PubMed · 6706522
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J A Peterson. 1984. Pseudocholecystitis.. https://pubmed.ncbi.nlm.nih.gov/6706522/
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Imaging techniques may lead to better insight in the diagnosis of the acute abdomen, and in specific cases to a more rapid diagnosis, especially in the upper abdomen. However, frequently the only result of the accessory diagnostic methods is delay of the necessary treatment. The yield of CT scanning in acute abdomen is too small to justify routine use. Ultrasonography is useful in selected cases, but not for routine application. Laparoscopic examination in acute abdomen in certain conditions facilitates making the correct diagnosis, but it constitutes an aggressive method for patients found free of abnormalities. Skillful history-taking and adequate performance of physical examination still constitute the basis of correct diagnosing. Technical aids may be of value. Good systematical studies of the clinical results and the cost effectiveness of physical examination and of the technological aids are still largely lacking.
HISTORY: A 32-year-old man had ten years previously undergone several laparotomies for recurrent ileus of the small intestine. They revealed severe intestinal oedema and histology showed hyperplasia of the lymphatic system but the aetiology was unclear. After a 10-year interval free of symptoms he presented with marked hypoproteinaemic oedema and exudative enteropathy the cause of which was to be clarified by exploratory laparotomy with excision of lymph nodes and a small section of small intestine. INVESTIGATIONS: Histology revealed intestinal lymphangiectasis with partly hyperplastic lymphoid tissue. Lymphangiography demonstrated several lymph nodes in the region of the aortic bifurcation and renal vessels with a central filling defect. It is thought likely that obstruction to lymphatic flow in this region resulted in oedema of the intestinal wall which caused the recurrent episodes of ileus. DIAGNOSIS: Retrospectively it is assumed that primary intestinal lymphangiectasis was responsible for the initial manifestation of an acute abdomen. For treatment of hypoproteiaemia with human albuminea prot system was implanted. The course was complicated by recurrent inflammation and thrombosis of the port catheter. Because of immune deficiency risk of carcinoma is high in primary intestinal lymphangiectasis. CONCLUSION: Primary intestinal lymphangiectasis, even though a rare condition, should be considered in the differential diagnosis of otherwise unclear acute abdomen.
A 39 year-old febrile man with lower abdominal pain and peritoneal reaction was operated on suspicion of acute appendicitis. During the past eighteen months he had been hospitalized twice due to similar symptoms, both times with spontaneous remission. The operative finding was a large multilobular vascular tumour which on pathological examination was a haemangiopericytoma, with no degree of malignancy. The tumour was removed in toto.