Search

Dietl’s crisis is described as episodic, crampy upper abdominal pain, nausea and vomiting associated with intermittent renal pelvi-ureteric junction (PUJ) obstruction. A child with this crisis often has a delay in diagnosis, with the clinical entity being underdiagnosed. Dietl’s crisis is one of

A 45-year-old man presented with right upper abdominal pain and low-grade fever for 2 weeks. Laboratory investigations showed polymorphonuclear leukocytosis with normal liver function tests. Ultrasound scan showed a heteroechoic lesion in the right lobe of the liver with mobile echogenic foci

Objective: To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of ropivacaine on shoulder tip pain (STP) or upper abdominal pain postoperatively after gynecological laparoscop...

Background: Blunt traumatic pancreatic injuries are rare conditions in case of motor vehicle collision (MVC) and isolated injuries even rarer. Surgical approach is usually preferred in case of advanced pancreatic injuries. In this study we try to shed the light on the role of completely conservative approach in the management of a proximal pancreatic injury. Case Summary: A 19-year-old male patient presented to the ER three days following MVC with upper abdominal pain. Abdominal US showed free intraperitoneal fluids and laboratory results showed elevated total leukocyte count, serum amylase and lipase. CT showed transection at pancreatic head which was grade 5 with free intrabdominal fluids; hence isolated pancreatic injury was diagnosed. At that point, the patient was hemodynamically stable and conservative management was implemented. He was admitted in the ICU for three days followed by 28 days in the ward where patient condition was closely monitored on daily bases. Serial interval imaging showed spontaneous resolution of the intraperitoneal collection together with improvement of the injury, respectively. After completing his course, the patient was discharged and monitored as an outpatient. Conclusion: Conservative treatment can be adopted in patients with proximal pancreatic injuries with complete duct disruption in otherwise hemodynamically stable patients.

Chronic pancreatitis (CP) should be suspected in the case of recurrent upper abdominal pain of unknown origin and/or clinical signs of exocrine pancreatic insufficiency (EPI). Alcohol is the most common etiological factor associated with CP, others being smoking, male gender, and hereditary forms. CP is often associated with recurrent episodes of acute exacerbations.As of today, there is no accepted clinical definition of CP. However, irreversible morphological changes within the pancreas often occur, including dilatation of the main and branch pancreatic ducts, calcifications in ducts and parenchyma, parenchymal atrophy, and development of pseudocysts, though less so in the early phase of CP.

Hepatic vein aneurysm is an extremely rare case. The etiology of hepatic vein aneurysms is uncertain, and endovascular treatment of this condition has not been reported. We report the case of a 71-year-old woman with right upper abdominal pain who was diagnosed with hepatic vein aneurysm and was successfully treated with an endovascular technique.

Gastric volvulus is seldom seen in clinical practice. The clinical triad, of upper abdominal pain, intractable retching and inability to pass nasogastric (NG) tube, if found, can help in diagnosis.

A 26-year-old man was admitted to our hospital due to upper abdominal pain. He had previously been diagnosed with gastroduodenal ulcer at 23 and 25 years old and had been treated with proton-pump inhibitors. Endoscopic hemostasis and a biopsy were performed on the hemorrhagic gastroduodenal ulcers. Laboratory and pathologic examinations demonstrated elevated serum IgG4 levels and the infiltration of IgG4-positive plasma cells into the gastroduodenal tissues. Based on the clinicopathologic findings and after excluding other causes, he was diagnosed with IgG4-related gastroduodenal ulcer. We herein report a rare case of IgG4-related disease manifesting as a gastroduodenal ulcer diagnosed by an endoscopic biopsy.

Tuberkulose (TB) ist eine der haufigsten Infektionskrankheit weltweit. Hier berichten wir uber einen 20-jahrigen Fluchtling aus Somalia, der sich zunachst mit rechtsseitigem Oberbauchschmerz, Erbrechen, Gewichtsverlust und Ikterus bei Verdacht auf eine Cholezystitis in unserer Klinik vorstellte. Im Rahmen der weiteren Diagnostik stellte sich eine Pylorusstenose dar, die – wie auch die Cholestase – durch komprimierende peripankreatische Lymphknotenpakete verursacht wurde. In einer zytologischen Untersuchung der Lymphknoten wurden eine verkasende Nekrose und Tuberkulosebakterien nachgewiesen.

