Abdominal Fullness Research Articles

S1741 Gelatinous Ascites and a Double Duct Sign: A Case of Pancreatic Adenocarcinoma

Introduction: Pseudomyxoma peritonei (PMP) is a rare disorder characterized by the accumulation of gelatinous material within the abdomen and pelvis. While usually appendiceal in origin, it can be seen with mucinous tumors arising from the ovary, GI tract, urachus, and pancreas. We describe a case of pancreatic adenocarcinoma diagnosed due to the clinical syndrome precipitated by pseudomyxoma peritonei. Case Description/Methods: A 59-year-old Hispanic male presented to the hospital for evaluation due to a 2 month history of poor oral intake and worsening abdominal fullness, distension, discomfort, and intermittent pain. The patient reported one prior hospitalization for pancreatitis of unclear etiology, 3 years ago. A CT abdomen & pelvis was obtained; findings reported include multiple hepatic subcapsular cystic liver lesions, abdominal omental caking, ascites, and extrahepatic biliary and pancreatic ductal dilatation without definitive evidence of a mass. CEA and CA 19-9 were found to be elevated at 49.4 and 416 respectively. CT chest revealed a left-sided pleural effusion. Upper endoscopy and colonoscopy were negative. Paracentesis yielded gelatinous ascites. Clinical suspicion for appendiceal malignancy was raised which required surgical exploration and biopsy to confirm. An MRI of the abdomen was obtained to assess for pancreatic mass given presence of double duct sign. MRI revealed 2.2 x 2.7 x 5 cm lesion in the body of the pancreas, pseudomyxoma peritonei with scalloping of the liver and extension into the right posterior mediastinum via the esophageal hiatus, metastatic deposits in the porta hepatis and peritoneal carcinomatosis. No apparent abnormality in the appendix was observed. EUS FNA was performed; splenic vessel invasion by the mass was noted. Cytopathology supported a diagnosis of pancreatic adenocarcinoma. The patient was initiated on palliative chemotherapy with gemcitabine and nab-paclitaxel which led to a significant reduction in ascites and pleural effusion and improvement in symptoms. Discussion: This case highlights the potential of malignancies such as pancreatic adenocarcinoma to cause pseudomyxoma peritonei despite it more commonly being associated with appendiceal origin. Knowledge of this can help guide diagnostic and therapeutic plans.

Laparoscopic removal of bilateral uterine remnants for symptomatic unilateral leiomyomas in a patient with Müllerian agenesis

To our knowledge, we present the first video demonstration of the laparoscopic removal of bilateral uterine remnants for symptomatic unilateral leiomyomas in a patient with Müllerian agenesis. A video case report. An academic medical center. A 44-year-old woman, gravida 0, with a history of Müllerian agenesis with presumed single uterine remnant who presented with worsening lower abdominal fullness and discomfort in the setting of known leiomyomas. Magnetic resonance imaging of the pelvis revealed a single rudimentary uterine remnant with 3 dominant leiomyomas, with the largest measuring 5.8 × 5.3 × 5.2 cm. After extensive counseling, she opted for definitive surgical management. She provided written consent for video recording and publication of this surgical case. Laparoscopic removal of bilateral uterine remnants, bilateral salpingectomy, and cystoscopy. Laparoscopic removal of bilateral uterine remnants with multiple unilateral leiomyomas, leading to resolution of lower abdominal bulk symptoms. Diagnostic laparoscopy revealed a right 12-cm pelvic mass consisting of a uterine remnant with 3 dominant leiomyomas, left 2-cm rudimentary uterine remnant, bilateral atrophic fallopian tubes, bilateral normal ovaries, and absent cervix and upper vagina. Procedure was uncomplicated with an estimated blood loss of 25 mL. Patient was discharged on the same day of surgery after meeting required milestones. Pathologic examination of the specimens was consistent with intraoperative findings. Müllerian agenesis is a rare congenital anomaly of the female reproductive tract in which uterine remnants may be found. Leiomyoma formation in uterine remnants is rare but possible. Magnetic resonance imaging is the most sensitive imaging modality for uterine remnants but not always accurate. When leiomyomas become symptomatic, surgery is the only definitive management option with laparoscopy as the standard of care when possible. Minor changes to the minimally invasive approach may be necessary to accommodate for anatomical differences.

