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Case Reports in Gastroenterology

Tomoki Sakakida, Hideki Sato, Toshifumi Doi, Takumi Kawakami, Yoshikazu Nakatsugawa, Ken Nishimura, Shinya Yamada, Hideki Fujii, Naoya Tomatsuri, Yusuke Okuyama, Hiroyuki Kimura, Norimasa Yoshida
We report a rare case of bile duct stone formation around an ingested fish bone as a nidus after pancreatoduodenectomy. A 78-year-old woman was admitted to our department for fever and epigastric pain. Abdominal computed tomography revealed an elongated bile duct stone containing a linearly shaped foreign body of bone density. Enteroscopic lithotomy was performed using single balloon enteroscopy to safely remove the stone and foreign body from the bile duct. The foreign body was determined to be a fish bone by pathological examination and component analysis...
January 2018: Case Reports in Gastroenterology
Xin-Bo Ai, Zhen-Jiang Wang, Qi-Chao Dong, Xu Lin, Yu-Ping Chen, Fei-Yue Gong, Hui Liang
Gastrointestinal histoplasmosis (GIH) without pulmonary and bone marrow involvement is very rare worldwide. It can be misdiagnosed as intestinal tuberculosis or Crohn's disease. There are just few case reports of GIH in patients with a positive HIV antibody test. Here, we report a patient who presented to our hospital with repeated intestinal obstruction. The suspicious diagnosis was intestinal tuberculosis or Crohn's disease due to unspecific clinical manifestations and radiologic images. Our patient's HIV antibody test was negative...
January 2018: Case Reports in Gastroenterology
Linda Kievit, Pia Kræmer, Stephen Hamilton-Dutoit, Henning Grønbæk
A 37-year-old male, who at the age of 8 years had been treated for right-sided Wilms' tumor with nephrectomy, radiotherapy, and chemotherapy, presented with noncirrhotic portal hypertension (NCPH), grade 2 esophageal varices, and ascites. A CT scan demonstrated hypoplasia of liver segments 2 and 3. A liver biopsy showed portal tract fibrosis without cirrhosis, with histological features of NCPH. Liver vein catheterization showed a normal portal pressure gradient of 5 mm Hg while spleen to hepatic vein pressure was 29 mm Hg...
January 2018: Case Reports in Gastroenterology
Jared Magee, Matthew Robles, Peter Dunaway
End-stage renal disease (ESRD) is a common disease encountered in clinical practice and is associated with increasing metabolic derangements through disease progression. Phosphate retention is one of the most common derangements and is associated with increased mortality. Hyperphosphatemia becomes increasingly prevalent as glomerular filtration rate decreases. Non-calcium phosphate-binding resins and dietary phosphate restriction are the mainstays for managing hyperphosphatemia in patients with ESRD. Sevelamer carbonate is the most frequently used non-calcium phosphate binder in the US due to ease of administration and an excellent safety profile...
January 2018: Case Reports in Gastroenterology
Bodil Ohlsson, Rita J Gustafsson, Ervin Toth, Bèla Veress, Henrik Thorlacius
A full-thickness biopsy of the bowel wall is required to evaluate the enteric nervous system. A patient with aggravating gastrointestinal symptoms underwent a laparoscopic full-thickness biopsy of the ileum and, 1 year later, an endoscopic full-thickness biopsy of the sigmoid colon. Both samples showed enteric neuropathy characterized by vacuolated and enlarged neurons. The length of the myenteric plexus was greater in the endoscopic (23 mm) compared to the laparoscopic (11 mm) biopsy, with fewer tissue artefacts in the laparoscopic approach...
January 2018: Case Reports in Gastroenterology
Naohisa Yoshida, Yuji Naito, Takaaki Murakami, Kiyoshi Ogiso, Ryohei Hirose, Yutaka Inada, Mitsuo Kishimoto, Rafiz Abdul Rani, Yoshito Itoh
Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum...
