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.

Frequency of endometriotic lesions in peritoneum samples from asymptomatic fertile women and correlation with CA125 values / Frequência de lesões endometrióticas em amostras de peritônio de mulheres férteis assintomáticas e correlação com valores de CA125

CONTEXT AND OBJECTIVE: Serological testing for CA125 has been widely used to detect endometriosis and to monitor its progression. However, controversy still exists regarding the usefulness of the plasma CA125 assay for diagnosing endometriosis. Furthermore, some authors have described superficial endometriosis as a cyclical and normal phenomenon in women's lives, and have indicated that development and progression of this disease would only occur in some women as a result of immunological changes. This study aimed to determine the frequency of endometriosis and the correlation between serum CA125 levels and the presence of endometriotic lesions in the peritoneum of asymptomatic fertile patients. DESIGN AND SETTING: Cross-sectional study at the Family Planning outpatient clinic of Faculdade de Medicina do ABC. METHODS: Eighty asymptomatic fertile patients who underwent tubal sterilization surgery were studied. Blood and peritoneum samples were collected. CA125 levels were measured from blood samples, and peritoneum biopsies were studied using histopathological tests. RESULTS: Histopathological evaluation of the peritoneum revealed that 16.25 percent of the patients had minimal or mild endometriosis. There was no statistically significant difference in CA125 levels between patients with and without endometriosis. CONCLUSION: The presence of endometriotic lesions in the peritoneum of fertile patients supports the hypothesis that incidental findings of minimal or mild endometriosis may not be of clinical significance, and that the progression of the disease probably occurs as a result of immunological and genetic abnormalities. Serum CA125 levels did not show any diagnostic significance with regard to detecting the disease.

CONTEXTO E OBJETIVO: O teste sorológico para CA125 tem sido largamente usado para detectar e monitorar a progressão da endometriose, entretanto, a utilidade do ensaio do CA125 plasmático para o diagnóstico da endometriose ainda é controversa. Além disso, alguns autores descreveram a endometriose superficial como sendo um fenômeno cíclico e normal na vida de uma mulher, e que o desenvolvimento e progressão desta doença ocorreriam apenas em algumas mulheres como resultado de alterações imunológicas. Este estudo teve como objetivo determinar a freqüência de endometriose e a correlação entre os níveis séricos de CA125 e a presença de lesões endometrióticas em peritônio de pacientes férteis assintomáticas. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado no Ambulatório de Planejamento Familiar da Faculdade de Medicina do ABC. MÉTODOS: Foram estudadas 80 pacientes férteis assintomáticas submetidas à cirurgia de esterilização tubária. Amostras de sangue e peritônio foram coletadas. Os níveis de CA125 foram medidos a partir das amostras de sangue e as biópsias de peritônio foram estudadas por ensaio histopatológico. RESULTADOS: O estudo histopatológico do peritônio revelou que 16,25 por cento das pacientes apresentavam endometriose mínima e leve. Os níveis de CA125 não demonstraram diferença estatística significante entre pacientes com e sem endometriose. CONCLUSÃO: A presença de lesões endometrióticas em peritônio de pacientes férteis reforça a hipótese de que achados acidentais de endometriose mínima e leve podem não ter significância clínica, e que é provável que a progressão da doença ocorra como resultado de alterações genéticas e imunológicas. Os níveis séricos de CA125 não demonstraram significância diagnóstica para a detecção da doença.

Disseminated tuberculosis presenting as mesenteric and cerebral abscess in HIV infection: case report

Disseminated tuberculosis in HIV infection involves multiple organs. Pulmonary and lymph node involvement are the commonest form of tuberculosis in HIV infection [1, 2]. Other forms of tuberculosis in the absence of lung and lymph node involvement are rare. Various forms of abdominal [3, 4] and neurological [5, 6] tubercular involvement in HIV infection have been reported. But tuberculosis presenting simultaneously with mesenteric and brain abscess has not been reported yet. We report a case of disseminated tuberculosis presenting as mesenteric and cerebral abscess in a HIV case without involving lung and lymph nodes. Bone marrow smears and fine needle aspiration cytology (FNAC) from mesenteric lesion were positive for acid fast bacilli (AFB) and the diagnosis of tuberculosis was confirmed by positive polymerase chain reaction (PCR). He responded well to treatment with anti tubercular drugs.

Omental cyst masquerading as ascites.

Two children presented with massive generalised enlargement of abdomen simulating ascites. Common medical causes being excluded. They were treated with antituberculous drugs without any response until the radiological features suggested and surgical exploration proved the condition to be omental cyst.

Hematoma retroperitoneal espontáneo: Caso clínico / Spontaneous retroperitoneal hematoma: Report of one case

Spontaneous retroperitoneal hematoma is a rare condition. We report a 78 year-old man with progressive pain in his right thigh and hip lasting one week. The pain subsequently was associated with abdominal pain in the right lower quadrant. Physical examination revealed pain to deep palpation of the area, associated with a diffuse positive rebound pain. An abdominal and pelvis CT scan showed an extensive mesenteric hematoma. During surgery, a large retroperitoneal encapsulated hematoma, without evidence of active bleeding, was found and drained. Pathology confirmed the diagnosis and was negative for cancer.

