ACG Case Reports JournalPub Date : 2025-07-21eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001760
Michael A Shi, Conrad J Fernandes, Christy Y Chai, And Ned Snyder Lll
{"title":"Ectopic Variceal Bleeding due to Petersen Hernia: A Rare Cause of Recurrent Gastrointestinal Hemorrhage.","authors":"Michael A Shi, Conrad J Fernandes, Christy Y Chai, And Ned Snyder Lll","doi":"10.14309/crj.0000000000001760","DOIUrl":"10.14309/crj.0000000000001760","url":null,"abstract":"<p><p>Petersen hernia is a rare complication that can occur following gastrojejunostomy procedures such as Roux-En-Y gastric bypass surgery. Bowel obstruction, ischemia, and mesenteric vessel thrombosis are recognized complications that can result in significant patient morbidity or mortality. In this study, we describe a case of mesenteric vein stenosis due to a Petersen hernia in a 61-year-old woman, manifesting as recurrent gastrointestinal bleeding. This noncirrhotic, portal hypertensive, ectopic variceal bleeding secondary to chronic superior mesenteric vein stenosis secondary to a Petersen hernia is a unique cause of recurrent gastrointestinal bleeding.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01760"},"PeriodicalIF":0.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681755","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}
ACG Case Reports JournalPub Date : 2025-07-21eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001769
Partha Pal, Mohammad Abdul Mateen, Rajesh Gupta, Manu Tandan, D Nageshwar Reddy
{"title":"Transperineal Ultrasound-Guided Endoscopic Sinusotomy for Recurrent Perianal Sinus in Crohn Disease.","authors":"Partha Pal, Mohammad Abdul Mateen, Rajesh Gupta, Manu Tandan, D Nageshwar Reddy","doi":"10.14309/crj.0000000000001769","DOIUrl":"10.14309/crj.0000000000001769","url":null,"abstract":"","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01769"},"PeriodicalIF":0.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681798","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}
ACG Case Reports JournalPub Date : 2025-07-21eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001768
Nancy Mayer, Vijay Kata, Dhaval Patel, Daniel Errampalli, Thomas O'Connor, Matthew Kaplan, Thomas Betlej, Nikhil Bhargava
{"title":"Cytomegalovirus Enteritis: A Rare Culprit of Protein Losing Enteropathy in an Immunocompetent Adult.","authors":"Nancy Mayer, Vijay Kata, Dhaval Patel, Daniel Errampalli, Thomas O'Connor, Matthew Kaplan, Thomas Betlej, Nikhil Bhargava","doi":"10.14309/crj.0000000000001768","DOIUrl":"10.14309/crj.0000000000001768","url":null,"abstract":"<p><p>Protein-losing enteropathy (PLE) is a rare complication of cytomegalovirus (CMV) enteritis in immunocompetent individuals. We present a case of a previously healthy 60-year-old woman with an acute CMV infection, manifesting as intractable vomiting and diarrhea, refractory electrolyte disturbances, and anasarca. The diagnostic evaluation showed low serum protein levels and an increased fecal alpha-1 antitrypsin clearance, confirming PLE. CMV-specific immunohistochemistry on duodenal samples subsequently confirmed that the PLE was caused by CMV enteritis. She completed treatment with valganciclovir for 3 weeks, resulting in symptom resolution and normalization of endoscopic findings. This case highlights the importance of recognizing CMV-associated PLE, particularly in immunocompetent individuals, for timely diagnosis and treatment.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01768"},"PeriodicalIF":0.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681754","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}
ACG Case Reports JournalPub Date : 2025-07-21eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001773
Abdelrahman Yakout, Daniela Fluxa, Aziza Nassar, Victoria Gomez
{"title":"The Overlap of Autoimmune Pancreatitis and Pancreatic Cancer: A Clinical Challenge.","authors":"Abdelrahman Yakout, Daniela Fluxa, Aziza Nassar, Victoria Gomez","doi":"10.14309/crj.0000000000001773","DOIUrl":"10.14309/crj.0000000000001773","url":null,"abstract":"<p><p>Autoimmune pancreatitis (AIP) and pancreatic cancer share clinical and radiological features, making biopsy the only definitive way of differentiating them. Numerous reports in the literature describe the co-occurrence of AIP and pancreatic cancer either in a synchronous manner or metachronous manner raising the question of which condition predisposes to the other and whether a causal relationship exists between them. Studies suggest shared mechanisms, including K-ras mutations and tumor suppressor gene silencing. This case highlights the importance of long-term surveillance in AIP patients to monitor for malignancy.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01773"},"PeriodicalIF":0.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681757","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}
ACG Case Reports JournalPub Date : 2025-07-21eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001767
Jacob C Jones, Penelope I Quiles, John G Quiles, Jerome G Edelson
{"title":"A Rare Case of A Pseudosarcomatous Stromal Tumor: A Unique Benign Ampullary Tumor.","authors":"Jacob C Jones, Penelope I Quiles, John G Quiles, Jerome G Edelson","doi":"10.14309/crj.0000000000001767","DOIUrl":"10.14309/crj.0000000000001767","url":null,"abstract":"<p><p>We present a case of a pseudosarcomatous stromal proliferation of the ampullary and duodenal mucosa and its treatment in an asymptomatic 61-year-old man with a history of prostate adenocarcinoma and carotid paraganglioma. There is a modicum of literature describing these cases and treatment involving the gastrointestinal tract. The intricacy of diagnosis can further complicate management which necessitates the need for discussion between the clinician and the pathologist to avoid unnecessary invasive intervention. Our example of a pseudosarcoma involving the ampullary and duodenal mucosa and its treatment is unprecedented, therefore, should serve as an example for similar cases.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01767"},"PeriodicalIF":0.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12282712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688609","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}
