[Pancreatic Mass or Cyst? Diagnostic Dilemma].

A santorinicele is a rare anomaly defined as focal cystic dilation of the terminal portion of the dorsal pancreatic duct at the minor papilla. Importantly this anomaly has been suggested as a possible cause of relative stenosis of the minor papilla. This anomaly has been associated with pancreatic divisum and recurrent acute pancreatitis. Magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic ultrasound (EUS) are the main diagnostic modalities. Endoscopic minor papilla sphincterotomy has been shown to improve pain and quality of life in patients with this anomaly presenting with recurrent pancreatitis. We present a case of a single episode of pancreatitis who underwent EUS for evaluation of possible pancreatic mass leading to a diagnosis of santorinicele and complete pancreatic divisum. We attempt to describe this anomaly, diagnostic approach, and management options.

Sigmoid Colonic Polyp as Initial Presentation of Metastatic Papillary Renal Cell Carcinoma.

BACKGROUND: Upon initial presentation, 25%-30% of patients with renal cell carcinoma have metastatic disease. Metastasis to the gastrointestinal tract is rare, but when it occurs, the large bowel is the least common site. CASE REPORT: A 75-year-old white male presented with vague abdominal symptoms and worsening hemoglobin and hematocrit levels. Colonoscopy revealed a polyp in the distal portion of the sigmoid colon. Histologic and immunohistochemical analysis suggested metastatic papillary renal cell carcinoma. CONCLUSION: To the best of our knowledge, this patient had a rare case of metastatic papillary renal cell carcinoma that metastasized to the colon and presented as a colon polyp.

Effects of Immunomodulators and Biologic Agents on Sexual Health in Patients With Inflammatory Bowel Disease.

BACKGROUND: Although much knowledge has been gained regarding the medical and surgical management of inflammatory bowel disease (IBD), a paucity of information is available on the psychosexual issues related to IBD. The aim of this study was to evaluate the sexual health of patients with IBD who were taking immunomodulators and/or biologic agents vs patients with IBD who were not on that medication regimen. METHODS: All study participants completed a validated sexual health questionnaire, the Female Sexual Function Index or the International Index of Erectile Function, to assess their subjective perception of the effect of IBD on the different domains of sexual function during the prior 1-month time period. RESULTS: No statistically significant differences in any baseline demographic variables were found for either sex between the group taking immunomodulators/biologic agents and the nontreatment group. Among females and males, individual question responses, domain scores, and total scores showed no statistically significant differences between the 2 treatment groups. CONCLUSION: Our data suggest that the use of immunomodulators or biologic agents does not affect female or male sexual health. However, treatment of patients with IBD must be individualized based on the aggressive nature of the disease, treatment goals, and the tolerability of various medications.

Meckel Diverticulum Harboring a Rare Gastrointestinal Stromal Tumor.

BACKGROUND: Tumors within a Meckel diverticulum are a rare complication observed in only 0.5%-3.2% of symptomatic cases. The majority of tumors are benign, but some malignant tumors, such as gastrointestinal stromal tumors (GISTs) can occur. CASE REPORT: We report the case of a 48-year-old female who presented with severe abdominal pain and nausea and was found to have a GIST arising from a Meckel diverticulum. CONCLUSION: The differential diagnosis of a pelvic mass in a middle-aged female presenting with gastrointestinal symptoms must remain broad. With an atypical presentation site, distinguishing benign tumors from malignant tumors such as GISTs is of paramount importance.

Primary Histoplasma capsulatum Enterocolitis Mimicking Peptic and Inflammatory Bowel Disease.

In immunocompromised patients, histoplasmosis may present as disseminated disease. We present a 52-year-old Caucasian male with symptoms of dyspepsia, postprandial epigastric pain, nausea, and nonbloody diarrhea. Upper and lower gastrointestinal endoscopies were suspicious for inflammatory bowel disease (IBD); however, biopsies were consistent with histoplasmosis, specifically in the duodenum.

Choice of sedation and its impact on adenoma detection rate in screening colonoscopies.

