Pub Date : 2024-08-22eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001471
Ayesha Khan, Julia Hawes, Julia Zhang, Ahmed Khan, Karen Szauter, Maryamnaz Falamaki, Michael L Kueht, Luca Cicalese, Sreeram Parupudi
Liver embolization is a common procedure for management of liver lesions. Embolization can be performed using only an embolic material or along with chemotherapy agents. Infrequent complications seen postliver embolization include pulmonary thromboembolism, hepatic infarct, liver abscess, liver failure, ischemic biliary strictures, and less frequently pancreatic damage (incidence of 1.7%). We describe a case of necrotizing pancreatitis after bland embolization of a large hepatic hemangioma. The exact mechanisms of acute pancreatitis after liver embolization are uncertain, although direct ischemic mechanisms, toxic effects of antineoplastic agents, and volume of embospheres used are believed to play a role.
{"title":"Necrotizing Pancreatitis After Bland Embolization of a Large Hepatic Hemangioma.","authors":"Ayesha Khan, Julia Hawes, Julia Zhang, Ahmed Khan, Karen Szauter, Maryamnaz Falamaki, Michael L Kueht, Luca Cicalese, Sreeram Parupudi","doi":"10.14309/crj.0000000000001471","DOIUrl":"10.14309/crj.0000000000001471","url":null,"abstract":"<p><p>Liver embolization is a common procedure for management of liver lesions. Embolization can be performed using only an embolic material or along with chemotherapy agents. Infrequent complications seen postliver embolization include pulmonary thromboembolism, hepatic infarct, liver abscess, liver failure, ischemic biliary strictures, and less frequently pancreatic damage (incidence of 1.7%). We describe a case of necrotizing pancreatitis after bland embolization of a large hepatic hemangioma. The exact mechanisms of acute pancreatitis after liver embolization are uncertain, although direct ischemic mechanisms, toxic effects of antineoplastic agents, and volume of embospheres used are believed to play a role.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001456
Julian Cardinal von Widdern, Franz Stangl, Walter A Wohlgemuth, Richard Brill, Jörg Kleeff, Jonas Rosendahl
Necrotizing pancreatitis with superinfection of necrotic tissue is associated with a high rate of complications and mortality. The step-up approach is a well-established treatment strategy for necrotizing pancreatitis, emphasizing minimally invasive and endoscopic interventions before considering surgical options. Minimally invasive strategies often involve percutaneous drainage of collections, which carries the risk of persisting cutaneous pancreatic fistulas. Since there is currently no guidance for managing this scenario, we present a novel treatment approach that utilized tissue glue to occlude a persisting and clinically compromising percutaneous fistula. In addition, we summarize the current knowledge in the treatment of percutaneous pancreatic fistulas and provide a potential therapeutic algorithm for further evaluation.
{"title":"Persisting Cutaneous Pancreatic Fistula in a Patient With Necrotizing Pancreatitis: A Novel Approach of Transfistulous Histoacryl Occlusion.","authors":"Julian Cardinal von Widdern, Franz Stangl, Walter A Wohlgemuth, Richard Brill, Jörg Kleeff, Jonas Rosendahl","doi":"10.14309/crj.0000000000001456","DOIUrl":"10.14309/crj.0000000000001456","url":null,"abstract":"<p><p>Necrotizing pancreatitis with superinfection of necrotic tissue is associated with a high rate of complications and mortality. The step-up approach is a well-established treatment strategy for necrotizing pancreatitis, emphasizing minimally invasive and endoscopic interventions before considering surgical options. Minimally invasive strategies often involve percutaneous drainage of collections, which carries the risk of persisting cutaneous pancreatic fistulas. Since there is currently no guidance for managing this scenario, we present a novel treatment approach that utilized tissue glue to occlude a persisting and clinically compromising percutaneous fistula. In addition, we summarize the current knowledge in the treatment of percutaneous pancreatic fistulas and provide a potential therapeutic algorithm for further evaluation.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001474
Taha Bin Arif, Bedoor Alabbas, Rakesh Vinayek
There are very few reports of bloodborne metastasis of lung adenocarcinoma to the gastrointestinal tract, primarily due to poor prognosis and short survival rate of metastasized carcinoma. We present a case of a 79-year-old man with a medical history of lung adenocarcinoma, who presented with complaints of weakness and melena for 1 week. He had symptomatic anemia, for which he was transfused with blood. Esophagogastroduodenoscopy showed a 10 mm sessile polyp in the gastric body that was removed. One month later, the patient presented with a similar complaint, and another esophagogastroduodenoscopy revealed 2 ulcerated lesions in the second portion of the duodenum. These lesions were treated by hemostatic clip placement and heater probe coagulation. Biopsy of lesions demonstrated thyroid transcription factor 1 and Napsin-positive tumor cells, consistent with lung adenocarcinoma. Owing to the poor prognosis of lung adenocarcinoma metastasizing to the lymph nodes, stomach, and duodenum, the patient was transferred to hospice care.
