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Intracholecystic Papillary Neoplasm of the Gallbladder Preoperatively Diagnosed by Endoscopic Ultrasonography and Peroral Cholangioscopy
Kuniyoshi, Noriyuki MD1; Imazu, Hiroo MD, PhD1; Hayama, Jo MD1; Nomura, Shuzo MD1; Kagawa, Atsunori MD1; Hamana, Suguru MD1; Osawa, Rota MD1; Oki, Yoko MD1; Fujisawa, Mariko MD1; Aoki, Hiroshi MD1; Higaki, Tokio MD, PhD2; Takayama, Tadatoshi MD, PhD2; Ohni, Sumie MD, PhD3; Moriyama, Mitsuhiko MD, PhD1
doi : 10.14309/crj.0000000000000574
May 2021 - Volume 8 - Issue 5 - p e00574
The Masquerading Biliary Cystadenoma
Stenberg, Daniel DO1; Alkhero, Mohammed MD1; Jamal, Mazen M. MD2; Tran, Michael MD3
doi : 10.14309/crj.0000000000000596
May 2021 - Volume 8 - Issue 5 - p e00596
An Ingested Foreign Body Performing a Vanishing Act
Park, Brian MD1; Von Khan, Kiel MD2; Raval, Jaydeep DO2; Neubert, Zachary DO1; Fawley, Ryan MD1
doi : 10.14309/crj.0000000000000575
May 2021 - Volume 8 - Issue 5 - p e00575
Acute Esophageal Necrosis as a Cause of Pneumomediastinum in a Patient With Diabetic Ketoacidosis
Gavric, Aleksandar MD1,2; Plut, Samo MD1,2; Dezman, Rok MD3,4; Novak, Gregor MD, PhD1,4
doi : 10.14309/crj.0000000000000568
May 2021 - Volume 8 - Issue 5 - p e00568
Delayed Pneumoperitoneum After Peroral Endoscopic Myotomy
Podboy, Alexander MD1; Ashhab, Ashraf MD1; Lo, Simon K. MD1
doi : 10.14309/crj.0000000000000593
May 2021 - Volume 8 - Issue 5 - p e00593
Invasive Adenocarcinoma of the Proximal Third of the Esophagus Originating From Heterotopic Gastric Mucosa
Ruiz-Ballesteros, Eduardo Jaime MD1; Angulo-Molina, Diego MD1; Keil-Ríos, Daniel MD1; Ramirez-Escutia, Paola MD1; Posada-Torres, Jose Antonio MD2; Camacho-Limas, Christian Patricio MD3; Peláez-Luna, Mario César MD1; Soria-Céspedes, Danny MD4
doi : 10.14309/crj.0000000000000591
May 2021 - Volume 8 - Issue 5 - p e00591
Mycobacterium avium Complex Infection Imitating Whipple Disease in an Immunocompromised Patient With Newly Diagnosed Acquired Immunodeficiency Syndrome
Chirayath, Subin DO1; Bin Liaquat, Hammad MD2; Bahirwani, Janak MD1; Labeeb, Atef MD3; Chaput, Kimberly DO2; Kaza, Chatargy MD3
doi : 10.14309/crj.0000000000000588
May 2021 - Volume 8 - Issue 5 - p e00588
Signet Ring Cell Carcinoma of the Ampulla of Vater Presenting With Bone Marrow Carcinomatosis
Goodwin, Andrew MD1; Pak, Kevin MD1; Sanchez, John MD2; Laczek, Jeffrey MD3; Matulonis, Robert DO4
doi : 10.14309/crj.0000000000000592
May 2021 - Volume 8 - Issue 5 - p e00592
A Tale of Too Many Ulcers: Simultaneous Crohn's and Beh?et Overlap Syndrome
Elton, Andrew BS1; Megna, Bryant MD2; Vaughn, Byron MD2,3; Shaukat, Aasma MD MPH3,4
doi : 10.14309/crj.0000000000000589
May 2021 - Volume 8 - Issue 5 - p e00589
A Rare Case of the Jejunal Ectopic Pancreas Observed With an Endoscope
Yamauchi, Ryohei MD1; Yamada, Takuya MD, PhD1; Yamaguchi, Toshio MD1; Hiramatsu, Naoki MD, PhD1
doi : 10.14309/crj.0000000000000614
May 2021 - Volume 8 - Issue 5 - p e00614
Role of Tissue Plasminogen Activator in Loculated Ascites
Alkhero, Mohammed MD1; Patel, Anesh MD1; De Silva, Sadie MD1
doi : 10.14309/crj.0000000000000590
May 2021 - Volume 8 - Issue 5 - p e00590
Postsurgical Presentation of Zollinger–Ellison Syndrome After Resection of Endometrioid Neuroendocrine Tumor
Almuhaidb, Aymen MD1; Davidson, Nicholas O. MD, DSc1
doi : 10.14309/crj.0000000000000562
May 2021 - Volume 8 - Issue 5 - p e00562
Zollinger–Ellison syndrome is a functional neuroendocrine tumor with inappropriate gastrin secretion and hyperchlorhydria causing severe peptic ulcer disease and chronic diarrhea. Although 70% of primary gastrinomas occur in the region of the duodenum, the diagnosis and localization of gastrinomas can be challenging because of small lesions that may arise functionally as lymph node metastases at initial presentation. We report a 76-year-old woman presenting with Zollinger–Ellison syndrome several months after surgical resection of endometrioid small cell neuroendocrine carcinoma and endometrioid adenocarcinoma.
