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Case Reports in Women's Health Dec 2023Oral bacteria in patients with periodontitis can disseminate into the bloodstream via broken oral epithelial cells, causing odontogenic maxillofacial infections, brain...
Oral bacteria in patients with periodontitis can disseminate into the bloodstream via broken oral epithelial cells, causing odontogenic maxillofacial infections, brain abscesses and endocarditis. However, pelvic infection caused by periodontitis is rare. The case of a 48-year-old woman with a long history of recurrent periodontal infections, who complained of abdominal distention and pain for 14 days after dental implantation, is reported here. Pelvic ultrasound and magnetic resonance imaging signaled multiple inflammatory encapsulated effusions in the posterior uterus, which were removed by laparoscopic surgery and tested with metagenomic next-generation sequencing (mNGS). Through mNGS, numerous oral pathogens, including , were identified in the pelvic effusions. The patient was subsequently diagnosed with a pelvic infection originating from periodontitis, and recovered after undergoing surgery and targeted antibacterial treatment. Thus, the possibility of extrabuccal complications in patients with a history of periodontitis or invasive oral procedures merits closer attention.
PubMed: 38046237
DOI: 10.1016/j.crwh.2023.e00563 -
Annals of Ibadan Postgraduate Medicine Dec 2023Fetus in fetu is a paediatric rarity. It involves the presence of a mass resembling a fetus inside the body of a child or an adult. It is described as a twin growing...
INTRODUCTION
Fetus in fetu is a paediatric rarity. It involves the presence of a mass resembling a fetus inside the body of a child or an adult. It is described as a twin growing inside the body of the other. It can be located in different parts of the body but commonly the retroperitoneum. It is usually benign.
CASE PRESENTATION
The patient was a 4 month old male infant who presented to the hospital with complaints of abdominal distention. The distention was noticed two months prior to presenting to our hospital. The distension was generalized and has been progressively increasing until presentation (1). There was no associated abdominal pain and no other abdominal symptoms.
CONCLUSION
Treatment is by complete excision for histological examination.
PubMed: 38706615
DOI: No ID Found -
Pediatric Emergency Care Nov 2023This case report describes a previously healthy pediatric patient with acute onset of abdominal pain and distention who was found to have an epigastric mass on physical... (Review)
Review
This case report describes a previously healthy pediatric patient with acute onset of abdominal pain and distention who was found to have an epigastric mass on physical examination. Point-of-care ultrasound (POCUS) demonstrated a large gastric mass with ultrasonographic features consistent with a trichobezoar. After POCUS was performed, trichophagia was confirmed on history, and the patient went to the operating room for removal of a large trichobezoar. We conclude POCUS may be helpful for evaluation of epigastric masses and diagnosis of gastric trichobezoars. We review the ultrasound technique, sonographic findings, and literature regarding ultrasound diagnosis of trichobezoars.
Topics: Humans; Child; Bezoars; Point-of-Care Systems; Point-of-Care Testing; Physical Examination; Ultrasonography
PubMed: 37815310
DOI: 10.1097/PEC.0000000000003062 -
Annals of Medicine and Surgery (2012) Nov 2023Early postoperative small bowel obstruction (EPSBO) is an obstruction that occurs within 4 weeks after the initial surgery. Routine prophylactic abdominal drainage does...
INTRODUCTION
Early postoperative small bowel obstruction (EPSBO) is an obstruction that occurs within 4 weeks after the initial surgery. Routine prophylactic abdominal drainage does not provide any benefit in colon cancer surgery. The cause of EPSBO due to the abdominal drainage tube is infrequent.
CASE PRESENTATION
A 72-year-old male patient was diagnosed with sigmoid carcinoma and underwent laparoscopic left colectomy. A surgical drain was placed in the pouch of Douglas through the incision of the right iliac fossa trocar site. On the fourth day, he began to flatus, and the abdominal pain decreased. However, on the ninth day after surgery, the patient had more abdominal pain, could not pass gas and defecate, and the abdomen was more distended. An abdominal computed tomography (CT) scan showed a dilated loop of the small intestine above the transition site with a drainage sonde and no dilation of the loop below the sonde. The patient was indicated to remove the sonde. He could pass gas and defecate the next day again and was relieved of the abdominal distention.
