Gangrenous Cholecystitis From Gallbladder Volvulus With a Hiatal Hernia

2022 ◽  
pp. 000313482110547
Author(s):  
Charles W. Armistead ◽  
Lauren E. Favors ◽  
Vincente A. Mejia
Keyword(s):  
Hiatal Hernia ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Acute Onset ◽  
Wall Thickening ◽  
Laboratory Studies ◽  
High Clinical Suspicion ◽  
Complete Work ◽  
Work Up ◽  
Distended Gallbladder

Gallbladder volvulus is a rare condition involving the rotation of the gallbladder about the cystic duct and vascular pedicle, compromising biliary drainage and blood flow. This report describes a case of gallbladder volvulus presenting in an 88-year-old female with acute onset of right upper quadrant abdominal pain, nausea, and vomiting. Complete work-up included a physical exam, laboratory studies, and computed tomography (CT), which was notable for a markedly distended gallbladder with circumferential wall thickening, pericholecystic fluid, a 12 mm common bile duct, and a hiatal hernia. Given that her initial presentation was consistent with acute cholecystitis, we elected to perform laparoscopic cholecystectomy. The definitive diagnosis of gallbladder volvulus was made intraoperatively after decompression of the gallbladder and visualization of counterclockwise rotation of the gallbladder around the hilum and the infundibulum. This case illustrates the challenge in preoperative diagnosis of gallbladder volvulus, which requires high clinical suspicion to provide prompt surgical intervention.

scholarly journals Gallbladder Volvulus Presenting as Acute Appendicitis

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Zachary Bauman ◽  
John Ruggero ◽  
John Lim
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Surgical Intervention ◽  
Clinical Suspicion ◽  
Initial Presentation ◽  
Definite Diagnosis ◽  
High Clinical Suspicion ◽  
Complete Work ◽  
Work Up ◽  
Intraoperative Visualization

We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.

scholarly journals Haemoptysis as the first presentation of COVID-19: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Elise Peys ◽  
Dieter Stevens ◽  
Yannick Vande Weygaerde ◽  
Thomas Malfait ◽  
Laurens Hermie ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Left Lung ◽  
Acute Onset ◽  
Added Value ◽  
Alveolar Haemorrhage ◽  
High Clinical Suspicion ◽  
Massive Haemoptysis ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up

Abstract Background Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that profoundly challenges healthcare systems all over the world. Fever, cough and fatigue are the most commonly reported clinical symptoms. Case presentation A 58-year-old man presented at the emergency department with acute onset haemoptysis. On the fifth day after admission, he developed massive haemoptysis. Computed tomography (CT) angiography of the chest revealed alveolar haemorrhage, more prominent in the left lung. Flexible bronchoscopy confirmed bleeding from the left upper lobe, confirmed by a bronchial arteriography, which was successfully embolized. Nasopharyngeal swabs (NPS) tested for SARS-CoV-2 using real-time polymerase chain reaction (RT-PCR) repeatedly returned negative. Surprisingly, SARS-CoV-2 was eventually detected in bronchoalveolar lavage (BAL) fluid. Conclusions Life-threatening haemoptysis is an unusual presentation of COVID-19, reflecting alveolar bleeding as a rare but possible complication. This case emphasises the added value of bronchoscopy with BAL in the diagnostic work-up in case of high clinical suspicion and negative serial NPS in patients presenting with severe symptoms.

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

Eagle Syndrome: an underdiagnosed cause of orofacial pain

2021 ◽  
Vol 14 (1) ◽  
pp. e238161
Author(s):  
João Ferreira de Barros ◽  
Maria Vieira Rodrigues ◽  
Leonor Aurélio Barroso ◽  
Isabel Cruz Amado
Keyword(s):  
Orofacial Pain ◽  
Rare Condition ◽  
Styloid Process ◽  
High Clinical Suspicion ◽  
Body Sensation ◽  
Cervical Approach ◽  
Considerable Length ◽  
Eagle Syndrome

