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Search Results (11)

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Keywords = rectal distension

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7 pages, 1640 KiB  
Case Report
Rare Cause of Lower Gastrointestinal Bleeding—Case Presentation and Literature Review
by Cristian Iorga and Cristina Raluca Iorga
Reports 2025, 8(2), 82; https://doi.org/10.3390/reports8020082 - 1 Jun 2025
Viewed by 609
Abstract
Background and Clinical Significance: Gastrointestinal bleeding is a critical medical emergency, with upper gastrointestinal bleeding occurring approximately five times more frequently than lower gastrointestinal bleeding (LGIB). The incidence of LGIB tends to increase with age, likely due to a greater prevalence of vascular [...] Read more.
Background and Clinical Significance: Gastrointestinal bleeding is a critical medical emergency, with upper gastrointestinal bleeding occurring approximately five times more frequently than lower gastrointestinal bleeding (LGIB). The incidence of LGIB tends to increase with age, likely due to a greater prevalence of vascular and diverticular diseases among older patients. However, there are rare or extremely rare causes of LGIB that demand significant diagnostic and therapeutic efforts, some of which may pose unexpected challenges during surgery. Case report: We present the case of a 75-year-old woman, previously treated for a cecal neoplasm 15 years ago, who was hospitalized due to intermittent lower gastrointestinal bleeding over the past three months. Initially, the patient declined a colonoscopic examination, and the bleeding stopped spontaneously. She was then discharged at her own request in stable condition. However, she returned with a recurrence of the bleeding. While preparing for a colonoscopy, she experienced subocclusive symptoms, abdominal distension, and vomiting. During emergency surgery, a floating coprolith, which was attached to one of the anastomosis sutures, was sensed through palpation and later confirmed via colotomy. The coprolith was removed, and hemostasis was achieved in situ, leading to a favorable postoperative recovery and normalization of intestinal transit. A literature review identified 24 articles that met the eligibility criteria concerning rare causes of LGIB. Appendiceal bleeding (due to erosions, arteriovenous malformations, or endometriosis) was the most common cause, whereas the rarest causes included jejunal hemangiomas and rectal ulcers resulting from mucormycosis. Diagnosing these conditions is often challenging, typically requiring CT scans, colonoscopy, and angiography, with surgical treatment being the primary method to ensure hemostasis. In conclusion, the diagnosis and management of LGIB present significant challenges for clinicians, and successful outcomes are usually achieved through a collaborative multidisciplinary team approach. Full article
(This article belongs to the Section Surgery)
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9 pages, 1031 KiB  
Article
The Diagnostic Pathway of Hirschsprung’s Disease in Paediatric Patients: A Single-Centre Experience
by Annita Budzanowski, Niamh Geoghegan, Alexander Macdonald and Muhammad Choudhry
Children 2024, 11(8), 970; https://doi.org/10.3390/children11080970 - 12 Aug 2024
Viewed by 1282
Abstract
Background: The presenting symptoms of patients with Hirschsprung’s disease (HD) are a failure to pass meconium, abdominal distension, and bilious vomiting. The gold standard diagnosis is a rectal biopsy to confirm aganglionosis. The aim of our study was to describe the diagnostic pathway [...] Read more.
Background: The presenting symptoms of patients with Hirschsprung’s disease (HD) are a failure to pass meconium, abdominal distension, and bilious vomiting. The gold standard diagnosis is a rectal biopsy to confirm aganglionosis. The aim of our study was to describe the diagnostic pathway of Hirschsprung’s disease at our institution and document the indication for a rectal biopsy. Methods: We have performed a prospective collection of all patients who underwent a rectal biopsy to exclude HD from December 2022 until September 2023 including. The following data were collected: patient’s age, presenting symptoms, type of biopsy, failure rate, complications, and histopathological results. Results: We identified 33 patients who underwent 34 rectal biopsies at 0.6 years of age. A total of 17 patients had a rectal suction biopsy (RSB), and 17 patients underwent a partial thickness under general anaesthesia (GA). 1/17 (6%) patients had an inconclusive RSB and subsequently underwent a biopsy under GA. Constipation and chronic abdominal distension plus vomiting were the most common presenting symptoms throughout all ages. Five patients (15%) had a rectal biopsy that was positive for HD. Conclusion: A protocolised approach to the assessment of infants and children with suspected HD ensures the appropriate utilisation of invasive procedures such as biopsy. Full article
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10 pages, 1064 KiB  
Article
Small Colon Faecalith with Large Colon Displacement in Ten Cases (2015–2023): A Detailed Case Description and Literature Review
by Nicola Scilimati, Anna Cerullo, Sara Nannarone, Rodolfo Gialletti, Gessica Giusto and Alice Bertoletti
Animals 2024, 14(2), 262; https://doi.org/10.3390/ani14020262 - 15 Jan 2024
Viewed by 2228
Abstract
Small colon impaction can result in accumulation of ingesta, gas, and fluid orally to the impaction site in horses. Large colon tympany, which is caused by ingesta fermentation, can be a predisposing factor for intestinal displacement. The aim of this study is to [...] Read more.
