scholarly journals Bleeding Duodenal Diverticulum with Iatrogenic Perforated Duodenal Diverticulum: Double Trouble

2021 ◽  
Vol 2 (5) ◽  
pp. 01-04
Author(s):  
Sarmukh Singh ◽  
Mohd A H ◽  
Azmi H
Keyword(s):  
Hypovolemic Shock ◽  
Digital Rectal Examination ◽  
Duodenal Diverticulum ◽  
Fistula Formation ◽  
Diffuse Peritonitis ◽  
Iatrogenic Perforation ◽  
Common Location ◽  
Intravenous Antibiotics ◽  
Endoscopic Clips ◽  
Abdominal Examination

Background: Duodenal diverticulum is the second most common location following the large bowel. Only 1–5% of patients with DD are symptomatic. Complications of duodenal diverticulum includes obstruction of duodenum, biliary pancreatic duct, pancreatitis, haemorrhage, diverticulitis with or without perforation, and other biliopancreatic manifestations including fistula formation in the bile duct, choledocholithiasis and cholangitis, bezoar formation inside the diverticulum, perforation and bleeding. Surgical or non-surgical treatment are considered in selected patient in treating perforated duodenal diverticulum. Case Presentation: We present a 69 year old gentleman presented to emergency department with complaint of passing out blackish stool for 2 days duration associated with presyncopal attack. On arrival, patient appear pale with class 3 hypovolemic shock symptoms. Abdominal examination revealed mild tenderness over epigastric region without signs of peritonism. Digital rectal examination showed fresh melena. Oesophagogastroduodenoscopy (OGDS) showed a huge diverticulum at duodenum (D3) with pooling of blood and blood clots. In view of bleeding at D3 diverticulum,adrenaline was injected and haemoclipped was applied. Hemostasis from bleeding duodenal diverticulum was successfuly secured. However, patient had iatrogenic perforated duodenal diverticulum. Conclusion: We present a case of upper gastrointestinal bleeding from a D3 diverticulum with iatrogenic perforated duodenal diverticulum due to endoscopic hemostasisinjection.We treated this patient conservatively by keep nil by mouth and started on parentral nutritional support, intravenous antibiotics and serial abdominal examination. We advocate in duodenal diverticulum bleeding the application of endoscopic clips and injection should be use juridiously. In case of iatrogenic perforation of duodenum diverticulum due to endoscopic hemostasis can still be treated conservatively in stable, elderly patients with no signs of diffuse peritonitis and no clinical evidence of sepsis

scholarly journals Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Beng Kwang Ng ◽  
Kembang Aziah Yakob ◽  
Wendy Yin Ling Ng ◽  
Pei Shan Lim ◽  
Rahana Abd Rahman ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Cystic Teratoma ◽  
Foreign Worker ◽  
Exploratory Laparotomy ◽  
Immunocompetent Patient ◽  
Nontuberculous Mycobacterium ◽  
Diagnostic Dilemma ◽  
Common Location ◽  
Intravenous Antibiotics ◽  
History Of

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

scholarly journals Bilateral extensive leg pyomyositis presenting with diabetic ketoacidosis

2021 ◽  
Vol 21 (2) ◽  
pp. 260-262
Author(s):  
Jil Shah ◽  
Khyatisha Seejore ◽  
Michael Mansfield
Keyword(s):  
Skeletal Muscle ◽  
Diabetic Ketoacidosis ◽  
Inflammatory Markers ◽  
Abscess Drainage ◽  
Predisposing Factor ◽  
Vein Thrombosis ◽  
Intravenous Antibiotics ◽  
History Of ◽  
Abdominal Examination ◽  
Deep Vein

Pyomyositis is a rare and serious acute purulent bacterial infection of the skeletal muscle. Diabetes is the most important predisposing factor and, if left untreated, the infection has significant complications. We report the case of an adult male who presented acutely with a history of abdominal pain, nausea and vomiting and bilateral thigh pain. His abdominal examination was unremarkable, but a fluctuant swelling was identified in both thighs. Biochemical investigations revealed raised inflammatory markers and diagnostic chemistry of diabetic ketoacidosis. Pyomyositis was treated with intravenous antibiotics and surgical abscess drainage. MRI is the definitive investigation of choice to diagnose pyomyositis. Differential diagnoses include cellulitis, septic arthritis and deep vein thrombosis.

