ABSTRACT
An elderly hypertensive lady presented with fever, respiratory symptoms, and mild abdominal discomfort and was diagnosed to have COVID-19 pneumonia. Respiratory symptoms improved with steroids, awake proning, high flow nasal cannula oxygen therapy and antibiotics. After 4 days, she developed non-occlusive superior mesenteric artery thrombosis, which initially responded to anticoagulants but was complicated on tenth day by intestinal obstruction necessitating emergency surgery. Challenges encountered perioperatively were multi systemic involvement, pneumonia, ventilation- perfusion mismatch, sepsis along with technical difficulties like fogging of goggles, stuck expiratory valve on anesthesia machine, inaudibility through stethoscope and discomfort due to personal protective equipment. Perioperative focus should be on infection prevention, maintenance of hemodynamics, and optimization of oxygenation with preoperative high flow nasal cannula oxygen therapy. Ultrasound lung helps in correct placement of endotracheal tube. We recommend daily machine check, taping of N95 mask to face and ambient operation theatre temperatures of 20-22°C to reduce technical problems.
Subject(s)
Anesthesia, General/methods , COVID-19/complications , Ileal Diseases/surgery , Intestinal Obstruction/surgery , Laparotomy , COVID-19/diagnosis , COVID-19/therapy , Emergencies , Female , Humans , Ileal Diseases/diagnosis , Ileal Diseases/virology , Intestinal Obstruction/diagnosis , Intestinal Obstruction/virology , Middle AgedSubject(s)
Cytomegalovirus Infections/pathology , Cytomegalovirus , Ileal Diseases/pathology , Ileocecal Valve/pathology , Ulcer/pathology , Colitis/pathology , Colitis/virology , Cytomegalovirus Infections/virology , Humans , Ileal Diseases/virology , Ileocecal Valve/virology , Male , Medical Illustration , Middle Aged , Ulcer/virologyABSTRACT
RATIONALE: Intussusception, a common cause of intestinal obstruction in children, typically requires medical reduction. Here, we describe the case of a pair of twins who had simultaneous intussusception and were positive for fecal adenovirus-strongly indicating that adenovirus infection may be a main cause of the intussusception. PATIENT CONCERNS: Two 1-year-old twin girls were brought to Cathay General Hospital one after another on the same day. Both presented with intermittent abdominal pain, abdominal distension, diarrhea, and loss of appetite. DIAGNOSES: Their laboratory data were adenovirus positivity in rectal swab culture. Intussusception was diagnosed through a lower gastrointestinal series. INTERVENTIONS: The twins were treated with reduction for intussusception. OUTCOMES: Both patients recovered well, without recurrence. LESSONS: Most cases of intussusception are idiopathic. However, some potential risk factors-as strongly suggested by the current cases-are genetic factors and adenovirus infection.
Subject(s)
Adenovirus Infections, Human/complications , Diseases in Twins/virology , Ileal Diseases/etiology , Intussusception/etiology , Female , Humans , Ileal Diseases/diagnostic imaging , Ileal Diseases/virology , Infant , Intussusception/diagnostic imaging , Intussusception/virology , Radiography, Abdominal , Twins, MonozygoticSubject(s)
Cytomegalovirus Infections/complications , Gastrointestinal Hemorrhage/drug therapy , Hemostatics/therapeutic use , Ileal Diseases/complications , Ileocecal Valve/pathology , Minerals/therapeutic use , Ulcer/complications , Antitubercular Agents/therapeutic use , Antiviral Agents/therapeutic use , Cystitis/complications , Cystitis/drug therapy , Cystitis/surgery , Erythrocyte Transfusion , Fatal Outcome , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Ileal Diseases/therapy , Ileal Diseases/virology , Ileocecal Valve/virology , Male , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Postoperative Complications/virology , Sclerosing Solutions/therapeutic use , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapy , Tuberculosis, Urogenital/surgery , Ulcer/therapy , Ulcer/virology , Urinary DiversionSubject(s)
Cytomegalovirus Infections/pathology , Granuloma, Plasma Cell/pathology , Granuloma, Plasma Cell/virology , Ileal Diseases/pathology , Ileocecal Valve/pathology , Aged , Biomarkers/analysis , Colonic Neoplasms/diagnosis , Cytomegalovirus Infections/diagnosis , Diagnosis, Differential , Female , Granuloma, Plasma Cell/diagnosis , Humans , Ileal Diseases/diagnosis , Ileal Diseases/virology , Immunohistochemistry , Sarcoma/diagnosisABSTRACT
Acute abdomen in dengue, a common arboviral disease found in tropical and subtropical countries, is not uncommon and can occasionally present as acute surgical emergency requiring urgent surgical intervention. The spectrum of acute abdomen presenting as surgical emergency in dengue infection that raises suspicion of an abdominal catastrophe includes acute appendicitis, acute cholecystitis, appendicitis and, rarely, intestinal perforation. All cases of intestinal perforation including appendicular, gastric and jejunal perforation have been reported in adult patients during the course of dengue infection. However, intestinal perforation during the course of dengue infection in the paediatric age group has never been reported. We report two cases of ileal perforation in children occurring during the course of dengue infection.
