Clinical Journal of Gastroenterology最新文献

{"title":"Avoiding unnecessary bowel resection in adult intussusception: a case report in a patient with multiple prior surgeries utilizing intraoperative enteroscopy.","authors":"Takuya Harada, Yuzuru Sakamoto, Takaya Ishikawa, Hirotaka Shoji, Kiko Toda, Tetsuhito Muranaka, Akinobu Taketomi","doi":"10.1007/s12328-025-02138-7","DOIUrl":"https://doi.org/10.1007/s12328-025-02138-7","url":null,"abstract":"<p><p>Intussusception is a rare condition in adults, accounting for approximately 5% of all cases. Unlike pediatric intussusception, which is typically idiopathic, the adult cases are usually associated with an underlying pathology, most commonly malignancies. The surgical intervention is often required, but in small bowel cases, where malignancy is less frequent than in colonic intussusception, the decision regarding resection requires careful consideration. There are no prior reports on the use of intraoperative enteroscopy for small bowel intussusception evaluation. We report the case of a 78-year-old woman who presented with acute abdominal pain, nausea, and bilious vomiting. She had a history of distal gastrectomy with gastroduodenostomy (Billroth-I) and total gastrectomy with Roux-en-Y for gastric ulcer and residual stomach cancer, respectively. Abdominal computed tomography (CT) revealed small bowel intussusception without clear evidence of a lead point lesion. The emergency laparotomy confirmed intussusception 15 cm distal to the Roux-en-Y anastomosis, which was manually reduced. The intraoperative enteroscopy revealed inflammatory changes but no malignancy or structural abnormalities. Given the absence of a lead point lesion and the viability of the bowel, resection was avoided. The patient had an uneventful postoperative course and was discharged without complications. Adult intussusception is frequently associated with malignancy, yet cases without a lead point lesion pose a diagnostic and therapeutic challenge. The surgical history, including prior anastomotic procedures, may contribute to the pathogenesis through disrupted intestinal pacemaker activity and retrograde contractions. While second-look surgery can aid in bowel viability assessment, it carries a high complication rate. This case highlights the potential role of intraoperative enteroscopy in evaluating small bowel viability, minimizing unnecessary resection, and improving surgical decision-making. Although further studies are needed to assess its role in optimizing surgical outcomes, intraoperative enteroscopy may be a valuable adjunct in cases of adult small bowel intussusception without an apparent lead point.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989704","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}

{"title":"Spontaneous rupture of hepatocellular carcinoma in Fontan-associated liver disease with fatal outcome: case report and literature review.","authors":"Taiki Okumura, Nana Yamakita, Ayumi Sugiura, Takanobu Iwadare, Hiroyuki Kobayashi, Shun-Ichi Wakabayashi, Yuki Yamashita, Hirohiko Motoki, Takefumi Kimura","doi":"10.1007/s12328-025-02132-z","DOIUrl":"https://doi.org/10.1007/s12328-025-02132-z","url":null,"abstract":"<p><p>The Fontan procedure is the definitive palliative operation for patients with single-ventricle physiology. In parallel with the longer survival time achieved by the Fontan procedure, however, the incidence of Fontan-associated liver disease is increasing as well. A 25-year-old man who underwent the Fontan procedure at the age of 3 years was referred to our hospital for further evaluation of congestive hepatopathy under suspicion of Fontan-associated liver disease. Upon presentation, a heterogeneous mass of 32 × 27 mm was identified in the S4 region of the liver. The tumor showed progressive enlargement along with a rising α-fetoprotein level. We suspected hepatocellular carcinoma and scheduled a hepatectomy. On the first day of hospitalization for preoperative examination in our cardiology department, he unexpectedly suffered spontaneous hepatocellular carcinoma rupture. In spite of emergency transcatheter arterial embolization of the hepatic artery and additional interventions, the patient ultimately succumbed to intraperitoneal bleeding. Given the poor prognosis of HCC rupture in Fontan-associated liver disease, early intervention is crucial to prevent fatal outcomes.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955212","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}

