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Polyarteritis nodosa diagnosed by surgically resected jejunal necrosis following acute abdomen

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World Journal of Gastroenterology 2013年第18期19卷 2830-2834页

作者： Yuta Hiraike Makoto Kodaira Munetaka Sano Yasuyuki Terazawa Shingo Yamagata Syuzo Terada Masaharu Ohura Ken Kuriki Department of Gastroenterology Yaizu City Hospital Yaizu City Shizuoka 425-8505 Japan Department of Nephrology Yaizu City Hospital Yaizu City Shizuoka 425-8505 Japan Department of Pathology Yaizu City Hospital Yaizu City Shizuoka 425-8505 Japan

The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.

关键词： Acute abdomen Polyarteritis nodosa Jejunal necrosis

A rare cause of acute abdomen–Spontaneous rectus sheath hematoma

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Asian Pacific Journal of Tropical Biomedicine 2016年第10期6卷 892-895页

作者： Hock Chin Chong Feng Yih Chai Yew Eng Tan Sophia Si Ling Heng Siti Asilah Mohd Desa Department of Surgery Hospital Queen Elizabeth Department of Surgery Hospital Keningau

Spontaneous rectus sheath hematoma(SRSH) is a rare entity that mimics acute *** sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms presentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in *** SRSH can be managed conservatively with good outcome.

关键词： Rectus muscle injury Epigastric vessel Spontaneous Acute abdomen

Acute abdomen in pregnancy due to isolated Fallopian tube torsion: The laparoscopic treatment of a rare case

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World Journal of Clinical Cases 2014年第11期2卷 724-727页

作者： Zacharoula Sidiropoulou António Setúbal General Surgery Department Hospital S?o Francisco Xavier-CHLO 1449-005 Lisbon Portugal Gynecology and Obstetrics Department Hospital da Luz 1500-650 Lisbon Portugal

In the last years, operative laparoscopy became a standard approach in gynaecology and general surgery. Even in pregnancy its use is becoming more widely accepted. In fact, it offers advantages similar to those in no pregnant women, associated with good maternal and fetal outcomes. Around 0.2% of pregnant women require abdominal surgery. The most common indications of laparoscopy in pregnancy are cholelithiasis complications, appendicitis, persistent ovarian cyst and adnexal torsion. Authors describe a very rare case of acute abdomen due to isolated Fallopian tube torsion in a 24 th weeks pregnant woman, managed by laparoscopic salpingectomy.

关键词： Fallopian tube torsion Acute abdomen Pregnancy Laparoscopy

TREATMENT OF ACUTE abdomen BY ELECTRO-ACUPUNCTURE——A Report of 245 Cases

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Journal of Traditional Chinese Medicine 1992年第2期12卷 110-113页

作者：顾月华 Nanjing International Acupuncture Training Center Nanjing College of Traditional Chinese MedicineNanjing 210005

Acute abdomen is an emergency diseasecommonly seen in *** can be caused bymany diseases and is characterized by ab-rupt onset,acute abdominal pain and evenshock in severe *** 1977,I haveused electro-acupuncture to tre... 详细信息

关键词： acupuncture clinic bilateral minutes abdomen moxibustion stimulation stimulator needle emergency

Localized Castleman disease of plasma cell type in the abdomen

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Chinese Medical Journal 2011年第17期124卷 2789-2791页

作者： LU Zhi-hua WU Mei Department of Radiology Affiliated Changshu Hospital of Soochow University Changshu Jiangsu 215500 China Department of Pathology Affiliated Changshu Hospital of Soochow University Changshu Jiangsu 215500 China

Castleman disease is a relatively rare entity, with the hyaline-vascular type the predominant form. Although the plasma cell type is uncommon, it still comprises approximately 10% of cases of localized diseases. In addition, the abdomen is a rare site for involvement and localized Castleman disease of the plasma cell type in the abdomen is rare. The radiologic features of localized plasma cell type in the abdomen are mostly limited to case reports. In addition to the conventional imaging findings, we present some new imaging findings of localized plasma cell type in the abdomen.

关键词： Castleman disease plasma cell type abdomen computed tomography

Acute abdomen presentation in dengue fever during recent outbreak

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Journal of Acute Disease 2017年第5期6卷 198-204页

作者： Bal Kishan Gupta Hardeva Ram Nehara Sahil Parmar Shyam Lal Meena Suresh Gajraj Jigyasa Gupta Department.of Medicine S.P.Medical CollegeBikanerIndia

Objective: To evaluate the etiology, clinical profile and outcome of acute abdomen presentation in Dengue Fever (DF). Methods: This clinical prospective study was done on confirmed cases of DF admitted in the department of medicine during recent epidemic (September 2015 to November 2016). All patients were evaluated clinically and by laboratory and imaging investigations and followed-up during hospital stay till discharge. The cause of pain abdomen was ascertained by blood tests (amylase, lipase and liver function test etc), radiology (Flat plate abdomen-erect, Ultrasonography of abdomen, CECT abdomen) and/or endoscopy. Results:Out of the 501 patients diagnosed as DF, 165 (32.93%) presented with acute abdomen. Some patients presented in other departments like surgery, gastroenterology and emergency, were later diagnosed as DF on laboratory evaluation. Various causes of acute abdomen in our study were nonspecific severe pain abdomen (67 cases), acute hepatitis (46) one had acute fulminant hepatitis, acute acalculous cholecystitis (31), ascitis (12), acute hyperemic gastritis with malena (5), acute pancreatitis (2), and 1 case each of acute appendicitis and acute jejuno-ileal intussuception. All patients were managed conservatively. One patient of acute pancreatitis died of multi-organ failure. Conclusion: Our study concludes that clinical vigilance about such type of presentations is important as timely recognition can influence outcome and may prevent unwanted surgery.

