Pub Date : 2024-08-05eCollection Date: 2024-08-01DOI: 10.14309/crj.0000000000001407
Sérgio Manuel Tubal Bronze, Daniel Conceição, Milena Mendes, Filipe Cardoso, Daniel Torres, Elia Coimbra, Tiago Bilhim
Flexible esophagogastroduodenoscopy is the gold standard for the management of acute upper gastrointestinal bleeding. This is a case of a man who was admitted in the emergency department because of melena with hypotension because of an ulcer in the anterior face of the duodenal bulb, refractory to 3 attempts of endoscopic therapy. Then, a gastroduodenal arterial embolization was tried, being impossible because of the presence of the median arcuate ligament, compressing the celiac trunk. A balloon-expandable stent was inserted in the celiac trunk, and then, the embolization was performed. After unsuccessful endoscopic management, the arterial embolization is one of the treatment options in nonvariceal acute upper gastrointestinal bleeding.
{"title":"Refractory Duodenal Ulcer in a Patient With Median Arcuate Ligament Compression: A Treatment Challenge.","authors":"Sérgio Manuel Tubal Bronze, Daniel Conceição, Milena Mendes, Filipe Cardoso, Daniel Torres, Elia Coimbra, Tiago Bilhim","doi":"10.14309/crj.0000000000001407","DOIUrl":"10.14309/crj.0000000000001407","url":null,"abstract":"<p><p>Flexible esophagogastroduodenoscopy is the gold standard for the management of acute upper gastrointestinal bleeding. This is a case of a man who was admitted in the emergency department because of melena with hypotension because of an ulcer in the anterior face of the duodenal bulb, refractory to 3 attempts of endoscopic therapy. Then, a gastroduodenal arterial embolization was tried, being impossible because of the presence of the median arcuate ligament, compressing the celiac trunk. A balloon-expandable stent was inserted in the celiac trunk, and then, the embolization was performed. After unsuccessful endoscopic management, the arterial embolization is one of the treatment options in nonvariceal acute upper gastrointestinal bleeding.</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/PMC11302938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896461","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 : 2024-07-27DOI: 10.14309/crj.0000000000001432
Jordan L. Pace, Michelle D. Hopstone, Peter S. Conti, Chloe K. Tom, Passant Mohamed, Yuna Gong, Vidyadhari Karne, Yuri Genyk, Navpreet Kaur, Jeffrey A. Kahn
We present a 49-year-old woman requiring living donor liver transplantation after liver metastasis from a pancreatic solid pseudopapillary tumor. After identifying a pancreatic mass and liver lesions, she underwent extensive surgical resection. Pathology revealed a solid pseudopapillary neoplasm of the head and body of the pancreas, extending into the peripancreatic soft tissues and confirmed to have spread to the liver. Subsequently, she underwent adjuvant chemotherapy and radiofrequency ablations of the new liver lesions. Despite immunotherapy and chemotherapy, there was a progression of the lesions. With interval growth of liver lesions, without evidence of extrahepatic disease, she underwent living donor liver transplantation.
