scholarly journals Primary Gastrointestinal Amyloidosis: An Unusual Cause of Acute Intestinal Pseudo-Obstruction

2019 ◽  
Vol 13 (3) ◽  
pp. 462-467
Author(s):  
Panu Wetwittayakhlang ◽  
Pimsiri Sripongpun ◽  
Sawangpong Jandee
Keyword(s):  
Small Bowel ◽  
Clinical Symptoms ◽  
Amorphous Material ◽  
Polarized Light ◽  
Abdominal Distension ◽  
Abdominal Radiograph ◽  
Plain Abdominal Radiograph ◽  
Colicky Pain ◽  
Intestinal Pseudo Obstruction ◽  
Fluid Levels

Amyloidosis of the gastrointestinal tract is an uncommon disorder characterized by the extracellular deposition of an abnormal fibrillar protein. It is rarely proven by biopsy. Amyloid deposition interferes with organ structure and its function. We report a case of a 64-year-old male who presented with severe colicky pain, unable to pass feces, and progressive abdominal distension for 2 days. Physical examination revealed marked abdominal distension, visible peristalsis, high-pitched hyperactive bowel sounds, and generalized tenderness. Plain abdominal radiograph showed markedly diffuse disproportional dilatation of the small bowel with different heights of air-fluid levels in the same loop. Abdominal computed tomography showed an evidence of small bowel obstruction, which revealed no gross mass or cause of obstruction, but long segment narrowing of the terminal ileum was seen. Ileocolonoscopy showed diffuse edematous mucosa of the ileum without mechanical obstruction but loss of normal bowel peristalsis. A random biopsy of the ileum was performed for pathological diagnosis, which reported extensive deposits of amorphous material within the muscle layers and in the submucosal vessels that stained strongly with Congo red and displayed the typical apple-green birefringence of amyloid protein when viewed under plane polarized light. Serum electrophoretic tests disclosed a monoclonal band of IgG-kappa monoclonal protein. His clinical symptoms improved after receiving chemotherapy with melphalan and prednisolone. Our case illustrated the rare cause of acute intestinal obstruction which mimicked a surgical condition. Primary intestinal amyloidosis should be in a differential diagnosis in patients without a demonstrated cause of obstruction.

scholarly journals Small bowel obstruction due to phytobezoar and adhesions following laparoscopic cholecystectomy

2015 ◽  
Vol 3 (2) ◽  
pp. 63
Author(s):  
Nidal Abu jkeim ◽  
Ahmad Al hazmi ◽  
Awad Alawad ◽  
Rashid Ibrahim ◽  
Ahmad Abu damis ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Abdominal Radiograph ◽  
Plain Abdominal Radiograph ◽  
History Of ◽  
Metallic Clip ◽  
Fluid Levels ◽  
Gallbladder Fossa

<p>We report a case of 51 –year-old female with history of laparoscopic cholecystectomy presented with abdominal pain and diagnosed as small bowel obstruction caused by adhesions. The initial presentation was periumbilical pain with nausea and vomiting. Plain abdominal radiograph showed dilated small bowel loops and multiple air fluid levels. Due to failure of conservative treatment, laparotomy was performed. An open metallic clip was adhering the bowel to the gallbladder fossa causing sharp angulation. A phytobezoar proximal to this angulation was exteriorized through enterotomy. The patient was recovered smoothly and discharged from our hospital.</p>

scholarly journals Plain Abdominal Radiographs: Can we Interpret Them?

2006 ◽  
Vol 88 (1) ◽  
pp. 23-26 ◽  
Author(s):  
C Beverly B Lim ◽  
Vivian Chen ◽  
Allon Barsam ◽  
Jeremy Berger ◽  
Richard A Harrison
Keyword(s):  
Small Bowel ◽  
Large Bowel ◽  
Correct Diagnosis ◽  
Abdominal Radiograph ◽  
Junior Doctors ◽  
Plain Abdominal Radiograph ◽  
Upper Limit ◽  
Diagnostic Role ◽  
Abdominal Radiographs ◽  
Normal Dimension

