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Clinical Journal of Gastroenterology

Kentaro Tominaga, Atsunori Tsuchiya, Hiroki Sato, Atsushi Kimura, Chiyumi Oda, Kazunori Hosaka, Yuzo Kawata, Naruhiro Kimura, Kazunao Hayashi, Junji Yokoyama, Shuji Terai
Ulcerative colitis (UC) is a chronic and recurrent inflammatory disease involving the intestine, and Guillain-Barré Syndrome (GBS) is rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. UC and GBS can be caused by immune system abnormalities and can co-exist. To date, there are 7 reported cases of GBS in patients with UC. However, only one patient developed UC after GBS treatment. We report a rare case of UC that appeared after intravenous immunoglobulin therapy for GBS...
February 18, 2019: Clinical Journal of Gastroenterology
Noriaki Oguri, Akihito Sakuraba, Hiromu Morikubo, Oki Kikuchi, Taro Sato, Soutaro Tokunaga, Shintaro Minowa, Osamu Ikezaki, Tatsuya Mitsui, Miki Miura, Daisuke Saito, Mari Hayashida, Hideaki Mori, Takako Osaki, Shigeru Kamiya, Mitsutoshi Senoh, Haru Kato, Tadakazu Hisamatsu
We report a case of community-acquired fulminant colitis caused by Clostridium difficile in Japan. A 46-year-old woman was diagnosed with severe infectious enterocolitis and was admitted at another hospital. The stool culture was positive for toxigenic C. difficile. Since the patient presented with fulminant C. difficile infection (CDI) with toxic megacolon, respiratory insufficiency, and circulatory failure, she was transferred to Kyorin University Hospital for intensive care. Intubation and antibiotic therapy were performed...
February 14, 2019: Clinical Journal of Gastroenterology
Takahiro Zenda, Ichiro Araki, Motoko Sasaki
Giant cell hepatitis in adults is considered a rapidly progressive and life-threatening disease, but there are few descriptions of a prolonged disease course. A 36-year-old Japanese man was referred to our hospital for further evaluation of abnormal liver function test results. Although asymptomatic, he had undergone follow-up for 9 years with these abnormalities. Because the cause of liver injury was not identified despite extensive noninvasive examinations, the patient underwent needle biopsy. He was finally diagnosed with post-infantile giant cell hepatitis (PIGCH) based on the presence of small numbers of giant multinucleated hepatocytes scattered primarily around the portal area...
February 14, 2019: Clinical Journal of Gastroenterology
Ryota Kiuchi, Takanori Sakaguchi, Ryo Kitajima, Satoru Furuhashi, Makoto Takeda, Takanori Hiraide, Yoshifumi Morita, Takasuke Ushio, Rei Ishikawa, Satoshi Baba, Hiroya Takeuchi
Hepatic angiomyolipoma (AML) is a rare stromal tumor composed of variable admixtures of thick-walled vessels, smooth muscles and adipose tissue. One of the specific radiological findings of hepatic AML is an early drainage vein noted via enhanced computed tomography (CT). We report a case of hepatic AML showing early drainage veins into both the hepatic and portal vein. The case involved a 46-year-old woman who was referred to our hospital because of a giant hepatic tumor. CT revealed well-enhanced 14 cm and 1 cm tumors in the left and right lobes, respectively...
February 14, 2019: Clinical Journal of Gastroenterology
Hidekazu Tanaka, Tomohiro Watanabe, Tomoyuki Nagai, Kosuke Minaga, Ken Kamata, Yoriaki Komeda, Masatoshi Kudo
Klebsiella oxytoca (K. oxytoca) is a causative organism for hemorrhagic antibiotic-associated colitis. K. oxytoca infection is a typical example of microbial substitution diseases caused by exposure to antibiotics prior to the onset of diarrhea. Here, we repot a case with ileitis associated with K. oxytoca infection in the absence of preceding antibiotic treatment. Interestingly, abdominal computed tomography revealed wall thickening of the ileum and hepatic portal venous gas (HPVG). K. oxytoca was isolated from the stool...
