Case Reports in Gastroenterology最新文献

{"title":"Hepatic Angiosarcoma Presenting as Ascites: Case Report of a Rare yet Lethal Disease.","authors":"Archit Garg, Mehak Bassi, Capecomorin Pitchumoni, Arkady Broder","doi":"10.1159/000546375","DOIUrl":"10.1159/000546375","url":null,"abstract":"<p><strong>Introduction: </strong>Angiosarcomas, constituting less than 1% of all sarcomas, are rare soft tissue tumors originating from the endothelial cells. Hepatic angiosarcoma (HAS) is a rare and aggressive primary hepatic malignancy accounting for only 0.5%-2% of all liver tumors. The patients often endorse nonspecific symptoms like vague abdominal pain, nausea, vomiting, and jaundice making the diagnosis challenging. Most patients succumb to death within 6 months of diagnosis due to liver failure or hemorrhage from spontaneous rupture of HAS. Therapeutic guidelines remain undefined, and management often involves a multidisciplinary approach. Surgical resection is the only potentially curative option, which has been shown to be most beneficial when HAS is limited to one lobe. Hepatic artery embolization is used in the case of rupture of HAS. Chemotherapy can be used for palliative care in cases of advanced tumors. We present a fatal case of metastatic HAS to underscore diagnostic pitfalls and therapeutic challenges.</p><p><strong>Case description: </strong>A 56-year-old male presented with 2 months of abdominal pain, distension, fatigue, and weight loss. Imaging revealed multifocal hypodense liver and splenic lesions. Laboratory findings included severe anemia (Hb 6.1 g/dL), thrombocytopenia (63 × 10³/mm³), and elevated liver enzymes. Ascitic fluid analysis demonstrated exudative, bloody ascites (SAAG <1.1) without malignant cytology. Liver biopsy confirmed HAS, showing atypical spindle cells infiltrating vascular channels, positive for CD34 and factor VIII. Despite transfusions, paracentesis, and palliative care, the patient developed disseminated intravascular coagulation and died 2 weeks post-diagnosis.</p><p><strong>Conclusion: </strong>HAS is a rapidly fatal malignancy often diagnosed at advanced stages due to nonspecific symptoms and lack of definitive risk factors in most cases. Multidisciplinary collaboration is essential for symptom management, though treatment options remain limited, and prognosis is poor. Therefore, it becomes imperative for clinicians to keep in mind the common presentation of a rare but lethal disease.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"488-495"},"PeriodicalIF":0.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552416","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 Inflammatory Bowel Disease: Calprotectin as a Marker for Trichobezoar? A Case Report.","authors":"Ammar Khayat","doi":"10.1159/000546623","DOIUrl":"10.1159/000546623","url":null,"abstract":"<p><strong>Introduction: </strong>Trichobezoar is an aggregation of swallowed hair strands that entangle in the stomach. It presents with abdominal pain, vomiting, and diarrhea. Diagnosis is usually made by imaging and endoscopy. Surgical removal is typically required, but endoscopic retrieval has been successful. Fecal calprotectin is a biomarker of inflammation that is typically elevated in inflammatory bowel disease (IBD) but is also elevated in other gastrointestinal (GI) disorders such as infections. Trichobezoar is not known to precipitate GI inflammation and has never been reported among the etiologies of elevated fecal calprotectin. Herein is a case presenting with vague abdominal pain and elevated fecal calprotectin that was attributed solely to a trichobezoar.</p><p><strong>Case presentation: </strong>A 7-year-old girl presented with abdominal pain for 6 months associated with occasional vomiting and diarrhea. Family history was positive for ulcerative colitis. Physical examination was unremarkable including normal growth. Diagnostic workup revealed elevated fecal calprotectin at 433.9 mg/kg. Upper and lower endoscopies were performed. A trichobezoar with Rapunzel syndrome was incidentally found in the stomach extending into the duodenum without frank obstruction. Histology showed reactive gastropathy in a few areas of mechanical rubbing by hair strands; otherwise, it was completely unremarkable in both upper and lower GI biopsies. Endoscopic retrieval of piecemeal hair locks was done. Surgical removal was subsequently done due to the generous size of the mass.</p><p><strong>Conclusion: </strong>Fecal calprotectin is an important biomarker for IBD, as well as other unusual GI pathologies, and clinical context is crucial when interpreting its value.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"482-487"},"PeriodicalIF":0.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483259","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":"Gastroduodenal Strongyloidiasis Diagnosed during Iron Deficiency Anemia Workup.","authors":"Malek Kreidieh, Neville Mobarakai, Sherif Andrawes, Robert Colef, Lara Kreidieh, Hassan Al Moussawi, Jean M Chalhoub","doi":"10.1159/000539769","DOIUrl":"10.1159/000539769","url":null,"abstract":"<p><strong>Introduction: </strong>The Strongyloidae family includes at least fifty species of intestinal nematode worms, and <i>Strongyloides stercoralis</i> is the most prevalent one among humans. As a result of this parasite's complex lifecycle, it can either remain localized in the intestines or disseminate to different organs throughout the body, culminating in hyperinfection in case of immunosuppression. Strongyloidiasis is rarely encountered in the USA, and an associated gastric involvement is uncommon.</p><p><strong>Case presentation: </strong>In this case report, we describe the case of an asymptomatic and immunocompetent Liberian patient with gastroduodenal strongyloidiasis whose diagnosis was based on histologic findings during endoscopic evaluation for iron deficiency anemia.