Epigastric Pain and Dysphagia in a 36-Year-Old Man Due to Primary Esophageal Small Cell Carcinoma.

BACKGROUND Small cell carcinoma is an aggressive malignant neuroendocrine tumor that most commonly occurs in the lung. Primary small cell carcinoma of the esophagus (PSCCE) is rare and is an aggressive malignancy with poor prognosis and no clear management guidelines. This report describes the case of a 36-year-old man presenting with epigastric pain, dysphagia, and melena due to a primary esophageal small cell carcinoma. CASE REPORT A 36-year-old presented to the Emergency Department (ED) with epigastric pain associated with food intake. Initial workup was unremarkable, and a presumed clinical diagnosis of reflux esophagitis and peptic strictures was made, prompting empiric treatment with anti-secretory therapies. Despite these therapies, he presented to the emergency room with progressively worsening dysphagia. Endoscopic examination (EGD) revealed a large necrotic mass, and computed tomography (CT) imaging revealed liver metastasis. Biopsies from both the liver and esophageal masses confirmed small cell carcinoma. His clinical course was complicated by a broncho-esophageal fistula, leading to massive hemoptysis, necessitating intubation. Unfortunately, his condition deteriorated rapidly, and he chose to pursue hospice care. He died 3 months after his initial presentation. CONCLUSIONS This report has presented a rare case of primary esophageal small cell carcinoma and our approach to management. We highlight the importance of early diagnosis, supported by histopathology, and the need for management guidelines.

Primary segmental omental torsion, mimicking acute appendicitis.

Primary segmental omental torsion (PSOT) is a very rare cause of acute abdominal pain, and it may often imitate the clinical picture of acute appendicitis. In instances of acute abdominal pain without anorexia, nausea, and vomiting, omental torsion should be included in the differential diagnosis. Any misdiagnosis may lead to major complications such as intraabdominal abscesses and adhesions. A 63-year-old overweight man with a body mass index (BMI) of 41 Kg/m2 presented to the emergency department on a remote island with acute abdominal pain. His medical history included type 2 diabetes mellitus managed with insulin, essential hypertension, osteoarthritis, and no previous abdominal operations. He reported a sharp pain originating in the epigastrium and the right hypochondrium that started five days prior. Physical examination revealed rebound tenderness and guarding across the abdomen with a positive McBurney sign. However, the patient did not report vomiting and was not nauseous. Vital signs were as follows: blood pressure 116/56 mmHg, heart rate 98 beats/min, respiratory rate 19 breaths/min, and a temperature of 38.2 0C. Laboratory results showed a white blood cell count of 10.6, neutrophils of 8.11, C-reactive protein (CRP) 74 mg/l, haemoglobin11.6 g/dl, and hematocrit 36.9%. Due to the absence of a radiographer at the hospital during that period, no imaging investigations were conducted. Diagnostic laparoscopy demonstrated diffused hemoperitoneum and necrotic mass at the site of the hepatic flexure. Initially suspected to be an advanced colon cancer, the decision was made to proceed with open surgery. The necrotic segment of the omentum was found at the right superior point of attachment of the omentum to the hepatic flexure. Consequently, the necrotic segment of the omentum was resected. A thorough investigation of the abdominal cavity did not detect any other abnormalities or pathologies. The patient recovered uneventfully and was transferred to the surgical ward. Torsion of the omentum is a very rare cause of acute abdominal pain. This case highlights the necessity of considering PSOT in the differential diagnosis of acute abdominal pain, especially in cases where symptoms are suggestive of appendicitis but diagnostic findings are negative.

Gastroduodenal artery aneurysm - an extremely rare but insidious cause of abdominal pain: a case report.

An arterial aneurysm is a localized weakening of the artery wall that results in pathological dilatation. All intra-abdominal artery aneurysms are labeled as visceral artery aneurysms (VAA), apart from the aorto-iliac artery aneurysms. VAA´s are rare, gastroduodenal artery aneurysms (GDAA), constituting 1.5% of visceral artery aneurysms. A woman in her early 80s´ presented with chronic epigastric pain, weight loss, and nausea. Conservative management was unsuccessful. Imaging revealed a GDAA, prompting endovascular coil embolization. Subsequent evaluation confirmed Polyarteritis Nodosa (PAN), treated with rituximab. The report underscores the diagnostic challenges, emphasizing the need for a multidisciplinary approach using imaging and angiography. GDAA's potential life-threatening rupture necessitates prompt intervention, as illustrated in this case. The rare association with PAN, although infrequent, underscores the importance of considering underlying etiologies in multiple visceral aneurysms. Early diagnosis and intervention are pivotal for this uncommon yet potentially lethal condition.

