Abdominal Pain Research Articles

Proximal bowel obstruction caused by high-grade duodenal adenocarcinoma: A rare case

Introduction: Duodenal adenocarcinoma is an exceptionally rare malignancy, constituting less than 0.5% of all gastrointestinal cancers. Its nonspecific symptoms often lead to delayed diagnosis and advanced disease at presentation. Case presentation: A 64-year-old female presented with epigastric pain, nausea, and biliary vomiting. Imaging revealed a proximal small bowel obstruction, and endoscopy identified a high-grade duodenal adenocarcinoma. The patient underwent a successful duodenojejunectomy, side-to-side anastomosis, and lymphadenectomy. Discussion: Post-operative recovery was uneventful, leading to discharge in stable condition. This case underscores the importance of considering duodenal adenocarcinoma in differential diagnoses for small bowel obstruction and highlights the effectiveness of surgical management. Conclusion: Duodenal adenocarcinoma, though rare, should be considered in patients with small bowel obstruction. Early diagnosis and prompt surgical intervention are crucial for favorable outcomes.

Early Detection and Central Nervous System Prophylaxis in Patients With High-Risk Features of Primary Lymphoma of the Female Genital Tract: The Key to Improved Prognosis.

Primary lymphoma of the female genital tract (PLFGT) is a rare disease. The incidence is gradually increasing each year. There have been few reports about PLFGT, and most of them have involved individual cases and small-sample retrospective analyses. The pathogenesis of PLFGT is still under exploration and may be associated with hormones, inflammation/infection, and immunodeficiency. Diffuse large B-cell lymphoma (DLBCL) is the most common pathological type. The majority of the patients presented with vaginal bleeding, abdominal pain, an abdominal mass, and other nonspecific symptoms. Lymphoma-associated B symptoms are quite rare. These patients initially visited gynecological departments, possibly leading to misdiagnosis due to nonspecific features. The treatment strategies for and prognosis of PLFGT differ substantially from those of other gynecologic malignancies. Thus, interdisciplinary cooperation among gynecologists, pathologists, and hematologists is essential.

Renal Abscess Associated with SGLT2 Inhibitors Administration in Heart Failure Without Other Previous Risk Factors: A Case Report

Background and Clinical Significance: Renal abscess represents one infectious urological complication with lethal potential. The treatment of this pathology may differ depending on the severity of the symptoms and the size of the infectious collection. Diabetes, immunosuppression, and associated urinary pathologies are most frequently responsible for the development of abscesses. This case report presents the first documented case of a renal abscess associated with Sodium-glucose cotransporter 2 (SGLT2) inhibitors in a person without previous predisposing pathologies. Case Presentation: A 62-year-old patient presented to the emergency department for pain in the right flank, vomiting, and dysuria. The patient’s medical history revealed Heart Failure New York Heart Association (NYHA) Class II, Coronary Artery Disease (CAD) with prior angioplasty, and permanent Atrial Fibrillation. No prior urological or immunosuppressive conditions were detected. The Computed Tomography (CT) evaluation confirmed the ultrasound suspicion of a right renal abscess performed in the emergency room. The only risk factor identified was the initiation of SGLT2 inhibitor therapy for cardiac pathology approximately 2 months before. According to the small dimensions and urine culture, the abscess was successfully treated with antibiotic administration in collaboration with the urology department. The infectious process was remitted within 2 weeks. Conclusions: To our knowledge this is the first documented case of a renal abscess associated with SGLT2 inhibitor administration in a person without previous predisposing risk factors. Despite the relatively low incidence of urinary tract infections (UTIs) associated with SGLT2 inhibitors, their widespread use in the treatment of various socially significant conditions highlights the need for both patients and medical specialists to be aware of all potential risks and pay increased attention to these cases.

