Case Reports in Gastroenterology

Eosinophilic granulomatosis with polyangiitis (EGPA), historically named Churg-Strauss syndrome, is a rare vasculitis affecting small- and medium-sized blood vessels. The disease has a predilection for numerous organs including the lungs, sinuses, kidneys, heart, nerves, and gastrointestinal tract but is prominently associated with asthma, rhinosinusitis, and eosinophilia. Gastrointestinal involvement is common; however, a gastrointestinal manifestation as the cardinal symptom following an infection is atypical...

Colon cancer has had a significant increase in its incidence in recent years. Many of the cases are diagnosed late; it is not unusual that a large number of cases present metastatic disease at the time of diagnosis, and the liver is the main organ where these lesions occur. Surgical approach to this condition has undergone many advances which have allowed a better approach to them. Local techniques such as embolization have gained momentum in recent years and are a great help to the surgical planning. We present the case of a 72-year-old female patient diagnosed with colorectal cancer and metastatic disease...

Malignant melanoma of the rectum is an exceedingly rare type of cancer with an aggressive presentation, comprising up to 4% of all anorectal cancers. Presentation of this cancer tends to occur in individuals in their late 80s, with nonspecific symptoms such as anal pain or rectal bleeding. Diagnosing rectal melanoma, especially in early stages, is difficult due to its amelanotic presentation and lack of pigmentation, which results in poor remission rates and prognosis. Furthermore, surgical treatment is difficult as these types of malignant melanomas tend to spread along submucosal planes; thus, complete resections are impractical, especially if caught later...

Breast cancers metastasize most commonly to the bone, brain, liver, and lungs, but rarely to the gastrointestinal tract. Although metastatic breast carcinomas in the stomach can be confused with primary gastric cancers due to their nonspecific presentation and rare incidence, it is important to differentiate the two since the treatment is different. Clinical suspicion is imperative for a prompt endoscopic evaluation and a definitive diagnosis that will lead to appropriate treatment. Therefore, it is important for clinicians to be aware of the possibility of gastric metastasis of breast cancers, especially in those with a history of invasive lobular breast carcinoma and a new onset of gastrointestinal symptoms...

Classic symptoms of rectal cancer (RC) such as hematochezia, tenesmus, rectal pain, and bowel habit changes are well known but can be nonspecific and misdiagnosed. Rare presentations, in combination with these conventional symptoms, can occur warranting a higher degree of clinical suspicion. Here, we report a case of rectal adenocarcinoma presenting as a perirectal abscess. A 52-year-old male with uncontrolled diabetes mellitus presented with a 2-year and 2-month history of rectal bleeding and changes in bowel habits, respectively, which were attributed to other conditions...

Gastric cancer is one of the most common diseases globally. Total gastrectomy is often performed surgically. However, late-stage anastomotic passage obstruction after total gastrectomy is relatively rare. Here, we report a case involving a 73-year-old male patient who experienced repeated aspiration pneumonia due to anastomotic passage obstruction 22 years after a total gastrectomy for gastric cancer. He was eventually hospitalized in the Department of Gastroenterology at our hospital because of difficulty eating...

Glomus tumor (glomus cell tumor) is a rare, often benign neoplasm, which is, in most cases, seen as a solitary bluish nodule involving the nail beds. Solid glomus tumor, glomangioma, and glomangiomyoma are the three main histopathological variants. In this case report, we present the rarest subtype of a glomus tumor, glomangiomyoma, in an atypical location: the stomach. A 45-year-old female from Syria presented to the clinic with severe dizziness and left epigastric abdominal pain accompanied by melena. We performed a thorough clinical study, laboratory workup, upper gastrointestinal endoscopy, endoscopic ultrasound, CT scan, as well as macroscopic and microscopic histologic examination of the surgical specimen, in addition to the immunohistochemical staining...

Sprue-like enteropathy (SLE) is a clinical syndrome similar to celiac disease and has been associated with the use of various angiotensin receptor blockers (ARBs), a class of medications frequently used in the management of hypertension. Currently, there has only been one documented case report which has observed this occurrence with the use of the ARB candesartan. A 90-year-old female patient presented with chronic diarrhea and weight loss of unclear etiology. Diagnostic esophagogastroduodenoscopy and ileocolonoscopy were macroscopically unremarkable, but histological samples revealed complete villous atrophy, chronic mucosal inflammation, and intraepithelial T-lymphocytic infiltration...

The diagnosis of carcinoid heart disease as a cause of ascites can be hard to establish. We report a patient with well-differentiated neuroendocrine neoplasm of the liver who presented with high serum ascites albumin gradient and high protein ascites due to carcinoid heart disease (CHD). As ascites caused by CHD are rare, the etiology can easily be overlooked, especially in the setting of alcohol use disorder and portal hypertension. Through our case report, we emphasize the importance of physical examination and peritoneal fluid analysis in the diagnosis of CHD...

We treated a 39-year-old Japanese man who was admitted for an abdominal mass. He had had neurofibroma-like skin lesions since childhood. Computed tomography and endoscopic ultrasound results were consistent with a tumor in the small intestine. Although the tumor was undetectable by single-balloon endoscopy, the patient's background and imaging results led us to suspect a gastrointestinal stromal tumor (GIST). He also met the diagnostic criteria for neurofibroma type 1 (NF1). We performed a surgical removal of the tumor, and the biopsy results led to a definitive diagnosis of GIST...

