Case Reports in Gastroenterology最新文献

Introduction: Gallstone ileus is rare but with high mortality. Although gallstone ileus usually requires urgent enterolithotomy, cholecystectomy, and fistula closure, we present a case of recurrent gallstone ileus treated with enterolithotomy alone.

Case presentation: A 69-year-old female presented to the emergency department with nausea, emesis, and abdominal pain. After computed tomography revealed the diagnosis of gallstone ileus, enterolithotomy was performed without postoperative complications. Cholecystectomy and fistula closure were not performed due to inaccessibility to the gallbladder and the high surgical invasion required. Four months later, the patient developed gallstone ileus again. A second enterolithotomy was performed immediately, resulting in a favorable outcome without complications.

Conclusion: In managing gallstone ileus, particularly in cases with surgical limitations, a less invasive strategy could be a reasonable option.

Introduction: Ulcerative colitis is a chronic inflammatory disease affecting the colon. Anti-tumor necrosis factor-alpha drugs are a cornerstone of management in ulcerative colitis both in induction and maintenance of remission. Thrombocytopenia is a rare side effect of these drugs.

Case presentation: We present a case of infliximab-induced immune thrombocytopenic purpura in a 34-year-old female ulcerative colitis patient.

Conclusion: Infliximab can be a cause of drug-induced immune-related thrombocytopenia and patient's platelet counts should be regularly monitored. In patients with severe thrombocytopenia and having been recently commenced on infliximab, prompt referral to hematology specialty is essential.

Introduction: Biliary stenting is commonly used for managing bile duct conditions, with stent migration occurring in up to 21% of cases. Colonic perforation from stent migration is rare, typically managed surgically or with conventional endoscopic clips. The use of over-the-scope clips (OTSCs) for such perforations is less documented.

Case presentation: An 89-year-old multimorbid woman presented with abdominal pain and new-onset constipation. Imaging revealed a migrated biliary stent causing sigmoid colon perforation. One year earlier, the stent had been placed for choledocholithiasis. Endoscopic removal of the stent and OTSC closure of the perforations were successfully performed, with no complications on follow-up.

Conclusion: This case demonstrates the successful use of OTSCs for closing a chronic colonic perforation caused by a migrated biliary stent. OTSCs may be a viable, less invasive alternative to surgery in similar cases.

Introduction: Gluten-associated disorders, including celiac disease (CeD) and non-celiac gluten sensitivity (NCGS), can present with various extraintestinal neurologic manifestations, including sensory neuropathy, ataxia, headaches, and seizures.

Case presentations: In this case series, we present 3 interesting patients with gluten-associated neurological disorders (GAND) across a spectrum of gluten-associated disorders severity, from gluten sensitivity, to CeD, to refractory CeD, illustrating variable presentations and treatment approaches for this underdiagnosed population.

Conclusion: For many patients with neurological presentations who initially lack gastrointestinal symptoms, diagnosis remains challenging. Once diagnosed, while a gluten-free diet has been the mainstay of treating GAND for many years, this approach may only prevent progression of disease without reversal of symptoms. Further studies are needed to help guide the development and standardization of treatments for this patient population.

Introduction: Celiac disease (CD) is a systemic, immune-mediated enteropathy that occurs following dietary consumption of gluten in genetically susceptible individuals. The global prevalence of celiac disease is estimated to be approximately 1.4%, with variation based on age, sex, and geographic location. CD typically presents early in life with diarrhea, abdominal pain, abdominal distention, weight loss, and impaired growth. In severe cases, patients with CD can present in a state of celiac crisis (CC), classically characterized with profuse diarrhea and life-threatening metabolic derangements.

Case presentation: In this report, we discuss a 23-month-old girl in a state of CC who presented atypically with hypoalbuminemia, generalized edema, and constipation.

Conclusion: Even in the presence of atypical symptoms, such as edema or constipation, CD should be considered as a differential diagnosis in pediatric patients with severe gastrointestinal disturbances. Additionally, we propose a revised definition of CC that is specific to the pediatric population.

Introduction: Dieulafoy's lesion is a rare but severe cause of digestive bleeding and can rarely present as a hemorrhagic shock which is associated with a severe prognosis. MALToma is a B-cell lymphoma of the mucosa-associated lymphoid tissue. It was reported that MALToma can be revealed by a Dieulafoy's lesion. Due to the lack of specific endoscopic or clinical characteristics, several endoscopies may be needed to establish the diagnosis of MALToma.

Case presentation: A 61-year-old male patient presented to the emergency department with melena and hematemesis. The patient was transferred to the intensive care unit due to hemorrhagic shock. The endoscopic work-up showed large gastric folds which were later confirmed as MALToma in anatomo-pathologic analysis. The echoendoscopy showed a vessel going through the entire gastric wall which endoscopically corresponded to a red non-bleeding lesion, confirming Dieulafoy's lesion as the origin of the bleeding. The patient received an endoscopic treatment and was rapidly discharged from the intensive care unit. The evolution was spontaneously favorable, and there was no repeat active bleeding.

Conclusion: A gastric MALToma was discovered thanks to a hemorrhagic shock on a Dieulafoy's lesion which has not yet been described in the literature.

Introduction: Celiac disease (CD) also called gluten-sensitive enteropathy is a noninfectious and an autoimmune cause of malabsorption. It can be difficult to diagnose because of wide range of gastrointestinal and extraintestinal symptoms.

