Clinical Journal of Gastroenterology最新文献

Unusual metastatic recurrence of pulmonary adenocarcinoma with a focal neuroendocrine component presenting with bilateral renal metastases and an accompanying pancreatic neuroendocrine tumor-like lesion: a case report. 肺腺癌异常转移复发伴局灶性神经内分泌成分，表现为双侧肾转移并伴有胰腺神经内分泌肿瘤样病变：1例报告。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-23 DOI: 10.1007/s12328-026-02471-5

Tsuyoshi Ueda, Koichiro Miyagawa, Koichi Nakamura, Kenta Kajitani, Daiki Uchihara, Nobuhiko Shinohara, Shinji Oe, Yuichi Honma, Shohei Shimajiri, Masaru Harada

{"title":"Unusual metastatic recurrence of pulmonary adenocarcinoma with a focal neuroendocrine component presenting with bilateral renal metastases and an accompanying pancreatic neuroendocrine tumor-like lesion: a case report.","authors":"Tsuyoshi Ueda, Koichiro Miyagawa, Koichi Nakamura, Kenta Kajitani, Daiki Uchihara, Nobuhiko Shinohara, Shinji Oe, Yuichi Honma, Shohei Shimajiri, Masaru Harada","doi":"10.1007/s12328-026-02471-5","DOIUrl":"https://doi.org/10.1007/s12328-026-02471-5","url":null,"abstract":"A 72-year-old woman with a history of resected lung adenocarcinoma presented with a pancreatic mass and multiple bilateral renal masses. Endoscopic ultrasound-guided tissue acquisition of the pancreatic lesion showed neuroendocrine morphology, synaptophysin positivity, focal chromogranin A positivity, and a Ki-67 labeling index of 2%, leading to an initial diagnosis of pancreatic neuroendocrine tumor grade 1. Renal biopsy also demonstrated neuroendocrine differentiation with a Ki-67 labeling index of 17%. However, the pancreatic lesion was hypovascular and poorly defined, and the multifocal bilateral renal involvement was atypical for a low-grade pancreatic neuroendocrine tumor. Re-evaluation of the resected lung specimen revealed a focal neuroendocrine component showing large cell neuroendocrine carcinoma-like features, although the strict diagnostic criteria for such a diagnosis were not fully met. Genomic analysis identified a KRAS G12V mutation shared by the renal and lung tumors, supporting the interpretation that the renal lesions represented metastatic recurrence of the previously resected lung tumor. Direct molecular confirmation was unavailable for the pancreatic lesion because of insufficient residual endoscopic ultrasound-guided tissue acquisition material; therefore, its origin remained diagnostically uncertain. Nevertheless, based on the overall clinicopathological context, the pancreatic lesion was interpreted as an accompanying neuroendocrine tumor-like lesion most consistent with metastatic recurrence. This case highlights the importance of integrating clinical history, imaging features, disease distribution, archival pathology, and molecular findings when evaluating neuroendocrine tumor-like lesions in patients with a prior malignancy.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypopharyngeal granular cell tumor treated with endoscopic submucosal dissection. 内镜下粘膜下剥离治疗下咽颗粒细胞瘤。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-21 DOI: 10.1007/s12328-026-02470-6

Nanami Imai, Yorinari Ochiai, Kei Kono, Yugo Suzuki, Junji Tanaka, Yutaka Takazawa, Shu Hoteya

