An interesting case of left paraduodenal hernia.

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

Comparison of Kidney-Ureter-Bladder Radiography with Computed Tomography Scout Film for the Diagnosis of Renal Calculi Taking Axial Computed Tomography as Gold Standard

Background: Nephrolithiasis is a widespread disease with an incidence of 17-13 in North American, 5-9% in Europe, and 1-5% in the Asian continent. Plain abdominal radiography is used to visualize renal stones, but the cysteine stones are often poorly visible, uric acid and mixed stones are not visible at all. The second diagnostic tool for the diagnosis of renal calculus is computed tomography. The CT scout film is often overlooked and did not use for the diagnostic purpose. Objective: To compare Kidney-ureter-bladder radiography with computed tomography scout film for the diagnosis of renal calculi taking axial computed tomography as a gold standard. Materials and Methods: It was a cross-sectional analytical study design conducted on 57 patients presenting with acute flank pain in Faisal Hospital Faisalabad. Patients having ages between 18-60 were included in the study. Pregnant patients and patients with lndinavir therapy were excluded from the study. Results: The sensitivity recorded for CT scout film was 66.7% and for the plain abdominal radiography was 80.7%. The calculus carrying Hounse field unit less than 200 HU were not visualized on both the modalities x-ray and plain abdominal radiography. However, the calculus greater than 5mm in size has a sensitivity of 73% on CT scout film. Conclusion: The sensitivity recorded for CT scout film was 66.7% and for the plain abdominal radiography was 80.7%. The calculus carrying Hounse field unit less than 200 HU were not visualized on both the modalities x-ray and plain abdominal radiography. However, the calculus greater than 5mm in size has a sensitivity of 73% on CT scout film.

PERFORATIVE PERITONITIS IN NEWBORNS: INSTRUMENTAL AND MORPHOLOGICAL EXAMINATION FINDINGS

The aim: To study and analyze the results of instrumental diagnostic measures and morphological verification of perforations of abdominal viscera in peritonitis in newborns, their importance in timely diagnosis, as well as to present authors’ experience of examining newborns with PP, taking into account the complexity of diagnosis and treatment of these patients. Materials and methods: The study is based on the results of examining 59 newborns with PP of various etiologies. Instrumental methods that were used in the diagnosis of PP and differential diagnosis of other emergencies involved the following: radiological examination (plain abdominal radiography), abdominal and retroperitoneal ultrasound, neurosonography, echocardiography, diagnostic abdominal paracentesis. Morphological verification of hollow viscus perforations was performed by methods of histologic examination in 54 newborns who underwent surgery. Results: It is emphasized that perforations in NEC and spontaneous gastrointestinal perforations have clinical and morphological differences. The analysis of morphological data showed absence of intestinal musculature or muscular wall defect in spontaneous gastrointestinal perforations. Perforations in NEC had massive gastric or bowel wall necrosis. Morphogenesis of gastrointestinal perforations in newborns is crucial for developing correct treatment strategy and choosing surgical approach. Conclusions: Diagnosis of PP in newborns should be comprehensive and include modern instrumental studies that enable to reliably establish the cause of peritonitis and indications for surgical treatment. Differential diagnosis of PP in newborns with other diseases aims to differentiate PP from a number of similar clinical symptoms of urgent conditions in order to conduct adequate preoperative preparation and appropriate surgery. Diagnostic markers of PP involve the following: pneumoperitoneum, free fluid in the abdomen, sentinel loop (intestinal distention), fixed bowel loop, cloudy brown or greenish intra-abdominal fluid with a large number of leukocytes and bacteria.

Imaging methods in non-traumatic acute abdomen

An acute abdomen is an urgent condition requiring rapid diagnosis and treatment. Nowadays, with the new developments and progression in ultrasonography (US) and computed tomography (CT), these methods have become a far better alternative to plain abdominal radiography. US is now an available and proven method used to provide a “final” diagnosis in various conditions. The frequency for CT examination for the diagnosis of acute abdomen has increased. A disadvantage of using CT examination includes high doses of radiation for the patient. Fortunately, this disadvantage is outweighed by the multitude of advantages. The advantages include high sensitivity and specificity in the detection of causes in urgent conditions. The CT protocol of examination is primarily lead by the radiologist.

Amoebic Colitis Presenting as Subacute Intestinal Obstruction with Perforation

Infestation with Entamoeba histolytica is worldwide, especially in developing areas. Presented case study included amoebic colitis in a 45 years old man complaining of abdominal distension and non-passage of stools since three days. Abdominal region was diffusely distended and tender in right iliac fossa. Plain abdominal radiography revealed prominent gut loops and minimal intergut free fluid. At laparotomy, malrotation of gut was present. Histopathological examination of intestinal samples confirmed final diagnosis of amoebic colitis post-operatively.

Megacolon Concurrent with Perineal Hernia in a Male Rough Collie

Perineal hernia occurs frequently in aged collies as a result of weakening of the pelvic diaphragmatic muscle or its total failure, thereby allowing displacement of abdominal contents into the perineum. Surgical management include subtotal colectomy, colotomy, internal obturator muscle transposition and perineal herniorrhaphy. This report highlights a case of perineal hernia associated with megacolon as well as its successful management in a dog. A seven years old, male Rough Collie was presented with a complaint of right perineal swelling that has lasted for a week as well as inappetance and absence of defecation. Physical examination was unremarkable except for 3% dehydration and a firm, large perineal non-reducible swelling. Plain abdominal radiography revealed perineal hernia with megacolon. Serum chemistry showed azotaemia. Emergency surgical intervention involving colotomy, perineal herniorrhaphy with incisional colopexy were conducted. Post-operative care included ceftriaxone injection at 50mg/kg intramuscularly, intravenous fluid infusion, one week fasting, daily wound dressing, Nutriplus® gel supplementation and administration of recovery diet post-fasting. Thus, surgical management using traditional perineal herniorrhaphy, colotomy with colopexy was effective in correcting the perineal hernia with megacolon.

Peritonitis by Spontaneous rupture of ovarian dermoid cyst: a case report

Background: Ovarian dermoid cyst is a benign congenital tumor. It is often incidentally diagnosed and can be revealed in very rare cases by spontaneous rupture. We report the case of a ruptured ovarian dermal cyst complicated by generalized peritonitis. Case report: This was a 20-year-old female patient, who consulted for abdominal pain associated with fever and vomiting. Physical examination found generalized abdominal contracture. Plain abdominal radiography found pneumoperitoneum. Biology showed leukocytosis at 18000 / mm3. Median laparotomy revealed a collection 2000 cc of pus with a ruptured right ovarian mass. An adnexectomy with lavage of abdominal cavity were performed. Anatomopathological examination concluded to an ovarian dermoid cyst with no sign of malignancy. The postoperative course was uneventful. Conclusion: Rupture of a dermoid cyst of the ovary is a rare acute complication. Examination of the operative specimen is mandatory to eliminate malignancy. Keywords: Ovary; Dermoid cyst; Rupture; Acute complication; Peritonitis; Ovary