1/51. Autoaggressive inflammation of the myenteric plexus resulting in intestinal pseudoobstruction.After a 3-year history of severe constipation, a 16-year-old girl required surgery to be relieved of impacted stools. Histologic examination showed ganglionitis in the myenteric plexus of the large bowel and ileum, whereas the submucosal plexus was spared. At this time, antineuronal nuclear antibodies (ANNA-1, anti-Hu) were found at high titer in the serum of the patient. One and a half years earlier, a paravertebral ganglioneuroblastoma had been removed. Histologic examination had shown undifferentiated neuroblasts and morphologically mature ganglion cells with both cell types embedded in an inflammatory infiltrate morphologically similar to the lymphoplasmocytic infiltration seen in the myenteric plexus. The patient's serum was found to bind to nuclei of mouse intestinal tract neurons, thus fulfilling defining criteria for ANNA-1. The serum also reacted with antigens of defined molecular weight in a Western blot, thus fulfilling defining criteria for anti-Hu. Expression of the Huantigen could be visualized in the nuclei of the patient's tumor cells by immunohistochemistry. These tests showed that an antitumor inflammatory response was the cause of the bowel disease. This is the first report of a tumor from the neuroblastoma group that caused paraneoplastic intestinal pseudoobstruction. Ganglionitis and subsequent aganglionosis are the hallmark of the morphologic diagnosis which cannot be obtained by suction biopsy in patients with intact submucosal plexus. Instead, serum testing for autoantibodies can reveal the etiology.- - - - - - - - - - ranking = 1keywords = bowel disease, bowel (Clic here for more details about this article) |
2/51. intestinal obstruction from midgut volvulus after laparoscopic appendectomy.We present the case of a 30-year-old man who developed a small bowel obstruction from an acute midgut volvulus 8 days after undergoing a laparoscopic appendectomy. There was no evidence of congenital malrotation or midgut volvulus on the initial computed tomography (CT) scan or at laparoscopy. Subsequently, a midgut volvulus developed in the absence of congenital malrotation.- - - - - - - - - - ranking = 0.028555309885183keywords = bowel (Clic here for more details about this article) |
3/51. Acute flare-up of conjunctival graft-versus-host disease with eosinophil infiltration in a patient with chronic graft-versus-host disease.Chronic graft-versus-host disease (cGvHD) is a disabling alloimmune disease. Acute flare-ups of alloimmune reactions can occur even at the chronic clinical stage necessitating modulation of immunosuppression therapy. We studied conjunctival lesions of a patient with an acute flare-up in cGvHD. Along with severe GvHD lesions, biopsies showed eosinophils with pathological signs of activation. Since eosinophil recruitment and activation is observed in flare-ups of patients with autoimmune or inflammatory bowel diseases, we suggest that activated eosinophils in target organs may be a marker of evolutive lesions in alloimmune reactions as in other kinds of inflammatory diseases.- - - - - - - - - - ranking = 7.4289090064302keywords = inflammatory bowel disease, inflammatory bowel, bowel disease, bowel (Clic here for more details about this article) |
4/51. Inflammatory bowel perforation during immune restoration after one year of antiretroviral and antituberculous therapy in an hiv-1-infected patient: report of a case.PURPOSE: This article reports an unusual presentation of bowel perforation. methods: We report the case of a 30-year-old HIV-infected male who suffered from an advanced state of CD4 cell depletion (29 CD4 cells per 106/l). abdominal pain and diarrhea led to further examinations. RESULTS: colonoscopy revealed a severe tuberculous ileocecal inflammation. tuberculosis and HIV infection were treated. The patient's response to antiretroviral therapy was excellent. After 11 months of potent antiretroviral treatment and 12 months of antituberculous therapy he suffered from acute abdominal pain with fever and ileus. laparotomy revealed two intestinal perforations of the jejunum and inflammation of the whole ileocecal region. CONCLUSION: Immunopathologic reactions caused by immune restoration are novel presentations of highly active antiretroviral treatment as shown here. The presented patient is an unusual case with a very late onset of inflammatory response, which led to intestinal perforation.- - - - - - - - - - ranking = 0.14277654942591keywords = bowel (Clic here for more details about this article) |
5/51. Transmural migration of a retained laparotomy sponge.The most common surgically retained foreign body is the laparotomy sponge. The clinical presentation of a retained sponge can vary from an incidental finding on plain radiograph to an intense inflammatory response with obstruction or perforation. In the case described here a patient reported abdominal pain 11 months after her hysterectomy. Although two sponge counts appeared in the operative record one laparotomy sponge had been overlooked. Apparently an inflammatory response created an abscess pocket around the sponge between the abdominal wall and the ileum resulting in perforation of the ileum. Through this opening the sponge migrated into the lumen of the small bowel, from which it was surgically removed. The patient recovered without complications. The case highlights the importance of a thorough exploration of all quadrants of the abdomen at the termination of surgical cases.- - - - - - - - - - ranking = 0.028555309885183keywords = bowel (Clic here for more details about this article) |
