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Journal of Medicine and Life Jan 2024Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances...
Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances of acute abdominal pain without anorexia, nausea, and vomiting, omental torsion should be included in the differential diagnosis. Any misdiagnosis may lead to major complications such as intraabdominal abscesses and adhesions. A 63-year-old overweight man with a body mass index (BMI) of 41 Kg/m presented to the emergency department on a remote island with acute abdominal pain. His medical history included type 2 diabetes mellitus managed with insulin, essential hypertension, osteoarthritis, and no previous abdominal operations. He reported a sharp pain originating in the epigastrium and the right hypochondrium that started five days prior. Physical examination revealed rebound tenderness and guarding across the abdomen with a positive McBurney sign. However, the patient did not report vomiting and was not nauseous. Vital signs were as follows: blood pressure 116/56 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, and a temperature of 38.2 C. Laboratory results showed a white blood cell count of 10.6, neutrophils of 8.11, C-reactive protein (CRP) 74 mg/l, haemoglobin11.6 g/dl, and hematocrit 36.9%. Due to the absence of a radiographer at the hospital during that period, no imaging investigations were conducted. Diagnostic laparoscopy demonstrated diffused hemoperitoneum and necrotic mass at the site of the hepatic flexure. Initially suspected to be an advanced colon cancer, the decision was made to proceed with open surgery. The necrotic segment of the omentum was found at the right superior point of attachment of the omentum to the hepatic flexure. Consequently, the necrotic segment of the omentum was resected. A thorough investigation of the abdominal cavity did not detect any other abnormalities or pathologies. The patient recovered uneventfully and was transferred to the surgical ward. Torsion of the omentum is a very rare cause of acute abdominal pain. This case highlights the necessity of considering PSOT in the differential diagnosis of acute abdominal pain, especially in cases where symptoms are suggestive of appendicitis but diagnostic findings are negative.
Topics: Humans; Appendicitis; Omentum; Male; Middle Aged; Diagnosis, Differential; Torsion Abnormality; Abdominal Pain; Acute Disease
PubMed: 38737669
DOI: 10.25122/jml-2023-0429 -
Medicine Feb 2023Abdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal...
INTRODUCTION
Abdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal perforation.
PATIENT CONCERNS
A 54-year-old man experienced abdominal pain and distension together with signs of peritoneal irritation after cadaveric renal transplantation. CT and standing abdominal plain film showed a large pneumoperitoneum in the abdominal cavity and the patient underwent an exploratory laparotomy but no gastrointestinal perforation was found.
DIAGNOSIS
No gastrointestinal perforation was found during the operation. In the search for the infectious agent, ascites culture was negative while next-generation sequencing was positive, suggesting the presence of intestinal flora ectopic to abdominal infection with anaerobic respiration fermentation leading to large amounts of gas.
INTERVENTIONS
The patient underwent exploratory laparotomy without gastrointestinal perforation, and then underwent abdominal lavage, placed abdominal drainage tube, and conducted culture and next-generation sequencing examination of ascites.
OUTCOMES
Postoperative symptoms were relieved and intestinal function recovered. After 3 months of outpatient follow-up, the patient had stable transplanted kidney function and was in good spirits and sleeping well, with a good appetite, soft and regular stools, no abdominal pain and distension, and no fever.
CONCLUSION
Patients after kidney transplantation should be wary of abdominal infection being misdiagnosed as gastrointestinal perforation.
Topics: Male; Humans; Middle Aged; Kidney Transplantation; Pneumoperitoneum; Ascites; Intraabdominal Infections; Abdominal Injuries; Peritoneum; Abdominal Pain; Intestinal Perforation
PubMed: 36749270
DOI: 10.1097/MD.0000000000032836 -
Ultrasound in Medicine & Biology Nov 2020We tested the effect of low-frequency ultrasound (LUS, 20 kHz, 4 W/cm) on the function of rat mesentery and human pulmonary arteries with wire myography. The vessels...
We tested the effect of low-frequency ultrasound (LUS, 20 kHz, 4 W/cm) on the function of rat mesentery and human pulmonary arteries with wire myography. The vessels were induced to contract with either noradrenaline or physiologic saline solution (PSS) with a high potassium concentration (KPSS) and then incubated with capsaicin (2.1 × 10 M, TRPV1 [transient receptor potential vanilloid 1] activator), dopamine (1 × 10 M, dopamine and α-receptor activator), or fenoldopam (dopamine receptor agonist, 1 × 10 M) with and without glibenclamide (1 μM, KATP [adenosine triphosphate {sensitive potassium channel (ATP)}-sensitive potassium channel] inhibitor and α-receptor modulator), and insonated. Vessels were incubated in Ca-free PSS and induced to contract with added extracellular Ca and noradrenaline. Pulmonary arteries were induced to contract with KPSS and dopamine. Then the vessels were insonated. LUS inhibited the influx of external Ca, inhibited the dopamine-induced vasoconstriction in the KPSS (glibenclamide reversible), reduced the capsaicin-induced vasorelaxation, increased the gentamicin-induced vasorelaxation and increased the dopamine-induced contraction in the KPSS in human pulmonary arteries.
