STRESS AND CONSTIPATION (VIBANDHA) - CRITICAL REVIEW

Thoughts and emotions triggered by stress can have an effect on stomach and bowel movement. Physical signs and symptoms of stress overload include chest pain, rapid heartbeat, loss of sexual drive, diarrhoea/ constipation. In this article we have tried to enlighten the association of stress and constipation. The mainly observed clinical features of Vibandha are Hard Stools, Excessive Straining, Sense of Incomplete Evacuation, Flatulence and Lower Abdominal Fullness. The stress hormone may contribute to constipation.

Intermittent percutaneous drainage of ovarian tumour

IntroductionAbdominal pain and distention are common in ovarian tumours. When the ovarian tumour grows too large, the tumour can cause these symptoms. Percutaneous drainage from ovarian tumours, which can alleviate symptoms, is traditionally discouraged for its potential risk of peritoneal tumour seeding.CaseA 73-year-old woman with a multilocular ovarian tumour reporting abdominal fullness and pain was referred to the palliative care outpatient department. The multilocular tumour occupied most of the intra-abdominal space, which was determined to cause her symptoms. To alleviate her symptoms, we performed intermittent percutaneous drainage for 1.5 years. A clinical autopsy revealed the tumour was an ovarian mucinous carcinoma. Despite iterative tumour drainage, we observed no feature of peritoneal dissemination.ConclusionIntermittent percutaneous drainage of ovarian tumours could reduce tumour-related abdominal symptoms without pathological evidence of peritoneal dissemination. This procedure can be a new palliative treatment option for ovarian tumour-related abdominal symptoms.

Gastric Antral Diverticula: A Rare Diverticula with a Unique Presentation

Gastric diverticula are the least common gastrointestinal diverticula. Patients can be diagnosed incidentally on EGD or present with variable symptoms such as abdominal fullness, anorexia, and perforation. Gastric diverticula can be acquired from malignancy, peptic ulcer disease, or prior surgery or be congenital. Treatment varies based on symptomatology ranging from conservative medical management with proton pump inhibitors to surgical treatment with open or laparoscopic resection. We present a case of a 73-year-old female with acquired gastric diverticulum presenting as a gastric outlet obstruction who was successfully treated with conservative medical therapy.

Giant Splenic Artery Aneurysm as a Rare Sequelae of Chronic Pancreatitis

Splenic Artery Aneurysms (SAAs) is the third commonest intra-abdominal aneurysms, following abdominal aorta and iliac artery aneurysms. The SAAs can be either true aneuryms or pseudoaneurysms. SAA measuring >5 cm are generally described as giant. Herein, a case of giant SAA is presented. A 52-year-old male patient with history of alcohol related chronic pancreatitis for the past five years presented with abdominal pain and upper abdominal fullness. Computed Tomography (CT) abdomen was suggestive of giant splenic aneursymal mass. Surgical treatment was planned due to the large size and symptomatic nature of the aneurysm. Splenic artery aneurysmectomy with distal pancreatectomy with splenectomy was performed. The most important and critical complication of giant SAA is spontaneous rupture which has high mortality. Open abdominal surgical excision is still the gold standard for management of giant splenic artery aneuryms, despite recent advances in endovascular treatment options.

Gastric carcinosarcoma with rhabdomyosarcomatous differentiation: a case report and literature review

Gastric carcinosarcoma with rhabdomyosarcomatous differentiation is a rare tumor. Herein, we report the case of a 34-year-old man with a history of dysphagia, upper abdominal fullness, and poor appetite. Endoscopic findings showed a large friable mass that originated from the gastric cardia and lesser curvature of the high body. Consequently, radical total gastrectomy with Roux-en-Y esophagojejunostomy was performed. Histopathological analysis of the resected specimen revealed that the mass had invaded the serosa without regional lymph node metastasis; moreover, the tumor was positive for desmin and myogenin. Finally, we conclude this report with literature review and discussion.