January 2018: Case Reports in Gastroenterology
David F Pinal-García, Carlos M Nuño-Guzmán, Audrey Gómez-Abarca, Jorge L Corona, Ismael Espejo
Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially life-threatening complication. Diagnosis may be difficult, particularly in the absence of known liver cirrhosis or tumor. A 20-year-old male patient presented with progressive abdominal pain and shock. His past medical history was uneventful. Anemia, acute renal failure, and abnormal liver function test were demonstrated. Mild hepatomegaly, perihepatic and flank fluid, and multiple hypodense liver lesions suggestive of intrahepatic metastases or multifocal HCC were revealed by computed tomography...
January 2018: Case Reports in Gastroenterology
Xavier Verhelst, Anja Geerts, Hans Van Vlierberghe, Peter Smeets, Clarisse Lecluyse
We report the case of a young woman with hereditary hemorrhagic telangiectasia (HHT) with severe liver involvement and pulmonary shunting. The medical imaging in this patient illustrates the severe shunting that can occur in these patients who often are asymptomatic. By showing this case, we want to highlight the role of liver transplantation in HHT with hepatic involvement.
January 2018: Case Reports in Gastroenterology
Jonathan Gapp, John Gross, Lakshmi Chintalacheruvu, Savio Reddymasu
Granular cell tumors (GCTs) have been described as neoplasms of Schwann cell origin. They are often benign and notably uncommon in the gastrointestinal tract. Recently, their incidence has become more common, likely as a result of increased colonoscopy screenings. Very few data exist regarding their potential for malignancy, but malignant GCTs have been reported. Here, we report the case of a young female patient who was diagnosed with an atypical GCT on the ileocecal valve with an overlying tubular adenoma which was found incidentally on colonoscopy...
January 2018: Case Reports in Gastroenterology
Mohammad Saud Khan, Faisal Jamal, Zubair Khan, Abhinav Tiwari, Hermann Simo, Himani Sharma
Duodenal perforation is a rare but life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). Duodenal perforation can cause air leak into the extraperitoneal space. In rare instances, the air in the extraperitoneal space could dissect along the fascial planes of the abdomen to reach scrotum, leading to pneumoscrotum. We present the case of a 35-year-old male patient who developed scrotal pain and swelling following ERCP. He was found to have extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema...
January 2018: Case Reports in Gastroenterology
Yousef Nassar, Seth Richter
Babesiosis is a zoonotic, tick-borne infection caused by the protozoan Babesia . It is transmitted by the Ixodes ticks which transmit the infection to humans. Babesia microti , Babesia duncani , Babesia divergens , and Babesia venatorum are species that have been identified as being infectious to humans worldwide. The most common species causing infection to humans is B. microti which is endemic to the Northeast and Midwestern United States with most infections occurring between the months of May and October...
September 2017: Case Reports in Gastroenterology
Jiannis Anastasiou, Anas Hussameddin, Abdulaziz Al Quorain
Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is regarded as a simple, low-cost procedure achieving significant weight loss within a short period of time. LSG is considered a safe procedure with a relatively low complication rate. The complications encountered nevertheless can result in significant morbidity and may even be lethal. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a case of a 31-year-old patient complicated by a 3...
September 2017: Case Reports in Gastroenterology
Kunishige Okamura, Masanori Ohara, Tsukasa Kaneko, Tomohide Shirosaki, Aki Fujiwara, Takumi Yamabuki, Ryo Takahashi, Kazuteru Komuro, Nozomu Iwashiro, Noriko Kimura
Rupture of pancreatic pseudocyst is one of the rare complications and usually results in high mortality. The present case was a rupture of pancreatic pseudocyst that could be treated by surgical intervention. A 74-year-old man developed abdominal pain, vomiting, and diarrhea, and he was diagnosed with cholecystitis and pneumonia. Three days later, acute pancreatitis occurred and computed tomography (CT) showed slight hemorrhage in the cyst of the pancreatic tail. After another 10 days, CT showed pancreatic cyst ruptured due to intracystic hemorrhage...
