Clinical Journal of Gastroenterology最新文献_第3页

Mesenteroaxial gastric volvulus associated with a wandering spleen in an older woman treated with anterior gastropexy and splenectomy: a case report. 经胃前固定术和脾切除术治疗的老年妇女肠系膜轴状胃扭转伴脾游离：1例报告。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-08-07 DOI: 10.1007/s12328-026-02415-z

Hirotaka Nomiya, Kazuya Ofuji, Takuto Nosaka, Arisa Tsuji, Ryotaro Sugata, Tadayoshi Otsuki, Seiichi Taguchi, Yoshiaki Imamura, Yasunari Nakamoto, Hiroyuki Suto

{"title":"Mesenteroaxial gastric volvulus associated with a wandering spleen in an older woman treated with anterior gastropexy and splenectomy: a case report.","authors":"Hirotaka Nomiya, Kazuya Ofuji, Takuto Nosaka, Arisa Tsuji, Ryotaro Sugata, Tadayoshi Otsuki, Seiichi Taguchi, Yoshiaki Imamura, Yasunari Nakamoto, Hiroyuki Suto","doi":"10.1007/s12328-026-02415-z","DOIUrl":"10.1007/s12328-026-02415-z","url":null,"abstract":"An 80-year-old woman with Parkinson disease presented with sudden abdominal pain, back pain, and vomiting during a meal. Computed tomography revealed marked gastric dilatation with cranial displacement and rotation of the antrum, consistent with mesenteroaxial gastric volvulus. This was accompanied by an ectopic spleen adjacent to the greater curvature and suspected pedicle torsion, consistent with a wandering spleen. Nasogastric tube passage was initially unsuccessful. Emergency upper gastrointestinal endoscopy achieved gastric decompression and transient detorsion; however, immediate retorsion was observed, and continuous decompression was maintained after successful tube placement. Definitive surgery was performed on hospital day 2. The stomach was reduced and fixed to the abdominal wall via anterior gastropexy; splenectomy was performed due to marked splenic mobility and concerns about recurrent torsion. Histopathological examination revealed congestion and partial hemorrhagic infarction compatible with splenic torsion. The postoperative course was uneventful; the patient was discharged on postoperative day 14 without recurrence during the follow-up. This case underscores that immediate retorsion after endoscopic reduction might warrant prompt definitive surgery with gastropexy and management of a wandering spleen should be individualized according to mobility and splenic viability.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1161-1168"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary mucosal melanoma of the maxillary sinus with spontaneous rupture of liver metastasis. 上颌窦原发性粘膜黑色素瘤伴自发性破裂肝转移。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-06-24 DOI: 10.1007/s12328-026-02381-6

Shusuke Okamura, Wataru Fukami, Risa Tanaka, Yoshinao Kinjo, Yusuke Nakamura, Yusuke Aoki, Hiromasa Watanabe, Erina Ueno, Hiroshi Kawano, Takumi Kawaguchi

{"title":"Primary mucosal melanoma of the maxillary sinus with spontaneous rupture of liver metastasis.","authors":"Shusuke Okamura, Wataru Fukami, Risa Tanaka, Yoshinao Kinjo, Yusuke Nakamura, Yusuke Aoki, Hiromasa Watanabe, Erina Ueno, Hiroshi Kawano, Takumi Kawaguchi","doi":"10.1007/s12328-026-02381-6","DOIUrl":"10.1007/s12328-026-02381-6","url":null,"abstract":"Spontaneous rupture of primary liver tumors is a well-recognized and potentially life-threatening complication of hepatocellular carcinoma, whereas rupture of metastatic liver tumors is rare. We report the case of a 60-year-old woman with spontaneous rupture of liver metastasis from a mucosal melanoma, a rare subtype of malignant melanoma. Intraperitoneal bleeding was controlled by transcatheter arterial embolization, and liver tumor biopsy confirmed metastatic melanoma. The maxillary sinus was identified as the primary site. Based on the clinical course, the liver metastases appeared over a short period and progressed rapidly. In addition, contrast-enhanced computed tomography (CT) performed immediately before rupture showed overall poor but heterogeneous enhancement of the ruptured tumor, with a tortuous dilated intratumoral vessel penetrating the lesion. Three-dimensional CT angiography reconstructed from this CT dataset demonstrated that the penetrating vessel represented a tumor-feeding artery, which was morphologically more consistent with a pre-existing hepatic vessel altered by tumor progression than with a newly formed tumor neovessel. Although rare, rupture of metastatic liver tumors may be associated with rapid tumor growth. Importantly, a tortuous dilated intratumoral vessel identified on pre-rupture CT may represent an imaging feature associated with tumor fragility and impending rupture.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1206-1214"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307144","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 staged endoscopic treatment of multiple gastrointestinal varices caused by oxaliplatin-induced sinusoidal obstruction syndrome. 成功分阶段内镜治疗奥沙利铂引起的多发性胃肠静脉曲张窦阻塞综合征。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-07-26 DOI: 10.1007/s12328-026-02411-3

