Prevention of type II endoleak by laparoscopic inferior mesenteric artery ligation.

Abdominal aortic aneurysm repair by endovascular techniques have gained wide acceptance as a treatment option. A potential well-known complication of endovascular repair includes endoleak. Specifically, type II endoleak, which is described as retrograde flow into the aneurysm sac through collateral vessels, can occur in up to 30% of patients. Certain preoperative factors can predict which patients may develop type II endoleak. This article describes laparoscopic inferior mesenteric artery ligation prior to endovascular abdominal aortic aneurysm repair as a viable treatment option in the prevention of type II endoleak.

Successful conservative treatment of spontaneous splenic rupture secondary to Babesiosis: a case report and literature review.

Babesiosis is caused by a protozoan parasite of the genus Babesia. In the United States, the usual infective organism Babesia microti, is most commonly transmitted through the bite of an infected Ixodestick. While the majority of patients exhibit sub-clinical signs and symptoms, significant illness can result. Spontaneous splenic rupture is a life-threatening complication of some viral and protozoan infections. We present a case of Babesiosis with spontaneous splenic rupture in which conservative management with blood transfusions and hospital-based care were successful, and the patient was spared splenectomy. To our knowledge, this is the first reported case treated without splenectomy. Our successful experience suggests conservative management may be appropriate for some patients.

Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis.

HYPOTHESIS: Use of a modified clinical grading score improves accuracy in diagnosing acute appendicitis in the pediatric population while decreasing the use of computed tomography (CT). DESIGN: Retrospective medical records review after approval by the institutional review board. We determined the Alvarado score for each patient and correlated it with the pathological findings and imaging studies to evaluate the efficacy of CT and its attendant radiation exposure. SETTING: Community teaching hospital. PATIENTS: Sixty-one patients, aged 3 to 16 years, admitted with suspected acute appendicitis. MAIN OUTCOME MEASURES: Sensitivity, specificity, and accuracy of the modified Alvarado scoring system. RESULTS: The standard Alvarado score for acute appendicitis had a sensitivity of 92% and a specificity of 82%, with an accuracy of 92%. In the modified Alvarado scoring system, CT findings were substituted for Alvarado scores in the ranges of 5 or 6, 5 to 7, 5 to 8, and 5 to 9. The modification resulted in the greatest accuracy (98%) in diagnosing appendicitis in patients with scores in the range of 5 to 7. This modification theoretically would have decreased the use of CT by about 27% in this group of retrospectively studied patients. Furthermore, in patients with Alvarado scores of 1 to 4, another diagnosis should be considered; in patients with scores of 5 to 7, CT should be performed; and, in patients with scores of 8 to 10, an appendectomy should be performed promptly without further studies. CONCLUSIONS: The modified Alvarado score is useful as an aid in diagnosing acute appendicitis in the pediatric population. This scoring system eliminates unnecessary use of CT and the attendant potential cancer-inducing radiation in the pediatric population.

Difficulty in identifying a bleeding Meckel's diverticulum: case report and review of the literature.

Meckel's diverticulum is the most commonly occurring congenital anomaly of the gastrointestinal tract. Diagnosis is usually made by scintigraphy using 99Tc(m) pertechnetate, with low accuracy in adults. We describe a case report and review the literature for difficulties in identifying a recurrent bleeding Meckel's diverticulum. Our patient had a "bladder diverticulum" on scintigraphy, which led to delay in diagnosis. The use of bladder lavage during scintigraphy may assist in distinguishing a Meckel's diverticulum from a bladder diverticulum.