scholarly journals A very rare case of submucosal invasive duodenal adenocarcinoma in a patient with a history of radiation therapy

Endoscopy ◽  
2021 ◽  
Author(s):  
Pierre Lafeuille ◽  
Jérôme Rivory ◽  
Thomas Lambin ◽  
Paul Bonniaud ◽  
Thierry Ponchon ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Rare Case ◽  
Duodenal Adenocarcinoma ◽  
History Of

A rare case of duodenal cancer with achalasia cardia

2019 ◽  
Vol 22 (2) ◽  
pp. 32-34
Author(s):  
Kartikesh Mishra
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Similar Case ◽  
Barium Meal ◽  
Duodenal Adenocarcinoma ◽  
Gastrointestinal Malignancies ◽  
Achalasia Cardia ◽  
Proliferative Growth ◽  
History Of ◽  
Duodenal Carcinoma

Duodenal adenocarcinoma constitutes 0.4% of gastrointestinal malignancies. Achalasia incidence rate is 0.5-1.2 per 100000. The combination is rare. This is a report of a 68-year-old male from Nepal with history of five years abdominal pain, dysphasia and weight loss. Duodenoscopy could confirm ulcero-proliferative growth at D1-D2. Barium meal depicted features of achalasia cardia. No similar case report suggests that occurrence of duodenal carcinoma and achalasia cardia is merely co- incidental. Discussion: No similar case report suggests that occurrence of duodenal carcinoma and achalasia cardia is merely co- incidental. Consent: Informed consent was obtained from the patient for publication of this case report .

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals A case of sigmoid volvulus in an unexpected demographic

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammad Saba ◽  
Joshua Rosenberg ◽  
Gregory Wu ◽  
Gudata Hinika
Keyword(s):  
Abdominal Pain ◽  
Severe Pain ◽  
Rare Case ◽  
Young Female ◽  
Sigmoid Volvulus ◽  
Case Presentation ◽  
Operative Complications ◽  
History Of ◽  
Male Sex ◽  
Emergent Laparotomy

Abstract Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

scholarly journals Exceeding Radiation Dose to Volume Parameters for the Proximal Airways with Stereotactic Body Radiation Therapy Is More Likely for Ultracentral Lung Tumors and Associated with Worse Outcome

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3463
Author(s):  
Mark Farrugia ◽  
Sung Jun Ma ◽  
Mark Hennon ◽  
Chukwumere Nwogu ◽  
Elisabeth Dexter ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Propensity Score ◽  
Stereotactic Body Radiation Therapy ◽  
Performance Status ◽  
Bronchial Tree ◽  
Lung Tumors ◽  
Gender Performance ◽  
Dose Fractionation ◽  
Stereotactic Body Radiation ◽  
History Of

The preferred radiotherapeutic approach for central (CLT) and ultracentral (UCLT) lung tumors is unclear. We assessed the toxicity and outcomes of patients with CLT and UCLT who underwent definitive five-fraction stereotactic body radiation therapy (SBRT). We reviewed the charts of patients with either CLT or UCLT managed with SBRT from June 2010–April 2019. CLT were defined as gross tumor volume (GTV) within 2 cm of either the proximal bronchial tree, trachea, mediastinum, aorta, or spinal cord. UCLT were defined as GTV abutting any of these structures. Propensity score matching was performed for gender, performance status, and history of prior lung cancer. Within this cohort of 83 patients, 43 (51.8%) patients had UCLT. The median patient age was 73.1 years with a median follow up of 29.9 months. The two most common dose fractionation schemes were 5000 cGy (44.6%) and 5500 cGy (42.2%) in five fractions. Multivariate analysis revealed UCLT to be associated with worse overall survival (OS) (HR = 1.9, p = 0.02) but not time to progression (TTP). Using propensity score match pairing, UCLT correlated with reduced non-cancer associated survival (p = 0.049) and OS (p = 0.03), but not TTP. Within the matched cohort, dosimetric study found exceeding a D4cc of 18 Gy to either the proximal bronchus (HR = 3.9, p = 0.007) or trachea (HR = 4.0, p = 0.02) was correlated with worse non-cancer associated survival. In patients undergoing five fraction SBRT, UCLT location was associated with worse non-cancer associated survival and OS, which could be secondary to excessive D4cc dose to the proximal airways.

A Call to Define Stereotactic Radiosurgery

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1371-1373 ◽  
Author(s):  
Bruce E. Pollock ◽  
L Dade Lunsford
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Single Session ◽  
Short History ◽  
Effective Radiation Dose ◽  
The Past ◽  
Radiation Delivery ◽  
History Of ◽  
Effective Radiation ◽  
And Training

Abstract STEREOTACTIC RADIOSURGERY IS the single-session, precise delivery of a therapeutically effective radiation dose to an imaging-defined target. Conceived and developed during the past 5 decades, stereotactic radiosurgery has involved significant advances, which have improved patient outcomes and made it a critical component of modern neurosurgical practice and training. In this article, a short history of stereotactic surgery and radiosurgery are presented, and radiosurgery is contrasted to radiation therapy. Adherence to accepted, descriptive terms in defining stereotactic radiosurgery and radiation therapy permits a clear distinction among the results of the different radiation delivery techniques for patients, physicians, and other interested parties.

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