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Multimodal Treatment of a Spontaneously Ruptured Echinococcus Cyst of the Spleen and Its Complications.
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-20 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/6657981
Sévérine De Bruijn, Annick De Weerdt, Glenn Broeckx, Maarten Spinhoven, Rudi De Paep, Dominique Robert, Niels Komen, Philippe G Jorens

Introduction: Cystic echinococcosis, also known as hydatid cyst, is a parasitic infection of mammals that can affect any organ. Although the diagnosis of primary splenic echinococcosis is challenging, especially in nonendemic areas, it can be life-saving because an anaphylactic shock may occur when the cyst ruptures. Recommendations regarding optimal treatment options after rupture are scarce, and the overall prognosis remains poor. Case Presentation: A patient with a spontaneous rupture of an isolated splenic hydatid cyst was treated with splenectomy and peritoneal lavage with a hypertonic salt solution. The patient survived despite rapidly progressive hypernatremia, which was treated with conventional therapy along with continuous venovenous hemofiltration with gradient sodium replacement. Discussion: When the decision is made to treat a patient with a spontaneously ruptured splenic echinococcus cyst, splenectomy is the only surgical option. Hypernatremia is a complication to be expected when hypertonic saline is used to rinse the splenic and abdominal cavities. Conclusion: This case highlights the importance of prompt surgical intervention and the management of hypernatremia in patients with ruptured splenic hydatid cysts.

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引用次数: 0
Splenic Artery Embolization for Upper Gastrointestinal Bleeding Caused by Hemosuccus Pancreaticus.
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-20 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/6149221
Evghenii Gutu, Dumitru Casian, Roman Smolnitchi, Vasile Culiuc, Andrei Scureac

Hemosuccus pancreaticus (HP) is a rare but potentially life-threatening condition, characterized by upper gastrointestinal bleeding from the ampulla of Vater, often originating from a ruptured pseudoaneurysm of the peripancreatic arteries. Despite its rarity, HP presents a diagnostic and therapeutic challenge due to its elusive clinical presentation and complex underlying pathophysiology. In this case report, we presented a compelling instance of HP, diagnosed in a 48-year-old man, complicated with gastrointestinal bleeding and severe anemia successfully managed with urgent endovascular intervention. We highlighted the importance of early recognition, prompt intervention, and interdisciplinary collaboration in achieving favorable outcomes in patients afflicted by this distinctly unusual condition.

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引用次数: 0
Incidentally Discovered Duodenal Gastrointestinal Stromal Tumour (GIST): Operative Treatment and Problems After Surgery-A Case Report and Literature Review.
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-14 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/5493240
Peter Lüthje, Ilona Nurmi-Lüthje

Background: Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of the digestive tract that can involve any part of the tract. The tumours can be harmless or life-threatening. Materials and Methods: A case report of a surgeon who fell in a Finnish sauna, and he immediately felt that some ribs were broken. Magnetic resonance imaging and ultrasound showed three fractured ribs and an intrasplenic haematoma. Contrast-enhanced computed tomography (CT) demonstrated a small intrasplenic anomaly but no haematoma. Incidentally, an incidentaloma in the left adrenal gland was diagnosed. Three months later, a control CT scan was performed. The radiological findings on the adrenal gland and laboratory examinations matched those of a benign adenoma. Incidentally, a small duodenal tumour was diagnosed. At the same time, anaemia (haemoglobin: 104 g/L) and iron deficiency (ferritin: 8 μg/L) were noticed. An esophagogastroduodenoscopy showed an intramural tumour localised after the bulb-descending junction. Because the tumour was submucosal, the pathological diagnosis failed. Three months later, a radical surgical resection of the tumour with a resection margin of 2 mm and primary closing of the duodenum was performed. Pathological examination showed a well-circumscribed submucosal mesenchymal tumour with spindle cells. A tumour-free margin was uncertain. Immunohistochemistry findings showed a GIST. Due to the uncertain margin, an esophagogastroduodenoscopy control was planned at 2 years postoperatively. The patient disagreed with the decision and ordered a private control CT 3 months after the operation. The new CT found no local recurrence or metastasis. The patient contacted the head surgeon of the clinic, who ordered a 1-year postoperative CT. The 1-year follow-up CT finding agreed with the previous findings. Conclusion: The aftertreatment of a radical-operated GIST is extremely important if histologic examination of the tumour-free margin is uncertain. In that case, CT controls should be considered once a year for at least 3 years.

