scholarly journals A112 ANGIOEDEMA,A RARE YET AN IMPORTANT CAUSE OF ABDOMINAL PAIN. A CASE STUDY AND LITERATURE REVIEW

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 130-131
Author(s):  
F M Almalki ◽  
M Cino ◽  
S Betschel ◽  
A N Sasson
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
Subcutaneous Tissue ◽  
Recurrent Abdominal Pain ◽  
Distal Segment ◽  
Interesting Case ◽  
Double Balloon Enteroscopy ◽  
Acquired Angioedema ◽  
Common Causes ◽  
History Of

Abstract Background Abdominal pain is a common gastroenterological symptom with an extensive deferential diagnoses. Angioedema is an important cause to remember after the more common causes have been excluded.It is caused by a deficiency in the inhibitor of the first component of classical complement pathway and is divided into hereditary or acquired.Acquired angioedema is associated with autoimmune or lymphoproliferative neoplasms.The clinical features of both include recurrent,self-limiting and circumscribed edema affecting the subcutaneous tissue of the upper respiratory airways and gastrointestinal tract. Aims We describe an interesting case of acquired angioedema presenting with recurrent abdominal pain. We also systematically review the current literature on this rare entity. Methods A search of electronic databases was performed inclusive to September 2019, for all studies and reviews of patients with acquired angioedema manifested as recurrent attacks of abdominal pain. Results: Case Report: 65 year old lady ho has an at least 2 year long history of abdominal pain and bloating associated on some occasions with nausea and vomiting.She presented to our emergency department in August,2018 with a day history of severe generalized abdominal pain and was found to have circumferential thickening,edema with mucosal hyperenhancement involving the distal segment of the small bowel.Splenomegaly was noted on that study.A double balloon enteroscopy was planned,but ultimately cancelled as her ileitis had resolved.The patient was discharged home as her pain resolved with conservative management which included intravenous fluid, pain medications and antiemetics.She then represented to the hospital on September 16, 2019 severe abdominal pain and throat tightness associated with shortness of breath. Again,noted was an extremely short segment of ileum with mucosal edema and hyperenhancement which resolved on a repeat CT scan done during that admission on September 18th, 2019.In light of the patient’s symptoms,CT scan findings,progressive anemia, thrombocytopenia and splenomegaly. It was thought that her abdominal pain is related to secondary to angioedema driven by a lymphoproliferative process as evident by the splenomegaly and worsening cytopenia. A bone marrow was done which revealed clonal B, so the diagnosis of lymphoma was made. The patient’s C1 esterase was 0.2 with reduced functional activity.CH50 less 10 perecent. A diagnosis of acquired angioedema was made and the patient was started on BERINERT 3000 IU SQ every three days with 1500 IU for break through with significant improvement in the frequency and severity of abdominal pain episodes. Conclusions Acquired angioedema is to be considered as a cause of recurrent abdominal pain in a patient with a lymphoproliferative malignancy after common causes and etiologies have been ruled out. Funding Agencies None

scholarly journals Laparoscopic reduction and repair of a left paraduodenal hernia

2019 ◽  
Vol 12 (12) ◽  
pp. e232098 ◽  
Author(s):  
Takashi Sakamoto ◽  
Alan Kawarai Lefor
Keyword(s):  
Abdominal Pain ◽  
Laparoscopic Repair ◽  
Recurrent Abdominal Pain ◽  
Paraduodenal Hernia ◽  
Enhanced Ct ◽  
History Of ◽  
Congenital Internal Hernia ◽  
Continuous Closure ◽  
Hernia Orifice ◽  
Similar Episode

Left paraduodenal hernias are the most common type of congenital internal hernia, but they are difficult to diagnose without appropriate imaging. A 79-year-old man with a history of recurrent abdominal pain had another similar episode of abdominal pain, which prompted him to seek evaluation. The pain resolved spontaneously on arrival to the hospital. Enhanced CT scan showed the characteristic findings of a left paraduodenal hernia and laparoscopic repair was undertaken. The small intestine was reduced successfully, and the hernia orifice was approximated with a continuous closure. He was discharged uneventfully 4 days after admission. The characteristic clinical and imaging findings of paraduodenal hernias are reviewed. Laparoscopic repair is reasonable in patients who have a paraduodenal hernia without intestinal ischemia.

