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The Oncologist Aug 2023Immune checkpoint inhibitors (ICIs) have increased our ability to treat an ever-expanding number of cancers. We describe a case series of 25 patients who were diagnosed...
BACKGROUND
Immune checkpoint inhibitors (ICIs) have increased our ability to treat an ever-expanding number of cancers. We describe a case series of 25 patients who were diagnosed with gastritis following ICI therapy.
MATERIALS AND METHODS
This was a retrospective study involving 1712 patients treated for malignancy with immunotherapy at Cleveland Clinic from January 2011 to June 2019 (IRB 18-1225). We searched electronic medical records using ICD-10 codes for gastritis diagnosis confirmed on endoscopy and histology within 3 months of ICI therapy. Patients with upper gastrointestinal tract malignancy or documented Helicobacter pylori-associated gastritis were excluded.
RESULTS
Twenty-five patients were found to meet the criteria for diagnosis of gastritis. Of these 25 patients, most common malignancies were non-small cell lung cancer (52%) and melanoma (24%). Median number of infusions preceding symptoms was 4 (1-30) and time to symptom onset 2 (0.5-12) weeks after last infusion. Symptoms experienced were nausea (80%), vomiting (52%), abdominal pain (72%), and melena (44%). Common endoscopic findings were erythema (88%), edema (52%), and friability (48%). The most common diagnosis of pathology was chronic active gastritis in 24% of patients. Ninety-six percent received acid suppression treatment and 36% of patients also received steroids with an initial median dose of prednisone 75 (20-80) mg. Within 2 months, 64% had documented complete resolution of symptoms and 52% were able to resume immunotherapy.
CONCLUSION
Patients presenting with nausea, vomiting, abdominal pain, or melena following immunotherapy should be assessed for gastritis and if other causes are excluded, may require treatment as consideration for complication of immunotherapy.
Topics: Humans; Immune Checkpoint Inhibitors; Retrospective Studies; Carcinoma, Non-Small-Cell Lung; Melena; Tertiary Care Centers; Lung Neoplasms; Gastritis; Helicobacter Infections; Abdominal Pain; Vomiting; Nausea
PubMed: 36905577
DOI: 10.1093/oncolo/oyad031 -
California Medicine Oct 1964Patients requiring emergency operation for severe acute colonic hemorrhage usually arrive in the operating room inadequately studied and the point of bleeding not known....
Patients requiring emergency operation for severe acute colonic hemorrhage usually arrive in the operating room inadequately studied and the point of bleeding not known. A well planned procedure for making an operative diagnosis is lacking. The fact that diverticular disease is the most common cause of massive colonic bleeding, dominates the surgical management of this problem. A critical interpretation of the color and the consistency of the stools must be made by the surgeon. Since the bleeding lesion is usually otherwise clinically silent, the character of the stools may be the only indication of the level of bleeding and the rate and the amount of the blood loss. A proctoscopic examination, followed by an emergency barium enema study if possible, is always done before subjecting a patient to laparotomy. The indications for emergency operation include acute exsanguinating hemorrhage, less severe but persistent colonic bleeding and recurrent colonic bleeding. The steps for the operative diagnosis and the surgical procedure utilized for a specific situation are discussed.
Topics: Colonic Diseases; Diagnosis, Differential; Diverticulum; Emergencies; Enema; Exsanguination; Feces; Gastrointestinal Hemorrhage; Humans; Melena; Proctoscopy; Surgical Procedures, Operative
PubMed: 14201233
DOI: No ID Found -
Chirurgia (Bucharest, Romania : 1990) 2019Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old...
Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old male patient who is admitted to the emergency room with the following complaints: upper GI tract bleeding manifested through hematemesis and melena, epigastric pain, lack of bowel movements. A contrast computed tomograohy is performed showing the presence of a hyper-dense stomach content, gastric wall thickening, abdominal fluid but with no signs of intestinal occlusion. A laparotomy is performed and ollowing an anterior gastrotomy a large quantity of pebbles is found along with a hemorrhagic and stenotic tumor of the lesser curvature. Taking into account the intraoperative aspect the decision was made to perform an end-to-side stapled esophago-jejunal anastomosis on an omega loop with a Braun entero-entero anastomosis following total gastric resection and D1 lymphadenectomy. Postoperative course is uneventful. A barium swallow carried out on the 10th day following surgery shows a functional anastomosis without leakage. On day 11, the patient is discharged. Pica is usually discovered by accident, most frequently on the operating table which is why thorough preoperative examination and investigations are required.
Topics: Anastomosis, Surgical; Esophagus; Gastrectomy; Gastrointestinal Hemorrhage; Hematemesis; Humans; Jejunum; Male; Melena; Middle Aged; Pica; Stomach
PubMed: 31264580
DOI: 10.21614/chirurgia.114.3.409 -
Clinics and Research in Hepatology and... Sep 2020The COVID-19 outbreak has become a pandemic that is threatening global health. The typical clinical manifestations were fever, cough, dyspnea, and myalgia or fatigue....
The COVID-19 outbreak has become a pandemic that is threatening global health. The typical clinical manifestations were fever, cough, dyspnea, and myalgia or fatigue. Digestive symptoms such as nausea, vomiting, diarrhea, abdominal pain usually accompany respiratory symptoms. However gastrointestinal bleeding as the first symptom is not reported. Here we reported a case of COVID-19 with gastrointestinal bleeding as the initial symptom to the emergency department with a real-time reverse transcriptase polymerase chain reaction test positive, and normal thorax tomography. The case demonstrate that; clinicians should be alerted to patients about COVID-19 when referring to atypical symptoms and every patient undergoing endoscopy should be considered potentially infected or can infect others.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Diarrhea; Electrocardiography; Gastrointestinal Hemorrhage; Humans; Lung; Male; Melena; Middle Aged; Myocardial Ischemia; Pandemics; Pneumonia, Viral; Real-Time Polymerase Chain Reaction; SARS-CoV-2; Tachycardia, Sinus
PubMed: 32505730
DOI: 10.1016/j.clinre.2020.05.001 -
Revista Espanola de Enfermedades... Dec 2022A 74-year-old male presented with melena and fatigue, without fever or abdominal pain. Laboratory examination revealed anemia, leukocytosis, elevated C-reactive protein...
A 74-year-old male presented with melena and fatigue, without fever or abdominal pain. Laboratory examination revealed anemia, leukocytosis, elevated C-reactive protein levels and conjugated hyperbilirubinemia with elevated liver enzymes. Upper endoscopy identified blood in the stomach and duodenum and a 6 mm hole in the anterosuperior surface of the duodenal bulb with spontaneous drainage of a bloody brownish content. The mucosa surrounding the hole was normal and there was a discrete mucosal flap that throbbed with air insufflation. Abdominal computed tomography identified a fistulous tract between the duodenal bulb and the gallbladder with a 2 mm caliber, suggesting a cholecystoduodenal fistula. Diagnosis is often difficult because symptoms are nonspecific and variable but gastrointestinal bleeding is a rare clinical presentation.
Topics: Male; Humans; Aged; Cholecystitis; Duodenum; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Melena
PubMed: 36148665
DOI: 10.17235/reed.2022.9174/2022 -
Cureus Oct 2022Bezoar occurs due to the ingestion of inedible material. The most common bezoar is a phytobezoar, which results from the ingestion of indigestible food particles found...
Bezoar occurs due to the ingestion of inedible material. The most common bezoar is a phytobezoar, which results from the ingestion of indigestible food particles found in vegetables and fruits. Other types include trichobezoar, which involves hair, lactobezoar, which involves milk products, pharmacobezoar, which involves medication, and in unusual cases, bezoar may involve different materials such as metals, plastics, and paper. We are presenting a case of a 19-year-old patient, a known case of Prader-Willi syndrome, who presented with difficulty breathing and tachypnea after aspiration of grape particles, and then he started to complain of melena and vomiting of dark content. He was admitted for urgent bronchoscopy and endoscopy, which showed a bezoar composed of grapes and threads. He was managed endoscopically by removing most of the threads and grape particles and releasing the tangled threads to facilitate its migration distally. Follow-up endoscopy showed complete resolution of the previously noticed content. We reported this case to discuss the endoscopic management of unusual bezoar involving threads.
