ISPUB.COM. Pneumatosis Cystoids Intestinalis in an Immunosuppressed Patient. M Hamodat, S Ryan, A Pirzada INTRODUCTION CASE REPORT
|
|
- Annice Bridges
- 5 years ago
- Views:
Transcription
1 ISPUB.COM The Internet Journal of Laboratory Medicine Volume 3 Number 2 Pneumatosis Cystoids Intestinalis in an Immunosuppressed Patient M Hamodat, S Ryan, A Pirzada Citation M Hamodat, S Ryan, A Pirzada.. The Internet Journal of Laboratory Medicine Volume 3 Number 2. Abstract We report the case of a 59 year old woman who presented to the emergency room with a four day history of abdominal pain worsening over the last 24 hours. She had previously been diagnosed with Alport s syndrome and had undergone an unrelated donor renal transplant in August She was on several immunosuppressants. There was some evidence of peritoneal signs on physical exam. Plain film X-ray and CT scan revealed marked pneumatosis intersinalis of the right and transverse colon. The patient underwent a laparotomy. The laparotomy showed crackly air throughout the serosa of the right and transverse colon, which was also pale in appearance. A subtotal colectomy and ileostomy was performed to correct the PCI and perforation. The patient had a successful recovery post-surgery. The success of surgical intervention in our case demonstrates the potential role for surgery in a patient with suspected PCI, with evidence of perforation. INTRODUCTION Pneumatosis intestinalis or pneumatosis cystoides intestinalis (PCI) is defined by the presence of submucosal and subserosal gas filled cysts within the large or small bowel. This condition often occurs in patients with ischemia or inflammatory disease of the bowel or in conditions such as chronic obstructive pulmonary disease, connective tissue disorders (such as Alport s syndrome), celiac disease, leukemia, amyloidosis, and acquired immunodeficiency syndrome. It can also be found in association with organ transplantation and immunosupression. PCI is a relatively rare condition [12] that can often be successively treated with conservative management including bowel rest, oxygen therapy, parenteral nutrition and broad spectrum antibiotics [234]. A 59 year old woman presented with a four day history of abdominal pain worsening over the last 24 hours. She had previously been diagnosed with Alport s syndrome and had undergone an unrelated donor renal transplant in August She is currently on several immunosuppressants. There was some evidence of peritoneal signs on physical exam. Plain film X-ray and CT scan revealed marked pneumatosis intersinalis of the right and transverse colon (Figure 1, 2). Here we report a case of a patient who presented with PCI and peritoneal signs. The patient had a history of Alport s syndrome and was on several immunosupproessants due to an unrelated renal transplant secondary to Alport s syndrome. To correct this condition the patient underwent surgical intervention. In the presence of secondary complications such as peritonitis, ischemia or perforation, surgical correction is often indicated; however this is debated and infrequently reported in the literature [3567]. CASE REPORT 1 of 6
2 Figure 1 Figure 1: CT scan of the transverse colon demonstrating air in the wall of the bowel performed for pneumatosis intestinalis and peritoneal signs. The gross pathological specimen showed a dilated bowel wall with an edematous and cystic appearance of the cecum and ascending colon. Figure 3 Figure 3: Gross image of the bowel shows cystic lesions. Figure 2 Figure 2: CT scan of right colon showing air in the wall of the colon Histological sections of the serosa, submucosa and muscularis propria showed cystically dilated spaces lined by unremarkable flattened endothelial like cells, devoid of red blood cells or proteinaceous fluid. The patient was then brought for a laparotomy. The laparotomy showed crackly air throughout the serosa and somewhat pale appearing serosa throughout the right and transverse colon. A subtotal colectomy and ileostomy was 2 of 6
3 Figure 4 Figure 6 Figure 4: H & E 2 x of bowel wall shows cystic changes mainly in the submucosa. Figure 6: Factor VIII x 20 shows negative staining of the flattened endothelial like lining of the cystic spaces. Figure 5 Figure 5: H & E 10x of bowel wall shows multinucleated giant cells surrounding the cystic spaces. These findings can be seen in both pneumatosis intestinalis and lymphangiomas. Immunostains factor V111 and CD31 were negative, ruling out lymphangioma as the cause (Figure 6, 7). 3 of 6 Figure 7 Figure 7: CD31 x20 shows negative staining of the flattened endothelial lining of the cystic spaces.