{"title":"Hypopharyngeal granular cell tumor treated with endoscopic submucosal dissection.","authors":"Nanami Imai, Yorinari Ochiai, Kei Kono, Yugo Suzuki, Junji Tanaka, Yutaka Takazawa, Shu Hoteya","doi":"10.1007/s12328-026-02470-6","DOIUrl":"https://doi.org/10.1007/s12328-026-02470-6","url":null,"abstract":"A 55-year-old woman was referred to our hospital after screening esophagogastroduodenoscopy revealed an erythematous area in the larynx. Detailed esophagogastroduodenoscopy at our institution initially suggested inflammatory changes. However, pharyngeal observation using the Valsalva maneuver revealed a 4-mm flat, elevated, whitish lesion in the postcricoid region of the hypopharynx. Although endoscopic differential diagnosis was challenging, lymphoid follicles were initially suspected; however, biopsy revealed inflammatory changes. Follow-up esophagogastroduodenoscopy four months later demonstrated persistent findings, and repeat biopsy established the diagnosis of a granular cell tumor.Endoscopic submucosal dissection was performed under general anesthesia, and en bloc resection was achieved. Histopathological examination confirmed a hypopharyngeal granular cell tumor with negative margins. Immunohistochemical analysis revealed diffuse positivity for S-100 protein. Granular cell tumors originate from Schwann cells and can arise throughout the body, including in the skin, oral cavity, and gastrointestinal tract, with the esophagus being the most common gastrointestinal site. The tongue is the most frequent site of granular cell tumors in the oral cavity, whereas their occurrence in the hypopharynx is extremely rare. We report an endoscopically detected hypopharyngeal granular cell tumor treated with endoscopic submucosal dissection. This tumor should be considered in the differential diagnosis of whitish elevated lesions in the hypopharynx.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Type 1 autoimmune pancreatitis with markedly low serum IgG4 and no detectable IgG4-positive plasma cells in pancreatic tissue. 1型自身免疫性胰腺炎，血清IgG4明显低，胰腺组织中未检测到IgG4阳性浆细胞。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-21 DOI: 10.1007/s12328-026-02468-0

Soshi Oyama, Tetsuya Ishizawa, Ayaka Sekiya, Yamato Nagata, Soichiro Honma, Hitomi Nakamura, Toshikazu Kobayashi, Yasuharu Kakizaki, Akiko Matsuda, Naohiko Makino

{"title":"Type 1 autoimmune pancreatitis with markedly low serum IgG4 and no detectable IgG4-positive plasma cells in pancreatic tissue.","authors":"Soshi Oyama, Tetsuya Ishizawa, Ayaka Sekiya, Yamato Nagata, Soichiro Honma, Hitomi Nakamura, Toshikazu Kobayashi, Yasuharu Kakizaki, Akiko Matsuda, Naohiko Makino","doi":"10.1007/s12328-026-02468-0","DOIUrl":"https://doi.org/10.1007/s12328-026-02468-0","url":null,"abstract":"Autoimmune pancreatitis (AIP) is typically associated with elevated serum IgG4 levels and IgG4-positive plasma cell infiltration in affected organs. We report a 57-year-old woman who presented with obstructive jaundice. Contrast-enhanced computed tomography showed diffuse pancreatic enlargement, distal bile duct stricture, and retroperitoneal fibrosis. Serum IgG4 was markedly decreased and remained below the reference range on repeated measurement, while immunohistochemical staining of pancreatic tissue showed no detectable IgG4-positive plasma cells. Histology revealed storiform-pattern fibrosis with lymphoplasmacytic infiltration. Type 2 AIP was considered unlikely based on the absence of granulocytic epithelial lesions on histology and the presence of extrapancreatic involvement. Oral prednisolone resulted in rapid clinical and radiological improvement. This case highlights that type 1 AIP can occur despite markedly low serum IgG4 levels and the absence of detectable IgG4-positive plasma cells in pancreatic tissue, emphasizing the importance of a comprehensive diagnostic approach including imaging, histology, extrapancreatic manifestations, and steroid responsiveness.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of acute autoimmune hepatitis complicated by autoimmune neutropenia and autoimmune hemolytic anemia. 急性自身免疫性肝炎合并自身免疫性中性粒细胞减少和自身免疫性溶血性贫血1例。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-21 DOI: 10.1007/s12328-026-02462-6

