Intermittent Abdominal Cramping Research Articles

Hyperplastic polyposis and cancer of the colon with gastrinoma of the duodenum

A 64-year-old woman presented to the emergency room with a 3-month history of intermittent abdominal cramps, accompanied by nausea, vomiting, anorexia, and decreased bowel movements consistent with a partial intestinal obstruction. She had a 12-year history of peptic ulcers, which had been treated with histamine-2 blockers. Physical examination, abdominal X-ray, abdominal CT scan, colonoscopy and assessment of gastrin levels. Duodenal neuroendocrine neoplasm showing gastrin expression and stage III (T3N2M0), poorly differentiated adenocarcinoma of the cecum arising from hyperplastic polyposis. Right-sided hemicolectomy with ileocolonic anastomosis, duodenal resection, leucovorin and 5-fluorouracil chemotherapy, annual colonoscopic surveillance, and polypectomy.

BURKITT-LIKE LYMPHOMA PRESENTING AS MULTIPLE POLYPOSIS

Introduction: Burkitt's lymphoma (BL) is one of the highly aggressive non-Hodgkin's lymphomas. It is a rare occurrence in adults. Burkitt-like lymphoma (BLL) is a morphologic variant of BL. Tumors often involve lymph nodes, the nasopharynx and gastrointestinal tract. However, the stomach is a rare site of occurrence. We report the case of a patient with BLL presenting as multiple polyposis of the stomach and small intestine. Case: A 28 year old male with a history of a Schatzki ring, dilated two years earlier, presented with intermittent abdominal cramping, fever, night sweats, nausea and vomiting of six weeks' duration. He had previously been treated for gastroenteritis and irritable bowel syndrome (IBS) with antibiotics and anticholinergic medications without relief. Physical examination revealed a left sided palpable axillary mass. His abdomen was soft and non-distended, with minimal epigastric tenderness. He had a positive fecal occult blood test. Laboratory tests were normal. A computerized tomography scan of the abdomen demonstrated low grade obstruction due to intussusception of the ileum, with diffuse small bowel mural defects and thickening of the small bowel wall. Upper endoscopy revealed extensive polyposis involving the stomach and duodenum. Colonoscopy was unremarkable. Pathology reports were suspicious for lymphoma. Bone marrow biopsy studies showed neoplastic cells positive for tumor markers CD-10 and CD-20, consistent with BLL. The patient was started on chemotherapy with methotrexate, cyclophosphamide, doxorubicin, vincristine and cytarabine. Discussion: BLL is a rare entity which infrequently involves the stomach. We believe this is the first reported case of BLL presenting as multiple polyposis of the stomach and small intestine. This case demonstrates that if abdominal pain presumed to be from gastroenteritis or IBS persists or worsens with treatment, or is associated with alarming features such as weight loss, fever, night sweats or bleeding, more serious pathology should be considered in the differential diagnosis.

Bloody diarrhea, fever, and pancytopenia in a patient with active ulcerative colitis

HISTORY OF PRESENT ILLNESS A 61-year-old woman with a history of ulcerative colitis (UC) was seen for treatment. She had persistent, profuse, watery diarrhea associated with intermittent abdominal cramping, anorexia, 16-pound weight loss, malaise, and bright red blood per rectum. These symptoms had been present since her first hospitalization for the same complaints 5 weeks earlier. She denied symptoms of fever, nausea, vomiting, joint pain, jaundice, or rash. At the time of her first hospitalization, the patient had pancytopenia. Her white blood count (WBC) was 1,800/mm3, hemoglobin (Hgb) level was 8.7 g/dL, and her platelet (Plt) count was 116,000/mm3. The patient’s absolute neutrophil count (ANC) was 400/mm3, and her absolute lymphocyte count (ALC) was 800/mm3. A bone marrow biopsy showed mildly hypercellular marrow with trilineage hematopoeisis and an increased number of early myeloid forms. Pancytopenia was thought to be either drug induced or secondary to viral gastroenteritis, and the patient was discharged home after discontinuation of her current medications. Despite this, and despite an initial response to growth factor support, the patient’s diarrhea persisted and pancytopenia recurred. UC had been diagnosed in 1994. The patient had never received treatment with corticosteroids. She had hypertension managed by weight loss. The patient gave a history of chronic anemia, but the exact degree and cause were uncertain. There was no history of blood transfusion in the last 40 years. The patient had undergone an appendectomy in her 20s and a bilateral tubal ligation in her 30s. When admitted, the patient was taking approximately six atropine/diphenoxylate tablets daily, a mesalamine enema at bedtime, and sucralfate 1 g, twice daily. There were no known drug allergies. Sulfa had caused vomiting in the past. The patient’s father died at 93 of Parkinson’s disease. Her mother was alive and well at 96. Her siblings and two children were all well. No one else in her family had inflammatory bowel disease (IBD). The patient was a widow. She worked in a jewelry store and rarely traveled outside the United States. She quit the use of tobacco 20 years before, and rarely drank alcohol. Review of systems was positive only for the complaint of a fever blister on her right upper lip.

Contrast-enhanced power Doppler sonography of the intestinal wall in the differentiation of hypervascularized and hypovascularized intestinal obstructions in patients with Crohn's disease.

