Heyndrickxia coagulans, a spore-forming probiotic, has garnered significant attention due to its exceptional tolerance to gastric acid and heat, alongside its multifaceted therapeutic potential. This review systematically delineates the unique biological characteristics of this bacterium, which include high survivability mediated by its spore form (retaining 73% viability after microwave treatment at 260 °C), dual lactate fermentation pathways, and plasticity in ATP synthesis that depends on pH and growth rate. Clinical evidence supports its efficacy in managing metabolic disorders (e.g., type 2 diabetes and non-alcoholic fatty liver disease), gastrointestinal conditions (e.g., constipation and irritable bowel syndrome), and neuropsychiatric disorders (e.g., depression and Alzheimer's disease). The underlying mechanisms involve the production of short-chain fatty acids (SCFAs), modulation of the TLR4/MyD88/NF-κB signaling pathway, and suppression of oxidative stress. Notably, therapeutic effects are strain-specific: H. coagulans MTCC 5856 (2 × 1010 CFU day-1) significantly reduces abdominal distension (P < 0.01), while the strain Unique IS-2 alleviates anxiety-like behaviors by upregulating hippocampal BDNF. Although toxicological assessments establish a no observed adverse effect level (NOAEL) of >1000 mg kg-1 in rodent models, its limited capacity for intestinal colonization presents a clinical challenge. Future research should prioritize large-scale clinical trials, multi-omics mechanistic investigations, and the development of synbiotic formulations to fully realize its potential as a next-generation therapeutic agent.

Giant Hydronephrosis Presenting as Abdominal Distension: An Unusual Case Presentation

Background Brucella can affect multiple organs in the body, with peritonitis being a rare complication primarily observed in patients with cirrhosis or undergoing peritoneal dialysis. We aim to analyse the clinical features of patients with peritoneal dialysis-associated peritonitis to provide a reference for clinical diagnosis and treatment. Methods A retrospective analysis was performed on three cases of Brucella -associated peritonitis in patients undergoing peritoneal dialysis, who were admitted to the First People’s Hospital of Kashi Prefecture between January 2022 and June 2025. The analysis covered general data, epidemiological history, clinical features, laboratory tests, and treatment efficacy. Results All three patients had been in contact with animals or had drunk raw milk. Two were male and one was female. The patients were aged 36, 40, and 50 years old. They were all on peritoneal dialysis, and the main symptoms were abdominal pain, abdominal distension, and malaise, with no fever. All three patients had low leukocyte counts in their blood, a normal or mildly elevated neutrophil ratio, significantly elevated C-reactive protein levels, and mildly elevated procalcitonin levels. Peritoneal effluent showed &amp;gt;100 leukocytes/mm 3 and a differential leukocyte count with a high proportion of mononuclear cells. Brucella was cultured from all peritoneal effluent samples, confirming the diagnosis of Brucella peritonitis. Symptoms decreased or disappeared following effective anti-infective treatment in all patients. Conclusion Brucella peritonitis occurs in patients undergoing peritoneal dialysis and is characterised by abdominal pain and pressure. The basis for confirming the diagnosis is the presence of elevated leukocytes, predominantly monocytes, in the peritoneal effluent, and the culture of Brucella in the peritoneal effluent. Effective treatment involves a combination of doxycycline and rifampicin for at least 6 weeks, which controls peritonitis without requiring the removal of the peritoneal dialysis catheter.

The transformation of Fanconi anemia into a hematological malignancy is consistent with the natural history of the disease. Few cases have been reported on acute myeloid leukemia, and even fewer cases involving coexistence with sickle cell anemia. Acute myeloid leukemia development is postulated to follow a multihit hypothesis where preleukaemic cells progress into leukemia through a second promotional mutation. Fever is a predominant clinical presentation, with blasts usually observed on peripheral blood smear and the immunophenotype confirmed with flow cytometry. In this case report from Tanzania, we present a case of acute myeloid leukemia with a failed induction in a patient with Sickle cell anemia andsuspected Fanconi anemia. A 6-year-old Haya boy from northern Tanzania presented to Muhimbili National Hospital with a congenital malformation of the left hand, short stature, and multiple café-au-lait spots distributed over the trunk, face, and limbs. He had experienced recurrent fever for 8 months, accompanied by headache, weight loss, and abdominal distension. Laboratory evaluation confirmed acute myeloid leukemia and sickle cell anemia with clinically suspicious features of Fanconi anemia. The patient was initiated on institutional treatment for acute myeloid leukemia. He had a failed induction and subsequently transitioned to home-based palliative care after prognostic counseling with the family. Thereafter, he had several admissions, mostly for blood product support, and eventually died 7 months post-discharge. The onset of acute myeloid leukemia in this case could be attributed to a malignant transformation from an underlying cancer predisposition syndrome. Our particular focus was on the leukemia treatment response where we observed a failed induction, prompting the need for alternative treatment approaches in this category of patients with acute myeloid leukemia in order to realize better treatment outcomes.