Atypical presentation of Morgagni hernia: Bowel loops in the neck

IntroductionMorgagni hernia is a rare congenital anomaly caused by the fusion defect between the septum transversum and the sternum. Patients may be asymptomatic or present with respiratory symptoms, abdominal pain, retrosternal pain, abdominal fullness, or gastrointestinal obstruction. Chest X-ray and thoracic computed tomography (CT) are the most commonly used modalities in imaging.AimWe describe an adult case in which the transverse colon was herniated from the retrosternal area to the thyroid gland without a history of trauma or surgery.Case studyA 24-year-old female patient living in the countryside presented to our hospital with the complaints of indigestion and chest pain persisting for 2 years. In the thorax CT examination of the patient, it was observed that the transverse colon had herniated to the retrosternal region and then to the neck.Results and discussionMost acquired anterior diaphragmatic hernias are due to blunt or penetrating traumatic injury. However, there are also case reports describing iatrogenic diaphragmatic hernias following a sternotomy performed during thoracic or cardiac surgery. In Morgagni hernia, the most frequently herniated organs are the greater omentum and transverse colon. There are also reports, albeit rarer, describing the herniation of the stomach, liver and small intestines.ConclusionsMorgagni hernia is a very rare type of hernia, especially in adult patients. The diagnosis of these patients can be easily made based on thoracic CT findings.

Signet-ring cell carcinoma of the appendix with ganglioneuromatosis: a case report

BackgroundPrimary cancer of the appendix, especially signet-ring cell carcinoma, is an uncommon disease, and it is rarely suspected before surgery. Diffuse intestinal ganglioneuromatosis that is not associated with neurofibromatosis-1 or multiple endocrine neoplasia 2b is also rare. The most frequent symptoms caused by it are changes in bowel habits, abdominal pain, and occlusive episodes.Case presentationThe patient was a 48-year-old woman who had a month-long history of chronic abdominal pain, fullness, constipation, and diarrhoea. Enhanced computed tomography showed a 100-mm irregular swelling in the appendix and thickening of the appendiceal wall with cystic dilatation. Based on a preoperative diagnosis of appendiceal cancer, the patient underwent laparoscopic ileocecal resection with D3 lymph node dissection. Pathological diagnosis revealed a signet-ring cell carcinoma of the appendix with ganglioneuromatosis. The patient completed four courses of capecitabine plus oxaliplatin (CAPEOX) as postoperative adjuvant chemotherapy, and 23-month postoperative outcome was noneventful without recurrence.ConclusionWe report a signet-ring cell carcinoma of the appendix that was detected early because of its presence with ganglioneuromatosis.

Abdominal pain caused by epiploic appendagitis

A 39-year-old woman with a body mass index of 25.8 presented to our internal medicine clinic with a 5-day history of left lower quadrant abdominal pain, abdominal fullness and frequent urination. The pain was dull, nonradiating, persistent and exacerbated by urination, walking and laughing, but not

Hepatic Angiosarcoma Post-Renal Transplantation: A Case Report

DNA damage and oncogenic viruses increase the risk of cancer post-kidney transplantation, including skin cancer, Kaposi's sarcoma, oral cancer, and non-Hodgkin lymphoma. Here we report an uncommon case of liver angiosarcoma that occurred 8 years after kidney transplantation. This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor source. A 57-year-old female patient received a cadaver kidney transplantation 8 years ago. She followed a long-term regimen of tacrolimus, mycophenolate sodium, and everolimus, with good renal function. She received annual regular abdominal ultrasound examinations after kidney transplantation, which showed no findings. The patient suffered from several symptoms for approximately 2 weeks before a scheduled abdominal ultrasound: diarrhea, epigastric pain, abdominal fullness, tea-colored urine, and little stool passage. The abdominal computerized tomography showed multiple hepatic tumors in both the hepatic lobes with engorged vasculatures and mild hemoperitoneum. A liver biopsy revealed the histopathology of angiosarcoma. The patient suffered multiple organ failure within one month of treatment. Various post-transplant malignancies are not uncommon after transplantation, warranting periodic screenings for any symptoms in these patients.

