Case Reports in Gastroenterology最新文献

Introduction: Aseptic hepatic abscesses are a highly uncommon phenomenon and even more rare in the spectrum of extraintestinal manifestations of inflammatory bowel disease. Part of the spectrum of "neutrophilic disease," both the pathogenesis and the optimal management of these aseptic abscesses remain unclear. In the context of inflammatory bowel disease, sometimes these abscesses appear despite normal endoscopic findings.

Case presentation: We describe a highly uncommon case of aseptic hepatic abscess formation in a patient with inflammatory bowel disease.

Conclusion: In doing so, we investigated the concept of "aseptic abscess syndrome" as it relates to similar autoimmune conditions.

Introduction: Diagnostic physicians tend to judge a low-dense area on computed tomography (CT) as central necrosis when it has no contrast enhancement and locates in the center of large tumors.

Case presentation: An 80-year-old woman was referred to our hospital due to the detection of an abdominal mass on ultrasound (US). CT showed a well-demarcated oval mass, 11 cm in size, with a central low-density area. US showed high internal echoes and enhanced posterior echoes. Magnetic resonance imaging (MRI) showed the low-density area on CT to be hypo-intense on T1-weighted images and hyper-intense on T2-weighted images. MRI further showed the central part of the tumor to be hyper-intense both on diffusion-weighted images and apparent diffusion coefficient images. Under the tentative diagnosis of a gastrointestinal stromal tumor with central necrosis, the patient underwent tumor resection, revealing the tumor to be a jejunal submucosal tumor. Pathological study showed collagen fibers with heterogeneous density and sparse proliferation of spindle cells. The center of the tumor had marked edema in addition to sparse collagen fibers. Immunostaining showed that the atypical cells were diffusely positive for β catenin and negative for S100 protein, desmin, and DOG1, leading to the diagnosis of desmoid tumor (DT).

Conclusions: Physicians should note that intra-abdominal DT can have edematous loose collagen fibers and may show central necrosis-like findings on CT.

Introduction: Turmeric is a common spice used in traditional Chinese and Ayurvedic medicine for a variety of purported health benefits. Recent concerns have arisen regarding turmeric-induced liver injury linked to formulations with enhanced bioavailability, often including piperine found in black pepper.

Case presentation: We explore a case of a 40-year-old female with increasing fatigue, pruritus, and dark urine following consumption of turmeric and black pepper "wellness shots" leading to a significant drug-induced liver injury.

Conclusion: This case underscores the critical need to recognise herbal remedies, such as turmeric, as potential sources of hepatotoxicity. Despite a reputation of safety, limited regulation and testing of turmeric may mean potential adverse effects are under-recognised. Understanding the mechanisms behind turmeric and black pepper's hepatotoxicity, including the role of potential genetic predispositions, requires further investigation for its safe use.

Introduction: Recent-onset colitis poses a diagnostic challenge, necessitating a thorough evaluation to identify potential infectious and non-infectious etiologies. We considered inflammatory bowel disease (IBD) secondary to dipeptidyl peptidase 4 (DPP-4) inhibitor-induced colitis.

Case presentation: This case report details the presentation and management of a patient with persistent dysentery, refractory to conventional treatments, ultimately attributed to IBD possibly secondary to long-term DPP-4 inhibitor use. Following an episode of suspected amebiasis, the patient experienced prolonged bloody diarrhea with an endoscopic image compatible with ulcerative colitis. Extensive infectious diagnostics were negative. Ultimately, the cessation of sitagliptin therapy resulted in rapid symptom resolution and normalization of eosinophilia, as well as endoscopic improvement. However, after a few weeks, the patient was readmitted with diarrhea after continued cessation of sitagliptin.

Conclusion: This case underscores the importance of considering IBD secondary to DPP-4 inhibitor use in the evaluation of patients with recent-onset IBD. Further research is needed to elucidate the pathophysiological mechanisms underlying the relationship between DPP-4 inhibitors and IBD.

Introduction: Intra-abdominal hemorrhage is a rare yet life-threatening complication of acute pancreatitis (AP), with a higher prevalence in cases of severe acute pancreatitis (SAP). This condition is primarily caused by vessel wall erosion and rupture of pseudoaneurysms (PSAs). However, SAP cases involving multiple sequential arterial hemorrhages are extremely rare. This condition is primarily brought on by the process of vessel wall degeneration and the development of PSAs. Nonetheless, SAP necessitating multiple episodes of arterial bleeding is very uncommon.

Case presentation: Here is the case history of a 31-year-old man already being treated for SAP. His condition was then complicated by massive, frequent intra-abdominal bleeding. The patient initially presented to the hospital with SAP. He was transferred to the intensive care unit for proper management. Massive intra-abdominal bleeds occurred on the 31st, 45th, and 60th days during hospitalization. The maximum blood loss was 1,500 mL. In each of the instances, digital subtraction angiography (DSA) embolization was carried out after the bleeding source had been verified. In order to manage SAP, continuous percutaneous drainage and staged pancreatic necrosectomy were undertaken for 6 months. No recurrence of intra-abdominal hemorrhage was detected. Infection of the abdominal cavity was properly controlled. The patient left the hospital in good condition.