Characteristic analysis of adverse reactions to natural and synthetic alpha-glucosidase inhibitors: a descriptive analysis using World Health Organisation-VigiAccess.

Are NONO variants linked to congenital heart disease? Patient reports and review.

Gastrointestinal tolerance, healthcare resource utilization, and cost analysis of whey peptide-based enteral formula in pediatric post-acute care: A retrospective study.

Description of alarm symptoms in women with gynecologic cancer

Retrograde colonic intussusception is a rare condition in adults, often caused by organic lesions such as tumors. Autonomic dysfunction in disorders like multiple system atrophy (MSA) might contribute to its occurrence. An 81-year-old bedridden woman with a history of MSA presented with severe abdominal pain and abdominal distension lasting 4days. She had chronic severe constipation managed with laxatives and manual disimpaction. CT imaging revealed retrograde intussusception of the rectum into the sigmoid colon. Endoscopic reduction was attempted but was unsuccessful due to scope impassability. Emergency laparotomy identified a 4-5cm tumor at the lead point, and manual reduction resulted in bowel perforation. Hartmann's procedure with D2 lymphadenectomy was performed. The tumor was histopathologically diagnosed as a tubulovillous adenoma with no malignant features. The patient's postoperative recovery was uneventful except for a urinary tract infection (Clavien-Dindo Grade II), and she was transferred to a rehabilitation facility on postoperative day 24. Failure of reduction by air enema should raise suspicion for retrograde intussusception, warranting prompt surgery if an organic lead point is suspected.

Cystic lymphangiomas belong to the group of tumours arising from the lymphatic system. In adults, they are less commonly seen, with the abdomen being the least common site. Here, the present case study included a 32-year-old female who had a history of tube drainage of an abdominal cystic mass six years ago at the same hospital. Following that procedure, she developed tachycardia clinically, along with fever and rigors. The patient now presented with abdominal pain and distension for five months. She was evaluated with an ultrasound and a Computed Tomography (CT) scan of the abdomen and pelvis, which revealed a similar retroperitoneal cystic lesion. The patient underwent complete excision of the cystic lesion, and her postoperative course was uneventful. We are reporting this case of a lymphangioma that became iatrogenically infected and resulted in a giant lymphangioma within six years. According to the literature, only three cases of retroperitoneal lymphangioma in adults with a size greater than 20 cm have been reported. Compared to these, this cystic lymphangioma represents the fourth largest reported case.

Abstract Chyloabdomen is a rare condition in veterinary medicine and has rarely been reported in association with non‐iatrogenic traumatic pancreatitis in dogs. A 1‐year‐8‐month‐old, male, entire, mixed‐breed working dog presented 4 days after a high‐speed collision that occurred during rough play with a medium‐sized dog due to acute abdominal pain, vomiting, anorexia, lethargy and progressive abdominal distention. Pancreatitis was diagnosed based on history, clinicopathological test results and ultrasonographic findings. Serum canine pancreas‐specific lipase concentration, analysed 6 days after initial trauma, was equivocal. Abdominal ultrasonography revealed a large volume of slightly echoic peritoneal effusion and enlargement of the pancreatic body and cranial aspect of the right pancreatic lobe, with marked hyperechogenicity of the peripancreatic tissue. Abdominocentesis was consistent with chyloabdomen. The dog received supportive care, was discharged after 3 days of hospitalisation, and was doing well 18 months later.

