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Epiploic appendagitis is a benign and self-limiting condition that has garnered more recognition, particularly in preoperative settings, thanks to advancements in imaging techniques, notably computed tomography (CT). Its distinct radiologic features facilitate accurate diagnosis prior to surgery. Despite its unique characteristics, the clinical presentation of epiploic appendagitis often resembles that of various other intra-abdominal medical and surgical conditions, leading to potential confusion. Here, we present the case of a 37-year-old otherwise healthy woman who was diagnosed with primary epiploic appendagitis based on CT scan findings conducted initially for suspected appendicitis. The patient received successful conservative treatment. This paper seeks to highlight the importance of recognizing this clinical condition and its characteristic imaging features, aiming to prevent unnecessary hospitalizations, antibiotic treatments, and the associated morbidity and mortality linked with surgical interventions.

RESUMEN

BACKGROUND: Adenocarcinoma has the highest incidence among malignant tumors of the small intestine (SI). Squamous cell carcinoma (SCC) often occurs in organs covered with squamous epithelium. Primary or metastatic SCC originating from the SI is very rare, with very few cases reported in the literature. CASE SUMMARY: This case report involves a 69-year-old man who developed abdominal pain after lunch. After admission, an abdominal computed tomography scan revealed perforation of the alimentary canal and multiple abnormal low-density lesions in the liver. During laparotomy, an approximately 4 cm × 3 cm-sized solid tumor was found in the jejunum, located 30 cm from the Treitz ligament, with a perforation. An intestinal segment of approximately 15 cm was removed, including the perforated portion. The pathological result was SCC. In combination with liver imaging, a diagnosis of SI SCC with multiple liver metastases was considered. The patient died from hepatic failure 1 mo after the operation. CONCLUSION: SI tumors are very rare compared to those originating in other digestive organs. Due to its insidious onset, the diagnosis of this disease is usually delayed. Clinicians must pay close attention to digestive symptoms such as persistent abdominal pain and melena.

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N,N-dimethylformamide (DMF) is a major solvent predominantly used in the chemical industry. The main toxic effects following exposure to DMF are gastric irritation, skin eruption and hepatotoxicity. However, hepatic failure induced by DMF is rare. In this report, we present a case of acute hepatic failure following exposure to a toxic dose of DMF via respiratory tract inhalation and skin absorption with detailed abdominal computed tomography scan, sequential laboratory data and polymorphisms. The patient recovered satisfactorily following artificial liver support therapy and pharmacological agents to protect the liver in addition to plasma, blood platelet and albumin transfusions. In view of the high mortality rate and rare occurrence rate of acute hepatic failure, the clinical characteristics, polymorphisms and therapeutic strategy of DMF poisoning are discussed.

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Retroperitoneal fibrosis (RPF) is rare. It is characterized by the gradual transformation of retroperitoneal adipose tissue into a fibrous mass surrounding the aorta, the inferior vena cava and the urinary tract responsible for progressive alteration in the renal function. It usually manifests as lumbar pain associated with renal failure and biologic inflammatory syndrome. We report 12 cases of retroperitoneal fibrosis in order to determine its clinical, radiological and therapeutic features. We conducted a retrospective study of 12 patients with retroperitoneal fibrosis whose medical data were collected in the Departement of Urology at the University Hospital Hassan II, Fes over a period of 9 years (2005-2013). The study involved ten men and two women. Clinical symptomatology was very variable, dominated by lumbar pain in all patients and hydrocele in 1 patient. Laboratory tests showed renal failure in all patients and inflammatory syndrome in 10 patients. The diagnosis of retroperitoneal fibrosis was suspected in all patients on ultrasound showing obstruction of the upper urinary tract without visible obstacle. The diagnosis was confirmed by abdominal CT scan without contrast that objectified a retroperitoneal tissue lesion enveloping the vessels and the urinary tract. Nine patients had idiopathic retroperitoneal fibrosis. Two patients had perianeurysmal fibrosis and one patient had post-radiation fibrosis. All patients underwent urinary drainage by double J. ureteral catheter. Seven patients underwent corticosteroid therapy. Six patients had an improvement of clinical and laboratory test outcome with disappearance of pain and improvement of the general condition. This study confirms the rarity of retroperitoneal fibrosis, the difficulty of diagnosis, pain associated with inflammatory syndrome and renal failure as common manifestations. Abdominal CT scan without contrast is the gold standard for definitive diagnosis. Urinary drainage is essential in most cases as well as regular monitoring of patients.

