Hamartomatous Polyp of the Small Bowel with Cyst Formation and Intestinal Perforation: A Rare Complication

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

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Solitary Peutz-Jeghers Type Polyp of Jejunum with Gastric Fundic and Antral Gland Lining Mucosa: A Case Report and Review of Literature

International Journal of Surgical Pathology ◽

10.1177/10668969211067760 ◽

2021 ◽

pp. 106689692110677

Author(s):

Bella Lingjia Liu ◽

Huifang Zhou ◽

Martina Risech ◽

Alex Ky ◽

Jane Houldsworth ◽

...

Keyword(s):

Family History ◽

Small Bowel ◽

Smooth Muscles ◽

Fundic Gland ◽

Muscularis Mucosa ◽

Hamartomatous Polyp ◽

Gi Tract ◽

First Case ◽

Mucocutaneous Pigmentation ◽

Peutz Jeghers Syndrome

Solitary Peutz-Jeghers type polyps are characterized by a hamartomatous polyp of the gastrointestinal (GI) tract in a patient without mucocutaneous pigmentation, family history of Peutz-Jeghers syndrome, or STK11/LKB1 mutations. Histologically identical to the polyps in Peutz-Jeghers syndrome, these sporadic polyps can arise anywhere along the GI tract, with typical arborizing smooth muscles extending from the muscularis mucosa. While the lining mucosa is generally the same as the organ in which it arises, gastric pyloric and osseous metaplasia have been reported in intestinal polyps in Peutz-Jeghers syndrome. Herein, the authors report the first case of a small intestinal solitary Peutz-Jeghers type polyp with gastric antral and fundic gland lining mucosa. A 43-year-old male was admitted for small bowel obstruction. Diagnostic laparoscopy revealed jejuno-jejunal intussusception with an associated polyp measuring 7.2 cm. Histological examination showed a hamartomatous polyp with arborizing smooth muscle bundles extending from the muscularis mucosae. The polyp was lined by non-dysplastic gastric antral and fundic gland mucosa, and was sharply demarcated from the adjacent non-polypoid intestinal mucosa. Colonoscopy, esophagogastroduodenoscopy and small bowel enteroscopy revealed no additional polyps or masses. Thorough investigation of the patient's family history was negative for Peutz-Jeghers syndrome or mucocutaneous pigmentation. Molecular analysis of the lesion was negative for STK11/LKB1 mutations. A diagnosis of solitary Peutz-Jeghers type polyp of the small bowel with gastric antral and fundic gland mucosal lining was rendered.

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1074 Gallstone Ileus: Two Decades After Cholecystectomy

British Journal of Surgery ◽

10.1093/bjs/znab259.358 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Matwala ◽

M R Iqbal ◽

T Shakir ◽

D W Chicken

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Rare Complication ◽

Open Cholecystectomy ◽

Gallstone Ileus ◽

Proximal Small Bowel ◽

Solid Diet ◽

History Of ◽

Ileocaecal Junction ◽

Tomography Scan

Abstract Introduction Gallstone ileus is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. We present a surprising case of gallstone ileus causing small bowel obstruction 19 years after open cholecystectomy. Case Report A 77-year-old male presented with a 3-day history of abdominal pain, 4 episodes of vomiting and absolute constipation. He had a surgical background of an open cholecystectomy and open appendicectomy 19 years and 45 years ago respectively. Medically, he had well-controlled hypertension and experienced a TIA 5 years prior. Computed Tomography Scan of the abdomen and pelvis revealed features consistent with an obstructing, heterogenous opacity in the distal small bowel without pneumobilia. The patient subsequently underwent diagnostic laparoscopy. Intraoperatively, an obstructing gallstone, measuring 4 cm, was found 50cm proximal to the ileocaecal junction, with dilatation of the proximal small bowel and distal collapse. Enterotomy and removal of the stone was done. Post-operatively, this gentleman recovered without complications and was discharged home two days later after being able to tolerate a solid diet. Conclusions This is the second reported case of gallstone ileus in a patient with previous cholecystectomy about two decades ago, according to our literature search. Although extremely rare, absence of the gallbladder does not exclude the possibility of gallstone ileus.

