Extensive Small Bowel Polyposis of Unknown Origin

We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest–abdomen–pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.

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796 Chronic Pneumoperitoneum: Cause or Consequence of Pneumatosis Cystoides Intestinalis

British Journal of Surgery ◽

10.1093/bjs/znab259.322 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Baggaley ◽

C Clements ◽

I Gerogiannis ◽

I Bloom

Keyword(s):

Small Bowel ◽

Unusual Case ◽

Unknown Origin ◽

Small Bowel Resection ◽

Pneumatosis Cystoides Intestinalis ◽

Emergency Laparotomy ◽

Spontaneous Pneumoperitoneum ◽

Life Threatening ◽

General Surgeons ◽

Perforated Viscus

Abstract Pneumatosis cystoides intestinalis (PCI), ‘gas cysts’ in the wall of the bowel, is a rare sign that can be found as a result of many different conditions, ranging from benign and asymptomatic, to life threatening. Its pathogenesis is not yet fully understood, and patients found to have PCI are treated in a heterogeneous manner. Pneumoperitoneum, however, is much more commonly seen by the General Surgeons, and most often occurs as a result of a perforated viscus; usually necessitating an emergent surgical intervention. Spontaneous pneumoperitoneum occurs very rarely, although it is seen more frequently with small bowel PCI, compared to large bowel PCI. We present here an unusual case of a patient with acute-on-chronic pneumoperitoneum and subsequently subacute small bowel obstruction associated with small bowel pneumatosis cystoides intestinalis. The patient also had extensive pan colonic and jejunal diverticulosis, although the area of perforation and PCI was discrete and located in the mid-ileum. It is unclear whether the patient had chronic pneumoperitoneum secondary to perforated PCI, or if the PCI developed secondary to an ileum perforation of unknown origin (fitting with the bacterial or mechanical theory of pathogenesis). The patient went onto to have an emergency laparotomy and small bowel resection 28 months after initial presentation and a trial of conservative management.

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A Case of Small Bowel Intimation with Sepsis

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i57b34058 ◽

2021 ◽

pp. 292-296

Author(s):

Sanjana Sontakke ◽

Sagar Alwadkar ◽

Mayur Wanjari

Keyword(s):

Small Bowel ◽

Abdominal Cavity ◽

Intestinal Barrier ◽

Unknown Origin ◽

Helical Ct ◽

Main Diagnosis ◽

Colon Wall ◽

Computed Tomographic ◽

Chief Complaints ◽

Loss Of Appetite

Introduction: Sepsis is a life-threatening organ failure that occurs in severely ill patients as a result of a primary infectious cause or subsequent infection of injured tissues. The systemic effects of sepsis have been extensively studied, and evidence of local alterations and repercussions in the intestinal mucosal compartment is gradually characterizing sepsis-related changes in the gut. The current study focuses on sepsis-induced intestinal barrier failure, which includes increased epithelial permeability, which may allow bacterial translocation. The small bowel, commonly known as the small intestine, is roughly 1 inch in diameter and 20 to 30 feet long. It has a lot of folds to help it fit inside the abdominal cavity. The small bowel is connected to the stomach on one end and the big intestine on the other. Patient information: He was 63 years old male admitted to Acharya Vinoba Bhave Rural hospital sawangi meghe Wardha in MICU ward with chief complaints of altering sensorium. Low urine output vomiting, loss of appetite, swelling of the abdomen crampy abdominal pain that comes and goes. The Main Diagnosis, Therapeutic Intervention and Outcomes: A CT scan revealed a thicker transverse colon wall. His flexible sigmoidoscopy revealed “patchy inflammation and an isolated area of severe deep ulceration with nodularity and edema,” according to the report. The patient was given a preliminary diagnosis of "Inflammatory Bowel Disease—likely Crohn's," and was treated with steroids and Patient was done colonoscopy and course of inj. hydrocortisone, inj. Neomol, inj. levipril. Conclusion: In the case of acute small-bowel obstruction, helical CT is a highly sensitive approach for diagnosing or ruling out intestinal ischemia. In patients with significant trauma who are being assessed for sepsis of unknown origin, abdominal computed tomographic scans accurately identify intra-abdominal foci of infection. This patient was diagnosed with small bowel intimation and sepsis.

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An unusual case of phytobezoar-induced small bowel obstruction

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz296 ◽

2019 ◽

Vol 2019 (11) ◽

Author(s):

Yasser Taha ◽

Khaled Salman ◽

Fahad Alrayyes ◽

Saad Alrayyes

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Plant Material ◽

Unusual Case ◽

Past History ◽

Unknown Origin ◽

Exploratory Laparotomy ◽

The Elderly ◽

Fibre Diet

Abstract Bezoars, and to lesser extent phytobezoars, are among the rare causes of small bowel obstruction. A bezoar generally describes retained concretions of indigestible foreign material that accumulate and conglomerate in the gastrointestinal tract, most commonly in the stomach. We present an unusual case of phytobezoar-induced sub-acute small bowel obstruction originating from unfamiliar plant material in a 74-year-old woman. The past history was insignificant regarding comorbidities other than depression. Presenting complaints were history of abdominal pain and vomiting. Imaging studies and physical examination suggested small bowel obstruction. The patient underwent exploratory laparotomy after 1 day of conservative treatment. We found a 4.5 cm obstructing phytobezoar intraoperatively. The undigested plant material caused the obstruction. Postoperatively, the plant was identified as Scorzonera papposa. The patient was discharged uneventfully. The elderly patients should avoid semi-cooked vegetables, plants of unknown origin and high-fibre diet.

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A 200-Year History of the Study of Childhood Language Disorders of Unknown Origin: Changes in Terminology

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig1-2019-0007 ◽

2020 ◽

Vol 5 (1) ◽

pp. 6-11 ◽

Cited By ~ 2

Author(s):

Laurence B. Leonard

Keyword(s):

Language Impairment ◽

Specific Language Impairment ◽

Scientific Literature ◽

Language Disorder ◽

Language Disorders ◽

Unknown Origin ◽

Developmental Language Disorder ◽

The Past ◽

History Of ◽

The Many

Purpose The current “specific language impairment” and “developmental language disorder” discussion might lead to important changes in how we refer to children with language disorders of unknown origin. The field has seen other changes in terminology. This article reviews many of these changes. Method A literature review of previous clinical labels was conducted, and possible reasons for the changes in labels were identified. Results References to children with significant yet unexplained deficits in language ability have been part of the scientific literature since, at least, the early 1800s. Terms have changed from those with a neurological emphasis to those that do not imply a cause for the language disorder. Diagnostic criteria have become more explicit but have become, at certain points, too narrow to represent the wider range of children with language disorders of unknown origin. Conclusions The field was not well served by the many changes in terminology that have transpired in the past. A new label at this point must be accompanied by strong efforts to recruit its adoption by clinical speech-language pathologists and the general public.

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