ABSTRACT
This case report describes the journey of a patient who suffered from life-limiting gastrointestinal symptoms after an acute bout of pancreatitis following ERCP for cholelithiasis bile following a ductal stone, and subsequent cholecystectomy. She was diagnosed and treated for IBS with medication without significant improvement. On implementation of a simple gluten and lactose exclusion diet she recovered to her premorbid state, and trials of gluten challenge triggered flares of symptoms. This case report will go on to discuss current evidence for use of gluten and lactose exclusion diets in some gluten sensitive patients misdiagnosed with IBS
ABSTRACT
Aim: The aim of this study was to determine common factors leading to incomplete colonoscopy with a special interest in patient body mass index [BMI], and also to determine most common second line investigation, its pick up rates for cancer and the success rate of re-scoping
Background: Wide availability of scope guide in all procedures may decrease failure rate
Methods: We retrospectively reviewed 2891 colonoscopies performed at our institution from August 2015 to July 2016. The cohort was composed of all incomplete procedures [148] during this time period and a second cohort [148] of complete examinations which were randomly selected for relation of BMI only. The data in incomplete colonoscopy group included age, gender, BMI, causes of failure, mode of referral, second line investigation. The success of re-scope to pick up a cancer was compared to other modalities i.e. CT Colonography etc
Results: Male to female ratio was 1:4.8. High incomplete colonoscopy rate was noted in females [81%]. Mean age in failure group was 64 +/-15. Average BMI was 28+/- 15.Most common mode of referral was urgent or suspected cancer [74%]. Common cause of failure was patient intolerance [30%]. Most common anatomical site of failure was sigmoid colon [35%]. Completion rate of re-scoping in experienced hands was 95%. A lower BMI is related with higher chances of failure or vice versa
Conclusion: Lower BMI has higher chance of failure, possibly due to less extra colonic fat leading to tortuous colon. Female sex is second most common cause of failure due to low intolerance to pain. Using stronger pain relief and equal distribution of these characteristics on different list will have least implications in busy cancer screening unit
ABSTRACT
Identifying the etiology of chronic diarrhoea might be challenging in some patients, and before a diagnosis is made these patients may spend a sulostantial length of time with unresolved symptoms leading to uncertainty and anxiety that is severely impairing their life quality. A 45-year-old female was referred by her general practitioner with a 5-year history of increasingly frequent episodes of cyclical diarrhoea, vomiting, abdominal pain and intermittent palpitations. Contrast CT Abdomen/Pelvis revealed a 36x33x46 mm mass in the aorto caval region of her retro-peritoneum, just above the bifurcation. On the basis of her symptoms, CT findings and an elevated plasma metanephrine level of 2314pmol/L [normal range 80 - 510pmol/L], it was at this point a likely diagnosis of a Phaeochromocytoma was made. The retroperitoneal mass was successfully resected, and the histology confirmed a phaeochromocytoma. Her symptoms rapidly improved and she made a good recovery. This unusual case highlights some of the dilemmas that arise when investigating patients with chronic and recurrent diarrhoea and vomiting