Coral snake envenomation induced acute pancreatitis

Abstract Background Coral snakes belong to the elapid group. They are venomous and are highly neurotoxic, but their bites are not considered lethal to life. We describe a case of coral snake poisoning leading to acute pancreatitis, which is a very rare complication reported in literature after snake envenoming. Case presentation A young female patient presented with complaints of generalized weakness, muscle spasms, and respiratory distress after the coral snake bite 1 day ago. She had bilateral ptosis and muscle power of 3/5 in all her limbs at the time of presentation for which she received anti-venom along with low-dose intravenous neostigmine in our hospital which improved her ptosis and muscle weakness gradually over 3 days. On day 4th of her admission, she developed severe generalized abdominal pain and tenderness in the epigastrium. Acute pancreatitis was diagnosed after appropriate investigations which was treated with supportive therapy, and the patient improved clinically. Conclusion Acute pancreatitis after coral snake envenomation is a rare and serious complication. Timely identification and initiation of appropriate management can improve clinical outcome of the patient.

Case report: Successful treatment of a thallium sulfate intoxication in a dog with use of Prussian blue

Soluble thallium salts are highly toxic, with mortality rates exceeding 70% in animals compared to 6%−15% in humans. Early identification of thallium intoxicated patients and decreasing the toxic load by targeted treatment using Prussian Blue are associated with a better outcome in humans. Prussian blue, however, is rarely available or used in veterinary settings. Here we present a rare report of the successful use of Prussian Blue in the management of a dog with a thallium intoxication. A 5-year-old miniature Schnauzer, ingested a thallium sulfate based rodenticide leading to lethargy, anorexia, regurgitation, abdominal pain, borborygmi, constipation, ataxia, dermatitis and progressive alopecia. Intervention involved supportive care with subcutaneous fluids, carprofen, butylscopolamine and dexamethasone in combination with targeted treatment using the chelating agent Prussian blue (15 days) followed by activated charcoal (4 days). The serum thallium concentration on the 5th day of the Prussian Blue treatment was 196 mcg/L confirming thallium intoxication. The serum thallium concentrations were 20.7 mcg/L and 21.5 mcg/L on days 14 and 34 of treatment, respectively. The calculated elimination half-life during the during PB treatment was 2.8 days. The patient showed gradual improvement over several weeks, achieving full recovery at 11 weeks. This case emphasizes the importance of a timely diagnosis and the early start of targeted therapy using Prussian blue, in the management of thallium intoxication in veterinary patients.

First detection and molecular characterization of porcine epidemic diarrhea virus (PEDV) in India: evidence of a new variant in Karnataka

BackgroundPorcine epidemic diarrhea (PED) is a significant pig disease causing high mortality in suckling pigs and high morbidity across all age groups. It is highly prevalent in Southeast Asia, posing a threat of transboundary transmission to India. Although antibodies were detected as early as 2003 in Assam, there was no evidence of viral detection or molecular characterization until this study. This study reports the first clinical outbreak of PED in India, followed by the detection and genetic characterization of PED virus (PEDV) during 2022-23.MethodsThe outbreak was characterized, and fecal samples (n = 21) were collected from affected pigs. These samples were screened for PEDV using RT-PCR, targeting the N, S, and M genes. Serosurveillance was conducted in eight districts, and serum samples (n = 339) were tested for PEDV antibodies using ELISA. Partial N, S, and M gene sequencing, followed by phylogenetic analysis using MEGA v11.0.13, was performed to identify the prevailing genotype and variations in the coding region.ResultsThis study identified the first clinical outbreak of PEDV in India, with morbidity rates of 55-57.1% and symptoms including yellow watery diarrhea, vomiting, and abdominal pain. PEDV was confirmed in 17 of 21 fecal samples by amplifying the N, S, and M genes. Serosurveys showed seropositivity in Mandya (2.8%), Bengaluru Rural (6.6%), and Kolar (21.6%), districts indicating PEDV circulation in the state of Karnataka, India. The phylogenetic analysis of the S and M genes placed our study sequences within the Genotype 2a (G2a) clade, aligning with other known G2a strains. In contrast, the phylogenetic tree of the N gene clustered our sequences within the Genotype 1a (G1a) clade suggesting potential recombination. The Indian PEDV strains clustered with strains of China, with unique amino acid substitutions in the S gene, particularly in the receptor binding region.ConclusionThis study reports the first clinical outbreak of PED in India and identifies the circulating genotype of PEDV. The study emphasizes the need for large-scale surveillance studies to understand the disease’s status. Understanding PEDV’s genetic diversity and evolution is essential to develop area-specific vaccines to mitigate the disease impact on India’s pig population.

