Schwannoma of the Small Intestine
We report this case of rare schwannoma of the small intestine and review the literature.Case Rep Gastroenterol 2019;13:294 –298 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 28, 2019 Category: Gastroenterology Source Type: research

Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia
We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn ’s disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were #x3c;0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic vis its. After initiation of subcutan...
Source: Case Reports in Gastroenterology - June 26, 2019 Category: Gastroenterology Source Type: research

Transplant-Amenable Hepatocellular Carcinoma in a Fontan Patient
The Fontan circulation alters a patient ’s physiology and imparts long-term risks related to chronically elevated systemic venous pressure. An increasing number of patients with Fontan physiology are surviving into adulthood and are at risk of hepatic sequalae. The ideal timeline and method of hepatic surveillance in the Fontan populati on remains to be defined. In this case, the patient was diagnosed with hepatocellular carcinoma more than 20 years after undergoing the Fontan procedure and was a candidate for combined heart-liver transplant. That her disease progressed prior to organ availability supports the argume...
Source: Case Reports in Gastroenterology - June 26, 2019 Category: Gastroenterology Source Type: research

Melanocytic Nevus of the Colon
Here, we report a very rare case of melanocytic nevus of the colon. A 54-year-old woman with an unremarkable medical history visited our hospital for screening colonoscopy. Colonoscopy revealed a pigmented flat lesion in the ascending colon. Histological evaluation of a biopsy specimen revealed proliferation of pigmented cells in the lamina muscularis propria. On immunohistochemical analysis, pigmented cells were positive for S-100 protein and Melan-A expression, and a diagnosis of colonic melanocytic nevus was made. Although the pathogenesis underlying colonic melanocytic nevi remains unclear, we speculate that colonic me...
Source: Case Reports in Gastroenterology - June 26, 2019 Category: Gastroenterology Source Type: research

Type 1 Autoimmune Pancreatitis with Imaging Appearance Similar to That of Malignant Cystic Tumor
A 79-year-old man was admitted with asymptomatic elevation of liver enzymes and tumor markers. Abdominal contrast-enhanced computed tomography demonstrated swelling of the pancreatic head, and additional blood test showed raised IgG4 levels. Histological examination by endoscopic ultrasonography (EUS)-guided fine needle aspiration for pancreatic head mass revealed storiform fibrosis and IgG4-positive plasma cell infiltration. We diagnosed this case as type 1 autoimmune pancreatitis (AIP). In addition, there was a cystic lesion in the pancreatic body apart from the pancreatic head mass. A mural nodule in the multilocular cy...
Source: Case Reports in Gastroenterology - June 14, 2019 Category: Gastroenterology Source Type: research

Pulmonary Embolism in a Donor of Living Donor Liver Transplantation
Pulmonary embolism (PE) is a rare but potentially fatal complication that may develop in a living liver donor. Here, we report a case of non-massive PE diagnosed by elevated serum D-dimer levels and successfully treated using anticoagulant therapy. A 57-year-old man underwent extended left hepatectomy as a living liver donor. His past medical history included hypertension and dyslipidemia which required medication and a history of smoking. Mechanical prophylactic measures for venous thromboembolism, including intermittent pneumatic compression and elastic stocking, were used; however, no pharmacological prophylaxis was use...
Source: Case Reports in Gastroenterology - June 13, 2019 Category: Gastroenterology Source Type: research

Challenges Associated with Colorectal Cancer in Pregnancy
We present a case of colorectal cancer in a young multiparous female and the associated difficulties in diagnosis and management. The challenges with colorectal cancers and pregnancies are expected to rise in the future with a decreasing trend in age of colorectal cancer occurrence and an increasing age of pregnancy due to lifestyle changes.Case Rep Gastroenterol 2019;13:253 –257 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 13, 2019 Category: Gastroenterology Source Type: research

