scholarly journals A Rare Cause of Dyspnoea: Right-sided Bochdalek Hernia in an Adult

2020 ◽  
Author(s):  
David Rocha Paiva ◽  
Daniela Casanova ◽  
Helio Martins ◽  
Margarida Cerqueira ◽  
Mariana Formigo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Gastrointestinal Symptoms ◽  
Abdominal Distension ◽  
Bochdalek Hernia ◽  
Thoracic Pain ◽  
X Ray ◽  
History Of ◽  
Emergent Laparotomy ◽  
Multiple Episodes

Right-sided Bochdalek hernia (BH) is very rarely diagnosed in adults. It commonly presents with gastrointestinal symptoms (pain, abdominal distension and vomiting). Breathlessness, recurrent chest infections and other pulmonary sequelae can also be present. We report the case of a 92-year-old man with a 3-day history of dyspnoea, fever and thoracic pain and multiple episodes of vomiting. An x-ray was performed, and the diagnosis of a large BH hernia was confirmed by computed tomography of the thorax. The condition may be fatal in cases where the small bowel undergoes necrosis or perforation. An emergent laparotomy was performed, but the patient did not improve clinically and died immediately after the procedure.

scholarly journals Trichobezoar: presenting as primary Intestinal obstruction

2015 ◽  
Vol 1 (1) ◽  
pp. 4-6
Author(s):  
KC Madhushankar ◽  
K Manjunath ◽  
B Saiprasad ◽  
M Saishayam
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Abdominal Mass ◽  
Gastrointestinal Symptoms ◽  
Laparoscopic Approach ◽  
Abdominal Distension ◽  
Rapunzel Syndrome ◽  
Rare Type ◽  
Pain Abdomen ◽  
History Of

ABSTRACT Rapunzel syndrome is a rare type of trichobezoar with an extension of the hair into the small bowel. Clinical presentation is deceptive and vague ranging from abdominal mass to gastrointestinal symptoms. Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness, like trichotillomania, trichophagia and gastric dysmotility. Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome. Trichobezoars presenting primarily as intestinal obstruction is very rare. Diagnosis can be established by endoscopy, ultrasonography and computed tomography scan. Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy. Psychiatric consultation is necessary to treat and prevent relapse. We present the case of a 6 years old girl, where the trichobezoar was not suspected at all, especially with negative history of trichophagia and trichotillomania. This girl presented with history of intermittent pain abdomen since 3 months and recent onset severe pain abdomen with abdominal distension and vomiting. Skiagram of abdomen revealed dilated small bowel loops with multiple air fluid levels suggestive of intestinal obstruction. Even ultrasonogram of abdomen was also inconclusive for cause of obstruction. At laparotomy, dilated small bowel loops with multiple interbowel adhesions were seen. A hard mass measuring 5 × 6 cm was seen at distal jejunum causing distal obstruction with pressure necrosis over bowel wall. Enterotomy was done which revealed trichobezoar which was removed en masse. Resection and anastomosis of necrosed jejunum was done. Patient recovered completely after the procedure. How to cite this article Madhushankar KC, Manjunath K, Saiprasad B, Saishayam M. Trichobezoar: Presenting as Primary Intestinal Obstruction. J Med Sci 2015;1(1):4-6.

Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

2020 ◽  
Vol 13 (11) ◽  
pp. e236429
Author(s):  
Bankole Oyewole ◽  
Anu Sandhya ◽  
Ian Maheswaran ◽  
Timothy Campbell-Smith
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Magnetic Beads ◽  
Iliac Fossa ◽  
Serous Fluid ◽  
Magnetic Resonance Scan ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
Multiple Episodes ◽  
Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

scholarly journals Fulminant amoebic colitis in the era of computed tomography scan: A case report and review of the literature

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Suman Mewa Kinoo ◽  
Vikesh V. Ramkelawon ◽  
Jaynund Maharajh ◽  
Bugwan Singh
Keyword(s):  
Computed Tomography ◽  
Bowel Wall ◽  
Abdominal Distension ◽  
Review Of The Literature ◽  
Computed Tomography Scan ◽  
Fulminant Colitis ◽  
Bowel Necrosis ◽  
Amoebic Colitis ◽  
History Of ◽  
Tomography Scan