4 This patient is on long-term immunosuppression and therefore at risk for opportunistic infections. There were no fungal forms or CMV inclusion aiding in the exclusion of an opportunistic infection as a cause. A chronic inflammatory cell infiltrate is seen in the submucosa and muscularis propria with eosinophilic predominance. Multinucleated giant cells are seen surrounding the cystic spaces. A section of the serosal surface of the ascending colon shows infiltration with chronic inflammatory cells and prominent vascular congestion. These findings are supportive of the presence of perforation and the findings of peritoneal signs on physical exam. In some areas there is surface mucosal ulceration with preservation of the lower parts of the crypts, this may suggest an element of ischemic necrosis associated with pneumatosis intestinalis. The histological findings are typical of pneumatosis intestinalsis. In addition, the presence of perforation explains the clinical decision to remove the bowel surgically instead of the usual conservative medical management. DISCUSSION Pneumatosis intestinalis or pneumatosis cystoides intestinalis (PCI) is a rare condition defined by intramural gas collection in the intestine. Predisposing factors for developing PCI include immunodeficiency, connective tissue disorders and bowel ischemia. In patients with PCI without evidence of bowel perforation conservative management is often the most successful course of action [234]. Many factors likely play a role in the etiology of PCI. The bacterial or infectious hypothesis suggests that gas forming bacteria, such as Clostridia, produce PCI by diminishing the integrity of the mucosa promoting the dissection of gas through tissue of the GIT [89]. The mechanical theory suggests that gas would penetrate into the submucosal and subserosal layers of the bowel through mucosal lesions caused by ulcerations or ischemia of the bowel [89]. Immunosuppression with corticosteroids has also been implicated in the causation of PCI, either by submucosal lymphoid depletion or by altering the mucous production [10]. In this case we present a patient with a history of a connective tissue disorder (Alport s syndrome) and who was on immunosuppressants for a previous renal transplant. When this patient presented, there was evidence of bowel perforation, through the presence of peritoneal signs and CT evidence. PCI can be a difficult diagnosis to make [11], however, previous papers report that the majority of patients with PCI are correctly diagnosed with clinical investigation, 4 of 6 x-ray and CT scan [19]. Given the presentation of PCI with peritonitis it was determined that this patient was in need of surgical intervention to repair the perforation. A subtotal colectomy and ileostomy was performed to correct the PCI and perforation. The patient had a successful recovery postsurgery. Previous cases report the recovery of patients with PCI and pneumoperitoneum that responded well to conservative treatment. However in these cases peritonitis was not present [ ]. The success of surgical intervention in our case demonstrates the potential role for surgery in a patient with suspected PCI and with evidence of perforation on CT scan and peritoneal signs on physical exam. References 1. Keam B, Lee JH, Oh MD, Kim I, Yoon SS, Kim BK, Park S. Pneumatosis intestinalis with pneumoperitoneum mimicking intestinal perforation in a patient with myelodysplastic syndrome after hematopoietic stem cell transplantation. Korean J Intern Med Mar;22(1): Tchabo NE, Grobmyer SR, Jarnagin WR, Chi DS.Conservative management of pneumatosis intestinalis. Gynecol Oncol Dec;99(3): Braumann C, Menenakos C, Jacobi CA. Pneumatosis intestinalis--a pitfall for surgeons? Scand J Surg. 2005; 94(1): Galm O, Fabry U, Adam G, Osieka R.Pneumatosis intestinalis following cytotoxic or immunosuppressive treatment. Digestion. 2001; 64(2): Nathan H, Singhal S, Cameron JL. Benign pneumatosis intestinalis in the setting of celiac disease. J Gastrointest Surg Jun;10(6): Wood BJ, Kumar PN, Cooper C, Silverman PM, Zeman RK. Pneumatosis intestinalis in adults with AIDS: clinical significance and imaging findings. Am J Roentgenol Dec;165(6): Quiroz ES, Flannery MT, Martinez EJ, Warner EA. Pneumatosis cystoides intestinalis in progressive systemic sclerosis: a case report and literature review. Am J Med Sci Dec;310(6): Calderón Duque AT, Mayol Martínez J, MartínezSarmiento J, Ramos A, Alonso Lera S, González Noguera P, Ortiz Oshiro E, FernándezRepresa JA. Intestinal pneumatosis. Gastroenterol Hepatol Nov;21(9): Scheidler J, Stäbler A, Kleber G, Neidhardt D. Computed tomography in pneumatosis intestinalis: differential diagnosis and therapeutic consequences. Abdom Imaging Nov-Dec;20(6): Halkic S, Zeini S, Mosimann F, Gillet M. Cystic pneumatosis of the colon after liver transplantation. Minerva Chir Jun;58(3): Kirchner J, Seipelt G, Heyd R, Dietrich CF, Jacobi V. Disseminated pneumoperitoneum during the therapy of lymphoma with methotrexate and cytosine arabinoside. Dtsch Med Wochenschr Oct
