scholarly journals Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Vatche Melkonian ◽  
Pablo Quadri ◽  
Chintalapati R. Varma ◽  
Mustafa Nazzal ◽  
Henry B. Randall ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Alcoholic Cirrhosis ◽  
Meld Score ◽  
Intestinal Malrotation ◽  
Midgut Volvulus ◽  
Bacterial Peritonitis ◽  
Alcohol Relapse ◽  
Pugh Class ◽  
Class C ◽  
Ladd’S Procedure

Intestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd’s procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being diagnosed with asymptomatic intestinal malrotation with subsequent intestinal complications is thus extremely rare and to our knowledge has not been previously reported. We describe a 56-year-old man with decompensated alcoholic cirrhosis (Child-Pugh class C, MELD score 22) who was initially observed after an incidental diagnosis of intestinal malrotation on computed tomography. Observation continued as his liver disease improved with alcohol cessation (Child-Pugh class A, MELD score 8). He later presented with a closed loop bowel obstruction secondary to midgut volvulus at the time of alcohol relapse and liver redecompensation (Child-Pugh class C, MELD score 22-29). He underwent emergency Ladd’s procedure during which his midjejunum was volvulized into an internal hernia space created by a thick Ladd’s band containing large varices. The postoperative course was complicated by ileus and loculated bacterial peritonitis. Based on our experience, we discuss special considerations with regard to the surgical technique and timing of Ladd’s procedure when encountering intestinal malrotation in a cirrhotic adult with portal hypertension.

scholarly journals Cryptosporidiosis in patients with diarrhea and chronic liver diseases

2014 ◽  
Vol 8 (12) ◽  
pp. 1584-1590 ◽  
Author(s):  
Nasser Mousa ◽  
Ahmed Abdel-Razik ◽  
Hala El-Nahas ◽  
Atef El-Shazly ◽  
Mohammad Abdelaziz ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Diseases ◽  
Meld Score ◽  
Chronic Liver ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cryptosporidium Infection ◽  
Chronic Liver Diseases ◽  
Pugh Class ◽  
Class C ◽  
Precipitating Factor

Introduction: The aim of this study was to evaluate the epidemiology and clinical significance of Cryptosporidium in patients with diarrhea and chronic liver diseases. Methodology: The study included 150 patients with chronic liver diseases and diarrhea, and 50 subjects with diarrhea as a control group. Stool samples were screened for the presence of Cryptosporidium by microscopic examination after modified Ziehl-Neelsen staining and detection of Cryptosporidium coproantigen by enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of Cryptosporidium infection in patients with chronic liver diseases was 30% (45/150) versus 14% (7/50) in controls. Cryptosporidium infection increased with the progression of chronic liver diseases from Child-Pugh class A to Child-Pugh class C (p<  0.001) and from model for end-stage liver disease (MELD) score ≤ 9 to MELD score > 9 (p< 0.031). Nine patients in Child-Pugh class C with diarrhea associated with Cryptosporidium infection developed hepatic encephalopathy, and only diarrhea was identified as a precipitating factor for hepatic encephalopathy. Conclusions: Cryptosporidium is one of the important causes of diarrhea in patients with chronic liver diseases. The infection significantly increased with the progression of chronic liver diseases. In patients with advanced chronic liver diseases, Cryptosporidium infection may be a precipitating factor of hepatic encephalopathy.

scholarly journals Clinical implications of prompt ascitic drain removal among cirrhosis with refractory ascites

2021 ◽  
Author(s):  
YJ Wong ◽  
HM Lum ◽  
PT Tan ◽  
EK Teo ◽  
JY Tan ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Alcoholic Cirrhosis ◽  
Meld Score ◽  
Refractory Ascites ◽  
Decompensated Cirrhosis ◽  
Resistant Organism ◽  
Bacterial Peritonitis ◽  
Drain Removal ◽  
Large Volume Paracentesis ◽  
End Stage

Introduction: Large-volume paracentesis (LVP) is the first-line treatment for decompensated cirrhosis with refractory ascites. While ascitic drain removal (ADR) within 72 hours was once considered safe, it was uncertain if ADR within 24 hours could further reduce the risk of ascitic drain-related bacterial peritonitis (AdBP). This study aimed to investigate the association between the timing of ADR and the presence of AdBP. Methods: All cirrhotics with refractory ascites who underwent LVP in our institution from 2014 to 2017 were studied. AdBP was diagnosed based on ascitic fluid neutrophil count ≥ 250 cells/mm3 or positive ascitic fluid culture following recent paracentesis within two weeks. Results: A total of 131 patients who underwent LVP were followed up for 1,806 patient-months. Their mean age was 68.3 ± 11.6 years, and 65.6% were male. Their mean Model for End-Stage Liver Disease (MELD) score was 15.2. The overall incidence of AdBP was 5.3%. ADR beyond 24 hours was significantly associated with longer median length of stay (five days vs. three days, p < 0.001), higher risk of AdBP (0% vs. 8.9%, p = 0.042) and AKI following LVP (odds ratio 20.0, 95% confidence interval 2.4–164.2, p = 0.021). Overall survival was similar in patients with ADR within and beyond 24 hours. Conclusion: ADR within 24 hours is associated with reduced risk of AdBP and AKI. As AdBP is associated with resistant organism and AKI, we recommend prompt ADR within 24 hours, especially among patients who have Child-Pugh C with alcoholic cirrhosis.

scholarly journals Intestinal Malrotation with Midgut Volvulus leading to Small Bowel Obstruction in a Young Adult: A Case Report

