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International Journal of Surgery Case... Apr 2023Ascariasis is a helminthic infection of humans caused by Ascaris lumbricoides. Pediatric patients infected with Ascaris can develop multiple complications including...
INTRODUCTION AND IMPORTANCE
Ascariasis is a helminthic infection of humans caused by Ascaris lumbricoides. Pediatric patients infected with Ascaris can develop multiple complications including appendicitis, gastrointestinal bleeding, hepatobiliary disease like cholangitis or obstructive jaundice, intussusception, and bowel obstruction among others. Ascaris is a rare cause of intestinal perforation even in endemic areas.
CASE PRESENTATION
A 2-year-old female Ethiopian toddler who was presented with a complaint of non-bilious, non-projectile vomiting of 06 days duration, about two-three episodes per day. Associated with this she had had progressive abdominal distension, intermittent abdominal cramps and loss of appetite. On examination, she was acutely sick looking. She had signs of dehydration. Subsequently, she was resuscitated, broad spectrum antibiotic started and operated. Finally, the child was discharged improved after 7 days of hospital stay.
CLINICAL DISCUSSION
The clinical presentation of ascariasis can vary from asymptomatic child to one with severe disease requiring surgical intervention like our patient. Severity of disease depends on the worm burden; heavy worm infestation produces a wide range of acute abdominal complications such as intestinal obstruction, intussusception, cholangiohepatitis, pancreatitis, and acute appendicitis. Intestinal ascariasis rarely causes volvulus and intestinal gangrene, perforation and peritonitis.
CONCLUSION
Ascariasis must be considered in the differential diagnosis in patients presented with peritonitis especially those living or from temperate and tropical countries with a history of passage of worms. Ileum perforation is possible in patients with ascariasis due to pressing directly into the bowel wall, inflammatory reaction, or volvulus and intestinal wall necrosis.
PubMed: 37015161
DOI: 10.1016/j.ijscr.2023.108097 -
International Journal of Surgery Case... Apr 2023Intestinal tuberculosis (TB) comprises of about 5 % of all cases of tuberculosis in susceptible communities. Intestinal tuberculosis establishes itself in the lymphoid...
INTRODUCTION AND IMPORTANCE
Intestinal tuberculosis (TB) comprises of about 5 % of all cases of tuberculosis in susceptible communities. Intestinal tuberculosis establishes itself in the lymphoid follicles of the Peyer's patches and spreads to the submucosal and subserosal planes. A gastroduodenal location for TB is very rare even in patients with pulmonary TB and gastroduodenal TB lesions are usually secondary.
CASE PRESENTATION
A 48 year old Ethiopian patient presented with non-bilious, non-projectile vomiting of ingested matter which progressively worsens over time. Associated with this he had burning type of epigastric pain for which he had been treated with antiulcer drugs on multiple occasion, but he had no improvement. The vomiting worsened over the past year and he had unquantified but significant weight loss. Subsequently the patient was diagnosed with duodenal TB and was treated with antituberculous drugs according to the national protocol for six months and the above symptoms subsided. The patient had significant weight gain after starting treatment.
CLINICAL DISCUSSION
The commonest site for gastro-intestinal tuberculosis (TB) is the ileocecal region and duodenal tuberculosis constitutes around 2 % of cases of abdominal tuberculosis. A high index of suspicion for tuberculosis is required in any patient with gastrointestinal symptoms living in endemic areas.
CONCLUSION
We suggest that a diagnosis of duodenal tuberculosis should always be considered in young patients presenting with gastric outlet obstruction (GOO) or unresponsive or relapsing dyspepsia, in areas where tuberculosis is endemic.
PubMed: 37001373
DOI: 10.1016/j.ijscr.2023.108080 -
Cureus Feb 2023Acute appendicitis due to a foreign body is a very rare condition with an incidence of 0.0005% of all appendicitis cases and among all age groups. It is one of the...
Acute appendicitis due to a foreign body is a very rare condition with an incidence of 0.0005% of all appendicitis cases and among all age groups. It is one of the atypical cases of appendicitis, and it is a rare condition commonly asymptomatic; there is a period of time between ingestion of the body and appendicitis. A 14-year-old female patient presented to the emergency room with right lower quadrant colicky pain. Moreover, it was progressive with six hours duration, preceded by loss of appetite. It was associated with nausea, non-projectile vomiting, and diarrhea. By taking the past medical history, the patient had a history of multiple times of foreign ingestions when she was younger. On examination, the patient appeared ill, and was vitally stable. On palpation, the patient had a right lower quadrant tenderness. The patient had positive pointing, rebound, Rovsing, and psoas signs. Full labs were done. Abdominal x-ray revealed a radiopaque metallic body in the right lower quadrant. By ultrasound, there was a minimal free fluid collection in the pelvis. Intraoperatively, the appendix looked hyperemic. Appendectomy was performed, and a needle was extracted from the appendix. Furthermore, the histopathology revealed an early inflamed appendix. Foreign body-causing appendicitis is a rare condition. We need to investigate suspected cases carefully because the presentation is atypical, and sometimes the patients are asymptomatic.