Towards painless and productive research relationships: reflections on study design by a researcher with chronic pain for participants with chronic pain

Building flexibility into the research design of a study allows for responsiveness to the embodied and fluctuating nature of participants’ chronic illnesses, which may be shaped, for instance, by flare-ups and periods of remission of acute pain. Whilst the methodology literature has, to some extent, considered how to accommodate the pain of research participants when designing a study, consideration of how methodological choices are responsive to the researcher's pain needs has not to date been foregrounded. From the perspective of a researcher with Ankylosing Spondylitis (AS), a form of inflammatory arthritis characterized by chronic pain, and Crohn's disease, a type of inflammatory bowel disease, characterized by stomach and joint pain, this paper provides insight into pain and researcher-participant relationships, from the perspective of a researcher in pain, designing a study to accommodate her own pain needs, as well as anticipating the needs of prospective participants in pain. This paper proposes the use of flexible, remote, and asynchronous research methods as ways to make studies inclusive for researchers living with pain, whilst fostering the most fruitful research relationships with participants who also live with pain, thereby moving towards a position of shared vulnerability. It also highlights the relative absence of the researcher's needs and possible vulnerability in ethics forms and considered by research ethics committees, in comparison to the needs and vulnerability of participants.

German surgeons' perspective on the application of artificial intelligence in clinical decision-making.

Artificial intelligence (AI) is transforming clinical decision-making (CDM). This application of AI should be a conscious choice to avoid technological determinism. The surgeons' perspective is needed to guide further implementation. We conducted an online survey among German surgeons, focusing on digitalization and AI in CDM, specifically for acute abdominal pain (AAP). The survey included Likert items and scales. We analyzed 263 responses. Seventy-one percentage of participants were male, with a median age of 49 years (IQR 41-57). Seventy-three percentage of participants carried out a senior role, with a median of 22years of work experience (IQR 13-28). AI in CDM was seen as helpful for workload management (48%) but not for preventing unnecessary treatments (32%). Safety (95%), evidence (94%), and usability (96%) were prioritized over costs (43%) for the implementation. Concerns included the loss of practical CDM skills (81%) and ethical issues like transparency (52%), patient trust (45%), and physician integrity (44%). Traditional CDM for AAP was seen as experience-based (93%) and not standardized (31%), whereas AI was perceived to assist with urgency triage (60%) and resource management (59%). On median, generation Y showed more confidence in AI for CDM (P = 0.001), while participants working in primary care hospitals were less confident (P = 0.021). Participants saw the potential of AI for organizational tasks but are hesitant about its use in CDM. Concerns about trust and performance need to be addressed through education and critical evaluation. In the future, AI might provide sufficient decision support but will not replace the human component.

A case study on efficacy of Ayurvedic medicines for expulsion of Renal stones

Renal stone disease is a prevalent health concern today. Patients suffering from renal calculi often hesitate to undergo surgery unless absolutely necessary, seeking non-invasive medical management through Allopathic, Homeopathic, or Ayurvedic systems. Lithotripsy is a common surgical intervention for recurrent kidney stones. In Ayurveda, renal stones are described as Mutrashmari, categorized under Ashtamahagada, and are considered a Kaphapradhan Tridoshaja Vyadhi. This case study presents a 42-year-old female patient experiencing left-sided abdominal pain radiating to her back, along with burning and obstructed micturition. Advised to undergo lithotripsy at a private hospital, she opted against the invasive procedure and sought Ayurvedic treatment instead. The successful management and expulsion of her renal stone through Ayurvedic medicines underline their efficacy as a non-invasive alternative for treating renal calculi.

New Insights into Ruling Out Internal Herniations After Laparoscopic Gastric Bypass on the Abdominal CT Scan: The OPERATE study.