Small colon impaction can result in accumulation of ingesta, gas, and fluid orally to the impaction site in horses. Large colon tympany, which is caused by ingesta fermentation, can be a predisposing factor for intestinal displacement. The aim of this study is to report the history, clinical, and surgical findings of horses and ponies referred for abdominal pain not responsive to drugs where a right dorsal displacement (RDD) or large colon volvulus (LCV), together with a small colon faecalith (SCF), were diagnosed during surgery. This study included a total of five horses and five ponies. Based on clinical features, ultrasonographic examination, and rectal palpation, an initial suspected diagnosis of RDD, LCV or severe large colon and caecum distension was made in all clinical cases. Due to the lack of response to medical treatment or worsening of colic symptoms, surgery was performed in all horses: diagnosis of RDD or LCV was made and a SCF was incidentally detected in all cases. While exploratory laparotomy was carried out in all the patients for the presence of a large colon issue, it was probably subsequent to an obstruction of the small colon caused by the presence of an SCF, which is generally difficult to diagnose. This study reported the presence of SCF as a possible cause of secondary RDD or LCV in horses and ponies that, to the authors’ knowledge, has never been reported. Full article
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12 pages, 442 KiB  
Article
Best Parameters of Heart Rate Variability for Assessing Autonomic Responses to Brief Rectal Distention in Patients with Irritable Bowel Syndrome
by M. Khawar Ali, Shiyuan Gong, Borko Nojkov, Colin Burnett and Jiande D. Z. Chen
Sensors 2023, 23(19), 8128; https://doi.org/10.3390/s23198128 - 28 Sep 2023
Cited by 2 | Viewed by 2179
Abstract
Heart rate variability (HRV) has been used to measure autonomic nervous system (ANS) activity noninvasively. The purpose of this study was to identify the most suitable HRV parameters for ANS activity in response to brief rectal distension (RD) in patients with Irritable Bowel [...] Read more.
Heart rate variability (HRV) has been used to measure autonomic nervous system (ANS) activity noninvasively. The purpose of this study was to identify the most suitable HRV parameters for ANS activity in response to brief rectal distension (RD) in patients with Irritable Bowel Syndrome (IBS). IBS patients participated in a five-session study. During each visit, an ECG was recorded for 15 min for baseline values and during rectal distension. For rectal distension, a balloon was inflated in the rectum and the pressure was increased in steps of 5 mmHg for 30 s; each distension was followed by a 30 s rest period when the balloon was fully deflated (0 mmHg) until either the maximum tolerance of each patient was reached or up to 60 mmHg. The time-domain, frequency-domain and nonlinear HRV parameters were calculated to assess the ANS activity. The values of each HRV parameter were compared between baseline and RD for each of the five visits as well as for all five visits combined. The sensitivity and robustness/reproducibility of each HRV parameter were also assessed. The parameters included the Sympathetic Index (SI); Root Mean Square of Successive Differences (RMSSD); High-Frequency Power (HF); Low-Frequency Power (LF); Normalized HF Power (HFn); Normalized LF Power (LFn); LF/HF; Respiratory Sinus Arrhythmia (RSA); the Poincare Plot’s SD1, SD2 and their ratio; and the pNN50, SDSD, SDNN and SDNN Index. Data from 17 patients were analyzed and compared between baseline and FD and among five sessions. The SI was found to be the most sensitive and robust HRV parameter in detecting the ANS response to RD. Out of nine parasympathetic parameters, only the SDNN and SDNN Index were sensitive enough to detect the parasympathetic modulation to RD during the first visit. The frequency-domain parameters did not show any change in response to RD. It was also observed that the repetitive RD in IBS patients resulted in a decreased autonomic response due to habituation because the amount of change in the HRV parameters was the highest during the first visit but diminished during subsequent visits. In conclusion, the SI and SDNN/SDNN Index are most sensitive at assessing the autonomic response to rectal distention. The autonomic response to rectal distention diminishes in repetitive sessions, demonstrating the necessity of randomization for repetitive tests. Full article
(This article belongs to the Special Issue Signal Processing in Biomedical Sensor Systems)
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17 pages, 44963 KiB  
Review
Recurrent Sigmoid Volvulus in Children—Our Experience and Systematic Review of the Current Literature
by Jonathan Hencke and Steffan Loff
Children 2023, 10(9), 1441; https://doi.org/10.3390/children10091441 - 24 Aug 2023
Cited by 4 | Viewed by 5146
Abstract
Sigmoid volvulus (SV) occurs rarely in children. After encountering two cases of recurrent SV, we reviewed the literature to define the recurrence risk, identify outcome predictors and to give treatment recommendations. We found 256 cases reported in children (mean age 10.2 years, gender [...] Read more.
