Case Reports in Gastrointestinal Medicine最新文献

Patients with cirrhosis have a high prevalence of peptic ulcer disease, which places them at increased risk for complications such as perforation. We report the case of a patient with decompensated cirrhosis who developed a duodenal ulcer perforation following an upper endoscopy for variceal screening. Due to poor surgical candidacy, he was managed conservatively through antibiotics, percutaneous drains, and endoscopic placement of a fully covered self-expandable metal stent (fcSEMS). With no established guidelines on managing duodenal perforations in cirrhotic patients, this case demonstrates a successful outcome with a nonoperative approach that can be considered when definitive surgical intervention is not feasible.

Neuroendocrine tumors (NETs) are rare neoplasms composed of neuroendocrine cells and seen in approximately 2% of malignancies in the United States. These are often underdiagnosed due to nonspecific presentations early in the disease course. Although found primarily in the gastrointestinal tract, lungs, and pancreas, these tumors can be seen anywhere in the body. The following case highlights an unusual presentation of a NET and subsequent management of hepatic hydrothorax in the setting of obstruction rather than decompensated liver cirrhosis.

Nasogastric (NG) tube placement is a routine inpatient procedure that is generally considered safe. NG perforation is a rare complication, but when it occurs, it is often serious or even deadly. The risk for perforation is increased in patients with a history of connective tissue disorders, inflammatory bowel disease, or prior abdominal surgeries such as Roux-en-Y gastric bypass (RYB). We present a fatal case of a 51-year-old woman with a recent RYB who suffered an NG-tube perforation leading to peritonitis and septic shock. This case highlights the extreme care healthcare providers must have when placing NG tubes in patients with prior abdominal surgeries, while offering suggestions on how to minimize the risk of fatal complications.

Venous malformations, previously referred to as cavernous hemangiomas, can affect the gastrointestinal tract and rarely the mesentery. When symptomatic, it can cause pain, hematochezia, or less frequently obstructive symptoms. In this paper, we report the case of a 60-year-old man who presented to the emergency department for abdominal pain and subocclusive symptoms. A CT scan with intravenous contrast revealed a well-defined mesenteric mass measuring 3.5 × 3.2 cm in the pelvic region with a localized anterior panniculitis. A surgical resection was performed which led to resolution of obstructive symptoms, with the histopathological analysis confirming the diagnosis of mesenteric venous malformation.

Background: Dulaglutide, a glucagon-like peptide-1 (GLP-1) agonist, is utilized for the management of type 2 diabetes and obesity, typically administered subcutaneously at a dosage of 0.75 mg/0.5 mL once weekly, with adjustments made as needed. While typically well tolerated, it may induce infrequent yet severe adverse effects, including acute pancreatitis.

Case presentation: In this case report, we present the first documented case of GLP-1-induced pancreatitis in Palestine. A 62-year-old female Palestinian patient with a history of type 2 diabetes complicated with nephropathy, hypertension, dyslipidemia, and cardiac catheterization three years prior without stenting. The patient developed acute pancreatitis following the initiation of 1.5 mg of a GLP-1 receptor agonist after 4 months of therapy. The patient experienced upper abdominal pain radiating to the back, nausea, and alternating diarrhea and constipation for 5 days. Laboratory investigations revealed elevated serum amylase and lipase levels, and imaging studies confirmed signs of acute pancreatitis. After the GLP-1 agonist was discontinued, the patient's symptoms improved, and she fully recovered.

Conclusion: GLP-1 receptor agonists are advantageous for the management of diabetes and obesity but may precipitate acute pancreatitis in predisposed individuals. Clinicians should be aware of this potential risk and promptly investigate any patient who presents with signs of acute abdominal pain during GLP-1 therapy.

We report an intriguing case of an 80-year-old male presented with high-grade fever and severe upper abdominal pain. An abdominal ultrasound indicated a deep-seated abscess in the Segment IV of liver. An elusive diagnosis was made after Contrast Enhanced Computed Tomography (CECT) scan of whole abdomen which disclosed a sharp, pointed fish bone accommodating between the distal part of gastric antrum and cavitary lesion of liver. In the operative room, an upper GI endoscopy revealed a healed duodenal ulcer. An explorative laparotomy was performed subsequently, and the perihepatic abscess cavity was drained along with the removal of fish bone about 3.15 cm in length from perihilar region without any damage to the adjoining structures. His management was centered around IV antibiotics, imaging, and subsequent surgical drainage. The gentleman made a good recovery.

