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Introducción: la enfermedad de Caroli es un trastorno congénito poco usual, el cual cursa con dilatación segmentaria multifocal de los conductos biliares intrahepáticos. Fue descrita por Jacques Caroli en 1958 como una dilatación sacular, segmentada o fusiforme de los ductos biliares intrahepáticos. Objetivo: caracterizar a la población que ha padecido la enfermedad de Caroli. Metodología: Revisión sistemática de la literatura. Resultados: se analizaron 66 artículos, el grupo de edad más afectado es los menores de 10 años, en el que se evidenció una mayor prevalencia en varones, y se encontró asociado con otras comorbilidades como el riñón poliquístico (20 %). La manifestación más frecuente fue la hepatomegalia (44,7 %), seguido de la fiebre (42,4 %) y el dolor abdominal en el hipocondrio derecho (41,2 %). Como método diagnóstico más utilizado se encontraba la resonancia magnética (73,8 %); dentro de los hallazgos predominó la dilatación intrahepática (76,5 %) y el manejo más empleado fue la antibioticoterapia para tratar las recurrencias por colangitis. Conclusión: la enfermedad de Caroli tiene una baja prevalencia, se presenta con mayor frecuencia en el continente americano, afecta principalmente a la primera década de la vida, tiene predilección por el sexo masculino y se caracteriza por una dilatación de los conductos intrahepáticos que puede afectar a otros órganos como los riñones, lo que produce quistes renales.

Background Point-of-care ultrasound (POCUS) is used frequently to evaluate the right upper quadrant of patients with high suspicion for biliary pathology. In patients with a history of cholecystectomy, the utility of POCUS can be overlooked. Case Report We report the case of an 83-year-old female patient who was ultimately diagnosed with cholangitis more than 60 years after undergoing cholecystectomy. POCUS demonstrated a dilated common bile duct (CBD), which was confirmed by computed tomography and magnetic resonance cholangiopancreatography to be due to a large stone. Why Should an Emergency Physician Be Aware of This? Choledocholithiasis and cholangitis can still occur in patients with a remote history of cholecystectomy. POCUS can be used to rapidly evaluate the CBD for dilatation in patients post cholecystectomy.

espanolEl sindrome HELLP es una complicacion de los trastornos hipertensivos del embarazo, principalmente observado en pacientes con preeclampsia severa y eclampsia; sin embargo, puede diagnosticarse en pacientes con preeclampsia agregada y en mujeres con hipertension gestacional (preeclampsia sin proteinuria). Generalmente el sindrome se manifiesta en el tercer trimestre. Se ha senalado que 2 tercios de las pacientes eran diagnosticadas antes del parto, el 70 % entre las 27-37 semanas, el 20 % despues de las 37 semanas y el 10 % restante antes de las 27 semanas. El sindrome HELLP se observa entre el 0,5 y 0,9 % de todas las gestaciones y del 4 al 14 % de todas aquellas con preeclampsia/eclampsia. La edad promedio de las que padecen este sindrome es de 25 anos. La metodologia de la investigacion, es una revision bibliografica, que se apoyo en medios electronicos para la busqueda de la informacion. Entre las conclusiones relevan-tes estan que Las manifestaciones clinicas son variadas y entre las que se menciona estan: dolor en cuadrante superior derecho, ictericia, nauseas y vomitos, cefalea, dolor en hombro derecho y cuello, alteraciones visuales, manifestaciones hemorragicas. Este sindrome pone en riesgo la vida de la madre, por las complicaciones que se pueden presentar como: hemorragia cerebral, insuficiencia renal, ruptura hepatica y mayor posibilidad de muerte asociada con eclampsia, principalmente cuando coexiste hipertension severa. Esta condicion reviste de gran importancia durante el embarazo, ya que debe ser tratada lo mas rapido posible, ya que dentro del abanico de tratamientos que pueden existir, la interrupcion del embarazo es una de las mas comunes y realizadas, esto con la finalidad de preservar la vida de la madre EnglishHELLP syndrome is a complication of hypertensive disorders of pregnancy, mainly observed in patients with severe pre-eclampsia and eclampsia; however, it can be diagnosed in patients with added pre-eclampsia and in women with gesta-tional hypertension (pre-eclampsia without proteinuria). The syndrome usually manifests itself in the third trimester. It has been reported that 2 thirds of the patients were diagnosed before delivery, 70% between 27-37 weeks, 20% after 37 weeks, and the remaining 10% before 27 weeks. HELLP syndrome occurs in 0.5% to 0.9% of all pregnancies and 4% to 14% of all pre-eclampsia / eclampsia. The average age of those with this syndrome is 25 years. The research methodology is a bibliographic review, which relied on electronic means to search for information. Among the relevant conclusions are that the clinical manifestations are varied and among those mentioned are: pain in the right upper quadrant, jaundice, nausea and vomiting, headache, pain in the right shoulder and neck, visual disturbances, hemorrhagic manifestations. This syn-drome puts the life of the mother at risk, due to complications that can occur such as: cerebral hemorrhage, kidney failure, liver rupture and a greater possibility of death associated with eclampsia, mainly when severe hypertension coexists. This condition is of great importance during pregnancy, since it must be treated as quickly as possible, since within the range of treatments that may exist, the interruption of pregnancy is one of the most common and carried out, this in order to preserve the life of the mother.

