Anti-TNF Exposure during Pregnancy in Crohn ’s Disease Patients
This study aimed to describe the management of 4 Crohn ’s disease patients who received anti-TNF therapy during pregnancy and present a literature review. We reported 4 cases composed of young women who became pregnant while receiving anti-TNF agents. The patients presented a satisfactory response to the clinical treatment and the pregnancies progress ed without complications. We did not observe maternal or embryonic toxicity, or unfavorable outcomes. The available data point to inflammatory activity as the main risk factor for unfavorable gestational evolution to date, and showed anti-TNF therapy to be safe during p...
Source: Case Reports in Gastroenterology - October 17, 2018 Category: Gastroenterology Source Type: research

Severe de novo Ulcerative Colitis following Ixekizumab Therapy
We report a unique case of severe new-onset ulcerative colitis in a young male complicated by cytomegalovirus infection who was on ixekizumab therapy for plaque psoriasis. We recommend that clinicians should exercise caution before prescribing ixekizumab as it seems to induce and exacerbate IBD.Case Rep Gastroenterol 2018;12:617 –621 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 17, 2018 Category: Gastroenterology Source Type: research

Erratum
Case Rep Gastroenterol 2018;12:586 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 5, 2018 Category: Gastroenterology Source Type: research

Alveolar Echinococcosis Mimicking a Hepatic Neoplasm with Lymph Node Metastasis: A Case Report
A 37-year-old man had an asymptomatic 17-mm mass in the liver by health check with ultrasonography. Five years later, he was referred to our hospital because the mass was slightly enlarged with a peripancreatic lymph node. We performed endoscopic ultrasonography fine-needle aspiration (EUS-FNA) to evaluate a lymph node, but it showed amorphous eosinophilic material and eosinophilic infiltrate in necrotic tissue of toothpaste-like white specimen. However, we diagnosed as potentially malignant liver mass with lymph node metastasis because of 2-deoxy-2-(fluorine-18) fluorodeoxyglucose uptake. We then performed hepatectomy and...
Source: Case Reports in Gastroenterology - October 5, 2018 Category: Gastroenterology Source Type: research

Secondary Adrenal Insufficiency after Treatment with Budesonide for Autoimmune Hepatitis
Autoimmune hepatitis (AIH) is a rare cause of chronic liver disease. The backbone of treatment is immunosuppressive medication, typically prednisolone as induction therapy and azathioprine as a maintenance therapy. Side effects of the long-term use of systemic corticosteroids are well known and have led to the use of alternative induction regimens. An attractive alternative is budesonide, a nonhalogenated glucocorticosteroid characterized by a high first-pass effect in the liver (90%), resulting in a high topical anti-inflammatory activity and a low systemic activity. It should be stressed that budesonide is contraindicate...
Source: Case Reports in Gastroenterology - October 5, 2018 Category: Gastroenterology Source Type: research

Overstaged Rectal Cancer by MRI due to Fibrosis Induced by Tattoo Marker
We describe a case of cT stage overestimation due to fibrosis of the rectal wall and perirectal fat, induced by carbon-based dye injection in a 66-year-old patient. In our case it was an overestimation of MR evaluation in the case of early invasive carcinoma. Although there have been some studies on tissue effect of carbon-based dyes, the possible scenario consequence of cancer stage overestimation due to fibrosis has not yet been described. Such a mistake could lead to inappropriate overtreatment. Clinicians must be aware of the possible consequences of dye injection and resultant overestimation of T stage of colorectal c...
Source: Case Reports in Gastroenterology - October 5, 2018 Category: Gastroenterology Source Type: research

Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery
We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully ac...
Source: Case Reports in Gastroenterology - September 20, 2018 Category: Gastroenterology Source Type: research

A Highly Advanced Gastric Cancer Maintaining a Clinical Complete Response after Chemoradiotherapy Comprising S-1 and Cisplatin
We report a patient with highly advanced gastric carcinoma who was treated successfully with chemoradiotherapy (CRT) comprising S-1 and cisplatin. The patient was a 71-year-old male who was diagnosed with advanced gastric carcinoma by esophagogastroduodenoscopy (EGD) by medical examination. EGD demonstrated type 3 advanced gastric carcinoma in the posterior wall of the upper gastric body. An abdominal computed tomography (CT) scan showed that the gastric wall was thickened due to gastric primary tumor, and large lymph nodes (LNs) including the lesser curvature LN, anterosuperior LN along the common hepatic artery and some ...
Source: Case Reports in Gastroenterology - September 20, 2018 Category: Gastroenterology Source Type: research

