Digestive System Diseases Commons^™

Navigating Complex Esophageal Perforations: A Case-Specific Approach To Successful Outcomes, Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S. Brar

HCA Healthcare Journal of Medicine

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the …

Severe Gastritis Mimics Acute Coronary Syndrome With Elevated Cardiac Enzymes, Michael Rollins, Laura Preece, Micheline Tantchou

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Biliary Obstruction From An Unexpected Source, Max Dinicola, Trevor Link, Derek Welch

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Oral N-Acetylcysteine In Hepatitis C - Induced Acute Liver Injury: A Case Report, Mohammed Irfan Khan, Shuchita Jhaveri, Renu Thomas, Kevin Garnepudi, Galvin Dhaliwal, Ahmed Ouni, Shane P. Sweeney, Julian Nguyen

Gulf Coast Division GME Research Day 2026

No abstract provided.

Immune Checkpoint Inhibitor-Induced Colitis, Alexis Lopez Cruz, Praise Ohabor, Zuhair Ali

Gulf Coast Division GME Research Day 2026

No abstract provided.

Colonic Perforation In A Patient On Glp-1 Agonist Therapy: A Case Report, Mohammed Irfan Khan, Shuchita Jhaveri, Azad Patel, Bilal Ashraf, Ahmed Ouni, John Paek, Sivatej Sarva

Gulf Coast Division GME Research Day 2026

No abstract provided.

Herbal Healing Gone Wrong: Herb-Induced Hepatitis Masquerading As Autoimmune Liver Disease, Sacha Saba, Mahi Basra, Andrew Ondracek, Roxana Bodin

West Florida Division GME Research Day 2026

No abstract provided.

Artificial Intelligence-Based Prediction Of Mortality In Acute-On-Chronic Liver Failure: A Systematic Review Of Prognostic Models, Pradeep Rajbhandari, Lawrence San Jose, Mohammad Mahfouz, Michael Waxman

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Pyoderma Gangrenosum As An Initial Presentation Of Rheumatoid Arthritis & Inflammatory Bowel Disease, Julian Reoyo, Jennifer Cucalon, Milton Alexis Torres, Toni Feghali, Francia Guerrero, Joseph Pino, Shahid Sulaiman

West Florida Division GME Research Day 2026

No abstract provided.

Case Report: Primary Recurrent Gallstones Following Cholecystectomy, Gabriel Noguera, Nimal Patel

West Florida Division GME Research Day 2026

No abstract provided.

From Peg To Perfusion: A Case Of Malnutrition Reversed By Mesenteric Revascularization, Sacha Saba, Mahi Basra, Alvin Newman Caro, Vikas Sethi, Marc Kudelko

West Florida Division GME Research Day 2026

No abstract provided.

An Unusual Source Of A Lethal Pathogen: Paeniclostridium Sordellii Bacteremia In Acute Cholecystitis, Myrna Garcia, Leena Algarin, Olutoyin Abitoye, Rachel Gnanaprakasam

North Texas GME Research Forum 2026

Paeniclostridium sordellii is a spore-forming, gram-positive, anaerobic bacilli known for its highly virulent toxin production, often leading to fulminant sepsis and shock. It is most commonly associated with gynecologic infections and necrotizing soft tissue infections associated with intravenous drug use. However, reports of P. sordellii bacteremia in the setting of gall bladder infections are quite rare. This case report highlights an unusual presentation of P. sordellii infection with bloodstream infection originating from acute cholecystitis, demonstrating a non-fulminant clinical course and successful treatment with ceftriaxone.

Ashwagandha-Associated Liver Injury: A Systematic Literature Review, David Teplitsky, Jacob Sebaugh, Danielle Ford, Rashid Syed

North Texas GME Research Forum 2026

Background: Ashwagandha (Withania somnifera), an herb with origins in Ayurvedic medicine, has recently grown in global popularity due to its reported stress- and anxiety-relieving properties. While generally regarded as safe, emerging cases in medical literature have raised concern for its ability to cause drug- or herb-induced liver injury (DILI/HILI). As use of this supplement rises, it is particularly important to characterize ashwagandha’s potential hepatotoxicity.

