An Extremely Rare Presentation of an Alpha-Fetoprotein-Producing Esophageal Adenocarcinoma
We report the case of a 76-year-old female who presented with progressive weakness, fatigue, and a decrease in appetite for weeks and who was found to have an AFP-producing EAC with an extraordinarily high AFP level of 46,135 ng/mL. CT angiography revealed abnormal thickening of the esophagus and multiple metastatic masses throughout the liver. Upper endoscopy revealed a large mass in the distal esophagus with extension into the stomach. Biopsy confirmed the EAC. Most cases are unsuccessfully treated with surgery and chemotherapy. Serial measurement of serum AFP may be useful for monitoring clinical status and treatment re...
Source: Case Reports in Gastroenterology - October 20, 2020 Category: Gastroenterology Source Type: research

Spontaneous Regression of Advanced Hepatocellular Carcinoma
In this report, we discuss possible mechanisms of spontaneous tumor regression and its therapeutic implications.Case Rep Gastroenterol 2020;14:491 –496 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 15, 2020 Category: Gastroenterology Source Type: research

Ascending Colon Schwannoma Surgically Treated after Accurate Preoperative Diagnosis
Colorectal schwannomas are rare and usually benign gastrointestinal mesenchymal tumors. However, these tumors are often overtreated, possibly owing to misleading malignant potential. To our knowledge, there have been no previous reports of ascending colon schwannoma preoperatively diagnosed as benign schwannoma. Herein, we report a case of ascending colon schwannoma accurately diagnosed by endoscopic biopsy and successfully treated by wedge resection. The patient was a 76-year-old woman with complaints of bloody stool. She had no relevant past medical history. Radiological findings revealed a protruded mass in the ascendin...
Source: Case Reports in Gastroenterology - October 15, 2020 Category: Gastroenterology Source Type: research

Pregnancy-Onset Acute Severe Colitis after in vitro Fertilization Embryo Transfer
We present the case of a 42-year-old woman who conceived after 9 attempts of in vitro fertilization and whose pregnancy was the result of a donated oocyte. Shortly after conception, she was diagnosed with severe active ulcerative colitis, and biologic therapy was introduced in the 28th week of pregnancy. Although therapy for IBD in pregnancy is considered safe for most drugs, this was not very well known in 2015. We also consider our case exceptional because we now have a 5-year follow-up of our patient and her child after having begun biologic therapy during late pregnancy.Case Rep Gastroenterol 2020;14:477 –482 (So...
Source: Case Reports in Gastroenterology - October 12, 2020 Category: Gastroenterology Source Type: research

Amoxycillin-Clavulanic Acid-Induced Esophageal Ulcer: An Unusual Cause
Pill-induced esophagitis or esophageal ulcers are considered when patients have retrosternal chest pain or odynophagia following the ingestion of suspicious medications. Various drugs have been reported to induce esophageal ulcers. However, amoxycillin-clavulanic acid-induced esophagitis or esophageal ulcer has not been reported in literature. Hence, we report the case of a 30-year-old Thai male who presented with acute, severe odynophagia and retrosternal chest pain. He had a history of taking amoxycillin-clavulanic acid for 12 days. An esophagogastroduodenoscopy was performed and revealed geographic clean-based ulcers, w...
Source: Case Reports in Gastroenterology - October 8, 2020 Category: Gastroenterology Source Type: research

Bleeding Gastric Heterotopic Polyp in the Duodenum of a Teenager with Severe Factor VII Deficiency
Heterotopic gastric tissue can be found throughout the intestinal tract, and when it is present in the small intestine, it can present with symptoms that include gastrointestinal bleeding, chronic abdominal pain, diarrhea, and chronic dyspepsia. This finding is incredibly rare in pediatrics, but if present, it can lead to significant morbidity and mortality. This can be especially true if a patient presents with a comorbidity of a bleeding disorder. We here present the case of a teenage male with a history of severe factor VII deficiency who was found to have iron deficiency anemia resulting in multiple blood transfusions ...
Source: Case Reports in Gastroenterology - October 8, 2020 Category: Gastroenterology Source Type: research

