Accidental Ingestion of a Plastic Water Bottle Cap

A 78-year-old male was turned up to the emergency room with a 5-day history of vomiting, diffuse abdominal pain, and altered bowel habits. After physical examination, routine blood tests, chest, and abdominal radiographs, as well as an abdominal ultrasound had been contacted to examine his ongoing symptoms, a serious intestinal obstruction was revealed. Bowel obstruction is interrelated with his medical history, as he suffered from inoperable prostate cancer. A CT scan was performed to exclude an associated complication. A plastic, 3cm diameter, water bottle cap was in the ileum revealed with no evidence of perforation or collection. A colonoscopy by an experienced endoscopist failed to reach and retrieve the plastic water bottle cap. Finally, the plastic water bottle cap was removed through an enterotomy. Even if a careful history taking can give a clue for diagnosis, the cause of bowel obstruction could be a surprise.

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Primary Ureteral Hemangiosarcoma in a dog

BMC Veterinary Research ◽

10.1186/s12917-020-02609-8 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Joseph A. Polit ◽

Elisabeth V. Moore ◽

Ember Epperson

Keyword(s):

Computed Tomography ◽

Adjunctive Therapy ◽

Poor Prognosis ◽

Abdominal Mass ◽

Abdominal Ultrasound ◽

Pathological Findings ◽

Case Presentation ◽

Routine Monitoring ◽

Abdominal Radiographs ◽

History Of

Abstract Background Primary ureteral neoplasia in dogs is extremely rare. To the best of the authors’ knowledge, this is the second documented case of a primary ureteral hemangiosarcoma. This case report describes the clinical and pathological findings of a primary distal ureteral hemangiosarcoma. Case presentation A 12-year-old spayed female goldendoodle was presented with a history of polyuria and weight loss. Abdominal radiographs revealed a large cranial abdominal mass. Abdominal ultrasound and computed tomography (CT) identified a left sided distal ureteral mass with secondary hydroureter and a left lateral hepatic mass with no evidence of connection or diffuse metastasis. A left ureteronephrectomy, partial cystectomy, and left lateral liver lobectomy were performed. Histopathology was consistent with primary ureteral hemangiosarcoma and a hepatocellular carcinoma. Adjunctive therapy including chemotherapy was discussed but declined. Conclusion Due to its rarity, the authors of this case presentation believe that ureteral hemangiosarcoma should be included as a differential diagnosis when evaluating a ureteral mass. With the unknown, and suspected poor prognosis, routine monitoring with adjunctive therapy should be considered.

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Recurrent Enterolithiasis Small Bowel Obstruction: A Case Seldom Described

Case Reports in Gastrointestinal Medicine ◽

10.1155/2017/4684182 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Ashish Lal Shrestha ◽

Pradita Shrestha

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Exploratory Laparotomy ◽

Diffuse Abdominal Pain ◽

Case Presentation ◽

Rare Phenomenon ◽

Significant Clinical Improvement ◽

History Of ◽

High Index Of Suspicion

Background. Enterolithiasis of the small bowel is a rare phenomenon in humans although it has been frequently described in equines. Primary enteroliths have been described including those occurring secondary to conditions like Crohn’s disease, small bowel diverticula, tuberculous or postoperative strictures, and blind loops but those occurring in an otherwise normal gut are exceedingly rare. Of even greater rarity is a recurrent small bowel enterolith presenting with obstruction. This may be the first report of such kind.Case Presentation. A 70-year-old man undergoing treatment for stable alcoholic liver disease presented to the emergency with gradually progressive diffuse abdominal pain associated with vomiting and constipation for 7 days. He had gaseous abdominal distention but was not obstipated. He had a history of 2 laparotomies in the past for small bowel obstruction secondary to enterolith impaction. He was initially managed conservatively but since there was no significant clinical improvement, he underwent an exploratory laparotomy. A recurrent enterolith 5 × 5 cm in size was found impacted in the mid ileum with multiple dense serosal adhesions and bands. Adhesiolysis and enterotomy with removal of enterolith were performed.Conclusion. Recurrent enterolithiasis of the small bowel is a rare phenomenon and may present with recurrent obstruction. Definitive preoperative diagnosis is not always possible and a high index of suspicion is required to avoid table misdiagnosis. Surgery is the mainstay of treatment once conservative measures fail. Laparoscopic methods may help in diagnosis and avoid possibility of a subsequent adhesive bowel obstruction but are associated with technical challenges.