Appendiceal Perforation due to Migration of a Dental Instrument
We report a patient with appendiceal perforation due to a foreign body (dental instrument for root canal treatment) in the appendix.Case Rep Gastroenterol 2018;12:551 –555 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - September 18, 2018 Category: Gastroenterology Source Type: research

Angiotensin-Converting Enzyme Inhibitor-Induced Gastrointestinal Angioedema: The First Danish Case Report
Angiotensin-converting enzyme inhibitors (ACEI) are widely used to treat hypertension and congestive heart failure. A rare side effect of ACEI therapy is angioedema, which in very rare cases may present as gastrointestinal angioedema (GA). A 45-year-old female presented with suddenly occurring diffuse abdominal pain. Imaging studies revealed small bowel wall edema. The patient had been on ACEI therapy for the last 6 months. The therapy was withdrawn, and the patient recovered quickly. There is no specific diagnostic test to confirm ACEI-induced GA, but symptoms usually regress completely after therapy discontinuation. An e...
Source: Case Reports in Gastroenterology - September 18, 2018 Category: Gastroenterology Source Type: research

Small-Bowel Obstruction Secondary to Ileal Trichobezoar in a Patient with Rapunzel Syndrome
Bezoars are conglomerations of undigested foreign material retained in the gastrointestinal tract. Trichobezoar is a compact conglomeration of swallowed hair and constitutes less than 6% of all bezoars. Their most frequent location is in the stomach but they may extend through the pylorus into the small bowel. This condition is known as Rapunzel syndrome. Many patients may remain asymptomatic or present a mild form of the disease characterized by abdominal pain, early satiety, nausea, and vomiting. Complications may manifest as gastric outlet obstruction or bleeding, and intestinal obstruction. A 15-year-old female patient...
Source: Case Reports in Gastroenterology - September 18, 2018 Category: Gastroenterology Source Type: research

Acute Abdomen with Ileus: A Heralding Presentation of Neuroleptic Malignant Syndrome
The pathophysiology of neuroleptic malignant syndrome (NMS) with use of psychotropic drugs is still unclear. Although a rare event with an incidence of 0.02 –3.2%, when not promptly recognized and managed, it carries a high mortality (10–20%) and morbidity rate. Presentation can be either typical, with muscle rigidity and hyperpyrexia, or atypical, the latter posing diagnostic and early management challenges in clinical practice. Our patient present ed with delayed fever and ileus, making early diagnosis difficult. We propose that NMS be considered an alternate diagnosis in patients using psychotropic medicatio...
Source: Case Reports in Gastroenterology - September 18, 2018 Category: Gastroenterology Source Type: research

