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Two Centimeter D1–2 Anterior Perforation Presenting 24 Hours Later
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Once the diagnosis is confirmed, the patient must be taken up for an emergency exploratory laparotomy after obtaining informed consent. Surgery is the standard treatment for peptic ulcer perforation and should be done as early as possible. The morbidity and mortality rates increase with delayed treatment.
Clinical Features of Colorectal Adenoma and Adenocarcinoma
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Jamie Murphy, Norman S. Williams
If colonoscopy and/or CT colonoscopy are both negative and the patient still has suspicious symptoms, what should be the next course of action? This will depend to some extent on the confidence that one has in the radiological and colonoscopic examinations. It might be that bowel preparation was poor for one of them, or that the operator was relatively inexperienced. In these circumstances, the appropriate procedure should be repeated and the previous fault corrected. If still no cause is found for the patient’s symptoms, the surgeon may be forced to perform a laparoscopy with on-table colonoscopy. With the advent of laparoscopy, exploratory laparotomy is now obsolete.
Trauma Imaging
Published in Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain, On Call Radiology, 2015
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain
In haemodynamically stable patients, CT is the imaging modality of choice. It can be undertaken relatively quickly and provides definitive imaging of the solid organs and bowel, enabling identification of apparent and occult injuries. In unstable patients, CT may not be appropriate given the time taken to transfer and scan the patient. Under these circumstances, it may be more prudent to proceed directly to exploratory laparotomy; this should be discussed with the referring trauma team. Ultrasound can also play a role in trauma imaging of the abdomen and pelvis, and has been shown to be a useful tool in identifying free fluid in unstable patients (Smith & Wood, 2013; Figure 5.19). It can be performed at the patient’s bedside, which may be more appropriate for critically unstable patients who cannot be transferred safely to the CT scanner. Ultrasound may also be more suitable for paediatric patients with a low clinical suspicion of significant injury. While a useful adjunct, it should be emphasised that ultrasound is not as sensitive or specific as CT for traumatic intraabdominal and pelvic injury.
Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report
Published in Gynecological Endocrinology, 2021
Likun Wei, Yanfang Zhang, Xueru Song
The present case had severe OHSS related to multiple pregnancy after ovulation induction. We described the detrimental effect of an internal hernia, strangulated intestinal obstruction, and subsequent intestinal necrosis on the patient’s health. This case highlighted the need for vigilance of surgical acute abdomen in women with OHSS when insufferable abdominal pain cannot be alleviated after conservative treatment, or persistent severe gastrointestinal symptoms are not easily explained by the initial diagnosis. Clinicians should pay more attention to a previous history of abdominal surgery, physical examination results, and imaging results, and seek the consultation of surgeons, in order to make an early diagnosis in acute abdomen. It is necessary to relax the indications of exploratory laparotomy to avoid subsequent severe complications. Triplet pregnancy is a common iatrogenic complication in infertility treatment by ovarian induction. In the present case, pregnancy termination was requested to relieve the progress of OHSS, which was a life-threatening condition. As OHSS can lead to fatal harm in reproductive women, physicians must attach great importance to the risk factors of OHSS and make exact evaluation and intervention during the infertility treatment to decrease the incidence and severity of OHSS.
Primary gastric lymphoma: A report of 16 pediatric cases treated at a single institute and review of the literature
Published in Pediatric Hematology and Oncology, 2020
Nilgün Kurucu, Canan Akyüz, Bilgehan Yalçın, İnci Y. Bajin, Ali Varan, Diclehan Orhan, İbrahim Karnak, Burça Aydın, Tezer Kutluk
In total, 11 patients underwent exploratory laparotomy. Six of them were found to be inoperable, and only biopsy was done. Gastrojejunostomy was performed without resection of the tumor in another patient. Furthermore, in Patient 5, solitary perforation over the gastric body was observed during surgery. The perforation was repaired, and gastrojejunostomy was performed. Subtotal gastrectomy with gastroduodenostomy or gastrojejunostomy was performed in three other patients. Five patients received radiotherapy to the tumor location. In Patient 7, radiotherapy was applied after two courses of chemotherapy because of progressive disease and obstructive jaundice. Chemotherapy could not be continued in Patient 11 because of severe hematological toxicity, and radiotherapy was applied. All patients except two were treated with various chemotherapeutic regimens including LSA2L2 and LMB protocols, depending on year of diagnosis and histopathological subtypes. Malignant lymphoid proliferation in the patient with MZL was resolved after H. pylori eradication.
Acute gastric necrosis caused by a β-hemolytic streptococcus infection: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2020
Carolien Kobus, J. J. van den Broek, M. C. Richir
Despite resuscitation the patient remained hypotensive and in respiratory distress, necessitating intubation and IC transfer. A central venous catheter was placed to administer noradrenalin and broad-spectrum antibiotics (ceftriaxone, metronidazole and gentamycin). An esophagogastroduodenoscopy was performed revealing a livid aspect of the entire stomach with pale areas and partly hemorrhagic mucosa, endoscopically suspicious for ischemia (Figure 1), whereas the esophagus and duodenum showed no abnormality. After which we decided to perform an emergency exploratory laparotomy. The stomach appeared to be entirely ischemic and partially necrotic although there was normal gastric blood supply. Other intestines and intra-abdominal organs showed a normal aspect. A total gastrectomy was executed and a jejunostomy was constructed for enteral feeding.