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Life-threatening bleeding with intussusception due to gastrointestinal stromal tumor: a case report.Surgical Case Reports Oct 2019Massive intraluminal bleeding requires urgent intervention and management. However, the source of bleeding on the small intestine is difficult to determine. Intestinal...
BACKGROUND
Massive intraluminal bleeding requires urgent intervention and management. However, the source of bleeding on the small intestine is difficult to determine. Intestinal tumor with intussusception is a rare and normally not an urgent condition. Herein, we present a rare case of intestinal intussusception with massive bleeding due to jejunal gastrointestinal stromal tumor (GIST) that required emergency surgical treatment.
CASE PRESENTATION
A 51-year-old male was admitted to the emergency department complaining of abdominal pain and acute hematochezia. Esophagogastroduodenoscopy (EGD) and colonoscopy could not determine the source of the bleeding site. Abdominal pelvic computed tomography (AP-CT) revealed GIST with intussusception, strongly suggestive of distal jejunal bleeding. Unresponsive transfusion with low blood pressure and continuous hematochezia led to emergency laparotomy. GIST, which was the leading point for intussusception, was located in the jejunum and showed mucosal ulceration of approximately 3.5 cm in diameter. Following resection and functional anastomosis, histology revealed a GIST with low mitotic count (< 5 per 50HPF). Moreover, immunochemical analysis revealed positivity for c-kit (CD117) and DOG-1. There were no complications 2 months after surgery.
CONCLUSIONS
Intussusception associated with GIST is a rare finding that can be life-threatening if it occurs with an ulcer. This case showed that the early detection of bleeding and emergency surgery could prevent severe complications.
PubMed: 31650395
DOI: 10.1186/s40792-019-0703-9 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... May 2018To observe ulcer characteristics of Crohn's disease under double balloon enteroscopy, and to evaluate the correlation between endoscopic severity and clinical... (Observational Study)
Observational Study
To observe ulcer characteristics of Crohn's disease under double balloon enteroscopy, and to evaluate the correlation between endoscopic severity and clinical manifestations. Methods: A prospective, observational study from July 2015 to December 2016 in the Third Xiangya Hospital, Central South University, we selected 45 patients with positive double-balloon enteroscopy (DBE) and confirmed Crohn's disease. Two digestive internal physician observed the ulcer characteristics of Crohn's disease under double balloon enteroscopy, and gave a simple endoscopic score for CD (SES-CD). We analyzed the correlation between SES-CD and Crohn's disease activity index (CDAI). Results: DBE indicated 24 patient ulcers (53.33%) locating at the end of the ileum, 5 (11.11%) locating at ileocolon, 16 (35.56%) locating at upper gatrointestinal tract and they did not affect the end of the ileum. Among them, 8 cases (17.78%) affected only jejunum. Thirty-two patients with longitudinal ulcers in Crohn's disease, accounting for 71.11%. There was no correlation between SES-CD score and CDAI score (r=0.237, P=0.136). Conclusion: The ulcerative appearance in Crohn's disease were diverse under double balloon enteroscopy. Crohn's disease could only affect the upper gastrointestinal tract or jejunum. The unwounded ileum and ileocecal valve couldn't be a sign to exclude Crohn's disease. CDAI score couldn't fully assess the prognosis of Crohn's disease.
Topics: Colon; Crohn Disease; Double-Balloon Enteroscopy; Humans; Ileal Diseases; Jejunal Diseases; Prospective Studies
PubMed: 29886464
DOI: 10.11817/j.issn.1672-7347.2018.05.006 -
BMC Gastroenterology Sep 2021There is rising utilization of immune checkpoint inhibitors (ICI) for a growing number of metastatic malignancies. While gastrointestinal side effects of ICI are common,...
BACKGROUND
There is rising utilization of immune checkpoint inhibitors (ICI) for a growing number of metastatic malignancies. While gastrointestinal side effects of ICI are common, isolated ICI-induced enteritis leading to small bowel hemorrhage is rare.
CASE PRESENTATION
A 71-year-old man with a previously resected right colon adenocarcinoma on atezolizumab and recently treated Clostridioides difficile presented with acute on chronic abdominal pain and non-bloody diarrhea. A CT scan revealed enteritis of the duodenum and jejunum without colitis. Initial endoscopic work-up revealed many clean-based non-bleeding duodenal ulcers to the third portion of the duodenum and normal rectosigmoid mucosa. The patient initially improved on steroids but was readmitted on day after discharge with hematochezia and hemorrhagic shock. Repeat CT showed improvement in enteritis; however, repeat push enteroscopy revealed multiple duodenal and jejunal ulcers, two with visible vessels requiring endoscopic intervention. He continued to have significant hemorrhage requiring transfusions despite IV methylprednisolone. Conventional angiogram revealed multiple sites of active extravasation, and he underwent small bowel resection and subsequent IR embolization due to persistent bleeding. He was then started on infliximab 10 mg/kg with resolution of his small bowel hemorrhage and diarrhea.
