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ACG Case Reports Journal Apr 2020We report an unusual case of Barrett's esophagus with prominent intramucosal Russell bodies, also known as Russell body Barrett's esophagus. We present this case to...
We report an unusual case of Barrett's esophagus with prominent intramucosal Russell bodies, also known as Russell body Barrett's esophagus. We present this case to emphasize the importance of recognizing this unusual entity. It also represents a potential diagnostic pitfall because the distended plasma cells may be mistaken for signet ring cells of gastric adenocarcinoma or low-grade lymphoma. Hence, an awareness of this entity is important to avoid diagnostic confusion.
PubMed: 32548195
DOI: 10.14309/crj.0000000000000367 -
Annals of the Royal College of Surgeons... Aug 2018Small bowel obstruction is the most common surgical emergency after a patient has had abdominal surgery. However, Boerhaave syndrome secondary to an ileostomy...
Small bowel obstruction is the most common surgical emergency after a patient has had abdominal surgery. However, Boerhaave syndrome secondary to an ileostomy obstruction has not been reported in current literature. We present a rare case of two concurrent surgical emergencies in a patient with Boerhaave syndrome and small bowel obstruction. A 38-year-old woman presented with sudden onset severe central chest pain associated with breathlessness. She had a history of Crohn's disease, which had been treated with pancolectomy and ileostomy. Clinical examination showed an extensive palpable surgical emphysema extending from the neck to the pelvis with a distended abdomen. Computed tomography contrast of the chest and abdomen reported bilateral pneumothoraces, ruptured oesophagus and distended small bowel secondary to obstruction at the ileostomy. She was referred to the nearest cardiothoracic centre for an urgent assessment. Unfortunately she passed away shortly after the scan. Ruptured oesophagus is associated with a high mobidity and mortality if it is not recognised, so early diagnosis and prompt treatment is crucial in reducing the mortality rate. There is a strong association between stoma formation and incidence of small bowel obstruction but no difference between an ileostomy and colostomy. This case helps to illustrate the challenging management of chronic recurring abdominal obstruction and the delicate balance of risk of complication versus benefit of various management being surgical or conservative. All general surgeons should be wary of the potential complication of oesophageal perforation secondary to intestinal obstruction.
PubMed: 30112937
DOI: 10.1308/rcsann.2018.0129 -
BMJ Case Reports Nov 2022Enterobius vermicularis infection is typically observed in paediatric patients and manifests with perianal pruritus, but other manifestations or ectopic presentations...
Enterobius vermicularis infection is typically observed in paediatric patients and manifests with perianal pruritus, but other manifestations or ectopic presentations have been reported in the literature. We present the case of a man in his 60ss with a large-bowel obstruction with symptoms including a 4-day history of progressive abdominal pain, distension, vomiting and absolute constipation. On examination, his abdomen was distended with tinkling bowel sounds on auscultation. Cross-sectional imaging demonstrated an obstructing mass in the distal descending colon. An emergency laparoscopic Hartmann's procedure was performed and the patient made an uneventful recovery. An intraoperative colonoscopy demonstrated numerous white threadworms in the colon. Histological analysis demonstrated a pseudotumour related to Enterobius vermicularis infection. This case represents a rare differential diagnosis for a large-bowel obstruction.
Topics: Male; Animals; Humans; Child; Enterobius; Enterobiasis; Colostomy; Abdominal Cavity; Colon
PubMed: 36446475
DOI: 10.1136/bcr-2022-252676 -
IEEE Robotics and Automation Letters Jul 2021Colonoscopy is the gold standard for colorectal cancer diagnosis; however, limited instrument dexterity and no sensor feedback can hamper procedure safety and...
Colonoscopy is the gold standard for colorectal cancer diagnosis; however, limited instrument dexterity and no sensor feedback can hamper procedure safety and acceptance. We propose a soft robotic sleeve to provide sensor feedback and additional actuation capabilities to improve safety during navigation in colonoscopy. The robot can be mounted around current endoscopic instrumentation as a disposable "add-on", avoiding the need for dedicated or customized instruments and without disrupting current surgical workflow. We focus on design, finite element analysis, fabrication, and experimental characterization and validation of the soft robotic sleeve. The device integrates soft optical sensors to monitor contact interaction forces between the colon and the colonoscope and soft robotic actuators that can be automatically deployed if excessive force is detected, to guarantee pressure redistribution on a larger contact area of the colon. The system can be operated by a surgeon via a graphic user interface that displays contact force values and enables independent or coordinated pressurization of the soft actuators upon demand, in case deemed necessary to aid navigation or distend colon tissue.
