Case Reports in Gastrointestinal Medicine最新文献

The objectives were to highlight that: (1) mesh erosion related partial small bowel obstruction after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair (IHR) as an uncommon complication can clinically and radiologically mimic ileocolic Crohn's disease in young adults; and (2) implore clinicians to consider a broad set of differential diagnosis and prompt involvement of other subspecialties, especially if preliminary investigations and treatment yield minimal results. The authors report a 34-year-old male who presented with computed tomography (CT) findings of ileitis, which was initially investigated for Crohns' disease. Due to persisting abdominal pain and negative initial investigations, he underwent a laparotomy demonstrating secondary mesh migration with erosion into distal ileum requiring bowel resection, 2.5 years after an uneventful laparoscopic right TEP IHR. The patient made an uneventful postoperative recovery and at 6 weeks follow-up, he had resolution of abdominal pains, and normal bowel function.

Metastases to the gastrointestinal tract from primary breast malignancies are rare. Acute gastrointestinal bleeding in patients with history of breast cancer, however, should raise clinical suspicion and warrant further investigation for metastatic disease involving the gastrointestinal tract. We report a case of a 74-year-old female with metastatic breast cancer and provoked thromboembolic events on anticoagulation, who was found to have poorly cohesive gastric carcinoma with immunohistochemistry consistent with primary breast malignancy, after presenting with new-onset melena. Use of anticoagulation may have exacerbated bleeding prompting endoscopic examination. Biopsy and histologic assessment are needed for definitive diagnosis and timely management.

Celiac crisis (CC) is a rare but potentially life-threatening complication of celiac disease (CD), characterized by severe diarrhea, electrolyte imbalances, and metabolic disturbances. We report the case of a 32-year-old pregnant woman presented significant dehydration, weight loss, and steatorrheic stools. Diagnosis was confirmed by duodenal biopsy, with rapid improvement following a gluten-free diet (GFD) and corticosteroids. The diagnosis of CC was established based on the acute clinical presentation and rapid improvement following a GFD and corticosteroid therapy. This case highlights the importance of early recognition and prompt management of CC, particularly in undiagnosed or untreated CD, to prevent severe maternal and fetal complications.

Mesenteric cysts are rare benign intra-abdominal tumors that are usually asymptomatic and diagnosed incidentally while being investigated for other conditions or their complications. Surgical excision remains the primary treatment option. Here we present the case of a 30-year-old male with progressive abdominal distension, initially misdiagnosed with liver disease and refractory ascites, leading to inappropriate diuretic therapy. Subsequent imaging revealed a giant mesenteric cyst, which was successfully managed with complete surgical excision.

Background: Several autoimmune diseases, such as autoimmune hepatitis (AIH), can arise or become decompensated following COVID-19 infection or vaccination; however, there is a lack of data regarding the management of concurrent COVID-19 infection and autoimmune diseases. Case Summary: In this paper, we present a case of a 9-year-old boy with yellowish discoloration of the skin and sclera, abnormal liver function test, followed by positive qRT-PCR for SARS-CoV-2 and progressive bicytopenia. After a lack of response to corticosteroids, intravenous immune globulin (IVIg) was administrated and a decline in liver enzymes, total bilirubin, and direct bilirubin was observed. Result and Discussion: This case illustrates how IVIg significantly improved the AIH symptoms in the patient with positive qRT-PCR for the SARS-CoV-2 test. We hope our report encourages further research on therapeutic approaches for AIH concomitant with COVID-19.

Gallstone ileus is an uncommon complication of cholelithiasis and the delayed diagnosis may be associated with increased risk of mortality. When gallstones block the cystic duct, they can lead to cholecystitis. If a fistula forms between the inflamed gallbladder and the adjacent intestine, the gallstones may pass into the intestinal tract and cause obstruction in the intestine. We report a case of 25-year-old female with developmental and epileptic encephalopathy who was intraoperatively diagnosed with gallstone ileus during surgery for small bowel obstruction of unknown origin. The patient had potential risk factors enhancing the formation of cholesterol gallstones, including long-term use of phenobarbital, vagus nerve injury in open gastrostomy and laparoscopic fundoplication, and tube feeding; however, the patient's gallstone had been undiagnosed for a long time. Computed tomography of the abdomen showed small bowel obstruction and pneumobilia. The presence of pneumobilia in a patient without a surgical history of the biliary system should raise suspicion of a bilioenteric fistula. The awareness of this complication of cholelithiasis is important to make an early diagnosis and to initiate the appropriate treatment.

Background: Perineurioma is a rare benign peripheral nerve sheath tumor that can arise in various body locations. In the gastrointestinal (GI) tract, perineuriomas are uncommon and have only been reported in case reports and case series. In addition, a new classification suggests reclassifying benign fibroblastic polyps as perineurioma when they show positive markers of perineurial differentiation. Objective: This study aims to enhance understanding of GI tract perineuriomas by presenting a new case and conducting a systematic literature review. Methods: We described a new case of colonic perineurioma and systematically reviewed all case reports and case series on GI perineuriomas and benign fibroblastic polyps with perineurial markers. We searched ScienceDirect, PubMed/MEDLINE, and Web of Science up to May 2024. Results: A total of 148 cases were analyzed, and most of the cases were published in the last decade (2014-2024). The majority were females (59.46%), with a mean age of 51 years (standard deviation [SD] ±14.87). Most GI perineuriomas (87.5%) were in the distal colon, predominantly in the sigmoid/rectosigmoid (56%) and rectum (14%). Outside the colon, the stomach was the most affected site (7 of 10 cases), with fewer cases in the small intestine and esophagus. The two most commonly performed stains were for epithelial membrane antigen (EMA) and glucose transporter 1 (GLUT-1), at 75% and 56% of cases, respectively. Noncolonic perineuriomas were generally larger and more symptomatic than colonic ones. Submucosal polyps were more likely symptomatic than mucosal polyps. Conclusion: Perineurioma in the GI tract is a rare benign polyp mainly identified in the distal colon. Its rarity and limited follow-up data restrict our understanding of recurrence rates. We recommend reporting uncommon polyp locations, detailing polyp morphologies, and using at least two markers for classification.

A variation of familial adenomatous polyposis (FAP), known as Gardner's syndrome (GS), can manifest as extraintestinal tumors, such as desmoid tumors (DTs). A key part in the diagnosing process is played by the clinician. Because DT frequently occurs before intestinal polyposis develops, doctors can identify the underlying illness early by looking for DT's telltale signs. Nevertheless, in this instance, the patient's failure to recognize the illness promptly following the excision of the tumor in the abdomen wall caused a delay in the diagnosis and impacted the disease's course.

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.

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.