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- Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report. [Journal Article]
- CEClin Endosc 2018 Aug 29
- Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PT...
Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.
- [Transurethral resection of prostate treatment for recurrence of a multilocular prostatic cystadenoma: a case report]. [Journal Article]
- BDBeijing Da Xue Xue Bao Yi Xue Ban 2018 Aug 18; 50(4):740-742
- Multilocular prostatic cystadenoma (MPC) is a rare benign tumor that originates from the prostate itself. MPC is usually characterized by large multilocular cysts located between the rectum and bladd...
Multilocular prostatic cystadenoma (MPC) is a rare benign tumor that originates from the prostate itself. MPC is usually characterized by large multilocular cysts located between the rectum and bladder. The clinical presentation includes obstructive voiding symptoms, such as poor stream, intermittency, sensation of incomplete emptying, acute urinary retention and sometimes constipation symptoms due to mechanical compression of the lower intestine. Most of the previously reported patients with MPC underwent open surgery. Although the natural history of MPC remains unknown, surgical excision may not always be necessary. Here we report the case of a 49-year-old male, treated by transurethral electroresection of prostate (TURP) for prostate cyst one and half years before．His biopsy of TURP showed benign prostatic tissue with no evidence of malignancy. However, the symptoms of urinary tract obstruction were obviously aggravated after the operation. Acute urinary retention occurred intermittently 3 times. In our hospital, his total prostate specific antigen (tPSA) was 5.440 μg/L, free prostate specific antigen (fPSA) was 1.528 μg/L. After examination, it was considered as benign lesions clearly. In the operation of TURP, we found that the tumor was multilocular cystic. Histologically, the cell was mucus. Concerning the immunophenotype, CK5/6(+) , p40(+), PSA(+), P504S(+), PAX-2(-), PAX-8(-), MUC1(+), MUC5ac(+), the results of special staining were as follows: AB(+), PAS(+). At the end of the follow up 3 months later, the routine semen analysis results showed that his semen volume was 3 mL and the sperm density and sperm mobility were normal. At the end of the follow up eight months later, the patient remained free of lower urinary tract symptoms and there were no signs of recurrence. His international prostate symptom score (I-PSS) had dropped from 32 to 4, and quality of life score (QOL) had dropped from 6 to 2. MPC is a rare benign tumor originating from the prostate. TURP may aggravate the symptoms of lower urinary tract obstruction in patients with MPC, and may be temporarily observed for some asymptomatic young and middle-aged patients.
- [Heterotopic tissue in the gastrointestinal tract]. [Review]
- PPathologe 2018 Aug 13
- Heterotopia of the gastrointestinal tract is a common finding. This is due to the complex embryogenesis and the relative ease to detect heterotopic tissue during endoscopy. The reason for biopsy is m...
Heterotopia of the gastrointestinal tract is a common finding. This is due to the complex embryogenesis and the relative ease to detect heterotopic tissue during endoscopy. The reason for biopsy is mostly to rule out neoplasms or to define specific causes of inflammation. Heterotopic tissue can occur in any location of the gastrointestinal tract. The most frequent are gastric heterotopia, pancreatic heterotopia, and heterotopia of Brunner's gland. On rare occasions, heterotopic tissue of salivary gland type as well as heterotopias of apocrine glands, thyroid, and prostatic tissue have been described. The most frequently involved organs are the small intestine, in particular the duodenum, the esophagus, and the stomach. Heterotopia of the large bowel occurs exclusively in the rectum. Most heterotopias do not cause symptoms and are easily diagnosed by biopsy and histology. However, depending on location, size, and the kind of underlying heterotopic tissue, they may cause significant complications, such as inflammation, ulceration and perforation, obstruction, intussusception, and severe life-threatening bleeding. Another rare but significant complication is neoplasia. Gastric heterotopias may give rise to pyloric gland adenomas within the bowel or rarely adenocarcinomas of the esophagus. Pancreatic heterotopia can be complicated by ductal type pancreatic adenocarcinomas, by acinus cell carcinomas, by intraductal papillary mucinous neoplasias, and also by endocrine tumors. The present paper summarizes our current knowledge about heterotopias in a topographic clinico-pathological manner.