INTRODUCTION Plain abdominal radiographs commonly form a part of medical assessments. Most of these films are interpreted by the clinicians who order them. Interpretation of these films plays an important diagnostic role and, therefore, influences the decision for admission and subsequent management of these patients. The aim of this study was to find out how well doctors in different specialties and grades interpreted plain abdominal radiographs. MATERIALS AND METHODS A total of 76 doctors from the Departments of Accident & Emergency, Medicine, Surgery and Radiology (17, 32, 23 and 4, respectively) participated in the study which involved giving a diagnosis for each of 14 plain abdominal radiographs (5 ‘normal’ and 9 ‘abnormal’). They were also asked the upper limit of normal dimensions of small bowel and large bowel. One point was awarded for correctly identifying whether a radiograph was normal/abnormal, 1 point for the correct diagnosis and 1 point for the correct bowel dimensions, giving a total score of 30. RESULTS Mean scores out of 30 for specialties were as follows: Accident & Emergency 13.1 (range, 2–22), Medicine 11.2 (range, 2–23), Surgery 15.0 (range, 8–24) and Radiology 17.0 (range, 14–20; P = 0.241). Mean scores out of 30 for different grades of doctors were as follows: pre-registration house officers 10.8 (range, 4–20), senior house officers 13.0 (range, 2–22), registrars/staff grades 13.8 (range, 2–23) and consultants 17.3 (range, 12–24; P = 0.028). Fifteen out of 76 (19.7%) doctors correctly identified the upper limit of normal dimension of small bowel; 24 out of 76 (31.6%) correctly identified the upper limit of normal dimension of large bowel. DISCUSSION The level of seniority positively correlated with skills of plain abdominal radiograph interpretation. A large number of doctors were unable to give the correct upper limit of normal dimensions for small and large bowel. CONCLUSIONS All doctors could benefit from further training in the interpretation of plain abdominal radiographs. This could perhaps take place as formal teaching sessions and be included in induction programmes. Until then, plain abdominal films should ideally be reported by radiologists where there are clinical uncertainties; important management decisions made by junior doctors based on these films should at least be confirmed with a registrar, if not a consultant.

scholarly journals Nonocclusive mesenteric ischemia associated with postoperative jejunal tube feeding: Indicators for clinical management

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052092912
Author(s):  
Hendrik Christian Albrecht ◽  
Mateusz Trawa ◽  
Stephan Gretschel
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Clinical Symptoms ◽  
Treatment Guideline ◽  
Tube Feeding ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Bowel Necrosis ◽  
Nonocclusive Mesenteric Ischemia ◽  
Jejunal Tube

Postoperative nutrition via a jejunal tube after major abdominal surgery is usually well tolerated. However, some patients develop nonocclusive mesenteric ischemia (NOMI). This morbid complication has a grave prognosis with a mortality rate of 41% to 100%. Early symptoms are nonspecific, and no treatment guideline is available. We reviewed cases of NOMI at our institution and cases described in the literature to identify factors that impact the clinical course. Among five patients, three had no necrosis and one had segmental necrosis and perforation. These patients recovered with limited resection and decompression of the bowel and abdominal compartment. In one patient with extended bowel necrosis at the time of re-laparotomy, NOMI progressed and the patient died of multiple organ failure. The extent of small bowel necrosis at the time of re-laparotomy is a relevant prognostic factor. Therefore, early diagnosis and treatment of NOMI can improve the prognosis. Clinical symptoms of abdominal distension, cramps and high reflux plus paraclinical signs of leukocytosis, hypotension and computed tomography findings of a distended small bowel with pneumatosis intestinalis and portal venous gas can help to establish the diagnosis. We herein introduce an algorithm for the diagnosis and management of NOMI associated with jejunal tube feeding.

scholarly journals Prolonged Intestinal Mucosal Barium Coating due to Ischemic Necrosis

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Vincent H. S. Low
Keyword(s):  
Small Bowel ◽  
Bowel Perforation ◽  
Mucosal Damage ◽  
Abdominal Radiograph ◽  
Wall Thickening ◽  
Plain Abdominal Radiograph ◽  
Transplantation Surgery ◽  
Abdominal Ct Scan ◽  
Bowel Wall Thickening ◽  
Fluid Collections

A case of a 63-year-old man with small bowel ischemia six weeks after transplantation surgery is presented. Plain abdominal radiograph obtained several days after ingestion of barium shows the sign of prolonged barium coating indicating severe mucosal damage. Abdominal CT scan demonstrates small bowel wall thickening as well as pockets of peritoneal fluid collections. Most critically, CT allows visualization of subtle traces of dense barium within the dependent portions of this fluid indicating bowel perforation.

scholarly journals Sudden Unexpected Death Associated with Ileocecal Duplication Cyst and Clinical Review

