History Of Obstipation Research Articles

Micropapillary Adenocarcinoma of the Sigmoid Colon Presenting as Intestinal Obstruction in an Elderly Woman

Colorectal carcinoma (CRC) is the second most common malignancy in Malaysia. Nonetheless, micropapillary adenocarcinoma (MPA) subtype has not been studied extensively since its initial description in 2005. This article is the first reported case of MPA of the sigmoid colon in Malaysia. An 84-year-old Chinese woman presented with a three-day history of obstipation and progressive abdominal distension. She was nauseated with poor oral intake and vomiting gastric content. Otherwise, she did not experience constitutional and gastrointestinal red flag symptoms. Systemic reviews were non-significance. Her elder brother had colon cancer, but she was never screened for CRC. Her abdomen was distended with no peritonism nor palpable mass. Erect abdominal radiograph showed dilated small and large bowels with multiple air fluids levels, no air under diaphragm seen in chest roentgenogram. Apart from elevated carcinoembryonic antigen and cancer antigen 125, her initial blood works were normal. Urgent surgical consult obtained for suspected malignant bowel obstruction. Contrasted computed tomography scan delineated a luminal narrowing at the sigmoid colon and confirmed the diagnosis. She underwent proctosigmoidectomy and discharged postoperatively. Histopathological examination came back as moderately differentiated MPA with nodal extension at stage pT4N2a. Despite 10% of CRC presented with intestinal obstruction, the cohort had a significantly lower survival rate with more advanced disease. Histologically, MPA behaves invasively and predicts nodal metastasis. Identification of micropapillary components is linked to poorer disease prognosis. Effective therapy remained unknown. This case describes the late presentation of MPA variant of CRC, which highlights its clinical and research implications.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S11

Intrathoracic intestinal diverticulum in a late presenting congenital bilateral diaphragmatic hernia: a case report

IntroductionHernias comprise 3% of all defects of the diaphragm. Bilateral hernias are extremely rare and usually occur in children. Here we present a case report of a bilateral Morgagni-Larrey diaphragmatic hernia with an intrathoracic intestinal diverticulum and late presentation. To the best of our knowledge this is the first report of this type.Case presentationA 37-year-old Hispanic man was admitted to our emergency department with a 4-day history of obstipation, abdominal pain, distension, nausea, and vomiting. During the initial evaluation, chest and abdominal X-rays were performed, which revealed intestinal displacement into his right and left hemithorax. During laparotomy, a Morgagni-Larrey hernia with a sac was found. His small bowel with a large diverticulum, transverse colon, descending colon, and epiploic fat were herniated into his thorax. Tissues were returned to his abdominal cavity and the hernia defects were corrected with running non-absorbable sutures. He had no postoperative complications.ConclusionsBilateral congenital diaphragmatic hernias remain extremely rare. However, they should be considered in adult patients with intestinal obstruction even when respiratory symptoms are absent. This is the first description of a patient with a prolapsed intestinal diverticulum and bilateral diaphragmatic hernias.

Behçet’s disease and celiac disease: a rare association or a possible link?

We read with great interest the recent clinical case reported by Caldas et al. [1] on the relation between Behcet’s disease (BD) and celiac disease (CD). The authors described the third case in the literature of this overlap in a 40-yearold woman with history of obstipation since her childhood. BD is a chronic, relapsing, inflammatory disease characterized by recurrent oral and genital aphthosis along with several other systemic manifestations including skin, ocular, articular, neurological, and vascular lesions. The underlying cause of the disease is unknown. Like the other autoimmune diseases, BD may represent an aberrant immune activity triggered by exposure to an antigen in those with a genetic predisposition to develop the disease [2]. On the other hand, patients affected by CD have greater risk of developing autoimmune diseases, among them rheumatic diseases. BD and CD share many clinical presentations, such as recurrent aphthous stomatitis, as well as gastrointestinal, musculoskeletal, and neurological involvements. Triolo et al. [3] searched anti-gliadin and anti-endomysial antibodies in 11 patients with BD and confirmed CD, through duodenal histology, in one case. Subsequently, Larner [4] described a suspect case of BD with atypical neurological complaints in the peripheral nervous system, which also confirmed CD through duodenal histological study. In both cases, the effect of a gluten-free diet on the symptomatology was not reported. There is suggestive but as yet inconclusive evidence of a probable association between CD and BD. It could be supposed that both diseases are likely the result of molecular mimicry between two undefined auto-antigens or virus trigger action. In accordance with the authors, we conclude that, the chance to prove this very rare association requires more case descriptions and case series studies. However, in patients affected by BD, it may, therefore, be important to investigate the possible link with an underlying undiagnosed CD.

Behçet’s disease associated with celiac disease: a very rare association

There are common findings between Behçet's disease (BD) and celiac disease (CD); however, association in the same patient is a rarity. We relate the third case in the literature of this overlap in a 40-year-old woman with history of obstipation since her childhood. She also presented asymmetric polyarthralgia, loss of weight, anemia, oral recurrent aphthas (>3/year) and genital ulcerations, inflammatory lower back pain, bowel bleeding and abdominal colic. Afterwards, she presented episodes of erythema nodosum, superficial thrombophlebitis, pseudofolliculitis and aseptic meningitis, thus fulfilling criteria for BD. Due to persistence of the digestive complaints, a gastrointestinal endoscopy was performed. The biopsy showed chronic duodenitis with intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. Endomysial antibody was positive. She fulfilled the diagnosis criteria for CD; a gluten-free diet was applied with clinical improvement. Ascertaining whether pathogenic mechanisms are common in these two conditions requires further investigation.

Pathologic quiz case. Elderly man with bright red blood per rectum. Pathologic diagnosis: metastatic hepatic epithelioid angiosarcoma.

71-year-old white man with no prior history of malignancy and a 2-week history of obstipation, increasing abdominal girth, and abdominal cramping sought medical attention after he began passing bright red blood per rectum. He underwent colonoscopy, which revealed a fungating and hemorrhagic rectosigmoid mass lesion. Shortly after colonoscopy, the patient experienced a rapid decrease in oxygen saturation and required intubation with mechanical respiration. During the next several days, he developed acute renal failure leading to multiple organ system failure and eventually death. Before he died, the patient was sent for computed tomographic scans of the chest, abdomen, and pelvis, which revealed extensive ‘‘metastatic disease’’ involving the lungs, liver, and multiple bony sites. While in radiology, a computed tomographic scan‐guided needle biopsy of a tumor nodule in the bony pelvis was conducted. The needle aspiration slides were relatively hypocellular and contained a mixture of discohesive cells. Some of these cells displayed overt cytologic features of malignancy, including large irregular nuclei and prominent eosinophilic nucleoli (Figure 1). Osteoclast-type giant cells were admixed with the malignant cells. The core biopsy demonstrated a sheetlike expanse of the same malignant cells, some of which possessed long, tapering cytoplasm. A smattering