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Cureus Aug 2023Malignant peritoneal mesothelioma (MPM) is a rare tumor of the serous membranes of the peritoneum and has been linked to exposure to asbestos and other risk factors. The...
Malignant peritoneal mesothelioma (MPM) is a rare tumor of the serous membranes of the peritoneum and has been linked to exposure to asbestos and other risk factors. The clinical manifestations are vague, with a wide clinical spectrum, predominantly related to the abdominal involvement of the disease. Localized mesothelioma is an uncommon manifestation of the disease. Common symptoms include abdominal pain or abdominal distention, nausea, anorexia, and weight loss. Rarely, patients present with paraneoplastic syndrome. Due to the nonspecific symptoms, many patients already have advanced disease at the time of diagnosis. The authors report a case of a 75-year-old female patient who presented with symptoms of asthenia, anorexia, progressive paleness, and weight loss lasting five months. She reports later new-onset symptoms of diffuse abdominal pain and diarrhea associated with nausea. Laboratory tests showed anemia, mild leukocytosis, thrombocytosis, elevated C-reactive protein (CRP), and elevated liver enzymes. An abdominal and pelvic computed tomography (CT) scan revealed marked tissue thickening of an irregular and striated configuration of the leaflets and peritoneal reflections in an omental cake pattern, and a chest CT scan showed multiple bilateral pulmonary nodules, suggesting diffuse malignant disease. A CT-guided biopsy of a peritoneal implant was performed, establishing the diagnosis of malignant peritoneal mesothelioma. Due to rapid clinical deterioration, the patient did not receive any systemic treatment, surgery, or radiotherapy and was transitioned to comfort care. As in the presented case, most cases of MPM have diffuse peritoneal involvement at the time of diagnosis, although extra-abdominal involvement is very rare. This disease presentation is associated with high morbidity and mortality compared to cases of localized disease. There is no specific imaging diagnostic modality or valuable tumor markers for MPM. Although a CT scan remains important in the diagnostic approach, the changes found are not specific. Radiographically, MPM may present as mesenteric or parietal peritoneal nodules, visceral peritoneal thickening, ascites, or omental masses. Although these features may raise suspicion of MPM, a biopsy is necessary to confirm the diagnosis. Therefore, due to the rarity of this disease and its nonspecific signs or symptoms, MPM is difficult to diagnose, and the prognosis remains poor.
PubMed: 37664365
DOI: 10.7759/cureus.42902 -
Cellular, Molecular and Clinical Aspects of Aortic Aneurysm-Vascular Physiology and Pathophysiology.Cells Feb 2024A disturbance of the structure of the aortic wall results in the formation of aortic aneurysm, which is characterized by a significant bulge on the vessel surface that... (Review)
Review
A disturbance of the structure of the aortic wall results in the formation of aortic aneurysm, which is characterized by a significant bulge on the vessel surface that may have consequences, such as distention and finally rupture. Abdominal aortic aneurysm (AAA) is a major pathological condition because it affects approximately 8% of elderly men and 1.5% of elderly women. The pathogenesis of AAA involves multiple interlocking mechanisms, including inflammation, immune cell activation, protein degradation and cellular malalignments. The expression of inflammatory factors, such as cytokines and chemokines, induce the infiltration of inflammatory cells into the wall of the aorta, including macrophages, natural killer cells (NK cells) and T and B lymphocytes. Protein degradation occurs with a high expression not only of matrix metalloproteinases (MMPs) but also of neutrophil gelatinase-associated lipocalin (NGAL), interferon gamma (IFN-γ) and chymases. The loss of extracellular matrix (ECM) due to cell apoptosis and phenotype switching reduces tissue density and may contribute to AAA. It is important to consider the key mechanisms of initiating and promoting AAA to achieve better preventative and therapeutic outcomes.
