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The parameters of a single incision laparoscopic surgery (SILS) to the base of the vermiform process, the neck of the gallbladder and the duodenal bulb were assessed using spiral computed tomography (CT) in 101 patients and in an anatomical study on 98 unfixed corpses. Four median approaches and access in the left iliac region to the base of the vermiform process, umbilical and epigastric accesses to the neck of the gall bladder, the vertical subcostal, left subcostal and umbilical accesses to the duodenal bulb were evaluated. According to the CT and anatomical data, it has been established that the umbilical access to the appendix provides the optimal conditions for performing surgical interventions using the SILS - technology. In addition, access “2” by individual criteria has the most advantageous spatial characteristics and can also be used for minimally invasive access to the appendix. When comparing the umbilical and epigastric accesses to the neck of the gallbladder, it was found that the epigastric approach is appropriate for the introduction of a manipulation trocar, the umbilical approach is for extracting the gallbladder and visualizing it in minimally invasive surgery. According to the CT and anatomical studies, it was found that the vertical subcostal access to the duodenal bulb has the characteristics sufficient to perform surgical interventions using a SILS - technology.

Contrast enhance CT scan of Abdomen showing a large encysted collection at the left of the abdomen extending from lumbar region to left iliac region pushing the surrounding viscera forward. Collection was due to retro-peritoneal hemorrhage in a Middle aged Lady with COVID-19 who was on therapeutic dose of anticoagulation with Low Molecular Weight Heparin. J MEDICINE JAN 2021; 22 (1) : 84-85

Eosinophilic fasciitis, also known as Shulman's syndrome, is a fibrosing scleroderma-like syndrome, which is a distinct entity. A 55-year-old man, presented with progressive skin darkening, thickening, and tightening over the left lower limb since 6 months. Dermatological examination revealed a hyperpigmented indurated area on the left thigh, extending to the anterior aspect of the left leg. A well-defined hypopigmented indurated plaque was present over the left iliac region. Histopathology and imaging studies confirmed the diagnosis of eosinophilic fasciitis and lichen sclerosus. The indurated lesion on the left lower limb responded dramatically well to oral corticosteroids. This is a rare case of unilateral eosinophilic fasciitis associated with ipsilateral extragenital lichen sclerosus.

A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4×2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.

A 63-year-old man was admitted with complaints of swelling and dull pain in the left lower extremity. Phlebography showed venous obstruction in the left iliac region due to thrombi. A femoro-femoral cross-over bypass was carried out using a spiral supported expanded polytetrafluoroethylene graft. The implanted graft was shown to be patent venography 12 days after surgery. Preoperative symptoms have improved in the 11 months since surgery.

Introduction Situs inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. When associated with dextrocardia, it is known as situs inversus totalis. This condition is rare and can be a diagnostic problem when associated with appendicular peritonitis. Case presentation We report the case of a 20-year-old African man who presented to the emergency department with a 4-day history of diffuse abdominal pain, which began in his left iliac region and hypogastrium. After examination, we initiated a surgical exploration for peritonitis. We discovered a situs inversus at the left side of his liver, and his appendix was perforated in its middle third. A complementary post-operative thoracic and abdominal tomodensitometry revealed a situs inversus totalis. Conclusion Appendicular peritonitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, tomodensitometry, magnetic resonance imaging, and laparoscopy may contribute to the early management of the disease and give guidance in choosing the most appropriate treatment for patients.

A szerzők jelen munkában négy juvenilis betegük esetét mutatják be, akiknél a krónikus ízületi gyulladást kísérő megacolont észleltek. A két betegség lefolyását és egymással való (feltehetőleg patogenetikai) kapcsolatát ismertetik, felhívva a figyelmet arra, hogy nem véletlen társulásról lehet szó. A mozgásszervi klinikai kép alapján mind a négy eset a szeronegatív spondylarthritisek csoportjába sorolható. A hasi statust illetően fizikális vizsgálattal minden alkalommal a bal oldali iliacalis régióban masszív rezisztenciát, nagy mennyiségű scibalakkal telített megacolont észleltek. A megacolon egy esetben bizonyult valódi Hirschprung-betegségnek, műtéti megoldására egy esetben került sor, amely egyúttal az arthritis remisszióját is eredményezte. A többi betegnél a krónikus obstipáció, megacolon továbbra is megoldásra vár.