Management of a Gastrobronchial Fistula Presenting 5 Years After a One-Loop Gastric Bypass
Saber, Toufic MD, MS1; Backi, Saleem Abdel MD1; Aoun, Charbel MD1; Ghabi, Elie BS2; El Rassi, Ziad MD1
doi : 10.14309/crj.0000000000000570
May 2021 - Volume 8 - Issue 5 - p e00570
Anastomotic leaks and gastric fistulas are recognized complications after sleeve gastrectomy and Roux-en-Y gastric bypass. They are, however, almost unheard of following a one-anastomosis gastric bypass. A gastrobronchial fistula, an exceedingly rare complication after bariatric surgery, has to date never been described following a one-anastomosis gastric bypass. Furthermore, there is no consensus regarding the management of this challenging complication. In our case, we present a patient who was discovered to have a gastrobronchial fistula 5 years after a one anastomosis gastric bypass. After 2 failed attempts at endoscopic stent placement, the patient was successfully managed with a laparoscopic Roux-en-Y gastrojejunostomy over the fistula.
Gastrocolic Fistula Management in a Pregnant Patient
Qasim, Abdallah MD1; Buaisha, Haitam MD2; Abuhazeem, Bader MD1; Jenkins, Erin MD2
doi : 10.14309/crj.0000000000000602
May 2021 - Volume 8 - Issue 5 - p e00602
We present a case of a pregnant woman admitted for malnutrition secondary to a large gastrocolic fistula (GCF). She has a history of perforated duodenal ulcer that required surgical pyloroplasty 6 years ago. This fistula was diagnosed on the gastrointestinal barium series showing direct transit of barium from the stomach to the colon. An upper endoscopy showed a large gastrocolonic fistula with stool leaking to the stomach. Her nutrition was optimized, then she underwent surgical repair. GCF is suspected in the patient presenting with malnutrition with a history of intra-abdominal surgery.
Sarcomatoid Carcinoma Arising in a Gastric Duplication Cyst
Ahmed, Mohamed A. H. MBBCh, MSc, PhD, FRCPath1; Liyanaarachchi, Kanchana Sanjeewani MBBS, DPath, MD2; Preston, Shaun R. BSc (Hons), MBChB, MD, FRCS (Eng), FRCS (Gen)2; Hewish, Madeleine BSc, MBBS, FRCP, PhD3; Bagwan, Izhar N. MD, FRCPath1
doi : 10.14309/crj.0000000000000584
May 2021 - Volume 8 - Issue 5 - p e00584
Malignancy arising within a gastric duplication cyst (GDC) is extremely rare; only 15 cases have been reported in the literature. We present a 70-year-old woman who was referred with a history of vague postprandial abdominal discomfort. Subsequent imaging identified a gastric cystic mass. A laparoscopic sleeve gastrectomy of a 90 × 60 × 60-mm cystic mass was performed. Histopathological examination showed the presence of a sarcomatoid carcinoma arising within a GDC. The patient, unfortunately, died 5 months after surgery with metastatic disease. To the best of our knowledge, this is the first case of sarcomatoid carcinoma arising within a GDC.
Schistosoma japonicum Associated With Colorectal Cancer
Almoghrabi, Anas MD1; Mzaik, Obaie MD2; Attar, Bashar MD, PHD1
doi : 10.14309/crj.0000000000000572
May 2021 - Volume 8 - Issue 5 - p e00572
Colorectal cancer (CRC) is one of the most common cancers worldwide, with increasing prevalence in Asian countries with a crude incidence of 21.1 per 100,000. Schistosoma is a genus of trematodes that infect millions of humans, affecting multiple organs, notably the intestines, liver, and bladder. Those trematodes may cause chronic inflammation in the affected organ leading to long-term complications such as fibrosis and neoplasia. There is rising evidence that infection with Schistosoma japonicum is correlated with the liver and CRC in endemic Asian countries. It is reported that chronic infection with Schistosomiasis raises the risk of CRC by 3 times. Less commonly seen outside of endemic areas, we present a case of S. japonicum-associated CRC in the United States in a woman with sigmoid adenocarcinoma and Schistosoma japonicum infection.
