Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Ejekhile Ojo, MPH, BS, OMS-III; John Gallaspy, MD; Gwenn Jackson, MD 1 VCOM-Louisiana; 2 Department of Obstetrics and Gynecology, Christus St. Frances Cabrini Hospital, Alexandria, LA 67 UNEXPECTED RESOLUTION OF PROTEINURIA IN A PREECLAMPTIC PATIENT FOLLOWING LACTULOSE THERAPY: A CASE REPORT

Da’Shira A. Brown, OMS-III 1 ; M. Andrew Sicard, MD 2 ; S. Singhal, MD 2 1 VCOM-Louisiana; Department of General Surgery, Opelousas General Hospital, Opelousas, LA 2 66 ACUTE GASTRIC NECROSIS: A GI EMERGENCY

Impact: Acute gastric necrosis is a rare condition, often diagnosed intraoperatively. Due to its rarity, diagnosis is frequently delayed and typically made only at laparotomy. Several causes have been reported such as acute gastric dilation, acute necrotizing gastritis, and ingestion of caustic agents. According to some authors, gastric perforation occurs more frequently on the lesser curvature due to its reduced elasticity coefficient and its greater stretching compared with other parts of the stomach. However, research on anterior gastric perforation and necrosis as reported in this case is limited. Conservative therapies may be applied, but surgery is the definitive treatment. Studies indicate that the primary outcomes of acute gastric necrosis include perforation, hemorrhage, infection, sepsis, and a 50 80% risk of death without prompt treatment. This case highlights the critical importance of tailoring treatment to the patient’s specific presentation to minimize mortality risks. Case: A 32-year-old female inmate arrived at the ED with altered mental status, seizure-like activity, and abdominal discomfort. Due to a distended abdomen, abnormal biochemical

tests and pneumoperitoneum on imaging, an exploratory laparotomy was performed. Intraoperatively, examination revealed necrosis of the anterior surface of the stomach and a perforation in the central aspect of the gastric body. The small bowel and colon remained viable, although appearing irritated from the gastric contents. The surgical team elected to perform a partial gastrectomy to remove the necrotic portion of the stomach. The gastric cardia, fundus, and antrum were still viable and left intact. The patient underwent abdominal lavage and was left in discontinuity with future plans to anastomosis. Postoperative recovery was complicated by continuous intrabdominal infection requiring IV antibiotics and antifungals. The patient slowly improved and eventually was transferred to a higher level of care for definitive surgery. Comments: The stomach is a well-vascularized organ; hence, infarction of the stomach is an uncommon phenomenon compared to other parts of the gastrointestinal tract. Acute gastric necrosis presents non-specific symptoms like epigastric pain, nausea, and possible peritonitis. The condition is characterized by

ischemic necrosis of the gastric mucosa and subsequent perforation if left untreated. Due to our patient’s history of polysubstance abuse, acute gastroenteritis and EGD findings, the etiology was likely multifactorial. Although ischemia is often caused by rapid gastric dilation, ingestion of caustic agents can also cause immediate gastric perforation. Early imaging and biochemical tests were important in deciding between conservative and surgical intervention. However, imaging alluded to that perforation had already occurred, so it was no longer an adequate option. A total gastrectomy could be the safest option, but it is also the most invasive treatment. Patients undergoing a partial gastric resection experience a better quality of life when discharged, since part of the stomach is still preserved. Thus, partial gastrectomy was done to preserve as much healthy tissue as possible. Additionally, the management of acute gastric necrosis involves the establishment of GI continuity or proximal diversion with a distal stoma, but our patient was too unstable, and the viability of the remaining esophagus and stomach was questionable for a good anastomosis.

Background: Preeclampsia, a pregnancy related disorder affecting 5-7% of pregnancies, is characterized by hypertension and proteinuria, with the latter being a key marker of renal involvement. Spontaneous resolution of proteinuria during pregnancy is rare. This case report discusses an unexpected resolution of proteinuria following lactulose therapy in a preeclamptic patient. Case: A 28-year-old gravida 3, para 1-1-0-1 woman at 28 weeks of gestation presented for routine prenatal care. Her medical history included severe preeclampsia after her second pregnancy, cholelithiasis, gestational anemia, and hypertension. Initial assessments revealed proteinuria of 411 mg in a 24-hour urine collection, alongside elevated blood pressure and preeclampsia-related headaches. Following the initiation of lactulose therapy, prescribed for its perceived renoprotective effects, the patient’s proteinuria decreased significantly to 223 mg at 32 weeks and improved to 182 mg by 34 weeks, with stable blood pressure and no additional interventions.

Discussion: This case raises questions about the potential systemic effects of lactulose on renal function during pregnancy. While lactulose is not conventionally used to treat proteinuria, its impact on the gut microbiome and systemic inflammation may provide an indirect benefit to renal health. Conclusion: The reduction in proteinuria following lactulose therapy in this preeclamptic patient underscores the need for further investigation into the therapeutic potential of lactulose in managing proteinuria and improving outcomes in preeclampsia. Larger, controlled studies are essential to determine the underlying mechanisms and establish guidelines for potential clinical applications.

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2025 Research Recognition Day