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Clinical Case Summary

A 50 year old paraplegic gentleman (secondary to a road traffic accident) with a diversion colostomy and preserved small bowel length, and a history of idiopathic cirrhosis, was admitted with a one week history of high output stoma. Initially felt to be infectious, he was resuscitated with volume and electrolyte replacement. Despite a negative infection, autoimmune and extended inflammatory screen, the high stoma output persisted between 4-6L per 24 hours. He subsequently developed circulatory failure due to volume losses and required intensive care support for fluid management, parenteral nutrition (PN) and inotropes. Serial cross sectional imaging showed oedematous jejunal and ileal bowel without evidence of vascular insufficiency.

His stoma output failed to respond to maximum doses of loperamide, octreotide, proton pump inhibitors or opiates. He was commenced on a trial of high dose steroids without any benefit. A colonoscopy showed grossly oedematous bowel, with biopsies demonstrating preserved crypt architecture on a background of significant oedema. He was PN dependant with challenging management of his fluid balance. Due to a new acute renal injury with nephrotic range proteinuria, further stains on his colonic biopsies were requested. These stained positive with congo red, showing apple green birefringence which was suggestive of a diagnosis of Amyloidosis.
Following consultation with the National Amyloidosis Referral Centre, further investigations were requested which showed an amyloid load in the spleen (SAP scan) and chronic pelvic sepsis (PET CT) likely to be driving a chronic inflammatory state. Due to the advance nature of his disease, no active treatment could be offered and the patient unfortunately passed away 8 months into their hospital admission due to multi-organ failure.
Through reporting of this case, we want to raise awareness of Amyloidosis as a rare cause of Type 2 intestinal failure.

AN UNUSUAL CASE OF INTESTINAL FAILURE

Krishna Shah 1, Adam Fadra 2, Aruchuna Ruban 1

1 Imperial College Healthcare NHS Trust, London, United Kingdom

2 Imperial College Healthcare NHS Trust, London, United Kingdom|||Imperial College Healthcare NHS Trust, London, United Kingdom

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

UEG Podcast Episode

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Best of UEG Week - HPB with Carolin Schneider

Topics

Hepatobiliary Pancreas

Published

2025

UEG Online Course

accredited

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Acute severe ulcerative colitis (ASUC) remains the most severe form of UC and is sometimes associated with mortality. Adequate evaluation, early and correct intervention, and follow-up with a multidisciplinary approach are crucial in management. A comprehensive approach to ASUC, epidemiology, definition, diagnosis, evaluation, and medical and surgical management are all discussed in this online course by Haluk Tarik Kani, Irene Marafini, Joana Roseira, Wilhelmus A. Bemelman and Fernando Magro.

Target audience
We believe both gastroenterology trainees and early career gastroenterologists and surgeons will find in this online course a thorough and updated review on ASUC management.

Acute Severe Ulcerative Colitis

Fernando Magro, Haluk Tarik Kani, Joana Roseira, Irene Marafini, Wilhelmus A. Bemelman

Event

Acute Severe Ulcerative Colitis

Topics

IBD

Accreditation status

accredited

Duration

1 hour

Published

2025

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UEG Podcast

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Best of UEG Week 2024 with Mary Phillips and Ulrike Beilenhoff on "Nursing"

Ulrike Beilenhoff, Mary Phillips

Topics

Primary Care

Published

2024

UEG Online Course

accredited

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This comprehensive course introduces participants to the transformative role of artificial intelligence in gastroenterology. Designed for healthcare professionals, the course covers fundamental AI concepts, clinical applications, and research perspectives. Key topics include machine learning techniques, AI-assisted diagnostics, and the integration of AI systems in clinical practice. Participants will explore the benefits and challenges of AI adoption, ethical considerations, and the regulatory landscape, with an emphasis on evidence-based decision-making.

The course includes extensive PowerPoint presentations and tailored video lectures. Examples are used to demonstrate real-world applications of the material. The total duration of the course is approximately 50 minutes, with an estimated completion time of 60 minutes, including the final assessment.

A Primer for Artificial Intelligence in Gastroenterology

Cem Simsek, Giulio Antonelli, Alanna Ebigbo

Event

A Primer for Artificial Intelligence in Gastroenterology

Topics

Endoscopy

Accreditation status

accredited

Duration

1 hour

Published

2025

UEG Online Course

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Intestinal failure is the rarest organ failure, but its prevalence across Europe is increasing. Patients have complex conditions and requirements, and optimal care involves multiple specialties and disciplines. Home parenteral nutrition — the first-line treatment for chronic intestinal failure — can significantly impact patients’ lives.

This online course provides in-depth coverage of all aspects of intestinal failure and parenteral nutrition. Authors Shameer Mehta and Sarah Williams discuss the aetiology and management of short bowel syndrome, followed by the causes, classification and management of intestinal failure.

Learning objectives

To understand how to reach a conclusive diagnosis of GORD
To know how to reach a conclusive diagnosis of no GORD
To understand how to deal with an inconclusive diagnosis

Target audience

This course is suitable for gastroenterologists in training, colorectal surgeons, nutrition nurses, dietitians, intensivists, and other healthcare professionals looking after patients receiving parenteral nutrition.

Intestinal failure and parenteral nutrition

Shameer Mehta, Sarah Williams

Event

Intestinal failure and parenteral nutrition

Topics

Small Intestine & Nutrition

Accreditation status

accredited

Duration

1 hour

Published

2021

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Clinical Case Summary

Introduction: Mastocytosis is an uncommon hematopoietic neoplasm characterized by clonal proliferation of atypical mast cells. The clinical manifestations of mastocytosis are heterogeneous,ranging from limited cutanous involvement to aggressive disease with various levels of extra cutanous multi-organ involvement. Most cases of mastocytosis are indolent, usually cutanous or indolent systemic mastocytosis (SM). Aggressive SM is a rare and often fatal disease. Gastrointestinal involvement in aggressive SM presents with non specific symptoms and the final diagnosis depends on the pathology. Herein, we present a special case of colonic mastocytosis
Clinical case: We report a case of 66 years old female patient who presented with chronic abdominal pain not responding to treatment. On physical examination showed abnormal abdominal pigmentation and reported that skin biopsy previously revealed urticaria pigmentosa. Laboratory investigations were unremarkable. Colonscopy was planned and showed diffuse reddish mottling of cecum and ascending colon. Multiple biopsies were taken and histopathological examination revealed focal crypt architectural distortion. The lamina showed moderate inflammatory cellular infiltrate. These are formed of lymphocytes and plasma cells with excess eosinophils > 100/HPF. Esinophilic cryptitis is seen. Subtle population of scattered ovoid cells with rounded ovoid nuclei are seen. Slide stained for CD117 revealed positive reaction highlighting frequent mast cells. Moderate diffuse colitis with frequent mast cells and excess eosinophils > 100/HPF. Picture is suggestive of mastocytosis involving colon. The patient started imatinib and prednisone and long term follow up showed complete relieve of abdominal pain.

COLONIC MASTOCYTOSIS:UNCOMMON COLONSCOPIC FINDING IN PATIENT WITH CHRONIC ABDOMINAL PAIN

Asmaa Gameel 1, Sherif El Behiry 2

1 Mansoura University, Mansoura, Egypt

2 Helwan University, Cairo, Egypt

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

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