Sigmoid volvulus (SV) occurs rarely in children. After encountering two cases of recurrent SV, we reviewed the literature to define the recurrence risk, identify outcome predictors and to give treatment recommendations. We found 256 cases reported in children (mean age 10.2 years, gender ratio (m:f) 2.3:1). Associations exist with Hirschsprung disease (HD) in 10%, neurodevelopmental disorders in 10.9% and chronic constipation in 10.2%. Common symptoms and clinical signs were abdominal pain (85%), distension (85%), tenderness (54%) and vomiting (59%). Signs of peritonitis were present in 14% and indicated a gangrenous sigmoid (X2 = 45.33; p < 0.001). A total of 183 had abdominal radiographs, and 65% showed a positive ‘coffee-bean-sign’. Contrast enemas were positive in 90%. A total of 124 patients underwent laparotomy; in 41 cases, the sigmoid was gangrenous and associated with more complications (X2 = 15.68; p < 0.001). Non-operative treatment (NOT) like endoscopic, fluoroscopic or rectal tube decompression was performed in 135 patients and successful in 79% with a 38–57% recurrence rate. A total of 73 patients subjected to elective surgery: 50 underwent sigmoid resection; 17 had surgery for HD. Clinicians should consider SV in all children with abdominal pain, distension and vomiting. Gangrene carries a higher morbidity. After successful NOT we recommend counselling about the recurrence risk and definitive surgery should be advised. HD is frequent in newborns but sometimes found in older children. Full article
(This article belongs to the Special Issue Abdominal Diseases and Surgery in Children)
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10 pages, 1256 KiB  
Review
Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
by Carla Mancilla Asencio and Zoltán Berger Fleiszig
Medicina 2022, 58(6), 785; https://doi.org/10.3390/medicina58060785 - 10 Jun 2022
Cited by 19 | Viewed by 4670
Abstract
Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was [...] Read more.
Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred. Full article
(This article belongs to the Special Issue Management of Severe Acute Pancreatitis)
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11 pages, 3065 KiB  
Review
Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review
by Francesco Menegon Tasselli, Fabrizio Urraro, Guido Sciaudone, Giulia Bagaglini, Francesca Pagliuca, Alfonso Reginelli, Franca Ferraraccio, Salvatore Cappabianca, Francesco Selvaggi and Gianluca Pellino
J. Clin. Med. 2021, 10(21), 5149; https://doi.org/10.3390/jcm10215149 - 2 Nov 2021
Cited by 38 | Viewed by 4453
Abstract
Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, [...] Read more.
Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Results: Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm3. Conclusions: A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization. Full article
(This article belongs to the Special Issue Colorectal Surgery: Latest Advances and Prospects)
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3 pages, 416 KiB  
Case Report
Constipation and Dilated Bowel: Hirschsprung’s Disease Is Not Always the Case
by Savas P. Deftereos, Soultana Foutzitzi, Georgios Karagiannakis, Maria Aggelidou, Dimitrios C. Cassimos and Katerina Kambouri
Clin. Pract. 2020, 10(4), 1270; https://doi.org/10.4081/cp.2020.1270 - 16 Oct 2020
Cited by 1 | Viewed by 1087
Abstract
A case of a 2-month-old boy with constipation and a localized abdominal distension in the right abdomen and hypogastrium is presented. Plain radiograph, ultrasound exam as well as a barium enema were suggestive of Hirschsprung’s disease (HD) (ultrashort segment disease). Nevertheless, rectal suction [...] Read more.
