Encapsulating peritoneal sclerosis in liver transplant

Encapsulating peritoneal sclerosis occurs due to chronic irritation of the peritoneal surface resulting in inflammation and fibrosis. Encapsulating peritoneal sclerosis usually occurs in patients requiring peritoneal dialysis (PD); however, it may also occur in liver transplant patients. The fibrosis in encapsulating peritoneal sclerosis could be severe enough to cause small bowel obstruction (SBO). Herein, we report a case of encapsulating peritoneal sclerosis secondary to liver transplantation that presented with SBO. The patient was started on Tamoxifen for encapsulating peritoneal sclerosis and evaluated at follow-up without any other intestinal obstruction episodes. This case demonstrates that encapsulating peritoneal sclerosis can occur as a liver transplant complication and present with small bowel obstruction.

Endometriosis is an important cause of pelvic pain in adolescence / Endometriose é causa importante de dor pélvica na adolescência

Objective: despite endometriosis being a common disease, where early detection is key to preventing its progression, it is a condition often overlooked in adolescents. The aim of this study was to report the clinical characteristics of adolescent patients with endometriosis monitored in a tertiary hospital. Methods: a retrospective study of 394 patients undergoing surgery with a histological diagnosis of endometriosis at the Endometriosis Division of the Gynecology Department at the Hospital das Clínicas of the University of São Paulo Medical School from 2008 to 2013. 21 adolescents were included (aged under 21 years). Results: the age ranged from 17.95 ± 1.48 years, the average time for diagnostic confirmation was 2.96 ± 2.93 years, and the age at the onset of symptoms was 15.28 ± 3.03 years on average. The sites affected were ovarian (38%), peritoneal (47.6%) and retrocervical (23.8%). Dysmenorrhea was found in 80.9 % of adolescents (severe in 33.3% of cases) and chronic pelvic pain in 66.6%. Conclusion: endometriosis in adolescents is an important differential diagnosis from pelvic pain and ovarian cysts, mainly among those with no response to conventional treatment. The main forms of involvement are peritoneal and ovarian. Despite the onset of symptoms in adolescence and advances in imaging methods, the diagnosis of this disease is still delayed. .

Objectivo: embora a endometriose seja uma doença prevalente, cujo diagnóstico precoce é fundamental para a prevenção de sua progressão, é uma condição frequentemente negligenciada em adolescentes. O objetivo deste estudo é levantar as características clínicas das pacientes adolescentes com endometriose acompanhadas em um hospital terciário. Métodos: levantamento retrospectivo de 394 pacientes submetidas à cirurgia com diagnóstico histológico de endometriose no Setor de Endometriose da Divisão de Clínica de Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de 2008 a 2013. Foram incluídas 21 adolescentes (idade menor de 21 anos). Resulados: a idade média foi de 17,95±1,48 anos, a média de tempo para a confirmação diagnóstica foi de 2,96±2,93 anos e a idade do início dos sintomas foi em média de 15,28±3,03 anos. Os locais de acometimento foram ovariano (38%), peritoneal (47,6%) e retrocervical (23,8%). Dismenorreia esteve presente em 80,9% das adolescentes (sendo severa em 33,3% dos casos) e dor pélvica crônica em 66,6%. Conclusão: endometriose em adolescentes é um importante diagnóstico diferencial de dor pélvica e cistos anexiais, principalmente entre aquelas sem resposta ao tratamento convencional. As principais formas de acometimento são peritoneais e ovarianas. Apesar do início dos sintomas na adolescência e dos avanços nos métodos de imagem, ainda se observa demora no diagnóstico dessa doença. .

Small Bowel Obstruction Caused by Peritoneal Immunoglobulin G4-Related Disease Mimicking Carcinomatosis: Case Report

We hereby report a case of diffuse pelvic peritoneal involvement by immunoglobulin G4-related disease (IgG4-RD). Numerous pelvic masses and nodules showing delayed enhancement on enhanced abdominal CT were found to congregate in the pelvic organs of a 57-year-old female presenting with intestinal subocclusion. The differentiation between peritoneal IgG4-RD and pelvic peritoneal carcinomatosis was only made by histopathology and immunohistochemistry performed after surgical resection. Autoimmune pancreatitis represents the historical prototype of IgG4-RD, but the spectrum of manifestations involving various organs has expanded during the last decade. In this report, we shortly review this clinical entity.