Purpose The aim of the present study is to describe the cavity-reducing internal capitonnage technique that we used for the surgical therapy of liver hydatid cyst, and contribute to the literature by presenting the short- and long-term outcomes of the patients who were operated on with this technique. Methods A drainage and internal capitonnage technique was performed on 12 cases due to liver hydatid cyst in our clinic between January 2016 and December 2019. Results The mean age of cases was 36.25 ± 12.5 years, with 7 females and 5 males. All cases had pain in the right upper quadrant, and a sense of fullness in 5 cases. None of the cases had ruptured cysts, jaundice, or other clinical manifestations. The preoperative laboratory findings were normal in 8 cases. Intraoperative biliary-cyst communication was demonstrated in 8 cases (66.7%). Cases were followed up for a mean duration of 38.1 months (range, 24-88 months). Conclusion The drainage/internal capitonnage with/without selective bile duct repair is a technique that can be performed with very low morbidity and mortality rates in experienced hands, especially for centrally located hydatid cysts.

Video Video 1 Single-session EDGE with ERCP and EUS gallbladder drainage.

Ventriculoperitoneal (VP) shunts are commonly used in neurosurgical procedures to treat hydrocephalus. Although shunt-associated abdominal complications are well documented, extrahepatic pseudocysts are a rare shunt complication in adult patients. Therefore, we herein report the case of a 54-year-old male patient who presented with a bulging mass around the previous surgical site at the right upper quadrant of the abdomen. He had a 4-year history of VP shunt surgery for posthemorrhagic hydrocephalus. A computed tomographic scan revealed a large extrahepatic pseudocsyt. Our case represented a rare entity of extrahepatic pseudocyst in adult patients underwent VP shunt surgery. The clinical presentation, diagnostic tools, and treatment methods were discussed.

A 39-year-old man with no medical history complained of right flank pain that developed 1 day prior. He reported no history of sexual activity or of travelling abroad for the past 6 months. His temperature was 38.0°C, his BP was 144/87 mm Hg and his pulse was 119 per minute. Physical examination revealed tenderness in the right flank, with no rebound tenderness. Laboratory evaluation revealed elevated white blood cell count of 12.9×109/L (neutrophils: 67.8%). A right upper quadrant ultrasound …

