Unusual Cause of Gastrointestinal Bleeding in a Patient with Turner Syndrome
We report the case of a patient with Turner syndrome with an episode of gastrointestinal bleeding, outlining our pathway for the investigation and treatment of this condition.Case Rep Gastroenterol 2018;12:292 –296 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 18, 2018 Category: Gastroenterology Source Type: research

Abdominoperineal Resection for Unexpected Distal Intramural Spreading of Rectal Cancer
Conclusion: An intraoperative frozen pathology examination was helpful for the additional resection, when unexpected distal spreading had occurred in rectal cancer. The evidence of a distal negative margin should not be underestimated.Case Rep Gastroenterol 2018;12:297 –302 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 18, 2018 Category: Gastroenterology Source Type: research

A Small Bowel Ulcer due to Clopidogrel with Cytomegalovirus Enteritis Diagnosed by Capsule and Double-Balloon Endoscopy
We report the first case of small bowel ulcers due to clopidogrel in a 74-year-old man. He presented with diarrhea and melena after having been taking low-dose aspirin (LDA) and clopidogrel. There was no evidence of bleeding in the stomach, duodenum, or colon. Capsule endoscopy showed multiple ulcers and erosions in the small intestine. Double-balloon endoscopy revealed multiple ulcers throughout the ileum. Examination of the biopsy specimen showed cytomegalovirus infection. His LDA was discontinued and he was prescribed ganciclovir. However, the small bowel ulcers were aggravated. Therefore, clopidogrel was discontinued. ...
Source: Case Reports in Gastroenterology - June 18, 2018 Category: Gastroenterology Source Type: research

Phlegmonous Proctitis: A Rare Entity of the Presentation of Proctitis
We report the case of an elderly woman who presented with acute severe lower abdominal pain, tenesmus, and fever. A computed tomography of the whole abdomen revealed a long segment of circumferential wall thickening of the rectum and rectosigmoid colon. Colonoscopy was done subsequently and showed marked edematous and erythematous rectal mucosa. When rectal tissue biopsy was performed, a large amount of pus came out at the biopsy site, which led to the diagnosis of phlegmonous proctitis.Case Rep Gastroenterol 2018;12:254 –259 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 15, 2018 Category: Gastroenterology Source Type: research

Pemphigus Vulgaris in the Mouth and Esophageal Mucosa
We report a case of PV with esophageal involvement in a 53-year-old woman who sought medical care, complaining of diffuse painful lesions in the oral cavity for approximately 1 month, with no improvement with nystatin. Upper digestive endoscopy (UDE) was performed with findings of vesiculobullous lesions in the proximal and middle esophagus, which were biopsied and for which histopathology confirmed PV in the esophageal mucosa. We draw attention to UDE as important for the diagnosis, and it should be indicated in patients with vesiculobullous lesions of the mouth, especially if there are esophageal complaints.Case Rep Gast...
Source: Case Reports in Gastroenterology - June 15, 2018 Category: Gastroenterology Source Type: research

Bicalutamide-Associated Acute Liver Injury and Migratory Arthralgia: A Rare but Clinically Important Adverse Effect
We describe a case of acute liver injury and migratory arthralgia in a patient receiving bicalutamide treatment for prostate cancer. A 67-year-old male with metastatic prostate cancer presented with a 6-day history of migratory arthralgia. He had been undergoing treatment with bicalutamide for 4 months; 3 weeks prior to symptom appearance the bicalutamide dose had been increased. He had no other symptoms. Liver tests and inflammatory markers were markedly elevated. Serology for hepatitis viruses A, B, and C, CMV, and EBV and autoimmune causes were all negative, and an ultrasound of the upper abdomen was normal. There was n...
Source: Case Reports in Gastroenterology - June 15, 2018 Category: Gastroenterology Source Type: research

Usefulness of Plain Computed Tomography with Swallowing of Gastrografin < sup > TM < /sup > for the Diagnosis of a Late-Onset Iatrogenic Diaphragmatic Hernia following Biopsy of a Diaphragmatic Tumor: Report of a Case
This report describes the rare case of a 14-year-old girl complicated by iatrogenic DH following the biopsy of granulomatous lesions of the left diaphragm, when a mediastinal mixed germ cell tumor was extirpated. Plain computed tomography (CT) with swallowing of GastrografinTM was useful for the diagnosis of this disorder. The patient presented to our hospital with frequent epigastric pain and vomiting 11 months after the original surgery. Chest X-ray, a gastrointestinal contrast study, and plain CT with swallowing of GastrografinTM revealed the left DH with gastric content. At laparotomy, the diaphragmatic defect, 3 &time...
Source: Case Reports in Gastroenterology - June 15, 2018 Category: Gastroenterology Source Type: research

