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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Amyand's hernia (AH) is a rare condition in which the vermiform appendix is herniated into the inguinal sac regardless of whether the appendix appears normal or is inflamed. Most cases of AH are diagnosed intraoperatively at the time of inguinal hernia repair as its clinical diagnosis is difficult, and the role of computed tomography (CT) and other diagnostic imaging has not been described well in the literature. We report the case of a 79-year-old female who presented to the emergency department with nonspecific symptoms of nausea, vomiting, and constipation. Her symptoms were nonspecific, and physical examination suggested that she did not have a strangulated hernia or appendicitis, but the emergency CT scan of the abdomen showed a perforated appendix trapped in the sac of a right-sided inguinal hernia. Complicated appendicitis in an AH is a surgical emergency, and an accurate diagnosis is necessary for proper triage of patients and appropriate management. CT plays a significant role in revealing an unsuspected diagnosis of AH. Radiologists must be aware of this rare presentation of the appendix in an inguinal hernia sac and be familiar with AH subtypes.
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PMID:Identification of perforated appendicitis within a right inguinal hernia sac (Amyand's hernia) by emergency abdominal CT scan: A case report. 3288 5

Thrombophlebitis of the portal vein (pylephlebitis) is a rare but serious condition with a high mortality rate of 11-50%. A 56-year-old male patient presented with a two-day history of postprandial, colic-like epigastric pain, nausea, fever, chills, and diarrhea. Clinical workup showed peritonism, leukocytosis, and elevated C-reactive protein (CRP). A computed tomography (CT) scan revealed a long-segment, partial thrombosis of the superior mesenteric vein as well as gas in the portal venous system. Additionally, extensive jejunal diverticulosis was present. Pylephlebitis mostly results from intestinal infections, e.g., appendicitis or diverticulitis. We assumed that the patient had suffered from a self-limiting episode of jejunal diverticulitis leading to septic thrombosis. Initially, antibiotic therapy and anticoagulation with heparin were administered. The patient deteriorated, and due to increasing abdominal defense, fever, and hypotension, a diagnostic laparoscopy was performed. Bowel ischemia could be ruled out, and after changing antibiotic therapy, the patient's condition improved. He was discharged without any further complications and without complaints on day 13. An underlying coagulopathy like myeloproliferative neoplasm or antiphospholipid syndrome could be ruled out.
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PMID:Jejunal Diverticulosis Probably Leading to Pylephlebitis of the Superior Mesenteric Vein. 3301 5

Acute abdominal pain is a frequent cause for evaluation in the clinic and emergency room. A number of causes of abdominal pain are diagnosed easily based on the history, physical exam, and some laboratory findings. However, unusual conditions may pose a challenge and require invasive procedures for diagnosis. Rare anomalies such as mobile caecum may present as either typical or atypical acute appendicitis. Endometriosis and pinworm infections can also present as acute appendicitis but are uncommon presentations. To increase the awareness of these uncommon causes of appendicitis, we present a 32 year old female who was previously diagnosed with irritable bowel syndrome later found to have all of the above mentioned rare conditions contributing to abdominal pain. She presented to the emergency room with a one day history of acute right lower quadrant abdominal pain along with nausea and non-bilious vomiting. Physical exam revealed right lower quadrant tenderness to palpation. A computerised tomography of the abdomen and pelvis demonstrated a mobile cecum in the left abdomen. She subsequently underwent a diagnostic laparotomy with cecopexy and appendectomy. Pathology of the appendix showed findings suggestive of endometriosis and intraluminal enterobius vermicularis. She was treated with two doses of pyrantel pamoate for the parasitic infection, and subsequently had resolution of her symptoms.
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PMID:Abdominal pain - a common presentation with unusual diagnosis: a case report. 3319 40


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