A Case of Isolated Cecal Necrosis Preoperatively Diagnosed with Perforation of Cecum

Isolated cecal necrosis (ICN) is a rare condition which is developed under decreased mesenteric perfusion. Only a few dozen cases of ICN have been reported previously. The patient was a 59-year-old male with a previous history of atrial fibrillation. He presented to our emergency room with the chief complaint of lower abdominal pain. Computed tomography imaging revealed a dilated cecum and presence of free air. With a preoperative diagnosis of perforation of the cecum; an urgent surgery was conducted. Intraoperative findings revealed an ischemic change of the cecum and a laparoscopic-assisted ileocecal resection was performed. The pathological findings showed transmural ischemic change on the anti-mesenteric side of the cecum, and the diagnosis of ICN was achieved. Preoperative diagnosis of ICN is difficult because of its non-specific radiological features. In patients with right lower abdominal pain, ICN should be considered as a differential diagnosis especially if the patient has a comorbidity causing hypotension attack.

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Adult Colo-Colic Intussusception Induced By a Lipoma Masquerading As a Sigmoid Polyp on Colonoscopy: A Case Report

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v5i1.16226 ◽

2013 ◽

Vol 5 (1) ◽

pp. 72-74

Author(s):

Junaid Nabi ◽

SM Quamrul Akhter ◽

Mohammad Abdullah Al Mamun ◽

Nelema Jahan ◽

Md Mamunur Rahman

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Preoperative Diagnosis ◽

Anal Verge ◽

Lower Abdominal Pain ◽

Histological Evaluation ◽

Midline Incision ◽

History Of ◽

Specific Symptoms ◽

Satisfactory Recovery

Intussusception in adults is rare, accounting for only 5% of all cases of intussusceptions and only 1% of bowel obstruction. Preoperative diagnosis is often difficult due to non specific symptoms and subacute nature. This case report was a per-operatively diagnosed adult colo-colic intussusception induced by a lipoma which mimicked a sigmoid polyp on colonoscopy. A 40-year-old Bengali woman was admitted with two weeks history of colicky lower abdominal pain. Ultrasound abdomen was unremarkable. Colonoscopy revealed a moderately enlarged sigmoid polyp at 25 cm from the anal verge. A midline incision laparotomy was performed only to reveal a colo-colic intussusception. The intussusception was reduced and the patient underwent a segmental resection of the involved bowel. Histological evaluation confirmed the diagnosis of lipoma of the colon. The patient however satisfactory recovery and remains well six months after surgery. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16226 J Shaheed Suhrawardy Med Coll, 2013;5(1):72-74

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Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

BMJ Case Reports ◽

10.1136/bcr-2019-232797 ◽

2021 ◽

Vol 14 (1) ◽

pp. e232797

Author(s):

Clemmie Stebbings ◽

Ahmed Latif ◽

Janakan Gnananandan

Keyword(s):

Abdominal Pain ◽

Iliac Fossa ◽

Lower Abdominal Pain ◽

Sudden Onset ◽

Greater Omentum ◽

Caribbean Woman ◽

History Of ◽

Right Iliac Fossa Pain ◽

The Right ◽

Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

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Enterocolic lymphocytic phlebitis: a rare pathology in children

BMJ Case Reports ◽

10.1136/bcr-2021-243826 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243826

Author(s):

Omar Nasher ◽

Naved Alizai

Keyword(s):