Methods: Cases of ashwagandha-induced liver injury were collected by accessing PubMed, Europe PMC, Google Scholar, and the HCA Healthcare Library and searching combinations of the terms “liver” or “hepatic” and one of the following names for …

Salvage Percutaneous Spyglass-Assisted Lithotripsy Via A Cholecystostomy Tract After Failed Ercp: A Case Report, Nicholas Gerden, Tiffany Hong, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

IR-driven percutaneous cholangioscopy with SpyGlass-assisted lithotripsy is an emerging salvage technique for biliary stone disease in patients with failed or contraindicated endoscopic retrograde cholangiopancreatography (ERCP) due to complex anatomy. We report an 85-year-old patient with an indwelling cholecystostomy tube and biliary stent who presented with recurrent obstructive jaundice, with cholangiography demonstrating occlusion of the common bile duct stent due to choledocholithiasis. Conventional ERCP was unsuccessful because of complex biliary and gastrointestinal anatomy. A multidisciplinary interventional radiology–gastroenterology approach was therefore pursued, utilizing antegrade percutaneous choledochoscopy through an existing cholecystostomy tract with SpyGlass-assisted lithotripsy, followed by cholecystostomy tube exchange. The procedure resulted …

Extra-Intestinal Clostridioides Difficile Abscess In A Small Bowel Gist: A Rare Tumor-Associated Complication, Nicholas Gerden, Pradip Gautam, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

Extra-intestinal infections caused by Clostridioides difficile are exceedingly rare and typically occur in settings that disrupt the gastrointestinal barrier, including recent gastrointestinal surgery, bowel perforation or microperforation, and severe colonic disease.

We present the case of a 75-year-old man with abdominal pain and hemoperitoneum in the setting of a suspected small bowel leak secondary to an intestinal mass. Computed tomography angiography revealed an 11.0 × 9.6 cm pelvic fluid collection, prompting exploratory laparotomy with drainage of a pelvic abscess and evacuation of hemoperitoneum. Intraoperatively, a small bowel perforation caused by a 4.4 cm gastrointestinal stromal tumor (GIST) was identified. Operative …

Operative Localization Of Occult Gastrointestinal Bleeding Using Intraoperative Small Bowel Endoscopy, Shuda Xia, Furrukh Jabbar, Muhammad T. Siddique

North Texas GME Research Forum 2026

No abstract provided.

Diagnostic Complexities In Patients Presenting With Peritoneal Tuberculosis: A Case Report, Christina Mie Minami, Bailey Weidner, Tyler Mcvay

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Sudden Onset Idiopathic Necrotizing Pancreatitis Unmasking Undiagnosed Advanced Cirrhosis, Maikel Tawadrous, Mohammad Mahfouz, Aradhana Pandey, Namin Farid

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Histotripsy In Liver Tumors: A Non-Thermal, Cavitation Platform Redefining Precision Ablation And Immuno-Oncology Synergy, Subuhee Ahmed, Shahzaib Maqbool, Pradeep Rajbhandari, Mohamad Mahfouz, Maikel Tawadrous

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Multifocal Gastrointestinal Diffuse Large B-Cell Lymphoma Initially Resembling Crohn’S Disease, Mary Moussa, Durga A. Kumar, Vikas Sethi, Alvin Boyd Newman-Caro, Christopher Halleman, Michael Schulman

West Florida Division GME Research Day 2026

No abstract provided.

Gastrointestinal Ebv In Immunosuppressed Hosts: A Case Of Ptld After Kidney Transplant, Mary Moussa, Baylen Shoemaker, Vikas Sethi, Alvin Boyd Newman-Caro, Rakhee Shah, Patricia Chun, Michael Schulman

West Florida Division GME Research Day 2026

No abstract provided.