CONCLUSIONS
Severe isolated ICI-enteritis is rare and can lead to clinically significant gastrointestinal hemorrhage. Patients with severe ICI-enteritis on endoscopy should be carefully monitored for steroid refractory disease for consideration of step-up therapy such as infliximab.
Topics: Aged; Endoscopy, Gastrointestinal; Enteritis; Gastrointestinal Hemorrhage; Humans; Infliximab; Jejunum; Male
PubMed: 34493214
DOI: 10.1186/s12876-021-01915-1 -
Annals of Surgery Apr 1973
Topics: Adult; Aged; Female; Follow-Up Studies; Gastrectomy; Gastroenterostomy; Humans; Jejunum; Male; Middle Aged; Peptic Ulcer Perforation; Postoperative Complications; Recurrence; Time Factors; Vagotomy
PubMed: 4691861
DOI: No ID Found -
Annals of the Royal College of Surgeons... Jan 1973
Topics: Adult; Aged; Bile; Cineradiography; Diet Therapy; Dumping Syndrome; Duodenum; Female; Gastrectomy; Humans; Jejunum; Male; Middle Aged; Pancreatic Juice; Peptic Ulcer; Postgastrectomy Syndromes; Psychophysiologic Disorders; Stomach; Vomiting
PubMed: 4686140
DOI: No ID Found -
Cureus Mar 2023With the growing obesity epidemic, surgeons are performing more bariatric surgeries, including Roux-en-Y gastric bypass (RYGB) reversals. Although studies have...
With the growing obesity epidemic, surgeons are performing more bariatric surgeries, including Roux-en-Y gastric bypass (RYGB) reversals. Although studies have identified indications for RYGB reversals, little information is available about the long-term effects of the procedure. We wish to highlight a case with long-term complications of RYGB reversal and subsequent management. We present a patient with multiple abdominal surgeries including an RYGB reversal that was complicated by a stenosed gastrogastric anastomosis that caused several gastrojejunostomy ulcerations and malnutrition secondary to intractable nausea and vomiting. A 51-year-old female with a complex surgical history including a simple RYGB reversal in 2019 presented to the ER with complaints of abdominal pain, uncontrolled diarrhea, and an inability to tolerate food for six months. Workup revealed multiple marginal ulcers at the remnant jejunum attached to the gastric pouch, and a stenosed gastrogastrostomy placed high along the cardia of the remnant stomach and pouch. This stenosis resulted in a nonfunctional, nondependent reversal that only drained when filled. Ultimately, a large gastrotomy was performed, and an endoscope was utilized to identify a small pinhole connection between the patient's pouch and the remnant stomach along the superomedial portion of the remnant stomach's fundus. The anvil of a 60 mm GIA black load stapler was guided through and fired twice to come across the stricture. After the stricture was completely crossed, the endoscope was passed through, confirming that it was widely patent. The postoperative course was uneventful, and the patient was discharged with total parenteral nutrition (TPN) on postoperative day 15 before being discontinued at her follow-up visit. She reported that she had been gaining weight and eating well. Long-term complications following RYGB reversal are not well-discussed in the literature. This case offers insight into such complications, discusses the surgical technique utilized to fix them, and calls for further research on the topic to better inform surgeons and patients alike.
PubMed: 37090345
DOI: 10.7759/cureus.36477 -
Case Reports in Gastrointestinal... 2016Burkitt's lymphoma is a very aggressive type of B-cell NHL with replication approaching 100%. Primary gastrointestinal lymphoma is rare. In our case, a 24-year-old male...
Burkitt's lymphoma is a very aggressive type of B-cell NHL with replication approaching 100%. Primary gastrointestinal lymphoma is rare. In our case, a 24-year-old male initially presented with symptomatic anemia. He was initially evaluated with colonoscopy and EGD, both of which were unremarkable. A capsule endoscopy was then performed to further evaluate his significant anemia which revealed friable inflamed ulcerated mass in the jejunum. A push enteroscopy was then performed to obtain tissue from the jejunal mass. Biopsy results and immunohistochemical stains were consistent with Burkitt's lymphoma. PET/CT scan revealed only jejunal involvement. Treatment consisted of bowel resection prior to chemotherapy due to concern for perforation with chemotherapy. Patient achieved complete remission after the treatment.
PubMed: 27672459
DOI: 10.1155/2016/3605813 -
BMC Gastroenterology Feb 2014Celiac disease can present in children and adults with a variety of manifestations including a rare complication known as ulcerative jejunitis. The latter has been...
BACKGROUND
Celiac disease can present in children and adults with a variety of manifestations including a rare complication known as ulcerative jejunitis. The latter has been associated with refractory celiac disease in adult onset patients. The objective of this case report is to describe the first pediatric case of ulcerative jejunitis in celiac disease, diagnosed by capsule endoscopy, which was not associated with refractory celiac disease.
