A 25-year-old man presented to the emergency department with severe abdominal pain and vomiting. He had previously presented 10 days prior with similar symptoms. Computed tomography imaging showed a large jejuno-jejunal intussusception. Multiple intestinal masses were identified intraoperatively with the rare diagnosis of intestinal lipomatosis later confirmed via histopathology. Diagnosis and management of rare surgical pathologies is always challenging. Intussusception should always be considered as a differential diagnosis for abdominal pain in adults, as adult intussusception is typically due to a structural abnormality with majority of cases requiring surgical intervention. Exploratory laparotomy with segmental resection and primary anastomosis proved to be a successful approach in our case, with the patient having an uneventful recovery. Follow-up has consisted of gastrointestinal endoscopy and colonoscopy, which have not demonstrated any further lipomas.
A 33-year-old woman sustained blunt abdominal trauma following a watermelon skiing accident in a rural location. She had massive haemoperitoneum and required transfer by helicopter to a level one trauma centre. At laparotomy, the cause of haemoperitoneum was found to be due to traumatic rupture of a para-adnexal leiomyoma. On review of the literature, this is the first reported case of traumatic haemoperitoneum from ruptured para-adnexal leiomyoma, and the first reported trauma associated injury from watermelon skiing.
Recent studies have indicated that commercially available heparin is a hetrogenous compound consisting of the molecules of diverse chain length and different molecular weights. Low molecular weight (LMW) heparin has been shown in vitro to possess unique properties which should not only improve its efficacy for preventing post-op DVT but also reduce or eliminate the risk of bleeding complications. The aim of this paper is to report the results of in vivo studies performed to test this hypothesis.Ten healthy volunteers received 5000 USP units of unfractionated heparin (mol. wt. 15,000 daltons) or equivalent amount of LMW heparin (mol. wt. 6000 daltons) subcutaneously. Blood samples were withdrawn 1/2 1, 3 and 5 hours later. These were analysed for anti-thrombotic effect using anti-factor Xa (anti Xa) assay and anticoagulant effect by estimating kaolin cephalin clotting time (KCCT) method. While both the preparations of heparin produced similar response in KCCT assay, LMW heparin was found to be 4 times more active in anti-Xa assay. 30 patients undergoing major abdominal surgery were randomly allocated to receive either 5000 units of unfractionated heparin or equivalent amount of LMW heparin every 12 hourly for 10 days. Blood samples were withdrawn before, during and immediately after surgery and every day during post-op period. These were analysed for anti-thrombin III and heparin concentrations, lipoprotein lipase, fibrinopeptide A, prekallikrein, TxB2 and 6-oxo-PGF1α to assess platelet effect. Significant differences were only observed in lipoprotein lipase and anti-thrombin III concentrations. In ongoing trial 43 patients undergoing major abdominal surgery have received 1500 units of LMW heparin every 12 hourly for 7 post-operative days. Only 1 patient has developed DVT and another wound haematoma. If these results are confirmed in a larger number of patient, then LMW heparin may be ideal drug for prophylaxis against DVT.
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