Visceral larva migrans presenting as acute abdomen in a child

An unusual presentation of visceral larva migrans observed in a patient is reported. A 5-year-old boy suffering fever, abdominal pain, tenderness, and rigidity in the right lower and upper quadrant of the abdomen was operated on, with the false diagnosis of acute abdomen, and exploratory surgery was carried out. The pathological examination of the liver biopsy revealed eosinophil-rich necrotizing granulomatous inflammation with Toxocara spp larva. The diagnosis was also confirmed by serologic results. Clinicians should remember that toxocaral visceral larva migrans may rarely mimic an acute abdomen and cause unnecessary operations.     

Spinal epidural abscess presenting as acute abdomen in a child.

Spinal epidural abscess is seldom encountered in children and rarely occurs in the absence of spinal pain. A case is described in which a child with a thoracic epidural abscess presented with abdominal rather than spinal pain. Thoracolumbar radicular inflammation and visceroparietal reflexes initiated by a s'spinal ileus' probably produced the symptoms and signs of acute intra-abdominal disease. Consideration of intraspinal disease is advisable in all cases of acute abdomen which exhibit atypical features.     

Amebiasis presenting as an acute abdomen

Eight cases of amebiasis complicated by an acute surgical abdomen and treated surgically are presented. An uncomplicated postoperative course followed early diagnosis and treatment whereas delayed diagnosis resulted in marked morbidity but no fatalities. Amebiasis, therefore, is not a contraindication to early surgery, but, if unrecognized, will result in marked morbidity and mortality.     

Chest disease presenting as an acute abdomen.

Four patients with primary disease in the chest are discussed, each coming to laparotomy. The final postoperative diagnoses were empyema, pulmonary tuberculosis, pulmonary embolism and bacterial endocarditis. These cases well illustrate the real risk of confusing an acute chest condition with an acute abdomen.     

Malignant pheochromocytoma presenting as an acute abdomen: a case report

A case of right adrenal malignant pheochromocytoma was reported. The patient was a 16-year-old boy who complained of severe right side abdominal pain due to spontaneous hemorrhage into the retroperitoneal space. Right adrenalectomy was performed on Feb. 22, 1988 but the preoperative high serous catecholamine level did not drop to the normal level. Postoperatively bone and liver metastasis were detected by a 131I-MIBG scan. He was treated with a combination chemotherapeutic regimen consisting of cyclophosphamide, vincristine and dacarbazine in 2 repeated cycles but there was no effect. He died 5 months after the operation.     

Heterotopic pregnancy presenting as an acute abdomen: a diagnostic masquerader

Simultaneous intrauterine and extrauterine pregnancy is called heterotopic pregnancy. It is a rare complication of pregnancy, especially in the absence of predisposing factors. It is known to present with a variety of symptoms and signs often leading to a delay in establishing the correct diagnosis. We report the case of a 29-year-old woman, known to be 14 weeks pregnant, presenting with acute abdominal pain. The confirmation of a viable intrauterine pregnancy led to a general surgery consultation. A heterotopic ruptured right ectopic tubal pregnancy was found. Right salpingectomy was performed. The patient recovered uneventfully. The intrauterine pregnancy was not affected. This case illustrates the variable presentation of heterotopic pregnancy and the need for general surgeons to be suspicious of pregnancy related complications, even in the presence of a viable intrauterine pregnancy.     

Unsuspected colchicine overdose in a female patient presenting as an acute abdomen

We report a case of multi-system organ failure as a result of unsuspected colchicine overdose in a patient with known gout and bulimia nervosa. The patient had initially presented with mild gastrointestinal symptoms with rapid progression to fulminant hepatic failure and multiple organ dysfunction before the causative agent was identified. The patient survived with aggressive intensive care support and ongoing medical treatment. Physicians should be aware of the risk assessment based on the ingested dose, that the clinical presentation of colchicine in toxic doses may be nonspecific with high potential for severe morbidity or death and that survival may occur despite multiple organ failure requinng aggressive support.     

Spontaneous rupture of a pancreatic acinar cell carcinoma presenting as an acute abdomen

INTRODUCTIONPancreatic acinar cell carcinoma is a rare malignant pancreatic neoplasm. To the best of our knowledge, there has been no report on spontaneous rupture of acinar cell carcinoma.PRESENTATION OF CASEA 39-year-old Azari male presented with a history of sudden onset, acute epigastric pain of 12-h duration. Eight hours later the patient's general condition rapidly deteriorated, blood pressure was decreased to 90/70 mm/Hg and heart rate was increased to 120 beat/min. Emergent abdominal computed tomography scan showed a well-defined hypo-dense, necrotic mass, measured 12 cm × 12 cm that was originating from the uncinate process of pancreas with marked free peritoneal fluid and extensive haziness of retroperitoneal and mesenteric fat compatible with marked bleeding. Emergent abdominal operation was performed and histopathology revealed acinar cell carcinoma of the pancreas.DISCUSSIONPancreatic acinar cell carcinoma (ACC) usually presents with abdominal pain, nausea and vomiting. To best of our knowledge, no report has been made of spontaneous rupture of ACC.CONCLUSIONPancreatic carcinoma may present as acute abdomen due to rupture of underlying neoplasm.     

Carcinoma urinary bladder presenting as acute abdomen

Bladder perforation presenting as acute peritonitis is a rare and dramatic event in the course of carcinoma urinary bladder. We present one such case and discuss the presentation, management and brief follow-up.     

Liver cell adenoma presenting as acute abdomen

A 31-year-old female presented with a sudden onset of acute abdominal pain in the right hypochondrium. Two days later, the patient was in shock and suffering from severe intra-abdominal bleeding. Investigations showed that the bleeding originated in the right lobe of the liver. The patient had been taking oral contraceptives for seven years. She underwent a laparotomy and right lobectomy of the liver which was performed successfully for bleeding cell adenoma. The patient made a full recovery.