Background: Gastric diverticula (GD) are outpouchings of the stomach wall that typically form in the fundus. They are the least common gastrointestinal diverticula, and are very rare anatomic abnormalities overall. Summary: Although most GD are asymptomatic and are usually discovered incidentally during routine diagnostic testing, they can present with variable symptoms. Occasionally, complications can develop that may be life-threatening and are indications for surgical management. Key Messages: Here, we provide a literature review of GD where we discuss the pathogenesis, clinical manifestations, investigations and diagnostic approach, and various management options for this uncommon disorder.

Intestinal parasitic infections are a major public health issue across the world and particularly in rural and urban areas of tropical and subtropical countries. Those at increased risk include inhabitants of poor and disadvantaged regions, which are more likely to have inadequate environmental sanitation, insufficient water supply, greater contact rates with reservoirs of infection, limited health literacy, and socioeconomic disparities. Of the intestinal nematodes (roundworms) that parasitize the human gastrointestinal tract, Ascaris lumbricoides is the largest in terms of size. It causes ascariasis, a “neglected tropical disease,” or NTD, that is among the most common helminthic human infections worldwide with an estimated 800 million to 1.2 billion people infected. It causes more than 60,000 deaths annually. However, in more than 85% of cases, infections do not result in symptoms – especially in individuals infected with a small number of worms. Thus, many individuals with intestinal ascariasis remain undiagnosed for years until either they experience symptoms and seek medical attention, the macroscopic adult worms are passed with the stool, or the adult worms are incidentally discovered during routine endoscopic procedures. Here, we present an interesting case of an elderly Bangladeshi man with seemingly innocuous complaints of intermittent mild abdominal symptoms and no recent travel history, who was discovered to have intestinal ascariasis during a screening colonoscopy.

Chronic intestinal pseudo-obstruction (CIPO) is an uncommon disorder characterized by the presence of bowel dilatation and abnormal motility. It is an important cause of chronic intestinal failure in patients with systemic sclerosis (SSc). Although intestinal pseudo-obstruction is an infrequent reason for hospitalization in these patients, it has been correlated with high in-hospital mortality compared to SSc patients hospitalized for other reasons as well as patients with intestinal pseudo-obstruction arising from other causes. Patients present with signs and symptoms of mechanical bowel obstruction, such as nausea, vomiting, constipation, abdominal pain, and abdominal distension, in the absence of an anatomic lesion blocking the movement of intestinal contents. Despite breakthroughs in our understanding of this disorder, these patients continue to be treated largely with organ-based symptomatic therapy. Unfortunately, despite treatment, they often experience decreased quality of life and impairment in their everyday lives. Here, we present an interesting case of an individual with SSc for many years who presented with signs and symptoms of CIPO.

BackgroundSince their introduction in 1980, gastrostomy tubes have become effective means of providing both short-term and long-term enteral access and nutritional support. These feeding tubes are ubiquitous in many health care facilities that care for the elderly, but carry high rates of unintended dislodgement - a complication that, if not detected promptly, is associated with substantial morbidity and health care costs. This study determined the dislodgment rate of gastrostomy tubes at 90 days in a cohort of 221 patients and tested the hypothesis that the implementation of a concise protocol to care for patients’ gastrostomy tubes would reduce these unintended dislodgements.MethodsThe dislodgment rate of gastrostomy tubes at 90 days in a cohort of 221 patients was determined. In addition, a randomized controlled trial was conducted in a long-term acute care hospital in which patients were alternately allocated to either of two geographically separate units: 1) a selected unit where a concise protocol to care for patients’ gastrostomy tubes was implemented, and 2) a separate unit where standard care was provided. Enrollment included patients diagnosed with dysphagia - who were receiving mechanical ventilatory support for chronic respiratory failure - who were being administered feedings, fluids and medications via a balloon gastrostomy tube. The primary endpoint was the number of unintended dislodgements of gastrostomy tubes during a 90-day study period.ResultsIn a cohort of 221 patients with balloon gastrostomy tubes placed that was observed for a period of 90 days, 64 (29.0%) had unintended gastrostomy tube dislodgement (P < 0.028). A total of 34 patients were enrolled in the randomized controlled trial with 17 in the treatment group and 17 in the control group. All subjects were followed for a maximum of 90 days. During the study period, there was one episode of unintended gastrostomy tube dislodgement (5.9%) in the treatment group, compared with six episodes (35.3%) in the control group (P < 0.047) and the previous cohort of 221 patients (P < 0.028).ConclusionThis study showed a significant reduction in dislodgements after implementation of a protocol that is an innovative, straightforward and economical solution to the problem of the unintended dislodgement of gastrostomy tubes.

Colorectal polyps are growths that form on the epithelium of the colon and rectum. While their prevalence varies considerably from region to region, they are common in adults. In fact, among asymptomatic, average-risk individuals at 50 years of age, the prevalence of colorectal polyps averages roughly 10% in sigmoidoscopy studies and more than 25% in colonoscopy studies. Approximately two-thirds of all colorectal polyps are adenomatous precancerous lesions that have the potential to become malignant. Usually, they are discovered and resected during colonoscopy. The spontaneous expulsion per rectum of a colorectal polyp is exceedingly rare. Here, we report a rare and unusual case that we believe is the first of spontaneous expulsion of an adenomatous polyp during defecation. These patients should undergo colonoscopy to search for additional polyps as well as other gastrointestinal pathology.