Case Reports in Gastrointestinal Medicine最新文献

We present a case of a Hispanic woman in her 70s who presented with nonspecific lower abdominal pain leading to a diagnosis of hepatic and colonic sarcoidosis. She had elevated liver function tests (LFTs), and imaging ruled out ischemia and cholangitis but revealed a cecal and ascending colon wall thickening with fat stranding. Infectious and autoimmune causes of elevated LFTs were excluded. A liver biopsy showed noncaseating granulomas, indicating hepatic sarcoidosis. Despite no bloody diarrhea, a colonoscopy was performed due to nonspecific abdominal pain and imaging-based evidence of colitis. A colonoscopy revealed diffuse areas of severely erythematous, hyperemic, and ulcerating mucosa in the ascending colon. Biopsies confirmed abundant noncaseating granulomas in the background of inflammation. Stool testing, imaging, and staining of biopsies excluded infectious or ischemic etiologies of colitis. The presence of hepatic sarcoidosis, along with age and symptom profile, prompted a diagnosis of colonic sarcoidosis rather than Crohn's colitis. Prednisone and methotrexate improved her symptoms and LFTs within 3 months of initiation.

We report a 64-year-old liver transplant recipient who developed early nondestructive post-transplant lymphoproliferative disorder (PTLD) and severe acute cellular rejection (ACR) concurrently. Hepatic lymphadenopathy led to a liver biopsy demonstrating early PTLD. Immunosuppression (IS) was reduced for early PTLD, which led to acute liver injury requiring high-dose steroids. However, subsequent augmentation in immunosuppression for ACR led to progression of PTLD, requiring rituximab treatment. This case highlights the complexity of managing conflicting liver transplant complications and underscores the importance of a multidisciplinary approach. In our case, prioritizing the treatment of rejection preserved the allograft function. Long-term follow-up showed complete resolution of both rejection and PTLD.

Background: Chronic secretory diarrhoea is a diagnostic challenge with a broad differential and significant impact on patient's quality of life. While common causes include microscopic colitis, bile acid diarrhoea, and laxative use, rarer aetiologies such as vasoactive intestinal peptide (VIP)-secreting neuroendocrine tumours (VIPomas) must be considered when standard investigations fail.

Case presentation: We present a 35-year-old woman with a two-year history of progressively worsening, fasting-persistent, high-volume watery diarrhoea leading to severe electrolyte abnormalities and weight loss requiring resuscitation in intensive care. Extensive biochemical, endoscopic, and radiological investigations-including faecal analysis, colonoscopy, neuroendocrine markers, multiphase CT, endoscopic ultrasound, and Ga-68 Dotatate PET imaging-failed to identify an underlying cause. Serum VIP levels remained within the normal range. Despite the absence of a definitive diagnosis, empirical treatment with the somatostatin analogue octreotide led to rapid and sustained symptom resolution. The patient was subsequently maintained on long-acting lanreotide with complete remission. Notably, diarrhoea recurred upon cessation of therapy, again resolving with reinitiation. After 4 years, the patient self-ceased lanreotide without symptom recurrence, and follow-up imaging remained unremarkable.

Discussion: This case highlights a diagnostic dilemma: clinical and biochemical features were highly suggestive of a VIPoma, yet no tumour was identified despite repeated advanced imaging and biochemical workup. The patient's remarkable therapeutic response to somatostatin analogue therapy, in the absence of confirmed neuroendocrine neoplasia, suggests that somatostatin analogues may have a broader role in the management of idiopathic secretory diarrhoea than currently appreciated.

Conclusion: We present a rare case of chronic secretory diarrhoea with suspected but unproven VIPoma, demonstrating sustained and reproducible response to somatostatin analogue therapy. This case supports the consideration of therapeutic trials of somatostatin analogues in refractory secretory diarrhoea of unknown origin.

Perivascular Epithelioid Tumors (PEComas) are predominantly present in uterine or gastric tissues. Liver presentations are uncommon and primary hepatic presentations are extremely rare. This is the case of a 31-year-old female patient, with previous diagnosis of hepatic abscess, the patient presented with a one-month history of abdominal pain and bilious emesis. Abdominal MR reported a lesion suggestive of hepatic adenoma. The team performed a partial hepatectomy, and histopathologic and immunohistochemical (IHC) studies reported a PEComa with high risk of confirmed malignant behavior metastatic workup. A complete left laparoscopic hepatectomy was performed due to positive surgical margins. Careful complete histologic and IHC studies are required for diagnosis. IHC reveals coexpression of melanocytic and muscle markers. These studies are usually performed after hepatectomy, the leading management strategy. Long-term follow-up and validated risk stratification scales for hepatic PEComas are needed. This report underscores the critical role of accurate diagnosis and the absence of precise information for management and prognosis of hepatic PEComas.

Background: Kaposi sarcoma (KS) is a multifocal angioproliferative disorder linked to Human Herpesvirus-8 (HHV-8), presenting in four forms: classic, endemic, iatrogenic, and AIDS-related. AIDS-related KS remains prevalent among HIV-positive individuals despite widespread use of antiretroviral therapy. Gastrointestinal (GI) involvement is the most common extracutaneous manifestation, primarily affecting the upper GI tract. It is often asymptomatic and typically requires endoscopic evaluation. While commonly associated with advanced HIV, GI KS can occasionally precede an HIV diagnosis. Despite its strong link to HHV-8, disseminated KS may develop in HHV-8-negative patients with late HIV diagnoses, raising concerns about AIDS progression. Management primarily includes highly active antiretroviral therapy (HAART), while liposomal doxorubicin is reserved for extensive disease to ensure symptom control, lesion regression, and improved survival.

