Prevalence and Management of Constipation and GI Diagnoses in Children With Solid Tumors

Purpose Despite continued development of targeted therapies for children with cancer, patients continue to experience an array of unwanted side effects. Children with solid tumors may experience constipation as a result many treatment variables. Our objective was to investigate the prevalence and treatment of constipation in hospitalized children with solid tumors treated with chemotherapy. Methods We retrospectively analyzed data from 48 children’s hospitals in the Pediatric Health Information System, extracting patients 0–21 years of age with a solid tumor diagnosis hospitalized from October 2015-December 2019. Primary study outcome investigated which solid tumor subgroups received the diagnosis of constipation or received the most constipation medications while receiving chemotherapy for a cancer diagnosis. Results We identified 13,375 unique patients with a solid tumor diagnosis receiving chemotherapy. Constipation was the most common gastrointestinal complaint with 8,658 (64.7%; 95% Cl: 63.9–65.5%) meeting our defined constipation diagnosis. Bone cancers had the highest percentage (69.9%) of patients with constipation, while Hodgkin’s lymphoma had the lowest, though 52.1% of patients were affected. A total of 44% (n = 35,301) of encounters received an opioid at some point during admission. Of patients receiving constipation medications, the most commonly prescribed was poly-ethyl glycol (n = 25,175, 31.7%), followed by docusate (n = 11,297, 14.2%), senna (n = 10,325, 13.0%), and lactulose (n = 5,501, 6.9%). Conclusions Constipation is the most common gastrointestinal issue that children with solid tumors experience while receiving chemotherapy. Increased attention should be given to constipation prophylaxis and treatment in children with solid tumors undergoing chemotherapy.

A CASE REPORT RESPIRATORY MANIFESTATIONS OF COVID-19 STARTING WITH A GASTROINTESTINAL COMPLAINT: A COINCIDENCE OR A CORRELATION?

Background: SARS COV-2 is the cause of the current outbreak of COVID-19. The infection of SARS COV-2 causes changes in the gut- lung axis and the intestinal microbiota pro-inflammatory cytokines interaction which leads to the injury of the gastrointestinal tract. One of the symptoms of COVID-19 outside the respiratory system is a complaint in the GIT. Materials and Methods: We present a COVID-19 case report that begins with a complaint of abdominal pain. Results: There was no previous suspicion of COVID-19, but after a radiological examination and SARS-COV2 positive PCR result, the patient was proven to be suffering from COVID-19. Conclusion: After hospitalization in the ICU for about 14 days, a recovery occurred and the patient was able to go home in a very good clinical condition.

Obstructive uropathy associated with primary ureteral endometrioma: case report and review of the literature

We report the case of a 56-year-old postmenopausal woman whopresented with incidental left hydronephrosis during an investigationfor a gastrointestinal complaint. The patient denied any historyof flank pain or hematuria. Contrast-enhanced computedtomography revealed severe right-sided ureterohydronephrosis aswell as renal atrophy. The contralateral kidney was normal, as wasthe patient’s overall renal function. A retrograde ureterogramdemonstrated complete ureteral obstruction 4 cm proximal to theureterovesical junction. Subsequent ureteroscopy revealed a polypoidmass completely occupying the ureteral lumen, of which thebiopsies demonstrated inconclusive atypical urothelial changes.The patient underwent a laparoscopic nephrectomy with opendissection of the distal ureter. The patient recovered well postoperatively.Final pathology revealed a benign obstructingendometrioma without evidence of invasion from periureteraltissue. This appears to be the first reported case of asymptomaticprimary ureteral endometrioma with secondary renal atrophy.Earlier investigation and treatment may have allowed for renalpreservation earlier in the course of the disease.Nous décrivons le cas d’une femme ménopausée de 56 ans présentantune hydronéphrose gauche découverte de façon fortuite aucours d’un examen mené pour donner suite à des symptômes gastro-intestinaux. La patiente n’avait pas d’antécédents de douleurau flanc ou d’hématurie. Une TDM avec agent de contraste arévélé une urétéro-hydronéphrose droite importante accompagnéed’une atrophie rénale. Le rein controlatéral et la fonction rénaleglobale de la patiente ne présentaient aucune anomalie. Uneurétérographie par voie rétrograde a permis d’observer une obstructioncomplète de l’uretère proximale à 4 cm de la jonction urétérovésicale.Une urétéroscopie subséquente a révélé une masse polypoïdeoccupant la totalité de la lumière urétérale et des analysesaprès biopsie ont montré des changements atypiques non concluantsau niveau de l’épithélium urinaire. La patiente a subi unenéphrectomie par laparoscopie avec dissection ouverte de l’uretèredistale. La patiente s’est bien rétablie après l’intervention. Lerapport final de pathologie a révélé un endométriome obstructifbénin sans signe d’invasion des tissus péri-urétéraux. Il sembleque ce soit ici le premier cas signalé d’endométriome urétéralprimitif asymptomatique avec atrophie rénale secondaire. Un examenet un traitement réalisés plus tôt dans le cours de l’évolutionde la maladie auraient pu permettre la préservation du rein.