Asunto(s)

Dolor de la Región Lumbar/etiología , Insuficiencia Renal/etiología , Fibrosis Retroperitoneal/diagnóstico , Adulto , Anciano , Aorta/patología , Drenaje/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Fibrosis Retroperitoneal/complicaciones , Fibrosis Retroperitoneal/fisiopatología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Vena Cava Inferior/patología

RESUMEN

Acute epiploic appendagitis is a relatively rare cause of lower abdominal pain that clinically mimics other acute abdomen conditions that require surgery such as acute diverticulitis or appendicitis. Here, we report a case of a 50-year-old lady who presented with an unusual lower abdominal pain. Awareness of such a clinical condition with its characteristic imaging findings is important to avoid costly hospitalization, unnecessary antibiotic courses, and the morbidity and mortality associated with surgical procedures.

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Dynamic postural control ability is necessary for fall prevention in our daily lives. It has been suggested that dynamic postural control ability is highly related to the muscles in the trunk as well as the lower limbs for the keep and move of the body. In this study, we reveal relationship between dynamic postural control ability and abdominal area. Subjects including 31 middle-aged people consist of 12 men and 19 women (mean age 60.0±7.6 years). We measured visceral fat area and cross-sectional area of the trunk muscle using abdominal computed tomography scan. The unstable tilt board is used for measuring dynamic postural control ability. Through multiple regression analysis, it is possible to relate dynamic postural control ability from gender, visceral fat, and deep trunk muscle such as psoas major muscle on abdominal computed tomography scan. It is considered that dynamic postural control ability involved not only increasing the volume of deep trunk muscle but also decreasing the amount of visceral fat.

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BACKGROUND: Spontaneous sub-capsular or peri-renal haemorrhage (Wunderlich syndrome) is a rare condition that involves a diagnostic challenge. In many cases, bleeding leads to haemodynamic instability that may be life threatening. Therefore, it is important to have a high clinical suspicion for timely action. OBJECTIVE: This paper highlights the experience of the Urology Department of the Western National Medical Center of the Mexican Institute of Social Security. METHODS: Retrospective study of consecutive non-randomized sampling. The Emergency Service Registry was reviewed for all admissions from 1 January 2010 to 31 December 2013 to identify patients with non-traumatic spontaneous retroperitoneal haemorrhage. Patient charts were reviewed to determine sex, age, vital signs, laboratory and imaging results, associated diseases, management, and outcomes. RESULTS: A total of 11 patients met the inclusion criteria for the study. All patients were received in the Emergency Department referred from secondary care hospitals. None of them were referred with a diagnosis of spontaneous retroperitoneal haemorrhage. The diagnosis was made in 100% of patients with abdominal CT scan. All patients received urgent surgical management on the day of admission due to haemodynamic instability. Ten patients underwent nephrectomy. Histopathological findings included, among others, angiomyolipoma, renal carcinoma, and metastatic hepatocellular injury. CONCLUSIONS: Spontaneous retroperitoneal haemorrhage is a lethal condition if not detected on time. The abdominal CT scan is the most accurate diagnostic method for detection. Surgical management is necessary in patients with haemodynamic instability.

Asunto(s)

Diagnóstico Precoz , Hemorragia/diagnóstico , Hemorragia/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal , Estudios Retrospectivos

RESUMEN

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) injections are increasingly being used as an alternative to traditional perioperative analgesia in the abdominal region. With the use of a "blind" TAP block technique, these procedures have had variable success in cadaver and in vivo studies. For more accurate injection with the intended medication, ultrasound guidance allows visualization of the correct layer of the abdominal wall planes in which the thoracolumbar nerves reside. OBJECTIVE: To assess the spread of various volumes of contrast placed under live ultrasound guidance into the TAP using computed tomography (CT). METHODS: Four TAP blocks were performed on 2 fresh frozen cadaver torsos with predetermined contrast volumes of 5, 10, 15, or 20 mL. A CT scan of the cadaver was then performed and interpreted by a musculoskeletal radiologist. This cadaver study was carried out at a tertiary care academic medical center. RESULTS: Cranial-caudal spread of injected contrast correlated with increasing injectate volume and was roughly 1 vertebral level (end plate to end plate) for the 5 mL injection and 2 vertebral levels for the 10, 15, and 20 mL injections. However, the degree of injectate spread may be different for live patients than for cadavers. CONCLUSION: This study helps further the understanding of injectate spread following ultrasound-guided TAP injections. Specifically, it suggests that 15 mL provides additional cranial-caudal spread and may be an optimal volume of anesthesia.