A 49-year-old lady presented with a one day history of vomiting, abdominal pain, and alcohol intoxication with signs of dehydration on a background of major depressive disorder. She was resuscitated with iv fluids and was started on alcohol detoxification regimen promptly. On examination her abdomen was soft but tender. X-ray Abdomen was organised which showed a foreign body in distal bowel. Initially, she denied ingestion of any foreign body on history taking. When the results of AXR were shared with her, then she admitted swallowing a car key disc battery. She was admitted to hospital for observation. Her abdominal pain subsided and started feeling better in herself. The following day, a repeat scan showed no evidence of foreign body in the distal part of the large bowel. Patient was reassured, no further medical or surgical input needed and was referred to Mental Health Team. Although the most of the patients with disc battery ingestion remain asymptomatic, there are cases reported in literature where serious complications developed and proved fatal. Therefore, more vigilant approach needs to be adopted where surveillance strategies can be implemented.
Collet-Sicard syndrome is a unique condition involving lesions of the skull base, which affect both the jugular foramen and the hypoglossal canal, affecting the lower cranial nerves IX, X, XI and XII. Symptoms of this pathology include loss of the palate of the posterior third of the tongue (IX nerve), vocal cord paralysis and dysphagia (X nerve), weakness in the sternocleidomastoid and trapezius (XI nerve) muscles and atrophy and paresis of the tongue muscles (XII nerve). The present report aims to describe the case in question, referring to a syndrome rare and little described in the literature. In the case of the patient reported, the conduct adopted was to perform radiotherapy sessions in order to prevent tumor progression since the surgery was contraindicated. Patient I.L.B, male, 61 years of age reported complaints of dysarthria, dysphasia and reduced tongue mobility, after an otorhinolaryngological evaluation a CT scan of the skull was requested (Figures 1A-B and 2A-B) which found an expansive, solid, hypovascular formation located in the jugular foramen and extending inferiorly to the right carotid space of probable neoplastic etiology. The main hypothesis considered is schwannoma. Subsequent referral to the neurologist and evaluation after detailed neurological examination showed a deviation of the tongue to the left side with right atrophy, impairment of the mobility of the right upper limb and paresis of the right lateral aspect of the neck. In addition to the reported symptoms, there were no alterations in other pairs of cranial nerves and other systems. In Magnetic Resonance Imaging (MRI) (Figures 3A-C and 4A-B), the neoplastic etiology for the neural sheath tumor (schwannoma) is confirmed. The next step was to refer the patient to the radiotherapy, after consulting the neurosurgeon who contraindicated surgery because of the presence of risks to damages in important brain areas and irreversible damage to the corresponding cranial nerves, which could lead to a total loss of their functions. Several radiotherapy sessions were performed without satisfactory results.
Background: Nice guidelines; Diagnostics Guidance (DG) 2.7 published 26 July 2017 suggests referral to secondary care for suspected cancer with positive Faecal Immunochemical testing (FIT) even when age and symptoms probability is low with Positive Predictive Value (PPV) ranging 0.1% to 3%. We attempted to do audit, to assess practice, with in and out-patient referrals to Gastroenterology department, referred with complaint of Melena or Rectal bleed towards Lower GI findings, to see if PPV fall within the range outlined by NICE DG 30. METHODS: Retrospectively analysis of Endoscopy outcomes of patient who underwent Colonoscopy or CT-Colonoscopy from January 2017 to December 2017 at Conquest Hospital. Patients with complaint of melena or rectal bleed, who underwent Endoscopy (OGD), scored less than 8 as per Oakland Criteria were included. Patient scoring 8 or more on Oakland Criteria, with coagulation disorders were excluded. All analysis was done using Excel and JASP. RESULTS: We categorised the data as group one; moderate to severe AND group two; mild severity, and analysed cumulative. Among group one we found, 3 patients with distal bowel cancer (1.56%), 2 with Angiodysplasia (1.04%), 2 with multiple oedematous polyps (1.04%), 1 with pseudo-membranous colitis (0.52%), 1 with distal colitis (0.52%). The group two, included 2 patients with single polyps (1.04%), 3 with milder diverticular disease (1.56%), 2 with haemorrhoids (1.04%), and 2 with Anal fissure (1.04%). Cumulative Upper GI findings in 91/192 (47.33 %), Lower GI findings in 101/192 (52.60 %). Chi Square test 4.88 with p <0.02. Prevalence 13.02%. OR of 1.11, 6.71 The PPV of 9.375% (higher as outlined by NICE guideline July 2017 for 0.1% to 3%). DISCUSSION: Retrospective root cause analysis via audit for outcome of Colonoscopy or CT-Colonography has significant advantages in diagnosing lower GI pathology. It provides basis for targeted educational programs to improve detection of lower GI pathology.
