scholarly journals A rare cause of small bowel diaphragm disease presenting with palpated abdominal mass

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Aghyad K Danial ◽  
Ahmad Al-Mouakeh ◽  
Yaman K Danial ◽  
Ahmad A Nawlo ◽  
Ahmad Khalil ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Medical History ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Past Medical History ◽  
Abdominal Symptoms ◽  
Diaphragm Disease ◽  
History Of ◽  
Specific Symptoms

Abstract Small bowel diaphragm disease is a rare complication related to non-steroidal anti-inflammatory drug (NSAID) use. It presents with non-specific symptoms such as vomiting, abdominal pain, subacute bowel obstruction and occasionally as an acute abdominal condition. We report a case of diaphragm disease in a 33-year-old female who presented with vomiting, constipation and abdominal pain started 5 days earlier. Physical examination revealed palpated abdominal mass. The patient’s past medical history was remarkable for NSAID use. The patient was managed by surgical resection of involved intestine and diagnosis was confirmed by histological examination. Although there are few published cases of diaphragm disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing patients presenting with non-specific abdominal symptoms with remarkable past medical history of NSAID use.

scholarly journals Unmasking of Neurosarcoidosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A618-A618
Author(s):  
Sharini Venugopal ◽  
Binita Neupane ◽  
Mahesh Nepal ◽  
Luis F Chavez
Keyword(s):  
Diabetes Insipidus ◽  
Medical History ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
Past Medical History ◽  
Water Excretion ◽  
History Of ◽  
Glucocorticoid Deficiency

Abstract Introduction: Central diabetes insipidus is a rare complication of neurosarcoidosis. In patients with concomitant adrenal insufficiency (AI), the symptoms of Diabetes Insipidus (DI) can be masked. Case: A 55-year-old female with past medical history of sarcoidosis presented to the hospital with hematemesis, nausea and dizziness. She has a past medical history of cardiac sarcoidosis that was revealed on a PET scan done before 10 years for which she was being treated with methotrexate and prednisone. She was off prednisone for a year prior to hospitalization. She underwent an upper endoscopy that showed diffusely erythematous gastric mucosa in the antrum. She was also hypotensive on admission, and she received packed red blood transfusions after which her sodium increased from 145mmol/L to 165mmol/L (Normal: 135-145mmol/L) in 48 hours. Further workup revealed persistent hypernatremia and urine osmolality was 75mOsm/kg H2O. (Normal: 50-1200mOsm/kg H2O). She was also hypoglycemic and hypotensive requiring multiple fluid boluses throughout her hospitalization. This prompted us to perform a random cortisol that came back at 2.1ug/dl (Normal: 3-23ug/dl) and 1.8ug/dl on two occasions. Cortisol Stimulation test was subsequently ordered, but was done only at 30 minutes, and Cortisol increased from 1.8ug/dl to 6.3ug/dl. Free thyroxine was 0.5 ng/dl (Normal: 0.9-1.8 ng/dl) and her TSH was 7.58uIU/ml (Normal: 0.55-4.78uIU/ml). MRI of the brain revealed extensive areas of extra-axial supra-sellar/infundibular nodular homogeneous intense enhancement that is most consistent with neuro-sarcoid. She was started on prednisone 40 mg daily, Desmopressin 0.05 mg twice daily, and levothyroxine as well. Her sodium level normalized and was 137mmol/L at discharge. She followed up later with outpatient Endocrinology and reported around 90lbs weight gain and no more episodes of nausea or vomiting or epistaxis or lightheadedness. Conclusion: The involvement of the hypothalamic-pituitary axis in sarcoidosis is extremely rare and attributes to < 1% of patients with a sellar mass. Small case series have shown that hypogonadism is the most common endocrine abnormality followed by DI. Our patient had a long-standing history of sarcoidosis with her pituitary dysfunction unmasked only on admission for other causes. She did not manifest any symptoms of DI or AI. There have been case reports where the symptoms of DI are masked due to underlying glucocorticoid deficiency. There have been theories that glucocorticoid deficiency impairs renal water excretion by both ADH (Anti-diuretic hormone) dependent and ADH independent pathways. Another notable feature in our case is that our patient presented with primary hypothyroidism. In fact, sarcoidosis has been commonly implicated in auto-immune polyglandular syndromes type 3, which can present with auto-immune thyroiditis more so in females.

