ACE inhibitor-induced small bowel angioedema, mimicking an acute abdomen

ABSTRACT Angiotensin-converting enzyme (ACE) inhibitors are the leading cause of drug-induced angioedema, being the face, tongue, lips and upper airway the most affected ones. We describe a case of a 32-year-old white female with angioedema of small intestine after 1 month of perindopril therapy. The patient presented severe abdominal pain, nausea and vomiting. Laboratory analyses revealed mild leukocytosis and abdominal computed tomography (CT) showed unspecific findings, including segmental jejunal wall thickening without obstruction and ascites. Regarding the clinical findings, similar to an acute abdomen with no clear cause, the patient underwent an emergency laparoscopy that excluded other pathological features. The symptoms recurred 1 month after and the CT scan revealed the same pattern. Perindopril was stopped and the patient improved, concluding that ACE inhibitor-induced visceral angioedema was responsible for this clinical presentation.

Intestinal ganglioneuroma in a neonatal Japanese black calf – Short communication

A 1-day-old male calf presented with clinical signs of severe progressive abdominal distension. Abdominal radiographic and ultrasonic images revealed several loop-like structures in the small intestine, which were indicative of gas retention. Experimental laparotomy was performed. However, the calf died during surgery. At necropsy, a round, well-circumscribed mass (3 × 3 × 2.5 cm) was found in the jejunal wall, and the jejunal lumen was narrowed. The mass was firm and had white to grey appearance on the cut surface. Histologically, the submucosa and the muscle layer were diffusely thickened due to abundance of neural tissues comprising several fascicles of nerve fibres and large aggregates of ganglion cells. Some ganglion cells contained basophilic Nissl substances in their cytoplasm. Immunohistochemically, these cells were positive for S-100 and synaptophysin. Ultrastructural examination revealed that the neoplastic ganglion cells contained dense core vesicles in the cytoplasm. Based on these findings, the neoplastic lesion was diagnosed as ganglioneuroma in the jejunum.

Jejunal Ulcer Caused by Schistosoma japonicum

Intestinal schistosomiasis can be caused by the trematodes Schistosoma japonicum that mainly exists in East Asia or the S. mansoni in Africa and South America. The adult worms of S. japonicum live in the mesenteric veins and excrete eggs that circulate to the liver and colon; the eggs migrate through the intestinal wall and pass out with the stool. Here, we report a case of jejunal ulcer caused by the infection of Schistosoma japonicum. A 63-year-old woman from Wuhan, China, was admitted with left quadrant abdominal pain and weight loss for more than 6 months. The patient’s computerized tomography reported cirrhotic liver changes, jejunal wall edema, and narrowed lumen; the upper enteroscopy corroborated these findings with the presence of several jejunal ulcers and edema. The pathology report showed chronic inflammation with ulcerative changes and S. japonicum eggs deposition. Schistosomiasis is one of the neglected tropical diseases that affect the poorest. Although a great improvement has been made to control it, there is a lot of work that remains to be fulfilled.

Recurrent feline gastrointestinal eosinophilic sclerosing fibroplasia and presumptive eosinophilic cystitis in a domestic short-haired cat: a case report

This report describes recurrent feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) and eosinophilic cystitis in an 8-year-old domestic short-haired cat. The cat presented with incontinence, pollakiuria, vomiting and weight loss. An abdominal mass was palpated and ultrasonography revealed severe segmental thickening of the jejunal wall with loss of layering. Complete resection of the jejunal mass was performed. The resected mass was composed of branching trabeculae of dense collagen, intermixed with bundles of large fibroblasts and inflammatory cells, which is consistent with FGESF. One year later, a new mass reoccurred in another intestinal segment. Between both FGESF occurrences, mycoplasmas were cultured from urine and fine needle aspiration of the urinary bladder wall showed numerous eosinophils only; therefore, a presumptive diagnosis of eosinophilic cystitis was made. All haematological analyses performed within the one-year period revealed eosinophilia.

Effect of Boswellia serrata Dietary Supplementation on Growth Performance, Gastrointestinal Microflora, and Morphology of Broilers

The study aimed to determine the effect of three different levels of Boswellia serrata resin added to broiler diets on the fundamental production parameters, dry matter digestibility, organic matter digestibility, energy digestibility, microbiological condition of the gastrointestinal tract, and histomorphology of the walls of the small intestine. Two hundred Ross 308 chicks were assigned into 4 groups (50 birds of equal body weight) in 5 replications of 10 chicks each (5 females and 5 males). The experiment lasted 6 weeks. The control group (B0) was fed a standard mixture, without supplementation, whereas in groups B1.5, B2, and B2.5, the Boswellia serrata resin was added at the levels of 1.5, 2.0, and 2.5% of the complete feed mixture, respectively. The dietary supplementation with 2.0 and 2.5% of Boswellia serrata resin contributed to a significant increase in the length of the duodenum and total intestine and in the digestibility of dry matter and organic matter in feed. In these groups, the values of FCR and EEI were positively influenced (P<0.05) and an improvement in the structure of the jejunal wall was also recorded (P<0.05). An increase in the count of Lactobacillus and Enterococcus in the intestinal contents in broilers fed with the Boswellia serrata resin supplemented diets was observed. In conclusion, the Boswellia serrata resin can be considered as an effective feed additive, which stimulates production and has a positive effect on intestinal microflora and morphology of broilers.

Intestinal Anisakiasis Treated Successfully with Prednisolone and Olopatadine Hydrochloride

The clinical characteristic of gastrointestinal anisakiasis is severe abdominal pain after eating raw fish. Intestinal anisakiasis is more uncommon than gastric anisakiasis. Most patients with intestinal anisakiasis need hospitalization because anisakiasis can cause intestinal obstruction, ileus, peritonitis or intestinal perforation. We report a case of intestinal anisakiasis. A 43-year-old woman presented with symptoms of intermittent abdominal pain 2 days after eating raw fish. Her brother had eaten the same food and had been suffering from gastric anisakiasis. Abdominal ultrasonography in this patient showed localized jejunal wall thickening with dilated lumen of proximal jejunum and ascites. According to the clinical course and examinations, she was diagnosed with intestinal anisakiasis. Administration of prednisolone 5 mg/day and olopatadine hydrochloride 10 mg/day improved her symptoms quickly without hospitalization. Prednisolone was administered for 10 days, and olopatadine hydrochloride was administered for a total of 6 weeks according to ultrasonographic findings. Six months after the treatment, the abdominal ultrasonography demonstrated normal findings. This case demonstrates that ultrasonography was quite useful for the diagnosis and surveillance of intestinal anisakiasis. Furthermore, treatment with corticosteroid and an antiallergic agent could be an option for patients with intestinal anisakiasis.