DISCUSSION
Once an EPSBO is considered, it is essential to think of the bowel obstruction caused by the drainage tube in the case of abdominal drainage. It is necessary to have a contrast CT scan to examine.
CONCLUSION
EPSBO due to intra-abdominal drainage is a rare condition that presents a challenge in diagnosis and treatment. Diagnosis usually begins on the fourth postoperative day, mainly in operations in the lower transverse mesentery, including drainage placement after laparoscopic surgery.
PubMed: 37915704
DOI: 10.1097/MS9.0000000000001369 -
Acta Paediatrica (Oslo, Norway : 1992) Sep 2023Demand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need... (Observational Study)
Observational Study
AIM
Demand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need to rule out malrotation and midgut volvulus (MGV). We aimed to examine predictive value of clinical parameters in the management of healthy neonates presenting with BV and re-assess the role of UGI in their management.
METHODS
A retrospective cohort study including medical, imaging and surgical data of neonates who underwent UGI due to BV.
RESULTS
A total of 157 term neonates, eight neonates (5.1%) had confirmed surgical diagnosis of malrotation, five of them had malrotation with MGV, including two neonates who underwent extensive intestinal resection due to necrosis. Neonates with a combination of abnormal plain radiograph and abdominal distention had 10 times higher odds of malrotation diagnosis, adjusting for age at first BV (p = 0.017). Neonates with a combination of abnormal plain radiograph, abdominal distention and abdominal tenderness had 25 times higher odds of MGV (p = 0.002).
CONCLUSION
This study reaffirms the role of UGI as the current main diagnostic tool for malrotation and MGV. Physical examination and plain radiograph findings can help but cannot substitute UGI study.
Topics: Infant, Newborn; Humans; Retrospective Studies; Vomiting; Radiography; Digestive System Abnormalities; Intestinal Volvulus
PubMed: 37266967
DOI: 10.1111/apa.16861 -
Medicine Feb 2024A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a... (Review)
Review
INTRODUCTION
A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a complete disruption of the MPD involved distal pancreatic resection and pancreaticojejunostomy Roux-en-Y anastomosis. Nevertheless, there have been no reported cases of hybrid surgery being employed for the complete disruption of the MPD.
PATIENT CONCERNS
A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck.
DIAGNOSES
Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV.
INTERVENTIONS
The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct.
OUTCOMES
The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction.
LESSONS
The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.
Topics: Male; Humans; Middle Aged; Pancreas; Pancreatic Ducts; Pancreatectomy; Abdomen; Abdominal Injuries; Wounds, Nonpenetrating; Rupture; Abdominal Pain
PubMed: 38306542
DOI: 10.1097/MD.0000000000037144 -
The American Journal of Emergency... Apr 2024Ultrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to...
OBJECTIVES
Ultrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting. Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs.
METHODS
We performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018-2020.
RESULTS
1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets.
CONCLUSIONS
Our study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup.
Topics: Child; Humans; Intussusception; Pneumoperitoneum; Retrospective Studies; Sensitivity and Specificity; Radiography, Abdominal; Abdomen
PubMed: 38181541
DOI: 10.1016/j.ajem.2023.12.030 -
Frontiers in Oncology 2023Intra-abdominal gossypiboma, a cotton-based retained foreign body after an abdominal surgery, is associated with various clinical manifestations and complications. Its...
INTRODUCTION
Intra-abdominal gossypiboma, a cotton-based retained foreign body after an abdominal surgery, is associated with various clinical manifestations and complications. Its infrequent occurrence and unpredictability make its early diagnosis particularly challenging. We herein present an atypical case of intra-abdominal gossypiboma mistaken for a jejunal tumor.
