Presumed pancreatic cyst proven to be venous malformation due to intestinal malrotation
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A 27-year-old man was admitted for evaluation of a 20-year history of chronic epigastric pain and weight loss of 3 kg over the preceding month. Despite several upper endoscopy examinations, no specific cause could be found. Physical examination showed mild epigastric tenderness. Laboratory findings were unremarkable apart from elevated creatinine level (3.17 mg/dL) due to focal segmental glomerulosclerosis. To investigate the cause of the abdominal pain, which became aggravated after a meal and improved with fasting, abdominal sonography was performed and showed a benign-looking 2-cm cystic lesion on the body of the pancreas ([Fig. 1 a]). Although the cyst was devoid of intraluminal Doppler signal ([Fig. 1 b]), it proved on abdominal magnetic resonance imaging (MRI) to be one of two focal venous aneurysms ([Fig. 2 a, b]). Twisting of mesenteric vessels along the mesentery was also visualized on abdominal MRI ([Fig. 2 c, d]). Thus, both the focal venous aneurysms and the persistent abdominal pain could be attributable to intestinal malrotation. The findings of a small-bowel series were also compatible with intestinal malrotation: the distal duodenum and jejunum were arranged in a corkscrew appearance on the right side of the ligament of Treitz ([Fig. 3 a]), and the cecum was also located in the right upper quadrant ([Fig. 3 b]) [1]. Surgical management was planned, and on laparotomy the small intestine was found to be arranged in a coiled fashion ([Fig. 4 a]). Ladd's band could clearly be demonstrated and was excised to resolve the intestinal malrotation ([Fig. 4 b]) [2].Keywords:
Exploratory laparotomy
Epigastric pain
OUR interest in retractile mesenteritis was first aroused when one of us (C.G.T.) was consulted on an exploratory laparotomy for a suspected tumor in the large bowel. The tumor was not found, and the only significant alteration was that of a large area of thickening and sclerosis at the root of the mesentery.A few months later we were faced with an almost identical situation. At an exploratory laparotomy for small-bowel obstruction, the suspected condition could not be detected, and both mesentery and mesosigmoid displayed areas of increased thickness, fibrosis and scarring. The pathological diagnosis in both these cases was . . .
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Volvulus of the jejunum and ileum in three horses was associated with intestinal strangulation in a mesenteric rent. The rent was in the jejunal mesentery at its point of attachment with an anomaly that was classified as a mesodiverticular band. The band also was attached to the dorsolateral surface of the jejunum, thus forming one side of a triangular hernial sac that was completed on the other side by the adjacent jejunal mesentery. Incarceration of a loop of small intestine in the hernial sac preceded rupture of the jejunal mesentery and subsequent intestinal strangulation. Surgical correction was successful in two horses and involved resection of the gangrenous intestine, then jejunocecal anastomosis. The third horse was euthanatized when intestinal rupture and peritonitis were found on exploratory laparotomy. Two mesodiverticular bands attached to the distal jejunum were incidental necropsy findings in a fourth horse.
Exploratory laparotomy
Jejunum
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Laparoscopic adjustable gastric banding (LAGB) is a technique used for the surgical management of morbid obesity. This report illustrates the case of a 46-year-old African American woman who presented with a rare case of small bowel obstruction (SBO) two years post-LAGB placement. SBO, in this case, was a result of LAGB connecting tube intertwinement within the mesentery, accompanied by adhesions. The patient was diagnosed clinically and radiologically by computed tomography (CT) scan, which showed high-grade SBO. Initially, an exploratory laparoscopy was conducted, which soon transformed into an exploratory laparotomy when the cause of obstruction was seen to be the intertwinement of the connecting tube of the gastric band with the mesentery. With the rise of bariatric procedures to combat the epidemic of obesity in American society, this rare complication secondary to one of the most widely performed procedures beckons the attention of bariatric surgeons, emergency personnel, and device manufacturers.
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Gastric banding
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Exploratory laparotomy
Debulking
Bowel resection
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Previously, the management of gunshot wounds (GSWs) to the anterior abdomen required exploratory laparotomy; however, this was associated with a considerable number of non-therapeutic surgeries. The use of non-operative management (NOM) of GSW to the abdomen is controversial, with many surgeons sceptical to accept this into their practice. The NOM of GSW to the abdomen employed in a selected group of patients has been shown to be safe and acceptable. Penetrating GSW to the thoraco-abdomen, back and lateral abdomen has been the most successful compared to the anterior penetrating wound. Most of the anterior GSWs to the abdomen are associated with viscus injury and require exploratory laparotomy. We report the case of a 58-year-old male who presented with a single GSW to the epigastrium with a contrast computed tomography scan demonstrating grade 3 liver lacerations, contusion to the right adrenal gland, with moderate free fluids in the retroperitoneum and the pelvis. The patient was haemodynamically stable and managed successfully with NOM. It is one of the safe routes of anterior penetration of GSW to the abdomen and treated with conservative management.
Exploratory laparotomy
Gunshot wound
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Mesenteric Ischemia
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Mesenteric Schwanoma is a rare condition We report this entity found in a patient admitted in surgical unit-I Jinnah hospital Lahore. He presented with Mass and continuous dull pain in lower abdomen On exploratory laparotomy the abdomen was found to be having two masses in the mesentery of small gut one about 18x10x5 cm and other 8x5x3 cm in size and diagnosis of mesenteric schwanoma was made on histological examination
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Acute abdomen
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Mesenteric fibromatosis, or intra-abdominal desmoid tumor, is a rare proliferative disease affecting the mesentery that can pose a diagnostic and therapeutic challenge. It is a locally aggressive tumor that lacks metastatic potential but often recurs locally. Mesenteric fibromatosis with intestinal involvement can be easily confused with other primary gastrointestinal tumors, especially with that of the mesenchymal origin. We report a case of a 46-year-old male with no significant medical or surgical history, complaining of left side abdominal pain and fever for 3 days. The patient was thoroughly investigated and contrast-enhanced CT abdomen revealed a well-defined mass over the left upper abdomen near the splenic flexure. Exploratory laparotomy was underwent and a mass measuring 5.6 cm in diameter arising from the descending mesocolon was identified. Complete removal was accomplished with no need of small bowel or colon resection. Histopathological examination showed mesenteric fibromatosis. Postoperatively, patient was well and 3-month followup showed normal recovery.
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Mesenteric panniculitis is a rare nonspecific inflammatory disease of the mesentery, and most of such cases have a chronic course. We have experienced a case of acute mesenteric panniculitis. A 23-year-old female admitted to our hospital with the complaints of abdominal pain and fever. An abdominal CT scan disclosed inflammatory changes of mesentery, yet exploratory laparotomy was done because of increasing abdominal pain. At laparotomy the mesentery of the small intestine was found to present an inflammatory thickness, and macroscopically it was diagnosed as mesenteric panniculitis. Histological diagnosis of biopsy was the same. In this patient remission could be attained by only antibiotic and non-steroidal anti-inflammatory drug therapy. In this paper we also reviewed 35 cases in the Japanese literature.
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Panniculitis
Acute abdomen
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