Background: Eosinophilic gastroenteritis is a rare disease of the gastrointestinal tract that may involve some or all of its layers.It may have a varied presentation and is characterized by eosinophilic infiltration. The diagnosis is typically confirmed by biopsy, which should reveal 20-25 eosinophils per high-power field on microscopic examination. Case Presentation: We report a 25 years old man who presented with acute abdominal pain and diarrhea. He was found to have moderate ascites on abdominal US. The investigations revealed peripheral eosinophilia with markedly elevated eosinophils (96%) in the ascitic fluid. The imaging studies showed diffuse concentric bowel wall thickening involving the entire small bowel and Colon. The diagnosis was confirmed by biopsy from the duodenum, terminal ileum and colon. The patient was managed with steroids. Conclusions: This case report highlights a rare entity of Eosinophilic gastritis, which is eosinophilic gastroenterocolitis, diagnosis is confirmed via histopathology along with clinical presentation and exclusion of other causes of tissue eosinophilia.
We report a case of a patient presenting with Boerhaave’s syndrome who developed a rare, reversible neurological complication, Collet-Sicard syndrome. A 30-year old male presented with a two-day history of acute abdominal pain and vomitting. On admission he was pyrexic, tachycardic and hypoxic. A CT of the chest, abdomen and pelvis showed air in the mediastinum and upper abdomen as well as considerable mediastinitis extending into the neck. CT with gastrografin showed extravasation of contrast into the mediatstinum, indicating an oesophageal perforation. The patient was admitted to the ITU and underwent a diagnostic laparoscopy with washout and drain placements. This was followed by an OGD with insertion of a fully covered oesophageal stent. The stent was removed after two weeks following complete healing. However, the patient experienced residual dysphagia related to neuromuscular palatal and tongue dysmotility. The patient was diagnosed with Collet-Sicard syndrome, a rare condition involving unilateral palsy of the lower cranial nerves. It was likely caused by mediastinitis that extended to the internal jugular foramen and caused temporary paralysis of cranial nerves IX, X, XI and XII. Eventually, control of the mediastinitis and inflammation in the subcutaneous neck facia led to the patient regaining normal function
The current global pandemic of Covid-19 (SARS_COV_2) has substantially affected our way of life. Through our understanding of its existence, we continue to see cases rising in quantities presenting with relevant manifestations that of respiratory etiology such as cough and shortness of breath. Other times, patients don’t present with any symptoms whatsoever. There are, however, few probable instances where this disease can manifest through less likely infective symptoms, mainly diarrhea. As the effect on the Gastrointestinal symptom is still elusive and well beyond our current knowledge, it is worthy to evaluate any patient with suspected diarrhea along with other complaints for Covid-19.
