Volume 89 - 2026 - Fasc.1 - Case reports
Recurrent gastrointestinal bleeding after Peptide Receptor Radionuclide Therapy for a small intestine neuroendocrine tumor
We report a case of a patient who received three cycles of
Peptide Receptor Radionuclide Therapy (PRRT) with [177Lu]
Lu-DOTATATE for a small intestine neuroendocrine tumor
(siNET) and developed recurrent GI (gastrointestinal) bleeding.
These complications required four admissions on intensive care
unit (ICU), transfusion of fourteen units of packed cells and
finally surgery. Radiation safety precautions were respected at
all hospital wards. Histopathology of the culprit lesion did not
reveal tumor, but showed a large-caliber angiodysplastic lesion.
The somatostatin receptor (SSTR) positive tumor consisted of a
confluent mass of adenopathies invading the mesenteric vein. We
hypothesize the amino-acid infusion, which is supportive therapy
given prior to PRRT, caused vasodilatation in the pre-existing
angiodysplastic lesion. The vasodilatation together with the high
venous pressure due to tumoral invasion of the mesenteric vein
may have aggravated bleeding symptoms. (
Ampullary Actinomycosis Mimicking Malignancy: A Case Report and Literature Review
This case discusses a 76-year-old female patient with a large
mass at the major papilla of Vater, initially suspected to be an
ampullary adenoma. The lesion, identified during an upper
endoscopy for anemia and fatigue, showed chronic inflammation
but no malignancy. The patient’s medical history included breast
cancer and a partial distal pancreatectomy for an intraductal
papillary mucinous neoplasm. Further imaging and biopsies did
not confirm malignancy or adenoma but suggested actinomycosis.
Actinomycosis, caused by Actinomyces species, presents challenges
due to its rarity, slow progression, and difficulty in diagnosis. It
can mimic malignancies, especially occurs following surgery,
and requires long-term antibiotic therapy. We present the first
documented case of actinomycosis involving the ampulla of Vater
and emphasize the importance of considering actinomycosis in the
differential diagnosis of ampullary masses, particularly in postsurgical
patients with granulomatous tissue.
GLP-1 receptor agonist-associated eosinophilic duodenitis presenting as a bowel obstruction : a case report and literature review
We report a rare drugs adverse effect of a GLP1-RA, presenting
as severe gastric stasis, eosinophilic duodenitis, and high bowel
obstruction. The patient, treated with oral semaglutide for type 2
diabetes and obesity, developed progressive upper gastrointestinal
symptoms culminating in faecal vomiting. Endoscopic and
histological findings revealed marked eosinophilic infiltration
of the duodenum. To our knowledge, this is the first reported
case linking semaglutide to eosinophil-driven duodenitis causing
mechanical obstruction. As the use of GLP1-RAs expands,
clinicians should be aware of rare but potentially serious
gastrointestinal adverse effects, particularly in patients with
risk factors for impaired motility. Early recognition of symptoms
and consideration of underlying eosinophilic gastrointestinal
disease are essential for timely diagnosis and management.
A rare twist in the abdomen: diagnostic and therapeutic approaches to omental infarction - a case report and literature review
Intraperitoneal focal fat infarction (IFFI) encompasses a group
of rare conditions that are clinically and radiologically similar,
arising from focal fatty tissue necrosis. These entities often mimic
other acute abdominal conditions such as acute appendicitis or
cholecystitis. We present the case of a 65-year-old female with
progressive abdominal pain, ultimately diagnosed with IFFI
using contrast-enhanced computed tomography (CT). Omental
infarction (OI) was the leading diagnosis, though a definitive
distinction from epiploic appendagitis (EA) could not be made
on imaging. Conservative management with anti-inflammatory
medication, analgesia, and low-molecular-weight heparins
(LMWH) proved effective, resulting in complete resolution within
five days. This case highlights the diagnostic value of CT-imaging in
differentiating IFFI from other causes of acute abdomen, thereby
avoiding unnecessary surgical interventions. The aetiology of OI
will be discussed, along with a detailed focus on management
strategies that may also apply to other causes of IFFI. (