ABSTRACT
Spontaneous diaphragm rupture is extremely rare. Usually a diaphragm rupture is trauma induced. We describe a case of an 18-year old patient admitted 2 hours after onset, presenting severe epigastric and left sided chest pain without any trauma history. Upright chest x-ray revealed displaced stomach and colon into the left pleural cavity with a collapsed left lung. Surgery for a left-sided diaphragm rupture with stomach, spleen and colon splenic flexure herniation was undertaken. We present a brief review regarding the aetiology, diagnostic and treatment policy of spontaneous diaphragmatic rupture.
Subject(s)
Hernia, Diaphragmatic/diagnostic imaging , Hernia, Diaphragmatic/surgery , Adolescent , Colonic Diseases/etiology , Diagnosis, Differential , Follow-Up Studies , Hernia, Diaphragmatic/complications , Humans , Male , Pneumothorax/etiology , Radiography , Rupture, Spontaneous , Splenic Diseases/etiology , Stomach Volvulus/etiology , Treatment OutcomeABSTRACT
Pseudomyxoma peritonei (PMP) is rare being characterized by intraperitoneal accumulation of mucinous ascites produced by neoplastic cells, mostly originating from a perforated appendiceal adenoma. The clinical signs of the disease are variable, and preoperative diagnosis is often difficult. We describe the clinical case of a 67-year-old patient referred to our unit one month after a left inguinal hernia repair, presenting clinical signs compliant with PMP. Surgical cytoreduction, peritonectomy, appendectomy, and greater omentectomy with perioperative intraperitoneal chemotherapy were performed. The patient was disease free for a 15 month period when he died apparently due to a cardiac event. We advocate that in all cases of gelatinous fluid in a hernia sac PMP must be suspected, thus histological investigation is mandatory as well as abdominal computed tomography (CT) in order to confirm the diagnosis.
Subject(s)
Hernia, Inguinal/etiology , Peritoneal Neoplasms/diagnosis , Pseudomyxoma Peritonei/diagnosis , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Appendectomy , Appendiceal Neoplasms/diagnosis , Appendiceal Neoplasms/surgery , Cystadenoma, Mucinous/diagnosis , Cystadenoma, Mucinous/surgery , Fatal Outcome , Follow-Up Studies , Heart Diseases/complications , Hernia, Inguinal/surgery , Humans , Injections, Intraperitoneal , Male , Perioperative Care , Peritoneal Neoplasms/complications , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/surgery , Pseudomyxoma Peritonei/complications , Pseudomyxoma Peritonei/drug therapy , Pseudomyxoma Peritonei/surgery , Reoperation , Risk Factors , Treatment OutcomeABSTRACT
Bleeding from duodenal varices is a rare, but often fatal manifestation of portal hypertension and these ectopic varices are more common in extrahepatic portal venous obstruction. There are over 160 cases of duodenal varices reported in the English literature. A 47-year-old female presented with massive hematemesis and prolonged shock. Initial endoscopy revealed non-bleeding small esophageal varices and large varices in the first portion of the duodenum with spurting bleeding. Endoscopic hemostasis was obtained with 5 detachable nylon loops. Portal hypertension was caused by liver cirrhosis and postthrombotic portal cavernoma. To the best of our knowledge this is the first case of successful mini-loop ligation of bleeding duodenal varices reported in the literature.
