scholarly journals Perforated diverticulitis in a patient with very proximal jejunal diverticula

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Constantinos Avgoustou ◽  
Dimitrios Velecheris
Keyword(s):  
Abdominal Distension ◽  
Perforated Diverticulitis ◽  
Jejunal Loop ◽  
Emergency Laparotomy ◽  
Rebound Tenderness ◽  
Cardiac Arrythmias ◽  
Cardiopulmonary Support ◽  
Abdomen Ct ◽  
Fluid Levels ◽  
Jejunal Diverticulitis

Background: We report a case of an elderly with peritonitis due to perforated jejunal diverticulitis, and we highlight the diagnostic evaluation and treatment alternatives. Case presentation: A 92-year-old woman was transferred to the Emergency Dept. with abdominal pain and vomiting for the past 12 hours. Physical examination revealed diffuse pain, abdominal distension, rebound tenderness and bowel silence. She was febrile, tachycardic, tachypneic, hypotensive and anuric. Blood gas estimation showed metabolic acidosis. She fulfilled the criteria of septic shock. At presentation, she was mildly malnourished. From her medical history, she had cardiac arrythmias, hypertension and diabetes mellitus under proper medication, and laparoscopic cholecystectomy. Laboratory investigations revealed Hct 44.6%, WBC 12.500/dL, glucose 300 mg/dL, creatinine 2.8 mg/dL, CRP 405 mg/L, and electrolyte deficit. Abdominal X-ray showed gastric, small intestinal and colonic gas, with no pneumoperitoneum or air-fluid levels. Chest/abdomen CT showed thickening of proximal jejunal loop and adjacent mesentery, and an extraluminal air bubble, suggesting possible perforation. The patient was given intense resuscitation and broad-spectrum antibiotics and underwent emergency laparotomy. Results: Four jejunal diverticula, sized 1-3 cm, were confined to a segment 12 cm long, located 6 cm from the Treitz ligament; the proximal diverticula was inflamed and perforated. The adjacent mesentery was inflamed and thickened; the bowel lumen remained open. We performed one-layer full-thickness suturing of the perforated diverticulum and omental patch closure. The patient was transferred intubated to ICU. E. Coli was isolated from peritoneal fluid cultures and antibiotic therapy was adjusted to antibiogram. The patient had a first bowel movement at day 5 and was extubated at day 21. She needed mild cardiopulmonary support and was discharged at day 30. Conclusions: Jejunal diverticulitis is a challenging disorder since its rarity makes diagnosis difficult and, thus delayed. The perforation of jejunal diverticulitis requires emergent surgery and poses technical dilemmas.

scholarly journals A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

2019 ◽  
Vol 12 (5) ◽  
pp. e228050
Author(s):  
Andrew James Brown ◽  
Thomas Whitehead-Clarke ◽  
Vera Tudyka
Keyword(s):  
Small Bowel ◽  
Bowel Perforation ◽  
Linear Structure ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Small Bowel Perforation ◽  
Chicken Bone ◽  
Abdomen Ct ◽  
Distal Migration ◽  
The Right

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!

scholarly journals Post-trauma transmesocolic hernia: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Doaa Hussin Salam ◽  
Mohannad Al-Tarakji ◽  
Abubaker Ibrahim Alaieb ◽  
Rajvir Singh ◽  
Ayman El-Menyar ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Motor Vehicle ◽  
Epigastric Pain ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Male Victim ◽  
Internal Hernias ◽  
Vehicle Collision ◽  
Clinical Consequences

Abstract The prevalence of transmesocolic hernias, a subtype of internal hernias (IHs), is generally low. Its clinical consequences, including strangulation, ischemia and even death, however, necessitate awareness. IHs are classified as congenital or acquired as resulting from surgery, trauma or intraperitoneal inflammation. This is a case of a 37-year-old male victim of a motor vehicle collision 1 month prior to the index admission. The trauma-related injuries were managed conservatively and then discharged home. The patient was re-admitted with a 2-day history of epigastric pain, vomiting and abdominal distension. A diagnosis of small bowel obstruction due to a transmesocolic hernia was made on CT and emergency laparotomy performed. The post-operative course was unremarkable. It is vital to consider transmesocolic hernias in trauma patients presenting with a picture of bowel obstruction even in the absence of prior surgery.

