An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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A CASE REPORT ON WILSON'S DISEASE INDUCED LIVER CIRRHOSIS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i4.16239 ◽

2017 ◽

Vol 10 (4) ◽

pp. 113

Author(s):

Remya Reghu ◽

Bini Vincent ◽

Aloysius James ◽

Syamaprasad Tv ◽

Reshma Reji

Keyword(s):

Liver Cirrhosis ◽

Case Report ◽

Portal Hypertension ◽

Medical History ◽

Copper Deposit ◽

Copper Transport ◽

Medical Professionals ◽

Genetic Abnormality ◽

History Of ◽

Cellular Copper

ABSTRACTWilsons disease is an inherited autosomal genetic abnormality genetic abnormality which results in impairment in cellular copper transport. Overtime this may leads to liver cirrhosis. The main focus of this case is to shows the importance of taking medical history. Here we discuss a case of 35 year old male diagnosed with Wilsons disease induced Liver cirrhosis and portal hypertension. He was physically very weak. Since the same genetic abnormality was the reason for the death of his sibling which was not considered while taking the medical history of this patient, this led to a late diagnosis of 4 years while the patient's condition became worst. Here in we report a case that provides an insight to medical professionals about taking proper medical history of patients.Key Words : Wilsons Disease, Liver Cirrhosis, Copper Deposit

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Posttraumatic Aneurysm of a Patent Umbilical Vein: Diagnosis and Specific Treatment

The Surgery Journal ◽

10.1055/s-0037-1604075 ◽

2017 ◽

Vol 03 (03) ◽

pp. e113-e116

Author(s):

Matthias Grade ◽

Siegfried Krishnabhakdi ◽

Thomas Vestring ◽

Micha Löbermann ◽

Joachim Arnold

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Acute Abdominal Pain ◽

Umbilical Vein ◽

Specific Treatment ◽

Rare Condition ◽

Risk Of Rupture ◽

Valuable Treatment ◽

Intrahepatic Portosystemic Shunt ◽

History Of

A patent umbilical vein is a rare condition in healthy volunteers, but can be detected in up to 11% of patients with liver cirrhosis as a consequence of portal hypertension.We report the case of a 52-year-old woman who was admitted to our department with acute abdominal pain after blunt trauma to her forehead and abdomen. She had a history of alcohol abuse with liver cirrhosis that had been classified as Child–Pugh stage C 5 years earlier. Signs of portosystemic shunting had been present at an earlier endoscopy, and esophageal varices were found.Clinical examination revealed typical signs of liver cirrhosis, and ultrasound examination showed an aneurysm of 6 cm of the umbilical vein, which had not been present at earlier examinations. After lowering portal hypertension by inserting a transjugular intrahepatic portosystemic shunt, an open surgical resection of the aneurysmal umbilical vein was performed without complications. The patient recovered well and was discharged from the hospital 10 days later.We hypothesize that the abdominal trauma prompted or aggravated umbilical vein aneurysm in this patient with liver cirrhosis and portal hypertension. Due to the risk of rupture, a surgery-based resection is a valuable treatment option.

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Urokinase Antigen in Plasma of Patients with Liver Cirrhosis and Hepatoma

Thrombosis and Haemostasis ◽

10.1055/s-0038-1660082 ◽

1985 ◽

Vol 54 (03) ◽

pp. 617-618 ◽

Cited By ~ 15

Author(s):

J C Kirchheimer ◽

K Huber ◽

P Polterauer ◽

B R Binder

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Liver Function ◽

Matched Control ◽

Malignant Growth ◽

Control Groups ◽

Impaired Liver Function ◽

Impaired Liver ◽

Specific Medication ◽

History Of

SummaryPlasma urokinase antigen levels were studied in 78 patients suffering from liver diseases. Blood was drawn before any specific medication was initiated. Impairment of liver function was comparable in all patients. In both groups of cirrhotic liver disease (alcoholic and non-alcoholic), normal levels of plasma urokinase antigen were found as compared to age-matched control groups. In both groups of patients with hepatomas (with or without a history of liver cirrhosis), however, significantly increased plasma urokinase antigen levels could be determined. These data indicate that an increase in plasma urokinase antigen might rather relate to malignant growth in liver disease than to impaired liver function.

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Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease

Endoscopy International Open ◽

10.1055/a-1233-1934 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1623-E1632

Author(s):

Carlos Robles-Medranda ◽

Roberto Oleas ◽

Miguel Puga-Tejada ◽

Manuel Valero ◽

Raquel Del Valle ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Chronic Liver Disease ◽

Predictive Value ◽

Strain Ratio ◽

Chronic Liver ◽

Spleen Stiffness ◽

Eus Elastography ◽

Sensitivity Specificity

Abstract Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

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A227 UMBILICAL HERNIA INCARCERATION IN LIVER CIRRHOSIS: A RARE COMPLICATION OF PARACENTESIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.225 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 263-265

Author(s):