PubMed: 34027062
DOI: 10.1109/lra.2021.3073651 -
Journal of Veterinary Diagnostic... Jan 2022A 14-y-old Miniature Pinscher bitch was admitted to a veterinary clinic because of inappetence and a distended abdomen; ultrasound examination revealed a fluid-filled...
A 14-y-old Miniature Pinscher bitch was admitted to a veterinary clinic because of inappetence and a distended abdomen; ultrasound examination revealed a fluid-filled uterus with a single 1-cm hyperechoic nodule in its lumen. Ovariohysterectomy was performed. Grossly, the uterine horns were distended irregularly and asymmetrically, and the uterine lumen contained 200-300 mL of brown watery fluid. A single white polypoid 0.9-cm diameter nodule was present at the site of the distended uterine horn and arose from the endometrium with a narrow stalk. Histologically, the polyp consisted of dense, smooth muscle fascicles admixed with glandular components; its surface was covered by simple cuboidal epithelium with areas of squamous metaplasia. The myomatous cells expressed the myogenic markers smooth muscle actin and desmin. We interpreted the mass as an adenomyomatous uterine polyp, which is a rare variant of an endometrial polyp.
Topics: Animals; Epithelium; Female; Hyperplasia; Uterine Neoplasms; Uterus
PubMed: 34510977
DOI: 10.1177/10406387211043221 -
Saudi Journal of Medicine & Medical... 2022Appendiceal mucocele is an appendicular dilatation secondary to the intraluminal accumulation of mucous material. Adequate pre-operative diagnosis and surgical resection...
Appendiceal mucocele is an appendicular dilatation secondary to the intraluminal accumulation of mucous material. Adequate pre-operative diagnosis and surgical resection remains the standard management. Here, we present three cases of appendiceal mucocele. In the first case, a 60-year-old female presented with signs and symptoms of acute appendicitis and was admitted and operated. An inflamed distended globular cystic mass of appendix measuring 10 × 6 × 4 cm with a wide base was found and the patient underwent right hemicolectomy. In the second case, a 30-year-old male with symptoms and signs of acute appendicitis was admitted to the emergency department. An open surgery was performed and a distended, tense, and inflamed appendix without perforation of size 6 × 1 × 1 cm was discovered and removed. The diagnosis of mucocele appendix was suspected and confirmed by postoperative dissection of the specimen and histopathology. In the third case, a 25-year-old female patient was subjected to diagnostic laparoscopy in view of non-specific pain abdomen. A diagnosis of mucocele of appendix was made intraoperatively and removed using a specimen bag. Appendiceal mucocele with acute presentation is a rare pathology that clinically resembles acute appendicitis. Preoperative detailed investigations to reach a definitive diagnosis are critical for adequate surgical resection and overall outcome.
PubMed: 36247061
DOI: 10.4103/sjmms.sjmms_646_21 -
International Journal of Trichology 2017Development of trichobezoars in children is primarily a psychiatric issue more than a pediatric surgical ailment. A definite history of trichotillomania and trichophagia...
BACKGROUND
Development of trichobezoars in children is primarily a psychiatric issue more than a pediatric surgical ailment. A definite history of trichotillomania and trichophagia may or may not be elicited. Surgical removal is required in patients presenting with huge bezoars. Psychiatric follow-up is of utmost importance to avoid recurrence.
MATERIALS AND METHODS
Records of children who were diagnosed and managed for the presence of gastric trichobezoars were retrospectively reviewed.
RESULTS
Five children presented over past 15 years (2000-2015) with varied presentations ranging from asymptomatic abdominal masses to features of bowel obstruction. There were three adolescent females (aged 10, 12, and 13 years) and two males (aged 2 and 6 years). All had a hugely distended stomach completely filled with the bezoar. After gastrotomy and removal of the bezoar, gastrostomy drainage was provided in three of these five patients whereas the remaining two had nasogastric tube in place. All three with gastrostomy had effective gastric decompression and oral feeds could be established early. On the other hand, remaining two in which gastrostomy was not inserted had prolonged adynamicity of the stomach and delayed establishment of oral feeds.
CONCLUSION
A procrastinated history results in a hugely distended stomach which remains adynamic for a long period of time after removal of the bezoar, and decompression by gastrostomy tube drainage in the postoperative period is a feasible option.
