Subacute Enteritis Two Months After COVID-19 Pneumonia With Mucosal Bleeding, Perforation, and Internal Fistulas

Chronic sequelae of COVID-19 remain undetermined. We report a case of postinfection sequelae in a patient presenting with subacute obstruction 2 months after COVID-19 infection. A 34-year-old man with a prior prolonged hospital stay due to COVID-19 complicated by upper gastrointestinal (GI) bleed presented with subacute obstruction and failure to thrive. Upper GI push enteroscopy revealed residual ulcers and multiple proximal jejuno-jejunal fistulae. Midline laparotomy revealed strictures with dense intra-abdominal adhesions, a large jejuno-jejunal fistula, and evidence of prior jejunal perforation following severe COVID-19 infection. The patient recovered after small bowel resection with anastomoses and was discharged home. Histopathological examination of resected specimen confirmed transmural infarction with evidence of prior hemorrhage, diffuse ulcers, and multifocal inflammation. This is the first report of a chronic GI sequelae resulting from COVID-19. As the pandemic evolves, medical professionals must be vigilant to consider alternative GI diagnoses in the COVID-19 survivors.

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Jejunojejunal intussusception in an adult: a rare presentation of abdominal pain in the emergency department

BMJ Case Reports ◽

10.1136/bcr-2021-243787 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243787

Author(s):

Ahmed Hasan Yousef Al Zaabi ◽

Jasmine Abdulla Al Janahi ◽

Salwa Najim Alremeithi ◽

Hasan Qayyum

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Small Bowel ◽

Histopathological Examination ◽

Operative Management ◽

Small Bowel Resection ◽

Adult Intussusception ◽

Resected Specimen ◽

Lead Point ◽

Rare Presentation

Abdominal pain is a common presentation to the emergency department (ED) and the differential diagnoses is broad. Intussusception is more common in children, with only 5% of cases reported in adults. 80%–90% of adult intussusception is due to a well-defined lesion resulting in a lead point, whereas in children, most cases are idiopathic. The most common site of involvement in adults is the small bowel. Treatment in adults is generally operative management whereas in children, a more conservative approach is taken with non-operative reduction. We present a case of a 54-year-old woman who presented to our ED with severe abdominal pain and vomiting. CT of the abdomen revealed a jejunojejunal intussusception. The patient had an urgent laparoscopy and small bowel resection of the intussusception segment was performed. Histopathological examination of the resected specimen found no pathologic lead point and, therefore, the intussusception was determined to be idiopathic.

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EP.TU.533A rare clinical presentation of Goblet Cell Adenocarcinoma of the appendix: Recommendations for safe & effective management

British Journal of Surgery ◽

10.1093/bjs/znab311.072 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Ganeshan Ramsamy ◽

Zoe Slack ◽

Giovanni Tebala

Keyword(s):

Small Bowel ◽

Goblet Cell ◽

Clinical Presentation ◽

Histopathological Examination ◽

Clinical Signs ◽

Operative Management ◽

Small Bowel Resection ◽

Right Hemicolectomy ◽

Bowel Ischaemia ◽

Operative Recovery

Abstract Background Goblet cell carcinoma (GCC) is a rare mixed neoplasm arising from the appendix, consisting of glandular and neuroendocrine tissue. It typically presents in adults with a mean age of 55-65 years old. Diagnosis is usually incidental via histopathological examination after 0.3% to 0.9% of all appendicectomies. Literature remains sparse on classification and prognosis of GCC, and cases documented in younger patients. Aims To highlight an interesting clinical presentation and intra- and post-operative management of GCC. To increase awareness for future practice when managing patients with GCC. Methods A 37 year-old male presented with left sided abdominal pain, constipation and fresh rectal bleeding. Computed Tomography demonstrated extensive SMV thrombus causing small bowel ischaemia. On the Intensive Care Unit, he underwent thrombolysis through a Transjugular Intrahepatic Porto-Systemic Shunt. A few days later, he developed bowel obstruction, necessitating a small bowel resection secondary to an ischaemic stricture. 9 months later, he presented with clinical signs of appendicitis. After an uneventful appendicectomy, he was diagnosed with GCC upon histopathological examination of the specimen. Results The patient made an uneventful post-operative recovery. A multidisciplinary team (MDT) decision was made to perform a completion right hemicolectomy, with histology confirming pT3N1M0 GCC. Adjuvant chemotherapy with 5-Fluorouracil was started. Conclusion This case highlights GCC with a preceding clinical course not yet published in the literature. It stresses the importance of the MDT in managing GCC. Although primarily diagnosed histologically, a clinical suspicion of GCC of the appendix is worth considering in pro-thrombotic patients.

