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Clinical Journal of Gastroenterology

Tomoya Iida, Daisuke Hirayama, Gota Sudo, Kei Mitsuhashi, Hisayoshi Igarashi, Kentaro Yamashita, Hiroo Yamano, Hiroshi Nakase
A 59-year-old woman presented to our hospital with a 6-month history of nausea, weight loss, and abdominal distension. Physical examination revealed abdominal distension without tenderness, and edema, numbness, and multiple peripheral neuropathy in the limbs. Blood test results showed anemia, hypoproteinemia, and hypoalbuminemia. Immunoelectrophoresis detected kappa-type Bence-Jones protein in both the serum and urine. Bone marrow examination did not reveal an increase of plasma cells. Computed tomography showed intestinal distension and retention of intestinal contents...
September 19, 2018: Clinical Journal of Gastroenterology
Jing Liu, Ge Bai, Jianxing Qiu, Yan Chi, Xiaoyu Hu, Yong Huang, Xiaoying Wang, Huahong Wang
A young patient had serious hematochezia for nearly 2 months without obvious cause. Abdominal CT images showed rare features such as serious hemorrhage and multiple miliary nodules in the small bowel. The colonoscopy showed multiple lymphoid follicles in the terminal ileum. The laparotomy showed adverse adhesion in the abdominal cavity and multiple miliary noduli in the surfaces of small bowel wall. The pathology suggested tuberculosis. This patient received anti-TB therapy and the condition improved gradually...
September 19, 2018: Clinical Journal of Gastroenterology
Rie Kure, Natsumi Uehara, Kazuaki Inoue, Tomomi Kogiso, Kazuhisa Kodama, Makiko Taniai, Katsutoshi Tokushige, Masayuki Nakano, Hiroto Egawa, Masakazu Yamamoto
Here, we describe a 42-year-old male patient with late-onset hepatic failure (LOHF) due to acute-onset autoimmune hepatitis. At first, his response to steroid therapy was good, but hepatitis relapsed during steroid pulse therapy. Deterioration of liver function caused LOHF, and LOHF has a poor prognosis, particularly when it is complicated by infection. Systemic infection by Staphylococcus aureus resulted in a skin rash and septic pulmonary embolism, and is an absolute contraindication for liver transplantation (LT)...
September 14, 2018: Clinical Journal of Gastroenterology
Naohito Uchida, Yuko Bando, Sae Hamaya, Yukiko Koyama, Kazuhiro Kozuka, Rie Kawakita, Yuki Sawada, Akihiko Tatemoto, Toshiaki Nakatsu
In all endoscopic ultrasound (EUS) examinations performed at our hospital, the heart, vasculature, and mediastinal lymph nodes from the esophagus are observed after checking for gastrointestinal pathologies. Since the introduction of EUS using a convex linear-array echoendoscope at our hospital in April 2015, EUS examinations have been performed in 371 cases for examining pancreaticobiliary diseases, submucosal tumors, and other pathologies during the 3-year period, till March 2018. We diagnosed 2 patients with asymptomatic cardiovascular disease while observing the mediastinum during EUS examination to examine identified pancreaticobiliary disease...
September 12, 2018: Clinical Journal of Gastroenterology
Rika Satoyoshi, Osamu Muto, Akio Masuda, Kei Kotanagi, Takuya Kichiraku, Kazuhiro Kudoh, Toshiya Sawada, Hideaki Miyazawa, Hitoshi Kotanagi
Immune checkpoint inhibitors may have different clinical effects compared with conventional anticancer drugs. An 85-year-old male received chemotherapy for recurrent gastric cancer. As liver metastasis progressed, nivolumab was introduced as a fourth line treatment. Progression of liver metastasis in size was observed in CT after 3 courses of nivolumab therapy. Nivolumab treatment was discontinued, because the general condition of the patient also worsened. However, his general condition improved as hepatobiliary enzyme levels, inflammatory response, and tumor markers improved...
