International surgical boards

2022-02-28 23:05:10 Peritoneal mice

Also called peritoneal loose bodies, they form due to torsion of epiploic appendages which are protrusions of subserosal fat of the colon, they undergo axial torsion, necrosis and sloughing, they then transform into a proteinaceous material which become calcified and float freely in the peritoneal cavity.

In most cases they are small and asymptomatic requiring no intervention, rarely they are large causing bowel obstruction, urine retension or urinary frequency.

In the above figure, a 62 year old male patient suffered urinary frequency for years, CT scan showed a mass in the pelvis (fig A), upon laparoscopic extraction and pathologic examination it was concluded to be a large peritoneal loose body. Open / Comment

2022-02-27 17:56:45 Open / Comment

2022-02-27 17:55:30 Open / Comment

2022-02-27 17:54:20 Open / Comment

2022-02-27 17:52:10 Open / Comment

2022-02-27 17:47:52 Open / Comment

2022-02-27 00:10:49 Open / Comment

2022-02-27 00:07:10 Pancreatic pseudocyst

This refer to the collection of pancreatic secretions in a well defined wall of granulation tissue or fibrous tissue.

It forms after trauma, acute pancreatitis or chronic pancreatitis, basically anything that lead to duct disruption and escape of pancreatic secretions, it requires 4 weeks or more from the index event for the wall to fully mature.

Most pseudocysts are located in the lesser sac, unusual locations do occur however like in the spleen or even the chest, but this is rare, most do go away on their own, but those over 6 cm, lasting over 12 weeks or occur due to chronic pancreatitis are unlikely to resolve spontaneously.

When appropriate drainage should be done, this can be done by simple percutaneous aspiration or by cystogastrostomy which are nowadays usually done by endoscopy.

Above table lists possible complications of pseudocysts. Open / Comment

2022-02-26 21:57:35 Open / Comment

2022-02-26 20:27:37 Possible x ray findings in acute pancreatitis

Sentinel loop sign, represents localised ileus of intestinal loops near the inflamed pancreas.

Generalised paralytic ileus, if inflammation is severe and diffuse, dilated bowel loops will be seen as intestinal obstruction.

Colon cut-off sign, describes a situation in which the colon seems to abruptly "end" as shown in the figure above, it may relate to functional retraction of the phrenicocolic ligament.

Renal halo sign, the inflammatory exudate in the retroperitoneal space seem to enhance the perirenal fat appearing as a radiolucent halo surrounding the kidney, this may occur around both kidneys.

Pleural effusion, may occur as a result of posterior disruption of inflamed pancreatic duct with subsequent formation of a pleuropancreatic fistula.

Calcified radio-opaque gallstone, may point toward gallstone pancreatitis, it has to be noted that only 10% of gallstones are radio-opaque. Open / Comment