Search Results (110)

Aim: Percutaneous liver ablation is a challenging procedure and operator-dependent. During the time when transarterial liver oncological therapies are favored over percutaneous liver ablation, we discuss the challenges of liver ablation with bowel interposition within the needle tract. Materials and Methods: In this IRB-approved retrospective review, we analyzed 481 cases of percutaneous microwave ablation performed between 2012 and 2025 using the NeuWave microwave ablation system with 15 or 20 mm probes under non-contrast CT guidance, with needle trajectories planned based on ultrasound. Dissection techniques were not performed, as intraprocedural ultrasound and CT assessment suggested that the ablation zone would remain confined to hepatic parenchyma. Cases of bowel transgression or close proximity were identified on post-procedural CT imaging, with a follow-up duration of 3 months performed consistently across all cases. Results: Three cases (0.6%) of bowel transgression or close proximity to bowel loops during needle placement were identified. There was no evidence of transmural bowel perforation or clinically significant bowel injury on clinical or radiologic follow-up. Post-procedural imaging demonstrated no free intraperitoneal air or fluid collections. Conclusions: In cases where the ablation zone is confined to hepatic parenchyma, bowel proximity to or inadvertent traversal by the cooled antenna shaft may not result in clinically significant injury and can be managed conservatively in selected patients. Full article

Background and Clinical Significance: Polycythemia vera (PV) is a myeloproliferative neoplasm associated with a markedly increased risk of arterial and venous thrombosis. Superior mesenteric artery (SMA) thrombosis is an exceptionally rare but potentially fatal complication. Case Presentation: We report the case of a 25-year-old man with previously diagnosed, JAK2-negative PV who presented with acute abdominal pain, nausea, vomiting, abdominal distension, and absence of stool and flatus, consistent with clinical features of intestinal obstruction. Laboratory testing revealed marked leukocytosis, elevated inflammatory markers, and subtherapeutic anticoagulation (INR 1.2) despite ongoing oral therapy. Multislice computed tomography demonstrated occlusion of the SMA with developed collateral circulation and features of small-bowel ischemia. Due to progression to an acute abdomen, emergency laparotomy was performed, revealing jejunal perforation with preserved viability of the remaining bowel. Primary closure was carried out, followed by peritoneal lavage and drainage. The postoperative course was uneventful. After correction of anticoagulation and therapeutic INR monitoring, no recurrent thrombotic events were observed during follow-up. Conclusions: This case underscores the importance of strict anticoagulation control, early imaging, and prompt surgical intervention in patients with PV, even in young individuals and in atypical vascular territories. Full article

Background and Clinical Significance: Burkitt lymphoma is an aggressive form of non-Hodgkin lymphoma of B-cell origin, caused by a MYC gene translocation on chromosome 8. There are three clinical subtypes, of which the sporadic subtype is most prevalent in the United States. Sporadic Burkitt lymphoma is diagnosed at a median age of 30 years and commonly manifests as bulky abdominal lesions, most often involving the ileocecal region. Pancreatic involvement is uncommon, and presentation as acute pancreatitis secondary to Burkitt lymphoma is exceedingly rare. Case Presentation: We present a case of a young male who presented with epigastric pain, nausea, and vomiting. He had a diffusely tender abdomen and elevated lipase levels. On imaging, he was found to have large retroperitoneal and intraperitoneal masses, contiguous with an enlarged pancreas. Burkitt lymphoma was confirmed upon biopsy of duodenal and gastric masses via endoscopic ultrasound. MRI brain and testicular ultrasound revealed unilateral fifth cranial nerve and bilateral testicular involvement, respectively. His course was complicated by bowel perforation requiring urgent surgery. However, he achieved complete remission with dose-dense systemic and intrathecal chemotherapy. Conclusions: This case highlights the diverse presentations of Burkitt’s lymphoma and a favorable prognosis with treatment. Clinicians should maintain a high index of suspicion for a malignant etiology of acute pancreatitis in patients without classic risk factors. Full article

