Daily Archives: May 27, 2015

Question: A 55-year-old woman with chronic constipation underwent screening colonoscopy. The colonic mucosa had a diffuse brown pigmentation consistent with melanosis coli. In the cecum a 1-cm, Paris class IIa lesion with a yellowish hue and concomitan… Continue reading →

Question: A 21-year-old woman was referred to our General Surgery Department in South Africa with progressive abdominal distention, abdominal discomfort, and intermittent vomiting over the previous year. She was still managing to pass stools and flatus… Continue reading →

Question: A 79-year-old man presented with a 4-month history of intermittent melena, weakness, and abdominal pain was admitted to our hospital. His past medical history was significant for hypertension and cholecystectomy. He denied previous radiothera… Continue reading →

Question: A 46-year-old man with a 3-month history of recurrent pancreatitis of unknown etiology was admitted for another episode of acute pancreatitis. Liver function tests (LFTs) at the time of initial presentation showed elevated bilirubin (4.5 mg/dL) and transaminase levels >200 U/L. CT scan and MR cholangiopancreatography (MRCP) revealed pancreatic inflammation, gallbladder wall thickening, and 0.9 cm common bile duct (CBD) dilatation. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and sludge removal (Figure A). Continue reading →

Question: A 61-year-old man with recurrent small bowel obstruction, hematochezia, and terminal ileal ulcerations seen on colonoscopy was referred to our institution for suspicion of inflammatory bowel disease. On physical examination, the patient was afebrile without abdominal distention, tenderness, organomegaly, or palpable masses. Laboratory assessment was notable for an elevated C-reactive protein of 40 mg/L (normal, <5 mg/L) and elevated serum chromogranin A of 196 ng/dL (normal, <93 ng/dL). Continue reading →

Question: A 64-year-old Japanese man was referred to our hospital for further investigation of a 1-month history of heartburn and epigastric pain. At presentation, the patient’s vital signs were unexceptional and he did not look seriously ill. Medica… Continue reading →

Shteyer et al reports correlative evidence of a truncating mutation of nNOSα in 2 probands (siblings) of achalasia.1 This excellent study leaves scope for additional discussion. Achalasia results from prejunctional defects of evoked nitric oxide (NO)… Continue reading →

Pouchitis is a common long-term complication in patients with ulcerative colitis (UC) undergoing proctocolectomy with ileal pouch-anal anastomosis. Since the inflammation occurs in a previously normal small bowel, studies of this process might provide … Continue reading →