ABSTRACT
BACKGROUND AND AIM: Colonoscopy with histopathological analysis of mucosal biopsy samples remains the gold standard procedure for diagnosing lower gastrointestinal disorders. This study aimed to determine the pattern of histopathological findings of mucosal biopsies obtained at colonoscopy over a 7-year period and to correlate the histological findings with the clinical profile of the patients. METHODS: This was a retrospective study conducted in a healthcare facility in southwestern Nigeria. The Histology reports from January 1, 2016, to December 31, 2022, were retrieved from the histopathology department of the institution to obtain the following information for analysis: age, gender, year of the test, presenting complaint, provisional clinical diagnosis, colonoscopy diagnosis, and histological diagnosis. RESULTS: The data of a total number of 81 patients were analyzed; 51 males (63.0%) and 30 females (37.0%) with a male-to-female ratio of 1.7-1. The age range of the patients was 30-86 years with a mean (±standard deviations) age of 59.87 ± 14.44. The most common indication for colonoscopy was hematochezia (23 (28.4%)) followed by change in bowel habit (16 [19.8%]), constipation (11 [13.6%]), and tenesmus (10 [12.3%]). Large bowel masses suggestive of cancers were the most common colonoscopy finding in the study subjects (36 [44.4%]). Colorectal cancer was the most common histologic abnormality in the study subjects (26 [32.1%]) followed by chronic nonspecific colitis (8 [9.9%]), polyps (7 [8.6%]), adenomas (5 [6.2%]) and acute on chronic colitis (5 [6.2%]). Twenty-two (27.2%) patients had normal histologic findings. Patients aged between 45 and 64 years had the highest prevalence of colorectal cancer (13 [50.0%]). CONCLUSION: Colorectal cancer was the most common histopathological finding in this study and the patients were mostly within the middle-age group. Early screening colonoscopy is therefore recommended and histopathological analysis of the mucosal specimens obtained is essential for early detection of premalignant lesions.
Résumé Contexte et Objectif:La coloscopie avec analyse histopathologique d'échantillons de biopsie muqueuse reste la procédure de référence pour diagnostiquer les troubles gastro-intestinaux inférieurs. Cette étude visait à déterminer le schéma des résultats histopathologiques des biopsies muqueuses obtenues à la coloscopie sur une période de sept ans et à corréler les résultats histologiques avec le profil clinique des patients.Méthodes:Il s'agissait d'une étude rétrospective menée dans un établissement de santé du sud-ouest du Nigeria. Les rapports d'histologie du 1er janvier 2016 au 31 décembre 2022 ont été récupérés auprès du service d'histopathologie de l'établissement afin d'obtenir les informations suivantes pour analyse : âge, sexe, année du test, plainte présentée, diagnostic clinique provisoire, diagnostic de coloscopie et diagnostic histologique.Résultats:Les données d'un nombre total de 81 patients ont été analysées; 51 hommes (63,0 %) et 30 femmes (37,0 %) avec un ratio hommes/femmes de 1,7 pour 1. La tranche d'âge des patients était de 30 à 86 ans avec un âge moyen (± ET) de 59,87 ± 14,44. L'indication la plus fréquente de la coloscopie était l'hématochézie (23 (28,4 %)), suivie de la modification du transit intestinal (16 (19,8 %)), de la constipation (11 (13,6 %)) et du ténesme (10 (12,3 %)). Les masses du gros intestin évocatrices de cancers étaient la constatation la plus fréquente de la coloscopie chez les sujets de l'étude (36 (44,4 %)). Le cancer colorectal était l'anomalie histologique la plus fréquente chez les sujets de l'étude (26 (32,1%)) suivi de la colite chronique non spécifique (8 (9,9%)), des polypes (7 (8,6%)), des adénomes (5 (6,2%)) et aigu sur la colite chronique (5 (6,2 %)). Vingt-deux (27,2 %) patients avaient des résultats histologiques normaux. Les patients âgés de 45 à 64 ans avaient la prévalence la plus élevée de cancer colorectal (13 (50,0 %)).Conclusion:Le cancer colorectal était la découverte histopathologique la plus courante dans cette étude et les patients appartenaient principalement au groupe d'âge moyen. Une coloscopie de dépistage précoce est donc recommandée et l'analyse histopathologique des échantillons de muqueuses obtenus est essentielle pour la détection précoce des lésions pré-malignes.
