S1536 A Retained Gallstone Post-Cholecystectomy Presenting as Abdominal Pain and Bloody Diarrhea

Background: Even though patients with inflammatory bowel disease (IBD) are not at increased risk of COVID-19 infection, patients with post-acute COVID-19 have been reported to have de novo IBD or a new diagnosis of IBD. Objective: This article reviews the presentation, diagnosis, and clinical course of patients described in the literature to have new-onset IBD after the diagnosis of COVID-19 infection as well as discusses the possible pathophysiological mechanism. Methodology: Extensive literature review by compiling information from case reports and original studies identified by a Pubmed and EMBASE search from inception to May 2021. Results: We identified 4 cases of de novo IBD that were reported in the literature, 2 weeks – 5 months after acute COVID-19 infection. Patients presented with persistent bloody diarrhea, abdominal pain, and anemia. Three patients were diagnosed with ulcerative colitis and one patient was diagnosed with Crohn's disease. Available evidence indicates that COVID-19 infection can instigate an intestinal inflammation and trigger de novo IBD, potentially through intestinal barrier leakage, alterations in gene expression, gut microbiota dysbiosis, and exaggerated immune response. Conclusion: The presence of the SARS-CoV-2 virus in the gut can cause de novo IBD through complex multiple factors. Further studies need to be done to confirm a causal link and the underlying mechanism. Clinicians should be vigilant about the possibility of IBD in patients present with anemia, abdominal pain, or chronic bloody diarrhea after a short interval of COVID-19 infection that warrant a referral to a gastroenterologist.

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A Dropped Gallstone Leading to Abdominal Pain and Bloody Diarrhea

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2021.09.015 ◽

2021 ◽

Author(s):

Brian M. Fung ◽

Aravind Sugumar ◽

Jen-Jung Pan

Keyword(s):

Abdominal Pain ◽

Bloody Diarrhea

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An Adolescent With Abdominal Pain, Rash, Joint Swelling, Severe Bloody Diarrhea, and Impressive Leukocytosis

Clinical Pediatrics ◽

10.1177/0009922814536266 ◽

2014 ◽

Vol 53 (12) ◽

pp. 1206-1208 ◽

Cited By ~ 3

Author(s):

Tarek Alsaied ◽

Jonathan Weber ◽

Alisha George ◽

Melissa Villegas ◽

Michael T. Vossmeyer

Keyword(s):

Abdominal Pain ◽

Bloody Diarrhea

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715. A 79 year old Female with Bloody Diarrhea and Hypovolemic Shock: Keep the Differential Diagnosis Open

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.907 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S409-S409

Author(s):

Sindhura Inkollu ◽

Sindhuja Korem ◽

sukrut Dwivedi ◽

Ramy Osman ◽

Arati Inamdar

Keyword(s):

Abdominal Pain ◽

New Jersey ◽

Early Recognition ◽

Regional Distribution ◽

Hypovolemic Shock ◽

Lower Abdominal Pain ◽

Developed Countries ◽

Bloody Diarrhea ◽

Lower Quadrant ◽

Intestinal Schistosomiasis

Abstract Background Schistosomiasis is considered one of the neglected tropical diseases which is rarely seen in USA. We are reporting herein a case of intestinal schistosomiasis presented as bloody diarrhea and hypovolemic shock at Monmouth Medical Center, New Jersey. Methods: Case Report A 79 year old female presented with bleeding into her colostomy bag and associated left lower abdominal pain for one day duration. She has a history of colon cancer diagnosed 25years ago, which was treated with chemotherapy and a left hemicolectomy with colostomy formation. On admission, her blood pressure was 78/51 mm Hg. She looked pale and her abdominal examination revealed tenderness in left lower quadrant. Laboratory findings showed hemoglobin of 5.3 g/dl. CT abdomen showed extensive colitis. She was resuscitated and treated with Piperacillin-Tazobactum for 6 days with minimal improvement. Stool for ova and parasites were negative. EGD was unremarkable with no evidence of acute bleeding. Colonoscopy showed severe ulcerative colitis in the distal 30cm of colon. Pathology revealed ischemic and necrotic tissue with numerous calcified schistosoma eggs in the colon (Figure 1). After furthering questioning, the patient mentioned that she travelled to South China 8months prior to presentation. Patient was then treated with Praziquental for one day for possible Schistosomiasis Japonicum, given the regional distribution. The patient showed marked clinical improvement and was discharged home later. Figure 1: Histopathology image showing calcified schistosoma eggs in colon Results Intestinal Schistosomiasis is a parasitic disease which peaks at age 15-20yrs, older patients usually have less parasitic burden. Symptoms include diarrhea, abdominal pain, dyspepsia and malnutrition. Heavily infected patients can have hemorrhagic diarrhea, obstruction and ischemic colitis. Definitive diagnosis requires egg identification. Treatment is relatively safe and effective, especially in the developed countries where the resistance to Praziquantel (PZQ) has not been reported yet. Conclusion Even though the worms that cause the disease are not found in USA, this case highlights the importance of recognizing Schistosomiasis especially in New Jersey, due to the high traveling immigrant population, as early recognition and treatment reduces morbidity and mortality. Disclosures All Authors: No reported disclosures

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Resolution of Severe Ulcerative Colitis with the Specific Carbohydrate Diet

Case Reports in Gastroenterology ◽

10.1159/000438745 ◽

2015 ◽

Vol 9 (2) ◽

pp. 291-295 ◽

Cited By ~ 4

Author(s):

Birgit N. Khandalavala ◽

Maya C. Nirmalraj

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Gastrointestinal Symptoms ◽

Bloody Diarrhea ◽

Severe Exacerbation ◽

Carbohydrate Diet ◽

Microscopic Evaluation ◽

Progressive Weight Loss ◽

Repeat Colonoscopy ◽

Specific Carbohydrate Diet

A 73-year-old female of Asian origin was diagnosed with ulcerative colitis (UC) after initial gastrointestinal symptoms of abdominal pain and bloody diarrhea. She had a relatively benign course over the subsequent 12 years. In 2009, she had increased left-sided abdominal pain, bloody diarrhea and progressive weight loss, due to a severe exacerbation. In spite of a variety of standard treatments, her condition continued to decline with a significant impact on normal life and functioning. In December of 2010, repeat colonoscopy and microscopy confirmed pancolitis, without diverticulitis. The Specific Carbohydrate Diet (SCD) was initiated due to failure of conventional therapies. Following this highly restricted diet, within a period of 3-6 months, improvement was noted, and within a year, no abdominal pain or diarrhea were present, and she returned to her baseline functioning and career. Two years later, repeat colonoscopy showed resolution of the pancolitis, confirmed with microscopic evaluation. Successful use of the SCD in children with UC has been documented. We describe previously unreported, highly beneficial results with both symptomatic and clinical improvement and complete remission of UC in an adult female with the SCD.

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