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Lu W, Yang L, Schulberg JD. An Unusual Cause of Small Bowel Obstruction. Gastroenterology 2024; 166:255-258. [PMID: 37813128 DOI: 10.1053/j.gastro.2023.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Weiwei Lu
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Linda Yang
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Julien D Schulberg
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia.
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Chen Zhou ZH, Ayala Calvo G, Martínez Chamorro E, Ibáñez Sanz L, Sanz de Lucas R, Borruel Nacenta S. Intestinal anisakiasis: CT imaging findings-a 10-year descriptive study in a single center. Emerg Radiol 2023; 30:621-627. [PMID: 37612541 DOI: 10.1007/s10140-023-02166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The aim of this study was to retrospectively review cases of intestinal anisakiasis diagnosed by CT over a 10-year period and to evaluate imaging findings associated with the disease. METHODS This retrospective study included 71 patients with clinical suspicion of intestinal anisakiasis in whom an abdominopelvic computed tomography (CT) was performed at a single institution between June 2011 and December 2021. To identify the cases, we used medical term search engines and the hospital's radiology case database. Clinical information was gathered from the medical records. A radiologist with five years of experience reviewed and analyzed the CT images to determine the characteristic findings of intestinal anisakiasis. RESULTS The study included 47 confirmed cases of intestinal anisakiasis. The mean age of the patients was 52 years (range 18-87 years), being more frequent in men than women (26:21). All patients reported ingestion of raw fish, most commonly anchovies in vinegar (30/47, 63,8%). Abdominal pain was the predominant symptom, accompanied by nausea, vomiting, and occasionally fever. The most common clinical suspicions were intestinal obstruction (14/47, 29,8%) and appendicitis (10/47, 21,3%), whereas intestinal anisakiasis was suspected in only 2 cases prior to imaging. CT showed thickening of the bowel wall with submucosal edema in all patients, predominantly involving the ileum (43/47, 91,5%), usually in a relatively long segment (mean of 17,5 cm, range 10-30 cm). Simultaneous involvement of multiple bowel segments was observed in 16 cases (34%). Intestinal obstruction with dilatation of proximal loops (33/47, 70,2%), ascites (45/47, 95,7%), and mesenteric fat striation (32/47, 68,1%) were also common findings. CONCLUSION This study demonstrates the value of computed tomography in suggesting the diagnosis of intestinal anisakiasis, which often presents with nonspecific clinical manifestations. The characteristic CT findings that provide diagnostic clues are bowel wall thickening with submucosal edema, typically involving a long segment of the ileum, with signs of intestinal obstruction, ascites, and mesenteric fat striation. Simultaneous involvement of several intestinal segments (typically the gastric antrum and right colon) is an additional finding to be considered and may provide a diagnostic clue.
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Affiliation(s)
- Zhao Hui Chen Zhou
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Gerardo Ayala Calvo
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Laín Ibáñez Sanz
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Fuchizaki U, Nagai K, Seike T. Unusual Large Nodules in the Colon. Gastroenterology 2023; 164:e10-e11. [PMID: 35964692 DOI: 10.1053/j.gastro.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Uichiro Fuchizaki
- Department of Gastroenterology, Kahoku Central Hospital, Tsubata, Ishikawa, Japan.
| | - Kazuki Nagai
- Department of Gastroenterology, Kahoku Central Hospital, Tsubata, Ishikawa, Japan
| | - Takuya Seike
- Department of Gastroenterology, Kahoku Central Hospital, Tsubata, Ishikawa, Japan
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Lin SN, Chen ZH, He Y. An Unusual Case of Bowel Obstruction: Diagnosis and Treatment. Gastroenterology 2022; 163:e35-e37. [PMID: 35870516 DOI: 10.1053/j.gastro.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Si-Nan Lin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Hui Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Yao He
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Ewy MW, Chatzopoulos K, Johnson AM. Pathology Out of Place. Gastroenterology 2022; 163:835-837. [PMID: 35643177 DOI: 10.1053/j.gastro.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Matthew W Ewy
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Amanda M Johnson
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Kimia Yavari S, Pourafkari L. Large Bowel Obstruction Secondary to Urinary Retention. Acta Med Acad 2022; 51:64-65. [PMID: 35695405 PMCID: PMC9982847 DOI: 10.5644/ama2006-124.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/17/2022] [Indexed: 03/16/2023] Open
Abstract
No abstract available.
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Affiliation(s)
| | - Leili Pourafkari
- Catholic Health System, Sisters of Charity Hospital, Buffalo, New York, USA.
