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Cureus Mar 2024Budd-Chiari syndrome (BCS) is a rare constellation of conditions due to obstruction of venous flow from anatomical levels ranging from the hepatic veins to the...
Budd-Chiari syndrome (BCS) is a rare constellation of conditions due to obstruction of venous flow from anatomical levels ranging from the hepatic veins to the confluence of the inferior vena cava (IVC) and right atrium. The resulting retrograde flow of blood leads to hepatomegaly, ascites, and liver failure among other features. Our case highlights the clinical features, diagnostic challenges, and management of a patient with a tumor thrombus from a metastatic prostate adenocarcinoma in a 67-year-old male leading to BCS. This patient, with a past history of prostate adenocarcinoma and aortic valve replacement on chronic warfarin anticoagulation, presented with acutely worsening abdominal pain and a distended abdomen, and imaging revealed an IVC filling defect. Subsequent imaging with a piflufolastat prostate-specific PET showing increased uptake in the IVC elucidated the diagnosis of tumor thrombosis. Management considerations include aggressive therapy and optimization of quality of life. The patient was offered both options, and options including surgical shunting, bypasses, and anticoagulation were discussed. After shared decision-making, the patient and family opted to choose the pathway of palliative radiation and anticoagulation.
PubMed: 38562314
DOI: 10.7759/cureus.55330 -
Topics in Companion Animal Medicine 2024Canine strongyloidosis by Strongyloides stercoralis is a parasitic disease emerging in Europe, which represents both a veterinary clinical issue and a public health...
Canine strongyloidosis by Strongyloides stercoralis is a parasitic disease emerging in Europe, which represents both a veterinary clinical issue and a public health challenge because of the zoonotic potential. The disease, not yet frequent in Europe, could induce severe clinical signs in dogs; thus, an early diagnosis and appropriate treatment are desirable. The aim of the present work is to retrospectively investigate the clinical and paraclinical findings in sick dogs naturally infected by S. stercoralis, with particular attention to ultrasound (US) changes at the gastrointestinal level. Twelve dogs were included in the study. The diagnosis was made by means of larval morphological identification on faecal samples and PCR. Most dogs presented with gastrointestinal signs; diarrhea and weight loss were the most common presenting complaint. Only one dog showed respiratory signs, associated to a parasitic cutaneous nodule. Hypoproteinaemia, anaemia, leucocytosis and an increase in alpha2-globulin fraction at serum protein electrophoresis were common (>50%) but not constant findings. The most reported US picture was a fluid-filled, distended, atonic small intestine mostly associated with altered wall layering, while the wall thickness commonly associated with chronic enteritis was only rarely reported. These changes, associated with other clinical and paraclinical alterations, could increase the suspicion of canine strongyloidosis and may direct clinicians to include strongyloidosis in the differential diagnosis of dogs with diarrhea. The histological examination at the intestinal level, available in five dogs, revealed the presence of parasites from the full-thickness biopsy, but not from the endoscopic biopsy. The critical points of diagnosis in clinical practice are also discussed.
Topics: Animals; Dogs; Dog Diseases; Strongyloidiasis; Male; Female; Retrospective Studies; Feces; Strongyloides stercoralis; Ultrasonography; Diarrhea
PubMed: 38184143
DOI: 10.1016/j.tcam.2024.100845 -
Journal of Surgical Case Reports Jul 2023The annular pancreas (AP) is an uncommon congenital anomaly, characterised by a circumferential envelope in the second portion of the duodenum. In recent years, some...
The annular pancreas (AP) is an uncommon congenital anomaly, characterised by a circumferential envelope in the second portion of the duodenum. In recent years, some genetic component has been found in the etiology. A newborn full-term male, weighing at 1910 g at birth, had a history of intrauterine growth restriction and diagnosis of tetralogy of Fallot, Down syndrome and congenital hypothyroidism. Duodenal membrane is suspected after persistent postprandial vomiting and abdominal distension; his abdomen was distended, hyperresonant and soft. The gastroduodenal series showed data compatible with a duodenal membrane so exploratory laparotomy was performed, finding the pancreas completely wrapping the second portion of the duodenum, so a diamond-shaped-duodenoduodenostomy anastomosis was performed. The AP should be considered, especially in male neonates with postprandial vomiting, abdominal distension, who show some other congenital anomaly, and in the abdominal X-ray, the sign of the double bubble is observed.
PubMed: 37489161
DOI: 10.1093/jscr/rjad407 -
Radiology Case Reports Nov 2023An imperforate hymen is a rare malformation present at birth; however, in most cases, diagnosis is missed until adolescence, when hematocolpometra and its symptoms...
