Successful endoscopic resection of an unusually enlarged and pedunculated type I gastric carcinoid tumour

Three distinct gastric carcinoid (GC) tumour types have been described based on differing biological behaviour and prognoses. Type I GC tumours account for the vast majority (70%–80%), are associated with chronic atrophic gastritis and have a low metastatic potential. Type II carcinoid tumours are the least common (5%–10%), are related to Zollinger-Ellison syndrome and occur in relation to multiple neoplasia type I. Sporadic type III tumours (15%–25%) are the most aggressive type, are unrelated to gastrin over secretion and carry the worst prognosis. In this case report, we present a patient with longstanding gastroesophageal reflux disease (GERD) who presented with epigastric abdominal pain and tarry stools and was found to have a large gastric polyp on endoscopy. Despite current literature recommending surgical resection for larger GC tumours, endoscopic resection was successfully used to excise the tumour with pathology demonstrating complete resection with negative margins.

Aggressive primary gastric lymphoma (PGL) masquerading as hepatocellular cancer (HCC) in alcoholic cirrhosis

Background The gastrointestinal tract is sa well-known site for extranodal Non-Hodgkin lymphomas, with the stomach is known to be the most common site on lymphoma, primary gastric lymphoma (PGL). The lymphoproliferative disorder rarely occurs in patients with cirrhosis. We report a unique case of metastatic PGL in a patient with cirrhosis. Case presentation A middle-aged male with decompensated alcoholic cirrhosis presented with two weeks of epigastric abdominal pain, abdominal distension, and jaundice. Abdominal triple-phase CT scan was consistent with cirrhosis, ascites, and multiple new hypodense liver lesions classified as an intermediate probability for HCC based on the LI-RADS classification system (LI RADS 3). Due to the CT findings in the setting of cirrhosis, a provisional diagnosis of HCC was made. Upper endoscopy revealed new multiple umbilicated submucosal nodules in the gastric body. Biopsy and immunostaining consistent with high-grade B-cell lymphoma. Targeted liver biopsy with similar morphology and immunostaining profile consistent with metastatic primary gastric DLBCL. Conclusions The case highlights the importance of recognizing metastatic PGL in patients with underlying cirrhosis to differentiate lymphoma from hepatocellular cancer. Targeted liver biopsies with lymphoma immunostaining are required to make a diagnosis.

Biliary type-II sphincter of Oddi dysfunction with a pancreatic duct dilation: a case report and review of the literature

Background The double-duct sign is defined as dilation of both the common bile duct and pancreatic duct, which usually indicates pancreatic malignancy. However, benign causes have also been reported to cause a double-duct sign. Case presentation We present the case of a 59-year-old Caucasian female patient admitted to the Gastroenterology Department with intermittent right epigastric abdominal pain and an intact gallbladder. A double-duct sign was seen on endoscopic ultrasound. The suspicion of pancreatic malignancy was excluded through follow-up investigations. Biliary type II sphincter of Oddi dysfunction was diagnosed with an association of the double-duct sign. Sphincterotomy was performed to reduce pain, and there was no recurrence of symptoms during follow-up. Conclusions This is the third reported case in the literature of the double-duct sign associated with sphincter of Oddi dysfunction. This case emphasizes that the double-duct sign is not always caused by a local malignancy. The literature review of the reported cases has been summarized to help in the diagnosis of future similar cases.

Wilkie's syndrome in an adolescent female patient

<p>One of the rare cases of the upper gastrointestinal tract obstruction is superior mesenteric artery syndrome (SMAS) but potentially life-threatening if not recognized early. It is due to loss of fat pad between the aorta and SMA which will lead to a compression of the third portion of the duodenum. It has a different angle which will lead to different presentations as well as severity. We are reporting the 15 year-old (y/o) female who is medically free, presented to the emergency department (ED) complaining of severe colicky epigastric abdominal pain for the last 5 days in the epigastric area. The diagnosis of SMAS was made after clinical and radiological investigation. After proper supportive resuscitative measures, definitive management of the surgery was done by laparoscopic approach (duodenojejunostomy). The diagnosis of SMA syndrome is considered challenging due to many presentations and might be confused with other clinical conditions. Unless early diagnosed and treated, the outcome might be catastrophic. Medical treatment is attempted first in many cases depending on the severity and presentation but if failed, surgery will be the best option.</p>

Laparoscopic management of an ascending colon hernia through the foramen of Winslow

