An unusual cause of abdominal distension

The objective: study the features of gynecological, physical history, diagnosis and treatment of patients with benign epithelial ovarian tumors (BeEOT) and borderline epithelial ovarian tumors (BEOT), determining the frequency of recurrence of ovarian tumors in the postoperative period. Patients and methods. According to a retrospective analysis of case histories of 112 women with epithelial ovarian tumors (EOT) underwent conservative or radical surgical treatment in a hospital, two groups were formed: I group – patients with benign epithelial ovarian tumors (BeEOT), which amounted to 85 (75.9%) women, and group II – patients with borderline epithelial ovarian tumors (BEOT), which amounted to 27 (24.1%) women. It was found that the main complaints of patients with EOT were pain (49.1%), abdominal distension (17%), and abnormal uterine bleeding (12.5%). The highest incidence of BeEOT (31.8%) observed in the age group of 41–50 years, while the peak incidence of BEOT (44.4%) corresponds to the age group of 51–60 years. Results. In BEOT endocrine pathology occurs significantly more frequently (p<0.05) than in BeEOT – 25.9% vs. 9.4%, respectively. Pathology of pancreatic-hepatobiliary system occurs significantly more frequently (p<0.05) in patients with BEOT compared with BeEOT – 81.5% versus 57.6%, respectively. Venous disorders (varicose veins of the pelvic organs, lower limbs, haemorrhoids) observed in BEOT significantly more frequently (p<0.05) than in BeEOT – 18.5% vs. 5.9%, respectively. EOT most often diagnosed in the period from 1 to 6 months after the first clinical manifestations with an average uptake of medical care 4.6±0.57 months. In assessing of peritoneal exudate cytogram the mesothelium cells are significantly more common for BeEOT (p<0.01) than BEOT – 79.4% versus 40.9%, respectively. Cervicitis is more likely significantly to occur in BeEOT (p<0.01) than in BEOT – 29.4% vs. 7.4%, respectively. The most common histological type among the benign tumors of the ovaries are endometriomas, which occurred in 48.2% of all BeEOT cases, and among the borderline tumors – serous tumors, which accounted for 59.3% of all BEOTs. Conclusion. The use of organ sparing surgery in EOT increases the risk of recurrence, especially in the case of endometrial histology or borderline variant of tumor. Key words: benign and borderline epithelial ovarian tumors, clinical-anamnestic analysis, diagnosis, treatment.

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THERAPEUTIC MANAGEMENT OF ASCITES IN SPITZ DOG IN BANGLADESH WITH A BRIEF REVIEW ON CANINE ASCITES

Journal of Veterinary Medical and One Health Research ◽

10.36111/jvmohr.2019.1(1).0005 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

M. A. Samad

Keyword(s):

Ascitic Fluid ◽

Clinical Examination ◽

Clinical Case ◽

Abdominal Distension ◽

Multiple Organ ◽

Therapeutic Management ◽

Vitamin Supplement ◽

Case Record ◽

Successful Recovery ◽

History Of

Background: Ascites is one of the most important clinical syndromes, caused by multiple organ disorders, characterized by abdominal distension with accumulation of fluid of various colors and consistencies depending on the etiology that are encountered commonly in canine practice worldwide. Although it has been reported from different countries including India but it has not yet been documented from Bangladesh. Objectives: To evaluate the successful therapeutic management of a clinical case of ascites in dog supported with its brief review for its appropriate application Materials and Methods: A female Spitz dog two and half years old brought for treatment with the history of abdominal distension on 1st November 2009. Clinical examination, abdominocentesis and laboratory examination of ascitic fluid were used for the diagnosis of ascites in dog. Results: Clinical examination revealed dyspnea, discomfort, lethargy, weakness, pale mucous membrane, normal rectal temperature 103.2 0F and distended abdomen with fluid thrill on palpation. Examination of ascitic fluid revealed clear white fluid (pure transudate) which is mainly hepatic origin resulting portal hypertension and hypoproteinaemia. Treatment with restricted sodium diet, antibiotic (amoxicillin), diuretic (furosemide; Lasix, Sanofi Aventis) and vitamin B-complex and C- vitamin supplement with regular monitoring assisted in successful recovery. The recovered dog survived for next five years up to 2014 and then died due to other reasons. Conclusions: This clinical case record on canine ascites with successful treatment along with review especially on the methods of diagnosis and cause-wise treatment would certainly help the clinician for proper management of the clinical cases of canine ascites. Keywords: Ascites, Spitz dog, Diagnosis, SAAG, Therapeutic management, Brief review