Lower Gastrointestinal Bleeding Associated With Sodium Polystyrene Sulfonate Use
Dantas, Eduardo MD1; Coelho, Mariana MD1; Sequeira, Cristiana MD1; Santos, Inês MD1; Martins, Cláudio MD1; Cardoso, Cláudia MD1; Freire, Ricardo MD1; Oliveira, Ana Paula MD1
doi : 10.14309/crj.0000000000000585
May 2021 - Volume 8 - Issue 5 - p e00585
Sodium polystyrene sulfonate (kayexalate) is a cation-exchange resin widely used in the management of hyperkalemia. Gastrointestinal adverse events are uncommon; symptoms are nonspecific, and mucosal injury can range from mild ulceration to bowel perforation. An 81-year-old man was admitted because of decompensation of cirrhosis with acute kidney injury and hyperkalemia, treated with sodium polystyrene sulfonate. During admission, he presented multiple episodes of hematochezia, accompanied by tachycardia and hemoglobin drop. Colonoscopy revealed colonic ulceration, and histopathological findings were compatible with ulceration due to kayexalate injury. Despite rare, the widespread use of sodium polystyrene sulfonate puts a large population at risk of serious complications related to its use.
Basidiobolomycosis of Right Colon Mimicking as Carcinoma of Colon
VS, Vikram MBBS1; Hallur, Vinay MD2; Samal, Swagatika MD3; Chouhan, Mohd Imran MD4; Bhat, Sunil Jee MD4; Kumar, Pankaj MD1; Mishra, Tushar S. MS1
doi : 10.14309/crj.0000000000000573
May 2021 - Volume 8 - Issue 5 - p e00573
Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with limited geographic distribution. However, the incidence of GIB has shown an increasing trend because of globalization and frequent traveling. GIB is commonly seen to mimic gastrointestinal malignancy and other diseases such as intestinal tuberculosis and inflammatory bowel disease. Tissue diagnosis is considered to be the gold standard for differentiating these mycotic lesions from tuberculosis and malignancy with confirmation of species performed by culture or polymerase chain reaction. The diagnosis of GIB should be conjectured in patients with suspicion of malignancy, with an inconclusive biopsy. It seems prudent to proceed with radical excision of mass early because both colonic malignancy and GIB have high mortality if untreated.
Systemic Immunoglobulin Light Chain Amyloidosis Involving the Large Intestine
Swaminathan, Renugadevi MD, MPH1; Igbinedion, Samuel MD2; Pandit, Sudha MD2
doi : 10.14309/crj.0000000000000578
May 2021 - Volume 8 - Issue 5 - p e00578
Amyloidosis is characterized by extracellular tissue deposition of fibrils resulting in disruption of tissue structure and function. Gastrointestinal amyloidosis commonly results from chronic inflammatory disorders (amyloid A amyloidosis) and is less commonly seen in immunoglobulin light chain amyloidosis. We present a rare case of a 50-year-old man with a history of immunoglobulin light chain amyloidosis who presented with abdominal pain, blood in stool, diarrhea, and weight loss. Colonoscopy and biopsies revealed amyloid deposits in the colon. The patient subsequently was referred to colorectal surgery for evaluation of total colectomy with further plans for chemotherapy and subsequent hematopoietic cell transplantation.
Rare Variant Hirschsprung Disease Presenting as Large Bowel Obstruction in Adulthood: Hypoganglionosis in the Anorectal Canal
Lee, Roland Y. MD1; Li, Huili MD2; White, Rachel V. DO1; Shin, Benjamin J. MD3; Birkholz, James H. MD3
doi : 10.14309/crj.0000000000000610
May 2021 - Volume 8 - Issue 5 - p e00610
Hirschsprung disease (HD) is a congenital bowel innervation disorder characterized by the absence of ganglion cells in the neural plexus of the colorectal wall. Variant HD describes a heterogeneous group of intestinal innervation disorders in which clinical presentation resembles HD despite the presence of ganglion cells seen in rectal biopsies. We present the first reported case of a rare variant HD, hypoganglionosis isolated in the anorectal canal, diagnosed in an adult who presented with a long history of constipation and treated with proctosigmoidectomy with coloanal anastomosis. Histopathology showed rare ganglion cells isolated in the anorectal canal.
