scholarly journals Gastric Cancer Presenting as Isolated Ascites: A Diagnostic Challenge

Author(s):  
Ines Duarte ◽  
Cristina Outerelo

Malignant ascites is a rare first manifestation of gastric carcinoma and is usually associated with symptoms which include early satiety, abdominal pain and deteriorating clinical state. The authors describe the case of a male patient presenting with malignant ascites of rapid onset which was the sole presentation of gastric cancer, highlighting the importance of upper gastric endoscopy even in the absence of gastrointestinal symptoms.

Author(s):  
Prachi Kamble ◽  
Samrudhhi Gujar ◽  
Savita Pohekar ◽  
Ranjana Sharma ◽  
Sheetal Sakharkar ◽  
...  

Introduction: Gastric cancer or stomach cancer is an any malignant tumor arising from the region extending between the gastroesophageal (GE) junction and the pylorus. The incidence and mortality of gastric cancer have been declining in most developed countries. The age-adjusted risk fell 5% from 1985-1990.Clinical. Findings: Abdominal pain in an  region, weakness and loss of appetite from 50 days, pain in lower limb from one month, nausea and vomiting, history of passage of black color stool (for two days, 50 days back), loss of weight five kg in last one month. Diagnostic Evaluation: Hb - 11.2 gm/dl Decreased , RBC 4.17cumm,CBC MCH- 22.6 Pico gm (decrease), Platelet -1.2 lakhs / cumm (decrease), Eosinophil- 9 % (increase )Monocytes-2% (decrease), KFT- sodium – 132 meq/L (decrease) LFT -bilirubin (conjugated) – 0.30 gm %(decrease)Bilirubin (unconjugated ) 0.33 gm %{ decrease}, CT scan, MRI, Upper GI endoscopy - showed abnormal mass ,Endoscopic ultrasound lesion as small as 2-3 mm in diameter, USG CECT Abdomen Report- showed enhancing wall thickening Involving body of gastric without obvious perigastric extension Or significant, consistent with gastric carcinoma. Histopathology report of gastrectomy specimen showed poorly Differentiated adenocarcinoma gastric­ mixed type – pT4a N1 M0. Therapeutic Interventions: Inf. Metrogyl 500 mg TDS, Inj. Amikacin 500 mg OD, Inj. Pantop 40 mg BD , Inj. Piptaz in 100ml NS 4.5  mg TDS, Inj. Levofloxacin 500 mg OD, Tab. Telma 40 mg OD, Inj. PCM in 100ml NS 500 mg TDS, Chemotherapy and Radiation therapy was also Done. Outcome: After treatment, the patient show improvement. His  abdominal pain , nausea and vomiting , pain in lower limb were relieved and After all pharmacological, surgical and medical intervention , patient is now in stables condition his mental and it physical condition is improving and laboratory value are in normal range, and he is able to do his daily activities. Conclusion: My patient was admit in surgery Ward No- 28 , AVBRH with a known case of Gastric carcinoma  and he had complaint of abdominal pain, nausea and vomiting ,pain in lower limb , weakness, black color stool and loss of appetite. After getting appropriate treatment his condition was improve.


2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Asad Jehangir ◽  
Kim Aderhold ◽  
Priya Rajagopalan ◽  
Oluwaseun Shogbesan ◽  
Sharon Swierczynski ◽  
...  

Gastric cancer is the 12th leading cause of cancer-related deaths in the United States and commonly metastasizes to the bones. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. Moreover, leptomeningeal carcinomatosis is an unusual complication of gastric cancer accounting for less than 1 percent of these patients. We present a unique case of a middle aged male who presented to the emergency department with worsening backache which started one month priorly. The only abnormal laboratory test was an elevated alkaline phosphatase of 154 IU/L. The imaging of his spine showed osteolytic lesions which on biopsy revealed signet ring cells. A small 2 cm ulcerated mass was found on esophagogastroduodenoscopy at the gastric cardia which on biopsy revealed signet ring gastric carcinoma. The patient received chemotherapy with capecitabine and oxaliplatin as well as radiation and showed a good response initially. A few months later, he presented with persistent worsening headaches and on brain imaging was found to have leptomeningeal carcinomatosis. Ten months after the diagnosis of gastric carcinoma, he passed away.


