Urothelial carcinoma masquerading as retroperitoneal fibrosis: A case report

Retroperitoneal fibrosis, a rare and often idiopathic condition, poses significant diagnostic challenges. While most cases are considered idiopathic or immune-mediated, a small but important proportion are associated with malignant neoplasms, with implications for prognosis and management. The present study describes the case of a 69-year-old man who presented to the emergency department of the Virgen de las Nieves University Hospital (Granada, Spain), with a 2-week history of epigastric pain, vomiting and altered bowel habits. Laboratory investigations revealed previously undiagnosed renal insufficiency. An abdominal computed tomography (CT) scan showed extensive diffuse retroperitoneal infiltration extending from the periduodenal region to the pubic bone, resulting in gastric dilatation and hydronephrosis. A CT-guided retroperitoneal biopsy was performed and pathology confirmed the presence of urothelial carcinoma. This diagnosis led to the initiation of a chemotherapy regimen consisting of carboplatin and gemcitabine specifically designed for urothelial carcinoma. A follow-up 18F-FDG PET scan performed 6 months later showed a partial functional response. This case illustrates a rare presentation of urothelial carcinoma masked by extensive retroperitoneal fibrosis, and highlights the importance of accurate diagnosis in reducing tumor burden and improving the clinical status of patients.

Retching Without Vomiting With Acute Abdominal Distension: A Clinical Cue

Gastric volvulus leading to acute gastric dilatation is a rare presentation of congenital diaphragmatic hernia. Urgent detorsion with gastropexy and closure of the diaphragmatic defect are essential to prevent further complications and recurrence. We present a rare case of an infant with acute gastric dilatation due to acute gastric volvulus secondary to congenital diaphragmatic hernia.

Massive Gastric Dilatation and Multi-Organ Ischemia Due to Superior Mesenteric Artery Syndrome: A Rare Case Report

BACKGROUND Superior mesenteric artery (SMA) syndrome, a rare condition in which the SMA and aorta occlude the third duodenal portion, can cause serious complications. We present the case of an 83-year-old Japanese man who presented with shock because of massive gastric dilatation due to SMA syndrome and developed multi-organ ischemia. CASE REPORT The day before admission, the patient had visited the emergency department with abdominal pain and was sent home following spontaneous symptom resolution, but experienced abdominal pain flare-up. His history included diabetes mellitus, hypertension, gastric ulcer, prostatic hypertrophy, esophageal hiatal hernia, and esophageal cancer. Plain computed tomography showed gastric dilatation and obstruction of the duodenal third portion by the SMA, leading to SMA syndrome diagnosis. Since a nasogastric tube could not be manually inserted into the stomach and the gastric dilatation could not be decompressed, the tube was inserted endoscopically. Endoscopy revealed mechanical obstruction of the gastric cardia and gastric mucosal ischemia. He was admitted to intensive care, and blood pressure was maintained with vasopressors and blood transfusion. The next day, contrast-enhanced computed tomography performed for persistently elevated lactate levels revealed extensive ischemia affecting multiple gastrointestinal organs. Surgery and other treatments were considered too risky due to the patient's advanced age and condition. Best supportive care was administered after discussion with the family, and he died on the second day of hospitalization. CONCLUSIONS SMA syndrome with extensive ischemia and infarction is rare. Given this, clinicians should remain vigilant for its potential complications.

Binge eating after a religious fast: Acute gastric dilation causing perforation - a case report

Acute gastric dilation after binge eating may lead to ischaemic necrosis and perforation of the gastric wall. Though rarely seen owing to the rich blood supply of the stomach, its sequelae may be avoided by prompt decompression of the dilated stomach. We present such a case heretofore rarely reported from India.

Gastric dilatation in patients with restrictive eating disorders

OBJECTIVES

To better understand gastric dimensions in patients diagnosed with restrictive eating disorders (EDs).

