Marked Distension Research Articles

Polycystic liver - A cyst-ridden abdomen.

A 44-year-old female with an established diagnosis of autosomal dominant polycystic kidney disease (based on imaging findings and family history) was being evaluated for weight loss, early satiety and progressive abdominal distension. Kidney function had been relatively stable for years. Because of a history of multiple liver cysts on ultrasonography, the patient was referred for Gastroenterology for evaluation. Magnetic resonance imaging of the abdomen revealed a large number of kidney and liver cysts (the largest with 70mm of diameter), occupying a significant portion of the abdominal cavity and causing marked distension. This case illustrates the massive volume that can be reached by the growing cysts, which is the main cause of morbidity in this disease and for which novel and effective therapies are still needed.

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.

Extrapulmonary hyalinizing granuloma: a rare case with intra-articular and tenosynovial involvement.

Extrapulmonary hyalinizing granuloma (EPHG) is a notably rare condition, representing an exaggerated chronic immune response to antigenic stimuli. This report presents the first documented case of intra-articular and tenosynovial EPHG with radiological evaluation and pathological confirmation in a 60-year-old man presenting with wrist pain and swelling. Imaging findings were relatively symmetric with marked distension of the distal radioulnar joints and extensor tendon sheaths with masses and nodules of various sizes surrounded by synovitis and accompanied by bony erosions. On US, the masses were heterogeneous but mostly hypo- to iso-echoic compared to muscle and relatively hypovascular. On MRI, compared to muscle, the nodules exhibited iso-intense signal on T1-weighted images, iso- to mildly hyper-intense signal on T2-weighted fat-suppressed images, and minimal enhancement on post-contrast images. The diagnosis of EPHG was revealed through biopsy and pathologic examination with glucocorticoids being effective in treatment.

Clinical approach to a rare case of hydrallantois in bitch

AbstractThe present case describes the clinical, sonographic and histopathological findings of hydrallantois in bitch. After 55 days of the first mating, nulliparous Golden Retriever bitch was presented with a primary complaint of perceptible abdominal distension and dyspnoea for the last 3‒4 days. Ultrasonography revealed marked uterine distension with well appreciable anechoic to hypoechoic allantoic regions along with fetal stress. During caesarean section, a cumulative 2.75 L of placental fluid was recovered from allantoic portion with an altered electrolyte profile in comparison to maternal plasma. The histopathology examination of one fetal kidney corroborated tubular degeneration, suggesting nephrosis to be the concomitant aetiology. In conclusion, the clinical examination and ultrasonography provided provisional diagnosis of the condition; caesarean section proved to be an ideal option in order to prevent the dystocia or any other complication during whelping in a bitch even if none of the puppies survived. This approach, with supportive therapy ensures comprehensive care post‐treatment.

Two-stage excision of type III sacrococcygeal teratoma with massive abdominal extension in a 3-month-old girl: A case report with brief literaturereview

Sacrococcygeal teratomas (SCTs) are the most common germ cell tumor in neonates occurring in approximately 1 in 30,000 to 40,000 births. Here in reporting a 3-month-old girl presented with rapid distension of the abdomen and a tumor-like growth at her right gluteal area, since birth. She also had features suggestive of intestinal obstruction. Clinical examination revealed marked distension of the abdomen, although it was soft and features suggestive of ascites. Visible bowel loops were also detected, suggesting intestinal obstruction. Her perineal/right gluteal examination revealed a soft-to-firm tumor. Her clinical and radiological investigations (ultrasonography and magnetic resonance imaging scan of the abdomen, pelvis, and perineal area) were suggestive of SCT. Abdominal exploration was carried out on an emergency basis for intestinal obstruction, and the cystic tumor was partially excised. After a few days, the remaining pelvic and perineal parts of the tumor were completely excised through posterior, sagittal incision. Her post-operative recovery was uneventful, and she was discharged in good condition. Her resected specimens were subjected to histology and were reported as mature teratoma, without any evidence of malignancy. She was doing well, without a recurrence, in a follow-up done 2 year after the surgical procedures.

