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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 15-year-old female presenting with anemia and positive for occult blood was diagnosed as having an adenomatous polyp with mild atypia in the cecum by colonoscopy. Microscopically, the majority of the surface of the tubulovillous adenoma was occupied by a well-differentiated adenocarcinoma, indicating that the adenoma-carcinoma sequence is involved in the development of colon cancers, even in children. Forty-three cases of proven carcinoma of the colon in Japanese children aged under 15 years are also reviewed. The majority of the patients were aged over 10. Although an emergency laparotomy was undertaken in 42.5% of these patients, the signs and symptoms observed in these children did not markedly differ from those of adults. Colon cancer should not be excluded in children only on the basis of age, and barium enema and colonoscopy should therefore be applied to pediatric patients with unexplainable bleeding and abdominal pain, especially those over 10 years of age.
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PMID:Carcinoma of the colon in children: case report and review of the Japanese literature. 800 May 15

The coexistence of pancreas divisum and gallbladder carcinoma is uncommon and, to the best of our knowledge, has never been reported in English literatures. We have encountered a 62-year-old patient with symptom of intermittent right upper quadrant abdominal pain. Abdominal ultrasonography and computed tomography showed a gallbladder tumor. Endoscopic retrograde cholangiopancreatography revealed existence of complete pancreas divisum but no anomalous union of pancreaticobiliary duct. He underwent cholecystectomy and histologic analysis revealed tubulovillous adenoma with focal malignant change in the gallbladder.
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PMID:Pancreas divisum coexistent with gallbladder carcinoma--report of a Chinese patient. 968 50

Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ. A 67-year-old man was admitted to our hospital with a 1-year history of lower abdominal pain for investigation. Barium enema showed a filling defect with an irregular surface in the cecum, and colonoscopy revealed a cecal tumor with a granular surface. Pathological examination of biopsy samples revealed tubulovillous adenoma with well-differentiated adenocarcinoma, and a diagnosis of cecal cancer in tubulovillous adenoma was made. Surgery was performed and the resected specimen was found to contain a tumor arising from the appendix. The tumor was 5.5 x 4.5 cm in size in the cecal cavity, and the appendix had invaginated into the cecum at its base. The cut surface of the appendix showed the villous tumor filling the appendiceal lumen and projecting into the cecal cavity. Microscopic examination revealed well-differentiated adenocarcinoma in tubulovillous adenoma. To the best of our knowledge, this is the first report of appendiceal intussusception caused by tubulovillous adenoma with carcinoma of the appendix.
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PMID:Appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ: report of a case. 1081 82

Intussusception has been considered an operative indication in adults as a result of the risk of ischemia and the possibility of a malignant lead point. Computed tomographic (CT) scans can reveal unsuspected intussusception. All CT reports from July 1999 to December 2005 were scanned electronically for letter strings to include the keyword intussusception. Identified CT scans were analyzed to characterize the intussusception and associated findings. Clinical, laboratory, pathological, and follow-up variables were gleaned from medical records. Findings were analyzed by treatment and findings at operation. Review of 380,999 CT reports yielded 170 (0.04%) adult patients (mean age, 41 years) with intussusceptions described as enteroenteric in 149 (87.6%), ileocecal in eight (4.7%), colocolonic in 10 (5.9%), and gastroenteric in three (1.8%). Radiological features included mean length of 4.4 cm (range, 0.8-20.5 cm) and diameter of 3.2 cm (range, 1.6-11.5 cm). Twenty-nine (17.1%) had a lead point, and 12 (7.1%) had bowel obstruction. Clinically, 88 (48.2%) patients reported abdominal pain, 52 (30.6%) had nausea and/or vomiting, and 74 (43.5%) had objective findings on abdominal examination. Thirty of 170 (17.6%) patients underwent operation, but only 15 (8.8%) patients had pathologic findings that correlated with CT findings. Seven had,enteroenteric intussusceptions from benign neoplasms (two), adhesions (one), local inflammation (one), previous anastomosis (one), Crohn's disease (one), and idiopathic (one). Three had ileocolic disease, including cecal cancer (one), metastatic melanoma (one) and idiopathic (one; whereas five patients had colocolonic intussusception from colon cancer (three), tubulovillous adenoma (one), and local inflammation (one). Of the 15 without intussusception at exploration, five had pathology related to trauma, four had nonincarcerated internal hernia after Roux-en-Y gastric bypass, four had negative explorations, one had adhesions, and one had appendicitis that did not correlate with CT findings. No patient in the observation group required subsequent operative exploration for intussusception at mean 14.1 months (range, 0.25-67.5 months) follow up. All operative patients demonstrated gastrointestinal symptoms versus 55.3 per cent of the observation group (P < 0.006). Analysis of CT features demonstrated differences among patients observed without operation, those without intussusception at exploration, and confirmed intussusception with regard to mean intussusception length 3.8 versus 3.8 versus 9.6 cm, diameter 3.0 versus 3.2 versus 4.8 cm, lead point 12.1 per cent versus 30 per cent versus 53.3 per cent, and proximal obstruction 3.8 per cent versus 0 per cent versus 46.7 per cent, respectively. Intussusceptions in adults discovered by CT scanning do not always mandate exploration. Most cases can be treated expectantly despite the presence of gastrointestinal symptoms. Close follow up is recommended with imaging and/or endoscopic surveillance. Length and diameter of the intussusception, presence of a lead point, or bowel obstruction on CT are predictive of findings that warrant exploration.
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PMID:Approach to management of intussusception in adults: a new paradigm in the computed tomography era. 1809 41