scholarly journals Rupture Spleen as Initial Presentation in A Patient of Chronic Myeloid Leukaemia: A Case Report

2016 ◽  
Vol 13 (2) ◽  
pp. 52-54
Author(s):  
Mohammad Ibrahim Khalil ◽  
Md. Nazmul Islam ◽  
Mafruha Akter ◽  
AZM Mostaque Hossain ◽  
Md. Amir Hossain
Keyword(s):  
Chronic Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Female Student ◽  
Care Center ◽  
Chronic Phase ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Rare Presentation ◽  
Health Care Center ◽  
Common Presentation

A 22 years female student presented with sudden severe abdominal pain in left upper quadrant followed by abdominal distension. She attended in surgery unit of a tertiary health care center. On examination she was in shock and the abdomen was distended, tender. She was evaluated as  surgical acute abdomen and emergency laparotomy revealed rupture of spleen and splenectomy was done. Her CBC showed gross leucocytosis with predominance of neutrophils and significant number of myelocytes and the PBF showed the features of chronic phase of chronic myeloid leukaemia. BCR-ABL was positive from bone marrow that confirms the diagnosis. Splenomegaly is a common presentation of CML. However spontaneous rupture of spleen is a very rare presentation of CML. Journal of Science Foundation, 2015;13(2):52-54DOI: http://dx.doi.org/10.3329/jsf.v13i2.27935

scholarly journals Resection of a colonic mass following trauma: a diagnostic dilemma

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Paul Burchard ◽  
Alan A Thomay
Keyword(s):  
Ct Scan ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Symptomatic Improvement ◽  
Diagnostic Dilemma ◽  
Vehicle Accident ◽  
Abdomen Ct ◽  
History Of ◽  
Mitotic Figures ◽  
The Right

Abstract A 53-year-old Caucasian male presented with a 2-week history of abdominal distension, pain, nausea and lethargy. His symptoms began 1 day after an all-terrain vehicle accident during which he suffered blunt-force trauma to his mid-right abdomen. CT scan demonstrated abnormal thickening of the ascending colon and terminal ilium with surrounding inflammation within the retroperitoneum and colonic mesentery. Given his likely mechanism and symptomatic improvement, he was initially managed conservatively. However, he was readmitted with recurrence of symptoms, and a repeat CT scan demonstrated no interval improvement. An exploratory laparotomy was performed and a firm, fixed mass of the right-colon and colonic mesentery was found. Final histopathology of the mass revealed a diffuse lymphoid infiltrate with numerous mitotic figures and apoptotic cells. Immunohistochemical staining was positive for CD45, CD20, CD10, and BCL-6 and negative for CD3, TdT, and BCL-2, indicating a diagnosis of Burkitt lymphoma.

scholarly journals Ogilvie Syndrome Following Caesarean Section: A Case Report

2021 ◽  
Vol 28 (2) ◽  
pp. E202126
Author(s):  
Sanae Sninate ◽  
Habib Bellamlih ◽  
Soukaina Allioui ◽  
Leila Jroundi ◽  
Fatima Zahrae Laamrani
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Young Patients ◽  
Abdominal Distension ◽  
Intravenous Contrast ◽  
History Of ◽  
Ogilvie Syndrome ◽  
Fluid Levels ◽  
Tomography Scan

Background. Ogilvie syndrome is a rare postpartum complication. It is characterized by an acute colonic pseudo-obstruction which occurs in the absence of a mechanical cause. Early detection of the diagnosis is essential to avoid cecal perforation. Case report. We report a case of Ogilvie syndrome following caesarean section in a 39-year-old woman (gravida 2, para 2) with a history of secondary infertility 10 years ago due to tubal stenosis and subserous fibroma, which led to the indication for cesarean section in second pregnancy at 39 weeks of gestation. Three days after cesarean section, the patient presented with significant abdominal distension and tenderness, vomiting, weakness, and nausea; an abdominal X-ray showed cecal distension. Abdominal computed tomography scan with intravenous contrast revealed distension of the ascending and transverse colon with air-fluid levels but without transitional mechanical obstruction. The patient was successfully treated. Conclusions. Ogilvie syndrome is a rare but serious complication that should be considered in fit young patients who present with pain, severe abdominal distension and failure to pass flatus after caesarean section.

