International Medical Case Reports Journal最新文献

{"title":"Vitrectomy with Low-Dose Subretinal t-PA for Hemorrhage Due to Traumatic Choroidal Rupture: A Case Series.","authors":"Agnieszka Joanna Nowosielska, Grzegorz Rotuski","doi":"10.2147/IMCRJ.S616758","DOIUrl":"10.2147/IMCRJ.S616758","url":null,"abstract":"<p><strong>Background: </strong>Choroidal rupture with subretinal hemorrhage comprising the fovea is thought to have poor prognosis regardless of surgical interventions. Being a relatively rare entity, managing patients, referring them in time and standardizing a therapeutic approach remains challenging. Many eyecare practitioners opt solely for conservative treatment, without recurring to any surgical treatment.</p><p><strong>Case reports: </strong>Three young adult males with blunt ocular trauma complicated by choroidal rupture with subretinal hemorrhage presented to the vitreoretinal surgeon appointment. All of them underwent pars plana vitrectomy with subretinal rtPA administration. All patients were then monitored for recovery with conservative treatment and despite the present post traumatic choroidal rupture, they achieved major improvement in visual acuity along with OCT parameters compared to their initial presentation.</p><p><strong>Conclusion: </strong>Not all vitreoretinal surgeons perform subretinal rtPA injection, partly due to not being trained in this aspect, but also due to controversies around this approach. Intravitreal rtPA injection is an easier alternative, although less impactful. Sometimes, even performing a gas endotamponade in the vitreous cavity without specific fibrinolytic treatment can improve results upon blood dislocation away from the fovea. Knowledge on the possibility of surgical intervention in patients with subretinal hemorrhage is important to be popularized among ophthalmologists, so they can refer these cases to vitreoretinal surgeons promptly instead of sticking to conservative treatment only, which may be the inferior choice in cases with macular involvement when time plays a key role.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"616758"},"PeriodicalIF":0.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793061","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}

{"title":"Trauma Unmasking Pituitary Apoplexy: Coexisting Epidural Hematoma and Sellar Mass - A Case Report with Selected Cases from the Literature.","authors":"Negin Safari Dehnavi, Ali Ghaleh, Mahan Ranjbar, Fatemeh Riyahi Zaniyani, Alireza Khoshnevisan, Milad Shafizadeh","doi":"10.2147/IMCRJ.S618555","DOIUrl":"https://doi.org/10.2147/IMCRJ.S618555","url":null,"abstract":"<p><strong>Background: </strong>Pituitary incidentalomas are sellar lesions identified on imaging performed for unrelated reasons. Lesions measuring 1 cm or larger are classified as macroincidentalomas. Pituitary apoplexy is an acute clinical syndrome caused by hemorrhage or infarction within the pituitary gland and may present with headache, ophthalmoplegia, altered consciousness, visual dysfunction, and hypopituitarism.</p><p><strong>Case presentation: </strong>A 36-year-old man presented with decreased consciousness after a motor vehicle crash. Noncontrast CT revealed a right parietal epidural hematoma with approximately 5 mm of midline shift and an incidental sellar mass. Emergency craniotomy and hematoma evacuation were performed, after which his Glasgow Coma Scale score improved to 15. Family members reported that left eyelid ptosis had begun 10 days before the crash. Subsequent MRI demonstrated a large heterogeneous sellar-suprasellar mass with T1-hyperintense components compatible with pituitary apoplexy. Endocrine evaluation showed central hypothyroidism, reduced gonadotropins, low prolactin, normal morning cortisol, and low-normal ACTH. Following endocrinology consultation, perioperative hydrocortisone was administered and later tapered. Endoscopic transsphenoidal resection revealed chronic motor oil-like blood and fragmented dark clot within the tumor. Histopathology confirmed a gonadotroph pituitary neuroendocrine tumor with a Ki-67 labeling index below 1%. The left ptosis resolved completely by the 3-month follow-up.</p><p><strong>Conclusion: </strong>Life-threatening traumatic lesions may coexist with sellar emergencies and obscure their neurological and endocrine manifestations. In this case, pre-injury left ptosis suggested that the sellar process preceded the crash, whereas the role of trauma as a precipitating or aggravating factor could not be established. After stabilization of the traumatic lesion, targeted sellar imaging and early endocrine involvement should be considered when cranial nerve findings or endocrine abnormalities remain unexplained.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"618555"},"PeriodicalIF":0.7,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793122","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}

