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Mind the Gap: Successful Endoscopic Closure of a Large Gastric Sleeve Leak Using an Endoscopic Stent and Over-the-Scope Clips
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is regarded as a simple, low-cost procedure achieving significant weight loss within a short period of time. LSG is considered a safe procedure with a relatively low complication rate. The complications encountered nevertheless can result in significant morbidity and may even be lethal. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a case of a 31-year-old patient complicated by a 3.06 cm staple-line leak 10 days after LSG. Review of the c...
Source: Case Reports in Gastroenterology - December 7, 2017 Category: Gastroenterology Source Type: research

Disease Control on Lanreotide Autogel ® 120 mg in a Patient with Metastatic Gastrinoma: A Case Report
We report a disease control on a long-acting SSA lanreotide in a patient with metastatic gastrinoma. A 60-year-old man, who had previously undergone a surgical resection of metastatic pancreatic gastrinoma, presented with abdominal bloating, edema in the lower limbs, fatigue, and weight loss. The gastrinoma relapse with additional metastases in the pancreas, duodenum, and liver was confirmed by positron emission tomography-computed tomography (PET-CT) scan; the patient ’s blood gastrin level was #x3e;5,000 ng/L. Treatment with the SSA octreotide long-acting release was initiated to treat the gastrinoma relapse. On th...
Source: Case Reports in Gastroenterology - December 6, 2017 Category: Gastroenterology Source Type: research

Pancreatic Pseudocyst Ruptured due to Acute Intracystic Hemorrhage
Rupture of pancreatic pseudocyst is one of the rare complications and usually results in high mortality. The present case was a rupture of pancreatic pseudocyst that could be treated by surgical intervention. A 74-year-old man developed abdominal pain, vomiting, and diarrhea, and he was diagnosed with cholecystitis and pneumonia. Three days later, acute pancreatitis occurred and computed tomography (CT) showed slight hemorrhage in the cyst of the pancreatic tail. After another 10 days, CT showed pancreatic cyst ruptured due to intracystic hemorrhage. Endoscopic retrograde cholangiopancreatography revealed leakage of contra...
Source: Case Reports in Gastroenterology - December 1, 2017 Category: Gastroenterology Source Type: research

Esophageal Metastatic Adenocarcinoma Diagnosed with Endoscopic Ultrasound
We present a case series of metastatic esophageal strictures diagnosed with EUS and FNA.Case Rep Gastroenterol 2017;11:686 –692 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Successful Treatment of Oral Lichen Planus with Direct-Acting Antiviral Agents after Liver Transplantation for Hepatitis C Virus-Associated Hepatocellular Carcinoma
Hepatitis C virus (HCV) infection is frequently associated with various extrahepatic manifestations, such as autoimmune features and immune complex deposit diseases. Oral lichen planus (OLP) is one such extrahepatic manifestation of HCV infection. Recently, direct-acting antivirals (DAA) have proved to be highly effective and safe for the eradication of HCV. Herein, we report a case of OLP accompanied by HCV-related hepatocellular carcinoma (HCC) that disappeared after liver transplantation and achievement of sustained virological response following interferon (IFN)-free treatment with ledipasvir (LDV) and sofosbuvir (SOF)...
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Long-Term Colon Stent Patency for Obstructing Colorectal Cancer Combined with Bevacizumab
We report a 65-year-old woman with a metastatic, obstructing colon tumor who has been successfully treated with stent placement and chemoimmunotherapy consisting of capecitabine and bevacizumab for 8 years.Case Rep Gastroenterol 2017;11:703 –709 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis
We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pylo...
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Multilocular Hepatic Abscess Formation and Sepsis due to < b > < i > Yersinia enterocolitica < /i > < /b > in a Patient with Hereditary Hemochromatosis and Type 2 Diabetes Mellitus
We present the case of a patient with sepsis with hepatic abscesses due to YE infection. Workup revealed a past diagnosis of diabetes mellitus and hemochromatosis which had been untreated for the previous 5 years due to patient refusal. This case highlights risk factors for systemic infection with YE. A high degree of suspicion for YE infection is warranted in patients with iron overload, diabetes mellitus, or immunosuppression.Case Rep Gastroenterol 2017;11:716 –720 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Superior Mesenteric Artery Syndrome Improved by Enteral Nutritional Therapy according to the Controlling Nutritional Status Score
Superior mesenteric artery syndrome (SMAS) is a relatively rare disease that involves bowel obstruction symptoms, such as vomiting and gastric distension, owing to the compression of the third portion of the duodenum from the front by the superior mesenteric artery (SMA) and from the rear by the abdominal aorta and the spine. SMAS is diagnosed on the basis of an upper gastrointestinal examination series indicating the obstruction of the third portion of the duodenum or a computed tomography scan indicating the narrowing of the branch angle between the aorta and the SMA (i.e., the aorta-SMA angle). Here, we report the case ...
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

