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

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.

scholarly journals Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Hideki Katagiri ◽  
Shozo Kunizaki ◽  
Mayu Shimaguchi ◽  
Yasuo Yoshinaga ◽  
Yukihiro Kanda ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Abdominal Surgery ◽  
Venous Thrombosis ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Anticoagulation Therapy ◽  
Mesenteric Venous Thrombosis ◽  
Laparoscopic Exploration ◽  
Abdominal Symptoms

Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms.

scholarly journals A rare cause of small bowel diaphragm disease presenting with palpated abdominal mass

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Aghyad K Danial ◽  
Ahmad Al-Mouakeh ◽  
Yaman K Danial ◽  
Ahmad A Nawlo ◽  
Ahmad Khalil ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Medical History ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Past Medical History ◽  
Abdominal Symptoms ◽  
Diaphragm Disease ◽  
History Of ◽  
Specific Symptoms

Abstract Small bowel diaphragm disease is a rare complication related to non-steroidal anti-inflammatory drug (NSAID) use. It presents with non-specific symptoms such as vomiting, abdominal pain, subacute bowel obstruction and occasionally as an acute abdominal condition. We report a case of diaphragm disease in a 33-year-old female who presented with vomiting, constipation and abdominal pain started 5 days earlier. Physical examination revealed palpated abdominal mass. The patient’s past medical history was remarkable for NSAID use. The patient was managed by surgical resection of involved intestine and diagnosis was confirmed by histological examination. Although there are few published cases of diaphragm disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing patients presenting with non-specific abdominal symptoms with remarkable past medical history of NSAID use.

scholarly journals Treatment and outcome for small bowel adenocarcinoma (SBA): a real life experience of two Italian centres

2017 ◽  
Vol 28 ◽  
pp. vi50
Author(s):  
M. Occhipinti ◽  
A. Botticelli ◽  
C.E. Onesti ◽  
M. Ghidini ◽  
R. Righini ◽  
...  
Keyword(s):  
Small Bowel ◽  
Life Experience ◽  
Real Life ◽  
Small Bowel Adenocarcinoma

scholarly journals Medical expulsion therapy in the management of ureteric calculi: a comparative real-life experience

2017 ◽  
Vol 4 (7) ◽  
pp. 2311
Author(s):  
Anil S. Degaonkar ◽  
Pundlik T. Jamdade ◽  
Nikhil S. Bhamare ◽  
Prashant A. Shirure ◽  
Manjuprasad M. S. ◽  
...  
Keyword(s):  
Life Experience ◽  
Real Life ◽  
Control Group ◽  
Open Label ◽  
Expulsion Rate ◽  
Abdominal Ultrasonography ◽  
Medical Expulsive Therapy ◽  
Ureteric Calculi ◽  
Common Causes ◽  
And Control

Background: One of the conservative management of ureteric caculi is by medical expulsive therapy by targeting common causes of obstruction such as edema, ureteral spasm and infection which will favour expulsion of calculi. The objective of this study was to assess comparative efficacy and safety of medical expulsive therapy of ureteric calculi.Methods: This was a randomized, prospective, open label, comparative study. Subjects satisfying inclusion and exclusion criteria were randomized into 4 groups tamsulosin, nifedipine, progesterone and control. Medical expulsion of calculi of 6mm to 15 mm size was carried out in 120 patients. Patients were followed up on OPD basis every third day. Calculi expulsion until day 28 as confirmed by abdominal ultrasonography was taken as the end point.Results: Expulsion rate in tamsulosin group was 90%, whereas nifedipine, progesterone group were 83.33% and 70% respectively which was significant compared to control group which was 36.6% (p < 0.005). Expulsion time was also reported to be significantly less in these groups as compared to control group. Therapy related adverse effects were minor and were seen in only 6 patients.Conclusions: Medical expulsive therapy of ureteric calculi of size 6 to 15mm with Tamsulosin, nifedipine and progesterone were safe and efficacious and could be implemented for initial management in selected patients.