Signet-ring cell sinus histiocytosis: report of the clinicopathologic characteristics of 4 cases with emphasis on the differential diagnosis of signet-ring cell lesions

Signet-ring cell sinus histiocytosis (SRCSH) represents a distinctly rare reactive phenomenon predominantly affecting axillary and pelvic lymph nodes (LNs) of individuals with breast or prostatic adenocarcinoma. Reports of SRCSH in the literature are sparse with only 12 previous examples, thus underscoring the rarity of this process. Here, we report 4 additional SRCSH cases affecting 2 women and 2 men (M:F = 1:1; age range: 50 to 71 years; mean age = 61 years). In the 2 men, pelvic LNs were excised during radical cystoprostatectomy for genito-urinary cancer, while in one woman SRCSH was incidentally discovered in axillary LNs during mastectomy for breast adenocarcinoma. The other female patient presented with a history of aortic valve replacement and enlarged supraclavicular LNs. Microscopically, all involved LNs exhibited marked distention with filling of the subcapsular and medullary sinuses by sheets of signet-ring histiocytes containing a singular large, cytoplasmic vacuole and a crescentric nucleus. Overt cytologic atypia, pleomorphism and mitoses were absent. Erythrophagocytosis and occasional fibrosis were appreciated. None of the LNs with SRCSH showed evidence of metastatic tumor. Immunohistochemically, signet-ring sinus histiocytes were invariably positive for CD68 and CD163 but negative for pancytokeratins. The histopathologic characteristics of SRCSH, albeit bland, in conjunction with the patient's medical history, may be misinterpreted as metastatic adenocarcinoma with signet-ring cell configuration. Immunohistochemical confirmation of the histiocytic lineage of the lesional cells in SRCSH usually suffices for rendering an accurate diagnosis. The underlying pathogenetic mechanism and possible biologic significance of SRCSH remain currently unknown.

Smooth muscle dysfunction in the pre-inflammation site in stenotic Crohn's-like colitis: implication of mechanical stress in bowel dysfunction in gut inflammation.

Background and Aims: Gut smooth muscle dysfunctions contribute to symptoms such as abdominal cramping, diarrhea, and constipation in inflammatory bowel disease (IBD). The mechanisms for muscle dysfunctions are incompletely understood. We tested the hypothesis that mechanical stress plays a role in muscle dysfunction in a rat model of Crohn's-like colitis where inflammatory stenosis leads to mechanical distention in the pre-inflammation site. Methods: Crohn's-like colitis was induced by intracolonic instillation of TNBS (65mg/kg) in Sprague-Dawley rats. Control rats were instilled with saline. The rats were fed with either regular solid food or exclusively liquid diet. Rats were euthanized by day 7. Results: When rats were fed with solid food, TNBS treatment induced localized transmural inflammation with stenosis in the instillation site and marked distention with no inflammation in the pre-inflammation site of the colon. Smooth muscle contractility was suppressed, and expression of cyclo-oxygenase-2 (COX-2) and production of prostaglandin E2 (PGE2) were increased not only in the inflammation site but also in the pre-inflammation site. Liquid diet treatment, mimicking exclusive enteral nutrition, completely released mechanical distention, eliminated COX-2 expression and PGE2 production, and improved smooth muscle contractility especially in the pre-inflammation site. When rats were administered with COX-2 inhibitor NS-398 (5mg/kg, i. p. daily), smooth muscle contractility was restored in the pre-inflammation site and significantly improved in the inflammation site. Conclusion: Colonic smooth muscle contractility is significantly impaired in stenotic Crohn's-like colitis rats not only in the inflammation site, but in the distended pre-inflammation site. Mechanical stress-induced expression of COX-2 plays a critical role in smooth muscle dysfunction in the pre-inflammation site in Crohn's-like colitis rats.