Simultaneous Resection for Synchronous Double Primary Cancers of the Pancreas and the Liver
In conclusion, we describe 2 cases of hepato-pancreatectomy for synchronous double primary cancers of the pancreas and the liver, where exclusion of the liver tumor as a metastatic lesion from the pancreatic cancer is important.Case Rep Gastroenterol 2018;12:504 –512 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Arterial Pseudoaneurysm within a Pancreatic Pseudocyst
The formation of pancreatic pseudocysts and (pseudo-)aneurysms of intestinal vessels are rare but life-threatening complications in acute and chronic pancreatitis. Here we report the rare case of a patient suffering from chronic pancreatitis with an arterial pseudoaneurysm within a pancreatic pseudocyst and present its successful therapeutic management by angioembolization to prevent critical bleeding. A 67-year-old male with a history of chronic pancreatitis presented with severe acute abdominal pain and vomiting to the emergency department. Seven weeks prior to the present admission, a CT scan had displayed a pancreatic ...
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Erratum
Case Rep Gastroenterol 2018;12:519 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Erratum
Case Rep Gastroenterol 2018;12:520 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Posterior Reversible Encephalopathy Syndrome following Ustekinumab Induction for Crohn ’s Disease
We report 2 cases of neurological adverse events, one of which is consistent with posterior reversible encephalopathy syndrome (PRES), in the setting of ustekinumab therapy for Crohn’s disease. The first patient had a seizure and classic neuroimaging features of PRES following induct ion with ustekinumab. The second patient presented with acute encephalopathy and atypical imaging findings concerning for PRES after ustekinumab induction. Both patients recovered fully following cessation of ustekinumab therapy. PRES associated with ustekinumab is uncommon, but must be a considerat ion in Crohn’s disease patients ...
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Jejunal Serrated Adenoma Diagnosed and Treated by Double-Balloon Enteroscopy
Serrated polyps are most commonly located in the colorectum and have been well recognized as an important precursor lesion for colorectal cancer. Serrated adenoma in the small intestine has been reported more rarely but may represent a distinct morphological and biological subtype with malignant potential. Here, we present the case of a 65-year-old female who underwent double-balloon enteroscopy due to obscure gastrointestinal bleeding. A polyp sized 3.5 × 2.0 cm with a long pedicle in the jejunum, located 50 cm distal to the Treitz ligament, was detected. Endoscopic mucosal resection was done. The pathological resul...
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Long-Term Survival in Gastroesophageal Junction Adenocarcinoma: Ramucirumab
We report a case of long-term survival with complete response of liver metastases within RAINBOW, a randomized, controlled trial of ramucirumab 8 mg/kg intravenously (days 1, 15) versus placebo, both plus paclitaxel 80 mg/m2 intravenously (days 1, 8, 15), every 4 weeks in patients with previously treated advanced gastroesophageal junction adenocarcinoma. A 64-year-old man with gastroesophageal junction adenocarcinoma and liver metastases received first-line folinic acid, 5-fluorouracil plus oxaliplatin (FOLFOX) following jejunostomy. On liver progression, he enrolled in RAINBOW (April 2012), receiving ramucirumab. In Novem...
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Successful Laparoscopy-Assisted Resection of the Descending Colon in a Patient with Multiple Large Renal Cysts and Stricture of the Colon due to Ischemic Colitis
Large pathological structures in the abdominal cavity curb the application of laparoscopic surgery. This case report describes a successful laparoscopy-assisted colectomy for benign colon disease in a patient with multiple large renal cysts. An 82-year-old man was referred to our department for treatment of stenosis of descending colon secondary to ischemic colitis. An abdominal computed tomography revealed multiple large renal cysts occupying a large proportion of the peritoneal cavity. To minimize the postoperative recovery period, laparoscopic surgery was planned despite the renal cysts. After inserting access ports, th...
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Lorazepam as a Cause of Drug-Induced Liver Injury
Lorazepam is a benzodiazepine derivative that is globally used for the therapy of anxiety and insomnia. A 51-year-old Japanese man with yellowish discoloration of the eyes and skin and pruritus was admitted due to liver dysfunction. He had taken lorazepam approximately 5 months prior to this admission. The clinical presentation and pathologic findings in the liver were consistent with drug-induced liver injury. After cessation of lorazepam, treatment with Stronger neo-minophagen C and ursodeoxycholic acid was started, and his liver injury resolved after 59 days. This case must serve as a warning to physicians to be aware o...
Source: Case Reports in Gastroenterology - September 2, 2018 Category: Gastroenterology Source Type: research

Multimodality Treatment of a Colorectal Cancer Stage IV Patient with FOLFOX-4, Bevacizumab, Rigvir Oncolytic Virus, and Surgery
Colorectal cancer is one of the most commonly diagnosed cancers worldwide. The treatment consists of surgical resection, systemic chemotherapy, and new biological agents. One more recently emerging treatment option is oncolytic virotherapy. Although the use of the new treatment methods shows improved overall and progression-free survival, in general, even with the new treatments, mortality remains high and combinations of treatments should be sought to treat patients with colorectal cancer. Here we report a stage IV colorectal cancer patient who received multimodality treatment including bevacizumab, FOLFOX-4, surgery, and...
Source: Case Reports in Gastroenterology - August 23, 2018 Category: Gastroenterology Source Type: research

