Wandering Gallbladder: A Case Report

Wandering gallbladder is a variation in the biliary anatomy described in the literature as being attached only by the cystic duct and its mesentery. Its propensity for torsion places it at risk for necrosis. There have been over 500 cases of gallbladder torsion reported in the literature but less than 10 reports of wandering gallbladder. To our knowledge there have been no reports of cholecystectomy for wandering gallbladder found incidentally. A 51-year-old male from Pakistan with hypertension, gastroesophageal reflux disease, high cholesterol, and renal stones presented with a chief complaint of right upper quadrant abdominal pain. Abdominal ultrasound was significant for a mildly distended gallbladder with small gallstones in the gallbladder fundus. The patient was discharged with a diagnosis of cholelithiasis and scheduled for laparoscopic cholecystectomy as an outpatient. During the procedure, upon entering the abdominal cavity, a gallbladder was not seen in the gallbladder fossa. It was attached to the cystic duct, thickened with a long mesentery and not attached to the liver. There were no signs of torsion. The patient was treated successfully and discharged home with an uncomplicated hospital course. Diagnosis can be challenging because the clinical presentation can be variable. Fewer than a dozen cases have been reported where the diagnosis was made preoperatively. Early diagnosis of gallbladder torsion with cholecystectomy is essential to avoid the deadly complications of perforation and bilious peritonitis. Understanding the pathophysiology, clinical findings, and treatment can have a broad impact across biliary surgery in preventing these complications.

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Clinical aspects and surgical technique in Mirizzi syndrome: A systematic review

International Journal of Development Research ◽

10.37118/ijdr.18563.05.2020 ◽

2020 ◽

pp. 35871-35873

Keyword(s):

Surgical Technique ◽

Cystic Duct ◽

Hepatic Duct ◽

Signs And Symptoms ◽

Mirizzi Syndrome ◽

Common Hepatic Duct ◽

Clinical Aspects ◽

Main Diagnosis ◽

Biliary Surgery ◽

Electronic Library

Mirizzi syndrome is described in the 1940s as follows: partial obstruction of the secondary common hepatic duct by gallstones, impacted on the cystic duct or gallbladder infundibulum, associated with the inflammatory response that involved the cystic duct and the common hepatic duct. As it is a rare and delicate condition, differential diagnosis is extremely important, in which the patient's clinical condition is verified through anamnesis and complementary exams, where immediately after the surgical intervention can be performed. This work aims to describe, through a literature review, the clinical aspects and the surgical technique in Mirizzi Syndrome. Were used as a database for research sites containing scientific articles available online such as Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo) and PubMed. 154 articles were found through the descriptors, where after applying the inclusion and exclusion criteria 11 articles remained to write the work. According to the articles surveyed, it is clear that most of them do not report the syndrome as the main diagnosis, possibly because it is a pathology with signs and symptoms very close to other diseases of the bile duct, therefore leaving the syndrome sometimes described in the context of these other diseases. Finally, it concludes that even though the preoperative diagnosis is rare, it should be suspected in individuals undergoing biliary surgery.

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Gastric antral vascular ectasia in children, rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-236896 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236896

Author(s):

Matthew Pizzuto ◽

Sarah Ellul ◽

Mohamed Shoukry

Keyword(s):

Gastrointestinal Endoscopy ◽

Abdominal Ultrasound ◽

Clinical Findings ◽

Evidence Based ◽

Gastric Antral Vascular Ectasia ◽

Perianal Area ◽

Rare Presentation ◽

Vascular Ectasia ◽

Blood Tests ◽

Abdominal Examination

A 14-year-old boy, a known case of perinatal hypoxic cerebral palsy, presented to paediatric emergency with acute melaena and blood staining around feeding gastrostomy site. Physical examination revealed pallor, but no signs of distress with an unremarkable abdominal examination. Routine blood tests revealed normochromic. Abdominal ultrasound scan and Meckel’s scan were unremarkable. The patient underwent examination under anaesthesia of the perianal area and joint upper and lower gastrointestinal endoscopy. Streak-like gastritis with no signs of active bleeding lesions were noted and patchy areas of colitis involving the descending and sigmoid colon and the rectum. All clinical findings and evidence-based diagnosis matched gastric antral vascular ectasia. He was successfully managed conservatively with elemental hydrolysed feeding formula.