6/51. Inflammatory fibroid polyp of the ileum causing intussusception: report of two cases with emphasis on cytologic diagnosis.Inflammatory fibroid polyp (IFP) of the gastrointestinal tract is a type of inflammatory pseudotumor or inflammatory myofibroblastic tumor that occurs most commonly in the stomach but also in the small and large bowel. Small-bowel IFP usually presents with intussusception. The purpose of the current study is to describe cytological features of this lesion with differential diagnoses since pathologists may be called on to render a diagnosis on fine-needle aspiration. Two cases of IFP are described with diagnostic features on imprint smears. Both were middle-aged obese women with a history of prior intra-abdominal surgical procedures who presented with signs of intestinal obstruction and were found to have a tumor causing intussusception. At intraoperative consult, scrape cytology specimens showed cellular smears with a heterogeneous population of myofibroblasts, inflammatory cells and vessels. The features together with clinical history are sufficient to suggest the diagnosis. IFP is a lesion with a characteristic morphology. The differential diagnosis includes several other lesions, hence triage of cytological specimen for culture, electron microscopy, and immunohistochemistry is important in facilitating a correct diagnosis. Although a surgical procedure may still be necessary once a diagnosis of IFP is made, treatment may be tailored for a less aggressive process.- - - - - - - - - - ranking = 0.057110619770365keywords = bowel (Clic here for more details about this article) |
7/51. cytomegalovirus pseudotumor presenting as bowel obstruction in a patient with acquired immunodeficiency syndrome.Although cytomegalovirus (CMV) can be fatal to patients with the acquired immunodeficiency syndrome (AIDS), it usually causes few, if any, symptoms. The virus has an affinity for the alimentary tract, especially the ileum and right colon. CMV infections of the gut are often erosive, resulting in enterocolitis, hemorrhage, or intestinal perforation. Inflammatory mass formation is rare. Kaposi's sarcoma and lymphoma are established causes of bowel obstruction in patients with AIDS. This report describes a case of ileocecal obstruction due to a discrete CMV-induced pseudotumor in a patient with AIDS.- - - - - - - - - - ranking = 0.14277654942591keywords = bowel (Clic here for more details about this article) |
8/51. Primary (retractile) mesenteritis in a child.We report a case of primary retractile mesenteritis presenting as acute abdominal pain requiring surgery in a 3-year-old boy. At laparotomy, a hemoperitoneum was discovered and the diagnosis of primary mesenteritis was made with the aid of frozen section biopsy of the small bowel mesentery. No resection was necessary, and he made an uneventful recovery and remains well on follow-up.- - - - - - - - - - ranking = 0.028555309885183keywords = bowel (Clic here for more details about this article) |
9/51. Bladder wall necrosis in an extremely low-birth-weight infant: a thought-provoking complication of necrotizing enterocolitis.An 879-g baby boy had catastrophic necrotizing enterocolitis (NEC) at 29 days of life and underwent surgical laparotomy with a subsequent ileostomy and peritoneal drain placement. The infant was subsequently stable until 42 days of life when a spontaneous perforation of the bladder apex was diagnosed by a suprapubic cystogram. laparotomy on day of life 46 found a loop of dead bowel herniating into a necrotic hole of the bladder dome. This case shows a previously unreported complication of NEC and discusses the possibility that prolonged use of a peritoneal drain may have permitted its genesis.- - - - - - - - - - ranking = 0.028555309885183keywords = bowel (Clic here for more details about this article) |
10/51. Retractile mesenteritis: report of a case.Retractile mesenteritis is a rare idiopathic inflammatory process of the mesenteric adipose tissue. A 58-year-old woman who presented with acute abdominal pain and vomiting underwent laparotomy for a small bowel obstruction of unknown etiology. The laparotomy showed dilated small bowel loops and multiple tumor-like fibrous plaques in the mesentery. Histological examination revealed nonspecific chronic inflammatory processes of the mesentery. The computed tomography finding of increased density of the mesenteric fat, known as the "fat-ring sign," in a patient with small bowel obstruction and no surgical history would suggest this rare diagnosis.- - - - - - - - - - ranking = 0.085665929655548keywords = bowel (Clic here for more details about this article) |
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