Torsión omental como causa de abdomen agudo pediátrico / Omental torsion a rare cause of acute abdomen in children

INTRODUCCIÓN: La torsión omental constituye una causa infrecuente de dolor abdominal del niño, con una frecuencia relativa estimada de un caso por cada 200 cirugías realizadas por sospecha de apendicitis. Se sugiere que la incidencia de esta patología estaría en aumento paralelo a la obesidad infantil, y al mayor conocimiento diagnóstico con imagenología. PRESENTACIÓN DE CASOS: Cinco pacientes fueron tratados en el Hospital Luis Calvo Mackenna con diagnóstico postoperatorio de torsión o infarto omental entre enero de 2006 y enero de 2011.Todos se presentaron con dolor abdominal agudo en el cuadrante inferior derecho acompañado de otros síntomas fuertemente sugerentes de una apendicitis aguda. En ninguno de los 5 casos se obtuvo diagnóstico imagenológico de urgencias, por lo que recibieron manejo exclusivamente quirúrgico (omentectomía con o sin apendicectomía, vía minilaparotomía o laparoscopía), con resultados satisfactorios. El estudio histopatológico demostró congestión, hemorragia y/o necrosis omental, e inflamación periférica apendicular. DISCUSIÓN: Con un mayor acceso a imágenes y conocimiento de esta patología por el equipo médico, se hace posible realizar el diagnóstico de forma preoperatoria, lo que es decisivo para posibilitar diferentes alternativas terapéuticas y puede evitar la cirugía restringiéndola a casos seleccionados.

INTRODUCTION: Omental torsion is a rare cause of abdominal pain in children, with an estimated incidence of one for every 200 appendectomies performed. A rise in that number has been projected, parallel to a higher prevalence of childhood obesity and a higher accuracy in diagnostic imaging. CASE REPORT: Five patients had a postoperative diagnosis of omental torsion in Hospital Luis Calvo Mackenna between January of 2006 and January 2011. All of them started an acute abdominal pain in right iliac fossa and general symptoms that resembled acute appendicitis. None of them had a correct diagnosis by emergency imaging; thereby a surgical resolution – open or laparoscopic omentectomy with or without appendectomy - was indicated with good outcomes. Histopathological study showed congestion, hemorrhage and/or omental necrosis, and periappendicular inflammation. DISCUSSION: With more readily available imaging studies and a higher index of suspicion, a preoperative diagnosis of omental torsion could be achieved, potentially avoiding unnecessary surgery.

Torsión primaria de epiplón: caso clínico / Primary omental torsion: report of one case

We report a 40 years old female consulting in the emergency room for abdominal pain and a mass in the left lower quadrant. An abdominal CAT sean showed an omental torsion. The patient was operated, excising the involved omentum. The postoperative period was uneventful and the patient was discharged three days after admission.

El objetivo de este trabajo es presentar el caso clínico de una paciente con torsión de epiplón manejado en nuestra institución. Se trata de una paciente de sexo femenino de 40 años de edad, que se presenta al servicio de urgencias por clínica de dolor abdominal de una semana de evolución asociado a masa abdominal en flanco izquierdo, en quien se realiza tomografía que revela cambios compatibles con torsión de epiplón por lo cual es llevada a cirugía realizándose resección de todo el omento.

Vesicoperitoneal fistula--an unusual cause of tense ascites.

We report a 55-year-old man who developed tense ascites due to vesicoperitoneal fistula. He had undergone surgery 32 years ago for excision of an infected urachal cyst, the tract and the umbilicus.

