Digestive System Diseases Commons^™

Case Report: Adult Distal Lleal Perforation Mimicking Meckel's Diverticulum, Dip Patel, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, but clinically significant disease in adulthood is uncommon and often difficult to diagnose before surgery. In adults, symptomatic Meckel’s most often presents with obstruction, bleeding, or inflammation, and cross-sectional imaging may not clearly distinguish it from other distal ileal processes.

We report the case of a 35-year-old man who presented with several days of fever, abdominal pain, vomiting, and diarrhea. CT imaging suggested a complicated distal ileal diverticular process, most concerning for perforated Meckel’s diverticulum with an adjacent abscess. He underwent emergent small bowel resection and abscess drainage. …

Title: Impact Of Hypertriglyceridemia ≥500 Mg/Dl On Acute Pancreatitis Outcomes: A Propensity Score–Matched Cohort Study, Jashanveer S. Johal, Bianca Patel, Mahmoud Al-Bataineh, Archana Salek, Om Patel, Jason Hyman, Yecheskel Schneider, Abdallah Hussein

Rowan-Virtua Research Day

Background: Hypertriglyceridemia is a recognized cause of acute pancreatitis, but the prognostic impact of markedly elevated triglycerides (TG) on clinical outcomes remains unclear. We evaluated whether TG ≥500 mg/dL at presentation predicts worse pancreatitis outcomes.

Methods: Using the TriNetX multicenter electronic health record network, adults hospitalized with acute pancreatitis and a TG measurement within 48 hours of admission between 2018–2024 were identified. Patients with TG ≥500 mg/dL were compared with those with TG < 500 mg/dL after 1:1 propensity score matching on demographics and comorbidities (n=7,014 per group). Primary outcomes included ICU stay, pancreatic complications, need for procedure, and all-cause mortality. Secondary outcomes included acute renal failure, cardiovascular events, repeat pancreatitis, infection, and liver failure. Odds ratios (OR) with 95% confidence intervals were estimated.

Results: Compared with TG < 500 mg/dL, patients with TG ≥500 mg/dL had higher risks of ICU admission (25.3% vs. 17.2%; OR 1.63), pancreatic complications (5.3% vs. 4.5%; OR 1.19), and mortality (4.6% vs. 3.3%; OR 1.39). Need for procedural intervention was lower in the high-TG group (1.2% vs. 3.6%; OR 0.34). Secondary outcomes including acute renal failure (15.5% vs. 10.7%; OR 1.54), repeat pancreatitis (58.6% vs. 51.9%; OR 1.31), and infection (13.7% vs. 12.0%; OR 1.17) were all significantly elevated. Cardiovascular events and liver failure did not differ significantly.

Conclusions: TG ≥500 mg/dL in acute pancreatitis was associated with greater ICU utilization, complications, and mortality, but lower procedural intervention rates. Admission triglyceride …

Case Report: Vancomycin-Resistant Enterococcus Faecium Urinary Tract Infection With Stercoral Colitis Presenting In An Elderly Patient, Muhammad Zain Raza, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 76-year-old female who presented with altered mental status characterized by confusion, decreased verbal interaction, and reduced responsiveness noted by her spouse. The patient had a history of chronic constipation and was brought from home for further evaluation. Initial evaluation raised concern for infection or intracranial hemorrhage as a possible cause of altered mental status. Imaging of the CT brain without contrast was unremarkable, however; abdomen and pelvis revealed a large rectal stool impaction with rectal wall thickening and surrounding perirectal fat stranding consistent with Stercoral Colitis. Urine culture subsequently identified vancomycin-resistant enterococcus faecium. The …

Case Report: Ascending Cholangitis Presenting As Sepsis With Encephalopathy In An Older Adult With Choledocholithiasis, David Marconi, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Acute cholangitis is a potentially life-threatening biliary infection usually precipitated by ductal obstruction. In adults ≥80 years, classic right upper quadrant pain and jaundice may be absent and delirium may predominate, increasing the risk of diagnostic delay.¹

