Delayed small bowel perforation due to blunt abdominal trauma and periappendicitis in a patient with situs inversus totalis: a report of a case.

BACKGROUND: Delayed intestinal perforation after blunt trauma is very rare. Peri-appendicitis is the serosal inflammation of the appendix, which is generally caused by extra-appendicular sepsis. Our purpose is to present this case with delayed ileum perforation after blunt trauma and peri-appendicitis. CASE REPORT: A 29-year-old male patient presented with abdominal pain starting from the left lower region, diffusing to all regions. He had a history of a blunt trauma to the left lower quadrant of the abdomen, caused by a wooden block springing from a press machine seven days before. There were no pathological signs in his first evaluation but at the radiological scanning after 16 hours, free air was detected under the left diaphragm. In the abdomen, CT dextrocardia, situs inversus totalis and minimal free liquid near the caecum was found. At laparotomy, a 0.5 cm perforation was observed, localised at the distal ileum and the appendix was oedematous and hyperaemic, consistent with acute inflammation. Resection of the injured bowel and appendectomy were performed. At the pathological examination, the perforation area was non-specific and peri-appendicitis was found. CONCLUSION: Delayed postraumatic perforation of the intestine occurs as a result of ischaemia. There is no reported case of a patient with situs inversus totalis. If acute abdomen is the case even with a history of minimal abdominal trauma, delayed intestinal trauma should be considered in the diagnosis. Peri-appendicitis secondary to intestinal perforation, which is a rare condition, should come to mind at the diagnosis.

Pseudoaneurysm of the renal interlobar artery in Behçet's disease.

Behçet's disease is a rare clinical event characterized by recurrent oral and genital ulcers, and iridocyclitis. Vascular involvement is a rare but serious form of the disease. We present a case of renal interlobar artery pseudoaneurysm occurring in a 20-year-old male patient with a 5-year history of Behçet's disease, who had been admitted because of right flank pain. Findings obtained on abdominal ultrasonography, abdominal computed tomography, and renal angiography confirmed a right renal pseudoaneurysm and subcapsular hematoma.

Visceral adipose tissue as an indicator of insulin resistance in nonobese patients with new onset type 2 diabetes mellitus.

BACKGROUND: Obesity and type 2 diabetes mellitus are characterized by insulin resistance. We determined the relationship between insulin resistance and visceral adipose tissue (VAT) and their correlation with bioimpedance analysis in nonobese new onset type 2 diabetes patients. METHODS: A number of 30 new onset type 2 diabetes patients and 20 healthy control subjects with similar features, age between 45 - 72 years old, BMI < 27 kg/m (2), C-peptide > 0.6 nmol/L, were included in study. Fasting blood glucose, HbA1c, serum lipids, BMI, insulin, C-peptide, HOMA-IR, bioimpedance analysis and visceral and subcutaneous adipose tissue (by computed tomography) were measured. RESULTS: In the patient group, VAT was significantly higher compared to healthy control group (33.17 +/- 10.23 % vs. 16.53 +/- 7.85 %, p < 0.001). In the patient group VAT was correlated with HOMA-IR (r = 0.62, p = 0.003), but no significant correlation was observed between VAT and bioimpedance analysis. CONCLUSIONS: The amount of VAT is significantly higher in nonobese new onset patients with type 2 diabetes than the healthy control group. In these patients, VAT measured by CT is an important indicator of insulin resistance. Although bioimpedance analysis can give an idea about total body fat and obesity, it is not sufficient in evaluating fat distribution and therefore is not effective in predicting insulin resistance.