Portal venous gas in intestinal malrotation with mild midgut volvulus

Abstract Background Portal venous gas has been considered as a radiological sign requiring urgent operative intervention; however, the reports concerning portal venous gas associated with favorable outcome are recently increasing. Case presentation We describe a 9-month-old boy with acute onset high fever and vomiting. The ultrasonography demonstrated micro-gas bubbles continuously floating in the intrahepatic portal vein. Contrast-enhanced CT, performed 1 h later from echography, revealed a whirlpool sign suggesting an intestinal malrotation with midgut volvulus, but with no signs of residual intrahepatic gas. Operative findings showed a mild volvulus with neither congestion nor ischemic change of the twisted bowel. Detorsion and Ladd’s procedure were completed laparoscopically. Conclusions Transient portal venous gas bubbles may be generated even in the mild intestinal volvulus with no bowel ischemia. Ultrasonography can be a sensitive detector to visualize such small amounts of gas.

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Ectopic Perforated Appendicitis in Supraumbilical Region in a Case of Incomplete Intestinal Rotation

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/516 ◽

2021 ◽

Vol 10 (31) ◽

pp. 2521-2524

Author(s):

Bhimarao Bhimarao ◽

Rashmi Mysore Nagaraju ◽

Lingaraj B. Patil

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Perforated Appendicitis ◽

Intestinal Malrotation ◽

Emergency Laparotomy ◽

Markers Of Inflammation ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Common Causes ◽

Uncommon Condition

Acute appendicitis is one of the most common causes of acute abdominal pain and the most common condition requiring emergency surgery. Intestinal malrotation is a relatively uncommon condition. Depending upon the location of the cecum and appendix, patients with acute appendicitis in intestinal malrotation present atypically with abdominal pain localized on the site of appendicitis. Due to atypical presentation of central abdominal pain, other differentials presenting in this region should be excluded and accurate diagnosis should be made. We present a patient who came with central abdominal pain with elevated markers of inflammation. Contrast enhanced CT of abdomen in this patient revealed ectopic appendicitis located in supraumbilical region with signs of incomplete rotation of the bowel. CT played a pivotal role in identifying the underlying rotational abnormality of bowel, in localizing the inflamed appendix, identifying complications (perforation) and excluding other possible intra-abdominal pathologies. It was also helpful in surgical planning. Emergency laparotomy with appendectomy and lavage were performed on this patient who subsequently recovered.

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Intestinal malrotation with solitary jejunal diverticulum presenting as midgut volvulus in an adult: an unusual presentation

International Surgery Journal ◽

10.18203/2349-2902.isj20212745 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2231

Author(s):

Debarghya Chatterjee ◽

Subrat Kumar Raul ◽

Elisheba Patras

Keyword(s):

Abdominal Pain ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Intestinal Malrotation ◽

Midgut Volvulus ◽

Rare Entity ◽

Intermittent Abdominal Pain ◽

Post Operative Period ◽

Jejunal Diverticulum ◽

Whirlpool Sign

Intestinal malrotation with midgut volvulus presenting in adults is a rare entity, and association with jejunal diverticulum is rarer still. Herein, we report and review such a case of malrotation and volvulus, associated with intestinal band adhesions and a solitary jejunal diverticulum. This 67 years old gentleman had presented with complaints of intermittent abdominal pain for past several years. Imaging of the abdomen revealed twisting of superior mesenteric artery and vein, evidence of midgut volvulus and intestinal malrotation with “whirlpool sign”. Laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery and a jejunal diverticulum. Adhesiolysis was performed, untwisting of the bowel was done and the jejunal diverticulum was resected. Post-operative period was uneventful. This case is being reported on account of its extreme rarity.

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Diagnostic computed tomography in acute interscapular pain

Heart ◽

10.1136/heartjnl-2019-315821 ◽

2019 ◽

Vol 106 (2) ◽

pp. 126-163

Author(s):

Shruti S Joshi ◽

Mardi Hamra ◽

David E Newby

Keyword(s):

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Venous Pressure ◽

Sudden Onset ◽

Acute Onset ◽

Left Ventricular ◽

List Type ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Clinical introductionA man in his 60s with no medical history presented with sudden-onset, severe interscapular pain. He was in circulatory shock with a blood pressure of 65/30 mm Hg, heart rate of 115 beats per minute, respiratory rate of 32 breaths per minute and a room air oxygen saturation of 89%. Examination demonstrated weak peripheral pulses, an elevated jugular venous pressure, faint dual heart sounds, no cardiac murmurs and bilateral lung crepitations. An ECG was recorded which showed a broad QRS (figure 1A). There were no previous ECGs to compare this with. In view of his presentation with acute-onset interscapular pain, CT of the aorta was organised by the emergency department clinicians (figure 1B–D). After the CT result was obtained, the on-call cardiologist was contacted and a bedside echocardiogram performed. This demonstrated severe left ventricular systolic dysfunction with akinesia of the apex and lateral walls. The patient was then transferred to the catheter laboratory for an emergency invasive coronary angiogram.Figure 1ECG and CT images at presentation (A) 12 lead ECG. (B) Contrast enhanced CT aorta - coronal view. (C) Contrast enhanced CT aorta - axial view. (D) CT aorta showing 4 chamber view of the heart.What is the most likely diagnosis?Pulmonary embolism.Aortic dissection.Acute myocardial infarction.Cardiac tamponade.