{"title":"Life-Threatening Spontaneous Retroperitoneal Hemorrhage Associated with Acenocoumarol Anticoagulation in a Young Patient with a Mechanical Aortic Valve: A Case Report.","authors":"Mohamed Omar Hassan, Hassan Omar Hersi, Nasra Mohamud Hilowle, Ahmed Elmi Abdi","doi":"10.2147/IMCRJ.S623300","DOIUrl":"https://doi.org/10.2147/IMCRJ.S623300","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous retroperitoneal hemorrhage is an uncommon but potentially fatal complication of anticoagulant therapy. Management is particularly difficult in patients with mechanical heart valves because urgent reversal must be balanced against the risk of valve thrombosis and systemic embolism.</p><p><strong>Case presentation: </strong>A 24-year-old man with a mechanical aortic valve receiving acenocoumarol presented with severe abdominal pain, abdominal distension, and syncope. Hemoglobin was 4 g/dL, serum creatinine was 2.5 mg/dL, and the international normalized ratio was 15. Contrast-enhanced computed tomography showed a large left perinephric retroperitoneal hematoma extending into the left iliopsoas muscle and pelvis, without hemoperitoneum or active contrast extravasation. Acenocoumarol was stopped, and he received intravenous vitamin K, fresh frozen plasma because prothrombin complex concentrate was unavailable, packed red blood cells, and intensive monitoring. He improved without invasive intervention, and anticoagulation was cautiously reintroduced after clinical and radiological stabilization.</p><p><strong>Conclusion: </strong>Spontaneous retroperitoneal hemorrhage should be considered in anticoagulated patients with abdominal or flank pain, syncope, unexplained anemia, hypotension, or acute kidney injury. Prompt diagnosis, urgent reversal, and individualized anticoagulation resumption are essential.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"623300"},"PeriodicalIF":0.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792945","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}

{"title":"Beyond the Physical Symptoms: An Exploratory Single‑Case Psychological Profile of an Adult with HSAN‑II.","authors":"Arash Jelodari, Laleh Hosseini","doi":"10.2147/IMCRJ.S629142","DOIUrl":"https://doi.org/10.2147/IMCRJ.S629142","url":null,"abstract":"<p><strong>Aim: </strong>Hereditary Sensory and Autonomic Neuropathy Type II (HSAN‑II) is an extremely rare autosomal recessive disorder characterized by progressive sensory loss, recurrent ulcers, and frequent amputations. Despite its severe physical consequences, the psychological impact of HSAN‑II remains largely unexplored. This exploratory single‑case report presents the psychological profile of a 31‑year‑old Iranian man diagnosed with HSAN‑II.</p><p><strong>Methods: </strong>A semi‑structured clinical interview and a battery of standardized psychological instruments were administered, including the Interpersonal Communication Skills Questionnaire, Rosenberg Self‑Esteem Scale, Differentiation of Self Inventory, Ryff's Psychological Well‑Being Scale (18‑item version), and Body Image Concern Inventory.</p><p><strong>Findings: </strong>Results revealed profound impairments across multiple domains: low interpersonal communication skills (total score = 121), low self-esteem (score = 18), poor self-differentiation (total score = 145), markedly reduced psychological well-being (total score = 49), and clinically significant body image concerns (total score = 76). Qualitative findings indicated that prolonged hospitalizations, social isolation during critical developmental periods, and visible physical deformities (including multiple amputations) were major contributing factors to these psychological difficulties.</p><p><strong>Conclusion: </strong>This preliminary single‑case evidence highlights the substantial psychosocial burden associated with HSAN‑II and underscores the need for routine psychological screening and multidisciplinary care in patients with rare genetic neuropathies. Although findings are not generalizable, they point to the potential value of early psychosocial interventions targeting body image, self‑esteem, and social skills.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"629142"},"PeriodicalIF":0.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792898","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}