A Hepatitis C Virus-Associated Chronic Hepatitis Patient Developing Various Adverse Events Including Severe Gingivitis, Gingival Bleeding, and Inflammation of Genital Vulva during the Course of Antiviral Therapy with Elbasvir/Grazoprevir
Oral direct-acting antivirals comprise the main therapy for hepatitis C virus (HCV)-associated liver disease in Japan. Daclatasvir/asunaprevir is the primary agent and sofosbuvir/ledipasvir is the secondary agent for HCV genotype 1b. Ombitasvir/paritaprevir/ritonavir was also recommended as a therapy for HCV genotype 1b. More recently, elbasvir (NS5A inhibitor)/grazoprevir (NS3/4A protease inhibitor) was also recommended as a potent therapy for HCV genotype 1b infection. This agent achieved an SVR12 as high as 96.5% for HCV virus-associated chronic hepatitis. We recently encountered a case treated with this agent and the f...
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Levonorgestrel-Releasing Intrauterine Device-Related Acute Liver Injury
We report for the first time acute liver injury associated with a levonorgestrel-releasing IUD. Our patient did not have any comorbidities that could have caused or exacerbated liver injury. A detailed workup and liver biopsy remained negative for any other potential cause of liver injury. The patient ’s symptoms resolved with removal of the device. She remained symptom free on subsequent outpatient follow-ups.Case Rep Gastroenterol 2017;11:734 –739 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Routine Treatment-Resistant < b > < i > Clostridium difficile < /i > < /b > Infection during Recovery from Myxedema
Development of the extreme form of hypothyroidism defined as myxedema is very rare. Acute symptoms and their management have been described in detail previously. However, not much attention has been devoted to therapeutic challenges that are faced in the recovery phase of the treatment, especially pertaining to the gastrointestinal system. The link between myxedema and the appearance of severeClostridium difficile infection (CDI) has not been established so far. A 61-year-old woman with no significant medical record was admitted to hospital because of infected heel pressure and thyroid dysfunction. A week later, due to hyp...
Source: Case Reports in Gastroenterology - November 29, 2017 Category: Gastroenterology Source Type: research

Multifocal Mass Lesions in Autoimmune Pancreatitis
A 59-year-old male patient with jaundice was referred to our hospital because of mass lesions in the pancreatic head and tail. An immunological examination revealed an elevated serum IgG4 level. Computed tomography showed two clear boundary mass lesions in the pancreatic head and tail. Magnetic resonance imaging showed that the mass lesions exhibited low intensity on T1-weighted images and iso-intensity on T2-weighted images. Magnetic resonance cholangiopancreatography showed an obstruction of the main pancreatic duct in the pancreatic head and tail. The possibility of malignant tumors could not be ruled out; therefore, we...
Source: Case Reports in Gastroenterology - November 10, 2017 Category: Gastroenterology Source Type: research