Herniation through the foramen of Winslow is rare, with a non-specific clinical presentation and his diagnosis may be difficult. A 44-year-old female was admitted with an acute epigastric abdominal pain. A computed tomography showed an internal hernia of the colon in the lesser sac. Laparoscopic reduction of the herniated contents and the fixation of the ascending colon with several non-absorbable sutures were performed. Twenty months after surgery, the patient has not experienced any recurrence. Computed tomography helps practitioners to the preoperative diagnosis of herniation through the foramen of Winslow, to the viability of the herniated contents and presence of occlusion. In case of herniation through the foramen of Winslow favored by a mobile ascending colon with a misapposition of the right Told fascia, the fixation of the colon with a non-absorbable suture was safe and may prevent the risk of recurrent internal hernia and colonic volvulus.

Giant Uterine Leiomyoma in a Young Woman as an Accidental Finding Due to an Ultrasound for Digestive Symptoms Caused by Acute Exacerbation of Chronic Gastritis – A Case Report

Uterine leiomyoma is the most common benign tumour encountered in female genital pathology. It originates from the level of the smooth muscle tissue, and from the morphological point of view, the tumour is well delimited, being surrounded by a pseudocapsule. We report a case of a 46-year old woman who, following a CT scan performed for epigastric abdominal pain and nausea, showed a dense bulky tumour formation, with multiple hyperdense inclusions inside and well-defined areas of necrosis, with maximum axial diameters of 133/168/249 mm (LL / AP / CC), having as a starting point most likely the uterine upper pole. A total hysterectomy is performed, with bilateral anexectomy, and the histopathological examination describes a giant subserosal leiomyofibroma of the uterus with signs of hyaline degeneration, left hydrosalpinx with strong stasis of the left tube, follicular hemorrhagic cysts of the left ovary.

Untreated Takayasu arteritis: an unusual case of widespread disease

A 38-year-old man with no medical history presented with bilateral flank and epigastric abdominal pain. CT abdomen and pelvis demonstrated diffuse nodules and lymphadenopathy, which were biopsied and showed chronic inflammatory changes. He later presented with pleuritic chest pain and was sent for a CT chest angiogram, which revealed perivascular inflammation involving the thoracic aortic arch, supra-aortic branch vessels and descending thoracic aorta. Further work-up showed vasculitic involvement of the coeliac, superior mesenteric and femoral arteries with heavy collateralisation. These findings were most consistent with widespread Takayasu arteritis that had been untreated for nearly 20 years. It was necessary to define the degree of active inflammation and need for immediate therapy, as the patient had a concomitant latent tuberculosis infection that precluded the use of immunosuppressive medications. This report illustrates an unusual case of Takayasu arteritis and highlights the presentation, diagnosis and work-up of suspected cases.

Pancreatitis aguda asociada a infección por parotiditis (papera). Informe de un caso

Mumps are a preventable disease by vaccination, caused by a Paramyxovirus. Even though we are in the vaccination era, different phenomena as the migratory movements, are generating a new rebound of this highly transmissible viral infection. We present a female with a severe epigastric abdominal pain and elevation of alpha-amylase and triacylglycerol lipase in blood analysis, after 48 hours of mumps infection. After the exclusion of more frequent causes, the patient was diagnosed with acute pancreatitis related to mumps. This case shows that, despite it is a rare cause, acute pancreatitis should be considered in patients with mumps who present acute abdominal pain. An early diagnosis and an appropriate treatment are necessary to prevent and minimise morbi-mortality related to acute pancreatitis.

Gallbladder torsion: A case report

Volvulus of the gallbladder or gallbladder torsion (GT), is a condition in which an organ twists along its long axis leading to the vascular source compromise. The GT was first diagnosed in 1898 as a rare cause of idiopathic cholecystitis. Some 500 cases have been reported ever since, and they account for 0.1% in acute cholecystitis cases. An 85-year-old male patient presented with epigastric abdominal pain that was referred to as the upper abdominal quadrant (UAQ). The pain did not radiate elsewhere but was constant and severe. Moreover, it did not change with eating; nonetheless, the patient had anorexia, nausea, and biliary vomiting that occur two times. Fever and chills, weight loss, and icterus were not observed. According to the ultrasound report, flat cholecystitiswas diagnosed, and the patient underwent cholecystectomy. During the operation, GT was confirmed. Diagnosis of GT in elderly patients without symptoms of acute abdomen and cholecystitis should be considered in differential diagnosis to prevent complications and mortality.