Inflammatory Pseudotumor of the Pancreas Mimicking a Pancreatic Neoplasm
A 78-year-old woman was admitted to our hospital with a pancreatic tumor, incidentally discovered in an abdominal ultrasound exam. She was asymptomatic and without any previous personal pathological condition. The computed tomography (CT) and the magnetic resonance imaging (MRI) scan showed a mass lesion of 4 cm in diameter, located in the pancreatic body, conditioning the invasion of the splenic vein. The patient was admitted to surgery. During the laparotomy, we found a tumoral lesion highly suspicious of pancreatic neoplasia located in the transition of the head/body of the pancreas, with an invasion of the portal vein ...
Source: Case Reports in Gastroenterology - June 13, 2019 Category: Gastroenterology Source Type: research

Synchronous Resection of Colon Adenocarcinoma and Bisegmentectomy of Liver Metastases
Colorectal cancer is one of the main neoplasms worldwide; at the time of diagnosis about 25% of cases already have an advanced stage with the presence of metastases. A 58-year-old female presented with nausea, vomiting, and black stools and diffuse abdominal pain associated with 7% weight loss. She was referred to our hospital with signs of digestive tract bleeding and anemic syndrome. Panendoscopy revealed body and fundus gastropathy and presence ofHelicobacter pylori, and colonoscopy showed a neoplastic lesion at the ascending colon level. A synchronous resection was performed in a single surgical time of colorectal canc...
Source: Case Reports in Gastroenterology - May 16, 2019 Category: Gastroenterology Source Type: research

Robot-Assisted Laparoscopic Resection of a Todani Type II Choledochal Malformation
Choledochal malformation (CM) comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. CM is classified into five different types. Our case describes a 58-year-old man presenting with acute abdominal pain. Further examination showed a Todani type II CM. Treatment for type II is complete cyst excision without the need for an extrahepatic bile duct resection. A robot-assisted laparoscopic resection of the CM was performed and the patient recovered without complications. Pathology results showed a Todani type II malformation in which complete squamous metaplasia has occurred. In thi...
Source: Case Reports in Gastroenterology - May 5, 2019 Category: Gastroenterology Source Type: research

An Esophageal Ulcer Associated with a Thoracoabdominal Aortic Aneurysm
An aortoesophageal fistula, an abnormal anatomical communication between the aorta and the esophagus, is a rare cause of upper gastrointestinal bleeding. The mortality rate of patients with this condition is very high. A 77-year-old man, who had undergone endovascular aortic repair for a ruptured abdominal aortic aneurysm, developed melena. An upper gastrointestinal endoscopy was performed. This detected an esophageal ulcer, which had the potential to develop into an aortoesophageal fistula. Therefore, thoracic endovascular aortic repair was performed on the following day. Thereafter, the course was uneventful. We encounte...
Source: Case Reports in Gastroenterology - April 24, 2019 Category: Gastroenterology Source Type: research

Cavernous Hemangioma of the Gallbladder Masquerading as a Carcinoma
Cavernous hemangioma arising from the gallbladder is extremely rare. Here, we report a cavernous hemangioma of the gallbladder masquerading as a carcinoma. A 75-year-old man was referred to our institution for a follow-up study after gastrectomy. Abdominal computed tomography revealed that the gallbladder was filled with a low-density mass with calcification of the wall. The patient underwent extended cholecystectomy. Histologically, the tumor consisted of vascular endothelial cellular elements and hematomas. The postoperative course was uneventful without complications. Presently, only 7 cases of cavernous hemangioma of t...
Source: Case Reports in Gastroenterology - April 24, 2019 Category: Gastroenterology Source Type: research

Chronic Diarrhea Secondary to Newly Diagnosed VIPoma
We present a case of a male with 6 months of diarrhea and malaise who was found to have significant kidney injury and hypokalemia requiring admission to the medical intensive care unit. Subsequent laboratory evaluation while admitted eventually showed a low stool osmotic gap ( –11 mOsm/kg) consistent with secretory diarrhea, in addition to significantly elevated VIP levels at 940 pg/mL (normal #x3c;75). Cross-sectional imaging with functional Gallium-68 dotatate PET-CT confirmed metastatic functional neuroendocrine tumor indicative of a VIPoma. Pathology on subsequent m etastatic liver lesion aspiration was consisten...
Source: Case Reports in Gastroenterology - April 24, 2019 Category: Gastroenterology Source Type: research

