Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are lifelong conditions with no definite cure. Several studies demonstrated that patients with IBD more frequently experience symptoms of common mental disorders, such as anxiety and depression, because of bidirectional communication through the gut-brain axis and the chronicity of symptoms, as well as because of impaired quality of life and reduced social functioning. However, psychological conditions of affected patients are often underestimated and not fully considered. Herein, we present the case of a 37-year-old woman with Crohn’s disease and a mild depressive condition, characterized by anxious distress, tachycardia, tachypnea, tremors, sweating, avoidant behaviors, and intestinal somatizations (diarrhea), who was treated with Pregabalin upon indication of the referring psychiatrist. Following the beginning of the treatment, the patient rapidly reported an improvement in the overall clinical symptoms as well as a better management of psychic and physical anxiety with a marked reduction in diarrheal discharges under stress at work. After 6 months of Pregabalin therapy, we additionally observed an improvement in Crohn’s disease activity, both clinically, in the laboratory, and endoscopically. Our case showed that patients with Crohn’s disease and anxiety problems may benefit from low-dose Pregabalin medication to improve both their mental and physical condition.

Antonio Maria D’Onofrio

Federica Di Vincenzo

Gaspare Filippo Ferrajoli

Franco Scaldaferri

Giovanni Camardese

Low Dose Pregabalin Improves Gastrointestinal Symptoms of Crohn’s Disease

Myeloid sarcoma (MS) is an extramedullary manifestation of acute myeloid leukemia (AML) and commonly occurs in sites such as the lymph nodes, skin, soft tissues, and bone. It more rarely manifests in the pancreas, with less than 20 cases reported in the literature since 1987. Despite its rarity, MS should be considered in the differential diagnosis of a soft tissue mass causing obstructive jaundice, especially if the patient has a known hematologic disease. Isolated cases of pancreatic MS have been known to progress to AML; therefore, it is crucial to differentiate MS from more common diagnoses, such as pancreatic cancer or pancreatitis. This is a case of a 70-year-old male with symptomatic obstructive jaundice secondary to pancreatic MS, ultimately requiring endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management. Also included is a comprehensive review of previous case reports with similar clinical presentations, management, and treatment of pancreatic MS.

Laura E. Lavette

Angela G. Niehaus

Clancy J. Clark

Jason D. Conway

Girish Mishra

Darius A. Jahann

Pancreatic Myeloid Sarcoma Causing Obstructive Jaundice: A Case Report and Literature Review

We report a case of a 62-year-old man who was brought in by emergency medical services after a fall and change in mental status. He was found to have severe hyperkalemia, acute kidney injury, and rhabdomyolysis. The hyperkalemia was treated with sodium polystyrene sulfonate (SPS). During hospitalization, he witnessed having black tarry stools along with a significant drop in hemoglobin. Endoscopic evaluation demonstrated nonbleeding large diffuse gastric ulcers with stigmata of recent bleeding, and ulcer biopsy revealed findings consistent with SPS-induced gastric ulceration. No other source of bleeding was localized, suggesting acute upper gastrointestinal bleeding due to SPS mucosal injury.

Hamzah Shariff

Shiva Naidoo

Ghazal Ghafari

Hongjie Li

Manisha Devi

Kishore Kumar

Upper Gastrointestinal Bleeding Secondary to Sodium Polystyrene Sulfonate Use: A Rare Adverse Effect of Commonly Prescribed Treatment

Primary yolk sac tumor (YST) of the liver is an extremely rare extragonadal germ cell tumor. Here, we present a case of a young man who developed primary YST of the liver which metastasized to periductal lymph nodes causing bile duct obstruction. A 32-year-old male was referred from an outside hospital for evaluation of painless jaundice. Initial investigation showed common bile duct compression from periductal lymph nodes. Inital biopsy results were concerning for adenocarcinoma. The patient was ultimately diganosed with primary YST of the liver. He was then started on a curative-intent chemotherapy regimen of bleomycin, etoposide, and cisplatin. This case highlights the importance of keeping the primary YST of the liver on the differential diagnosis as initial staining patterns are similar to adenocarcinoma which has a very different management.

