Abdominal Fullness Research Articles

7536 Missed Silent Retroperitoneal Paraganglioma

Abstract Disclosure: S. Lamichhane: None. D.T. Price: None. J.J. Faria-Briceno: None. A. Kaur: None. Introduction: Paragangliomas are rare neuroendocrine tumors comprising about 15-20% of all chromaffin cell tumors and can arise anywhere along the sympathetic and parasympathetic ganglionic chain from skull base to the pelvic floor. About 75% of sympathetic paragangliomas arise in the abdomen out of which majority are functional and secrete catecholamines responsible for the typical clinical features. While the diagnosis is usually made by clinical features and lab elevation of catecholamines, it is estimated that 10-15% of paragangliomas are non-functional and another 10% do not manifest clinically according to the hormone activity, thus posing a significant diagnostic challenge. We report a case of a retroperitoneal paraganglioma diagnosed by biopsy as it was initially missed owing to its silent nature clinically and biochemically. Case report:A 48-year-old smoker with panic disorder, remote history of spontaneous pneumothorax, and exploratory laparotomy for motor vehicle accident visited ER due to left-sided abdominal fullness and weight loss of 10-20 pounds for several months. Review of systems was negative except for mild constipation. He denied taking any medications and BP had been normal. CT abdomen showed a large 13.3 cm mixed cystic and solid mesenteric mass. Core biopsy revealed pheochromocytoma and patient was referred to Endocrinology. Labs showed elevated plasma free metanephrines (MN) 80 pg/ml, normetanephrines (NMN) 190 pg/ml, total MN 270 pg/ml, all less than twice the upper limit of normal and inconclusive, non-elevated 24-hour urine MN and NMN but with inadequate collection, and normal plasma catecholamines. MRI revealed a 13.5 cm mass in the left retroperitoneal sympathetic chain separate from the left adrenal gland and inferior to the left kidney. After pre-op optimization with alpha and beta blocker, patient had an uncomplicated open resection of the mass along with the retroperitoneal lymph nodes (LN). Pathology resulted in 3 benign LNs, a 16.5 cm paraganglioma negative for margin, lymph-vascular invasion, and necrosis. Genetic panel was negative. Follow-up post-surgery at 1 and 3 months with mildly elevated catecholamines and MRI abdomen at 3 months without evidence of recurrent or residual mass and metastasis. PET scan is pending prior authorization. Conclusion: Silent retroperitoneal paragangliomas are exceedingly rare. The diagnosis is often missed when the tumors are asymptomatic, and biomarkers are not elevated. The lack of specific imaging characteristics also adds to the diagnostic challenge. Early recognition can avoid the potential risk of life-threatening hypertensive crisis during surgical intervention. Our case highlights the importance of considering this rare entity in the differential diagnosis of retroperitoneal mass. Presentation: 6/1/2024

Clinical value of modified Shenling Baizhu powder in treating targeted therapy-induced diarrhea in non-small cell lung cancer.

To assess clinical value of modified Shenling Baizhu powder (, SBP) in intervening targeted therapy-induced diarrhea. This study was a prospective randomized controlled study. Eighty-five non-small cell lung cancer (NSCLC) patients with diarrhea who took targeted drugs were randomly divided into two groups. The experimental group received modified SBP, while the control group received imodium. During 2 courses of treatment (1 week/course) and 2 weeks of follow-up, we observed remission and recurrence of diarrhea, as well as the improvement of Karnofsky score (KPS) in the two groups and drug safety. Eighty cases were completed, with 40 cases in the experimental group and 40 cases in the control group. The control group's diarrhea remission rate was significantly lower than the experimental group's (P<0.05). After 2 courses of treatment, the symptom scores of both groups were lower than before, with that of the experimental group remarkably lower (P<0.05). Furthermore, the experimental group experienced less abdominal fullness and appetite loss than the control group (P<0.05). There was no prominent difference in overall diarrhea recurrence, time, or KPS after treatment between the two groups (P>0.05). No unique adverse events occurred in experimental group or control group. The modified SBP could improve targeted therapy-induced diarrhea in NSCLC, and is superior to imodium in relieving diarrhea, improving related symptom scores and symptoms, with no obvious drug-related adverse events.