An imperforate hymen is a rare malformation present at birth; however, in most cases, diagnosis is missed until adolescence, when hematocolpometra and its symptoms develop. At this stage, every further delay in diagnosis and treatment will negatively affect the quality of life of young females. It may also be one of the causes of endometriosis and its consequences, such as subfertility. Sonography of the pelvis and physical examination are the diagnostic modalities of choice for diagnosing hematocolpometra and imperforate hymen. We present a case of a 14-year-old patient admitted to the obstetrics and gynecology clinic with complaints of lower abdominal pain and urinary retention following dysuria. The patient was previously examined by a family doctor who misidentified the issue and treated it as a urinary infection. After the symptoms worsened, the patient was referred to a gynecologist. An ultrasound examination showed a distended vagina and uterus, suggesting hematocolpometra, and after further inspection, it was revealed to be caused by an imperforate hymen. A hymenectomy was performed, and about 900 mL of blood was drained. Symptoms and complaints ceased, and the patient was discharged the next day.
PubMed: 37732002
DOI: 10.1016/j.radcr.2023.08.098 -
International Journal of Surgery Case... Mar 2024Necrotizing fasciitis (NF) is a rare and rapidly progressing soft tissue infection. The commonly involved body parts are the extremities and trunk. Necrotizing fasciitis...
INTRODUCTION
Necrotizing fasciitis (NF) is a rare and rapidly progressing soft tissue infection. The commonly involved body parts are the extremities and trunk. Necrotizing fasciitis (NF) involving the retroperitoneum is very uncommon but associated with higher morbidity and mortality. There are only a few patients survived according to the report.
PRESENTATION OF CASE
This is a 19-year-old male patient presented with abdominal pain, high-grade fever, vomiting and abdominal distension for 3 days. On physical examination, he was hypotensive, tachycardic and febrile. He had a distended, tender abdomen, and hypoactive bowel sound. There were no significant pertinent findings on the other systems. Laboratory tests showed leukocytosis, thrombocytopenia, and elevated liver enzymes. After optimizing with resuscitation and initiating antibiotics, a laparotomy was performed. The finding was 300 ml of hemorrhagic fluid, ischemic cecum and ascending colon, and retroperitoneal necrosis. Subsequently, multiple debridement and right hemicolectomy with stoma was performed. Despite the close monitoring in the ICU, the patient died of uncontrolled sepsis.
CLINICAL DISCUSSION
Necrotizing fasciitis (NF) is a rapidly progressing infectious condition that requires urgent intervention. While it is rare for the retroperitoneum to be affected by NF, it is associated with a high mortality rate. The symptoms of retroperitoneal NF are not specific, making it difficult to diagnose. Here, we present a case of retroperitoneal NF with signs and symptoms of generalized peritonitis, resembling perforated appendicitis.
CONCLUSION
When patients are presented with a case of generalized peritonitis, it is important to include retroperitoneal NF as a potential differential diagnosis.
PubMed: 38382145
DOI: 10.1016/j.ijscr.2024.109412 -
World Journal of Clinical Cases Oct 2023Although intestinal obstruction is one of the most common surgical emergencies in an infant, it is difficult to diagnose neonatal enteric duplication cysts (EDC)...
BACKGROUND
Although intestinal obstruction is one of the most common surgical emergencies in an infant, it is difficult to diagnose neonatal enteric duplication cysts (EDC) preoperatively owing to their rarity as a cause of intestinal obstruction. We describe a case report of a neonatal EDC presenting intestinal obstruction and shock.
CASE SUMMARY
A 32-d-old male infant with a prenatal sonographic finding of bladder distension was admitted to our hospital for a severely distended abdomen, fever, and oliguria. The first diagnostic hypothesis was septic shock and intestinal obstruction. The patient's symptoms worsened; following an emergency surgical exploratory laparotomy and histopathological findings, the final diagnosis of cecal duplication cyst was confirmed. The patient's postoperative course was uneventful, and on the fifth postoperative day, oral feeding restarted. Twenty days later, the patient was discharged from the hospital.
CONCLUSION
Although EDC located in the cecum is exceptional, it should be considered when evaluating suspected intestinal obstruction and shock.
PubMed: 37901014
DOI: 10.12998/wjcc.v11.i28.6931 -
Circulation Journal : Official Journal... May 2024The gold standard graft for coronary artery bypass grafting (CABG) is the internal thoracic artery (ITA), and the second recommendation is the radial artery. However,... (Review)
Review
The gold standard graft for coronary artery bypass grafting (CABG) is the internal thoracic artery (ITA), and the second recommendation is the radial artery. However, complete revascularization with arterial grafts alone is often difficult, and the saphenous vein (SV) is the most commonly used autologous graft for CABG, because it is easier to use without restriction for the length of the graft. On the other hand, the patency of SV grafts (SVGs) is poor compared with that of arterial grafts. The SVG is conventionally harvested as a distended conduit with surrounding tissue removed, a procedure that may cause vascular damage. A no-touch technique of SVG harvesting has been reported to result in improved long-term patency in CABG comparable to that when using the ITA for grafting. Possible reasons for the excellent long-term patency of no-touch SVGs are the physical support provided by preserved surrounding perivascular adipose tissue, preservation of the vascular wall structure including the vasa vasorum, and production of adipocyte-derived factors. In this review, we discuss recent strategies aimed at improving the performance of SVGs, including no-touch harvesting, minimally invasive harvesting and mechanical support using external stents.