Listeria Monocytogenes Brain Abscess in Crohn ’s Disease Treated with Adalimumab
Listeria monocytogenes is a gram-positive bacterium that causes listeriosis. Brain abscess is a very uncommon manifestation of listeriosis and has not been reported to be associated with adalimumab (humira), one of the approved medications for treating Crohn ’s disease. A 45-year-old female with Crohn’s disease presented with sudden onset of fever, headache, nausea, vomiting, and altered mental status for 1 day. She was on prednisone and 6-mercaptopurine. She had started taking adalimumab 17 days prior to admission. She had signs of toxicity, confus ion, and nuchal rigidity, but showed neither central nervous s...
Source: Case Reports in Gastroenterology - November 9, 2017 Category: Gastroenterology Source Type: research

Autoimmune Hepatitis: A Risk Factor for Cholangiocarcinoma
We report an interesting case of perihilar CCA in the setting of autoimmune hepatitis along with a literature review. This case highlights the importance of early treatment and close clinical follow-up of patients with autoimmune hepatitis for development of CCA.Case Rep Gastroenterol 2017;11:672 –677 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 9, 2017 Category: Gastroenterology Source Type: research

Microvillus Inclusion Disease Variant in an Infant with Intractable Diarrhea
We report a case of MVID variant with a homozygous gene mutation in syntaxin 3(STX3). The patient is a male Saudi infant who presented shortly after birth with severe vomiting, metabolic acidosis, and mild diarrhea. Electron microscopy study for small intestinal biopsy was consistent with MVID. MYO5B gene mutation was excluded; subsequently, whole exome sequencing (WES) was performed, which revealed homozygous gene mutation inSTX3. Using WES in clinical environment can be a useful tool for diagnosing difficult and rare inherited congenital enteropathies.Case Rep Gastroenterol 2017;11:647 –651 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 3, 2017 Category: Gastroenterology Source Type: research

Gastric Adenocarcinoma with Dual Differentiation toward Neuroendocrine and α-Fetoprotein-Producing Features: Report of 2 Cases
Some gastric carcinomas show composite features of neuroendocrine carcinoma (NEC) and α-fetoprotein (AFP)-producing carcinoma, which are very rare; only a few cases have been reported to date. We reviewed an additional 2 such cases of gastric carcinoma, which were both advanced aggressive tumors showing regional lymph node metastasis and distant metastasis. Both cases were accompani ed by ordinary adenocarcinoma forms, implying that they had preceded the NEC and AFP-producing carcinoma components. A distinctive feature was the finding suggestive of dual differentiation of tumor cells to neuroendocrine and AFP-produci...
Source: Case Reports in Gastroenterology - November 3, 2017 Category: Gastroenterology Source Type: research

A Rare Case of Intraductal Tubulopapillary Neoplasm of the Pancreas Rupturing and Causing Acute Peritonitis
An intraductal tubulopapillary neoplasm (ITPN) is a very rare pancreatic tumor. Here we report an extremely rare case of an ITPN rupturing and causing acute peritonitis. A 50-year-old woman presented with left flank pain and vomiting. A computed tomography (CT) scan revealed gigantic multilocular cysts in the pancreatic tail and massive fluid collection in the abdominal cavity. The serum, urine, and abdominal fluid amylase levels were highly elevated, so she was conservatively treated with intraperitoneal drainage and antibiotics for a diagnosis of ruptured pancreatic cysts. After this patient recovered, a CT scan revealed...
Source: Case Reports in Gastroenterology - November 3, 2017 Category: Gastroenterology Source Type: research

A Silent Asymptomatic Solid Pancreas Tumor in a Nonsmoking Athletic Female: Pancreatic Ductal Adenocarcinoma
A silent solid endocrine tumor of pancreas, intraductal adenocarcinoma of pancreas, is the fourth leading cancer-related death in the US. However, it is expected to become the third leading cause by 2030 owing to delayed diagnosis and slow progress in management. Chronic pancreatitis is at risk for pancreatic ductal adenocarcinoma (PDAC). PDAC is diagnostic with transabdominal sonogram, blood test such as carbohydrate antigen 19-9 (CA 19-9), and imaging. PDAC has a dismal prognosis. The survival rate in 5 years is barely 6%, while late detection rate is 80 –85% with unresectable stage upon diagnosis. Here, we present...
Source: Case Reports in Gastroenterology - October 30, 2017 Category: Gastroenterology Source Type: research

