Cause Of Abdominal Discomfort Research Articles

Lymphangioma of small bowel in adults: A rare cause of abdominal symptoms

BackgroundLymphangioma is unusual malformation of the lymphatic system and rarely occurred in adults below diaphragm. Lymphangioma in small intestine sometimes caused unspecific symptoms and even bleeding, however, this area was most difficult for endoscopic examination and worth investigation. MethodsFrom 1999 to 2019, we retrospectively collected eighteen adult patients with the pathological diagnosis of lymphangioma from duodenum to terminal ileum. The clinical symptoms, origin site, predisposing factor, pre-operative image surveillance, surgical intervention, histopathological findings, follow-up period, and outcome were reviewed and analyzed. ResultsThe mean age of diagnosis was 50.11 years old with female predominance. The most common symptoms were abdominal pain (77.78%), palpable mass (27.78%) and intestinal bleeding (16.67%). With the different gross and microscopic findings, the adult intestinal lymphangioma could be classified as “simple”, “polyposis”, and “cystic cavernous”. ConclusionIntestinal lymphangioma in adults is a rare cause of abdominal discomfort but should be listed in differential diagnosis during daily practice. The morphology and classification may be different from pediatric group, and more large-scale studies are need for thorough investigation.

Metastatic low-grade endometrial stromal sarcoma of uterus presenting as a primary pancreatic tumor: case presentation and literature review

BackgroundMetastatic tumors to the pancreas are uncommon, accounting for approximately 2% of pancreatic malignancies. The most common primary tumors to give rise to pancreatic metastases are carcinomas.Case presentationA 50-year old female patient was investigated for a cause of abdominal discomfort. She had a 2-year history of menorrhagia and dysmenorrhea which was ascribed to a fibroid uterus. On imaging, she was found to have a large solid and cystic mass in the tail of the pancreas. Imaging also confirmed a fibroid uterus. A distal pancreatectomy and splenectomy showed a 9 cm circumscribed mass within, and grossly confined to, the parenchyma of the pancreatic tail.Microscopically, the pancreatic lesion was lobulated, and well-circumscribed, but focally infiltrative. It comprised sheets of uniform spindled to epithelioid cells with round to oval nuclei, coarse to vesicular chromatin, visible nucleoli, nuclear grooves and clear to eosinophilic cytoplasm. Prominent arterioles were identified. The stroma was collagenized in areas. Occasional hemosiderin-laden macrophages were seen, and focal cystic change was present. There was no evidence of nuclear pleomorphism, mitotic activity or necrosis, and there was no evidence of endometriosis despite multiple sections being taken. Immunohistochemistry showed that the tumor cells were positive for CD10, estrogen receptor (ER), progesterone receptor (PR), Wilms tumor-1 (WT-1) and smooth muscle actin (SMA). RNA sequencing detected a PHF1 rearrangement.The morphological, immunohistochemical and molecular features were of a low-grade endometrial stromal sarcoma (LG-ESS). Subsequent total hysterectomy and bilateral salpingo-oophorectomy 3 months later, showed uterine fibroids and a 5 cm low-grade endometrial stromal sarcoma confined to the uterus, with lymphatic invasion.ConclusionsTo the best of our knowledge, this is the first documented case of metastatic endometrial stromal sarcoma of uterus presenting as a primary pancreatic neoplasm. An unexpected extra-uterine location and unusual presentation of ESS may make the diagnosis challenging, despite classic histological features. Morphological, immunohistochemical and molecular findings must be combined to render the correct diagnosis.

A variant of the median arcuate ligament syndrome: are sagittal images enough for diagnosis?

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a rare cause of abdominal discomfort, postprandial pain and weight loss. Doppler ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and selective catheter angiography can be used to identify this abnormality. Classically, the "fish hook" appearance is seen on sagittal images. In our case, mild stenosis (20%) was seen at the origin of the celiac artery without typical "fish hook" appearance. Higher degree stenosis (55%) was demonstrated on axial images. We are presenting a rare case of a MALS caused by prominent crura.

Probiotics and Irritable Bowel Syndrome

BackgroundIrritable bowel syndrome (IBS) is a major cause of abdominal discomfort and gut dysfunction worldwide. It is a poorly understood functional gastrointestinal disorder for which no effective medication is available. It is a benign condition, but its social and economic burden is significant. The symptoms consist of abdominal pain, bloating, flatulence, and irregular bowel movements. Alterations in the intestinal microbiota and mucosal inflammation may contribute to the development of IBS and probiotics could thus relieve the symptoms. This review gives an overview on the existing data on the effects of probiotics on the gastrointestinal symptoms of IBS.MethodsA PUBMED search was made to review the relevant literature, and additional studies were obtained from the references of the selected articles.ResultsClinical trials suggest that certain probiotics or combinations of bacteria have beneficial effects on the IBS symptoms. However the heterogeneity of studies, e.g. suboptimal study design, inadequate number of subjects, different doses and vehicles, inadequate length, make it difficult to compare the differences between probiotics and the effect may be strain-specific.ConclusionsThough evidence is very promising, no general recommendations on the use of probiotics in IBS can be given yet. Further clinical trials and data on the mechanisms of action are needed. Probiotics are considered safe and if future scientific data is able to substantiate their efficacy in IBS, they certainly could be a treatment option in relieving the symptoms in IBS.