{"title":"Unresectable Metastatic Solid Pseudopapillary Pancreatic Neoplasm Treated With Liver Transplantation","authors":"Jordan L. Pace, Michelle D. Hopstone, Peter S. Conti, Chloe K. Tom, Passant Mohamed, Yuna Gong, Vidyadhari Karne, Yuri Genyk, Navpreet Kaur, Jeffrey A. Kahn","doi":"10.14309/crj.0000000000001432","DOIUrl":"https://doi.org/10.14309/crj.0000000000001432","url":null,"abstract":"\u0000 We present a 49-year-old woman requiring living donor liver transplantation after liver metastasis from a pancreatic solid pseudopapillary tumor. After identifying a pancreatic mass and liver lesions, she underwent extensive surgical resection. Pathology revealed a solid pseudopapillary neoplasm of the head and body of the pancreas, extending into the peripancreatic soft tissues and confirmed to have spread to the liver. Subsequently, she underwent adjuvant chemotherapy and radiofrequency ablations of the new liver lesions. Despite immunotherapy and chemotherapy, there was a progression of the lesions. With interval growth of liver lesions, without evidence of extrahepatic disease, she underwent living donor liver transplantation.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141797909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.14309/crj.0000000000001333
Syed Murtaza Haider Zaidi, Ramsha Haider, Syeda Amna Batool Kazmi, Ali Husnain, Saniah Khan, Sabrina Merchant, H. Tayyab, F. R. Wazeen, A. Chaudhary
{"title":"Beyond Antibiotics: Novel Approaches in the Treatment of Recurrent Clostridioides difficile Infection","authors":"Syed Murtaza Haider Zaidi, Ramsha Haider, Syeda Amna Batool Kazmi, Ali Husnain, Saniah Khan, Sabrina Merchant, H. Tayyab, F. R. Wazeen, A. Chaudhary","doi":"10.14309/crj.0000000000001333","DOIUrl":"https://doi.org/10.14309/crj.0000000000001333","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastric signet ring cell adenocarcinoma (SRCA) is an aggressive malignancy primarily diagnosed in advanced stages. Metastasis to other organ systems is uncommon, however, associated with poor prognosis. We present a young patient with persistent pain in the testicle. Histopathologic examination of the resected testicle revealed metastatic signet ring adenocarcinoma prompting follow-up endoscopy with biopsy confirming gastric SRCA. After 10 months of systemic chemotherapy, the patient developed worsening headaches, and cerebrospinal fluid cytology confirmed leptomeningeal metastasis. This case underscores the rare manifestation of SRCA and the importance of vigilance for atypical presentations to ensure timely diagnosis and management.
{"title":"Gastric Signet Ring Cell Adenocarcinoma With Metastasis to the Testicles and Leptomeninges","authors":"Hamzah Shariff, Tristan Luu, Haluk Kavis, Joshua Obuch","doi":"10.14309/crj.0000000000001419","DOIUrl":"https://doi.org/10.14309/crj.0000000000001419","url":null,"abstract":"\u0000 Gastric signet ring cell adenocarcinoma (SRCA) is an aggressive malignancy primarily diagnosed in advanced stages. Metastasis to other organ systems is uncommon, however, associated with poor prognosis. We present a young patient with persistent pain in the testicle. Histopathologic examination of the resected testicle revealed metastatic signet ring adenocarcinoma prompting follow-up endoscopy with biopsy confirming gastric SRCA. After 10 months of systemic chemotherapy, the patient developed worsening headaches, and cerebrospinal fluid cytology confirmed leptomeningeal metastasis. This case underscores the rare manifestation of SRCA and the importance of vigilance for atypical presentations to ensure timely diagnosis and management.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.14309/crj.0000000000001452
Scott Edelson, Cyrus V. Edelson, Jacob Jones, John G. Quiles
Enterovaginal fistulas (EF) are a rare, pathologic connection between the small bowel and vagina. EF commonly present with abnormal passage of stool, flatus, and purulence through the vaginal orifice, leading to increased risk of severe infections, and cause extreme discomfort for patients. A 70-year-old woman with a history of urothelial carcinoma was treated surgically, resulting in a persistent symptomatic EF. Her course was complicated by multiple failed surgical attempts to fistula closure. Ultimately, she was deemed a poor surgical candidate. Gastroenterology successfully closed her fistula using a cardiac occluder device. This case highlights an innovative solution to treat patients with refractory fistulas.
{"title":"Endoscopic Deployment of Cardiac Septal Occluder Device to Close an Enterovaginal Fistula","authors":"Scott Edelson, Cyrus V. Edelson, Jacob Jones, John G. Quiles","doi":"10.14309/crj.0000000000001452","DOIUrl":"https://doi.org/10.14309/crj.0000000000001452","url":null,"abstract":"\u0000 Enterovaginal fistulas (EF) are a rare, pathologic connection between the small bowel and vagina. EF commonly present with abnormal passage of stool, flatus, and purulence through the vaginal orifice, leading to increased risk of severe infections, and cause extreme discomfort for patients. A 70-year-old woman with a history of urothelial carcinoma was treated surgically, resulting in a persistent symptomatic EF. Her course was complicated by multiple failed surgical attempts to fistula closure. Ultimately, she was deemed a poor surgical candidate. Gastroenterology successfully closed her fistula using a cardiac occluder device. This case highlights an innovative solution to treat patients with refractory fistulas.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.14309/crj.0000000000001428
Anthony A. Xu, Sara Vincent, Samuel Ma, Vanessa Catania, Neda Zarrin-Khameh
Extraintestinal manifestations of inflammatory bowel disease occur commonly and can lead to considerable morbidity. Pancreatic manifestations of inflammatory bowel disease have been reported to be more common in Crohn's disease (CD) than ulcerative colitis. We report a case of granulomatous inflammation in the body of the pancreas with exocrine pancreatic insufficiency, which prompted a diagnosis switch from ulcerative colitis to CD. This is of interest to readers to remind them that pancreatic manifestations can occur and are more common in CD.
