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Retroperitoneal Fibrosis With Skeletal Muscle Invasion as an Early Manifestation of Metastatic Gastric Cancer
Shetty, Naman S. MBBS1; Calhoun, Avery MD2; Sunjaya, Dharma MD3; Greer, Ashley MD4; Willingham, Field F. MD, MPH3
doi : 10.14309/crj.0000000000000553
April 2021 - Volume 8 - Issue 4 - p e00553
A Simple Hemorrhagic Hepatic Cyst: Warfarin Mediated
Natarajan, Piruthiviraj MD1; Thangarasu, Sudhagar MD, FACP1; Kunam, Vamsi Krishna MD2; Loganathan, Priyadarshini MD1; Ganesh, Swaytha Ramaraj MD3; Gajendran, Mahesh MD, MPH, FACP1
doi : 10.14309/crj.0000000000000567
April 2021 - Volume 8 - Issue 4 - p e00567
An Anomalous Cause of Portal Hypertension
Brown, Sara A. MD1; Trinh, Vincent Q. MD, FRCPC, MSc2; Healan, Steven MD, MSCI3; Bichell, David MD4; Frischhertz, Benjamin MD3; Scanga, Andrew MD1
doi : 10.14309/crj.0000000000000552
April 2021 - Volume 8 - Issue 4 - p e00552
Portal hypertension is a syndrome marked by an increase in the pressure of the portal vein. Portal hypertension can be diagnosed clinically or if the measurement of the hepatic venous pressure gradient is greater than 5 mm Hg. Cirrhosis is the most common etiology in Western countries, but there are other causes which lead to presinusoidal portal hypertension. We present a patient with a rare cause of portal hypertension.
Thyroid Disease–Induced Hepatic Dysfunction: A Clinical Puzzle
Anugwom, Chimaobi M. MD1; Leventhal, Thomas M. MD1
doi : 10.14309/crj.0000000000000555
April 2021 - Volume 8 - Issue 4 - p e00555
The diagnostic evaluation of an individual with clinical and laboratory evidence of thyroid dysfunction in the setting of acute liver injury is crucial. There is a complex relationship between the thyroid and the liver, and so, it requires a careful elucidation of the inciting disease process before instituting a treatment plan. We discuss a patient who had presented with coagulopathy, encephalopathy, and laboratory evidence of acute liver injury, hence adjudged to have developed drug-induced acute liver failure and transferred for liver transplant evaluation. She was found to have liver dysfunction from uncontrolled thyroid disease, with immediate and rapid improvement after controlling severe hyperthyroidism.
A Diagnostic Quagmire: PFIC5 Presenting as a Rare Cause of Neonatal Cholestasis
Giang, Sophia MD1; Gordon, Ruth Lillian BA2; Haas, Kelly B. MD3
doi : 10.14309/crj.0000000000000558
April 2021 - Volume 8 - Issue 4 - p e00558
Progressive familial intrahepatic cholestasis is a heterogeneous group of autosomal recessive disorders defined by defects in bile excretion and transport. We describe a 6-week-old boy from Micronesia presenting with failure to thrive and jaundice. His diagnostic workup was remarkable for direct hyperbilirubinemia, hepatitis, and hepatic ultrasound with possible portosystemic shunting. The presence of toxoplasma IgG initially raised concern for congenital toxoplasmosis. Ultimately, the absence of bile salt export pump staining on liver histology and subsequent genetic studies confirmed a diagnosis of progressive familial intrahepatic cholestasis type 5, an exceedingly rare cause of neonatal cholestasis.
Acute-Onset Eosinophilic Gastroenteritis and Ascites Secondary to Occult Toxocariasis
Elton, Andrew BS1; Megna, Bryant MD2; Boothby, Aaron MD2; Vaughn, Byron MD2,3
doi : 10.14309/crj.0000000000000556
April 2021 - Volume 8 - Issue 4 - p e00556
Eosinophilic gastroenteritis is a rare entity, and although usually idiopathic, it may arise from gastrointestinal infections. We report a case of a 33-year-old woman from Vietnam presenting with acute abdominal pain, new-onset eosinophilic ascites, peripheral eosinophilia, and a positive Toxocara antibody. The patient had no recent international travel, known animal host contact, or other toxocariasis risk factors. She was treated with ivermectin and mebendazole with complete resolution of symptoms. This case emphasizes the consideration of a broad differential for eosinophilic ascites, including atypical presentations of infectious pathogens.
