Hepatic Adenomatosis In A 32-Year-Old Male With No Risk Factors For Hepatic Adenoma.

Hepatic Adenomatosis most commonly arises in the background of hepatic adenoma in young women and less commonly in men with underlying risk factors. Rarely, it can arise in young men with none of the associated risk factors and thus can go undetected for a prolonged period resulting in delayed intervention and avoidable complications. We present a rare case of a 32-year-old asymptomatic male that presented for routine evaluation and was subsequently diagnosed with Hepatic Adenomatosis.

Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.

Platypnea orthodeoxia: a 'laid-back' case of dyspnoea.

A man with end-stage liver disease who presented with shortness of breath. He exhibited clinical platypnea (worsening shortness of breath on sitting up) and orthodeoxia (oxygen desaturation on sitting up). Follow-up investigations led to the diagnosis of hepatopulmonary syndrome.

Gastrointestinal Stromal Tumor Masquerading as a Spontaneous Rectal Hematoma.

A 78-year-old Caucasian male with a history of atrial fibrillation and anticoagulation with warfarin presented with a change in bowel habits and weight loss. A computed tomography (CT) scan showed a 3.5 cm rectal mass. After biopsy with colonoscopy and endoscopic ultrasonography, the rectal mass was highly suspicious for rectal hematoma. When the rectal mass did not resolve after 1 month of follow-up, surgery showed the patient to have a rectal gastrointestinal stromal tumor. He is being treated with imatinib and follow-up CT scans. This case illustrates the importance of a high level of suspicion for a gastrointestinal stromal tumor when a rectal mass is found.

Association of Helicobacter pylori infection with the development of colorectal polyps and colorectal carcinoma.

BACKGROUND AND AIMS: Recent studies have suggested a possible association between Helicobacter pylori (HP) infection and colon neoplasia. HP infection causes hypergastrinemia, and gastrin increases colorectal mucosal proliferation, potentially leading to colorectal cancer. We investigated whether HP infection is associated with colon neoplasia. METHODS: We conducted a cross-sectional, single-center study in which patients who underwent routine outpatient colonoscopy and were tested for HP infection on esophagogastroduodenoscopy from January 1, 2008 to November 1, 2009 were identified. Patient demographic data (gender and age) and information on colon polyp characteristics (size, number of polyps, location, morphology, and histology) were abstracted from retrospective chart review. Presence of adenoma/carcinoma was compared in the HP-positive cases and HP-negative controls. RESULTS: A total of 192 patients were included in the study, with 96 patients each in the HP-positive and -negative groups. The two groups did not differ significantly in gender, age, polyp size, number of polyps, polyp location, morphology, and histology. Adenomatous colon polyps were noted in 31% of the HP-positive cases and in 26% of the HP-negative controls (P = 0.52). Colon carcinoma was found in 6% of HP-positive and 2% of HP-negative patients (P = 0.28). CONCLUSION: The higher prevalence of adenomatous colon polyps/carcinoma in HP-positive patients compared to HP-negative patients was not statistically significant. Larger studies are needed to examine further the potential association between HP infection and colorectal adenoma/carcinoma.

Acute buried bumper syndrome.

Buried bumper syndrome (BBS) is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. This unusual phenomenon occurs when the internal bumper of a PEG tube erodes and migrates through the gastric wall and becomes lodged anywhere between the gastric wall and the skin. If not removed and treated appropriately, it can lead to life-threatening complications. It is considered to be a late complication, with most cases occurring from months to years later. We present an unusual case of a very rapid development of BBS, along with a brief review of contributing factors and treatment recommendations.

An unusual cause of upper GI bleeding: gastric antral vascular ectasia.

Gastric antral vascular ectasia (GAVE) is characterized by red patches or spots in either a diffuse or linear array in the antrum of the stomach. This syndrome is commonly referred to as watermelon stomach because of its typical endoscopic appearance. Patients with GAVE frequently have occult bleeding requiring continual transfusions. It is important to distinguish the differences while treating GAVE in cirrhotics and portal hypertensive gastropathy (PHG) since the treatment options are vastly different.

Successful endoscopic transpapillary management of intrahepatic pancreatic pseudocyst.

CONTEXT: Intrahepatic pancreatic pseudocyst extension is a rare but complex clinical entity requiring multimodality approach for management. There is no consensus regarding the optimal strategy for the treatment of intrahepatic pancreatic pseudocyst and the literature is limited to a few case reports. Most of the published cases were managed by surgical or percutaneous drainage. CASE REPORT: We hereby report a case of intrahepatic pancreatic pseudocyst extension which failed to resolve by percutaneous drainage. Endoscopic transpapillary drainage was utilized which led to complete resolution of the intrahepatic pancreatic pseudocyst. CONCLUSION: The excellent results obtained in our patient suggest that it should be considered as primary treatment and may obviate the need for more aggressive and potentially morbid procedures.

Biliary obstruction and pancreatitis caused by diffuse nodular hyperplasia of Brunner's gland.

INTRODUCTION: Brunner's gland hyperplasia (BGH) of the duodenum is an uncommon finding at endoscopy and is usually asymptomatic. Symptomatic BGH presenting with biliary obstruction and pancreatitis is extremely rare and the literature is limited to a few case reports. CASE: We report an unusual case of diffuse BGH of duodenum involving the ampulla of Vater that led to this clinical presentation. Biopsies revealed BGH and successful endoscopic therapy utilizing sphincterotomy and plastic stent placement led to complete recovery. CONCLUSION: Albeit its uncommon clinical presentation, it can become challenging in terms of diagnosis and management. A high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.

Giant ulcerated lipoma of the colon causing iron deficiency anemia successfully treated with endoscopic ultrasound-assisted resection.

Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.

CT enterography and fistulizing Crohn's disease: clinical benefit and radiographic findings.

BACKGROUND: To estimate the clinical benefit of CT enterography (CTE) in patients with fistulizing Crohn's disease and describe the appearance of fistulas at CTE. METHODS: Crohn's patients who had undergone CTE, which diagnosed an abscess or fistula, were identified. A gastroenterologist reviewed clinical notes prior to and following CTE to assess the pre-CTE clinical suspicion for fistula/abscess, and post-CTE alteration in patient management. A radiologist reassessed all fistula-positive cases, which were confirmed by a non-CT reference standard, to describe their radiologic appearance. RESULTS: Fifty-six patients had CT exams identifying 19 abscesses and 56 fistulas. There was no or remote suspicion of fistula or abscess at pre-imaging clinical assessment in 50% of patients. Thirty-four patients (61%) required a change in or initiation of medical therapy and another 10 (18%) underwent an interventional procedure based on CT enterography findings. Among 37 fistulas with reference standard confirmation, 30 (81%) were extraenteric tracts, and 32 (86%) were hyperenhancing compared to adjacent bowel loops. Most fistulas (68%) contained no internal air or fluid. CONCLUSION: CTE detects clinically occult fistulas and abscesses, resulting in changes in medical management and radiologic or surgical intervention. Most fistulas appear as hyperenhancing, extraenteric tracts, usually without internal air or fluid.