Unravelling a case of rare peritoneal encapsulation following blunt abdominal trauma: a case report

Peritoneal encapsulation (PE) is a rare condition that has been described interchangeably with sclerosing encapsulated peritonitis as well as abdominal cocoon. Here we report a case of perforative peritonitis following blunt injury abdomen in a 30-year-old male patient. Computed tomography (CT) of the abdomen showed pneumoperitoneum possibly gastrointestinal tract perforation. Exploratory laparotomy was performed and the entire small bowel was encapsulated in a peritoneal sac. Peritoneal sac was excised. Perforation was noted in the proximal jejunum and primary closure done. Post-operative recovery was uneventful. PE is an extremely rare congenital condition in which there is abnormal return of the midgut loop to the abdominal cavity in the early stages of development. The small intestine is thus covered by the original dorsal mesentery, forming the characteristic accessory peritoneal sac. Management of cases is difﬁcult as CT ﬁndings may not be characteristic and may only be diagnosed at laparotomy. A discussion of the case and review of the literature are presented.

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Choledochal Cyst Coexisting with Gallbladder Carcinoma - An Uncommon Case Report

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v16i4.33621 ◽

2017 ◽

Vol 16 (4) ◽

pp. 602-605

Author(s):

Jahangir Hossain Bhuiyan ◽

Mohibul Aziz ◽

Omar Faruk ◽

Mahbub Hasan

Keyword(s):

Choledochal Cyst ◽

Gallbladder Carcinoma ◽

Medical Science ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Abdominal Ultrasound ◽

Low Grade ◽

College Hospital ◽

Medical College ◽

Operative Recovery

Choledochal Cyst is a relatively rare condition. Even rarer is a choledochal cyst in association with a gallbladder carcinoma. This study reports a rare case of choledochal cyst coexisting with gallbladder carcinoma in a Bangladeshi patient. A 35 year old lady presented at IBN Sina Medical College Hospital, Kallyanpur, Dhaka with the history of recurrent right upper quadrant abdominal pain from childhood, which became severe for last 4 days before admission. The pain was colicky in nature and radiated to the back. Episodes were associated with low-grade fever, anorexia as well as vomiting. The preoperative diagnosis was made by abdominal ultrasound and MRCP. Exploratory laparotomy, enbloc cholecystectomy with excision of the choledochal cyst and roux-en-Y hepaticojejunostomy was also done. Post operative recovery was uneventful. Patient was followed up for six months and no obvious complication was noticed. Early suspicion of this rare pancreato-billiary disease is important because surgical treatment is the only way to avoid the complications of the disease.Bangladesh Journal of Medical Science Vol.16(4) 2017 p.602-605

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Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0769-4 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Takeshi Ueda ◽

Tetsuya Tanaka ◽

Takashi Yokoyama ◽

Tomomi Sadamitsu ◽

Suzuka Harada ◽

...

Keyword(s):

Conservative Treatment ◽

Abdominal Cavity ◽

Vital Signs ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Case Presentation ◽

Free Air ◽

Spontaneous Pneumoperitoneum ◽

Upper Abdominal ◽

Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

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Chylolymphatic Cysts in Children: A Rare Condition

10.53350/pjmhs211561503 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1503-1505

Author(s):

M. Z. Anjum ◽

M. S. H. Ansari ◽

S. Mustafa ◽

T. M. Butt ◽

M. A. Qureshi

Keyword(s):

General Surgery ◽

Pediatric Surgery ◽

Abdominal Mass ◽

Rare Condition ◽

Surgical Excision ◽

Exploratory Laparotomy ◽

Clinical Findings ◽

Paediatric Surgery ◽

Mesenteric Cysts ◽

Operative Recovery

Objective: To find out the clinical findings, anatomical types and preferred operative treatment for paediatric chylolymphatic cysts. Study Design: Prospective study Place and Duration of Study: Department of Pediatric Surgery/General Surgery Bahawal Victoria Hospital, Bahawalpur and Department of Pediatric Surgery/General Surgery Unit-ll, DHQ Teaching Hospital, Dera Ghazi Khan from 1st January 2018 to 31st December 2020 Methodology: Fifteen patients of either gender with age from 18 months to 8 years (96 months) enrolled. Clinical data of all the patients diagnosed as chylolymphatic cyst on exploration was recorded. Results: There were 8 (53.3%) females and 7 (46.7%) males with mean age was 49.80±27.07 (months). Four patients (26.66%) presented with abdominal mass, 5 patients (33.33%) presented with abdominal pain, 1 patient (6.66%) with abdominal mass and pain while 5 patients (33.33%) presented with signs of intestinal obstruction. Three (20%) had cysts at multiple sites, i.e., mesentery of jejunum, ileum and mesentery of sigmoid colon, 5 (33.33%) patients had cysts in jejunal mesentery while 9 (53.33%) patients’ cyst was found in ileal mesentery and 1 (6.66%) had cyst in mesentery of cecum. Fourteen underwent exploratory laparotomy and 1 was managed laparoscopically. Post-operative recovery in 14 patients was uneventful and 1 patient managed by open surgery underwent respiratory complications and later expired. No recurrence was noted during follow up period up to 6 months. Conclusion: Surgical exploration and surgical excision and sometimes resection anastomosis of gut is mainstay of treatment with excellent results. Key words: Paediatric mass abdomen, Mesenteric cysts, Chylolymphatic cyst, Paediatric surgery

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A unique case of diagnosis of a heterotopic pregnancy at 26 weeks – case report and literature review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03465-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Kajdy ◽

Katarzyna Muzyka-Placzyńska ◽

Dagmara Filipecka-Tyczka ◽

Jan Modzelewski ◽

Marek Stańczyk ◽

...

