Browsing by Tema "Abdominal pain"

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A Diagnostic Twist: Cavernous Hemangioma Presenting as Acute Appendicitis
(Medknow, 2025) Jesus Sebastian Luna Medrano; Fiorella Guadalupe Rodriguez Campian; Brigida del Pilar Grecia; A R Castañeda; Rick Jordan; Margarida Rafael; Pedro Merino
Abstract Cavernous hemangiomas are benign vascular tumors relatively frequent in organs such as the skin, central nervous system and bones and exceptionally rare in the gastrointestinal tract. These lesions typically show up as intermittent stomach pain, chronic iron deficiency anemia, or lower gastrointestinal hemorrhage. e present the case of a 16-year-old male with 24 hours of severe right iliac fossa pain radiating to the left ,associated with vomiting , fever and anorexia. Physical exam revealed positive Mc Burney , Rovsing and Blumberg signs. Laboratory tests showed leukocytosis with neutrophilia. Clinical suspicion of acute appendicitis led to exploratory laparotomy.Intraoperatively, a coralliform mass approximately 8 × 10 cm in size was discovered, involving the cecum and the proximal third of the ascending colon. The mass had an ecchymotic appearance.The patient recovered uneventfully, passing stool on postoperative day six, and was discharged in stable condition with a soft diet and scheduled outpatient follow-up. Histopathological analysis confirmed the diagnosis of a cavernous hemangioma. Although the initial clinical suspicion pointed toward acute appendicitis, intraoperative findings revealed a cavernous hemangioma of the colon, an exceptionally rare vascular lesion in this age group and location. Timely surgical management and appropriate postoperative care contributed to a favorable outcome, reinforcing the critical role of early intervention and vigilant clinical follow-up in rare gastrointestinal vascular pathologies. Cavernous hemangioma ,acute appendicitis ,vascular malformation, acute abdominal pain.
Abdomen agudo en el adulto mayor
(Q16635223, 2004) Ricardo Espinoza G; Paulina Balbontín M; Sebastián Feuerhake L; Cecilia Piñera M.
Acute abdomen in the elderly has a high rate of complications and mortality. According to the causes of acute abdomen in this group, evaluation in the emergency setting with an ultrasonography may be very useful. In the elderly, elective correction of potential causes of acute abdomen should be done.
Características clínicas de pacientes internados en el Hospital de Apoyo de Iquitos "César Garayar García" durante la epidemia de dengue, enero-febrero de 2011
(National Institute of Health of Peru, 2011) Víctor Fiestas Solórzano; Moisés Sihuincha Maldonado; Fernando Donaires Toscano; Salomón Durand Velazco; María García M; Enrique Mamani; Juan Carlos Gómez de la Torre
We conducted a clinical description of confirmed dengue cases admitted to the Hospital “ César Garayar García” in Iquitos from January 25 to February 5, 2011. According to current WHO classification, major warning signs leading to hospitalization were: abdominal pain (28/28) and persistent vomiting (15/28), the causes of severity were: hypotension (9 / 13), severe bleeding (6 / 13) and plasma extravasation with respiratory distress (4 / 13). The median patient age was 22 years, however, 8 / 13 patients classified as severe dengue were under 16 years. In conclusion, unlike previous epidemics, we found a high involvement of young people and severity in the clinical presentation predominating a high frequency of shock (hypotension) and vascular leakage, which could be related to the circulation of an emerging variant DENV-2 which is more virulent.