Laparoscopic Resection of a Primary Retroperitoneal Mucinous Cystadenoma
We report the case of a 41-year-old woman who complained of right-sided intermittent abdominal pain. Imaging studies revealed a right retroperitoneal smooth cystic lesion (50 mm) without invasive features. Laparoscopic resection was then performed. During surgery, a right retroperitoneal mass with no connection to neighboring tissues was found. The tumor, wrapped by retroperitoneal fat tissue, was resected and removed from the body without exposure. Furthermore, histopathological findings indicated PRMC. The patient was discharged without any complications and observed to have no recurrence 6 months postoperatively.Case Re...
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Early Gastric Adenosquamous Carcinoma Resected Using Endoscopic Submucosal Dissection
Adenosquamous carcinoma (ASC) is characterized as a mixed neoplasia (adenocarcinoma with glandular architecture and squamous cell carcinoma [SqCC]). Because most ASCs are found in the advanced stage at the time of diagnosis, early gastric ASC is an extremely rare tumor. Here, we present the case of an incidental finding of early gastric ASC in a 61-year-old Korean man during a health screening. Histological biopsy through esophagogastroduodenoscopy revealed a moderately differentiated adenocarcinoma in the distal body. The patient underwent endoscopic submucosal dissection and was diagnosed with ASC. The SqCC components of...
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Repeated Enterocutaneous Fistula in a Munchausen Syndrome Patient
We describe a case of repeated enterocutaneous fistula in Munchausen syndrome. A 53-year-old Japanese male was admitted to our hospital for the treatment of a high-flow enterocutaneous fistula. Surgery was performed two times, but the fistula recurred each time. Chopsticks with blood on them were coincidentally detected in the trash in the patient ’s room. It was revealed that the enterocutaneous fistula was caused by self-mutilation. A psychiatrist was consulted, and the patient was diagnosed with Munchausen syndrome. The psychiatrist initiated treatment and the patient admitted the self-harm. His prolonged wound si...
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Osteopathic Manipulative Treatment in a Paediatric Patient with Oesophageal Atresia and Tracheo-Oesophageal Fistula
This study is aimed to evaluate the effectiveness of osteopathic manipulative treatment (OMT) in dysphagia symptoms and aspiration risk. This is a clinical case report on a 40-day-old infant with a diagnosis of oesophageal atresia and tracheo-oesophageal fistula. The patient received one OMT every 15 days for 7 times. The clinical outcome was the clinical changes in dysphagia symptoms assessed by the Paediatric Eating Assessment Tool-10 (PEDI-EAT-10). At the first osteopathic evaluation (T0), the total score of the PEDI-EAT-10 was 7, at the fourth osteopathic evaluation (T1), the total score was 3, and at the seventh osteo...
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Efficacy of Mucosal Cutting Biopsy for the Histopathological Diagnosis of Gastric Submucosal Tumors
Conclusions: MCB was an effective procedure for diagnosing gastric SMT, especially in the case of small SMTs located at the middle third of the stomach.Case Rep Gastroenterol 2019;13:185 –194 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Autoimmune Pancreatitis Type 1 Associated with a Pancreatic Pseudocyst
We report the case of a 73-year-old male with diffuse pancreatic enlargement and an adjacent cystic lesion (60 × 80 mm) on computed tomography scan. Based on these imaging findings and an elevated serum IgG4 concentration, AIP complicated by a pancreatic pseudocyst was diagnosed, and treatment with glucocorticoids was started. Regular follow-ups showed a good response to treatment with regression of the pan creatic pseudocyst and remittent pancreatic swelling.Case Rep Gastroenterol 2019;13:195 –199 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Biliary Involvement in Type 2 Autoimmune Pancreatitis
Autoimmune pancreatitis (AIP) is a rare condition classified in 2 subtypes. Their distinction relies on a combination of clinical, serological, morphological and histological features. Type 1 is a pancreatic manifestation of IgG4-related disease characterized by multiorgan infiltration by IgG4 plasmocytes. In this condition, hepatobiliary infiltration is frequent and often mimics cholangiocarcinoma or primary sclerosing cholangitis. On the other hand, type 2 is commonly limited to the pancreas. Herein, we describe the case of a patient who presented a type 2 AIP associated with cholangiopathy, a condition not described in ...
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Emphysematous Gastritis Associated with < b > < i > Sarcina ventriculi < /i > < /b >
Emphysematous gastritis is a rare and lethal gastrointestinal emergency if not promptly identified and managed. In rare cases, emphysematous gastritis is associated withSarcina ventriculi infection, usually in patients with delayed gastric emptying. Here we report a lethal case ofS. ventriculi-associated emphysematous gastritis in the absence of delayed gastric emptying in which the diagnosis was confirmed postmortem. This case provides an opportunity to review the clinical presentation, pathophysiology, and management of emphysematous gastritis so that the condition can be promptly diagnosed and managed to prevent signifi...
Source: Case Reports in Gastroenterology - April 15, 2019 Category: Gastroenterology Source Type: research