Naoya Kinsho, Tsunetaka Kato, Takuto Hikichi, Jun Nakamura, Takumi Yanagita, Mitsuru Otsuka, Eisuke Kameoka, Daiki Nemoto, Masao Kobayakawa, Hiromasa Ohira

{"title":"Successful staged endoscopic treatment of multiple gastrointestinal varices caused by oxaliplatin-induced sinusoidal obstruction syndrome.","authors":"Naoya Kinsho, Tsunetaka Kato, Takuto Hikichi, Jun Nakamura, Takumi Yanagita, Mitsuru Otsuka, Eisuke Kameoka, Daiki Nemoto, Masao Kobayakawa, Hiromasa Ohira","doi":"10.1007/s12328-026-02411-3","DOIUrl":"10.1007/s12328-026-02411-3","url":null,"abstract":"Sinusoidal obstruction syndrome is a well-known hepatic vascular injury associated with oxaliplatin-based chemotherapy and can lead to non-cirrhotic portal hypertension. Although splenomegaly and thrombocytopenia are common clinical manifestations, clinically significant gastrointestinal varices may persist or newly develop after oxaliplatin cessation. The optimal therapeutic strategy for multiple gastrointestinal varices caused by oxaliplatin-induced sinusoidal obstruction syndrome remains unclear. Here, we report a case of a 71-year-old man who developed non-cirrhotic portal hypertension after oxaliplatin-based adjuvant chemotherapy for rectal cancer. Contrast-enhanced computed tomography and ultrasonography revealed splenomegaly, portal collateral vessels, gallbladder wall thickening, and decreased portal venous flow velocity without findings suggestive of liver cirrhosis or hepatic venous outflow obstruction. Esophagogastroduodenoscopy revealed esophageal, duodenal, and gastric varices. Considering that portal hypertension persisted > 3 years after oxaliplatin cessation, spontaneous regression was considered unlikely. A staged endoscopic treatment strategy was adopted to avoid abrupt changes in portal hemodynamics. Endoscopic injection sclerotherapy was first performed for esophageal varices, followed by n-butyl-2-cyanoacrylate injection for duodenal and gastric varices. High-risk bleeding varices were completely eradicated without adverse events. No variceal bleeding occurred during 6 months of follow-up. This case suggests the safety and effectiveness of risk-based prioritization and staged endoscopic treatment strategy for multiple gastrointestinal varices associated with oxaliplatin-induced sinusoidal obstruction syndrome.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1140-1146"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590829","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

Endometriosis in the cecum diagnosed via forward-viewing endoscopic ultrasound-guided tissue acquisition with a 19G fine-needle biopsy needle: a case report. 前视内镜超声引导下19G细针活检针组织采集诊断盲肠子宫内膜异位症1例报告。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-07-06 DOI: 10.1007/s12328-026-02392-3

Kensei Kawasaki, Kotaro Takeshita, Shuta Otachi, Kenji Matsuo, Yuki Kano, Eisuke Nakao, Eisuke Akamine, Satoshi Asai