scholarly journals Tuberculous Colitis: A Case Report

2020 ◽  
Vol 5 (4) ◽  
Keyword(s):  
Abdominal Pain ◽  
Medical History ◽  
Joint Pain ◽  
Past Medical History ◽  
Food Ingestion ◽  
Urine Color ◽  
History Of ◽  
Bleeding Per Rectum ◽  
H Pylori ◽  
Tuberculous Colitis

21-year old Bangladeshi man with no past medical history presented with abdominal pain for 10 days. He described his abdominal pain as a periumbilical colicky in nature, started mild then progressed to severe 4 days prior to ED presentation. It worsened with food ingestion. He had lost around 6 kilograms over a month. The pain was not associated with diarrhea, nausea or vomiting. He did not have dysuria, change in urine color, nor fever. He did not have history of black stool, fresh bleeding per rectum. He did not have sick contact, and he did not have skin rash or joint pain. His past medical history is significant for Helicobacter pylori (H. pylori) associated gastritis, which was treated successfully, 3 years ago.

scholarly journals An Unusual Presentation of Cholecystoduodenal Fistula: Abdominal Pain out of Proportion to Exam

2019 ◽  
Vol 3 (3) ◽  
pp. 305-306
Author(s):  
Ryan McCreery ◽  
Matthew Meigh
Keyword(s):  
Abdominal Pain ◽  
Multimodality Imaging ◽  
Rare Complication ◽  
Gallbladder Disease ◽  
Final Diagnosis ◽  
Cholecystoduodenal Fistula ◽  
Case Presentation ◽  
History Of ◽  
Biliary Enteric Fistula ◽  
Specific Symptoms

Cholecystoduodenal fistula (CDF) is a rare complication of gallbladder disease. Clinical presentation is variable, and preoperative diagnosis is challenging due to the non-specific symptoms of CDF. We discuss a 61-year-old male with a history of atrial fibrillation who presented with severe abdominal pain out of proportion to exam. The patient was diagnosed promptly and successfully managed non-operatively. This case presentation emphasizes the need to maintain a broad differential diagnosis for abdominal pain out of proportion to exam, with the possibility of a biliary-enteric fistula as a possible cause. It also stresses the importance of a multimodality imaging approach to arrive at a final diagnosis.

scholarly journals Small Bowel Intussusception due to Multiple Intestinal Metastases from Lung Adenocarcinoma

2021 ◽  
Vol 18 (3) ◽  
pp. 189-193
Author(s):  
Faten Limaiem ◽  
Saadia Bouraoui
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Lung Adenocarcinoma ◽  
Medical History ◽  
Left Lung ◽  
Adult Intussusception ◽  
Past Medical History ◽  
Small Bowel Tumors ◽  
Surgical Specimen ◽  
History Of

Metastatic small bowel tumors are rare. They often present with small bowel occlusion, bleeding, perforation, or intestinal intussusception. Pulmonary adenocarcinoma with metastasis to the small intestine causing intussusception is exceedingly rare. A 72-yearold male patient with a past medical history of left lung adenocarcinoma, presented to the emergency department with abdominal pain and vomiting. On admission, an X-ray of the abdomen without preparation showed some hydroaeric levels on the small intestine. The abdominopelvic  computed tomography (CT) scan revealed an ileo-ileal invagination, with an image of the invagination rod. The patient underwent a  surgical resection of the small bowel with the removal of the ischemic areas and immediate anastomosis. Macroscopic examination of the surgical specimen revealed five tumor masses varying in size between 1 and 4 cm. The histological examination of the samples taken from these tumors, coupled with an immunohistochemical study confirmed the diagnosis of intestinal metastases of pulmonary origin  expressing cytokeratin 7 (CK7) and thyroid transcription factor 1 (TTF1) but negative for CK20, chromogranin, and synaptophysin. The  postoperative course was uneventful, and the symptoms transiently recovered. However, the patient died 3 months later. We should consider multiple metastatic lesions in adult intussusception, especially in patients with a past medical history of lung cancer.  