METHOD

In this retrospective study, 56 patients, with restrictive EDs, and 60 gender/age/race-matched patients from an outpatient clinic, were studied. Difference in stomach size, between cohorts, was ascertained, and regression analyses were used to examine associations with stomach size in the ED cohort.

RESULTS

Patients with EDs were found to have significantly enlarged gastric dimensions when compared to the control group (M:14.8 cm [SD: 3.2] vs. 11.4 cm [SD: 2.9], p < .0001). Among the ED cohort, blood urea nitrogen (BUN), on the day of imaging, positively correlated with gastric dimensions (r = .43, p = .0009), while hypoalbuminemia negatively correlated with gastric dimensions (r = -.37, p = .005). BUN and albumin nadir were also significantly associated with stomach size (r²  = .26, F[2,53] = 9.46, p = .0003). There was no significant correlation between gastric dimensions and ED diagnosis, percent ideal body weight, gender, duration of illness, engagement in vomiting behaviors, diagnosis of superior mesenteric artery syndrome, or use of promotility agents.

DISCUSSION

Findings in this study suggest that malnutrition, secondary to EDs, may be associated with an enlarged stomach. The relationship between the gastric dimensions and reported GI symptoms in this population remain to be determined.

PUBLIC SIGNIFICANCE

There are many physiologic changes to the gastrointestinal system that develop with malnutrition but the contribution of these physiologic changes toward the reported GI symptoms and refeeding difficulties is unclear. This is the first study to suggest that patients with malnutrition, secondary to EDs, may be associated with an enlarged stomach, and this potential relationship requires further investigation.

Acute Gastric Dilatation Complicated by Necrosis and Perforation Following a Binge Eating Episode

Acute gastric dilatation is a rare entity limited to case reports in the literature. It is characterized by significant distention of the stomach beyond physiologic parameters. The sequelae of this phenomenon are life-threating, as it can lead to gastric perforation. It is frequently reported in patients who suffer from eating disorders, particularly binge eating disorder and bulimia nervosa. We present a case of a 28-year-old female who suffered from acute gastric dilatation following significant food intake. Her long hospital course was complicated by gastric necrosis and perforation, requiring multiple laparotomies prior to the restoration of a functional gastrointestinal tract. We aim to demonstrate the true gravity of this diagnosis and raise its awareness.

Liver Lobe Torsion in a Guinea Pig (Cavia porcellus)

A 5-year-old, female intact guinea pig (Cavia porcellus) presented for acute inappetence. The abdomen was severely distended and tympanic with moderate discomfort. Radiographs showed gastric distension and displacement. Gastric dilatation and volvulus were suspected. At necropsy, the left lateral liver lobe was torsed at the hilus and infarcted. Histopathology showed regionally extensive coagulative necrosis and markedly congested sinusoids, causing marked hepatic cord atrophy and dissociation. Final diagnoses were severe gastric dilatation with left lateral liver lobe torsion (LLT) and regionally extensive liver infarction, and hemoabdomen. Reports of LLT in guinea pigs are likely underrepresented in the literature. LLTs should be considered in guinea pigs presenting for acute inappetence and abdominal distension. Laboratory tests and abdominal ultrasound can help differentiate LLT from other gastrointestinal pathologies seen in guinea pigs, such as gastric dilatation and volvulus. Early recognition of LLT in guinea pigs could potentially improve patient outcomes. This is the first published report of LLT in a guinea pig.

Gigantic Stomach: A Rare Manifestation of Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is characterized by degeneration and atrophy of skeletal, cardiac, and smooth muscles after a latent period of apparently normal development and function. The gastrointestinal manifestations start in the second decade of life and are mainly due to atrophy of smooth muscle layers. Refractory gastroparesis and chronic constipation can lead to severe gastric and small bowel dilatation, which can be life threatening. Here, we present a case of a 21-year-old male with a gigantic stomach secondary to DMD resolved with conservative management and no surgical intervention.