Resected Intrahepatic Cholangiocarcinoma with Anaphylactic Shock from a Preoperative Liver Function Test before Hepatectomy
The indocyanine green test is a reliable liver function examination before major hepatectomy, and anaphylaxis is rarely a concern. A 65-year-old male patient without epigastralgia was diagnosed with a 2.2-cm intrahepatic cholangiocarcinoma. He had no history of allergic reactions. Some liver dysfunction was indicated by the laboratory data; however, there was no marked obstructive jaundice and the liver functional reserve was maintained by technetium-99m galactosyl serum albumin. The indocyanine green test was routinely performed, but the patient immediately demonstrated severe anaphylaxis due to indocyanine green administ...
Source: Case Reports in Gastroenterology - March 31, 2019 Category: Gastroenterology Source Type: research

Endoscopic Findings of Esophageal Adenosquamous Carcinoma Diagnosed by Endoscopic Mucosal Resection
Adenosquamous carcinoma (ASC) is a rare histological type of esophageal carcinoma. Esophagogastroduodenoscopy for the health checkup of a 71-year-old male revealed the presence of a slightly elevated lesion like a submucosal tumor at the lower part of the esophagus. The center of it was slightly depressed, and the depressed area was not stained by iodine. Magnifying endoscopy with narrow-band imaging revealed reticular pattern vessels in the depressed area, whereas no irregularity of the microvascular pattern of the surrounding area was evident. One of the biopsied specimens taken from the depressed area was diagnosed as s...
Source: Case Reports in Gastroenterology - March 31, 2019 Category: Gastroenterology Source Type: research

Sarcoidosis of the Intra- and Extrahepatic Bile Ducts with Concomitant Cholangitis in a Patient with Ulcerative Colitis
Cholangitis in patients with ulcerative colitis (UC) can lead to misdiagnosis of primary sclerosing cholangitis (PSC). Furthermore, it can mimic cholangiocellular carcinoma, which also can lead to inappropriate and potentially harmful treatment of the patient. An 18-year-old male patient with known UC presented with pain in his right upper abdomen and elevation of the cholestatic liver enzymes (alkaline phosphatase: 197 U/L, γ-glutamyltransferase: 229 U/L) and increased inflammatory parameters (leukocytosis and CrP of 13.6 mg/L). Magnetic resonance cholangiopancreatography revealed unclear stenosis in the bifurcation...
Source: Case Reports in Gastroenterology - March 31, 2019 Category: Gastroenterology Source Type: research

Comparison of Duodenal Mucosal Chromogranin-A Expression in Non-Alcoholic Fatty Pancreas Dyspeptic Patients with and without Endosonography-Diagnosed Early Chronic Pancreatitis: A Case Series Study
In conclusion, among dyspeptic patients with NAFP, the duodenal mucosa chromogranin-A showed incr eased expression in those with pancreatic fibrosis and endosonography-diagnosed ECP.Case Rep Gastroenterol 2019;13:102 –112 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - March 7, 2019 Category: Gastroenterology Source Type: research

