Introduction: Recurrence is an important problem after Helicobacter pylori infection, and intrafamilial transmission has an important role in recurrence. In this study, we aimed to investigate the significance of intrafamilial transmission for recurrence development after treatment as well as its usefulness in prevention. Materials and methods: Of the 109 patients who had dyspepsia and underwent endoscopy, 74 patients had H. pylori infection and were enrolled in this study. Infected family members were also detected. Patients were randomly divided into groups I and II, with each group containing 37 individuals. In group I, patients and their infected family members were treated together at the same time. In group II, only the patients were treated. Treatment success was evaluated at the 1st month and evaluation for recurrence was carried out at the 6th month. Results: Helicobacter pylori infection was detected in 67.8% of the patients with dyspepsia. Two patients in each group did not show up at the 1st month control. Eradication was achieved in 63 of the 70 patients (90.0%) who completed their treatment. After 6 months, patients with successful treatment had no recurrence in any of the 32 patients in group I. There were recurrence in 3 of the 31 patients (9.7%) in group II; however, there was no statistically significant difference between the groups (p = 0.113). Conclusion: Our study showed that eradication treatment in patients and family members with H. pylori infection resulted in a decrease in the number of recurrences even though it was not statistically significant.

Introduction: Dyspepsia is a common symptom with an extensive differential diagnosis. Endoscopy alone may miss serious mucosal lesions in about 15 to 30% of cases. The aim was to determine histopathological features of gastric and duodenal mucosal biopsies in patients with dyspepsia and normal looking upper gastrointestinal (GI) endoscopy. Materials and methods: One hundred and five adult patients presenting with dyspepsia with no endoscopic mucosal lesions in the upper GI tract were included. Gastric biopsy specimens according to Sydney–Houston system for grading gastritis and biopsy from duodenum were taken. The histopathological features were graded according to the Sydney–Houston system classification for grading gastritis. Results: The histological lesions were found in 65.7% (69 out of 105 endoscopy free dyspeptic patients). Chronic inflammation was the commonest finding. Neutrophilic activity, glandular atrophy, and mild degree of intestinal metaplasia were present in 27, 45, and 6 patients (22.8, 42.8, and 5.7% respectively). Helicobacter pylori was present in 54 patients with histopathological lesions and in 6 patients without histopathological lesions, and the difference was significant (p = 0.045). Conclusion: The endoscopic diagnosis of dyspepsia correlated poorly with histopathological findings. The histopathological examination allowed detection and grading of gastric pathology in dyspepsia with normal endoscopy and the commonest finding was the moderate chronic gastritis.

Objective: It was aimed to determine if there was a correlation between celiac disease (CD) and Helicobacter pylori (H. pylori) by comparing the prevalence of H. pylori in patients with and without CD. Materials and methods: The patients who were diagnosed with CD and tested for H. pylori and the patients who presented for gastroscopy and tested for H. pylori were evaluated retrospectively and the prevalence of H. pylori was compared. Results: Fifteen (48%) of 31 patients who were diagnosed with CD and tested for H. pylori were males and had a mean age of 33.1 ± 12.7 years (17–72). In the CD group, H. pylori was positive in 15 patients (48%), and 592 antrum biopsy that was performed were included as the control group. Of these patients, 299 (50.5%) were males and had a mean age of 44.4 ± 17.05 years (16–96). Helicobacter pylori were positive in 316 patients (53.4%). Helicobacter pylori prevalence was similar in the groups with and without CD (p > 0.5). Conclusion: Although the prevalence of H. pylori was lower in celiac patients compared to the control group, the difference was not statistically significant. Although no findings suggesting a correlation between CD and H. pylori was found, further studies should be conducted.

Aim: Recent studies have shown an increase in the incidence of gastric neuroendocrine tumors (NETs) (carcinoids). This may be attributable to the frequent employment of endoscopy in clinical practice and the increasing use of proton pump inhibitors. From the literature that is available, it is interesting to note that the profile of patients with gastric carcinoids is different in the Asian population when compared to the western societies. As limited data is available from India, we evaluated retrospectively the clinical profile and pathology of gastric carcinoids presenting to our hospital. Materials and methods: A total of 31 patients with gastric carcinoids who presented to our institution from 2006 till 2013 were included in this study. The clinical data were obtained from the case files and the histopathology slides were reviewed. Results: Gastric carcinoids constituted about 32% of all gastrointestinal (GI) NETs and were second only to duodenal carcinoids in frequency. Men were more commonly affected (74%) and the majority were of type 1 (90%). Multifocal gastric atrophy with intestinal metaplasia was additional features seen in the majority of cases with type 1 carcinoids. Conclusion: This study, one of the largest series reported from India, shows that the frequency and profile of gastric carcinoids is different in this population when compared to the west. It also raises the possibility that Helicobacter pylori induced multifocal gastric atrophy might be a triggering factor for the most common type 1 gastric carcinoid rather than autoimmune gastritis.

