Epigastric Pain Secondary to Accumulation of Extravasated Fluid in Pararenal and Perirenal Areas, in Shock Due to Dengue

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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Adenoid cystic carcinoma of the labium oris with rare metastasis to the pleural cavity

BMJ Case Reports ◽

10.1136/bcr-2020-237622 ◽

2021 ◽

Vol 14 (1) ◽

pp. e237622

Author(s):

Osama Mosalem ◽

Anas Alsara ◽

Fawzi Abu Rous ◽

Borys Hrinczenko

Keyword(s):

Side Effects ◽

Adenoid Cystic Carcinoma ◽

Pleural Cavity ◽

Epigastric Pain ◽

Asian Woman ◽

Upper Lip ◽

Adenoid Cystic ◽

History Of ◽

The Right

A 57-year-old Southeast Asian woman with a remote history of adenoid cystic carcinoma (ACC) of the right labium superius oris (upper lip) presented to the hospital with vague epigastric pain. On workup, she was found to have multiple pleural nodules. Histopathology confirmed the diagnosis of metastatic ACC. After 8 months of active surveillance, evidence of disease progression was found and the patient was started on pembrolizumab. Follow-up after starting pembrolizumab showed stable disease with no significant side effects.

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Unusual Tissue – Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction

Case Reports in Gastroenterology ◽

10.1159/000512427 ◽

2021 ◽

pp. 338-343

Author(s):

Thu L. Nguyen ◽

Shivani Kapur ◽

Stephen C. Schlack-Haerer ◽

Grzegorz T. Gurda ◽

Milan E. Folkers

Keyword(s):

Gastric Outlet Obstruction ◽

Epigastric Pain ◽

Outlet Obstruction ◽

Needle Aspiration ◽

Pancreatic Tissue ◽

Cystic Mass ◽

Pancreatic Heterotopia ◽

History Of

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

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De novo gastric cancer developing after liver transplantation from deceased donor for biliary atresia: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01210-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Naruki Higashidate ◽

Suguru Fukahori ◽

Shinji Ishii ◽

Nobuyuki Saikusa ◽

Naoki Hashizume ◽

...

Keyword(s):

Gastric Cancer ◽

Liver Transplantation ◽

Biliary Atresia ◽

De Novo ◽

Epigastric Pain ◽

Gastroesophageal Junction ◽

Deceased Donor ◽

Lymphoproliferative Disease ◽

Endoscopic Examination ◽

De Novo Malignancy

Abstract Background Apart from Kasai’s procedure, liver transplantation (LTx) has dramatically improved the outcome of children with biliary atresia (BA). However, de novo malignancy has been reported to be one of the major causes of late mortality after LTx among adults. We report a rare case of de novo gastric cancer developing after LTx for BA received during childhood. Case presentation A 21-year-old male patient who had undergone LTx for BA at age 2 years occasionally visited our outpatient clinic due to symptoms of epigastric pain and dysphagia. Endoscopic examination and computed tomography revealed advanced gastric cancer at the gastroesophageal junction with multiple liver metastases. Despite systemic chemotherapy, the disease progressed, resulting in patient’s death 2 years after the diagnosis. Conclusions De novo malignancy in the absence of post-transplant lymphoproliferative disease is rare in pediatric patients who received LTx. To the best of our knowledge, no report has been available on the development of gastric cancer after LTx for BA during childhood. Primary physicians should therefore establish a follow-up plan for patients receiving LTx for BA considering the potential for the development of de novo malignancy, including gastric cancer, despite its rarity.

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Laparoscopic treatment for celiac artery stenosis caused by median arcuate ligament compression with Adachi V type vascular anomaly: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01226-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hiroshi Saito ◽

Koichiro Sawada ◽

Jyunichi Ogawa ◽

Masashi Hashimoto ◽

Masahiro Oshima ◽

...

