Case Reports in Gastrointestinal Medicine最新文献

This case report describes a rare occurrence of nonsteroidal anti-inflammatory drugs (NSAID)-induced focal colonic granulomatous mass mimicking a malignant colonic mass. It highlights the diagnostic challenges of NSAID-related gastrointestinal complications and stresses the importance of considering such causes in similar presentations. Prompt recognition and withdrawal of the offending NSAID can prevent unnecessary surgical intervention and facilitate symptom resolution. This case underscores the value of a detailed medication history and cautious NSAID use to reduce the risk of adverse gastrointestinal effects.

We present the case of a 49-year-old man admitted for acute liver failure complicated by hemodynamically unstable hemobilia secondary to bleeding varices in the bile duct. Placement of a fully covered self-expanding bare metal stent (FCSEMS) was considered the best treatment of choice over hepatic artery embolization in this patient because of the venous source of bleeding. The success of this procedure indicates that FCSEMS can be considered as a bridge to liver transplantation in patients with acute liver failure who develop hemodynamically unstable hemobilia secondary to portal hypertensive biliopathy.

The Centers for Medicare and Medicaid's Acute Hospital Care at Home waiver in 2020 has enabled the management of acute conditions that were traditionally cared for in the hospital to transition to the home setting. To our knowledge, data regarding the management of patients with acute severe ulcerative colitis (ASUC) in hospital at home (HaH) programs has not been reported. We conducted a retrospective review of ASUC patients admitted to our HaH program from our adult hospital, who demonstrated early clinical response but required a comprehensive, closely monitored treatment environment that was provided in the patients' homes. Patients received daily evaluations by hospitalists, gastroenterologists, and registered nurses with clinical assessments, monitoring of vitals, and therapeutics (e.g., intravenous fluids, corticosteroids, etc.), alongside daily blood monitoring for worsening inflammation. Patient demographics and UC disease characteristics were extracted from electronic health records. Outcomes of interest included emergency department (ED) visit, readmission, and mortality within 30 days of index admission; hospital-acquired conditions (HACs) of interest (delirium, catheter associated infections, and falls) during HaH stay; length of stay (LOS) in traditional hospital vs. HaH phase; and need for escalation back to traditional hospital. Three eligible and consenting ASUC patients were transferred to HaH. Two were female and one male, with a mean age of 59.7 years. The mean LOS in the traditional hospital was 8.7 days (range: 4-18), and 6 days (range: 4-9) in HaH. There were no escalations from HaH back to the traditional hospital. One patient had a 30-day ED visit (33%) with readmission (33%). There were no deaths within 30 days of index admission or documented HACs during HaH stay. Our case series highlights the preliminary feasibility of HaH for the management of ASUC patients, as a promising alternative to prolonged hospital-based care, without compromising patient safety or care quality.

Bezoars are rare gastrointestinal masses composed of indigestible substances, typically found in the stomach but at times occurring at more distal locations. Rectal seed bezoars are particularly unusual and manifest with nonspecific gastrointestinal complaints, predisposing to making the diagnosis difficult and delaying appropriate therapy. We describe a case of a 68-year-old female presenting with acute constipation, tenderness of the rectum, and per-rectal bleeding. The patient had a history of recent consumption of approximately 100 g of sunflower seeds. Examination and imaging of the abdomen revealed findings of obstruction at the rectum. Following the rectal enema, the patient passed a clumped mass of sunflower seeds per rectum, which is consistent with a rectal seed bezoar. She was treated conservatively with stool softeners, antibiotics, ointments, and sitz baths. This case is striking because it illustrates the clinical significance of rectal seed bezoars as a rare but reversible cause of acute constipation. Strong suspicion, meticulous dietary history, and focused examination are needed for diagnosis. Early diagnosis and conservative management can prevent complications and make the employment of invasive diagnostics unnecessary.

