scholarly journals Accessory spleen torsion: a rare cause of acute abdominal pain

2021 ◽  
Vol 8 (3) ◽  
pp. 991
Author(s):  
Madison Bowles
Keyword(s):  
Abdominal Pain ◽  
Accessory Spleen ◽  
Paediatric Population ◽  
Haemorrhagic Shock ◽  
Splenic Tissue ◽  
Main Body ◽  
Diagnostic Challenge ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis ◽  
Accessory Spleens

Accessory spleens, which are also known as a splenunculus or a splenule, are a benign developmental anomaly in which nodules of splenic tissue exist separate to the main body of the spleen. It is a reasonably common phenomenon which is present in approximately 10-30% of the population, however they only infrequently become symptomatic. Torsion of an accessory spleen is a rare cause of abdominal pain with few cases reported in the literature, most commonly in the paediatric population. Without treatment, torsion can lead to significant complications including haemorrhagic shock, peritonitis or rupture. The rarity portends a diagnostic challenge and thus a high index of suspicion is crucial for attaining a prompt diagnosis and timely management. This case gives an account of a 43-year-old female who presented with abdominal pain secondary to a torted accessory spleen. 

scholarly journals The real cause of right lower abdominal pain: an analysis of ultrasonographic findings

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094618
Author(s):  
Xia Zhang ◽  
Biaohu Liu ◽  
Xiangming Zhu ◽  
Guobing Hu
Keyword(s):  
Abdominal Pain ◽  
Histopathological Examination ◽  
Splenic Vein ◽  
Lower Abdominal Pain ◽  
Accessory Spleen ◽  
Large Mass ◽  
Splenic Tissue ◽  
Common Disease ◽  
Ureteral Calculus ◽  
The Right

A pelvic accessory spleen is uncommon and most patients with this condition are asymptomatic. Ureteral calculus is a common disease and can cause acute abdominal pain. We report a 51‐year‐old male patient who presented at our hospital with acute right lower abdominal pain and gross hematuria. A large mass on the right side of the pelvis was detected on an ultrasound examination, as well as a calculus in the lower segment of the right ureter. Computed tomography angiography showed the presence of a long vascular pedicle with an artery originating from the splenic artery and a vein that joined with the splenic vein. Laparoscopy was carried out and it showed a solid mass covered with omentum on the right lower abdomen. The mass was then removed surgically. Histopathological examination of the resected specimens confirmed splenic tissue. We speculate that the accessory spleen and ureteral calculus caused right lower abdominal pain in our case. However, the ureteral calculus might have played a much more important role in causing acute right lower abdominal pain than the accessory spleen.

Consideration of pulmonary thromboembolism in paediatric patients presenting to the emergency department with abdominal pain

2021 ◽  
Vol 14 (5) ◽  
pp. e239175
Author(s):  
Wasyla Ibrahim ◽  
Farhat Mushtaq
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Lower Limb ◽  
Pulmonary Thromboembolism ◽  
Signs And Symptoms ◽  
Paediatric Population ◽  
Limb Trauma ◽  
High Index Of Suspicion ◽  
Lower Limb Trauma

Venous thromboembolism (VTE) is a recognised complication of lower limb trauma in adult patients and classically presents with cardiopulmonary symptoms. However, the risk of VTE and its presenting signs and symptoms are less well documented in the paediatric population. We report the case of a child who presented to our emergency department with abdominal pain 2 weeks after lower limb fracture, who was subsequently found to have a pulmonary thromboembolism (PTE). This case report highlights the importance of having a high index of suspicion for VTE in the paediatric population if there are predisposing risk factors and to consider PTE as a differential cause of abdominal pain. To the authors’ knowledge, no case has been described in which a child presenting with abdominal pain was consequently found to have a pulmonary embolism.

scholarly journals A Giant Egg-like symptomatic Loose Body in the Peritoneal Cavity: A Case Report

1970 ◽  
Vol 29 (6) ◽  
Author(s):  
Berhanetsehay Teklewold ◽  
Anteneh Kehaliw ◽  
Melat Teka ◽  
Bereket Berhane
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Incidental Finding ◽  
Loose Body ◽  
Loose Bodies ◽  
Diagnostic Challenge ◽  
First Case ◽  
Appendices Epiploicae ◽  
The One ◽  
High Index Of Suspicion

Background: Peritoneal loose bodies are rare lesions that are usually found as an incidental finding during abdominal surgery. Large loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. Peritoneal loose bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity.Case Presentation: We report here the first case, in the local Ethiopian context, of a giant “egg-like” loose peritoneal body measuring 7 × 6 cm found in a 50-year-old man who presented with a cramping abdominal pain and features of abdominal obstruction. The current hypothesis as regards these bodies and the diagnostic challenges is discussed.Conclusion: Small peritoneal loose bodies are common but giant and symptomatic ones’, like the one discussed here, are very rare and a diagnostic challenge. And, in the context of intestinal obstruction, a high index of suspicion is needed in order to diagnose them.

