Anatomy, Sonographic Features, and Dimensional Variations of Spleen among Individuals with Different Sociodemographic and Anthropometric Measurement

The spleen is a vital lymphoid soft organ located in the left hypochondrium region. It is a multi-dimensional organ that enlarges in all dimensions during some disease conditions. Recently, splenomegaly prevalence has been increasing throughout the world. Due to the lack of attention in clinical practice, splenomegaly has become quite a common problem in all parts of the world. The detection of the spleen by palpation is not approval of enlarged spleen because normal spleen may be palpable. A detailed knowledge of morphometric variations of the spleen is of great value in diagnosing splenomegaly clinically, radiologically, and for surgical procedures. Measurement of spleen size by sonography is important as it gives true result than splenic palpation and for identification of disorders present with enlargement or reduction of the spleen. Therefore, this study aimed to assess the anatomy, sonography, and dimensional variation of spleen among individuals with different sociodemographic and anthropometric measurements. The current study reviews different types of literature conducted on spleen all over the world. The result from overall spleen dimensions review shows measurements vary: spleen length (7–14 cm), spleen width (2–7.5 cm), spleen thickness (2–7 cm), and spleen volume (20–350 cm3). The literature revealed that spleen dimensions are affected by geographical differences, races, nutritional status, physical exercise, and anthropometric measurements. The result from reviews shows that spleen dimensions are larger in males than females. As age increases, spleen dimensions significantly decrease. Spleen dimensions positively correlate with height, weight, body mass index, and body surface of individuals. The spleen dimensions were higher in males than in females and have significant positive correlation with height, weight, body mass index, and body surface area. Clinicians, radiologists, and surgeons should confirm splenomegaly by both palpation and sonography. Spleen dimensions variation due to geographical sex, age, and other anthropometric measurements should be taken into consideration during their clinical investigation. Radiologists should measure all dimensions of spleen rather than the length to rule out splenomegaly correctly.

To the technique of gastric resection for highly located ulcers

Gastric resection in high ulcers can often be difficult. The removal of up to two-thirds of the stomach, according to Finsterer, is undesirable, and the imposition of an anastomosis on the part of the stomach, hidden in the left hypochondrium, seems to be a rather serious intervention.

LAPAROSCOPIC STUDY OF CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS

BACKGROUND: Situs inverses totalis is a rare congenital anomaly with transposition of major organs to opposite side of the body. Due to atypical clinical presentation and due to contra lateral presence of the gall bladder, it causes clinical challenge to operate with complete reorientation of anatomy. Visual motor skills are particularly tested when it comes to lapararoscopy. MATERIAL AND METHODS: A 25 year, lady presented with left hypochondriac pain and diagnosed as calculus cholecystitis with situs inverses total is. After ruling out associated anamolies patient underwent elective laparoscopic cholecystectomy. Around 60 cases of situs inverses total is with cholecystectomy have been reported till date. These cases cause technical and visuo-motor difculty due to contra lateral deposition of gall bladder in left hypochondrium during laparoscopic cholecystectomy. Consumption of extra time also been reported during calot's dissection, as it's like operating on a mirror image, Department of General surgery Darbhanga medical college and Hospital Laheriasarai Darbhanga Bihar. CONCLUSION: Laparoscopic cholecystectomy, the gold standard treatment for cholelithiasis, is a feasible option even in cases with SIT; in the hands of good experienced, ambidextrous laparoscopic surgeons

Management of Gallbladder Empyema in a patient with Situs Inversus, Levocardia and Morbid Obesity: a Case Report.

Situs Inversus with levocardia is an unusual condition, in which the main organs of the thorax and abdomen are located in a reverse or enantiomorphic position in relation to the usual topography. It is estimated a prevalence of 1:10000 people with some Situs Inversus condition, but Situs Inversus with Levocardia is reported in only 1:22000 cases. The presence of acute cholecystitis in patients is an extremely rare event,however, one of its possible complications, Gallbladder Empyema can develop, causing an increase in severity and the need for surgical intervention. Since the inversion of abdominal organs proper to Situs Inversus with levocardia is commonly associated with the transposition of great vessels, fatally, as described in the literature of Vesicle empyema and Situs Inversus, it only occurred in patients with dextrocardia, not yet being reported in patients with Levocardia. We report a case of a female patient with pain in the left hypochondrium with Situs Inversus Viscerum, Levocardia, Empyema of Biliary Vesicles and Morbid Obesity.

