Case Reports in Gastroenterology最新文献

Introduction: Vesico-peritoneal fistula (VPF) is an uncommon type of fistula in the urogenital tract and a rare cause of ascites.

Case presentation: Although VPF mainly occurs as an early postoperative complication of gynecological surgery, we report a case of a 71-year-old female patient who presented with ascites, pseudo-renal failure, and peritonitis caused by a VPF as a delayed complication of radiotherapy.

Conclusion: In this case report, we discuss treatment strategies based on previously published case studies and our experience. We provide a diagnostic overview of commonly available imaging techniques, such as computed tomography scans and magnetic resonance imagings. Despite their widespread use, these imaging modalities have not led to any shift in the diagnostic process, with the definitive diagnosis being confirmed only by retrograde cystography.

Introduction: Spinal cord stimulation (SCS) for chronic abdominal pain is not novel. However, this has been explored only when the pain has a clear dermatomal association such as the right upper quadrant for sphincter of Oddi dysfunction or the left upper quadrant for post-traumatic splenectomy. The present report thereby discusses the utility of SCS when the visceral pain is diffusely distributed across all four quadrants of the abdomen.

Case presentation: A patient in their 70s presented with a 30-year history of chronic abdominal pain diffusely located in all four quadrants. The patient had a pancreatic cyst removed via pancreaticoduodenectomy in 1991 complicated by chronic pancreatitis and visceral hyperalgesia. After failed pharmacological management and various outpatient nerve blocks and trigger point injections, the patient underwent SCS placement via five 4-contact paddle leads at the mid- to superior thoracic 7 level. At 1-month follow-up, the patient's visual analog scale score decreased from 8/10 (prior to implantation) to 0/10. The patient also discontinued his chronic opioid regimen post-SCS placement but continued duloxetine. Device settings remained the same throughout the postoperative period: pulse width of 500 microseconds (inter-burst) and 1,000 microseconds, frequency of 40 Hertz, and current of 1.7 milliamperes. At 12-month follow-up, the patient continued to report >90% pain relief at nearly the same SCS settings as the initial programming.

Conclusion: SCS may be a reliable treatment option for chronic abdominal, visceral hyperalgesia when the pain is diffusely located in all 4 quadrants and without a clear dermatomal pattern.

Introduction: The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical discectomy and fusion (ACDF) surgery.

Case presentation: An 83-year-old male experienced dysphagia >2 months post-ACDF. The patient presented with a narrowed pharyngoesophageal segment due to cervical hardware and reduced epiglottic inversion due to pharyngeal narrowing on videofluoroscopic swallow study (VFSS). He completed dysphagia therapy using neuromuscular electrical stimulation (NMES). Structural alterations and a complicated medical course after treatment impacted therapeutic outcomes. Reductions in penetration or aspiration and improved hyoid excursion were found post-treatment, though impairment persisted. The patient ended therapy after the post-treatment VFSS and began to experience odynophagia and submental pain. The patient experienced a complicated post-treatment course including bilateral cancerous masses at the base of tongue with subsequent surgery and chemoradiation.

Conclusions: While considered rare, these findings present a post-operative course of chronic dysphagia post-ACDF surgery where morphological changes to the pharynx significantly altered swallowing function. Swallowing function should be tracked routinely and longitudinally in post-ACDF surgery patients. NMES may be a potential dysphagia therapy modality to explore.

Introduction: Splenic artery aneurysm (SAA) is a rare but potentially life-threatening condition. SAA can occur following an acute or chronic pancreatitis as a pseudoaneurysm, iatrogenic (post-pancreatic/splenic surgery) or post-traumatic. If symptomatic, it needs to be treated urgently as it has a high risk of rupture.

Case presentation: Here is a case where a ruptured aneurysm presented in an unusual manner: first as an acute abdomen and second, delayed, as hemorrhagic shock. Only emergency laparotomy and splenectomy saved the patient's life.

Conclusion: If a splenic artery pseudoaneurysm is detected on CT scan, there is an increased risk of rupture irrespective of the size and the patient that should be proactively managed. Concomitant abdominal findings and diseases can delay diagnosis and underestimate the risk.

Introduction: Hepatitis E virus (HEV) is a global cause of acute viral hepatitis, for which there is currently no FDA-approved medication. This case report describes a unique instance of a healthy US female presenting with acute HEV, who was treated with ribavirin to address her acute liver injury.

Case presentation: A 36-year-old US female, nonpregnant, without liver disease, developed nonspecific symptoms post-travel to Indonesia, leading to acute liver injury with concern for failure. Liver biopsy showed severe hepatocellular necrosis (>50%) with mixed infiltrate; HEV PCR was positive (93,700,000 IU/mL) [Am J Gastroenterol. 2024;119(10S):S2872-3]. After risk-benefit analysis, ribavirin treatment resolved symptoms and normalized biomarkers in a month, avoiding emergency transplantation.

Conclusion: HEV infection should be considered in acute liver injury cases in the US, especially with exposure risks. Ribavirin's role in acute cases warrants further study, potentially averting major morbidity and mortality.

Introduction: There is an increased incidence of opioid use disorder (OUD) originating from prescription misuse. Diagnosing OUD remains challenging, particularly in patients with multiple medical comorbidities where other potential etiologies may cause overlapping symptoms.