Topics: Animals; Humans; Mesentery; Myography; Pulmonary Artery; Rats; Rats, Wistar; Ultrasonic Waves
PubMed: 32768323
DOI: 10.1016/j.ultrasmedbio.2020.07.002 -
Leaving a foreign object in the body of a patient during abdominal surgery: still a current problem.Polski Przeglad Chirurgiczny May 2019Leaving a foreign object (retained surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated... (Review)
Review
INTRODUCTION
Leaving a foreign object (retained surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated phenomenon which is dangerous to the health of the patient and the legal security of the medical personnel. These adverse events are easy to avoid through the use of appropriate means of prevention. The aim of the present paper is the collection of epidemiological data and determination of risk factors, symptomatology, health effects, and prevention methods associated with RSIs.
MATERIAL AND METHODS
Analysis of global scientific publications in the databases PubMed, ClinicalKey, Google Scholar, ScienceDirect, and Scopus related to the subject of RSIs.
RESULTS
The frequency of RSI incidents ranges from 1 to 10 in 10,000 surgeries, which results in at least one case in an average multispeciality hospital on a yearly basis. The items most frequently left behind include soft foreign objects, such as swabs and bandages (90%). Risk factors include emergency surgical procedures, high patient BMI, significant loss of blood during surgery, and neglect in counting the material and surgical tools. The postoperative course, although in many cases asymptomatic, may be complicated by inflammation, bleeding, or perforation, leading to the necessity of a second operation and, in 2 to 4% of cases, even ending in death. Imaging tests are effective diagnostic tools. Effective methods of preventing RSIs are based on checklists and systems for counting and monitoring the location of material and tools.
CONCLUSIONS
The globally occurring problem of RSIs requires education of the operating block personnel regarding risk factors and identification with elimination of adverse events of this type. Diagnostics based on imaging should take into account non-specific complaints resulting from a possible oligosymptomatic course. An RSI should not be regarded as a medical error. Changes in the perception of the phenomenon aim aimed at minimising the legal liability of the staff in the event of leaving a foreign object in a patient's body.
Topics: Abdominal Cavity; Foreign Bodies; Humans; Medical Errors; Patient Care Team; Patient Safety; Risk Factors; Surgical Instruments; Surgical Procedures, Operative
PubMed: 31849358
DOI: 10.5604/01.3001.0013.2024 -
Critical Care (London, England) Mar 2016This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at... (Review)
Review
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Topics: Abdominal Cavity; Emergency Medicine; Humans; Intra-Abdominal Hypertension; Monitoring, Physiologic
PubMed: 26983963
DOI: 10.1186/s13054-016-1220-x -
Annals of Anatomy = Anatomischer... Oct 2023Aseptic peritonitis is a reaction of the local immune system aimed at rejection of a foreign body, which, having antigenic properties, does not (unlike a pathogen)...
BACKGROUND
Aseptic peritonitis is a reaction of the local immune system aimed at rejection of a foreign body, which, having antigenic properties, does not (unlike a pathogen) counteract the immune system. The suture materials, namely catgut thread, used in intracavitary surgical operations possess xenogenic properties and can be used for antigenic stimulation of the immune system of the peritoneal cavity. Consequently, we decided to use a catgut suture for antigenic stimulation of the immune system of the peritoneal cavity and to study the morphological features of the results of experimental modeling of aseptic peritonitis in albino rats.
METHOD
The study involved 15 Wistar albino male rats, weighing 286,13 ± 6,26 g. To study the dynamics of destructive changes made by the catgut implant in the peritoneal cavity of the experimental animals, the animals were assigned into three groups in accordance with the time interval of their euthanasia at 3, 7, and 14 days of the experiment.
RESULTS
After modeling an aseptic peritonitis, the investigation the abdominal cavity showed that in four out of five animals of the first group, that is, on day 3 of the experiment, the catgut implant had adhered to the greater omentum. The search for the fifth implant led to an unexpected discovery: we found it conjoined with the second derivative of the visceral peritoneum, similar in structure to the greater omentum, but related to the testes. On day 7, the implant embedded into the peritoneal cavity of the animals, had adhered to the serous formations of the testes in all five cases (100%, three of them - to the left epididymal omentum, and another two - to the right one). On day 14 (n = 5) it was found that in three cases it had adhered to the serous formations of the testes (60%, one of them to the left epididymal omentum, another two - to the right one) and in two cases it had adhered to the greater omentum (40%).
CONCLUSION
During the experiment on implantation of a xenogenic substrate in the form of flat bundles made from the catgut thread into the peritoneal cavity of sexually mature male rats, it was found for the first time that their acceptors were not only the greater omentum, but also two derivatives of the peritoneum, homeomorphic to it and associated with the epididymides, which we reasonably called epididymal omenta and described in details.