Eosinophilic peritonitis with colon cancer: a case report

Background Eosinophilic gastrointestinal disorders (EGIDs) are a rare group of inflammatory disorders that can occur anywhere along the gastrointestinal tract, from the esophagus to the rectum. In particular, those with malignant or benign tumors are extremely rare. Case presentation A 62-year-old man was referred to our hospital with a chief complaint of abdominal fullness. The peripheral white blood cell count was 19,400/µL, and the eosinophil count was 13,300/µL. Abdominal computed tomography showed massive ascites. Cytology of the ascitic fluid showed a large amount of eosinophils and no malignancy. Upper and lower gastrointestinal endoscopies were performed on the suspicion of EGIDs, and colon cancer with no other abnormalities was found. The biopsies of the cancer lesions and non-cancer lesions also showed significant differences in eosinophil counts per high-power field (HPF) between the cancer and non-cancer lesions (median 77.5 [IQR 52–115] vs. 40.5 [35–56]/HPF, P < 0.05). Exploratory laparoscopy showed cloudy massive ascites and thickening of the mesentery. Pathological examination of the mesentery showed a large amount of eosinophils (median 177.5 [IQR 91–227]/HPF) and no malignancy. Based on these findings, it was suspected that the massive ascites due to eosinophilic peritonitis could be associated with colon cancer. Steroid administration resulted in immediate disappearance of the ascites, and laparoscopic left hemicolectomy was safely performed 6 weeks after steroid administration. Conclusion This report presented a case of eosinophilic peritonitis that could be related to colon cancer. Exploratory laparoscopy was useful to detect the cause of ascites. The possibility that eosinophilic peritonitis was associated with colon cancer is discussed based on the histopathological findings.

Acceptability and Adherence to Peanut-Based Energy-Dense Nutritional Supplement Among Adult Malnourished Pulmonary Tuberculosis Patients in Ballabgarh Block of Haryana, India

Background: Undernutrition is a leading risk factor for tuberculosis and is associated with adverse treatment outcomes. Energy-dense nutritional supplement (EDNS) may be helpful in managing undernutrition in tuberculosis patients. Methods: A longitudinal study was conducted among 102 newly diagnosed pulmonary tuberculosis patients in the Ballabgarh tuberculosis unit in Haryana, India, between September 2018 and February 2019. Participants were provided daily supplementation with 2 sachets of peanut-based EDNS providing 1000 kcal along with the tuberculosis chemotherapy for 2 months. Acceptability was assessed after one month of supplementation. Reported side effects were assessed every 15 days for 2 months and adherence, in terms of proportion of supplement consumed, was assessed on weekly basis for 2 months. Weight was measured at baseline and after 1 month and 2 months. Results: Mean age of participants was 33 years (standard deviation: 13.8) and 75.5% of the participants were male. Almost 100% of the participants found the taste, smell, consistency, and color of the EDNS acceptable. Three participants rejected it after one month of consuming EDNS and another 7 rejected after 2 months of consuming EDNS. After consuming EDNS for 2 months, 13.9% of the participants complained of nausea, 11.9% complained of vomiting, 10.9% complained of diarrhea, and 9.9% complained of pain in the abdomen and abdominal fullness or bloating anytime during the period of supplementation. The adherence to EDNS among the participants was reported as 92.6%. Conclusion: A peanut-based EDNS was highly acceptable and safe, and the adherence to it was high among patients with pulmonary tuberculosis.

Multiple Giant Liver Cysts in a Nepalese Lad

Background. While evaluating a child with multicystic liver pathology, both the congenital and acquired etiologies need to be considered. While typicality of findings on abdominal imaging makes the diagnosis of cystic echinococcosis relatively easy, choosing the appropriate line of management is equally crucial. Case Presentation. An 8-year-old previously healthy lad presented to the office with progressive upper abdominal fullness and pain for a year. Blood workup was normal. CT imaging made a diagnosis of multicystic giant hepatic hydatidosis. Treatment consisting of oral albendazole combined with surgical excision resulted in a fruitful outcome. To the best of our knowledge, this probably represents the first case of multiple giant hepatic hydatidosis at such a young age being reported from Nepal. Conclusion. Childhood liver cysts are uncommon. Considering the endemicity, echinococcal etiology needs consideration. Surgical ablation is required for large cysts, and the mode of management is dictated by the size and location.

Laparoscopic Management of Large Right Paratubal Cyst: A Case Report

Paratubal cysts are generally small but there are rare cases of large paratubal cyst and this case is one of them. Here we report a case of a young female with complains of abdominal fullness since 3 months. On examination, a huge mass (25 x 25 cm) extending from symphysis pubis upto xiphisternum was noted. Ultrasongraphy showed a cystic mass of 27 x 27 cm. Intraoperatively, the cyst was paratubal. It was drained with the help of veress needle and laparoscopic cystectomy was done. A large adnexal cyst extending above umbilicus is traditionally managed by laparotomy. But with the advent of laparoscopy, even a huge cyst can be managed by laparoscopy.