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An Invasive Hemolymphangioma of the Pancreas in a Young Woman

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207322666190103110747 ◽

2019 ◽

Vol 21 (10) ◽

pp. 798-800 ◽

Cited By ~ 1

Author(s):

Zhijun Zhang ◽

Qinghong Ke ◽

Weiliang Xia ◽

Xiuming Zhang ◽

Yan Shen ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Young Woman ◽

Benign Tumor ◽

Abdominal Distension ◽

Accurate Diagnosis ◽

Cystic Tumor ◽

Rare Benign Tumor ◽

Radical Surgical Resection

Background: Hemolymphangioma is a rare benign tumor. To the best of our knowledge, there were only 10 reports of this tumor of the pancreas until March 2018. Case Report: Here, we reported a large invasive hemolymphangioma of the pancreas in a young woman with a complaint of abdominal distension and an epigastric mass about 3 weeks. She was found to have a huge multilocular cystic tumor at the neck and body of pancreas on computed tomography. She was eventually diagnosed with hemolymphangioma of the pancreas after operation. After 2 years of follow-up, there was no signs of recurrence. Conclusion: From our case and literature, we can conclude that hemolymphangioma of the pancreas is uncommon benign tumor, and it is hard to make an accurate diagnosis preoperatively. Radical surgical resection should be performed whenever possible. The prognosis of this disease seems good.

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Gas-filled urachal abscess with a pinging sound in a heifer calf

Veterinární Medicína ◽

10.17221/61/2019-vetmed ◽

2019 ◽

Vol 64 (No. 8) ◽

pp. 362-366 ◽

Cited By ~ 1

Author(s):

R Sato ◽

K Yamada ◽

Y Shinozuka ◽

H Ochiai ◽

K Onda

Keyword(s):

Fistulous Tract ◽

Failure To Thrive ◽

Abdominal Distension ◽

Intravenous Urography ◽

University Hospital ◽

Growth Depression ◽

Poor Growth ◽

History Of ◽

Heifer Calf ◽

Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

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Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature

Case Reports in Transplantation ◽

10.1155/2019/9089317 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Tommy Ivanics ◽

Semeret Munie ◽

Hassan Nasser ◽

Shravan Leonard-Murali ◽

Atsushi Yoshida ◽

...

Keyword(s):

Liver Transplantation ◽

Enteral Feeding ◽

Early Recognition ◽

Medium Chain Triglyceride ◽

Serum Triglyceride ◽

Chylous Ascites ◽

Abdominal Distension ◽

Invasive Treatment ◽

Management Options ◽

Early Enteral Feeding

Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.

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Amisulpride: A New Drug for Management of Postoperative Nausea and Vomiting

Annals of Pharmacotherapy ◽

10.1177/1060028020987012 ◽

2021 ◽

pp. 106002802098701

Author(s):

Stacy L. Haber ◽

April Graybill ◽

Ani Minasian

Keyword(s):

