Japanese Journal of Gastroenterology最新文献

A 67-year-old female patient, with a chief complaint of melena, was referred to our hospital because of a pancreatic tumor. A blood assessment revealed anemia with a hemoglobin (Hb) level of 7.7g/dL. Contrast-enhanced computed tomography (CT) detected a large pancreatic tail tumor and liver metastasis. Upper endoscopy demonstrated bile juice containing a blood-like red in the duodenum. We confirmed the pancreatic cancer diagnosis via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). CT after the procedure indicated a hematoma in the pancreatic tumor. The patient required frequent blood transfusions due to severe anemia. The second upper endoscopy demonstrated bleeding from the papilla of Vater. We diagnosed the patient with hemosuccus pancreaticus (HP). Pancreatic cancer, not hematoma, was considered to cause HP because we detected blood, such as red bile juice, before EUS-FNA. Her Hb levels decreased although she underwent coil embolization of the left gastric artery and splenic artery branches. We considered surgical treatment to stop the bleeding, but we abandoned surgery because of the pancreatic cancer invasion of the surrounding organs. We then attempted radiation therapy. Her Hb level stopped decreasing following treatment. She did not need frequent blood transfusions until she received radiation therapy and died 3 months later. The autopsy revealed a final diagnosis of anaplastic carcinoma. HP is an uncommon disease caused by bleeding from the papilla of Vater. HP is frequently caused by chronic pancreatitis, but it is also induced by a pancreatic tumor. Most HP cases received interventional radiology and surgical treatment. Here, we describe a case of HP caused by pancreatic cancer in which radiation therapy was effective for hemostasis.

This case report describes Crohn's disease complicated by squamous cell carcinoma in an enterocutaneous fistula. A 48-year-old male patient was diagnosed with Crohn's disease 24 years ago and has undergone five surgical operations. An enterocutaneous fistula originated from the midline abdominal wound 11 years after the onset. Azathioprine was initiated instead of surgery due to frequent recurrence of the fistula and his short residual small intestine (approximately 170cm). We followed him every 3 months and continued prescribing azathioprine as his fistula secretions decreased and became manageable. He noticed a mass at the same site 13 years after the appearance of the enterocutaneous fistula which was diagnosed as squamous cell carcinoma through biopsy. The tumor was markedly reduced after preoperative chemoradiotherapy. We resected the affected intestinal tract and abdominal wall associated with the enterocutaneous fistula, and he acheived a pathological complete response. Squamous cell carcinoma originating from an enterocutaneous fistula in Crohn's disease is rare;however, long-standing inflammatory lesions should be carefully monitored for carcinogenesis.

Atezolizumab and bevacizumab combination therapy was initiated in a 71-year-old female patient with unresectable hepatocellular carcinoma. Severe anemia, which was managed with blood transfusion and demonstrated improvement, was observed after the treatment. However, anemia subsequently reoccurred, accompanied by signs of hemolysis. The condition was diagnosed as autoimmune hemolytic anemia due to atezolizumab. Steroid therapy exhibited improvement, and second-line treatment with lenvatinib was successfully initiated. The possibility of autoimmune hemolytic anemia should be considered when anemia is observed during immunotherapy for hepatocellular carcinoma.