Massive Upper and Lower GI Bleed from Simultaneous Primary (AL) Amyloidosis of the Stomach and Transverse Colon in a Patient with Multiple Myeloma
We report a case of gastric and colonic amyloidosis on anticoagulation presenting with massive upper and lower GI bleeding. A 67-year-old lady known to have multiple myeloma and AL amyloidosis on rivaroxaban presented with massive upper GI bleeding. Esophagogastroduodenoscopy showed a mass lesion (3 × 7 cm) located along the greater curvature in the body/antrum with active bleeding. Mucosal biopsies revealed amyloid deposition. She underwent partial gastrectomy and recovered well after surgery, and was discharged home on rivaroxaban. The patient presented again 4 weeks after discharge with ble eding per rectum, and a...
Source: Case Reports in Gastroenterology - October 30, 2017 Category: Gastroenterology Source Type: research

Intussusception due to an Inverted Meckel ’s Diverticulum Diagnosed by Double-Balloon Enteroscopy
An 18-year-old man presented after undergoing multiple investigations for abdominal pain. Retrograde double-balloon enteroscopy showed a protruding red lesion in the ileum with small ulcers, approximately 75 cm proximal to the ileocecal valve, resulting in an intussusception. An inverted Meckel ’s diverticulum was strongly suspected. Pressure was applied to the protruding lesion using contrast medium injection after wedging the lumen with a balloon. The intussusception partially reduced, avoiding the need for emergent surgery. Endoscopic tattooing was performed to mark the lesion for sub sequent resection. Elective l...
Source: Case Reports in Gastroenterology - October 30, 2017 Category: Gastroenterology Source Type: research

Hepatocyte Nuclear Factor 1 α-Mutated Hepatocellular Adenomas: An Atypical Presentation
In this study, we report the case of a 23-year-old female oral contraceptive user with H-HCA. Usually, H-HCA is considered to be nonsevere in most cases and often requires outpatient follow-up. However, in this case, the injury had substantially increased in volu me and evolved with a major bleeding frame, which was an unusual finding for this subtype of adenoma. The therapeutic used for this patient was a laparoscopic left hepatic segmentectomy. Thus, the choice of treatment to be performed in a patient with H-HCA can depend on the tumor size (#x3e;5 cm), t he outcome of previous bleeding, and the risk of bleeding recurre...
Source: Case Reports in Gastroenterology - October 30, 2017 Category: Gastroenterology Source Type: research

Internal Hernia into the Treitz Fossa after Pancreaticoduodenectomy
The development of an internal hernia into the Treitz fossa after pancreaticoduodenectomy has not been previously reported. We herein present such a case with a brief review of the literature. A 43-year-old man who had undergone pancreaticoduodenectomy with reconstruction of the digestive tract by the Child method at our hospital 7 months previously presented with abdominal pain. Computed tomography showed intestinal ileus with formation of a small intestinal loop that was suspected to be an internal hernia. Intraoperatively, we found that the dilated small intestine had entered the upper side of the abdomen from the ligam...
Source: Case Reports in Gastroenterology - October 30, 2017 Category: Gastroenterology Source Type: research

Unusual Clinical Presentation of Hemobilia with Recurrent Vasovagal Episodes
We present the case of an 80-year-old man who had laparoscopic cholecystectomy complicated by hemobilia. He had an unusual presentation of hemobilia in the form of transient vasovagal episodes in addition to abdominal pain and hematochezia.Case Rep Gastroenterol 2017;11:554 –558 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

A Case of Basaloid Squamous Cell Carcinoma of Polypoid Type in the Esophagus
Basaloid squamous cell carcinoma of the esophagus is very rare. Further, polypoid type of esophageal cancer is also rare. We have recently treated a case of basaloid squamous cell carcinoma which presented as a 1.3-cm esophageal polyp. A 48-year-old woman was referred to our hospital because of a polypoid mass at 36 cm distance from the upper incisor on endoscopic examination, and the result of the biopsy was basaloid squamous cell carcinoma. The patient underwent Ivor Lewis operation with lymph node dissection. Two basaloid squamous cell carcinomas, of 1.3 and 0.4 cm, were diagnosed in the final pathologic examination. Re...
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

