1/340. Ovarian strumal carcinoid with severe constipation: immunohistochemical and mRNA analyses of peptide yy. Functioning ovarian carcinoid tumors are well known to cause carcinoid syndrome. Recently, strumal and trabecular ovarian carcinoid tumors are reported to cause severe constipation possibly because of tumor-producing peptide yy (PYY). We studied a case of primary ovarian strumal carcinoid who had had severe constipation until the tumor was removed by surgical operation. Immunohistochemically, many tumor cells were strongly positive for PYY. By Northern blot and reverse transcription polymerase chain reaction analyses, PYY mRNA was expressed in a complete form as detected in normal human colon mucosa. From these findings, an ovarian strumal carcinoid is strongly suggested to express complete PYY mRNA and therefore complete PYY protein that results in severe constipation. ( info) |
2/340. Sigmoid colon cancer presenting as complete rectal prolapse: report of a case. We describe herein the unusual case of a 76-year-old woman who was diagnosed as having sigmoid colon cancer after presenting with complete rectal prolapse. The rectal prolapse was considered to have been caused by constipation accelerated by the colon cancer. The relationship between colorectal cancer and rectal prolapse has not yet been clarified; however, this case report suggests that rectal prolapse can present as a symptom of colorectal cancer. Thus, patients with a sudden onset of rectal prolapse should be screened for colorectal cancer. ( info) |
3/340. Continuous inferior mesenteric ganglion block for the control of abdominal pain. BACKGROUND AND OBJECTIVES: A 71-year-old woman was referred for control of intractable left-sided abdominal pain and constipation caused by stage 2B rectosigmoid colon cancer. She was treated with an intravenous morphine sulfate infusion at 4 mg/h which made her drowsy and lethargic. Because the distal colon is innervated by the inferior mesenteric sympathetic ganglion, it was hypothesized that a continuous block of this ganglion would provide both pain control and increased intestinal motility. methods: The patient was placed in a prone position, and a Tuohy needle was placed at an entry site 7 cm lateral to the L3 spinous process. The needle was advanced 2 cm anterior to the L3 vertebral body with fluoroscopic guidance. An 18-gauge indwelling catheter was placed through the needle and a continuous infusion with 0.1% bupivacaine was maintained for 4 days. RESULTS: The patient obtained immediate pain relief and bowel motility. She remained awake and comfortable throughout the duration of therapy. She was discharged home 3 days after stopping the infusion and required a minimal amount of opioids. CONCLUSION: Continuous inferior mesenteric ganglion block may be an option in providing relief for pain caused by distal colon pathology. ( info) |
| Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately. ( info) |
5/340. An unusual case of colonic duplication causing chronic constipation in a child. A case of colonic duplication producing chronic constipation in a 8-year-old boy is presented. barium enema studies demonstrated a long tubular shape of duplication that branched out from the lower part of descending colon. Successful surgical treatment was achieved by excision of the duplication with a portion of adjacent bowel and an end-to-end anastomosis. ( info) |
6/340. Acute hyperphosphatemia caused by sodium phosphate enema in a patient with liver dysfunction and chronic renal failure. We report a case of acute hyperphosphatemia secondary to rectal administration of sodium phosphate and sodium biphosphate (Fleet enema). parathyroid hormone and calcitonin levels were measured along with phosphate clearance and the tubular reabsorption of phosphate. ( info) |
7/340. Reduction in constipation and laxative requirements following opioid rotation to methadone: a report of four cases. constipation is a common symptom in cancer patients, especially in those who are receiving opioid analgesics for pain. Although several articles have recently examined constipation with respect to causation and treatment, little research has been done to elucidate the effects of different opioids on the bowel. Recent research has found that laxative doses may be lower in patients using methadone as an analgesic, but changes in constipation were not measured. We report here on four cases in which patients had improvement in constipation and decreased laxative requirements following opioid rotation to methadone. ( info) |
8/340. Coccygeal fracture, constipation, convulsion, and confusion: a case report of malignant hypertension in a child. Malignant hypertension is an unusual but well described cause of seizures in pediatrics. It is a medical emergency that must be recognized and emergently treated to prevent morbidity and mortality. In contrast to adults, hypertension in children is usually secondary to an underlying disease process. We present a complex case of hypertensive encephalopathy with seizures as the initial presentation of a pelvic mass, describe the initial work-up and stabilization and present an overview of the literature. review of the medical literature described only one similar presentation (1). Interestingly, acute symptoms in this patient may have been precipitated by use of an over-the-counter medication. ( info) |
9/340. Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation: further clinical and histological characterization in a patient. Hereditary internal anal sphincter myopathy is a very rare condition, only three families have so far been described in the literature. In this case report further clinical and histological findings of one affected member of one of the above families are presented. ( info) |
10/340. Scintigraphic evaluation of colonic transit in two patients with idiopathic chronic constipation. Bowel transit in two women with protracted constipation was evaluated after oral administration of In-111 DTPA in water. Serial abdominal images were obtained for as long as 96 hours to assess transit through the stomach, small bowel, and colon. In both patients, large bowel transit was delayed. A pattern of colonic inertia was observed in one patient, whereas retention in the distal colon was seen in the other patient. Both patients underwent total colectomy with marked symptomatic relief. Colonic transit studies of these patients are presented, and the literature is reviewed. ( info) |