Caregiver perspectives for the prevention, diagnosis and treatment of childhood giardiasis in Havana City, Cuba. A qualitative study

Although long considered a non-pathogenic protozoan, Giardia lamblia is now a well recognized cause of abdominal discomfort, diarrhoea and failure-to-thrive in children. The overall prevalence of this infection in Cuban population is about 7.2%; however, higher prevalences have been found among young children attending day-care centres and primary school in the country. Anecdotally, clinical giardiasis is generally considered to place a large burden on both diagnostic and treatment services in Cuba. In order to gain insight into caregivers’ perspectives with respect to this infection in children, a qualitative study was carried out in a paediatric hospital in Cuba. Focus group discussions were conducted to gather information about the awareness of the giardiasis, their mode of transmission and symptoms, diagnosis process, treatment seeking behaviour, possible ways of prevention, and barriers for not adopting preventive behaviours, the source and channels of information about this disease. Caregivers have knowledge of giardiasis, although there were myths and misconceptions regarding giardiasis. Manifestations like diarrhoea, abdominal pain and nausea were cited; however, asymptomatic forms of these infections are hardly accepted. Boiling water and washing hands before eating and after defecation and washing vegetables were mentioned among the principal ways of preventing this infection. The most commonly mentioned reasons for not adopting preventive behaviours included lack of time due to outdoor activities and limitation of combustible distribution. Treatment-seeking behaviour when giardiasis suspected mainly included visiting the nearby family doctor. The findings of this study reveal the need for a health education intervention in areas of misperceptions and confusion.

Molecular identification of gas-forming coliforms in breast-fed colicky and healthy infants

Aim. Excessive intestinal gas is thought to be the cause of abdominal discomfort in infants with infantile colic but data on the bowel bacteria potential responsible of the intraintestinal air load are scanty. At present findings reported some differences in gut micorbiota between colicky and healthy infants which could be involved in the aetiopathogenesis of such disturb. In this study, we aimed to investigate stool of colicky and healthy infants in order to evaluate the presence and quantity of coliforms with gas-forming capability through molecular analysis.

Intestinal gas in plain abdominal radiographs does not correlate with symptoms after lactulose challenge

Intestinal gas production and abdominal discomfort can be triggered by the ingestion of carbohydrates such as lactulose. Using plain abdominal radiographs, we studied whether subjective complaints after a lactulose breath test would be quantitatively related to intestinal gas volumes. Abdominal symptoms after the breath test were quantified by a written questionnaire and gas volumes were scored in plain abdominal radiographs, in 50 consecutive patients with unexplained, irritable bowel syndrome-like symptoms. Breath excretion of hydrogen and methane was determined in all patients. Forty-two (84%) of the patients claimed that their post-breath test symptoms were a true replicate of their customary discomfort. Total symptom scores (sum of scores for pain/discomfort, borborygmi, bloating, diarrhea, constipation) or any specific symptom score were not significantly correlated to gas volume scores (r=-0.04; P=0.8 for total symptom score). The 13 (26%) methane producers had significantly higher mean gas volume scores compared with nonproducers (0.38 vs. 0.24; P=0.0008), but fewer symptoms (total symptom score 11.9 vs. 18.2; P=0.17). Intestinal gas volume, as scored in plain abdominal radiographs, is not correlated with abdominal discomfort after lactulose challenge. Intestinal gas may not be the major cause of abdominal discomfort following carbohydrate ingestion in patients with functional gut disorders.

