{"title":"Autoimmune Pancreatitis: Unusual Cause of Pancreatic Mass in Children","authors":"P. Sherwani, A. Kaur, Rohan Malik, M. Jana","doi":"10.7869/TG.560","DOIUrl":"https://doi.org/10.7869/TG.560","url":null,"abstract":"","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90648417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anando Sengupta, S. Sharma, K. Das, V. Mittal, P. Kar
Bisphosphonates are pyrophosphate analogues that bind at the bone mineral surface, where they potently inhibit osteoclast-mediated bone resorption. They are used in the treatment of hypercalcemia due to malignancy, osteolytic lesions from multiple myeloma, bone metastasis from solid tumours, osteoporosis, and Paget’s disease. They have also been used effectively in the medical management of primary hyperparathyroidism to decrease serum calcium.1,2 Inhibition of osteoclast activity in bone by bisphosphonates can result in hypocalcaemia and hypophosphatemia. The majority of patients do not manifest hypocalcaemia due to compensatory mechanisms such as raised Parathyroid Hormone (PTH). However, in patients with low Vitamin D levels, renal failure, prior parathyroidectomy, hypomagnesemia, and hypoparathyroidism, these compensatory mechanisms may be blocked, resulting in hypocalcaemia.3-5 Here we report a case in which the use of bisphosphonate for severe hypercalcemia due to primary hyperparathyroidism, led to life-threatening hypocalcaemia. Case Report
{"title":"Severe Bisphosphonate Induced Hypocalcaemia in the Background of Severe Necrotizing Pancreatitis due to Primary Hyperparathyroidism.","authors":"Anando Sengupta, S. Sharma, K. Das, V. Mittal, P. Kar","doi":"10.7869/TG.559","DOIUrl":"https://doi.org/10.7869/TG.559","url":null,"abstract":"Bisphosphonates are pyrophosphate analogues that bind at the bone mineral surface, where they potently inhibit osteoclast-mediated bone resorption. They are used in the treatment of hypercalcemia due to malignancy, osteolytic lesions from multiple myeloma, bone metastasis from solid tumours, osteoporosis, and Paget’s disease. They have also been used effectively in the medical management of primary hyperparathyroidism to decrease serum calcium.1,2 Inhibition of osteoclast activity in bone by bisphosphonates can result in hypocalcaemia and hypophosphatemia. The majority of patients do not manifest hypocalcaemia due to compensatory mechanisms such as raised Parathyroid Hormone (PTH). However, in patients with low Vitamin D levels, renal failure, prior parathyroidectomy, hypomagnesemia, and hypoparathyroidism, these compensatory mechanisms may be blocked, resulting in hypocalcaemia.3-5 Here we report a case in which the use of bisphosphonate for severe hypercalcemia due to primary hyperparathyroidism, led to life-threatening hypocalcaemia. Case Report","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91477429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Piyush Bawane, Mayank Jain, M. Srinivas, T. Michael, J. Venkataraman
Background : Data regarding the type of breaks and its impact on peristalsis in gastro esophageal reflux disease(GERD) is scanty. Aim : To study the prevalence and significance of segmental breaks in symptomatic GERD cases. To identify the endoscopy grading and dietary factors that are likely to affect esophageal motility. Materials and Methods : 106 patients with GERD were included. Baseline patient information included age, gender, BMI, diet recall and upper endoscopy report.Normal (Group I) and ineffective swallows (Group II, minor peristaltic defects) were compared for proximal and distal segment breaks . Impact of multiple rapid swallows was assessed in a subset of cases.Appropriate statistical tests were used. p value <0.05 was considered as statistically significant. Results : 72 patients had normal esophageal motility (Group I) and 30 had minor peristalitc abnormality (Group II). BMI was significantly higher in Group II. Mean basal LES pressure, IRP and DCI in Group II was significantly low and a significant proportion of swallows in patients in Group II had breaks greater than 5 cm in S1 and more than 2 cm in S2 and S3. The basal LES pressure and BMI cut off was 12.1 mm Hg and 26.1 kg per m2respectively. The odds ratio of having a minor peristaltic disorder was 3.2 times(1.4-4.1, p 0.001) with the combination of these two factors. Conclusion : Majority of GERD patients had normal motility. Even in those with minor peristaltic abnormality, the peristaltic reserve was good.Patients in group II had significantly lower basal LES pressures and higher BMI.