Functional dyspepsia: How to manage the burn and the bloat.

Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.

Spontaneous pneumoperitoneum in the absence of visceral perforation in a patient with systemic sclerosis: a case report.

We present the case of a 44 year old woman with systemic sclerosis who presented with intense abdominal pain without signs of peritonitis. An abdominal computed tomography showed generalized intestinal dilation, intestinal pneumatosis and an extensive pneumoperitoneum. A diagnostic laparoscopy was performed but no perforation nor gastrointestinal leakage were found. Spontaneous pneumoperitoneum in patients with systemic sclerosis without visceral perforation is an extremely rare complication. Physicians must have a low threshold of suspicion for this entity when a patient with systemic sclerosis presents with spontaneous pneumoperitoneum in the absence of peritoneal signs.

Presentamos el caso de una mujer de 44 años con diagnóstico de esclerosis sistémica, quien presentó dolor abdominal intenso sin datos de irritación peritoneal. Una tomografía computarizada de abdomen mostró dilatación generalizada de asas intestinales, neumatosis intestinal y neumoperitoneo extenso, por lo cual se realizó una laparoscopía diagnóstica, sin encontrar sitio de perforación. El neumoperitoneo espontáneo en pacientes con esclerodermia sin evidencia de perforación visceral es una complicación extremadamente rara. El médico deberá mantener un alto índice de sospecha para esta condición ante un paciente con esclerosis sistémica que se presente con un neumoperitoneo espontáneo sin datos de irritación peritoneal.

Diagnostic utility of the Alvarado scale in older adults with suspected acute appendicitis.

BACKGROUND: Acute appendicitis remains as a differential diagnosis in older patients with abdominal pain. The Alvarado scale may assist to guide the diagnosis and treatment of this entity. The operative characteristics of the scale are little known in this population. METHOD: We conducted a systematic review of original studies published between 1986 and 2022 evaluating the diagnostic performance of the Alvarado scale in older adults with suspected acute appendicitis. The review was conducted according to the PRISMA statement. The evaluation of the methodological quality of the studies was performed according to the ROBINS-I criteria. RESULTS: Four original studies of retrospective design including 480 patients were identified. The heterogeneity and poor methodological quality limited an aggregate statistical analysis (meta-analysis). The value of the ROC curve of the scale varies between 0.799 and 0.969. From the available studies, the value of the ROC curve is lower in comparison to the RIPASA scale and comparable to the Lintula scale. CONCLUSIONS: The evidence on the diagnostic performance of the Alvarado scale in older adults is limited. The poor methodological quality of the available studies calls for a prudent use of this tool in this population. Our findings offer opportunities for future research.

ANTECEDENTES: La apendicitis aguda es un diagnóstico diferencial en el adulto mayor con dolor abdominal. La escala de Alvarado se utiliza para orientar el diagnóstico y el tratamiento. Las características operativas de la escala son poco conocidas en este grupo de pacientes. MÉTODO: Revisión sistemática de estudios originales publicados entre 1986 y 2022 que evaluaron el rendimiento diagnóstico de la escala de Alvarado en adultos mayores con sospecha de apendicitis aguda, con base en la declaración PRISMA. La evaluación de la calidad metodológica de los estudios se realizó con los criterios ROBINS-I. RESULTADOS: Se identificaron cuatro estudios originales de diseño retrospectivo que incluyen 480 pacientes. La heterogeneidad y la baja calidad metodológica limitaron un análisis estadístico agregado (metaanálisis). El valor de la curva ROC de la escala varía entre 0.799 y 0.969. En los estudios disponibles, el valor de la curva ROC es inferior al de la escala RIPASA y similar al de la escala de Lintula. CONCLUSIONES: La evidencia que sustenta el rendimiento diagnóstico de la escala de Alvarado en los adultos mayores es limitada. La pobre calidad de los estudios disponibles advierte sobre el uso prudente de esta herramienta en este grupo poblacional. Los hallazgos identificados ofrecen oportunidades de investigación futura.