A Patient with Nafcillin-Associated Drug-Induced Liver Failure
We present a case of liver failure attributable to nafcillin use in a 68-year-old male with a history methicillin-sensitiveStaphylococcus and L3/L4 osteomyelitis. After starting long-term antibiotic therapy, he presented with painless jaundice which necessitated discontinuation of the drug. At the time of presentation, the patient ’s lab work exhibited a bilirubin/direct bilirubin of 9.4/8.2 mg/dL, alkaline phosphatase of 311 IU/L, and aspartate transaminase/alanine transaminase of 109/127 IU/L. The patient was switched to i.v. vancomycin given the concern for drug-induced liver injury. Imaging did not show obstructi...
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

A Rare Thermophilic Bug in Complicated Diverticular Abscess
Actinomycosis is a form of painful abscess in the gastrointestinal tract or in deep tissue caused by actinomyces species. They are one of the commensal bacteria in the oral cavity and gastrointestinal tract of humans but can opportunistically cause infection in immunosuppressive hosts through invasion of breached mucosa or necrotic tissue while mimicking malignancy, gastrointestinal tuberculosis, and inflammatory bowel disease.Actinomyces israelii is, by far, the major and most common human pathogen throughout literatures. By virtue of rarity and diagnostic confusion with masquerading malignancies, only 10% of the cases ha...
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

Hepatectomy for Hilar Cholangiocarcinoma with Right-Sided Ligamentum Teres Using a Hepatectomy Simulation System
Right-sided ligamentum teres (RSLT) is a rare congenital anomaly often accompanied by variation of the hepatic vasculature. We herein report a surgical case of a hilar cholangiocarcinoma with RSLT in whom preoperative hepatectomy simulation proved useful for understanding the anatomical structure of the liver. A 78-year-old male with obstructive jaundice was referred to our department for further examination. The patient was suspected of having a hilar cholangiocarcinoma originating from the left hepatic bile duct by contrast-enhanced computed tomography (CT), and CT also showed right umbilical portion (RUP). Three-dimensi...
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

Renoportal Anastomosis in Left Lateral Lobe Living Donor Liver Transplantation: A Pediatric Case
In adult liver transplantation, renoportal anastomosis (RPA) has been introduced as a useful technique for patients with grade 4 portal vein thrombosis and a splenorenal shunt. Here, we report a pediatric case in which RPA allowed a left lateral lobe living donor liver transplantation (LDLT) despite portal vein thrombosis and a large splenorenal shunt. At 36 days old, the patient underwent a Kasai operation for biliary atresia. At 17 months old, she underwent LDLT because of repetitive cholangitis. Pretransplant examinations revealed a large splenorenal shunt and portal vein thrombosis. Simple end-to-end portal reconstruct...
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

A Tale of Two Lymphomas
We present a patient with coeliac disease who developed refractory coeliac disease II, which was complicated by the development of metachronous lymphomas.Case Rep Gastroenterol 2017;11:593 –598 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

Postpolypectomy Intramural Colonic Hematoma: The Conservative Management of a Potentially Fatal Complication
We present a case of postpolypectomy hematoma diagnosed with CT imaging and successfully managed in a conservative fashion.Case Rep Gastroenterol 2017;11:599 –602 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

Pneumoperitoneum after Endoscopic Retrograde Cholangiopancreatography due to Rupture of Intrahepatic Bile Ducts and Glisson ’s Capsule in Hepatic Metastasis: A Case Report and Review of Literature
Conclusion: In our case, pneumoperitoneum resulted from rupture of intrahepatic bile ducts and Glisson ’s capsule in hepatic metastasis. This case emphasizes the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP.Case Rep Gastroenterol 2017;11:603 –609 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

