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Cureus May 2024Herniation of bowel contents between the peritoneal cavity proper and the omental bursa, through the foramen of Winslow, can present diagnostic challenges that can...
Herniation of bowel contents between the peritoneal cavity proper and the omental bursa, through the foramen of Winslow, can present diagnostic challenges that can potentially delay necessary surgical intervention. This case describes a 49-year-old female with a past medical history of hiatal hernia and biliary dyskinesia who presented to the emergency department with severe epigastric and right lower quadrant abdominal pain one day after a reported gastrointestinal illness of unknown etiology. Initial emergency department workup demonstrated an elevated white blood cell count without lactic acidosis. Computed tomography imaging was interpreted as gastric distension with volvulus around the mesentery and second portion of the duodenum. Intraoperatively, the entirety of the right colon was noted to have passed through the foramen of Winslow into the lesser sac. This led to twisting of the mesocolon causing compression of the duodenum and a gastric outlet obstruction. After surgical reduction of the herniation, the patient noted great improvement in pain and other symptoms.
PubMed: 38953091
DOI: 10.7759/cureus.61387 -
Cureus May 2024We present a case report of a giant solitary fibrous tumor (SFT) with a review of the literature and discuss its biological features and diagnosis. A 43-year-old man...
We present a case report of a giant solitary fibrous tumor (SFT) with a review of the literature and discuss its biological features and diagnosis. A 43-year-old man presented to our emergency department with abdominal pain and distension with an evolution of two days. Contrast-enhanced computed tomography (CT) showed a large, well-circumscribed semisolid mass (12 cm x 10 cm x 12 cm) localized in the pancreatic head. The histological diagnosis obtained by endoscopic ultrasound-guided trans-duodenal tumor biopsy with fine-needle aspiration showed proliferating short spindle-shaped cells, suggesting a mesenchymal neoplasia of low grade. We proceeded to a Whipple surgical technique. The histopathological study of the resected tumor confirmed proliferating spindle-shaped cells in the tissue, and one mitotic figure was observed in 10 high-power fields (HPFs). Immunostaining was positive for CD34 and STAT-6. The histological diagnosis was a malignant pancreatic SFT. In the six months posterior to the surgical procedure, the patient has been free of recurrent disease. Preoperative diagnosis is difficult and requires comprehensive evidence including clinical, immunohistochemistry, and histological features. Since there are currently no recognized best practices, we advise total surgical excision and careful clinical monitoring.
PubMed: 38953073
DOI: 10.7759/cureus.61467 -
Cureus May 2024Acute appendicitis is the most common non-obstetric reason for exploratory laparotomy during pregnancy. This case report involves a primigravida patient who presented to...
Early Diagnosis of Acute Appendicitis in the Second Trimester of Pregnancy Based on Non-typical Clinical Findings: Report of a Rare Case and a Mini-Review of the Literature.
Acute appendicitis is the most common non-obstetric reason for exploratory laparotomy during pregnancy. This case report involves a primigravida patient who presented to the emergency department of the General Hospital of Trikala at 15 weeks of gestation due to diffuse abdominal pain, primarily in the epigastric region. She also reported watery bowel movements. The ongoing atypical clinical symptoms, along with elevated inflammatory markers, strongly indicated a diagnosis of acute appendicitis. An immediate exploratory laparotomy was performed, during which acute localized inflammation of the appendix was found, leading to an appendectomy. Histological examination confirmed the diagnosis of acute appendicitis. The patient reported pain relief immediately after the surgery. On the fourth postoperative day, she was discharged without any signs of a threatened second-trimester miscarriage. At 39 gestational weeks, she delivered by elective cesarean section due to breech presentation. This paper discusses the case and highlights the significant challenges in the early diagnosis and management of acute appendicitis during pregnancy, emphasizing the importance of preventing potentially life-threatening complications for both the mother and the fetus.
PubMed: 38953065
DOI: 10.7759/cureus.61463 -
Journal of Vascular Surgery Cases and... Aug 2024Testicular ischemia is one of the most rarely reported complications of endovascular abdominal aortic aneurysm repair (EVAR). Although the pathogenesis remains unclear,...
Testicular ischemia is one of the most rarely reported complications of endovascular abdominal aortic aneurysm repair (EVAR). Although the pathogenesis remains unclear, thromboembolic events in the setting of testicular artery origin occlusion by the stent graft and poor baseline collateral testicular circulation are presumed causes. A 73-year-old man developed acute right testicular infarction 3 days after EVAR, requiring orchiectomy. This case emphasizes the importance of recognizing and evaluating testicular pain after EVAR and counseling patients on this possible EVAR complication.