Disasters that develop in the liver due to hydatid cyst: a case report.

Hilar cavernous transformation is the formation of venous structures rich in collateral around the portal vein. Portal vein thrombosis is a rare entity. Although there are many reasons for its etiology, few cases have been reported secondary to hydatid cysts in the liver. Here, we present a 24-year-old patient with complaints of abdominal pain and swelling. Her CT and MRI scans show cholelithiasis with portal vein thrombosis and hilar cavernous transformation due to giant hydatid cyst compression in the lateral liver sector.

La transformación cavernosa hiliar es la formación de estructuras venosas ricas en colaterales alrededor de la vena porta. La trombosis de la vena porta es una afección poco frecuente. Aunque existen muchas razones en su etiología, se han descrito pocos casos secundarios a quiste hidatídico en el hígado. Aquí se presenta el caso de una paciente de 24 años con quejas de dolor abdominal e hinchazón. La tomografía computarizada y la resonancia magnética mostraron colelitiasis con trombosis de la vena porta y transformación cavernosa hiliar por compresión del quiste hidatídico gigante en el sector lateral del hígado.

OHVIRA syndrome: clinical implications of a delayed diagnosis.

Obstructed Hemi Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome is a rarely encountered müllerian duct anomaly. Delayed diagnosis is common due to normal onset of puberty and menstruation. We report a case of a woman in her early 20s with a background history of multiple emergency department visits, ward admissions and surgeries for chronic abdominal pain. She was reviewed at 1 month postlaparotomy for recurrent pelvic abscess and was finally diagnosed to have an OHVIRA syndrome, 11 years after her first clinical presentation. Excision of the vaginal septum completely resolved her symptoms. We are reporting this case to highlight the clinical implications resulting from the delayed diagnosis, to look into factors contributing to the delay and to highlight the importance of having a high index of suspicion to diagnose this unique condition.

Anterior Cutaneous Nerve Entrapment Syndrome Caused by a Fixation Device: A Case Report.

Anterior cutaneous nerve entrapment syndrome (ACNES) is characterized by abdominal wall neuralgia. We report an 85-year-old woman with ACNES caused by a fixation device during the bipolar hip arthroplasty. To prevent ACNES as a perioperative peripheral nerve injury, it is important to maintain patients in the appropriate position during the operation. A positive Carnett's sign means the abdominal pain originates from the abdominal wall and is useful in diagnosing ACNES. Thus, physicians should examine Carnett's sign to differentiate ACNES in patients with abdominal pain developing after an operation.

Chronic Pancreatitis Pain Associated With Energy Drink Consumption: A Case Report.

Chronic pancreatitis is commonly associated with heavy alcohol use and cigarette smoking, though many cases of chronic pancreatitis are idiopathic. Energy drink consumption has been on the rise over the last decade, with an adverse health risk profile including gastrointestinal symptoms such as dyspepsia, reflux, and gastritis. There have been several case reports linking energy drink consumption to presentations of acute pancreatitis in adult patients. To our knowledge, the association between energy drinks and episodes of chronic pancreatitis flares has not been well studied. This article explores a case of chronic pancreatitis pain related to excessive energy drink consumption in an adult male patient. This study aims to shed light on energy drinks as a potential etiology of chronic pancreatitis flares, and emphasizes the importance of counseling patients on the potential risks of excessive energy drink consumption.

[Gastric rupture as a complication of anorexia nervosa]. / Maagruptuur als complicatie van anorexia nervosa.

BACKGROUND: Anorexia nervosa may cause several gastro-intestinal complications. CASE DESCRIPTION: A 21-year-old woman presented herself with abdominal pain and vomiting a day after her first binge-eating episode. In her recent history she had lost 40 kg in weight and her BMI was 15 at presentation. Imaging showed gastric distension and ascites in all quadrants, suspicious of a gastric rupture. A blow-out of the stomach was seen during a diagnostic laparotomy, which was treated with a gastric sleeve procedure. Following surgery, the patient was diagnosed with anorexia nervosa of the restrictive type with a first episode of binge-eating. CONCLUSION: Gastric rupture is a rare and unknown complication of anorexia nervosa with a high mortality.

