Small bowel obstruction caused by secondary jejunal tumor from renal cell carcinoma: A case report

BACKGROUNDSecondary jejunal tumor from renal cell carcinoma (RCC) is extremely rare in clinical practice and is easily missed and misdiagnosed because of the low incidence and atypical symptoms.CASE SUMMARYA 38-year-old male patient was diagnosed pathologically with left RCC after radical nephrectomy in 2012. The patient then suffered multiple lung metastases 2 years later and was treated with oral sorafenib without progression for 6 years. In 2020, an emergency intestinal segmental resection due to intestinal obstruction was required, and postoperative pathology confirmed a jejunal secondary tumor from RCC. The patient had a smooth recovery following surgery. Three months after surgery, the patient was diagnosed with left adrenal metastasis, and subsequent sintilimab therapy has stabilized his condition.CONCLUSIONThis report is written to remind urologists and pathologists of the potential for small intestinal secondary tumors when a patient with a history of RCC seeks treatment for digestive symptoms. Enteroscopy and abdominal contrast-enhanced computed tomography are essential means of examination, but severe cases require immediate surgical intervention despite the lack of a preoperative examination to distinguish tumor attributes.     

Endoscopic titanium clip closure of gastric fistula after splenectomy: A case report

This report describes a 52-year-old male patient with blunt abdominal traumatic rupture of the spleen due to injuries sustained in an automobile accident. Following splenectomy, the patient developed a gastric fistula. He underwent a long period of conservative treatment, including antibiotics and total parenteral nutrition, which was ineffective. The fistula could not be closed and titanium clip closure using a gastroscopy was then performed in order to close the fistula. After endoscopic therapy and clipping surgery, the patient’s general condition improved significantly, and he had no post-procedural abdominal complications. On post-clipping day 6, the gastric fistula was completely closed as shown by X-ray examination of the upper digestive tract. The patient was discharged from hospital and no complications were observed during the six-month follow-up period. Our report suggests that titanium clip closure using endoscopy may be the choice of treatment in patients with a gastric fistula.     

Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report

BACKGROUND Pyoderma gangrenosum resulting from or associated with congenital preauricular fistula is rarely reported.CASE SUMMARY We report a rare case of pyoderma gangrenosum misdiagnosed as preauricular fistula infection.To our knowledge,this is the first report to describe pyoderma gangrenosum originating from the site of preauricular fistula.The lesion continued expanding even after combined treatment of systemic antibiotics and thorough debridement.Taking into account the possibility of pyoderma gangrenosum,we applied soft care with normal saline and Vaseline gauze dressing.Systemic corticosteroids were not used until intestinal Clostridium difficile was controlled.No local recurrence was noted at the 12-mo follow-up.CONCLUSION This case highlights the necessity of considering rare diseases,such as pyoderma gangrenosum,when the preauricular sinus deteriorates with general management.The treatment strategy is mutually conflicting between pyoderma gangrenosum and infection of the preauricular sinus.     

Coil embolization of arterioportal fistula complicated by gastrointestinal bleeding after Caesarian section: A case report

BACKGROUNDMost intrahepatic arterioportal fistulae (IAPF) are acquired. The few cases of congenital fistulae are diagnosed in infants and children.CASE SUMMARYWe report a 31-year-old female patient presenting with haematemesis and melena three weeks after delivering her second child. The patient had a 20-year history of abdominal distention and nausea. IAPF, along with splenomegaly and ascites, was found by Doppler sonography and confirmed by computed tomography angiography. The patient was treated with endovascular coil embolization, resulting in occlusion of the fistula.CONCLUSIONThis was an unusual case of possible congenital IAPF that manifested during a second pregnancy and was complicated by portal hypertension.     

Cholecystoduodenal fistula presenting with upper gastrointestinal bleeding: A case report

BACKGROUNDCholecystoduodenal fistula is a rare complication of cholelithiasis. Symptoms are usually non-specific and often indistinguishable from those of etiologic diseases, but it rarely presents as severe gastrointestinal bleeding. Bleeding associated with cholecystoduodenal fistula usually requires surgery because significant bleeding from the cystic artery is unlikely to be resolved by conservative management or endoscopic hemostasis.CASE SUMMARYWe report a case of cholecystoduodenal fistula that presented with hematemesis which was diagnosed by endoscopy and computed tomography. Endoscopic hemostasis could not be achieved, but surgical treatment was successful. Additionally, we have presented a literature review.CONCLUSIONCholecystoduodenal fistula should be considered as differential diagnosis when a patient with history of gallstone disease presents with gastrointestinal bleeding.     

Gallstone ileus: A rare cause of small intestine obstruction

Gallstone ileus is a very rare cause of mechanical bowel obstruction with often‐delayed presentation and nonspecific symptoms. Aerobilia is found in approximately 50% of patients with gallstone ileus.     

Gastrointestinal bleeding caused by syphilis: A case report

BACKGROUNDSyphilis is a chronic, classic sexually transmitted disease caused by Treponema pallidum, which can invade almost all organs of the body and produce various symptoms and signs. Although there are some cases of colorectal bleeding caused by syphilis, small intestinal bleeding caused by syphilis is still rare.CASE SUMMARYA 58-year-old man had experienced recurrent abdominal pain and melena for 3 years. Repeated gastroenteroscopy and computed tomography angiography examinations failed to find bleeding lesions. During the same admission, multiple intestinal ulcers were found by capsule endoscopy, and syphilis was also diagnosed. With a history of atrial fibrillation and chronic pancreatitis, he had undergone mitral valve replacement and tricuspid valvuloplasty for valvular heart disease. After anti-syphilis treatment, the melena and abdominal pain disappeared and his hemoglobin gradually increased. It is considered that gastrointestinal bleeding, chronic pancreatitis, atrial fibrillation, and heart valvular disease may have been caused by syphilis.CONCLUSIONThis case report found that syphilis can mimic systemic disease and cause intestinal bleeding. In addition, treatment of the disease requires both sexual partners to be treated. Finally, although syphilis is easy to treat, it is more important to consider that bleeding could be caused by syphilis.