Laceration of the transverse mesocolon in an old man with a habit of abdominal massage for constipation: a case report

Abstract Background Abdominal massage for the resolution of constipation has been reported to be safe and recommended in some studies. It is conventionally performed for the elderly suffering from intractable constipation. Meantime, isolated mesenteric injury after blunt abdominal trauma is uncommon. Here, we report a case of isolated mesenteric injury following self-abdominal massage for constipation. Case presentation A 68-year-old man consulted a local hospital due to a sudden abdominal pain. He had a history of prostate cancer treated with radiation therapy 3 years ago, and he had been suffering from chronic constipation for many years. A plain computed tomography (CT) revealed a fist-sized homogeneous mass-like lesion located in the left upper abdomen and a moderate amount of ascites. With the initial diagnosis of a malignant tumor accompanied by peritonitis carcinomatosa, he was hospitalized for further examinations. On the next day, his hemoglobin concentration dropped from 11.6 to 6.6 g/dl, and diagnostic paracentesis showed bloody ascites. He was urgently transferred to our tertiary emergency center. An enhanced CT demonstrated a non-enhanced, homogeneous, 8.5 cm in diameter, mass lesion located to the posterior of the stomach with massive bloody ascites. He underwent an emergency exploratory laparotomy, and it showed a 5 cm of laceration in the transverse mesocolon adjacent to Treitz’s ligament and approximately 1.5 l of intraabdominal hemorrhage. Hemostasis of the bleeding from the laceration was achieved by suture ligations, but the gap of the laceration could not be closed by suturing because the tissue was too fragile. Blood transfusion with 4 units of packed red blood cells and 10 units of fresh frozen plasma was performed during operation. He was discharged without any significant complications except for postoperative paralytic ileus. Later on, it turned out that he had a habit of massaging his abdomen for the resolution of intractable constipation and did it hard 1 day before the onset. Conclusions This is the first report of life-threatening mesenteric injury caused by self-abdominal massage to resolve constipation, though other etiologies such as rupture of small aneurysms could not perfectly be excluded. Abdominal massage is reported to be effective and safe for the resolution of constipation; however, this case demonstrated it could be detrimental.

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Primary Papillary Serous Carcinoma of the Peritoneum

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v8i2.9774 ◽

2014 ◽

Vol 8 (2) ◽

pp. 60-62

Author(s):

NM Jayakumar ◽

PS Sangam ◽

VU Grampurohit ◽

AF Myagery

Keyword(s):

Exploratory Laparotomy ◽

Serous Carcinoma ◽

Ovarian Malignancy ◽

Simple Cyst ◽

Rare Type ◽

Moderate Amount ◽

Obstetrics And Gynaecology ◽

Pain Abdomen ◽

Eosinophilic Cytoplasm ◽

Papillary Serous Carcinoma

Primary papillary serous carcinoma of peritoneum (PPSCP) is a rare type of primary peritoneal adenocarcinoma and is clinico-histopathologically indistinguishable from primary ovarian papillary serous carcinoma. A 70 -year- female presented with pain abdomen of 4 months duration. On examination partially mobile vague mass was present in the suprapubic region. Exploratory laparotomy revealed normal right ovary and the left ovary showed simple cyst. Nodular, firm tumour was seen arising from omentum and measured 20x13x9.3 cm. Microscopically tumour was composed of large sheets of polygonal cells having large hyperchromatic and pleomorphic nuclei and moderate amount of eosinophilic cytoplasm forming cribriform pattern and papillae. It has similar prognosis as that of ovarian malignancy. This case of extraovarian papillary serous carcinoma of peritoneum (EPSCP) is presented here for its rarity.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 60-62 DOI: http://dx.doi.org/10.3126/njog.v8i2.9774

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The importance of anemia and health-related quality of life in the elderly

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2020.v39.135-149 ◽

2020 ◽

Vol 39 (2) ◽

pp. 135

Author(s):

Raditya Wratsangka ◽

Rully Ayu Nirmalasari Haryadi Putri

Keyword(s):

