scholarly journals Internal Herniation through Foramen of Winslow: A Diagnosis Not to be Missed

2016 ◽  
Vol 9 ◽  
pp. CGast.S38453 ◽  
Author(s):  
Edmund Leung ◽  
Simon Bramhall ◽  
Prajeesh Kumar ◽  
Moustafa Mourad ◽  
Amdad Ahmed
Keyword(s):  
Epigastric Pain ◽  
Primary Anastomosis ◽  
Delayed Diagnosis ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Cross Sectional ◽  
Foramen Of Winslow ◽  
Lesser Sac ◽  
Cross Sectional Imaging ◽  
Severe Epigastric Pain

Introduction Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality. Method We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on “PubMed” as a search platform using the keywords “foramen of Winslow” and “hernia”. Case Summary A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient's postoperative recovery was uneventful. Conclusion Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity.

scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

scholarly journals A rare case of COVID-19 related stomach gangrene after an abortion: a case report

2021 ◽  
Vol 8 (4) ◽  
pp. 1360
Author(s):  
Komal Gupta ◽  
Gopal Puri ◽  
Jnaneshwari Jayaram ◽  
Muhammed Huzaifa ◽  
Kamal Kataria
Keyword(s):  
Epigastric Pain ◽  
Subtotal Gastrectomy ◽  
Abdominal Distension ◽  
Posterior Wall ◽  
Emergency Laparotomy ◽  
Rt Pcr ◽  
Missed Abortion ◽  
Medical Termination ◽  
Arterial Thrombus ◽  
Severe Epigastric Pain

A 25 year old female had presented with complaints of severe epigastric pain with abdominal distension and vomiting for 4 days. She had undergone medical termination of pregnancy for a missed abortion of 5 weeks of gestation 5 days prior. The patient's COVID-19 RT PCR was found to be positive. Her CECT showed covid related changes in bilateral lungs and pneumoperitoneum. Stomach was distended. Other small bowels appeared normal. Patient underwent emergency laparotomy. Two third of stomach appeared gangrenous with a perforation in the posterior wall of stomach so she underwent a subtotal gastrectomy. She had features of covid associated coagulopathy (CAC) with high D-dimer (520 ng/ml), thrombocytosis (up to 705,000/mcl), high activated partial thromboplastin time (aPTT) (up to 55.6 sec) and high prothrombin time (PT) (up to 27.9 sec and INR 2.11) for which low molecular heparin was given. Stomach is a highly vascular organ. Gangrene of the stomach has been very rarely reported. CAC is known to lead to both arterial thrombus and venous thromboembolism. COVID-19 related abortions have also been reported though the exact mechanism not certain but CAC could be one of them.

scholarly journals Ingested Fish Bone: An Unusual Mechanism of Duodenal Perforation and Pancreatic Trauma

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitrios Symeonidis ◽  
Georgios Koukoulis ◽  
Ioannis Baloyiannis ◽  
Apostolos Rizos ◽  
Ioannis Mamaloudis ◽  
...  
Keyword(s):  
Foreign Body ◽  
Epigastric Pain ◽  
Elevated Serum ◽  
Delayed Diagnosis ◽  
Pancreatic Head ◽  
Fish Bone ◽  
Postoperative Recovery ◽  
Intestinal Lumen ◽  
Duodenal Wall ◽  
Duodenal Perforation

Ingestion of gastrointestinal foreign bodies represents a challenging clinical scenario. Increased morbidity is the price for the delayed diagnosis of complications and timely treatment. We present a case of 57-year-old female patient which was admitted in the emergency room department complaining of a mid-epigastric pain over the last twenty-four hours. Based on the patient's history, physical examination and elevated serum amylase levels, a false diagnosis of pancreatitis, was initially adopted. However, a CT scan confirmed the presence of a radiopaque foreign body in the pancreatic head and the presence of air bubbles outside the intestinal lumen. The patient was unaware of the ingestion of the foreign body. At laparotomy, after an oblique duodenotomy, a fish bone pinned in the pancreatic head after the penetration of the medial aspect of the second portion of the duodenal wall was identified and successfully removed. The patient had an uneventful postoperative recovery. Wide variation in clinical presentation characterizes the complicated fish bone ingestions. The strategically located site of penetration in the visceral wall is responsible for the often extraordinary gastrointestinal tract injury patterns. Increased level of suspicion is of paramount importance for the timely diagnosis and treatment.

scholarly journals Tentorial Dural Arteriovenous Fistulas as a Cause of Thalamic Edema: 2 Cases of an Important Differential Diagnosis to Consider

2020 ◽  
Vol 11 (1) ◽  
pp. 33-39
Author(s):  
Mougnyan Cox ◽  
Pavel Rodriguez ◽  
Suyash Mohan ◽  
Neda I. Sedora-Roman ◽  
Bryan Pukenas ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Delayed Diagnosis ◽  
Imaging Findings ◽  
Imaging Diagnosis ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
Important Differential Diagnosis ◽  
Dural Arteriovenous Fistulas ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The differential diagnosis for bilateral thalamic edema is extensive and includes vascular, neoplastic, metabolic, and infectious causes. Of the vascular causes of thalamic edema, arterial and venous infarctions are well-documented, but dural arteriovenous fistulas (dAVFs) are a relatively uncommon and widely underrecognized cause of thalamic edema. Dural AVFs are notoriously difficult to diagnose clinically, especially in the absence of hemorrhage, and cross-sectional imaging findings can be subtle. This can result in a delayed diagnosis, and occasionally, an invasive biopsy for further clarification of a purely vascular disease. In this review, we detail our experience with the imaging diagnosis of dAVF as a cause of thalamic edema and present a short differential of other vascular causes.