2017 ◽  
Vol 24 (1) ◽  
pp. 1 ◽  
Author(s):  
J. Zhou ◽  
L. Fang ◽  
W.Y Wu ◽  
F. He ◽  
X.L. Zhang ◽  
...  

Background Gastrointestinal (gi) symptoms are the most notable side effects of chemotherapeutic drugs; such symptoms are currently treated with drugs. In the present study, we investigated the effect of acupuncture on gi symptoms induced by chemotherapy in patients with advanced gastric cancer.Methods A cohort of 56 patients was randomly divided into an experimental group and a control group. All patients received combination chemotherapy with oxaliplatin–paclitaxel. Patients in the experimental group received 30 minutes of acupuncture therapy daily for 2 weeks. The frequency and duration of nausea, vomiting, abdominal pain, and diarrhea, the average days and costs of hospitalization, and quality-of-life scores were compared between the groups.Results Nausea was sustained for 32 ± 5 minutes and 11 ± 3 minutes daily in the control and experimental groups respectively (p < 0.05). On average, vomiting occurred 2 ± 1 times daily in the experimental group and 4 ± 1 times daily in the control group (p < 0.05). Abdominal pain persisted for 7 ± 2 minutes and 16 ± 5 minutes daily in the experimental and control groups respectively (p < 0.05). On average, diarrhea occurred 1 ± 1 times daily in the experimental group and 3 ± 1 times daily in the control group (p < 0.05). The average quality-of-life score was higher in the experimental group than in the control group (p < 0.05). No adverse events were observed for the patients receiving acupuncture.Conclusions Acupuncture, a safe technique, could significantly reduce gi symptoms induced by chemotherapy and enhance quality of life in patients with advanced gastric cancer. 


2020 ◽  
Vol 22 (2) ◽  
pp. 79-82
Author(s):  
Md Azizur Rahman ◽  
Abdullah Md Abu Ayub Ansari ◽  
Kazi Mazharul Islam ◽  
Md Aminur Rahman ◽  
ABM Abdul Matin ◽  
...  

Background: Carcinoma of the stomach is a major cause of cancer mortality worldwide. Due to social impact of gastric carcinoma (GC), there is a need to stratify patients into appropriate screening, surveillance and treatment programs. Although histopathology remains the most reliable and less expensive method, numerous efforts have been made to identify and validate novel biomarkers to accomplish the goals. In recent years, several molecules have been identified and tested for their clinical relevace in GC management. Among the biomarkers with the exception of HER2, none of the biomarkers is currently used in clinical practice, and some of them were described in single studies. Materials and Methods: This prospective type of observational study was performed in the Department of Surgery, Dhaka Medical College Hospital, Dhaka, 6 months from approval of protocol. Total 45 consecutive patients aged 18 years and above without consideration of gender were selected purposefully. Every patient was evaluated by clinical examination, appropriate investigations and after a confirm diagnosis of the tissue from the cancer. All patients have undergone operative intervention and Gastrectomy specimens were subtotal (including cardiac and pylorus), subtotal (including the pylorus), total radical gastrectomy and oesophago-gastrectomy sample. All specimens obtained were immersed in 10% formalin. Samples of whom were sent to the department of pathology, DMCH for histopathology examination. Portion of representative tissue/block was sent to AFIP (Armed Forces Institute of Pathology, Dhaka) for immunohistochemistry to find out the HER2 expression in gastric cancer and gastro-oesophageal cancer. Data was collected in a pre-designed questionnaire by face to face interview. Result and observation: In this study when 45 cases were categorized according to WHO grading system it was observed that majority (30) patients were found in grade II, among them 3(10%) were HER2 positive. But with grade III tumour the HER2 positivity were found more i,e; 37.5% (3/8). Grade- I tumor show HER2 neu expression 28.57% (2/7) and according to location most of the cases with HER2 positive expression was located in the gastro-esophageal junction which is 27.27% (3/11) than gastric carcinoma which is 14.70% (5/34). Conclusion: Most of the patients of gastric and gastrooesophageal junction adenocarcinoma are diagnosed at a very late stage, so they require special attention in treatment protocol, including chemotherapy and immunotherapy for increasing their survivability. The study showed with poorly differentiated (high grade) tumour, the HER2 positivity were found more. Journal of Surgical Sciences (2018) Vol. 22 (2) : 79-82


2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.