Hepatitis with Syncytial Giant Cells in an Elderly Man

Giant cell transformation of hepatocytes is a nonspecific tissue reaction in neonates that is rarely seen outside of infancy. In children, it is particularly striking in cholestatic disorders and is prominent in neonatal hepatitis. In older patients, the presence of numerous hepatocyte giant cells is termed adult or postinfantile giant cell hepatitis (PIGCH) or syncytial giant cell hepatitis. About 25.0% of reported patients with PIGCH remain stable or have a gradual resolution of the disease. Corticosteroid treatment results in improvement in some but not all patients, and in the setting of autoimmune hepatitis, the clinical course may be progressive. We present a rare case of adult giant cell syncytial hepatitis with associated steatosis in a 79-year-old male, who presented with complaints of abdominal fullness, nausea, loss of appetite, and jaundice for the past 1 month.

Dilated sigmoid colon with Chilaiditi's sign mimicking diaphragmatic hernia: A case report.

IntroductionChilaiditi's sign is a rare radiological presentation characterized by colonic interposition between the diaphragm and liver which is usually confused with conditions such as diaphragmatic hernia, pneumoperitoneum and subdiaphragmatic abscess.Case presentationWe report a case of 55 year old male presenting with abdominal pain since a year which was associated with abdominal fullness, loss of appetite and constipation. Further investigations showed us as a case of diaphragmatic hernia but intra operatively it was found to be Dilated sigmoid colon with Chilaiditi's sign.Clinical discussionIt is a rare incidental finding with major preponderance in male. The intestinal, hepatic and diaphragmatic causes predispose its pathology. Conservative management is the first line of treatment but the complicated abdominal pathologies are managed by various surgical intervention.ConclusionDilated sigmoid colon along with Chilaiditi's sign can sometime mimic as Diaphragmatic hernia which can make enormous difference in our pre and post-operative diagnosis. Chilaiditi's syndrome is a rare entity so early diagnosis is of utmost benefit.

A RARE CASE OF A 27-YEAR-OLD FEMALE PRESENTED WITH DUODENAL OBSTRUCTION DUE TO ANNULAR PANCREAS

Background. Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue surrounding the descending portion of the duodenum. It is thought to originate from the incomplete rotation of the ventral pancreatic bud. Objective. To present a case description of a 27-year-old female with duodenal obstruction due to annular pancreas Material and methods. The clinical manifestations, laboratory and instrumental findings of a female patient. Results. We report the case of a 27-year-old female with 3 months history of upper abdominal pain, nausea, postprandial fullness, and recurrent vomiting. Physical examination revealed nothing except for the thin-built body. Routine biochemical and hematological investigations were within normal limits. The patient's standing direct abdominal graphy revealed air-fluid level and dilated both stomach and the first part of duodenum. Upper gastrointestinal series showed circumferential extrinsic compression on the 2nd portion of the duodenum. Abdominal computerized tomography (CT) and ultrasonography (USG) revealed a ring of pancreatic tissue encircling the second part of the duodenum. We present the clinical presentation, treatment plan which is performed through a duodenojejunostomy bypass procedure, and follow-up of the patient. Conclusions. Annular pancreas is associated with duodenal atresia. It usually appears in infancy but might become clinically evident in adulthood with obstruction of the duodenum. The symptoms include constipation, nausea, and vomiting. and usually arise due to obstruction to gastric emptying. In order to confirm the presence of annular pancreas, abdominal CT scans with high resolution and angiography protocols as well as magnetic resonance imaging are helpful.

New Specialized Kombucha-Based Non-alcoholic Pasteurized Beverage Shows Favorable Profile of Short-Term Safety and Tolerability in Patients With Constipation.