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Leiomyoma of Broad Ligament Mimicking Ovarian Malignancy– Report of a Unique Case

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i3.13723 ◽

2015 ◽

Vol 12 (3) ◽

pp. 219-221

Author(s):

D Mallick ◽

M Saha ◽

S Chakrabarti ◽

J Chakraborty

Keyword(s):

Histopathological Examination ◽

Broad Ligament ◽

Cystic Mass ◽

Reproductive Age ◽

Ca 125 ◽

Resected Specimen ◽

Benign Tumors ◽

Ovarian Malignancy ◽

Unique Case ◽

The Right

Tumors of the broad ligament are uncommon. Leiomyoma, which is the commonest female genital neoplasm, is also the most common solid tumor of the broad ligament. Leiomyomas affect 30% of all women of reproductive age but the incidence of broad-ligament leiomyoma is <1%. These benign tumors are usually asymptomatic. A case is being described where a 52 year old presented with gradual abdominal swelling which was clinically and radiologically diagnosed as ovarian malignancy. On abdominal and bimanual palpation a soft cystic mass was noted in the right pelvic region. CA 125 was mildly raised. CEA, CA 19.9 levels were within normal limit. The radiological diagnosis was ovarian cyst with possibility of malignant changes. Staging laparotomy and histopathological examination of the resected specimen revealed a right sided broad ligament leiomyoma with cystic changes. The degenerative changes in the leiomyoma lead to the clinical and radiological diagnostic confusion. Thus, though uncommon, broad ligament leiomyoma should be considered during evaluation of adnexal masses for optimal patient management. The above description of leiomyoma in the broad ligament is a highly unique case and thus deserves appropriate attention.Kathmandu University Medical Journal Vol.12(3) 2014; 219-221

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A Clinicopathological Review of 324 Appendices Removed for Acute Appendicitis in Durban, South Africa: A Retrospective Analysis

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x12486167521677 ◽

2009 ◽

Vol 91 (8) ◽

pp. 688-692 ◽

Cited By ~ 32

Author(s):

I Chamisa

Keyword(s):

South Africa ◽

Acute Appendicitis ◽

Retrospective Analysis ◽

Histopathological Examination ◽

Carcinoid Tumour ◽

White Cell Count ◽

Delayed Presentation ◽

Midline Laparotomy ◽

Inflammatory Conditions ◽

Operative Findings

INTRODUCTION Acute appendicitis remains a common surgical condition and the importance of specific elements in the clinical diagnosis remain controversial. A variety of neoplastic and inflammatory conditions mimic acute appendicitis. The purpose of this study was to determine the presenting pattern of acute appendicitis and to review the pathological diagnosis. PATIENTS AND METHODS This is a retrospective analysis of 324 patients who had appendicectomy for acute appendicitis at Prince Mshiyeni Memorial Hospital (Natal, South Africa) during the period January 2002 to December 2004. Patient demographics, clinical features, white cell count, operative findings, outcome and histology results were recorded on a special patient proforma. RESULTS A total of 371 patients underwent appendicectomy during this period and 324 (M:F, 3.6:1) were available for analysis. The majority of our patients were in the second decade (43.1%) with only 29.3% presenting within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Generalised and localised abdominal tenderness were present in 62.0% and 19.4% of patients, respectively. Pyrexia was noted in 41.0%. Localised and generalised peritonitis were present in 26.4% and 14.0%, respectively. The most common incisions were lower midline laparotomy (47.2%) and gridiron (37.3%). The negative appendicectomy rate was 17.0%. Acute appendiceal inflammation and gangrenous appendicitis was present in 36.1% and 9.6%, respectively. The perforation rate was 34.0% and there was a direct correlation with delayed presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 8.6% of cases. Postoperative complications included: wound sepsis (25.3%), prolonged ileus (6.2%), peritonitis (4.6%) and chest infection (3.4%). Four patients died (1.2%) all from the perforated group. CONCLUSIONS Our patients present late with advanced disease and complications. All surgeons should bear in mind the possibility of parasitic infestations mimicking acute appendicitis and the presence of significant unusual histological findings in our setting justifies routine histopathological examination of appendices.

