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Successful Fecal Microbiota Transplantation in a Patient with Severe Complicated < b > < i > Clostridium difficile < /i > < /b > Infection after Liver Transplantation
Clostridium difficile infection (CDI) represents one of the most common healthcare-associated infections. Due to increasing numbers of recurrences and therapy failures, CDI has become a major disease burden. Studies have shown that fecal microbiota transplantation (FMT) can both be a safe and highly efficacious therapy for patients with therapy-refractory CDI. However, patients undergoing solid organ transplantation are at high risk for CDI due to long-term immunosuppression, previous antibiotic therapy, and proton pump inhibitor use. Additionally, these patients may be especially prone to adverse events related to FMT. He...
Source: Case Reports in Gastroenterology - February 21, 2018 Category: Gastroenterology Source Type: research

A Surgically Resected Pancreatic Schwannoma with Obstructive Jaundice with Special Reference to Differential Diagnosis from Other Cystic Lesions in the Pancreas
Pancreatic schwannomas are uncommon. About 60% of pancreatic schwannomas develop cystic lesions, and the differential diagnosis from other cystic pancreatic tumors is difficult. A 43-year-old man presented for evaluation of liver dysfunction detected during a medical checkup. Blood testing detected obstructive jaundice. A computed tomography scan revealed a well-defined polycystic tumor of about 5 cm at the pancreatic head. We performed surgical resection to treat the patient ’s symptoms and facilitate long-term management. Histopathological examination revealed spindle-shaped cells. Immunohistochemical studies showe...
Source: Case Reports in Gastroenterology - February 21, 2018 Category: Gastroenterology Source Type: research

Elbasvir/Grazoprevir, an Alternative in Antiviral Hepatitis C Therapy in Patients under Amiodarone Treatment
A sofosbuvir/ledipasvir combination is part of a first-line treatment of hepatitis C. However, in patients concurrently treated with amiodarone, cardiac side effects have been described, resulting in an official warning in 2015 by the American Food and Drug Administration and the European Medicines Agency when combining those substances. This deprived numerous hepatitis C patients with concurrent cardiovascular problems of receiving this highly effective treatment. Here we present a treatment alternative with an elbasvir/grazoprevir regimen, based on our successful treatment of a patient under concurrent amiodarone therapy...
Source: Case Reports in Gastroenterology - February 21, 2018 Category: Gastroenterology Source Type: research

A Bile Duct Stone Formation around a Fish Bone as a Nidus after Pancreatoduodenectomy
We report a rare case of bile duct stone formation around an ingested fish bone as a nidus after pancreatoduodenectomy. A 78-year-old woman was admitted to our department for fever and epigastric pain. Abdominal computed tomography revealed an elongated bile duct stone containing a linearly shaped foreign body of bone density. Enteroscopic lithotomy was performed using single balloon enteroscopy to safely remove the stone and foreign body from the bile duct. The foreign body was determined to be a fish bone by pathological examination and component analysis.Case Rep Gastroenterol 2018;12:69 –75 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 14, 2018 Category: Gastroenterology Source Type: research

Ileum Histoplasmosis Mimicking Intestinal Tuberculosis and Crohn ’s Disease
Gastrointestinal histoplasmosis (GIH) without pulmonary and bone marrow involvement is very rare worldwide. It can be misdiagnosed as intestinal tuberculosis or Crohn ’s disease. There are just few case reports of GIH in patients with a positive HIV antibody test. Here, we report a patient who presented to our hospital with repeated intestinal obstruction. The suspicious diagnosis was intestinal tuberculosis or Crohn’s disease due to unspecific clinical manif estations and radiologic images. Our patient’s HIV antibody test was negative. She had no medical prescriptions. Therefore, our differential diagnos...
Source: Case Reports in Gastroenterology - February 9, 2018 Category: Gastroenterology Source Type: research

A Rare Multifocal Pattern of Type 2 Autoimmune Pancreatitis with Negative IgG4: A Potential Diagnostic Pitfall That May Mimic Multifocal Pancreatic Adenocarcinoma
We report, to the best of our knowledge, the first case of a multifocal pattern of type 2 AIP characterized with both CT and MR imaging. This rare imaging pattern of AIP may mimic the appearance of more worrisome malignant etiologies such as multifocal pancreatic adenocarcinoma or lymphoma, with overlapping imaging characteristics potentially complicating or delaying diagnosis. Therefore, recognition of this atypical pattern of AIP and avoidance of this potential diagnostic pitfall is crucial.Case Rep Gastroenterol 2018;12:46 –55 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 7, 2018 Category: Gastroenterology Source Type: research