背景:关于胃食管反流病(GERD)的断裂类型及其对蠕动的影响的资料很少。目的:探讨有症状的反流胃食管反流中节段断裂的发生率及意义。确定可能影响食管运动的内镜分级和饮食因素。材料与方法:纳入106例胃食管反流患者。基线患者信息包括年龄、性别、BMI、饮食回忆和上颌内窥镜检查报告。比较正常燕子(组I)和无效燕子(组II，轻微蠕动缺陷)近端和远端节段断裂情况。在部分病例中评估了多次快速吞咽的影响。采用了适当的统计检验。P值<0.05为差异有统计学意义。结果:食管运动正常72例(I组)，轻度蠕动异常30例(II组)，II组BMI明显增高。II组患者的平均基础LES压、IRP和DCI均明显较低，且II组患者中有显著比例的吞口S1大于5cm, S2和S3大于2cm。基础LES压和BMI分别为12.1 mm Hg和26.1 kg / m2。合并这两个因素时，患有轻微蠕动障碍的比值比为3.2倍(1.4-4.1,p 0.001)。结论:大多数胃食管反流患者运动功能正常。即使有轻微的蠕动异常，蠕动储备也很好。II组患者基底LES压明显降低，BMI明显升高。
{"title":"Factors Predicting Peristaltic Abnormalities in Gastroesophageal Reflux","authors":"Piyush Bawane, Mayank Jain, M. Srinivas, T. Michael, J. Venkataraman","doi":"10.7869/TG.556","DOIUrl":"https://doi.org/10.7869/TG.556","url":null,"abstract":"Background : Data regarding the type of breaks and its impact on peristalsis in gastro esophageal reflux disease(GERD) is scanty. Aim : To study the prevalence and significance of segmental breaks in symptomatic GERD cases. To identify the endoscopy grading and dietary factors that are likely to affect esophageal motility. Materials and Methods : 106 patients with GERD were included. Baseline patient information included age, gender, BMI, diet recall and upper endoscopy report.Normal (Group I) and ineffective swallows (Group II, minor peristaltic defects) were compared for proximal and distal segment breaks . Impact of multiple rapid swallows was assessed in a subset of cases.Appropriate statistical tests were used. p value <0.05 was considered as statistically significant. Results : 72 patients had normal esophageal motility (Group I) and 30 had minor peristalitc abnormality (Group II). BMI was significantly higher in Group II. Mean basal LES pressure, IRP and DCI in Group II was significantly low and a significant proportion of swallows in patients in Group II had breaks greater than 5 cm in S1 and more than 2 cm in S2 and S3. The basal LES pressure and BMI cut off was 12.1 mm Hg and 26.1 kg per m2respectively. The odds ratio of having a minor peristaltic disorder was 3.2 times(1.4-4.1, p 0.001) with the combination of these two factors. Conclusion : Majority of GERD patients had normal motility. Even in those with minor peristaltic abnormality, the peristaltic reserve was good.Patients in group II had significantly lower basal LES pressures and higher BMI.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88702821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pravir A Gambhire, R. Thanage, Ashok R. Mohite, Vinay G. Zanwar, S. Vaidyanathan, Samit Jain, A. Subramanyam, P. Rathi
Background: Irritable bowel syndrome (IBS) is a chronic condition. Some patients may benefit from probiotics and rifaximin in diarrhea-predominant IBS (IBS-D). Relaxation therapy has also been tried. Aims and Objectives: To assess the efficacy of rifaximin, VSL#3, and relaxation therapy in IBS-D patients. Methods: 196 patients with IBS-D were randomly assigned to three groups. Group A, B, and C received rifaximin, VSL#3, and relaxation therapy, respectively. Patients were followed up for six months. Results: Relaxation therapy (2.69 ± 0.67) group had significantly improved generalized ill-feeling over VSL# (3.87 ± 0.34) at the end of 6 months. IBS severity score improved in all the groups till the end of the study but relaxation therapy (199.19 ± 30.02) was significantly better than rifaximin (217.21 ± 39.9) and VSL# (250.41 ± 14.78). The subjective global assessment was improved significantly in the relaxation therapy group (2.05 ± 0.9) as compared to rifaximin (3.02 ± 0.85) and VSL#3 (3.84 ± 0.37).. Conclusion: Patients with IBS-D do better with rifaximin and VSL#3 in the short term. Patients respond better to relaxation therapy at the end of 6 months. Relaxation therapy is being a non-pharmacological and cost-effective therapy, could be implemented on a long-term basis.