An 82-year-old woman presented with generalized weakness and altered mental status. She was febrile (101.9 °F [38.8 °C]) and tachycardic (113 beats/min) without hypotension. Laboratory testing demonstrated leukocytosis and marked cholestatic liver injury (total bilirubin 2.8 mg/dL, alkaline phosphatase 660 U/L) with hyperbilirubinemia and acute encephalopathy consistent with sepsis-associated organ dysfunction. Computed tomography and ultrasound suggested biliary obstruction and cholelithiasis; magnetic resonance cholangiopancreatography …

Refeeding Syndrome In A Person Experiencing Homelessness: A Case Report, James Espinosa, Jose Gerald Aragon, Md Fateha, Alan Lucerna

Rowan-Virtua Research Day

Refeeding syndrome (RFS) is a potentially life-threatening metabolic disturbance that occurs following nutritional reintroduction in severely malnourished individuals. It is characterized by rapid intracellular shifts of electrolytes—most notably hypophosphatemia—driven by insulin-mediated metabolic changes. Although commonly associated with eating disorders and chronic illness, RFS may also occur in socially vulnerable populations.

We report the case of a 64-year-old male experiencing homelessness who presented to the emergency department with weakness, muscle cramps, and confusion after resuming regular meals at a local shelter following prolonged minimal intake. Laboratory evaluation revealed severe hypophosphatemia (0.7 mg/dL), hypokalemia (3.0 mmol/L), and hypomagnesemia (1.2 mg/dL). Electrocardiogram demonstrated …

Gut Microbiota Dysbiosis In Down Syndrome: Implications For Gastrointestinal And Neurological Health, Ashlyn Mcclelland, Jennifer Lecomte, Wendy Aita, Andrea Iannuzzelli

Rowan-Virtua Research Day

Down syndrome (DS) is the most common autosomal aneuploidy and has strong associations with increased gastrointestinal, neurological, and immune disorders. Emerging evidence suggests that gut microbiota dysbiosis may play a prominent role in disorders of gut-brain interaction, including constipation and irritable bowel syndrome affecting over half of individuals with DS. This review examines how gut microbiota alterations can contribute to chronic systemic inflammation and neurological manifestations in DS. Included articles were published between 2014 and 2025 and evaluated microbiota composition, inflammatory markers, and gastrointestinal or neurological outcomes in human or animal models of DS.

Across seven studies, characteristic microbiome shifts …

Obesity Paradox In Post-Cholecystectomy Outcomes: A Bmi Class–Based Trinetx Analysis At 6 Months And 1 Year, Jashanveer S. Johal, Mahmoud Al-Bataineh, Bianca Patel, Archana Salek, Om Patel, Jason Hyman, Yecheskel Schneider, Abdallah Hussein

Rowan-Virtua Research Day

Background: Obesity is traditionally associated with higher perioperative risk, yet observational data suggest an "obesity paradox" in which obese patients experience comparable or better outcomes than non-obese peers. We evaluated the impact of obesity (BMI ≥30 kg/m²) and obesity class on post-cholecystectomy outcomes.

Methods: A retrospective cohort study was conducted using the TriNetX global federated network. Adults undergoing cholecystectomy with BMI < 30 kg/m² were propensity score–matched 1:1 to those with BMI ≥30 kg/m², yielding 81,048 patients per group. Primary outcomes included choledocholithiasis, procedural complications, need for ERCP, and ED/inpatient utilization; secondary outcomes included mortality, respiratory and cardiovascular complications, and upgrade of care. Outcomes were assessed at 6 months and 1 year. A prespecified subgroup analysis compared BMI 30–39 versus BMI ≥40 kg/m² (40,238 per cohort).

Results: Obese patients consistently demonstrated lower rates of major outcomes at both timepoints. At 1 year, BMI < 30 had higher risks of choledocholithiasis (9.1% vs. 8.0%; RR 1.13), procedural complications (3.8% vs. 3.1%; RR 1.22), ERCP (5.4% vs. 4.6%; RR 1.19), and ED/inpatient visits (30.3% vs. 28.8%; RR 1.05; all p< 0.001). Mortality was also higher in non-obese patients at 1 year (1.4% vs. 1.2%; RR 1.20). Within the obese subgroup, BMI 30–39 and BMI ≥40 had broadly similar complication and utilization rates, though 1-year mortality was lowest in class I–II obesity (0.8% vs. 1.0%; RR 0.85).