关键词： Acute abdomen Acute hepatitis Acute acalculus cholecystitis Acute pancreatitis Acute Ileo-Jejunal intussuception Acute appendicitis

Contribution of EFAST Ultrasound in the Management of Chest and abdomen’s Blunt Trauma in the City of Parakou, Benin

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Open Journal of Anesthesiology 2020年第11期10卷 388-407页

作者： Tchaou Blaise Adelin Savi De Tovè Kofi-Mensa Tchégnonsi N’vènonfon Charles Frederic Gandji Elohonnan Wilfred Ngamo Deugoue Gabriel Marie Allodé Salako Alexandre Department of Anesthesia Resuscitation and Emergency CHUD Parakou The Republic of Benin Department of Radio-Diagnostic and Medical Imagery CHUD Parakou The Republic of Benin Department of Visceral Surgery National Teaching Hospital-HKM Cotonou The Republic of Benin Department of General Surgery CHUD Parakou The Republic of Benin

Background: Blunt thoracic and abdominal traumas are frequent and have a poor prognosis in the absence of prompt diagnosis and adequate management. An ultrasound performed in the emergency room allows a precise diagnosis and a better orientation of the victims. Objective: To assess the contribution of EFAST ultrasound in the management of blunt thoracic and abdominal traumas. Patients and method: Cross-sectional descriptive and analytical study with prospective data collection carried out from February 20th to August 20th, 2017 in the emergency and intensive care units of the Parakou University Hospital Centre. An ultrasound machine fitted with a 3.5 MHz convex probe was used to search for post-traumatic effusion by the EFAST technique on admission and then as needed over 24 hours and after surgery. Results: Sixty-three patients were collected with an 85.71% male predominance. The average age was 31.36 ± 13.29 years. The time to perform the EFAST ultrasound was 7 ± 3 min. EFAST was positive in 50.79% of patients. Five patients (7.93%) received emergency treatment for hemodynamic instability and positive EFAST within an average of 3.46 ± 2 hours. Eighteen patients (27.58%) received after monitoring by EFAST, surgery within 9 hours 12 minutes (hemoperitoneum) and 27 hours 58 minutes (hemothorax). Two patients were tested positively for EFAST after surgery. Conclusion: The introduction of an EFAST ultrasound as a sorting tool in an environment with limited resources is desirable and feasible.

关键词： Emergencies Blunt Trauma EFAST Thorax abdomen

Investigation of Open abdomen Visceral Skin Graft Revascularization and Separation from Peritoneal Contents

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Surgical Science 2018年第1期9卷 24-43页

作者： Katharine E. Caldwell Ross M. Clark Brittany B. Coffman Jacquelyn S. Brandenburg Thomas R. Howdieshell Departments of Surgery University of New Mexico Health Sciences Center Albuquerque USA Pathology University of New Mexico Health Sciences Center Albuquerque USA

Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling;and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.

关键词： Open abdomen Visceral Skin Graft Mesothelial Cells

Utilization of Milk as an Oral Contrast Agent in CT Scan of the abdomen

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Advances in Computed Tomography 2015年第3期4卷 33-41页

作者： Asma Badawood Nisreen Alsioufi Samar Fathuddin Nabeel Mishah Saddiq Jastaniah Department of Diagnostic Radiology Faculty of Applied Medical Sciences King Abdulaziz University Jeddah KSA Radiology Department King Abdulaziz University Hospital Jeddah KSA

The present study aimed to evaluate using the whole milk as alternative oral contrast for the as-sessment of gastrointestinal CT enterography. Fifty patients undergo (18 female and 32 male) aged from 21 to 79 years (mean 45 years) undergo abdominal CT at the department of diagnostic radiology of King Abdulaziz University Hospital. They receive 1 - 1.5 liter whole milk. Siemens SOMATOM definition CT Scan Machine with 64 slices and dual source was utilized to image all pa-tients in research population group where iodinated oral contrast media was replaced by a whole milk available in the local market. Patients were scanned as per the routine protocol used for CT abdomen at KAUH-CT Unit: Helical Mode with 0.7 Pitch was performed on all paints in supine po-sition using a 16-detector row scanner (Bright Speed S, General Electric-Milwaukee Wisconsin, USA). The following parameters were applied: collimation of 16 × 0.625 (1.25 - 3.75) mm, pitch of 3, Slice thickness: 5 mm, gantry rotation time of 400 mAs, tube voltage of 120 KV and scan time 11.05 second. The images of all cases were reviewed by two qualified radiologists. Conclusion: The present study suggested that whole milk was found to be an effective alternative negative contrast for the assessment of the jejunum, ileum and terminal ileum in CT enterography. It was excellent for gastric imaging and we recommended replacing milk as negative oral contrast since it is available and cost effective. Further research to be conducted with modified milk drinking timing for better large bowel distention.

关键词： CT Contrast Media Milk abdomen Bowl Stomach