CASE PRESENTATION
A 33-year-old female presented to the emergency room with an acute episode of progressive abdominal pain and distention, nausea, and vomiting for 20 hours. She had undergone an urgent cesarean section due to fetal tachycardia seven years prior. The initial diagnosis of small bowel obstruction (SBO) due to a jejunal tumor was established by computed tomography. Subsequent to successful medical management of the SBO, a laparoscopy-assisted resection of the mass and the adherent jejunal segment was conducted, culminating in a primary side-to-side jejunojejunostomy. Examination of the excised tissue revealed an approximately spherical fibrous mass, 6 × 6 × 5 cm in dimension, embedded in the jejunal wall, housing a 20 × 20-cm gauze. Postoperative recovery and routine follow-up ensued without complications.
CONCLUSION
In light of this case, the need for clinicians to maintain an elevated awareness and suspicion of gossypiboma should be accentuated when evaluating an intra-abdominal mass, especially in patients with a prior history of high-risk laparotomy. Laparoscopic surgery stands out as a technically proficient and minimally invasive strategy for diagnosing and treating intra-abdominal gossypiboma. Besides, it is imperative to emphasize the importance of meticulous surgical procedures and postoperative protocols to prevent such oversights, reaffirming the need for consistent intraoperative counts and checks of surgical items.
PubMed: 38090487
DOI: 10.3389/fonc.2023.1326032 -
Journal of Vascular Research 2024Carbamylation is a nonenzymatic post-translational modification of proteins characterized by the binding of isocyanic acid to amino groups of proteins, which leads to...
INTRODUCTION
Carbamylation is a nonenzymatic post-translational modification of proteins characterized by the binding of isocyanic acid to amino groups of proteins, which leads to the alteration of their properties. An increase in serum carbamylation-derived products, including homocitrulline (HCit), has been shown to be associated with the development of cardiovascular diseases.
METHODS
HCit was quantified by LC-MS/MS within extracts of aneurysmal and control human aortas. A mouse model of aortic aneurysm (ApoE-/- mice perfused with angiotensin II and fed with sodium cyanate) was used to evaluate the role of carbamylation in aneurysm development.
RESULTS
HCit quantification showed a greater heterogeneity of values in aneurysmal aortas in comparison with control ones. At the maximum diameter of dilation, HCit values were significantly higher (+94%, p < 0.05) compared with less dilated areas. No differences were observed according to aneurysm size or when comparing ruptured and unruptured aneurysms. No significant effect of carbamylation on aneurysm development was observed using the animal model.
CONCLUSIONS
These results evidenced the accumulation of HCit within aneurysmal aortas but do not allow concluding about the exact participation of protein carbamylation in the development of human abdominal aortic aneurysms.
Topics: Humans; Mice; Animals; Protein Carbamylation; Chromatography, Liquid; Mice, Knockout, ApoE; Tandem Mass Spectrometry; Aorta; Angiotensin II; Aortic Aneurysm, Abdominal; Dilatation, Pathologic; Aorta, Abdominal
PubMed: 38246153
DOI: 10.1159/000534613 -
Clinical Case Reports Sep 2023The low sensitivity of ascites culture for acid-fast bacilli necessitates a peritoneal biopsy when tuberculous peritonitis is suspected. Findings in the peritoneum on...
KEY CLINICAL MESSAGE
The low sensitivity of ascites culture for acid-fast bacilli necessitates a peritoneal biopsy when tuberculous peritonitis is suspected. Findings in the peritoneum on computed tomography may prompt suspicion of tuberculous peritonitis.
ABSTRACT
A 47-year-old Nigerian man presented with fever, abdominal distention, and weight loss. Abdominal computed tomography revealed massive ascites and peritoneal thickening. Despite failing to culture acid-fast bacilli from ascites, histological examination and culture of peritoneum revealed multidrug-resistant tuberculosis peritonitis. Peritoneal biopsy is mandatory when tuberculosis peritonitis is suspected.
PubMed: 37655128
DOI: 10.1002/ccr3.7759