February 9, 2019: Clinical Journal of Gastroenterology
Shinya Kawaguchi, Takuya Ohtsu, Shuzo Terada, Shinya Endo
A 44- and a 66-year-old woman underwent nasopancreatic drainage (NPD) to treat obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer. Both patients were diagnosed with stage IV lung cancer and underwent chemotherapy for 17 and 15 months, respectively. Abdominal ultrasonography and computed tomography revealed a solid pancreatic tail tumor measuring 2.5 cm and 1.3 cm in diameter, respectively. Additionally, we observed dilatation of the upstream main pancreatic duct (MPD) and edematous parenchyma with peripancreatic inflammatory changes limited to the pancreatic tail...
February 6, 2019: Clinical Journal of Gastroenterology
Chonlada Krutsri, Tomohisa Iwai, Mitsuhiro Kida, Hiroshi Imaizumi, Toshihiro Kawano, Masayoshi Tadehara, Masafumi Watanabe, Kosuke Okuwaki, Hiroshi Yamauchi, Koizumi Wasaburo
Pancreatic granular cell tumors (GCTs) are rare and making an imaging diagnosis of pancreatic GCT is difficult because it has no definite characteristics on contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging (MRI) owing to varying findings. We report about a 32-year-old woman who presented with an incidental finding of a pancreatic tumor with a past history of excision of a right forearm GCT nodule 12 years ago. CE-CT revealed a 23-mm-sized homogeneous low enhancement tumor in the arterial phase in the pancreatic body...
February 6, 2019: Clinical Journal of Gastroenterology
Masahiro Okada, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Satoshi Shinozaki, Keijiro Sunada, Alan Kawarai Lefor, Hironori Yamamoto
A 67-year-old woman presented with symptoms of bowel obstruction. Radiographic and ultrasonographic findings suggested colo-colonic intussusception caused by a colonic lipoma. Colonoscopy with an endoscope tip balloon was performed for reduction. The intussusception was partially reduced by injecting dilute contrast media with a wedged inflated balloon at the endoscope tip. For definitive treatment of the polyp, ischemia was induced using a detachable snare. The abdominal pain well improved after endoscopic treatment...
February 1, 2019: Clinical Journal of Gastroenterology
Maiko Namba, Tomokazu Kawaoka, Hiroshi Aikata, Kenichiro Kodama, Shinsuke Uchikawa, Kazuki Ohya, Kei Morio, Hatsue Fujino, Takashi Nakahara, Eisuke Murakami, Masami Yamauchi, Masataka Tsuge, Akira Hiramatsu, Michio Imamura, Yasutaka Baba, Kazuo Awai, Kazuaki Chayama
We report a 74-year-old male patient with compensated cirrhosis after hepatic C virus eradication. After the patient underwent hepatectomy for hepatocellular carcinoma, multiple lung and lymph node metastases were detected by computed tomography. Computed tomography also revealed a portosystemic shunt from the superior mesenteric vein to the right testicular vein. He was administered lenvatinib (12 mg). Five days after the initiation of lenvatinib, he developed grade 3 hepatic encephalopathy, and his ammonia level increased...
January 31, 2019: Clinical Journal of Gastroenterology
Toshihiko Kakiuchi, Yasufumi Ohtsuka, Tadashi Sato, Aiko Nakayama, Kumiko Jinnouchi, Masafumi Oka, Muneaki Matsuo
Coenzyme Q10 deficiency causing gastrointestinal symptoms has not been reported. At least 15 genes are involved in CoQ10 biosynthesis, and one of the genes is AarF domain-containing kinase 4 (ADCK4). This case report first showed a patient who presented with Crohn's disease (CD) combined with ADCK4 glomerulopathy (ADCK4-GN). After approximately 2 years of infliximab treatment for CD, this patient has remained in clinical remission with no adverse effects. Moreover, two important findings were obtained: first, individuals with ADCK4-GN may present with complications, such as CD, which is a gastrointestinal disease, and infliximab may be effective for CD associated with ADCK4-GN...