CASE PRESENTATION
The 9 year old girl presented with a history of abdominal pain and vomiting. Laboratory investigations revealed a slightly elevated IgA tissue transglutaminase antibody level in the setting of serum IgA deficiency. Initial upper endoscopy with biopsies was not conclusive for celiac disease. Further investigations included positive IgA anti-endomysium antibody, and positive HLA DQ2 typing. Video capsule endoscopy showed delayed appearance of villi until the proximal to mid jejunum and jejunal mucosal ulcerations. Push enteroscopy with biopsies subsequently confirmed the diagnosis of celiac disease and ulcerative jejunitis. Immunohistochemical studies of the intraepithelial lymphocytes and PCR amplification revealed surface expression of CD3 and CD8 and oligoclonal T cell populations. A repeat capsule study and upper endoscopy, 1 year and 4 years following a strict gluten free diet showed endoscopic and histological normalization of the small bowel.
CONCLUSION
Ulcerative jejunitis in association with celiac disease has never previously been described in children. Capsule endoscopy was essential to both the diagnosis of celiac disease and its associated ulcerative jejunitis. The repeat capsule endoscopy findings, one year following institution of a gluten free diet, also suggest that ulcerative jejunitis is not always associated with refractory celiac disease and does not necessarily dictate a poor outcome.
Topics: Biopsy; Capsule Endoscopy; Celiac Disease; Child; Enteritis; Female; Humans; Jejunal Diseases; Jejunum; Ulcer
PubMed: 24524552
DOI: 10.1186/1471-230X-14-29 -
World Journal of Gastroenterology Jul 2017To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel... (Observational Study)
Observational Study
AIM
To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior.
METHODS
Twenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; = 25), computed tomography (CT) enterography ( = 21), magnetic resonance (MR) enterography ( = 2), and abdominopelvic CT ( = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated.
RESULTS
The main symptoms were abdominal pain ( = 12) and anemia ( = 10). All patients showed small bowel strictures ( = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum ( = 47) or jejunum ( = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement ( = 48) that were also noted on initial SBS ( = 36) with shallow ulcers ( = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures.
CONCLUSION
Under characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.
Topics: Abdominal Pain; Adolescent; Adult; Anemia; Chronic Disease; Constriction, Pathologic; Crohn Disease; Diagnosis, Differential; Enteritis; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Intestinal Obstruction; Intestine, Small; Magnetic Resonance Imaging; Male; Middle Aged; Rare Diseases; Recurrence; Republic of Korea; Retrospective Studies; Tomography, X-Ray Computed; Ulcer; Young Adult
PubMed: 28740350
DOI: 10.3748/wjg.v23.i25.4615 -
BMC Gastroenterology Jan 2021Chronic active Epstein-Barr virus infection (CAEBV) is defined as Epstein-Barr virus (EBV)-positive T/NK cell-related neoplasia, and its major clinical symptom is...
BACKGROUND
Chronic active Epstein-Barr virus infection (CAEBV) is defined as Epstein-Barr virus (EBV)-positive T/NK cell-related neoplasia, and its major clinical symptom is systemic inflammation presenting as infectious mononucleocytosis, whereas enteritis and diarrhea are minor clinical symptoms. The complex mixture of tumorigenic processes of EBV-positive cells and physical symptoms of systemic inflammatory disease constitutes the varied phenotypes of CAEBV. Herein, we describe a case of CAEBV that was initially diagnosed as Crohn's disease (CD) based on ileal ulcers and clinical symptoms of enteritis.
CASE PRESENTATION
A 19-year-old woman complained of abdominal pain and fever. Blood examination showed normal blood cell counts without atypical lymphocyte but detected modest inflammation, hypoalbuminemia, slight liver dysfunction, and evidence of past EBV infection. The esophagogastroduodenoscopic findings were normal. However, colonoscopy revealed a few small ulcers in the terminal ileum. The jejunum and ileum also exhibited various forms of ulcers, exhibiting a cobblestone appearance, on capsule endoscopy. Based on these clinical findings, she was strongly suspected with CD. In the course of treatment by steroid and biologics for refractory enteritis, skin ulcers appeared about 50 months after her initial hospital visit. Immunohistology of her skin biopsy revealed proliferation of EBV-encoded small RNA (EBER)-positive atypical lymphocytes. We retrospectively assessed her previous ileal ulcer biopsy before treatment and found many EBER-positive lymphocytes. Blood EBV DNA was also positive. Therefore, she was diagnosed with extranodal NK/T-cell lymphoma with CAEBV-related enteritis rather than CD. She was treated with cyclosporine and prednisolone combination therapy for CAEBV-related systemic inflammation and chemotherapy for malignant lymphoma. Unfortunately, her disease continued to progress, leading to multiple organ failure and death at the age of 23 years.
CONCLUSION
Clinicians need to remember the possibility of CAEBV as a differential diagnosis of refractory enteritis. Enteritis with intestinal ulcer is a rare symptom of CAEBV, and it is impossible to acquire a definitive diagnosis by ulcer morphology only. In cases where the possibility of CAEBV remains, tissue EBVR expression should be checked by in situ hybridization and blood EBV DNA.
Topics: Adult; Chronic Disease; Enteritis; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Retrospective Studies; Ulcer; Young Adult
PubMed: 33407170
DOI: 10.1186/s12876-020-01589-1