Case presentation: This report highlights a 28-year-old male with Crohn's disease (CD) with recurrent hospitalizations of abdominal pain, hematuria, nausea, vomiting, and diarrhea. An extensive workup was negative for a Crohn's flare; however, the patient's symptoms improved within 48 h of admission, coinciding with opioid administration for pain management. Subsequently, the patient was diagnosed with opioid withdrawal and discharged with a buprenorphine clinic appointment to initiate medications for OUD.

Conclusion: This case highlights the complexity of diagnosing opioid withdrawal in a patient with CD and the persistent stigma in the healthcare community regarding persons who use opioids.

Introduction: Curcumin and QingDai (QD, indigo) are two herbal extracts used in traditional medicine. A combination of curcumin with QD (CurQD) was reported to be effective in ulcerative colitis, but its effectiveness in Crohn's disease (CD) is unknown. We report on the use of CurQD for the treatment of CD.

Case presentation: The patient was a 35-year-old male with colonic and perianal CD responsive to infliximab therapy, who had to discontinue therapy due to a concomitant cardiomyopathy diagnosis. After cessation of infliximab treatment, he experienced clinical and endoscopic relapse which responded to initiation of CurQD therapy with regained clinical and endoscopic remission.

Conclusion: In summary, the present case report describes, for the first time, a possible benefit of CurQD nutraceutical in the induction and maintenance of remission in a Crohn's patient. However, more data, preferably from adequately powered randomized controlled trials, are needed to corroborate these observations.

Introduction: Hypergastrinemia in a patient with refractory reflux, steatorrhea, or peptic ulcer disease with a gastric pH <4 is concerning for Zollinger-Ellison syndrome (ZES), but antral G-cell hyperplasia can also present in this manner and is distinguished from ZES based on negative radiographic studies and secretory stimulation testing with a typical gastrin response to a standardized test meal.

Case presentation: A 51-year-old female with a history of a Nissen fundoplication for refractory reflux presented with a 3-month history of heartburn, diarrhea, and 55-pound weight loss. Evaluation included negative upper and lower endoscopies with biopsies and negative MR enterography. A 48-h fecal fat study revealed 501 g of stool and 51 g of fat per 24 h. A serum gastrin level off PPI was elevated at 589 pg/mL with a gastric pH of 2 on gastric aspirate. An EUS, DOTATATE PET scan, and secretin stimulation test were negative for ZE. A standardized test meal with serial gastrin monitoring demonstrated an 8-fold increase in serum gastrin. Open abdominal exploration and intraoperative ultrasound showed no evidence of a gastrinoma and an antrectomy and Billroth II anastomosis was performed in treatment of G-cell hyperplasia. Pathology demonstrated a moderately increased G-cell population. Postoperatively, her hypergastrinemia and steatorrhea resolved and she regained 60 pounds.

Conclusion: Antral G-cell hyperplasia should be considered in patients with symptoms suggestive of gastrinoma with negative secretin stimulation testing and imaging studies. A standardized test meal demonstrates a substantial increase in serum gastrin levels and antrectomy is the treatment of choice for refractory symptoms.

Introduction: For aviation personnel, calculous cholecystitis often requires surgical treatment because of the potential risks to flight safety whether symptomatic or asymptomatic. Although much effort has been put on the precaution of gallstone formation, the incidence of long-term post-cholecystectomy syndrome (PCS) seems more apparent in the limited number of cases undergoing cholecystectomy. The purpose of article was to elucidate the possible mechanism of gallstone formation and the development of long-term PCS caused by variations of bile duct, as well as choice of surgical treatments, just in this particular group of aviation personnel.

Case presentation: Seven aviation pilots who underwent laparoscopic cholecystectomy in recent 5 years were reviewed, and 3 cases who developed long-term PCS because of variations of bile duct were presented. Variations of bile duct included existence of accessory extrahepatic bile, absence of common bile duct, and absence of cystic duct. Long-term PCS was characterized as epigastric dull pain and diarrhea or sparse stool, and became aggravated when resuming trainings of flight stimulations. Dietary adjustment and oral antispasmodic or cholagogic drug therapy, combined with relieving apprehensions after surgery, helped them recover well and resume flight.

Conclusion: Variation of bile duct may be an important potential risk for gallstone formation and development of long-term PCS with the cause of probable decrement of bile drainage under the physiological environment of aviation.

Introduction: Sartan-induced enteropathy is an uncommon side effect of treatment with angiotensin II receptor antagonists (ARBs), which has predominantly been described for olmesartan.

Case presentation: For the first time, we describe sartan-induced enteropathy as an adverse drug reaction associated with azilsartan in a 74-year-old male patient who was admitted to the hospital twice within 5 months because of excessive non-bloody diarrhea and weight loss. In this case, histopathological findings of intraepithelial lymphocytosis and intestinal villous atrophy resembled celiac disease; however, celiac disease-specific antibodies remained negative, and a gluten-free diet did not result in significant clinical recovery, while symptoms stopped rapidly after stopping azilsartan. When the patient was seen 5 months later, he was free of clinical symptoms, and histological changes disappeared after stopping azilsartan.

Conclusion: This case illustrates sprue-like enteropathy as a potential side effect of azilsartan, emphasizing to consider this differential diagnosis in ARB-treated patients with chronic diarrhea. The causality of our findings was confirmed by drug de-challenge and re-challenge resulting in typical histological changes.