OHVIRA SYNDROME – A RARE CASE REPORT

Aims And Objectives Of Study:1. To evaluate the role of magnetic resonance imaging (MRI) in diagnosing uterine anomalies which helps in the early detection. 2. To aid the gynecologist/surgeon for prompt surgical intervention and hence preventing adverse outcomes. 19-year-old adolescent girl Materials And Methods: presented to the Gynecology Department with history of menarche 8 months back having complaints of pain in lower abdomen and irregular cycles. The patient was referred to the Department of Radio-diagnosis at SIMS & RC, Bangalore for further evaluation. The radiologist evaluated the case separately by MRI examination, using GE 1.5T MRI. Multiplanar multisequence MRI of female pelvis was performed and the imaging features were recorded. The imaging features and nal diagnosis were documented in a structured case record form. Result: MRI revealed two uterine horns with two external os opening into two separate vaginal canals. Marked distention of right hemivagina with uid levels due to transverse septum at lower third of right hemi vagina and right renal agenesis were noted. Per operative ndings conrmed the imaging ndings. In our Conclusion: study we found that the knowledge of the syndrome helped in early detection and the timely diagnosis by imaging which aided the gynaecologist for the prompt surgical intervention preventing adverse outcomes.

Neonatal Posterior Urethral Valves as a cause of Acute Abdominal Distention

Introduction: An 18-day-old term, male presented to the emergency department (ED) for 1-2 days of progressive abdominal distention. Case Report: Over the past week the infant had been spitting more, but it was non-bilious and non-projectile. He had no fevers. On examination, he was ill appearing with a distended abdomen. A flat-plate of his abdomen was obtained that was concerning for possible partial small bowel obstruction, which led to extensive imaging with an upper and lower gastro-intestinal contrast studies that were negative. Ultimately, an ultrasound was performed that revealed marked bladder distention with hydronephrosis. A urinary catheter was placed to relieve his bladder obstruction. Avoiding cystourethrogram confirmed a diagnosis of posterior urethral valves. Conclusion: Posterior urethral valves (PUVs) as a cause of abdominal distention in the neonate is a rare presentation. PUVs have an incidence of 1/4000 male births; of which 1/3rd are detected in-utero, 1/3rd in the first year of life. Most infants with PUVs will present with a urinary tract infection, others present with failure to thrive, poor urine stream and or grunting while urinating. The neonate with acute abdominal distention warrants a thorough and expedited evaluation for possible acute surgical etiologies, such as midgut volvulus due to malrotation. Early identification of bladder obstruction by point of care ultrasound would have helped focus the evaluation and lead to earlier relief of his bladder obstruction. PUVs should be considered on all male infants with urinary tract infection, failure to thrive, poor urinary stream or abdominal distention.

Ultrasound “whirlpool sign” of small bowel volvulus

Small bowel volvulus is a real surgical emergency. Early diagnosis and prompt operation are essential to prevent gangrene in the small intestine, which is associated with high morbidity and mortality. This is a life-threatening complication of intestinal malrotations, which is defined by abnormal twisting of a loop of small bowel around the axis of its own mesentery during embryologic development [1]. Clinical signs are represented by the high neonatal obstruction syndrome. Imaging has an essential role in diagnosis. Abdominal X-Ray shows marked distension of the intestines concerning for acute obstruction, however it can further lead to missed or delayed diagnoses. The associated abdominal Doppler ultrasound confirm the diagnosis of volvulus by showing “whirlpool sign”. This sign corresponds to a clockwise wrapping of the superior mesenteric vein and the mesentery around the superior mesenteric artery.

S3582 Disguised as Post-Operative Ileus: A Case of a Giant Gastric Ulcer Causing Outlet Obstruction and Gastric Pneumatosis