Mehran Peyvasteh,1 Shahnam Askarpour,1 Mahmood Khoshkhabar,1 Hazhir Javaherizadeh2 1Department of Pediatric Surgery, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IranCorrespondence: Shahnam AskarpourDepartment of Pediatric Surgery, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Email Shahnam_askarpour@yahoo.comBackground: The main therapeutic option for hypertrophic pyloric stenosis (HPS) is pyloromyotomy surgical technique which can be performed via different methods, including right upper quadrant (RUQ) transverse incision and supraumbilical curved skin incision; thus, the aim of this study was to evaluate and compare clinical efficacy of supraumbilical curved skin incision and standard (RUQ) skin incision.Materials and Methods: In this retrospective case-control study, 35 patients with HPS were initially evaluated. After evaluating hospital records, 31 patients with completed hospital records were included: 9 from case group and 22 from control group. Demographic information, surgery parameters and postoperative complications were extracted from the hospital records or calling parents.Results: Results showed that the surgery parameters such as surgery duration (P=0.211), postoperative fasting duration (P=0.831), and hospitalization duration (P=0.521) in both groups were similar. Moreover, surgery complications such as duodenal or gastric perforation and surgical site infection did not differ between the groups (P> 0.05). While we found that Vancouver Scar Scale was significantly lower in supraumbilical curved skin incision as compared to control group (1.8 ± 0.5 vs 5.1 ± 0.7, P< 0.001, respectively).Conclusion: The results of this study showed the beneficial effects of supraumbilical curved skin incision technique on surgery scar outcomes and gives best cosmetic results with minimal complications, which could be replaced to RUQ operative technique and significantly lead to better control of surgery scar.Keywords: hypertrophic pyloric stenosis, supraumbilical curved skin incision, right upper quadrant transverse incision

Background Retrocecal appendicitis may be challenging to find. We present the first case series in which retrocecal appendicitis was found on point-of-care ultrasound (POCUS). Case Reports In each of the five cases, appendicitis was found by a pediatric emergency physician in the right periumbilical region or right upper quadrant. Why Should an Emergency Physician Be Aware of This? The POCUS practitioner should scan both the right upper and right lower quadrant of the abdomen in search of appendicitis, as well as in search of signs of perforation.

Se presenta el caso de una paciente femenina de 25 años de edad, a quien se le realizó colecistectomía convencional por colecistitis litiásica aguda. En el 5to día postoperatorio, paciente presentó ictericia generalizada, vómitos y dolor intenso en hipocondrio derecho. Se realizó colangiopancreatografía retrógrada endoscópica, evidenciando coledocolitiasis residual.

A pyogenic liver abscess secondary to appendicitis infection is a rare manifestation that has not been well illustrated in the United States due to its infrequency and the variability of each clinical presentation. Here, we discuss a 55-year-old male who presented with abdominal pain, fever, chills, and weight loss and was found to have a pyogenic liver abscess suspected secondary to radiographic-proven acute appendicitis. The purpose of this article is to describe a patient who presented with noteworthy clinical features and a rare cause of hepatic abscess, to aid in the treatment and diagnosis of future patients.

Point-of-care ultrasound can be used at the bedside to assess the haemodynamic status and fluid responsiveness of a pregnant woman. Previous studies demonstrated that views from the apical and parasternal windows are readily obtainable in labouring women. However, using the subcostal window to assess the inferior vena cava can be challenging because of the gravid uterus. A potential alternative is the right upper quadrant transhepatic window. We sought to compare visualisation of the inferior vena cava via the subcostal and right upper quadrant windows, in full-term pregnant women. This was a prospective pilot study carried out in a tertiary academic obstetric centre. Thirty pregnant non-labouring women at full term were recruited. In each patient, the inferior vena cava was visualised through both the subcostal and the right upper quadrant windows. Time to acquire each image, acquisition success rates and ease of obtaining images were compared for both approaches. Image quality was then reviewed and rated by two independent expert reviewers. There was a significant difference in the time required to obtain each view; subcostal median (interquartile range): 52 (35–59) seconds, right upper quadrant median (interquartile range): 23 (11–55) seconds ( P=0.0045). Operator-defined successful image acquisition was 100% for the right upper quadrant window compared to 80% for the subcostal window. Ease of obtaining the view, as rated by the operator, was significantly easier in the right upper quadrant window compared to the subcostal window ( P