Crohn’s disease (CD) is a complex inflammatory bowel disease, defined by chronic transmural inflammation and marked heterogeneity in both anatomical distribution and disease behavior, with potential involvement of any segment of the gastrointestinal tract and multiple phenotypes. Advanced cross-sectional imaging nowadays plays a central role in CD management, reliably assessing both luminal and extraluminal inflammatory manifestations, supporting initial diagnosis, phenotypic characterization, and longitudinal monitoring of disease activity, complications and treatment response. Over the last two decades, Intestinal Ultrasound (IUS), MR Enterography (MRE), and Computed Tomography Enterography (CTE) have become central components of the diagnostic pathway. MRE has emerged as the most comprehensive, radiation-free modality for evaluating intestinal extent, inflammatory activity, and complications in Crohn’s disease. Multiparametric MRE, combining T2-weighted imaging, contrast-enhanced sequences, diffusion-weighted imaging, and cine acquisitions, enables a real “Crohn’s disease staging”, namely a thorough evaluation of the transmural inflammation, of fibrotic and fistulizing lesions in the small and large bowel, as well as in the perianal region. IUS provides a dynamic, widely accessible, safe and repeatable imaging technique that is particularly well suited for tight-monitoring strategies, early assessment of therapeutic response, and routine follow-up, especially in experienced centers. Notably CTE, despite concerns related to cumulative ionizing radiation exposure, remains indispensable in acute clinical settings owing to its rapid acquisition, broad availability, and high diagnostic accuracy for detecting abscesses, perforation, and bowel obstruction. Combined, these three modalities offer a complementary and patient-tailored framework for optimal CD management. This review outlines the pathological complexity of Crohn’s disease, traces the evolution of imaging approaches, and provides a comparative overview highlighting the specific strengths and limitations of each modality. Full article

Surgical necrotising enterocolitis (NEC) continues to carry significant morbidity and mortality in preterm and very-low-birth-weight infants. This review presents up-to-date evidence to guide the shift from medical to surgical treatment and to improve management during and after surgery. Need for surgery is best anticipated through dynamic clinical assessment, supported by laboratory markers of systemic inflammation or ischemia and targeted imaging, while pneumoperitoneum remains the sole absolute indication for immediate intervention. In infants without perforation, the timing of surgery remains challenging: delayed surgery after clinical deterioration worsens long-term outcomes, whereas very early surgery often reflects severe disease leading to greater bowel loss, highlighting the need for carefully timed intervention after brief stabilisation. Laparotomy remains the cornerstone of surgical management, with peritoneal drainage serving as a temporising option for the most unstable infants and laparoscopy emerging as a feasible adjunct. Long-term complications, including strictures, short bowel syndrome, neurodevelopmental impairment, bronchopulmonary dysplasia and severe retinopathy of prematurity highlight the need for better predictive tools, enhanced imaging of bowel viability, and rigorous nutritional support, while long-term quality-of-life outcomes remain insufficiently studied. Full article

Background and Clinical Significance: Ventriculoperitoneal (VP) shunting remains the standard definitive treatment for progressive neonatal obstructive hydrocephalus. Congenital chylous ascites is an uncommon neonatal condition, most often related to developmental lymphatic abnormalities. The concurrence of hydrocephalus requiring VP diversion with congenital chylous ascites is exceptionally rare and may first become apparent during abdominal access for shunt placement. Awareness of this possibility is clinically important because milky peritoneal fluid at shunt surgery can mimic gastrointestinal injury, and persistent postoperative abdominal fluid collections may be misattributed to shunt-related complications. Case Presentation: A late-preterm female infant (36 weeks’ gestation; birth weight 2.3 kg) presented with congenital hydrocephalus. Cranial ultrasonography was consistent with isolated aqueductal stenosis. Preoperative abdominal ultrasonography demonstrated mild ascites. On 27 May 2025, a VP shunt was placed for obstructive hydrocephalus. Upon entering the peritoneal cavity, milky-white fluid was encountered, prompting concern for bowel injury; however, careful exploration showed no gastrointestinal perforation. Ascitic fluid analysis revealed markedly elevated triglycerides (2300 mg/dL), confirming chylous ascites. The VP shunt was completed without an intraoperative complication. During follow-up, the infant showed appropriate growth (weight 3.0 kg; length 50 cm), while ascites persisted, and she was referred for multidisciplinary evaluation and management. Conclusions: This case highlights an exceptionally rare association of congenital chylous ascites with isolated aqueductal stenosis, identified incidentally during VP shunt insertion. Prompt intraoperative recognition, biochemical confirmation, and coordinated follow-up are essential to distinguish congenital chylous ascites from shunt-related abdominal fluid collections and to guide appropriate multidisciplinary care. Full article