2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110184
Author(s):  
Yi Wang ◽  
Peiqing Ma ◽  
Kan Liu ◽  
Dongkui Xu ◽  
Qian Liu

Poorly differentiated gastric adenocarcinoma is commonly associated with lymph node metastasis, peritoneal spread, and liver metastasis but rarely with intraintestinal metastasis. Most patients with metastatic gastric carcinoma are unable to undergo surgical treatment and have a poor prognosis. A 42-year-old man with hunger-related abdominal pain was diagnosed as having gastric cancer. After the first surgery (distal partial gastrectomy) and the second surgery (gastric stump carcinoma (GSC) resection), the patient suffered repeated multiple intracolonic metastases and underwent three additional resection operations. The patient survived for 154 months after the first operation. In patients with gastric carcinoma that metastasizes to the colonic lumen, radical resection, if possible, can extend survival. Once patients develop extensive extraintestinal metastasis, radical resection cannot be performed, and patients often exhibit a poor prognosis.


Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 643
Author(s):  
Angela Saviano ◽  
Mattia Brigida ◽  
Alessio Migneco ◽  
Gayani Gunawardena ◽  
Christian Zanza ◽  
...  

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Antonio Pizuorno ◽  
Nora A. Fierro ◽  
Edgar D. Copado-Villagrana ◽  
María E. Herrera-Solís ◽  
Gholamreza Oskrochi ◽  
...  

Abstract Background Covid-19 in Mexico is on the rise in different parts of the country. We aimed to study the symptoms and comorbidities that associate with this pandemic in 3 different regions of Mexico. Methods We analyzed data from SARS-CoV-2 positive patients evaluated at healthcare centers and hospitals of Mexico (n = 1607) including Northwest Mexico (Sinaloa state), Southeast Mexico (Veracruz state) and West Mexico (Jalisco state) between March 1 and July 30, 2020. Mexico consists of a total population that exceeds 128 million. Demographics, comorbidities and clinical symptoms were collected. Statistical descriptive analysis and correlation analyses of symptoms, comorbidities and mortality were performed. Results A total of 1607 hospitalized patients positive for COVID-19 across all 3 regions of Mexico were included. The average age was 54.6 years and 60.4% were male. A mortality rate of 33.1% was observed. The most common comorbidities were hypertension (43.2%), obesity (30.3%) and diabetes (31.4%). Hypertension was more frequent in West (45%), followed by Northwest (37%) and Southeast Mexico (29%). Obesity was around 30% in Northwest and West whereas an 18% was reported in Southeast. Diabetes was most common in West (34%) followed by Northwest (22%) and Southeast (13%). This might be related to the highest mortality rate in Northwest (31%) and West (37%) when compared to Southeast. Most common symptoms in our overall cohort were fever (80.8%), cough (79.8%), headache (66%), dyspnea (71.1%), myalgia (53.8%), joints pain (50.8%) and odynophagia (34.8%). Diarrhea was the main gastrointestinal (GI) symptom (21.3%), followed by abdominal pain (18%), and nausea/ vomiting (4.5%). Diarrhea and abdominal pain were more common in West (23.1 and 21%), followed by Southeast (17.8, and 9.8%) and Northwest (11.4 and 3.1%). Conclusion Our study showed a high mortality rate likely related to high frequencies of comorbidities (hypertension, obesity and diabetes). Mortality was different across regions. These discrepancies might be related to the differences in the frequencies of comorbidities, and partially attributed to differences in socio-economic conditions and quality of care. Thus, our findings stress the need for improved strategies to get better outcomes in our population.


2021 ◽  
Vol 14 ◽  
pp. 117954762110177
Author(s):  
Rebecca DeBoer ◽  
Sahani Jayatilaka ◽  
Anthony Donato

Whipple’s disease (WD) is an uncommon cause of seronegative arthritis. WD is known for its gastrointestinal symptoms of diarrhea, weight loss, and abdominal pain. However, arthritis may precede gastrointestinal symptoms by 6 to 7 years. We describe a case of an 85-year-old Caucasian male with multiple joint complaints, not responsive to traditional treatments for conditions such as rheumatoid arthritis and osteoarthritis. We suggest that WD be considered for seronegative arthritis especially affecting large joints.


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