Introduction: Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine. While the liver is a common site of metastases. Case Presentation: We describe a 73-year-old female who reported to our center with complains of swelling and pain in the right upper quadrant of stomach. CECT revealed large well-localized multicystic mass in the right lobe of the liver. A suspicion of hydatid cyst was given. However, immunogenic tests results were negative for hydatid cyst. The AFP level was also unremarkable. Conclusion: Histopathological examination with immunohistochemical panel along with other serological and radiological investigations made the diagnosis possible due to its vague clinical presentation.

Thirty five years old women presented to the Accident and Emergency Department with acute onset right upper quadrant abdominal pain with normal vitals. CT images revealed a malrotation causing midgut volvulus and intestinal obstruction. On emergency exploratory laparotomy, the gut loops showed partial ischemia due to a double twist at the root of mesentery and malrotation of the gut along with the caecum which was mobile coming from left iliac fossa and lying in the right iliac fossa. Duodeno-jejunal junction was identified. The coils of the intestine were untwisted and rotation was corrected. The gut color changed back to normal. She was discharged painless after routine post-operative care.

Introduction In this pilot study, we aimed to determine qualitative and quantitative microbiological changes after the implementation of orthodontic appliances. Methods A total of 10 healthy patients aged 12-15 years were recruited who needed to undergo orthodontic treatment with buccal fixed appliances. Gingival conditions were assessed by the Gingival Index, Periodontal Screening Index, and Sulcus Bleeding Index. Microbiological samples were collected before and 1 week after the start of therapy at premolars and molars of the right upper quadrant. Bacterial species were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Results The total number of bacteria increased. Six bacterial species were identified that are involved in the development of caries and other infectious processes. The bacteria selectively adapted more efficiently to the new oral milieu compared with the general oral microbial background. There was a significant increase in Streptococcus spp at the premolars and molars. In all individuals, symptoms of inflammation and gingivitis were detected as a response to the bacterial challenge. Conclusions Orthodontic treatment induces significant changes in the oral microbial flora associated with gingivitis and an enhanced risk for cariogenic reactions within the first days of orthodontic treatment. To prevent or reduce infectious side effects, oral hygiene instructions and control of patients are necessary before and during the beginning of the therapy.

Hepatic solitary fibrous tumors (SFTs) are mostly benign and rare because of information regarding the clinical symptoms, treatment, and prognosis of their malignant forms is currently lacking. A literature review concerning malignant SFTs revealed that there were a few cases where patients experienced abdominal right upper quadrant (RUQ) pain as their first clinical symptom, and metastases were found after being diagnosed with hepatic SFT. Here, we report a patient who was previously healthy without any clinical symptoms such as RUQ pain or weight loss, but had the appearance of a metastatic mass as the first clinical presentation before a primary hepatic SFT was detected (J Liver Cancer 2019;19:143-148)

