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Metastases to duodenum in cervical squamous cell carcinoma: A case report and review of the literature.
Chen, Y, Zhang, H, Zhou, Q, Lu, L, Lin, J
Medicine. 2022;(2):e28526
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Abstract
RATIONALE Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature. PATIENT CONCERNS We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days. DIAGNOSIS Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis. INTERVENTIONS The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient's diet quickly resumed. OUTCOMES The patient refused further intervention and was discharged home to continue palliative care at the local hospital. LESSONS Clinicians should be alert to patients' past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.
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Case report on pathogenetic link between gluten and IgA nephropathy.
Costa, S, Currò, G, Pellegrino, S, Lucanto, MC, Tuccari, G, Ieni, A, Visalli, G, Magazzù, G, Santoro, D
BMC gastroenterology. 2018;(1):64
Abstract
BACKGROUND A relationship between IgA nephropathy (IgAN) and celiac disease (CD) has been reported. We show the pathogenetic link for the first time. CASE PRESENTATION A 39-year-old man with cystic fibrosis (CF) and CF-related diabetes started to present gross hematuria, back pain and headache. At admission, laboratory analysis showed increase in serum creatinine of 1.5 mg/dl, together with hematuria and mild proteinuria (1 g/24 h). He underwent a renal biopsy to investigate the cause of hematuria and renal failure. Biopsy was consistent with IgAN. In view of patient reported dyspepsia, an upper gastrointestinal endoscopy with duodenal biopsies was undertaken and was normal. We looked for mucosal deposits of tTG-2 in the duodenum and the renal mesangium. tTG-2 deposits were found both in the duodenum and in renal biopsies, where they topographically replicated mesangial IgA deposits. After one year on a continued gluten containing diet, the patient developed a Marsh 2 type duodenal pathology. CONCLUSIONS Our findings suggest a connection between CD and IgAN in terms of an immune-mediated gluten-induced pathogenesis even in the absence of villous atrophy and serum celiac autoantibodies.
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Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review.
Dibra, A, Këlliçi, S, Çeliku, E, Draçini, X, Maturo, A, Çeliku, E
Il Giornale di chirurgia. 2015;(1):29-31
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Abstract
We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.
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Effect of total enterectomy, pancreatectomy, and portal vein ligation on liver function and histology: a case report.
Vivarelli, M, Lauro, A, Cucchetti, A, D'Errico, A, Pironi, L, Pinna, AD
Transplantation proceedings. 2007;(1):300-2
Abstract
Impaired hepatic function and histology have been observed in experimental models of diversion of the portal vein blood inflow from the liver and among patients with intestinal failure. Survival after total enterectomy, pancreatectomy, and portal vein ligation, and the effect of such a condition on liver function have never been reported in humans. Herein a 32-year-old woman with familial adenomatous polyposis and multiple desmoid tumors involving the mesentery and the retroperitoneum underwent total enterectomy and pancreatectomy followed by en bloc transplantation of the stomach, small bowel, and pancreas. Due to early graft failure, the patient underwent graftectomy, ligation of the portal vein, and external drainage of the common bile duct. Liver function tests were checked daily and a liver biopsy performed 15 days after graftectomy. The patient died of a ruptured mycotic aneurysm of the abdominal aorta at 27 days after the graftectomy. Liver function tests remained normal throughout the postoperative period; liver biopsy showed normal hepatic architecture with mild portal inflammation and cholestasis and spotty necrosis. Total enterectomy with pancreatectomy and ligation of the portal vein are compatible with survival in humans (at least in the short term), allowing normal hepatic function with minimal histological alterations to the liver.
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Intestinal goblet cell autoantibody associated enteropathy.
Hori, K, Fukuda, Y, Tomita, T, Kosaka, T, Tamura, K, Nishigami, T, Kubota, A, Shimoyama, T
Journal of clinical pathology. 2003;(8):629-30
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Abstract
This report describes a case of refractory enteropathy with circulating intestinal goblet cell autoantibodies (IGA). A 19 year old man with hyperthyroidism had suffered from protracted diarrhoea for nearly 10 years. Histological examination showed evidence of collagenous enterocolitis. The diarrhoea did not improve despite fasting under total parenteral nutrition. An immunofluorescence assay demonstrated IGA without anti-enterocyte autoantibodies, the hallmark of autoimmune enteropathy, although other criteria were fulfilled. None of 109 controls, including 55 cases of inflammatory bowel disease and one of lymphocytic colitis, had IGA. This case is considered to be a variant of autoimmune enteropathy, and might be a distinct entity.
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[Manifestation of adult celiac disease during the puerperium].
Bajor, J, Lomb, Z, Anga, B, Beró, T
Orvosi hetilap. 2003;(52):2565-9
Abstract
The coeliac disease is a T cell mediated autoimmune enteropathy, presents in genetically susceptible person exposed to gluten. It can manifest in any age group but it is becoming more commonly diagnosed in adulthood. Very rarely it manifests during pregnancy or after childbirth, possibly due to hormonal and immunological changes. In authors' case a young female developed severe diarrhoea resulting in malabsorption following both of her pregnancies. On the first presentation the gluten sensitive enteropathy was not diagnosed despite detailed gastroenterological and endocrine workup. Following her first pregnancy she remained free of symptoms for years on a normal diet. After the birth of her second child her symptoms flared up and she was admitted to authors' department. The diagnosis of coeliac disease was confirmed by the histological finding from a small bowel biopsy. The coeliac specific serologic markers were also positive (antibodies to gliadin, endomysium and tissue transglutaminase). Significant improvement was achieved with supportive therapy and gluten-free diet. Despite the fact that authors' patient's symptoms were transient, the diagnosis of latent coeliac disease seems to be evident. Lifelong gluten-free diet is mandatory to prevent the late complications.