2010 ◽  
Vol 4 ◽  
pp. CMPed.S4850 ◽  
Author(s):  
Y Kashiwagi ◽  
S. Suzuki ◽  
K. Watanabe ◽  
S. Nishimata ◽  
H. Kawashima ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Duplication Cyst ◽  
Multiple Organ ◽  
Watery Diarrhea ◽  
Abdominal Radiograph ◽  
Unexpected Death ◽  
Plain Abdominal Radiograph ◽  
Abdominal Symptoms

Duplications of the alimentary tract are very rare. A one-month-old female presented with symptoms of anorexia, vomiting and continuous watery diarrhea. The plain abdominal radiograph showed thickened intestinal wall and signs of small bowel obstruction. The fevers, vomiting, and continuous wartery diarrhea persisted despite antibiotics, and worsened. The patient failed to respond to medical managements, 27 hours after admission, the patient died due to multiple organ failures. The autopsy was performed, small bowel obstruction due to an ileocecal duplication cyst (3 × 3 cm) was recognized. The ileocecal duplication cyst was attached to the ileum which was changed edematous and necrotic. This potential diagnosis should be borne in mind for a patient who complains of abdominal symptoms with an unknown cause, and duplication cyst should be recognized as a fatal cause in infant.

Accuracy of Computed Tomography in Small Bowel Obstruction

2013 ◽  
Vol 79 (6) ◽  
pp. 641-643 ◽  
Author(s):  
Rebecca E. Barnett ◽  
Jason Younga ◽  
Brady Harris ◽  
Robert C. Keskey ◽  
Daryl Nisbett ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Retrospective Chart Review ◽  
Clinical Findings ◽  
Abdominal Radiograph ◽  
Plain Abdominal Radiograph ◽  
Ischemic Bowel

Small bowel obstruction is a common clinical occurrence, primarily caused by adhesions. The diagnosis is usually made on the clinical findings and the presence of dilated bowel loops on plain abdominal radiograph. Computed tomography (CT) is increasingly used to diagnose the cause and location of the obstruction to aid in the timing of surgical intervention. We used a retrospective chart review to identify patients with a diagnosis of small bowel obstruction between 2009 and 2012. We compared the findings on CT with the findings at operative intervention. Sixty patients had abdominal CT and subsequent surgical intervention. Eighty-three per cent of CTs were correct for small intestine involvement and 80 per cent for colon involvement. The presence of adhesions or perforation was correctly identified in 21 and 50 per cent, respectively. Sixty-four per cent correctly identified a transition point. The presence of a mass was correctly identified in 69 per cent. Twenty per cent of the patients who had ischemic small bowel at surgery were identified on CT. CT has a role in the clinical assessment of patients with small bowel obstruction, identifying with reasonable accuracy the extent of bowel involvement and the presence of masses and transition points. It is less reliable at identifying adhesions, perforations, or ischemic bowel.

scholarly journals A Young Diabetic Lady with Emphysematous Pyelonephritis

1970 ◽  
Vol 13 (1) ◽  
pp. 72-74
Author(s):  
Ahmad Mursel Anam ◽  
Farzana Shumy ◽  
Mohammad Mufizul Islam Polash ◽  
Raihan Rabbani ◽  
Abed Hussain Khan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Paralytic Ileus ◽  
Clinical Suspicion ◽  
Abdominal Radiograph ◽  
Emphysematous Pyelonephritis ◽  
Plain Abdominal Radiograph ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Levels ◽  
High Degree

A rare and potentially life-threatening condition is reported. A young diabetic lady presented with septic shock and features of paralytic ileus. A plain abdominal radiograph suggested “megacolon with gas-fluid levels”. But high degree of clinical suspicion persuaded us to perform a CT scan of abdomen, which revealed emphysematous pyelonephritis. This enabled us to start early effective treatment and eventually save the patient. DOI: http://dx.doi.org/10.3329/jom.v13i1.10055 JOM 2012; 13(1): 72-74

scholarly journals Breath Hydrogen Gas Concentration Linked to Intestinal Gas Distribution and Malabsorption in Patients with Small-bowel Pseudo-obstruction

2009 ◽  
Vol 4 ◽  
pp. BMI.S2139 ◽  
Author(s):  
Yoshihisa Urita ◽  
Toshiyasu Watanabe ◽  
Tadashi Maeda ◽  
Yosuke Sasaki ◽  
Susumu Ishihara ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Close Association ◽  
Bacterial Overgrowth ◽  
Hydrogen Gas ◽  
Abdominal Radiograph ◽  
Breath Hydrogen ◽  
Plain Abdominal Radiograph ◽  
Intestinal Gas