Ai Toyodome, Seiichi Mawatari, Haruka Kondo, Akinobu Sho, Haruka Sakae, Kohei Oda, Kotaro Kumagai, Shuji Kanmura

{"title":"A case of acute autoimmune hepatitis complicated by autoimmune neutropenia and autoimmune hemolytic anemia.","authors":"Ai Toyodome, Seiichi Mawatari, Haruka Kondo, Akinobu Sho, Haruka Sakae, Kohei Oda, Kotaro Kumagai, Shuji Kanmura","doi":"10.1007/s12328-026-02462-6","DOIUrl":"https://doi.org/10.1007/s12328-026-02462-6","url":null,"abstract":"An 84-year-old woman was admitted to her referring hospital after blood tests revealed severe liver dysfunction. During follow-up, her neutrophil count, which had been normal at admission, significantly decreased, prompting transfer to our hospital. Laboratory evaluation revealed profound neutropenia (22/μL) and persistent severe liver dysfunction. An antinuclear antibody titer of 1:320 and elevated immunoglobulin G levels raised concern for autoimmune hepatitis (AIH). Her anemia subsequently worsened, with hemoglobin decreasing to 6.9 g/dL. Haptoglobin was undetectable, and the direct Coombs test was positive. She was diagnosed with autoimmune neutropenia and warm autoimmune hemolytic anemia complicated by acute AIH. Prednisolone (PSL) 40 mg (0.8 mg/kg) was initiated for AIH, resulting in rapid improvement in liver function and neutrophil count, along with gradual improvement in anemia. After tapering PSL to 5 mg, no recurrence of hepatitis or cytopenia was observed, and the direct Coombs test became negative. This represents an extremely rare clinical presentation, which we report along with a brief review of literature.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Local recurrence at anastomotic site presenting as a submucosal tumor-like lesion 23 years after rectal cancer surgery. 直肠癌术后23年吻合口局部复发表现为粘膜下肿瘤样病变。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-21 DOI: 10.1007/s12328-026-02469-z

Keita Mikami, Satoshi Sato, Ryoichi Kikuchi, Sho Suto, Yutaro Ashida, Keisuke Furusawa, Kenta Yoshida, Chikara Iino, Tadashi Yoshizawa, Hirotake Sakuraba

{"title":"Local recurrence at anastomotic site presenting as a submucosal tumor-like lesion 23 years after rectal cancer surgery.","authors":"Keita Mikami, Satoshi Sato, Ryoichi Kikuchi, Sho Suto, Yutaro Ashida, Keisuke Furusawa, Kenta Yoshida, Chikara Iino, Tadashi Yoshizawa, Hirotake Sakuraba","doi":"10.1007/s12328-026-02469-z","DOIUrl":"https://doi.org/10.1007/s12328-026-02469-z","url":null,"abstract":"Late recurrence of colorectal cancer > 5 years after curative resection is uncommon, and anastomotic local recurrence occurring > 0 years postoperatively is exceedingly rare. We report a case of local recurrence presenting as a submucosal tumor (SMT)-like lesion at the anastomotic site 23 years after surgery for rectal cancer. The patient had a history of rectal cancer surgery and treatment with 5-fluorouracil 23 years prior and presented with a positive fecal occult blood test. Colonoscopy revealed a 15 mm SMT-like lesion with a central depression at the rectal anastomosis. Endoscopic ultrasound (EUS) elastography demonstrated marked stiffness, with an elasticity score of 5. EUS-guided tissue acquisition confirmed adenocarcinoma, and immunohistochemical findings supported the local recurrence. The patient subsequently underwent laparoscopic low anterior resection. Histopathological examination of the resected specimen revealed a diverticulum-like structure formed by invagination of the lamina propria into the submucosa at the previous anastomotic site, with adenocarcinoma identified within this structure; as it was similar to the histopathological findings from the initial surgery. Careful long-term follow-up may be warranted, even in patients who remain recurrence-free for > 5 years after surgery, particularly in cases requiring adjuvant chemotherapy. Furthermore, EUS elastography may be a useful diagnostic modality for SMT-like lesions.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Colorectal neoplasia detected during colonoscopic surveillance in Li-Fraumeni syndrome: a retrospective case series. 在Li-Fraumeni综合征的结肠镜监测中发现结直肠肿瘤：回顾性病例系列。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-15 DOI: 10.1007/s12328-026-02466-2

