Abdominal Swelling Research Articles

071. Pantaloon Hernia with Bladder Herniation: A Case Report And Review Of Literature

Background: Pantaloon hernias are a rare mix of direct and indirect inguinal hernias on the same side, making them clinically challenging. Bladder herniation, which can occur with pantaloon hernias, adds specific diagnostic and treatment challenges. Inguinal hernias account for about 75% of all abdominal wall hernias and mostly affect men. Case: A 57-year-old man came to Saiful Anwar Hospital with a left inguinal lump that had been present for six days. He also experienced abdominal swelling, pain, nausea, and vomiting. The lump had become irreducible for the last two days. A physical exam showed a 13x7 cm mass in the left inguinal area. The patient had signs of an inguinal hernia and reported urinary issues, including a feeling of incomplete emptying and urination. Surgery was done on January 13, 2024, using an open technique. During the procedure, the hernia sac had fluid, trapped ileum, and omentum. A part of the bladder was also found protruding through the Inguinal Triangle of Hasselbach, causing a 1x1 cm defect. The hernia sac was repaired with a 10x15 cm mesh. Conclusion: This case highlights the rarity of pantaloon hernias and emphasizes the importance of prompt diagnosis and intervention. Continued research is essential for advancing clinical outcomes and understanding the complexities associated with this condition

Kinetics of viral hemorrhagic septicemia virus (VHSV) and immune response in olive flounder (Paralichthys olivaceus) at altered temperature

Viral hemorrhagic septicemia virus (VHSV) is a pathogen that causes hemorrhagic septicemia in olive flounder at water temperatures below 15 °C, leading to symptoms such as abdominal swelling due to ascites and muscle hemorrhaging, and in severe cases, mortality. In this study, we investigated the proliferation of NCCs, the transcriptional analysis of CD4 and CD8, and the expression of pro-inflammatory cytokines (IL-1β, IL6, TNFα) and the cytokines (IL12, IL15, IFN-1β, IFNγ) involved in cytotoxic cell activation in the kidney of olive flounder during VHSV infection at suboptimal temperature (17 °C) and following a shift to optimal temperature (10 °C). Following viral infection, the population of NCCs and CD8 gene expression steadily increased. Meanwhile, IL12, IL15, and IFN-1β levels exhibited an early surge, reaching their peak within 1–2 days post-challenge at 17 °C. Notably, in olive flounder that were re-challenged with VHSV at 10 °C after an initial challenge at 17 °C, there was a rapid and robust expansion of NCCs and increased CD4 and CD8 gene expression, demonstrating the mounting of immune memory by NCCs and an efficient adaptive immune response from CD4+ and CD8+ T cells against VHSV infection.

Pediatric cancer mortality: Analyzing early deaths and fatalities in a resource-limited tertiary care context.

Children with suspected cancer may succumb to their bad condition shortly after admission, even before a definitive diagnosis can be reached. We aimed to address the issue of delayed presentation and early deaths among children suspected of having cancer. We analyzed also the types and causes of mortalities across different tumor types. A retrospective review of reports from newly admitted patients between 2006 and 2010 at the pediatric oncology department of the South Egypt Cancer Institute (SECI) was done. Parameters included age, gender, diagnosis, symptoms, the interval between initial symptoms and the first visit to SECI, the duration from admission to death, and the cause of death. Among the 502 patients with confirmed malignancies, 238 (47.4%) succumbed. Causes of death were predominantly treatment-related mortalities (TRM) (66%). Mortalities within hematological malignancies were mainly TRM (81%), whereas solid tumors were primarily disease-related (70%), p <0.0001. The leading causes of TRM was infection (60%). About 5% of patients experienced early death within 48 hours after presenting to SECI. The mean duration from initial symptoms to the first SECI visit was 67 days, and the period from admission to death averaged 27 hours. Common initial symptoms included abdominal swelling (29.6%), or fever (26%). The leading causes of death were respiratory failure (29.6%), tumor lysis syndrome (22%), or septicemia (22%). Delayed presentation leading to early deaths poses a significant obstacle to the successful treatment of childhood cancers. Early diagnosis and improved supportive care are essential to enhancing the overall survival, particularly in patients with hematologigical malignancies.