Subject(s)
Colonoscopy , Tertiary Care Centers , Humans , Male , Female , Middle Aged , Retrospective Studies , Aged , Nigeria/epidemiology , Biopsy/methods , Adult , Aged, 80 and over , Colorectal Neoplasms/pathology , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/diagnosis , Colon/pathology , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/pathology , Intestinal Mucosa/pathologyABSTRACT
Hemorrhagic bowel syndrome (HBS) is characterized by a dissecting intramucosal hematoma at the small bowel, causing obstruction and severe hemorrhage in dairy cattle. Recent investigation revealed the presence of early-stage lesions in cows affected by HBS. These are presumed to be the initial stage of the hematoma, as both share unique dissection of the lamina muscularis mucosae (LMM) as histological hallmark. Early-stage lesions of HBS have not been characterized in greater detail, and neither has the hypothesis of mucosal abrasion as etiology been explored. Therefore, the first objective of the present study was to characterize the morphology of early-stage lesions, by gross examination, histochemistry, immunohistochemistry and transmission electron microscopy. The second objective was to determine the effect of mucosal abrasion to the small intestine in an ex vivo model. A total of 86 early-stage lesions from 10 cows with HBS were characterized. No underlying alterations at the LMM were evident which could explain their occurrence. However, degeneration at the ultrastructural level of the LMM smooth muscle cells was present in 3 of 4 lesions, it is however unclear whether this is primary or secondary. Bacteriological examination did not reveal any association with a specific bacterium. Experimental-induced and early-stage lesions were gross and histologically evaluated and scored in three cows with HBS and seven controls. Experimentally induced lesions in both affected cows and controls, were histologically very similar to the naturally occurring early-stage lesions. Altogether, the results are suggestive for mucosal trauma to play a role in the pathogenesis of HBS.
Subject(s)
Cattle Diseases , Gastrointestinal Hemorrhage , Intestinal Mucosa , Animals , Cattle , Cattle Diseases/pathology , Intestinal Mucosa/pathology , Intestinal Mucosa/ultrastructure , Female , Gastrointestinal Hemorrhage/veterinary , Gastrointestinal Hemorrhage/pathology , Microscopy, Electron, Transmission/veterinary , Intestine, Small/pathology , Immunohistochemistry/veterinary , Intestinal Diseases/veterinary , Intestinal Diseases/pathologyABSTRACT
Proranolol has long been recommended to prevent variceal bleeding in patients with cirrhosis. However, the mechanisms of propranolol in liver fibrosis have not yet been thoroughly elucidated. Autophagic cell death (ACD) of activated hepatic stellate cells (HSCs) is important in the alleviation of liver fibrosis. Our study aims to assess the mechanisms of propranolol regulating HSC ACD and liver fibrosis. ACD of HSCs was investigated using lentivirus transfection. The molecular mechanism was determined using a PCR profiler array. The role of autophagy-related protein 9b (ATG9b) in HSC ACD was detected using co-immunoprecipitation and co-localization of immunofluorescence. Changes in the signalling pathway were detected by the Phospho Explorer antibody microarray. Propranolol induces ACD and apoptosis in HSCs. ATG9b upregulation was detected in propranolol-treated HSCs. ATG9b upregulation promoted ACD of HSCs and alleviated liver fibrosis in vivo. ATG9b enhanced the P62 recruitment to ATG5-ATG12-LC3 compartments and increased the co-localization of P62 with ubiquitinated proteins. The PI3K/AKT/mTOR pathway is responsible for ATG9b-induced ACD in activated HSCs, whereas the p38/JNK pathway is involved in apoptosis. This study provides evidence for ATG9b as a new target gene and propranolol as an agent to alleviate liver fibrosis by regulating ACD of activated HSCs.
Subject(s)
Autophagic Cell Death , Esophageal and Gastric Varices , Humans , Hepatic Stellate Cells/metabolism , Propranolol/pharmacology , Propranolol/metabolism , Up-Regulation , Phosphatidylinositol 3-Kinases/metabolism , Esophageal and Gastric Varices/metabolism , Esophageal and Gastric Varices/pathology , Gastrointestinal Hemorrhage/metabolism , Gastrointestinal Hemorrhage/pathology , Liver Cirrhosis/metabolism , Liver/metabolism , AutophagyABSTRACT
INTRODUCTION: There exists variation regarding the approach to anticoagulation and variceal hemorrhage (VH) prophylaxis among patients with cirrhosis and portal vein thrombosis (PVT). METHODS: A survey was distributed to gastroenterology and hepatology providers to assess the approach to anticoagulation and VH prophylaxis among patients with PVT in cirrhotic patients. RESULTS: Providers were more likely to start anticoagulation if the patient was listed for liver transplantation, was symptomatic, or had superior mesenteric vein thrombosis. For prevention of first VH, many providers opt for combination therapy with both nonselective beta blockers and variceal ligation. DISCUSSION: Although providers agree on the clinical scenarios that merit initiation of anticoagulation, practice variation was identified in the means of preventing first VH.
