Partial Segmental Thrombosis of the Corpus Cavernosum Associated With Inappropriate Sildenafil Use.

The case presented is of a 39-year-old male with severe right groin pain and perineal pain the morning after sexual intercourse with the use of sildenafil without a diagnosis of erectile dysfunction. Partial segmental thrombosis of the corpus cavernosum (PSTCC) was diagnosed using magnetic resonance imaging and treated with direct oral anticoagulation without complications. Sildenafil use has been noted as an inciting factor for PSTCC in only two other cases of less than 60 cases reported in the literature and has even been used successfully as a component of therapeutic management of PSTCC in another previous case.

Real-World Effectiveness of Ustekinumab in Ulcerative Colitis in a United States Multicenter Cohort Consortium.

BACKGROUND: Pivotal trials have shown that ustekinumab is effective in ulcerative colitis (UC). However, the population included in these trials do not represent the cohort of patients treated in the real world. In this study, we aimed to describe the effectiveness and safety of ustekinumab in a clinical cohort of patients with UC. METHODS: We performed a multicenter retrospective cohort study and included patients with active UC starting ustekinumab. Variables collected included demographics, clinical data, and disease activity (measured using partial Mayo score [PMS] and endoscopic Mayo score) at follow-up. The primary outcomes were cumulative rates of steroid-free clinical and biochemical remission (SFCBR), defined as a PMS <2 while off steroids and a normal C-reactive protein and/or fecal calprotectin. RESULTS: A total of 245 patients met inclusion criteria. The median time of follow-up was 33 (interquartile range, 17-53) weeks, and 214 (87.3%) had previous exposure to a biologic and/or tofacitinib. Rates of SFCBR, clinical remission, and endoscopic remission at 6 and 12 months were 12.0% (n = 16 of 139), 29.0% (n = 71 of 175), and 18.0% (n = 7 of 39), and 23.8% (n = 15 of 63), 54.3% (n = 57 of 105), and 31.0% (n = 9 of 29), respectively. Non-Hispanic White race, higher baseline PMS, and the use of concomitant corticosteroids were independently associated with failure to achieve SFCBR. Of the 73 that were dose escalated, 28.4% did not respond, 49.3% experienced a benefit, and 21.6% achieved remission. CONCLUSIONS: In a population enriched with refractory UC, ustekinumab was well tolerated and induced remission in a significant number of patients. Larger studies with a longer follow-up are warranted.

Ustekinumab was shown to be efficacious and safe in a population of patients with refractory ulcerative colitis. Those patients with exposure to multiple drug classes and higher disease burden at baseline are less likely to respond.

Gastroenterological Education: Do Digital Data Depositories Make a Difference?

During the three or more years of GI Fellowship, trainees acquire a large percentage of the specialized medical knowledge that they will carry throughout their careers. It is thus important to foster a commitment to continuous learning and practices during fellowship intended to extend beyond training. Since relying solely on traditional textbooks is no longer adequate, numerous valuable resources exist as supplementary aids for learning and studying. Nevertheless, lacking a practical structure to navigate the sheer volume of these resources can be overwhelming. The sources of knowledge in gastroenterology during the digital age include published guidelines, eBooks, podcasts, board examination preparation, mobile applications, and engagement with social media. This article seeks to offer trainees and early career gastroenterologists' guidance for effectively utilizing diverse digital tools for ongoing and lifelong education.

Loose Screws: Removal of Foreign Bodies From the Lower Gastrointestinal Tract.

While both the American Society for Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) have released guidelines on the management of ingested foreign bodies in the upper gastrointestinal (GI) tract, neither has addressed indications or techniques for endoscopic removal of foreign bodies in the lower GI tract, perhaps due to the high likelihood of foreign body passage once the foreign body has reached the lower GI tract. We present the case of a 45-year-old woman presenting to the emergency department following the intentional ingestion of multiple screws and nails, complaining of acute abdominal pain and nausea. Imaging revealed four nails in the colon and two adjacent screws in the distal small bowel. In the absence of signs of acute obstruction or bowel perforation, she was admitted for expectant management but subsequently required endoscopic removal of two retained screws in the lower GI tract.

Weight Loss Success With Repeat Intragastric Balloon Placement After Hyperinflation and Removal of the Index Balloon.

Intragastric balloons are an increasingly common endoscopic alternative to bariatric surgery for the treatment of obesity. Hyperinflation is a rare complication that presents as acute-onset epigastric pain, nausea, vomiting, early satiety, abdominal distention or bloating, and rapid weight loss. Hyperinflation requires prompt diagnosis and removal of the balloon to prevent complications including gastric outlet obstruction or gastric perforation. We present a case of intragastric balloon hyperinflation with removal of the index device, followed by replacement with a second balloon, resulting in continued weight loss without further adverse events.

