1
|
Mirmoosavi S, Salehi M, Fatahi R, Arero AG, Kamali Sarvestani H, Azmoudeh-Ardalan F, Salahshour F, Safaei M, Ghaderkhani S, Alborzi Avanaki F. Gastrointestinal basidiobolomycosis - A rare fungal infection: Challenging to diagnose yet treatable - Case report and literature review. IDCases 2023; 32:e01802. [PMID: 37250379 PMCID: PMC10220263 DOI: 10.1016/j.idcr.2023.e01802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
Gastrointestinal Basidiobolomycosis is a rare manifestation of Basidiobolus ranarum infection. In this report, we present two cases of gastrointestinal Basidiobolomycosis. The first patient presented with obstructive symptoms, fever, and weight loss. The diagnosis of Basidiobolomycosis was not made until after surgery, when Liposomal amphotericin-B combined with itraconazole were administered, leading to the resolution of laboratory markers of inflammation and patient's symptoms. The second case involves a young woman who presented with hematochezia, perianal induration, and abdominal pain. The patient had previously been diagnosed with Crohn's disease and treated accordingly, but her symptoms did not improve. Due to the endemicity of tuberculosis in Iran, the patient was treated for TB but still showed no improvement. However, a perianal biopsy sample revealed the Splendore Hoeppli phenomenon and fungal elements in GMS staining, leading to the diagnosis of gastrointestinal Basidiobolomycosis. Treatment with itraconazole and co-trimoxazole led to a significant improvement in symptoms and laboratory indices after one week, including the resolution of perianal induration. The key takeaway from this report is the importance of considering rare infections in the differential diagnosis of gastrointestinal conditions such as IBD and GI obstruction.
Collapse
Affiliation(s)
- Saeed Mirmoosavi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammadreza Salehi
- Research Center for Antibiotic Stewardship & Antimicrobial Resistance, Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Reza Fatahi
- Research Center for Antibiotic Stewardship & Antimicrobial Resistance, Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Amanuel Godana Arero
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hasti Kamali Sarvestani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Farid Azmoudeh-Ardalan
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Faeze Salahshour
- Advance Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Masoomeh Safaei
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sara Ghaderkhani
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Foroogh Alborzi Avanaki
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| |
Collapse
|
2
|
Huang J, Zhao Y, Cao Y, Zhang Q, Ran D, Li J, Luo L, Qiu F, Meng L. Anaplastic lymphoma kinase tyrosine kinase inhibitors associated gastrointestinal obstruction, perforation, and ulceration: an analysis of the FDA adverse event reporting system database (FAERS). Int J Clin Pharm 2022. [PMID: 35776375 DOI: 10.1007/s11096-022-01425-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND : There have been cases reporting anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) and associated serious gastrointestinal (GI) adverse drug reactions (gastrointestinal obstruction, perforation, and ulceration). These adverse drug reactions are not in the drug package inserts, and the drug relationships are not proven in the literature. AIM: We aimed to examine the potential association between GI obstruction, perforation, and ulceration, and ALK-TKIs by data mining of the US FDA Adverse Event Reporting System (FAERS). METHOD : We conducted a disproportionality analysis of GI obstruction, perforation, and ulceration by estimating the reporting odds ratios (ROR) and the information component (IC) with 95% confidence intervals. RESULTS : A total of 279 cases of ALK-TKI-associated GI obstruction, perforation, and ulceration from January 1, 2011, to December 31, 2020, were identified. GI obstruction, perforation, and ulceration cause 16% of cases of death. A significantly increased reporting rate for GI obstruction [ROR 1.77 (1.45-2.15); IC 0.82 (0.53-2.03)] and perforation [ROR 1.61 (1.28-2.02); IC 0.68 (0.35-1.92)] was observed for ALK-TKIs as a drug class. The signal of GI ulceration was detected only in crizotinib [ROR 1.23 (1.01-1.50); IC 0.29 (0.01-1.51)]. A statistically significant ROR and IC emerged for the site of the esophagus. CONCLUSION : Overall, the pharmacovigilance study of the FAERS indicates slightly increased reporting of GI obstruction and perforation, which may cause severe or even fatal outcomes among ALK-TKIs users.
Collapse
|
3
|
Hsieh YL, Hsu WH, Lee CC, Wu CC, Wu DC, Wu JY. Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor: A case report and review of the literature. World J Clin Cases 2021; 9:838-846. [PMID: 33585630 PMCID: PMC7852652 DOI: 10.12998/wjcc.v9.i4.838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric gastrointestinal stromal tumor (GIST) is the most common etiology of gastroduodenal intussusception. Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection, the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection (ESD) in Japan in 2017.