- Efficacy of 18-fluoro deoxy glucose-positron emission tomography computed tomography for the detection of colonic neoplasia proximal to obstructing colorectal cancer. [Journal Article]
- MMedicine (Baltimore) 2018; 97(31):e11655
- Identification of secondary colonic neoplasia proximal to obstructing colorectal cancer is essential for determining the range of colorectal resection.We examined the accuracy of 18-fluoro deoxy gluc...
Identification of secondary colonic neoplasia proximal to obstructing colorectal cancer is essential for determining the range of colorectal resection.We examined the accuracy of 18-fluoro deoxy glucose-positron emission tomography (FDG-PET) for detection of colonic neoplasia.We recruited patients with obstructing colorectal cancer from our registry. Preoperative FDG-PET was performed, and the detection rate for colonic neoplasia was estimated. Preoperative colonoscopy or postoperative colonoscopy within a year after operation was employed as the indexed standard.Ninety-three patients were included in this study. Colonic neoplasia proximal to obstruction was confirmed in 83 cases. The sensitivity and positive predictive value of FDG-PET were 25.3% and 77.8%, respectively. The sensitivity was higher in larger lesions (3.2% for <5 mm, 29.4% for 6-10 mm, 45.5% for 11-20 mm, and 71.4% for >21 mm) and in higher pathological grade lesions (14.6% for low-grade adenoma, 38.5% for high-grade adenoma, 66.7% for carcinoma in situ, and 100% for invasive carcinoma). The round shape in PET images was a predictor for neoplasia, with an area under the curve of 0.75293 at an aspect ratio of 1.70.FDG-PET should be used as a screening modality for invasive colorectal cancer (CRC) proximal to obstructing colorectal cancer.
- [The 465th case: intestinal obstruction, gastrointestinal hemorrhage and duodenal fistula]. [Journal Article]
- ZNZhonghua Nei Ke Za Zhi 2018 Aug 01; 57(8):614-616
- This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal blee...
This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn's disease. The patient was treated with thalidomide and recovered well during follow-up.
- Clinical characteristics of lupus enteritis in Japanese patients: the large intestine-dominant type has features of intestinal pseudo-obstruction. [Journal Article]
- LLupus 2018; 27(10):1661-1669
- This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our ...
This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our hospital between 2001 and 2015 were retrospectively reviewed. Diagnosis of lupus enteritis was based on the following three criteria: (1) abdominal symptoms, (2) diffuse long-segment bowel thickening and (3) a requirement for glucocorticoid therapy. Lupus enteritis was identified in 17 patients (3.5%) and there were two distinct types: small intestine-dominant and large intestine-dominant. Significant differences between the two types were noted with respect to the age, frequency of biopsy-proven lupus nephritis, frequency of rectal involvement, maximum bowel wall thickness, and requirement for steroid pulse therapy. Among patients with large intestine-dominant lupus enteritis, 60% had extra-intestinal symptoms (hydroureter, bladder wall thickening, and bile duct dilatation) that are known complications of intestinal pseudo-obstruction. Two patients with large intestine-dominant lupus enteritis developed intestinal pseudo-obstruction either before or after diagnosis of lupus enteritis. Five patients (29%) developed recurrence during a median observation period of 7.2 years (1.4-14.4 years). In conclusion, large intestine-dominant lupus enteritis resembles intestinal pseudo-obstruction and these two diseases may have a common pathogenesis.
- Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States. [Journal Article]
- IEIntern Emerg Med 2018 Jun 12
- Toxic megacolon (TM) is a potentially fatal condition characterized by non-obstructive colonic dilatation and systemic toxicity. It is most commonly caused by inflammatory bowel disease (IBD). Limite...