BACKGROUND: Studies have demonstrated that the use of sedation (regardless of type) increases polyp detection rates during colonoscopy. Compared to conscious sedation (CS), propofol sedation (PS) has led to detection of more advanced polyps, yet no apparent difference was found in the overall adenoma detection rate (ADR) in patients undergoing colonoscopy for various reasons. We aimed to assess whether there was a significant difference in the ADR in patients specifically undergoing screening colonoscopies using PS versus CS. METHODS: This is a retrospective analysis of 699 consecutive patients who underwent inpatient screening colonoscopies at one academic inpatient center. The decision to perform endoscopy using PS versus CS was determined on an individual basis by each provider, taking into account various patient parameters. RESULTS: No significant difference was noted between ADR or location of detected adenomas between the CS and PS groups. When accounting for each variable, only total endoscopy time of less than 20 min resulted in a statistically significant ADR difference between the two sedation groups (CS: 15.6% vs PS: 21.3%, P = 0.038). CONCLUSION: ADR in screening colonoscopies is not increased by the use of PS compared to CS. While the use of propofol-based anesthesia is clearly associated with increased patient satisfaction and pain levels, the ADR is not enhanced, and its widespread use in screening colonoscopy sedation should still be investigated.

Adverse Effects of Grape Seed Extract Supplement: A Clinical Case and Long-Term Follow-Up.

Grape seed extract (GSE) supplement use is becoming more popular today for its potential chemopreventive and chemotherapeutic role. We report a 49-year-old male who presented with recurrent nausea, vomiting, diarrhea, and acute weakness following GSE use. A thorough medical workup ensued and no causes were identified clinically, procedurally, or with imaging. Symptoms resolved after GSE discontinuation and the patient remained symptom-free 5 years later. This case illustrates the paucity of documented detailed clinical cases and lack of controlled trials detailing a thorough and reproducible adverse effect profile of GSE supplement.

Collagenous colitis with mucosal ulcerations in a patient without nonsteroidal anti-inflammatory drug or lansoprazole use.

Chronic watery diarrhea combined with normal-appearing colonic mucosa at endoscopy with abnormal histopathology is classified as microscopic colitis. Microscopic colitis encompasses both collagenous and lymphocytic colitis. A 42-year-old Caucasian woman presented with severe diarrhea for six weeks with loose watery stools every 1-2 h, approximately 15 episodes per day. She denied any melena or significant abdominal pain. She denied nonsteroidal anti-inflammatory drug or lansoprazole use, and was only taking diphenoxylate/atropine for her symptoms. Colonoscopy revealed superficial ulcerations in the distal ascending and transverse colon and scattered ulcerations in the descending and sigmoid colon, with biopsy confirming collagenous colitis. We report a rare case of collagenous colitis accompanied by mucosal ulcerations in the absence of known culprits of mucosal ulcerations, such as nonsteroidal anti-inflammatory drugs or lansoprazole.

African American ethnicity is not associated with development of Barrett's oesophagus after erosive oesophagitis.

BACKGROUND: Barrett's oesophagus is the primary risk factor for oesophageal adenocarcinoma; erosive oesophagitis is considered an intermediate step with Barrett's oesophagus development potential upon healing. Barrett's oesophagus occurs in 9-19% following erosive oesophagitis but minimal data exists in African Americans. The study aim was to determine if ethnicity is associated with Barrett's oesophagus formation following erosive oesophagitis. METHODS: Retrospective review of endoscopies from September 2007 to December 2012 was performed. Inclusion criteria were erosive oesophagitis on index endoscopy, repeat endoscopy ≥6 weeks later and non-Hispanic white or African American ethnicity. Barrett's oesophagus frequency following erosive oesophagitis by ethnicity was compared. RESULTS: A total of 14,303 patients underwent endoscopy during the study period; 1636 had erosive oesophagitis. Repeat endoscopy was performed on 125 non-Hispanic white or African American patients ≥6 weeks from the index procedure. Barrett's oesophagus occurred in 8% of non-Hispanic whites while no African American developed it on repeat endoscopy following erosive oesophagitis (p=0.029). No significant difference was seen between ethnic groups in any clinical parameter assessed. CONCLUSIONS: African American ethnicity appears to result in decreased Barrett's oesophagus formation following erosive oesophagitis. Further investigation to demonstrate factors resulting in decreased Barrett's oesophagus formation among African Americans should be performed.