Incarcerated inguinal hernia? No, acute pancreatitis

Open Medicine ◽  
2011 ◽  
Vol 6 (6) ◽  
pp. 770-772 ◽  
Author(s):  
Jose Ramia-Angel ◽  
Eloy Sancho ◽  
Rafael Lozoya ◽  
Andrej Gasz ◽  
Jose Santos
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Pancreatitis ◽  
Incarcerated Hernia ◽  
Intravenous Antibiotic ◽  
Incarcerated Inguinal Hernia ◽  
Testicular Pain ◽  
Inguinal Area ◽  
History Of ◽  
The Right

AbstractA 62-year-old man presented to the Emergency Department with a 2-day history of right testicular pain. The initial diagnosis was orchiepididymitis (later found to be mistaken), and intravenous antibiotic treatment was started. Twenty-four hours later, the patient had mild pain in the right inguinal area and right infra-abdominal area. We performed an inguinal ultrasound that showed an incarcerated mass of mixed echogenicity in the right inguinal area. Surgery was performed because we thought the patient had an inguinal incarcerated hernia. Two days after the surgical procedure, the patient began to have fever and erythema and pain in the back. Abdominal computed tomography (CT) showed an acute pancreatitis with a peripancreatic collection from the pancreas to right inguinal area. We have reviewed similar cases in the literature and note that, infrequently, an inguinal mass can be the first sign of mostly asymptomatic acute pancreatitis.

scholarly journals A141 SPONTANEOUS ESOPHAGEAL PERFORATION: AN UNREPORTED COMPLICATION OF LYMPHOCYTIC ESOPHAGITIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 128-129
Author(s):  
A LAGROTTERIA ◽  
A W Collins ◽  
A Someili ◽  
N Narula
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Case Report ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Esophageal Perforation ◽  
Distal Esophagus ◽  
Chest Discomfort ◽  
History Of ◽  
Lymphocytic Esophagitis

Abstract Background Lymphocytic esophagitis is a new and rare clinicopathological entity. It is a histological pattern characterized by lymphocytic infiltrate without granulocytes. Its etiology and clinical significance remains unclear. The clinical manifestations are typically mild, with reflux and dysphagia the most commonly reported symptoms. Aims We describe a case report of spontaneous esophageal perforation associated with lymphocytic esophagitis. Methods Case report Results A previously well 31-year-old male presented to the emergency department with acute food impaction. His antecedent symptoms were acute chest discomfort and continuous odynophagia following his most recent meal, with persistent globus sensation. The patient had no reported history of allergies, atopy, rhinitis, or asthma. A previous history of non-progressive dysphagia was noted after resuscitation. Emergent endoscopy revealed no food bolus, but a deep 6 cm mucosal tear in the upper-mid esophagus extending 24 to 30 cm from the incisors. Chest computed tomography observed small volume pneumoperitoneum consistent with esophageal perforation. The patient’s recovery was uneventful; he was managed conservatively with broad-spectrum antibiotics, proton pump inhibitor therapy, and a soft-textured diet. Endoscopy was repeated 48 hours later and revealed considerable healing with only a residual 3-4cm linear laceration. Histology of biopsies taken from the mid and distal esophagus demonstrated marked infiltration of intraepithelial lymphocytes. There were no eosinophils or neutrophils identified, consistent with a diagnosis of lymphocytic esophagitis. Autoimmune indices including anti-nuclear antibodies and immunoglobulins were normal, ruling out a contributory autoimmune or connective tissue process. The patient was maintained on a proton pump inhibitor (pantoprazole 40 mg once daily) following discharge. Nearly six months following his presentation, the patient had a recurrence of symptoms prompting representation to the emergency department. He described acute onset chest discomfort while eating turkey. Computed tomography of the chest redemonstrated circumferential intramural gas in the distal esophagus and proximal stomach. Conclusions Esophageal perforation is a potentially life-threatening manifestation of what had been considered and described as a relatively benign condition. From isolated dysphagia to transmural perforation, this case significantly expands our current understanding of the clinical spectrum of lymphocytic esophagitis. Funding Agencies None

scholarly journals Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

2021 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Chukwubuike Kevin Emeka
Keyword(s):  
Pediatric Surgery ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Tertiary Hospital ◽  
Prior History ◽  
Testicular Pain ◽  
History Of ◽  
The Mean ◽  
Urological Emergency ◽  
The Right

