Endoscopic Closure of an Acute Duodenal Perforation Occurring during Endoscopic Ultrasound Using Endoclips and Polyglycolic Acid Sheets with Fibrin Glue
Acute duodenal perforation during endoscopic ultrasound (EUS) is a serious complication. The conventional endoscopic treatment for duodenal perforations such as endoscopic clipping is unsatisfactory; recently, the effectiveness of over-the-scope clipping (OTSC) has been reported. A 91-year-old woman was referred to our hospital with the chief complaint of jaundice. Contrast-enhanced computed tomography showed a 2-cm mass in the pancreatic head; we planned EUS-guided fine-needle aspiration. During exploration for a puncture route from the duodenal bulb using a linear echoendoscope under carbon dioxide insufflation, the duod...
Source: Case Reports in Gastroenterology - March 1, 2021 Category: Gastroenterology Source Type: research

Giant Calculus with More than 100 Small Calculi in Choledochal Cysts
We present the case of a 8.0 × 4.5 × 4.0 cm sized giant calculus with #x3e;100 small calculi in type IVa CCs with heterotopic pancreas in a 45-year-old male, which is a surprisingly rare occurrence. Magnetic resonance cholangiopancreatography showed multifocal irregular dilatation of intrahepatic biliary radicles with multipl e filling defects with a giant calculus in CC with cholelithiasis. The case was successfully managed with open cholecystectomy and choledochotomy with retrieval of 1 giant and more than 100 small calculi with excision of CC with Roux-en-Y hepaticojejunostomy. Histopathological examination ...
Source: Case Reports in Gastroenterology - February 26, 2021 Category: Gastroenterology Source Type: research

Eosinophilic Cholangitis with Poor Prognosis after Corticosteroid- and Ursodeoxycholic Acid-Related Remission of Peripheral and Peribiliary Eosinophilia
A 79-year-old man presented with high fever, marked eosinophilia, altered biochemical liver function tests (LFT) with predominance of biliary enzymes, and severe wall thickening of the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) suggested cholecystitis, without signs of biliary strictures. Laparoscopic cholecystectomy and exploratory liver excision revealed eosinophilic cholangitis and cholecystitis, complicated with hepatitis and portal phlebitis. Prednisolone monotherapy rapidly improved peripheral eosinophilia, but not LFT. Liver biopsy showed that infiltrating eosinophils were replaced by lymphocyte...
Source: Case Reports in Gastroenterology - February 18, 2021 Category: Gastroenterology Source Type: research

Successful Enucleation of a Large Pancreatic Head Schwannoma
A presumed benign cystic tumor in the pancreatic head had been pointed out to a 78-year-old man 4 years ago. In addition to no communication between the tumor and the main pancreatic duct, magnetic resonance imaging showed that the cystic fluid was serous. Gradual tumor enlargement from 2.1 to 4.0 cm urged us to resect the tumor. In order to safely enucleate the tumor, we preoperatively placed a pancreatic duct stent and covered the pancreatic parenchyma with a polyglycolic acid sheet, fibrin glue, and thrombin after tumor enucleation. The patient postoperatively developed grade B pancreatic fistula but recovered with anti...
Source: Case Reports in Gastroenterology - February 18, 2021 Category: Gastroenterology Source Type: research

Severe Hypertriglyceridemia-Induced Acute Pancreatitis
We report the steps necessary for establishing the right diagnosis and the management of HTG-induced AP, which are inevitable for the reduction of severity and mortality. This case study shows that hypercholesterolemia is an underdiagnosed and potentially lethal disease. Once diagnosed, all measures should be considered to control blood cholesterol and lipid levels. The decision to administer PCSK9 inhibitors should not be solely based on economical calculation, but rather individual factors s hould also be considered to weigh the risk/benefit ratio.Case Rep Gastroenterol 2021;15:218 –224 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 18, 2021 Category: Gastroenterology Source Type: research

Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center
In conclusion, the percutaneous approach has a big role in managing critically ill patients in the ICU setting. However, expertise, training experience, and a multidisciplinary team approach are very important for successful management and patient outcome.Case Rep Gastroenterol 2021;15:210 –217 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 18, 2021 Category: Gastroenterology Source Type: research