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引用次数: 0
Disseminated Chickenpox Following Live Varicella Vaccination in a Crohn's Disease Patient on Combination Immunosuppression.
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-20 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/6088333
Quintin Solano, Sarah Uttal, Peter D R Higgins, Jeffrey A Berinstein

Novel therapeutics used in the treatment of inflammatory bowel disease pose an increased risk of viral reactivation in patients. We present a case of a patient with refractory Crohn's disease (CD) who developed primary varicella (chickenpox) of a vaccine-viral strain after receiving combination immunosuppression with high-dose corticosteroids, tumor necrosis factor inhibitor (TNFi), and a Janus kinase inhibitor (JAKi) in the hospital. While this patient recovered and did not experience long term adverse effects, her case provides an opportunity for improvement. To improve safety, healthcare facilities should develop protocols that use electronic medical records enhanced with clinical decision support systems to identify and protect immunocompromised patients from inappropriate live vaccinations.

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引用次数: 0
Typhoid Fever as a Cause of Liver Failure in the United States: A Case Report. 伤寒作为肝衰竭的原因在美国:一个病例报告。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/3087201
Syed Mujtaba Baqir, Neha Sharma, Aruge Lutaf, Monica Ghitan, Yu Shia Lin

Background: Typhoid fever is a multisystemic illness caused by Salmonella typhi and Salmonella paratyphi, transmitted fecal orally through contaminated water and food. It is a rare diagnosis in the US, with most cases reported in returning travelers. Hepatitis and cholestasis are rare sequelae of salmonella infection. However, acute liver failure (ALF) is exceptionally uncommon. We report a case of typhoid fever in a returning traveler to the US progressing to ALF. Case Presentation: A 48-year-old man presented with high-grade fever, abdominal pain, vomiting, acholic stools, dark urine, and yellowish discoloration of skin and sclera for one week. He was immune to hepatitis A and B, with no recent change in medications. He had no history of alcohol consumption. On presentation, the patient was tachycardic but well perfused with diffuse abdominal tenderness. Laboratory results showed leukocytosis, elevated creatinine, mixed hepatocellular and cholestatic pattern of raised liver enzymes, elevated ammonia levels, and negative hemolytic parameters. Viral, autoimmune, and metabolic causes of hepatitis were negative. Ultrasound of the abdomen revealed a normal biliary system and a computerized tomography (CT) scan of the abdomen showed multiple liver cysts, mesenteric and porta-hepatis lymphadenopathy, and mild thickening of the terminal ileum. Intravenous (IV) ceftriaxone and metronidazole were initiated. Blood cultures grew S. typhi. The patient clinically deteriorated and developed altered mental status, respiratory distress, and an up-trending Model for End-Stage Liver Disease (MELD) score and was upgraded to the intensive care unit. IV meropenem was initiated, resulting in clinical recovery and negative repeat blood cultures. The patient completed 2 weeks of meropenem and was discharged. Conclusion: Typhoid fever can cause life-threatening liver failure which is rare. Clinicians should be aware of this due to the rapid progression and life-threatening clinical course, as well as the rise of multidrug-resistant and extensively drug-resistant typhoid causing delays in starting the right antibiotic.