Benign small intestinal tumour, though rare, have been reported. We report a case of sessile and extensive tubulovillous adenoma in a 13-year-old girl. She presented in a private hospital with three months history of abdominal pain, abdominal distension, vomiting, constipation, weight loss and anorexia. Significant findings on examination were weight loss, dehydration, and a huge smooth, not tender, mobile and indentable mass which extended from the left lumbar region to right iliac fossa. Visible peristalsis coursing from left to right was seen on the mass. Erect and supine plain abdominal x-rays revealed features of partial intestinal obstruction and abdominal ultrasound scan revealed dilated and hypertrophied bowel segment but could not say the bowel segment affected. The affected segment was found to be a 55cm portion of terminal ileum at operation which was resected due to hypertrophied proximal and collapsed distal segments, features in keeping with chronic intestinal obstruction, and ileo-ileal anastomosis done. Histology report was that of benign tubulovillous adenoma and the girl has enjoyed stable health for more than a year on close follow up in surgical outpatient clinic. This case highlights the unusual presentation and unusual gross nature of this small intestinal adenoma, which was found to be a benign adenoma on histological examination.
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PMID:Small intestinal tubulovillous adenoma--case report and literature review. 1976 76

INTRODUCTION: Intussusception in adults is an infrequent cause of intestinal occlusion that is usually due to neoplasm lesions. The unspecific nature of the clinical presentation often delays diagnosis. It is most commonly emergency explorative laparotomy which clarifies the etiology of the occlusion. The authors report a case of intestinal occlusion caused by ileocecal-colonic invagination with a small cecal adenocarcinoma as lead point, in a 74-year-old woman. CASE REPORT: A 74-year-old woman came to the Emergency Department, complaining of crampy pain in the mid- and lower abdomen. An abdominal ultrasound revealed a "pseudokidney sign" apparently involving the cecum. Because there were no clear signs of occlusion, the patient was dicharged on the same day. Three days later, upon admission, the patient complained of episodes of abdominal pain with intervals of moderate well-being, associated with nausea, vomiting and an inability to pass stool (but not gas) for 36 hours. On clinical examination her abdomen was distended and tender on palpation in all quadrants, especially in the right iliac fossa where a large mass could be felt. Standard abdominal x-Ray documented gaseous distension of some loops of the jejunum-ileum with some air-fluid level. The patient underwent an abdominal CT scan which showed advanced intussusception that appeared to be ileocolic and multiple enlarged lymphnodes were found in the invaginated mesentery at the base of which there appears to be a thickening of the intestinal wall that is probably neoplastic in nature. The patient underwent explorative laparotomy. Ileocecal-colonic intussusception caused by a cecal growth 5 cm in diameter was found on examination of the surgical specimen. Histology showed that the cause of the large swelling of the ascending colon was a vegetating ulcerated adenocarcinoma (medium grade differentiation: G2), measuring 6.5x 4.0 cm, arising from a tubulovillous adenoma infiltrating the submucosa. CONCLUSIONS: Most cases of intussusception are caused by structural lesions, a large percentage of which are malignant, especially in the colon. In our patient the lead point was a small cecal polyp which, together with the last loop of the ileum and the ileocecal valve, was pulled into the ascending colon. Although most cases of intussusception in adults are diagnosed at the operating table, noninvasive diagnostic tools like ultrasonography and CT scanning are very useful. Treatment in adults is usually surgical and involves en bloc resection of the lesion. Manual reduction of the intussusception is not advisable because of the risk of dissemination if the lead point is malignant. KEY WORDS: Cecal adenocarcinoma, Itestinal resection, Intussusception in adults.
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PMID:Ileocecal-colonic intussusception caused by cecal adenocarcinoma A case report. 2307 Feb 65

