Small bowel diverticulosis uncommon cause of chronic intermittent abdominal pain

Midgut volvulus in adults is a rare entity that may present with intermittent colicky abdominal pain mixed with completely asymptomatic episodes. This small bowel twist may result in complications of obstruction, ischemia, hemorrhage, or perforation. With a midgut volvulus, complications may be life-threatening, and emergent surgical intervention is the mainstay of treatment. This current case involves an 80-year-old woman with intermittent abdominal pain with increasing severity and decreasing interval of time to presentation. A CAT scan revealed mesenteric swirling with possible internal hernia. A diagnostic laparoscopy followed by laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery, and a large jejunal diverticulum. The adhesions were lysed enabling untwisting of the bowel, allowing placement of the small bowel in the correct anatomic position and resection of the jejunal diverticulum. This is a rare case of midgut volvulus with intermittent abdominal pain, associated with jejunal diverticulum managed successfully. A midgut volvulus should be considered in the differential diagnosis of a patient who present with a small bowel obstruction secondary to an internal hernia, especially when a swirl sign is present on the CAT scan.

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Unusual case of small bowel intussusception in adult revealing a Peutz-Jeghers syndrome

BJR|case reports ◽

10.1259/bjrcr.20210082 ◽

2021 ◽

Author(s):

Habib Bellamlih ◽

Ayman El Farouki ◽

Rachid Oulahyane ◽

Nabil Moatassim Billah ◽

Ittimade Nassar

Keyword(s):

Small Intestine ◽

Abdominal Pain ◽

Small Bowel ◽

Unusual Case ◽

Genetic Disorder ◽

Hamartomatous Polyps ◽

Chronic Anemia ◽

Intermittent Abdominal Pain ◽

Small Bowel Intussusception ◽

Peutz Jeghers Syndrome

Peutz-Jeghers syndrome is a rare genetic disorder characterized by hyperpigmented mucocutaneous macules, hamartomatous polyps of the small intestine, and family history. These hamartomatous polyps can cause intermittent abdominal pain, chronic anemia, or even intussusception. Imaging has an important role in the diagnosis of this syndrome but also in the identification of complications and periodic surveillance. Here we present a demonstrative case of a Peutz-Jeghers syndrome associated with intussusception in a 16-year-old patient.

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Hernia interna estrangulada por plastrón en el tercio distal del apéndice cecal

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2019.62.6.03 ◽

2019 ◽

Vol 62 (6) ◽

pp. 24-27

Author(s):

Leslie M. Leyva Sotelo ◽

José E. Telich Tarriba ◽

Daniel Ángeles Gaspar ◽

Osvaldo I. Guevara Valmaña ◽

André Víctor Baldín ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Early Diagnosis ◽

Intestinal Obstruction ◽

Acute Abdomen ◽

Internal Hernia ◽

Wide Spectrum ◽

Internal Hernias ◽

Mild Abdominal Pain ◽

Made In

Internal hernias are an infrequent cause of intestinal obstruction with an incidence of 0.2-0.9%, therefore their early diagnosis represents a challenge. The most frequently herniated organ is the small bowel, which results in a wide spectrum of symptoms, varying from mild abdominal pain to acute abdomen. We present the case of an eight-year old patient with nonspecific digestive symptoms, a transoperative diagnosis was made in which an internal hernia was found strangulated by plastron in the distal third of the appendix. Appendectomy was performed and four days later the patient was discharged without complications.

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Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-236429 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236429

Author(s):

Bankole Oyewole ◽

Anu Sandhya ◽

Ian Maheswaran ◽

Timothy Campbell-Smith

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Magnetic Beads ◽

Iliac Fossa ◽

Serous Fluid ◽

Magnetic Resonance Scan ◽

History Of ◽

Right Iliac Fossa Pain ◽

Multiple Episodes ◽

Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

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B-Lymphoblastic Lymphoma of the Small Bowel: An Extremely Rare Occurrence

The American Surgeon ◽

10.1177/0003134821998679 ◽

2021 ◽

pp. 000313482199867

Author(s):

Nikolaos G Symeonidis ◽

Kalliopi E Stavrati ◽

Efstathios T Pavlidis ◽

Kyriakos K Psarras ◽

Eirini Martzivanou ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Soft Tissues ◽

Lymphoblastic Lymphoma ◽

Emergency Laparotomy ◽

Rare Occurrence ◽

Small Bowel Tumor ◽

Gastrointestinal Lesions ◽

Immature B Cells ◽

B Lymphoblastic Lymphoma

B-lymphoblastic lymphoma is a neoplasm of immature B cells and is characterized by aggressive behavior and disease progression. Common sites of involvement are skin, lymph nodes, bone, soft tissues, breast, and the mediastinum. Gastrointestinal lesions are rarely encountered and therefore not fully described. We herein report the case of a 28-year-old male, who presented with abdominal pain and CT scan showed a tumor involving the small bowel and its mesentery. He underwent emergency laparotomy and enterectomy. Histopathology report revealed B-lymphoblastic lymphoma affecting the small bowel and the adjacent mesentery. This is the first documented case of a small bowel tumor diagnosed as B-lymphoblastic lymphoma in published literature.

