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Acute Abdomen as a Clinical Presentation of COVID-19-Associated Multisystem Inflammatory Syndrome in Children. 作为 COVID-19 相关多系统炎症综合征临床表现的儿童急性腹部。
IF 0.6 Q4 SURGERY Pub Date : 2024-07-31 eCollection Date: 2024-01-01 DOI: 10.1155/2024/9941131
Elmira Hajiesmaeil Memar, Fatemeh Tahghighi, Sedigheh Yousefzadegan, Parisa Sadeghirad, Ashraf Mousavi, Ramin Zare Mahmoudabadi, Hossein Saeidi, Mehri Ayati, Sahar Naderi, Sara Memarian, Seyedmusa Zeinalabedin, Bahar Ashjaei, Hojatollah Raji, Leila Tahernia, Hosein Alimadadi, Vahid Ziaee

Background: On December 2019, a novel coronavirus disease (COVID-19) spread worldwide and became a pandemic. Multisystem inflammatory syndrome in children (MIS-C) due to cytokine release syndrome following COVID-19 presents with various manifestations. We hypothesize that one of the rare manifestations is acute abdomen. Case Presentation. In this case series, eight cases (five girls and three boys) of gastrointestinal (GI) involvement and acute abdomen were reported to be associated with the cytokine storm due to COVID-19 infection. All patients were of Iranian nationality (Caucasian ethnicity), with a mean age of 8.9 years (range 3.5-14). They all presented with fever and acute abdominal pain. Additionally, maculopapular rash and edema of the extremities were common presentations. Free fluid on abdominal ultrasound or computerized tomography (CT) scan was observed in all patients. All cases tested positive for COVID-19. In six cases, laparotomy or abdominal surgery was performed for a diagnosis of acute abdomen, but appendicitis was confirmed in only one case. None of the cases presented with phlegmon. Elevated serum lipase and amylase levels were noted in two cases. Seven patients received corticosteroid pulse therapy. Clinical symptoms improved after one or two doses, and all patients were discharged after 4 weeks of follow-up with no mortality or morbidity.

Conclusion: Patients experiencing unexplained acute abdominal pain along with fever, skin rash, and peripheral edema, who had a history of COVID-19 infection prior to or during the episode of acute abdomen symptoms, should be considered to have MIS-C. Furthermore, methylprednisolone pulse therapy could be a safe treatment option, reducing hospitalization duration in this patient population.

背景:2019年12月,一种新型冠状病毒疾病(COVID-19)在全球范围内传播并成为大流行病。由 COVID-19 引起的细胞因子释放综合征(Cytokine release syndrome)导致的儿童多系统炎症综合征(MIS-C)表现多种多样。我们推测其中一种罕见的表现是急腹症。病例展示。在本病例系列中,有 8 例(5 名女孩和 3 名男孩)胃肠道(GI)受累和急腹症与 COVID-19 感染引起的细胞因子风暴有关。所有患者均为伊朗籍(高加索人种),平均年龄为 8.9 岁(3.5-14 岁不等)。他们均表现为发热和急性腹痛。此外,斑丘疹和四肢水肿也是常见表现。所有患者的腹部超声波或计算机断层扫描(CT)均可观察到游离液体。所有病例的 COVID-19 检测结果均呈阳性。在六例病例中,为诊断急腹症进行了开腹手术或腹部手术,但只有一例确诊为阑尾炎。所有病例均无痰。两例患者的血清脂肪酶和淀粉酶水平升高。七名患者接受了皮质类固醇脉冲治疗。所有患者均在随访 4 周后出院,无死亡或发病情况:结论:出现不明原因的急性腹痛并伴有发热、皮疹和外周水肿的患者,如果在出现急性腹痛症状之前或期间有 COVID-19 感染史,应考虑感染 MIS-C。此外,甲基强的松龙脉冲疗法也是一种安全的治疗方法,可缩短这类患者的住院时间。
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引用次数: 0
A Rare Cause of Pain in a Patient Following Roux-en-Y Choledochojejunostomy. 胆总管空肠吻合术(Roux-en-Y Choledochojejunostomy)术后患者疼痛的罕见原因。
IF 0.6 Q4 SURGERY Pub Date : 2024-07-25 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5536057
Kristiana Sather, Matthew Wheelwright, Guru Trikudanathan, Gregory Beilman