Keyword(s):

Gestational Age ◽

Abdominal Cavity ◽

Uterine Cavity ◽

Rare Condition ◽

Exploratory Laparotomy ◽

First Trimester ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Intrauterine Pregnancy ◽

Unique Case

Abstract Background Heterotopic pregnancy (HP) is a rare condition when at least two pregnancies are present simultaneously at different implantation sites and only one located in the uterine cavity. The majority of cases are diagnosed in the first trimester. Case presentation We present a unique case of HP diagnosed at 26 weeks of spontaneous pregnancy in a patient without any relevant risk factors. We performed an extensive review of HP cases from MEDLINE (PUBMED) published in English between 2005-2019 to prove this case's uniqueness. A 24-year-old woman presented because of threatened preterm birth. Despite treatment, pain aggravated, without progression of labor. An emergency ultrasound exam revealed free fluid in the abdominal cavity. Suspicion of active bleeding prompted the medical team to perform an exploratory laparotomy. The surgery team found a ruptured heterotopic pregnancy. This was an unexpected cause of nontraumatic hemoperitoneum at such advanced gestational age. The postoperative period was uneventful, and the intrauterine pregnancy continued to term. The final review included 86 out of 124 records. A total number of 509 cases were identified, but not all of them had complete data. The maximum reported gestational age at the time of diagnosis was 16 weeks of pregnancy, while our case became symptomatic and was diagnosed at 26 weeks of pregnancy. Conclusions Regardless of pregnancy age, HP can be a cause of hemoperitoneum, and it should be included in the differential diagnosis of acute abdomen in the second trimester.

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BLUNT ABDOMINAL TRAUMA WITH HAEMOPERITONEUM TREATED BY EXPLORATORY LAPAROTOMY VERSUS ONLY ABDOMINAL DRAINAGE: A PROSPECTIVE AND COMPARATIVE STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.842 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Dhawal Panchal ◽

Firdaus Dekhaiya ◽

Harin Tailor

Keyword(s):

Hospital Stay ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Exploratory Laparotomy ◽

Blunt Injury ◽

Abdominal Drainage ◽

Duration Of Hospital Stay ◽

Considerable Morbidity ◽

Injured Patients

In today’s mechanized world, Blunt Abdominal Trauma (BAT) is a common emergency which is associated with considerable morbidity and mortality. More than 75% of abdominal traumas are blunt in nature and liver and spleen are the commonest organs to be injured as a result of BAT. The aim is to analyse and compare two groups of patient of blunt abdominal trauma managed conservatively with drainage and one by exploratory laparotomy. 50 cases of blunt abdominal trauma were taken. The patient were studied which includes age ,sex, mode of injury, initial vitals on presentation, Mortality in each group, duration of hospital stay, pre interventions and post interventions state and requirements, complications and follow up. It was observed 48% of patients were in between age group ranging from 10 to 30. Overall in terms of sex ratio, males dominated the no. of cases. RTA was most common mode of trauma. Liver and spleen was most common organ to be injured. Patients managed by laparotomy had higher mortality rate, duration of hospital stay was more, and complication were more. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients. Keywords: Blunt Abdominal Trauma, Haemoperitoneum , laparotomy , Abdominal Drainage.

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HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

10.36106/ijsr/9522431 ◽

2021 ◽

pp. 58-59

Author(s):

Jayanta Sarkar ◽

Mini Sengupta

Keyword(s):

Ectopic Pregnancy ◽

Abdominal Cavity ◽

Lower Abdominal Pain ◽

Cardiac Activity ◽

Exploratory Laparotomy ◽

Sudden Onset ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Short Period ◽

The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

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Occurrence of parasitism by Dioctophyma renale in ring-tailed coatis (Nasua nasua) of the Tiete Ecological Park, São Paulo, Brazil

Pesquisa Veterinária Brasileira ◽

10.1590/s0100-736x2009001200001 ◽

2009 ◽

Vol 29 (12) ◽

pp. 959-962 ◽

Cited By ~ 9

Author(s):

Liliane Milanelo ◽

Márcia Bento Moreira ◽

Lílian S. Fitorra ◽

Bruno S.S. Petri ◽

Melissa Alves ◽

...