PubMed: 36938180
DOI: 10.7759/cureus.34948 -
Taiwanese Journal of Obstetrics &... Nov 2022To report a case and review literature of bowel metastases from cervical squamous cell carcinoma.
OBJECTIVE
To report a case and review literature of bowel metastases from cervical squamous cell carcinoma.
CASE REPORT
A 49-year-old woman with a history of FIGO 2013 stage IVB cervical squamous cell carcinoma presented with refractory nausea, projectile vomiting, anorexia, postprandial abdominal pain, and significant weight loss for six months. Restaging images didn't reveal viable tumors but thickened duodenal wall indicating gastric outlet obstruction. Initially, the etiology was masked by chronic erosive duodenitis and mistreated as a duodenal ulcer. After repeated gastrointestinal endoscopic biopsy confirming intramural duodenal metastasis from cervical squamous cell carcinoma, the patient was treated successfully by gastrojejunostomy and adjuvant chemotherapy. She has remained asymptomatic and disease-free for more than 12 months since the surgical metastasectomy.
CONCLUSION
Intestine metastasis from cervical cancer is a rare cause that may present as projectile vomiting due to gastric outlet obstruction. Prompt recognition and surgical intervention may provide good outcomes despite the metastatic nature.
Topics: Female; Humans; Middle Aged; Uterine Cervical Neoplasms; Stomach Diseases; Gastric Outlet Obstruction; Vomiting; Carcinoma, Squamous Cell
PubMed: 36427973
DOI: 10.1016/j.tjog.2021.10.011 -
Clinical Case Reports Jul 2022Congenital adrenal hyperplasia (CAH) is a rare condition usually referred to as a group of genetic disorders resulting due to a deficiency of steroid enzymes required by...
Congenital adrenal hyperplasia (CAH) is a rare condition usually referred to as a group of genetic disorders resulting due to a deficiency of steroid enzymes required by adrenal glands to produce cortisol and mineralocorticoid hormones. It has an autosomal recessive mode of inheritance and is further categorized into two types-Classic and Non-Classic. Non-Classic CAH is a more common milder form that presents late after puberty. Classic CAH, although more severe, is rare and detected at birth and is associated with the life-threatening adrenal crisis in both sexes and virilization of the external genitalia in females (46, XX) patients, whereas in males, no overt abnormality of the external genitalia is present. We present a case of a four-month-old male child with the classic form of CAH who was brought with complaints of loose stools, projectile non bilious vomiting, decreased urine output, and failure to feed for 3 days. The child had a clinical presentation of salt wasting with hypoglycemia and hyperpigmentation of his genitalia. The USG findings revealed increased anteroposterior diameter of renal pelvis indicative of a growth in the suprarenal area. 17-hydroxyprogesterone (17-OHP) was found to be elevated confirming the diagnosis. He was treated with hydrocortisone with gradual improvement in his glucose and electrolytes. The patient was discharged home on replacement therapy consisting of oral prednisolone and fludrocortisone acetate and followed up as outpatient with significant improvement in the clinical findings. The fact that the child was not screened for CAH at birth led to the critical consequences of the disease in this case. To prevent life-threatening adrenal crisis and help perform appropriate sex assignments for affected female patients, newborn screening (NBS) programs for the classical form of CAH should be made mandatory even in low- and middle-income countries.
PubMed: 35846927
DOI: 10.1002/ccr3.6010 -
Journal of the ASEAN Federation of... 2022A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent...
A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent pancreatitis with a pancreatic pseudocyst. Elevated serum calcium levels provided an etiologic link between hypercalcemia and pancreatitis. On examination, a nodule was found in the left side of her neck which was later diagnosed as a giant left inferior parathyroid adenoma. This report highlights the critical analysis of history, examination, and investigations to reach an ultimate diagnosis. Pseudocyst drainage and parathyroidectomy resolved her symptoms.
