scholarly journals A rare acute presentation of intestinal malrotation in the elderly

2020 ◽  
Vol 7 (10) ◽  
pp. 3432
Author(s):  
Abidemi A. Adesuyi ◽  
Oladele O. Situ ◽  
Cephas S. Batta
Keyword(s):  
The Elderly ◽  
Intestinal Malrotation ◽  
Age Group ◽  
Midgut Volvulus ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Acute Presentation ◽  
History Of ◽  
High Index Of Suspicion

Intestinal malrotation, a congenital anomaly of the midgut, typically presents in pediatrics age group with the most feared complication of midgut volvulus and its catastrophic sequelae. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist. We report a 65-year-old man admitted following a referral with a 12-hour history of acute abdomen with an initial diagnosis of acute pancreatitis but later had laparotomy with intraoperative findings of a midgut volvulus and gangrenous ileal segment secondary to intestinal malrotation. This case emphasizes the importance of early diagnosis to prevent the disastrous complication of this disease. The rarity of this condition portends a formidable diagnostic challenge in adults hence the awareness of its possibility and a high index of suspicion is crucial in diagnosis.

scholarly journals Acute midgut volvulus in a septuagenarian with secondary jejunoileal diverticulitis and undiagnosed congenital malrotation: an unusual presentation

2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
Gregory Sigler ◽  
Laura Baker ◽  
Shaheer Tadros ◽  
Janelle Rekman ◽  
Sameer S Apte
Keyword(s):  
Umbilical Hernia ◽  
The Elderly ◽  
Midgut Volvulus ◽  
Surgical Exploration ◽  
Duodenojejunal Flexure ◽  
Umbilical Hernia Repair ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Ladd's Bands

Abstract A 79-year-old male presented with abdominal pain, incidental umbilical hernia and acute midgut volvulus that was not detected until surgical exploration. When he presented to hospital, computed tomography (CT) findings indicated perforated jejunoileal diverticulitis; however, in the operating room clockwise volvulization of the jejunum and ileum, secondarily inflamed jejunoileal diverticula, incomplete malrotation (right-sided duodenojejunal flexure), right retroperitoneal adhesions (Ladd’s bands) and numerous other congenital adhesive bands were found. A modified Ladd’s procedure and umbilical hernia repair were completed including detorsion, division of Ladd’s bands with medialization of the cecum and lysis of other congenital adhesions without appendectomy. The patient recovered to baseline function by 3 weeks postoperatively. Acute midgut volvulus is a life-threatening surgical emergency that is exceptionally rare in the elderly. CT is relatively insensitive, so misdiagnosis is common. A high index of suspicion is required, especially in patients with a history of congenital gastrointestinal abnormalities. Prompt surgical exploration for correction and prevention is crucial.

RECURRENT SUB -ACUTE INTESTINAL OBSTRUCTION PRESENTED AS MIDGUT MALROTATION WITH VOLVULUS MANAGED BY LAAD'S PROCEDURE AND SURGERY IN AN ADULT PATIENT: A CASE REPORT AND LITERATURE REVIEW

2021 ◽  
pp. 6-8
Author(s):  
Sukanta Sikdar ◽  
Mala Mistri ◽  
Tuhinsubhra Mandal
Keyword(s):  
Case Report ◽  
Intestinal Obstruction ◽  
Adult Population ◽  
Exploratory Laparotomy ◽  
Acute Intestinal Obstruction ◽  
Intestinal Malrotation ◽  
Uneventful Recovery ◽  
Midgut Volvulus ◽  
Rare Presentation ◽  
Diagnostic Dilemma

Background: Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist, and CT scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating "whirlpool sign". In our patient Case presentation: 42 years old male who presented to the emergency department with acute onset of pain in the RUQ, vomiting, and absolute obstipation for the last 2 days. This patient had a history of similar two episodes of sub-acute intestinal obstruction in the last 6 months which has been managed conservatively. The patient underwent an elective exploratory laparotomy after 2 days of failed conservative management. Operative findings included the presence of adhesive bands in the RUQ (Ladd's Band), volvulus of the mid-portion of the small bowel in a clockwise fashion, and multiple intraabdominal adhesions and empty RIF and caecum pulled up in RUQ. We subsequently performed a Ladd's procedure, multiple adhesiolysis, and caecopexy and the patient had an uneventful recovery with eventual discharge on postoperative day 12. This case report reviews the incidence of malrotation in adults. It also high Conclusion: lights the difficulty in diagnosing midgut volvulus in the adult population given the nonspecific, insidious symptoms, therefore, prompting awareness of its existence and a high degree of clinical suspicion. Malrotation should be considered in the differential diagnosis in patients presented with acute abdomen and intestinal ischemia.

scholarly journals Silent primary ovarian ectopic pregnancy following ovulation induction: diagnostic dilemma

2021 ◽  
Vol 10 (9) ◽  
pp. 3654
Author(s):  
Kalyani Saidhandapani ◽  
Yashaswi Pandey ◽  
Priya Shaunthini
Keyword(s):  
Ovulation Induction ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Ovarian Pregnancy ◽  
Threatening Condition ◽  
Reproductive Techniques ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Urine Pregnancy Test