Background: Acute liver failure (ALF) is a critical illness with a large number of viral and nonviral causes. Clinical course and etiologies in the Asian countries are different from those reported from the Western world and mortality is high. There may even be intracountry variations in large countries like India, which have differing culture, ethnicity, and environment. Data from North-east part of India is lacking. Materials and methods: Acute liver failure cases (>14 years of age) seen over a period of 8 years (n = 255) were studied at a Government Medical College in Assam for their etiological and other demographic profile. Viral serology was carried out and revalidated at a laboratory in New Delhi. Results: Majority of cases were <30 years of age. Commonest etiology was nonviral (non-ABCE). Amongst viral causes, hepatitis A and E were common, while hepatitis B virus (HBV) was rare. Unknown herbal medication use was very frequent in our cases with a significantly higher mortality. Mortality was highest in cases in 3rd decade of life. Statistically, international normalized ratio (INR) was the strongest predictor of death. Conclusion: Unlike the rest of India, hepatitis virus is not the major cause of ALF in our part; hepatitis A being commoner than hepatitis E, and B is rare. Unknown herbal medications are major cause of mortality and is important medicosocial issue. Our study highlights the differences in the profile of ALF from other Indian and western studies, possibly due to sociocultural factors prevalent in this part.

Aims: We aimed to perform a meta-analysis of the predictive capacity of fecal calprotectin (FC) in activity and relapse of Crohn’s disease (CD). Materials and methods: MEDLINE, EMBASE, and the Cochrane Library databases were searched systematically. Pooled sensitivity, specificity, and other diagnostic indices were evaluated. Results: A total of 1,252 CD patients from 18 different studies were analyzed. The pooled sensitivity and specificity of FC at a cutoff value of 50 μg/g to predict activity of CD were 0.91 [95% confidence interval (CI): 0.87–0.95] and 0.47 (95% CI: 0.35–0.59) respectively. The pooled sensitivity and specificity of FC at a cutoff value of larger than 150 μg/g to monitor relapse of CD was 0.75 (95% CI: 0.67–0.82) and 0.71 (95% CI: 0.66–0.76) respectively. The area under the summary receiver operating characteristic (SROC) curve of FC for detecting CD activity was 0.78 (50 μg/g), 0.88 (100 μg/g), 0.85 (>150 μg/g), and the diagnostic odds ratio (DOR) was 10.21 (50 μg/g), 10.20 (100 μg/g), 11.68 (>150 μg/g) respectively. Conclusion: As a simple and noninvasive marker, FC is useful to predict the activity and relapse in CD patients, and the capacity of FC to predict CD activity was superior to its application in monitoring relapse of CD.

A total of 302 patients with liver echinococcosis (LE) complicated by lesions of bile duct during 1988 to 2015 were analyzed. The patients were divided into two groups. In the first group, 227 patients were included with lesions of segmental bile ducts in the form of cystobiliary and bilio-bronchial fistulas. In the second group, 75 patients with lesions of hepatic bile were enrolled. Diagnosis of LE and its complications was made by ultrasonography and computed tomography (CT). Surgical treatment included echinococcectomy with complete liquidation of a residual cavity (35.1%), echinococcectomy with suturing (46.0%), external drainage of a residual cavity (7.3%), pericystectomy (8.6%), and resection of a liver (3.0%). Postoperative complications related to operative intervention developed in 29 patients. Lethal outcomes took place in 6 cases (2.0%). The analysis has shown that the form of bile duct lesions, methods of surgical operation for liquidation of hydatid cysts, and its biliary complications had influenced the treatment outcome. More optimal results are received after complete liquidation of residual cavity in different ways and suturing of cystobiliary fistulas during operation. For prevention of complications related to the presence of residual cavity, laser processing of walls of a residual cavity by ozonized 17% hypertonic solution of NaCl was used and this procedure showed obvious (p < 0.05) advantages.