{"title":"Endometriosis in the cecum diagnosed via forward-viewing endoscopic ultrasound-guided tissue acquisition with a 19G fine-needle biopsy needle: a case report.","authors":"Kensei Kawasaki, Kotaro Takeshita, Shuta Otachi, Kenji Matsuo, Yuki Kano, Eisuke Nakao, Eisuke Akamine, Satoshi Asai","doi":"10.1007/s12328-026-02392-3","DOIUrl":"10.1007/s12328-026-02392-3","url":null,"abstract":"Subepithelial lesions (SELs) in the lower gastrointestinal tract are rare, and diagnosis and treatment of colorectal SELs are often challenging. Although endoscopic ultrasound-guided tissue acquisition (EUS-TA) is useful for minimally invasive histological diagnosis, few reports have described its use for right-sided colonic SELs because advancing an oblique-viewing echoendoscope into the right colon is difficult. A 30-year-old woman was referred to our hospital after colonoscopy revealed a protruding cecal lesion suggestive of an SEL. Contrast-enhanced computed tomography showed a 37-mm contrast-enhancing mass and an adjacent lesion, thought to be an enlarged lymph node, and gastrointestinal stromal tumor was suspected. A forward-viewing echoendoscope was inserted transanally and advanced successfully to the cecum in 4 min. EUS-TA of the cecal mass was performed using a 19-gauge fine-needle biopsy needle, and EUS-TA of the adjacent lesion was performed using a 25-gauge fine-needle biopsy needle. Histopathological and immunohistochemical examinations showed endometrial glands and stroma with positivity for estrogen receptor, progesterone receptor, and CD10, leading to a definitive diagnosis of endometriosis. This diagnosis enabled initial non-surgical management without immediate surgery.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1069-1074"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390080","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

Multidisciplinary treatment with conversion surgery after radiological complete response of liver metastasis to gemcitabine, cisplatin, and durvalumab in metastatic distal cholangiocarcinoma. 转移性远端胆管癌在吉西他滨、顺铂和杜伐单抗的肝转移放射学完全缓解后进行多学科治疗和转换手术。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-08-07 DOI: 10.1007/s12328-026-02421-1

Atsushi Tomioka, Nao Kawaguchi, Mitsuaki Ishida, Sota Watanabe, Yasuhiko Ueda, Hiroki Hamamoto, Ryo Tanaka, Yoshiro Imai, Mitsuhiro Asakuma, Sang-Woong Lee

{"title":"Multidisciplinary treatment with conversion surgery after radiological complete response of liver metastasis to gemcitabine, cisplatin, and durvalumab in metastatic distal cholangiocarcinoma.","authors":"Atsushi Tomioka, Nao Kawaguchi, Mitsuaki Ishida, Sota Watanabe, Yasuhiko Ueda, Hiroki Hamamoto, Ryo Tanaka, Yoshiro Imai, Mitsuhiro Asakuma, Sang-Woong Lee","doi":"10.1007/s12328-026-02421-1","DOIUrl":"10.1007/s12328-026-02421-1","url":null,"abstract":"Introduction: Distant metastasis in distal cholangiocarcinoma (DCC) generally precludes curative treatment. However, chemo-immunotherapy may enable multidisciplinary treatment with curative intent in selected patients. We report a rare case of metastatic DCC with liver metastasis that achieved radiological complete response after gemcitabine, cisplatin, and durvalumab (GCD) therapy, followed by resection of the residual primary lesion.Case presentation: A 73-year-old woman with a history of total gastrectomy presented with DCC and a solitary liver metastasis. Following endoscopic ultrasound-guided hepaticojejunostomy and eight cycles of gemcitabine, cisplatin, and durvalumab (GCD) therapy, the liver metastasis achieved a radiological complete response. After 16 cycles of durvalumab maintenance therapy, conversion pancreaticoduodenectomy without hepatectomy was performed because disease remained controlled despite residual primary disease. Pathological examination revealed residual viable tumor (ypT2N2M0). Immunohistochemistry suggested differences in the immune microenvironment between the primary tumor and liver metastasis. The patient remained recurrence-free 15 months after surgery.Conclusions: This rare case highlights the heterogeneous response between the primary tumor and liver metastasis after GCD therapy and demonstrates the potential role of conversion surgery in selected patients with metastatic DCC. It provides important insight into treatment decision-making in this clinical setting.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1320-1327"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683411","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 young pregnant woman with oesophageal cancer who responded to carboplatin plus nab-paclitaxel therapy. 一位食管癌的年轻孕妇对卡铂加nab-紫杉醇治疗有反应。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-07-13 DOI: 10.1007/s12328-026-02395-0

Yoshinori Kikuchi, Kazuhisa Yamaguchi, Munehiro Wakabayashi, Naobumi Tochigi, Naoyuki Harada, Atsuro Terahara, Takahisa Matsuda

