A Rare Case of Malignant Insulinoma Associated With Gastrointestinal Bleed.

A gastrointestinal bleed (GIB) in the setting of metastatic insulinoma is a rare phenomenon. It appears that cases of metastatic insulinoma causing GIB are rare, often influenced by the tumor's location. Our case involves an 82-year-old male with dementia and a history of recurrent hypoglycemia, presenting with an episode of altered mental status. The patient exhibited hypoglycemia alongside a melena episode and anemia. Diagnostic criteria, including Whipple's triad, confirmed endogenous insulin production. Computed tomography (CT) showed a left paraaortic/retroperitoneal mass. Esophagogastroduodenoscopy (EGD) visualized an extrinsic mass at the gastric body, which caused an ulcerated surface that was treated with clipping and hemostasis. The patient's recurrent hypoglycemic episodes were treated with glucose, while his GIB was managed with hemostasis and clipping. However, the patient was not a surgical candidate, and further medical treatment was ceased by the family.

A Case of Gastric Glomus Tumor Misdiagnosed as Carcinoid Tumor.

Glomus tumor is a rare mesenchymal tumor commonly located in the periphery of glomus bodies, such as the subungual regions (e.g., fingernails and toenails). Other locations include the forearm, wrist, or trunk. Even rare is when these tumors are found in the submucosa. In the stomach, it is commonly found at the gastric antrum. Gastric glomus tumors (GGTs) are often found incidentally after a presumption of other gastric tumors is diagnosed, such as gastrointestinal stromal tumors (GISTs) or carcinoid tumors. The variable clinical presentation of GGT and the fact that histology is the only way to confirm the diagnosis is what makes GGT such an elusive tumor. Our case is a patient that presented with weight loss and reflux. Esophagogastroduodenoscopy (EGD) and colonoscopy were done, and the diagnosis of carcinoid tumor was presumed. Preliminary pathology was suggestive of a diagnosis of carcinoid tumor. The patient eventually had a subtotal gastrectomy, and a biopsy with immunohistochemical staining of the specimen was received, finally confirming the diagnosis of a GGT.

Acute Hemorrhagic Rectal Ulcer Syndrome: A Known Yet Often Overlooked Etiology of Gastrointestinal Bleeding in Chronically Ill Patients.

Acute Hemorrhagic Rectal Ulcer Syndrome (AHRUS) is a known and potentially overlooked cause of severe gastrointestinal bleeding in patients with critical illness. It presents as a sudden and brisk painless bleed. It is common among elderly patients who have chronic conditions such as coronary artery diseases associated with the use of anti-platelets, diabetes mellitus, hypoalbuminemia, liver diseases, sepsis, stroke, and chronic renal failure on hemodialysis. AHRUS could result in fatal gastrointestinal hemorrhage. Here, we report a case of acute hemorrhagic rectal ulcer with the above-mentioned risk factors and make the argument that AHRUS should be an important differential in a similar population presenting with a gastrointestinal bleed.

Gastric Volvulus, An Important Yet Commonly Overlooked Etiology of Upper Gastrointestinal Bleeding: A Case Study.

Gastric volvulus is a distinct and uncommon pathology that usually presents with vomiting secondary to gastric outlet obstruction and gastrointestinal bleeding with an association with hiatal hernia. We present a case of a 71-year-old female who presented to the emergency department (ED) with a three-day history of coffee ground emesis. Of note, the patient was recently in the hospital under medical observation two weeks prior, with similar complaints of hematemesis. Chest X-ray revealed a left basilar opacity representing bowel gas suggestive of a hiatal hernia. Intravenous proton pump inhibitors were initiated but due to persistent recurrence of symptoms and progressive discomfort, a computed tomography (CT) of the chest and abdomen was ordered. This revealed a partial gastric volvulus with signs suggestive of vascular compromise of the herniated part of the stomach. She subsequently underwent emergent laparotomy, repair of the hiatal hernia, and partial gastrectomy and gastropexy. Post-surgical biopsy findings showed focal mucosal necrosis and ulceration, focal foveolar hyperplasia, edematous changes, and overall congestion in the submucosal tissue. She was discharged five days later with no complications or recurrence of symptoms.

Isolated Superior Mesenteric Artery Dissection: A Rare Etiology of Colic Ischemia.

Although isolated superior mesenteric artery dissection is a rare disease entity, it possesses high mortality. The pathophysiology remains a mystery. In this case, we report a 68-year-old male with compromised coronary circulation been evaluated for coronary artery bypass surgery (CABG) and who developed a sudden, localized, right-sided abdominal pain. It was diagnosed on a computer tomography arteriogram (CTA), revealing a short segmental dissection involving the superior mesenteric artery (SMA). Vascular surgery was consulted and the decision was made to conservatively manage this patient's condition with anticoagulation. He was seen subsequently in the outpatient setting with a resolution of abdominal pain and a repeat computer tomography scan of the abdomen revealed resolution of previously seen colitis changes. Abdominal discomfort is a common complaint for which patients are seen in a variety of therapeutic settings, it is critical to bring attention to this case in order to raise awareness of the possibility of isolated SMA dissection as one of the underlying causes.

Gastric Glomus Tumor Presenting With Gastrointestinal Bleed and Pulmonary Embolism: A Rare Entity With Management Dilemma.

Glomus tumors are rare neoplasms originating from smooth muscle cells of the glomus body. They rarely involve the gastrointestinal tract, and when they do, they present as acute gastrointestinal bleeds with symptoms such as hematemesis or melena. We present a rare case of a gastric glomus tumor in a 50- year- old male presenting with shortness of breath and gastrointestinal bleed requiring transfusions. Coincidently, he was also found to have a pulmonary embolism that usually would require anticoagulation, which was contraindicated in an active gastrointestinal bleed. He eventually required an inferior vena cava (IVC) filter and underwent a partial gastrectomy. Due to gastric glomus tumor being a rare entity, there is a paucity of data to have a classification and grading or staging system, and tumors are usually considered benign. The exact diagnosis is dependent on histopathological findings as it can mimic a gastrointestinal stromal tumor (GIST). Pulmonary embolism, a common phenomenon, can often be seen in patients with malignancy. Our patient was diagnosed with a glomus tumor which is usually benign. As per our literature search, there are no documented cases of GGT with concomitant Pulmonary embolism diagnosis that would point to a causal association.

Hyperlipidemia: A Review of the Novel Methods for the Management of Lipids.

Hyperlipidemia is the most common modifiable cause of atherosclerotic cardiovascular disease. Our understanding of managing hyperlipidemia has led us to the concept of the inverse correlation of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein (non-HDL) cholesterol with the advent of a major adverse cardiovascular event. This review will provide an overview of lipids and their metabolism. Additionally, it will focus on hyperlipidemia and approaches to its management.

Mimicking an Intraluminal Lesion: A Case Report on Mantle Cell Lymphoma.

Mantle cell lymphoma is typically an aggressive, rare form of non-Hodgkin lymphoma that arises from cells originating in the "mantle zone." Here, we describe a case of mantle cell lymphoma associated with gastrointestinal bleeding, which was worked up as a possible gastrointestinal lesion or intraluminal pathology. The patient presented with symptomatic microcytic anemia associated with a positive guaiac fecal test. However, after an extensive workup to elucidate the symptomatic anemia's etiology, mantle cell lymphoma associated with a positive guaiac test was the culprit. Usually, mantle cell lymphoma is diagnosed at a later stage involving the bone marrow and gastrointestinal tract.