Unusual Cause of Abdominal Pain

Article · March 2013with3 Reads
DOI: 10.1053/j.gastro.2012.12.037 · Source: PubMed
  • [Show abstract] [Hide abstract] ABSTRACT: Duplication cyst of the duodenum is rare. This study describes a case of duodenal duplication and evaluates its clinical features through a literature review. A case of duodenal duplication is reported, and related articles published from 1999 to 2009 on PubMed were reviewed. Clinical manifestations, diagnostic examinations, and methods of management were analyzed. Including this report, there had been 38 citations in literature that provide adequate descriptions of 47 cases of duodenal duplication cysts. Nineteen (40.4%) were discovered before 10 years of age, whereas 10 (21.3%) were found in the second decade. The remaining 18 patients (38.3%) were older than 20 years. The case number decreased as age increased. Overall, 80% of cases presented with abdominal pain, and 53% were complicated with pancreatitis. The most common symptom in duodenal duplication cysts is abdominal pain with or without nausea or vomiting. The most common complication is pancreatitis. Differential diagnoses of pancreatitis, hepatitis, cholestasis, or intussusception should include duplication cyst of the duodenum.
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  • [Show abstract] [Hide abstract] ABSTRACT: Acute pancreatitis is one of the most common conditions for which emergent imaging is indicated. Alcohol consumption and cholelithiasis are the most common causes of acute pancreatitis in adults, whereas the majority of cases in children are idiopathic or secondary to trauma. A wide variety of structural and biochemical abnormalities may also cause pancreatitis. Although in some cases it is difficult to identify the specific cause of the disease radiologically, certain uncommon types of acute or chronic pancreatitis may have unique imaging features that can help the radiologist make an accurate diagnosis. These unusual types include autoimmune pancreatitis, groove pancreatitis, tropical pancreatitis, hereditary pancreatitis, and pancreatitis in ectopic or heterotopic pancreatic tissue. Pancreatitis may occasionally be seen in association with cystic fibrosis or pancreas divisum, or secondary to worm infestation of the pancreaticobiliary tree (eg, by Ascaris lumbricoides). In addition, primary pancreatic and duodenal masses may occasionally manifest as acute or recurrent acute pancreatitis. Knowledge of the classic imaging findings of these entities allows prompt recognition of the relevant pathologic condition, thereby preventing misdiagnosis and subsequent inappropriate or delayed management.
    Full-text · Article · Jul 2009
  • [Show abstract] [Hide abstract] ABSTRACT: Abstract Phlebosclerotic colitis is a rare condition characterized by sclerosis of the tributaries of the superior mesenteric vein leading to chronic venous ischaemia and calcification of the colonic wall. The radiological features are characteristic. Although many cases are treated conservatively, there are some indications for surgical resection. We report the first case of perforated phlebosclerotic colitis with intraabdominal abscess and review the literature on this rare topic and discuss the indications for surgical resection.
    Full-text · Article · Nov 2008
  • [Show abstract] [Hide abstract] ABSTRACT: Nonthrombotic stenosis or occlusion of the mesenteric veins is a rare cause of intestinal ischemia. The aim of this study was to describe a new disease entity causing chronic ischemic colitis. Seven patients were diagnosed as having mesenteric phlebosclerosis. All seven patients had calcifications in the small mesenteric veins and their intramural branches. No evidence of vasculitis or portal hypertension was recognized. None of the patients had a history of gastrointestinal disease or of prolonged drug use. We report clinical, laboratory, radiographic, endoscopic, and histopathologic findings. Clinical findings included abdominal pain and diarrhea of a gradual onset and chronic course. A positive fecal occult blood test and mild anemia were often found. The patients had linear calcifications and stenosis in the right colon, which were discovered by plain abdominal radiography and barium enema, respectively. Endoscopic findings included edematous, dark colored mucosa and ulcerations. Four patients underwent a subtotal colectomy because of persistent abdominal pain or ileus. The histopathologic findings were macroscopically characterized by a dark purple or dark brown colored colonic surface, the swelling and disappearance of plicae semilunares coli, and marked thickening of the colonic wall, while they were microscopically characterized by marked fibrous thickening of the venous walls with calcifications, marked submucosal fibrosis, deposition of collagen in the mucosa, and foamy macrophages within the vessel walls. These peculiar lesions have not previously been fully described. The cause and pathogenesis still remain unknown. We conclude that such lesions represent a new clinicopathologic disease entity and propose the term "idiopathic mesenteric phlebosclerosis."
    Article · Mar 2003
  • [Show abstract] [Hide abstract] ABSTRACT: Idiopathic mesenteric phlebosclerosis (IMP) is a recently known and rare disease entity, which is a member of non-thrombotic, non-inflammatory stenosis or occlusion of the mesenteric veins. In spite of the unique histopathology and particular location, the cause and pathogenesis of IMP remain unknown. The aim of this brief study was to propose a pathogenesis and possible etiology based on the reviewed clinical data and some newly discovered pathologic findings in several recent cases in our and other hospitals. The clinical data of 5 patients were collected, with detailed tracing of past history, drug use and dietary habit. The histologic sections were reviewed in detail, with additional histochemical stains and immunohistochemical stains in 4 available cases. The most important of our findings other than the previously described typical features was a unique type of coagulative necrosis, which we call mummification, involving not only the muscular coat of veins in early and late phases but also the subsequent hyperplastic myointima in veins, portion of the media of arteries closely neighboring the sclerotic vein, a zone of muscular wall of the colon around the passing sclerotic veins and the inner zone of muscular wall of the colon, and accompanied by fibrosis/sclerosis and then calcification in the damaged tissues. Two of our patients were a couple who had been taking Chinese herbs regularly. A pathogenesis is suggested for at least a subgroup of cases of IMP: the disease is initiated by a slow but longstanding direct hypoxic injury to the venous muscular layer, which leads to gradual mummification and then sclerosis and calcification of the venous muscle. This is followed by the repeated same damage of the subsequent reactively hyperplastic myointima in the veins, and these changes finally result in gradual venous occlusion. Certain toxins or biochemicals, probably existing in the frequently ingested contents and absorbed to the venous return, may play the most important role in this damage. However, analysis of more cases is required to support the proposal, and if such support is found, the toxic agents remain to be clarified via further laboratory investigations.
    Full-text · Article · Jul 2007
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