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Case Reports in Gastroenterology

Gorana Gasljevic, Nina Boc, Erik Brecelj, Jasna But Hadzic, Marko Klancic, Jernej Mlakar
Endoscopic colorectal tattooing with carbon-based dyes is commonly employed in order to assist with later localization of the lesion. Although carbon is thought to be nontoxic, there usually is some inflammatory reaction with fibrosis and granuloma formation after tissue injection. The aim of this report is to alert to a possible underestimated, late consequence of colorectal carbon-based marker tattooing, namely pronounced fibrosis at the site of the injection that could lead to a blurring and misinterpretation of changes evaluated by radiological techniques...
September 2018: Case Reports in Gastroenterology
Filip De Maeyer, Bruno Lapauw, Anne Hoorens, Anja Geerts, Hans Van Vlierberghe, Xavier Verhelst
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...
September 2018: Case Reports in Gastroenterology
Takahiro Amano, Shiro Hayashi, Tsutomu Nishida, Tokuhiro Matsubara, Kei Takahashi, Dai Nakamatsu, Yoshito Tomimaru, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Hiromi Tamura, Shiro Adachi, Keizo Dono, Masami Inada
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...
September 2018: Case Reports in Gastroenterology
Masahiro Yura, Tsunehiro Takahashi, Kazumasa Fukuda, Rieko Nakamura, Norihito Wada, Junichi Fukada, Hirofumi Kawakubo, Hiroya Takeuchi, Naoyuki Shigematsu, Yuko Kitagawa
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 para-aortic LNs were detected...
September 2018: Case Reports in Gastroenterology
Jeffrey Sun, Cheuk-Kwan Sun, Cheuk-Kay Sun
Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis...
September 2018: Case Reports in Gastroenterology
Chukwunonso Chime, Ahmed Alemam, Kishore Kumar, Manjeet Dhallu
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 presented with delayed fever and ileus, making early diagnosis difficult...
September 2018: Case Reports in Gastroenterology
Bertha E García-Ramírez, Carlos M Nuño-Guzmán, Ricardo E Zaragoza-Carrillo, Hugo Salado-Rentería, Audrey Gómez-Abarca, Jorge L Corona
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...
September 2018: Case Reports in Gastroenterology
Marijana Rincic Antulov, Runar B Båtevik
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...
September 2018: Case Reports in Gastroenterology
Toshio Arai, Kazutoyo Kogi, Yuki Honda, Takao Suzuki, Koji Kawai, Masako Okamoto, Takahiro Fujioka, Nobuhiro Murata
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...
May 2018: Case Reports in Gastroenterology
Hiromichi Maeda, Ken Okamoto, Tsutomu Namikawa, Mai Shiga, Kazune Fujisawa, Michiko Tadokoro, Kazuhiro Hanazaki, Michiya Kobayashi
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...
May 2018: Case Reports in Gastroenterology
Maria Angeles Gil-Delgado, Olivier Lucidarme, Jean Baptiste Bachet, Naima Mahi, David Khayat
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...
May 2018: Case Reports in Gastroenterology
Anning Yin, Zhi Zeng, Xinyue Wan, Honggang Yu, Liang Zhao
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...
May 2018: Case Reports in Gastroenterology
Avantika Mishra, Darren N Seril
Biological agents are frequently used in the management of inflammatory bowel disease, and it is important to understand the potential adverse effects of these therapies. Ustekinumab is a human monoclonal antibody that interferes with interleukin-12 and -23 cytokine signaling and is approved for the treatment of moderate to severe 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...
May 2018: Case Reports in Gastroenterology
Bodil Ohlsson
[This corrects the article DOI: 10.1159/000486390.].
May 2018: Case Reports in Gastroenterology
Veit Phillip, Rickmer Braren, Nikolaus Lukas, Roland M Schmid, Fabian Geisler
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...
May 2018: Case Reports in Gastroenterology
Tomohiko Taniai, Koichiro Haruki, Hiroaki Shiba, Shinji Onda, Taro Sakamoto, Katsuhiko Yanaga
Simultaneous resection of synchronous hepatocellular carcinoma (HCC) and pancreatic ductal adenocarcinoma (PDAC) is extremely rare. Case 1 is a 64-year-old woman, who had undergone anterior resection for rectal cancer 3 years earlier was pointed out to have a cystic tumor in the pancreatic tail and a solitary tumor in the liver. CT revealed a hypovascular tumor in the pancreatic tail and a liver tumor with early enhancement. With a diagnosis of simultaneous HCC and PDAC, she underwent laparotomy, in which intraoperative frozen section examination of the liver was compatible with HCC...
May 2018: Case Reports in Gastroenterology
Alexander A Smirnov, Aleksandr N Burakov, Aleksandr N Shvetsov, Egor V Blinov, Kirill D Semenikhin, Nadezhda V Konkina, Sergey Y Dvoreckij
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 leiomyoma...
May 2018: Case Reports in Gastroenterology
Yuichi Honma, Kazuhiro Sumida, Noriyoshi Ogino, Masashi Kusanaga, Sota Minami, Shinsuke Kumei, Hidehiko Matsuoka, Tatsuyuki Watanabe, Masaaki Hiura, Shintaro Abe, Michihiko Shibata, Masaru Harada
Obesity is a major contributor to insulin resistance and nonalcoholic fatty liver disease, which is the most common cause of chronic liver diseases. Nonalcoholic steatohepatitis (NASH) can progress to liver cirrhosis and end-stage liver diseases. Some cases already show severe liver fibrosis at the time of diagnosis. 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...
May 2018: Case Reports in Gastroenterology
Yoshifumi Morita, Takanori Sakaguchi, Ryo Kitajima, Satoru Furuhashi, Ryota Kiuchi, Makoto Takeda, Takanori Hiraide, Yasushi Shibasaki, Hirotoshi Kikuchi, Yuji Suzuki, Kei Tsukamoto, Tomoharu Matsuura, Hiroya Takeuchi
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 hemorrhagic shock...
May 2018: Case Reports in Gastroenterology
Yukie Sunata, Hideki Mori, Yuichiro Hirai, Yoko Kubosawa, Shigeo Banno, Satoshi Kinoshita, Yoshihiro Nakazato, Toshihiro Nishizawa, Masahiro Kikuchi, Toshio Uraoka
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.
May 2018: Case Reports in Gastroenterology
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