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

Sudden Onset of Diplopia and a Skeletal Muscle Antibody

2021 ◽  
pp. 160-162
Author(s):  
John R. Mills
Keyword(s):  
Computed Tomography ◽  
Myasthenia Gravis ◽  
Patent Foramen Ovale ◽  
Time Course ◽  
Vision Loss ◽  
Sudden Onset ◽  
Foramen Ovale ◽  
Clinical Disorder ◽  
History Of ◽  
The Right

A 62-year-old man with a history of migraine came to the emergency department with sudden onset of horizontal diplopia and, subsequently, bilateral ptosis. He noted feeling unsteady when walking. He reported that the diplopia worsened throughout the day. He had a history of hepatitis C infection. He had some vision loss in his left eye, which was thought to relate to a retinopathy. He disclosed that he had a history of cold feet and had notably high arches. He had a pacemaker because of syncope attributed to sick sinus syndrome. Computed tomography angiography of the head and neck were ruled negative for intracranial stenosis, occlusions, or aneurysms. Computed tomography of the head indicated a tiny lacunar infarct in the right caudate head. Magnetic resonance imaging of the brain identified a tiny, periaqueductal, enhancing abnormality in the right midbrain that was thought to be likely ischemic, but there was some concern for a demyelinating or inflammatory lesion. Cerebrospinal fluid evaluation indicated an increased protein concentration. Serologic evaluation for myasthenia gravis striational antibodies were positive at a titer of 1:240. Serum protein studies indicated the presence of polyclonal hypergammaglobulinemia. Myasthenia gravis was effectively ruled out. Given the hyperacute time course, the patient’s clinical disorder was most probably explained by an ischemic stroke that affected the oculomotor nuclei regions causing ptosis and ophthalmoparesis. On follow-up, the patient was discovered to have a patent foramen ovale. Whether the patent foramen ovale was a contributing factor to the stroke is uncertain. The recurrence rate in this setting is thought to be low relative to other causes of stroke. Ultimately it was decided to not close the patent foramen ovale and to maintain the patient on clopidogrel and adult low-dose aspirin. The onset of diplopia is typically sudden, but this occurs exclusively with vascular pathologic processes. Diplopia that appears intermittently with diurnal variation suggests the possibility of a neuromuscular junction disease such as myasthenia gravis.

Pseudodiagnosis of Pseudoseizure

2020 ◽  
pp. 105-110
Author(s):  
Pat Croskerry
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
The Past ◽  
Autopsy Report ◽  
History Of ◽  
History Of Depression ◽  
Tomography Scan ◽  
Surprising Finding

In this case, a 35-year-old male is brought to a community hospital emergency department by ambulance having suffered an apparent seizure in the street. He is well known to the nurses and physician who see him. He has had several visits for seizures, and he has a history of depression. He has had electroencephalography studies and a computed tomography scan of his head in the past and has had assessments by both neurology and psychiatry. While he is in the department, he has an atypical seizure. There is a consensus among the ED staff that his seizures may be factitious. After a period of observation, he is discharged. Approximately 6 months later, the physician hears that the patient has died and tracks down his autopsy report, which had a surprising finding.

scholarly journals Isolated right testicular pain for six days: an unusual presentation of occult abdominal aortic aneurysm leak

2011 ◽  
Vol 93 (4) ◽  
pp. e1-e2 ◽  
Author(s):  
Rachael O Forsythe ◽  
Victoria Lavin ◽  
Simon CA Fraser ◽  
Alan McNeill
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Case Reports ◽  
Haemodynamic Instability ◽  
Older Patient ◽  
Testicular Pain ◽  
Lower Back ◽  
Abdominal Aortic ◽  
History Of ◽  
The Right

Abdominal aortic aneurysm (AAA) rupture commonly presents with abdominal or lower back pain and haemodynamic instability. There have been case reports of co-existing left testicular pain; however, very few cases describe right testicular pain as the sentinel symptom. We discuss the case of a 75-year-old man who presented to the on-call urologists with a 6-day history of right testicular pain. On examination, a painless AAA was detected. The patient was stable and a CT scan demonstrated a large AAA extending into the right iliac vessels, with suggestion of leakage. Attempted emergency repair was unsuccessful and the patient died in theatre. This atypical presentation of occult aneurysm leak highlights the need for clinical vigilance in the older patient with seemingly benign groin symptoms, including isolated right testicular pain.

