scholarly journals Prolapsed ileocolic intussusception in an adult : A bizarre presentation leading to delayed diagnosis in a low resource setting

2021 ◽  
Vol 9 (2) ◽  
pp. 115-120
Author(s):  
M. Umar ◽  
Y. Stephen ◽  
U. Aminu ◽  
I. Adogu
Keyword(s):  
Delayed Diagnosis ◽  
Exploratory Laparotomy ◽  
Adult Intussusception ◽  
Tubular Adenoma ◽  
Ileocolic Intussusception ◽  
Abdominal Symptoms ◽  
Resource Setting ◽  
Low Resource Setting ◽  
History Of ◽  
High Index Of Suspicion

Background: Intussusception is the telescoping of one part of the intestine into the lumen of the adjoining part, which occurs more in the ileocaecal part of the intestine. It is the most common cause of intestinal obstruction in children younger than 3years of age. Occurrence is rare in adult, with prolapsed intussusceptions even rarer and occuring more in association with an underlying predisposing intestinal abnormality.Case Report: A 19year old boy presented with 6months history of recurrent non-specific, occasionally dull aching abdominal pain, progressive weight loss and a 4hour history of anal protrusion. He had presented multiple times to a peripheral hospital where the definitive diagnosis was missed. He was evaluated for ileocolic intussusception and he had exploratory laparotomy and right hemi colectomy done.Conclusion: Intussusceptions are rare outside childhood, however there should be a high index of suspicion of intussusception in adult with nonspecific abdominal symptoms who has not responded to conventional conservative therapy. Keywords: intussusception, ileocolic, tubular adenoma, adult intussusception

Case of second primary breast cancer in ectopic breast tissue and review of the literature

2021 ◽  
Vol 14 (4) ◽  
pp. e241361
Author(s):  
Jamin Kweku Addae ◽  
Thomas Genuit ◽  
Joseph Colletta ◽  
Kathy Schilling
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Breast Tissue ◽  
Delayed Diagnosis ◽  
Left Breast ◽  
Second Primary ◽  
Female Population ◽  
Accessory Breast ◽  
History Of ◽  
High Index Of Suspicion

Accessory breast tissue (ABT) is found in approximately 2%–6% of the female population and are subject to most of the physiological and pathological changes that occur in pectoral breast. Primary breast cancer occurring in ABT is a rare occurrence and a second primary breast cancer occurring in an accessory breast has never been reported. We report the case of a 60-year-old woman with a history of mastectomy for left breast cancer 5 years prior to presentation, who presented with an enlarging right axilla mass found to be a second primary breast cancer in an accessory tissue on biopsy. Many physicians are unfamiliar with the clinical presentation of accessory breast cancer due to the rarity of the condition and this ultimately results in delayed diagnosis and advanced disease at presentation. It is therefore prudent that physicians have a high index of suspicion when patients present with axillary masses.

scholarly journals Vaping in today’s pandemic: E-cigarette, or vaping, product use–associated lung injury mimicking COVID-19 in teenagers presenting with respiratory distress

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096959
Author(s):  
Daphne O Darmawan ◽  
Kriti Gwal ◽  
Brian D Goudy ◽  
Sanjay Jhawar ◽  
Kiran Nandalike
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Respiratory Distress ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Product Use ◽  
Abdominal Symptoms ◽  
History Of ◽  
High Index Of Suspicion

The clinical presentation of children and adolescents infected with severe acute respiratory syndrome coronavirus 2 can range from asymptomatic to mild or moderate manifestations. We present a case series of three adolescents who presented during the coronavirus disease 2019 (COVID-19) pandemic with symptoms concerning for COVID-19, including fever, abdominal symptoms, cough, respiratory distress, and hypoxemia. Their laboratory results showed elevated inflammatory markers that are also commonly seen in COVID-19. The chest imaging studies mimicked COVID-19 with non-specific ground glass opacities and interstitial prominence patterns. However, severe acute respiratory syndrome coronavirus 2 testing was negative and further questioning of these adolescents and their parents revealed a history of vaping marijuana-related products leading to the eventual diagnosis of e-cigarette, or vaping, product use–associated lung injury. Our patients were successfully treated with corticosteroids. The providers caring for pediatric patients, especially adolescents, should continue to have a high index of suspicion for e-cigarette, or vaping, product use–associated lung injury in patients presenting with unexplained respiratory failure, while ruling out COVID-19.

scholarly journals Pneumatosis intestinalis: cost paid for rheumatoid arthritis treatment

