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ACG Case Reports Journal

Akshay Sharma, Sachin Goyal, Camelia Arsene, Geetha Krishnamoorthy, Murray Ehrinpreis
The Fusobacterium species is known for its association with septic thrombophlebitis of the internal jugular vein (Lemierre's syndrome). Lemierre's syndrome is associated with septic emboli to the liver and lungs, often causing multiple abscesses. We present a unique case of Fusobacterium septicemia in which the bacteria invaded the portal vein through the gastrointestinal mucosa due to diverticulitis and spread hematogenously to the liver and lungs, causing abscesses. It was treated successfully with 6 weeks of antibiotics...
2018: ACG Case Reports Journal
Scott Friedberg, Adam Slivka, Anil Dasyam, Dhiraj Yadav
Pancreatic calcifications, exocrine insufficiency, and endocrine insufficiency are hallmarks of chronic pancreatitis, and their prevalence increases with the duration of disease. We present a case of chronic pancreatitis in which a dramatic and spontaneous decrease in the burden of both parenchymal and intraductal calcifications was noted during longitudinal follow-up. We discuss the possible reasons for spontaneously vanishing calcifications, an entity rarely described in the literature.
2018: ACG Case Reports Journal
Saud Alsahli, Aziz Al Anazi, Maher M Al Hatlani, Amna Kashgari, Fahd Al Sufiani, Majid Alfadhel, Fuad Al Mutairi
Inflammatory bowel diseases (IBDs) are idiopathic autoimmune diseases that are characterized by inflammation of both the small and large intestine. Although IBD is common in the general population, the pathophysiology remains ambiguous. Clear understanding of IBD pathophysiology would be a major step toward curative treatment in the future. Hyperhomocysteinemia has been associated with multiple autoimmune diseases including IBD, but homocystinuria has not been associated with IBD before. We report a 9-year-old girl with Crohn's disease and homocystinuria...
2018: ACG Case Reports Journal
Gordon Robbins, Jessica Tracht, Drew Davis, Heba Iskandar
Autoimmune enteropathy is an uncommon cause of chronic diarrhea rarely seen in adults. The disease is secondary to an autoimmune process in the gut that leads to villous blunting and subsequent watery diarrhea, abdominal pain, and severe weight loss. The disease has only been described in 37 adults prior to our case, and variable treatment success has been documented with steroids, immunomodulators, and TNF-α inhibitors. This case is the first to show success in treating autoimmune enteropathy with vedolizumab and provides physicians with an additional therapeutic option when limited by a patient's comorbidities and side effects of other drugs...
2018: ACG Case Reports Journal
Tatsuya Osuga, Ryota Nakano, Yoshihiro Ikura
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Sara L Robinson, Brett W Sadowski, Christa Eickhoff, Edward Mitre, Patrick E Young
Emphysematous gastritis (EG) is an uncommon and potentially fatal disease characterized by gastric pneumatosis in the setting of infection. While this disease has been described in the literature, it has not previously been identified as a potential complication of cyclic vomiting syndrome. We describe a patient with a history of cyclic vomiting syndrome who presented acutely ill and was found to have radiographic, endoscopic, and histologic evidence of EG. This case illustrates how an untreated functional bowel disorder can lead to severe and potentially fatal complications...
2018: ACG Case Reports Journal
Michael Rogers, Francisco Sylvester, Steven Lichtman
Congenital defects of bile acid synthesis are rare disorders that cause progressive liver dysfunction. Prolonged neonatal hyperinsulism (PNH) is a separate entity that leads to persistent hypoglycemia secondary to stress. We present a 4-month-old infant who presented with liver failure secondary to a bile acid synthesis defect. The patient's liver failure resolved with oral cholic acid therapy. This patient also developed PNH, which slowly resolved over time. This case illustrates a possible relationship between cholestatic liver failure and PNH...
2018: ACG Case Reports Journal
Steffi Em van de Ven, Kirill V Pavlov, Jaap J Beutler, Robbert Ch Scheffer
Bile cast nephropathy is an often overlooked condition of acute renal injury in the setting of high serum bilirubin. While the exact pathophysiology remains unknown, possible mechanisms of renal injury are tubular obstruction from bile casts, direct toxicity from bile acids, and decreased renal perfusion due to hemodynamic changes. We present a patient with hyperbilirubinemia as a result of common bile duct obstruction due to pancreatic adenocarcinoma who developed anuric acute renal injury. Urine analysis showed bile casts that were highly suggestive for bile cast nephropathy...
2018: ACG Case Reports Journal
Dana Berg, Raja Chandra Chakinala, Gregory Veillette, Beth Schorr-Lesnick
Bezoar-induced small bowel obstruction is a rare entity, but it should be highly suspected in those with prior abdominal or bariatric surgery. The cornerstone of treatment for intestinal bezoars has been surgical exploration to relieve the obstruction. We present a patient with obstructive jejunal phytobezoar formation that was relieved via an endoscopic approach rather than a surgical modality.
2018: ACG Case Reports Journal
Abimbola Chris-Olaiya, Jessica Zweig, Bryan Doherty, Timothy Cornnell, Vinod Nambudiri, Nino Balanchivadze
Surgical mesh migration is a very rare cause of gastrointestinal (GI) bleeding. We report a 56-year-old woman who presented with massive GI bleeding 10 years after ventral hernioplasty with mesh. Esophagoduodenoscopy and colonoscopy were normal. Computed tomographic angiography of the abdomen showed no active GI bleeding or bowel perforation. Tagged red blood cell scan suggested active bleeding in the proximal ileum. Exploratory laparotomy showed the ventral hernia mesh eroding into the ileum. This case emphasizes the limitations of radiologic imaging in evaluating GI bleeding and the recognition of ventral mesh migration and invasion as a potential etiology of small-bowel bleeding...