</p><p><strong>Conclusion: </strong>This case sheds light on the importance of suspecting the diagnosis of disseminated strongyloidiasis in high-risk individuals with iron deficiency anemia in combination with peripheral eosinophilia.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"467-475"},"PeriodicalIF":0.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367943","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 Rare Cause of Ascites: Vesicoabdominal Fistula as a Late Complication of Radiation-Induced Cystitis - A Case Report.","authors":"Jakub Klevar, Pavel Hrabák, Radan Brůha, Libor Zámečník","doi":"10.1159/000546596","DOIUrl":"10.1159/000546596","url":null,"abstract":"<p><strong>Introduction: </strong>Vesico-peritoneal fistula (VPF) is an uncommon type of fistula in the urogenital tract and a rare cause of ascites.</p><p><strong>Case presentation: </strong>Although VPF mainly occurs as an early postoperative complication of gynecological surgery, we report a case of a 71-year-old female patient who presented with ascites, pseudo-renal failure, and peritonitis caused by a VPF as a delayed complication of radiotherapy.</p><p><strong>Conclusion: </strong>In this case report, we discuss treatment strategies based on previously published case studies and our experience. We provide a diagnostic overview of commonly available imaging techniques, such as computed tomography scans and magnetic resonance imagings. Despite their widespread use, these imaging modalities have not led to any shift in the diagnostic process, with the definitive diagnosis being confirmed only by retrograde cystography.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"476-481"},"PeriodicalIF":0.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367942","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":"Spinal Cord Stimulation for Diffuse Visceral Hyperalgesia in the Abdomen: A Case Report and Literature Review.","authors":"James Mamaril-Davis, Ryan Palsma, Martin Weinand","doi":"10.1159/000546229","DOIUrl":"10.1159/000546229","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord stimulation (SCS) for chronic abdominal pain is not novel. However, this has been explored only when the pain has a clear dermatomal association such as the right upper quadrant for sphincter of Oddi dysfunction or the left upper quadrant for post-traumatic splenectomy. The present report thereby discusses the utility of SCS when the visceral pain is diffusely distributed across all four quadrants of the abdomen.</p><p><strong>Case presentation: </strong>A patient in their 70s presented with a 30-year history of chronic abdominal pain diffusely located in all four quadrants. The patient had a pancreatic cyst removed via pancreaticoduodenectomy in 1991 complicated by chronic pancreatitis and visceral hyperalgesia. After failed pharmacological management and various outpatient nerve blocks and trigger point injections, the patient underwent SCS placement via five 4-contact paddle leads at the mid- to superior thoracic 7 level. At 1-month follow-up, the patient's visual analog scale score decreased from 8/10 (prior to implantation) to 0/10. The patient also discontinued his chronic opioid regimen post-SCS placement but continued duloxetine. Device settings remained the same throughout the postoperative period: pulse width of 500 microseconds (inter-burst) and 1,000 microseconds, frequency of 40 Hertz, and current of 1.7 milliamperes. At 12-month follow-up, the patient continued to report >90% pain relief at nearly the same SCS settings as the initial programming.</p><p><strong>Conclusion: </strong>SCS may be a reliable treatment option for chronic abdominal, visceral hyperalgesia when the pain is diffusely located in all 4 quadrants and without a clear dermatomal pattern.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"461-466"},"PeriodicalIF":0.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324495","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":"Effects of Neuromuscular Electrical Stimulation on Chronic Dysphagia in a Single Subject after Anterior Cervical Discectomy and Fusion Surgery: A Case Report.","authors":"Anna Munson, Matthew Dumican, Katherine Rigley","doi":"10.1159/000546013","DOIUrl":"10.1159/000546013","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical discectomy and fusion (ACDF) surgery.</p><p><strong>Case presentation: </strong>An 83-year-old male experienced dysphagia >2 months post-ACDF. The patient presented with a narrowed pharyngoesophageal segment due to cervical hardware and reduced epiglottic inversion due to pharyngeal narrowing on videofluoroscopic swallow study (VFSS). He completed dysphagia therapy using neuromuscular electrical stimulation (NMES). Structural alterations and a complicated medical course after treatment impacted therapeutic outcomes. Reductions in penetration or aspiration and improved hyoid excursion were found post-treatment, though impairment persisted. The patient ended therapy after the post-treatment VFSS and began to experience odynophagia and submental pain. The patient experienced a complicated post-treatment course including bilateral cancerous masses at the base of tongue with subsequent surgery and chemoradiation.</p><p><strong>Conclusions: </strong>While considered rare, these findings present a post-operative course of chronic dysphagia post-ACDF surgery where morphological changes to the pharynx significantly altered swallowing function. Swallowing function should be tracked routinely and longitudinally in post-ACDF surgery patients. NMES may be a potential dysphagia therapy modality to explore.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"445-454"},"PeriodicalIF":0.