scholarly journals Clozapine-induced stercoral colitis: a surgical perspective

2019 ◽  
Vol 12 (8) ◽  
pp. e227718 ◽  
Author(s):  
Jayan George ◽  
Richard Hotham ◽  
William Melton ◽  
Keith Chapple
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
Total Colectomy ◽  
Postoperative Recovery ◽  
Presenting Symptoms ◽  
History Of

We describe a case of a 46-year-old man with schizophrenia treated with clozapine who presented as an emergency with abdominal pain on the background of a 1 month history of constipation. The initial presenting symptoms were vague and a diagnosis was difficult to establish. Initial CT of the abdomen and pelvis demonstrated only minor abnormalities. He continued to deteriorate until a further CT scan revealed worsening stercoral colitis. He subsequently underwent an emergency total colectomy and ileostomy formation and had a complicated prolonged postoperative recovery. This case highlights the risks that clozapine can have on slowing bowel transit and the dangerous consequences that can occur if not identified early.

scholarly journals Abdominal intussusception associated with coeliac disease: case report and literature review

2021 ◽  
Author(s):  
Rashid Hameed ◽  
Noshine Irrum ◽  
Subodhini P. Arachchige ◽  
Edwin Tan ◽  
Jacinta Tobin
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Literature Review ◽  
Coeliac Disease ◽  
Recurrent Abdominal Pain ◽  
Immune Infiltration ◽  
Disease Case ◽  
Classical Pattern ◽  
History Of

In genetically susceptible individuals, gluten ingestion triggers and immune infiltration and bowel damage in the classical pattern of coeliac disease, with variable symptoms. Intussusception is a condition where one segment of intestine ‘telescopes’ inside of another portion of intestine, which may cause symptoms of abdominal pain due to obstruction. Intussusception has been associated with coeliac disease. We report a 4-year-old girl presented with recurrent abdominal pain of variable severity and found to have intussusception on two occasions, which on both occasions reduced spontaneously during ultrasound examinations. She was later diagnosed with coeliac disease. This case highlights the importance of considering coeliac screening in patients with a history of recurrent abdominal pain and intussusception.

Case 5.1

2014 ◽  
pp. 245-246
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Diabetes Mellitus ◽  
Abdominal Pain ◽  
Signal Intensity ◽  
Recurrent Abdominal Pain ◽  
Iron Deposition ◽  
History Of ◽  
T2 Weighted Images

35-year-old man with a long history of diabetes mellitus and recent episode of peritonitis now presents with recurrent abdominal pain and fever Axial fat-suppressed FSE T2-weighted images (Figure 5.1.1) show multiple hyperintense lesions in the spleen. The diffuse, decreased signal intensity throughout the remainder of the spleen is due to hemosiderosis and iron deposition. Gadolinium-enhanced axial 3D SPGR images (...

Adolescent with abdominal pain poorly responsive to analgesia

2020 ◽  
pp. edpract-2020-320772
Author(s):  
Neil Chanchlani ◽  
Philip Jarvis ◽  
James W Hart ◽  
Christine H McMillan ◽  
Christopher R Moudiotis
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
White Cell Count ◽  
Autism Spectrum ◽  
Free Fluid ◽  
List Type ◽  
Reactive Protein ◽  
Normal Limits ◽  
History Of ◽  
Normal Gallbladder

Case presentationA 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).Table 1Serology and further investigations throughout admissionDay 1Day 2Day 3Day 4Serology White cell count (3.8–10.6×109/L)7.514.615.713.6 Neutrophils (1.8–8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0–21 μmol/L)812Further investigations Urine dipstickNegative UltrasoundSmall volume of free fluid, normal gallbladder, pancreas and appendix not visualisedFigure 1CT scan of the abdomen (A) and pelvis (B).QuestionsWhat is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation?Renal function.Coagulation.Amylase and lipase.Gamma glutamyltransferase.What are the acute treatment principles?What is the the most common cause?Idiopathic.Gallstones.Medications.Genetic.Answers can be found on page 2.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

scholarly journals Refractory Abdominal Pain in a Patient with Chronic Lymphocytic Leukemia: Be Wary of Acquired Angioedema due to C1 Esterase Inhibitor Deficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Abdullateef Abdulkareem ◽  
Ryan S. D’Souza ◽  
Joshua Mundorff ◽  
Pragya Shrestha ◽  
Oluwaseun Shogbesan ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Chronic Lymphocytic Leukemia ◽  
Upper Airway ◽  
Recurrent Abdominal Pain ◽  
Final Diagnosis ◽  
Lymphocytic Leukemia ◽  
C1 Inhibitor Deficiency ◽  
Acquired Angioedema ◽  
C1 Esterase Inhibitor ◽  
Esterase Inhibitor

