World Journal of Gastrointestinal Surgery最新文献

{"title":"Multimodal diagnostic and surgical approach to spontaneous esophageal rupture induced by severe coughing: A case report.","authors":"Shu-Yun Xiong, Chang-Jiang Liu, Yong-Feng Li, Han-Liang Zhang, Xiao-Wei Chen, Hai-Man Wang, Ji-Cai Chen","doi":"10.4240/wjgs.v17.i4.101578","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.101578","url":null,"abstract":"<p><strong>Background: </strong>Boerhaave syndrome, or spontaneous esophageal rupture, is a rare and life-threatening emergency, typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting. Early diagnosis is challenging as its symptoms often resemble those of other diseases. Understanding its pathological features and treatment strategies is therefore critical for clinical practice.</p><p><strong>Case summary: </strong>This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension. Following severe coughing, the patient developed chest pain, vomiting, and respiratory distress. Initial clinical evaluation was inconclusive, with a suspected diagnosis of cardiovascular or gastrointestinal conditions. After further examination, the diagnosis of spontaneous esophageal rupture was confirmed. Chest X-ray, computed tomography, and endoscopy revealed a rupture in the lower esophagus, along with mediastinal abscess and pleural effusion. Laboratory tests showed mild infection markers. The patient underwent surgical repair of the esophageal rupture (approximately 3 cm in length) with mediastinal drainage. Postoperatively, the patient's temperature normalized within 3 days, respiratory function improved, and pleural effusion significantly decreased. After two weeks of treatment, the patient was discharged without complications and had a favorable prognosis. The study suggests that while violent coughing is a rare trigger, it can lead to severe damage, and imaging techniques play a crucial role in diagnosis.</p><p><strong>Conclusion: </strong>Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges. Early recognition and timely intervention are crucial for improving prognosis. This case highlights the importance of imaging and surgical treatment, offering new insights for managing similar cases and providing valuable clinical guidance.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"101578"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data.","authors":"Hong-Yu Long, Xin Yan, Jia-Xian Meng, Feng Xie","doi":"10.4240/wjgs.v17.i4.104615","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104615","url":null,"abstract":"<p><strong>Background: </strong>Effective management of liver abscess depends on timely drainage, which is influenced by the liquefaction degree. Identifying predictive factors is crucial for guiding clinical decisions.</p><p><strong>Aim: </strong>To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.</p><p><strong>Methods: </strong>This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage. Patients were divided into a poor liquefaction group (<i>n</i> = 28) and a well liquefaction group (<i>n</i> = 82) based on the ratio of postoperative 24-hour drainage volume to abscess volume, using a cutoff value of 0.3. Clinical characteristics, laboratory indicators, and computed tomography imaging features were compared. A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.</p><p><strong>Results: </strong>Independent predictive factors for good liquefaction included the absence of diabetes [odds ratio (OR) = 0.339, <i>P</i> = 0.044], absence of pneumonia (OR = 0.218, <i>P</i> = 0.013), left-lobe abscess location (OR = 4.293, <i>P</i> = 0.041), cystic features (OR = 5.104, <i>P</i> = 0.025), and elevated preoperative serum alanine aminotransferase (ALT) levels (OR = 1.013, <i>P</i> = 0.041). The logistic regression model based on these factors demonstrated an area under the curve of 0.814, with a sensitivity of 90.24% and specificity of 67.86%. Five-fold cross-validation yielded an average accuracy of 83.61% and a kappa coefficient of 0.5209.</p><p><strong>Conclusion: </strong>Pneumonia, diabetes, abscess location, abscess composition, and preoperative serum ALT levels are significant predictors of liver abscess liquefaction. The model can guide clinical decision-making.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104615"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging bias field correction improves tumor prognostic evaluation after transcatheter arterial chemoembolization for liver cancer.","authors":"Ke Liu, Jun-Biao Li, Yong Wang, Yan Li","doi":"10.4240/wjgs.v17.i4.104187","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104187","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter arterial chemoembolization (TACE) is a key treatment approach for advanced invasive liver cancer (infiltrative hepatocellular carcinoma). However, its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor's diffuse and multifocal growth pattern. Volumetric imaging, especially enhanced tumor volume (ETV), offers a more comprehensive assessment. Nonetheless, bias field inhomogeneity in magnetic resonance imaging (MRI) poses challenges, potentially skewing volumetric measurements and undermining prognostic evaluation.</p><p><strong>Aim: </strong>To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE, and to analyze how this improved measurement impacts prognostic prediction.