Manual vs pressure-controlled facemask ventilation during the induction of general anesthesia in children: A prospective randomized controlled study

BACKGROUND

Gastric insufflation frequently occurs during facemask ventilation in children. In the present study, we compared the incidence of gastric insufflation between pressure-controlled facemask ventilation and manual facemask ventilation during general anesthesia induction in children.

METHODS

Children in the pressure-controlled ventilation group (n = 76) received pressure-controlled facemask ventilation at an inspiratory pressure of 13 cm H₂ O. In the manual ventilation group (n = 75), facemask ventilation was manually performed by anesthesiologists, who tried to maintain an inspiratory pressure of 13 cm H₂ O. The adjustable pressure limiting valve was set at 13 cm H₂ O. The incidence of gastric insufflation during 90 seconds after the initiation of ventilation was assessed using epigastric auscultation and gastric ultrasonography.

RESULTS

The incidence of gastric insufflation was significantly higher in the manual  facemask ventilation group than in the pressure-controlled ventilation group (48% vs 12%, respectively; odds ratio 7.78, 95% confidence interval [CI] 3.38-17.9; P < 0.001). The mean peak airway pressure during ventilation was significantly higher in the manual ventilation group than in the pressure-controlled ventilation group (16.1 [3.0] cm H₂ O vs 13.0 [0.1] cm H₂ O; 95% CI of differences, 2.36-3.71 cm H₂ O; P < 0.001). The manual ventilation group exhibited a wide peak airway pressure  range (11-26 cm H₂ O) and a wide variation of tidal volume (0-7.0 mL/kg) compared with those of the pressure-controlled ventilation group (13-14 cm H₂ O and 0.6-16.0 mL/kg, respectively).

CONCLUSION

At an inspiratory pressure of 13 cm H₂ O, pressure-controlled ventilation may be more effective than manual ventilation in preventing gastric insufflation while providing stable ventilation in children.

Gastric Necrosis and Perforation Following Massive Gastric Dilatation in an Adolescent Girl: A Rare Cause of Acute Abdomen

Gastric necrosis with perforation is a rare and potentially life-threatening condition in childhood beyond the neonatal period. We report a case of gastric necrosis and perforation of a portion of the great curvature due to a massive gastric dilatation caused by pathological aerophagia in a 13-years-old, mentally impaired adolescent girl. Despite the successful surgical treatment, the patient's condition rapidly deteriorated post-operatively and she died due to the multisystem organ failure and multiple infections. In addition, we surveyed the literature on this rare condition and assessed the preventive actions to reduce this life-treating condition.

Fetal Primary Small Bowel Volvulus Associated with Acute Gastric Dilatation Detected by Ultrasonography

Fetal intestinal volvulus is a rare condition, and fetal diagnosis of this disease is still challenging, especially in primary cases not accompanied by other comorbidities, such as intestinal malformations. Herein, we report a case of fetal primary small bowel volvulus associated with acute gastric dilatation detected by ultrasonography. We speculate that the mechanism of acute gastric dilatation in our case was peristatic malfunction of the whole intestine caused by a strangulated ileus resulting from fetal intestinal volvulus. In conclusion, acute gastric dilatation detected by fetal ultrasound can indicate the fetal intestinal volvulus.

Review of gastric torsion in eight guinea pigs (Cavia porcellus)

The authors present eight cases of gastric dilatation and volvulus (GDV) in guinea pigs from the Department and Clinic of Exotic Animal and Wildlife Medicine, University of Veterinary Medicine, Budapest, Hungary between 2012 and 2016. Seven animals were operated on and two survived. Gastric torsion has been noted in many mammalian species. Gastric volvulus has a high morbidity and high mortality rate with a guarded to poor prognosis in all of these species. How GDV develops is still not widely understood. Postmortem examinations, in both our cases and previously reported cases, have failed to reveal the exact causes of the gastric torsions. The aetiology of gastric torsion in guinea pigs is probably multifactorial. Feeding fewer meals per day, eating rapidly, decreased food particle size, exercise, stress after a meal, competition, age, and an aggressive or fearful temperament, are all likely and potential risk factors for GDV development in a similar fashion to dogs. Sex, breeding, dental diseases, anatomical abnormalities, pain and pregnancy may also be contributing factors.