Amoebic colitis, caused by ingestion of water or food contaminated with the protozoan Entamoeba histolytica, can progress to a fulminant colitis. Computed tomography (CT) findings reported in the literature on this type of colitis are sparse. We present a 59-year-old male patient with a one-week history of progressive abdominal pain, abdominal distension and associated watery and bloody diarrhoea. A CT scan revealed deep ulcerations with submucosal and intramural tracking of contrast. Colonoscopy and biopsy confirmed a diagnosis of Amoebic colitis. The patient required a laparotomy and demised. Deep ulcerations with submucosal and intramural tracking of contrast on CT are diagnostic of fulminant amoebic colitis. Although not demonstrated at CT in this case, discontinuous bowel necrosis, omental wrapping (seen at laparotomy in our case) and neovascularisation of the bowel wall may be other features to look out for.

scholarly journals Small Bowel Diverticulosis Causing Pneumoperitoneum without Peritonitis: A Case Report

2018 ◽  
Vol 01 (01) ◽  
pp. 069-071
Author(s):  
Geena Benjamin ◽  
Agnes Thomas ◽  
Mathew Koshy
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Bowel Perforation ◽  
Chronic Abdominal Pain ◽  
Rare Finding ◽  
X Ray ◽  
Computed Tomography Images ◽  
Clinical Presentations ◽  
Fatal Complications

AbstractSmall bowel diverticulosis is a rare finding, with varied clinical presentations, which make the diagnosis difficult and delayed. Many cases are asymptomatic. However, it is an entity that can present with fatal complications. Here, we present a case of a 79-year-old male patient with diffuse small bowel diverticulosis, who presented with loose stools and acute exacerbation of chronic abdominal pain. Plain abdominal X-ray showed dilated bowel loops and pneumoperitoneum, which raised the possibility of bowel perforation. Computed tomography images revealed diffuse small bowel diverticulosis and pneumoperitoneum. Subsequent explorative laparotomy revealed no bowel perforation. Small bowel diverticulosis is a well-known cause of chronic/recurrent pneumoperitoneum without peritonitis or surgery.

scholarly journals Laparoscopic Nephroureterectomy for Adult Patient with Primary Obstructive Megaureter

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Kimito Osaka ◽  
Kazuhide Makiyama ◽  
Shinji Ohtake ◽  
Hiroyuki Yamanaka ◽  
Futoshi Sano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Renal Function ◽  
Surgical Intervention ◽  
Abdominal Distension ◽  
Retrograde Pyelography ◽  
Ureteral Catheter ◽  
Large Size ◽  
History Of ◽  
Obstructive Megaureter ◽  
Laparoscopic Nephroureterectomy

A 29-year-old female with a complaint of abdominal distension was referred to our hospital. She had a history of being treated for pyelonephritis three times. By computed tomography and retrograde pyelography, she was diagnosed with adult left primary megaureter. Her left renal function was severely deteriorated. She hoped for surgical intervention before becoming pregnant. Laparoscopic nephroureterectomy for megaureters seems to be difficult due to the large size. By sucking urine from an inserted ureteral catheter and setting trocar positions, we successfully performed laparoscopic nephroureterectomy for megaureter.

scholarly journals Gallstone Ileus: An Unlikely Cause of Mechanical Small Bowel Obstruction

2017 ◽  
Vol 11 (2) ◽  
pp. 389-395 ◽  
Author(s):  
Estela Abich ◽  
Daniel Glotzer ◽  
Edward Murphy
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Gallstone Ileus ◽  
Abdominal Distension ◽  
Acute Onset ◽  
Female Population ◽  
Coffee Ground ◽  
Intestinal Obstructions ◽  
Emergent Laparotomy

Gallstone ileus is a rare disease that accounts for 1–4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal fistula, pneumobilia, and small bowel obstruction. Emergent laparotomy with a one-stage procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. The postoperative course was uneventful until postoperative day 4 when the patient was found tachycardic, lethargic, and unresponsive. We reviewed the literature on the diagnosis and treatment of gallstone ileus.

scholarly journals Bortezomib Induced Paralytic Ileus: Are we Aware?

