ACG Case Reports Journal最新文献

Dysphagia is a common symptom after magnetic sphincter augmentation, a minimally invasive antireflux alternative to laparoscopic Nissen fundoplication. A 69-year-old woman underwent LINX procedure in 2017 for GERD symptoms, after which she had the onset of dysphagia. EndoFLIP demonstrated narrowing and stiffness at lower volumes but acceptable distensibility at the largest balloon volume. The treatment plan aimed to improve swallowing by ingesting larger solid boluses and avoiding additional invasive procedures. This visualization of the obstruction on EndoFLIP presented a more physiologic approach to treatment with ingesting larger, rather than smaller, solid food boluses.

Endoscopic balloon dilation is an established option for the management of fibrostenosing Crohn's disease (CD). Transmural assessment by cross-sectional imaging in addition to endoscopy is imperative for the management of patients with stenoses. Intestinal ultrasound (IUS) is a noninvasive, relatively inexpensive, point-of-care disease monitoring tool being incorporated into daily clinical practice in inflammatory bowel disease. With the rise in IUS utilization in the management of CD, there are opportunities to understand the pathophysiology of this condition and its treatment in new ways. We describe the first successful IUS-guided endoscopic balloon dilation in a patient with fibrostenotic CD who presented with bowel obstruction.

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.

Efavirenz is a non-nucleoside reverse transcriptase inhibitor widely used in HIV treatment. Although generally well-tolerated, rare cases of severe hepatotoxicity have been reported. We present a case of a patient on efavirenz-based highly active antiretroviral therapy who developed jaundice and marked transaminitis 1 year after initiation. Infectious, autoimmune, and toxic causes were ruled out, and genetic testing revealed no metabolic abnormalities. Treatment involved corticosteroids, immunosuppressants, and switching to dolutegravir, leading to resolution. This is the first documented case in the Philippines of delayed-onset efavirenz-induced liver injury, underscoring the importance of ongoing liver monitoring during antiretroviral therapy.

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.