Atypical Manifestations of IgG4-Related Disease as Multiple Liver Abscesses with Subcapsular Tracts and Migratory Pulmonary Nodules Mimicking Parasitic Infection
This report revealed IgG4-related liver disease with atypical presentation presenting with multiple liver abscesses and linear tracts mimicking parasitic infection.Case Rep Gastroenterol 2020;14:458 –466 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - October 8, 2020 Category: Gastroenterology Source Type: research

Radiation Esophagitis in a Patient with Oral Carcinoma and Bone Metastasis
We describe herein a case of radiation esophagitis in a patient with oral carcinoma with multiple general bone metastases. Cisplatin, fluorouracil, and cetuximab were given for 3 cycles. Radiation therapy (30 Gy) to the thoracic vertebrae and lumbar vertebrae was prescribed to prevent worsening of bone metastases and relieve pain. Neutropenia was also observed due to chemotherapy. After the end of radiation therapy, the patient experienced chest pain, heartburn, and dysphagia. Upper gastrointestinal endoscopy revealed severe radiation esophagitis of endoscopic Fukui Acute Radiation Esophagitis grade 4. Oral food was discon...
Source: Case Reports in Gastroenterology - September 15, 2020 Category: Gastroenterology Source Type: research

Alcoholic Hepatitis: A Common Disease with Uncommon Presentation
We describe a patient who presented with alcoholic hepatitis with direct hyperbilirubinemia, elevated alkaline phosphatase (ALP), and hypertriglyceridemia. All the imaging and laboratory work excluded obstructive causes, and liver biopsy confirmed the diagnosis. Alcoholic hepatitis is a common condition, but some unusual presentations can lead one to think of uncommon pathologies. This case reflects that alcoholic hepatitis can present with high levels of triglycerides as well as a cholestatic pattern with direct hyperbilirubinemia and ALP without an obvious obstruction cause.Case Rep Gastroenterol 2020;14:448 –452 (...
Source: Case Reports in Gastroenterology - August 26, 2020 Category: Gastroenterology Source Type: research

Black Esophagus in the Setting of Alcohol Abuse after External Beam Radiation
Acute esophageal necrosis (AEN), black esophagus, or Gurvits syndrome is a rare clinical disorder characterized by a striking endoscopic appearance of necrotic esophageal mucosa, universally affecting the distal esophagus and ending abruptly at the gastroesophageal junction. It has been gaining traction as a demonstrable cause of upper gastrointestinal bleeding in the 21st century. Its pathophysiology is multifactorial affecting men and the elderly disproportionally, with a mortality rate nearing 36%. AEN has been associated with numerous conditions in the past, and we aim to present an unusual case of AEN on the setting o...
Source: Case Reports in Gastroenterology - August 26, 2020 Category: Gastroenterology Source Type: research

Infected Pancreatic Necrosis Mimicking Pancreatic Cancer
Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with inf...
Source: Case Reports in Gastroenterology - August 26, 2020 Category: Gastroenterology Source Type: research

Alpha-Fetoprotein-Producing Early Gastric Cancer with Intramucosal Hepatoid and Fetal Enteric Differentiation
We report three cases of AFP-producing early gastric cancer which had an intramucosal hepatoid component. Immunohistochemistry showed that the hepatoid component was diffusely immunoreactive for SALL4, AFP, arginase-1, and HepPar1, and focally for CDX2 and PDX1. An intramucosal transition between the hepatoid component and conventional intramucosal adenocarcinoma was identified. Two patients also had a coexistent fetal enteric component, which was admixed with a hepatoid component. Although at an early stage one patient subsequently developed liver metastasis and a second patient was suspected of having liver metastasis, t...
Source: Case Reports in Gastroenterology - August 26, 2020 Category: Gastroenterology Source Type: research

Rectal Prolapse Concomitant with Uterovaginal Prolapse Protects the Ileum from Necrosis in Transanal Ileum Evisceration through a Traumatic Tear on the Sigmoid Wall
Eviscerated ileum passing through a traumatic tear on the sigmoid wall is a rare case and all the cases reported previously showed that the eviscerated intestines were necrotic. However, in this case, although the huge size of eviscerated intestine had already exceeded the intestinal ischemic time, the small intestine outside the anus was not necrotic. Here we report the case of a 73-year-old female who presented with evisceration of the small intestine out of her anus as long as 200 cm 7 h before. The eviscerated small intestine (ileum) appeared still viable and there were no signs of pain, obstruction, or peritonitis. An...
Source: Case Reports in Gastroenterology - August 26, 2020 Category: Gastroenterology Source Type: research

