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Acta Medica Okayama Apr 2017We retrospectively analyzed the cases of 14 patients (9 women, 5 men, mean age: 51.6 years) with cytomegalovirus (CMV) involvement in the esophagus, stomach, and/or...
We retrospectively analyzed the cases of 14 patients (9 women, 5 men, mean age: 51.6 years) with cytomegalovirus (CMV) involvement in the esophagus, stomach, and/or duodenum diagnosed at a single center, to determine their endoscopic features and clinical backgrounds. Thirteen patients (92.9%) had hematologic disease; the other had rheumatoid arthritis. Of the former, 12 patients underwent allogeneic hematopoietic stem cell transplantation, and 9 of these patients had graft-versus-host disease (GVHD) before undergoing esophagogastroduodenoscopy (EGD). All 14 patients had been taking one or more immunosuppressive agents including cyclosporine (n=10), corticosteroids (n=9), mycophenolic acid (n=6), tacrolimus (n=3), and methotrexate (n=1). Tests for CMV antigenemia were positive in 11 patients (78.6%). EGD examinations revealed esophageal (n=3), gastric (n=9), and duodenal involvement (n=6). Macroscopically, esophageal lesions by CMV infection presented as redness (n=1), erosions (n=1), and ulcers (n=1). Gastric lesions manifested as redness (n=7), erosions (n=3), exfoliated mucosa (n=2), and verrucous erosions (n=1). Mucosal appearances in the duodenum varied: redness (n=2), ulcers (n=2), multiple erosions (n=2), single erosion (n=1), edema (n=1). CMV was detected even in the intact duodenal mucosa (n=1). In conclusion, physicians must recall the relevance of CMV infection when any mucosal alterations exist in the upper gastrointestinal tract of immunosuppressed patients.
Topics: Adult; Aged; Cytomegalovirus Infections; Duodenal Diseases; Endoscopy, Digestive System; Esophageal Diseases; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Stomach Diseases; Upper Gastrointestinal Tract
PubMed: 28420890
DOI: 10.18926/AMO/54977 -
Annals of the Royal College of Surgeons... Jul 2017Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs...
Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.
Topics: Abdominal Pain; Adult; Duodenal Diseases; Humans; Intussusception; Male; Pancreaticoduodenectomy; Young Adult
PubMed: 28660832
DOI: 10.1308/rcsann.2017.0104 -
BMC Veterinary Research May 2024Common marmosets (Callithrix jacchus) are widely used as primate experimental models in biomedical research. Duodenal dilation with chronic vomiting in captive common...
BACKGROUND
Common marmosets (Callithrix jacchus) are widely used as primate experimental models in biomedical research. Duodenal dilation with chronic vomiting in captive common marmosets is a recently described life-threatening syndrome that is problematic for health control. However, the pathogenesis and cause of death are not fully understood.
CASE PRESENTATION
We report two novel necropsy cases in which captive common marmosets were histopathologically diagnosed with gastric emphysema (GE) and pneumatosis intestinalis (PI). Marmoset duodenal dilation syndrome was confirmed in each case by clinical observation of chronic vomiting and by gross necropsy findings showing a dilated, gas-filled and fluid-filled descending duodenum that adhered to the ascending colon. A diagnosis of GE and PI was made on the basis of the bubble-like morphology of the gastric and intestinal mucosa, with histological examination revealing numerous vacuoles diffused throughout the lamina propria mucosae and submucosa. Immunostaining for prospero homeobox 1 and CD31 distinguished gas cysts from blood and lymph vessels. The presence of hepatic portal venous gas in case 1 and possible secondary bacteremia-related septic shock in case 2 were suggested to be acute life-threatening abdominal processes resulting from gastric emphysema and pneumatosis intestinalis.
CONCLUSIONS
In both cases, the gross and histopathological findings of gas cysts in the GI tract walls matched the features of human GE and PI. These findings contribute to clarifying the cause of death in captive marmosets that have died of gastrointestinal diseases.