{"title":"A young pregnant woman with oesophageal cancer who responded to carboplatin plus nab-paclitaxel therapy.","authors":"Yoshinori Kikuchi, Kazuhisa Yamaguchi, Munehiro Wakabayashi, Naobumi Tochigi, Naoyuki Harada, Atsuro Terahara, Takahisa Matsuda","doi":"10.1007/s12328-026-02395-0","DOIUrl":"10.1007/s12328-026-02395-0","url":null,"abstract":"The case involved a 35-year-old female patient in the fifth month of pregnancy. The patient complained of dysphagia in the early stages of pregnancy and was referred to our hospital after developing dyspnea. An MRI revealed an 8 cm tumor in the anterior mediastinum compressing the airway. The fetus was delivered via emergency cesarean section, and a cervical lymph node biopsy confirmed squamous cell carcinoma. The tumor was diagnosed as an anterior mediastinal tumor of unknown primary origin, and treatment with nanoparticle albumin-bound paclitaxel (nab-PTX) plus Carboplatin (CBDCA) resulted in significant tumor shrinkage. Following shrinkage, the tumor was ultimately diagnosed as esophageal cancer. Subsequently, recurrence in the esophagus and brain metastasis were detected. Still, after undergoing radiation therapy, surgical treatment, and chemotherapy, no recurrence was observed for more than one year after the final treatment. The results of this study demonstrate that the combination therapy of nab-PTX plus CBDCA is highly effective not only for lung squamous cell carcinoma but also for esophageal squamous cell carcinoma.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1075-1081"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429921","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

Letter to the editor to 'Diagnostic and therapeutic utility of gastric tissue culture in a case of phlegmonous gastritis': reanalysis of the 2015-2025 case series: culture-positive phlegmonous gastritis has lower mortality than culture-negative cases. 致编辑的“痰性胃炎病例中胃组织培养的诊断和治疗效用”的信：2015-2025年病例系列的再分析：培养阳性痰性胃炎的死亡率低于培养阴性病例。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-05-19 DOI: 10.1007/s12328-026-02339-8

Zhili Zheng, Xinqiao Chu, Zhen Liu

引用次数: 0

A case of small pancreatic neuroendocrine tumor of less than 10 mm showing metastasis to multiple organs. 1例小于10毫米的胰腺神经内分泌小肿瘤，表现为多器官转移。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-06-28 DOI: 10.1007/s12328-026-02380-7

Tomoki Ogata, Kazuo Hara, Nozomi Okuno, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Shimpei Matsumoto, Keigo Oshiro, Waki Hosoda

{"title":"A case of small pancreatic neuroendocrine tumor of less than 10 mm showing metastasis to multiple organs.","authors":"Tomoki Ogata, Kazuo Hara, Nozomi Okuno, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Shimpei Matsumoto, Keigo Oshiro, Waki Hosoda","doi":"10.1007/s12328-026-02380-7","DOIUrl":"10.1007/s12328-026-02380-7","url":null,"abstract":"Small non-functioning pancreatic neuroendocrine tumors (pNETs) measuring under 10 mm are considered eligible for observation and follow-up, although a minority of small NETs may exhibit show an aggressive behavior. We report a case of small G2-NET that was surgically removed and later developed metastatic recurrence in multiple organs. The patient, a woman in her sixties with a pancreatic body cyst, had been under follow-up for more than a decade. Several years later, a hypoechoic area appeared in the pancreatic body. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed twice; however, a definitive diagnosis was not obtained. Subsequent EUS revealed extension of the lesion into the main pancreatic duct, which was diagnosed as a pancreatic body tumor with intraductal extension. Distal pancreatectomy was performed, and histology revealed a small G2-NET, measuring 8 × 7 mm in diameter. Multiple metastatic tumors were detected 4.5 years after surgery, and the patient is currently undergoing treatment with everolimus and lanreotide. This case supports the viewpoint that small G2-NETs, even those measuring less than 10 mm, may have a risk of metastasis, highlighting the need for careful follow-up and appropriate therapeutic interventions.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1199-1205"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338153","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 portal hypertension associated with a giant hepatic arterioportal fistula successfully treated with partial hepatic arterial embolization. 经部分肝动脉栓塞治疗门静脉高压症合并巨大肝动脉门静脉瘘1例。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-07-20 DOI: 10.1007/s12328-026-02403-3

Makoto Ueno, Keisuke Ojiro, Yukie Nakadai, Takaya Tabuchi, Ryosuke Kasuga, Nobuhito Taniki, Shingo Usui, Masashi Tamura, Nobuhiro Nakamoto, Takanori Kanai

