Colonoscopic Splenic Injury: A Simplified Radiologic Approach

Abstract Introduction The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has provided enormous challenges in the delivery of surgical care. In addition to respiratory tract infections, coronavirus disease 2019 (COVID-19) is associated with both arterial and venous thrombotic complications. Case Details: We present a case of acute superior mesenteric venous (SMV) thrombosis in a 36-year-old female patient who underwent Roux-en-Y gastric bypass three years previously. Her presentation with acute abdominal pain occurred 6 days after a positive nasopharyngeal swab. An admission CT scan demonstrated an abrupt cut off in the proximal SMV with resultant small bowel oedema. Subsequent thrombophilia screening and mutation testing for myeloproliferative neoplasms were all negative. She had also previously carried three pregnancies to term without any thrombotic complications. Hence, the high suspicion of acute COVID-19 induced mesenteric thrombosis. Conclusions In patients who have previously undergone Rouy-en-Y gastric bypass and lost significant weight, acute abdominal pain normally raises a high suspicion of internal hernia. However, as the pandemic progresses surgeons need to be mindful of COVID-19 induced mesenteric thrombosis as a differential diagnosis during the workup of acute abdominal pain. This was well demonstrated on a CT scan with intravenous contrast.

Download Full-text

Typhoid fever colitis with massive lower gastrointestinal bleeding

International Surgery Journal ◽

10.18203/2349-2902.isj20190412 ◽

2019 ◽

Vol 6 (2) ◽

pp. 601

Author(s):

Yousif Salem ◽

Keith Johnston ◽

Amro Salem

Keyword(s):

Abdominal Pain ◽

Gastrointestinal Bleeding ◽

Typhoid Fever ◽

Ct Scan ◽

Rare Complication ◽

Right Hemicolectomy ◽

Lower Gastrointestinal Bleeding ◽

High Light ◽

Bleeding Per Rectum ◽

Endemic Areas

Authors are presenting the case of a 34year old female, with no known comorbidities, who after recent travel to Pakistan, presented with fever for 1 month and was diagnosed with typhoid fever.During her admission she developed bleeding per rectum and abdominal pain labeled as right-side colitis, confirmed by endoscopy and CT scan, which was managed surgically by extended right hemicolectomy and ileostomy.The aim of this case is to discuss a rare complication of typhoid fever which is lower gastrointestinal bleeding, and high light the importance of considering rare infectious cases if not in endemic areas.

Download Full-text

Acute Abdomen in Adult Revealing Unusual Complicated Epiploic Appendagitis: A Case Report

10.21203/rs.3.rs-46880/v1 ◽

2020 ◽

Author(s):

yahya charifi ◽

alaoui lamrani My Youssef ◽

Chbani Laila ◽

Boubbou Meryem ◽

Maaroufi Mustapha ◽

...

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

Epigastric Pain ◽

Rare Complication ◽

Iliac Fossa ◽

Abdominal Ultrasound ◽

Left Iliac Fossa ◽

Epiploic Appendagitis ◽

Complicated Form ◽

Invasive Techniques

Abstract BACKGROUND Epiploic appendagitis is a torsion of fatty appendages of ligamentum trees (1), its a rare cause of abdominal pain that usually manifests by right or left iliac fossa pain, reminding of appendicitis, diverticulitis or ischemia of the omentum. CASE PRESENTATION We report the case of a 56 years old male patient admitted for an epigastric pain and a right-upper quadrant abdominal pain, for whom he underwent an abdominal ultrasound and a CT-scan who shown an abscessed mass under colic transverse to the unusual seat. CT scan is still the key modality for diagnosis, avoiding unnecessary surgery. Complications of primary epiploic appendagitis have rarely been described in the literature. Another more rare complication is appendagitis with associated abscess, in this condition, we must also think about complicated diverticulitis. The treatment of uncomplicated forms is generally conservative, however, some authors have suggested a surgical method . For therapeutic management of its complication, there has been much interest in the use of minimally invasive techniques such as percutaneous drainage to minimize the morbidity and mortality that is associated with surgery. CONCLUSION The diagnosis of epiploic appendagitis is still uncommon, CT scan, can eliminate other diagnosis of acute abdominal pain such as diverticulitis and appendicitis. It also allows the diagnosis of the rare complicated forms such as abscesses associated with epiploic appendagitis. The treatment of typical forms is usually conservative, while the complicated form requires surgery because of the potential associated pathology.

