Lymphangioma of the jejunal mesentery and jejunal polyps presenting as an acute abdomen in a teenager

Cystic lymphangioma of the small bowel mesentery is a rare clinical entity, especially after childhood. Medical literature reveals a limited number of such cases presenting as acute abdomen due to bowel obstruction, small bowel volvulus and bleeding into the tumour. We present the management experience of an 18-year-old woman who presented with rapid onset diffuse peritonism and raised inflammatory markers. Computed tomography showed a mass in the small bowel mesentery with suspicion of segmental bowel ischaemia. Emergency laparotomy revealed a mass in the mid-jejunal mesentery close to the bowel wall with no bowel ischaemia. The patient made an uncomplicated recovery after segmental bowel resection and end-to-end anastomosis. Histology confirmed the mass as a cystic lymphangioma involving the jejunal mesentery and two small jejunal polyps. Lymphangioma could be considered in the differential diagnosis of an acute abdomen in a young adult when the presentation is atypical.

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An Uncommon An Uncommon Cause of Acute Abdomen in Underprivileged Communities

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.175 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

David Muchuweti ◽

Hopewell Mungani ◽

Farai Mahomva ◽

Edwin Gamba Muguti ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Acute Abdomen ◽

Bowel Obstruction ◽

Bowel Wall ◽

Haemodynamic Instability ◽

Small Bowel Volvulus ◽

General Surgeons ◽

Heavy Infestation ◽

Emergency Abdominal Surgery

Oftentimes general surgeons working in poorly resourced communities carry out emergency abdominal surgery in patients with acute abdomen with no definitive preoperative diagnosis. The definitive diagnosis is made at laparotomy. Perforated small bowel obstruction secondary to heavy Infestation with Ascaris Lumbricoides brings a number of intraoperative challenges requiring correct intraoperative surgical management decisions. We present a case of a 17 year-old patient who was admitted with a diagnosis of small bowel obstruction who at laparotomy was found to have perforated gangrenous small bowel volvulus with heavy worm load visible through the bowel wall. Because of faecal peritoneal contamination and haemodynamic instability she underwent a two staged procedure with good outcome.

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Cocaine-induced mesenteric ischaemia requiring small bowel resection

BMJ Case Reports ◽

10.1136/bcr-2020-238593 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238593

Author(s):

Asya Veloso Costa ◽

Asiya Zhunus ◽

Rehana Hafeez ◽

Arsh Gupta

Keyword(s):

Small Bowel ◽

Social History ◽

Bowel Resection ◽

Early Recognition ◽

Small Bowel Resection ◽

Emergency Laparotomy ◽

Mesenteric Ischaemia ◽

Bowel Ischaemia ◽

Systemic Complications ◽

Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

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Acute mesenteric ischaemia due to superior mesenteric vein (SMV) thrombosis

BMJ Case Reports ◽

10.1136/bcr-2020-239110 ◽

2021 ◽

Vol 14 (4) ◽

pp. e239110

Author(s):

Muhammad Salah Muhammad Ahmad ◽

Muhammad Rafaih Iqbal ◽

Jonathan Simon Refson

Keyword(s):

Small Bowel ◽

Surgical Management ◽

Superior Mesenteric Vein ◽

Anticoagulation Therapy ◽

Emergency Laparotomy ◽

Bowel Ischaemia ◽

Thrombotic Occlusion ◽

Mesenteric Vein ◽

Coffee Ground ◽

History Of

A 77-year-old male patient presented with a 5-day history of abdominal pain, coffee ground vomiting and blood-stained diarrhoea. CT scan of the abdomen and pelvis demonstrated a long segment thrombotic occlusion of the superior mesenteric vein (SMV) extending up to the proximal portion of the portal vein causing significant acute small bowel ischaemia. Patient’s deteriorating clinical condition warranted surgical management. Successful surgical management required multidisciplinary teamwork between emergency, vascular surgeons, anaesthetists and intensivists. Emergency laparotomy revealed gangrene of an estimated 120 cm of small bowel segment starting from duodenojejunal junction and a long segment thrombotic occlusion of the SMV extending up to the portal confluence. Resection of gangrenous small bowel without anastomosis and thrombo-embolectomy of SMV along with laparostomy was done at the initial operation. Patient was admitted in the intensive care unit on systemic heparinisation through intravenous administration of unfractionated heparin. Second relook exploration was done after 48 hours followed by anastomosis of the small bowel and closure of the abdomen. Patient made a good recovery following anticoagulation therapy and was discharged on postoperative day 10.

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