A comparative study of two-dimensional and three-dimensional ultrasonography in evaluation of gastric affections in dogs

Aim:

The objective of the study was to obtain and compare the two-dimensional (2D) and three-dimensional (3D) ultrasonographic images of pathological conditions of the stomach in dogs in clinical cases.

Materials and Methods:

In our study, 12 clinical conditions of the stomach were recorded using ultrasonography. The ultrasound machine used for this study was 3D ultrasound machine (Nemio-XG: Toshiba, Japan) having four-dimensional volumetric transducer.

Results:

Present study was done to compare 2D and 3D ultrasonographic images in different gastric affections in dogs. In case of uremic gastropathy due to inflammatory response, the wall of the stomach was 0.6 cm thick and hyperechoic and gastric folds were also hyperechoic indicative of gastritis. In second, third, and fourth case of gastritis the wall of the stomach was 0.7, 0.6, and 0.55 cm, respectively thick and hyperechoic. In fifth and sixth case of gastritis, inflammatory response due to ingestion of polythene and sand led to gastritis and ultrasonographically, the wall of the stomach was 0.6 cm and 0.7 cm thick, respectively, and hyperechoic. In case of gastric ulcer, ultrasonographically, there was a disruption of gastric mucosal layer. In cases of gastric dilatation, anechoic content indicating fluid was seen in stomach area and due to dilatation boundary of the stomach was not clear and the increase in the lumen of the stomach was observed. In case of foreign body, ultrasonographically the wall of the stomach was 0.55 cm thick and hyperechoic. In the middle of the stomach, multiple hyperechoic shadows of the foreign bodies i.e. leather and bunch of straw of grass were observed. In case of pyloric stenosis ultrasonographically, anechoic lumen of the pylorus surrounded by 0.5 cm hypoechoic thickened muscle. In some cases, 3D ultrasonography was not diagnostic i.e. gastric foreign bodies and gastric dilatation. These conditions were better visualized on the 2D sonogram.

Conclusion:

The appearance of clinical conditions of the stomach such as gastritis and pyloric stenosis were more distinct on 3D ultrasonogram than 2D ultrasonogram. The 3D ultrasonography was not diagnostic in cases of gastric foreign bodies and gastric dilatation.

Acute gastric dilatation due to binge eating may be fatal

Acute gastric dilatation was first described by Duplay in 1833. Since the stomach has rich blood circulation, necrosis and perforation due to dilatation are rarely seen. Clinically, more than 90% of cases have complaints of vomiting. The most useful method to determine diagnosis and etiology is computerized tomography (CT). Medical treatment is suitable for cases that have no necrosis or peritonitis findings. Delay in surgical treatment increases the risk of mortality. The present case is that of a diagnosis of gastric perforation due to acute gastric dilatation in a 24-year-old female patient.

Rupture of gastrointestinal stromal tumor presenting with sudden onset chest and back pain and accompanied by gastric dilatation

Case

A 72-year-old man with hypertension was admitted with acute-onset chest and back pain followed by epigastralgia. He was transported by helicopter due to suspected acute aortic dissection. Systolic blood pressures were equal in both arms. Physical examination showed epigastric tenderness without rebound. Blood tests showed leukocytosis. Electrocardiogram and echocardiogram were normal. Abdominal radiography showed acute gastric dilatation with an air-outlined large mass-like shadow. Abdominal computed tomography revealed a 6-cm exophytic mass and large intramural hematoma in the lesser curvature of the gastric body.

Outcome

The patient underwent urgent laparotomy with total gastrectomy. The resected tumor showed positivity for CD117 and CD34 but negativity for S100, indicating a gastrointestinal stromal tumor. Fourteen days after the surgery, the patient was uneventfully discharged.

