdominal distension for two days. The abdominal ultrasound scan revealed air within the portal vein and in the wall of the stomach. Plain X-ray abdomen confirmed the presence of gas in the gastric wall and in the proximal duodenal wall. Upper gastrointestinal contrast study revealed complete obstruction at the second part of the duodenum. The child underwent emergency laparotomy, which revealed a duodenal web as the cause of the duodenal obstruction. During the surgery, windsock deformity was noted. This case illustrates that although rare, proximal duodenal obstruction due to duodenal web may present in early childhood and that alarming imaging features such as gastric emphysema and portal venous air could be associated with benign conditions.

scholarly journals Rupture Spleen as Initial Presentation in A Patient of Chronic Myeloid Leukaemia: A Case Report

2016 ◽  
Vol 13 (2) ◽  
pp. 52-54
Author(s):  
Mohammad Ibrahim Khalil ◽  
Md. Nazmul Islam ◽  
Mafruha Akter ◽  
AZM Mostaque Hossain ◽  
Md. Amir Hossain
Keyword(s):  
Chronic Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Female Student ◽  
Care Center ◽  
Chronic Phase ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Rare Presentation ◽  
Health Care Center ◽  
Common Presentation

A 22 years female student presented with sudden severe abdominal pain in left upper quadrant followed by abdominal distension. She attended in surgery unit of a tertiary health care center. On examination she was in shock and the abdomen was distended, tender. She was evaluated as  surgical acute abdomen and emergency laparotomy revealed rupture of spleen and splenectomy was done. Her CBC showed gross leucocytosis with predominance of neutrophils and significant number of myelocytes and the PBF showed the features of chronic phase of chronic myeloid leukaemia. BCR-ABL was positive from bone marrow that confirms the diagnosis. Splenomegaly is a common presentation of CML. However spontaneous rupture of spleen is a very rare presentation of CML. Journal of Science Foundation, 2015;13(2):52-54DOI: http://dx.doi.org/10.3329/jsf.v13i2.27935

Delayed presentation of a congenital duodenal web managed successfully with incision of web

2020 ◽  
Vol 13 (12) ◽  
pp. e237307
Author(s):  
Mahendra Kumar Jangid ◽  
Reyaz Ahmad ◽  
Sujeet Pandre
Keyword(s):  
Abdominal Pain ◽  
Duodenal Obstruction ◽  
Accurate Diagnosis ◽  
Unusual Presentation ◽  
Contrast Study ◽  
Delayed Presentation ◽  
History Of ◽  
Duodenal Web ◽  
High Index Of Suspicion ◽  
The Web

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.

scholarly journals Congenital Duodenal Obstruction, Situs Inversus Totalis, and Gastric Perforation in a Neonate

2017 ◽  
Vol 6 (2) ◽  
pp. 35 ◽  
Author(s):  
Rajat Piplani ◽  
Samir Kant Acharya ◽  
Deepak Bagga
Keyword(s):  
Situs Inversus ◽  
Duodenal Obstruction ◽  
Gastric Perforation ◽  
Duodenal Atresia ◽  
Situs Inversus Totalis ◽  
Contrast Study ◽  
Congenital Duodenal Obstruction ◽  
Duodenal Web ◽  
Lesser Curvature

We report a rare case of incomplete congenital duodenal obstruction (Type 1 duodenal atresia) in association with situs inversus totalis presenting with gastric perforation in a neonate. The infantogram was suggestive of perforation with air under diaphragm along with dextrocardia. On exploration, a pin point perforation at fundus near lesser curvature along with situs inversus was noted. Primary closure of gastric perforation was done. Patient was then discharged on full breast feeds but was readmitted with intolerance to feeds and recurrent bilious vomiting. Further, upper GI contrast study revealed partial duodenal obstruction. On re-exploration, duodenal web with central aperture was seen and duodeno-duodenostomy was done.

scholarly journals Atraumatic Ruptured Giant Renal Tumor

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Gezahen Negusse Ayane ◽  
Khutsafalo Kadimo
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Tumor ◽  
Left Kidney ◽  
Papillary Renal Cell Carcinoma ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Rare Presentation ◽  
Keywords Renal Cell Carcinoma

Massive hemoperitoneum due to spontaneous rupture of renal cell carcinoma is a rare presentation during emergency laparotomy. A 60-year-old female patient presented with severe abdominal pain, nausea, vomiting and abdominal distension. A massive hemoperitoneum secondary to ruptured left kidney tumor was found during laparotomy. Histology confirmed a papillary renal cell carcinoma. Ruptured renal cell carcinoma can be a cause of bleeding into the retroperitoneum space. Emergency sonography and laparotomy are advocated for its management. Keywords: Renal cell carcinoma, Rupture, Complex mass, Nephrectomy, Papillary

scholarly journals Imaging pearls of the annular pancreas on antenatal scan and its diagnostic dilemma: A case report