Eagle Syndrome (ES), also termed stylohyoid syndrome or styloid syndrome, is a rare condition characterised by a cluster of symptoms related to an elongation of the styloid process (SP) of the temporal bone. These may range from mild pharyngeal foreign body sensation and dysphagia to severe orofacial pain. High clinical suspicion is necessary owing to the unspecific clinical picture and limited diagnostic clues. Until a definitive diagnosis is achieved, these patients may develop symptoms which significantly impact their quality of life. The aim of this article is to report a case of ES in which a considerable length of SP was documented. Diagnosis was made years after the initial complaints and several medical workups by different specialties. Surgical resection of the elongated process by cervical approach was the adopted treatment modality. Patient recovery and follow-up was satisfactory, with remission of the afflicting symptoms.

Tracheoinnominate fistula: surgical management of an iatrogenic disaster

2006 ◽  
Vol 120 (8) ◽  
pp. 676-680 ◽  
Author(s):  
R W Ridley ◽  
J B Zwischenberger
Keyword(s):  
Operating Room ◽  
Surgical Management ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Pectoralis Major Muscle ◽  
Muscle Flap ◽  
Rare Condition ◽  
Innominate Artery ◽  
Significant Potential ◽  
High Index Of Suspicion

Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.

Spontaneous renal artery dissection: an elusive diagnosis

2021 ◽  
Vol 14 (9) ◽  
pp. e245949
Author(s):  
Catherine Mary Henry ◽  
Peter MacEneaney ◽  
Gemma Browne
Keyword(s):  
Renal Artery ◽  
Antihypertensive Treatment ◽  
Rare Condition ◽  
Acute Onset ◽  
Flank Pain ◽  
Artery Dissection ◽  
Renal Infarction ◽  
Ct Angiogram ◽  
Systemic Anticoagulation ◽  
The Right

Spontaneous renal artery dissection is a rare condition with an often non-specific presentation, resulting in a challenging diagnosis for clinicians. This is the case of a 39-year-old man who presented with an acute-onset right flank pain, mild neutrophilia and sterile urine. CT of abdomen and pelvis showed a patchy hypodense area in the right kidney originally thought to represent infection. He was treated as an atypical pyelonephritis with antibiotics and fluids. When his symptoms failed to improve, a diagnosis of renal infarction was considered and CT angiogram of the aorta revealed a spontaneous renal artery dissection. He was managed conservatively with systemic anticoagulation, antihypertensive treatment and analgesia and discharged home with resolution of his symptoms and normal renal function.

scholarly journals Metastatic adrenal pheochromocytoma to the thoracic spine

2010 ◽  
Vol 9 (3) ◽  
pp. 343-346 ◽  
Author(s):  
Michael T. Scalfani ◽  
Paul M. Arnold ◽  
Karen K. Anderson
Keyword(s):  
Differential Diagnosis ◽  
Surgical Intervention ◽  
Hepatic Metastases ◽  
Posterior Fixation ◽  
Original Diagnosis ◽  
Average Survival ◽  
Progression Of Disease ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Work Up

To report on a case of pheochromocytoma metastases to the spine occurring more than 20 years after initial diagnosis. A 34-year-old female with a history of metastatic pheochromocytoma diagnosed at age 12 presented with weakness, heart palpitations, and circumferential back pain of five months duration. The patient had undergone multiple laparatomies for abdominal and hepatic metastases. Work-up revealed a destructive lesion at T9. After two weeks of preoperative phenoxybenzamine to control her hypertension, she underwent decompression, posterior fixation and fusion. Surgical intervention was followed by radiation therapy, zoledronic acid, and only one cycle of chemotherapy due to intolerance of side effects. The patient survived 25 years after original diagnosis, which far exceeds the average survival of less than 15 years. The patient died 26 months postoperatively due to progression of disease. Pheochromocytoma with spine metastases occurring more than 20 years after diagnosis is very uncommon, and should be considered in the differential diagnosis of a patient with a history of pheochromocytoma.

scholarly journals Suspected botulism outbreak after the consumption of vegetarian pâté in the south of Viet Nam