5 18;121(42): Scheidler J,Stabler A, Klebber G, Neidhardt D. Computed tomography in pneumotosis intestinalis :differential diagnosis and therapeutic consequences. Abdomen imaging.1995; 20(6): of Kirchner J, Seipelt G, Heyd R, Dietrich CF, Jacobi V.Disseminated Pneumoperitoneum during the therapy of lymphoma with methotrexate and cytosine arabinoside. Dtsch Med Wachenschr. 1995; 121(42):
6 Author Information Mowafak Hamodat, MB, CH, B, MSc, FRCPC Department of Pathology and Laboratory Medicine, Eastern Health of St.John s Health Sciences Suzanne C. Ryan, BSc. Department of Pathology and Laboratory Medicine, Eastern Health of St.John s Health Sciences Amrah Pirzada, M.B.B.S, D.A.B.A Department of Pathology and Laboratory Medicine, Eastern Health of St.John s Health Sciences 6 of 6
Pneumatosis intestinalis, not always a surgical emergency
Pneumatosis intestinalis, not always a surgical emergency Poster No.: C-2233 Congress: ECR 2012 Type: Educational Exhibit Authors: E. Vanhoutte, M. Lefere, R. Vanslembrouck, D. Bielen, G. De 1 1 2 1 1
More informationAccepted Article. Massive gastrointestinal pneumatosis in a patient with celiac disease and superior mesenteric artery syndrome
Accepted Article Massive gastrointestinal pneumatosis in a patient with celiac disease and superior mesenteric artery syndrome Aleix Martínez-Pérez, Ramón Trullenque-Juan, Sandra Santarrufina-Martínez,
More informationCytomegalovirus Colitis in an Immunocompetent Patient: A Case Report
ISPUB.COM The Internet Journal of Surgery Volume 17 Number 2 Cytomegalovirus Colitis in an Immunocompetent Patient: A Case Report M Ud Citation M Ud. Cytomegalovirus Colitis in an Immunocompetent Patient:
More informationPneumatosis intestinalis after adult living donor liver transplantation: report of three cases and collective literature review
Korean J Hepatobiliary Pancreat Surg 2015;19:25-29 http://dx.doi.org/10.14701/kjhbps.2015.19.1.25 Original Article Pneumatosis intestinalis after adult living donor liver transplantation: report of three
More informationPneumatosis intestinalis (PI) has been described in association
BRIEF COMMUNICATION Pneumatosis intestinalis in a patient with chronic bronchiectasis Maya Doumit MSc MD 1, Nav Saloojee MD FRCPC 1, Richard Seppala MD 2 M Doumit, N Saloojee, R Seppala. Pneumatosis intestinalis
More informationCase History B Female patient 1970 Clinical History : crampy abdominal pain and episodes of bloody diarrhea Surgical treatment
Case History B-1325945 Female patient 1970 Clinical History : crampy abdominal pain and episodes of bloody diarrhea Surgical treatment Case History B-1325945 Pathology Submucosa & Muscularis Endometriosis
More informationJournal of Biomedical Graphics and Computing, June 2012, Vol. 2, No.1
CASE REPORT Recurrent extensive idiopathic pneumatosis intestinalis of the small intestine with pneumoperitoneum: Effective treatment with the surgical intervention Maki Kitagawa 1, 2, Nobuki Yamaoka 2,
More informationSeptic Phlebitis and Gas in the Inferior Mesenteric Vein: CT findings in Two Cases and Review of Literature
ISPUB.COM The Internet Journal of Surgery Volume 16 Number 2 Septic Phlebitis and Gas in the Inferior Mesenteric Vein: CT findings in Two Cases and Review of J McClenathan Citation J McClenathan. Septic
More informationNecrotizing Enterocolitis: the role of ultrasound in the assessment of bowel viability
Necrotizing Enterocolitis: the role of ultrasound in the assessment of bowel viability Ricardo Faingold, MD. Department of Medical Imaging The Montreal Children s Hospital McGill University SPR Vancouver
More informationDetection of hepatic portal venous gas: its clinical impact and outcome
Emerg Radiol (2006) 12: 164 170 DOI 10.1007/s10140-006-0467-y ORIGINAL ARTICLE Sebastian T. Schindera. Juergen Triller. Peter Vock. Hanno Hoppe Detection of hepatic portal venous gas: its clinical impact
More informationChristopher Lau Kings County Hospital SUNY Downstate Medical Center February 24, 2011
Christopher Lau Kings County Hospital SUNY Downstate Medical Center February 24, 2011 37 year old male presented with 1 day history of abdominal pain Pain was diffuse but worst in the epigastric area No
More informationCT Evaluation of Bowel Wall Thickening. Dr: Adel El Badrawy; M.D. Lecturer of Radio Diagnosis Faculty of Medicine Mansoura University.
CT Evaluation of Bowel Wall Thickening By Dr: Adel El Badrawy; M.D. Lecturer of Radio Diagnosis Faculty of Medicine Mansoura University. The CT findings of bowel wall thickening includes 1 Degree of thickening.
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 4 2013 Article 6 Case report: Intussusception of the colon through a colostomy: A rare presentation of colonic intussusception. Dr. Nora Trabulsi Dr.
More informationSWISS SOCIETY OF NEONATOLOGY. Spontaneous intestinal perforation or necrotizing enterocolitis?
