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International Journal of Emergency... Jun 2024The World Health Organization (WHO) reports that Asia and Africa have the highest Chronic Liver Disease (CLD) mortality rate. Cirrhosis, responsible for 22.2 fatalities...
BACKGROUND
The World Health Organization (WHO) reports that Asia and Africa have the highest Chronic Liver Disease (CLD) mortality rate. Cirrhosis, responsible for 22.2 fatalities per 100,000 people, is India's 10th most common cause of mortality. The increasing prevalence of chronic liver disease necessitates a study to identify predictive factors for patients who visit the emergency department. Identifying elements that enhance the predictive value of mortality in unstable patients with CLD complications is important in emergency departments. This study aims to determine Clinical and Laboratory Parameters as mortality predictors in adult chronic liver disease patients.
METHODOLOGY
The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with chronic liver disease above 18 years of age who satisfied the inclusion criteria were clinically evaluated. Clinical and demographic details were collected, and data was analyzed.
RESULTS
Two hundred thirty-six patients were enrolled. The mean age was 50.77 ± 14.26 years. 78.4% of the participants were men. Abdominal distension, affecting 59.7% of patients, was the most common presenting ailment, followed by melena and hematemesis, affecting 41.9% and 32.6%, respectively. The mean stay in the emergency department was 10.29 ± 8.10 h. Refractory septic shock, the leading cause of mortality, accounts for 69.2% of all deaths, alongside grade 4 hepatic encephalopathy and massive Upper Gastrointestinal (UGI) bleeding, as identified in our study. Factors such as altered mental sensorium, high respiratory rate, low SpO2, increased heart rate, low systolic blood pressure, low diastolic blood pressure, and low Glasgow Coma Scale (GCS) on Emergency Department (ED) arrival are significantly associated with mortality.
CONCLUSIONS
Chronic liver disease, a prevalent condition in India, most commonly seen in middle aged men and lower socioeconomic groups. The parameters independently associated with mortality in our study were presence of altered mental sensorium, Glasgow coma scale, Child Pugh class and need for ICU admission. Understanding the presentation pattern, and mortality predictors can help ED physicians in managing acute events and follow-ups.
PubMed: 38872111
DOI: 10.1186/s12245-024-00647-9 -
DEN Open Apr 2025Despite endometriosis being a relatively common chronic gynecological condition in women of childbearing age, small bowel endometriosis is rare. Presentations can vary...
Despite endometriosis being a relatively common chronic gynecological condition in women of childbearing age, small bowel endometriosis is rare. Presentations can vary from completely asymptomatic to reported symptoms of abdominal pain, bloating, and diarrhea. The following two cases depict very atypical manifestations of ileal endometriosis that presented as obscure intermittent gastrointestinal bleeding and bowel obstruction requiring surgical intervention. The first case describes a previously healthy 40-year-old woman with severe symptomatic iron deficiency anemia and intermittent melena. A small bowel enteroscopy diagnosed multiple ulcerated strictures in the distal small bowel as the likely culprit. Despite nonsteroidal anti-inflammatory drug-induced enteropathy being initially considered as the likely etiology, histopathological examination of the resected distal ileal segment revealed evidence of endometriosis. The second case describes a 66-year-old with a presumptive diagnosis of Crohn's disease who reported a 10-year history of intermittent perimenstrual abdominal pain, diarrhea, and nausea with vomiting. Following two subsequent episodes of acute bowel obstruction and surgical resection of the patient's stricturing terminal ileal disease, histopathological examination demonstrated active chronic inflammation with endometriosis. Small bowel endometriosis should be considered as an unusual differential diagnosis in women who may present with obscure gastrointestinal bleeding from the small bowel or recurrent bowel obstruction.
PubMed: 38868705
DOI: 10.1002/deo2.395 -
Cureus May 2024Dual antiplatelet therapy (DAPT), vital post-percutaneous coronary intervention (PCI) to prevent cardiovascular events (CVEs) via aspirin and P2Y12 receptor antagonists,...