Acute abdomen is a severe and sudden onset of pain over a short span of time, requiring urgent diagnosis and treatment. The prevalence of acute abdomen is found to be 5 percent in emergency department cases and a lower percentage in the OPD cases. Objectives: To diagnose the causes of acute abdomen via gray-scale ultrasonography in adults at a tertiary care hospital. Methods: The Study design was a descriptive cross-sectional. Data was collected through proforma and reports, and collected from the Diagnostic Center CMH Lahore. Data analysis was done through IBM SPSS software version 26.0, and the association between causes and the gender of the patient was calculated via chi chi-square test. Results: Out of 186 patients, 45.7% were male and 54.3% female, with a mean age of 47.44 years. Common symptoms/signs included nausea/vomiting (72.6%), fever (50%), abdominal tenderness (52.7%), and abdominal distension (33.9%). Moderate pain was the most prevalent severity of pain in 41.9% patients. RHC was the most prevalent region of pain (71%). Ultrasound diagnoses included cholelithiasis (20.4%), hydronephrosis (13.4%), acute cholecystitis (12.4%), renal colic (11.8%), and acute pancreatitis (8.1%), respectively. Other diagnoses were liver abscess (2.7%), splenic lesions (1.6%), and an unremarkable study (18.82%). Conclusions: The Current study concludes that there is a significant association between acute cholecystitis and the gender of the patient. It also highlights the significance of ultrasound in diagnosing the causes of acute abdomen, with cholelithiasis, hydronephrosis, renal colic, and acute cholecystitis as the most frequent causes of acute abdomen.

Spring viremia of carp (SVC) is a highly contagious disease that affects cyprinids, resulting in systemic hemorrhage, abdominal distension, exophthalmia, and high mortality in juveniles. This can lead to significant losses in the aquaculture industry. The World Organization for Animal Health (WOAH) recommends a two-step semi-nested reverse transcription polymerase chain reaction (RT-PCR) method for diagnosis. However, this method is labor-intensive, requires large reagent volumes, and is prone to carry-over contamination. Here, we evaluated the detection sensitivity of one-step semi-nested RT-PCR (combining RT and primary amplification in a single tube, followed by a second nested PCR step) against conventional two-step semi-nested RT-PCR. SVC virus (SVCV) subgroup Ia was tested using cell culture, RT-quantitative PCR, and one-step RT-PCR. The two-step semi-nested PCR method detected viral RNA up to a 10−2 dilution, whereas one-step semi-nested RT-PCR detected it up to a 10−5 dilution, showing a 1000-fold improvement in sensitivity. Moreover, detection rates increased from 84.2% with two-step semi-nested RT-PCR to 91.7% with one-step semi-nested RT-PCR in fish tissue samples. One-step semi-nested RT-PCR reduces processing time, minimizes handling steps, and contamination risk, and enhances analytical sensitivity. This supports its adoption as a practical, high-throughput diagnostic tool for SVCV and consideration for future WOAH guidelines.

BACKGROUND Leiomyoma is a benign gynecological neoplasm most commonly seen in the uterus, while primary ovarian leiomyomas are exceptionally uncommon. These tumors can grow to a large size and undergo degenerative changes, including infarction. Large ovarian leiomyomas with a solid-cystic appearance on imaging can closely resemble malignant ovarian neoplasms, leading to diagnostic uncertainty. We present a case of giant ovarian leiomyoma exhibiting clinical and radiological features closely mimicking those of an ovarian malignancy. CASE REPORT A 68-year-old para 4 woman presented with a four-year history of progressive abdominal distension, which had notably increased over the past two years. A computed tomography (CT) scan of the thorax, abdomen, and pelvis (CT-TAP) revealed a well-defined, lobulated, heterogeneously enhancing, solid-cystic mass, predominantly occupying the left lower abdominal quadrant and originating from the right ovary. Tumor marker analysis showed normal levels of CEA and CA19-9 with a mildly elevated CA-125 level of 51 U/ml. The calculated Risk of Malignancy Index (RMI) was 153, raising suspicion for an ovarian malignancy. In light of these findings, the patient was planned for a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO). The intraoperative findings revealed a right ovarian mass measuring 20×20 cm. Histopathological examination confirmed an ovarian leiomyoma with cystic degeneration. CONCLUSIONS The case report demonstrates the preoperative diagnostic challenges associated with giant ovarian leiomyoma, which can result in an unnecessary radical surgical procedure. This underscores the importance of meticulous preoperative and intraoperative assessment to ensure accurate diagnosis and appropriate management.