Gallbladder-duodenal (cholecystoduodenal) fistula is an uncommon bilioenteric fistula between the gallbladder and the duodenum. It usually occurs following a chronic case of cholecystitis upon which the gallbladder adheres to the adjacent duodenum, and a stone penetrates through the wall. The case presented herein is that of a gallbladder-duodenal fistula detected primarily with the use of ultrasound imaging, and subsequently confirmed by computed tomography. The patient is a 54-year-old woman who was admitted with upper abdominal pain. The fistula was caused by chronic cholecystitis, however no gallstones were present in the duodenum. Surgical management was undertaken for the patient, and the recovery was uneventful.

A Bochdalek hernia (BH) is a congenital abnormality with incomplete closure of the diaphragm. It is usually manifested in infants but rarely in adults. Here, we report an adult patient with gastric volvulus and giant BH that were safely repaired by endoscopic reduction and elective laparoscopic surgery, respectively. A 79-year-old woman presented with left upper abdominal pain but no history of trauma. CT revealed a giant BH with gastric volvulus. After emergency endoscopic reduction of the volvulus, elective laparoscopic repair of the BH was performed. The 8 × 8-cm defect was repaired with interrupted nonabsorbable sutures and a mesh. The patient's postoperative course was uneventful, and no complications or recurrence were observed in the 6 months that followed.

A 47-year-old man presented with right upper abdominal pain for 1 month. Contrast-enhanced CT revealed hilar bile duct stenosis with dilatation of the intrahepatic bile ducts, and his serum CA19-9 and CA242 levels were significantly elevated. 18F-FDG and 68Ga-FAPI PET/CT were performed for differential diagnosis. 18F-FDG PET/CT showed only mild FDG uptake in the hepatic hilum. Astonishingly, in 68Ga-FAPI PET/CT, intense radioactivity was presented on the same region, which indicated massive fibroblasts aggregation in hepatic hilum. The patient was finally diagnosed as portal biliopathy caused by cavernous transformation of the portal vein.

Tuberculosis can affect extrapulmonary organs. Gallbladder tuberculosis is one of the rare extrapulmonary tuberculosis. Fewer than 120 cases have published since reported in 1870. We reported a 55-year-old woman who came to the hospital with a chief complaint of right upper abdominal pain. The abdominal ultrasonography obtained gallstones. The patient was initially diagnosed with acute cholecystitis, and laparoscopic cholecystectomy was performed. The histopathologic examination of the gallbladder showed chronic cholecystitis inflammation cells, while the smear showed acid-fast bacilli. The primary diagnosis was gallbladder tuberculosis. Antituberculosis treatment was performed with good clinical outcome and radiological improvement.

Introduction: Acute pancreatitis (AP) is a sudden, reversible inflammatory process of the pancreas, caused by self-digestion. In Ecuador in 2016, 4715 cases were presented, with a mortality of 2.99%. The etiology includes gallstones, alcoholism, hypertriglyceridemia. It presents with upper abdominal pain, nausea and vomiting, it is hospital management. Methodology: It is a descriptive review of the literature on the diagnosis and treatment of BP, based on 31 articles in English and Spanish. Discussion and Results: AP is diagnosed by the clinic and by the serum measurement of lipase and pancreatic amylase. You can also perform other studies such as C-reactive protein, alanine aminotransferase, aspartate aminotransferase, ultrasonography, computed tomography, magnetic resonance imaging, among others. The management of the intake as the main points of perfusion, analgesia, nutrition, clinical, radiology, retrograde endoscopic cholangiopancreatography, antibiotic and surgery. Conclusion: Although the diagnosis is generally clinical and laboratory, for atypical cases, imaging studies are very useful to confirm or exclude the diagnosis. The treatment of PA is summarized in the PANCREAS nemotechnics. (P perfusion, A analgesia, N nutrition, C clinical, R radiology, E endoscopic retrograde cholangiopancreatography, A antibiotic, S surgery). Keywords: pancreatitis, inflammation, diagnosis, treatment. RESUMEN Introducción: La pancreatitis aguda (PA) es un proceso inflamatorio repentino, reversible del páncreas, causado por autodigestión. En Ecuador en el 2016 se presentaron 4 715 casos, con una mortalidad del 2,99%. En la etiología constan: Cálculos biliares, alcoholismo, hipertrigliceridemia. Se presenta con dolor abdominal superior, náuseas y vómito, es de manejo hospitalario. Metodología: Es una revisión bibliográfica descriptiva, sobre el diagnóstico y tratamiento de la PA, en base a 31 artículos en inglés y español. Discusión y Resultados: La PA se diagnostica mediante la clínica y por la medición sérica de lipasa y amilasa pancreática; también se pueden realizar otros estudios como proteína C reactiva, alanina aminotranferasa, aspartato aminotransferasa, ultrasonografía, tomografía computarizada, imagen por resonancia magnética, entre otros. El tratamiento apunta a brindar una adecuada perfusión de tejidos, buena analgesia y principalmente evitar complicaciones. El manejo toma como como principales puntos perfusión, analgesia, nutrición, clínica, radiología, colangiopancreatografia retrograda endoscópica, antibiótico y cirugía. Conclusiones: A pesar de que el diagnóstico es generalmente clínico y de laboratorio, para casos atípicos son de gran utilidad los estudios de imagen para confirmar o excluir el diagnóstico. El tratamiento de PA se resume en la nemotecnia PANCREAS. (P perfusión, A analgesia, N nutrición, C clínica, R radiología, E colangiopancreatografía retrógrada endoscópica, A antibiótico, S cirugía). Palabras clave: pancreatitis, inflamación, diagnóstico, tratamiento.