Introduction: Giant gastric ulcers (GGU), defined as ulcers larger than 2-3cm, are relatively rare in the setting of widespread proton pump inhibitor (PPI) use. Though usually located in the lesser curvature, GGU may occur in any part of the stomach. Typical symptoms are similar to that of peptic ulcer disease (PUD), i.e. epigastric pain and gastrointestinal bleeding, however GGU are highly prone to perforation and are more likely to be malignant in the elderly. Overall, gastric outlet obstruction is the least common complication of PUD. Case Description/Methods: A 74-year-old obese male with history diabetes, sleep apnea, and prior laparoscopic gastric banding surgery was admitted for elective surgery for Charcot arthropathy. Post-operatively, he developed nausea, vomiting and abdominal bloating. Abdominal x-ray showed distention of the small bowel concerning for ileus. Exam showed a non-tender abdomen with distention and tympany on percussion. His emesis resolved with antiemetics, however distention persisted despite passing gas and stool. Three days after surgery, he developed acute anemia without overt bleeding requiring blood transfusions. Abdominal X-ray and CT was performed which showed marked gaseous distention of the stomach and gastric wall pneumatosis. Nasogastric tube was placed for decompression with subsequent resolution of his distention. Due to concern for gastric band erosion, Gastroenterology was consulted. Upper endoscopy was performed which revealed a 4cm clean-based ulcer with overlaying eschar along the greater curvature with surrounding erythema and edema. Biopsies of the ulcer border showed acute erosive gastropathy with focal clustering of eosinophils without evidence of dysplasia. He was started on PPI and sucralfate, and remained clinically stable without further gastrointestinal symptoms. (Figure) Discussion: Gastric pneumatosis due to gastric emphysema is caused by disruption of mucosa leading to air migrating into the gastric wall. Etiologies vary, including injury from instrumentation, severe vomiting, pulmonary pathology, penetrating gastric ulcers, or gastric outlet obstruction. Few cases reports have described gastric emphysema resulting from gastric band erosion, however there are no reports describing this occurring in the absence of full erosion. Overall, gastric emphysema is relatively rare, as is development of GGU. To our knowledge, this is the first reported case of unperforated giant gastric ulcer resulting in outlet obstruction with gastric pneumatosis.Figure 1.: CT abdomen showing marked gaseous distention of the stomach and gastric wall pneumatosis (Figure 1a). Upper endoscopy findings of a friable, erythematous giant ulcer with clean-base overlaying the greater curvature with significant surrounding erythema and edema in the fundus/cardia (Figure 1b and 1c), as well as multiple surrounding small ulcerations, some with clean-base and some with flat pigmented spots, throughout (not pictured). No evidence of active bleeding, visible vessel, or high-risk features for bleeding.

S2788 A Rare Case of Duodenal Crohn’s Disease Presenting as Megaduodenum

Introduction: Crohn’s disease of the duodenum is exceedingly rare and accounts for less than 2% of Crohn’s disease cases, disease confined to the duodenum is an even rarer entity.[1] Megaduodenum is typically seen in infants and its presence in adults is the subject of a few case reports. We present an unusual presentation of an adult patient with Crohn’s disease presenting as megaduodenum. Case Description/Methods: A 20-year-old male with a history of gastroparesis presented with mild epigastric pain, intractable nausea, vomiting, and 60 pounds of weight loss over the last six months. The patient had severe food intolerance to the point where he required total parenteral nutrition. CT scan showed distention of the stomach with tapering of the proximal duodenum, followed by subsequent marked diffuse distention of the remaining duodenum with subsequent narrowing at the duodenojejunal junction. (a). An esophagoduodenoscopy (EGD) was performed that showed distended duodenum, a proximal duodenal stricture, and another stricture at the duodenojejunal junction with inflamed mucosa and severe stenosis which could not be traversed. (b,c). Biopsies showed duodenitis consistent with Crohn’s disease. A PEG-J tube was placed for enteral feeding which the patient did not tolerate and ultimately required resection of the distended duodenum. Discussion: Megaduodenum is usually congenital and is a rare entity in adults. In this case, duodenal distention was likely acquired and unfortunately required resection due to the severity of symptoms. In our opinion, the patient likely had skipped lesions in the duodenum with significant dilatation of the inflamed area. There was no colorectal involvement confirmed by a colonoscopy. Post-operative biopsies also confirmed Crohn’s disease in the duodenum.Figure 1.: (a): Megaduodenum on CT scan Figure (b): Duodenal distention on EGD Figure (c): Duodenal stricture on EGD.

S2891 A Case of Endoscopic Ultrasound-Guided Gastrojejunostomy for Gastric Outlet Obstruction in a Patient With a Migrated FCSEMS

