Objective:Rare disease Background:Strangulation ileus is caused by external obstruction to the small bowel, which results in ischemia and loss of bowel peristalsis. Low-grade appendiceal mucinous neoplasm (LAMN) is a low-grade adenocarcinoma that arises in the appendix. LAMN is usually asymptomatic but can present with appendiceal rupture and pseudomyxoma peritonei (PMP). This report is of a rare presentation of LAMN with strangulation ileus in a 92-yearold man.
Case Report:A 92-year-old man was admitted to the emergency room with sudden onset of lower abdominal pain and abdominal distension. Laboratory investigations showed a leukocytosis with a white blood cell (WBC) count of 14.6×10 3 /μL with 85.5% neutrophils, blood urea nitrogen (BUN) of 26.6 mg/dL, and serum creatinine of 2.6 mg/dL, consistent with acute renal failure. Arterial blood gas analysis showed lactic acidosis (pH of 7.11) with a base excess of -20.8 mmol/L and lactate of 13.7 mmol/L. Abdominal computed tomography (CT) showed ascites and a dilated obstructed closed loop of the distal ileum associated with an external mass (3.9×2.8 cm). An initial diagnosis was of strangulation ileus due to Meckel's diverticulum. Emergency ileocecal resection was performed. Histopathology showed a low-grade mucinous tumor arising from the mucosa of the appendix, consistent with LAMN. At a 13-month follow-up, the patient was well with no tumor recurrence.
Conclusions:This report is of a rare case of LAMN that presented as a surgical emergency with strangulation ileus.
Introduction:
The main mechanism of death and the pathological appearance of cases of benzyl alcohol intoxication has not been fully investigated. Autopsy reports of cases of benzyl alcohol intoxication have not been published.
Case presentation:
A 24-year-old man was found in the state of cardiopulmonary arrest at a construction site. He had been performing paint stripping. He was immediately transferred to the hospital, but he did not recover. An autopsy showed focal coloring of the skin without any major caustic injury. A histopathological investigation showed vacuolar degeneration in the epidermis and dermo-epidermal junction, and severe erosion of the tracheal and bronchial mucosa. No pathological changes in the kidney were evident. A neuropathological investigation showed central chromatolysis of neuronal cells in pontine nuclei and grumose degeneration in the cerebellar dentate nucleus. The blood content of benzyl alcohol was 780.0 μg/mL.
Lessons:
Present case suggest that multiple pathways of exposure may be associated with more rapid progression in acute benzyl alcohol intoxication, and that early and/or severe involvement of the central nervous system rather than renal dysfunction may be associated with an early death.
Conventional jejunal reconstruction procedures for large duodenal defects include jejunal serosal patch repair and duodenojejunostomy and have some risks of postoperative complications. The pedicled jejunal flap is used for reconstruction following laryngopharyngectomy, esophagectomy and other gastrointestinal surgeries. We report two cases of successful closure of duodenal defects after partial duodenectomies by pedicled jejunal flap reconstruction. Case 1: A 72-year-old man was diagnosed with gastrointestinal stromal tumor by esophagogastroduodenoscopy (EGD), endoscopic ultrasound-guided fine needle aspiration biopsy and computed tomography (CT). Case 2: A 63-year-old woman was diagnosed with early duodenal cancer using EGD and CT. Partial duodenectomy and pedicled jejunal flap reconstruction were performed in both patients. A part of the jejunum was formed into a pedicled flap to fit the duodenal defect and duodenojejunal anastomosis was performed. The patients did not report any postoperative gastrointestinal symptoms or abnormal findings during follow-up EGD or upper gastrointestinal radiography.
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