{"title":"A case of portal hypertension associated with a giant hepatic arterioportal fistula successfully treated with partial hepatic arterial embolization.","authors":"Makoto Ueno, Keisuke Ojiro, Yukie Nakadai, Takaya Tabuchi, Ryosuke Kasuga, Nobuhito Taniki, Shingo Usui, Masashi Tamura, Nobuhiro Nakamoto, Takanori Kanai","doi":"10.1007/s12328-026-02403-3","DOIUrl":"10.1007/s12328-026-02403-3","url":null,"abstract":"Adult-onset symptomatic hepatic arterioportal fistula (HAPF) is a rare vascular abnormality for which optimal treatment strategies have not been established. We report a case of a symptomatic giant HAPF successfully treated with interventional radiology. A woman in her 60 s presented with massive ascites. Imaging studies revealed an intrahepatic HAPF with multiple abnormal communications between the posterior segmental branch of the portal vein and arterial inflow from the right hepatic artery and the right inferior phrenic artery, leading to a diagnosis of portal hypertension associated with HAPF. Due to the high surgical risk associated with massive ascites, partial transcatheter arterial embolization targeting the major hepatic arterial inflow was performed instead of using a portal venous approach. Although complete shunt occlusion was not achieved, the disappearance of early portal venous enhancement was used as the procedural endpoint, suggesting a marked reduction in hepatofugal portal flow. Following treatment, ascites resolved, serum albumin levels improved, and liver volume increased on follow-up imaging. The patient has remained recurrence-free for two years after treatment. Partial hepatic arterial embolization aimed at flow reduction, rather than complete shunt obliteration, may be an effective and less invasive therapeutic strategy for complex HAPF.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1257-1263"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520031","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

Severe pancreatic exocrine insufficiency presenting with hypoalbuminemia, anasarca, and pulmonary edema in a patient with prior gastrectomy and suspected immunoglobulin G4-related pancreatobiliary disease. 曾行胃切除术并疑似免疫球蛋白g4相关胰胆管疾病的患者出现严重胰腺外分泌功能不全，表现为低白蛋白血症、贫血和肺水肿。

IF 0.8

Clinical Journal of Gastroenterology Pub Date : 2026-10-01 Epub Date: 2026-07-23 DOI: 10.1007/s12328-026-02404-2

Naoya Fujita, Kenichi Hashimoto, Akinori Sekizawa, Hiroshi Takazaki, Yosuke Ono, Yasuhiro Obuchi, Nobutaka Hirooka, Yuji Tanaka

{"title":"Severe pancreatic exocrine insufficiency presenting with hypoalbuminemia, anasarca, and pulmonary edema in a patient with prior gastrectomy and suspected immunoglobulin G4-related pancreatobiliary disease.","authors":"Naoya Fujita, Kenichi Hashimoto, Akinori Sekizawa, Hiroshi Takazaki, Yosuke Ono, Yasuhiro Obuchi, Nobutaka Hirooka, Yuji Tanaka","doi":"10.1007/s12328-026-02404-2","DOIUrl":"10.1007/s12328-026-02404-2","url":null,"abstract":"A 55-year-old man with prior subtotal gastrectomy was admitted with generalized edema, 16-kg weight gain, dyspnea, and frequent watery pale stools. Laboratory tests revealed severe hypoalbuminemia (1.0 g/dL), anemia, elevated myogenic enzymes, liver dysfunction, and markedly decreased pancreatic enzyme levels. Computed tomography showed bilateral pleural effusion, pulmonary edema, ascites, diffuse soft tissue edema, and marked pancreatic atrophy. Stool Sudan III staining was positive, and urinary para-aminobenzoic acid excretion was reduced. Although cardiac, renal, and hepatic disorders were considered, they did not adequately explain the presentation. Pancreatic exocrine insufficiency was diagnosed. Serum immunoglobulin G4 was elevated at 199 mg/dL, and previous imaging showed poor visualization of the hilar bile duct, gallbladder wall thickening, and gallbladder atrophy. Therefore, possible immunoglobulin G4-related pancreatobiliary disease was considered the leading possible etiology of pancreatic atrophy and exocrine insufficiency, with prior gastrectomy as a modifying factor. Treatment with albumin, diuretics, and pancrelipase (1,800 mg/day) rapidly improved the overall condition of the patient. This case highlights that pancreatic exocrine insufficiency can present with severe third-space fluid shift, pulmonary edema, and compartment syndrome-like findings, highlighting the need to assess multifactorial causes.","PeriodicalId":10364,"journal":{"name":"Clinical Journal of Gastroenterology","volume":" ","pages":"1264-1272"},"PeriodicalIF":0.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0