Fr198 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE

2021 ◽  
Vol 160 (6) ◽  
pp. S-262
Author(s):  
Kathryn A. Peterson ◽  
Robert M. Genta ◽  
Henrik S. Rasmussen ◽  
Bradford Youngblood ◽  
Amol P. Kamboj
Keyword(s):  
Eosinophilic Esophagitis ◽  
Life Experience ◽  
Real Life ◽  
Bowel Symptoms

Surgical treatment of melanoma metastases to the small bowel: A single cancer referral center real-life experience

2020 ◽  
Author(s):  
Gianfranco Gallino ◽  
Andrea Maurichi ◽  
Roberto Patuzzo ◽  
Ilaria Mattavelli ◽  
Consuelo Barbieri ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Small Bowel ◽  
Life Experience ◽  
Real Life ◽  
Referral Center ◽  
Melanoma Metastases ◽  
Single Cancer

P-BN05 Solitary jejunal diverticulum: a rare unexpected cause of chronic pneumoperitoneum

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mina Fouad ◽  
Barry Appleton
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Histopathological Examination ◽  
Muscularis Propria ◽  
Air Bubbles ◽  
Abdominal Symptoms ◽  
Jejunal Diverticulum ◽  
Operative Recovery

Abstract Background Jejunal diverticula are rare acquired herniation of the mucosa and submucosa through the muscularis propria. They are asymptomatic in the majority of cases, however, they can present with non-specific abdominal symptoms and rarely complicate leading to acute abdomen. Perforation usually results in symptoms and signs of acute peritonitis and it is not an identifiable aetiology of chronic pneumoperitoneum. Computed tomography scan may identify intestinal wall oedema, air bubbles travelling through the mesentery, free intra-abdominal air and/or fluid . Radiological diagnosis requires high index of suspicion of such pathology. We report a case of an isolated jejunal diverticulum as a cause for aseptic chronic pneumoperitoneum . Methods A 77-year-old female was referred to the ambulatory emergency surgical unit (AESU) with a 4-month history of nonspecific abdominal pain, considerable weight loss, diarrhea, nausea and a few episodes of vomiting.Physical examination revealed no constitutional signs of sepsis and her abdomen was mildly distended but soft and nontender to palpation. Laboratory investigations were unremarkable. CT scan of her abdomen and pelvis on her first visit showed pneumoperitoneum with associated low volume ascites, which raised the possibility of sealed gastrointestinal perforation. In the absence of any clear signs of sepsis, a strategy of ambulatory, conservative management and follow up was chosen. Four months after her initial presentation our patient presented with ongoing vague abdominal symptoms with weight loss and failure to thrive.  A CT colonogram described pneumoperitoneum and larger volume of ascites is in comparison to the previous CT scan. There was an unusual pattern of mural gas in some loops of small bowel in the left side of the abdomen that suggested pneumatosis. MDT decided to proceed with diagnostic laparoscopy. Results Laparoscopy exploration revealed odorless pneumoperitoneum, moderate amount of non-turbid bile stained serous ascites and thin fibrinous covering. We identified a jejunal diverticulum associated with mesenteric air bubbles and moderately enlarged reactive feeling lymph nodes in the diverticular segment . A small bowel resection with a primary side-to-side anastomosis,  washout of the abdomen and cholecystectomy were done through a Kocher’s subcostal incision. She made an uneventful post-operative recovery and was discharged home well on day 4. Histopathological examination of the resected specimens confirmed the presence of a ruptured isolated jejunal diverticulum with a breach in muscularis propria and chronic cholecystitis in the gallbladder. Conclusions In summary, our case report highlights the importance of being aware of the possibility of  perforated jejunal diverticula as a possible source of chronic pneumoperitoneum causing chronic nonspecific abdominal pain, diarrhea and unexplained weight loss. The surgical option of segmental resection and primary anastomosis was beneficial in this patient. However, calculating the risk benefit ratio remains the mainstay of the management plan, which, as ever, should be tailored to each patient’s general condition and fitness with appropriate counselling and consent.

scholarly journals A Case-Control Study of Real-Life Experience with Ceftolozane-Tazobactam in Patients with Hematologic Malignancy and Pseudomonas aeruginosa Infection

2018 ◽  
Vol 63 (2) ◽  
pp. e02340-18 ◽  
Author(s):  
Ana Fernández-Cruz ◽  
Natalia Alba ◽  
María Auxiliadora Semiglia-Chong ◽  
Belén Padilla ◽  
Gabriela Rodríguez-Macías ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Case Control Study ◽  
Life Experience ◽  
Hematologic Malignancy ◽  
Real Life ◽  
Case Control ◽  
Control Group ◽  
Content Type ◽  
Hospital Acquired ◽  
Control Study

