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  • 1.

    【2hr】Robot-Assisted Laparoscopic Resection of a Todani Type II Choledochal Malformation

    包量

    机译 机器人辅助的Todani II型胆总管畸形的腹腔镜切除术
    摘要：Choledochal malformation (CM) comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. CM is classified into five different types. Our case describes a 58-year-old man presenting with acute abdominal pain. Further examination showed a Todani type II CM. Treatment for type II is complete cyst excision without the need for an extrahepatic bile duct resection. A robot-assisted laparoscopic resection of the CM was performed and the patient recovered without complications. Pathology results showed a Todani type II malformation in which complete squamous metaplasia has occurred. In this paper, we report, to the best of our knowledge, the first description of a robot-assisted laparoscopic resection of a type II CM.
  • 2.

    【2hr】Synchronous Resection of Colon Adenocarcinoma and Bisegmentectomy of Liver Metastases

    包量

    机译 结肠腺癌同步切除和肝转移双段切除术
    摘要：Colorectal cancer is one of the main neoplasms worldwide; at the time of diagnosis about 25% of cases already have an advanced stage with the presence of metastases. A 58-year-old female presented with nausea, vomiting, and black stools and diffuse abdominal pain associated with 7% weight loss. She was referred to our hospital with signs of digestive tract bleeding and anemic syndrome. Panendoscopy revealed body and fundus gastropathy and presence of Helicobacter pylori, and colonoscopy showed a neoplastic lesion at the ascending colon level. A synchronous resection was performed in a single surgical time of colorectal cancer and liver metastases with a duration of 4 h and bleeding of 900 mL. The oral feeding started 24 h after surgery, presenting gas channeling at 24 h and evacuations at 48 h. The total intrahospital stay was 5 days. Synchronous resection of hepatic metastases in colorectal cancer is still rarely performed, despite the fact that in recent years the number of cases has increased because of better surgical techniques. Synchronous resection of colorectal cancer and liver metastases can be performed safely, without increasing transoperative mortality when performed in specialized centers with a multidisciplinary team; however, it is essential to emphasize the importance of negative surgical margins (R0) of the primary tumor and later to be complemented with adjuvant treatment with chemotherapy.
  • 3.

    【2hr】Inflammatory Pseudotumor of the Pancreas Mimicking a Pancreatic Neoplasm

    包量

    机译 模仿胰腺肿瘤的胰腺炎性假瘤
    摘要：A 78-year-old woman was admitted to our hospital with a pancreatic tumor, incidentally discovered in an abdominal ultrasound exam. She was asymptomatic and without any previous personal pathological condition. The computed tomography (CT) and the magnetic resonance imaging (MRI) scan showed a mass lesion of 4 cm in diameter, located in the pancreatic body, conditioning the invasion of the splenic vein. The patient was admitted to surgery. During the laparotomy, we found a tumoral lesion highly suspicious of pancreatic neoplasia located in the transition of the head/body of the pancreas, with an invasion of the portal vein and several peri-regional lymph nodes. We performed biopsies of the pancreatic mass and lymphadenectomy of the peri-regional pancreatic lymph nodes. Histological analysis found an inflammatory pseudotumor of the head/body of the pancreas, without signals of malign epithelial neoplasm and also without criteria for immunoglobulin G4-related disease. During the follow-up, a PET/CT and MRI confirmed that the pancreatic lesion had disappeared without any treatment. Inflammatory pseudotumor of the pancreas is a rare entity not fully understood. Despite this, the administration of corticosteroids and immunosuppressive therapy could be taken into consideration as the disease carries a risk.
  • 4.

    【2hr】Pulmonary Embolism in a Donor of Living Donor Liver Transplantation

    包量

    机译 活体供体肝移植供体中的肺栓塞
    摘要：Pulmonary embolism (PE) is a rare but potentially fatal complication that may develop in a living liver donor. Here, we report a case of non-massive PE diagnosed by elevated serum D-dimer levels and successfully treated using anticoagulant therapy. A 57-year-old man underwent extended left hepatectomy as a living liver donor. His past medical history included hypertension and dyslipidemia which required medication and a history of smoking. Mechanical prophylactic measures for venous thromboembolism, including intermittent pneumatic compression and elastic stocking, were used; however, no pharmacological prophylaxis was used. Although the patient ambulated on postoperative day (POD) 1, he developed hypoxia. Serum D-dimer level was elevated to 29.3 ng/mL on POD 2. Enhanced computed tomography revealed small peripheral PEs in the branches of the right upper, right middle, and left lower lobes without deep vein thrombosis. Intravenous heparin was initiated followed by warfarin. The thrombi resolved completely by POD 13, following which warfarin was continued for 3 months. As of 25 months after donation, the patient remains well without recurrence of PE. Early diagnosis and treatment of postoperative PE are critical for preventing mortality of liver donors.
  • 5.