Disappearance of Gastric Hyperplastic Polyps after the Discontinuation of Proton Pump Inhibitor in a Patient with Liver Cirrhosis
Here, we report on a rare case of gastric hyperplastic polyps which disappeared after the discontinuation of proton pump inhibitor (PPI). The patient was an 83-year-old woman with liver cirrhosis and portal hypertension, along with gastroesophageal reflux disease treated by PPI. An initial upper gastrointestinal endoscopy showed unique polypoid lesions in the greater curvature of the stomach. Biopsy specimens of the lesions were diagnosed as hyperplastic polyps and she was followed. One year later, a second endoscopy showed that the lesions had increased in number and size, and an endoscopic mucosal resection (EMR) was per...
Source: Case Reports in Gastroenterology - February 18, 2021 Category: Gastroenterology Source Type: research

Autoimmune Pancreatitis after a Seven-Year History of Suspicious Pancreatic Cancer
In this case report, we present a case of autoimmune pancreatitis (AIP) diagnosis in a patient after a 7-year history of suspicious pancreatic cancer. Kim ’s and Japanese criteria were used to diagnose AIP. Our case avoided undesirable invasive procedures and recovered thanks to the proper diagnosis and timely treatment with prednisone. Early and accurate diagnosis of AIP, in this case, had a significant impact on the treatment and prognosis process .Case Rep Gastroenterol 2021;15:195 –201 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 17, 2021 Category: Gastroenterology Source Type: research

Perforated Acute Appendicitis in a Six-Day-Old Neonate: A Rare Differential Diagnosis of Neonatal Peritonitis
Acute appendicitis is a rare diagnosis of acute abdomen in neonates which is associated with high mortality due to late diagnosis. Here, we presented a case of acute neonatal appendicitis in a 6-year-old full-term infant with Down syndrome and pulmonary atresia with ventricular septal defect. The patient underwent surgery and postoperative critical care. However, he died on postoperative day 5 due to worsening sepsis and decompensated hemodynamic instability.Case Rep Gastroenterol 2021;15:188 –194 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 16, 2021 Category: Gastroenterology Source Type: research

Hepatitis B Virus Reactivation with Discontinuation of Nucleoside Analogue in Patients Who Received Allogeneic Hematopoietic Stem Cell Transplantation
Reactivation of hepatitis B virus (HBV) is known to occur frequently after hematopoietic stem cell transplantation (HSCT). The reactivation can be prevented by nucleos(t)ide analogue (NA), but it is unclear how long NA should be continued. Here, we report 3 cases of HBV reactivation with discontinuation of NA following the discontinuation of immunosuppressive therapies after HSCT. Three male patients aged 34, 59, and 54 years received allogeneic HSCT (allo-HSCT) for chronic myeloid leukemia, mixed phenotype acute leukemia, and myelodysplastic syndrome, respectively. Before HSCT, 2 patients were positive for hepatitis B sur...
Source: Case Reports in Gastroenterology - February 12, 2021 Category: Gastroenterology Source Type: research

Acute Gastric Dilatation: A Cause for Concern
We present our experience of 2 patients who presented with severe hyperglycemia and were found to have acute gastric dilation on imaging. Only one of the patients was treated with nasogastric tube placement for decompression and eventually made a full recovery.Case Rep Gastroenterol 2021;15:171 –177 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 12, 2021 Category: Gastroenterology Source Type: research

IgG4-Related Pseudotumors Mimicking Metastases in Liver and Lungs
A 47-year-old man complained intermittent dull pain at the right upper quadrant abdomen and right neck swelling for 3 months. Blood tests revealed leukocytosis with mild eosinophilia. Computed tomography (CT) showed the presence of multiple nodules in the liver and both lung fields. Positron emission tomography/CT (PET/CT) scans found increased uptake at lymph nodes of the right neck, in the lung, liver, and prostate. The patient was diagnosed with IgG4-related disease (IgG4-RD) based on the biopsy findings from the right neck lymph nodes, showing enriched IgG4-positive lymphoplasmacytic cells. It is often difficult to dis...
Source: Case Reports in Gastroenterology - February 12, 2021 Category: Gastroenterology Source Type: research

