10-Pound Weight Loss and Lower Abdominal Pain

70-year-old woman with 20-lb weight loss over the past 6 months and crampy lower abdominal pain Axial fat-suppressed FSE T2-weighted images (Figure 9.20.1) and postgadolinium axial (Figure 9.20.2) and sagittal (Figure 9.20.3) 3D SPGR images demonstrate a large, heterogeneously enhancing mass in the pelvis, with markedly increased T2-signal intensity and multiple cystic regions on postcontrast images. The origin of the lesion from the sigmoid colon is difficult to discern, but it is probably best appreciated on the axial postgadolinium images. Note the invasion of the bladder dome, with a gas pocket in the anterior bladder....

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ID: 38: PRIMARY SQUAMOS CELL CARCINOMA OF THE RECTUM

Journal of Investigative Medicine ◽

10.1136/jim-2016-000120.63 ◽

2016 ◽

Vol 64 (4) ◽

pp. 943-944

Author(s):

N Vyas ◽

H Alkhawam ◽

R Sogomonian ◽

S Ahmad ◽

RA Ching Companioni ◽

...

Keyword(s):

Weight Loss ◽

Squamous Cell Carcinoma ◽

Abdominal Pain ◽

Cell Carcinoma ◽

Squamous Cell ◽

Transvaginal Ultrasound ◽

Lower Abdominal Pain ◽

Normocytic Anemia ◽

Dense Layer ◽

Rectal Mass

IntroductionSquamous cell carcinoma (SCC) of the gastrointestinal (GI) tract is an uncommon occurrence, as it usually involves the esophagus or anal canal. Approximately 90% of cases of rectal malignancy are adenocarcinoma and other rectal cancers include lymphoma (1.3%), carcinoid (0.4%), and sarcoma (0.3%). We are presenting a rare and unique case of patient with SCC of the rectum presenting with lower abdominal pain and significant weight loss.CaseA 52 year old female was admitted with a two month history of diffuse lower abdominal pain and hematochezia. The pain was constant and pressure like. The patient was a nonsmoker and nondrinker. Review of systems was pertinent for an unintentional weight loss of 10lbs. Physical examination revealed diffuse lower abdominal tenderness and a firm, irregular anterior rectal mass. She had no lymphadenopathy and her skin exam was normal. Laboratory results a normocytic anemia with a hemoglobin of 8.8 g/dl and a CEA of 1.35 ng/ml. Abdominal CT scan revealed a 7 cm irregular rectal mass with extra luminal compression to the rectosigmoid area, (figure 1). The mass did not extend from uterus and confirmed with transvaginal ultrasound. Patient underwent a flex sigmoidoscopy which revealed a lesion 5 cm from anal verge extending distally. There is a semi-circumferential narrowing occupying 7% of lumen and a dense layer of mass tissue with superficial friability of mucosa. Biopsy was taken from the mass, histology shows invasive moderately differentiated squamous cell carcinoma (figure 1).DiscussionSCC of the rectum has a very similar presentation to colon adenocarcinoma. Diagnoses can be established by proctoscopy/colonoscopy and more specifically, a biopsy to get a definitive histological analysis. The latter is a used to differentiate from SCC of the anus, which presents similarly. Immunohistochemistry has proved useful in characterizing lesions, especially when using cytokeratin stains. Pathogenesis is unclear due to its rarity; however one of the proposed mechanisms suggests that inflammation or infection results in squamous metaplasia from which carcinoma develops. Thus there is an association with HPV and various squamous cancers. In conclusion, SCC of rectum is a distinct entity and it is important to shed some light on this rare condition because it has different epidemiology, etiology, pathogenies and requires a different treatment approach than other colorectal carcinomas. Surgery is the primary treatment which consists of local excision versus radical resection and the need for adjuvant therapy.Abstract ID: 38 Figure 1

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CLINICOPATHOLOGIC FEATURES OF CERVICAL CANCER PATIENTS SEEN IN A COMPREHENSIVE CANCER CENTRE IN NORTH-WESTERN NIGERIA

Open Journal of Medical Research (ISSN: 2734-2093) ◽

10.52417/ojmr.v2i1.211 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

M. A. Usman ◽

S. A. Otene

Keyword(s):

