Abdominal pain caused by thrombosis of a gastroepiploic artery aneurysm--a case report.

Symptomatic visceral aneurysms usually present with abdominal pain and shock, gastrointestinal bleeding, or hemobilia when the aneurysm ruptures. Less frequently, visceral aneurysms are found incidentally during abdominal computed tomography or angiography. Thrombosis is a frequent complication of popliteal and femoral aneurysms but is rarely seen with a visceral aneurysm.

Portal hypertensive hemorrhage from a left gastroepiploic vein caput medusa in an adhesed umbilical hernia.

Caput medusa is a frequent incidental finding in patients with portal hypertension that usually represents paraumbilical vein portosystemic collateral vessels draining into body wall systemic veins. A symptomatic caput medusa was seen in a morbidly obese patient after an umbilical hernia repair, which was fed not by the left portal vein but by the left gastroepiploic vein, in a recurrent adhesed umbilical hernia that likely contained herniated omentum. Refractory hemorrhage from this caput medusa was successfully treated by transjugular intrahepatic portosystemic shunt creation and balloon-occluded variceal sclerosis.

Peripheral tumors of the intercostal nerves.

Fewer than 10% of primary neural tumors of the chest originate peripherally from intercostal nerves; most neural tumors of the chest arise in the mediastinum. Most patients with primary tumors of the intercostal nerve are asymptomatic. We report a case of neurilemmoma arising from an intercostal nerve in a woman seen for severe pain in the chest wall.

Blunt rectal trauma causing intramural rectal hematoma: report of a case.

An unusual case is reported in which intramural rectal hematoma resulted from rectal insertion of a foreign body. The patient was admitted to the hospital for observation and was catheterized because of urinary retention. The patient was discharged from the hospital after four days; for the last two days of this hospital stay, the patient received a liquid diet.

Adenoid cystic breast cancer.

Background: Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers.

Methods: Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast.

Unusual duplication of appendix and cecum: extension of the Cave-Wallbridge classification.

Duplicated appendix has, to date, been classified into 3 types. The authors present a type of duplicated appendix not previously described. Surgical exploration was done in a 14-year-old girl who had an acute abdomen.

Visceral artery aneurysms as seen in a community hospital.

Background: Visceral artery aneurysm (VAA) is a rare but important form of vascular pathology.

Methods: A retrospective chart review was performed for all patients treated for VAAs from 1980 to 1998 at the Northern California Kaiser Hospitals.

Results: Thirty-one patients with VAAs were treated, 11 men and 20 women with an average age of 60 years.

Clinical presentation of mucin-secreting tumors of the pancreas.

Background: Pancreatitis and jaundice secondary to ductal obstruction are common in intraductal papillary mucinous tumors (IPMT) of the pancreas. However, the incidence and severity of the complications of obstruction are not well documented. The aim of the study was to investigate the clinical presentation and outcome of 10 patients with IPMT.

Perforated jejunal diverticula.

Jejunal diverticular (JD) perforation is an uncommon cause of acute abdominal pain in the elderly. From 1971 to 1994 we treated 13 such patients, 9 men and 4 women, with a mean age of 68 years. All patients experienced sudden onset of abdominal pain, nausea and vomiting, and leukocytosis (range of white blood cell counts, 14,000-21,000).

Ductal carcinoma in situ of the breast: results of treatment by conservative surgery and definitive irradiation.

Purpose: To determine local control, survivorship, and cosmesis in women with ductal carcinoma in situ treated by conservative surgery and radiation therapy.

Methods And Materials: We retrospectively analyzed the results of treatment in 56 women with in situ carcinoma of the breast, treated between 1976 and 1990 by conservative surgery and irradiation. Two women had bilateral tumors, for a total of 58 breasts at risk.

Surgical scar endometrioma.

Relatively few instances of surgical scar endometrioma have been reported. Herein we review 24 patients treated for this condition at the institutions at which we work between 1972 and 1992. The age of the patients ranged from 17 to 47 years, with an average age of 31.

Gastric perforation as a complication of splenectomy: report of five cases and review of the literature.

A rare complication of splenectomy is gastric perforation and fistula. Patients with this complication often complain of pain in the left upper quadrant and left shoulder, and of fever, tachycardia and upper abdominal tenderness. Chest radiographs often show a pleural effusion in the left hemithorax.