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Abstract Introduction Adult Intussusception is an uncommon diagnosis, with one to three cases occurring in a population of 1,000,000 per year, primarily due to underlying pathological lead points, of which 70% are malignant. Lipoma is the most common benign tumour, and primary adenocarcinoma is the most common malignant one. Early diagnosis and treatment are essential to reducing poor outcomes, including ischemia, perforation, and sepsis. Computed tomography imaging is a modality of choice for diagnosis. With a diagnostic accuracy of up to 100% and a specificity of up to 71%. Surgical intervention is the definitive treatment, and the decision is taken according to the situation. Case presentation A 61-year-old Black African female presented to our surgical casualty with intermittent colicky abdominal pain for 1 month. After that, she started to experience abdominal swelling in the right iliac fossa. A CT scan confirmed the presence of colo-colic Intussusception, cecum-ascending-transverse colon. Laparotomy was scheduled, and a right hemicolectomy was done accordingly. Diagnosis of adenocarcinoma (Dukes stage B2) was made histologically. Conclusion Intussusception in adults is a challenging diagnosis requiring high clinical suspicion and has a high incidence of fatal complications. Colonic cancer can be worsening by any infection and chronic medical problem. CT imaging is the lifesaving modality of choice for diagnosis. Good patient outcomes depend on timely diagnosis and recruitment of a multi-disciplinary team.

Background and Purpose: The role of early/emergency shockwave lithotripsy (SWL) in symptomatic upper ureteral calculi has still not been established. We have performed a randomized comparison between early (<48 hours) vs delayed (>48 hours) SWL for symptomatic upper ureteral stones less than 1 cm to evaluate the feasibility, safety, and efficacy of early SWL in these patients., Patients and Methods: One hundred and sixty consecutive patients with a single radiopaque upper ureteral stone <1 cm, who presented with an episode of colicky pain and who were undergoing treatment between July 2008 and June 2009 in our department were included. The patients were hospitalized and randomized into two groups-group A: SWL was performed within 48 hours of onset of colicky pain (early SWL) using the electromagnetic lithotripter (Dornier Alpha Compact) along with analgesics and hydration therapy; group B: SWL was performed after 48 hours (delayed SWL) along with analgesics and hydration therapy. The statistical analysis was performed in two groups regarding the patient demographic profile, presence of hydronephrosis, time to stone clearance, success rates, number of sessions needed, auxiliary procedures, modified efficiency quotient (EQ), and complications., Results: Eighty patients were enrolled in each group. The mean stone size was 7.3 mm in group A vs 7.5 mm in group B (P = 0.52). The stone fragmentation rate was 88.75% in group A vs 91.2% in group B (P = 0.35). The overall 3-month stone-free rate was 86.3% (69/80) for group A vs 76.2% (61/80) for group B (P = 0.34). The mean time taken for stone clearance was significantly less in group A than in group B (10.2 days vs 21.1 days; P = 0.01). The number of sessions needed in group A were significantly less than in group B (1.3 vs 2.7; P = 0.01). The auxiliary procedure rate was also significantly lesser in group A than group B (16.3% vs 32.5%; P = 0.001). The modified EQ (in %) was 67.2 in group A vs 59.4 in group B (P = 0.21). The steinstrasse formation and requirement for percutaneous nephrostomy (PCN) were significantly less in group A (P:0.02 and P:0.01 respectively)., Conclusions: Early SWL (within 48 hours of onset of colicky pain) is feasible, safe, and highly efficacious in the management of symptomatic proximal ureteral stones <1 cm, resulting in a lesser requirement of number of SWL sessions, time taken for stone clearance, auxiliary procedure rate, and fewer complications in comparison with delayed SWL.

A case of lactobezoar is described in a toddler with an acute history of abdominal pain, vomiting, and lethargy. Despite normal dietary habits, he had developed a gastric milk coagulum which led to a palpable epigastric tumor. Intussusception was suspected but disproven by barium enema. In retrospect, plain abdominal radiographs demonstrated characteristic mottled filling defects in the stomach from a lactobezoar. Conservative therapy led to prompt disintegration of the lactobezoar.

Background: Use of ureteral stents has become an integral part of urological practice. However, it also brought with it many complications. Double J (DJ) stent knotting is a rare stent complication, and only a few cases have been reported in the literature. Although the exact cause is unknown and, in the literature, it is generally thought that knots occur due to traction. In this case report we present for the first time that spontaneous knots can occur due to ureteral peristalsis or ureteral anomalies. Case presentation: Two patients (67 and 35 aged-Caucasian person) with ureteral stones who presented to the emergency department with colicky pain and had no previous history of urological surgery. We observed knot formation in the routine urinary system radiographs taken before stent removal in two patients whose ureters were observed to be narrow during endoscopic ureteral stone treatment. The stents were successfully removed using gentle traction under general anesthesia. Conclusions: We discussed the cause and solution of spontaneous knot formation. We emphasized the importance of the direct urinary system radiograph taken before DJ stent removal. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case demonstrates an atypical presentation of choledochal cysts (CDCs) and elaborates on the diagnostic challenges encountered when presented with CDCs in adulthood, as it principally presents in children. A choledochal cyst is a rare congenital anomaly characterized by cystic dilations in the extrahepatic and intrahepatic biliary trees. These cysts are classified according to their location and characteristics. This case study aims to demonstrate how nonspecific clinical features can pose a diagnostic dilemma when presented in adults. Additionally, the case report provides an overview of diagnostic methods and treatment options. In this case, we discuss a 50‐year‐old female who presented with a 2‐ to 3‐day history of severe colicky pain in the right upper quadrant of her abdomen without any other symptoms or abnormal laboratory tests. In addition to ultrasonography evidence of CBD dilation and cholelithiasis, MRCP results confirmed the diagnosis. She underwent surgical intervention involving cyst excision, a Roux‐en‐Y hepatojejunostomy, and a cholecystectomy. The postoperative period was without significant complications. The case presented here illustrates the potential outcomes for individuals who present with choledochal cysts during adulthood. Often, these cases present with vague symptoms or as the underlying cause of a more severe condition. This case contributes to the existing knowledge of choledochal cysts by providing insight into the clinical presentation, diagnostic methods, and treatment options. [ABSTRACT FROM AUTHOR]