Krukenberg tumour in a 46-year-old black African woman with a background of ovarian fibroma- A case report

BackgroundTumours that metastasize to the ovary can occur in conjunction with other ovarian lesions, including benign sex cord stroma tumours like fibroma or fibrothecoma. This case report presents a unique instance of metastatic signet ring carcinoma involving the ovary in a background of fibroma in a Black African woman.Patient presentationA 46-year-old gravida 3, para 0 (2 alive), patient was referred from the general outpatient clinic to the gynecology clinic due to progressive abdominal swelling over the past eight months. Abdominal examination revealed marked distension with massive ascites. Physical examination of the chest demonstrated dullness to percussion over both lung bases, with increased dullness noted on the right. Auscultation revealed decreased air entry in the right middle and lower lung zones, with normal to increased air entry in the remaining lung fields. Abdominopelvic ultrasound revealed a large irregularly marginated homogeneous solid mass in the right adnexa measuring 16.4 × 11.7 × 12.7 cm. An abdominal CT scan revealed bilateral pleural effusion, which was more pronounced on the right, ascites, and evidence of pulmonary and hepatic metastasis. Serum chemistry revealed abnormal levels of several analytes, including elevated CA 125 at 1,108.8 (normal range 0–35) U/L and CA 19–9 at 63.8 (normal range 0–35) U/L. She subsequently underwent staging laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy, without any postoperative complications. The histologic sections of the right and left ovaries revealed a moderately cellular lesion composed of intersecting bundles of spindle cells in a fascicular and storiform pattern. Additionally, pockets of small round to oval-shaped cells with intracytoplasmic clear vacuoles pushing the nucleus to the periphery (signet ring cells) were identified in a few foci. These cells were initially thought to be ovarian stroma or theca cells. Microscopic examination revealed signet ring cells with cytoplasmic positivity for periodic acid-Schiff (PAS) staining. The histopathological diagnosis was metastatic signet ring cell carcinoma involving the ovary, with an underlying ovarian fibroma.ConclusionsOvarian metastatic signet ring carcinoma in a background of fibroma can pose a significant diagnostic challenge, as signet ring cells can mimic the ovarian stroma or theca cells, especially if they are only observed in a few foci of the sections.

A Case of Abdominal Discomfort for Long Duration

In our regular medical practice, we encounter a lot of patients with abdominal discomfort. Commonly every physician suspects this kind of symptoms as gaseous distension of gastro-intestinal tract or acidity. The most valuable thing is the proper physical examination to rule out any underlying pathology. Most common causes of epigastric pain are associated with gastritis, or hepatobiliary system and pancreas related disorders. Here we will describe a 47-year-old male patient who presented with abdominal discomfort for last 6 months. For last 2 months he developed an epigastric lump which was increasing in size and was associated with weight loss. After proper clinical evaluation and necessary relevant investigations, he was diagnosed having Non-Hodgkin’s Lymphoma (NHL). Non-Hodgkins Lymphoma represents monoclonal proliferation of lymphoid cells. The incidence of these tumors increases with age. Clinically the proliferation rate indicates whether it is a high- or low-grade tumor. The patient underwent some investigations like CT guided FNAC from the enlarged abdominal lymph node which confirmed high grade Non-Hodgkins Lymphoma and started with chemotherapy and responded well. As abdominal discomfort is one of the common complaints, we face during our regular medical practice so routine physical examination including abdominal examination is very crucial and informative for clinical diagnosis and Lymphoma is an important differential diagnosis in case of any abdominal lump. Bangladesh Crit Care J September 2024; 12 (2): 175-178

Identification and characteristics of Plesiomonas shigelloides isolated from Mastacembelus armatus