Background: A 13-year-old boy presented with acute abdominal pain in the right upper quadrant without previous trauma. Abdominal ultrasound (US) revealed a mass in the right liver lobe with free intraperitoneal fluid, suggestive for hemoperitoneum. Magnetic resonance imaging confirmed a subcapsular lesion (5.7 x 4.6 x 4.1 cm), suggestive for fibrolamellar hepatocellular carcinoma (FL-HCC). Positron emission tomography-computed tomography revealed mild to moderate fluorodeoxyglucose (FDG) avidity, with no other FDG avid lesions. Hepatic tumor markers were negative. Case report: An elective right hepatectomy with cholecystectomy and hilar lymph node resection was performed. Results: Histology showed a central fibrous scar and confirmed a FL-HCC (pT1bN0M0). The resected lymph nodes were tumor-free. Treatment of FL-HCC should consist of complete tumor resection with concurrent lymph node resection +/- orthotopic liver transplantation. Long-term follow-up is advised. A follow-up interval of 3-4 months in the first 2 years after surgical resection can be justified as FL-HCC have a high recurrence rate of more than 50% within 10-33 months. Conclusions: Malignancy can be a rare cause of abdominal pain in pediatric patients. An abdominal US is essential to prevent misdiagnosis. Treatment of FL-HCC should consist of R0 tumor resection with concurrent lymphadenectomy +/- orthotopic liver transplantation.

Most of the case reports on hydatid cyst have documented its diagnosis and treatment involving either lungs or liver. This case report is unique as it documents the standard diagnostic and treatment approach followed for curing concurrent multiple hydatid cysts involving liver and right lung simultaneously via single stage surgery. A 52-year-old male presented with symptoms of simple pneumonia along with mild pain in the right upper quadrant. Hydatid cyst was considered as the differential diagnosis after physical examination. Both CT scan and MRI confirmed the presence of multiple cysts both in the liver as well as right lung. A single stage radical removal of cysts from both the organs was performed. The patient was hemodynamically stable, and no complications were reported postoperatively. This case report highlights the importance of considering hydatid cyst as a differential diagnosis in the light of vague presenting symptoms. Also, it emphasizes on the benefits of single stage surgery for removing cysts from both the organs simultaneously. Keywords: Hydatid cyst, Water lily appearance, Liver, Lungs, Single stage surgery

Right upper quadrant (RUQ) abdominal pain is a common complaint. Acute cholecystitis (AC) is the primary diagnostic consideration in most adults presenting with acute onset RUQ abdominal pain; however, a variety of other conditions can mimic AC. Abdominal ultrasound (US) receives the highest score for imaging appropriateness for these patients. This article reviews the sonographic findings of uncomplicated and complicated AC and provides practical technical tips. The radiologist should be familiar with conditions that can mimic AC, be able to suggest these alternative diagnoses when findings are present on US, and recommend additional tests or procedures, if needed.

Background: The three major approaches for Ramstedt pyloromyotomy – right upper quadrant incision, supraumbilical incision and laparoscopic method, are often compared, with some preference given to the supraumbilical approach. It becomes widely adopted in many centers around the world. Aim: To analyse the early results of the supraumbilical incision in treatment of hypertrophic pyloric stenosis and to test a hypothesis that this technique may be valuable in our clinical conditions. Materials and methods: Within a ten-month period five children with hypertrophic pyloric stenosis were selected (using single random sample) for pyloromyotomy via supraumbilical incision and another five children - via Robertson incision. This technique consists of semi lunar cutting in the upper half of umbilicus, extended cranially in the midline. After a Ramstedt pyloromyotomy, linea alba is sutured and the reshaped skin is sutured in semilunar manner around the umbilicus. The scar was estimated with Patient and Observer Scar Assessment Scale. Results: The operations were performed by pediatric surgeons with different experience and with basic equipment. The operative time was 5-10 min longer for the supraumbilical incision. The pyloromyotomy led to a definitive healing, with timely feeding and discharging, without any complication. The quality of the scar was significantly better after the supraumbilical incision. Conclusion: Supraumbilical incision is reliable and related to low complication rates. It leaves better scar than the Robertson incision and is an excellent alternative in search for less invasive techniques.