September 11, 2018: Clinical Journal of Gastroenterology
Gabriele Dragoni, Marco Le Grazie, Beatrice Orlandini, Francesca Rogai
Golimumab is the third anti-TNF agent approved for the treatment of ulcerative colitis. Despite initial success demonstrated by PURSUIT trials, only few real-life studies have been published evaluating its efficacy and safety in clinical practice. Its subcutaneous route and monthly administration represent an advantage in patient compliance, respectively, vs infliximab (intravenous) and adalimumab (two doses per month). The most important weakness of the molecule which often leads clinicians to choose another anti-TNF is the impossibility to dose escalate or reduce the frequency of administrations in case of secondary failure; ongoing studies are trying to solve this problem by monitoring drug levels and the eventual presence of neutralizing anti-drug antibodies...
September 11, 2018: Clinical Journal of Gastroenterology
Takuya Seike, Takuya Komura, Yoshiaki Shimizu, Hitoshi Omura, Tatsuo Kumai, Takashi Kagaya, Hajime Ohta, Atsuhiro Kawashima, Kenichi Harada, Shuichi Kaneko, Masashi Unoura
A 60-year-old man with an unruptured cerebral aneurysm and family history of moyamoya disease was admitted to our hospital with epigastric pain since the previous day. Serum levels of pancreatic enzyme were elevated and abdominal contrast-enhanced computed tomography showed localized enlargement of the pancreatic tail in the arterial phase and revealed numerous areas of fine mesh-like vascular hyperplasia consistent with an enlarged pancreatic tail. We diagnosed pancreatic arteriovenous malformation (P-AVM) with acute pancreatitis...
September 4, 2018: Clinical Journal of Gastroenterology
Rodrigo Cañada Surjan, Tiago de Castro Basseres, Otavio Micelli, Eloy Taglieri, Daniel Bauab Puzzo, José Celso Ardengh
Pancreatic fluid collections are common pancreatitis complications that frequently require drainage. Endoscopic ultrasound-guided placement of expandable lumen apposing metallic stents has recently emerged as an effective and less invasive treatment option. It is associated with less morbidity, lower costs, and faster clinical recovery than other therapeutic modalities. Nevertheless, this procedure may result in severe complications such as bleeding, buried stent syndrome, and prosthesis dislodgement (with perforation and peritoneal leakage)...
August 31, 2018: Clinical Journal of Gastroenterology
Umaporn Seehawong, Yoshinori Morita, Yoshiko Nakano, Takehiro Iwasaki, Chonlada Krutsri, Hiroya Sakaguchi, Tomoya Sako, Toshitatsu Takao, Shinwa Tanaka, Takashi Toyonaga, Eiji Umegaki, Yuzo Kodama
A 74-year-old female, who was diagnosed with superficial esophageal cancer, underwent endoscopic submucosal dissection (ESD) at another hospital, but a perforation occurred during the procedure. The perforation was closed with endoscopic clips, and the ESD was halted. The patient was referred to our hospital, and ESD was retried. There was severe fibrosis around the lesion, and injections into the submucosal layer were difficult. In addition, it was not possible to identify the submucosal layer, and making an oral-side incision caused a large perforation along the incision line...
August 31, 2018: Clinical Journal of Gastroenterology
Kazuhiro Tange, Tomoyuki Yokota, Kotaro Sunago, Michiko Aono, Hironori Ochi, Shunji Takechi, Toshie Mashiba, Akira Iino Hida, Yumi Oshiro, Kouji Joko, Teru Kumagi, Yoichi Hiasa
We experienced a rare case of acute pancreatitis caused by Candida infection. A 52-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Blood tests revealed high amylase and hepatobiliary enzyme abnormalities, and the patient was hospitalized for acute pancreatitis. Abdominal computed tomography showed a 15-mm space-occupying lesion at the parenchyma of the pancreatic head. Endoscopic retrograde cholangiopancreatography was performed after conservative treatment, which revealed a cystic lesion with a suspected solid component inside involving both lower bile duct and pancreatic duct...