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315957","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":"Post-Pancreatitis Splenic Artery Pseudoaneurysm as a Luring Danger: A Case Report.","authors":"Daniel Schweckendiek, Kuno Lehmann, Vincent Van den Bosch","doi":"10.1159/000546314","DOIUrl":"10.1159/000546314","url":null,"abstract":"<p><strong>Introduction: </strong>Splenic artery aneurysm (SAA) is a rare but potentially life-threatening condition. SAA can occur following an acute or chronic pancreatitis as a pseudoaneurysm, iatrogenic (post-pancreatic/splenic surgery) or post-traumatic. If symptomatic, it needs to be treated urgently as it has a high risk of rupture.</p><p><strong>Case presentation: </strong>Here is a case where a ruptured aneurysm presented in an unusual manner: first as an acute abdomen and second, delayed, as hemorrhagic shock. Only emergency laparotomy and splenectomy saved the patient's life.</p><p><strong>Conclusion: </strong>If a splenic artery pseudoaneurysm is detected on CT scan, there is an increased risk of rupture irrespective of the size and the patient that should be proactively managed. Concomitant abdominal findings and diseases can delay diagnosis and underestimate the risk.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"439-444"},"PeriodicalIF":0.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315958","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":"Ribavirin Treatment in Acute HEV-Induced Liver Injury in a Healthy US Female: A Case Report.","authors":"Nadera Altork, Michele P Fischer, Lukman Cheraghvandi, Arul M Thomas","doi":"10.1159/000546235","DOIUrl":"10.1159/000546235","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis E virus (HEV) is a global cause of acute viral hepatitis, for which there is currently no FDA-approved medication. This case report describes a unique instance of a healthy US female presenting with acute HEV, who was treated with ribavirin to address her acute liver injury.</p><p><strong>Case presentation: </strong>A 36-year-old US female, nonpregnant, without liver disease, developed nonspecific symptoms post-travel to Indonesia, leading to acute liver injury with concern for failure. Liver biopsy showed severe hepatocellular necrosis (>50%) with mixed infiltrate; HEV PCR was positive (93,700,000 IU/mL) [Am J Gastroenterol. 2024;119(10S):S2872-3]. After risk-benefit analysis, ribavirin treatment resolved symptoms and normalized biomarkers in a month, avoiding emergency transplantation.</p><p><strong>Conclusion: </strong>HEV infection should be considered in acute liver injury cases in the US, especially with exposure risks. Ribavirin's role in acute cases warrants further study, potentially averting major morbidity and mortality.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"455-460"},"PeriodicalIF":0.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12173439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315959","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":"Opioid Withdrawal Misdiagnosed as a Crohn's Flare.","authors":"Matthew Christopher Ryan, Marcel Jose Yibirin Wakim, Sebastian Suarez","doi":"10.1159/000546335","DOIUrl":"10.1159/000546335","url":null,"abstract":"<p><strong>Introduction: </strong>There is an increased incidence of opioid use disorder (OUD) originating from prescription misuse. Diagnosing OUD remains challenging, particularly in patients with multiple medical comorbidities where other potential etiologies may cause overlapping symptoms.</p><p><strong>Case presentation: </strong>This report highlights a 28-year-old male with Crohn's disease (CD) with recurrent hospitalizations of abdominal pain, hematuria, nausea, vomiting, and diarrhea. An extensive workup was negative for a Crohn's flare; however, the patient's symptoms improved within 48 h of admission, coinciding with opioid administration for pain management. Subsequently, the patient was diagnosed with opioid withdrawal and discharged with a buprenorphine clinic appointment to initiate medications for OUD.</p><p><strong>Conclusion: </strong>This case highlights the complexity of diagnosing opioid withdrawal in a patient with CD and the persistent stigma in the healthcare community regarding persons who use opioids.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"434-438"},"PeriodicalIF":0.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301178","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":"Curcumin-QingDai Combination as Treatment for Crohn's Disease: A Case Report.","authors":"Netanel Krugliak, Mark S Silverberg","doi":"10.1159/000546012","DOIUrl":"10.1159/000546012","url":null,"abstract":"<p><strong>Introduction: </strong>Curcumin and QingDai (QD, indigo) are two herbal extracts used in traditional medicine. A combination of curcumin with QD (CurQD) was reported to be effective in ulcerative colitis, but its effectiveness in Crohn's disease (CD) is unknown. We report on the use of CurQD for the treatment of CD.</p><p><strong>Case presentation: </strong>The patient was a 35-year-old male with colonic and perianal CD responsive to infliximab therapy, who had to discontinue therapy due to a concomitant cardiomyopathy diagnosis. After cessation of infliximab treatment, he experienced clinical and endoscopic relapse which responded to initiation of CurQD therapy with regained clinical and endoscopic remission.</p><p><strong>Conclusion: </strong>In summary, the present case report describes, for the first time, a possible benefit of CurQD nutraceutical in the induction and maintenance of remission in a Crohn's patient. However, more data, preferably from adequately powered randomized controlled trials, are needed to corroborate these observations.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"423-427"},"PeriodicalIF":0.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274261","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}