scholarly journals Gigantic large bowel lipoma of hepatic flexure

2016 ◽  
Vol 63 (1) ◽  
pp. 125-128
Author(s):  
S. Ðurdjevic ◽  
G. Barisic ◽  
I. Dimitrijevic ◽  
Z. Krivokapic
Keyword(s):  
Intestinal Obstruction ◽  
Epigastric Pain ◽  
Submucosal Tumor ◽  
Histological Finding ◽  
Pathological Finding ◽  
Colonic Neoplasm ◽  
Postoperative Recovery ◽  
Hepatic Flexure ◽  
Wall Thickening ◽  
Patient Reported

Introduction: Lipoma is the third most common benign colonic neoplasm following hyperplastic and adenomatous polyps with a reported incidence of 0.2-4.4%. In 90% of cases, submucosa of the right colon is involved. These neoplasms are usually asymptomatic and require no treatment. However, giant lipomas, more than 4 cm in diameter are symptomatic in 75% of cases, causing intestinal obstruction and intussusception. Case report: 48-year-old man, with no significant medical history, nonsmoker, with unremarkable family history was admitted to hospital. Three weeks prior to admission, the patient experienced intermittent epigastric pain that lasted for 3 hours (8-9/10 on a pain scale). He also reported heartburn and flatulence following meals, as well as having change in appearance and stool frequency. Patient reported liquid stools with no traces of blood. Upper GI endoscopy showed no abnormalities. Colonoscopy revealed submucosal tumor at the level of hepatic flexure, 5.5 x3.5 cm in diameter with no other pathological finding. Abdominal MDCT reveals colonic wall thickening at the level of hepatic flexure 4.5 cm in diameter, interposition of transversal colon prehepatically and high below the diaphragm (Chialiditi syndrome). CEA values were within normal range. We performed laparscopical exploration followed by colotomy with tumor excision, through minimal upper midline incision. Histological finding confirmed the diagnosis of lipoma. Postoperative recovery was complicated due to pseudomembranous clostridial colitis but treated successfully with antibiotics. The patient is doing well, has no complaints 6 months after surgery. Conclusion: Reported incidence of colonic lipoma is rather low. However, giant ones are associated with high risk of intestinal obstruction, so we believe that detailed diagnostic work-up followed by elective operative treatment should be considered.

scholarly journals Undifferentiated colonic neoplasm with SMARCA4 germline gene mutation and loss of SMARCA4 protein expression: a case report and literature review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Huanli Duan ◽  
Wei Gao ◽  
Leiming Wang ◽  
Feng Cao ◽  
Lianghong Teng
Keyword(s):  
Protein Expression ◽  
Tumor Cells ◽  
Epigastric Pain ◽  
Abdominal Distension ◽  
Colonic Neoplasm ◽  
Right Hemicolectomy ◽  
Hepatic Flexure ◽  
The Right ◽  
Multiple Liver Metastases ◽  
Enhanced Computed Tomography

Abstract Background Nonsense mutation or inactivation of SMARCA4 (BRG1) is associated with a monomorphic undifferentiated histological appearance in tumors at different sites. The association between SMARCA4 alteration and undifferentiated colonic carcinoma needs to be further elucidated. Methods A 61-year-old male patient presented to the hospital with intermittent epigastric pain in the right upper abdomen and abdominal distension. The enhanced computed tomography detected a mass in the hepatic flexure of the colon and multiple liver metastases. Results The right hemicolectomy contained a 4.5-cm undifferentiated malignancy with cells arranged in sheets, abundant necrosis, and areas showing rhabdoid morphology. The immunohistochemistry result showed that these tumor cells were focally positive for cytokeratin (CK), CK8, and CK18; however, diffusely positive for vimentin, P53, Fli-1, and SALL-4. Notably, tumor cells showed a heterogeneous loss of SMARCA4 expression pattern and intact SMARCB1 expression. Next-generation sequencing showed a germline SMARCA4 c.3277C>T(p.R1093*)mutation, somatic APC mutation, and no abnormal SMARCB1 gene. The tumor exhibited microsatellite stability, negative PD-L1 expression, and few infiltrating CD8 + T cells. The patient died a month later after surgery. Conclusions We presented a rare case of undifferentiated colonic neoplasm with loss of SMARCA4 protein expression and germline SMARCA4 mutation. Moreover, the role of SMARCA4 alterations in tumor diagnosis and treatment was also summarized.