Introduction: Sump syndrome is a rare complication following bilioenteric anastomosis, most commonly following choledochoduodenostomy. This is only the third case in the literature of sump syndrome of the distal common bile duct (CBD) following end-to-side Roux-en-Y choledochojejunostomy (RYCJ). Case Presentation. A 69-year-old man with a history of end-to-side RYCJ for recurrent primary choledocholithiasis presented 3 years postoperatively with right upper quadrant (RUQ) abdominal pain affecting his quality of life. The work up revealed mild leukocytosis and computed tomography (CT) imaging that showed dilation of the distal CBD remnant. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with the removal of large amounts of debris with initial resolution of his pain, but the pain recurred after several months and after two further ERCPs with only short-term resolution of pain, he eventually underwent an open distal CBD excision and the pain has since resolved.

Conclusions: This case report describes a rare case of sump syndrome following RYCJ that presented with abdominal pain alone. Sump syndrome may have a wide array of presenting symptoms, and the pathophysiology of sump syndrome varies based on bilioenteric reconstruction. Although it has rarely been reported to occur in the distal blind CBD remnant following either RYCJ or hepaticojejunostomy, it is important to consider this in the differential for patients with abdominal pain following any bilioenteric reconstruction.

简介结石综合征是胆肠吻合术后的一种罕见并发症,最常见于胆总管吻合术后。这是文献中第三例端侧 Roux-en-Y 胆总管空肠吻合术(RYCJ)后远端胆总管(CBD)出现底盘综合征的病例。病例介绍。一名 69 岁的男性曾因复发性原发性胆总管结石接受过端侧 RYCJ 手术,术后 3 年出现右上腹疼痛,影响了生活质量。检查发现轻度白细胞增多,计算机断层扫描(CT)成像显示 CBD 远端残余扩张。他接受了内镜逆行胰胆管造影术(ERCP),清除了大量残渣,疼痛得到初步缓解,但几个月后疼痛再次复发,又接受了两次ERCP,疼痛仅得到短期缓解,最终他接受了开放性CBD远端切除术,疼痛自此缓解:本病例报告描述了一例罕见的 RYCJ 术后尾闾综合征病例,患者仅表现为腹痛。肿块综合征的表现症状多种多样,根据胆肠重建的不同,肿块综合征的病理生理学也各不相同。虽然很少有报道称 RYCJ 或肝空肠吻合术后 CBD 远端盲端残留物会出现这种情况,但对于任何胆肠重建术后出现腹痛的患者来说,在鉴别时考虑到这一点非常重要。
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引用次数: 0
Radiation-Induced Low-Grade Glioma following Radiotherapy for Squamous Cell Carcinoma of the Scalp: Case Report and Literature Review. 头皮鳞状细胞癌放疗后放疗诱发的低级别胶质瘤:病例报告和文献综述。
IF 0.6 Q4 SURGERY Pub Date : 2024-07-09 eCollection Date: 2024-01-01 DOI: 10.1155/2024/1907435
Moayad M Z Ahmed, Fawaz E M Abdelradi, Rabee A ELfeel

Introduction: Radiation-induced gliomas (RIGs) were reported in the literature in general. In most of the reported cases and the reviewed articles, patients have a history of primary intracranial tumors like craniopharyngioma, medulloblastoma, and ependymoma, and the commonly resulting secondary tumors are meningiomas and sarcomas, mainly not gliomas. Case Presentation. A 50-year-old woman had a history of left scalp temporal region periauricular squamous cell carcinoma, which was verified by the histology result of a biopsy 11 years ago. On the basis of that, she began receiving low-dose radiation sessions when she was 39 years old. She exhibits cranial symptoms and a radiological sign of cancer 9 years later. After a successful excision procedure, histology revealed diffuse astrocytoma Grade 2. Our case is suspected to fit the criteria for being identified as RIG, which is a syndrome that is thought to occur infrequently in the literature.

