Subclinical TRAPS treated with canakinumab

Tumor necrosis factor receptor–associated periodic syndrome (TRAPS) is a rare autoinflammatory disease characterized by recurrent episodes of fever and systemic inflammation. We describe the case of a 19-year-old patient who was referred to our attention with frequent subclinical TRAPS episodes characterized by mild arthralgias and crampy abdominal pain, without fever. Inflammatory markers, including serum amyloid A which increases the risk of long-term amyloidosis, were persistently high also when the patient was in good general conditions. Therapy with human anti-interleukin 1β monoclonal antibody, canakinumab, led to disease control and normalization of the inflammatory markers, which are currently still normal. This clinical case supports the need to treat also subclinical TRAPS. In this respect, canakinumab is effective and reduces the risk of developing amyloidosis.

Surgical Management of Gallstone Ileus in Low-Settings Hospital during COVID-19 Outbreak: A Case Report

Introduction Gallstone ileus is a very infrequent complication of cholelithiasis in which single or multiple stones pass through an abnormal fistula to the lumen of the intestine leading to a true mechanical obstruction. We are reporting a case of a female who developed intestinal obstruction due to gallstones during the coronavirus disease 2019 (COVID-19) outbreak and was managed urgently surgically in a low-settings hospital. Case Presentation An 85-year-old white female with 40 years history of gallstone disease, hypertension, and type-2 diabetes presented to the accidents and emergency unit with upper central crampy abdominal pain for 5 days associated with green color vomiting and absolute constipation. On examination, she was barely stable, dehydrated, had a distended abdomen, and guarding in the epigastric region. Her electrolytes were disturbed and had elevated serum creatinine and blood urea. Imaging studies confirmed gallstone ileus. Management was surgical despite the lack of facilities and equipment including COVID-19 personal protective equipment. Conclusion Despite being an infrequent complication, gallstone ileus might present at the most unexpected time and in the least equipped hospital where the surgeon's suspicion, risk stratification, and improvisation by utilizing what is available are the keys for successful management and saving lives.

An Accidental Intestinal Myiasis Caused by Cochliomyia macellaria

Intestinal myiasis is recognized as pseudomyiasis or accidental myiasis caused by dipteran fly larvae transmitted to humans via contaminated food or water. A case of intestinal myiasis acquired via contaminated food is reported in this case study. The patient is a 4-year-old boy who had frequent episodes of crampy abdominal pain and diarrhoea and the passage of many live worms at each time. As the child had the habit of eating ripe guava from his garden, the infection source was suggested as ripe guava, and the possibility was explored. All larvae collected from faeces and fruit were morphologically similar, and it has been identified as Cochliomyia macellaria. The treatment with several antihelmintics failed, and the recovery was achieved with a simple measure of abstinence from eating guava that came from his garden.

Obturator hernia: case report

Obturator hernia, protrusion of abdominal content through the obturator foramen, is a rare type of abdominal wall hernia. Late patient presentation is associated with significant morbidity and mortality. We present rare case of obturator hernia causing small bowel obstruction in a 65-year-old-female patient. She presented with crampy abdominal pain, nausea and vomiting of three days duration. She was diagnosed with acute surgical abdomen and managed surgically at Arsi University College of health sciences, Assela, Ethiopia. Intraoperative finding revealed left-side obturator hernia, which is an extremely rare occurrence. Despite delayed presentation, our patient had smooth postoperative recovery. Obturator hernia is exceedingly rare, and it poses a diagnostic challenge as signs and symptoms are often nonspecific, making a preoperative diagnosis difficult. So, it should be considered as differential diagnosis in elderly patients presenting with acute surgical abdomen.

