ABSTRACT
Early pain management with opioid by patients admitted for abdominal pain is widely contested. Emergency physicians are feared to interfere with physical examination and the ability to make a correct diagnosis. The present review tends to show that opioids are safe in this context. The authors consider that early provision of pain management, even with opioids, should be effective.
Subject(s)
Abdomen, Acute/diagnosis , Abdomen, Acute/drug therapy , Analgesics/therapeutic use , Emergency Medicine , Humans , Physical ExaminationABSTRACT
Isolated agenesis of the gallbladder (AG) is a rare anomaly. Twenty-three percent of the patients are symptomatic and present with right upper abdominal pain, nausea and fatty food intolerance. The condition is frequently mistaken with excluded or sclero-atrophic gallbladder, regardless of the imaging modality used. Consequently, AG leads often to unnecessary and potentially dangerous surgery. During laparoscopy, the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to dissect the triangle of Callot represent an increased risk of iatrogenic injury to biliary or portal structures. The aim of this study is to discuss the pitfalls of the available radiological exams and the management of this rare condition. We describe two cases of AG, with a review of the literature. A high index of suspicion is necessary when interpreting the radiological images. In case of doubt, a MRI-cholangiography is mandatory. Because of possible inherited transmission, relatives with a history of biliary symptoms should be investigated, even when asymptomatic.
Subject(s)
Digestive System Abnormalities/diagnosis , Gallbladder/abnormalities , Adult , Aged , Cholangiography , Diagnosis, Differential , Digestive System Abnormalities/surgery , Fibrosis , Gallstones/diagnosis , Gallstones/surgery , Humans , Laparoscopy , Liver Function Tests , Male , Tomography, X-Ray ComputedABSTRACT
Arrow wounds are very rare. We present herein a case of hilar penetrating thoracic trauma caused by an arrow, and a review of the literature, to clarify the management of these cases and their indications for surgery. Depending on the type of arrowhead, the tissue elasticity can narrow the wound track around the shaft of the arrow, sometimes causing a tamponade effect. In the mediastinal or hilar area, an arrow should not be removed before an injury to the major blood vessels or the heart has been ruled out.
