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Cureus Aug 2022Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical...
Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea. SM occurs predominantly in Caucasian men, during the fifth to seventh decades of life. We present a 69-year-old woman with SM whose symptoms were thought to be from irritable bowel syndrome. A 69-year-old female with a history of fibromyalgia presented with recurrent bouts of abdominal pain across her mid-abdomen lasting 30 minutes to an hour associated with nausea, alternating constipation and diarrhea with occasional mucus, and bloating. She used bismuth subsalicylate and ondansetron with temporary relief. Upper endoscopy and colonoscopy were unrevealing. Initially, she was felt to have irritable bowel. Later she presented with nausea and right upper quadrant pain and underwent cholecystectomy. When her pain recurred, the patient had a CT abdomen and pelvis which showed multiple sub-centimeter mesenteric lymph nodes with surrounding haziness and stranding in the root of the mesentery consistent with SM. The patient had a pannus biopsy showing fat necrosis that confirmed the diagnosis. She continued to have waxing and waning symptoms over several years and in the interim was diagnosed with melanoma limited to the skin. The patient had a particularly severe episode of abdominal pain prompting a repeat CT scan with a subsequent biopsy of an enlarged left para-aortic lymph node that revealed lymphoma. Our patient's diagnosis of SM was delayed as her symptoms were mistaken for irritable bowel syndrome. Worsening symptoms should alert clinicians to an alternate diagnosis such as SM. There are characteristic radiographic findings on CT scans and biopsy of the lesions. SM's association with neoplastic diseases such as lymphoma, melanoma, colorectal, and prostate cancer is controversial, however, practitioners should be aware of this possibility and consider biopsy for any suspicious lesions.
PubMed: 36185930
DOI: 10.7759/cureus.28573 -
Journal of Medical Case Reports May 2024Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic... (Review)
Review
BACKGROUND
Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not.
CASE PRESENTATION
We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful.
CONCLUSION
Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
Topics: Humans; Female; Wandering Spleen; Adult; Abdominal Pain; Splenectomy; Tomography, X-Ray Computed; Pelvic Pain; Spleen
PubMed: 38790071
DOI: 10.1186/s13256-024-04580-6 -
Annals of the Royal College of Surgeons... May 2023Diaphragmatic hernias can be congenital or acquired and are a protrusion of intra-abdominal contents through an abnormal opening in the diaphragm. Acquired defects are...
Diaphragmatic hernias can be congenital or acquired and are a protrusion of intra-abdominal contents through an abnormal opening in the diaphragm. Acquired defects are rare and occur secondary to direct penetrating injury or blunt abdominal trauma. This case review demonstrates two unconventional cases of large diaphragmatic hernias with viscero-abdominal disproportion in adults. Case 1 is a 27-year-old man with no prior medical or surgical history. He presented following a 24-h history of increasing shortness of breath and left-sided pleuritic chest pain, and no history of trauma. Chest X-ray demonstrated loops of bowel within the left hemithorax with displacement of the mediastinum to the right. Computed tomography (CT) scan confirmed a large diaphragmatic defect causing herniation of most of his abdominal contents into the left hemithorax. He underwent emergency surgery, which confirmed the viscero-abdominal disproportion. He required an extended right hemicolectomy to reduce the volume of the abdominal comtents and laparostomy to reduce the risk of abdominal compartment syndrome and recurrence of the hernia. Case 2 is a 76-year-old man with significant medical comorbidities who presented with acute onset of abdominal pain. He had a history of traumatic right-sided chest injury as a child resulting in right-sided diaphragmatic paralysis. Chest X-ray demonstrated a large right-sided diaphragmatic hernia with abdominal viscera in the right thoracic cavity. CT scan of the chest, abdomen and pelvis demonstrated both small and large bowel loops within the right hemithorax, compression of the right lung and displacement of the mediastinum to the left. The CT scan also demonstarted viscero-abdominal disproportion. Operative management was considered initially but following improvement with basic medical management and no further deterioration, a non-operative approach was adopted. Both cases illustrate atypical presentations of adults with diaphragmatic hernias. In an ideal scenario, these are repaired surgically. When the presumed diagnosis shows characteristics of a viscero-abdominal disproportion and surgery is pursued, the surgeon must consider that primary abdominal closure may not be possible and multiple operations may be necessary to correct the defect and achieve closure. Sacrifice of abdominal viscera may also be necessary to reduce the volume of abdominal contents.
