Case Report Telescoping Intestine in an Adult

Protrusion of a bowel segment into another (intussusception) produces severe abdominal pain and culminates in intestinal obstruction. In adults, intestinal obstruction due to intussusception is relatively rare phenomenon, as it accounts for minority of intestinal obstructions in this population demographic. Organic lesion is usually identifiable as the cause of adult intussusceptions, neoplasms account for the majority. Therefore, surgical resection without reduction is almost always necessary and is advocated as the best treatment of adult intussusception. Here, we describe a rare case of a 44-year-old male with a diffuse large B-cell lymphoma involving the terminal ileum, which had caused ileocolic intussusception and subsequently developed intestinal obstruction requiring surgical intervention. This case emphasizes the importance of recognizing intussusception as the initial presentation for bowel malignancy

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Gastrointestinal Kaposi′s sarcoma presenting as ileocolic intussusception

Context: Kaposi′s sarcoma (KS) is the most common neoplasm in patients with acquired immune deficiency syndrome (AIDS). Gastrointestinal (GI) involvement with KS commonly occurs in association with cutaneous lesions or lymph node involvement, with GI tract involvement alone occurring in only 3.5% of cases. There are several case reports described in the literature about asymptomatic intestinal KS with skin manifestations. Although GI KS is usually asymptomatic, hemorrhages from the oral cavity, esophagus, stomach, and large bowel have been reported in this disease. Case Report: Our case is unique, in a way that the patient does not have skin manifestation, and also is that the first manifestation presented as acute intestinal intussusception and obstruction with nodular mass lesions of the stomach and GI tract due to GI KS. Conclusion: As a differential diagnosis of KS, nonHodgkin lymphomas frequently involve the gut in AIDS patients. Furthermore, tumors of the gut with spindle-shaped cells such as leiomyomas, rhabdomyosarcomas, high-grade pleomorphic sarcomas, or GI stromal tumors have to be considered in the differential diagnosis. Overall, the visceral involvement of the KS is usually associated with poor prognosis. Our case illustrates the importance of physicians to recognize GI KS as a differential diagnosis for HIV positive patients with recurrent abdominal pain. It is commonly occurs in association with cutaneous lesions or lymph node involvement and rarely presents with GI involvement alone, which is makes it a challenge to the physician

Small Intestinal Ischemia with Pneumatosis in a Young Adult: What Could Be the Cause?

This case highlights one of the infrequent complications of a commonly abused substance. A particular high index of suspicion of ischemic bowel is associated with cocaine abuse and should be included in the differential diagnosis of any young adult or middle-aged patient with abdominal pain and/or bloody diarrhea, particularly in the absence of other predisposing factors. To our knowledge, we report a rare case of ischemic small bowel associated with gangrene and pneumatosis intestinalis due to cocaine abuse

Pulmonary Septic Emboli due to Azygos Vein Septic Thrombosis

The triad of extrapulmonary infection, contiguous septic vein thrombosis, and septic pulmonary embolism is a rare complex but associated with significant morbidity and mortality. Septic azygos vein thrombosis is extremely rare and potentially serious since it may also cause pulmonary emboli and sudden death. We report a case of a 32-year-old woman with history of IV drug abuse who presented with epidural abscess and methicillin-resistant S. aureus (MRSA) bacteremia. Later she developed signs of septic pulmonary embolism secondary to septic azygos vein thrombosis. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients with avoidance of potential complications

Hearing Loss and Kidney Dysfunction: Finding a Unifying Diagnosis

Microscopic polyangiitis (MPA) is a systemic vasculitis that affects small caliber vessels, with renal and lung compromise. Diagnosis can be challenging; timely diagnosis and treatment are important to prevent devastating complication, particularly renal failure. We present a case of a patient with microscopic polyangiitis presented with renal and pulmonary involvements with concomitant sensorineural hearing loss. We provide diagnostic, therapeutic, and prognostic keys to microscopic polyangiitis

Hyponatremia associated with unilateral hand weakness and numbness: A case report

Context: The key clinical features in this case are to make the diagnosis apical lung cancer (Pancoast tumor) in a patient with brachial plexopathy and to recognize the association between syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a paraneoplastic syndrome and non-small cell lung cancer (NSCLC). Case Report: We herein describe a rare case of NSCLC presented as pancoast tumor complicated by brachial plexopathy and associated with SIADH as a paraneoplastic phenomena. There were no renal insufficiency, congestive cardiac failure, liver insufficiency, volume depletion, diuretic use, hypoadrenalism, and hypothyroidism in our patient. Furthermore, the findings of serum hyponatraemia and hypo-osmolality associated with an inappropriate high urinary osmolality indicate that the SIADH was present in our patient due to the NSCLC. Conclusion: Our case also emphasizes that early recognition and appropriate applied management may significantly improve symptoms and prevent complications of hyponatremia which may enhance quality of life in patients with paraneoplastic SIADH

Lipid profile in Egyptian patients with coronary artery disease

Background: No data are available about plasma lipid profile in Egyptians with coronary artery disease (CAD). Plasma lipid profile may differ according to ethnic origin and geographic area. Objectives: Identify plasma lipid abnormalities in Egyptians with CAD and define the role of age, type of CAD, and the presence of hypertension (HT) on lipid profile. Methods: Retrospective consecutive sampling of lipid profile of 1000 patients with CAD. Results were compared to a control group of 1920 non-coronary individuals. Results: Patients’ age range was 19–90 years. HT was present in 56.7% of patients. The commonest isolated lipid abnormality was a reduced HDL-C in men and increased plasma triglycerides (TG) in women. Patients with myocardial infarction (MI) had a lower HDL-C than those with angina pectoris (AP). Abnormalities were more severe and more prevalent in the young age group. No significant difference in lipid profile was present between normotensive (NT) and hypertensive (HT) CAD patients. Conclusion: Dyslipidemia is common among Egyptians with CAD. Lipid profile was influenced by age, gender, type of CAD, but not by the presence of HT. The high prevalence rate of risk factors particularly among young Egyptians is remarkable and can explain the epidemic of CAD among Egyptians

Menthol Toxicity: An Unusual Cause of Coma

The US Food and Drug Administration (FDA) consider menthol an effective substance, which help in common cold symptoms and labeled to have low toxicity profile. Direct exposure to high menthol amount has been reported in animal; but no studies have been done to show the effect of menthol on long-term use in humans. Up to our knowledge we are reporting a rare case of chronic exposure to significant amount of menthol associated with cutaneous, gastrointestinal and neurological manifestations