CASE SUMMARY An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month. Initially, she visited a local clinic for help, where abdominal sonography revealed a space-occupying lesion around the liver, so she was referred to our hospital for further confirmation. Abdominal sonography was repeated, which revealed a mass with an alternating concentric echogenic lesion. Esophagogastroduodenoscopy (EGD) was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet. EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found. Several differential diagnoses were suspected, including gastroduodenal intussusception, gastric cancer invasion to the duodenum, or pancreatic cancer with adherence to the gastric antrum and duodenum. Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb. Under the impression of gastroduodenal intussusception, ESD was performed at the base of the gastroduodenal intussusception; unfortunately, a gastric perforation was found after complete resection was accomplished, so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion. The gastric tumor was pathologically proved to be a GIST. After the operation, there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation.
CONCLUSION We present the second case of gastroduodenal intussusception caused by GIST treated by ESD. It is also the first case report of gastroduodenal intussusception by GIST in Taiwan, and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.
Collapse
Affiliation(s)
- Yi-Lun Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Ching-Chun Lee
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Jeng-Yih Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| |
Collapse
|
4
|
Siddens ED, Al-Habbal Y, Bhandari M. Gastrointestinal obstruction secondary to enteral nutrition bezoar: A case report. World J Gastrointest Surg 2020; 12:369-376. [PMID: 32904084 PMCID: PMC7448207 DOI: 10.4240/wjgs.v12.i8.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/02/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-operative enteral nutrition via gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient. It has its own set of complications, including obstruction, abscess formation, necrosis, and pancreatitis. We present here a case of small bowel obstruction caused by enteral nutrition bezoar. It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature.
CASE SUMMARY The 70-year-old female presented to our institution for a pancreaticoduodenectomy (Whipple’s procedure) for pancreatic adenocarcinoma. On day 5 post-operative, having failed to progress and developing symptoms of small bowel obstruction, she underwent a computed tomography scan, which showed features of mechanical small bowel obstruction. Following this, she underwent an emergency laparotomy and small bowel decompression. The recovery was long and protracted but, ultimately, she was discharged home. A literature search of reports from 1966-2020 was conducted in the MEDLINE database. We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar. Of those 14 cases, all but 4 occurred after upper gastrointestinal surgery; all but 1 case required further surgical intervention for deteriorating clinical picture. The postulated causes for this include pH changes, a reduction in pancreatic enzymes and gastric motility, and the use of opioid medication.
CONCLUSION Enteral feed bezoar is a complication of enteral feeding. Despite rare incidence, it can cause significant morbidity and potential mortality.
Collapse
Affiliation(s)
- Edward David Siddens
- General Surgery, Fiona Stanley Hospital, Upper Gastrointestinal Unit, Perth, Western Australia, WA 6150, Australia
| | - Yahya Al-Habbal
- General Surgery, Fiona Stanley Hospital, Upper Gastrointestinal Unit, Perth, Western Australia, WA 6150, Australia
| | - Mayank Bhandari
- General Surgery, Fiona Stanley Hospital, Upper Gastrointestinal Unit, Perth, Western Australia, WA 6150, Australia
| |
Collapse
|
5
|
Syal S, Sen A, Sugandhi N, Nanda M, Jhadav A. Metabolic profile and outcome of pre- and post-ampullary gastrointestinal obstruction in children: Conventional or unconventional wisdom. Afr J Paediatr Surg 2020; 17:18-22. [PMID: 33106448 PMCID: PMC7818667 DOI: 10.4103/ajps.ajps_27_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Conventionally, it is well accepted that the intestinal obstructions in children, especially gastric outlet obstruction are associated with significant metabolic derangement which has impact on its outcome. The study aimed to compare the metabolic profile and treatment outcome of pre- and post-ampullary gastrointestinal obstruction in children at a tertiary care setting. MATERIALS AND METHODS A prospective observational study was conducted on 30 children with intestinal obstruction and categorised into Group 1 (pre-ampullary, n = 11) and Group 2 (post-ampullary, n = 19) as per their anatomical site of pathology. Patients were evaluated at both pre- and post-operative period (Day 1 and 10) with haematological, biochemical and blood gas. The pre- and post-operative metabolic profile, resuscitative time and outcome were compared in two groups. RESULTS Except mild leucocytosis (Group II > I), rest of the pre-operative and post-operative haematological parameters were within normal range and statistically comparable among groups. Although the pre-operative sodium values were within the normal limit in both groups, it was relatively higher in Group I (Group I = 137.82 ± 4.238 vs. Group II = 134.26 ± 4.653), (P = 0.04). The mean bicarbonate values were within the normal limit in both groups (22.49 and 19.34), but the difference was statistically significant (P = 0.031). Mean partial pressure of carbon dioxide level was higher than normal range in Group I (38.464 ± 20.6493) but was comparable with Group II (P = 0.15). The time required for pre-operative resuscitation was 16.6 versus 24.87 h in Group I versus Group II (P = 0.02). In Group I, all children were improved, whereas four children expired in Group II. CONCLUSION Metabolic profile in both pre- and post-ampullary intestinal obstruction was found to be normal in majority of the scenario. Children with post-ampullary obstruction need extensive pre-operative resuscitation and have relatively poor outcome.