A 15-year-old female patient presented to emergency with bilious vomiting after taking meals for the last 3 months along with intermittent colicky pain in the epigastrium for the last 1 month. Initially, the frequency of vomiting was 2–3 times/week which gradually increased to 4–5 times/day in the last 2 weeks. She had no history of any abdominal pathology or past history of tuberculosis or abdominal surgery. A review of systems showed she had a weight loss of about 10 kgs in the last 3 months along with loss of appetite. Physical examination revealed soft distention of the upper abdomen with mild tenderness in the epigastrium. CT scan of the abdomen showed concentric heterogenous luminal narrowing near duodenojejunal flexure with gross dilatation of the duodenum and stomach. The patient underwent resection of D4 and proximal jejunum with side-to-side D2-jejunum anastomosis. Histopathological examination revealed the luminal lesion to be an adenocarcinoma. [ABSTRACT FROM AUTHOR]

BACKGROUND Ureteral stones are a common urological condition causing significant discomfort and morbidity. Medical expulsive therapy (MET) is a noninvasive approach to facilitate the passage of stones. This study aimed to compare the efficacy and safety of silodosin and tamsulosin as MET in patients with distal ureteral stones (DUS). METHODS We searched CINAHL, Cochrane Library, PubMed, and ScienceDirect for randomized controlled trials (RCTs) on the administration of silodosin and tamsulosin for DUS. The primary outcomes analyzed were stone expulsion rates and expulsion times, measured as risk ratio (RR) and mean difference (MD), respectively. Statistical analyses were performed using Review Manager 5.4 and STATA 17. RESULTS 14 RCTs comprising 1,535 patients (770 received silodosin) met the inclusion criteria. The silodosin group had notably higher stone expulsion rates (RR 1.20, 95% confidence interval [CI] 1.13-1.27, p<0.00001, I² = 37%), shorter expulsion times (MD -2.98, 95% CI -4.35-1.62, p<0.01, I² = 85%), and fewer colicky pain episodes (MD -0.35, 95% CI -0.59-0.10, p<0.01, I² = 83%) than the tamsulosin group. Retrograde ejaculation was the only adverse event that had a significant difference between both groups, statistically favoring tamsulosin (RR 1.61, 95% CI 1.12-2.33, p = 0.01, I² = 0%). CONCLUSIONS Silodosin should be preferred as the first-line MET agent for DUS owing to its better expulsion rate, shorter stone expulsion time, and fewer colicky pain episodes. However, tamsulosin may be used in selected cases where patients experience retrograde ejaculation after receiving silodosin. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shock wave lithotripsy (ESWL) was first introduced by Chaussy in 1980 for the treatment of urolithiasis, which has revolutionized the treatment of urinary stones. Renal colic, urinary tract obstruction, uremia, and renal failure can occur because of the stone fragments obstructing the ureter during the post-ESWL period. The role of double-J (DJ) stents in ESWL is controversial. Aims and Objectives: The aim of the study was to evaluate the role of DJ stent in patients with renal and upper ureteric calculus undergoing extracorporeal shockwave lithotripsy. Materials and Methods: Two hundred patients with solitary calculus 5 mm–2 cm in size, amenable to ESWL, located in renal pelvis, upper or middle calyx, upper ureter visiting Lok Nayak Hospital, New Delhi from December 2015 to April 2019 were studied and randomized into two groups: Test group (non-stented, 100 patients) and control group (Stented, 100 patients). Both groups underwent ESWL and subsequently compared for the following parameters: Stone clearance, post lithotripsy pain and analgesic dose requirement, number of ESWL sittings and shockwaves required, steinstrasse, urinary tract infection (UTI), and hematuria. Patients were followed up for 3 months after stone clearance to look for any recurrence. Results: There was a significant difference (P<0.05) in the two groups with smaller number of ESWL sittings and number of shockwaves required, low frequency of colicky pain episodes and mean pain score, less analgesic dose requirement, lower incidence of hematuria, and UTI in non-DJ stent group. The overall stone clearance was higher in the non-DJ stent group (96.4%) as compared to the DJ stent group (89.3%). The incidence of steinstrasse was higher in the DJ stent group (10.7%) as compared to none in the non-DJ stent group. Conclusions: There is no additional benefit of DJ stent on stone clearance, rather stenting further increases the morbidity due to associated complications. DJ stenting should not be performed in patients undergoing ESWL for renal and upper ureteric calculus up to 2 cm size. [ABSTRACT FROM AUTHOR]

