ACG Case Reports Journal最新文献

Delayed radiation-induced injuries generally manifest months to years after the completion of radiation therapy and can be challenging to diagnose and treat because of a paucity of evidence-based therapeutic options. Individuals who receive high doses of radiation therapy are more likely to experience delayed radiation injuries, but those who receive relatively low radiation doses may also rarely develop this condition. We present the case of a patient who developed delayed radiation-induced enteritis several weeks after receiving low-dose radiation therapy to the terminal ileum. The patient's signs and symptoms improved significantly after administration of hyperbaric oxygen therapy.

Intussusception involves telescoping of a proximal bowel segment into a distal segment. Non-Meckel small bowel diverticula are rare and typically asymptomatic. We report a 37-year-old man with Crohn's disease presenting with persistent abdominal pain despite normal colonoscopies and inflammatory markers. Magnetic resonance enterography and capsule endoscopy revealed concentric small bowel thickening; double-balloon enteroscopy identified a large diverticulum in the ileum. Surgical resection was performed, with pathology revealing non-Meckel diverticula, and symptom resolution postoperatively. This case underscores the importance of advanced imaging in diagnosis and consideration of small bowel diverticula in the differential diagnosis for abdominal pain.

Roux-en-Y gastric bypass (RYGB) is a widely performed bariatric procedure that rarely leads to complications involving the remnant stomach. We present the case of severe gastric outlet obstruction caused by ulceration in the remnant stomach 2 decades after RYGB. Multimodal imaging confirmed the diagnosis, with direct visualization achieved via access through a gastrostomy-tube tract. This case highlights the importance of sustained clinical vigilance with the possibility of late-onset complications of RYGB, such as remnant gastric ulcers, which may manifest long after the routine postprocedural follow-up period.

Acute esophageal necrosis and a Dieulafoy lesion are both recognized causes of upper gastrointestinal bleeding. Although exceedingly rare, prompt diagnosis and treatment are critical to prevent life-threatening complications. They both share similar risk factors which include but are not limited to advanced age, cardiovascular disease, chronic kidney disease, hypertension, and diabetes. We report a case of acute esophagus necrosis which possibly led to the development of an actively bleeding esophageal Dieulafoy lesion resulting in massive hemorrhage and cardiac arrest. To our best knowledge, this is the first known description of an actively bleeding Dieulafoy lesion occurring after the diagnosis of acute esophagus necrosis.

Crohn's disease (CD) can rarely present with extraintestinal complications involving the renal and cutaneous systems. We describe a 19-year-old man who initially presented with palpable purpura and proteinuria and was diagnosed with leukocytoclastic vasculitis and Immunoglobulin A nephropathy. He subsequently developed fecaluria and abdominal pain, and further evaluation confirmed fistulizing CD with enterovesical fistulae. Initiation of infliximab and azathioprine resulted in clinical improvement and weight gain. This case highlights that CD may exhibit atypical extraintestinal manifestations, such as cutaneous and renal manifestations, which may precede the development of full-blown fistulizing CD. Early recognition and multidisciplinary management are key to prevent complications.

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the clonal proliferation of Langerhans (CD1a/CD 207) cells. In adults, LCH is uncommon and typically presents as a multisystem disease affecting the lungs, bones, and pituitary gland. Primary hepatic involvement is exceedingly rare. We report the case of a 36-year-old man who presented with cholestatic jaundice. Subsequent lymph node and liver biopsies confirmed the diagnosis of multisystem LCH. The patient was initiated on prednisolone and demonstrated a favorable initial response. However, he ultimately succumbed to respiratory complications. This case highlights an atypical presentation of LCH where hepatic involvement preceded pulmonary symptoms. Early recognition is critical, as hepatic injury in the initial stages of LCH may be reversible.

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We present the case of a 49-year-old man with cirrhosis secondary to chronic hepatitis B and a history of Helicobacter pylori-positive gastric mucosa-associated lymphoid tissue (MALT) lymphoma, who was later found to have an incidental early-stage signet ring cell adenocarcinoma during surveillance. This case highlights the role of chronic inflammation in gastric carcinogenesis and underscores the importance of long-term endoscopic monitoring and the utility of endoscopic submucosal dissection in appropriately selected patients.