</p><p><strong>Methods: </strong>We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024. The improved N4 bias field correction algorithm was applied to process MRI images, and the ETV before and after treatment was calculated. The ETV measurements before and after correction were compared, and their relationship with patient prognosis was analyzed. A Cox proportional hazards model was used to evaluate prognostic factors, with Martingale residual analysis determining the optimal cutoff value, followed by survival analysis.</p><p><strong>Results: </strong>Bias field correction significantly affected ETV measurements, with the corrected baseline ETV mean (505.235 cm³) being significantly lower than before correction (825.632 cm³, <i>P</i> < 0.001). Cox analysis showed that the hazard ratio (HR) for corrected baseline ETV (HR = 1.165, 95%CI: 1.069-1.268) was higher than before correction (HR = 1.063, 95%CI: 1.031-1.095). Using 412 cm³ as the cutoff, the group with baseline ETV < 415 cm³ had a longer median survival time compared to the ≥ 415 cm³ group (18.523 months <i>vs</i> 8.926 months, <i>P</i> < 0.001). The group with an ETV reduction rate ≥ 41% had better prognosis than the < 41% group (17.862 months <i>vs</i> 9.235 months, <i>P</i> = 0.006). Multivariate analysis confirmed that ETV reduction rate (HR = 0.412, <i>P</i> < 0.001), Child-Pugh classification (HR = 0.298, <i>P</i> < 0.001), and Barcelona Clinic Liver Cancer stage (HR = 0.578, <i>P</i> = 0.045) were independent prognostic factors.</p><p><strong>Conclusion: </strong>Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer. The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis, providing important reference for developing individualized treatment strategies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104187"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term efficacy of laparoscopic radical resection for colorectal cancer and risk of unplanned reoperation after surgery.","authors":"Wen-Bin Li, Jiang Li, Wei Yu, Jian-Hua Gao","doi":"10.4240/wjgs.v17.i4.102442","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102442","url":null,"abstract":"<p><strong>Background: </strong>Surgery is the first choice of treatment for patients with colorectal cancer. Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions. With the continuous development of medical technology, laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.</p><p><strong>Aim: </strong>To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer, and the differences in the risk analysis of unplanned reoperation after operation.</p><p><strong>Methods: </strong>As the research subjects, this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022. Among them, 50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group. Data pertaining to clinical indexes, gastrointestinal hormones, nutrition indexes, the levels of inflammatory factors, quality of life, Visual Analog Scale score, and the postoperative complications of the two groups of patients before and after treatment were collected, and the therapeutic effects in the two groups were analyzed and compared.</p><p><strong>Results: </strong>Compared with the control group, perioperative bleeding, peristalsis recovery time, and hospital stays were significantly shorter in the research group. After surgery, the levels of gastrin (GAS) and motilin (MTL) were decreased in both groups, and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group. The hemoglobin (Hb) levels increased after surgery, and the level of Hb in the research group was significantly higher compared with the control group. After the operation, the expression levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group. One year after the operation, the quality of life of the two groups was greatly improved, with the quality of life in the research group being significantly better.</p><p><strong>Conclusion: </strong>Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction; moreover, the quality of life of patients was significantly improved, which warrants further promotion.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102442"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforated peptic ulcer in pregnancy and puerperium: A systematic review.","authors":"Goran Augustin, Jure Krstulović, Ante Tavra, Zrinka Hrgović","doi":"10.4240/wjgs.v17.i4.101682","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.101682","url":null,"abstract":"<p><strong>Background: </strong>Peptic ulcer disease (PUD) during pregnancy is extremely rare. Perforated peptic ulcer (PPU) during pregnancy has high maternal and fetal mortality. Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.</p><p><strong>Aim: </strong>To identify predictive factors for early diagnosis and treatment, and the association between the diagnosis and maternal/neonatal outcomes.</p><p><strong>Methods: </strong>We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed following preferred reporting items for systematic reviews and meta-analysis. The search items included: 'ulcer', 'PUD', 'pregnancy', 'puerperium', 'postpartum', 'gravid', 'labor', 'perforated ulcer', 'stomach ulcer', 'duodenal ulcer', 'peptic ulcer'. Additional studies were extracted by reviewing reference lists of retrieved studies. We included all available full-text cases and case series. Demographic, clinical, obstetric, diagnostic and treatment parameters, and outcomes were collected.