Introduction and importance Although variations from the standard anatomy of the extrahepatic bile ducts are common, duplication of the cystic duct draining a single gallbladder is an extremely rare variant. We herein describe the first report of gallbladder cancer spreading into the aberrant cystic duct. Case presentation A 60-year-old female presented with upper abdominal pain, and she was diagnosed with gallbladder cancer. Intraoperatively, she was found to have a duplicated cystic duct draining a single gallbladder, and her cancer had spread into the aberrant cystic duct entering the anterior right hepatic duct. Right hepatectomy with extrahepatic bile duct resection was performed to achieve R0 resection. Clinical discussion In the English literature, 28 cases of duplicated cystic duct draining a single gallbladder have been reported. However, no cases of gallbladder cancer have been described in these previous reports. Conclusion We report the first case of gallbladder cancer spreading into the aberrant cystic duct. To perform an oncologically adequate operation, exact assessment of the biliary tree is essential not only preoperatively but also intraoperatively., Highlights • Duplication of the cystic duct draining a single gallbladder is rare in the anatomical variations of the biliary tract. • A 60-year-old female with gallbladder cancer was found to have a duplicated cystic duct draining a single gallbladder. • Her cancer had spread into the aberrant cystic duct entering the anterior right hepatic duct. • We report the first case of gallbladder cancer spreading into the aberrant cystic duct.

Acute or recurrent pain in the right upper part of the abdomen is a common cause for visits to physicians. Not less than two thirds of episodes of pain in this area are conditioned by biliary colic and acute cholecystitis. Other most common causes include diseases of the liver, pancreas, prepyloric and pyloric parts of the stomach and the beginning portion of the small intestine, the right kidney, and also subhepatic appendicitis. Some cases of developing pain are associated with the right lung affection and involvement of the diaphragmatic pleura, with heart diseases, involvement of the locomotor system and nerves. Taking into account a high prevalence of cholelithiasis in Russia – around 10–12% – we can conclude that episodes of biliary colic develop every year in 1 of 500–1000 individuals. In Russia, approximately half a million cholecystectomies are performed annually. The prevalence of gall stones among the paediatric population amounts to 2%. As distinct from adults, who in 80% of cases have an asymptomatic course of disease, pain episodes in children manifest themselves in 60–67% of cases. The diiagnosis of acute cholecystitis might meet with considerable difficulties; a scale for assessment of the likelihood of acute cholecystitis has been developed. Unlike in adults, in children a significantly large proportion of cases occur due to acalculous cholecystitis. Differentiating the causes of pain might be difficult, therefore, its character and concomitant symptoms should be thoroughly analysed, and the findings of additional examinations should also be taken into consideration (at the first step – assessment of haematological and biochemical parameters, urinalysis, electrocardiogram and abdominal ultrasonography). Key words: right upper abdominal pain, biliary colic, biliary dyskinesia, cholelithiasis