Summary Background The patient with colonic obstruction may frequently have bacterial overgrowth and increased breath hydrogen (H2) levels because the bacterium can contact with food residues for longer time. We experienced two cases with intestinal obstruction whose breath H2 concentrations were measured continuously. Case 1 A 70-year-old woman with small bowel obstruction was treated with a gastric tube. When small bowel gas decreased and colonic gas was demonstrated on the plain abdominal radiograph, the breath H2 concentration increased to 6 ppm and reduced again shortly. Case 2 A 41-year-old man with functional small bowel obstruction after surgical treatment was treated with intravenous administration of erythromycin. Although the plain abdominal radiograph demonstrated a decrease of small-bowel gas, the breath H2 gas kept the low level. After a clear-liquid meal was supplied, fasting breath H2 concentration increased rapidly to 22 ppm and gradually decreased to 9 ppm despite the fact that the intestinal gas was unchanged on X-ray. A rapid increase of breath H2 concentration may reflect the movement of small bowel contents to the colon in patients with small-bowel pseudo-obstruction or malabsorption following diet progression. Conclusions Change in breath H2 concentration had a close association with distribution and movement of intestinal gas.

CHRONIC INTUSSUSCEPTION

PEDIATRICS ◽  
1949 ◽  
Vol 4 (2) ◽  
pp. 183-187
Author(s):  
HENRY A. REISMAN ◽  
ARTHUR D. WOLK
Keyword(s):  
Case Reports ◽  
White Male ◽  
Male Infant ◽  
Abdominal Distension ◽  
Acute Type ◽  
Pediatric Service ◽  
Colicky Pain ◽  
Chronic Intussusception ◽  
Prompt Diagnosis ◽  
Typical Picture

THE proper and prompt diagnosis of intussusception constitutes one of the important emergencies in pediatric practice. The acute type, however, does not present as great a diagnostic problem as does chronic intussusception. Its diagnosis is usually facilitated by the classical symptomatology of colicky pain, vomiting, abdominal distension with blood and mucus in stools occurring in a male infant. Chronic intussusception, on the other hand, presents no such typical picture. In fact, evidence pointing to it is often vague and the signs of intestinal obstruction are frequently lacking. It is with this consideration that the following two cases of chronic intussusception of differing location and etiology are presented. Case Reports Case 1. W.B., 5 yr. old white male, was admitted to the Pediatric Service of Queens General Hospital on December 3, 1947 because of abdominal pain of 8 wks.' duration. Pain was localized to the para-umbilical region, intermittent and colicky in nature. Attacks were of 5 to 10 secs. duration, recurring frequently throughout the day except in the 2 wks. prior to admission when the incidence decreased to about 1 attack every 3 days. Pain was not related to or influenced by excitement, emotion, food, defecation, micturition or diversion. The only episode of vomiting occurred 4 days prior to admission. At the onset of the present illness, patient had mild constipation easily relieved by enemata. This was followed by mild diarrhea. In the wk. prior to hospitalization, the mother noted dark red blood in the stools. Patient had anorexia, wt. loss of 3.2 kg. and complained of fatigue and lethargy.

scholarly journals A report of chronic intestinal pseudo-obstruction related to systemic lupus erythematosus

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 562-564 ◽  
Author(s):  
Ruiqiang Wang ◽  
Bowen Zheng ◽  
Biyue Wang ◽  
Pupu Ma ◽  
Fengmei Chen ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Clinical Symptoms ◽  
Gastrointestinal Disorder ◽  
Lower Limbs ◽  
Class Iii ◽  
Systemic Lupus ◽  
Intravenous Corticosteroid ◽  
Clinical Presentations ◽  
Intestinal Pseudo Obstruction

AbstractChronic intestinal pseudo-obstruction (CIPO) is a functional gastrointestinal disorder with symptoms of ileus. CIPO can either be idiopathic or secondary to other diseases such as systemic lupus erythematosus (SLE). SLE is involved in many parts of the gastrointestinal system with variable clinical presentations. Reports about reduplicated CIPO as a complication of SLE is infrequent. A 49-year-old female suffering from clinical symptoms of ileus has been hospitalized 3 times over 1 year. Her examination results showed no observation of mechanical obstruction. In August 2017, she came to the nephrology department due to edema in both lower limbs along with symptoms of ileus. After thorough examination, she was diagnosed with secondary CIPO related to SLE. Results of renal biopsy confirmed to be lupus nephritis (Class III-(A) + V). The symptoms of ileus are gradually improved after treatment of full-dose intravenous corticosteroid for 5 days.

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