{"title":"Upper Gastrointestinal Bleeding Due to Metastatic Lung Adenocarcinoma in the Stomach and Duodenum.","authors":"Taha Bin Arif, Bedoor Alabbas, Rakesh Vinayek","doi":"10.14309/crj.0000000000001474","DOIUrl":"10.14309/crj.0000000000001474","url":null,"abstract":"<p><p>There are very few reports of bloodborne metastasis of lung adenocarcinoma to the gastrointestinal tract, primarily due to poor prognosis and short survival rate of metastasized carcinoma. We present a case of a 79-year-old man with a medical history of lung adenocarcinoma, who presented with complaints of weakness and melena for 1 week. He had symptomatic anemia, for which he was transfused with blood. Esophagogastroduodenoscopy showed a 10 mm sessile polyp in the gastric body that was removed. One month later, the patient presented with a similar complaint, and another esophagogastroduodenoscopy revealed 2 ulcerated lesions in the second portion of the duodenum. These lesions were treated by hemostatic clip placement and heater probe coagulation. Biopsy of lesions demonstrated thyroid transcription factor 1 and Napsin-positive tumor cells, consistent with lung adenocarcinoma. Owing to the poor prognosis of lung adenocarcinoma metastasizing to the lymph nodes, stomach, and duodenum, the patient was transferred to hospice care.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Portal cavernoma cholangiopathy refers to changes in the intrahepatic and extrahepatic biliary ducts in patients with extrahepatic portal venous obstruction. Spontaneous hemobilia in the setting of portal cavernoma cholangiopathy is extremely rare, and it poses diagnostic as well as therapeutic challenge. Here, we report the case of a 10-year-old girl with extrahepatic portal venous obstruction, who presented with hemobilia. Computed tomography angiography of abdomen and endoscopic ultrasound confirmed the presence of pericholedochal, paracholedochal, and intracholedochal varices. Hemostasis was achieved with the placement of a fully covered self-expanding metallic stent into the common bile duct. Fully covered self-expanding metallic stent is safe and effective for control of bleeding in children presenting with hemobilia.
{"title":"Successful Hemostasis Using Fully Covered Self-Expanding Metallic Stent for Spontaneous Hemobilia in a Child With Portal Cavernoma Cholangiopathy.","authors":"Arghya Samanta, Anshu Srivastava, Samir Mohindra, Rajanikant Yadav, Ujjal Poddar, Moinak Sen Sarma, Basant Kumar","doi":"10.14309/crj.0000000000001473","DOIUrl":"10.14309/crj.0000000000001473","url":null,"abstract":"<p><p>Portal cavernoma cholangiopathy refers to changes in the intrahepatic and extrahepatic biliary ducts in patients with extrahepatic portal venous obstruction. Spontaneous hemobilia in the setting of portal cavernoma cholangiopathy is extremely rare, and it poses diagnostic as well as therapeutic challenge. Here, we report the case of a 10-year-old girl with extrahepatic portal venous obstruction, who presented with hemobilia. Computed tomography angiography of abdomen and endoscopic ultrasound confirmed the presence of pericholedochal, paracholedochal, and intracholedochal varices. Hemostasis was achieved with the placement of a fully covered self-expanding metallic stent into the common bile duct. Fully covered self-expanding metallic stent is safe and effective for control of bleeding in children presenting with hemobilia.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001466
Anthony J Mauro, Phoenix D Bell, Kevin McGrath
Gastrointestinal follicular lymphoma (GI-FL) is an uncommon non-Hodgkin lymphoma that affects the gastrointestinal tract. It typically occurs within the duodenum with the appearance of multiple nodules. Treatment options, depending on stage and grade of the tumor, include aggressive chemotherapy, immunotherapy, radiotherapy, surgical or endoscopic resection, or simply monitoring as focal disease may be indolent. We present a rare case of a GI-FL presenting as a solitary lesion within the cecum treated via endoscopic full-thickness resection using the Ovesco full-thickness resection device. This case demonstrates the effectiveness of endoscopic full-thickness resection in treating small GI-FL in the colon.
