Cases reported "Flatulence"

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1/14. Five-layer repair of rectovaginal fistula using a vaginal approach. A case report.

    We present a case of a rectovaginal fistula which was revealed as an incidental finding at the time of posterior colporrhaphy. We describe a previously unreported 5-layer repair through a vaginal approach in preference to the more frequently reported approaches of endoanal flap or conversion to a fourth degree tear. The diagnosis and management of rectovaginal fistulas is discussed. ( info)

2/14. Ovarian cancer: a case study.

    Ovarian cancer is the leading cause of death from gynecologic malignancies in the united states, accounting for approximately 15,000 deaths each year. patients commonly present to their primary care providers with vague abdominal symptoms. health care providers need to become more aware of the importance of pursuing seemingly vague symptoms. A discerning knowledge of the risk factors and symptoms of this disease enables the clinician to institute appropriate assessment strategies, intervention, and referral, resulting in reduced mortality rates. This case report of a white woman aged in her 60s diagnosed with ovarian cancer stresses the need for early screening and detection, disease education, and prompt referral and management to displace the fear associated with the diagnosis and improve survival. ( info)

3/14. The solution was the problem.

    There are increasing numbers of adults living in the community who require enteral tube feeding. While there is significant evidence of the importance of this treatment, there are side effects which can cause difficulties for patients, their carer tabers and health professionals. Gastrointestinal complications are the most common side effects with feed formula being cited as the main culprit, often without investigating other potential causes. Many patients requiring aggressive nutrition support also require concurrent drug therapy to manage underlying disease. Drugs are often given via tubes in liquid form. These elixirs often contain large quantities of sorbitol, which will increase the osmolar concentration. There is a lack of awareness from primary health-care professionals about the difficulties that can arise when giving medications to patients receiving enteral feeding which may affect patient care and the nutritional outcomes. ( info)

4/14. Hepatic portal venous gas: clinical significance of computed tomography findings.

    Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance. Most cases with HPVG are related to mesenteric ischemia that have been associated with extended bowel necrosis and fatal outcome. With the help of computed tomography (CT) in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia has improved. There has been also an increasing rate of detection of HPVG with certain nonischemic conditions. In this report, we present two cases demonstrating HPVG unrelated to mesenteric ischemia. One patient with cholangitis presented abdominal pain with local peritonitis and survived after appropriate antibiotic treatment. laparotomy was avoided as a result of lack of CT evidence of ischemic bowel disease besides the presence of HPVG. The other case had severe enteritis. Although his CT finding preluded ischemic bowel disease, conservative treatment was implemented because of the absence of peritoneal signs or clinical toxic symptoms. Therefore, whenever HPVG is detected on CT, urgent exploratory laparotomy is only mandatory in a patient with whom intestinal ischemia or infarction is suspected on the basis of radiologic and clinical findings. On the other hand, unnecessary exploratory laparotomy should be avoided in nonischemic conditions that are usually associated with a better clinical outcome if appropriate therapy is prompted for the underlying diseases. patients with radiographic diagnosis of HPVG should receive a detailed history review and physical examination. The patient's underlying condition should be determined to provide a solid ground for exploratory laparotomy. A flow chart is presented for facilitating the management of patients with HPVG in the ED. ( info)

5/14. health seeking related to ovarian cancer.

    Critical review of general health-seeking models showed a need for expansion to include the early and atypical symptom period associated with ovarian cancer and the role of self and primary care in the diagnostic process. Data from family functioning research showed that in the self-care phase, the initial gastrointestinal symptoms were unrecognized as serious, given common sense labels, and self-managed. When primary care provider care was sought, misdiagnoses occurred three fourth of the time. Diagnostic delays occurred in these 2 phases of care. An expansion of a model of health seeking links personal and family risks and adds early symptom data may be obtained through monthly self-monitoring by women using a symptom checklist. Organization of risks and symptom information assists in interpretation of disparate streams of data and gives a recommended outcome: high personal risk level high family risk level high early and persistent symptoms presence = high need for a prompt gynecological evaluation. The restructured health-seeking process requires women be taught how to monitor their ovarian health. nurses and primary care providers need frequent continuing education updates and the health media need current and accurate information about this malignancy. ( info)

6/14. Aerophagia and anesthesia: an unusual cause of ventilatory insufficiency in a neonate.

    We describe a healthy neonate with abdominal distention, inadequate ventilation, and delayed extubation during anesthesia for minor surgery. Following rectal decompression and successful extubation, extreme abdominal distention recurred postoperatively after ingestion of clear fluids. We elicited a history of frequent and excessive flatus from the parents, and abdominal radiography revealed distended loops of small bowel with small lung volumes suggestive of aerophagia. The differential diagnosis of aerophagia is reviewed, the anesthetic implications discussed, and relevant literature pertaining to this condition summarized. ( info)

7/14. Endoscopic placement of flatus tube using "lasso" technique with snare wire.

    A 55-year old man presented with acute sigmoid volvulus. The distal level of obstruction was above the level which could be reached by the rigid sigmoidoscope to allow decompression, and so a flatus tube was "lassoed" onto the side of a flexible endoscope which allowed accurate placement under direct vision. This technique allows accurate placement of catheters, feeding tubes and other devices endoscopically, which cannot be placed through the instrument channel of the endoscope. ( info)

8/14. Pathologic childhood aerophagy: an under-diagnosed entity.

    Three children with pathologic childhood aerophagy are described. This entity is characterized by progressive abdominal distension during the day, non-distended abdomen in the morning, and visible air swallowing. The condition is usually self-limited, and treatment is symptomatic and by reassurance. Early recognition and diagnosis of this condition might help avoid unnecessary and expensive diagnostic investigations. ( info)

9/14. Follow-up of a flatulent patient.

    This paper describes a low-flatulence diet developed by an extremely flatulent patient. Based on meticulous recording of each passage of flatus, the patient employed an elimination diet to determine what foods were responsible for his gas production. The diet reduced the frequency of his gas passage from 34 /- 7 to 17 /- 5 times per day (normal: 14 /- 6) and similar reductions were observed by two other flatulent patients during adherence to the diet. The rectal gas of each of these subjects largely consisted of two gases (CO2 and H2) which result from bacterial fermentation of carbohydrates. The diet, which is low in lactose and wheat products, presumably minimizes the quantity of carbohydrates delivered to the colonic bacteria. ( info)

10/14. Definitive surgical therapy for incapacitating "gas-bloat" syndrome.

    Posterior gastropexy appears to be the treatment of choice in the occasional patient with persistent debilitating post-fundoplication syndrome. This syndrome occurs to this extent only rarely (less than 1%) and chronic small-bowel obstruction or dysfunction may be a predisposing factor. We prefer the posterior gastropexy of Hill in cases of reflux esophagitis uncomplicated by Barretts mucosa, stricture, or esophageal shortening. The authors especially caution against the use of fundoplication as an incidental procedure for anatomic repair of an asymptomatic hiatus hernia or in patients with a history of small bowel obstruction. ( info)
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