Cation Exchange Resins and colonic perforation. What surgeons need to know
(Elsevier BV, 2015) María Rita Rodríguez‐Luna; Enrique Fernández-Rivera; Joaquín E. Guarneros-Zárate; Jorge Tueme-Izaguirre; José Roberto Hernández-Méndez
ABSTRACT INTRODUCTION: Since 1961 the use of Cation Exchange Resins has been the mainstream treatment for chronic hyperkalemia. For the past 25 years different kind of complications derived from its clinical use have been recognized, being the colonic necrosis the most feared and lethal of all. PRESENTATION OF CASE: We report a case of a 72-year-old patient with chronic kidney disease, treated with calcium polystyrene sulfonate for hyperkalemia treatment who presented in the emergency department with constipation treated with hypertonic cathartics. With clinical deterioration 48 h later progressed with colonic necrosis requiring urgent laparotomy, sigmoidectomy and open abdomen management with subsequent rectal stump perforation and dead. The histopathology finding: calcium polystyrene sulfonate embedded in the mucosa, consistent with the cause of perforation. DISCUSSION: Lillemoe reported the first case series of five uremic patients with colonic perforation associated with the use of SPS in sorbitol in 1987 and in 2009 the FDA removed from the market the SPS containing 70% of sorbitol. The pathophysiologic change of CER goes from mucosal edema, ulcers, pseudomembranes, and the most severe case transmural necrosis. Up to present day, some authors have questioned the use of CER in the setting of lowering serum potassium. Despite its worldwide use in hyperkalemia settings, multiple studies have not demonstrated a significant potassium excretion by CER. CONCLUSION: Despite the low incidence of colonic complication and lethal colonic necrosis associated with the CER clinical use, the general surgeon needs a high index of suspicion when dealing with patients treated with CER and abdominal pain. Highlights
Clip migration after cholecistectomy
(Arán Ediciones, 2021) Alberto García Reyes; M López-Cantarero García-Cervantes; Juan Antonio Bellido Luque; Inmaculada Sánchez-Matamoros Martín; Ángel Nogales Muñoz
We present the case of a 43-year-old female who underwent cholecystectomy with choledochotomy and laparoscopic lithoextraction for choledocholithiasis, who came to the emergency room due to abdominal pain of 3 days' evolution. An abdominal CT scan showed a possible cholangitis with a liver abscess at the level of segment VI, with metal density material near to the lesion. The inflammatory process extended to the right iliac psoas.
[Digestive changes in cholecystectomized patients].
(National Institutes of Health, 1982) Freddy Leonardo Pavón Patiño; R Ponce; J Lora; C Aguilar; Juan José Guillermo Ríos
An important number of cholecystectomized patients after some years of complete well-being, begin complaining of symptoms such as periodic diarrhea or constipation, abdominal pain, regurgitation, vomiting, etc. The purpose of this study is to try to identify an alteration or lesion in the stomach or colon in cholecystectomized patients of more than five years standing, which may be causing the aforementioned condition. The forty patients under observation, free of biliary tract post-operative lesions, were subjected to: hemogram, amylasemia, either infusion cholangiograph or ERCP, fecal parasitological-tests, upper digestive and colon X Ray series, esophagus, stomach and duodenal endoscopy with biopsies. Additionally, ten underwent a colonoscopy which also included biopsy. The result of the radiological, amylasemia and hemogram studies was normal in all cases. The parasitological tests were negative. In every case, a moderate to severe superficial, chronic gastritis was found as well as minor histopathological alterations in the colon mucosa. The presence of bile in both duodenum and colon in interdigestive periods, alterations in the enterohepatic circulation as well as in the biliary composition itself, are suggested as the possible causes of the patients symptoms.
Fatal Dengue, Chikungunya and Leptospirosis Co-Infection: The Febrile Patient in Tropical Areas, Importance of Co-Infection Assessment
(2018) Jaime A. Cardona‐Ospina; Carlos Eduardo Jiménez-Canizales; Heriberto Vásquez-Serna; Jesús Alberto Garzón-Ramírez; José Fair Alarcón-Robayo; Juan Alexander Cerón-Pineda; Alfonso J. Rodríguez‐Morales
Background: The febrile patient from tropical areas, in which emerging arboviruses are endemic, represent a diagnostic challenge and potential co-infections with other pathogens (i.e bacteria or parasites) are usually overlooked. Objectives: We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. Results: An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 hours of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue IgM, NS1 ELISA, MAT for Leptospira interrogans and RT-PCR for chikungunya, were positive. Discussion: This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.
Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas
(Multidisciplinary Digital Publishing Institute, 2018) Jaime A. Cardona‐Ospina; Carlos Eduardo Jiménez-Canizales; Heriberto Vásquez-Serna; Jesús Alberto Garzón-Ramírez; José Fair Alarcón-Robayo; Juan Alexander Cerón-Pineda; Alfonso J. Rodríguez‐Morales
The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and <i>Leptospira interrogans</i> co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for <i>Leptospira interrogans</i> and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.
