scholarly journals A 61-year-old Female with Right Upper Abdominal Pain

2020 ◽  
Vol 4 (4) ◽  
pp. 630-631
Author(s):  
Drew Long ◽  
Brit Long
Keyword(s):  
Interventional Radiology ◽  
Abdominal Pain ◽  
Source Control ◽  
Day Hospital ◽  
Biliary Injury ◽  
Case Presentation ◽  
Image Guided ◽  
Upper Abdominal ◽  
Gallbladder Fossa

Case Presentation: A 61-year-old female presented to the emergency department with right upper quadrant abdominal pain following a cholecystectomy 18 days prior. Computed tomography (CT) of her abdomen demonstrated a large abscess in her post-hepatic fossa. She was admitted to the general surgery service and received an image-guided percutaneous drain placement with interventional radiology with immediate return of purulent material. She was discharged home after a three-day hospital course with outpatient antibiotics and follow-up. Discussion: Patients may have multiple complications following cholecystectomy, including infection, bleeding, biliary injury, bowel injury, or dropped stone. The emergency clinician must consider cholecystectomy complications including gallbladder fossa abscess in patients presenting with abdominal pain in the days to weeks following cholecystectomy, especially if they present with signs of sepsis. Critical actions include obtaining CT and/or ultrasonography, initiating broad spectrum antibiotics, and obtaining definitive source control by either surgery or interventional radiology.

scholarly journals Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

2020 ◽  
Vol 35 (1) ◽  
pp. 104-112
Author(s):  
Vilja Koskensalo ◽  
Marianne Udd ◽  
Mia Rainio ◽  
Jorma Halttunen ◽  
Matias Sipilä ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
University Hospital ◽  
Long Term Results ◽  
Biliary Duct ◽  
Complication Rates ◽  
Biliary Sphincterotomy ◽  
Significant Difference ◽  
Upper Abdominal

Abstract Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

scholarly journals Outcome of Conservative Management in Biliary Ascariasis - A Study of 98 Cases

1970 ◽  
Vol 19 (1) ◽  
pp. 25-28 ◽  
Author(s):  
AS Khan ◽  
B Bhowmik ◽  
HAN Hakim ◽  
MA Islam
Keyword(s):  
Abdominal Pain ◽  
Conservative Management ◽  
Diagnostic Tools ◽  
Biliary Disease ◽  
Common Presentation ◽  
Biliary Ascariasis ◽  
Clinical Presentations ◽  
History Of ◽  
Upper Abdominal

Objectives: History of ascariasis is very old. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of Bangladesh. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Materials and Methods: Ninty eight cases of hepatobiliary ascariasis were studied over a period of 2 years (April 03 - April 05). All the patients were aged between 12 and 73 years and all were admitted with acute right upper abdominal pain. Ultrasound was the diagnostic tool of choice with 100% results. Results: In this study, biliary ascariasis was found to be more common in females 64.29% (64 patients). The most common presentation was upper abdominal pain in 100% of the patients (98 patients). Complications observed were obstructive jaundice in 08.16% (8 patients), cholangitis in 74.49% (73 patients). History of worm emesis was present in 21.42% (21 patients). Conservative management was successful in 96.94% (95 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients). Conclusion: In endemic countries, biliary ascariasis should be suspected in patients with biliary disease. Most of the patients respond to conservative management. Keywords: Acute upper abdominal pain; biliary ascariasis; Ultrasonography DOI: 10.3329/jdmc.v19i1.6247 J Dhaka Med Coll. 2010; 19(1) : 25-28.

scholarly journals Gastric schwannoma: a case report and literature review

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095782
Author(s):  
Changsheng Pu ◽  
Keming Zhang
Keyword(s):  
Wedge Resection ◽  
Postoperative Recovery ◽  
Postoperative Treatment ◽  
Laparoscopic Wedge Resection ◽  
Case Presentation ◽  
Gastric Tumors ◽  
Gastric Schwannoma ◽  
History Of ◽  
Upper Abdominal