Membranous dysmenorrhoea is an uncommon condition characterized by the spontaneous flaking of endometrium into a single piece that maintains the shape of the uterus. The common symptom of membranous dysmenorrhoea is a colicky pain caused by uterine contractions. Because only a limited number of cases have been published in the literature, the case report we present is peculiar. This report describes a case of membranous dysmenorrhoea that occurred after an artificial frozen thawed embryo transfer cycle using vaginal progesterone. The patient, during hormone replacement treatment, reported an intense abdominal colicky pain resulting in the loss of membranous endometrial tissue. A histopathological exam was performed with a clear diagnosis of membranous dysmenorrhoea. Moreover, photos were recorded and provided together with this article. The importance of such a case report relies on the actual debate about the appropriate progesterone route of administration. Although different medical approaches exist, progesterone administration is the most widespread. However, the intramuscular, oral, and subcutaneous means of administration are gaining popularity. On this peculiar case report, the patient underwent a subsequent frozen thawed embryo transfer cycle with subcutaneous progesterone administration. The embryo transfer resulted first in a clinical pregnancy and subsequently in a spontaneous delivery without any complications. [ABSTRACT FROM AUTHOR]

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Background/Aims Crohn’s disease (CD) is a chronic, recurrent, inflammatory disorder characterized by transmural inflammation that affect any part of the gastrointestinal tract. The clinical symptoms and radiographic findings of CD varies greatly hence we report a case of a 20-year-old Filipino male with CD who presented with large bowel obstruction and colon-cut-off-sign by computed tomography (CT). Case Presentation A 20-year-old Filipino male presented with 1 year intermittent loose stools with occasional colicky pain associated with perianal fistula. A colonoscopy was done showing multiple linear ulcerations at the terminal ileum with skip lesions all throughout the colon. Histopathology revealed severe chronic active ileocolitis. Patient was treated for CD with oral budesonide and sulfasalazine. However after 1 week he complained of vomiting, severe abdominal pain and constipation for 4 days with an impression of large bowel obstruction. On physical examination, there was direct tenderness while rebound tenderness, rigidity, and guarding were absent and laboratories revealed mild leukocytosis and elevated erythrocyte sedimentary rate (ESR) with fecal calprotectin of 1494.0 ug/g. CT scan showed and abrupt cut-off at the level of splenic flexure with associated collapse of the descending down to rectosigmoid colonic segments or the colon-cut-off-sign with no lymphadenopathies. Treatment with infliximab was initiated at a dose of 5 mg/kg and Intravenous Hydrocortisone which induce prompt relief of obstructive symptoms avoiding surgical management. Conclusion This report aspires to emphasize atypical presentation and radiologic findings of CD. Colon Cutoff Sign can be commonly seen in acute pancreatitis but should also be considered in CD as a transmural inflammatory disease that can cause intestinal obstruction. It is important to stress that reviewing atypical presentations and radiologic findings will be helpful in the diagnosis of such cases in the future to avoid jeopardizing the quality of life of patients with CD. [ABSTRACT FROM AUTHOR]

Background/Aims Primary gastrointestinal lymphomas are rare, comprising 1–4% of gastrointestinal malignancies, with Burkitt’s lymphoma accounting for 0.3–1.3% of non-Hodgkin’s lymphomas. Typically affecting the ileum in children and adolescents, Burkitt’s lymphoma in adults can cause ileocolic intussusception. This report presents a rare case of ileocolic intussusception caused by small intestinal Burkitt’s lymphoma. Case Presentation 28-year-old male presented with progressive colicky pain in the right lower quadrant for 4 days, accompanied by nausea and bloatedness. Medical history was unremarkable. Physical examination revealed a distended abdomen, hypoactive bowel sounds, tympanitic percussion, and direct and rebound tenderness in the right lower quadrant with guarding. Laboratory tests revealed leukocytosis, and CT scan identified a 3.5x4.2x3.6 cm mass at the ileocecal junction, indicating ileocolic intussusception The patient underwent a right hemicolectomy and ileo-transverse colostomy with end-to-side anastomosis. Intraoperative findings revealed a 5 cm intussuscepted ileum in the cecum, a 4x4x3 cm ileocecal valve lead point, and a 1.5 cm tumor. Biopsy was consistent with Burkitt’s lymphoma. The patient received chemotherapy with rituximab, etoposide, doxorubicin, vincristine, prednisone, cyclophosphamide, and filgrastim for 6 cycles. Follow-up CT scans and colonoscopy showed no new masses and normal colonic mucosa. Discussion Burkitt’s lymphoma, linked to previous malabsorption syndromes, IBD, and immunosuppression, presents with nonspecific symptoms, such as abdominal pain. Diagnosis involves CT scans and laparotomy. Biopsy shows CD20 positivity and atypical lymphoid proliferation. Treatment includes surgical resection and chemotherapy. Prognosis varies by age and disease site. The survival rate is approximately 60%. More research on adult cases is recommended. [ABSTRACT FROM AUTHOR]

