BACKGROUND

Enteric duplication cyst is a rare congenital anomaly of the digestive tract, affecting 0.2% of children and 5- 6% of adults, occurring in 1 in 4,500 births. Intussusception is uncommon in adults, accounting for less than 5% of cases, and is found in 1% of bowel obstruction patients. Clinical symptoms in adults can differ from the typical pediatric presentation.

CASE

A 40-year-old female was hospitalized with epigastric pain and vomiting, which began 12 hours prior to admission. She experienced crampy pain, escalating to severe pain radiating to the right upper quadrant, along with 12 episodes of non-bilious vomiting. She had a previous history of acute cholecystitis and no known comorbidities. Upon admission, her blood pressure was elevated, and she had icteric sclerae and a tender right upper quadrant with a mass in the epigastrium. Laboratory findings showed leukocytosis, hypokalemia, hypoalbuminemia, and hyperbilirubinemia. A computed tomography of the whole abdomen with contrast revealed duodenojejunal intussusception with biliary obstruction, along with a duodenal duplication cyst measuring 4.2 x 5.8 cm, acting as the lead point, with invagination of part of the pancreatic head into the intussusception. She was managed with decompression, medications, and intravenous antibiotics. After three days, she underwent exploratory laparotomy, pancreatoduodenectomy, segmental resection of the jejunum, and anastomosis procedures. Histopathology confirmed the duodenal duplication cyst, showing intestinal-type mucosa lining exhibiting ischemic necrosis with no atypia or malignant tumor cells. The patient tolerated the procedure well, and her symptoms resolved. She was discharged on the 14th hospital day in stable condition.

CONCLUSION

Adult duodenojejunal intussusception is a rare disease that is difficult to diagnose due to its nonspecific symptoms and is possible in cases of duplication cysts which can act as a lead point, such as in our patient. Therefore, a high index of suspicion and imaging plays an important role in the diagnosis of a duplication cyst with intussusception in adults especially those presenting with abdominal pain, vomiting, and jaundice. A correct and timely diagnosis is needed to prevent various complications including bowel infarction and sepsis.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdominal Pain ; Cysts ; Female ; Intussusception ; Jaundice ; Jaundice, Obstructive ; Pain ; Research Report

The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Human ; Female ; Adult: 25-44 Yrs Old ; Laparoscopy ; Appendectomy ; Appendix ; Appendicitis ; Abdominal Pain

Introduction: Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly within the fallopian tube. Rare implantation sites include the ovary, cervix, abdominal cavity, and retroperitoneal space. Retroperitoneal ectopic pregnancy (REP) is exceedingly rare and potentially lifethreatening. Its deep location near major vessels and retroperitoneal structures often results in delayed diagnosis due to nonspecific clinical manifestations. Because of its rarity and diagnostic difficulty, documentation of such cases is important to improve clinical recognition and management. Case Description: A 30-year-old gravida presented with a two-week history of severe lumbar pain and difficulty in ambulation, without vaginal bleeding or systemic symptoms. Transabdominal ultrasonography revealed a viable extrauterine gestation located beneath the pancreas, corresponding to a gestational age of 9 weeks and 5 days. Exploratory laparotomy identified a 5 × 4 cm ectopic mass adjacent to the right lateral aspect of the abdominal aorta, which was successfully excised. Histopathologic examination demonstrated immature chorionic villi and extravillous trophoblasts without associated decidual tissue, confirming the diagnosis of retroperitoneal ectopic pregnancy. This represents a rare documented case from Davao del Norte, Philippines. Discussion: The vast majority of ectopic pregnancies occur within the fallopian tube, while retroperitoneal implantation is exceptionally uncommon. Accounting for less than 1% of all ectopic gestations, REP is associated with significant morbidity due to delayed recognition and the technical complexity of surgical management. This case, which followed natural conception and presented solely with lumbar pain, underscores the importance of considering rare implantation sites in women with unexplained abdominal or back pain. Early imaging and prompt surgical intervention are critical to achieving favorable outcomes. Conclusion This report highlights a rare presentation of retroperitoneal ectopic pregnancy and emphasizes the vital role of comprehensive clinical, radiologic, and pathologic correlation in establishing the diagnosis. Increased awareness may facilitate earlier detection and improved management of future cases.
Female ; Pregnancy ; Pregnancy, Abdominal ; Pain