Subject(s)
Esophageal and Gastric Varices , Liver Diseases , Varicose Veins , Venous Thrombosis , Humans , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/therapy , Portal Vein , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Gastrointestinal Hemorrhage/pathology , Liver Diseases/pathology , Liver Cirrhosis/complications , Liver Cirrhosis/pathology , Venous Thrombosis/etiology , Anticoagulants/therapeutic use , North AmericaABSTRACT
Anorectal malignant melanomas are rare, accounting for less than 2% of all melanomas. Malignant effusions developing secondary to malignant melanoma are highly uncommon. Herein, we present the cytomorphological features of a metastatic anorectal malignant melanoma presenting with ascites at the initial clinical presentation.
Subject(s)
Melanoma , Humans , Male , Aged , Melanoma/diagnosis , Melanoma/pathology , Ascitic Fluid/pathology , Cytology , Ascites/pathology , Gastrointestinal Hemorrhage/pathologySubject(s)
Anemia , Stomach Neoplasms , Humans , Gastrointestinal Tract/pathology , Stomach , Anemia/etiology , Stomach Neoplasms/complications , Stomach Neoplasms/pathology , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathologyABSTRACT
Objective: To investigate the risk factors and construct a nomogram model for predicting the occurrence of cirrhotic portal vein thrombosis in patients combined with esophagogastric variceal bleeding (EVB). Methods: Clinical data on 416 cirrhotic PVT cases was collected from the First Hospital of Lanzhou University between January 2016 and January 2022. A total of 385 cases were included after excluding 31 cases for retrospective analysis. They were divided into an esophagogastric variceal bleeding group and a non-esophagogastric variceal bleeding group based on the clinical diagnosis. The esophagogastric variceal group was then further divided into an EVB group and a non-bleeding group. All patients underwent gastroscopy, serology, and imaging examinations. The risk factors of PVT combined with EVB were identified by univariate analysis using SPSS 26. The prediction model of cirrhotic PVT in patients combined with EVB was constructed by R 4.0.4. The prediction efficiency and clinical benefits of the model were evaluated by the C-index, area under the receiver operating characteristic curve, calibration plots, and decision curve. The measurement data were examined by a t-test or Mann-Whitney U test. The counting data were tested using the χ(2) test or the Fisher exact probability method. Results: There were statistically significant differences in the etiology, Child-Pugh grade,erythrocyte count, hematocrit, globulin, and serum lipids between the esophageal and non-esophageal varices groups (P < 0.05). There were statistically significant differences in etiology, erythrocyte count, hemoglobin, hematocrit, neutrophil percentage, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and neutrophil lymphocyte ratio (NLR) between the EVB and non-bleeding groups (P < 0.05). Multivariate logistic regression analysis showed that etiology (OR = 3.287, 95% CI: 1.497 ~ 7.214), hematocrit (OR = 0.897, 95% CI: 0.853 ~ 0.943), and high-density lipoprotein cholesterol (OR = 0.229, 95% CI: 0.071 ~ 0.737) were independent risk factors for cirrhotic PVT patients combined with EVB. The constructed normogram model predicted the probability of bleeding in patients. The nomogram model had shown good consistency and differentiation (AUC = 0.820, 95% CI: 0.707 ~ 0.843), as verified by 10-fold cross-validation (C-index = 0.799) and the Hosmer-Lemeshow goodness of fit test (P = 0.915). The calibration plot and the decision curve suggested that the prediction model had good stability and clinical practicability. Conclusion: The risk factors for EVB occurrence include etiology, erythrocyte, hemoglobin, hematocrit, percentage of neutrophils, total protein, globulin, albumin/globulin, urea, high-density lipoprotein cholesterol, calcium, and NLR in patients with cirrhotic liver. The constructed prediction model has good predictive value, and it can provide a reference for medical personnel to screen patients with high bleeding risk for targeted treatment.