ObjectivesKombucha is a globally known beverage, perceived as “healthy”. It may be a basis for the development of new specialized beverages to increase dietary fiber consumption. However, safety and tolerability of the kombucha-based beverages is poorly studied yet. Aim: to assess short-term safety and tolerability of new kombucha-based pasteurized specialized non-alcoholic beverage, enriched with inulin.MethodsThis study (NCT05164861) enrolled subjects with constipation-predominant irritable bowel syndrome (per ROME IV). The subjects were randomized to receive either 220 ml of the non-alcoholic kombucha-based pasteurized beverage (KG), enriched with inulin (1.15 g/100ml) or 220 ml water (control group, CG), for 10 days. Except study product, subjects were advised to follow their usual diet. Organoleptic evaluation of the beverage; assessment of symptoms (abdominal pain/discomfort, abdominal fullness, bloating, heartburn) with the use of 5-point Likert scale; blood chemistry and hematology were performed before (BL) and on the 10th day of study (EOT). Patients were asked to report any adverse events during the study period.ResultsThere were 20 subjects in KG and 20 in CG groups. New specialized food product was well-tolerated, no SAE occurred during the study. No exacerbation of the pre-existing symptoms was observed in KG, including abdominal pain/discomfort (1.28 ± 0.56 vs 1.25 ± 0.56; p > 0.05), abdominal fullness (1.53 ± 0.69 vs 1.22 ± 0.47; p > 0.05), bloating (1.60 ± 0.64 vs 1.37 ± 0.60; p > 0.05), and heartburn (1.28 ± 0.62 vs 1.25 ± 0.52; p > 0.05) during the study. The rate of AEs was low (5%) and did not differ compared to CG. Mean integrative score of organoleptic evaluation of the beverage was good (91.0 ± 13.7%) with non-significant increase at EOT (94.2 ± 6.5%). No laboratory AE were observed.ConclusionsThis study suggest that new specialized kombucha-based drink enriched with inulin is well-tolerated, and has favorable safety profile.Funding SourcesRussian Science Foundation (research grant # 19-76-30,014).

Efficacy of Newly Developed Kombucha-Based Specialized Food Product for Treatment of Constipation-Predominant Irritable Bowel Syndrome

ObjectivesAim: to assess the efficacy of kombucha-based specialized food product, enriched with inulin in patients with constipation-predominant irritable bowel syndrome.MethodsThe study (NCT05164861) was approved by LEC and enrolled subjects with constipation-predominant irritable bowel syndrome (according to ROME IV). The subjects were randomized to receive either 220 ml of a non-alcoholic drink, based on pasteurized kombucha (KG), enriched with inulin (1.15 g/100ml) or 220 ml water (control group, CG), for 10 days. Except study product, subjects were advised to follow their usual diet. Standard examination included evaluation of stool frequency (bowel movements per day), stool form (with the Bristol stool scale) and evaluation of concomitant symptoms (abdominal pain/discomfort, abdominal fullness, bloating, and feeling of incomplete bowel emptying) with the use of 5-point Likert scale before (BL) and 10 days after the start of intervention (EOT).ResultsThe complete data of 40 subjects were available for the analysis. Significant increase of stool frequency was found at the EOT compared to BL in KG (n = 20), Mean ± SD: 0.60 ± 0.31 to 0.85 ± 0.19 times/day; p = 0.004, while there was no change in CG (n = 20): 0.63 ± 0.33 vs 0.72 ± 0.28, p > 0.05. Mean values of stool scale form increased in KG (2.95 ± 1.15 to 4.4 ± 0.97; p = 0.001), while remained unchanged in CG (2.94 ± 1.2 vs 3.4 ± 1.2, p = 0.6). Mean values of the Bristol stool scale in KG and CG differed significantly at EOT (p = 0.018). Significant decrease in mean values of incomplete bowel emptying feeling was found in KG (1.88 ± 0.78 at BL vs 1.41 ± 0.56 points at EOT, p = 0.015), but not in the control group. There was no difference in patient's reports for other symptoms between KG and CG.ConclusionsNew specialized kombucha-based drink enriched with inulin is well-tolerated and increases stool frequency and consistency in patients with constipation-predominant irritable bowel syndrome.Funding SourcesRussian Science Foundation (research grant # 19-76-30,014).

Evaluation of Significant Endoscopic Findings Using Alarm Features of Dyspepsia in Patients Visiting Gastroenterology Department at RIHS Islamabad

Objective: The aim of this study is to analyze significant findings of upper gastrointestinal endoscopy in patients having alarming features of dyspepsia. Study Design: Retrospective study Methodology: This retrospective study was conducted in the Gastroenterology Department at RIHS Islamabad from March 2021 to March 2022 and included adult patients presenting with alarm features and were referred for gastroscopy for dyspepsia. Those ageing below 18 years were excluded. The information including demographic data, referral for the procedure, endoscopic findings and present alarm features and dyspeptic symptoms was recorded. The diagnosis was made on the basis of visual examination. Results: A total of 140 patients who underwent gastroscopic procedures were included in the study. Most of the subjects (74.1%) reported epigastric burning, 10.8% complained of heartburn, 10.8% of regurgitation and 8% reported globus. Few of the participants reported symptoms such as bloating (5.3%), burping (5.3%), abdominal fullness (3.8%), chest pain (3.8%) and early satiety (0.8%). No significant relation was observed between warning signs and findings from the endoscopy. Conclusion: Dyspeptic patients showing alarming signs such as vomiting, dysphagia and upper gastrointestinal bleeding must be prescribed immediate endoscopy. Keywords: Dyspepsia, gastroenterology, endoscopic findings, epigastric burning

