An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma INTRODUCTIONPrimary hyperparathyroidism is one of the most encountered endocrine pathologies, with an incidence of 21.6/100,000. In the etiology, the leading cause is solitary adenoma (87%-91%), generally originating from chief cells (1). Adenoma originating from more than one gland is a rarer event and comprises 2%-15% of all adenomas (2). The rare form (1%) of water-clear cell hyperplasia (WCCH) of hyperparathyroidism was first described by Albright et al. (3) in 1934. As adenoma in the etiology is even more uncommon, only 19 cases have been reported since 1994, and of those cases, adenoma was in both parathyroid glands in only one case (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).Hypercalcemic crisis, which was first described by Hannas in 1939, is a severe and life-threatening condition of severe hypercalcemia progressing to associated failure of various systems (21). Of the known cases, the case reported here is the first of hypercalcemic crisis caused by water-cell clear adenoma (WCCA). In previous reports related to WCCA, the histopathological features of the disease have generally been the focus. The aim of this study was to present the preoperative and postoperative periods of the disease and to evaluate the clinical characteristics. Defining the clinical characteristics of these kinds of rare cases can be considered useful for clinicians.In this case report, we present a patient who was successfully treated for double WCCA, and the case is discussed in comparison with the 19 cases reported in literature. Objective: To evaluate the clinical characteristics of a patient operated for water-clear cell adenoma and to discuss these in the light of relevant literature. MATERIAL AND METHODS Material and Methods:PubMed and Google Scholar were searched to identify articles related to water-clear cell adenoma using the following keywords: parathyroid tissue, parathyroid gland, parathyroid cells, parathyroid adenoma, parathyroid hyperplasia, water-clear-cell, and water clear cell. The search included case reports, review articles, and original articles that had been published between January 1990 and November 2014 without any restrictions on language. All articles that contained information on the study population and treatment related data were identified and retrieved. In addition, an evaluation was of a case of a 47-year-old male patient with PHC who was treated at our clinic was conducted.Results: A total of 19 patients, including our new case, (age range: 18 to 81 years, mean±SD: 57.47±16.31 years) were included in the analysis. Eleven patients were female. Information about adenoma location was available from studies involving 17 patients and they indicated the following distribution of locations: left inferior (n=10), right superior (n=4). When preoperative imaging methods were examined, a false negative result was given by ultrasonography in 28.5% of patients and only 57.1% were positive on scintig...
Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology.How to cite this articleSertkaya M, Emre A, Pircanoglu EM, Yazar FM, Tepe M, Cengiz E, Isler A, Vicdan H. A Rare cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(2):179-182.
To establish a standard approach in patient management by determining the parameters that affect the decision of surgical or conservative treatment in adhesive small bowel obstructions. 94 patients who were admitted to the emergency department with symptoms of ileus and were diagnosed with adhesive intestinal obstruction according to clinical, examination and imaging findings were grouped as patients who were followed up with conservative methods (Group 1) and patients who underwent surgery (Group 2). All patients' laboratory values (hemoglobin, white blood cell (WBC), C- reactive protein (CRP), Blodd urea nitrogen (BUN)/creatinin, sodium, potassium, Lactate dehydrogenase (LDH), lactate and amylase) and imaging findings (air-fluid level in direct abdominal X-ray, increase in small intestine diameter (≥3.95 cm) in computerized tomography), wall thickness increase (>3mm), transition zone, fecal sign, and presence of contrast in the colon) were evaluated, and criteria for early surgery and non-operative follow-up-treatment criteria were determined. 72% (n:68) of the patients were classified as Group 1 and 28% (n:26) as Group 2, and no significant difference was found between the groups according to age and gender. Surgical treatment with increased lactate (r:0.326, p=0.001), diameter increase in the small intestine (r:0.299, p=0.003) and wall thickness increase (r:0.540, p<0.001), change in air-fluid levels on direct X-ray ( A significant correlation was found between r:-0.291, p=0.004) and contrast transfer to the colon on tomography (r:-0.668, p<0.001) and the decision for conservative treatment. Although adhesive intestinal obstruction is a condition that can mostly be managed non-operatively, the early surgical decision significantly reduces mortality and morbidity in cases with an operation indication. It was concluded that the standard approach protocol based on laboratory and imaging findings determined in the non-operative or operative treatment management helps in the differential diagnosis and early surgical decision and reduces the length of stay of the patient.
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