Early diagnosis of an ovarian pregnancy, of all the diagnoses relating to extrauterine gestations, is perhaps a diagnostic challenge faced by an obstetrician and a radiologist. About 0.5% of extrauterine implantations occur in the ovary. Recent studies have demonstrated infertility and Assisted reproductive techniques (ARTs), multiparity, use of intrauterine devices as risk factors for ovarian ectopic. Knowledge pertaining to ovulation induction and risk of ovarian ectopic is even more scant. In this article, we report a case report of ovarian pregnancy following ovulation induction with letrozole. Patient visited with history of missed menstrual period, mild abdominal pain and a weakly positive urine pregnancy test. Provisional diagnosis of right tubal ectopic was made. Diagnosis of ruptured ovarian ectopic was made on explorative laparoscopy which was later confirmed histopathologically. Patient had normal intra and post-operative course. An ovarian ectopic can present as a life-threatening condition and a high index of suspicion can prevent morbidity as well as mortality. Ovarian pregnancy in a primigravida with ovulation induction without an alarming sign, as in this case, is the rarest entity came across till date.

ANTERIOR ABDOMINAL WALL ABSCESS A RARE PRESENTATION OF LEFT SIDED COLONIC CARCINOMA: A DIAGNOSTIC CHALLENGE FOR A GENERAL SURGEON

2021 ◽  
pp. 26-28
Author(s):  
Sukanta Sikdar ◽  
Mala Mistri ◽  
Subhabrata Das ◽  
Dibyendu Chatterjee
Keyword(s):  
Abscess Formation ◽  
Colonic Carcinoma ◽  
Uneventful Recovery ◽  
General Surgeon ◽  
Bowel Habit ◽  
Abdominal Abscess ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Carcinoma Of The Colon ◽  
History Of

Background: The various presentations of carcinoma of the colon are well known. Abscess formation occurs in 0.3 to 0.4% and is the second most common complication of perforated lesions. Perforation and penetration of adjacent organs with intra-abdominal abscess formation as the initial presentation is uncommon. It is difcult to make an accurate diagnosis of abscess formation as the rst evidence of colonic carcinoma preoperatively. A 68 yrs old female who presented to the ED with acute onset of left lower abdominal f Case presentation: ullness, pain and local redness for 15 days. She denied any history of vomiting, fever, anorexia but history of altered bowel habit. Clinically she had a palpable lump (20 x15) cm in left lumber region .The lump was parietal with local raise of temperature , redness and tenderness can be elicited . So our initial impression was parietal wall abscess and we underwent emergency drainage of abscess. She had uneventful recovery and discharged after 2 weeks. She was admitted with similar presentation in previous location 30 days after discharge. Now we investigate thoroughly, a CECT scan of whole abdomen which conrms radio-logically as carcinoma of descending colon with abscess extending into the parietal wall .We underwent an exploratory laparotomy and HPE proven as adenocarcinoma of the colon. Post op she developed SSI which was managed with regular dressing and she was discharged in post-op day 20. We report this case because of an unusual Conclusion: presentation of left sided colonic Ca. The accurate preoperative diagnosis of these conditions extremely complicated because of the fuzzy clinical presentation. The CT scan can diagnose malignancy pre-operatively, even if the denitive diagnosis of colonic perforated neoplasia may be evident only during surgery. So early diagnosis and prompted intervention can save the patient to developed sepsis and to reduce signicantly the morbidity and mortality. The importance is to focus on the differential diagnosis and keep in mind that a colon carcinoma can present with abdominal abscess. Surgeons should be aware of this differential because it is easily ignored pre-operatively.

scholarly journals Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate

2017 ◽  
Vol 13 (2) ◽  
pp. 172-174 ◽  
Author(s):  
S. Koirala ◽  
A. Poudel ◽  
R. Basnet ◽  
K. Subedi
Keyword(s):  
Respiratory Rate ◽  
Pompe Disease ◽  
Clinical Findings ◽  
Diagnostic Challenge ◽  
Floppy Infant ◽  
History Of ◽  
Infantile Pompe Disease ◽  
High Index Of Suspicion ◽  
To Receive ◽  
Remote Part

Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia.Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease.

scholarly journals A case of colonic gallstone ileus with a spontaneous evacuation

1970 ◽  
Vol 9 (1) ◽  
pp. 47-49 ◽  
Author(s):  
A Bajracharya ◽  
OP Pathania ◽  
S Adhikary ◽  
CS Agrawal
Keyword(s):  
Bowel Obstruction ◽  
Large Bowel ◽  
Gallstone Ileus ◽  
Abdominal Distension ◽  
The Elderly ◽  
Large Bowel Obstruction ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
History Of ◽  
Spontaneous Evacuation