INTRODUCTION
Dual antiplatelet therapy (DAPT), vital post-percutaneous coronary intervention (PCI) to prevent cardiovascular events (CVEs) via aspirin and P2Y12 receptor antagonists, faces controversy when combined with proton pump inhibitors (PPIs) due to potential impacts on bleeding risk and antiplatelet efficacy, prompting the need for further research to determine optimal co-administration practices. This work evaluated the effects of PPIs on CVEs and inflammatory factors in patients with upper gastrointestinal bleeding (UGIB) undergoing DAPT after PCI.
MATERIALS AND METHODS
The data of 166 patients who underwent PCI and developed UGIB while on DAPT from April 2021 to April 2023 were retrospectively analyzed. The patients were rolled into two groups: those who received PPI treatment and those who did not, namely, the PPI and non-PPI group, respectively. Clinical data from these patients was analyzed, intending to provide relevant theoretical evidence for clinical practice. Furthermore, the occurrence of CVEs and the levels of inflammatory factors of patients in all groups were statistically analyzed.
RESULTS
Melena was the most common clinical symptom observed in all UGIB patients. The incidence of CVEs in the PPI group was not greatly different from that in the non-PPI group (>0.05). The distribution of CVEs occurrence among different PPI drugs also exhibited no obvious difference (>0.05). The PPI group exhibited greatly lower C-reactive protein (CRP) and tumor necrosis factor α (TNF-α) based on the non-PPI group (<0.05).
CONCLUSION
Melena was the most frequent clinical manifestation in UGIB patients. The use of PPIs did not increase the risk of CVEs, and different PPI drugs did not affect the occurrence of CVEs. Furthermore, PPIs lowered CRP and TNF-α levels in serum of these patients.
PubMed: 38854272
DOI: 10.7759/cureus.59925 -
Cureus May 2024Hydatid cystic disease, also called cystic echinococcosis, arises from , a tapeworm infestation. It results in developing cysts primarily in the liver, although they can...
Hydatid cystic disease, also called cystic echinococcosis, arises from , a tapeworm infestation. It results in developing cysts primarily in the liver, although they can also occur in other organs. While the spleen is an uncommon site for cyst formation, it can still be affected. These infections are more prevalent in rural and underdeveloped regions, particularly among individuals involved in livestock rearing and animal care. The case we came across was of a 32-year-old female from a rural background engaged in animal handling and farming. She presented to our hospital with left hypochondriac pain, decreased appetite, and generalized weakness, but the patient had a history of two episodes of melena, which was self-limiting. Subsequent investigations revealed a diagnosis of splenic hydatid cyst with perisplenic collaterals and cystic compression of the splenic vein, causing symptoms of non-cirrhotic portal hypertension. Here, we present a unique case of splenic hydatid cyst leading to non-cirrhotic portal hypertension. This rare presentation poses diagnostic challenges and emphasizes the importance of considering parasitic infections in differential diagnoses.
PubMed: 38854266
DOI: 10.7759/cureus.60025 -
International Journal of Surgery Case... Jul 2024Aortoenteric fistulas are rare and life-threatening pathology characterized by an abnormal connection between the aorta and the gastrointestinal tract.
BACKGROUND
Aortoenteric fistulas are rare and life-threatening pathology characterized by an abnormal connection between the aorta and the gastrointestinal tract.
CASE PRESENTATION
The patient is a 61-year-old male who initially presented with hypogastric pain, hematemesis, and melena. Computed tomography angiography (CTA) revealed an abdominal aorta aneurysm but not a fistula. Imaging modalities were inconclusive in the diagnosis. The patient became unstable hemodynamically and was transferred to the operation room. The definitive diagnosis of aortoenteric fistula was confirmed during surgical exploration. Urgent surgery was performed; however, the patient experienced a cascade of complications, including rebleeding, intestinal leakage, and hemodynamic instability due to aortic bleeding. Despite rigorous interventions, the patient expired due to multiple organ failure 53 days after the first repair surgery.
CLINICAL DISCUSSION
There is no definite imaging method due to the lack of guidelines, and the absence of exact findings has led to intraoperative diagnosis in up to 50 % of cases. This is one of the modalities of choice to examine suspected aortoenteric fistulas. Many authors prefer Computed tomography (CT) with intravenous contrast for suspected AEF despite its limitations in clarity. Others recommend CT angiography as the preferred modality. It is worth noting that, as reported in a comprehensive retrospective review, the mortality rate is approximately 46 % within 60 days after AEF repair surgery.