Conclusion: In conclusion, the way that this condition manifested in our case is considered rare due to old age and the low doses of radiation received. Despite being an important part to confirm the diagnosis, genetic studies were unfortunately not done in our case, but we mainly based on the criteria mentioned by Cahan et al., which are mainly taken from the clinical history and histopathology. Here, we present an example of considering such a diagnosis when suspected clinically, but a genetic study for confirmation should be thought of even if it is not available in the locality.

前言放射诱导胶质瘤(RIGs)在文献中多有报道。在大多数报道的病例和综述文章中,患者都有原发性颅内肿瘤病史,如颅咽管瘤、髓母细胞瘤和上皮瘤,常见的继发性肿瘤是脑膜瘤和肉瘤,主要不是胶质瘤。病例介绍。一名 50 岁的女性曾患左侧头皮颞区耳周鳞状细胞癌,11 年前的活组织检查结果证实了这一点。在此基础上,她在 39 岁时开始接受低剂量放射治疗。9 年后,她出现了头颅症状和癌症放射学征兆。切除手术成功后,组织学显示为弥漫性星形细胞瘤 2 级。我们的病例被怀疑符合 RIG 的鉴定标准,而这种综合征在文献中并不常见:总之,由于患者年龄较大,接受的辐射剂量较低,我们病例中的表现方式被认为是罕见的。尽管基因研究是确诊的重要依据,但遗憾的是,我们并没有对我们的病例进行基因研究,而是主要依据 Cahan 等人提到的标准,这些标准主要来自临床病史和组织病理学。在此,我们举例说明,如果临床上怀疑有这种诊断,即使当地没有遗传学研究,也应考虑进行遗传学研究以确诊。
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引用次数: 0
Total Thickness Bilateral Rupture of the Rectus Abdominis: A Case Report and Literature Review. 腹直肌全厚度双侧断裂:病例报告与文献综述
IF 0.6 Q4 SURGERY Pub Date : 2024-07-09 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8868853
Dernas Suhail, Olivia Smith, Philip Lim, Srinivas Chintapatla

Rupture of the rectus abdominis is a rare condition. We describe the case of a young male trainee paratrooper who presented with sudden onset severe lower abdominal pain that occurred during military training. Magnetic resonance imaging revealed full-thickness bilateral rupture of the rectus abdominis. Our management involved injecting botulinum toxin into the rectus muscles preoperatively, reconstructing the rectus muscles, and placing a supportive biosynthetic mesh. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks. As there is no consensus on the management of this rare injury, we conducted a literature review on all cases reporting rupture of the rectus abdominis from the year 2000. After comparing the outcomes of conservatively versus surgically managed patients, we can conclude that generally, management of such defects is dependent on size, severity, and patient factors; however, surgical treatment yields comparable results to conservative treatment.