Background: In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in children and compare them with the treatment outcomes of previously used endoscopic retrograde cholangiopancreatography (ERCP). Methods: From January 2000 to January 2022, a total of 84 children (78.5% female) underwent laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. Of these, 6 children underwent laparoscopic cholecystectomy (LC) + ERCP and 14 children underwent LCBDE for choledochiothiasis. The primary end point of the study was the success of treatment in terms of the incidence of complications, recurrence rate, and rate of reoperation. Secondary endpoints were stone characteristics, presenting symptoms, duration of surgery, and length of hospital stay. Results: The majority of patients were female in both groups (83.5% vs. 85.7%), mostly overweight with a median BMI of 27.9 kg/m2 and 27.4 kg/m2, respectively. Obstructive jaundice, colicky pain, acute pancreatitis, and obstruction of the papilla were the most common symptoms in both groups. The majority of patients (68%) had one stone, whereas two or more stones were found in 32% of patients. The median diameter of the common bile duct was 9 mm in both groups. The procedure was successfully completed in all patients in the ERCP group. In the group of patients treated with LCBDE, endoscopic extraction of the stone with a Dormia basket was successfully performed in ten patients (71.4%), while in the remaining four patients (28.6%) the stones were fragmented with a laser because extraction with the Dormia basket was not possible. The median operative time was 79 min in the LCBDE group (IQR 68, 98), while it was slightly longer in the ERCP group, 85 min (IQR 74, 105) (p = 0.125). The length of hospital stay was significantly shorter in the LCBDE group (2 vs. 4 days, p = 0.011). No complications occurred in the LCBDE group, while two (40%) complications occurred in the ERCP group: pancreatitis and cholangitis (p = 0.078). During the follow-up period, no conversions, papillotomies, or recurrences were recorded in either group. Conclusions: Exploration of the common bile duct and removal of stones by LCBDE is safe and feasible in pediatric patients for the treatment of choledocholithiasis. Through this procedure, choledocholithiasis and cholelithiasis can be treated in a single procedure without papillotomy or fluoroscopy. Compared with LC + ERCP, LCBDE is associated with a shorter hospital stay. The incidence of complications was rather low but not statistically significant. [ABSTRACT FROM AUTHOR]

Synchronous tumors of gall bladder and colon cancer are rare, and the underlying genetic, environmental, and immunological factors could play a role in the development of such tumors. Till date, only a few cases of synchronous gall bladder and colonic malignancies have been reported. A 60-year-old lady presented with sub-acute onset of colicky pain in the abdomen and vomiting. Imaging showed the presence of thickening in the ileocecal junction along with a thickened gall bladder. A provisional diagnosis of gall bladder tumour with ileocecal tuberculosis or a synchronous colonic malignancy was made. Laparotomy revealed synchronous tumors in the gall bladder and caecum. Radical cholecystectomy with radical right hemicolectomy was performed. The final histopathology report confirmed the presence of two independent malignancies. A tailored treatment approach for both sites based on clinical findings and anticipated outcomes must be considered. Further immunohistochemical studies must be conducted to confirm the presence of dual malignancies. Metastases from one site to the other should be ruled out. [ABSTRACT FROM AUTHOR]

Deep endometriosis, defined as external adenomyosis, is a late stage of endometriosis. Associated with very severe pain, in addition to probably being a cofactor of infertility, with a low prevalence, the diagnosis is integrated by high clinical suspicion and confirmed with imaging studies. Deep infiltration can reach sigmoid colon, which would have surgical indication as resolving treatment. We report the case of deep infiltrating endometriosis affecting sigmoid colon of a 42-year-old woman, who was diagnosed with colicky pain in the left lower quadrant and chronic constipation. Colonoscopy revealed a 90% stenosis in the proximal portion of sigmoid colon, as well as mural thickening proximal to the site of stenosis, reported by computed tomography with oral contrast, for which it was decided to perform robot-assisted sigmoidectomy, with a 6-month follow-up and with imaging control, patient continues asymptomatic and without the presence of lesions suggestive of recurrence, and there is no functional impairment. [ABSTRACT FROM AUTHOR]

Objective. The aim of this prospective cohort study was to assess the differences in signs and symptoms of primary-care patients with expected and those with unexpected gallstones referred for upper abdominal ultrasound (US). Material and methods. A total of 430 patients were referred by 76 general practitioners (GPs) for abdominal US to one of the three participating hospitals in The Netherlands. All GPs were asked to complete a standardized questionnaire before and after abdominal US. Patients with expected gallstones had a clinical suspicion of gallstones and cholelithiasis on abdominal US, patients with unexpected gallstones had cholelithiasis without a clinical suspicion of gallstones. Results. Almost 50% of the patients were referred for abdominal US because of a clinical suspicion of gallstones. Cholelithiasis was detected by US in 29% of the patients with, and 11% of those without a clinical suspicion of gallstones. In patients suspected of gallstones, those with cholelithiasis detected by US were significantly less often of male gender, they had no prior cholecystectomies, were more likely to have colicky pain, and were more frequently referred to a medical specialist after US. Patients with unexpected gallstones were more often male, had fewer complaints of upper abdominal and colicky pain, and were less frequently referred to a medical specialist after US, in comparison with patients with expected gallstones. Conclusions. Gallstones were detected by upper abdominal US in 29% of the patients with, and 11% of those without a clinical suspicion of gallstones. This study showed marked differences in signs and symptoms of patients suspected of gallstones with and without cholelithiasis detected on abdominal US, and in patients with expected and unexpected gallstones. [ABSTRACT FROM AUTHOR]