Postoperative Nausea ◽

Data Extraction ◽

Postoperative Nausea And Vomiting ◽

Abdominal Distension ◽

Complete Response ◽

Nausea And Vomiting ◽

Dopamine Antagonists ◽

Dopamine Antagonist ◽

Additional Information ◽

Pubmed Search

Objective: To review the pharmacology, efficacy, and safety of amisulpride and determine its role in the management of postoperative nausea and vomiting (PONV). Data Sources: A PubMed search (1946 to November 2020) using the terms amisulpride and APD421 was conducted. Study Selection and Data Extraction: Relevant reports on intravenous amisulpride were included. Data Synthesis: Six clinical trials were evaluated. In 4 trials on the prevention of PONV, a greater percentage of patients who received amisulpride 5 mg compared with placebo experienced a complete response (44%-60% vs 31%-33%, respectively, when used as monotherapy; 58% vs 47%, respectively, when used in combination with another antiemetic). In 2 trials on the treatment of PONV, a significantly greater percentage of patients who received amisulpride 10 mg compared with placebo experienced a complete response (31.4% vs 21.5%, respectively, in patients who had not received prophylaxis; 41.7% vs 28.5%, respectively, in patients who had received prophylaxis). Adverse effects included infusion site pain, chills, hypokalemia, procedural hypotension, and abdominal distension. Relevance to Patient Care and Clinical Practice: Amisulpride is effective for the management of PONV and may be less likely to cause QT prolongation and extrapyramidal symptoms than other dopamine antagonists. Additional information is needed on its use for chemotherapy-induced nausea and vomiting and in children. Conclusions: Amisulpride is an important new option for the multimodal management of PONV in adults, and it may be the preferred dopamine antagonist because of the more favorable safety profile that results from its unique pharmacological properties.

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Comparison of outcomes of high-flow nasal cannula and noninvasive positive-pressure ventilation in patients with hypoxemia and various APACHE II scores after extubation

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211004235 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110042

Author(s):

Xiaoke Shang ◽

Yanggan Wang

Keyword(s):

Positive Pressure Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Abdominal Distension ◽

Apache Ii ◽

Positive Pressure ◽

Apache Ii Score ◽

Subgroup Ii ◽

Significant Difference ◽

Group A ◽

Group B

Aims: The study aimed to compare and analyze the outcomes of high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NPPV) in the treatment of patients with acute hypoxemic respiratory failure (AHRF) who had extubation after weaning from mechanical ventilation. Methods: A total 120 patients with AHRF were enrolled into this study. These patients underwent tracheal intubation and mechanical ventilation. They were organized into two groups according to the score of Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II); group A: APACHE II score <12; group B: 12⩽ APACHE II score <24. Group A had 72 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (36 patients in each subgroup). Group B had 48 patients and patients given HFNC were randomly assigned to subgroup I while patients given NPPV were assigned to subgroup II (24 patients in each subgroup). General information, respiratory parameters, endpoint event, and comorbidities of adverse effect were compared and analyzed between the two subgroups. Results: The incidence of abdominal distension was significantly higher in patients treated with NPPV than in those treated with HFNC in group A (19.44% versus 0, p = 0.005) and group B (25% versus 0, p = 0.009). There was no significant difference between the HFNC- and NPPV-treated patients in blood pH, oxygenation index, partial pressure of carbon dioxide, respiratory rate, and blood lactic acid concentration in either group ( p > 0.05). Occurrence rate of re-intubation within 72 h of extubation was slightly, but not significantly, higher in NPPV-treated patients ( p > 0.05). Conclusion: There was no significant difference between HFNC and NPPV in preventing respiratory failure in patients with AHRF with an APACHE II score <24 after extubation. However, HFNC was superior to NPPV with less incidence of abdominal distension. The reviews of this paper are available via the supplemental material section.

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Ogilvie's syndrome presented with delirium in an older lady with corticobasal syndrome

Palliative & Supportive Care ◽

10.1017/s1478951521001000 ◽

2021 ◽

pp. 1-3

Author(s):

Feyza Mutlay ◽

Derya Kaya ◽

Ahmet Turan Isik

Keyword(s):