{"title":"Role of Relaxation Therapy In Diarrhea Predominant Irritable Bowel Syndrome","authors":"Pravir A Gambhire, R. Thanage, Ashok R. Mohite, Vinay G. Zanwar, S. Vaidyanathan, Samit Jain, A. Subramanyam, P. Rathi","doi":"10.7869/TG.553","DOIUrl":"https://doi.org/10.7869/TG.553","url":null,"abstract":"Background: Irritable bowel syndrome (IBS) is a chronic condition. Some patients may benefit from probiotics and rifaximin in diarrhea-predominant IBS (IBS-D). Relaxation therapy has also been tried. Aims and Objectives: To assess the efficacy of rifaximin, VSL#3, and relaxation therapy in IBS-D patients. Methods: 196 patients with IBS-D were randomly assigned to three groups. Group A, B, and C received rifaximin, VSL#3, and relaxation therapy, respectively. Patients were followed up for six months. Results: Relaxation therapy (2.69 ± 0.67) group had significantly improved generalized ill-feeling over VSL# (3.87 ± 0.34) at the end of 6 months. IBS severity score improved in all the groups till the end of the study but relaxation therapy (199.19 ± 30.02) was significantly better than rifaximin (217.21 ± 39.9) and VSL# (250.41 ± 14.78). The subjective global assessment was improved significantly in the relaxation therapy group (2.05 ± 0.9) as compared to rifaximin (3.02 ± 0.85) and VSL#3 (3.84 ± 0.37).. Conclusion: Patients with IBS-D do better with rifaximin and VSL#3 in the short term. Patients respond better to relaxation therapy at the end of 6 months. Relaxation therapy is being a non-pharmacological and cost-effective therapy, could be implemented on a long-term basis.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78643722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Anikhindi, Ashish Kumar, Vikas Singla, Praveen Sharma, N. Bansal, N. Verma, A. Arora
Background: Acute Pancreatitis (AP) presents with a wide range of severity and has varying outcomes. We report our experience with 358 consecutive patients with AP admitted to a tertiary care centre in North India for two years. Methods: In this retrospective study, clinical, biochemical, radiological, and treatment-related data of patients admitted with AP was collected and analysed. Predictors of 120-day mortality and treatment outcomes were analysed. Results: 358 patients (median age 42 years, 78% males) were included. The most common aetiology was biliary (37%) and alcohol (32%). Sixty-nine percent of patients had severe disease at admission according to the revised Atlanta classification. A total of 81 of 358 patients (23%) died within 120 days, with most of the deaths occurring within the first month of illness. A significant proportion of patients having severe AP (74/248, 29.8%) succumbed to illness, while only 6.4% (7/110) patients with mild or moderately severe AP had mortality within 120 days. On multivariate (Cox regression) analysis, the independent factors predicting 120-day mortality were: CT severity index >5 (OR 4.4), presence of respiratory failure (OR 14.9), presence of circulatory failure (OR 4.4), and severe pancreatitis on admission according to revised Atlanta classification (OR 56.4). Conclusions: Biliary and alcohol are the most common aetiologies of acute pancreatitis in north India. Acute pancreatitis still carries a poor outcome with a 23% mortality rate. Patients having severe pancreatitis at admission, according to revised Atlanta classification, are at the highest risk for mortality and should receive intensive care..