White Plaques With High Stakes: A Case Of Esophageal Leukoplakia, Boney Lapsiwala, Ritika Sharma, Karthik Kasireddy, Devika Pavuluri, Rupali Prabhukhot, Amjad Awan

North Texas GME Research Forum 2026

Introduction: Esophageal leukoplakia, also termed esophageal epidermoid metaplasia (EEM), is a rare esophageal epithelial disorder characterized by keratinized squamous plaques on esophagogastroduodenoscopy (EGD). With a prevalence of < 0.5%, it is often incidentally identified during evaluation for nonspecific upper gastrointestinal symptoms. EEM is considered a premalignant condition due to its association with esophageal squamous cell carcinoma (SCC), yet management and surveillance strategies remain undefined.

Case Presentation: A 65-year-old woman with hypothyroidism, hypertension, hyperlipidemia, and remote aplastic anemia treated with bone marrow transplantation 35 years prior presented with chronic cough and progressive dysphagia to solids and liquids. She denied tobacco, alcohol, or illicit drug use. No weight loss, abdominal pain, or blood in stool was noted. CT of the neck with contrast revealed curvilinear mucosal hyperenhancement involving the mid to distal thoracic esophagus without lymphadenopathy. Physical examination and …

Gastroparesis As Initial Feature Of Neuromyelitis Optica Spectrum Disorder, Jasmine M. Silva, Jorim J. Parmar, Shivani Gandhi, Sreevani Gudiseva

North Texas GME Research Forum 2026

No abstract provided.

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

Esophageal Squamous Cell Carcinoma Incidentally Detected On Barium Swallow: A Case Report, Muhammad Rubeel Akram, Aditya Rao, Muhammad T. Siddique

North Texas GME Research Forum 2026

Background: Esophageal cancer is an aggressive malignancy with a poor prognosis, and has high rates of recurrence despite curative-intent therapy. While endoscopy with biopsy remains the gold standard for diagnosis, non-diagnostic imaging studies are performed when evaluating for dysphagia, and may bring to light underlying pathology, warranting further workup. Surgical resection following neoadjuvant chemoradiation is often performed, but postoperative complications and disease recurrence are important concerns. This case highlights the crucial role of early detection via imaging and the clinical burden associated with esophageal squamous cell carcinoma.

Case Presentation: A 76-year-old female presented with dysphagia and underwent a barium esophagogram, …

A Not So Typical Case Of Alcoholic Pancreatitis, Wendy Phillips, Kaleem Munazzah, Asad Rehman, Robert Keller

North Texas GME Research Forum 2026

BACKGROUND Acute pancreatitis (AP) has become one of the leading gastrointestinal diagnoses resulting in inpatient hospitalization¹. AP is diagnosed by meeting two of three criteria: characteristic clinical presentation, biochemical evidence (elevated lipase or amylase levels), and imaging findings with pancreatic inflammation. Gallstones and heavy alcohol use account for most cases (40%–70% and 25%–35%, respectively). Hypertriglyceride induced AP (HTG-AP) accounts for only about 7-10% of AP cases³ and often tends to present in younger, male, obese, patients with a higher rate of diabetes¹. Below we present a unique case of a coinciding alcoholic and HTG - AP in an otherwise healthy …

Intestinal Tuberculosis Masquerading As Crohn’S Disease: A High-Risk Diagnostic Mimic, Maikel Tawadrous, Tejaswi Vadde, Subuhee Ahmed, Lawrence San Jose, Chelsea Curry, Aradhana Pandey

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

"Qt Okay, Bowel Not Okay"- Dofetilide Masking An Evolving Small-Bowel Obstruction, Tejaswini Yeshala, Pankti Shah, Syed Ali Abidi, Archana Machavarapu

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

A Histopathological Mystery: A Rare Atypical Feature Of Microscopic Colitis, Mohammad Mahfouz, Pratyush Kumar, Kumar Abhishek, Archana Machavarapu

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Turning Yellow On Rhythm Control: Dofetilide And The Unexpected Cholestatic Storm, Tejaswi Vadde, Mohammad Mahfouz, Prithvi Basu Roy, Subuhee Ahmed, Archana Machavarapu, Chelsea Curry

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.