HighlightsSuperior mesenteric artery syndrome is rare cause of duodenal obstruction.Superior mesenteric artery syndrome is caused by narrowing of aortomesenteric angle.High index of suspicion is needed for diagnosis.Most common cause is significant weight loss.Simple Contrast enhanced CT scan can help in reaching diagnosis.
Melanosis peritonei is an unusual and uncommon condition characterized by pigment deposition in the peritoneum. It is usually associated with other conditions. During a right inguinal hernia open repair for an 86-year-old gentleman, widespread black spots were observed on the hernial sac. After appropriate histopathological and immunohistochemical studies, the diagnosis of melanosis peritonei was established. The past medical history of the patient included an endoscopic excision of a sigmoid polyp which was found to be an adenocarcinoma with <1mm clearance margin on histopathology. Being recognized as an extremely rare condition, melanosis peritonei should be differentiated from other conditions including metastatic melanoma.
Benign tumours of vascular and lymphatic origin are known as lymphangiomas. In this report, we present a case of a 26-year-old lady admitted with symptoms of small bowel obstruction. Her computed tomography (CT) scan showed a well-defined mass in the small bowel mesentery associated with small bowel volvulus. Segmental resection of the bowel, including the mass, was performed. Microscopic examination and immunohistochemistry of the specimen were consistent with lymphangioma of the small bowel mesentery.
Aim
Ultrasound scan is the preferred imaging modality in children as it carries no risk of radiation exposure. In this audit, the number of inpatient paediatric ultrasound referrals was assessed over a period of one year. The waiting time was also reviewed in addition to the impact of the results on the management plan.
Method
This was a retrospective audit which included patients who were below 16 and had inpatient ultrasound scan. Case notes were included from January 2020 to December 2020 in a busy district hospital in the UK. The time taken to perform the ultrasound scans and the impact on the management plan were only analysed for the scans requested for abdominal pain.
Results
A total of 914 paediatric ultrasounds scans were requested in 2020. A total number of 28 scans were requested for abdominal pain. The waiting time ranged from 3 to 135 hours with a mean of 23 hours. No scans were positive for appendicitis. Only 2 scans were positive for gynaecological pathologies, i.e., ovarian cysts. All the 28 patients were discharged without undergoing any procedure. Out of the 28 patients, 15 patients had a length of hospital stay of more than 24 hours before discharge.
Conclusions
A mean delay of 23 hours could potentially delay the management of paediatric patients with acute abdominal pathology. None of the patients in this audit underwent any procedure following performed scans. This may indicate that such scans did not alter the management of the studied patients in this audit.
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