Subject(s)
Esophageal and Gastric Varices , Globulins , Varicose Veins , Venous Thrombosis , Humans , Liver Cirrhosis/pathology , Esophageal and Gastric Varices/complications , Portal Vein/pathology , Nomograms , Retrospective Studies , Calcium , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Risk Factors , Venous Thrombosis/complications , Varicose Veins/complications , Varicose Veins/pathology , Hemoglobins , Urea , Lipoproteins, HDL , Cholesterol , AlbuminsABSTRACT
Melanoma is a cancer that frequently metastasises to the small bowel, but most cases are asymptomatic and are diagnosed postmortem. Therefore, CT and PET CT cannot detect all lesions and conventional endoscopic study only detects 10-20% of lesions. In this study, we present the case of a 68-year-old patient with a history of cutaneous melanoma and a diagnosis of intestinal melanoma. Thanks to capsule endoscopy, two lesions compatible with cutaneous melanoma metastasis to the small bowel were detected, allowing a much more effective surgical planning. Capsule endoscopy is an innovative technique that improves preoperative diagnosis, as it is able to detect bowel segments that cannot be inspected by conventional endoscopy. It also has a better resolution than conventional CT, improving sensitivity in the detection of lesions.
Subject(s)
Capsule Endoscopy , Intestinal Neoplasms , Melanoma , Skin Neoplasms , Humans , Aged , Melanoma/diagnostic imaging , Melanoma/pathology , Capsule Endoscopy/methods , Skin Neoplasms/pathology , Endoscopy, Gastrointestinal , Intestine, Small/pathology , Intestinal Neoplasms/diagnostic imaging , Intestinal Neoplasms/surgery , Gastrointestinal Hemorrhage/pathologyABSTRACT
INTRODUCTION: Discordance between gastrointestinal (GI) symptoms and endoscopic inflammation in patients with ulcerative colitis (UC) is known. However, the correlations between symptoms and endoscopic and histologic (endo-histologic) mucosal healing and remains unknown. METHODS: We performed a secondary analysis of prospectively collected clinical, endoscopic, and histologic data on 254 colonoscopies from 179 unique adults at a tertiary referral center from 2014 to 2021. Spearman's rank was used to assess the correlation between patient reported outcomes and objective assessments of disease activity, as measured by validated instruments: Two-item patient-reported outcome measure (PRO-2) for stool frequency and rectal bleeding, the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for endoscopic inflammation, and the Geboes score for histologic inflammation. The predictive value of objective assessments of inflammation and clinical symptoms was described using sensitivity, specificity, and positive/negative predictive value. RESULTS: One-quarter (28%, 72/254) of cases were in endo-histologic remission; of these, 25% (18/72) report GI symptoms (22% diarrhea; 6% rectal bleeding). Endo-histologically active disease had higher sensitivity (95% rectal bleeding; 87% diarrhea) and negative predictive value (94% rectal bleeding, 78% diarrhea) for clinically active disease compared to active disease on endoscopic (77%) or histologic assessment only (80%). The specificity of endo/histologic inflammation for GI symptoms was < 65%. PRO-2 was positively correlated with endoscopic disease activity (Spearman's rank 0.57, 95% CI 0.54-0.60, p < 0.0001) and histologic disease activity (Spearman's rank 0.49, 0.45-0.53, p < 0.0001). CONCLUSION: One-quarter of patients with ulcerative colitis in endo-histologic (deep) remission have gastrointestinal symptoms, more commonly with diarrhea than rectal bleeding. Endo-histologic inflammation has high sensitivity (≥ 87%) for diarrhea/rectal bleeding.
Subject(s)
Colitis, Ulcerative , Humans , Adult , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/pathology , Colonoscopy , Inflammation/pathology , Mucous Membrane/pathology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Diarrhea/etiology , Diarrhea/pathology , Severity of Illness IndexABSTRACT
BACKGROUND AND AIMS: Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD. APPROACH AND RESULTS: This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts ( p < 0.05). CONCLUSIONS: An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
Subject(s)
Elasticity Imaging Techniques , Esophageal and Gastric Varices , Non-alcoholic Fatty Liver Disease , Humans , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Cohort Studies , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/complications , Magnetic Resonance Imaging , Gastrointestinal Hemorrhage/pathology , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/complications , Liver Cirrhosis/diagnostic imagingABSTRACT
Hemorrhagic bowel syndrome (HBS) is a sporadic and fatal disease of predominantly lactating dairy cattle, characterized by segmental hemorrhage and luminal clot formation in the small intestine. Although, Clostridium perfringens and Aspergillus fumigatus have been associated with HBS, the pathogenesis and cause are currently unknown. In this study, 18 naturally occurring cases of HBS (7 necropsied immediately following euthanasia, 11 with 12-48 hour postmortem intervals) were investigated to characterize the pathology and the intestinal microbiome. Hemorrhagic bowel syndrome was characterized by a single small-intestinal, intramucosal hematoma with dissection of the lamina muscularis mucosae. In most cases necropsied immediately after euthanasia (4/7), the intestinal mucosa proximal to the hematoma contained 9 to 14, dispersed, solitary or clustered, erosions or lacerations measuring 4 to 45 mm. In 77% (37/48) of these mucosal lesions, microscopic splitting of the lamina muscularis mucosae comparable to the hematoma was present. These findings suggest the intramucosal hematoma to originate from small mucosal erosions through dissecting hemorrhage within the lamina muscularis mucosae. No invasive fungal growth was observed in any tissue. Bacteriological cultivation and nanopore sequencing showed a polymicrobial population at the hematoma and unaffected intestine, with mostly mild presence of C perfringens at selective culture. Gross and microscopic lesions, as well as the culture and sequencing results, were not in support of involvement of C perfringens or A fumigatus in the pathogenesis of HBS.
