- Left lower quadrant pain: an unlikely diagnosis in a case of acute abdomen. [Journal Article]
- JCJ Community Hosp Intern Med Perspect 2018; 8(5):296-299
- Splenic infarct is an incredibly rare diagnosis for abdominal pain. One study involving two hospitals over ten years describes only 0.0037% of all hospital admissions presenting with splenic infarcti...
Splenic infarct is an incredibly rare diagnosis for abdominal pain. One study involving two hospitals over ten years describes only 0.0037% of all hospital admissions presenting with splenic infarction. Our report describes a case of massive splenomegaly causing pain in a different location compared to the normal anatomical location of the spleen with an unexpected cause, lymphoma. High clinical suspicion for lymphoma as a cause of splenic infarction is critical because this disease can otherwise be clinically silent. This case emphasizes the importance of a thorough clinical workup and persistence in diagnostic pursuit.
- Surgical management of retroperitoneal schwannoma complicated with severe hydronephrosis: A case report. [Case Reports]
- MMedicine (Baltimore) 2018; 97(39):e12528
- CONCLUSIONS: Preoperative imaging and preoperative ultrasound-guided biopsy are helpful to make accurate diagnosis. The final diagnosis is based on postoperative histological and immunohistochemical findings. The primary treatment option is complete surgical resection of the retroperitoneal schwannoma and the involved upper urinary system when severe hydronephrosis occured. Local recurrence and overall survival are closely correlated with negative resection margins and pathology types.
- [Deep Vein Thrombosis Due to Compression of Huge Hepatic Cyst Successfully Treated by Inferior Vena Cava Filter and Cyst Drainage]. [Case Reports]
- KJKorean J Gastroenterol 2018 Sep 25; 72(3):146-149
- An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressin...
An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.
- Uncommon cause of pelvic inflammatory disease leading to toxic shock syndrome. [Journal Article]
- BCBMJ Case Rep 2018 Sep 23; 2018
- A 44-year-old Caucasian female with a history of endometriosis is admitted to the intensive care unit due to severe left lower quadrant abdominal pain, nausea and vomiting. With patients' positive ch...
A 44-year-old Caucasian female with a history of endometriosis is admitted to the intensive care unit due to severe left lower quadrant abdominal pain, nausea and vomiting. With patients' positive chandelier sign on pelvic examination, leucocytosis, elevated erythrocyte sedimentation rate and elevated C-reactive protein indicated that she had pelvic inflammatory disease (PID). PCR tests were negative for Neisseria gonorrhoeae and Chlamydia trachomatis; however, her blood and urine cultures grew Group A streptococci (GAS) with a negative rapid Streptococcus throat swab and no known exposure to Streptococcus On further review, patient met criteria for GAS toxic shock syndrome based on diagnostic guidelines. The patient was promptly treated with intravenous antibiotics and supportive care, and she acutely recovered. This case demonstrates a rare cause of PID and an atypical aetiology of severe sepsis. It illuminates the importance of considering PID as a source of infection for undifferentiated bacteraemia.
- Infarcted accessory spleen masquerading as a mesenteric cyst. [Journal Article]
- BCBMJ Case Rep 2018 Aug 16; 2018
- An accessory spleen is a rare entity which is usually asymptomatic. When symptomatic, it presents as an acute abdomen, with either torsion, rupture or haemorrhage. We present the case of a 20-year-ol...
An accessory spleen is a rare entity which is usually asymptomatic. When symptomatic, it presents as an acute abdomen, with either torsion, rupture or haemorrhage. We present the case of a 20-year-old man who presented with chronic lower abdominal pain since 3 months and a lump in the left lower quadrant. On clinical examination and investigations, the lump was diagnosed as a mesenteric cyst, and an uncomplicated laparoscopic excision was performed. The postoperative histopathological examination reported it as an infarcted accessory spleen.
- Subcutaneous Heparin Leads to Rectus Sheath Hematoma: A Rare Complication. [Journal Article]
- CCureus 2018 Jun 08; 10(6):e2769
- Rectus sheath hematoma (RSH) is a rare complication that usually occurs in patients receiving anticoagulation therapy. It can mimic an acute abdomen and be life-threatening. RSH can develop even with...