Plesiomonas shigelloides (P. shigelloides), a dominant pathogenic strain identified as YY001, was successfully isolated and characterized from the hepatopancreas of diseased Mastacembelus armatus (M. armatus) for the first time. The strain was identified through a comprehensive approach that included morphological, physiological, and biochemical characterization, as well as 16S rRNA, 23S rRNA, and gyrB gene sequence analysis. Strain YY001 is classified as a Gram-negative bacterium, with optimal growth conditions observed at 28°C and pH 7.0. Results from the bacterium hemolysis test indicated the absence of hemolytic activity in YY001. However, the strain exhibited amplification of nine virulence genes: nanE, waaA, clpP, ssb, actP, aphA, astA, astD, and astB. Drug-resistance testing showed that YY001 displayed resistance only to penicillin G, oxacillin, norfloxacin, and tetracycline, while remaining sensitive to the majority of other antibiotics. Furthermore, nine drug-resistance genes, including emrD, catB, macB, ksgA, tolC, bacA, MdfA, sul1, and DegP, were detected through amplification. Experimental infection demonstrated that YY001 induced symptoms such as abdominal swelling, visceral edema, and hemorrhage, with hepatopancreatic manifestations being particularly severe. The median lethal dosage of strain YY001 in M. armatus was 9.7×108 colony-forming units (CFU)/mL within 48 h, and 4.9×106 CFU/mL within 192 h under the conditions of intraperitoneal injection. The hepatopancreas, gill, and intestine of infected fish showed obvious pathological symptoms, including tissue loosening, hemorrhage, and cell necrosis. The results of this study provided evidence for a more comprehensive understanding of P. shigelloides strain YY001 infection in M. armatus.

Spontaneous rectus sheath hematoma as a differential diagnosis for localized abdominal swelling in chronic liver disease: A rare case report.

Spontaneous rectus sheath hematoma is a rare complication in chronic liver disease patients. Early clinical suspicion with prompt radiological evaluation is crucial for accurate diagnosis and timely management. Spontaneous rectus sheath hematoma can present as an acute abdomen in the emergency department. The rupture of the upper and lower epigastric arteries and their branches is the main cause of hematoma formation. Hepatic dysfunction can affect the clotting process, increasing the risk of hematoma development. Computed tomography is the preferred diagnostic tool. Most hematomas can be managed conservatively, with only a few requiring minimal intervention or surgical management. We report an uncommon instance of spontaneous rectus sheath hematoma in a patient with chronic liver disease presenting with painful abdominal distention, mimicking a hernia and initially posing a diagnostic challenge. The rectus sheath hematoma was definitively diagnosed through clinical and radiological evaluation and subsequently evacuated with successful outcomes.

Mesenteric Dedifferentiated liposarcoma presenting as a massive abdominal lump: A Rare Case

This case study examines a sixty five-year-old male presenting with a distended abdomen, lower back discomfort, and dyspnea on lying down, progressing over three months. Physical examination revealed multiple hard palpable lumps in the abdomen. Initial radiological evaluation indicated a connective tissue tumor, leading to a trucut biopsy revealing a spindle cell neoplasm of uncertain malignant potential. The tumor was found to be resistant to immunotherapy and neoadjuvant chemotherapy. Surgical resection unveiled multiple mesenteric tumors along the small bowel and also involving the descending colon, diagnosed as a dedifferentiated liposarcoma. Liposarcoma encompasses five histological subtypes, with dedifferentiated being the least common and comprised of poorly differentiated cells. Although liposarcomas typically originate from the retroperitoneum, the occurrence of dedifferentiated liposarcoma in the small bowel mesentery is exceedingly rare. This case report aims to underscore this uncommon occurrence, discuss diagnostic and treatment strategies, and advocate for further research into targeted therapies addressing specific immunohistochemistry markers to enhance outcomes for such patients, who generally face a grim prognosis Keywords – dedifferentiated liposarcoma , mesenteric tumors, spindle cell malignancy, mesenchymal tumors of GIT.

Niemann-Pick Disease: A case report

This case study’s major objective to explore the limitations of treatment and management arisen of having Niemann pick disease, due to poor prognosis or lack of early diagnosis. Mrs. Pinki, 30 years old female patient from Chuadanga, with the complaint of upper abdominal swelling for 6 months, generalized weakness for last 3 months, anorexia &amp; nausea for same duration, came to private chamber somewhere in Bangladesh, on 10th April 2023. She also complained generalized weakness for last 6 months associated with anorexia, nausea for same duration. Bone marrow examination confirmed the possible diagnosis of Niemann pick disease. Until her last follow up report, the patient was alive and clinically sound comparing to her previous condition. However, due to her lower socio-economic condition, she didn’t continue the follow ups and could not able to do Sphingomyelinase enzyme level according to the physician’s advice. Social awareness against consanguineous marriage &amp; adding enzyme estimation facilities can a revolutionary change in reducing the mortality rate of this disease.

