Sign of leser-trélat associated with esophageal squamous cell cancer.

The sign of Leser-Trélat is a rare paraneoplastic phenomenon marked by accelerated onset of multiple seborrheic keratoses. The occurrence of the sign often points towards underlying visceral malignancies which in a majority are adenocarcinomas of the gastrointestinal tract. We report this case of a 65-year-old man who presented with sign of Leser-Trélat and was diagnosed with poorly differentiated squamous cell cancer of the esophagus. To our knowledge this is only the second such reported association of Leser-Trélat sign with squamous cell cancer of esophagus.

A fascinating presentation of hepatic hydrothorax.

We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The pre-ventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.

Ascaris lumbricoides: To Expect the Unexpected during a Routine Colonoscopy.

Ascaris lumbricoides is a common nematode infecting humans worldwide with increased prevalence in tropical and subtropical areas of less developed countries. Recently, it has been estimated that over one billion individuals are infected with ascariasis worldwide with 7% in USA. Although most of these cases are due to increasing immigration and travel outside America it is worth recognizing that prevalence of ascariasis is high in southeastern parts of USA due to their temperate climate. Infections of A. lumbricoides are largely asymptomatic, and hence a large population of people carrying this worm remains undetected for years until they develop some symptoms. Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscopic procedures. Here, we present a case of an intestinal ascariasis found during routine colonoscopy in an African-American man from the Bronx with perianal itching. He denied any history of travel outside USA but reported frequent visits to South Carolina. This case illustrates the fact that ascariasis should be suspected even if immigration or travel outside USA is not involved. It should be suspected even in cases of travel within USA to the south east where endemic cases are reported.

"Downhill" Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding.

"Downhill" varices are a rare cause of acute upper gastrointestinal bleeding. Rarely these varices are reported in patients receiving hemodialysis as a complication of chronic dialysis vascular access. We present a case of acute upper gastrointestinal bleeding in an individual with end-stage renal disease receiving hemodialysis. Esophagogastroduodenoscopy revealed "downhill" varices in the upper third of the esophagus without any active bleeding at the time of the procedure. An angiogram was performed disclosing superior vena caval occlusion, which was treated with balloon angioplasty. Gastroenterologists should have a high index of suspicion for these rare "downhill" varices when dealing with acute upper gastrointestinal bleeding in patients receiving hemodialysis and manage it appropriately using endoscopic, radiological, and surgical interventions.

Cecal schwannoma: a rare cause of gastrointestinal bleeding in a young woman with review of literature.

Schwannomas are rare mesenchymal tumors of the gastrointestinal tract. Occurrence of these tumors is more common in the stomach than in the large intestine. These tumors usually present as polypoidal intraluminal lesions and based on their location can present with rectal bleeding, colonic obstruction, and abdominal pain or defecation disorders. We present a case of a thirty-five-year-old woman who presented with abdominal pain and melena. Patient was diagnosed with a nonobstructing superficially ulcerated mass in the cecum on colonoscopy and required right hemicolectomy. A very rare pathological diagnosis of cecal schwannoma was made postoperatively.

Role of Alendronate in Managing Osteoporosis in Celiac Disease - Illustrative Case Report.

Management of bone density loss, as the result of calcium malabsorption in celiac disease, is critical in preventing premature bone fracture. As many of these patients need follow-up with primary care providers, internists are expected to be aware of screening and prompt management of osteopenia or osteoporosis in celiac disease. We present a case of a 32-year-old man with celiac disease who was diagnosed with osteoporosis. He was treated with calcium, vitamin D and alendronate which improved bone mineral density. This case illustrates the importance of using bisphosphonate in treating osteoporosis in celiac disease.

Successful Management of Pancreatic Ascites with both Conservative Management and Pancreatic Duct Stenting.

Pancreatic ascites is a rare complication and should be suspected in patients with chronic alcoholism and pancreatitis presenting with ascites. The etiology is likely from a pancreatic pseudocyst leakage or due to ductal disruption. Treatment is controversial but includes conservative medical therapy or endoscopic transpapillary pancreatic duct stenting or surgery. We present a case of pancreatic ascites in a patient with alcohol use and chronic pancreatitis. Patient received conservative therapy including octreotide. An endoscopic retrograde cholangiopancreatography was performed, which confirmed a pancreatic duct dehiscence with extravasation of the injected contrast. This was treated with placement of a stent. Patient improved clinically and symptomatically. This case report augments the existing data from two prior reported case series, and this modality of management should be actively pursued in such cases.

Mucosa-associated lymphoid tissue lymphoma presenting as massive gastrointestinal bleeding: a case report.

We present a 71-year-old man with mucosa-associated lymphoid tissue (MALT) lymphoma of the colon presenting with massive gastrointestinal hemorrhage. At laparotomy two areas of irregular mucosa were noted in the ascending colon and cecum. Pathology revealed MALT lymphoma. MALT lymphoma of the colon is rare and the presentation as well as outcome of our case makes him unique.