scholarly journals ACE Inhibitor Induced Isolated Angioedema of the Small Bowel: A Rare Complication of a Common Medication

2021 ◽  
Vol 2021 ◽  
pp. 1-4 ◽  
Author(s):  
Marc D. Squillante ◽  
Anna Trujillo ◽  
Joseph Norton ◽  
Saurabh Bansal ◽  
David Dragoo
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Rare Complication ◽  
The Body ◽  
Wall Thickening ◽  
Interstitial Tissue ◽  
Moderate Amount ◽  
Entire Small Bowel ◽  
Difficulty Breathing ◽  
Mucosal Edema

Angioedema is a subcutaneous or submucosal tissue swelling due to capillary leakage and transudation of fluid into the interstitial tissue. It can be localized or generalized as part of a widespread reaction known as anaphylaxis. Millions of people in United States and all over the world receive ACEI antihypertensive therapy. ACEI is known to cause angioedema with an incidence of 0.7 percent. We present a case of 40-year-old female who was started on lisinopril three days prior to presentation for newly diagnosed hypertension. She presented with nonspecific severe abdominal pain, nausea, and vomiting. She denied having difficulty breathing or swelling anywhere in the body. On exam, she did not have facial, lip, tongue, or throat swelling. Her abdomen was tender without guarding or rigidity. Laboratory examination was unrevealing except for mild leukocytosis. Computed tomography scan (CT scan) of the abdomen with oral and IV contrast revealed a moderate amount of ascites with diffuse wall thickening, hyperenhancement, and mucosal edema of the entire small bowel. In the absence of any other pathology, matching history, and imaging findings highly suggestive of angioedema, she was diagnosed with isolated small bowel angioedema as a result of ACEI therapy. She was managed conservatively, and lisinopril was discontinued. A week later on follow-up, all her symptoms had resolved, and repeat CT scan showed resolution of all findings.

scholarly journals A Rare Case: Tuberculous Peritonitis, Encapsulating Peritoneal Sclerosis, and Incisional Hernia in Continuous Ambulatory Peritoneal Dialysis Patient

2021 ◽  
Vol 9 (C) ◽  
pp. 128-132
Author(s):  
Enita R. Kurniaatmaja ◽  
Ria Bandiara ◽  
Ika Kustiyah Oktaviyanti ◽  
Mohammad Rudiansyah
Keyword(s):  
Peritoneal Dialysis ◽  
Ct Scan ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Peritoneal Dialysis Patient ◽  
Good Prognosis ◽  
Tuberculous Peritonitis ◽  
Resistant Bacteria ◽  
Wall Thickening ◽  
Fluid Analysis

BACKGROUND: Peritonitis is the most common infectious complication of peritoneal dialysis (PD) with an estimated ratio of 1:20–30 patients per month. In addition, less than 3% cases are due to Mycobacteria, although not all are caused by Mycobacteria tuberculosis. Therefore, specific examinations are needed for proper diagnosis. Encapsulating peritoneal sclerosis (EPS), another rare complication of PD, accounts for 0.7–13.6 per 1000 patients per year. CASE REPORT: A 37-year-old man undergoing PD, with complaints of intermittent abdominal pain and cloudy fluid, followed by nausea, vomiting, and constipation. Furthermore, visible protrusion was observed on the abdominal wall due to the wound from the Tenckhoff catheter insertion surgery. This is clearly comprehended as the patient sits or stands but disappears on lying down. Along with the condition, continuous ambulatory PD (CAPD) ultrafiltration ability decreases, rough defecation occurs, with a hard sensation on the lower right abdomen. Moreover, the patient had earlier suffered peritonitis for the 3rd time. The results of the dialysate fluid analysis showed a cloudy liquid coloration, as the number of cells 278, polymorphonuclear 87, mononuclear 13, Ziehl–Neelsen +1 and acid-resistant bacteria +3 staining, including GeneXpert MTB/RIF, were positive. Furthermore, abdominal computed tomography (CT) scan revealed a thick peritoneum, partly with calcification, air-filled intestinal, dilated colon with wall thickening. Furthermore, the mesentery lining the liver and intestine were observed to be dense with multiple calcifications to support an EPS. Definitive diagnosis is confirmed by laparotomy and/or laparoscopy, but CT scan provides an alternative. Subsequently, CAPD utilization is discontinued and switched to renal replacement therapy to hemodialysis twice a week due to several complications associated with PD, ranging from recurrent peritonitis, tuberculous peritonitis, EPS, and incisional hernias responsible for an ineffective PD ultrafiltration. CONCLUSION: At present, the combination of clinical symptoms, radiology, and medical pathology remains the key to diagnosing tuberculous peritonitis and EPS. Consequently, prompt and precise analysis determines a good prognosis.

