Herniation and torsion of the gallbladder through the foramen of Winslow is a rare condition, and there have been no reports on the development of obstructive jaundice as a complication. We present here the case of obstructive jaundice caused by such a condition. The subject was a 97-year-old female who was hospitalized with the chief complaints of epigastric pain and jaundice. The bulbar conjunctiva and skin were yellowish, and jaundice and inflammation were confirmed through a blood test. She was diagnosed as having torsion of a floating gallbladder by abdominal ultrasonography and CT, and herniation of the gallbladder into the foramen of Winslow was suspected. When emergency surgery was performed, the above conditions were confirmed, and jaundice was shown to be caused by external compression of the common bile duct from the dorsal side by the gallbladder. Her postoperative recovery was uneventful, and she was discharged on hospital day 23. At present, about 24 months after the operation, the patient remains in good health and is followed-up as an outpatient. To the best of our knowledge, this is the first report of obstructive jaundice due to herniation and torsion of the floating gallbladder through the foramen of Winslow.

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Surgical therapy has been traditionally used for type IIIa pancreatic injuries. However, in recent years , successful cases of nonoperative management (NOM) have been reported. This paper reports the case of a child with blunt pancreatic injury (type IIIa). Who was treated by NOM and symptoms went into remission. The patient is a nine-year-old boy who bruised his abdomen falling at a playground. Using abdominal CT, we diagnosed this case as a type IIIa pancreatic injury. Because his vital signs were stable without abdominal symptoms, we decided to choose NOM. During hospitalization, we treated the patient with fasting, bed rest, intravenous infusion, and administered a protease inhibitor. Formation of a pancreatic pseudocyst was discovered during the course, but a follow-up exam revealed that the pseudocyst had gone into remission and the patient was discharged.

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Spontaneous intracranial hypotension (SIH) is a clinical syndrome in which hypovolemia of the cerebrospinal fluid results in various neurologic symptoms. Although most patients with SIH initially visit general practitioners complaining of persistent postural headache with gradual or subacute onset, some may visit the emergency department complaining of severe headache or neck pain of sudden onset, mimicking aneurysmal subarachnoid hemorrhage, cervical arterial dissection, or herniated cervical disc. Rarely, patients with SIH may present with a low-grade fever, mimicking viral meningitis. Three of fifteen patients with SIH who have been treated in our institution during the last four years presented to the emergency department with such acute, misguiding signs and symptoms. These three cases are presented to show tips and potential pitfalls in diagnosing SIH. Making an accurate diagnosis of SIH in emergency settings is often challenging, and requires combination of thorough history taking/neurologic examination, and accurate imaging study interpretation.

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We report the case of an ovarian injury caused by traffic accident. A 22-year-old woman received chest and abdominal injuries after falling a height of 5m from her moving car. She was initially diagnosed as having hemorrhagic shock with intraperitoneal hemorrhage. We therefore operated to examine her internal injuries and stop the bleeding if we could locate it. Finally, we detected bleeding from the corpus luteum cyst and a tumor in the ovary and sutured the bleeding area for hemostasis and resected the tumor. The clinical course was uneventful after the operation. Although, blunt ovarian injury is a rare occurrence, according to the literature, we should keep this type of injury in mind in female blunt abdominal trauma patients.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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