Subject(s)
Dengue/complications , Ileal Diseases/virology , Intestinal Perforation/virology , Child , Female , Humans , MaleABSTRACT
A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.
Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Epstein-Barr Virus Infections/etiology , Ileal Diseases/virology , Ileum/pathology , Methotrexate/adverse effects , Ulcer/virology , Aged , Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/immunology , Epstein-Barr Virus Infections/pathology , Epstein-Barr Virus Infections/surgery , Female , Herpesvirus 4, Human , Humans , Ileal Diseases/pathology , Ileal Diseases/surgery , Immunocompromised Host , Intestinal Diseases/drug therapy , Intestinal Mucosa/virology , Methotrexate/administration & dosage , Treatment Outcome , Ulcer/pathology , Ulcer/surgeryABSTRACT
We report a case of a patient with acquired immunodeficiency syndrome (AIDS) and ileocecal ulcer. A 31-year-old man was admitted with chief complaints of decreased body weight and abdominal pain. Colonoscopy revealed a round punched-out ulcer on the ileocecal valve. Initially, we suspected entero-Behçet's disease and simple ulcer as the cause of the ileocecal ulcer. However, after histologic examination of tissue biopsies obtained during colonoscopy, we diagnosed the patient as having cytomegalovirus (CMV) enteritis. Based on the patient's white blood cell depletion and CMV enteritis, we performed a human immunodeficiency virus (HIV) antibody test. The test was positive, and the diagnosis of AIDS was established. The number of patients with AIDS has been increasing in Japan; thus, we should consider the possibility of CMV enteritis and AIDS in young adult patients affected by ileocecal ulcer with no notable history.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Cecal Diseases/diagnosis , Cytomegalovirus Infections/diagnosis , Ileal Diseases/diagnosis , Ulcer/diagnosis , Adult , Behcet Syndrome/diagnosis , Cecal Diseases/complications , Cecal Diseases/virology , Colonoscopy , Cytomegalovirus Infections/complications , Humans , Ileal Diseases/complications , Ileal Diseases/virology , Male , Ulcer/complicationsSubject(s)
Ileal Diseases/diagnosis , Lymphoma, Large B-Cell, Diffuse/diagnosis , RNA, Viral/analysis , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antineoplastic Agents/therapeutic use , Double-Balloon Enteroscopy , Heart Transplantation/adverse effects , Herpesvirus 4, Human/genetics , Humans , Ileal Diseases/therapy , Ileal Diseases/virology , Lymphoma, Large B-Cell, Diffuse/chemistry , Lymphoma, Large B-Cell, Diffuse/therapy , Lymphoma, Large B-Cell, Diffuse/virology , Male , Middle Aged , RituximabSubject(s)
Colonic Diseases/virology , Cytomegalovirus Infections/complications , Cytomegalovirus/immunology , Enterocolitis/virology , Ileal Diseases/virology , Leukemia/complications , Ulcer/virology , Aged , Antibodies, Viral/analysis , Colonic Diseases/diagnosis , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/virology , Diagnosis, Differential , Endoscopy, Gastrointestinal , Enterocolitis/diagnosis , Female , Humans , Ileal Diseases/diagnosis , Leukemia/diagnosis , Tomography, X-Ray Computed , Ulcer/diagnosisSubject(s)