Vanishing Tumor in a Liver Graft from a Hepatitis B Virus Surface Antigen-Positive Donor
We report a case of vanishing tumor considered as inflammatory pseudotumor (IPT) found in the liver after living donor liver transplantation (LDLT) from a hepatitis B virus surface antigen-positive donor. The radiological findings were similar to those of hepatocellular carcinoma (HCC). However, the tumor disappeared completely within several months and was suggested to have been an IPT. IPT is known to be associated with biliary duct operation or biliary infection, and it can show various enhancement patterns in radiological studies, sometimes resembling HCC. It should be considered in the differential diagnosis of a live...
Source: Case Reports in Gastroenterology - October 25, 2017 Category: Gastroenterology Source Type: research

A Tale of Two Lymphomas
We present a patient with coeliac disease who developed refractory coeliac disease II, which was complicated by the development of metachronous lymphomas.Case Rep Gastroenterol 2017;11:593 –598 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 6, 2017 Category: Gastroenterology Source Type: research

Postpolypectomy Intramural Colonic Hematoma: The Conservative Management of a Potentially Fatal Complication
We present a case of postpolypectomy hematoma diagnosed with CT imaging and successfully managed in a conservative fashion.Case Rep Gastroenterol 2017;11:599 –602 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 6, 2017 Category: Gastroenterology Source Type: research

Pneumoperitoneum after Endoscopic Retrograde Cholangiopancreatography due to Rupture of Intrahepatic Bile Ducts and Glisson ’s Capsule in Hepatic Metastasis: A Case Report and Review of Literature
Conclusion: In our case, pneumoperitoneum resulted from rupture of intrahepatic bile ducts and Glisson ’s capsule in hepatic metastasis. This case emphasizes the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP.Case Rep Gastroenterol 2017;11:603 –609 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 6, 2017 Category: Gastroenterology Source Type: research

Vanishing Tumor in a Liver Graft from a Hepatitis B Virus Surface Antigen-Positive Donor
We report a case of vanishing tumor considered as inflammatory pseudotumor (IPT) found in the liver after living donor liver transplantation (LDLT) from a hepatitis B virus surface antigen-positive donor. The radiological findings were similar to those of hepatocellular carcinoma (HCC). However, the tumor disappeared completely within several months and was suggested to have been an IPT. IPT is known to be associated with biliary duct operation or biliary infection, and it can show various enhancement patterns in radiological studies, sometimes resembling HCC. It should be considered in the differential diagnosis of a live...
Source: Case Reports in Gastroenterology - October 6, 2017 Category: Gastroenterology Source Type: research

A Rare Thermophilic Bug in Complicated Diverticular Abscess
Actinomycosis is a form of painful abscess in the gastrointestinal tract or in deep tissue caused by actinomyces species. They are one of the commensal bacteria in the oral cavity and gastrointestinal tract of humans but can opportunistically cause infection in immunosuppressive hosts through invasion of breached mucosa or necrotic tissue while mimicking malignancy, gastrointestinal tuberculosis, and inflammatory bowel disease.Actinomyces israelii is, by far, the major and most common human pathogen throughout literatures. By virtue of rarity and diagnostic confusion with masquerading malignancies, only 10% of the cases ha...
Source: Case Reports in Gastroenterology - September 27, 2017 Category: Gastroenterology Source Type: research

Hepatectomy for Hilar Cholangiocarcinoma with Right-Sided Ligamentum Teres Using a Hepatectomy Simulation System
Right-sided ligamentum teres (RSLT) is a rare congenital anomaly often accompanied by variation of the hepatic vasculature. We herein report a surgical case of a hilar cholangiocarcinoma with RSLT in whom preoperative hepatectomy simulation proved useful for understanding the anatomical structure of the liver. A 78-year-old male with obstructive jaundice was referred to our department for further examination. The patient was suspected of having a hilar cholangiocarcinoma originating from the left hepatic bile duct by contrast-enhanced computed tomography (CT), and CT also showed right umbilical portion (RUP). Three-dimensi...
Source: Case Reports in Gastroenterology - September 27, 2017 Category: Gastroenterology Source Type: research