{"title":"The Revised Atlanta Classification is the Strongest Predictor of Mortality in Patients with Acute Pancreatitis: A Study on 358 Patients","authors":"S. Anikhindi, Ashish Kumar, Vikas Singla, Praveen Sharma, N. Bansal, N. Verma, A. Arora","doi":"10.7869/TG.555","DOIUrl":"https://doi.org/10.7869/TG.555","url":null,"abstract":"Background: Acute Pancreatitis (AP) presents with a wide range of severity and has varying outcomes. We report our experience with 358 consecutive patients with AP admitted to a tertiary care centre in North India for two years. Methods: In this retrospective study, clinical, biochemical, radiological, and treatment-related data of patients admitted with AP was collected and analysed. Predictors of 120-day mortality and treatment outcomes were analysed. Results: 358 patients (median age 42 years, 78% males) were included. The most common aetiology was biliary (37%) and alcohol (32%). Sixty-nine percent of patients had severe disease at admission according to the revised Atlanta classification. A total of 81 of 358 patients (23%) died within 120 days, with most of the deaths occurring within the first month of illness. A significant proportion of patients having severe AP (74/248, 29.8%) succumbed to illness, while only 6.4% (7/110) patients with mild or moderately severe AP had mortality within 120 days. On multivariate (Cox regression) analysis, the independent factors predicting 120-day mortality were: CT severity index >5 (OR 4.4), presence of respiratory failure (OR 14.9), presence of circulatory failure (OR 4.4), and severe pancreatitis on admission according to revised Atlanta classification (OR 56.4). Conclusions: Biliary and alcohol are the most common aetiologies of acute pancreatitis in north India. Acute pancreatitis still carries a poor outcome with a 23% mortality rate. Patients having severe pancreatitis at admission, according to revised Atlanta classification, are at the highest risk for mortality and should receive intensive care..","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87267522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. John, B. Simon, A. Eapen, Tharani Putta, P. Joseph, R. Raju, M. Rymbai, F. Vyas
Background : The portal annular pancreas is a rare morphological variant where the pancreatic parenchyma encircles the portal vein or the superior mesenteric vein and fuses with the body of the pancreas. It may be mistaken for a pancreatic head mass and has grave implications for patients planned for pancreatic surgeries. Aim : This study aimed to determine the prevalence of portal annular pancreas in a cohort of patients attending a tertiary care referral centre in South India and to assess how frequently this was identified and reported in a routine CT scan report. Methods : A retrospective review of consecutive contrast-enhanced multi-detector computed tomography (MDCT) scans of the abdomen during the study period was used to assess for the presence of portal annular pancreas. It was classified into suprasplenic, infrasplenic, and mixed variants based on its relation to the splenoportal confluence. In addition, the radiology reports were reviewed with regard to mention of this variant. Results : The prevalence of portal annular pancreas in our study population was 25 out of 1000 patients (2.5%). There was an increased frequency of this anomaly in females; male: female ratio was 1:2.1. The most common morphological type was suprasplenic fusion. The portal annular pancreas was mentioned in only 1 out of 25 (4%) of the radiology reports. Conclusion : The prevalence of portal annular pancreas was 2.5% with a female preponderance in our series. This entity can be easily overlooked, and increased awareness would improve identification, thereby mitigating complications associated with pancreatic surgery.
{"title":"Portal Annular Pancreas: An Underrecognized Variant, Prevalence, and Clinical Relevance","authors":"R. John, B. Simon, A. Eapen, Tharani Putta, P. Joseph, R. Raju, M. Rymbai, F. Vyas","doi":"10.7869/TG.554","DOIUrl":"https://doi.org/10.7869/TG.554","url":null,"abstract":"Background : The portal annular pancreas is a rare morphological variant where the pancreatic parenchyma encircles the portal vein or the superior mesenteric vein and fuses with the body of the pancreas. It may be mistaken for a pancreatic head mass and has grave implications for patients planned for pancreatic surgeries. Aim : This study aimed to determine the prevalence of portal annular pancreas in a cohort of patients attending a tertiary care referral centre in South India and to assess how frequently this was identified and reported in a routine CT scan report. Methods : A retrospective review of consecutive contrast-enhanced multi-detector computed tomography (MDCT) scans of the abdomen during the study period was used to assess for the presence of portal annular pancreas. It was classified into suprasplenic, infrasplenic, and mixed variants based on its relation to the splenoportal confluence. In addition, the radiology reports were reviewed with regard to mention of this variant. Results : The prevalence of portal annular pancreas in our study population was 25 out of 1000 patients (2.5%). There was an increased frequency of this anomaly in females; male: female ratio was 1:2.1. The most common morphological type was suprasplenic fusion. The portal annular pancreas was mentioned in only 1 out of 25 (4%) of the radiology reports. Conclusion : The prevalence of portal annular pancreas was 2.5% with a female preponderance in our series. This entity can be easily overlooked, and increased awareness would improve identification, thereby mitigating complications associated with pancreatic surgery.