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Abdominal ultrasound in amazonian manatee (Trichechus inunguis) (Natterer, 1883)

Brazilian Journal of Biology ◽

10.1590/1519-6984.247609 ◽

2023 ◽

Vol 83 ◽

Author(s):

U. H. A. Barreto ◽

A. S .S. Ribeiro ◽

L. N. Coutinho ◽

L. A. Moraes ◽

P. Souza-Júnior ◽

...

Keyword(s):

Urinary Bladder ◽

Subcutaneous Tissue ◽

Abdominal Cavity ◽

Well Being ◽

Abdominal Ultrasound ◽

Diagnosis And Prognosis ◽

Ultrasound Findings ◽

Real Time Information ◽

Time Information ◽

Reduced Time

Abstract Morphophysiological species researches are fundamental, and diagnostic imaging is an excellent technique, already used in wild animals, with great application, not invasive and provide real-time information of each body. Amazonian manatees are on the list of endangered animals classified in the vulnerable category and knowledge of the normal pattern of ultrasound anatomy of organs and tissues is important for the maintenance and well-being of captive specimens contributing to reintroduction actions. The objective of the study was to standardize the examination technique and describe the ultrasound findings of the liver, gallbladder, stomach, urinary bladder and the subcutaneous tissue of the abdominal region in Trichechus inunguis, in order to contribute with the anatomical and sonographic knowledge and assist in the diagnosis and prognosis diseases. The study used 18 animals to describe the normal sonographic anatomy in the abdominal cavity of the Amazonian manatee. During abdominal scan, it was possible to visualize the features of the liver, gallbladder, stomach, urinary bladder obtained satisfactory results in this study. Therefore, other structures were not primarily identified by the reduced time, lots of fat and gases in intestines of animals.

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Hyperaldosteronism and Hyperprogesteronism in a Cat

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2009.07.010 ◽

2009 ◽

Vol 11 (9) ◽

pp. 758-762 ◽

Cited By ~ 28

Author(s):

Katherine Briscoe ◽

Vanessa R Barrs ◽

Darren F Foster ◽

Julia A Beatty

Keyword(s):

Muscle Wasting ◽

Clinical Signs ◽

Plasma Renin ◽

Abdominal Ultrasound ◽

Serum Biochemistry ◽

Zona Glomerulosa ◽

Clinical Findings ◽

Neoplastic Cells ◽

Limb Weakness ◽

Plasma Aldosterone Concentration

Clinical findings and investigations A 14-year-old female neutered domestic shorthair cat was referred for investigation of progressive hair loss, muscle wasting and hind limb weakness. Diabetes mellitus had been diagnosed 8 months earlier and was well controlled. Abnormalities on serum biochemistry included persistent mild azotaemia, hypochloridaemia, hypokalaemia, metabolic alkalosis and elevated creatine kinase. Physical examination revealed a pot-bellied appearance, with muscle wasting, marked thinning and fragility of the skin, bilaterally symmetrical alopecia, a gallop rhythm and systolic hypertension (173 mmHg). A large, lobulated left adrenal mass was identified using abdominal ultrasound. Confirmation of diagnosis Primary hyperaldosteronism was diagnosed based on an elevated plasma aldosterone concentration and normal plasma renin activity. Hyperprogesteronism was confirmed by adrenocorticotrophic hormone stimulation test. Practical relevance This is only the second reported case of hyperaldosteronism and hyperprogesteronism in the cat. Clinicians should be alert to the possibility of concurrent hyperaldosteronism and hyperprogesteronism in cats with adrenal tumours showing clinical signs referable to both conditions. The putative mechanism is either increased secretion of aldosterone and progesterone from neoplastic cells of the zona glomerulosa and fasciculata/reticularis, respectively, or increased production of progesterone, as an intermediate in the synthesis of aldosterone, from neoplastic cells of the zona glomerulosa alone.