An Unexpected Cause of Recurrent Jaundice after Resolution of Acute Hepatitis E
In this report, we describe a rare case of liver enzyme disturbance caused by myeloid sarcoma of the gallbladder and biliary tract. A 63-year-old man with progressive chronic myeloid leukemia presented with acute hepatitis. Viral serology revealed an infection with hepatitis E virus. The liver enzymes and bilirubin improved gradually under treatment with ribavirin, but there was a flair up shortly after. Imaging including CT and echo-endoscopy showed a thickened infiltrated gallbladder wall and dilated bile ducts, suspected for myeloid sarcoma. Biopsy of an atypical skin lesion, present at the same time, confirmed the diag...
Source: Case Reports in Gastroenterology - August 14, 2020 Category: Gastroenterology Source Type: research

Gastric Outlet Obstruction due to Malposition of Gastrostomy Tube: A Rare and Commonly Misdiagnosed Condition
Nearly all disease processes worsen with malnutrition. However, providing adequate and optimal nourishment can be challenging in individuals who are not able to eat. Insertion of a gastrostomy tube is a well-established method for providing enteral access for long-term nutritional support. Although enteral tube feedings are generally well tolerated, gastrostomy tube placement is associated with several complications. An uncommon, and often initially misdiagnosed, complication of gastrostomy tube placement is gastric outlet obstruction (GOO), which refers to the clinical outcome of any disease process that mechanically obst...
Source: Case Reports in Gastroenterology - July 30, 2020 Category: Gastroenterology Source Type: research

Recurrence of Noninvasive Perianal Extramammary Paget ’s Disease in the Lymph Nodes without Local Recurrence after Complete Excision
Primary extramammary Paget ’s disease (EMPD) is a rare intraepithelial adenocarcinoma. Lymph node metastasis from noninvasive EMPD originating in the anorectal region is extremely rare, and the recurrence of noninvasive EMPD is commonly associated with local recurrence mainly due to an insufficient resection margin. We here in report a case of inguinal and para-aortic lymph node recurrence without local recurrence after complete margin-free surgical resection of noninvasive perianal EMPD. The patient was a man in his 40s who presented with an erythematous plaque of 7 × 5 cm in the perianal region, which had bee...
Source: Case Reports in Gastroenterology - July 30, 2020 Category: Gastroenterology Source Type: research

Diarrhea as an Initial Presentation in Patients with Medullary Thyroid Cancer: Delaying the Diagnosis
In conclusion, MTC should be considered when evaluating chronic diarrhea.Case Rep Gastroenterol 2020;14:391 –401 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - July 30, 2020 Category: Gastroenterology Source Type: research

Fatal Hepatitis-Associated Aplastic Anemia in a Young Male
We present a case of a young male who was admitted to the Department of Gastroenterology and Hepatology for acute hepatitis of an unknown cause. Liver biopsy revealed extensive inflammatory process with hepatocyte necrosis. Forty days later, new onset pancytopenia was identified. Bone marrow biopsy showed severe hypocellularity, and he was diagnosed with severe hepatitis-associated aplastic anemia. Treatment with cyclosporine was initiated, but with inadequate response, and pretransplant evaluation was started. Due to severe neutropenia, following alveotomy procedure, the patient developed deep neck infection with conseque...
Source: Case Reports in Gastroenterology - July 28, 2020 Category: Gastroenterology Source Type: research

Anterior Cutaneous Nerve Entrapment Syndrome Occurring after Endoscopy
A 45-year-old lady presented for a follow-up endoscopy examination for mild abdominal pain due to gastric ulcers. She experienced a severe, markedly different type of pain with labor-like contractions 3 days later. Physical examination revealed tenderness confined to a 1 × 1-cm area and positive Carnett’s sign. The pain completely resolved 10 min after a subcutaneous lidocaine injection. The patient was diagnosed with anterior cutaneous nerve entrapment syndrome. The pain returned within several hours and anterior neurectomy was performed several days later. The pain subsided immediately and no recurrence was s...
Source: Case Reports in Gastroenterology - July 28, 2020 Category: Gastroenterology Source Type: research