2018: ACG Case Reports Journal
Hany Shehab, Hany Mikhail
Bariatric surgery leaks remain a dreaded complication with ominous consequences. Fully covered stents have shown efficacy in the treatment of leaks; however, stent migration remains a major drawback. Ultra-large stents have shown reduced rates of migration and coapt better against the walls, but deep ulcers occur in almost all patients, as well as frequent severe intolerance, bleeding, and perforation. We have developed a large expandable stent with physical characteristics and a particularly flexible mesh design that make it much less traumatic than conventional large stents while maintaining the advantage of being less prone to migration...
2018: ACG Case Reports Journal
Vahe Shahnazarian, Daryl Ramai, Andrea Culliford
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Arjun Prakash, Anoop K Koshy, Harshavardhan Rao B, Rama P Venu
Pancreatic duct (PD) leak leading to pancreatic ascites is a serious complication of chronic pancreatitis. Endoscopic management with endoscopic retrograde cholangiopancreatography (ERCP) has been found to be successful; however, if selective cannulation of the PD is unsuccessful, an endoscopic ultrasound-guided rendezvous procedure can help in bridging PD leaks, provided the duct is dilated. We report a successful endoscopic ultrasound-guided rendezvous procedure in a patient with PD leak, pancreatic ascites, and a nondilated duct with failed ERCP who was a poor candidate for surgery...
2018: ACG Case Reports Journal
Shana Kothari, Tarek Almouradi
No abstract text is available yet for this article.
2018: ACG Case Reports Journal
Tomomi Kogiso, Takaomi Sagawa, Yoshihito Kotera, Hiroto Egawa, Masakazu Yamamoto, Katsutoshi Tokushige
We report a rare case of marked elevation of α-fetoprotein in the absence of hepatocellular carcinoma caused by a relapse of hepatitis C virus (HCV) infection. A 58-year-old man underwent liver transplantation to treat hepatocellular carcinoma caused by HCV-related liver cirrhosis. The HCV was of genotype 2a, and the ribonucleic acid titer was >8.0 log IU/mL. Direct-acting antiviral drugs were prescribed for 12 weeks; however, the HCV infection relapsed after treatment had ended, and α-fetoprotein levels increased to 8,981 ng/mL...
2018: ACG Case Reports Journal
Samuel O Igbinedion, Krunal Patel, Hrishikesh Samant, Gregory P Wellman
Cytomegalovirus (CMV) disease in liver transplant patients with donor-seronegative and recipient-seronegative (D-/R-) status is a rarity. Ganciclovir-resistant CMV disease in this population has not been reported in the literature. We present a 62-year-old man who underwent orthotopic liver transplant from a cadaveric donor. The patient's status was CMV D-/R-, and he had completed 90 days of valganciclovir therapy for CMV prophylaxis, yet he developed CMV disease. We highlight the danger of the liberal use of CMV prophylaxis in this subset of the liver transplant population...
2018: ACG Case Reports Journal
Tej Mehta, Oluwagbenga Serrano, Cristina Jensen, Douglas Yim
Esophageal bleeding has a broad differential. One rare cause of esophageal bleeding is an intercostal artery pseudoaneurysm, which usually presents as hemothorax secondary to trauma or an iatrogenic cause; we identified only 9 reported cases in the English literature. Rarer still is pseudoaneurysm of the intercostal-bronchial trunk, which has not been reported in the literature. We report a 61-year-old man with an intercostal-bronchial trunk pseudoaneurysm who presented with hematemesis and signs of upper gastrointestinal bleeding without previous history of trauma...
2018: ACG Case Reports Journal
Rohit Das, Herbert Zeh, Amer Zureikat, Adam Slivka, Georgios I Papachristou
We present a 65-year-old man with a history of a Roux-en-Y gastric bypass and an ampullary adenocarcinoma, treated initially with a Whipple operation, who developed chronic left upper quadrant pain as a consequence of retained gastric contents within a dilated gastric remnant that was no longer in continuity. This was treated successfully with the endoscopic ultrasound-guided creation of a gastrogastric conduit via a covered metal stent. This represents a unique complication of pancreaticoduodenectomy in patients with a prior Roux-en-Y gastric bypass...
2018: ACG Case Reports Journal
Alex Zhornitskiy, Deepthi Karunasiri, James H Tabibian
A 37-year-old man with a history of receptive and penetrating anal sex with men presented with abdominal pain, bright red blood per rectum, and fevers. Recent evaluation by his primary care doctor was notable for negative urine for Neisseria gonorrhea and Chlamydia trachomatis . Rectal swab on admission was positive for C. trachomatis . The patient was ultimately diagnosed with lymphogranuloma venereum, a disease typically seen in tropical climates, although it is more common now in western countries, specifically in men who have sex with men...
2018: ACG Case Reports Journal
Vivy Tran, Jennifer Phan, Benjamin Nulsen, Lizhou Huang, Marc Kaneshiro, Guy Weiss, Wendy Ho, Jonathan Sack, Christina Ha, Daniel Uslan, Jenny S Sauk
Patients with inflammatory bowel disease (IBD) are at increased risk of developing Clostridium difficile infection (CDI). Fecal microbiota transplantation (FMT) is an effective therapy with a high success rate in preventing recurrent CDI. However, patients with IBD have decreased response to FMT for recurrent CDI, with several reports also suggesting potential IBD flare post-FMT. We present a case of mild ileocolonic Crohn's disease in a patient treated with FMT for recurrent CDI who subsequently developed severe steroid-refractory flare requiring surgical intervention 1 week post-FMT...
2018: ACG Case Reports Journal
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