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Introduction: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and is becoming the most frequent indication of liver transplantation. At present, since no Food and Drug Association (FDA) approved medication exists for NAFLD patients, bariatric surgery is indicated for the significant improvement in obesity-related comorbidities, such as NAFLD. However, alternative therapy is emerging to manage NAFLD. Problematically, many patients taking herbal remedies, such as Silymarin (milk thistle), with little/no understanding of its purported properties. Methods: Fifty-two morbidly-obese (47.84 ± 6.48 kg m-2) patient candidates (mean age: 38.90 ± 10.28 years; n = 41 women and 11 men) for bariatric surgery with NAFLD were randomly assigned to determine the efficacy of eight weeks of Silymarin supplementation (140 mg four times daily for a total of 560 mg) on the aspartate transaminase (AST)/alanine transaminase (ALT) (AST/ALT) ratio, Fibrosis-4 (Fib-4) score, NAFLD score, sonographic grading, and fibroscan stages of NAFLD. Results: Significant (p ≤ 0.05) improvements were found in AST/ALT ratio, BMI and sonographic grading. No significant change was found for fibroscan staging, Fib-4, and NAFLD scores. Conclusion: Silymarin improved ultrasound fatty liver grading and liver enzymes morbidly-obese patient candidates for bariatric surgery with NAFLD after only eight weeks, without any adverse effects.
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INTRODUCTION AND IMPORTANCE: The omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature. CASE PRESENTATION: We present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery. CLINICAL DISCUSSION: OMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance. CONCLUSION: Preoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.
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INTRODUCTION AND IMPORTANCE: Gastric pneumatosis with concurrent hepatic portal vein gas is an extremely rare condition in the adult population. It can be idiopathic or associated with well-known etiologies. Gastric outlet obstruction can progressively inflate the stomach and cause pneumatosis. Regarding abdominal signs and the presence of acute abdomen, management varies from just conservative to emergent surgical interventions. CASE PRESENTATION: We introduce an adult patient who presented to our hospital with weakness and dyspnea. After initial measures, unexpectedly we found intraabdominal free gas, concurrent gastric pneumatosis, and aeroportia. Due to the absence of positive abdominal signs, the patient was treated successfully without any surgical or endoscopic interventions. DISCUSSION: Gastric outlet obstruction is a well-known cause of gastric pneumatosis. Progressive dilation of the stomach due to pyloric stenosis is well-described both in infants and adult populations. CONCLUSION: In stable patients, gastric drainage and correction of electrolyte disturbance are the only required treatment. However endoscopic and surgical interventions should be considered in unstable patients or those developing acute abdomen.