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

2020 ◽  
Vol 13 (11) ◽  
pp. e236429
Author(s):  
Bankole Oyewole ◽  
Anu Sandhya ◽  
Ian Maheswaran ◽  
Timothy Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Serous Fluid ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Multiple Episodes ◽  
Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

scholarly journals A227 UMBILICAL HERNIA INCARCERATION IN LIVER CIRRHOSIS: A RARE COMPLICATION OF PARACENTESIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 263-265
Author(s):  
A LAGROTTERIA ◽  
A Aruljothy ◽  
K Tsoi
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Small Bowel ◽  
Large Volume ◽  
Umbilical Hernia ◽  
Rare Complication ◽  
Abdominal Wall Hernia ◽  
Refractory Ascites ◽  
Large Volume Paracentesis

Abstract Background Patients with decompensated liver cirrhosis with ascites frequently have umbilical hernias with a prevalence of 20% and are managed with large volume paracentesis (LVP). Common complications of LVP include hemorrhage, infection, and bowel perforation that occur infrequently with a frequency of less than 1%. However, incarceration of umbilical hernias has been reported as a rare complication of LVP and is speculated to be from ascitic fluid decompression that reduces the umbilical hernia ring diameter resulting in entrapment of the hernia sac. It is unclear whether the quantity or the fluid removal rate increases the herniation risk. Based on case series, this rare complication occurs within 48 hours of the LVP and requires emergent surgical repair and involves a high risk of morbidity and mortality due to potential infection, bleeding, and poor wound healing. Aims We describe a case report of an incarcerated umbilical hernia following a bedside large-volume paracentesis. Methods Case report Results A 59-year-old Caucasian male presented to the emergency department with a 24-hour history of acute abdominal pain following his outpatient LVP. His medical history included Child-Pugh class C alcoholic liver cirrhosis with refractory ascites managed with biweekly outpatient LVP and a reducible umbilical hernia. He reported the onset of his abdominal pain 2-hours after his LVP with an inability to reduce his umbilical hernia. Seven liters of clear, straw-coloured asitic fluid was drained. Laboratory values at presentation revealed a hemoglobin of 139 g/L, leukocyte count of 4.9 x109 /L, platelet count of 110 xo 109 /L, and a lactate of 2.7 mmol/L His physical exam demonstrated an irreducible 4 cm umbilical hernia and bulging flanks with a positive fluid wave test. Abdominal computed tomography showed a small bowel obstruction due to herniation of a proximal ileal loop into the anterior abdominal wall hernia, with afferent loop dilation measuring up to 3.4 cm. He was evaluated by the General Surgery consultation service and underwent an emergent laparoscopic hernia repair. There was 5 cm of small bowel noted to be ecchymotic but viable, with no devitalized tissue. He tolerated the surgical intervention with no post-operative complications and was discharged home. Conclusions Ultrasound-guided bedside paracentesis is a common procedure used in the management of refractory ascites and abdominal wall hernia incarceration should be recognized as a potential rare complication. To prevent hernia incarceration, patients with liver cirrhosis should be examined closely for hernias and an attempt should be made for external reduction prior to LVP. A high index of suspicion for this potential life-threatening condition should be had in patients who present with symptoms of bowel obstruction following a LVP. Funding Agencies None

scholarly journals Past medical history of tumors other than meningioma is a negative prognostic factor for tumor recurrence in meningiomas WHO grade I