Removed: Giant mesenteric cysts: A rare case series with clinical insights

Introduction and significanceMesenteric cysts are rare, non-cancerous tumors found mainly in children. The symptoms can vary depending on the size and location of the cyst. While the exact cause is unknown, complete surgical removal is the main and most effective treatment for mesenteric cysts. Case presentationThree cases involving young boys were presented. They primarily complained of abdominal swelling without pain. Radiological tests revealed mesenteric cysts near the jejunum and transverse colon, and another near the sigmoid colon, which were both successfully removed. Clinical discussionDespite being uncommon, mesenteric cysts should be considered when diagnosing abdominal masses in children. ConclusionSurgical intervention is crucial for patients with mesenteric cysts. Complete surgical removal leads to a positive prognosis, even for large or complex cases. This stresses the importance of considering. Environmental factors are potential causes for the formation and development of these tumors.

Patent urachus with subcutaneous communication and ventral abdominal swelling in a domestic short‐hair cat

AbstractA 3‐month‐old, male, entire, domestic shorthair kitten underwent investigations for stranguria and haematuria, and was diagnosed with a urinary tract infection secondary to a suspected extramural vesicourachal diverticulum. Lower urinary tract signs resolved with a 14‐day course of amoxicillin clavulanate. Three months later, the kitten re‐presented for investigation of acute onset ventral abdominal discomfort and bruising. On presentation, clinical examination revealed omphalitis and subcutaneous bruising, with no evidence of an umbilical stoma. Ultrasonography demonstrated a patent urachus communicating with the subcutaneous tissue space, resulting in accumulation of urine at the level of the umbilicus. A ventral midline coeliotomy was performed to allow resection of the urachal remnant, including a partial cystectomy. The cat was urinating normally within 10 hours postoperatively, and the wound healed without complication. No postoperative complications or recurrent lower urinary tract signs were reported at follow‐up (312 days).

Dual Heterotropic Tissue Associated with a Type IV A Choledochal Cyst: A Rare Case Report

Abstract A choledochal cyst (CC) is one of the rare congenital diseases of the biliary tract and is more common in females. The association of ectopic pancreatic and splenic tissue with CC is an extremely rare condition. An 11-year-old girl child presented with a vague abdominal lump and intermittent dull abdominal pain for 5 months with early satiety and weight loss in the current case scenario. Her laboratory findings were normal. A type IV CC was discovered on ultrasonography, and the distal common bile duct displayed significant cystic dilatation on magnetic resonant cholangiopancreatography. After the CC was surgically removed, it was sent for histopathological examination. Sections revealed dual heterotropic elements, which included pancreatic and splenic tissues in a CC. It was very uncommon for both to exist independently in the CC and in this instance, both were observed together. This will be the first documented case, in which the CC contained dual ectopic tissue from the spleen and pancreas. Ectopic splenic tissue in the CC has never been documented in the literature. It is crucial to be aware of this entity when splenic or pancreatic tissue experiences changes due to inflammation, even though its clinical significance is uncertain. In the ectopic rests, bleeding, blockage, and malignant transformation are the possible outcomes.

Anti‐synthetase syndrome complicated by multifocal tuberculosis: A thought‐provoking differential diagnosis with tumors

AbstractMycobacterium tuberculosis, which mainly affects the lungs but can also invade other systems, presents a diagnostic challenge when co‐existing with autoimmune disease. We report a case of 31‐year‐old Asian woman with anti‐synthetase syndrome who developed abdominal and subcutaneous lumps during treatment, along with elevated tumor markers, raising suspicion of malignancy. Pathological examination revealed M. tuberculosis infection, changing the diagnosis to multifocal extrapulmonary tuberculosis. This case highlights the need for prompt and detailed evaluations, and the importance of broad differential diagnosis.

Hepatoblastoma: A Case Report

Hepatoblastoma is a rare type of pediatric malignant disease and represents the most frequent cause of liver tumors during childhood. We describe the diagnosis and treatment of a 14-month-old female patient who presented with abdominal swelling, anorexia, and weight loss. Initial investigations indicated elevated alpha-fetoprotein levels and thrombocytosis. A CT scan showed a heterogeneous mass arising in the right lobe of the liver. Histology revealed hepatoblastoma, epithelial type, and fetal pattern. The patient was treated as a standard risk according to the Pretext classification (Pretext I-III) with neoadjuvant Cisplatin (4 cycles) following the SIOPEL 3 protocol, resulting in a 40% reduction in tumor size and a successful partial hepatectomy.