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Gastric antral vascular ectasia in children, rare presentation

BMJ Case Reports ◽

10.1136/bcr-2020-236896 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236896

Author(s):

Matthew Pizzuto ◽

Sarah Ellul ◽

Mohamed Shoukry

Keyword(s):

Gastrointestinal Endoscopy ◽

Abdominal Ultrasound ◽

Clinical Findings ◽

Evidence Based ◽

Gastric Antral Vascular Ectasia ◽

Perianal Area ◽

Rare Presentation ◽

Vascular Ectasia ◽

Blood Tests ◽

Abdominal Examination

A 14-year-old boy, a known case of perinatal hypoxic cerebral palsy, presented to paediatric emergency with acute melaena and blood staining around feeding gastrostomy site. Physical examination revealed pallor, but no signs of distress with an unremarkable abdominal examination. Routine blood tests revealed normochromic. Abdominal ultrasound scan and Meckel’s scan were unremarkable. The patient underwent examination under anaesthesia of the perianal area and joint upper and lower gastrointestinal endoscopy. Streak-like gastritis with no signs of active bleeding lesions were noted and patchy areas of colitis involving the descending and sigmoid colon and the rectum. All clinical findings and evidence-based diagnosis matched gastric antral vascular ectasia. He was successfully managed conservatively with elemental hydrolysed feeding formula.

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Endometriosis Mimicking a Cecum Mass with Complete Bowel Obstruction: An Infrequent Cause of Acute Abdomen

Case Reports in Surgery ◽

10.1155/2019/7024172 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Gabriel A. Molina ◽

Darwin R. Ramos ◽

Alberto Yu ◽

Patricio A. Paute ◽

Paul S. Llerena ◽

...

Keyword(s):

Intestinal Obstruction ◽

Bowel Obstruction ◽

Preoperative Diagnosis ◽

Malignant Tumors ◽

Signs And Symptoms ◽

Final Diagnosis ◽

Intestinal Involvement ◽

History Of ◽

Ovarian Abscess ◽

Fertile Women

Endometriosis is a common entity among fertile women which unfortunately manifests through variable symptomatology. Intestinal involvement in endometriosis is quite common and can simulate several diseases such as Crohn’s disease, appendicitis, tubo-ovarian abscess, or malignant tumors. Intestinal obstruction due to endometriosis is rare, and preoperative diagnosis is difficult because the signs and symptoms are nonspecific and can be easily confused. In the case of patients without a history of endometriosis, diagnosis is further complicated. We present a case of a 41-year-old female patient. She presented to the emergency room with complete bowel obstruction and a mass in the cecum. Surgery was decided, and the patient underwent full recovery. Endometriosis was the final diagnosis for the observed condition.

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Persistently raised aspartate aminotransferase (AST) due to macro-AST in a rheumatology clinic

Diagnosis ◽

10.1515/dx-2014-0065 ◽

2015 ◽

Vol 2 (2) ◽

pp. 137-140 ◽

Cited By ~ 2

Author(s):

Wycliffe Mbagaya ◽

Joanne Foo ◽

Ahai Luvai ◽

Claire King ◽

Sarah Mapplebeck ◽

...

Keyword(s):

Liver Function ◽

Aspartate Aminotransferase ◽

Normal Liver ◽

Abdominal Ultrasound ◽

Liver Function Tests ◽

Analytical Investigation ◽

Normal Liver Function ◽

Rheumatology Clinic ◽

History Of ◽

Liver Biopsies

AbstractMacrocomplexes between immunoglobins and aspartate aminotransferase (macro-AST) may result in persistently increased AST concentration. The presence of macro-AST in patients has been implicated in unnecessary investigations of abnormal liver function tests. We report the case of a 44-year-old female who presented to the rheumatology clinic with a 12-months’ history of constant widespread pain affecting her limbs and was found to have an elevated AST concentration. Further information from her GP revealed a 14-years’ history of elevated AST with otherwise normal liver function. Previous abdominal ultrasound and two liver biopsies carried out 2 years apart were normal. This prompted further analytical investigation by the biochemistry department which identified macro-AST as the cause. This case illustrates that persistently raised isolated AST concentration with no other abnormal indices may warrant macroenzyme analysis potentially avoiding unnecessary invasive investigations.

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Melioidosis: A Rare Cause of Liver Abscess

Case Reports in Hepatology ◽

10.1155/2016/5910375 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Peter Franz M. San Martin ◽

Catherine S. C. Teh ◽

Ma. Amornetta J. Casupang

Keyword(s):

Liver Abscess ◽

Burkholderia Pseudomallei ◽

Abdominal Ultrasound ◽

Open Drainage ◽

High Grade Fever ◽

Rare Presentation ◽

Culture Studies ◽

Moderate Growth ◽

Male Farmer ◽

History Of

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth ofBurkholderia pseudomalleiin which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound.Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused byBurkholderia pseudomalleihas not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence.