Surgical Resection ◽

Preoperative Diagnosis ◽

Diagnostic Laparoscopy ◽

Adult Population ◽

Lower Abdominal Pain ◽

Paediatric Population ◽

Rare Clinical Entity ◽

Clinical Challenge ◽

History Of ◽

Venous Vasculature

Enterocolic lymphocytic phlebitis (ELP) is a rare pathology, usually seen in the adult population. The condition affects the venous vasculature of the intestine sparing the arteries and lymphatics. It is commonly identified histologically after surgical resection making the preoperative diagnosis a clinical challenge. As the condition can lead to intestinal ischaemia and necrosis, surgical resection of the affected segment is the treatment of choice. We report the case of a 9-year-old girl who presented with a 2-day history of lower abdominal pain and anorexia. The initial diagnosis of appendicitis was made clinically and the patient underwent a diagnostic laparoscopy . The appendix was macroscopically normal and there were no other obvious intra-abdominal pathologies to account for her presenting complaints . The appendix was removed, as per the preoperative discussion and consent from parents. She recovered well and was discharged home the following day. The histological examination of the appendix demonstrated ELP. We describe this rare clinical entity in a child especially in view of the scarce published literature in the paediatric population.

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Possible GoLytely-Associated Cardiac Arrest: A Case Report and Literature Review

Journal of Pharmacy Practice ◽

10.1177/0897190019825965 ◽

2019 ◽

Vol 33 (3) ◽

pp. 364-367 ◽

Cited By ~ 2

Author(s):

Yoonsun Mo ◽

Shiv Gandhi ◽

Jose Orsini

Keyword(s):

Cardiac Arrest ◽

Abdominal Pain ◽

Sudden Cardiac Arrest ◽

Lower Abdominal Pain ◽

The Past ◽

Life Threatening ◽

History Of ◽

Artery Disease ◽

Possible Cause

Purpose: To report a case of sudden cardiac arrest possibly associated with the administration of GoLytely® (polyethylene glycol 3350 and electrolytes). Summary: A 60-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presented to the emergency department with complaints of constipation and lower abdominal pain over the past week, and the inability to urinate over the past day. The patient had received GoLytely as treatment to alleviate symptoms of constipation and abdominal pain. However, several hours after administration of the bowel prep solution, the patient suffered an episode of cardiac arrest. After ruling out other possible etiologies, GoLytely was suspected as a possible cause of cardiac arrest. The patient had suffered an anoxic brain injury and remained intubated and unconscious until he eventually expired, 20 days after the event. Conclusion: Although GoLytely appears to be a safe agent with fewer side effects, clinicians need to be mindful of potential life-threatening adverse events following GoLytely administration and monitor patients closely during and after administration.

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Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen

Case Reports in Gastroenterology ◽

10.1159/000502683 ◽

2019 ◽

Vol 13 (3) ◽

pp. 364-368

Author(s):

Vishnu Charan Suresh Kumar ◽

Kishore Kumar Mani ◽

Hisham Alwakkaa ◽

James Shina

Keyword(s):

Abdominal Pain ◽

Bowel Wall ◽

Acute Diverticulitis ◽

Lower Abdominal Pain ◽

Wall Thickening ◽

Antibiotic Administration ◽

Epiploic Appendagitis ◽

High Attenuation ◽

History Of ◽

Bowel Wall Thickening

Epiploic appendages are peritoneal structures that arise from the outer serosal surface of the bowel wall towards the peritoneal pouch. They are filled with adipose tissue and contain a vascular stalk. Epiploic appendagitis is a rare cause of acute lower abdominal pain. It most commonly results from torsion and inflammation of the epiploic appendages, and its clinical features mimic acute diverticulitis or acute appendicitis resulting in being often misdiagnosed as diverticulitis or appendicitis. This frequently leads to unnecessary hospitalization, antibiotic administration, and unwarranted surgeries. Epiploic appendagitis is usually diagnosed with CT imaging, and the classic CT findings include: (i) fat-density ovoid lesion (hyperattenuating ring sign), (ii) mild bowel wall thickening, and (iii) a central high-attenuation focus within the fatty lesion (central dot sign). It is treated conservatively, and symptoms typically resolve in a few days. Therefore, epiploic appendagitis should be considered as one of the differential diagnosis for acute lower abdominal pain and prompt diagnosis of epiploic appendagitis can avoid unnecessary hospitalization and surgical intervention. In this case report, we discuss a 72-year-old woman who presented with a 2-day history of acute left lower abdominal pain.

