http://casereports.bmj.com This feed contains articles for BMJ Case Reports Subject Collection "Gastroenterology" BMJ Case Reports http://casereports.bmj.com http://casereports.bmj.com/cgi/content/short/2013/may23_1/bcr2013009856?rss=1 A 62-year-old man underwent pancreaticoduodenectomy (PD) for intraductal papillary mucinous carcinoma (IPMC) in 2006. No signs of adenocarcinoma at the resection margin were found by intraoperative pathological examination of frozen sections. The postoperative pathological diagnosis was invasive carcinoma derived from IPMC and moderately differentiated tubular adenocarcinoma. A blood analysis in 2011 showed serum (CA19-9) to be increased since the initial resection. Imaging test showed a recurrent tumour at the site of the pancreaticogastrostomy (PG) in the remnant pancreas. We conducted total remnant pancreatectomy for recurrent IPMC and partial gastrectomy. Because both lesions had a histopathological resemblance, the pathological diagnosis was recurrent invasive IPMC. Based on this experience, it is important to facilitate early detection by annual check-up. And also, we recommend PG as a reconstructive intervention in patients at high risk of IPMC recurrence in the remnant pancreas following PD as it is grossly visible on upper gastrointestinal endoscopy. Ohkura, Y. Sasaki, K. Matsuda, M. Hashimoto, M. 2013-05-23 doi:10.1136/bcr-2013-009856 Total pancreatectomy for recurrent intraductal papillary mucinous carcinoma in remnant pancreas of pancreaticoduodenectomy for intraductal papillary mucinous adenocarcinoma BMJ Publishing Group Ltd MAY23_1 2013 201300985 2013-05-23 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2012007408?rss=1 Wilson disease is a rare heredodegenerative inborn error of copper metabolism with varied neuropsychiatric, hepatic and other manifestations. Here we report a case of Wilson disease with neurological manifestations in a 7-year-old girl with concurrent asymptomatic liver involvement and characteristic radiological findings of signal intensity alterations in bilateral striata and thalami along with changes in central pons too like central pontine myelinolysis (CPM), which is of rare occurrence. Verma, R. Rai, D. 2013-05-22 doi:10.1136/bcr-2012-007408 Central pontine myelinolysis associated with Wilson disease in a 7-year-old child BMJ Publishing Group Ltd MAY22_1 2013 201200740 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2012008277?rss=1 Gastroduodenal tuberculosis (GDTB) is rare in the West. Its presentation can be non-specific and often mimics other more common conditions such as peptic ulcer disease, malignancy and Crohn's disease. Our case describes a 33-year-old Indian immigrant who presented with a 3-year history of dyspepsia and underwent balloon dilation for gastric outlet obstruction (GOO). While biopsies from the duodenum revealed only non-caseating granuloma, a high index of suspicion was maintained and colonoscopy, performed despite the absence of lower gastrointestinal symptoms, revealed a single discrete nodular and ulcerated area in the proximal transverse colon; this eventually grew Mycobacterium tuberculosis. Our patient avoided undergoing major surgery and was successfully treated with balloon dilation and antitubercular medication. We highlight the importance of having a concerted, proactive approach to diagnosis. We discuss the therapeutic challenges involving this rare condition and explain the rationale for high-dose antisecretory therapy. Padmanabhan, H. Rothnie, A. Singh, P. 2013-05-22 doi:10.1136/bcr-2012-008277 An unusual case of gastric outlet obstruction caused by tuberculosis: challenges in diagnosis and treatment BMJ Publishing Group Ltd MAY22_1 2013 201200827 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2013009511?rss=1 Angiosarcoma of the liver is a rare disease; however, it ranks as the third most common primary liver malignancy. Diagnosis is difficult and prognosis is very poor. After the onset of clinical symptoms, the disease often progresses rapidly, decreasing the chances of curative treatment. We report the case of an 83-year-old male patient who presented with postprandial fullness. Upper abdominal ultrasound showed a hypervascular mass in segment 6 of the liver. The results of anatomopathological examination and immunohistochemistry were compatible with the diagnosis of primary angiosarcoma of the liver. Patient refused surgery (haepatectomy), and treatment was then initiated with transarterial chemoembolisation, followed by percutaneous radiofrequency ablation. The patient is currently cured based on clinical and radiological evidence. This case report is the first in the literature to describe the combined use of transarterial chemoembolisation with percutaneous radiofrequency ablation in the treatment of primary angiosarcoma of the liver. Nunes, T. F. Barbosa, F. C. P. Miiji, L. N. O. de Souza, L. G. O. 2013-05-22 doi:10.1136/bcr-2013-009511 Chemoembolisation combined with percutaneous radiofrequency ablation in the treatment of primary angiosarcoma of the liver BMJ Publishing Group Ltd MAY22_1 2013 201300951 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2013009561?rss=1 A 63-year-old man underwent endoscopic evaluation of the rectal stump for rectal bleeding and suffered a massive cerebral air embolism with severe neurological impairment and subsequent death. The patient underwent a Hartmann's procedure 9 month previously for ischaemic bowel and was noted to have portal hypertension at laparotomy. We