Perforated small bowel lymphoma: a rare presentation of Crohn's disease

Adenocarcinoma and lymphoma, potential complications of Crohn's disease (CD), may result in small intestinal perforations, particularly in those on immunosuppressive therapy. The ileum is typically the site of small intestinal perforations in CD, and the link between CD and lymphoma remains uncertain. This case report explores a long-term CD patient on immunosuppressive therapy who presented with acute abdominal pain. Imaging revealed signs of intestinal perforation, successfully managed with surgery. The final pathology report confirms the diagnosis of diffuse large B-cell lymphoma. This report sheds light on the complicated nature of gastrointestinal lymphoma in CD patients.

A rare case of Behçet's disease complicated by Budd-Chiari syndrome and perforated duodenal ulcers in a young male

Behçet's disease (BD) is characterized by skin lesions, uveitis, and recurrent oral and genital ulcers. Vascular problems, predominantly affecting veins, lead to thrombosis, increasing the risk of ruptured artery aneurysms and Budd-Chiari syndrome (BCS). Morbidity and mortality are significantly heightened by rare occurrences such as pulmonary artery aneurysms, cardiac involvement, and BCS. Prompt diagnosis and treatment are pivotal for prognosis improvement, particularly in males with early onset. We present a case of a 16-year-old male with BD history, who developed abdominal distension, pedal edema, and shortness of breath. Clinical examination and laboratory findings revealed thrombosis in the right popliteal vein and BCS. Despite the initiation of lifelong anticoagulation therapy, the patient later suffered a gastrointestinal bleed from perforated duodenal ulcers, necessitating emergency intervention. Given a high Model for End-Stage Liver Disease (MELD) score and associated mortality risk, the patient was promptly referred for liver transplantation.

A case of gastric duplication cyst in an 18-year-old female

INTRODUCTION

Gastric duplication cysts (GDCs) are rare congenital anomalies, usually diagnosed in childhood, but can occasionally present in adults with non-specific symptoms such as abdominal pain, nausea, vomiting, and dysphagia. Advanced imaging, particularly endoscopic ultrasonography (EUS), plays a crucial role in diagnosis, while surgical or endoscopic resection is the definitive treatment.

PRESENTATION OF CASE

An 18-year-old female with no significant medical history presented with recurrent epigastric pain radiating to the back, abdominal fullness, heartburn, and difficulty swallowing solid foods for one month. Upper endoscopy revealed a gastric mass, and EUS identified a 30 - 28 mm cystic lesion adjacent to the stomach fundus. Fine-needle aspiration confirmed the diagnosis of a gastric duplication cyst. The patient underwent successful endoscopic unroofing, leading to symptom resolution.

CLINICAL DISCUSSION

GDCs in adults are uncommon and often present with vague gastrointestinal symptoms, making diagnosis challenging. Imaging modalities such as EUS and fine-needle aspiration are essential for differentiation from other gastric lesions, including gastrointestinal stromal tumors and pancreatic cysts. Traditional management involved surgical resection, but endoscopic approaches, such as unroofing, offer a less invasive alternative with favorable outcomes.

CONCLUSION

This case emphasizes the need for GDCs to be considered in the differential diagnosis of gastric masses. Early identification with EUS and minimally invasive intervention, such as endoscopic unroofing, can effectively resolve symptoms and prevent complications.

Successful surgical management of esophageal leiomyoma presenting with gastroesophageal reflux disease symptoms: A case report

INTRODUCTION

Esophageal leiomyoma is the most common benign submucosal mesenchymal tumor of the esophagus, typically asymptomatic but can cause symptoms such as dysphagia, chest pain, or regurgitation when large. Diagnosis is often incidental, confirmed by imaging techniques like computed tomography (CT) and endoscopic ultrasound (EUS), with surgical enucleation being the standard treatment.

PRESENTATION OF CASE

A 28-year-old male presented with a one-year history of persistent epigastric discomfort and gastroesophageal reflux disease (GERD) symptoms unresponsive to proton pump inhibitors. Chest radiograph and CT scan revealed a well-defined submucosal mass in the esophagus. Upper gastrointestinal endoscopy and EUS confirmed the lesion's benign nature. Fine-needle aspiration biopsy showed spindle-shaped cells, confirming esophageal leiomyoma. The patient underwent minimally invasive tumor resection via video-assisted thoracoscopic surgery (VATS), with a smooth postoperative recovery.

DISCUSSION

Esophageal leiomyomas are rare, often asymptomatic, and may present with nonspecific symptoms if large. CT and EUS are key diagnostic tools, and minimally invasive surgery, such as VATS, is the preferred treatment for larger tumors due to shorter recovery times and fewer complications. Early identification and appropriate surgical intervention are crucial for optimal outcomes.

CONCLUSION

Esophageal leiomyoma should be considered in patients with GERD-like symptoms unresponsive to therapy. Early imaging, endoscopic evaluation, and minimally invasive surgery provide excellent outcomes, with regular follow-up recommended to monitor for recurrence.