BACKGROUND AND AIM Post-endoscopic submucosal dissection electrocoagulation syndrome (PECS) has become a common adverse event after colorectal endoscopic submucosal dissection (ESD) and esophageal ESD. However, little is known about PECS after gastric ESD. Therefore, this study aimed to investigate the clinical features of PECS after gastric ESD. METHODS Patients who underwent ESD for gastric cancer or adenoma between January 2016 and December 2017 were retrospectively investigated. PECS was clinically diagnosed based on the presence of upper abdominal pain and localized abdominal tenderness with a temperature of >37.5°C, without perforation. We analyzed the clinical features of PECS. RESULTS A total of 637 ESD cases were enrolled; PECS occurred in 32 patients (5.0%), all of whom were diagnosed on postoperative Day 1. Among PECS cases, unplanned prolongation of hospitalization or fasting period was observed in 15 patients (47%). As a result, the median durations of hospitalization and fasting period were significantly longer in PECS cases (P = 0.008 and P

Slipping rib syndrome (SRS) is an underdiagnosed condition that can lead to debilitating lower chest and upper abdominal pain (Am J Med Sci 2019; 357: 168). It is caused by hypermobility of the anterior ends of the costal cartilages of false ribs, allowing the eighth to tenth ribs to slip under the rib above, giving its name (Semin Pediatr Surg 2018; 27: 183). Failure to recognize this syndrome can expose patients to extensive and unnecessary investigations for unclear symptoms. Although more commonly reported in adults, SRS is a relatively uncommon but recognized cause of lower chest or upper abdomen pain in adolescence (Pediatr Anesth 2001; 11: 740). It is important for clinicians to familiarize themselves with and consider the diagnosis of SRS when assessing and managing adolescents with persistent thoracic pain. We present a case of a 14-year-old girl with unresolved thoracic pain for more than 4 years and was ultimately diagnosed with SRS.

Dyspepsia is a disorder that refers mainly to central upper abdominal pain or discomfort. When a cause of this symptom is not identified the condition is termed functional dyspepsia (FD), that affects a large part of the general population. The relevance of FD is due to its high prevalence, but also to its chronic or intermittent course. This induces a significant burden for each national healthcare system. The pathogenesis of FD is complex and multifactorial, depending on cultural, environmental, and biological factors. Although considered of main importance in the pathophysiology of several gastroduodenal diseases, in the context of FD Helicobacter pylori (H. pylori) infection plays a limited role. The diagnosis of FD requires the exclusion of organic gastroduodenal diseases as well as H. pylori infection. Thus, the diagnostic workup includes a complete anamnesis, biochemical tests, and endoscopy with biopsy (when requested), and the satisfaction of clinic criteria recommended by the Rome IV consensus. The treatment of FD is also challenging, in fact more and more studies focused on a wide range of different therapies, with a multitude of results. The aim of this literature review is to provide an update of the new evidences useful for diagnosis and management of FD.

A 52-year-old female patient came to our hospital with upper abdominal pain over more than four days. Magnetic resonance cholangiopancreatography confirmed gallstones, common bile duct dilatation, and suspected choledocholithiasis. After the recommended preoperative preparation, the patient underwent laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography (ERCP), also called laparoendoscopic rendezvous surgery (LERV). During surgery sand-like stones were successfully removed from the common bile duct.

Background Duodenal Diaphragm in adults is very uncommon, caused by congenital and acquired changes. It is reported that acquired duodenal diaphragm is related to the long-term use of nonsteroidal anti-inflammatory drugs. Case summary We report an adult presentation of duodenal diaphragm in a 77-year-old woman, suffered from acute cholangitis and choledocholithiasis. She was performed endoscopic retrograde cholangiopancreatography (ERCP) procedure to remove the stone in common bile duct (CBD). After the stenosis ring dilated by endoscopic balloon dilatation, ERCP procedure was applied, and the CBD stone was removed successfully. Conclusion Duodenal diaphragm is difficult to diagnose in clinic. Although the patient in this case had relatively mild symptoms of incomplete upper hemi-abdominal obstruction, these symptoms could be obscured by the emergency acute upper abdominal pain with fever as clinical manifestations of acute cholangitis.

A previously well 50-year-old male presented with a six-year history of worsening right-sided upper abdominal pain, postprandial nausea, and early satiety. His blood tests, including full blood count, liver biochemistry, and serum amylase, were normal. CT of the abdomen with intravenous contrast demonstrated concentric segmental mural thickening of the body and fundus of the gallbladder, with intramural cystic foci (rosary sign). MRI of the abdomen demonstrated segmental gallbladder mural thickening with fluid-filled intramural diverticula (pearl necklace sign) and an hourglass configuration of the gallbladder, consistent with segmental gallbladder adenomyomatosis. The patient subsequently underwent laparoscopic cholecystectomy with histological confirmation of gallbladder adenomyomatosis, without evidence of malignancy. His postoperative recovery was uneventful.

