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Case Reports in Gastroenterology

Rawad A Yared, Hussein A Badran, Mohammed Hussein Kamareddine, Youssef Ghosn, Roula Bou Khalil, Khaled El Ajamy, Camil Chouairy, Said G Farhat
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...
May 2018: Case Reports in Gastroenterology
Jamil Shah, Abul Shahidullah, Yingxian Liu
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...
May 2018: Case Reports in Gastroenterology
Kyawzaw Lin, Aung Naing Lin, Sandar Linn, Pwint Phyu Hlaing, Viswanath Vasudevan, Madhavi Reddy
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 months...
May 2018: Case Reports in Gastroenterology
Yoh Asahi, Takuto Suzuki, Akiufumi Sawada, Masaya Kina, Joji Takada, Hiroko Gotoda, Hiroyuki Masuko
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, ischemia, or obstruction...
May 2018: Case Reports in Gastroenterology
Kazuhiro Suzumura, Etsuro Hatano, Masaharu Tada, Hideaki Sueoka, Hiroshi Nishida, Kenjiro Iida, Seikan Hai, Hayato Miyamoto, Tatsuya Andoh, Takahiro Ueki, Kentaro Nonaka, Keiji Nakasho, Jiro Fujimoto
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...
May 2018: Case Reports in Gastroenterology
Kimberly A Wong, Kristin A Olson, Eric W Chak
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 < 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 laparoscopy with biopsy was performed...
May 2018: Case Reports in Gastroenterology
Yudai Koya, Tomohiro Suzuki, Mayumi Tai, Osamu Ichii, Nobuo Matsuhashi, Yutaka Ejiri, Michihiko Shibata, Masaru Harada
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 completely 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 with tumor hypoxia...
May 2018: Case Reports in Gastroenterology
Norio Kubo, Norifumi Harimoto, Kenichiro Araki, Kei Hagiwara, Takahiro Yamanaka, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Masaya Miyazaki, Hideaki Yokoo, Hiroyuki Kuwano, Ken Shirabe
Hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor. Preoperative diagnosis of HEHE is difficult because it does not manifest specific symptoms or tumor markers. 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)...
May 2018: Case Reports in Gastroenterology
Oluwaseun Shogbesan, Abdullateef Abdulkareem, Binu Pappachen, John Altomare
Neuroendocrine neoplasms (NENs) are a diverse group of tumors arising throughout the body with a common origin from neuroendocrine cells. Well-differentiated NENs, also known as neuroendocrine tumors (NETs), are generally indolent and are often found incidentally, while poorly differentiated tumors are more aggressive. Carcinoid tumors are NETs arising from the gastrointestinal tract and less commonly from the lungs, thymus, and kidneys. NETs in the mesentery arise from metastasis from primary tumor, and carcinoid syndrome in this setting results from concomitant metastasis to the liver...
May 2018: Case Reports in Gastroenterology
Rosario Fornaro, Marco Frascio, Michela Caratto, Elisa Caratto, Rita Bianchi, Andrea Razzore, Giuseppe Caristo, Camilla Sticchi, Marco Casaccia
Perianal fistula is a very debilitating event and a cause of morbidity in patients with Crohn's disease (CD). Its malignant transformation is very rare with an incidence of around 0.004-0.7$. Presence of disease in the colon and rectum is the major risk factor for the development of a perianal fistula. In this report we show a case of adenocarcinoma arising from a perianal fistulizing CD. This type of tumor is highly aggressive, difficult to diagnose, and has a rather poor prognosis. The different neoplastic transformations and the different types of tumors that may appear in patients with CD, especially at the colorectal level or at the level of an eventual anastomosis, are to date well documented and described in the literature, while there is a lack of information and of treated cases concerning the occurrence of cancer at the level of a fistula...
May 2018: Case Reports in Gastroenterology
Naruhiro Kimura, Atsunori Tsuchiya, Akihiro Nakamura, Muneatsu Ueda, Seiichi Yoshikawa, Takahiro Hoshi, Akito Takano, Satoshi Takagi, Tsutomu Miura, Satoshi Yamada, Masahiko Yanagi, Tatsuo Tani, Hiroyuki Hirahara
A 52-year-old man was admitted due to severe epigastric lesion pain. Esophagus gastroduodenal endoscopy showed impaired duodenal dilatation, and contrast-enhanced computed tomography revealed a pancreaticoduodenal artery (PDA) aneurysm 13 mm in diameter below the head of the pancreas, retroperitoneal hematoma, idiopathic celiac artery (CA) dissection, and common hepatic artery disruption. Angiographic embolization with a mixture of N-butyl-1,2-cyanoacrylate and lipiodol was performed, and follow-up study showed improvement of the dilatation of the duodenum and disappearance of the aneurysm...
