BACKGROUND Xanthogranulomatous inflammation(XGI)is an uncommon process involving an accumulation of inflammatory cells,commonly lipid-laden macrophages.XGI has been described to occur throughout the body but only rare...BACKGROUND Xanthogranulomatous inflammation(XGI)is an uncommon process involving an accumulation of inflammatory cells,commonly lipid-laden macrophages.XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract.We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum,in which the patient had an initial diagnostic laparoscopy,continued to have symptoms,then proceeded to have the definitive treatment.To our knowledge,this is the first report of XGI associated with a prior small bowel anastomosis.CASE SUMMARY We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers.She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior.Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis.She underwent a laparotomy,resection of the prior anastomosis and re-anastomosis,with final histopathological examination findings consistent with mural XGI.CONCLUSION XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.展开更多
BACKGROUND The ongoing coronavirus disease 2019(COVID-19)pandemic has significantly disrupted both elective and acute medical care.Data from the early months suggest that acute care patient populations deferred presen...BACKGROUND The ongoing coronavirus disease 2019(COVID-19)pandemic has significantly disrupted both elective and acute medical care.Data from the early months suggest that acute care patient populations deferred presenting to the emergency department(ED),portending more severe disease at the time of presentation.Additionally,care for this patient population trended towards initial non-operative management.AIM To examine the presentation,management,and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic.METHODS A retrospective chart review of patients diagnosed with acute cholecystitis,symptomatic cholelithiasis,or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June,2020 and in the same months of 2019.Patients were selected through a research repository using international classification of diseases(ICD)-9 and ICD-10 codes.Across both years,313 patients were identified with either type of gallbladder disease,while 361 patients were identified with acute appendicitis.The primary outcome was overall incidence of disease.Secondary outcomes included presentation,management,complications,and 30-d re-presentation rates.Relationships between different variables were explored using Pearson’s r correlation coefficient.Variables were compared using the Welch’s t-Test,Chi-squared tests,and Fisher’s exact test as appropriate.RESULTS Patients with gallbladder disease and appendicitis both had more severe presentations in 2020.With respect to gallbladder disease,more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort[50%(80)vs 35%(53);P=0.01].Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores[mean(SD)1.39(0.56)vs 1.16(0.44);P=0.02].With respect to appendicitis,more patients were diagnosed with a perforated appendix at presentation in 2020[20%(36)vs 16%(29);P=0.02]and a greater percentage were classified as emergent cases using the emergency severity index[63%(112)vs 13%(23);P<0.001].While a greater percentage of patients were admitted to the hospital for gallbladder disease in 2020[65%(104)vs 50%(76);P=0.02],no significant differences were observed in hospital admissions for patients with appendicitis.No significant differences were observed in length of hospital stay or operative rate for either group.However,for patients with appendicitis,30-d re-presentation rates were significantly higher in 2020[13%(23)vs 4%(8);P=0.01].CONCLUSION During the COVID-19 pandemic,patients presented with more severe gallbladder disease and appendicitis.These findings suggest that the pandemic has affected patients with acute surgical conditions.展开更多
文摘BACKGROUND Xanthogranulomatous inflammation(XGI)is an uncommon process involving an accumulation of inflammatory cells,commonly lipid-laden macrophages.XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract.We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum,in which the patient had an initial diagnostic laparoscopy,continued to have symptoms,then proceeded to have the definitive treatment.To our knowledge,this is the first report of XGI associated with a prior small bowel anastomosis.CASE SUMMARY We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers.She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior.Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis.She underwent a laparotomy,resection of the prior anastomosis and re-anastomosis,with final histopathological examination findings consistent with mural XGI.CONCLUSION XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.
文摘BACKGROUND The ongoing coronavirus disease 2019(COVID-19)pandemic has significantly disrupted both elective and acute medical care.Data from the early months suggest that acute care patient populations deferred presenting to the emergency department(ED),portending more severe disease at the time of presentation.Additionally,care for this patient population trended towards initial non-operative management.AIM To examine the presentation,management,and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic.METHODS A retrospective chart review of patients diagnosed with acute cholecystitis,symptomatic cholelithiasis,or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June,2020 and in the same months of 2019.Patients were selected through a research repository using international classification of diseases(ICD)-9 and ICD-10 codes.Across both years,313 patients were identified with either type of gallbladder disease,while 361 patients were identified with acute appendicitis.The primary outcome was overall incidence of disease.Secondary outcomes included presentation,management,complications,and 30-d re-presentation rates.Relationships between different variables were explored using Pearson’s r correlation coefficient.Variables were compared using the Welch’s t-Test,Chi-squared tests,and Fisher’s exact test as appropriate.RESULTS Patients with gallbladder disease and appendicitis both had more severe presentations in 2020.With respect to gallbladder disease,more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort[50%(80)vs 35%(53);P=0.01].Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores[mean(SD)1.39(0.56)vs 1.16(0.44);P=0.02].With respect to appendicitis,more patients were diagnosed with a perforated appendix at presentation in 2020[20%(36)vs 16%(29);P=0.02]and a greater percentage were classified as emergent cases using the emergency severity index[63%(112)vs 13%(23);P<0.001].While a greater percentage of patients were admitted to the hospital for gallbladder disease in 2020[65%(104)vs 50%(76);P=0.02],no significant differences were observed in hospital admissions for patients with appendicitis.No significant differences were observed in length of hospital stay or operative rate for either group.However,for patients with appendicitis,30-d re-presentation rates were significantly higher in 2020[13%(23)vs 4%(8);P=0.01].CONCLUSION During the COVID-19 pandemic,patients presented with more severe gallbladder disease and appendicitis.These findings suggest that the pandemic has affected patients with acute surgical conditions.
