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PubMed1989

[Neutropenic enterocolitis].

In three patients with neutropenia who had died after a short period from their basic disease (myelodysplasia, medullary carcinoma, acute myeloic leukaemia), autopsy revealed segmental necrotising enterocolitis in the caecal region (neutropenic enterocolitis). Morphologically the enterocolitis was characterised by necrotized mucosa, marked oedema of the intestinal wall, intramural gas, the absence of pseudomembranes and a nearly complete absence of inflammatory cell infiltrates. In one case a palpable abdominal tumour had been produced by pseudotumorous thickening of the intestinal wall. The pathogenesis in these three cases might be a neutropenia-associated disturbance of the intestinal flora with selective proliferation of toxin-producing clostridia.

Aged↗
PubMed1975

Ileocaecal tuberculosis.

A retrospective study of 92 cases of ileocaecal tuberculosis, carried out at the Institute Hospital, New Delhi, is reported. The maximum incidence of the disease appeared to be between the ages of 20 and 40 years. There were 57 females and 35 males in the series. The majority of patients had symptoms for more than a year before they presented for treatment. Varying grades of intestianl obstruction constituted the usual clinical presentation, 44% of patients having subacute and 16% acute intestinal obstruction. Perianal fistula and abscesses were not seen. Most patients had no evidence of pulmonary tuberculosis. Barium X-ray studies were very helpful in the diagnosis. Bowel resection or short-circuiting gave very satisfactory results.

Adolescent↗
PubMed1994

[Perforated diverticulum of the cecum: conservative therapy or resection?].

The diverticulum of the right colon is a rare disease in Western Countries but is very common in Eastern races. The etiology is usually congenital in the lesions limited to the cecum (true diverticulum). The diagnosis is rarely made preoperatively. The most useful help is from CT and US. Because the clinical features suggest an acute appendicitis, in most cases of appendicectomized patients the intervention is made without any other investigations. At laparotomy, when the diverticulum is surely identified, a conservative treatment is recommended (diverticulectomy or invagination). If there are some doubts an ileo-colic resection is more opportune. After recovery it is useful to study the colon with an Rx clisma.

Cecal Diseases↗
PubMed1997

Colonic volvulus: a rare presentation of Hirschsprung's disease.

Although rare, patients with Hirschsprung's disease (HD) may be admitted with colonic volvulus. Among 302 patients with HD two patients were admitted with colonic volvulus (0.66%). Involved segments were cecum and sigmoid colon. During the same period, 11 patients including those with HD were diagnosed with colonic volvulus. An aganglionic segment below sigmoid colon, and a freely mobile mesosigmoid seem to be the cause of sigmoid volvulus. However, extension of aganglionosis above the sigmoid colon in addition to anatomic tendency seems to result in volvulus of proximal segments. Because HD has been associated with colonic volvulus, children who present with colonic volvulus should be suspect for underlying HD.

Cecal Diseases↗
PubMed1997

[Ileocaecal tuberculosis. Apropos of a case].

The authors report a case of ileocaecal tuberculosis in a 27-year-old man with no particular risk factor for this disease. The initial diagnosis was terminal ileitis discovered at appendicectomy. The diagnosis of ileal tuberculosis was suspected in the presence of giant cell follicles on ileal biopsies, and was confirmed by the presence of AFB in the gastric intubation fluid. This patient presented known atypical pulmonary images for several years, which had never been investigated in more detail. A favourable course was observed in response to triple-agent, then double-agent antibiotic therapy. This case illustrates the fact that ileal tuberculosis still exists today, and that it does not exclusively affect "high-risk" patients.

Abdominal Pain↗
PubMed1983

Diverticulitis of the cecum.

Ten patients with diverticulitis of the cecum are reported upon herein. The disease is difficult to distinguish preoperatively from that of appendicitis and may be difficult to distinguish intraoperatively from carcinoma of the cecum. The diverticula are usually solitary and may be of the true or false variety. A review of the literature is presented, and the difficulties of diagnosis and treatment are discussed. We advocate local resection of the diverticulum, when possible, and a right hemicolectomy when the diagnosis is in doubt or when local resection or invagination would jeopardize the ileocecal valve or the blood supply to the intestine. With more awareness of diverticulitis of the cecum, intraoperative diagnosis may be made easier and the treatment simplified.

Adult↗
PubMed1993

[Magnetic resonance imaging in the exploration of abdominal and anoperineal fistulas in Crohn's disease].

In a twelve month period, ten patients with fistulas related to Crohn's disease were explored by magnetic resonance imaging performed with a high-field supraconductive magnet. This technique demonstrated 3 cases of peri-anal abcesse invisible by other imaging modalities, and in 8 cases, fistules tracts, including 5 complex fistules, and one communicating with the bladder. This examination defined the extension of these lesions relative to the elevator plane, and demonstrated diffusion to the inferior space in 4 cases, to the superior space in 2 cases, and to both spaces in 2 cases. This method seems to be efficacious and does not expose the patient to X-rays.