Download Full-text

Splenic Abscess after Sleeve Gastrectomy

Case Reports in Medicine ◽

10.1155/2020/4850675 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Rany Aoun ◽

Michel Gabriel ◽

Elias El Haddad ◽

Roger Noun ◽

Ghassan Chakhtoura

Keyword(s):

Abdominal Pain ◽

Sleeve Gastrectomy ◽

Ct Scan ◽

Laparoscopic Sleeve Gastrectomy ◽

Percutaneous Drainage ◽

Clinical Presentation ◽

Rare Complication ◽

Splenic Abscess ◽

Intravenous Antibiotics

Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy (LSG). Clinical presentation includes fever, leucocystosis, and abdominal pain. CT SCAN is a must for diagnosis. The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy. We report the thirteen case of a splenic abscess after LSG. In our patient, the abscess occurred three weeks after LSG in a 21-year-old man, and it was successfully treated conservatively.

Download Full-text

Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽

10.1024/0301-1526/a000154 ◽

2011 ◽

Vol 40 (6) ◽

pp. 495-498 ◽

Cited By ~ 1

Author(s):

Rajkovic ◽

Zelic ◽

Papes ◽

Cizmek ◽

Arslani

Keyword(s):

Atrial Fibrillation ◽

Small Intestine ◽

Abdominal Pain ◽

Ct Scan ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Abdominal Cavity ◽

Celiac Axis ◽

Contrast Administration ◽

Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patients condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

Download Full-text

Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽

10.33883/jms.v21i2.328 ◽

2019 ◽

Vol 21 (2) ◽

pp. 117-119

Author(s):

Munir Ahmad Wani ◽

Mubarak Ahmad Shan ◽

Syed Muzamil Andrabi ◽

Ajaz Ahmad Malik

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Ct Scan ◽

Bowel Obstruction ◽

Emergency Surgery ◽

Gallstone Ileus ◽

Gall Stone ◽

Life Threatening ◽

Life Threatening Complication ◽

Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

Download Full-text

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

The Heart Surgery Forum ◽

10.1532/hsf.1322 ◽

2015 ◽

Vol 18 (3) ◽

pp. 088

Author(s):

Ye-tao Li ◽

Xiao-bin Liu ◽

Tao Wang

Keyword(s):

Abdominal Pain ◽

Infective Endocarditis ◽

Aortic Valve ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mycotic Aneurysm ◽

Acute Abdominal Pain ◽

Rare Complication ◽

Emergency Operation ◽

History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

Download Full-text

Assessment of clinical outcomes among CT scan in the diagnosis of chronic abdominal pain

MedPulse International Journal of Radiology ◽

10.26611/10131032 ◽

2019 ◽

Vol 10 (3) ◽

pp. 15-18

Author(s):

Anant Madhukarrao Bhuibhar ◽

◽

Challa Anil Kumar ◽

Lalwani Shyam Tekchand ◽

◽

...