{"title":"Relapsed refractory immune checkpoint inhibitor-induced colitis treated with tacrolimus and maintained with vedolizumab.","authors":"Shohei Igarashi, Koji Shimaya, Kota Fujimaki, Masayoshi Ko, Takato Maeda, Norihiro Hanabata, Kosuke Kanazawa, Hiroshi Numao, Masaki Munakata, Hirotake Sakuraba","doi":"10.1007/s12328-025-02126-x","DOIUrl":"https://doi.org/10.1007/s12328-025-02126-x","url":null,"abstract":"<p><p>A 58-year-old man was administered anti-programmed death ligand 1 and cytotoxic T-lymphocyte-associated protein 4 antibodies for primary lung cancer with brain metastasis. Subsequent development of diarrhea was diagnosed as immune-related adverse event (irAE) colitis. Initially, his condition improved with prednisolone (1 mg/kg/day). Therefore, the dose was reduced to 5 mg, and his condition was maintained with 5-aminosalicylic acid. However, diarrhea recurred after re-administration of another immune checkpoint inhibitor. Prednisolone (0.5 mg/kg/day) was ineffective for the first relapse. After two doses of infliximab, irAE colitis improved. One year later, diarrhea recurred after steroid tapering. Treatment comprising prednisolone (1 mg/kg/day), two doses of infliximab, granulocyte-monocyte apheresis, and ustekinumab for the second relapse failed to improve his condition. Tacrolimus was initiated 3 months after the second flare occurred, resulting in rapid symptom resolution. Due to frequently relapsed irAE colitis, vedolizumab was administered as maintenance therapy, allowing steroids and tacrolimus to be discontinued and maintaining remission. Tacrolimus may be effective for relapsed refractory irAE colitis, particularly for cases that cannot be successfully treated with infliximab and other treatments. Vedolizumab can be used as maintenance therapy for frequently relapsing irAE colitis.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976877","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}

{"title":"A successfully resected case of giant hepatic hemangioma with symptomatic massive pleural effusion: a case report.","authors":"Yasuto Futagawa, Koichiro Haruki, Masashi Tsunematsu, Shinji Onda, Norimitsu Okui, Kenei Furukawa, Michinori Matsumoto, Tadashi Uwagawa, Kyohei Abe, Toru Ikegami","doi":"10.1007/s12328-025-02134-x","DOIUrl":"https://doi.org/10.1007/s12328-025-02134-x","url":null,"abstract":"<p><p>Giant hepatic hemangiomas can be symptomatic and develop complications, therefore, surgical interventions are considered for such cases. However, hepatic hemangioma presenting pleural effusion is extremely rare. The patient was a 68-year-old female presenting dyspnea, and was referred to our hospital for evaluation of giant hepatic hemangioma of 20 cm with right pleural effusion. Contrast-enhanced computed tomography showed a giant hepatic hemangioma, which stretched umbilical portion, right Glissonean pedicle, and middle hepatic vein and compressed inferior vena cava. The right diaphragm was cranially elevated. Massive pleural effusion was observed. We diagnosed as symptomatic giant hepatic hemangioma. Three days before surgery, right hepatic artery embolization was performed to reduce the tumor volume at the timing of surgery. Intraoperative findings revealed the tumor was severely adherent to the diaphragm and there were feeding arteries from there. Extended right hemihepatectomy with thoracic drainage were performed. The pathologic evaluation confirmed cavernous hemangioma. Postoperative courses were uneventful and the chest tube was removed on postoperative day 4. The patient was discharged on postoperative day 8. One month after the operation, she remained well without recurrence of pleural effusion. We herein report a successfully treated case of giant hepatic hemangioma with symptomatic massive pleural effusion.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976560","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}

{"title":"A case of Budd-Chiari syndrome with acute venous thrombosis and liver failure: highlighting the importance of early intervention and anticoagulation therapy.","authors":"Yumi Otoyama, Masamichi Kimura, Koji Nishikawa, Jun Imamura, Kiminori Kimura","doi":"10.1007/s12328-025-02135-w","DOIUrl":"https://doi.org/10.1007/s12328-025-02135-w","url":null,"abstract":"<p><p>Budd-Chiari syndrome is a rare and potentially fatal disorder characterized by obstruction or narrowing of the hepatic veins and inferior vena cava. The acute form of the disease often leads to rapid liver failure. In Asia, membranous obstruction of the hepatic portion of the inferior vena cava and localized stenosis at the hepatic venous origin are more common, while in Western countries, hepatic vein obstruction due to underlying thrombotic conditions is more prevalent. Treatment strategies vary and depend on disease severity and location. Anticoagulation therapy is the standard treatment in Western countries but is less commonly used in Japan where catheter-based interventions, such as recanalization, balloon dilation, and stenting, are more frequently employed. We report the case of a 51-year-old man diagnosed with Budd-Chiari syndrome after the treatment of esophageal varices. He initially responded well to nafamostat and balloon dilation, maintaining stability for 8 years, but later developed acute complications, including venous thrombosis and liver failure, despite previously stable follow-up. The patient succumbed to his condition despite aggressive treatment, highlighting the importance of early detection and intervention. This case underscores the need for clearer guidelines on anticoagulation therapy in Japan and emphasizes early management to improve prognosis.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983721","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}