Background: Internal hernia (IH) after laparoscopic colorectal surgery is a potentially severe complication. It may go undiagnosed in patients having their abdominal CT scan during oncologic follow-up. We evaluated the occurrence of IH on CT scans after laparoscopic curative resection for rectal cancer (LRRC) and routine closure of the mesenteric defect. Methods: Data from 189 consecutive patients undergoing elective curative LRRC in a 14-year period (June 2005-june 2019) were prospectively collected. Only patients with abdominal CT scans, performed as routine oncologic follow-up, between 3 months and 7 years post-operatively were included in the study and reviewed by a surgeon and a radiologist. Results: A total of 161 patients were eligible for the study with a median age of 69 years (IQR: 59–77) at surgery. They had abdominal follow-up CT scans at a median of 39.5 months (IQR: 12.8–62.7) after surgery. The prevalence of IH was 11.2% (18/161 patients). Of the 18 patients, 15 (83.3%) were fully asymptomatic, 2 (11.1%) reported chronic abdominal discomfort (including mostly nausea and colicky pain) during their oncologic follow-up (however, IH was not suspected neither prompted additional investigations), and 1 (5.6%) was reoperated elsewhere for IH and acute small bowel obstruction. Conclusions: IH following LRRC is not uncommon, with a prevalence > 10% in our experience. Most of these patients remain fully asymptomatic, but in a few patients, IH might be responsible for some symptoms or require reoperation. Awareness of this complication is important, given the potential risk of acute small bowel obstruction. [ABSTRACT FROM AUTHOR]

Background: The aim of this randomized controlled study was to determine whether octreotide (OCT) or scopolamine butylbromide (SB) was the more effective antisecretive drug controlling gastrointestinal (GI) symptoms due to malignant bowel obstruction (MBO) caused by advanced ovarian cancer. Methods: Ninety-seven advanced ovarian cancer patients with inoperable MBO were randomized to OCT 0.3 mg/day (OCT group, n = 48) or SB 60 mg/day (SB group, n = 49) for 3 days through a continuous subcutaneous infusion. The following parameters were measured: episodes of vomiting, nausea, dry mouth, drowsiness, and continuous and colicky pain, using a Likert scale corresponding to a numerical value (none 0, slight 1, moderate 2, severe 3) recorded before starting the treatment (T0) and 24 h (T1), 48 h (T2), and 72 h after (T3) and the daily quantity of GI secretions through the Nasogastric tube (NGT) during the period of study. One patient in the SB group is not included in any assessments since she withdrew consent prior to receiving any treatment because of rapidly progressing cancer. Results: OCT significantly reduced the amount of GI secretions at T1, T2, and T3 (P < 0.05) compared with SB. NGT secretions significantly reduced at T1, T2, and T3 compared with T0 (P < 0.05) in the OCT group, while in the SB group, only at T3, NGT secretions significantly reduced compared with T0. OCT treatment induced a significantly rapid reduction in the number of daily episodes of vomiting and intensity of nausea compared with SB treatment. No significant changes were observed in dry mouth, drowsiness, and colicky pain after either drug. Continuous pain values were significantly lower in the OCT group than in the SB group at T2 and T3 (P < 0.05). Conclusions: At the doses used in this study, OCT was more effective than SB in controlling gastrointestinal symptoms of bowel obstruction. Further studies are necessary to understand the role of hydration more clearly in such a clinical situation. [ABSTRACT FROM AUTHOR]

Obstructive bowel disorders (OBD) are characterized by lumen distention due to mechanical or functional obstruction in the gut. Abdominal pain is one of the main symptoms in OBD. In this article, we aim to critically review the potential mechanisms for acute and chronic pain in bowel obstruction (BO). While clustered contractions and associated increase of intraluminal pressure may account for colicky pain in simple obstruction, ischemia may be involved in acute pain in severe conditions such as closed loop obstruction. Recent preclinical studies discovered that visceral sensitivity is increased in BO, and visceral hypersensitivity may underlie the mechanisms of chronic abdominal pain in BO. Mounting evidence suggests that lumen distension, as a circumferential mechanical stretch, alters gene expression (mechano-transcription) in the distended bowel, and mechano-transcription of nociceptive and inflammatory mediators plays a critical role in the development of visceral hypersensitivity in BO. Mechano-transcription of nerve growth factor (NGF) in gut smooth muscle cells is found to increase voltage-gated Na+ channel (Nav) activity of the primary sensory neurons by up-regulating expression of TTX-resistant Nav 1.8, whereas mechanical stretch- induced brain-derived neurotrophic factor (BDNF) reduces Kv currents especially A-type (IA) currents by down-regulating expression of specific IA subtypes such as Kv 1.4. The NGF and BDNF mediated changes in gene expression and channel functions in the primary sensory neurons may constitute the main mechanisms of visceral hypersensitivity in OBD. In addition, mechanical stretch-induced COX-2 and other inflammatory mediators in the gut may also contribute to abdominal pain by activating and sensitizing nociceptors. [ABSTRACT FROM AUTHOR]