SWISS SOCIETY OF NEONATOLOGY Spontaneous intestinal perforation or necrotizing enterocolitis? June 2004 2 Stocker M, Berger TM, Neonatal and Pediatric Intensive Care Unit, Children s Hospital of Lucerne,
More informationHepatic Portal Venous Gas: An Ominous Sign Of Abdominal Catastrophe In A Blunt Abdominal Trauma Scenario. A Case Report
ISPUB.COM The Internet Journal of Surgery Volume 25 Number 1 Hepatic Portal Venous Gas: An Ominous Sign Of Abdominal Catastrophe In A Blunt Abdominal Trauma D BV, B P., S P., S BP., S B. Citation D BV,
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 2 2013 Article 18 Revenge of the Christmas Turkey; Unusual Presentation of Colonic Perforation Secondary to Foreign Body. Mashuk Khan Sudeep Thomas Warwick
More informationDelayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer
CASE REPORT Clin Endosc 2015;48:251-255 Print ISSN 2234-2400 / On-line ISSN 2234-2443 http://dx.doi.org/10.5946/ce.2015.48.3.251 Open Access Delayed Perforation Occurring after Endoscopic Submucosal Dissection
More informationHDF Case Whipple s disease
HDF Case 952556 Whipple s disease 63 yo female complaining of a diarrhea for 2 months, weigth loss (12 Kg in 3 months), and joint pains. Duodenal biopsy performed. Scanning view, enlarged intestinal villi,
More informationColon ischemia. Bible class 12 September Stefan Christen. ACG Clinical Guideline: Am J Gastroenterol 2015
Colon ischemia Bible class 12 September 2018 Stefan Christen ACG Clinical Guideline: Am J Gastroenterol 2015 Definition Definition Imbalance between blood supply and metabolic demands of the colonocytes
More information[A RESEARCH COORDINATOR S GUIDE]
2013 COLORECTAL SURGERY GROUP Dr. Carl J. Brown Dr. Ahmer A. Karimuddin Dr. P. Terry Phang Dr. Manoj J. Raval Authored by Jennifer Lee A cartoon about colonoscopies. 1 [A RESEARCH COORDINATOR S GUIDE]
More informationAbdominal Complications After Bone Marrow Transplantation in Children: Sonographic and CT Findings
1023 Pictorial Essay Abdominal Complications After Bone Marrow Transplantation in Children: Sonographic and CT Findings Ellen C. Benya,1 2 Carlos J. Sivit, 2 and Ralph R. Quinones2 3 Bone marrow transplantation
More informationFiliform polyposis of ulcerative colitis
Filiform polyposis of ulcerative colitis Authors: Keisuke Yamada, Hironori Samura, Tatsuya Kinjo, Tetsu Kinjo, Akira Hokama, Jiro Fujita Article type: Clinical image Received: December 7, 2018. Accepted:
More informationColon ischemia. ACG Clinical Guideline; Am J Gastroenterol 2015
Colon ischemia ACG Clinical Guideline; Am J Gastroenterol 2015 Manifestations Acute, reversible Irreversible : gangrene, fulminant colitis/stricture formation, chronic ischemic colitis Recurrent sepsis
More informationImaging abdominal vascular emergencies. V.Stoynova
Imaging abdominal vascular emergencies V.Stoynova Abdominal vessels V. Stoynova 2 Acute liver bleeding trauma anticoagulant therapy liver disease : HCC, adenoma, meta, FNH, Hemangioma Diagnosis :CT angiography
More informationConservative management for spontaneous pneumoperitoneum
CASE SERIES REPORT Morrison et al. 1 PEER REVIEWED OPEN ACCESS Conservative management for spontaneous pneumoperitoneum Michael Morrison, Sarah Brown, Ryan Enders, Ranjeet Kalsi, Christopher Esper ABSTRACT
More informationSpontaneous perforation of the colon: CT findings and clinical characteristics
Spontaneous perforation of the colon: CT findings and clinical characteristics Poster No.: C-0724 Congress: ECR 2012 Type: Scientific Exhibit Authors: H. Cho, H. Y. Han, T. J. Chun, I. K. Yu ; Daejon/KR,
More informationTONG Rui, QIN Ying, QIN Lei, LIANG Hao *
130 2016 2 1 41 2 20 [ ] 1995 6 2015 6 20 20 16 (80.0%) 4 (20.0%) 1 1 5 2 + 7 4 [ ] [ ] R574.62 [ ] A [ ] 0577-7402(2016)02-0130-06 [DOI] 10.11855/j.issn.0577-7402.2016.02.09 TONG Rui, QIN Ying, QIN Lei,
More informationThis is the second learning component (Learning Component 2) in our first learning module (Learning Module 1). In this component we review a very
This is the second learning component (Learning Component 2) in our first learning module (Learning Module 1). In this component we review a very basic response to injury inflammation. We ll look at examples
More informationSurgical Management of IBD. Val Jefford Grand Rounds October 14, 2003
Surgical Management of IBD Val Jefford Grand Rounds October 14, 2003 Introduction Important Features Clinical Presentation Evaluation Medical Treatment Surgical Treatment Cases Overview Introduction Two
More informationSupported by the Eastern Association for the Surgery of Trauma s Multi-institutional and Acute Care Surgery Ad Hoc Committees
Multi-institutional, Prospective, Observational Study Comparing the Gastrografin Challenge versus Standard Treatment in Adhesive Small Bowel Obstruction Supported by the Eastern Association for the Surgery
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 1 2013 Article 14 ISSUE 1 Diffuse Intestinal Lipomatosis Presenting as Adult Intussusception Christopher W. Snyder Jamie A. Cannon University of Alabama
More informationMorphologic Criteria of Invasive Colonic Adenocarcinoma on Biopsy Specimens
ISPUB.COM The Internet Journal of Pathology Volume 12 Number 1 Morphologic Criteria of Invasive Colonic Adenocarcinoma on Biopsy Specimens C Rose, H Wu Citation C Rose, H Wu.. The Internet Journal of Pathology.
