Jejunal Gastrointestinal Stromal Tumor (GIST) as a Rare Cause of GI Bleed: A Case Report.

Jejunal gastrointestinal stromal tumor (GIST) is a rare cause of recurrent gastrointestinal bleeding (GIB). Early diagnosis for patients with jejunal GIST is often challenging, which can lead to delays in treatment. We present a case of a 32-year-old male patient with persistent abdominal pain and hematemesis despite treatment for gastroesophageal reflux disease (GERD). Upon initial ER visit, CT result was consistent with intra-abdominal abscess and the patient underwent interventional radiology (IR) drainage. On a second ER visit three weeks later, CT showed a suspicious lesion in the small bowel. The patient underwent exploratory laparoscopy which revealed a mass in the jejunum. The lesion was resected successfully and pathology report confirmed the diagnosis of GIST with positive immunohistochemistry marker cluster of differentiation (CD)117. The patient was discharged with no complications post-operatively. In conclusion, recurrent GIB and unusual imaging findings should raise clinical suspicion for alternative causes for GIB, including tumors such as GIST.

The Function of Osteopathic Medicine in the Treatment of Adhesive Capsulitis.

Adhesive capsulitis (frozen shoulder) may result from any injury to the shoulder. The main signs and symptoms are pain, decreased range of motion, and stiffness of the joint. A patient could have additional causes that can include muscle spasm, rotator cuff tear, or weakness of the upper extremities, which could make treatment decisions more complicated. Multiple therapeutic and surgical approaches exist. Successful outcomes for adhesive capsulitis are due to timely diagnosis and effective treatment options. In our case report, a 58-year-old female developed acute sharp pain in her shoulders, decreased range of motion, as well as bilateral weakness in her upper extremities. The symptoms developed after doing repetitive overhead arm motion while swimming without proper conditioning. The pain was debilitating and prevented the patient from completing simple daily maneuvers. Significant weakness in the upper extremities made it impossible for her to independently dress herself. Initially, the patient's symptoms were attributed to the chronic effects of osteoarthritis and rotator cuff tear. One orthopedic surgeon recommended replacement of the right shoulder. As a second opinion, another orthopedic surgeon recommended bilateral shoulder replacement. The orthopedic surgeons' decisions were based on physical examination and reading the MRI, which confirmed total rotator cuff tear and osteoarthritis. Before proceeding with surgical treatment, the patient was evaluated by an osteopathic specialist. The osteopathic specialist's decision was based on osteopathic principles that the body is a unit capable of self-regulation and that structure and function are reciprocally interrelated. Observation and palpation are particularly important means of uncovering information. After the first examination, the osteopathic physician diagnosed and successfully restored cervical spine mobility problems (cervical somatic dysfunctions) and relieved a trapezius muscle spasm. The patient's upper extremities gained strength after the first treatment and she was able to dress herself (which is a task she was unable to do in over a year with continuous physical therapy treatment). At this point, surgical treatment became an alternative option. The patient preferred to continue osteopathic manipulation and osteopathic manipulation under anesthesia. The patient experienced a resolution of her symptoms over time. A stepwise approach to management is necessary for patient assessment and diagnosis, especially when the alternative recommendation is surgery.