Cholangiocarcinoma Presenting after Eight Years of Treatment of IgG4-Related Autoimmune Pancreatitis with Steroids
We report a patient with IgG4-related AIP who developed cholangiocarcinoma after 8 years of steroid treatment. A 76-year-old male presented with fever (37.8 °C) due to biliary obstruction and cholangitis. He had been treated with steroids for 8 years to control inflammation due to IgG4-related AIP. During 8 years of treatment, hepatobiliary enzyme levels were well controlled within their normal range, but serum IgG4 levels remained elevated. A computed tomography scan showed intrahepatic bile duct dilatation. Magnetic resonance cholangiopancreatography showed obstructive changes at the junction of the cystic and common...
Source: Case Reports in Gastroenterology - February 5, 2021 Category: Gastroenterology Source Type: research

Dramatic Deep and Durable Remission of Acute Fulminant Ulcerative Colitis Achieved with Cyclosporine in a Patient Who Failed the Induction Intravenous Phase of Cyclosporine
We present the case of a 36-year-old man with acute severe UC refractory to steroids and multiple biologics, who “failed” IV cyclos porine for 2 weeks, much longer than the usually accepted induction phase, and achieved remission with continuation of oral cyclosporine. This case demonstrates the possibility that continued therapy with cyclosporine for a longer duration than the currently accepted timeline can lead to remission a nd avoidance of colectomy in properly selected and monitored patients.Case Rep Gastroenterol 2021;15:147 –153 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 4, 2021 Category: Gastroenterology Source Type: research

Wilson ’s Disease Presenting in Late Adult Life
We report a case of WD presenting with liver function impairment in late adult life and started on treatment. Therefore, early diagnosis and treatment of WD can prevent related complications.Case Rep Gastroenterol 2021;15:142 –146 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 4, 2021 Category: Gastroenterology Source Type: research

Endoscopic Removal of a Press-Through Pack from the Anal Canal
The incidence of press-through pack (PTP) ingestion has been increasing. In many cases, the ingested PTP is lodged in the esophagus. Here, we report a case of endoscopic removal of a PTP from the anal canal. An 89-year-old man with mild dementia presented with a 3-day history of anal pain. On digital rectal examination, we felt a hard and sharp object, which could not be manually removed due to its shape. Therefore, it was removed endoscopically. We inserted an endoscope with a large-caliber soft oblique cap and observed the PTP in the anal canal. It was successfully removed using grasping forceps. The patient was stable, ...
Source: Case Reports in Gastroenterology - February 3, 2021 Category: Gastroenterology Source Type: research

Pancreatic Metastasis from Malignant Melanoma: Not All That Glitters Is Gold
We present a case of metastatic melanoma to the pancreas. A 60-year-old man presented with a history of weight loss, vague abdominal pain, jaundice, and pruritus. Laboratory tests showed increased total bilirubin, with a direct fraction predominance, as well as increased alkaline phosphatase and gamma glutamyl transferase. Imaging studies revealed a mass in the head of the pancreas. Endoscopic ultrasound (EUS)-guided fine needle biopsy was performed, and histologic examination confirmed the diagnosis of metastatic melanoma. This case report illustrates the invaluable use of EUS-guided tissue acquisition in the study of pan...
Source: Case Reports in Gastroenterology - February 3, 2021 Category: Gastroenterology Source Type: research

Large Fundic Gland Polyp Associated with Long-Term Proton Pump Inhibitor Administration Mimicking Gastric-Type Neoplasm
A 57-year-old man with a 10-year history of proton pump inhibitor (PPI) use presented with multiple fundic gland polyps (FGPs) including one #x3e;20 mm, whitish, semi-pedunculated polyp. Black spots and cobblestone-like mucosa were also observed in the stomach upon endoscopy; therefore, the lesion was considered to result from long-term PPI administration. Endoscopically, we diagnosed this polyp as a neoplastic lesion with gastric phenotype rather than a non-neoplastic lesion. Biopsy revealed an atypical glandular lesion that was indeterminate for neoplasia; therefore, we performed en bloc resection via endoscopic submucos...
Source: Case Reports in Gastroenterology - February 3, 2021 Category: Gastroenterology Source Type: research

