Found 72 Abstracts CONTROL ID

117 Pages·2013·7.46 MB·English

Found 72 Abstracts

CONTROL ID: 1700796
TITLE: Successful Medical Management of Gastric Pneumatosis with Associated Portal Venous Air
PRESENTER: Joseph Yarze
PRESENTER (INSTITUTION ONLY): Gastroenterology Associates of Northern New York
PRESENTER (COUNTRY ONLY): United States
ABSTRACT BODY:
Purpose: An 80-year-old woman with afib, DM. COPD and cardiomyopathy was admitted with dyspnea and bilateral
pneumonia. She was treated with meropenem IV, and a few days later, she began to complain of epigastric pain and
nausea. The gastrointestinal symptoms progressed, and a CT scan revealed scant air in the main portal vein (Figure
1), gastric pneumatosis (Figure 2) and mild gastric distention. GI and surgical consultations were requested.
Abdominal exam showed mild epigastric tenderness without signs of peritoneal irritation. Bloodwork revealed a normal
peripheral WBC and a normal serum bicarbonate level. She was kept NPO, metronidazole and esomeprazole IV were
added to her medical regimen and ngt suction was instituted. The patient remained clinically stable, her abdominal
pain and nausea subsided and a repeat CT scan 48 hrs later revealed resolution of the gastric pneumatosis and PV
air. NGT suction was then discontinued and an oral diet was allowed. H. pylori stool antigen test was negative. The
patient made a full clinical recovery and was discharged 2 weeks later. Outpatient EGD, performed 10 weeks later,
revealed mucosal scarring in the gastric antrum.