FRI509 A Girl With Trisomy 21 Presents With Van Wyk-Grumbach Syndrome
(Endocrine Society, 2023) Juan Pablo Hayes Dorado; Marco Antonio Calla Ayala; Andrea Colque Arias; Karem Lanuza Gaite; Marco Rossell Lopez; Daniela Frias Eid
Abstract Disclosure: J. Hayes dorado: None. M. Calla Ayala: None. A. Colque Arias: None. K. Lanuza Gaite: None. M. Rossell Lopez: None. D. Frias Eid: None. Van Wyc-Grumbach syndrome (VWGS) is a rare presentation of long standing prepubertal hypothyroidism characterized by bilateral multicystic enlarged ovaries, vaginal bleeding and delayed bone age. It appeared that high TSH could produce FSH and LH like activity leading to multiple ovarian cysts. A 7-year-old girl with trisomy 21, presented with vaginal bleeding for 2 days prior to admission. Physical exam revealed bradycardia (68 bbm), apathy, sluggishness, as well as dry skin and eyelid oedema. She had no breast development nor pubic hair.Causes of vaginal bleeding such as trauma, possible abuse, foreign body insertion and urethral prolapse were excluded. There was no purpura or bleeding from other sites.The abdominal sonogram revealed bilateral ovarian cystic masses (V:17.29 cm3 and 16.48 cm3, right and left, respectively). Bone age was delayed almost 3 years behind her chronological age. Laboratory tests revealed TSH 860 μIU/mL, T4 0.71 μg/dL, FSH 8.12 mIU/mL, LH &lt; 0.1 mIU/mL, estradiol 193 pg/mL, thyroid peroxidase Abs 184 IU/mL, thyroglobulin Abs 212 IU/mL, Β-hCG &lt; 0.1mU/mL, confirming severe hypothyroidism. The girl was diagnosed with VWGS due to unrecognized chronic lymphocytic thyroiditis and LT4 treatment (75mug/OD) was initiated. The patient responded with complete remission of symptoms and regression of the ovarian cysts one month after initiation of treatment. It is very important to think of VWGS and investigate for thyroid status during the evaluation of ovarian cysts or isolated premature menarche. Early recognition can eliminate unnecessary surgery to remove ovarian cysts, as appropriate treatment with levothyroxine leads to complete remission of symptoms. Even when the diagnosis of VWGS is confirmed, practitioners must be watchful to consider surgical intervention in the presence of uncontrolled vaginal bleeding, hemodynamic instability, or failure of regression of ovarian cysts with exogenous thyroid hormone replacement. Presentation: Friday, June 16, 2023
Hemobilia: A Narrative Review of Current Diagnostic Techniques and Emerging Management Strategies
(Cureus, Inc., 2024) T. Grau Carmona; C. Hooper; Vaidarshi Abbagoni; Haya Al Shakkakee; Aarfa Devani; J. Illan; Valencia Maryjose; Eduardo González; Ilean López Cervantes
Ilheus Virus Infection in Human, Bolivia
(Centers for Disease Control and Prevention, 2012) Erika A. Venegas; Patricia V. Aguilar; Cristhopher D. Cruz; Carolina Guevara; Tadeusz J. Kochel; Jorge Vargas; Eric S. Halsey
To the Editor: Ilheus virus (ILHV) was first isolated from mosquitoes of the genera Ochlerotatus and Psorophora near Ilheus, Bahia, Brazil, in 1944 (1). After its discovery, the virus was also isolated from other mosquito species, including the genera Culex, Sabethes, Haemagogus, and Trichoprosopon, and from a variety of birds in different countries in Latin America (2). Only a few reports describe isolation of this virus from humans in Central and South America with symptoms ranging from subclinical to severe febrile disease (2–6). In mild cases, patients often reported gastrointestinal or respiratory symptoms lasting ≈1 week. In severe cases, either the central nervous or cardiac system can be affected. However, long-term sequelae or deaths have not been described. No epidemics attributed to ILHV have been reported. In November 2005, a 15-year-old boy (farmer) sought medical attention in a health clinic in Magdalena, Bolivia, after having fever for 5 days. The patient’s symptoms included malaise, asthenia, conjunctival injection, vesicular rash, facial edema, arthralgia, myalgias, bone pain, abdominal pain, headache, and earache. Signs of cardiac, neurologic, or renal damage were not detected. A blood specimen was obtained during the clinic visit, and a convalescent-phase sample was obtained 24 days after onset of symptoms. At that follow-up visit, the patient reported a full recovery from his symptoms. Both samples were sent to the Naval Medical Research Unit No. 6 in Lima, Peru, for processing as part of a clinic-based study to determine the etiology of febrile illnesses in Bolivia (7). The study was approved by the Naval Medical Research Unit No. 6 Institutional Review Board (Navy Medical Research Center Detachment 2000.0008) and conducted in collaboration with the Bolivia Ministry of Health. Serologic analyses showed a 64-fold IgM seroconversion between the acute-phase (<100) and convalescent-phase samples (6,400) by using an IgM ELISA as described (8). Samples were also tested by ELISA for the following arboviruses: West Nile virus, dengue virus, Oropouche virus, Guaroa virus, Rocio virus, St. Louis encephalitis virus, yellow fever virus, Venezuelan equine encephalitis virus, and Mayaro