Introduction and Importance: Cystic echinococcosis is a common cystic infection in endemic areas. Solitary lesions are commonly found in the liver and are primarily caused by Echinococcus granulosus. Other organs can be involved as well but to a lesser degree. This paper presents a rare manifestation of a hydatid liver cyst causing acute pancreatitis. Case Presentation: A 67-year-old female presented with right upper quadrant pain, nausea, and vomiting. She was found to have a large hepatic cystic echinococcosis occupying the right lobe of the liver with associated acute pancreatitis. After endoscopic retrograde cholangiopancreatography (ERCP), three small yellow membrane fragments-presumed to be daughter cyst membranes-were found obstructing the common bile duct at the ampulla of Vater. The patient underwent laparoscopic unroofing of the hepatic cystic echinococcosis and laparoscopic cholecystectomy with an uneventful postoperative course. Clinical Discussion: Treatment modalities for hepatic cystic echinococcosis depend on the size of the cyst, imaging findings, cyst activity status, and associated complications. In nonendemic countries, where demographic changes occur due to travel from endemic regions, a high index of suspicion is necessary for timely diagnosis. A laparoscopic approach was chosen for its benefits related to minimally invasive surgery. While laparoscopic management of hepatic cystic echinococcosis is well described, its use in cases complicated by acute pancreatitis remains infrequently reported. Conclusion: Cystic echinococcosis most commonly presents in the liver. When associated with acute pancreatitis, a combined approach involving albendazole, ERCP, and sphincterotomy is typically required, with surgical resection depending on cyst classification.

Chyloperitoneum after colorectal surgery remains a relatively rare complication with estimated incidence of 1%-6.5%. In colorectal surgery, this complication is mostly described after D3 right colectomy. Nonoperative treatment involves several approaches. We present a rare case of chyloperitoneum after laparoscopic left hemicolectomy for left-sided colonic adenocarcinoma. A CT scan and a triglycerides dosage on the chylous liquid were performed to confirm the diagnosis. The patient was successfully treated only by nutritional measures, avoiding prolonged fasting or invasive treatment. Fasting and complete parenteral nutrition are not necessarily required in the treatment of chyle leakage.

Diagnosing inflammatory bowel disease (IBD) can be challenging in the presence of mimicking conditions, such as infectious colitis. An accurate diagnosis is important to avoid unnecessary treatment. Nontyphoidal Salmonella species are an important cause of infectious colitis that at times can mimic IBD. Salmonella enterica serotype Saintpaul has caused numerous fatal foodborne gastroenteritis outbreaks worldwide. It has also been known to cause other infections, such as bacteremia, splenic abscesses, and meningitis, but has only rarely been known to cause colitis. Worryingly, antibiotic resistance rates of S. Saintpaul are rising. This case report presents a woman with S. Saintpaul colitis mimicking Crohn's disease. Despite an initial plan to start biologic therapy, long-term follow-up while off immunosuppressant therapy confirmed S. Saintpaul as the underlying cause of colitis, sparing our patient long-term immunosuppression. This case highlights the importance of ruling out infectious colitis before beginning long-term immunosuppressive therapy and the challenges of mimicking conditions as well as the novelty of the Saintpaul serotype causing colitis.

Metastasis to the duodenum from colorectal cancer is exceptionally rare and presents significant diagnostic and therapeutic challenges. We describe a 68-year-old female with right colon adenocarcinoma, who developed a duodenal metastasis despite treatment with FOLFOX chemotherapy. Transition to FOLFIRI yielded limited success, emphasizing the need for innovative approaches. Genetic analysis revealed a KRAS G12D mutation, for which targeted therapies are not yet approved. Immunohistochemistry confirmed the gastrointestinal origin of the duodenal mass. Literature indicates that surgical resection can offer curative potential in select cases, although it was not viable here. Emerging KRAS-targeted agents, such as MRTX1133, represent promising options for addressing this mutation. This case underscores the challenges of managing rare metastatic patterns, the potential of personalized therapies, and the necessity for further research into innovative treatments for advanced colorectal cancer. It highlights the importance of developing targeted strategies to improve outcomes for patients with such complex metastatic diseases.