Dysdiadochokinesia, Ataxia, and Anemia: A Sign of Intraluminal Malignant Mesothelioma?
Rozner, Raquel MD1; Shah, Shawn L. MD1; Chiu, Kenrry MDCM2; Crawford, Carl V. MD1
doi : 10.14309/crj.0000000000000560
April 2021 - Volume 8 - Issue 4 - p e00560
An 87-year-old man presented with altered mental status and ataxia was found to have a neuron-restricted antibody in his cerebrospinal fluid, concerning for a paraneoplastic syndrome of unknown origin. He also exhibited anemia, but otherwise normal electrolytes and liver chemistries. He underwent positron emission tomography/computed tomography which revealed abdominal lymphenopathy. He then underwent push enteroscopy and was found to have a jejunal mass, biopsy proven to be malignant mesothelioma. Malignant mesothelioma is 4–5 times more prevalent in men than women. It is limited to the small bowel, and paraneoplastic syndromes are extremely rare and carry a poor prognosis. The presence of anemia with cerebellar symptoms should trigger a search for a paraneoplastic syndrome-related malignancy.
Incarcerated Colonoscope in a Left Inguinal Hernia During Diagnostic Colonoscopy
Torrealba, Mauricio MD1; Matlock, Robert MD2; Petrun, Branden MD3; Zera, Richard MS, MD, PhD3; Malli, Ahmad MD4
doi : 10.14309/crj.0000000000000564
April 2021 - Volume 8 - Issue 4 - p e00564
Colonoscope entrapment in an inguinal hernia is rare and few cases have been described in the literature. We present a 54-year-old patient who underwent a diagnostic colonoscopy which was complicated by incarceration of the colonoscope in a left inguinal hernia. This rare complication occurs more frequently during withdrawal, and our case was unique, given the incarceration of the colonoscope occurred during the insertion phase. Recognizing this scenario is very important to immediately proceed with general anesthesia and surgical consultation for successful nonoperative hernia reduction and colonoscope removal. We recommend reattempting colonoscopy after surgical hernia repair or proceed with computed tomography colonography if appropriate for the indication.
Successful Closure of the Tip of the “J” Fistula of the Ileal Pouch With Double Over-the-Scope Clips
Lescaille, Yaniuska MD, MPH1; Rosh, Joel R. MD2; Kiran, Ravi P. MD, MPH1; Shen, Bo MD, FACG1
doi : 10.14309/crj.0000000000000566
April 2021 - Volume 8 - Issue 4 - p e00566
Ileal pouch-anal anastomosis is the surgical procedure of choice for patients who require colectomy for complicated ulcerative colitis with or without associated dysplasia and familial adenomatous polyposis. Leaks from the suture lines or anastomosis can lead to pouch failure. Treatment options have been radiographic drainage and surgical intervention. Endoscopic therapy has emerged a viable nonsurgical treatment option for some of the complications associated with J-pouch surgery. Here, we present a case of endoscopic management of a leak from the tip of the J-pouch with sequential application of 2 over-the-scope clips.
Use of an Over-the-Scope Clip for Closure of an Iatrogenic Nephrocolic Fistula Resulting From Cryoablative Therapy for Renal Cell Cancer of a Transplanted Renal Graft
Nassani, Najib MD, MSc1; Villa, Edward MD1; Carroll, Robert E. MD1
doi : 10.14309/crj.0000000000000559
April 2021 - Volume 8 - Issue 4 - p e00559
Although uncommon, cryoablation of tumors can result in collateral damage to adjacent organs resulting in difficult-to-treat perforation and fistulization. Full-thickness closure of defects has been described with the use of over-the-scope clips. We describe the case of a 56-year-old woman who underwent cryoablation of renal cell carcinoma of her transplanted kidney that was complicated by cryoinjury to her sigmoid colon with subsequent nephrocolic fistula and abscess formation resistant to conservative treatment. We report a case of successful abscess drainage and use of over-the-scope clip for closure of an iatrogenic renal graft nephrocolic fistula.
