Abdominal Swelling Research Articles

VARIOUS PRESENTATION OF HYDATID CYST IN ADULT POPULATION: A CASE SERIES FROM TERTIARY CARE HOSPITAL IN CENTRAL INDIA.

Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Liver and lungs being the most commonly affected organs whereas splenic infection is rarer and its primary involvement occurs in less than 2% of abdominal Cystic echinococcosis. The clinical spectrum of hepatic hydatid cyst as well as splenic hydatid cyst may include abdominal lump with vague dull aching pain, postprandial fullness, retrosternal burn, nausea, vomiting with fever. Usually patient has history of dogs, cattle as well as goats as their pet animals. Sero-diagnosis plays a pivotal role in evaluation of abdominal lump which may later reveal itself as hepatic, splenic or hepato-splenic hydatid cyst. Here, we present different cases of hepatic and splenic hydatid cyst for which a combination of haematological as well as abdominal ultrasonography and computed tomography (CT) were used for preoperative diagnosis

Diagnosis of primary biliary melanoma with distinct imaging features: a case report and literature review

Primary biliary melanoma arises from proliferating melanocytes in the mucosal surface of the bile duct and is extremely rare. Since the vast majority of biliary melanomas represent metastases of cutaneous origin, accurate preoperative diagnosis of melanoma and exclusion of other primary sources are vital in cases involving primary lesions. Although melanomas with pigmented cells have typical signal characteristics, obtaining a non-invasive pre-treatment diagnosis remains difficult, due to their low incidence. Here, the case of a 61-year-old male Asian patient who presented with upper quadrant abdominal pain, swelling and jaundice for 2 weeks, and who was diagnosed with primary biliary melanoma following extensive preoperative blood analyses, computed tomography (CT) and magnetic resonance imaging (MRI), is described. Post-resection immunohistochemistry confirmed the diagnosis and the patient received six chemotherapy cycles of temozolomide and cisplatin, however, progression of multiple liver metastases was observed at the 18-month follow-up CT. The patient continued with pembrolizumab and died 17 months later. The present case of primary biliary melanoma is the first reported diagnosis based on typical MRI features and the exhaustive exclusion of a separate primary origin.

Wilms tumour in a 5 Year Old Child –A Case Report

Abdominal lump in a child is a common and worrisome clinical presentation which necessitates many radiological and hematological investigations for diagnosis. Though differential diagnoses are many, detailed history taking and thorough clinical examination can help in diagnosing the organ involved before doing investigations. We are presenting a case of Stage 2 Wilms tumour in a 5 year old child presented with abdominal lump and pallor.

Large benign cystic teratoma of the ovary: a case report

Cystic teratoma is the most common ovarian germ cell tumour. It is made up of ectoderm, mesoderm, and endoderm that eventually become hair, muscle, teeth, or bone. These tumors are usually benign. A 30-year-old para 6+0 with 2 living children, presented to the gynaecological clinic of the Federal Medical Centre, Yenagoa with complaints of abdominal swelling of four-year duration. Physical examination revealed a young woman, in no obvious distress. Her abdomen was uniformly enlarged, moved with respiration and non-tender, smooth, firm, mobile in two planes and not attached to underlying structures or overlying skin. It was dull to percussion, and there was ascites demonstrable by fluid thrill. Report of abdominopelvic ultrasound scan revealed a huge cystic mass arising from the right adnexae, and extending into the abdomen. She subsequently had right ovarian cystectomy, and was discharged home on the 3rd day post-operation. Histopathology report revealed a diagnosis of benign cystic teratoma. She is presently on follow-up. Ovarian cyst is commoner among the women of reproductive age-group. Routine pelvic examination is advised to enable early detection and prompt management of this condition. Prognosis is usually good when the cyst is benign.

Non-Hodgkin’s Gastric Lymphoma: Case Report

More than 95% of gastric lymphomas are Non-Hodgkin’s lymphoma. It is very difficult to distinguish primary gastric lymphoma from secondary stomach dissemination. Here we reported a case of high-grade B cell type Non-Hodgkin’s gastric lymphoma. The patient presented with upper abdominal swelling associated with anorexia, vomiting, and weight loss. He was hemodynamically unstable and needed ICU support. But before starting R-CHOP chemotherapy he was expired. The diagnosis of gastric lymphoma can be delayed for many years due to the presence of nonspecific symptoms. High-grade Non-Hodgkin’s lymphoma is very aggressive, but treatment response is better than low-grade lymphoma. Here we suggest early diagnosis and management of high-grade Non-Hodgkin’s gastric lymphoma to save the patient’s life.

