Gastroenterology Commons^™

A Challenging Diagnosis Of Intestinal Tuberculosis Mimicking Crohn's Disease, Justin Sanchez, Gabriel Gonzales, Monte Troutman

North Texas GME Research Forum 2024

Intestinal tuberculosis (ITB) is an underrecognized disease that shares many clinical, radiologic, endoscopic, and pathologic features with Crohn's disease, making differentiation difficult. This poses a significant problem as initiation of immunosuppressives for an assumed diagnosis of CD in a patient with ITB can lead to exacerbation of infection and life-threatening consequences. A 30-year-old Nepali man with a medical history only significant for Raynaud disease presented with a febrile illness, right lower quadrant abdominal pain, and productive cough over the course of a month. He immigrated from Nepal 3 years prior to presentation, denying other risk factors or specific symptoms of …

A Case Report And A Review Of Pediatric Hepatoblastoma, Anthony D. Derenzi, Audrey Bowen

HCA Healthcare Journal of Medicine

Introduction

Hepatoblastoma is a rare pediatric cancer. Approximately 100 cases of hepatoblastoma are reported per year. Due to the limited incidence of this disorder an internationally agreed- upon criteria was developed to classify patients as standard or high-risk. Studies involving chemotherapeutic agents, surgery, and liver transplants have been demonstrated to improve the disease-free survival rate. The combination of chemotherapeutic agents and surgery demonstrated the ability of these regimens to downgrade the initial diagnostic staging of tumors and transform previously unresectable tumors into resectable tumors.

Case Presentation

The following case of hepatoblastoma presents a 4-year-old male who presented to the emergency …

Proton Pump Inhibitor Use And Adverse Effects In South Atlantic Hospitals, Nicholas D'Angelo, Ramyar Sigarchy, Anthony Esswein, Sidra Asrar

HCA Healthcare Journal of Medicine

Background

Proton pump inhibitors (PPI) have transformed the management of acid-related gastrointestinal disorders, becoming one of the top-selling medications in the United States. There is no doubt that PPIs have a significant therapeutic impact on patients with gastroesophageal reflux disease and gastrointestinal bleeding. However, evidence is mounting that PPIs are overprescribed, leading to more patients possibly experiencing adverse effects. There is a great deal of ongoing debate surrounding the significance and impact of these adverse effects.

Methods

We conducted a study in 9 HCA hospitals in the southeastern United States to determine the number of patients who started on PPIs …

Acute Esophageal Necrosis And Duodenal Disease In The Setting Of Recently Initiated Chemotherapy, Kulveer Dabb, Ryan Jansen Van Rensburg, Heba Yusuf, Daniel Klein, Alexander D. Lake, Mohamed Kaif

HCA Healthcare Journal of Medicine

Introduction

Acute esophageal necrosis (AEN), commonly referred to as “black esophagus” or Gurvits syndrome, is a rare condition characterized by diffuse black mucosa in the distal esophagus. Most often, the patient is an older male with multiple comorbidities, presenting with upper gastrointestinal bleeding. The exact pathogenesis is unclear, but it is often thought to be secondary to acute vascular hypo-perfusion or ischemia of the esophageal mucosa in critically ill patients with certain secondary comorbid conditions such as renal insufficiency, diabetes mellitus, dyslipidemia, coronary artery disease, malnourishment, alcohol abuse, or association with an underlying malignancy.

Case Presentation

We present a case …

Adenocarcinoma Of The Transverse Colon Presenting As Anterior Abdominal Wall Abscess, Jenn Klein, Nima Avin, Sunil Gandhi

HCA Healthcare Journal of Medicine

Introduction

Locally invasive colon carcinoma comprises a small fraction of the incidence of colon carcinoma. Complications, such as perforation and obstruction, can occur in less than 0.5% of cases and often present differently based on location.

Case Presentation

We present a case of an 85-year-old woman who presented with an acute abdominal wall abscess which was caused by perforation of transverse colon carcinoma.

Conclusion

En-bloc resection increases 5-year survival, and adjuvant chemotherapy reduces the risk of recurrence in patients with stage II resectable colon carcinoma.

Disrupted Pancreatic Duct With Necrotic Fluid Collection, Treated With Endoscopic Management, Amir Aghaabdollah, Kelly Volland, Anabel Rodriguez Loya

West Florida Division GME Research Day 2023

No abstract provided.

A Retrospective Look At Visceral Manipulation On Gastrointestinal Complaints In An Inpatient Setting, Fletcher Eldemire, Adithi Vemuri, Marcey Wright, Daniel Breznau

West Florida Division GME Research Day 2023

No abstract provided.