{"title":"Bacteremic Group A Streptococcal Co-Infection in Two Adults with H3N2 Influenza in Japan, 2025-2026: A Case Series.","authors":"Masafumi Seki","doi":"10.2147/IMCRJ.S617504","DOIUrl":"10.2147/IMCRJ.S617504","url":null,"abstract":"<p><p>Two adult cases of influenza with bacteremia due to Group A <i>Streptococcus pyogenes</i> (GAS) in the 2025-2026 season, which was a major season of H3N2 subclade (subclade K) type influenza in Japan, are presented. Case 1: A 52-year-old man with no underlying diseases and no vaccination history was admitted as influenza A. The onset was five days ago, and GAS was isolated from his blood. He was in shock with lobular pneumonia, high inflammation, and renal dysfunction, and finally he died although intensive care and appropriate antiviral/antibiotic treatment. Case 2: A 68-year-old woman with no underlying disease was admitted as influenza A. She received laninamivir inhalation on Day -1 and had history of the influenza vaccine for the season. She was also in shock and renal dysfunction status but did not show obvious pneumonia although <i>Streptococcus pneumoniae</i> (<i>S</i>. <i>pneumoniae</i>) was isolated from her sputum. In addition, GAS was also isolated from her blood on admission. She finally recovered by intensive care and appropriate antibiotic treatment. Both patients showed septic status and acute kidney injury (AKI) on admission; however, one patient survived and the other did not. These cases highlight the severity of influenza-GAS co-infection during a season in which H3N2 subclade K predominated. Early antiviral treatment within 48 hours, vaccination, and high index of suspicion for invasive GAS in influenza patients with shock will be needed.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"617504"},"PeriodicalIF":0.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759255","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}

{"title":"New-Onset Psychotic Episode as the Primary Manifestation One Week After Liver Transplantation: A Case Report and Comprehensive Review About the Risk Factors.","authors":"Yanqun Zheng, Zhuyao Lin, Mo Zhu, Qianwei Wang, Shenxun Shi, Chunhong Shao","doi":"10.2147/IMCRJ.S556097","DOIUrl":"10.2147/IMCRJ.S556097","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative neurological and neuropsychiatric complications (NNC) after liver transplantation (LT) have become an important research concern, but the difficulties arise with the diagnosis of the majority subclinical form of NNC.</p><p><strong>Case report: </strong>We report a middle-aged man who developed fluctuating psychotic symptoms, marked personality change, and behavioral disturbance approximately one week after LT. No overt focal neurological deficits, such as hemiparesis, aphasia, or seizures, were observed. Brain MRI showed small periventricular/subcortical white-matter lesions with hyperintensity on T2WI and FLAIR images and punctate hyperintensity on DWI. The findings were interpreted as suggestive of suspected silent ischemic brain injury. Tacrolimus-related neurotoxicity, PRES, metabolic/hepatic encephalopathy, infection, seizure-related states, and alcohol-related encephalopathy were considered in the differential diagnosis. Contemporaneous tacrolimus trough levels and EEG data were unavailable, so tacrolimus neurotoxicity and non-convulsive seizure-related psychiatric symptoms could not be completely excluded. The patient received symptomatic psychiatric treatment and rehabilitation, and his neuropsychiatric symptoms gradually resolved, with stable liver function at the last follow-up.</p><p><strong>Conclusion: </strong>This case illustrates that suspected silent ischemic brain injury after LT may present primarily as fluctuating psychotic symptoms and personality or behavioral changes, and may be easily mistaken for postoperative delirium, calcineurin-inhibitor neurotoxicity, infection, or metabolic/hepatic encephalopathy. In atypical or high-risk patients, early brain MRI may help identify potential brain involvement and guide timely neurological and neuropsychiatric evaluation.</p><p><strong>Key message: </strong>New-onset psychotic symptoms after LT should not be automatically attributed to postoperative delirium. Even when MRI findings do not definitively confirm acute infarction, timely neuropsychiatric assessment and early brain MRI may help identify potential structural brain involvement in high-risk or atypical patients.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"556097"},"PeriodicalIF":0.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760083","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}