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A227 UMBILICAL HERNIA INCARCERATION IN LIVER CIRRHOSIS: A RARE COMPLICATION OF PARACENTESIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.225 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 263-265

Author(s):

A LAGROTTERIA ◽

A Aruljothy ◽

K Tsoi

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Small Bowel ◽

Large Volume ◽

Umbilical Hernia ◽

Rare Complication ◽

Abdominal Wall Hernia ◽

Refractory Ascites ◽

Large Volume Paracentesis

Abstract Background Patients with decompensated liver cirrhosis with ascites frequently have umbilical hernias with a prevalence of 20% and are managed with large volume paracentesis (LVP). Common complications of LVP include hemorrhage, infection, and bowel perforation that occur infrequently with a frequency of less than 1%. However, incarceration of umbilical hernias has been reported as a rare complication of LVP and is speculated to be from ascitic fluid decompression that reduces the umbilical hernia ring diameter resulting in entrapment of the hernia sac. It is unclear whether the quantity or the fluid removal rate increases the herniation risk. Based on case series, this rare complication occurs within 48 hours of the LVP and requires emergent surgical repair and involves a high risk of morbidity and mortality due to potential infection, bleeding, and poor wound healing. Aims We describe a case report of an incarcerated umbilical hernia following a bedside large-volume paracentesis. Methods Case report Results A 59-year-old Caucasian male presented to the emergency department with a 24-hour history of acute abdominal pain following his outpatient LVP. His medical history included Child-Pugh class C alcoholic liver cirrhosis with refractory ascites managed with biweekly outpatient LVP and a reducible umbilical hernia. He reported the onset of his abdominal pain 2-hours after his LVP with an inability to reduce his umbilical hernia. Seven liters of clear, straw-coloured asitic fluid was drained. Laboratory values at presentation revealed a hemoglobin of 139 g/L, leukocyte count of 4.9 x109 /L, platelet count of 110 xo 109 /L, and a lactate of 2.7 mmol/L His physical exam demonstrated an irreducible 4 cm umbilical hernia and bulging flanks with a positive fluid wave test. Abdominal computed tomography showed a small bowel obstruction due to herniation of a proximal ileal loop into the anterior abdominal wall hernia, with afferent loop dilation measuring up to 3.4 cm. He was evaluated by the General Surgery consultation service and underwent an emergent laparoscopic hernia repair. There was 5 cm of small bowel noted to be ecchymotic but viable, with no devitalized tissue. He tolerated the surgical intervention with no post-operative complications and was discharged home. Conclusions Ultrasound-guided bedside paracentesis is a common procedure used in the management of refractory ascites and abdominal wall hernia incarceration should be recognized as a potential rare complication. To prevent hernia incarceration, patients with liver cirrhosis should be examined closely for hernias and an attempt should be made for external reduction prior to LVP. A high index of suspicion for this potential life-threatening condition should be had in patients who present with symptoms of bowel obstruction following a LVP. Funding Agencies None

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Intestinal obstruction due to small bowel herniation through foramen of Winslow: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02629-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

P. K. B. S. C. Bandara ◽

A. M. Viraj Rohana ◽

Aloka Pathirana

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Intestinal Obstruction ◽

Reflux Disease ◽

Bowel Loop ◽

Internal Herniation ◽

Small Bowel Loop ◽

Foramen Of Winslow

Abstract Background Intestinal obstruction due to internal herniation of the bowel is a rare clinical entity which is often overlooked in the differential diagnosis of patients with abdominal pain who have no previous history of abdominal surgery. Several sites of bowel internal herniation have been described, amongst which internal herniation through the foramen of Winslow accounts for about 8% of cases. These patients present with nonspecific abdominal pain associated with symptoms of gastroesophageal reflux disease, and hence the diagnosis is often overlooked. The usual symptoms of intestinal obstruction can be delayed, which results in a delay in diagnosis and gangrene of the herniated bowel segment. Abdominal radiographs and computed tomography are helpful in the diagnosis. Open reduction is the management of choice; however, laparoscopic reduction has also been attempted, with good results. Case presentation We report a case of a middle-aged Sri Lankan man who presented with features of gastroesophageal reflux disease, developed features of intestinal obstruction and was found to have a gangrenous small bowel loop which had herniated through the foramen of Winslow. Following needle aspiration and reduction of the herniated small bowel loop, the gangrenous part of the small bowel was resected and an ileoileal anastomosis performed. The large foramen of Winslow was partially closed with interrupted stitches. The patient made an uneventful recovery. Conclusion Since delayed diagnosis of bowel obstruction is detrimental, it is of utmost importance to diagnose it early. Because internal herniation of the small bowel through the foramen of Winslow presents with nonspecific symptoms including features of gastroesophageal reflux disease, as documented in several cases worldwide and also presented by our patient, there should be a high degree of suspicion of internal herniation of the bowel causing bowel obstruction and low threshold for extensive investigation of patients presenting with symptoms of gastroesophageal reflux disease which does not resolve with usual medication.

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Multiple Small Intestine Ulcers with Desquamation of the Fingers

Case Reports in Gastroenterology ◽

10.1159/000479222 ◽

2017 ◽

Vol 11 (2) ◽

pp. 452-461

Author(s):

Azusa Kawasaki ◽

Kunihiro Tsuji ◽

Hisashi Doyama

Keyword(s):

Computed Tomography ◽

Small Intestine ◽

Abdominal Pain ◽

Small Bowel ◽

Yersinia Pseudotuberculosis ◽

Oral Ulcers ◽

Palmar Erythema ◽

Antibody Titers ◽

Endoscopic Characteristics ◽

Multiple Ulcers

A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.

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620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doab052.620 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Kathryn Peterson ◽

Robert Genta ◽

Henrik Rasmussen ◽

Bradford Youngblood ◽

Amol Kamboj

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Eosinophilic Esophagitis ◽

Life Experience ◽

Real Life ◽

Gastrointestinal Disorder ◽

Control Group ◽

Abdominal Symptoms ◽

Gi Symptoms ◽

Initial Work

Abstract Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms. Methods 52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment. Results 45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group. Conclusion In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.

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