A case of resected anaplastic carcinoma of the pancreas producing granulocyte-colony stimulating factor with literature review

BackgroundGranulocyte colony-stimulating factor (G-CSF)-producing tumors have been reported in various organs, and the prognosis of patients with G-CSF-producing pancreatic cancers is particularly dismal. In this report, we present a case of G-CSF-producing anaplastic carcinoma of the pancreas (ACP), characterized by early postoperative recurrence and rapid, uncontrolled growth.Case presentationA 74-year-old man presented to our hospital with complaints of abdominal fullness and pain after eating. On admission, it was observed that the peripheral leukocyte counts and serum G-CSF levels were significantly elevated (23,770/µL and 251 pg/mL, respectively). Computed tomography of the abdomen revealed a pancreatic head tumor involving the superior mesenteric vein. Pathologically, ultrasound-guided fine-needle aspiration confirmed ACP. Subsequently, we performed a subtotal stomach-preserving pancreaticoduodenectomy with portal vein reconstruction and partial transverse colon resection. On postoperative day (POD) 7, the leukocyte count decreased from 21,180/μL to 8490/μL; moreover, computed tomography revealed liver metastasis. Therefore, mFOLFILINOX chemotherapy was initiated on POD 30. However, the tumor exhibited rapid progression, and the patient died on POD 45.ConclusionsG-CSF-producing ACP is rare, and the prognosis of patients is extremely poor. Basic research is required to develop effective drugs against G-CSF-producing tumors, and large-scale studies using national databases are needed to develop multidisciplinary treatment methods.

Tidal Versus Intermittent Peritoneal Dialysis in Chronic Peritoneal Dialysis Patients: Randomized, Open-Label, Prospective Control Study.

Tidal peritoneal dialysis (TPD) provides better fluid flow mechanics and is more comfortable for the patient, owing to fewer alarms and less pain during inflow and outflow. The long-term characteristics of patients with TPD were not evident. In this randomized controlled follow-up study, we aimed to explore the characteristics of patients with TPD, compared to IPD. A total of 85 patients were randomized to either IPD or 70% TPD between January 2019 and December 2020, and all patients were followed up on December 2021. The characteristics of patients between the two groups were analyzed using a t-test or chi-square as appropriate. The overall survival and technical survival were analyzed using Kaplan-Meier analysis. Forty-two patients were assigned to IPD, and 43 patients were assigned to TPD. The basal characteristics of patients were not different between the two groups. In an average of 16 months of follow-up, 19 patients died, and 25 patients dropped out of peritoneal dialysis. The two groups had no difference in overall survival and technical survival. TPD was associated with high urine volume (p = 0.001), lower blood urea nitrogen (p = 0.002), lower phosphorus (p = 0.004), and fewer cycler alarms (p < 0.001). The chance of patients reporting abdominal fullness was higher in patients with TPD (p = 0.001). In the randomized, controlled, follow-up study, TPD may preserve residual renal function and is associated with lower urea nitrogen and phosphorus in chronic peritoneal dialysis patients. TPD is associated with fewer cycler alarms but may increase the chance of patients reporting abdominal distension.

Duodenum in the right hemithorax: An unusual case of a large paraesophageal hernia

Abstract Paraesophageal hernia is an uncommon condition where the gastric fundus herniates through the diaphragm without the accompanied migration of the gastroesophageal junction. A woman in her late 60s presented with symptoms of vomiting and decreased appetite for 1 year, accompanied by abdominal fullness in the epigastrium, nausea, and retrosternal burning sensation. Her symptoms worsened over the past month, leading to intolerance to a liquid diet. Upon examination, a vague, tender mass was palpated over the epigastrium, and decreased breath sounds were noted over the right hemithorax. Computed tomography suggested the presence of paraesophageal hernia. An exploratory laparotomy was performed. Intraoperatively, a 4 cm paraesophageal diaphragmatic defect was found through which the antrum and the first part of the duodenum had herniated. The hernial contents were reduced, and anatomical closure was performed. Paraesophageal hernias necessitate careful history and examination, along with an individualized treatment approach, to achieve optimal patient outcomes.

COVID-related constrictive pericarditis requiring pericardiectomy: a case report

BackgroundThe COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date.Case presentationA patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient’s pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient’s dyspnea resolved; one month later, leg edema and abdominal bloating were relieved.ConclusionsAlthough an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.