Women's awareness of ovarian cancer risk factors and symptoms in Western Iran in 2020–2021

ObjectivesThis study aimed to investigate awareness of women living in the western region of Iran about warning signs and risk factors for ovarian cancer.MethodsThis cross-sectional, descriptive-analytical study was conducted in Sanandaj and Kermanshah, Iran, 2020 and 2021. In this study, 1081 women aged 18–70 years were selected as the sample to fill out the electronic version of the Ovarian Cancer Awareness Measure (OCAM) to identify the significant variables of ovarian cancer warning signs and risk factors. The obtained data were statistically analyzed by descriptive statistics and ordinal logistic regression in SPSS 19.ResultsIn this study, 60.9% of the participants had medium awareness of the subject. The results indicated that participants with higher educational attainment (P < 0.05) and those with a history of cancer (P < 0.001) showed higher knowledge of cancer. The lowest level of awareness of symptoms was associated with acute symptoms such as dysphagia (swallowing problems) most days, persistent bloating, a sense of abdominal fullness or heaviness, and frequent urination. Moreover, the lowest awareness of risk factors was related to the history of IVF treatments and the application of talcum powder to the genital area.ConclusionThe study findings showed that women living in the western region of Iran have moderate awareness of ovarian cancer and insufficient knowledge of cancer warning signs; this suggests that it is necessary to train Iranian women to raise awareness of the signs and risk factors for ovarian cancer.

A Novel Case of Recurrent Mucinous Borderline Ovarian Tumor: Early Relapse and Fatal Outcome

Unlike ovarian carcinomas, borderline ovarian tumors (BOTs) are associated with a favorable prognosis: their recurrence rate is around 5–7%, and the survival rate is more than 97% when diagnosed early. There are only a few reports of recurrence and fatal outcomes. Herein, we report a novel case of recurrent mucinous BOT, with a literature review. A 63-year-old woman presented to a local doctor with abdominal fullness. She was diagnosed as having a polycystic tumor. The lesion was suspected to be a mucinous BOT (M-BOT) on magnetic resonance imaging. Upper and lower gastrointestinal endoscopy revealed no digestive cancerous lesions, and surgery was performed. Intra-operative diagnosis confirmed the diagnosis, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy were performed. The final pathological diagnosis was non-invasive M-BOT (stage I c1 (T1c1N0M0)). The result of immunohistochemical staining supported the diagnosis of primary ovarian mucinous tumor.Four months after surgery, relapse occurred. Blood tests revealed an elevated carbohydrate antigen 19-9 level, and computed tomography revealed multiple liver metastases, peritoneal dissemination, left ureter infiltration, and carcinomatous peritonitis. Although the patient underwent chemotherapy, she died. This case of a very short progression-free and overall survival in stage I M-BOT indicates that some M-BOTs could result in fatal clinical outcomes despite diagnosis at an early stage. Frequent follow-up appointments after surgery could help detect relapse and increase survival in such cases.

MO671: Should We Undergo Peritoneal Dialysis in Malnourished Chronic Kidney Disease Patients?