A 24-year-old woman presented with right shoulder pain that started 6 days prior. Three days ago, she developed right upper quadrant abdominal pain. These pains worsened during deep inspiration and right lateral recumbent position. The right shoulder pain was localised to the trapezius ridge. Her last menstrual period was 14 days ago, and her last sexual intercourse was 6 weeks prior to the symptom onset. Physical examination revealed …

Background Hepatic and biliary diseases are prevalent worldwide, but the majority of people lack access to diagnostic medical imaging for their assessment. The liver and gallbladder are readily amenable to sonographic examination, and ultrasound is a portable, cost-effective imaging modality suitable for use in rural and underserved areas. However, the deployment of ultrasound in these settings is limited by the lack of experienced sonographers to perform the exam. In this study, we tested an asynchronous telediagnostic system for right upper quadrant abdominal ultrasound examination operated by individuals without prior ultrasound experience to facilitate deployment of ultrasound to rural and underserved areas. Methods The teleultrasound system utilized in this study employs volume sweep imaging and a telemedicine app installed on a tablet which connects to an ultrasound machine. Volume sweep imaging is an ultrasound technique in which an individual scans the target region utilizing preset ultrasound sweeps demarcated by easily recognized external body landmarks. The sweeps are saved as video clips for later interpretation by an experienced radiologist. Teleultrasound scans from a Peruvian clinic obtained by individuals without prior ultrasound experience were sent to the United States for remote interpretation and quality assessment. Standard of care comparison was made to a same-day ultrasound examination performed by a radiologist. Results Individuals without prior ultrasound experience scanned 144 subjects. Image quality was rated “poor” on 36.8% of exams, “acceptable” on 38.9% of exams, and “excellent” on 24.3% of exams. Among telemedicine exams of “acceptable” or “excellent” image quality (n = 91), greater than 80% of the liver and gallbladder were visualized in the majority of cases. In this group, there was 95% agreement between standard of care and teleultrasound on whether an exam was normal or abnormal, with a Cohen’s kappa of 0.84 (95% CI 0.7–0.98, p Conclusion This asynchronous telediagnostic system allows individuals without prior ultrasound experience to effectively scan the liver, gallbladder, and right kidney with a high degree of agreement with standard of care ultrasound. This system can be deployed to improve access to diagnostic imaging in low-resource areas.

Highlights • Cardiophrenic lymph node resection. • Advanced ovarian cancer. • Cytoreductive surgery., Upfront debulking surgery followed by adjuvant chemotherapy still remains as the mainstay approach to patients with advanced ovarian cancer (Eisenhauer et al., 2006). Upper abdominal surgery is often required to achieve complete gross resection and there are several studies in the literature reporting increased survival, as well as a minimal but acceptable increase in morbidity, as a result of this shift in the surgical paradigm (Chi et al., 2009). Cardiophrenic lymph nodes (CPLNs), also referred to as paracardiac and supradiaphragmatic lymph nodes, are located just above the diaphragm. In diseases such as advanced ovarian cancer, where there is often considerable abdominal and peritoneal tumor burden, these lymph nodes can harbor metastases. These nodes are usually larger than 5 mm in diameter and are easily identified on computed tomography. Evidence suggests that this finding should not preclude primary debulking surgery (if resectable disease in the abdomen) as it is associated with an increased median overall survival even in stage IV disease (Cowan et al., 2017, Prader et al., 2016). We present a video highlighting one of the most commonly performed debulking procedures in the upper abdomen – right diaphragmatic peritoneal stripping (the patient had multiple small implants in both the diaphragmatic peritoneum and Morisońs Pouch peritoneum, so en bloc resection was performed) – followed by a transabdominal excision of an enlarged right cardiophrenic lymph node. The defect was closed with a 2-0 polypropylene running suture.