The present study aims to consider the effects of age on liver enzyme levels of obese men following 15 weeks of moderate-intensity interval training (MIIT). Ten obese middle-aged persons (aged 55.2 ± 4.31 years; height 171.4 ± 3.59 cm; weight 95.7 ± 14.61 kg; and body mass index [BMI] 32.53 ± 4.59 kg/m2) and 10 obese young adults (age 22.7 ± 1.25 years; height 177.4 ± 3.94 cm; weight 100.7 ± 8.04 kg; and BMI 32 ± 2.39 kg/m2) were enrolled in this study. Interval training was followed by 65 to 75% of VO2max, 1 set, 2 minutes and seven repetitions, 1 minute rest–relief interval with 50% of VO2max. Blood sampling was carried out in order to measure aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). All analyses were conducted by Statistical Package for the Social Sciences (SPSS) software (version 16 for windows). A descriptive statistics including mean and standard deviation was obtained for all parameters. Analysis of covariance (ANCOVA) and test of normality (Shapiro–Wilk test) were used. Paired sample t-test was used to compare the pretest and posttest data in each group. Comparison between middle-aged and young adults has shown that MIIT causes significant increase of ALT levels in young adults. There is no significant difference between middle-aged and young adults on other variables. Also paired sample t-test shows that ALP was decreased in both groups.

Objectives: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the world. This study was carried out to see the epidemiological and clinicopathological profile of sporadic cases of CRC in Bangladesh. Materials and methods: The patients diagnosed to have colorectal carcinoma in two private medical centers of Bangladesh from January 2012 to December 2014 were enrolled in this study. Demographic data, clinical presentations, site of lesions, and histological types were analyzed. Results: Total 158 patients were included in this study. The mean age was 50.77 years and male to female ratio was 1.55:1. Rectal bleeding was the commonest symptom irrespective of age and sex followed by abdominal pain (33, 20.9%), weight loss (29, 18.3%), abdominal mass (26, 16.4%), and altered bowel habit (22, 13.9%). Common histological type was adenocarcinoma (156, 98.7%). Conclusion: Colorectal cancer commonly affects males >40 years of age. Most common site of involvement is rectum, which is followed by left colon.

Introduction: In this study, we aimed to investigate the histological and clinical effect of angiotensinconverting enzyme (ACE) and ACE gene polymorphism in nonalcoholic fatty liver disease (NAFLD) and their roles in the progression of the disease. Materials and methods: Liver function tests, body mass index, waist circumference, lipid parameters, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), homeostasis model assessment-IR (HOMA-IR), ACE, and ACE gene polymorphism were evaluated in the NAFLD group and control group. The study group was evaluated by dividing the group into four subgroups by ACE gene polymorphism (D/D homozygous, I/I homozygous, D/I heterozygous, I/D heterozygous). Liver biopsies were evaluated according to Brunt Classification. Results: A total of 31 patients who were diagnosed with NAFLD and 40 healthy individuals were included in the study. The ACE level was found to be 11.69 ± 1.99 in the NAFLD group and 11.52 ± 1.72 in the control group (p = 0.70). There was a negative correlation between ACE levels and HOMA-IR levels (p = 0.008, r= −0.512). Biochemical parameters were not different among ACE gene polimorphism subgroups, except FBG (between D/D, I/D and D/I, I/D; p = 0.02). When the ACE levels were compared in terms of grade and stage, no significant difference was found (for stage and grade p = 0.68). The ACE gene polymorphism subgroups did not differ by histopathologic findings; grade and stage (for grade p = 0.42, for stage p = 0.92). Conclusion: In this study, we could not find a correlation of ACE and ACE gene polymorphism with metabolic risk factors and the disease severity in NAFLD.