Topics: Animals; Callithrix; Pneumatosis Cystoides Intestinalis; Emphysema; Male; Monkey Diseases; Stomach Diseases; Female; Duodenal Diseases
PubMed: 38783305
DOI: 10.1186/s12917-024-04087-8 -
BMC Pulmonary Medicine Sep 2021Chronic cough is characterized by cough as the only or main symptom, with a duration of more than 8 weeks and no obvious abnormality in chest X-ray examination. Its...
BACKGROUND
Chronic cough is characterized by cough as the only or main symptom, with a duration of more than 8 weeks and no obvious abnormality in chest X-ray examination. Its etiology is complex, including respiratory disease, digestive system disease, circulation system disease, and psychological disease. Although a set of etiological diagnosis procedures for chronic cough have been established, it is still difficult to diagnose chronic cough and there are still some patients with misdiagnosis.
CASE PRESENTATION
We present a case of a 54-year-old female patient who had chronic cough for 28 years. Physical examination had no positive signs and she denied any illness causing cough like tuberculosis, rhinitis. Recurrent clinic visits and symptomatic treatment didn't improve the condition. Finally, gastroscopy identified the possible etiology of choledochoduodenal fistula that was proved by surgery. And after surgery, the patient's cough symptoms were significantly improved.
CONCLUSION
We report a rare case of chronic cough caused by choledochoduodenal fistula which demonstrates our as yet inadequate recognition of the etiology and pathogenesis. Written informed consent was obtained from the patient.
Topics: Biliary Fistula; Cholangiopancreatography, Magnetic Resonance; Chronic Disease; Common Bile Duct Diseases; Cough; Duodenal Diseases; Female; Gastroscopy; Humans; Intestinal Fistula; Middle Aged; Treatment Outcome
PubMed: 34507583
DOI: 10.1186/s12890-021-01658-5 -
Cirugia Y Cirujanos 2017Wilkie syndrome, also referred as superior mesenteric artery syndrome, is an unusual cause of a proximal small bowel obstruction. It is characterised by the compression...
BACKGROUND
Wilkie syndrome, also referred as superior mesenteric artery syndrome, is an unusual cause of a proximal small bowel obstruction. It is characterised by the compression of the duodenum in its third portion due to a narrowing of the space between the superior mesenteric artery and the aorta. Its presentation symptoms are consistent and include the obstruction of the proximal small bowel. However, the physical and laboratory findings are non-specific. Nevertheless, many imaging methods are useful for its diagnosis. The management of this condition varies between observation and surgery, depending on each particular case.
CLINICAL CASE
The case is presented of a 19 year-old male who began with acute, intense abdominal pain, nausea, vomiting, and diarrhoea. On examination, he had abdominal wall rigidity and hyperesthesia. Imaging studies were requested, revealing a decreased superior mesenteric artery angle, a shortening of the aortic mesenteric distance, and a decrease in the calibre of the third duodenal portion, all findings concomitant with Wilkie syndrome. Conservative treatment was applied and the patient was discharged without complications.
CONCLUSIONS
Wilkie syndrome continues to be an unknown condition to the general practitioner, and the underdiagnosis of this condition may put a patient at risk of serious complications. A high index of suspicion is required to reach a diagnosis. Early treatment should give a good outcome most of the time.
Topics: Abdomen, Acute; Analgesics; Conservative Treatment; Diagnostic Errors; Duodenal Diseases; Duodenoscopy; Emergencies; Fluid Therapy; Gastroenteritis; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Male; Superior Mesenteric Artery Syndrome; Tomography, X-Ray Computed; Young Adult
PubMed: 26769525
DOI: 10.1016/j.circir.2015.08.009 -
BMJ Case Reports Apr 2019We describe the case of an 82-year-old Caucasian woman who presented to our institution as a transfer from an outside hospital with nausea, vomiting and abdominal pain...
