Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0232487 (abdominal discomfort)
 1,724 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Villous tumors of the duodenum are extremely rare, only 41 cases having been described in the world literature. Modes of presentation were: gastrointestinal bleeding (11 cases); obstructive jaundice (9 cases); duodenal obstruction (10 cases); vague abdominal discomfort (8 cases) and as an incidental finding on barium study of the upper gastrointestinal tract (2 cases) or at autopsy (1 case). Twelve of the 42 cases were associated with invasive adenocarcinoma. These were confined to patients over 50 years of age. Benign tumors should be treated with local excision while in those harboring adenocarcinoma pancreaticoduodenectomy is the treatment of choice. Endoscopy and biopsy should assume a major role in attempting to obtain an accurate preoperative diagnosis. Caution is advised in that the superficial portions of the tumor may appear benign while deeper portions may contain invasive adenocarcinoma. An additional case with a bizarre presentation is described and the literature reviewed.
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PMID:Villous tumors of the duodenum. 85 Nov 7

Papillotubular adenoma of the ampullary region in a rare tumor which has the potential for malignant transformation. Although reported more frequently nowadays, ampullary tumors are difficult to diagnose before operation unless they cause obstructive jaundice. Occasionally they are detected by ultrasonography, computed tomography or ERCP in patients who complain of nonspecific upper abdominal discomfort. We report a case of a periampullary papillotubular adenoma causing generalized pruritus and weight loss but no jaundice. The tumor was extirpated by pancreaticoduodenectomy, and the patient has remained healthy for over five years.
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PMID:Papillotubular adenoma of the ampullary region. 248 74

Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.
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PMID:Retroperitoneal perforation of the duodenum from biliary stent erosion. 1612 9

A 16-year-old girl presented with abdominal discomfort, weakness, and jaundice. General examination revealed deep icterus with hard lymph nodes in left supraclavicular region. On gastrointestinal examination, we appreciated a hard intra-abdominal lump in the right hypochondrium. Biochemical evaluation showed features of obstructive jaundice. Imaging confirmed the presence of gall bladder lump with multiple intra-abdominal lymph nodes. Fine needle aspiration cytology of neck nodes demonstrated metastatic adenocarcinoma. Fine needle aspiration cytology of the gall bladder lump (done under sonographic guidance) confirmed poorly differentiated adenocarcinoma. To the best of our knowledge, malignancy of the gall bladder has not been reported in individuals less than 18 years in India, and only three cases have been reported worldwide in English literature.
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PMID:Gall bladder Adenocarcinoma in a Young Girl. 2613 73

Chylous ascites as first manifestation of pancreatic carcinoma is very rare. Usual presentations of pancreatic malignancy are abdominal discomfort, back pain, obstructive jaundice and duodenal obstruction. Development of chylous ascites during the course of the disease signifies poor prognosis. Malignancy and tuberculosis are the most common causes of this condition in developed and developing countries, respectively. Diagnosis is made on elevated triglyceride levels in ascitic fluid examination. Management is directed towards the treatment of primary cause and the chylous ascites. High protein and medium chain triglyceride diet is usually advised along with Orlistat for managing this condition. Peritoneovenus shunting can also be done but at the risk of complications. Our patient developed chylous ascites early in the course of the pancreatic carcinoma. CT scan abdomen was non-conclusive and cervical lymph node biopsy later on revealed that the primary disease was occult pancreatic carcinoma. Key Word: Chylous ascites, Triglyceride level, Pancreatic carcinoma.
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PMID:Chylous Ascites: A Rare Initial Presentation of Pancreatic Carcinoma. 3303 89

Obstructive jaundice is characterized by an obstruction of the intrahepatic or extrahepatic biliary system, and the most common causes include pancreatic and duodenal periampullary cancer. There have been some cases reporting obstructive jaundice caused by infection. Deep tissue infection usually develops in the individuals who are immunologically compromised or chronically ill, while a few cases reported in the immunocompetent patients. Those cases were diagnosed by fungal culture or percutaneous biopsy. Here, we presented an interesting case of obstructive jaundice secondary to fungal infection confirmed by postoperative pathological examination. A 79 years old man complaint about upper abdominal discomfort, darkened urine, and skin itch, with a history of esophageal cancer operation 5 years ago. The serology for hepatitis virus and human immunodeficiency virus (HIV) was negative. Imaging examinations showed a nodular located at distal common bile duct. As evidenced by increased level of cancer antigen 19-9 (CA19-9), the patient was highly suspected to be malignant obstructive jaundice. Thus, pylorus preserving pancreaticoduodenectomy (PPPD) was conducted. To our surprise, the ultimate diagnosis was fungal infection at the site of duodenum ampulla by the postoperative pathological examination, with no evidence of malignance. Anti-infective therapy was conducted subsequently, combined by fluconazole, sulperazone and tinidazole. Three weeks later, the patient was generally in good condition and discharged from hospital. During the 2-year follow-up, no fungal infection or tumor recurrence was observed. This case reminded us that fungal infection could be the cause of obstructive jaundice in an elderly person.
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PMID:Obstructive jaundice secondary to fungal infection: a rare case report. 3317 82