Aim: Open access endoscopy allows physicians and general practitioners (GIs) to refer patients for endoscopy without prior outpatient consultation. This system was introduced to reduce waiting time to the procedure and subsequent diagnosis. Concerns have been raised regarding misuse of this system with increasing number of inappropriate referrals and hence more normal examinations, which has implications on a public-funded health system. The aim of this study was to assess the appropriate use of the open access system at a rural New Zealand hospital and to see if the diagnostic yield improves by following the American Society of Gastroenterology (ASGE) guidelines for upper gastrointestinal endoscopy [esophagogastroduodenoscopy (OGD)]. Materials and methods: This was a prospective study including all the patients who had OGD at Taranaki Base Hospital between December 2013 and 2014. A total of 1,019 patients had OGD during this time period. The ASGE guidelines were used to see the relationship between appropriateness of OGD and finding of a relevant endoscopic diagnosis. Results: Fifty-eight percent of the OGDs were judged to be appropriate and 42% inappropriate by the explicit criteria. No cancer was found in OGDs judged to be inappropriate. Upper gastrointestinal (GI) endoscopies judged appropriate yielded significantly more relevant lesions than those judged to be inappropriate [65% vs 32%; odds ratio 3.94, 99% confidence interval (CI) 2.78, 5.57; p < 0.01]. Conclusion: The use of ASGE guidelines increases diagnostic yield of OGDs done, which is crucial to cost-effectiveness of an open access system and makes the system more efficient in selecting and treating patients who need it the most, in an acceptable time span.

Aim: Elucidating differences in gene expression may be useful in understanding the molecular pathogenesis and for developing specific markers for the outcome of hepatitis B virus (HBV) infection. In the present study, expressions of host gene interferon gamma-inducible protein (IP-10), p53, and Foxp3 were studied in hepatocytes of patients with chronic HBV infection to determine a possible link between selected host gene expression and the outcome of HBV infection. Materials and methods: The study was conducted in 60 patients with chronic HBV infection and they were divided into four groups: HBV-positive cirrhosis (n = 15), HBV-negative cirrhosis (n = 15), HBV-positive hepatocellular carcinoma (HCC) (n = 15) and HBV-negative HCC (n = 15). Total messenger ribonucleic acid (mRNA) extraction was done followed by complementary deoxyribonucleic acid (cDNA) synthesis, and finally gene expression was performed using real-time polymerase chain reaction (PCR) technique. Results: I P-10 a nd p 53 g ene e xpressions w ere l ower i n H BV-positive c irrhosis, a nd F oxp3 g ene expression was upregulated in HBV-positive cirrhosis in comparison to HBV-negative cirrhosis. The expressions of all the three genes were upregulated among HBV-positive HCC in comparison to HBVnegative HCC. The expression of IP-10, p53, and Foxp3 genes was upregulated in HBV-positive HCC in comparison to HBV-positive cirrhosis. Conclusion: This study indicates that there are variations in the expression of the selected genes among cirrhosis and HCC patients with or without HBV. All the three selected genes were more or less upregulated in HBV-positive HCC patients, but only Foxp3 expression was upregulated in HBVpositive cirrhosis. These three particular genes may have a role in the molecular pathogenesis and clinical outcome of HBV-positive cirrhosis and HCC patients. These aspects need further evaluation by studies with larger numbers of cirrhosis and HCC patients.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the West, and is also increasing alarmingly in South Asia, reaching an epidemic proportion of 30% because of epidemic of obesity and metabolic syndrome (MS) in younger South Asians in the last two decades. Prevalence of MS and fatty liver is escalating in geometric progression in South Asian countries, such as India, Pakistan, Sri Lanka, Bangladesh, Nepal, Bhutan, Burma, and Maldives because of sedentary lifestyle, poor health awareness, socioeconomic growth, affluence, urbanization, and dietary westernization. Almost 20% of world’s population resides in South Asia, making it the most populous and most densely populated geographic region in the world, thereby having most of MS and NAFLD cases within its territory. The risk factors and course of NAFLD do not differ between South Asians and other ethnic populations, but the obesity epidemic is more recent in South Asia than elsewhere in the world. Nonalcoholic fatty liver disease may progress through stages of simple bland steatosis, nonalcoholic steatohepatitis (NASH), hepatic fibrosis, cirrhosis, and finally hepatocellular carcinoma (HCC). It is frequently associated with obesity, MS, dyslipidemia, insulin resistance (IR), and type-2 diabetes mellitus (DM). Nonalcoholic fatty liver disease is frequently diagnosed with abdominal ultrasonography (US) study. Despite its high prevalence in the community till now, no definitive pharmacotherapy is available for NAFLD. However, modification of risk factors, such as dyslipidemia, control of diabetes, and weight reduction do help to some extent. The nonobese South Asians are also at increased risk of having NAFLD and NASH as, despite of absence of frank obesity in South Asians, they are metabolically more obese compared to other ethnic population and more prone to develop NAFLD-related complications. Therefore, the cost-effective US abdomen should be included in the list of tests for persons undergoing preemployment or master health checkups for early diagnosis of NAFLD in this resource-constraint South Asian region, so that early necessary measures can be undertaken to reduce NAFLD associated morbidity and mortality in the community.