Topics: Male; Rats; Animals; Rats, Wistar; Peritoneum; Peritonitis; Omentum; Mesentery
PubMed: 37739240
DOI: 10.1016/j.aanat.2023.152160 -
Journal of Visceral Surgery Jun 2017
Review
Topics: Abdominal Cavity; Female; Humans; Intestinal Volvulus; Intubation, Gastrointestinal; Laparoscopy; Laparotomy; Male; Mesentery; Postoperative Care; Recovery of Function; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 28522281
DOI: 10.1016/j.jviscsurg.2017.04.002 -
Medicine Oct 2020Leiomyomatosis peritonealis disseminata (LPD) is a rare benign lesion primarily consisting of smooth muscle cells, which mostly affects premenopausal females. Here, we...
RATIONALE
Leiomyomatosis peritonealis disseminata (LPD) is a rare benign lesion primarily consisting of smooth muscle cells, which mostly affects premenopausal females. Here, we reported 3 females with LPD (age, 40-48 years) admitted for pelvic masses.
PATIENT CONCERNS
All 3 LPD cases received laparoscopic uterine fibroid morcellation at 3, 8, and 14 years ago, respectively. Two cases were admitted for pelvic masses. One case was admitted for recurrent fibroids with pollakiuria.
DIAGNOSES
LPD was considered in 2 cases preoperation according to imaging examination, and one of them received ultrasound-guided biopsy of the lesion in the right lobe of the liver. One case was considered as recurrent fibroids preoperation. After surgery, all cases were pathologically diagnosed as LPD consisting of benign smooth muscle cells.
INTERVENTIONS
A total abdominal hysterectomy, salpingo-oophorectomy, and debulking was performed for all 3 cases. Intraoperative exploration revealed that the fibroids distributed in the mesentery (3 cases), broad ligament (1 case), omentum (1 case), liver (1 case), and rectus abdominis (1 case).
OUTCOMES
No recurrence was found during postoperative following-up (5-12 months).
LESIONS
Preoperative diagnosis of LPD is presented as a challenge due to unspecific clinical manifestations. Its diagnosis mainly depends on histopathologic evaluation. Surgery still is the primary treatment for LPD. For patients without reproductive desire, total abdominal hysterectomy, salpingo-oophorectomy, and debulking can be performed, and the affected tissue should be removed as much as possible based on the risk assessment.
Topics: Abdominal Cavity; Adult; Female; Humans; Laparoscopy; Leiomyomatosis; Middle Aged; Morcellation; Pelvis; Postoperative Complications; Ultrasonography
PubMed: 33031323
DOI: 10.1097/MD.0000000000022633 -
IEEE Journal of Translational... 2022In recent years, computer-assisted diagnosis of patients is an increasingly common topic. Multi-organ segmentation of clinical Computed Tomography (CT) images of the...
BACKGROUND
In recent years, computer-assisted diagnosis of patients is an increasingly common topic. Multi-organ segmentation of clinical Computed Tomography (CT) images of the patient's abdomen and magnetic resonance images (MRI) of the patient's heart is a challenging task in medical image segmentation. The accurate segmentation of multiple organs is an important prerequisite for disease diagnosis and treatment planning.
METHODS
In this paper, we propose a new method based on multi-organ segmentation in CT images or MRI images; this method is based on the CNN-Transformer hybrid model, and on this basis, a progressive sampling module is added.
RESULTS
We performed multi-organ segmentation on CT images and MRI images provided by two public datasets, Synapse multi-organ CT dataset (Synapse) and Automated cardiac diagnosis challenge dataset (ACDC). By using Dice Similarity Coefficient (DSC) and Hausdorff_95 (HD95) as the evaluation metric for the Synapse dataset. For the Synapse dataset of CT images, the average DSC reached 79.76%, and the HD95 reached 21.55%. The DSC indicators of Kidney(R), Pancreas, and Stomach reached 80.77%, 59.84%, and 81.11%, respectively. The average DSC for the ACDC dataset of MRI images reaches 91.8%, far exceeding other state-of-the-art techniques.
CONCLUSION
In this paper, we propose a multi-sampled vision transformer MPSHT based on the CNN-Transformer structure. The model has both the advantages of CNN convolutional network and Transformer, and at the same time, the addition of a progressive sampling module makes the model's segmentation of organs more accurate, making up for the shortcomings of the previous CNN-Transformer hybrid model.
Topics: Humans; Tomography, X-Ray Computed; Abdominal Cavity; Diagnosis, Computer-Assisted; Heart; Kidney
PubMed: 36457896
DOI: 10.1109/JTEHM.2022.3210047 -
Asian Journal of Surgery Jul 2023
Topics: Humans; Foreign Bodies; Abdominal Cavity
PubMed: 36801123
DOI: 10.1016/j.asjsur.2023.02.006