Gastric adenocarcinoma presenting with multiple skeletal muscle metastases

2021 ◽  
Vol 14 (1) ◽  
pp. e239518
Author(s):  
Dharanesh Daneti ◽  
Kuppusamy Senthamizhselvan ◽  
Surendra Kumar Verma ◽  
Pazhanivel Mohan
Keyword(s):  
Skeletal Muscle ◽  
Ct Scan ◽  
Outlet Obstruction ◽  
Needle Aspiration ◽  
The Body ◽  
Wall Thickening ◽  
Lower Back ◽  
Positron Emission ◽  
Needle Aspiration Cytology ◽  
Skeletal Muscle Metastases

A 42-year-old man presented to the gastroenterology clinic with features of gastric outlet obstruction, significant weight loss, anaemia, ascites, and pain in the lower back and left thigh. CT scan of the abdomen and pelvis showed wall thickening in the antropyloric region of the stomach and enhancing soft tissue lesion in the left psoas and right gluteal region. Gastroscopy revealed a circumferential growth in the antrum and pylorus of the stomach, and biopsy from the growth was reported as moderately differentiated adenocarcinoma. Positron emission tomography-CT scan showed multiple skeletal muscle metastases all over the body. Fine-needle aspiration cytology and immunohistochemistry from the psoas lesion confirmed metastatic adenocarcinoma deposits. He underwent antropyloric stenting for his obstructive symptoms and received supportive care, finally succumbed to his illness after 6 weeks.

scholarly journals Common Jejunal Tract Intussusception into the Jejuno-Jejunal Anastomosis as Long-Term Complication after near Total Gastrectomy for Distal Gastric Cancer

2020 ◽  
pp. 1-4
Author(s):  
Massimiliano Fabozzi ◽  
Angelo Gragnaniello ◽  
Ferdinando Amodio ◽  
Francesco Corcione ◽  
Mafalda Romano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Small Bowel ◽  
Ct Scan ◽  
Total Gastrectomy ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Small Bowel Resection ◽  
Intestinal Loop ◽  
Co Morbidity ◽  
Distal Gastric Cancer

Background: Intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB) and extremely rare after near total gastrectomy. Case Presentation: 46-years-old woman (BMI=40 kg/m2 , co-morbidity: hypertension) operated about seven months before of near total gastrectomy (for distal gastric cancer) with a small bowel resection with Roux and Y gastric reconstruction , presented epigastric pain after meals, alvus alterations lasting by a week, vomiting in the last days with leukocytosis and transaminase and amylase increase. The CT scan showed peri-hepatic fluid, gastric, duodenal and jejunal dilatation, a "target like imagine" of jejuno-jejunal anastomosis with small bowel air-fluid levels, normal intestinal loop downstream the jejuno-jejunal anastomosis. During laparoscopy we discovered ischemia of common jejunal tract intussuscepted into the jejuno-jejunal anastomosis. The common ischemic intestinal tract and the anastomosis were resected “enbloc” and jejuno-jejunal anastomosis was performed again. Conclusion: The symptoms of small bowel intussusception after near total gastrectomy are not specifics but the risk of severe complications requires an early diagnosis and treatment. According to literature data, CT-scan is the gold standard for the diagnosis but in unclear cases it is mandatory an early laparoscopic exploration to confirm the clinical suspicion and to perform the appropriate treatment.