    【2hr】Type 1 Autoimmune Pancreatitis with Imaging Appearance Similar to That of Malignant Cystic Tumor

    包量

    机译 1型自身免疫性胰腺炎，影像学表现与恶性囊性肿瘤相似
    摘要：A 79-year-old man was admitted with asymptomatic elevation of liver enzymes and tumor markers. Abdominal contrast-enhanced computed tomography demonstrated swelling of the pancreatic head, and additional blood test showed raised IgG4 levels. Histological examination by endoscopic ultrasonography (EUS)-guided fine needle aspiration for pancreatic head mass revealed storiform fibrosis and IgG4-positive plasma cell infiltration. We diagnosed this case as type 1 autoimmune pancreatitis (AIP). In addition, there was a cystic lesion in the pancreatic body apart from the pancreatic head mass. A mural nodule in the multilocular cyst was detected by EUS, and there was positive uptake of fluorodeoxyglucose in positron emission tomography/magnetic resonance imaging. The preoperative diagnosis of this cystic lesion was intraductal papillary mucinous carcinoma, and distal pancreatomy was performed. Histopathological findings showed various sizes of retention cysts caused by IgG4-positive plasma cell infiltration around the pancreatic branch ducts. The mural nodule was a fibrotic mass with diffuse infiltration of IgG4-positive cells. This cystic lesion mimicking malignant cystic neoplasm occurred in relation to AIP. This case provided important information helping to understand the mechanism of formation of mural nodules in multilocular cysts in patients with type 1 AIP.
  • 6.

    【2hr】Melanocytic Nevus of the Colon

    包量

    机译 结肠的黑素细胞痣
    摘要：Here, we report a very rare case of melanocytic nevus of the colon. A 54-year-old woman with an unremarkable medical history visited our hospital for screening colonoscopy. Colonoscopy revealed a pigmented flat lesion in the ascending colon. Histological evaluation of a biopsy specimen revealed proliferation of pigmented cells in the lamina muscularis propria. On immunohistochemical analysis, pigmented cells were positive for S-100 protein and Melan-A expression, and a diagnosis of colonic melanocytic nevus was made. Although the pathogenesis underlying colonic melanocytic nevi remains unclear, we speculate that colonic melanocytic nevi develop via abnormal migration or differentiation of neural crest cells during embryogenesis.
  • 7.

    【2hr】Transplant-Amenable Hepatocellular Carcinoma in a Fontan Patient

    包量

    机译 丰坦患者的移植适应性肝细胞癌
    摘要：The Fontan circulation alters a patient's physiology and imparts long-term risks related to chronically elevated systemic venous pressure. An increasing number of patients with Fontan physiology are surviving into adulthood and are at risk of hepatic sequalae. The ideal timeline and method of hepatic surveillance in the Fontan population remains to be defined. In this case, the patient was diagnosed with hepatocellular carcinoma more than 20 years after undergoing the Fontan procedure and was a candidate for combined heart-liver transplant. That her disease progressed prior to organ availability supports the argument for hepatic surveillance in this population.
  • 8.

    【2hr】Schwannoma of the Small Intestine

    包量

    机译 小肠神经鞘瘤
    摘要：Schwannomas of the gastrointestinal tract are rare. Herein, we report a case of schwannoma originating from the small intestine. A 78-year-old woman underwent medical follow-up after surgery for bladder cancer, and a mass in the upper part of the pelvis was revealed by abdominal CT. With the diagnosis of a submucosal tumor of the small intestine, she underwent partial intestinal resection. The submucosal tumor was pathologically composed of S100-positive spindle cells and diagnosed as schwannoma. We report this case of rare schwannoma of the small intestine and review the literature.
  • 9.

