Case Reports in Gastrointestinal Medicine最新文献

Vibration-controlled transient elastography (VCTE) is used for the noninvasive assessment of liver fibrosis. We present a case of significant weight loss over 1 year, resulting in a marked improvement in liver stiffness suggesting a decrease in liver fibrosis from stage 4 (cirrhosis) to stage 2 (moderate fibrosis) notably without a change in the grade of hepatic steatosis. The improvement in two stages of fibrosis over this short time frame is due to the overestimation of liver stiffness in a subject with class 3 obesity and not due to the resolution of fibrosis. Therefore, this case highlights that BMI, due to excess subcutaneous abdominal adipose tissue and not intrahepatic lipid accumulation, can cause a significant overestimation of liver fibrosis with VCTE.

Chylous leakage is an uncommon and serious clinical condition, especially occurring after retroperitoneal operations. Here, we report a case of cervical chylous leakage combined with chylothorax in a 57-year-old woman postretroperitoneal surgery, and our conservative approach led to resolution/clinical improvement. The causes of this rare complication are discussed. We considered that the venous thrombosis, the increased intra-abdominal pressure, or the patient positioning during the surgery may lead to the chylous particles leakage and chylothorax. Because of its rarity, we hope this case report will improve clinicians' understanding of cervical chylous leakage combined with chylothorax and provide suitable treatment options for future clinical reference.

Perianal Paget's disease (PPD) is a rare skin adenocarcinoma that arises in the apocrine glands of the perianal region. It is often misdiagnosed as eczema, leukoplakia, squamous cell carcinoma, Bowen's disease, lichen planus, or condylomata acuminata. We report a case of a 63-year-old male who presented to the emergency room (ER) for evaluation of an anal mass that had persisted over 6 months. The patient was found to have a rectal adenocarcinoma with pagetoid spread and underwent neoadjuvant chemoradiation with symptom improvement. However, the patient declined further chemotherapy and the planned abdominal perineal resection with reconstruction, as it would require a permanent colostomy.

A 75-year-old female was diagnosed with a type 0-I, moderately differentiated, early gastric carcinoma on the posterior wall of the middle gastric body during esophagogastroduodenoscopy (EGD). Several small whitish structures, referred to as white globe appearances (WGAs), were noted on the oral side outside the demarcation line of the cancerous protrusion. Although this area was flat without cancerous mucosal changes on the surface, subepithelial cancer extension was suspected. The histopathology of the resected specimen revealed that the carcinoma with submucosal invasion had significant lymphatic invasion with submucosal lateral extent along lymphatic vessels. In some areas, the carcinoma within the lymphatic vessels regressed from the submucosal layer towards the mucosal lamina propria, penetrating the muscularis mucosas. The intralymphatic carcinoma reaching just beneath the epithelium was considered to manifest WGA features during endoscopy.

Introduction: Foreign body (FB) ingestion represents a frequently encountered scenario in clinical practice. Most ingested FBs typically pass spontaneously, requiring no intervention. Endoscopic removal stands out as the least invasive method, with only a minimal 1% needing surgical intervention. Case Presentation. We present a case of a 30-year-old male who ingested multiple FBs located in the stomach and small bowel. While successful removal of the stomach FB was achieved through endoscopy, the second FB in the small bowel proved challenging due to perforation concerns and limited expertise. Given a history of prior surgical intervention resulting in a large incisional hernia, surgical removal was discouraged. Consequently, a collaborative decision involving surgeon and interventional radiologist (IR) led to the adoption of a fluoroscopic-guided removal approach facilitated by IR techniques.

Conclusion: This case highlights the potential for a less invasive alternative in situations where both endoscopic and surgical interventions are deemed not feasible.

Introduction: The occurrence of acute respiratory failure as a result of esophageal bezoars is a rare phenomenon. We present a patient who failed initial endoscopic intervention. Successful resolution was achieved through a novel approach involving a combination of Creon and Coca-Cola. Subsequently, the patient was diagnosed with achalasia, a condition that potentially contributed to the formation of the esophageal bezoar. Case Description. An 82-year-old man presented with respiratory distress, necessitating endotracheal intubation for airway protection. A chest computed tomogram (CT) showed pneumonia and a distended esophagus compressing the trachea, raising the possibility of an esophageal food bolus. Endoscopy revealed a severely dilated esophagus containing a significant amount of food and a phytobezoar in the lower esophagus. He failed various endoscopic techniques to remove the obstruction. Given the patient's poor surgical candidacy, he was started in a thrice-daily regimen of Creon dissolved in 165 mL of Coca-Cola, over a 4-day period. A subsequent endoscopy revealed no discernible evidence of food or bezoar. The patient was weaned from mechanical ventilation. A high-resolution esophageal manometry identified type 1 achalasia.