The sickle cell trait is considered a benign entity that generally does not show clinical manifestations. However, some complications have been described under certain conditions, such as a decrease in oxygen level, dehydration, and strenuous physical efforts. Among them, splenic infarct is a rare complication that presents as left upper abdominal pain in a situation of stress such as high altitude exposure. We present two cases of splenic infarcts in patients with undiagnosed sickle cell trait who showed to our institution with severe abdominal pain after coming from high altitude cities.

An extramedullary plasmacytoma involving the gastrointestinal tract is extremely rare. We report an appendiceal extramedullary plasmacytoma in a 35-year-old man who presented to the emergency department because of upper abdominal pain. Computed tomography (CT) imaging revealed an incidental mass (3.7 × 1.9 × 1.6 cm) at the tip of the appendix. Microscopically, the appendix, periappendiceal soft tissue, and nearby lymph nodes were diffusely infiltrated by plasma cells that were kappa light chain restricted. Subsequent workup included an unremarkable bone marrow biopsy, as well as urine and serum electrophoresis. A diagnosis of kappa-restricted solitary extramedullary plasmacytoma was made. To our knowledge, this is the first case reported of an appendiceal extramedullary plasmacytoma in the medical literature.

Background: High-frequency ultrasound (HFUS) is a mobile, radiation-free imaging tool for the diagnosis of musculoskeletal disorders. We aim to demonstrate the diagnostic value of dynamic HFUS for undiagnosed lower chest, upper abdomen, and loin pain with this case series. Case Series: A cricketer presented with long-standing left-sided dull ache lower chest and upper abdominal pain, aggravated on exertion and leaning forward. His previous laboratory and previous imaging tests were unrevealing. Dynamic HFUS of his left ribs during hooking maneuver demonstrated slipping of the eighth rib over the seventh rib associated with clicking. He also reported tenderness over this region. He was diagnosed with slipping rib syndrome (SRS), and was treated with the eighth nerve block under the HFUS guidance. The second and third cases presented with chronic undiagnosed waxing and waning loin pain despite extensive laboratory and radiological workup. Both patients demonstrated twelfth rib HFUS probe tenderness in a sitting position with a specific movement that reproduced the pain during the dynamic HFUS study. The diagnosis of twelfth rib syndrome (TRS) was confirmed and treated successfully with a local intercostal nerve block. Review of the Literature: HFUS is the most underutilized imaging tool for the diagnosis of unexplained upper abdominal and lower chest pain syndromes. We identified only a few such reported cases managed with the help of HFUS. Conclusion: The dynamic HFUS is a valuable imaging modality for the undiagnosed lower chest, upper abdominal, or loin pain.

Herniation of the amniotic sac into the peritoneal cavity or bladder is a rare but serious condition during pregnancy, which has not been reported in pored congenital uterine anomaly. Here, we report a rare case to draw obstetricians' attention to the atypical uterine rupture. A primigravida at 35 weeks of gestation was admitted for upper abdominal pain. A primary diagnosis of uterine rupture was made after finding the amniotic sac herniation through obstetric ultrasound. Exploration during emergent cesarean section revealed symmetrical pored defect on the uterine horn. The diagnosis of uterine anomaly was eventually made. The educational meaning of this rare case is that it is advisable to rule out uterine anomalies when signs of uterine rupture are suspected during pregnancy while contributory risk factors have not been identified. Besides, it is of vital importance to make a full assessment of both the mother and the fetus so to determine the appropriate time of termination.

Abdominal pain is a frequent presentation to general practice; it comprises a wide range of different abdominal and extra-abdominal causes. Upper abdominal pain can be located in the epigastrium, the right and left upper quadrants, and renal angles. It may be associated with back or shoulder tip pain. Causes of abdominal pain can be benign or malignant, and may be life-threatening. Patients with upper abdominal pain may need urgent hospital admission, but many patients can be managed in the community. This article gives an overview of the important causes of upper abdominal pain, their assessment and management.