ABSTRACT We present our experience in patients with hematologic malignancy and Pseudomonas aeruginosa infection treated with ceftolozane-tazobactam. We performed a single-center case-control study comparing patients with hematologic malignancy and P. aeruginosa infection treated with ceftolozane-tazobactam (study group) with similar patients not treated with ceftolozane-tazobactam (control group) to assess safety and efficacy. Nineteen cases and 38 controls were analyzed. Cases were younger (45.6 years versus 57.6 years; P = 0.012) and less frequently had bacteremia (52.6% versus 86.8%; P = 0.008). They also had worse Multinational Association for Supportive Care in Cancer (MASCC) scores (10.2 versus 16.1; P = 0.0001), more hospital-acquired infections (78.9% versus 47.4%; P = 0.013), and more extremely drug-resistant (XDR) P. aeruginosa infections (47.4% versus 21.1%; P = 0.015). Cases received a median of 14 days (7 to 18 days) of ceftolozane-tazobactam (monotherapy in 11 cases [57.9.6%]). Ceftolozane-tazobactam was mostly used as targeted therapy (16 cases; 84.2%) because of resistance (9 cases; 47.4%), failure (4 cases; 21.1%), and toxicity (3 cases; 15.8%). Ten cases had bacteremia (52.6%). The sources were pneumonia (26.3%), catheter-related bacteremia (21.1%), primary bacteremia (21.1%), and perianal/genital (15.7%), urinary (10.5%), and skin/soft tissue (5.3%) infection. No toxicity was attributed to ceftolozane-tazobactam. More than 60% had neutropenia, and 15.8% fulfilled the criteria for sepsis. There were no significant differences in clinical cure at day 14 (89.5% versus 71.1%; P = 0.183) or recurrence (15.8% versus 10.5%; P = 0.675). Thirty-day mortality was lower among cases (5.3% versus 28.9%; P = 0.045). Ceftolozane-tazobactam was well tolerated and at least as effective as other alternatives for P. aeruginosa infection in patients with hematologic malignancy, including neutropenic patients with sepsis caused by XDR strains.

scholarly journals Gossypiboma Masquerading as Small Bowel Malignancy

2020 ◽  
Vol 12 (2) ◽  
pp. 123-125
Author(s):  
Amir H Boghratian ◽  
Ahmad M Al-Taee
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Gastric Bypass Surgery ◽  
High Body Mass Index ◽  
Mini Gastric Bypass ◽  
Surgical Approaches ◽  
Cross Sectional ◽  
Presenting Symptoms ◽  
Retained Foreign Body ◽  
Abdominal Symptoms

Gossypiboma refers to inadvertently retained foreign objects after surgical operations. High body mass index and emergency surgery are risk factors of the condition. Presenting symptoms are usually non-specific and it may result in serious complications such as bowel obstruction. Removal can be attempted with endoscopic or surgical approaches depending on the site and presence of complications. This case highlights the need for considering gossypiboma in patients presenting with abdominal symptoms after recent abdominal surgery. Herein we report the case of a 30-year-old woman with abdominal pain two months after mini-gastric bypass surgery. Cross-sectional imaging showed a hyperdense area in the small bowel concerning for malignancy. However, upper endoscopy revealed a 10 × 40 cm retained surgical gauze in the afferent loop that was successfully retrieved. Although rare, retained foreign body should be considered in the differential diagnosis of postoperative abdominal pain.

scholarly journals EVALUATING THE EFFECTS OF A BOARD GAME IN COGNITION IN LEARNING SHIPPING MANAGEMENT FOR HIGHER EDUCATION

2020 ◽  
Vol 2 (7) ◽  
pp. 180-210
Author(s):  
Shanizan Herman Mohd Radzi ◽  
Hoe Tan Wee ◽  
Amri Yusoff
Keyword(s):  
Higher Education ◽  
Undergraduate Students ◽  
Teaching And Learning ◽  
Life Experience ◽  
Learning Experience ◽  
Real Life ◽  
Performance Comparison ◽  
Control Group ◽  
Board Game ◽  
Control Group Design

This study proposes the use of board games for teaching and learning shipping management in higher education and examines its effects on cognition. It employs a game-based learning approach to engage students with real-life experience in shipping management so that students are able to experiment with the causes and effects of their decisions based on the theory they have learned. An instance of a shipping management game was developed from the board game framework which stands on the discreet event simulation of a realistic shipping process and activity. A quasi-experimental research design was adopted to measure the effectiveness of the board game in giving students some understanding of shipping operations. Data were gathered from a sample of 67 undergraduate students, using a non-equivalent control group design. Students who received the game-based method performed better in the post-test assessment. A performance comparison indicated that there was a difference in students’ achievement for the tramp services and liner services contents. The use of board game aims to expose students to the best learning experience when they immerse themselves in solving problems and making decisions in the game. Moreover, the board game provides a transparent learning space, which encourages students to make knowledge discovery at their own pace in a non-threatening environment.

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