Renoportal Anastomosis in Left Lateral Lobe Living Donor Liver Transplantation: A Pediatric Case
In adult liver transplantation, renoportal anastomosis (RPA) has been introduced as a useful technique for patients with grade 4 portal vein thrombosis and a splenorenal shunt. Here, we report a pediatric case in which RPA allowed a left lateral lobe living donor liver transplantation (LDLT) despite portal vein thrombosis and a large splenorenal shunt. At 36 days old, the patient underwent a Kasai operation for biliary atresia. At 17 months old, she underwent LDLT because of repetitive cholangitis. Pretransplant examinations revealed a large splenorenal shunt and portal vein thrombosis. Simple end-to-end portal reconstruct...
Source: Case Reports in Gastroenterology - September 27, 2017 Category: Gastroenterology Source Type: research

Carbohydrate Antigen 19-9-Positive Gastric Adenocarcinoma: Autopsy Findings and Review of the Literature
Carbohydrate antigen 19-9 (CA19-9) is a well-known tumor marker for pancreatobiliary cancer, and several studies have shown that an elevated serum CA19-9 level is associated with more aggressive biological behavior in gastric cancer (GC). However, the clinicopathological characteristics of CA19-9-positive GC remain unclear. We herein report an autopsy case of CA19-9-positive GC in an 84-year-old man who was admitted to our hospital because of paralysis and anemia. Autopsy revealed an ulcerative-invasive tumor measuring 72 × 60 mm in the anterior wall of the gastric body. The tumor had invaded beyond the muscularis pr...
Source: Case Reports in Gastroenterology - September 26, 2017 Category: Gastroenterology Source Type: research

Unusual Clinical Presentation of Hemobilia with Recurrent Vasovagal Episodes
We present the case of an 80-year-old man who had laparoscopic cholecystectomy complicated by hemobilia. He had an unusual presentation of hemobilia in the form of transient vasovagal episodes in addition to abdominal pain and hematochezia.Case Rep Gastroenterol 2017;11:554 –558 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - September 26, 2017 Category: Gastroenterology Source Type: research

A Case of Basaloid Squamous Cell Carcinoma of Polypoid Type in the Esophagus
Basaloid squamous cell carcinoma of the esophagus is very rare. Further, polypoid type of esophageal cancer is also rare. We have recently treated a case of basaloid squamous cell carcinoma which presented as a 1.3-cm esophageal polyp. A 48-year-old woman was referred to our hospital because of a polypoid mass at 36 cm distance from the upper incisor on endoscopic examination, and the result of the biopsy was basaloid squamous cell carcinoma. The patient underwent Ivor Lewis operation with lymph node dissection. Two basaloid squamous cell carcinomas, of 1.3 and 0.4 cm, were diagnosed in the final pathologic examination. Re...
Source: Case Reports in Gastroenterology - September 26, 2017 Category: Gastroenterology Source Type: research

A Patient with Nafcillin-Associated Drug-Induced Liver Failure
We present a case of liver failure attributable to nafcillin use in a 68-year-old male with a history methicillin-sensitiveStaphylococcus and L3/L4 osteomyelitis. After starting long-term antibiotic therapy, he presented with painless jaundice which necessitated discontinuation of the drug. At the time of presentation, the patient ’s lab work exhibited a bilirubin/direct bilirubin of 9.4/8.2 mg/dL, alkaline phosphatase of 311 IU/L, and aspartate transaminase/alanine transaminase of 109/127 IU/L. The patient was switched to i.v. vancomycin given the concern for drug-induced liver injury. Imaging did not show obstructi...
Source: Case Reports in Gastroenterology - September 26, 2017 Category: Gastroenterology Source Type: research

Hemothorax following Uncomplicated Endoscopic Variceal Sclerotherapy and Ligation for Esophageal Varices
Endoscopic variceal sclerotherapy and ligation are standard treatment modalities used for the management of esophageal varices. Reportedly, sclerotherapy and ligation are associated with complications such as hematuria, pulmonary thrombus formation, pleural effusion, renal dysfunction, and esophageal stenosis. However, hemothorax following sclerotherapy and ligation has not yet been reported. We treated a patient who presented with liver cirrhosis and polycythemia vera and later developed hemothorax following the above-mentioned procedures. An 86-year-old man diagnosed with liver cirrhosis due to chronic hepatitis type B a...
Source: Case Reports in Gastroenterology - September 15, 2017 Category: Gastroenterology Source Type: research