Minimally Invasive Stapled Abdominal Wall Repair: A New Surgical Technique.

Background: Diastasis recti (DR) is a common condition, especially in women after pregnancy, often associated with concomitant hernia defects and defined as a rupture of the midline and a separation of the rectus muscle more than 2 cm. Symptoms related to this are low back pain, urinary incontinence and pelvic prolapse, as well as abdominal bulging and core instability. We analyzed clinical and functional outcomes after treatment of DR alone or associated with midline hernias in 219 patients who underwent a midline reconstruction using miSAR® technique (minimally invasive stapled abdominal wall reconstruction). Methods: Between April 2019 and April 2022, 219 patients were treated with miSAR®. All patients were requested to quantify preoperative and postoperative functional symptoms (urinary incontinence, low back pain, abdominal swelling, and respiratory distress). Results: Twenty-seven men and 192 women underwent the miSAR® technique. The mean body mass index was 23.9 kg/m2. We performed the miSAR® technique in patients affected by incisional midline hernia and umbilical hernia alone or associated with DR. Composite mesh was used in 91.8% of cases. The average operating time was 90 minutes. Seven percent of the patients had postoperative complications, including two retromuscular hematomas, two retromuscular seromas, and one postoperative bleeding event. Two patients were readmitted for bowel obstruction. After surgery, there was symptomatic improvement in urinary incontinence, low back pain, respiratory symptoms, and abdominal swelling; this improvement was confirmed at 6 months and at 1- and 2-year follow-up. At the 1-year follow-up, the overall recurrence rate was 2.83%. Conclusion: miSAR® is a feasible and effective technique and shows promising results in the treatment of DR and ventral hernia. Possible enhancements include use of preoperative Botox to treat defects larger than 6 cm. Multicentric analysis is needed to validate the technique, and longer follow-up is required to assess the recurrence rate.

An unusual initial presentation of colorectal cancer: abdominal wall and scrotal abscess associated with right ventricular metastasisAn unusual initial presentation of colorectal cancer: abdominal wall and scrotal abscess associated with right ventricular metastasis

A 56-year-old man presented to the emergency department with a painful abdominal lump with redness of the overlying skin in the right iliac fossa, swelling, and redness of the scrotum. Laboratory tests revealed a marked increase in white blood cell count (50.73x109/L), neutrophil count (48.18x109/L), and C-reactive protein levels (37.36 mg/dL). Abdominal contrast-enhanced Computed Tomography (CT) scan showed a voluminous neoplastic lesion involving the ascending colon, the cecum, and the last ileal loop, which was in communication with a large abscess located in the anterior abdominal wall and extended craniocaudal up to the right scrotum; a mass within the right ventricle was also seen. The patient underwent a right hemicolectomy and a right orchiectomy. Histological examination revealed a low-grade mucinous adenocarcinoma of the right colon as well as a significant abscess of the right testis' tunica vaginalis. The patient died one month after surgery.

Enormous ectopic liver tissue at the gastrohepatic ligament: a rare entity at Muhimbili National Hospital, Tanzania

BackgroundEctopic liver tissue (ELT) is a developmental abnormality in which liver tissue develops at an extrahepatic site without connection to the true liver. It is a rare entity with an incidence of 0.24–0.56% according to data described in laparoscopic or autopsy studies. The detailed mechanism behind the development of ELT is poorly understood. ELT predominantly has an asymptomatic nature, even by means of radiological studies the diagnosis of ELT without surgery or autopsy is difficult. ELT has been reported mostly to be found frequently on the gallbladder and rarely on the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Due to its variations anatomically, ELT recognition should gain clinical importance and surgeons need to be aware of these possible disparities.Case presentation.We present a 59-year-old female from Western Tanzania was presented to us with 2-month history of painless upper abdominal swelling. An abdominal CT scan was performed, and it revealed a large mass located at the gastrohepatic region with blood supply mainly from the left hepatic artery and omentum. Technically difficult excision of 17 × 12 cm tumor at gastrohepatic ligament was performed, with uneventful recovery. Post-operative histology results revealed capsulated hepatic parenchyma without the biliary components and limited sinusoids with tissue degeneration. To date, no complications happened during follow-up for one year.ConclusionELT is a rare entity with a predominantly asymptomatic nature. Preoperatively diagnosis is difficult even with images. It has anatomical variation and is hardly found along the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Increased awareness of this congenital anomaly may result in increased detection rates.

