Abdominal Pain and Vomiting in a Patient with Over-anticoagulation -- a Rare Case of Spontaneous Intramural Hematoma of the Jejunum

Anticoagulants, including vitamin K antagonists, are widely used for therapeutic and prophylactic purposes. Bleeding is the most important complication of anticoagulant therapy due to over-anticoagulation. Over-anticoagulation may present in unusual ways, such as spontaneous intramural hematoma of the small bowel. The classical clinical picture consists of abdominal pain, small bowel obstruction (that can present as vomiting) and hemorrhagic symptoms that can be related to the bowel or other parts of the body. Radiological examinations are essential for the diagnosis. Ultrasound can be helpful in the diagnostic process, but computed tomography is the procedure of choice. Conservative treatment is usually successful, including procedures that stop the over-anticoagulant consequences. A surgical approach is reserved for complications such as necrosis or perforation of the bowel. The diagnosis is definitively confirmed by the spontaneous resolution of the pathological findings on a follow-up computed tomography scan. We present a case of a 72-year-old woman who was diagnosed with this rare condition affecting the jejunum in the emergency department in our hospital.

Small bowel perforation after low-velocity trauma: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab095 ◽

2021 ◽

Vol 2021 (4) ◽

Author(s):

S Sinz ◽

L Benigno ◽

M A Zadnikar ◽

M E Biraima-Steinemann

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Case Report ◽

Small Bowel ◽

Diagnostic Laparoscopy ◽

Bowel Perforation ◽

Small Bowel Perforation ◽

Low Velocity ◽

Abstract We report the case of a 63-year-old patient with a low-velocity abdominal trauma and bowel perforation. The patient slipped on a wet floor and fell down the stairs. On admission, the patient complained about abdominal pain. A computed tomography scan showed traumatic hematoma of the jejunum in the left upper quadrant and a small amount of intra-abdominal air. Also rib fractures on the left side were diagnosed. We performed a diagnostic laparoscopy and found a bowel perforation, which was manually repaired.

Multiple Small Intestine Ulcers with Desquamation of the Fingers

Case Reports in Gastroenterology ◽

10.1159/000479222 ◽

2017 ◽

Vol 11 (2) ◽

pp. 452-461

Author(s):

Azusa Kawasaki ◽

Kunihiro Tsuji ◽

Hisashi Doyama

Keyword(s):

Computed Tomography ◽

Small Intestine ◽

Abdominal Pain ◽

Small Bowel ◽

Yersinia Pseudotuberculosis ◽

Oral Ulcers ◽

Palmar Erythema ◽

Antibody Titers ◽

Endoscopic Characteristics ◽

Multiple Ulcers

A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.

An Infant with COVID-19-Associated Intussusception

The American Surgeon ◽

10.1177/00031348211047456 ◽

2021 ◽

pp. 000313482110474

Author(s):

Gwyneth A. Sullivan ◽

Nicholas J. Skertich ◽

Kody B. Jones ◽

Michael Williams ◽

Brian C. Gulack ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Lymphoid Hyperplasia ◽

Ileocolic Intussusception ◽

Common Cause ◽

Caregiver Education ◽

Intermittent Abdominal Pain ◽

The Right ◽

Intussusception is the most common cause of bowel obstruction in infants four to ten months old and is commonly idiopathic or attributed to lymphoid hyperplasia. Our patient was a 7-month-old male who presented with two weeks of intermittent abdominal pain associated with crying, fist clenching and grimacing. Ultrasound demonstrated an ileocolic intussusception in the right abdomen. Symptoms resolved after contrast enemas, and he was discharged home. He re-presented similarly the next day and was found to be COVID-19 positive. Computed tomography scan demonstrated a left upper quadrant ileal-ileal intussusception. His symptoms spontaneously resolved, and he was discharged home. This suggests that COVID-19 may be a cause of intussusception in infants, and infants presenting with intussusception should be screened for this virus. Additionally, recurrence may happen days later at different intestinal locations. Caregiver education upon discharge is key to monitor for recurrence and need to return.

Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings

Case Reports in Gastrointestinal Medicine ◽

10.1155/2021/6695806 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Joseph Wetherell ◽

Katherine Woolley ◽

Rishi Chadha ◽

Julia Kostka ◽

Edin Adilovic ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Respiratory Distress ◽

Clinical Symptoms ◽

Failure To Thrive ◽

Rare Condition ◽

Imaging Findings ◽

Atypical Symptoms ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

Sclerosing encapsulating peritonitis is a rare condition caused by a fibrotic membrane covering the small bowel which may lead to abdominal pain or obstruction. The cause may be primary and idiopathic or secondary to several diseases, treatments, and/or medications. The condition typically presents with bowel obstruction, and only one previous case has described ascites as the presenting sign. Sclerosing encapsulating peritonitis is typically diagnosed intraoperatively. We present a case of a patient who presented with atypical clinical symptoms including respiratory distress, recurrent abdominal ascites, and failure to thrive who was diagnosed nonoperatively.

Right Lower Quadrant Abdominal Pain: Do Not Forget About Ovarian Torsion on the Computed Tomography Scan

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2018.01.006 ◽

2018 ◽

Vol 55 (2) ◽

pp. e43-e45 ◽

Cited By ~ 1

Author(s):

William Shyy ◽

Roneesha S. Knight ◽

Nathan A. Teismann

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Ovarian Torsion ◽

Lower Quadrant ◽

Quadrant Abdominal Pain ◽

Right Lower Quadrant ◽

Adaptive Dosing of Nivolumab + Ipilimumab Immunotherapy Based Upon Early, Interim Radiographic Assessment in Advanced Melanoma (The ADAPT-IT Study)

Journal of Clinical Oncology ◽

10.1200/jco.21.01570 ◽

2021 ◽

Author(s):

Michael A. Postow ◽

Debra A. Goldman ◽

Alexander N. Shoushtari ◽

Allison Betof Warner ◽

Margaret K. Callahan ◽

...

Keyword(s):

Computed Tomography ◽

Progression Free Survival ◽

Advanced Melanoma ◽

Free Survival ◽

Immunotherapy Trial ◽

Grade 3 ◽

Almost All ◽

PURPOSE Nivolumab + ipilimumab (nivo + ipi) is highly efficacious but has high toxicity. Standard treatment in advanced melanoma is four doses of nivo + ipi followed by nivo alone. Whether four doses of nivo + ipi are needed is unclear. METHODS The Adaptively Dosed ImmunoTherapy Trial (ADAPT-IT) study ( NCT03122522 ) is a multicenter, single-arm phase II clinical trial. Patients received two doses of nivo (1 mg/kg) + ipi (3 mg/kg) followed by a computed tomography scan at week 6. Patients without new lesions or index lesion tumor growth of > 4% had protocol-defined early favorable antitumor effect (FATE) and ceased nivo + ipi, transitioning to nivo monotherapy. Patients without FATE at week 6 received the standard third and fourth doses of nivo + ipi followed by nivo monotherapy. The primary end point was response rate by RECIST 1.1 at week 12. Secondary end points included additional efficacy assessments and safety. RESULTS Sixty patients were enrolled; 41 patients (68%) had FATE at week 6 and met criteria for stopping nivo + ipi. Best overall response rates by RECIST at week 12 or any time afterward were 48% (95% CI, 35 to 62) and 58% (95% CI, 45 to 71), respectively. With a median follow-up of 25 months, the estimated 18-month progression-free survival and overall survival are 52% and 80%, respectively. Fifty seven percent of patients had grade 3-5 treatment-related toxicity. CONCLUSION The efficacy and toxicity of standard four dose nivo + ipi induction therapy in melanoma is likely driven by the first two doses. An interim computed tomography scan after two doses guided cessation of combination dosing and identified almost all responders. Longer follow-up and further study are needed to fully understand the implications of a shortened induction course of nivo + ipi.

