Hemorrhagic cholecystitis: case report and literature review Introduction: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis with a high mortality. Materials and Method: Patient with abdominal pain in right hypochondrium and jaundice. Laboratory analyses and hepatobiliary ultrasound suggested acute cholecystitis, however, general worsening during hospital stay was observed and a computed tomography was performed, revealing hemorrhagic cholecystitis and hemoperitoneum. Results: Urgent laparotomy which confirmed tomographic results, successfully solved with cholecystectomy. Discussion: Hemorrhagic cholecystitis diagnosis is difficult as symptoms at the beginning do not differ from acute cholecystitis, then, clinical suspicion and a correct image analysis is crucial for its detection. Conclusion: Although, perforated hemorrhagic cholecystitis with hemoperitoneum is a very rare entity with confused diagnosis, an abdominal computed tomography with intravenous contrast is very important in any patient with severe acute cholecystitis suspicion.
Objective:To describe the clinical characteristics and location of lesions in patients with deeply infiltrating endometriosis using the revised Enzian (rEnzian) classification.Material and Methods:The clinical records of 60 patients undergoing laparoscopy for deeply infiltrating endometriosis at Hospital Civil de Culiacán, Sinaloa and Hospital San Javier, Jalisco, Mexico, were reviewed. Age, body mass index (BMI), number of pregnancies, childbearing, previous abortions, laparoscopic suggestion (pelvic pain, bleeding, infertility), and size and location of the lesions were assessed according to the rEnzian classification.Results:The mean age of the patients was 30.5 years. The mean BMI was 25.6 kg/m2. Sixty-eight percent were nulliparous and 13% had at least one birth. Eighty-five percent had pelvic pain and 8.3% had infertility. Seventy percent (n=42) of the women had ovarian endometriomas (middle compartment); uterosacral and the torus uterinus ligaments were affected in 23.3%, rectum and sigmoid colon in 35% (posterior compartment), and the appendix and small intestine in 3.3%. According to the rEnzian classification, the most affected compartment was C2 (rectum and sigmoid colon with 1-3 cm lesions).Conclusion:Pelvic pain was the main symptom of patients with deeply infiltrating endometriosis, mainly in nulliparous women. According to the rEnzian classification, the C2 compartment was the most affected (rectum and sigmoid colon).
Alvarado and RIPASA presented good sensitivity, however, AIR is more specific, and has better accuracy for the diagnosis of acute appendicitis, making a better screening and thus reducing unnecessary surgeries. Therefore, it is recommended to use more AIR than Alvarado and RIPASA.
BackgroundAdult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a trapped mass; the most frequent bezoar is a trichobezoar. When a trichobezoar extends into the small intestine it is defined as Rapunzel’s syndrome. Literature describing complications related to this pathology remains scarce.Case presentationA 16-year-old Mexican girl presented to our emergency room with acute abdomen and a presumptive diagnosis of intestinal obstruction. Computed tomography was suggestive of intussusception. Surgery confirmed a jejunal-jejunal intussusception with a mass within the gastric cavity extending into her small intestine, corresponding to a trichobezoar. A manual intussusception reduction and a gastrotomy with extraction of the trichobezoar were performed.ConclusionsWe present a case of a jejunum intussusception as a complication of Rapunzel syndrome. Our patient had a favorable outcome after surgical intervention with a manual intussusception reduction, with retrograde displacement of the trichobezoar into the gastric lumen, and a complete extraction through a gastrostomy. Follow-up included psychiatric evaluation.
Recording Doublet photography provides a reliable CVS dissection criterion. It can be easily reproduced during laparoscopic cholecystectomy. The identification of cystic structures adds to the culture of safety during laparoscopic cholecystectomy.
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