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Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology varies from relatively mild, such as crying before passage of soft stools or infrequent defecation to severe problems with faecal impaction and the daily involuntary loss of faeces in the underwear. Conventional radiography is widely available, relatively cheap and is non-invasive. The drawback however, is radiation exposure. This review describes and evaluates the value of different existing scoring methods to assess faecal loading on an abdominal radiograph with or without the use of radio-opaque markers, to measure colonic transit time, in the diagnosis of these defecation-related FGIDs. Insufficient evidence exists for a diagnostic association between clinical symptoms of functional constipation or functional nonretentive faecal incontinence and faecal loading on an abdominal radiograph. Furthermore, evidence does not support the routine use of colonic transit studies to diagnose functional constipation. Colonic transit time measurement may be considered in discriminating between functional constipation and functional non-retentive faecal incontinence and in patients in which the diagnosis is not clear such as having an unreliable medical history. In children with the suspicion of defecation-related FGIDs, the diagnosis should be made based on the Rome IV criteria. [ABSTRACT FROM AUTHOR]

A 77-year-old woman was referred to urology with blockages of her suprapubic catheter (SPC). The catheter was replaced easily in the emergency department, however, no urine was draining, only a cloudy green fluid was visible. On cystoscopy bilious material was identified in the bladder. There was no catheter visible. There seemed to be a fistulous tract entering the bladder at the left dome. The urethra was dilated, a urethral catheter was placed and the SPC was removed. A CT demonstrated that the SPC tract transfixed a loop of pelvic small bowel and entered the bladder with no intraperitoneal contrast leak. The patient recovered well and did not require laparotomy. This case emphasises that bowel perforation, although rare, must be considered as a complication of SPC placement even years after initial insertion when catheter problems arise. Unusually, we learn that this complication may not present with abdominal pain or peritonism. [ABSTRACT FROM AUTHOR]

The association between epidermolysis bullosa (EB) and pyloric atresia (PA) is rare but well documented. Herein, we report a case of EB associated with congenital PA. A female baby, weighing 1480 g, was born vaginally to a 31-year-old gravida 7 lady at 33 weeks of gestation. Polyhydramnios was detected on antenatal assessment. The parents were non-consanguineous Saudis with no family history of significant illness. At birth, welldemarcated areas of peeled skin were present over knees, left leg and periumbilical region. Systemic examination revealed no other abnormality. On second day, the patient developed recurrent vomiting and abdominal distension. An abdominal X-ray revealed a single gastric gas bubble suggesting pyloric obstruction. Following gastroduodenostomy, the baby developed severe sepsis with multiorgan dysfunction and expired on 25th day of life. Skin biopsy showed cleavage within lamina lucida [ABSTRACT FROM AUTHOR]

This case is of a 39-year-old Filipino woman who within 2 months developed, Cushing's features she had no known comorbidities and no history of steroid intake. The patient also presented with hyperpigmentation of knuckles and toes, metabolic alkalosis and persistent hypokalaemia noted as proximal muscle weakness. The patient was referred to our institution for acutely worsening behavioural and psychiatric changes. Work-up for endogenous Cushing's syndrome revealed a significant adrenocorticotropic hormone production from an ectopic source. Further imaging was requested to locate the tumour, but the patient eventually succumbed to the drastic complications of hypercortisolism. On autopsy, the patient was found to have an ectopic well-differentiated neuroendocrine tumour located at the pancreatic head with metastasis to the right hepatic lobe. [ABSTRACT FROM AUTHOR]

A case of congenital obstructed Treitz's hernia presenting with bilious vomiting in a newborn baby girl has been presented. Internal herniation of contents within a peritoneal sac of the right paramesocolic hernia formed abdominal cocoon which simulated volvulus neonatorum. Plain radiographs and contrast studies were helpful in defining the nature and extent of the lesion. The patient underwent exploratory laparotomy, reduction of small bowel contents from the hernial sac forming an abdominal cocoon, Ladd's procedure to correct associated midgut malrotation with incidental appendicectomy uneventfully and recovered well. [ABSTRACT FROM AUTHOR]