Topics: Male; Child; Humans; Adult; Aged; Hernias, Diaphragmatic, Congenital; Diaphragm; Abdomen; Thorax; Lung
PubMed: 36239968
DOI: 10.1308/rcsann.2022.0107 -
American Journal of Veterinary Research Mar 2019OBJECTIVE To describe a technique for endoscopic evaluation of the coelomic viscera of koi (Cyprinus carpio) and to evaluate the ability to visually examine coelomic...
OBJECTIVE To describe a technique for endoscopic evaluation of the coelomic viscera of koi (Cyprinus carpio) and to evaluate the ability to visually examine coelomic structures by use of an approach cranial or caudal to the pelvic girdle. ANIMALS 16 subadult koi. PROCEDURES Koi were anesthetized with buffered tricaine methanesulfonate. Coelioscopic examination was performed via a ventral midline incisional approach cranial or caudal to the pelvic girdle. A 2.7-mm × 18-cm 30° oblique endoscope within a 4.8-mm operating sheath and infusion of saline (0.9% NaCl) solution was used. Ease of entry into the coelomic cavity and visual examination of structures were scored for each fish. Fish were euthanized 2 or 8 weeks after the procedure, and necropsy was performed. RESULTS The coelioscopic procedure was tolerated well, and all koi recovered uneventfully. For all fish, ease of entry and visual examination scores of the liver, intestines, gonads, heart, and anterior kidney were satisfactory to excellent. Visual examination of the posterior kidney and swim bladder was satisfactory to difficult, whereas the spleen and gallbladder were not visually identified. No significant differences were noted in entry or visual examination scores between the cranial and caudal approaches or between sexes. Minor complications included mild hemorrhage, rupture of the gonadal capsule, formation of adhesions between the viscera and incision site, and delayed healing of the incision. CONCLUSIONS AND CLINICAL RELEVANCE Diagnostic coelioscopy of koi appeared to be safe and effective. This procedure could have potential for use in examination of coelomic structures and disease diagnosis.
Topics: Animals; Carps; Endoscopy; Female; Fish Diseases; Male
PubMed: 30801217
DOI: 10.2460/ajvr.80.3.221 -
Animals : An Open Access Journal From... Jul 2019Leonardo da Vinci was one of the most influencing personalities of his time, the perfect representation of the ideal Renaissance man, an expert painter, engineer and... (Review)
Review
Leonardo da Vinci was one of the most influencing personalities of his time, the perfect representation of the ideal Renaissance man, an expert painter, engineer and anatomist. Regarding Leonardo's anatomical drawings, apart from human anatomy, he also depicted some animal species. This comparative study focused only on two species: Bears and horses. He produced some anatomical drawings to illustrate the dissection of "a bear's foot" (Royal Collection Trust), previously described as "the left leg and foot of a bear", but considering some anatomical details, we concluded that they depict the bear's right pelvic limb. This misconception was due to the assumption that the bear's (1st toe) was the largest one, as in humans. We also analyzed a rough sketch (not previously reported), on the same page, and we concluded that it depicts the left (forearm) and (hand) of a dog/wolf. Regarding Leonardo's drawing representing the horse anatomy "The viscera of a horse", the blood vessel arrangement and other anatomical structures are not consistent with the structure of the horse, but are more in accordance with the anatomy of a dog. In addition, other drawings comparing the anatomy of human leg muscles to that of horse pelvic limbs were also discussed in motion.
PubMed: 31295863
DOI: 10.3390/ani9070435 -
Chirurgia (Bucharest, Romania : 1990) 2015Perineal hernia is the protrusion of intra-abdominal viscera through the pelvic floor. We present a patient with recurrent perineal hernia - 12x9 cm with a palpable... (Review)
Review
Perineal hernia is the protrusion of intra-abdominal viscera through the pelvic floor. We present a patient with recurrent perineal hernia - 12x9 cm with a palpable soft, hardly adjustable in the pelvic tunnel formation and attenuated skin over it. The patient was operated by abdominoperineal approach. We performed two layer Titanium mesh plasty of the pelvic floor with the use of the omentum and the pelvic muscles.
Topics: Aged; Hernia, Abdominal; Herniorrhaphy; Humans; Male; Pelvic Floor; Perineum; Rectal Neoplasms; Recurrence; Reoperation; Surgical Mesh; Titanium; Treatment Outcome
PubMed: 25800322
DOI: No ID Found -
BMC Urology Jan 2021Although several distribution patterns of periprostatic neurovascular bundles have been proposed, variant dissection technique based on these patterns still confused...
BACKGROUND
Although several distribution patterns of periprostatic neurovascular bundles have been proposed, variant dissection technique based on these patterns still confused surgeons. The aim of this study was to describe the periprostatic neurovascular bundles and their relationship with the fascicles around prostate and provide the accurate morphologic knowledge of periprostatic tissue for prostate operation.
