Case Reports in Gastroenterology最新文献

{"title":"<i>Aggregatibacter aphrophilus</i> Bacteremia Associated with Systemic Hemangiomatosis in an Elderly Patient with Ulcerative Colitis: A Case Report.","authors":"Abigail Grace Hendrie, Vikas Pabby","doi":"10.1159/crg/abwag004","DOIUrl":"https://doi.org/10.1159/crg/abwag004","url":null,"abstract":"<p><strong>Introduction: </strong>Older patients on biologic therapy for inflammatory bowel disease may be at increased risk for opportunistic infections, reflecting both age-related and immunosuppression-related factors. <i>Aggregatibacter aphrophilus,</i> a HACEK organism, is a rare cause of invasive infection that is typically associated with endovascular disease.</p><p><strong>Case presentation: </strong>We present the case of a 70-year-old male with ulcerative colitis treated with adalimumab who presented with 4 weeks of fevers, chills, night sweats, and weight loss. CT imaging revealed an intraluminal esophageal lesion and multiple hypodense splenic lesions. Endoscopy demonstrated a vascular-appearing esophageal lesion, and MRI revealed diffuse hemangiomatosis involving the esophagus, spleen, and head and neck musculature. Brain MRI demonstrated a lesion consistent with a septic embolus. Blood cultures grew <i>A. aphrophilus.</i> Applying the 2023 Duke-ISCVID criteria, this case fulfills criteria for possible infective endocarditis. The patient was treated with intravenous ceftriaxone for 4 weeks with clinical improvement. Adalimumab was held after discharge, and ulcerative colitis was subsequently managed with mesalamine with achievement of clinical remission.</p><p><strong>Conclusion: </strong>Clinicians should be vigilant for complications of immunosuppressive therapy for older patients with inflammatory bowel disease and maintain a broad differential for bacteremia, considering uncommon pathogens such as <i>A. aphrophilus.</i> The esophageal hemangioma precluding transesophageal echocardiography in this case illustrates the diagnostic importance of the 2023 Duke-ISCVID criteria and alternative cardiac imaging modalities in the evaluation of suspected native valve endocarditis when standard approaches are anatomically contraindicated.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"417-429"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263158","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":"Pelvic Wandering Spleen with Splenic Infarction, Sigmoid Volvulus, and Hydronephrosis: A Case Report.","authors":"Kreshnike Dedushi Hoti, Flaka Pasha, Masum Rahman, Jeton Shatri, Kaltrina Goçaj, Floren Kavaja","doi":"10.1159/crg/abwag012","DOIUrl":"https://doi.org/10.1159/crg/abwag012","url":null,"abstract":"<p><strong>Introduction: </strong>Wandering spleen (WS) is a rare clinical condition characterized by the absence or laxity of the splenic suspensory ligaments, which are normally responsible for anchoring the spleen in its typical position in the left upper quadrant of the abdomen. In WS, these ligaments are either congenitally absent or have become lax due to factors such as pregnancy, trauma, or connective tissue disorders, allowing the spleen to migrate abnormally within the abdominal cavity. This abnormal mobility places the spleen at high risk for torsion, leading to vascular compromise, ischemia, and eventual infarction. While isolated WS is rare, its occurrence alongside simultaneous gastrointestinal, urological, and gynecological complications is uncommon and presents a diagnostic and therapeutic challenge.</p><p><strong>Case presentation: </strong>We report a case of a 31-year-old female, identified as Albanian, who presented to our department with acute, severe lower abdominal pain and a sensation of pelvic pressure. Physical examination suggested diffuse tenderness in the lower abdomen. Laboratory investigations showed elevated inflammatory markers, including leukocytosis and elevated C-reactive protein, along with deranged liver function tests. Magnetic resonance imaging revealed a pelvic spleen with evidence of complete infarction, as demonstrated by the absence of contrast enhancement and the classic \"whirling sign\" of twisted splenic vessels, indicative of torsion. Additionally, imaging uncovered a sigmoid colon volvulus, left ovarian enlargement likely secondary to congestion, and left-sided hydronephrosis due to ureteral compression. The patient underwent an emergency laparotomy, during which a splenectomy, appendectomy, and decompression of the sigmoid colon were performed. Postoperative recovery was smooth, and the patient was discharged in stable condition with appropriate follow-up.</p><p><strong>Conclusion: </strong>This case presents the role of cross-sectional imaging in diagnosing complex, multisystem abdominal emergencies. Early detection and timely surgical intervention are paramount crucial in preventing debilitating outcomes, such as peritonitis or sepsis. The case adds to the limited literature by illustrating a rare presentation of WS complicated by simultaneous involvement of the splenic, gastrointestinal, urological, and gynecological systems, emphasizing the need for high clinical suspicion and multidisciplinary management in similar scenarios.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"397-407"},"PeriodicalIF":0.