Quality Of Life ◽

Hemoglobin Concentration ◽

The Elderly ◽

World Population ◽

Health Related Quality ◽

Wide Range ◽

Related Quality ◽

Health Related ◽

The Impact

Anemia is a global health problem with an extremely high prevalence and occurring in nearly 25% of the world population, particularly in the elderly group. Currently Indonesia is facing a rapid growth of the elderly population, with around 21 million elderly (8.2% of the total population), that is projected to increase to 33.7 million (11.8%) in the year 2025. Anemia in the elderly is frequently neglected, although the facts show that low hemoglobin concentration is an important marker of physiological decline and functional limitations. Although the factor of intrinsic aging may cause low hemoglobin concentration, anemia in the elderly is known to have a wide range w88ith regard to etiology, underlying disorders, and possible mechanisms, such that it should be clinically followed up. Whatever its causes or underlying pathophysiological, anemia in the elderly has been proven to play a role in their morbidity and mortality, and may decrease their quality of life, that comprises all aspects of physical, mental, and social health, known as health-related quality of life (HRQoL). The impact of anemia on HRQoL has been studied in various populations, and most studies report the presence of an association between HRQoL and anemia in elderly individuals, which on the subscale level is particularly associated with physical health. Early diagnosis of anemia is important to prevent aggravation of the condition, to retard the progress of the disease, and to improve the health-related quality of life (HRQoL) of the patient. Prior to determining the treatment plan, the primary diagnosis and the comorbidities, especially treatable disorders, had better be identified first. The available data show that the overall prognosis will improve for anemia in patients with well-managed and corrected chronic disorders.

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Isolated intestinal polyarteritis nodosa in an elderly patient

BMJ Case Reports ◽

10.1136/bcr-2020-241431 ◽

2021 ◽

Vol 14 (3) ◽

pp. e241431

Author(s):

Ariana González-Meléndez ◽

Eduardo J Medina-Parrilla ◽

Román Vélez ◽

Luis M Vilá

Keyword(s):

Abdominal Pain ◽

Polyarteritis Nodosa ◽

Elderly Population ◽

Systemic Vasculitis ◽

Exploratory Laparotomy ◽

The Elderly ◽

High Dose ◽

Systemic Involvement ◽

Intestinal Pseudo Obstruction ◽

Single Organ

Polyarteritis nodosa (PAN) is a necrotising systemic vasculitis involving medium-sized and small-sized vessels. PAN limited to a single organ is rare, particularly in the elderly population. Herein, we present a 73-year-old-woman who developed severe abdominal pain. Mesenteric angiography showed multifocal areas of segmental dilation and narrowing of the superior mesenteric, ileocolic and right colonic arteries. Exploratory laparotomy revealed multiple areas of necrosis of the jejunum for which resection was performed. Histopathological exam disclosed mesenteric vasculitis with fibrinoid necrosis of the arterial wall with leucocytic infiltrates and haemorrhages consistent with PAN. She was started on high-dose corticosteroids with an initial good response. However, 6 months later, she developed intestinal pseudo-obstruction for which oral cyclophosphamide was started. After 5 months of cyclophosphamide therapy, she remained stable without further relapses. Our case suggests that PAN should be considered in elderly patients presenting with abdominal pain even in the absence of systemic involvement.

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952 When A Surgeon Was Called to The Obstetric Unit: A Rare Case of Gonococcal Peritonitis in A 12-Week Pregnancy

British Journal of Surgery ◽

10.1093/bjs/znab259.342 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Ann Jacob ◽

L Jacob

Keyword(s):