Malignant rhabdoid tumour of liver: Conundrum on ascitic fluid

Ascitic fluid analysis is an important tool for diagnosis and staging. Cytological analysis is routinely done as a part of workup for ascites. This is challenging in paediatric malignancies where multiple differentials need to be considered at times with limited cellularity. We present a case of malignant rhabdoid tumour of liver in a young child presenting with abdominal lump and ascites. The diagnosis was offered on ascitic fluid cytology based on cytomorphology, supporting immunohistochemistry and later confirmed on biopsy. This report briefly discusses its differentials and approach to diagnosis.

The relationship between fermentable carbohydrates and post-prandial bowel symptoms in patients with functional bowel disorders.

A low fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (FODMAP) diet alleviates symptoms of irritable bowel syndrome (IBS). We aimed to investigate the relationship between habitual FODMAP intake and post-prandial bowel symptoms in adults with IBS, functional diarrhoea (FD), or constipation (FD) (functional bowel disorders), and in healthy adults (controls). 292 participants (173 with functional bowel disorders and 119 controls) completed a food and symptom times diary. Estimated meal portion sizes were entered into the Monash FODMAP Calculator to analyse FODMAP content. Wilcoxon and ANOVA tests were used to investigate the relationship between FODMAP intake and post-prandial bowel symptoms. IBS participants experienced more post-prandial bowel symptoms compared to participants with other functional bowel disorders or controls. Meals associated with abdominal pain contained on average increased excess fructose (0.31 g vs. 0.18 g, p < 0.05), sorbitol (0.27 g vs. 0.10 g, p < 0.01), and total FODMAP (3.46 g vs. 2.96 g, p < 0.05) compared to meals not associated with pain. Abdominal swelling was associated with increased sorbitol (0.33 g vs. 0.11 g, p < 0.01), and total FODMAP (3.26 g vs. 3.02 g, p < 0.05) consumption. Abdominal bloating was associated with increased galacto oligosaccharide consumption (0.18 g vs. 0.14 g, p < 0.05). These findings support the role of FODMAP in post-prandial bowel symptom onset, however, the amount and type of FODMAP triggering symptoms vary between individuals. Future research should investigate the relationship between the effect of individual FODMAP consumption on post-prandial bowel symptoms for each subtype, the interaction of FODMAP with differing functional bowel disorders and whether longitudinally symptoms and dietary intake are stable.

Health-related quality of life (HRQoL) impact of lenvatinib (len) plus pembrolizumab (pembro) versus len plus placebo (pbo) as first-line (1L) therapy for advanced hepatocellular carcinoma (aHCC): Phase 3 LEAP-002 study.

506 Background: In LEAP-002 (NCT03713593), len + pembro achieved a median OS of 21.2 mo vs 19.0 mo with len + pbo with manageable safety in both arms in 1L aHCC, although the significance thresholds for OS and PFS were not met. We present here the results of prespecified exploratory patient (pt)-reported outcomes (PROs). Methods: 794 pts were randomized. PROs were assessed by EORTC QLQ-C30, EuroQol-5D5L (EQ5D-5L), and EORTC QLQ-HCC18 questionnaires. Analysis population for HRQoL endpoints included pts who received ≥1 dose of study Tx and completed ≥1 HRQoL assessment. Least squares mean (LSM) score changes from baseline (BL) to wk 27 were compared using a constrained longitudinal data analysis model (covariates: Tx, time, Tx by time interaction, and stratification factors). Kaplan-Meier method was used to estimate time to deterioration (TTD, time to 1st onset of ≥10 [out of 100] deterioration from BL in a given scale or subscale/confirmed by a 2nd adjacent ≥10 deterioration from BL) for EORTC QLQ-C30 global health status (GHS)/QoL, physical functioning (PF), and EORTC QLQ-HCC18 abdominal swelling, pain and fatigue, as reported by pts. Stratified Cox proportional hazards model was used to assess the magnitude of the Tx difference (HR) between arms in TTD. Results: Compliance with PRO assessments was &gt;91% from BL until wk 27 in both arms. From BL to wk 27, LSM changes in GHS/QoL, PF, role functioning (RF), QLQ-HCC18 functional/domain scores and EQ5D-5L VAS were generally similar between the two arms (Table). Treatment with len + pembro delayed deterioration of patient-reported quality of life vs len + pbo (median TTD, 11.5 vs 4.3 mo; HR, 0.80; 95% CI, 0.65-0.98). LSM score difference (95% CI) was 0.5 (-2.5, 3.4) for GHS/QoL, -1.7 (-4.5, 1.1) for PF, -1.0 (-4.9, 2.9) for RF, 1.0 (-2.2, 4.3) for abdominal swelling, 2.0 (-1.2, 5.2) for fatigue, 2.0 (-1.0, 5.0) for pain, and 0.6 (-2.0, 3.2) for EQ5D-5L VAS. Median TTD in QLQ-C30 PF (5.7 vs 9.1 mo; HR, 1.14; 95% CI, 0.93-1.41) and QLQ-HCC18 abdominal swelling (NR vs NR; HR, 1.19; 95% CI, 0.89-1.60) /fatigue (2.9 vs 2.8 mo; HR, 0.98; 95% CI, 0.81-1.19)/pain (9.6 vs 7.9 mo; HR, 0.93; 95% CI, 0.75-1.16) was similar between the arms. Conclusions: Len + pembro generally preserved HRQoL vs len + pbo in 1L for aHCC. Combined with efficacy and safety results from LEAP-002, these findings support continued development of len + pembro in HCC. Clinical trial information: NCT03713593 . [Table: see text]