Eine 46-jahrige Patientin stellte sich mit akuten rechtsseitigen Oberbauchschmerzen vor. In der Osophagogastroduodenoskopie wurde eine Duodenalstenose im Bereich der Pars horizontalis duodeni festgestellt. Die Computertomographie des Abdomens, Endosonographie, Doppler‑/Duplexsonographie und Angiographie ergaben in der Zusammenschau ein Aneurysma eines Asts der A. pancreaticoduodenalis inferior innerhalb eines Umgehungskreislaufs von der A. mesenterica superior zur A. hepatica propria. Die Umgehung hatte sich aufgrund eines Verschlusses des Truncus coeliacus gebildet. Die symptomatische Duodenalstenose wurde durch ein lokales Hamatom nach stattgehabter Aneurysmaruptur verursacht. Nach erfolgreichem Coiling des zufuhrenden Gefases zum Aneurysma war das Hamatom in Verlaufskontrollen regredient und die Patientin beschwerdefrei.

Objetivo. Determinar las características clínicas y manejo de casos de hematoma hepático subcapsular (HHS), como consecuencia de preeclampsia y síndrome HELLP durante los años 2004 al 2016. Diseño. Estudio descriptivo, retrospectivo, tipo serie de casos. Lugar. Instituto Nacional Materno Perinatal, Lima, Perú. Material. Historias clínicas de pacientes con HHS. Métodos. Se revisó los casos de HHS atendidos durante los años 2004 al 2016, identificados en forma retrospectiva. Con fines de comparación, se identificó también los casos de la literatura mundial en PubMed. Principales medidas de resultados. Incidencia, características clínicas, manejo y evolución. Resultados. Se encontró 31 casos de HHS, con incidencia de 1 en 6 000 a 9 000 partos. La edad promedio fue 34 años y 81 % multíparas. La forma de diagnóstico más frecuente fue la visión directa durante la cesárea (45%). El síntoma más frecuente fue dolor en abdomen superior (52%), cefalea (36%), estado de conciencia alterado (31 %) Y hematuria (48%). En 90% se practicó empaquetamiento hepático y en 10% observación y monitoreo. En 44% se colocó Bolsa de Bogotá en la primera intervención quirúrgica y en los últimos 2 años se utiliza el sistema VAC para evitar el síndrome comparta mental. El 74% de los casos sobrevivió y 26% falleció. El promedio de estancia hospitalaria fue de 23,2 días. Conclusiones. La incidencia de hematoma hepático subcapsular como consecuencia de preeclampsia y síndrome HELLP fue 1 en 6 000 a 9 000 partos. La hematuria fue un signo relevante y debiera ser motivo de estudio posterior. El 90% de empaquetamiento hepático tuvo diferencias estadísticas con lo reportado en la literatura mundial (p = 0,0025), debido probablemente a la tendencia en procedimientos conservadores. A pesar de solo usar manejo quirúrgico, la cifra de mortalidad fue similar a la reportada en la literatura mundial (26% versus 17%; p = 0,2702). Objective: To determine the clinical characteristics and management of subcapsular hepatic hematoma (SHH) as a result of severe preeclampsia and HELLP syndrome in the period 2004-2016. Design: Descriptive, retrospective study, series of cases type. Setting: Instituto Nacional Materno Perinatal, Lima, Peru. Material: We reviewed the clinical charts of patients with SHH. Methods: The clinical charts of cases with SHH attended at our institution between 2004 and 2016 were reviewed. Search also included PubMed and the results were compared with those in the literature. Main outcome measures: Incidence, clinical features, diagnosis, management and results. Results: 31 cases of SHH were found, with an incidence of 1 in 6 000 to 9 000 births. The mean maternal age was 34 years and 80% were multiparous. Diagnosis was usually through direct visualization of the hepatic rupture during caesarean section (45%). The most frequent symptoms were upper abdominal pain (52%), headache (36%), alteration of consciousness (31 %) and hematuria (48%). Liver packing was performed in 90% of the cases; observation and monitoring, in 10%. In 44% of cases, a Bogotá bag was placed during the first surgery. During the last 2 years, we have recurred to vacuum-assisted closure to prevent compartment syndrome. 74% of cases survived and 26% died. The average hospital stay was 23.2 days. Conclusions: The incidence of subcapsular hepatic hematoma as a result of severe preeclampsia and HELLP syndrome was 1 in 6 000 to 9 000 births. Hematuria was a significant sign and should be studied further. Liver packing was performed in 90% of patients, a statistically significant higher rate than that reported in the literature (p=0.0025), maybe due to a preference for conservative management. Despite only performing surgical treatment, the mortality rate was similar to that reported in the literature (26% versus 17%; p=0.2702).