Adult↗
PubMed2001

[Neck swelling as the major symptom of lymph node and intestinal tuberculosis].

BACKGROUND: Gut tuberculosis appears to be a rare diagnosis in Central Europe. The main diagnostic method is endoscopy with biopsy in order to win histology and a culture. By means of endoscopy the differential diagnosis to Crohn's disease is sometimes difficult. Computertomography and/or ultrasound can facilitate the diagnosis of gut tuberculosis. CASE REPORT: A 64-year-old woman presented in our hospital with cervical lymph nodes and ulcerations in the cecum and near the ileocecal valve. Major symptoms were abdominal pain, loss of weight, diarrhea and febrile temperature. Histology and culture revealed tuberculosis. The common antituberculotic therapy had to be stopped due to severe allergic reaction. After desensitization the patient could be treated successfully with a triple antituberculotic therapy without further complication. CONCLUSION: Beside the early treatment with tuberculotic drugs it is very important to consider the differentiation of a gut tuberculosis.

Antitubercular Agents↗
PubMed1997

[An adult case of dermatomyositis complicated with cecum perforation and panniculitis].

The case of dermatomyositis complicated with cecum perforation and panniculitis occurred in a 62-year-old woman was reported. She was admitted to Keio University Hospital with a history of proximal muscular weakness, and dysphagia. Physical examination showed erythema over the face and shoulder. Serum level of muscle enzymes was remarkably increased. The diagnosis of dermatomyositis was made based on proximal muscular weakness, elevated serum level of muscle enzymes and myogenic change of electromyocardiogram. The treatment with 60 mg/day of prednisolone was started, and was a good response. However, 7 months later the disease became active again when the amount of prednisolone was reduced to 13 mg/day. Subsequently she complained of abdominal pain on the right lower quadrant. The surgical findings included peritonitis due to the perforation of the cecum and multiple ulcers of the cecum. After operation, azathioprine was added. Four years and 9 months later, she noticed skin erythema with ulceration and subcutaneous nodule. Skin biopsy indicated the findings of the panniculitis with membrano-cystic lesion. It was thought that both cecum perforation and panniculitis were caused by angiopathy which was often seen in childhood dermatomyositis.

Cecal Diseases↗
PubMed1997

[Diverticular disease of the appendix].

The incidence of appendiceal diverticulosis in pathologic specimens is 0.004-2.1%. Diverticular disease of the appendix is classified as congenital (true) or acquired (false). The clinical presentation differs from that of acute appendicitis. The average age is older, the pain is often intermittent, and while localized in the right lower abdominal quadrant, is of longer duration. No further treatment besides appendectomy is needed. Since a high rate of perforations, peritonitis and lower gastrointestinal bleeding have been reported as complications, it is recommended that in those with an incidental finding of diverticula of the appendix during surgery, that appendectomy be performed. It is not recommended to perform prophylactic appendectomy when diverticula of the appendix are found on barium enema.

Appendectomy↗
PubMed1990

[Acute idiopathic dilatation of the right colon or Ogilvie's syndrome. Apropos of a case encountered after cesarean section].

The syndrome of acute colectasia of the right colon following a caesarean section is a rare disease observed and described for the first time by Ogilvie in 1948. Many etiopathological hypotheses have been formulated but recent studies demonstrate the role of the neuro-vegetative nervous system, causing the functional obstacle responsible for the idiopathic right colon dilatation. The clinical picture of low obstruction is seldom typical, as in our case; however, the abdominal X-Ray easily confirms the diagnosis, since the caecal distention may exceed 10 cm in diameter. Most of the time, the prognosis is favorable after aspiration via colonoscopy; caecal perforation is always the spontaneous outcome, due to the "vicious cycle" perpetuating the functional obstruction.

Adult↗
PubMed1992

Volvulus of the cecum and large colon caused by multiple mesenteric defects in a horse.

A 2-year-old Standardbred colt was examined because of signs of abdominal pain of 12 hours' duration. Clinical signs of disease, including tachycardia and abdominal distention, and rectal palpation findings of distention and thickening of the ventral colon, were consistent with displacement or early strangulation obstruction of the large colon. Surgical exploration revealed volvulus of the large colon around an axis formed by the dorsal mesenteric attachment of the transverse colon. The cecum could be completely exteriorized and lacked the cecocolic ligament and dorsal mesenteric attachments. The dorsal mesenteric attachments of the right ventral and dorsal colons were also lacking. The viscera were repositioned, and the horse was discharged 13 days after surgery. The horse developed severe colic 6 months later and was euthanatized. Mesenteric volvulus and omental adhesions were found at necropsy.

Animals↗
PubMed1985

[Ileocecal Crohn disease with sigmoid involvement].