MUCINOUS MESENTERIC CYST OF SIGMOID MESOCOLON : A RARE ENTITY

10.36106/gjra/8000880 ◽

2021 ◽

pp. 22-23

Author(s):

K.Prasanth Kumar ◽

A.D.V. Lavanya ◽

P.Surendra Reddy

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Small Bowel ◽

Physical Examination ◽

Mesenteric Cyst ◽

Rare Entity ◽

Small Bowel Mesentery ◽

Mesenteric Cysts ◽

Sigmoid Mesocolon

Mesenteric cysts are rare and occur in patients of any age. They are asymptomatic and found incidentally or during the management of their complications. They commonly originate from the small bowel mesentery, although a proportion of them have been found to originate from the mesocolon (24%) and the retroperitoneum [1] [2,3,4,5] (14.5%). A mesenteric cyst originating in the sigmoid mesocolon is a very rare nding. They are a rare cause of abdominal pain and are discovered incidentally. If symptomatic, patients with these cysts present with abdominal pain, vomiting and low backache. Performing a thorough physical examination and conducting radiological investigations like ultrasonography (USG), computed tomography (CT) are keys in diagnosing the mesenteric cysts.

Voluminous Intrapericardial Lipoma Mimicking Pericardial Effusion

Case Reports in Medicine ◽

10.1155/2020/6295634 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Fabíola Prado de Morais ◽

Noah Romero Nakajima ◽

Olívia Félix Marconi Andalécio ◽

Pedro de Santana Prudente ◽

Guilherme Emílio Ferreira ◽

...

Keyword(s):

Computed Tomography ◽

Pericardial Effusion ◽

Signs And Symptoms ◽

Tumor Location ◽

Pathological Examination ◽

Radiologic Imaging ◽

Heart Tumors ◽

Lipomas are rare primary heart tumors and may involve the endocardium, myocardium, or pericardium. Signs and symptoms depend on the tumor location and size. The intrapericardial lipoma we report has massive dimensions and mimics a pericardial effusion. A 38-year-old male complained of dyspnea and precordial pain. On physical examination, heart sounds were diminished. The patient had received extensive medication for a clinically suspected pericardial effusion due to heart failure. A voluminous mass resembling fat within the pericardial sac was revealed by transesophageal echocardiography and a computed tomography scan. The tumor was removed successfully by a subxiphoid surgical approach. The diagnosis of a 635 gram intrapericardial lipoma was confirmed by pathological examination. After surgery, the patient recovered well and was completely asymptomatic at a follow-up at 90 days. No medications were being taken since. The diagnosis of a pericardial effusion should be secured by imaging exams to avoid unnecessary medications. Cardiac lipomas can be readily recognized by their typical features on radiologic imaging. The surgical pathology examination confirms the diagnosis and rules out malignancy criteria.

Grisel syndrome: a delayed presentation in an asymptomatic patient

The Journal of Laryngology & Otology ◽

10.1017/s0022215107006263 ◽

2007 ◽

Vol 121 (8) ◽

pp. 800-802 ◽

Cited By ~ 8

Author(s):

J Doshi ◽

S Anari ◽

I Zammit-Maempel ◽

V Paleri

Keyword(s):

Skull Base ◽

Asymptomatic Patient ◽

Neck Region ◽

Rare Condition ◽

Delayed Presentation ◽

Head And Neck Region ◽

Grisel Syndrome ◽

AbstractGrisel syndrome is a rare condition characterised by atlanto-axial subluxation following an inflammatory process in the head and neck region. It occurs more commonly in children and usually presents with cervical pain and torticollis, in addition to symptoms of the primary infection. We present the case of an asymptomatic 78-year-old man who was incidentally found to have atlanto-axial subluxation on a routine follow-up computed tomography scan, three months following successful treatment of a skull base infection. This case emphasises the importance of appropriate follow-up imaging for patients with skull base infections, even if they respond clinically to medical treatment.