Glycogen Hepatopathy: A Rare and Underrecognized Cause of Recurrent Transaminitis in Patients with Uncontrolled Type 2 Diabetes Mellitus
We present the case of a 54-year-old woman with poorly controlled insulin-dependent type 2 diabetes who was hospitalized twice within 1 month with diabetic ketoacidosis/hyperosmolar hyperglycemic state and reversible transaminitis. Interestingly, she had normal liver function tests performed at the time of admission and transaminitis was noted 1 day later, after she was treated with high doses of intravenous insulin therapy. Subsequently, liver enzymes recovered to normal levels with optimization of glucose control.Case Rep Gastroenterol 2018;12:466 –472 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - August 23, 2018 Category: Gastroenterology Source Type: research

A Case of Gastroparesis after Cryoballoon Ablation followed by Medication-Induced Recovery within 6 Months
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and cryoballoon ablation was developed as a new treatment modality for symptomatic AF. Gastroparesis is rarely reported as a transient complication of ablation, and its frequency and risk are not clear. We experienced a rare case of gastroparesis after cryoballoon ablation followed by medication-induced recovery within 6 months.Case Rep Gastroenterol 2018;12:473 –478 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - August 23, 2018 Category: Gastroenterology Source Type: research

Lethal Bleeding from a Duodenal Cancerous Ulcer Communicating with the Superior Mesenteric Artery in a Patient with Pancreatic Head Cancer
Pancreatic cancer often invades the duodenum and causes obstruction, but rarely causes massive duodenal bleeding. A 68-year-old male was admitted to our hospital because of vomiting. Enhanced abdominal CT showed a hypovascular tumor with air bubbles in the uncinate process of the pancreas. The tumor invaded the duodenum and metastasized to the liver and peritoneum. The main trunk of the superior mesenteric artery (SMA) was circumferentially involved. After admission, he had hematemesis and melena. Emergency gastroduodenoscopy revealed pulsating vessels in the third portion of the duodenum and he eventually experienced hemo...
Source: Case Reports in Gastroenterology - August 23, 2018 Category: Gastroenterology Source Type: research

A Young Adult Patient with Nonalcoholic Steatohepatitis Developed Severe Gastroesophageal Varices Associated with Severe Obesity and Diabetes Mellitus
We present the case of a 44-year-old male with overt obesity who was admitted with hematemesis due to the rupture of gastric varices. We diagnosed him with NASH with severe liver fibrosis. This case shows that we should be concerned about the progression of liver fibrosis due to NASH associated with severe obesity even in young patients.Case Rep Gastroenterol 2018;12:487 –496 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - August 23, 2018 Category: Gastroenterology Source Type: research

Peroral Endoscopic Myotomy in Diffuse Thickened Esophageal Wall in an Adolescent
Achalasia is an extremely rare pathology in children. Peroral endoscopic myotomy (POEM) is the gold standard for the surgical treatment of achalasia in adults, but only a limited number of cases of achalasia treatment using POEM in children have been published in the literature. Sometimes, high-resolution manometry signs of achalasia can mimic diffuse esophageal leiomyoma. This case report represents the first known successful performance of POEM on a 15-year-old female with diffuse thickening of the esophagus with signs and symptoms of achalasia and suspicion for Alport syndrome associated with diffuse esophageal leiomyom...
Source: Case Reports in Gastroenterology - August 23, 2018 Category: Gastroenterology Source Type: research

Adenocarcinoma Arising from Perianal Fistulizing Crohn ’s Disease
In this report we show a case of adenocarcinoma arising from a perianal fistulizing C D. This type of tumor is highly aggressive, difficult to diagnose, and has a rather poor prognosis. The different neoplastic transformations and the different types of tumors that may appear in patients with CD, especially at the colorectal level or at the level of an eventual anastomosis, are to da te well documented and described in the literature, while there is a lack of information and of treated cases concerning the occurrence of cancer at the level of a fistula. Due to the rarity of cases, we tried to identify the most frequent and...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Primary Mesenteric Carcinoid Tumor Presenting with Carcinoid Syndrome
We present a 64-year-old man with carcinoid syndrome from a mesenteric carcinoid tumor without evidence of liver metastasis or other primary tumor sites.Case Rep Gastroenterol 2018;12:396 –401 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

