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Cureus Jan 2024Typically, non-typhoidal (NTS) causes gastroenteritis; however, NTS can also lead to extraintestinal manifestations like bacteremia, meningitis, and abscess in...
Typically, non-typhoidal (NTS) causes gastroenteritis; however, NTS can also lead to extraintestinal manifestations like bacteremia, meningitis, and abscess in vulnerable populations such as children, elderly, and immunocompromised individuals. Extraintestinal manifestations in an immunocompetent patient are uncommon. Here, we report a case of iliacus myositis and bacteremia caused by NTS in a healthy adult. A previously healthy 23-year-old Japanese woman presented to the emergency room due to a one-day history of vomiting, abdominal pain, and diarrhea. She had a fever, and her blood test showed leukocytosis. Computed tomography (CT) of the abdomen and pelvis revealed a thickening of the ascending colon. She was diagnosed with gastroenteritis and treated with antibiotics. Blood culture at that time was negative, but serogroup 09 was detected in stool culture. Subsequently, her symptoms improved; however, on day 13, she returned to our hospital complaining of pain in her left thigh. CT scan of the abdomen and pelvis revealed no abscess or muscle inflammation, but due to persistent symptoms, the patient was admitted to the hospital, and antibiotics were initiated. serogroup 09 was detected from the blood culture obtained at the time of admission. Magnetic resonance imaging of the hip joint and CT of the abdomen and pelvis after admission revealed inflammation in the left iliacus muscle and an abscess near the left ilium. The patient was treated successfully with antibiotics. This case highlights two findings. First, NTS can cause bacteremia even in a healthy adult with no risk factors for bacteremia. Second, NTS bacteremia can cause complications in an immunocompetent adult. This case implies that even in the case of NTS infection in otherwise healthy individuals, if there are signs of bacteremia or complications, it is essential to conduct blood culture and additional tests.
PubMed: 38344588
DOI: 10.7759/cureus.52182 -
Journal of Medical Case Reports Feb 2024Regorafenib is an oral diphenylurea multikinase inhibitor and currently approved for use following third-line therapy for metastatic colorectal cancer (CRC) patients....
BACKGROUND
Regorafenib is an oral diphenylurea multikinase inhibitor and currently approved for use following third-line therapy for metastatic colorectal cancer (CRC) patients. Only one case has previously been reported of metastatic CRC showing a complete response (CR) to regorafenib.
CASE PRESENTATION
A 68-year-old Japanese man underwent laparoscopy-assisted ileocecal resection and D3 lymphadenectomy due to his ascending colon cancer. Eighteen months after surgery, a laparoscopic hepatic left lateral segmentectomy was performed due to a liver tumor, and a pathological diagnosis of colorectal liver metastasis was made. Three months after the second surgery, contrast-enhanced computed tomography (CT) revealed multiple lung metastases. The patient had undergone 18 courses of the FOLFOX + bevacizumab chemotherapy regimen as their first-line therapy and 11 courses of the FOLFIRI + ramucirumab chemotherapy regimen as their second-line therapy. As their third-line therapy, the patient was administered the regorafenib chemotherapy regimen. We evaluated the chemotherapy treatment's effect on the lung tumors by CT after 3, 7, 11, and 17 courses of the regorafenib chemotherapy regimen, finding that the lung tumors had shrunk with time; thus, each tumor was considered a partial response (PR) based on the RECIST guidelines. After 21 courses of the regorafenib chemotherapy regimen, the chemotherapy was discontinued in response to the patient's wishes. Even at 1 and 3 months after the discontinuation of the chemotherapy, CT revealed that the lung tumors had shrunk, with each considered a PR. Furthermore, 9 months after the discontinuation of the chemotherapy, CT revealed scarring of the lung tumors. This was considered a CR, rather than a PR. The patient remains disease-free 18 months after the discontinuation of chemotherapy.
CONCLUSIONS
In this paper, we present the second case of radiological CR with regorafenib for multiple lung metastases of ascending colon cancer. Currently, there is no consensus on a treatment strategy for patients with radiological CR.