PubMed: 28839386
DOI: 10.4103/ijt.ijt_38_17 -
The American Journal of Forensic... Sep 2021We report 3 individuals with clostridial sepsis, 2 culture-confirmed and 1 assumed based on historical information and autopsy findings. Case 1: a 46-year-old man with...
We report 3 individuals with clostridial sepsis, 2 culture-confirmed and 1 assumed based on historical information and autopsy findings. Case 1: a 46-year-old man with history of colon cancer status postcolectomy was found unresponsive and rapidly developed decompositional changes. At autopsy, within 1 day of his death, he had marked gaseous distention of the scrotum and palpable crepitance from the eyes to the feet, with bullae formation in the suprapubic region and left thigh. Postmortem culture of bullae fluid grew Clostridium septicum. Case 2: a 63-year-old woman with history of non-Hodgkin's lymphoma who was identified to have Clostridium perfringens by hospital cultures. Autopsy was performed the day after death. The skin had a generalized red-tan discoloration. The liver had large gas pockets in the parenchyma. Microscopic examination revealed bacterial rods. Other than diverticulosis and mild coronary artery atherosclerosis, no other disease process was identified. Case 3: a 34-year-old man was found dead in his apartment, which was 68°F, just under 1 day after having last been known alive. He was cooled before autopsy and autopsied less than 24 hours after being found. He had fixed anterior lividity, an abdomen that was distended by gas formation, and a scrotum that was distended by gas formation. There was no green discoloration of the abdomen. Glomerular capillaries contained bacterial rods with terminal spores. Because no other cause was identified, the cause of death was certified as probable clostridial sepsis.
Topics: Adult; Clostridium; Clostridium Infections; Fatal Outcome; Female; Humans; Male; Middle Aged; Sepsis
PubMed: 33346972
DOI: 10.1097/PAF.0000000000000647 -
Journal of Minimal Access Surgery 2020We present the case of a pericaecal hernia treated successfully with a laparoscopic approach and full recovery after surgery. A 53-year-old female patient with a...
We present the case of a pericaecal hernia treated successfully with a laparoscopic approach and full recovery after surgery. A 53-year-old female patient with a personal history of depression, osteoporosis and irritable bowel syndrome consulted to the emergency department for abdominal pain and distension in the last 12 h, associated with one episode of vomit and diminished frequency in the passage of stools. The right abdomen was tender to palpation, and blood work revealed no leucocytosis. A computed tomography scan showed small bowel loops distended and displaced to the right parietocolic recess, lateral to the ascending colon. Exploratory laparoscopy was performed confirming the presence of small bowel loops incarcerated in the paracaecal fossa. These ones were reduced with gentle manoeuvres, and the peritoneal folds incised to prevent recurrence. The patient was started on an oral diet 2 days after surgery and discharged home on the 3 post-operative day.
PubMed: 31929229
DOI: 10.4103/jmas.JMAS_257_19 -
Journal of Medical Imaging and... Oct 2016Several different neutral oral contrast agents have been trialled in magnetic resonance and CT enterography (CTE). In the Auckland region, Mannitol 2.5% and VoLumen are... (Comparative Study)
Comparative Study
INTRODUCTION
Several different neutral oral contrast agents have been trialled in magnetic resonance and CT enterography (CTE). In the Auckland region, Mannitol 2.5% and VoLumen are both used in CTE. This study compares the performance of these two neutral oral contrast agents in CTE.
METHODS
Computed tomography enterography data were collected from 25 consecutive studies that used either Mannitol or VoLumen in 2014. All images were reviewed by three radiologists blinded to the type of oral contrast. Each quadrant was assessed for maximum distension, proportion of bowel loops distended, presence of inhomogeneous content and bowel wall visibility. Assessment also included whether the contrast agent reached the caecum and an overall subjective quality assessment. Patients were invited to answer a questionnaire regarding tolerability of the preparations.
RESULTS
Mannitol achieves better wall visibility in the right upper quadrant, left upper quadrant and left lower quadrant (P < 0.01). Overall differences in study quality favours Mannitol (P < 0.01) with 48% of the Mannitol studies being considered excellent compared with 4% of the VoLumen studies. There was no difference in maximal distension or proportion of loops distended.
CONCLUSION
Mannitol in CTE achieves studies of a better quality than and is a viable alternative to VoLumen.
Topics: Contrast Media; Humans; Intestines; Mannitol; Tomography, X-Ray Computed
PubMed: 27469175
DOI: 10.1111/1754-9485.12486