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80596796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tropical Gastroenterology 104 are the endoscopic treatment of choice for IGV1,2 and GOV2. Endoscopic glue is associated with a significant risk of complications such as embolisation, bleeding, ulceration and extrusion.2-4 Also, it is difficult to see varices properly in the presence of an active bleed or a large blood clot or food residue in the fundus by a conventional gastroscope. Endoscopic ultrasound (EUS) overcomes the limitations of conventional endoscopy. EUS-guided delivery of cyanoacrylate (CYA) glue enables realtime precise delivery of the glue directly into the varix lumen. Moreover, EUS also enables the use of Doppler evaluation to confirm varix obliteration simultaneously. The various EUS-guided therapies used for gastric varices include glue injection, coil placement and combination of both the above. While glue placement carries a risk of embolisation, coils larger than the size of the varix are costly. Thus, a combination of EUS-guided coil and glue decreases the cost (lesser numbers of coils are needed) and reduces the risk of embolisation (lesser amount of glue is needed and the coils act as a scaffold to retain the glue, thereby decreasing the chances of glue embolization). In a retrospective study of 152 patients, EUS-guided combined coil and glue injection of high-risk gastric varices appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis.5 Once obliteration was achieved, post-treatment bleeding from varices occurred in only 3% of patients during long-term follow-up.5 While asymptomatic glue embolization in the glue-alone group is very common,6 combination therapy appears safe and may reduce the risk of glueembolisation. EUS-guided coil and glue has been shown to be effective in several other studies also.6,7 To summarise, we present a series of 3 cases where endoscopy failed and IR-guided intervention was not possible/feasible. EUS-guided therapy achieved variceal obliteration in all these cases.
{"title":"So Near, Yet So Far…","authors":"A. RajeevS, A. Thomas, N. Ananth, E. Simon","doi":"10.7869/TG.545","DOIUrl":"https://doi.org/10.7869/TG.545","url":null,"abstract":"Tropical Gastroenterology 104 are the endoscopic treatment of choice for IGV1,2 and GOV2. Endoscopic glue is associated with a significant risk of complications such as embolisation, bleeding, ulceration and extrusion.2-4 Also, it is difficult to see varices properly in the presence of an active bleed or a large blood clot or food residue in the fundus by a conventional gastroscope. Endoscopic ultrasound (EUS) overcomes the limitations of conventional endoscopy. EUS-guided delivery of cyanoacrylate (CYA) glue enables realtime precise delivery of the glue directly into the varix lumen. Moreover, EUS also enables the use of Doppler evaluation to confirm varix obliteration simultaneously. The various EUS-guided therapies used for gastric varices include glue injection, coil placement and combination of both the above. While glue placement carries a risk of embolisation, coils larger than the size of the varix are costly. Thus, a combination of EUS-guided coil and glue decreases the cost (lesser numbers of coils are needed) and reduces the risk of embolisation (lesser amount of glue is needed and the coils act as a scaffold to retain the glue, thereby decreasing the chances of glue embolization). In a retrospective study of 152 patients, EUS-guided combined coil and glue injection of high-risk gastric varices appears to be highly effective for hemostasis in active bleeding and primary and secondary bleeding prophylaxis.5 Once obliteration was achieved, post-treatment bleeding from varices occurred in only 3% of patients during long-term follow-up.5 While asymptomatic glue embolization in the glue-alone group is very common,6 combination therapy appears safe and may reduce the risk of glueembolisation. EUS-guided coil and glue has been shown to be effective in several other studies also.6,7 To summarise, we present a series of 3 cases where endoscopy failed and IR-guided intervention was not possible/feasible. EUS-guided therapy achieved variceal obliteration in all these cases.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89343785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Bhatt, Dhaval Mangukiya, P. Desai, Krishna Parekh
Corresponding Author: Dr Keyur Bhatt Email: drkeyurbhatt@gmail.com Self-Knotting of the Feeding Jejunostomy Tube: An Extremely Rare Complication with the surgery. Through a Makuuchi incision, the abdominal cavity was entered. The umbilical hydatid was removed completely. An abdominal wall defect wasnoted corresponding to the location of the umbilical hydatid cyst and it was repaired to prevent any herniation. The liver hydatid was opened, contents aspirated and the wall was removed in fragments. Agenesis of the right lobe of liver was noted during the surgery and this was confirmed by the absence of liver to the right of gallbladder. There was compensatory enlargement of the left lobe of liver. However, no other anatomical anomalies were found. The hydatid cyst had occupied the space available due to agenesis of right lobe of liver and it had made a biliary communication resulting in death and calcification of the larva. The biliary communication was carefully closed with polydioxanone suture. A cholecystectomy was also done.