2020 ◽  
Vol 9 ◽  
pp. 27
Author(s):  
Pradeep Kumar Roul ◽  
Ashish Kaushik ◽  
Manish Kumar Gupta ◽  
Poonam Sherwani
Keyword(s):  
Duodenal Obstruction ◽  
Fetal Mri ◽  
Annular Pancreas ◽  
Therapeutic Interventions ◽  
Contrast Study ◽  
Imaging Features ◽  
Double Bubble ◽  
Diagnostic Dilemma ◽  
Antenatal Period ◽  
Antenatal Ultrasonography

Background: Annular pancreas is an uncommon cause of duodenal obstruction and rarely causes complete duodenal obstruction. Due to its rarity of identification in the antenatal period and overlapping imaging features with other causes of duodenal obstruction; it is often misdiagnosed. Case presentation: A 33-year-old primigravida came for routine antenatal ultrasonography at 28 weeks and 4 days of gestational age. On antenatal ultrasonography, dilated duodenum and stomach were seen giving a double bubble sign and a hyperechoic band surrounding the duodenum. Associated polyhydramnios was also present. Fetal MRI was also done. Postpartum ultrasonography demonstrated pancreatic tissue surrounding the duodenum. The upper gastrointestinal contrast study showed a non-passage of contrast beyond the second part of the duodenum. Due to symptoms of obstruction, the neonate was operated on, and the underlying cause was found to be the annular pancreas. Conclusion: Diagnosis of duodenal obstruction due to the annular pancreas is very important in the antenatal period to plan for appropriate therapeutic interventions after birth. A double bubble sign is seen due to various etiologies however the presence of a hyperechoic band in the antenatal ultrasound may point to the diagnosis of the annular pancreas.

scholarly journals Perforated diverticulitis in a patient with very proximal jejunal diverticula

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Constantinos Avgoustou ◽  
Dimitrios Velecheris
Keyword(s):  
Abdominal Distension ◽  
Perforated Diverticulitis ◽  
Jejunal Loop ◽  
Emergency Laparotomy ◽  
Rebound Tenderness ◽  
Cardiac Arrythmias ◽  
Cardiopulmonary Support ◽  
Abdomen Ct ◽  
Fluid Levels ◽  
Jejunal Diverticulitis

Background: We report a case of an elderly with peritonitis due to perforated jejunal diverticulitis, and we highlight the diagnostic evaluation and treatment alternatives. Case presentation: A 92-year-old woman was transferred to the Emergency Dept. with abdominal pain and vomiting for the past 12 hours. Physical examination revealed diffuse pain, abdominal distension, rebound tenderness and bowel silence. She was febrile, tachycardic, tachypneic, hypotensive and anuric. Blood gas estimation showed metabolic acidosis. She fulfilled the criteria of septic shock. At presentation, she was mildly malnourished. From her medical history, she had cardiac arrythmias, hypertension and diabetes mellitus under proper medication, and laparoscopic cholecystectomy. Laboratory investigations revealed Hct 44.6%, WBC 12.500/dL, glucose 300 mg/dL, creatinine 2.8 mg/dL, CRP 405 mg/L, and electrolyte deficit. Abdominal X-ray showed gastric, small intestinal and colonic gas, with no pneumoperitoneum or air-fluid levels. Chest/abdomen CT showed thickening of proximal jejunal loop and adjacent mesentery, and an extraluminal air bubble, suggesting possible perforation. The patient was given intense resuscitation and broad-spectrum antibiotics and underwent emergency laparotomy. Results: Four jejunal diverticula, sized 1-3 cm, were confined to a segment 12 cm long, located 6 cm from the Treitz ligament; the proximal diverticula was inflamed and perforated. The adjacent mesentery was inflamed and thickened; the bowel lumen remained open. We performed one-layer full-thickness suturing of the perforated diverticulum and omental patch closure. The patient was transferred intubated to ICU. E. Coli was isolated from peritoneal fluid cultures and antibiotic therapy was adjusted to antibiogram. The patient had a first bowel movement at day 5 and was extubated at day 21. She needed mild cardiopulmonary support and was discharged at day 30. Conclusions: Jejunal diverticulitis is a challenging disorder since its rarity makes diagnosis difficult and, thus delayed. The perforation of jejunal diverticulitis requires emergent surgery and poses technical dilemmas.

scholarly journals Intra-abdominal Solitary Myofibroma in a Child: A Rare Case Report

2021 ◽  
Author(s):  
Smita Singh ◽  
Jyoti Garg ◽  
Kusha Sharma ◽  
Kiran Agarwal
Keyword(s):  
Histopathological Examination ◽  
Smooth Muscle Actin ◽  
Iliac Fossa ◽  
Correct Diagnosis ◽  
Neck Region ◽  
Abdominal Distension ◽  
Malignant Tumours ◽  
Rare Presentation ◽  
Anaplastic Lymphoma ◽  
Abdominal Masses