scholarly journals Transverse colonic volvulus due to mesenteric fibromatosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Akihiro Yoshida ◽  
Yasutake Uchima ◽  
Naoki Hosaka ◽  
Kosuke Minaga ◽  
Masatoshi Kudo
Keyword(s):  
Transverse Colon ◽  
Colonic Neoplasms ◽  
Right Hemicolectomy ◽  
Large Bowel Obstruction ◽  
Postoperative Recovery ◽  
Thyroid Tumor ◽  
Hepatic Flexure ◽  
Colonic Volvulus ◽  
Mesenteric Fibromatosis ◽  
Histopathological Results

Abstract Background Colonic volvulus, a condition in which a colonic segment partially twists around its base, is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. However, volvulus of the transverse colon is the rarest type of large intestinal volvulus. Moreover, the occurrence of transverse colonic volvulus secondary to a benign tumor originating from outside the intestine has never been reported. We hereby report a case of transverse colonic volvulus caused by mesenteric fibromatosis. Case presentation A 53-year-old female with a history of rheumatoid arthritis and thyroid tumor presented with abdominal pain for 1 day. Abdominal computed tomography revealed intestinal torsion at the hepatic flexure. Twisted and obstructed mucosa of the transverse colon was observed during colonoscopy, but no tumor invasion of the mucosal surface was detected. A solid mass of a mesenteric origin with involvement of the transverse colon was observed during surgery. The mass was diagnosed surgically as transverse colonic volvulus induced by a mesenteric tumor. Hence, the patient underwent a right hemicolectomy. Histopathological results indicated mesenteric desmoid-type fibromatosis. The postoperative recovery was uneventful, and the patient was discharged 8 days after surgery. Conclusions Although mesenteric fibromatosis is rare, this disease should be considered when managing transverse colonic volvulus resulting from nonmucosal tumors.

scholarly journals Patient-reported recovery in upper abdominal cancer surgery care: A prospective study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110169
Author(s):  
Anna Johansson ◽  
Jessica Karlsson ◽  
Victoria Fomichov ◽  
Anna Lindhoff Larsson ◽  
Per Sandström ◽  
...  
Keyword(s):  
Physical Symptoms ◽  
Postoperative Recovery ◽  
Cancer Surgery ◽  
Social Dimension ◽  
University Hospital ◽  
Care Process ◽  
Five Dimensions ◽  
Patient Reported ◽  
Upper Abdominal ◽  
A Prospective Study

The study aimed to describe and analyse patient-reported recovery in patients after upper abdominal cancer surgery. This study had a quantitative design and patients were consecutively included in a university hospital in southern Sweden. Twenty-four patients answered the Postoperative Recovery Profile (PRP) questionnaire at three measurement points. All five dimensions were affected. In the physical symptoms dimension, the majority of patients reported a lack of energy upon discharge. High levels of anxiety were reported. Over 50% of patients reported some degree of depressed mood at all three measurement points. In the social dimension, the majority of patients reported some degree of being dependent on help from others in everyday life at 4 weeks after discharge. Few patients are fully recovered at 4 weeks after discharge. Individual patient-reported recovery estimates may be valuable in identifying and planning interventions tailored to each patient’s needs throughout the care process.

scholarly journals Gastric schwannoma: a case report

2016 ◽  
Vol 6 (4) ◽  
Author(s):  
Hayfa Romdhane ◽  
Myriam Cheikh ◽  
Zeineb Mzoughi ◽  
Sana Ben Slama ◽  
Rym Ennaifer ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Submucosal Tumor ◽  
Muscularis Propria ◽  
Partial Gastrectomy ◽  
Gastric Antrum ◽  
Submucosal Tumors ◽  
Gastric Schwannoma ◽  
One Year ◽  
Immunohistochemical Studies ◽  
Enhanced Computed Tomography

Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis <em>via</em> endoscopy is a challenging issue due to the difficulty of differentiation from other submucosal tumors. A 54-year-old woman presented with epigastric pain persisting for the last 10 months. Upper endoscopy revealed an elevated submucosal mass of the gastric antrum. The overlying mucosa was normal. Biopsy specimens yielded only unspecific signs of mild inactive chronic inflammation. Endoscopic ultrasound examination noted a hypoechoic homogeneous mass lesion located in the gastric antrum. The mass appeared to arise from the muscularis propria, and there was no perigastric lymphadenopathy. A contrast-enhanced computed tomography scan identified a homogeneous round mass and arising from the antrum of the stomach. Submucosal tumor was suspected and surgical intervention was recommended. The patient underwent an elective laparoscopic partial gastrectomy. The histopathologic features and immunohistochemical-staining pattern were consistent with a benign gastric schwannoma. Our patient shows no recurrence with a follow-up of one year. The definitive diagnosis of gastric schwannomas requires immunohistochemical studies. Complete margin negative surgical resection, as in this case, is the curative treatment of choice. The clinical course is generally benign.

scholarly journals Axial torsion and gangrene of Meckel’s diverticulum: Case report

2015 ◽  
Vol 143 (1-2) ◽  
pp. 79-82
Author(s):  
Sasa Radovic ◽  
Drago Albijanic ◽  
Marko Albijanic ◽  
Zoran Krstic
Keyword(s):  
Epigastric Pain ◽  
Ileocecal Valve ◽  
Postoperative Recovery ◽  
Normal Appearance ◽  
Abdominal Incision ◽  
Surgical Exploration ◽  
Axial Torsion ◽  
Abdominal Symptoms ◽  
Complete Physical Examination ◽  
Midline Abdominal Incision

Introduction. Meckel?s diverticulum (MD) is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients. Case Outline. An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with endto- end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days. Conclusion. Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.

scholarly journals A case of severe multifocal enteritis caused by unusual pattern of Henoch-Schönlein purpura

2014 ◽  
Vol 05 (01) ◽  
pp. 033-036
Author(s):  
Sung Bum Kim ◽  
Tae Nyeun Kim ◽  
Kook Hyun Kim
Keyword(s):  
Vascular Endothelium ◽  
Epigastric Pain ◽  
Oral Prednisone ◽  
Immunoglobulin A ◽  
Neutrophil Infiltration ◽  
Wall Thickening ◽  
Henoch Schonlein Purpura ◽  
Unusual Pattern ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

AbstractA 58-year-old male visited our hospital with a complaint of epigastric pain for 2 days. Physical examination showed no purpuric skin lesion. Abdominal computed tomography scan showed concentric segmental wall thickening of the duodenum. Esophagogastroduodenoscopy showed diffuse erythematous mucosa with exudates at the duodenum. On 4th hospital day, he developed hematochezia. colonoscopy showed circumferential erythematous mucosa with ulcerative hemorrhage at terminal ileum. The microscopic examination identified lots of neutrophil infiltration and deposition of immunoglobulin A (IgA) on vascular endothelium. Treatment with oral prednisone 40 mg was initiated. On 19th day, the patient developed hematuria and proteinuria. Histologic examination on renal biopsy showed focal proliferative glomerulonephritis and strongly positive IgA staining in the glomerular mesangium. Severe hemorrhagic mucosa on endoscopy, deposition of IgA on kidney and intestinal vascular endothelium suggests the diagnosis of Henoch–Schönlein purpura (HSP). We report severe multifocal enteritis caused by unusual pattern of HSP.