Zellweger spectrum disorders (ZSDs) are known to present with variable hepatic manifestations ranging from benign hepatosplenomegaly and elevated liver enzymes to advanced liver cirrhosis with hepatocellular carcinoma. However, the progression of liver disease in ZSD patients over time is poorly characterized due to scarcity of the disease. Herein, we report a case of newly diagnosed liver cirrhosis in a ZSD patient with rapid progression and fatal outcome to demonstrate key clinical learning points.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis of small to medium vessels. Gastrointestinal involvement is uncommon and is associated with higher mortality. Treatment is based on empiric evidence. In this article, we report a case of EGPA-related pancolitis and stricturing small bowel disease managed with a combination of mepolizumab and surgical resection.

We report a case of a 70-year-old male with delayed perforation in the cecum treated by endoscopic ultrasonography-guided drainage for a pelvic abscess. The lesion was a 50-mm laterally spreading tumor, and endoscopic submucosal dissection (ESD) was performed. No perforation was detected during the operation, and en bloc resection was achieved. He had fever and abdominal pain on postoperative day (POD) 2. Computed tomography (CT) revealed the intra-abdominal free air, leading to a diagnosis of delayed perforation after ESD...

Leukocytoclastic vasculitis (LCV) is rarely associated with anti-tumor necrosis factor [TNF] α therapy. We report a 22-year-old man with new onset of a pustular rash on his bilateral upper and lower extremities while on adalimumab therapy for Crohn's disease. Skin biopsy of the affected area showed perivascular extravasation of erythrocytes, neutrophils, eosinophils and vascular damage surrounding blood vessels associated with fibrin, consistent with LCV. Patient was treated with topical steroids and subsequently transitioned to ustekinumab therapy with follow-up colonoscopy showing minimal active disease...

Colonic metastasis from ovarian cancer is extremely rare, with only seven reported cases. A 77-year-old woman who had previously undergone surgery for ovarian cancer was admitted to a local hospital with anal bleeding. Histopathological analysis confirmed the presence of adenocarcinoma. Colonoscopy revealed a descending colon tumor. The patient was diagnosed with Union for International Cancer Control T3N0M0 descending colon cancer or colon metastasis of the ovarian cancer. Laparoscopic left colectomy was performed; intraoperative frozen section diagnosis confirmed metastasis from ovarian cancer, and the absence of invasion to the serosal surface suggested hematogenous metastasis...

A mechanical obstruction is not a physiological entity, and when it occurs within the 30-day postoperative period, it is called an early postoperative small bowel obstruction. Kinking of small bowel segments at the ileostomy outlet secondary to a distended bladder is an unusual source of early postoperative small bowel obstruction. A 36-year-old female underwent a redo J-Pouch surgery and creation of loop ileostomy after pouch failure related to recurrent small bowel obstruction and perianal fistulae. Her foley catheter was removed on postoperative day 3 and she passed a trial of void test...

Retroperitoneal and mediastinal emphysema after colon resection is extremely rare, especially in the absence of anastomotic leakage. The feasibility and safety of conservative treatment for this complication are unknown. We report a patient who underwent open sigmoid colon resection for colon cancer and developed retroperitoneal and mediastinal emphysema that was not caused by anastomotic leakage. Retroperitoneal and mediastinal emphysema occurred as a result of diverticular perforation. We were able to treat this patient successfully with conservative management...

Tyrosine kinase inhibitors (TKIs) such as imatinib improve the prognosis of patients with gastrointestinal stromal tumors (GISTs). However, treatment options for GISTs are still limited, and the continuation of TKIs is difficult due to adverse events in some cases. The effectiveness of low-dose imatinib is unclear. We report 2 cases to show effectiveness of low-dose imatinib in patients with adverse events. The first case is a male in his early 60s with a history of intestinal GIST resection who was diagnosed with recurrent GIST with peritoneal dissemination...

Autoimmune gastritis is immune-mediated gastritis that destroys the oxyntic mucosa. Autoimmune hepatitis is an inflammatory liver disease caused by an autoimmune reaction. These diseases share similar pathogeneses as organ-specific autoimmune disorders; however, cases involving both diseases are quite rare and scarcely reported. Herein, we report a patient with concurrent autoimmune gastritis and hepatitis who developed enlargement of hyperplastic polyps and progression of gastric atrophy. The patient was a 79-year-old female referred to our hospital for the treatment of hyperplastic polyps detected on a follow-up upper gastrointestinal endoscopy...

Granular cell tumor (GCT) was first described by Abrikossoff in 1926. It is a mostly benign tumor with rare malignant transformation. It is defined as a soft tissue neoplasm with abundant eosinophilic cytoplasm. The mean age of diagnosis for GCT is around 45 years. It is rare for GCT to be found in the gastrointestinal (GI) tract. Within the subset of GI tract, the colon is an extremely rare site for it to be found. Franburg-Smith histopathology criteria are used to differentiate a benign from a malignant GCT...