A case report of primary ovarian leiomyoma

Primary ovarian Leimyoma is a rare benign mesenchymal tumour usually arising from smooth muscle of walls of ovarian blood vessels. It’s mostly discovered incidentally. Here we report a case in which a 24-year-old unmarried woman presented with pain and discomfort in lower abdomen since 10 days. On further evaluation through imaging and blood works, we proceeded with surgical management. Immunohistochemistry confirmed the final diagnosis of ovarian leiomyoma. However, it’s important to keep this entity as a differential diagnosis for solid ovarian tumors.

Role of diagnostic laparoscopy in chronic and recurrent pain abdomen

Background: Chronic and recurrent abdominal pain of unknown origin represents a significant problem in surgical patients and poses a diagnostic dilemma. With advances in optics, laparoscopy allows visualisation of entire peritoneal cavity and further makes histological diagnosis possible. The rapidly increasing popularity of laparoscopy may be attributed to several factors including its applicability in both emergency and elective settings, high diagnostic yield, therapeutic management in the same setting, low patient morbidity, reduced hospital stays and expenditure. The objective of the study was to evaluate the role of diagnostic laparoscopy in chronic and recurrent pain abdomen.Methods: We conducted a prospective descriptive study on 50 patients who suffered from chronic and recurrent pain in abdomen for more than 3 months with inconclusive clinical or radiological diagnosis. All patients were subjected to diagnostic laparoscopy and findings were noted down. Therapeutic procedures were conducted at the same setting wherever indicated. Histopathological evaluation reports were followed up.Results: Out of 50 patients, laparoscopy established diagnosis in 44 patients, proving diagnostic efficacy at 88%. The most common finding at diagnostic laparoscopy was appendicitis (28%), followed by adhesions (24%). Other findings were tuberculosis (16%), pelvic inflammatory disease (8%), endometriosis (3%), partial torsion of ovarian cyst (4%), cholecystitis (2%). However, diagnostic laparoscopy showed normal study in 6 patients (12%). Appendicectomy followed by adhesiolysis were the most common procedures performed.Conclusions: Recurrent appendicitis is the most common cause of chronic and recurrent pain abdomen. Diagnostic laparoscopy is a safe and effective modality for both diagnostic and therapeutic management of such patients.

A rare case of isolated fallopian tube torsion

Isolated torsion of fallopian tube is a rare occurrence. Diagnostic difficulty gets compounded in adolescents because the most commonly used imaging study in young, usually sexually inactive, population is transabdominal ultrasonography which may show normal ovaries, leading clinicians to abandon a diagnosis of adnexal torsion. Other imaging modalities such as CT scan or MRI are less useful for a rapid diagnosis because of the risk of radiation exposure, cost, or lack of ready availability. Delays in diagnosis may increase the likelihood of necrosis of the fallopian tube which would result in salpingectomy as was the case in our case report. Here authors present one such case, wherein one 12 year old girl who attained menarche at 10 years of age presented with acute paraumblical pain and vomiting without any fever, bowel and bladder disturbances. On examination there was tenderness in right iliac fossa. Her USG report was unremarkable. She initially was put-on broad-spectrum antibiotics but without any amelioration of symptoms. Diagnosed as appendicitis by surgeon, she was taken up for laparoscopic appendicectomy. However, it turned out to be a case of fallopian tube torsion, wherein the tube had become gangrenous for which salpingectomy was done.

Epiploic appendagitis with acute pyelonephritis: a case report

Coexistence of acute epiploic appendagitis with acute pyelonephritis is a rare occurrence. Present study report here a case of a 36-year-old male with a past history of appendectomy presenting with complaints of pain abdomen, nausea, increased frequency of micturition and dysuria. On examination, there was tenderness and guarding in the left iliac fossa. CECT abdomen revealed resolving acute epiploic appendagitis with acute pyelonephritis. He was managed conservatively with antibiotics and anti-inflammatory agents to which he responded. Thus, epiploic appendagitis is a benign self-limiting condition which when diagnosed early prevents unnecessary surgical interventions.

Proposta de escore preditor de desfechos para abdome agudo / Outcomes prediction score for acute abdomen: a proposal

RESUMO Objetivo: estabelecer a correlação entre dados objetivos coletados na avaliação inicial e os desfechos nos casos de dor abdominal aguda. Métodos: estudo retrospectivo, de caso controle, em que foram revisados prontuários de pacientes atendidos em um serviço de urgência e emergência no ano de 2016, diagnosticados com dor abdominal e pélvica. Resultados: de 2.352 prontuários avaliados, 330 foram considerados válidos para o estudo. Destes pacientes, 235 (71,2%) receberam alta e os 95 (28,8%) restantes foram internados, submetidos à cirurgia ou morreram. A análise estatística demonstrou que sexo masculino, idade ≥50 anos, temperatura axilar >37,3ºC, anemia, leucocitose >10.000/mm3, neutrocitose acima de 7.700/mm3, linfopenia <2.000/mm3 e hiperamilasemia são variáveis isoladamente associadas a pior desfecho. Conclusão: a presença de três ou mais das variáveis avaliadas aumenta fortemente a chance de um paciente sofrer os desfechos de cirurgia ou morte, sendo a chance de óbito tanto maior quanto maior o número de variáveis presentes.