Rectus sheath hematoma (RSH) is a rare complication that usually occurs in patients receiving anticoagulation therapy. It can mimic an acute abdomen and be life-threatening. RSH can develop even with prophylactic dose of heparin. Early recognition is necessary to decrease morbidity and mortality. RSH should be considered in anticoagulated patients who develop sudden onset of abdominal pain. RSH is usually managed conservatively, but sometimes requires surgery. Patients who are taking antiplatelet require careful monitoring with the use of anticoagulation (AC). It is important to identify them early. This is a case of 69-year-old female who presented with epigastric pain secondary to rectus sheath hematoma. She was receiving subcutaneous injections of heparin for left lower quadrant pain and swelling for venous thromboembolism prophylaxis. Ultrasound of abdomen revealed large rectus sheath hematoma.
- Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature. [Journal Article]
- JMJ Med Case Rep 2018 Aug 06; 12(1):214
- CONCLUSIONS: The disorders associated with aortomesenteric compression can lead to serious symptoms and sometimes death. Diagnosis is challenging not only because of the lack of awareness of these rare disorders, but also because they are associated with symptoms that are similar to those seen in less serious diseases. Guidance for health care professionals with respect to relevant radiological and clinical markers needs to be reconsidered in order to clarify the etiology of the diseases and create better diagnostic protocols.
- Epiploic appendagitis: A rare cause of acute abdomen. [Journal Article]
- RCRadiol Case Rep 2018; 13(3):599-601
- Epiploic appendagitis is a rare cause of acute abdomen that often manifests with acute onset of pain in the left or right lower quadrant. Its symptoms can mimic and be mistaken for acute diverticulit...
Epiploic appendagitis is a rare cause of acute abdomen that often manifests with acute onset of pain in the left or right lower quadrant. Its symptoms can mimic and be mistaken for acute diverticulitis, appendicitis, or omental infarction. In this case report, we discuss a 65-year-old woman who presented with sharp right upper and lower quadrant abdominal pain, for which she had an emergent abdominal computed tomography (CT) scan. On CT images, epiploic appendagitis will appear as oval lesions with a central area of fat attenuation, accompanied by surrounding inflammation. Ultrasound and magnetic resonance imaging are more often used to evaluate acute abdominal pain in the pediatric and obstetric populations, so the respective findings of acute epiploic appendagitis must be recognized in those examinations as well. Despite the rarity of the condition and its common omission from differential diagnoses, the ability to recognize and diagnose epiploic appendagitis from its imaging is important for radiologists, especially considering its potential complications. If not diagnosed correctly, epiploic appendagitis can result in unnecessary hospital admission and patient workup, antibiotic use, dietary restrictions, and perhaps even unnecessary surgery. In this case, the diagnosis of epiploic appendagitis using CT allowed the patient to avoid surgery and other invasive treatment, and the patient was eventually discharged on conservative medical management.
- Severe abdominopelvic actinomycosis with colon perforation and hepatic involvement mimicking advanced sigmoid colon cancer with hepatic metastasis: a case study. [Case Reports]
- BSBMC Surg 2018 Aug 02; 18(1):51
- CONCLUSIONS: Abdominopelvic actinomycosis presenting with colon perforation and hepatic involvement is extremely rare; however, it is clinically similar to advanced colon cancer with liver metastasis, therefore, complicating the preoperative diagnosis. A diagnosis of abdominopelvic actinomycosis should be considered in patients with a history of IUD and chronic abdominal pain, along with an abdominal mass or cutaneous abscess. If surgery is indicated, preoperative empirical antibiotic therapy for actinomycosis and frozen biopsy during surgery may be considered.
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- Handlebar hernia - A rare complication from blunt trauma. [Journal Article]
- IJInt J Surg Case Rep 2018; 49:118-120
- CONCLUSIONS: A high level of suspicion is required to diagnose handlebar hernias. Even relatively low-speed trauma can result in this insidious injury. Laparoscopic repair has been demonstrated to be successful in this case.Despite being a rare entity, handlebar hernias should be suspected when significant blunt force is applied to the abdominal wall from a handle bar injury. They may not be obvious on physical examination and therefore further imaging is often important. Management involves prompt surgical repair to prevent complications.