2020 ◽  
Vol 9 (2) ◽  
pp. 149-152
Author(s):  
Junaid Zia Hashmi ◽  
Talha Kareem ◽  
Masood ur Rauf Khan Hiraj
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Iliac Fossa ◽  
Rare Condition ◽  
Intestinal Malrotation ◽  
Uneventful Recovery ◽  
Midgut Volvulus ◽  
Left Iliac Fossa ◽  
Ladd’S Procedure

The developing intestine rotates around the superior mesenteric vessels during physiological herniation from 6th to 10th weeks of embryogenesis. Intestinal malrotation leading to midgut volvulus and small bowel obstruction is a rare condition. Patients who develop this condition usually present in the first year of their life. Intestinal malrotation is characterized by right sided duodenojejunal junction, caecum in left iliac fossa and a narrow mesentery. Ladd’s procedure is the treatment of choice which is done to restore the normal anatomy. We report the case of an 18-year-old male patient, who presented with intestinal malrotation in emergency department of Nishtar Hospital, Multan. It is an uncommon age for presentation of this anomaly. The patient had fecal peritonitis due to caecal perforation. He underwent Ladd’s procedure in which ileocolostomy was made after right hemicolectomy. The patient had an uneventful recovery after the surgery and had no complaints on follow up visit one week after the discharge.

scholarly journals Pasteurella multocida peritonitis after cat scratch in a patient with cirrhotic ascites

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Roshan Gunathilake ◽  
Ajay Verma ◽  
Michael Caffery ◽  
David Sowden
Keyword(s):  
Multiple Organ Failure ◽  
Organ Failure ◽  
High Mortality ◽  
Pasteurella Multocida ◽  
Early Recognition ◽  
Alcoholic Cirrhosis ◽  
Multiple Organ ◽  
Bacterial Peritonitis ◽  
Appropriate Treatment ◽  
Pugh Class

<em>Pasteurella multocid</em>a, a zoonotic agent transmitted by canines and felines, has been very rarely reported to cause bacterial peritonitis in humans. <em>Pasteurella multocida</em> peritonitis is associated with high mortality even with appropriate treatment, therefore its early recognition is essential. We report a case of <em>Pasteurella multocida</em> peritonitis following cat scratch in a patient with Child Pugh Class C alcoholic cirrhosis, culminating in multiple organ failure and death.

Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

2021 ◽  
Vol 15 (9) ◽  
pp. 2943-2947
Author(s):  
Muhammad Siddique ◽  
Muhammad Abdul Quddus ◽  
Tahir Iqbal ◽  
Hefsa Qamar ◽  
Muhammad Ikram Shah ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Operational Definition ◽  
Cross Sectional ◽  
Bacterial Peritonitis ◽  
Number Of Patients ◽  
Class B ◽  
Pugh Class ◽  
Class C

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

Serum miR-21 and miR-26a Levels Negatively Correlate with Severity of Cirrhosis in Patients with Chronic Hepatitis B

MicroRNA ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Shili Jiang ◽  
Wei Jiang ◽  
Ying Xu ◽  
Xiaoning Wang ◽  
Yongping Mu ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Curve Analysis ◽  
Pugh Class ◽  
Operating Characteristic Curve ◽  
Class C ◽  
Circulating Levels

Background and Objective: Accurately evaluating the severity of liver cirrhosis is essential for clinical decision making and disease management. This study aimed to evaluate the value of circulating levels of microRNA (miR)-26a and miR-21 as novel noninvasive biomarkers in detecting severity of cirrhosis in patients with chronic hepatitis B. </P><P> Methods: Thirty patients with clinically diagnosed chronic hepatitis B-related cirrhosis and 30 healthy individuals were selected. The serum levels of miR-26a and miR-21 were quantified by qRT-PCR. Receiver operating characteristic curve analysis was performed to evaluate the sensitivity and specificity of the miRNAs for detecting the severity of cirrhosis. Results: Serum miR-26a and miR-21 levels were found to be significantly downregulated in patients with severe cirrhosis scored at Child-Pugh class C in comparison to healthy controls (miR-26a p<0.01, and miR-21 p<0.001, respectively). The circulating miR-26a and miR-21 levels in patients were positively correlated with serum albumin concentration but negatively correlated with serum total bilirubin concentration and prothrombin time. Receiver operating characteristic curve analysis revealed that both serum miR-26a and miR-21 levels were associated with a high diagnostic accuracy for patients with cirrhosis scored at Child-Pugh class C (miR-26a Cut-off fold change at ≤0.4, Sensitivity: 84.62%, Specificity: 89.36%, P<0.0001; miR-21 Cut-off fold change at ≤0.6, Sensitivity: 84.62%, Specificity: 78.72%, P<0.0001). Our results indicate that the circulating levels of miR-26a and miR-21 are closely related to the extent of liver decompensation, and the decreased levels are capable of discriminating patients with cirrhosis at Child-Pugh class C from the whole cirrhosis cases.

scholarly journals RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenzhen Zhang ◽  
Guomin Xie ◽  
Li Liang ◽  
Hui Liu ◽  
Jing Pan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Poor Prognosis ◽  
Alcoholic Cirrhosis ◽  
Normal Liver ◽  
Neutrophil Infiltration ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

Mo1002 MELD Score Is a Risk for First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis

2014 ◽  
Vol 146 (5) ◽  
pp. S-983
Author(s):  
Rashid Khan ◽  
Whitney Jennings ◽  
Habeeb Salameh ◽  
Kirk Russ ◽  
Matthew J. Skinner ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Meld Score ◽  
First Episode ◽  
Bacterial Peritonitis
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