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Endometriosis
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ceana Nezhat, Pavan Ananth, Dahlia Admon
A 28-year-old woman presented to the emergency department with right-sided chest and shoulder pain, followed by sudden-onset epigastric pain and vomiting, during her menstrual period. Her history was significant for recurrent pneumothoraces, hemoptysis, chest pain, and fevers during the preceding 18 months, each time associated with the onset of menses, and she had undergone bilateral apical pleurectomies as a result. On examination, she was hypotensive and tachycardic, with diffuse abdominal tenderness, rebound, and guarding. Chest x-ray showed free air under the right hemidiaphragm, and the decision was made for emergent laparotomy due to suspected perforated abdominal viscus. Intraoperatively, there was turbid free fluid in the right paracolic gutter but no other significant abdominal or pelvic pathology. The diaphragmatic surfaces were not evaluated. She recovered well until her next menstrual period, at which point she again became febrile with hemoptysis and a right-sided hemothorax. A right-sided open lung biopsy was performed, which revealed a lesion at the right lung base containing hemorrhagic tissue and eosinophilic infiltrate consistent with endometriosis. Most likely, peritonitis occurred as a result of fluid draining from her thoracic cavity into the abdominal cavity through a defect in the diaphragm, either from a diaphragmatic fenestration or from the erosion of an endometriotic implant through the diaphragm. The patient was then started on a gonadotropin-releasing hormone agonist to suppress menstruation with resolution of her symptoms.
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
If these are not expanding or pulsatile, blunt injuries are best left alone, as the damage is usually renal. Renal injuries can generally be managed non-operatively including the use of selective embolization. However, with penetrating injury, because of the risk of damage to adjacent structures such as the ureter, it is safer to explore lateral haematomas. The surgeon must also be confident that there is no perforation of the posterior part of the colon in the paracolic gutters on either side.
Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 50-year-old builder is involved in a high-speed RTA. CT is performed according to trauma protocol, demonstrating extra-peritoneal rupture of the bladder. Which of the following best describes this? Contrast pooling in the paracolic gutters.Contrast outlining small bowel loops.Flame-shaped contrast seen in the perivesical fat.CT cystogram is usually normal.Intramural contrast on CT cystogram.
Incidentally found mucinous epithelial tumors of the appendix with or without pseudomyxoma peritonei: diagnostic and therapeutic algorithms based on current evidence
Published in Acta Chirurgica Belgica, 2021
Wim Ceelen, Marc De Man, Wouter Willaert, Gabrielle H. van Ramshorst, Karen Geboes, Anne Hoorens
When the diagnosis is made on imaging studies, the first step is to exclude extra-appendiceal disease using either CT scan or diffusion-weighted MR imaging. When PMP is found, the appropriate algorithm applies (Figure 2). When the disease is limited to the appendix, the patient should undergo a (laparoscopic) appendectomy that should encompass the mesenteriolum, which is a peritoneal duplicature that connects the appendix with the mesentery of the ileum. In patients with large mucinous tumors (e.g. mucocele), care must be taken to avoid rupture and spillage of the cystic contents. When the tumor extends to the base of the appendix, a caecal wedge resection should be performed. During the same procedure, the peritoneal surfaces should be thoroughly inspected. Areas at risk include the right iliac fossa, right paracolic gutter, right diaphragmatic surface, greater omentum, and pelvic peritoneum. Any suspicious lesions should be biopsied. In female patients, the ovaries are frequently involved and should be carefully inspected.
Traumatic jejunal perforation associated with SARS-CoV-2 (COVID-19) infection
Published in Baylor University Medical Center Proceedings, 2021
Jonathan Kopel, Luong Linda, Irfan Warraich, Grant Sorensen, Gregory L. Brower
The patient had two large lacerations in the right periorbital region. An obvious open right ankle fracture with the talus extruded from the ankle wound and deformity to the right thumb were noted. Computed tomography (CT) of the head showed a large subgaleal hematoma with areas of active bleeding in the right frontoparietal region measuring up to 9 cm in the transverse and 2 cm in the vertical dimensions, without underlying calvarial fracture. No acute intracranial abnormality or fracture in the cervical spine was noted. CT of the body with contrast showed a small amount of free fluid in the right paracolic gutter and the cul-de-sac. There was a nondisplaced fracture of the left first rib. The patient had an elevated white blood cell count (14,760/mm3), with neutrophilia (12,720/mm3) and lymphopenia (1,170/mm3). She was also found to be positive for COVID-19 using the Abbott ID NOW COVID-19 rapid nucleic acid amplification test from nasal swab samples collected before surgery. The patient did not report any symptoms related to COVID-19 or recall any known exposures or contacts.
Intraabdominal continuous negative pressure therapy for secondary peritonitis: an observational trial in a maximum care center
Published in Acta Chirurgica Belgica, 2020
V. Müller, S. K. Piper, J. Pratschke, W. Raue
A swab for microbiological investigation was obtained. After completion of source controlling surgery, the abdominal cavity was rinsed with 8–10 L physiological Ringer Solution. Afterwards, the Suprasorb® sheet was inserted covering the complete intestinal organ package. Special attention was payed to reach the paracolic gutters, the subphrenic and pelvic spaces. In cases of interenteric abscesses, additional sheets were placed between the intestinal loops. A polyurethane foam was inserted between the sheet and the inner abdominal wall. The fascial edges of the laparotomy were approximated with interrupted dynamic sutures ensuring sufficient effluent possibility as described elsewhere [21]. The dressing was completed with an epifascial polyurethane foam and an air-tight adhesive film. Negative pressure of 50 mmHg was applied and continuously maintained until the planned relaparotomy 48 h after initial insertion. At this time, the complete dressing was either changed regarding the same criteria as during the initial operation or the fascia was closed with running resorbable sutures if there was no reasonable suspicion for ongoing peritonitis left. In case of unstable fascial edges or a retraction preventing a tension-free approximation, a resorbable mesh was implanted and the wound prepared for only cutaneous closure, secondary granulation or plastic surgery.