Testicular seminoma presenting as a large conglomerate mass in abdomen

Testicular seminoma commonly occurs in young men aged between 15 and 45 years old. Those with testicular cancer may present with a lump or swelling in the testicle. If treated and managed early, patients can expect a greater than 95% success rate. However, advanced stages of testicular seminoma can lead to eventual metastasis. We present a 45-year-old male patient with a prior history of testicular seminoma who was admitted to the emergency department with abdominal distension and acute abdominal pain. The CT identified a rather sizable abdominal mass and the biopsy confirmed metastatic testicular seminoma. Lymphoma was considered as the other differential diagnosis. Abdominal metastasis is rare in patients with testicular seminoma and usually leads to a poor survival outcome. Our patient did not attend follow-up appointments postorchidectomy, likely resulting in abdominal metastasis of testicular seminoma. This demonstrates the importance of ongoing surveillance of seminoma patients, and the challenges associated with differentiating large abdominal conglomerate mass in the CT scan. This patient is currently on active chemotherapy with bleomycin, cisplatin, and etoposide.

A detailed intake-status profiling of seafoods in adult food-protein-induced enterocolitis syndrome patients

BACKGROUND

Adults with food-protein-induced enterocolitis syndrome (FPIES) often develop severe abdominal symptoms after eating seafood. However, no investigation of a food elimination strategy for adult FPIES patients has been performed to date.

METHODS

We conducted a retrospective cohort study of seafood-avoidant adults by telephone interview, based on the diagnostic criteria for adult FPIES reported by González et al. We compared the clinical profiles, abdominal symptoms, and causative seafoods between FPIES and immediate-type food allergy (IgE-mediated FA) patients. We also profiled the detailed intake-status of seafoods in adult FPIES patients.

RESULTS

Twenty-two (18.8 %) of 117 adults with seafood-allergy were diagnosed with FPIES. Compared with the IgE-mediated FA patients, FPIES patients had an older age of onset, more pre-existing gastrointestinal and atopic diseases, more episodes, longer latency and duration of symptoms, more nausea, abdominal distention, and severe abdominal pain, and more frequent vomiting and diarrhea. In particular, abdominal distention-reflecting intestinal edema and luminal fluid retention-may be the most distinctive characteristic symptom in adult FPIES (p < 0.001). Bivalves, especially oysters, were the most common cause of FPIES. Strikingly, intake-status profiling revealed that many FPIES patients can safely ingest an average of 92.6 % of seafood species other than the causative species.

CONCLUSIONS

There are many differentiators between FPIES and IgE-mediated FA, which may reflect differences in the underlying immunological mechanisms. Although seafood FPIES is unlikely to induce tolerance, many patients can ingest a wide variety of seafood species after a long period from onset.

Congenital adhesion band: A rare case in a neonate

Diseases of the gastrointestinal system may be congenital or acquired. Intestinal obstruction is common in children and neonates, and it has various causes. Obstructions due to congenital adhesion bands are rare. Few cases were reported in the literature. In this paper, we will discuss the case of an 8-day-old girl who was presented to the emergency department with signs of intestinal obstruction.

A healthy young patient with hepatic portal vein gas due to acute gastric dilatation: a case report

Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.

Giant Hydronephrosis: A Rare Case Report and Literature Review

Giant hydronephrosis (GH), characterized by the presence of more than 1 L of fluid in the renal collecting system, is a rare urological condition, particularly in adults. Obstruction of the pyeloureteral junction is the most common cause of GH. We report the case of a 51-year-old man who presented with dyspnea, edema of the lower limbs, and major abdominal distension. The patient was diagnosed with obstruction of the pyeloureteral junction, causing a left giant hydronephrotic kidney. After renal drainage of 27 L of urine, a laparoscopic nephrectomy was performed. GH usually manifests as asymptomatic abdominal distension or vague symptoms. However, very few published reports describe cases of GH initially presenting with respiratory and vascular manifestations.