Progress in the Treatment of Ovarian Cysts by Combination of Traditional Chinese and Western Medicine

Ovarian cyst is a common benign tumor in gynecology, often occurring in women of childbearing age. Its essence is a solid or liquid cystic filling structural disease formed inside or on the surface of the ovary, which is not easy to be detected in the early stage, the onset is slow, and serious symptoms and signs such as abdominal fullness, menstrual disorders, and touching mass will occur, affecting women's work and life. At present, both Chinese medicine and Western medicine have certain cognition and advantages in the treatment of ovarian cysts. Chinese medicine can be divided into internal treatment and external treatment, while Western medicine can be divided into drug treatment and surgical treatment. Clinical treatment should be fully considered in the selection of patients' clinical conditions. This paper analyzes the advantages of TCM and Western medicine in clinical treatment, aiming to improve clinical efficacy, reduce cyst recurrence, promote ovarian function recovery, and better protect female ovarian health through the combination of traditional Chinese and Western medicine.

Polyp Endotherapy for Multiple Jejunal Lipomas Presenting as Small Bowel Intussusception: “Loop and Let Go Technique”

AbstractA 46-year-old woman presented with abdominal pain, vomiting, and intermittent constipation for the last 2 days. She had similar history of recurrent symptoms for the last 6 months. Abdominal examination showed mild central abdominal tenderness and generalized abdominal fullness and no palpable mass. A diagnosis of intestinal obstruction was considered. Nasogastric aspiration was performed with intravenous (IV) antibiotics and IV fluids. Computed tomography (CT) scan of the abdomen showed “bowel in bowel” or “target” sign appearance of jejunum with a submucosal hypodense lesion (suggestive of lipoma) acting as the lead point. There were two more submucosal lipomas of sizes approximately 3 cm each in the distal jejunal loops. A diagnosis of jejunal lipomas causing small bowel intussusception was made. The patient improved with conservative management. Exploratory laparotomy was planned with an intent to resect the small bowel. The patient did not provide consent for the same and so the option of enteroscopy-guided polyp endotherapy was offered to the patient. An antegrade single balloon enteroscopy was done (SIF-Q180, Olympus Medical Systems, United States). Three submucosal lesions with smooth overlying mucosa were noted in the mid and distal jejunum consistent with lipomas. The base of the lesions was ligated tightly using endoloop to make them ischemic and detach. Notable changes in color and mucosal appearance were noted after the application of endoloop. Since all the lipomas detected on cross-sectional radiologic imaging have been tackled via antegrade route, a retrograde enteroscopy was not attempted further. After 2 days, the patient was discharged in stable condition. Follow-up cross-sectional imaging at 3 months showed no residual lipomas, and she remained symptom-free at the end of 6 months.

Lymphomas with massive splenomegaly – a case series

Hairy cell leukaemia (HCL) is an uncommon chronic B-cell lymphoma. Classical HCL and its variant are separate entities. Splenic marginal zone lymphoma (SMZL) is rare accounting for &lt;2%of lymphoid neoplasms2. A 62-year-old woman presented with constitutional symptoms and mild splenomegaly was having pancytopenia, monocytopenia and hairy cells in the peripheral blood. Bone marrow aspiration was a dry tap while trephine biopsy revealed diffuse lymphoid cell infiltration with characteristic fried egg appearance and fibrosis. Morphological and immunophenotypic diagnosis was HCL. She was successfully treated with IV-cladribine and G-CSF for chemotherapy induced severe neutropenia. She achieved complete remission in 6 months. A 56-year-old woman presented with abdominal distension and lower limb swelling was having marked splenomegaly, absolute lymphocytosis, mild neutropenia and anaemia. Blood film revealed lymphocytes showing moderate cytoplasm and cytoplasmic projections. With bone marrow biopsy and flow cytometry, splenic B-cell lymphoma/leukaemia with prominent nucleoli was diagnosed and was treated with rituximab monotherapy. A 76-year-old woman presented with progressive abdominal fullness, unintentional weight loss and early satiety was having splenomegaly, bicytopenia and absolute lymphocytosis consisting predominantly of small mature lymphocytes and occasional lymphocytes with polar villi. Morphological and immunopheno-typical results confirmed SMZL. She was treated with rituximab monotherapy.

Comparison of metronidazole versus clarithromycin in first-line vonoprazan-based triple therapy for Helicobacter pylori: A multicenter randomized trial in Japan.