Topics: Male; Humans; Aged; Colon, Ascending; Colonic Neoplasms; Bevacizumab; Rectal Neoplasms; Lung Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Phenylurea Compounds; Pyridines
PubMed: 38321556
DOI: 10.1186/s13256-023-04337-7 -
World Journal of Clinical Cases Jan 2024Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous development. It is particularly rare for an individual to have more...
BACKGROUND
Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous development. It is particularly rare for an individual to have more than two primary cancers. In this report, we present a case study of an elderly man who was diagnosed with three heterochronous cancers in the renal pelvis, bladder, and colon.
CASE SUMMARY
On December 30, 2014, a 51-year-old Chinese man was admitted to our hospital with complaints of intermittent painless gross hematuria for the preceding week. A computed tomography (CT) scan revealed wall thickening in the left ureter's upper segment, while a CT urography revealed a left renal pelvis tumor. A successful laparoscopic radical resection of the left renal pelvis tumor was subsequently performed at Shanghai Zhongshan Hospital in January 2015. The pathological findings after the surgery revealed a low-grade papillary urothelial carcinoma of the renal pelvis. The final pathological tumor stage was pT1N0M0. After surgery, this patient received 6 cycles of intravenous chemotherapy with gemcitabine and carboplatin, as well as bladder infusion therapy with gemcitabine. On December 18, 2017, the patient was admitted once again to our hospital with a one-day history of painless gross hematuria. A CT scan showed the presence of a space-occupying lesion on the posterior wall of bladder. Cystoscopic examination revealed multiple tumors in the bladder and right cutaneous ureterostomy was performed under general anesthesia on December 29, 2017. The postoperative pathological findings disclosed multifocal papillary urothelial carcinoma of the bladder (maximum size 3.7 cm × 2.6 cm). The bladder cancer was considered a metastasis of the renal pelvis cancer after surgery. The pathological tumor stage was pT1N0M1. The patient refused chemotherapy after surgery. After another six years, the patient returned on February 28, 2023, complaining of periumbilical pain that had lasted six days. This time, a CT scan of the abdomen showed a tumor in the ascending colon, but a subsequent colonoscopy examination indicated a tumor in the descending colon. On March 12, 2023, a subtotal colectomy and an ileosigmoidal anastomosis were carried out under general anesthesia. Postoperative pathological findings revealed that all three tumors were adenocarcinomas. The final pathological tumor stage was pT3N0M0. The patient had an uneventful postoperative recovery and was discharged without complications.
CONCLUSION
The case of this elderly man presents a rare occurrence of metachronous primary cancers in the renal pelvis and colon. Bladder cancer is considered a metastasis of renal pelvis cancer after surgery. Optimal treatment can be implemented by evaluating the patient's histological features, clinical history, and tumor distribution correctly.
PubMed: 38313656
DOI: 10.12998/wjcc.v12.i2.392 -
MSphere Feb 2024The gut microbiota is inextricably linked to human health and disease. It can confer colonization resistance against invading pathogens either through niche occupation...
The gut microbiota is inextricably linked to human health and disease. It can confer colonization resistance against invading pathogens either through niche occupation and nutrient competition or via its secreted metabolites. Short-chain fatty acids (SCFA) are the primary metabolites in the gut as a result of dietary fiber fermentation by the gut microbiota. In this work, we demonstrate that the interaction of single-species gut commensals on solid media is insufficient for pathogen inhibition, but supernatants from monocultures of these commensal bacteria enriched in acetate confer inhibition against anaerobic growth of the enteric pathogen . The three primary SCFAs (acetate, propionate, and butyrate) strongly inhibit the intestinal commensal Nissle as well as a panel of enteric pathogens besides at physiological pH of the cecum and ascending colon. This inhibition was significantly milder on anaerobic gut commensals and previously demonstrated to be associated with microbiota recovery after antibiotic-induced dysbiosis. We describe a general suppression of bacterial membrane potential by these SCFAs at physiological cecum and ascending colonic pH. Furthermore, the strength of bacterial inhibition increases with increasing alkyl chain length. Overall, the insights gained in this study shed light on the potential therapeutic use of SCFAs for conferring colonization resistance against invading pathogens in a dysbiotic gut.IMPORTANCERising antimicrobial resistance has made treatment of bacterial infections increasingly difficult. According to the World Health Organization, it has become a burgeoning threat to hospital and public health systems worldwide. This threat is largely attributed to the global rise of carbapenem-resistant in recent years, with common hospital-acquired pathogens growing increasingly resistant to last-line antibiotics. Antibiotics disrupt the homeostatic balance of the gut microbiota, resulting in the loss of colonization resistance against enteric pathogens. This work describes the ability of short-chain fatty acids (SCFAs) produced by gut microbiota to be effective against a wide panel of enteric pathogens without major impact on common gut commensal species. We also demonstrate a previously undescribed link between alkyl chain length and antibacterial effects of SCFAs. SCFAs, thus, hold promise as an alternative therapeutic option leveraging on the antimicrobial activity of these endogenously produced gut metabolites without disrupting gut microbiota homeostasis.