scholarly journals Diagnosis and Management of Bacterial Meningitis in the Paediatric Population: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Catherine L. Tacon ◽  
Oliver Flower
Keyword(s):  
Bacterial Meningitis ◽  
Paediatric Population ◽  
Diagnostic Techniques ◽  
Significant Morbidity ◽  
Early Management ◽  
Laboratory Techniques ◽  
Clinical Tools ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis ◽  
New Vaccines

Paediatric bacterial meningitis is a neurological emergency which, despite advances in medical management, still has a significant morbidity and mortality. Over recent decades new vaccines have led to a change in epidemiology of the disease; however, it remains a condition that requires a high index of suspicion, prompt diagnosis, and early management in the emergency department. New laboratory techniques and clinical tools are aiding the diagnosis of bacterial meningitis, yet some controversies still exist in its management. This paper outlines the changing epidemiology of the disease, current diagnostic techniques as well as controversies and advances in the management of bacterial meningitis in the paediatric population.

scholarly journals Intrapancreatic accessory spleen mimicking malignant tumor: three case reports

2019 ◽  
Vol 8 (6) ◽  
pp. 205846011985934 ◽  
Author(s):  
Maria Zurek Munk-Madsen ◽  
Kristine Zakarian ◽  
Peter Sandor Oturai ◽  
Carsten Palnæs Hansen ◽  
Birgitte Federspiel ◽  
...  
Keyword(s):  
Single Photon ◽  
Case Reports ◽  
False Negative ◽  
Photon Emission ◽  
Accessory Spleen ◽  
Splenic Tissue ◽  
Emission Computed Tomography ◽  
Intrapancreatic Accessory Spleen ◽  
Photon Emission Computed Tomography ◽  
Accessory Spleens

Intrapancreatic hypervascular lesions may represent metastases, neuroendocrine tumors, or intrapancreatic accessory spleens. The benign intrapancreatic accessory spleen can be difficult to separate from a malignant neuroendocrine tumor or metastasis. We report three cases of pancreatic lesions that underwent pancreatic surgery due to suspicion of malignancy on imaging; all cases were histologically intrapancreatic accessory spleens. Our cases point to the importance of performing single-photon emission computed tomography with heat-damaged Tc-99m-pertechnetate labelled erythrocytes to identify splenic tissue, even though small lesions can show a false-negative result.

scholarly journals Tubercular septal abscess in a postoperative patient: a novel entity

2018 ◽  
pp. bcr-2018-224892
Author(s):  
Fatima Sarwar ◽  
Sana Sheikh ◽  
Naqeeb Ullah Khan ◽  
Syeda Nidaa Fatima
Keyword(s):  
Extrapulmonary Tuberculosis ◽  
High Index ◽  
Diagnostic Tools ◽  
Diagnostic Challenge ◽  
Case Scenario ◽  
Appropriate Treatment ◽  
History Of ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis ◽  
Septal Abscess

Extrapulmonary tuberculosis is a rather uncommon and potentially challenging phenomenon. Such manifestation, particularly in the scenario of a late postoperative period, is extremely rare and requires a high index of suspicion, prompt diagnosis and appropriate treatment.We present the case scenario of a patient with history of successfully treated pulmonary tuberculosis many years earlier, without any signs of recurrence, who developed primary nasal septal tuberculosis after undergoing septoplasty to correct his septal deviation. His postoperative course remained uneventful for 4 months. He then presented with a spontaneous nasal septal abscess, which proved to be tubercular in nature on investigations. Appropriate diagnosis was established, and the patient was treated successfully with antituberculous therapy.Recurrent tuberculosis may present a diagnostic challenge for healthcare professionals. Only a high index of suspicion, modern diagnostic tools and institution of appropriate treatment including surgical intervention as required will ensure a promising outcome.

scholarly journals 486 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M T Tan ◽  
M M Akhter Rahman ◽  
K Sasapu
Keyword(s):  
Abdominal Pain ◽  
Clinical Features ◽  
Diagnostic Laparoscopy ◽  
Epigastric Pain ◽  
Perforated Appendicitis ◽  
Paediatric Population ◽  
Hemorrhagic Pancreatitis ◽  
Spontaneous Hemoperitoneum ◽  
Acute Hemorrhagic Pancreatitis ◽  
High Index Of Suspicion

Abstract Introduction Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis. Presentation of the case A- 9-year-old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management. Discussion The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment. Conclusions A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases. Key Statement Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.

scholarly journals Mesenchymal Hamartoma in Children: A Diagnostic Challenge

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Muhammad Rehan Khan ◽  
Larry A. Binkovitz ◽  
Thomas C. Smyrk ◽  
D. Dean Potter ◽  
Katryn N. Furuya
Keyword(s):  
Abdominal Pain ◽  
Signs And Symptoms ◽  
Mesenchymal Hamartoma ◽  
Gamma Glutamyl Transferase ◽  
Older Children ◽  
Diagnostic Challenge ◽  
Caroli Syndrome ◽  
Magnetic Resonance Imaging Mri ◽  
Glutamyl Transferase ◽  
High Index Of Suspicion

