scholarly journals Rapunzel Syndrome and Small Bowel Intussusceptions Due to a Cotton Thread Bezoar: A Case Report

2018 ◽  
Vol 01 (01) ◽  
pp. 056-059
Author(s):  
Vineetha Raghu ◽  
Anita N. Nagadi ◽  
Ashwini Chethan Kumar
Keyword(s):  
Adolescent Girl ◽  
Rapunzel Syndrome ◽  
Compulsive Eating ◽  
Distal Small Intestine ◽  
Cotton Thread ◽  
Imaging Characteristics ◽  
Psychiatric Disturbances ◽  
History Of ◽  
Perforation Peritonitis ◽  
Nutritional Disturbances

AbstractRapunzel syndrome is a rare disease in which a trichobezoar extends into the duodenum or distal small intestine. It is associated with compulsive eating of indigestible substances or pica and is more common in cases of underlying psychiatric disturbances. If left untreated, gastrointestinal bezoars with or without the Rapunzel syndrome may lead to several complications such as ulceration, perforation, peritonitis, pancreatitis, biliary obstruction, severe nutritional disturbances, and rarely intestinal obstruction. We present an exceptionally rare case of Rapunzel syndrome caused by a large cotton thread bezoar in an adolescent girl, associated with multiple jejunal intussusceptions. Further, we present a literature review of this entity. An interesting association of bezoar with intussusception is explained. Since a history of pica may not be forthcoming in all cases, it is important to be familiar with the imaging characteristics, complications, and management of bezoars.

Small Intestinal Angiosarcoma Leading to Perforation and Acute Abdomen

2004 ◽  
Vol 128 (1) ◽  
pp. 95-98
Author(s):  
Katalin Kelemen ◽  
Qing Qing Yu ◽  
Lydia Howard
Keyword(s):  
Malignant Neoplasm ◽  
The Elderly ◽  
Severe Bleeding ◽  
Multiple Tumor ◽  
Distal Small Intestine ◽  
Computed Tomographic ◽  
Free Air ◽  
Undifferentiated Cells ◽  
History Of ◽  
Vascular Channels

Abstract A 76-year-old man presented to the emergency room with abdominal pain and fatigue. The patient had a history of gastrointestinal bleeding. An abdominal computed tomographic scan showed collections of free air in the abdomen with obstruction of the distal small intestine and multiple masses in the liver. Laparotomy revealed a widespread malignant neoplasm in the abdomen, with multiple tumor nodules in the ileal wall, mesentery, and liver. The ileal wall was perforated within the area of one of the tumors. Pathologic examination of the lesion showed a neoplasm composed of solid sheets of spindle and undifferentiated cells, forming interlacing delicate vascular channels with atypical endothelial cells. The tumor cells were positive for the endothelial marker CD31, whereas reactivity for a broad panel of epithelial and other endothelial markers was negative. This case demonstrates that although angiosarcomas of the gastrointestinal tract are rare, they should be considered in cases of intestinal perforation or severe bleeding, especially in the elderly. A broad panel of immunochemical markers might be necessary to establish the pathologic diagnosis.

scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

scholarly journals Rapunzel syndrome resulting in gastric perforation

2016 ◽  
Vol 98 (1) ◽  
pp. e6-e7 ◽  
Author(s):  
JS Parakh ◽  
A McAvoy ◽  
DJ Corless
Keyword(s):  
Gastric Perforation ◽  
Postoperative Recovery ◽  
Patch Repair ◽  
Free Fluid ◽  
Proximal Jejunum ◽  
Rapunzel Syndrome ◽  
Omental Patch ◽  
History Of ◽  
Entire Stomach

We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review.

The natural history of pineal cysts in children and young adults

2010 ◽  
Vol 5 (2) ◽  
pp. 162-166 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Cormac O. Maher ◽  
Karin M. Muraszko ◽  
Hugh J. L. Garton
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Initial Study ◽  
Older Children ◽  
Imaging Evaluation ◽  
Imaging Appearance ◽  
Imaging Characteristics ◽  
History Of ◽  
The Mean