Signet Ring Carcinoma of the Appendix Presenting as Crohn ’s Disease in a Young Male
Primary signet ring cell carcinoma is a rare event in surgery. It looks like acute appendicitis and it is difficult to diagnose it on clinical grounds alone. The diagnosis is always confirmed by histopathology of a surgically removed appendix. A young man, 22 years old, presented with vomiting, diarrhea, and cramps in his abdomen without abdominal tenderness (mild abdominal discomfort in the right lower abdominal quadrant without signs of peritoneal irritation) during the previous month. The first endoscopic results showed only changes of mucosa that could be attributed to endoscopic and clinical representation of Crohn &r...
Source: Case Reports in Gastroenterology - June 15, 2018 Category: Gastroenterology Source Type: research

Hepatic Failure by Spontaneous Reactivation of Hepatitis B Virus without a Trigger Factor in a Patient with Anti-HBs
A patient who has achieved resolution of acute hepatitis B and acquired anti-HBs would get protective immunity against hepatitis B virus (HBV). However, reactivation of HBV could happen if the patient was exposed to an immunocompromised state by using immunosuppressive drugs or chemotherapeutic agents. That is because cccDNA could reside within hepatocytes after recovery of acute hepatitis B. Therefore, guidelines for hepatitis B recommend the use of prophylactic antiviral agents such as entecavir or tenofovir in patients with anti-HBc IgG. The reactivation of hepatitis B without exposure to an immunocompromised state is v...
Source: Case Reports in Gastroenterology - June 15, 2018 Category: Gastroenterology Source Type: research

Mixed Neuroendocrine Carcinoma and Squamous Cell Carcinoma of the Colon: Case Report and Literature Review
Neuroendocrine carcinoma (NEC) of the colon is very rare, and squamous cell carcinoma (SCC) of colon cancer is rare. We recently treated a patient with both NEC and SCC that initially presented as multiple unresectable liver and lung metastases. A 68-year-old Japanese man was referred to our hospital because of diarrhea with descending colon cancer obstruction. He underwent a left colectomy. Based on immunohistochemistry results, we diagnosed mixed NEC and SCC, the primary lesion location of which was probably the lung in the final pathologic examination. He began systemic palliative chemotherapy with CDDP and CPT-11. Afte...
Source: Case Reports in Gastroenterology - June 5, 2018 Category: Gastroenterology Source Type: research

Pancreatic Duct Stricture That Rapidly Progressed to Pancreatic Ductal Adenocarcinoma and Formed a Mass within 3 Months: A Case Report
The natural growth rate of pancreatic carcinoma in situ with pancreatic duct stricture remains unclear. Herein, we present a case with pancreatic duct stricture that rapidly grew to form a mass lesion within 3 months. A 74-year-old woman was referred to us for the investigation of a pancreatic duct dilatation. Initial images did not reveal any clear mass lesions near the pancreatic duct stricture. Pancreatic juice cytology showed suspicious findings. Distal pancreatectomy was recommended; however, the patient refused to undergo surgical treatment at that time. Images taken 3 months later demonstrated a nodular pancreatic b...
Source: Case Reports in Gastroenterology - June 5, 2018 Category: Gastroenterology Source Type: research

Autoimmune Ascites Responding to Mycophenolate Mofetil: A Case Report
We present an interesting case of ascites in a 67-year-old Caucasian male with symptoms of recurrent abdominal distention and significant weight gain, refractory to standard therapies. An extensive 3-year long workup was only significant for serum-ascites albumin gradient #x3e; 1.1 g/dL, ascitic fluid protein of 3.0 g/dL, and peritoneal biopsies showing minor inflammatory changes. Both common and rare causes of ascites were ruled out. Empiric treatment with mycophenolate mofetil (CellCept) resulted in resolution of symptoms with no need for a repeat paracentesis for #x3e; 2 years, suggesting the diagnosis of autoimmune asc...
Source: Case Reports in Gastroenterology - May 31, 2018 Category: Gastroenterology Source Type: research