Collapse
Affiliation(s)
- Sarita Syal
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Amita Sen
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Nidhi Sugandhi
- Department of Pediatric Surgery, Safdarjung Hospital, New Delhi, India
| | - Monika Nanda
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Avinash Jhadav
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
6
|
Nunes G, Fonseca J, Barata AT, Dinis-Ribeiro M, Pimentel-Nunes P. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique? GE Port J Gastroenterol 2019; 27:172-184. [PMID: 32509923 DOI: 10.1159/000502981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/27/2019] [Indexed: 12/18/2022]
Abstract
Background Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.
Collapse
Affiliation(s)
- Gonçalo Nunes
- Gastroenterology Department, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Jorge Fonseca
- Gastroenterology Department, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal.,CiiEM - Center for Interdisciplinary Research Egas Moniz, Monte da Caparica, Portugal
| | - Ana Teresa Barata
- Gastroenterology Department, GENE - Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
7
|
Abstract
A patient had intestinal obstruction due to a rare cause. The patient presented unusual signs and symptoms. Although we performed a thorough diagnostic workup (CT, ultrasound, radiography, endoscopy), only laparotomy revealed that a bezoar caused the intestinal obstruction. The bezoar consisted of a herbal preparation, which was mentioned by the patient twice as a possible cause of his symptoms. All in all, the patient was right.
Collapse
Affiliation(s)
- Anna Lubecka
- Department of General and Oncological Surgery, Provincial Clinical Hospital in Zielona Góra, Poland Head: Jędrzej Bandurski, PhD
| | - Jacek Szmeja
- Department of General, Endocrinological and Gastroenterological Surgery, Karol Marcinkowski Poznan University of Medical Science, Poznan, Poland Substitute head: Tomasz Banasiewicz, PhD
| |
Collapse
|
8
|
Kawai A, Kikuyama M, Enokida K, Kawaguchi S, Shirane N, Terada S. A case of pancreatic cancer with severe vomiting treated by endoscopic ultrasound-guided celiac ganglia neurolysis. Clin J Gastroenterol 2017; 10:464-8. [PMID: 28815450 DOI: 10.1007/s12328-017-0761-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
A 50-year-old man with advanced pancreatic cancer was admitted for intractable severe vomiting 5-6 times a day, continuing over a week. He had been treated for advanced pancreatic cancer with chemotherapy for 6 months, and had undergone self-expandable metalic stent placement for obstructive jaundice due to the pancreatic cancer 4 months before admission. No abnormal findings suggesting gastrointestinal obstruction or brain metastasis were revealed on diagnostic imaging. We performed endoscopic ultrasound-guided celiac ganglia neurolysis twice by injecting ethanol into the celiac ganglion. After the treatments, the vomiting disappeared, and his eating habits gradually returned to normal. The patient died 7 months after treatment due to the advanced pancreatic cancer without recurrence of the vomiting.
Collapse
|
9
|
Theilla M, Cohen J, Kagan I, Attal-Singer J, Lev S, Singer P. Home parenteral nutrition for advanced cancer patients: Contributes to survival? Nutrition 2017; 54:197-200. [PMID: 28571682 DOI: 10.1016/j.nut.2017.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN. METHODS All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality. RESULTS Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population. CONCLUSION These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access.