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263101","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":"Disseminated Histoplasmosis Presenting as an Obstructive Mass in Crohn's Disease: A Case Report.","authors":"Julia Ronnen, Afreen Karimkhan, Sui Zee, Rong Xia","doi":"10.1159/crg/abwag014","DOIUrl":"https://doi.org/10.1159/crg/abwag014","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with Crohn's disease are at increased risk for both colorectal carcinoma and opportunistic infections due to chronic inflammation and long-term immunosuppressive therapy. Fungal infections such as histoplasmosis may mimic malignancy or inflammatory exacerbation, leading to diagnostic delay.</p><p><strong>Case presentation: </strong>We report a 50-year-old woman with a 10-year history of Crohn's disease treated with a tumor necrosis factor inhibitor and an interleukin-23 antagonist who presented with abdominal pain, diarrhea, and colonic masses. Colonoscopic biopsies showed dense inflammation with necrotizing granulomata. Grocott's methenamine silver stain and immunohistochemistry revealed intracytoplasmic budding yeasts consistent with <i>Histoplasma capsulatum</i>, confirmed by polymerase chain reaction. The urinary Histoplasma galactomannan antigen test was negative, while serum 1,3 β-D-glucan was positive. The patient was successfully treated with amphotericin B followed by itraconazole, with complete clinical recovery. Retrospective history revealed travel to Ecuador.</p><p><strong>Conclusion: </strong>Gastrointestinal histoplasmosis can closely mimic Crohn's flare or malignancy, especially in immunosuppressed patients. Careful histopathologic evaluation and integration of clinical and laboratory findings are essential for timely diagnosis and effective antifungal therapy.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"408-416"},"PeriodicalIF":0.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263137","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 Pulsating Gastric Ulcer Revealing an Atrio-Gastric Conduit Fistula: A Case Report On Rare and Life-Threatening Late Complication After Esophagectomy.","authors":"Garvita Singhal, Rizwan Safdar","doi":"10.1159/crg/abwag013","DOIUrl":"https://doi.org/10.1159/crg/abwag013","url":null,"abstract":"<p><strong>Introduction: </strong>Atrio-gastric conduit fistula (AGCF) is an exceedingly rare but often fatal complication following esophagectomy with gastric pull-through reconstruction. While fistulous communication involving the left atrium has been described in association with conditions such as atrial fibrillation and prior ablation procedures, its occurrence as a late complication of esophagectomy is exceptionally uncommon. Due to its rarity and nonspecific presentation, AGCF poses a significant diagnostic challenge.</p><p><strong>Case presentation: </strong>We describe the case of an elderly male with an history of esophagectomy and chemoradiation, admitted for recurrent hematochezia and syncope. Upper endoscopy demonstrated a pulsatile gastric ulcer within the intrathoracic gastric conduit, raising concern for vascular communication, which was further diagnosed as a fistulous connection between left atrium and gastric lumen by imaging. This was treated with a surgical repair followed by successful recovery.</p><p><strong>Conclusion: </strong>This case highlights the importance of identifying atypical endoscopic features in cases of gastrointestinal bleeding and avoiding potentially catastrophic endoscopic intervention.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"430-435"},"PeriodicalIF":0.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263070","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":"Diffuse Cavernous Hemangioma of the Rectum Diagnosed after a 15-year History of Recurrent Gastrointestinal Bleeding: A Case Report.","authors":"Kazuhiko Obata, Kazutake Okada, Kan Uchiyama, Ryuzo Murai","doi":"10.1159/crg/abwag015","DOIUrl":"https://doi.org/10.1159/crg/abwag015","url":null,"abstract":"<p><strong>Introduction: </strong>Diffuse cavernous hemangioma of the rectum (DCHR) is a rare benign vascular lesion of the gastrointestinal tract that typically manifests in childhood with recurrent painless hematochezia. Owing to its rarity and nonspecific presentation, DCHR is frequently misdiagnosed as hemorrhoidal disease or inflammatory bowel disease, culminating in substantial diagnostic delay. Reports on laparoscopic surgery for DCHR are limited.</p><p><strong>Case presentation: </strong>A 26-year-old woman was referred to our institution for the evaluation of microcytic anemia and recurrent painless hematochezia associated with defecation since childhood, persisting for over 15 years. Lower gastrointestinal endoscopy revealed bluish-purple dilated and tortuous vessels throughout the rectum, accompanied by mucosal swelling and congestion. Contrast-enhanced computed tomography (CT) demonstrated diffuse rectal wall thickening with gradual enhancement and serpentine dilated vessels with numerous phleboliths in the mesorectum, leading to a diagnosis of DCHR. Laparoscopic intersphincteric resection (Lap-ISR) with a diverting loop ileostomy was performed, with an estimated blood loss of 310 mL. Histopathological examination revealed numerous diffusely dilated, thin-walled vessels extending from the submucosa to the subserosa, with phleboliths exhibiting calcification. The diverting ileostomy was closed 4 months postoperatively. Eight months after surgery, neither hematochezia nor anemia has recurred, and anorectal function has been well preserved.