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Retroperitoneal pararenal castleman’s disease: a case report

Journal of Pathology of Nepal ◽

10.3126/jpn.v3i6.9004 ◽

2013 ◽

Vol 3 (6) ◽

pp. 509-511

Author(s):

S Shrestha ◽

U Nepal ◽

N Lamichhane ◽

P Chhetri

Keyword(s):

Preoperative Diagnosis ◽

Histopathological Examination ◽

Castleman’S Disease ◽

Accurate Diagnosis ◽

Renal Tumors ◽

Unknown Etiology ◽

Resected Specimen ◽

Castleman's Disease ◽

Vascular Type ◽

Hyaline Vascular Type

Castleman’s diseas is a rare lymphoproliferative disorder of unknown etiology. We report a 28 years old woman with solitary Castleman’s disease in the left pararenal space. This case was diagnosed preoperatively as renal cell carcinoma. The patient underwent a radical nephrectomy with dissection of pararenal mass. Histopathological examination of the surgically resected specimen showed the hyaline vascular type of Castleman’s disease. A preoperative diagnosis of Castleman’s disease is difficult; therefore, a surgical resection and histopathological evaluation can provide an accurate diagnosis of tumor. Taking this case into consideration, we suggest that Castleman’s disease should be included in the differential diagnosis of renal tumors. DOI: http://dx.doi.org/10.3126/jpn.v3i6.9004 Journal of Pathology of Nepal (2013) Vol. 3, 509-511

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HYPERPLASTIC GASTRIC POLYPS PRESENTING WIT MASSIVE UPPER GASTRO-INTESTINAL BLEED

Journal of Nepal Medical Association ◽

10.31729/jnma.579 ◽

2004 ◽

Vol 43 (154) ◽

Author(s):

Prahlad Karki ◽

J A Ansari ◽

A Sinha ◽

S Rijal

Keyword(s):

Hyperplastic Polyp ◽

Histopathological Examination ◽

Epigastric Pain ◽

Occult Blood ◽

Anterior Wall ◽

Intestinal Bleeding ◽

Polypoid Mass ◽

Large Size ◽

Usual Site ◽

Gi Bleed

A 39 year old man presented with massive upper Gastro-intestinal (GI) Bleed of 4 days duration. There wash/o chronic epigastric pain of 6 months duration. Upper Gl Endoscopy revealed a large polypoid mass of 6cms x 5 cms in diameter on anterior wall of body. After resuscitation surgical exploration was done. Biopsyand histopathological examination revealed hyperplastic polyp. Cornual polyp of very large size (5 cm x 6cms) with presentation with massive upper gastrointestival bleeding is quite unusual. These polyp are foundin people older than 50, usual site is antrum and they usually present with occult blood loss.Key Words: Hyperplastic polyp, upper gastro-intestinal bleeding.

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Intravenous leiomyomatosis: the first reported case of intraoperative intracaval embolisation of tumour to the right atrium

BMJ Case Reports ◽

10.1136/bcr-2019-233341 ◽

2020 ◽

Vol 13 (3) ◽

pp. e233341

Author(s):

Gillian A Corbett ◽

Catherine O'Gorman ◽

Waseem Kamran

Keyword(s):

Right Atrium ◽

Uterine Leiomyoma ◽

Histopathological Examination ◽

Vena Cava ◽

Abdominal Distension ◽

Preoperative Imaging ◽

Intravenous Leiomyomatosis ◽

Midline Laparotomy ◽

First Case ◽

The Right

Intravenous leiomyomatosis is extremely rare. This case describes a 42-year-old woman who presented with abdominal distension, cyclical bloating and urinary retention. Preoperative imaging showed a multilobulated uterine mass. Following multidisciplinary team discussion, a complete staging surgery consisting of midline laparotomy, total hysterectomy and bilateral salpingo-oophrectomy was performed. Intraoperatively, a large multilobulated uterine mass was noted with engorgement of the infundibulopelvic ligaments due to intravascular extension of tumour. On removal of the uterus, the patient desaturated and became hypotensive. Intraoperative transoesophageal echocardiography revealed mass extending from the inferior vena cava (IVC) into the right atrium (RA). The cardiothoracic surgical team retrieved a worm-like mass extending from the IVC into the RA. Histopathological examination diagnosed a large uterine leiomyoma with intravenous leiomyomatosis. The mass from the RA was a bland spindle cell tumour which matched the uterine mass histopathologically. Intravenous leiomyomatosis is a rare variant of uterine leiomyoma. Although intracardiac extension has been described, this is the first case of intraoperative embolisation of pelvic tumour to the RA at hysterectomy.

