General Medicine
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30438
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Browsing General Medicine by Author "Gajula, Prianka"
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Item Eosinophilic Gastritis: An Imposter of Gastric Malignancy(2021) Salim, Hamza; Gajula, Prianka; Raza, AliIntroduction: Eosinophilic gastroenteritis (EGE) is an uncommon condition characterized by eosinophilic infiltration into the lining of the GI tract with a predilection for the stomach and proximal small bowel. Symptoms are non-specific, and the disease is known to take a chronic, relapsing/remitting course. To date, approximately 300 cases are described in literature. Here, we present a case of EGE closely mimicking gastric malignancy. Case Description: A 57-year-old male with a past medical history of DM II, HTN, GERD, and ESRD was admitted to the hospital with 30 lbs weight loss, postprandial fullness, and intractable vomiting. Physical examination showed moderate tenderness to deep palpation in the upper abdomen. CT scan revealed gastric outlet obstruction from an incidental finding of gastric antrum mass. An EGD was performed and revealed a malignant appearing mass in the pre-pyloric region of the stomach. Biopsies showed peptic duodenitis without any evidence of malignancy or H. Pylori infection. After a multi-disciplinary discussion, the decision was made to perform diagnostic laparoscopy, followed by gastrojejunostomy, for the gastric outlet obstruction. Discussion The pathogenesis of EGE is not well understood. Available evidence suggests that it is a hypersensitivity reaction. Histopathological analysis can confirm the diagnosis. Eosinophilic infiltration can involve any layer of the stomach (mucosa, muscularis propria, or serosa), which impacts clinical presentation. The treatment is primarily based on dietary modifications and systemic steroids. In conclusion, eosinophilic gastroenteritis should remain on the differential diagnosis in appropriate clinical cases where the diagnosis of cancer is unclear.Item Nasopleural Drainage of Empyema via Esophago-Pleural Fistula: A Novel Endoscopic Rescue Technique(2021) Salim, Hamza; Gajula, Prianka; Raza, AliBackground: Esophago-pleural fistulas (EPF) are rare entities. These can occur spontaneously or following surgical manipulation and can result in empyema formation. Treatment of empyema in this patient population is difficult, and a variety of techniques have been described. Here, we present a novel rescue technique for empyema management via endoscopy, when percutaneous and surgical techniques were not feasible. Case Information: A 90-year-old female presented with acute gastric volvulus requiring emergent partial gastrectomy and gastrostomy tube placement. Her clinical course was complicated by necrosis of the gastric cardia resulting in perforation and contamination of the mediastinum, requiring distal esophageal stump creation and multiple washouts. She was started on long term antimicrobial agents, with plans of maintaining esophageal discontinuity for six months prior to considering re-anastomosis. She was unstable for surgical drainage. An urgent transnasal endoscopy was performed using an ultra-slim scope. A small fistulous connection was noted between the distal esophageal stump and the left pleural cavity. She had a remarkable clinical improvement within 24 hours. A week after conservative management, a percutaneous drain placement was successfully performed. Conclusion: Empyema management ranges from conservative chest tube placement to aggressive surgical management. Endoscopic drainage is another option when percutaneous and surgical options are not possible. Our case demonstrates a novel rescue technique for the management of empyema in patients who already have an EPF and are not good candidates for conventional treatment. This technique can only be used short-term, as a bridge to definitive treatment.