Internal herniation (IH) is a potentially life-threatening complication after gastric bypass. Accurate diagnosis of IH remains challenging. This study aims to validate the Eindhoven2020 (EHV20) scoring system for ruling out IH and seeks to improve its diagnostic accuracy through additional radiologic parameters. Patients participating in a prospective study on abdominal pain after gastric bypass surgery were selected if a CT scan was performed. CT scans were scored following the EHV20 scoring system containing ten signs of IH to confirm the individual and collective accuracy of these signs. Also, we evaluated the diagnostic value of additional radiologic parameters: delayed passage of contrast, dilated intestinal loops, and free fluid. A total of 375 patients with abdominal pain were included. IH was confirmed during laparoscopy in 27 patients. On CT, the highest sensitivity was achieved by the swirl sign (66.7%) and the highest specificity by a small bowel behind the superior mesenteric artery (99.7%). The area under the receiver operating characteristic curve (AUC) based on the EHV20 scoring system for ruling out IH was 0.845 (95% CI 0.730-0.959). The AUC could be improved to 0.905 (95% CI 0.825-0.985) (p = 0.088) through the incorporation of several additional signs. Overall, this new scoring system included swirl sign, small bowel obstruction, enlarged nodes, venous congestion, mesenteric edema, dilated alimentary or biliary loop, free fluid, and backward flow in the biliary loop with possible backflow in the residual stomach. Incorporation of additional CT signs into an existing scoring system can help clinicians to safely rule out IH in patients with abdominal pain after bariatric surgery.

Investigation of Microvascular Involvement Through Nailfold Capillaroscopic Examination in Children with Familial Mediterranean Fever

Background and Objectives: Familial Mediterranean fever (FMF) is a lifelong autoinflammatory disease characterized by episodes of fever and aseptic polyserositis. Commonly associated with vasculitis, FMF’s impact on microcirculation was investigated by examining nailfold capillaries using capillaroscopy. Materials and Methods: This study included 32 female and 28 male FMF patients diagnosed according to the Tel Hashomer and Yalçınkaya criteria and a control group of 20 female and 10 male age-matched cases. Demographic characteristics, medical history (abdominal pain, fever, chest pain, and joint pain), and physical examination findings of the cases were assessed. FMF gene mutations, acute-phase reactants, urine analysis, and spot urine protein/creatinine ratios were evaluated. Nailfold capillaries were examined via capillaroscopy by the same dermatology specialist. Results: There was no significant age or gender difference between groups. The most common symptoms in the case group were abdominal pain (81.7%) and joint pain (65%). Pathological findings in capillaroscopy, such as microhemorrhages and avascular areas, were significantly more frequent in the FMF case group (p < 0.001; p < 0.001). Physiological findings, including hairpin-shaped capillaries and shortened loops, were significantly more common in the control group (p = 0.001; p = 0.034). No significant relationships were found between kidney involvement, subclinical inflammation, presence of microhemorrhages and avascular areas in capillaroscopy, and disease duration. Additionally, no significant differences were observed in capillaroscopic findings between those with exon-10 mutations in the MEFV gene and those with non-exon-10 mutations. Conclusions: In conclusion, our study demonstrated secondary microvascular findings due to inflammation in FMF patients using capillaroscopy, a cost-effective and safe tool.