炎症性肠病的肠外表现很常见，可导致相当高的发病率。据报道，炎症性肠病的胰腺表现在克罗恩病（CD）中比溃疡性结肠炎更常见。我们报告了一例胰腺体肉芽肿性炎症伴胰腺外分泌功能不全的病例，该病例促使诊断从溃疡性结肠炎转为克罗恩病。这对读者很有意义，提醒他们胰腺表现可能发生，而且在 CD 中更为常见。
{"title":"Crohn's Disease–Associated Granulomatous Pancreatitis With Exocrine Pancreatic Insufficiency","authors":"Anthony A. Xu, Sara Vincent, Samuel Ma, Vanessa Catania, Neda Zarrin-Khameh","doi":"10.14309/crj.0000000000001428","DOIUrl":"https://doi.org/10.14309/crj.0000000000001428","url":null,"abstract":"\u0000 Extraintestinal manifestations of inflammatory bowel disease occur commonly and can lead to considerable morbidity. Pancreatic manifestations of inflammatory bowel disease have been reported to be more common in Crohn's disease (CD) than ulcerative colitis. We report a case of granulomatous inflammation in the body of the pancreas with exocrine pancreatic insufficiency, which prompted a diagnosis switch from ulcerative colitis to CD. This is of interest to readers to remind them that pancreatic manifestations can occur and are more common in CD.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) is a type of malignancy that usually appears as a tumor in the bone. However, in a few patients with ES/PNET, it can occur outside of the bone. Although extraosseous ES/PNET can appear in various parts of the body, involvement of small bowel is rare. If it does, it can present with vague abdominal pain and gastrointestinal bleeding. This case report presents a 28-year-old gentleman with extraosseous ES/PNET in the duodenum who experienced gastrointestinal bleeding as a presenting symptom.
{"title":"Extraosseous Ewing Sarcoma With Upper Gastrointestinal Bleeding","authors":"Ajay Kumar Yadav, Milan Shrestha, Sabin Rajbhandari, Roshan Kafle, Swarup Shrestha, Dibas Khadka, Saugat Poudel, Mukesh Paudel","doi":"10.14309/crj.0000000000001447","DOIUrl":"https://doi.org/10.14309/crj.0000000000001447","url":null,"abstract":"\u0000 Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) is a type of malignancy that usually appears as a tumor in the bone. However, in a few patients with ES/PNET, it can occur outside of the bone. Although extraosseous ES/PNET can appear in various parts of the body, involvement of small bowel is rare. If it does, it can present with vague abdominal pain and gastrointestinal bleeding. This case report presents a 28-year-old gentleman with extraosseous ES/PNET in the duodenum who experienced gastrointestinal bleeding as a presenting symptom.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141797858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.14309/crj.0000000000001385
Muhammed Yaman Swied, Yahia Al Turk, Michael Maitar
Appendiceal tumors are rare and are most commonly diagnosed incidentally during surgical removal of the appendix for acute appendicitis. Appendiceal adenocarcinomas are the most common appendiceal cancers, and their metastasis to the breast is extremely uncommon. We report a case of mucinous appendiceal adenocarcinoma presenting with breast metastasis. To the best of our knowledge, there has been only one case published in the literature about appendiceal cancer with metastasis to the breast. Interestingly, our patient's initial presentation was palpable breast masses rather than gastrointestinal symptoms.