Case presentation: This case report describes a rare presentation of disseminated GI KS in an HHV-8-negative patient newly diagnosed with HIV, indicating potential AIDS progression. The patient exhibited violaceous cutaneous lesions and GI symptoms, including abdominal pain and dysphagia. Endoscopy revealed esophageal masses and ulcer-like lesions in the stomach and duodenum, with histology and IHC confirming KS despite negative HHV-8 status. Management included HAART and liposomal doxorubicin, with close IRIS monitoring. The patient remained hemodynamically stable and was discharged on HAART, chemotherapy, and prophylactic antifungal and antibiotic therapies following negative cultures and stable clinical status.

Conclusion: This case highlights the need for vigilance in the atypical manifestation of HHV-8-negative disseminated GI KS in an undiagnosed HIV-positive patient, emphasizing the clinical presentation, diagnostic approach, and disease management. The patient's stabilization underscores the importance of early recognition, comprehensive diagnostic evaluation, and a multidisciplinary approach in managing complex cases.

Background: Acute gastrointestinal bleeding from a gastric lipoma is a very rare but severe condition, about 50 cases of which have been reported in the worldwide literature at the time of writing. It largely occurs from a lesion larger than 4 cm localized in the antrum of the stomach.

Objective: We report the case of a patient with severe comorbidities presenting with melena and, on examination, a large subepithelial lesion in the gastric antrum, with a small ulceration and visible vessel at the summit. After stabilization and endoscopic hemostasis, the lesion was successfully treated by endoscopic submucosal dissection and a diagnosis of a large gastric antral lipoma was confirmed. We have collected similar case reports published worldwide and made a careful review of the literature and ESGE guidelines; we present these here with the aim of helping to find the best modality of treatment for future patients with large gastric lipoma.

Conclusion: We present, to the best of our knowledge, the first case of acute gastrointestinal bleeding from a gastric lipoma in the Czech Republic, discuss the existing literature on similar cases, and make recommendations for the treatment of this condition in line with the relevant ESGE guidelines.

While colonoscopy is generally considered to be a safe procedure, serious complications such as intestinal perforation may also occur. Herein, we describe an extremely rare clinical case of acute colonic perforation during colonoscopy treatment. A 55-year-old female patient with good health presented to our hospital with abdominal pain for 2 months. While undergoing endoscopic submucosal dissection (ESD) of a colonic polyp, the patient developed sudden abdominal distension and dyspnea. An emergency computed tomography (CT) scan was performed and demonstrated bilateral massive pneumothorax, pneumomediastinum, pneumoperitoneum, and generalized subcutaneous emphysema (SCE). The patient underwent gas extraction, bilateral intercostal pneumothorax drainage, and conservative medical management. The patient had a favorable postoperative course and was discharged home on day 14. This case report highlights the clinical rarity of gas extravasation complications during colonoscopy and underscores the importance of multidisciplinary collaboration for accurate diagnosis and effective management, thereby avoiding surgical procedures.

Introduction: Autoimmune pancreatitis (AIP) and pancreatic cancer are top differentials of obstructive jaundice originating from the pancreas. Case Description/Methods: The patient's findings were concerning for malignant biliary obstruction, but a thorough workup determined that the patient had AIP-NOS. She underwent EBS and was discharged on a steroid taper. Follow-up demonstrated complete resolution of symptoms, laboratory markers, and imaging. Conclusion: Adequate pancreatic tissue is not always obtained with 22-gauge needles. Biliary stenting is justifiable in AIP with significant hyperbilirubinemia. It is important to consider AIP for with a pancreatic head mass and obstructive jaundice to optimize outcome.

Simple renal cysts are the most common cystic abnormalities of the kidney, typically observed in older individuals and often asymptomatic, requiring no treatment. These cysts are usually detected incidentally during imaging for unrelated conditions. Giant renal cysts, defined as those exceeding 15 cm in diameter and containing over 1500 mL of serous fluid, are exceptionally rare. We report a case of a 34-year-old male presenting with a rapidly growing giant renal cyst (40 × 28 cm) in the left kidney, resulting in malnutrition and significant weight loss. The patient underwent successful laparoscopic transperitoneal cyst excision. At the 1-year follow-up, the patient was asymptomatic, with no evidence of residual cyst recurrence.

Solid-type serous cystadenoma (SSCA) of the pancreas is an extremely rare benign condition among pancreatic cystic neoplasms. Although the imaging characteristics are not pathognomonic, this entity may mimic other solid pancreatic tumors. In particular, it can closely resemble a pancreatic neuroendocrine neoplasm (pNEN) on radiologic studies. We report the case of a 67-year-old woman who presented with abdominal pain. Preoperative abdominal magnetic resonance imaging (MRI) with contrast demonstrated a solid, hypervascular lesion at the pancreas, measuring 3.5 × 2.2 × 1.9 cm, with marked enhancement on dynamic imaging. A nonfunctioning pancreatic neuroendocrine tumor was initially suspected. The patient underwent laparoscopic pancreaticoduodenectomy. Histopathologic examination revealed a solid variant of serous cystadenoma, a rare subtype of pancreatic cysts. The patient remains asymptomatic, with no evidence of recurrence or residual disease at 7 years postoperatively. This case highlights the diagnostic challenge of distinguishing solid-type serous cystadenomas from other pancreatic lesions based on imaging alone, underscoring the role of pathology in definitive diagnosis.