scholarly journals 1568 A Case of Small Bowel Intussusception Occurring Six Years After Laparoscopic RYGB

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M N A Abusheikha ◽  
A Arman ◽  
W A Al Natsheh ◽  
R M A A Ayoub ◽  
R I Addasi
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Case Reports ◽  
Rare Complication ◽  
Postnatal Period ◽  
Oral Contrast ◽  
Delay In Diagnosis ◽  
First Case ◽  
Small Bowel Intussusception ◽  
Laparoscopic Rygb

Abstract Introduction We present a case of small bowel intussusception occurring in a female who had previously undergone Laparoscopic RYGB. Few case reports of retrograde intussusception occurring in pregnant patients with a history of LRYBG have been published. Up to our knowledge, this is the first case of this rare complication presenting in the postnatal period. Case report Our patient, a female in her thirties, gave birth to a healthy baby via caesarian section six years after her LRYGB. On the day following her operation, she experienced epigastric severe, progressive abdominal pain associated with nausea and vomiting. Abdominal examination showed epigastric and left upper quadrant tenderness, hypoactive bowel sounds and no palpable masses. Small bowel obstruction was suspected. A nasogastric tube was inserted and an abdominal CT scan with oral contrast was ordered. The CT scan showed multiple concentric segments of small bowel loops representing the intussusceptum pulled into the intussuscipiens, giving the classic doughnut sign. The patient was subsequently taken to theatre for a laparotomy. The mass was comprised of the biliopancreatic limb which was dilated as the common limb was retrogradely intussuscepting into it. The bowel was ischemic and remained so after manual reduction. A 45cm ischemic segment was resected and then primary re-anastomosis was done. Her postoperative course was unremarkable. Discussion Intussusception can present years after the original surgery, and imaging is not always reliable. Seeing as bariatric surgery is getting more popular, physicians should be well aware of this serious complication as delay in diagnosis increases morbidity and mortality.

CT Appearances in Treated Abdominal Tuberculosis: A Radiologist's Dilemma

2021 ◽  
Author(s):  
Vinita Rathi ◽  
Varun Yadav ◽  
Bonny S. Deep ◽  
Shuchi Bhatt ◽  
Subhash Giri
Keyword(s):  
Small Bowel ◽  
Lymph Nodes ◽  
Ct Scan ◽  
Wall Thickness ◽  
Residual Disease ◽  
Multidetector Ct ◽  
Abdominal Tuberculosis ◽  
Adult Patients ◽  
Wall Thickening ◽  
Ileocecal Tuberculosis

Abstract Objective To study the CT appearances of the abdomen after completion of antitubercular therapy (ATT) in adult patients. Methods Multidetector CT scan abdomen was done in 20 adults within 1 month of completing ATT. CT appearances were compared with pretreatment scans which were available in 7 cases. Results We found that residual ileocecal wall thickening and enhancement was significant (p < 0.05) after treatment in cases of ileocecal tuberculosis (TB). Mild decrease in wall thickness and diameter of the involved dilated small bowel loops was seen. Numerous large, matted nodes with necrosis persisted in the mesentery and retroperitoneum in treated TB, but reduction in the size of nodes was appreciated. Conclusion Our results help to fill the vacuum in the database of CT appearances in treated abdominal TB. Persistence of bowel changes and lymph nodes should not be mistaken for recurrence of TB or residual disease.

scholarly journals Relapsing Polychondritis Initially Presenting with Hoarseness and Difficulty Breathing in a 21-Year-Old Male