scholarly journals The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Moysis Moysidis ◽  
Daniel Paramythiotis ◽  
Anestis Karakatsanis ◽  
Evropi Amanatidou ◽  
Elisavet Psoma ◽  
...  
Keyword(s):  
Incidental Findings ◽  
Duodenal Diverticulum ◽  
Common Site ◽  
Case Presentation ◽  
Postoperative Course ◽  
First Case ◽  
Intravenous Antibiotics ◽  
Therapeutic Decisions ◽  
Duodenal Diverticula ◽  
Bowel Rest

Abstract Background The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy. Case presentation We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home. Conclusions Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.

scholarly journals Clinical, laboratory and ultrasonographic findings in 38 calves with type-4 abomasal ulcer

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Ueli Braun ◽  
Christina Widmer ◽  
Karl Nuss ◽  
Monika Hilbe ◽  
Christian Gerspach
Keyword(s):  
Clinical Laboratory ◽  
Clinical Findings ◽  
Pathological Examination ◽  
Severe Illness ◽  
Diffuse Peritonitis ◽  
Laboratory Findings ◽  
Poor General Health ◽  
Abdominal Examination ◽  
The Right ◽  
Tentative Diagnosis

Abstract Background Type-4 abomasal ulcers (U4) are perforated ulcers causing diffuse peritonitis. This retrospective study describes the clinical, laboratory and ultrasonographic findings in 38 calves with U4. The medical records of 38 calves aged three days to 20 weeks with U4 were scrutinised. Results The most common clinical findings were poor general health (95%), reduced skin elasticity (95%), rumen atony (91%), abdominal guarding (76%) and positive percussion auscultation and/or swinging auscultation on the right side of the abdomen (75%). The most frequent laboratory findings were increased numbers of segmented neutrophils (87%), eosinopenia (87%), acidosis (84%), azotaemia (79%) and hyponatraemia (79%). The most frequent abdominal ultrasonographic findings were intestinal atony (68%), fluid (67%) and fibrin deposits (58%) in the abdomen. Thirty-five calves were euthanased and three calves died spontaneously. All calves underwent pathological examination. Diffuse peritonitis caused by a transmural abomasal ulcer was the principal diagnosis in all calves. Conclusions Perforated abomasal ulcers cause severe illness, and a thorough clinical examination combined with ultrasonographic abdominal examination should lead to a tentative diagnosis.

scholarly journals Infant Bladder Rhabdomyosarcoma in a Shared-Care Centre in Ghana: Case Report and Review of the Literature

2021 ◽  
Vol 6 (05) ◽  
pp. 351-355
Author(s):  
Edwin M.T. Yenli ◽  
Kingsley A Bimpong ◽  
Nihad Salifu ◽  
Peter G. Kwarteng ◽  
Ernest K. Cheyuo ◽  
...  
Keyword(s):  
Digital Rectal Examination ◽  
Pelvic Mass ◽  
Posterior Urethral Valve ◽  
Paediatric Oncology ◽  
West African ◽  
Resource Limited ◽  
Daunting Task ◽  
Urethral Valve ◽  
Abdominal Examination ◽  
Study Setting

