Postpartum spontaneous subcapsular hepatic hematoma related to preeclampsia.

Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum.

Cecal lipoma presenting as acute intestinal obstruction in an elderly woman: a case report.

Colonic lipomas are rare nonepithelial tumors that are usually detected incidentally during surgery or colonoscopy. Although lipomas generally remain asymptomatic, when they exceed 2 cm of diameter they may cause abdominal pain, obstruction, or intussusception. Here we present a case of an elderly woman referred by her general practitioner to a general hospital of Crete because of acute abdominal pain along with signs of intestinal obstruction and a positive history of appetite loss. Abdominal computed tomography was performed. To marginalise the risk of malignancy, a right hemicolectomy was performed. Histopathological examination of the resected specimen confirmed the diagnosis of cecal lipoma.

Acute torsion of a wandering spleen in a post-partum female: A case report.

INTRODUCTION: Wandering spleen is a rare condition characterized by ectopic position of the spleen due to the absence or laxity of peritoneal ligaments that hold the organ within the left upper quadrant. Lower abdomen and pelvis are the most common locations of the wandering spleen. The disorder usually remains asymptomatic. PRESENTATION OF CASE: We present a case of acute abdomen due to torsion of a wandering spleen in a primiparus, healthy female shortly after delivery. Diagnosis was based on ultrasonography and computed tomography and was confirmed later on surgery. Total splenectomy was performed successfully. DISCUSSION: The rarity of the condition and the nonspecific clinical symptoms and signs make prompt diagnosis challenging. CONCLUSION: Prompt recognition and intervention are necessary in order to minimize the risk of complications. For this reason physicians have to include the condition in the differential diagnosis of acute abdominal pain especially when they encounter females in a pregnancy or post-natal period.

Massive gastrointestinal bleeding due to isolated jejunal varices in a patient without portal hypertension.

INTRODUCTION: Isolated ectopic varices located in the small bowel are uncommon. Portal hypertension caused by liver cirrhosis is the most common predisposing risk factor. PRESENTATION OF CASE: We present an unusual case of massive gastrointestinal bleeding from idiopathic jejunal varices in a 73-year-old Caucasian male without portal hypertension. Exploratory laparotomy disclosed ectopic varices located in the small intestine. Segmental resection of the jejunum with end to end anastomosis resulted in a complete resolution of the haemorrhage. During a 5 year follow up, the patient is stable with no bleeding recurrence. DISCUSSION: Information on aetiology, diagnosis and management of jejunal varices is reviewed. CONCLUSION: Diagnosis and management of isolated jejunal varices is challenging. Surgeons as well as acute care physicians have to consider idiopatic form of jejunal varices as a potential cause of gastrointestinal bleeding when gastroduodenoscopy and colonoscopy are negative.