{"title":"Intestinal failure from thymoma-associated autoimmune enteropathy: a rare case report.","authors":"Paris Hoey, Vishal Kaushik, Leo Francis, Niwansa Adris","doi":"10.1007/s12328-025-02119-w","DOIUrl":"https://doi.org/10.1007/s12328-025-02119-w","url":null,"abstract":"<p><p>We describe a case of altered bowel habit, early satiety, anorexia and weight loss caused by autoimmune enteropathy. This diagnosis was confirmed by biopsies obtained from upper gastrointestinal endoscopy and ileocolonoscopy. Further investigations revealed multiple pulmonary nodules which were metastases from a malignant thymoma. The patient was commenced on oral budesonide and Mesalazine, in addition to oral and enteral supplementation driven by the specialist nutrition support team, but she did not achieve histological remission, nor did she demonstrate improvement in her nutritional status. She received 3-weeks of in-patient parenteral nutrition, but then subsequently deteriorated as she declined home parenteral nutrition. The patient died eight months later from complications of her disease. This case highlights the rare manifestation of metastatic thymoma presenting with autoimmune enteropathy that led to intestinal failure and death.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986845","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}

{"title":"Long-term survival after chemotherapy combined immunotherapy for recurrent mixed neuroendocrine-non-neuroendocrine neoplasms of the common bile duct.","authors":"Jia Li, Chunyan Yuan, Yulin Pan, Yuanyuan Yang, Nannan Lai, Xia Sheng","doi":"10.1007/s12328-025-02128-9","DOIUrl":"https://doi.org/10.1007/s12328-025-02128-9","url":null,"abstract":"<p><p>Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) of the common bile duct (CBD) are extremely rare, with few literature reported. A 68-year-old male was admitted to our hospital with choledocholithiasis with acute cholangitis. Abdominal computed tomography showed that the CBD was occupied and clearly dilated. Consequently, the patient underwent pancreaticoduodenectomy with regional lymph node dissection. The resected tumor at the distal bile duct was 25 × 25 × 13 mm, consisting of 30% adenocarcinoma and 70% neuroendocrine carcinoma microscopically. The patient then received six cycles of adjuvant chemotherapy. Subsequently, regular monitoring of the patient's tumor marker CA19-9 showed progressive elevation. The patient was readmitted to hospital for tumor recurrence and metastasis and received palliative second-line Gemcitabine and cisplatin chemotherapy and three courses of combined immunochemotherapy (Tyvyt [Sintilimab] + Gemcitabine + Cisplatin). Throughout the treatment course, the tumor marker CA19-9 persistently remained elevated. The patient achieved an overall survival (OS) of 29 months. We found that the continuous elevation of the tumor marker CA19-9 during follow-up might suggest tumor recurrence and an unfavorable prognosis. For patients with multiple metastases of cholangiocarcinoma, combined immunotherapy could potentially assist in prolonging survival. Currently, there is no standardized treatment for biliary MiNENs, and larger scale studies are needed to establish diagnosis and treatment protocols to improve the overall survival of patients.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957109","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}