Introduction: Fully covered self-expandable metal stents (FCSEMS) are often used to resolve benign strictures causing gastric outlet obstruction (GOO). With a short length and anti-migration waist, the TaeWoong Medical FCSEMS is designed to produce radial force against the stricture and greatly reduce stent migration. We report the case of a patient with a retroperitoneal hematoma causing GOO secondary to a duodenal stricture. The FCSEMS placed across the stricture was complicated by stent migration to the stomach, and a gastrojejunostomy (GJ) was performed using a lumen-apposing metal stent (LAMS) and LAMS dilation. Case Description/Methods: A 47-year-old man with no significant history was admitted for GOO secondary to spontaneous non-traumatic hemorrhagic retroperitoneal bleeding. He presented with recurrent episodes of acute epigastric pain radiating to his back, nausea, and vomiting and was found to have pancreatitis with an elevated lipase of 661. Computed tomography (CT) showed a retroperitoneal hematoma surrounding a severely thickened descending and proximal duodenum and the head of the pancreas. Marked distention of the stomach was consistent with GOO. The patient was evaluated by the gastroenterology service, and an esophagogastroduodenoscopy (EGD) revealed a stricture involving the distal D2 and proximal D3 that could not be traversed with the endoscope. An 18 mm x 140mm FCSEMS was placed across the stricture and secured to the antral wall. Three days after discharge, he developed a recurrence of symptoms after advancing his diet to solids. Repeat x-ray and an endoscopic ultrasound (EUS) guided EGD showed the complete migration of the duodenal FCSEMS into the stomach (Panels 1 and 2). The FCSEMS was removed using rat-toothed forceps and an EUS GJ was performed using a 20 mm x 10 mm cautery enhanced LAMS (Panel 3). The patient was able to tolerate both solids and liquids before discharge. Discussion: Despite previously reported benefits of stent anchoring and favorable outcomes of the TaeWoong FCSEMS design, migration occurred. GJ to relieve GOO has emerged as an alternative to refractory cases of endoscopic stenting or surgical GJ, with lower reintervention rates. The use of LAMS to create a GJ successfully mitigated the obstruction in this patient with a complicated hospital course. EUS GJ to relieve obstruction has shown to be promising, and continued research on its safety and efficacy compared to standard therapies (namely FCSEMS) is merited.Figure 1.: 1) X-ray abdomen and pelvis showing the migrated duodenal stent. 2) - Endoscopic view of the migrated FCSEMS in the stomach. 3) - Endoscopic view of the fully deployed LAMS showing the anastomotic connection between the stomach and jejunum, bypassing the duodenal stricture.

S2720 Crohn’s Disease Manifesting as a Jejunal Obstruction at Diagnosis

Introduction: Crohn’s disease is an inflammatory bowel disease caused by transmural inflammation and may affect any portion of the luminal gastrointestinal tract. It is commonly associated with abdominal pain, fatigue, weight loss and diarrhea as the initial presentation. It is vastly uncommon that Crohn’s disease is diagnosed as a bowel obstruction as it initial presentation. We present a gentleman whose initial presentation of Crohn’s disease was a small bowel obstruction from an inflammatory mass. Case Description/Methods: Patient is a 21-year-old male with no significant past medical history who presented to the ED with myalgias, abdominal pain, nausea, and vomiting for one month. He was recently seen at a different hospital for similar symptoms. He underwent EGD which showed Mallory Weiss tears in the esophagus and a gastric emptying study which showed abnormal transit of solids and liquids. He was treated at that time for gastroparesis. On this admission, he had a normal gastric emptying study. He continued to have large amounts of emesis in amounts over one liter in volume. A CT abdomen and pelvis with oral contrast showed marked distention and dilation of the duodenum to the level of the superior mesenteric artery to where there was relative obstruction and moderate narrowing and a stricture in the proximal to mid jejunum with mesenteric nodal prominence. A small bowel series with gastrograffin had similar findings. Patient underwent a laparoscopic small bowel resection where a small bowel mass at the level of the mid jejunum was found, causing focal narrowing and partial obstruction. The mass pathology revealed a central structure with mural thickening and features suggestive of Crohn’s disease. His post operative course was unremarkable, and he followed up with gastroenterology outpatient for evaluation and treatment of his new diagnosis of Crohn’s disease. (Figure) Discussion: Crohn’s disease includes a wide collection of clinical presentations. Small bowel obstruction progresses in moderate to severe cases of Crohn’s, which typically is a chronic issue. To our knowledge, one other case report has been published with the initial presentation of Crohn’s disease manifesting as an obstruction. Our patient had misleading initial work up and isolated jejunal involvement without other intestinal involvement which may have contributed to the delay in his diagnosis.Figure 1.: Left and middle panels reveal the small bowel series with small intestine narrowing and dilatation. Right similarly reveals small bowel dilation and mesenteric nodal prominence.