2020 ◽  
Author(s):  
Shailendra Prasad Verma ◽  
Avaneesh Shukla ◽  
Punita Pavecha ◽  
Durga Prasad Verma ◽  
Rashmi Kushwaha
Keyword(s):  
Multiple Myeloma ◽  
Peripheral Neuropathy ◽  
Side Effects ◽  
Paralytic Ileus ◽  
Gastrointestinal Symptoms ◽  
Abdominal Distension ◽  
Stool Frequency ◽  
Weekly Dose ◽  
X Ray ◽  
Rare Side Effect

Bortezomib is one of the most commonly used drugs in the treatment of multiple myeloma. It has many well-known side effects like peripheral neuropathy, thrombocytopenia and diarrhoea. Paralytic ileus has been rarely reported in patients of multiple myeloma receiving bortezomib and one should be aware about this entity. Stool frequency should be carefully monitored and the drug should be stopped timely to prevent complications of paralytic ileus. The patient was admitted for management of multiple myeloma and supportive care. He was started on the VTD (Bortezomib/thalidomide/dexamethasone) protocol. He developed abdominal distension and absolute constipation soon after the 2nd weekly dose of bortezomib. Abdominal X-ray revealed grossly dilated large bowel loops. Although he was given lactulose, glycerine suppository enema, the problem of abdominal distension and constipation persisted. His gastrointestinal symptoms improved and he was able to pass stools after bortezomib was removed from the protocol. One should be aware of this rare side effect of bortezomib. Bortezomib dose should be modified or it should be stopped timely to prevent complications.

scholarly journals An uncommon case of small bowel obstruction due to phytobezoar in a known case of tubercular abdomen: a decisional dilemma

2017 ◽  
Vol 4 (8) ◽  
pp. 2868
Author(s):  
Mayank Mishra ◽  
Neeraj Sharma ◽  
Vivekanand Rai ◽  
Alok Tripathi ◽  
Anil Kumar Keshri
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Abdominal Distension ◽  
Bowel Loop ◽  
Delay In Diagnosis ◽  
History Of ◽  
To Come ◽  
Mango Seed ◽  
Upper Abdomen

Study report the case of middle aged male who was presented with abdomen pain and diagnosed of small bowel obstruction caused by bezoar in a case of tubercular abdomen and review the literature. The initial presentation was generalised pain with nausea and vomiting and abdominal distension. Plain abdomen film showed diffuse dilated bowel loop in upper abdomen. Patient had similar recurrent episode 12 months back when he was managed conservatively and diagnosed as tubercular abdomen and he had taken ATT for 3 months. At this time patient managed conservatively, but did not respond. Later a CECT whole abdomen was done and patient diagnosed as cocoon abdomen with mass or a foreign body impacted at distal jejunal region with proximal bowel dilatation. Later patient revealed ingestion of a large mango seed 4 months back. Later patient was explored, adhesionolysis and enterotomy was done and phytobezoar was removed. Early history of recurrent tubercular obstruction with non- specific symptoms. Later recognition of condition by typical imaging and leading questions induced history image play an important role in to come to a diagnosis, with significant delay in diagnosis; and increase the morbidity and mortality. 

scholarly journals Empyema necessitatis due to Citrobacter freundii: Case report

2018 ◽  
Vol 66 (4) ◽  
pp. 639-642
Author(s):  
Diego Andrés Rodríguez-Lugo
Keyword(s):  
Computed Tomography ◽  
Cognitive Deficit ◽  
Middle Lobe ◽  
Citrobacter Freundii ◽  
X Ray ◽  
First Case ◽  
Antibiotic Management ◽  
History Of ◽  
Chest X Ray ◽  
Positive Report

Introduction: This paper presents the first case of empyema necessitatis secondary to infection with Citrobacter freundii (according to the databases consulted), and one of the few reports of this pathology in Colombia.Case presentation: This is the case of a 26-year-old patient from a rural area, with a history of severe cognitive deficit, who was taken to the emergency department due to a clinical picture of 15 days of evolution consisting of neurological deterioration associated with asthenia, adynamia, fever and cough with purulent expectoration. On admission, a chest x-ray was taken, finding pneumonia of the middle lobe with associated pleural effusion, for which empirical antibiotic management was initiated. The patient presented clinical deterioration and appearance of right pectoral mass, so a computed tomography of the thorax was performed, revealing empyema necessitatis. Close drainage and culture of the collection were made, with negative mycobacteria culture and positive report for C. freundii. The patient received specific antibiotic treatment for 8 weeks, with complete improvement of his clinical condition.Conclusion: Besides being the first case of empyema necessitatis by C. freundii that has been reported, this case is important because of the low amount of reports on this pathology in Colombia, considering that its main cause is tuberculosis, which is endemic in the country.

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