Chronic Intestinal Pseudo-Obstruction Due to Incidentally Found Thymoma
Castaneda, Daniel MD1; Miret, Rafael DO2; Rajagopalan, Rajaganesh MD2; Castillo, Michael MD2; Gonzalez, Adalberto MD1; Castro, Fernando MD1
doi : 10.14309/crj.0000000000000608
May 2021 - Volume 8 - Issue 5 - p e00608
Chronic intestinal pseudo-obstruction is a severe gastrointestinal tract disorder mimicking a bowel obstruction with no mechanical causes. Our patient presented with bowel obstruction symptoms, and a thymoma was incidentally found during the diagnostic workup. After failing conservative management, the patient underwent exploratory laparotomy that showed negative results for a mechanical cause of obstruction. Laboratory workup was suggestive of paraneoplastic syndrome, and the patient was started on steroids and pyridostigmine course with symptom resolution. Thus, in patients with chronic intestinal pseudo-obstruction, paraneoplastic syndrome should be considered in the differential diagnosis.
Microbiome Responses to Vancomycin Treatment in a Child With Primary Sclerosing Cholangitis and Ulcerative Colitis
Britto, Savini Lanka MD1; Hoffman, Kristi Louise PhD, MPH2; Tessier, Mary Elizabeth MD1; Petrosino, Joseph PhD2; Miloh, Tamir MD1; Kellermayer, Richard MD, PhD1,3
doi : 10.14309/crj.0000000000000577
May 2021 - Volume 8 - Issue 5 - p e00577
The therapeutic effects of off-label oral vancomycin in pediatric and adult primary sclerosing cholangitis (PSC)-inflammatory bowel disease, more commonly PSC-ulcerative colitis (UC), indicate the translational relevance of disease-associated microbiome findings. This is the first report on longitudinal salivary and fecal microbiome changes in a pediatric PSC-UC patient over the first 90 days of vancomycin therapy. Increase in bacterial diversity and abundance changes in Fusobacterium, Haemophilus, and Neisseria were observed. Our findings highlight the importance of longitudinal microbiome sampling in PSC-UC and serve as a nidus for larger-scale observations toward advancing microbial therapeutics for PSC.
Acute Kidney Injury Presenting as Hepatorenal Syndrome in the Setting of Glecaprevir/Pibrentasvir Treatment for Hepatitis C
Fansiwala, Kush BA1,*; Saltiel, Jason MD1,*; Poles, Michael MD, PhD1
doi : 10.14309/crj.0000000000000587
May 2021 - Volume 8 - Issue 5 - p e00587
A 65-year-old man with chronic hepatitis C virus and hepatocellular carcinoma, after surgical resection and chemotherapy, was started on a regimen of glecaprevir and pibrentasavir for treatment of his hepatitis C virus. Ten days later, he developed hepatotoxicity with subsequent progression to hepatorenal syndrome (HRS). On discontinuation of glecaprevir/pibrentasavir and initiation of HRS treatment, he had improvement in his renal and hepatic function. Although there have been recent safety concerns surrounding hepatocellular injury secondary to glecaprevir/pibrentasavir, this is the first case report of HRS secondary to severe hepatotoxicity induced by glecaprevir/pibrentasavir.
Hepatitis B Virus/Hepatitis D Virus–Coinfected Liver Transplant Candidate Receiving Hepatitis B Virus-Deoxyribonucleic Acid–Positive Allograft and Treated With High-Dose Hepatitis B Immune Globulin
Hammami, Muhammad Baraa MD1; Kohli, Ruhail MD1; Woreta, Tinsay MD, MPH1; Sulkowski, Mark S. MD2; Hamilton, James P. MD1; Toman, Lindsey PharmD3; Saberi, Behnam MD1; Laurin, Jacqueline MD1; Wang, Jacqueline Garonzik MD4; Philosophe, Benjamin MD, PhD4; Cameron, Andrew M. MD, PhD4; Gurakar, Ahmet MD1
doi : 10.14309/crj.0000000000000582
May 2021 - Volume 8 - Issue 5 - p e00582
Liver transplantation (LT) for patients with hepatitis D virus (HDV) and hepatitis B virus (HBV) coinfection is uncommon in the United States. Previous case reports described poor outcomes when hepatitis B surface antigen (HBsAg)-positive grafts are transplanted in HBV/HDV-coinfected recipients. However, LT from an HBsAg-negative/HBV-deoxyribonucleic acid–positive donor in an HBV/HDV-coinfected recipient has not been reported. We describe the clinical course and management of an HBV/HDV-coinfected recipient who had LT from an HBsAg-negative/HBV-deoxyribonucleic acid–positive deceased donor and was treated with high-dose hepatitis B immune globulin in combination with an oral tenofovir alafenamide.