PubMed: 38952999
DOI: 10.1016/j.jvscit.2024.101522 -
Iranian Journal of Medical Sciences Jun 2024Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria...
Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP.
METHODS
This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the test, Fisher's exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant.
RESULTS
The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures.
CONCLUSION
Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region's bacterial resistance features.
Topics: Humans; Peritonitis; Child; Female; Male; Iran; Child, Preschool; Anti-Bacterial Agents; Tertiary Care Centers; Infant; Adolescent; Drug Resistance, Bacterial; Ascites; Bacterial Infections; Microbial Sensitivity Tests
PubMed: 38952643
DOI: 10.30476/ijms.2023.98747.3082 -
Cureus Jun 2024The authors report on the case of a 69-year-old female who presented to the emergency department due to exquisite abdominal pain she described as occurring after she...
The authors report on the case of a 69-year-old female who presented to the emergency department due to exquisite abdominal pain she described as occurring after she coughed. Imaging revealed a rectus sheath hematoma (RSH). A RSH is an uncommon but significant cause of acute abdominal pain that occurs when blood accumulates in the sheath of the rectus abdominis muscle. It can be caused by a muscular tear or a ruptured epigastric artery and can happen spontaneously or after trauma. The etiology, presentation, diagnosis, and management are discussed.
PubMed: 38952600
DOI: 10.7759/cureus.61488 -
Cureus Jun 2024Uroperitoneum secondary to spontaneous bladder rupture is a rare cause of ascites associated with significant morbidity and mortality. It can be difficult to detect and...
Uroperitoneum secondary to spontaneous bladder rupture is a rare cause of ascites associated with significant morbidity and mortality. It can be difficult to detect and is often initially mistaken for other, more common etiologies. We present the case of a 56-year-old female with a history of cervical cancer treated with chemotherapy and radiation, radiation proctitis, and diabetes mellitus who presented with subacute onset abdominal pain and distension, urinary retention, and nausea. She had been diagnosed with cervical squamous cell cancer 12 years prior to presentation and was successfully treated with two months of chemotherapy and radiation, and a presumed recurrence five years later was treated to remission with chemotherapy. The golden-yellow appearance of her ascitic fluid during diagnostic paracentesis raised suspicion for urinary ascites that was confirmed by an elevated ascites-to-serum creatinine ratio and computed tomography (CT) cystography. Subsequent CT cystogram demonstrated leakage of contrast from the bladder with a 0.5 cm irregularity noted at the bladder dome, potentially representing the site of extravasation. A Foley catheter was placed at the time of admission with an immediate output of 1 L of fluid. Subsequently, her abdominal distension significantly improved, and her creatinine began to downtrend. Gynecologic oncology and urology were consulted and determined that she was not a candidate for surgical intervention given the significance of her bladder scarring. Positron emission tomography (PET)/CT was performed and revealed no active cancer. At the time of discharge, she had no episodes of emesis. Additionally, her creatinine had fallen to 1.0 mg/dl. She was discharged with a Foley catheter with plans to follow up with outpatient urology. While relatively uncommon, uroperitoneum should be suspected in patients presenting with new-onset ascites who have risk factors for spontaneous bladder rupture such as pelvic irradiation. Uroperitoneum has a significant rate of mortality and morbidity. Ascites urea and creatinine studies, followed by a CT cystogram if these studies are abnormal, should be performed in any patient with risk factors for uroperitoneum. Patients should be managed with the placement of a Foley catheter and urology consultation for surgical evaluation.
PubMed: 38952593
DOI: 10.7759/cureus.61498 -
Journal of Pathology and Translational... Jul 2024Colonic duplication constitutes a rare congenital anomaly, characterized by the presence of hollow cystic or tubular structures exhibiting an epithelial-lined intestinal...
Colonic duplication constitutes a rare congenital anomaly, characterized by the presence of hollow cystic or tubular structures exhibiting an epithelial-lined intestinal wall. Diagnostic challenges persist due to its low incidence and manifestation of nonspecific symptoms such as abdominal pain or constipation, resulting in a reluctance to pursue surgical resection. As associated malignancies in colonic duplication are rare, the inherent malignant potential of these anomalies remains undetermined. Additionally, despite reported instances of associated malignancies in colonic duplication, there is an absence of reports in the literature detailing tubular adenoma within these cases. The histologic features of the presented case are particularly noteworthy, situated at the precancerous stage, intimating potential progression towards adenocarcinoma within colonic duplication.