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Perforation - a rare complication of a small-bowel carcinoid

European Journal of Gastroenterology & Hepatology ◽

10.1097/00042737-200012070-00015 ◽

2000 ◽

Vol 12 (7) ◽

pp. 807-808

Author(s):

Marko Duvnjak ◽

Tajana Pavic ◽

Tatjana Goranovic

Keyword(s):

Small Bowel ◽

Rare Complication

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Symptomatic Cystic Lesion Following Deep Brain Stimulation Surgery

Deep Brain Stimulation ◽

10.1093/med/9780190647209.003.0007 ◽

2020 ◽

pp. 37-40

Author(s):

Vibhash D. Sharma ◽

Shilpa Chitnis

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Rare Complication ◽

Cyst Formation ◽

Management Options ◽

Unexplained Symptoms ◽

The Common ◽

Deep Brain Stimulation Surgery ◽

Deep Brain

Deep brain stimulation therapy is an effective therapy for selected patients with movement disorders. The procedure is relatively safe, but complications related to the surgical procedure or implanted hardware can occur. The common complications include hemorrhage, infarct, infection, and confusion. Noninfectious cyst formation around the DBS lead is a rare but potential complication of this procedure, which can occur several weeks to months after DBS lead implantation. This chapter describes a case of noninfectious cyst formation at the tip of DBS lead in a patient with essential tremor. Clinical presentation, role of imaging, and the management options for this rare complication are discussed. This case also illustrates the importance of post-DBS imaging in suspected cases with new or unexplained symptoms.

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Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction

Case Reports in Gastroenterology ◽

10.1159/000444413 ◽

2016 ◽

Vol 10 (1) ◽

pp. 67-71 ◽

Cited By ~ 4

Author(s):

Glenn Harvin ◽

Adam Graham

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bowel Resection ◽

Rare Complication ◽

Small Bowel Resection ◽

Sclerosing Mesenteritis ◽

Exact Etiology ◽

Resected Tissue ◽

Uncommon Condition

Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction.

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

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz230 ◽

2019 ◽

Vol 2019 (8) ◽

Cited By ~ 1

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.

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Large cell lymphoma complicating acute lymphoblastic leukemia

Blood ◽

10.1182/blood.v63.4.935.935 ◽

1984 ◽

Vol 63 (4) ◽

pp. 935-939 ◽

Cited By ~ 4

Author(s):

R Ellerbroek ◽

K Foucar ◽

A Kowal-Vern ◽

JD Kemp ◽

T Kisker ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Small Bowel ◽

Complete Remission ◽

Cell Lymphoma ◽

Lymphoblastic Leukemia ◽

Rare Complication ◽

Large Cell ◽

Terminal Deoxynucleotidyl Transferase ◽

Large Cell Lymphoma ◽

Multiagent Chemotherapy

Abstract Non-Hodgkin's lymphoma (NHL) is a very rare complication of acute lymphoblastic leukemia (ALL). We present the pathologic, clinical, immunologic, and ultrastructural features of the third reported example of NHL following successfully treated ALL. This white girl developed ALL with predominantly L1 cells at 3.5 yr of age. The lymphoblasts were terminal deoxynucleotidyl transferase (TdT) positive and were non-B, non-T cells. She achieved a complete remission with standard induction therapy and has remained in continuous complete remission. Four and one- third years after the onset of ALL, she developed multifocal, pleomorphic large cell lymphoma of the small bowel, which resulted in episodes of intussusception and obstruction. These pleomorphic and frequently multinucleated lymphoma cells lacked TdT, common ALL antigen, and all tested markers of B cell, T cell, and histiocyte differentiation. Following three small bowel resections, systemic multiagent chemotherapy, and abdominal irradiation, she is currently free of disease.

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Small bowel perforation secondary to CMV-positive terminal ileitis postrenal transplant

BMJ Case Reports ◽

10.1136/bcr-2019-231662 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231662 ◽

Cited By ~ 1

Author(s):

Kosuke Kato ◽

Michelle Cooper

Keyword(s):

Small Bowel ◽

Rare Complication ◽

Bowel Perforation ◽

Lower Abdominal Pain ◽

Right Hemicolectomy ◽

Small Bowel Perforation ◽

Cmv Infection ◽

Terminal Ileitis ◽

Intravenous Ganciclovir ◽

Cmv Disease

Cytomegalovirus (CMV) infection of the gastrointestinal tract is common in immunosuppressed patients; however, small bowel perforation from tissue-invasive CMV disease after many years of immunosuppressive therapy is a rare complication requiring timely medical and surgical intervention. We report a case of a postrenal transplant patient who presented to the emergency department with severe lower abdominal pain with CT of the abdomen/pelvis revealing a small bowel perforation. He underwent an emergent laparoscopic right hemicolectomy, and his histopathology of the terminal ileum was positive for CMV disease. He was successfully treated with intravenous ganciclovir postoperatively. We discuss the pathophysiology, histopathological features and treatment of CMV infection.

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