Intra-abdominal masses in children are usually malignant. Benign tumours at this location are not seen frequently. It is even rarer to find solitary myofibromas intra-abdominally as these tumours are known to have predilection for the head and neck region. We present an unusual case of solitary myofibroma with abdominal localisation in a six-year-old male child who presented with abdominal distension since six months. Computed Tomography (CT) abdomen revealed a complex solid-cystic mass extending from umbilicus to right iliac fossa and measuring 9×6×4 cm. Histopathological examination revealed a tumour displaying biphasic nodular pattern with the presence of lighter staining fascicles of mature myoid cells along with darker staining and more cellular areas of smaller primitive cells. On Immunohistochemistry (IHC), tumour cells were positive for vimentin and Smooth Muscle Actin (SMA) with variable reactivity for desmin while these were negative for CD34 and Anaplastic Lymphoma Kinase 1 (ALK). Based on the histopathological and immunohistochemical findings, final diagnosis of myofibroma was made. Recognition of these lesions is extremely challenging owing to their rare presentation intra-abdominally and also because of their close morphological overlap with other spindle cell tumours commonly found at this site. This case highlights the combined role played by histopathology and IHC in making a clear distinction between different entities. It is imperative for both clinicians and histopathologists to establish the correct diagnosis as excision of the solitary myofibroma is curative in most cases and offers better clinical course than the more commonly found malignant tumours at this site.

scholarly journals Intramural Duodenal Hematoma In 2-year Old Child

2018 ◽  
Vol 9 (3) ◽  
pp. 18
Author(s):  
Dayanand Hota ◽  
Kamal Nain Rattan ◽  
Ahmad Khursheed ◽  
Manish Swami ◽  
Harish Bhardwaj
Keyword(s):  
Duodenal Obstruction ◽  
Intramural Hematoma ◽  
Abdominal Distension ◽  
Rare Entity ◽  
Diagnostic Dilemma ◽  
X Ray ◽  
Duodenal Hematoma ◽  
High Degree ◽  
High Intestinal Obstruction ◽  
Head Of Pancreas

Background: Intramural hematoma of the duodenum is a rare cause of acquired duodenal obstruction. It is often a diagnostic dilemma and a high degree of suspicion is required to make an early and accurate diagnosis in children. Case Report: A 2-year-old child presented with bilious vomiting and abdominal distension. X-ray abdomen showed high intestinal obstruction. Ultrasound and CT scan abdomen gave suspicion of pancreatic pseudo-cyst near head of pancreas. At surgery, an intramural hematoma of the duodenum was found and drained. Conclusion: Intramural duodenal hematoma is a rare entity especially in children and should be considered in differential diagnosis of acquired duodenal obstruction.

scholarly journals Diagnostic Dilemma of a Rare, Giant Retroperitoneal Schwannoma: A Case Report and Review of Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Mahendra Singh ◽  
Lovekesh Kumar ◽  
Rajkumar Chejara ◽  
Om Prakash Prasad ◽  
Yuvraj Kolhe ◽  
...  
Keyword(s):  
Low Frequency ◽  
Surgical Excision ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Postoperative Recovery ◽  
Cystic Mass ◽  
Imaging Features ◽  
Diagnostic Dilemma ◽  
Complete Surgical Excision ◽  
Retroperitoneal Schwannoma

Schwannoma is a benign tumour of peripheral nerve sheath. It usually arises from head, neck, and trunk. Retroperitoneal schwannoma is a rare entity, accounting for only 0.3–3% of total schwannomas. Majority of retroperitoneal schwannomas reported in literature have a diameter of 5 to 15 cm. Preoperative diagnosis is difficult due to low frequency, nonspecific clinical course, and nonspecific imaging features. Histology usually provides definitive diagnosis. Schwannomas are solitary, well-circumscribed, and noninvasive, so complete surgical excision provides good result. We report a case of a 23-year-old male, who presented with progressive abdominal distension and intermittent episodes of intestinal obstruction. CECT was suggestive of huge solid-cystic mass in abdominopelvic region. Image guided percutaneous aspiration revealed around 1 litre of frank pus and FNAC was suggestive of abscess. Exploratory laparotomy revealed a large 32 × 28 × 26 cm mass with solid and cystic components containing 1 litre of pus. Histological features of tumour were suggestive of benign schwannoma and immunohistochemistry for S-100 was positive. Postoperative recovery was uneventful. We report this case of a retroperitoneal schwannoma because of giant size, rare location, unusual presentation, and diagnostic dilemma.

Sign in / Sign up

Export Citation Format

Share Document