Keyword(s):

Population Control ◽

Abdominal Cavity ◽

Exploratory Laparotomy ◽

Renal Tissue ◽

Intermediate Hosts ◽

Wild Mammals ◽

Rigid Structure ◽

Nasua Nasua ◽

Males And Females ◽

The Right

Dioctophymosis is a worldwide renal parasitosis caused by the Dioctophyma renale nematode, which results in progressive destruction of renal tissue. Aquatics annelids are considered the main intermediate hosts and the literature refers as permanent hosts of dogs, wild mammals and even humans. During procedures for population control of coatis (Nasua nasua) in the Ecological Park of Tietê (PET), was noticed the presence of parasitosis by D. renale. From 68 animals, males and females, young and adults, submitted to exploratory laparotomy, 51 were positive for the presence of worms, 9 were found only in the right kidney. In 10 cases, in addition to right kidney parasitism, worms were also observed in the abdominal cavity. In 24 cases D. renale was found only in the abdominal cavity and in 8 animals the right kidney was reduced to a small rigid structure. The study showed that the preferred site for parasitism of the worm, considered erratic, was the abdominal cavity in 66.66% of the cases.

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Intestinal lymphoma in a Boxer breed dog – case report

Clínica Veterinária ◽

10.46958/rcv.2019.xxiv.n.142.p.72-82 ◽

2019 ◽

Vol XXIV (142) ◽

pp. 72-82

Author(s):

Sayonara da Luz Ferro ◽

Fernanda Jönck ◽

Marta Cristina T. Heckler ◽

Ewerton Cardoso ◽

Mateus Rychescki ◽

...

Keyword(s):

Weight Loss ◽

Abdominal Cavity ◽

Clinical Signs ◽

Exploratory Laparotomy ◽

Needle Aspiration ◽

Free Fluid ◽

Intestinal Lymphoma ◽

Mesenteric Lymph Nodes ◽

Abdominal Ultrasonography ◽

Tissue Biopsy

Intestinal lymphoma is the second most common form of lymphoma in dogs. It is characterized by the presence of neoplastic lymphocytes in the gastrointestinal tract or mesenteric lymph nodes. The chief clinical signs are vomiting, diarrhea, anorexia and weight loss. The diagnosis is made through fine needle aspiration and cytology, or by tissue biopsy and histopathology, and chemotherapy is the treatment of choice. We report a case of intestinal lymphoma in a five years old Boxer, presented with history of hematochezia and lethargy of 7 days duration, and 20 days of anorexia and persistent weight loss. Abdominal ultrasonography revealed free fluid in the abdominal cavity, and an intestinal mass. Exploratory laparotomy was performed and a tissue biopsy was performed. Histopathology confirmed the diagnosis of intestinal lymphoma, but the patient died during the surgical procedure.

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Transvaginal uterine evisceration during labor in a Bengal queen

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116919872301 ◽

2019 ◽

Vol 5 (2) ◽

pp. 205511691987230

Author(s):

Mila Freire ◽

Mouhamadou Diaw

Keyword(s):

Physical Examination ◽

Surgical Intervention ◽

Patient Survival ◽

Uterine Prolapse ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Rapid Identification ◽

Urethral Catheterization ◽

Case Summary ◽

History Of

Case summary A 2.5-year-old Bengal queen was admitted with a 12-h history of a mass protruding from the vulva during labor. At that time, three healthy kittens had already been delivered. Physical examination identified the mass as a portion of the uterus that was eviscerated without eversion of the mucosa. Exploratory laparotomy revealed a vaginal vault rupture with a large portion of the uterus herniated through the tear and eviscerated through the vulva. Ovariohysterectomy was performed, and a dead fetus was removed with the uterus. Reconstruction of the vaginal rupture required careful dissection and urethral catheterization. The queen recovered without complications. Relevance and novel information Uterine evisceration through a vaginal tear is a very rare condition that sometimes is erroneously referred to as ‘prolapse’. Uterine prolapse and uterine evisceration may have similar presenting signs; however, proper identification and surgical correction is key when the uterus is eviscerated. This case highlights the importance of differentiating these two conditions and of rapid identification and surgical intervention for successful patient survival.

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Peritonitis Associated with Intra-Abdominal Pathology in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686089301302s83 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 335-337 ◽

Cited By ~ 33

Author(s):

Antonios H. Tzamaloukas ◽

Leo E. Obermiller ◽

Laurence J. Gibel ◽

Glen H. Murata ◽

Barbara Wood ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Abdominal Cavity ◽

Severe Infection ◽

Exploratory Laparotomy ◽

Enteric Pathogens ◽

Severe Malnutrition ◽

Diagnostic Features ◽

Free Air ◽

Bowel Gangrene

Features helpful in diagnosis and associated with death were evaluated In 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) In continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, Increasing free air in the abdominal cavity) were infrequently found. A comparison of patients who died (n=11, 42%) and those who survived revealed that death was associated with bowel gangrene (5/6 died), recovery of bacteroides from the dialysate, more frequent and severe comorbid conditions (bacteremia, pneumonia, intra-abdominaland intracerebral bleeding, septic shock, hepatic failure), the development of severe malnutrition and thrombocytopenia during infection, and multiple surgical procedures until the diagnosis was established. Peritonitis associated with intra-abdominal pathology In CAPD patients is a severe infection with considerable diagnostic difficulty and high mortality. Early exploratory laparotomy upon suspicion of the nature of the peritonitis, usually raised by the recovery of enteric pathogens from the dialysate, may improve mortality.

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