腹直肌断裂是一种罕见病。我们描述了一例年轻男性受训伞兵的病例,他在军事训练期间突发剧烈下腹痛。磁共振成像显示他双侧腹直肌全厚度断裂。我们的治疗方法包括术前在直肌内注射肉毒杆菌毒素,重建直肌,并放置支撑性生物合成网片。术后,患者在 3 周时可以无痛行走,10 周时可以无痛慢跑,25 周时可以跑 2 英里。由于对这种罕见损伤的处理尚未达成共识,我们对 2000 年以来所有报告腹直肌断裂的病例进行了文献回顾。在比较了保守治疗和手术治疗患者的疗效后,我们得出结论:一般来说,此类缺损的治疗取决于缺损的大小、严重程度和患者因素;不过,手术治疗与保守治疗的效果相当。
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引用次数: 0
Complete Transection of the Abdominal Wall Secondary to Being a Rear Seat-Belted Passenger. 后排座位乘客继发腹壁完全横断。
IF 0.6 Q4 SURGERY Pub Date : 2024-06-27 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4335543
Jamshed Zuberi, Yousef Masoudpoor, Severija Saladziute, Emma Morel, Daniel Garcia, Diya Khetan, Erem Tutal, Natasha Becker, Peter Park, Stephanie Bonne

Garrett and Braunstein introduced the concept of the "seat belt sign" in motor vehicle collision (MVC) victims. They defined this as abdominal wall bruising from a lap belt. These signs of trauma are not uncommon. However, "seat belt syndrome," a pattern of musculoskeletal and internal organ injuries resulting from deceleration forces exerted by the safety device is rarely seen. Here, we illustrate a case of traumatic closed rupture of the rectus abdominis muscle secondary to seat belt injury. This potential injury is important to recognize and our case will illustrate the need for careful imaging review and clinical assessment to identify associated intra-abdominal injuries.

加勒特和布劳恩斯坦提出了机动车碰撞(MVC)受害者 "安全带征兆 "的概念。他们将其定义为腹带造成的腹壁瘀伤。这些创伤征兆并不少见。然而,"安全带综合症",一种因安全装置产生的减速力而导致的肌肉骨骼和内脏器官损伤的模式,却很少见。在此,我们展示了一例因安全带损伤而导致的腹直肌创伤性闭合性断裂。识别这种潜在的损伤非常重要,我们的病例将说明有必要进行仔细的影像检查和临床评估,以识别相关的腹内损伤。
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引用次数: 0
The "Little-Old-Lady's Hernia", Obturator Hernia: A Case Report and Literature Review. 老太太的疝气"--闭孔疝:病例报告和文献综述。
IF 0.6 Q4 SURGERY Pub Date : 2024-06-18 eCollection Date: 2024-01-01 DOI: 10.1155/2024/1039438
Enrique Salazar-Rios, Alexa Cruz Olascoaga

Obturator hernias, though rare, are clinically significant abdominal hernias, predominantly affecting elderly, thin women, with an estimated prevalence of less than 1%. The primary treatment involves surgical intervention to reduce and repair the defect, either through laparotomy or laparoscopy, with bowel resection needed in up to 75% of patients. Here, we present the case of an 83-year-old woman presenting with abdominal pain and a history of constipation. An abdominal computed tomography scan demonstrated a left obturator hernia with small bowel obstruction. Successful reduction of the hernia was achieved, albeit requiring intestinal resection via an open surgical approach. Subsequently, the patient achieved complete recovery.

腹股沟疝虽然罕见,但在临床上是一种重要的腹部疝气,主要影响老年、瘦弱的女性,发病率估计不到 1%。主要治疗方法是通过开腹手术或腹腔镜手术进行手术干预,以缩小和修复缺损,多达 75% 的患者需要切除肠道。在此,我们介绍了一名 83 岁女性的病例,她因腹痛和便秘而就诊。腹部计算机断层扫描显示其左侧闭孔疝伴有小肠梗阻。尽管需要通过开腹手术切除肠道,但成功缩小了疝气。随后,患者完全康复。
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引用次数: 0
Non-Islet Cell Tumor Hypoglycemia Secondary to a 20 cm Intra-Abdominal Leiomyoma in a Male Patient: A Case Report and Literature Review. 一名男性患者因 20 厘米腹腔内子宫肌瘤导致的非胰岛细胞瘤低血糖症:病例报告和文献综述。
IF 0.6 Pub Date : 2024-06-14 eCollection Date: 2024-01-01 DOI: 10.1155/2024/6651107
Michelle D Lippincott, James D McDonald, Marilyn M Bui, Ricardo J Gonzalez, Rachel K Voss

