scholarly journals Nonoperative Management of Perforated Diverticulitis of the Duodenum: Report of Three Cases and Review of Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Rutger Franken ◽  
Martijn Möllers ◽  
Alexander de Mol van Otterloo ◽  
Julien Puylaert
Keyword(s):  
Correct Diagnosis ◽  
Good Condition ◽  
Acute Onset ◽  
Perforated Diverticulitis ◽  
Review Of Literature ◽  
Laboratory Findings ◽  
Duodenal Diverticula ◽  
Duodenal Diverticulitis ◽  
Upper Abdomen

Duodenal diverticula are relatively frequent but complications are uncommon. The mortality rate of perforated duodenal diverticulitis is high, and its management is controversial. We report three patients with a perforated duodenal diverticulitis who were successfully treated with conservative antibiotic therapy. The clinical presentation in all three patients was acute onset of pain in the upper abdomen. In all cases, ultrasound showed no abnormalities, but computed tomography revealed the correct diagnosis. All three were treated with broad-spectrum antibiotics and total parenteral nutrition. They recovered clinically and laboratory findings normalized. During follow-up visit, all patients were asymptomatic. This study contributes another three patients to the small number of successful conservatively treated cases of perforated duodenal diverticulitis described in literature. We suggest that in patients in good condition with no septic signs, conservative treatment with close clinical follow-up should be the treatment of choice.

scholarly journals Borderline ovarian tumour of mixed seromucinous histology and bilateral presentation: a case report and review of literature

2020 ◽  
Vol 8 (3) ◽  
pp. 1172
Author(s):  
Monika Anant ◽  
Sutapan Samanta ◽  
Ruchi Sinha
Keyword(s):  
Correct Diagnosis ◽  
Ovarian Tumour ◽  
Review Of Literature ◽  
Lower Abdomen ◽  
Medical Specialties ◽  
Borderline Ovarian Tumour ◽  
Bilateral Presentation ◽  
Ovarian Tumours ◽  
Ovarian Masses

This article reports the case of a 40 year old woman who presented to the gynaecologic outpatient clinic with pain lower abdomen and an abdominopelvic lump. Clinical assessment, biochemical and radiological investigations revealed bilateral complex ovarian masses. Surgical exploration and histology of ovarian masses confirmed a rare bilateral borderline seromucinous cystadenoma. The purpose of this paper is to highlight the importance of thorough examination of women with symptoms of ovarian tumour which can be vague and to emphasize the necessity of a good collaboration between various medical specialties (primary physician/gynaecologist, oncosurgeon, radiologist and histopathologist) for correct diagnosis, optimum care and best outcome. This article also provides overview of the pathology and biology of borderline ovarian tumours, diagnosis, principles of surgical management and to appreciate the value of follow up.

scholarly journals A Retroperitoneal Inflammatory Pseudotumor involving Duodenum: A Case Report and Review of literature

2018 ◽  
Vol 28 (2) ◽  
pp. 61-63
Author(s):  
MM Sarker ◽  
MS Ali ◽  
MK Sarker ◽  
NA Perveen
Keyword(s):  
Case Report ◽  
Tumor Recurrence ◽  
Inflammatory Pseudotumor ◽  
Primary Repair ◽  
Review Of Literature ◽  
Complete Surgical Resection ◽  
Rare Lesion ◽  
Unclear Etiology ◽  
Upper Abdomen

Inflammatory pseudotumor or (IPT) is a rare lesion of unclear etiology reported in various organs. Although mostly benign, these tumor may pose a therapeutic challenge in cases of recurrence. We report the case of a 65- years -old male who presented with a mass in the left upper abdomen and upon evaluation was noted to have IPT in the retro-peritoneum involving the duodenum. Complete surgical resection was done with primary repair of the 3rd part of the duodenum with no evidence of tumor recurrence on 6 months follow-up. We review the literature and discern the epidemiological, clinical, pathophysiological and management aspects of IPTs.TAJ 2015; 28(2): 61-63

scholarly journals Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Adriá Rosat ◽  
Ayaya Alonso ◽  
Javier Padilla ◽  
Pablo Sanz ◽  
M. Aránzazu Varona ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Correct Diagnosis ◽  
Gastric Fundus ◽  
Abdominal Ct ◽  
Associated Symptoms ◽  
Abdominal Ct Scan ◽  
Diaphragmatic Herniation ◽  
Upper Abdomen ◽  
Uncommon Complication

Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient’s condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

scholarly journals Case Report (Precis): Two Telemedicine Consultants Miss Foot Drop: When To See Patients in Person

2020 ◽  
Vol 11 ◽  
pp. 301
Author(s):  
Nancy E. Epstein
Keyword(s):  
Correct Diagnosis ◽  
Acute Onset ◽  
Chief Complaint ◽  
Foot Drop ◽  
Low Back ◽  
Initial Screening ◽  
Inflammatory Agent ◽  
Telemedicine Consultation ◽  
Strenuous Activity

Background: Telemedicine has been rapidly adopted due to COVID-19. In the earliest days, most screenings were performed by primary care/internal medicine consultants; referrals to subspecialists were minimized. Now, as the pandemic has evolved over 6 months, secondary telemedicine consultations should be limited, and earlier involvement of appropriate subspecialists should be reconsidered to optimize patient management. Case Description: An older individual spoke to an on-call general medical physician with the chief complaint of the acute onset of low back pain after moderately strenuous activity, with severe unilateral radiculopathy. The telemedicine physician recommended a non-steroidal. anti-inflammatory agent without any specific recommendations regarding follow-up. A few days later, with progression of unilateral pain and numbness, a second telemedicine medical consultation was performed; a Medrol dose pack and muscle relaxant were now recommended, again without any follow-up recommendations. Days later, with increased unilateral pain/ near anesthesia in the foot, the patient was seen by a spinal surgeon who found; unilateral SLR positive at 20 degrees, a 0/5 foot drop, loss of the Achilles Response, and decreased pin appreciation in the L5 distribution. The patient’s emergent lumbar MR showed a large unilateral disc herniation with inferior migration at the appropriate level, warranting surgical consideration. Conclusion: Here, we emphasized several points. First, telemedicine may be adequate for the initial screening, but further complaints would be better evaluated in person by either a medical or surgical subspecialist; here, both could have recognized the very clear unilateral foot drop. Second, the patient should have had a scheduled follow-up in-person consultation. Third, appropriate diagnostic studies should have been ordered at the time of the second telemedicine consultation to establish the correct diagnosis and direct treatment.

scholarly journals The Difficult Path to Correct Diagnosis of Hepatolithiasis: A Case Report

2021 ◽  
Vol 64 (2) ◽  
pp. 125-128
Author(s):  
Peter Mikolajčík ◽  
Alexander Ferko ◽  
Michal Demeter ◽  
Martin Vorčák ◽  
Ľudovít Laca
Keyword(s):  
Clinical Picture ◽  
Correct Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Good Prognosis ◽  
Definitive Treatment ◽  
Stone Extraction ◽  
Laboratory Findings ◽  
Biliary Ducts ◽  
Obstructive Cholangitis

Hepatolithiasis is a benign disease, where stones are localized proximal to the confluence of hepatic ducts. The clinical picture may differ depending on whether the stones cause complete, partial, or intermittent biliary obstruction. The course can vary from asymptomatic to fatal, thus, early diagnosis and treatment is critical for a good prognosis. The gold standard in imaging is magnetic resonance cholangiopancreatography (MRCP). However, correct diagnosis can be challenging due to atypical clinical picture and laboratory findings. We present a case where hepatolithiasis was misdiagnosed initially due to incomplete reporting and documentation of MRCP. Choledocholithiasis was diagnosed based on initial MRCP, and endoscopic stone extraction was indicated. However, an unusual post-interventional course and signs of obstructive cholangitis led to an endoscopic re-intervention, which confirmed absence of pathology in extrahepatic biliary ducts. The cholangitis recurrence required intensive antibiotic treatment, and CT examination revealed intrahepatic S3 bile duct dilatation. Thus, a re-evaluation of initial MRCP and repeated MRCP confirmed hepatolithiasis. Further, laparoscopic bisegmentectomy was chosen as the definitive treatment due to the location of the lesion. The patient recovered and remained symptom free upon a 12 month follow up.

Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

1996 ◽  
Vol 35 (04) ◽  
pp. 116-121 ◽  
Author(s):  
G. E Fueger ◽  
M. Vejda ◽  
R. M. Aigner
Keyword(s):  
Bone Scintigraphy ◽  
Antibiotic Treatment ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Serum Parameters ◽  
Wbc Count ◽  
Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

Assessment of Duodenal Diverticula: Computed Tomography Findings

2019 ◽  
Vol 15 (10) ◽  
pp. 948-955
Author(s):  
Erdem Yilmaz ◽  
Osman Kostek ◽  
Savas Hereklioglu ◽  
Muhammet Goktas ◽  
Nermin Tuncbilek
Keyword(s):  
Computed Tomography ◽  
Contrast Agent ◽  
Ampulla Of Vater ◽  
Common Type ◽  
Radiological Features ◽  
New Findings ◽  
Duodenal Diverticula ◽  
Median Diameter ◽  
Colonic Diverticula

Aims: To demonstrate the prevalence, accompanying pathologies, imaging and follow up findings of Duodenal Diverticula (DD) with Multidetector Computed Tomography (MDCT). Materials and Methods: Consecutive 2910 abdominal MDCTs were retrospectively reviewed on axial, coronal and sagittal planes. DD were evaluated for prevalence, location, number, size, contents, diverticular neck, accompanying pancreaticobiliary pathologies, jejunal and colonic diverticula, respectively. Results: DD were diagnosed in 157 cases (5.4%) and found mostly in the second part of the duodenum. Juxta-ampullary DD was the most common type (78.3%) and mostly located ventral (n:86, 69.9%) to the ampulla of Vater. DD was solitary in 123 patients (78.3%) and more than one in 34 patients (21.7%). The median diameter of DD was 2.5 cm (range 1.5-3.6 cm) in the long-axis. The lumen of DD contains air and contrast agent (n:96, 61.1%); air, contrast agent and debris (n:42, 26.7%) in most cases. Colonic diverticula (n:36, 22.9%), cholelithiasis (n:32, 20.4%), choledocholithiasis (n:7, 4.4%), and biliary dilatation (n:8, 5.1%) were the most common additional findings. Median follow-up time was 23 months (range 11 to 41 months). In three cases, new findings (cholelithiasis, n:3, choledocholithiasis, n:1) were detected. Conclusion: Accompanying pathologies with DD diagnosis are valuable for physicians in order to manage the patients. Following clinical and radiological features of well-diagnosed DD might reduce the possible complications.

Young Male with Bilateral ICA Dissection: Beyond CADISS Trial

2021 ◽  
pp. 251660852098428
Author(s):  
Vikas Bhatia ◽  
Chirag Jain ◽  
Sucharita Ray ◽  
jay Kumar
Keyword(s):  
Management Strategies ◽  
Young Male ◽  
Acute Onset ◽  
The Body ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke Study ◽  
History Of

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.

Bilateral ovarian cysts of mature cystic teratoma and Endometrioma: Its surgical challenges and review of literature

2021 ◽  
pp. 228402652110321
Author(s):  
Vimee Bindra ◽  
Mamatha Reddy ◽  
Girija Shankar Mohanty ◽  
Neha Agarwal ◽  
Aditya Kulkarni
Keyword(s):  
Dermoid Cyst ◽  
Germ Cell Tumors ◽  
Cystic Teratoma ◽  
Pelvic Endometriosis ◽  
Review Of Literature ◽  
Ovarian Endometriosis ◽  
Nulliparous Women ◽  
Ovarian Endometrioma ◽  
Ovarian Endometriomas

Teratomas are most frequent germ cell tumors of ovary with an incidence of 15%–20% of all ovarian neoplasm while endometriomas are present in 25.5%–45% of women with pelvic endometriosis. In spite of their increased individual incidence, association of cystic teratomas and ovarian endometriomas is extremely rare. Our case is that of a 33-year-old nulligravida who presented with heavy menstrual flow and pain during periods for last few months, ultrasonography revealed 74 × 57 mm mass in right adnexa-likely ovarian dermoid, enlarged left ovary with two small cysts of size 33 × 29 mm and 25 × 20 mm likely endometrioma, managed by laparoscopy, found to have left ovarian endometrioma of 6 × 6 cm and right ovarian dermoid cyst of 10 × 8 cm size, histopathology confirmed the same. This association of teratoma in one ovary and endometrioma in other ovary of same patient poses a surgical challenge, when it affects young and nulliparous women. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst to assess ovarian reserve, recurrence of either of the cysts, and it also presents a challenge to clinicians to predict the post-operative course of such cases.

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