Herlyn-Werner-Wunderlinch: An unusual presentation in a patient with Prader-Willi syndrome.

Herlyn-Werner-Wunderlich syndrome is an uncommon urogenital anomaly defined by uterus didelphys, obstructed hemi-vagina and unilateral renal anomalies. The most common clinical presentation is dysmenorrhoea following menarche, but it can also present as pain and an abdominal mass. Prader-Willi syndrome is a rare neuroendocrine genetic syndrome. Hypothalamic dysfunction is common and pituitary hormone deficiencies including hypogonadism are prevalent. We report the case of a 33-year-old female with Prader-Willi syndrome who was referred to the Gynaecology clinic due to vaginal bleeding and abdominal pain. Abdominal ultrasound revealed a haematometra and haematocolpos and computed tomography showed a uterus malformation and a right uterine cavity occupation (hematometra) as well as right kidney agenesis. Vaginoscopy and hysteroscopy were performed under general anaesthesia, finding a right bulging vaginal septum and a normal left cervix and hemiuterus. Septotomy was performed with complete haematometrocolpos drainage. The association of the two syndromes remains unclear.

Gastrointestinal Conditions: Pancreatitis.

Acute pancreatitis is among the most common gastrointestinal disorders requiring hospitalization. The main causes are gallstones and alcohol use. Patients typically present with upper abdominal pain radiating to the back, worse with eating, plus nausea and vomiting. Diagnosis requires meeting two of three criteria: upper abdominal pain, an elevated serum lipase or amylase level greater than 3 times the normal limit, and imaging findings consistent with pancreatitis. After pancreatitis is diagnosed, the Atlanta classification and identification of the systemic inflammatory response syndrome can identify patients at high risk of complications. Management includes fluid resuscitation and hydration maintenance, pain control that may require opioids, and early feeding. Feeding recommendations have changed and "nothing by mouth" is no longer recommended. Rather, oral feeding should be initiated, as tolerated, within the first 24 hours. If it is not tolerated, enteral feeding via nasogastric or nasojejunal tubes should be initiated. Antibiotics are indicated only with radiologically confirmed infection or systemic infection symptoms. Surgical or endoscopic interventions are needed for biliary pancreatitis or obstructive pancreatitis with cholangitis. One in five patients will have recurrent episodes of pancreatitis; alcohol and smoking are major risk factors. Some develop chronic pancreatitis, associated with chronic pain plus pancreatic dysfunction, including endocrine failure (insulin insufficiency) and/or exocrine failure that requires long-term vitamin supplementation.

Pseudogestational Sac Delaying Diagnosis of Ectopic Pregnancy: A Case Report.

BACKGROUND: Diagnosis of ectopic pregnancy can be complicated by nonspecific laboratory and radiographic findings. The multiple alternative diagnoses must be weighed against each other based on the entire clinical presentation. CASE REPORT: We present a case of a 20-year-old woman who arrived to the Emergency Department (ED) with abdominal pain and ended up being transferred for an Obstetrics evaluation of a possible heterotopic pregnancy. Her radiology-performed ultrasound had revealed an "intrauterine gestational sac" along with an adnexal mass near the right ovary. The patient was not undergoing assisted-reproductive fertilization, nor did she have meaningful risk factors for heterotopic pregnancy. The patient was managed expectantly over the ensuing week to see whether the intrauterine fluid was a true gestational sac. After multiple repeat ED visits, the diagnosis of ectopic pregnancy was made. Ultimately, the patient elected for surgical management of her ectopic pregnancy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case offers a reminder of the subtleties of radiographic identification of intrauterine pregnancies and the ever-present need to "clinically correlate."

Chief complaints and computed tomography results in the emergency department: a three-year retrospective cohort study.