Septic Shock ◽

Peritoneal Fluid ◽

Abdominal Cavity ◽

Exploratory Laparotomy ◽

General Surgeon ◽

Emergency Laparotomy ◽

Intrauterine Pregnancy ◽

Moderate Amount ◽

Purulent Fluid ◽

Fluid Culture

Abstract Background Primary bacterial peritonitis presenting as septic shock is infrequently seen in clinical practice. This is a case of gonococcal peritonitis presenting as septic shock in a pregnant lady needing emergency laparotomy, drainage of purulent fluid and abdominal lavage. Case Presentation A 35-year-old woman presented with severe generalised abdominal pain. No history of fever, vomiting, urinary or bowel complaints. She was in her 4th pregnancy, at 12-weeks gestation. She was afebrile but tachycardic and hypotensive. Abdomen was tender and there was no vaginal bleeding. Ultrasound scan showed minimal fluid in hepatorenal area and a viable intrauterine pregnancy. Differential diagnosis were ruptured appendix, ectopic pregnancy, acute abdomen and shock. Exploratory laparotomy was done. Moderate amount of purulent fluid was noted within the abdominal cavity and no bleeding was seen. General surgeon was called for assistance by the Obstetrician as no foci of infection was found. The uterus, fallopian tubes, ovaries, appendix, bowel and upper abdominal organs were found to be intact. Peritoneal fluid culture was taken. Drainage of purulent fluid and peritoneal wash was done. She was nursed in ICU because of peritonitis with septic shock and AKI. Peritoneal fluid culture showed Neisseria gonorrhoea and IV ceftriaxone was given for 7 days. Postoperatively she recovered well but needed evacuation of uterus for a missed miscarriage. She was screened for other STIs and were negative. Discussion Gonorrhoea is the second most common reported STI. It can present as acute peritonitis when the infection has spread beyond upper reproductive tract organs.

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Incidental Diagnosis of Pseudomyxoma Peritonei After Emergent Splenectomy

The American Surgeon ◽

10.1177/0003134820954822 ◽

2020 ◽

pp. 000313482095482

Author(s):

Alexandra C. Ferre ◽

Matthew Burstein ◽

Kevin M. El-Hayek

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Pseudomyxoma Peritonei ◽

Exploratory Laparotomy ◽

Histological Evaluation ◽

Splenic Trauma ◽

Computed Tomography Imaging ◽

Moderate Amount ◽

Tomography Imaging ◽

Unexpected Findings

Pseudomyxoma peritonei (PMP) is a rare disease associated with mucinous ascites. Pseudomyxoma peritonei has a low incidence and is difficult to diagnose. Pseudomyxoma peritonei usually presents with vague abdominal pain after significant progression. Computed tomography imaging is the most common modality for diagnosis; however, diagnosis as a result of surgical intervention in cases of acute abdomen has become increasingly common. We present a unique case of a 66-year-old man who was incidentally diagnosed with PMP after undergoing an emergent splenectomy for presumed blunt trauma. The patient presented to the emergency room with abdominal pain, shortness of breath, and diaphoresis. Computed tomography imaging revealed a splenic hematoma with suspicion of extravasation and a moderate amount of free intraperitoneal fluid consistent with blood. The patient was taken to the operating room emergently for an emergent splenectomy where splenic laceration was noted, as were multiple areas of nodularity in the omentum and cecum. Histologic evaluation of these lesions led to the diagnosis of PMP. After recovery from his initial splenectomy, the patient underwent exploratory laparotomy, cytoreductive surgery, cholecystectomy, removal of appendiceal mucocele, and hyperthermic intraperitoneal chemotherapy without complication. Final pathology was consistent with PMP and primary mucinous appendiceal adenocarcinoma. This case highlights an unusual presentation of PMP for a patient who was undergoing surgery for presumed splenic trauma. Surgeons must maintain a high index of suspicion and should perform histological evaluation when such unexpected findings are encountered.

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Descriptive study of all Danish patients undergoing emergency exploratory laparotomies in the period 2003–2014

Scandinavian Journal of Public Health ◽

10.1177/1403494819875271 ◽

2020 ◽

Vol 48 (3) ◽

pp. 243-249

Author(s):

Sarah A. Toftlund ◽

Ismail Gögenur ◽

Lau C. Thygesen

Keyword(s):