We describe the case of an 82-year-old Caucasian woman who presented to our institution as a transfer from an outside hospital with nausea, vomiting and abdominal pain with CT imaging concerning for a duodenal mass or abscess in the juxtapapillary region of the second part of the duodenum. Upper endoscopy showed a non-bleeding duodenal diverticulum with purulent discharge consistent with diverticulitis. She underwent endoscopic disimpaction with irrigation and received a 14 day course of antibiotics, after which she presented for follow-up 1 month after discharge without complications. This case highlights the rarity of juxtapapillary duodenal diverticulitis, its nonspecific clinical presentation and imaging findings and the importance of early diagnosis and management to prevent severe complications including perforation.
Topics: Abdominal Pain; Aged, 80 and over; Anti-Bacterial Agents; Diverticulitis; Duodenal Diseases; Endoscopy; Female; Humans; Nausea; Therapeutic Irrigation; Tomography, X-Ray Computed; Treatment Outcome; Vomiting
PubMed: 30981989
DOI: 10.1136/bcr-2019-229259 -
The American Journal of Gastroenterology Jan 2009Celiac disease (CD) is a chronic inflammatory disease of the small bowel that is characterized by increased intraepithelial lymphocytes (IELs) and villous atrophy of the...
OBJECTIVES
Celiac disease (CD) is a chronic inflammatory disease of the small bowel that is characterized by increased intraepithelial lymphocytes (IELs) and villous atrophy of the mucosa. It is unclear how often intraepithelial lymphocytosis in the absence of atrophy is a manifestation of gluten sensitive enteropathy. The objective of this study was to identify factors that discriminate patients with CD from those with lymphocytic duodenosis (LD, intraepithelial lymphocytosis without villous atrophy). We compared Class 2 HLA type, presenting symptoms, and serology in patients with LD and CD.
METHODS
Retrospective review of 124 systematically assessed patients with LD compared with 454 CD patients with villous atrophy. All patients had duodenal biopsies and Class 2 HLA typing performed. HLA type, symptoms, serology pattern, and response to a gluten-free diet were analyzed using univariate logistic regression modeling, adjusted for age and gender.
RESULTS
Half of the (63 (51%)) LD patients lack the Class 2 HLA genotypes encoding DQ2 or DQ8 whereas only 11 (2%) CD patients had neither DQ2 nor DQ8, P<0.001. The genes encoding DQ2 were much more prevalent in CD (91%) than that in LD (37%, P<0.001), however, the rate of carriage of DQ8 did not differ between the two groups (15% vs. 15%, P=0.9). Although diarrhea and weight loss were equally frequent in LD and CD patients, LD patients were less likely to be associated with anemia (P=0.007), malaise (P=0.006), skin disorder (P=0.007), or a family history of CD (P<0.001). The LD subjects were much less likely to have tissue transglutaminase or endomysial antibodies than were CD subjects (12% or 0% vs. 87% and 87%; P<0.001, respectively).
CONCLUSIONS
The LD cohort differs significantly in terms of HLA type, serology, and clinical features, suggesting that the majority of patients with LD do not belong in the spectrum of CD.
Topics: Adult; Atrophy; Autoantibodies; Biopsy, Needle; Celiac Disease; Duodenal Diseases; Duodenum; Female; GTP-Binding Proteins; Genes, MHC Class II; Genotype; Gliadin; HLA-DQ Antigens; Humans; Immunoglobulin A; Intestinal Mucosa; Lymphocytes; Male; Protein Glutamine gamma Glutamyltransferase 2; Transglutaminases
PubMed: 19098862
DOI: 10.1038/ajg.2008.7 -
Australian Family Physician Oct 2015Endoscopic biopsies of the upper gastrointestinal (GI) tract are taken to make a diagnosis of inflammation, dysplasia or malignancy, to assess treatment success and...
BACKGROUND
Endoscopic biopsies of the upper gastrointestinal (GI) tract are taken to make a diagnosis of inflammation, dysplasia or malignancy, to assess treatment success and monitor patients' progress.