Capsule Endoscopy/methods , Cytomegalovirus Infections/complications , Cytomegalovirus/immunology , Gastrointestinal Hemorrhage/etiology , Ileal Diseases/complications , Antibodies, Viral/analysis , Biopsy , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/virology , Diagnosis, Differential , Gastrointestinal Hemorrhage/diagnosis , Humans , Ileal Diseases/diagnosis , Ileal Diseases/virology , Intestinal Mucosa/pathology , Intestinal Mucosa/virology , Male , Middle AgedABSTRACT
Intestinal intussusception is the invagination of an intestinal segment into another. Childhood intussusception is usually idiopathic, whereas adult intussusception is usually due to a definable intraluminal lesion or to a systemic disease. Although the aetiology of idiopathic forms often remains unclear, there is appreciable evidence to support an indirect role played by certain infectious agents. In this report we present a case of childhood intussusception probably due to adenovirus infection.
Subject(s)
Adenoviridae Infections/complications , Ileocecal Valve , Intussusception/virology , Female , Humans , Ileal Diseases/virology , InfantABSTRACT
Representing a rare cause of bowel obstruction, the ileal intussusception is commonly met in the pediatric surgery. Even if in children's cases the symptoms can mimick a multitude of abdominal syndromes, usually in adult cases the symptoms fit the pattern of the intestinal obstruction. This paper presents 2 clinical cases of small bowel intussusception in adult, the particularity of cases being that the pathogenesis couldn't be established first hand; the pathology exam revealed only minor inflammatory responses,including modest reactive lymph nodes in the vicinity of lesions, without further alterations. The etiology of bowel intussusception was finally attributed to viral infection with gastroenteritis, based on clinical and pathological criteria.
Subject(s)
Ileal Diseases/virology , Ileocecal Valve , Intestinal Obstruction/virology , Intussusception/virology , Aged , Female , Humans , Ileal Diseases/diagnosis , Ileal Diseases/surgery , Intussusception/diagnosis , Intussusception/surgery , Middle Aged , Treatment OutcomeABSTRACT
Disseminated herpes simplex virus (HSV) infection usually manifests in the immunocompromised. However, anecdotal examples of visceral HSV disease and viremia have complicated type I diabetes. A case of a 53-year-old type I diabetic patient with bowel obstruction one week subsequent to bronchitis is reported. At laparotomy, a perforated segment of ileum was associated with an adhesive peritoneal band. HSV cytopathic atypia and HSV immunohistochemical staining were confined to fibrocytes and mesothelial cells without involvement of the epithelium. Dissemination of symptomatic HSV pneumonia was verified by histology, immunohistochemistry, in situ hybridization, polymerase chain reaction and direct fluorescence antibody. Intravenous acyclovir resolved symptoms. This is a novel documentation of HSV complicating ileal adhesive band disease. Furthermore, this case indicates that the HSV cytopathic effect is not unique to the epithelium. Disseminated infection can manifest in myofibrocytes and mesothelium, distinguishing it from standard epithelial atypia of localized HSV infection.