Hepatitis B virus (HBV) infection is endemic in Bangladesh. Studies have indicated that HBV is the major cause of chronic hepatitis B (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) in this country. Recently, HBV-related acute on chronic liver failure (HBV-ACLF) has emerged as a serious and emergent medical problem in Bangladesh. To develop a strategy to address HBV-related problems and their influence on health care delivery system, proper understandings about extent of problems and nature of economic burden should be explored. Conservative estimates indicate that about 50 million or more of Bangladeshi have been infected by HBV at some point of their life. Out of the total Bangladeshi population, about 2 to 5% is chronically infected with HBV (about 3–8 million) (1–6%) and considerable number of these patients will eventually develop LC, HCC, or ACLF (about 1 million). Although proper statistics is lacking, it is estimated that HBV-related liver diseases account for a majority of hospital admissions and around 20,000 deaths every year in Bangladesh. In addition, complex clinical features of HBV-related liver diseases have been documented in Bangladesh that show similarity and differences from HBV infection in other Asian countries. Although vaccination against HBV and containment of horizontal transmission are in progress in Bangladesh for reduction of new HBV infection, there is a lack of national strategy for treatment of millions of chronic HBV-infected subjects. This paper will provide an insight regarding the economic impact of HBV in Bangladesh that may act as a primary impetus for developing national HBV eradication program, a goal set by World Health Organization (WHO).

Spontaneous common bile duct (CBD) perforation leading to biliary peritonitis is a rare entity in children. It is an unusual cause of acute abdomen and is potentially fatal. Preoperative diagnosis is rare. A 10-yearold girl was referred from a private hospital after laparotomy for acute abdomen. Intraoperatively, bile was found in the peritoneal cavity which was drained, and the patient was referred to Topiwala National Medical College. Endoscopic retrograde cholangiopancreaticography (ERCP) and stenting was done. The stent was removed after 8 weeks, and the girl is doing well during follow-up.

Invasive bacterial infections have become the leading cause of morbidity and mortality among solid organ transplant recipients (SOTRs). Acinetobacter baumannii can cause a serious infection in SOTRs. Multidrug-resistant A. baumannii (MDR-Ab) represents a major problem in liver transplant recipients. Here, we presented a respiratory infection related to MDR-Ab pathogenesis in a patient who underwent liver transplantation due to acute hepatic failure. Accordingly, it has been emphasized that infections after the liver transplantation should be accomplished after due consideration of all relevant facts with a multidisciplinary approach.

Laparoscopic sleeve gastrectomy (LSG) is a frequently used bariatric surgery method. It is possible to incidentally detect gastrointestinal stromal tumors (GISTs) of stomach or other gastric tumors during this procedure. In the literature, there is limited data about cooccurrence of GIST in obesity, and treatment of such cases is still controversial. On the contrary, currently accepted treatment of local and nonmetastatic GIST cases is surgery alone, and of cases with systemic disease is surgery combined with imatinib mesylate therapy. Incidental detection of GIST during bariatric surgery may require a modification in the planned procedure, and an extensive exploration and picking a convenient surgical procedure will become necessary. Here, we present two cases – a gastric GIST and a GIST of small intestine – both of which were incidentally detected during LSG performed for obesity.

Bleeding from duodenal varices is a rare complication of portal hypertension, occurring in only 0.4% of these patients and is often life-threatening because of the difficulty in diagnosis and treatment. Treatment options include surgical procedures and endoscopic and endovascular treatments. A 48-year-old female cirrhotic patient was admitted to our clinic with upper gastrointestinal (GI) tract bleeding. Endoscopic examination revealed nonbleeding Lm, Cb, RC (+), F3-F3-F2 esophageal and nodular-bleeding-oozing duodenal varices. Esophageal varices were eradicated with band ligation at two sessions. After one session of 2% polydocanol sclerotheraphy, no signs of bleeding were determined. Complete eradication was achieved after five sessions and 1 year apart from the initial treatment duodenal varices were eradicated. Although duodenal varices are rare, they are frequently fatal. There are limited data regarding optimal treatment. Successful treatment depends both on patient factors (hepatic synthetic function, comorbidities, size/location of the varices) and center expertise. Long-term eradication is variable and may depend on the cause and extensiveness of the ectopic varices.

Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology.

An inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor, is a rare neoplasm characterized by myofibroblastic spindle and inflammatory cells that cause masses in many sites of body. It is often benign, but in some cases neoplastic transformation has been reported as a result of aggressive growing. In our case, an inflammatory myofibroblastic tumor was reported by biopsy of a 25 × 15 cm abdominal mass.

Mucocele of the appendix is a rare clinicopathological entity simulating acute appendicitis. The most common form of the mucocele is cystadenoma, which is characterized by luminal dilatation producing large amounts of mucin. We present a new case of a giant mucocele of appendix with mucinous cystadenoma. A 61-year-old female was admitted with complaints of severe lower right quadrant pain. Ultrasonography and computed tomography (CT) suggested that it was a mucocele, but due to severity of pain, she underwent an emergency operation. Fortunately, without a perforation, it was a giant mucocele and the operation was terminated with an uneventful appendectomy with segmental cecal resection. The histopathological evaluation of the specimen reported to be a mucocele with mucinous cystadenoma with negative surgical margins. The patient was discharged postoperative 6th day, and a control colonoscopy and abdominal CT was planned for 6 months following surgery. Appendicular mucocele is rare and difficult to diagnose preoperatively, and sometimes it may be of large size which increases the risk of perforation. Pseudomyxoma peritonei (PP) is the most feared complication of mucocele perforation. Appendectomy with negative margins is a requirement for adequate treatment for most cases. Utmost care should be taken during surgery to avoid perforation of mucocele.

We present a case of ulcerative colitis (UC) in a patient during the first severe relapse with colonic dilatation and coexisting of giant renal tumor. Kidney tumor was constricting on colon and imitating toxic megacolon (TM). The patient with severe acute colitis (SAC) was admitted to the Department of Gastroenterology and Hepatology with inflammatory bowel disease (IBD) diagnosed in the previous month, based on clinical symptoms, endoscopy, and histopathology results. Computed tomography (CT) revealed a giant left kidney tumor without evidence of infiltration, a dilatation of the transverse colon up to 6 cm, and narrow light of the descending colon. There were no signs of intestinal obstruction or perforation. The control X-rays revealed maintaining megacolon, with dilatation of splenic flexure projection up to 6.5 to 7.5 cm. The patient was treated conservatively with no apparent improvement and finally operated on. Intraoperatively, a large tumor of the kidney (12 cm) constricting intestine was revealed. Left-sided nephrectomy and partial resection of the colon with the emergence of a colostomy was performed. The histopathology exam revealed renal mucinous tubular and spindle cell carcinoma (RMTSCC), a very rare malignant kidney tumor of low malignant potential and relative good prognosis. It was identified in the past 20 years. To date, approximately 100 such cases of cancer have been described.

The Budd–Chiari syndrome (BCS) is a rare disorder due to chronic liver disease (CLD), which is caused by the obstruction of hepatic venous outflow that can be located at any place from the small hepatic venules up to the entrance of the inferior vena cava (IVC) into the right atrium. Among the causes of BCS, the rarer one is coagulation factor deficiencies. Here, we report a case of BCS associated with deficiency of protein C resulting in thrombus in IVC. The patient was a 50-year-old male, who had been suffering from recurrent abdominal and leg swelling for a long period of 7 years. He was evaluated thoroughly, and other causes of liver cirrhosis were excluded.

Aim: Duodenal metastasis of testicular cancer is an uncommon condition in clinical practice. Here, we have reported a case of this nature. Background: Testicular cancers are among the most seen cancer types among young men. Metastasis of testicular cancer generally occurs through hematogenous and lymphatic drainage. Gastrointestinal (GI) metastasis of testicular cancer has been reported rarely. Case report: A duodenal mass was seen in esophagogastroduodenoscopic examination in a man who was admitted into hospital for medical treatment of resistant nausea and vomiting. He was previously diagnosed with testicular cancer. Computed tomography (CT) views were compatible with primary duodenal tumor. The duodenal mass was compatible with germ cell neoplasm metastasis. He received chemotherapy regime which includes cisplatin, paclitaxel, and ifosfamid. Nausea and vomiting symptoms decreased and metastatic mass and lymph nodes were regressed. Conclusion: Duodenum metastasis of testicular cancer can be treated with a chemotherapy regimen, and patients can improve radiologically and symptomatically without the need of any surgery. Physicians should keep in mind that GI metastasis of testicular cancer may present with nausea and vomiting symptoms.