We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 y...We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.展开更多
Biliary tract cancers(BTCs)are an increasing public health concern due to their rising incidence-particularly among individuals under 60 years of age-their frequent late-stage diagnosis,and their poor prognosis,with a...Biliary tract cancers(BTCs)are an increasing public health concern due to their rising incidence-particularly among individuals under 60 years of age-their frequent late-stage diagnosis,and their poor prognosis,with a 5-year survival rate of less than 20%and a median overall survival(OS)of around 12 months(1,2).BTCs originate from the intrahepatic or extrahepatic bile ducts or the gallbladder.This anatomical heterogeneity is compounded by diverse risk factors,resulting in a complex disease landscape at the molecular level.Over the past decade,significant progress has been made in unraveling the molecular characteristics of these neoplasms,enabling advances in selected tumor subgroups through the development of targeted therapies and personalized medicine approaches(e.g.,FGFR2 fusions,IDH1 mutations,HER2 amplification or overexpression,BRAF mutations)(3,4).Despite these advances in molecularly defined subsets,the vast majority of patients with BTC still face dismal outcomes,underscoring the urgent need for effective systemic strategies accessible to all patients,not only to biomarker-selected minorities.展开更多
文摘We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.
文摘Biliary tract cancers(BTCs)are an increasing public health concern due to their rising incidence-particularly among individuals under 60 years of age-their frequent late-stage diagnosis,and their poor prognosis,with a 5-year survival rate of less than 20%and a median overall survival(OS)of around 12 months(1,2).BTCs originate from the intrahepatic or extrahepatic bile ducts or the gallbladder.This anatomical heterogeneity is compounded by diverse risk factors,resulting in a complex disease landscape at the molecular level.Over the past decade,significant progress has been made in unraveling the molecular characteristics of these neoplasms,enabling advances in selected tumor subgroups through the development of targeted therapies and personalized medicine approaches(e.g.,FGFR2 fusions,IDH1 mutations,HER2 amplification or overexpression,BRAF mutations)(3,4).Despite these advances in molecularly defined subsets,the vast majority of patients with BTC still face dismal outcomes,underscoring the urgent need for effective systemic strategies accessible to all patients,not only to biomarker-selected minorities.