Primary omental torsion: Two case reports

To describe two cases of primary omental torsion as an uncommon cause of abdominal pain. Two female patients presented to our surgical service with right-sided abdominal pain. In view of their clinical presentation and workup, both patients required operative intervention. At laparotomy, the cause of the pain was recognized to be due to infarcted omentum secondary to torsion. Both patients underwent omentectomy and appendectomy and had an uneventful recovery. Primary torsion of the omentum is difficult to diagnose preoperatively; this condition is usually detected during surgical exploration for acute abdominal pain

A Case of Primary Omental Torsion Presenting as an Acute Abdominal Pain / 대한소화기학회지

Torsion of greater omentum is a rare cause of acute abdomen. However, it should be included in the differential diagnoses in addition to acute cholecystitis, acute appendicitis, cecal diverticulitis, and other variable causes of acute abdomen. Diagnosis is usually made at laparotomy for suspected appendicitis. In some cases, computed tomography demonstrates a successful preoperative detection of omental torsion. We report a case of surgically and pathologically proven torsion with subsequent infarction of greater omentum presented as an acute abdominal pain.

Abdominal Wall Endometrosis after Cesarean Section / 대한소화기학회지

No abstract available.

Hepatic hydatid cysts with biliary, and peritoneal rupture and transdiaphragmatic migration.

Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a vital role in the diagnosis of this disease. Rupture of the cyst can give rise to a wide spectrum of complications. We describe a case of hepatic hydatid cyst with rupture into the biliary tree, right pleural cavity and dissemination into the peritoneal cavity, with associated splenic hydatid cysts. MRI may be a useful non-invasive diagnostic tool in such disseminated cases to define the complete extent of the disease.

Omental cyst--a rare entity.

A case of omental cyst in a young girl who presented with distension and a lump in abdomen and having difficulty in micturition is reported. Pre-operative diagnosis was achieved by ultrasonography. An exploratory laparotomy with excision of cyst was done and histopathologic examination of the specimen confirmed the diagnosis. The postoperative course was uneventful. The aetiopathogenesis, special features of the disease and review of literature is discussed.

Primary omental torsion in children. the pre-disposing factors and role of laparoscopy in diagnosis and treatment

To determine the predisposing factors and to evaluate the role of laparoscopy in the diagnosis and management of primary omental torsion in children. We retrospectively reviewed the clinical records of all children treated for primary omental torsion from August 1999 to December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. Demographic data, clinical presentation, diagnostic and therapeutic modalities were evaluated. Follow-up was also obtained. Six children were included in the study. Their age ranging between 9-12 years [average 10.4 years]. All of them presented with right lower quadrant [RLQ] pain mimicking appendicitis. The duration of symptoms varied from 3-5 days prior to presentation. Localized RLQ tenderness with guarding was demonstrated in all patients. All children were noted to be obese. Only one patient had low grade fever and nausea. None of the patients had an elevated white blood cell count. Laparoscopic exploration was carried out in all cases for possible appendicitis. Appendix was found to be normal and torted omentum was clearly seen in all cases. The infarcted omentum was removed laparoscopically; all patients had uneventful recovery and were discharged on second postoperative day. Pathological examination showed necrotic infarcted omentum with no other abnormalities. Follow-up documented complete resolution of the patient's symptoms. Clinical presentation of primary omental torsion mimics that of acute appendicitis. Its diagnosis is usually difficult and almost impossible pre-operatively. Obesity, paucity of gastrointestinal symptoms and relatively long duration of symptoms should increase the index of suspicion. We believe that the laparoscopic approach is an excellent tool for the diagnosis and treatment for the primary omental torsion

Omental torsion: a case report.

Omental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy.

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.

Maniobra de movilización del pedículo mesentérico superior / Mobilizing maneuver of the superior mesenteric pedicle

Se realiza una investigación bibliográfica, con el fin de actualizar la base anátomo-embriológica y los objetivos de la maniobra de movilización del pedículo mesentérico superior en cirugía general y determinar la prioridad en su creación, basados en el análisis de los trabajos originales referidos a esta maniobra. Se concluyó que la prioridad en su empleo correspondió a los autores Petrov y Koundadzé de Rusia, quienes la emplearon para alargar la porción del intestino utilizada en las esofagoplastias, mientras que los autores norteamericanos Cattell y Braasch la realizaron para mejorar el acceso a las porciones 3ª y 4ª del duodeno y al ángulo duodeno-yeyunal, 10 años después(AU)

A bibliographic investigation was made aimed at updating the anatomicoembriological base and the objectives of the mobilizing maneuver of the superior mesenteric pedicle in general surgery and at determining the priority in its creation, based on the analysis of the original papers referring to this maneuver. It was concluded that the priority in its use corresponded to the Russian authors Petrov and Koundadzé, who used it to enlarge the portion of the intestine utilized in the esophagoplasties, whereas the US authors Cattell and Broasch performed it to improve the access to the 3rd and 4th portions of the duodenum and to the duodeno-jejunal angle, 10 years later(AU)

Inflammatory myofibroblastic tumor.

Inflammatory myofibroblastic tumors are well described in lung and upper respiratory tract of young adults and children. Intra-abdominal forms of the disease are reported to occur most frequently in the liver, followed by stomach, bowel and spleen. A 13-year-old girl who had intermittent fever ranging from 99-101 degrees F of three months period and significant weight loss was referred as a case of pyrexia of unknown origin. The patient was subjected to laparotomy. A solid mass was found arising from the mesentery, four feet from the iliocaecal junction and was adherent to the wall of ileum. The patient became afebrile after the removal of the mass and has gained weight and remained well during the ten months since discharge.