Publications by authors named "Orlando Fleites"

Acute onset of abdominal pain with emesis and lack of stool or flatus is an alarming presentation for possible small bowel obstruction (SBO). SBO should be high on the differential diagnosis due to concomitant signs and symptoms that are highly sensitive in diagnosing SBO. These include diffuse tenderness on palpation of the abdomen, abdominal distention, hypotension, vomiting, and lack of flatus or stool.

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Recurrent abdominal pain in the adult population is a complex symptom with a broad spectrum of diagnoses. The diagnosis of intussusception in the elderly is considerably rarer than in the younger population. High clinical suspicion is required, and imaging is needed for confirmation.

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Bariatric surgery for the treatment of obesity, first introduced in the 1950s and 1960s, is now relatively commonplace. Often patients will first have an adjustable gastric band inserted, as this does not require altering or removing parts of the gastrointestinal tract. This procedure is associated with short hospital stays and quick recoveries and may be adjusted without further surgery.

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Small bowel obstruction (SBO), of both partial and complete types, is a condition predominantly caused by intra-abdominal adhesions and hernias. However, a known but very uncommon cause of SBO is malignancies, which are more complicated than those caused by adhesions and hernias, and associated with poorer prognoses; of these, small bowel adenocarcinoma is an even rarer etiology of SBO. The majority of SBO cases that are treated have resolution of symptoms and do not have recurrence/persistence of the condition; however, reports suggest that approximately one-fifth of SBO cases that are treated will result in recurrence/persistence of SBO requiring repeat admission.

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We present a case in which a 55-year-old male with a past medical history of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) presented with sharp, worsening right-sided abdominal pain radiating across the entire abdomen after eating peanuts. Computed tomography (CT) imaging showed evidence of acute sigmoid diverticulitis complicated by a walled-off perforation. The patient's past medical history suggested previous recurrent episodes of diverticulitis.

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Chronic appendicitis is a rare condition involving appendiceal inflammation as these conditions typically present acutely and are treated with appendectomy. However, in a small minority of patients, appendicitis can have a mild presentation and become recurrent or chronic appendicitis. Due to the acute nature and immediate treatment of patients presenting with typical symptoms of appendicitis, chronic appendicitis has been often overlooked and/or misdiagnosed.

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