A LAGROTTERIA ◽

A Aruljothy ◽

K Tsoi

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Small Bowel ◽

Large Volume ◽

Umbilical Hernia ◽

Rare Complication ◽

Abdominal Wall Hernia ◽

Refractory Ascites ◽

Large Volume Paracentesis

Abstract Background Patients with decompensated liver cirrhosis with ascites frequently have umbilical hernias with a prevalence of 20% and are managed with large volume paracentesis (LVP). Common complications of LVP include hemorrhage, infection, and bowel perforation that occur infrequently with a frequency of less than 1%. However, incarceration of umbilical hernias has been reported as a rare complication of LVP and is speculated to be from ascitic fluid decompression that reduces the umbilical hernia ring diameter resulting in entrapment of the hernia sac. It is unclear whether the quantity or the fluid removal rate increases the herniation risk. Based on case series, this rare complication occurs within 48 hours of the LVP and requires emergent surgical repair and involves a high risk of morbidity and mortality due to potential infection, bleeding, and poor wound healing. Aims We describe a case report of an incarcerated umbilical hernia following a bedside large-volume paracentesis. Methods Case report Results A 59-year-old Caucasian male presented to the emergency department with a 24-hour history of acute abdominal pain following his outpatient LVP. His medical history included Child-Pugh class C alcoholic liver cirrhosis with refractory ascites managed with biweekly outpatient LVP and a reducible umbilical hernia. He reported the onset of his abdominal pain 2-hours after his LVP with an inability to reduce his umbilical hernia. Seven liters of clear, straw-coloured asitic fluid was drained. Laboratory values at presentation revealed a hemoglobin of 139 g/L, leukocyte count of 4.9 x109 /L, platelet count of 110 xo 109 /L, and a lactate of 2.7 mmol/L His physical exam demonstrated an irreducible 4 cm umbilical hernia and bulging flanks with a positive fluid wave test. Abdominal computed tomography showed a small bowel obstruction due to herniation of a proximal ileal loop into the anterior abdominal wall hernia, with afferent loop dilation measuring up to 3.4 cm. He was evaluated by the General Surgery consultation service and underwent an emergent laparoscopic hernia repair. There was 5 cm of small bowel noted to be ecchymotic but viable, with no devitalized tissue. He tolerated the surgical intervention with no post-operative complications and was discharged home. Conclusions Ultrasound-guided bedside paracentesis is a common procedure used in the management of refractory ascites and abdominal wall hernia incarceration should be recognized as a potential rare complication. To prevent hernia incarceration, patients with liver cirrhosis should be examined closely for hernias and an attempt should be made for external reduction prior to LVP. A high index of suspicion for this potential life-threatening condition should be had in patients who present with symptoms of bowel obstruction following a LVP. Funding Agencies None

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Unusual case of Giardia lamblia causing eosinophilic ascites along with Plesiomonasshigelloides gastroenteritis

Biomedicine ◽

10.51248/.v41i2.806 ◽

2021 ◽

Vol 41 (2) ◽

pp. 321-323

Author(s):

Ballal Mamatha ◽

Shetty Vignesh ◽

Agarwal Manali ◽

Nayal Bhavna ◽

Umakanth Shashikiran

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Giardia Lamblia ◽

Complete Resolution ◽

Unusual Case ◽

Peripheral Eosinophilia ◽

Short Trip ◽

Eosinophilic Ascites ◽

History Of

A case report of a healthy, immunocompetent male,an international traveller from Germany who had visited India for a short trip,presented at our OPD with a history of loose stools, fever and abdominal pain,for two months. After thorough investigations, he was diagnosed to have an infection withGiardia lambliaacute gastroenteritis (AGE) along witheosinophilic ascites with peripheral eosinophilia, withassociatedPlesiomonasshigelloidesdiarrhoea. He was then treated with metronidazole and cotrimoxazole, which resulted in complete resolution of the symptoms.

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Hepatic Hydrothorax in a Patient with Liver Cirrhosis: a Case Report

Current Internal Medicine Research and Practice Surabaya Journal ◽

10.20473/cimrj.v2i2.28702 ◽

2021 ◽

Vol 2 (2) ◽

pp. 42

Author(s):

Martino Handoyo ◽

Titong Sugihartono

Keyword(s):

Liver Cirrhosis ◽

Case Report ◽

Portal Hypertension ◽

Pleural Effusion ◽

Ascitic Fluid ◽

Pleural Space ◽

Sodium Restriction ◽

Hepatic Hydrothorax ◽

Lower Survival Rate ◽

Advanced Liver Cirrhosis

Hepatic hydrothorax is a transudative pleural effusion which presents in 5-10% patients with liver cirrhosis. Although fairly uncommon, it is associated with higher morbidity and lower survival rate. The mechanism is yet to be understood fully, but the most widely accepted pathogenesis involves the presence of portal hypertension, diaphragmatic defects, and negative intrathoracal pressure, all of which lead to the formation of unidirectional passage of ascitic fluid from peritoneal cavity into pleural space. Due to its origin, the pleural effusion has similar characteristics to ascitic fluid. We herein report the case of a 60-year-old woman with advanced liver cirrhosis and right-sided moderate hepatic hydrothorax. Treatment given to the patient includes diuretics, sodium restriction, and repeated thoracentesis. Subsequent evaluation of the patient revealed improvement both clinically and radiologically.

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Abdominal intussusception associated with coeliac disease: case report and literature review

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211904 ◽

2021 ◽

Author(s):

Rashid Hameed ◽

Noshine Irrum ◽

Subodhini P. Arachchige ◽

Edwin Tan ◽

Jacinta Tobin

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Literature Review ◽

Coeliac Disease ◽

Recurrent Abdominal Pain ◽

Immune Infiltration ◽

Disease Case ◽

Classical Pattern ◽

History Of

In genetically susceptible individuals, gluten ingestion triggers and immune infiltration and bowel damage in the classical pattern of coeliac disease, with variable symptoms. Intussusception is a condition where one segment of intestine ‘telescopes’ inside of another portion of intestine, which may cause symptoms of abdominal pain due to obstruction. Intussusception has been associated with coeliac disease. We report a 4-year-old girl presented with recurrent abdominal pain of variable severity and found to have intussusception on two occasions, which on both occasions reduced spontaneously during ultrasound examinations. She was later diagnosed with coeliac disease. This case highlights the importance of considering coeliac screening in patients with a history of recurrent abdominal pain and intussusception.

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