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Pseudotumoral Colic Tuberculosis: A Rare Pathological Entity  [PDF]
Eddy Oleko Ekuke, Pierlesky Elion Ossibi, El Mahdi Benkoukous, Moussa Sylla, Boubacar Efared, Laila Chbani, Abdelmalek Ousadden, Khalid Mazaz, Khalid Ait Taleb
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.712069
Abstract: Colic tuberculosis is rare even in countries endemic to Mycobacterium spp. Its incidence seems to be increasing over the last decade. Presentation in the form of abdominal mass is exceptional and often misdiagnosed as gastrointestinal tumor. The possibility of a colic involvement of this infection needs to be considered given the broad spectrum of clinical manifestations of TB infection. We present a case of pseudo colic tuberculosis in a 58-year-old patient with no history of disease.
Differentiated surgical tactics in patients with colic polyps and polyposis  [cached]
Dilshod Sapaev,Sarimbek Navruzov,Shukur Mamatkulov,Sharafat Sapaeva
Medical and Health Science Journal , 2010,
Abstract: Choice of tactics and method of surgical treatment in colic polyps and polyposis (CPP) remains the issue of the day. Surgical tactics has to be differentiated and individual, depending on the character of the disease and the level of involvement of colon. Timely diagnostic and prognosis of course of CPP is a prerequisite for development and choosing the most effective differentiated surgical tactics. In 102 patients, there were applied newly developed methods of complex diagnostics and differentiated surgical tactics developed by us. Differentiated surgical tactics should be applied using both endoscopic and radical operations, taking into account the extent and character of involvement, as well as the risk of malignization. Application of the developed algorithm of differentiated surgical tactics allows significant improving the treatment outcomes. Particularly this approach helps to increase several times the recovery rate and reduce the rate of relapses.
Intricacies in the surgical management of appendiceal mucinous cystadenoma: a case report and review of the literature
Muhammad R Khan, Rashida Ahmed, Taimur Saleem
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-129
Abstract: We report the case of a 70-year-old Asian woman from Karachi who presented with pain in the right iliac fossa for 15 days. On physical examination, a mobile and firm mass was palpable in the right iliac fossa. A colonoscopy was performed which showed external compression of the cecum. A biopsy of the mucosa was normal. Computed tomography scan showed a mucocele of the appendix with minimal periappendiceal fat stranding. She underwent an initial diagnostic laparoscopy to evaluate any mucin spillage in the peritoneal cavity. Once no spillage was identified, an open appendectomy was then performed. Intra-operatively, a frozen section of the appendiceal sample was sent to ascertain the need for an extension of surgery to a right hemicolectomy. Absence of any malignancy on the frozen section obviated the need for a surgical extension. The final histopathological examination showed a mucinous cystadenoma of the appendix. The patient was symptom-free at one year after surgery.It is important to distinguish between mucinous cystadenomas and mucinous cystadenocarcinomas. However, this distinction remains elusive in the pre-operative setting. A simple appendectomy using an intra-operative frozen section appears to be a reasonable surgical approach for selected cases with an intact mucocele of the appendix. However, long-term follow-up is warranted in such patients to evaluate the risks of using this approach.Mucinous cystadenoma, a type of appendiceal mucocele, is a rare clinical entity [1]. Mucoceles of the appendix account for only about 0.3% of appendix specimens, with mucinous cystadenomas being the most commonly encountered appendiceal mucoceles [2]. Mucoceles that are less than 2 cm in diameter are usually simple retention cysts, while hyperplastic epithelium, cystadenoma and cystadenocarcinoma are more likely to be greater than 2 cm [3]. In a review of 2660 appendectomy specimens, mucinous cystadenoma was reported in 0.6% of the cases [4].A consensus on the optimal man
Surgical Treatment of Congenital True Macroglossia  [PDF]
Sabrina Araújo Pinho Costa,Mário César Pereira Brinhole,Rogério Almeida da Silva,Daniel Hacomar dos Santos,Mayko Naruhito Tanabe
Case Reports in Dentistry , 2013, DOI: 10.1155/2013/489194