通讯作者:Dr Keyur Bhatt e - mail: drkeyurbhatt@gmail.com喂养空肠造口管的自结:手术中极为罕见的并发症。通过makuchi切口，进入腹腔。脐带包虫被完全去除。发现腹壁缺损与脐包虫囊肿的位置相对应，并进行修复以防止任何疝出。打开肝包虫，抽吸内容物，将肝壁撕成碎片。手术中发现肝右叶发育不全，胆囊右侧肝脏缺失证实了这一点。肝左叶代偿性增大。但未见其他解剖异常。棘球蚴因肝右叶发育不全而占据了可用的空间，并造成了胆道通讯，导致幼虫死亡和钙化。用聚二氧环酮缝合仔细关闭胆道通讯。同时进行了胆囊切除术。
{"title":"Self-Knotting of the Feeding Jejunostomy Tube: An Extremely Rare Complication","authors":"K. Bhatt, Dhaval Mangukiya, P. Desai, Krishna Parekh","doi":"10.7869/TG.543","DOIUrl":"https://doi.org/10.7869/TG.543","url":null,"abstract":"Corresponding Author: Dr Keyur Bhatt Email: drkeyurbhatt@gmail.com Self-Knotting of the Feeding Jejunostomy Tube: An Extremely Rare Complication with the surgery. Through a Makuuchi incision, the abdominal cavity was entered. The umbilical hydatid was removed completely. An abdominal wall defect wasnoted corresponding to the location of the umbilical hydatid cyst and it was repaired to prevent any herniation. The liver hydatid was opened, contents aspirated and the wall was removed in fragments. Agenesis of the right lobe of liver was noted during the surgery and this was confirmed by the absence of liver to the right of gallbladder. There was compensatory enlargement of the left lobe of liver. However, no other anatomical anomalies were found. The hydatid cyst had occupied the space available due to agenesis of right lobe of liver and it had made a biliary communication resulting in death and calcification of the larva. The biliary communication was carefully closed with polydioxanone suture. A cholecystectomy was also done.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85802013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monika Gupta, Namita Bhutani, S. Yadav, L. Monga, R. Verma, R. Sen
Tropical Gastroenterology 110 for the diagnosis of pancreatic/peripancreatic TB. In a retrospective analysis done in Korean study by Song et al, it was found that EUS-FNB gave diagnosis in 76.2% patients (16 out of 21)6. However, in our patient EUS-FNB examination was inconclusive. Laparoscopy will help whenever there is diagnostic dilemma. Along with tissue sampling, other tissue involvement can be visualized on laparoscopy. Along with tissue sampling, other tissue involvement can be visualized on laparoscopy. Presence of caseating granulomas on histopathology, demonstration of TB bacilli on ZN stain, culture or GeneXpert positivity are diagnostic features. Abdominal tuberculosis responds well to anti tubercular treatment unless it is a drug resistant scenario. It is recommended to give 6 months course of anti-tubercular treatment (ATT) for abdominal TB7. Our patient symptomatically responded well to ATT and she is on follow up now.
