Raghav Bansal

Acute hepatitis E presenting with clinical feature of autoimmune hepatitis

A 32-year-old immigrant man presented with new onset jaundice. His past medical history was significant for type 2 diabetes mellitus, hypertension, and hyperlipidemia. His initial laboratory finding and liver biopsy were suggestive of autoimmune hepatitis (AIH). The plan was to start steroids pending negative results for viral serology, but it came back positive for hepatitis E virus. The patients liver function test and clinical condition improved significantly on conservative management over a period of 1 month. Therefore, we suggest testing for hepatitis E especially in immigrants or recent travelers to endemic areas who presents with clinical features suggestive of AIH.

Sodium Polystyrene Sulfonate in Sorbitol-Induced Colonic Ulcerations

Figure 1. A 63-year-old man with a history of type 2 diabetes and a stroke 3 years ago, underwent a screening colonoscopy in an outpatient clinic. A 10-mm polyp was detected at the cecum, near the appendiceal orifice. A repeat colonoscopy revealed small nodular areas around the polyp. Polypectomy and submucosal injection of the nodular area (indigo carmine) were performed (a–c). The endoscopic presentation was similar to that of lymphoid nodular hyperplasia in the terminal ileum, and diagnosis was made after biopsies at both locations. (Informed consent was obtained from the patient to publish these images.)

A Case of Unresolved and Worsening Retroperitoneal Abscess

Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to a perforation that occurred during an ERCP. A 54-year-old female patient was admitted to an outside hospital with gallstone pancreatitis and underwent ERCP with sphincterotomy followed by laparoscopic cholecystectomy. An abdominal CT scan was performed at the outside hospital 10 days later for worsening abdominal pain which showed multiple loculated pockets in the right upper and lower quadrant. Her condition improved after IV antibiotics and percutaneous drainage. Her symptoms recurred a month later and she presented to our hospital. Repeat abdominal CT scan at our hospital revealed recurrence of her abscesses. Multiple drains were placed and the abscess cavity was washed out without much improvement. EGD revealed a small mucosal defect in the distal portion of the duodenal bulb which was closed successfully using an over-the-scope clip. Repeat CT scan after 8 weeks from the endoscopic closure showed near complete resolution of the abscess. ERCP-associated perforation is a rare complication and can be challenging to diagnose and treat; prompt recognition is mandatory for favorable prognosis. Our patient was managed successfully via nonsurgical approach.

Simple measures to prevent a massive upper gastrointestinal bleed

Nasogastric (NG) tube is frequently used in clinical practice for a variety of indications; however, NG tubes are not without risks, and there are a multitude of gastrointestinal complications that are associated with their use. Simple precautions can help prevent these NG tube‐related injuries.

Colorectal Cancer Associated with Strongyloides stercoralis Colitis

Strongyloides stercoralis colitis is a severe but easily curable disease with a high mortality rate if left untreated. Strongyloidiasis can persist up to several decades and may lead to a chronic colitis similar to that seen in inflammatory bowel disease (IBD), and the two are often confused. Chronic colitis from IBD is associated with an increased risk of colorectal cancer, so it is plausible that chronic colitis from strongyloidiasis may carry a similar risk. Our case report associates chronic Strongyloides colitis and colorectal cancer.

Acute Gastric Ischemia After Chemoembolization in a Patient with Hepatocellular Carcinoma

A 72-year-old man presented with severe diffuse abdominal pain and melena. His past history was significant for hepatitis C cirrhosis and hepatocellular carcinoma status post partial resection five years ago and recurrent malignant lesions treated with multiple sessions of transarterial chemoembolization (TACE). He had received his last TACE treatment of a lesion in segment 6 via a distal branch of the right renal artery 2.5 months prior to the presentation. His examination was significant for moderate abdominal distension and tenderness. Laboratory findings were notable for the following: hemoglobin, 7.4 g/dl; creatinine, 2.4 mg/dl; and lactate, 10.1 mmol/l. Initial computerized tomography of the abdomen/pelvis without contrast showed cirrhosis and a hepatic mass, a markedly distended stomach, and gas in the gastric wall, an intrahepatic portion of the portal vein, and the gastric veins (a). Esophagogastroduodenoscopy showed ulceration and necrosis localized to the fundus and proximal lesser curvature (b). The patient was managed conservatively with bowel rest, intermittent nasogastric tube suction, intravenous (IV) fluids, IV pantoprazole, and broad-spectrum antibiotics. He responded well to medical management, showing marked improvement on repeat imaging with contrast (c). (Informed consent was obtained from the patient to publish these images.)

Giardiasis and Nodular Lymphoid Hyperplasia of the Duodenum.

A 29-year-old Hispanic man presented with abdominal pain and chronic diarrhea. The results of the initial work-up were unremarkable. Esophagogastroduodenoscopy revealed duodenal nodules (a). Histology revealed nodular lymphoid hyperplasia (NLH) (b, arrows) and parasites, morphologically consistent with Giardia lamblia (c, arrows). NLH of the gastrointestinal tract is a rare and benign lymphoproliferative disorder characterized by the presence of nodules (<10 mm) distributed along the small bowel, stomach, colon, and rectum. The pathogenesis of NLH is unknown, but it has been associated with several conditions. The clinical presentation is variable and depends on the size and extent of the nodules as well as the patient’s immune status. The diagnosis is based on specific pathological findings. Treatment is directed toward the associated conditions, which include intestinal and extraintestinal lymphoma. The role of surveillance is controversial. Our patient was deemed immunocompetent and treated successfully with a course of metronidazole.

Distribution and histopathology of colorectal polyps in the Asian population in the United States.

436 Background: Limited data exists for colorectal polyps in Asian population in U.S. Advanced polyps are considered as a high risk for CRC and require close surveillance. The aim of the study was to evaluate and compare the characteristics of polyps based on patient demographics, anatomic distribution, size, and histopathology in the Asian population living in one of the most heavily populated and diverse communities in U.S. Methods: We conducted a retrospective, single center chart review study of all asymptomatic Asian patients who underwent screening colonoscopy at a New York City hospital from Jan 2006 to Dec 2010. The patients without polyps were excluded from the study. Based on histopathology and size, polyps were divided into 2 groups: advanced and non-advanced. Results: Of the total 1,300 patients, 311 were found to have colon polyps. Mean age of the study population was 60.8 years (range 50-82). There were 173 males and 138 females, with male to female ratio 1.3:1. In gender analysis, 61% of th...