BACKGROUND Dyspepsia is a common presenting complaint of various upper gastrointestinal disorders. The symptoms of causes of dyspepsia often overlap and this makes aetiological diagnosis difficult. Endoscopy is the ideal procedure for identifying organic diseases of the foregut and rapid urease test with endoscopy is a gold standard method for diagnosing the h.pylori infection. Helicobacter pylori infection is associated with various upper gastrointestinal pathologies. MATERIALS AND METHODS This hospital-based case-controlled study was carried out in a tertiary hospital, Dr. Bhim Rao Ambedkar Hospital, which is attached to Pt. J.N.M. Medical College, Raipur, and which provides open access service to endoscopy. Eighty two consecutive adult outpatients and admitted patients under Department of Surgery and Medicine with upper abdominal pain and dyspepsia were screened for eligibility and underwent upper gastrointestinal endoscopy using forward-viewing endoscopes from March 2015 to September 2016. Patients with dyspepsia who are over 18 years of age should undergoendoscopy (EGD) for initial work up and divided in case having endoscopic findings and control having normal findings, then apply rapid urease test to all of these patients. RESULTS The most commonly identified endoscopic findings were gastritis (36%), Peptic Ulcer Disease (PUD) (13.3%), oesophagitis (11%), duodenitis (7.3%). Gastric cancer was identified in 4.9% of patients and all of them were aged 18 years and above (p>0.05). H. pylori infection was detected in 51% (n=42) of patients. Gastritis andoesophagitis were statistically significantly associated with H. pylori (p0.05). Gastritis, GERD and PUD are the leading causes of dyspepsia. H. pylori infection is present in significant proportion of dyspeptic patients. CONCLUSION In present study, we are concluded that all upper abdominal pain is not due to acid peptic disease, but most of upper abdominal pain is due to acid peptic disease with H.pylori positivity. This would prevent irrational use of antacids and antisecretory drugs. So patients having longer symptoms should have always screen for RUT testing. Screening of H.pylori which highly prevent the patients more succeptible for carcinoma of stomach and awareness of the disease makes the present to hospital at earlier stage and prevent devastating complications.

A 52 years old woman presented to emergency service after eating chicken meat few days before that. She had upper abdominal pain, vomiting, weakness and fever of 38C°. A control abdominal CT scan showed linear 50 mm foreign body that perforated the pyloric wall and penetrated into the liver. US, CT and fibro gastroscopy have been used to discover cause for the patient’s problem.

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition classically characterized by chronic abdominal pain, weight loss, and abdominal bruit. Chronic mesenteric ischemia caused by intermittent compression of the celiac artery by the MAL provokes upper abdominal pain that is sympathetically mediated via the celiac plexus. Because it is a diagnosis of exclusion, diagnosis of MALS in the clinical setting is typically challenging. We present an atypical case which highlights the utility of celiac plexus block as both an assistant diagnostic tool and a predictor of surgical outcomes for suspected MALS.

Aims: The study aimed to evaluate the safety and efficacy of navigated magnetic resonance imaging (MRI)-guided celiac plexus neurolysis (CPN) using a 0.4 T open magnetic resonance system. Materials and Methods: A retrospective analysis was performed on 23 patients with unresectable pancreatic cancer who underwent MRI-guided CPN between January 2013 and October 2017. Clinical outcomes were evaluated by recording the complications, the opioid intake, and questionnaire before the intervention and at the time point of 1 day, 1 month, and 3 months postprocedure using a numerical visual analog scale (VAS). Results: Navigated MRI guidance allowed the precise placement of needle in the targeted area and the visualization of the injected neurolysis agents for all cases. The VAS scores decreased from 8.8 ± 1.0 to 2.9 ± 0.9, 4.2 ± 1.7, and 4.7 ± 1.8 at 1 day, 1 month, and 3 months postprocedure (P < 0.05). This intervention reduced the dosage of opioid consumption 1 month after the procedure (52.3 ± 10.4 mg before the treatment vs. 28.2 ± 4.9 mg after the treatment; P < 0.001). Treatment-related side effects included hematoma in one patient, short episodes of diarrhea in three patients, and hypotension in four patients. Conclusions: With the assistance of the navigation system, MRI-guided CPN is a safe and effective treatment approach for managing the upper abdominal pain in patients with unresectable pancreatic cancer.

