A case report of open appendectomy in treating acute perforated appendicitis with necrotizing fasciitis of the abdominal wall: a rare complication of a common disease*

We present a case of a 37-year-old woman referred to our hospital with a 1-week history of significant weakness, anorexia, and mild abdominal pain. According to laboratory and radiographic data, the patient was diagnosed with perforated appendicitis and gangrene.

Massive Multifocal Familial GIST: A Case Report

Gastrointestinal stromal tumors (GIST) are uncommon mesenchymal neoplasms of the gastrointestinal tract. The majority of GISTs are the result of sporadic mutations, most commonly of the KIT proto-oncogene. Germline mutations account for 5% of GISTs and result in rare familial syndromes. We present a 66-year-old male with a family history of GIST who presented with mild abdominal pain and was found to have a massive, multifocal GIST. The main tumor was resected via laparotomy and the weight was found over 2 kg. He was commenced on adjuvant therapy with imatinib and will be closely monitored. Familial GISTs tend to be larger, multifocal and diagnosed at a younger age. Familial GISTs are extremely rare conditions. There is little to no evidence on the long-term outcomes of treatment on which to base management decisions.

Giant Mesenteric Hemangioma without Small Intestinal Involvement Report of a Case and Review of Literature

there were approximately twenty cases reported in the English literature, of which five cases were designated as giant hemangioma. We reported another giant mesenteric hemangioma, measuring 35x20x11 cm. with a weight of 5,5 Kilograms. The etiology of mesenteric hemangioma was still debatable. In our case, the patient only experienced mild abdominal pain, without gastrointestinal hemorrhage. Therefore, we were in favor of mesenteric origin as opposed to gastrointestinal origin. The symptoms were non-specific, ranging from abdominal pain, nausea, vomiting, and gastrointestinal bleeding if Gastrointestinal tract was involved. Preoperative diagnosis was very challenging despite the modern images’ technics have become available, such as computed tomography magnetic resonance and ultrasonography. The final diagnoses of mesenteric hemangioma have been exclusively established by histological examination after surgical removal of the tumor. Surgical resection with clear margin is the treatment of choice.

Effectiveness of hemostatic powders in lower gastrointestinal bleeding: a systematic review and meta-analysis

Background and study aims There is limited evidence on the effectiveness of hemostatic powders in the management of lower gastrointestinal bleeding (LGIB). We aimed to provide a pooled estimate of their effectiveness and safety based on the current literature. Patients and methods Literature review was based on computerized bibliographic search of the main databases through to December 2020. Immediate hemostasis, rebleeding rate, adverse events, and mortality were the outcomes of the analysis. Pooled effects were calculated using a random-effects model. Results A total of 9 studies with 194 patients were included in the meta-analysis. Immediate hemostasis was achieved in 95 % of patients (95 % confidence interval [CI] 91.6 %–98.5 %), with no difference based on treatment strategy or bleeding etiology. Pooled 7- and 30-day rebleeding rates were 10.9 % (95 %CI 4.2 %–17.6 %) and 14.3 % (95 %CI 7.3 %–21.2 %), respectively. Need for embolization and surgery were 1.7 % (95 %CI 0 %–3.5 %) and 2.4 % (95 %CI 0.3 %–4.6 %), respectively. Overall, two patients (1.9 %, 95 %CI 0 %–3.8 %) experienced mild abdominal pain after powder application, and three bleeding-related deaths (2.3 %, 95 %CI 0.2 %–4.3 %) were registered in the included studies. Conclusion Novel hemostatic powders represent a user-friendly and effective tool in the management of lower gastrointestinal bleeding.

Tubal Stump Ectopic: A Case Report on Repeat Ipsilateral Tubal Ectopic Pregnancy

Background: Tubal Stump Ectopic is an infrequent event with critical obstetrical consequences. A case is illustrated from Northern Ireland in which an ectopic pregnancy was discovered in the tubal stump previously undergone salpingectomy. Case Facts: A 34-year-old woman (G2 E1) with a tubal stump ectopic of a previous cornual excision two years prior, presented to EPAU complaining of mild abdominal pain and 6 weeks amenorrhoea. She was clinically stable (β-hCG 1407 mIU/mL), while TVUS revealed no evidence of IUP or adnexal mass but fluid in the Pouch of Douglas. Laparoscopic salpingectomy was performed after a diagnosis of tubal stump ectopic. Inference: Women who has had a previously ectopic pregnancy are at a significantly greater probability of relapse. To correctly and quickly identify the implanted location, a TVUS should be conducted. Laparoscopic diagnostic salpingectomy should be performed through excision by diathermy to prevent the risk of EP in the tubal stump.