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An Intra-Abdominal Desmoid Tumor, Embedded in the Pancreas, Preoperatively Diagnosed as an Extragastric Growing Gastrointestinal Stromal Tumor

Case Reports in Oncology ◽

10.1159/000468983 ◽

2017 ◽

Vol 10 (1) ◽

pp. 301-307 ◽

Cited By ~ 7

Author(s):

Mari Mizuno ◽

Yoshiaki Kawaguchi ◽

Aya Kawanishi ◽

Yohei Kawashima ◽

Atsuko Maruno ◽

...

Keyword(s):

Gastrointestinal Stromal Tumor ◽

Desmoid Tumor ◽

Abdominal Cavity ◽

Partial Gastrectomy ◽

Abdominal Ultrasound ◽

Needle Aspiration ◽

Stromal Tumor ◽

Conversion To Open Surgery ◽

Enhanced Computed Tomography ◽

Abdominal Desmoid Tumor

A 45-year-old woman was found to have a pancreatic tumor by abdominal ultrasound performed for a medical check-up. Abdominal contrast-enhanced computed tomography showed a hypovascular tumor measuring 30 mm in diameter in the pancreatic tail. Endoscopic ultrasound-guided fine needle aspiration was performed. An extragastric growing gastrointestinal stromal tumor was thereby diagnosed preoperatively, and surgical resection was planned. Laparoscopic surgery was attempted but conversion to open surgery was necessitated by extensive adhesions, and distal pancreatectomy, splenectomy, and partial gastrectomy were performed. The histological diagnosis was an intra-abdominal desmoid tumor. A desmoid tumor is a fibrous soft tissue tumor arising in the fascia and musculoaponeurotic tissues. It usually occurs in the extremities and abdominal wall, and only rarely in the abdominal cavity. We experienced a case with an intra-abdominal desmoid tumor that was histologically diagnosed after laparotomy, which had been preoperatively diagnosed as an extragastric growing gastrointestinal stromal tumor. Although rare, desmoid tumors should be considered in the differential diagnosis of intra-abdominal tumors. Herein, we report this case with a literature review.

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Amoebic liver abscess in a COVID-19 patient: a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06819-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Andrea L. Maricuto ◽

Viledy L. Velásquez ◽

Jacinto Pineda ◽

David M. Flora-Noda ◽

Isaac Rodríguez ◽

...

Keyword(s):

Liver Abscess ◽

Abdominal Cavity ◽

Exploratory Laparotomy ◽

Abdominal Ultrasound ◽

Amoebic Liver Abscess ◽

Stool Examination ◽

Nasopharyngeal Swab ◽

Suspected Case ◽

Middle Income ◽

Patient Reported

Abstract Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

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Clinical and ultrasound findings before and after praziquantel treatment among Venezuelan schistosomiasis patients

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822007000500003 ◽

2007 ◽

Vol 40 (5) ◽

pp. 505-511 ◽

Cited By ~ 23

Author(s):

Raiza Ruiz-Guevara ◽

Belkisyolé Alarcón de Noya ◽

Sharon Kay Valero ◽

Pablo Lecuna ◽

Miguel Garassini ◽

...

Keyword(s):

Abdominal Ultrasound ◽

Clinical Findings ◽

Control Measures ◽

World Health ◽

Periportal Fibrosis ◽

Praziquantel Treatment ◽

Before And After ◽

Complete Reversal ◽

Health Organization ◽

The Impact

Abdominal ultrasound can be a useful tool for diagnosing periportal fibrosis related to Schistosoma mansoni infection, and also for planning and monitoring the evolution of hepatic morbidity following control measures. We evaluated the standardized ultrasound methodology proposed by the World Health Organization for detecting periportal fibrosis and portal hypertension, among patients from an endemic area in Venezuela, and the impact of praziquantel treatment 3-5 years later. After chemotherapy, complete reversal of periportal lesions was observed in 28.2% of the cases and progression of the disease in 5.1%. Improvement in the hepatic disease started with a reduction in the periportal thickening followed by a decrease in the size of the left hepatic lobe, spleen and mesenteric and spleen veins. Ultrasound confirmed the clinical findings after chemotherapy among the patients with reversal of the disease. However, in patients with more advanced disease, these findings were contradictory. There was no correlation between evolution of the disease seen on ultrasound and age, intensity of infection or serological findings.