Rhabdomyosarcoma is a fairly common soft tissue sarcoma among children. Genitourinary rhabdomyosarcoma accounts for one tenth of rhabdomyosarcomas in the West African sub-region. However, its occurrence and management are yet to be reported in our resource limited study setting. Care of such patients could be a daunting task. A comprehensive paediatric oncology service should be advocated to optimize the chances of survival. A seven-month old boy was referred to our facility on account of posterior urethral valve. A week’s complaint of crying on micturition, with associated passage of scanty urine and irritability, although he was apparently well since birth with no urinary complaints. A suprapubic mass was palpated on abdominal examination. Digital rectal examination revealed a nodular pelvic mass. Open cystostomy done and histopathology showed embryonal rhabdomyosarcoma of the urinary bladder. Chemotherapy was commenced on a modified Malignant Mesenchymal Tumour protocol of the International Society of Paediatric Oncology group. The mass was reduced by a third after six cycles of chemotherapy. In resource limited settings, the management of paediatric genitourinary rhabdomyosarcoma, using multidisciplinary and multimodal approach to include the hub for comprehensive paediatric oncology services should be advocated to optimize chances of survival.

scholarly journals The Trends of Complicated Acute Colonic Diverticulitis—A Systematic Review of the National Administrative Databases

Medicina ◽  
2019 ◽  
Vol 55 (11) ◽  
pp. 744 ◽  
Author(s):  
Roberto Cirocchi ◽  
Georgi Popivanov ◽  
Alessia Corsi ◽  
Antonio Amato ◽  
Riccardo Nascimbeni ◽  
...  
Keyword(s):  
Acute Diverticulitis ◽  
Complicated Diverticulitis ◽  
Administrative Databases ◽  
Fistula Formation ◽  
Diffuse Peritonitis ◽  
Significant Discrepancy ◽  
Full Spectrum ◽  
Free Perforation ◽  
Icd Codes ◽  
Definition Of

Background and Objectives: The diverticular disease includes a broad spectrum of different “clinical situations” from diverticulosis to acute diverticulitis (AD), with a full spectrum of severity ranging from self-limiting infection to abscess or fistula formation to free perforation. The present work aimed to assess the burden of complicated diverticulitis through a comparative analysis of the hospitalizations based on the national administrative databases. Materials and Methods: A review of the international and national administrative databases concerning admissions for complicated AD was performed. Results: Ten studies met the inclusion criteria and were included in the analysis. No definition of acute complicated diverticulitis was reported in any study. Complicated AD accounted for approximately 42% and 79% of the hospitalizations. The reported rates of abscess varied between 1% and 10% from all admissions for AD and 5–29% of the cases with complicated AD. An increasing temporal trend was found in one study–from 6% to 10%. The rates of diffuse peritonitis ranged from 1.6% to 10.2% of all hospitalizations and 11% and 47% of the complicated cases and were stable in the time. Conclusions: The available data precluded definitive conclusions because of the significant discrepancy between the included studies. The leading cause was the presence of heterogeneity due to coding inaccuracies in all databases, absence of ICD codes to distinguish the different type of complications, and the lack of coding data about some general conditions such as sepsis, shock, malnutrition, steroid therapy, diabetes, pulmonary, and heart failure.

Significance and preliminary investigation of urological symptoms and signs

2013 ◽  
pp. 7-36
Author(s):  
John Reynard ◽  
Simon Brewster ◽  
Suzanne Biers
Keyword(s):  
Urinary Incontinence ◽  
Lower Urinary Tract ◽  
Preliminary Investigation ◽  
Digital Rectal Examination ◽  
Flank Pain ◽  
Nocturnal Polyuria ◽  
Urinary Tract Symptoms ◽  
Urological Symptoms ◽  
Abdominal Examination ◽  
Symptoms And Signs

Haematuria I: definition and types 8 Haematuria II: causes and investigation 10 Haemospermia 14 Lower urinary tract symptoms (LUTS) 16 Nocturia and nocturnal polyuria 18 Loin (flank) pain 20 Urinary incontinence 24 Genital symptoms 26 Abdominal examination in urological disease 28 Digital rectal examination (DRE) ...

scholarly journals Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know

2021 ◽  
Vol 18 (21) ◽  
pp. 11687
Author(s):  
Ángel Borque-Fernando ◽  
Cristina Redondo-Redondo ◽  
Concepción Orna-Montesinos ◽  
Luis Mariano Esteban ◽  
Sophia Denizón-Arranz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Clinical Practice ◽  
General Practitioners ◽  
Cancer Diagnosis ◽  
Digital Rectal Examination ◽  
Scrotal Pain ◽  
Knowledge And Skills ◽  
Abdominal Examination ◽  
Very High

