ACG Case Reports Journal最新文献

Giant common bile duct stones are hard to extract, with high adverse events and recurrence, and single treatments have limitations. This study explores managing them with endoscopic retrograde cholangiopancreatography (ERCP) combined with percutaneous transhepatic cholangial drainage (PTCD) sinus tract. A 66-year-old man with recurrent common bile duct stones (multiple large extrahepatic stones) complicated by cholangitis and acute liver failure was admitted. He first received PTCD with T-tube drainage, ERCP for stone extraction, and stent placement. Three months later, a 71 × 30-mm stone was found and successfully fragmented via PTCD sinus tract and 2 ERCP sessions with electrohydraulic lithotripsy, without complications. This combined technique enables minimally invasive staged drainage, lithotripsy, and stone extraction for complex giant stones, providing early drainage with minimal trauma and a new strategy for recurrent or high-risk patients.

A 24-year-old man with progressive dysphagia underwent submucosal tunneling endoscopic resection for a mid-esophageal leiomyoma. Within 24 hours, he developed chest pain, fever, tachycardia, and subcutaneous emphysema. CT showed bilateral pneumothorax and a periesophageal collection, and endoscopy revealed purulent discharge from the closure site. Clip removal allowed drainage, broad-spectrum antibiotics were started, and a nasojejunal tube was placed. He recovered fully with resolution of the pneumothorax, emphysema, and abscess. Follow-up endoscopy showed healed pseudodiverticula. This case highlights a rare early postsubmucosal tunneling endoscopic resection esophageal wall abscess and the value of timely recognition and endoscopic management.

The incidence of immune-related hepatitis (IRH) is rising due to increasing use of immune checkpoint inhibitors for the treatment of several malignancies. While most cases respond to corticosteroid therapy, some patients require additional immunosuppressive agents, for which evidence to guide management is still evolving. We present the first documented case of ruxolitinib use as a tertiary agent for IRH following failure of corticosteroids and tocilizumab, suggesting a potential role for Janus kinase inhibitors as a rescue therapy for severe IRH.

We present a woman in her 70s who experienced 2 episodes of pancreatitis within 4 months. She was diagnosed with a microcystic-type serous neoplasm 3 years prior. The second acute pancreatitis episode was complicated by intracystic hemorrhage due to a pseudoaneurysm, which was treated successfully with coil embolization. Although large serous neoplasms are associated with complications, a combination of recurrent pancreatitis and intracystic hemorrhage due to pseudoaneurysm is extremely rare.

Patients with chronic hepatitis B often require prolonged nucleos(t)ide analogue since functional cure is rarely achieved. Medication nonadherence can trigger life-threatening hepatitis B virus (HBV) reactivation. We report a 58-year-old Asian man with HBeAg-negative chronic hepatitis B and cirrhosis. After 10 years of entecavir therapy, he achieved undetectable HBV DNA and fibrosis regression, but quantitative hepatitis B surface antigen remained >1200 IU/mL. He self-discontinued medication and presented with severe hepatitis reactivation. Liver condition gradually improved on restarting nucleos(t)ide analogue. This case highlights that medication cessation with a high hepatitis B surface antigen titer can precipitate severe hepatitis and liver failure, even after long-term HBV DNA suppression.

A 30-year-old man with a history of liver transplantation (LT) for primary sclerosing cholangitis presented with a clinical picture compatible with ascending cholangitis. The patient was started on antibiotic therapy, and a magnetic resonance imaging with cholangiopancreatography (MRCP) revealed biliary dilation. The patient then underwent double-balloon endoscopic retrograde cholangiopancreatography (DBE-ERCP). Endoscopic findings revealed an ulcerated mass obstructing the hepatico-jejunostomy (HJ), and biopsies were taken. Pathology was compatible with nondestructive post-transplant lymphoproliferative disorder, and the patient received treatment with rituximab. Eight weeks after treatment, repeat DBE-ERCP showed resolution of the mass and a patent HJ. To our knowledge, this is the first report of a diagnosis of post-transplant lymphoproliferative disorder at the HJ after LT identified with DBE-ERCP.

We present a case of recurrent penile and scrotal swelling determined to be an extraintestinal manifestation (EIM) of Crohn's disease. Genitourinary complications are a rare EIM, with most cases reported in pediatric populations. Initial treatment assumed cellulitis, delaying appropriate care. Recognition of the swelling as an EIM allowed for targeted treatment with prednisone, leading to rapid resolution. EIMs of Crohn's disease can be difficult to identify, especially rare forms like scrotal and penile edema. Increased awareness and early recognition are essential for streamlined treatment, particularly in adult patients where such presentations are rarely reported in the literature.