Hepatitis E Viral Association with Autoimmune Hepatitis: A Viral Trigger or Cross-Reactivity
We present a case of a 36-year-old lady with systemic lupus erythematosus who presented with abdominal pain, nausea, vomiting, and jaundice. She was initially diagnosed as acute hepatitis E virus (HEV) infection based on positive serology, but she did not improve with conservative management. Subsequently, she underwent liver biopsy that showed features characteristic of AIH. We discuss the role of HEV as a possible trigger of AIH. We also highlight the possibility of cross-reactivity between liver antigens and HEV as an explanation for the positive HEV serology in AIH. We explore the management options of cases in which b...
Source: Case Reports in Gastroenterology - February 3, 2021 Category: Gastroenterology Source Type: research

Cystic Pancreatic Neuroendocrine Tumor in a Patient with Neurofibromatosis Type 1
Neurofibromatosis type 1 (NF-1) is strongly associated with neurofibromas and malignancies. Solid pancreatic neuroendocrine tumors (PanNETs) have been recently reported in patients with NF-1. PanNETs are always solid and rarely present with a cystic appearance due to central necrosis and hemorrhage caused by rapid growth. A 33-year-old female diagnosed with NF-1 at age 16 was referred for evaluation of a pelvic mass found on abdominal ultrasound. Magnetic resonance imaging showed a 6 cm solid pelvic mass adjacent to the left external iliac artery, and contrast-enhanced computed tomography scan showed a 3-cm solid para-aort...
Source: Case Reports in Gastroenterology - February 1, 2021 Category: Gastroenterology Source Type: research

Diffuse Gallbladder Adenomyomatosis with an Inflammatory Complication in an Adult
We present the rare case of a 51-year-old man who was admitted to hospital due to abdominal pain concomitant with inflammatory syndrome. Imaging and histological findings were appropriate to diagnose diffuse GA and complication of cholecystitis.Case Rep Gastroenterol 2021;15:100 –107 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 1, 2021 Category: Gastroenterology Source Type: research

Response to “Cytomegalovirus Enterocolitis in a Patient with Refractory Immune-Related Colitis”
Case Rep Gastroenterol 2021;15:97 –99 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 26, 2021 Category: Gastroenterology Source Type: research

Recurrent Encephalopathy and Severe Anion Gap Metabolic Acidosis in a Patient with Short Bowel: It Is D-Lactic Acidosis
We present the case of a 61-year-old female with a history of an ileojejunal bypass at age 18 who presented to hospital with acute-onset encephalopathy, ataxia, and severe anion gap metabolic acidosis (AGMA). On initial investigations there were no identifiable etiologies for the AGMA. Further history revealed that she had been experiencing these symptoms on a recurrent basis for the past 40 years. An oral carbohydrate load was given to the patient in hospital which reproduced her symptoms and the AGMA. A serum D-lactate level returned elevated several weeks later. A 2-month follow-up revealed that all her symptoms had cea...
Source: Case Reports in Gastroenterology - January 26, 2021 Category: Gastroenterology Source Type: research

Use of Non-Selective Beta-Blocker for Refractory Stomal Variceal Hemorrhage
Bleeding stomal varices are often difficult to manage given the comorbidities that are associated with their presentation. Here, we report a case of a 62-year-old female with stomal variceal hemorrhage in the setting of chronic portal vein thrombosis who was ineligible for transhepatic intrajugular portosystemic shunt or surgery as a result of her challenging anatomy and peri-operative risks. Despite coil embolization, this patient experienced refractory bleeds which ceased following the initiation of a non-selective beta-blocker (NSBB). This case provides further evidence for the expanding role of NSBBs as an important th...
Source: Case Reports in Gastroenterology - January 26, 2021 Category: Gastroenterology Source Type: research

Alpha-Fetoprotein-Producing Gastric Cancer with Nonbiliary Pancreatitis
This study describes the different presentations of this rare but aggressive subtype of gastric cancer with a review of the literature.Case Rep Gastroenterol 2021;15:80 –86 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 25, 2021 Category: Gastroenterology Source Type: research

Blastic Mantle Cell Lymphoma of the Gastroesophageal Junction: A Unique Presentation and Literature Review
We present the unique case of a 76-year-old male who presented with worsening dysphagia, weight loss, and heartburn and who was found to have blastic variant of MCL in the GEJ. He had undergone extensive workup in the past for an ulcerative, gastric/GEJ lesion, found on four separate esophagogastroduodenoscopies (EGDs) and two esophageal ultrasounds, whose biopsies were repeatedly negative for malignancy. On admission, physical examination and labs were unremarkable, but computed tomography showed an irregular mass involving the GEJ. EGD on admission showed a large friable, ulcerated lesion with heaped-up margins involving...
Source: Case Reports in Gastroenterology - January 25, 2021 Category: Gastroenterology Source Type: research