Cervical Cancer ◽

Weight Loss ◽

Squamous Cell Carcinoma ◽

Abdominal Pain ◽

Cell Carcinoma ◽

Clinical Features ◽

Squamous Cell ◽

Vaginal Bleeding ◽

Lower Abdominal Pain ◽

North Western

The purpose of this study was to evaluate the socio-demographic and clinicopathological features of patients with cervical cancer seen in a comprehensive cancer center in North-western Nigeria. It was a six years retrospective study of patients with cervical cancer treated in the Department of Radiotherapy and Oncology, UDUTH, Sokoto. Data was obtained from the patients’ case notes using a semi-structured data extraction form. A total of 220 cases were reviewed for patients whose mean age was 49.9 years (SD ± 11.9); with the age range of 24-87 years. Results show that squamous cell carcinoma was the most common histological type seen in 182(82.7%) of the patients, followed by adenocarcinoma 22(10%) and clear cell carcinoma 9(4.1%). Vaginal bleeding 110(50%), foul-smelling vaginal discharge103 (46.8%), fatigue 67(30.5%), lower abdominal pain 65(20.5%) and weight loss 30(13.6%) were the commonest clinical features. 176(80%) patients presented late stages (IIB – IVB) of cervical cancer. Concluding, most of the women with cervical cancer presented with features of vaginal bleeding or foul-smelling vaginal discharge, weight loss, fatigue and lower abdominal pain, with commonest histological categorization being squamous cell carcinoma. Late presentation of the disease was obviously observed in most of the cases diagnosed. The clinical features of cervical cancer identified in the cases reviewed are indicators of advanced disease. Thus, it is imperative that advocacy for cervical cancer screening should be stepped up in order to ensure early detection and prevent the progression of the disease to advanced stages.

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Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0036-1593045 ◽

2016 ◽

Vol 76 (10) ◽

Author(s):

A Jurga-Karwacka ◽

GM Karwacki ◽

FD Schwab ◽

A Schötzau ◽

C Zech ◽

...

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Pyometra: An Atypical Cause of Abdominal Pain

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211022481 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110224

Author(s):

Leonidas Walthall ◽

Marc Heincelman

Keyword(s):

Abdominal Pain ◽

Vaginal Discharge ◽

Elderly Women ◽

Lower Abdominal Pain ◽

Endometrial Biopsy ◽

Laboratory Evaluation ◽

Inpatient Service ◽

Gynecologic Malignancy ◽

Intravenous Contrast ◽

Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

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Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01007-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Michio Itabashi ◽

Yoshiko Bamba ◽

Hisako Aihara ◽

Kimitaka Tani ◽

Ryousuke Nakagawa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Lower Abdominal Pain ◽

Anterior Wall ◽

Middle Part ◽

Presacral Space ◽

Previous Surgery ◽

Afferent Limb ◽

Radiographic Findings ◽

Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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Seronegative Arthritis as a Complication of Whipple’s Disease

Clinical Medicine Insights Case Reports ◽

10.1177/11795476211017717 ◽

2021 ◽

Vol 14 ◽

pp. 117954762110177

Author(s):

Rebecca DeBoer ◽

Sahani Jayatilaka ◽

Anthony Donato

Keyword(s):

Rheumatoid Arthritis ◽

Weight Loss ◽

Abdominal Pain ◽

Gastrointestinal Symptoms ◽

Whipple’S Disease ◽

Seronegative Arthritis ◽

Whipple's Disease ◽

Caucasian Male

Whipple’s disease (WD) is an uncommon cause of seronegative arthritis. WD is known for its gastrointestinal symptoms of diarrhea, weight loss, and abdominal pain. However, arthritis may precede gastrointestinal symptoms by 6 to 7 years. We describe a case of an 85-year-old Caucasian male with multiple joint complaints, not responsive to traditional treatments for conditions such as rheumatoid arthritis and osteoarthritis. We suggest that WD be considered for seronegative arthritis especially affecting large joints.