    【2hr】Measurement of Adenosine Deaminase in Ascitic Fluid Contributed to the Diagnosis in a Case of Tuberculous Peritonitis

    包量

    机译 腹水中腺苷脱氨酶的测定有助于结核性腹膜炎的诊断
    摘要：A diagnosis of tuberculous peritonitis (TBP) is difficult because of nonspecific manifestation and limited effectiveness of conventional diagnostic tools. Recently, the usability of measurement of ascitic adenosine deaminase (ADA) was shown. We report here a case of TBP in which measurement of ascitic ADA contributed to the diagnosis. A 93-year-old male developed a large amount of ascites. Analyses of the ascitic fluid revealed exudation, though antibiotics treatment was ineffective. Using paracentesis, the ADA level in the ascites was measured and shown to be high. Under suspicion of TBP, an exploratory laparoscopy was performed and a definitive diagnosis of TBP was made.
  • 10.

    【2hr】Rapid Regression of B-Cell Non-Hodgkin's Lymphoma after Eradication of Hepatitis C Virus by Direct Antiviral Agents

    包量

    机译 直接抗病毒药物根除丙型肝炎病毒后B细胞非霍奇金淋巴瘤迅速消退
    摘要：A 47-year-old woman visited Tokai University Hospital complaining of left cervical lymph node swelling in 2007. The laboratory data were almost normal except for slight anemia (Hgb 10.5 g/dL), elevation of serum soluble interleukin (IL)-2 receptor levels (645 U/mL [normal range 220–530 U/mL]), and positive hepatitis C virus (HCV) antibody. Serum transaminase and lactated dehydrogenase levels were normal. Contrast-enhanced computed tomography (CT) showed lymph node swelling with a diameter of 3 cm at the left supraclavicular fossa and mild splenomegaly, and <sup>18</sup>F-fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT) revealed abnormal uptake in the left supraclavicular fossa. The patient was diagnosed as having indolent nodal marginal zone B-cell lymphoma by lymph node biopsy. After 9 years with no progression of lymphoma, the patient received 12-week ledipasvir/sofosbuvir therapy for HCV infection and achieved sustained virologic response without any adverse effects. The left supraclavicular mass disappeared in the FDG-PET/CT performed 5 months after antiviral therapy indicating complete response. The serum soluble IL-2 receptor concentration decreased to 244 U/mL. Thereafter, her lymphoma was in remission for 3 years.
  • 11.

    【2hr】Hepatitis E-Induced Acute Myocarditis in an Elderly Woman

    包量

    机译 一名老年妇女戊型肝炎诱发的急性心肌炎
    摘要：Hepatitis E is a common, mainly water-borne hepatotropic virus prevalent mainly in Southeast Asia, Africa, the Middle East, and Central America. In the eastern part of India epidemics of acute hepatitis E are well reported. Hepatitis E commonly presents as self-limiting acute viral hepatitis among young adults, except for some critical clinical complications during pregnancy. In epidemiological research, subclinical acute hepatitis E infection is also reported from different parts of the world, including developed nations such as the USA (predominantly in the population aged >60 years). Though primarily hepatotropic, in the literature there are reports of rare extrahepatic manifestation of acute hepatitis E. Here we present an elderly lady with acute hepatitis E who primarily presented with acute myocarditis.
  • 12.

    【2hr】Recurrent Fever and Failure to Thrive in an 11-Year-Old Boy

    包量

    机译 一名11岁男孩的反复发烧和无法存活
    摘要：Recurrent fever is frequent among children and mostly associated with viral infections inoculated via social contacts with others of the same age. Rarely, severe conditions such as hematological malignancies, pediatric rheumatoid diseases, chronic infections, or inherited recurrent fever syndromes are causative. Herein, we present the case of an 11-year-old boy with frequently recurring high-fever episodes since early childhood, failure to thrive, and iron deficiency who was found to have classical celiac disease (CD) with highly elevated tissue transglutaminase and anti-gliadin antibodies and marked duodenal villous atrophy. Upon implementation of a gluten-free diet, the boy ceased to have fevers, antibodies decreased markedly, his iron status improved, and he significantly gained weight. Although infrequent, recurrent fever should be included into the polymorphic clinical picture of CD, and the threshold of testing for diagnostic antibodies should be low in such patients.
  • 13.