Vomiting in children is common and mostly related to medical condition. However there are surgical conditions associated with vomiting which needs to be acknowledge and diagnosed early. Bilious vomiting is an ominous symptom and needs to be taken seriously. Any baby who vomits bile should be considered as having an underlying intestinal obstruction until proved otherwise
Neuroendocrine tumours (NETs) located in the gastrointestinal tract have had an increased incidence during the past 10 years. Well-differentiated tumour formations located in the small intestine have a slow evolution, with the patients being asymptomatic in the early stages and accidental diagnosis in most cases. In this presentation we report the case of a 55-year-old female patient, with total thyroidectomy performed in 2010 for a papillary thyroid carcinoma, currently undergoing replacement therapy with Euthyrox (75µg / day), asymptomatic. During the ultrasound monitoring of some pre-existing liver haemangiomas, a solid formation was highlighted, vascularised at the level of the last ileal loop. The investigations after the ultrasound, namely, the colonoscopy with examination of the terminal ileum on about 30 cm, PET-CT scan (positron emission tomography/computed tomography), morphological results correlated with the immunophenotypic ones (CHROMO, Synaptophysin, Ki67), have led to the diagnosis of a G1 neuroendocrine tumour located in the terminal ileum. At the same time, the PET-CT scan also showed a left lung nodule, minimally metabolically active, for which excision was recommended, in order to establish the certain diagnosis between a primary formation and a secondary metastasis.
Conference Series LLC Ltd will be conducted a Webinar on “20th International Conference on Gastroenterology and Hepatology” on September 24-25, 2020 with the theme “Gastroenterology Practice in COVID-19 Pandemic”. The webinar aimed at providing a great scope for online interaction of researchers, healthcare professionals, academicians, industrialists, students and practitioners focusing in the field of gastroenterology and Hepatology worldwide on a global cybernetic platform. With the active participation and support of the Organizing Committee Members, Editorial Board Members and impressive presentations of all eminent scientists, talented researchers and young student community made this conference one of the most successful and productive events in ME Conferences. ME Conferences offers its heartfelt appreciation to Societies and Organizations and is also obliged to the Organizing Committee Members, adepts of field, various outside experts, company representatives and other eminent personalities who interlaced with Conference series in supporting and making the conference never before one. The Keynote presentations were given by: Dr. Amin Gohary, Burjeel Hospitals, UAE Dr. Chandra Puli, Barking, Havering and Redbridge University Hospitals NHS Trust, United Kingdom Dr. Mansoor Zafar, Conquest Hospital, East Sussex Healthcare NHS Trust, United Kingdom Dr. Narendra Chopde, India World Gastro 2020 would also like to thank the following speakers for their splendid presentations on their research. Dr. Roxana Elena Mirica, Carol Davila University of Medicine and Pharmacy, Romania Dr. Ahmad Almaiman, King Khalid University Hospital, KSA Dr. Ivette Santillan Lomeli, UNAM, Mexico Dr. Mousa Abu Ghoush, Zayed Military Hospital, UAE Rahul Penumaka, Imperial College London, United Kingdom Dr Yousef Khoulu, Queen Mary University of London, United Kingdom Dr. Muhammad Shahbaz, East Sussex Healthcare NHS Trust, United Kingdom We earnestly thank the Organizing Committee Members, Participants and Media Partners for their thoughtful presence and liberal support, without which the conference would not have reached the apex of success. Your response is our inspiration; recalling this maxim and seeing the triumph of World Gastro 2020, ME Conferences would like to announce the commencement of the webinar on 21st International Conference on Gastroenterology and Hepatology” scheduled for August 12-13, 2021 in Dubai, UAE. We welcome all the eminent researchers, professors, students and delegate participants from worldwide to partake in this forthcoming gathering to witness invaluable scientific discussions and add to the future advancements in the field of Gastroenterology and Hepatology.
A 71 years of age male assessed in the Emergency Department for worsening dysphagia. On further inquiry he gave history of weight loss, regurgitation, halitosis, cough, aspiration pneumonia, and neck pain. He had remote history of Endoscopic stapling eight years ago for Zenker’s diverticulum. He underwent Upper Gastrointestinal Endoscopy, and Magnetic Resonance Imaging of Cervical Spine that suggested upper pouch and suggestion for Barium swallow for further characterization. The Barium swallow demonstrated the Zenker’s diverticulum posterior to oesophagus, between C6, C7 cervical spine level. Patient was managed with Total Parenteral Nutrition via Peripherally inserted Central Catheter (PICC) line, with regular refeeding bloods, chest physiotherapy and antibiotics that resulted in weight gain. Patient consented for Endoscopic Stapling with Otorhinolaryngology (ENT) Surgeons, with improvement of his symptoms. Learning Points: 1. Progressively worsening dysphagia is an important clue. 2. Regurgitation of food eaten 1 to even 5 days ago is important clue in the history taking, towards narrowing down to Zenker’s diverticulum. 3. Differentiation between Dysphagia and Regurgitation of food is important differential to consider towards possible diagnosis. 4. Importance of Barium swallow imaging, in better characterization of organic cause. 5. Zenker’s diverticulum can recur following treatment.