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SURGICAL MANAGEMENT OF PAINFUL OS SUBFIBULARE: A CASE REPORT

Journal of Musculoskeletal Research ◽

10.1142/s0218957720720021 ◽

2020 ◽

Vol 23 (01) ◽

pp. 2072002

Author(s):

Kunal A. Shah ◽

Ajay C. Shah

Keyword(s):

Ligament Reconstruction ◽

Ankle Instability ◽

Previous History ◽

Rare Condition ◽

Surgical Excision ◽

Ossification Center ◽

Anterior Talofibular Ligament ◽

Ankle Pain ◽

Avulsion Fractures ◽

History Of

Separated ossicle at the tip of lateral malleolus, a rare condition called os subfibulare, sometimes is a cause of ankle pain. There are two theories regarding the origin of os subfibulare. One theory proposes that it is caused by an avulsion fracture attributable to pull of the anterior talofibular ligament, whereas the other theory proposes that it is the result of an accessory ossification center. Accessory bones may be stable or may sustain injuries and become avulsed. Most cases have described the surgical treatment of avulsion fractures with excision of the fragment and anterior talofibular ligament reconstruction. We describe a rare case of a symptomatic Os subfibulare caused by an accessory ossification center in a 27-year-old female with no previous history of trauma. Surgical excision was done without ligament reconstruction and the symptoms resolved completely after the surgery and there was no residual ankle instability.

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Type 1 Diabetes, ACTH Deficiency, and Hypothyroidism Simultaneously Induced by Nivolumab Therapy in a Patient with Gastric Cancer: A Case Report

Case Reports in Oncology ◽

10.1159/000510044 ◽

2020 ◽

Vol 13 (3) ◽

pp. 1185-1190

Author(s):

Shoko Marshall ◽

Aki Kizuki ◽

Tadashi Kitaoji ◽

Hiroshi Imada ◽

Hayato Kato ◽

...

Keyword(s):

Gastric Cancer ◽

Type 1 Diabetes ◽

Blood Glucose Control ◽

Previous History ◽

Rare Condition ◽

Outpatient Setting ◽

Acth Deficiency ◽

History Of ◽

Low Cortisol

Nivolumab, a fully human IgG4 immune checkpoint inhibitor (ICI) antibody, has been approved for a variety of cancers. Several endocrine-associated immune-related adverse events have been reported, but the incidence rate is relatively low. This is a case of a patient with gastric cancer who underwent nivolumab therapy, leading to type 1 diabetes as well as adrenocorticotropic hormone (ACTH) deficiency and hypothyroidism almost simultaneously. A 70-year-old man with no previous history of diabetes was treated with nivolumab monotherapy for gastric cancer in November 2018. After 8 courses of nivolumab, he was diagnosed with type 1 diabetes associated with ICI; consequently, insulin therapy was initiated in March 2019. In April 2019, he was transported to hospital due to suffering from prolonged hypoglycemia, disturbed consciousness, and fever. He frequently experienced episodes of hypoglycemia, with poor controlled glycemia. His disturbed consciousness and fever also sustained. Further investigation of his hormones revealed low cortisol and ACTH levels, as well as hypothyroidism. His blood glucose control was improved after the introduction of hydrocortisone and thyroid hormone; he became alert and afebrile. In January 2020, he received a followed-up in an outpatient setting under insulin, hydrocortisone, and thyroid replacement therapy. Endocrine defect associated with ICIs, especially type 1 diabetes or ACTH deficiency, is a rare condition. To the best of our knowledge, this is the 1st case of multiple endocrinopathies simultaneously induced by nivolumab. Various endocrine concomitant defects should be taken into consideration when treating with nivolumab.

