scholarly journals Adult intussusception secondary to an appendiceal tumour in a patient with ulcerative colitis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
M. G. Davey ◽  
E. T. Conlon ◽  
G. Forde ◽  
V. M. Byrnes ◽  
P. A. Carroll
Keyword(s):  
Ulcerative Colitis ◽  
Normal Mucosa ◽  
Right Hemicolectomy ◽  
Sudden Onset ◽  
Hepatic Flexure ◽  
Adult Intussusception ◽  
Low Grade ◽  
Appendiceal Tumour ◽  
History Of ◽  
Ileocecal Intussusception

Abstract Background Intussusception in adult patients is uncommon and appendiceal lead points are particularly rare. Case presentation We present the case of a 42-year-old male with a history of ulcerative colitis, presenting with sudden onset abdominal pain and bloody diarrhoea. Endoscopy revealed grossly normal mucosa in the descending colon with a congested polypoid mass in the proximal transverse colon. Computed tomography revealed ileocecal intussusception at the hepatic flexure. A right hemicolectomy was performed, where a grossly dilated appendix was noted, resected and sent for histopathological evaluation. Results revealed low-grade appendiceal mucinous neoplasm. Post-operatively, the patient remained symptom free, however required reintroduction of biologic therapy due to relapse of his ulcerative colitis 12 weeks later. Conclusion This case depicts a rare acute surgical presentation and reminds physicians and surgeons of the importance of ‘thinking outside the box’ in clinical practice.

scholarly journals P397 Surveillance in ulcerative colitis: Can we predict the risk for intraepithelial neoplasia?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S368-S369
Author(s):  
J Estorninho ◽  
P Freire ◽  
S Lopes ◽  
M Ferreira ◽  
M Ferreira ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Duration ◽  
Intraepithelial Neoplasia ◽  
Screening Colonoscopy ◽  
Low Grade ◽  
Surveillance Colonoscopy ◽  
High Quality ◽  
Increased Risk ◽  
History Of ◽  
Low Grade Dysplasia

Abstract Background Ulcerative colitis (UC) has been associated with an increased risk of colorectal cancer (CRC). Although dye spray chromoendoscopy showed superiority to standard colonoscopy in surveillance studies, with the availability of higher-resolution colonoscopes, the utility of chromoendoscopy (CE) has been questioned. We aimed to evaluate the risk of intraepithelial neoplasia (IN) after a high-quality screening colonoscopy (making use of CE or random biopsies (RB) and removing all detected lesions) in a population with longstanding UC and to identify potential risk factors for dysplasia incidence. Methods In a previous study, 145 patients with clinically and endoscopic longstanding (≥8 yr) distal/extensive UC without primary sclerosing cholangitis and/or history of IN were prospectively randomised to undergo CE or RB. In this study, after a median follow-up of 5 additional years, we evaluated subsequent IN incidence in these patients, submitted to surveillance colonoscopy. Patients without high-quality surveillance colonoscopy (with good bowel preparation and cecum intubation) using high-definition were excluded. Results One hundred and twenty-one patients were included. Nine had removed adenomas with low-grade dysplasia in the index colonoscopy. Now, in surveillance colonoscopy, we detected 9 (7.4%) IN: low-grade dysplasia was found in 8 (6.6%) patients and a colorectal adenocarcinoma in 1 (0.008%) patient. After multivariate analysis, IN was significantly associated with older age (68 vs. 52 years, p < 0.05) and higher disease duration (26 vs. 20 years, p < 0.05). No association was found between IN and previous detection of IN in screening colonoscopy sex, the CE or RB use in index colonoscopy, extent of disease, The presence of pseudopolyps, smoking habits, familial history of CRC or maintenance therapy for UC. Conclusion In this study, older patients and higher disease duration were associated with a higher risk of IN in surveillance colonoscopy.

scholarly journals Rare presentation of ileocolic intussusception secondary to mantle cell lymphoma

2019 ◽  
Vol 12 (8) ◽  
pp. e229425
Author(s):  
Veeresh Aukhojee ◽  
Creski M Gilong ◽  
Gayatri Seewoogoolam ◽  
Paul N Strauss
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Adult Population ◽  
Right Hemicolectomy ◽  
Sudden Onset ◽  
Hepatic Flexure ◽  
Ileocolic Intussusception ◽  
Abdominal Ct ◽  
Rare Presentation ◽  
Mantle Cell

Mantle cell lymphoma is a type of B-cell non-Hodgkin’s lymphoma (NHL) and accounts for 3%–6% of all adult NHL.1 2 Bowel intussusception secondary to lymphoma is rare in adults, accounting for only 4% of all cases.3The authors present the case of a 53-year-old man, recently diagnosed with mantle cell lymphoma, who presented with sudden onset right-sided abdominal pain and was found to have ileocolic intussusception up to the hepatic flexure on abdominal CT. He underwent an emergency right hemicolectomy and intraoperatively, the terminal ileum could be seen telescoping into the caecum, up to the hepatic flexure. Although intussusception is uncommon in the adult population, an underlying bowel pathology should always be considered and prompt imaging should be organised to confirm the diagnosis and allow initiation of management in a timely manner.

