scholarly journals Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass

2013 ◽  
Vol 95 (4) ◽  
pp. e1-e3 ◽  
Author(s):  
MP Thomas ◽  
SK Avula ◽  
R England ◽  
L Stevenson
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Diagnostic Imaging ◽  
Imaging Modality ◽  
Iliac Fossa ◽  
Abdominal Mass ◽  
Spigelian Hernia ◽  
Emergency Setting ◽  
Rare Type ◽  
Emergency Presentation

Spigelian hernias are a rare type of hernia through the Spigelian aponeurosis, whose contents commonly include omentum or small bowel. In the absence of incarceration or strangulation, they can be difficult to diagnose clinically. In the emergency setting, they can present rarely as a painful abdominal mass and computed tomography provides a reliable diagnostic imaging modality. We report an emergency presentation of a Spigelian hernia containing the appendix.

Concurrent Spigelian and Grynfeltt-Lesshaft Hernias

2021 ◽  
pp. 000313482110562
Author(s):  
Ryan M. Huttinger ◽  
Matthew S. Kazaleh ◽  
Dylan J. Skinner ◽  
Marsha C. Nelson
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Synthetic Mesh ◽  
Accurate Diagnosis ◽  
Spigelian Hernia ◽  
Lower Quadrant ◽  
Superior Lumbar Triangle ◽  
Lumbar Triangle ◽  
Right Lower Quadrant

Only 0.12% to 2% of diagnosed hernias are Spigelian type. Even less frequently encountered—Grynfeltt-Lesshaft hernias—hernias have unknown incidence. A Spigelian hernia is encountered along the Spigelian fascia and Grynfeltt-Lesshaft hernias are bounded by the superior lumbar triangle. These unique hernias can both be intermuscular, given their anatomical borders which allow concealment and preclusion of accurate diagnosis. Here, an 86-year-old male presented with symptoms consistent with small bowel obstruction. On physical exam, a right lower quadrant hernia and right posterior flank mass were appreciated. Computed tomography revealed obstruction secondary to bowel incarceration within Spigelian hernia and additional Grynfeltt-Lesshaft hernia. The patient underwent reduction and repair of Spigelian hernia with synthetic mesh, while repair of asymptomatic hernia was deferred. These unusual hernias are difficult to distinguish, given their negligible occurrence and unreliable exam findings. Clinicians must remain cognizant of their features to aid in diagnosis and mitigate potential sequelae.

scholarly journals Inferior epigastric artery pseudoaneurysms

2015 ◽  
Vol 97 (4) ◽  
pp. 255-258 ◽  
Author(s):  
KJ Edwards ◽  
SK Avula ◽  
BDH Babu ◽  
RA England
Keyword(s):  
Computed Tomography ◽  
Imaging Modality ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Clinical Importance ◽  
Surgical Excision ◽  
Haemodynamic Instability ◽  
Inferior Epigastric Artery ◽  
Percutaneous Procedures ◽  
Epigastric Artery

IntroductionInferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication.MethodsWe describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000.FindingsThe main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique.ConclusionsThe incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.

Use of ultrasonography by veterinary surgeons in small animal clinical emergencies

Ultrasound ◽  
2012 ◽  
Vol 20 (2) ◽  
pp. 77-81 ◽  
Author(s):  
Panagiotis Mantis
Keyword(s):  
Computed Tomography ◽  
Veterinary Medicine ◽  
Imaging Modality ◽  
Small Animal ◽  
Emergency Setting ◽  
Limited Availability ◽  
Veterinary Surgeons ◽  
Thoracic And Abdominal

Computed tomography may be the imaging modality of choice for diagnosing haemorrhage after trauma; however, it has limited availability in veterinary medicine, requires sedation or anaesthesia to restrain the animal, and is expensive. Ultrasound, in many situations, offers a portable, rapid and economic alternative. This article reviews the use of ultrasound by veterinary surgeons in the emergency setting. Both thoracic and abdominal applications are described.