{"title":"Gastrointestinal Follicular Lymphoma of the Cecum Treated via Endoscopic Full-Thickness Resection.","authors":"Anthony J Mauro, Phoenix D Bell, Kevin McGrath","doi":"10.14309/crj.0000000000001466","DOIUrl":"10.14309/crj.0000000000001466","url":null,"abstract":"<p><p>Gastrointestinal follicular lymphoma (GI-FL) is an uncommon non-Hodgkin lymphoma that affects the gastrointestinal tract. It typically occurs within the duodenum with the appearance of multiple nodules. Treatment options, depending on stage and grade of the tumor, include aggressive chemotherapy, immunotherapy, radiotherapy, surgical or endoscopic resection, or simply monitoring as focal disease may be indolent. We present a rare case of a GI-FL presenting as a solitary lesion within the cecum treated via endoscopic full-thickness resection using the Ovesco full-thickness resection device. This case demonstrates the effectiveness of endoscopic full-thickness resection in treating small GI-FL in the colon.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001470
Kais Zakharia, Venkata Muddana
Inflammatory myofibroblastic tumors are rare tumors that have been described in virtually all organs. Even though they are extremely rare in the esophagus, several cases have been described in the literature. Surgical resection has been the therapeutic modality used in most of those cases. In this report, we describe a case of inflammatory myofibroblastic tumor that was successfully managed endoscopically for the first time with the endoscopic submucosal dissection technique.
{"title":"Management of Esophageal Inflammatory Myofibroblastic Tumor With Endoscopic Submucosal Dissection.","authors":"Kais Zakharia, Venkata Muddana","doi":"10.14309/crj.0000000000001470","DOIUrl":"10.14309/crj.0000000000001470","url":null,"abstract":"<p><p>Inflammatory myofibroblastic tumors are rare tumors that have been described in virtually all organs. Even though they are extremely rare in the esophagus, several cases have been described in the literature. Surgical resection has been the therapeutic modality used in most of those cases. In this report, we describe a case of inflammatory myofibroblastic tumor that was successfully managed endoscopically for the first time with the endoscopic submucosal dissection technique.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001453
Reid Schalet, Francis Carro Cruz, Ivan Berezowski, Cyrus Adams-Mardi, Hanna Haile, Samuel A Schueler, Marie L Borum
Boerhaave syndrome, an esophageal perforation due to increased intraesophageal pressure, may mimic other cardiovascular conditions including acute coronary syndrome. In this report, we present a case of a 63-year-old man who presented with chest pain and ischemic electrocardiogram abnormalities, prompting an initial diagnosis of ST elevation myocardial infarction. After coronary stenting, the patient continued to have chest pain, ST segment elevations, and newly elevated cardiac enzymes. A computed tomography scan showed esophageal perforation, requiring endoscopic stenting. This case underscores the diagnostic and therapeutic challenges of Boerhaave syndrome and the importance of considering this condition in adults with chest pain and ischemic electrocardiogram changes.
