Double pylorus in cirrhosis.

Double pylorus is an uncommon clinical condition that can be acquired or congenital. Most acquired cases arise as a complication of peptic ulcer disease and less commonly from other conditions such as gastric malignancy. We present a case of double pylorus in a cirrhotic patient diagnosed during surveillance endoscopy for esophageal varices.

Rare Case of Leukemoid Reaction in a Patient With Severe Alcoholic Hepatitis.

Alcoholic hepatitis results from excessive alcohol consumption in patients with or without underlying chronic liver disease. Leukemoid reactions have been associated with poor outcomes in severe alcoholic hepatitis. There are only a handful of reported cases describing this relationship, and the striking similarity in these cases was a high short-term mortality rate. We believe that these patients represent a unique subgroup of patients with alcoholic hepatitis and that leukemoid reaction is a poor prognostic indicator in this condition. Here, we describe a case of 55-year-old male with severe alcoholic hepatitis with superimposed candida esophagitis who was found to have leukemoid reaction during diagnostic workup.

Abdominal Cerebrospinal Fluid Pseudocyst as a Complication of Ventriculoperitoneal Shunt Placement.

The abdominal cavity has long been used for absorption of cerebrospinal fluid (CSF) in patients with hydrocephalus. Although the procedure is quite common, there are complications that can potentially arise following ventriculoperitoneal (VP) shunt insertion. Here, we report a case of a 39-year-old female patient in which a large abdominal pseudocyst was developed as a complication of VP shunt placement. Ultrasonographical evaluation of the abdomen showed a well-defined cystic mass lesion later confirmed on CT abdomen. She subsequently underwent surgical excision of the pseudocyst with resolution of previous symptoms. Clinicians should be aware of this complication since early diagnosis improves outcome and reduce patient's suffering and distress.

Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods.

Small intestinal bacterial overgrowth (SIBO) is a commonly diagnosed gastrointestinal disorder affecting millions of individuals throughout the United States. It refers to a condition in which there is an excess and imbalance of small intestinal bacteria. Despite its prevalence, it remains underdiagnosed due to the invasive nature of diagnostic testing. Symptoms observed in SIBO, including abdominal distension, bloating, diarrhea, and gas formation, are nonspecific and can overlap with other gastrointestinal disorders. Frequently cited predisposing factors include gastric acid suppression, dysmotility, gastric bypass, and opioids. The diagnostic gold standard remains small bowel aspirate and culture. However, due to its invasive nature, it remains an unpopular method among patients and clinicians alike. Glucose and lactulose breath testing have become the go-to diagnostic method in clinical practice due to its noninvasive nature and low cost. Treatment is guided towards the eradication of bacteria in the small bowel and usually consists of a prolonged course of oral antibiotics. Due to recent advances in our understanding of the human microbiome, we are surely poised for a transformation in our approach to diagnosing and treating this condition.

Zieve syndrome in acute alcoholic hepatitis.

A 31-year-old woman presented with acute alcoholic hepatitis, jaundice, anemia, and hypertriglyceridemia following ethylene glycol poisoning. She had no previous history of anemia or gastrointestinal bleeding. Laboratory findings were consistent with acute hemolytic anemia. She was diagnosed with Zieve syndrome and was managed with supportive measures. Zieve syndrome is a rare occurrence with only a handful of published case reports. Although rare, the diagnosis should be on the differential in this subgroup of patients to avoid unnecessary and invasive diagnostic interventions.

Rectal malakoplakia.

Malakoplakia is a rare chronic granulomatous disease with potential to affect multiple organs. Gastrointestinal involvement is considered one of the most common locations outside of the urinary tract. Herein, we present the case of a man who presented to our clinic with painless hematochezia. Physical examination findings were unremarkable; however, colonoscopy revealed a frond-like/villous, fungating, and polypoid nonobstructing circumferential mass in the rectum. Histopathological examination of the lesion revealed findings consistent with malakoplakia.

Quadruple therapy for gastric high-grade B-cell lymphoma.

Most low-grade gastric lymphomas arising from the mucosa-associated lymphoid tissue (MALT) are directly related to Helicobacter pylori infection. Most cases of MALT lymphoma limited to the stomach can be cured with H. pylori eradication and remain in remission for years. In contrast, high-grade lymphomas of the stomach, although potentially related to H. pylori, do not usually respond to H. pylori eradication. Here, we present the case of a woman with high-grade diffuse large B-cell lymphoma who achieved complete remission following H. pylori eradication.

Helicobacter pylori-Negative MALT Lymphoma Presenting as a Massive Recurrent Gastrointestinal Hemorrhage.

Primary gastric lymphoma is rare, representing 5% of all primary gastric neoplasms. The presenting complaints of gastric mucosa-associated lymphoid tissue (MALT) lymphoma are usually nonspecific. However, life-threatening gastrointestinal bleeding from the stomach is unusual and sparsely reported. While studies reveal an indolent course, we present a case that presented with massive and recurrent hematemesis leading to hypovolemic shock secondary to endoscopically confirmed MALT lymphoma, which was treated with radiotherapy to achieve remission. She had no autoimmune diseases and tested negative for Helicobacter pylori. Our case emphasizes the importance of early diagnosis and timely intensive radiotherapy of a localized but aggressive gastric MALT lymphoma.