scholarly journals EP.WE.641Spectrum of Right Iliac Fossa Pain Presentation and Management During the First COVID-19 Lockdown: A Single Institution Experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Salman Bodla ◽  
Chinedu Ndegbu
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Imaging ◽  
Imaging Modality ◽  
Iliac Fossa ◽  
Management Approach ◽  
Conservative Approach ◽  
Diagnosis Rate ◽  
Right Iliac Fossa Pain ◽  
Management Approaches ◽  
Surgical Unit

Abstract Aims Acute surgical presentations and management approaches have witnessed a changing pattern occasioned by COVID-19 pandemic and attendant lockdown. We report the spectrum of right iliac fossa (RIF) pain referrals and management trend within an acute surgical unit before and during the National lockdown. Methods A retrospective review of all patients referred to the acute surgical unit with RIF pain before and during first National lockdown was undertaken. Patients managed during these periods were segregated into Pre-Lockdown (January-2020) and Lockdown (April/May-2020) cohorts. Relevant data were obtained from patients’ electronic medical records and main outcome measures compared between both arms were definitive diagnosis, rate of acute appendicitis, diagnostic imaging modality utilised, management approach and post-operative 30-day complications. Results RIF pain referrals were fewer (17% vs. 23%, P = 0.045) but more likely to be related to acute appendicitis during the lockdown (52% vs. 28%, P = 0.002). However, the risk of presenting with complicated appendicitis did not alter significantly (26% vs. 19%, RR = 1.34, P = 0.56). Diagnostic imaging was increasingly deployed (for RIF pain: 91% vs. 74%, P = 0.07; for appendicitis: 77% vs. 42%, P = 0.007) especially computerised tomography scan (45% vs. 31%). Increased adoption of conservative approach in the management of acute appendicitis was significant (61% vs 23%, RR 2.65, P = 0.01) although other outcomes such as length of stay, post-operative complication and 30-day re-presentation rates were comparable to pre-lockdown phase. Conclusion Fewer RIF pain but more likelihood of acute appendicitis, increased use of radiological imaging and conservative approach to management reflect an evolving pattern during the lockdown phase.

scholarly journals Mimickers of Acute Appendicitis

2021 ◽  
Author(s):  
Esam Amer
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Imaging Modality ◽  
Correct Diagnosis ◽  
Emergency Setting ◽  
Magnetic Resonance Imaging Mri ◽  
Clinical Conditions

Acute appendicitis (AA) is a common surgical diagnosis in patients presenting to the Emergency Department with acute abdominal pain. A wide variety of other clinical conditions can present with a very similar presentation to acute appendicitis and therefore it can be occasionally challenging to make the correct diagnosis. In this review paper, the focus is to shed some light on the differential diagnosis of acute appendicitis which includes a variety of gastrointestinal, vascular, urological, and gynaecological conditions. In the emergency setting there are three main imaging modalities to evaluate patients presenting with abdominal pain, this includes computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI). The choice of imaging modality for each clinical condition is variable and as such being familiar with those differential diagnoses is vital in deciding what is the best imaging modality for every patient presenting with abdominal pain.

scholarly journals Aorto-caval fistula clinically presenting as left renal colic Findings of multislice computed tomography

Medicina ◽  
2008 ◽  
Vol 44 (8) ◽  
pp. 619 ◽  
Author(s):  
Donatas Gedvilas ◽  
Diana Argatu ◽  
Saulius Lukoševičius ◽  
Algidas Basevičius
Keyword(s):  
Computed Tomography ◽  
Aortic Aneurysm ◽  
Multislice Computed Tomography ◽  
Renal Colic ◽  
Clinical Symptoms ◽  
Imaging Modality ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Vena Cava ◽  
Vascular Pathology