Preoperative Diagnosis and Surgical Approach of Appendiceal Mucinous Cystadenoma: Usefulness of Volcano Sign
We report a case of appendiceal mucinous cystadenoma that was successfully diagnosed preoperatively and treated by laparoscopic resection. We could find volcano sign on colonoscopy and cystic lesion without any nodules at the appendix on computed tomography (CT). Without any malignant factors in preoperative examinations, we performed laparoscopic appendectomy including the cecal wall. We could avoid performing excessive operation for cystadenoma with accurate preoperative diagnosis and intraoperative finding and pathological diagnosis during surgery. Appendiceal mucocele is a rare disease that is divided into 3 pathologic...
Source: Case Reports in Gastroenterology - September 15, 2017 Category: Gastroenterology Source Type: research

Intraparenchymal Hemorrhage due to Brain Metastasis of Hepatocellular Carcinoma
We report a case of a 54-year-ol d man previously diagnosed with alcohol-induced cirrhosis of the liver and HCC. The patient was admitted presenting progressive left hemiparesis and headache which started 2 days earlier, with no history of cranioencephalic trauma. After admission, cranial computed tomography revealed an intraparenc hymal hemorrhage area with surrounding edema in the right frontal lobe. An angioresonance requested showed a large extra-axial mass lesion located in the right frontal region with well-defined contours and predominantly hypointense signal on T2 sequence. At first, the radiological findings sugge...
Source: Case Reports in Gastroenterology - September 13, 2017 Category: Gastroenterology Source Type: research

Laparoscopic Resection of a Jejunal Mesenteric Pseudocyst
An unusual case of a jejunal mesenteric pseudocyst treated by laparoscopic resection is reported. A 44-year-old woman was admitted to our hospital with intermittent upper abdominal pain and diarrhea. Physical examination revealed slight periumbilical tenderness, and no masses were palpable. Contrast-enhanced computed tomography showed a 4-cm-sized nonenhancing high-density mass with a heterogeneous pattern on a proximal small bowel loop. Based on these findings, a gastrointestinal stromal tumor accompanied by hemorrhagic and cystic change, a mesenteric hematoma, or a desmoid tumor was diagnosed. Laparoscopy was performed t...
Source: Case Reports in Gastroenterology - September 13, 2017 Category: Gastroenterology Source Type: research

Acinar Cell Cystadenocarcinoma of the Pancreas
Acinar cell cystadenocarcinoma is a rare malignant epithelial neoplasm of the pancreas with a diffusely cystic, gross architecture in which the cysts are lined with neoplastic epithelial cells that demonstrate evidence of pancreatic exocrine enzyme production. This is the 10th case that has been reported in the literature. A 77-year-old male complaining of left hypochondrial pain was referred to our hospital for treatment of a pancreatic tumor. A huge, honeycomb-structured tumor was detected in the pancreatic tail. Distal pancreatectomy with total resection of the residual stomach and partial resection of the transverse co...
Source: Case Reports in Gastroenterology - September 11, 2017 Category: Gastroenterology Source Type: research

Malignant Gastric Outlet Obstruction from Pancreatic Cancer
We report an exceptional case of a 73-year-old woman with T4N1M0 adenocarcinoma of the uncinate process of the pancreas who developed significant gastric outlet obstruction – an uncommon yet potentially life-threatening complication of disease progression. She developed progressive abdominal pain and emesis, and profound dilatation of her stomach was detected on a radiation therapy simulation CT scan that required urgent decompression. Malignant gastric outlet obstru ction must be included in the differential diagnosis when patients with known advanced disease of the pancreas present with obstructive upper gastrointe...
Source: Case Reports in Gastroenterology - September 6, 2017 Category: Gastroenterology Source Type: research