Multiple myeloma presenting as plasmacytoma causing obstructive jaundice.

Jaundice, weight loss, and anorexia are common symptoms that raise concern for pancreatic malignancy. Although the most common form of pancreatic malignancy is pancreatic adenocarcinoma, not all pancreatic malignancies are exocrine in origin. Pancreatic plasmacytomas are plasma cell tumors that can lead to similar presentations. Plasmacytomas are classified as either intra- or extramedullary, depending on their location; intramedullary plasmacytomas are more common than extramedullary plasmacytomas. Here, we present a case of pancreatic plasmacytoma in association with advanced multiple myeloma diagnosed using endoscopic ultrasonography-guided fine-needle aspiration.

Primitive neuroectodermal tumor of the pancreas.

Primitive neuroectodermal tumors (PNETs) are rare small round cell malignancies closely related to Ewing's sarcoma. Involvement of the abdominal cavity, specifically the pancreas, is extremely rare. PNETs affect predominantly children and young adults. The clinical presentation is mostly vague, with a short history of symptoms even in metastatic disease. Findings on imaging studies are nonspecific. The diagnosis can be suggested by the microscopic appearance of the tumor cells, but should be confirmed by histology, immunohistochemistry, fluorescence in situ hybridization, immunoreactivity evaluation of MIC2-protein (CD99) expression, and when possible testing for the chromosome translocation t(11;22) (q24,q12). In adults, the prognosis is poor with no standard treatment. Here, we present a case of pancreatic PNET in a 61-year-old man who presented with persistent abdominal pain and weight loss.

Corrigendum to "A Rare Case of New-Onset Ulcerative Colitis following Initiation of Secukinumab".

[This corrects the article DOI: 10.1155/2019/2975631.].

Isolated Intestinal Ganglioneuroma Mimicking Small Bowel Crohn's Disease.

Ganglioneuromas (GNs) are hamartomatous tumors derived from the autonomic nervous system. GNs are frequently associated with neurofibromatosis-1 and multiple endocrine neoplasia type 2b and commonly present with constipation, abdominal pain, weight loss, obstruction, and gastrointestinal bleeding. We report a 40-year-old man with symptoms of chronic abdominal pain, weight loss, and diarrhea for 1 year. Imaging was suggestive of thickening of ileal wall with a stricture, and subsequent biopsy revealed intestinal GN. To our knowledge, this is the first case report of an isolated intestinal GN masquerading as Crohn's disease.

A Rare Case of New-Onset Ulcerative Colitis following Initiation of Secukinumab.

Secukinumab is an IgG monoclonal antibody widely used for treatment of ankylosing spondylitis, psoriasis, and psoriatic arthritis. Recently, there has been increasing controversy regarding potential adverse effects of the drug especially in those with underlying inflammatory bowel disease. We present the case of a young male patient who developed severe new-onset ulcerative colitis following initiation of secukinumab for psoriasis, with excellent response and rapid resolution of symptoms with infliximab.

Epidemiology of human furuncular myiasis of Cordylobia anthropophaga (Grunberg) in Nigeria.

Two hundred people were randomly selected for myiasis infection in the Niger Delta region of Nigeria, except in some states where we did not get the stipulated number (200) to sample. In each of the six states sampled within the Niger Delta in 2009, 88% of 200 patients examined in Rivers State had the Cordylobia infection followed by Cross Rivers State (>86%), Bayelsa (>84%) while Edo, Delta, and Akwa Ibom states showed higher than 82% infection in that order. Our findings showed that women, children, and infants are commonly affected by furuncular myiasis irrespective of skin color, age, blood group, race, sex, genotype, etc. Infection due to C. anthropophaga occurs throughout the year; the rate of infection is higher during the rainy season (when humidity is normally higher) than the dry seasons. Most cases of human myiasis are not reported but treated locally. The Niger Delta populace (especially the areas sampled) consists of people with diverse occupations; some are fishermen, traders, farmers, and refuse disposers. They move from one place to another predisposed to myiasis-causing agents due to the types of work they do. Two major categories of people based on skin color (i.e., white and black skinned) are recognized for this research. People with albinism are also part of the colored African group, however, according to the data, there does not seem to be any difference between them and others. Cordylobia infection is a neglected disease of the Niger Delta region. Therefore, there was the need to know the spread and factors that promote spreading as well as populations of the myiasis-causing agent in the Niger Delta. The data presented here provides good travel information to the Niger Delta region as well as other parts of Nigeria. Human furuncular myiasis affects neonates ranging from 3 to 11 days old, children, and adults in Nigeria. C. anthropophaga maggots penetrate all types of skin; people with albinism, white skin, and black skin. Some of the factors that affect the distribution include unhygienic situations, high humidity, poverty, and use of soiled clothes. Details of our findings are presented.

Incidence of multiple myiases in breasts of rural women and oral infection in infants from the human warble fly larvae in the humid Tropic-Niger Delta.

Twenty-eight rural women of the Niger Delta were infected with the human warble fly (Tumbu fly) larva, Cordylobia anthropophaga, and of the women examined, 22 (78.5%) were nursing-mothers. Among the percentage of women with cutaneous myiasis, 20 had multiple myiases in their breasts. Larvae were also extracted from the upper and lower lips of breast-fed infants. A positive correlation was drawn between the incidence of breast and oral myiases.