Systemic Botulism Toxicity Caused by Pyloric Botox Injection to Treat Gastroparesis
We report the case of a 27-year-old female with Emery-Dreifuss muscular dystrophy who developed severe systemic botulism toxicity following the intrapyloric injection of 100 units of Botox to treat gastroparesis. The patient eventually made a full recovery.Case Rep Gastroenterol 2020;14:373 –376 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - July 28, 2020 Category: Gastroenterology Source Type: research

Tumor Lysis Syndrome after Combination Therapy of Nivolumab and Sorafenib in a Woman with Advanced Hepatocellular Carcinoma
Tumor lysis syndrome (TLS) is a life-threatening emergency that usually develops in rapidly proliferating hematologic malignancies or advanced solid tumor following cytotoxic chemotherapy or therapeutic interventions. TLS is especially rare in patients with hepatocellular carcinoma (HCC). Therefore, we present a case of a female patient with newly diagnosed advanced HCC who developed TLS and hepatic failure after receiving combination therapy of nivolumab and sorafenib. To our knowledge, this is the first case of TLS in a patient with advanced HCC owing to combination therapy of nivolumab and sorafenib. We also reviewed th...
Source: Case Reports in Gastroenterology - July 28, 2020 Category: Gastroenterology Source Type: research

A Rare Manifestation of a Bleeding Tubulovillous Duodenal Polyp Presenting as an Upper Gastrointestinal Hemorrhage
We present a case of a 76-year-old male with recurrent hematemesis who was found to have an intestinal-type, pedunculated tubulovillous adenoma in the descending duodenum. An isolated occurrence of nonampullary sporadic duodenal adenoma is a rare finding. Presentation as an upper gastrointestinal hemorrhage is also extremely uncommon. Our patient ’s polyp was pedunculated, which is atypical, because most sporadic duodenal adenomas are morphologically flat or sessile. The purpose of this case is to present a rare cause of upper gastrointestinal bleeding and to depict characteristics of an isolated duodenal tubulovillo...
Source: Case Reports in Gastroenterology - July 28, 2020 Category: Gastroenterology Source Type: research

Perforated Goblet Cell Carcinoid of the Appendix
Goblet cell carcinoid (GCC) of the perforated appendix is rare, and its pathological features and prognosis remain poorly described. A 71-year-old woman was admitted to our hospital for right lower abdominal pain, vomiting, and high-grade fever. She was diagnosed with acute appendicitis and underwent emergency laparoscopic appendectomy. Intraoperative examination revealed an enlarged and perforated appendix. Histopathological examination revealed GCC of the appendix with subserosal invasion. She underwent laparoscopic ileocecal resection with lymph node dissection (D3) following appendectomy. Histopathological findings sho...
Source: Case Reports in Gastroenterology - July 22, 2020 Category: Gastroenterology Source Type: research

Intestinal Obstruction due to Acute Appendicitis
Acute appendicitis has been proven to be a usual cause of mechanical small bowel obstruction since 1901, but there has been very little specific research on this subject. It usually occurs as an effect of adhesion because of periappendicular inflammation. Although previous studies exist, this presentation of acute appendicitis is not widely identified, which might lead to delays in making the right diagnosis and initiating treatment. We herein report a 17-year-old male patient who presented with the clinical manifestations of intestinal obstruction and fever for 3 days. Preoperative ultrasound and subsequent computed tomog...
Source: Case Reports in Gastroenterology - July 22, 2020 Category: Gastroenterology Source Type: research

Gastric Metastasis from Colorectal Cancer Mimicking a Submucosal Tumor
Signet-ring cell carcinoma, a colorectal cancer (CRC) subtype, sometimes shows metastases to uncommon metastatic sites. However, gastric metastasis is extremely rare. Here, we describe a case of gastric metastasis from colonic cancer. A 76-year-old woman presented with anemia. Colonoscopic biopsy revealed a CRC on the transverse colon showing a poorly differentiated adenocarcinoma with a partial component of the signet-ring carcinoma. Computed tomography revealed multiple subcutaneous nodules on her chest and back, and a tumor in the left lower lobe of her lung. Esophagogastroduodenoscopy showed a submucosal tumor-like les...
Source: Case Reports in Gastroenterology - July 22, 2020 Category: Gastroenterology Source Type: research