Topics: Male; Humans; Female; Aged; Aortic Aneurysm, Abdominal; Aorta; Cytokines; Phenotype; Apoptosis
PubMed: 38334666
DOI: 10.3390/cells13030274 -
Cureus Mar 2024Spontaneous perforation of the colon is a rare disease defined as sudden perforation of a healthy colon without evidence of trauma or disease. These perforations are...
Spontaneous perforation of the colon is a rare disease defined as sudden perforation of a healthy colon without evidence of trauma or disease. These perforations are typically classified as either stercoral or idiopathic. Cecal perforation during pregnancy is an uncommon and potentially life-threatening condition requiring prompt recognition and surgical intervention. We present a case of a 33-year-old woman at 29 weeks and three days gestation presenting with spontaneous cecal perforation. She presented to the emergency department with diffuse abdominal pain and distention lasting for three days, associated with nausea and vomiting. Following evaluation, she was diagnosed with diffuse peritonitis. The diagnosis of this condition relies on both the clinical presentation and the utilization of radiographic imaging. The patient underwent an emergent explorative laparotomy with prompt surgical intervention to repair the 1.2 x 0.8 cm perforation found on her distended cecum. The surgical repair consisted of the excision of the edges and the primary suture of the perforation with an omental patch. Her post-procedure course was uneventful, and she later delivered a healthy baby at full term. This case highlights the importance of considering uncommon causes of acute abdominal pain in pregnant women to ensure timely diagnosis and management.
PubMed: 38595875
DOI: 10.7759/cureus.55862 -
Life (Basel, Switzerland) Dec 2023Gastric ischemia is uncommon because the stomach has multiple collateral blood supplies. The etiology of gastric ischemia is vascular insufficiency caused by systemic...
Gastric ischemia is uncommon because the stomach has multiple collateral blood supplies. The etiology of gastric ischemia is vascular insufficiency caused by systemic hypotension, vasculitis, or disseminated thromboembolism. Mechanical causes include gastric volvulus and acute gastric distention. Uncommon as gastric ischemia is, we are the first to report a 65-year-old male who developed gastric ischemia leading to gastric pneumatosis 26 days after initial treatment for severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), via laparoscopic imaging. We conclude that physicians should be suspicious of gastric ischemia when the patient is infected with SARS-CoV-2 with severe abdominal pain and should proceed with medical conservative care instead of surgery.
PubMed: 38255662
DOI: 10.3390/life14010047 -
Cureus Dec 2023A fibroepithelial polyp (FEP) of the penis is a rare benign swelling and often under-recognised lesion that has the potential to become malignant in some cases. The...
A fibroepithelial polyp (FEP) of the penis is a rare benign swelling and often under-recognised lesion that has the potential to become malignant in some cases. The pathogenesis is still unclear, but it is hypothesised to be due to chronic irritation most often associated with condom catheter use or phimosis. We describe a case of an FEP measuring 10 cm in largest diameter developing from the ventral prepuce with a longstanding post-radiation penoscrotal oedema. A 62-year-old male with a history of bladder cancer presented to the emergency department with abdominal distention, vomiting, and obstipation for three days to the emergency department. He had post-radiation penoscrotal edema for the last 10 years and penile tip growth for the last two years. Foley's catheter insertion was done through the urethra after dorsal slit of prepuce, and an incisional biopsy was sent, which was found to be an FEP.
PubMed: 38192923
DOI: 10.7759/cureus.50204 -
SAGE Open Medical Case Reports 2023Colonic volvulus is one of the most common causes of bowel obstruction. It could occur in different parts of the colon. The sigmoid is the most common part, but it...
Colonic volvulus is one of the most common causes of bowel obstruction. It could occur in different parts of the colon. The sigmoid is the most common part, but it rarely occurs in the transverse colon because of the colon's anatomical features. So, simultaneous sigmoid and transverse colon volvulus is a rare phenomenon that could endanger patients' lives due to its rarity, ischemia, necrosis of the colon wall, and the lack of a definite algorithm to approach this disease. So, it is essential to consider this disease as one of the most important differential diagnoses in patients with abdominal pain and distention. In this article, a 45-year-old male presented to the surgical ward with severe prolonged abdominal pain, diagnosed with simultaneous sigmoid and transverse colon volvulus during laparotomy.