Acute Esophageal Necrosis Following Acetaminophen Overdose: An Unreported Cause Of Black Esophagus, Karolina N. Dziadkowiec, Renuka Reddy, Akiva J. Marcus

HCA Healthcare Journal of Medicine

Acute esophageal necrosis (AEN), also known as “black esophagus” or Gurvits syndrome, is an uncommon finding with an unclear etiology and pathogenesis. This condition often presents as an upper gastrointestinal bleed in older men with multiple comorbidities. AEN is characterized by circumferential black, necrotic mucosa in the esophagus. We present a case of AEN following acetaminophen overdose. The patient was ultimately discharged from the hospital with oral omeprazole twice daily, a clear liquid diet, and a recommendation for follow-up in the outpatient setting for repeat EGD in 4 to 6 weeks. Acetaminophen overdose, although a rare cause, must be considered …

Colonic Migration Of A Nephroureteral Stent Through A Colovesical Fistula, Nicholas Pigg, Kevin Carr, Julio Zayas, Eduardo Franca

HCA Healthcare Journal of Medicine

We describe a case of a patient with a two-year history of prostate cancer who underwent placement of nephroureteral stents. He subsequently presented to the hospital with complications from prolonged retention of the stents, which ultimately lead to a secondary diagnosis of adenocarcinoma of the rectum. A colonoscopy performed approximately two weeks after a bilateral nephroureteral tube exchange demonstrated what was believed to be locoregional metastatic disease and a fistulous connection with the distal nephroureteral stents. Radiographic features of this complication are discussed together with proper management and possible complications of distal nephroureteral stents. Both nephroureteral stents were explanted, and …

A Rare Presentation Of Bilateral Bochdaleck Congenital Diaphragmatic Hernia, A Case Study, Manuel Britto, Sean Michael, Sofia I. Cartaya, Bernard Alfredo Cartaya

HCA Healthcare Journal of Medicine

Introduction

Congential diaphragmatic hernias (CDH) are a rare process that have a prevalence of 1–4 cases per 10,000 live births, and of these, bilateral Bochdalek congenital diaphragmatic hernias are even rarer entities that occur in about 1% of cases. This finding is rarely documented in literature. This paper offers a detailed methodical timeline documentation of the events that occurred after delivery and includes how to approach the diagnosis and management of such a rare and volatile condition.

Presentation

The neonate was born at 35 weeks and 6 days gestation. Unfortunately, despite intensive cardiopulmonary resuscitation efforts, the neonate expired within less …

Hydrogen Peroxide Colitis: The Accidental Enema, Ramin Karimi, Ashish Sharma, Kevin Tran, Sebastian Montgomery

HCA Healthcare Journal of Medicine

Chemical colitis is defined as inflammation of the large intestine or colon as a result of exposure from a harsh chemical through an enema or other procedure. In this case, the chemical is hydrogen peroxide, which is commonly used as an antiseptic for minor abrasions. Hydrogen peroxide enemas were once popular for difficult to treat constipation. However, resultant colitis and proctitis limited its use. When administered rectally in a high enough concentration, intense abdominal pain and transient bloody diarrhea can occur, with the majority of affected patients making a full recovery with supportive management. Here we discuss a case of …

Intestinal Dysbiosis Disguised As A Rectal Fistula Treated With Autologous Fecal Microbiota Transplantation, Nicolina Scibelli, Pratishtha Singh, Kathleen Raynor

South Atlantic Division GME Research Day 2021

No abstract provided.

Gastric Antral Diverticula: A Rare Diverticula With A Unique Presentation, Pratishtha Singh, Kathleen Raynor, Chadley Froes

Gastroenterology

Gastric diverticula are the least common gastrointestinal diverticula. Patients can be diagnosed incidentally on EGD or present with variable symptoms such as abdominal fullness, anorexia, and perforation. Gastric diverticula can be acquired from malignancy, peptic ulcer disease, or prior surgery or be congenital. Treatment varies based on symptomatology ranging from conservative medical management with proton pump inhibitors to surgical treatment with open or laparoscopic resection. We present a case of a 73-year-old female with acquired gastric diverticulum presenting as a gastric outlet obstruction who was successfully treated with conservative medical therapy.

Trichobezoer: An Unusual Presentation With Congestive Heart Failure, Madeeha Malik, Fatima Javed, Bassam Helou, Furrukh Malik

HCA Healthcare Journal of Medicine

Trichobezoars are impactions of hair that accumulate in the gastrointestinal track and are most often located in the stomach. They are often associated with psychiatric illnesses like trichotillomania and trichophagia, which usually occurs in young and adolescent females. Gastric trichobezoars (GT) are the most common variety of bezoar found in the stomach. The most common complications that arise alongside GT include gastric erosion, ulceration or perforation of the small intestine. Gastric outlet obstruction, obstructive jaundice, pancreatitis and death have been reported, though these complications are rare. We report a 40-year-old female who presented to the hospital with dyspnea on exertion …

