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41/137. Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review.

    Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind.
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42/137. A case of metastatic squamous cell carcinoma of the hypopharynx manifesting as acute abdomen.

    INTRODUCTION: Squamous cell head and neck cancers are usually confined to local and regional sites but occasionally, patients may present with rare manifestations of distant metastases. CLINICAL PICTURE: A 23-year-old female was treated with concurrent chemo-radiotherapy for stage IVA post-cricoid squamous cell carcinoma. A month later, she presented with acute abdomen and was found to have extensive peritoneal nodules at laparotomy. intestinal obstruction soon followed. TREATMENT: She was managed conservatively for the intestinal obstruction and given weekly paclitaxel. OUTCOME: She continued to deteriorate and succumbed shortly after the diagnosis of carcinomatosis peritoneii. CONCLUSION: This rare and aggressive presentation reminds us to be cognizant of relapsed head and neck cancers manifesting atypically, and the need for more aggressive search of distant disease in at least some subgroups of head and neck cancer.
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43/137. Intestinal ischemia as the first manifestation of vasculitis.

    OBJECTIVE: To summarize current knowledge regarding the diagnosis and management of gastrointestinal vasculitis. methods: Three cases of gastrointestinal vasculitis with acute abdominal ischemia as their first manifestation are presented. Underlying diseases were microscopic polyangiitis, systemic lupus erythematosus (SLE), and polyarteritis nodosa (PAN). Relevant English-language articles collected from the pubmed database were reviewed. RESULTS: Among the angiitides, PAN, SLE, and Henoch-Schonlein are those most commonly accompanied by gastrointestinal complications. Intestinal vasculitis usually occurs when there is evidence of generalized disease activity. Abdominal computerized tomography is a valuable tool for diagnosing intestinal ischemia and suspected vasculitis. CONCLUSIONS: In young patients presenting with intestinal ischemia, it is essential to assess the possibility of an underlying systemic disease. With prompt initiation of immunosuppressive treatment, surgery may be avoided. prognosis is improved when there is minimal delay in surgical intervention.
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44/137. Eosinophilic enteritis presenting as acute abdomen: US features of two cases.

    Eosinophilic enteritis is a rare disease which may mimic acute abdominal emergency. Two sonographically documented cases are presented, which were subsequently proven at operation. Although the sonographic features of severe echolucent bowel wall thickening were not specific, combination with clinical and laboratory data may suggest the correct diagnosis.
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45/137. Addison's disease presenting with an acute abdomen and complicated by cardiomyopathy.

    adrenal insufficiency typically presents with non-specific symptoms, followed by shock secondary to a salt-wasting crisis and/or the vascular effects of glucocorticoid deficiency if it progresses to acute adrenal insufficiency. rhabdomyolysis and cardiac dysfunction are rarely reported, particularly in children. We report a child with adrenal insufficiency, presenting with acute abdominal signs, probably secondary to rhabdomyolysis, and complicated by reversible cardiomyopathy. Acute adrenal insufficiency should be considered with this presentation. The possibility of impaired cardiac function during its treatment should also be considered.
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46/137. adenocarcinoma of the appendix in pregnancy: a case report.

    BACKGROUND: Perforation of an adenocarcinoma of the appendix in a pregnant woman is rare and may present as a pelvic mass and acute appendicitis. CASE: A 30-year-old woman, gravida 3, para 2-0-0-2, presented at 26 weeks' gestation with an acute abdomen, right-sided pelvic mass and uterine contractions. tocolysis and prompt surgical exploration revealed a perforated appendix. The patient underwent a right hemicolectomy with primary anastomosis, her postoperative course was benign, and she delivered a viable infant at term vaginally. pathology revealed a perforated adenocarcinoma of the appendix. The patient was free of disease at 36 months. CONCLUSION: adenocarcinoma of the appendix in pregnancy is rare, may present as an acute abdomen with a mass and is managed with right hemicolectomy.
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47/137. Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence.

    Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis.
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48/137. Tubo-ovarian abscess mimicking ovarian tumor in a sexually inactive girl.

    Tubo-ovarian abscess is a serious complication of pelvic inflammatory disease rarely seen in sexually inactive girls. early diagnosis and treatment are essential to prevent further sequela including infertility, ectopic pregnancy, and chronic pelvic pain. We present a case of 19-year-old sexually inactive girl who presented with abdominal pain and pelvic mass resembling ovarian tumor. Unilateral tubo-ovarian abscess with extensive bowel adhesions was determined at laparotomy. drainage of the abscess and postoperative antibiotic therapy cured the patient.
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49/137. Polymicrobial bacteremia caused by escherichia coli, edwardsiella tarda, and shewanella putrefaciens.

    edwardsiella tarda, a member of enterobacteriaceae, is found in freshwater and marine environments and in animals living in these environments. This bacterium is primarily associated with gastrointestinal diseases, and has been isolated from stool specimens obtained from persons with or without clinical infectious diseases. shewanella putrefaciens, a saprophytic gram-negative rod, is rarely responsible for clinical syndromes in humans. Debilitated status and exposure to aquatic environments are the major predisposing factors for E. tarda or S. putrefaciens infection. A 61-year-old woman was febrile with diarrhea 8 hours after ingesting shark meat, and two sets of blood cultures grew escherichia coli, E. tarda and S. putrefaciens at the same time. She was successfully treated with antibiotics. We present this rare case of polymicrobial bacteremia caused by E. coli, E. tarda and S. putrefaciens without underlying disease, which is the first found in taiwan. This rare case of febrile diarrhea with consequent polymicrobial bacteremia emphasizes that attention should always be extended to these unusual pathogens.
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50/137. Rare cause of abdominal pain in childhood: computed tomography findings in a 14-year-old boy with a colonic carcinoma.

    Carcinoma of the colon during infancy and childhood is a rare disease, and the diagnosis is usually not taken into consideration in a child complaining of abdominal pain. Owing to the lack of awareness of its occurrence and the histological cell type, it generally presents as advanced disease. We report on the case of a 14-year-old patient admitted to hospital with an acute abdomen and a 2-month history of night sweats and weight loss of 10 kg. Ultrasound and computed tomography revealed an unclear mass of the lower abdomen, and colonoscopic histopathologic examination disclosed an obstructing tubular-papillary adenocarcinoma of the sigmoid colon. Colonic carcinoma should be included as a differential diagnosis in young patients with abdominal pain of unknown etiology.
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