Case presentation: Here, we present 5 cases of CD out of total 160 patients assessed for malabsorption at a tertiary care facility in western Maharashtra between 2022 and 2023. The male-to-female ratio was 1.5:1, and the age of patients ranged from 2 to 60. Chronic diarrhea was the most prevalent symptom, followed by weight loss and stomach pain. In each case, laboratory results showed elevated tissue transglutaminase IgA (tTG-IgA), along with varied levels of calcium and vitamin D deficiency. Two cases had normal endoscopic findings, one had whitish granular mucosa, while 2 cases had duodenal fold scalloping. Histopathological analysis verified the diagnosis, classifying the cases as Marsh types 3a, 3b, and 3c. There was no relationship between the severity of the histopathology and tTG-IgA levels.

Conclusion: This case series of 5 cases takes into account the prevalence of CD as a cause of malabsorption in western India. It also emphasizes the significance of taking CD into account in patients with malabsorption and the necessity of following a multidisciplinary approach encompassing nutritional assessment, clinical evaluation, histopathology, and serology for an accurate diagnosis and course of treatment.

Introduction: Cytomegalovirus (CMV) infection is a notable gastrointestinal infection affecting immunocompromised patients. In the gastrointestinal tract, CMV often presents with patchy or diffuse mucosal involvement and can cause fulminant colitis. However, polypoid CMV lesions are rare. We present a case of a 49-year-old man with ulcerative colitis (UC) in remission on ozanimod who developed CMV isolated to inflammatory colon polyps.

Case presentation: A 49-year-old patient with UC in clinical remission on ozanimod underwent routine surveillance colonoscopy, which revealed multiple inflamed polyps with white caps. Biopsy results confirmed inflammatory polyps with positive CMV immunostaining, while adjacent tissues and plasma CMV PCR tests were negative. The patient successfully completed a 3-week course of valganciclovir. Follow-up colonoscopy revealed additional inflammatory polyps but no evidence of CMV. He remained in clinical remission and continued ozanimod therapy.

Conclusion: The unusual nature of this presentation suggests a clinically silent CMV reactivation or, alternatively, a primary CMV infection in our patient, with an unclear natural history and optimal management. This report emphasizes the importance of considering CMV in UC patients with unusual endoscopic findings and the need for multidisciplinary collaboration to optimize care.

Introduction: Wilson's disease (WD) is a rare genetic condition characterized by impaired copper metabolism and can rarely present as acute liver failure with an associated high mortality rate. Treatment often requires liver transplantation, and few rescue treatments have been shown to be effective by randomized trials. This is a case report and scoping literature review on plasmapheresis in acute liver failure due to WD.

Case presentation: We report a case of a previously undiagnosed 32-year-old female who presented with acute liver failure due to WD. Initial severity indices (MELD = 31 and RWPI - Revised Wilson Prognostic Index = 14) warranted liver transplant referral; however, no facilities were available. The patient was managed by two sessions of plasmapheresis with plasma exchange with persistent improvement in MELD score over 1 week. Subsequent ongoing chelation therapy resulted in a total reversal of clinical liver disease over 2 years. Literature review resulted in 74 patients reported to have been treated with plasmapheresis for WD and acute liver failure. Of these, 40% survived without transplant. Out of the total patients reported, 54 patients had an available NWI score, with 46 patients having a high-risk score of ≥11 (85%) and 8 patients had a score <11 (15%). Of the 46 patients with a score ≥11, 21 (46%) recovered without liver transplantation, 16 (35%) underwent liver transplantation, 8 (17%) died of liver failure, and 1 (∼2%) died of sepsis. Of the 8 patients with a score of <11, 4 (50%) recovered without a liver transplantation, and 4 (50%) underwent transplantation.

Conclusion: The outcomes observed in the literature and the favorable outcome of our patient suggest an emphasis on the use of urgent plasmapheresis with plasma exchange as an initial intervention for acute liver failure in WD, although further randomized controlled trials are needed for determining the optimal dose and duration of treatment.

Introduction: COVID-19 infection can cause bowel ischemia, with an incidence ranging from 0.22% to 10.5. The COVID-19 vaccine reduces respiratory symptoms and the need for cardiopulmonary support. However, its effects on other manifestations, such as bowel ischemia, have not been extensively studied. Despite having mild respiratory symptoms and receiving three doses of the COVID-19 vaccine, our patient developed ischemic colitis after her first infection and small bowel ischemia following her second infection.

Case presentation: An 86-year-old woman presented to the emergency department (ED) with abdominal pain after a mild COVID-19 infection. She was admitted with ischemic colitis, but conservative treatment failed. In the operating room, her entire colon was found to be ischemic, necessitating a total colectomy with end ileostomy. Nine months later, she returned to the ED with mild respiratory symptoms and severe right upper quadrant pain. Imaging revealed pneumoperitoneum and a mid-abdominal abscess. An emergency laparotomy revealed small bowel perforation, with final histology confirming ischemia. The patient had received three doses of the COVID-19 vaccine and was on therapeutic anticoagulation for a history of pulmonary embolism.

Conclusion: COVID-19 may increase the risk of bowel and colon ischemia even after vaccination. Patients presenting to the ED with severe abdominal pain and a recent COVID-19 infection should be carefully evaluated for ischemic events.