Successful Endoscopic Removal of a Biliary Stent with Stent-Stone Complex after Long-Term Migration
A 49-year-old man was referred to our hospital for an abnormality of the hepatobiliary enzyme. The patient was diagnosed with primary sclerosing cholangitis 9 years ago, and he had a biliary stent with a string placed as an inside stent. We attempted to remove the stent 6 months later, but the string was cut off, so the stent could not be removed. Removal was attempted again, but the patient cancelled the outpatient appointments. During the examination performed at the present visit, we discovered that the biliary stent had migrated into the bile duct, and a stone had formed around the stent. We attempted to remove the ste...
Source: Case Reports in Gastroenterology - March 7, 2019 Category: Gastroenterology Source Type: research

EpCAM- and/or NCAM-Expressing Hepatocellular Carcinoma in Which Behavior of Hepatic Progenitor Cell Marker-Positive Cells Are Followed
Hepatic progenitor cell (HPC) marker-positive hepatocellular carcinomas (HCCs) have recently been extensively analyzed, and their prognosis has been reported as poor compared to HPC marker-negative HCCs. However, previous studies have analyzed the existence of HPC marker-positive cancer cells only in primary lesions, as well as the recurrence rate and prognosis of such tumors. Here, we are the first to report the behavior of HPC marker-positive cancer cells during vascular invasion and metastasis of an HCC. We concurrently analyzed EpCAM- and/or NCAM-expressing cancer cells in the primary, vascular invasion, and metastatic...
Source: Case Reports in Gastroenterology - March 7, 2019 Category: Gastroenterology Source Type: research

Gut Microbiota Profiles in Nonalcoholic Fatty Liver Disease and Its Possible Impact on Disease Progression Evaluated with Transient Elastography: Lesson Learnt from 60 Cases
Conclusion: There is a change in the composition of gut microbiota in NAFLD patients. The proportion of Bacteroides is significantly higher in significant liver fibrosis, which may play a role in NAFLD progression.Case Rep Gastroenterol 2019;13:125 –133 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - March 7, 2019 Category: Gastroenterology Source Type: research

Esophageal Stenosis in a Patient with Lichen Planus
We present the case of a patient with esophageal lichen planus complicated with esophageal stenosis, who was rather resistant to treatment.Case Rep Gastroenterol 2019;13:134 –139 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - March 7, 2019 Category: Gastroenterology Source Type: research

Hemobilia Derived from Cystic Artery Pseudoaneurysm
Cystic artery pseudoaneurysm (CAP) is a rare disease, with small number of previous reports related to CAP. Besides, it is frequently prone to critical condition due to arterial bleeding. Here, we presented a case of ruptured CAP with acute calculus cholecystitis and its subsequent successful management with temporary endoscopic biliary drainage for obstructive jaundice and embolization for the culprit artery without cholecystectomy. Since CAP is at high risk of bleeding, intravascular treatment, which is only one currently available therapeutic option, is urgently required in the clinical sites.Case Rep Gastroenterol 2019...
Source: Case Reports in Gastroenterology - February 26, 2019 Category: Gastroenterology Source Type: research

Late Cutaneous Metastasis Originating from Gastric Cancer with Synchronous Metastasis
An 89-year-old man was diagnosed with late cutaneous metastasis in the right axilla 6 years after undergoing a surgery for gastric cancer with synchronous cutaneous metastasis in the same site. The patient became aware of small reddish nodules in the right axilla, and computed tomography imaging showed an irregular thickening of the right axillary skin. No other sign of recurrence was observed. By en-bloc resection, the nodules were diagnosed as late cutaneous metastasis from gastric cancer. The patient received no additional postoperative chemo- or radiotherapy and was only carefully observed. Cutaneous metastases from ga...
Source: Case Reports in Gastroenterology - February 26, 2019 Category: Gastroenterology Source Type: research