BACKGROUND: Computed tomography (CT) is frequently performed in the patients who admitted to the emergency department (ED), discharged but returned to ED within 72 h. It is unknown whether the main complaints of patients assist physicians to use CT effectively. This study aimed to find the association between chief complaints and the CT results. METHODS: This three-year retrospective cohort study was conducted in the ED of a tertiary medical center. Adult patients who returned to the ED after the index visit were included from 2019 to 2021. Demographics, pre-existing diseases, chief complaints, and CT region were recorded by independent ED physicians. A logistic regression model with an odds ratio (OR) and 95% confidence interval (CI) was used to determine the relationship between chief complaints and positive CT results. RESULTS: In total, 7,699 patients revisited ED after the index visit; 1,202 (15.6%) received CT. The top chief complaints in patients who received CT were abdominal pain, dizziness, and muscle weakness. Patients with abdominal pain or gastrointestinal symptoms had a significantly higher rate of positive abdominopelvic CT than those without it (OR 2.83, 95% CI 1.98-4.05, p < 0.001), while the central nervous system and cardiopulmonary chief complaints were not associated (or negatively associated) with new positive CT findings. CONCLUSION: Chief complaints of patients on revisit to the ED are associated with different yields of new findings when CT scans of the chest, abdomen and head are performed. Physicians should consider these differential likelihoods of new positive findings based on these data.

Splenic artery pseudoaneurysm; a cause or consequence: a case report.

BACKGROUND: Splenic artery pseudoaneurysm is a rare complication of recurrent pancreatitis usually presenting as an incidental finding on abdominal computed tomography. CASE PRESENTATION: We present the case of a 66-year-old north African male with a known history of previous pancreatitis who presented with upper gastrointestinal bleeding along with recurrent epigastric pain for 3 days. Investigations did not reveal any particular pancreatitis etiology. Computed tomography of the abdomen with contrast showed splenic artery pseudoaneurysm along with findings suggestive of acute pancreatitis. Upper and lower endoscopies failed to identify gastrointestinal the bleed source. The patient underwent intervention radiology embolization of the aneurysm sac with multiple coils via right retrograde common femoral artery-celiac access. The patient was discharged with a plan for capsule endoscopy in outpatient setting. CONCLUSION: Splenic artery pseudoaneurysm is a life-threatening complication and carries a high mortality rate if left untreated. Prompt identification through various imaging modalities, followed by urgent intervention, is crucial to avoid adverse outcomes.

An Unexpected Lymphoma: A Rare Case of Primary Gastric Burkitt's Lymphoma.

Primary gastric Burkitt's lymphoma is an aggressive non-Hodgkin's lymphoma that has been rarely reported in the literature. The majority of primary gastric lymphomas are diffuse large B-cell lymphomas and mucosa-associated lymphoid tissue (MALT) lymphomas. Patients with primary gastric Burkitt's lymphoma can present with abdominal pain, hematemesis, melena, perforation, and obstruction. Diagnosis is made with a combination of clinical, radiological, and pathological findings. Treatment data are limited due to the limited cases reported. We present a case of a 47-year-old female who presented with diffuse abdominal pain, melena, and coffee-ground emesis that was diagnosed with primary gastric Burkitt's lymphoma following biopsies taken from a gastric ulcerated mass found on upper endoscopy.

Mesenteric panniculitis associated with non-alcoholic fatty liver disease: A case series.

Mesenter ic p anniculitis (MP) is a b enign infla mmatory condi tion of the abdomin al mesentery, whi ch presents with a wid e variety of symptoms. I t is diagnosed non - invasively through com puted to mography (CT ) scan, whereas biopsy is still co nside red th e gold standa rd. Steroids are the first line of treatment. Here, we report four cases who presented with abdominal pain. These patients were overweight and the CT scan findings were suggestive of mese nte ric panniculitis. Three cases had concomitant non- alcoholic steatohep atitis w ith el evated alanine transaminase levels, dyslipidaemia, and insulin resistance. FibroSca n showed moderate to severe steatosis. PNPLA3 rs738409 genotype was homozygous positive (GG) in one patient, whereas two patients were heterozygous positive (CG ). This a ssociat io n has not been well-described so far and w arrants f ur ther inve s tigation. There may be some common predisposing factors.

Intestinal perforation due to colorectal cancer during pregnancy: case report and literature review.

Colorectal cancer (CRC) in pregnancy is sporadic. We reported a case of a woman at 23 + 4 weeks of gestation who presented with abdominal pain. The patient underwent an ultrasound and MRI, during which a colonic mass was noted. Considering a probable incomplete intestinal obstruction, a colonoscopy, biopsy, and colonic stenting were performed by a multidisciplinary team. However, sudden hyperthermia and CT demonstrated intestinal perforation, and an emergency caesarean section and colostomy were conducted. The histological analysis confirmed moderately high-grade adenocarcinoma.