ABSTRACT Objective: to establish a correlation between objective data collected at the initial evaluation and the outcomes in cases of acute abdominal pain. Methods: we conducted a retrospective, case-control study in which we reviewed medical records of patients treated at an emergency room in 2016, diagnosed with abdominal and pelvic pain. Results: of the 2,352 medical records evaluated, we considered 330 valid for the study. Of these patients, 235 (71.2%) were discharged and the remaining 95 (28.8%) were hospitalized, submitted to surgery, or died. The statistical analysis demonstrated that male gender, age ≥50, axillary temperature >37.3ºC, anemia, leukocytosis >10,000/mm3, neutrophil count above 7,700/mm3, lymphocyte count less than 2,000/mm3 and hyperamylasemia were variables in independently associated with worse outcome. Conclusion: the presence of three or more of the evaluated variables greatly increases the chances of a patient suffering the outcomes of surgery or death, the chance of death being greater the greater the number of variables present.

Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism

Background & objectives: The frequency and predictors of pancreatitis in primary hyperparathyroidism (PHPT) are not well understood. The objective of the present study was to evaluate the frequency of pancreatitis in patients with PHPT and its association with clinical and biochemical parameters of the disease. Methods: In this retrospective study all consecutive patients with PHPT registered in the PHPT registry (www.indianphptregistry.com) from the year 2004 to 2013 were included. The clinical, biochemical and radiological parameters related to pancreatitis were evaluated in histologically proven PHPT patients. Results: A total of 218 patients (63 men; mean age: 40.6±14.4 yr) underwent surgery for PHPT during the study. Pancreatitis occurred in 35 [16%, 18 acute and 17 chronic pancreatitis (CP)] patients and male:female ratio was 1:0.94. Skeletal manifestations were seen less frequently in PHPT with pancreatitis as compared to that of PHPT without pancreatitis. PHPT with pancreatitis had significantly higher serum calcium (12.4±2.0 vs. 11.7±1.5 mg/dl, P <0.05) in comparison to PHPT without pancreatitis. PHPT with acute pancreatitis (AP) had higher serum calcium (P <0.05) and parathyroid hormone (PTH) (P <0.05) levels than PHPT with CP. Curative parathyroidectomy improved the symptoms associated with pancreatitis as there was no recurrence in AP group, whereas recurrence was observed only in about 10 per cent patients of the CP group. Interpretation & conclusions: Pancreatitis was observed in 16 per cent of PHPT patients with male predominance in the study population. No recurrence of AP was observed after curative surgery. It may be proposed that serum amylase with calcium and PTH should be measured in all patients of PHPT with pain abdomen to rule out pancreatitis.

Analysis of gallstones disease correlating with clinical symptoms in patients with calculous cholecystitis in emergency surgical unit at Kilpauk Medical College

Background: Gallstones, complex biomineralized deposits formed in the gallbladder, are still a major health problem all over the world. Cholelithiasis is common with the incidence ranging from 10% to 20% of the world population. Over the past two decades, a great deal has been learned about the epidemiology of and risk factors for gallstones. Ultrasonography has played a major role in this process, providing a rapid, risk-free method of screening large populations. Prior to the availability of ultrasound, most studies relied on highly selective autopsy data and limited oral cholecystography. Aim and objectives: To determine the Biochemical analysis of Gall stones and to study the clinical spectrum of acute cholecystitis. Materials and methods: About 50 consecutive cases were admitted, examined, investigated and diagnosed as calculus cholecystitis during the period of January 2016 to September 2016 are selected and detailed history of all the 50 cases were taken according to the proforma. Information regarding the age, nature of the symptoms, and duration of the symptoms, diet history, and history of OCP intake, Alcohol ingestion, and diabetes were obtained. All patients’ undergone detailed examination underwent investigations. Results: All cases fall between 22 and 75 years. There is an increased incidence in the 5th and 6th decade with the maximum incidence in the 5th decade. Pain abdomen was the most common Ganganesamy, S. Dharmarajan. Analysis of gallstones disease correlating with clinical symptoms in patients with calculous cholecystitis in emergency surgical unit at Kilpauk Medical College. IAIM, 2017; 4(8): 81-86. Page 82 presenting symptom in our study seen in 49 (98%) of the cases followed by fever in 17 (34%) cases. Dyspepsia was seen in 12 (24%) cases, 7 cases (14%) each presented with nausea/vomiting or jaundice. Among the ultrasonographic findings of cholelithiasis most common finding was thickened gall bladder wall seen in 40 cases (80%) Ultra sonogram revealed 76% (38 cases) had multiple stones and 24% (12) has solitary stone. Mass was seen in 5 cases (10%).Of the total 50 cases with cholelithiasis 38 patients (76%) had mixed stones, followed by pigment stones in 8 cases (16%) followed by cholesterol stones in remaining 4 cases (8%). Majority of the patients were in the age group 41-50 (32%) followed by the 51-60 age group (24%). Conclusion: Majority of patients underwent Laparoscopic cholecystectomy (86%) with reduced number of stay in the hospital, pain and disability as compared to open cholecystectomy. The commonest type of stone was mixed stone. Most of the gallstones were associated with grade 1 cholecystitis (78%), Grade 2 cholecystitis was seen in 20% of our study patients, Grade 3 was seen in 2% of our study patients.

Death due to ruptured ectopic pregnancy natural death or negligence.

A young adult female of low socio-economic status, and a labourer by profession, was brought dead to the Government Medical College & hospital, Chandigarh. History provided by her husband revealed that she had pain abdomen for the last five days for which she was getting treatment from a private practitioner. She had been prescribed NSAIDs and antispasmodics for the same. However, she was not investigated upon and no attempt was made by the practitioner to arrive at any diagnosis. The autopsy was conducted on the next day and at autopsy, about two-and-a-half liters of blood was present in the abdomen and pelvic cavity. Careful internal examination revealed a ruptured ectopic pregnancy as the source of bleeding. The case is discussed with regard to establishing whether the death could have been natural, due to the negligence of the treating doctor or due to contributory negligence. However, even in cases of contributory negligence, the “last chance doctrine” may not save the physician.