Subject(s)
Herpes Simplex/virology , Herpesvirus 2, Human/isolation & purification , Ileal Diseases/virology , Intestinal Mucosa/virology , Acyclovir/therapeutic use , Antibodies, Viral/blood , Antiviral Agents/therapeutic use , DNA, Viral/analysis , Diagnosis, Differential , Female , Herpes Simplex/diagnosis , Herpes Simplex/drug therapy , Humans , Ileal Diseases/diagnosis , Ileal Diseases/drug therapy , In Situ Hybridization , Intestinal Mucosa/pathology , Middle Aged , Polymerase Chain ReactionABSTRACT
Churg-Strauss syndrome, or allergic granulomatous angiitis, is an uncommon vasculitic syndrome. We describe a 53-year-old man with Churg-Strauss syndrome and subsequent opportunistic cytomegalovirus enterocolitis. During intensive care, including steroid-pulse therapy, the patient developed rapidly progressive anemia caused by active bleeding from his small intestine, resulting in resection of 20 cm of ileum. Diagnosis of Churg-Strauss syndrome was confirmed both by characteristic clinical features and by histology. Histologic examination also revealed multiple shallow ulcers accompanied by cytomegalovirus infection. Characteristic angiitis was found in the ileum with normal-like mucosa, and it was not necessarily associated with ileal ulcers. This finding suggests that cytomegalovirus infection may be one of the causes or exacerbating factors for ileal ulcers in Churg-Strauss syndrome, although ulcers of the intestine have usually been considered to be caused by ischemia resulting from angiitis.
Subject(s)
Churg-Strauss Syndrome/pathology , Cytomegalovirus Infections/pathology , Cytomegalovirus/isolation & purification , Ileal Diseases/pathology , Opportunistic Infections/pathology , Ulcer/pathology , Anemia/etiology , Anemia/pathology , Churg-Strauss Syndrome/drug therapy , Churg-Strauss Syndrome/virology , Cytomegalovirus/pathogenicity , Cytomegalovirus Infections/complications , Dose-Response Relationship, Drug , Enterocolitis/pathology , Enterocolitis/virology , Humans , Ileal Diseases/surgery , Ileal Diseases/virology , Ileum/pathology , Ileum/surgery , Ileum/virology , Immunocompetence/drug effects , Immunocompromised Host , Intestinal Mucosa/pathology , Intestinal Mucosa/virology , Male , Methylprednisolone/adverse effects , Middle Aged , Opportunistic Infections/complications , Ulcer/surgery , Ulcer/virologyABSTRACT
A 32-year-old man, who had no previous medical history, was hospitalized with 3-week duration of abdominal pain, fever, and watery diarrhea. Initial colonoscopy showed subepithelial hemorrhagic spots throughout the entire colon together with well-circumscribed ulcer around the ileocecal valve. Serologic test disclosed HIV-positive and repeated biopsies at ulcer base finally revealed that the patient had cytomegalovirus ulcer in ileocecal area.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Colitis/virology , Cytomegalovirus Infections/diagnosis , Ileal Diseases/virology , Ileocecal Valve , Ulcer/virology , AIDS-Related Opportunistic Infections/complications , Adult , Colitis/complications , Colitis/diagnosis , Colonoscopy , Cytomegalovirus Infections/complications , Humans , Ileal Diseases/complications , Ileal Diseases/pathology , Ileocecal Valve/pathology , Male , Ulcer/complications , Ulcer/pathologyABSTRACT
BACKGROUND: Several studies have shown an association between vaccination with the rotavirus vaccine and the development of intussusception. We evaluated the plausibility of a causal association between natural rotavirus infection and intussusception. METHODS: We performed ultrasound measurements, in infants with confirmed rotavirus infection and in healthy control subjects, of the ileum wall thickness and mesenteric lymph nodes, at enrollment and 1 month later. RESULTS: Thirteen pairs of patients with rotavirus infection and control subjects were enrolled. The mean distal ileum wall thickness at the first examination was 3.0 mm in patients with rotavirus infection and 2.0 mm in control subjects (P = .037). The maximum lymph node size in patients with rotavirus infection was 11.6 mm at the first examination and 7.4 mm at the second examination (P = .017). Nodal aggregates and free fluid were also observed more commonly among patients with rotavirus infection (54% vs. 9%; P = .033 for both). CONCLUSION: Rotavirus infection was associated with increased distal ileum wall thickness and lymphadenopathy during the illness period. These changes suggest a plausible mechanism by which rotavirus infection could cause intussusception.