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Atri E, Mallory C, Perez A, Wong V, Cordon BH. A Case Report of Large Bowel Obstruction in a Patient With an Inflatable Penile Prosthesis. Sex Med 2021; 9:100391. [PMID: 34237684 PMCID: PMC8360932 DOI: 10.1016/j.esxm.2021.100391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Inflatable penile prostheses (IPP) consist of 2 cylinders implanted into the corpora cavernosa, a pump placed in the scrotum, and a saline-filled reservoir traditionally placed in the space of Retzius. IPPs are used to treat refractory erectile dysfunction with few rare, but serious, complications. Cases of reservoirs causing erosion into the bladder, small bowel obstructions, vascular compression, and inguinal herniation have been described. AIM We highlight the importance of keeping a broad differential diagnosis when assessing patients with bowel obstructions. METHODS A 68-year-old man with a previous IPP placement presented with left lower quadrant abdominal pain, constipation and obstipation for 5 days. On exam, he was afebrile, and noted to have a firm, distended, tympanic abdomen. CT scan showed a distended cecum at 11 cm, narrowing of the proximal sigmoid with adjacent inflammatory changes, and minimal peri-colonic air, suggestive of a localized perforation. The IPP reservoir was seen in the left iliac fossa, coinciding with the lead point of the obstruction, suggesting that the reservoir may have itself caused the obstruction. The patient was taken to the operating room for an emergent exploratory laparotomy, which revealed a mass in the colon abutting the IPP reservoir. MAIN OUTCOME MEASURES Considerations for IPP component explantation, factors considered for reintervention, and preservation of penile length with avoidance of penile fibrosis. RESULTS A left colectomy with transverse colostomy was successfully performed and the IPP reservoir was explanted. Intraoperative frozen section revealed adenocarcinoma. Upon initial review of the imaging, it was thought that the IPP reservoir may have caused the obstruction, but intraoperatively, the colonic tumor was found to be the culprit. CONCLUSION Although complications related to IPPs, including bowel obstructions, have been previously described in the literature, treatment for large bowel obstructions must take into account all possible etiologies, including malignancy. Atri E, Mallory C, Perez A, et al. A Case Report of Large Bowel Obstruction in a Patient With an Inflatable Penile Prosthesis. Sex Med 2021;9:100391.
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Affiliation(s)
- Elias Atri
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Chase Mallory
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Alejandra Perez
- Columbia University Division of Urology at Mount Sinai Medical Center, Miami, FL, USA
| | - Vivian Wong
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Billy H Cordon
- Columbia University Division of Urology at Mount Sinai Medical Center, Miami, FL, USA.
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Worland T, Bloom A, Robertson M. An Unusual Case of Small Bowel Obstruction. Gastroenterology 2021; 160:e12-e13. [PMID: 33039463 DOI: 10.1053/j.gastro.2020.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Thomas Worland
- Monash Health, Department of Gastroenterology, Melbourne, Australia.
| | - Ashley Bloom
- Monash Health, Department of Gastroenterology, Melbourne, Australia
| | - Marcus Robertson
- Monash Health, Department of Gastroenterology, Melbourne, Australia
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Qu JY, Li Z. Is It a Crohn's Disease? Gastroenterology 2021; 160:1477-1478. [PMID: 33347882 DOI: 10.1053/j.gastro.2020.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Jun-Yan Qu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Robot engineering laboratory for precise diagnosis and therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Gupta S, Bourke MJ, Burgess NG. Pain and Pigmentation: A Puzzling Presentation. Gastroenterology 2021; 160:1034-1036. [PMID: 33096097 DOI: 10.1053/j.gastro.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Sunil Gupta
- Westmead Hospital, Department of Gastroenterology and Hepatology; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Westmead Hospital, Department of Gastroenterology and Hepatology; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas G Burgess
- Westmead Hospital, Department of Gastroenterology and Hepatology; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
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Stidham RW, Guentner AS, Ruma JL, Govani SM, Waljee AK, Higgins PDR. Intestinal Dilation and Platelet:Albumin Ratio Are Predictors of Surgery in Stricturing Small Bowel Crohn's Disease. Clin Gastroenterol Hepatol 2016; 14:1112-1119.e2. [PMID: 27155551 PMCID: PMC4955711 DOI: 10.1016/j.cgh.2016.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/01/2016] [Accepted: 04/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is a challenge to predict how patients with small bowel Crohn's disease (CD) will respond to intensified medical therapy. We aimed to identify factors that predicted surgery within 2 years of hospitalization for CD, to guide medical versus surgical management decisions. METHODS We performed a retrospective review of adults hospitalized for small bowel CD from 2004 through 2012 at a single academic referral center. Subjects underwent abdominal computed tomography or magnetic resonance imaging within 3 weeks of hospitalization. Imaging characteristics of small bowel dilation, bowel wall thickness, and disease activity were assessed by a single, blinded radiologist. Multivariate analysis by Cox proportional hazards regression techniques was used to generate a prediction model of intestinal resection within 2 years. RESULTS A total of 221 subjects met selection criteria, with 32.6% undergoing surgery within 2 years of index admission. Bivariate analysis showed high-dose steroid use (>40 mg), ongoing treatment with anti-tumor necrosis factor agents at admission, platelet count, platelet:albumin ratio, small bowel dilation (≥35 mm), and bowel wall thickness to predict surgery (P ≤ .01). Multivariate modeling demonstrated small bowel dilation >35 mm (hazard ratio, 2.92; 95% confidence interval, 1.73-4.94) and a platelet:albumin ratio ≥125 (hazard ratio, 2.13; 95% confidence interval, 1.15-3.95) to predict surgery. Treatment with anti-tumor necrosis factor agents at admission conferred a nonsignificant increased trend for risk of surgery (hazard ratio, 1.61; 95% confidence interval, 0.994-2.65). CONCLUSIONS Small bowel dilation >35 mm and high platelet:albumin ratios are independent and synergistic risk factors for future surgery in patients with structuring small bowel CD. Platelet:albumin ratios may capture the relationship between acute inflammation and cumulative damage and serve as markers of intestinal disease that cannot be salvaged with medical therapy.
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Affiliation(s)
- Ryan W. Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Amanda S. Guentner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julie L. Ruma
- Department of Radiology, Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Shail M. Govani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Peter D. R. Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
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