2021 ◽  
Vol 5 ◽  
pp. 257
Author(s):  
Le Quoc Hung ◽  
Vo Ngoc Anh Tho ◽  
Do Thi Ngoc Khanh ◽  
Vo Thi Thanh Hien ◽  
Jeremy N. Day ◽  
...  
Keyword(s):  
Early Recognition ◽  
Specific Treatment ◽  
Case Series ◽  
Acute Onset ◽  
Viet Nam ◽  
Food Hygiene ◽  
High Clinical Suspicion ◽  
Cranial Nerve Palsies ◽  
Life Threatening ◽  
Botulinum Neurotoxins

Botulism and other botulinum neurotoxins-producing clostridia  are potentially life-threatening diseases caused by toxins produced by Clostridium botulinum. Here we reported a case series of six patients who presented with botulism following ingestion of commercially made pâté. The key features of presentation were acute onset of bilateral cranial nerve palsies and symmetrical descending weakness in the absence of fever resulting in the need for mechanical ventilation in all six patients. The clinical diagnosis of botulism was confirmed through the identification of C. botulinum from the suspected food source.  Given that botulinum antitoxin was not available in Vietnam at the time, and their severe status, all patients received a trial of plasma exchange therapy, but no clear benefit was seen. Due to its rarity, diagnosing botulism is a challenge, demanding high clinical suspicion. Successful outcomes depend upon early recognition and rapid initiation of specific treatment with botulinum antitoxin. There is a need to improve global access to antitoxin.  These cases, the first in Viet Nam, serve as a reminder of the need to maintain the highest possible food hygiene and preservation practices.

scholarly journals A Case of Neonatal Marfan Syndrome: A Management Conundrum and the Role of a Multidisciplinary Team

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Elliott J. Carande ◽  
Samuel J. Bilton ◽  
Satish Adwani
Keyword(s):  
Marfan Syndrome ◽  
Surgical Intervention ◽  
Rare Condition ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Cardiac Complications ◽  
Chromosome 15 ◽  
Fibrillin 1 ◽  
Neonatal Marfan Syndrome

Neonatal Marfan syndrome (nMFS) is a rare condition with a poor prognosis. It is genotypically and phenotypically distinct from the typical Marfan syndrome and carries a poorer prognosis. This case report describes the progression of a 14-month-old girl diagnosed with nMFS at 5 months of age. Her diagnosis followed the identification of a fibrillin-1 mutation (FBN1gene, exon 26, chromosome 15), which is a common locus of nMFS. This patient developed severe cardiac complications resulting in congestive cardiac failure in early life and required major cardiac surgery. Since surgical intervention, our patient is still reliant on a degree of ventilator support, but the patient has gained weight and echocardiography has demonstrated improved left ventricular function and improved tricuspid and mitral valve regurgitation. Therefore, we argue the importance of a cautious multidisciplinary approach to early surgical intervention in cases of nMFS.

Platypnoea-orthodeoxia syndrome: the importance of the patient’s posture for diagnosis

2021 ◽  
Vol 14 (6) ◽  
pp. e243210
Author(s):  
Carla Pereira Fontes ◽  
Samuel Barbosa Fonseca ◽  
Mário Santos
Keyword(s):  
Transthoracic Echocardiography ◽  
Rare Condition ◽  
Definitive Diagnosis ◽  
Clinical Suspicion ◽  
Oxygen Desaturation ◽  
Arterial Oxygen ◽  
Common Cause ◽  
Intracardiac Shunt ◽  
High Clinical Suspicion ◽  
Functional Components

Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by the association of dyspnoea and arterial oxygen desaturation induced by standing and relieved by recumbency. The precise mechanism remains poorly understood, but it appears to involve both anatomical and functional components producing a significant right-to-left shunting under certain postural conditions. This syndrome is associated with either intracardiac or extracardiac aetiologies, and the diagnosis depends on high clinical suspicion. Intracardiac shunt is the most common cause of POS and can be identified through echocardiography with bubble study. We report the case of a patient with POS secondary to a paradoxical shunt through the patent foramen oval, whose definitive diagnosis was only possible with contrasted transthoracic echocardiography in the sitting and standing positions.

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