Wunderlich Syndrome is a rare potentially life-threatening phenomenon that involves spontaneous non-traumatic retroperitoneal hemorrhage. At present, identifying the course of conservative management in these patients, especially in pregnancy, has not been clinically established. Presented here is a known case of Tuberous Sclerosis Complex with a Bilateral, 10cm Angiomyolipoma in a 31-year-old female, initially managed with active surveillance. At 27 weeks of pregnancy, she presented with a sudden onset of left flank pain with a hematocrit of 22%. Anemia was corrected with blood transfusions. A contrast-enhanced MRI of the abdomen showed a large subcapsular perirenal hematoma of the left kidney. Renal angioembolization of the bleeding segmental renal artery was done. The patient was conservatized until 37 weeks of pregnancy and underwent cesarean section delivery.

Four months after angioembolization, she had a recurrence of the left flank pain associated with gross hematuria and hypovolemic shock. The patient underwent emergency renal exploration of the left kidney via a transabdominal approach. Three liters of hemoperitoneum and a large expanding left retroperitoneal hematoma were noted intraoperatively. Early vascular control before nephrectomy of the left kidney was done. The postoperative course was unremarkable and the patient was discharged with improved condition.

This case displays a unique course in the management of a bleeding angiomyolipoma especially during pregnancy. Renal angioembolization can aid in achieving the age of viability in pregnancy. However, close monitoring for rebleeding should be kept in mind. A lower threshold for conservative management should be utilized when patients have a previous history of bleeding.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Anemia ; Angiomyolipoma ; Arteries ; Blood ; Blood Transfusion ; Cesarean Section ; Conservative Treatment ; Emergencies ; Female ; Flank Pain ; Hematocrit ; Hematoma ; Hematuria ; Hemoperitoneum ; Hemorrhage ; History ; Hypovolemia ; Insemination, Artificial, Heterologous ; Kidney ; Life ; Nephrectomy ; Pain ; Patients ; Pregnancy ; Recurrence ; Renal Artery ; Research Report ; Sclerosis ; Shock ; Syndrome ; Tuberous Sclerosis ; Watchful Waiting

Duplication of common bile duct is a rare anatomic congenital anomaly of the biliary tree that may present with many types. Such cases are usually clinically silent unless presented with other concomitant conditions that may also be symptomatic in normal variants. Obstruction of the duplicated common bile ducts due to bile duct stones or choledocholithiasis have also been seldom reported. Hence, we present a case of a 42-year-old female, presenting with abdominal pain and jaundice, with incidental finding of duplication of common bile duct Type IV, with choledocholithiases of duplicates on intra-operative cholangiogram. This will be the first in its kind to adequately document and report the intra-operative findings of this anatomic congenital anomaly in our locale.

Human ; Female ; Adult: 25-44 Yrs Old ; Choledocholithiasis ; Cholangiography ; Common Bile Duct ; Biliary Tract ; Bile Ducts ; Abdominal Pain ; Bile

Empathy is crucial for communication and survival for individuals. Whether empathy in pain contagion shows sex differences and its underlying mechanisms remain unclear. Here, we report that pain contagion can occur in stranger female rats, but not in stranger males. Blocking oxytocin receptors in the anterior cingulate cortex (ACC) suppressed pain contagion in female strangers, while oxytocin administration induced pain contagion in male strangers. In vitro, corticosterone reduces neuronal activation by oxytocin. During male stranger interactions, higher corticosterone decreased oxytocin receptor-positive neuronal activity in the ACC, suppressing pain contagion. These findings highlight the role of oxytocin in pain contagion and suggest that sex differences in empathy may be determined by the balance of oxytocin and corticosterone in the ACC. This study suggests an approach for the treatment of certain mental disorders associated with abnormal empathy, such as autism and depression.
Animals ; Oxytocin/pharmacology* ; Gyrus Cinguli/drug effects* ; Male ; Female ; Corticosterone/pharmacology* ; Empathy/drug effects* ; Sex Characteristics ; Receptors, Oxytocin/antagonists & inhibitors* ; Pain/psychology* ; Rats ; Rats, Sprague-Dawley ; Neurons/metabolism*