scholarly journals A rare case of COVID-19 related stomach gangrene after an abortion: a case report

2021 ◽  
Vol 8 (4) ◽  
pp. 1360
Author(s):  
Komal Gupta ◽  
Gopal Puri ◽  
Jnaneshwari Jayaram ◽  
Muhammed Huzaifa ◽  
Kamal Kataria
Keyword(s):  
Epigastric Pain ◽  
Subtotal Gastrectomy ◽  
Abdominal Distension ◽  
Posterior Wall ◽  
Emergency Laparotomy ◽  
Rt Pcr ◽  
Missed Abortion ◽  
Medical Termination ◽  
Arterial Thrombus ◽  
Severe Epigastric Pain

A 25 year old female had presented with complaints of severe epigastric pain with abdominal distension and vomiting for 4 days. She had undergone medical termination of pregnancy for a missed abortion of 5 weeks of gestation 5 days prior. The patient's COVID-19 RT PCR was found to be positive. Her CECT showed covid related changes in bilateral lungs and pneumoperitoneum. Stomach was distended. Other small bowels appeared normal. Patient underwent emergency laparotomy. Two third of stomach appeared gangrenous with a perforation in the posterior wall of stomach so she underwent a subtotal gastrectomy. She had features of covid associated coagulopathy (CAC) with high D-dimer (520 ng/ml), thrombocytosis (up to 705,000/mcl), high activated partial thromboplastin time (aPTT) (up to 55.6 sec) and high prothrombin time (PT) (up to 27.9 sec and INR 2.11) for which low molecular heparin was given. Stomach is a highly vascular organ. Gangrene of the stomach has been very rarely reported. CAC is known to lead to both arterial thrombus and venous thromboembolism. COVID-19 related abortions have also been reported though the exact mechanism not certain but CAC could be one of them.

scholarly journals Petersen's hernia after esophagectomy with antesternal jejunal reconstruction: Case report

2017 ◽  
Author(s):  
Kenji Kudo ◽  
Kosuke Narumiya ◽  
Yuji Shirai ◽  
Yosuke Yagawa ◽  
Masaho Ota ◽  
...  
Keyword(s):  
Small Intestine ◽  
Acute Abdominal Pain ◽  
Abdominal Cavity ◽  
Jejunal Loop ◽  
Emergency Laparotomy ◽  
Abdominal Ct ◽  
Right Thoracotomy ◽  
Contrast Enhanced ◽  
Petersen’S Hernia ◽  
Low Density Area

Abstract Petersen's hernia after esophagectomy is quite rare. The patient was a 75-year-old man, who had undergone esophagectomy via right thoracotomy and reconstruction with a jejunal loop by the antesternal route in 2014. In March 2015, severe acute abdominal pain occurred after endoscopy. Contrast-enhanced abdominal CT revealed a diffuse low density area in the abdominal cavity and partial dilatation of the small intestine with torsion of the superior mesenteric artery. The patient underwent emergency laparotomy, revealing chyle-like ascites and pallor of almost the entire small intestine due to circulatory impairment because of strangulation after herniation through Petersen's defect. After strangulation was relieved, the color and motility of the small intestine recovered rapidly. Then we closed the defect between the jejunal pedicle and the transverse mesocolon. This is the first English report showing Petersen's hernia after esophagectomy.

scholarly journals Cascade of Surgical Complications: A Case of Necrotizing Fasciitis

2019 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Small Bowel ◽  
Necrotizing Fasciitis ◽  
Abdominal Distension ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Joint Reconstruction ◽  
Tertiary Centre ◽  
Level 3 ◽  
General Surgeons

