Midgut volvulus due to jejunal diverticula: A case report

Jejunal diverticulosis is uncommon and often asymptomatic. It can produce significant complications, and some complications are potentially life threatening and require early surgical treatment, such as obstruction, hemorrhage and perforation. There is no consensus on the management of this disease. Only a few cases of jejunal diverticulosis with midgut volvulus have been reported. We herein report a case of 57-year-old woman with jejunal diverticulosis causing small bowel volvulus who complained of intermittent upper abdominal pin-prick for 5 years that eventually progressed to a complete obstruction. The computed tomography scans revealed a mesenteric vessel "whirlpool" and laparotomy showed midgut volvulus secondary to jejunal diverticula. This case highlights jejunal diverticulosis causing small bowel volvulus as an uncommon mechanism of small bowel obstruction, which should be included in the differential diagnosis of small bowel obstruction.     

Recurrent abdominal complaints caused by a cecal neurofibroma: a case report

Gastrointestinal involvement of neurof ibromatosis type 1 (NF1, Von Recklinghausen’s disease) is generally associated with the upper gastrointestinal tract. Abdominal manifestation of NF1 includes several tumors such as malignant peripheral nerve sheath tumors, gastrointestinal stromal tumors and ampulla of vater tumors. However, colonic involvement in NF1 patients is rare. We report a case of a patient presenting with dysphagia, weight loss, intermittent abdominal pain and constipation caused by a single c...     

Case of ileus due to an appendix epiploica]

A 79-year-old woman who had an abdominal pain and vomiting admitted to the hospital with a diagnosis of ileus. An ileus tube was inserted and the fluoroscopic study of the small intestine revealed narrowing of the two parts, jejunum and the ileum. Because no improvement was obtained by conservative treatment, an operation was performed. We observed that an appendix epiploica of the sigmoid colon extended long, and its tip was adherent to the retroperitoneum. The small intestine was impacted into the aperture formed by the band. Seventeen cases with intestinal obstruction due to an appendix epiploica have been reported in Japan, including this case.     

Graft kidney hydronephrosis caused by transplant ureter inguinal hernia: A case report

Rationale:Ureteral obstruction of the graft kidney is a common complication of kidney transplantation. However, ureteral obstruction caused by inguinal hernia has rarely been reported. We present a rare case of ureteral obstruction with allograft dysfunction caused by an inguinal hernia.Patient concerns:A 76-year-old man, who was a renal transplant recipient, presented with bilateral pitting oedema, reduced urine output, and right inguinal hernia.Diagnoses:Abdominal computed tomography revealed severe hydroureteronephrosis of the kidney allograft. A right inguinal hernia with ureteral incarceration was observed.Interventions:The patient underwent graft percutaneous nephrostomy, followed by antegrade insertion of a double-J tube (DJ). Gradual improvement was observed in his renal function. Right inguinal herniorrhaphy was performed 5 days later.Outcomes:The renal function returned to normal after percutaneous nephrostomy and insertion of the DJ. A right inguinal direct-type hernia with ureter adhesion to the hernial sac was observed during the surgery. The posterior wall defect was repaired by the McVay technique. The DJ was removed after 1 month. The patient''s renal function remained stable at 6-month follow-up.Lessons:The orientation of the graft kidney has a significant influence on the location of the ureter. Upward orientation of the hilum will result in superficial location of the ureter, rendering it close to the hernial sac and susceptible to incarceration. The transplant surgeon should be aware of such a presentation of graft dysfunction with inguinal hernia to prevent a delay in the diagnosis and graft loss.     

嵌顿于膀胱子宫陷凹的腹内疝致小肠梗阻1例

腹内疝是一种少见的外科急腹症,最常表现为小肠肠管进入正常或异常孔隙而导致的肠梗阻.由于解剖结构的因素,腹内疝有多种类型,但嵌顿于膀胱子宫陷凹的腹内疝迄今未见报道.本文报道嵌顿于膀胱子宫陷凹的腹内疝致小肠梗阻1例.患者女性,35岁,以"下腹突发剧烈绞痛2h"入院.腹部彩超和CT显示小肠肠管扩张,肠管内积液.扩张肠管堆积位于子宫前方与膀胱后方.急诊剖腹探查发现,距回盲瓣40cm处见一约50cm小肠经由膀胱子宫陷凹处疝入,因无肠管血运异常,仅行肠粘连松解术治疗.本病例提示,超声和CT不仅有助于发现小肠梗阻的病因,更有助于各型腹内疝的诊断.     

A case of mucoid impaction of bronchi (MIB) due to Schizophyllum commune]

A 51-year-old woman was admitted because of a productive cough. Atelectasis of the left upper lobe and eosinophilia were noted. The atelectasis was resolved after bronchoscopic removal of the mucous plug. Pathologically, it consisted of eosinophil accumulation with hyphae. Cultures of sputum samples revealed Schizophyllum commune. We diagnosed this case as mucoid impaction of bronchi due to S. commune. Eight months later, a productive cough developed again. Chest radiography showed atelectasis of the right middle lobe. Cultures of bronchial washings yielded S. commune and Aspergillus niger. The atelectasis was resolved by four months of administration of itraconazole (200 mg daily).     