ACG Case Reports JournalPub Date : 2025-07-21eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001756
Yannis Lafazanos, Robin David, Nahren Asado, Miguel Gonzalez, Eli D Ehrenpreis
{"title":"Pembrolizumab-Induced Duodenitis Mimicking Celiac Disease.","authors":"Yannis Lafazanos, Robin David, Nahren Asado, Miguel Gonzalez, Eli D Ehrenpreis","doi":"10.14309/crj.0000000000001756","DOIUrl":"10.14309/crj.0000000000001756","url":null,"abstract":"<p><p>Pembrolizumab is a programmed cell death-1 (PD-1) inhibitor frequently used as primary immunotherapy in many cancers, including melanoma, lung, renal cell, cervical, urothelial, and gastric cancers. Given its immune-checkpoint inhibition and upregulation of the immune response, pembrolizumab has been associated with many immune system-related adverse effects including stomatitis, conjunctivitis, pneumonitis, myositis, and even type 1 diabetes mellitus. Colitis is the most frequent gastrointestinal adverse reaction, with upper gastrointestinal reactions like esophagitis, gastritis, and duodenitis being rare. In this report, we present a case of pembrolizumab-induced enteropathy that endoscopically and histologically mimicked celiac disease.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01756"},"PeriodicalIF":0.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681756","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":"Stealth Erosion: A Rare Case of Gastric Band Complication 2 Decades Postimplantation With a Prolonged and Complex Hospital Course.","authors":"Karan J Yagnik, Suryansh Atreya, Pranay Joshi, Sankalp Acharya, Dharmesh Kaswala, Wael Ghali","doi":"10.14309/crj.0000000000001770","DOIUrl":"10.14309/crj.0000000000001770","url":null,"abstract":"<p><p>A woman in her 60s presented with epigastric pain and fever, initially managed as acute cholecystitis. Imaging was inconclusive, but esophagogastroduodenoscopy on hospital day 4 revealed gastric band erosion 20 years postlaparoscopic adjustable gastric banding. Surgery confirmed partial erosion with abscess along the band tract and subcutaneous port site. Postoperative complications included gastric leak, candida infection, and abdominal wall abscess, managed with antibiotics, drainage, and supportive care. She was later discharged on oral antibiotics but developed a pulmonary embolism requiring anticoagulation. Laparoscopic adjustable gastric banding complications, including erosion, should be considered even decades later; early endoscopy may prevent delays and related complications.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01770"},"PeriodicalIF":0.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673707","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":"An Elusive Case of Arterial Appendiceal Bleeding: Diagnostic and Therapeutic Insights.","authors":"Seema Belani, Janki Luther, Surachai Amornsawadwattana, Judy Trieu","doi":"10.14309/crj.0000000000001778","DOIUrl":"10.14309/crj.0000000000001778","url":null,"abstract":"<p><p>We present a case of hematochezia because of a small arterial bleed endoscopically seen at the appendiceal orifice. The bleed was slowed with hemostatic clip placement, which allowed for preoperative imaging and appropriate resuscitation. The patient was taken for definitive laparoscopic appendectomy with complete resolution of gastrointestinal bleeding.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01778"},"PeriodicalIF":0.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673705","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}
ACG Case Reports JournalPub Date : 2025-07-18eCollection Date: 2025-07-01DOI: 10.14309/crj.0000000000001775
Yara Salameh, Hadi K Abou Zeid, Khushboo S Gala, Roopa Kumari, Andrew C Storm
{"title":"Gastrojejunal Anastomosis Adenocarcinoma Occurring After Trans-Oral Revision for Weight Recurrence After Roux-en-Y Gastric Bypass.","authors":"Yara Salameh, Hadi K Abou Zeid, Khushboo S Gala, Roopa Kumari, Andrew C Storm","doi":"10.14309/crj.0000000000001775","DOIUrl":"10.14309/crj.0000000000001775","url":null,"abstract":"<p><p>Weight recurrence is a late complication after Roux-en-Y gastric bypass. The transoral outlet reduction (TORe) emerged as an endoscopic alternative to revisional surgery for weight recurrence due to a dilated and incompetent gastrojejunal anastomosis. The procedure has been documented as safe and effective in clinical trials and other high-quality medical literature. Several cases of squamous metaplasia of the gastric pouch after repeated TORe procedures using argon plasma coagulation have been reported. We present a case of a late-onset adenocarcinoma of the gastrojejunal anastomosis after a TORe procedure performed using argon plasma coagulation and suturing.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01775"},"PeriodicalIF":0.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673706","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":"Tacrolimus-Induced Acute Esophageal Necrosis Postorthotopic Liver Transplantation.","authors":"Wei Tang, Makeda Dawkins, Daniel Basta, Nao Hara, Fouzia Shakil, Bodin Roxana, Shireen Pais, Kenji Okumura, Seigo Nishida, Abhay Dhand","doi":"10.14309/crj.0000000000001772","DOIUrl":"10.14309/crj.0000000000001772","url":null,"abstract":"<p><p>Acute esophageal necrosis, or \"black esophagus,\" is a rare but severe condition characterized by circumferential black necrotized esophageal mucosa with an abrupt transition at the gastroesophageal junction. The \"two-hit\" hypothesis suggests that an initial ischemic insult predisposes the esophageal mucosa to further injury from luminal acid exposure or medications. We present the first documented case of tacrolimus-induced acute esophageal necrosis without preceding hemodynamic instability in a liver transplant recipient, which resolved with discontinuation of tacrolimus and transition to cyclosporin.</p>","PeriodicalId":7394,"journal":{"name":"ACG Case Reports Journal","volume":"12 7","pages":"e01772"},"PeriodicalIF":0.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673708","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}