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Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

10.21203/rs.3.rs-533515/v1 ◽

2021 ◽

Author(s):

Naohiro Yoshida ◽

Yoshihiko Sadakari ◽

Kazuhito Tamehiro ◽

Kazuma Ohkawara ◽

Hiroyuki Nakane ◽

...

Keyword(s):

Surgical Treatment ◽

Pneumatosis Intestinalis ◽

Bowel Ischemia ◽

Portal Venous Gas ◽

Ct Findings ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Relationship ◽

Group 1

Abstract Background: Contrast-enhanced computed tomography (CT) is a reliable diagnostic tool often used to investigate the etiology of portal venous gas (PVG) and pneumatosis intestinalis (PI). However, there are few reports that offer an analysis of the relationship between particular CT findings and clinical outcomes. In this paper, we sought to close that gap and present the results of our analyses that reveal which CT findings are correlated with life-threatening cases.Methods: 39 patients were diagnosed with PVG or PI from contrast-enhanced CT scans and underwent treatment at St. Mary’s Hospital from January 2009 to December 2018. We reviewed patients’ medical charts, laboratory data, and CT scan images retrospectively. We defined cases resulting in operation or death as group 1, and patients with conservative treatment who survived as group 2. We then analyzed the relationship between each CT finding and clinical feature.Results: The primary underlying diseases identified for PVG and PI were bowel ischemia (13/39), enteritis (9/39), constipation (5/39), iatrogenic disease (4/39), and hemodialysis (3/39). Poor enhancement of the intestinal wall and extrahepatic venous gas were correlated with bowel ischemia (p=0.0002 and p=0.0003, respectively). Free air was less correlated with bowel ischemia (p=0.02). Wall thickness was correlated with enteritis (p=0.02). Mortality in cases with bowel ischemia and perforation was quite high (60%) even if patients underwent surgery (33.3%). Conversely, patients with enteritis, constipation, hemodialysis and gastric dilatation who did not require surgery resulted in more favorable outcomes with conservative treatment. In the multivariate analysis, extra hepatic venous gas was the only solitary factor correlated with group 1 (p=0.0008).Conclusions: Extra hepatic venous gas was the strongest predictive factor of clinical outcome in contrast-enhanced CT findings correlated with bowel ischemia and required surgical treatment. The other CT findings were useful in diagnosing the underlying disease, but were not correlated with clinical outcomes. The necessity for surgical treatment remains dependent on the root cause.

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Quadriplegia and rhabdomyolysis as a presenting feature of Conn’s syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-234686 ◽

2021 ◽

Vol 14 (1) ◽

pp. e234686

Author(s):

Sumanth Kollipara ◽

Shruthi Ravindra ◽

Kanthilatha Pai ◽

Sahana Shetty

Keyword(s):

Adrenal Adenoma ◽

Secondary Hypertension ◽

Acute Onset ◽

Conn’S Syndrome ◽

Presenting Symptoms ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Accelerated Hypertension ◽

Biochemical Evaluation ◽

Elevated Creatinine

Conn’s syndrome is an important endocrine cause for secondary hypertension. Hypokalaemia paralysis and rhabdomyolysis with accelerated hypertension may be the presenting symptoms of Conn’s syndrome. Here, we present one such case of a 38-year-old woman presenting with accelerated hypertension and acute onset quadriplegia. On biochemical evaluation, she was found to have severe hypokalaemia, metabolic alkalosis and elevated creatinine phosphokinase. Further evaluation revealed an elevated aldosterone renin ratio suggestive of primary hyperaldosteronism which was localised to left adrenal adenoma on contrast-enhanced CT. Patient’s blood pressure and serum potassium levels normalised after resection of the adrenal adenoma.

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Appendicular abscess masquerading as right testicular mass

BMJ Case Reports ◽

10.1136/bcr-2018-229038 ◽

2019 ◽

Vol 12 (5) ◽

pp. e229038

Author(s):

Pon Rachel Vedamanickam

Keyword(s):

Spermatic Cord ◽

Iliac Fossa ◽

Acute Onset ◽

Testicular Mass ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right

A 38-year-old man presented with an acute onset of pain and swelling of the right testis. On examination, he was tender in the right iliac fossa (RIF) with a grossly enlarged and tender right testis. Ultrasonography and contrast-enhanced CT of the abdomen and pelvis revealed right epididymo-orchitis, a bulky and inflamed right spermatic cord and a well- defined, thick-walled collection in the RIF.

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Sinonasal polyposis complicated with extradural abscess and lateral rectus palsy

BMJ Case Reports ◽

10.1136/bcr-2021-242667 ◽

2021 ◽

Vol 14 (5) ◽

pp. e242667

Author(s):

Aswin Chandran ◽

Harithraa Cheniappangoundar Baskar ◽

Anup Singh ◽

Rajeev Kumar

Keyword(s):

Nasal Polyposis ◽

Early Recognition ◽

Clinical Findings ◽

Acute Onset ◽

Mortality And Morbidity ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

High Index Of Suspicion ◽

Orbital Complications

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.

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