A Case Series of Extrapulmonary Mycobacterium in Liver Transplant Recipients
Lamm, Kevin MD1; Jacobs, Carl MD2; Russo, Mark W. MD, MPH, FAASLD, FACG, AGAF1
doi : 10.14309/crj.0000000000000571
May 2021 - Volume 8 - Issue 5 - p e00571
Liver transplant recipients are at increased risk of infection because of the immunosuppression required after transplantation. Infection by Mycobacterium species increases the morbidity and mortality of liver transplant recipients. The prompt recognition and diagnosis of opportunistic infection is necessary for good outcomes, particularly during periods of increased immunosuppression. The balance of immunosuppressive therapies during prolonged treatment with hepatotoxic medications has not been well studied and should be tailored for the unique clinical setting of each patient. The goal of treatment in these patients is to eradicate the disease and preserve allograft function.
Infliximab-Induced Acute Liver Failure in a Patient With Crohn's Disease Requiring Orthotopic Liver Transplantation
Mustafa Alikhan, Muhammed MD1; Mansoor, Emad MD2; Satyavada, Sagarika MD2; Greer, Katarina MD2; Xin, Wei MD3; Cohen, Stanley MD2; Cooper, Gregory MD2; Katz, Jeffry MD2
doi : 10.14309/crj.0000000000000586
May 2021 - Volume 8 - Issue 5 - p e00586
Tumor necrosis factor-alpha inhibitors are not known to have significant liver toxicity; however, a few case reports state otherwise. We report the case of a 25-year-old man with Crohn's disease who was initiated on infliximab. The patient developed severe mixed hepatocellular and cholestatic liver injury that progressed into acute liver failure. Based on clinical history, laboratory findings, and histology, this was presumed because of the development of autoimmune hepatitis secondary to infliximab. He underwent liver transplantation. The mainstay of treatment in this rare condition involves steroid therapy and possible transplantation. Patients must then avoid anti–tumor necrosis factor-alpha therapy for life.
Hepatitis-Induced Porphyria: Are Direct-Acting Antiviral Agents the Way of the Future?
John, Jason J. BS1; Sterling, Richard K. MD, MSc2
doi : 10.14309/crj.0000000000000581
May 2021 - Volume 8 - Issue 5 - p e00581
Porphyria cutanea tarda (PCT) is the most common porphyria and has a strong association with hepatitis C virus (HCV) infection and iron overload. Previous HCV treatment regimens, including interferon with or without ribavirin, may precipitate PCT relapse. Few case reports have shown that newer oral therapies, such as direct-acting antiviral agents, can successfully treat PCT parallel with HCV treatment. We present a case of a patient with non–iron-associated mixed porphyria that dramatically improved with direct-acting antiviral agent therapy for his HCV supporting the association of porphyria with chronic HCV.
Reactivation of Hepatitis B After Ibalizumab Therapy for Multidrug-Resistant Human Immunodeficiency Virus
Kaplan, Alyson MD1; DeHaan, Elliott MD2; Maltz, Charles MD, PhD1
doi : 10.14309/crj.0000000000000594
May 2021 - Volume 8 - Issue 5 - p e00594
Despite the decreasing morbidity associated with the human immunodeficiency virus (HIV), a large percentage of persons with HIV have at least 1 drug resistance mutation. Ibalizumab, a recently approved drug, targets multidrug-resistant HIV. We present a case of reactivation of hepatitis B after initiation of ibalizumab therapy.
Solitary Metastasis of Hepatocellular Carcinoma to the Rectus Abdominis 13 Years After the Initial Treatment
Kato, Rei MD1; Sakamoto, Akio MD, PhD1; Noguchi, Takashi MD, PhD1; Matsuda, Shuichi MD, PhD1; Terajima, Hiroaki MD, PhD2
doi : 10.14309/crj.0000000000000607
May 2021 - Volume 8 - Issue 5 - p e00607
Solitary muscle metastasis of hepatocellular carcinoma (HCC) is extremely rare, and late metastasis is also rare. We present a 59-year-old man who had received initial treatment for HCC 13 years previously. Ultrasonography revealed a tumor between the abdominal wall and the liver surface. Tumor resection was performed with suspected intrahepatic metastasis or abdominal wall metastasis of HCC, and the tumor was found to be within the rectus abdominis without an association with the liver. Histologically, the resected material was confirmed to be a muscle metastasis of HCC. We discuss the management of muscle metastasis of HCC.
