ACG Case Reports Journal最新文献

Drug-induced liver injury is one of the most common causes of acute liver failure in the Western world. Despite discontinuation of the offending agent, it can still tax a grim prognosis. We describe a case of a menopausal woman taking a herbal supplement called "Provitalize" to relieve hot flashes and bloating. This is the first case report of liver injury from this supplement. She initially presented with mild jaundice and elevated transaminases. Unfortunately, she rapidly progressed to encephalopathy, experienced multiorgan failure, and then died.

IgG4-related disease (IgG4-RD) is an autoimmune syndrome that is characterized by elevated levels of serum IgG4 and infiltration of various tissue types by IgG4 immunoreactive plasma cells. The IgG4-RD can result in systemic disease and the formation of inflammatory mass lesions, frequently addressed as pseudotumors. While IgG4-RD can manifest in various organs, liver involvement is rare, and because it is an immune-mediated inflammatory process, it is uncommon in patients who are immunocompromised. Furthermore, despite IgG4-RD responding well to immunosuppressive treatment, cases of spontaneous remission are exceedingly rare in the literature. In this report, we present the unique case of a self-resolving IgG4-RD lesion of the liver in a HIV positive patient.

The use of intestinal ultrasound (IUS) in the clinical assessment of intestinal disorders remains in its infancy in North America. We present a case in which IUS was used as a complement to Crohn's disease treatment in a 19-year-old man. After endoscopy and diagnosis, IUS was employed alongside other investigations to elucidate the extent of disease activity. It allowed identification and monitoring of complications such as free fluid and mucosal inflammation. IUS provided a marker of disease activity, even during apparent clinical remission. This case demonstrates that IUS can enhance disease monitoring and inform direction of therapy.

Duodenal diverticulitis complicated by abscess formation is a rare clinical entity, albeit may, in some cases, be associated with significant morbidity and mortality. We present a unique case that elucidates the success of endoscopic management of duodenal diverticulitis complicated by an abscess in the third part of the duodenum, through forward-viewing endoscopic maneuvers. Although surgery has been the primary interventional strategy for complicated duodenal diverticulitis beyond medical management, endoscopy is shown to be a safe and effective alternative in the clinically stable patient and/or poor surgical candidate, for this uncommon sequela of duodenal diverticulosis.

Hepatitis from nontyphoidal Salmonella gastroenteritis is rare, especially in immunocompetent patients. We present the case of a 30-year-old woman who was found to have Salmonella serotype C2 gastroenteritis and elevated liver function tests concerning for concurrent hepatitis. An extensive workup was negative for other etiologies, making Salmonella the likely culprit. The patient was managed with supportive measures as her liver function tests and symptoms were improving before obtaining microbiological data. Since the role of antibiotic therapy in such cases is not well studied, disease severity in accordance with current guidelines should be used to tailor treatment on a case-by-case basis.

A gastrogastric fistula is a delayed complication of the endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography. Endoscopic closure of these fistulae poses a significant challenge, and surgical intervention may be required in some patients. In this study, we discuss the case of a 69-year-old woman with persistent fistula following the endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography procedure. Despite the failure of conventional advanced endoscopic fistula closure methods, successful closure of the fistula was achieved using a postinfarct ventricular septal defect occluder.

Hernia repair frequently employs surgical mesh. However, potential complications exist, including mesh migration into adjacent organs, leading to serious outcomes such as enteric fistulas. We report an unprecedented case of composite mesh leading to gastric penetration and subsequent gastrocutaneous fistula formation, identified during endoscopic investigation as a foreign body. A 70-year-old man who underwent right hemicolectomy and incisional hernia repair using composite mesh presented in with symptoms of intestinal obstruction and a small bowel content leak. Following these complications, a small bowel resection was performed, and an ileostomy was created. During an endoscopic investigation, the composite mesh used in the hernia repair during the ileostomy creation was found as a foreign body penetrating the gastric antral area, causing a gastrocutaneous fistula. An exploratory laparotomy was successfully carried out. This case highlights the need to consider mesh-related complications and advocates for research into prevention and management of such adverse outcomes.