Search

A 38-year-old woman with a history of Crohn's disease, multiple bowel resections, and ileostomy placement presented to the hospital with symptoms of increased ileostomy output for 1 week. She reported that she was emptying her bag fifteen times a day as opposed to her normal 3–4 times a day. Upon workup, she was found to have an acute kidney injury (AKI), and stool studies were positive for Cryptosporidium. She was treated with nitazoxanide 500 mg p.o. BID for 3 days along with continued rehydration. The patient was discharged after creatinine (Cr) and electrolytes returned to baseline. She continued to have elevated ileostomy output, and 1 week later, she was readmitted for another AKI and worsening of symptoms. At this hospitalization, stool studies were negative for Cryptosporidium, and the gastroenterologist consult recommended evaluation for active Crohn's and Lomotil for possible short bowel syndrome. Eventually, her laboratory results improved, and she was discharged again before the full workup was completed. The patient's ileostomy output continued to remain high following the second hospital discharge, and she eventually returned with another AKI, her third visit in a month. The workup for active Crohn's was completed, with fecal calprotectin, serum cortisol, and small bowel follow-through all returning to normal. At this time, postinfectious inflammatory syndrome was suspected, and she was started on 60 mg of prednisone for 2 weeks. Steroid therapy elicited a significant response with normalization of her ileostomy output and return of laboratory results to baseline. The patient was discharged without return of symptoms at follow-up. [ABSTRACT FROM AUTHOR]

Intestinal volvulus is defined as a twisting of the bowel on its mesentery. It itself is a rare occurrence, with documented incidence of 1% as the cause of all small bowel obstruction, with further 0.82% of them being associated with intestinal malrotation. The classical radiographic feature described in literatures is the whirlpool sign. We herein report a rare presentation of congenital malrotation causing a small bowel obstruction in a 43-year-old man. The patient presented with acute abdominal pain and underwent an emergency laparotomy and resection of small and large bowel (total of 3 m with primary anastomosis), with an estimated 2.6 m of viable small bowel left. The patient had a prolonged recovery complicated by another relook operation, superior mesenteric vein thrombus and a high-output stoma with subsequent electrolyte derangements and acute kidney injury. He was discharged on Day 26 and had been seen in the outpatient department with good functionality. [ABSTRACT FROM AUTHOR]

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient. [ABSTRACT FROM AUTHOR]

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging.tempspacetempspaceWe describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function.tempspacetempspaceTeduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea.tempspacetempspaceA literature review of similar cases yielded 18 patients who underwent 19 kidney transplants.tempspacetempspaceDespite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2.tempspacetempspaceIn conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes.tempspacetempspaceFurther, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient. [ABSTRACT FROM AUTHOR]

Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient. [ABSTRACT FROM AUTHOR]

A 53-year-old man developed a Legionella pneumophila pneumonia complicated by rhabdomyolysis, acute kidney injury, and protracted ileus. Risk factors were smoking and chronic alcoholism, but the patient had no history of previous abdominal surgery. Hemodialysis was required for a period of 5 weeks with a full renal recovery. Pneumonia required respiratory support but for a limited period of 6 days. The protracted course of the ileus led to explorative laparotomy despite negative computed tomography findings. No cause of mechanical obstruction was found at surgery and common etiologies of intestinal obstruction were excluded. Parenteral nutrition was needed for a total of 4 weeks, before recovery of intestinal motility. This case illustrates the apparent discrepancy between the pulmonary symptoms and the extrapulmonary manifestations that could be seen as a consequence of an exaggerated immune response. [ABSTRACT FROM AUTHOR]

We describe a unique case of a 53-year-old woman who underwent a nonrelated living donor kidney transplant 9 years after a previous small bowel transplant from her sister. The patient had suffered from short bowel syndrome secondary to volvulus after undergoing bariatric surgery for morbid obesity. Her entire small bowel had to be resected emergently, but she also developed acute kidney failure at the time. This initial kidney injury associated with long-term exposure to calcineurin-inhibitor medication eventually led to end-stage renal disease. A successful kidney transplant from a different, nonrelated adult donor was performed. Of note, the unrelated kidney donor matched exactly the 2 HLA-A and HLA-B antigens that the recipient had not matched with her sister. We discuss the unique HLA configuration between the patient and her 2 living donors, the absence of posttransplant rejection and posttransplant immunosuppressive therapy. To our knowledge this is the first published report of a successful kidney after a previous bowel transplant using (2 different) living donors. [ABSTRACT FROM AUTHOR]