Akihiro Takagi, Masahiro Tajika, Makoto Hori, Nobuhito Ito, Tsutomu Tanaka, Waki Hosoda, Masahito Shimizu, Issei Imoto, Yasumasa Niwa

{"title":"Colorectal neoplasia detected during colonoscopic surveillance in Li-Fraumeni syndrome: a retrospective case series.","authors":"Akihiro Takagi, Masahiro Tajika, Makoto Hori, Nobuhito Ito, Tsutomu Tanaka, Waki Hosoda, Masahito Shimizu, Issei Imoto, Yasumasa Niwa","doi":"10.1007/s12328-026-02466-2","DOIUrl":"https://doi.org/10.1007/s12328-026-02466-2","url":null,"abstract":"Background: Li-Fraumeni syndrome (LFS), caused by germline pathogenic variants in TP53, predisposes affected individuals to multiple early-onset malignancies. Although the risk of colorectal cancer (CRC) is increasingly recognized, evidence regarding colonoscopic surveillance remains limited.Case presentation: We present a series of seven genetically confirmed patients with LFS who underwent colonoscopic surveillance at our institution. All patients were women with a history of multiple primary malignancies. Adenomas were identified at the initial colonoscopy in two patients. Among the remaining five patients with negative baseline examinations, four subsequently had colorectal neoplastic lesions detected within 2-3 years. Overall, colorectal neoplasia was detected in five patients, including three advanced adenomas and one CRC diagnosed at 32 years of age. A serrated lesion was observed in one patient. The median age at first detection of colorectal neoplasia was 32.5 years.Conclusion: This case series demonstrates that colorectal neoplasia may be detected at a young age in patients with LFS, including within a relatively short interval after a negative colonoscopic examination. These findings underscore the importance of careful and regular colonoscopic surveillance in this high-risk population.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful endoscopic retrieval of a plastic gallbladder stent that had completely migrated into the gallbladder. 成功的内镜取出已完全迁移到胆囊的塑料胆囊支架。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-12 DOI: 10.1007/s12328-026-02464-4

Toshihiko Motohara, Toshiro Masuda, Masato Kajiwara, Ryu Takekuma, Hideaki Miyamoto, Yuki Adachi, Eri Oda, Toshihiko Yusa, Takatoshi Ishiko, Toru Beppu