hypothesise that air entered the venous plexus around rectum and entered the azygos vein via a porto-systemic shunt and travelled retrogradely via the superior vena cava to the venous sinuses of the brain. Baban, C. K. Murphy, M. Hennessy, T. O'Hanlon, D. 2013-05-22 doi:10.1136/bcr-2013-009561 Fatal cerebral air embolism following endoscopic evaluation of rectal stump BMJ Publishing Group Ltd MAY22_1 2013 201300956 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2013009672?rss=1 Cerebral venous sinus thrombosis is a rare but serious cause of headache. In this report, we present a young man with poorly controlled Crohn's disease who presented with a 2-week history of headache and fluctuating left-sided sensory and motor symptoms. CT demonstrated changes consistent with either a subarachnoid haemorrhage or venous sinus thrombosis. The ensuing magnetic resonance venogram confirmed superior sagittal venous sinus thrombosis and an infarct of his right superior frontal lobe. The patient was started on low-molecular weight heparin and steroids. He required multi-disciplinary input from the stroke physicians, neurologists, gastroenterologists, dieticians and physiotherapists. He made a full neurological recovery and is now on long-term azathioprine. The purpose of this report is to highlight the consideration of venous sinus thrombosis in the diagnosis of headache and as a rare extraintestinal complication of Crohn's disease. Miller, C. P. Stedman, J. Nagaratnam, K. Gray, R. 2013-05-22 doi:10.1136/bcr-2013-009672 Headache in a young male: the clot thickens BMJ Publishing Group Ltd MAY22_1 2013 201300967 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2013009714?rss=1 We describe a 79-year-old gentleman with a longstanding history of chronic lymphocytic leukaemia who presented with subacute onset of cholestatic jaundice. Comprehensive review of the patient's data and medications failed to reveal any obvious causes. Exhaustive testing including abdominal CT and magnetic resonance cholangiopancreatography failed to reveal any obstruction. A liver biopsy demonstrated scattered non-caseating granulomas. The patient was diagnosed with granulomatous hepatitis and treated with oral steroids and eventually improved. It was thought to be due to paraneoplastic cholestasis as an extrahepatic manifestation of non-Hodgkin's lymphoma. Alirhayim, Z. Dyal, H. Alarhayem, A. Donthireddy, V. 2013-05-22 doi:10.1136/bcr-2013-009714 Non-Hodgkin's lymphoma: a cause of paraneoplastic cholestasis BMJ Publishing Group Ltd MAY22_1 2013 201300971 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may21_1/bcr2013009168?rss=1 A 55-year-old man attended the emergency department following an episode of collapse. He was known to have chronic pancreatitis and a pancreatic pseudocyst. He had recently been recumbent due to chronic abdominal pain. On arrival he was unwell. Baseline observations revealed an oxygen saturation of 87% on room air, pulse 115 bpm and blood pressure 86/57 mm Hg. Physical examination was unremarkable except for mild abdominal tenderness. He was started on high-flow oxygen, intravenous fluid and broad-spectrum antibiotics. A chest x-ray was unremarkable. Massive pulmonary embolus was considered a likely diagnosis. The patient underwent an urgent CT pulmonary angiogram (CTPA). As this was undertaken as an urgent investigation straight from the resuscitation area a d-dimer test was not performed. The CTPA showed no evidence of pulmonary embolism but demonstrated a subdiaphragmatic collection. An arterial phase abdominal CT scan was thus performed, which confirmed a large subcapsular splenic haematoma and splenic vein thrombosis. The patient was resuscitated with blood products and transferred for splenic artery embolisation. Sawrey, M. Hughes, R. G. 2013-05-21 doi:10.1136/bcr-2013-009168 An interesting cause of collapse in a patient with chronic pancreatitis BMJ Publishing Group Ltd MAY21_1 2013 201300916 2013-05-21 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may21_1/bcr2013009406?rss=1 We present a case of transmural fibrotic gallbladder in a patient with previously undiagnosed gallbladder disease and describe our surgical approach to treating this patient. Su, L. S. Burke, L. H. Ertl, C. W. 2013-05-21 doi:10.1136/bcr-2013-009406 Conversion of laparoscopic cholecystectomy to open surgical procedure due to complete fibrosis of the gallbladder BMJ Publishing Group Ltd MAY21_1 2013 201300940 2013-05-21 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may21_1/bcr2013009768?rss=1 Haemobilia, defined as bleeding into the biliary tree is a rare condition. We describe a case report of a patient who presented it as a complication of iatrogenic portobiliary fistula, followed after an open cholecystectomy. The patient presented to the emergency department with late onset symptoms of haematemesis and melena a month after surgery. Findings were confirmed by Doppler ultrasound that showed the appearance of intragallbladder mass with high echogenicity representing a blood clot. Also, next to the portal vein and the biliary duct a lesion with mixed blood flow was detected confirming a portobiliary fistula. This case was successfully managed by angiography and selective embolisation. Hurtarte-Sandoval, A. R. Flores-Robles, B. J. Penate-Dardon, J. D. Gonzalez-Galilea, A. 2013-05-21 doi:10.1136/bcr-2013-009768 Haemobilia due to iatrogenic portobiliary fistula after cholecystectomy BMJ Publishing Group Ltd MAY21_1 2013 201300976 2013-05-21 CASE-REPORT