Apatient is operated on with the presumptive diagnosis of acute appendicitis. However, at operation, the appendix and cecum are found to be normal. The terminal ileum though is red, edematous, and thickened with creeping of the mesenteric fat onto the ileum for a distance of approximately 30 cm. There is no dilation of the bowel proximal to the area of inflammation.The remainder of the small bowel is normal.What is the appropriate operative procedure?
Answer(s): B
From the description, the diagnosis in this patient is acute regional enteritis. The incidental finding of regional enteritis in patients operated on for the presumed diagnosis of acute appendicitis is treated medically unless there is proximal obstruction. The risk of operating on patients with regional enteritis is the formation of a fistula and/or abscess, especially if the area to be resected is involved with the disease process. However, if the cecum and the appendix are not involved, it is advisable to perform an appendectomy. In this instance, it would be safe and eliminate acute appendicitis from the differential if his symptoms recurred.
A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal testicular mass. Further management of his condition would include which of the following?
Testicular cancer is the most common malignancy in men between the ages of 15 and 35. It typically presents as unilateral scrotal swelling. On examination, it is important to distinguish intraparenchymal masses (usually malignant) from extraparenchymal masses (usually benign). This is easily done with scrotal ultrasound. Upon the diagnosis of an intraparenchymal testicular mass, a staging CT scan of the chest, abdomen, and pelvis should be obtained. It is reasonable to evaluate the serum levels of beta- HCG and AFP as they may be elevated in 8085% of patients with nonseminomatous germ cell tumors. LDH, on the other hand, can be elevated in patients with seminomas and can be of prognostic significance. Finally, if elevated, these serum markers can serve as a means to monitor the presence of residual disease and should be measured after resection of the tumor. Additionally, the mass should be excised in order to establish a histologic diagnosis. Aradical orchiectomy should be performed from an inguinal approach. Less invasive approaches such as biopsies or a scrotal approach to the tumor should be avoided as they can alter the lymphatic drainage and potentially adversely affect overall outcomes
A 25-year-old male presents to your office for evaluation of a testicular mass that he found in the shower. On examination, his left testicle is larger than his right with a firm palpable mass. Ascrotal ultrasound confirms the presence of a solitary intraparenchymal testicular mass. The most likely diagnosis in this patient is which of the following?
Answer(s): C
Which of the following is characteristic of Hirschsprung's disease?
Answer(s): A
Although constipation is the most common presenting feature of Hirschsprung's disease, some patients suffer from diarrhea. The severity of symptoms does not correlate well with the extent of bowel involvement. Enterocolitis, a major cause of death, requires vigorous treatment. This complication can occur even after removal of the aganglionic segment of the bowel. Increased acetylcholinesterase activity has been noted in the serum, affected aganglionic bowel, and erythrocytes of afflicted persons.Eighty percent of affected infants are male.
A 25-year-old male comes to the ER after a motor vehicle collision, complaining of vague left-sided abdominal pain. After initial evaluation, a CT of the abdomen is obtained as shown in Figure. Which of the following statements is true concerning the injury?
Because of the risk of postsplenectomy sepsis, attempts should be made for splenic salvage when possible. Most patients are managed nonoperatively. Nonoperative management is contraindicated in the presence of hypotension or persistent bleeding. If patients are treated operatively, attempts are still made at splenic salvage if possible instead of splenectomy. Attempts at splenic salvage are contraindicated in hemodynamically unstable patients or patients with multiple concomitant injuries, as it prolongs the operation and increases blood loss. The risk of postsplenectomy sepsis from encapsulated organisms persists throughout life, but the highest incidence is in the first 2 years following splenectomy. Patients should be vaccinated against Pneumococcus, Meningococcus, and Haemophilus influenzae prior to discharge from the hospital.
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