PubMed: 36348828
DOI: 10.7759/cureus.29900 -
BMC Pediatrics May 2018Henoch-Schönlein purpura is a common small vessel vasculitis in children. Acute pancreatitis rarely presents as a complication of Henoch-Schönlein purpura and has not...
BACKGROUND
Henoch-Schönlein purpura is a common small vessel vasculitis in children. Acute pancreatitis rarely presents as a complication of Henoch-Schönlein purpura and has not been well characterized.
METHODS
We retrospectively reviewed 13 cases of Henoch-Schönlein purpura with acute pancreatitis among 3212 patients who attended our hospital between January 2003 and June 2016 and analyzed their clinical characteristics, laboratory findings, imaging findings, treatment and overall prognosis.
RESULTS
All patients had abdominal manifestations, including significant abdominal pain (13/13), vomiting (9/13), abdominal distension (3/13) and melena (6/13). Serum amylase level significantly increased in all patients, and urine amylase was increased in 7 cases (7/10). However, increased urine lapse was only noted in 2 cases (2/5), and diffuse swelling of the pancreas was seen in 2 cases (2/13) by abdominal ultrasonography. Although all patients had typical skin purpura (13/13), 5 patients (5/13) with acute pancreatitis initially experienced acute abdominal pain in clinical onset of Henoch-Schönlein purpura. Glucocorticoid therapy was effective in alleviating abdominal symptoms of Henoch-Schönlein purpura patients with acute pancreatitis. All patients were in good general condition without any abdominal complications 6-12 months after discharge.
CONCLUSIONS
Acute pancreatitis is rarely observed in Henoch-Schönlein purpura children and has no specific clinical features that differentiate it from abdominal manifestations of Henoch-Schönlein purpura. Therefore, in Henoch-Schönlein purpura patients with severe abdominal pain, serum amylase levels should be assessed to confirm the diagnosis of acute pancreatitis. Early diagnose of Henoch-Schönlein purpura with acute pancreatitis and treatment timely was very important for good clinical outcomes.
Topics: Abdominal Pain; Acute Disease; Adolescent; Amylases; Child; Child, Preschool; Female; Glucocorticoids; Humans; IgA Vasculitis; Infant; Male; Melena; Methylprednisolone; Pancreatitis; Pulse Therapy, Drug; Retrospective Studies; Vomiting
PubMed: 29751784
DOI: 10.1186/s12887-018-1142-7 -
The Turkish Journal of Gastroenterology... Aug 2012Small bowel neoplasms are very uncommon, especially leiomyosarcoma of the small bowel. Therefore, there is often a delay before small bowel leiomyosarcoma is diagnosed... (Review)
Review
Small bowel neoplasms are very uncommon, especially leiomyosarcoma of the small bowel. Therefore, there is often a delay before small bowel leiomyosarcoma is diagnosed and treatment is started. A 60-year-old Caucasian male was admitted to our hospital with progressive melena. Gastroscopy and colonoscopy did not reveal the cause of the melena, but magnetic resonance imaging showed a jejunal tumor. After laparoscopic resection, the tumor appeared to be a grade 2 leiomyosarcoma. Small bowel neoplasms can be accurately detected by magnetic resonance enterography or wireless capsule endoscopy. Treatment almost always consists of resection of the primary tumor and its metastases. The role of chemo- and radiotherapy is not yet clear and prognosis remains very poor, with low five-year survival rates.
Topics: Anemia; Humans; Jejunal Neoplasms; Leiomyosarcoma; Magnetic Resonance Imaging; Male; Melena; Middle Aged; Prognosis
PubMed: 22965511
DOI: 10.4318/tjg.2012.0406 -
BMC Urology Jun 2023Pure testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumor extremely poor prognostic with the tendency to bleed at the metastatic site. At the...