    【2hr】Severe Hepatotoxicity due to Ibrutinib with a Review of Published Cases

    包量

    机译 依鲁替尼引起的严重肝毒性并发表病例
    摘要：Ibrutinib, an irreversible Bruton's tyrosine kinase inhibitor, is an effective treatment for Waldenström's macroglobulinemia, chronic lymphocytic leukemia, and several other types of lymphoma. Studies prior to FDA approval in 2015 failed to demonstrate any hepatotoxicity. However, since then, there have been 2 reports in the literature of severe hepatic injury. We present a third case of a 77-year-old woman presenting with nausea and jaundice after recent discontinuation of ibrutinib and compare the presentation as well as course of all 3 known cases. The sudden onset of acute hepatotoxicity is idiosyncratic, occurring weeks after starting ibrutinib treatment. Liver biopsies in all cases revealed mixed hepatocellular and cholestatic features. Improvement progressed slowly upon discontinuation of ibrutinib. Awareness of ibrutinib hepatotoxicity, periodic surveillance of liver function tests, early recognition of any abnormalities, and prompt discontinuation of the medication are recommended.
  • 14.

    【2hr】Challenges Associated with Colorectal Cancer in Pregnancy

    包量

    机译 妊娠结直肠癌的挑战
    摘要：Colorectal cancer is epidemiologically a disease of the middle-aged and elderly. However, it may occur in the young where it presents with virulent biological behavior and poor prognosis. The symptoms of colorectal cancer may be masked by symptoms of pregnancy and the patient may attribute it to the pregnancy, especially in multiparous patients whose anxiety and apprehension levels may be lower and hence present late to health care providers. Antenatal women who present with such symptoms must be investigated further under the available repertoire of investigations possible in pregnancy without causing any maternal or fetal hazard. Treatment with chemotherapy and radiation for cancer in this setting is further hampered by justifiable concerns over fetal well-being. We present a case of colorectal cancer in a young multiparous female and the associated difficulties in diagnosis and management. The challenges with colorectal cancers and pregnancies are expected to rise in the future with a decreasing trend in age of colorectal cancer occurrence and an increasing age of pregnancy due to lifestyle changes.
  • 15.

    【2hr】Subcutaneous Magnesium Sulfate to Correct High-Output Ileostomy-Induced Hypomagnesemia

    包量

    机译 皮下硫酸镁纠正高产量回肠造口术引起的低镁血症
    摘要：Fluid and magnesium abnormalities are common in patients with high-output stomas. Subcutaneous magnesium administration may be more feasible for long-term management in ambulatory patients, but magnesium sulfate is approved only for intravenous or intramuscular injection. We describe the management of chronic hypomagnesemia and dehydration secondary to a high-output ileostomy following radiation and chemotherapy for anal squamous cell carcinoma with intermittent home-based subcutaneous magnesium infusions in a 61-year-old female with a history of Crohn's disease and multiple bowel resections. Despite aggressive management with intravenous magnesium sulfate and oral magnesium glucoheptonate over 8 months, 49% of her magnesium concentrations were <0.60 mmol/L (mean 0.61 ± 0.09) necessitating 4 emergency, 1 hospital, and 4 infusion clinic visits. After initiation of subcutaneous magnesium sulfate, all magnesium concentrations were >0.60 mmol/L (mean 0.79 ± 0.08 mmol/L over 9 months). The patient tolerated the infusions well, only developing one minor episode of infusion-related cellulitis. A systematic review of the literature identified 14 reports where subcutaneous magnesium sulfate<sub></sub>was effective and treatment for adults or children with hypomagnesemia was safe. Home-based intermittent administration of subcutaneous magnesium may be a helpful and safe intervention to temporarily prevent and treat select patients with recurrent symptomatic hypomagnesemia.
  • 16.

    【2hr】Endosonographic Appearances of a Rare Duodenal Tumour, Brunner's Gland Hamartoma

    包量

    机译 罕见的十二指肠肿瘤，布鲁纳氏腺瘤的超声内镜检查
    摘要：Brunner's gland hamartoma (BGH) is a rare sub-epithelial tumour of the duodenum, which may cause haemorrhagic or obstructive gastrointestinal symptoms. Their accurate histological diagnosis often remains elusive before resection. Although endoscopic ultrasonography (EUS) is considered an excellent modality to study lesions within the gastrointestinal wall, only a few reports have described endosonographic characteristics of BGHs. A reliable pre-resection diagnosis with EUS may not only allay fear of malignancy but may as well avert a major surgery for the patients. In this report, we present a rare case of a large BGH in a young female who presented with acute gastrointestinal bleeding. Here, the endosonographic features assuaged the concern for malignancy while aiding in complete and uneventful surgical resection of the tumour via a submucosal plane.
  • 17.