Subject(s)
Intestines , Lactation , Female , Cattle , Animals , Intestines/pathology , Clostridium perfringens , Gastrointestinal Hemorrhage/microbiology , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/veterinary , Hematoma/pathology , Hematoma/veterinary , SyndromeABSTRACT
BACKGROUND: Patients with obscure gastrointestinal bleeding undergo small bowel capsule endoscopy (SBCE), but often return for recurrent bleeding or anemia. The RHEMITT score evaluates patients based on 7 variables (heart failure, chronic kidney disease, Saurin P1/P2 lesions, major bleeding, incomplete SBCE, smoking status, and endoscopic treatment) and seeks to predict the risk of rebleeding. AIMS: This study aims to perform an external validation of the RHEMITT score in the United States. METHODS: SBCEs performed to evaluate anemia or GI bleeding from a tertiary-care center's PillCam database between 1/22/2018 and 7/21/2020 were reviewed. Variables based on the RHEMITT score were collected. The primary outcome was rebleeding, defined as (1) melena or hematochezia or (2) hemoglobin drop of 2 g/dL. Patient were categorized into low, intermediate, and high-risk categories based on RHEMITT score. The accuracy of the RHEMITT score for predicting rebleeding was assessed. RESULTS: A total of 361 SBCEs were included in the study. Age, indication for SBCE, endoscopic treatment, antiplatelet use, cirrhosis, heart failure, chronic kidney disease, and major bleeding were significantly associated with risk of rebleed (p < 0.05). Each increasing risk category for the RHEMITT score predicted increased probability of this study's primary outcome, rebleeding (p < 0.001). There was a significant association between RHEMITT risk category and rebleeding-free survival (log-rank p < 0.001). An area under the receiver operating characteristic curve for the RHEMITT score was 0.790 (p < 0.001). CONCLUSION: Our findings validate the RHEMITT score and confirm acceptable performance for predicting rebleeding at a tertiary referral center in the United States.
Subject(s)
Capsule Endoscopy , Humans , Capsule Endoscopy/adverse effects , Tertiary Care Centers , Retrospective Studies , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , ROC Curve , RecurrenceABSTRACT
BACKGROUND: Nodular liver (NOD) in cystic fibrosis (CF) suggests advanced CF liver disease (aCFLD); little is known about progression of liver disease (LD) after detection of sonographic NOD. METHODS: Clinical, laboratory, and ultrasound (US) data from Prediction by Ultrasound of the Risk of Hepatic Cirrhosis in CFLD Study participants with NOD at screening or follow-up were compared with normal (NL). Linear mixed effects models were used for risk factors for LD progression and Kaplan-Meier estimator for time-to-event. RESULTS: 54 children with NOD (22 screening, 32 follow-up) and 112 NL were evaluated. Baseline (BL) and trajectory of forced expiratory volume, forced vital capacity, height/BMI z-scores were similar in NOD vs NL. Platelets were lower in NOD at BL (250 vs 331×103/microL; p < 0.001) and decreased by 8600/year vs 2500 in NL. Mean AST to Platelet Ratio Index (1.1 vs 0.4; p < 0.001), Fibrosis-4 Index (0.4 vs 0.2, p < 0.001), and spleen size z-score (SSZ) [1.5 vs 0.02; p < 0.001] were higher in NOD at BL; SSZ increased by 0.5 unit/year in NOD vs 0.1 unit/year in NL. Median liver stiffness (LSM) by transient elastography was higher in NOD (8.2 kPa, IQR 6-11.8) vs NL (5.3, 4.2-7, p < 0.0001). Over 6.3 years follow-up (1.3-10.3), 6 NOD had esophageal varices (cumulative incidence in 10 years: 20%; 95% CI: 0.0%, 40.0%), 2 had variceal bleeding, and 2 underwent liver transplantation; none had ascites or hepatic encephalopathy. No NL experienced liver-related events. CONCLUSIONS: NOD developed clinically evident portal hypertension faster than NL without worse growth or lung disease.