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

Clinical Outcomes ◽

Chronic Abdominal Pain

Download Full-text

A227 UMBILICAL HERNIA INCARCERATION IN LIVER CIRRHOSIS: A RARE COMPLICATION OF PARACENTESIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.225 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 263-265

Author(s):

A LAGROTTERIA ◽

A Aruljothy ◽

K Tsoi

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Small Bowel ◽

Large Volume ◽

Umbilical Hernia ◽

Rare Complication ◽

Abdominal Wall Hernia ◽

Refractory Ascites ◽

Large Volume Paracentesis

Abstract Background Patients with decompensated liver cirrhosis with ascites frequently have umbilical hernias with a prevalence of 20% and are managed with large volume paracentesis (LVP). Common complications of LVP include hemorrhage, infection, and bowel perforation that occur infrequently with a frequency of less than 1%. However, incarceration of umbilical hernias has been reported as a rare complication of LVP and is speculated to be from ascitic fluid decompression that reduces the umbilical hernia ring diameter resulting in entrapment of the hernia sac. It is unclear whether the quantity or the fluid removal rate increases the herniation risk. Based on case series, this rare complication occurs within 48 hours of the LVP and requires emergent surgical repair and involves a high risk of morbidity and mortality due to potential infection, bleeding, and poor wound healing. Aims We describe a case report of an incarcerated umbilical hernia following a bedside large-volume paracentesis. Methods Case report Results A 59-year-old Caucasian male presented to the emergency department with a 24-hour history of acute abdominal pain following his outpatient LVP. His medical history included Child-Pugh class C alcoholic liver cirrhosis with refractory ascites managed with biweekly outpatient LVP and a reducible umbilical hernia. He reported the onset of his abdominal pain 2-hours after his LVP with an inability to reduce his umbilical hernia. Seven liters of clear, straw-coloured asitic fluid was drained. Laboratory values at presentation revealed a hemoglobin of 139 g/L, leukocyte count of 4.9 x109 /L, platelet count of 110 xo 109 /L, and a lactate of 2.7 mmol/L His physical exam demonstrated an irreducible 4 cm umbilical hernia and bulging flanks with a positive fluid wave test. Abdominal computed tomography showed a small bowel obstruction due to herniation of a proximal ileal loop into the anterior abdominal wall hernia, with afferent loop dilation measuring up to 3.4 cm. He was evaluated by the General Surgery consultation service and underwent an emergent laparoscopic hernia repair. There was 5 cm of small bowel noted to be ecchymotic but viable, with no devitalized tissue. He tolerated the surgical intervention with no post-operative complications and was discharged home. Conclusions Ultrasound-guided bedside paracentesis is a common procedure used in the management of refractory ascites and abdominal wall hernia incarceration should be recognized as a potential rare complication. To prevent hernia incarceration, patients with liver cirrhosis should be examined closely for hernias and an attempt should be made for external reduction prior to LVP. A high index of suspicion for this potential life-threatening condition should be had in patients who present with symptoms of bowel obstruction following a LVP. Funding Agencies None

Download Full-text

An unusual case of chronic abdominal pain: an association between Celiac disease and Crohn’s disease

Oxford Medical Case Reports ◽

10.1093/omcr/omab008 ◽

2021 ◽

Vol 2021 (4) ◽

Author(s):

Leen Jamel Doya ◽

Maria Naamah ◽

Noura Karkamaz ◽

Narmin Hajo ◽

Fareeda Wasfy Bijow ◽

...

Keyword(s):

Crohn’S Disease ◽

Abdominal Pain ◽

Celiac Disease ◽

Crohn's Disease ◽

Histological Study ◽

Gastrointestinal Diseases ◽

Bowel Diseases ◽

Oral Corticosteroids ◽

History Of ◽

High Caloric Diet

ABSTRACT Inflammatory bowel diseases (IBD) and Celiac disease (CeD) are immune-mediated gastrointestinal diseases with incompletely understood etiology. Both diseases show a multifactorial origin with a complex interplay between genetic, environmental factors, and some components of the commensal microbiota. The coexistence of celiac disease with Crohn’s disease is rarely reported in the literature. Here, we report a case of a 13-year-old Syrian male who presented with a history of abdominal pain, anorexia and pallor. CeD and Crohn’s disease was documented on gastrointestinal endoscopy and histological study. The patient was treated with a gluten-free, low fiber, high caloric diet, and a course of oral corticosteroids with an improvement in growth rate and abdominal pain.

Download Full-text