Sevelamer-Induced Gastrointestinal Injury Presenting as Gastroenteritis
End-stage renal disease (ESRD) is a common disease encountered in clinical practice and is associated with increasing metabolic derangements through disease progression. Phosphate retention is one of the most common derangements and is associated with increased mortality. Hyperphosphatemia becomes increasingly prevalent as glomerular filtration rate decreases. Non-calcium phosphate-binding resins and dietary phosphate restriction are the mainstays for managing hyperphosphatemia in patients with ESRD. Sevelamer carbonate is the most frequently used non-calcium phosphate binder in the US due to ease of administration and an ...
Source: Case Reports in Gastroenterology - February 1, 2018 Category: Gastroenterology Source Type: research

Adult Presentation of Noncirrhotic Portal Hypertension and Ascites following Treatment for Wilms ’ Tumor in Childhood
A 37-year-old male, who at the age of 8 years had been treated for right-sided Wilms ’ tumor with nephrectomy, radiotherapy, and chemotherapy, presented with noncirrhotic portal hypertension (NCPH), grade 2 esophageal varices, and ascites. A CT scan demonstrated hypoplasia of liver segments 2 and 3. A liver biopsy showed portal tract fibrosis without cirrhosis, with histological f eatures of NCPH. Liver vein catheterization showed a normal portal pressure gradient of 5 mm Hg while spleen to hepatic vein pressure was 29 mm Hg. NCPH after therapy for Wilms’ tumor is described in children within the first few year...
Source: Case Reports in Gastroenterology - February 1, 2018 Category: Gastroenterology Source Type: research

A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy
In conclusion, CSP should only be adopted for benign cases, as cancerous lesions have a possibility for invading the submucosa, like in our case.Case Rep Gastroenterol 2018;12:27 –31 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 19, 2018 Category: Gastroenterology Source Type: research

Endoscopic versus Laparoscopic Full-Thickness Biopsy in the Pathological Evaluation of the Enteric Nervous System
A full-thickness biopsy of the bowel wall is required to evaluate the enteric nervous system. A patient with aggravating gastrointestinal symptoms underwent a laparoscopic full-thickness biopsy of the ileum and, 1 year later, an endoscopic full-thickness biopsy of the sigmoid colon. Both samples showed enteric neuropathy characterized by vacuolated and enlarged neurons. The length of the myenteric plexus was greater in the endoscopic (23 mm) compared to the laparoscopic (11 mm) biopsy, with fewer tissue artefacts in the laparoscopic approach. Clinical deterioration was paralleled by enteric neuropathy with an increase in t...
Source: Case Reports in Gastroenterology - January 19, 2018 Category: Gastroenterology Source Type: research

Coexisting Granular Cell Tumor and Tubular Adenoma of the Ileocecal Valve
Granular cell tumors (GCTs) have been described as neoplasms of Schwann cell origin. They are often benign and notably uncommon in the gastrointestinal tract. Recently, their incidence has become more common, likely as a result of increased colonoscopy screenings. Very few data exist regarding their potential for malignancy, but malignant GCTs have been reported. Here, we report the case of a young female patient who was diagnosed with an atypical GCT on the ileocecal valve with an overlying tubular adenoma which was found incidentally on colonoscopy. This represents the first known report of a GCT with atypical features o...
Source: Case Reports in Gastroenterology - January 17, 2018 Category: Gastroenterology Source Type: research

Severe Hepatic and Pulmonary Involvement in Rendu-Osler-Weber Syndrome
We report the case of a young woman with hereditary hemorrhagic telangiectasia (HHT) with severe liver involvement and pulmonary shunting. The medical imaging in this patient illustrates the severe shunting that can occur in these patients who often are asymptomatic. By showing this case, we want to highlight the role of liver transplantation in HHT with hepatic involvement.Case Rep Gastroenterol 2018;12:13 –18 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 17, 2018 Category: Gastroenterology Source Type: research

Spontaneous Rupture of Hepatocellular Carcinoma in a Young Patient with Fatal Outcome
Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially life-threatening complication. Diagnosis may be difficult, particularly in the absence of known liver cirrhosis or tumor. A 20-year-old male patient presented with progressive abdominal pain and shock. His past medical history was uneventful. Anemia, acute renal failure, and abnormal liver function test were demonstrated. Mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC were revealed by computed tomography. Two actively bleeding liver tumors and multiple tumors i...
Source: Case Reports in Gastroenterology - January 17, 2018 Category: Gastroenterology Source Type: research