Hypothermia-Related Acute Pancreatitis
Acute pancreatitis (AP) is an inflammatory disease presenting from mild localized inflammation to severe infected necrotic pancreatic tissue. In the literature, there are a few cases of hypothermia-induced AP. However, the association between hypothermia and AP is still a myth. Generally, mortality from acute pancreatitis is nearly 3 –6%. Here, we present a 40-year-old chronic alcoholic female who presented with acute pancreatitis induced by transient hypothermia. A 40-year-old chronic alcoholic female was hypothermic at 81°F on arrival which was improved to 91.7°F with warming blanket and then around 97°...
Source: Case Reports in Gastroenterology - May 31, 2018 Category: Gastroenterology Source Type: research

< b > < i > Ascaris lumbricoides < /i > < /b > : A Startling Discovery during Screening Colonoscopy
Intestinal parasitic infections are a major public health issue across the world and particularly in rural and urban areas of tropical and subtropical countries. Those at increased risk include inhabitants of poor and disadvantaged regions, which are more likely to have inadequate environmental sanitation, insufficient water supply, greater contact rates with reservoirs of infection, limited health literacy, and socioeconomic disparities. Of the intestinal nematodes (roundworms) that parasitize the human gastrointestinal tract,Ascaris lumbricoides is the largest in terms of size. It causes ascariasis, a “neglected tr...
Source: Case Reports in Gastroenterology - May 31, 2018 Category: Gastroenterology Source Type: research

Rare Incidence of Acute Liver Injury with Potassium Para-Aminobenzoate Introduction
We present a case of Peyronie ’s disease treated with potassium para-aminobenzoate that developed acute liver injury. After starting the new treatment, the patient complained of right upper quadrant pain. He was found to have elevated liver enzymes. The condition resolved after stopping potassium para-aminobenzoate use. We rep ort a potassium para-aminobenzoate side effect of liver injury that can be managed conservatively.Case Rep Gastroenterol 2018;12:230 –233 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - May 31, 2018 Category: Gastroenterology Source Type: research

Esophageal Large-Cell Neuroendocrine Carcinoma with Inconsistent Response to Treatment in the Primary and Metastatic Lesions
Esophageal large-cell neuroendocrine carcinoma (NEC) is a rare malignant tumor that is characterized by high-grade malignancy and a poor prognosis. However, the rarity of esophageal NEC has prevented the development of an established treatment, and no reports have described a discrepancy in the effectiveness of cisplatin plus irinotecan between primary and metastatic lesions. A 43-year-old Japanese man was referred to our hospital with refractory epigastralgia. A previous gastrointestinal endoscopy had revealed a 50-mm type 2 tumor in the abdominal esophagus. The pathological findings indicated poorly differentiated squamo...
Source: Case Reports in Gastroenterology - May 31, 2018 Category: Gastroenterology Source Type: research

Signet Ring Cell Carcinoma of the Ampulla of Vater: A Rare Histopathological Variant
Signet ring cell carcinoma (SRCC) of the ampulla of Vater is an extremely rare tumor. Our case describes a 45-year-old female presenting with jaundice and pruritus. Computed tomography, endoscopy, and endoscopic retrograde cholangiopancreatography showed a tumor of the ampulla of Vater without distant metastasis. Histological biopsy confirmed a malignant tumor with SRCC characteristics and immunohistochemical staining revealed a mixed type profile (both intestinal and pancreatobiliary characteristics). A pylorus-preserving pancreatoduodenectomy was performed and the patient recovered without complications. Pathology result...
Source: Case Reports in Gastroenterology - April 27, 2018 Category: Gastroenterology Source Type: research

Multidetector-Row Computed Tomography and Colonoscopy for Detecting a Rectal Dieulafoy Lesion as a Source of Lower Gastrointestinal Hemorrhage
A Dieulafoy lesion of the rectum is a very rare entity that can cause massive lower gastrointestinal (GI) hemorrhage. Identifying the bleeding point is sometimes difficult because these lesions are very small. We herein describe an 82-year-old man with active hemorrhage due to a rectal Dieulafoy lesion. He was referred to our hospital because of persistent hematochezia from the morning of that day. He had a history of atrial fibrillation, chronic heart failure, diabetes mellitus, and hyperuricemia. Prompt multidetector-row computed tomography (MDCT) enabled us to detect active bleeding from the lower rectum. Subsequently, ...
Source: Case Reports in Gastroenterology - April 27, 2018 Category: Gastroenterology Source Type: research

