Case Reports in Gastrointestinal Medicine最新文献

Small bowel strictures are a common complication of Crohn's disease (CD), which can lead to obstruction, perforation, and fistula formation. However, strictures can stem from other etiologies in CD patients, including malignancy, prior surgery, radiation, and ischemia. We present a patient who developed a new long-segment jejunal and ileal stricture within 2 months after ileocolic resection. What was initially treated as worsening CD was ultimately an unrelated ischemic stricture due to suspected superior mesenteric artery thrombosis following ileocolic resection. The contrasting location of the stricture compared to her previous disease, timing of progression, and lack of response to anti-inflammatory treatment prompted a reassessment of the underlying disease process.

The relationship between the human immunodeficiency virus (HIV) and inflammatory bowel disease (IBD) is poorly understood. The coexistence of the two conditions is uncommon with scattered retrospective studies in the literature. Whereas HIV was initially thought to propagate IBD flares and increase disease severity, more studies are coming out showing that HIV may actually be protective against IBD development and relapse, particularly due to the depletion of CD4 lymphocytes. We present a HIV-positive female with new onset ulcerative colitis at the age of 42. Her HIV was poorly controlled for 25 years but with new gastrointestinal symptoms for 9 months, an endoscopic evaluation was done which revealed a new inflammatory bowel disease diagnosis, which warranted immediate therapy. In describing this patient's case, we discuss the uncommon coexistence of HIV and IBD and investigate potential relationships between the two conditions.

Background: Pseudoachalasia is a rare manifestation of anti-Hu-associated syndrome. We present the case of a 61-year-old female patient presenting primarily with progressive pain and sensory disturbance of all limbs. Neurological symptoms progressed after the primary treatment response and onconeural anti-Hu-antibodies were tested positive, which is often a surrogate to paraneoplastic syndrome. Subsequently, after repeated imaging, a lung carcinoid tumor was resected without detectable recurrence after surgery. Nearly 90 months after the first neurological manifestation, the patient developed dysphagia and the diagnosis of pseudoachalasia was established by esophageal manometry. Due to recurrence after pneumatic dilatation, endoscopic botulinum toxin injection provided good clinical results for the patient. Purpose: This case illustrates that anti-Hu-associated paraneoplastic pseudoachalasia may occur late in the clinical course, indicating that new-onset dysphagia in anti-Hu-positive individuals should be thoroughly investigated by imaging, endoscopy, manometry, and histology.

Sulfasalazine, a commonly prescribed medication for treating ulcerative colitis, can cause a severe yet rare adverse drug reaction known as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. In this case, a female patient experienced a severe flare of her ulcerative colitis, accompanied by sulfasalazine-induced DRESS syndrome. The ulcerative colitis flare and acute liver injury resolved with a treatment regimen of high-dose steroids and cyclosporine. However, she continued to have treatment-resistant dermatologic changes and delayed organ involvement, including the development of hyperthyroidism that required close multidisciplinary follow-up. IVIG was used to successfully wean steroids and cyclosporine after a year of therapy.

Introduction: Cecal epidermoid cyst (CEC) is a rare and benign lesion; the origin can be acquired or congenital, but the pathogenesis remains unclear. We present a case report of a patient with a cecal cyst treated by hemicolectomy. Histopathology revealed an epidermoid cyst (EC) of the cecum. Case Presentation: A 28-year-old woman was admitted to the hospital with abdominal pain, without significant past medical history. CT and MRI scans were performed, and a large cystic mass in the anterior portion of the pelvic region was detected. Imaging techniques managed to localize the site and dimensions of the neoplasm; however, they did not provide a conclusive diagnosis. The differential diagnosis was made with appendiceal mucocele, duplication cyst, or endometriotic cyst formation. Laparoscopic right hemicolectomy was performed; the mass did not present with any adhesions with the surrounding organs. Macroscopically, the mass appears as irregular extraluminal cystic lesion arising from the cecal wall of 104 × 83 × 68 mm. Microscopically, the cystic wall was lined by keratinized stratified squamous epithelium. No malignant findings were identified. Thus, the histopathologic evaluation leads to the final diagnosis of EC. Conclusions: ECs are rare benign neoplasms that can be acquired or congenital. They can vary both in their clinical and imaging presentation; the lesion can be associated with nonspecific symptoms or be asymptomatic. A wide heterogeneity both in sex distribution and age is observed. Imaging techniques are useful, but the final diagnosis can be made only after the complete surgical excision of the neoplasm and its histopathological examination.