PubMed: 37654550
DOI: 10.1177/2050313X231197001 -
Medicina (Kaunas, Lithuania) Jul 2023The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations,... (Review)
Review
The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients.
Topics: Humans; COVID-19; SARS-CoV-2; Pandemics; Gastrointestinal Diseases; Lung; Gastrointestinal Tract
PubMed: 37512143
DOI: 10.3390/medicina59071332 -
Frontiers in Surgery 2023Hepatic angiomyolipoma (HAML) is a rare mesenchymal neoplasm that predominantly affects middle-aged women. In this study, we present a case of a 49-year-old woman with a...
Hepatic angiomyolipoma (HAML) is a rare mesenchymal neoplasm that predominantly affects middle-aged women. In this study, we present a case of a 49-year-old woman with a giant HAML accompanied by spontaneous subcapsular rupture. The patient initially experienced nausea and abdominal distention, followed by an enlargement of the upper abdominal circumference. Laboratory examination revealed decreased serum hemoglobin, while tumor biomarkers were within normal ranges. Imaging studies, such as abdominal ultrasound and contrast-enhanced computed tomography (CT), demonstrated a large upper abdominal mass with heterogeneous density and hypervascularity. The tumor appeared to have invaded the left liver, raising concerns about possible malignancy. Subsequent positron-emission tomography/CT confirmed increased fluorodeoxyglucose uptake in the mass. Laparoscopic exploration revealed a protruding, well-encapsulated tumor from the left liver, exhibiting subcapsular hemorrhage. Surgical resection of the tumor and the left liver was performed, leading to a successful outcome.
PubMed: 37492622
DOI: 10.3389/fsurg.2023.1164613 -
Pharmaceutical Biology Dec 2023A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction.
CONTEXT
A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction.
OBJECTIVE
To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD).
MATERIALS AND METHODS
The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota.
RESULTS
Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention ( < 0.01), increased 2.6-fold sloppy stools ( < 0.05) and eliminated hard stool completely ( < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and , 2-146FA, , 2-1-58FAA, and were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation.
DISCUSSION AND CONCLUSIONS
TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.
Topics: Humans; Constipation; Dysbiosis; Feces; Gastrointestinal Microbiome; Peritoneal Dialysis; Drugs, Chinese Herbal
PubMed: 36994999
DOI: 10.1080/13880209.2023.2193595 -
Annals of Medicine and Surgery (2012) Nov 2023Neutropenic enterocolitis (NE) is a life-threatening necrotizing enterocolitis, particularly in neutropenic patients.
INTRODUCTION AND IMPORTANCE
Neutropenic enterocolitis (NE) is a life-threatening necrotizing enterocolitis, particularly in neutropenic patients.
CASE PRESENTATION
We are presenting a case of a 22-year-old male who presented chief complaints of abdominal pain, reddish black stool, abdominal distention, and low-grade fever with laboratory and bone marrow findings suggestive of aplastic anemia. Computed tomography scan of the abdomen and pelvis with contrast was used to establish the diagnosis of necrotizing enterocolitis. Nonsurgical management including broad-spectrum antimicrobials, bowel rest, nasogastric suction, fluid and nutritional support, and blood product support, helped this patient to recover.
CLINICAL DISCUSSION
NE is a life-threatening inflammatory condition of the small and large intestines. Typical symptoms of NE include diffuse abdominal pain, fever, and watery or bloody diarrhea. Diagnosis of NE is done by clinical and imaging findings. Management of the primary disease is important to improve the ultimate survival of the disease.
CONCLUSION
Early identification and management of neutropenic enterocolitis help to reduce mortality.
PubMed: 37915650
DOI: 10.1097/MS9.0000000000001322