Signet-Ring Cell Carcinoma Presenting as Hematochezia in a Patient with Crohn ’s Disease
We report a patient with Crohn’s disease who was diagnosed with signet-ring cell carcinoma in the setting of a Crohn’s flare. Diagnosis was made with endoscopy. Treatment included laparoscopic-assisted right hemicolectomy with ileostomy with subsequent chemotherapy as an outpatient .Case Rep Gastroenterol 2019;13:85 –88 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 21, 2019 Category: Gastroenterology Source Type: research

Laparoscopic Resection of an Abdominal Wall Metastasis 5 Years after Primary Colorectal Cancer Resection
We report the case of a 65-year-old male with a metachronous abdominal wall metastasis secondary to colorectal cancer. The patient had presented 5 years ago to another facility with a perforated sigmoid colon cancer (pT4a[SE], N0, M0, pStage II), rectal cancer (T2[MP], N0, M0, pStage I), and Fournier gangrene. He had then undergone sigmoidectomy and rectal resection along with S-1 adjuvant chemotherapy. No relapse was observed thereafter. However, currently, 5 years after initial surgery, the patient noticed a palpable mass in the left lower abdomen and was referred to our hospital for further assessment and treatment. Per...
Source: Case Reports in Gastroenterology - February 15, 2019 Category: Gastroenterology Source Type: research

Surgical Laparotomy for Repeated Delayed Arterial Hemorrhage after Pancreaticoduodenectomy
Postpancreatectomy hemorrhage is one of the major life-threatening complications of pancreatic surgery. Radiological intervention is used as a first-line approach for the initial treatment of late arterial hemorrhage. However, rehemorrhage has a high risk for mortality, and it is undecided which urgent intervention provides optimal management for rehemorrhage. We experienced a successful surgical laparotomy for the repeated delayed arterial hemorrhage caused by a pancreaticoduodenectomy (PD) for chronic pancreatitis. A 57-year-old man had undergone PD with pancreaticogastrostomy for tumor-forming pancreatitis with possible...
Source: Case Reports in Gastroenterology - February 14, 2019 Category: Gastroenterology Source Type: research

Primary Gastrointestinal Stromal Tumor of the Liver with Cystic Changes
Gastrointestinal stromal tumors (GISTs) are known to originate specifically from the intestinal cells of Cajal located in the gastrointestinal mesenchyme. GISTs developing outside of the digestive tract have barely been reported. We encountered a first case of large primary GISTs in the liver with cystic changes. A 63-year-old man with a past history of brain infarction visited our hospital. The computed tomography (CT) revealed a 6-cm and a 10-cm mass in the right and the caudal lobe of the liver, respectively. These tumors have marginal enhancement in the arterial phase; however, they presented as hypodense in the intern...
Source: Case Reports in Gastroenterology - February 14, 2019 Category: Gastroenterology Source Type: research

Successful Resection of Solitary Abdominal Wall Metastasis of Sarcomatous Intrahepatic Cholangiocarcinoma
In this report, we present the case of a 75-year-old woman admitted to our hospital with the chief complaint of weight loss. Various imaging techniques demonstrated a single mass in the liver and cecum. A cecal gastrointestinal stromal tumor accompanied by liver metastasis was suspected, and ileocecal resection was performed for diagnostic purposes. However, the tumor was present in the abdominal wall rather than in the cecum. The tumor was resected and diagnosed as undifferentiated sarcoma. We suspected the liver tumor was a series of lesions, so we performed hepatectomy. As the tumor was composed of both adenocarcinoma a...
Source: Case Reports in Gastroenterology - February 14, 2019 Category: Gastroenterology Source Type: research

Rectal Dieulafoy ’s Lesion: A Rare Etiology of Lower Gastrointestinal Hemorrhage
A Dieulafoy ’s lesion is defined as a dilated submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion. It is a rare cause of gastrointestinal bleeding that is difficult to identify and subsequently manage. Most commonly, they occur in the upper gastrointestinal tr act, namely the stomach. A Dieulafoy’s lesion of the rectum, however, is an exceedingly rare presentation that can lead to life-threatening gastrointestinal bleeding. Our case consists of an 84-year-old man, who presented with lower gastrointestinal bleeding secondary to a Dieulafoy’s lesion of the r...
Source: Case Reports in Gastroenterology - February 14, 2019 Category: Gastroenterology Source Type: research