Mucormycosis is a rare angioinvasive fungal infection, more commonly seen in immunosuppressed patients, with reported mortality rates of 95% in disseminated disease. We present a case report of a patient with T-cell acute lymphoblastic leukaemia who developed disseminated infection with mucormycosis (involving the pancreas, left occipital lobe, right lower lobe of lung, appendix and right kidney) after having completed induction and consolidation chemotherapy. Growth of Lichtheimia corymbifera was initially isolated following a right pleural tap with fungal elements identified repeatedly on subsequent pathology specimens. Following radical surgical debridement and concurrent treatment with combination antifungal therapy, the patient survived. This case demonstrates that aggressive multisite surgical de-bulking of disseminated fungal foci, in conjunction with combination antifungal therapy and reversal of immunosuppression, can result in survival despite the grave prognosis associated with disseminated mucormycosis. [ABSTRACT FROM AUTHOR]

Visceral larva migrans (VLM) is a systemic manifestation of migration of second stage larvae of nematodes through the tissue of human viscera. It is not uncommon but is underdiagnosed in developing countries. The liver is the most common organ to be involved due to its portal venous blood supply. The imaging findings are subtle and differentiation from hepatocellular carcinoma (HCC), metastases, cystic mesenchymal hamartoma and granulomatous diseases is difficult. This case report highlights the imaging features of hepatic lesions of VLM along with clinical and laboratory data which help in clinching the diagnosis. [ABSTRACT FROM AUTHOR]

Gastric volvulus is a rare cause for acute visceral obstruction, with a high mortality rate that rises with delay in definitive treatment. A 33-year-old woman with a rare chromosomal mutation (46,XX,del(6)(q25.1q25.3)) presented with evidence of acute visceral obstruction. Diagnostic difficulties delayed treatment and she clinically deteriorated. Urgent CT imaging revealed acute mesentero-axial gastric volvulus. At laparotomy, global failure of colonic and splenic fixation was found. The viscera were de-rotated, the stomach salvaged and gastropexy and colopexy were performed. This is the first report of gastric volvulus secondary to congenital absence of colonic and splenic ligamentous attachments occurring in a patient over 30 years of age. This case is interesting not only due to unique pathology, but also highlights that general surgeons must be aware of the possibility of unusual causes for intestinal obstruction in patients with recognised genetic abnormalities, even in adult cases, to avoid harmful diagnostic delay. [ABSTRACT FROM AUTHOR]

A 63-year-old man was referred to our office with an enlarging left adrenal mass found on work-up for prostate cancer. Imaging performed over the course of 6 months demonstrated an increasing left adrenal mass from 2.8 to 3.6 cm. Functional testing of the adrenal lesion was performed. The adrenal mass was non-functional. Owing to the enlarging size, the patient underwent a laparoscopic left adrenalectomy without complication and was discharged home the following day. Gross pathological evaluation demonstrated a 3.2 cm, well-encapsulated, partially cystic mass. Histological evaluation demonstrated a small round blue cell tumour suspicious of sarcoma. Immunohistochemical testing revealed strong CD99 positivity consistent with Ewing family of tumours. Reverse transcriptase PCR demonstrated the presence of the Ewing sarcoma fusion transcript. The patient is currently enrolled in an ongoing research chemotherapy protocol at our institution using vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide. [ABSTRACT FROM AUTHOR]

Acute appendicitis is one of the most common conditions requiring emergency surgery. However, acute appendicitis presenting with left lower quadrant abdominal pain is extremely rare. Imaging, particularly CT , plays an important role in establishing an accurate and prompt diagnosis, as delay in diagnosis may occur due to lack of uniformity in the clinical signs and symptoms. We report a rare case of a 10-year-old boy who presented with persistent left lower quadrant pain of several days duration, in which the CT scan of the abdomen and pelvis was essential in establishing the correct diagnosis. The malpositioned inflamed appendix was clearly identified in the left side of the abdomen, with the characteristic CT findings of uncomplicated intestinal malrotation. Left-sided acute appendicitis should be considered in the differential diagnosis of young patients presenting with left lower quadrant pain, in order to avoid delay in diagnosis and guide the surgical intervention. [ABSTRACT FROM AUTHOR]