Conclusions: Obesity was associated with better post-cholecystectomy outcomes compared with BMI < 30 kg/m², supporting an obesity paradox in biliary surgery. BMI alone should not deter cholecystectomy, and perioperative risk stratification should incorporate factors beyond weight class.

Mental Health Comorbidities And Ibd Outcomes On Anti-Tnf Therapy, Jashanveer S. Johal, Mahmoud Al-Bataineh, Archana Salek, Bianca Patel, Om Patel, Jason Hyman, Yecheskel Schneider, Abdallah Hussein

Rowan-Virtua Research Day

Background: Depression and anxiety are prevalent in inflammatory bowel disease (IBD) and may adversely affect biologic therapy outcomes. We evaluated the impact of comorbid mood disorders on clinical outcomes among IBD patients treated with anti-TNF agents.

Methods: Using a global de-identified electronic health record network, adults with Crohn's disease or ulcerative colitis initiating an anti-TNF agent between 2018–2023 were identified. Cohort 1 included patients with a documented mood disorder (depression and/or anxiety) at or prior to anti-TNF initiation; Cohort 2 included those without mood disorders. Propensity score matching (1:1) on demographics and comorbidities yielded 9,605 patients per cohort. Primary outcomes …

Risk Of Colorectal And Gastrointestinal Neoplasia In Inflammatory Bowel Disease Treated With Adalimumab Versus Vedolizumab And Ustekinumab: A 5-Year Multicenter Retrospective Cohort Study, Jashanveer S. Johal, Archana Salek, Mahmoud Al-Bataineh, Bianca Patel, Abdallah Hussein, Om Patel, Jason Hyman, Yecheskel Schneider

Rowan-Virtua Research Day

Background: Inflammatory bowel disease (IBD) is associated with increased colorectal cancer (CRC) risk, but comparative neoplastic risks across biologic classes remain uncertain. We evaluated 5-year risks of CRC and GI neoplasia in IBD patients treated with adalimumab versus vedolizumab and ustekinumab using real-world data.

Methods: Using the TriNetX Global Collaborative Network, two parallel 5-year propensity score–matched cohort analyses were conducted among adults with Crohn's disease or ulcerative colitis initiating adalimumab, vedolizumab, or ustekinumab between 2018–2024, excluding patients with prior CRC or colectomy. The adalimumab–vedolizumab analysis matched 13,292 patients per cohort; the adalimumab–ustekinumab analysis matched 14,591 per cohort. Primary outcomes were …

Anesthetic And Perioperative Challenges Of End-Stage Liver Disease In Non-Hepatic Surgery: A Case For Score-Triggered Perioperative Protocols, Katarina Rusinak Bs, Christopher Hoffman Do, Cory Levitt Md

Rowan-Virtua Research Day

Introduction: End-stage liver disease (ESLD) significantly increases perioperative morbidity and mortality during non-hepatic surgery. Although validated risk stratification tools, including the Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, are available, their use frequently remains limited to quantifying risk without prompting standardized perioperative protocols. This case demonstrates that elevated cirrhosis-specific risk scores should function as triggers for enhanced preparation and multidisciplinary planning, following models established in other high-risk clinical contexts.

Case Report: A 43-year-old female with decompensated alcohol-related cirrhosis was scheduled for total thyroidectomy for papillary thyroid cancer, a procedure required for liver transplant eligibility. Preoperative evaluation revealed …

Adaptive Leggings For Crohn’S/Colitis/Isbs Patients With A Colostomy Bag, Sarah E. Liebbe

Apparel Merchandising and Product Development Undergraduate Honors Theses

As the prevalence of inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, continues to rise in the United States, an increasing number of individuals undergo colostomy or ileostomy procedures requiring the use of an ostomy bag (Crohn’s & Colitis Foundation, 2023). While these medical devices are essential for maintaining health and quality of life, they often introduce challenges related to clothing, including discomfort, lack of support, limited concealment, and restricted self-expression (Hubbard et al., 2019). Despite growing attention to inclusive design within the fashion industry, adaptive apparel for ostomy patients remains limited in availability, style, and affordability, leaving …