Sahil M. Patel

Kenneth M. Sigman

Mohannad F. Dugum

Primary Yolk Sac Tumor of the Liver: A Rare Cause of Bile Duct Obstruction

Superior mesenteric artery syndrome (SMAS) is a rare and unusual disease, suspected clinically and confirmed radiologically. It represents a duodenal obstruction secondary to the impingement of the third portion of the duodenum between the abdominal aorta (AA) and the superior mesenteric artery (SMA) due to decreased intraabdominal fat. High morbidity and mortality rates are linked to missed or late diagnosis that can lead to complications, such as gastric perforation and gastric hemorrhage. We present the case of a 33-year-old man who was not previously known to have a SMAS, who presented to the emergency department with signs of septic shock, complaining of fever and respiratory symptoms for several days. Investigations showed aspiration pneumonia secondary to an upper gastrointestinal obstruction with signs of SMAS on a computed tomography (CT) scanner. Acute and rapid deterioration led to cardiac arrest and death. Through this article, we highlight the importance of early and correct diagnosis of SMAS which can sometimes be challenging, since no number is strictly diagnostic and radiological images must be interpreted in light of the clinical history and physical examination.

Rhea Akel

Iskandar Daou

Dany Jamal

Elham Hobeika

Rany Aoun

Georges Nawfal

Deadly Aspiration Pneumonia Secondary to Superior Mesenteric Artery Syndrome

Familial Mediterranean fever (FMF) is a hereditary disorder characterized by episodes of fever, polyserositis, or cutaneous inflammation. The FMF attacks last 1–3 days and have no apparent triggers. Recurrent deposition of the serum amyloid A (SAA) protein in the gut can cause intractable diarrhea, dysmotility, and recurrent abdominal pain. Gastrointestinal amyloidosis is a rare, but serious, complication of FMF. In this case report, we describe a rare case of chronic diarrhea and recurrent abdominal pain due to FMF-induced gastrointestinal amyloidosis.

Lefika Bathobakae

Nida Ansari

Anas Mahmoud

Shayee Hasan

Ruhin Yuridullah

Sohail Qayyum

Sam Rae

Gastric, Colonic, and Rectal Amyloidosis in the Setting of Familial Mediterranean Fever: A Unique Cause of Intractable Diarrhea

A liver cyst is hepatic fluid-filled cavities often detected in clinical surveillances such as a health examination. Although the liver cyst is usually asymptomatic and observed without any therapeutic intervention, it can be symptomatic and needs treatment due to its enlargement, hemorrhage, and infection. A 74-year-old woman presented with upper abdominal pain and a huge liver cyst in the left lobe. Several examinations including image findings revealed that the symptom could be derived from the liver cyst. Although there is no definite guideline of treatment for symptomatic liver cysts, percutaneous ultrasound-guided drainage with sclerotherapy or surgery is often selected. Because of anatomical accessibility to the liver cyst and the patient’s wish, we performed endoscopic transgastric drainage with insertion of both an internal stent and an external nasocystic tube. Sclerotherapy with minocycline hydrochloride was performed through the nasocystic tube, and the liver cyst shrunk completely without any complications. This is the first reported method of administering minocycline hydrochloride through a nasocystic tube, which can be a therapeutic option for patients with symptomatic liver cysts.

Kengo Yoshitomi

Yudai Koya

Koichiro Miyagawa

Yuki Maruno

Koki Yamaguchi

Ryuta Taniguchi

Koji Onitsuka

Yoshitaka Sakamoto

Shinji Oe

Masaru Harada

Symptomatic Liver Cyst Successfully Treated with Transgastric Drainage and Sclerotherapy Using Minocycline Hydrochloride

Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu–Osler–Weber syndrome, is a vascular disorder of autosomal dominant etiology. The hallmark clinical feature is the presence of recurrent episodes of epistaxis in patients with vascular malformations and a tendency to bleed. We present the case of a 71-year-old woman who presented to the emergency department with upper gastrointestinal bleeding caused by esophageal varices, in conjunction with gastric angiodysplasias. The presence of oronasopharyngeal telangiectasias and hepatomegaly raised suspicion of HHT. The diagnostic workup confirmed the presence of angiodysplasia in the gastric region, portal arteriovenous malformation, and a pulmonary shunt.

Denisse Morales-Tovar

Froylan D. Martínez-Sánchez

Alejandro Gabutti-Thomas

Rodolfo Rivera-Martínez

Jacqueline Córdova-Gallardo

A Rare Association: Hereditary Hemorrhagic Telangiectasia with Liver Cirrhosis Causing Portal Hypertension

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Case Reports in Gastrointestinal Medicine publishes case reports and case series focusing on gastroenterology, hepatology, pancreas and biliary, and related cancers.

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Case Reports in Gastrointestinal Medicine - Table of contents 2024

Case Reports in Gastrointestinal Medicine | Hindawi

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Case Reports in Gastrointestinal Medicine publishes case reports and case series focusing on gastroenterology, hepatology, pancreas and biliary, and related cancers.

Case Reports in Gastrointestinal Medicine