To use power Doppler sonography to quantify the vascularization in the area of stenosed bowel segments in patients with Crohn's disease and to draw conclusions from these findings with regard to the development of these stenoses. The study collective included 11 patients with confirmed Crohn's disease and sonographically visualized stenoses of the small bowel together with intermittent abdominal cramping as a clinical correlate. Power mode examination was repeated after application of a sonographic signal-enhancing agent. Semiquantitative evaluation based on the sonographically indicated degree of vascularization led to the presumptive diagnosis of either inflammatory or cicatricial intestinal obstruction. Sonographic diagnoses were compared with the findings of surgery and subsequent histologic examination or with patients' clinical responses to conservative therapy. Nine of 11 patients underwent surgery within 1 year of examination. All 3 cases in which sonography had facilitated the diagnosis of cicatricial stenosis were confirmed at postoperative histologic examination; similarly, the surgical and histologic findings in the other 6 patients confirmed the sonographic diagnosis of inflammatory stenosis. Power Doppler sonography in combination with the use of a signal-enhancing agent appears to be effective in the recognition of predominantly cicatricial stenoses in patients with Crohn's disease.

URETERAL OBSTRUCTION DUE TO COLONIC DUPLICATION

Ureteral obstruction due to intrinsic or extrinsic factors is a common clinical occurrence. However, the diagnosis can be difficult, especially with rare etiologies. We report on a patient with renal colic from ureteral obstruction caused by a segmental duplication of the hindgut. CASE REPORT A 24-year-old man presented with acute right flank pain and nausea. He had no history of kidney stones, infections of the urinary tract or hematuria. At age 17 years he had undergone percutaneous drainage of a right psoas abscess, of which the etiology was unclear. He reported intermittent crampy abdominal pain since the early teenage years. On physical examination, the patient was afebrile with normal vital signs. Right costovertebral tenderness was present as well as mild tenderness in the right upper quadrant. Laboratory evaluations, including complete blood count, creatinine and electrolytes, were normal. Urinalysis demonstrated microscopic hematuria without leukocytes, bacteria or crystals. A scout film of the abdomen showed no radiopaque shadows. Excretory urogram revealed obstruction of the proximal right ureter with associated hydronephrosis (fig. 1, A). The patient was referred to us with a diagnosis of a right ureteral stone. Intermittent abdominal cramping and right flank pain were persistent. Right retrograde pyelography showed a normal distal and mid ureter (fig. 1, B). The proximal ureter was dilated and the obstruction appeared to be due to extrinsic compression. A right ureteral stent was placed to relieve the obstruction. Abdominal computerized tomography demonstrated a tubular, thick walled cavity extending from the right retroperitoneal region just anterior to the proximal right ureter, which extended across the midline towards the left colon (fig. 2, A). Differential diagnosis of an abscess or tumor was considered and a barium enema was ordered (fig. 2, B). A blind-ending pouch arising from the splenic flexure, crossing the midline and ending in the region of the right kidney was seen. A large filling defect was near the neck of the pouch. Diagnosis was duplication of the colon causing ureteral obstruction. On surgical exploration the duplicated colonic segment was removed and ureterolysis with omental wrapping of the right ureter was performed. The filling defect seen on barium enema was a massive fecalith in the duplicated hindgut. Pathological examinations revealed all 3 layers of native bowel, which was consistent with a true duplication of the hindgut. Convalescence was uneventful with complete resolution of symptoms. After removal of the ureteral stent, a nuclear renal scan demonstrated normal function of the right kidney without evidence of obstruction.

Medical Management of a Large Aortic Thrombus in a Young Woman With Essential Thrombocythemia

Medical Management of a Large Aortic Thrombus in a Young Woman With Essential Thrombocythemia

Index of Suspicion

Index of Suspicion

Bladder perforation by an intrauterine device

A case of perforation of the urinary bladder by a Copper 7 IUD inserted in a 32-year old para 5 women 6 months previously is reported. The gynecologist had noted that the insertion was difficult. The patient presented with intermittent abdominal cramping pain and gross hematuria. She had experienced 3 episodes of lower abdominal pain treated with antibiotics and spasmolytic. She has diffuse abdominal tenderness and rebound pain in the pubic region. The only abnormal findings were gross red blood cells in the urine, white blood count of 14,000 and hemoglobin 12.0 g. Real time sonography showed the IUD within the bladder surrounded by hypoechoic echoes found to be blood clots during cystoscopy. A plain abdominal x-ray suggested the IUD was encrusted with calculi. The IUD was removed by cystoscopy. The woman was treated with antibiotics for 10 days and recovered. This is believed to be the 1st published report of an IUD detected by sonography to be in the urinary bladder.

Ritodrine Hydrochloride and Preterm Labor

A primigravida is admitted to the labor and delivery unit complaining of intermittent backache and abdominal cramping. She has had an uncomplicated pregnancy and there is no evidence of ruptured amniotic membranes. Fetal gestational age of 32 weeks correlates with fundal height and date of last menstrual period. The fetal heart rate is 130 to 140. Mild contractions of 30-second duration can be felt every 4 to 5 minutes. A vaginal exam reveals 3 cm dilation, 80 percent effacement, and 0 station. Urinalysis from a sterile catheterized specimen is negative for bacteria and white blood cells. The obstetrician orders an immediate intravenous infusion of ritodrine hydrochloride (Yutopar)-a uterine relaxant. The obstetrical

Spasm and Fibrosis of the Sphincter and Due to Reflex Action

SPASM and fibrosis of the anal sphincter associated with a long history of marked constipation, tenesmus, mild intermittent abdominal cramps and an almost daily intake of cathartics is a rather frequently observed clinical entity about which little has been written, but which is important enough on occasions to suggest major but unnecessary surgery.1 2 3 Twenty-one cases are reviewed in the present study. These patients were first seen because of variable complaints. Some sought advice because of constipation alone. Others complained of tenesmus. The majority, however, complained of vague abdominal discomfort, intermittent mild abdominal cramps, a sense of pelvic fullness, anorexia, flatus . . .