Palliative Care ◽

Health Care Professionals ◽

Colonic Obstruction ◽

Holistic Approach ◽

Abdominal Distension ◽

Corticobasal Syndrome ◽

Ogilvie's Syndrome ◽

Geriatric Population ◽

Ogilvie’S Syndrome ◽

Neurological Illnesses

Abstract Objective Corticobasal syndrome (CBS) is one of an atypical parkinsonian syndromes characterized by extrapyramidal features as well as cortical involvement signs. A variety of factors may lead to delirium in older adults with chronic progressive life-limiting neurological illnesses like CBS. Ogilvie's syndrome (OS) is an acute colonic pseudo-obstruction in which abdominal distension, nausea, vomiting, and constipation can be seen. We report a case of OS identified as the underlying possible cause of delirium in an 80-year-old woman with CBS. We also discuss the importance of holistic approach which is essential to manage the underlying cause and to preserve the quality of life in particular for the frail geriatric population who potentially needs palliative care or already benefits from palliative care. Method An older patient with CBS presented with symptoms similar to that of acute colonic obstruction and subsequently developed delirium. The patient was found to have colonic pseudo-obstruction (OS). Result Neostigmin infusion was therefore given to treat it and delirium was resolved. Significance of results To the best of our knowledge, clinical manifestation of delirium as OS in a patient with CBS has not been previously reported. OS may be superimposed to CBS in older patients, and OS in such patients may play a role as a precipitating factor for the development of delirium. Given the fact that CBS is progressive and rare neurodegenerative disease and almost all of these patients need palliative care, eventually, health-care professionals, especially in palliative care, should be aware of distinctive challenges of life-limiting chronic neurological illnesses, such as conditions that may lead to the development of acute colonic pseudo-obstruction because the rapid treatment of them prevents the use of potentially harmful drugs, surgical procedures, or inappropriate interventions.

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Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

Journal of International Medical Research ◽

10.1177/03000605211019641 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110196

Author(s):

Xiaotong Peng ◽

Zhi Duan ◽

Hongling Yin ◽

Furong Dai ◽

Huining Liu

Keyword(s):

Adverse Events ◽

Soft Tissues ◽

Malignant Tumors ◽

Cystic Teratoma ◽

Abdominal Distension ◽

Epithelioid Angiosarcoma ◽

History Of ◽

New Ideas ◽

The Right ◽

Clinical Awareness

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

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Primary squamous cell carcinoma of the pancreas with a large pseudocyst of the pancreas as the first manifestation: a rare case report and literature review

BMC Gastroenterology ◽

10.1186/s12876-021-01804-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xia Qiu ◽

Yajie Meng ◽

Meiqin Lu ◽

Chuan Tian ◽

Min Wang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Cell Mass ◽

Elevated Serum ◽

Abdominal Distension ◽

Needle Aspiration ◽

Pancreatic Pseudocysts ◽

Primary Squamous Cell Carcinoma ◽

Ki 67

Abstract Background Primary squamous cell carcinoma (SCC) of the pancreas with pseudocysts, especially diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), is extremely rare. Case presentation A 64-year-old man was admitted to our department for abdominal distension. Two months ago, he experienced abdominal pain for 1 day and was diagnosed with acute pancreatitis in another hospital. After admission, laboratory tests showed the following: amylase 400 U/L, lipase 403 U/L, and carbohydrate antigen 19–9 (CA19-9) 347 U/mL. Abdominal computed tomography (CT) revealed pancreatitis with a pseudocyst with a diameter measuring 7 cm. During linear EUS, a large pseudocyst (5.4 × 5.2 cm) was observed in the pancreatic body. EUS-FNA was performed. We obtained specimens for histopathology and placed a plastic stent through the pancreas and stomach to drain the pseudocyst. Puncture fluid examination revealed the following: CA19-9 > 12,000 U/mL carcinoembryonic antigen (CEA) 7097.42 ng/ml, amylase 27,145.3 U/L, and lipase > 6000 U/L. Cytopathology revealed an abnormal cell mass, and cancer was suspected. Furthermore, with the result of immunohistochemistry on cell mass (CK ( +), P40 ( +), p63 ( +), CK7 (−) and Ki-67 (30%)), the patient was examined as squamous cell carcinoma (SCC). However, the patient refused surgery, radiotherapy and chemotherapy. After drainage, the cyst shrank, but the patient died 3 months after diagnosis due to liver metastasis and multiple organ failure. Conclusion For patients with primary pancreatic pseudocysts with elevated serum CEA and CA19-9 levels, we should not rule out pancreatic cancer, which may also be a manifestation of primary pancreatic SCC. EUS-FNA is helpful for obtaining histopathology and cytology and thus improving diagnostic accuracy.

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