scholarly journals Adult Burkitt’s lymphoma presenting as intussusception: first UK case report

2017 ◽  
Vol 99 (7) ◽  
pp. e206-e208 ◽  
Author(s):  
R Simson ◽  
A Planner ◽  
Roderick Alexander
Keyword(s):  
Epigastric Pain ◽  
Recurrent Abdominal Pain ◽  
Burkitt’S Lymphoma ◽  
Right Hemicolectomy ◽  
Burkitt's Lymphoma ◽  
Adult Intussusception ◽  
Lead Point ◽  
History Of ◽  
The Uk ◽  
Specific Symptoms

Colonic intussusception is rare in adults and can present with non-specific symptoms that can make diagnosis difficult and delayed. Unlike in children, it is commonly due to a pathological lead point that is often malignant. This case is the first reported case of adult intussusception due to Burkitt's lymphoma in the UK. We describe the case of a 22-year-old woman who presented with 4-week history of intermittent epigastric pain. On the third hospital admission, the diagnosis was made by abdominal computed tomography, which showed the ‘target’ sign, suggestive of intussusception. A right hemicolectomy was performed and histology later confirmed Burkitt’s lymphoma. This case demonstrates the difficulty in diagnosing intussusception in adults, which must be considered in recurrent abdominal pain when more common causes have been ruled out. The rare diagnosis of Burkitt’s lymphoma made early diagnosis and treatment important.

scholarly journals Synchronous Adenocarcinoma of the Colon and Rectal Carcinoid

2016 ◽  
Vol 10 (3) ◽  
pp. 600-604 ◽  
Author(s):  
Vamshidhar Vootla ◽  
Rafeeq Ahmed ◽  
Masooma Niazi ◽  
Bhavna Balar ◽  
Suresh Nayudu
Keyword(s):  
Hepatic Flexure ◽  
Rectal Carcinoid ◽  
Neuroendocrine Neoplasm ◽  
Wall Thickening ◽  
Low Grade ◽  
Invasive Adenocarcinoma ◽  
Laboratory Findings ◽  
Synchronous Tumor ◽  
History Of ◽  
Adenocarcinoma Of The Colon

Primary colonic adenocarcinoma and synchronous rectal carcinoids are rare tumors. Whenever a synchronous tumor with a nonmetastatic carcinoid component is encountered, its prognosis is determined by the associate malignancy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little effect on the prognosis of the individual. This article reports a synchronous rectal carcinoid in a patient with hepatic flexure adenocarcinoma. We present a case of a 46-year-old Hispanic woman with a history of hypothyroidism, uterine fibroids and hypercholesterolemia presenting with a 2-week history of intermittent abdominal pain, mainly in the right upper quadrant. She had no family history of cancers. Physical examination was significant for pallor. Laboratory findings showed microcytic anemia with a hemoglobin of 6.6 g/dl. CT abdomen showed circumferential wall thickening in the ascending colon near the hepatic flexure and pulmonary nodules. Colonoscopy showed hepatic flexure mass and rectal nodule which were biopsied. Pathology showed a moderately differentiated invasive adenocarcinoma of the colon (hepatic flexure mass) and a low-grade neuroendocrine neoplasm (carcinoid of rectum). The patient underwent laparoscopic right hemicolectomy and chemotherapy. In patients diagnosed with adenocarcinoma of the colon and rectum, carcinoids could be missed due to their submucosal location, multicentricity and indolent growth pattern. Studies suggest a closer surveillance of the GI tract for noncarcinoid synchronous malignancy when a carcinoid tumor is detected and vice versa.

scholarly journals Natural history of low grade dysplasia in patients with primary sclerosing cholangitis and ulcerative colitis

2013 ◽  
Vol 7 (12) ◽  
pp. 968-973 ◽  
Author(s):  
Preethi G.K. Venkatesh ◽  
Ramprasad Jegadeesan ◽  
Norma G. Gutierrez ◽  
Madhusudhan R. Sanaka ◽  
Udayakumar Navaneethan
Keyword(s):  
Ulcerative Colitis ◽  
Natural History ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Low Grade ◽  
History Of ◽  
Low Grade Dysplasia

scholarly journals Atypical Euglycemic Ketoacidosis in a non-diabetic Patient due to acute pancreatitis

2021 ◽  
Vol 11 (3) ◽  
pp. 332-336
Author(s):  
Andree Emanuilov Manov ◽  
Ikechukwu Ogbu
Keyword(s):  
Acute Pancreatitis ◽  
Metabolic Acidosis ◽  
Medical History ◽  
Clinical Presentation ◽  
Sudden Onset ◽  
Low Grade ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
Severe Metabolic Acidosis ◽  
History Of