背景:伤寒是一种由伤寒沙门菌和副伤寒沙门菌引起的多系统疾病,可通过受污染的水和食物经粪便经口传播。在美国,这是一种罕见的诊断,大多数病例报告发生在返回的旅行者身上。肝炎和胆汁淤积是沙门氏菌感染的罕见后遗症。然而,急性肝衰竭(ALF)是非常罕见的。我们报告一例伤寒在返回旅行者到美国进展到ALF。病例介绍:一名48岁男性,表现为高热、腹痛、呕吐、胆汁性便、尿色深、皮肤和巩膜变黄,持续一周。他对甲型和乙型肝炎有免疫力,近期用药也没有变化。他没有饮酒史。就诊时,患者心动过速,但血流灌注良好,伴有弥漫性腹部压痛。实验室结果显示白细胞增多,肌酐升高,肝酶升高的混合肝细胞和胆汁淤积模式,氨水平升高,溶血参数阴性。病毒性、自身免疫性和代谢性肝炎均为阴性。腹部超声显示胆道系统正常,腹部CT显示多发肝囊肿,肠系膜及肝门淋巴结病变,回肠末端轻度增厚。开始静脉注射头孢曲松和甲硝唑。血液培养培养出伤寒沙门氏菌。患者临床病情恶化,出现精神状态改变、呼吸窘迫,终末期肝病(MELD)评分呈上升趋势,并被升级至重症监护病房。开始静脉滴注美罗培南,临床恢复,重复血培养阴性。患者完成2周美罗培南治疗后出院。结论:伤寒可引起危及生命的肝功能衰竭,但罕见。临床医生应该意识到这一点,因为它的进展迅速,临床病程危及生命,而且耐多药和广泛耐药伤寒的增加导致开始使用正确抗生素的延误。
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引用次数: 0
A Rare Case of Colorectal Cancer With Delayed Metastasis to the Duodenum. 结直肠癌延迟转移至十二指肠1例。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-13 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/6679555
Ammad Javaid Chaudhary, Abdulmalik Saleem, Muhammad Shahzil, Nosheen Hafeez, Taher Jamali, Brian Ginnebaugh

Colorectal cancer (CRC) continues to be a significant global health issue contributing to a high mortality rate. Despite advancements in treatment, the risk of recurrence remains due to inherent mutations and the rapid turnover of intestinal mucosa. We present an exceptionally rare case of CRC metastasis to the duodenum in a 42-year-old female who has been compliant with postsurgical surveillance. Despite previous negative surveillance results, elevated CEA levels and a 3-cm mesenteric mass were detected, raising concerns for carcinoma, which was later confirmed by biopsy. The tumor board deemed her ineligible for surgery due to vascular involvement, leading to palliative care and an attempt at neoadjuvant therapy. Vigilant monitoring is crucial for early detection and intervention.

结直肠癌(CRC)仍然是一个重要的全球健康问题,导致高死亡率。尽管治疗取得了进步,但由于固有的突变和肠黏膜的快速更新,复发的风险仍然存在。我们报告一例罕见的结直肠癌转移至十二指肠的病例,患者为42岁女性,术后随访。尽管之前的监测结果为阴性,但检测到CEA水平升高和3厘米的肠系膜肿块,引起了对癌症的关注,后来通过活检证实了这一点。肿瘤委员会认为她不适合手术,因为血管受累,导致姑息治疗和新辅助治疗的尝试。警惕监测对于早期发现和干预至关重要。
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引用次数: 0
Endoscopic View of the Aorta Through the Oesophagus: An Unusual Complication Post Thoracic Endovascular Aortic Repair. 经食道主动脉的内窥镜观察:胸腔血管内主动脉修复术后的一种罕见并发症。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-10 eCollection Date: 2025-01-01 DOI: 10.1155/crgm/6277906
Kushedison Yunus, Hasib Ahmadzai, Eleanor Noreen Dunlop, Andrew Thomson

We present a case of an 80-year-old female who presented with chest pain, vomiting and night sweats a few weeks post thoracic endovascular aortic aneurysm repair (TEVAR). A computed tomography (CT) scan demonstrated a type 1B endoleak for which she underwent a repeat TEVAR. Postoperatively, she developed fever, dysphagia, haematemesis and melaena. CT angiography subsequently confirmed an aorto-oesophageal fistula (AEF). Gastroscopy was performed to confirm this and found an ovoid oesophageal perforation with visible aortic graft and purulent fluid. Serial endoscopic oesophageal stents were placed and the patient recovered after an oesophageal Ultraflex stent was placed. Unfortunately, however, the patient was found unresponsive at home with black vomitus and in cardiac arrest and passed away 18 months after her initial endoscopic procedure. This case highlights that AEF is a complication following a TEVAR procedure. This can be managed temporarily with oesophageal stent placement and an Ultraflex stent in the longer term. However, oesophageal stent placement is not curative in cases of significant oesophageal perforation as it does not lead to lead to closure of a large defect.