Background Abdominal compartment syndrome (ACS) is associated with mortality in patients with critical illness such as severe acute pancreatitis, but it remains unclear whether decompressive laparotomy for ACS can improve the prognosis of patients. Case presentation A woman in her 60s visited our hospital because of upper abdominal pain. On the basis of her laboratory data and abdominal contrast-enhanced computed tomography findings, acute gallstone pancreatitis was diagnosed. She underwent endoscopic sphincterotomy for the removal of the common bile duct stone. Then, a drainage tube was placed in the bile duct. However, on the 5th hospital day, her intra-abdominal pressure increased to 22 mmHg and renal dysfunction was observed, which led to the diagnosis of ACS. As intensive medical treatments did not improve her ACS, she underwent decompressive laparotomy on the 9th hospital day. Postoperatively, her laboratory data and intravesical pressure improved, and she was discharged from the hospital after abdominal closure, continuous drainage, and antibiotic therapy. Conclusion As the effectiveness of decompressive laparotomy for ACS has not been established, this treatment indication remains controversial. Decompressive laparotomy is considered useful for the management of ACS, if it is performed at an appropriate time, as in the present case.

Anterior myelomeningocele manifesting as a posterior mediastinal mass has rarely been described. These anomalies, characterized by protrusion of meninges and spinal cord through open vertebral arches, manifest with devastating spinal or neurologic problems. This report describes the case of a young woman with a long-term history of right upper abdominal pain and low-grade fever but no associated neurologic or spinal defects. Relevant investigations showed a posterior mediastinal mass in the right paraspinal region. Through a right posterolateral thoracotomy, complete excision of the growth with preservation of major surrounding structures was performed. Histopathologic examination revealed myelomeningocele. This report discusses a rare case of anterior myelomeningocele at the thoracic level without neurospinal involvement.

A 45-year-woman was admitted through emergency medical services with sudden severe upper abdominal pain in the epigastrium with radiation to the back. The pain in the upper abdomen was associated with recurrent bouts of bilious vomiting. She denied any other gastrointestinal symptoms. She had

A 26-year-old man presented with severe upper abdominal pain radiating to the back for the past 2 days. He also had multiple episodes of non-bilious vomiting. He was a chronic smoker and an alcoholic for the past 8 years. He had no history of diabetes mellitus or any drug abuse. On examination

Hepatocellular carcinoma with extrahepatic metastasis are a threat to public health worldwide. Lung, bones and abdominal lymph nodes are the major sites of metastasis from liver primary, adrenal metastasis being a less common site. Here we present an old male presented with upper abdominal pain diagnosed as advanced, unresectable hepatocellular carcinoma with right adrenal metastasis. Patient was treated with multi-kinase inhibitor sorafenib and outcome was acceptable with good patient compliance.

Caroli's disease is a rare congenital disease of the liver characterized by multiple segmental cystic dilatation of intrahepatic bile ducts. The disease is referred as Caroli's syndrome when it is associated with congenital hepatic fibrosis. The clinical features include jaundice, right upper abdominal pain, and fever due to the associated complications of bacterial cholangitis. Owing to the rarity of this disorder, the diagnosis and treatment is often delayed.

Introduction: Clinical manifestations of pancreatitis are so varied that if the physician only bear the classic symptoms, he will diagnose just part of the cases. Method: This is a descriptive study of patients diagnosed with acute or chronic pancreatitis in the Conjunto Hospitalar de Sorocaba, Sao Paulo, Brazil. We reviewed 39 medical records, which covered all cases of pancreatitis from June 2013 to June 2014. Results: We found 26 cases of acute pancreatitis and 4 of chronic pancreatatis. Biliary etiology accounted for 50,0% of cases, followed by alcoholic (26.7%) and idiopathic (13.3%). The classic upper abdominal pain was found in 11 patients, and in 3 of them it irradiates to the back. Several other painful manifestations have been reported. The duration of the pain ranged from 6 hours to 5 months. The etiologies found showed different distribution between genders. The duration of pain was higher among cases of chronic pancreatitis (median 70.5 versus 2 days; p=0.02), and the values of amylase were higher in acute pancreatitis (median 929 versus 52.5 U/L; p=0.00). Conclusions: Acute pancreatitis and chronic acutized pancreatitis, when properly diagnosed, have a benign curse, solving in a few days. The characterization of pain and other clinical manifestations are little scrutinized in medical records, perhaps because of the relative ease of classic cases diagnosis and the availability of laboratory tests. de avaliacao laboratorial.

A 54-year-old man presented to the emergency department with a 1-month history of edema in the lower legs and a 1-week history of upper abdominal pain. He also reported intermittent nausea, early satiety, and diarrhea but did not have fevers, chills, or vomiting.