A case of a 2-month-old boy with constipation and a localized abdominal distension in the right abdomen and hypogastrium is presented. Plain radiograph, ultrasound exam as well as a barium enema were suggestive of Hirschsprung’s disease (HD) (ultrashort segment disease). Nevertheless, rectal suction biopsy was negative for neuronal abnormalities and unexpectedly on plain radiograph vertebral abnormalities were noticed. Subsequently magnetic resonance imaging of the spine and abdomen was performed, to evaluate possible spinal cord lesions and potential abnormalities of the perineal region musculature. A syringe throughout medullary cone was noted. The well-known issue, that the diagnosis of HD does not depend on the imaging (radiological) findings, was confirmed. The step-bystep diagnostic approach from the initial thought of ultrashort segment HD to the later imaging-based diagnosis of syringomyelia is discussed in this present paper. Full article
16 pages, 2608 KiB  
Article
Researching New Therapeutic Approaches for Abdominal Visceral Pain Treatment: Preclinical Effects of an Assembled System of Molecules of Vegetal Origin
by Carmen Parisio, Elena Lucarini, Laura Micheli, Alessandra Toti, Lorenzo Di Cesare Mannelli, Giulia Antonini, Elena Panizzi, Anna Maidecchi, Emiliano Giovagnoni, Jacopo Lucci and Carla Ghelardini
Nutrients 2020, 12(1), 22; https://doi.org/10.3390/nu12010022 - 20 Dec 2019
Cited by 19 | Viewed by 6218
Abstract
Abdominal pain is a frequent symptom of irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBDs). Although the knowledge of these pathologies is progressing, new therapeutic strategies continue to be investigated. In the present study, the effect of a system of molecules of [...] Read more.
Abdominal pain is a frequent symptom of irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBDs). Although the knowledge of these pathologies is progressing, new therapeutic strategies continue to be investigated. In the present study, the effect of a system of molecules of natural origin (a medical device according to EU Directive 93/42/EC, engineered starting from Boswellia serrata resins, Aloe vera polysaccharides and Matricaria chamomilla and Melissa officinalis polyphenols) was evaluated against the intestinal damage and visceral pain development in DNBS-induced colitis model in rats. The system (250 and 500 mg kg−1) was orally administered once daily, starting three days before the injection of 2,4-dinitrobenzenesulfonic acid (DNBS) and for 14 days thereafter. The viscero-motor response (VMR) to colon-rectal balloon distension (CRD) was used as measure of visceral sensitivity. The product significantly reduced the VMR of DNBS-treated animals. Its effect on pain threshold was better than dexamethasone and mesalazine, and not lower than amitriptyline and otilonium bromide. At microscopic and macroscopic level, the tested system was more effective in protecting the intestinal mucosa than dexamethasone and mesalazine, promoting the healing of tissue lesions. Therefore, we suggest that the described system of molecules of natural origin may represent a therapeutic option to manage painful bowel diseases. Full article
(This article belongs to the Special Issue Nutrition and Inflammatory Bowel Disease (IBD))
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4 pages, 604 KiB  
Case Report
Sclerosing Angiomatoid Nodular Transformation Presend Nodulartransformation Presenting with Abdominal Hemorrhage: First Report in Infancy
by Gloria Pelizzo, Vincenzo Villanacci, Luisa Lorenzi, Orietta Doria, Anna Maria Caruso, Vincenza Girgenti, Elettra Unti, Laura Putignano, Gabrio Bassotti and Valeria Calcaterra
Pediatr. Rep. 2019, 11(2), 7848; https://doi.org/10.4081/pr.2019.7848 - 23 May 2019
Cited by 16 | Viewed by 1647
Abstract
A limited number of sclerosing Angiomatoid Nodular Transformation (SANT) have been reported in pediatric age. We describe the first case of SANT occurring in a nine-week-old female infant that was admitted to our unit for severe abdominal distension and rectal bleeding. Enlarged spleen [...] Read more.
A limited number of sclerosing Angiomatoid Nodular Transformation (SANT) have been reported in pediatric age. We describe the first case of SANT occurring in a nine-week-old female infant that was admitted to our unit for severe abdominal distension and rectal bleeding. Enlarged spleen was detected on physical examination. Laboratory investigations revealed severe anemia and coagulation abnormalities. Abdominal ultrasound and computed tomography revealed ascites and splenomegaly with a large mass at the lower medial splenic pole. A diagnosis of intraabdominal hemorrhage was presumed and an exploratory laparotomy was performed. A complete transformation of the giant splenomegaly to bossellated masses and multiple bleeding capsular ruptures without subcapsular hematoma were found and an urgent splenectomy was performed. At histology, a SANT was diagnosed (CD34, CD31, CD8 positivity). The postoperative follow up was uneventful. SANT may also occur in infancy with a potentially lifethreatening presentation. Splenectomy may represent the only treatment in severe cases. Full article
1 pages, 419 KiB  
Technical Note
Novel Use of the Heald Anal Stent after Transanal Endoscopic Microsurgery
by Alun E. Jones and Guy F. Nash
Surg. Tech. Dev. 2011, 1(1), e15; https://doi.org/10.4081/std.2011.e15 - 31 Aug 2011
Abstract
Distension of the rectum following transanal endoscopic microsurgery (TEMS) increases rectal intra-luminal pressure and may promote pelvic sepsis by contaminating the rectal defect [...] Full article
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