Acute Gastric Dilatation: A Cause for Concern

Acute gastric dilatation is the radiological finding of a massively enlarged stomach as seen on plain film X-ray or a computerized tomography scan of the abdomen. It is a rare entity with high mortality if not treated promptly and is often not reported due to a lack of physician awareness. It can occur due to both mechanical obstruction of the gastric outflow tract, or due to nonmechanical causes, such as eating disorders and gastroparesis. Acute hyperglycemia without diagnosed gastroparesis, such as in patients with diabetic ketoacidosis, may also predispose to acute gastric dilatation. Prompt placement of a nasogastric tube can help deter its serious complications of gastric emphysema, ischemia, and/or perforation. We present our experience of 2 patients who presented with severe hyperglycemia and were found to have acute gastric dilation on imaging. Only one of the patients was treated with nasogastric tube placement for decompression and eventually made a full recovery.

Risk factors of poor prognosis in patients with pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome after transjugular intrahepatic portosystemic shunt

AIMS

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective method in treating patients with severe hepatic sinusoidal obstruction syndrome induced by pyrrolidine alkaloids (PA-HSOS). However, some patients still have poor postoperative prognosis. So, we aim to evaluate the predictors associated with poor outcomes in PA-HSOS patients receiving TIPS.

METHODS

Patients who were diagnosed as PA-HSOS and received TIPS in our hospital between January 2013 and April 2019 were reviewed retrospectively. Baseline information and clinical data were collected. The hazard ratios (HRs) of factors associated with poor prognosis were analyzed by Cox proportional hazard analysis. The Kaplan-Meier method was used to analyze and compare the cumulative incidence of the poor results and survival rate of patients.

RESULTS

During a median of 19.25-month follow-up, death occurred in 17 patients. We found that prothrombin time at baseline with an adjusted HR 1.110 (95% confidence interval 1.014-1.216, p = 0.024) and serum total bilirubin of 9 mg/dl 5 days after TIPS with an adjusted HR 1.114 (95% confidence interval 1.042-1.190, p = 0.001) were independent risk factors for death. The 1-year and 5-year survival rate were 86.2% and 82.1%, respectively. The 1-year survival rate in patients with prothrombin time > 17.85 s at baseline and serum total bilirubin > 9 mg/dl at 5 days after TIPS was significantly lower than that of patients below the corresponding threshold, respectively.

CONCLUSIONS

Prolonged prothrombin time at baseline and increased serum total bilirubin levels 5 days after TIPS are independent risk factors for predicting death after TIPS treatment in PA-HSOS patients.

Apatinib for treatment of a pseudomyxoma peritonei patient after surgical treatment and hyperthermic intraperitoneal chemotherapy: A case report

BACKGROUND

Pseudomyxoma peritonei (PMP) is a rare benign, but progressive, disease according to myxoma histopathology. Surgical resection is the preferred and most effective treatment, but the outcomes are often unsatisfactory.

CASE SUMMARY

A 63-year-old Chinese woman with PMP received apatinib at a daily dose of 0.5 mg for 15 d per cycle and at a daily dose of 0.4 mg to date for recurrent abdominal distension after surgical treatment and hyperthermic intraperitoneal chemotherapy. During the follow-up period, apatinib was the maintenance treatment with a progression-free period of 10 mo and the toxicity of apatinib was controllable and tolerable. Unfortunately, recurrence occurred 10 mo after administration. After two operations, the patient gave up treatment at the 18^th mo and eventually died of intestinal obstruction and multiple organ failure.

CONCLUSION

Apatinib may be an option for recurrent PMP after surgical treatment, but this conclusion remains to be confirmed.

Challenging diagnosis of prune belly syndrome antenatally: a case report

Background

Prune belly syndrome is a rare congenital condition of uncertain etiology.