We present the case of a 39-year-old woman with a history of severe ulcerative colitis (UC) that was refractory to 5-aminosalicylates, corticosteroids, and biologics, and who subsequently underwent total colectomy with ileal pouch-anal anastomosis (IPAA). She developed chronic antibiotic-refractory pouchitis (CARP) characterized by recurrent abdominal pain, cramping, and diarrhea unresponsive to standard treatments. A comprehensive workup, including testing for anti-tissue transglutaminase IgA antibodies, led to the diagnosis of de novo celiac disease, confirmed by endoscopic and histopathologic findings. Initiation of a gluten-free diet resulted in the resolution of symptoms, with no relapse observed during a 9-month follow-up. Our case highlights the importance of considering secondary etiologies such as celiac disease in patients with chronic refractory pouchitis and emphasizes the need for tailored management strategies.

Background: Acquired ileal diverticulum is an extremely rare condition that occurs in the ileum and is caused by acquired factors. Strangulated intestinal obstruction, a life-threatening variant of bowel obstruction, is associated with exceedingly high mortality rates. Here, we present a case of acquired ileal diverticulum causing strangulated intestinal obstruction, which was treated at our hospital. Case Report: A 65-year-old female with no previous history of intestinal obstruction presented with acute abdominal pain. An exploratory laparotomy revealed an acquired ileal diverticulum and an internal hernia. Conclusion: Acquired ileal diverticulum leading to strangulated intestinal obstruction is rare. Clinicians should consider the possibility of this disease when encountering intestinal obstruction patients with no history of abdominal surgery.

Acute ischemic pancreatitis and duodenitis are uncommon diagnoses that can affect patients with shock. As respiratory, cardiac, and neurological manifestations of shock are prioritized, resultant gastrointestinal (GI) related pathologies can be overlooked, leading to underdiagnosis of these conditions. In this report, we highlight the importance of recognizing acute ischemic pancreatitis and duodenitis in our description of a unique patient presenting with GI related complaints with underlying cardiogenic shock.

Kaposi sarcoma (KS), an angioproliferative neoplasm driven by human herpesvirus 8, predominantly affects patients with acquired immune deficiency syndrome (AIDS) or those on immunosuppressive therapy. Gastrointestinal involvement in KS is underreported, with limited literature highlighting its clinical significance and morphological diversity on endoscopy. This case report illustrates the complexities of diagnosing and managing gastrointestinal KS in an AIDS patient who presented with upper gastrointestinal bleeding. The diagnosis was established through the characteristic endoscopic appearance of the lesions, supported by histopathological confirmation. This case emphasizes the variable endoscopic manifestations of KS, ranging from linear ulcers to nodular lesions, and underscores the necessity for heightened clinical vigilance and multiple deep biopsies to avoid false-negative results. Treatment options, primarily palliative, include highly active antiretroviral therapy, chemotherapy, and radiation, yet the prognosis remains poor with high short-term mortality. This report contributes to the sparse literature on gastrointestinal KS, advocating for increased awareness and early intervention to potentially improve outcomes in this patient population.

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by hamartomatous polyps in the gastrointestinal (GI) tract, pigmented mucocutaneous lesions, and an increased risk of cancer. We report a case of a 22-year-old male from Ethiopia who presented with recurrent abdominal pain and a history of surgery for bowel obstruction. Endoscopic evaluation revealed multiple polyps in the stomach, ileum, and colon, which were confirmed histopathologically as hamartomatous polyps. Mucocutaneous pigmentation and family history of GI symptoms and maternal breast cancer led to the diagnosis of PJS, despite the unavailability of genetic testing. The patient underwent therapeutic polypectomy and was advised on cancer surveillance. This case highlights the importance of recognizing and managing PJS in resource-limited settings, emphasizing the need for early diagnosis and vigilant surveillance to prevent complications, especially when genetic testing may not be readily available.