Primary prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in people with HIV (PWH) and CD4+ counts <200 cells/µL using trimethoprim/sulfamethoxazole (TMP-SMX) is highly effective but often poorly tolerated. Alternative agents may have limited efficacy or availability. Although rezafungin demonstrated PCP protection comparable to TMP-SMX in animal models, human data are limited to the ongoing ReSPECT trial, and evidence in PWH is lacking. We report the first use of rezafungin as PCP prophylaxis in a PWH. A 43-year-old man presenting with AIDS (HIV-RNA 8.48 × 10⁶ copies/mL; CD4+ 20 cells/µL) was admitted with disseminated tuberculosis and multiple bowel perforations requiring urgent surgery. The postoperative course was marked by infectious and surgical complications. Antitubercular therapy and TMP-SMX prophylaxis were initiated postoperatively, followed by antiretroviral therapy (ART). Later, TMP-SMX was discontinued due to hypersensitivity. Because drug–drug interactions precluded atovaquone or dapsone and pentamidine was unavailable, rezafungin was started. No adverse events or fungal breakthrough infections occurred despite abdominal complications. Further data are needed to determine whether rezafungin represents a viable prophylactic option when standard agents are contraindicated or unavailable. Full article

As survival rates for children with cancer and immune disorders have improved, clinical focus has shifted toward managing serious treatment-related complications. Intestinal perforation remains life-threatening and is typically diagnosed by signs of peritonitis and inflammation. This report presents three high-risk pediatric patients who developed severe intestinal perforation without the usual clinical symptoms. Each patient was receiving high-dose corticosteroids and/or targeted biologic immunomodulators (ruxolitinib, anakinra, tocilizumab, eculizumab). Classic indicators such as fever, leukocytosis, hemodynamic instability, and abdominal pain were absent, despite surgical findings of fecal contamination and bowel necrosis. All three patients survived to hospital discharge. These cases demonstrate that potent immunomodulatory therapies can mask the physiological response to perforation. Relying solely on traditional clinical signs may delay diagnosis. In this population, subtle findings such as persistent gastrointestinal bleeding, feeding intolerance, or minor imaging abnormalities should prompt consideration of perforation. Early imaging and multidisciplinary review are essential for timely intervention and improved outcomes. Full article

The goals of ulcerative colitis (UC) treatment are focused on improving quality of life, achieving steroid-free remission, and minimizing the risk of cancer. In UC traditional management, a step-up strategy involves introducing increasingly more immunosuppressive medications, thus avoiding unnecessary overexposure to more potent drugs. However, in cases of severe, acute UC, priority is rapid and effective treatment to minimize the risk of complications such as bleeding, intestinal perforation, toxic megacolon or the need for colectomy. Modern approach to UC management shifts to an “accelerated step-up” or “top-down” approach in high-risk patients to prevent bowel damage. A holistic approach—integrating molecular research, clinical management and patient-centered care—enhances our understanding of disease mechanisms and therapeutic strategies, ultimately supporting improved outcomes and overall quality of life. This review aims to present the treatment options for UC along with an overview of the most modern therapies and experimental agents. Full article