Subject(s)
Cystic Fibrosis , Elasticity Imaging Techniques , Esophageal and Gastric Varices , Hypertension, Portal , Humans , Child , Follow-Up Studies , Cystic Fibrosis/complications , Cystic Fibrosis/epidemiology , Cystic Fibrosis/pathology , Esophageal and Gastric Varices/pathology , Gastrointestinal Hemorrhage/pathology , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/diagnostic imaging , Liver Cirrhosis/etiologyABSTRACT
BACKGROUND: Umbilical discharge in an adult is rare and generates broad diagnostic considerations. Umbilical anatomy is variable owing to congenital abnormalities and acquired pathology such as umbilical hernias. The umbilicus can be a site of primary or metastatic malignancy or endometriosis. CASE PRESENTATION: A 40-year-old white American woman came to the clinic with a 2-day history of spontaneous umbilical bleeding. She reported periumbilical pain associated with nausea and emesis. There were no visible skin abnormalities, but deep palpation of the abdomen produced a thin, watery, serosanguineous fluid from the umbilicus. She experienced a similar episode of umbilical bleeding 5 years prior without clear cause. Laboratory workup was notable for mildly elevated C-reactive protein . Computed tomography imaging revealed a fat-containing umbilical hernia with fat necrosis, necessitating complete surgical resection of the umbilicus. CONCLUSIONS: Umbilical hernia with fat necrosis is a rare condition that should be considered in adults with umbilical discharge. Additional diagnostic considerations in adults with spontaneous umbilical bleeding/discharge include embryonal remnants, omphalitis, and metastasis. If the cause is not readily apparent on physical exam, imaging with computed tomography should be considered to assess for hernia and embryonal anomalies.
Subject(s)
Endometriosis , Fat Necrosis , Hernia, Umbilical , Neoplasms , Skin Diseases , Adult , Female , Humans , Umbilicus/pathology , Umbilicus/surgery , Hernia, Umbilical/complications , Hernia, Umbilical/diagnostic imaging , Hernia, Umbilical/surgery , Fat Necrosis/complications , Fat Necrosis/pathology , Gastrointestinal Hemorrhage/pathology , Endometriosis/pathology , Skin Diseases/pathologyABSTRACT
Background: Mature colonic teratomas are rare tumors and no case, to the best of our knowledge, has been reported from the African continent. In addition, some pedunculated teratomas in the colon have been treated by endoscopic polypectomy and classified as primary teratoma of the colon. We report a case of a distinct intra sigmoid pedunculated teratoma originating from the retroperitoneum of a 4-year-old African girl and we highlight the potential for misclassification of primary origin of endoscopically removed polypoid teratomas in the colon. Case Presentation: A 4 year-old black African female child who presented with abdominal pain and hematochezia. On clinical assessment, she was found to be anaemic and to have a sigmoid colon mass. At surgery, there was a mobile mass within the lumen of sigmoid colon and the mass was fixed to the retroperitoneum by a stalk of tissue. Pathologist's review of the resected sigmoid segment showed a pedunculated intra-sigmoid mass with the stalk traversing the wall of the colon. The mass was histologically proven a mature solid teratoma. Conclusions: This, to the best of our knowledge, is the first report of intra sigmoid teratoma from the African continent. It highlights the potential for misclassification of endoscopically resected colonic teratomas.
Subject(s)
Colonic Polyps , Teratoma , Child, Preschool , Female , Humans , Abdomen , Colon, Sigmoid/surgery , Colon, Sigmoid/pathology , Colonic Polyps/complications , Colonic Polyps/diagnosis , Colonic Polyps/surgery , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Gastrointestinal Hemorrhage/pathology , Teratoma/complications , Teratoma/diagnosis , Teratoma/surgeryABSTRACT
To evaluate whether combinations of liver lobe and spleen volumes obtained on magnetic resonance imaging (MRI) could predict esophagogastric variceal bleeding (EVB) in hepatitis B-related cirrhotic patients. Ninety-six consecutive patients with hepatitis B-related cirrhosis underwent upper abdominal contrast-enhanced MRI within 1 week after initial hospitalization, and grouped based on outcomes of EVB during the 2 years' follow-up after being discharged. Total liver volume (TLV), spleen volume (SV) and 4 liver lobe volumes including right lobe volume (RV), left medial lobe volume (LMV), left lateral lobe volume (LLV), and caudate lobe volume (CV) were measured on MRI. Percentages of individual liver lobe volumes in TLV (including RV/TLV, LMV/TLV, LLV/TLV, and CV/TLV), ratios of SV to individual liver lobe volumes (including SV/RV, SV/LMV, SV/LLV, and SV/CV), and SV/TLV were statistically analyzed to predict EVB. Patients with EVB had lower RV than without EVB (P valueâ =â .001), whereas no differences in LMV, LLV, CV, and TLV were found (P valuesâ >.05 for all). Among percentages of individual liver lobe volumes in TLV, RV/TLV was lower whereas LMV/TLV and LLV/TLV were greater in patients with EVB than without EVB (P valuesâ <.05 for all). SV, ratios of SV to individual liver lobe volumes, and SV/TLV in patients with EVB were larger than without EVB (P valuesâ <.05 for all). Among parameters with difference between patients with and without EVB, SV/RV could best predict EVB with an area under receiver operating characteristic curve of 0.84. SV/RV could best predict EVB in hepatitis B-related cirrhotic patients.