An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2 months the patient was well and asymptomatic, with normal barium contrast imaging results. [ABSTRACT FROM AUTHOR]

Von Hippel-Lindau (VHL) disease is an inherited, autosomal-dominant syndrome caused by heterozygous germline mutations in the VHL gene, and predisposing to the development of benign and malignant tumours and cysts in multiple organ systems involving eyes, kidneys, pancreas, liver and central nervous system. The responsible tumour suppressor gene for VHL disease is in chromosome 3p25. We are presenting a case of a patient with both cerebellar as well as spinal haemangioblastoma in addition to polycystic pancreas. We operated on both the spinal and the cerebellar haemangioblastomas and the patient had made a very good recovery. We present this case for its rarity along with the literature review. [ABSTRACT FROM AUTHOR]

We reported a rare case of Budd-Chiari syndrome (BCS) associated with tamoxifen use, which was later complicated by heparin-induced thrombocytopenia and thrombosis (HITT). The patient was a 44 year-old woman with a medical history of lobular carcinoma in situ, who had been on tamoxifen for 2 years, presented with abdominal pain and distention. Imaging studies followed by a liver biopsy confirmed the diagnosis of BCS. On extensive work-up, the patient was found to have an unclassified myeloproliferative disorder with positive JAK-2 V617 mutation. After discontinuing tamoxifen, the patient was started on intravenous heparin. However, later in the course, she developed HITT. Myeloproliferative disorder, in conjunction with tamoxifen, predisposed the patient to be highly thrombophilic resulting in BCS. HITT was found to be relatively common in BCS. Anticoagulation and blood count need to be carefully monitored, and the possibility of HITT emergence in these patients should always be kept in mind. [ABSTRACT FROM AUTHOR]

Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE). [ABSTRACT FROM AUTHOR]

We report an 8-year-old boy who developed high fever and low-back pain. He was diagnosed as having a paravertebral abscess with severe disseminated Staphylococcus aureus infection. He received intravenous antibiotics and drainage of the abscess. Afterwards, he developed thrombosis, endocarditis and empyema thoracis. He received further intravenous antibiotics and proper drainages for his conditions. He eventually recovered well. This case highlights the need for rapid diagnosis and appropriate treatment of severe S aureus infection to prevent serious complications. [ABSTRACT FROM AUTHOR]

Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency and its presentation in adulthood is extremely rare. Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. This case describes a middle aged man presenting with post-traumatic acute abdomen and finally being diagnosed as a case of gastric volvulus due to congenital diaphragmatic hernia which was till now asymptomatic and undiagnosed. Clinical examination and chest x-ray was suggestive of hiatus hernia. Contrast-enhanced CT of thorax and abdomen revealed hiatus hernia and gastric volvulus. A provisional diagnosis of post-traumatic hiatus hernia with associated gastric volvulus was made and was operated on an emergency basis. Surprisingly, the intraoperative findings revealed significant adhesions near the diaphragm suggestive of congenital diaphragmatic hernia. Hence, a diagnosis of gastric volvulus due to congenital diaphragmatic hernia was made which remained asymptomatic and undiagnosed till adulthood. He responded well to operative management and remained asymptomatic afterwards. [ABSTRACT FROM AUTHOR]

Metastasis to gastrointestinal tract from breast cancer is an uncommon situation. We report a case of a 52-year-old woman who had a mastectomy for solid-tubular carcinoma of the breast 16 years ago and bilateral salpingo-oophorectomy for metastatic ovarian tumours 5 years ago, was incidentally found to have colonic metastatic tumour detected by positron emission tomography/CT (PET/CT) during follow-up. After identifying a definite location of the tumour in the ascending colon under laparoscopic investigation, laparoscopy-assisted partial colectomy was successfully performed. Histopathology of the resected specimen showed it to be metastasis from solid-tubular carcinoma of the breast. We should be aware that breast cancer can metastasise to the gastrointestinal tract even after the long interval from initial therapy. An index of high suspicion and detailed assessment is mandatory to make a correct diagnosis and following less invasive surgical treatment. [ABSTRACT FROM AUTHOR]