Object The authors reviewed their experience with pediatric pineal cysts to define the natural history and clinical relevance of this common intracranial finding. Methods The authors identified all patients with pineal cysts who had been clinically evaluated at their institution over an 11.5-year interval and were < 25 years of age at the time of diagnosis. All inclusion criteria were met in 106 patients, and included repeated MR imaging as well as repeated clinical evaluation over at least a 6-month interval. Results The mean age at diagnosis was 11.7 ± 7.2 years. Forty-two patients were male and 64 were female. On follow-up MR imaging evaluation at a mean interval of 3.0 years from the initial study, 98 pineal cysts had no increase in size and no change in imaging appearance. Six pineal cysts increased in size and 2 others had a change in imaging characteristics without associated growth. Younger age was associated with cyst change or growth on follow-up imaging (p = 0.02). The mean age of patients with cysts that changed or grew was 5.5 years, and the mean age of patients with stable pineal cysts was 12.2 years. Initial cyst size and appearance on MR imaging were not significant predictors of growth or change in imaging appearance at follow-up. Similarly, the patient's sex was not a significant predictor of growth or change in imaging characteristics. Conclusions Follow-up imaging and neurosurgical evaluation may be considered optional in older children with pineal cysts.

Leiomyosarcoma metastases to the spine

2007 ◽  
Vol 6 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Mohamed Samy A. Elhammady ◽  
Glen R. Manzano ◽  
Nathan Lebwohl ◽  
Allan D. Levi
Keyword(s):  
Spinal Metastases ◽  
Smooth Muscle Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Initial Presentation ◽  
En Bloc ◽  
Initial Manifestation ◽  
Term Survival ◽  
Imaging Characteristics ◽  
History Of

✓Leiomyosarcoma is a rare malignant smooth-muscle tumor that rarely metastasizes to bone. It is extremely uncommon for osseous metastasis to be the initial presentation of leiomyosarcoma or to be the initial manifestation of recurrence in patients with a history of leiomyosarcoma. The authors have treated four cases of metastatic leiomyosarcoma with the lesion initially presenting in the spine, and a fifth case of disseminated leiomyosarcoma that involved the spine. In their report, they highlight the cases of two of these patients and provide tabular data for the remaining three. The authors performed a comprehensive review of the literature on spinal leiomyosarcomas and retrospective chart reviews of five surgically treated patients in whom a spinal metastatic leiomyosarcoma was diagnosed. Their series consists of five women who ranged in age from 36 to 47 years (mean age 43.2 years). Four patients had known, or presumed, uterine primary lesions, whereas one harbored a retroperitoneal primary tumor. These lesions generally appear as lytic foci on imaging studies, but variable imaging characteristics were observed. All cases were managed aggressively: four patients underwent posterior/posterolateral decompression and fusion, and one underwent anterior–posterior en bloc resection and fusion. In all cases preoperative symptoms resolved. Two patients died 9 and 13 years after initial presentation. The remaining patients are alive and neurologically intact. Metastatic spinal leiomyosarcomas tend to symptomatically involve only one spinal level at the time of diagnosis and are known to recur locally. These lesions commonly affect women in early middle age, and long-term survival, even in those with systemic metastatic lesions, is better than that seen in individuals with more aggressive spinal metastases. Attempted gross-total resection with fusion, as opposed to minimal palliative decompression, is recommended.

Postpartal psychosis: Serbian experience

2011 ◽  
Vol 26 (S2) ◽  
pp. 1098-1098
Author(s):  
M. Jasovic-Gasic ◽  
A. Damjanovic ◽  
M. Ivkovic ◽  
B. Dunjic-Kostic
Keyword(s):  
Family History ◽  
Psychiatric Disorders ◽  
Positive Family History ◽  
Clinical Manifestations ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Psychiatric Disturbances ◽  
Psychological Disturbances ◽  
Clinical Center ◽  
History Of

IntroductionChildbirth and the postpartal period present a form of specific maturational crisis and an extremely vulnerable period for every woman, especially for those who have potential for some psychological disturbances.AimWe explored sociodemographic and clinical manifestations of women in the postpartal period who were hospitalized at the Institute of Psychiatry, Clinical Center of Serbia.MethodThis retrospective study included 60 patients with psychiatric disorders developed within six months after childbirth. Inclusion criteria were: negative psychiatric hystory, negative history of puerperal episode, and postpartal disorder as a first manifestation of psychiatric disturbances. Patients were diagnosed according to RDC criteria (research diagnostic criteria).ResultsPatients with psychotic features were predominant, average age 23.6; married; mothers of male offspring and with positive family history of psychiatric disorders in 30%. Subacute development of clinical manifestations was noticed, 3.5 weeks after childbirth on average. No psychopathology was observed before third postpartal day. Obstetric manifestations did not influence psychopathology.ConclusionChildbirth is a significant risk factor for the expression of mental dysfunction in the puerperal period. The most vulnerable group is women with clinical expression of dysfunction, specific sociodemographic characteristics, and positive family history of psychiatric disorders.