    【2hr】Acute Pancreatitis Masquerading as Inferior Wall Myocardial Infarction: A Review

    包量

    机译 急性胰腺炎伪装成下壁心肌梗死的研究进展
    摘要：A rare presentation of acute pancreatitis is with electrocardiographic (ECG) changes that mimic myocardial ischemia. We present a report of a patient that presented with hemodynamic instability and new ECG changes of ST segment elevations in contiguous leads II, III, and aVF mimicking an inferior wall myocardial infarction. Emergent coronary angiography showed no significant coronary obstruction, but it was followed by a left-sided hemiplegia with radiographic evidence of diffuse embolic stroke. The patient was later found to have an underlying diagnosis of pancreatitis. Additional history that later became available indicated a history of severe acute pancreatitis treated elsewhere a few months prior to the current admission. We present the first comprehensive review of the literature comprising 36 total cases with pancreatitis masquerading as acute myocardial infarction, with inferior wall STEMI pattern being the most frequent. We present this case to highlight the diagnostic dilemma posed by this masquerade of a high acuity myocardial infarction and to highlight alternative diagnoses to be considered in such clinical circumstances.
  • 18.

    【2hr】Easy Detection and Fast Removal of Gastric Anisakis during Narrow-Band Imaging Endoscopy with L-Menthol Administration

    包量

    机译 带有L-薄荷醇的窄带成像内窥镜检查过程中易于检测和快速去除胃茴香
    摘要：Anisakiasis is a parasitic disease caused by the ingestion of raw or uncooked seafood infected with third-stage larvae of the anisakid nematodes. A 45-year-old Japanese man presented with epigastric pain and itchy skin with rash on his arm, chest, and back after eating vinegar-marinated raw mackerel sushi. He underwent an emergent endoscopic examination using narrow-band imaging (NBI) that revealed two anisakid larvae. NBI showed the larvae more clearly than white light imaging on the cardiac region of the stomach. We sprayed L-menthol on the larvae for stopping their movement and then easily removed them using biopsy forceps. The macroscopic examination and genotype analysis of the specimens revealed the two larvae as belonging to A. simplex sensu stricto. Our case demonstrates the usefulness of endoscopic examination with NBI and of the L-menthol spray in visualizing and immobilizing the larvae for removal.
  • 19.

    【2hr】Epiploic Appendagitis: An Often Misdiagnosed Cause of Acute Abdomen

    包量

    机译 上腹部阑尾炎：急性腹部常被误诊的原因
    摘要：Epiploic appendages are peritoneal structures that arise from the outer serosal surface of the bowel wall towards the peritoneal pouch. They are filled with adipose tissue and contain a vascular stalk. Epiploic appendagitis is a rare cause of acute lower abdominal pain. It most commonly results from torsion and inflammation of the epiploic appendages, and its clinical features mimic acute diverticulitis or acute appendicitis resulting in being often misdiagnosed as diverticulitis or appendicitis. This frequently leads to unnecessary hospitalization, antibiotic administration, and unwarranted surgeries. Epiploic appendagitis is usually diagnosed with CT imaging, and the classic CT findings include: (i) fat-density ovoid lesion (hyperattenuating ring sign), (ii) mild bowel wall thickening, and (iii) a central high-attenuation focus within the fatty lesion (central dot sign). It is treated conservatively, and symptoms typically resolve in a few days. Therefore, epiploic appendagitis should be considered as one of the differential diagnosis for acute lower abdominal pain and prompt diagnosis of epiploic appendagitis can avoid unnecessary hospitalization and surgical intervention. In this case report, we discuss a 72-year-old woman who presented with a 2-day history of acute left lower abdominal pain.
  • 20.

    【2hr】IgG4-Related Disease with Esophageal Involvement

    包量

    机译 食管参与性IgG4相关疾病
    摘要：We report the case of a 56-year-old man who presented with dysphagia and weight loss. An esophagoduodenoscopy revealed a severe esophageal stricture in the distal esophagus. After surgical resection, the final pathologic analysis revealed that the tumor was comprised of benign-appearing fibroinflammatory cells with an increase and predominance of IgG4-positive plasma cells. He did not, however, have any other symptoms indicative of systemic autoimmune disease or connective tissue disorders. Histologically, abundant infiltration of IgG4-positive plasma cells and lymphocytes was observed. The patient was diagnosed with IgG4-related disease, definitive, with esophageal involvement.
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