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563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.300 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Gungadin ◽

A Taib ◽

M Ahmed ◽

A Sultana

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Unusual Case ◽

Gallstone Ileus ◽

Gall Stone ◽

Case Presentation ◽

Peritoneal Encapsulation ◽

History Of ◽

Gall Stone Ileus

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

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1074 Gallstone Ileus: Two Decades After Cholecystectomy

British Journal of Surgery ◽

10.1093/bjs/znab259.358 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Matwala ◽

M R Iqbal ◽

T Shakir ◽

D W Chicken

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Rare Complication ◽

Open Cholecystectomy ◽

Gallstone Ileus ◽

Proximal Small Bowel ◽

Solid Diet ◽

History Of ◽

Ileocaecal Junction ◽

Tomography Scan

Abstract Introduction Gallstone ileus is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. We present a surprising case of gallstone ileus causing small bowel obstruction 19 years after open cholecystectomy. Case Report A 77-year-old male presented with a 3-day history of abdominal pain, 4 episodes of vomiting and absolute constipation. He had a surgical background of an open cholecystectomy and open appendicectomy 19 years and 45 years ago respectively. Medically, he had well-controlled hypertension and experienced a TIA 5 years prior. Computed Tomography Scan of the abdomen and pelvis revealed features consistent with an obstructing, heterogenous opacity in the distal small bowel without pneumobilia. The patient subsequently underwent diagnostic laparoscopy. Intraoperatively, an obstructing gallstone, measuring 4 cm, was found 50cm proximal to the ileocaecal junction, with dilatation of the proximal small bowel and distal collapse. Enterotomy and removal of the stone was done. Post-operatively, this gentleman recovered without complications and was discharged home two days later after being able to tolerate a solid diet. Conclusions This is the second reported case of gallstone ileus in a patient with previous cholecystectomy about two decades ago, according to our literature search. Although extremely rare, absence of the gallbladder does not exclude the possibility of gallstone ileus.

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Phlegmonous gastritis in 2 yearling horses

Journal of Veterinary Diagnostic Investigation ◽

10.1177/10406387211065044 ◽

2022 ◽

pp. 104063872110650

Author(s):

Julie B. Engiles ◽

Francisco A. Uzal ◽

Mauricio A. Navarro ◽

Virginia B. Reef ◽

Susan J. Bender

Keyword(s):

Clinical Signs ◽

Poor Response ◽

Abdominal Ultrasound ◽

Mucosal Injury ◽

Response To Treatment ◽

Bacterial Populations ◽

Proliferative Enteropathy ◽

Mucosal Involvement ◽

Phlegmonous Gastritis ◽

History Of

Phlegmonous gastritis was diagnosed in 2 yearling fillies that were presented with a 1-wk history of fever, lethargy, and hypoproteinemia, associated with a previous diagnosis of equine proliferative enteropathy based on clinical signs and PCR assay detection of Lawsonia intracellularis in fecal samples. Abdominal ultrasound revealed enlargement of the stomach and expansion of its submucosal layer with hypoechoic fluid, as well as thickened hypomotile small intestinal segments. Given the poor prognosis and poor response to treatment, both horses were euthanized, one on the day of presentation and the other after 3 wk of intensive medical management including a combination of antimicrobials, analgesics, and intravenous colloids. At autopsy, acute mural gastritis characterized by severe submucosal edema with suppurative inflammation (i.e., phlegmonous gastritis) and necroulcerative enteritis compatible with the necrotizing form of equine proliferative enteropathy were identified in both horses. The gastric inflammation was associated with thrombosis and mixed bacterial populations, including Clostridium perfringens, that were confined to the submucosa without evidence of mucosal involvement; toxin genes compatible with C. perfringens type C were identified in one case. Human phlegmonous gastritis is an uncommon, often-fatal pyogenic infection that is often associated with mucosal injury, bacteremia, or immunocompromise. Our finding of this unusual gastric lesion in 2 horses with similar signalment, clinical disease, and spectrum of postmortem lesions suggests a similar etiopathogenesis that possibly involves local, regional, or distant hematogenous origin, and should be considered a potential complication of gastrointestinal mucosal compromise in horses.

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An interesting case of left paraduodenal hernia.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4648 ◽

2021 ◽

Vol 28 (05) ◽

pp. 755-758

Author(s):

Sahar Saeed ◽

Abeera Butt ◽

Syed Asghar Naqi ◽

Muhammad Mohsin Ali

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Interesting Case ◽

Paraduodenal Hernia ◽

Absorbable Suture ◽

Internal Hernias ◽

Plain Abdominal Radiography ◽

History Of ◽

Operative Recovery

Paraduodenal fossa hernias (PDFHs) represent 53% of all congenital internal hernias and 0.2-0.9% of all small bowel obstructions. Most of these hernias are diagnosed incidentally on laparotomy, and carry up to 50% lifetime risk of development of small bowel obstruction. We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia in a 17 year male, containing over 30% of the small bowel (jejunum and ileum), presenting with a history of recurrent incomplete small bowel obstruction. Plain abdominal radiography showed distended loops of jejunum and few air fluid levels. After laparotomy and identification of hernia, small gut was reduced and examined, which was found to be structurally and functionally intact with normal vascularity. The defect was closed with continuous absorbable suture (Vicryl 2-0) sparing the inferior mesenteric vessels. Patient’s post-operative recovery remained uneventful and he was discharged on 4th post-operative day.

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