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HAEMATOETIOLOGICAL EVALUATION OF SPLENOMEGALY

10.36106/ijar/3104661 ◽

2020 ◽

pp. 38-40

Author(s):

Y.V.S. Prabhakar ◽

Vasireddy Teja ◽

Ponnaganti Vasundhara

Keyword(s):

Case Series ◽

Sampling Technique ◽

Abdominal Ultrasound ◽

Liver Function Tests ◽

Clinical Findings ◽

Haematological Parameters ◽

Blood Picture ◽

Additional Tool ◽

Case Series Study ◽

Series Study

BACKGROUND: Splenomegaly is usually the result of an underlying disorder.Causes ranging from infections to haematological malignancies. AIMS AND OBJECTIVES : Present study aims to find out the frequency of various haematological causes of splenomegaly and to study its haematological parameters . MATERIAL AND METHODS: This descriptive case series study was carried out at Department of Medicine at Nri General Hospital from 1st March 2019 to 31st August 2019,over a period of six months. 100 patients older than 13 years of age with clinically enlarged spleen were selected for this study. Sampling technique is Non propability convinient sampling. After getting informed consent from the patients proforma filled elaborating history, important clinical findings and investigations like abdominal ultrasound , complete blood picture , liver function tests , virals were performed. RESULTS: Males (57%) are most commonly affected than females (43%). The most common age group in males was 41-50 yrs and females was 21-30 yrs. The maximum cases were identified with moderate splenomegaly.Among the haematological causes 57% were leukemias,of which 30% were chronic and 27% were acute . CONCLUSION : Splenomegaly in a symptomatic person should always be investigated thoroughly as most of the cases are treatable. Haematological parameters with enlarged spleen is utmost important as an additional tool in evaluating the etiopathogenesis of splenomegaly.

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Small intestinal herniation through the broad ligament in a mare outside of the gestation period – a case report

Acta Veterinaria Brno ◽

10.2754/avb201887040331 ◽

2018 ◽

Vol 87 (4) ◽

pp. 331-337

Author(s):

Cristian Crecan ◽

Iancu Morar ◽

Mircea V. Mircean ◽

Daniela Oros ◽

Alexandra Muresan ◽

...

Keyword(s):

Post Partum ◽

Abdominal Cavity ◽

Broad Ligament ◽

Abdominal Ultrasound ◽

Uterine Horn ◽

Presumptive Diagnosis ◽

Ultrasound Evaluation ◽

Persistent Abdominal Pain ◽

One Year ◽

The Right

A Furioso-North Star mare, aged 8 years, was examined for colic signs. The mare had a history of dystocia and post partum vaginal lacerations, acute endometritis and laminitis approximately one year before the admission for colic. Signs of persistent abdominal pain, moderate distended abdomen, non-passage of manure, fever, tachycardia, tachypnoea, congested mucus membranes, and “toxic line” were recorded. No intestinal borborygmi were present in the four quarters of the abdomen. On rectal examination, the colon, the ventral band of the caecum, the right ovary and the uterine horn were palpated on the right side of the abdomen. The spleen, the nephrosplenic ligament, the left ovary and a firm, distended and painful small intestine (SI) loop were palpated on the left side. The left uterine horn and the adjacent broad ligament were not detectable. Percutaneous abdominal ultrasound evaluation revealed a large amount of fluid in the abdominal cavity, SI distention and absence of peristalsis. Abdominocentesis yielded approximately 20 ml of red-tinged peritoneal fluid with increased mean protein concentration (5.2 mg/dl), white blood cell count (12,550 cells/μl), and lactate (14 mmol/dl). A presumptive diagnosis of SI strangulation was made. Surgical resection of the affected intestinal loops was recommended. Due to poor prognosis and financial limitations, the mare was euthanized. Post mortem macroscopic diagnosis was a herniation of 3 metres of the mid-jejunum through the left mesometrium, resulting in a complete and complicated strangulation. To prevent this type of SI strangulation, we recommend transrectal palpation of the urogenital tract (including the broad ligament) after foaling. If a defect is identified, we recommend flank laparoscopy for correction.

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