Introduction: The upper and lower lip consists of the numerous amounts of fine grooves. This pattern of grooves will be definite throughout the lifetime. The groove of the lip shows variations and play important role in forensic medicine and crime investigation. The objective of this study is to find out the prevalence of type I lip print in at least one lip quadrant among first- and second- year medical and dental students of a medical college. Methods: The study was conducted on 240 students of a medical college between November 2020- January 2021 after getting the ethical clearance from the Institutional Review Committee (reference no. KMC-IRC 0311202006). The convenient sampling was done. The patterns of the grooves of the lip were studied. The data was analysed with Statistical Package for the Social Sciences 20 version. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Out of 240 students, type I lip pattern was seen in at least one quadrant in 190 (79.6%) (73.38-84.94 at 95% CI) students. One hundred and fifty-nine (66.3%) had type I pattern in the right upper quadrant, 160 (66.7%) in left upper quadrant, 181 (75.4%) in right lower quadrant, and 177 (73.8%) in left lower quadrant. Type Ia was maximum found in 115 (47.9%) and type Ib in 66 (27.5%) in lower left quadrant of lip. Conclusions: Our findings showed a higher prevalence of type I lip pattern than those reported by other national studies done among medical students.

A 49-year-old woman with no inflammatory bowel disease history presented to our clinic with abnormal liver function tests and right upper quadrant abdominal pain. Blood tests revealed a mixed pattern of liver injury. Abdominal magnetic resonance imaging demonstrated hepatomegaly with periportal edema and hyper-enhancing bile ducts without any sign of biliary obstruction or stricturing. Screening for viral hepatitis and autoimmune liver diseases was negative. An elevated immunoglobulin G (IgG) level suggested the possibility of autoimmune hepatitis (AIH), and a biopsy confirmed the presence of severe interface hepatitis with necrotic areas and focal lymphoid nodular formation. IgG4 staining revealed marked IgG4-positive plasma cell infiltration. A diagnosis of IgG4-associated seronegative AIH was made, and the patient was started on prednisone and azathioprine, with rapid resolution of the enzyme abnormalities. This clinical vignette highlights the potential challenges in establishing a diagnosis of IgG4-associated AIH and cholangitis, as demonstrated by the importance of confirmatory histopathology. Clinicians should maintain a high index of suspicion when confronted with a mixed pattern of liver injury with elevated immunoglobulins but seronegative autoimmune markers.

Removal of upper abdominal disease remains one of most challenging parts of surgery in advanced ovarian cancer. The right upper quadrant of the abdominal cavity is an anatomical region that generally is the most affected by cancer metastases in those patients. This video educational lecture is an

Amyloidosis is a disorder characterized by deposition of abnormally folded proteins in the extracellular space of various tissues and organs, possibly leading to their dysfunction. In the majority of cases, amyloidosis presents with systemic involvement including the gastrointestinal tract; however, localized gastroduodenal amyloidosis is rare. We report a case of gastroduodenal amyloidosis in a 36-year-old male with multiple comorbidities who presented with right upper quadrant abdominal pain. Reports of gastroduodenal amyloidosis and other relevant literature were also reviewed and discussed alongside this case.

Highlight With less than 20 cases reported worldwide, cystic dilation of the cystic duct (type 6 biliary cyst) is a very rare condition which can commonly present as right upper quadrant abdominal pain. Dharan presents imaging of this rare entity and briefly discusses the available literature.

A woman was admitted with pain in the epigastrium and right upper quadrant that radiated to the back, as well as nausea and dry heaves.

Background Hepatobiliary Scintigraphy (HIDA) aids the diagnosis of acute cholecystitis (AC) but has limitations. We sought to design a model based on the Tokyo Guidelines 2018 (TG18) to predict HIDA results. Methods A retrospective review of patients who underwent a HIDA scan during the evaluation of AC was performed. Using logistic regression techniques incorporating the TG18 criterion and additional readily available patient characteristics, a prediction model was created to identify patients likely to test negative for acute cholecystitis by HIDA scan. Results In 235 patients with suspected AC, a HIDA scan was performed. Variables associated with positive HIDA results were male gender (RR 2.0 (CI 1.33-2.99), age (OR 1.02 (CI 1.01-1.04), right upper quadrant tenderness (RR 1.7 (CI 1.1-2.8)), clinical Murphy's sign (RR 2.2 (CI 1.5-3.4)), ultrasound findings suggestive of AC by any of its components (RR 3.2 (CI 1.6-6.5)), gallbladder wall thickening (RR 2.0 (CI 1.3-3.1)), and gallbladder distention (RR 1.9 (CI 1.3-2.9)). These variables allowed for creation of a model to predict HIDA results. The model predicted HIDA results in 36.9% of patients with an area under the curve of 0.81. Conclusions In the era of TG18, HIDA is probably over utilized. We developed an accurate, simple model based on TG18 that identifies a group of patients for whom a HIDA scan is unnecessary to establish the diagnosis of AC.