May 2018: Case Reports in Gastroenterology
Rafeeq Ahmed, Kishore Kumar, Jasbir Makker, Masooma Niazi, Bhavna Balar
Mantle cell lymphoma is a rare and aggressive subtype of B-cell non-Hodgkin lymphomas. Mantle cell lymphoma frequently involves extranodal sites, and gastrointestinal tract is involved microscopically and macroscopically in more than 80$ of cases. We present two cases of recurrent mantle cell lymphoma presenting with lower and upper gastrointestinal bleeding, respectively. A 58-year-old woman with a history of recurrent mantle cell lymphoma treated with chemotherapy and stem cell transplantation presented with left-sided abdominal pain and hematochezia...
May 2018: Case Reports in Gastroenterology
Jamil Shah, Abul Shahidullah
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...
May 2018: Case Reports in Gastroenterology
James E Heubi, Kenneth D R Setchell, Kevin E Bove
Zellweger spectrum disorders (ZSDs), a subgroup of peroxisomal biogenesis disorders, have a generalized defect in peroxisome function. Liver disease in ZSDs has been linked to accumulation of C27 -bile acid intermediates due to the lack of peroxisomal β-oxidation of these intermediates to form primary C24 -bile acids. Oral treatment with primary bile acid, cholic acid (CA), inhibits formation of hepatotoxic C27 -bile acids by restoring normal physiologic feedback inhibition on bile acid synthesis. 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...
May 2018: Case Reports in Gastroenterology
Natascha Roehlen, Richard F Knoop, Katharina Laubner, Jochen Seufert, Henning Schwacha, Robert Thimme, Andreas Fischer
Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a well-established, minimally invasive interventional treatment for nonresectable hepatocellular carcinoma (HCC). Generally, TACE is regarded as safe and effective with a low complication rate. However, remote gastrointestinal ischemia due to the carryover of embolic material into visceral arteries is a rare but serious complication of TACE. 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...
May 2018: Case Reports in Gastroenterology
Annalisa Pasetti, Elvira Capoferro, Giulia Querzoli, Renzo Montanari, Paolo Bocus
Brunner's gland hamartoma (BGH) is an uncommon benign tumor arising from alkaline-based mucin-secreting glands of the duodenum. These lesions are typically discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics, even though they can eventually lead (in the case of increasing size) to obstructive or hemorrhagic symptoms. 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 from the anterior wall of the duodenal bulb...
May 2018: Case Reports in Gastroenterology
Katsuji Sawai, Takanori Goi, Yumi Takegawa, Yoshihiko Ozaki, Seiichi Taguchi, Hidetaka Kurebayashi, Hiroyuki Suto
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...
May 2018: Case Reports in Gastroenterology
Constantine Melitas, Mick Meiselman
Obesity, insulin resistance, and metabolic syndrome continue to increase in prevalence. Hypertriglyceridemia is commonly associated and represents a valuable marker of metabolic syndrome. An increase in subcutaneous fat deposition places patients at risk for visceral adipose deposition in sites such as the liver, heart, and pancreas. Pancreatic steatosis in the setting of metabolic syndrome is a rapidly emerging entity whose clinical spectrum remains to be defined. Hypertriglyceridemia is an accepted cause of acute pancreatitis but its role in chronic pancreatic injury remains to be explored...
May 2018: Case Reports in Gastroenterology
Bruce J Grattan, Tracy Bennett, Michael R Starks
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.
May 2018: Case Reports in Gastroenterology
Antonio Meštrović, Ivan Žaja, Žarko Ardalić, Pavle Vrebalov-Cindro, Ivan Šustić, Marko Puljiz, Andre Bratanić, Damir Bonacin
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 case of a young woman with exacerbation of previously diagnosed mild UC complicated by multiple thrombotic incidents due to MTHFR gene mutation.
May 2018: Case Reports in Gastroenterology
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