ACG Case Reports Journal最新文献

Azygos continuation of the inferior vena cava (ACIVC) is a rare congenital anomaly characterized by the absence of the intrahepatic segment of the inferior vena cava. Although typically benign and incidental, it can mimic other pathologies on imaging. We present a case of ACIVC in a 37-year-old man, initially misdiagnosed as portal hypertension with mediastinal varices and possible liver cirrhosis, with the diagnosis ultimately confirmed by CT angiography demonstrating ACIVC. This report highlights the diagnostic challenges of ACIVC and underscores the importance of correlating imaging findings with the clinical picture for accurate diagnosis.

Acute liver injury is a rare yet serious complication of bariatric surgery, particularly Roux-en-Y gastric bypass. We report the case of a 39-year-old woman with a history of hepatitis A and metabolic dysfunction-associated steatotic liver disease who developed acute liver injury after significant weight loss and malnutrition post-Roux-en-Y gastric bypass. On admission, she presented with steatorrhea, jaundice, and severe hepatic dysfunction. Investigations revealed vitamin A and D deficiencies, steatosis, fibrosis (F3), and severe malabsorption. Total parenteral nutrition was initiated 3 days postadmission and continued for 5.5 months. The patient achieved 8kg weight gain, normalization of liver function tests and vitamin levels, and reversal of steatosis and fibrosis (F0/S2 on repeat Fibroscan). Clinically, her symptoms resolved, and she no longer required a liver transplant. This case highlights the potential of early, sustained total parenteral nutrition in reversing acute liver injury secondary to malnutrition and underscores the importance of comprehensive nutritional support postbariatric surgery.

Anastomotic leakage after Hartmann reversal is a challenging complication with limited management options. We report a 27-year-old woman who developed a recurrent leak after reversal surgery. Instead of repeat laparotomy, she underwent combined endoscopic vacuum-assisted therapy and diverting colostomy. Serial sponge exchanges promoted cavity collapse, infection resolution, and granulation, achieving healing without permanent diversion. This case illustrates the role of endoscopic vacuum-assisted therapy as a minimally invasive salvage option for recurrent colorectal leaks, highlighting its value in preserving bowel continuity and reducing morbidity in complex surgical scenarios.

Duodenal diverticula are common but rarely complicated by abscess formation. Standard management includes antibiotics, percutaneous drainage, or surgery when minimally invasive approaches fail. We report a 75-year-old woman with a 4.4 × 4.0 cm duodenal diverticular abscess refractory to antibiotics. Endoscopic ultrasound-guided drainage with an 8 × 8 mm lumen-apposing metal stent led to immediate pus evacuation and clinical resolution. This case illustrates the expanding role of lumen-apposing metal stents as a safe, minimally invasive option for complex duodenal abscesses when conventional approaches are not feasible.

Pancreaticopleural fistula (PPF) is a rare complication of pancreatitis, occurring in <1% of cases, typically presenting with left-sided pleural effusions. Right-sided PPFs are even more uncommon, with an estimated incidence of 0.076%, which can delay recognition. We report a 50-year-old man with alcohol-related pancreatitis who developed a massive, recurrent right-sided pleural effusion. Initial thoracentesis drained 1.5 L of dark, amylase-rich fluid, followed by a subsequent single-tap drainage of 5.2 L, with a cumulative drainage volume of 13.9 L during the admission. Endoscopic retrograde cholangiopancreatography demonstrated a mid-pancreatic duct leak, and a 7 Fr × 5 cm transpapillary stent was placed. Computed tomography imaging confirmed a fistulous tract communicating with the right pleural space. Despite repeated thoracenteses, rapid reaccumulation necessitated chest tube placement. Interval chest imaging after discharge showed resolution of pleural effusion with subsequent removal of pancreatic stent. This case underscores the importance of considering right-sided PPF in patients with acute pancreatitis presenting with massive or recurrent right pleural effusions.

A 54-year-old man with hepatitis C cirrhosis presented with apparent spontaneous bacterial peritonitis, but further work-up confirmed the diagnosis of fluid overload-associated large B-cell lymphoma (FOA-LBCL). FOA-LBCL is a recently recognized entity with limited data on pathogenesis and treatment. Flow cytometry and cytological evaluation of ascitic fluid were key in establishing the diagnosis, whereas peripheral blood flow cytometry and imaging studies helped to exclude alternate infectious causes and secondary involvement by other lymphomas. We report a unique case of FOA-LBCL requiring multidisciplinary diagnosis and management.

Drug-induced liver injury describes the result of toxicity to the liver from offending drugs and/or their metabolites. Most cases are acute and resolve quickly after the medication is discontinued. It is a diagnosis of exclusion after ruling out other causes of liver injury, such as infectious and autoimmune etiologies. When drug-induced liver injury is suspected, the culprit can be determined by establishing a temporal relationship between drug exposure and the development of signs and symptoms of liver injury. In this case presentation, we discuss a patient who developed liver injury from pyridostigmine in the management of acute colonic pseudo-obstruction (Ogilvie syndrome).

Surgical clip migration is a rare but important cause of delayed postcholecystectomy complications. An 83-year-old man presented 8 years after laparoscopic cholecystectomy with abdominal pain and jaundice. Imaging showed biliary dilation with a 20-mm common bile duct stone. Endoscopic retrograde cholangiopancreatography with cholangioscopy identified a migrated surgical clip serving as the nidus. Electrohydraulic lithotripsy achieved fragmentation, followed by balloon extraction and placement of a fully covered metal stent. The patient recovered uneventfully. This case highlights the need to consider clip migration in patients with late-onset biliary obstruction after cholecystectomy and supports cholangioscopy-guided lithotripsy as a definitive therapy.