Background: Nowadays the number of complications of gastroesophageal reflux disease (GERD) is increasing all over the world. One of the conditions which can contribute development of GERD complications seems to be obstructive sleep apnea/hypopnea syndrome (OSAHS). But the mechanisms of negative impact of OSAHS on esophageal mucosa are not completely researched. Aim: To evaluate plasma N-terminal E-cadherin concentration in patients with GERD and OSAHS. Material and methods: 120 patients have been examined at Grodno City Hospital â2, Belarus. Patients have undergone esophagogastroduodenoscopy with biopsy of the lower third of esophagus. For diagnostics of OSAHS somnological study with calculation of apnea/hypopnea index (AHI) was performed. Plasma E-cadherin concentration was evaluated using linked immunosorbent assay. Patients were divided into 4 groups: group 1 (n=29) – with GERD, group 2 (n=35) – with GERD and OSAHS, group 3 (n=30) – with OSAHS, group 4 (n=26) – comparison group. Results: We have not revealed statistically significant difference between group 1 and group 4 in plasma E-cadherin level (0,207 (0,128; 0,295) and 0,128 (0,067; 0,281) ng/ml (p=0,082), but patients with erosive esophagitis have higher levels of plasma E-cadherin in contrast with patients of comparison group (0,284 (0,176; 0,858) and 0,128 (0,067; 0,281) ng/ml (p=0,03). In group 2 patients demonstrate higher levels of E-cadherin in comparison with group 1 (0,379 (0,277; 0,538) and 0,207 (0,128; 0,295) ng/ml respectively (p=0,017), group 3 (0,379 (0,277; 0,538) and 0,231(0,131; 0,303) ng/ml (p=0,014), group 4 (0,379 (0,277; 0,538) and 0,128 (0,067; 0,281) ng/ml respectively (p=0,000). Positive correlation between E-cadherin level and AHI has been obtained (r=0,43, p<0,05). Conclusions: The presence of OSAHS has negative effect on the state of esophageal mucosa in patients with GERD. This fact is confirmed by increasing of N-terminal E-cadherin in plasma and can indicate the loss of E-cadherin in esophageal mucosa with development of disturbances in functioning of tight junctions.
The 19th International Conference on Gastroenterology and Digestive Disorders was held during September 24-25,2020 with the theme of “Clinical Trials and Advancements in Gastroenterology” received an immense response. With the active participation and support of the Organizing Committee Members, eminent scientists, talented researchers and young student community made this conference one of the most successful and productive events in ME Conferences. The conference was initiated with a warm welcome note from our Moderator and followed by Keynote sessions. We would like to convey the great appreciation to Dr. Amin Gohary from Burjeel hospital UAE, and Dr. Ivette Santillan Lomeli who contributed a major part to the success of this event as the Honorable moderators for the conference. The highlights of the meeting were the enlightening keynote lectures from: Amin Gohary, Burjeel hospital, UAE Dr.Chandra ,from NHS, UAE Dr.Nardendra from ,India World Gatsro 2020 would also like to thank the following speakers for their splendid presentations on their research. Dr. Mansoor Zafar, MBBS, MRCP. Specialty Registrar, Gastroenterology and General Internal Medicine.Conquest Hospital, East Sussex Healthcare NHS Trust. Dr.Chandra puli, FRCP Edin,MRCP(Gastro UK) MRCP, MBBS , UK Dr.Mousa Abu Ghoush, Zayed Military Hospital, United Arab Emirates, UAE Dr. Ivette Santillan Lomeli , graduating from gastrointestinal endoscopy fellowship (UNAM), Mexico Rahul penumaka , Student at Imperial College London, UK