Topics: Humans; Enterobacteriaceae; Klebsiella pneumoniae; Fatty Acids, Volatile; Bacteria; Anti-Bacterial Agents; Acetates
PubMed: 38305176
DOI: 10.1128/msphere.00781-23 -
World Journal of Clinical Cases Jan 2024Intestinal malrotation is a congenital defect of embryonic development caused by various teratogenic factors. In this condition, the intestinal tube, along with the...
BACKGROUND
Intestinal malrotation is a congenital defect of embryonic development caused by various teratogenic factors. In this condition, the intestinal tube, along with the superior mesenteric artery serving as the axis for the counterclockwise movement, is incomplete or abnormally rotated due to incomplete attachment of the mesentery and abnormal intestinal tube position. Such a case is usually asymptomatic and thus difficult to detect. Therefore, similar variant malformations are only found during an operation required for other abdominal diseases.
CASE SUMMARY
An elderly male patient was admitted to the hospital due to gastric cancer. An abdominal computed tomography (CT) scan with contrast revealed that the ascending and descending colon were parallel on the right side of the abdominal cavity, while the sigmoid colon extended into the right iliac fossa, allowing the diagnosis of congenital midgut malrotation. Following thorough preoperative preparation, the patient underwent laparoscopic radical gastrectomy to treat his gastric cancer. Intraoperatively, an exploration of the abdominal cavity uncovered the absence of the transverse colon. The distal colon at the hepatic flexure, along with the ascending colon, extended into the right iliac fossa, where it continued as the sigmoid colon. As planned, the laparoscopic radical gastrectomy was performed, and the patient was discharged from the hospital 7 d after the surgery.
CONCLUSION
Asymptomatic intestinal malrotation is best detected by CT, requiring no treatment but possibly interfering with the treatment of other diseases.
PubMed: 38292641
DOI: 10.12998/wjcc.v12.i1.210 -
JNMA; Journal of the Nepal Medical... Oct 2023Mesenteric ischemia is a surgical emergency. The presence of hepatic portal venous gas and pneumatosis intestinalis is a frequent finding in computed tomography. Not all...
UNLABELLED
Mesenteric ischemia is a surgical emergency. The presence of hepatic portal venous gas and pneumatosis intestinalis is a frequent finding in computed tomography. Not all hepatic portal venous gas and pneumatosis intestinalis are due to mesenteric ischemia. A 70-year-old female, with a known case of diabetes mellitus, rheumatic heart disease and atrial fibrillation under warfarin presented with diffuse abdominal pain, multiple episodes of vomiting and ecchymosis in bilateral flanks. Evaluation of the coagulation profile suggested warfarin-induced coagulopathy. Portal venous gas was detected during an ultrasound examination. Subsequent contrast-enhanced computed tomography abdomen showed hepatic portal venous gas, pneumatosis intestinalis, paucity of branches of the ileocolic artery, and reduced enhancement of caecum and ascending colon. Mild ascites were present in the pelvis. Arterial blood gas analysis revealed compensated metabolic acidosis. The patient was managed conservatively and discharged after nine days of hospital admission. Conservative approach can be considered for suspected mesenteric ischemia in surgically unfit candidates.