To date, no randomized trials have compared the efficacy of 7-day vonoprazan, amoxicillin, and metronidazole triple therapy (VAM) versus 7-day vonoprazan, amoxicillin, and clarithromycin triple therapy (VAC) as a first-line treatment for Helicobacter pylori eradication. This study was performed to compare the efficacy of VAM and VAC as first-line treatments. This prospective multicenter randomized trial was performed in Japan and involved 124 H. pylori-positive patients without a history of eradication. Patients without antibiotic resistance testing of H. pylori were eligible. The patients were randomized to receive either VAC (vonoprazan 20 mg + amoxicillin 750 mg + clarithromycin 200 or 400 mg twice a day) or VAM (vonoprazan 20 mg + amoxicillin 750 mg + metronidazole 250 mg twice a day) for 7 days, with stratification by age and sex. Eradication success was evaluated using the 13C-urea breath test. We evaluated safety using patient questionnaires (UMIN000025773). The intention-to-treat and per-protocol eradication rates of VAM were 91.3% (95% confidence interval [CI], 82.0-96.7%) and 92.6% (95% CI, 83.7-97.6%), respectively, and those of VAC were 89.1% (95% CI, 77.8-95.9%) and 96.1% (95% CI, 86.5-99.5%), respectively. No significant difference was observed between VAM and VAC in either analysis (P = 0.76 and P = 0.70, respectively). Abdominal fullness was more frequent in patients who received VAM than VAC. These findings suggest that VAM as a first-line treatment in Japan can be categorized as grade B (intention-to-treat cure rate of 90-95%) and have potential as a first-line national insurance -approved regimen.

Coexistence of IgG4-related disease and tubercular lymphadenopathy in a rheumatoid arthritis patient

Extrapulmonary tuberculosis is a very common cause of generalised lymphadenopathy especially in tuberculosis endemic regions like India. A 33-year-old lady who had been diagnosed with rheumatoid arthritis 5 years back and had received treatment with biologicals including adalimumab presented with a 3 week history of persistent fever associated with significant weight loss and abdominal fullness. Investigations pointed towards a picture of tubercular aetiology although, a definite microbiological diagnosis was not possible at this stage. Patient also had an underlying subacute thyroiditis with diffusely increased uptake in Tc99 scan. Considering the background risk factor of use of biologicals and typical clinical presentation resembling tuberculosis, a decision to start antitubercular therapy was taken. The fever resolved but it recurred after 2 weeks and then after an extensive workup, the diagnosis of coexistent IgG4-related disease along with microbiological diagnosis of tuberculosis was established. This case highlights the importance of an active search for coexistent pathologies in cases of lymphadenopathy with insufficient response to standard therapy.

Idiopathic Portal Hypertension: A Case Report of an Adult Indian Rural Female of “Banti Syndrome”

Non-cirrhotic portal fibrosis (NCPF)/idiopathic portal fibrotic hypertension (IPH) is one of the major diseases that include a group of diseases caused by increased portal venous pressure which is thought to be due to intrahepatic or prehepatic lesions in the absence of liver cirrhosis. In the present case a 35-year-old female presented with abdominal fullness and pain in the upper abdomen for the past two months which was not associated with the consumption of water or food, nausea, or vomiting. When we investigated it was seen that she had severe anemia with pancytopenia with no malarial parasite on peripheral smear, liver renal and liver function tests were within the normal range. The diagnosis of Banti’s syndrome was made. However, the patient was then vitally stable and was started on propranolol and was advised for splenectomy due to refractory anemia. The present study provides easy and conventional diagnostic techniques for clinical diagnosis and proves the radiological technique.

Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature

BackgroundDuodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucial. However, this is often overlooked.Case presentationA 35-year-old man presented with abdominal pain, fullness, vomiting, and weight loss. Upper gastrointestinal endoscopy and radiography revealed nearly pinpoint stenosis with edematous and reddish mucosa in the D1/D2 portion of the duodenum. Computed tomography (CT) showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph nodes, and portal vein stenosis. Conventional mucosal biopsy during endoscopy revealed ulcer scars. We initially suspected stenosis due to peptic ulcers; however, chest CT revealed cavitary lesions in both lung apices, suggesting tuberculosis. Due to the suspicion of duodenal TB and the need to obtain deeper tissue samples, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The tissue sample showed caseating granulomas with multinucleated giant cells, and acid-fast bacilli were positive by Ziehl–Neelsen staining. The patient was diagnosed with duodenal TB and subsequent GOO. Because the patient had difficulty eating, surgical intervention was prioritized over antitubercular drugs, and laparoscopic gastrojejunostomy was performed. The patient started an oral diet on the 3rd postoperative day and began antitubercular treatment immediately after discharge on the 11th day. During the 6th month of treatment, endoscopic examination revealed residual duodenal stenosis; however, the bypass route functioned well, and the patient remained asymptomatic.ConclusionsAn aggressive biopsy should be performed to diagnose duodenal TB. EUS-FNA has proven to be a useful tool in this regard. Both nutritional improvement and antitubercular treatment were achieved early and reliably by performing laparoscopic gastrojejunostomy for duodenal TB with GOO.

Management challenges for Gestational Trophoblastic Neoplasia in a 54 years old perimenopausal woman ; A case report.

Background: Gestational trophoblastic diseases (GTD) are pregnancy-related disorders that originate from trophoblast cells. They include benign and aggressive tumors, such as invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Gestational trophoblastic neoplasia (GTN) mostly occur in women of reproductive age, whereas it is extremely rare in postmenopausal women. Case presentation: A 54-year-old woman presented with prolonged bleeding, abdominal fullness, and pelvic mass with a history of a missed abortion two months prior to the onset of the symptoms and was medically managed. Her general and systemic examination findings were unremarkable. On abdominal examination, the uterus was 14 weeks in size. On speculum examination, the cervix and vagina were normal. On bimanual examination, the uterus was 14 weeks, mobile, and the adnexa were normal. Investigations included serum beta-human chorionic gonadotropin (hCG), abdominopelvic magnetic resonance imaging, and chest computed tomography. Her initial hCG was 179,000 mIu/ml with a bulky uterus and endometrial mass of approximately 6 cm and multiple bilateral chest metastatic nodules. The patient was scored as stage III:10 and started on etoposide, methotrexate, actinomycin alternating with cyclophosphamide, and vincristine (EMACO). She received 11 cycles of EMACO. Her management included repeated transfusions, granulocyte-stimulating factors administration, and ICU admission. Discussion: Gestational trophoblastic neoplasia accounts for rare gynecological malignancies in postmenopausal women. The risk of GTD progressing to GTN is 5% in younger women and five-fold higher (27%) after 45 years. Conclusion: GTN is a rare gynecological malignancy in postmenopausal women. The presentation mimics other gynecological malignancies. Hence, a high index of suspicion is required. Histopathological confirmation is mostly unavailable. It carries a poor prognosis compared with younger women with a high incidence of metastatic, recurrent, and low tolerance to standard multi-agent chemotherapeutic drugs.

A survey of post COVID-19 symptoms from the perspective of traditional medicine

Background: Individuals experiencing post-COVID-19 syndrome may endure lingering health deterioration, leading to challenges in daily activities and impacting mental and physical health, thus potentially burdening themselves, their families, and society. According to traditional medicine (TM), post-COVID-19 represents a recovery period following the flu in COVID. At this stage, the body remains incompletely restored, characterized by depleted vital energy and damaged body fluids, thus affecting the functions of various organ systems. To comprehensively understand post-COVID-19 symptoms from the perspective of traditional medicine and offer valuable insights for diagnosis, treatment, and prevention, this study conducted a survey of post-COVID-19 symptoms using the latent tree model. Methods: A cross-sectional descriptive study was conducted. Data were collected through direct interviews with 282 post-COVID-19 patients over three months at the Ho Chi Minh City Traditional Medicine Hospital from January 2023 to May 2023. Results: Among the collected samples, 38 post-COVID-19 symptoms were recorded, with the five most common symptoms being forgetfulness (58.2%), fatigue (47.5%), hair loss (42.6%), sleep disorders (25.9%), and shortness of breath (25.5%). Analysis using a latent tree model unveiled that within the kidney viscera, forgetfulness and hair loss emerged as primary symptoms, accompanied by tinnitus, anxiety, and hearing impairment. In the spleen viscera, fatigue prevailed as the main symptom, alongside muscle soreness, abdominal fullness, diarrhea, and constipation. In the lung viscera, shortness of breath was identified as the predominant symptom, accompanied by rapid breathing, coughing, breathing difficulties, and a sore throat. In the liver viscera, insomnia was the most perceived symptom, with secondary symptoms including anxiety, headache, and dizziness. In the heart viscera, primary symptoms included attention disorders and insomnia, with secondary symptoms being chest tightness. Conclusion: The most common symptoms observed were forgetfulness, fatigue, hair loss, sleep disorders, and shortness of breath. Post-COVID-19 symptoms affect all five visceras according to traditional medicine. Key words: Post COVID-19 symptoms; Traditional Medicine; Latent tree model.