Intussusception occurs when a proximal segment of intestine invaginates into a distal segment. It is a common cause of intestinal obstruction in children but is infrequent in adults. A 77-year-old woman presented with a 1-month history of intermittent abdominal pain associated with nausea and distended abdomen. Imaging showed a complex elongated sausage-shaped mass in the transverse colon with no obstructive pattern or free air. Surgery confirmed colonic intussusception in addition to a palpable cecal mass requiring a right hemicolectomy. Histologic study demonstrated adenocarcinoma in situ within a tubulovillous adenoma. Surgical excision of the affected intestine is the recommended treatment of choice.
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PMID:Cecal adenocarcinoma presenting as colonic intussusception in adulthood. 2582 46

A polyp is defined as a mass of the mucosal surface that protrudes into the lumen of the gastrointestinal tract. Neoplastic epithelial polyps are classified histologically as either benign adenoma or malignant carcinoma. The colonic polyps that most commonly present in children occur sporadically and individually and are of the juvenile type; they are most frequently associated with painless rectal hemorrhage (which is the most common symptom). Adenomatous polyps are similar to other nontumoral polyps, and it is very rare for children to have symptoms other than rectal bleeding. This report describes two rare cases of polyps in pediatric patients. An 11-year-old girl presented with tubulovillous adenoma and a 13-year-old boy with tubular adenoma; both patients complained of rectal hemorrhage as well as anemia and abdominal pain. Epithelial adenoma is a tumor that is rarely found in adults or children. Colonoscopic perforation and biopsy are mandatory for establishing a definitive diagnosis and avoiding medical mismanagement.
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PMID:Adenomatous Polyps in Adolescent Girl and Boy: A Report of Two Cases. 2783 72

We report a case of a 48-year-old female patient, who presented with abdominal pain, jaundice, and lack of appetite. Ultrasound showed intrahepatic biliary dilatation with retroperitoneal lymphadenopathy. Further magnetic resonance cholangiopancreatography detected Klatskin tumor. Computed tomography (CT) confirmed the Klatskin tumor with liver metastases and retroperitoneal lymphadenopathy. Biopsy from the hepatic lesion identified mucinous adenocarcinoma, likely originating from bile ducts. Endoscopic retrograde cholangiopancreatography was performed 3 times with stents placed in the left and right hepatic bile ducts. Later the patient had hematochezia and was referred to colonoscopy. Tubulovillous adenoma with dysplasia was diagnosed with signs of in situ cancer. Preoperative CT was done for further staging: new pulmonary metastases were discovered. Sigmoid colon was resected. Histopathology verified a poorly differentiated mucinous adenocarcinoma within the tubulovillous adenoma. Intraoperative biopsies of porta hepatis mass resembled metastatic lymph nodes in hepatoduodenal ligament, mimicking Klatskin tumor. Retrospective analysis of CT data demonstrated presence of sigmoid colon tumor.
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PMID:Hepatoduodenal lymph node metastasis mimicking Klatskin tumor in a patient with sigmoid colon mucinous cancer. 2882 10

Lipomas of the digestive tract are rare benign tumours which, in most cases, are totally asymptomatic. Because of their localization within the intestinal wall, endoscopy may be completely negative so contrast-enhanced computed tomography (CT) is very important for detecting and typing these lesions. The case of a 49-year-old man with abdominal pain is presented. Colonoscopy and biopsy of a polypoid lesion on the right colonic flexure concluded for tubulovillous adenoma. The subsequent CT showed a polylobate lesion of 5 cm in diameter with predominant fat density causing luminal sub-stenosis. Histological examination of the surgical specimen confirmed the presence of a voluminous submucosal lipoma. CT allows to diagnose lipomas of the large bowel thanks to the density measurement (between -40 and -120 Hunsfield Units) with an accurate detection of the site and nature of lumen stenosis.
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PMID:Lipoma of the transverse colon covered by tubulovillous adenoma: a rare indication for surgical treatment. 2954 84


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