Boerhaave 综合征是一种因食管内压增高而导致的食管穿孔,可能会诱发其他心血管疾病,包括急性冠状动脉综合征。在本报告中,我们介绍了一例 63 岁的男性患者,他出现胸痛和缺血性心电图异常,初步诊断为 ST 段抬高型心肌梗死。冠状动脉支架植入术后,患者继续出现胸痛、ST 段抬高和新的心肌酶升高。计算机断层扫描显示食管穿孔,需要进行内窥镜支架植入术。该病例强调了 Boerhaave 综合征在诊断和治疗方面的挑战,以及在成人胸痛和缺血性心电图改变时考虑该病症的重要性。
{"title":"Boerhaave Syndrome Mimicking Acute Coronary Syndrome.","authors":"Reid Schalet, Francis Carro Cruz, Ivan Berezowski, Cyrus Adams-Mardi, Hanna Haile, Samuel A Schueler, Marie L Borum","doi":"10.14309/crj.0000000000001453","DOIUrl":"10.14309/crj.0000000000001453","url":null,"abstract":"<p><p>Boerhaave syndrome, an esophageal perforation due to increased intraesophageal pressure, may mimic other cardiovascular conditions including acute coronary syndrome. In this report, we present a case of a 63-year-old man who presented with chest pain and ischemic electrocardiogram abnormalities, prompting an initial diagnosis of ST elevation myocardial infarction. After coronary stenting, the patient continued to have chest pain, ST segment elevations, and newly elevated cardiac enzymes. A computed tomography scan showed esophageal perforation, requiring endoscopic stenting. This case underscores the diagnostic and therapeutic challenges of Boerhaave syndrome and the importance of considering this condition in adults with chest pain and ischemic electrocardiogram changes.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142034876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001457
Gourav Jyoti Borah, Pritam Das, Kartik Balankhe, Naganath K Wodeyar, S Rakesh Kumar, Samir Mohindra
Hemophagocytic lymphohistiocytosis syndrome (HLH) is a rare hyperinflammatory disorder linked to acute pancreatitis. While there are only a few case reports available on this particular association, we would like to share the case of a 60-year-old man who experienced acute-onset abdominal pain typical of pancreatitis. Three days after admission, he developed fever, pancytopenia, hypertriglyceridemia, and hyperferritinemia. A bone marrow biopsy performed for evaluation of fever revealed hemophagocytosis. Initiation of treatment for HLH showed dramatic improvement. It is important to note that while HLH may be rarely associated with pancreatitis, early diagnosis and treatment is critical and can be life-saving.
{"title":"Hemophagocytic Lymphohistiocytosis Syndrome: A Rare Manifestation of Acute Pancreatitis.","authors":"Gourav Jyoti Borah, Pritam Das, Kartik Balankhe, Naganath K Wodeyar, S Rakesh Kumar, Samir Mohindra","doi":"10.14309/crj.0000000000001457","DOIUrl":"10.14309/crj.0000000000001457","url":null,"abstract":"<p><p>Hemophagocytic lymphohistiocytosis syndrome (HLH) is a rare hyperinflammatory disorder linked to acute pancreatitis. While there are only a few case reports available on this particular association, we would like to share the case of a 60-year-old man who experienced acute-onset abdominal pain typical of pancreatitis. Three days after admission, he developed fever, pancytopenia, hypertriglyceridemia, and hyperferritinemia. A bone marrow biopsy performed for evaluation of fever revealed hemophagocytosis. Initiation of treatment for HLH showed dramatic improvement. It is important to note that while HLH may be rarely associated with pancreatitis, early diagnosis and treatment is critical and can be life-saving.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our case highlights a rare instance of recurrent metastatic solid pseudopapillary epithelial neoplasms of the pancreas, emerging 8 years after radical pancreatic resection-an extended interval surpassing the reported average. Managing solid pseudopapillary epithelial neoplasm during pregnancy is uniquely challenging, given the increase in the expression of progesterone receptors during the intrapartum period, leading to tumor growth. Although surgical resection remains the primary approach, systemic chemotherapy, radiation therapy, and liver transplant are other considerations. The absence of consensus guidelines for recurrence monitoring emphasizes the need for vigilant, long-term surveillance extending beyond the conventional 5-year mark.
{"title":"Late Presentation of Recurrent Solid Pseudopapillary Pancreatic Neoplasm With Liver Metastases During Pregnancy.","authors":"Ammad Javaid Chaudhary, Taher Jamali, Yara Dababneh, Abdulmalik Saleem, Reena Salgia","doi":"10.14309/crj.0000000000001418","DOIUrl":"10.14309/crj.0000000000001418","url":null,"abstract":"<p><p>Our case highlights a rare instance of recurrent metastatic solid pseudopapillary epithelial neoplasms of the pancreas, emerging 8 years after radical pancreatic resection-an extended interval surpassing the reported average. Managing solid pseudopapillary epithelial neoplasm during pregnancy is uniquely challenging, given the increase in the expression of progesterone receptors during the intrapartum period, leading to tumor growth. Although surgical resection remains the primary approach, systemic chemotherapy, radiation therapy, and liver transplant are other considerations. The absence of consensus guidelines for recurrence monitoring emphasizes the need for vigilant, long-term surveillance extending beyond the conventional 5-year mark.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11302941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}