Background Gastric schwannoma is a rarely seen gastric tumor accounting for only 0.2% of all gastric tumors. It is difficult to distinguish a gastric schwannoma from other gastric tumors preoperatively. Case presentation: A 30-year-old man with no significant medical history or physical examination findings presented with a 1-month history of right upper abdominal discomfort. The preoperative diagnosis was a gastrointestinal stromal tumor, but the postoperative pathologic and immunohistochemical examinations confirmed a gastric schwannoma. The patient underwent laparoscopic wedge resection of the stomach without additional postoperative treatment, and his postoperative recovery was uneventful. No recurrence or metastasis was found at the 2-year follow-up examination. Conclusion Although gastric schwannomas are usually not malignant, they are difficult to distinguish from other malignant stromal tumors preoperatively. Surgical resection should be recommended when a schwannoma is malignant or considered to be at risk of becoming malignant.

scholarly journals Two giant connected retroperitoneal schwannomas: A rare case report

2020 ◽  
Author(s):  
Tao Yang ◽  
Lanqing Cao ◽  
Wei Li ◽  
Kai Zhang ◽  
Yuecheng Zhu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Rare Case ◽  
Low Density ◽  
Soft Tissue Density ◽  
Case Presentation ◽  
Benign Schwannoma ◽  
Rare Case Report ◽  
Retroperitoneal Schwannoma ◽  
Specific Symptoms

Abstract Background：There are few reports of large retroperitoneal schwannomas and few guidelines for the diagnosis and surgical treatment.Case presentation：A 40-year-old female came to our department due to abdominal pain for 1 day and there are no other specific symptoms. There were no abnormalities in the patient's tumor markers. Plain computer tomography (CT) scan of the whole abdomen revealed two mass soft tissue density shadows behind the peritoneum, with uneven internal density, cystic low-density shadows and patchy calcification shadows. The larger mass was about 12.0 cm × 12.3 cm in size. Then tumors were completely excised by a reasonable surgical approach while the surrounding organs closely related to the tumor were preserved. Postoperative pathology confirmed that the tumor was benign schwannoma. In the 18-month follow-up, the patient had no recurrences and was asymptomatic.Conclusion：We summarize the diagnosis and treatment of a rare giant retroperitoneal schwannoma. Laparotomy for the management of retroperitoneal giant schwannomas may be a safe and effective method.

scholarly journals Histiocytic Necrotizing Lymphadenitis Mimicking Acute Appendicitis in a Child: A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Chun-Zhen Hua ◽  
Yu-Kai Chen ◽  
Shun-Zhi Chen ◽  
Wei-Zhong Gu ◽  
Qiang Shu
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Pathological Examination ◽  
Recurrent Fever ◽  
Histiocytic Necrotizing Lymphadenitis ◽  
Mesenteric Lymph Nodes ◽  
Case Presentation ◽  
Necrotizing Lymphadenitis ◽  
Low Incidence

Background: Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease (KFD), is a self-limiting inflammatory disease with low incidence and high misdiagnosis rate in children. Furthermore, cases where the clinical presentation resembles acute appendicitis are very rare.Case Presentation: A 14-year-old boy was misdiagnosed as acute appendicitis and received operative treatment at his early visit. He suffered from abdominal pain, vomiting, diarrhea, fever, and lymphadenitis at the ileocecal junction, which were found by B-ultrasonography examination and surgery. Lymphadenectomy, as well as appendectomy, was performed, and KFD was identified by pathological examination. The patient was transferred to our hospital for further therapy because of recurrent fever and abdominal pain after the appendectomy. His temperature became normal after methylprednisolone was administered, and no recurrence was observed till now during follow-up.Conclusions: Necrotizing lymphadenitis involving mesenteric lymph nodes may cause acute-appendicitis-like symptom; KFD should be a diagnostic consideration for mesenteric lymphadenitis.