PubMed: 38952256
DOI: 10.4132/jptm.2024.06.04 -
Zhonghua Yi Xue Za Zhi Jul 2024To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. This was a randomized... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the effectiveness and safety of multimodal analgesia in patients with end-stage head and neck cancer in open gastrostomy surgery. This was a randomized controlled trial. From June to December 2023, 50 patients with end-stage head and neck cancer who underwent elective open gastrostomy surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were prospectively selected. The patients were divided into multimodal analgesia group and local anesthesia group using the random number table method according to different anesthesia methods, with 25 cases in each group. In multimodal analgesia group, a multimodal analgesia regimen was adopted: ultrasound-guided abdominal wall nerve block (rectus sheath block and transverse abdominis plane block)+intravenous injection of oxycodone+intravenous injection of flurbiprofen axetil and dexamethasone. In local anesthesia group, local infiltration anesthesia with ropivacaine was adopted. The main outcome measure was the incidence of intraoperative pain numeric rating scale (NRS) score>3 points in the two groups. The secondary observation indicators included NRS score and hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)] at various time points during surgery [before anesthesia (T0), at the time of incision (T1), 10 minutes after surgery (T2), during gastric body traction (T3), and at the end of surgery (T4)], incidence of adverse reactions, postoperative patient satisfaction score, as well as the NRS scores at rest and activity (coughing) within 24 hours after surgery. The multimodal analgesia group included 21 males and 4 females, aged (61.4±9.9) years. There were 19 males and 6 females in the local anesthesia group, aged (58.6±10.8) years. The incidence of intraoperative NRS score>3 points and the incidence of salvage analgesia in the multimodal analgesia group were both 12.0% (3/25), which were lower than 60.0% (15/25) in the local anesthesia group, and the differences were statistically significant (all <0.001); The NRS score [ (, )] at T3 in the multimodal analgesia group was 2 (2, 3) points, which were lower than 5 (3, 6) points in the local anesthesia group (<0.05). There were smaller variabilities in MAP and HR in the multimodal analgesia group than those in the local anesthesia group (all <0.05). The incidence of intraoperative tachycardia, surgical traction reaction, and nausea in the multimodal analgesia group was lower than that in the local anesthesia group (all <0.05). The postoperative satisfaction score of patients in the multimodal analgesia group was (9.25±0.71) points, which were higher than (7.33±0.87) points in the local anesthesia group (<0.001). NRS score during postoperative activity within 24 hours in the multimodal analgesia group were (2.36±0.75) points, which were lower than (3.03±0.81) points of the local anesthesia group (=0.005). No adverse reactions such as urinary retention, nausea, vomiting and dizziness occurred in both groups. Compared with local anesthesia, the multimodal analgesic strategy could provide better analgesic effect and longer duration, better hemodynamic stability, and fewer intraoperative adverse reactions in patients with end-stage head and neck cancer undergoing open gastrostomy.
Topics: Humans; Head and Neck Neoplasms; Analgesia; Nerve Block; Gastrostomy; Male; Anesthesia, Local; Pain, Postoperative; Female; Pain Management; Prospective Studies; Anesthetics, Local; Middle Aged; Pain Measurement
PubMed: 38951104
DOI: 10.3760/cma.j.cn112137-20240119-00135 -
Regional Anesthesia and Pain Medicine Jun 2024The erector spinae plane block (ESP block) is frequently employed for thoracic, abdominal, and spinal surgeries, yet its precise mechanism of action remains a subject of...
BACKGROUND
The erector spinae plane block (ESP block) is frequently employed for thoracic, abdominal, and spinal surgeries, yet its precise mechanism of action remains a subject of debate. While initially postulated to influence both ventral and dorsal rami of the spinal nerve, recent studies indicate a predominant impact on the dorsal rami with limited involvement of the ventral rami. To elucidate this mechanism, we conducted an observational study to assess the distribution of ESP infiltration to the ventral rami.
METHODS
We performed 20 ESP infiltrations bilaterally in 10 unembalmed cadavers, targering the T9 transverse process level. A volume of 20 mL of ropivacaine 0.2% and methylene blue 0.01% was used. Dissection was carried out to assess dye distribution, with a focus on involvement of the ventral and dorsal rami, as well as lateral and longitudinal spread within the spinal muscular plane.
RESULTS
No evidence of dye staining was observed in the ventral rami in any of the cadavers; however, the dorsal rami consistently displayed staining. The dye exhibited extensive longitudinal diffusion across the paravertebral musculature, spanning a median of 10 vertebral spaces (T5-L2). The range extended from 3 to 18 spaces, with an IQR of 11 levels (T4-L2), predominantly affecting the longissimus and iliocostalis muscles.
CONCLUSIONS
The infiltration of injectate into the ESP does not contact the ventral rami of segmental spinal nerves. The inference that an in vivo ESP block is a paravertebral "by-proxy" is, therefore, unlikely.
PubMed: 38950933
DOI: 10.1136/rapm-2024-105691