September 2017: Case Reports in Gastroenterology
Jan K Adamski, Björn B Jäschke, Raija S Uusitalo-Seppälä, Kalle V J Moilanen, Antti V Pehkonen, Wojciech Weigl
Development of the extreme form of hypothyroidism defined as myxedema is very rare. Acute symptoms and their management have been described in detail previously. However, not much attention has been devoted to therapeutic challenges that are faced in the recovery phase of the treatment, especially pertaining to the gastrointestinal system. The link between myxedema and the appearance of severe Clostridium difficile infection (CDI) has not been established so far. A 61-year-old woman with no significant medical record was admitted to hospital because of infected heel pressure and thyroid dysfunction...
September 2017: Case Reports in Gastroenterology
Hira Imad Cheema, Ashutosh Gupta
Oral contraceptives have long been associated with liver injury. However, very little attention is paid to the metabolic side effects of hormone-releasing intrauterine devices (IUDs). These devices are generally considered safe and commonly used. We report for the first time acute liver injury associated with a levonorgestrel-releasing IUD. Our patient did not have any comorbidities that could have caused or exacerbated liver injury. A detailed workup and liver biopsy remained negative for any other potential cause of liver injury...
September 2017: Case Reports in Gastroenterology
Kazuo Tarao, Akira Sato
Oral direct-acting antivirals comprise the main therapy for hepatitis C virus (HCV)-associated liver disease in Japan. Daclatasvir/asunaprevir is the primary agent and sofosbuvir/ledipasvir is the secondary agent for HCV genotype 1b. Ombitasvir/paritaprevir/ritonavir was also recommended as a therapy for HCV genotype 1b. More recently, elbasvir (NS5A inhibitor)/grazoprevir (NS3/4A protease inhibitor) was also recommended as a potent therapy for HCV genotype 1b infection. This agent achieved an SVR12 as high as 96...
September 2017: Case Reports in Gastroenterology
Kazuhiro Takehara, Kazuhiro Sakamoto, Rina Takahashi, Masaya Kawai, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Makoto Takahashi, Yutaka Kojima, Tetsu Fukunaga, Yoshiaki Kajiyama, Seiji Kawasaki
Superior mesenteric artery syndrome (SMAS) is a relatively rare disease that involves bowel obstruction symptoms, such as vomiting and gastric distension, owing to the compression of the third portion of the duodenum from the front by the superior mesenteric artery (SMA) and from the rear by the abdominal aorta and the spine. SMAS is diagnosed on the basis of an upper gastrointestinal examination series indicating the obstruction of the third portion of the duodenum or a computed tomography scan indicating the narrowing of the branch angle between the aorta and the SMA (i...
September 2017: Case Reports in Gastroenterology
Matthias Sauter, Stephan R Vavricka, Pascal Locher, Benjamin Preiswerk, Dominik Weishaupt, Christoph A Meier, Benjamin Misselwitz
Infection with Yersinia enterocolitica (YE) typically presents with mild gastroenteritis without systemic infection. However, systemic YE infection has been described in states of iron overload. We present the case of a patient with sepsis with hepatic abscesses due to YE infection. Workup revealed a past diagnosis of diabetes mellitus and hemochromatosis which had been untreated for the previous 5 years due to patient refusal. This case highlights risk factors for systemic infection with YE. A high degree of suspicion for YE infection is warranted in patients with iron overload, diabetes mellitus, or immunosuppression...
September 2017: Case Reports in Gastroenterology
Hirokazu Honda, Takashi Ikeya, Erika Kashiwagi, Shuichi Okada, Katsuyuki Fukuda
Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level...
September 2017: Case Reports in Gastroenterology
Anouk E J Latenstein, Mathijs P Hendriks, Emo E van Halsema, Jeanin E van Hooft, Anne-Marie van Berkel
Self-expanding metal stents can be considered as initial treatment for malignant large bowel obstruction in the palliative setting. It is suggested that systemic anti-angiogenic therapy increases the risk of stent perforation. We report a 65-year-old woman with a metastatic, obstructing colon tumor who has been successfully treated with stent placement and chemoimmunotherapy consisting of capecitabine and bevacizumab for 8 years.
September 2017: Case Reports in Gastroenterology
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