This report concerns 14 patients with Morbus Crohn and inflammatory conglomerat tumors between ileo-coecum and sigma. In the case of primary affliction of the ileo-coecum and secondary involvement of the sigma (group A), it is generally sufficient to perform an ileo-coecal resection and suture over the sigma, if a fistula is present. In case of Morbus Crohn afflicting primarily the sigma (group B) or simultaneous involvement of ileo-coecum and sigma (group C), a double resection is necessary. It was always possible to demonstrate the presence of an ileo-sigmoidal fistula by means of barium enema and mostly possible with barium meal or enteroclysis. We consider preoperative colonoscopy with graduated biopsies to be absolutely necessary to determine the exact stage of the illness. Fistulas can be more accurately demonstrated by radiogram than endoscopically.

Adult↗
PubMed2004

[Solitary perforated diverticulum of the cecum: a case report].

The Authors report a case of acute abdomen caused by a perforated solitary diverticulum of the cecum recently treated. This is a rare disease that usually is diagnosed, in the surgical theatre because it is a topic of emergency surgery. From Literature analysis it is obvious that a correct preoperative diagnosis is difficult to make because of the large number of possible abdominal pathologies with similar symptoms. Also the therapeutic approach is so extremely variable that the operation could range from a simple conservative type to right hemicolectomy. A proper approach will be conservative with a simple diverticulectomy when the inflammatory reaction is localized in the colonic wall while a right colectomy could be performed when the inflammatory reaction is more advanced or a large mass suggestive of a carcinoma is present.

Abdomen, Acute↗
PubMed1997

Schistosomiasis: an unusual cause of right lower quadrant abdominal pain.

Schistosomiasis, although unusual in North America, is a common disease worldwide. Symptoms vary depending on the species involved. Immigrants from endemic regions are the commonly affected patients found in North America. In most cases, schistosomiasis does not present with right lower quadrant pain. Even in endemic regions, this form of presentation is uncommon. In the United States, most cases of right lower quadrant pain often will be treated as appendicitis. Questions remain unanswered as to whether the schistosomes cause appendicitis or are found incidentally in these cases. Stool and urine specimens may be helpful in making a diagnosis. Most cases require operative intervention to rule out appendicitis and to obtain tissue for histopathologic diagnosis. Praziquantel is effective in eradicating infestations.

Abdominal Pain↗
PubMedDate not supplied

Usefulness of pediatric colonoscopes in adult colonoscopy.

Use of small diameter, extraflexible pediatric colonoscopes has proved to be valuable in adult endoscopy practice, not only for passing strictures and stomas but also where either fixation due to diverticular disease or postoperative adhesions, or unavoidably painful looping made passage of adult colonoscopes impossible. In 70 of 78 (92%) of the cases where the adult colonoscope could not be passed through the sigmoid colon by an expert endoscopist, the pediatric colonoscope passed through, often very easily. Fifteen of these patients were considered to have been saved surgery by successful passage. The "failure" rate for all colonoscopy examinations was only 2%; this low failure rate was attributable to the use of pediatric instruments whenever passage through the sigmoid colon proved to be impossible with standard colonoscopes. In our opinion every unit performing frequent colonoscopies should have a pediatric colonoscope available for selected adult patients as well as for use in children.

Biopsy↗
PubMed1990

Appendiceal infection by Entamoeba histolytica and Strongyloides stercoralis presenting like acute appendicitis.

A 58-year-old male from Puerto Rico who was taking orally administered cortisone analogs for chronic obstructive pulmonary disease presented with fever, absolute eosinophilia, right lower quadrant pain, and rebound tenderness associated with Strongyloides stercoralis infection of the appendix. A 37-year-old alcoholic male developed fever, right lower quadrant abdominal pain, and rebound tenderness because of infection of the appendix with Entamoeba histolytica. These are the seventh reported case of isolated amebic appendicitis and the ninth reported case of appendiceal involvement with Strongyloides. In all these cases the diagnosis was made only after surgery. Patients with unexplained right lower quadrant pain, particularly if immunosuppressed or with an appropriate travel history, should have stool examinations for ova and parasites. Early diagnosis and treatment may prevent life-threatening complications such as perforation and peritonitis.

Adult↗
PubMedDate not supplied

[Appendiceal mucocele associated with colonic neoplasm. Report of 2 cases and review of the literature].

Appendiceal mucocele is a rare entity frequently associated with colorectal cancer. We report two cases of mucocele associated with colorectal tumours. The first case (male, 64 yrs) is an appendiceal mucinous cystadenoma found incidentally during surgery for colon cancer. There is no evidence of disease after a 4-year follow-up. The second case (male, 66 yrs) is a mucocele associated with mucosal hyperplasia that was found during surgery for acute appendicitis with a periappendicular abscess. Endoscopic follow-up showed a rectal adenocarcinoma that was initially treated with local excision with T.E.M.. Examination of the pathology specimen documented vascular invasion and the patient underwent curative colorectal resection. The preoperative radiological and endoscopic diagnostic procedures and the current therapeutic approaches described in the literature are reviewed. The relevance of the association between appendiceal mucocele and colorectal cancer is emphasized. Thorough investigation of the colorectal tract is recommended after diagnosing an appendiceal mucocele.

Aged↗