Clostridioides difficile-Associated Atypical Hemolytic-Uremic Syndrome Successfully Treated With Eculizumab: A Case Report and Literature Review.

Clostridioides difficile infection is a rare precipitant for patients to develop atypical hemolytic-uremic syndrome, of which the pathogenesis remains unclear. Previous reports suggest activation of cytokine storm from binding of cyotoxins A and B to colonic wall membranes. CASE SUMMARY: We present a case of a previously healthy 21-year-old woman who developed fulminant C. difficile colitis and atypical hemolytic-uremic syndrome requiring abdominal surgery and renal replacement therapy. She was ultimately treated with eculizumab without the use of plasmapheresis and remains in remission with full renal recovery. CONCLUSIONS: Our patient's significant response to terminal complement inhibitor, without the use of plasmapheresis, suggests that the underlying pathology is significantly driven by the alternative complement pathway. We propose that C. difficile-associated atypical hemolytic-uremic syndrome be defined as primary atypical hemolytic-uremic syndrome and strongly consider eculizumab as first-line therapy.

Severe acute liver injury associated with Yersinia enterocolitica.

Yersinia enterocolitica is a Gram-negative bacterium that causes foodborne illnesses, typically characterised by acute febrile gastroenteritis and is associated with a variety of manifestations. Isolated febrile illness without gastrointestinal symptoms is rare. We report a case of Y. enterocolitica infection with severe anicteric hepatitis. A 33-year-old Chinese man with no significant medical history presented on multiple occasions to the emergency department with recurrent high-grade fever and chills, but without gastrointestinal symptoms. Hepatic panel showed rising transaminases that peaked at Aspartate Aminotransferase (AST) of 991 U/L and Alanine Aminotransferase (ALT) of 1664 U/L. CT of the abdomen revealed terminal ileitis and mesenteric adenitis. As part of workup, we found positive serology for Y. enterocolitica Ultimately, he improved with supportive care. This case highlights the importance of thorough workup of terminal ileitis and 'Crohn's mimics' which ultimately revealed a unifying diagnosis; and an important addition to the workup for undifferentiated severe isolated hepatocellular liver injury.

Dissolving Potassium Tablets Masquerading as Concealed Foreign Body Ingestion.

Foreign body ingestion is a common consultation for gastroenterologists. Without knowing the object(s) ingested, the differential diagnosis is broad, especially in patients with underlying mental health conditions, such as uncontrolled bipolar disorder, prior suicide attempts, or recreational drug use. The differential should include substances taken with suicidal intent or for concealment of illicit drugs. Certain foreign objects may require urgent or emergent endoscopic intervention. However, one should also consider benign, iatrogenic causes such as large, radiolucent potassium pills given in the emergency department, which do not require further intervention or hospitalization.

Transient Central Diabetes Insipidus after Discontinuation of Vasopressin.

Central diabetes insipidus (CDI) is an uncommon condition resulting from lack of vasopressin secretion from the posterior pituitary gland typically caused by some form of destruction of the gland. Here we present a case of transient CDI after discontinuation of vasopressin used for septic shock without evidence of overt pituitary damage. Serum sodium concentration peaked at 160 mmol/L in the setting of polyuria within days of vasopressin discontinuation without identified alternative etiologies. Sodium levels and urine output normalized with administration of desmopressin with continued stability after desmopressin was discontinued. This is one of few reported cases of diabetes insipidus occurring after discontinuation of vasopressin and the rapid and profound response to desmopressin in this case proves a central etiology. This case allows for speculation into predisposing risk factors for this phenomenon including preexisting neurological disease.

Successful Modified Therapy in a Patient with Probable Infection-Associated Hemophagocytic Lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, hyperinflammatory syndrome characterized by clinical signs and symptoms of extreme inflammation. In adults, HLH is typically a complication of infections, autoimmune diseases, and malignancies. While the disease is often fatal, classic management of HLH revolves around early diagnosis and initiation of protocolized therapy. We present a case of a previously healthy 56-year-old female who developed distributive shock requiring intubation, vasopressors, and continuous venovenous hemofiltration. In the setting of multiple infectious syndromes, severe cytopenias, and rising direct hyperbilirubinemia, her diagnosis of HLH was confirmed. Therapy was initiated with dexamethasone and two doses of reduced-intensity etoposide based on the patient's clinical course. Over the next few weeks, she continued to improve on dexamethasone monotherapy and has maintained remission up to the present with complete resolution of her cytopenias and return of baseline renal function. Our case highlights the variability in the management of probable infection-associated HLH (IHLH) with a good patient outcome. We demonstrate the potential to treat IHLH with partial protocols and minimal chemotherapeutics.