It is characterized with a triad of abdominal distension due to deficient abdominal wall, genitourinary tract anomalies, and musculoskeletal anomalies. This condition varies in its severity which makes diagnosis challenging during early antenatal scanning.

Case presentation

We reported a severe phenotype of prune belly syndrome which was not fully suspected in a 29-year-old Saudi woman was G4T2P0A1L2 at 21 weeks of gestation at the time of early antenatal presentation; however, it became apparent during diagnosis at a subsequent follow-up scan during advanced gestational age.

Conclusion

We conclude that suspicion of such anomalies through an early antenatal scan require an urgent further follow-up scan in a tertiary center. The referral to the tertiary center must be to an experienced ultrasonographer and maternal–fetal medicine specialist for a decision to be made antenatally regarding the course of pregnancy and post-delivery management based on the severity of the condition.

A pediatric case developing critical abdominal distension caused by a combination of humidified high-flow nasal cannula oxygen therapy and nasal airway

Background

We describe a pediatric patient who suffered from critical abdominal distention caused by a combination of humidified, high-flow nasal cannula (HHFNC) oxygen therapy and nasal airway.

Case presentation

A 21-month-old boy with a history of chronic lung disease was admitted to the intensive care unit (ICU). Immediately after admission, his airway was established using a tracheal tube and mechanical ventilation was started. Five days after the commencement of mechanical ventilation, finally, his trachea was extubated. Immediately after extubation, HHFNC therapy at 20 L/min with an FiO₂ of 0.35 was applied. However, severe stridor was observed, then a nasal airway was placed in the left nostril. However, he became restless. Critical abdominal distention was observed. A subsequent chest X-ray revealed that the nasal airway was placed too deeply, and the gastrointestinal air was severely accumulated. Immediately, the nasal airway was removed, and HHFNC flow was reduced to 10 L/min. Frequent suctioning and continuous gastric drainage were required, which achieved gradual improvement of respiratory condition.

Conclusions

We need to recognize that HHFNC therapy is one of the positive pressure ventilation system. Therefore, HHFNC therapy might cause the similar adverse events to noninvasive pressure ventilation.

Abdominal distention and poor appetite as presenting symptoms of systemic amyloidosis

Amyloidosis is a rare diasease in China. Because of complicated manifestations and elusive early clinical symptoms, the early diagnosis of amyloidosis is difficult and its misdiagnosis rate is high. Clinicians should raise their awareness of amyloidosis and have a good knowledge of the clinical features of amyloidosis to improve its diagnosis. Biopsy of the lesion and Congo red staining are reliable for the diagnosis of amyloidosis.

A case report of abdominal distention caused by herpes zoster

Gastrointestinal complications caused by herpes zoster are extremely rare. Here, we described a case of abdominal distention caused by herpes zoster. The patient was a 59-year-old female who suffered from unexplained paroxysmal and a burning pain on the right part of her waist and abdomen, accompanied by abdominal distention. Intestinal pseudo-obstruction was diagnosed by abdominal radiography. Distention of the right abdominal wall was still apparent after one month. In this report, we found that recovery from abdominal distention caused by herpes zoster is difficult and may require surgical intervention.

Treatment of pediatric Ogilvie’s syndrome with low-dose erythromycin: A case report

Acute colonic pseudo-obstruction is a poorly understood syndrome, characterized by the signs, symptoms and radiological pattern of a large bowel obstruction without evidence for a mechanical obstruction. We report a case of a 2-year old boy who presented with progressive abdominal distention, vomiting and abdominal pain on postoperative d 3. Plain abdominal Χ-ray showed markedly dilated large bowel. Mechanical colonic obstruction was ruled out with hypaque enema. Ogilvie’s syndrome was suspected. The patient received treatment with oral erythromycin which had an immediate beneficial effect. During the 6 mo follow-up, no recurrences of symptoms were observed. We provide a safe and effective therapy for Ogilvie’s syndrome in pediatric individuals.