The Feature of Solitary Small Nodular Type of Hepatic Epithelioid Hemangioendothelioma
We report a resected case of small and solitary HEHE. The patient, a 74-year-old man, had undergone surgical resection for left renal cell carcinoma 20 years ago. During follow-up, a tumor approximately 1.3 cm in diameter was detected by computed tomography (CT) at liver segment VIII. It showed isodensity in the arterial phase, low density in the portal venous phase, and homogeneous enhancement in the late phase on CT and magnetic resonance imaging (MRI). We performed hepatic resection of the right hepatic vein drainage area. A pathological diagnosis of HEHE was made. Although small and solitary HEHE is rare, an enhancemen...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Spontaneous Regression of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus
An 83-year-old man underwent transcatheter arterial chemoembolization (TACE) for a 20-mm hepatocellular carcinoma (HCC) in Couinaud ’s segment 4. Computed tomography (CT) 4 months after TACE showed tumor thrombus in the portal vein in addition to diffuse metastases and arterioportal shunts in the left lobe. Although we performed the best supportive care, the tumor thrombus in the portal vein and tumors in the left lobe had com pletely disappeared on CT 16 months after the TACE. Rapidly grown portal vein tumor thrombus and arterioportal shunt might be the causes of spontaneous regression of HCC, probably associated wi...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

An Unusual Cause of Abdominal Ascites
Abdominal ascites is most commonly caused by portal hypertension from liver cirrhosis. When present, portal hypertension is associated with an elevated serum-ascites albumin gradient (SAAG) ≥1.1 g/dL. In contrast, a SAAG #x3c; 1.1 g/dL suggests malignancy, tuberculosis, pancreatitis, or nephrotic syndrome. Here, we present a case of low SAAG ascites caused by epithelioid peritoneal mesothelioma in a woman with no known liver disease. The diagnosis proved elusive until diagnostic lapa roscopy with biopsy was performed.Case Rep Gastroenterol 2018;12:420 –424 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Difficulty Achieving a Preoperative Diagnosis of IgG4-Related Sclerosing Cholangitis
A 75-year-old male was admitted to our hospital because of bile duct stenosis. He had no medical history of autoimmune disease. The level of tumor markers, serum IgG, and IgG4 were within normal ranges. Computed tomography showed perihilar and distal bile duct stenosis and wall thickening without swelling or abnormal enhancement of the pancreas. Endoscopic retrograde cholangiopancreatography showed perihilar and distal bile duct stenosis. A biopsy and cytology from the distal bile duct stenosis suggested adenocarcinoma, and cytology from the perihilar bile duct also suggested adenocarcinoma. A preoperative diagnosis of per...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Pneumatosis Cystoides Intestinalis Secondary to Sunitinib Treatment for Gastrointestinal Stromal Tumor
A 67-year-old man with liver and retroperitoneal metastases from a gastrointestinal stromal tumor arising in the jejunum had been administered oral sunitinib for 2 months. He presented to our department with right-sided lower abdominal pain. His general condition was good, with no high-grade fever, and the other vital signs were also stable. Contrast-enhanced computed tomography was promptly performed, and pneumatosis cystoides intestinalis (PCI) was detected in a wide area around the ileocecal lesion. There were no signs of acute abdomen requiring emergency surgery due to conditions such as intestinal perforation, ischemi...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Ginseng-Related Drug-Induced Liver Injury
Ginseng is commonly used as a medicinal herb for memory and concentration and general well-being. Drug-induced liver injury (DILI) is one of the most challenging disorders and trending events in the United States which are related to body building and weight loss supplements. Currently, herbal and dietary supplementation is the second most common cause of DILI. Here, we report on a 45-year-old healthy Chinese woman who presented with dull intermittent left upper quadrant abdomen pain for a month. Upon thorough history taking, she had been taking ginseng tea and supplementation for her menopausal symptoms for almost 3 month...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Drug-Induced Autoimmune Hepatitis in a Patient Treated with Minocycline: A Rare Adverse Effect
Drug-induced autoimmune hepatitis is an acute and potentially severe adverse effect, which has been reported following the long-term use of minocycline. The condition ’s typical biochemical findings include an elevated antinuclear antibody titer, hypergammaglobulinemia with elevated levels of serum immunoglobulin G, and, sometimes, positive anti-smooth muscle antibodies. Characteristically, transaminase levels are very elevated, while markers of cholestasis and bilirubin levels are mildly increased, and histological features are very similar to those observed in sporadic autoimmune hepatitis. Here, we describe an int...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Colonic Malakoplakia: A Rare Finding in a Healthy Male
Malakoplakia is a rare chronic granulomatous disease that may affect many organs, including the lung, brain, adrenal glands, pancreas, bone, and the genitourinary tract. The gastrointestinal tract is the most common site of involvement outside of the urinary tract. Herein, we present a case of a 65-year-old male who presented with abdominal pain and unintentional weight loss. Physical examination findings were unremarkable, but colonoscopy revealed an isolated large, flat, soft, and pale lesion in the transverse colon. Histopathological examination of the lesion showed expansion of the lamina propria due to numerous lympho...
Source: Case Reports in Gastroenterology - August 21, 2018 Category: Gastroenterology Source Type: research

