Multiple giant diverticula of the foregut causing upper gastrointestinal obstruction

Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.

Gastrointestinal obstruction secondary to enteral nutrition bezoar: A case report

BACKGROUND Post-operative enteral nutrition via gastric or jejunal feeding tubes is a common and standard practice in managing the critically ill or post-surgical patient.It has its own set of complications,including obstruction,abscess formation,necrosis,and pancreatitis.We present here a case of small bowel obstruction caused by enteral nutrition bezoar.It is the second recorded incidence of this complication after pancreaticoduodenectomy in the medical literature.CASE SUMMARY The 70-year-old female presented to our institution for a pancreaticoduodenectomy(Whipple’s procedure)for pancreatic adenocarcinoma.On day 5 post-operative,having failed to progress and developing symptoms of small bowel obstruction,she underwent a computed tomography scan,which showed features of mechanical small bowel obstruction.Following this,she underwent an emergency laparotomy and small bowel decompression.The recovery was long and protracted but,ultimately,she was discharged home.A literature search of reports from 1966-2020 was conducted in the MEDLINE database.We identified eight articles describing a total of 14 cases of small bowel obstruction secondary to enteral feed bezoar.Of those 14 cases,all but 4 occurred after upper gastrointestinal surgery;all but 1 case required further surgical intervention for deteriorating clinical picture.The postulated causes for this include pH changes,a reduction in pancreatic enzymes and gastric motility,and the use of opioid medication.CONCLUSION Enteral feed bezoar is a complication of enteral feeding.Despite rare incidence,it can cause significant morbidity and potential mortality.

Effectiveness and safety of chemotherapy for patients with malignant gastrointestinal obstruction:A Japanese populationbased cohort study

BACKGROUND The impacts of chemotherapy on patients with malignant gastrointestinal obstructions remain unclear,and multicenter evidence is lacking.AIM To evaluate the effectiveness and safety of chemotherapy in patients with unresectable malignant gastrointestinal obstructions.METHODS We conducted a multicenter retrospective cohort study that compared the chemotherapy group who received any chemotherapeutics after interventions,including palliative surgery or selfexpandable metal stent placement,for unresectable malignant gastrointestinal obstruction vs the best supportive care(BSC)group between 2014 and 2019 in nine hospitals.The primary outcome was overall survival,and the secondary outcomes were patency duration and adverse events,including gastrointestinal perforation and gastrointestinal bleeding.RESULTS In total,470 patients in the chemotherapy group and 652 patients in the BSC group were analyzed.During the follow-up period of 54.1 mo,the median overall survival durations were 19.3 mo in the chemotherapy group and 5.4 mo in the BSC group(log-rank test,P<0.01).The median patency durations were 9.7 mo[95% confidence interval(CI):7.7-11.5 mo]in the chemotherapy group and 2.5 mo(95%CI:2.0-2.9 mo)in the BSC group(log-rank test,P<0.01).The perforation rate was 1.3%(6/470)in the chemotherapy group and 0.9%(6/652)in the BSC group(P=0.567).The gastrointestinal bleeding rate was 1.5%(7/470)in the chemotherapy group and 0.5%(3/652)in the BSC group(P=0.105).CONCLUSION Chemotherapy after interventions for unresectable malignant gastrointestinal obstruction was associated with increased overall survival and patency duration.

Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor:A case report and review of the literature

BACKGROUND Gastric gastrointestinal stromal tumor(GIST)is the most common etiology of gastroduodenal intussusception.Although gastroduodenal intussusception caused by gastric GIST is mostly treated by surgical resection,the first case of gastroduodenal intussusception caused by gastric GIST was treated by endoscopic submucosal dissection(ESD)in Japan in 2017.CASE SUMMARY An 84-year-old woman presented with symptoms of postprandial fullness with nausea and occasional vomiting for a month.Initially,she visited a local clinic for help,where abdominal sonography revealed a space-occupying lesion around the liver,so she was referred to our hospital for further confirmation.Abdominal sonography was repeated,which revealed a mass with an alternating concentric echogenic lesion.Esophagogastroduodenoscopy(EGD)was performed under the initial impression of gastric cancer with central necrosis and showed a tortuous distortion of gastric folds down from the lesser curvature side to the duodenal bulb with stenosis of the gastric outlet.EGD was barely passed through to the 2nd portion of the duodenum and a friable ulcerated mass was found.Several differential diagnoses were suspected,including gastroduodenal intussusception,gastric cancer invasion to the duodenum,or pancreatic cancer with adherence to the gastric antrum and duodenum.Abdominal computed tomography for further evaluation was arranged and showed gastroduodenal intussusception with a long stalk polypoid mass 5.9 cm in the duodenal bulb.Under the impression of gastroduodenal intussusception,ESD was performed at the base of the gastroduodenal intussusception;unfortunately,a gastric perforation was found after complete resection was accomplished,so gastrorrhaphy was performed for the perforation and retrieval of the huge polypoid lesion.The gastric tumor was pathologically proved to be a GIST.After the operation,there was no digestive disturbance and the patient was discharged uneventfully on the 10th day following the operation.CONCLUSION We present the second case of gastroduodenal intussusception caused by GIST treated by ESD.It is also the first case report of gastroduodenal intussusception by GIST in Taiwan,and endoscopic reduction or resection is an alternative treatment for elderly patients who are not candidates for surgery.

Unusual presentations of eosinophilic gastroenteritis:Case series and review of literature

Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

Malignant transformation of ectopic pancreatic cells in the duodenal wall

Ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple's procedure and had an uneventful post-operative recovery. Traditional imaging studies are often inconclusive in the definitive diagnosis, whilst endoscopic ultrasonography and guided biopsy may aid accurate pre-operative diagnosis. Diagnostic uncertainty warrants surgical exploration and if necessary extended resection is indicated.

Superior mesenteric artery syndrome caused by weight loss in a malnourished Syrian man

Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal obstruction in which the third part of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta,and the compression of the duodenum is caused by a narrowed aortomesenteric angle.We report in this case a 35-year-old patient who came with features of small bowel obstruction,weight loss and had a history of malnutrition because of war.Multi-slice computerized tomography showed a narrowed aortomesenteric angle and distance.Conservative treatment was presented and,after 3 months of observation,the patient gained weight.