2016 ◽  
Vol 31 (2) ◽  
pp. 41-46
Author(s):  
Paula Francezca Padua ◽  
William L. Lim
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Cricoid Cartilage ◽  
Relapsing Polychondritis ◽  
The Body ◽  
Laryngeal Edema ◽  
Upper Respiratory Tract ◽  
Delay In Diagnosis ◽  
Difficulty Breathing ◽  
Tract Infections

Objective:       To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis. Design:                       Case Report Setting:                       Tertiary Private Hospital in Metro Manila Case Report:              A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan.  He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis. Conclusion:                Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis.  It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis.       Keywords:     Polychondritis, Relapsing; airway involvement; imaging

scholarly journals A prospective study evaluating preoperative (clinical, imaging) and intraoperative predictors of suboptimal debulking in advanced epithelial ovarian cancer

2016 ◽  
Author(s):  
Anupama Rajanbabu ◽  
Kiran Bagul ◽  
Keyword(s):  
Ovarian Cancer ◽  
Small Bowel ◽  
Ct Scan ◽  
Epithelial Ovarian Cancer ◽  
Survival Benefit ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Imaging Results ◽  
Advanced Epithelial Ovarian Cancer ◽  
Optimal Debulking

Introduction: In advanced epithelial ovarian cancer, there is a survival benefit for patients who achieve optimalcytoreduction. Suboptimallycytoreduced patients are at risk of the increased morbidity of a surgery without associated survival benefit. Predicting which patients can undergo optimal cytoreduction represents a critical decision-making point. Present study analyses the predictors, pre operative (clinical and radiologic) and intraoperative of suboptimal debulking. Methods: This was a prospective observational study conducted at Amrita Institute of Medical Sciences from March 2013 to May 2015. All the patients with clinically (physical examination, laboratory and imaging results) diagnosed Stage IIIc epithelial ovarian, fallopian tube, or primary peritoneal carcinoma (PPC) who were planed for primary debulking surgery were included. The demographic data and details of tumor markers, radiological investigations including CT scan, intra operative findings and histopathologic details were collected. Statistical analysis was done using SPSS v20.0. Results: 36 patients fit the inclusion criteria. Gross ascites wasthe clinical parameter found to be associated with suboptimal debulking. CT scan had low sensitivity (35-53%) in diagnosing small bowel mesenteric and porta hepatis disease and high sensitivity in diagnosing diffuse peritoneal thickening, omental disease, diaphragmatic and nodal disease. On univariate analysis diffuse peritoneal thickening and small bowel serosa and mesenteric disease were significantly consistent with sub optimal debulking. Conclusion: Finding out disease at the sites which are associated with suboptimal debulking (diffuse peritoneal thickening, smallbowel mesenteric and serosal disease) pre operatively or at the beginning of surgery can predict optimal debulking and can help avoid un necessary surgery.

scholarly journals A227 UMBILICAL HERNIA INCARCERATION IN LIVER CIRRHOSIS: A RARE COMPLICATION OF PARACENTESIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 263-265
Author(s):  
A LAGROTTERIA ◽  
A Aruljothy ◽  
K Tsoi
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Small Bowel ◽  
Large Volume ◽  
Umbilical Hernia ◽  
Rare Complication ◽  
Abdominal Wall Hernia ◽  
Refractory Ascites ◽  
Large Volume Paracentesis