High Risk ◽

Exploratory Laparotomy ◽

The Elderly ◽

Descriptive Study ◽

Small Sample ◽

Logistic Regression Models ◽

Number Of Patients ◽

National Patient ◽

Study Population ◽

Small Sample Sizes

Aim: Emergency exploratory laparotomy is a high-risk procedure, but most studies are based on small sample sizes, and no nationwide studies have reported the number of patients and the mortality risk. This descriptive study reports the prevalence, incidence and 30- and 365-day mortality of all patients undergoing emergency exploratory laparotomies in Denmark from 2003 to 2014. Methods: The study population is based on the Danish National Patient Register, which includes all patient contacts with Danish hospitals, including patients undergoing emergency surgery. All patients were followed in registers on mortality. Rates and proportions were estimated using Poisson and logistic regression models. Results: The number of prevalent patients was 15,330 through the period (2003–2014) of whom 13,795 were incident patients. Prevalence increased with age and peaked at 1% for the 80- to 84-year-old age group. The overall incidence was 27 per 100,000 person-years, which strongly increased with age (87 per 100,000 person-years among men and 85 per 100,000 person-years among women). The 30-day mortality was 16.5% and the 365-day mortality was 23.1%. Both increased strongly with age and did not improve over the study period. Both 30- and 365-day mortality were higher among unmarried patients compared to married patients. Conclusions: Emergency exploratory laparotomies are common high-risk procedures especially for the elderly population. These results can be used to focus on better postoperative care to reduce the mortality.

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Positive Seatbelt Sign with Avulsed Leiomyoma following Motor Vehicle Accident Leading to Hemoperitoneum

Case Reports in Emergency Medicine ◽

10.1155/2018/4251408 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Martin A. C. Manoukian ◽

Amode R. Tembhekar ◽

Sarah E. Medeiros

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Accident ◽

Incidental Finding ◽

Major Complication ◽

Exploratory Laparotomy ◽

Fresh Frozen Plasma ◽

Reproductive Age ◽

Packed Red Blood Cells ◽

Vehicle Accident ◽

Increased Risk

A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata. Upon exploratory laparotomy, a free-floating intraperitoneal mass was identified as an avulsed uterine leiomyoma. A uterine laceration containing a subserosal leiomyoma was also identified. The gynecological team was consulted, and a myomectomy of the subserosal leiomyoma followed by a closure of the uterine laceration was performed. The patient was transfused with a total of three units of packed red blood cells and two units of fresh frozen plasma. The postoperative course was without major complication. A positive seatbelt sign and hemoperitoneum in a reproductive-age woman with leiomyomata should increase the clinical suspicion for uterine injury and decrease the threshold for obtaining a gynecological consultation.

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Bouveret’s Syndrome: A Case Report and a Brief Literature Review

Acta Médica Portuguesa ◽

10.20344/amp.11664 ◽

2020 ◽

Vol 33 (5) ◽

pp. 347

Author(s):

Rita Peixoto ◽

Joana Correia ◽

Mário Guimarães Soares ◽

António Gouveia

Keyword(s):

Case Report ◽

Diagnostic Tests ◽

Gallstone Ileus ◽

Outlet Obstruction ◽

Exploratory Laparotomy ◽

The Elderly ◽

Cholecystoduodenal Fistula ◽

Bouveret’S Syndrome ◽

Clinical Surveillance ◽

Bouveret's Syndrome

Bouveret’s syndrome is a rare cause of gastric outlet obstruction. We report a case of a 68-year-old woman admitted with upper digestive obstruction. A few months later, and after several diagnostic tests and clinical surveillance, a cholecystoduodenal fistula was suspected. During exploratory laparotomy, the diagnosis of Bouveret’s syndrome was confirmed and a pyelolithotomy, pyloroplasty and a cholecystectomy were performed. The patient was asymptomatic 7 months after the operation. This syndrome represents only 1% - 3% of all cases of gallstone ileus, being more frequent in women and in the elderly. The presentation is quite nonspecific, but in most cases the symptomatology suggests an upper digestive occlusion. Treatment can be achieved by lithotripsy, but most patients require a surgical approach.