The herbal preparation, STW5-II, reduces proximal gastric tone and stimulates antral pressures in healthy humans.

The herbal preparation, STW5-II, improves upper gastrointestinal symptoms, including abdominal fullness, early satiation, and epigastric pain, in patients with functional dyspepsia, and in preclinical models decreases fundic tone and increases antral contractility. The effects of STW5-II on esophago-gastric junction pressure, proximal gastric tone and antropyloroduodenal pressures, disturbances of which may contribute to symptoms associated with disorders of gut-brain interaction, including functional dyspepsia, in humans, have, hitherto, not been evaluated. STW5-II or placebo (matched for color, aroma, and alcohol content) were each administered orally, at the recommended dose (20 drops), to healthy male and female volunteers (age: 27 ± 1 years) in a double-blind, randomized fashion, on two separate occasions, separated by 3-7 days, to evaluate effects on (i) esophago-gastric junction pressures following a standardized meal using solid-state high-resolution manometry (part 1, n = 16), (ii) proximal gastric volume using a barostat (part 2, n = 16), and (iii) antropyloroduodenal pressures assessed by high-resolution manometry (part 3, n = 18), for 120 min (part 1) or 180 min (parts 2, 3). STW5-II increased maximum intrabag volume (ml; STW5-II: 340 ± 38, placebo: 251 ± 30; p = 0.007) and intrabag volume between t = 120 and 180 min (p = 0.011), and the motility index of antral pressure waves between t = 60 and 120 min (p = 0.032), but had no effect on esophago-gastric junction, pyloric, or duodenal pressures. STW5-II has marked region-specific effects on gastric motility in humans, which may contribute to its therapeutic efficacy in functional dyspepsia.

A rare enterouterine fistula between uterine leiomyoma and sigmoid colon in a nulliparous woman: a case report

BackgroundThe commonest benign neoplasm encountered in women of reproductive age group is uterine leiomyoma which usually presents with abnormal uterine bleeding, chronic pelvic pain, urinary disturbances, urinary retention, constipation, and dyspareunia. Uterine leiomyoma presenting with bowel fistulization is a rare presentation. To our knowledge and based on a thorough literature search, no previous reports of uterine leiomyoma showing spontaneous fistulous communication with the sigmoid colon have been reported.Case presentationA nulliparous woman in her early 30s presented with complaints of lower abdominal pain, abdominal fullness, pus discharge from the vagina, and difficulty in respiration. On contrast-enhanced computed tomography (CECT), a large heterogeneously enhancing mass was seen in the rectouterine space showing air-fluid levels, with a fistulous communication with the adjacent sigmoid colon. Histopathological examination proved the lesion to be a uterine leiomyoma.ConclusionThe chance of fistulization with the bowel should be considered whenever a uterine mass with an air-fluid level is encountered.

Giant hepatic hemangioma in a patient with cirrhosis: challenging to manage.

Giant hepatic hemangiomas are occasional in patients with cirrhosis. It remains a challenge to decide on the need for treatment and choose the most appropriate intervention. A 62-year-old woman was recently diagnosed with cirrhosis and complained of upper abdominal fullness, reduction in oral food intake, and weight loss of 6 kg over the last three years. Upper digestive endoscopy evidenced thin-caliber esophageal varices and significant extrinsic compression of the lesser gastric curvature. Abdominal computed tomography revealed an exophytic tumor in the left hepatic lobe, measuring 11.5 cm, which had progressive centripetal contrast enhancement from the arterial phase, compatible with hepatic hemangioma. Serum tumor markers were negative, and her liver function was unimpaired. The patient underwent surgical resection (non-anatomical hepatectomy of segments II and III) which had no immediate complications, and the histopathological evaluation confirmed cavernous hepatic hemangioma. Two weeks later, she was admitted to the emergency room with jaundice, signs of hepatic encephalopathy, and moderate ascites, and was further diagnosed with secondary bacterial peritonitis. As no perforations, abscesses, or fistulas were observed on subsequent imaging tests, clinical management was successfully carried out. This case highlights that giant hepatic hemangiomas may be symptomatic and warrant treatment. In the setting of cirrhosis and portal hypertension, physicians should be aware of the risk of hepatic decompensation following surgical resection, even in patients with Child-Pugh class A.