We describe the case of a previously healthy 40- year-old Female with a known medical history of essential hypertension (HTN). She did not have past medical history of Diabetes Mellitus. She presents to the emergency department with sudden onset of severe shortness of breath that began shortly after non-bilious, non-bloating emesis. She also reported low-grade fever, nausea, cough, abdominal pain, pleuritic chest pain, and generalized weakness. She was found to have acute pancreatitis. She was diaphoretic. She had Kussmaul breathing. She was subsequently admitted to the intensive care unit (ICU) for severe metabolic acidosis. The cause of her metabolic acidosis and clinical presentation was found to be the acute pancreatitis which very rarely can be the cause of euglycemic ketoacidosis.

scholarly journals Peripherally Embolizing Aortic Thrombus: The Work-Up, Management, and Outcome of Primary Aortic Thrombus

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ramy Mando ◽  
Robert Gemayel ◽  
Ashish Chaddha ◽  
Julian J. Barbat ◽  
Elvis Cami
Keyword(s):  
Filling Defect ◽  
Sudden Onset ◽  
Low Grade ◽  
Unique Case ◽  
Descending Aorta ◽  
Aortic Thrombus ◽  
Risk Patients ◽  
History Of ◽  
Work Up

Background. Primary aortic thrombus is an uncommon entity and not frequently reported in the literature. Herein, we discuss the presentation and management of a patient with a primary thoracic mural thrombus. Case Summary. A 46-year-old female with past medical history of tobacco dependence presented for low-grade fever and sudden onset, severe right upper quadrant abdominal pain with associated nausea and vomiting. Computed tomography (CT) revealed an intraluminal polypoid filling defect arising from the isthmus of the aorta projecting into the proximal descending aorta and findings consistent with infarction of the spleen and right kidney. Infectious, autoimmune, hematologic, and oncologic work-up were all unyielding. The patient was started on heparin and later transitioned to apixaban 5 mg twice a day and 81 mg of aspirin daily. She was also counseled regarding smoking cessation. Two months follow-up CT revealed resolution of the thrombus. Patient had no further thromboembolic complications. Discussion. We present a unique case of primary aortic thrombus. To our knowledge, this is the first reported case managed successfully with a NOAC. This diagnosis is one of exclusion and through work-up should be completed. Our aim is to raise awareness of this condition and successful management with apixaban in low-risk patients.

205 Internal Herniation of The Caecum and Ascending Colon Through the Foramen of Winslow: A Case Report

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Lasheen ◽  
A Amin
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Right Hemicolectomy ◽  
Sudden Onset ◽  
Internal Herniation ◽  
Ascending Colon ◽  
Tissue Viability ◽  
Foramen Of Winslow ◽  
History Of ◽  
Operative Findings

Abstract Introduction An internal hernia occurs when part of the bowel protrudes through a mesenteric or a peritoneal orifice which could be either normally present or acquired. These hernias usually represent a challenge to diagnose. Of the natural anatomical orifices is the Foramen of Winslow through which the caecum and the ascending colon could herniate. Case Report An 85-year-old gentleman presented with a one-day history of abdominal pain. His pain had a sudden onset, an intermittent course and was limited to the epigastric region. He was nauseated but not vomiting. He had opened his bowels a day before presenting to the hospital. CT scan of the revealed herniation of the caecal pole through the foramen of Winslow and into the lesser sac. The decision was made to perform a laparotomy where it was revealed that the caecum and part of the ascending colon had herniated through the foramen of Winslow. Content of the hernia, which was viable, was carefully reduced and right hemicolectomy was performed. Conclusions With the scarcity of similar cases, we currently have no consensus of management. Dealing with the hernia at laparotomy would be usually the choice of the surgeon depending on tissue viability and other operative findings.

scholarly journals Conservative Treatment of Puerpera with Severe Hemorrhagic Shock and Secondary Coagulopathy

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Dejan Lazic ◽  
Vesna Stankovic ◽  
Dragce Radovanovic ◽  
Mladen Pavlovic ◽  
Miladin Boskovic ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Abdominal Mass ◽  
Ileocecal Valve ◽  
Right Hemicolectomy ◽  
Adult Intussusception ◽  
Lead Point ◽  
Rare Type ◽  
Risk Of Malignancy ◽  
Ileocecal Intussusception ◽  
Intestinal Obstructions

AbstractAdult intussusception is a rare entity which is distinct from paediatric cases in incidence, aetiology, and management. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions, 0,08% of all abdominal surgeries and 0,003-0,02% of all hospital admissions. Ileocolic intussusception in adults is a unique variant in which nearly 100% of cases have a malignant lead point. In our report, we described a case of a patient with ileocecal intussusception caused by a rare type of the gastrointestinal tumor. The female patient was admitted to hospital for occasional pain in the lower right quadrant of the abdomen followed by abdominal discomfort and appearance of blood in the stool. The result of CT scan of the abdomen and pelvis showed a tumor mass and intussusception at the ileocecal junction, which was confirmed peroperatively. Open right hemicolectomy was performed adhering to oncological principles. The final pathologic diagnosis indicated the gastrointestinal stromal tumor of the ileocecal valve. The diagnosis of intussusception in adults is delicate, and timely surgical treatment can be vital. Patients with the palpable abdominal mass, digestive tract obstruction, gastrointestinal bleeding, or lead point computed tomography must undergo a surgical examination. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option for the treatment of ileocecal intussusception in adults.

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