Conclusion: Symptomatic gastric pneumatosis with PVG usually presages the need for surgical intervention. This case
suggests that under the proper clinical scenario, with a thoughtful multidisciplinary approach, experienced clinicians
may successfully manage this problem non-operatively, and there is not always a mandate for surgical intervention.
Methods: n/a
Results: n/a
Conclusion: n/a
CURRENT CATEGORY: G. Clinical Vignettes/Case Reports
CURRENT SUB-CATEGORY: B. Stomach
PRESENTATION TYPE: Poster Only
ACG Research Grant Support: No
Supported by Industry Grant: No
Commercial Products or Services: No
Initiated Research: Investigator
Financial Relationships: No
FDA Approval: No
Designed Study: Investigator
Abstract Author: Investigator
AUTH DESIG: ACG Membership Status <font color="red">*</font>:
Joseph Yarze : ACG Member
Joseph D'Agostino : ACG Non-Member
Axial CT demonstrating gastric pneumatosis (circle)
Axial CT demonstrating air in portal vein (circle)
IMAGE CAPTION: Axial CT demonstrating gastric pneumatosis (circle) Axial CT demonstrating air in portal vein
(circle)
(no table selected)
AVERAGE SCORE: 5
REVIEWER FLAGS: (none)
REVIEWER RECOMMENDATION CODE DESCRIPTION: None
REVIEWER COMMENTS:
Somashekar Krishna: Not unique. Poor attention to writing (ie too many abbreviations, punctuation errors).|Julia
LeBlanc: [No Comments]|Girish Mishra: [No Comments]|Rayburn Rego: [No Comments]
CONTROL ID: 1706965
TITLE: Hiatal Hernia Squeezing the Heart to Flutter
PRESENTER: Arpan Patel
PRESENTER (INSTITUTION ONLY): Suny Upstate Medical University
PRESENTER (COUNTRY ONLY): United States
ABSTRACT BODY:
Purpose: An 80-year-old female presented to the hospital with failure to thrive, weakness and decreased oral intake
for 14 days. Her past medical history was significant for polio. On admission, her EKG showed atrial flutter, but no ST
segment changes. She denied any chest pain, palpitations, shortness of breath, nausea and vomiting.
Echocardiogram revealed no wall motion abnormalities or valvular disease. Chest x-ray and confirmation with CT
revealed a large hiatal hernia with majority of the stomach, and evidence of organoaxial volvulus. She was started on
B-blocker for rate control, but still was having paroxysmal episodes of atrial flutter. Our patient was then taken for
gastropexy to repair the hernia. Immediately after the surgery, the patient was taken off B-blocker. During the next 72
hours after the procedure, she did not have any episode of atrial flutter. Our patient was discharged without any rate
control medication. Initially presenting with failure to thrive and atrial flutter, our patient was, interestingly, found to
have a severely large hiatal hernia causing her atrial flutter. Although the hernia occupied more than 50% of her
thorax, it was impressive that she did not show any typical symptoms of hiatal hernias, such as reflux/GERD-like
symptoms. We concluded that her atrial flutter was caused directly by the mechanical effect of the large hiatal hernia
pressing against her heart, as the flutter resolved after the operation and she was in sinus rhythm during follow up.
Methods: NA
Results: NA
Conclusion: NA
CURRENT CATEGORY: G. Clinical Vignettes/Case Reports
CURRENT SUB-CATEGORY: B. Stomach
PRESENTATION TYPE: Oral or Poster
ACG Research Grant Support: No
Supported by Industry Grant: No
Commercial Products or Services: Yes
Initiated Research: Investigator
Financial Relationships: No
FDA Approval: No
Designed Study: Investigator
Abstract Author: Investigator
AUTH DESIG: ACG Membership Status <font color="red">*</font>:
Arpan Patel : ACG Non-Member
Rushikesh Shah : ACG Non-Member
Aakash Aggarwal : ACG Non-Member
Sravanthi Nandavaram : ACG Non-Member
CXR showing hiatal hernia
CT Scan showing hiatal hernia
IMAGE CAPTION: CXR showing hiatal hernia CT Scan showing hiatal hernia
(no table selected)
AVERAGE SCORE: 4
REVIEWER FLAGS: (none)
REVIEWER RECOMMENDATION CODE DESCRIPTION: None
REVIEWER COMMENTS:
Somashekar Krishna: [No Comments]|Julia LeBlanc: [No Comments]|Girish Mishra: [No Comments]|Rayburn Rego:
[No Comments]
CONTROL ID: 1707046
TITLE: Gastroparesis Associated with Sarcina Ventriculi Infection of the Stomach
PRESENTER: Shiva Ratuapli
PRESENTER (INSTITUTION ONLY): Mayo Clinic Arizona
PRESENTER (COUNTRY ONLY): United States
ABSTRACT BODY:
Purpose: Sarcina ventriculi is a Gram-positive organism, reported to be found, rarely, in the gastric specimens of
patients with gastroparesis. Only eight cases of Sarcina, isolated from gastric specimens, have been reported so far.
Sarcina has been implicated in the development of gastric ulcers, emphysematous gastritis and gastric perforation.
We report another case of Sarcina ventriculi of the stomach, associated with iron deficiency anemia and
gastroparesis.

A 73-year-old male with past history of antrectomy and gastrojejunostomy (Bilroth II), along with truncal vagotomy,
presented with iron deficiency anemia. He did not have any gastrointestinal symptoms or weight loss. His labs showed
decreased hemoglobin of 8.5 g/ dL and decreased mean corpuscular volume (MCV) of 63.2 fL. The iron level was
markedly reduced at 12 mcg/dL (normal 50–150), with an elevated total iron binding capacity (TIBC) of 490 mcg /dL
(normal 250–400) and reduced iron % saturation of 2% (normal 14–50). An esophagogastroduodenoscopy (EGD)
showed diffuse gastric erythema, along with two four-mm polyps at the anastomosis (Figure 1). There was also a
large amount of retained food in the stomach. Tissue biopsies showed marked inflammation and presence of Sarcina
organisms (Figure 2). He was treated with metronidazole 250 mg three times a day, and ciprofloxacin 250 mg twice
daily for one week. Repeat EGD 3 months later showed improvement of gastric erythema and absence of food
bezoar.