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Spontaneous Perinephric Urinoma Secondary to Drug Induced Acute Interstitial Nephritis: A Case Report

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1723924 ◽

2021 ◽

Author(s):

Rajesh Kumar Varatharajaperumal ◽

Rupa Renganathan ◽

V Mangalakumar ◽

Sriman Rajasekaran ◽

Venkatesh Kasi Arunachalam

Keyword(s):

Abdominal Pain ◽

Interstitial Nephritis ◽

Lower Abdominal Pain ◽

Acute Interstitial Nephritis ◽

Computed Tomography Scan ◽

Drug Induced ◽

Significant Deterioration ◽

Loin Pain ◽

Tomography Scan ◽

Collecting System

AbstractUrinoma is defined as the extravasation of urine from any part of the urinary collecting system, which causes lipolysis of the surrounding fat, resulting in an encapsulated collection. The most common cause of urinoma is the direct obstruction of the urinary system. The other etiologies include trauma and postinstrumentation/surgery. Parenchymal cause for spontaneous urinoma is exceedingly rare. We present a case of a 30-year-old gentleman who presented with lower abdominal pain and was treated with a Diclofenac injection. The pain got better temporarily, but he presented again with right loin pain after 3 days. His computed tomography scan images revealed bilateral perinephric urinoma. As there was significant deterioration of renal function, he underwent a renal biopsy. The histopathology was reported as acute interstitial nephritis (AIN). Drug-induced AIN is very rarely presented with acute loin or abdominal pain due to spontaneous perinephric urinoma, as it was seen in our case.

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Roberts uterus: a rare congenital anomaly

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175304 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5657

Author(s):

Nagendra Sardeshpande ◽

Pratima Chipalkatti ◽

Jainesh Doctor

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Adnexal Mass ◽

Lower Abdominal Pain ◽

Uterine Horn ◽

Transabdominal Ultrasound ◽

Septate Uterus ◽

Bicornuate Uterus ◽

Rare Congenital Anomaly ◽

Hysteroscopic Resection

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.

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Fuke Qianjin Combined with Antibiotic Therapy for Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/5372839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yu Chen ◽

Shaobin Wei ◽

Li Huang ◽

Mei Luo ◽

Yang Wu ◽

...

Keyword(s):

Abdominal Pain ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Meta Analysis ◽

Lower Abdominal Pain ◽

Effective Rate ◽

Chinese Patent ◽

Meta Analyses

Background. Pelvic inflammatory disease (PID) without timely and proper treatment can cause long-term sequelae; meanwhile, patients will be confronted with the antimicrobial resistance and side effects. Chinese patent medicine as a supplement is used to treat PID with satisfactory clinical efficacy. This study evaluated the efficacy and safety of Fuke Qianjin (FKQJ) combined with antibiotics in the treatment of PID. Methods. Eight electronic databases and other resources were searched to make a collection of the randomized controlled trials (RCTs) from 1990 to 2019. The RCTs contrasting the effect of FKQJ combined with antibiotics regimens and antibiotics alone in reproductive women with PID were included. The antibiotics regimens are all recommended by the guidelines. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality of the included studies. Then, the meta-analyses were performed by RevMan 5. 3 software if appropriate. Results. Twenty-three RCTs (2527 women) were included in this review. The evidence showed that FKQJ combined with antibiotics improved the markedly effective rate compared to antibiotics alone group (RR = 1.38, 95% CI 1.27 to 1.49, I2 = 42%), shortened the improvement time of low abdominal pain (MD = −1.11, 95% CI −1.39 to −0.84, I2 = 38%), and increased the rate of lower abdominal pain improvement (RR = 1.35, 95% CI 1.19 to 1.55, I2 = 0). The implementation of adjuvant reduced the recurrent rate compared with antibiotics alone (RR = 0.27, 95% CI 0.13 to 0.56, I2 = 0%). Conclusions. Based on available evidence, FKQJ combined with antibiotics therapy have certain outcomes on increasing the markedly effective rate, decreasing the recurrent rate compared with antibiotics alone group. This therapy appears to improve lower abdominal pain and curtail the relief time. Due to the low quality and the risk of bias, any high-quality evidence or longer follow-up period should be advisable and necessary in the future.

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