Adalimumab Dose-Escalation Therapy Is Effective in Refractory Crohn ’s Disease Patients with Loss of Response to Adalimumab, Especially in Cases without Previous Infliximab Treatment
Conclusions: Adalimumab dose-escalation therapy is effective in refractory Crohn ’s disease patients with loss of response to adalimumab, especially in cases without previous infliximab treatment.Case Rep Gastroenterol 2019;13:37 –49 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - February 6, 2019 Category: Gastroenterology Source Type: research

Endoscopic Retrieval of Mis-Swallowed Table Spoon
Mis-swallowed foreign body is a common scenario for endoscopy intervention. Although a long object is rarely seen in our clinical setting, limited published articles could be found for proper retrieval. We hence report a 30-year-old female who mis-swallowed a long table spoon, which was retrieved by a snare from the duodenal second portion with conventional endoscopy.Case Rep Gastroenterol 2019;13:32 –36 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 17, 2019 Category: Gastroenterology Source Type: research

Acute Esophageal Necrosis: A View in the Dark
Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be older men, as me...
Source: Case Reports in Gastroenterology - January 16, 2019 Category: Gastroenterology Source Type: research

Successful Endoscopic Management of Double Iatrogenic Perforations Induced by Endoscopic Retrograde Cholangiopancreatography and Computed Tomography-Guided Colon Drainage
Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk procedure with a significantly high rate of complications, such as pancreatitis, bleeding, perforation, and infection. Pancreatitis is the most common post-ERCP complication with an incidence of approximately 3.5%. Although perforation is a rare complication with an incidence of 0.1 –0.6%, it may be associated with a high rate of mortality of 1.0–1.5%. Here, we report a rare case of ERCP-induced double iatrogenic perforations in the duodenum and colon complicated by an intra-abdominal abscess. The post-ERCP perforation was successfully sealed ...
Source: Case Reports in Gastroenterology - January 13, 2019 Category: Gastroenterology Source Type: research

Splenic Injury with Subsequent Pleural Effusion: An Underreported Complication of Colonoscopy
We present a case in which a previously healthy 59-year-old female developed a splenic injury and later pleural effu sion after screening colonoscopy.Case Rep Gastroenterol 2019;13:6 –11 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - January 13, 2019 Category: Gastroenterology Source Type: research

Duodenal Ulceration following Holmium Laser Lithotripsy
The epidemiology of peptic ulcer disease (PUD) has changed considerably in the last several decades. Previously a chronic disease characterized by frequent recurrences with a high rate of surgical interventions, it is now largely a self-limited disease that is medically managed. The role of acid suppression was widely recognized as being important in the pathogenesis of PUD in the 19th century, while it was not until the 1980s and 1990s that the importance ofHelicobacter pylori infection was identified. Today, PUD is largely caused by eitherH. pylori infection or nonsteroidal anti-inflammatory drug use. However, other less...
Source: Case Reports in Gastroenterology - January 13, 2019 Category: Gastroenterology Source Type: research

Metachronous Sigmoid Carcinoma and Mantle Cell Lymphoma in Intestines
It is rare that colon carcinoma and mantle cell lymphoma (MCL) occur one after another in intestines. We found two malignancies of sigmoid carcinoma and MCL in a single patient, who had initially been diagnosed with sigmoid carcinoma and treated with radical resection in our hospital. Good postoperative recovery was reported without recurrence signs, which lasted for 7 years and 5 months until polyps of sigmoid colon were found by colonoscopy. Biopsy and immunohistochemistry revealed MCL, but the patient refused treatment. One year later, MCL was diagnosed again in the transverse colon. The patient is currently under obser...
Source: Case Reports in Gastroenterology - January 13, 2019 Category: Gastroenterology Source Type: research