Conclusion

Intramural bleeding of submucosal tumors including gastrointestinal stromal tumor should be considered in cases of acute gastric dilatation. Abdominal radiography may be a clue regarding the presence of this condition.

Gastrointestinal complications associated with anorexia nervosa: A systematic review

OBJECTIVE

A systematic review identifying gastrointestinal (GI) complications attributable to anorexia nervosa (AN) was completed.

METHOD

Studies of any design exploring the pathogenesis of complications and treatment strategies were included. The review was completed in accordance with PRISMA standards.

RESULTS

A total of 123 articles were retained, including one randomized control trial. The majority of included studies were case reports and case series. Controlled studies demonstrated that patients with AN were more likely to have delays in gastric motility, gastric emptying and intestinal transit than comparator groups although results were not uniform across all studies. Published reports suggest that complications can occur at any segment of the GI tract. These issues may derive as a consequence of severe malnourishment, from eating disorder related symptoms such as self-induced purging or from the refeeding process itself. Multiple studies noted that patients with AN report high rates of GI symptoms although in the few cases where medical testing was undertaken, correlations between self-reported symptoms and measurable pathology were not demonstrated.

DISCUSSION

GI complications may occur throughout the entire GI tract in patients with AN. It is recommended that clinicians use careful judgment when pursuing targeted investigation or introducing symptom specific treatments in response to GI complaints. Evidence suggests that most GI complications resolve with refeeding and cessation of ED symptoms.

Life-threatening acute gastric dilatation with aorta compression in a 3-year-old child

We report a fatal case of acute gastric dilatation in a 3-year old boy who presented with severe abdominal pain and massive gastric distension in the emergency room. On physical examination the patient was in shock due to acute abdomen and lower limb ischemia. Initial laboratory findings showed multi-organ failure with acute renal failure and pancreatitis. Abdominal computed tomography (CT) showed marked dilatation of the stomach resulting in compression of the abdominal aorta. The left kidney, spleen and pancreas were not visible on CT due to the necrotic changes. The patient was quickly stabilized by initial volume resuscitation, but suddenly deteriorated immediately after gastric decompression via nasogastric tube, and died from multi-organ failure 3 h after initial presentation.

Massive gastric dilatation caused by eating binges demanding surgical intervention: a case report

The clinical picture of an acute abdomen is frequently encountered in emergency medicine. In most cases abdominal pathologies underlie this condition, however, also extra-abdominal diseases may present or cause an acute abdomen. The fact that this condition is potentially life-threatening highlights the importance of instant action. Here, we report on the case of a young woman that presented with an acute abdomen in our clinic. Imaging revealed a massively distended stomach reaching the lesser pelvis. Initially, the etiology for the gastric dilatation remained unsolved. On the same day we performed an explorative laparotomy in which massive amounts of clotted, undigested food was recovered via a gastrotomy. Postoperatively, upon psychiatric consultation, an eating disorder with daily eating binges could be revealed as being the cause for the acute and dramatic gastric dilatation. The patient fully recovered from surgery and psychiatric co-treatment was initiated. This unique case report demonstrates how a psychiatric condition may lead to an acute abdomen, however, it also emphasizes the importance of prompt diagnosis and adequate therapy to avoid complications and allowing for full recovery.

Gastric necrosis and perforation caused by acute gastric dilatation

Acute gastric dilatation was first defined by Duplay in 1833. We herein present the case of a 55-year-old male patient diagnosed with gastric necrosis and perforation caused by acute gastric dilatation. Since the stomach has a rich blood circulation, necrosis and perforation are rarely seen. Clinically, more than 90% of cases have complaints of vomiting. The most useful method in revealing the diagnosis and aetiology is computerized tomography. Medical treatment is appropriate for cases where no necrosis and peritonitis findings are detected through endoscopy. Delays in surgical treatment increase the risk of mortality.