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Novel Approach for Enterocutaneous Fistula Treatment with the Use of Viable Cryopreserved Placental Membrane

Case Reports in Surgery ◽

10.1155/2016/8797691 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Frederick Nichols ◽

Aaron Overly

Keyword(s):

Standard Treatment ◽

Surgical Complication ◽

Enterocutaneous Fistula ◽

Small Bowel Resection ◽

Jejunostomy Tube ◽

Novel Approach ◽

Venous Catheterization ◽

Fistula Treatment ◽

Prolonged Hospital

Enterocutaneous fistulas (ECF) are a difficult and costly surgical complication to manage. The standard treatment of nil per os (NPO) and total paraenteral nutrition (TPN) is not well tolerated by patients. TPN is also known for complications associated with long term central venous catheterization and for high cost of prolonged hospital stay. We present two low output ECF cases successfully treated with viable cryopreserved placental membrane (vCPM) placed into the fistula tracts. One patient is a 59-year-old male with a low output ECF from a jejunostomy tube site four weeks after the surgery. The second patient is an 87-year-old male with a low output ECF following a small bowel resection secondary to a strangulated inguinal hernia. He was evaluated on day 41 after surgery. NPO and TPN for several weeks did not resolute the ECF. The fistulae were closed postoperatively in both patients with zero output on the same day after one vCPM application. On day 3 postoperatively both patients were started on clear liquid diets and subsequently advanced to regular diets. The ECF have remained resolved for over 2 months. The use of vCPM is a novel promising approach for treatment of ECF.

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Malignant Peripheral Nerve Sheath Tumour of the Maxilla

Case Reports in Otolaryngology ◽

10.1155/2014/230849 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Puja Sahai ◽

Bidhu Kalyan Mohanti ◽

Devajit Nath ◽

Suman Bhasker ◽

Subhash Chander ◽

...

Keyword(s):

Peripheral Nerve ◽

Histopathological Examination ◽

Present Report ◽

Neck Region ◽

Future Research ◽

Resected Specimen ◽

Nerve Sheath Tumour ◽

Nerve Sheath ◽

Local Tumour ◽

Peripheral Nerve Sheath Tumour

A 38-year-old man was diagnosed with malignant peripheral nerve sheath tumour of the maxilla. He was treated with total maxillectomy. Histopathological examination of the resected specimen revealed a close resection margin. The tumour was of high grade with an MIB-1 labelling index of almost 60%. At six weeks following the surgery, he developed local tumour relapse. The patient succumbed to the disease at five months from the time of diagnosis. The present report underlines the locally aggressive nature of malignant peripheral nerve sheath tumour of the maxilla which necessitates an early therapeutic intervention. A complete resection with clear margins is the most important prognostic factor for malignant peripheral nerve sheath tumour in the head and neck region. Adjuvant radiotherapy may be considered to improve the local control. Future research may demarcate the role of targeted therapy for patients with malignant peripheral nerve sheath tumour.

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Mesenteric Cystic Lymphangioma “Intra-abdominal Catastrophe”

Asian Journal of Advanced Research and Reports ◽

10.9734/ajarr/2020/v14i330330 ◽

2020 ◽

pp. 1-5

Author(s):

R. S. Kiran ◽

S. Sarmukh ◽

H. Azmi

Keyword(s):

Intestinal Obstruction ◽

Histopathological Examination ◽

Primary Anastomosis ◽

Abdominal Mass ◽

Exploratory Laparotomy ◽

Small Bowel Resection ◽

Cystic Lymphangioma ◽

Co Morbidity ◽

Mesenteric Mass ◽

Life Threatening

Lymphangioma is a benign tumour of lymphatic origin. Lymphangioma in peritoneal cavity is extremely rare (5%), particularly in adults. Hereby, we are reporting a case of a Malay gentleman with no co morbidity presented with sign and symptoms of intestinal obstruction. We proceeded with exploratory laparotomy with small bowel resection with primary anastomosis. Intraoperatively, revealed soft mesenteric mass measuring around 5X5 cm and it was 80 cm from duodenum-jejunum flexure. Histopathological examination showed mesenteric cystic lymphangioma (MCL). Cystic intra-abdominal mass should be included MCL as a diagnosis although it’s rare. Surgical management is still a mainstay of treatment due to its potential to invade vital structures and develop life threatening complication such as intestinal obstruction and bleeding. The surgical outcome after a complete clear margin resection can avoid recurrence.

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