Next-Generation Sequencing for Non-Ampullary Duodenal Carcinoma Suggesting the Existence of an Adenoma-Carcinoma Sequence
We present a 68-year-old woman without a genetic or familial history of familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome, or Lynch syndrome who presented to Kosei Hospital, Japan, with exertional dyspnea induced by abdominal pain lasting 3 weeks. A duodenal tumor was suspected by contrast-enhanced computed tomography. Esophagogastroduodenoscopy showed a lesion accompanied by a white microprotuberance on the descending part of the duodenum opposite the papilla, with a giant ulcerative lesion at the center of the white lesion. Biopsy revealed a low-grade adenoma, high-grade adenoma, and adenocarcinoma. Immunohist...
Source: Case Reports in Gastroenterology - January 25, 2021 Category: Gastroenterology Source Type: research

Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis
Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdom...
Source: Case Reports in Gastroenterology - January 25, 2021 Category: Gastroenterology Source Type: research

Anisakiasis of the Terminal Ileum Removed by Colonoscopy
A 35-year-old Japanese man with no significant medical history presented to the emergency department complaining of abdominal pain, nausea, and vomiting 35 h after ingesting raw horse mackerel, sardines, and tuna. Computed tomography of the abdomen with intravenous contrast revealed significant thickening of the terminal ileum with mild proximal dilatation and moderate ascites. On colonoscopy, an actively moving anisakis larva was discovered in the terminal ileum. The larva was removed with endoscopic forceps. The patient ’s symptoms resolved quickly following the procedure.Case Rep Gastroenterol 2021;15:47 –52...
Source: Case Reports in Gastroenterology - January 25, 2021 Category: Gastroenterology Source Type: research

Colorectal Metastasis from Ovarian Neoplasm Mimicking Primary Colon Cancer
Metastasis to the colon from another primary internal malignancy is an untypical and a seldom reported entity. Direct visualization during colonoscopy is considered the gold standard of diagnosis. Pathologic diagnosis with immunohistochemical staining is essential to differentiate primary colorectal malignancy from secondary metastasis to the colon. We, hereby, present a case of a 53-year-old female status-post resection of left-sided papillary serous ovarian neoplasm who presented 2 years later with a single rectosigmoid intraluminal ulcerative mass imitating a primary colon cancer. Biopsies of the mass were consistent wi...
Source: Case Reports in Gastroenterology - January 21, 2021 Category: Gastroenterology Source Type: research

Case of Incarcerated Femoral Hernia Treated with Laparoscopic Surgery after Groin Hernia Repair
An 81-year-old man was brought to our hospital due to a suspicion of left incarcerated femoral hernia. He was previously diagnosed with incarcerated left groin hernia and was treated using the mesh plug method 1 month back at another hospital. Abdominal computed tomography scan revealed small bowel obstruction, incarcerated bowel, and compression of the left femoral vein. Thus, the patient was diagnosed with incarcerated femoral hernia. An emergency laparoscopic surgery was then performed, and we found that the small bowel was incarcerated into the let femoral ring and was necrotic. However, there was no recurrence of left...
Source: Case Reports in Gastroenterology - January 21, 2021 Category: Gastroenterology Source Type: research

Novel Endoscopic Therapy for Gastric Varices Using Direct Forward-Viewing Endoscopic Ultrasonography
The objective of this retrospective study was to evaluate the usefulness of a new method, direct forward-viewing endoscopic ultrasonography (DFV-EUS) for the treatment of GV. We performed endoscopic injection sclerotherapy with histoacryl (EIS-HA) using DFV-EUS for GV in four patients. The paracentesis success rate was 75% (3/4). DFV-EUS has a significant advantage for the treatment of GV in that it can show physicians endoscopic and ultrasound views in real time during the delivery of the sclerosant into the GV. However, the proper use of the ultrasound view must be elucidated through further research for safer and more e...
Source: Case Reports in Gastroenterology - January 21, 2021 Category: Gastroenterology Source Type: research

