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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Involvement of the posterior compartment is more frequent than the anterior compartment, and rectovaginal scarring is a severe manifestation of endometriosis. The rate of gastrointestinal involvement in endometriosis is quite variable in the literature (3.8–37%) (36). The sigmoid colon is the most common site, followed by the rectum, ileum, appendix, and caecum. The rectum and the sigmoid are the most common locations in 95% of the patients. Appendiceal endometriosis is found in 5–20% of patients (37). Small intestine lesions mostly involve the terminal ileum and account for up to 5–16% of gastrointestinal endometriosis cases. Extremely rare locations that have been reported include the gallbladder, the Meckel diverticulum, stomach, and endometriotic cysts of the pancreas and liver. Twenty-one cases of cystic liver masses were diagnosed as hepatic endometriomas. Gall bladder endometriosis is exceptionally rare (38). Very severe rectovaginal endometriosis can cause difficulty in bowel emptying and, rarely, can present as an obstruction.
Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Another way to get a look at your intestines is for the doctor to do an actual visual exam by performing a sigmoidoscopy, a colonoscopy, or a capsule endoscopy. In both a sigmoidoscopy and a colonoscopy, the doctor inserts a flexible lighted tube into the anus and up through part of the large intestine. Flexible sigmoidoscopy lets the doctor see only the last third of the large intestine (the sigmoid colon). Colonoscopy allows the doctor to see the entire large intestine, and sometimes the terminal ileum (or the last bit of the small intestine) so it’s usually the better procedure, although it does take a bit more time and effort to prepare for it. In both cases, the scope transmits images of the lining of the intestine to a computer or video monitor. The doctor can actually see if there is any inflammation, ulcers, or bleeding. Both procedures also allow the doctor to remove any polyps or other growths and to take very small samples of tissue or biopsies, which can then be looked at carefully under a microscope.
HPB Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
London Lucien Ooi Peng Jin, Teo Jin Yao
There are several issues to consider here: Is the sigmoid colon cancer symptomatic and are the symptoms debilitating, e.g. is there impending obstruction or significant bleeding? This will affect the considerations for timing of resection/management of the primary lesion.What is the tumour burden in the liver and the relative residual liver remnant volume? This has relevance to operability as well as prognosis.Has complete staging been done to determine if this is liver-only metastases or are there metastases elsewhere?
Changes in colonic enteroendocrine cells of patients with irritable bowel syndrome following fecal microbiota transplantation
Published in Scandinavian Journal of Gastroenterology, 2022
Tarek Mazzawi, Trygve Hausken, Magdy El-Salhy
The participants’ selection, screening and transplantation process are detailed in a previous publication [22]. Briefly, 83 patients with diarrhea-predominant and mixed type IBS according to Rome III criteria who were referred to the University Hospital of North Norway at Harstad, were included. They were allocated to receive donor-FMT (either fresh or frozen feces) or placebo FMT (own feces), in a ratio 2:1, by colonoscope to cecum in a double-blinded, randomized, placebo-controlled study after a serial of medical and physical tests to establish eligibility. To standardize the transplantation procedure, feces were collected from only two donors who fulfilled predetermined inclusion criteria. The randomization sequence was sealed in non-transparent envelopes and reveled to researchers when all participants completed a 12-month follow-up. Biopsy samples were obtained from sigmoid colon at baseline as part of the FMT procedure. Using the same cohort of IBS patients in the REFIT study [22], 10 recipients among of the best responders (6 females and 4 males, age range 19–66, mean 44 years old), defined by >100 points improvement in IBS-symptom severity score (IBS-SSS) after FMT compared to baseline, and 10 non-responders (5 females and 5 males, age range 32–69, mean 53 years old) without any changes in IBS-SSS (<100 point change), consented to a new biopsy one year after FMT. They had diarrhea-predominant IBS (n = 10) and mixed-IBS (n = 10) subtypes. Out of these participants (n = 20), 16 received donor-FMT and four received placebo FMT.
A deadly cold
Published in Baylor University Medical Center Proceedings, 2022
Four months after her 53rd birthday, she went to the emergency department reporting a brown vaginal discharge and lower abdominal cramps; pelvic examination showed fecal material entering the vagina from a defect in its posterior wall. Computed tomography confirmed the presence of fecal material in the endometrial cavity, as well as thickening of the wall of the sigmoid colon and adherence of the sigmoid to the posterior aspect of the uterus. Colonoscopy showed a partially obstructing large mass in the sigmoid; biopsy was negative for malignancy. An exploratory laparotomy revealed uterine malignancy with spread to the adherent sigmoid as well as supravesical fat and small bowel mesentery. A colostomy was done, and pathology confirmed squamous cell carcinoma that was deemed cervical in origin. Mia underwent cisplatin-based chemotherapy and radiation therapy but developed lung, liver, and brain metastases before she died nearly 2½ years after the cancer diagnosis.
Faecal immunochemical testing (FIT): sources of result variation based on three years of routine testing of symptomatic patients in English primary care
Published in British Journal of Biomedical Science, 2021
T James, BD Nicholson, R Marr, M Paddon, JE East, S Justice, JL Oke, B Shine
The mean result was below 10 µg/g (negative) in 27 (82%), and six (18%) had mean results above (positive). Four of the six positive results had all three replicates above the threshold and imprecision estimates were calculated: median CV, % of 27.8%, range 20.5% to 48.6%. Two further samples had discrepant result relative to the 10 µg/g NICE threshold. The first had replicates of <1.1, <1.1, 34.5 µg/g (two below the LOD and one above the LOQ). Clinical details of this patient were rectal bleeding and endoscopy showed an 8 mm polyp in the sigmoid. Histology revealed the polyp to be non-dysplastic and hyper-plastic. This patient was discharged. The second of these discrepant results had replicates <1.1, <1.1, 14.7 μg/g (two below the LOD and one positive relative to the NICE threshold of 10 μg/g). This patient was being followed up by an established vague symptoms pathway [20] and whilst nothing abnormal was detected after 9 months of follow-up, at the time of patient assessment they were noted to be taking non-steroidal anti-inflammatory drugs.