Zinner's syndrome is a very rare congenital condition characterised by seminal vesicle cyst, obstruction of the ejaculatory duct and ipsilateral renal agenesis. Here, we present a 25-year- old young short-statured male presented with left lower abdominal colicky pain. MRI abdomen showed the absence of the left kidney with a seminal vesicle cyst on the left side. The cyst in question was laparoscopically de-roofed. A second case is a 16-years-old young male who presented with intermittent lower abdominal pain. MRI abdomen showed seminal vesicle cyst with ipsilateral absent kidney which is managed conservatively with medication. Level of evidence : Not applicable [ABSTRACT FROM AUTHOR]

A 52-year-old man with a history of urolithiasis presents to the emergency department with a sudden, sharp, continuous right flank colicky pain. Laboratory workup demonstrates acute kidney injury with a mild hyperkalaemia. During the observation period, the patient develops an atypical broad complex sinus bradycardia and eventually short asystolic periods. This was caused by a severe therapy-resistant hyperkalaemia, wherefore emergency haemodialysis was necessary. Radiographic results showed a giant hydronephrosis with a blowout of the right kidney and an obstructing calculi of 21 mm in the distal ureter. We will discuss the mechanism of reversed intraperitoneal dialysis causing the refractory hyperkalaemia and the need of close ECG monitoring in patients where kidney blowout is considered. [ABSTRACT FROM AUTHOR]

A 43-year-old woman was admitted to the gastroenterology department with colicky pain in the upper abdomen. Four years earlier, she had undergone a laparoscopic cholecystectomy because of cholecystitis. She recognised her current complaints from that previous episode. An endoscopic retrograde cholangiopancreatography showed a cavity with a diameter of 2 cm which contained multiple concrements near the liver hilus. An elective surgical exploration was performed. Near the clip of the previous cholecystectomy a bulging of the biliary tract with its own duct was visualised and resected. Histological examination of this "neo" gallbladder showed that the bulging was consistent with the formation of a reservoir secondary to bile leakage, probably caused by a small peroperative lesion of the common bile duct during the previous cholecystectomy. In conclusion, our patient presented with colicky pain caused by concrements inside a 'neo' gallbladder. [ABSTRACT FROM AUTHOR]

Heterotopic or ectopic tissue is a congenital anomaly, which is defined as the presence of the tissue outside its normal location, without neural, vascular, or anatomic connection with the main body of an organ in which it normally exists. This tissue is usually discovered incidentally and may be asymptomatic or may present with nonspecific gastrointestinal (GI) symptoms. Pancreatic and gastric heterotopia are the two predominantly occurring heterotopic tissues in the GI tract.[1],[2] The prevalence of ectopic pancreatic tissue in the GI tract ranges from 0.6% to 13.7% of autopsy series and it can be present anywhere in the GI tract with the most common localizations being stomach (27.5%), duodenum (25.5%), colon (15.9%), esophagus, and Meckel's diverticulum.[3],[4],[5] It is a rare finding in the gallbladder and its prevalence has not been ascertained due to lack of large-scale studies and systematic review of literature. Similarly, heterotopic gastric tissue is common throughout the GI tract from the tongue to the rectum,[6],[7] but it is extremely rare in the gallbladder with only around 34 cases reported in literature so far, while other cases of different types of heterotopic tissues in the gallbladder such as liver tissue and others such as adrenal and thyroid tissues have been described.[8] The most common presentation of ectopic tissue in the gallbladder is colicky pain in the epigastrium or right upper quadrant sometimes associated with nausea and vomiting. Here, we are presenting two incidentally detected cases, each of gastric and pancreatic heterotopias in the gallbladder. [ABSTRACT FROM AUTHOR]