METHODS
The pelvic viscera were obtained from 26 adult male cadavers. They were embedded in celloidin and cut into successive slices. The slices were explored with anatomic microscopy. 3-Dimensional reconstruction was achieved with celloidin sections and series software.
RESULTS
The prostatic capsule which surrounded the dorsal, bilateral aspect of the prostate was attached ventrally to anterior fibrous muscular stroma (AFMS). The lower part of the striated sphincter completely embraced the urethral; the upper part of this muscle covered the lower ventral surface of prostate. The upper ventral surface of prostate is covered by the circular muscle of detrusor. The levator fascia and the capsule adhered on the most convex region of the lateral prostate, but separated on the other region. The pelvic neurovascular bundles (PNVB) divided into the anterior and posterior divisions. The anterior division continued as dorsal vascular complex (DVC). The distal part of DVC entered into penile hilum. The posterior division continued as neurovascular bundles, and then as the cavernous supply (CS). The distal part of CS joined into pudendal neurovascular bundles.
CONCLUSIONS
The capsule and AFMS formed a pocket like complex. There were anterior and posterior neurovascular approaches from PNVB to penile hilum.
Topics: Aged; Aged, 80 and over; Blood Vessels; Cadaver; Collodion; Humans; Male; Middle Aged; Nervous System; Prostate
PubMed: 33407368
DOI: 10.1186/s12894-020-00778-0 -
Ethiopian Journal of Health Sciences Oct 2022Abdominopelvic vascular structures are exposed to be compressed by adjacent organs or might cause compression of the adjacent hollow viscera. Most of these conditions...
BACKGROUND
Abdominopelvic vascular structures are exposed to be compressed by adjacent organs or might cause compression of the adjacent hollow viscera. Most of these conditions are asymptomatic and they are detected on imaging incidentally. However, when they are symptomatic, they can lead to a variety of uncommon syndromes in the abdomen and pelvis. Aim of the study was to assess the prevalence of incidental abdominopelvic vascular compressions on computed tomography.
METHOD
A retrospective cross-sectional study was conducted. All the CT was performed using 64 slice machine. All computed tomography scan of the abdomen between January and April 2019 were evaluated. Data were collected by evaluating abdominal Computed Tomographic scans from Picture archiving and communication system (PACS). Statistical analysis was performed by using SPSS version 25.0 software.
RESULTS
Out of 623 multi detector abdominopelvic computed tomography (MDCT) performed between January 2019 and April 2019; a total of 513 (N = 513) patients were included in the study. This study group comprised of 277 (54 %) females and 236 male (46%) patients. Mean age was 38 ± 20 (mean ± SD). We identified 35(6.8%) participants with imaging features of Superior mesenteric artery (SMA) compressions and a 34(6.6%) with imaging features of nutcracker phenomenon. The celiac artery was compressed by median arcuate ligament (MAL) in 22(4.3%) of them.
CONCLUSION
Incidentally detected intraabdominal vascular compressions are common to asymptomatic patients. This result emphasizes that, vascular compression syndromes diagnosis should not be made on imaging alone.
Topics: Female; Humans; Male; Adolescent; Young Adult; Adult; Middle Aged; Retrospective Studies; Prevalence; Cross-Sectional Studies; Tomography, X-Ray Computed; Vascular Diseases; Abdomen
PubMed: 36339956
DOI: 10.4314/ejhs.v32i1.8S -
Case Reports in Gastroenterology 2021A 50-year-old female with no significant medical history initially presented to an urgent care center with symptoms of acute onset abdominal pain, nausea, and emesis....
A 50-year-old female with no significant medical history initially presented to an urgent care center with symptoms of acute onset abdominal pain, nausea, and emesis. Chest and abdominal X-ray revealed free air under the diaphragm, prompting immediate transfer to the emergency department. Continued abdominal tenderness and pain were concerning for perforated viscus. The patient was transferred to the operating room, and diagnostic laparoscopy was performed. Inflammation and contamination were discovered in the right side of the abdomen and pelvis secondary to a small bowel (SB) perforation. Segmental SB resection revealed a perforated diverticulum. Pathological examination confirmed a diagnosis of gastrointestinal stromal tumor (GIST) at the perforated segment. On postoperative day 5, the patient was discharged home, and at 30-month follow-up, the patient continued to do well. Although rare, SB diverticula are commonly false (i.e., pseudodiverticula). The concomitant presence of a GIST in a true SB diverticulum presenting with perforation has not yet been reported.
PubMed: 34720825
DOI: 10.1159/000518019