Rectal Foreign Body of Eggplant Treated Successfully by Endoscopic Transanal Removal
We report a patient in our hospital who had a rectal foreign body inserted into the deep part of the proctosigmoid that could be removed endoscopically. A 66-year-old man visited our hospital because of an eggplant which had been inserted into his rectum by his friend and could not be removed. Since plain abdominal computed tomography showed a foreign body thought to be an eggplant in the proctosigmoid, the foreign body was captured and removed with a snare under lower gastrointestinal endoscope guidance.Case Rep Gastroenterol 2018;12:189 –193 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 26, 2018 Category: Gastroenterology Source Type: research

Hemophagocytic Lymphohistiocytosis Secondary to Unknown Underlying Hodgkin Lymphoma Presenting with a Cholestatic Pattern of Liver Injury
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon disease that often presents with nonspecific findings. A high index of suspicion is necessary to make a prompt diagnosis and prevent fatal disease. A 45-year-old man presented with fever, hypotension, abdominal pain, nausea, and vomiting. Imaging showed hepatosplenomegaly and laboratory tests revealed pancytopenia, increased ferritin, and a cholestatic pattern of injury with elevated alkaline phosphatase and total bilirubin. Due to a history of Crohn disease, systemic lupus erythematous, and rheumatoid arthritis, the patient was on immunosuppressants, including inflix...
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Small Bowel Obstruction Caused by Dried Persimmon
We present the case of an 87-year-old female who suffered from small bowel obstruction caused by ingestion of a huge, dried astringent persimmon. She was initially treated conservatively, but removal by enterotomy was performed after relief failed to be achieve d with conservative therapy.Case Rep Gastroenterol 2018;12:147 –152 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

< b > < i > Ascaris lumbricoides < /i > < /b > Discharge from the Mouth
A 68-year-old Japanese man presented withAscaris lumbricoides discharge from his mouth. The infection was suspected to have occurred while the patient was in the Philippines. ThisA. lumbricoides migration occurred because a proton pump inhibitor was used and Billroth I resection had been performed, which reduced gastric acid secretion and increased gastric pH. In addition, the pylorus had been removed during Billroth I resection, enabling easy access to the stomach. The number of imported foods, of infected migrants and refugees, and of overseas travels is increasing, and these factors may lead to an increase inA. lumbrico...
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Neoterminal Ileal Polyposis and Ulceration after Restorative Proctocolectomy with a Current Review of the Literature
We describe a case of proximal neoterminal ileal polyposis associated with deep ulceration suggestive of Crohn ’s disease and review the available literature. A 36-year-old male presented with resistant pouchitis 11 years after surgery for ulcerative colitis. With all-negative initial workup, pouchoscopy showed multiple deep ulcers in the proximal ileum with some polyps. Biopsy of polyps showed inflammator y polyps with negative immunohistological staining for IgG pouchitis. With no treatable etiology for pouchitis and the presence of inflammatory polyps, there are no guidelines for surveillance of this condition. De...
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Renal Infarction during Anticoagulant Therapy after Living Donor Liver Transplantation
Conclusion: Renal infarction is a rare complication of LDLT. In this case, renal infarction was incidentally diagnosed during anticoagulant therapy and was successfully treated.Case Rep Gastroenterol 2018;12:165 –169 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Ectopic Pancreatic Tissue Adherent to the External Gallbladder Wall
Heterotopic pancreatic tissue can be found in the gastrointestinal tract, with the stomach and small bowel being the most common sites of localization. The gallbladder is seldom affected. Here, we report 2 cases of ectopic pancreas within the fatty tissue adherent to the organ wall. Both cases concerned young women (31 and 36 years old) who were treated with a laparoscopic cholecystectomy due to persistent abdominal symptoms thought to be related to chronic cholecystitis. Pathological examination revealed the presence of ectopic pancreatic tissue type 1.Case Rep Gastroenterol 2018;12:170 –175 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Athlete ’s Hepatitis in a Young Healthy Marathon Runner
We report a case of a 48-year-old healthy young male who presented wit h athlete’s hepatitis confirmed by liver biopsy after a 14-mile marathon run. To our knowledge, this is the second case of athlete’s ischemic hepatitis reported in the literature. It is a diagnosis worth considering in patients involved in extreme exercise programs.Case Rep Gastroenterol 2018;12:176 –181 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Possibility of Interstitial Lung Disease as a Phlebosclerotic Colitis Manifestation
Phlebosclerotic colitis presents with ischemic bowels and calcification of the mesenteric veins. Owing to its rarity, we have little information on the complications of this disease. Herein, we report on a 77-year-old woman with phlebosclerotic colitis and interstitial lung disease. She was diagnosed as having phlebosclerotic colitis by CT and colonoscopy. At the same time, chest CT also showed interstitial lung disease. After 4 years, she experienced exacerbation of interstitial lung disease. She recovered without treatment. The occurrence of interstitial lung disease may have been associated with her phlebosclerotic coli...
Source: Case Reports in Gastroenterology - April 24, 2018 Category: Gastroenterology Source Type: research