Hemoperitoneum in horses: 67 cases (1989–2004)

To evaluate clinical findings, underlying causes, and short-term outcome associated with hemoperitoneum in horses. Retrospective case series. 67 horses with hemoperitoneum. Medical records of horses with hemo-peritoneum (excluding postoperative abdominal hemorrhage) from 1989 through 2004 were analyzed. Information obtained included history, signalment, physical examination findings, diagnostic test results, and short-term outcome. Breed distribution was 28 Thoroughbreds, 13 Arabians, 10 Quarter Horses, 5 Warmbloods, 3 Appaloosas, and 1 each of 8 other breeds. There were 40 mares, 23 geldings, and 4 stallions. Median age was 12 years (range, 1 month to 40 years). Signs of abdominal discomfort were the primary complaint in 79% of horses. Clinical findings included shock (60%) and pale mucous membranes (60%). Median heart rate was 76 beats/min (range, 30 to 216 beats/min), median respiratory rate was 30 breaths/min (range, 8 to 92 breaths/min), median Hct was 31% (range, 10.5% to 73.0%), and total protein concentration was 5.8 g/dL (range, 3.3 to 8.7 g/dL). Cause of hemoperitoneum was attributed to trauma (25.4%), neoplasia (17.9%), uterine artery rupture (13.4%), mesenteric injury (11.9%), disseminated intravascular coagulopathy (6.0%), other causes (3.0%), and idiopathic causes (22.4%). Fifty-one percent of horses survived to hospital discharge, 37% were euthanized, and 12% died. Poor short-term outcome was significantly associated with high respiratory rate and certain underlying causes. Hemoperitoneum is an infrequent but important cause of abdominal discomfort in horses. Predominant underlying causes were trauma, neoplasia, and idiopathic causes. Identification of underlying cause is important because of its association with outcome.

Splenic Torsion in an Alpaca

To describe the clinical signs, diagnostic evaluation and surgical management of an alpaca with splenic torsion. Six-year-old female alpaca. Splenic torsion and uterine torsion were the inciting cause for persistent abdominal discomfort in this alpaca. Rectal examination, abdominocentesis, and transabdominal ultrasonographic findings were suggestive of a splenic lesion. Surgical management involved splenectomy of a necrotized spleen. Although rare in occurrence, splenic torsion should be considered as a potential cause of abdominal discomfort in alpacas. Splenectomy is a reasonable and successful method of treatment for a devitalized spleen secondary to splenic torsion in alpacas. Splenic torsion causes persistent abdominal discomfort in camelids and may be associated with uterine torsion. Rectal examination, transabdominal ultrasound and abdominocentesis are useful diagnostic tools to differentiate splenic torsion from other causes of abdominal discomfort. Splenectomy is an uncomplicated procedure in camelids and has a favorable prognosis.

Lesions (ulcers and/or erosions) and desquamations location in the gastric mucosa from asymptomatic Quarter Horse foals: endoscopic survey

Gastric ulcer accounts for an important cause of abdominal discomfort in young horses. Concerning either the presence or absence of clinical signs and their variations, the lesions location in the gastric mucosa and complications resulting from ulcerative lesions, four clinical syndromes have been described in foals: 1) Asymptomatic or silent ulcers; 2) Symptomatic or active ulcers; 3) Perforated ulcers; and 4) Gastric or duodenal obstruction. With the aim of studying the distribution of lesions (ulcers and/or erosions) and desquamations from the non-glandular epithelium in the gastric mucosa of young horses and a possible relationship between both alterations (lesion/desquamation), sixty Quarter Horse foals without signs of gastric disease underwent gastroscopy. Foals were divided by age in four groups of 15 animals as follows: 1 to 30 days, 31 to 60 days, 61 to 90 days and 91 to 120 days. Lesions were most prevalent in the stratified squamous epithelial mucosa mainly adjacent to the margo plicatus along the greater curvature followed by squamous mucosa next to the cardia along the lesser curvature, glandular and non-glandular fundus and antrum. Regions of the fundus and margo plicatus were similarly affected by desquamations. There was no association between lesions and desquamations occurrence.

Diversion colitis: A cause of abdominal discomfort in spinal cord injury patients with colostomy

Diversion colitis is thought to result from nutritional deficiencies secondary to fecal diversion. Symptoms include hemorrhagic purulent rectal discharge, abdominal pain, and tenesmus. 5-Aminosalicylic acid (5-ASA) and N-butyrate enemas have been reported to help this condition in non-spinal cord injury (SCI) patients. We report the case of a 49-year-old C6 ASIA B tetraplegic man who had received colostomy because of intractable ileus 10 years earlier. He presented with a 2-week history of rectal pain and bleeding. Abdominal and rectal examination on admission were unremarkable. Colonoscopy showed a partial stricture 70cm proximally to the rectum. The colonic mucosa appeared granular and friable with evidence of linear ulceration. Histopathologic study was consistent with colitis. The patient developed fever, abdominal distention, and extensive retroperitoneal air after endoscopy, suggesting colonic perforation. He was treated with daily 5-ASA suppository and total parenteral nutrition for the presumed diagnosis of diversion colitis, and intravenous antibiotics for perforated colon. After 6 weeks of treatment with 5-ASA, the patient had decreased rectal pain and bleeding. This experience suggests that diversion colitis may be a cause of abdominal discomfort in SCI patients and that 5-ASA may be used in the management of diversion colitis.