Colonic gallstone is an uncommon entity with a high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations, especially in the elderly population, often with multiple co-morbidities. We present a case of colonic gallstone ileus with spontaneous evacuation in a 67 years female who had a threeday history of intermittent bouts of colicky abdominal pain, vomiting , constipation and progressive abdominal distension, features of large bowel obstruction treated non operatively for 72 hours and passage of the stone spontaneously. Keywords: gallstone ileus; large bowel obstruction; colonic gallstone DOI: 10.3126/hren.v9i1.4363Health Renaissance, 2011: Vol.9 No.1:47-49

scholarly journals A Five Years Old Child with Failure To Thrive and Vomiting Presenting as a Diagnostic Dilemma: A Case Report

2020 ◽  
Vol 58 (228) ◽  
Author(s):  
Anita Lamichhane ◽  
Rupesh Sharma ◽  
Ramana Rajkarnikar ◽  
Rubee Awale ◽  
Prapti Shrestha ◽  
...  
Keyword(s):  
Failure To Thrive ◽  
Exploratory Laparotomy ◽  
Age Group ◽  
Older Children ◽  
Diagnostic Challenge ◽  
High Resolution Computed Tomography ◽  
Diagnostic Dilemma ◽  
Recurrent Vomiting ◽  
Colicky Pain ◽  
Band Failure

Vomiting with failure to thrive in older children is a diagnostic challenge due to the diversity in the diagnosis. We report a case of a five-years-old girl with failure to thrive, history of recurrent vomiting and intermittent colicky pain abdomen since 45 days of life. Intestinal malrotation with Ladd’s band was diagnosed based on clinical acumen, high- resolution computed tomography, barium follow through and intraoperative findings. Exploratory laparotomy with Ladd’s procedure was performed under general anesthesia which showed malrotation at the duodenojejunal junction with a short route of mesentery with floating caecum with Ladd’s band. Failure to thrive with malrotation of the gut in the older age group is rare in itself. As there are very few cases reported in this age group, so we undertook to report this case to increase the awareness of knowledge concerning the diagnosis and timely management to prevent the comorbidity of this condition.

scholarly journals Diffuse infiltrating retinoblastoma: A diagnostic conundrum

2021 ◽  
Vol 7 (2) ◽  
pp. 204-206
Author(s):  
Harsha Bhattacharjee ◽  
Aditi Mehta ◽  
Dipankar Das ◽  
Kasturi Bhattacharjee ◽  
Manabjyoti Barman ◽  
...  
Keyword(s):  
Family History ◽  
Multimodal Imaging ◽  
Positive Family History ◽  
Neovascular Glaucoma ◽  
Exudative Retinal Detachment ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Progressive Loss ◽  
History Of ◽  
High Index Of Suspicion

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

scholarly journals Morel-Lavallée lesion in a ‘non-traumatic’ thigh: a diagnostic challenge!

2019 ◽  
Vol 18 (1) ◽  
pp. 145-148
Author(s):  
Devesh Sanjeev Ballal ◽  
Balaji Jayasankar ◽  
Gabriel Rodrigues ◽  
Ranjini Kudva
Keyword(s):  
Soft Tissue ◽  
Medical Science ◽  
Surgical Excision ◽  
Diagnostic Challenge ◽  
Soft Tissue Neoplasm ◽  
Diagnostic Dilemma ◽  
Degloving Injury ◽  
Closed Degloving Injury ◽  
History Of ◽  
Closed Degloving

Background: Morel-Lavallée Lesion (MLL) or Morel-Lavallée Seroma (MLS) is a posttraumatic seroma that occurs following a closed degloving injury. It is very important for trauma surgeons to be aware of this relatively rarely reported entity as early diagnosis increases the likelihood of successful management. Case report: We present a patient, wherein the patient had no history of trivial trauma and presented with a gradually growing swelling of left thigh, that was clinically and radiologically diagnosed as a soft tissue neoplasm, successfully managed by surgical excision and were reported to be a MLS. The clinical diagnostic dilemma was solved by the histopathologist! Conclusion: A differential diagnosis of MLL should be kept in mind in patients presenting with soft tissue swellings. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.145-148

scholarly journals Denture Impaction Causing an Upper Esophageal Diverticulum

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Shireen Samargandy ◽  
Hani Marzouki ◽  
Talal Al-Khatib ◽  
Mazin Merdad
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
The Elderly ◽  
Barium Swallow ◽  
Diagnostic Challenge ◽  
Case Presentation ◽  
History Of ◽  
Endoscopic Diverticulotomy ◽  
Tomography Scan ◽  
Rule Out

Background. Dentures are a common cause of inadvertent foreign body ingestion particularly in the elderly. Due to their radiolucent nature, they often present a diagnostic challenge to care providing physicians. Case Presentation. A 66-year-old female presented to our otolaryngology clinic with a 2-year history of dysphagia. Her physical examination was unremarkable. Computed tomography scan of the neck and barium swallow suggested Zenker diverticulum. She was planned for endoscopic diverticulotomy; however, during surgery, a foreign body was incidentally found and retrieved, which was a partial lower denture. The diverticulum resolved thereafter, and the patient's symptoms abated. Conclusion. The authors recommend evaluating the esophagus endoscopically first in cases of upper esophageal diverticular formation, even when planning an open repair approach, to rule out any concealed foreign bodies.

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