Volume 73 - 2010 - Fasc.3 - Letters
Giant appendix as result of chronic appendicitis : report of a case
During operations, surgeons often find a wide range of appendix sizes in patients with varying body dimen- sion (1). The appendix length of male patients is longer than those of females with a mean of 7.5 cm and 6.5 cm respectively1. Anyway, it is rare that the appendix match- es the caecum and ascending colon in length, and, even if some appendices of more than 22 cm in length are described in literature, the only works available are too old or based on non-scientific references (2).
Protein-losing enteropathy caused by spontaneous superior mesenteric artery dissection with thrombosis
Protein-losing enteropathy (PLE) is a rare clinical condition caused by continuous protein leakage into the digestive tract, resulting in hypoproteinemia, which can be complicated by edema, ascites, and malnutrition (1). It is observed in association with various disorders. However, its association with isolated spontaneous dis- section of the superior mesenteric artery with thrombo- sis (DSMAT) has not been reported before. We describe a patient who exhibited PLE due to DSMAT, and discuss the possible mechanisms and treatment of refractory hypoproteinemia in this condition.
A case of intestinal obstruction caused by a peritoneal loose body mimicking gallstone ileus
Peritoneal loose bodies (also known as peritoneal mice) are usually small in size, ranging from 0.5 to 2.5 cm, and asymptomatic. They have been reported to grow to larger dimension causing symptoms such as acute urine retention (1-2), and abdominal pain (3-4). We report a rare case presenting initially as gallstone ileus. Final diagnosis at exploratory laparotomy was a peri- toneal loose body causing intestinal obstruction.
A 69-year-old woman presented to the emergency department, complaining of abdominal pain with nausea and vomiting since midnight. Her medical history was significant for acute appendicitis with rupture and gen- eral peritonitis 50 years previously and status post hys- terectomy 30 years previously for myomatous uterus. She had two episodes of intestinal obstruction in recent 3 years which were resolved after conservative manage- ment.
Cutaneous metastases from carcinoma of the bile duct
A 68-year-old woman was admitted because of pain- less obstructive jaundice of three days duration when she noticed yellow colored sclerae and dark colored urine. Two months before presentation, she noticed a reddish, gradually enlarging, skin nodule at the neck above the left supraclavicular area whereas a second lesion was noticed on the chest above the xyphoid 20 days before her admission. On physical examination the skin and sclerae appeared yellow. The nodule at the neck was well circumscribed with erythema, measuring approximately 2 cm in diameter (Fig. 1A) whereas the chest lesion was a 0.8-cm red papule (Fig. 1B). Both lesions were asymptomatic, hard on palpation, not fixed to the underlying tissues and non-tender. Abdominal examination revealed mild tenderness in the right upper abdominal quadrant but no mass was palpable. There were no enlarged neck, axillary or inguinal lymph nodes.