A 35 year old woman presented with headache and fever. Computed brain tomography showed diffuse low attenuation in the cerebral white matter. Several months later, serological tests for systemic lupus erythematosus (SLE) became positive. In spite of immunosuppressive therapy she relapsed after six months of treatment, presenting with abdominal symptoms and signs. On this occasion an abdominal CT scan showed distended and oedematous loops of bowel attributed to an underlying vasculitis. This case illustrates novel CT scan appearances in two systems involved in SLE. [ABSTRACT FROM PUBLISHER]

The majority of ingested foreign bodies pass of their own accord without causing any adverse impact on the patient, while others present a greater management dilemma. We present a case of a 36-year-old man admitted to the hospital with a 10-day history of colicky abdominal pain following voluntary ingestion of multiple pairs of vinyl gloves. The plain-film abdominal X-ray confirmed small bowel obstruction and gastric bezoar. After failed conservative management he opted for endoscopic retrieval. Following exposure to stomach acid the gloves had lost their structural integrity becoming hard, sharp and brittle. As a result endoscopic removal was abandoned due to the risk of traumatic injury to the oesophagus. A midline laparotomy was performed and the gloves were retrieved via enterotomy. While many foreign bodies are suitable for endoscopic extraction this case demonstrates that the retrieval of vinyl gloves is unlikely to be successful due to significant chemical change. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 49-year old female patient with renal artery aneurysm with an ovarian vein thrombosis. It states that the patient was presented with a medical history of post menopausal bleeding and dull aching epigastric pain. It mentions that a 5.3x2.4x3 centimeter initially thrombosed left renal artery aneurysm arising 4.5 millimeter from the origin of the left renal artery was revealed in the tomography.

Cytomegalovirus (CMV) infection causes siginificant morbidty and mortality in immunopromised patients. Though it is usually silent in immunocompetent adults, rarely it can cause serious life-threatening complications. Gastrointestinal tract is one of the commonly involved organs, where it produces a spectrum of clinical manifestation ranging from mild non-specific abdominal pain and diarrhoea to severe infection with toxic megacolon and death. We present a 65-year-old immunocompetent male patient admitted with acute colonic obstruction secondary to CMV-induced colonic stricture, highlighting the importance of considering it as a differential diagnosis for colonic obstruction and reviewing its management. [ABSTRACT FROM AUTHOR]

We presented a case of a cholecystoduodenal fistula in a patient 4 years post-Roux-en-Y gastric bypass. The patient presented with biliary colic symptoms after a stone became impacted in the fistula and outflow through the cystic duct was intermittently obstructed by a second stone. The fistulous tract was taken down with a cholecystectomy and duodenum repaired with a modified Graham patch. [ABSTRACT FROM AUTHOR]

Stump appendicitis (SA) is a rare and under-reported complication of open as well as laparoscopic appendicectomy. Diagnosis of SA is often delayed and requires a high index of suspicion in those presenting with signs and symptoms of appendicitis and a history of appendicectomy. We presented a case of SA in a 20-year-old man with a history of open appendicectomy. He was managed conservatively using intravenous antibiotics. The risk of SA is influenced by surgical technique; however, it is unclear whether the incidence is higher with laparoscopic or open procedures. There is little evidence guiding the management of SA with the majority of reported cases treated operatively. This diagnosis should be suspected on the basis of history and examination and CT scanning is a useful tool in most adult cases aiding diagnosis. Management may be guided by the progression of the patient's symptoms either towards operative intervention or a conservative approach. [ABSTRACT FROM AUTHOR]

The article presents images of ventriculoperitoneal (VP) shunt fracture and migration into the scrotum, in a 14-year-old boy.