Spontaneous rupture of the spleen during pregnancy or after delivery is an extremely rare, potentially life-threatening complication that poses major diagnostic and therapeutic challenges. A 33-year-old woman at 27 weeks of gestation presented with a 1-week history of polyhydramnios and progressive abdominal distension. She had no history of trauma and recognized risk factors. On presentation, abdominal ultrasonography demonstrated large-volume ascites, which was not evident on the initial non-contrast whole-abdominal CT performed because of maternal instability. The patient showed a progressive decline in hemoglobin and abnormal fetal umbilical artery flow. After multidisciplinary consultation involving surgery, obstetrics/gynecology, radiology/ultrasound, and neonatology, an emergency cesarean delivery with exploratory laparotomy was undertaken. Intraoperative exploration revealed active hemorrhage originating near the splenic hilum with a ruptured splenic capsule and omental adhesions. A total splenectomy was performed after family consent after discussion with the team, and postoperative paraffin-embedded tissue confirmed spontaneous splenic rupture. However, this was a rare case. We hypothesize that marked polyhydramnios with increased intra-abdominal pressure and traction of omental adhesions contributed to splenic capsular rupture, intraperitoneal hemorrhage, and hemorrhagic shock. This case emphasizes the importance of close monitoring of amniotic fluid volume and prompt evaluation of acute abdominal pain in pregnancy, particularly in patients with polyhydramnios. Our review of published literature highlights that spontaneous splenic rupture, although rare, can occur during the antenatal period and is frequently associated with delayed diagnosis and poor outcomes. Early recognition and timely surgical intervention remain essential for improving maternal and fetal survival.

Abstract This report describes two cases of pneumoperitoneum in cats receiving treatment for hypercortisolism and diabetes mellitus. Both cats presented with abdominal distention and lethargy and diagnoses of pneumoperitoneum were radiographically confirmed. No clear underlying cause or other predisposing factors were documented and both cats were subsequently euthanased. One of the cats underwent necropsy, which confirmed a perforated gastric ulcer with no evidence of underlying neoplasia or other pathology. This case report may suggest a possible association between pneumoperitoneum and hypercortisolism and/or trilostane therapy in cats, which has not been documented previously and warrants further investigation.

Background Colorectal cancer during pregnancy is rare and poses significant challenges for maternal and fetal care. Postoperative nursing interventions are essential to optimize recovery and prevent complications. Case presentation A 33-year-old primigravida (G1P0) at 29 5 weeks’ gestation presented with abdominal distension, lower back pain, anorexia, and fatigue. Imaging and laboratory tests revealed right ascending colon wall thickening, hepatic lesions, fecal occult blood positivity, elevated AFP (162.4 IU/mL) and CA125 (64.5 U/mL), and severe anemia. She underwent cesarean section with right hemicolectomy, D3 lymph node dissection, and partial hepatectomy. Postoperative nursing care included pain management via patient-controlled analgesia, parenteral and oral nutrition, fluid and electrolyte monitoring, drainage tube care, early mobilization, fever surveillance, deep vein thrombosis prophylaxis, psychological support, and maternal-neonatal separation management. Outcome The patient recovered progressively without subjective complaints. No incision infection, vaginal fluid leakage, or mastitis occurred. The surgical incision healed with Grade A outcome, and she was discharged in stable condition. Conclusion This case demonstrates the effectiveness of integrated, evidence-based postoperative nursing strategies in managing colorectal cancer during late pregnancy, providing guidance for similar complex cases.