</p><p><strong>Results: </strong>Forty-three cases were collected. The mean maternal age was 30.9 years; 36.6% were multiparous, and 63.4% were nulliparous or primiparous, with multiparas being older than primiparas. Peptic ulcer perforated in 44.2% of postpartum and 55.8% of antepartum patients. Antepartum PPU incidence increased with advancing gestation 2.3% in the first, 7% in the second, and 46.5% in the third trimester. The most common clinical findings were abdominal tenderness (72.1%), rigidity (34.9%), and distension (48.8%). Duodenal ulcer predominated (76.7%). In 79.5%, the time from delivery to surgery or vice versa was > 24 hours. The maternal mortality during the third trimester and postpartum was 10% and 31.6%, respectively. The trimester of presentation did not influence maternal mortality. The fetal mortality was 34.8%, with all deaths in gestational weeks 24-32.</p><p><strong>Conclusion: </strong>Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum. Early intervention reduced fetal mortality but without influence on maternal mortality. Maternal mortality did not depend on the use of X-ray imaging, perforation location, delivery type, trimester of presentation, and maternal age. Explorative laparoscopy was never performed during pregnancy, only postpartum.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"101682"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection for esophageal precancerous lesions and early esophageal carcinoma: Analysis of efficacy and serum tumor markers.","authors":"Xiao-Chen Yuan, Ping Jia, Tian Tian, Jun Zhu, Xiao-Yan Zhang","doi":"10.4240/wjgs.v17.i4.103700","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.103700","url":null,"abstract":"<p><strong>Background: </strong>Tumor progression in patients with esophageal precancerous lesions (EPLs) or early esophageal carcinoma (EEC) is typically confined in both extent and location. Prompt and effective intervention significantly improves treatment outcomes and prognosis for these individuals.</p><p><strong>Aim: </strong>To determine the effect of endoscopic submucosal dissection (ESD) on efficacy, serum tumor markers (STMs), and 6-month postoperative recurrence rate in patients with either EPL or EEC.</p><p><strong>Methods: </strong>This study initially enrolled 120 patients with EPL or EEC, who were admitted from April 2021 to April 2024. Participants were divided into the control group (60 cases), which underwent thoracotomy, and the research group (60 cases) which received ESD treatment. The comparative analysis involved information regarding the efficacy (dissection area and resection rate per unit time), complications (delayed bleeding, wound infection, esophageal reflux, and postoperative esophageal stenosis), surgery-related parameters (bleeding volume, operation duration, and hospital length of stay), STMs [carcinoembryonic antigen (CEA), carbohydrate antigen 724 (CA724), and tumor-specific growth factor (TSGF)], and the 6-month postoperative recurrence rate of the two groups.</p><p><strong>Results: </strong>Data indicated statistically higher dissection area and resection rate per unit of time in the research group than in the control group. Meanwhile, the research group demonstrated a notably lower overall incidence rate of complications, bleeding volume, operation duration, and hospital length of stay. Further, the CEA, CA724, and TSGF were markedly reduced in the research group after treatment, which were statistically lower compared to the baseline and those of the control group. Finally, during the follow-up, a comparable 6-month postoperative recurrence rate was determined in the two groups.</p><p><strong>Conclusion: </strong>ESD is clinically effective and safe for EPL and EEC and can significantly restore abnormally increased levels of STMs.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"103700"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic management of intraductal oncocytic papillary neoplasm of the pancreas: Two case reports and review of literature.","authors":"Guo-Zhen Wu, Li-Na Lu, Hai-Ping Lin, Xin-Yu Wang, Shi-An Yu, Min Yu","doi":"10.4240/wjgs.v17.i4.105096","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.105096","url":null,"abstract":"<p><strong>Background: </strong>Intraductal oncocytic papillary neoplasm (IOPN) of the pancreas is an extremely rare pancreatic tumor, with only sporadic cases reported in the literature. IOPN is difficult to diagnose and highly prone to misdiagnosis. IOPN carries a certain risk of progressing to invasive cancer. Surgical resection is the primary treatment for IOPN. According to the existing literature reports, the vast majority of patients with IOPN of the pancreas undergo open surgery, while only one case of laparoscopic surgery have been reported.</p><p><strong>Case summary: </strong>This report presents two cases of IOPN in elderly female patients, aged 60 and 61. Both patients were asymptomatic, and their pancreatic masses were discovered incidentally. Preoperative diagnosis of IOPN is challenging and prone to misdiagnosis. In the first case, the patient underwent a laparoscopic distal pancreatectomy and splenectomy. The surgical procedure spanned 342 minutes, with an estimated intraoperative blood loss of around 100 mL. The patient experienced an uneventful postoperative recovery and was discharged on the 8^th postoperative day. For the second case, a laparoscopic pancreaticoduodenectomy was performed. The operation lasted for 431 minutes with an intraoperative blood loss of approximately 50 mL. The patient also demonstrated a favorable postoperative course and was discharged on the 24^th postoperative day. Postoperative pathology and immunohistochemistry confirmed the diagnosis of IOPN. No recurrence was observed in either patient after follow-up periods of 8 and 10 months, respectively.