Intermittent abdominal pain in IgA vasculitis

ABSTRACT Objective: To assess intermittent abdominal pain in IgA vasculitis patients and its relation to demographic data, clinical manifestations and treatments. Methods: A retrospective cohort study included 322 patients with IgA vasculitis (EULAR/PRINTO/PRES criteria) seen at the Pediatric Rheumatology Unit in the last 32 years. Sixteen patients were excluded due to incomplete data in medical charts. Intermittent abdominal pain was characterized by new abdominal pain after complete resolution in the first month of disease. Results: Intermittent abdominal pain was observed in 35/306 (11%) IgA vasculitis patients. The median time between first and second abdominal pain was 10 days (3–30 days). The main treatment of intermittent abdominal pain included glucocorticoid [n=26/35 (74%)] and/or ranitidine [n=22/35 (63%)]. Additional analysis showed that the frequency of intermittent purpura/petechiae (37 vs. 21%; p=0.027) and the median of purpura/petechiae duration [20 (3–90) vs. 14 (1–270) days; p=0.014] were significantly higher in IgA vasculitis patients with intermittent abdominal pain compared to those without. Gastrointestinal bleeding (49 vs. 13%; p<0.001), nephritis (71 vs. 45%; p=0.006), glucocorticoid (74 vs. 44%; p=0.001) and intravenous immunoglobulin use (6 vs. 0%; p=0.036) were also significantly higher in the former group. The frequency of ranitidine use was significantly higher in IgA vasculitis patients with intermittent abdominal pain versus without (63 vs. 28%; p<0.001), whereas the median of ranitidine duration was reduced in the former group [35 (2–90) vs. 60 (5–425) days; p=0.004]. Conclusions: Intermittent abdominal pain occurred in nearly a tenth of IgA vasculitis patients, in the first 30 days of disease, and was associated with other severe clinical features. Therefore, this study suggests that these patients should be followed strictly with clinical and laboratorial assessment, particularly during the first month of disease course.

Unusual case of small bowel intussusception in adult revealing a Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is a rare genetic disorder characterized by hyperpigmented mucocutaneous macules, hamartomatous polyps of the small intestine, and family history. These hamartomatous polyps can cause intermittent abdominal pain, chronic anemia, or even intussusception. Imaging has an important role in the diagnosis of this syndrome but also in the identification of complications and periodic surveillance. Here we present a demonstrative case of a Peutz-Jeghers syndrome associated with intussusception in a 16-year-old patient.

A Rare Case of Bilobed Giant Peritoneal Loose Body

A 50-year-old male patient was referred to Department of Radiodiagnosis for evaluation of a longstanding intermittent abdominal pain associated with a palpable mass migrating in different quadrants of the abdomen and had gradually increased in size over last few years. The initial ultrasonographic (USG) evaluation revealed a well circumscribed bilobed hypoechoic pelvic solid space occupying lesion (SOL) with central calcific foci. Subsequent contrast enhanced computed tomography (CECT) imaging showed a 10.1 x 7.5 x 5.8 cm, bilobed non-enhancing pelvic mass with central dense calcific foci and concentric soft tissue layers of different attenuation. The mass was diagnosed to be a giant peritoneal loose body (gPLB) and confirmed by surgical exploration.

An Infant with COVID-19-Associated Intussusception

Intussusception is the most common cause of bowel obstruction in infants four to ten months old and is commonly idiopathic or attributed to lymphoid hyperplasia. Our patient was a 7-month-old male who presented with two weeks of intermittent abdominal pain associated with crying, fist clenching and grimacing. Ultrasound demonstrated an ileocolic intussusception in the right abdomen. Symptoms resolved after contrast enemas, and he was discharged home. He re-presented similarly the next day and was found to be COVID-19 positive. Computed tomography scan demonstrated a left upper quadrant ileal-ileal intussusception. His symptoms spontaneously resolved, and he was discharged home. This suggests that COVID-19 may be a cause of intussusception in infants, and infants presenting with intussusception should be screened for this virus. Additionally, recurrence may happen days later at different intestinal locations. Caregiver education upon discharge is key to monitor for recurrence and need to return.

A case of Brucellosis with Large Periaortic Mass And Secondary Vasculitis In A Patient Presenting Intermittent Abdominal Pain

Background Brucellosis is still highly prevalent and causes high morbidity. It can involve any organ system and has been implicated in protean complications. Cardiovascular involvement is the main cause of mortality. This case described a female patient infected by Brucella with large periaortic mass and secondary vasculitis whose manifestation was abdominal pain. The aim was to raise the awareness of earlier recognition of Brucella infections without fever and remitting risk by taking appropriate treatments for those with cardiovascular involvement.Case presentation A case was reported regarding a female present intermittent abdominal pain. Two months later, she was admitted to the Department of Rheumatology and Immunology in our hospital due to high inflammatory markers, the large periaortic mass and vasculitis manifestations in aortic computed tomography angiography. By detailed examination, Brucellosis was highly suggestive based on positive blood cultures. Finally, no discomfort has ever occurred, and the mass was prominently reduced after antibiotic therapy of half a year.Conclusions The clinical manifestations of brucellosis are protean. For those without fever and cardiovascular involvement as the main manifestation, especially vasculitis, we must not just set the standard rigidly, instead, it is recommended to carry out the relevant differential diagnosis to avoid misdiagnosis or missed diagnosis.

Intestinal malrotation with solitary jejunal diverticulum presenting as midgut volvulus in an adult: an unusual presentation

Intestinal malrotation with midgut volvulus presenting in adults is a rare entity, and association with jejunal diverticulum is rarer still. Herein, we report and review such a case of malrotation and volvulus, associated with intestinal band adhesions and a solitary jejunal diverticulum. This 67 years old gentleman had presented with complaints of intermittent abdominal pain for past several years. Imaging of the abdomen revealed twisting of superior mesenteric artery and vein, evidence of midgut volvulus and intestinal malrotation with “whirlpool sign”. Laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery and a jejunal diverticulum. Adhesiolysis was performed, untwisting of the bowel was done and the jejunal diverticulum was resected. Post-operative period was uneventful. This case is being reported on account of its extreme rarity.

Caecal Volvulus

Colonic volvulus is the third leading cause of large bowel obstruction. About 35% of these are located in the caecum. Though, relatively, a rare cause of obstruction, the incidence of caecal volvulus is steadily increasing at a rate of about 5% per year. Mortality due to caecal volvulus may be as high as 40% especially in the presence of gangrene and sepsis. Clinical presentation may be acute and fulminant or as a mobile caecum syndrome with intermittent abdominal pain. “Whirl,” “Coffee bean,” and “bird beak” signs seen on computed tomography are pathognomonic. Colectomy is the preferred treatment as it obviates any chance of recurrence. A conservative approach to colectomy such as limited ileocaecal resection and ileostomy formation in critically ill patients or in those with poor physiological reserve may be associated with better postoperative outcomes.

An unusual band causing intestinal obstruction: case report

We report an unusual case of intestinal obstruction. The child presented with intermittent abdominal pain. Initial USG abdomen and CT abdomen were inconclusive. Diagnostic laparoscopy followed by Laparotomy was done to remove bezoar made up of a rubber band and thread balls. Iron and zinc deficiencies are the preventable causes of pica. Plasticobezoars are rare and should be suspected when symptoms are not consistent with other common causes of obstruction.