Giant Symptomatic Rectal Mucocele following Subtotal Colectomy
Conclusion: Our case report underlines the importance of active endoscopic surveillance of the remaining colon and rectum in patients with diverting stomas and inflammatory bowel disease in order to detect stenosis. If endoscopic control is not possible due to obliteration, surgical therapy must be discussed due to the risk of developing cancer.Case Rep Gastroenterol 2018;12:143 –146 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 20, 2018 Category: Gastroenterology Source Type: research

Cronkhite-Canada Syndrome Associated with Metastatic Colon Cancer
Cronkhite-Canada syndrome is characterized by gastrointestinal and ectodermal manifestations. In this paper, we describe a 64-year-old Iranian male, presenting with Cronkhite-Canada syndrome with metastatic colon cancer. The patient was suffering from hair loss, which occurred on the scalp at first and then, during 5 months, extended to the whole body. After that, his sense of taste was impaired, and 2 months later, gastrointestinal symptoms gradually started, with weight loss of 20 kg over 2 months with an initial weight of 100 kg. Finally, he was admitted to our center 10 months after the onset of symptoms. On skin exami...
Source: Case Reports in Gastroenterology - April 13, 2018 Category: Gastroenterology Source Type: research

Colorectal Adenocarcinoma with an Alternative Serrated Pathway
In a 64-year-old woman, we identified a flat, elevated lesion that was located at the caecum and was composed of 3 different areas (areas A, B, and C). We diagnosed it as “carcinoma with sessile serrated adenoma/polyp (SSA/P)” histologically. Although area A was diagnosed as classical SSA/P, area B was regarded as a high-grade SSA/P. In contrast, area C showed a differentiated-type adenocarcinoma that invaded the submucosa. The patient had a recurrence of cancer 1.5 years after endoscopic resection. Overexpression of TP53 was detected in area C. AlthoughBRAF mutation was detected in all areas, CpG island methyl...
Source: Case Reports in Gastroenterology - April 13, 2018 Category: Gastroenterology Source Type: research

Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study
Conclusion: In comparison to the administration of indomethacin alone, a single application of epinephrine and the combination of epinephrine and indomethacin seem to be effective in reducing the cases of PEP. A further randomized clinical trial with a larger sample size is required to confirm the efficacy of our medication in the prevention of pancreatitis after ERCP.Case Rep Gastroenterol 2018;12:125 –136 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 13, 2018 Category: Gastroenterology Source Type: research

Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case
Phlebosclerotic colitis (PC) is a rare, potentially life-threatening disease of unclear pathogenesis almost exclusively reported in Asian patients of both genders. A fibrous degeneration of venous walls leads to threadlike calcifications along mesenteric vessels and colonic wall thickening, detectable by CT. This causes disturbed blood drainage and hemorrhagic infarction of the right-sided colonic wall. This is a report of PC in a Caucasian woman in Europe without Asian background and no history of herbal medications, a suspected cause in Asian patients. CT revealed no calcification of the mesenteric vein or its tributarie...
Source: Case Reports in Gastroenterology - April 13, 2018 Category: Gastroenterology Source Type: research

Adenosquamous Carcinoma of the Colon
Overall, colorectal cancer is the third most commonly diagnosed cancer in both men and women, meaning that it is one of the more widely recognized preventable cancers. Instances of colorectal malignancies though are overwhelmingly attributable to adenocarcinoma. Colorectal cancers with components of squamous cell carcinoma represent a statistical anomaly. Here, we present the case of a 50-year-old male, who complained of abdominal pain and weight loss over a 3-month period of time. Biopsies from a colonoscopy ultimately revealed that this patient ’s colon cancer consisted of both adenocarcinoma and squamous cell carc...
Source: Case Reports in Gastroenterology - March 1, 2018 Category: Gastroenterology Source Type: research

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