virus. All test results were negative for these viruses. Virus isolation was attempted on the acute-phase serum sample by using Vero and C6/36 cells, but the culture did not yield any virus. Attempts to isolate virus by intracranial inoculation in suckling mice were also unsuccessful (University of Texas Medical Branch, Institutional Animal Care and Use Committee protocol 9505045). Viral RNA was extracted from the acute-phase sample and reverse transcription PCR specific for a portion of the nonstructural protein 5 gene was performed by using a described method (9). A 189-bp PCR product was obtained, purified, and sequenced by using flavivirus primers FU1 and cFD2 (9) and further analyzed by using BLAST (www.ncbi.nlm.nih.gov/blast), resulting in ≈95% homology to ILHV. Phylogenetic analysis with neighbor-joining and parsimony methods grouped the nucleotide sequence of the ILHV virus from Bolivia with ILHV strains from Ecuador and Peru (Figure). Figure Phylogenetic analysis of the nonstructural protein 5 (NS5) gene region of 7 Ilheus virus isolates and a 189-bp nt sequence (FMB 202 Bolivia). Alignments were analyzed by using the neighbor-joining method with the Kimura 2-parameter algorithm in MEGA5 ... Magdalena is a tropical city in northern Bolivia that borders Brazil. The city is surrounded by rivers and chestnut fields, and agriculture and fishing are the main sources of employment. Despite having ecoepidemiologic conditions similar to those in other locations with a history of ILHV transmission, the virus had not been detected in the area. The patient had no travel history in the 30 days preceding his illness, indicating that the virus is probably endemic to the area. Mild unspecific symptoms, a short viremic period, and lack of advanced confirmatory laboratory techniques in situ are some of the barriers impeding the diagnosis of ILHV in disease-endemic areas. High levels of antibody cross-reactivity among flaviviruses, which are also endemic to the area, might render diagnosis even more difficult. The presence of the main ILHV vector, Psorophora sp. mosquitoes, in the city suggests that much of the population that labors outdoors may be at risk for ILHV infection.
Isquemia intestinal por trombosis mesentérica en paciente geriátrico, resuelta por intervencionismo. Reporte de caso
(National University of Colombia, 2020) Bianca Eunice López Zenteno; Georgina Cornelio Rodríguez; Eduardo Amador Mena
Mesenteric thrombosis represents a vascular urgency caused by the abrupt interruption of blood flow, whether arterial or venous; clinical presentation can be nonspecific, which can represent a diagnostic challenge. According to its vascular etiology, a different therapeutic approach is required. If there is clinical suspicion or signs of peritonitis, the imaging diagnosis can support to identify the presented pathology. On this occasion, there is a clinical case of an 84-year-old http://doi.org/10.22201/fm.24484865e.2020.63.2.04 | Vol. 63, n.o 2, Marzo-Abril 2020 25 patient who goes to the emergency department for generalized abdominal pain, which led to a diagnostic imaging study, to confirm this finding. Key words: Intestinal ischemia; atherosclerosis; Mesenteric thrombosis; catheterization
OHVIRA syndrome: report of a case in Bolivia
(2024) L. Castedo; Jhossmar Cristians Auza-Santiváñez; Roberto Carlos Jiménez Fernández; Elier Carrera González; Alba Rossio López Castillo; Jorge Soneira Pérez
Introduction: the OHVIRA Syndrome was described by Herlyn Werner Wunderlich and in 1976 Wunderlichdescribed a grouping of right renal aplasia with bicornuate uterus and simple vagina in the presence of an isolated hematocervix, as a characteristic triad uterus didelphys, intercepted hemivagina and ipsilateral renal anomaly, it is generally performed The diagnosis occurs in puberty at the beginning of menarche, with manifest symptoms of progressive dysmenorrhea and non-specific abdominal pain in the hypochondrium; urinary retention, urinary infection or a pelvic mass usually appear.Clinical case: the case of a 13 - year - old patient is presented, who comes to the clinic with abdominal pain andtransvaginal bleeding. Imaging studies are performed and due to the characteristics of said studies, the presence of OHVIRA Syndrome is suspected.Discussion: once the imaging studies were performed and the diagnosis confirmed, a surgical procedure wasperformed under general anesthesia. Through exploratory laparotomy, a bicornuate uterus was visualized, theright uterus larger than the left, and adherence to the abdominal wall, so an open intervention was decided.Conclusions: OHVIRA syndrome coexists with a rare malformation and is often misdiagnosed as other morecommon etiologies of dysmenorrhea in adolescents, as a consequence it delays a correct and early diagnosis,increasing the risk of kidney damage and its complications. In our clinical case, a timely diagnosis was made andsurgical treatment was subsequently planned with a favorable outcome
[Parental perception of their child's pain tolerance and abdominal postoperative analgesic requirements].