{"title":"Incidental Isolated Bilateral Clavicular Agenesis Discovered During Preoperative Hernia Assessment of a 78-Year-Old Male in Rural Uganda: A Case Report.","authors":"Bakwanamaha Maha Alain, Arthur Ajwang, Mugarura Anwar Biraali, Ojangole Albert, Micheal Mugenyi, Mumbere Vahwere Bienfait","doi":"10.2147/IMCRJ.S628204","DOIUrl":"10.2147/IMCRJ.S628204","url":null,"abstract":"<p><strong>Background: </strong>Bilateral agenesis of the clavicles is an extremely rare congenital anomaly. It is most commonly associated with cleidocranial dysplasia, an autosomal dominant skeletal disorder characterized by delayed closure of cranial sutures, dental anomalies, and hypoplastic or aplastic clavicles. Diagnosis typically occurs in childhood. We report a rare case of a 78-year-old male diagnosed incidentally with bilateral clavicular agenesis during a routine preoperative workup for a recurrent inguinal hernia.</p><p><strong>Case presentation: </strong>A 78-year-old African male presented with a recurrent left inguinal hernia. His medical history was significant for hypertension and a previous hernioplasty 10 years prior. During routine preoperative physical examination and chest radiography, a complete bilateral absence of the clavicles was noted. The patient had hypermobility of the shoulder girdle but reported no functional impairment throughout his 78 years of life. He successfully underwent a left inguinal hernioplasty under spinal anesthesia and had an uneventful recovery.</p><p><strong>Conclusion: </strong>Complete bilateral clavicular agenesis can remain entirely asymptomatic and functionally benign into late adulthood, allowing for unhindered manual labor. In low-resource settings, routine preoperative radiography for unrelated conditions serves as a vital diagnostic tool for uncovering such latent congenital anomalies.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"628204"},"PeriodicalIF":0.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759495","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}

{"title":"A Diagnostic Dilemma in a Breast Cancer Patient on Tamoxifen: Perihepatic Endometriosis Masquerading as Metastatic Disease.","authors":"Monerah Abdulrahman M Almohideb, Shayma Abdullah E Aloumi","doi":"10.2147/IMCRJ.S622542","DOIUrl":"10.2147/IMCRJ.S622542","url":null,"abstract":"<p><p>Breast cancer metastasis to the liver carries a poor prognosis, and the identification of hypermetabolic hepatic or perihepatic lesions on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in a patient with a known oncological history typically raises immediate concern for disease progression. We report the case of a 49-year-old woman with a prior history of breast cancer, managed on tamoxifen, in whom PET/CT and conventional CT imaging demonstrated findings highly suggestive of widespread osseous and peritoneal metastases. Surgical excision of the dominant perihepatic lesion revealed endometriosis on histopathological examination, with no evidence of malignancy. The coexisting skeletal lesions, by contrast, represented true osseous metastases and were treated with systemic therapy. This case illustrates the potential for endometriosis, particularly in the context of tamoxifen-associated endometrial stimulation, to generate false-positive findings on functional imaging, and underscores the essential role of tissue biopsy in guiding oncological decision-making.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"622542"},"PeriodicalIF":0.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724630","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}