Abstract: Macroglossia is a morphological and volumetric alteration of the tongue, caused by muscular hypertrophy, vascular malformation, metabolic diseases, and idiopathic causes and also associated with Down and Beckwith-Wiedemann syndromes. This alteration can cause dental-muscle-skeletal deformities, orthodontic instability, masticatory problems, and alterations in the taste and speech. In this paper we present a case of true macroglossia diagnosed in a female patient, 26 years, melanoderma, no family history of disease, with a history of relapse of orthodontic treatment for correction of open bite, loss of the lower central incisors, and complaint of difficulty in phonation. The patient was submitted to glossectomy under general anesthesia using the “keyhole” technique, with objective to provide reduction of the lingual length and width. The patient developed with good repair, without taste and motor alterations and discrete paresthesia at the apex of the tongue. 1. Introduction Macroglossia is an uncommon condition that can lead to several alterations like dental-muscle-skeletal deformities, orthodontic treatment instability, masticatory, and breathing and phonation problems, characterized by increased size of the tongue, can be caused by congenital malformations or acquired diseases. The most common causes are muscle hypertrophy and congenital vascular malformations, such as lymphangioma and hemangioma, they are also characteristics found in the Beckwith-Wiedemann syndrome, and can be present in the Down syndrome [1–14]. It can be acquired as a result of amyloidosis, myxedema, angioedema, and macromegalia [1, 5, 14–19]. The tongue can also be normal in size but can seem increased when compared with adjacent structures because of anteroposterior mandible or maxillary transverse deficiency or also due to cysts, tumors, and tonsillar hyperplasia that can move up and out the tongue. This last condition is called pseudomacroglossia and must be differentiated from true macroglossia, because its correction is achieved by treating the primary disease [20]. Accurate diagnosis of true macroglossia is obtained through the signs and symptoms of this alteration, which is of fundamental importance for the correct indication for surgical treatment, in order to restore proper function and provide stability for orthodontic treatment [21]. The surgical treatment indicated for the true macroglossia is the reductive glossectomy. Several techniques have been proposed in the literature to enable the reduction of the tongue. Peripheral incisions with marginal resection of tissue
Bladder metastases of appendiceal mucinous adenocarcinoma: a case presentation
Gianluigi Taverna, Matteo Corinti, Piergiuseppe Colombo, Fabio Grizzi, Mauro Severo, Alessando Piccinelli, Guido Giusti, Alessio Benetti, Paolo A Zucali, Pierpaolo Graziotti
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-62
Abstract: A case is reported of a 45-years old woman with mucinous cystadenocarcinoma of the appendix with bladder metastasis. Although ultrasonography and voided urinary cytology were negative, abdomen computed tomography (CT) scan and cystoscopy and subsequent pathological examination revealed a mass exclusively located in the anterior wall of the bladder. Histopathology of the transurethral bladder resection revealed a bladder adenocarcinoma [6 cm (at the maximum diameter) × 2,5 cm; approximate weight: 10 gr] with focal mucinous aspects penetrating the muscle and perivisceral fat. Laparotomy evidenced the presence of a solid mass of the appendix (2,5 cm × 3 cm × 2 cm) extending to the loco-regional lymph nodes. Appendectomy and right hemicolectomy, linfoadenectomy and partial cystectomy were performed. The subsequent pathological examination revealed a mucinous cystadenocarcinoma of the appendix with metastatic cells colonising the anterior bladder wall and several colic lymph nodes.The rarity of the appendiceal carcinoma invading the urinary bladder and its usual involvement of nearest organs and the posterior bladder wall, led us to describe this case which demonstrates the ability of the appendiceal cancer to metastasize different regions of urinary bladder.The appendiceal adenocarcinoma invading the urinary bladder is extremely rare [1-4], and it is very difficult to be diagnosed before the surgical inspection. Here we describes a case of appendiceal cystoadenocarcinoma metastising the bladder anterior wall diagnosed in a patient with monosymptomatic episodes of gross hematuria. Our diagnostic schema and the adopted pharmacological treatment are also discussed.A 45-years old woman presented at our health centre (IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy) with some episodes of gross hematuria. The ultrasonography and voided urinary cytology, and the physical examination were negative. The patient never had any gastrointestinal symptom and presented a negat
Acute abdominal pain presenting as a rare appendiceal duplication: a case report
Ali Mahmood, Nadia F Mahmood, Jennifer L Williams
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-79