(National Institutes of Health, 2014) Eugenio Larragoiti-Correa; Mario Enrique Rendón‐Macías
it is important to identify children perceived as poorly tolerant or not tolerant to pain before a painful procedure, in order to plan an efficient strategy for pain control.
Prevalencia de Blastocystis hominis en Pacientes sintomáticos.
(1996) Sarelie Carrero Sulbarán; María Claudia Pérez; Mirna Pérez Feo; José Eliel Carrero Guerra
Blastocystis hominis is a protozoan potential cause of gastrointestinal diseases. This work is to determine the prevalence of Blastocystis hominis in symptomatic patients and relate it with the presence of other intestinal parasites. There were examined 783 fecal samples from persons of the Santa Juana community, Municipio Libertador, Merida, Venezuela, who attended a private laboratory in the area, referred by a rural physician because they either had gastrointestinal symptoms or need a routine coproparasitescopic test. The samples were directly examined in fresh, progressively stained by lugol and Faust methods. The results showed that the age of the patients was between 1 and 60 years. 40.8% children, 59.11% adults; 51.50% males, 48.40% females; 32.18% symptomatic, 67.18% asymptomatic; 35% parasited, of which 49.5% with B. hominis, 42.85% females, 57.14% males, 15.23% children, 84.76% adults, 93.33% symptomatic, 6.66% asymptomatic. The higher incidence age was between 19 and 30 years. The higher value (17.15%) of other parasites was observed in children. B. hominis was the agent with higher prevalence in symptomatic patients. The severe symptoms (abdominal pain, recurrent diarrhea, abdominal crumbs, anorexia, nausea and vomits) were associated to different types of parasites in tile samples.
Primary peritonitis by Streptococcus pyogenes. A condition as rare as it is aggressive
(Arán Ediciones, 2016) Israel Abellán Morcillo; Antonio González; Pilar Selva Cabañero; Antonio Muñoz Bernabé
We report the case of a 60-year-old female patient who presented to the emergency room for abdominal pain standing with impaired general status, fever of up to 38.7ºC, and somnolence. Upon arrival the patient had a heart rate of 115 bpm, hypotension (80/40 mmHg),acute respiratory distress, and both hepatic and renal failure. During her examination the patient was drowsy and had a diffusely tender abdomen with peritoneal irritation signs. Blood tests revealed 22,000 WBCs (82%N), CRP 32.4 mg/dL, total bilirubin 3.2 mg/dL, GOT 300 U/L, GPT 160 U/L, LDH 200 U/L, AP 310 U/L, 91,000 platelets, creatinine2.3 mg/dL, and PA 64%. An abdominal CT scan was performed, which revealed a minimal amount of free intraperitoneal fluid with no other findings. Given the patient's poor status an exploratory laparoscopy was carried out, which found a moderate amount of diffuse purulent exudate, particularly in interloop and lesser pelvis areas, with no additional findings. Following surgery she was transferred to the intensive care unit on wide spectrum antibiotics .Peritoneal exudate cultures from the surgical procedure revealed Streptococcus pyogenes. The patient had a favorable outcome being subsequently discharged from hospital at day 10 after the procedure. S. pyogenesis a beta hemolytic streptococcus well known as a cause of pharyngotonsillar, skin and soft tissues infection. Primary peritonitis by S.pyogenesis a rare condition with only a few isolated cases reported. PP cases by S.pyogenes predominantly involve previously healthy young women. PP diagnosis is usually retrospective, when other causes have been ruled out by surgery and culture is positive post hoc. An appropriate differential diagnosis from conditions such as gram-negative shock, staphylococcal toxic shock, meningococcal disease, viral infection, etc., is crucial. Abdominal CT may be helpful but a variable amount of free intraperitoneal fluid is usually the only finding. The surgical approach is usually laparoscopy in experienced sites. Attentive monitoring at an intensive care unit and adequate antibiotic therapy are key in association with surgery. There is no clear consensus on the antibiotics to be used for severe infection with S.pyogenes; empirical amoxicillin-clavulanic is usually the initial choice, followed after microbiological confirmation by clindamycin and a third-generation cephalosporin.