Abstract BACKGROUND AND AIMS The implementation of peritoneal dialysis (PD) in end-stage renal disease has been associated with various long-term pathophysiologic changes, which result in adverse consequences, such as malnutrition, occurring in 30–50% of patients. Specific factors to PD might be associated with poor oral intake as continuous absorption of glucose from PD solutions and abdominal fullness induced by the dialysate can suppress appetite. There are several accepted strategies for stratifying malnutrition in PD, such as laboratory markers [serum albumin and normalized protein catabolic ratio (nPCR)] and the recent use of bioimpedance spectroscopy (BIS) (with low lean tissue index). We aimed to evaluate if PD patients with a poor nutritional status at the beginning of the technique had worse outcomes (peritonitis, PD failure, hospitalizations, and death). METHOD We studied a cohort of incident patients from a single PD unit between 1 July 2011 and 31 August 2021, who had one BIS measurement and a peritoneal equilibration test in the first 3 months after the start of PD. We also collect laboratory data within 6 months from the BIS evaluation (serum albumin). Besides demographic parameters, we evaluated established endpoints (peritonitis, PD failure, hospitalizations and death). RESULTS There were included 91 PD patients. The mean age of patients was 65.40 $ \pm $ 13.88 years with a median dialysis vintage of 24 (IQR 14–31.61) months; 59.3% were male and 28% had diabetes. During the follow-up period, 5.5% of the cohort died, 56% were hospitalized and 47.3% had at least one episode of peritonitis. Furthermore, the transfer to hemodialysis occurred in 18 cases (19.8%) and 15 (16.5%) received a renal transplant. There was no difference in nutritional markers median in patients that had clinical endpoints versus those who had not (Table 1). In a multivariable analysis, neither nPCR, nor albumin nor lean tissue index were predictors of peritonitis, PD failure or hospital admissions. CONCLUSION In this study, we found that malnourished patients, prevalent in PD, did not have worse clinical endpoints (higher rate of infections, hospital admissions and PD failure). Although adequate nutrition has been deemed vital to the success of PD, this modality of renal replacement therapy did not result in worse outcomes, despite the malnutrition markers at the beginning of PD. Further studies are warranted to evaluate the positive impact of PD in nutrition status.

Endocrine cell micronests in an ovarian mucinous borderline tumor: a potential diagnostic pitfall for microinvasion

The occurrence of endocrine cell micronests in ovarian tumors is rarely reported. To our knowledge, there are only three prior cases reported to date: one occurring in an ovarian mucinous cystadenoma, one in an ovarian mucinous cystadenofibroma, and another in an ovarian mucinous carcinoma with a predominant borderline component. This is a 27-year-old woman that presented with a one-month history of abdominal pain and fullness. Imaging studies revealed a large multiloculated cystic and solid mass measuring 23 cm occupying the majority of the pelvis and abdomen concerning for a primary ovarian malignancy. The patient underwent a right salpingo-oophorectomy with appendectomy. Histologic sections from the ovary showed a multiloculated, cystic and focally solid mass lined by gastrointestinal-type mucinous epithelium with variable degrees of proliferation accounting for greater than 10% of the tumor. In addition to the mucinous epithelial component, there were several foci of bland, monotonous epithelioid cells arranged in solid nests with focal tubular/acinar formation within the fibrous septa and mucinous epithelium. Immunohistochemical studies showed that these cells were positive for cytokeratin, EMA, and synaptophysin, while negative for inhibin. The Ki-67 proliferation index was low (<1%). The presence of endocrine cell nests associated with an ovarian mucinous neoplasm is a rare phenomenon. Whether this represents preservation of endocrine cells in the context of epithelial degeneration or an independent neoplastic component is unclear. Progression related to this endocrine cell proliferation is unlikely and the recognition of this phenomenon holds more diagnostic value than prognostic significance, as it could be confused with microinvasion or sex cord stromal elements.

Solid pseudopapillary neoplasm of pancreas presenting after bicycle handlebar injury: diagnostic pitfalls in a young female-A case report.

Introduction and importanceSolid pseudopapillary neoplasm (SPN) of pancreas is a rare neoplasm with very low malignant potential. It mainly affects females in third decade of life and has favourable prognosis.Case presentationWe report a case where a 17-years old girl presented with history of blunt abdominal trauma with handlebar of bicycle 6 months back, following which she developed abdominal pain and fullness in epigastrium. Keeping pancreatic pseudocyst as provisional diagnosis, she was investigated. The final diagnosis of SPN of pancreas came as a surprise.The mass, about 6x5cm, was excised and Roux-en-Y distal pancreatico-jejunostomy was done.Clinical discussionPatient showed no recurrence or metastasis till one year of follow-up. This is the first case report of SPN presenting after handlebar injury.ConclusionTimely and adequate resection provides good long-term survival.