Collapse
Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Johnathan Cohen
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ilia Kagan
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Joelle Attal-Singer
- Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Institute of Endocrinology, Diabetes Services, Sackler School of Medicine, Tel Aviv University, Israel
| | - Shaul Lev
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel
| | - Pierre Singer
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
| |
Collapse
|
10
|
Lee JH, Jo KM, Kim TO, Park JH, Park SH, Jung JW, Hur SC, Yang SY. Giant Brunner's Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction. Clin Endosc 2016; 49:570-574. [PMID: 27737521 PMCID: PMC5152786 DOI: 10.5946/ce.2016.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 08/11/2016] [Accepted: 08/25/2016] [Indexed: 02/06/2023] Open
Abstract
Brunner's gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.
Collapse
Affiliation(s)
- Ju Hyoung Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyeong Min Jo
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Ha Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Won Jung
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - So Chong Hur
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Yeun Yang
- Division of Gastroenterology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
11
|
Coleski R, Baker JR, Hasler WL. Endoscopic Gastric Food Retention in Relation to Scintigraphic Gastric Emptying Delays and Clinical Factors. Dig Dis Sci 2016; 61:2593-601. [PMID: 27193562 DOI: 10.1007/s10620-016-4173-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 04/17/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastric food residue frequently is observed on endoscopy despite fasting. AIMS To delineate factors promoting endoscopic food retention in the stomach. METHODS Two series of analyses were performed. Magnitudes of retained food in 834 patients from an endoscopy database were related to obstructive versus non-obstructive etiologies and gastric emptying findings. Emptying delays in 619 patients from a scintigraphy database were associated with endoscopic food retention, gastroparesis etiologies, and medications that modify gastric transit. RESULTS On endoscopy, 310 (37 %) had large, 338 (41 %) showed medium, and 103 (12 %) exhibited small amounts of retained food in the stomach. Of 433 patients with definable etiologies of food retention, 106 (24 %) had obstructive causes. One hundred three of 327 (31 %) with non-obstructive conditions underwent scintigraphy showing mean 52 ± 29 % 4-h retention. From the scintigraphy database, 164/619 patients (26 %) with delayed emptying exhibited food retention on endoscopy. Four-hour scintigraphic retention was greater with versus without retained food (41 ± 25 vs. 32 ± 22 %, P < 0.001). Retained food occurred more frequently with postsurgical (28/69, 41 %) versus diabetic (33/139, 24 %) and idiopathic (65/294, 22 %) gastroparesis (P = 0.006). Opiate use was more prevalent with increasing food retention (P = 0.02), while other medications that delay or accelerate emptying did not relate to retained food. CONCLUSIONS Gastric food retention has obstructive and non-obstructive causes, and is found in one-quarter of gastroparesis, especially postsurgical cases. Gastric emptying delays correlate with amounts of retained food on endoscopy. Retention is influenced by opiates, but not other medications. These analyses delineate pathogenic factors promoting gastric food retention.
Collapse
|
12
|
Masarwa I, Bahouth Z, Halachmi S. Giant Congenital Hydronephrosis Obstructing the Gastro Intestinal System and the Contralateral Kidney in a New Born. Urol Case Rep 2016; 8:1-3. [PMID: 27313982 PMCID: PMC4898913 DOI: 10.1016/j.eucr.2016.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022] Open
Abstract
A 5 day old baby, with known left hydronephrosis which discovered by prenatal US presented with gastrointestinal tract obstruction. Laboratory work up demonstrated abnormal renal function and metabolic acidosis combined with hyperkalemia. Radiology tests showed bilateral hydronephrosis with huge left renal pelvis crossing the midline and causing deviation of the gut laterally. This acute presentation beside inability to receive oral feeding made us prefer immediate left renal drainage with pyelostomy in order to restore renal function, relieve the pressure effect of the huge renal pelvis and stabilize the baby. Dismembered pyeloplasty was done at age of 3 months.
Collapse
|
13
|
Nakahara K, Okuse C, Matsumoto N, Suetani K, Morita R, Michikawa Y, Ozawa SI, Hosoya K, Kobayashi S, Otsubo T, Itoh F. Enteral metallic stenting by balloon enteroscopy for obstruction of surgically reconstructed intestine. World J Gastroenterol 2015; 21:7589-7593. [PMID: 26140008 PMCID: PMC4481457 DOI: 10.3748/wjg.v21.i24.7589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/15/2014] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
We present three cases of self-expandable metallic stent (SEMS) placement using a balloon enteroscope (BE) and its overtube (OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine.
