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Perforated cecal carcinoma presenting as thigh emphysema.

Gastrointestinal perforation into the retroperitoneum may present as thigh emphysema. In the elderly, abdominal symptoms may be minimal. We report a patient with a perforated cecal carcinoma presenting as right hip pain with thigh emphysema. A diagnosis of perforated intra-abdominal viscus was suspected from the radiographs. The patient initially did well after surgery, which included a hemicolectomy and debridement of necrotic muscle down to the knee. He later succumbed from cardiac arrest following a dyspneic episode.

Adenocarcinoma↗

Early vasculitis in the mercuric chloride induced Brown Norway rat model is neutrophil independent.

In the Brown Norway rat, mercuric chloride (HgCl2) induces an autoimmune syndrome characterized by necrotizing vasculitis, predominantly affecting the caecum, and a polyclonal B-cell response. The time course of vasculitis is biphasic, with an alphabeta T-cell independent phase occurring within 24 h, and a T-cell and neutrophil dependent phase, maximal at two weeks. The pathogenesis of the early phase of vasculitis is unclear, and this study aims to examine the role of neutrophils. Rat neutrophils were depleted using cyclophosphamide. RP3, an antirat neutrophil monoclonal antibody, inhibited neutrophil leucocytosis but did not deplete neutrophils. Vasculitis was induced by subcutaneous HgCl2 injection. Serial measurements of peripheral blood leucocyte count were made. Rats were killed after 24 or 72 h. The macroscopic appearance of the caecum was scored by an experienced observer, and samples taken for histological examination. Caecums were excised and myeloperoxidase, a marker enzyme for neutrophil infiltration, assayed. Cyclophosphamide induced marked neutropaenia whereas RP3 inhibited the neutrophilia observed after HgCl2 injection. Vasculitis was present in both treated and control animals, with no significant differences in macroscopic or microscopic scores between the groups. Tissue myeloperoxidase activity was low in all animals and did not differ significantly between groups. The data do not support a role for neutrophils in the initial pathogenesis of vasculitis in this model.

Animals↗

Colonic carcinoma with granulomatous (sarcoid) reaction.

A 74 year old man had a right hemicolectomy for a caecal adenocarcinoma. Microscopic examination also revealed non-caseating epithelioid granulomatas within the adjacent stroma and some of these granulomata contained centrally located malignant cells. Granulomatous inflammation was not present within the lymph nodes and the importance of this rare occurrence is discussed.

Adenocarcinoma↗

Diagnosis and treatment of caecal volvulus.

Caecal volvulus is an infrequently encountered clinical condition and an uncommon cause of intestinal obstruction. Patients with this condition may present with highly variable clinical presentations ranging from intermittent, self limiting abdominal pain to acute abdominal pain associated with intestinal strangulation and sepsis. Lack of familiarity with this condition is a factor contributing to diagnostic and treatment delays. The objective of this review is to promote clinicians' awareness of this disease through patient case illustration, discussion of disease pathogenesis, clinical features, and management strategies.

Acute Disease↗

Intestinal obstruction in cattle.

Based on a series of 100 cases, the paper reviews the causes, diagnosis and treatment of apparent bowel obstruction in cattle with particular emphasis on non-obstructive tympanitic disorders of the intestine.

Acidosis↗

Clinical findings in cattle with dilatation and torsion of the caecum.

Dilatation and torsion of the caecum is usually an acute illness with signs of ileus and this paper presents the clinical findings from 111 heifers and cows with the condition. On admission 61 per cent of the animals had been ill for less than 24 hours; the general condition was disturbed in 58 per cent of the animals, 39 per cent showed signs of colic; the rectal temperature was abnormal in 55 per cent, the heart rate in 40 per cent and the respiration rate in 52 per cent of the animals; rumen motility was reduced or absent in 85 per cent. One or more tests for foreign bodies were positive in 58 per cent, and swinging auscultation and percussion auscultation on the right side, either alone or in combination, were positive in 83 per cent of the animals. On rectal examination it was possible to palpate a pathologically distended, displaced or twisted caecum in 95 per cent of the animals. In 87 per cent defecation was reduced or absent. The most reliable diagnostic investigations were rectal examination and swinging and percussion auscultation on the right side.

Animals↗