scholarly journals Spontaneous bowel perforation in the setting of colonic involvement with scleroderma

2020 ◽  
Vol 13 (1) ◽  
pp. e233220
Author(s):  
Weronika Stupalkowska ◽  
Betania Mahler-Araujo ◽  
John Bennett ◽  
Stavros Gourgiotis
Keyword(s):  
Bowel Perforation ◽  
Multiorgan Failure ◽  
Colonic Perforation ◽  
Source Control ◽  
Emergency Laparotomy ◽  
Colonic Involvement ◽  
Abdominal Symptoms ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Physiological Reserve

Here we present a rare case of spontaneous colonic perforation in a middle-aged woman affected by systemic sclerosis (SSc). In spite of maximal medical support and prompt emergency laparotomy for source control the patient died due to multiorgan failure within 48 hours of admission. This case emphasises that although rarely, patients with scleroderma can present with colonic perforation which unfortunately due to their decreased physiological reserve, can lead to rapid and irreversible deterioration and subsequent death. It is therefore essential that clinicians faced with abdominal symptoms and signs in patients affected by SSc are able to quickly differentiate acute visceral perforation from benign causes.

Infliximabterápia mellett kialakuló appendicitis perianalis Crohn-betegben

2018 ◽  
Vol 159 (10) ◽  
pp. 405-409 ◽  
Author(s):  
Zsolt Szakács ◽  
Nándor Faluhelyi ◽  
András Fincsur ◽  
András Papp ◽  
Áron Vincze ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biological Therapy ◽  
Perforated Appendicitis ◽  
Radiological Findings ◽  
Abdominal Symptoms ◽  
Acute Relapse ◽  
Aged Woman ◽  
Common Causes ◽  
Middle Aged Woman

Abstract: The differential diagnosis of acute abdominal complaints is challenging in Crohn’s disease. This is particularly true in patients in remission induced by biological therapy. In addition to the acute relapse of Crohn’s disease, other common causes, such as acute appendicitis exhibiting similar and often atypical course, should be taken into consideration irrespective of the age. An ileocecal flare-up is unlikely to occur in patients with perianal Crohn’s disease in remission induced by infliximab even if laboratory and radiological findings point towards this diagnosis. We report the case of a middle-aged woman in remission induced by infliximab who developed acute abdominal symptoms due to perforated appendicitis. Orv Hetil. 2018; 159(10): 405–409.

scholarly journals An unusual case of caecal perforation following ileostomy reversal

2019 ◽  
Vol 12 (8) ◽  
pp. e229961 ◽  
Author(s):  
Gamze Aksakal ◽  
Suat Ng ◽  
Vinna An
Keyword(s):  
Unusual Case ◽  
Bowel Perforation ◽  
Loop Ileostomy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Colonic Perforation ◽  
Emergency Laparotomy ◽  
Ileostomy Reversal ◽  
History Of ◽  
Long Course ◽  
Caecal Perforation

A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.

scholarly journals Gastric Pneumatosis: An Atypical Presentation of Desmoid Tumor

2021 ◽  
Vol 5 (4) ◽  
pp. 473-475
Author(s):  
Catarina Jorge ◽  
Miguel Varela ◽  
Júlio Soares ◽  
Hugo Uribe ◽  
Luis Flores ◽  
...  
Keyword(s):  
Desmoid Tumor ◽  
Surgical Intervention ◽  
Clinical Course ◽  
Chief Complaint ◽  
Portal System ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
Shorten Hospital Stay ◽  
Aged Woman ◽  
Middle Aged Woman

Case presentation: A middle-aged woman presented to the emergency department with a chief complaint of abdominal pain, fever, vomiting, and diarrhea. Abdominal computed tomography revealed gastric pneumatosis and air in the portal system. The patient had an unfavorable clinical course with pneumoperitoneum and septic shock due to secondary peritonitis. She underwent emergency laparotomy where neoformation of the mesentery root was found with infiltration of the small intestine and jejunal perforation. The anatomopathological study of the tumor revealed that it was a desmoid tumor. Discussion: To our knowledge this is the first report in the literature of gastric pneumatosis as the initial presentation of a mesenteric desmoid tumor. Although it usually has a benign clinical course, its locally invasive characteristics can lead to critical illness. Physicians shouldn’t overlook these types of complications, as early identification and surgical intervention can modify the prognosis and shorten hospital stay.

A middle aged woman with isolated ACTH deficiency associated with transient GH deficiency

2014 ◽  
Author(s):  
Michelle Mangual ◽  
Jose Hernan-Martinez ◽  
Monica Santiago ◽  
Carlos Figueroa ◽  
Rafael Trinidad ◽  
...  
Keyword(s):  
Gh Deficiency ◽  
Middle Aged ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Aged Woman ◽  
Middle Aged Woman

scholarly journals P.005 Lisdexamfetamine precipitated pathological gambling

2018 ◽  
Vol 45 (s2) ◽  
pp. S17-S17 ◽  
Author(s):  
F Chaudhary ◽  
A Hirsch ◽  
W MacPherson ◽  
J Nayati
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Nucleus Accumbens ◽  
Pathological Gambling ◽  
Risk Taking ◽  
Gambling Behavior ◽  
Hyperactivity Disorder ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
History Of ◽  
Mental Status Examination

Background: Lisdexamfetamine has not heretofore been reported to cause pathological gambling. Such a case is presented. Methods: A middle-aged woman, without past interest in gambling, gaming, or risk taking behavior, with childhood history of attention deficit hyperactivity disorder presented with difficulty focusing and concentrating. Lisdexamfetamine was started at 20 mg daily and gradually escalated due to lack of efficacy. At 70 mg daily, she began binging on sweets and gambling all day, every day at nearby riverboats, which she had never frequented previously. Upon reduction to 60 mg daily, the gambling resolved. Ritalin 20 mg every morning and 50 mg every afternoon was used without gambling reoccurrence. Results: Mental Status Examination: Alert, cooperative and oriented x 3 with good eye contact. Euthymic, without mania, thoughts logical and goal directed. Conclusions: Enhanced dopamine in the nucleus accumbens may induce hedonic activities including gambling, binging on sweets, or sexual activity (Moore et al. 2014). Lisdexamfetamine has been described to induce mania, and pathological gambling may have been an isolated manifestation of early mania. In those who have recently begun lisdexamfetamine, query should be made regarding change in gambling behavior and in those who are pathologically gambling, investigation should be entertained as to whether they are taking lisdexamfetamine.

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