1170] Figure 1. Forest plots for rate of (A) portal vein thrombosis (PVT) recanalization, (B) bleeding events, and (C) all-cause mortality following use of anticoagulation as therapy for PVT in the setting of cirrhosis.

Introduction: Gastroesophageal reflux disease (GERD) is a very common disease that often presents with symptoms such as heartburn, dysphagia, odynophagia, chronic cough, asthma, belching and regurgitation. Common etiologies of GERD are-Transient lower esophageal sphincter(LES) relaxation, motility disorder, lower esophageal sphincter (LES) incompetence, short lower esophageal sphincter (, 2 to 5 cm) and increased intra-abdominal pressure due to obesity or pregnancy for example. Dolichocolon is an uncommon disease in which patients have redundant colon. It commonly presents with constipation, lower abdominal pain and in severe cases, volvulus. Dolichocolon is an unusual cause of GERD. We present an unusual presentation of an uncommon pathology. Case Description/Methods: Our patient is 56-year-old woman presented with chronic cough and chronic abdominal pain. Initially patient was diagnosed with GERD. Fundoplication was planned since patient failed medical management. During workup, dolichocolon was discovered and after subtotal colectomy, the patient's symptoms of GERD resolved (Figure ). Discussion: Dolichocolon is defined as redundant colon. We can use the following criteria to diagnose it. • Sigmoid colon above the line between iliac crests.• Transverse colon below the aforementioned line.• Extra loops at the hepatic and splenic flexure. If all of the aforementioned redundancies are present at the same time a fully developed Dolichocolon is diagnosed. The reason for the redundant sigmoid colon is thought to be the pathological elongation of the hindgut and hence subsequently the elongation of the sigmoid colon. Although Dolichocolon largely is due to congenital malformation, there are certain theories that abnormal fecal transport, loss of Cajal cells and dietary habits also play a role in acquired dolichocolon. The imaging modality of choice for diagnosis is Barium enema, although we could still use computerized tomography, colonic transit study or magnetic resonance imaging. Our proposed theory for the cause of patient's symptoms is that the redundant colon increasing pressure on the stomach and hence resulting in symptoms of GERD. This case highlights the importance of Dolichocolon as a cause of abdominal complaints and presents an unusual presentation of a rare pathology.

Introduction: Perineuriomas are benign spindle cell neoplasms of the peripheral nerve sheath which seldomly involve the GI tract. Colorectal perineuriomas have an incidence of 0.1%-0.46% of all colonic polyps, usually occurring in the sigmoid colon and rectum, and are often diagnosed incidentally on routine screening colonoscopy. They are not associated with neurofibromatosis syndromes (NF1-2) and require no additional followup. Herein, we describe a case of colonic mucosal perineurioma in a patient referred for colonoscopy after a positive gFOBT. Case Description/Methods: A 57-year-old male with hypertension and dyslipidemia presented to the GI clinic after a positive gFOBT. He was asymptomatic and physical examination was unremarkable. Laboratory evaluation showed mild anemia with Hgb of 13.5 g/dL and a low-normal MCV of 80.1 mm 3 . Iron studies were normal. Colonoscopy revealed a 2-mm sessile rectosigmoid polyp (Figure), which underwent cold snare polypectomy with histopathology notable for bland spindle cells with small elongated nuclei and imperceptible cell borders. No significant nuclear atypia or mitotic activity was identified. Immunohistochemistry (IHC) showed focal epithelial membrane antigen (EMA) staining of stromal cells; S100 stain was negative. These findings were consistent with perineurioma. Remainder of colonoscopy only showed multiple subcentimeter tubulovillous and tubular adenomas of the right colon. Discussion: Colorectal perineuriomas typically appear as small, solitary sessile polyps less than 6 mm in diameter (median 4 mm). Histologically, they appear as uniformly elongated spindle cells with rare mitotic activity. IHC shows diffuse, strongly positive staining of spindle cells with GLUT1 and claudin 1 and focal or faintly positive EMA staining. Two of the 3 positive stains generally support the diagnosis. Colorectal perineuriomas lack S100 protein expression unlike other soft tissue neuromas such as schwannomas and neurofibromas. This case highlights the importance of correct diagnosis in order to avoid overtreatment, as these may resemble malignant neoplasms such as gastrointestinal stromal tumors which are histologically similar but stain positive for c-kit/CD117 and DOG-1. These tumors are more common in females, with a median age of 51. They do not recur after excision, and given their benign nature, do not require surveillance after polypectomy.[2019] Figure 1. A. Colonoscopy showing a 2-mm sessile rectosigmoid polyp, confirmed as a perineurioma on pathology B. Closer image of the same perineurioma, visualized using Narrow Band Imaging (NBI).

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