Keyword(s):

Epigastric Pain ◽

Vascular Anomaly ◽

Celiac Artery ◽

Artery Stenosis ◽

Laparoscopic Treatment ◽

Median Arcuate Ligament ◽

Case Presentation ◽

Arcuate Ligament ◽

Major Vascular Injury

Abstract Background Median arcuate ligament syndrome (MALS), which results from compression of the median arcuate ligament (MAL), is a rare cause of abdominal pain and weight loss. Treatment is dissection of the MAL; however, the laparoscopic procedure is not yet established and it involves the risk of major vascular injury, especially in cases with an anomaly. Case presentation A 47-year-old man was evaluated at the hospital for epigastric pain. Contrast computed tomography scan revealed stenosis of the celiac artery origin due to the MAL. An Adachi V type vascular anomaly was also observed. Laparoscopic treatment was performed to release pressure on the celiac artery. Laparoscopic ultrasonography was used to less invasively confirm the release of the MAL. Despite a concomitant Adachi V type vascular anomaly, surgery was safely performed using the laparoscopic magnification view and intraoperative ultrasonography. Follow-up ultrasonography confirmed the celiac artery stenosis has not recurred. Conclusions A rare case of MALS with an Adachi V type vascular anomaly is presented and the laparoscopic treatment is detailed.

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Immunohistochemical detection of procalcitonin in fibrolamellar hepatocellular carcinoma

Clinical Journal of Gastroenterology ◽

10.1007/s12328-021-01354-1 ◽

2021 ◽

Author(s):

Kotaro Matsumoto ◽

Kentaro Kikuchi ◽

Ayako Hara ◽

Hiromichi Tsunashima ◽

Koichi Tsuneyama ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Histopathological Examination ◽

Epigastric Pain ◽

Positive Staining ◽

C Reactive Protein ◽

Fibrolamellar Hepatocellular Carcinoma ◽

Tumor Biopsy ◽

Reactive Protein ◽

Right Lobe ◽

The Right

AbstractA 25-year-old woman with fever and epigastric pain was referred to our hospital. Blood examination showed significant liver dysfunction, markedly high C-reactive protein (CRP 19.1 mg/dL) and procalcitonin (48.3 ng/mL) levels. Dynamic computed tomography showed a tumor approximately 120 mm in size in the right lobe of the liver, but with no abscess formation. The patient was hospitalized and started on antibiotics; her CRP level improved, but the procalcitonin level did not decrease. Histopathological examination of the liver tumor biopsy revealed fibrolamellar hepatocellular carcinoma (FLC). Positive staining of the FLC with an anti-procalcitonin antibody suggested the production of procalcitonin.

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Eosinophilic Cholecystitis Associated with Eosinophilic Granulomatosis with Polyangiitis

Case Reports in Gastroenterology ◽

10.1159/000511863 ◽

2020 ◽

Vol 14 (3) ◽

pp. 668-674

Author(s):

Hiroyuki Ito ◽

Yusuke Mishima ◽

Tsubomi Cho ◽

Naoki Ogiwara ◽

Yoshimasa Shinma ◽

...

Keyword(s):

Cerebral Hemorrhage ◽

Granulomatosis With Polyangiitis ◽

Epigastric Pain ◽

White Blood Cells ◽

Gallbladder Wall ◽

Antineutrophil Cytoplasmic Antibodies ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Test Results ◽

Laboratory Investigations ◽

Eosinophilic Granulomatosis

We report a case of eosinophilic cholecystitis associated with eosinophilic granulomatosis with polyangiitis (EGPA) complicated by cerebral hemorrhage. A 60-year-old man presented to a local hospital with a diagnosis of acute cholecystitis, with persistent fever and epigastric pain for 2 weeks. His symptoms persisted despite 3-week hospitalization; therefore, he was transferred to our hospital for further evaluation. Laboratory investigations upon admission showed white blood cells 26,300/µL and significant eosinophilia (eosinophils 61%). Abdominal computed tomography revealed no gallbladder enlargement but a circumferentially edematous gallbladder wall. Additional blood test results were negative for antineutrophil cytoplasmic and perinuclear antineutrophil cytoplasmic antibodies; however, immunoglobulin (Ig)G and IgE levels were high at 1,953 mg/dL and 3,040/IU/mL, respectively. He improved following endoscopic transnasal gallbladder drainage for cholecystitis and was diagnosed with EGPA and received corticosteroid and immunosuppressant combination therapy. The eosinophil count decreased immediately after treatment, and abdominal pain and numbness resolved. He returned with left-sided suboccipital hemorrhage likely attributed to EGPA 6 months after discharge. EGPA is characterized by inflammation of small blood vessels and clinically manifests with an allergic presentation of bronchial asthma, as well as renal dysfunction, interstitial pneumonia, enteritis, and cerebral hemorrhage. Few reports have described cholecystitis as a presenting symptom of EGPA. We report a rare case of such a presentation with added considerations.