BACKGROUND
Pure testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumor extremely poor prognostic with the tendency to bleed at the metastatic site. At the time of the diagnosis, 70% of patients have metastatic lesions. Depending on the site of the metastasis, symptoms vary. Gastrointestinal involvement is seen in less than 5% of cases, mostly in the duodenum.
CASE PRESENTATION
We present a 47 years old male with testicular choriocarcinoma involving the jejunum, lung, liver, and kidney presenting with acute abdominal pain, melena, and dyspnea with some paraneoplastic symptoms. The patient had increased, severe and constant pain in the right lower quadrant for the previous four days. Additionally, he was complaining of nausea, vomiting, anorexia, and a history of melena for the last 10 days. Dyspnea on exertion, hemoptysis, and dry cough were the symptoms he was suffering from, for almost one year. The patient's general appearance was pale, ill, and thin with 10 kg of weight loss during the last some months. The computed tomography (CT) scan reported multiple metastatic lesions in both liver lobes and the left kidney. Pathologic study of the samples of small bowel lesions showed metastatic choriocarcinoma. Following the patient had been referred to an oncologist to start the chemotherapy regime. Finally, the patient has expired after 40 days of his first admission.
CONCLUSIONS
Testicular choriocarcinoma is a rare but fatal malignancy among young men. Gastrointestinal metastases are infrequent involvement represented by melena and acute abdominal pain, obstruction, and mass. Physicians should consider it as a differential diagnosis for acute abdomen and gastrointestinal bleeding causation.
Topics: Female; Humans; Male; Middle Aged; Melena; Testicular Neoplasms; Choriocarcinoma; Gastrointestinal Neoplasms; Abdominal Pain
PubMed: 37270552
DOI: 10.1186/s12894-023-01271-0 -
Medicine Jan 2019Considering the low incidence of colorectal follicular lymphoma (FL) and its clinical features in endoscopic views, only a few studies have described the pathological...
RATIONALE
Considering the low incidence of colorectal follicular lymphoma (FL) and its clinical features in endoscopic views, only a few studies have described the pathological diagnosis and treatment of this disease. This study aimed to reveal the overall process of clinical diagnosis and treatment of colorectal FL by conducting a case review.
PATIENT CONCERNS
A 27-year-old female presented to our department because of "severe bloody stool" lasting for more than 1 month. Her primary symptom was melena. Colonoscopy revealed widespread flat polyps with various immunophenotypes (CD10+, BCL2+, BCL6+, cyclin D1-, CD5-) in the colorectal area.
DIAGNOSIS
In accordance with manifestations on positron emission tomography-computed tomography (PET/CT), the patient was diagnosed with stage IV colorectal FL.
INTERVENTIONS
PET/CT reexamination after 2 courses of rituximab, cyclophosphamide, liposomal doxorubicin, vincristine sulfate, and hydroprednisone (R-CHOP) regimen and 3 courses of R-CHOP plus etoposide regimen for chemotherapy indicated a significant reduction in tumor burden. Subsequently, rituximab was administered alone in 2 treatment courses.
OUTCOMES
Lesions on PET/CT disappeared after reexamination. No recurrence was observed within the 12-month follow-up period.
LESSONS
Colorectal FL is a rare disease with an inert clinical course and is common in the ileocecal area. Endoscopic views show multiple polyps. Interventional treatment is usually provided after observation of clinical symptoms or during disease progression. The disease has a relatively good prognosis.
Topics: Adult; Aftercare; Antineoplastic Agents, Immunological; Antineoplastic Combined Chemotherapy Protocols; Colonoscopy; Colorectal Neoplasms; Female; Humans; Lymphoma, Follicular; Melena; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Rare Diseases; Rituximab; Treatment Outcome
PubMed: 30653103
DOI: 10.1097/MD.0000000000013985