More informationChapter 14: Training in Radiology. DDSEP Chapter 1: Question 12
DDSEP Chapter 1: Question 12 A 52-year-old white male presents for evaluation of sudden onset of abdominal pain and shoulder pain. His past medical history is notable for a history of coronary artery disease,
More informationADULT INTUSSUSCEPTION SECONDARY TO LYMPHANGIOMA OF THE CECUM: A CASE REPORT
ADULT INTUSSUSCEPTION SECONDARY TO LYMPHANGIOMA OF THE CECUM: A CASE REPORT Chin-Fan Chen, 1 Chieh-Han Chuang, 2 Chien-Yu Lu, 3 Ching Hu, 4 Ting-Lu Kuo, 5 and Jan-Sing Hsieh 2,6 Departments of 1 Surgery,
More informationPneumatosis Intestinalis and Pneumoperitoneum After Bilateral Lung Transplantation in Adults
Gastrointestinal Imaging Original Research Thompson et al. Pneumatosis Intestinalis and After Lung Transplantation Gastrointestinal Imaging Original Research William M. Thompson 1,2 Lisa Ho 1 Carlos Marroquin
More informationד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה
ד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה Presentaion: S.A is 38 years old. Referred for rectal bleeding investigation. Describes several occasions of bleeding and abdominal pain.
More information59 yo male with past medical history of prostate carcinoma, presented with upper abdominal pain
December 2016 59 yo male with past medical history of prostate carcinoma, presented with upper abdominal pain Contributed by: Divya Sharma, MD. Fellow, Gastrointestinal Pathology, Department of Pathology
More informationGeneral Data. 王 X 村 78 y/o 男性
General Data 王 X 村 78 y/o 男性 Chief Complaint Vomiting twice this early morning Fever up to 38.9ºC was noted Present Illness (1) Old CVA with left side weakness for more than 10 years and with bed ridden
More informationSmall Bowel Intussusception in an Adult due to Lipoma: a Rare Cause of Obstruction. Case report and Literature Review
ISPUB.COM The Internet Journal of Surgery Volume 25 Number 1 Small Bowel Intussusception in an Adult due to Lipoma: a Rare Cause of Obstruction. Case report and Literature Review Yashpal, M Bansal, A Kudva
More informationPneumatosis Intestinalis: when to worry?
Pneumatosis Intestinalis: when to worry? Poster No.: C-1441 Congress: ECR 2013 Type: Educational Exhibit Authors: F. Rego Costa, C. Maciel, C. Esteves, L. Melão; Porto/PT Keywords: Gastrointestinal tract,
More informationA Case of Pneumatosis Cystoides Intestinalis Mimicking Intestinal Perforation
Showa Univ J Med Sci 26 2, 169 173, June 2014 Case Report A Case of Pneumatosis Cystoides Intestinalis Mimicking Intestinal Perforation Takahiro UMEMOTO 1, Yoshikuni HARADA 1, Makiko SAKATA 1, Gaku KIGAWA
More informationWalter Wiesner 1,2 Koenraad J. Mortelé 1 Jonathan N. Glickman 3 Hoon Ji 1 Pablo R. Ros 1
Walter Wiesner 1,2 Koenraad J. Mortelé 1 Jonathan N. Glickman 3 Hoon Ji 1 Pablo R. Ros 1 Received March 19, 2001; accepted after revision May 31, 2001. 1 Department of Radiology, Brigham and Women s Hospital,
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 2 2013 Article 12 Conservative Management of Perforated Duodenal Diverticulitis Rocio Gonzalez Lopez Maria Isabel Pérez Moreiras Eva Iglesias Porto Carlos
More informationLOINC. Clinical information. RCPA code. Record if different to report header Operating surgeon name and contact details. Absent.
Complete as narrative or use the structured format below 55752-0 17.02.28593 Clinical information 22027-7 17.02.30001 Record if different to report header Operating surgeon name and contact details 52101004
More informationUncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception
Case Report Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception Karl Mrak Department of Surgery, Brothers of Mercy Hospital, St. Veit, Glan, Austria Correspondence
More informationPneumoperitoneum in a non-acute abdomen pneumatosis cystoides intestinalis
Ooi Surgical Case Reports (2015) 1:44 DOI 10.1186/s40792-015-0046-0 CASE REPORT Open Access Pneumoperitoneum in a non-acute abdomen pneumatosis cystoides intestinalis Siang Mei Sally Ooi Abstract Aim:
More informationCaeco-colic Intussusception Simulating an Appendicular Mass
Article ID: WMC003206 ISSN 2046-1690 Caeco-colic Intussusception Simulating an Appendicular Mass Corresponding Author: Dr. Matthew O Adelekan, Surgeon, North manchester General Hospital - United Kingdom
More informationX-Ray Corner. Imaging of the Stomach. Pantongrag-Brown L
THAI J 178 Imaging of the Stomach GASTROENTEROL 2014 X-Ray Corner Imaging of the Stomach Pantongrag-Brown L Imaging modalities used in stomach include plain radiographs, UGI study, US, CT, PET CT and MRI.
More informationCase Scenario 1. The patient has now completed his neoadjuvant chemoradiation and has been cleared for surgery.
