Case seriesPatients: Male, 33 • Male, 18 • Male, 19Final Diagnosis: Congenital band causing a small bowel obstructionSymptoms: Progressive abdominal pain that eventually becomes excessiveMedication: —Clinical Procedure: Laparoscopic band removalSpecialty: SurgeryObjective:Rare diseaseBackground:Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy.Case Reports:All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention.Conclusions:Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative.

Patient: Female, 25 Final Diagnosis: Leo-ileo-cecal intussuception Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Intussusception is defined as the penetration or telescoping of a segment of bowel into a more distal segment. Intussusception is a common cause of small bowel obstruction, especially in children. However, this finding is much less common in adults. Furthermore, when present in adults, intussusception is often found in association with some sort of organic mass, such as a tumor or pancreatic divisum that acts as a lead point, dragging the proximal segment into the distal one. The presence of an intussusception in an adult patient with no obvious lead point is very uncommon. Case report: Here we report a case of ileo-ileo-cecal double intussusception in an adult patient that yielded no lead point on surgical exploration. The patient was a 25-year-old female who presented with symptoms of obstruction and was diagnosed with the intussusception via computed tomography scan. Surgical resection of the bowel was necessary as reduction could not be accomplished. Conclusions: The finding of intussusception in an adult patient is far less common than in children, and even more rare when a lead point is not established. When surgery is required, a thorough exploration should be performed to search any signs of a potential lead point. Laparoscopy is usually preferred to laparotomy; however, in this case the degree of distention determined the surgical approach. Thus, due to severe distention, laparotomy was preferred.

A 68-year-old male with a past medical history of interstitial pulmonary fibrosis (IPF) on nintedanib and chronic nintedanib-induced diarrhea for three years presented with hematochezia and worsening diarrhea. Diarrhea had persisted despite the use of cholestyramine and oral antidiarrhea medications. As part of the evaluation of diarrhea, he had undergone colonoscopy two years prior, which had shown non-specific moderate diffuse colitis. No significant abnormalities had been noted on physical exam and lab tests. On the present admission, colonoscopy showed diffuse erythematous, friable, and granular mucosa throughout the entire colon. Biopsies were taken and pathology was reported as acute superficial inflammation and possible nintedanib-induced colitis. Since the patient wanted to continue nintedanib as a part of IPF treatment, 9 mg oral budesonide was started, and the patient was followed up after four months. At his follow-up visit, the patient reported that diarrhea had completely resolved. In this report, we illustrate and discuss a case of nintedanib-induced colitis, which can be resistant to oral antidiarrhea medication and cholestyramine. The mechanism of this side effect is not completely understood; however, it may be related to direct inflammation of the intestinal epithelium, given that nintedanib metabolites are excreted primarily in the stool. As a result, it has been hypothesized that steroids could potentially treat this diarrhea by relieving this inflammation. In our patient, we elected to use budesonide due to less associated systemic side effects and possible similarity of inflammation between nintedanib-associated colitis and inflammatory bowel disease.

A 67-year-old female presented with a chief complaint of hematochezia. Medical history was notable for stage 1a endometrial carcinoma status post treatment with radiotherapy alone. The patient was not considered a candidate for surgical intervention at the time due to multiple underlying comorbidities. Colonoscopy revealed a 4 cm, nonobstructive, friable, and ulcerated mass in the sigmoid colon. Initially this was concerning for a primary colorectal carcinoma, although immunohistochemistry revealed a uterine endometrial origin of the lesion. A total hysterectomy was eventually performed along with surgical resection of the affected segment of the colon, which was followed by radiation therapy. This case illustrates an unusual site of metastasis for endometrial carcinoma. The colonic metastasis of endometrial adenocarcinoma is reported to be rare and unusual, especially in the absence of endometriosis. Immunohistochemistry staining is an important adjunct in distinguishing the diagnosis of endometrial adenocarcinoma from primary colorectal carcinomas. Primary colon cancers are cytokeratin-7 negative and cytokeratin-20 positive, whereas endometrial cancers are cytokeratin-7 positive and cytokeratin-20 negative. This case is important given the scarcity and peculiarity of metastatic colon cancer originating from uterine adenocarcinomas. The possibility of metastatic disease should be maintained with identification of solitary colonic lesions, especially when there is a prior history of malignancy.

Patient: Male, 73Final Diagnosis: LeishmaniaSymptoms: FeverMedication: —Clinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:Leishmaniasis is a parasitic infection spread by the bite of infected sand flies that are usually present in the Middle East, Africa, and some parts of Asia and Europe. Leishmaniasis manifests in 3 different forms: Visceral (also known as Kala Azar), which is the most serious type; cutaneous, which is the most common type; and mucocutaneous. The symptoms of this infection range from a silent infection to fever, enlargement of the liver and spleen, weight loss, and pancytopenia.Case Report:In this case report, we discuss a 73-year-old man known to have chronic lymphocytic leukemia (CLL), presenting with unremitting fever and who to our surprise was found to have Kala Azar.Conclusions:Early diagnosis and treatment are very important in treating visceral leishmaniasis. While the conventional treatment in immunocompromised patients is liposomal amphotericin B, our patient responded to corticosteroids.