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Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Typical symptoms of PUD include epigastric pain, which is relieved by food or antacids. Patients often describe a dull “gnawing” or burning sensation, which may awaken them at night or may occur in the morning before eating or after meals. Because the abdominal pain is often relieved by eating, patients with PUD may gain weight. Other symptoms arise when duodenal or gastric ulcer is complicated by hemorrhage, perforation, penetration, or obstruction (Table 3). If the ulcer bleeds, the patient may develop black or tarry stools (melena) or hematemesis. Ulcer penetration into an arterial blood vessel can lead to massive, brisk bleeding with rapid transit of blood through the gastrointestinal tract and bright red blood per rectum (hematochezia). Abdominal pain that radiates to the back indicates possible penetration of the ulcer posteriorly through the wall of the stomach or duodenal bulb into surrounding organs. Duodenal bulb ulcers may penetrate into the pancreas, whereas gastric ulcers can erode into the liver or colon. The sudden onset of severe pain in conjunction with physical findings of an acute abdomen (rebound tenderness, guarding, absent bowel sounds, and distention) is associated with free perforation of the ulcer, which is a surgical emergency. Finally, prolonged nausea and vomiting can result from gastric outlet obstruction caused by edema and inflammation surrounding an ulcer crater located in the prepyloric or pyloric region. It is important to note that complicated ulcer disease may present with no antecedent history of abdominal pain or other symptoms.
Mixed Cavernous Hemangioma-Lymphangioma of the Gastroesophageal Junction
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Kimberly Song, Christopher W. Seder, Ozuru Ukoha
A 61-year-old Hispanic man with a history of gastroesophageal reflux disease and hypertension presented with increasing fatigue. He denied any history of unintentional weight loss, hematochezia, or hematemesis. He did not drink alcohol or use tobacco and had a maternal history of esophageal cancer. Physical exam revealed a well-nourished man with mild epigastric tenderness. Routine bloodwork revealed anemia with a hemoglobin of 12 g/dL. He was referred to gastroenterology for an endoscopy. His colonoscopy was normal, but upper endoscopy demonstrated a soft, bluish polypoid lesion 25 cm from the incisors extending submucosally to the gastroesophageal junction (Figure 43.1). The stomach and duodenal bulb appeared normal. Biopsy was not performed due to its hypervascular appearance. Positron-emission tomography-computed tomography (PET-CT) demonstrated esophageal thickening with a low-attenuating 12 × 11 × 8 cm mass extending from the carina to gastroesophageal junction with areas of increased metabolic activity ranging from SUV 2.5 to 7.6 (Figure 43.2). No axillary, mediastinal, or hilar lymphadenopathy was identified. Endoscopic ultrasound further characterized the mass as being nearly circumferential and heterogeneous in composition with cystic and hypervascular areas (Figure 43.3).
Upper GI Crohn’s Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Diane Mege, Janindra Warusavitarne, Yves Panis
Since the first report of duodenal involvement in 1937,2,25 approximately 300 cases have been reported so far, with a prevalence ranging between 1.8 and 4.5%. The largest series of gastroduodenal lesions included 89 patients.3 The duodenum, particularly the duodenal bulb, is more frequently involved than the stomach.24,26–34 When the gastric antrum is involved, usually it is contiguous with duodenal disease.35–37
Resolution of a hepatoduodenal fistula after nivolumab treatment in a patient with hepatocellular carcinoma: challenges in immunotherapy
Published in Acta Clinica Belgica, 2022
Thomas De Somer, Erik Vanderstraeten, Vincent Bouderez, Els Monsaert, Christophe Van Steenkiste
Systemic treatment with sorafenib was started. However, the tolerance for sorafenib was poor. The patient experienced excessive weight loss, had a pronounced anorexia and diarrhea and his WHO performance status deteriorated to 3 to 4. The AFP-level initially declined to 800,6 µg/l after 1 month of treatment with sorafenib, but started to gradually increase afterwards. Radiographic re-evaluation after 3 months of treatment with sorafenib showed stable disease on contrast enhanced abdominal CT. However, there was a new finding of air inclusions in the largest lesion in the left liver lobe, which appeared to be connected to the duodenum. The presence of a large fistula in the duodenal bulb was confirmed by gastroscopy (Figure 2). A percutaneous endoscopic gastrostomy with jejunal extension was placed for enteral nutrition. Treatment with sorafenib was discontinued and the patient was evaluated for second line treatment with nivolumab by compassionate use, based on the data of the phase I/II studies available at that time.
Crohn’s disease exclusion diet in children with Crohn’s disease: a case series
Published in Current Medical Research and Opinion, 2021
Luca Scarallo, Elena Banci, Valentina Pierattini, Paolo Lionetti
A 12-year-old boy with unremarkable past medical history presented to our outpatient clinic with a 3-month history of epigastric pain, reduced appetite and weight loss. Prior to our center’s referral, the patient was evaluated at a secondary-level pediatric center and a 2-week empirical trial with a proton pump inhibitor was attempted, without symptoms alleviation. Physical examination was unremarkable except for the presence of 2 perianal skin tags. His blood tests revealed a slight increase of C-reactive protein (CRP, 1.15 mg/dL), with normal erythrocyte sedimentation rate (ESR); and fecal calprotectin was elevated at 500 microg/g. Hemoglobin was 12.9 g/dL, albumin and transaminases were in the normal range with a pediatric Crohn’s disease activity index (PCDAI) of 20. Bowel ultrasound scan showed no abnormal bowel thickenings. Esophagogastroduodenoscopy (EGD) showed aphthous ulcers in the duodenal bulb but was otherwise normal. Ileo-colonoscopy revealed aphthous ulcers in the terminal ileum, cecum, ascending and descending colon. Biopsies collected during endoscopies confirmed chronic inflammation with mucosal architecture disruption, confirming diagnosis of CD. A magnetic resonance enterography (MRE) revealed multiple enhancement with only limited thickening in the terminal ileum and in the upper digestive tract distally to Treitz’ ligament. No strictures or fistulas were observed (Paris Classification: A1b, L3-L4a,B1,G1, P1)16.
Duodenal bulb obstruction caused by a gallstone (Bouveret syndrome) successfully treated with endoscopic measures
Published in Baylor University Medical Center Proceedings, 2020
Gilles Jadd Hoilat, Vanessa Sostre, Judie N. Hoilat, Ceren Durer, Seren Durer, Gowthami Kanagalingam, Divey Manocha
On postoperative day 1, there was biliary drainage in the Blake drain. A hepatobiliary iminodiacetic acid scan came back negative and a subsequent computed tomography scan showed no definite evidence of peripheral contrast enhancement suggestive of postsurgical fluid with air. Days later, there was still concern for high output from the drain and she was evaluated by the gastroenterology service for endoscopic retrograde cholangiopancreatography (ERCP). An endoscopic procedure showed that the duodenal bulb was impacted with a large 3 cm stone (Figure 1a, 1b), causing gastric outlet obstruction. The impacted stone was successfully removed with a snare (Figure 1c, 1d). A small bile leak was found at the cystic duct stump; a 10 mm size biliary sphincterotomy was performed and one plastic stent was placed in the common bile duct with bile drainage. Upon review of previous imaging and the surgical report and discussion with the surgical team, there was no evidence of any sort of fistula that would normally lead to the gastric outlet obstruction. After ERCP, the patient experienced marked improvement of her symptoms. She was tolerating her diet and subsequently was discharged home.