Introduction. The ingestion of caustic substances represents a medical/surgical emergency, the severity of the lesions usually depends on the nature and quantity of the ingested product, and the treatment requires a multidisciplinary approach. Aim and methods. to retrospectively analyze the profile of the patients with caustics ingestion from Bihor Emergency Clinical County Hospital between 1st of January 2013 and 31st of December 2023. We carefully analyzed the files of the aforementioned patients for clinical, biological, endoscopic, therapeutic as well as the evolving patterns. Results. We included 42 patients, with a clear male predominance, M/F ratio of 1.62. The mean age was 34.6 years ±14.2, rural/urban ratio 24/18. From the studied group, 12 patients (28.5%) were known and followed-up with a psychiatric illness. Accidental ingestions were less frequent n=13 (31%) than voluntary ingestions n=29(69%). Among the substances, HCl/bleach was the most used n=20 (47.6%), followed by ethylene glycol n=12 (28.6%), NaOH n=5 (11.9%), H2SO4 n=2 (4.8%), unknown substance n=3 (7.1%). At admission, 23 (54.8%) patients presented oropharyngeal lesions, vomiting in 32 cases (76.2%), epigastric pain in 32 cases (76.2%), esophageal syndrome in 10 cases (23.8%), hematemesis in 4 cases (9.5%), peritoneal syndrome in 3 cases (7.1%), acute renal failure in 7 cases (16.7%). After excluding a surgical emergency, the UGIE performed in the first 24 hours after admission, showed according to the Zargar classification: grade I esophageal lesions -7 cases (16.7%), grade II -18 cases (42.9%), grade III - 6 cases (14.3%) and grade IV -3 (7.1%). Grade I gastric lesions were observed in 18 patients (42.8%), grade II in 4 patients (9.5%), grade III in 13 patients (31%), grade IV in 2 (4.8%). All patients received medical treatment (PPI, metoclopramide) and parenteral nutrition according to severity. Early pneumomediastinum after UGIE was observed in 3 patients (7.1%). The in-hospital mortality rate was (16.7%). A predictive factor for unfavourable prognosis is hyperleukocytosis (p=0.018). There is no significant correlation between the amount ingested (p=0.8) or age (p=0.6) and the evolution of the patients or between the product ingested and the severity of esophageal/gastric involvement at admission. Conclusion. In our study, the epidemiological profile of caustic ingestion was dominated by the voluntary ingestion of HCL/bleach, the symptomatology was mainly digestive, and hyperleukocytosis represented an unfavourable prognostic factor. [ABSTRACT FROM AUTHOR]

Chylothorax is a rare complication after LTx resolving in a minority of cases with non-surgical management, primarily tube drainage, low-fat or parenteral nutrition and somatostatin analogues. In refractory chylothorax, surgical ligation and thoracic duct embolization have been used.1 Thoracic duct embolization has been effectively undertaken with varying combinations of alcohol, coiling, glue or lipiodol (iodinated poppy seed oil).2-3 Lipiodol is theorised to cause intraluminal inflammation and duct closure. Previous cases have reported profound lung injury with pulmonary embolization.2,4-5 A 67-year-old woman underwent a left single LTx for Chronic Obstructive Pulmonary Disease. Her post-LTx course was complicated by acute kidney injury and pulmonary venous congestion with high chest drain output. 7 days post-LTx, a persistent chyle leak was noted. Failing medical management, methylene guided lymphangiography deployed 30ml lipiodol and alcohol into the cisterna chyli. Unfortunately, on subsequent imaging lipiodol had accumulated in the pleural space and the interstitium of the LTx with spread to the retrocural space and thoracic inlet (Fig. 1A). The patient remained in ICU for 3-weeks, requiring slow wean of invasive ventilation via tracheostomy. Despite initial concerns of permanent lung fibrosis post-lipiodol, there was progressive resorption over the next month. The patient was decannulated and discharged home without supplemental oxygen (Fig. 1B). She achieved her peak lung function 1 year following LTx (FEV1 50%, FVC 42%). Complete radiological clearance of lipiodol was noted at 3 years (Fig. 1C). She remains alive with stable Chronic Lung Allograft Dysfunction (FEV1 20%) 11 years following LTx with no recurrent pleural effusions. This case shows long-term single LTx survival despite lipiodol escape during attempted embolization without development of fibrosis. [ABSTRACT FROM AUTHOR]