Introduction: Incidental detection of gallbladder (GB) polyps are common, however further follow up and management is still a dilemma. Extensive use of imaging modalities like ultrasonography (USG) has attributed higher incidence of GB polyps, however limitation of USG for confirmation of true polyps has raised need for correlation with clinical symptoms and assessment of outcomes to determine further management. This study was aimed to assess the true outcome of lesions suspected or diagnosed as gall bladder polyp on USG. Material & Methods: Total 108 patients with GB polyp diagnosed on USG between Jun’ 2008 and Jun’ 2014 at Amrita Institute of Medical Sciences, Kochi were included in the study. All subsequent USG reports of these patients were reviewed to determine changes in GB polyp size. The computerized hospital based medical record was searched to obtain clinical and pathologic followup including those who underwent surgery for the diagnosis or symptoms thereof. Statistical analysis of study outcomes was done using statistical software after ensuring accuracy and quality of data. Results: 108 patients (mean age 50.4±13.3 years; range, 21-80 years) with GB polyps were included in the study. USG of abdomen was done in 46% of cases due to symptoms related to GB disease while 20% symptoms unrelated to GB disease and rest 34% had USG as a subset of general health check-up with mean polyp size of 4.7 mm. USG follow up was performed in 53 (49%) patients with mean follow up duration of 24 months (range 1-5 years). 20 (18.5%) patients underwent cholecystectomy and none of them came as true polyps on histopathology, 25 (23%) patients were lost to follow up after primary USG and 10 (9.25%) patients died due to reasons unrelated to GB disease. Conclusion: The prevalent risk of malignant transformation of GB polyps and increased usage of imaging modalities results in over diagnose GB polyps on USG by radiologists. Higher imaging modalities do not add significant specificity in diagnosis of true polyp. However, a large cohort must be studied prospectively for confirmation
Hepatocellular carcinoma (HCC) is an extremely rare tumour during pregnancy. HCC during pregnancy has a poor outcome and 20% of patients have distant metastasis at presentation according to previous reports. Malignancies should be carefully approached and considered as differential diagnoses in pregnant women. We present a case of a pregnant female with HCC associated with hepatitis B infection expressing biliary immunophenotype. Hepatocellular carcinoma (HCC) is an important, rare entity during pregnancy.
Background & Aim: Claims databases are used ever more widely in medical research. The building blocks of such databases are the ICD-10 CM codes, which are used to identify study patients, exposures and procedures. We aimed to determine the performance characteristics of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) and the current procedural terminology (CPT) coding systems in identifying patients with acute esophageal variceal hemorrhage and esophageal variceal band ligation. Methods: Both liver cirrhosis and acute gastrointestinal hemorrhage were ascertained using manual electronical medical record review. The study patients’ billing records were obtained and searched for ICD-10 CM code I85.xx for esophageal variceal hemorrhage and 06L34CZ, 06L38CZ and CPT code 43244 for esophageal variceal band ligation. Results: 1,231 patient encounters were included. Alcohol was the most common etiology for liver cirrhosis (62.3%), and hematemesis (40.5%) was the most common patient presentation. A principal diagnosis ICD-10 CM code of I85.xx was associated with high sensitivity (84.8%), specificity (88.6%), positive (PPV, 92.9%) and negative (NPV, 77.0%) predictive values for presence of esophageal varices. For esophageal variceal band ligation, the ICD-10 CM had lower sensitivity than the CPT codes (51% versus 77%, respectively). However, both systems had similar specificity (99% and 99%), positive (97% and 96%), and negative (86% and 93%) predictive values in this setting. Conclusion: ICD-10 CM diagnostic code I85.xx and procedure codes 06L34CZ and 06L38CZ as well as CPT code 43244 accurately identified patients with acute esophageal variceal hemorrhage and esophageal variceal band ligation, respectively.