Background: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. Methods: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. Results and limitations: A total of 127 answers were obtained, in which ‘Urological infections’, ‘Renal colic’, ‘PSA levels and screening for prostate cancer’, ‘Benign prostatic hyperplasia’, ‘Hematuria’, ‘Scrotal pain’, ‘Prostate cancer diagnosis’, ‘Bladder cancer diagnosis’, ‘Urinary incontinence’, and ‘Erectile dysfunction’ were rated as Very high or High formative requirements (>75%). Regarding urological skills, ‘Abdominal examination’, ‘Interpretation of urinalysis’, ‘Digital rectal examination’, ‘Genital examination’, and ‘Transurethral catheterization’ were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. Conclusions: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients’ proper care by future GPs.

scholarly journals Over-the-scope clip

2016 ◽  
Vol 07 (02) ◽  
pp. 047-050
Author(s):  
Bhanwar Singh Dhandhu ◽  
Kumar Shwetanshu Narayan ◽  
Surinder Sultania ◽  
Sandeep Nijhawan
Keyword(s):  
Success Rate ◽  
Gastrointestinal Hemorrhage ◽  
Dynamic Compression ◽  
Iatrogenic Perforation ◽  
Chronic Fistula ◽  
Endoscopic Clips ◽  
Different Types ◽  
Over The Scope Clip ◽  
Fistula Treatment ◽  
Good Success Rate

AbstractThe endoscopic clips were first described by Hayashi in Japan in 1975. Since then, many different types of clips have been introduced to the gastroenterology practice. Over-the-scope clip (OTSC) or the “beer claw” was introduced in the year 2010. It works on the principle of dynamic compression and is applied over the scope like a band ligator. OTSC is a new endoscopic modality which can be used in acute gastrointestinal hemorrhage, iatrogenic perforation, anastomotic leak, and chronic fistula treatment with fairly good success rate and therefore, is now being considered as an alternative to surgery, especially in situations where surgery is not feasible.

scholarly journals Autopsy Techniques in Patients With History of Radiofrequency Ablation for Atrial Fibrillation

2021 ◽  
Author(s):  
Bindu Challa ◽  
Keluo Yao ◽  
Patricia Allenby ◽  
Charles L. Hitchcock ◽  
Youri Ivanov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Hypovolemic Shock ◽  
Fistula Formation ◽  
Esophageal Fistula ◽  
En Bloc ◽  
Epigastric Discomfort ◽  
Presenting Symptoms ◽  
History Of

Context.— Esophageal fistula formation is one of the most feared complications of radiofrequency catheter ablation. This procedure and its many variations, such as the “maze,” are becoming the mainstream treatment for atrial fibrillation owing to limitations of antiarrhythmic drugs. The incidence of this complication rate has been reported to be from 0.01% to 1%. Objective.— To delineate the importance of using the en bloc Letulle method of dissection for identifying esophageal fistulas for cases with a history of radiofrequency catheter ablation. Design.— Six autopsy cases with a history of radiofrequency catheter ablation for atrial fibrillation were selected from 1736 autopsies performed between 2009 and 2020. Results.— The initial presenting symptoms included neurologic symptoms, chest pains, epigastric discomfort, and sepsis. Transesophageal echocardiogram of 4 cases showed no evidence of thrombus or vegetation, however, 2 cases had evidence of atrial esophageal fistula. The autopsy findings included 5 atrial esophageal fistulas and 1 esophagopericardial fistula. Atrial esophageal fistulas were small and could be detected without difficulty when the en bloc Letulle technique was used and would have been easily missed by the Virchow method. The immediate causes of the deaths were myocardial ischemia, septic emboli to brain and heart, hypovolemic shock secondary to exsanguination, stroke, and coagulopathy. Conclusions.— To date, this is the largest collection of autopsy cases showing esophageal fistula associated with prior radiofrequency catheter ablation. The Letulle dissection method is preferable in this setting.

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