Chronic Intestinal Pseudo-Obstruction in Systemic Sclerosis: An Uncommon Presentation
Chronic intestinal pseudo-obstruction (CIPO) is an uncommon disorder characterized by the presence of bowel dilatation and abnormal motility. It is an important cause of chronic intestinal failure in patients with systemic sclerosis (SSc). Although intestinal pseudo-obstruction is an infrequent reason for hospitalization in these patients, it has been correlated with high in-hospital mortality compared to SSc patients hospitalized for other reasons as well as patients with intestinal pseudo-obstruction arising from other causes. Patients present with signs and symptoms of mechanical bowel obstruction, such as nausea, vomit...
Source: Case Reports in Gastroenterology - June 29, 2018 Category: Gastroenterology Source Type: research

En Bloc Endoscopic Resection of Large Pedunculated Brunner ’s Gland Hamartoma: A Case Report
We report the case of a 67-year-old Caucasian man with two episodes of melena and epigastric pain during the last month. Esophagogastroduodenoscopy revealed a large pedunculated and eroded polyp inside the antrum with a 2-cm-long stalk arising fr om the anterior wall of the duodenal bulb. Endoscopic ultrasonography showed a submucosal lesion with homogeneous hyperechoic parietal thickening and some central gaps. The muscularis was undamaged. No lymphadenopathy was observed. We performed an en bloc endoscopic resection of the polyp. The size of the whole piece was approximately 6 × 3 × 2 cm, pseudocapsulated and...
Source: Case Reports in Gastroenterology - June 28, 2018 Category: Gastroenterology Source Type: research

Ischemic Duodenal Ulceration after Transarterial Chemoembolization for Hepatocellular Carcinoma: A Case Report
In this report, we present a case of duodenal ulceration with contained perforation and severe necrotizing pancreatitis after TACE in a patient with nonresectable HCC and underlying hepatitis C virus associated with Child-Pugh stage B liver cirrhosis. This patient showed, for the first time, complete endoscopic and clinical recovery within 2 months of conservative treatment. Considering the high mortality rate from surgical intervention in all previously reported patients, the significant recovery potential demonstrated by our case suggests conservative treatment with antibiotics and parenteral nutrition combined with clos...
Source: Case Reports in Gastroenterology - June 28, 2018 Category: Gastroenterology Source Type: research

Long-Term Cholic Acid Therapy in Zellweger Spectrum Disorders
We present the long-term CA treatment and liver-related outcomes for 3 pediatric patients with ZSDs who have received CA treatment for ≥15 years. Ongoing CA treatment was associated with stabilized liver function, as shown by serum biochemistries and liver histopathology, and no treatment-related adverse effects were observed. All 3 patients have attended regular school with classroom accommodations and attained a good quality of life. Our patient outcomes suggest that early and ongoing CA therapy may sustain liver function in patients with ZSDs.Case Rep Gastroenterol 2018;12:360 –372 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 28, 2018 Category: Gastroenterology Source Type: research

