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Colonic diverticula and colonic polyps are two of the most common causes of lower gastrointestinal (GI) hemorrhage [1, 2]. Colonic polyps or carcinoma can arise from the normal mucosa near or within a diverticulum [3]. Case reports describe colonic tumors found within a diverticulum, e.g., colon polyps [4], carcinoids [5], lymphoma [6], and adenocarcinoma [3, 7–13]. Rarely adenocarcinoma in a diverticular colonic abscess has been reported [14, 15]. None of the cases has presented as hematochezia or been associated with diverticular bleeding. We report a case of malignant colon polyp within a diverticulum presenting as diverticular hemorrhage.

To estimate the clinical benefit of CT enterography (CTE) in patients with fistulizing Crohn's disease and describe the appearance of fistulas at CTE.Crohn's patients who had undergone CTE, which diagnosed an abscess or fistula, were identified. A gastroenterologist reviewed clinical notes prior to and following CTE to assess the pre-CTE clinical suspicion for fistula/abscess, and post-CTE alteration in patient management. A radiologist reassessed all fistula-positive cases, which were confirmed by a non-CT reference standard, to describe their radiologic appearance.Fifty-six patients had CT exams identifying 19 abscesses and 56 fistulas. There was no or remote suspicion of fistula or abscess at pre-imaging clinical assessment in 50% of patients. Thirty-four patients (61%) required a change in or initiation of medical therapy and another 10 (18%) underwent an interventional procedure based on CT enterography findings. Among 37 fistulas with reference standard confirmation, 30 (81%) were extraenteric tracts, and 32 (86%) were hyperenhancing compared to adjacent bowel loops. Most fistulas (68%) contained no internal air or fluid.CTE detects clinically occult fistulas and abscesses, resulting in changes in medical management and radiologic or surgical intervention. Most fistulas appear as hyperenhancing, extraenteric tracts, usually without internal air or fluid.

Buried bumper syndrome (BBS) is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. This unusual phenomenon occurs when the internal bumper of a PEG tube erodes and migrates through the gastric wall and becomes lodged anywhere between the gastric wall and the skin. If not removed and treated appropriately, it can lead to life-threatening complications. It is considered to be a late complication, with most cases occurring from months to years later. We present an unusual case of a very rapid development of BBS, along with a brief review of contributing factors and treatment recommendations.

Brunner's gland hyperplasia (BGH) of the duodenum is an uncommon finding at endoscopy and is usually asymptomatic. Symptomatic BGH presenting with biliary obstruction and pancreatitis is extremely rare and the literature is limited to a few case reports.We report an unusual case of diffuse BGH of duodenum involving the ampulla of Vater that led to this clinical presentation. Biopsies revealed BGH and successful endoscopic therapy utilizing sphincterotomy and plastic stent placement led to complete recovery.Albeit its uncommon clinical presentation, it can become challenging in terms of diagnosis and management. A high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.

Background and aims Recent studies have suggested a possible association between Helicobacter pylori (HP) infection and colon neoplasia. HP infection causes hypergastrinemia, and gastrin increases colorectal mucosal proliferation, potentially leading to colorectal cancer. We investigated whether HP infection is associated with colon neoplasia. Methods We conducted a cross-sectional, single-center study in which patients who underwent routine outpatient colonoscopy and were tested for HP infection on esophagogastroduodenoscopy from January 1, 2008 to November 1, 2009 were identified. Patient demographic data (gender and age) and information on colon polyp characteristics (size, number of polyps, location, morphology, and histology) were abstracted from retrospective chart review. Presence of adenoma/carcinoma was compared in the HP-positive cases and HP-negative controls. Results A total of 192 patients were included in the study, with 96 patients each in the HP-positive and -negative groups. The two groups did not differ significantly in gender, age, polyp size, number of polyps, polyp location, morphology, and histology. Adenomatous colon polyps were noted in 31% of the HP-positive cases and in 26% of the HP-negative controls (P = 0.52). Colon carcinoma was found in 6% of HP-positive and 2% of HP-negative patients (P = 0.28). Conclusion The higher prevalence of adenomatous colon polyps/carcinoma in HP-positive patients compared to HP-negative patients was not statistically significant. Larger studies are needed to examine further the potential association between HP infection and colorectal adenoma/carcinoma.

A 78-year-old Caucasian male with a history of atrial fibrillation and anticoagulation with warfarin presented with a change in bowel habits and weight loss. A computed tomography (CT) scan showed a 3.5 cm rectal mass. After biopsy with colonoscopy and endoscopic ultrasonography, the rectal mass was highly suspicious for rectal hematoma. When the rectal mass did not resolve after 1 month of follow-up, surgery showed the patient to have a rectal gastrointestinal stromal tumor. He is being treated with imatinib and follow-up CT scans. This case illustrates the importance of a high level of suspicion for a gastrointestinal stromal tumor when a rectal mass is found.