Non-islet cell tumor hypoglycemia (NICTH) is a rare clinical entity associated with large mesenchymal tumors. Its pathogenesis is most commonly mediated by tumor overproduction of "big" insulin-like growth factor-2. Here, we present a 54-year-old male who presented with noninsulin-mediated hypoglycemia and a 20 cm intra-abdominal leiomyoma. His hypoglycemic episodes resolved after the resection of his tumor. To our knowledge, this is the only documented case in the English literature of NICTH associated with leiomyoma in a male patient. NICTH due to a benign leiomyoma should be in the differential diagnosis for any patient with hypoglycemia and an abdominal mass.

非胰岛细胞肿瘤性低血糖症(NICTH)是一种与大型间质肿瘤相关的罕见临床症状。其发病机制最常见的是肿瘤过量分泌 "大 "胰岛素样生长因子-2。在此,我们介绍一名 54 岁的男性患者,他出现了非胰岛素介导的低血糖症,腹腔内有一个 20 厘米长的子宫肌瘤。肿瘤切除后,他的低血糖症状缓解。据我们所知,这是英文文献中唯一一例男性患者伴有子宫肌瘤的 NICTH 病例。对于任何伴有低血糖和腹部肿块的患者,良性子宫肌瘤引起的 NICTH 都应列入鉴别诊断范围。
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引用次数: 0
An Epiphrenic Diverticulum with Previous Perforation Excised Laparoscopically. 腹腔镜下切除曾有穿孔的虹膜外憩室
IF 0.6 Pub Date : 2024-06-12 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3556567
Amitabh Yadav, Samiran Nundy

An epiphrenic diverticulum (ED) is a rare pseudodiverticulum commonly located at the lower end of the oesophagus. Surgical treatment is only required in patients with worsening dysphagia or repeated chest infection due to microaspirations, and most patients are now treated with minimally invasive surgery (MIS) using the laparoscopic or thoracoscopic approach. Laparoscopic surgery is considered difficult in the presence of previous perforation of the diverticula owing to the intraperitoneal and mediastinal adhesions and is associated with an increased incidence of complications. We were able to perform a laparoscopic transhiatal resection safely on a patient who had a large ED with a wide neck and dense abdominal and mediastinal adhesions due to previous localized perforation.

上膈憩室(ED)是一种罕见的假性憩室,通常位于食道下端。只有吞咽困难恶化或由于微小憩室导致反复胸部感染的患者才需要手术治疗,目前大多数患者都采用腹腔镜或胸腔镜微创手术(MIS)治疗。由于腹腔内和纵隔粘连,腹腔镜手术被认为在憩室穿孔的情况下很难进行,而且并发症的发生率也会增加。我们对一名ED较大、颈部较宽、腹腔和纵隔粘连致密的患者安全地实施了腹腔镜下经食管憩室切除术。
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引用次数: 0
Uncommon Presentation of a Perforated Appendicitis Leading to Duodenal Fistula: Case Report and Literature Review. 穿孔性阑尾炎导致十二指肠瘘的罕见表现:病例报告和文献综述。
IF 0.6 Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8269752
Jad El Bitar, Hani Maalouf, Souad Ghattas, Ribal Aby Hadeer, Ahmad Younes, Hind Rahban, Ziad El Rassi

Multiple types of fistulas associated with the appendix have been reported; however, duodenal fistula resulting from perforated acute appendicitis has only been documented in one previous case. In this report, we present the case of an 18-year-old male patient who was diagnosed to have a complicated appendicitis in its normal position with abscess formation. He was started on IV antibiotics and underwent a CT-guided drainage of the abscess with drain placement. Two days later due to biliary output from the drain, CT fistulography and diagnostic laparoscopy were performed that revealed the presence of a duodenal fistula. The potential for duodenal fistula formation in patients with complicated appendicitis must always be taken into consideration. Consequently, it is crucial to establish an appropriate management plan aimed at preventing additional serious complications arising from duodenal perforation.