Topics: Female; Humans; Adult; Parathyroid Neoplasms; Adenoma; Neck; Pancreatitis, Chronic; Hypercalcemia; Gastric Outlet Obstruction
PubMed: 35800590
DOI: 10.15605/jafes.037.01.11 -
JPMA. the Journal of the Pakistan... Jun 2022Rumination syndrome is a functional gastrointestinal disorder with effortless, non-projectile regurgitation seen mostly in paediatric population and seems to be an...
Rumination syndrome is a functional gastrointestinal disorder with effortless, non-projectile regurgitation seen mostly in paediatric population and seems to be an uncommon gastrointestinal disorder due to lack of awareness among physicians. Here we report three such cases in adult patients that were labeled "refractory vomiting". No such case has been reported from Pakistan which makes this a unique case series. All of our patients were diagnosed within six to fifteen months of initial symptoms, hence a high index of suspicion is required for early diagnosis of Rumination Syndrome to avoid excessive and repeated investigations, causing emotional trauma and financial loss to patients and their families.
Topics: Adult; Child; Gastrointestinal Diseases; Humans; Pakistan; Rumination Syndrome; Vomiting
PubMed: 35751337
DOI: 10.47391/JPMA.2244 -
Infectious Disorders Drug Targets 2023Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non- HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3...
INTRODUCTION
Idiopathic CD4+ Lymphocytopenia (ICL) is a rare entity grouped in non- HIV-related syndromes. ICL is characterized by a marked low CD4 T cell count of <300 cells/mm3 with ambiguous natural history and prognosis. In addition, cryptococcal and nontuberculous mycobacterial infections are reported as known opportunistic infections. Therefore, management turns around vigilant follow-up and treatment of the current clinical scenario of these patients.
CASE PRESENTATION
Here, a 55-year-old lady was referred with a history of diffuse headache and intermittent fever for two months, projectile vomiting, and altered mental status for five days. Nonpruritic maculopapular rashes and diffuse desquamation of the skin were noted. She had no significant previous medical history. Based on clinical findings and investigations, she was diagnosed with ICL having disseminated cryptococcosis. Unfortunately, the patient did not undergo specific treatment as she was recognized late, and unfortunately, she died.
CONCLUSION
It is of paramount importance to recognize the clinical entity as early as possible to start appropriate treatment, which may positively impact the outcome. Therefore, the clinician must be aware of disseminated cryptococcosis associated with non-HIV states.
Topics: Female; Humans; Middle Aged; T-Lymphocytopenia, Idiopathic CD4-Positive; Cryptococcosis; Lymphopenia; CD4-Positive T-Lymphocytes; CD4 Lymphocyte Count
PubMed: 35726810
DOI: 10.2174/1871526522666220621110723 -
Veterinary Clinical Pathology Dec 2022A 7-year-old mixed-breed neutered male cat was presented with a history of chronic vomiting with increased frequency in the last month, progressing to depression and...
A 7-year-old mixed-breed neutered male cat was presented with a history of chronic vomiting with increased frequency in the last month, progressing to depression and profuse projectile vomiting. Abdominal ultrasonography revealed an area of marked segmental duodenal thickening associated with a nodule, and euthanasia was performed due to a poor prognosis. Grossly, at the postmortem examination, the wall of a duodenal segment was severely expanded by a nodule measuring 5.0 cm in diameter, resulting in marked luminal narrowing and obstruction. Smears were made by scraping the cut surface of the tumor during the postmortem examination. The smears were highly cellular and contained mesenchymal cells arranged individually or in large non-cohesive aggregates. Cells varied in morphology from spindle to round to stellate-shaped with marked anisocytosis and anisokaryosis. Numerous bi- and multinucleated neoplastic cells were observed. Histologic examination revealed a densely cellular neoplastic proliferation of mesenchymal cells that effaced the duodenal submucosa, muscularis externa, and serosa layers. Most cells were spindle-shaped; however, some tumor areas had numerous round cells and bi- and multinucleated neoplastic cells. Spindle cells showed variable cytoplasmic immunoreactivity for vimentin, smooth muscle actin, and desmin. Round, bi-, and multinucleated giant cells only had marked multifocal cytoplasmic immunoreactivity for vimentin. Neoplastic cells did not have immunoreactivity for cytokeratin, GFAP, S100, and CD117. A final diagnosis of duodenal leiomyosarcoma was made. This article reports the pathologic, cytologic, and immunohistochemical findings of this case and discusses the main differential diagnoses in cases of intestinal sarcomas in domestic animals.
Topics: Cats; Male; Animals; Leiomyosarcoma; Vimentin; Sarcoma; Diagnosis, Differential; Vomiting; Cat Diseases
PubMed: 35466406
DOI: 10.1111/vcp.13124