How to Differentiate Sites of Gastrointestinal Bleeding in Patients with Hematochezia by Using Clinical Factors?

Hematochezia is one of common gastrointestinal complaint at the Emergency Department (ED). Causes may be due to upper (UGIB) or lower (LGIB) gastrointestinal tract bleeding. Here, clinical factors were studied to differentiate sites of bleeding in patients with hematochezia. All patients with an age of more than 18 years who were diagnosed with GIB at the ED, Ramathibodi Hospital, Thailand were enrolled. Patients who presented with hematochezia and received complete workups to identify causes of bleeding were studied and categorized as being in the UGIB or LGIB groups. There were 1,854 patients who presented with GIB at the ED. Of those, 76 patients presented with hematochezia; 30 patients were in the UGIB group, while 43 patients were in the LGIB group. Clinical variables between both groups were mostly comparable. Three clinical factors were significantly associated with UGIB causes in patients with hematochezia including systolic blood pressure, hematocrit level, and BUN/Cr ratio. The adjusted odds ratios for all three factors were 0.725 (per 5 mmHg increase), 0.751 (per 3% increase), and 1.11 (per unit increase). Physicians at the ED could use these clinical factors as a guide for further investigation in patients who presented with hematochezia.

A Rare Case of Myeloid Sarcoma Presenting as an Anorectal Ulcer

Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn’s disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.

Water use and acute diarrhoeal illness in children in a United States metropolitan area

SUMMARYWe examined the association between water exposures and acute diarrhoeal illness (ADI) in children under non-outbreak conditions in a major US metropolitan area. We used a nested case-control study of children seen in an urban/suburban emergency department. Cases were those seen for a complaint of diarrhoea, while controls were age-matched children with a non-gastrointestinal complaint. Parents of subjects completed a validated water-use survey. Stratum-specific adjusted odds ratios (aOR) were calculated for the three main water effects: water source [surface vs. ground (well)], drinking-water type (tap vs. bottled), and use of water filters. Of 2472 subjects, 45% drank mostly or only bottled water. Well-water use was associated with increased odds of ADI compared to surface water [aOR 1·38, 95% confidence interval (CI) 1·01–1·87]. Use of bottled water did not affect the odds of ADI in well-water users, but increased the odds of ADI for surface-water users (aOR 1·27, 95% CI 1·02–1·57). We conclude that well-water use and bottled-water use are associated with increased odds of ADI in children.

Trichophytobezoar Without Gastrointestinal Complaints

Gastrointestinal complaints may be the presenting symptoms of trichophytobezoar. We report a patient, who had an epigastric lump and enlarged lymph nodes on the left side of the neck, but without any gastrointestinal complaint. The clinical diagnosis suggested lymphoma or gastric cancer with secondary masses in the cervical lymph nodes. The diagnosis ultimately proved to be tubercular lymphadenitis on biopsy and gastric trichophytobezoar on endoscopy and laparotomy.