Conclusion: Spontaneous bleeding in the abdominal cavity is a severe and life-threatening complication of SAP. This is often caused by vessel wall erosion. In such cases, DSA plays a crucial role in diagnosis and management. Besides precisely locating the bleeding source, one can perform a much-needed embolization immediately. Consequently, the disease is under total control, and the patient is much more likely to survive.

Introduction: We report the case of a 60-year-old female with a history of perforated gastric ulcer, abdominal abscesses, enterocutaneous fistula, and small bowel obstruction requiring durable gastric decompression prior to delayed fistula takedown. The patient had contraindications to or failed attempts at traditional gastrostomy approaches (surgical, endoscopic, interventional radiology).

Case report: Gastrostomy was successfully performed via a novel technique combining interventional radiology and endoscopic placement.

Discussion: In certain patients with complex presentations, a hybrid approach to gastrostomy tube placement using fluoroscopy and endoscopy may prove a viable alternative when traditional methods are contraindicated or unsuccessful.

Introduction: Esophageal variceal bleeding (EVB) is a common complication of portal hypertension. Guidelines recommend initiation of vasoactive agents in combination with antimicrobial therapy prior to endoscopic variceal ligation. In cases of refractory EVB, trans-jugular intrahepatic portosystemic shunt (TIPSS) is recommended; however, it is contraindicated in up to 35% of cases.

Case presentation: We report a case of a 61-year-old male newly diagnosed with hepatocellular carcinoma and extensive portal vein thrombosis. The patient developed a refractory EVB failing medical and endoscopic therapies which was successfully treated with transcutaneous left gastric vein embolization (LGVE).

Conclusion: LGVE could be contemplated in instances where anatomical complexities or contraindications to TIPSS arise.

Introduction: Vedolizumab is a commonly prescribed biologic agent due to its safety profile and clinical efficacy. Severe infusion-related reactions are exceedingly rare, with no previously documented cases of anaphylaxis to vedolizumab infusion following a drug holiday.

Case presentation: We report the case of a 65-year-old male with ulcerative colitis who had a severe anaphylactic reaction to the first re-induction infusion of vedolizumab following a 30-month drug holiday. No pre-infusion prophylactic medication was administered. Upon commencement of the infusion, the patient developed anaphylactic symptoms including airway compromise that required intensive care unit admission and treatment with an adrenaline infusion.

Conclusion: Anaphylactic reactions to vedolizumab after a drug holiday can occur. As is done for infliximab, we recommend administration of an antipyretic, antihistamine, and corticosteroid prior to vedolizumab re-induction infusions when it is given after a drug holiday.

Introduction: Patients with short bowel syndrome (SBS) on conventional oral diets often face nutritional deficiencies and dehydration, a challenge further compounded during pregnancy. This case report describes the use of a glucagon-like peptide-2 (GLP-2) analog in the nutritional management of an SBS patient dependent on total parenteral nutrition (TPN).

Case presentation: A 29-year-old woman with a significant medical history of Crohn's disease leading to SBS was traditionally dependent on TPN for sustenance. During her pregnancy, she was successfully managed with a GLP-2 analog, which enabled her to wean off TPN. This successful management underscores the therapeutic potential of GLP-2 analogs in effectively altering the nutritional landscape for SBS patients, including during the physiologically demanding period of pregnancy.

Conclusion: GLP-2 analogs helped with the nutritional management of patients with SBS during pregnancy and helped them wean off TPN. There is a need for further research and exploration into GLP-2 analogs as viable alternatives to conventional treatments such as TPN in the care and management of SBS patients during pregnancy.

Introduction: Dieulafoy lesion is one of the most under-recognized sources of gastrointestinal (GI) bleeding (GI), typically manifesting as acute upper gastrointestinal bleeding; endoscopy is usually the first diagnostic and therapeutic modality utilized to handle these lesions by employing a variety of procedures.

Case report: This is a case of an 81-year-old female who was being assessed after experiencing repeated bouts of melena with hemoglobin drop. The patient had multiple comorbidities but no history of gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) revealed only Erythematous duodenopathy without active bleeding; the initial colonoscopy revealed a large amount of blood without identifying the source of bleeding; a second colonoscopy revealed classic Dieulafoy lesions in the splenic flexure, which were injected and clipped, and the bleeding ceased.

Conclusion: Dieulafoy lesions are most frequently found in the stomach and gastroesophageal junction, but they have also been documented in other parts of the gastrointestinal tract. In this particular instance, the lesions were identified in the colon, which is an unusual location for them, and they were treated endoscopically by clipping and injecting. In conclusion, colonic Dieulafoy lesions, although rare, have the potential to cause life-threatening bleeding and should be included in the differential diagnosis of lower gastrointestinal bleeding.