KEYWORDS
case reports; mesenteric ischemia; portal vein; rheumatic heart disease; warfarin.
Topics: Female; Humans; Aged; Portal Vein; Warfarin; Mesenteric Ischemia; Rheumatic Heart Disease; Tomography, X-Ray Computed; Pain
PubMed: 38289773
DOI: 10.31729/jnma.8302 -
Cureus Dec 2023Intramural gastrointestinal hematomas are commonly observed following abdominal trauma or are associated with coagulopathy disorders. In contrast, idiopathic...
Intramural gastrointestinal hematomas are commonly observed following abdominal trauma or are associated with coagulopathy disorders. In contrast, idiopathic gastrointestinal hematoma is rare, and colonic involvement is sporadic, with very few published reports. We report the case of a 29-year-old female who presented with right hypogastric pain over the last three days. Abdominal CT with contrast revealed an 8.5 × 6 × 7.5 cm pre-occlusive intramural hematoma of the ascending colon up to the hepatic flexure with diffuse edematous wall thickening, indicating colonic obstruction. On colonoscopy, the site of the intramural hematoma was identified without active bleeding or obvious pathology, and the colonoscope successfully passed through the region. The patient was managed conservatively. A month later, abdominal CT revealed complete resolution of the colonic hematoma. After two months of follow-up, the patient was free from gastrointestinal symptoms. In conclusion, idiopathic colon intramural hematoma is rare, with a challenge in diagnosis and treatment; efforts should be made to treat it with conservative therapy.
PubMed: 38288191
DOI: 10.7759/cureus.51330 -
Revista Espanola de Enfermedades... Jan 2024Langerhans cell histiocytosis (LCH) is a monoclonal proliferative disease that can affect multiple organs. It is a rare disorder, and children are the most commonly...
Langerhans cell histiocytosis (LCH) is a monoclonal proliferative disease that can affect multiple organs. It is a rare disorder, and children are the most commonly affected. Its classification depends on whether the disease is localized (usually bone or skin) or systemic. We present the case of a 49-year-old woman with a previous diagnosis of LCH in 2018 with only cutaneous involvement, managed with topical corticosteroids. After developing hypertransaminasemia, a PET-CT scan was performed, showing dissemination of the disease with bone, hepatosplenic and gynecological involvement. In addition, hypermetabolic lesions were described in the cecum with ileocecal adenopathies. A colonoscopy was performed showing in the cecum and ascending colon multiple sessile polyps of 5-10mm with central fibrin-coated erosions, from which biopsies were obtained. Histology revealed typical features of LCH with positive staining for CD1A, S100 and Langerin.
PubMed: 38284911
DOI: 10.17235/reed.2024.10152/2023 -
Journal of Surgical Case Reports Jan 2024Intussusception is a phenomenon commonly associated with the paediatric population. In adults, intussusception is frequently a result of a neoplastic process. We present...
Intussusception is a phenomenon commonly associated with the paediatric population. In adults, intussusception is frequently a result of a neoplastic process. We present the case of a 56-year-old gentleman who was diagnosed to the local Emergency Department with a 4-day history of worsening severe, left sided lower abdominal pain. The pain was colicky in nature. Computed tomography identified a long-segment intussusception involving distal small bowel, caecum, ascending colon, the entirety of transverse colon and its associated mesentery. The patient proceeded to theatre where a laparotomy and right hemicolectomy was performed. Histopathological analysis of the specimen identified an ileal myxoma as the lead-point of the intussusception. This report emphasises the value of prompt investigation in atypical clinical presentations.
PubMed: 38283410
DOI: 10.1093/jscr/rjad734 -
International Journal of Surgery Case... Feb 2024An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of...
INTRODUCTION
An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here.
PRESENTATION OF CASE
A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications.
DISCUSSION
There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. <10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %.
CONCLUSION
A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.
PubMed: 38280345
DOI: 10.1016/j.ijscr.2024.109312