Case Reports in Gastroenterology最新文献

Introduction: Autoimmune pancreatitis (AIP) is a rare and distinct condition in children compared to adults. Despite being based on adult diagnostic criteria, several differences have been reported, making pediatric AIP a challenging diagnosis.

Case presentation: A 14-year-old adolescent presented to the emergency department with abdominal pain, vomiting, and jaundice. A combination of biological and radiological assessments led to the diagnosis of AIP. The patient experienced a swift and complete recovery without intensive treatment.

Conclusion: AIP in children is an intriguing diagnosis and should be considered when a child presents with abdominal pain, vomiting, and jaundice. The natural history and pathophysiology of the disease are still uncertain. Specific markers for the disease need to be established. Studies on larger sample sizes are necessary to address these questions and improve AIP diagnosis and management.

Introduction: Acute esophageal necrosis, or black esophagus, is a rare clinical phenomenon typically seen in older men after an acute triggering event. It may present with dysphagia due to stricturing or dysmotility, a complication of severe esophageal inflammation.

Case presentation: Here we describe a case of a woman with several cardiovascular risk factors who developed black esophagus following diverticular-related hemorrhagic shock and presented with chest pain followed by dysphagia and food impaction likely as a result of mucosal sloughing and altered esophageal motility. The diagnosis was confirmed endoscopically and pathology revealed coagulative necrosis due to ischemia.

Discussion: Acute esophageal necrosis should be suspected in patients with cardiovascular risk factors and hemodynamic compromise and may be confirmed with endoscopy. As dysphagia may complicate this condition, slow advancement of diet while healing is advised.

Introduction: Acute severe ulcerative colitis (ASUC) is a serious complication affecting 9%-15% of patients with UC within 3 months of diagnosis and up to 28% of patients during the course of the disease. Despite the use of infliximab and calcineurin inhibitors, the rate of colectomy remains high both during the hospitalization and in the 5 years after an acute episode. We present a case of ASUC that was unresponsive to conventional therapies but was successfully treated with filgotinib.

Case presentation: A 21-year-old male with a recent diagnosis of UC presented to our hospital with a severe flare. He received rescue therapy of high-dose intravenous steroids and 10 mg/kg infliximab. We observed little clinical and biochemical benefits. The patient declined the surgical option. Therefore, we decided to start a second rescue therapy with a new and rapid-acting Janus kinase inhibitor, filgotinib, due to its characteristics and pharmacokinetic profile of rapid absorption and metabolism. The patient showed an immediate clinical and biochemical response at 48 h, an endoscopic response at week 3, and an endoscopic remission at week 10. No recurrence was observed after 12 months of follow-up. The patient is in clinical remission with a good quality of life.

Conclusion: Filgotinib may be an effective second-line therapy in an emergency setting such as ASUC in patients unresponsive to conventional therapy.

Introduction: Chronic gastrointestinal bleeding in patients with Crohn's disease presents diagnostic challenges. Adult intussusception is rare and typically caused by a pathological lead point, such as a tumor or inflammatory lesion. Lipomas, though benign, can lead to obstruction and bleeding, requiring differentiation from inflammatory causes for appropriate management.

Case presentation: A 70-year-old male with Crohn's disease and chronic anemia presented with recurrent obscure gastrointestinal bleeding. Initial endoscopy was unremarkable, but capsule endoscopy identified a bleeding jejunal lesion. Double-balloon enteroscopy and imaging confirmed a jejunal lipoma causing intermittent intussusception. Due to persistent anemia, the patient underwent laparoscopic resection, with pathology confirming an ulcerated lipoma. His anemia resolved postoperatively.

Conclusion: This case underscores the importance of considering structural lesions like lipomas in patients with chronic bleeding and Crohn's disease. A multimodal approach, including advanced imaging and enteroscopy, is crucial for accurate diagnosis and management. Surgical resection remains the preferred treatment for symptomatic small bowel lipomas.

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Introduction: Primary (or idiopathic) panniculitis involving the intra-abdominal adipose tissue is rare, and its pathogenesis remains unknown. A case of primary eosinophilic panniculitis that involved the greater omentum of a girl is reported.

Case presentation: The patient, an 11-year-old girl, complained of dull periumbilical pain and nausea, and radiological examination showed a mass lesion in the abdomino-pelvic cavity. On laparoscopy, a plaque-like, flat mass was seen in the greater omentum, and laparoscopic omental resection was performed. On histopathological examination, the interlobular fibrous septa of omental adipose tissue were widened by inflammatory edema, prominent infiltration of eosinophils, and loose proliferation of myofibroblasts. Dense lymphocytic infiltration was also noted around small veins. Inflammatory changes were mild in the fat lobules, and fat necrosis and infiltration of lipid-laden macrophages were absent. Findings of obliterative phlebitis or arteritis were not seen.