Background: Human epidermal growth factor receptor 2 (HER2)-positive gastric cancer accounts for approximately 15% of gastric cancer cases. Trastuzumab (Trz), a monoclonal antibody targeting HER2, has been shown to improve overall survival when combined with chemotherapy. However, while Trz-induced cardiotoxicity (TIC) is a well-recognized adverse effect in breast cancer chemotherapy, reports on its occurrence in gastric cancer treatment remain limited. Case Presentation: An 80-year-old Japanese male with HER2-positive advanced gastric cancer (cStage III) developed ventricular arrhythmia and heart failure during postoperative chemotherapy with the Trz + SOX regimen (Trz, oxaliplatin, and TS-1). The patient initially underwent distal gastrectomy with D1+ lymphadenectomy for anemia and pyloric stenosis. Metastasis to the #8a lymph node (anterior superior lymph node of the common hepatic artery) and pancreatic invasion via lymph nodes were treated with two cycles of the Trz + SOX regimen, leading to a partial response. However, after the 11th cycle, he developed ventricular tachycardia and heart failure. Cardiac imaging and laboratory findings revealed no coronary artery disease or structural abnormalities, suggesting TIC as the underlying cause. Antiarrhythmic therapy with pharmacological agents led to symptom resolution, and no recurrence of arrhythmia or heart failure was observed. Discussion: This case highlights the potential cardiotoxicity associated with nonanthracycline-based Trz regimens for gastric cancer. Pathophysiologically, HER2 signaling inhibition in cardiomyocytes may impair stress responses and repair mechanisms. The patient's advanced age, history of hypertension and anemia, and cumulative exposure to chemotherapy may have contributed to increased cardiac vulnerability. Careful monitoring of cardiac function is essential in elderly and comorbid patients undergoing Trz-based therapy for gastric cancer to mitigate the risk of cardiotoxicity. Conclusion: Trz-based chemotherapy for HER2-positive gastric cancer, even without anthracyclines, may pose a risk of cardiotoxicity, particularly in elderly or comorbid patients. Further research is warranted to elucidate underlying mechanisms and optimize monitoring and prevention strategies in this population.

Background: Cholangiocarcinoma (CCA) is a rare malignancy of the biliary epithelium, accounting for approximately 3% of gastrointestinal cancers. The clear-cell variant of CCA is rare, with only nine documented cases worldwide. This case report describes a unique presentation of clear-cell intrahepatic (or peripheral) cholangiocarcinoma (ICC), highlighting its clinical course, histopathological features, and management. Case Presentation: A 56-year-old female with no significant medical history presented with postprandial right upper quadrant and epigastric pain. Following an initial diagnosis of gallbladder stones, laparoscopic cholecystectomy was performed. However, persistent epigastric pain, nausea, and vomiting led to further evaluation, revealing a 2.7 × 2.5 cm mass in the gallbladder bed compressing the common bile duct with associated intrahepatic biliary dilation. Endoscopic retrograde cholangiopancreatography confirmed the findings, and the patient underwent a left hemihepatectomy with radical choledectomy and biliary reconstruction. Histopathology demonstrated clear-cell ICC. Postoperatively, the patient received adjuvant chemotherapy and remained disease free at 14 months' follow-up. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines and the Cochrane Handbook. A comprehensive search of PubMed and SCOPUS was performed without restrictions until December 2024 to identify case reports and case series of clear-cell CCA. Data on clinical presentation, diagnostic findings, treatment modalities, and outcomes were extracted and analyzed. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Results: The systematic review included 7 studies reporting 9 cases of clear-cell CCA. The mean patient age was 59.7 years, and 77.8% of the cases underwent surgical intervention. Outcomes varied, with disease-free survival ranging from 7 to 30 months in the reported cases. Factors such as tumor size and the presence of metastasis influenced prognosis. Conclusion: Clear-cell CCA, though rare, should be considered in the differential diagnosis of biliary masses. Early surgical intervention is pivotal for improved outcomes, but further studies are needed to develop consensus treatment guidelines. Reporting additional cases is essential to enhance understanding and optimize management of this rare malignancy.