{"title":"Gastrointestinal Stromal Tumor of the Anal Canal: An Extreme rarity","authors":"Monika Gupta, Namita Bhutani, S. Yadav, L. Monga, R. Verma, R. Sen","doi":"10.7869/TG.548","DOIUrl":"https://doi.org/10.7869/TG.548","url":null,"abstract":"Tropical Gastroenterology 110 for the diagnosis of pancreatic/peripancreatic TB. In a retrospective analysis done in Korean study by Song et al, it was found that EUS-FNB gave diagnosis in 76.2% patients (16 out of 21)6. However, in our patient EUS-FNB examination was inconclusive. Laparoscopy will help whenever there is diagnostic dilemma. Along with tissue sampling, other tissue involvement can be visualized on laparoscopy. Along with tissue sampling, other tissue involvement can be visualized on laparoscopy. Presence of caseating granulomas on histopathology, demonstration of TB bacilli on ZN stain, culture or GeneXpert positivity are diagnostic features. Abdominal tuberculosis responds well to anti tubercular treatment unless it is a drug resistant scenario. It is recommended to give 6 months course of anti-tubercular treatment (ATT) for abdominal TB7. Our patient symptomatically responded well to ATT and she is on follow up now.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89472838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prakash Baburao Sonkusare, Pranav Kumar Raghuwanshi, V. Narkhede, Sanjay Kumar
Our patient was a 30 year-old female, who was a diagnosed case of tubercular meningitis (TBM) and was on antitubercular treatment (ATT) for 5 days before she came to us. She was being investigated for fever with headache before being diagnosed as TBM 30 days prior to her presentation and had received multiple oral antibiotics on outpatient basis. She had also been admitted in two different hospitals and received intravenous (IV) antibiotics during that period. She presented with complaints of passage of loose stools 7 to 8 times per day for the last 5 days.The stools were watery in nature and associated with abdominal distension and pain for 3 days, bilateral pedal edema for 3 days and breathlessness for 2 days before admission to this hospital. She was diagnosed with Clostridium difficile (C. difficile) pseudomembranous colitis following a sigmoidoscopy (Figure 1) and a positive stool test for C. difficile toxin. She had an initial leukocyte count of 21360/mm3 with a serum albumin level of 1.3 g/dl and a serum creatinine level of 0.6 mg/dl, thus classifying her as having severe C. difficile colitis. She was started on IV metronidazole and oral vancomycin which was uptitrated to 500 mg every six hours. She continued to have diarrhea even despite 3 days of treatment. She was started on the higher antibiotic, IV Tigecycline, but continued to have abdominal distension and pain, suggesting refractory CDI.1,2 Repeat sigmoidoscopy showed the same picture as earlier without any improvement. Given the severity and refractoriness to the standard antibiotics, a decision to perform fecal microbial transplantation (FMT) was taken on day 6.
{"title":"Treatment of the First Severe Attack of Pseudomembranous Colitis with Fecal Microbiota Transplantation","authors":"Prakash Baburao Sonkusare, Pranav Kumar Raghuwanshi, V. Narkhede, Sanjay Kumar","doi":"10.7869/TG.546","DOIUrl":"https://doi.org/10.7869/TG.546","url":null,"abstract":"Our patient was a 30 year-old female, who was a diagnosed case of tubercular meningitis (TBM) and was on antitubercular treatment (ATT) for 5 days before she came to us. She was being investigated for fever with headache before being diagnosed as TBM 30 days prior to her presentation and had received multiple oral antibiotics on outpatient basis. She had also been admitted in two different hospitals and received intravenous (IV) antibiotics during that period. She presented with complaints of passage of loose stools 7 to 8 times per day for the last 5 days.The stools were watery in nature and associated with abdominal distension and pain for 3 days, bilateral pedal edema for 3 days and breathlessness for 2 days before admission to this hospital. She was diagnosed with Clostridium difficile (C. difficile) pseudomembranous colitis following a sigmoidoscopy (Figure 1) and a positive stool test for C. difficile toxin. She had an initial leukocyte count of 21360/mm3 with a serum albumin level of 1.3 g/dl and a serum creatinine level of 0.6 mg/dl, thus classifying her as having severe C. difficile colitis. She was started on IV metronidazole and oral vancomycin which was uptitrated to 500 mg every six hours. She continued to have diarrhea even despite 3 days of treatment. She was started on the higher antibiotic, IV Tigecycline, but continued to have abdominal distension and pain, suggesting refractory CDI.1,2 Repeat sigmoidoscopy showed the same picture as earlier without any improvement. Given the severity and refractoriness to the standard antibiotics, a decision to perform fecal microbial transplantation (FMT) was taken on day 6.","PeriodicalId":23281,"journal":{"name":"Tropical gastroenterology : official journal of the Digestive Diseases Foundation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79656767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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