The American Journal of Cardiology MARCH 26e29, 2015 11 IN AND C reduce the endoleak in the left iliac artery, vascular plaquewas placed to the left iliaca interna (Figure 6). Later, the left femoral approach was preferred as amain body and stentwas advanced through stiff wire and 14F sheath to cover the aneurysm neck to just below the renal arteries level, and image was taken again at his level. Stent was opened slightly at the infrarenal level to define optimal implantation place (Figure 1). Stentwas opened fully after defining the optimal level (Figure 1). The aneurysmwas completely closed and did not have any flow into. The extension stent was implanted to cover both iliac artery and left common iliac artery aneurysm (Figure 1). Procedure was terminated without any complication. Aneurysm in this patient began just distal to the left renal artery and was significantly angled and tortuous, additionally, aneurysm was extending to the left iliac region. In conclusion, aneurysm repair can be done safely in sharply angled iliac and abdominal aneurysms and in patients with high surgical risk. Vascular plaque should also placed to reduce the endoleak possibility.

Situs inversus totalis is an uncommon congenital positional anomaly in which orientation of all asymmetric organs in the body are mirror image of normal morphology. The condition if undetected may pose a diagnostic problem of abdominal pathology. We present a case of situs inversus totalis with acute appendicitis in adult female who was previously unaware of her situs anomaly. A 35-year-old adult female presented with history of acute pain abdomen in left iliac region; clinically, she was diagnosed to be acute diverticulitis. Further investigation with abdominal computerized tomography (CT) and ultrasound imaging confirmed situs inversus with acute appendicitis. Patient underwent emergency laparoscopic appendectomy under general anesthesia; intraoperative electrocardiogram (ECG) monitoring was done with reverse lead placement.

TYPHOID FEVER COMPLICATED RY CIRCUMSCRIBED PNEUMONIA. Case I. Miss G., 25 years old, was seen November 10, 1884. The temperature was 104.5°, the pulse 108, and the respiration 32. For five days she had been feeling poorly, and had suffered with headache and nausea. She had a chill and there had been some cough. The tongue was heavily coated. The bowels were regular. On examining the chest a region of dulness was found at the base of the right lung in front. The dulness did not extend above the nipple, and was not marked. In the back it was wanting. Over this area moist râles with slightly prolonged expiratory sounds could be heard. Before the present illness there had been no cough. The abdomen was slightly tympanitic, and there was slight tenderness in the left iliac region. November ii. On the following day the temperature rose to 105.2°. Diarrhœa and

On the morning of Aug. 11, 1913, I was called by the proprietor of a hotel to see one of his employees, a dishwasher, who, he said, had been sick since the day before. The patient, a Dane, aged 68, stated that he had fallen on a cup about two weeks before and cut himself. He complained of severe pain in the left iliac and hypogastric region. He gave no history of vomiting, but stated that his bowels had moved the day before and that he had urinated that morning. His temperature was 99 and his pulse 80. There was blood on the bed. Examination showed a mass in the left iliac region. I took him to the hospital, and on further examination found blood coming from the rectum, and a deep laceration through the mucous membrane and the sphincter muscle in its posterior aspect. Examination under anesthesia disclosed a

At Winchester, Ky., June, 1886, the author read a paper before the Kentucky State Medical Society on ulceration of the sigmoid cavity—Inversion of Trunk, Electric and Reflected Light in Diagnosis and Treatment, which was published in the American Practitioner and News , Vol. 11. New Series, No. 17, August 21, 1886, at Louisville, Ky. On November 30, 1885, the writer visited J——Mc. at Crab Orchard, Ky., who had had an attack of acute dysentery in August, 1885, and had made an incomplete recovery, and had been treated by his physician for chronic dysentery from September 18 to November of that year. Age of patient was 20 years, good family history, former health good, habits and morals good, and the following general and local conditions existed, viz.: The patient was pale, weak and anemic; the tongue had a yellowish-white coat; the bowels were tympanitic and painful in the left iliac region, especially