2021 ◽  
Author(s):  
Annamaria Biczok ◽  
Philipp Karschnia ◽  
Raffaela Vitalini ◽  
Markus Lenski ◽  
Tobias Greve ◽  
...  
Keyword(s):  
Medical History ◽  
Tumor Recurrence ◽  
Clinical History ◽  
Study Endpoint ◽  
Past Medical History ◽  
Who Grade ◽  
Increased Risk ◽  
History Of ◽  
Meningioma Recurrence ◽  
The Impact

Abstract Background Prognostic markers for meningioma recurrence are needed to guide patient management. Apart from rare hereditary syndromes, the impact of a previous unrelated tumor disease on meningioma recurrence has not been described before. Methods We retrospectively searched our database for patients with meningioma WHO grade I and complete resection provided between 2002 and 2016. Demographical, clinical, pathological, and outcome data were recorded. The following covariates were included in the statistical model: age, sex, clinical history of unrelated tumor disease, and localization (skull base vs. convexity). Particular interest was paid to the patients’ past medical history. The study endpoint was date of tumor recurrence on imaging. Prognostic factors were obtained from multivariate proportional hazards models. Results Out of 976 meningioma patients diagnosed with a meningioma WHO grade I, 416 patients fulfilled our inclusion criteria. We encountered 305 women and 111 men with a median age of 57 years (range: 21–89 years). Forty-six patients suffered from a tumor other than meningioma, and no TERT mutation was detected in these patients. There were no differences between patients with and without a positive oncological history in terms of age, tumor localization, or mitotic cell count. Clinical history of prior tumors other than meningioma showed the strongest association with meningioma recurrence (p = 0.004, HR = 3.113, CI = 1.431–6.771) both on uni- and multivariate analysis. Conclusion Past medical history of tumors other than meningioma might be associated with an increased risk of meningioma recurrence. A detailed pre-surgical history might help to identify patients at risk for early recurrence.

1074 Gallstone Ileus: Two Decades After Cholecystectomy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Matwala ◽  
M R Iqbal ◽  
T Shakir ◽  
D W Chicken
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Rare Complication ◽  
Open Cholecystectomy ◽  
Gallstone Ileus ◽  
Proximal Small Bowel ◽  
Solid Diet ◽  
History Of ◽  
Ileocaecal Junction ◽  
Tomography Scan

Abstract Introduction Gallstone ileus is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. We present a surprising case of gallstone ileus causing small bowel obstruction 19 years after open cholecystectomy. Case Report A 77-year-old male presented with a 3-day history of abdominal pain, 4 episodes of vomiting and absolute constipation. He had a surgical background of an open cholecystectomy and open appendicectomy 19 years and 45 years ago respectively. Medically, he had well-controlled hypertension and experienced a TIA 5 years prior. Computed Tomography Scan of the abdomen and pelvis revealed features consistent with an obstructing, heterogenous opacity in the distal small bowel without pneumobilia. The patient subsequently underwent diagnostic laparoscopy. Intraoperatively, an obstructing gallstone, measuring 4 cm, was found 50cm proximal to the ileocaecal junction, with dilatation of the proximal small bowel and distal collapse. Enterotomy and removal of the stone was done. Post-operatively, this gentleman recovered without complications and was discharged home two days later after being able to tolerate a solid diet. Conclusions This is the second reported case of gallstone ileus in a patient with previous cholecystectomy about two decades ago, according to our literature search. Although extremely rare, absence of the gallbladder does not exclude the possibility of gallstone ileus.

620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kathryn Peterson ◽  
Robert Genta ◽  
Henrik Rasmussen ◽  
Bradford Youngblood ◽  
Amol Kamboj
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Eosinophilic Esophagitis ◽  
Life Experience ◽  
Real Life ◽  
Gastrointestinal Disorder ◽  
Control Group ◽  
Abdominal Symptoms ◽  
Gi Symptoms ◽  
Initial Work

Abstract   Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms. Methods 52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment. Results 45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group. Conclusion In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.

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