Colonopleurobronchial fistula (CPBF) is a rare complication which occurs due to diversified causes. Expectoration of the faecal material is the classical clinical symptom which suggests the diagnosis. Various causes include infection of pulmonary or abdominal origin, inflammatory bowel disease, colonic malignancy, diaphragmatic hernia and colonic interposition. Crohn’s disease is the frequent underlying pathology, colonic malignancy accounts for rare cause. Due to the presence of liver in right upper quadrant, most of the fistulas are on the left side. Here we describe a rare case of a 38-year-old man presented with right-sided CPBF due to underlying colonic malignancy. Bronchial block was done, however the patient succumbed to death.

The liver is a highly complex organ involved in maintaining the health and balance of multiple systems of the body. It is found in the right upper quadrant of the abdomen and receives a dual blood supply from the portal vein and the hepatic artery. As such, vast amounts of nutrients enter the liver, providing the necessary materials and energy for carbohydrate, protein, and lipid synthesis and metabolism. The liver is also a vital site for the metabolism and clearance of exogenous drugs. In addition, the liver is a storage organ and plays a role in regulating the haematological and endocrine systems. This chapter discusses the liver’s macroscopic and microscopic anatomy from a functional perspective, followed by a thorough discussion of its various physiological functions.

Right upper quadrant ultrasound is often the first step in the evaluation of hepatobiliary disease. An in-depth knowledge of the ultrasound findings of common and important diseases, as well as the limitations of and new advances in ultrasound technology, is key to helping patients and referring providers reach diagnostic and management decisions. The utility of contrast-enhanced ultrasound is expanding, shear wave elastography is emerging as a sophisticated quantitative measure of fibrosis, and the new US LI-RADS reporting standard is changing surveillance practices for patients with cirrhosis. This article will provide a review of hepatobiliary ultrasound interpretation with an emphasis on diagnostic accuracy and new techniques.

Right upper quadrant (RUQ) abdominal pain and discomfort is a common presenting complaint often associated with abdominal pathology. We report a rare presentation of structural intracranial pathology in a patient initially presenting with RUQ abdominal discomfort. While initial investigations concentrating on abdominal causes revealed no likely culprit, progression of symptoms to involve right lower limb weakness eventually prompted the patient's re-presentation and eventual definitive diagnosis. This case depicts a hitherto unreported cause for abdominally-manifested seizures.

Author(s): Wiese, Krista Shaw; Ernest, Stacey; Dukes, W. Seth | Abstract: Introduction: Uterine ruptures in blunt trauma are an extremely rare complication. Furthermore, while perimortem cesarean sections in cardiac arrest patients are a well-established practice in emergency medicine, cesarean sections in the emergency department are rarely performed on non-arresting patients.Case Report: A multigravida woman at approximately 24 weeks gestation presented as a transfer from an outside hospital after a motor vehicle collision. Upon arriving to our facility, she underwent an emergency cesarean section in the trauma bay and was found to have a uterine rupture with the fetus free floating in the right upper quadrant of the abdomen.Conclusion: Uterine rupture is a rare but important complication of blunt abdominal trauma in pregnant patients. Resuscitative cesarean sections may be necessary for favorable outcomes. A well prepared and diversified team was essential to maternal survival.