Subperitoneal or extra-uterine fibroids are justly regarded, in the treatment, as one of the most difficult problems in surgery, hence this report.Mrs. W., aet. 38, and mother of four children, detected a movable "lump" or tumor in the left iliac region some three years prior to the operation for its removal. She attributed its cause to overexertion and fright, caused by a prairie fire that consumed her home. In a few months it had attained a size that inconvenienced her. She received little benefit from her local physicians, whom she consulted from time to time, there being little uniformity of opinion in diagnosis and treatment.Menorrhagia and dysmenorrhœa were well marked characteristic symptoms, and of late a frequent recurrence of haemorrhage has annoyed and weakened her. I first saw the case in April, 1883; found the patient confined to her bed by an enormous abdominal tumor, evidently fibroid; her

Mrs. H., aged 50 years, consulted me at St. Elizabeth's Hospital in September, 1898, and gave the following brief history: At about the age of 14 she was taken sick with pain in the abdomen. No diagnosis was made by her physician, and, after many months of suffering a spontaneous opening appeared at the umbilicus, with a discharge of large quantities of pus. About twenty years before I saw her, a fecal fistula appeared through the same opening, discharging both pus and feces. On examination a large, hard, immovable mass could be palpated, irregular in outline and extending from the site of the fistula along the left iliac region far into the pelvis. A vaginal examination revealed both anterior and posterior culs-de-sac filled with a hard mass and the uterus firmly fixed. On September 17 an incision was made around the fistula, and on opening the abdomen, the intestines were

Two recent reports of the rarer abdominal conditions prompt a report of a case of gangrenous appendix epiploica, simulating acute appendicitis, in the left iliac region. Max and Philip Thorek1reported a case of epiploitis with abscess occurring two months after an operation for hernia. "In postoperative epiploitis two types are mentioned, one chronic, the other acute, of embolic or thrombotic origin." G. H. Colt2reported three cases of appendices epiploicae and says that Johanssen in 1927 collected reports of twenty cases from the literature. Localized pain and tenderness with nausea or vomiting would suggest the possibility of a torsion of an appendix epiploica. In the case to be reported there was no twist of the pedicle and hence the condition was of embolic or thrombotic origin. REPORT OF CASE A. B. L., a man, was apparently in good health until two days before I saw him, when

I report to-day six cases of laparotomy for penetrating stab wounds of the abdomen in which the viscera were injured, one death and five recoveries. Case 1. Wound of Descending Colon and Ileum; Laparotomy; Recovery.—Edward T., colored, aet. 16, was admitted to the City Hospital July 23, 1890. Two hours previous he was stabbed with a long, narrow-bladed "chicken knife." The wound of entrance was quite small and situated in the left iliac region, near the free extremity of the twelfth rib. Two inches of omentum protruded. The patient's general condition was excellent; there was but little pain; pulse 62, respiration 23, rectal temperature 100° F. Percussion gave dulness in the left lumbar and iliac regions. The liver dulness was greatly diminished. After thorough antiseptic precautions, an incision 4 inches long was made in the left linea semilunaris. Considerable blood and faecal matter were found in the cavity. There were

Gangrenous appendicitis occurring with visceral transposition is so uncommon that it is thought well to report the following case: A married woman, aged 18, who had had no pregnancies and whose previous history was negative, had irregular menses during the past year. Jan. 30, 1915, she took a course of calomel. Next day she felt well. At 11 p. m. she was awakened by a sudden, severe abdominal pain, of a cramping, colicky nature, in the midabdomen, which continued all night and was accompanied by vomiting. Pain continued all next day, but became localized in the left iliac region and there remained constant with occasional vomiting. She took castor oil and applied hot applications with no relief. February 2 she was driven to town. The trip took four hours. She vomited once and suffered much. Examination forty hours after onset revealed a medium-sized woman, plainly in severe pain; she leaned