scholarly journals Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure

2020 ◽  
Vol 13 (2) ◽  
pp. e232812
Author(s):  
Syed Tausif Ahmed ◽  
Matthew Barvo ◽  
Nayana Kamath ◽  
Richard Alweis
Keyword(s):  
Emergency Department ◽  
Asbestos Exposure ◽  
Anticoagulation Therapy ◽  
Abdominal Distension ◽  
High Density ◽  
Chemotherapy Treatment ◽  
Lower Limb Pain ◽  
History Of ◽  
The Right ◽  
Vague Abdominal Pain

A 75-year-old man presented to the emergency department with 1-day history of right lower limb pain and 3-month history of vague abdominal pain. In the emergency department a thrombus was discovered in the right popliteal artery. CT scan of the abdomen and pelvis revealed high-density material in the pelvis, multiple hypodensities on the liver, ascites with omental nodularity, and high-density material along the stomach wall. He underwent thrombectomy and was started on anticoagulation therapy. The core needle biopsy revealed primary omental mesothelioma. There was no history of any known asbestos exposure. He also had to undergo therapeutic paracentesis twice due to abdominal distension. Mesothelioma treatment of carboplatin and pemetrexed was started, and the patient is currently receiving this chemotherapy treatment regimen.

scholarly journals PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY

2019 ◽  
Vol 5 (6) ◽  
pp. e384-e387 ◽  
Author(s):  
Abraham E. Wei ◽  
Matthew R. Garrett ◽  
Ankur Gupta
Keyword(s):  
Computed Tomography ◽  
Rare Case ◽  
Clinical Laboratory ◽  
Parathyroid Tissue ◽  
Severe Hypercalcemia ◽  
Positron Emission ◽  
Affected Tissue ◽  
History Of ◽  
The Right ◽  
Recurrent Hyperparathyroidism

Objective: To present a rare case of parathyromatosis. Methods: We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results: A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion: This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.

scholarly journals 57 Emergency Department Computed Tomography in Early Acute Pancreatitis

2017 ◽  
Vol 70 (4) ◽  
pp. S23-S24
Author(s):  
K. Ullah ◽  
M. Lohse ◽  
J. Seda ◽  
H.C. Thode ◽  
A.J. Singer ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Pancreatitis

Extradural spinal angiolipoma associated with bone lysis in a dog

1998 ◽  
Vol 34 (5) ◽  
pp. 373-376 ◽  
Author(s):  
U Reif ◽  
CT Lowrie ◽  
SD Fitzgerald
Keyword(s):  
Computed Tomography ◽  
Spinal Cord ◽  
Bone Remodeling ◽  
Spinal Tumor ◽  
Histological Findings ◽  
History Of ◽  
Bone Lysis ◽  
Left And Right ◽  
The Difference ◽  
The Right

An extradural spinal tumor was diagnosed in a 12-year-old Labrador retriever that was presented with a one-week history of paraparesis. Myelography indicated a deviation of the spinal cord to the right side at the level of the second lumbar (L2) vertebra. The difference in length measuring the left and right sides of the L2 vertebra suggested a fracture of the vertebral body. Severe bone remodeling and an extradural mass were seen on computed tomography (CT). Clinical, radiographical, and histological findings are described and considered homologous to extradural angiolipomas described in the human literature.

scholarly journals Extraabdominal parasitic lipoleiomyoma

2021 ◽  
Vol 17 (1) ◽  
pp. 48-51
Author(s):  
Tae Hoon Lee ◽  
Se-Jin Baek
Keyword(s):  
Computed Tomography ◽  
Histopathological Examination ◽  
Preoperative Localization ◽  
Imaging Studies ◽  
Palpable Mass ◽  
Inguinal Area ◽  
Pathological Evaluation ◽  
The Right

Extrauterine parasitic lipoleiomyoma is a very rare fatty tumor, with uncertain histopathogenesis. Although imaging studies play an important role in preoperative localization and diagnosis of lipoleiomyoma, a pathological evaluation is paramount for confirmation of diagnosis. We describe a case of a 49-year-old woman with a palpable mass in the right inguinal area. Computed tomography of the abdomen and pelvis revealed a fluid- and fat-containing mass. Histopathological examination of the mass, which was successfully resected, confirmed the diagnosis of lipoleiomyoma. The patient was discharged on a postoperative day 2 without any complications.

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