Hepatic arteriovenous fistula refers to the direct abnormal communication between the hepatic artery and the portal vein or hepatic vein. Clinical symptoms of hepatic arteriovenous fistula primarily depend on the blood flow volume, location, and duration of the fistula. Symptoms may include liver fibrosis, portal hypertension, enlarged heart, and ultimately heart failure. Congenital hepatic artery-portal fistula is a rare condition, predominantly observed in children or infants. Although interventional hepatic artery embolization is typically the initial treatment choice, it may not always be effective. We present a case of a 22-year-old Chinese male patient with hepatic arteriovenous fistula who underwent multiple interventional therapies. The patient was diagnosed with "hepatic artery-portal fistula, viral hepatitis B, and ascites" at Shengjing Hospital in August 2018, following complaints of abdominal distension. Hepatic artery embolization and diuretic treatment were administered, resulting in symptom relief. However, after discharge, the patient experienced recurrent abdominal distension, hematemesis, and melena. Consequently, hepatic artery embolization was performed periodically in May 2020, November 2020, January 2021, May 2021, and August 2021 to manage these conditions. During the hepatic artery embolization procedure, the contrast agent was monitored entering the portal vein directly from the hepatic artery. In the present case, interventional therapy was unable to completely block the fistula, providing only temporary relief. Consequently, liver transplantation is considered the ultimate treatment option for complex and diffuse intrahepatic vascular fistulas following hepatic artery embolization. The patient has currently been approved and registered for liver transplantation. Patients with diffuse hepatic arteriovenous fistula are prone to symptoms of portal hypertension, such as gastrointestinal bleeding caused by esophageal-gastric varices and ascites resulting from poor venous return, which significantly impact patient safety and quality of life. Arterial embolization provides only temporary symptom control. In cases where diffuse hepatic arteriovenous fistula is suspected or when interventional treatment fails, prompt liver transplantation should be considered. Therefore, this case report aims to enhance the understanding of the timing and selection of hepatic arteriovenous fistula treatment, along with providing a review of previous studies.

Distinguishing postoperative ileus (POI) from early mechanical small bowel obstruction (SBO) remains a challenging clinical dilemma after abdominal surgery, especially among elderly, frail patients with baseline gastrointestinal dysfunction. We describe an 83-year-old man with multiple comorbidities who underwent a robotic umbilical hernia repair converted to open due to incarcerated omentum and small-bowel dilation. The postoperative course was notable for persistent abdominal distention, high nasogastric output, alternating imaging interpretations of jejunal obstruction versus ileus, severe malnutrition requiring total parenteral nutrition, multidrug-resistant urinary infection, and progressive debility. Despite partial return of bowel function, the patient remained debilitated and elected hospice care. This case underscores the diagnostic ambiguity between persistent POI and partial SBO, emphasizes multidisciplinary management, and highlights the importance of aligning treatment with patient-centered goals in frail postoperative patients.

Background: Peritoneal lymphangiomatosis is a rare benign lymphatic disorder with diagnostic and therapeutic challenges. It may mimic peritoneal carcinomatosis or mesothelioma, often requiring histological confirmation. Management options are limited, and long-term data on targeted therapies, including sirolimus, remain scarce. Case Presentation: We present the case of a 45-year-old woman with a history of surgically corrected atrial septal defect, who developed progressive abdominal distension and dysuria in May 2014. Abdominal ultrasound (US) and contrast-enhanced abdominal computed tomography (CT) revealed diffuse ascites, peritoneal thickening, and cystic changes. Diagnostic uncertainty led to an exploratory laparotomy in May 2015, where histopathology confirmed peritoneal lymphangiomatosis. After failed conservative management including dietary modification, diuretic therapy, and repeated paracenteses, she was started on sirolimus 2 mg/day in August 2016. Her serum trough levels were maintained between 5–15 ng/mL. She achieved a Karnofsky Performance Score of 100% (indicating full functional capacity) within two months and has remained in complete clinical and radiologic remission for over 8 years. Diabetes mellitus type 2 was diagnosed during follow-up and is well controlled with insulin therapy. Conclusion: This case underscores the difficulty of diagnosing peritoneal lymphangiomatosis and highlights the transformative potential of sirolimus therapy. To our knowledge, this is one of the longest documented remissions of peritoneal lymphangiomatosis under mechanistic target of rapamycin (mTOR) inhibition. Keywords: peritoneal lymphangiomatosis, sirolimus, mTOR inhibitor, rare disease, ascites, lymphatic malformation, case report, remission, Karnofsky score, targeted therapy.