Case Of Enterococcus Cecorum Human Bacteremia, United States, Alexander D. Lake, Ryan Fields, Francia Guerrero, Yousef Almuzaini, Koravangala Sundaresh, Joseph Staffetti

HCA Healthcare Journal of Medicine

Enterococcus cecorum rarely serves as a human pathogen, and only 6 cases of this microbe inoculating humans have been documented. We present an elderly female with a marked vascular history presenting with epigastric pain and diarrhea, followed by shaking chills. Laboratory findings revealed leukocytosis, with imaging showing diffuse colonic thickening. She had a bout of bloody diarrhea, raising the likelihood of ischemic colitis with her vascular history. To our surprise, both sets of blood cultures drawn on admission grew Enterococcus cecorum. This case is unique as it is the first documented case of E. cecorum human infection in the …

Goblet Cell Carcinoma Of The Appendix: A Case Report On Goblet Cell Carcinoid, Sheliza Kabani, Aubtin Saedi, Austin Lehr, Lina O'Brien

HCA Healthcare Journal of Medicine

Goblet cell carcinoid of the appendix is a rare neoplasm with histological features of both neuroendocrine and adenocarcinomas. The combination of its aggressive behavior, infrequent occurrence, and variable clinical presentation convolutes the management of this tumor. We report the case of a 75-year-old female presenting with acute appendicitis. A laparoscopic appendectomy was performed. The pathology report showed goblet cell carcinoid at the base of the appendix with involvement of the proximal surgical margins. At her postoperative visit, the patient’s pathology report and options for management were reviewed, and the patient agreed to proceed with a right hemicolectomy 8-10 weeks after …

Type Iii Gastric Neuroendocrine Tumor: Case Report Of A Rare Gastric Carcinoma, Christopher L. Orpiano, Michael Quinn, Gurjeet Kang, Aric Tucker, Aric Tucker, Lakshminarasimhan Venu, Joseph Staffetti

Gastroenterology

No abstract provided.

Early Aggressive Hydration Is Associated With Decreased Opioid Use And Readmission In Mild Acute Pancreatitis, Shreyans Doshi, Hong Liang, Hale Z. Toklu, Selina Fritze, Sue-Wei Luu

HCA Healthcare Journal of Medicine

Background: Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement.

Objective: In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP.

Methods: Retrospective data from patients admitted to 12 hospitals (2015–2017) was used for analysis. Five hundred patients who …

Gastroesophageal Reflux Disease: A General Overview, Julia Fashner

HCA Healthcare Journal of Medicine

Gastroesophageal reflux disease (GERD) varies in presentation and the patient’s symptoms of regurgitation in the throat or epigastric pain do not necessarily correlate with the severity of their disease. This general overview of GERD will include information on guidelines and diagnostic testing; lifestyle, medical and surgical management; and GERD in special populations. The pathophysiology of GERD is multifactorial, and a step-wise approach will assist physicians in making the diagnosis as GERD has a significant financial burden to the U.S. healthcare system.

Neuroendocrine Tumor Of The Gallbladder, A Rare Incidental Finding, Alvaro Frometa, Yasna Chaudhary, Omar Ansari, Nigel Jagoo, Iqbal Kapadia

HCA Healthcare Journal of Medicine

Background: Neuroendocrine tumors are a rare finding in the gallbladder. The incidence of this entity in the gallbladder is roughly 1.13 cases per 100,000 in the US, with a steady increase in the last decade. Gallbladder neuroendocrine tumors are generally asymptomatic; the majority of cases have been reported as incidental findings in specimens, resected due to secondary symptomatology, such as chronic cholecystitis. Treatment strategies are limited, in part due to the often advanced stage in which this disease presents. Furthermore, there is a restricted utility of diagnostic tools for early detection; these factors contribute to the poor prognosis of this …

Internal Hernia As A Late Complication Of Roux-En-Y Gastric Bypass Procedure, Samantha Purton, Gabriel Meshekow, My Myers, Edgar Mercado, Allan Katz

West Florida Division GME Research Day 2020

As the prevalence of obesity continues to rise, so does the popularity of bariatric surgery. Previously the Roux-en-Y gastric bypass was the most common bariatric procedure, but now falls second to the gastric sleeve. It remains a relevant procedure, however, accounting for 17% of bariatric procedures in 2018. Due to its prevalence, it is important that the radiologist be familiar with the procedure and its complications such as leak, obstruction, stricture, or, as in this case, internal herniation through a mesenteric defect. Internal hernias are more commonly associated with the laparoscopic approach versus open. This is likely due to fewer …

A Rare Cause Of Pneumoperitoneum, Robert Zusman, George Michael, Anna E. Augustin, My Myers, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

Pneumoperitoneum is most commonly associated with a perforated viscus. When free air is seen on imaging, the most common course of action is an emergent exploratory laparotomy. However, pneumoperitoneum may not always be indicative of a perforated bowel. In the case described below, we will discuss a patient who developed acute peritonitis and pneumoperitoneum after undergoing chest compressions during cardiopulmonary resuscitation (CPR) and positive pressure mechanical ventilation.