{"title":"A case of pneumopericardium due to metallic stent placement in the esophagus.","authors":"Kohei Matsuoka, Tsuyoshi Hasegawa, Taichi Shoji, Haruhito Kinoshita, Tomohiro Kawachiya, Junichi Hara, Hitoshi Teraoka, Masaichi Ohira","doi":"10.1007/s12328-025-02130-1","DOIUrl":"https://doi.org/10.1007/s12328-025-02130-1","url":null,"abstract":"<p><p>Pneumopericardium, defined as the presence of air inside the pericardial cavity, is generally considered to be an emergency because it can cause cardiac tamponade. Pneumopericardium associated with self-expanding metallic stent (SEMS) placement is extremely rare. We present a fatal case of pneumopericardium caused by SEMS placement. An 84 year-old man had tumor-induced stenosis of the jejunal limb after total gastrectomy. SEMSs were inserted twice to improve the symptoms without complications. Two days after the implantation of a central venous access port for anorexia, the patient suddenly complained of chest pain and dyspnea, and decreased blood pressure was observed. Chest CT revealed the presence of air in the pericardial cavity. As urgent echography showed cardiac tamponade, pericardiocentesis was performed immediately. The hemodynamic condition temporarily improved after drainage. Although we planned the placement of an additional SEMS to close the fistula, he died 3 days after the onset of symptoms. Pneumopericardium with cardiac tamponade is a potentially fatal situation. An early diagnosis and treatment are important for the management of esophago-pericardial fistula. Prompt drainage is the best management and SEMS placement can achieve effective short-term results.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966678","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}

{"title":"Intrapancreatic cholangiocarcinoma associated with pancreaticobiliary maljunction without bile duct dilatation 27 years after cholecystectomy.","authors":"Hirotaka Kashima, Akihisa Fukuda, Taro Ueo, Ryuki Minami, Masaya Ohana, Hiroshi Seno","doi":"10.1007/s12328-025-02131-0","DOIUrl":"https://doi.org/10.1007/s12328-025-02131-0","url":null,"abstract":"<p><p>A 77-year-old woman was referred to our hospital because of dilatation of the common bile duct. She had undertaken cholecystectomy for abdominal pain and abnormality of gallbladder 27 years before. Computed tomography (CT) and endoscopic ultrasonography (EUS) showed a tumor in the intrapancreatic bile duct and dilatation of the extrahepatic and intrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor in the intrapancreatic bile duct and pancreaticobiliary maljunction (PBM). Previous CT did not show dilatation of the bile duct, indicating that she had PBM without biliary dilatation. Biopsy of the tumor revealed adenocarcinoma, and she was diagnosed with distal cholangiocarcinoma. She undertook pancreatoduodenectomy. Pancreatography of the surgically resected specimen confirmed the connection between the main pancreatic duct and common bile duct. The final pathological diagnosis of the tumor was intrapancreatic papillary adenocarcinoma, pT2N0M0, stage IB. Recurrence has not been observed for 6 years after surgery. For PBM without bile duct dilatation, prophylactic cholecystectomy is recommended to prevent gallbladder carcinoma; however, biliary diversion surgery is controversial and is not generally recommended. Our case underscores that PBM without bile duct dilatation has a risk of extrahepatic biliary cancer and that careful follow-up is important after prophylactic cholecystectomy for a long period.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983271","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}

{"title":"Pathological complete response following addition of durvalumab to gemcitabine and cisplatin therapy for intrahepatic cholangiocarcinoma with Lynch syndrome-associated mismatch repair deficiency.","authors":"Koshiro Fukuda, Akiyoshi Kasuga, Yasuyuki Shigematsu, Kenichiro Kato, Hiromichi Ito, Arisa Ueki, Takeshi Okamoto, Masato Ozaka, Yu Takahashi, Naoki Sasahira","doi":"10.1007/s12328-025-02122-1","DOIUrl":"https://doi.org/10.1007/s12328-025-02122-1","url":null,"abstract":"<p><p>A 64-year-old man with a history of surgery for rectal cancer and colon cancer was referred for a hepatic mass identified on computed tomography (CT). He was diagnosed with unresectable intrahepatic cholangiocarcinoma (ICC) with perihilar and para-aortic lymph node metastases. After 4 cycles of gemcitabine and cisplatin combination therapy (GC therapy), follow-up CT showed slight enlargement of the primary tumor and a slight increase in carbohydrate antigen (CA) 19-9. Genetic testing was performed during GC therapy based on the strong family history of cancer. Germline pathogenic variant in MLH1 was identified, leading to the diagnosis of Lynch syndrome (LS) with mismatch repair deficiency (dMMR: loss of MLH1/PMS2). Durvalumab was added to GC therapy following regulatory approval in Japan. A significant reduction in tumor size and CA19-9 was observed after only two cycles of GC and durvalumab therapy. Continuous improvement was observed, and conversion surgery involving liver resection, partial inferior vena cava resection, and perihilar and para-aortic lymph nodes dissection was performed with curative intent. No malignant cells were found in any of the resected specimens, consistent with pathological complete response.</p>","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966883","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}