The Limiting Reagent for Peristalsis

Question: A 62-year-old woman with a history of renal cell carcinoma surgically managed via left nephrectomy and small bowel obstructions treated surgically presented with 4 days of oral intolerance and abdominal distention. Her last bowel movement and flatus were 3 days prior. She was afebrile, vital signs stable, with a white blood cell count of 12.9 × 103/μL. Computed tomography findings were significant for marked distension of the stomach and proximal duodenum, with a transition point in the left midabdomen and distal collapsed loops of small bowel and colon.

Suscetibilidade de caprinos à intoxicação por Tephrosia cinerea

ABSTRACT: Spontaneous and experimental poisoning by Tephrosia cinerea in the northeastern semiarid region of Brazil has only been described in sheep. Pathologically, such poisoning leads to ascites and centrilobular liver fibrosis. However, these effects require an experimental study in goats. This study aimed to determine the goats’ susceptibility to the ingestion of T. cinerea and the minimum toxic dose, describing the main clinical and anatomopathological findings. Poisoning was reproduced experimentally in one sheep that received 10g/kg of the ground plant and in two goats, the first receiving a dose of 5g/kg and the second receiving 10g/kg of the ground plant. The sheep presented abdominal distension 34 days after beginning the ingestion of the plant, developing sternal decubitus, breathing difficulty, opisthotonos, mandibular trismus, salivation, dysphagia, vocalization, and pedaling movements on the 50th day of the experiment. Fluid accumulation was observed in the abdominal cavity and liver via necropsy, with an irregular, slightly whitish capsular surface. Histologically, the main lesions observed in the liver were moderate fibrosis, marked sinusoidal distension, accompanied by marked hemorrhage, sometimes forming bridges between the centrilobular regions, associated with a dissociation of hepatocyte cords. There were discrete Alzheimer’s type II astrocytes in the gray matter in the region of the occipital cortex in the nervous system. Goat 2 showed apathy, drowsiness, and weight loss; on the 62th day, lateral decubitus evolved to sternal decubitus, with a rotation of the neck towards the flank. At necropsy, marked edema was observed on the face and dewlap, and a slight accumulation of liquid; slightly yellowish material was observed in the abdominal cavity. There were discrete blackened areas on the capsular surface in the liver. Histologically, the liver showed mild centrilobular fibrosis associated with mild dissociation of hepatocyte cords and mild vacuolar degeneration of the hepatocyte cytoplasm. Goat 1 showed no clinical signs; at necropsy, discrete multifocal areas were observed in the liver on the capsular surface. Histologically, diffuse intracytoplasmic vacuolar degeneration of hepatocytes was detected. The clinical picture and anatomopathological findings differ between the species, proving the lower susceptibility of goats to Tephrosia cinerea ingestion (compared to sheep), with differences in the pathogenesis and epidemiological aspects of poisoning.

Stercoral Colitis Complicated with Ischemic Colitis in a Myotonic Dystrophy Patient: A Rare Case Report

Stercoral Colitis (SC) is a rare and serious inflammatory condition of the large bowel wall occurs due to distention and increase in the intraluminal pressure secondary to impaction of hard stool. Ischemic colitis may complicate SC and may progress to perforation, and subsequently peritonitis and death if not recognized and treated urgently. Myotonic Dystrophy (DM) has been associated with disorders of the gastrointestinal tract and manifests as reflux, constipation, and dysphagia. Severe colonic impaction, colitis and intestinal pseudo-obstruction, are rarely reported with this condition in the literature. We describe a case of stercoral colitis in a (DM) patient that was successfully treated with conservative measures. We herein present 23-year-old male known case of Myotonic dystrophy (DM) with history of chronic constipation on laxatives, presented with 3 days of abdominal distention, pain, absolute constipation and occasional fecal vomiting. Abdominal exam showed distended abdomen with generalized tenderness with no rigidity or rebound- tenderness. Lab tests were significant for leukocytosis and lactic acidosis. CT (computed tomography) abdomen with contrast: showed marked distention of the rectosigmoid colon with impacted stool, bowel wall thickening and surrounding fat stranding without any finding suggestive of perforation. The patient was diagnosed as case of (SC) with ischemic colitis and treated conservatively with manual evacuation, enema, and laxatives. He dramatically improved and was discharged home. Our conclusion is that stercoral colitis can occur in young patients with a history of chronic constipation like in (DM) patients. Chronic constipation complicated by fecal impaction is the major risk factor for (SC). Computed tomography (CT) is the gold standard imaging modality for the diagnosis of (SC). Elevated lactic acid should raise the suspicion of ischemic colitis complicating the (SC) which requires urgent intervention to prevent the perforation with its consequent high mortality. Early conservative treatment with manual evacuation, enema, and laxatives showed to be effective and decreased the risk of perforation.