</p><p><strong>Conclusions: </strong>Early clinical suspicion is crucial to ensure the timely diagnosis of DCHR in young patients presenting with recurrent painless hematochezia dating from childhood. Lap-ISR represents a feasible sphincter-preserving approach for extensive, transmurally involved DCHR, enabling complete excision while sparing the patient a permanent stoma.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"436-444"},"PeriodicalIF":0.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263098","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":"IgG4-Related Sclerosing Cholangitis, a Rare Differential Diagnosis for a Common Clinical Presentation: A Case Report.","authors":"Tiago Alexandre Ventura Antunes, Diogo Feijó, João Maldonado, Maria João Amaral, Marco Serôdio, Catarina Melo, J Guilherme Tralhão","doi":"10.1159/crg/abwag011","DOIUrl":"https://doi.org/10.1159/crg/abwag011","url":null,"abstract":"<p><strong>Introduction: </strong>Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is a rare immune-mediated fibroinflammatory disease that represents a significant diagnostic challenge, as it may closely mimic malignant biliary neoplasms, particularly cholangiocarcinoma (CCA).</p><p><strong>Case presentation: </strong>This report describes a 71-year-old man with a history of cholecystectomy for acute calculous cholecystitis who presented with new-onset obstructive jaundice. Magnetic resonance cholangiopancreatography demonstrated parietal thickening of the common hepatic duct at the confluence of the right and left hepatic ducts, associated with diffusion restriction and intrahepatic biliary dilatation. Serum CA 19-9 was markedly elevated, even after biliary drainage and endoluminal biopsies were inconclusive. Given the strong suspicion of perihilar CCA, the patient underwent right hepatectomy extended to segment 1 with extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy. Definitive histopathological examination revealed IgG4-SC involving both extrahepatic and intrahepatic bile ducts, without evidence of malignancy.</p><p><strong>Conclusion: </strong>Isolated IgG4-SC remains a major diagnostic challenge because its clinical, biochemical, endoscopic, and radiological features may closely mimic CCA. This case highlights the limitations of current preoperative diagnostic tools and emphasizes the importance of considering IgG4-SC in the differential diagnosis of isolated biliary strictures. Although earlier assessment of serum IgG4 may broaden the diagnostic workup, definitive diagnosis may still only be achieved on histopathological examination. When malignancy cannot be confidently excluded, surgical resection remains an appropriate and often unavoidable management strategy.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"445-456"},"PeriodicalIF":0.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263156","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":"Impacted Drug-Packet in the Sigmoid Colon in a Resource-Constrained Setting: A Case Report.","authors":"Elroy Patrick Weledji, Verdo Zisuh Anutebeh","doi":"10.1159/crg/abwag010","DOIUrl":"https://doi.org/10.1159/crg/abwag010","url":null,"abstract":"<p><strong>Introduction: </strong>The management of a retained cannabis-filled packet in the colorectal portion of the gut depends on its depth and the consequences caused.</p><p><strong>Case presentation: </strong>This is a case of a young male prisoner in sub-Saharan Africa, Cameroon who presented with progressive lower abdominal pain and constipation from an impacted foreign body (FB) in the sigmoid colon. This followed the insertion of the FB per annum. The primary challenges of transanal FBs which then become lodged are patient embarrassment, which can delay presentation and increase the risk of complications such as bowel perforation, and the difficulty of removing the object. Following failed conservative management, the impacted FB in the sigmoid colon was retrieved through a laparotomy.</p><p><strong>Conclusion: </strong>The learning point in this case is that a retained FB in the sigmoid colon has a much higher chance of retrieval through a laparotomy than transanally.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"390-396"},"PeriodicalIF":0.7,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263150","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":"Turbid Orange Ascites in a Patient with Cirrhosis: A Case Report.","authors":"Maddison Chokljat, Teagan Wanigaratne, Clarissa Rentsch, Joshua Haron Abasszade, Phil Ha","doi":"10.1159/crg/abwag009","DOIUrl":"https://doi.org/10.1159/crg/abwag009","url":null,"abstract":"<p><strong>Introduction: </strong>Unusual ascitic fluid colouration can provide important diagnostic clues but may also lead to unnecessary investigations if misinterpreted. Turbid orange ascites is rare and poorly described, with differential diagnoses, including chylous, haemorrhagic, malignant, and infectious causes.