Emergency room visits by patients with HAE based on data from the Canadian 2020 national survey

Introduction: Hereditary angioedema (HAE) is a genetic disorder resulting in low or dysfunctional C1 inhibitor (C1-INH): Type 1/2 HAE and/or dysregulation of bradykinin production: HAE with normal C1INH (HAEnC1-INH). HAE is characterized by recurring, painful swelling occurring in any part of the body. Laryngeal swelling can be fatal and abdominal swelling is very painful. Consequently, HAE patients often require emergency room (ER) visits.

CLEAR CELL LEIOMYOSARCOMA OF THE ANTERIOR ABDOMEN -A RARE CASE PRESENTATION

Leiomyosarcoma is a rare type of malignant smooth muscle tumor. It accounts for around 10-20% of soft tissue sarcomas. We report a case of Leiomyosarcoma with clear cell change in a 62 years old male, who had complaints of anterior abdominal swelling for the last one year. On local abdominal examination, the swelling was diffuse, 10x3cm in size, firm and non-tender and appeared to arise from the anterior abdominal wall. On ultrasonography a heterogenous mass of 10x4 cm was found. Computed tomography scan showed a mass of size 10x4x2 cm in the anterior abdominal wall infiltrating into the fat spaces. He was diagnosed as a case of leiomyosarcoma with clear cell change on the basis of histopathological examination of the excisional biopsy.

Euphorbia neriifolia (Indian Spurge Tree): A Plant of Multiple Biological and Pharmacological Activities

Although India has a well-established and growing economy surrounding synthetic drug chemistry with an antibiotic base, a large part of the population, especially in forested villages and tribal belts, is relying solely on plant-derived drugs. This is due to a lower number of side effects, low chances of resistance development against pathogenic microorganisms, as well as the diversity and affordability of such drugs. In the Indian subcontinents, Euphorbia neriifolia Linn. (EN) is one of the valuable plants from the big family of Euphorbiaceae, which is usually found in rocky and hilly areas. E. neriifolia was found to be useful in curing tumors, abdominal swelling, bronchial infection, hydrophobia, earache, cough and cold, asthma, leprosy, gonorrhea, spleen enlargement, leucoderma, snake bites, scorpion stings, and causing appetite improvement, etc. Different in vitro and in vivo experimental studies were performed to determine the antioxidant, anti-diabetic, immunomodulatory, anti-inflammatory, anti-arthritic, wound healing, anti-atherosclerosis, radioprotective, anti-anxiety, anti-convulsant, anti-psychotic, anti-thrombotic, dermal irritation, hemolytic, analgesic, anti-fertility, diuretic, anti-microbial, anti-diarrheal, and anti-carcinogenic activities of the various parts of EN. Several bioactive compounds, such as euphol, nerifoliol, taraxerol, euphonerins A–G, lectin, etc., were isolated from E. neriifolia and need to be investigated further for various biological activities (cardiovascular and neuronal diseases). In the pharmaceutical sector, E. neriifolia was selected for the development of new drugs due to its broad pharmacological activities. Therefore, in the present review, distribution, classification, morphological and microscopical description, phytochemical investigation, pharmacological activities, medicinal uses, harmful effects, and their treatment were evaluated, especially against different lifestyle-related diseases.

Delayed prosthetic seroma: a localized inflammatory response to COVID vaccination and infection?