Torsión omental: una causa de abdomen agudo / Omental torsion: an acute abdomen etiology

Introducción. La torsión omental es una causa poco común de abdomen agudo que usualmente semeja apendicitis aguda. La mayoría de los casos son diagnosticados durante laparotomía. Puede ser primaria o bien secundaria; la primera se presenta sin evidencia de patología intraabdominal preexistente. Material y métodos. Del primero de enero del 2001 al 31 de diciembre del 2005, se llevó a cabo un estudio descriptivo, observacional, longitudinal y retrospectivo en pacientes con diagnóstico preoperatorio de apendicitis aguda con el objetivo de conocer la incidencia de apendicitis aguda confirmada por anatomopatología y la incidencia de torsión omental. Resultados. Se incluyeron 2,135 pacientes sometidos a cirugía con el diagnóstico preoperatorio de apendicitis aguda de los cuales hubo confirmación histológica posoperatoria en el 91.71% de los casos. Se encontraron 8 casos de torsión omental, para una incidencia del 0.37%, que se diagnosticaron todos transoperatoriamente. Se detectó mayor frecuencia en las primera y cuarta décadas de la vida; el 75% se observó en adultos. El 62.5% de los casos presentó torsión secundaria. Discusión. La torsión omental es una causa poco frecuente de abdomen agudo cuyo principal diagnóstico diferencial es apendicitis aguda. En nuestra serie, encontramos una incidencia de torsión omental dos veces superior a la reportada en la literatura (0.16 contra 0.37), así como una diferencia en cuanto a su distribución por grupos de edad y por sexo.

INTRODUCTION: Omental torsion is an uncommon cause of acute abdomen, usually mimicking acute appendicitis; almost all described cases are diagnosed with laparotomy. It can be a primary or secondary condition. Primary torsion occurs without evidence of intrabdominal abnormalities. MATERIAL AND METHODS: Retrospective, observational, longitudinal, descriptive study carried out between January 2001 and December 2005. Patients diagnosed as acute appendicitis were included and we assessed diagnostic accuracy by means of anatomopathology and omental torsion incidence. RESULTS: 2135 patients were included; diagnostic accuracy was 91.71%. Eight omental torsion cases were identified, with an incidence of 0.37% and all diagnosed with laparotomy. Patients in the first and fourth decades of life were mostly affected; 75% of the cases were observed in adults, and 62.5% displayed secondary torsion. DISCUSION: Omental torsion is a rare cause of acute abdomen. Acute appendicitis is a frequent differential diagnosis that should be taken into account. In our series, we found a two-fold higher incidence of omental torsion, compared with previously reported incidence data. We also found a difference in age and sex distribution among patients with this diagnosis.

Peritoneal adhesions: pathogenesis, assessment and effects.

BACKGROUND: As modem surgery has evolved, there has been an increase in iatrogenic peritoneal adhesions. Most surgeons manage adhesions and their related complications on a regular basis. Studies in recent years have improved the understanding of the pathogenesis and impact of adhesions, which are discussed. METHODS: A systematic search of literature was performed to identify publications addressing the etiopathogenesis, clinical spectrum and effects of adhesions, using the following database: Medline (1966 to April 2005), Embase (1974 to April 2005), and the Cochrane controlled trials register. The reference lists of key publications so identified were in addition scrutinized for additional articles of relevance. RESULTS: Adhesions occur in more than three fourths of patients following laparotomy. Perironeal trauma results in a unique inflammatory process in which fibrin formation and fibrinolysis play a central role. The effects of adhesions are unpredictable but are wide ranging, causing a significant health care burden. Intestinal obstruction, infertility, problems at reoperative surgery and cumulative costs of care over many years are the key concerns. While adhesiolysis is beneficial in adhesive intestinal obstruction and infertility, its value in chronic pain is uncertain. CONCLUSION: Every violation of the peritoneum carries a potentially lifelong risk of a range of complications. Data available on the epidemiology and natural history of adhesions call for a wider acknowledgement of the problem in the planning of services and greater attention to preventive strategies.