Life-Threatening Intraparenchymal Hemorrhage of Steroid-Induced Hepatic Adenomas in a Healthy Man
Nugent, Timothy S. MD1; Donlon, Noel MB, BCh, BAO1; Kelly, Michael MB, BCh, BAO1; Iqbal, Masood MD2; Murphy, Noelle MD3; Ryan, Mark MB, BCh, BAO, FRCR4; Maguire, Donal MB, MD, FRCSI1
doi : 10.14309/crj.0000000000000601
May 2021 - Volume 8 - Issue 5 - p e00601
Hepatocellular adenomas are uncommon benign epithelial tumors of the liver that are associated with several risk factors such as anabolic androgens and oral contraceptive pills. They may present as incidental findings, with abdominal pain or hemorrhage. This case report details the presentation and management of a life-threatening hepatocellular adenomas hemorrhage in a seemingly healthy 28-year-old man. After initial conservative management, a clinical deterioration prompted urgent reevaluation and successful embolization of the liver through transarterial embolization. As oral contraceptive pills use and anabolic steroid abuse have become more prevalent in recent decades, we may begin to see more of these presentations.
Dropped Gallstone-Related Right Subhepatic and Parietal Wall Abscess: A Rare Complication After Laparoscopic Cholecystectomy
Ray, Sukanta MS, MCh1; Kumar, Dilip MS1; Garai, Dibyendu MD2; Khamrui, Sujan MBBS, DGO1
doi : 10.14309/crj.0000000000000579
May 2021 - Volume 8 - Issue 5 - p e00579
Gallbladder perforation and stone spillage is a common intraoperative problem during laparoscopic cholecystectomy. Most of these stones are retrieved intraoperatively. The incidence of lost or unretrieved stones is approximately 2%, and very few patients may develop complication. Most common complication of dropped or spilled gallstones is abscess, particularly around the abdominal wall port sites and in the perihepatic space. We report a case of dropped stone-related right subhepatic and parietal wall abscess 39 months after laparoscopic cholecystectomy. The patient was treated successfully by operative drainage of the abscess along with complete removal of stones. The patient was asymptomatic at 6-month follow-up.
Endoscopic Ultrasound–Directed Transgastric Endoscopic Retrograde Cholangiopancreatography for Removal of Cystic Duct Coils: A Novel Application of an Emerging Technique
Parvataneni, Swetha MD1; Kumar, Vikas S. MD2; Khan, Yakub I. MD3; Deivert, Duane E. DO3; Obuch, Joshua MD3; Khara, Harshit S. MD, FACG, FASGE3
doi : 10.14309/crj.0000000000000576
May 2021 - Volume 8 - Issue 5 - p e00576
The altered anatomy of patients after Roux-en-Y gastric bypass (RYGB) surgery creates technical challenges for endoscopic and surgical treatment of gallstones. We present a unique case of a post-RYGB patient with complicated gallbladder surgery requiring coiling and embolization of the cystic duct for bile leak. The cystic duct coils migrated out into the bile duct forming a nidus for infection and biliary obstruction, which was resolved using the novel endoscopic ultrasound–directed transgastric routine endoscopic retrograde cholangiopancreatography technique, with successful transpapillary removal of cystic duct coils in RYGB anatomy.
An Uncommon Cause of Biliary Obstruction in a Patient With Budd-Chiari Syndrome
Mago, Sheena DO1; Mavilia, Marianna DO1; Swales, Colin Thomas MD2
doi : 10.14309/crj.0000000000000597
May 2021 - Volume 8 - Issue 5 - p e00597
Biliary varices (BVs) are an infrequent complication of chronic portal hypertension. Most cases of BVs are asymptomatic and are likely underdiagnosed. We present a case of a 34-year-old woman with Budd-Chiari syndrome who was found to have BVs caused by a significant inferior vena cava (IVC) stenosis. This case demonstrates that preprocedure imaging for variceal screening should be considered before biliary tract procedures to prevent complications.
Use of a Lumen-Apposing Metal Stent for Management of Pouch Outlet Stenosis After Vertical Banded Gastroplasty
Cundra, Lindsey B. MD1; Marcuard, Maurice MD2; Parekh, Parth J. MD, FACP3
doi : 10.14309/crj.0000000000000580
May 2021 - Volume 8 - Issue 5 - p e00580
Lumen-apposing metal stents (LAMSs) offer a novel alternative for the treatment of anastomotic strictures or short, benign gastrointestinal strictures. In the bariatric realm, LAMSs provide a potentially safer, efficacious, and nonsurgical approach to surgical revision. Here, we present a case where a LAMS was successfully used to manage pouch outlet stenosis from a previous vertical banded gastroplasty.