We present a patient whom we believe developed a late abdominal mesh collection in response to COVID-19 mRNA vaccination booster and COVID-19 infection. A polypropylene mesh was placed during her right breast reconstruction operation 2years ago where she underwent a right transverse abdominis rectus muscle (TRAM) free flap. She recovered uneventfully from this operation. This lady, though vaccinated, developed respiratory symptoms and tested positive for COVID-19 infection 3days after her booster injection. She then noticed right-sided abdominal swelling 3days after the onset of respiratory symptoms. She only presented 1month later due to a 7-day history of pain at the site of abdominal swelling. A computed tomography scan confirmed the presence of a seroma, and she underwent ultrasound-guided percutaneous drainage. A COVID Antigen Rapid Test of the fluid returned positive, though the PCR swab returned negative. There have been no published reports of periprosthetic mesh seroma after COVID-19 vaccination or infection to date. We wanted to share our experience so that other surgeons may be aware of this potential presentation given the current ongoing pandemic. Level of evidence: Level V, risk/prognostic.

Multiple leiomyosarcomatous lesions arising from the mesentery in a young female: An unusual rare case presentation

Rationale: Primary mesenteric leiomyosarcoma is a very rare finding. It is seen predominantly in the seventh decade and is very rare in the young. Fine needle aspiration cytology is the initial diagnostic procedure in soft tissue lesions, followed by excision biopsy. Patient Concerns: Herein, we present a rare case of primary multiple mesenteric leiomyosarcoma in a 19 year old female, who presented with abdominal lump and pain since the last 4 months. Diagnosis: CT scan of abdomen showed multiple large multiloculated masses in the sub-hepatic space and sub-diaphragmatic region, which seemed to be arising from the mesentery. The uterus and cervix were normal. Fine needle aspiration cytology of the mass revealed fascicles of spindled cells with elongated, blunt ended fusiform nuclei admixed with dispersed cells or stripped nuclei. Some cells showed pleomorphism with occasional intranuclear vacuoles. Grossly the resected specimen was multiple nodular, brown, soft to firm, with the largest measuring 8.5x8x2.5 cm and the smallest 2.2x2.2x1 cm in size. On microscopic examination, sections showed fascicular pattern of atypical spindle cells having cigar shaped nuclei showing pleomorphism and eosinophilic fibrillary cytoplasm with 1-2 mitotic figures/10HPF. Immunohistochemistry with SMA showed strong diffuse cytoplasmic positivity and desmin showed mild focal cytoplasmic positivity in the tumor cells. A diagnosis consistent with primary multiple mesenteric leiomyosarcoma was given. Interventions: Wide surgical excision of the mass lesion was performed. The patient was subsequently administered 6 cycles of 5- Fluorouracil based chemotherapy. Outcomes: She is recovering well after 2 month of follow up period. Lessons: Our case will widen the vision of both physicians and pathologists to consider the possibility of primary mesenteric leiomyosarcoma in young females, presenting without any involvement of female genital tract, thus guide in the proper diagnosis and management of such lesions.

Giant gastric bezoar: A case report and the review of literature

ABSTRACT A bezoar is a packed collection of undigested or partially digested food found in the gastrointestinal (GI) tract. The stomach is the most common site of bezoars and bezoars are most commonly found in the stomach and can affect people of any age or gender. Patients with behavioral disorders, abnormal gastric emptying, altered GI motility as in diabetes disorders are predisposed to the formation of gastric bezoars. The majority of gastric bezoars are asymptomatic, whereas others require treatment in the form of endoscopic or surgical removal. Gastric bezoar can occasionally result in serious complications such as gastric outlet obstruction, bleeding, and perforation. As a result, early detection and treatment are critical to avoid potentially serious complications. We report an extremely rare case of giant gastric trichobezoar in a young female that was timely and successfully managed surgically. A 25-year-old female presented with symptoms of repetitive nausea and vomiting, especially postmeals, early satiety, intermittent abdominal pain, weight loss, and abdominal lump. An abdomen examination revealed a mass in the epigastric region extending to the right hypochondrium of 20 cm × 14 cm, firm to hard in consistency with a palpable inferior margin. Ultrasonography and contrast-enhanced tomography scan abdomen confirmed the diagnosis of gastric bezoar. The patient was prepared and Elective OT was done with the removal of a large gastric trichobezoar measuring 24 cm × 16 cm and weighing 1865 g. Gastrostomy closure was done in two layers and the postoperative period was uneventful. The patient is doing well and is on regular follow-up.