Mesenchymal hamartoma is a benign tumor of the liver with a poorly understood pathogenesis. It is uncommon in older children, especially after 2 years of age. The signs and symptoms may be nonspecific; therefore, a high index of suspicion is required for diagnosis and treatment. We report a 5-year-old previously healthy male who presented with acute abdominal pain, fatigue, and fever. He was diagnosed with pneumonia initially and treated with antibiotics. A computed tomography (CT) scan done for evaluation of his persistent abdominal pain demonstrated a hepatic mass. Follow-up magnetic resonance imaging (MRI) of the liver demonstrated multiple serpiginous tubular-type structures, read as possible Caroli syndrome. He had a normal abdominal examination and normal biochemistries including alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, and alpha-fetoprotein. He was referred to our institution for second opinion. On further review of his imaging studies, the lesion was thought to be a mesenchymal hamartoma. He subsequently underwent resection of the mass. Pathology confirmed the diagnosis of mesenchymal hamartoma.

EP.FRI.86 Spontaneous haemoperitoneum due to acute hemorrhagic pancreatitis in a child: A Case report

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
May Ting Tan ◽  
Mohammad Mahbub Akhter Rahman ◽  
Kishore Sasapu
Keyword(s):  
Abdominal Pain ◽  
Clinical Features ◽  
Diagnostic Laparoscopy ◽  
Epigastric Pain ◽  
Perforated Appendicitis ◽  
Paediatric Population ◽  
Hemorrhagic Pancreatitis ◽  
Spontaneous Hemoperitoneum ◽  
Acute Hemorrhagic Pancreatitis ◽  
High Index Of Suspicion

Abstract Introduction Hemoperitoneum resulting from acute pancreatitis (AP) is rare. It is more commonly associated with chronic pancreatitis. Seldom, it has been associated with paediatric population. Here we report a case of spontaneous hemoperitoneum due to acute hemorrhagic pancreatitis in a child presented with the clinical features suggestive of acute appendicitis. Presentation of the case A 9-year old girl presented with abdominal pain and clinical features consistent with perforated appendicitis, underwent diagnostic laparoscopy. This revealed hemoperitoneum due to acute hemorrhagic pancreatitis with fat saponification in the omentum around the splenic flexure. She was stable postoperatively and was transferred to a tertiary paediatric unit for further management. Discussion The incidence of paediatric AP is increasing at 1/10,000 children per year. The definition of paediatric AP is based on the Atlanta criteria in adults. Biliary condition, systemic illness, and medications remain the main causes of AP in children. Intravenous fluid therapy with crystalloids remains the mainstay of treatment.  Conclusion A high index of suspicion is required to reach the diagnosis as symptoms are commonly comprised of abdominal pain, irritability, nausea, vomiting, and epigastric pain. USS is the investigation of choice. Majority of the patient recovers completely with a recurrence reported only on 15-35% of the cases.  Key Statement Inclusion of amylase or lipase to be considered in the routine workup if there is a suspicion of an alternate diagnosis. Diagnostic laparoscopy remains a viable option for patients presented with features of peritonism to establish a diagnosis.

scholarly journals Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background

Open Medicine ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 087-094
Author(s):  
Zbyněk Tüdös ◽  
Paulína Szász ◽  
Lucia Veverková ◽  
František Hruška ◽  
Igor Hartmann ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Accessory Spleen ◽  
Splenic Tissue ◽  
Splenic Cells ◽  
The Right ◽  
Reproductive Gland ◽  
Accessory Spleens

AbstractFoci of splenic tissue separated from the spleen can occur as a congenital anomaly. Isolated nodules of splenic tissue are called accessory spleens or spleniculli. However, nodules of splenic tissue can merge with other organs during embryonic development, in which case we speak of spleno-visceral fusions: most often, they merge with the tail of the pancreas (thus forming spleno-pancreatic fusion or an intrapancreatic accessory spleen), with the reproductive gland (i.e., spleno-gonadal fusion), or with the kidney (i.e., spleno-renal fusion). Our case report describes the fusion of heterotopic splenic tissue with the right adrenal gland, which was misinterpreted as a metastasis of a renal cell carcinoma. To the best of our knowledge, this is the first reported case of spleno-adrenal fusion. Spleno-visceral fusions usually represent asymptomatic conditions; their main clinical significance lies in the confusion they cause and its misinterpretation as tumors of other organs. We believe that the cause of retroperitoneal spleno-visceral fusions is the anomalous migration of splenic cells along the dorsal mesentery to the urogenital ridge, together with primitive germ cells, at the end of the fifth week and during the sixth week of embryonic age. This theory explains the possible origin of spleno-visceral fusions, their different frequency of occurrence, and the predominance of findings on the left side.

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