Subject(s)
Esophageal and Gastric Varices , Hepatitis B , Esophageal and Gastric Varices/diagnostic imaging , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/pathology , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Hepatitis B/complications , Hepatitis B/pathology , Humans , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/complications , Liver Cirrhosis/diagnostic imaging , Liver Cirrhosis/pathology , Magnetic Resonance Imaging , Prospective Studies , Spleen/diagnostic imaging , Spleen/pathologyABSTRACT
BACKGROUND: Heterotopic gastric mucosa has been scarcely reported in the veterinary literature. Its presence can be asymptomatic or associated with various clinical signs ranging from apathy, vomiting, to abdominal pain. This report illustrates the presence of heterotopic gastric mucosa in the jejunum of an adult dog. It is the first to describe severe anemia, requiring acute blood transfusion, following intestinal hemorrhage caused by heterotopic gastric mucosa. CASE PRESENTATION: A twelve-year-old, intact male Maltese dog was presented with a history of apathy, vomiting and anemia. The dog was on a strict diet for recurrent diarrhea, food intolerance and skin allergy. Clinical examination revealed severe anemic mucous membranes and painful abdominal palpation. Blood examination confirmed severe regenerative anemia. Ultrasonography showed an intestinal neoplasm, gall bladder sludge and non-homogeneous liver parenchyma. Three-view thoracic radiographs failed to show any metastatic lesions or enlarged lymph nodes. After initial stabilization and blood transfusion, a midline exploratory laparotomy was performed. Three different masses were found in the jejunum. Resection and anastomosis of approximately 40 cm of jejunum was performed, followed by liver and lymph node biopsy and placement of an esophagostomy tube. Two days after surgery the dog started to clinically improve and was discharged from the hospital on the sixth day after surgery. Histopathology revealed the intestinal masses to be heterotopic gastric mucosa associated with intramural cystic distensions, multifocal ulceration and bleeding into the intestinal lumen. Two years after surgery, the dog did not have a recurrence of anemia or gastrointestinal signs. CONCLUSIONS: This case demonstrates that heterotopic gastric mucosa can be considered one of the differential diagnoses in case of severe anemia due to gastrointestinal hemorrhage and suspected intestinal tumors. Although in most described cases in literature the finding seems to be incidental on necropsy, our report shows that heterotopic gastric mucosa can be the etiology of life-threatening signs. In addition, because no recurrent diarrhea episodes occurred after surgical resection of the ectopic tissue, it is likely that the heterotopic gastric mucosa was the cause of the food intolerance signs in this dog.
Subject(s)
Anemia , Dog Diseases , Anemia/veterinary , Animals , Diarrhea/veterinary , Dog Diseases/pathology , Dogs , Food Intolerance/complications , Food Intolerance/pathology , Food Intolerance/veterinary , Gastric Mucosa/pathology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/veterinary , Jejunum/surgery , Male , Vomiting/veterinaryABSTRACT
BACKGROUND: Capsule endoscopy is a gold standard diagnostic method for small bowel lesions. There is scarce evidence regarding vari- ables that may increase the odds of identifying small bowel lesions with this endoscopic method. The aim of this work is to describe variables associated with a higher probability of finding small bowel lesions on capsule endoscopy. METHODS: Cross-sectional study was performed using our Department's adult patients' capsule endoscopy database. The presence of any small bowel mucosal lesion was registered. Other variables were examined: age, gender, reason for referral, quality of bowel cleans- ing, and intestinal transit time. These variables were compared between those patients showing at least 1 lesion versus those without lesions. Univariate and multivariate analysis was performed to determine variables significantly associated with the presence of bowel lesions. RESULTS: In total, 140 studies were analyzed; 90% were performed due to occult gastrointestinal bleeding. Median age was 69 years (60-75); 54.29% were males. Bowel cleansing was adequate in 94.29%; 68.57% showed at least 1 lesion. Non-significant difference was observed in terms of age between groups of comparison (70 [61-76] vs 63 [59-74], P = .07). No difference was found comparing bowel cleansing, gender, or reason for referral. Intestinal transit time was significantly longer among those patients with a bowel lesion (359 minutes [257-427] vs 279 minutes [200-333], P = .05). On multivariate analysis, age and intestinal time were significantly associ- ated with the presence of at least one small bowel lesion (odds ratio 1.02 [1-1.06] and 1.09 [1.03-1.12], respectively). CONCLUSION: Age and intestinal transit time were significantly associated with the presence of abnormal findings on capsule endoscopy.