Abstract: We report the case of a 15-year-old African American girl who presented to our hospital with right lower quadrant pain and was subsequently found to have appendiceal duplication.There are two categorical systems that have described and stratified appendiceal duplication. Both classification systems have been outlined and referenced in this case report. A computed tomography scan has been included to provide a visual aid to help identify true vermiform appendiceal duplication. The presence of this anatomical abnormality is not a reason for surgical intervention; however, should this be found in the setting of acute appendicitis, aggressive resection of both appendices is mandatory.Appendiceal duplication is a rare anomaly that has been described less than 200 times in the literature. The incidence of duplicated appendices has been previously reported to be approximately 0.0004% [1]. This anatomical finding has been associated with intestinal, bone and genitourinary abnormalities as well [2-5]. While the presence of appendiceal duplication in the absence of inflammation is not always and/or immediately a surgical issue, once there is evidence of appendicitis, prompt and aggressive surgical intervention is necessary.A 15-year-old African American girl presented to our emergency room with abdominal pain. The pain had started 48 hours previously, with the onset in the supra-umbilical region and subsequent radiation to her right lower quadrant. The pain was exacerbated by movement of her right lower extremity. Our patient denied nausea, vomiting, chills or rigor. Upon physical examination, she had point tenderness in her right lower quadrant, without rebound tenderness, guarding or rigidity. Her white blood cell count was mildly elevated at 11,000 k/CMM (cubic millimeter) without leukemoid shift. A urine analysis did not reveal any abnormalities and a urine pregnancy test was negative.An ultrasound was performed, which did not visualize the appendix or any inflammatory ch
Appendiceal Mucocele Presenting as a Right Adnexal Mass: A Case Report  [PDF]
Grigor Gortchev,Slavcho Tomov,Dobromir Dimitrov,Vasil Nanev,Tatyana Betova
Obstetrics and Gynecology International , 2010, DOI: 10.1155/2010/281053
Abstract: A 68-year-old female presented to the Gynecologic Oncology Clinic with a right-lower quadrant abdominal mass ?cm in diameter palpable on pelvic examination. Her routine laboratory tests were normal. Transvaginal ultrasonography revealed a cystic mass in the right adnexa 3.9?cm in diameter, which was thought to arise in the ovary. At the time of laparoscopy, a ?cm tumor arising from the distal end of the appendix was noted. A laparoscopic appendectomy with tumor removal was performed. Histologic examination of the surgical specimen revealed a mucocele of the appendix (AM). Although rare, this tumor should be considered in the differential diagnosis of a right adnexal mass. These tumors can be identified laparoscopically and removed by minimally invasive surgery. 1. Introduction Appendiceal mucocele (AM) is a rare entity that can present in a variety of ways. The incidence of AM is estimated to be 0.2-0.3% of appendectomy specimens. Appendiceal mucocele was first described by Rokitanski in 1842, and the term refers to dilatation of the appendiceal lumen by an abnormal accumulation of mucus [1]. Mucoceles are histologically subdivided into four types based on the following classification introduced by the World Health Organization [2]:(1)retention mucocele or obstructive form of mucocele defined as cystic dilatation of the distal appendix with accumulation of abnormal mucoid material in the appendiceal lumen secondary to appendiceal outflow obstruction,(2)mucinous cystadenoma defined as a dilated mucus/mucin-filled appendix containing adenomatous mucosa lined by atypical mucinous epithelium containing basal nuclei and showing only minimal dysplastic features,(3)mucinous cystadenocarcinoma defined as adenocarcinoma associated with mucus-filled cystic dilatation of the appendix presenting as a mucocele,(4)myxoglobulosis defined as cystic dilatation of the appendix associated with mucinous globoid bodies. 2. Case Report A 68-year-old postmenopausal female presented to the Gynecologic Oncology Clinic with a two-day history of spotting. She did not report any abdominal pain. Her medical history was significant in that she was hypertensive and had adult-onset diabetes mellitus. Her abdomen was soft and nondistended, with normoactive bowel sounds. Bimanual palpation in the lower-right abdominal quadrant revealed a tumor mass 4?cm in diameter. It was slightly mobile and had smooth walls. This mass was confirmed on pelvic and rectal examinations. The patient’s laboratory tests were as follows: hemoglobin 10.9?g/l, white blood cells , blood glucose 6.2?mmol/l, blood
Stump Appendicitis: An Uncompleted Surgery, a Rare but Important Entity with Potential Problems  [PDF]
J. A. A. Awe,A. M. Soliman,R. W. Gourdie
Case Reports in Surgery , 2013, DOI: 10.1155/2013/972596