Emphysematous hepatitis is a rare condition characterized by the presence of gas within the hepatic parenchyma. Only a limited number of cases have been reported, with most patients experiencing poor outcomes and median survival time ranging from hours to days after diagnosis. We present a case of a patient with uncontrolled diabetes, abdominal pain, and fatigue who was found to have emphysematous hepatitis. The patient was successfully treated with antibiotics and percutaneous drainage without the need for surgical intervention. This case represents the second reported instance of survival following percutaneous drainage, highlighting the potential efficacy of this minimally invasive approach.

Eosinophilic colitis is a rare gastrointestinal (GI) pathology characterised by abnormal eosinophilic infiltration into the digestive tract's mucosa. It can present as a primary disorder or as a secondary manifestation, with a wide range of clinical presentations, necessitating a broad differential diagnosis by clinicians. We report an unusual case of eosinophilic colitis caused by a tapeworm in a young male who presented with intestinal obstruction. This case underscores the diagnostic challenges associated with eosinophilic colitis and highlights the essential role of histopathology in confirming the diagnosis. The absence of standardised histological criteria for eosinophil counts in colonic mucosa further complicates the diagnosis. Consequently, management should be individualised, taking into account the patient's condition and the underlying aetiology.

Introduction: Drug-induced liver failure (DILI) is one of the causes of acute liver injury (13%-20%), encompassing both predictable and idiosyncratic reactions. While the latter are rare, it can lead to severe liver damage in vulnerable patients. Although topical minoxidil is a widely used treatment for androgenetic alopecia, cases of liver failure linked to its use are extremely uncommon and have not been widely described. This case report discusses the potential for severe liver injury following topical minoxidil application.

Case presentation: A 21-year-old female with no significant medical history presented with jaundice, elevated liver enzymes, and impaired liver function three and a half weeks after starting topical minoxidil for alopecia areata. Laboratory tests revealed significantly elevated transaminases, bilirubin, and disturbed coagulation. A liver biopsy revealed centrilobular necrosis, which indicated drug-induced liver damage. After discontinuation of minoxidil, the patient's condition improved rapidly, with a marked decrease in liver enzymes and disappearance of clinical symptoms.

Conclusions: This is the first evidence of severe drug-induced liver failure associated with topical minoxidil. It underscores the potential for hepatotoxicity even with over-the-counter drugs that are thought to have minimal systemic absorption. The rapid improvement after discontinuation of the drug and exclusion of differential diagnoses suggests a causal relationship. In cases of severe liver failure of unclear origin, all substances should be considered in the case history.

Introduction: Immune checkpoint inhibitor-related pancreatitis, also known as type 3 autoimmune pancreatitis (AIP), is uncommon and has a widely ranging clinical presentation. We present the biopsy findings of a case consistent with type 3 AIP-an entity recently described in the literature, the pathologic findings of which have not been well characterized.

Case report: A 71-year-old male with metastatic mucosal melanoma of the urethra was treated with immune checkpoint inhibitor (ICI) therapy (nivolumab/relatlimab) and developed vague epigastric discomfort. He was found to have an elevated lipase, which increased to > 20x the upper limit of normal. Subsequent imaging showed new infiltrative masses in the pancreatic head and distal body/tail. Endoscopic ultrasound with fine needle biopsy (FNB) was performed. This showed T-lymphocyte predominant infiltrates, in the acini and septal areas, with concomitant acinar, duct, and venular damage, including both CD4 and CD8 lymphocytes, which were considered consistent with type 3 AIP. He was treated successfully with prednisone.

Discussion: On biopsy, there was no evidence of malignancy or features of type 1 or type 2 AIP. Histologic findings included moderate infiltration and damage to the pancreatic parenchyma, ductal, and vascular structures by CD4 and CD8 lymphocytes, pointing to immune-mediated pancreatic injury, and supportive of ICI-mediated injury to the pancreas of this patient. The clinical presentation of type 3 AIP ranges from asymptomatic lipase elevation to asymptomatic pancreatitis to acute symptomatic pancreatitis. There may be no clear temporal relationship to treatment initiation. Type 3 AIP typically presents along with other immune-related adverse events. Endoscopic ultrasound with FNB contributed to diagnostic certainty in this case and changed our patient's management, allowing for appropriate treatment of his immune-related adverse event.