Topics: Humans; Coronary Artery Bypass; Saphenous Vein; Adipose Tissue; Vascular Patency; Tissue and Organ Harvesting; Graft Occlusion, Vascular; Stents
PubMed: 37914280
DOI: 10.1253/circj.CJ-23-0581 -
Cureus Apr 2024A 19-year-old girl with a short stature and presenting low intelligence quotient, illegible speech, and a greatly distended abdomen was seen at the gynecological...
A 19-year-old girl with a short stature and presenting low intelligence quotient, illegible speech, and a greatly distended abdomen was seen at the gynecological outpatient department. She underwent investigation and was found to have large abdominopelvic multicystic ovaries with no malignant features and CA125 levels within the normal range for premenopausal women. Her thyroid-stimulating hormone (TSH) was markedly elevated. She received a diagnosis of untreated severe hypothyroidism with benign giant ovarian cysts, posing a grave risk of cyst rupture and imminent complications. The parents were counseled, and they accepted the risk, agreeing to conservative therapy. Levothyroxine replacement therapy was initiated, and after one month, her TSH levels normalized. Follow-up ultrasonography after one month of her therapy revealed a marked decrease in ovarian cyst size. Thyroid replacement therapy was continued, and at the end of three months, the cysts disappeared, and the ovaries, much smaller, showed polycystic ovarian morphology. Careful analysis of clinical signs, investigations, and appropriate therapy helped avoid unnecessary surgery.
PubMed: 38784352
DOI: 10.7759/cureus.58837 -
Annals of Medicine and Surgery (2012) Jun 2024The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in...
INTRODUCTION
The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality.
CASE PRESENTATION
The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of 'intestinal obstruction secondary to an incarcerated obturator hernia'. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up.
DISCUSSION
The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship-Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection.
CONCLUSION
Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.
PubMed: 38846839
DOI: 10.1097/MS9.0000000000002073 -
West African Journal of Medicine Nov 2023Urolithiasis is the presence of mineral deposits in the urinary tract. It is rare in under-5 children and in Sub-Saharan Africa. Although metabolic abnormality is...
INTRODUCTION
Urolithiasis is the presence of mineral deposits in the urinary tract. It is rare in under-5 children and in Sub-Saharan Africa. Although metabolic abnormality is implicated in 50% of cases, infection, decreased urine volume and flow (dehydration state) have been implicated. We report a case of bilateral ureteric calculi in an infant with diarrhoea disease and dehydration.
CASE REPORT
A.S, is an 8-month-old male with prolonged loose, large-volume stool, large-volume vomiting, high-grade fever, body weakness, and peri-orbital swelling that progressed to generalized body swelling and absent urine for 2 days. He was conscious, afebrile (36.90C), pale with anasarca. Had distended abdomen with ascites. Dyspnea, coarse crepitation, and hypoxemia. Tachycardia (PR -180/min) Hypertensive (BP - 125/79mmHg). PCV - 20%, WBC - 24,000/l, platelet - 110,000/l. Creatinine (1030 umol/l), Urea - 30mmol/l, Multi drug resistant E.Coli. Bilateral Grade II nephritis, hydro-uretero-nephrosis, right pelvi-ureteric and left vesico-ureteric junction calculi. Managed for Diarrhoea disease complicated with Bilateral Obstructive uropathy secondary to Bilateral Ureteric Calculi. Had bilateral open ureteric exploration, ureterolithotomy, Stenting, intraoperative transfusion, antibiotics, analgesics, and IVF. 24-hr post-surgery: urine output (3.26ml/kg/hr): right stent (210ml), left stent (423ml) while urethral catheter (150ml), 742umol/l, Urea: 26mmol/l 48-hr post-surgery: Urine output 5.1ml/kg/hr (1224ml/24hr); Cr: 424umol/l, Urea: 16mmo/l 5 days post-surgery: Urine output 3.1ml/kg/hr (725ml/24hr); Cr: 47umol/l, Urea: 4.6 mmo/l, Patient was discharged home and currently on follow-up in paediatric nephrology and urology clinics.
CONCLUSION
A high index of suspicion of obstructive uropathy in children with diarrhoea disease, and dehydration, who have developed acute kidney injury is recommended.
Topics: Child; Humans; Male; Infant; Dehydration; Kidney; Acute Kidney Injury; Urea; Calculi
PubMed: 37971290
DOI: No ID Found