Crowned Dens Syndrome Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer
We report the case of a 75-year-old man who presented with sudden neck pain after endoscopic submucosal dissection (ESD) for gastric cancer. He could nod but could not rotate his head. Computed tomography showed calcifications surrounding the odontoid process consistent with CDS. Prolonged dietary restrictions and proton pump inhibitor use following the ESD procedure may have caused hypomagnesemia, a precipitating factor for CDS. We prescribed colchicine 1 mg/day and symptoms resolved completely in 3 days. This is the first report of CDS after ESD. CDS should be included in the differential diagnosis of neck pain after end...
Source: Case Reports in Gastroenterology - January 21, 2021 Category: Gastroenterology Source Type: research

Sunitinib-Induced Acute Liver Failure
We present a case of fatal acute liver failure and cardiomyopathy within 2 weeks of sunitinib therapy initiation for advanced pancreatic neuroendocrine carcinoma. We believe our case is unique due to the rarity of its presentation. It highlights hepatotoxicity as a potentially fatal side effect of sunitinib therapy.Case Rep Gastroenterol 2021;15:17 –21 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 21, 2021 Category: Gastroenterology Source Type: research

Improvement of Cyclic Vomiting Syndrome with Outpatient Ketamine Infusions
This report is the first, to our knowledge, to describe the use of outpatient ketamine infusions as therapy for refractory CVS. We describe a 63-year-old woman with history of CVS who presented with abdominal pain and recurrent episodes of nausea and vomiting. She first received ketamine during an inpatient admission for a CVS flare, with the aim of treating the abdominal pain. Given her improvement, she was offered a series of outpatient ketamine infusions, which led to a significant reduction in her symptoms. Thus, ketamine may be useful as both an abortive and prophylactic therapy in CVS. Prior reports have noted the an...
Source: Case Reports in Gastroenterology - January 18, 2021 Category: Gastroenterology Source Type: research

More than Pus – Primary Hepatic Epithelioid Angiomyolipoma Masquerading as Liver Abscess
We report a case of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess. A 46-year-old man presented with a 5-day history of fever with epigastric pain and nausea. On the night of admission, his temperature spiked to 39 °C, his blood pressure was 135/79, his heart rate 98, his liver function test revealed albumin 37 g/L, bilirubin 25 μmol/L, ALP 298 U/L, ALT 247 U/L, and AST 344 U/L. The clinical suspicion was hepatobiliary sepsis and intravenous ceftriaxone was commenced. CT of the abdomen showed an ill-defined hypodense focus in segment 4A/8 (4.5 × 3.5 cm) with a minimal fluid component ...
Source: Case Reports in Gastroenterology - January 8, 2021 Category: Gastroenterology Source Type: research

Diffuse Esophageal Squamous Papillomatosis: A Rare Disease Associated with Acanthosis Nigricans and Tripe Palms
We report a case of acanthosis nigricans with tripe palms that was associated with diffuse esophageal squamous papillomatosis. A 40-year-old Thai woman with underlying systemic lupus erythematosus and secondary Sjögren’s syndrome, who was recently diagnosed with acanthosis nigricans and tripe palms was investigated for occult gastrointestinal malignancy. An upper GI endoscopy revealed diffuse squamous papilloma along the entire esophagus and lower GI endoscopy revealed one pedunculated hyperplastic polyp 1 cm in size at the sigmoid colon. Long-term follow-up is needed to reassure these coexisting conditions belo...
Source: Case Reports in Gastroenterology - December 16, 2020 Category: Gastroenterology Source Type: research

Surgery for Ampullary Cancer in a Patient with Pancreatic Lipomatosis Caused by Cystic Fibrosis
A patient with cystic fibrosis (CF) with pancreatic insufficiency presented with jaundice due to an ampullary tumour. CF is known for a higher incidence of gastrointestinal malignancies. The patient suffered from pancreatic insufficiency. At computed tomography (CT), pancreatic lipomatosis with absence of the pancreatic duct was seen. This is uncommon, also in patients with CF. During surgery, a total pancreatectomy was performed, because there was no possibility to construct a duct to mucosa anastomosis due to the absence of the pancreatic duct and more importantly the pancreas was already afunctional. The presence of lip...
Source: Case Reports in Gastroenterology - December 15, 2020 Category: Gastroenterology Source Type: research