Background & Aims: Autoimmune enteropathy is a rare cause of intractable diarrhea associated with circulating gut autoantibodies and a predisposition to autoimmunity. It is rarely observed in adults, with only 11 cases reported to date. Methods: Fifteen adults with autoimmune enteropathy were identified at the Mayo Clinic, Rochester, from May 2001–June 2006. The demographic, clinical, and treatment data were abstracted from their records. Results: The study population was 87% white, 47% female, with median age of 55 years (interquartile range, 42–67 years). All patients had protracted diarrhea, weight loss, and malnutrition. Celiac disease was excluded by lack of response to gluten-free diet or absence of the celiac disease susceptibility HLA genotypes. Fourteen patients were tested for gut epithelial cell antibodies, and 93% were positive for anti-enterocyte and/or anti–goblet cell antibodies. Predisposition to autoimmune diseases was noted in 80%, as indicated by a variety of circulating autoantibodies. Small intestinal histopathologic findings included subtotal villous atrophy and lymphoplasmacytic infiltration in the lamina propria with relatively few surface intraepithelial lymphocytes. T-cell receptor gene rearrangement studies were negative in all cases. Immunosuppressive therapy was required in 93% of cases. Clinical improvement was noted in 60% after 1–8 weeks of steroid therapy. Conclusions: Autoimmune enteropathy is a heterogeneous disease and should be considered in the differential diagnosis of malabsorption and small bowel villous atrophy. The presence of gut epithelial cell antibodies can help confirm the diagnosis. No single agent is unequivocally effective in inducing remission, and immunosuppressive therapy is required in most cases.

Background & Aims: Sclerosing mesenteritis is a rare non-neoplastic disease that affects the small bowel mesentery with chronic fibrosing inflammation. There are few data on the natural history and therapeutic options for this condition. Methods: We performed a retrospective and prospective study to describe the clinical characteristics, therapy, and outcome of all cases of sclerosing mesenteritis diagnosed at the Mayo Clinic, Rochester, from 1982–2005. Results: Ninety-two cases were identified; 70% were male, with a median age of 65 years (interquartile range, 55–72). Common presenting symptoms included abdominal pain in 70%, diarrhea in 25%, and weight loss in 23%. Treatment included medical therapy alone in 26%, surgery alone in 13%, surgery followed by medical therapy in 9%, and 52% received no treatment. Ten percent responded to surgery alone, 20% responded to additional medical treatment after surgery, and 38% responded to medical therapy alone. Tamoxifen in combination with prednisone was used in 20 patients, and 60% improved. Non-tamoxifen–based regimens were used in 12 patients, and 8% improved. Eighteen deaths were noted during the study period, and 17% were attributed to complications of sclerosing mesenteritis or its treatment. Conclusions: Although a relatively benign condition, sclerosing mesenteritis can have a prolonged debilitating course with a fatal outcome. Our results suggest that symptomatic patients might benefit from medical therapy, particularly tamoxifen and prednisone combination treatment. Long-term follow-up is needed to substantiate these results.

inflammation in 7% (n = 37), fibrostenotic disease in 50 % (n = 270) and penetrating disease in 43% (231/538) of the cases. Laparoscopy was used in 383 (71%) patients, while 47 patients (12%) were converted. Median hospital stay was 7 days (IQR: 5 8). Overall postoperative morbidity was reported in 122 (23%) patients. 15 patients (3%) developed an anastomotic leak, despite a low ileostomy rate. Indeed, 7% (n = 38) had an ileostomy. All but one stomas were reversed after a median time lapse of 5 months (IQR: 4 7). Specimen length (p = 0.002) and preoperative anti-TNF use (p = 0.0353) increased the risk of anastomotic leakage significantly. Median follow up was 6 years (IQR : 2 9). Clinical recurrence after 5 and 10 years were 45% and 55% respectively. Postoperative smoking (p = 0.0047) and microscopic section margin positivity (p < 0.0001) significantly influenced clinical recurrence. Surgical recurrence after 5 and 10 years were 6.5% and 19.1% respectively. Surgical recurrence was significantly influenced by smoking (p = 0.012), postoperative treatment regimen (p = 0.0008) and microscopic resection margin positivity (p = 0.0119). Conclusion: Ileocecal resection for Crohn's disease is safe and is more effectively keeping the patient in surgical remission than previously reported. Overall surgical recurrence rate is low. The risk of surgical recurrence is not a valid argument to delay surgery in Crohn's patients.