EVIDENCE BASED MANAGEMENT OF UPAPLUTA YONIVYAPAD – IN VITRO CASE STUDY REPORT

Vaginitis is a common problem during pregnancy. Most commonly Candidial vaginitis & Bacterial vaginitis forms are found. It has hazardous effects on pregnancy like miscarriage, preterm labour etc. Therefore, careful manage- ment of patient is necessary. Ayurveda described this condition under Yonivyapad chapter which labelled as Upapluta Yonivyapad which means overflowed vaginal discharge with vaginal itching & mild abdominal pain. We can correlate Upapluta Yonivyapad with Candidial vaginitis. In this case study we have taken 2 cases of Candidial Vaginitis & local application of herbal drugs kwath was done. Evidence based beneficial results shown through HPE to the patient of Upapluta Yonivyapad & is safe during pregnancy. By this we can conclude that the ayurvedic drugs is the best solution to treat vaginitis during pregnancy. Keywords: Vaginitis, Upapluta Yonivyapad.

COVID-19 multisystemic inflammatory syndrome in adults: a not to be missed diagnosis

We report COVID-19 multisystemic inflammatory syndrome in an adult patient with an atypical presentation (mild abdominal pain) and a negative (repeated) reverse transcriptase-PCR, in the absence of lung involvement on lung ultrasound. In this case, focused cardiac ultrasound revealed signs of myopericarditis and enabled us to focus on the problem that was putting our patient in a perilous situation, with a quick, non-time-consuming and easy-to-access technique. Serology test was performed and SARS-CoV-2 infection was confirmed more than a week after admission to the coronary unit. As the patient had a general good appearance, the potential implications of missing this diagnosis could have been fatal.

Sclerosing Angiomatoid Nodular Transformation of the Spleen: Analysis of Clinical and Pathological Features in Five Cases

Objective: We aimed to summarize the clinical and pathological features of sclerosing angiomatoid nodular transformation (SANT) in spleen among five cases.Methods: Five cases (male: 3; female: 2; mean age: 47.6 years) with SANT confirmed by pathological analysis between July 2010 and November 2019 in our hospital were included in this study. The clinical, imaging, and pathological data were analyzed retrospectively.Results: Three patients presented with mild abdominal pain or discomfort, while the other two were symptom free. Two patients received ultrasonography (US), and all patients underwent a computerized tomography (CT) scan in our hospital. The typical “spoke wheel” pattern was seen in two cases, and central calcification was detected in one case on the CT scans. All patients indicated peripheral enhancement around the SANT lesion during the arterial phase. Open or laparoscopic splenectomy was performed for treatment. No patient showed recurrence in the follow-up. The pathological characteristics of our cases were in line with those of previous literatures.Conclusions: Peripheral enhancement around the SANT lesion during the arterial phase should be taken into consideration for the diagnosis of SANT as an imaging sign on CT scans. Special attention should be paid to the splenic integrality during the laparoscopic approach, due to the probability of malignancy and the fragility of the spleen.

Testicular Torsion and Contralateral Torsion of the Appendix Testis

Testicular torsion is a urological emergency that results in deterioration of the blood supply of the testicle and ischemia as a result of the rotation of the spermatic cord around itself. It may show a wide clinical variety with inflammatory manifestations varying from mild abdominal pain to severe scrotal pain. Orchiectomy may be required in cases which are delayed and cannot be operated urgently. Torsion of the testis and epididymis are other frequently seen causes of acute scrotum in children. Growth of masses and hormonal stimulation in the adolescent age cause an increase in the tendency of the torsion of appendix testis which have a small pedicle and epididymis. In the presence of sudden scrotal pain, testicular torsion should be considered, if there is clinical suspicion, patients should be evaluated with color doppler ultrasound (CDUS) and scrotal exploration should be performed immediately. A 20-year-old male whose clinical picture, and scrotal ultrasonography suggested the presence of testicular torsion is presented in this case report.