我们报告一例80岁的女性患者,在胸椎血管内动脉瘤修复术(TEVAR)后几周出现胸痛、呕吐和盗汗。计算机断层扫描(CT)显示1B型腔内漏,她接受了重复TEVAR。术后出现发热、吞咽困难、呕血、黑黑等症状。CT血管造影证实主动脉-食管瘘(AEF)。胃镜检查证实了这一点,发现一个卵形食管穿孔,可见主动脉移植和脓性液体。在内镜下放置一系列食管支架,患者在放置食管Ultraflex支架后康复。然而,不幸的是,患者在家中被发现无反应,有黑色呕吐物和心脏骤停,并在首次内窥镜手术18个月后去世。本病例强调AEF是TEVAR手术后的并发症。这可以暂时通过放置食管支架和长期使用Ultraflex支架来解决。然而,食管支架置入术不能治愈严重食管穿孔的病例,因为它不能导致大缺损的闭合。
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引用次数: 0
A Challenging Case of Recurrent Ogilvie Syndrome: Exploring Causes and Treatment Modalities. 一个具有挑战性的病例复发奥吉维综合征:探讨原因和治疗方式。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-14 eCollection Date: 2024-01-01 DOI: 10.1155/crgm/5378390
Ahmad Alnasarat, Mostafa Elrazzaz, Nouraldeen Manasrah

Introduction: Acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is a rare condition marked by significant colon distention without mechanical obstruction. Symptoms include abdominal pain, bloating, nausea, vomiting, and an inability to pass gas or stool. Although common in males over 60, we report a challenging case of a 44-year-old man from Africa with recurrent abdominal distention and discomfort. Ultimately, he improved after receiving multiple treatment modalities, highlighting the complexities of Ogilvie syndrome management. Case Presentation: A 44-year-old Nigerian male in the United States with hypertension and significant alcohol use disorder presented with altered mental status and bilateral lower extremity weakness after fasting and hydrochlorothiazide abuse. Initial diagnostics indicated metabolic encephalopathy from hypokalemia and dehydration. Despite aggressive treatment, he developed severe abdominal distension and obstipation. A CT scan showed diffuse colonic dilatation without a normal small bowel. Conservative measures failed, necessitating ICU transfer, TPN, and empiric antibiotics. Despite an initial response to colonoscopy decompression, the patient experienced recurrence. Neostigmine significantly improved his condition, leading to full recovery and discharge. Conclusion: This challenging case highlights the complexities of managing Ogilvie syndrome and the importance of early identification and a stepwise approach to treatment. Incorporating a patient-centered plan utilizing conservative measures, pharmacological agents and endoscopic interventions are essential for improving outcomes in these cases.

简介:急性结肠假性梗阻(ACPO)或Ogilvie综合征是一种罕见的疾病,其特征是明显的结肠扩张而没有机械阻塞。症状包括腹痛、腹胀、恶心、呕吐、不能排便或排气。虽然常见于60岁以上的男性,但我们报告了一个来自非洲的44岁男性复发性腹胀和不适的挑战性病例。最终,在接受多种治疗方式后,他的病情有所好转,这凸显了奥吉维综合征治疗的复杂性。病例介绍:美国一名44岁尼日利亚男性,患有高血压和明显的酒精使用障碍,在禁食和滥用氢氯噻嗪后出现精神状态改变和双侧下肢无力。初步诊断为低钾血症和脱水引起的代谢性脑病。尽管进行了积极的治疗,他还是出现了严重的腹胀和便秘。CT扫描显示弥漫性结肠扩张,没有正常的小肠。保守措施失败,需要转入ICU, TPN和经验性抗生素。尽管最初对结肠镜减压有反应,但患者经历了复发。新斯的明显著改善了他的病情,使他完全康复出院。结论:这个具有挑战性的病例强调了管理奥吉维综合征的复杂性,以及早期识别和逐步治疗的重要性。结合以患者为中心的计划,采用保守措施,药物和内镜干预是改善这些病例结果的必要条件。
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引用次数: 0
Primary Esophageal Rhabdomyosarcoma: An Exceptionally Rare Cause of Pediatric Dysphagia. 原发性食管横纹肌肉瘤:小儿吞咽困难的罕见病因。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-12 eCollection Date: 2024-01-01 DOI: 10.1155/crgm/3648155
Maryam Ataollahi, Amirali Mashhadiagha, Fereshteh Karbasian, Reza Moshfeghinia, Javad Arabpour, Bita Geramizadeh

