rare cause of pneumoperitoneum - a ruptured infected endometriotic cyst

Pneumoperitoneum is a surgical emergency that results from gastrointestinal tract perforation, most commonly perforation of the duodenum caused by peptic ulcer. It rarely results from nonsurgical causes. We present a case of rupture infected endometriotic cyst that was presented as acute abdomen with pneumoperitoneum in which exploratory laparotomy was done with salpingooophrectomy

Milk of calcium gallbladder - limy bile syndrome: an unusual cause for acute cholecystitis

A rare disorder in which accumulation of calcium salts in the gallbladder leads to the formation of a whitish substance known as the milk of calcium gallbladder or limy bile syndrome. We report such a case which presented as acute cholecystitis. The diagnosis was done by plain X-ray and ultrasonography [USG] of the abdomen and laparoscopic cholecystectomy was performed. The pathogenesis for such a case is also discussed

Management of liver trauma in Kuwait

The aim of this study was to introduce the concept of non-operative management [NOM] for blunt liver trauma by establishing a protocol and a prospective Liver Trauma Registry in Kuwait. A prospective Liver Trauma Registry was started in 4 hospitals and it included 117 patients who had sustained blunt liver trauma [94 men and 23 women]. Unstable patients were taken to surgery while stable patients were managed conservatively regardless of the grade of liver injury. High-grade [III-VI] liver injuries were managed in collaboration with the liver surgery specialist. The mean age of the 117 patients was 29.02 +/- 11.18 years [range 7-63]. NOM was successful in 94 [96%] patients and failed in 4 [4%] [these 4 then underwent successful surgery]. Nineteen [16.2%] were unstable and underwent surgery immediately; 15 [79%] of them survived [they had had grade III-V injuries] and 4 died [2 with grade V injuries and 2 with grade VI injuries]. Perihepatic packing was necessary in 8/19 [42%] patients. The overall mortality was 3.4% [4/117]. This study showed that NOM was successful in a majority of patients with blunt liver trauma. In addition, it confirmed that the magnitude of liver injury and haemoperitoneum did not preclude NOM as long as the patient was haemodynamically stable

Accuracy of the Fischer scoring system and the Breast Imaging Reporting and Data System in identification of malignant breast lesions

Fischer developed a scoring system in 1999 that made identifying malignant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance [MR] imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data System [MRM BI-RADS] grade and the final diagnosis. The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging. There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 [64%], category IV in 7 [28%], and category III in 2 [8%] lesions. Benign lesions were graded as category V in 3 [10%], category IV in 6 [20%], and category III in 3 [10%], category II in 10 [33%] and category I in 8 [27%] lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions. The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies

Accuracy of the fischer scoring system and the breast imaging reporting and data system in identification of malignant breast lesions

Fischer developed a scoring system in 1999 that made identifying malignant lesions much easier for inexperienced radiologists. Our study was performed to assess whether this scoring system would help beginners to accurately diagnose breast lesions on magnetic resonance [MR] imaging and to assess the correlation between the magnetic resonance mammography Breast Imaging Reporting and Data System [MRM BI-RADS] grade and the final diagnosis. The lesion morphology and contrast kinetics of 63 masses in 41 patients were evaluated on MRI and accorded a MRM BI-RADS final assessment category using the Fischer scoring system. The accuracy was evaluated after the final diagnosis was obtained by tissue sampling and follow-up imaging. There were 25 malignant and 30 benign lesions. Eight lesions were seen by MRI only and we could not verify their pathology since we did not have MR-guided biopsy facilities at the time of the study. On MR mammography, the proven carcinomatous lesions were characterized as BI-RADS category V in 16 [64%], category IV in 7 [28%], and category III in 2 [8%] lesions. Benign lesions were graded as category V in 3 [10%], category IV in 6 [20%], and category III in 3 [10%], category II in 10 [33%] and category I in 8 [27%] lesions. The MRM BI-RADS category accurately predicted malignancy in 92% and a benign pathology in 70% of the lesions. The overlap between the MRM features of chronic inflammatory lesions and carcinomas resulted in a lower accuracy in diagnosing benign as compared to malignant lesions. The MRM BI-RADS lexicon using the Fischer scoring system is useful and has a high predictive value, especially for malignant breast lesions, and is easy to apply. Overlapping features between benign inflammatory and malignant lesions might yield a reduced accuracy in inflammatory pathologies

Bleeding duodenal varices: a case report and review of literature

A rare case of a patient with bleeding duodenal varices diagnosed by endoscopy in which bleeding was controlled initially by sclerotherapy is reported. Diagnosis was confirmed by coeliac and superior mesenteric angiogram with selective injections of hepatic and gastroduodenal arteries. Recurrence of haemorrhage was treated successfully by suture ligation of duodenal varices alone, and a shunting procedure was not required. Duodenal varices should not be overlooked as a cause of gastrointestinal bleeding in patient with cirrhosis