CONCLUSION
This report adds to the limited data about primary aortojejunal fistulas, an extremely rare type of aortoenteric fistulas which has been reported in only a few cases. Understanding the importance of promptly suspecting, diagnosing, and intervening is crucial, emphasizing the importance of sharing such cases for medical guidance and better patient outcomes.
PubMed: 38851068
DOI: 10.1016/j.ijscr.2024.109842 -
Quantitative Imaging in Medicine and... Jun 2024Intestinal lipoma is considered the most common benign tumor that causes intussusception. This retrospective case-control study aimed to present the clinical and...
BACKGROUND
Intestinal lipoma is considered the most common benign tumor that causes intussusception. This retrospective case-control study aimed to present the clinical and multidetector computed tomography (MDCT) features between intestinal lipomas with and without intussusception and examine risk factors that predict intussusception caused by intestinal lipomas.
METHODS
We retrospectively analyzed 281 adult patients diagnosed with intestinal lipoma by radiologists using whole-abdominal MDCT between January 2015 and August 2022. Patients were divided into adult intussusception (AI) and non-AI groups based on MDCT images. Univariate logistic regression was performed to identify risk factors for intestinal lipoma-induced intussusception.
RESULTS
A total of 281 patients with intestinal lipomas were included in the study, with an average age of 68.0±11.3 years, and the male to female ratio was about 1:1.4. Among them, 24 patients developed lipoma-induced intussusception. Patients in the AI group presented with more abdominal pain (70.8% . 47.1%, P=0.03), nausea/vomiting (37.5% . 14.8%, P=0.009), hematochezia/melena (29.2% . 11.3%, P=0.02), and abdominal tenderness (66.7% . 24.9%, P<0.001). Lipomas were more common in the small bowel (224/281, 79.7%) than the large bowel (57/281, 20.3%). Lipomas in the AI group showed more heterogeneous hypodensity (41.7% . 15.6%, P=0.004), longer length (median, 2.2 . 1.2 cm, P<0.001), and larger volume (median, 4.1 . 0.6 cm, P<0.001). In the univariate logistic regression, lipoma density [odds ratio (OR) =3.875, 95% confidence interval (CI): 1.609-9.331, P=0.003] and lipoma length (OR =3.216, 95% CI: 1.977-5.231, P<0.001) were risk factors for intestinal lipoma-induced intussusception.
CONCLUSIONS
More patients in the AI group have digestive tract symptoms than those in the non-AI group. Lipoma density and length are risk factors for intussusception in patients with intestinal lipoma. In addition, the common site of intestinal lipoma may have changed from the colon to the small intestine.
PubMed: 38846289
DOI: 10.21037/qims-23-1530 -
Cureus May 2024Gastric leiomyomas are benign, submucosal tumors found incidentally on unrelated imaging or during autopsy. The majority of leiomyomas are asymptomatic; however,...
Gastric leiomyomas are benign, submucosal tumors found incidentally on unrelated imaging or during autopsy. The majority of leiomyomas are asymptomatic; however, patients can develop central ulcerations on the lesions leading to upper gastrointestinal (GI) bleeding. A 75-year-old female, with a past medical history of hypertension, hyperlipidemia, and a cerebrovascular accident, presented with complaints of melena, near-syncope events, lightheadedness, weakness, and hematemesis. A computed tomography (CT) of the abdomen with contrast found a heterogeneous low-attenuation mass of 4×4×3 cm within the gastric fundus and near the gastroesophageal (GE) junction. After an open gastrostomy and excisional biopsy, the mass was identified as a leiomyoma. This case report reviews the presentation, diagnostic assessments, and treatment of a gastric leiomyoma in a complex location proximal to the gastroesophageal junction. Gastric leiomyomas should be considered as a differential diagnosis for patients presenting with an upper gastrointestinal bleed.
PubMed: 38846219
DOI: 10.7759/cureus.59810 -
Cureus May 2024Renal cell carcinoma (RCC) has a high metastatic potential. While metastasis to common sites like the lungs, liver, bones, and brain is well-documented, metastasis to...