Aggressive Recurrent Pancreatic Cancer Producing Granulocyte Colony-Stimulating Factor
Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein which stimulates the proliferation, differentiation, and functional activation of myeloid hematopoietic cells. G-CSF-producing pancreatic cancer is rare and its prognosis is strikingly poor. A 69-year-old woman with well-to-moderately differentiated ductal adenocarcinoma (pT3N0M0, stage IIA) underwent distal pancreatectomy and splenectomy. Postoperative adjuvant chemotherapy with S-1 was administered for 6 months. Eleven months after surgery, periodic blood examination revealed remarkable leukocytosis (19,120/ µL) without fever, which worsened 3 weeks la...
Source: Case Reports in Gastroenterology - July 13, 2020 Category: Gastroenterology Source Type: research

Successful Thrombectomy via a Surgically Reopened Umbilical Vein for Extended Portal Vein Thrombosis Caused by Portal Vein Embolization prior to Extended Liver Resection
Selective portal vein embolization (PVE) before extended liver surgery is an accepted method to stimulate growth of the future liver remnant. Portal vein thrombosis (PVT) of the main stem and the non-targeted branches to the future liver remnant is a rare but major complication of PVE, requiring immediate revascularization. Without revascularization, curative liver surgery is not possible, resulting in a potentially life-threatening situation. We here present a new surgical technique to revascularize the portal vein after PVT by combining a surgical thrombectomy with catheter-based thrombolysis via the surgically reopened ...
Source: Case Reports in Gastroenterology - July 1, 2020 Category: Gastroenterology Source Type: research

Enoxaparin-Induced Liver Injury
This report describes a case of enoxaparin-induced hepatotoxicity in a 61-year-old male diagnosed with pulmonary embolism. Elevations of liver enzymes were noted within 1 week of starting the drug, followed by a dramatic improvement upon its discontinuation, with subsequent normalization in the following days.Case Rep Gastroenterol 2020;14:315 –319 (Source: Case Reports in Gastroenterology)
Source: Case Reports in Gastroenterology - June 10, 2020 Category: Gastroenterology Source Type: research

Groove Pancreatitis Associated with Transient Liver Injury Mimicking Ampullary Neoplasm
We report a 52-year-old male smoker with hypertension, asthma, and alcohol abuse who was admitted with severe epigastric pain radiating to the back. He was found to have acute pancreatitis. A computed tomography scan of the abdomen showed a mass lesion in the peri-ampullary region. MRI of the abdomen revealed dilated common bile duct and duodenal mass and features suggestive of groove pancreatitis. During the hospital stay, bilirubin and liver enzymes started to rise and then decreased gradually to the previous normal range. The secondary workup for liver disease was unremarkable. The patient improved and was discharged. S...
Source: Case Reports in Gastroenterology - June 2, 2020 Category: Gastroenterology Source Type: research

Synchronous Hepatocellular Carcinoma in a Patient with Primary Gastric Cancer: An Exceptional Association
Hepatocellular carcinoma (HCC) is the most frequent type of liver cancer. Liver cirrhosis of any etiology is considered the main risk factor for the development of HCC. However, HCC in noncirrhotic livers remains an uncommon finding. The association of HCC with a primary gastric adenocarcinoma was described in the literature as part of a hepatoid adenocarcinoma which is a special type of primary gastric carcinoma characterized by histologic similarities to HCC with excessive production of α-fetoprotein. Herein, we report the case of a 50-year-old male patient, with no history of pre-existing liver disease, who was ad...
Source: Case Reports in Gastroenterology - May 28, 2020 Category: Gastroenterology Source Type: research

Factitious Disorder Presenting with Refractory Enterocutaneous Fistula that Underwent 7 Surgeries
The formation of a post-appendicectomy fistula is rare but devastating. Major etiological factors include leakage from the appendiceal stump, neoplasm of the appendix and/or cecum, infection, inflammatory bowel disease, and distal obstruction. The management of enterocutaneous fistula involves enteral nutrition, drainage, antibiotic coverage, as well as surgical excision and segmental resection of the involved bowel. Here we present a case where a young female suffered from refractory enterocutaneous fistula after appendicectomy. Despite extensive treatments, her symptoms persisted and contradicted with objective test resu...
Source: Case Reports in Gastroenterology - May 27, 2020 Category: Gastroenterology Source Type: research