Paclitaxel-Induced Bowel Perforation: A Rare Cause of Acute Abdomen
We present a case of necrotizing small and large bowel perforation in a patient with breast cancer, 2 weeks after paclitaxel administration.Case Rep Gastroenterol 2020;14:687 –694 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - December 14, 2020 Category: Gastroenterology Source Type: research

Endoscopic Diagnosis of Bouveret Syndrome
Bouveret syndrome is a form of gallstone ileus and a rare complication of chole(cysto)lithiasis. It describes gastric outlet obstruction secondary to an impacted gallstone. Here, we report a case of an 82-year-old female patient with gastric outlet obstruction and penetration of gallstones into the duodenal bulb on endoscopic imaging. Based on these findings Bouveret syndrome was diagnosed and confirmed by computed tomography.Case Rep Gastroenterol 2020;14:683 –686 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - December 14, 2020 Category: Gastroenterology Source Type: research

Laparoscopy-Assisted Repair for Intersigmoid Hernia
Intersigmoid hernia is a rare clinical entity. Only 6 cases of laparoscopic repair for intersigmoid hernia have been reported since 1977. We herein report such a case, which was successfully diagnosed preoperatively and treated with laparoscopic repair. A 50-year-old man with a chief complaint of abdominal pain and vomiting was admitted for the treatment of small bowel obstruction. The patient had no history of abdominal surgery. Computed tomography showed a dilated small bowel and a closed loop of small bowel dorsal to the sigmoid colon and the sigmoid mesocolon. With a diagnosis of an incarcerated internal hernia, the pa...
Source: Case Reports in Gastroenterology - December 11, 2020 Category: Gastroenterology Source Type: research

Eosinophilic Cholecystitis Associated with Eosinophilic Granulomatosis with Polyangiitis
We report a case of eosinophilic cholecystitis associated with eosinophilic granulomatosis with polyangiitis (EGPA) complicated by cerebral hemorrhage. A 60-year-old man presented to a local hospital with a diagnosis of acute cholecystitis, with persistent fever and epigastric pain for 2 weeks. His symptoms persisted despite 3-week hospitalization; therefore, he was transferred to our hospital for further evaluation. Laboratory investigations upon admission showed white blood cells 26,300/ µL and significant eosinophilia (eosinophils 61%). Abdominal computed tomography revealed no gallbladder enlargement but a circum...
Source: Case Reports in Gastroenterology - December 11, 2020 Category: Gastroenterology Source Type: research

Prolonged Survival of a Patient with Advanced-Stage Combined Hepatocellular-Cholangiocarcinoma
Combined hepatocellular-cholangiocarcinoma (cHCC/CCA) represents a rare type of primary liver cancer with a very limited prognosis. Although just recently genomic studies have contributed to a better understanding of the disease ’s genetic landscape, therapeutic options, especially for advanced-stage patients, are limited and often experimental, as no standardized treatment protocols have been established to date. Here, we report the case of a 38-year-old male patient who was diagnosed with extensive intrahepatic cHCC/CCA in an otherwise healthy liver without signs of chronic liver disease. An interdisciplinary stepw...
Source: Case Reports in Gastroenterology - December 10, 2020 Category: Gastroenterology Source Type: research

A Bitter Pill to Swallow: Pseudoachalasia Secondary to Oesophageal Deviation Resulting from Mediastinal Shift and Left Atrial Enlargement after Left Lower Lobectomy
Pseudoachalasia, also known as secondary achalasia, is a rare clinical condition mimicking idiopathic achalasia but unrelated to primary loss of nitrergic innervation. It has mostly been attributed to malignancy infiltrating the oesophageal wall, but several other benign underlying pathologies have been reported. Because of similar manometric appearance, high-resolution manometry (HRM) of the oesophagus alone cannot distinguish between idiopathic achalasia and pseudoachalasia. Misdiagnosis can result in ineffective treatment by dilatation or even more invasive therapy. This is the first case-report of pseudoachalasia secon...
Source: Case Reports in Gastroenterology - December 3, 2020 Category: Gastroenterology Source Type: research