August 28, 2018: Clinical Journal of Gastroenterology
Michelle Maggie Shnayder, Prasoon Mohan
Bleeding from the pancreatic duct is a rare source of gastrointestinal hemorrhage and is referred to as hemosuccus pancreaticus. Often a result of pseudoaneurysm formation from chronic pancreatitis, hemosuccus pancreaticus is a difficult diagnosis due to its peculiar clinical presentation. This is a case of a 51-year-old male with a history of chronic pancreatitis, who initially presented with a pancreatic mass found on CT scan. The mass was found to be inconclusive for malignancy on endoscopic ultrasound-guided fine needle aspiration...
August 28, 2018: Clinical Journal of Gastroenterology
Nobuhiro Ando, Keisuke Iwata, Kenji Yamazaki, Shogo Shimizu, Junichi Sugihara, Masaki Katayama, Hitoshi Iwata, Takuji Iwashita, Masahito Shimizu
This report describes a case of liver hilar tuberculous lymphadenitis complicated by biliary stricture, diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). A 44-year-old woman was referred to our center for further evaluation of abnormal liver function tests. Abdominal ultrasound/contrast-enhanced computed tomography (CT) revealed a 15-mm hypovascular mass with a weakly enhanced margin at the liver hilum. Magnetic resonance cholangiopancreatography revealed dilatation of the intrahepatic bile ducts in the left lobe of liver and gradual narrowing of the left hepatic duct...
August 25, 2018: Clinical Journal of Gastroenterology
David Wen, Elena Collantes, Bruno Sgromo
A 62-year-old female patient diagnosed with oesophageal adenocarcinoma underwent radical treatment consisting of neoadjuvant chemotherapy and oesophagectomy with no major complications. Eleven months later, she re-presented with a mass at one of the chest drain sites. A PET-CT scan and biopsy demonstrated this to be a single recurrence of the oesophageal adenocarcinoma. Excision of the metastatic lesion was considered as per metachronous single site metastasis. However, the operation was postponed due to acute kidney injury...
August 25, 2018: Clinical Journal of Gastroenterology
Michael McFarlane, Ayesha Azam, David Snead, Ben Disney
Pemphigus vulgaris (PV) is a rare autoimmune bullous disease which affects the skin and mucous membranes. Oesophageal involvement is rare and has previously been limited to case reports and case series. A recent large case series of 477 PV patients showed that 26/477 (5.4%) had symptomatic oesophageal involvement. We present the case of a 54-year-old Somalian lady with a 10-year history of cutaneous PV, currently in remission, who developed dysphagia and odynophagia and was subsequently found to have oesophageal PV involvement with multiple flaccid bullae which were positive for anti-DSG3 antibodies on in-direct immunofluorescence...
August 23, 2018: Clinical Journal of Gastroenterology
Yosuke Murata, Katsushi Hiramatsu, Yumi Yoshida, Yu Akazawa, Yasushi Saito, Takuto Nosaka, Yoshihiko Ozaki, Ryoko Hayama, Kazuto Takahashi, Tatsushi Naito, Kazuya Ofuji, Hidetaka Matsuda, Masahiro Ohtani, Tomoyuki Nemoto, Yasunari Nakamoto
Owing to effective treatments and sanitary improvements, the incidence of latent tuberculosis infection (LTBI) has decreased. However, approximately one-quarter of the world's population is thought to have LTBI, and the reactivation of tuberculosis (TB) sometimes occurs in immunocompromised hosts. A 54-year-old man presented with a fever. The patient had past histories of alcoholic and hepatitis C virus-related cirrhosis and hepatocellular carcinoma (HCC). He was treated with drug-eluting beads transarterial chemoembolization (DEB-TACE) for HCC three times, beginning 10 months before his current visit...