Imaging modalities are not included in The European League Against Rheumatism, The Pediatric Rheumatology International Trials Organization and The Pediatric Rheumatology European Society 2010 criteria for the evaluation of abdominal purpura. The objective of the present study was to compare diagnostic parameters of ultrasound, X-ray and computed tomography (CT) for diagnosis of abdominal purpura considering the American College of Rheumatology (ACR) criteria as 'reference standard' in children with acute abdominal pain. Medical records of 215 children with acute abdominal pain were reviewed. Data regarding demographics and clinical characteristics, laboratory tests, X-ray, ultrasound findings, and computed tomographic images were collected and analyzed. Decision curve analysis was used for evaluation of the beneficial score for each diagnostic modality. Among diagnostic modalities, CT had the highest sensitivity (0.939); however, ultrasound findings had the highest accuracy (0.861) for diagnosis of abdominal purpura. Unlike X-ray and laboratory tests, ultrasound and CT were successful at detecting abdominal purpura when children had only colicky pain and were aged <20 years; however, occult blood stool test and granulocytes in the walls of small venules and arterioles (biopsy results) were negative. With respect to the ACR criteria, there were seven and three inconclusive results for ultrasound and CT, respectively. Abdominal ultrasound is an easy, non-invasive and safe method for the detection of abdominal purpura in children. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Intussusception is not very common in adults, and acute intestinal obstruction with intussusception due to inflammatory myofibroblastic tumor (IMT) is extremely rare. IMT is an uncommon lesion and has no single defined cause. It predominantly affects the pediatric age group and commonly involves the lungs. Here we present a case of IMT causing ileocolic intussusception leading to acute intestinal obstruction in an adult. Case Report: A 40-year-old female came to the emergency department with severe colicky pain in her abdomen, and reported 6 to 7 episodes of vomiting with bilious contents, along with an inability to pass feces and flatus for 3 days. An x-ray of her abdomen in erect posture revealed multiple air-fluid levels. Because she had a previous history of tuberculosis, a possible tubercular stricture as the cause of her acute obstruction was considered; an exploratory laparotomy was performed showing her bowel loops were dilated with ileocolic intussusception. The lead point of intussusception (a well-defined 4×4×3.5 cm solid mass), was found at 15 cm proximal to the ileocecal junction. A right hemicolectomy with ileo-transverse anastomosis was performed. The histopathological examination confirmed the presence of IMT. Conclusions: IMT causing ileocolic intussusception with acute intestinal obstruction is an extremely rare presentation of an uncommon entity in adults. High index of suspicion, and appropriate investigations (x-ray abdomen, ultrasound, computed tomography, and colonoscopy) depending on presentation and clinical condition of the patient can result in prompt diagnosis and early management. [ABSTRACT FROM AUTHOR]

Membranous dysmenorrhoea is an uncommon condition characterized by the spontaneous flaking of endometrium into a single piece that maintains the shape of the uterus. The common symptom of membranous dysmenorrhoea is a colicky pain caused by uterine contractions. Because only a limited number of cases have been published in the literature, the case report we present is peculiar. This report describes a case of membranous dysmenorrhoea that occurred after an artificial frozen thawed embryo transfer cycle using vaginal progesterone. The patient, during hormone replacement treatment, reported an intense abdominal colicky pain resulting in the loss of membranous endometrial tissue. A histopathological exam was performed with a clear diagnosis of membranous dysmenorrhoea. Moreover, photos were recorded and provided together with this article. The importance of such a case report relies on the actual debate about the appropriate progesterone route of administration. Although different medical approaches exist, progesterone administration is the most widespread. However, the intramuscular, oral, and subcutaneous means of administration are gaining popularity. On this peculiar case report, the patient underwent a subsequent frozen thawed embryo transfer cycle with subcutaneous progesterone administration. The embryo transfer resulted first in a clinical pregnancy and subsequently in a spontaneous delivery without any complications.

We conducted a retrospective case note review to assess whether or not gallbladder aspiration can be applied as a temporary measure for the treatment of acute cholecystitis in average-surgical-risk patients. Gallbladder aspiration was performed in 79 consecutive average-surgical-risk patients with acute cholecystitis, who had no indications of emergent surgery and who complained of severe colicky pain. Elective surgery became possible in 92% of patients by gallbladder aspiration. The percentage reached 97 when percutaneous cholecystostomy was added (four patients). Emergent surgery was needed in one patient suffering bile leakage following gallbladder aspiration. Colicky pain was controlled soon after the procedure in most cases. Neither major complications nor mortalities were observed in the following surgical therapies. It is suggested that gallbladder aspiration might be applied as a temporary measure for acute cholecystitis in average-surgical-risk patients, although early surgery should remain the primary choice of therapy in such patients. [ABSTRACT FROM AUTHOR]

In advanced cancer patients with inoperable bowel obstruction, the administration of antisecretive and antiemetic drugs has proved to be effective in controlling gastrointestinal symptoms caused by bowel obstruction. However, controlled studies concerning the most effective antisecretive drug are lacking. The aim of this randomized controlled study was to determine whether octreotide or hyoscine butylbromide was the more effective antisecretive drug for use in states of inoperable bowel obstruction. Eighteen patients with inoperable bowel obstruction randomly received octreotide 0.3 mg daily ( n=9) or hyoscine butylbromide (HB) 60 mg daily ( n=9) s.c. The following parameters were measured: episodes of vomiting, nausea, drowsiness, continuous and colicky pain, using a Likert scale corresponding to a numerical value: (none 0, slight 1, moderate 2, severe 3) recorded before starting the treatment (T0) and 24 h (T1), 48 h (T2) and 72 h after (T3), and the mean daily amounts of fluids administered i.v. or s.c. during the period of study. Three patients dropped out of the study because data were incomplete. Octreotide treatment induced a significantly rapid reduction in the number of daily episodes of vomiting and intensity of nausea compared with HB treatment at the different time intervals examined. No relevant changes were found in dry mouth, drowsiness and colicky pain. Lower levels of hydration were associated with nausea regardless of the treatment. At the doses used in this study, octreotide was more effective than HB in controlling gastrointestinal symptoms of bowel obstruction. Further studies are necessary to understand the role of hydration more clearly in such a clinical situation. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous Pyelonephritis (XGPN) is a chronic inflammatory disease usually associated with renal stones, mimicking several malignant and benign pathology causing diagnostic dilemma. A rare case of XGPN of renal pelvis has been presented here. A 34-year-old female presented with left renal colicky pain, with gross haematuria without any palpable renal lump. Computed Tomography (CT) scan showed a 4.5×4.3×4.0 cm sized heterogeneous solid cystic non enhancing Space Occupying Lesion (SOL) in left renal pelvis. It was provisionally diagnosed as transitional cell carcinoma of left renal pelvis and patient underwent laparoscopic nephroureterectomy. Histopathology revealed it as XGPN. This highlights the fact that there are several overlaps of clinical and radiological findings of these entities making its diagnosis a challenging task. [ABSTRACT FROM AUTHOR]