January 31, 2019: Clinical Journal of Gastroenterology
Yusuke Onozato, Yu Sasaki, Yasuhiko Abe, Takao Yaoita, Makoto Yagi, Naoko Mizumoto, Masakuni Shoji, Takashi Kon, Shoichi Nishise, Yoshiyuki Ueno
Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon benign disorder leading to esophageal strictures. The etiology remains unknown; however, anti-fungal treatments or endoscopic balloon dilation can improve early esophageal strictures and these rarely require surgical treatment. We report a case of a 46-year-old male with a 6 cm-long esophageal stricture due to EIPD, which did not improve following treatment with an anti-fungal agent, eventually causing aspiration pneumonia. Therefore, we performed a thoraco-laparoscopic esophagectomy, and his symptoms were improved after surgery...
January 29, 2019: Clinical Journal of Gastroenterology
Daisuke Uchida, Yoshinari Kawai, Hironari Kato, Hiroyuki Okada
A 74-year-old man presented to the emergency department with acute abdominal pain in addition to anemia and melena, which were suspected to be due to gastrointestinal bleeding. Computed tomography (CT) revealed a blood-filled duodenum and acute pancreatitis. We prioritized treatments for pancreatitis, as the vital signs were stable, and temporary hemostasis was achieved. Two days later, esophagogastroduodenoscopy revealed a duodenal ulcer with an exposed vessel, and endoscopic hemostasis was performed. We urge clinicians to consider the possibility of pancreatitis associated with massive bleeding due to a duodenal ulcer...
January 29, 2019: Clinical Journal of Gastroenterology
Yu Watahiki, Takuto Hikichi, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Minami Hahimoto, Tadayuki Takagi, Rei Suzuki, Mitsuru Sugimoto, Naoki Konno, Yuki Sato, Hiroki Irie, Hiromasa Ohira
A 37-year-old woman was diagnosed by esophagogastroduodenoscopy (EGD) as having a 15-mm subepithelial lesion (SEL) in the gastric body. For 2 years, she experienced epigastric pain and anemia; she then underwent emergency EGD, which revealed a significant morphological change of the lesion. The SEL had a disintegrated tip and its submucosal portion was substantially exposed out of the mucosa, showing an "erect penis like appearance". Based on the pathological findings of biopsied samples from the exposed portion and the endoscopic features, an inflammatory fibroid polyp (IFP) was suspected...
January 25, 2019: Clinical Journal of Gastroenterology
Yoshihide Kanno, Yutaka Noda, Shinsuke Koshita, Takahisa Ogawa, Kaori Masu, Masaya Oikawa, Takaho Okada, Naoya Akazawa, Takashi Sawai, Kei Ito
A 13-mm mass was observed in the pancreatic head of a 70-year-old woman who had undergone melanoma resection in the nasal cavity 10 years earlier. Endoscopic ultrasonography (EUS) showed that the mass consisted of multiple hypoechoic nodules. EUS-guided fine needle aspiration and pancreatic juice cytologies revealed neoplastic cells positive for HMB45 and melan-A staining with a few melanin granules, indicating the presence of a metastatic malignant melanoma. These additional stainings were evaluated after surgery...
January 22, 2019: Clinical Journal of Gastroenterology
Ronald Samuel, Mohammad Bilal, Ranjana Nawgiri, Shehzad Merwat, Sreeram Parupudi, Praveen Guturu
Hepatocellular carcinoma (HCC) is a potentially fatal complication of chronic liver disease. Liver transplantation is now the preferred treatment due to good outcomes. We present a unique case of recurrence of HCC at the porta hepatis four years after orthotopic liver transplantation diagnosed via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Our report also highlights that intrahepatic recurrence of HCC can be surgically treated. However, further studies are needed to develop treatment algorithms for intra-hepatic recurrence of HCC post liver transplantation...