Case Scenario 1 July 10, 2010 A 67-year-old male with squamous cell carcinoma of the mid thoracic esophagus presents for surgical resection. The patient has completed preoperative chemoradiation. This
More informationGRANULOMATOUS COLITIS: SIGNIFICANCE OF INVOLVEMENT OF THE TERMINAL ILEUM
GASTROENTEROLOGY 64: 1071-1076, 1973 Copyright 1973 by The Williams & Wilkins Co. Vol. 64, No.6 Printed in U.S.A. GRANULOMATOUS COLITIS: SIGNIFICANCE OF INVOLVEMENT OF THE TERMINAL ILEUM JAMES A. NELSON,
More informationDiffuse vascular malformation of large intestine clinically and radiologically misdiagnosed as ulcerative colitis
Journal of Surgical Case Reports, 2017;2, 1 5 doi: 10.1093/jscr/rjx016 Case Report CASE REPORT Diffuse vascular malformation of large intestine clinically and radiologically misdiagnosed as ulcerative
More informationRegression of Advanced Gastric MALT Lymphoma after the Eradication of Helicobacter pylori
Gut and Liver, Vol. 6, No. 2, April 2012, pp. 270-274 CASE REPORT Regression of Advanced Gastric MALT Lymphoma after the Eradication of Helicobacter pylori Soo-Kyung Park, Hwoon-Yong Jung, Do Hoon Kim,
More informationYou are called to see another patient. Melissa Wong, MD Richmond University Medical Center 30 April 2015
You are called to see another patient Melissa Wong, MD Richmond University Medical Center 30 April 2015 Case Presentation 51F, progressive abdominal pain x 1d +flatus, +BM Last colonoscopy 2013 (hyperplastic
More informationHISTOLOGY. GIT Block 432 Histology Team. Lecture 1: Alimentary Canal (1) (Esophagus & Stomach) Done by: Ethar Alqarni Reviewed by: Ibrahim Alfuraih
HISTOLOGY Lecture 1: Alimentary Canal (1) (Esophagus & Stomach) Done by: Ethar Alqarni Reviewed by: Ibrahim Alfuraih Color Guide: Black: Slides. Red: Important. Green: Doctor s notes. Blue: Explanation.
More informationPlain abdomen The standard films are supine & erect AP views (alternative to erect, lateral decubitus film is used in ill patients).
Plain abdomen The standard films are supine & erect AP views (alternative to erect, lateral decubitus film is used in ill patients). The stomach can be readily identified by its location, gastric rugae
More informationCrohn s Disease. Resident Lecture 1/17/19
Crohn s Disease Resident Lecture 1/17/19 Objectives Features/Classification of Crohn s Disease Medical Treatment Surgical Indications Surgical Considerations 2 Case 25 yo F presents to your office with
More informationGastrointestinal Tract Imaging. Objectives. Reference. VMB 960 April 6, Stomach Small Intestine Colon. Radiography & Ultrasound
Gastrointestinal Tract Imaging VMB 960 April 6, 2009 Stomach Small Intestine Colon Objectives Radiography & Ultrasound Contrast Examination of the Small Intestine Reference Chapters 45 47 Pages 750 805
More informationWhen should we operate for recurrent diverticulitis. Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital
When should we operate for recurrent diverticulitis Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital ASCRS Practice parameters for the Treatment of Acute Diverticulitis
More information8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank
Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,
More informationCase Report A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient
Case Reports in Surgery Volume 2016, Article ID 2893925, 4 pages http://dx.doi.org/10.1155/2016/2893925 Case Report A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent
More informationThe Prognostic Value of Portal Venous Gas on CT: An Analysis of Six Cases
The Prognostic Value of Portal Venous Gas on CT: An Analysis of Six Cases Poster No.: C-1759 Congress: ECR 2015 Type: Educational Exhibit Authors: T. P. Howard, S. Pittman, R. Gullipalli, A. Hartery ;
More informationTerumitsu; Nagayasu, Takeshi
NAOSITE: Nagasaki University's Ac Title Author(s) Citation A rare case of segmental ulcerative Tominaga, Tetsuro; Nonaka, Takashi; Shuichi; Kunizaki, Masaki; Sumida, Terumitsu; Nagayasu, Takeshi Acta medica
More informationCase 2 A 60 year old woman with severe chronic obstructive. airways disease presented with a 2-day history
Postgrad Med J (1991) 67, 999-1003 The Fellowship of Postgraduate Medicine, 1991 Pneumoperitoneum without peritonitis Barry D. Daly,' J. Ashley Guthrie' and Neville F. Couse2 Departments of 'Radiology
More informationThe appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The appendix.
The appendix is a small, tube-like structure attached to the first part of the large intestine, also called the colon. The appendix is located in the lower right portion of the abdomen. It has no known
More information... Inflammatory disorder of the colon that occurs as a complication of antibiotic treatment.
Definition Inflammatory disorder of the colon that occurs as a complication of antibiotic treatment. " Epidemiology Humans represent the main reservoir of Clostridium difficile, which is not part of the
More informationA rare cause of abdominal pain and gastrointestinal bleeding: Colonic lipoma causing intussusception
www.edoriumjournals.com CLINICAL IMAGES PEER REVIEWED OPEN ACCESS A rare cause of abdominal pain and gastrointestinal bleeding: Colonic lipoma causing intussusception Daniela Ferreira, Marta Salgado, Isabel
More informationMETASTASES FROM GASTRIC CARCINOMA TO COLON LESIONS: A CASE REPORT IN THE FORM OF MULTIPLE FLAT ELEVATED CASE PRESENTATION
H.C. Lee, M.T. Yang, K.Y. Lin, et al METASTASES FROM GASTRIC CARCINOMA TO COLON IN THE FORM OF MULTIPLE FLAT ELEVATED LESIONS: A CASE REPORT Hsi-Chang Lee, Min-Ta Yang, 1 Kuang-Yang Lin, 1 Hsing-Yang Tu,
More informationPerforation of a Duodenal Diverticulum. Elective Student S. C.