Abstract: Appendicectomy for appendicitis is one of the commonest surgical procedures performed worldwide. The residual appendiceal stump left after an initial appendectomy risks the development of stump appendicitis. Stump appendicitis is a real recognized entity but not often considered when evaluating patients with right lower quadrant abdominal pain, especially those with past history of appendectomy. It remains a clinical challenge with the result that its diagnosis and effective treatment are often delayed with possible attendant morbidity or mortality. Stump appendicitis results from obstruction of the lumen of the remaining appendix stump, usually by a faecolith. This increases intraluminal pressure, impairing venous drainage and allowing subsequent bacterial infection. We present the case of a twenty-five (25)-year-old female who underwent laparoscopic appendicectomy and presented four and half (4(1/2)) months later with fever, right lower quadrant abdominal pain, and tenderness associated with repeated vomiting. Exploratory laparotomy was carried out after clinical and imaging studies which revealed big inflammatory mass with abscess at the right iliac fossa and recurrent appendicitis of the appendiceal stump. Surgical treatment is easy but recognition of this important entity but potentially dangerous condition should always be borne in mind in order to avoid delay in its diagnosis and treatment. 1. Introduction Acute Appendicitis is one of the most common causes of abdominal pain, and it is one of the common surgical emergencies treated by general surgeons. Most surgical personnel are quite familiar with the common complications after appendectomy such as wound infections and pelvic abscesses [1]. The postoperative development of stump appendicitis is an exceedingly rare entity with only 36 reported cases in the English language literature [2–4]. Stump appendicitis is an acute inflammation of the residual appendiceal stump and is an underreported complication that can occur after open or laparoscopic appendectomy [5–13]. The entity has been recorded as occurring from about three weeks to an interval of twenty-three (23) years after appendectomy, but our case presented only four and half (4(1/2)) months after laparoscopic appendectomy [14, 15]. With the introduction of laparoscopic appendectomy in the last fifteen to twenty (15–20) years; however, incidence of stump appendicitis has probably increased even though this was not supported by the findings of Liang et al. [3]. The fact that the diagnosis of stump appendicitis is usually not considered as
Appendiceal ascariasis in children
Wani Imtiaz,Maqbool Muddasir,Amin Abid,Shah Firdous
Annals of Saudi Medicine , 2010,
Abstract: Background : The propensity of Ascaris lumbricoides to wander leads to varied surgical complications in the abdomen. Wandering A lumbricoides may sometimes reach the vermiform appendix and its presence there may remain silent or incite pathology. Our aim was to study ascariadial appendicitis. Methods : Over a period of 3 years, we identified children who were found to have appendiceal ascariasis during surgery for different intestinal complications due to ascariasis. We studied the relationship between ascariasis and its lodgement inside the vermiform appendix in these patients. No preoperative diagnosis was made in this series. Results : We found 11 patients with appendiceal ascariasis. It was incidentally found that 8/11 (72.7%) patients had worms inside their vermiform appendix but not appendicitis, whereas the remaining three patients (27.2%) were found to have Ascaris-associated appendicitis. The characteristic finding in Ascaris-infested vermiform appendix was that the worm is positioned with its head at the base and its tail at the tip of the appendix. Conclusion : Migration of A lumbrocoides inside the vermiform appendix is an incidental finding and tends to pursue a silent course in most patients. Only rarely does the presence of Ascaris inside the vermiform appendix cause appendicitis.
Infantile Colic
D M Roberts, M Ostapchuk
South African Family Practice , 2007,
Abstract: Infantile colic can be distressing to parents whose infant is inconsolable during crying episodes. Colic is often defined by the “rule of three”: crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. The physician's role is to ensure that there is no organic cause for the cry-ing, offer balanced advice on treatments, and provide support to the family. Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behaviour interventions have not been proved to be more effective than placebo. Families may turn to untested resources for help, and the physician should offer sound advice about these treatments. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects. Physicians should watch for signs of continuing distress in the child and family, particularly in families whose resources are strained already. South African Family Practice Vol. 49 (1) 2006: pp. 44-47
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