{"title":"Successful endoscopic retrieval of a plastic gallbladder stent that had completely migrated into the gallbladder.","authors":"Toshihiko Motohara, Toshiro Masuda, Masato Kajiwara, Ryu Takekuma, Hideaki Miyamoto, Yuki Adachi, Eri Oda, Toshihiko Yusa, Takatoshi Ishiko, Toru Beppu","doi":"10.1007/s12328-026-02464-4","DOIUrl":"https://doi.org/10.1007/s12328-026-02464-4","url":null,"abstract":"Endoscopic gallbladder stenting is a useful transpapillary drainage technique for acute cholecystitis, especially in patients who are poor candidates for cholecystectomy or percutaneous gallbladder drainage. However, long-term placement may cause late adverse events, including migration. Complete migration of a gallbladder stent into the gallbladder is rare and may make retrieval challenging. A 77-year-old woman was referred to our hospital with epigastric pain. Imaging studies suggested biliary tract inflammation with gallbladder debris and bile duct dilatation, but no gallstones or common bile duct stones. Because her condition showed insufficient improvement with antibiotics, a transpapillary biliary stent and a transpapillary gallbladder stent were placed endoscopically. Her symptoms and laboratory data improved after stenting. One year later, the distal end of the gallbladder stent had migrated from the duodenum into the common bile duct. Fifteen months after treatment, the stent had completely migrated into the gallbladder. Because symptoms of biliary infection had improved and there was no indication for cholecystectomy, endoscopic retrieval was attempted. After cystic duct cannulation, bile aspiration was performed to reduce gallbladder volume. A guidewire was placed as a safety wire, and an EndoSheather was advanced into the gallbladder. The migrated stent was grasped with biopsy forceps through the sheath and gently withdrawn into the duodenum before removal through the endoscope channel. No complications occurred. Endoscopic retrieval through the cystic duct may be feasible for a gallbladder stent that has completely migrated into the gallbladder when careful wire access, bile aspiration, safety-wire placement, and sheath-assisted forceps manipulation are used.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of recurrent early gastric cancer with a giant injection-related granuloma after endoscopic submucosal dissection resulting in non-curative resection. 早期胃癌复发伴巨大注射相关肉芽肿，经内镜下粘膜夹层切除无效。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-10 DOI: 10.1007/s12328-026-02467-1

Rina Motomiya, Eriko Koizumi, Daijiro Tashiro, Shinobu Kunugi, Yasuhiro Terasaki, Kazutoshi Higuchi, Jun Omori, Naohiko Akimoto, Ryuji Ohashi, Masanori Atsukawa

{"title":"A case of recurrent early gastric cancer with a giant injection-related granuloma after endoscopic submucosal dissection resulting in non-curative resection.","authors":"Rina Motomiya, Eriko Koizumi, Daijiro Tashiro, Shinobu Kunugi, Yasuhiro Terasaki, Kazutoshi Higuchi, Jun Omori, Naohiko Akimoto, Ryuji Ohashi, Masanori Atsukawa","doi":"10.1007/s12328-026-02467-1","DOIUrl":"https://doi.org/10.1007/s12328-026-02467-1","url":null,"abstract":"A 69-year-old man underwent endoscopic submucosal dissection (ESD) for early gastric cancer of the lower gastric body. The lateral margin was positive, corresponding to an eCura C-1 classification, and surveillance with upper gastrointestinal endoscopy every 6 months was performed. Local recurrence was detected 4 years later, and repeat ESD resulted in an eCura C-2 classification, prompting additional surgical resection. No lymph node metastasis was identified, and the patient remained recurrence-free for 11 months. Histopathological examination of the surgical specimen revealed extensive foreign body granuloma formation involving the deep muscularis propria and subserosal tissue. The granulomas were Alcian-blue positive, with staining intensity reduced after hyaluronidase treatment, suggesting the involvement of a hyaluronic acid-containing submucosal injection agent. No granulomas were observed in the repeat ESD specimen obtained 6 months before surgery. Inflammatory cell infiltration around the lymphatic vessels was observed, suggesting the involvement of lymphatic pathways to the gradual spread and extensive distribution of the granulomatous reaction over time. Submucosal injection-related granuloma formation after ESD is rare, but extensive granuloma formation may complicate the interpretation of post-ESD findings and potentially increase the technical difficulty of subsequent treatment. Clinicians should be aware of this possibility when performing surveillance and additional treatment after ESD.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Elective combined surgical management of concurrent gastrocolic and duodenocolic fistulae in longstanding Crohn's disease. 长期克罗恩病并发胃结肠和十二指肠结肠瘘的选择性联合手术治疗。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-09 DOI: 10.1007/s12328-026-02465-3

Ezaam Naik Fraz, Neal Martin, Manil Chouhan, Yui Kaneko, Richard Gartrell, William Jiaen Wang