Machine learning for predicting severe dengue in Puerto Rico

BackgroundDistinguishing between non-severe and severe dengue is crucial for timely intervention and reducing morbidity and mortality. World Health Organization (WHO)-recommended warning signs offer a practical approach for clinicians but have limited sensitivity and specificity. This study aims to evaluate machine learning (ML) model performance compared to WHO-recommended warning signs in predicting severe dengue among laboratory-confirmed cases in Puerto Rico.MethodsWe analyzed data from Puerto Rico’s Sentinel Enhanced Dengue Surveillance System (May 2012–August 2024), using 40 clinical, demographic, and laboratory variables. Nine ML models, including Decision Trees, K-Nearest Neighbors, Naïve Bayes, Support Vector Machines, Artificial Neural Networks, AdaBoost, CatBoost, LightGBM, and XGBoost, were trained using fivefold cross-validation and evaluated with area under the receiver operating characteristic curve (AUC-ROC), sensitivity, and specificity. A subanalysis excluded hemoconcentration and leukopenia to assess performance in resource-limited settings. An AUC-ROC value of 0.5 indicates no discriminative power, while values closer to 1.0 reflect better performance.ResultsAmong the 1708 laboratory-confirmed dengue cases, 24.3% were classified as severe. Gradient boosting algorithms achieved the highest predictive performance, with an AUC-ROC of 97.1% (95% CI: 96.0–98.3%) for CatBoost using the full 40-variable feature set. Feature importance analysis identified hemoconcentration (≥ 20% increase during illness or ≥ 20% above baseline for age and sex), leukopenia (white blood cell count < 4000/mm3), and timing of presentation at 4–6 days post-symptom onset as key predictors. When excluding hemoconcentration and leukopenia, the CatBoost AUC-ROC was 96.7% (95% CI: 95.5–98.0%), demonstrating minimal reduction in performance. Individual warning signs like abdominal pain and restlessness had sensitivities of 79.0% and 64.6%, but lower specificities of 48.4% and 59.1%, respectively. Combining ≥ 3 warning signs improved specificity (80.9%) while maintaining moderate sensitivity (78.6%), resulting in an AUC-ROC of 74.0%.ConclusionsML models, especially gradient boosting algorithms, outperformed traditional warning signs in predicting severe dengue. Integrating these models into clinical decision-support tools could help clinicians better identify high-risk patients, guiding timely interventions like hospitalization, closer monitoring, or the administration of intravenous fluids. The subanalysis excluding hemoconcentration confirmed the models’ applicability in resource-limited settings, where access to laboratory data may be limited.Graphical

Case report: Successful laparoscopic management of early abdominal pregnancy

BackgroundAbdominal pregnancy is characterized by the implantation of the gestational sac within the peritoneal cavity, specifically outside the fallopian tubes, ovaries, and cervix. This exceedingly rare form of ectopic pregnancy accounts for about 1% of all ectopic pregnancies. When rupture occurs, it can result in a life-threatening situation for the patient, necessitating immediate medical intervention.Case informationIn this study, we report a 33-year-old female patient who presented with abdominal pain and was subsequently diagnosed with an early abdominal pregnancy. Laparoscopic intervention revealed gestational tissue and a rupture site located in the pouch of Douglas. The gestational tissue was successfully excised via laparoscopy, and the rupture site was sutured to achieve hemostasis. Postoperative histopathological analysis confirmed the presence of chorionic villi and trophoblast cells.ConclusionThis case highlights the critical importance of precise diagnosis and laparoscopic intervention in the management of abdominal pregnancy. It is imperative for clinicians to exercise a prudent approach in the diagnosis and treatment of abdominal pregnancy, utilizing a comprehensive assessment that integrates medical history, clinical manifestations, and auxiliary diagnostic tests to enhance the detection and comprehension of this condition.

Unveiling 12th Rib Syndrome: A Case Report of 2 Cases and Diagnostic Insights

Abstract Twelfth (12th) rib syndrome, a rare condition that causes hypochondrial and flank pain, involves the irritation or entrapment of the 12th intercostal nerve due to structural abnormalities or trauma to the 12th rib. This study presents a case report of a 54-year-old gentleman with persistent left hypochondrium pain and a 78-year-old lady with unremitting right hypochondrium pain despite multiple outpatient department visits in different sub-specialties over a prolonged period of time. The patients were evaluated and diagnosed with 12th rib syndrome. This article aims to enhance the awareness of 12th rib syndrome among clinicians, underscore the importance of considering it in differential diagnoses for hypochondrium pain, and provide insights into effective management approaches.

Development of a Pediatric Age-Based and Weight-Adjusted Nomogram for Bladder Volumes Associated With Successful Completion of Transabdominal Pelvic Ultrasound (TPU).