Sigmoid Volvulus with Widespread Bowel Ischemia after Endoscopic Reduction Successfully Treated with Elective Laparoscopic Surgery
An 87-year-old man complaining of abdominal distention was referred to our hospital. Plain radiograph and enhanced computed tomography (CT) showed a dilated sigmoid colon with a coffee bean sign, leading to the diagnosis of sigmoid volvulus. Based on symptoms and the CT and laboratory test findings, we initially treated the patient with endoscopic reduction, resulting in successful reduction of the sigmoid volvulus with widespread presumed mucosal ischemia. Due both to the lack of emerging symptoms suggesting colon perforation and to the laboratory test findings after endoscopic reduction, we treated the patient without fu...
Source: Case Reports in Gastroenterology - May 13, 2020 Category: Gastroenterology Source Type: research

Cytomegalovirus Colitis with a Cobblestone Appearance
Cytomegalovirus (CMV) colitis with a cobblestone appearance is rare, and its endoscopic and pathological features remain poorly described. A 78-year-old woman was admitted to our hospital for disturbance of consciousness, high-grade fever, and diarrhea occurring up to 7 times a day. Sigmoidoscopy revealed a circumferential ulcer with mucosal defect, an ulcer with a cobblestone appearance extending from the upper rectum to the sigmoid colon, and an irregular ulcer on the lower rectum. She was histopathologically diagnosed with CMV colitis and intravenously treated with ganciclovir (5 mg/kg) for 7 weeks. Colonoscopy after tr...
Source: Case Reports in Gastroenterology - May 13, 2020 Category: Gastroenterology Source Type: research

Massive Hepatomegaly Secondary to Amyloidosis with Normal Liver Chemistries
We report a case of a 50-year-old male who presented to our gastroenterology clinic with marked hepatomegaly secondary to hepatic amyloidosis, in concert with bone marrow involvement and nephrotic syndrome. Biopsies in conjunction with Congo red staining demonstrated 95% replacement of hepatic structure and 80% replacement of bone marrow with amyloid deposition. Despite these findings, liver chemistries, renal function, and blood count were normal. Our case presents not only the rare finding of primary hepatic amyloidosis but also an atypical presentation of this disorder. Although rare, AL amyloidosis should be in a diffe...
Source: Case Reports in Gastroenterology - May 13, 2020 Category: Gastroenterology Source Type: research

Over-the-Scope Clip to the Rescue! A Novel Tool for Refractory Acute Nonvariceal Upper Gastrointestinal Hemorrhage
Nonvariceal upper gastrointestinal hemorrhage (NVUGIH) is more prevalent than lower gastrointestinal hemorrhage and carries a high risk of mortality in the elderly, especially those with significant cardiovascular comorbidities. Traditional endoscopic methods, such as through-the-scope clips, electrocautery, and epinephrine injection, are frequently used to control these bleeds; however, they carry a 10% risk of rebleeding, and this itself carries a mortality risk of 36%. The larger over-the-scope clips (OTSC) that were initially used for the closure of fistulas and perforations are now gradually being implemented to manag...
Source: Case Reports in Gastroenterology - May 12, 2020 Category: Gastroenterology Source Type: research

Fatal Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer: A Clinical Case of Rare Oncological Emergency
Tumor lysis syndrome (TLS) is a potentially life-threatening complication of chemotherapy. It usually occurs in rapidly proliferating hematological malignancies. TLS is deemed spontaneous (STLS) when it occurs prior to any cytotoxic or definite treatment. STLS is extremely rare in solid tumors. Here, we report a rare case of fatal STLS in a 47-year-old woman diagnosed with metastatic colon cancer. The patient developed acute renal failure with anuria, electrolyte disturbances, and metabolic acidosis before initiating chemotherapy. Despite appropriate management of TLS, including renal replacement therapy, she died within a...
Source: Case Reports in Gastroenterology - May 7, 2020 Category: Gastroenterology Source Type: research

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