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Unilateral Twin Ectopic Pregnancy in a Patient With a History of Multiple Sexually Transmitted Infections

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/idog/2006/10306 ◽

2006 ◽

Vol 2006 ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Charles J. Rolle ◽

Clifford Y. Wai ◽

Roger Bawdon ◽

Rigoberto Santos-Ramos ◽

Barbara Hoffman

Keyword(s):

Ectopic Pregnancy ◽

Sexually Transmitted Infections ◽

Fallopian Tube ◽

Lower Abdominal Pain ◽

Rare Condition ◽

Operative Trauma ◽

Sexually Transmitted ◽

Uncommon Presentation ◽

Increased Risk ◽

History Of

Background. The incidence of unilateral twin ectopic pregnancy is a rare condition. Several factors increase the risk of ectopic pregnancy, the most important of which is pelvic inflammatory disease, followed by operative trauma, congenital anomalies, tumors, and adhesions resulting in anatomically distorted fallopian tubes. We present a case of a woman with a history of four confirmed sexually transmitted infections (STIs) including Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus 2, and Treponema pallidum. The case illustrates the potential impact of sexually transmitted infections (STIs) on the risk of a twin ectopic pregnancy. Case. A 24-year-old primigravida, presented with an unknown last menstrual period, lower abdominal pain, watery vaginal discharge, and vaginal spotting. During this hospitalization, serumβ-HCG testing was 263 mIU/mL and transvaginal ultrasonographic examination suggested a nonviable unilateral twin ectopic pregnancy. At exploratory laparotomy, a 10 cm mass involving the right fallopian tube and ovary was excised. Pathological evaluation of the specimen identified a monochorionic, diamnionic twin ectopic pregnancy within the fallopian tube. Conclusions Patients with a history of multiple (STIs) are known to be at risk for the development of chronic pelvic infection and postinflammatory scarring. The resulting distortion of the normal tubal anatomy leads to an increased risk of an uncommon presentation of ectopic pregnancy.

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Procidencia with rare complication -a case report

KYAMC Journal ◽

10.3329/kyamcj.v3i1.13662 ◽

2013 ◽

Vol 3 (1) ◽

pp. 262-264

Author(s):

Mst Atia Sultana ◽

Monira Akter ◽

Shafiul Anam

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Rare Complication ◽

Lower Abdominal Pain ◽

Chemical Substances ◽

Abdominal Tenderness ◽

History Of

Mrs. Lalbanu 65 years old lady presented to us with the complaints of something coming down per vagina for 10 years, foul smelling discharge for 2 months, fever & maggot formation for 5 days, she also gave history of applying some chemical substances on her prolapsed mass of genitalia, and she also complains of lower abdominal pain for last 5 days. On examination, prolapsed mass was distorted, edematous, infected, irreducible & there were maggots, her temperature was raised & having lower abdominal tenderness. She was treated at first conservatively & then surgically. Now she is well & with our follow up.DOI: http://dx.doi.org/10.3329/kyamcj.v3i1.13662 KYAMC Journal Vol. 3, No.-1, June 2012 pp.262-264

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Thyrotoxic periodic paralysis in new-onset hyperthyroidism – a case report and review of the literature

Revista de Ciências Médicas e Biológicas ◽

10.9771/cmbio.v12i4.9207 ◽

2014 ◽

Vol 12 (4) ◽

pp. 531

Author(s):

Joaquim Custódio da Silva Junior ◽

Helton Estrela Ramos

Keyword(s):

Case Report ◽

Previous History ◽

Rare Condition ◽

Periodic Paralysis ◽

Emergency Physicians ◽

Review Of The Literature ◽

Font Size ◽

Thyrotoxic Periodic Paralysis ◽

History Of ◽

New Onset

Thyrotoxic periodic paralysis (TPP) is a rare condition related to hyperthyroidism, with specific clinical and physiopathological features. In this article, we discuss a case report of a patient that develops TPP with no previous history of thyroid illness, highlighting semiological characteristics that can help Emergency physicians to suspect of this condition. Subsequently, we review the recent articles about TPP, with focus in the molecular basis of ion channelopathies and predisposing factors, and discuss the therapeutic approach at acute phase of TPP and prevention of crisis recurrence.

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