To develop a nomogram for pediatric bladder volumes associated with the successful completion of transabdominal pelvic ultrasound (TPU) in female pediatric patients presenting with lower abdominal and/or pelvic pain in the emergency department. This study hypothesizes that the target bladder volumes for successful TPU vary by age and weight. We retrospectively calculated bladder volumes on all successful transabdominal pelvic ultrasound studies during a 2-year period for patients 8 to 18 years old by ellipsoid bladder volume formula using the largest cross-sectional areas captured on transverse and longitudinal cine clips. Measurements were collected by 2 study personnel with initial measurements validated by a pediatric radiologist. Bladder volume by age and weight percentile groups were descriptively analyzed, and a quantile regression model was used to regress bladder volume on age adjusting for patient weight. We analyzed bladder volumes from 1030 successful transabdominal pelvic ultrasound studies. The greatest drop in median volume was seen amongst non-overweight children in younger age groups. Nomogram bladder volumes for transabdominal pelvic ultrasound increase consistently with age and weight until approximately 13 years old and 60kg, respectively, with minimal change thereafter in patients 13 to 18 years old. We provide a pediatric age-based and weight-adjusted nomogram for bladder volumes associated with successful transabdominal pelvic ultrasound imaging. Further evaluation of its use is warranted to decrease inefficiency in bladder filling prior to TPU completion and improve timeliness in diagnosing pelvic emergencies.

Navigating diagnostic challenges: case reports on differentiating uterine fibroids from leiomyosarcoma through imaging and clinical evaluation.

Differentiating between uterine fibroids and leiomyosarcoma poses significant challenges, particularly in cases of atypical fibroid degeneration. Accurate diagnosis is crucial for appropriate treatment and patient outcomes. We present two case reports to illustrate the complexities involved in distinguishing these conditions. Both cases involved patients with similar clinical presentations and imaging findings. The diagnostic process included trans-abdominal and trans-vaginal ultrasound, CT scans, and histopathological examination. In Case 1, the patient presented with worsening abdominal pain and imaging revealed multiple myomas. Histological examination confirmed benign fibroids following surgery. Case 2 involved a patient with an abdominal mass and CT findings suggestive of a fibroid. However, ultrasound characteristics raised suspicion of malignancy, and subsequent histopathological analysis confirmed leiomyosarcoma. These case reports underscore the importance of combining clinical evaluation with advanced imaging techniques for accurate differentiation between uterine fibroids and leiomyosarcoma. While ultrasound plays a critical role, its effectiveness is enhanced by the experience of the sonographer and the integration of other diagnostic modalities. Future multicenter studies should focus on refining these diagnostic approaches to improve accuracy and patient outcomes.

Leiomyosarcomas of the inferior vena cava: diagnostic features on contrast-enhanced CT, ultrasonography and MRI

PurposeTo evaluate clinical presentation and imaging characteristics of leiomyosarcomas of the inferior vena cava (IVC LMS) using contrast-enhanced CT (CECT), ultrasonography (US), magnetic resonance imaging (MRI), and to identify features that facilitate early and accurate pre-operative diagnosis.Materials and methodsOur study enrolled 21 patients with pathologically confirmed IVC LMS from October 2015 to June 2022. All participants underwent CECT, and additionally, 12 participants had US examinations and 3 had MRI. Images were independently reviewed by two experienced radiologists. The clinical presentations and diagnostic characteristics were recorded.ResultsThe study involved 16 female and 5 male patients, with an average age of 55 ± 11 years (ranging from 34 to 80 years). Common clinical symptoms included abdominal pain, back pain, leg discomfort, abdominal distension, jaundice, and the presence of an abdominal mass. On CT scans, a large, lobulated, heterogeneous mass with progressive enhancement was typically seen in 13 of the 21 patients (61.9%). Ultrasonography revealed that IVC LMS typically presented as a lobulated, heterogeneous, hypoechoic mass. Color Doppler imaging evaluated lumen obstruction in 8 of the 12 patients (66.7%), and high velocity flow signals were detected by Pulsed wave Doppler in 4 of the 12 patients (33.3%). On MRI, IVC LMS presented as a heterogeneous mass that exhibited intermediate intensity on T1-weighted images, slightly high intensity on T2-weighted images and high intensity on diffusion-weighted images.ConclusionSeveral diagnostic characteristics on CECT, US and MRI could aid in the diagnosis of IVC LMS. The detection of a heterogeneous mass with progressive enhancement along the inferior vena cava on CECT was strongly indicative of IVC LMS. Both CT and US are effective in accurately indicating the location of the tumor within the IVC.

Pneumatosis intestinalis in systemic sclerosis: navigating diagnostic and therapeutic challenges.