A maternal death due to the intracerebral hemorrhage caused by antiphospholipid syndrome: a case report

Clinical Rheumatology - Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by the presence of antiphospholipid antibodies in patients with arterial or venous thrombosis...     

Syncope upon swallowing caused by an esophageal hiatal hernia compressing the left atrium: a case report

We describe a patient with syncope associated with swallowing. This syncope was caused by transient compression of the left atrium (LA) by an esophageal hiatal hernia. Two-dimensional echocardiography demonstrated a hyperechoic mass compressing the LA from the posterior. With air insufflation of the esophagus, compression of the LA by this hernia sac was seen to increase. Pulsed and color Doppler echocardiography revealed greatly decreased velocity of blood flowing into the LA and left ventricle (LV). Thus, marked compression of the LA by an esophageal hiatal hernia can cause syncope by impeding blood flow from the LA to the LV. Echocardiography proved highly useful in diagnosis.     

Intussusception up to splenic flexure by cecal carcinoma in an adult: report of a case

A 73-year-old woman was admitted because of constipation and appetite loss. She was diagnosed as having intussusception caused by a colonic tumor, based on the results of physical examination and imaging such as ultrasonography, computed tomography and barium enema. Operation revealed that right colon from the cecum up to the hepatic flexure of the ascending colon was not fixed to the retroperitoneum, and a circular cecal carcinoma was invaginated to the splenic flexure of the transverse colon. We experienced a rare case of ileocolic intussusception up to the splenic flexure by a cecal carcinoma with mesenterium ileo-colicum commune in an adult.     

Atrial dissection-like appearance caused by ileus due to metastatic renal cell carcinoma

Atrial dissection is an uncommon entity, defined as a gap from the mitral or tricuspid annular area to the interatrial septum or atrial wall, creating a new chamber with or without communication into the true left or right atrium. We present the interesting images of an atrial dissection-like appearance in the right atrium, which was actually caused by an ileus due to metastatic renal cell carcinoma in a 82-year-old man. The causes of true atrial dissection were also briefly discussed.     

Ileum perforation due to delayed operation in obturator hernia:A case report and review of literatures

A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening ...     

Ileum perforation due to delayed operation in obturator hernia:A case report and review of literatures

A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening ...     

A case of ileus caused by a fecalith in an elderly patient with severe dementia

An 82-year-old woman with severe dementia, living in a nursing home, had severe chronic constipation, possibly due to the presence of multiple risk factors for constipation such as a past history of abdominal open surgery, diabetes, hypothyroidism, and bedridden status. She visited our department accompanied by nursing staff with complaints of nausea and vomiting. Abdominal X-ray films and computed tomography (CT) images showed ileus. We diagnosed strangulation ileus, and performed an emergency laparotomy. There was a mobile cystic lesion located 180 cm from the ileocecal junction which was causing the intestinal obstruction. The cystic lesion was surgically removed via an enterotomy. The greatest dimensions of the cystic lesion were 5 × 3 cm, and it was histologically diagnosed as a fecalith. We report a rare case of ileus caused by a fecalith in an elderly patient.     

Sepsis due to Salmonella Oranienburg--a case report]

A previously healthy 15-year-old female was admitted to our hospital complaining of nausea and vomiting. She did not complain of diarrhea. A physical examination revealed a lower right quadrant abdominal tenderness without rebound or spontaneous pain and a knocking pain of the costovertebral angle. A high fever, knocking pain of costovertebral angle, and urinary findings including Gram's stain, lead us to suspect a urinary tract infection, cefotiam was administered intravenously. Spiking fever with shaking chills continued for three days, and three sets of blood cultures were positive for Salmonella Oranienburg, but her urine culture was negative. Her history was taken again, revealing an intake of a processed squid product. The product was confirmed by the local public health center to be Salmonella Oranienburg. Finally food poisoning by Salmonella Oranienburg with sepsis was diagnosed. With cefotiam she became better and was discharged from the hospital on the 10th hospital day. During admission to the hospital she did not experience any diarrhea, and her stool culture was negative. Epidemics of Salmonella Oranienburg food poisoning are relatively rare in the literature. In Japan, one has arisen as a result of contamination of a processed squid product in March 1999. However, there have been no cases without so-called gastroenteritic symptoms (abdominal pain and diarrhea) who were previously healthy and developed sepsis caused by Salmonella Oranienburg, reported in Japan. Even in previously healthy patients, with an epidemic situation of non-typhoidal salmonellosis, salmonella sepsis must be ruled out. Among such cases, those who present with spiking fever and shaking chills should be given antibiotic therapy after taking appropriate cultures.     

糖皮质激素致乙型肝炎病毒再激活死亡1例报道

我国是乙型肝炎病毒(HBV)感染高流行区,HBV感染者在接受免疫抑制剂或细胞毒性药物治疗期间或之后,可能出现不同程度的HBV再激活,死亡率较高。预防性应用拉米夫定等抗乙肝病毒药物可有效降低HBV再激活发生率和死亡率。本文报道1例糖皮质激素治疗致HBV再激活死亡的病例,并结合文献复习,探讨并提高对HBV再激活的发生率、危险因素、诊断及治疗等的认识。