{"title":"Appendiceal Adenocarcinoma Presenting as Palpable Breast Masses","authors":"Muhammed Yaman Swied, Yahia Al Turk, Michael Maitar","doi":"10.14309/crj.0000000000001385","DOIUrl":"https://doi.org/10.14309/crj.0000000000001385","url":null,"abstract":"\u0000 Appendiceal tumors are rare and are most commonly diagnosed incidentally during surgical removal of the appendix for acute appendicitis. Appendiceal adenocarcinomas are the most common appendiceal cancers, and their metastasis to the breast is extremely uncommon. We report a case of mucinous appendiceal adenocarcinoma presenting with breast metastasis. To the best of our knowledge, there has been only one case published in the literature about appendiceal cancer with metastasis to the breast. Interestingly, our patient's initial presentation was palpable breast masses rather than gastrointestinal symptoms.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141797848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.14309/crj.0000000000001446
Fares A. Mashal, Joseph A. Awad, Benjamin F. Tillman, Claudio A. Mosse, R. Thandassery
Idiopathic multicentric Castleman disease is a rare lymphoproliferative disorder that can be potentially fatal without timely diagnosis and treatment. We describe the first-ever reported occurrence of idiopathic multicentric Castleman disease with thrombocytopenia, anasarca, fever, reticulin fibrosis/renal insufficiency, and organomegaly syndrome in a liver transplant recipient. The diagnosis was challenging as the clinical presentation closely mimicked decompensated cirrhosis, and the profound thrombocytopenia limited tissue diagnosis. However, we were able to establish the diagnosis and treat it effectively. This case report signifies that a high index of suspicion and aggressive treatment can be lifesaving in liver transplant recipients presenting with this rare disorder.
{"title":"Idiopathic Multicentric Castleman Disease With Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis/Renal Insufficiency, and Organomegaly (TAFRO) Syndrome in a Liver Transplant Recipient","authors":"Fares A. Mashal, Joseph A. Awad, Benjamin F. Tillman, Claudio A. Mosse, R. Thandassery","doi":"10.14309/crj.0000000000001446","DOIUrl":"https://doi.org/10.14309/crj.0000000000001446","url":null,"abstract":"\u0000 Idiopathic multicentric Castleman disease is a rare lymphoproliferative disorder that can be potentially fatal without timely diagnosis and treatment. We describe the first-ever reported occurrence of idiopathic multicentric Castleman disease with thrombocytopenia, anasarca, fever, reticulin fibrosis/renal insufficiency, and organomegaly syndrome in a liver transplant recipient. The diagnosis was challenging as the clinical presentation closely mimicked decompensated cirrhosis, and the profound thrombocytopenia limited tissue diagnosis. However, we were able to establish the diagnosis and treat it effectively. This case report signifies that a high index of suspicion and aggressive treatment can be lifesaving in liver transplant recipients presenting with this rare disorder.","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141798590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20eCollection Date: 2024-07-01DOI: 10.14309/crj.0000000000001449
Katherine Shepherd, George Obeng, Cara Randall, Joanna Kolodney, Megan Willard
Multiple myeloma (MM) is a disease of plasma cell replication, leading to a disruption of hematopoiesis, which commonly presents clinically with anemia and fatigue. Extramedullary myelomas are plasma cell collections in bone or soft tissue associated with MM and most often occur later in the disease process. We present a case of a patient with symptomatic anemia with actively bleeding gastric nodules, which were later found to be extramedullary gastric myelomas when pathology demonstrated kappa-restricted plasma cell neoplasms. To confirm the overall diagnosis, a bone marrow biopsy verified the patient had MM.
{"title":"Unveiling Multiple Myeloma: Actively Bleeding Extramedullary Gastric Myelomas Lead to Diagnosis.","authors":"Katherine Shepherd, George Obeng, Cara Randall, Joanna Kolodney, Megan Willard","doi":"10.14309/crj.0000000000001449","DOIUrl":"10.14309/crj.0000000000001449","url":null,"abstract":"<p><p>Multiple myeloma (MM) is a disease of plasma cell replication, leading to a disruption of hematopoiesis, which commonly presents clinically with anemia and fatigue. Extramedullary myelomas are plasma cell collections in bone or soft tissue associated with MM and most often occur later in the disease process. We present a case of a patient with symptomatic anemia with actively bleeding gastric nodules, which were later found to be extramedullary gastric myelomas when pathology demonstrated kappa-restricted plasma cell neoplasms. To confirm the overall diagnosis, a bone marrow biopsy verified the patient had MM.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747149","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号