Colonic Histoplasmosis Presenting as Polyps in an Asymptomatic Patient With Liver Transplant
Cui, Min MD1; Wong, Richard C.K. MD2; Gholam, Pierre M. MD2
doi : 10.14309/crj.0000000000000598
May 2021 - Volume 8 - Issue 5 - p e00598
Infection of the gastrointestinal tract by Histoplasma capsulatum is generally considered to be a manifestation of disseminated disease. The most common symptoms from gastrointestinal histoplasmosis include abdominal pain and diarrhea. Isolated asymptomatic gastrointestinal histoplasmosis is unusual, and diagnosis can be challenging. We report a 57-year-old man with a history of liver transplant presented with numerous colonic polyps, and the biopsies demonstrated granulomatous colitis with fungal microorganism consistent with H. capsulatum. Antigen/antibody tests for Histoplasma were confirmatory. The patient was asymptomatic with no clinical or radiological evidence of pulmonary involvement. He responded well to itraconazole treatment, and urine antigen tested negative 6 months after the initiation of the treatment. Follow-up colonoscopy performed 12 months after treatment with itraconazole showed no evidence of colonic histoplasmosis.
TeleInGEstion Remote Video Capsule Endoscope
Sreenivasan, Aditya MD1; She, Tianyu BA2; Gross, Seth MD3; Storch, Ian MD4
doi : 10.14309/crj.0000000000000609
May 2021 - Volume 8 - Issue 5 - p e00609
We describe 2 cases in which video capsule endoscopy was performed remotely using TeleInGEstion Remote Video Capsule Endoscopy (TIGER VCE), given limited access to endoscopy during the COVID-19 pandemic. The patients ingested the CapsoCam capsule during a televisit, and the video was subsequently reviewed remotely by the physician. TIGER VCE was used to diagnose a benign etiology of melena and used to confirm a diagnosis of Crohn's disease before the initiation of biologic therapy. These cases demonstrate the safety and efficacy of TIGER VCE. We feel that this technique may be considered as a standard ingestion technique in the future.
Combining Cyclosporine With Ustekinumab in Acute Severe Ulcerative Colitis
Shaffer, Seth R. MD1; Traboulsi, Cindy MD1; Krugliak Cleveland, Noa MD1; Rubin, David T. MD1
doi : 10.14309/crj.0000000000000604
May 2021 - Volume 8 - Issue 5 - p e00604
We have demonstrated the effectiveness and safety of combining cyclosporine and vedolizumab to treat ulcerative colitis (UC). We present 2 cases of hospitalized acute severe UC who had failed therapy with antitumor necrosis factor and vedolizumab and were treated successfully with induction cyclosporine and safely bridged to ustekinumab maintenance therapy. Both patients have avoided colectomy. There were no adverse events. We propose this novel treatment combination in medically resistant acute severe UC.
Inflammatory Bowel Disease and Primary Sclerosing Cholangitis in a Pediatric Patient With Neurofibromatosis Type 1
Lehan, Emily MD1; Wang, Tao MD2; Soboleski, Don MD3; Acker, Amy MD1; Kehar, Mohit MD1,4
doi : 10.14309/crj.0000000000000605
May 2021 - Volume 8 - Issue 5 - p e00605
We describe a case of a 15-year-old adolescent boy with neurofibromatosis type 1 who presented with inflammatory bowel disease and primary sclerosing cholangitis. The literature available on the association of neurofibromatosis type 1 with inflammatory bowel disease is limited to 7 clinical case reports, and none had comorbid primary sclerosing cholangitis. We present a review of the published literature on this rare association and add the findings of our patient.
Cyclosporine-Induced Kaposi Sarcoma in a Patient With Ulcerative Colitis
Clarke, Lindsay M. MD1; Chawla, Karan MD2; Tabbara, Nadeem MD3; Szvarca, Daniel MD4; Stachura, Anna MD5; Theisen, Brian MD6; Chandler, Matthew MD2; Borum, Marie L. MD, EdD, MPH, MACP, FACG2
doi : 10.14309/crj.0000000000000600
May 2021 - Volume 8 - Issue 5 - p e00600
Kaposi sarcoma (KS) is an angioproliferative neoplasm associated with human herpesvirus-8. Gastrointestinal KS has been well documented in immunosuppressed solid organ transplant patients, with only 26 iatrogenic cases published in patients with inflammatory bowel disease. We report a 24-year-old patient with ulcerative colitis, maintained on cyclosporine for 2 years, who presented with watery, nonbloody diarrhea and weight loss. Colonoscopy revealed human herpesvirus-8-positive hemorrhagic nodules throughout the colon and terminal ileum, with diffuse lymphadenopathy on computed tomography consistent with KS. As gastrointestinal KS may present with symptoms that mimic inflammatory bowel disease, it is critical to maintain suspicion in patients on prolonged immunosuppression to reduce complications.