Perforation of a Duodenal Diverticulum 2008 4 Elective Student S. C. Case History An elderly male presented to the Emergency Department with abdominal pain. Chief Complaint: Worsening, diffuse abdominal
More informationOutcome after emergency surgery in patients with a free perforation caused by gastric cancer
experimental and therapeutic medicine 1: 199-203, 2010 199 Outcome after emergency surgery in patients with a free perforation caused by gastric cancer Hironori Tsujimoto 1, Shuichi Hiraki 1, Naoko Sakamoto
More informationMast cell profile in appendicitis
Original Research Article DOI: 10.18231/2394-6792.2017.0120 Mast cell profile in appendicitis G. Patil Anuradha 1, AM Anita 2, Saini Kr. Seemant 3,*, S. Pratima 4 1 HOD, 2 Associate Professor, 3 PG Student,
More informationPreoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma
377 Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma Hiroaki Shiba a Yoshinobu Mitsuyama a Ken Hanyu a Kenji Ikeuchi b Hirotaka Hayashi c Katsuhiko Yanaga a a Department of
More information-2002: Rectal blood loss, UC? (no definite diagnosis) rectal mesalazine. -June 2008: Recurrence of rectal blood loss and urgency
SD, male 40 yrs. old. (680718M467.) -2002: Rectal blood loss, UC? (no definite diagnosis) rectal mesalazine -June 2008: Recurrence of rectal blood loss and urgency Total colonoscopy: ulcerative rectitis,
More informationGastrointestinal Tract. Anatomy of GI Tract. Anatomy of GI Tract. (Effective February 2007) (1%-5%)
Gastrointestinal Tract (Effective February 2007) (1%-5%) Anatomy of GI Tract Esophagus bulls-eye or target EG junction seen on sagittal scan posterior to left lobe of liver and anterior to aorta Anatomy
More informationORIGINAL ARTICLE. Severe Acute Gastrointestinal Graft-vs-Host Disease. An Emerging Surgical Dilemma in Contemporary Cancer Care
ORIGINAL ARTICLE Severe Acute Gastrointestinal Graft-vs-Host Disease An Emerging Surgical Dilemma in Contemporary Cancer Care Jennifer L. Irani, MD; Corey S. Cutler, MD, MPH; Edward E. Whang, MD; Thomas
More informationColon Ischemia (CI): New Developments and Guidelines for Management. Spectrum of CI
Colon Ischemia (CI): New Developments and Guidelines for Management Lawrence J. Brandt, MD, MACG Professor of Medicine and Surgery Albert Einstein College of Medicine Emeritus Chief of Gastroenterology
More informationPrimary mucinous adenocarcinoma developing in an ileostomy stoma
Gut, 1988, 29, 1607-1612 Primary mucinous adenocarcinoma developing in an ileostomy stoma P J SMART, S SASTRY, AND S WELLS From the Departments of Histopathology and Surgery, Bolton General Hospital, Fan
More informationObjectives. Pediatric Mortality. Another belly pain. Gastroenteritis. Spewing & Pooing Child 4/18/16
Gastro-tastrophies A Review of Pediatric GI Emergencies Objectives Discuss common presentations of Pediatric Abdominal Pain complaints Discuss work up and physical exam findings Discuss care, management
More informationPneumatosis intestinalis leading to perioperative hypovolemic shock: Case report
WORLD JOURNAL OF EMERGENCY SURGERY CASE REPORT Open Access Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report Yukako Takami *, Toshimori Koh, Minoru Nishio and Noboru Nakagawa
More informationEmergency radiology of the large-bowel: What radiologists should know
Emergency radiology of the large-bowel: What radiologists should know Poster No.: C-1659 Congress: ECR 2016 Type: Educational Exhibit Authors: A. Falkowski, D. Boll; Basle/CH Keywords: Colon, Emergency,
More informationA916: rectum: adenocarcinoma
General facts of colorectal cancer The colon has cecum, ascending, transverse, descending and sigmoid colon sections. Cancer can start in any of the r sections or in the rectum. The wall of each of these
More informationStaging Challenges in Lower GI Cancers. Disclosure of Relevant Financial Relationships. AJCC 8 th edition and CAP protocol updates
Staging Challenges in Lower GI Cancers Sanjay Kakar, MD University of California, San Francisco March 05, 2017 Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education
More informationColorectal Cancer Structured Pathology Reporting Proforma DD MM YYYY
Colorectal Cancer Structured Pathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth DD MM YYYY S1.02 Clinical details
More informationPathogenic mechanisms of intestinal pneumatosis and portal venous gas: should patients with these conditions be operated immediately?
