Crizotinib is a first-line tyrosine kinase inhibitor used for the treatment of metastatic lung cancer. Crizotinib-induced hepatotoxicity is a rare event. We report a case of a 46-year-old female with a history of metastatic lung cancer who presented with acute liver failure after being on crizotinib for two months. e medication was discontinued, and she was treated with N-acetylcysteine for seven days. Her liver function tests returned to normal limits after 26 days after admission. e precise mechanism and risk factors of crizotinib-induced hepatotoxicity remain unknown. Physicians should be aware of the potentially lethal side effect caused by crizotinib.

Intussusception is common in children, but it is rare in adults. The most common causes of adult intussusception (AI) are due to a pathological lead point with a common etiology being malignancy. Intraluminal irritants should be considered the possible etiology of intussusception in patients without a pathological lead point. Marijuana use has increased dramatically in the United States over the last decade. With increasing public acceptance and legalization of marijuana, various adverse side effects have become more prominent. Marijuana has been shown to disrupt gastrointestinal tract motility by inhibiting cholinergic mechanisms. Here we describe four cases of AI who are chronic marijuana users. This well-referenced review gives attention to the harmful effects of marijuana, given the increasing use of marijuana and its derivatives in the United States.

No abstract

Introduction: Deep Invasive gastrointestinal endometriosis (DIGIE) is rare. Out of all endometriosis cases, 7-12% of cases can have gastrointestinal involvement, ranging from single lesions, to multiple lesions, to full colonic stenosis. Symptoms can include dyspareunia, dysmenorrhea, infertility, dysphasia, diarrhea, constipation, bloating, and rectal bleeding. Here we present a patient who was incidentally found to have endometrioma. Case Description/Methods: A 24-year-old female with a past medical history significant for polycystic ovarian syndrome, HIV and endometriosis, presented to the hospital with chief complaints of fever, dysuria, hematochezia, and lower abdominal pain which had been ongoing for 3-4 days. On admission, the patient was noted to be hemodynamically stable. Abnormal laboratory results included hematocrit 32.6% (reference range 36-46%), hemoglobin 10.2 g/dL (reference range 12-16 g/dL), mean corpuscular volume 72.4 fL (reference range 80-100 fL), ferritin 15.8 ng/mL (reference range 6.3-137 ng/mL), total iron binding capacity 306 mcg/dL (reference range 265-497 mcg/dL), and iron 19 mcg/dL (reference range 37-170 mcg/dL). The following day, she underwent a colonoscopy which showed isolated diverticulosis involving the sigmoid colon. There was an active oozing diverticulum that was successfully treated with endoscopic clip placement. At the rectosigmoid junction, there was a 3 cm submucosal lesion bulging into the lumen. This appeared to have a smooth surface and was without ulceration. Biopsies were taken and the pathology showed submucosal granulation tissue with chronic inflammatory reaction and iron deposition. CD10 specific immunostains were positive, suggesting the diagnosis of an endometrioma (Figure). Discussion: This case highlights an incidental finding of DIGIE. It is important to think about colonic involvement in patients with endometriosis who have GI complaints. Rarely, these lesions can cause obstruction and may require surgery. There are currently no formal guidelines or recommendations, with most of these patients being managed on a personalized basis. Management for these patients includes symptomatic therapies, progresterones, colonic shaving, disc excision, and laparoscopic resection. As for our patient, she pursued conservative symptomatic management with close outpatient Gynecology follow up.[2533] Figure 1. A 3 cm submucosal lesion bulging into the lumen at the rectosigmoid junction.

reported in pregnant women. Due to its very low incidence, there are no specific guidelines to treat these patients with such a complex disease and most of them receive standard chemotherapy with low probability of survival.[3644] Figure 1. Upper endoscopy showing diffuse nodular-appearing mucosa, suspicious for linitis plastica (a). Pathology showing poorly-differentiated adenocarcinoma positive for CDX2 (b) and pan-cytokeratin (c).