Renal cell carcinoma (RCC) has a high metastatic potential. While metastasis to common sites like the lungs, liver, bones, and brain is well-documented, metastasis to the colon, particularly the descending colon, remains an uncommon occurrence. When RCC does metastasize to the gastrointestinal tract, it commonly spreads to the small bowel and stomach. There are few cases reported in literature involving RCC metastasis to the colon. The commonly affected areas within the colon include the rectosigmoid colon, splenic flexure, and transverse colon. We describe an 87-year-old male with a history of stage III RCC diagnosed three years ago, followed by left-sided nephroureterectomy, partial adrenalectomy, and perinephric lymph node dissection. He presented to the emergency department (ED) with melena and generalized abdominal pain for one week. Stool occult blood was positive. Computed tomography (CT) of the abdomen was significant for stable postsurgical changes related to prior left nephrectomy and colonic mass at the proximal descending colon. A colonoscopy revealed a necrotic appearing friable mass in the descending colon. The pathology of the mass revealed proliferated atypical cells positive for paired box 8 (PAX8), a cluster of differentiation 10 (CD10), RCC, and pan-cytokeratin and negative for caudal-type homeobox 2 (CDX2), thyroid transcription factor-1 (TTF-1), and a cluster of differentiation 68 (CD68), consistent with metastatic RCC.
PubMed: 38841042
DOI: 10.7759/cureus.59756 -
Revista Espanola de Enfermedades... Jun 2024Adenocarcinoma accounts for 90% of malignant gastric tumours. Lymphomas, gastrointestinal stromal tumours (GIST) and other less frequent tumours account for 10%....
Adenocarcinoma accounts for 90% of malignant gastric tumours. Lymphomas, gastrointestinal stromal tumours (GIST) and other less frequent tumours account for 10%. However, rhabdomyosarcoma (RMS) remains a rare cause within the broad differential diagnosis of gastric lesions. Most cases of gastrointestinal RMS in adults are metastatic disease so primary RMS is extremely rare. A few cases reports of esophageal and gastric RMS have been published. This is a 76-year-old patient with a history of oncological oncology of poorly differentiated lung adenocarcinoma T2N1M0 in 2008 treated with surgery with no signs of recurrence. She presented to emergency with occasional episodes of melena and iron deficiency anemia for the last 3 months. The laboratory findings showed moderated anemia. Gastroscopy was performed and a prominent submucosal and ulcerated bulge was observed at the posterior wall of the gastric body and fundus. A histologic examination reveled tissue fragments composed of small round spindle-shaped cells. Tumor cells had atypical nuclei showing dense chromatin ad pale to eosinophilic cytoplasm. Immunohistochemically, the tumor was positive for AE1/3, desmin, myogenin and CD56. Patient was diagnosed with primary gastric RMS. Thoraco-abdominopelvic CT showed a locally advanced stage (T2 N1M0).
PubMed: 38832592
DOI: 10.17235/reed.2024.10538/2024 -
European Journal of Gastroenterology &... Jul 2024Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied...
BACKGROUND
Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied to patients with obscure gastrointestinal bleeding, but there are few studies on its application in children with MD. This article aims to provide evidence in favor of the auxiliary diagnosis of MD in children by analyzing its characteristics using SBCE.
METHODS
We retrospectively collected the clinical data of patients with suspected MD.
RESULTS
A total of 58 children were included in this study. All 58 children presented overt gastrointestinal bleeding (bloody stool or melena). Capsule endoscopy identified protruding lesions in 2 cases, double-lumen changes in 30 cases (all considered as MD), vascular lesions in 7 cases, intestinal mucosal inflammatory lesions in 3 cases, ulcers or erosion in 3 cases, and no obvious abnormalities in SBCE in 12 cases. Both SBCE and technetium-99 scans were performed for 24 cases, 22 of which were diagnosed MD by their combined results, giving a diagnostic coincidence rate of 91.7%. Eight cases were highly suspected as MD but were negative for the technetium-99 scan and positive for SBCE.
CONCLUSION
SBCE has high accuracy in the diagnosis of MD in children, especially when performed in combination with a technetium-99 scan, which can greatly improve the diagnostic rate of MD in children.
Topics: Humans; Meckel Diverticulum; Capsule Endoscopy; Male; Female; Retrospective Studies; Child; Child, Preschool; Gastrointestinal Hemorrhage; Adolescent; Infant; Intestine, Small; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals
PubMed: 38829942
DOI: 10.1097/MEG.0000000000002783