OBJECTIVE
This article provides a guide to understanding histology reports sent to general practitioners (GPs) from endoscopy and anatomical pathology providers for the diagnosis of increasingly prevalent upper GI diseases.
DISCUSSION
Many upper GI diseases are increasing in prevalence and new diseases are emerging that require biopsy for diagnosis. Oesophageal disease (particularly gastro-oesophageal reflux disease and eosinophilic oesophagitis) and coeliac disease (real and perceived wheat sensitivity) are common. However, infection with Helicobacter pylori is declining. Drugs can also affect the GI tract, and endoscopy can detect damage with biopsy confirmation.
Topics: Barrett Esophagus; Biopsy; Celiac Disease; Duodenal Diseases; Endoscopy, Gastrointestinal; Esophagitis; Gastrointestinal Diseases; Gastrointestinal Tract; General Practice; Humans; Stomach Diseases
PubMed: 26484483
DOI: No ID Found -
BMC Gastroenterology Sep 2018IgG4-related disease (IgG4-RD) is a newly recognized autoimmune systemic disorder characterized by elevated levels of serum IgG4 and abundant infiltration of... (Review)
Review
BACKGROUND
IgG4-related disease (IgG4-RD) is a newly recognized autoimmune systemic disorder characterized by elevated levels of serum IgG4 and abundant infiltration of IgG4-positive plasmacytes in the affected organs. The liver, biliary system and pancreas are the most commonly affected organs. However, involvement of the digestive tract is very rare. To date, only a few cases of isolated gastric IgG4-RD have been reported.
CASE PRESENTATION
We present a case of IgG4-RD of the liver, gallbladder, pancreas and duodenum, which was clinically misinterpreted and thereafter over-treated. A 52-year-old male presented with obstructive jaundice for 3 years, melena for 5 months and hematemesis for 10 days. Three years prior, the patient had undergone biopsies of pancreatic lesions, liver lesions, cholecystectomy and choledochojejunostomy. Histopathology showed chronic inflammatory changes. Endoscopy at admission revealed a duodenal ulcer with active bleeding. Despite medical management, the patient presented with repeated gastrointestinal bleeding. Upon evaluation, serum IgG4 levels were found to be elevated. Histopathology of the duodenal ulcer biopsy and repeated examination of the gallbladder and pancreatic and liver biopsies confirmed IgG4 positive plasma cell infiltration. A definitive diagnosis of IgG4-RD was made and steroid administration was initiated. At last follow up, 11 months to-the-day after initiating steroid treatment, the patient was asymptomatic.
CONCLUSIONS
Notably, IgG4-RD of multiple digestive organs is still very rare. As a systemic disease, it is characterized by the infiltration of IgG4-bearing plasma cells and raised IgG4 levels. Histopathology findings remain the diagnostic gold standard for this disorder.
Topics: Anti-Inflammatory Agents; Autoimmune Diseases; Diagnostic Errors; Digestive System Diseases; Duodenal Diseases; Gallbladder Diseases; Gastrointestinal Hemorrhage; Glucocorticoids; Humans; Immunoglobulin G; Liver Diseases; Male; Middle Aged; Mycophenolic Acid; Pancreatic Diseases; Prednisolone; Prednisone; Recurrence
PubMed: 30180812
DOI: 10.1186/s12876-018-0867-y -
World Journal of Gastroenterology May 2022Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children....
BACKGROUND
Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children. Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases, coagulation disorders, malignancy, collagenosis, peptic ulcers, vasculitis and upper endoscopy procedures. In adults the most common risk factor reported is anticoagulation therapy. The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding.
CASE SUMMARY
The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™ stent (Boston Scientific Corp., Marlborough, MA, United States).
CONCLUSION
Endoscopic lumen-apposing metal stent Hot AXIOS™ stent is a safe and feasible treatment of duodenal intramural hematoma in our case.
Topics: Adult; Child; Duodenal Diseases; Endoscopy; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction
PubMed: 35721883
DOI: 10.3748/wjg.v28.i20.2243