A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

Acute superior mesenteric artery occlusion associated with COVID-19 pneumonia: a case report

Background The novel 2019 coronavirus disease (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2, has spread rapidly around the world and has caused many deaths. COVID-19 involves a systemic hypercoagulable state and arterial/venous thrombosis which induces unfavorable prognosis. Herein, we present a first case in East Asia where an acute superior mesenteric artery (SMA) occlusion associated with COVID-19 pneumonia was successfully treated by surgical intervention. Case presentation A 70-year-old man presented to his local physician with a 3-day history of cough and diarrhea. A real-time reverse transcriptase-polymerase chain reaction test showed positive for COVID-19, and he was admitted to the source hospital with the diagnosis of moderate COVID-19 pneumonia. Eight days later, acute onset of severe abdominal pain appeared with worsening respiratory condition. Contrast CT showed that bilateral lower lobe/middle lobe and lingula ground glass opacification with distribution suggestive of COVID-19 pneumonia and right renal infarction. In addition, it demonstrated SMA occlusion with intestinal ischemia suggesting extensive necrosis from the jejunum to the transverse colon. The patient underwent an emergency exploratory laparotomy with implementing institutional COVID-19 precaution guideline. Upon exploration, the intestine from jejunum at 100 cm from Treitz ligament to middle of transverse colon appeared necrotic. Necrotic bowel resection was performed with constructing jejunostomy and transverse colon mucous fistula. We performed second surgery to close the jejunostomy and transverse colon mucous fistula with end-to-end anastomosis on postoperative day 22. The postoperative course was uneventful and he moved to another hospital for rehabilitation to improve activities of daily living (ADLs) on postoperative day 45. As of 6 months after the surgery, his ADLs have completely improved and he has returned to social life without any intravenous nutritional supports. Conclusions Intensive treatment including surgical procedures allowed the patient with SMA occlusion in COVID-19 pneumonia to return to social life with completely independent ADLs. Although treatment for COVID-19 involves many challenges, including securing medical resources and controlling the spread of infection, when severe abdominal pain occurs in patients with COVID-19, physicians should consider SMA occlusion and treat promptly for life-saving from this deadly combination.

Abdominal migraine in children-An underdiagnosed entity

Abdominal migraine is one of the causes for chronic and recurrent abdominal pains, characterised by recurrent episodes and paroxysms of moderate to severe abdominal pain. Here, we share a case of recurrent severe abdominal pain in a 9-year-old girl who was treated over a period of three months for giardiasis, chronic appendicitis and H. pylori infection, in that order. However, after she was correctly diagnosed with abdominal migraine and accordingly treated with drugs used for the treatment of migraine headaches such as propranolol, flunarizine, cyproheptadine and ergotamine tartrate, she responded well to this regimen.

Abdominal Pain in Young Adults

Aim. A study of abdominal pain incidence in young adults in relation to dietary habits and psychological profile for advancement of health-promoting technologies.Materials and methods. An anonymous quiz survey covered 3,634 students enrolled at Omsk State Medical University in higher and secondary vocational education programmes via online use of the GSRS and WHO CINDI programme questionnaires to assess eating patterns and dietary preferences, as well as a brief multifactor personality inventory scale. Respondents with abdominal pain were divided into subcohorts by pain severity according to GSRS scores (mild, moderate or severe pain).Results. Abdominal pain was reported by 2,300 (63.29%) respondents, of whom 1,243 (54.0%) rated symptoms as mild, 996 (43.3%) and 61 (2.7%) — as moderate to severe. Abdominal pain complaints were more frequent in women (2I = 33.96, p <0.001), but gender had no effect on pain intensity. Pain associated with abdominal bloating and distention (57.65%), gastroesophageal reflux symptoms (38.75%), constipation (30.54%) or diarrhoea (28.4%). The presence and severity of abdominal pain was distinctive of individuals spending the most of average monthly income on food purchase and those actively consuming tea, coffee, added sugar, extra salt in cooked food, while having low intake of fruit and vegetables. A typical personality in severe abdominal pain is hypothymic depressive, hypochondriac in moderate and psychasthenic in mild pain.Conclusion. Abdominal pain is common among medical students predominating in females, associates with the eating pattern, dietary habits and psychological profile.

SEVERITY OF IRRITABLE BOWEL SYNDROME SYMPTOMS AND FODMAPS INTAKE IN UNIVERSITY STUDENTS

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) symptoms such as diarrhea, bloating and abdominal pain can reduce University student’s productivity and learning ability. One of the possible treatments for IBS is the temporarily exclusion of foods that have a high content of short-chain fermentable carbohydrates, the fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). OBJECTIVE: This study aimed to assess University student’s intake of foods that are rich in FODMAPs, looking for possible associations with the severity of IBS symptoms. METHODS: A cross-sectional study was carried out, with undergraduate students from a private University in the city of São Paulo, Brazil, aged between 19 and 46 years old and that were enrolled in different courses and stages. Students were invited to participate and those who gave their formal consent were included in this research. A sociodemographic and lifestyle questionnaire was applied, in addition to the Gastrointestinal Symptom Rating Scale - GSRS. Students also responded a short Food Frequency Questionnaire, developed to investigate habitual FODMAPs intake of Brazilian adult population. Spearman’s correlation analysis between the student’s GSRS scores and the frequency of foods rich in FODMAPs intake were performed in SPSS v.21. RESULTS: Fifty-six students were interviewed, with mean age of 21.4 years old (SD=4.41), with a predominance of women (76.8%). The GSRS results showed that 58.9% of students felt minimal to moderate abdominal discomfort and 14.3% had moderately severe to very severe abdominal pain during the prior week to the interview. Besides abdominal pain, the gastrointestinal symptoms that were most reported by students were flatulence (98.2%), stomach rumbling (89.3%) and eructations (85.7%). Greater symptom severity was observed in women (P=0.004) and sedentary students (P=0.003). Regarding FODMAPs consumption, honey (P=0.04), chocolate (P=0.03) and milk table cream (P=0.001) intakes were positively correlated with the greater severity of symptoms. CONCLUSION: Although clinical diagnosis is necessary to establish IBS, 73.2% of the students presented minimal to very severe abdominal pain during the prior week. Female had sedentary students had greater severity of gastrointestinal symptoms. A low FODMAP diet, well oriented, could bring some symptoms relief to these University students.

Haines describes a case of streptococcal peritonitis, pleurisy and epididymitis (Amer. Med. J. v. 97, no. 9).

(Amer. Med. J. v. 97, No. 9). Child 9 months. was ill with intermittent T, chills for 3 weeks and apparently severe abdominal pain, no vomiting, but poor appetite.