Adventitial Macrophage Accumulation Impairs Perivascular Nerve Function In Mesenteric Arteries With Inflammatory Bowel Disease, Elizabeth A. Grunz, Benjamin W. Jones, Olubodun Michael Lateef, Sidharth Sen, Katie Wilkinson, Trupti Joshi, Erika M. Boerman

Biomedical Sciences

Introduction: Inflammatory bowel disease involves aberrant immune responses and is associated with both cardiovascular disease risk and altered intestinal blood flow. However, little is known about how inflammatory bowel disease affects regulation of perivascular nerves that mediate blood flow. Previous work found perivascular nerve function is impaired in mesenteric arteries with Inflammatory bowel disease. The purpose of this study was to determine the mechanism of impaired perivascular nerve function.

Methods: RNA sequencing was performed on mesenteric arteries from IL10−/− mice treated with H. hepaticus to induce disease (inflammatory bowel disease) or left non-gavaged (Control). For all other studies, Control and …

Understanding The Role Of Toxs As A Bile Sensing Component Of The Toxrs Virulence Regulatory System In Vibrio Spp., Minje Kim

Dartmouth College Ph.D Dissertations

Pathogenic Vibrio bacteria, such as V. cholerae and V. parahaemolyticus, colonize in the human small intestine to cause severe gastrointestinal disease. During the infection, these bacteria encounter bile salts, antimicrobial cholesterol metabolites secreted into the intestine. Pathogenic Vibrio species have evolved to utilize bile salts as signals to regulate virulence. The signaling depends in part on ToxRS, a conserved co-component transmembrane transcription regulator. ToxRS consists of the transcription factor ToxR and its membrane-tethered binding partner ToxS. ToxS is required for ToxR stability and full transcriptional activity. Although bile salts are known to influence ToxRS-dependent virulence gene expression, the molecular …

Non-Surgical Pneumoperitoneum Following Vaginal Intercourse: A Case Report, Jessica Gocinski, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Case Report Of Carcinosarcoma Of The Ampulla Of Vater With A Monoclonal Histologic Variant, Peter D. Park, Christopher Oxner

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

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.

Colo-Ovarian Fistula Presenting As Tubo-Ovarian Abscess, Jessica Harper, Michelle Mieles, Kyle Biggs

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Reducing Surgical Site Infection After Colorectal Surgery: A Multidisciplinary Review Of Process Improvement, Robin Daemmrich, Quentin Dipasquale, Deborah Klepac, Nick Mathers, Travis Holloway

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Limited English Proficiency, Acculturative Stress, And Quality Of Life Among Korean American Patients With Chronic Hepatitis B, Hee-Soon Juon, Gilbert C. Gee, Julia G. Katcher, Daniel Yang, Katherine Smith, Ann C. Klassen

Department of Medical Oncology Faculty Papers

BACKGROUND: Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world and disproportionately affects Asian Americans, who are further impacted by the lower quality of life imposed by the infection. Limited English proficiency (LEP) and acculturative stress play an important role in the study of patients with CHB, but the interrelationships of LEP, acculturative stress, and health outcomes are not well studied in this population. This study aims to explore how acculturative stress mediates the relationship between LEP and health outcomes among Korean American patients with CHB.

METHODS: A total of 365 CHB patients completed …

Investigating Corollaries Between Streptococcus Gallolyticus Subsp. Gallolyticus Virulence And Colorectal Cancer, Tyler G. Myers

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

Streptococcus gallolyticus subsp. gallolyticus (Sgg) is a gram-positive, non-beta-hemolytic bacterium that belongs to the Lancefield group D of streptococcal pathogens. For the past several decades, associations between Sgg bacteremia and colorectal cancer (CRC) have been apparent, with gastroenterologists routinely recommending colonoscopies for positive cases of Sgg in either blood or stool samples. However, current research has not wholly established whether Sgg acts as a causative agent of CRC or if pre-existing cancers make the lumen of the colon more hospitable to its colonization. Regardless, Sgg has been implicated in the modulation of host inflammatory pathways and subsequent remodeling …