Pneumatosis intestinalis, characterised by the presence of intramural bowel gas, is a radiological finding with varied clinical implications, ranging from incidental detection to severe underlying pathology, including bowel ischaemia or perforation. Its association with systemic sclerosis, a connective tissue disorder, remains rare and poorly understood, presenting unique diagnostic and therapeutic challenges. A comprehensive literature review was conducted, analysing 34 documented cases of pneumatosis intestinalis associated with systemic sclerosis, examining demographic profiles, clinical features, diagnostic findings, and outcomes of various management strategies. Pneumatosis intestinalis in systemic sclerosis predominantly occurs in older female patients and is associated with gastrointestinal dysmotility and microvascular damage. Symptoms range from asymptomatic presentations to severe abdominal pain with obstructive symptoms, with the latter increasing the likelihood of surgical intervention. Non-operative management, encompassing antibiotic therapy, oxygen supplementation, and dietary modifications, was associated with favourable outcomes and the lowest mortality. In contrast, surgical intervention, often necessitated by suspected ischemia or perforation, was associated with significantly higher morbidity and mortality. Pneumatosis intestinalis in systemic sclerosis is a complex clinical entity demanding a nuanced, multi-disciplinary approach to management. Non-operative management should remain the cornerstone of treatment for clinically stable presentations, with surgery reserved for those with clear indications. The absence of standardised guidelines underscores the need for further research to refine diagnostic criteria and therapeutic protocols, ultimately improving long-term outcomes in this complex intersection of gastrointestinal and systemic disease.

Pancreaticojejunostomy Obstruction Due to Jejuno-Jejunal Intussusception in the Roux Limb: A Rare Late Complication Following Longitudinal Pancreaticojejunostomy

Abstract Lateral pancreaticojejunostomy (LPJ) is done as a decompressive procedure for chronic pancreatitis with dilated main pancreatic duct (MPD) with a success rate of up to 80% in relieving pain with low morbidity and mortality. Roux limb obstruction following Roux-en-Y LPJ is a very rare complication and it has not been described earlier. Here, we report a rare case of pancreaticojejunostomy (PJ) obstruction caused by jejuno-jejunal intussusception in the Roux limb. We present a case of a 31-year-old lady with recurrent episodes of intermittent colicky upper abdominal pain for 8 months. She underwent Roux-en-Y LPJ 20 years back for idiopathic chronic calcific pancreatitis. Her imaging revealed dilated MPD with a dilated Roux limb due to narrowing in the distal roux limb with intussusception. She underwent robotic-assisted resection of jejuno-jejunal intussusception and anastomosis along with cholecystectomy. She recovered well post-operatively and her pain subsided. PJ obstruction following pancreatoduodenectomy has been reported in the literature. However, similar presentation is rare following LPJ. This is the first ever case to be reported with Roux limb obstruction following LPJ. We present this case to emphasise the importance of high-quality imaging in diagnosing this rare case. Robotic-assisted surgery in adults for intussusception is a novel approach and not much discussed in the literature.

Stones Unearthed: A Journey to Wellness with Ayurvedic Urolithiasis (Mutraashmasri) Management

Urolithiasis is a prevalent clinical condition impacting over 10% of the population in industrialized nations, causing symptoms like intense renal pain, lower abdominal discomfort, painful urination, and cloudy or foul-smelling urine. Despite various medical treatments, managing renal calculi proves financially burdensome, with recurrent stone formation posing a persistent challenge. Ayurvedic diagnostics, including assessing individual constitution (Prakriti), urine (Mutra), and pulse (Nadi), lay the foundation for understanding Mutraashmari causes. Renal calculi are closely linked to Agni (digestive fire) imbalances and the accumulation of Ama (toxins). Ayurvedic interventions aim to enhance Agni, eliminate Ama, and restore Doshic equilibrium, encompassing dietary changes, lifestyle adjustments, and herbal formulations. This case report presents a 45-year-old male with renal calculi (7.7mm at ureteropelvic junction and 7.4mm at ureter-bladder junction) experiencing severe pain, backache, hematuria, and recurrent urinary tract infections. After ineffective allopathic treatment, the patient sought Ayurvedic care, achieving complete urolithiasis dissolution within one month.