January 17, 2019: Clinical Journal of Gastroenterology
Keiichi Kimura, Yoshito Hayashi, Keisuke Otani, Yoshiki Tsujii, Hideki Iijima, Fumiaki Isohashi, Kazuhiko Ogawa, Tetsuo Takehara
Only a few cases of esophageal granulocyte-colony-stimulating-factor (G-CSF)-producing esophageal carcinosarcoma are reported, and patients with G-CSF-producing tumors are typically considered to have poor prognosis. An 89-year-old man was examined for low-grade fever and dysphagia. Chest computed tomography revealed a huge 80-mm tumor on the thoracic esophagus without direct invasion to surrounding organs. Esophagogastroduodenoscopy (EGD) showed a huge mass occupying the esophageal lumen with a superficial flat lesion...
January 16, 2019: Clinical Journal of Gastroenterology
Takuya Hirosawa, Naoki Morimoto, Kouichi Miura, Kohei Ono, Shunji Watanabe, Takeshi Fujieda, Kozue Murayama, Yoshinari Takaoka, Hiroaki Nomoto, Mamiko Tsukui, Norio Isoda, Toshiro Niki, Katsutoshi Tokushige, Hironori Yamamoto
Congenital hepatic fibrosis (CHF), a fibropolycystic disease, is characterized by bile duct malformation, periportal fibrosis, and renal polycystic disease. Although cholangiocellular carcinoma is the primary tumor arising from fibropolycystic diseases, hepatocellular carcinoma (HCC) is extremely rare. In addition, no algorism for determining the optimum HCC treatment has yet been available in cases of fibropolycystic disease due to variations in the background liver and renal conditions. We herein report a patient with HCC arising from CHF that was successfully treated using radiofrequency ablation (RFA) under laparoscopic assistance...
January 7, 2019: Clinical Journal of Gastroenterology
Hiroyuki Ito, Shin-Ichiro Hiraiwa, Tomoko Sugiyama, Takuma Tajiri, Yoko Yamaji, Motoki Kaneko, Shingo Tsuda, Hitoshi Ichikawa, Junko Nagata, Seiichiro Kojima, Shinji Takashimizu, Takayuki Shirai, Norihito Watanabe
We reported the case of a 50-year-old man diagnosed with extrinsic NK/T-cell lymphoma. He was initially diagnosed with locally advanced unresected pancreatic duct carcinoma and was treated with combination chemotherapy using gemcitabine and nabpaclitaxel. One month after treatment, he developed bleeding. Upper gastrointestinal endoscopy showed a deep ulcer lesion from the duodenal bulb to the inner wall of the descending section that was not observed before treatment. Coil embolization was performed, but the necrotic area widened after treatment; the patient died of disseminated intravascular coagulation after 1 week...
January 2, 2019: Clinical Journal of Gastroenterology
Yasutoshi Shiratori, Katsuyuki Fukuda, Takashi Ikeya, Koichi Takagi, Kenji Nakamura
Amyloidosis is a syndrome involving amyloid protein deposition in various organs, resulting in organ dysfunction. Symptoms of gastrointestinal amyloidosis are usually nonspecific, such as diarrhea and body weight loss. We, here, report a patient who presented to the hospital with simultaneous hematemesis, melena, and intestinal pseudo-obstruction, leading to a diagnosis of primary gastrointestinal amyloidosis based on computed tomography (CT) and endoscopic findings. CT showed diffuse wall thickening from the duodenum to the jejunum, jejunal dilation, and fluid accumulation throughout the gastrointestinal tract...
December 20, 2018: Clinical Journal of Gastroenterology
Federico Salom, Frédéric Prat
An increase in the diagnosis of pancreatic cystic neoplasm has been described lately. Surgical treatment or surveillance is advised depending on the type of lesion diagnosed. The most accurate diagnostic approach is needed to make the best therapeutic decision. Endoscopic ultrasound is a very valuable tool in the evaluation of pancreatic cystic neoplasm. It generates high-quality images and allows the possibility of sampling the cystic fluid for cytology, microbiological and molecular evaluation. Even with this evaluation, the sensitivity of this approach is not always adequate...
December 18, 2018: Clinical Journal of Gastroenterology
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