Inpatient outcomes of inflammatory bowel disease in hospitalized patients with COVID-19: analysis of a nationally representative sample.

Purpose: To compare the risks of adverse outcomes, including mortality, gastrointestinal bleeding, and venous thromboembolism, between COVID-19 patients with inflammatory bowel disease (IBD) and those without IBD. Methods: We analyzed data from the National Inpatient Sample between January and December 2020. The study included adult patients with Crohn's disease (CD) and ulcerative colitis (UC) who contracted COVID-19. Inpatient outcomes were compared between the IBD and non-IBD COVID-19 cohorts. Results: Out of 1,050,045 COVID-19 hospitalizations, 0.28% had CD (2954 patients) and 0.26% had UC (2794 patients). After adjusting for confounding factors, UC patients had a significantly higher risk of deep vein thrombosis compared to non-IBD patients, with an adjusted odds ratio (aOR) of 2.55 (P < 0.001). However, CD patients did not show a significant association with deep vein thrombosis (aOR 1.29, P = 0.329). There were no significant associations between IBD patients (both UC and CD) and pulmonary embolism, nonvariceal gastrointestinal bleeding, or in-hospital mortality. UC patients had a longer average hospital stay (8.25 days) compared to non-IBD patients (adjusted mean difference 0.89, P = 0.007). Healthcare resource utilization was similar among the three groups. Conclusion: Our national study on COVID-19 hospitalizations indicates that patients with IBD have comparable rates of gastrointestinal bleeding, pulmonary embolism, and mortality as those without IBD. However, patients with UC hospitalized with COVID-19 have a higher risk of deep vein thrombosis than COVID-19 patients hospitalized without UC. Further research is needed to better understand the relationship between COVID-19 and IBD.

Diffuse Large B Cell Lymphoma Raising Suspicion for an Infection: A Case Report.

Newly discovered liver lesions have a broad differential ranging from malignancy to infection. While tissue biopsy is the gold standard diagnostic modality, imaging can also aid in diagnosis. Hepatocellular carcinoma (HCC) can be diagnosed via imaging alone; however, masses suspicious for infection ultimately require biopsy and culture. We report a case of a 72-year-old male who presented with subjective fever, nausea, decreased appetite, dark urine, elevated liver function tests, and CT evidence of an exophytic liver mass. Differentials included infections such as hepatobiliary actinomycosis, abscess, solid malignancy, or lymphoma. Obtaining a definitive diagnosis with tissue biopsy endoscopically and percutaneously was quite difficult due to the location of the lesion around the porta hepatis. Subsequent laparoscopic biopsy revealed diffuse large B cell lymphoma (DLBCL).

Decreasing the burden: An unusual GIST presentation, a case report.

INTRODUCTION: Gastrointestinal stromal tumours (GIST) are notoriously one of the most common mesenchymal tumours of the alimentary canal. Most commonly originating from the gastric stroma, they are recognized by their mass effects on the abdominal cavity. Recurrence frequently occurs with GIST and these tumours may become refractory to tyrosine kinase inhibitors (TKIs). Therefore, resection may be indicated for improved outcomes. PRESENTATION OF CASE: We present a 52-year-old African American male with a surgical history of GIST resection with recurrence that came to the emergency room with worsening diffuse abdominal pain. The tumour was refractory to two TKIs, Imatinib and Sunitinib. Computed tomography (CT) of the abdomen and pelvis was done which showed severe metastatic disease with carcinomatosis, multiple dilated loops of small bowel in the left hemiabdomen without discrete transition point. After seventeen days on nasogastric tube, antiemetics, the patient worsened, and it was decided to go to surgery. In this report, attention is focused on the surgical approach of tumour debulking with subsequent Regorafenib therapy for decreased obstructive symptoms and improved quality of life. CONCLUSION: This case serves as an example of the importance of surgical debulking in addition to molecular therapy for patients with severely extensive GISTs. Tumour debulking is important to decrease tumour burden, improve chemotherapeutic response and improve quality of life especially in persons refractory to pharmacological therapy.