Pseudo aneurism of right hepatic artery. Uncommon complication
(Elsevier BV, 2016) M. Goitia-Durán; M. Saavedra Pozo
Re-emergence of Chapare hemorrhagic fever in Bolivia, 2019
(Elsevier BV, 2020) Caitlin M. Cossaboom; A Ramírez; Carla Romero; Maria Morales-Betoulle; Guerra Vega; Jhemis T. Molina Gutiérrez; Roxana Loayza Mafayle; J.C.A. Ardaya; Sánchez Martínez; M. Cruz Zambrana
Refractory abdominal pain resistant to medical management as the main manifestation of ischemic gallbladder
(Elsevier BV, 2024) Sofía Morales-González; Francisco E. Domínguez; Luis Alfonso Rodríguez-Palomares
In the present paper, we discuss the importance of clinical evaluation by presenting three cases whose diagnosis was acute cholecystitis.Their clinical presentation was characterized by abdominal ischemic pain, with no data of acute complicated cholecystitis in imaging or laboratory studies.However, during surgical procedures, the gallbladders of all three patients were found in an ischemic phase.We observe that conventional studies are not able to identify gallbladder ischemia before the surgery.Contrasting computed tomography must be used, but we emphasize that clinical suspicion must be obtained.
Spontaneous Splenic Rupture Case Report: an Approach to Anatomy Importance for Radiological Correlation
(Wiley, 2020) Roberto Javier Rueda‐Esteban; Juan Daniel Pedraza-Rodriguez; Diego Ontiveros Ramírez; Felipe Perdomo
Spontaneous splenic rupture (SSR) is a rare entity , usually associated with hematologic malignancies, infectious processes or inflammatory diseases. Timely diagnosis by ultrasound and/or computed tomography allows early clinical and/or surgical management , reducing the mortality . Our aim is to expose, through a clinical case of SSR, the importance of anatomy knowledge and its radiological correlation in medical education. A 26‐year‐old man, diagnosed with chronic myeloid leukemia (CML) without chemotherapy treatment, attends to the emergency department for 10/10 (VAS) colic pain in the right inferior abdominal quadrant, irradiated to the ipsilateral inguinal region, associated with non‐emetic nauseas, abdominal distention and dysuria. At presentation, heart rate was 80 beats/minute, respiratory rate 18 breaths/minute, blood pressure 123/71 mmHg, temperature 36.0 ° C and SatO2 87%. Initial workup positive findings were leukocytosis (270.000/mm3), low hemoglobin (11.2 g/dL) and hematocrit (33.3%), thrombocytosis (925.000 platelets), and Hypokalemia (2,96 mEq/L). Abdominal computed tomography showed hepato‐splenomegaly and a poorly defined lesion with irregular borders, infiltration and vascular tracts on the spleen inferior segment. Considerable accumulation of free liquid in the abdominal cavity was present. After 2 hours the patient reported an increase in pain, associated to abdominal guarding and rebound tenderness. Heart rate of 134 beats/minute, respiratory rate 30 breaths/minute, blood pressure 150/70 mmHg, SatO2 84% and metabolic acidosis (pH 7.0). Based on the suspicion of hypovolemic shock, an emergency xipho‐pubic laparotomy was performed, finding a 1500cc hemoperitoneum, active bleeding, clots and splenic segments. Complete splenectomy was selected obtaining a surgical specimen (spleen) of 2 Kg, 32 cm in cephalo‐caudal length, and a lower pole rupture. Patient’s postoperative evolution was satisfactory, specific treatment for CML was initiated and he was discharged 14 days after the surgical procedure. An early diagnosis is crucial for the reduction of morbidity and mortality in patients suffering a SSR. This is carried out through the proper interpretation of diagnostic images. This clinical approach requires a broad body anatomy knowledge, and the capacity to extrapolate it to a bidimensional representation. Several researchers confirm that the inclusion of diagnostic‐images in the anatomy curriculum leads to an early exposure of medical student to these tools, which improves their imaging interpretation and diagnostical skills . Finally, the implementation of these diagnostic tools in the anatomy program could lead to better medical practice and, as seen in this case, to a reduction on mortality.