Spontaneous aorto-caval fistula is a rare complication of abdominal aortic aneurysm. A definitive diagnosis is sometimes difficult, as the classic diagnostic signs (pulsatile abdominal mass with bruit, high-output hearth failure, and acute dyspnea) are present in about half of the patients. Diagnosis may be suspected from clinical symptoms, but sometimes atypical clinical features may obscure the actual situation. Computed tomography findings include early detection of contrast medium in the dilated inferior vena cava, which is isodense with the adjacent aorta, an associated aortic aneurysm, loss of normal anatomic space between aorta and vena cava, and rarely one can even visualize the abnormal communication between aorta and vena cava. Prompt radiological diagnosis is of key importance in the management of these patients. We describe findings of multislice computed tomography of the patient with dissecting aortic aneurysm and aortocaval fistula, clinically presenting as left renal colic. Multislice computed tomography is the imaging modality of choice for diagnosis of abdominal vascular pathology as it is noninvasive, fast and demonstrates a high diagnostic accuracy.

scholarly journals Point-of-care Transperineal Ultrasound to Diagnose Abscess in the Emergency Department

2019 ◽  
Vol 3 (4) ◽  
pp. 349-353 ◽  
Author(s):  
Hamid Shokoohi ◽  
Matthew Pyle ◽  
Sarah Frasure ◽  
Ubah Dimbil ◽  
Ali Pourmand
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Diagnostic Imaging ◽  
Imaging Modality ◽  
Point Of Care ◽  
Transperineal Ultrasound ◽  
Point Of Care Ultrasound ◽  
Ultrasound Technique ◽  
Rectal Pain ◽  
Optimal Imaging

Perineal and rectal pain are common presentations in the emergency department (ED). In the majority of cases, clinical examination is sufficient to detect local anorectal pathologies. However, perianal and rectal abscesses and fistulas are often the primary concerns prompting diagnostic imaging in the ED. Currently, computed tomography is the preferred imaging modality. Recently, transperineal ultrasound has emerged as an optimal imaging modality for the diagnosis of perineal and perianal abscesses. We present a case in which point-of-care ultrasound accurately detected an intersphincteric abscess, and review the appropriate ultrasound technique to evaluate patients with suspected perianal and rectal abscesses.

scholarly journals Evaluating the risk of appendiceal perforation when using ultrasound as the initial diagnostic imaging modality in children with suspected appendicitis

Ultrasound ◽  
2017 ◽  
Vol 25 (3) ◽  
pp. 166-172
Author(s):  
Stephen Alerhand ◽  
James Meltzer ◽  
Ee Tein Tay
Keyword(s):  
Computed Tomography ◽  
Diagnostic Imaging ◽  
Imaging Modality ◽  
Ultrasound Scan ◽  
Computed Tomography Scan ◽  
Perforation Rate ◽  
Suspected Appendicitis ◽  
Significant Difference ◽  
Tomography Scan ◽  
Appendiceal Perforation

Background Ultrasound scan has gained attention for diagnosing appendicitis due to its avoidance of ionizing radiation. However, studies show that ultrasound scan carries inferior sensitivity to computed tomography scan. A non-diagnostic ultrasound scan could increase the time to diagnosis and appendicectomy, particularly if follow-up computed tomography scan is needed. Some studies suggest that delaying appendicectomy increases the risk of perforation. Objective To investigate the risk of appendiceal perforation when using ultrasound scan as the initial diagnostic imaging modality in children with suspected appendicitis. Methods We retrospectively reviewed 1411 charts of children ≤17 years old diagnosed with appendicitis at two urban academic medical centers. Patients who underwent ultrasound scan first were compared to those who underwent computed tomography scan first. In the sub-group analysis, patients who only received ultrasound scan were compared to those who received initial ultrasound scan followed by computed tomography scan. Main outcome measures were appendiceal perforation rate and time from triage to appendicectomy. Results In 720 children eligible for analysis, there was no significant difference in perforation rate between those who had initial ultrasound scan and those who had initial computed tomography scan (7.3% vs. 8.9%, p = 0.44), nor in those who had ultrasound scan only and those who had initial ultrasound scan followed by computed tomography scan (8.0% vs. 5.6%, p = 0.42). Those patients who had ultrasound scan first had a shorter triage-to-incision time than those who had computed tomography scan first (9.2 (IQR: 5.9, 14.0) vs. 10.2 (IQR: 7.3, 14.3) hours, p = 0.03), whereas those who had ultrasound scan followed by computed tomography scan took longer than those who had ultrasound scan only (7.8 (IQR: 5.3, 11.6) vs. 15.1 (IQR: 10.6, 20.6), p < 0.001). Children < 12 years old receiving ultrasound scan first had lower perforation rate (p = 0.01) and shorter triage-to-incision time (p = 0.003). Conclusion Children with suspected appendicitis receiving ultrasound scan as the initial diagnostic imaging modality do not have increased risk of perforation compared to those receiving computed tomography scan first. We recommend that children <12 years of age receive ultrasound scan first.