Conclusion: Isolated involvement of the omentum by a panniculitic process is rare, and the pathogenesis of eosinophilic septal panniculitis found in the present case remains unknown, but involvement of a hypersensitivity reaction against some unknown stimuli is presumed, based on the histopathological resemblance of the omental lesions to erythema nodosum or eosinophilic panniculitis of the skin. We should keep in mind the possibility that the omental lesion in this patient is a harbinger of more serious immunological disorders. Careful, long-term follow-up and monitoring of the patient are needed.

Introduction: Endoscopic clot removal in complex huge esophageal hematoma is a rare clinical entity.

Case presentation: A 48-year-old male patient presented to our hospital with vomiting blood with black stool for 1 day after drinking alcohol. Esophageal hematoma was diagnosed after chest CT and EGD. After conservative treatment with intravenous fluids, the patient's symptoms of vomiting blood persisted and the hemoglobin decreased significantly. We decided to perform another EGD: the huge hematoma had ruptured. We performed endoscopic hemostasis and blood clot removal. Long-term postoperative follow-up shows the mucosa heals well.

Conclusion: Endoscopic clot removal is an effective method of treating esophageal huge hematoma accompanied by rupture.

Introduction: Intramural oesophageal dissection is a rare oesophageal injury that occurs primarily in the elderly and is associated with aggravating factors such as coagulopathy or anticoagulation therapy. It can be emetogenic, trauma-related, iatrogenic, or spontaneous.

Case presentation: We present an unusual case of an 87-year-old woman on low dose aspirin who presented with severe chest pain and sudden onset of haematemesis without prior history of forceful vomiting or Valsalva manoeuvres. An emergency upper gastrointestinal endoscopy confirmed the initial diagnosis of a spontaneous intramural oesophageal haematoma and a follow up computed tomography scan of the chest confirmed the presence of an intramural oesophageal dissection.

Conclusion: Spontaneous intramural oesophageal dissections should be considered as a differential diagnosis in a patient presenting with acute chest pain without known risk factors such as coagulopathy.

Introduction: Collagenous sprue (CS) is an extremely rare enteropathy of unknown etiology and if untreated, can lead to substantial morbidity and mortality. CS often copresents with celiac disease. The presence of a subepithelial collagen band on histology differentiates CS from celiac disease, as both have villous blunting. The management of the two diseases is different, and thus it is critical that the proper diagnosis of CS is made promptly to prevent complications.

Case presentation: We present a case report of CS in an elderly male who was initially diagnosed with celiac disease alone before returning to care years later with unresolved gastrointestinal symptoms.

Conclusion: Clinicians must verify that CS has been ruled out following a celiac disease diagnosis. In regard to CS's mechanism, CS's high frequency of comorbid autoimmune conditions and its robust response to corticosteroids support an immune-mediated process. Future research should continue to aim to elucidate the mechanism as it would allow for a more targeted approach to treatment, such as anti-fibrotic or specific immunomodulator therapy.

Introduction: Organ-preserving treatment for rectal cancer using local excision (LE) and/or chemoradiotherapy (CRT) is increasingly used. Locoregional metastasis precludes LE and locoregional regrowth, recurrence, or persistence after LE or chemoradiation (CRT) may prompt total mesorectal excision (TME). We believe that the time has passed to make such life-changing treatment decisions without pathological confirmation and investigated the use of linear endoscopic ultrasound with fine-needle aspiration (EUS-FNA).

Case presentations: We report 8 cases of suspected locoregional tumor growth (LRTG) on MRI: adjacent or in the rectal wall, within the mesorectal fascia, high presacral region, and obturator foramen. MRI images were studied thoroughly before and during EUS to identify the target lesion using rectal EUS-FNA. Patients were prepared using an enema. The procedure was performed on an outpatient basis without conscious sedation. FNA was performed using a 25G needle. The patient received a 3-day course of ciprofloxacin after the procedure to prevent infection of the perirectal space. Identification of the target was the most difficult part of EUS but was successful in all cases. FNA revealed adenocarcinoma in 7 cases. Five cases were confirmed by TME results: 1 patient died before the operation, and 1 patient was treated with CRT. One patient with a suspected node in the obturator foramen was free of tumors on FNA. The TME resection specimen contained 31 lymph nodes without metastasis. All procedures were well tolerated, and no complications were observed.

Conclusion: Suspected LRTG on MRI can be confirmed using EUS-FNA. In the era of organ-preserving treatment for rectal cancer, EUS-FNA may play a supportive role when considering TME or CRT.