A 60 year old female presented with abdominal distension and non-specific abdominal pain and describes herself to have a ‘lazy bowel’, with a complicated surgery history. Patient subsequently underwent an emergency laparotomy for multiple small bowel perforations, requiring small bowel resection. The patient developed necrotizing fasciitis (NF) due to an increased use of inotropes during surgery which causes excessive vasoconstriction, and she had a major portion of the abdominal flab removed. This followed by a 33 day ITU admission (level 3) due to septic shock and poor pulmonary compliance. During the ITU stay, the patient was taken back into theatre 14 times for vac dressing changes to reduce the pressure from 150 mmHg down to 25 mmHg. Back in the surgery ward, the patient developed a fistula due to the vac dressing eroding the small bowel, leading to a proximal jejunostomy in situ which effectively worked as a high output stoma. The patient later suffered from re-feeding syndrome as the feed was primarily through the jejunostomy. Eventually absorbable mesh was added behind the vac dressing to protect the soft tissue underneath and the final stage was referral to plastic surgeons that would a joint reconstruction of the abdominal wall with the general surgeons at St Marks (tertiary centre for intestinal feeding and the combined reconstruction).

scholarly journals Atraumatic Ruptured Giant Renal Tumor

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Gezahen Negusse Ayane ◽  
Khutsafalo Kadimo
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Tumor ◽  
Left Kidney ◽  
Papillary Renal Cell Carcinoma ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Rare Presentation ◽  
Keywords Renal Cell Carcinoma

Massive hemoperitoneum due to spontaneous rupture of renal cell carcinoma is a rare presentation during emergency laparotomy. A 60-year-old female patient presented with severe abdominal pain, nausea, vomiting and abdominal distension. A massive hemoperitoneum secondary to ruptured left kidney tumor was found during laparotomy. Histology confirmed a papillary renal cell carcinoma. Ruptured renal cell carcinoma can be a cause of bleeding into the retroperitoneum space. Emergency sonography and laparotomy are advocated for its management. Keywords: Renal cell carcinoma, Rupture, Complex mass, Nephrectomy, Papillary

scholarly journals A giant retroperitoneal liposarcoma with hemoperitoneum: A rare tumor with unusual presentation

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Soma Mukherjee ◽  
Nandita Bhartiya ◽  
Purnima Tiwari ◽  
Ujjawal Khurana
Keyword(s):  
Early Diagnosis ◽  
Acute Abdomen ◽  
Abdominal Distension ◽  
Good Health ◽  
Hemodynamic Instability ◽  
Emergency Laparotomy ◽  
Histopathological Analysis ◽  
Rare Tumor ◽  
Retroperitoneal Liposarcoma ◽  
Histologic Types

Retroperitoneal liposarcoma (RPLS) is a rare mesenchymal tumor which accounts for 0.02–0.7% of all malignancy. The presentations of these tumors are non-specific and early diagnosis is often missed. We are reporting a rare case of 17-year-old girl who came to us with complaints of abdominal distension and other non-specific symptoms but after few hours of admission, she had acute abdomen with hemodynamic instability. She underwent emergency laparotomy and found to have a giant 25 × 20 × 10 cm ruptured retroperitoneum tumor causing hemoperitoneum. The tumor involved left ovary and fallopian tube as well. Complete resection of tumor with left salpingooophorectomy was done. The patient was kept in intensive care unit and discharged in good health after 15 days. This presentation of RPLS has not been reported yet and may demand early diagnosis and management of these tumors. The histopathology revealed dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation. The patient is completely fine at 16 months of follow-up while writing this report. Again, heterologous dedifferentiation of liposarcoma with spindle cell component is a rare morphologic spectrum. Liposarcomas can have various histologic types. In dedifferentiated types, the line of differentiation needs to be identified to decide further line of treatment. Therefore, thorough histopathological analysis and immunostaining is needed. Treatment includes complete surgical resection. Role of radiotherapy and chemotherapy is debatable and is still under trial. Dedifferentiated RPLS with rhabdomyosarcomatous differentiation is a rare tumor and its presentation as acute abdomen and hemoperitoneum has never been reported previously.

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