scholarly journals Foramen of Winslow hernia: an open approach

2021 ◽  
Vol 8 (4) ◽  
pp. 1312
Author(s):  
Muhammad F. Rosley ◽  
Senal Medagedara ◽  
Marius Jordaan
Keyword(s):  
Epigastric Pain ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Operative Management ◽  
Open Approach ◽  
Cross Sectional ◽  
Foramen Of Winslow ◽  
Internal Hernias ◽  
Preventative Measures ◽  
The Right

Foramen of Winslow hernia (FWH) are considered rare even among other internal hernias. It was first described in 1834 and historically had a mortality rate of close to 50%. With modern advancement and availability of cross-sectional imaging, this number has improved dramatically to 5%. Operative management is required for all patients which can be performed with either an open or laparoscopic approach. Preventative measures for recurrence remain controversial as no case of recurrence has been reported to date. We present a case study of a 62 years old woman who presented to the emergency department with severe epigastric pain and a CT scan confirming an FWH. She underwent urgent laparotomy and the hernia was easily reducible without need of intestinal resection. We opted to fixate the right colon and close the foramen of Winslow to prevent future recurrence. She recovered from her surgery well and was discharged home without any complications.

scholarly journals Jejunogastric Intussusception: A Rare Complication of Gastric Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Gokhan Cipe ◽  
Fatma Umit Malya ◽  
Mustafa Hasbahceci ◽  
Yeliz Emine Ersoy ◽  
Oguzhan Karatepe ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Gastric Surgery ◽  
Postoperative Recovery ◽  
Jejunogastric Intussusception ◽  
History Of ◽  
Operative Findings ◽  
Severe Epigastric Pain ◽  
Emergent Laparotomy

Jejunogastric intussusception is a rare complication of gastric surgery. It usually presents with severe epigastric pain, vomiting, and hematemesis. A history of gastric surgery can help in making an accurate and early diagnosis which calls forth an urgent surgical intervention. Only reduction or resection with revision of the previously performed anastomosis is the choice which is decided according to the operative findings. We present a case of JGI in a patient with a history of Billroth II operation diagnosed by computed tomography. At emergent laparotomy, an efferent loop type JGI was found. Due to necrosis, resection of the intussuscepted bowel with Roux-en-Y anastomosis was performed. Postoperative recovery was uneventful.

scholarly journals DELAYED DIAGNOSIS OF EXTRAPULMONARY TUBERCULOSIS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN BIHAR

2020 ◽  
pp. 12-15
Author(s):  
Sant Kumar ◽  
Prabhat Kumar Sinha ◽  
Debarshi Jana
Keyword(s):  
Fever Of Unknown Origin ◽  
Comprehensive Evaluation ◽  
Imaging Finding ◽  
Extrapulmonary Tuberculosis ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Atypical Presentations

Background: Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in Bihar. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis. Material and Methods: We retrospectively analyzed EPTB patients at DMCH, Laheriasarai, Bihar, who were referred with FUO fromMithilanchal area around like; Darbhanga, Madhubani, Samsatipur and other places. The subjects were assigned to groups of early diagnosis and delayed diagnosis within3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups. Results: A total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis. Conclusion: Febrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.

scholarly journals A case report of caecal herniation through the foramen of Winslow

2018 ◽  
Vol 100 (6) ◽  
pp. e142-e144
Author(s):  
K Shek ◽  
N Ditkofsky ◽  
S Ashamalla ◽  
C Patel
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Diabetic Ketoacidosis ◽  
Epigastric Pain ◽  
Right Hemicolectomy ◽  
Rare Entity ◽  
Foramen Of Winslow ◽  
Time Of Surgery ◽  
Abdominal Computed Tomography ◽  
Lesser Sac

Caecal herniation through the foramen of Winslow is a rare entity of which radiologist should be aware. We present a case of this entity in a patient presenting with diabetic ketoacidosis and ongoing epigastric pain. Abdominal computed tomography demonstrated herniation of the caecum into the lesser sac via the foramen of Winslow. Despite the caecum appearing viable at the time of surgery, the surgeons performed a right hemicolectomy via laparotomy to prevent future recurrence.

State-of-the-art pulmonary arterial imaging – Part 2

VASA ◽  
2018 ◽  
Vol 47 (5) ◽  
pp. 361-375 ◽  
Author(s):  
Harold Goerne ◽  
Abhishek Chaturvedi ◽  
Sasan Partovi ◽  
Prabhakar Rajiah
Keyword(s):  
Pulmonary Artery ◽  
State Of The Art ◽  
Therapy Monitoring ◽  
Pulmonary Arteries ◽  
Imaging Modalities ◽  
Cross Sectional ◽  
Multiple Imaging ◽  
Cross Sectional Imaging ◽  
Pulmonary Arterial ◽  
Arterial Imaging

Abstract. Although pulmonary embolism is the most common abnormality of the pulmonary artery, there is a broad spectrum of other congenital and acquired pulmonary arterial abnormalities. Multiple imaging modalities are now available to evaluate these abnormalities of the pulmonary arteries. CT and MRI are the most commonly used cross-sectional imaging modalities that provide comprehensive information on several aspects of these abnormalities, including morphology, function, risk-stratification and therapy-monitoring. In this article, we review the role of state-of-the-art pulmonary arterial imaging in the evaluation of non-thromboembolic disorders of pulmonary artery.

State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 6-26 ◽  
Author(s):  
Fabian Rengier ◽  
Philipp Geisbüsch ◽  
Paul Schoenhagen ◽  
Matthias Müller-Eschner ◽  
Rolf Vosshenrich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Repair ◽  
Imaging Modality ◽  
Open Surgical Repair ◽  
Cross Sectional ◽  
Transcatheter Aortic Valve ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.

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