A Patient with Ulcerative Colitis Complicated by Systemic Vein Thrombosis
Crohn ’s disease and ulcerative colitis (UC) patients have an increased risk for thromboembolic complications, the most common of them are deep venous thrombosis and pulmonary embolism. Other locations and genetic mutations of coagulation factors are not so common in these patients. Here we present a ca se of a young woman with exacerbation of previously diagnosed mild UC complicated by multiple thrombotic incidents due to MTHFR gene mutation.Case Rep Gastroenterol 2018;12:322 –326 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 25, 2018 Category: Gastroenterology Source Type: research

Diaphragm Disease: NSAID-Induced Small Bowel Stricture
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is ubiquitous. However, it remains an oftentimes under-recognized risk factor for the development of strictures and small bowel obstruction. Herein we describe the case of a 63-year-old female with a prolonged course of abdominal pain and occult anemia found to have a diaphragmatic stricture in the small bowel related to chronic NSAID use.Case Rep Gastroenterol 2018;12:327 –330 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 25, 2018 Category: Gastroenterology Source Type: research

Metabolic Pancreatitis: Pancreatic Steatosis, Hypertriglyceridemia, and Associated Chronic Pancreatitis in 3 Patients with Metabolic Syndrome
We present 3 patients with chronic abdominal pain and pancreatic steatosis in the setting of underlying metabolic syndrome with hypertriglyceridemia. These cases were identified in one endoscopic ultrasonographer ’s practice over a 12-month period. Each patient had documented hypertriglyceridemia but no history of acute hypertriglyceride-induced pancreatitis. A history of significant alcohol exposure was carefully excluded. Each patient underwent endoscopic ultrasonography (EUS) which proved critical in de lineating the spectrum of chronic pancreatic injury. Each of our patients had EUS documentation of pancreatic st...
Source: Case Reports in Gastroenterology - June 25, 2018 Category: Gastroenterology Source Type: research

Acute Small Bowel Perforation Caused by Obstruction of a Novel Tag-Less Agile < sup > TM < /sup > Patency Capsule
A 74-year-old man visited our hospital complaining of abdominal pain. An abdominal computed tomography scan showed multiple wall thickness of the small bowel. Capsule endoscopy was recommended for further evaluation, and patency capsule examination was performed. Eighteen hours after patency capsule ingestion, he experienced small bowel perforation with severe peritonitis caused by intestinal pressure rising because of the patency capsule trapped in his terminal ileum. An ileocolic resection was performed, including the removal of the sclerotic ileum as an emergency surgery. A pathological examination showed transmural inf...
Source: Case Reports in Gastroenterology - June 25, 2018 Category: Gastroenterology Source Type: research

Spontaneous Resolution of IgG4-Related Hepatic Inflammatory Pseudotumor Mimicking Malignancy
Hepatic inflammatory pseudotumor (IPT) is characterized by a well-circumscribed benign tumor mimicking or often mistaken for a malignant lesion. A 48-year-old male presented to the hospital with complaints of epigastric pain, with initial laboratory findings showing mildly elevated alkaline phosphatase (140 U/L) with normal AST, ALT, bilirubin, and lipase, a CD4 count of 384, and an HIV viral load of #x3e; 10 million copies. The total IgG level was elevated to 2,228 mg/dL (normal IgG4 level 114 mg/dL). Contrast-enhanced MRI of the abdomen showed heterogeneous mass-like infiltration in the right lobe of the liver measuring ...
Source: Case Reports in Gastroenterology - June 22, 2018 Category: Gastroenterology Source Type: research

Gastroparesis in a Patient with Gastric AL Amyloidosis
Systemic amyloidosis is a group of complex disorders characterized by the extracellular deposition of nonbranching fibrils in various tissues, ultimately leading to a variety of clinical presentations including isolated or multiorgan dysfunction. Amyloid involvement of the gastrointestinal tract is common depending on the subtype of this disease; light chain primary amyloidosis (AL) and secondary amyloidosis (AA) affect the gastrointestinal tract in unique ways due to differing pathophysiology. A case is reported of gastroparesis associated with AL amyloidosis diagnosed by esophagogastroduodenoscopy and study of gastric em...
Source: Case Reports in Gastroenterology - June 22, 2018 Category: Gastroenterology Source Type: research

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