Chronic pain, frequently comorbid with neuropsychiatric disorders, significantly impairs patients' quality of life and functional capacity. Accumulating evidence implicates the chemokine CCL2 and its receptor CCR2 as key players in chronic pain pathogenesis. This review examines the regulatory mechanisms of the CCL2/CCR2 axis in chronic pain processing at three hierarchical levels: (1) Peripheral Sensitization: CCL2/CCR2 modulates TRPV1, Nav1.8, and HCN2 channels to increase neuronal excitability and CGRP signaling and calcium-dependent exocytosis in peripheral nociceptors to transmit pain. (2) Spinal Cord Central Sensitization: CCL2/CCR2 contributes to NMDAR-dependent plasticity, glial activation, GABAergic disinhibition, and opioid receptor desensitization. (3) Supraspinal Central Networks: CCL2/CCR2 signaling axis mediates the comorbidity mechanisms of pain with anxiety and cognitive impairment within brain regions, including the ACC, CeA, NAc, and hippocampus, and it also increases pain sensitization through the descending facilitation system. Current CCL2/CCR2-targeted therapeutic strategies and their development status are discussed, highlighting novel avenues for chronic pain management.
Humans ; Chronic Pain/physiopathology* ; Animals ; Neuroglia/metabolism* ; Chemokine CCL2/metabolism* ; Receptors, CCR2/metabolism*

Temporomandibular joint osteoarthritis (TMJ-OA) is a common disease often accompanied by pain, seriously affecting physical and mental health of patients. Abnormal innervation at the osteochondral junction has been considered as a predominant origin of arthralgia, while the specific mechanism mediating pain remains unclear. To investigate the underlying mechanism of TMJ-OA pain, an abnormal joint loading model was used to induce TMJ-OA pain. We found that during the development of TMJ-OA, the increased innervation of sympathetic nerve of subchondral bone precedes that of sensory nerves. Furthermore, these two types of nerves are spatially closely associated. Additionally, it was discovered that activation of sympathetic neural signals promotes osteoarthritic pain in mice, whereas blocking these signals effectively alleviates pain. In vitro experiments also confirmed that norepinephrine released by sympathetic neurons promotes the activation and axonal growth of sensory neurons. Moreover, we also discovered that through releasing norepinephrine, regional sympathetic nerves of subchondral bone were found to regulate growth and activation of local sensory nerves synergistically with other pain regulators. This study identified the role of regional sympathetic nerves in mediating pain in TMJ-OA. It sheds light on a new mechanism of abnormal innervation at the osteochondral junction and the regional crosstalk between peripheral nerves, providing a potential target for treating TMJ-OA pain.
Animals ; Osteoarthritis/physiopathology* ; Mice ; Sympathetic Nervous System/physiopathology* ; Temporomandibular Joint Disorders/physiopathology* ; Arthralgia ; Sensory Receptor Cells ; Disease Models, Animal ; Norepinephrine ; Male ; Temporomandibular Joint/physiopathology* ; Pain Measurement

The primary clinical manifestation of osteoarthritis (OA) is pain, yet considerable variability exists in the pain experience among OA patients. This narrative review aims to explore the mechanisms driving OA pain heterogeneity to inform the development of targeted interventions that improve treatment efficacy and patient outcomes. A comprehensive literature search was conducted across multiple databases (PubMed, Scopus, and Google Scholar) for papers published between January 1, 2020, and December 31, 2024. Inclusion criteria focused on studies addressing pain mechanisms and therapeutic interventions in OA. This review identifies key mechanisms of OA pain, including joint alterations, angiogenesis, nervous system involvement, peripheral and central sensitization, and psychosocial factors. It highlights the underlying distinct mechanisms in OA pain, which contribute to the variability in individuals' responses to treatment. It was suggested that interactions between neuroimmune and neurovascular systems are key contributors to chronic pain in OA. This narrative review emphasizes the complexity of OA pain, highlighting the importance of thoroughly understanding the underlying mechanisms for developing personalized and effective pain management strategies. Additional research is required to refine treatment approaches and explore long-term effects.
Humans ; Osteoarthritis/complications* ; Pain Management/methods* ; Chronic Pain/etiology*