Toxic megacolon (TM) is a potentially fatal condition characterized by non-obstructive colonic dilatation and systemic toxicity. It is most commonly caused by inflammatory bowel disease (IBD). Limited data for TM are available demonstrating incidence, in-hospital outcomes and predictors of mortality. We sought to investigate incidence, characteristics, mortality and predictors of mortality associated with it. Data were obtained from the Healthcare Cost and Utilization Project (HCUP)'s Nationwide Inpatient Sample (NIS) database from January 2010 through December 2014. An analysis was performed on SAS 9.4 (SAS Institute Inc., Cary, NC). Patients below 18 years were excluded. A mixed-effects logistic regression model was developed to analyze predictors of mortality. Thus, 8139 (weighted) cases of TM were diagnosed between 2010 and 2014. TM is more prevalent in women (56.4%) than in men (43.6%), with a mean age of onset at 62.4 years, affecting whites (79.7%) more than non-whites. The most common reason for hospital admission included IBD (51.6%) followed by septicemia (10.2%) and intestinal infections (4.1%). Mean length of stay was 9.5 days and overall in-hospital mortality was 7.9%. Other complications included surgical resection of the large intestine (11.5%) and bowel obstruction (10.9%). Higher age, neurological disorder, coagulopathy, chronic pulmonary disease, heart failure, and renal failure were associated with greater risk of in-hospital mortality. TM is a serious condition with high in-hospital mortality. Management of TM requires an inter-disciplinary team approach with close monitoring. Patients with positive predictors in our study require special attention to prevent excessive in-hospital mortality.
- Gastrointestinal metastasis of primary lung cancer: An analysis of 366 cases. [Journal Article]
- OLOncol Lett 2018; 15(6):9766-9776
- The gastrointestinal (GI) tract is not a common site of metastasis in primary lung cancer. The aim of the present study was to reveal the clinical and prognostic characteristics of gastrointestinal m...
The gastrointestinal (GI) tract is not a common site of metastasis in primary lung cancer. The aim of the present study was to reveal the clinical and prognostic characteristics of gastrointestinal metastases of lung cancer (GMLC). Information on 366 cases of GMLC was collected and factors that affect severe GI complications were analyzed. Univariate and multivariate survival analyses were performed using the Cox proportional hazards model. Of the cases analyzed, the small intestine (59.6%) and colorectum (25.6%) were the two organs where lung cancer was most likely to metastasize in the GI tract. Squamous cell carcinoma (28.5%), adenocarcinoma (27.6%) and large cell carcinoma (20.9%) were the three most common histological types. However, compared with the histological distributions of primary lung cancer, patients with large cell carcinoma exhibited the highest elevated risk of GMLC [relative risk (RR), 4.07; P<0.001] and those with adenocarcinoma exhibited the lowest risk (RR, 0.58; P<0.001). Differences in organ involvement and in histological type led to varying GI complications. It was also indicated that chemotherapy was associated with a decreased risk of hemorrhage (P=0.006), but there was no reduction in the risk of hemorrhage associated with perforation and obstruction (P>0.05). The median overall survival time of GMLC patients was 2.8 months (range, 0-108 months). The survival analyses revealed that perforation and extra-GI metastasis were negative prognostic factors but abdominal surgery was identified a positive prognostic factor. In conclusion, the histological distribution of GMLC differed from that of primary lung cancer. Sufficient and careful patient evaluation, targeted surgeries and systemic therapies for specific patients are able to increase patient survival rate and improve the quality of life.
- Surgical management of anorectal foreign bodies. [Journal Article]
- NJNiger J Clin Pract 2018; 21(6):721-725
- CONCLUSIONS: A careful assessment is a key point for the correct diagnosis and treatment of AFBs. Clinical conditions of patients and type of AFBs are important in the choice of treatment strategy. If the AFBs are large, proximally migrated or the patients with an AFB have acute abdomen due to perforation, pelvic abscess, obstruction, or bleeding, surgery is needed as soon as possible. There are different types of surgical approaches such as less invasive transanal extraction under anesthesia and more invasive abdominal routes such as laparotomy or laparoscopy. The stoma can be done if there is colonic perforation. In the management of AFBs, the priority must be less invasive methods as possible.
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- Japanese clinical practice guidelines for allied disorders of Hirschsprung's disease, 2017. [Letter]
- PIPediatr Int 2018; 60(5):400-410
- CONCLUSIONS: Clinical practice recommendations for allied disorders of Hirschprung's disease are given for each CQ, along with an assessment of the current evidence. We hope that the information will be helpful in daily practice and future studies.