Mitsuyoshi et al. Surgical Case Reports (2015) 1:104 DOI 10.1186/s40792-015-0104-7 CASE REPORT Pathogenic mechanisms of intestinal pneumatosis and portal venous gas: should patients with these conditions
More informationUnusual Differential Disease Entity of Right Lower Abdominal Pain, Ileal Diverticulitis Perforation: A Report of Three Cases
Int Surg 2017;102:530 535 DOI: 10.9738/INTSURG-D-17-00081.1 Unusual Differential Disease Entity of Right Lower Abdominal Pain, Ileal Diverticulitis Perforation: A Report of Three Cases Pyong Wha Choi 1,
More informationThe Morphologic Profile of Inflammatory Bowel Disease and the Diagnostic Problem of Crohn s Disease versus TB Colitis A Case Series
OPEN ACCESS CASE REPORT The Morphologic Profile of Inflammatory Bowel Disease and the Diagnostic Problem of Crohn s Disease versus TB Colitis A Case Series Maria Lourdes Tilbe, Francia Victoria De Los
More informationReferences. GI Biopsies. What Should Pathologists Assistants Know About Gastrointestinal Histopathology? James M Crawford, MD, PhD
What Should Pathologists Assistants Know About Gastrointestinal Histopathology? James M Crawford, MD, PhD jcrawford1@nshs.edu Executive Director and Senior Vice President for Laboratory Services North
More information2015 복영증례 51/M C.C. Past Hx: DM, HTN (1998), Lab: WBC (11500/ μl ), CRP (0.71 mg/dl) 순천향서울병원황지영, 홍성숙 APCT (HAD #1) APCT (HAD#1) APCT (HAD #15)
Case 1 2015 복영증례 순천향서울병원황지영, 홍성숙 51/M C.C Abdominal pain and chilling (1 week ago) Diarrhea (a month ago) Past Hx: DM, HTN (1998), Alcoholic liver disease (2008) Lab: WBC (11500/ μl ), CRP (0.71 mg/dl)
More informationAlimentary Canal (I)
Alimentary Canal (I) Esophagus and Stomach (Objectives) By the end of this lecture, the student should be able to discuss the microscopic structure in correlation with the function of the following organs:
More informationAppendix A UPMC Health System Quality Improvement Projects vs. Research Studies Quality Improvement Review Screening Tool
Appendix A UPMC Health System Quality Improvement Projects vs. Research Studies Quality Improvement Review Screening Tool PAGE 1 Date of Submission: June 26, 2014 - Addendum Title of Project: Assessment
More informationManagement of Clostridium Difficile: Total Colectomy versus Colon Sparing Surgery
Management of Clostridium Difficile: Total Colectomy versus Colon Sparing Surgery Rahul Narang, MD Colon and Rectal Surgery Assistant Professor of Surgery No Disclosure Clostridium Difficile Colitis: Treatments,
More informationImaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients
Genitourinary Imaging Pictorial Essay Ti et al. Encapsulating Peritoneal Sclerosis in CPD Patients Genitourinary Imaging Pictorial Essay Joanna P. Ti 1 li l-radi 2 Peter J. Conlon 2 Michael J. Lee 1 Martina
More informationStomach Computerized Tomography indications, technique, examples. VUH SK Radiology and nuclear medicine center Radiologist Dileta Rutkauskaitė
Stomach Computerized Tomography indications, technique, examples VUH SK Radiology and nuclear medicine center Radiologist Dileta Rutkauskaitė Stomach Computerized Tomography gastroente rologist Oncologist
More informationGastric Cancer Histopathology Reporting Proforma
Gastric Cancer Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given name(s) Date of birth Sex Male Female Intersex/indeterminate
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationINTRA-THORACIC AND INTRA-ABDO-MINAL PERFORATION OF THE COLON IN TRAUMATIC DIAPHRAGMATIC
INTRA-THORACIC AND INTRA-ABDO-MINAL PERFORATION OF THE COLON IN TRAUMATIC DIAPHRAGMATIC Pages with reference to book, From 14 To 16 S. Amjad Hussain, Chinda Suriyapa, Karl Grubaugh ( Depts. of Surger and
More informationAbstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 Final Pathology:
Abstracting Upper GI Cancer Incidence and Treatment Data Quiz 1 Multiple Primary and Histologies Case 1 A 74 year old male with a history of GERD presents complaining of dysphagia. An esophagogastroduodenoscopy
More informationIntussusception Secondary to a Meckel Diverticulum in an Adolescent
48) Intussusception Secondary to a Meckel Diverticulum in an Adolescent Yener O., Demir M., Yigitbaşı R. Department of Surgery, Göztepe Training and Research Hospital, Istanbul, Turkey Received March 28,
More informationColo-Colonic Intussusception Caused by a Submucosal Lipoma
168 Colo-Colonic Intussusception Caused by a Submucosal Lipoma Case Report and Review of the Literature B.A. Twigt S.K. Nagesser D.J.A. Sonneveld Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
More informationAcute colonic pseudo-obstruction complicating chemotherapy in paediatric oncohaematological patients: clinical and imaging features
The British Journal of Radiology, 85 (2012), 377 381 Acute colonic pseudo-obstruction complicating chemotherapy in paediatric oncohaematological patients: clinical and imaging features 1 G E LEE, MD, 1
More information