scholarly journals A Bullet Injury to the Liver Complicated by Biliary Broncho Pleural Fistula and IVC Thrombosis: Case Presentation and Review for Management Guidelines

2020 ◽  
pp. 1-4
Author(s):  
Arwa El Rifai ◽  
Arwa El Rifai ◽  
M. Zorkot ◽  
S. Emsieh ◽  
G. Abi Saad
Keyword(s):  
Hepatic Duct ◽  
Left Hepatic Duct ◽  
Case Presentation ◽  
Management Guidelines ◽  
Upper Abdominal ◽  
The Right ◽  
Abdominal Quadrant ◽  
Chest Tube Drain ◽  
Bullet Injury

This is a case report of a 20-year-old male who presented to our hospital after sustaining a gunshot to the left upper abdominal quadrant with an exit right below the right scapula. On investigation, he was found to have a large right sided hemothorax and an extensive laceration in the liver. A right chest tube drain was inserted, initially drained blood and days later started draining bile. Consequently, the patient started coughing up bile and diagnosis of a biliary-broncho-pleural fistula was made. ERCP with sphincterotomy and stenting of a left hepatic duct injury was subsequently performed. The patient also developed an IVC thrombus that was discovered incidentally on follow up imaging and was treated with anticoagulation

scholarly journals Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Salvatore Savasta ◽  
Ivan Fiorito ◽  
Thomas Foiadelli ◽  
Anna Pichiecchio ◽  
Patrizia Cambieri ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Unknown Origin ◽  
Lyme Neuroborreliosis ◽  
Review Of Literature ◽  
Case Presentation ◽  
Neurological Sequelae ◽  
Cranial Nerve Palsies ◽  
Radiological Images

Abstract Background Lyme neuroborreliosis can cause a variety of neurological manifestations. European children usually present facial nerve palsy, other cranial nerve palsies and aseptic meningitis. Case presentation We hereby report a case of Lyme neuroborreliosis in a 9-year-old boy with abdominal pain as first symptom and subsequent onset of attention deficit and ataxia. Diagnosis was made by detection of specific antibody in both serum and cerebrospinal fluid with neuro-radiological images suggestive for this infectious disease. A 12-months follow-up was performed during which no relevant neurological sequelae were revealed. Conclusion This case report shows that abdominal radiculitis, although extremely rare, could be the first manifestation of early Lyme neuroborreliosis in pediatric patients. Pediatricians must consider Lyme disease in the differential diagnosis of abdominal pain of unknown origin in children, especially in countries where the infection is endemic.

scholarly journals Isolated Hepatosplenic Tuberculosis: A Rare Case Report

2019 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Rare Case ◽  
Malignant Cell ◽  
Rare Case Report ◽  
Rare Gene ◽  
Upper Abdominal ◽  
Disseminated Disease ◽  
Multiple Nodules

Background: Tuberculosis is common in Bangladesh. It rarely involves the liver and spleen and when it does so, it is usually associated with disseminated disease. Method: We report a patient with isolated tuberculosis of the liver and spleen. Results: A 55 years old female presented with fever with chill and rigor and upper abdominal pain. USG revealed multiple hypoechoic lesions with central echogenicity in liver and spleen. CT scan showed multiple hypo density lesions in the liver and spleen. AFP, CEA and CA-19-9 were normal. As temperature was not subsided with antibiotics, pus from liver and spleen was aspirated and sent for gram and AFB stain, C/S, malignant cell, and Gene Xpert. All but Gene Xpert reports were negative. A detailed workup failed to identify other focus of tuberculosis. CAT-1 Anti tubercular started and the fever subsided. The patient gained weight on the subsequent follow up. Conclusion: Tuberculosis should also be considered in the differential diagnosis for multiple nodules in the liver and spleen along with other diagnosis, though it is rare. Gene X pert is a good diagnostic tool.

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