Hypereosinophilic syndrome is a disease characterised by a persistently elevated eosinophil count. The syndrome can be reactive to infections, autoimmune disease, cancers, etc. Multiple organ involvement can occur including cardiomyopathies, pulmonary involvement and neuropathies. We describe a case of a patient who presented with signs and symptoms of asthma with recurrent asthma exacerbations, but in fact proved to be hypereosinophilic syndrome secondary to strongyloides infection. [ABSTRACT FROM AUTHOR]

Adrenal crisis is a group of clinical manifestation predominantly with hypotensive shock, electrolyte imbalance in a patient with adrenal insufficiency or in a patient who was abruptly withdrawn from glucocorticoid treatment acute myeloid leukaemia (AML) is one of the most common acute leukaemia in adults. Though the above diseases are commonly seen in individual patients, the coexistence of both conditions in the same patient is rare. We reported a 64-year-old African-American man with a history of bilateral deep vein thrombosis, who presented initially with fatigue, neutropenia and macrocytic anaemia. The patient developed a small bowel obstruction during his first hospital course, which resolved spontaneously with conservative management after an exploratory laparotomy. While waiting for his bone marrow biopsy, the patient developed hypotension, hyponatraemia and hyperkalaemia for which adrenal crisis was suspected. Later on, laboratory studies confirmed the diagnosis of primary adrenal insufficiency and the bone marrow was conclusive for AML. [ABSTRACT FROM AUTHOR]

A rare case of large adrenal mass which was non-functioning is presented. It is difficult to make preoperative diagnosis in these cases as the imaging findings are non-specific. Radical excision is mandatory as preoperative malignancy cannot be ruled out. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding from variceal origin is a frequent complication in the cirrhotic population. Duodenal variceal haemorrhage, however, is infrequent and the endoscopic management of such lesions is not straightforward. Non-endoscopic options include vasoactive drugs, transjugular intrahepatic portosystemic shunt (TIPS), transvenous obliteration and surgery as rescue therapy. We present a patient with Child-Pugh A hepatitis C virus-cirrhosis with acute bleeding from a duodenal varix. It was managed with elastic band ligation but late rebleeding occurred after 6 weeks. Gastroduodenoscopy revealed active bleeding from the ligation eschar. Band ligation and sclerosis were attempted but unsuccessful. Terlipressin was started and the patient referred for TIPS. Surprisingly, angiography showed a normal hepatic vein pressure gradient; therefore, TIPS was not performed. Haemorrhage ceased with medical treatment alone. The patient remained stable and was discharged after 10 days, being currently under evaluation for hepatitis C therapy. [ABSTRACT FROM AUTHOR]

We report the rare case of a patient presenting with a spontaneous hepatic subcapsular haematoma after playing golf. The patient had no underlying predisposing conditions. A CT scan of the abdomen/pelvis demonstrated a 1 cm deep low-attenuation subcapsular collection around the anterolateral aspect of the liver. The patient was treated conservatively and was discharged from inpatient care after 72 h. This is only the second reported case of a spontaneous subcapsular haematoma. [ABSTRACT FROM AUTHOR]

During an acute outbreak of Norovirus in the local area, a 77-year-old woman was admitted with a short history of diarrhoea and vomiting. A working diagnosis of viral gastroenteritis complicated by acute renal failure, secondary to dehydration, was made. Despite judicious fluid resuscitation and regular antiemetics, the patient's symptoms persisted with only mild improvement in her renal function. An abdominal radiograph revealed evidence of significant small bowel obstruction and subsequent CT of the abdomen and pelvis identified a 1.5 cm intraluminal density at a transition point raising the suspicion of gallstone ileus. An urgent laparotomy with stone removal was carried out without complications. The patient recovered well postoperatively and was discharged home after 3 days. [ABSTRACT FROM AUTHOR]

A 12-year-old patient presented with a severe delay of eruption in permanent maxillary and mandibular incisors. On examination, there was over-retained primary teeth and delayed eruption of permanent teeth. Retained primary teeth showed light yellow discolouration whereas permanent teeth were distinct yellow with thin or little enamel. Subsequent imaging revealed all the premolars except maxillary left first premolar showed signs of intra-alveolar coronal resorption, nephrocalcinosis with bilateral multiple calculi and small papillary tip calcifications, marked increase in alkaline phosphatase. Subsequent dental treatment for restoring the functional and aesthetic requirement followed by appropriate treatment for renal problem was undertaken. [ABSTRACT FROM AUTHOR]