{"title":"Bilateral Pathological Femoral Fractures Secondary to Long-Term Tenofovir Disoproxil Fumarate-Induced Osteomalacia in a Woman Living with HIV: A Case Report.","authors":"Jeya Sushimitha Jawahar Kanth, Morrish Obol Okello, Thuparambil M Ravi Anish, Florence Namutebi, Patricia Namawejje, Micheal Collins Segawa, Morris K Rutakingirwa, Phoebe Mbabazi, David Meya","doi":"10.2147/IMCRJ.S629491","DOIUrl":"10.2147/IMCRJ.S629491","url":null,"abstract":"<p><strong>Background: </strong>People living with HIV on long-term antiretroviral therapy (ART) face increased risks of bone loss and fragility fractures, partly due to tenofovir disoproxil fumarate (TDF), a commonly used nucleoside reverse transcriptase inhibitor. TDF is associated with proximal tubular dysfunction, renal phosphate wasting, osteomalacia, and pathological fractures. This case highlights severe, bilateral femoral fractures as a rare but debilitating manifestation of chronic TDF-induced osteomalacia in a postmenopausal woman.</p><p><strong>Case presentation: </strong>A 43-year-old African woman with HIV (diagnosed >15 years prior) presented with progressive generalized bone pain and inability to bear weight after minor trauma. She had received TDF-based ART for 12 years. One year earlier, her regimen was switched to abacavir/lamivudine/dolutegravir due to emerging bone pain. Examination revealed bilateral hip tenderness, immobility, stage-4 sacral and ischial pressure ulcers, and rectal prolapse secondary to prolonged immobility and constipation. Laboratory findings included severe hypophosphatemia (0.33 mmol/L), elevated alkaline phosphatase (320 U/L), low-normal 25-hydroxy-vitamin D, and upper-normal PTH, with normal renal function and no overt Fanconi syndrome at presentation. Pelvic radiographs confirmed bilateral pathological femoral fractures (right intertrochanteric, left subcapital). Other causes (malignancy, infection, primary metabolic disorders) were excluded. Management involved permanent TDF discontinuation, supplementation with calcium, phosphate, and vitamin D, orthopaedic fixation, and intensive wound care. Serum phosphate and alkaline phosphatase normalized, bone pain resolved, and no new fractures occurred, though full ambulation remained limited due to complications.</p><p><strong>Conclusion: </strong>This case demonstrates TDF as a reversible cause of severe osteomalacia and pathological fractures in long-term HIV treatment, emphasizing early recognition, regimen substitution to non-TDF agents, and proactive bone/mineral monitoring to prevent such outcomes in vulnerable populations.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"629491"},"PeriodicalIF":0.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712537","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}

{"title":"Gastric Outlet Obstruction from Brunner Gland Hyperplasia Mimicking Malignancy: A Case Report.","authors":"Khadar Hassan Ibrahim, Abdukadir Mohamed Hassan, Fathi Yasin Yusuf","doi":"10.2147/IMCRJ.S614221","DOIUrl":"10.2147/IMCRJ.S614221","url":null,"abstract":"<p><strong>Background: </strong>Gastric outlet obstruction (GOO) is a clinical syndrome caused by mechanical narrowing at the distal stomach, pylorus, or proximal duodenum. Although malignancy remains an important concern in adults, rare benign duodenal lesions may produce a similar clinical and radiologic picture.</p><p><strong>Case presentation: </strong>A 55-year-old man presented with an approximately 8-month history of recurrent upper abdominal pain, postprandial vomiting, early satiety, epigastric fullness, and progressive unquantified weight loss. Upper gastrointestinal endoscopy showed a lower esophageal mucosal break greater than 5 mm, retained gastric contents despite fasting, an apparently open pylorus, and inability to advance the endoscope into the second part of the duodenum because the patient began vomiting; complete visualization and biopsy were therefore not feasible. Laboratory investigations demonstrated hypernatremia followed by worsening creatinine and hypokalemia, consistent with dehydration-associated prerenal kidney injury. Contrast-enhanced computed tomography showed marked gastric dilatation with retained intragastric contents and distal gastric/pyloroduodenal narrowing, without a discrete mass or obvious lymphadenopathy on the available images. Because malignancy could not be excluded and endoscopic tissue diagnosis or dilation was not feasible, exploratory laparotomy with distal gastrectomy was performed. Histopathology localized the diagnostic abnormality to the duodenal mucosa at the distal/pyloroduodenal end of the resected specimen and showed chronic duodenitis with Brunner gland hyperplasia, fibrosis, muscle hypertrophy on the gastric side, and no atypia or malignancy. The patient recovered uneventfully and remained clinically well at the available short-term postoperative follow-up; the exact duration of follow-up was not documented.</p><p><strong>Conclusion: </strong>This case highlights Brunner gland hyperplasia as a rare benign cause of GOO that can closely mimic malignancy, particularly when endoscopic access and preoperative tissue diagnosis are limited. Integration of endoscopic, radiologic, operative, and histopathologic findings is essential to guide timely management.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"614221"},"PeriodicalIF":0.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706605","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}