scholarly journals A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

2017 ◽  
Vol 55 (4) ◽  
pp. 188-197 ◽  
Author(s):  
Frederick-Anthony Farrugia ◽  
Evangelos Misiakos ◽  
Georgios Martikos ◽  
Panagiotis Tzanetis ◽  
Anestis Charalampopoulos ◽  
...  
Keyword(s):  
Adrenal Incidentaloma ◽  
Plasma Renin ◽  
Review Of The Literature ◽  
European Guidelines ◽  
Mesh Terms ◽  
Imaging Characteristics ◽  
Benign Adenoma ◽  
History Of ◽  
Plasma Metanephrines ◽  
Radiological Characteristic

Abstract Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI). Method. An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented. Results. The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis. Conclusion. Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.

scholarly journals Ultrasound imaging features of bronchial anthracofibrosis

2021 ◽  
Author(s):  
xiaofeng lu ◽  
daishun liu ◽  
xiaoyan cai ◽  
qingshong zeng ◽  
li zou ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Clinical Symptoms ◽  
Tube Wall ◽  
Airway Remodeling ◽  
Imaging Features ◽  
Clinical Markers ◽  
Bony Tissue ◽  
Imaging Characteristics ◽  
Flat Type ◽  
History Of

Abstract Purpose To determine the ultrasound imaging characteristics of participants with bronchial anthracofibrosis (BAF) and identify clinical markers for prevention and treatment. Methods We randomly selected 1,243 participants (including 113 with BAF) who underwent bronchoscopy and treatment at our institution from April 2018 to October 2019. BAF was classified as flat, deep seated retracted, or mucosal protrusion type, based on microscopy. Ultrasound probes were used to determine the maximum thickness of the tube wall and submucosa. The average values of the submucosal and bony tissue areas of the BAF subtypes were compared. Results The BAF group included 13 participants with a history of tuberculosis (11.5%) and 57 with biofuel exposure (50.4%). The average exposure time was 17.4 ± 6.2 years; BAF accounted for 10% of bronchoscopies performed. The maximum tube-wall thicknesses of the deep-seated retracted (17.3 ± 5.7) and black protruding (19.3 ± 5.4) groups were significantly greater than that of the flat group (12.5 ± 5.0; P < 0.05). The maximum thicknesses of the submucosa in the deep-retracted (9.8 ± 3.0) and black protruding (14.5 ± 5.0) groups were significantly greater than that of the flat group (6.6 ± 3.5; P < 0.05). The ratios of bone tissue in the flat and black protruding groups were 33.3 ± 9.3% and 34.9 ± 12.1%, respectively; the ratio in the deep-seated retracted group (65.2 ± 8.7%) was significantly reduced (P < 0.05). The flat type showed no significant change (P > 0.05). Conclusion Differences in BAF airway remodeling among the different subtypes may lead to varying clinical symptoms. Analyzing the characteristics of BAF airway remodeling and the regulatory pathway may provide new clues for treatment.

scholarly journals A Critically Ill Child with Gangrenous Appendicitis Masquerading as Hollow Viscous Perforation

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ashish Lal Shrestha ◽  
Santosh Maharjan ◽  
Anil Dev Pant ◽  
Pankaj Bahadur Nepali
Keyword(s):  
Complicated Appendicitis ◽  
Source Control ◽  
Successful Outcome ◽  
Short History ◽  
Radiological Findings ◽  
Case Presentation ◽  
Abdominal Symptoms ◽  
Perforated Appendix ◽  
History Of ◽  
Perforation Peritonitis

Background. Severe complications of acute appendicitis (AA) hitherto well described are less common in clinical practice nowadays. When a septic child is encountered with a short history of abdominal symptoms and disproportionate signs of peritonitis further complicated by radiological findings causing a diagnostic conundrum, management becomes exceedingly demanding. Case Presentation. A 10-year-old previously healthy boy presented to the emergency room with generalized abdominal pain associated with fever and jaundice for a day. Blood workup revealed leucopenia, hyperbilirubinemia, hyponatremia, and elevated CRP. Initial radiological evaluation suggested hollow viscous perforation. He was diagnosed to have hollow viscous perforation peritonitis in severe sepsis. At laparotomy, generalized peritoneal contamination was found, the source of which could be traced down to the gangrenous perforated appendix. Conclusion. Complicated appendicitis, in children, can present with baffling findings. Timely identification of an ill child, adequate workup, prompt resuscitation, and source control are imperative for a successful outcome.

Sign in / Sign up

Export Citation Format

Share Document