Colonic tuberculosis masquerading as ascending colon carcinoma in a patient of FIGO Stage IIB cervical carcinoma following chemo-radiotherapy: A case report

Introduction and importanceColonic tuberculosis may masquerade colonic carcinoma. Also, intestinal tuberculosis may mimic colonic carcinoma, Crohn's disease, ulcerative colitis, etc.Case presentationA 40 years female was diagnosed with cervical carcinoma FIGO Stage IIB underwent chemo-radiotherapy. She was symptom-free for a few months and then she developed right-sided abdominal pain and abdominal fullness for 4 months. She underwent a colonoscopy that showed ulcerative growth and friable tissue in hepatic flexure of colon and histopathology and immunohistochemistry findings suggested non-Hodgkin's lymphoma or poorly differentiated carcinoma. Then right standard hemicolectomy was performed and histopathology showed tuberculosis. The patient received medications for tuberculosis and the patient improved.Clinical findings and investigationsPreoperatively suspected colonic carcinoma in developing countries (where the prevalence of tuberculosis is high) may sometimes come out as colonic tuberculosis in histopathology. The biopsy sample taken from colonoscopy was examined by histopathology, which showed nonspecific results, and the case was mistakenly thought of as colonic carcinoma preoperatively.Interventions and outcomesThe case underwent right standard hemicolectomy and to the surprise, the excised specimen came out as tuberculosis. The patient received anti-tubercular drugs and the patient is symptomatically better.Relevance and impactColonic tuberculosis can mimic colonic carcinoma. Histopathology will confirm colonic tuberculosis and response to anti-tuberculosis drugs will verify the diagnosis. Though a patient undergoing chemotherapy may develop lymphoma, colonoscopic biopsy may not be conclusive. In any symptomatic patient with colonic stricture, surgery is the treatment of choice.

A case involving laparoscopic decortication of a large simple renal cyst using conventional monopolar device.

Introduction and importanceSimple renal cysts are common in adults, but most of them are asymptomatic. Usually, percutaneous puncture is an initial treatment, but laparoscopic decortication may be effective for recurrent simple renal cyst. Herein, we report a case in which a large symptomatic simple renal cyst was treated with laparoscopic decortication using conventional monopolar device.Case presentationA 34-year-old female visited our hospital with chief complaints of back pain and abdominal fullness. Computed tomography showed a right simple renal cyst (diameter: 140 mm). We performed percutaneous drainage with sclerotherapy, but the cyst recurred a month later. Thus, we carried out laparoscopic decortication. We opened the cyst wall via a retroperitoneal approach and trimmed it using monopolar scissors. The operation time was 124 min. The patient's postoperative course was uneventful, and no complications were observed. Following surgery, the patient was asymptomatic.Clinical discussionIn our case, we performed operation using a conventional monopolar device without sealing devices. It has been reported that the use of sealing devices can make laparoscopic surgery safer and reduce the operation time, but we herein report that laparoscopic decortication with a conventional monopolar device is an effective and safe treatment option for symptomatic simple renal cysts and that more expensive energy sources are not required.ConclusionWe successfully performed laparoscopic decortication of a large symptomatic simple renal cyst. This operation is minimally invasive and safe.

Efficacy of a Product Containing Xyloglucan and Pea Protein on Intestinal Barrier Function in a Partial Restraint Stress Animal Model.

Functional abdominal bloating and distension (FABD) are common and frequent symptoms in patients with pre-existing gastrointestinal (GI) disorders. FABD is characterized by recurrent abdominal fullness and bloating. The pathophysiology of FABD is still unclear. However, the plausible mechanisms involved are small intestinal bacterial overgrowth (SIBO), imbalance of gut microbiota, visceral hypersensitivity, intestinal permeability alteration, and disruption of intestinal barrier function. Thus, the creation of a barrier on the wall of the intestine could represent an alternative therapeutic strategy to prevent FABD. This study aimed to investigate the effect of two natural substances, Xyloglucan (XG) and Pea-protein (PP), known for their mucosal-protective properties, in an in vivo model of Partial restraint-stress (PRS). Our results showed that the pre-treatment with a product containing XG and PP in stressed-rats was able to reduce the number of abdominal contractions and visceral hypersensitivity. Moreover, XG and PP were able to reduce intestinal permeability alteration, restoring tight-junctions (TJs) expression and decreased the lactulose–mannitol ratio, a quantitative marker used to measure intestinal permeability, compared to PRS-group. In conclusion, the data obtained revealed that the product containing XG and PP was able to restore the normal intestinal-barrier function; therefore, it could be considered a therapeutic strategy to manage FABD.