Atypical presentation at acute gastritis: significant gastric wall thickening as a presentation of a primary Helicobacter pylori infection in children

2021 ◽  
Vol 14 (7) ◽  
pp. e243912
Author(s):  
Kiyokuni Nakamura ◽  
Ryo Tamura ◽  
Yoshitomi Yasui ◽  
Hideaki Okajima
Keyword(s):  
Helicobacter Pylori ◽  
Epigastric Pain ◽  
Gastric Wall ◽  
Malignant Tumour ◽  
Wall Thickening ◽  
Atypical Presentation ◽  
Negative Consequences ◽  
Ulcer Disease ◽  
Acute Gastritis ◽  
H Pylori

Helicobacter pylori infection could cause chronic inflammation in the stomach and induce peptic ulcer disease or even malignant tumour. The initial infection of the organism happens in childhood but most of cases are latent. We had a case of 10-year-old girl who presented with acute epigastric pain and significant thickening of the stomach wall on CT. The finding seemed atypical for acute gastritis so oesophagogastroduodenoscopy and serology examination were added and the primary infection of H. pylori was confirmed with the exclusion of other possible diagnoses like eosinophilic gastritis and IgA vasculitis. Acute gastritis is one of the most common sickness in children, however, it would be worthwhile considering further investigation including H. pylori infection in a case of atypical presentation to prevent negative consequences derived from chronic H. pylori infection.

scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

scholarly journals Congenital or acquired? Obstructive jaundice in reoperated duodenal atresia

2019 ◽  
Vol 12 (8) ◽  
pp. e231021 ◽  
Author(s):  
Mervin Feng Ji Goh ◽  
Malcolm Han Wen Mak ◽  
Yee Low ◽  
Caroline Choo Phaik Ong
Keyword(s):  
Obstructive Jaundice ◽  
Intestinal Obstruction ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Postoperative Recovery ◽  
Duodenal Atresia ◽  
Emergency Laparotomy ◽  
Type I ◽  
Diagnostic Dilemma ◽  
Distal Common Bile Duct

A 55-day-old boy was transferred to our unit with intestinal obstruction and obstructive jaundice after two neonatal operations for duodenal atresia and intestinal malrotation. Abdominal ultrasound showed dilated intrahepatic and extrahepatic ducts with cut-off at the distal common bile duct (CBD). He underwent emergency laparotomy for adhesive intestinal obstruction with a contained abscess from mid-jejunal perforation. Biliary dissection was not attempted due to poor preoperative nutritional status. Tube cholecystostomy was created for biliary decompression. Postoperative magnetic resonance cholangiopancreatography showed dilated CBD with cut-off at the ampulla but did not demonstrate pancreaticobiliary maljunction (PBMJ). The diagnostic dilemma was whether our patient had congenital PBMJ or had developed biliary stricture from perioperative ischaemic scarring. He underwent definitive surgery at 7 months: excision of dilated CBD with Roux-en-Y hepaticojejeunal reconstruction, excisional tapering duodenoplasty and jejunostomy creation. Intraoperative finding was type I choledochal cyst and subsequently confirmed on histology. Postoperative recovery was uneventful and bilirubin levels normalised.

scholarly journals Bouveret’s syndrome: A challenging case of gastric outlet obstruction.

2020 ◽  
Vol 27 (06) ◽  
pp. 1316-1319
Author(s):  
Marrium Gul ◽  
Irfan Qadir ◽  
Muhammad Qasim Butt
Keyword(s):  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Duodenal Bulb ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Blood Analysis ◽  
Bouveret’S Syndrome ◽  
Endoscopic Extraction ◽  
Bilioenteric Fistula ◽  
Bouveret's Syndrome

Bouveret’s syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. We present case of a 40-year-old female presented with epigastric pain and intractable vomiting for 2 days. Her physical examination and laboratory workup including blood analysis, amylase test and lipase test were normal. Plain abdominal X-ray did not show any signs of small bowel obstruction. A nasogastric tube was placed and drained 2.5 L of gastric contents immediately. Esophagogastroduodenoscopy showed a dilated stomach with excessive secretions and a large blackish-brown hard stone in the duodenal bulb. After failed attempt at endoscopic extraction, patient underwent laparotomy and removal of stone via duodenal incision. Subsequently, the patient exhibited a good postoperative recovery. The condition of the patient has remained stable after being followed up for one year.

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