Background: Esophageal embryonal rhabdomyosarcoma (ERMS), a rare pediatric cancer, mimicked achalasia in a case involving dysphagia and vomiting. Diagnosis and chemotherapy necessitate careful monitoring due to potential complications. Case presentation: A 12-year-old girl with no prior medical history presented with progressive dysphagia and vomiting. Initial diagnosis suggested achalasia, but further evaluation revealed a large mediastinal mass causing esophageal compression. Biopsies confirmed primary ERMS of the esophagus with metastases. Despite chemotherapy, she developed complications, including neutropenic enterocolitis and posterior reversible encephalopathy syndrome (PRES). Unfortunately, she succumbed to neutropenic sepsis. Conclusion: In this case study, we presented our experience regarding the clinical course of this disease, treatment strategy, and prognosis, in addition to the limited previous information in the literature.

背景:食管胚胎性横纹肌肉瘤(ERMS)是一种罕见的儿童癌症,在一个涉及吞咽困难和呕吐的病例中模仿贲门失弛缓症。由于潜在的并发症,诊断和化疗需要仔细监测。病例介绍:一名12岁女孩,无既往病史,表现为进行性吞咽困难和呕吐。初步诊断为贲门失弛缓症,但进一步检查发现一个大的纵隔肿块引起食管压迫。活检证实原发性食管ERMS伴转移。尽管化疗,她出现并发症,包括中性粒细胞减少性小肠结肠炎和后部可逆性脑病综合征(PRES)。不幸的是,她死于中性粒细胞减少性败血症。结论:在本病例研究中,除了文献中有限的信息外,我们还介绍了我们对该疾病的临床病程、治疗策略和预后的经验。
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引用次数: 0
A Rare Case of Autoimmune Pancreatitis in a 9-Year-Old Male Patient: A Comprehensive Diagnosis and Successful Treatment. 一名 9 岁男性患者的自身免疫性胰腺炎罕见病例:综合诊断与成功治疗。
IF 0.6 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-05 eCollection Date: 2024-01-01 DOI: 10.1155/crgm/5564385
Hadi Farhat, Christie Dib, Yehya Tlaiss, Ayman Tabcheh, Pierre Hani

Autoimmune pancreatitis (AIP) is a rare and complex condition that can be difficult to identify due to its resemblance to malignancies. This case report presents a unique instance of AIP in a 9-year-old male patient who presented with painless jaundice and elevated liver function test results. His symptoms were persistent even after previous common bile duct stent placement, requiring additional investigation. The possibility of AIP was raised by further serological tests and imaging examinations. The diagnosis was then confirmed by multiple characteristic findings revealed through history, imaging, clinical examination, histology, and lab results. Treatment was initiated with corticosteroids, which resulted in a complete resolution of symptoms and remarkable recovery. This case emphasizes the significance of including AIP in the differential diagnosis of pancreatic disorders, even in pediatric patients.

自身免疫性胰腺炎(AIP)是一种罕见而复杂的疾病,因其与恶性肿瘤相似而难以识别。本病例报告介绍了一名 9 岁男性患者的独特 AIP 病例,该患者出现无痛性黄疸和肝功能检查结果升高。即使在之前放置胆总管支架后,他的症状仍持续存在,因此需要进行进一步检查。通过进一步的血清学检测和影像学检查,发现了 AIP 的可能性。随后,通过病史、影像学检查、临床检查、组织学检查和实验室结果发现的多个特征性结果,确诊了该病。患者接受了皮质类固醇治疗,症状完全缓解,病情明显好转。本病例强调了将 AIP 纳入胰腺疾病鉴别诊断的重要性,即使是儿童患者也不例外。
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引用次数: 0
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Case Reports in Gastrointestinal Medicine
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