Conclusion: Sarcina ventriculi is a rare bacterium, seen predominantly in patients with delayed gastric emptying.
Review of the published cases, along with our case, suggests that it is frequently an innocent bystander, rather than a
pathogenic organism. Given its association with life-threatening illness in two reported cases, it may be prudent to
treat with antibiotics until further understanding is achieved.
Methods: N/A
Results: N/A
Conclusion: N/A
CURRENT CATEGORY: G. Clinical Vignettes/Case Reports
CURRENT SUB-CATEGORY: B. Stomach
PRESENTATION TYPE: Oral or Poster
ACG Research Grant Support: No
Supported by Industry Grant: No
Commercial Products or Services: No
Initiated Research: Investigator
Financial Relationships: Not Applicable
FDA Approval: No
Designed Study: Investigator
Abstract Author: Investigator
AUTH DESIG: ACG Membership Status <font color="red">*</font>:
Shiva Ratuapli : ACG Member
Dora LamHimlin : ACG Non-Member
Russell Heigh : ACG Member
IMAGE CAPTION:
(no table selected)
AVERAGE SCORE: 4.25
REVIEWER FLAGS: (none)
REVIEWER RECOMMENDATION CODE DESCRIPTION: None
REVIEWER COMMENTS:
Somashekar Krishna: [No Comments]|Julia LeBlanc: [No Comments]|Girish Mishra: [No Comments]|Rayburn Rego:
[No Comments]
CONTROL ID: 1709894
TITLE: A Major Pain in the…Back and Epigastrium: An Unusual Case of Spontaneous Celiac Artery Dissection
PRESENTER: Kumkum Patel
PRESENTER (INSTITUTION ONLY): Winthrop-University Hospital
PRESENTER (COUNTRY ONLY): United States
ABSTRACT BODY:
Purpose: A 60-year-old woman with past medical history of mitral valve prolapse, chronic low back pain and a 30
packs-a-year smoking history presented for a 2nd admission of poorly-controlled mid-back pain 10 days after her 1st
admission. She had concomitant epigastric pain, which was sharp/burning in quality, radiating to the right side and to
the mid-back and was not associated with food, nor did it improve with pain medications. She denied nausea,
vomiting, diarrhea, constipation, dark stools or blood per rectum. Physical examination revealed epigastric and mid-
back tenderness on palpation. Labs were normal except for a hemoglobin drop from 14g/dL to 12.1 g/dL over two
days. MRI and CT scans of the thoracolumbar spine from the 1st admission were normal. Abdominal ultrasound and
EGD from the current admission were normal. Contrast-enhanced abdominal CT scan revealed the development of a
spontaneous celiac artery dissection as the cause of the epigastric pain. A subsequent CT angiography scan four
days later did not reveal worsening of the dissection. She was discharged on aspirin and clopidogrel with outpatient
follow-up. Thus far, less than 50 cases of isolated spontaneous celiac artery dissections have been reported. The
advent of CT scans and MRI has increasingly enabled its detection. While most patients classically present with
epigastric pain, some cases reported chest pain, pancreatitis or were asymptomatic on admission. Risk factors may
include hypertension, arteriosclerosis, smoking, and cystic medial necrosis. There is a 5:1 male to female ratio, with
an average presenting age of 55, thus making our female patient a unique case. Management of dissection may
include surgical repair, endovascular stenting and selective embolization. Limited dissection can be managed
conservatively with anti-platelet and/or anticoagulation agents and strict blood pressure control, as was done in our
case. Further investigation is warranted on this case on whether our patient has a variant of Marfan’s Disease due to
the history of mitral valve prolapse and now a celiac artery dissection. The patient will undergo testing for the fibrillin-1
gene.
Methods: N/A
Results: N/A
Conclusion: N/A
CURRENT CATEGORY: G. Clinical Vignettes/Case Reports
CURRENT SUB-CATEGORY: B. Stomach
PRESENTATION TYPE: Poster Only
ACG Research Grant Support: No
Supported by Industry Grant: No
Commercial Products or Services: No
Initiated Research: Investigator
Financial Relationships: No
FDA Approval: No
Designed Study: Investigator
Abstract Author: Investigator
AUTH DESIG: ACG Membership Status <font color="red">*</font>:
Kumkum Patel : ACG Member
Orel Benshar : ACG Non-Member
Raluca Vrabie : ACG Member
Anik Patel : ACG Member
Marc Adler : ACG Non-Member
George Hines : ACG Non-Member
IMAGE CAPTION:
(no table selected)
AVERAGE SCORE: 4.25
REVIEWER FLAGS: (none)
REVIEWER RECOMMENDATION CODE DESCRIPTION: None
REVIEWER COMMENTS:
Somashekar Krishna: It would be interesting to see EUS of Celiac artery dissection! nice case.|Julia LeBlanc: [No
Comments]|Girish Mishra: [No Comments]|Rayburn Rego: [No Comments]
CONTROL ID: 1713980
TITLE: Coconut Bezoars in Patients with Prior Bariatric Surgery: Report of Two Cases
PRESENTER: Himanshu Verma
PRESENTER (INSTITUTION ONLY): Lahey Clinic
PRESENTER (COUNTRY ONLY): United States
ABSTRACT BODY:
Purpose: Phytobezoars are concretions that are formed in the GI tract from undigested vegetable matter. Risk factors
for bezoar formation include gastroparesis, use of high-dose antacids, high intake of vegetables/citric fruits and prior
gastric surgery. Bezoars are especially noted to form in patients with vagotomy and pyloroplasty, or Billroth 2. There
are fewer reports of bezoars in bariatric surgery patients. Coconut is an unusual source of bezoar formation, and only
one case of coconut bezoar has been described in a bariatric patient. We present two cases of coconut bezoars in
patients with prior bariatric surgery; one in a gastric bypass patient and one in a lap band patient.