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Diagnostic utility of alarm features in predicting malignancy in patients with dyspeptic symptoms

Indian Journal of Gastroenterology ◽

10.1007/s12664-021-01155-x ◽

2021 ◽

Author(s):

Anurag Shetty ◽

Girisha Balaraju ◽

Shiran Shetty ◽

Cannanore Ganesh Pai

Keyword(s):

Weight Loss ◽

Epigastric Pain ◽

Characteristic Curve ◽

Abdominal Mass ◽

Screening Tools ◽

Disease Epidemiology ◽

Dyspeptic Symptoms ◽

Malignant Lesions ◽

Alarm Features ◽

Gastric Malignancy

Abstract Background Clinical features are of modest benefit in determining the etiology of dyspepsia. Dyspeptic patients with alarm features are suspected to have malignancy; but the proportions of patients and true cutoff values of various quantitative parameters in predicting malignancy are explored to a lesser extent. Methods This is a prospective observational study of consecutive patients undergoing esophagogastroduodenoscopy (EGD) for dyspeptic symptoms. Patients’ alarm features and clinical details were recorded in a predesigned questionnaire. The diagnostic accuracy of alarm features in predicting malignancy was studied. Results Nine hundred patients, 678 (75.3%) males, with a mean (standard deviation [SD]) age of 44.6 (13.54) years were enrolled. Commonest indication for EGD was epigastric pain in 614 (68.2%) patients. Dyspepsia was functional in 311 (34.6%) patients. EGD revealed benign lesions in 340 (37.8%) and malignancy in 50 (5.5%) patients. Among the malignant lesions, gastric malignancy was present in 28 (56%) and esophageal malignancy in 20 (40%) patients. Alarm features were present in 206 (22.9%), out of which malignant lesions were seen in 46 (22.3%) patients. Altogether, the alarm features had a sensitivity of 92% and specificity of 81.2% for predicting malignancy. The sensitivity and specificity for weight loss were 76% and 90.8%, while that of abdominal mass were 10% and 99.9% respectively. Based on receiver operating characteristic curve, the optimal age for screening of malignancy was 46.5 years in this population. Conclusions Patients of age group 40 to 49 years with dyspeptic alarm symptoms (predominant weight loss) need prompt endoscopy to screen for malignancy. The alarm features are inexpensive screening tools, found to be useful in India, and should be utilized in countries with similar healthcare conditions and disease epidemiology.

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Utility of endoscopic transpapillary pancreatic cyst drainage for intraductal papillary mucinous neoplasm infection

BMJ Case Reports ◽

10.1136/bcr-2021-242583 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242583

Author(s):

Shunsuke Watanabe ◽

Masao Toki ◽

Junji Shibahara ◽

Tadakazu Hisamatsu

Keyword(s):

Intraductal Papillary Mucinous Neoplasm ◽

Cyst Wall ◽

Pancreatic Cyst ◽

Epigastric Pain ◽

Drainage Tube ◽

Endoscopic Drainage ◽

Endoscopic Retrograde Pancreatography ◽

Endoscopic Retrograde ◽

Mucinous Neoplasm ◽

Route Of Infection

A 61-year-old woman with intraductal papillary mucinous neoplasm (IPMN) infection, who was treated with antibiotics, developed IPMN reinfection with febrile epigastric pain and was febrile. CT showed that the diameter of the IPMN had grown and hardened, with thickening of the cyst wall. Endoscopic retrograde pancreatography was then performed and a nasopancreatic cyst drainage tube was placed into the cyst. Symptoms and inflammatory findings improved considerably 17 days after endoscopic drainage. Few reports and evidence have been found regarding IPMN infections, and the frequency of onset, route of infection and optimal drainage method remain unknown. This study indicated that endoscopic transpapillary pancreatic cyst drainage was effective and is highly recommended for IPMN infection.

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Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively

BMJ Case Reports ◽

10.1136/bcr-2020-237842 ◽

2021 ◽

Vol 14 (1) ◽

pp. e237842

Author(s):

Arun Ahluwalia ◽

Matthew George Roy Allaway ◽

Serena Giga ◽

Richard James Curran

Keyword(s):

Acute Cholecystitis ◽

Inflammatory Markers ◽

Epigastric Pain ◽

Vital Signs ◽

Rare Condition ◽

Liver Function Tests ◽

Uneventful Recovery ◽

Imaging Characteristics ◽

Gallbladder Torsion ◽

Torsion Of The Gallbladder

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.

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