与阑尾相关的瘘管有多种类型,但因急性阑尾炎穿孔而导致十二指肠瘘的病例仅有一例。在本报告中,我们介绍了一名 18 岁男性患者的病例,他被诊断为复杂性阑尾炎,阑尾位置正常,并有脓肿形成。他开始静脉注射抗生素,并在 CT 引导下进行了脓肿引流术,同时放置了引流管。两天后,由于引流管排出胆汁,医生为他进行了CT瘘管造影和诊断性腹腔镜检查,结果显示存在十二指肠瘘。必须始终考虑到复杂性阑尾炎患者十二指肠瘘形成的可能性。因此,制定适当的管理计划以防止十二指肠穿孔引起其他严重并发症至关重要。
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引用次数: 0
Giant Ganglioneuroma of the Lumbar Spine: A Rare Cause of Radiculopathy 腰椎巨型神经节瘤:放射病的罕见病因
IF 0.6 Pub Date : 2024-05-23 DOI: 10.1155/2024/9477892
Lina Altalhi, Abdulaziz Alayyaf, Mohammed Bin-Mahfooz, Duaa Alhumoudi, Ali Alkhaibary, Fahd AlSufiani, Ali H. Alassiri, Saad AlQahatani, Sami Khairy, Ahmed Alkhani
Background. Ganglioneuroma (GN) is a rare, benign tumor that originates from neural crest cells and can potentially affect any anatomical site within the sympathetic nervous system. Typically, GNs are more frequently reported in children and young adults, with a slightly higher prevalence in females. We are reporting a rare case of a giant lumbar spine ganglioneuroma by outlining the clinical presentation, radiological finding, management, and outcome. Case Description. A 37-year-old female presented with low back pain radiating to the right lower limb for few years. Neurological examination revealed bilateral lower limb hyperreflexia (+3). Lumbar spine CT and MRI revealed a right paravertebral soft tissue lesion with heterogeneous signal intensity and enhancement at L1 to L3. The patient underwent complete resection of the lesion via a retroperitoneal approach. The surgery was uneventful. The histopathological sections were suggestive of mature ganglioneuroma. She was discharged in stable condition with follow-up at neurosurgery clinic. Conclusion. Giant ganglioneuromas are rare, benign tumors of sympathetic neurons. Complete surgical resection is the most effective therapeutic option for ganglioneuroma to avoid recurrence. Given the benign nature of ganglioneuroma, chemotherapy and radiotherapy tend to have a limited role following surgical resection.
背景。神经节细胞瘤(Ganglioneuroma,GN)是一种罕见的良性肿瘤,起源于神经嵴细胞,有可能影响交感神经系统内的任何解剖部位。通常情况下,GN 多见于儿童和青壮年,女性发病率略高。我们报告了一例罕见的巨大腰椎神经节细胞瘤病例,概述了该病的临床表现、放射学发现、治疗和预后。病例描述。一名 37 岁女性因腰痛放射至右下肢数年前来就诊。神经系统检查显示双侧下肢反射亢进(+3)。腰椎 CT 和 MRI 显示,右侧椎旁软组织病变,信号强度不均,L1 至 L3 处增强。患者接受了经腹膜后入路的病灶完全切除术。手术顺利。组织病理切片显示为成熟的神经节细胞瘤。患者出院后在神经外科门诊接受随访,情况稳定。结论巨大神经节细胞瘤是一种罕见的交感神经元良性肿瘤。彻底手术切除是避免神经节瘤复发的最有效治疗方案。鉴于神经节细胞瘤的良性性质,化疗和放疗在手术切除后的作用有限。
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引用次数: 0
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Case Reports in Surgery
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