A Case Report on Peritoneal Tuberculosis in an Immunocompromised Patient

Background: Peritoneal tuberculosis (PTB) is one of the most challenging forms of extra pulmonary tuberculosis. Abdominal TB cases make up above 3% of all extra pulmonary TB as per the Index TB Guidelines. PTB is commonly due to reactivation of latent tuberculosis in the peritoneum. Numerous cases were still misdiagnosed due to nonspecific presentation. The golden standard for diagnosis is laparoscopic biopsy. Presenting signs and symptoms of PTB are unspecific such as ascites, abdominal pain and distension, fever, weight loss, diarrhea/constipation. Peritoneal tuberculosis is a significant cause of ascites in developing countries. The causative agent of peritoneal tuberculosis is Mycobacterium tuberculosis. Case Presentation: In this case study, a 52 year old male had complaints of progressive abdominal distension and fever for 2 weeks. Patient underwent diagnostic paracentesis, upper and lower GI endoscopy, biopsy and gene xpert to confirm peritoneal tuberculosis. Patient with peritoneal TB have gradually progressive abdominal swelling due to ascites and abdominal pain. Conclusion: Peritoneal tuberculosis should be considered in differential diagnosis. Differential diagnosis, especially in the developing countries or under developed countries. This case highlights the easy diagnosis of the condition other than the other case reports.

The Barrier Disruption and Pyroptosis of Intestinal Epithelial Cells Caused by Perfringolysin O (PFO) from Clostridium perfringens.

Clostridium perfringens (C. perfringens), a Gram-positive bacterium, produces a variety of toxins and extracellular enzymes that can lead to disease in both humans and animals. Common symptoms include abdominal swelling, diarrhea, and intestinal inflammation. Severe cases can result in complications like intestinal hemorrhage, edema, and even death. The primary toxins contributing to morbidity in C. perfringens-infected intestines are CPA, CPB, CPB2, CPE, and PFO. Amongst these, CPB, CPB2, and CPE are implicated in apoptosis development, while CPA is associated with cell death, increased intracellular ROS levels, and the release of the inflammatory factor IL-18. However, the exact mechanism by which PFO toxins exert their effects in the infected gut is still unidentified. This study demonstrates that a C. perfringens PFO toxin infection disrupts the intestinal epithelial barrier function through in vitro and in vivo models. This study emphasizes the notable influence of PFO toxins on intestinal barrier integrity in the context of C. perfringens infections. It reveals that PFO toxins increase ROS production by causing mitochondrial damage, triggering pyroptosis in IPEC-J2 cells, and consequently resulting in compromised intestinal barrier function. These results offer a scientific foundation for developing preventive and therapeutic approaches against C. perfringens infections.

Splenic Abscesses in the Pediatric Population: A Literature Review of an Uncommon Entity.

Splenic abscess in the pediatric population is a rare but serious condition. Its incidence is reported to be between 0.05% and 0.7%. Splenic abscess is an infectious suppurative process with a discernible macroscopic filling defect in the subcapsular space or spleen parenchyma. Causes include bacterial infection through the hematogenous route or from locoregional spread such as the gastrointestinal tract, septic emboli, trauma, sickle cell anemia, and malarial infestation. Diagnosis is often delayed due to non-specific signs and symptoms. Symptoms include fever, abdominal pain, and palpable left upper abdominal swelling. Ultrasound and cross-sectional imaging such as CT scans are useful for the diagnosis of splenic abscess but contrast-enhanced CT scans are considered the gold standard because of their high sensitivity and specificity. Treatment options range from antimicrobial therapy, percutaneous drainage, and aspiration to surgical interventions such as splenectomy. As it has a high mortality rate, prompt diagnosis and appropriate treatment are essential for optimal outcomes.