ERCP-Related Duodenal Perforation Presenting as Pneumoscrotum
We present the case of a 35-year-old male patient who developed scrotal pain and swelling following ERCP. He was found to have extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed with retroperitoneal duodenal perforation. He was managed conservatively with close monitoring and supportive care.Case Rep Gastroenterol 2018;12:1 –6 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 5, 2018 Category: Gastroenterology Source Type: research

Hepatic Pseudolymphoma with Fluorodeoxyglucose Uptake on Positron Emission Tomography
A 69-year-old woman with chronic hepatitis B was admitted to our hospital with a hepatic tumor. The levels of 2 tumor markers, carcinoembryonic antigen and carbohydrate antigen 19-9, were slightly elevated; however, the α-fetoprotein and protein levels induced by vitamin K antagonist II were within the normal limits. Abdominal ultrasonography showed a well-defined peripheral hypoechoic mass that was isoechoic and homogeneous on the inside. Computed tomography showed a poorly enhanced tumor of 13 mm in diameter in the 5th segment of the liver. Fluorodeoxyglucose positron emission tomography showed a slight uptake (max...
Source: Case Reports in Gastroenterology - December 21, 2017 Category: Gastroenterology Source Type: research

Vedolizumab Treatment for Ulcerative Colitis in an Elderly Multimorbid Patient with Hemophilia A
In conclusion, we describe the first patient in the literature with UC and hemophilia A who stayed in long-term remissi on under therapy with vedolizumab. From our point of view, vedolizumab can be safely administered in the setting of UC and hemophilia A. Antiplatelet drugs which inhibit primary hemostasis must be used with caution in this setting. Bleeding episodes can be treated safely and effectively with factor VIII (Kogenate®).Case Rep Gastroenterol 2017;11:774 –779 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - December 21, 2017 Category: Gastroenterology Source Type: research

Eighteen Month Interval Growth of Terminal Ileal Primary Adenocarcinoma: A Consideration for Current Screening Guidelines
Primary adenocarcinoma of the small intestine comprises one of the rarest gastrointestinal malignancies. Further, the terminal ileum is very seldom implicated. This entity occurs sporadically and evades traditional colonoscopic evaluation in which the terminal ileum is not visualized. Herein, a case of interval development of primary terminal ileal adenocarcinoma over a 2-year period is reported as followed by direct endoscopic and colonoscopic visualization. This case demonstrates cecal involvement not found on initial evaluation without the provision of terminal ileum intubation. Relevant guidelines regarding the evaluat...
Source: Case Reports in Gastroenterology - December 21, 2017 Category: Gastroenterology Source Type: research

Vedolizumab as a Potential Culprit in the Development of Ovarian Teratoma?
We present the case of a patient who developed an ovarian teratoma after initiation of vedolizumab therapy.Case Rep Gastroenterol 2017;11:786 –790 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - December 21, 2017 Category: Gastroenterology Source Type: research

Spontaneous Hepatitis B Seroclearance upon Development of Hepatocellular Carcinoma
We describe two novel cases of spontaneous hepatitis B seroclearance following the development of HCC, prior to resection. Following resection, specimens were HBsAg- and HBcAg-negative in both tumor and peritumor tissues. Although the precise mechanism of this is poorly understood, nonuniform integration of hepatitis B virus DNA within the liver could lead to selective tumorigenesis of HBsAg-producing cells, explaining the observed clearance of serum HBsAg with the development of HCC.Case Rep Gastroenterol 2017;11:797 –802 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - December 21, 2017 Category: Gastroenterology Source Type: research

Laparoscopic Resection of an Epithelial Cyst in an Intrapancreatic Accessory Spleen
An epithelial cyst in an intrapancreatic accessory spleen (ECIAS) is rare. We herein report a case of a patient with ECIAS who underwent laparoscopic surgery. A 57-year-old woman was referred to our hospital because of a pancreatic tail tumor. She was asymptomatic, and a physical examination revealed no remarkable abnormalities. The levels of the tumor marker carbohydrate antigen 19-9 (CA19-9) and s-pancreas-1 antigen (SPan-1) were elevated. Ultrasonography showed a well-defined homogeneous cystic tumor. Computed tomography showed a well-demarcated cystic tumor in the pancreatic tail. Magnetic resonance imaging showed that...
Source: Case Reports in Gastroenterology - December 21, 2017 Category: Gastroenterology Source Type: research

Babesiosis Presenting as Acute Liver Failure
We report a case of an elderly man with acute liver failure due to an infection withB. microti.Case Rep Gastroenterol 2017;11:769 –773 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - December 18, 2017 Category: Gastroenterology Source Type: research

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