A 57-year-old man presented with fever and progressive odynophagia three days after a suspected fish bone impaction. Laboratory tests revealed leukocytosis (17,400/µL) and an elevated C-reactive protein level (8.93 mg/dL). Initial chest radiography was unremarkable, ruling out pneumomediastinum. Contrast-enhanced computed tomography (CT) of the neck revealed focal thickening of the cervical esophageal wall, along with a low-attenuation collection and mild fat stranding surrounding the esophagus. Also, extraluminal air was absent. These findings supported the diagnosis of intramural abscess rather than free perforation. Upper endoscopy revealed a submucosal bulging lesion with a pinpoint mucosal defect that was actively draining pus, consistent with a contained intramural collection. Water-soluble contrast esophagogram confirmed smooth passage without extravasation, obstruction, or the double-lumen sign. The patient received bowel rest, intravenous piperacillin/tazobactam, and close observation. Symptoms and inflammatory markers improved, and follow-up CT confirmed the resolution of the intramural collection. Esophageal intramural abscesses develop when an infection spreads within the submucosa after a mucosal breach. In East Asia, this often occurs due to fish bone impaction. Early CT enables the differentiation of esophageal intramural abscess from perforation or dissection and guides the selection of conservative, rather than interventional, management. Full article

Cecal volvulus is a rare cause of acute abdominal pain, resulting from torsion of the cecum and ascending colon due to abnormal mobility caused by inadequate peritoneal fixation. Clinical presentation is often vague and nonspecific, which can delay diagnosis and treatment. Computed tomography (CT) is the imaging modality of choice, as it not only confirms the presence and location of the volvulus but also identifies serious complications such as ischemia or perforation. Abdominal radiographs may be inconclusive, especially when the twisted bowel loop is fluid-filled, aligned antero-posteriorly, or obscured by adjacent gas-filled loops. We present the case of a 65-year-old woman who arrived at the emergency department with sudden-onset abdominal pain. Abdominal CT revealed classic signs of cecal volvulus, including the rarely reported ‘embryo sign,’ which proved crucial for swift diagnosis and intervention. Recognizing both common and less common CT features, such as the embryo sign, is paramount for rapid diagnosis and appropriate management in emergency situations. Familiarity with the full radiologic spectrum of this condition can significantly improve patient outcomes. Full article

Background and Clinical Significance: Ingestion of foreign bodies may lead to perforation of the gastrointestinal tract in its various segments. This may be accompanied by infections of the mediastinum after esophageal perforations and peritonitis after perforations of the stomach and bowel. Case Presentation: A 64-year-old man was admitted to the hospital because of abdominal pain and fever. The laboratory testing showed increased indices of inflammation. A CT scan of the abdomen revealed perforation of the stomach pylorus wall from a foreign body. Additionally, there were imaging findings suggesting concealed peritonitis in the adjacent area of stomach perforation. A 3.9 cm foreign body was removed with gastroscopy. The investigation into the nature of the foreign body suggested that it was a fish otolith (a structure composed of calcium carbonate, also known as an ear bone). The patient adhered to a Mediterranean diet. He recalled ingesting parts of the head of a 2.5 kg sea bream about 40 days before his admission to the hospital. The patient received broad-spectrum antimicrobial treatment, specifically intravenous ampicillin/sulbactam (2 g/1 g) every 8 h. He had complete resolution of his infection, with full resolution of symptoms and normalization of all abnormal signs noted in the physical examination at outpatient follow-up. Conclusions: Ingestion of a fish otolith may lead to perforation of the gastrointestinal tract and subsequent intra-abdominal infection. Prompt diagnosis with abdominal imaging, especially a CT scan, removal of the foreign body by upper gastrointestinal endoscopy (if possible), and broad-spectrum antibiotics are necessary for the successful management of such cases. Full article

Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis, most frequently metastasizing to the liver, peritoneum, and lungs. Intestinal metastases are exceptionally rare and easily misinterpreted as primary small-bowel tumors, typically presenting with acute complications such as obstruction, perforation, or bleeding. Methods: We combined a detailed case description with a narrative literature review. PubMed/MEDLINE and Embase (2000–2025) were searched for case reports and case series describing intestinal metastases from PDAC with histopathological and immunohistochemical confirmation. Case presentation: We report a female patient presenting with acute intestinal obstruction caused by a synchronous ileal metastasis from PDAC. Imaging revealed an ileal stenosing lesion and a pancreatic body mass. An exploratory laparotomy identified a 3 cm transmural ileal tumor with additional serosal nodules. Histopathology confirmed a moderately differentiated adenocarcinoma. Immunohistochemistry supported pancreatic origin (CK7+, CA19-9+, faint CDX2), with mutant-type p53 positivity, ultra-low HER2/Neu expression, and a Ki-67 index of ~50%. The patient underwent segmental enterectomy with terminal ileostomy, followed by systemic therapy. Conclusions: This represents an exceptional and rare clinical finding rather than a presentation from which broad conclusions can be drawn. Histopathological and immunohistochemical analysis supported pancreatic origin and helped avoid misclassification as a primary intestinal neoplasm. It underscores the importance of careful clinicopathological correlation and multidisciplinary evaluation in atypical metastatic scenarios, while illustrating how surgery can provide symptom control and enable systemic therapy. Given its rarity, these observations should be interpreted with caution and regarded as descriptive rather than generalizable. Full article

Post-transplant lymphoproliferative disorder (PTLD) poses significant risks following organ transplantation, characterized by potential aggressiveness. This report aims to discuss a case of PTLD presenting as B-cell large-cell lymphoma (DLBCL) post kidney and pancreas transplantation. A 44-year-old female with type 1 diabetes underwent simultaneous cadaver kidney and pancreas transplantation. She presented with fever, night sweats, and weakness, revealing multiple lesions on CT, including in transplanted and native kidneys and pancreas. A biopsy of the transplant kidney confirmed PTLD, DLBCL subtype, with complex immunohistochemical findings. Chemotherapy (R-CHOP) was initiated but complicated by bowel perforation necessitating surgery and antibiotics, transplant renal vein thrombosis, pyelonephritis, and neutropenia. Despite the complications, the normal function of the transplanted kidney was maintained, which made it possible to implement the standard chemotherapy protocol. This case underscores the diagnostic challenges and therapeutic complexities of PTLD, specifically DLBCL, in transplant recipients. The co-infection of COVID-19 and aspergillosis in a multiple immunocompromised patient indicated a possible rapid course of the disease with global respiratory insufficiency and a fatal outcome despite all applied therapeutic modalities. Full article

Background: Multiple high-powered magnet ingestion is a surgical emergency due to inter-loop attraction leading to ischemia, necrosis, perforation, and fistula formation. While well documented in children, adult cases—particularly those complicated by entero-enteric fistula—remain rare, and management is largely extrapolated from pediatric guidelines. Objective: To present a rare case of adult entero-enteric fistula following multiple neodymium magnet ingestion, we review the literature and propose an adapted management algorithm for adults. Methods: A narrative PubMed review was performed to identify pediatric and adult cases of magnet ingestion complicated by gastrointestinal fistula. Search terms included magnet ingestion, entero-enteric fistula, neodymium, and adult. Reported case characteristics, diagnostic modalities, treatments, and outcomes were analyzed. Results: A 38-year-old male with schizophrenia presented with small bowel obstruction five days after ingesting multiple magnets. Abdominal radiography revealed clustered radiopaque bodies in the distal ileum. Emergency laparotomy identified an entero-enteric fistula caused by pressure necrosis from inter-loop magnetic attraction. Segmental enterectomy with side-to-side anastomosis was performed, with uneventful recovery. The literature review identified only a few adult cases, which showed similar pathophysiology but frequent diagnostic delays and higher complication rates compared with pediatric cases. Conclusions: This case adds to the scarce adult literature on magnet-induced entero-enteric fistula and supports the adaptation of pediatric-based protocols for adults, with attention paid to psychiatric comorbidity and delayed presentation. Early imaging, timely intervention, and multidisciplinary care are essential to prevent severe gastrointestinal injury. Full article