A Large Recurrent Retroperitoneal Lymphangioma in a Previously Healthy Adolescent Male: A Case Report

Lymphangiomas are uncommon benign lymphatic vessel tumors that can affect any area of the body served with the lymphatic system. Intra-abdominal lymphangiomas are considered rare, accounting for less than 5 percent of all lymphangioma cases. In this case report, we present a recurrent large retroperitoneal lymphangioma in a previously healthy 15-year-old boy. The patient presented to the Emergency Department with abdominal pain lasting for one week. The pain, described as diffuse, crampy, and non-radiating, gradually increased with time and was aggravated by movement. A large retroperitoneal fluid collection was found on the Computed Tomography (CT) scan. Subsequently, the patient underwent CT-guided drainage, at which 700ml of bloody fluid was extracted. After three months, the patient was readmitted to the hospital for a similar presentation of abdominal fullness and pain. Complete blood count analysis indicated an unremarkable profile, except for a left shift of 82.2% neutrophils and a white blood cell count of 11,300/mcl. A CT scan of the abdomen reported a large, thin-walled cystic lesion in the right hemi-abdomen with minimal thin internal septations, resulting in moderate right hydronephrosis/hydroureter.

Extraskeletal Osteosarcoma with Extensive Gastrointestinal Tract Involvement

Abstract Introduction/Objective Extraskeletal osteosarcoma (ESOS) is a rare aggressive mesenchymal tumor that originates from soft tissues or visceral organs, differentiating it from primary bone osteosarcoma. ESOS represents less than 5% of all osteosarcomas and less than 1% of soft tissue sarcomas. Primary ESOS in the gastrointestinal tract (GIT) is exceedingly uncommon, with a low incidence rate Methods/Case Report A 70 year-old-man with a history of hypertension, Myasthenia Gravis, hypothyroidism (status post total thyroidectomy), and skin cancer presented to the clinic with a chief complaint of abdominal fullness of 4 months duration. Primary work-up revealed anemia (Hemoglobin 7 g/dl) and peripheral blood smear was suggestive of bone marrow infiltration. Evaluation with upper gastrointestinal endoscopy and ultrasound demonstrated regular mucosal folds of the stomach with a solid-cystic lesion between the body of the pancreas and the posterior aspect of the stomach. The patient underwent a fine needle biopsy showing a spindle cell lesion with positive immunohistochemistry (IHC) for Smooth Muscle Actin (SMA), beta-Catenin, CD34, and negative for panCK, DOG-1, and CD117; suggestive of leiomyoma. The patient underwent a total gastrectomy, distal pancreatectomy, and splenectomy. Examination of the specimen confirmed a high-grade malignant spindle cell lesion with numerous associated osteoclast-like multinucleated giant cells, and focal areas consistent with osteoid changes. The IHC was requested and the cells were positive for WT1 and Muscle Specific Actin, SATB2, and Ki-67&amp;gt;90% whereas the cells were negative for SMA, Myo-D1, Myogenin, S100, SOX10, MART1, CD34, CD31, and Calretinin. Also, the genetic analysis for MDM2 was negative. These findings confirmed the diagnosis of ESOS with abdominal visceral involvement (stomach, pancreas, and omentum) Results (if a Case Study enter NA) NA Conclusion ESOS is an extremely rare condition that demands a comprehensive evaluation involving clinical, radiological, histopathological, and immunohistochemical analyses to establish an accurate diagnosis. Distinguishing ESOS from primary bone osteosarcoma is vital due to the different treatment strategies. Additionally, ESOS requires a unique therapeutic approach compared to more prevalent gastrointestinal sarcomas like GIST or leiomyosarcoma. The mainstay of ESOS treatment entails complete surgical resection of the tumor with clear margins, accompanied by adjuvant chemotherapy. Ensuring precise diagnosis is of utmost importance to provide suitable and effective treatment