Collapse
|
14
|
Hantson P, Capron A, Maillart JF. Oesophageal and gastric obstruction in a cocaine body packer. J Forensic Leg Med 2014; 27:62-4. [PMID: 25287802 DOI: 10.1016/j.jflm.2014.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/24/2014] [Accepted: 08/20/2014] [Indexed: 01/08/2023]
Abstract
While the management of asymptomatic body packers is mainly conservative, few individuals will require surgery for acute toxicity related to packets rupture, intestinal obstruction or very slow progression of the packages. Obstruction of the lower oesophagus or stomach is not frequently reported. We report the case of a 49-year-old woman who had ingested 92 cocaine-containing packages. She was admitted to the hospital after opioid syndrome related to the intake of morphine and codeine to decrease intestinal transit. The presence of more than 80 packages was suspected in the stomach on the initial abdomen computed tomography. Due to the absence of progression of the packages after four days of well-conducted laxative therapy and to major gastric distension at abdomen tomography, surgery was decided and gastrotomy allowed the evacuation of 80 packages that were still present in the stomach or in the lower oesophagus. In addition, 12 other packages had been retrieved either after laxative therapy (9) or by evacuation via the anal canal (3) after palpation of the intestine during the surgical procedure. No complication was observed.
Collapse
|
15
|
Abstract
The case of a 77-year-old woman with symptoms of gastric outlet obstruction is presented. Transabdominal ultrasonography findings were suspicious of Bouveret's syndrome. Upper endoscopy confirmed this diagnosis. Bouveret's syndrome is a rare complication of gallstone disease caused by a bilioenteric fistula leading to gastric outlet obstruction by a gallstone and should be suspected in any patient who presents with pneumobilia without recent endoscopic retrograde cholangiopancreatography or biliary surgery.
Collapse
Affiliation(s)
- Martina Keller
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Carola Epp
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christa Meyenberger
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michael Christian Sulz
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
16
|
Yamabuki T, Omi M, Yonemori A, Misu K, Inomata H, Abiko Y, Mori M, Nihei K. Gastrointestinal Obstruction due to Solitary Lymph Node Recurrence of Alpha-Fetoprotein-Producing Gastric Carcinoma with Enteroblastic Differentiation. Case Rep Gastroenterol 2014; 8:1-6. [PMID: 24574942 PMCID: PMC3934807 DOI: 10.1159/000358046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We report an unusual case of alpha-fetoprotein (AFP)-producing gastric carcinoma with enteroblastic differentiation. A 75-year-old woman was admitted to our hospital with occasional upper abdominal discomfort. We performed gastroscopy and observed a type 2 tumor, primarily in the pyloric region. Histological examination of biopsies confirmed gastric adenocarcinoma. Based on these findings, we diagnosed gastric adenocarcinoma and performed laparoscopic distal gastrectomy with lymph node dissection. Histological examination revealed an invasive lesion composed of adenocarcinoma with a tubulopapillary growth pattern. Tumor cells were cuboidal in shape with characteristically clear cytoplasm rich in glycogen. Two regional lymph node metastases were seen microscopically. Immunohistochemically these cells were positive for AFP, carcinoembryonic antigen, caudal-type homeobox transcription factor 2 and common acute lymphoblastic leukemia antigen. The final diagnosis was AFP-producing gastric carcinoma with enteroblastic differentiation. 26 months after initial surgery, the patient was readmitted to our hospital for gastrointestinal obstruction due to lymph node recurrence.