Acquired angioedema due to C1 inhibitor deficiency (C1INH-AAE) is a rare and potentially fatal syndrome of bradykinin-mediated angioedema characterized by episodes of angioedema without urticaria. It typically manifests with nonpitting edema of the skin and edema in the gastrointestinal (GI) tract mucosa or upper airway. Edema of the upper airway and tongue may lead to life-threatening asphyxiation. C1INH-AAE is typically under-diagnosed because of its rarity and its propensity to mimic more common abdominal conditions and allergic reactions. In this article, we present the case of a 62-year-old male with a history of recently diagnosed chronic lymphocytic leukemia (CLL) who presented to our hospital with recurrent abdominal pain, initially suspected to haveClostridium difficilecolitis and diverticulitis. He received a final diagnosis of acquired angioedema due to C1 esterase inhibitor deficiency due to concomitant symptoms of lip swelling, cutaneous nonpitting edema of his lower extremities, and complement level deficiencies. He received acute treatment with C1 esterase replacement and icatibant and was maintained on C1 esterase infusions. He also underwent chemotherapy for his underlying CLL and did not experience further recurrence of his angioedema.

scholarly journals Acute Small Gut Obstruction as an Atypical Presentation of Acute Appendicitis without Rupture or Perforation of the Appendix

2021 ◽  
Vol 39 (4) ◽  
pp. 261-265
Author(s):  
ABM Moniruddin ◽  
Salma Chowdhury ◽  
Tanvirul Hasan ◽  
Kazi Muhammad Mahmudul Hasan ◽  
- RounakJahan ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Young Male ◽  
Recurrent Abdominal Pain ◽  
Acute Intestinal Obstruction ◽  
Atypical Presentation ◽  
Radiological Evaluation ◽  
Post Operative Period ◽  
History Of ◽  
Operative Findings

Acute appendicitis is a very common surgical emergency. It has got diverse presentations and various complications. Here, we report case history of a young male patient with a 2- year history of recurrent abdominal pain, who presented to our center with a 4-day history of increasing abdominal pain, constipation and vomiting. Clinical and radiological evaluation revealed it as a case of acute intestinal obstruction preoperatively. Per-operative findings suggested acute appendicitis without perforation, small gut obstruction by adhesions, appendicular lump or internal herniation. Appendicectomy was done along with other necessary procedures. His post-operative period was uneventful. This case is reported here to highlight that acute appendicitis may present with atypical features like acute small gut obstruction. J Bangladesh Coll Phys Surg 2021; 39: 261-265

scholarly journals Giant Ovarian Tumor Presenting as a Huge Abdomino-Pelvic Mass in a Teenage Girl: A Case Report

2021 ◽  
Vol 39 (2) ◽  
pp. 137-141
Author(s):  
Muhammad Jamaluddin ◽  
Hajrah Hilal Ahmed
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ovarian Tumor ◽  
Abdominal Cavity ◽  
Lower Abdominal Pain ◽  
Pelvic Mass ◽  
Interesting Case ◽  
Ovarian Cysts ◽  
Teenage Girl ◽  
Common Causes

Ovarian cysts are common causes of lower abdominal pain and abdominal distention in females. While most of them are benign and rarely grow immensely to achieve a huge size, they may be neoplastic in origin, reaching enormous dimensions with minimum or without raising any symptoms.Here, we present an interesting case of a 19-year-old female,who presented with huge abdominal swelling and pain in whole abdomen from whom a 9.1 kg borderline mucinous ovarian cyst, occupying the whole abdominal cavity was removed. J Bangladesh Coll Phys Surg 2021; 39(2): 137-141

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