Abstract Background Patients with decompensated liver cirrhosis with ascites frequently have umbilical hernias with a prevalence of 20% and are managed with large volume paracentesis (LVP). Common complications of LVP include hemorrhage, infection, and bowel perforation that occur infrequently with a frequency of less than 1%. However, incarceration of umbilical hernias has been reported as a rare complication of LVP and is speculated to be from ascitic fluid decompression that reduces the umbilical hernia ring diameter resulting in entrapment of the hernia sac. It is unclear whether the quantity or the fluid removal rate increases the herniation risk. Based on case series, this rare complication occurs within 48 hours of the LVP and requires emergent surgical repair and involves a high risk of morbidity and mortality due to potential infection, bleeding, and poor wound healing. Aims We describe a case report of an incarcerated umbilical hernia following a bedside large-volume paracentesis. Methods Case report Results A 59-year-old Caucasian male presented to the emergency department with a 24-hour history of acute abdominal pain following his outpatient LVP. His medical history included Child-Pugh class C alcoholic liver cirrhosis with refractory ascites managed with biweekly outpatient LVP and a reducible umbilical hernia. He reported the onset of his abdominal pain 2-hours after his LVP with an inability to reduce his umbilical hernia. Seven liters of clear, straw-coloured asitic fluid was drained. Laboratory values at presentation revealed a hemoglobin of 139 g/L, leukocyte count of 4.9 x109 /L, platelet count of 110 xo 109 /L, and a lactate of 2.7 mmol/L His physical exam demonstrated an irreducible 4 cm umbilical hernia and bulging flanks with a positive fluid wave test. Abdominal computed tomography showed a small bowel obstruction due to herniation of a proximal ileal loop into the anterior abdominal wall hernia, with afferent loop dilation measuring up to 3.4 cm. He was evaluated by the General Surgery consultation service and underwent an emergent laparoscopic hernia repair. There was 5 cm of small bowel noted to be ecchymotic but viable, with no devitalized tissue. He tolerated the surgical intervention with no post-operative complications and was discharged home. Conclusions Ultrasound-guided bedside paracentesis is a common procedure used in the management of refractory ascites and abdominal wall hernia incarceration should be recognized as a potential rare complication. To prevent hernia incarceration, patients with liver cirrhosis should be examined closely for hernias and an attempt should be made for external reduction prior to LVP. A high index of suspicion for this potential life-threatening condition should be had in patients who present with symptoms of bowel obstruction following a LVP. Funding Agencies None

scholarly journals Challenge in diagnosis of late onset necrotizing enterocolitis in a term infant: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunadi ◽  
Dian Nirmala Sirait ◽  
Aditya Rifqi Fauzi ◽  
Ninditya Nugroho ◽  
Fadil Fahri ◽  
...  
Keyword(s):  
Ct Scan ◽  
Necrotizing Enterocolitis ◽  
Intestinal Inflammation ◽  
Late Onset ◽  
Gastrointestinal Disease ◽  
Early Recognition ◽  
Ileocecal Valve ◽  
Abdominal Distention ◽  
Clinical Deterioration ◽  
Wall Thickening

Abstract Background Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up. Case presentation Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure. Conclusion Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

scholarly journals Internal hernia following total gastrectomy with Roux-en-Y reconstruction

2011 ◽  
Vol 93 (6) ◽  
pp. e71-e73 ◽  
Author(s):  
JO Larkin ◽  
F Cooke ◽  
N Ravi ◽  
JV Reynolds
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Total Gastrectomy ◽  
Internal Hernia ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Postoperative Recovery ◽  
Entire Small Bowel ◽  
History Of ◽  
Swirl Sign

Internal herniation is a well-described complication after a gastric bypass, particularly when performed laparoscopically, although it is rarely described following a total gastrectomy. A 55-year-old lady presented with a 24-hour history of vomiting and rigors 10 months after a radical total gastrectomy with Roux-en-Y reconstruction for a gastric adenocarcinoma. Computed tomography (CT) showed a complete small bowel obstruction and a mesenteric swirl sign, indicating a possible internal hernia. The entire small bowel was found at laparotomy to have migrated through the mesenteric defect adjacent to the site of the previous jejunojejunostomy and was dark purple and aperistaltic. The small bowel was reduced through the defect. At a second laparotomy, the small bowel looked healthy and the defect was repaired. Postoperative recovery was unremarkable. Of numerous signs described, the mesenteric swirl sign is considered the best indicator on CT of an internal hernia following Roux-en-Y reconstruction in gastric bypass surgery. A swirl sign on CT in a patient with abdominal pain should always raise the suspicion of an internal hernia.

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