A 47-year-old female with a history Roux-en-Y gastric bypass seven years ago presented with four days of nausea
and vomiting after eating corn bread with coconut. CT scan revealed an approximately 3-cm, fat density material at
the gastrojejunal anastomosis. Upper endoscopy revealed a coconut bezoar in the gastric pouch. The bezoar was
broken into small pieces with a snare and flushed through the anastomosis into the jejunum. The entire bezoar was
cleared from the stomach. The patient had resolution of symptoms and was able to tolerate a liquid diet.

A 37-year-old female with a history of Lap band placement three years ago presented with nausea and vomiting after
eating half a coconut. Her lap band was deflated but her symptoms persisted. CT scan revealed a 2-cm x 2.2-cm fat
density material located just above the gastric band. Upper endoscopy revealed a coconut bezoar above the gastric
lap band. The bezoar was broken up with a snare and pushed into the stomach below the lap band. The patient
experienced resolution of her symptoms and was able to resume her normal diet.

We report the first case of a coconut bezoar in a lap band patient and only the second case report in a patient with a
prior Roux-en Y gastric bypass surgery. Bariatric surgery should be recognized as a possible risk factor for bezoar
formation. Bariatric patients should avoid intake of significant amounts of coconut, as it may predispose to bezoar
formation.
Methods: na
Results: na
Conclusion: na
CURRENT CATEGORY: G. Clinical Vignettes/Case Reports
CURRENT SUB-CATEGORY: B. Stomach
PRESENTATION TYPE: Poster Only
ACG Research Grant Support: No
Supported by Industry Grant: No
Commercial Products or Services: No
Initiated Research: Investigator
Financial Relationships: No
FDA Approval: No
Designed Study: Investigator
Abstract Author: Investigator
AUTH DESIG: ACG Membership Status <font color="red">*</font>:
Himanshu Verma : ACG Member
David Burns : ACG Member
Dmitry Nepomnayshy : ACG Non-Member
(No Image Selected)
(no table selected)
AVERAGE SCORE: 5
REVIEWER FLAGS: (none)
REVIEWER RECOMMENDATION CODE DESCRIPTION: None
REVIEWER COMMENTS:
Somashekar Krishna: [No Comments]|Julia LeBlanc: [No Comments]|Girish Mishra: [No Comments]|Rayburn Rego:
[No Comments]