Failure to Thrive and Vomiting in a 32-day-old Girl.

Failure to Thrive and Vomiting in a 32-day-old Girl.

S1934 Acute Colonic Ischemia: A Rare Complication of Stevens-Johnson Syndrome

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions characterized by necrotic epidermal detachment and blister formation. Mucosal involvement of oropharyngeal, ocular, and urogenital surfaces is most common, but involvement of the small bowel and colon is distinctively rare. We present a unique case of SJS with colonic involvement resulting in acute colonic ischemia. Case description/methods: A 36 year-old female with systemic lupus erythematosus, hypertension, and asthma presented with one day of fever and emesis after taking ibuprofen for sore throat. On admission, she was febrile to 104°F. Laboratory evaluation was non-diagnostic. A diffuse pink morbilliform rash was noted, which rapidly progressed to widespread erythema, targetoid lesions, and bullae. Skin biopsy was consistent with SJS. A week into hospitalization, she developed respiratory failure requiring intubation and transfer to the intensive care unit. CT of the chest, abdomen, and pelvis revealed multifocal pneumonia but normal small and large bowel. She was treated with broad spectrum antibiotics and one dose of subcutaneous etanercept. The patient then developed worsening abdominal pain and distension. Repeat abdominal CT showed marked diffuse colonic distension with pneumatosis from the cecum to proximal transverse colon (Fig. 1). Abdominal arterial vasculature was patent. Exploratory laparotomy confirmed full thickness colonic ischemia. She underwent right and transverse colectomy with end ileostomy. Histology of the colonic mucosa was consistent with ischemia. She was started on IVIG and IV methylprednisolone therapy. The patient gradually improved. Her recovery was complicated by intra-abdominal and pelvic abscesses requiring percutaneous drainage, along with persistent abdominal pain. Further evaluation of her pain included a normal ileoscopy and upper endoscopy and an abdominal CT demonstrating enteritis which was managed with supportive care. The patient was ultimately discharged to a rehabilitation facility. Discussion: SJS/TEN is a potentially fatal and often drug-induced dermatologic reaction involving mucocutaneous membranes. We present a case of SJS thought secondary to ibuprofen use resulting in acute colonic ischemia, which is infrequently encountered and associated with significant morbidity. Clinicians must maintain high suspicion for gastrointestinal involvement of SJS/TEN to allow for prompt diagnosis and intervention.Figure 1.: Colonoscopy revealing a 5 cm polypoid mass at the hepatic flexure.

A radiolucent bronchial foreign body in a two‐ and a half‐month‐old Labrador Retriever with acute onset respiratory distress

AbstractA two‐ and a half‐month‐old intact male Labrador Retriever was presented to the Texas A&M University Veterinary Medical Teaching Hospital for acute onset respiratory distress with concern for a potential foreign body. Upon intake by the emergency service, the puppy was exhibiting expiratory dyspnoea. Radiographs revealed marked gas distension of the oesophagus and stomach. No radiopaque foreign bodies were identified. Bronchoscopy revealed a dark brown foreign body in the right middle lobe bronchus. The foreign material was pliable and crumbled upon removal attempts with a snare retrieval device. The majority of the foreign body was removed en masse; it most closely resembled faecal material. Three‐view thoracic radiographs performed 1 day post‐endoscopy revealed aspiration pneumonia. The dog was discharged from the hospital with doxycycline, and the pneumonia was nearly resolved at the 1‐week recheck. The dog was sent home with another 2 weeks of doxycycline and made a full recovery at home.