Japanese Journal of Gastroenterology最新文献

This case concerns a 39-year-old male with a history of adjustment disorder, and he had been using Ashwagandha-self-prescribed and self-imported online-for stress relief and vitality enhancement for the past 3 months. He visited the emergency department with symptoms of hyperventilation, and blood tests showed total bilirubin of 2.37mg/dL, ALT of 384U/L, and ALP of 92U/L, indicating hepatocellular-type liver dysfunction, thereby raising suspicion for drug-induced liver injury (DILI). Although ursodeoxycholic acid was initiated after referring to our hospital, his condition showed minimal improvement. A liver biopsy showed no infiltration of inflammatory cells, no dilation of the bile ducts, and no bile plugs, ruling out bile outflow obstruction. However, bilirubin deposition within hepatocytes and hepatocellular degeneration were noted. With a suspected defect in the hepatocellular bile transport, phenobarbital was started, resulting in rapid improvement of jaundice. Reports of DILI caused by Ashwagandha are rare, and this case exhibited clinical findings and test results different from those previously reported.

This case concerns a woman in her 20s with abdominal pain. Abdominal computed tomography revealed a large hepatic tumor with extensive infiltration of both liver lobes. She developed acute liver failure and was immediately admitted to our hospital. Her condition rapidly deteriorated, progressing to multiple organ failure, leaving insufficient time for comprehensive evaluation. She died 4 days after admission. Autopsy showed marked hepatomegaly due to tumor, with the liver weighing 3400g. Pathological diagnosis was combined hepatocellular-cholangiocarcinoma (cHCC-CCA), a rare primary liver cancer. We report an extremely rare case of cHCC-CCA in a young woman without a history of chronic liver disease.

A 68-year-old woman presented with vomiting and upper abdominal pain. Computed tomography (CT) and endoscopic ultrasound revealed a stone in the peripapillary diverticulum, with biliary dilation due to extrinsic compression, consistent with Lemmel's syndrome. Although the symptoms initially improved, they worsened 2 days later. The CT imaging showed migration of the diverticular stone to the small intestine portion corresponding to pelvic region, resulting in bowel obstruction. The patient underwent laparoscopic stone removal and had a smooth recovery. This report presents a rare case of bowel obstruction caused by migration of a stone originating from a duodenal peripapillary diverticulum, with detailed follow-up of the clinical course.

A 65-year-old woman was diagnosed with hepatocellular carcinoma (HCC) in February 20XX-1. Following three cycles of transarterial chemoembolization (TACE) for recurrent HCC, combination therapy with atezolizumab and bevacizumab (Atezo+Beva) was initiated in February Y, 20XX. Eight days after treatment initiation (Y+8), the patient developed a fever and generalized malaise. By day 14 (Y+14), her symptoms worsened, prompting a visit to her primary physician, where a fever of 39°C was recorded. However, no hypoxemia was observed, and she was sent home. The following day (Y+15), she developed dyspnea and hypoxemia (SpO₂ in the 80% range), and chest computed tomography (CT) revealed a hilar central alveolar infiltration. She was subsequently admitted to her previous hospital. Comprehensive evaluation led to a diagnosis of congestive heart failure associated with thyrotoxicosis. According to the IMbrave150 study, thyroid dysfunction occurs in 13.4% of patients receiving Atezo+Beva therapy;however, cases classified as Common Terminology Criteria for Adverse Events Grade 3 or higher, requiring hospitalization, are extremely rare, with an incidence of only 0.3%.