Determination of quality standards and evaluation of In vitro Antibacterial activity of Kanchanara Guggulu: An ayurvedic formulation

Introduction: Ayurveda is one of the most renowned Indian traditional health-care systems and has been adopted globally in recent decades. In Ayurveda Kanchanara guggulu (KG) tablet is one of the Indian traditional medicines used in the treatment of various indications such as tonsilitis, cyst, abdominal lump, and fistula-in-ano. Methods: In the present study, KG tablet was prepared and standardized on basis of physical, physico-chemical properties, high-performance thin-layer chromatography (HPTLC) fingerprint, and phytochemical analysis. Heavy metal test of lead, arsenic, mercury, and cadmium was carried out to confirm the permissible limit as per the AYUSH and WHO standards. The antibacterial activity of the KG tablet was evaluated on two human pathogenic bacteria Escherichia coli and Staphylococcus aureus. Results: The heavy metal limit was found below the limit of quantification and within the allowable limit as per the AYUSH and WHO standards. The tablet showed comparable antimicrobial activity against both strains. The tablets were found to be having satisfactory quality parameters such as hardness, disintegration test, and friability values as per the pharmacopeia standards. Conclusion: The tested parameters based on the present study can be used as a reference approach for quality control of KG formulation. The HPTLC study was found to be an effective tool for quality control of herbal formulation to check the inter-batch batch consistency of the formulation. The antimicrobial activity against human pathogens substantiates its traditional uses.

Wilson’s Disease with Late Hepatic Involvement

Wilson’s Disease (WD) is an autosomal recessive condition that affects copper metabolism and manifests itself clinically in different ways. The diagnosis is indicated by low serum copper and ceruloplasmin concentrations, increased urine copper excretion and/ or increased hepatic copper concentrations. The present case report is about a 55-year-old male with chief complaints of loss of appetite, abdominal swelling, tremors in hand and head, slurring of speech for 10 days. Ultrasound (USG) findings were suggestive of liver cirrhosis with portal hypertension and liver function tests were also deranged. He was prescribed diuretics and asked to review after 10 days. Kayser-Fleischer ring was observed through slit lamp examination in both the eyes, which is a hallmark of WD. The Magnetic Resonance Imaging (MRI) of brain also revealed positive findings-hyperintensity throughout the mesencephalon for WD. Thereafter, the patient was treated with penicillamine and his symptoms improved after few days

Abdominal Hernia in a Common Mynah (Acridotheres tristis) Associated With Hepatic Lipidosis and Concurrent Respiratory Aspergillosis

Hepatic lipidosis and hernia are problems that can occur in pet birds due to different causes. Aspergillosis is also an important disease of pet birds. This article reports an interesting case which, to our knowledge, is the first one in Iran. A 7-year-old male common mynah was presented to the clinic of avian diseases at the University of Tehran, Tehran City, Iran, with a history of severe dyspnea, anorexia, feeding with a high-energy diet, and recently been in the northern parts of Iran. Unfortunately, the bird died. Necropsy was done to diagnose the cause of death. Tissue samples from abdominal viscera, lungs, and air sacs were collected and fixed in 10% buffered formalin and stained with hematoxylin and eosin. Bacterial cultures from the liver and bone marrow were performed on blood and MacConkey agars. In the external carcass examination, the abdominal swelling, hernia, and yellow discoloration under the skin were obvious. At necropsy, the liver was enlarged with yellowish discoloration. There was also a high amount of fat around the abdominal viscera. Microscopically, fatty change, hepatocellular necrosis, and hemorrhages were seen in the liver. There were also vegetative forms of Aspergillus on the lung’s parenchyma and air sacs. No bacterial growth was observed. Pet birds are usually restricted to a cage by minimal contact with other birds; thus, diseases related to management are common among these birds. So keeping in suitable conditions with an appropriate, balanced diet is important for their health.

A rare case of extremely large mature ovarian cystic teratoma

Mature ovarian cystic teratoma, also known as the dermoid cyst, is one of the most common benign ovarian neoplasms that can occur in different age groups and could appear in various sizes. Diagnosing this problem as soon as possible is essential due to complications that can coincide, such as torsion, rupture, internal hemorrhage and malignant transformation. In this article, we reported a 66-year-old female patient with a single huge mature ovarian cyst teratoma who presented to the surgical ward with abdominal pain and swelling but did not see any doctor during that period and disregarded her problems for 4 years.

Diagnostic Challenge in A Young Male Patient Presenting with Feeling of Upper Abdominal Lump and Recent Onset Black Tarry Stool

Diagnostic Challenge in A Young Male Patient Presenting with Feeling of Upper Abdominal Lump and Recent Onset Black Tarry Stool

Simple hepatic cyst presenting as huge abdominal lump in a newborn baby: A rare case report

Simple hepatic cyst presenting as huge abdominal lump in a newborn baby: A rare case report