Non-Operatively Managed Primary Small Bowel Volvulus: A Case Report

Background: Primary small intestinal volvulus is one of the common causes of intestinal obstruction in various localities of the developing world. Although operative intervention has been the usual mode of treatment; this case report depicts with meticulous follow-up & care, there is a possibility for relief of obstruction with non-operative management.Case presentation: This is a case report of a 20-year-old male patient presented with crampy abdominal pain and frequent bilious vomiting. Plain abdominal film showed multiple distended small bowel loops with air fluid level, consistent with small bowel obstruction. Ruling out other etiologies primary small bowel volvulus was entertained and naso-gastric tube inserted, patient catheterized and kept nil per oral. After 48 hours of admission all symptoms resolved the patient resumed feeding and was discharged home. Conclusions: The reported case shows evidence in which the pa­tient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

Irritable Bowel Syndrome: The Most Common Presentation, Severity Ranking and Therapeutic Regimens among Patients Attending Outpatient

Background: Irritable bowel syndrome (IBS) is one of the most common GI disorders in people under 50 years of age.Objective: To Formulate an overview about demographics of IBS and patterns of presentation, to determine IBS patients severity ranking, and to recognize the main regimens with their patient satisfaction.Methods: This is a cross sectional clinical study that is conducted in Outpatient Consultant Internal Medicine Clinic in Al-Kindy Teaching Hospital from 11/12/2017 to 24/12/2017. The patients suffering from IBS are diagnosed by a consultant according to the symptom-based Rome criteria for functional GI disorders, by implementing a questionnaire collecting thorough information. 77 cases of IBS patients were collected (24 male and 53 female).Results: This study revealed that majority of patients were female (68.8%). Most of the patients were married, employees and housewives, aged between (20-30 yrs). Most patients use anxiolytics, muscle relaxants and proton pump inhibitor. There is a high IBS prevalence among low educational level (high school graduates and non-school graduates).Most patients in our study had constipation.Aggravating factors Psychological factors (stress) are intrinsically associated with IBS and symptoms in a large percentage of patients.Antispasmodics usage in our study show high effectiveness for IBS patients especially those with crampy abdominal pain and diarrhea.Conclusions: Diagnosing and managing IBS can be a big challenge since many drugs used to reduce symptoms and severity, but also, they could be unnecessary medication that could aggravate bowel symptoms and have adverse effects on the long term.

Lipomatous polyp causing colo-colic intussusception

<p>A lipoma is a benign tumour that arises from an adipose tissue. It is the leading benign soft tissue tumour. It can occur anywhere in the human body. Lipomas in the gastrointestinal tract are quite rare and usually asymptomatic. We report a 70 years old male patient who presented with crampy abdominal pain. CT scan of the abdomen showed colo-colic intussusception. The patient was explored and the finding was colo-colic intussusception with a mass as a leading point. En-block resection done. Histology confirmed the mass as a lipoma.</p>

Congenital band adhesion causing a proximal jejunal obstruction: an uncommon presentation and diagnosis

A 20-year-old woman with no medical or surgical history presented with acute onset crampy abdominal pain on a background of uninvestigated similar chronic abdominal pain. She became obstructed during her admission and a contrast swallow showed a complete obstruction at the level of the proximal jejunum. A diagnostic laparoscopy revealed a congenital band adhesion from the greater omentum to the proximal jejunum to be the cause, and dissection of the band relieved her obstruction. This case presents a rare cause of mechanical obstruction, and highlights the seriousness of investigating obstructive symptoms even in atypical patient populations.

Pneumatosis cystoides intestinalis (PCI) in a patient with undiagnosed systemic sclerosis

Pneumatosis cystoides intestinalis (PCI) refers to the presence of gas within the wall of the small or large intestine. The pathophysiology is incompletely understood and is probably multifactorial in nature. PCI is a known but rare complication of systemic scleroderma, and the aetiology of PCI in patients with scleroderma is not fully understood. We present the case of a patient who was referred to gastroenterology clinic by her general practitioner for investigation of 8 months of weight loss, urgency, diarrhoea, bloating and crampy abdominal pain. Extensive investigations were performed to exclude infective, inflammatory or malignant aetiologies for these symptoms. She was diagnosed with PCI on her colonoscopy and was subsequently screened for secondary causes. Our patient was diagnosed with the limited cutaneous (CREST) variant of systemic scleroderma. This case report illustrates that PCI could be an uncommon presentation of systemic sclerosis, therefore clinicians should be aware of the association between these conditions.