{"title":"Elective combined surgical management of concurrent gastrocolic and duodenocolic fistulae in longstanding Crohn's disease.","authors":"Ezaam Naik Fraz, Neal Martin, Manil Chouhan, Yui Kaneko, Richard Gartrell, William Jiaen Wang","doi":"10.1007/s12328-026-02465-3","DOIUrl":"https://doi.org/10.1007/s12328-026-02465-3","url":null,"abstract":"Internal fistulization is a recognized complication of Crohn's disease, reflecting its transmural inflammatory nature and cumulative bowel damage over time. Internal fistulae occur in approximately 20-35% of patients with Crohn's disease, characteristically involving enteroenteric, ileosigmoid or enterovesical communications. In contrast, fistulous involvement of the stomach or duodenum is exceedingly rare, with only isolated cases and small case series reported in the literature. We report the case of a man in his 60s with longstanding Crohn's disease who was incidentally found to have concurrent gastrocolic and duodenocolic fistulae during investigation for acute calculous cholecystitis. Notably, the patient had been minimally symptomatic from a luminal disease perspective, with no clinical features suggestive of fistula-related complications, and his presenting symptoms were attributed to acute biliary pathology rather than chronic penetrating Crohn's disease. Cross-sectional imaging identified complex fistulous disease, confirmed on magnetic resonance imaging, which was addressed electively at the time of planned cholecystectomy, prior to the development of fistula-related morbidity. This case highlights the potential for clinically silent penetrating Crohn's disease and underscores the value of cross-sectional imaging and the potential role of proactive, elective surgical management. In this case, the postoperative course was uncomplicated and the patient remained clinically well at 9-month follow-up.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful endoscopic drainage for gastropericardial fistula caused by a gastric conduit ulcer after esophagectomy. 食管切除术后胃导管溃疡引起胃心包瘘的内镜引流术成功。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-08 DOI: 10.1007/s12328-026-02429-7

Shunsuke Yamagishi, Yukiyasu Okamura, Yasuhiro Okumura, Ryo Muraishi, Takeharu Kato, Hayato Abe, Yusuke Mitsuka, Nao Yoshida, Osamu Aramaki, Kosuke Narumiya

{"title":"Successful endoscopic drainage for gastropericardial fistula caused by a gastric conduit ulcer after esophagectomy.","authors":"Shunsuke Yamagishi, Yukiyasu Okamura, Yasuhiro Okumura, Ryo Muraishi, Takeharu Kato, Hayato Abe, Yusuke Mitsuka, Nao Yoshida, Osamu Aramaki, Kosuke Narumiya","doi":"10.1007/s12328-026-02429-7","DOIUrl":"https://doi.org/10.1007/s12328-026-02429-7","url":null,"abstract":"Gastric conduit ulcer is a postoperative complication of esophagectomy. However, penetration into the pericardium is extremely rare and often fatal. Although surgical drainage is standard treatment, optimal management when surgery is difficult remains unclear. A 60-year-old man in shock was transferred to our hospital 2 years after mediastinoscopic esophagectomy with gastric conduit reconstruction for esophageal cancer. Computed tomography revealed air and fluid in the pericardial cavity. Upper gastrointestinal endoscopy revealed a perforated gastric conduit ulcer. The patient was diagnosed with mediastinitis and purulent pericarditis. Emergency laparoscopic transhiatal exploration and placement of a chest tube in the left pleural cavity were performed; however, dense adhesions prevented access to the perforation site and pericardial cavity. Because direct pericardial drainage could not be achieved, endoscopic drainage was performed, resulting in rapid improvement of inflammatory findings and a favorable outcome. Few cases of pericardial penetration caused by gastric conduit ulcers have been reported, all showing a rapidly progressive course. Therefore, this condition should be considered an acute, life-threatening event requiring prompt management. Adjunctive endoscopic drainage may serve as a complementary rescue option in selected patients when conventional surgical or percutaneous access to the pericardial cavity is technically difficult or fails to achieve direct drainage.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0