</p><p><strong>Case presentation: </strong>We describe a case of a man in his late 60s with alcohol-related cirrhosis who was found to have striking turbid orange ascitic fluid on index abdominal paracentesis. Biochemical analysis demonstrated a high serum-ascites albumin gradient consistent with portal hypertension, elevated erythrocytes indicating haemorrhagic ascites, and moderate hypertriglyceridaemia, suggesting chylous ascites. The fluid colour resolved with supportive management and reduction in triglyceride levels.</p><p><strong>Conclusion: </strong>This case highlights how combined haemorrhagic and lipid components may alter ascitic fluid appearance. Integrating visual assessment with biochemical findings and clinical context is essential to guide diagnosis and avoid unnecessary investigations.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"384-389"},"PeriodicalIF":0.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263127","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":"Definitive Diagnosis of Abdominal Tuberculous Lymphadenitis by Endoscopic Ultrasound-Guided Tissue Acquisition and Bacterial Culture: A Case Report.","authors":"Maiko Morii, Akie Yoshikawa-Kimura, Akinobu Nakata, Yoshinori Shimamoto, Hirotsugu Maruyama, Yu Nishida, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Masahiro Kato, Masanori Shiohara, Yasuhiro Fujiwara","doi":"10.1159/crg/abwag003","DOIUrl":"https://doi.org/10.1159/crg/abwag003","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-abdominal lymphadenopathy presents a diagnostic challenge. Tuberculous lymphadenitis is an important differential diagnosis as several noninfectious conditions can mimic its presentation. Although endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a minimally invasive diagnostic tool, combining multiple examinations - such as Ziehl-Neelsen staining, bacterial culture, and polymerase chain reaction - is essential for accurate diagnosis due to the paucibacillary nature of extrapulmonary tuberculosis. We report a case of abdominal tuberculous lymphadenitis diagnosed through EUS-TA and bacterial culture.</p><p><strong>Case presentation: </strong>A 66-year-old Japanese woman had experienced a fever lasting several weeks and a weight loss of 2 kg over the past year. Computed tomography (CT) revealed multiple lymphadenopathies in the mediastinum and abdominal cavity. We performed EUS-TA on a hypoechoic lymphadenopathy in the peripancreatic region to differentiate among infectious, inflammatory, and neoplastic causes of lymphadenopathy. Histopathological examination revealed the presence of epithelioid cell granulomas, indicative of tuberculosis. An interferon-γ release assay was subsequently performed and found to be positive, prompting the second EUS-TA to obtain samples for the identification of <i>Mycobacterium tuberculosis</i>. The patient was diagnosed with abdominal tuberculous lymphadenitis based on the cumulative findings. The patient improved clinically after 4 months of antituberculous therapy, accompanied by a marked reduction in the lymphadenopathies on follow-up CT.</p><p><strong>Conclusion: </strong>This case highlights the importance of incorporating bacterial culture, in addition to histopathological examination, as an essential diagnostic tool for tuberculous lymphadenitis.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"370-376"},"PeriodicalIF":0.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263086","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":"Primary Colonic Mucosal-Associated Lymph Tissue Lymphoma: A Case Report.","authors":"Rutvi Katariya, Jonathan Dvorak, Jared Block, Paris Charilaou","doi":"10.1159/crg/abwag006","DOIUrl":"https://doi.org/10.1159/crg/abwag006","url":null,"abstract":"<p><strong>Introduction: </strong>Mucosal-associated lymph tissue (MALT) lymphoma, also known as extranodal marginal zone lymphoma (EMZL), is a B-cell non-Hodgkin lymphoma very rarely found in the colon.</p><p><strong>Case presentation: </strong>We report the case of a 48-year-old female who underwent screening colonoscopy. Aside from weight loss attributed to semaglutide use and night sweats felt to be related to menopause, she reported no abnormal symptoms and had an unremarkable physical exam and laboratory evaluation. Five sub-centimeter sessile polyps found in the cecum, transverse, and descending colon revealed MALT lymphoma. Subsequent esophagogastroduodenoscopy revealed no <i>Helicobacter pylori</i> infection. Based on staging, the patient and oncologic team opted for active surveillance with annual colonoscopies. There has been no evidence of recurrence aside from a single 2-mm ganglioneuroma.</p><p><strong>Conclusion: </strong>This case highlights the expanding role of surveillance-based management in carefully selected patients with low-burden primary colonic EMZL. The pathogenesis of primary colonic EMZL remains uncertain, although proposed contributing factors include chronic antigenic stimulation and immune dysregulation. Although rare, MALT lymphoma should therefore remain in the differential diagnosis when endoscopists encounter isolated, otherwise routine-appearing colonic polyps, even in the absence of potential risk factors such as <i>H. pylori</i> infection.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"20 1","pages":"377-383"},"PeriodicalIF":0.7,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149263073","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}