Introduction: Bladder leiomyomas (LM) are uncommon, non-cancerous growths that originate from the smooth muscle cells of the bladder and constitute 0.5% of bladder tumor cases. This review aims to compile existing data and present a summary of bladder leiomyomas' characteristics, management, and related outcomes. Method: We conducted systematic review of studies that investigated bladder leiomyoma. Case studies or series describing individuals with bladder leiomyoma who underwent surgery and the outcomes were included. Four databases were used in our literature search, which was carried out until January 2024: PubMed, Proquest, EBSCOHost, and Google Scholar. We utilized MeSH terms such as "leiomyoma," "urinary bladder," and looked for synonyms of "bladder leiomyoma" in free text. Results: A total of 99 studies with 119 patients were included. Most reported bladder leiomyoma cases were female, accounting for 79.0% of all cases. While symptomatic patients primarily presented with lower urinary tract symptoms (LUTS) (59.7%), hematuria (24.4%), acute urine retention (11.8%), and about 16.8% of cases were incidentally detected. Storage-related symptoms were the most common LUTS (37.0%). Different diagnostic techniques were used, frequently combining CT (Computed Tomography), MRI (Magnetic Resonance Imaging), USG (Ultrasonography), and/or cystoscopy. Bladder leiomyomas were commonly found on the left lateral wall (26.9%) and the bladder neck (17.6%). In more than half of the cases (52.1%) the treatment techniques used were transurethral resection (TURBt/TUR). Fifteen out of 119 cases (12.6%) had recurrence or remain symptomatic. Symptomatic symptoms at first presentation and extended location are frequently found among recurrent or symptomatic cases after first management. Conclusion: Management of bladder leiomyoma should focus on the relief of symptoms and recurrence and be personalized based on the tumor characteristics, patient symptoms, and surgeon's expertise. Further investigation is necessary to fully understand the best course of treatment and long-term results for bladder leiomyomas. In particular, prospective trials with bigger participant pools and meticulously controlled factors should be the main emphasis of this research. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to assess any predisposing factors to the morbidity of fashioning and reversal of diverting ileostomy in a prospective cohort of patients who have undergone TME and low colo-rectal or colo-anal anastomosis for rectal cancer. Materials and Methods: Consecutive patients with rectal cancer undergoing low anterior resection and a defunctioning loop ileostomy in three surgical units from 2016 to 2020 were included in the study and retrospectively analyzed. Results: One hundred eighty-two patients from three centres were included. Ileostomy-related mortality was 0.5%, attributed to renal failure.. Ileostomy-related morbidity was 46%. Postoperative ileus was seen in 37.4%, and dehydration in 18.8% of the patients. The readmission rate for ileostomy-related reasons was 15.4%. Stoma care was problematic in 15.7% or poor in 7% of the cases. Advanced age, male gender and obesity were independent risk factors for ileostomy-related morbidity. Ileostomy was reversed in 165 patients. The morbidity in 165 patients was 16%. Ileus was seen in 10.3%, anastomotic leak in 4.8% and wound infection in 12.7% of the cases. One patient died because of an anastomotic leak. No predisposing factors that affect the outcomes of ileostomy closure were identified. Conclusions: Diverting ileostomy-related morbidity is high. Life threatening dehydration and renal failure from ileus is more commonly seen in elderly, male and obese patients and should be anticipated. Ileostomy closure-related morbidity is low. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Despite its prevalence, limited research has explored the direct correlation between irritable bowel syndrome (IBS) and endometriosis, particularly in regions like Saudi Arabia. This study aimed to bridge this gap by investigating the prevalence of IBS among endometriosis patients and identifying associated risk factors. Materials and Methods: The study conducted a cross-sectional analysis, it was done at King Abdulaziz University Hospital, Jeddah. From September to December 2023. Women who were diagnosed with endometriosis and aged above 18 years old were included. Results: Our study revealed that 47.8% of endometriosis patients had previously been diagnosed with IBS. Interestingly, Saudi patients exhibited a significantly higher prevalence of IBS compared to non-Saudi individuals. While no substantial link emerged between IBS prevalence and other demographic or endometriosis-related factors, patients with chronic digestive conditions like food intolerance, esophageal reflux, and inflammatory colon diseases showed a higher likelihood of IBS. Conclusions: This study underscores a substantial association between IBS and endometriosis, urging healthcare providers to consider IBS as a potential comorbidity in affected patients. The findings stress the importance of holistic assessments and awareness regarding overlapping symptoms and risk factors. Further research is encouraged to unveil underlying mechanisms and devise optimal management strategies for individuals grappling with both conditions. [ABSTRACT FROM AUTHOR]