2019 ◽  
Vol 12 (7) ◽  
pp. e229329 ◽  
Author(s):  
Pratyusha Tirumanisetty ◽  
Jose William Sotelo ◽  
Michael Disalle ◽  
Meenal Sharma
Keyword(s):  
Rheumatoid Arthritis ◽  
Bowel Wall ◽  
Loop Ileostomy ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Right Hemicolectomy ◽  
Necrotic Bowel ◽  
History Of ◽  
High Index Of Suspicion

A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.

scholarly journals Jejunojejunal Intussusception Induced by a Gastrointestinal Stromal Tumor

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Ali H. Zakaria ◽  
Salam Daradkeh
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Stromal Tumor ◽  
Exploratory Laparotomy ◽  
Stromal Tumor ◽  
Therapeutic Interventions ◽  
Adult Intussusception ◽  
Lead Point ◽  
Imaging Studies ◽  
High Index Of Suspicion ◽  
Intestinal Obstructions

Background. Adult intussusception is a rare entity representing less than 1% of all intestinal obstructions. Diagnosis of the condition is difficult requiring a high index of suspicion and the utilization of imaging studies, especially CT scans. Diagnostic laparoscopy and/or exploratory laparotomy can be used as a diagnostic and therapeutic intervention. In over 90% of cases, an underlying lead point is identified. In the patient described here, it was a gastrointestinal stromal tumor (GIST), a relatively rare mesenchymal tumor comprising only 0.2–1.0% of the gastrointestinal tract neoplasms and believed to originate from neoplastic transformation of the interstitial cells of Cajal. GISTs may occur anywhere along the gastrointestinal tract, but most commonly arise in the stomach and small intestine. Literature review revealed only few cases reporting GISTs as a leading point of adult's intussusception.Case Presentation. In this report, we are presenting a rare case of jejunojejunal intussusception in a 78-year-old female patient with a GIST located in the terminal jejunum being the leading point, demonstrating the importance of imaging studies, especially CT scan, laparoscopy, and exploratory laparotomy as diagnostic and therapeutic interventions.

scholarly journals Exploring the Diagnosis and Management of Bouveret's Syndrome

2016 ◽  
Vol 54 (201) ◽  
pp. 33-35 ◽  
Author(s):  
Mukul Bhattarai ◽  
Pardeep Bansal ◽  
Bharat Patel ◽  
Alexander Lalos
Keyword(s):  
Clinical Practice ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Outlet Obstruction ◽  
Exploratory Laparotomy ◽  
Fistula Repair ◽  
Bouveret’S Syndrome ◽  
Abdominal Symptoms ◽  
History Of ◽  
Bouveret's Syndrome

Bouveret’s syndrome is an unusual cause of gastric outlet obstruction secondary to gallstone impaction. It is so rare that it is commonly missed in clinical practice if it is not considered in differential diagnoses of intestinal obstruction more specifically in man who does not report the history of gall stone. Furthermore, there are no definitive guidelines on approach and management of this condition. We present a seventy eight year old man who developed acute abdominal symptoms due to impaction of a gallstone in the duodenum. He did not have history of gall stone. The diagnosis was supported via CT abdomen and Endoscopy. The patient was successfully managed by exploratory laparotomy followed by anterior pylorotomy to remove the stone without cholecystectomy and fistula repair. Keywords: Bouveret’s syndrome; cholelithiasis; enterolithotomy; Gallstone ileus. | PubMed

scholarly journals Delayed Presentation of Intussusception with Perforation after Splenectomy in Patient with Blunt Abdominal Trauma

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Ibrahim Afifi ◽  
Hassan Al-Thani ◽  
Sajid Attique ◽  
Sherwan Khoschnau ◽  
Ayman El-Menyar ◽  
...  
Keyword(s):  
Small Bowel ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Delayed Diagnosis ◽  
Rare Event ◽  
Exploratory Laparotomy ◽  
Adult Intussusception ◽  
Delayed Presentation ◽  
Ileocecal Junction ◽  
Fall From Height

Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception.

scholarly journals Recurrent Enterolithiasis Small Bowel Obstruction: A Case Seldom Described

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.

scholarly journals Bilateral osteochondral defects of the patellae in an 11-year-old girl