Subject(s)
Capsule Endoscopy , Adult , Aged , Capsule Endoscopy/methods , Cross-Sectional Studies , Female , Gastrointestinal Hemorrhage/pathology , Humans , Intestine, Small/pathology , Male , Retrospective StudiesABSTRACT
BACKGROUND AND AIM: Hematochezia is a major adverse event associated with colorectal endoscopic submucosal dissection (ESD). This study aimed to distinguish between hematochezia that required endoscopic hemostasis and hematochezia that required no hemostasis. METHODS: This retrospective study included consecutive patients who underwent ESD for colorectal tumors at the Osaka International Cancer Institute between September 2017 and August 2020. The exclusion criteria were as follows: patients with coexisting advanced colorectal cancers or inflammatory bowel diseases, patients who received incomplete ESD or emergency surgery, or patients who underwent ESD for multiple lesions. We evaluated whether the patients had hematochezia and underwent emergency colonoscopy and hemostasis during hospitalization. The degree of hematochezia in the saved photographs was assessed using the hematochezia scale and classified as mild, moderate, or severe. Blood pressure, heart rate, time from ESD to first hematochezia, and total number of hematochezia episodes were also evaluated. RESULTS: Among the 437 patients who underwent ESD, 44 were excluded, and 393 patients were evaluated. Hematochezia was observed in 100 patients (25%). Emergency colonoscopy was performed in 12 patients (3%), and hemostasis was required in six patients (2%). For patients with hematochezia, only mild hematochezia and hematochezia that developed ≤ 48 h after ESD were significantly associated with no intervention for hemostasis. The positive predictive value for no intervention for hemostasis was 100% (93-100%) for mild hematochezia and 98% (93-100%) for hematochezia ≤ 48 h. CONCLUSIONS: Mild hematochezia and hematochezia ≤ 48 h were negative predictors of hemostasis, in which emergency colonoscopy may be avoided.
Subject(s)
Colorectal Neoplasms , Endoscopic Mucosal Resection , Colonoscopy/adverse effects , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/etiology , Colorectal Neoplasms/surgery , Endoscopic Mucosal Resection/adverse effects , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Humans , Intestinal Mucosa/pathology , Intestinal Mucosa/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Capsule endoscopy (CE) provides a novel approach to evaluate obscure gastrointestinal bleeding. Yet CE is not routinely utilized in the inpatient setting for a variety of reasons. We sought to identify factors that predict complete CE and diagnostically meaningful CE, as well as assess the impact of inpatient CE on further hospital management.1 na d2 METHODS: We conducted a retrospective review of patients undergoing inpatient CE at a tertiary referral, academic center over a 3 year period. We analyzed data on patient demographics, medical history, endoscopic procedures, hospital course, and results of CE. The primary outcome was complete CE and the secondary outcome was positive findings of pathology on CE. RESULTS: 131 patients were included (56.5% were men 43.5% women, median age of 71.0 years). Overall, CE was complete in 77.1% of patients. Complete CE was not related to motility risk factors, gender, or administration modality. Patients with incomplete CE tended to be older, have lower BMI, and Caucasian, however results did not reach statistical significance (p = 0.06; p = 0.06; p = 0.08 respectively). Positive CE was noted in 73.3% of patients, with 35.1% of all patients having active bleeding. Positive CE was not associated with AVM risk factors or medication use. 28.0% of patients underwent subsequent hospital procedures, among which 67.6% identified the same pathology seen on CE. CONCLUSIONS: Contrary to previous studies, we found the majority of inpatient CEs were complete and positive for pathology. We found high rates of correlation between CE and subsequent procedures. The use of CE in the inpatient setting helps to guide the diagnosis and treatment of hospitalized patients with obscure gastrointestinal bleeding.