Endoscopic Mucosectomy: A Novel Technique for Management of Polypoidal Solitary Rectal Ulcer Syndrome
Jha, Ashish Kumar MD, DM1; Purkayastha, Subham MD1; Dayal, Vishwa Mohan MD, DM1
doi : 10.14309/crj.0000000000000563
April 2021 - Volume 8 - Issue 4 - p e00563
Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder often challenging to treat. Surgical treatment is associated with suboptimal outcomes and postoperative complications. Argon plasma coagulation helps control rectal bleeding and healing of ulcers, but more extended follow-up data are not available. The macroscopic appearance of SRUS can be polypoid in 17%–25% of cases. Here, we describe a novel endoscopic technique for treating symptomatic patients with polypoidal variant of SRUS after failed medical and endoscopic argon plasma coagulation treatments.
A Rare Case of Dorsal Agenesis of Pancreas, Choledochal Cyst, and Hirschsprung Disease in a Young Patient
Chapa, Uday Kumar MS1; Dutta, Souradeep MS1; Remesh, Athul Minija MBBS1; Jain, Ankit MS1; Abhinaya, Reddy MS1; Nelamangala Ramakrishnaiah, Vishnu Prasad MCh1
doi : 10.14309/crj.0000000000000561
April 2021 - Volume 8 - Issue 4 - p e00561
Dorsal pancreatic agenesis is a rare congenital pancreatic malformation. There is just 1 reported case associating it with choledochal cyst. However, no cases have reported yet with both coexisting with Hirschsprung disease. We report a case of a 23-year-old man, presenting with on and off epigastric pain, sometimes radiating to the back. His medical records showed he had Hirschsprung disease as a neonate, for which he underwent Duhamel procedure. Ultrasound imaging revealed a choledochal cyst and a nonvisualized distal portion of the pancreas. Further cross-sectional imaging confirmed the findings—a type 1 choledochal cyst and a dorsal agenesis of the pancreas in a patient with Hirschsprung disease.
Sometimes You Have to Judge a Book by Its Cover: The Case of a Masquerading Pancreatic Mucinous Cyst
Miller, John Jr MD1; Agostini-Vulaj, Diana DO2; Howard, Victoria PA1; Schoeniger, Luke MD, PhD, FACS3; Kothari, Truptesh MD, MS, FACG, FASGE1
doi : 10.14309/crj.0000000000000554
April 2021 - Volume 8 - Issue 4 - p e00554
Pancreatic cystic lesions are difficult to evaluate amid acute pancreatitis. Without previous pancreatic imaging, it is challenging to discern between pancreatic acute fluid collections and cystic neoplasms. We present a 29-year-old woman with acute pancreatitis and initial cross-sectional imaging suggesting a 2.8-cm cystic lesion in the body/tail of the pancreas. Endoscopic ultrasound completed 5 weeks after index presentation revealed findings worrisome for a cystic neoplasm, but fine-needle aspiration findings suggested lesion to be a pseudocyst (normal carcinoembryonic antigen and cytology, negative mucin stain).
When Variants Collide: An Unusual Presentation of Metastatic Gastric Mixed Neuroendocrine-Non-Neuroendocrine Neoplasm
Deliwala, Smit S. MD1; Ponnapalli, Anoosha MD1; Gakhal, Inderdeep MD1; Modi, Viraj BS2; Haykal, Tarek MD3; Bachuwa, Ghassan MD, MS, MHSA, FACP, AGSF1; Chawla, Saurabh MD, FACG4
doi : 10.14309/crj.0000000000000569
April 2021 - Volume 8 - Issue 4 - p e00569
Gastrointestinal neuroendocrine neoplasms were recently reclassified into the 2019 World Health Organization schema into well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinomas, and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs). Among these, gastric MiNENs are exceedingly rare and often metastasize quickly without diagnostic clues. We present a refractory gastric MiNEN with unique presenting features. This case highlights the clinical spectrum of these tumors, the importance of accurate histochemical interpretation, and clinical management in the absence of formalized guidelines. Future therapies looking at novel targets and palliative symptom relief are needed.
Correction to: A Rare Presentation of Omental Lymphangioma Masquerading as Malignancy in an Adult Patient
Alameri, Aws MD; Museedi, Abdulrahman MD; Nashawi, Mouhamed BS; Ghali, Abdullah BS; Nathanson, Robert MD, FACP
doi : 10.14309/crj.0000000000000551
April 2021 - Volume 8 - Issue 4 - p e00551