August 23, 2018: Clinical Journal of Gastroenterology
Takanori Ito, Masatoshi Ishigami, Yoji Ishizu, Teiji Kuzuya, Takashi Honda, Masaya Matsushima, Taichi Kato, Yoshiki Hirooka
Major aortopulmonary collateral arteries (MAPCAs) are unique vessels associated with hypoxia induced by congenital heart disease (CHD). Although MAPCAs are essential to supply blood to the lungs, their development and proliferation can induce life-threatening complications, such as rupture into the lung. Here, we describe a rare case of esophageal bleeding from MAPCAs in a CHD patient, which was successfully treated by transcatheter arterial embolization (TAE). A 16-year-old male with CHD experienced a hematemesis and melena after the Bentall procedure to treat valvular heart disease...
August 21, 2018: Clinical Journal of Gastroenterology
Shuhei Ishiyama, Junji Shiode, Masao Yoshioka, Junichirou Nasu, Akiko Fujiwara, Mamoru Itoh, Masakuni Fujii, Shusuke Saitoh, Mitsuhiro Kanetoh, Hisanori Oka
Rectal varices are ectopic varices that occur in patients with portal hypertension and cause abrupt gastrointestinal bleeding. Endoscopic variceal ligation is a minimally invasive treatment used for patients with bleeding from rectal varices. Endoscopic treatment of colorectal tumors accompanied by rectal varices has been rarely reported. It is very important to control bleeding during treatment. The patient was a 76-year-old man who had a chief complaint of bloody stools. A flat-elevated-type neoplastic lesion measuring about 20 mm was found above the rectal varices...
August 14, 2018: Clinical Journal of Gastroenterology
Takeshi Urade, Shigeteru Oka, Shinya Iimori, Mariko Man-I, Tomoki Abe, Hidehiro Sawa, Yoshiteru Iwatani, Yukiko Morinaga, Daisuke Kuroda
Gallbladder metastasis from breast cancer, especially from ductal carcinoma, is rare. Herein, we report a rare case of gallbladder metastasis from ductal carcinoma of the breast that was diagnosed after laparoscopic cholecystectomy (LC) for acute cholecystitis. A 78-year-old woman presented with right upper abdominal tenderness and positive Murphy's sign during chemotherapy for advanced multiple metastases of the breast cancer. Abdominal ultrasonography and computed tomography showed a slightly thickened gallbladder wall and two calculi...
August 14, 2018: Clinical Journal of Gastroenterology
Helena Moreira Silva, Gisela Silva, Emília Costa, Rosa Lima, Fernando Pereira
We describe the case of a previously healthy 8-year-old girl presenting with a 1-year history of iron deficiency anemia. There was no report of hematemesis, abdominal pain or melena. Laboratory work-up excluded iron malabsorption as the underlying cause. Therefore, endoscopic evaluation was performed to exclude gastrointestinal blood loss, which revealed the presence of a 7 mm reddish lesion located within the ampulla of Vater. Capsule endoscopy excluded alternative diagnoses and concomitant lesions. Histopathological examination confirmed the diagnosis of pyogenic granuloma...
August 9, 2018: Clinical Journal of Gastroenterology
Tomomasa Tochio, Katsumi Mukai, Youichirou Baba, Hiroki Asakawa, Kenji Nose, Satomi Tsuruga, Hiroaki Kumazawa, Yoshiaki Isono, Hiroki Tanaka, Shimpei Matsusaki, Tomohiro Sase, Tomonori Saito, Hiroshi Okano, Miki Usui, Gen Watanabe
Primary clear cell adenocarcinoma (CCA) of the colorectum is a rare tumor. We report on a 48-year-old man with early stage CCA in the descending colon who underwent detailed examination with image-enhanced endoscopy, such as magnifying endoscopy with narrow-band imaging and crystal violet staining. The tumor was treated successfully with endoscopic mucosal resection at our hospital.
July 30, 2018: Clinical Journal of Gastroenterology
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