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and potassium 3.6 mmol/L. His Clostridioides difficile antigen and GI pathogen panel came back negative. Other studies included a negative HIV and CMV quantitative viral load test. Initial KUB showed moderate gaseous dilation of the bowel which appeared to be mostly colon with findings secondary to ileus or possible distal colon obstruction. Over his month long hospitalization he received several interventions including a nasogastric tube for decompression and 2 rounds of neostigmine. Gastroenterology was consulted with 2 colonoscopies preformed for decompression and biopsies. Biopsies showed focal acute inflammation without psuedo-membranes, viral inclusions, ischemic changes, or evidence of chronic active colitis. Due to his malnourishment he required total parenteral nutrition. His abdominal pain, distention, and constipation persisted so general surgery was consulted who placed a cecostomy tube for drainage that failed to resolve his symptoms. Ultimately he underwent a subtotal colectomy with end ileostomy with resolution of his distention and discharged home (Figure). Discussion: Loperamide inhibits colonic motility as a peripheral opioid agonist. This anti-kinetic effect is the proposed mechanisms of this man's pseudo-obstruction. Most acute pseudo-obstructions respond to medical management with neostigmine. When patients fail treatment with neostigmine and colonoscopy, a cecostomy tube can be placed for drainage. A subtotal colectomy is an intervention of last resort for these patients but necessary in our patient due to his malnutrition that required TPN and persistent ileus. [2016] Figure 1. A. Patient's initial KUB B. Operative photo of subtotal colectomy C. Patient's abdomen with surgical incision, ileostomy, and stitched up cecostomy tube opening.

Gastric siderosis is the deposition of excess amount of iron from oral ferrous sulfate supplements to the gastric mucosa. It is an often overlooked entity in the literature and can be related to symptoms such as dyspepsia, nausea, and melena through mucosal injury. Different etiologies of gastric siderosis display distinct histopathological patterns. Pattern B, which is most commonly associated with oral iron supplements, is seen when iron is deposited in the extracellular space of the lamina propria. It is crucial to consider gastric siderosis as a potential diagnosis in symptomatic patients and to evaluate the necessity of oral ferrous sulfate supplements.Case 2: A 70-year-old man with hepatitis C and gastroesophageal reflux disease (GERD) was admitted for progressively worsening dysphagia over the past 2 years. The patient took PPI daily for previously diagnosed nondysplastic Barrett's esophagus. In addition,

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