Conclusion: Esophageal food impaction leading to respiratory failure is rare. Endoscopy remains the mainstay approach. Surgical interventions carry significant risks. This case emphasizes the potential for noninvasive management in patients with esophageal bezoars and also underscores the significance of contemplating esophageal pathologies when addressing cases of respiratory failure. The use of Coca-Cola and Creon emerges as a safe, effective, and cost-efficient treatment, providing a feasible option when endoscopy proves unsuccessful before considering more aggressive interventions.

Background: Colonoscopy is a resource used for the diagnosis, treatment, and monitoring of benign and malignant colorectal pathologies. The incidence of perforation is 0.03%-0.65% in diagnostic colonoscopy; however, the incidence can be up to 10 times higher in therapeutic interventions, such as polypectomies, increasing the risk of complications up to 0.07-2.1%. Materials and methods. Case report of a 71-year-old female who presents a rare complication due to a perforation in the sigmoid which developed pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema as a complication of a diagnostic colonoscopy where a biopsy of a friable lesion was performed.

Results: A 71-year-old female that went to the emergency room due to acute generalized abdominal colic spasm pain with a duration of 7 hours, associated with significant abdominal distension, malaise, diaphoresis, progressive dyspnea, and massive subcutaneous emphysema that developed after performing panendoscopy and colonoscopy for diverticulosis follow-up. An abdominal CT scan with double contrast was performed, reporting suggestive data of hollow viscus perforation, pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema in the thorax, neck, and skull base. She underwent an exploratory laparotomy finding a perforation in the sigmoid for which sigmoidectomy was performed, and for the pneumothorax and pneumomediastinum, endopleural tubes were placed in both hemithoraxes. The massive subcutaneous emphysema subsided with observation and oxygen.

Conclusion: A rare complication of the use of colonoscopy as a diagnostic and therapeutic method is presented. The purpose of presenting this case is for the doctor who performs these interventions to suspect this complication in a timely manner, not delaying the diagnosis and carrying out an urgent therapeutic approach as in this case with exploratory laparotomy, finding the perforation site and carrying out the corresponding surgical management. We demonstrated that massive subcutaneous emphysema can be managed with observation if there is no other alarm data evident that required another surgical approach.

Tailgut cyst or retrorectal cystic hamartoma is a rare congenital lesion, thought to arise from a portion of the embryological hindgut, usually benign, with no or unspecific symptoms, mainly diagnosed in middle-aged women. Complete surgical resection of the cyst is recommended to avoid complications and confirm the diagnosis. In this report, we present our experience in the successful endoscopic management of a tailgut cyst, outlining the endoscopic resection technique and discussing under what conditions this approach may be applicable.

Malignant rectal strictures are uncommon, but they may pose a diagnostic challenge in clinical practice. We report the case of an 85-year-old male with an initially puzzling presentation of abdominal distention and discomfort. The patient was ultimately diagnosed with a rectal stricture caused by a plasmacytoid variant of urothelial cell carcinoma originating from the bladder. This case emphasizes the necessity of considering unique etiologies when evaluating rectal strictures and the aggressive character of this type of urothelial carcinoma.

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are lifelong conditions with no definite cure. Several studies demonstrated that patients with IBD more frequently experience symptoms of common mental disorders, such as anxiety and depression, because of bidirectional communication through the gut-brain axis and the chronicity of symptoms, as well as because of impaired quality of life and reduced social functioning. However, psychological conditions of affected patients are often underestimated and not fully considered. Herein, we present the case of a 37-year-old woman with Crohn's disease and a mild depressive condition, characterized by anxious distress, tachycardia, tachypnea, tremors, sweating, avoidant behaviors, and intestinal somatizations (diarrhea), who was treated with Pregabalin upon indication of the referring psychiatrist. Following the beginning of the treatment, the patient rapidly reported an improvement in the overall clinical symptoms as well as a better management of psychic and physical anxiety with a marked reduction in diarrheal discharges under stress at work. After 6 months of Pregabalin therapy, we additionally observed an improvement in Crohn's disease activity, both clinically, in the laboratory, and endoscopically. Our case showed that patients with Crohn's disease and anxiety problems may benefit from low-dose Pregabalin medication to improve both their mental and physical condition.