Encapsulated Mesenteric Fat Necrosis
A 33-year-old female presented at the emergency department with a 36-hour history of peri-umbilical pain associated with anorexia and nausea. On physical examination, she was tender to palpation in the right lower quadrant. Psoas sign was absent, and there was no rebound tenderness. Laboratory examination revealed slightly elevated neutrophil count and elevated C-reactive protein. Her past medical history was unremarkable.Appendicitis was suspected and abdominal ultrasound was performed, which demonstrated an oval hyperechogenic mass with a hypo-echogenic rim in the right para-umbilical region (Figure A). There was maximal probe tenderness at that point. The appendix was not well seen. Subsequent CT showed a round, encapsulated mass with predominantly fat attenuation located in the right para-umbilical region (Figures B and C). There were no calcifications present within the mass. No enhancement was seen after intravenous contrast administration. The appendix appeared normal.These imaging findings, associated with the clinical presentation of the patient, led to the diagnosis of encapsulated mesenteric fat necrosis. Published on 2016-03-31 18:35:09
We present a clinical case of a 9-year-old overweight girl with OI, whose diagnosis was based on imaging diagnostics and enabled conservative treatment with no complications. The case we have described confirms that the conservative treatment is an effective and safe therapy.
ConclusionHypothyroidism should be considered in patients with protracted postoperative ileus after abdominal surgery.
The classic findings of acute appendicitis –right lower quadrant (RLQ) pain, anorexia, and leukocytosis–have been well known to physicians since the mid twentieth century. However, emergency medicine and surgical providers continue to rely on imaging to confirm the diagnosis. We aimed to evaluate the increase in reliance on computed tomo graphy (CT) scans for diagnosis of acute appendicitis over time.
Abstract INTRODUCTION: The classic findings of acute appendicitis-right lower quadrant pain, anorexia, and leukocytosis-have been well known. However, emergency medicine and surgical providers continue to rely on imaging to confirm the diagnosis. We aimed to evaluate the increase in reliance on computed tomography (CT) scans for acute appendicitis diagnosis over time. METHODS: We conducted a retrospective study of patients ≥18 years presenting to UNC Hospitals with signs and symptoms of acute appendicitis who subsequently underwent appendectomy from 2011 to 2015. Demographic, clinical, laboratory, and path...
We report a 42-year-old male who appeared in the morning in the emergency department with abdominal pain localized in the right lower abdomen and associated with anorexia and nausea. Clinical examination, laboratory tests, and abdominal ultrasound revealed deep tenderness at Mc Burney point and a mild elevation of CRP (0.7 mg/dL). In the evening, the symptoms were exacerbated, and a diagnostic laparoscopy was performed. Intra-operatively, the appendix was normal and a twisted, necrotic epiploic appendage originating from the antimesenteric border of the mid ascending colon was found. Laparoscopic resection of the necrotic ...
We report on a 13-year-old boy who presented with right iliac fossa pain associated with anorexia, tenderness, guarding and rebound tenderness. Abdominal ultrasound showed findings of acute appendicitis. However, laparoscopy revealed a wooden toothpick perforating MD and a hyperemic appendix. The FB was removed and laparoscopic diverticulectomy and appendectomy performed. Perforation of MD by a FB is a diagnostic challenge and it should be included in the differential diagnosis of acute abdomen in children.
BY JEFFREY LOMBARDO, MD, &MARK SUPINO, MDThe progressive suprapubic pain was a cunning symptom.The 38-year-old man had had five days of that pain and dysuria. By the time he presented to our ED, his pain had spread to the right lower quadrant as well. He had a history of diverticulitis after a laparoscopic left hemicolectomy four years earlier.He reported no fevers, but complained of nausea and diarrhea. He was afebrile at 36.8°C with a pulse of 76 bpm. All other vital signs were normal. Physical exam was significant for suprapubic pain and right lower quadrant tenderness to palpation without rebound, guarding, ...
A 20-year-old man presented to the Emergency Department (ED) with 3 days of constant abdominal pain that waxed and waned in intensity. He was seen in the ED 2 days prior, at which time his appendix was not well visualized on computed tomography (CT) of the abdomen and pelvis with i.v. contrast only. Symptoms included anorexia, loose stool, subjective fevers, and cramp-like periumbilical and right lower quadrant pain. The patient denied blood in his stool or vomiting. Vital signs were normal. Physical examination demonstrated tenderness in the right lower abdomen and periumbilical region.
Conclusion Although infection with R. planticola is typically benign when treated appropriately, this pathogen has homology with Klebsiella species, and has the potential to acquire antimicrobial resistance. The case presented here suggests that R. planticola should be considered as a potential source of bacteremia in inflammatory/infectious gastrointestinal tract diseases even in the absence of typical risk factors.
This article discusses tips and pitfalls in diagnosis and addresses many of the controversies that surround the management of this condition.