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Non Puerperal Uterine Inversion Secondary to Submucosal Fibroid: A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49825.15143 ◽

2021 ◽

Author(s):

Nilaj Bagde ◽

Sefali Shinde ◽

Vinita Singh ◽

Rahul Satarkar ◽

Habung Yarang

Keyword(s):

Exploratory Laparotomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Packed Red Blood Cells ◽

Submucous Myoma ◽

Uterine Inversion ◽

Satisfactory Condition ◽

Fibroid Polyp ◽

Uncommon Condition ◽

Vaginal Canal

Non Puerperal Uterine Inversion (NPUI) is a very uncommon condition. The incidence of puerparal uterine inversion make an estimate of 1/30,000 deliveries and NPUI approximately 17% of all uterine inversion. The most common cause which leads to uterine inversion is a submucous myoma attached to the fundus but diagnosis can be difficult to make. The management of uterine inversion is always challenging for a surgeon. In the present case a 38-year-old woman, presented with significant anaemia because of menorrhagia. She used to feel mass occasionally into the vaginal canal which never comes out of the introitus, the mass was elucidated as a fibroid polyp. On investigation, her haemoglobin was 6.6 gm%, with continous bleeding per vaginum, patient was transfused with three units packed red blood cells and planned for surgery. A diagnosis of incomplete uterine inversion secondary to a submucous fibroid was made at exploratory laparotomy. Total abdominal hysterectomy, right salpingectomy with left salpingo-oophorectomy was performed. The patient was discharged under satisfactory condition.

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Epidemiological, clinical, and laboratory findings for patients of different age groups with confirmed coronavirus disease 2019 (COVID-19) in a hospital in Saudi Arabia

PLoS ONE ◽

10.1371/journal.pone.0250955 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250955

Author(s):

Mutasim E. Ibrahim ◽

Obaid S. AL-Aklobi ◽

Mosleh M. Abomughaid ◽

Mushabab A. Al-Ghamdi

Keyword(s):

Saudi Arabia ◽

Laboratory Data ◽

Age Groups ◽

Clinical Manifestations ◽

Hemoglobin Concentration ◽

The Elderly ◽

Laboratory Findings ◽

Reactive Protein ◽

Creatine Kinase Mb ◽

D Dimer

Background Although the coronavirus disease 2019 (COVID-19) pandemic continues to rage worldwide, clinical and laboratory studies of this disease have been limited in many countries. We investigated the epidemiologic, clinical, and laboratory findings of COVID-19 infected patients to identify the effective indicators correlated with the disease. Methods A retrospective study was conducted at King Abdullah Hospital in Bisha Province, Saudi Arabia, from March 20 to June 30, 2020. Patients of different age groups were confirmed as having COVID-19 infection using a real-time polymerase chain reaction. The demographic, clinical, and laboratory data of the patients were statistically analyzed. Results Of the 132 patients, 85 were male and 47 were female, with a mean age of 50.9 years (SD±16.7). The patients were elderly (n = 29) and adults (n = 103). Of these, 54 (40.9%) had comorbidities, (25%) were admitted to the intensive care unit (ICU), and 12 (9.1%) died. On admission, the main clinical manifestations were fever (84.1%), cough (64.4%), shortness of breath (25%), chest pain (20.5%), and fatigue (18.2%). In all patients, increased neutrophils and decreased lymphocytes were observed. Patients’ lactate dehydrogenase (LDH) was elevated. C-reactive protein (CRP) was elevated in 48.5%, D-dimer in 43.2%, and the erythrocyte sedimentation rate (ESR) in 40.9% of patients. The elderly showed higher neutrophil (p = 0.011) and lower lymphocyte (p = 0.009) counts than adults. Glucose, creatine kinase-MB, LDH, bilirubin, D-dimer, and ESR were significantly higher in the elderly than in the adults. The COVID-19 death group had a higher leucocyte count (p = 0.036), and higher urea (p = 0.029) and potassium (p = 0.022) than the recovered group but had a lower hemoglobin concentration (p = 0.018). A significant association was determined between COVID-19 death and the presence of cardiovascular disease (χ2(1) = 16.297, p<0.001), hypertension (χ2(1) = 12.034, p = 0.001), renal failure (χ2(1) = 3.843, p = 0. 05), old age (t (130) = 4.9, p <0.001), and ICU admission (χ2(1) = 17.6 (1), p<0.001). Conclusions Investigating some of the laboratory and clinical parameters could help assess the disease progression, risk of mortality, and follow up patients who could progress to a fatal condition.

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