Inflammatory Bowel Disease: A Gastrointestinal Presentation of Congenital Plasminogen Deficiency
Balram, Bhairavi MD, FRCPC1; Thiesen, Aducio MD, PhD, MSc, FRCPC2; Kroeker, Karen I. MD, MSc, FRCPC1
doi : 10.14309/crj.0000000000000613
May 2021 - Volume 8 - Issue 5 - p e00613
Plasminogen deficiency (PD) is a rare autosomal recessive disease that results in the formation of fibrin-rich pseudomembranes, which impair wound-healing capacity. We report a 21-year-old man with congenital PD-associated inflammatory bowel disease. After an episode of Clostridioides difficile infection, he developed chronic diarrhea. Colonoscopy revealed moderate friability and erythema of the colon. Histology showed fibrin deposits in the lamina propria of the colonic mucosa with surrounding inflammation and focal ulceration. He was treated with infliximab and achieved clinical remission. To our knowledge, this is the first reported case of colonic involvement of PD.
Discordant Pathological and Endoscopic Diagnosis: Consider Floaters
Sapp, Abby R. DO1; Wander, Praneet MD1; Ali, Usman MD2; Gong, Yulan MD3; Milano, Reza V. MD, MPH4; Bartel, Michael J. MD, PhD1
doi : 10.14309/crj.0000000000000583
May 2021 - Volume 8 - Issue 5 - p e00583
A tissue floater or extraneous cross-contamination tissue on a microscopic slide is rare; however, it is a potential cause of diagnostic error. Occasionally, on collecting and processing of specimens, cross-contamination of tissue occurs leading to pathologic findings that are inconsistent with endoscopic findings. If the extraneous tissue is neoplastic, it can lead to a false-positive diagnosis. We present a case of discordant pathological and endoscopic diagnosis of invasive squamous carcinoma of the esophagus.
Natural Killer Cell Enteropathy With Extraintestinal Involvement: Presenting as Symptomatic Anemia
Panigrahi, Manas Kumar MD, DM1; Patra, Susama MD2; Kumar, Chandan MD1; Nayak, Hemanta Kumar MD, DM1; Ayyanar, Pavithra MD2; Bhat, Sunil Jee MD1; Chouhan, Mohd Imran MD1; Samal, Subash Chandra MD, DM1
doi : 10.14309/crj.0000000000000599
May 2021 - Volume 8 - Issue 5 - p e00599
Natural killer (NK) cell enteropathy is a newly described disease entity with benign behavior and an indolent clinical course, characterized by the atypical proliferation of NK cells throughout the gastrointestinal tract. The exact etiology is unknown. It closely mimics NK/T-cell lymphoma. We describe this atypical entity in a young adult man presenting with vague upper gastrointestinal symptoms and anemia requiring blood transfusion. The response to budesonide therapy points toward a possible low-grade autoimmune process. Considering the benign behavior and self-limiting course, recognizing this entity is essential to avoid over the investigation and aggressive, inappropriate therapy.
Recurrent Candida-Associated Esophageal Strictures in an Immunocompetent Patient
Narang, Natasha DO1; Pinillos, Hugo MD2,3; Amog-Jones, Glenda MD4,5; Gomez, Adam MD4,5; Alishahi, Yasmin MD2,3
doi : 10.14309/crj.0000000000000603
May 2021 - Volume 8 - Issue 5 - p e00603
Esophageal stricture due to Candida esophagitis is a rare complication reported among immunocompromised patients in only limited case reports. We describe a unique case of a 36-year-old man with chronic mucocutaneous candidiasis without underlying immunocompromise who experienced over 10 years of recurrent dysphagia due to esophageal strictures from candidiasis. His symptoms were initially believed to be due to eosinophilic esophagitis; however, numerous biopsies from the esophagus were negative for eosinophils. Several upper endoscopies, however, did reveal fungal elements consistent with Candida spp. He experienced recurring episodes of dysphagia and persistent esophageal stricture, requiring multiple antifungal courses and endoscopic balloon dilatations.
Advanced Endoscopy Training in the United States: An Advanced Fellow's Perspective
Mulki, Ramzi MD1
doi : 10.14309/crj.0000000000000612
May 2021 - Volume 8 - Issue 5 - p e00612
2020 PEER REVIEWER RECOGNITION
doi : 10.14309/crj.0000000000000565
May 2021 - Volume 8 - Issue 5 - p e00565