Ultrasonografía doppler color en el diagnostico de mononucleosis infecciosa en el niño / Color doppler ultrasonography in the diagnosis of the infectious monucleosis in children

La mononucleosis infecciosa (MNI) es una enfermedad frecuente que afecta a niños y adolescentes y es causada por el virus Epstein-Barr. En la mayor parte de los casos (80 por ciento) se presenta como un cuadro agudo, caracterizado por fiebre, faringoamigdalitis y linfoadenopatías (forma anginosa). Con menor frecuencia, puede presentarse con poliadenopatías asociadas a fiebre baja y faringitis leve. La ultrasonografía (US) Doppler color ha demostrado ser de utilidad en el estudio de adenopatías en el niño y puede ser de utilidad en el diagnóstico de MNI. Objetivos: Describir los hallazgos de la US Doppler color en la MNI. Pacientes y Método: Se revisó en forma retrospectiva los antecedentes clínicos y estudios por imágenes de 10 niños con diagnóstico confirmado de MNI y en quienes se efectuó US como parte de su estudio. Resultados: El estudio US Doppler color de las adenopatías cervicales mostró hallazgos relativa-mente constantes en todos los pacientes: adenopatías bilaterales múltiples, ovaladas o semi-rredondeadas, con una razón largo-ancho < 2, hiper o isoecogénicas con respecto al músculo, sin necrosis o alteración de estructuras vecinas. Mostró además aumento de flujo vascular en todas las adenopatías. En los cuatro pacientes con US abdominal, se encontró hepatoesplenomegalia (3 pacientes) o esplenomegalia (1 paciente). En dos pacientes, el bazo mostraba un aspecto reticular y nodular fino, que podría ser secundario a la hiperplasia linfática reactiva, con compromiso fundamentalmente de la pulpa blanca, que ha sido descrita en el estudio histológico del bazo en pacientes con esta patología(9). Conclusiones: La MNI es una enferme-dad frecuente en el niño y en la mayoría de los casos el diagnóstico se sospecha clínicamente y se confirma con el estudio serológico específico. La US Doppler color muestra un aspecto relativamente constante en el estudio de las adenopatías periféricas en esta enfermedad y puede ser de utilidad en el diagnóstico.

Torsion of the greater omentum with inguinal hernia.

Torsion of the greater omentum is an uncommon cause of acute abdomen, often diagnosed only intraoperatively. We report a 30-year-old man with torsion of the greater omentum in association with inguinal hernia, diagnosed on CT scan and managed conservatively.

Nódulo granulomatoso com Enterobius vermicularis em epíploon simulando metástase de câncer de ovário / Granulomatous nodule with Enterobius vermicularis in epiploon simulating metastasis of ovarian cancer

Os autores descrevem caso de enterobíase peritoneal apresentando-se como granuloma necrosante, em adolescente com tumor do seio endodérmico do ovário. O diagnóstico foi estabelecido por biópsia de nódulo do epíploon, durante laparotomia para reestadiamento de câncer de ovário após tratamento clínico. Nódulos granulomatosos peritoneais causados por parasitas podem simular metástases, confundindo o estadiamento de neoplasias

A case of abdominal cocoon

Abdominal cocoon is a rare disease of the peritoneum and almost invariably presents as an acute or subacute intestinal obstruction with or without a mass. The etiology of this disease is largely unknown and abdominal cocoon of unknown etiology has been limited to the tropical and subtropical zones and primarily affects young adolescent females. In the temperate zone, only one case has been reported from the United Kingdom, but the patient was also born in Pakistan. No case of abdominal cocoon purely developed in the temperate zone has been reported. Recently, we experienced a case of abdominal cocoon in a 34-year-old female patient(Korean) who had never been abroad. The diagnosis was made postoperatively by reviewing the literature. We herein report this rare condition developed in an unusual geographical location with a brief review of the literature.

Torçäo primária de grande epíploo como causa de abdome agudo / Primary torsion of omentum as cause of acute abdomen

Os autores apresentam um caso de torçäo primária de grande epíploo. O quadro clínico-laboratorial sugeriu apendicite aguda em todos os aspectos. Eles comentam sua incidência e a dificuldade diagnóstica no pré-operatório.