scholarly journals Volvulus of ileum: A rare case of small bowel obstruction and the effectiveness of abdominal ultrasound imaging for the diagnosis

2019 ◽  
Vol 15 (2) ◽  
Author(s):  
Bajhat Barakat ◽  
Raffaele Pezzilli
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Imaging Modality ◽  
Abdominal Ultrasound ◽  
Computed Tomography Scan ◽  
Mesenteric Lymph Nodes ◽  
Abdominal Ultrasonography ◽  
Primary Type ◽  
Tomography Scan ◽  
Secondary Type

Primary type small bowel volvulus is observed mainly in children and young adults, whereas the secondary type is usually found between the ages of 40 and 90 years and is mainly due to adhesions after previous surgery: tumors and mesenteric lymph nodes can also be responsible for the secondary type. Diagnosis is difficult and the computed tomography scan is the most relevant imaging modality. For this reason we believe that the case presented in which diagnosis was primary made by abdominal ultrasonography and then confirmed first by computed tomography scan and definitively by surgical exploration is worth reporting.

scholarly journals Ascites matters

Ultrasound ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 69-79 ◽  
Author(s):  
Velauthan Rudralingam ◽  
Clare Footitt ◽  
Ben Layton
Keyword(s):  
Computed Tomography ◽  
Imaging Modality ◽  
Qualitative Assessment ◽  
Emergency Setting ◽  
Wide Range ◽  
Underlying Illness ◽  
Complex Fluid ◽  
Line Imaging ◽  
Systemic Condition

The excess accumulation of intra-peritoneal fluid, referred to as ascites, is an important clue that points to a significant underlying illness. This may be due to a pathological event within the peritoneal cavity or secondary to an underlying systemic condition. Ascites is broadly classified into transudate and exudate, based on protein content, with a potential wide range of differential diagnoses. Traditionally, computed tomography has been regarded as the imaging modality of choice to demonstrate ascites and diagnose the underlying cause. However, ultrasound can reliably detect small volumes of fluid and is a useful first-line imaging modality for clinical triage. For instance, in the emergency setting, the detection of a trace of ascites may be the earliest indicator of an acute abdomen needing surgery. Ultrasound can quantify the volume of ascites and aid in the decision process for fluid drainage. Ultrasound is superior to computed tomography in the qualitative assessment of fluid. Broadly, simple fluid is anechoic, whereas complex fluid may appear particulate, layered or contain septations. On computed tomography, both have a uniform hypo-dense appearance and are often indistinguishable. Given ultrasound, in comparison to computed tomography, is safe, relatively inexpensive and readily available, it is a valuable tool in the assessment of ascites. Once ascites is detected on ultrasound, it is imperative for the operator to have a systematic approach to attempt to provide an underlying diagnosis. Through a series of cases, this article aims to increase awareness and reaffirm the role of ultrasound in the assessment of ascites.

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