Adenosquamous Carcinoma of the Choledochus
The patient was an 86-year-old man who was admitted with obstructive jaundice. Computed tomography revealed a tumor in the hilar choledochus with peripheral hepatic duct dilatation. Endoscopic cholangiography (ERC) demonstrated the defect in the choledochus. Brushing cytology during ERC showed Orange-G-philic keratinized atypical cells, which led to a diagnosis of squamous cell carcinoma. Chemotherapy with tegafur-gimeracil-oteracil potassium was ineffective and was discontinued due to adverse effects. The patient died 5 months after the diagnosis and autopsy revealed tubular adenocarcinoma of the hilar bile duct with squa...
Source: Case Reports in Gastroenterology - January 4, 2019 Category: Gastroenterology Source Type: research

Pulse Granulomas in Interval Appendectomy Specimens: Histochemical Identification of Cellulose Matter
This report presents histopathologic findings of pulse granuloma lesions observed in two appendectomy cases, with some histochemical examinations of cellulose matter which is reportedly a major component to provoke pulse granuloma reaction. Our patients in both cases were girls in their teens, and they underwent interval appendectomy for acute appendicitis. Both appendectomy specimens revealed ruptured walls with inflammatory granulation tissue with marked foreign body reaction including characteristic collections of ring-like, curled ribbon-like, and/or lobulated nephrosclerosis-like hyaline structures and various foreign...
Source: Case Reports in Gastroenterology - December 20, 2018 Category: Gastroenterology Source Type: research

Laparoscopic Excisional Cholecystectomy with Full-Thickness Frozen Biopsy in Suspected Gallbladder Carcinoma
Owing to the advantages of a laparoscopic approach, laparoscopic cholecystectomy (LC) is thought to be the treatment of choice in gallbladder disease, even in cases of suspected malignancy. However, it is difficult to differentiate between cholecystitis and gallbladder carcinoma (GBC). We performed radical hepatectomy in patients with pT2 GBC diagnosed by full-thickness frozen biopsy. A 75-year-old Japanese man presented to our hospital with discomfort in the right upper quadrant of the abdomen. This patient was diagnosed with suspected GBC and was scheduled to undergo LC and intraoperative histological examination. Follow...
Source: Case Reports in Gastroenterology - December 14, 2018 Category: Gastroenterology Source Type: research

Idiopathic Pan-Colonic and Small-Intestine Varices
Idiopathic colonic varices represent a rare source of gastrointestinal haemorrhage with a presumed incidence around 0.0007%. Herein, we present a case of idiopathic colonic and small-intestine varices. According to our knowledge, this case report is the first description of both pan-colonic and small-intestine idiopathic varices of this extent. A young male patient without any previous notable medical history was admitted to the hospital because of massive enterorrhagia with haemodynamic instability. Colonoscopy revealed massive pan-colonic varices. After stabilization, numerous diagnostic procedures were performed in orde...
Source: Case Reports in Gastroenterology - December 14, 2018 Category: Gastroenterology Source Type: research

Incidentally Detected Amyloid Light-Chain Amyloidosis Caused by Monoclonal Gammopathy of Undetermined Significance: Possible Time-Dependent Change in Colonic Findings
Amyloid light-chain (AL) amyloidosis is associated with plasma cell disorder and monoclonal light chains. This type of amyloidosis is the prominent type involving the gastrointestinal tract. Monoclonal gammopathy of undetermined significance (MGUS) is the most common plasma cell disorder and a known precursor of more serious diseases. A 72-year-old male was treated for high blood pressure, diabetes, and gout at the clinic of a private physician. Due to a positive fecal occult blood test discovered during colon cancer screening, he underwent colonoscopy and was diagnosed with adenomatous polyps by biopsies. Two months later...
Source: Case Reports in Gastroenterology - December 6, 2018 Category: Gastroenterology Source Type: research

Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor
We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, bec...
Source: Case Reports in Gastroenterology - November 28, 2018 Category: Gastroenterology Source Type: research