Midgut malrotation: case series

Mal rotation of midgut is associated with other anomalies usually encountered in neonatal period or early childhood. If undetected in childhood it presents in adulthood with small bowel obstruction, repeated appendicitis or chronic abdominal symptoms. CECT abdomen is mandatory for diagnosis though it often presents as surgical surprise on abdominal laparotomy. Hereby, we presented 3 cases where it was undetected till adulthood though CECT was mandatory for definitive diagnosis. Case 1 patient presented with chronic abdominal pain on left abdomen was actually malrotation with appendix lying on left hypochondrium and stenosed fourth part duodenum adding to vomiting off and on. Case 2 patient in adulthood presented with repeated sub-acute intestinal obstruction because of midgut mal-rotation. Relieved after Ladd band was cut and obstructive symptoms relieved. Case 3 patient had inflammed appendix in subhepatic position was cause of chronic pain with para duodenal hernial sac adding to intestinal obstruction with malrotation of midgut.

Torsion of the wandering spleen as an abdominal emergency: a case report

Background Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium. Case presentation A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen’s pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully. Conclusion Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.

Scrotal meconium pseudocysts: meconium periorchitis as a rare cause of postnatal acute scrotum

A 10-day-old newborn was taken to the paediatric emergency room due to scrotal swelling. Physical examination showed scrotal enlargement and palpable intrascrotal hard formations. Laboratory blood tests revealed no significant alterations. Testicular ultrasonography showed thickened and hypoechoic scrotal walls and bilateral intrascrotal isoechoic nodules with small internal calcifications. An abdominal X-ray confirmed evidence of bilateral scrotal microcalcifications and small calcifications in the left hypochondrium. Urgent laparotomy performed for scrotal exploration verified the presence of nodular formations on the vaginal tunic of both testicles; the nodules were removed. Bilateral orchidopexy was performed in the same surgical session. When dealing with an acute scrotum in a newborn both emergency radiologists and clinicians should consider the possibility of scrotal meconium pseudocyst as a rare but possible cause of periorchitis.

Polycythemia vera as a rare cause of hypertension in a young man

Polycythemia vera (PV) is an orphan haematological disease and one of the most common myeloproliferative diseases, with the incidence rate of about 0.4–2.8 cases per 100 000 population per year. In patients, proliferation of all three haematopoietic lineages is observed, typically with the development of erythrocytosis. As a rule, PV occurs in patients aged 60–70 years, slightly more often in men. The main clinical signs of PV are weakness, significant burning sensation in fingers and palms due to the increased blood viscosity and microcirculation disorders, discomfort in the left hypochondrium due to splenomegaly at the background of extramedullary haematopoietic sites development, as well as gross vascular complications (thrombosis) of various localisation. Our clinical case represents a rare cardiac manifestation of the PV in a young man.

Addison’s disease with primary hypothyroidism in a case of visceral leishmaniasis and HIV coinfection

A 41-year-old man presented with vomiting and loose stools. He had a history of long-term intermittent fever, generalised skin hyperpigmentation, dragging sensation in the left hypochondrium and unintentional weight loss. He was receiving combination antiretroviral therapy since 2010 for HIV infection. He also received antitubercular therapy for tuberculous spondylitis. During the hospital stay, he was found to have postural hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia, pancytopenia, hypothyroidism, hyperglobulinaemia and hypoalbuminaemia with reversal of serum albumin/globulin ratio. The morning plasma cortisol was lower than normal and could not be appropriately stimulated after the Synacthen test. The bone marrow histopathology was suggestive of visceral leishmaniasis. He was diagnosed as a case of visceral leishmaniasis and HIV coinfection with primary adrenal insufficiency (Addison’s disease) and primary hypothyroidism, as a rare and unusual presentation.