Combined Intraoperative Identification and Monitoring of Recurrent Laryngeal Nerve Paresis during Minimally Invasive Esophagectomy: Surgical Technique Using Nerve Integrity Monitoring for Esophageal Carcinoma
Recurrent laryngeal palsy occurs after No. 106 rec RL lymphadenectomy procedure, which is assumed to cause postoperative respiratory complications. A 71-year-old Japanese man with T1b N0 M0 stage 1 esophageal cancer was scheduled for thoracoscopic esophagectomy with two-field lymph node dissection using nerve integrity monitoring (NIM). The patient demonstrated an uneventful postoperative course with 56 days remission. Under general anesthesia conditions, a single-lumen intubation tube was inserted for NIM. The automatic periodic stimulation electrode was placed on the bilateral vagus nerves on the left and right, respecti...
Source: Case Reports in Gastroenterology - November 30, 2020 Category: Gastroenterology Source Type: research

Rectal Bleeding after Insertion of a Percutaneous Endoscopic Gastrostomy Tube
We present a case of rectal bleeding due to colon injury during PEG tube placement. This required urgent exploratory laparoscopic surgery with segmental resection of the transverse colon and replacement of the PEG tube. Postoperatively, the patient significantly improved with time and tolerated PEG tube feeding.Case Rep Gastroenterol 2020;14:637 –643 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 30, 2020 Category: Gastroenterology Source Type: research

Primary Hepatic Lymphoma in a Patient with Chronic Hepatitis B
Primary hepatic lymphoma is a rare disease, accounting for only 0.1% of malignant liver tumors. The subtype of diffuse large B-cell lymphoma (DLBCL) is more infrequent. In contrast to hepatitis C virus, the association between hepatitis B virus and lymphoma is less clear. Here, we report the case of a 52-year-old patient followed for chronic hepatitis B complicated by cirrhosis, associated with a primary hepatic DLBCL, with a good response to chemotherapy.Case Rep Gastroenterol 2020;14:632 –636 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - November 26, 2020 Category: Gastroenterology Source Type: research

Anaplastic Carcinoma of the Pancreas: Clinical and Morphological Characteristics
Anaplastic pancreatic carcinoma is a very rare histological subtype of pancreatic cancer, which is characterized by a more aggressive course than for conventional ductal adenocarcinoma. In this article, we consider the features of the clinical course, the difficulties of diagnosis in connection with the absence of pathognomonic signs of pancreatic cancer, and the morphological picture of this disease in a patient 60 years of age. This clinical case clearly demonstrates the complexities of the pancreatic carcinoma diagnosis, fast disease progression, and extremely unfavorable prognosis. It is important for clinicians to rem...
Source: Case Reports in Gastroenterology - November 24, 2020 Category: Gastroenterology Source Type: research

An Emphasis on Screening to Detect Liver Cirrhosis and Hepatocellular Carcinoma in Patients Having Undergone the Fontan Procedure in Early Childhood
The Fontan procedure is a surgical procedure for patients with single-ventricle anatomy that results in the flow of systemic venous blood to the lungs without passing through a ventricle. Before the 1970s, most children with single-ventricle anatomy failed to survive into adulthood. With the introduction of the Fontan procedure, and its many modifications, the survival rate of these patients improved exponentially. With patients surviving longer, complications from this procedure are being documented for the first time. Cardiovascular complications are expected early on and are well studied. More serious are the non-cardio...
Source: Case Reports in Gastroenterology - November 23, 2020 Category: Gastroenterology Source Type: research

Heterotopic Gastric Mucosa in the Ileum: A Rare Cause for Intussusception in Adults
Intussusception is the leading cause for intestinal obstruction in children. However, it accounts for only 5% of bowel obstructions in adults. Heterotopic gastric mucosa (HGM) can occur anywhere in the gastrointestinal tract; nevertheless, its occurrence in the small intestine is rare unless associated with remnants of vitelline duct (Meckel ’s diverticulum). Herein, we describe a case of a 33-year-old male who presented with symptoms and signs of intestinal obstruction caused by ileo-colic intussusception, in which polypoid HGM acted as the organic lead point for intussusception. Several cases of intussusception cau...
Source: Case Reports in Gastroenterology - November 11, 2020 Category: Gastroenterology Source Type: research