2021 ◽  
Vol 14 (4) ◽  
pp. e240790
Author(s):  
Miguel Rodriguez Ruiz ◽  
Ibidumo Igah ◽  
Farhad Iranpour ◽  
Akash Patel
Keyword(s):  
Knee Pain ◽  
Delayed Diagnosis ◽  
Operative Management ◽  
Osteochondral Defects ◽  
Clinical Disorder ◽  
History Of ◽  
Sporting Activities ◽  
High Index Of Suspicion ◽  
Non Operative Management

Osteochondral defect or osteochondritis dissecans (OCD) of the knee usually affects young, active populations. It is a challenging diagnosis as patients typically present with poorly localised activity-related pain, which is non-specific and covers many differentials. We present an active 11-year-old girl with bilateral osteochondral defects of the patellae: a rare clinical disorder which was affecting her sporting activities. She had a 12-month history of bilateral anterior knee pain before the diagnosis was achieved with appropriate imaging. Her pain significantly improved with activity modification and physiotherapy. Follow-up will require outpatient clinic assessment and imaging to determine if non-operative management continues to be successful or surgery may be required. This case report emphasises the importance of appropriate high index of suspicion when managing patients with non-specific knee pain. It also demonstrates the importance of judicious use of imaging to avoid a missed or delayed diagnosis.

Stump Resections Resulting from Incomplete Operations

2007 ◽  
Vol 73 (1) ◽  
pp. 75-78
Author(s):  
Taner Yigit ◽  
Oner Mentes ◽  
Mehmet Eryilmaz ◽  
Mujdat Balkan ◽  
Ali Ihsan Uzar ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Surgical Intervention ◽  
Enterocutaneous Fistula ◽  
Delayed Diagnosis ◽  
Clinical Event ◽  
Incomplete Resection ◽  
Abdominal Symptoms ◽  
Abdominal Exploration ◽  
History Of ◽  
Emergency Surgical Intervention

Stump viscera caused by an incomplete operation can present the same symptoms as before the first operation. Furthermore, as an acute clinical event, these incomplete resections may sometimes cause acute abdomen and may need emergency surgical intervention. A 34-year-old woman with a history of laparoscopic cholecystectomy 5 days before was admitted with acute abdominal symptoms. Abdominal exploration revealed that she had undergone incomplete resection of the gallbladder. Another patient, a 21-year-old man, was admitted with complaints of fluid drainage from his appendectomy incision scar. He was diagnosed as having enterocutaneous fistula. Abdominal exploration revealed a stump appendix fistulizing to the abdominal wall. The third patient was a 32-year-old man with an appendectomy scar who was admitted with complaints of acute appendicitis. The patient was diagnosed as having acute appendicitis and underwent an appendectomy. A stump appendix was removed during the operation. Surgeons should be aware of stump pathologies and keep in mind a possible incomplete operation to prevent delayed diagnosis and treatment.

scholarly journals Undiagnosed advanced abdominal pregnancy: a case report

2021 ◽  
Vol 7 (12) ◽  
pp. 590
Author(s):  
Ekundayo O. Ayegbusi ◽  
Oluwatoyin O. Fadare ◽  
Akintunde O. Fehintola ◽  
Akinyosoye D. Ajiboye ◽  
Akaninyene E. Ubom
Keyword(s):  
Breech Presentation ◽  
Fetal Outcome ◽  
Morbidity And Mortality ◽  
Abdominal Pregnancy ◽  
Emergency Cesarean ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Advanced Abdominal Pregnancy ◽  
Live Fetus ◽  
High Index Of Suspicion

<p class="abstract">Abdominal pregnancy is a rare form of extra-uterine gestation in which implantation occurs in the peritoneal cavity, unlike this case it rarely reaches advanced gestation and viability of fetal outcome are not commonly documented. Abdominal pregnancy accounts for about 1-2% of ectopic gestation. It is associated with poor fetal outcome and great morbidity and mortality due to heamorrhage especially in a low resource setting. We present an undiagnosed advanced case of abdominal pregnancy of a 30 yr old unbooked G2P1+0 (1A) with early ultrasound estimation of 37 weeks and 6 days. She presented with (abdominal) labour pains and ultrasound diagnosis of breech presentation, suspicion of a bicornuate uterus and intrauterine growth restriction. She was planned for emergency cesarean delivery on this basis but found advanced abdominal pregnancy, and subsequently on delivery had good maternal and fetal outcome. Abdominal pregnancy with live fetus is extremely rare, and requires a high index of suspicion, to avoid high risk of maternal morbidity and mortality and it is also imperative for all healthcare givers to localized pregnancy whenever they get in contact with a woman who has recently missed her period.</p>

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