</p><p><strong>Conclusion: </strong>These cases demonstrate that laparoscopic surgery can be considered as one of the treatment options for IOPN of the pancreas.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"105096"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancement of indocyanine green fluorescence imaging technology in laparoscopic surgery for rectal cancer.","authors":"Chu-Ying Wu, Yue-Jia Zhu, Kai Ye","doi":"10.4240/wjgs.v17.i4.104020","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104020","url":null,"abstract":"<p><p>Indocyanine green fluorescence imaging technology has been increasingly utilized in rectal surgery in recent years. As a safe tracer, indocyanine green can facilitate lymph node tracing, assess the blood supply at anastomotic sites, and localize tumour lesions during laparoscopic surgery, thereby resulting in favourable outcomes. This technology helps surgeons to achieve more precise diagnoses and treatments in laparoscopic procedures, thus ultimately benefiting patients. However, the current application of indocyanine green fluorescence imaging technology still lacks standardized regulations, and certain effects remain contentious. This study provides a comprehensive review of the application of indocyanine green in laparoscopic surgery for rectal cancer based on the pertinent literature.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104020"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric adenocarcinoma of fundic gland mucosa arising in heterotopic gastric mucosa of the duodenum: A case report.","authors":"Qun-Ying Yang, Jing Xu, Jian-Wen Hu, Xiao-Dong Huang","doi":"10.4240/wjgs.v17.i4.102730","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.102730","url":null,"abstract":"<p><strong>Background: </strong>Heterotopic gastric mucosa (HGM) is the most common type of epithelial heterotopia, which can occur in any part of the gastrointestinal tract. The duodenum is one of the common sites of HGM. HGM is usually considered benign, and malignant transformation of HGM in the duodenum is extremely rare.</p><p><strong>Case summary: </strong>We reported a middle-aged man admitted to the hospital due to abdominal pain, whose gastroduodenoscopy revealed a polypoid uplift in the duodenum. The attending physician directly removed the lesion using a snare, histopathological analysis demonstrated multidirectional cellular differentiation on the basis of duodenal HGM. The hematoxylin and eosin stains of the duodenal lesion demonstrated HGM, the superficial mucosa exhibited gastric foveolar-type epithelium, numerous mucous glands were identified beneath the foveolar region. Additionally, focal areas displayed several signet-ring cell changes. Gastric foveolar-type epithelium was diffusely positivity for MUC5AC and Ki67. Numerous mucous gland was positivity for MUC6, partially positive for MUC2, pepsinogen I and H⁺/K⁺ ATPase. It was eventually diagnosed gastric adenocarcinoma of fundic gland mucosa on the basis of duodenal HGM.</p><p><strong>Conclusion: </strong>We reported the first case of gastric adenocarcinoma of fundic gland mucosa arising in the duodenum on the basis of HGM. Although HGM is mostly benign, there is also a risk of carcinogenesis.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"102730"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type III choledochal cyst confirmed by aspiration and treated with endoscopic fenestration plus internal drainage: A case report.","authors":"Zi-Meng Wang, Song Su, En-Qiang Ling-Hu, Ning-Li Chai","doi":"10.4240/wjgs.v17.i4.104102","DOIUrl":"https://doi.org/10.4240/wjgs.v17.i4.104102","url":null,"abstract":"<p><strong>Background: </strong>Type III choledochal cysts (CCs) are extremely rare, and they present as dilatations and herniations of the end of the common bile duct into the duodenum. Moreover, type II CCs may be easily misdiagnosed as intraduodenal polyps or tumors. Thus, adequate differential diagnosis and selection of appropriate treatment are important.</p><p><strong>Case summary: </strong>A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization. After evaluation by magnetic resonance imaging and endoscopic ultrasonography, the duodenal papilla was pressed, and the bile flowed out slowly, which was speculated to be the cause of his symptoms. The lesion was punctured with a submucosal injection needle, and golden clear fluid was aspirated. Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin, direct bilirubin, amylase and lipase. Taken together, these findings confirmed that the lesion was a type III CC. The patient underwent fused surgical procedures. Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife. After drainage, the incision was sealed with tissue clips. During follow-up, the patient recovered well, and no abdominal pain symptoms or acute pancreatitis recurred.</p><p><strong>Conclusion: </strong>Laboratory tests of cyst aspirates are beneficial for diagnosis, and endoscopic fenestration plus internal drainage works well to mitigate cysts.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 4","pages":"104102"},"PeriodicalIF":1.8,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}