Collapse
Affiliation(s)
- Takumi Yamabuki
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Sapporo, Japan
| | - Makoto Omi
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Sapporo, Japan
| | - Atsuya Yonemori
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Sapporo, Japan
| | - Kenjiro Misu
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Sapporo, Japan
| | - Hitoshi Inomata
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Sapporo, Japan
| | - Yukie Abiko
- Department of Pathology, Sapporo General Pathology Laboratory, Sapporo, Japan
| | - Michio Mori
- Department of Pathology, Sapporo General Pathology Laboratory, Sapporo, Japan
| | - Kazuyoshi Nihei
- Department of Surgery, Kushiro Red Cross Hospital, Kushiro, Sapporo, Japan
| |
Collapse
|
17
|
Hyun D, Park HS, Seo S, Choo IW, Lim S, Nam MH, Do YS, Choo SW, Shin SW, Park KB, Cho SK. A novel animal model of gastrointestinal obstruction for the development of stent. J Surg Res 2014; 187:445-9. [PMID: 24267615 DOI: 10.1016/j.jss.2013.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/02/2013] [Accepted: 10/24/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND The need for newer gastrointestinal (GI) stents has been continuously raised. Newly developed stents are generally tested for physical properties in vitro and directly introduced to clinical practice because there is no reliable animal model of GI obstruction. The aim of this study was to establish an animal model both that can represent obstruction of the GI tract and be used to develop new stents. MATERIAL AND METHODS Surgical obstruction of the descending colon by wrapping with a nonabsorbable synthetic mesh and rubber bands was made in 17 healthy mongrel dogs. Four days later, a covered self-expanding metallic stent was placed for the obstructed segment in each dog under fluoroscopic guidance. Patency and migration of the inserted stents were evaluated clinically on a daily basis and fluoroscopically on a weekly basis. After sacrifice of the dogs, the degree and extent of residual colonic obstruction were assessed fluoroscopically. The specimen of the colonic obstructed segment was examined microscopically. RESULTS In all 17 mongrel dogs, segmental obstruction in the descending colon was successfully created and confirmed with fluoroscopic examination using a contrast medium. The percentage of luminal narrowing ranged from 99%-100%. Stent placement was technically successful in all 17 dogs. During the follow-up period, stent migration occurred in 12 dogs and indwelling time of a stent ranged from 0-95 d (mean 29.2 ± 38.8 d). On postmortem pathologic examination, it was found that fibrosis had newly formed outside the colonic longitudinal muscle layer in all dogs. CONCLUSIONS Our canine colonic obstruction model is the first animal model that can be feasible for developing a new design of stent and provide in vivo data on complications, particularly stent migration.
Collapse
|
18
|
Abstract
Acute gastrointestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The blockage can occur at any level throughout the gastrointestinal tract. The clinical symptoms depend on the level and extent of obstruction. Various benign and malignant processes can produce acute gastrointestinal obstruction, which often represents a medical emergency because of the potential for bowel ischemia leading to perforation and peritonitis. Early recognition and appropriate treatment are thus essential. The typical clinical symptoms associated with obstruction include nausea, vomiting, dysphagia, abdominal pain and failure to pass bowel movements. Abdominal distention, tympany due to an air-filled stomach and high-pitched bowel sounds suggest the diagnosis. The diagnostic process involves imaging including radiography, ultrasonography, contrast fluoroscopy and computer tomography in less certain cases. In patients with uncomplicated obstruction, management is conservative, including fluid resuscitation, electrolyte replacement, intestinal decompression and bowel rest. In many cases, endoscopy may aid in both the diagnostic process and in therapy. Endoscopy can be used for bowel decompression, dilation of strictures or placement of self-expandable metal stents to restore the luminal flow either as a final treatment or to allow for a delay until elective surgical therapy. When gastrointestinal obstruction results in ischemia, perforation or peritonitis, emergency surgery is required.
Collapse
Affiliation(s)
- Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Videnska 9, 140 21 Prague 4, Czech Republic.
| |
Collapse
|
19
|
Bini R, Voghera P, Tapparo A, Nunziata R, Demarchi A, Capocefalo M, Leli R. Malignant transformation of ectopic pancreatic cells in the duodenal wall. World J Gastroenterol 2010; 16:1293-5. [PMID: 20222176 PMCID: PMC2839185 DOI: 10.3748/wjg.v16.i10.1293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple’s procedure and had an uneventful post-operative recovery. Traditional imaging studies are often inconclusive in the definitive diagnosis, whilst endoscopic ultrasonography and guided biopsy may aid accurate pre-operative diagnosis. Diagnostic uncertainty warrants surgical exploration and if necessary extended resection is indicated.
Collapse
|
20
|
Sheikh RA, Prindiville TP, Pecha RE, Ruebner BH. Unusual presentations of eosinophilic gastroenteritis: Case series and review of literature. World J Gastroenterol 2009; 15:2156-61. [PMID: 19418590 PMCID: PMC2678588 DOI: 10.3748/wjg.15.2156] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.
Collapse
|
21
|
Balducci G, Dente M, Cosenza G, Mercantini P, Salvi PF. Multiple giant diverticula of the foregut causing upper gastrointestinal obstruction. World J Gastroenterol 2008; 14:3259-61. [PMID: 18506936 PMCID: PMC2712863 DOI: 10.3748/wjg.14.3259] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin-testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.
Collapse
|