A Rare Case Of Perforated Jejunal Diverticulitis, Mohamed Nagi Md, Stanley Deturris Md, Ang Darwin

General Surgery

Introduction: Jejunal diverticulosis is a rare condition with clinical incidence of 0.5%. It is less common than colonic and duodenum diverticulosis. It is usually asymptomatic and diagnosed incidentally but it may cause chronic symptoms and acute complications. The aim of the case report to increase the awareness about the disease Case Report: This is a 56-year-old Caucasian male who presented with abdominal pain and fever and was diagnosed with transverse colon diverticulitis with microperforation on CT scan. Patient was treated nonoperatively with antibiotics and was discharged home. Two months later, he presented with similar recurrent abdominal pain and was found …

Bradycardia In The Setting Of Gastric Sarcoidosis, Kameron Black Mph, Michelle Levine Do, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Metastatic Leiomyosarcoma Presenting As Polycystic Liver Disease, Michael Burkholz Do, Apurva Modi Md

Gastroenterology

No abstract provided.

Pantoprazole Continuous Infusion Versus Intermittent Bolus For Gastrointestinal Bleed Prior To Esophagogastroduodenoscopy (Egd), Vy Dang Pharmd, Mickayla Clark Pharmd, Bcps, Kartika Shetty Md, James Hwang, Pinak Shah, Scott J. Anderson

Gastroenterology

Purpose: Practice guidelines recommend patients with non-variceal upper gastrointestinal (GI) bleeds who have a high risk of active bleeding, nonbleeding visible vessels, and adherent clots should be given proton pump inhibitors (PPIs) intravenous (IV) bolus followed by continuous infusion after esophagogastroduodenoscopy (EGD). The use of PPIs before EGD has shown to reduce the requirement for EGD, however, there are no studies evaluating the difference in outcomes of continuous infusion PPI versus intermittent IV bolus PPI prior to EGD. The objective of this study is to evaluate clinical outcomes of continuous infusion PPI versus intermittent IV bolus PPI prior to EGD. …

Bone Metastasis In Appendicular Skeleton: Rare Occurrence In Colorectal Cancer, Pratikkumar Vekaria Md, Chandrika Raiyani Md, Ravis Patel Md, Devin Vaishnani Md, Tejas Raiyani Md

Gastroenterology

Colorectal cancer (CRC) is considered as preventable cancer if diagnosed in the early stage. It is also second leading cause of death from cancer in US. Bone metastases (BM) is uncommon presentation with CRC and if it occurs, it involves axial skeletal more than extremities. Many case studies also reports that survival after BM is considerably poor than without BM. Cancer type and genetic mutations also play an important role in such metastasis.

Gastroenterology, A Guiding Light In Hemophagocytic Lymphohistiocytosis, Sahityan Viswanathan, Jeffrey Capati, Long T. Hoang

Gastroenterology

No abstract provided.

Double Pylorus: Case Report Of Atypical Presentation, Christopher Lozano Orpiano Do, Gurjeet Kang Do, Michael Quinn Do, Lakshminarasimhan Venu Md, Joseph Staffetti Md

Gastroenterology

Introduction: Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies, consisting of a gastroduodenal fistula extending from the prepyloric gastric antrum to the duodenal bulb through an accessory channel. In the majority of cases, it is a complication when peptic ulcers erode and create a fistula between the duodenal bulb and the distal stomach. It usually presents on the lessor curvature of the gastric antrum and on a superior wall of the duodenal bulb. It is commonly an endoscopic finding, since clinical presentation is similar to other peptic diseases.

Case …

Salivary Gland Choristoma: A Rare Finding At Gastroesophageal Junction, Isin Y. Comba Md, Richard Henriquez Md, Sundeep Kumar Md, Hilda Merino-Chavez Md, Maria Wallis-Crespo Md, Christopher Cooper Md, Lakhinder Bhatia Md

Gastroenterology

Introduction: Choristoma is tumor-like outgrowth of heterotopic and mature tissue located at anatomically unusual sites. Heterotopic salivary gland tissue (HSGT) has been most commonly described in head and neck region but can rarely involve gastrointestinal (GI) tract with a few cases reported in the literature.

Case Description/Methods: An 87-year-old female with past medical history of gastroesophageal reflux disease (GERD), hypertension, and chronic kidney disease was admitted for an acute DVT. Due to worsening anemia, she underwent an upper endoscopy that showed a small nodularity at the GE junction (figure 1a), a large hiatal hernia, and reflux esophagitis in the lower …